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Year 3 - Medical Block Workbooks > Respiratory > Flashcards

Respiratory Flashcards

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USMLE® Step 1 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
Q

CF Medical management

A

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
Q

Pneumothorax types

A

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
Q

Effusions

  1. Classes
  2. Causes
A

Transudate effusions

  1. HF
  2. Chirosis
  3. Hypoalbuminaemia
  4. Hypothyroid
  5. PE
  6. Mitral stenosis
  7. SVCOExudate
  8. Malignancy
  9. Infection
  10. Inflammation
    • RA
    • Pancreatitis
    • Lymphatic/connective tissue
  11. Drugs, fungi, yellow nail syndrome
28
Q

Light’s Criteria

A

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
  1. > 35g/L protein - Exudate
29
Q

Four common ILDs?

A

ILDs

  1. UIP
    • Usual interstitial pneumonia
  2. NSIP
    • Non-specific interstitial pneumonia
  3. Extrinsic allergic alveolitis
  4. Sarcoidosis
30
Q

UIP

- S&S ABCD

A

Usual interstitial pneumonia

A. Reduced chest expansion

B Fine inspirations crepitations (basal/ axillary)

C. Features of pulmonary hypertension

D. Clubbing

31
Q

Extrinsic Allergic Alveolitis

  1. Acute vs chronic presentations
  2. Common causes
A

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
  1. Common causes
    • Methotrexate
    • Amiodarone
    • Bleomycin
    • Nitrofurantoin
    • Penicillamine
32
Q

Sarcoidosis

  1. Histology
  2. Investigation findings
A

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
Q

Horner’s syndrome:

- Features

A

Horner’s

  1. Miosis
  2. Ptosis
  3. Anhydrosis
  4. Enopthalmos
34
Q

Lung cancer

- Sites for metastasis

A

Lung metastases

  1. Liver
  2. Adrenals (addison’s)
  3. Bone
  4. Pleura
  5. CNS
35
Q

Lung cancer

- Three paraneoplastic syndromes

A

Lung paraneoplastic syndromes

  1. HHM Hypercalcaemia
    • PTHrP
    • SSC
  2. SIADH
    • SCLC
  3. ECS
    • Ectopic Cushing’s
    • ACTH
    • SCLC
36
Q

Sleep Apnoea

- Assessment of tiredness

A

Epworth Sleepiness Scale

- 0 	Would never doze
- 1 	Slight chance
- 2 	Moderate chance
- 3 	High chance
37
Q

Sleep Apnoea

- Management

A

Sleep Apnoea Mx

  1. Lifestyle
  2. Mandibular advancement devices
  3. Nasal CPAP
  4. Gastroplasty/bypass/tracheostomy
  5. NIV prior to CPAP
    • In retainers
38
Q

CPAP vs NIV

A

CPAP
- Constant positive pressure

NIV
- Bi-level of pressure (IPAP and EPAP)

39
Q

Lung Cancer Treatment

- Stages I & II
- Stages III & IV
A

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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