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things i don't know, but need to know, for fourth year > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What antibiotic is used in P.Jirovecci

A

Co-trimoxazole

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2
Q

Legionella

A

Flu + Dry Cough
Bradychardia
Confusion
Hyponaetramia

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3
Q

What is the antibiotic of choice in Legionella Pneumonia

A

Macrolides

Azithromycin and Erythromicin

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4
Q

How is Legionella diagnosed

A

Urinary Antigen

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5
Q

What is offered to a COPD patient with recurrent infections?

A

Azithromycin prophylaxis

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6
Q

In a viral induced wheeze what is prescribed?

A

First Line - SABA

Second Line - ICS or Oral Montelukast

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7
Q

In a multiple trigger wheeze what is prescribed?

A

A trial of a ICS or Oral Montelukast for 4-6 weeks

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8
Q

In a secondary pneumothorax <1cm what is the management?

A

Admission and Oxygen

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9
Q

If you have an acute exacerbation in a COPD. What are the indications for using non invasive ventilation?

A

Despite receiving adequate treatment they have a Respiratory Acidosis of 7.25-7.35.

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10
Q

What non invasive ventilation is used first line in acidotic COPD patients?

A

Bi-PAP

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11
Q

What is Klebsiella linked to?

A

Development of an empyema

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12
Q

When can a COPD patient receive Long Term Oxygen Therapy?

A

Stopped Smoking

Over two separate occasions pO2 <7.3

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13
Q

Management of Acute Bronchitis

A

Guided by CRP
20-100 Delayed Amoxicillin or doxycycline prescription
>100 - Immediate Amoxicillin or Doxycycline prescription

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14
Q

Upper Zone Fibrosis

A 
Coal
Sarcoidosis
Silicon
Ankylosing Spondylitis
TB
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15
Q

Lower Zone Fibrosis

A

Idiopathic Pulmonary Fibrosis
Connective Tissue Disorders
Drugs induced - bleomycin amiodarone
Asbestosis

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16
Q

If Emphysema is located mainly in the upper lungs what is the likely cause?

A

COPD

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17
Q

If emphysema is located mainly in the lower lobes what is the likely cause?

A

Alpha 1 Anti Trypsin deficiency

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18
Q

Treatment for Alpha 1 Anti trypsin Deficiency

A 
Bronchodilator
Physiotherapy
IV A1AT protein
Lung volume reduction surgery
Transplant
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19
Q

If someones Wells PE score is over 4 what does this mean?

A

A PE is likely - CTPA should be done ASAP

If there is a delay with the CTPA a DOAC should be started.

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20
Q

If someones WELLs score comes back less than four what does this mean?

A

PE is unlikely - D-Dimer is indicated to rule it out completely.

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21
Q

WELLs score of less than 4 but D-Dimer is +ve

A

CTPA is indicated - if delay in getting DOAC should be started

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22
Q

What is indicated in all patients with a suspected PE?

A

Chest X-Ray to rule out other pathology

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23
Q

WELLs score of less than 4 and a -ve D-Dimer

A

PE is ruled out stop anticoagulation if started and look for alternative.

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24
Q

If someones WELLs score is over 4 but their CTPA shows no signs what is the next investigation to undertake?

A

Doppler for DVT

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25
Q

Criteria for Bi PAP use in COPD

A

Persistent Respiratory Acidosis 7.25-7.35 despite tailored oxygen therapy.

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26
Q

Gynaecomastia

Hypertrophic pulmonary osteoarthropathy

A

Adenocarcinoma

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27
Q

SIADH
Ectopic ACTH
Lamberton Eaton sydrome

A

Small Cell Carcinoma

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28
Q

Clubbing

Hypercalcaemia (pPTH)

A

Squamous Cell Carcinoma

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29
Q

If someone has had a PE which has a trigger i.e recent surgery. How long should they be anticoagulated ?

A

3 months DOAC

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30
Q

If someone has an unprovoked PE how long should they be anti coagulated for?

A

6 months DOAC

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31
Q

When is Heparin and warfarin used in a PE?

A

Contraidicated

Or eGFR <15 - LMWH is used to bridge warfarin cover

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32
Q

CAP - CURB65 = 0 - 2

A

Amoxicillin Oral
Pen allergy Doxycycline
5 days

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33
Q

CAP CURB65 = 3 - 5

A

IV Co Amoxiclav + Oral Doxycycline
Pen allergic - levofloxacin mono therapy
5 days

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34
Q

CAP - ICU or HDU

A

IV Co-Amoxiclav + Clarithromycin
Stepping down to Doxycycline
Pen allergy - Levofloxacin monotherapy
5 days

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35
Q

HAP - Non Severe

A

Amoxicillin 5 days

Pen allergy = doxycycline

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36
Q

HAP - Severe

A

IV Amoxicillin + Gentamicin
Pen allergy = Co trimoxazole + Gentamicin
Step Down therapy is Oral Co Trimoxazole
7 days

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37
Q

Aspiration Pneumonia - Non severe

A

Oral Amoxicillin + Metronidazole
Pen allergy - Doxycycline + metronidazole
5 days

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38
Q

Aspiration Pneumonia - Severe

A

IV Amoxicillin + Metronidazole + Gentamicin
Pen allergy - either doxycycline or clarithromycin
7 days

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39
Q

What are the indications for Antibiotic use in a COPD exacerbation?

A

Purulent Sputum

No purulent sputum but consolidation on X-Ray

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40
Q

Antibiotics in acute exacerbation of COPD

A

1st line Amoxicillin

2nd line Doxycycline

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41
Q

A dry cough +/- haemoptysis
Chest x ray shows a cresenteric lesion
past medical history of cavitating lesion

A

Aspergilloma

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42
Q

What can pre dispose you to an aspergilloma?

A

TB
Sarcoid
Bronchiectasis
Anklysoing spondylitis

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43
Q

What investigations should be undertaken in a query aspergilloma?

A

Chest Xray

High titre aspergillose precipitant

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44
Q

<6mm Mantoux test

A

Unlikely infection or vaccination.

Can administer BCG if required

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45
Q

6 - 15mm Mantoux test

A

Likely TB or BCG vaccination

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46
Q

> 15mm

A

Extremely likely TB infection

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47
Q

A1AT - obstructive or restrictive?

A

Obstructive present similarly to COPD

48
Q

Pleural effusion - Protein >30g

A

Exudate - think malignancy infection PE etc

49
Q

Pleural Effusion - Protein <30g

A

Transudate - HF, Cirrhosis Nephrotic syndrome

50
Q

Other signs pleural effusion is due to an exudate.

A

Increased LDH - Pleural LDH is over 2/3 of normal plasma LDH

Pleural Protein / Serum protein = > 0.5

51
Q

Pleural effusion in Rheumatoid Arthritis or TB

A

Low glucose

52
Q

Pleural effusion in pancreatitis or oesophageal perforation

A

Raised amylase

53
Q

Diagnosis of asthma.

A

<5 years - clinical diagnosis only
6-17 years - Spirometry and Bronchodilator reversibility test
>18 - Spirometry Bronchodilator reversibility test and FeNO

54
Q

When is a bronchodilator reversibility test positive. Indicating asthma is likely?

A

If FEV1 increase by 12% or more

55
Q

When might you use the FeNO test in someone aged 6-17?

A

If you have a strong clinical suspicion and reasoning but the other tests have come back negative.

56
Q

Someone with a label of recent onset asthma has signs of eosinophilia and bronchiectasis what should be on your mind?

A

Allergic Bronchopulmonary Aspergillus - Increased IgE Aspergillus +ve

57
Q

How is allergic bronchopulmonary aspergillosis managed?

A

Oral glucocorticoids -> Itraconazol

58
Q

ABG in panic attack

A

Respiratory Alkalosis
Low CO2
Normal O2 and HCO3

59
Q

Contraindication to surgical management of lung cancer

A

SVC obstruction
Vocal chord paralysis
FEV1 <1.5l
Malignant pleural effusion

60
Q

What investigation is diagnostic of Sleep Apnoea

A

Polysomnography

61
Q

Idiopathic Pulmonary Fibrosis - Diagnosis and Management

A

Spirometry -> reduced gas exchange transfer factor (TLCO) -> high resolution CT

Pulmonary rehab -> pirfenidone -> lung transplant

62
Q

Management of pneumonia with a CURB65 of 0

A

Antibiotics at home

63
Q

COPD management

A
  1. SABA or SAMA
  2. Asthmatic - ICS + LABA + SABA ( replaced SAMA)
    Non Asthmatic - SABA (replaced SAMA) + LABA + LAMA
  3. SABA + LABA + LAMA + ICS
64
Q

If someone has developed HAP after day 5 in hospital what antibiotics are required?

A

Piperacillin and Tazobactam
or Ceftazadime
or Ciprofloxacin
Needs to cover pseudomonas

65
Q

How long between each inhaler dose?

A

30 seconds

66
Q

PEFR 50-75%
Normal speech
RR <25
Pulse<110

A

Moderate asthma

67
Q

PEFR 33-50%
Cant complete a sentence
RR >25
>110bpm

A

Severe asthma attack

68
Q 
PEFR <33%
<92% sats
Silent chest
Bradychardia Hypotension 
Confusion
Normal pCO2
A

Life threatening

69
Q

Increased pCO2

Mechanical ventilation required

A

Near fatal

70
Q

When should an ABG be undertaken in acute asthma?

A

If oxygen sats <92%

71
Q

Indications for a chest xray in asthma

A

Life threatening exacerbation
Pneumothorax
Failure to respond to management

72
Q

Bordatella pertusis - diagnosis and management

A

Whooping cough + post coughing vomiting + subconjunctival haemorrhage
Nasal swab for diagnosis

Macrolides given + close house hold prophylaxis
Vaccine for 16-32 weeks pregnant
Admit if under 6 months
Start school 48hrs after antibiotics

73
Q

Mesothelioma - diagnosis

A

X ray -> Pleural CT -> Pleural aspirate -> Thoracoscopy + histology

74
Q

Acute - Dyspnoea Dry cough and fever
Chronic - Lethargy dyspnoea productive cough anorexia
Farmer, bird keeper, mushroom picker

A

Extrinsic Allergic Alveolitis
Type III hypersensitivity
Avoid allergy + oral glucocorticoids

75
Q

Diagnosis of Extrinsic Allergic Alveolitis

A

Chest Xray -> upper and mid zone fibrosis
Bronchealveolar lavage -> lymphocytosis
Bloods - IgG and no eosinophils

76
Q

How is latent TB managed?

A

Rifampicin + Isoniazide for 3 months
or
Isoniazide for 6 months

77
Q

What medication is given to all people suffering with an acute exacerbation of COPD regardless of whether they qualify for antibiotics?

A

30mg Prednisolone for 5 days

78
Q

Staging COPD

A

COPD is a FEV1/FVC ratio of <0.7

Stage 1 is mild = >80% predicted FEV1
Stage 2 is moderate = 50% - 79% predicted FEV1
Stage 3 is severe = 30% - 49% predicted FEV1
Stage 4 is V.Severe = <30% predicted FEV1

79
Q

What are some characteristics that might point you more towards a Strep Pneumonia as a cause of pneumonia?

A

Reactivation of cold sores

Rust coloured sputum

80
Q

What conditions affecting the lungs can cause an increased Transfer Coefficient ?

A

Scoliosis
Pneumonectomy
Neuromuscular weakness
Ankylosing spondylitis

81
Q

What lung conditions increase the TLCO?

A

Asthma

Pulmonary Haemorrhage

82
Q

Alongside Co Trimoxazole what should be used in Pneumocytis Jiroveci Pneumonia?

A

Steroids if hypoxic

83
Q

Long term mechanical ventilation places you at risk of.

A

Tracheal Oesophageal Fistula -> aspiration pneumonia

84
Q

Someone develops dyspnoea and hypoxemia 72 hours post surgery

A

Atelectasis - alveolar collapse -> shows opaque area

Sit upright and chest physio

85
Q

What is the first thing you should do in anyone who is breathless?

A

Sit upright

86
Q

When starting asthma management. What should be considered if they report a persistent night time cough keeping them up at night.

A

Start on SABA + ICS

87
Q

Type 1 pneumothorax + <2cm rim and no symptom

A

Discharge

88
Q

Type 1 pneumothorax + >2m rim and symptoms

A

Chest drain

89
Q

Type 1 Pneumothorax + <2cm rim + symptoms

A

Aspirate

90
Q

Secondary Pneumothorax + <1cm rim and no symptoms

A

Admit for 24 hours and oxygen

91
Q

Secondary Pneumothorax + >2cm rim + SOB

A

Chest drain

92
Q

Secondary Pneumothorax + 1-2cm + Symptoms

A

Aspirate

93
Q

Advice post pneumothorax

A

NEVER scuba dive

Fly 1 week post Xray check

94
Q

What are some indications for chest drain removal

A

Pneumothorax - if no longer spontaneously bubbles or coughing doesn’t cause bubbles
Pleural effusion - if drain has been dry for 24 hours

95
Q

If someone develops worsening SOB and cough post chest drain insertion what might be happening?

A

Re expansion pulmonary oedema - clamp the drain and send for xray

96
Q

Management of Non small cell lung cancer

A

1st line - curative lobectomy
Curative radiotherapy is offered for Stage I, II, III
Palliative Chemotherapy is offered for Stage III, IV

97
Q

Management of Small Cell Lung cancer

A

Generally just palliative chemotherapy

98
Q

Contraindications to curative lobectomy in lung cancer

A

FEV1 <1.5
Vocal chord paralysis
Metastatic disease
SVC obstruction

99
Q

Management of pleural plaques

A

X ray
No further investigations required
Often asymptomatic and no malignant potential

100
Q

Management of sarcoid

A

Generally just symptomatic - NSAIDs paracetamol etc
Steroids if - Neuro/cardio/renal/hepatic/splenic/ocular involvement
- worsening pulmonary function
-Hypercalcaemia
-Lupus pernio

101
Q

Life Threatening Asthma

A 
PEFR < 33% best or predicted
Oxygen sats < 92%
'Normal' pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
102
Q

Severe Asthma

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

103
Q

Moderate

A

PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm

104
Q

Long term oxygen therapy in COPD

A 
pO2 Kpa 7.3-7.8
\+ 1 off the following 
Polycythaemia
Peripheral oedema 
Pulmonary hypertension
105
Q

Allergic Bronchopulmary Aspergillosis management

A

Reducing prednisilone course

+/- Itraconazole

106
Q

TB diagnosis

A

3 early morning sputum tests +ve for acid fast bacilli

+ history

107
Q

Diagnostic of mycoplasma pneumonia

A

Urine Serology

108
Q

Commonest cause of occupational asthma

A

Isocyonate

109
Q

Latent TB management

A

6 months Isoniazide + pyroxidine
3 months Isoniazide + pyroxidine + rifampicin
Pyroxidine is Vitamin B6

110
Q

A diurnal variation could indicate what in the context of COPD?

A

> 20% over the day is indicative of asthmatic features.

Include ICS in management.

111
Q

What is a 1 pack year?

A

20 cigarettes a day for a year.

So 40 cigarettes is 2 pack years and 30 is 1.5 pack years

112
Q

Causes of type II respiratory failure

A 
COPD
Brain lesion
Bronchitis
MND
Deformity - scoliosis etc
113
Q

Causes of type I respiratory failure

A 
Ventilation perfusion mismatch 
Patent shunt
Pneumonia
ARDS
PE
114
Q

How does acute TB usually present on X ray

A

Patchy opacification across both upper zones

115
Q

PE management at initial presentation

A

General history and examination
Chest Xray to exclude other causes
Calculate WELLs score

116
Q

Indications for a thoracotomy

A

1.5L of blood removed initially
or
>200ml still draining an hour

things i don't know, but need to know, for fourth year (31 decks)

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