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2b deck > resp important > Flashcards

resp important Flashcards

1
Q

COPD spirometry

A

FEV1/FVC ratio less than 70%, FEV1 less than 80%

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2
Q

treatment COPD

A

1- SABA/SAMA
2- no asthmatic features: add LABA + LAMA (if taking SAMA, switch it to SABA)
3- asthmatic features: add LABA + ICS, if patients remain breathless then add LAMA also

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3
Q

first line antibiotics for infectious exacerbation of COPD

A

amoxicillin or clarithromycin or doxycycline

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4
Q

Most frequent cause of COPD exacerbation

A

haemophilus influenzae

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5
Q

COPD symptoms in a young person may be a sign of

A

A1AT deficiency

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6
Q

how to tell severity of COPD

A

mild COPD- normal FEV1
moderate COPD- FEV1 50-70%
severe COPD- FEV1 30-49%
very severe FEV1<30%

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7
Q

clinical features Wegener’s granulomatosis

A
  • saddle nose/sinus pain/epistaxis
  • airway constriction- difficulty breathing, cough
  • kidney problems- reduced urine production, increased blood pressure, haematuria/proteinuria
  • skin purpura/nodules
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8
Q

tests for Wegener’s granulomatosis

A
  • cANA- IgG antibody
  • increased ESR + CRP
  • CXR- fluffy infiltrates or nodules
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9
Q

treatment Wegener’s granulomatosis

A
  • corticosteroids + cyclophosphamide (or rituximab) for disease remission
  • Azathioprine and methotrexate for maintenace
  • plasma exchange if severe renal disease & pulmonary haemorrhage
  • Co-trimoxazole - prophylaxis against pneumocystis jirovecii and staph colonisation
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10
Q

small cell cancer features

A

Paraneoplastic syndrome- ACTH, ADH and also can create autoantibodies that destroy neurones, causing lambert-eaton syndrome

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11
Q

adenocarcinoma features

A
  • can cause pancoast tumours in upper nerve
  • can damage thoracic inlet, brachial plexus and cervical sympathetic nerve; Horner’s syndrome (constricted pupil, drooping upper eyelid and cant sweat on same side as nerve damage)
  • Often see triad of clubbing, long bone swelling and arthritis
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12
Q

squamous cell carcinoma features

A
  • Form square shaped cells that produce keratin pearls
  • Centrally located
  • Paraneoplastic syndrome possible- parathyroid hormone release, which decreases calcium in bones - leads to hypercalcaemia (more calcium in blood) and bones are more brittle
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13
Q

Bronchial carcinoid tumour features

A
  • Develop from mature endocrine cells
  • Can be located throughout the lungs
  • Paraneoplastic syndrome- tumours release serotonin which causes increased peristalsis of gut, diarrhoea, and bronchoconstriction which causes asthma
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14
Q

lung cancer associated with gynaecomastia

A

adenocarcinoma

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15
Q

cancer with strongest associated with smoking

A

squamous cell carcinoma

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16
Q

stats for moderate asthma

A

PEFR 50-75% best of predicted
RR<25/min
pulse <110

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17
Q

stats for severe asthma

A

PEFR 33-50% best of predicted
cannot complete sentences
RR >25/min
Pulse >110

18
Q

stats for life-threatening asthma

A 
PEFR <33% best or predicted 
Oxygen sats <92% 
'normal' pCO2 
silent chest, cyanosis, feeble respiratory effect 
confusion or soma 
hypotension or bradycardia
19
Q

acute asthma attack management

A 
1- oxygen 
2- salbutamol 
3- ipratropium bromide nebuliser 
4- IV hydrocortisone or oral Prednisolone 
5- magnesium sulfate IV
20
Q

investigations for asthma

A
  • FEV1/FVC <70% (obstructive)
  • peak flow- variability of more than 20% between am and pm measurements
  • fractional exhaled nitric oxide + bronchodilator reversibility test if the spirometry comes back normal despite symptoms
21
Q

asthma management in adults

A 
1- SABA 
2- SABA + ICS 
3-  SABA + ICS + LABAS
4-ABA + ICS + LTRA (e.g. montelukast) 
5- SABA + LTRA + MART
22
Q

types of hypersensitivity

A

ACID
1- Allergy (immediate)- IgE
2- Cytotoxic- antibody dependent- IgM/IgG e.g. Goodpasture’s
3- Immune complex- IgG + neutrophils e.g. SLE, pneuomonitis, Wegener’s
4- Delayed hypersensitivity- cell mediated by T cells- e.g. Tuberculosis =, nickel, poison IV

23
Q

o Kidney biopsy: inflammation in the basement membrane- ‘crescent glomerulonephritis’
AND
CXR shows infiltrates due to pulmonary haemorrhage

A

Goodpasture’s syndrome (anti-glomerular basement membrane disease, a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure.)

24
Q

diagnostic test for severity of Pneumonia + use of score

A 
Confusion- 1 point 
Urea >7mmol/L - 1 point 
RR >30 - 1 point 
B: SBP<90 OR DBP <60- 1 
65- age over 65

score of 0-1= home treatment, 2=admission/close outpatient management, 3-5= admission as severe

25
Q

pneumonia antibiotics

A

 Strep pneumoniae / H. influenzae / mycoplasma pneumoniae = amoxicillin,
clarithromycin or doxycycline
 Legionella pneumophilia = fluroquinolone
 Chlamoydophila species = tetracycline
 Pneumocystis jiroveci = co-trimoxazole
 Gram -ve bacilli / pseudomonas / anaerobes = aminoglycoside IV + antipseudomonal penicillin IV
 Strep pneumoniae / anaerobes from aspiration = cephalosporin IV + metronidazole

26
Q

most common organisms causing;
1- community acquired pneumonia
2- hospital acquired pneumonia

A

1- strep pneumoniae most common, but can also be caused by haemophilus influenzae or Moraxella
2- hospital acquired usually caused by staph aureus but may also be caused by pseudomonas, bacteriodes, clostridia

27
Q

cell wall can hold onto dye despite being exposed to alcohol, which creates a bright red colour with a Ziehl-Neelson stain

A

mycobacterium tuberculosis

28
Q

sarcoidosis signs/symptoms

A
  • bilateral hilar lymphadenopathy
  • fever
  • erythema nodosum (swollen subcutaneous fat under ski, causing red bumps and patches)
  • polyarthralgia
  • uveitis- can cause vision changes
29
Q

bilateral hilar lymphadenopathy

A

sarcoidosis

30
Q

Facial rash plus lymphadenopathy

A

sarcoidosis

31
Q

drugs which can cause pulmonary fibrosis

A
  • Methotrexate
  • Nitrofurantoin
  • Amiodarone
  • Sulphasalazine
  • Bleoycin
32
Q

features pleural effusion

A

dyspnoea, non-productive cough or chest pain are possible presenting symptoms
classic examination findings include dullness to percussion, reduced breath sounds and reduced chest expansion

33
Q

Pleural effusion: causes

A

Pleural effusions may be classified as being either a transudate or exudate according to the protein concentration.

Transudate (< 30g/L protein)
heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome

Exudate (> 30g/L protein)
infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler's syndrome
yellow nail syndrome
34
Q

pleural effusion investigations

A
  • PA CXR
  • ultrasound- increases the likelihood of successful pleural aspiration and is sensitive for detecting pleural fluid septations; contrast CT is now also increasingly performed to investigate the underlying cause, particularly for exudative effusions
  • PLEURAL ASPIRATION
35
Q

management pleural effusion

A

Options for managing patients with recurrent pleural effusions include:
recurrent aspiration
pleurodesis
indwelling pleural catheter
drug management to alleviate symptoms e.g. opioids to relieve dyspnoea

36
Q

pneumothorax features

A 
dyspnoea
chest pain: often pleuritic
sweating
tachypnoea
tachycardia
37
Q

management pneumothorax

A
  • first line aspiration

- if aspiration fails, insert chest drain

38
Q

PE management

A
  • large clots and haemodynamically unstable= alteplase 10mg over 1 min then 90mg over 2 hours
  • haemodynamically stable= LMWH
    then start oral anticoagulant
39
Q

pink puffers and blue bloaters

A

differentiation in COPD:
pink puffer= emphysema: high alveolar ventilation, near normal partial pressure of O2, normal or low partial pressure
of CO2, breathless but not cyanosed, can progress to type 1 respiratory failure

blue bloater= chronic bronchitis: have low alveolar ventilation, low partial pressure of O2, high partial pressure of CO2,
cyanosed but not breathless, may develop cor pulmonale, their respiratory centres are insensitive to CO2
and they require a hypoxic drive to maintain respiratory effort (be careful when giving supplementary
oxygen)

40
Q

type I resp failure + causes

A

hypoxia (PaO2<8kPa) with normal or low pCO2

caused by ventilation /perfusion mismatch e.g. pneumonia, pulmonary oedema, PE, asthma, emphysema, pulmonary fibrosis, acute respiratory distress syndrome

41
Q

type II resp failure + causes

A

hypoxia (PaO2<8kPa) with hypercapnia (PaCO2>6kPa)

caused by:

  • pulmonary disease e.f. asthma, COPD, pneumonia, end stage pulmonary fibrosis, obstructive sleep apnoea
  • reduced respiratory drive- sedative drugs, CNS tumour, trauma
  • neuromuscular disease- cervical cord lesion, diaphragmatic paralysis, poliomyelitis, myasthenia gravis, guillan-barre syndrome
  • thoracic wall disease- flail test, hyphoscoliosis

2b deck (18 decks)

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