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Respiratory Flashcards

1
Q

features of moderate asthma exacerbation

A
  • PEFR 50-75%
  • speech normal
  • RR <25
  • pulse <110
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2
Q

features of severe asthma exacerbation

A
  • PEFR 33-50%
  • can’t complete sentences
  • RR >25
  • pulse >110
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3
Q

features of life-threatening asthma exacerbation

A
  • PEFR <33%
  • sats <92%
  • silent chest, cyanosis, poor respiratory effort
  • bradycardia, dysrhythmia, or hypotension
  • exhaustion, confusion or coma
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4
Q

adults - dose of salbutamol nebs in acute asthma

A

5mg (with O2) - 15-20 min intervals

in children - under 5 = 2.5mg, over 5 = 5mg

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5
Q

adults - dose of ipratropium bromide in acute asthma

A

500mcg (with O2) - 4-6 hourly

in children - 250mcg every 5 mins

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6
Q

adults - dose of hydrocortisone/ prednisolone in acute asthma

A

200mg IV

or prednisolone 40mg PO

in children - 1-2mg per kg per day prednisolone PO

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7
Q

adults - dose of magnesium sulphate in acute asthma

A

2g IV over 20 mins

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8
Q

when can you discharge someone with acute asthma exacerbation

A

inhalers 4 or more hours apart

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9
Q

follow up after acute asthma exacerbation

A
  • see GP/asthma nurse in 2 days to review meds

- see resp specialist within 1 month of discharge

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10
Q

most common bacterial cause of infective exacerbation of COPD

A

h. influenzae

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11
Q

most common viral cause of infective exacerbation of COPD

A

human rhinovirus

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12
Q

management of acute COPD exacerbation

A
  • venturi to keep oxygen 88-92
  • salbutamol nebs 5mg B2B
  • ipratropium bromide 500mcg nebs
  • prednisolone 30mg PO
  • oral abx if infective signs
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13
Q

antibiotic to give in infective exacerbation of COPD

A

amoxicillin 500mg TDS 5 days

or doxycycline/ clarithromycin

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14
Q

when to give abx in acute bronchitis

A
  • systemically very unwell
  • signs suggestive of pneumonia
  • co-morbidities or immunosuppression
  • CRP >100 (offer delayed if 20-100)
  • > 65 with acute cough and 2+, or >80 with acute cough and 1+ of: hospitalisation in previous year, diabetes, heart failure or taking steroids
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15
Q

abx to give if required in acute bronchitis

A

orał doxycycline (not in pregnancy)

amoxicillin if pregnant or clarithromycin /erythromycin if penicillin allergic

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16
Q

management of primary pneumothorax if <2cm and not SOB

A

? discharge (review in outpatients in 2-4 weeks)

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17
Q

management of primary pneumothorax if >2cm/SOB

A
  • aspirate with 16-18G cannula, <2.5L

- if fails (still >2cm) then insert chest drain and admit

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18
Q

management of secondary pneumothorax

A
  • > 2cm/SOB - chest drain
  • 1-2cm - aspiration 16-18G cannula, <2.5L, if fails (still >1cm), chest drain
  • <1cm - O2 and admit for 24 hours
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19
Q

where is the triangle of safety (for chest drain insertion)

A
  • anterior = pectoralis major
  • posterior = latissimus dorsi
  • 5th rib
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20
Q

do you always put in a chest drain after aspirating a tension pneumothorax

A

yes

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21
Q

investigations for suspected PE if wells score <4 or >4

A
  • <4 = D-dimer, if positive do CTPA

- >4 = CTPA

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22
Q

PERC score (HAD CLOTS)

A
  • hormones
  • age >50
  • DVT/PE history
  • coughing blood
  • leg swelling
  • O2
  • tachycardia
  • surgery/trauma

if none are met - <2% chance of PE

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23
Q

a massive PE is

A

PE + hypotension or cardiac arrest - give alteplase

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24
Q

a submassive PE is

A
  • hypoxia
  • echo/ECG showing right heart strain
  • positive cardiac biomarker e.g. troponin
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25
Q

management of PE

A
  • ABCDE
  • LMWH or fondaparinux for minimum 5 days or until INR >2
  • warfarin/DOAC commended within 24 hours
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26
Q

how long to give LMWH or fondaparinux after PE

A
  • minimum 5 days or until INR >2
  • until end of pregnancy if pregnant
  • 6 months in patient with active cancer or IVD
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27
Q

when NOT to give LMWH or fondaparinux after PE

A
  • increased risk bleeding
  • haemodynamically unstable
  • severe renal impairment
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28
Q

common cause of HAP in alcoholics

A

Klebsiella

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29
Q

most likely location of aspiration pneumonia

A

R lower lobe

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30
Q

management of VAP

A

tazocin/levofloxacin

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31
Q

type of pneumonia associated with erythema multiforme/nodosum

A

mycoplasma

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32
Q

type of pneumonia which can be caused by exposure to birds

A

chlamydophila psittaci

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33
Q

CURB-65 score

A 
AMTS <8 
Urea >7
RR >30
BP <90 or <60 
Age >65

score 1 point for each

0-1 = low risk (manage at home0 
2 = intermediate risk (hospital)
3 = high risk (ICU?)
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34
Q

atypical pneumonia screen includes screening for

A
  • mycoplasma
  • legionella
  • chlamydia
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35
Q

when to use flucloxacillin in pneumonia

A

if staph suspected (e.g. influenza)

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36
Q

when to use vancomycin in pneumonia

A

if ?MRSA

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37
Q

treatment of severe pneumonia

A

IV amoxicillin + macrolide (e.g. clarithromycin) for 7-10 days

consider using co-amoxiclav, ceftriazone or tazocin with a macrolide if highly severe

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38
Q

treatment of HAP

A

not severe = co-amoxiclav 5 days (doxy if penicillin allergic)

tazocin if severe symptoms

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39
Q

reversibility of PEFR after bronchodilator in asthma

40
Q

definitions of controlled, partially controlled and uncontrolled asthma

A
  • controlled = <2 symptoms a week in the day
  • partially controlled = >2/week, any at night, >1 exacerbation a year
  • uncontrolled = 3+ features a week
41
Q

pattern in reducing ICS dose in asthma

A

consider dose reductions every 3 months - decreasing dose by 25-50% each time

42
Q

what is a positive bronchodilator test

A

asthma diagnosis - +ve test is improvement in FEV1 of 12% or more

43
Q

what to do if high vs intermediate probability of asthma

A
  • high probability = 6 week trial of treatment

- intermediate probability = spirometry with BDR (positive = treatment, negative = objective tests)

44
Q

how to carry out spirometry for COPD diagnosis

A
  • no bronchodilator 4-6 hours before, no big meal, no smoking 24 hours before
  • best of 3 consistent readings, ensure at least 2 FEV1 within 100ml/5% of each other
45
Q

grades 1-4 of COPD

A

FEV1%:

  • > =80 = stage 1
  • 50-79 = stage 2
  • 30-49 = stage 3
  • <30 = stage 4
46
Q

cardiac complication of COPD

A

cor pulmonale - right heart failure secondary to lung disease (caused by pulmonary HTN as a consequence of hypoxia)

47
Q

features of cor pulmonale

A
  • peripheral oedema
  • raised JVP
  • systolic parasternal heave
  • loud pulmonary 2nd heart sound
  • widening of pulmonary artery on CXR
  • RVH on ECG
48
Q

when is pulmonary rehabilitation recommended for COPD

A
  • functionally disabled by COPD
  • MRC dyspnoea scale 3+
  • recent hospitalisation
49
Q

what prophylactic antibiotics are sometimes used in COPD

A

azithromycin 3x a week

50
Q

when can you offer LTOT for COPD

A
  • if FEV1 30-49%
  • oedema, cyanosis, polycythaemia, raised JVP
  • ABG twice at least 3 weeks apart - offer If pO2 <7.3 or pO2 7.3-8 and secondary polycythaemia, peripheral oedema or pulmonary hypertension
  • NOT to patients who smoke
51
Q

when is light’s criteria used for pleural effusions

A

when borderline between transudate and exudate - when protein level is 25-35g/L

exudate is likely when one of the following is met:

  • pleural fluid protein/serum protein =>0.5
  • pleural fluid LDH/serum LDH =>0.6
  • pleural fluid LDH >2/3 the upper limits of normal serum LDH
52
Q

causes of a pleural effusion with low glucose (<3.3)

A
  • RA
  • TB
  • empyema (LDH >1000)
53
Q

causes of a pleural effusion with raised amylase

A
  • pancreatitis
  • oesophageal perforation
  • malignancy
54
Q

causes of blood stained pleural effusion

A
  • mesothelioma
  • PE
  • TB
  • trauma
55
Q

how much can you aspirate of a pleural effusion

56
Q

when to drain a pleural effusion

A
  • fluid purulent or turbid

- empyema/ parapneumonic effusion with ph <7.2

57
Q

paraneoplastic syndromes associated with SCLC

A
  • SIADH
  • ACTH (Cushing’s)
  • LEMS
58
Q

type of NSCLC centrally vs peripherally located

A
  • central = squamous cell (close to bronchi - can present with bronchial obstruction)
  • peripheral = adenocarcinoma
59
Q

type of lung cancer which may secrete beta-hCG

A

large cell

60
Q

type of lung cancer which can secrete PTHrp = malignancy-related hypercalcaemia

A

squamous cell

61
Q

where can pain be caused in a Pancoast tumour (SCC)

A

in distribution of nerve root (Pancoast syndrome) - pain in R arm, weakness of muscles of R hand

62
Q

how to biopsy lymph nodes in the mediastinum

A

end-bronchial ultrasound (EBUS)

63
Q

most common mets of lung cancer

A
  • adrenals
  • liver
  • brain
  • bone
64
Q

what is sarcoidosis

A

multisystem chronic inflammatory condition - formation of non-caveating epithelioid granulomas

65
Q

how can sarcoidosis affect the eyes

A
  • anterior uveitis
  • dry eyes
  • glaucoma
66
Q

neuro effects of sarcoidosis

A
  • Bell’s palsy
  • lesions of cranial nerves
  • hoarseness
  • headache
67
Q

why can sarcoidosis cause hypercalcaemia

A

macrophages in granulomas cause increased conversion of vitamin D to its active form

68
Q

what is lupus pernio

A

chronic raised red lesion on face (looks a bit like butterfly rash - sign of sarcoidosis)

69
Q

pulmonary function tests in sarcoidosis

A

can be a restrictive pattern (lung fibrosis)

70
Q

when is serum ACE tested

A

for sarcoidosis

71
Q

1st line management for sarcoidosis

A

oral glucocorticoids

other treatments include methotrexate, azathioprine, mycophenolate, anti TNF etc.

72
Q

commonest mutation for CF

A

delta F508 on chromosome 7 (CFTR gene)

73
Q

FEV1 in CF

A

obstructive - recurrent chest infections = bronchiectasis

74
Q

organisms causing recurrent chest infections in CF

A
  • s. aureus

- h. influenzae

75
Q

Newborn screening finding in CF

A

increased immunoreactive trypsin on newborn bloodspot card (Guthrie card)

76
Q

what is diagnostic of CF on sweat test (gold standard)

A

chloride levels >60mmols - 2 abnormal tests needed for diagnosis (false positive could be caused by malnutrition, thyroid, adrenal insufficiency, skin oedema)

77
Q

liver complication of CF

A

sluggish bile flow - cirrhosis and portal hypertension

78
Q

most common presentation of TB outside the lungs

A

sterile pyuria - may be salpingitis, abscesses and infertility in females, epididymis swelling in males

79
Q

MSK presentations of TB

A

pain, arthritis, osteomyelitis, abscess (of vertebral bodies = Pott’s disease)

80
Q

CNS presentations of TB

A

tuberculosis meningitis and tuberculomas

81
Q

skin presentation of TB

A

erythema nodosum

82
Q

how does primary TB usually appear on CXR

A

central apical portion with left lower lobe infiltrate/pleural effusion

83
Q

CXR of reactivated TB

A

apical lesions

84
Q

contact screening for TB

A

Mantoux test to household contacts - Mantoux positive if 15mm or greater

85
Q

how long to give abx for active TB without CNS involvement vs TB with CNS involvement

A
  • without CNS = 6 months

- with CNS = 12 months

86
Q

management of latent TB

A
  • 6 months isoniazid/3 months rifampicin and isoniazid if known not to have HIV
  • 6 months isoniazid if HIV
87
Q

what does the Mantoux test show

A

6-15mm = previous TB/BCG injection

> 15mm = TB infection

88
Q

when can you not give BCG vaccine

A 
pregnant
previous TB 
HIV 
positive Mantoux
>35
89
Q

why can hypothyroidism and amyloidosis increase risk of obstructive sleep apnoea

A

both can cause macroglossia

90
Q

how is complete apnoea defined

A

10 second pause in breathing activity

91
Q

how is partial apnoea defined

A

(hypopnoea) - 10 second period where ventilation is reduced by at least 50%

92
Q

mild, moderate and severe obstructive sleep apnoea

A

5 or more respiratory events per hour:

  • 5-14 = mild
  • 15-30 = mod
  • > 30 = severe

for mod/severe = CPAP 1st line - must be worn for minimum 4 hours/night

93
Q

most common symptoms of CO poisoning

A

headache

N+V

94
Q

what antibody is positive in 30% of IDF cases

95
Q

potential complication of tricuspid endocarditis

A

can lead to septic PE = lung abscess?

Year 5 notes (10 decks)

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