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YEAR 1 > resp clinical > Flashcards

resp clinical Flashcards

1
Q

asthma AEx

A

extrinsic -
atopic, genetic

intrinsic -
no trigger identified, late onset

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2
Q

asthma Sx

A

episodic symptoms
diurnal variability
dry cough + wheeze
SOB
decreased exercise tolerance

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3
Q

asthma SGx

A

history of other atopic conditions (eczema, hayfever, food allergies)
family history

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4
Q

asthma Ix

A

CLINICAL DX
high prob -> try treatment

mid prob -> spirometry
- obstructive pattern
- bronchodilator reversibility

low prob -> consider referral / other causes

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5
Q

asthma Tx

A
  1. SABA + ICS
  2. add LABA / LAMA
  3. add montelukast / theophylline
  4. add oral steroid / omalizumab/mepolizumab/dupilumab
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6
Q

ACUTE asthma Tx

A

60% O2
salbutamol + ipratropium NEB
hydrocortisone IV OR oral prednisolone
Mg sulphate / aminophylline IV

intubation if failing

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7
Q

COPD AEx

A

smoking
age
genetic predisposition

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8
Q

COPD Sx

A

chronic symptoms
progressive SOB
chronic cough
non-atopic exacerbations

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9
Q

COPD SGx

A

wheezing (CB)
reduced breath sounds (EM)

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10
Q

COPD Ix

A

clin presentation + spirometry
- obstructive pattern

DLCO decreased in EM

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11
Q

COPD Tx

A

smoking, pulm rehab, vaccines

TL - LAMA, Dx ?
TR - LAMA/LABA, LAMA/LABA/ICS (EoS)
BL - bronchodilator
BR - LABA or LAMA

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12
Q

ACUTE COPD Tx

A

oral prednisolone
increase SAMA / SABA
antibiotics (infection)

hospital = O2 + NEB/NIV

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13
Q

CF AEx

A

autosomal recessive
caucasians

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14
Q

CF Sx

A

recurrent resp infections
chronic daily cough + sputum
SOB
nasal polyps
haemoptysis

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15
Q

CF SGx

A

salty sweat
infertility (males)
CF related diabetes
cyanosis
clubbing
chest hyperinflation
bilateral course crackles
GI symptoms also

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16
Q

CF Ix

A

sweat test - diagnostic
genetic testing for CFTR mutations

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17
Q

CF Tx

A

chest physiotherapy
CFTR modulators = kaftrio
lung transplant at FEV1 <40%

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18
Q

CF Tx (exacerbation)

A

more physio, antibiotics 2 weeks

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19
Q

CF Tx (systemic)

A

pancreas - CREON (exocrine failure), diabetes monitoring

liver - TIPSS (portal hypertension)

bowels - DIOS, laxatives, fluids + hydration

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20
Q

pneumonia AEx

A

step. pneumoniae
H. influenza (nurseries)
staph. aureus (PWID)

legionella (water/abroad)
mycoplasma (young)
coxiella (farming)

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21
Q

pneumonia Sx

A

SOB
pleuritic chest pain
productive cough
fever

elderly -
confusion
diarrhoea
reduced mobility

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22
Q

pneumonia SGx

A

rigors
crackles and rub
tachypnoea
herpes labialis (reactivation of HSV)
cyanosis

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23
Q

pneumonia Ix

A

CAP generally not Ix

FBC, CRP, U+E
CXR = consolidation
sputum culture, blood culture (generally for suspected res / atypical)

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24
Q

pneumonia Tx (CAP)

A

CURB 0-2: amoxicillin PO/IV (AL: doxycycline)

CURB 3-5: co-amoxiclav IV + doxy PO (AL: levofloxin)

ICU: co-amoxiclav + clarithromycin IV (AL: levofloxin)

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25
Q

pneumonia Tx (HAP/aspiration)

A

non-severe: PO amoxicillin (AL: doxycycline)

severe: amoxicillin + gentamycin IV (AL: doxycycline + gent)

aspiration + metronidazole to each (anaerobic cover)

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26
Q

pneumonia Tx (atypicals)

A

doxycycline
legionella: clarithromycin / erythromycin OR levofloxin

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27
Q

pleural effusion AEx

A

transudative -
HF, liver cirrhosis
(protein <30)

exudative - malignancy, infection (protein >30)

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28
Q

pleural effusion Sx

A

chest pain
dry cough
SOB
difficulty taking deep breaths

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29
Q

pleural effusion SGx

A

reduced chest expansion (one side)
stony dull percussion

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30
Q

pleural effusion Ix

A

CXR
aspiration - colour, cytology, microbiology, pH, glucose
pleural biopsy

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31
Q

pleural effusion Tx

A

treat underlying disorder

(infection) simple effusion = antibiotics
complicated = antibiotics + chest drain

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32
Q

empyema AEx

A

complication of pneumonia
primary = iatrogenic / idiopathic

RF: immuno def / suppression

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33
Q

empyema Sx

A

slow to resolve pneumonia
may get better + spike

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34
Q

empyema Ix

A

CXR - fluid level (meniscus)
USS - preferred method
CT - empyema / abscess distinction

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35
Q

empyema Tx

A

broad spec Iv antibiotics (amoxi + metronidazole)

oral antibiotics after cultures (usually co-amoxiclav)

chest tube drainage (5th ICS, midaxillary)

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36
Q

intrapulmonary abscess AEx

A

complication of pneumonia
can be due to septic emboli (PWID)

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37
Q

intrapulmonary abscess Sx

A

pneumonia that worsens despite treatment
weight loss
cough +/- sputum
lethargy, tiredness, weakness

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38
Q

intrapulmonary abscess Ix

A

CXR - walled cavity
CT - differentiate abscess / empyema

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39
Q

intrapulmonary abscess Tx

A

broad spec antibiotics
(occasionally) surgical drainage / resection

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40
Q

bronchiectasis AEx

A

CF (most common)
bronchial obstruction
lung infection
immunodeficiency
idiopathic

41
Q

bronchiectasis Sx

A

chronic productive cough
fever + malaise
haemoptysis (flecks)

42
Q

bronchiectasis SGx

A

clubbing
recurrent infections
coarse crackles
reduced / absent breath sounds

43
Q

bronchiectasis Ix

A

CT - thickened + dilated airways, ‘signet rings’

44
Q

bronchiectasis Tx

A

underlying cause
physio - airway clearing techniques
antibiotics for acute exacerbations

45
Q

lung cancer AEx

A

smoking
asbestos
pollution

46
Q

lung cancer Sx

A

cough 3+ weeks
SOB
haemoptysis
chest / shoulder pain
weight loss
tiredness / lack of energy
hoarse voice (recurrent laryngeal nerve)

47
Q

lung cancer SGx

A

stridor
clubbing
enlarged liver
swollen lymph nodes
tracheal deviation
pleural rub / stony dull percussion
recurrent pneumonia

48
Q

lung cancer Ix

A

FBC, coagulation screen, decreased Na+, increased Ca2+
CXR - peripheral not visible

biopsy - bronchoscopy (central), Ct guided (peripheral), lymph node /pleural fluid aspiration

CT thorax (staging), PET scan (mets), USS (pleural effusion)

49
Q

lung cancer Tx

A

SCLC - chemo / radiotherapy

NSCLC - peripheral excised,
chemo / radiotherapy

palliative - chemo / radiotherapy, stenting, analgesia, antiemetics

50
Q

mesothelioma AEx

A

asbestos (20-40 years later)

51
Q

mesothelioma Sx

A

SOB
chest pain
weight loss

52
Q

mesothelioma SGx

A

present w/ pleural effusion
stony dull percussion

53
Q

mesothelioma Ix

A

CXR - plural effusion, ‘pleural mass w/ lobulated margin’, pleural thickening
CT - pleural mass (staging)

biopsy - thoracoscopy
aspiration - lymphocytes + decreased glucose

54
Q

mesothelioma Tx

A

palliative - chemo / radiotherapy

TALC (sclerosing agent)
long term pleural catheter

54
Q

pneumothorax AEx

A

primary spontaneous -
no underlying lung disease
(usually) ruptured bulla
RF = tall thin men, smokers

secondary spontaneous -
underlying lung disease (COPD), iatrogenic, trauma

55
Q

pneumothorax Sx

A

PSP can be asymptomatic

acute pleuritic chest pain
SOB

56
Q

pneumothorax SGx

A

hypoxia
tachycardia
reduced breath sounds / expansion (one side)
hyper-resonant percussion

57
Q

tension pneumothorax SGx

A

hypotension
tachycardic
raised resp rate
tracheal deviation
elevated JVP

58
Q

pneumothorax Ix

A

CXR

59
Q

pneumothorax Tx

A

none if asymptomatic

PSP = needle asp (5th ICS, midaxillary), chest drain if fails

60
Q

tension pneumothorax Tx

A

needle decompression (large gauge canula, 2nd/3rd ICS, midclavicular)

61
Q

restrictive lung disease AEx

A

intrinsic + extrinsic

62
Q

restrictive lung disease Sx

A

progressive SOB
+/- dry cough

CO2 retention = headache, confusion, lethargy

63
Q

restrictive lung disease SGx

A

finger clubbing
obese / kyphosis / scoliosis
fibrotic crepitations
pleural effusion / ascites
cyanosis

CO2 retention = flushed skin, bounding pulse, rapid resp rate, premature heartbeats, muscle twitches, flapping tremor

64
Q

restrictive lung disease Ix

A

PFT - restrictive pattern
ABGs - type 1/2 resp failure, decreased PaCO2

CXR, chest CT, USS (pleural + abdominal)

bloods - connective tissue screen, vasculitis screen, eosinophilia, secondary polycythaemia (chronic hypoxia)

65
Q

restrictive lung disease Tx

A

treat underlying cause
supportive = O2, CPAP, NIV

66
Q

pulmonary hypertension AEx

A

LV systolic dys
mitral regurg / stenosis
cardiomyopathy

hypoxia, PE, congenital HD

67
Q

pulmonary hypertension Sx

A

fatigue
SOB
chest pain

68
Q

pulmonary hypertension SGx

A

dependant oedema
elevated JVP
right ventricular heave
tricuspid murmur
loud P2
hepatomegaly (pulsatile)
central cyanosis

69
Q

pulmonary hypertension Ix

A

echo doppler - estimates systolic pressure
right heart catherization (confirms)

ECG - right axis deviation, RBBB
CXR - cardiomegaly

70
Q

pulmonary hypertension Tx

A

primary = vasodilators + lung transplant
secondary = treat cause

71
Q

idiopathic pulmonary fibrosis AEx

A

unknown
(repeated injury to alveolar epithelium - NOT inflamm)

more common in smokers

72
Q

idiopathic pulmonary fibrosis Sx

A

progressive SOB
dry cough
weight loss
fatigue
malaise

73
Q

idiopathic pulmonary fibrosis SGx

A

clubbing
cyanosis
bilateral fine inspiratory crackles

74
Q

idiopathic pulmonary fibrosis Ix

A

PFT - restrictive
CXR - bilateral infiltrates
CT - reticulonodular fibrotic shadowing, traction bronchiectasis, honeycombing (late stage)

biopsy - only if CT isnt diagnostic, usual interstitial pneumonia pattern

75
Q

idiopathic pulmonary fibrosis Tx

A

antifibrotic drugs
(nintedanib / pirfenidone)
O2 if hypoxic
lung transplant (young)

76
Q

pneumoconiosis AEx

A

inhaled mineral dust (asbestos / coal)
caplan’s syndrome = occ dust + RA
silicosis = silica

77
Q

pneumoconiosis Sx

A

dry cough
progressive SOB
NO PAIN - malignancy

78
Q

pneumoconiosis SGx

A

clubbing
inspiratory crackles

79
Q

pneumoconiosis Ix

A

simple = incidental CXR finding (asymptomatic)

complicated =
spirometry - restrictive
CXR - progressive massive fibrosis

80
Q

sarcoidosis AEx

A

unknown
type 4 hypersensitivity

81
Q

sarcoidosis Sx

A

fever
weight loss
fatigue
cough
wheeze
SOB
chest pain

82
Q

sarcoidosis SGx

A

lung crackles
hepatomegaly
splenomegaly
uveitis
erythema nodosum
skin infiltration

83
Q

sarcoidosis Ix

A

CXR - bilateral hilar lymphadenopathy
CT - peripheral nodular infiltrates

biopsy - non-caseating granulomas
PFT - restrictive pattern

bloods - increased serum ACE, increase CRP, hypercalcaemia

84
Q

sarcoidosis Tx

A

acute = self-limiting, steroids in affected vital organ

chronic = PO steroids, immunosuppression

85
Q

hypersensitivity pneumonitis AEx

A

type 3 hypersensitivity to inhaled pathogen

(thermophilic bacteria (farmers), avian proteins, fungi)

86
Q

ACUTE hypersensitivity pneumonitis Sx / SGx

A

malaise
dry cough
pyrexia
SOB

crackles
NO wheeze

87
Q

CHRONIC hypersensitivity pneumonitis Sx / SGx

A

progressive cough + SOB
malaise

crackles
clubbing (unusual)

88
Q

hypersensitivity pneumonitis Ix

A

acute = CXR - widespread pulmonary infiltrates

chronic = CXR - pulmonary fibrosis
PFT - restrictive pattern
bloods - serum antibodies

lung biopsy if in doubt - non-caseating granulomas

89
Q

hypersensitivity pneumonitis Tx

A

acute = O2 + steroids, avoid antigen

chronic = antigen avoidance, PO steroids, anti-fibrotic therapy

90
Q

TB AEx

A

mycobacterium tuberculosis
(also mcyo bovis (from cows))

RF = immigrants, recent contacts, social deprivation, immunosuppression)

91
Q

TB Sx

A

90% pulmonary only
cough +/- haemoptysis
SOB

10% extra
fever + chills
night sweats
fatigue
loss of appetite
weight loss
erythema nodosum
range of organ specific Sx

92
Q

TB Ix

A

active = CXR - shadows, lesions, consolidation, ghon focus (granuloma), bilateral hilar lymphadenopathy
ziehil-neelson stains
histology - granuloma w/ caseous necrosis

latent = tuberculin skin test

93
Q

TB Tx

A

acute = rifampicin + isoniazid (6m), pyrazinamide + ethambutol (4m)

latent = rifampicin + isoniazid (3m) OR isoniazid (6m)

94
Q

sleep apnoea AEx

A

overweight, middle aged men

enlarged tonsils / adenoids, retrognathia, acromegaly, hyperthyroidism, oropharyngeal deformity, neurological, drugs, anaesthesia

95
Q

sleep apnoea Sx

A

excessive daytime sleepiness (epworth sleepiness scale)
loud snoring
unrefreshed, restless sleep

96
Q

sleep apnoea Ix

A

overnight sleep study = oximetry, domiciliary reading, full polysomnography

97
Q

sleep apnoea Tx

A

treat underlying cause
CPAP
mandibular advancement drive (mild cases)

surgery (mandibular deformities etc)

YEAR 1 (11 decks)

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