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cardio + resp > resp notes > Flashcards

resp notes Flashcards

1
Q

spirometry contraindications

A
  • active infection e.g. TB
  • aortic aneurysm, pneumothorax, recent surgery (forced exhalation will worsen)
  • chest infection
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2
Q

what is bronchiectasis?

A
  • widening of bronchioles due to chronic infection
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3
Q

most common organisms in bronchiectasis

A
  • haemophilus influenzae, most common
  • pseudomonas
  • step pneumoniae
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4
Q

causes bronchiectasis

A
  • post infective e.g. TB, HIV
  • obstruction
  • congenital e.g. cystic fibrosis
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5
Q

best investigation bronchiectasis

A
  • high resolution CT - widened bronchioles, signet ring sign
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6
Q

most common causative agent bronchiolitis

A
  • RSV
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7
Q

presentation bronchiolitis

A
  • < 1 year old
  • cough, wheeze, breathlessness, feeding difficulties (often why they’re admitted)
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8
Q

COPD consists of which two conditions?

A

chronic bronchitis and emphysema

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9
Q

causes of centriacinar, panacinar and distal acinar emphysema

A
  • centri (proximal), smoking
  • panacinar (all), alpha-1 antitrypsin deficiency
  • distal, atelectasis
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10
Q

investigations COPD

A

spirometry - obstructive
CXR - hyperinflation, bullae, flat hemidiaphragm
FBC - polycythaemia

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11
Q

management acute exacerbation COPD

A

oxygen therapy with 24% venturi mask - aim for sats of 88-92%
nebulised salbutamol + ipratropium
steroids
abx if infection
consider aminophylline IV
NIV (BiPAP) if acidotic

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12
Q

long term management COPD - asthmatic features

A

LABA + ICS

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13
Q

long term management COPD - non-asthmatic features

A

LABA + LAMA

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14
Q

which antibiotic can be used in COPD prophylaxis

A
  • azithromycin
  • check ECG (can prolong QT interval)
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15
Q

inheritance pattern cystic fibrosis

A

autosomal recessive

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16
Q

pathophysiology cystic fibrosis

A
  • mutation in chromosome 7
  • in CFTR protein
  • abnormal chloride secretion + thickening of mucous secretions
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17
Q

presentation cystic fibrosis

A

neonates - meconium ileus
recurrent chest infections
pancreatic insufficiency - diabetes, malabsorption, steatorrhoea
infertility

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18
Q

diagnosis cystic fibrosis

A

sweat test - increased chloride in sweat (>60)

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19
Q

presentation + examination idiopathic pulmonary fibrosis

A
  • dry cough + SOB insidious onset > 3months
  • fine bibasal end-inspiratory crackles + clubbing
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20
Q

medical management idiopathic pulmonary fibrosis

A
  • pirfenidone (antifibrotic, anti-inflam)
  • nintedanib (targets tyrosine kinase)
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21
Q

drugs that cause drug induced pulmonary fibrosis

A
  • amiodarone
  • methotrexate
  • nitrofurantoin
  • chemo drugs e.g. cyclophosphamide
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22
Q

hypersensitivity reactions in extrinsic allergic alveolitis/hypersensitivity pneumonitis

A

type III + type IV

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23
Q

investigations hypersensitivity pneumonitis

A

imaging - fibrosis in upper areas
bronchoalveolar lavage - lymphocytosis
assays for IgG

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24
Q

causes of upper pulmonary fibrosis

A

CHARTS
Coal
Hypersensitivity pneumonitis
Ank spond
Radiation
Tuberculosis
Sarcoidosis

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25
Q

causes of lower pulmonary fibrosis

A
  • idiopathic pulmonary fibrosis
  • drugs (methotrexate, amiodarone, nitrofurantoin, cyclophosphamide)
  • connective tissue disorders
  • asbestosis
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26
Q

most common type of lung cancer

A

adenocarcinoma

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27
Q

lung cancer most associated with non-smokers

A

adenocarcinoma

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28
Q

paraneoplastic features squamous cell carcinoma of lung

A

hypertrophic pulmonary osteoarthropathy - clubbing
PTHrp - hypercalcaemia + bone destruction

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29
Q

lung cancer that most commonly cavitates

A

squamous cell carcinoma

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30
Q

what is lambert-eaton syndrome

A

due to small cell lung cancer
antibodies against pre-synaptic voltage-gated calcium channel in motor neurons
weakness, better with repetition

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31
Q

paraneoplastic features of small cell carcinoma

A

ADH
ACTH
lambert-eaton

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32
Q

investigations lung cancer

A
  • sputum cytology
  • CXR
  • contrast CT
  • bronchoscopy
  • EBUS
33
Q

2ww referral for CXR criteria

A

> 40 + unexplained haemoptysis
2 or more of these symptoms if >40 and not smoked
1 or more of these symptoms if >40 and have smoked
- weight loss
- fatigue
- cough
- SOB
- appetite loss
- chest pain

34
Q

features OSA

A
  • daytime sleepiness
  • morning headache
  • snoring
  • concentration problems
35
Q

features klebsiella pneumonia

A
  • common in alcoholics (klebsiSTELLA) and diabetics
  • can occur following aspiration
  • ‘red-currant jelly’ sputum
  • affects upper lobes
36
Q

which pneumonia is common in patients with cystic fibrosis

A

pseudomonas aeruginosa

37
Q

management tension pneumothorax

A

16G bore needle at second intercostal space, mid-clavicular line

38
Q

management primary pneumothorax

A

if patient not short of breath and pneumothorax <2cm - conservative management
if patient is short of breath or >2cm - 16-18G needle
if fails - intercostal drain

39
Q

management secondary pneumothorax

A

patient not short of breath + pneumothorax < 1cm - conservative
patient not short of breath + pneumothorax 1-2cm - aspirate, if unsuccessful - chest drain
short of breath or >2cm - chest drain

40
Q

CXR signs PE

A

hamptoms hump - peripheral wedge opacity
westermark’s sign - regional oligaemia (no vessels)
fleischner’s sign - enlarged pulmonary artery

41
Q

investigation in PE when CTPA contraindicated

A

VQ scan

42
Q

management PE

A

DOAC
any contraindications - LMWH
if massive - thrombolysis

43
Q

features sarcoidosis

A
  • erythema nodosum, bilateral hilar lymphadenopathy, fever, arthralgia
  • breathlessness, cough, weight loss
  • lupus pernio
  • hypercalcaemia
44
Q

lofgrens syndrome (triad in sarcoidosis)

A

erythema nodosum
polyarthralgia
bilateral hilar lymphadenopathy

45
Q

management sarcoidosis

A

oral steroids + bisphosphonates to protect against osteoporosis
second line - methotrexate, azathioprine

46
Q

investigations active tuberculosis

A

CXR - upper lobe consolidation
sputum culture - acid fast bacilli
NAAT (nucleic acid amplification test)

47
Q

investigations latent TB

A

mantoux test
interferin gamma release assays (IGRA)

48
Q

management TB

A

rifampicin
iosiniazid
pyrazinamide
ethambutol
all for first 2 months
top two for 4 months

49
Q

side effects rifampicin

A

orange secretions
flu-like symptoms

50
Q

side effects iosinazid

A

peripheral neuropathy (im so numb-azid)
hepatitis, agranulocytosis

51
Q

side effects pyrazinamide

A

uric acid - gout
arthralgia, myalgia
hepatitis

52
Q

side effect ethambutol

A

optic neuritis
EYEthambutol

53
Q

what is the flow rate of a nasal cannula

A

2-4L/minute

54
Q

differentials in a ‘white out’ of hemi-thorax if trachea deviated towards white out

A

pneumonectomy
complete lung collapse

55
Q

differentials in a ‘white out’ of hemi-thorax if trachea central

A

consolidation
pulmonary oedema
mesothelioma

56
Q

differentials in a ‘white out’ of hemi-thorax if trachea deviated away from white out

A

pleural effusion
diaphragmatic hernia
large thoracic mass

57
Q

causes lower lobe fibrosis

A

CAID
Connective tissue disorders
Asbestos
Idiopathic pulmonary fibrosis
Drugs

58
Q

features moderate acute asthma

A

PEFR 50-75%
normal speech
RR <25
HR < 110

59
Q

features severe acute asthma

A

PEFR 33-50%
can’t complete sentences
RR >25
HR >110

60
Q

features life-threatening acute asthma

A

PEFR <33%
sats <92%
normal pCO2
silent chest, cyanosis, feeble resp effort
haemodynamic instability
exhaustion, confusion, coma

61
Q

features superior vena cava syndrome

A

symptoms:
swelling of your face, neck, upper body, and arms
trouble breathing or shortness of breath
coughing
causes:
lung cancer
non-hodgkins lymphoma

62
Q

indication ABG asthma

A

sats <92%

63
Q

features mycoplasma pneumonia

A

symptoms - flu, arthralgia, myalgia, dry cough, headache
auto-immune haemolytic anaemia due to cold agglutinins
erythema multiforme

64
Q

follow up pleural plaques

A

benign - no malignant change - no follow up needed

65
Q

what do patients need for discharge after acute asthma attack

A

PEFR >75% of expected,
inhaler technique checked
stable on discharge medications (i.e. no longer requiring acute asthma treatment) for at least 12-24 hours.

66
Q

indications long term oxygen therapy COPD

A

PaO2 < 7.3 kPa + non-smokers
PaO2 7.3 - 8 AND nocturnal hypoxia, polycythaemia, peripheral oedema + pulmonary hypertension

67
Q

management acute exacerbation COPD

A

5 day course oral pred

68
Q

stages COPD

A

FEV1 of predicted
stage 1 - >80%
stage 2 - 50-79%
stage 3 - 30-49%
stage 4 - <30%

69
Q

commonest cause pneumonia after influenza

A

staph aureus

70
Q

management covid 19

A

hospitalised + hypoxia - dexamethasone + remdesivir
ventilation - tocilizumab
molnupiravor - inhibits cov2 replication (use within 5 days)

71
Q

significant FeNO result

A

> 40 ppb in adults or >35 ppb in children

72
Q

significant bronchodilator reversibility result

A

> 12%

73
Q

paraneoplastic features adenocarcinoma

A

gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)

74
Q

first line management COPD

A

SABA or SAMA (e.g. ipratropium)

75
Q

management asthma (non-acute)

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + leukotriene receptor antagonist
  4. SABA + ICS + LAMA
76
Q

management suspected occupational asthma

A

peak flow diary in and out of work
referral to secondary care

77
Q

examination findings bronchiectasis

A

coarse crackles and high-pitched inspiratory squeaks

78
Q

management bronchitis

A

supportive
abx (doxicycline) if - comorbid, systemically unwell, CRP raised

79
Q

features ABPA

A

eosinophilia + bronchiectasis
treat with oral steroids

cardio + resp (8 decks)

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