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Respiratory Flashcards

1
Q

What are the features of steroid response in COPD?

A

Blood eosinophilia
FEV1 variation >400ml with time
>20% diurnal variation in peak expiratory flow rate (PEFR)

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2
Q

What are the features of kartegener syndrome?

A
  1. dextrocardia or complete situs inversus
  2. bronchiectasis
  3. recurrent sinusitis
  4. subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
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3
Q

What are the various steps of management for smoking cessation in pregnant women?

A
  1. CBT, motivational interviewing or structured self-help and support from NHS Stop Smoking Services
  2. Nicotine replacement therapy

varenicline and bupropion are contraindicated

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4
Q

What medications cause long QT syndrome?

A 
Anti-arrhythmic medication
Antibiotics - macrolides and fluroquinolone
Antidepressants - TCA, SSRI, lithium
Antipsychotics - haloperidol
Antiemetic - ondensetron
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5
Q

What is the typical presentation of Psittacosis?

A 
Flu-like symptoms (90%): fever, headache and myalgia
Respiratory symptoms (82%): dyspnoea, dry cough and chest pain
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6
Q

What is the treatment for psittacosis?

A

1st-line: tetracyclines e.g. doxycycline

2nd-line: macrolides e.g. erythromycin

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7
Q

What is the management of acute exacerbations of COPD?

A
  1. increase frequency of bronchodilator use and consider giving via a nebuliser
  2. Oral prednisolone 30 mg for 5 days
  3. Oral Antibiotics - amox, clarithro or doxycycline
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8
Q

How do you differentiate sarcoidosis and tuberculosis?

A

Whilst tuberculosis is usually limited to the lungs and the major presenting complaint is cough, sarcoidosis has a classic systemic presentation, with erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, and polyarthralgia.

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9
Q

What do blood tests results show in sarcoidosis? and how do you monitor the disease?

A

Hypercalcaemia
Raised ESR

Monitoring - ACE levels

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10
Q

How do you differentiate between ARDS vs cardiogenic pulmonary oedema?

A

Pulmonary capillary wedge pressure - less than 18 mm Hg - cardiogenic
ARDS - pulmonary cap wedge pressure is normal

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11
Q

What is the step by step management of ARDS?

A
  1. Treat the underlying cause
  2. Antibiotics (if signs of sepsis)
  3. Negative fluid balance i.e. Diuretics
  4. Recruitment manoeuvres such as prone ventilation, use of positive end expiratory pressure
  5. Mechanical ventilation strategy using low tidal volumes, as conventional tidal volumes may cause lung injury (only treatment found to improve survival rates)
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12
Q

What is the discharge advise to be given after a a pneumothorax?

A

Smoking - cut down
flying - dont fly for a week after pneumothorax
Deep sea diving - avoid lifelong

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13
Q

What is the suspected diagnosis if the patient presents with 3 week h/o cough (productive with clear sputum), intermittent low-grade fever. CXR normal, blood only shows raised CRP?

A

Acute bronchitis

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14
Q

What is the management of acute bronchitis?

A

CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)

First line Abx - doxycycline

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15
Q

What are the conditions causing fibrosis in the upper lobe of the lungs?

A 
CHARTS
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
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16
Q

What are the conditions causing fibrosis in the lower lobe of the lungs?

A

RASIO (lower lober)

  • Rheumatoid
  • Asbestosis
  • Scleroderma
  • Idiopathic Pulmonary fibrosis (most common cause overall)
  • Other - drug-induced: amiodarone, bleomycin, methotrexate
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17
Q

What are the causes of ARDS?

A 
infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
cardio-pulmonary bypass
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18
Q

Which cancers met to the lungs?

A

Cancers metastasising to lung = Before Computers People Read Books

Breast
Colorectal
Prostate
Renal
Bladder
Breast
Bladder
Bidney
Brostate
Brectum
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19
Q

What causes tracheal deviation towards the side of the affected lung?

A

Atelectasis

Agenesis of lung

Pneumonectomy

Pleural fibrosis

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20
Q

What causes tracheal deviation away from the side of the affected lung?

A

Pneumothorax

Pleural effusion

Large mass

21
Q

What blood test may suggest lung cancer in the context of the right history?

A

Raised platelets

22
Q

What are some causes of respiratory alkalosis?

A

High rates of breathing

  1. Anxiety leading to hyperventilation
  2. Pulmonary embolism
  3. Salicylate poisoning (leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis)
  4. CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
    altitude
  5. Pregnancy
23
Q

A 74-year-old female presents to the GP with a 2 week history of increasing weakness of her upper and lower limbs. She also reports dysphagia to solids and liquids. She is currently undergoing chemotherapy for small cell lung cancer. On examination there is weakness of the limbs but this slowly improves with prolonged exertion.

What is the most likely diagnosis?

A

Lambert Eaton syndrome

24
Q

What is the criteria for LTOT in COPD patients?

A

any one of :

  1. cyanosis
  2. polycythaemia
  3. raised JVP
  4. FEV1 < 30%
  5. oxygen saturations <92%
  6. peripheral oedema

ABG is required
- Pa02 < 7.3, the patient qualifies for LTOT

  • Pa02 between 7.3-8 in the presence of secondary polycythaemia, pulmonary hypertension or peripheral oedema also qualify the patient for LTOT
25
Q

What is the treatment for the exacerbation of asthma?

A
  1. Oxygen
  2. SABA - salbutamol, terbutaline
  3. ICS - 40-50mg prednisolone oral, beclometasone inhaler
  4. ipratropium bromide - severe or life threatening asthma in patients who have not responsed to beta-agonist or corticosteroid treatment
  5. IV magnesium sulphate
  6. IV theophylline
26
Q

What is the centor criteria?

A

C an’t Cough
E xudates on tonsils
N odes tender
T emperature

27
Q

What is the sign of a patient getting tired during an acute exacerbation of asthma?

A

The respiratory alkalosis is normalised and the pC02 returns to baseline

28
Q

what are the indications for chest drain insertion in pleural effusion?

A
  1. Patient with frankly purulent or turbid/cloudy pleural fluid on sampling
  2. The presence of organisms identified by gram stain and/pr culture from a non-purulent pleural fluid sample
  3. Pleural fluid pH <7.2 in patients with suspected pleural infection
29
Q

What is the biggest prognostic factor for asthma attacks?

A

LOOK at pCO2 in the ABG

30
Q

What are features of a moderate asthma attack?

A
  1. PEFR 50-75% best or predicted
  2. Speech normal
  3. RR < 25 / min
  4. Pulse < 110 bpm
31
Q

What are features of a severe asthma attack?

A
  1. PEFR 33 - 50% best or predicted
  2. Can’t complete sentences
  3. RR > 25/min
  4. Pulse > 110 bpm
32
Q

What are the features of life-threatening asthma?

A
  1. PEFR < 33% best or predicted
    Oxygen sats < 92%
  2. ‘Normal’ pC02 (4.6-6.0 kPa)
  3. Silent chest, cyanosis or feeble respiratory effort
  4. Bradycardia, dysrhythmia or hypotension
  5. Exhaustion, confusion or coma
33
Q

What are features of near fatal asthma?

A

Near-fatal is defined as a raised pCO2 rather than a normal pCO2.

34
Q

What are the causes of clubbing?

A 
C- Cyanotic heart disease , Cystic fibrosis
L - Lung cancer, lung abscess
U - Ulcerative colitis
B - Bronchiectasis 
B - Benign mesothelioma 
I - Idiopathic pulmonary fibrosis, Infective endocarditis
N - Neurogenic tumours
G - GI (cirrhosis)
35
Q

what are the acute features of sarcoidosis?

A

erythema nodosum
bilateral hilar lymphadenopathy
swinging fever
polyarthralgia

36
Q

what are the insidious symptoms of sarcoidosis?

A

dyspnoea
non-productive cough
malaise
weight loss

37
Q

what is the skin manifestation of sarcoidosis

A

lupus pernio

38
Q

what is the endocrine abnormality associated with sarcoidosis?

A

hypercalcaemia - macrophages inside the granulomas casue an increased conversion of vit D to its active form

39
Q

what are the causes of restrictive lung disease?

A
  1. pulmonary fibrosis
  2. asbestosis
  3. sarcoidosis
  4. ankylosing spondylitis
  5. neuromusclar disorders
  6. severe obesity
40
Q

what are the 4 features that define the treatement escalation in COPD?

A
  1. previous diagnosis of asthma or atopy
  2. raised blood eosinophil count
  3. substantial variation in FEV 1 over time
  4. substantial diurnal variation in peak expiratory flow
41
Q

what are the causes of transudates?

A
  1. heart failure
  2. hypoalbuminaemia
  3. hypothyoridism
  4. meig’s syndrome
42
Q

what are the causes of exudates?

A
  1. infection
  2. connective tissue disease - RA and SLE
  3. neoplasia - lung cancer, mesotheliam a
  4. pancreatitis
  5. pulmonary embolism
  6. dresslers syndrome
43
Q

what medication can be used for altitude related disorder?

A

acetazolamide - prevent AMS by inducing primary metabolic acidosis and compensatory respiratory alkalosis

44
Q

what is the tx for allergic bronchopulmonary aspergillosis?

A

oral glucocorticoids

itraconazole is used as second line

45
Q

what are the cardiac causes of clubbing?

A
  1. cyanotic heart disease
  2. bacterial endocarditis
  3. atrial myxoma
46
Q

what are the respiratory causes of clubbing?

A

lung cancer
pyogenic condition - cystic fibrosis, bronchiectasis, abscess, empyema
TB
asbestosis, mesothelioma

47
Q

what is the lights criteria to differentiate exudate from transudate?

A
  1. Pleural fluid protein: serum protein ratio > 0.5
  2. Pleural fluid LDH: serum LDH ratio > 0.6
  3. Pleural fluid LDH > two-thirds upper limit of normal serum LDH

Pleural fluid with a protein level >30g/L is indicative of an exudate

48
Q

What are the features of churg strauss disease?

A 
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive in 60%

Fourth (14 decks)

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