Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine Finals: HARD STUFF ONLY > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are symptoms of pulmonary fibrosis?

A

SOB
DRY cough
Fatigue
Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are signs of pulmonary fibrosis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is seen on CXR in pulmonary fibrosis?

A

Widespread infiltrates, interstital shadowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is seen on CT in pulmonary fibrosis?

A

Ground glass opacification, honeycombing, mosaicism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What drugs cause pulmonary fibrosis?

A

MADNEsS

Methotrexate
Amiodarone
Dopamine agonists
Nitrofurantoin
Sulfasalazine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is seen on ECG in pulmonary HTN?

A

P mitrale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is aspiration pneumonia treated?

A

IV Cephalosporin + IV Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is seen on CXR in lung cancer?

A

Nodule
Pleural effusion
Consolidation
Hilar lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where do you aspirate a pneumothorax?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where do you place a chest drain?

A

5th intercostal space mid-axillary line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where do you decompress a tension pneumothorax?

A

Wide bore cannula 2nd intercostal space mid clavicular line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which malignancies are most likely to cause pleural effusions?

A

Adenocarcinoma

Mesothelioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are side effects of pyrazinamide?

A

Hyperuricaemia leading to gout

Liver toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are features of Kartagener’s syndrome?

A 
Complete situs invertus
Bronchiectasis
Recurrent sinusitis
Subfertility
Right testicle hangs lower
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is a NSCLC managed?

A

Lobectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is a SCLC managed?

A

Palliative chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What can raised amylase on pleural aspirate suggest?

A

Pancreatitis

Oesophageal perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What can heavy blood staining on pleural aspirate suggest?

A

Mesothelioma
TB
PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the management of obstructive sleep apnoea?

A

CPAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How can sleepiness be assessed in obstructive sleep apnoea?

A

Epworth sleepiness scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How and when can you step down asthma management?

A

If a patient has not had to use their salbutamol can trial stepping down steroids by 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the most common cause of pneumonia after a recent influenza infection?

A

Staph aureus

32
Q

How to decide what type of oxygen to give?

A

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
Q

What causes tracheal deviation TOWARDS problem?

A

Pneumonectomy
Lung collapse
Lung hypoplasia

34
Q

What causes tracheal deviation AWAY from problem?

A

Tension pneumothorax

massive pleural effusion

35
Q

When should you consider azithromycin prophylactically in patients with COPD?

A

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
Q

What advice must you give someone post-pneumothorax?

A
  • Stop smoking
  • No scuba diving for life
  • No flying for 1 week post check x-ray
37
Q

What to consider when a young person presents with COPD symptoms?

A

Alpha-1 anti-trypsin

38
Q

How much does spirometry need to improve by for a diagnosis of asthma?

A

12%

39
Q

What medication can be used to prevent altitude sickness?

A

Acetozolamide

40
Q

Why can the chest become hyper-resonant in an acute asthma attack?

A

Air trapped in narrow airways

41
Q

How does Klebsiella pneumonia appear on XR?

A

cavitating lesions in the upper zone

42
Q

How much prednisolone is it safe for breastfeeding women to take?

A

Up to 40mg daily

43
Q

How to differentiate type of compensation from an ABG?

A

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
Q

What are contraindications to chest drain insertion?

A

INR > 1.3
Platelet count <75
Pulmonary bullae
Pleural adhesions

45
Q

Why does type 1 respiratory failure occur?

A

Ventilation-perfusion mismatch (V/Q mismatch)

Asthma, congestive heart failure, PE, pneumonia, pneumothorax

46
Q

Why does type 2 respiratory failure occur?

A

Alveolar hypoventilation

COPD, pulmonary fibrosis, opiates, neuromuscular disease

47
Q

When is oxygen given in an acute asthma exacerbation and what oxygen is given?

A

If sats drop below 94%

15L via non-rebreather mask

48
Q

Common infective organisms in those with cystic fibrosis?

A

Strep pneumonia
H influenzae
P aeruginosa
Burkholderia cepacia

49
Q

Risk factors for obstructive sleep apnoea

A 
Obesity
Acromegaly
Enlarged tonsils
Nasal polyps
Alcohol
50
Q

Risk factors for lung cancer

A 
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
Q

Causes of bronchiectasis

A 
CF
Kartagener’s
Lung cancer
Allergic bronchopulmonary aspergillosis
TB
52
Q

Should you insert a chest drain above or below the rib and why?

A

ABOVE the rib - due to avoiding the neurovascular bundle immediately beneath the ribs.

53
Q

What are indications for long term oxygen in COPD?

A

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
Q

Causes of pulmonary HTN?

A 
COPD
Asthma
Interstitial lung disease
Bronchiectasis
Cystic fibrosis
55
Q

Pulmonary causes of clubbing?

A

Lung cancer
Bronchiectasis
Pulmonary fibrosis

56
Q

Where does lung cancer most commonly metastasise?

A

Brain
Breast
Bone
Adrenals

57
Q

Biopsy: TB vs. Sarcoidosis

A 
TB = caseating granuloma
Sarcoidosis = non-caseating granuloma
58
Q

How does acute sarcoidosis present?

A

Erythema nodosum
Bilateral hilar lymphadenopathy – dry cough, SOB
Polyarthralgia
Fever

59
Q

How does chronic sarcoidosis present?

A

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
Q

Which pleural effusions need draining with a chest drain?

A

If the fluid is purulent or turbid/cloudy

if the fluid is clear but the pH is less than 7.2

61
Q

What is the 2WW criteria for lung cancer?

A

Any age with CXR findings suggestive of lung cnacer

>40 with unexplained haemoptysis

62
Q

What are features of granulomatosis with polyangitis? (Wegener’s)

A 
Kidney and respiratory tract problems
Chronic sinusitis
Epistaxis
Saddle-nose deformity
Cough
Haemoptysis
Pleuritic
Haematuria
Proteinuria
63
Q

What paraneoplastic syndromes are associated with small cell lung cancer?

A

Cushing’s

SIADH –> Hyponatraemia

Lambert-Eaton

64
Q

What paraneoplastic syndromes are associated with squamous cell carcinoma?

A

Raised PTH mimic –> Hypercalcaemia

HPOA

65
Q

What paraneoplastic syndromes are associated with adenocarcinoma?

A

Gynaecomastia

HPOA

66
Q

4 examples of extrinsic allergic alveolitis?

A

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
Q

What is the most common cause of pneumoconiosis and what does it cause?

A

Coal workers pneumoconiosis

leads to upper lobe fibrosis

68
Q

What is Allergic bronchopulmonary aspergillosis, what marker is it associated with and how is it managed?

A

Allergy to Aspergillus spores

Eosinophilia

Management = oral prednisolone

69
Q

What is re-expansion pulmonary oedema?

A

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
Q

What are options for smoking cessation?

A

NRT
Varenicline
Bupropion

71
Q

What are side effects of NRT?

A

Nausea and vomiting
Headache
Flu-like symptoms

72
Q

What is the most common SE of Varenicline and when should it be avoided?

A

SE: Nausea
CI: Pregnancy, history of depression or self harm

73
Q

What is the main SE of Bupropion?

A

Increased risk of seizures - avoid in those with epilepsy

Also CI in pregnancy

74
Q

When should you consider NIV in someone with an acute COPD exacerbation/

A

Hypoxia + pH <7.35

75
Q

What are the asthma diagnostic criteria?

A 
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions