Resp Pass Med Flashcards
What decreases first CRP or white cells
White cells
Benign ovarian tumour as cites and plural effusion
Meigs syndrome
NG tubes are safe to use if the pH is what on aspirate
<5.5
If pH >5.5 on NG tube aspirate do what
Request a CXR to confirm position of tube
Pleural fluid with protein > 30 is indicative of an
Exudate
Give 4 causes of a transudative pleural effusion (protein <30)
HF
Liver disease nephrotic syndrome malabsorption
Hypothyroid
Meigs syndrome
Give causes of an exudative pleural effusion
Infection CTD neoplasia pancreatitis PE dresslers yellow nail syndrome
Alpha one antitrypsin causes what type of pattern on spriometry
Obstructive
What can abx be prescribed for in upper Resp tract infections as exceptions
3 or more of centir criteria
Younger than 2 years with bilateral otitis media
Otorrhoea and acute otitis media in kids
What are the cantor criteria
Tonsillitis mar exudate
Lymphadenopathy
Fever of history of
No cough
3 or more can prescribe
When can non invasive ventilation be given in COPD
pH between 7.25 and 7.35
If in COPD the pH is <7.25 then use
Invasive ventilation
Parallel line shadows on ct
Tram lines in bronchiectasis
Collapsing during exertion is associated with what
Aortic stenosis
Diagnose mesothelioma
Thoracoscopy and histology
Before starting azithromycin do what
An ECG to rule out prolonged QT interval and also do baseline LFTs
What is the diagnostic criteria for COPD
FEV1/fvc ratio <70% and symptoms suggestive of COPD
What features of COPD would make you think that it would be steroid responsive
Previous diagnosis of asthma or atopy
A higher blood eosinophil count
A substantial variation in FEV1 over time (at least 400mls)
Substantial diurnal variation in peak flow (at least 20%)
How long should you hold your breath after using an inhaler
10 seconds
How long should you wait between inhaler doses
30 seconds
What is the triangle of safety for a chest drain
Base of axilla
Lateral edge of pec major
5th ICS
Anterior border of lat Dorsi
BiPAP is a form of
Non invasive ventilation
What can mimic a pneumothorax in COPD
Emphysematous Bullae
What are the biochemical features of an empyema
Turbid effusion with pH <7.2 low glucose high LDH
First line COPD
Sama or Saba (salbutamol or salmetarol)
Vaccines in COPD
One off pneumococcal and annual flu
Treatment of exacerbation of asthma
Short course of oral pred and daily inhaled corticosteroid to control asthma
Scale used in OSA
Epworth
Are inhalers safe in pregnancy
Yes no need to stop as there is a need for good control throughout
If copd and on Saba/sama and still breathless but is steroid responsive
Add a Laba and ICS
What is chest drain swinging
The water seal rises on inspiration and falls on expiration
What can cause pulmonary fibrosis of the upper lobs
CHaRTS Coal workers pneumoconiosis Hypersensitivity pneumonitis Ank spond Radiation TB Silicosis and sarcoidosis
What type of fibrosis mainly affects the lower zones
Idiopathic pulmonary fibrosis
CTD
Drugs (amiodarone methotrexate bleomycin)
Asbestosis
Prevent high altitude cerebral oedema with
Acetazolamide
Treat high altitude cerebral oedema with
Dexamethasone
Ground glass on CT
Fibrosis
What are pleural plaques
Benign features of asbestos exposure
What is the most dangerous form of asbestosis
Crocidolite (blue)
How is military TB spread
Through the pulmonary venous system
Sudden deterioration after initiating ventilation suggests
Tension pneumothorax
Indications for steroid treatment for sarcoid are
Parenchyma lung disease
Uveitis
Hypercalcaemia
Neurological or cardiac involvement
Hyponatraemia is seen in what type of lung cancer
Small cell
What does SCC of the lung cause
Hypercalcaemia (increases PtH) or hyperthyroid (increased Tsh)
What is the criteria for a post bronchodilator response indicative of asthma
FEV1 of 12%
How can mitral stenosis cause haemoptysis
Rupture of the bronchial veins caused by raised left atrial pressure
Gynaecomastia is associated with what type of lung cancer
Adenocarcinoma
How can you further investigate asthma if spirometry is negative?
Fractional exhaled nitric oxide testing
A combination of bronchiectasis and dextrocardia is highly suggestive of what syndrome
Kartageners syndrome
Histology and anatomy of a mesothelioma a
Pleural based mass with fibrosis and plaque formation
Mixed sarcomatous and carcinomatous features
Needle into pleural cavity is inserted above or below the rib
Above as the NVB runs below
Tinnitus and overdose
?salicylate poisoning
Treat psittacosis with
Tetracyclines like doxycycline
High calcium and lung cancer
Squamous cc or bony mets
Anti TNF on rheumatoid can do what
Reactivate TB
Air crescent sign on CT
Aspergillosis
What is the sweat test for CF
Give the muscarinic pilocarpine and then measure the chloride content of sweat
Diagnosis of TB is by
Sputum microscopy and culture
What is contraindicated in massive haemoptysis
Non invasive ventilation as may aspirate and positive pressure may prevent clot formation
Dry non productive cough T1RF hyponatraemia and mild renal impairemwnt
A typical pneumonia like legionella or mycoplasma
Bat wing appearance on chest radiograph
Pulmonary oedema
What is another name for farmers lung
Hypersensitivity pneumonitis
What are the signs of a pleural effusion
Reduced chest explanation on the size of the effusion
Trachea can be deviated
Stony dull to percuss
Reduced vocal resonance
Most common cause of pleural effusion in a homeless person apart from trauma
Aspiration pneumonia
Salbutamol is a beta 1/2 agonist
2
What are the 5 causes of hypoxaemia
Hypoventillation Vq mismatch Right to left shunt Low inspired o2 Diffusion abn
What is a classic feature of pneumocystis jirovecci
Desaturation on exercise
What is the main cause of malabsorption in Cf and how do you treat it
Pancreatic insufficiency
Replacement pancreatic enzymes
Treatment of stable and unstable PE
Stable - LMWH
Unstable - thrombolysis
Score 0 on MRC dyspnoea scale
No breathlessness except with strenuous exercise
Score 1 on MRC dyspnoea scale
Breathlessness when hurrying on the level or walking up a slight hill
Score 2 on MRC dyspnoea scale
Walk slower than others or has to stop for own breath when walking at own pace
Score 3 on MRC dyspnoea scale
Stops for breath after walking for 100m or a few mins on level ground
Score 4 on MRC dyspnoea scale
Too breathless to leave the house (breathless on dressing and undressing)
Which respiratory pathogen associated with Cf is a contraindication to lung transplant
Burkholderia cenocepacia
Bibasal reticular nodular shadowing on X-ray
IPF
What type of X-ray is used to detect abn that are obscured by the heart or sternum
Lateral
Which X-ray view is used to detect small pleural effusion a
Lateral decubitus view
What type of X-ray is used to study diaphragmatic movement
PA view with fluoroscopy
Patient with normal obs put peak flow of 30% predicted in surgery what do you don
Oral prednisalone salbutamol Neva high flow o2 call ambulance for immediate transfer to hospital
If curb score 0-1
Home
If curb score 2
Hospital
If curb score >3
Consider ITU
What actually is alpha 1 antitrypsin in the body
A glycoproteins
Working in a ceramic factory is a risk factor for the development of
Silicosis
What is used as a marker of disease severity in CoPD
FEV1
How would you treat a non infective exac of CoPD I
Pred
What does the FEV1 need to be for the pt to qualify for a transplant
<25%!
What disorders are associated with IPF
RA SLE SS IBD PBC
High calcium cancer
Squamous
Low na in blood high na in urine cancer
SIADH in small cell cancer
In any size of pneumothorax and the patient is shoet of breath what do you do
Aspirate
RA on immunosuppressive therapy and a cough productive of green sputum and repeated chest infections
Bronchiectasis
What are the three Cs of pulmonary fibrosis
Clubbing cyanosis cough
SOB in a young person with oedema palpitations syncope exertional angina and a murmur
Familia primary pulmonary hypertension
Gold standard for TB diagnosis a
3 separate sputum cultures for culture and microscopy
Describe the blood supply to the lungs
Pulmonary artery and bronchial arteries as dial blood supply so if pulmonary artery blocked then they have an option
What is the eye condition associated with sarcoidosis
Keratoconjunctivitis sicca
How would you investigate for sarcoidosis
CXr Trans bronchial biopsy and broncheolar lovage PFT Serum ACE Kveim test Tuberculin test
Unilateral pleural effusions are usually caused by
Local pathology such as trauma tumour or infection
Cancer at upper border of lung
Adenocarcinoma
Cancer in centre of lung
SCC associated with smoking