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Medicine Finals: HARD STUFF ONLY > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

What are symptoms of pulmonary fibrosis?

A

SOB
DRY cough
Fatigue
Weight loss

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2
Q

What are signs of pulmonary fibrosis?

A

End-inspiratory crackles (bibasal)
Clubbing
Cyanosis
Reduced chest expansion

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3
Q

What is seen on CXR in pulmonary fibrosis?

A

Widespread infiltrates, interstital shadowing

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4
Q

What is seen on CT in pulmonary fibrosis?

A

Ground glass opacification, honeycombing, mosaicism

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5
Q

What drugs cause pulmonary fibrosis?

A

MADNEsS

Methotrexate
Amiodarone
Dopamine agonists
Nitrofurantoin
Sulfasalazine
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6
Q

What are causes of ARDS?

A 
Pulmonary causes of ARDS:
Sepsis
Aspiration
Pulmonary contusion (bruise in or on lungs – caused by force to the chest)
TRALI

Non-pulmonary causes:
Non-chest sepsis
Acute pancreatitis
DIC
Drug overdose
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7
Q

What is the stepwise management of asthma?

A
  1. SABA
  2. Add daily low dose ICS
  3. Add montelukast
  4. LABA
  5. Increase dose of ICS
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8
Q

What is the staging of COPD?

A 
By FEV1
Stage 1 = >80%
Stage 2 = 50-79%
Stage 3 = 30-49%
Stage 4 = <30%
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9
Q

What is seen on ECG in pulmonary HTN?

A

P mitrale

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10
Q

How do you determine the management of pneumonia?

A

CURB65 or CRB65 (in general practice)

Confusion
Urea > 7
RR > 30
BP systolic <90 or diastolic <60
>65

If CURB65 of 0/1 and CRB65 of 0 = Oral Amoxicillin/Doxy/macrolide
If CURB65 of 2 or CRB65 of ½ = 2 Antibiotics
If CURB65 of 3-5 or CRB65 ¾ - Admit for IV Co-Amox + Another oral

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11
Q

How is aspiration pneumonia treated?

A

IV Cephalosporin + IV Metronidazole

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12
Q

What is seen on CXR in lung cancer?

A

Nodule
Pleural effusion
Consolidation
Hilar lymphadenopathy

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13
Q

What is seen on ECG in PE?

A

Sinus tachycardia

S1Q3T3
Deep S in lead I
Pathological Q in lead III
Inverted T in lead III

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14
Q

Where do you aspirate a pneumothorax?

A

16-18G cannula placed in the 5th intercostal space mid-clavicular line.

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15
Q

Where do you place a chest drain?

A

5th intercostal space mid-axillary line

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16
Q

Where do you decompress a tension pneumothorax?

A

Wide bore cannula 2nd intercostal space mid clavicular line

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17
Q

How to analyse pleural effusion fluid analysis?

A

Protein (g/L) > 35 = Exudative, <25 = Transudative.

If between 25-35.. Light's criteria:
Exudative if meets one of these criteria
1) Pleural protein:Serum protein >0.5
2) Pleural LDH:Serum LDH >0.6
3) Pleural LDH >2/3 upper limit for serum LDH
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18
Q

Which malignancies are most likely to cause pleural effusions?

A

Adenocarcinoma

Mesothelioma

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19
Q

What are side effects of pyrazinamide?

A

Hyperuricaemia leading to gout

Liver toxicity

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20
Q

What are features of Kartagener’s syndrome?

A 
Complete situs invertus
Bronchiectasis
Recurrent sinusitis
Subfertility
Right testicle hangs lower
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21
Q

What is atelectasis? How does it present?

A

Basal alveolar collapse
Common post-operative complication
Dyspnoea + Hypoxia at around 72 hrs post -op

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22
Q

What is correct inhaler technique?

A

1) Remove cap and shake
2) Breathe out gently
3) Put mouthpiece in mouth, as you begin to breathe in , slow and deep, press canister down and continue to inhale steadily
4) Hold breath for 10 seconds
5) For a second dose wait for approx 30 seconds

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23
Q

When to use CPAP vs. BiPAP?

A

BiPAP is used in T2RF - eg in a COPD exacerbation
Helpful in COPD patients who retain CO2

CPAP is used in cardiogenic pulmonary oedema eg Heart failure which has not responded to Furosemide
Also used in hypoxia, pneumonia and obstructive sleep apnoea

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24
Q

How is a NSCLC managed?

A

Lobectomy

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25
How is a SCLC managed?
Palliative chemo
26
What can raised amylase on pleural aspirate suggest?
Pancreatitis | Oesophageal perforation
27
What can heavy blood staining on pleural aspirate suggest?
Mesothelioma TB PE
28
What is the management of obstructive sleep apnoea?
CPAP
29
How can sleepiness be assessed in obstructive sleep apnoea?
Epworth sleepiness scale
30
How and when can you step down asthma management?
If a patient has not had to use their salbutamol can trial stepping down steroids by 50%
31
What is the most common cause of pneumonia after a recent influenza infection?
Staph aureus
32
How to decide what type of oxygen to give?
Critically ill? - Yes - 15L NRM Not critical - any conditions predisposing them to T2RF? - Yes - Venturi lowest dose to maintain 88-92% - No - Nasal cannual lowest dose to maintain 94-98%
33
What causes tracheal deviation TOWARDS problem?
Pneumonectomy Lung collapse Lung hypoplasia
34
What causes tracheal deviation AWAY from problem?
Tension pneumothorax | massive pleural effusion
35
When should you consider azithromycin prophylactically in patients with COPD?
If they... * do not smoke and * have optimised non-pharmacological management and inhaled therapies, relevant vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and continue to have 1 or more of the following, particularly if they have significant daily sputum production: * frequent (typically 4 or more per year) exacerbations with sputum production * prolonged exacerbations with sputum production * exacerbations resulting in hospitalisation.
36
What advice must you give someone post-pneumothorax?
* Stop smoking * No scuba diving for life * No flying for 1 week post check x-ray
37
What to consider when a young person presents with COPD symptoms?
Alpha-1 anti-trypsin
38
How much does spirometry need to improve by for a diagnosis of asthma?
12%
39
What medication can be used to prevent altitude sickness?
Acetozolamide
40
Why can the chest become hyper-resonant in an acute asthma attack?
Air trapped in narrow airways
41
How does Klebsiella pneumonia appear on XR?
cavitating lesions in the upper zone
42
How much prednisolone is it safe for breastfeeding women to take?
Up to 40mg daily
43
How to differentiate type of compensation from an ABG?
if pH is normal but on lower side of normal = kidneys compensated for respiratory acidosis If pH is normal but on higher side of normal = lungs compensated for metabolic alkalosis
44
What are contraindications to chest drain insertion?
INR > 1.3 Platelet count <75 Pulmonary bullae Pleural adhesions
45
Why does type 1 respiratory failure occur?
Ventilation-perfusion mismatch (V/Q mismatch) | Asthma, congestive heart failure, PE, pneumonia, pneumothorax
46
Why does type 2 respiratory failure occur?
Alveolar hypoventilation | COPD, pulmonary fibrosis, opiates, neuromuscular disease
47
When is oxygen given in an acute asthma exacerbation and what oxygen is given?
If sats drop below 94% | 15L via non-rebreather mask
48
Common infective organisms in those with cystic fibrosis?
Strep pneumonia H influenzae P aeruginosa Burkholderia cepacia
49
Risk factors for obstructive sleep apnoea
``` Obesity Acromegaly Enlarged tonsils Nasal polyps Alcohol ```
50
Risk factors for lung cancer
``` Smoking (tobacco and cannabis) Passive smoking Occupation exposure (asbestos, silica, welding fumes, coal) HIV Organ transplantation Radiation exposure (X-ray, gamma rays). Beta-carotene supplements in smokers. ```
51
Causes of bronchiectasis
``` CF Kartagener’s Lung cancer Allergic bronchopulmonary aspergillosis TB ```
52
Should you insert a chest drain above or below the rib and why?
ABOVE the rib - due to avoiding the neurovascular bundle immediately beneath the ribs.
53
What are indications for long term oxygen in COPD?
PaO2 < 7.3 on two readings more than 3 weeks apart
 paO2 7.3-8 plus one of: 
Nocturnal hypoxia, polcythaemia, peripheral oedema, pulmonary HTN 
 PATIENT NEEDS TO BE A NON-SMOKER
54
Causes of pulmonary HTN?
``` COPD Asthma Interstitial lung disease Bronchiectasis Cystic fibrosis ```
55
Pulmonary causes of clubbing?
Lung cancer Bronchiectasis Pulmonary fibrosis
56
Where does lung cancer most commonly metastasise?
Brain Breast Bone Adrenals
57
Biopsy: TB vs. Sarcoidosis
``` TB = caseating granuloma Sarcoidosis = non-caseating granuloma ```
58
How does acute sarcoidosis present?
Erythema nodosum Bilateral hilar lymphadenopathy – dry cough, SOB Polyarthralgia Fever
59
How does chronic sarcoidosis present?
Pulmonary: cough, Dyspnoea  Systemic: fatigue, weight loss, Arthralgia, fever, lymphadenopathy  Ocular: uveitis, conjunctivitis, optic neuritis  Dermatological: erythema nodosum, lupus pernio (purple rash on face)
60
Which pleural effusions need draining with a chest drain?
If the fluid is purulent or turbid/cloudy | if the fluid is clear but the pH is less than 7.2
61
What is the 2WW criteria for lung cancer?
Any age with CXR findings suggestive of lung cnacer | >40 with unexplained haemoptysis
62
What are features of granulomatosis with polyangitis? (Wegener’s)
``` Kidney and respiratory tract problems Chronic sinusitis Epistaxis Saddle-nose deformity Cough Haemoptysis Pleuritic Haematuria Proteinuria ```
63
What paraneoplastic syndromes are associated with small cell lung cancer?
Cushing's SIADH --> Hyponatraemia Lambert-Eaton
64
What paraneoplastic syndromes are associated with squamous cell carcinoma?
Raised PTH mimic --> Hypercalcaemia HPOA
65
What paraneoplastic syndromes are associated with adenocarcinoma?
Gynaecomastia HPOA
66
4 examples of extrinsic allergic alveolitis?
bird fanciers' lung: avian proteins from bird droppings farmers lung: spores of Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni) malt workers' lung: Aspergillus clavatus mushroom workers' lung: thermophilic actinomycetes*
67
What is the most common cause of pneumoconiosis and what does it cause?
Coal workers pneumoconiosis | leads to upper lobe fibrosis
68
What is Allergic bronchopulmonary aspergillosis, what marker is it associated with and how is it managed?
Allergy to Aspergillus spores Eosinophilia Management = oral prednisolone
69
What is re-expansion pulmonary oedema?
Complication of drainage of pleural effusion Causes pulmonary oedema due to rapid fluid output To prevent - Drain tubing should be clamped regularly - should not exceed 1L of fluid over a short period of time.
70
What are options for smoking cessation?
NRT Varenicline Bupropion
71
What are side effects of NRT?
Nausea and vomiting Headache Flu-like symptoms
72
What is the most common SE of Varenicline and when should it be avoided?
SE: Nausea CI: Pregnancy, history of depression or self harm
73
What is the main SE of Bupropion?
Increased risk of seizures - avoid in those with epilepsy | Also CI in pregnancy
74
When should you consider NIV in someone with an acute COPD exacerbation/
Hypoxia + pH <7.35
75
What are the asthma diagnostic criteria?
``` FeNO > 40 parts per billion Post-bronchodilator improvement of 200ml Post-bronchodilator improvement in Fev1 of 12% Peak flow variability of 20% or more FEV1/FVC ratio <0.7 ```

Medicine Finals: HARD STUFF ONLY (23 decks)

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