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Pocket MSRA - Book 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the most common obstructive lung disease?

A

Asthma
COPD
CF
Bronchiectasis

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2
Q

What is the main finding on examination for obstructive lung disease?

A

Wheeze +/- crackles if added infection

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3
Q

What are the spirometry findings for obstructive lung disease?

A

FEV1:FVC <0.7

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4
Q

What patient factors increase the likelihood of asthma in the case of diagnostic uncertainty?

A

Sx - wheeze, SOB, chest tightness
Diurnal variation
Response to exercise, allergen or cold air
Year-year variation, no progression
Sx after ASA or BB
PHx/FHx atopy/asthma
Widespread wheeze
Low FEV1/PEF during sx (normal at rest)
Eosinophilia
Age onset <20
Normal CXR
Immediate response to bronchodilators

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5
Q

What patient factors lower the likelihood of asthma in the case of diagnostic uncertainty?

A

Prominent dizziness/light headedness/tingling
Chronic productive cough
Lack of wheeze
Sx w/ colds only
Progressively worsening
Change in voice
Cardiac disease
Smoking hx > 20PY
Normal PEF during sx OR abnormal b/w sx
Age onset >40
CXR - hyperinflated lungs
Limited response to bronchodilators

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6
Q

What investigation should be done if there is intermediate probability of asthma?

A

Test for bronchodilator reversibility with spirometry

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7
Q

What % improvement in spirometry should be seen for a diagnosis of asthma?

A

> 15%

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8
Q

What alternative diagnoses might need to be considered?

A

COPD
Eosiniophilic inflammation (bloods, FeNO)
Atopy (IgE)
Methacholine challenge

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9
Q

What is the key feature of occupational asthma?

A

Worse during work, remits when away from work (w/e or holidays)

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10
Q

How should occupational asthma be diagnosed?

A

Peak flow diary to assess trends

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11
Q

What occupations does occupational asthma commonly occur in?

A

Food processors
Animal handlers
Welders
Paint sprayers

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12
Q

What are the treatment steps on the asthma ladder?

A

Step 1 - SABA prn
Step 2 - SABA prn + low-dose ICS maintenance
Step 3 - SABA prn + ICS + LTRA
Step 4 - SABA prn + LABA + ICS (review LTRA)
Step 5 - SABA prn + MART (ICS + LABA) + LTRA

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13
Q

When should patients be moved up or down the asthma ladder?

A

If >/< 3x episodes of sx/week

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14
Q

When should patients be automatically started on Step 2 of the asthma ladder?

A

If sx occuring >3x/week or waking at night in adults >17

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15
Q

What type of drug is Salbutamol and how is it used in asthma management?

A

SABA
Works acutely

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16
Q

What type of drug is Salmeterol and how is it used in asthma management?

A

LABA
Delayed onset
Reduces nocturnal sx

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17
Q

What are the side effects of B2 agonists?

A

Tachycardia
Tremor/anxiety
Cramps
Paradoxical bronchospasm
Hypokalaemia
Hyperglycaemia
Hyperlactataemia

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18
Q

How are steroids used in asthma management?

A

ICS or PO/IV
5-7 in acute flares
Chronic PO if uncontrolled by ICS
Aim to be at lowest dose

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19
Q

What additional protections are required in patients on long-term steroids for asthma management?

A

Bone/GI protection

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20
Q

What are the side effects/risks of steroids in asthma management?

A

Thrush (rinse mouth after usage of ICS)
Adrenal suppression (may need steroid card)
Psychoses (high dose acute treatments)
Reactive leucocytosis BUT immunosuppressed

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21
Q

What are MART inhalers and why are they used?

A

LABA + ICS
Helps w/ comliance

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22
Q

What are LRTAs?

A

Leukotriene receptor antagonists
Montelukast

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23
Q

Why are LRTAs used in asthma management?

A

Additive effect w/ ICS

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24
Q

What are the side effects of LRTAs?

A

Abdo pain
Thirst
Headache
Churg-Strauss syndrome (v. rare)

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25
What are the features of Churg-Strauss syndrome?
Eosinophilia Vasculitic rash Pulmonary-renal syndrome
26
Why is Theophylline given at night?
To prevent morning dipping of PEF
27
Why is Theophylline rarely used in 1o care?
Zero-order kinetics = saturable and metabolised by liver -variation in smokers, liver/heart failures Affected by inducers Narrow therapeutic index
28
What are the features of Theophylline toxicity?
GI upset (N) Tachycardia Seizures Hypokalaemia Hyperglycaemia
29
What type of drug is Sodium Cromoglicate and why is it used in asthma management?
INH mast cell stabilisers Prophylaxis in mild/exercise-induced asthma (esp. paeds)
30
What type of drug is Iptratropium?
SAMA (anticholinergic)
31
What type of drug is Tiatropium?
LAMA (anticholinergic)
32
What type of drug is Omalizumab and why is it used in asthma management?
Anti-IgE Mab Used in persistent allergic asthma in 2o care
33
What type of drug is Mepolizumab and why is it used in asthma management?
Anti-IL5 Mab Used in refractory eosinophilic asthma in 2o care
34
What PEF is seen in a moderate asthma exacerbation?
PEF >50-75%
35
What is the management of a moderate asthma exacerbation?
SABA nebs PO Prednisolone
36
What are the features of a severe asthma exacerbation?
Cannot speak in full sentences HR >110bpm RR >25/min PEFR 33-50%
37
What is the management of a severe asthma exacerbation?
SABA nebulisers PO Prednisolone Consider single dose IV Mg Admit
38
What are the features of a life threatening asthma exacerbation?
Silent chest Confused Cyanotic Bradycardia RR low (exhaustion) PaCO2 raised PEFR <33%
39
What is the management of a life threatening asthma exacerbation?
SABA nebulisers PO Prednisolone IV Mg Admit and likely need ventilatory support SAMA NOT FOR NIV
40
What is the Samter triad?
Asthma Nasal polyp Aspirin sensitivity
41
What drug is contraindicated in sever asthma?
Beta-blockers -10% intolerant
42
What acute respiratory event are asthmatics at increased risk of developing?
Pneumothorax
43
What are the GOLD categories for COPD severity?
Mild - FEV1 >80% Moderate - FEV1 50-79% Severe - FEV1 30-49% V. severe - FEV1 <30%
44
What are the treatment steps on the COPD ladder?
Step 1 - SABA or SAMA Step 2 - LABA + LAMA or ICS (ICS if asthmatic sx or steroid responsiveness, LAMA if neither of these) Step 3 - 3/12 trial of LABA + LAMA + ICS -if no improvement rever to LABA/LAMA
45
Why should ICS not be given alone in COPD?
Increase mortality as risk of pneumonia
46
What are the common side effects of antimuscarinics?
Dry mouth Nausea Headache
47
What are the rare side effects of antimuscarinics?
Constipation Tachycardia Retention Confusion Blurred vision (dilated pupils) Angle-closure glaucoma Hypersensitivity
48
In which patient groups should caution be taken when prescribing antimuscarinics?
BPH and glaucoma prone patients
49
What are the features of anticholinergic toxicity?
Hyperactive delirium (mad as hatter) Mydriasis/reduced vision (blind as bat) Retention (full as flask) Dry skin (dry as bone) Hot to touch (hot as hare) Flushed apperance (red as beet)
50
What additional treatments should be considered in COPD management?
Annual Flu + PC vaccine Pulmonary rehab Mucolytics SMOKING CESSATION LTOT
51
What are the requirements for starting LTOT?
Non-smoker PaO2 <7.3 persistently DESPITE maximum rx OR PaO2 <8 AND evidence of pulmonary HTN (RVH, peripheral oedema), polcythaemia, nocturnal hypoxia OR Palliative
52
What is the immediate management of a COPD exacerbation?
Neb SAMA + SABA Controlled O2 Target SpO2 88-92% Steroids If infective exacerbation - add Amox/Doxy
53
What additional management steps may be required in a severe/refractory COPD exacerbation?
IV Aminophylline loading dose NIV Intubation
54
When should NIV be considered in a COPD exacerbation?
RR >30 pH <7.35 PaCO2 rising despite adequate treatment (T2RF)
55
When should intubation be considered in a COPD exacerbation?
If pH <7.26 PaCO2 rising despite NIV
56
What is the inheritance pattern of cystic fibrosis?
Autosomal recssive
57
Which gene is affected in cystic fibrosis?
Ch7 CFTR
58
What is the carrier rate of the Ch7 CFTR gene in caucasians?
1:25
59
How are UK neonates screened for CF?
Heel-prick (raised immunoreactive trypsin) -follow on CFTR PCR screen
60
What findings on the sweat test are suggestive of CF?
High Na + Cl (defective NaCl CFTR channels)
61
What are the features of a neonatal presentation of CF?
Failure to thrive Meconium ileus Rectal prolapse
62
What are the features of a respiratory presentation of CF?
Recurrent LRTIs Nasal polyps Bronchiectasis (eventually)
63
What are the features of a GI presentation of CF?
Pancreatic insufficiency (DM + steatorrhea) Distal intestinal obstruction Gallstones Cirrhosis
64
What systems are commonly affected by CF?
Respiratory GI Reproductive
65
What are the reproductive sx of CF?
Male infertility (undeveloped vas + epididymis) Female subfertility
66
What is the management of CF?
Physiotherapy Abx for acute infective exacerbations Mucolytics Bronchodilators Immunisation Yearly CXR surveillance O2/diuretics/NIV if cor pulmonale --> b/l lung-heart transplant Creon Ursodeoxycholic acid if cirrhotic --> liver translant DM management (yearly OGTT)
67
What organisms commonly cause infective exacerbations in CF?
Staph aureus Pseudomonas Burkholderia cepacia
68
Which infective organism is a contraindication for lung-heart transplant in CF?
Burkholderia cepacia
69
What type of drug is Ivacaftor?
CFTR potentiator for G551D mutation
70
What type of drug is Lumacaftor?
CFTR corrector for classic F508 mutation
71
What is Bronchiectasis?
Permanent thinning and dilatation of the airways
72
What are the presenting features of Bronchiectasis?
Persistent cough Copious sputum Intermittent haemoptysis Constitutional sx (wt loss)
73
What are the causes of Bronchiectasis?
Extrinsic narrowing Blockage Congenital Infective Inflammatory
74
What are the congenital causes of Bronchiectasis?
Young syndrome 1o ciliary dyskinesis (Kartagener's syndrome)
75
What are the features of Young syndrome?
Obstructive azoospermia Chronic sino-pulmonary infections --> Bronchiectasis
76
What are the features of 1o ciliary dyskinesis (Kartagener's syndrome)?
Paranasal sinusitis Bronchiectasis Hearing loss Situs inversus Infertility
77
What are the CXR features of Bronchiectasis?
Tramline & ring shadows (thickened bronchial walls)
78
What are the high-res CT features of Bronchiectasis?
Small airway dilatation > nearby vessels -signet ring sign = dilated bronchus w/ pulm aa nearby Cysts Mucous plugging
79
What is the management of Bronchiectasis?
Airway clearance (PT, mucolytics) Bronchodilators Long-term abx/prophylactic Steroids Surgery (if localised)
80
What antibiotic is commonly used prophylactically in CF and Bronchiectasis?
Azithromycin -anti-inflammatory in nature
81
What are the common restrictive lung conditions?
Interstitial lung disease Sarcoidosis Occupational lung disease
82
What is the main finding on examination for restrictive lung disease?
Fine crackles that do not change on inspiration/expiration, coughing or movement Bronchial sounds
83
What are the spirometry findings for restrictive lung disease?
FEV1:FVC >0.7
84
What is the underlying pathological process in ILD?
Diffuse, chronic, progressive inflammation
85
How dose ILD present?
Dry cough Exertional SOB Clubbing
86
In which respiratory conditions is clubbing commonly present?
CF Bronchiectasis ILD TB
87
What is the gold standard investigation for suspected ILD?
High-res CT
88
What is the management of ILD?
Steroids Cyclophosphamide +/- Azithromycin if refractory
89
What are the major complications of ILD?
Cor pulmonale (requires LTOT) Infections Lung cancer (10x increased risk)
90
What is cor pulmonale?
RHF 2o pulmonary disease
91
What is Sarcoidosis?
Multi-system granulomatous inflammation
92
What are the stages of respiratory Sarcoidosis based on CT findings?
Stage 0 - no changes Stage 1 - bilateral hilar lymphadenopathy (BHL) Stage 2 - BHL + peripheral pulmonary infiltrates Stage 3 - SOLELY peripheral pulmonary infiltrates Stage 4 - progressive fibrosis, honeycombing (bullae), pleural involvement
93
What are the non-respiratory manifestations of Sarcoidosis?
Endocrine - hypercalcaemia, hypercalcuria (renal stones) ENT/eyes - uveitis, sicca, parotid gland enlargement Cardiomyopathy Bone cyst Hepatosplenomegaly Neuropathies (Bell's) Skin manifestations
94
What are the skin manifestations of Sarcoidosis?
Erythema nodosum (painful red shin nodules) Lupus pernio (purple-blue lesions on distal parts) Subcutaneous nodules
95
What is Lofgren's syndrome?
Acute clinical presentation of sarcoidosis
96
What are the features of Lofgren's syndrome?
Fever Erythema nodosum Polyarthralgia (esp. ankles) BHL
97
What biochemical findings may be present in Sarcoidosis?
Hypercalcaemia High serum ACE Lymphopenia High ESR
98
What is the management of Sarcoidosis?
Steroids +/- NSAIDs
99
Which conditions are associated with apical fibrosis?
BREAST PX -bronchopulmonary aspergillosis -radiotherapy -EAA (hypersensitivity pneumonitis) -ankylosing spondylitis -sarcoidosis -TB -pneumconiosis -histiocytosis X
100
Which conditions are associated w/ basal fibrosis?
RACIST -rheumatoid arthritis -asbestosis -connective tissue disease/cryptogenic fibrosing alveolitis -idiopathic pulmonary fibrosis (most common) -scleroderma -treatments (drugs)
101
What drugs are associated w/ basal fibrosis?
Bulsuphan Bleomycin Nitrofurantoin Hydralazine Methotrexate Amidoarone
102
What is Pneumoconiosis?
Group of ILD caused by breathing in certain kinds of dust particles -asbestosis -silicosis -coal-worker's lung
103
What is Asbestosis?
ILD/lung ca 2o asbestos exposure
104
What are the two types of lung ca seen in Asbestosis?
Mesothelioma - coloured asbestos Bronchial adenocarcinoma - white asbestos
105
What is Berylliosis and what industries is it seen in?
ILD Aerospace/nuclear industries
106
What is Silicosis and what industries is it seen in?
ILD Pottery, sandblasting, quarrying (clay)
107
What is Coal-worker's lung and what features might be seen?
ILD caused by inhalation of coal dust Numerous small nodules, black sputum/lung
108
What is Caplan's disease?
Coal-worker's lung + rheumatoid arthritis + pulmonary rheumatoid nodules (cavities)
109
What types of EAA/hypersensitivity pneumonitis are linked to workplace exposure?
Malt-worker's lung Farmer's lung Mushroom-worker's lung Sugar-worker's lung Bird-fancier's lung
110
What organism is implicated in Malt-worker's lung?
Aspergillus clavatus
111
Which organisms are implicated in Farmer's lung?
Saccharaopolyspora rectivirgula Actinomyces Micropolyspora
112
What organism is implicated in Mushroom-worker's lung?
Thermophilic actinomyces
113
What organism is implicated in Sugar-worker's lung?
Thermoactinomyces sacchari
114
What is the insulting agent in Bird-Fancier's lung?
Avian antigens
115
What scoring system is used to assess severity in CAP?
CURB-65 -confusion (AMT <8) ->65 y/o -urea >6 -RR >30 -sys BP <90 OR dias BP <60 0-1 - discharge w/ PO abx >1 - admit for IV abx
116
What are the features of atypical pneumonia?
Insidious onset (walking pneumonia) Malaise Headache Myalgia Arthralgia Dry-ish cough
117
What is the most common causative pathogen in pneumonia?
Strep pneumoniae
117
How may Strep pneumoniae present?
Herpes labialis Lobar consolidation on CXR +ve urinary antigens
118
Which class of antibiotics has good action against Strep pneumoniae?
Penicillins
119
Which patient groups are at risk of Staph aureus pneumonia?
Complicates flu infection IVDU
120
What CXR findings are suggestive of staph aureus pneumonia?
Bilateral cavitations
121
Which antibiotics have good action against staph aureus?
Flucloxacillin Vanc if MSRA Linezolid/Clindamycin if PVL
122
Which patient groups are at risk of Klebsiella pneumonia?
Elderly Diabetic Alcoholic
123
How may Klebsiella pneumonia present?
Redcurrant sputum CXR - cavitating upper lobe lesion Usually drug-resistant
124
Which patient groups are at risk of aspiration pneumonia?
Patients w/ unsafe swallow
125
Which antibiotics may be required in aspiration pneumonia?
Add in gram neg/anaerobe cover (Metronidazole)
126
Where is Legionella commonly found?
Water systems -air-cons -showers -cruise ships
127
What features may Legionella pneumonia present with?
Hyponatraemia Confusion D/V Deranged LFTs AKI Lymphopenia CXR - bibasal consolidation
128
Which classes of antibiotics are used to treat Legionella pneumonia?
Macrolides Fluoroquinolones
129
When is Mycoplasma pneumonia seen?
Winter epidemics
130
What features may Mycoplasma pneumonia present with?
Erythmea multiforme Cold agglutinin (anaemia) Myocarditis Glomerulonephritis Meningoencephalitis
131
Which classes of antibiotics are used to treat Mycoplasma pneumonia?
Macrolides Fluroquinolones Tetracyclines NOT PENICILLIN - no cell wall
132
When is Chlamydia psittaci seen?
Pt contact w/ infected birds (parrots)
133
What features may Chlamydia pssitaci pneumonia present with?
Meningo-encephalitis Infective endocarditis (culture neg) Hepatitis AKI Splenomegaly +ve serology
134
Which classes of antibiotics are used to treat Chlamydia pssitaci pneumonia?
Tetracyclines Macrolides
135
Which patient groups are at risk of Pseudomonas pneumonia?
Bronchiectasis/CF Hospital-acquired (ITU)
136
Which antibiotics are used to treat Pseudomonas pneumonia?
Limited effective options Tazocin Ciprofloxacin Meropenem Gentamicin Ceftazidime
137
Which patients are at risk of Pneuomcystis Pneumonia (PCP)?
Immunosuppressed
138
What features may Pneuomcystis Pneumonia (PCP) present with?
SOBOE w/ low PaO2 CXR - ground glass opacification, b/l perihilar interstitial shadowing
139
Which investigation is used to diagnose Pneuomcystis Pneumonia (PCP)?
Bronchoalveolar lavage
140
Which antibiotic is used to treat Pneuomcystis Pneumonia (PCP)?
Co-trimoxazole
141
What are the presenting sx of TB?
General - pyrexia, night sweats, malaise, anorexia, clubbing, haemoptysis, cough Cardiac - pericarditis CNS - meningitis, Pott's disease (vertebral collapse) GI/GU - colicky abdo pain, loin pain, sterile pyuria, haematuria Derm - erythema nodosum, lupus vulgaris (red-brown apple-jelly nodule)
142
What is Milliary TB?
Disseminated TB due to haematogenous spread
143
What test is used to diagnose latent TB?
IGRA
144
Which other infective disease should be screened for if latent TB is diagnosed?
HIV
145
Which patients should be offered prophylactic BCG vaccination?
Living/visiting a high risk area TB in parents/grandparents/family Children <15 vaccinated as newborns AND high risk Adults <35, negative mantoux test, high risk HIV sufferers
146
What is the management of active TB?
Rifampicin Isoniazid (with Pyroxine) Pyrazinamide Ethambutol RIPE for 2/12 then IR for 4/12
147
What are the side effects of Rifampicin?
INDUCER Orange-red urine/tears Transient hepatitis
148
What are the side effects of Isoniazid?
Peripheral neuropathy -given w/ prohylactic pyridoxine (B6) Hepatiits Drug-induced lupus
149
What are the side effects of Pyrazinamide?
Hepatitis Rash Arthralgia Gout
150
When are steroids used in TB management?
TB Pericarditis/Meningitis
151
What are the side effects of Ethambutol?
Red-green colour blindness Nystagmus Optic neuritis Peripheral neuropathy
152
Which patient groups are at risk of fungal pneumonia?
Immunosuppressed
153
Which organisms are seen in fungal pneumonia, what patient groups do they affect, and what investigations are indicated?
Aspergillus --> serology Candida - ICU patients --> cultures & PCR Histoplasmosis - bats, bird's --> Urine Ag, serology Blastomycosis - compost (USA) --> KOH culture Cryptococcus - pigeon droppings --> india ink stain & serology
154
What are the common causes of viral pneumonia?
Influenza Covid Swine flu (H1N1) Bird flu
155
Which patient groups should be offered routine flu vaccination?
>50 y/o Pregnant HCW Co-morbid Immunosuppressed
156
What should patients with complicated flu/requiring prophylaxis be offered?
Oseltamivir (neuraminidase inhibitor)
157
What medication can be used to treat swine flu?
Zanamivir (oseltamivir resistance)
158
How should avian flu be treated?
Antivirals -7-10/7 after known exposure OR 2/7 post sx
159
What are the five ways in which aspergillus can affect the lungs?
1 - Asthma (Type 1 hypersensitivity) 2 - Allergic bronchopulmonary aspergillosis (Types 1 & 3 hypersensitivity) 3 - Extrinsic allergic alveolitis (Types 3 & 4 hypersensitivity) 4 - Aspergilloma 5 - Invasive aspergillosis
160
What lab findings are suggestive of allergic bronchopulmonary aspergillosis and how should it be treated?
IgE RAST +ve Eosinophilia Raised IgE Treat w/ steroids
161
How does EAA present?
Atypical pneumonia (4-6hrs post exposure) Chronically restrictive lung disease
162
How should EAA be treated?
Avoid exposure O2 Steroids
163
What are the CXR findings of an Aspergilloma?
Fungus ball in pre-existing lung cavity
164
How should Aspergilloma be treated?
Excision (if massive haemoptysis) PO anti-fungals (poor penetration)
165
Which patient groups are at risk of invasive aspergillosis?
Sick patients w/ weak immunity
166
What investigations are used to diagnose invasive aspergillosis?
Beta-glucan Serology Radiology
167
How should invasive aspergillosis be treated?
Azoles Amphotericin
168
What are the two main types of lung ca?
Small cell (oat) - 15-20% Non-small cell - 80-85%
169
What is the main risk factor for small cell lung ca?
Smoking
170
What are the paraneoplastic manifestations of small cell lung ca?
SIADH (hyponatraemia) Cushing's (ectopic ACTH) Lambert-Eaton syndrome
171
Describe Lambert-Eaton syndrome?
Peripheral neuropathy Weakness relieved by exertion
172
What is the treatment for small cell lung ca?
Chemo/radiotherapy too SMALL for surgery
173
What are the main types of non-small cell lung ca?
Squamous cell ca Adenocarcinoma (most common) Large cell ca Carcinoid tumour
174
How does squamous cell lung ca present?
Central tumours causing bronchial obstruction --> infection Hypercalcaemia
175
How does squamous cell lung ca spread?
Local spread common Metastasizes relatively late
176
In which patients does adenocarcinoma lung ca present?
Non-smokers Females <45 Hypertrophic osteoarthropathy Asbestos exposure
177
How does adenocarcioma lung ca spread?
Peripheral so often invade pleura/mediastinal lymph nodes Metastasizes to brain/bone
178
How does large cell lung ca spread?
Metastasize early
179
What are carcinoid tumours?
Slow-growing tumours arising in neuro-endocrine cells
180
What are the sx of carcinoid syndrome?
Flushing Diarrhoea Wheeze all 2o 5-HT release
181
What are cannonball mets and what is the likely 1o?
Large cannonball like lesions on CXR/CT Commonly metastasize from RCC
182
What 1o cancers commonly metastasize to the lungs?
Breast Colon ca
183
What is a Pancoast tumour?
Tumour at the apex of the lung -commonly NSCLC
184
How do Pancoast tumours commonly present?
Incidental finding Horner's syndrome -ipsilateral ptosis -miosis -anhidrosis
185
What is a mesothelioma?
Pleural cell tumour -primarily related to asbestos exposure -no relationship to smoking
186
How do mesotheliomas present?
Recurrent pleural effusions/pleurisy
187
How are mesotheliomas treated?
Chemotherapy Pleurodesis/drainage POOR PROGNOSIS
188
How are NSCLC treated?
Surgery
189
What factors suggest a solitary pulmonary nodule may be cancerous?
Female Older FHx Larger (>5mm) Emphysema Upper lobe Spiculated Sub-solid (ground glass)
190
How should solitary pulmonary nodules be followed up?
If no prev. imaging - CT scan in 3/12 If stable over 2 years - discharge
191
What are the risk factors for PE?
Embolic hx Pregnant/recent birth Oestrogen Obesity Immobility Surgery/Trauma Malignancny
192
What is the Well's score?
Pre-test likelihood score for PE (>4 = likely) DVT sx +3 Likely PE +3 Tachycardia +1.5 >3/7 immobilisation OR w/i 30/7 surgery +1.5 PHx VTE +1.5 Haemoptysis +1 Cancer +1
193
What investigations are commonly used to diagnose PE?
D-dimer (rules out, non-specific, age adjusted) CTPA (gold-standard) V/Q Lower limb USS (if DVT suspected)
194
When should V/Q scan be used over CTPA?
If CTPA absolutely contraindicated - renal impairment, contrast allergy If pregnant AND CXR normal
195
How should PEs be managed?
IVI LMW Bridge to warfarin or DOAC Thrombolysis if haemodynamically unstable w/ evidence of RHS Vena cava filter if anticoagulation contraindicated
196
What are the contraindications to thrombolysis?
Recent bleeding Recent high-risk events (spinal surgery, major trauma) Known hx of haemorrhagic stroke Uncontrolled HTN Severe liver disease
197
How long should anticoagulation be continued for following a PE?
Unprovoked - 3-6/12 to lifelong -LOOK FOR CANCER Provoked - 3/12
198
What are the two main types of pleural effusions?
Exudate (>3-3.5g/dL) Transudate (<2.5g/dL)
199
What are the causes of an exudative pleural effusion?
Inflammation/infection Empyema Parapneumonic TB Cancers
200
What are the causes of a transudative pleural effusion?
Failures - heart, liver, renal Hypothyroidism Meig's syndrome
201
What is Meig's syndrome?
Unilateral transudative effusion (RIGHT) w/ ascites associated w/ ovarian fibroma
202
What are the features of an exudative pleural effusion?
Protein >3-3.5g/dL Effusion protein:Serum protein >0.5 Effusion LDH:Serum LDH >0.6 Effusion LDH >2/3 upper limit normal
203
What are the features of a transudative pleural effusion?
Protein <2.5g/dL Effusion protein:Serum protein <0.5 Effusion LDH:Serum LDH <0.6 Effusion LDH <2/3 upper limit normal
204
How should 1o pneumothorax be managed?
SOB +/- rim of air >2cm --> aspirate --> if fail for chest drain ASx +/- rim of air <2cm --> discharge and r/v in 1/12
205
How should 2o pneumothorax be managed?
SOB +/- rim of air >2cm --> chest drain ASx AND 1-2cm --> aspirate + admit to observe for 24hrs (CXR) ASx AND <1cm - admit to observe for 24hrs (CXR_
206
How is the size of a pneumothorax measured?
From 1st visible lung margin to chest wall at level of hilum
207
What is a tension pneumothorax and how should it be managed?
Pneumothorax w/ haemodynamic compromise/mediastinal shift/tracheal deviation NEEDLE THORACOCENTESIS
208
When should surgical treatment of pneumothorax be considered?
Bilateral pneumothoraces Failure of lung expansion 2/7 after drain 3x episodes same side Previous contralateral PTx
209
What is Obesity Hypoventilation Syndrome?
Daytime hypercapnia +/- actual airway obstruction
210
What is Obstructive Sleep Apnoea?
Intermittent and repeated UA collapse during sleep Results in daytime somnolence and irregular breathing at night
211
What risk factors are there for OHS/OSA?
Obesity Alcohol Smoking
212
How does OHS/OSA present?
Daytime sleepiness (Epworth) Cognitive effect Decreased libido
213
How should OHS/OSA be managed?
Lifestyle advice Sleeping/positioning technique Nocturnal CPAP -routine referral
214
How is an orophrayngeal airway measured?
From incisor to angle of jaw
215
When should an oropharyngeal airway be used?
If no cough/gag reflex -otherwise can cause laryngospasm/vomiting
216
When should a nasopharyngeal airway be used?
If cough/gag reflex intact Seizing patients
217
When should a nasopharyngeal airway not be used?
Facial trauma/base of skull fractures
218
When should an LMA/iGel be used?
If BVM unsuccessful at restoring O2 despite prior adjunct use If fails --> intubation/surgical airway

Pocket MSRA - Book 1 (7 decks)

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