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Medicine > Respiratory > Flashcards

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
Q

CURB-65 components and management

A

Confusion
Urea > 7
RR > 30
BP < 90/60
> 65 years old

0-1: outpatient treatment
2 - hospital admission
>3: intensive care assessment

26
Q

Antibiotic management for pneumonia according to CURB65

A

0-1: oral amoxicillin 5d (or macrolide)
2: amoxicilin + macrolide (IV or oral) 7-10d
>3: IV co-amoxiclav + macrolide

27
Q

Pharyngitis investigations

A

FeverPAIN/Centor
RADT (rapid antigen deteciton test)

28
Q

Pharyngitis antibiotics

A

1st: Phenoxymethylpenicillin
2nd: Clarithromycin/erythromycin

29
Q

Sinusitis causative organisms

A

Strep pneumoniae
H influenzae
Rhinoviruses

30
Q

Sinusitis management

A

1st: Analgesia + intranasal decongestants
2nd: Intranasal corticosteroids if > 10 days symptoms
3rd: Phenomethylpenicillin (if severe)

31
Q

Most common type of lung cancer

A

Non-small cell lung cancer

32
Q

Lung cancer: most associated with cigarette smoking

A

Squamous cell carcinoma

33
Q

Most common lung cancer in non-smokers

A

Non-small adenocarcinoma

34
Q

Kulchitsky cells

A

Associated with small cell lung cacner

35
Q

Primary tumours causing secondary lung cancer

A

Breast
Bowel
Bladder
Kidney
Prostate

36
Q

Metastatic sites of primary lung cancer

A

Liver
Bone
Adrenal glands
Brain

37
Q

Small cell lung cancer: paraneoplastic features

A

Lambert Eaton syndrome
Cushing’s syndrome: ACTH secretion
ADH

38
Q

Squamous cell lung cancer: paraneoplastic features

A

PTHrp
HPOA (hypertrophic pulmonary osteoarthropathy)
Hyperthyroidism

39
Q

Adenocarcinoma lung cancer: paraneoplastic features

A

Gynaecomastia
HPOA (hypertrophic pulmonary osteoarthropathy)

40
Q

Cause of hoarse voice in lung cancer

A

Recurrent laryngeal nerve palsy

41
Q

Pemberton’s sign

A

Red/swollen face when lifting arms up - due to superior vena cava obstruction

42
Q

Horner’s syndrome triad

A

Ptosis
Miosis
Anhydrosis

43
Q

Lung cancer investigations

A

1st: CXR
CT for staging
PET-CT

Diagnostic: bronchoscopic/percutaneous biopsy + histology

44
Q

Pleural effusion investigations + findings

A

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
Q

Pleural effusion management

A

Dependent on cause
Fluid overload or congestive HF - diuretic
Infective - antibiotics
Large effusions often need aspiration or drainage

46
Q

Pleural effusion: protein values in transudate vs exudate

A

Transudate < 30g/L
Exudate > 30g/L

47
Q

Pleural effusion: protein values in transudate vs exudate

A

Transudate < 30g/L
Exudate > 30g/L

48
Q

Causes of transudative pleural effusion

A

Systemic diseases:
Heart/renal failure
Fluid overload
Hypoalbuminaemia - nephrotic syndrome/cirrhosis

49
Q

Causes of exudative pleural effusion

A

Inflammatory diseases:
RA
TB
Lung cancer
Pneumonia

50
Q

Pulmonary embolism treatment

A

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
Q

Type I respiratory failure

A

Low O2
Normal CO2

52
Q

Type II respiratory failure

A

Low O2
High CO2
Alveolar hypoventilation

Medicine (13 decks)

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