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Year 3 - Medical Block Workbooks > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What do the flow-volume charts look like for:

  1. Normal lungs
  2. COPD
  3. Restrictive disease
A

Normal lungs:

(`\
U

COPD
(|_
U

Restrictive Disease

/\
U

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2
Q

Medical management of Anaphylaxis

A
  1. Oxygen
  2. IM adrenaline (0.5 mg)
  3. IV hydrocortisone (200mg)
  4. IV clorpheniramine[chlorphenamine] (10mg)
  5. Nebs: Salbutatmol, adrenaline
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3
Q

Asthma severity and management?

A
  1. Acute:
    - Salbutamol (5mg, repeat at 15 mins)
    - Prednisolone (40 mg PO) [IV - hydrocortisone]
  2. Severe:
    - Nebs Ipratropium bromide (500mg)
    - Salbutamol (back to back 5mg)
  3. Life-threatening/near-fatal:
    - URGENT ITU
    - Aminophylline IV
    - Salbutamol IV
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4
Q

COPD exacerbation medical management

A
  1. Oxygen: Check ABG for 88-92% or 94-98%
  2. Nebs: Salbutamol and ipratropium
  3. Prednisolone 30mg STAT and 7 days
  4. ABx as necessary
  5. Consider aminophylline
  6. Consider NIV in Type 2 acidosis
  7. Consider IT in <7.25 acidosis
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5
Q

CURB 65 criteria?

A 
C onfusion (MMT 2+)
U rea (<7.0)
RR (<30)
Bp (<90/60)
65 (YO)
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6
Q

Haemoptysis management

A
  1. ABCDE
  2. Lie on side of lesion
  3. Stop anticoags/pltlts, NSAIDs,
  4. Tranexamic acid (5 days PO or IV)
    [Anti-fibrinolytic - stop tPa working]
  5. Vitamin K
  6. CT aortogram
  7. ABx as required
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7
Q

Tension Pneumothorax Management

A

Large bore IV cannula into:
2nd ICS, MCL

Chest drain into the affected side

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8
Q

PE Management

A
  1. ABCDE
  2. Oxygen
  3. Analgesia
  4. SC LMWH
  5. CTPA
    - IV Alteplase
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9
Q

Thrombolysis Contraindications (Absolute and relative)

A
  1. Stroke <6 months (Haemorhagic or ischaemic)
    2 CNS Neoplasia
  2. Recent trauma or surgery
  3. GI bleed <1 month
  4. Aortic dissection/IE
  5. Bleeding disorder/Pregnancy/Liver
    Warfarin/DOAC
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10
Q

Criteria for Safe asthma discharge

  1. Inpatient Review
  2. Follow-up
A

Review

  1. PERFR > 75%
  2. Stop regular nebulisers for 24hrs prior to discharge
  3. Inpatient asthma nurse review
  4. PEFR meter provided and written action plan

Follow-up

  1. Prednisolone PO 5+ days
  2. GP follow up within 28 hours
  3. Respiratory clinic follow up within 4 weeks
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11
Q

What are differentials and pathologies for Eosinophilia

A
  1. Atopy
    - Steroid-respondant asthma
    - COPD
    - Hayfever/allergies
  2. Infection
    - Aspergillosis
    - Chronic ABx
    - Pneumonia
    - Parasites
  3. Disorders
    - Granulomatosis with polyangiitis
    - Lymphoma
    - SLE
    - Hypereosinophilic syndrome
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12
Q

What are the conditions for starting LTOT?

A

Need:

  1. pO2 < 7.3 (consistent)
    - Below 8 in cor pulmonale

Safety:

  1. Non smoker
  2. Non retainer
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13
Q

What are common organisms of CAP, HAP, and atypicals?

A

CAP:

  1. Strep p.
  2. HiB
  3. Moraxella catarrhalis

Hospital:

  1. E Coli
  2. MRSA
  3. Pseudomonas

Atypical:

  1. Legionella
  2. Chlamydia pneumoniae
  3. Mycoplasma pneumoniae
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14
Q

Management of TB

A

Acute:

  1. ABCDE
  2. Culture
  3. Sputum x3
    - Ziehl-Neelson

Side room:

  1. Chest CT
  2. Quadruple therapy
    - Rifampicin
    - Isoniazid
    - Pyrazinamide
    - Ethambutol
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15
Q

TB drugs

- ADRs

A

R:

  1. hepatitis & rashes
  2. interactions
  3. orange

I:

  1. hepatitis & rashes
  2. neuropathy
  3. psychosis

P:

  1. hepatitis
  2. vomiting & arthralgia

E:
1. retrobulbar neuritis

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16
Q

Causes of bronchiectasis?

Three Acute, three chronic

A

Acute

  1. Post infective
    - whooping cough/tb
  2. Obstruction (FB/Node/tumour)
  3. Toxin

Chronic

  1. Immune deficiency
    - Hypogammaglobulinaemia
    - 2° immunodeficiency
  2. Genetic/mucociliary:
    - CF, 1°CD, Young’s, Kartagener
  3. Allergic aspergillosis
17
Q

Bronchiectasis exacerbation organisms and ABx?

A
  1. HiB: Amoxicillin (doxy)
  2. Pseudomonas : cipro
  3. Moraxella catarrhalis
  4. Stenotrophomonas maltophilia
18
Q

Allergic bronchopulmonary aspergillosis

  1. pathogenesis
  2. management
A

Pathogenesis:

  1. Exposure to aspergillus fumigatus
  2. Hypersensitivity reaction (type 1 and type 3)

Management

  1. Treat with steroids
    - if ongoing symptoms and high IgE
19
Q

Approach to CXR

A
  1. ABCDE
    • Airway
    • Breathing
    • Circulation
    • Disability/bones
    • Everything else eg. Phneumoperitoneum
  2. ABCD Review
    • Apices
    • Behind diaphragm
    • Cardiac shadow
    • Diaphragm
    • Edges
      • Peripheral Lung
      • Hilar Lung
20
Q

CXR Veil sign

A

Veil Sign

  1. Left upper collapse
  2. Raised hemi-diaphragm
  3. Increased whiteness
21
Q

Describing location on CXR

A

CXR Location

  1. Right/Left
  2. Zones
    • Upper
    • Middle
    • Lower
22
Q

A-a oxygen gradient

  1. Definition
  2. Healthy range
A

A-a oxygen gradient

  1. Definition
    • PAO2: Alveolar
    • PaO2: Arterial
  2. Healthy range
    • Less than 2kPa in young people or 4 in older
    • > 4kPa implies lung pathology
23
Q

CF diagnosis criteria

A

CF diagnosis

  1. Genetic: sibling or newborn screening
  2. Sweat test
    • > 60mmol/l increased sweat chloride
  3. Presentations
    • Meconium ileus
    • Intestinal malabsorption (pancreatic enzymes)
    • Recurrent chest infections
  4. Screening
24
Q

DIOS

  1. Cause
  2. Dx
  3. Mx
A

Distal intestinal obstruction syndrome

  1. Cause
    • Faecal obstruction at illeo-cecal junction
    • Insufficient pancreatic enzymes
    • Salt deficiency
  2. Dx
    • RIF mass
    • AXR
  3. Mx
    • PO Gastrografin (osmotic agent)
25
CF Medical management
CF Medical management 1. Mucolytic - Pulmozyme (nebulised DNase) 2. Pancreatic enzyzme replacement therapy - Creon 3. Fat soluble multivitamins 4. LT ABx - Inhaled/news 5. Insulin
26
Pneumothorax types
Pneumothorax types ``` 1. Mechanism Spontaneous - Primary spontaneous - Secondary spontaneous Traumatic - Iatrogenic ``` ``` 3. Severity Tension - Emergency - Breach in lung - Air escapes from lung to pleura - Air cannot escape from pleura to lung Non-tension ```
27
Effusions 1. Classes 2. Causes
Transudate effusions 1. HF 2. Chirosis 3. Hypoalbuminaemia 4. Hypothyroid 5. PE 6. Mitral stenosis 7. SVCO Exudate 1. Malignancy 2. Infection 3. Inflammation - RA - Pancreatitis - Lymphatic/connective tissue 4. Drugs, fungi, yellow nail syndrome
28
Light’s Criteria
Light’s Criteria 1. <25g/L protein - Transudate ``` 2. 25-35 g/L protein Exudate if: - Pleural fluid/serum protein >0.5 - Pleural fluid/Serum LDH >0.6 - Pleural fluid LDH >2/3 of upper normal limit ``` 3. >35g/L protein - Exudate
29
Four common ILDs?
ILDs 1. UIP - Usual interstitial pneumonia 2. NSIP - Non-specific interstitial pneumonia 3. Extrinsic allergic alveolitis 4. Sarcoidosis
30
UIP | - S&S ABCD
Usual interstitial pneumonia A. Reduced chest expansion B Fine inspirations crepitations (basal/ axillary) C. Features of pulmonary hypertension D. Clubbing
31
Extrinsic Allergic Alveolitis 1. Acute vs chronic presentations 2. Common causes
Extrinsic Allergic Alveolitis ``` 1. Acute vs chronic presentations Acute - Hours after exposure - Usually reversible - Self limiting in 1-3 days - Can recur Chronic - Chronic exposure - Less reversible ``` 2. Common causes - Methotrexate - Amiodarone - Bleomycin - Nitrofurantoin - Penicillamine
32
Sarcoidosis 1. Histology 2. Investigation findings
Sarcoidosis 1. Histology - Non-caseating granulomas - Respiratory system and/or all organs - Immunological 2. Investigation findings - PFTs: Obstructive then fibrotic - CXR: 4 stages i) Lymphadenopathy ii) Visible lymph nodes iii) X ray shadows iv) Fibrotic - ECG, ECHO, MRI
33
Horner’s syndrome: | - Features
Horner’s 1. Miosis 2. Ptosis 3. Anhydrosis 4. Enopthalmos
34
Lung cancer | - Sites for metastasis
Lung metastases 1. Liver 2. Adrenals (addison’s) 3. Bone 4. Pleura 5. CNS
35
Lung cancer | - Three paraneoplastic syndromes
Lung paraneoplastic syndromes 1. HHM Hypercalcaemia - PTHrP - SSC 2. SIADH - SCLC 3. ECS - Ectopic Cushing’s - ACTH - SCLC
36
Sleep Apnoea | - Assessment of tiredness
Epworth Sleepiness Scale - 0 Would never doze - 1 Slight chance - 2 Moderate chance - 3 High chance
37
Sleep Apnoea | - Management
Sleep Apnoea Mx 1. Lifestyle 2. Mandibular advancement devices 3. Nasal CPAP 4. Gastroplasty/bypass/tracheostomy 5. NIV prior to CPAP - In retainers
38
CPAP vs NIV
CPAP - Constant positive pressure NIV - Bi-level of pressure (IPAP and EPAP)
39
Lung Cancer Treatment - Stages I & II - Stages III & IV
Lung Cancer Treatment for Stages I & II 1. Curative surgery Treatment for Stages III & IV 1. Chemotherapy 2. Curative radiotherapy 3. Palliative care 4. Watchful waiting

Year 3 - Medical Block Workbooks (7 decks)

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