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Respiratory Flashcards

1
Q

Asthma risk factors

A

LBW
Hx atopy
Not breastfed
Exposure to allergens

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2
Q

Asthma spirometry results

A

FEV1 reduced
FVC normal
FEV1/FVC < 0.7

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3
Q

Asthma management children > 5

A

(1) SABA
(2) SABA + ICS
(3) SABA + ICS + LTRA
(4) SABA + ICS + LABA (STOP LTRA)

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4
Q

Asthma management adults

A

(1) SABA
(2) SABA + ICS
(3) SABA + ICS + LTRA
(4) SABA + ICS + LABA (continue LTRA if needed)

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5
Q

Asthma attack - what does normal pCO2 indicate?

A

Very bad - patient is tiring and not blowing off CO2
Intervention is needed

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6
Q

Asthma acute management

A

Oxygen if O2 <92%
Salbutamol (inhaler/nebulised) +/- Ipratropium (nebulised)
Steroids (pred 3 days / dex 1 day)

Escalating:
MgSO4 nebulised
Salbutamol IV
Amino/theophylline
MgSO4 IV
Hydrocortisone IV

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7
Q

COPD investigations + results

A

FEV1/FVC < 0.7
CXR- hyperinflation, bullae, flat hemidiaphragm, exclude malignancy
FBC - exclude secondary polycythaemia

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8
Q

COPD management

A

1st: SABA/SAMA

2nd:
No asthmatic features: SABA + LABA + LAMA
Asthmatic features: SABA/SAMA + LABA + ICS

3rd: SABA + LABA + LAMA + ICS

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9
Q

COPD acute management

A

(1) Bronchodilators and Oxygen
(2) Oral prednisolone
(3) CPAP before intubation and ventilation

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10
Q

Indications for long-term oxygen management for COPD

A

FEV1 < 30% predicted
Cyanosis
Polycythaemia
Peripheral oedema
Raised JVP
O2 less than or equal to 92% on room air

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11
Q

Infective exacerbation of COPD: causative organisms

A

H influenzae
Strep pneumonia
Moraxella catarrhalis

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12
Q

COPD stages

A

Stage 1 Mild FEV1 ≥ 80% predicted

Stage 2 Moderate FEV1 50-79% of predicted

Stage 3 Severe FEV1 30-49% of predicted

Stage 4 Very Severe FEV1 <30% of predicted

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13
Q

Management of spontaneous pneumothorax

A

Primary
<2cm: Discharge
Aspiration
Chest Drain

Secondary
<1cm: O2 and admit
1-2cm: Aspirate
>2cm: Chest drain

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14
Q

Tension pneumothorax management

A

Urgent decompression (2nd intercostal space in midlavicular line)
Chest drain insertion

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15
Q

Management of active TB

A

RIPE 2 months
RI 4 months

Ziehl-Neelsen stain of sputum

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16
Q

Management + investigation of latent TB

A

RI 6 months
I 3 months

Mannoux test

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17
Q

Bronchiectasis investigations + results

A

CXR: cystic shadows, thickened bronchial walls (tramline and ring shadows)
CT: bronchial wall dilation & lack of bronchial tapering (diagnostic!)
Sputum culture: most likely H Influenza
Obstructive spirometry

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18
Q

Bronchiectasis management

A

Physical training
Postural drainage
Prophylactic antibiotics
Surgery (localised disease)

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19
Q

Definition of pneumonia

A

Inflammation of alveoli caused by infection

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20
Q

Pneumonia: causative organisms of community-acquired pneumonia

A

Streptococcus pneumoniae
Haemophilus influenzae
Staph aureus

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21
Q

Pneumonia: causative organisms of hospital-acquired pneumonia

A

Pseudomonas aeruginosa
E.coli
Klebsiella (classic in alcoholics)

22
Q

Pneumonia: causative organisms in immunocompromised individuals

A

Pneumocystis jiroveci

23
Q

Pneumonia: causative organisms of atypical pneumonia

A

Legionella pneumophila
Mycoplasma pneumoniae
Chlamydia psittaci
Chlamydophila pneumoniae
Coxiella burnetii

24
Q

Pneumonia investigations

A

CURB-65
FBC, U+E, CRP, WCC, urea
Sputum culture - MCS
CXR

25
CURB-65 components and management
Confusion Urea > 7 RR > 30 BP < 90/60 > 65 years old 0-1: outpatient treatment 2 - hospital admission >3: intensive care assessment
26
Antibiotic management for pneumonia according to CURB65
0-1: oral amoxicillin 5d (or macrolide) 2: amoxicilin + macrolide (IV or oral) 7-10d >3: IV co-amoxiclav + macrolide
27
Pharyngitis investigations
FeverPAIN/Centor RADT (rapid antigen deteciton test)
28
Pharyngitis antibiotics
1st: Phenoxymethylpenicillin 2nd: Clarithromycin/erythromycin
29
Sinusitis causative organisms
Strep pneumoniae H influenzae Rhinoviruses
30
Sinusitis management
1st: Analgesia + intranasal decongestants 2nd: Intranasal corticosteroids if > 10 days symptoms 3rd: Phenomethylpenicillin (if severe)
31
Most common type of lung cancer
Non-small cell lung cancer
32
Lung cancer: most associated with cigarette smoking
Squamous cell carcinoma
33
Most common lung cancer in non-smokers
Non-small adenocarcinoma
34
Kulchitsky cells
Associated with small cell lung cacner
35
Primary tumours causing secondary lung cancer
Breast Bowel Bladder Kidney Prostate
36
Metastatic sites of primary lung cancer
Liver Bone Adrenal glands Brain
37
Small cell lung cancer: paraneoplastic features
Lambert Eaton syndrome Cushing's syndrome: ACTH secretion ADH
38
Squamous cell lung cancer: paraneoplastic features
PTHrp HPOA (hypertrophic pulmonary osteoarthropathy) Hyperthyroidism
39
Adenocarcinoma lung cancer: paraneoplastic features
Gynaecomastia HPOA (hypertrophic pulmonary osteoarthropathy)
40
Cause of hoarse voice in lung cancer
Recurrent laryngeal nerve palsy
41
Pemberton's sign
Red/swollen face when lifting arms up - due to superior vena cava obstruction
42
Horner's syndrome triad
Ptosis Miosis Anhydrosis
43
Lung cancer investigations
1st: CXR CT for staging PET-CT Diagnostic: bronchoscopic/percutaneous biopsy + histology
44
Pleural effusion investigations + findings
CXR Blunting of costophrenic angle Fluid in lung fissures Meniscus sign Tracheal and mediastinal deviation if large effusion Thoracocentesis Analyse protein count, cell count, pH, glucose
45
Pleural effusion management
Dependent on cause Fluid overload or congestive HF - diuretic Infective - antibiotics Large effusions often need aspiration or drainage
46
Pleural effusion: protein values in transudate vs exudate
Transudate < 30g/L Exudate > 30g/L
47
Pleural effusion: protein values in transudate vs exudate
Transudate < 30g/L Exudate > 30g/L
48
Causes of transudative pleural effusion
Systemic diseases: Heart/renal failure Fluid overload Hypoalbuminaemia - nephrotic syndrome/cirrhosis
49
Causes of exudative pleural effusion
Inflammatory diseases: RA TB Lung cancer Pneumonia
50
Pulmonary embolism treatment
Apixaban or Rivaroxaban first line or LMWH for 5d followed by dabigatran 3 months for provoked > 3 months for unprovoked Haemodynamic instability - thrombolysis with alteplase
51
Type I respiratory failure
Low O2 Normal CO2
52
Type II respiratory failure
Low O2 High CO2 Alveolar hypoventilation

Medicine (13 decks)

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