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Finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What level of pO2 is severe respiratory failure?

A

<8kpa

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2
Q

What is the presentation of respiratory failure?

A

*SOB
*Anxiety
*Tachypnoea
*Confusion
*Cardiac dysfunction

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3
Q

What investigations should be carried out in suspected respiratory failure?

A

*Pulse oximetry
*ABG
*FBC, D dimer, serum bicarbonate
* ECG
*Pulmonary funciton tests

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4
Q

What is type 1 resp failure

A

Low oxygen, normal CO2

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5
Q

What are the causes of type 1 respiratory failure?

A

*Pulmonary oedema
*COPD
*Asthma
*PE
*Pneumothorax
*Pulmonary fibrosis

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6
Q

What is type 2 respiratory failure?

A

Low oxygen, high Co2

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7
Q

What are the causes of type 2 respiratory failure?

A

*COPD
*Chest wall abnormalities
*Muscle weakness
*CNS depression

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8
Q

What is the management of respiratory failure?

A

*ABCDE
*Oxygen
*Management of underlying cause

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9
Q

What are the features of COPD?

A

*Productive cough
*Dyspnoea
*Wheeze
*Recurrent respiratory infection

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10
Q

Grade 1 MRC

A

Breathless on strenuous exericse

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11
Q

Grade 2 MRC

A

Breathless on walking up a hill

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12
Q

Grade 3 MRC

A

Breathless that slows walking on the flat

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13
Q

Grade 4 MRC

A

SOB after 100m

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14
Q

Grade 5 MRC

A

Unable to leave the house due to SOB

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15
Q

What investigations should be carried out in COPD?

A

*Spirometry
*Chest X ray
*FBC
*Consider an ABG if acutely unwell

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16
Q

What is the typical spirometry for someone with COPD?

A

*FEV1/FVC<0.7
*Obstructive picture
*Not fully reversible

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17
Q

What are the signs of COPD on X Ray?

A

*Hyperinflation
*Bullae
*flat hemidiaphragm

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18
Q

What may be seen on a FBC in someone with COPD?

A

*Polycythaemia
*Anaemia
*Leucocytosis

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19
Q

Stage 1 COPD

A

FEV1>80% - must also have symptoms

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20
Q

Stage 2 COPD

A

Moderate, FEV1 50-79%

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21
Q

Stage 3 COPD

A

Severe, FEV1 30-49%

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22
Q

Stage 4 COPD

A

FEV1 <30%, very severe

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23
Q

What is the non-pharmaceutical management of COPD

A

*Smoking cessation
*Annual influenza vaccine
*One off pneumococcal vaccine
*Pulmonary rehabilitation

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24
Q

What is step 1 of pharmaceutical management of COPD?

A

SABA (salbutamol) or SAMA (ipratropium bromide)

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25
Q

What is step 2 of pharmaceutical management of COPD?

A

*If there is a steroid response then LABA+ ICS (fostair)
*If no steroid response then LABA and LAMA

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26
Q

What is the treatment of an exacerbation of COPD?

A

*Prednisolone
*Inhalers and nebulisers
*Antibiotics if evidence of infection
*Physiotherapy

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27
Q

What is the treatment of a severe exacerbation of COPD?

A

*IV aminophylline
*Non-invasive ventilation
*Intubation and ventilation ->ICU
*Doxapram as a respiratory stimulant

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28
Q

What is step 3 of pharmaceutical management of COPD?

A

Oral theophylline

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29
Q

When should mucolytics be considered in COPD

A

In those with a chronic productive cough

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30
Q

What antibiotic can be used as prophylaxis in COPD?

A

Azithromycin

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31
Q

Before giving LTOT, what investigation do you have to do?

A

2 ABGs at least 3 weeks apart

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32
Q

Which patients should be offered LTOT?

A

*pO2 <7.3kPa
*pO2 7.3 to 8 AND one of:
- secondary polycythaemia
- oedema
- pulmonary hypertension

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33
Q

Immunoglobulin asthma

A

IgE

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34
Q

What is the presentation of asthma?

A

*Episodic symptoms
*Diurnal variation
*Dry cough, wheeze and SOB
*History of atopy
*Bilateral widespread polyphonic wheeze

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35
Q

What investigations should be carried out for asthma?

A

*Spirometry
*Chest X ray to exclude other pathologies
*FBC
*Consider IgE immunoassay
*Consider fractional exhaled nitric oxide

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36
Q

Spirometry in asthma

A

*Obstructive picture
*FEV1/FVC <80%
*Reversibility over 12%

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37
Q

FBC in asthma

A

May be normal, may see raised eosinophils and/or neutrophilia

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38
Q

What is the management of asthma?

A

*SABA - salbutamol
*ICS - beclometasone dipropionate
*LABA - salmeterol
*Leukotriene receptor antagonist - montelukast

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39
Q

Moderate acute asthma

A

*Peak flow 50-75%
*Normal speech

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40
Q

Acute severe asthma

A

*Peak flow 33-50%
*Unable to complete sentences in one breath
*Signs of respiratory distress
*Resp rate >25
*Heart rate >110

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41
Q

Life threatening asthma

A

*Peak flow <33%
*Saturations <92%
*Exhaustion and poor respiratory effort
*Hypotension
*silent chest
*Cyanosis
*Altered consciousness/confusion

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42
Q

What is the management of moderate acute asthma?

A

*Nebulised SABA and SAMA
*Steroids (oral prednisolone or IV hydrocortisone)

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43
Q

What is the management of acute severe asthma?

A

*Nebulised SABA and SAMA, steroids
*Oxygen to maintain SATs
*Aminophylline
*Consider IV salbutamol

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44
Q

What is the management of life threatening asthma?

A

*IV magnesium sulfate
*HDU admission

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45
Q

Pneumonia on chest X ray

A

*Consolidation

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46
Q

What is the presentation of pneumonia?

A

*Shortness of breath
*Productive cough
*Fever
*Haemoptysis
*Pleuritic chest pain
*Delerium

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47
Q

What are the signs of pneumonia?

A

*Tachycardia and tachypnoea
*Hypoxia
*Hypotension
*Fever

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48
Q

What are the characteristic chest signs of pneumonia?

A

*Bronchial breath sounds
*Focal coarse crackles
*Dullness to percussion

49
Q

What is the assessment for pneumonia?

A

CURB-65

50
Q

Explain the result of a CURB-65 score

A

*0/1 manage at home
*≥2 hospital
*≥3 ICU

51
Q

Explain CURB 65

A

C- confusion
U - urea >7
R - respiratory rate ≥ 30
B - blood pressure <90 systolic or ≤60 diastolic
65 - aged ≥65

52
Q

What is the most common cause of pneumonia?

A

Streptococcus pneumoniae

53
Q

What is a common cause of pneumonia in those with COPD?

A

Haemophilus influenzae

54
Q

What cause of pneumonia is seen in those with HIV?

A

Pneumocystis jiroveci

55
Q

What is the treatment for pneumonia caused by pneumocystis jiroveci?

A

Co-trimoxazole

56
Q

What is a hospital acquired pneumonia?

A

48 hours + after admission

57
Q

What investigations should be carried out in suspected pneumonia?

A

*FBC - neutrophilia if bacterial
*U+Es (For urea, look for dehydration also)
*CRP
*Chest X Ray
*Sputum (and blood) cultures

58
Q

What is the management of a low severity pneumonia?

A

5 day course of amoxicillin

59
Q

What is the management of a moderate/high severity pneumonia?

A

7 day course of amoxicillin and a macrolide

60
Q

What are the complications of pneumonia?

A

*Pleural effusion
*Empyema
*Lung abscess
*Sepsis

61
Q

What are the risk factors for PE

A

*Immobility
*Recent surgery
*Long haul travel
*Pregnancy
*Oestrogen: HRT or oral contraceptive pill
*Polycythaemia
*SLE
*Thrombophilia
*Malignancy

62
Q

What is the presentation of DVT?

A

*unilateral swelling
*Oedema
*Tender calf
*Colour changes
*Dilated superficial veins

63
Q

What is the presentation of PE?

A

*Tachypnoea >20
*Crackles
*Tachycardia
*Fever
*Signs of PE

64
Q

Results of WELLS score

A

*≥4 means PE is likely, immediate CTPA, if there is a delay, anticoagulate. If negative, carry out proximal leg USS
*<4 arrange a D-dimer

65
Q

What are the ECG changes due to PE?

A

*Large S wave in lead I
*Large Q wave in lead III
*Inverted t wave in lead III
*RBBB and right axis deviation
*Sinus tachycardia

66
Q

What investigations should you carry out in suspected PE?

A

*CTPA (echo if haemodynamically unstable)
*D dimer
*FBC
*ECG
*UEs to check baseline renal function
*LFTs to check baseline function
*Coagulation studies

67
Q

What is the management of PE?

A

*Apixaban or rivaroxaban
*PESI score to risk stratify

68
Q

How long should you coagulate after PE?

A

*At least 3 months if there is a reversible cause
*>3 if cause unclear
*3-6 months in active cancer

69
Q

What is Budd Chiari syndrome?

A

Clot in the hepatic vein causing acute hepatitis

70
Q

What is a pneumothorax?

A

Air in the pleural space

71
Q

What are the causes of pneumothorax?

A

*Spontaneous
*Trauma
*Iatrogenic: lung biopsy, mechanical ventilation, central line insertion
*Lung pathology: infection, asthma, COPD

72
Q

What is the investigation for pneumothorax

A

Xray

73
Q

What is the management of pneumothorax?

A

*If no SOB and <2cm air then no treatment and follow up in 2-4 weeks
*If SOB or >2cm air, aspirate and if it fails twice then insert a chest drain
*If unstable then chest drain

74
Q

What is the presentation of pneumothorax?

A

*Chest pain
*Dyspnoea
*Ipsilateral reduced breath sounds
*Cough
*Hyper-resonance on percussion

75
Q

Where is the safe space for aspiration?

A

Either 2nd intercostal space in mid clavicular line or the 4th/5th intercostal space in the mid axillary line (lateral dorsi, pectoralis major lateral edges)

76
Q

Where is triangle of safety for chest drain?

A

4th/5th intercostal space in the mid axillary line (lateral dorsi, pectoralis major lateral edges)

77
Q

What is a tension pneumothorax

A

A pneumothorax in which there is continual entrance of air with trapping in the pleural space causing haemodynamic compromise

78
Q

What are the types of lung cancer?

A

*Non small cell: adenocarcinoma, squamous, large cell
*Small cell
*Mesothelioma

79
Q

What is the presentation of lung cancer?

A

*SOB
*Cough
*Haemoptysis
*Finger clubbing
*Recurrent pneumonia
*Weight loss
*Lymphadenopathy

80
Q

What are the extrapulmonary manifestations of lung cancer?

A

*Recurrent laryngeal palsy
*Phrenic nerve palsy
*Superior vena cava obstruction
*Horner’s syndrome
*SIADH: SCLC ectopic ADH secretion
*Cushing’s: SCLC ectopic ACTH
*Hypercalcaemia: squmous cell carcinoma secreting PTH
*Limbic encephalitis: antibodies against small cell lung cancer causing inflammation in the brain
*Lamert-Eaton mysathenic syndrome: antibodies against voltage calcium channels

81
Q

Presentation of limbic encephalitis

A

*Short term memory impairment
*Hallucination
*Confusion
*Seizures

82
Q

What is the presentation of lambert-eaton myasthenic syndrome?

A

*Proximal weakness
*Diplopia
*Dysphagia
*Slurred speech

83
Q

What is the presentation of superior vena cava obstruction?

A

*Facial swelling
*Difficulty breathing
*Distended veins
*Pemberton’s sign (hands above head ->cyanosis)

84
Q

Referral criteria for suspected lung cancer in >40s

A

*Clubbing
*Lymphadenopathy
*Recurrent or persistent chest infection
*Raised platelet count
*Chest signs of lung cancer
*2 week wait

85
Q

Referral criteria for suspected lung cancer in <40s

A

*Refer if a smoker with one of the following or a non smoker with two of:
*Cough
*SOB
*Fatigue
*Chest pain
*Weight loss
*Loss of appetite

86
Q

What are the investigations for suspected lung cancer?

A

*CXR
*CT staging and PET-CT
*Bronchoscopy with endobronchial US
*Histology via bronchoscopy or percutaneous biopsy

87
Q

What are the signs of lung cancer on CXR?

A

*Hilar enlargement
*Peripheral opacity
*Unilateral pleural effusion
*Collapse

88
Q

What is the treatment of lung cancer?

A

*Surgery 1st line for non small cell
*Radiotherapy
*Chemotherpay
*Small cell: chemo and radio
*Endobronchial treatment for bronchial obstruction

89
Q

What are the exudative causes of pleural effusion

A

Due to inflammation:
- Lung cancer, mesothelioma, metastases
- Pneumonia
- Rheumatoid arthritis, SLE
- Tuberculosis

90
Q

What are the transudative causes of pleural effusion?

A

Due to fluid shift (<3g/dL)
- congestive cardiac failure
- hypoalbuminaemia
- hypothyroidism
- Meig’s syndrome (R sided pleural effusion with ovarian malignancy)

91
Q

What is the presentation of pleural effusion?

A
  • SOB
  • Dullness to percussion
  • Reduced breath sounds
  • tracheal deviation away from the effusion if massive
92
Q

What are the investigations for pleural effusion?

A
  • Chest X ray
  • pleural aspiration or sample from the drain
93
Q

What is the management of pleural effusion?

A
  • conservative if small
  • pleural aspiration
  • chest drain
94
Q

What is empyema?

A

Infected pleural effusion

95
Q

Diagnosis of empyema

A

*Suspect in patients with improving pneumonia with new or ongoing fever
*Pleural aspiration: pus, acidic pH, low glucose, high LDH

96
Q

What is Light’s criteria?

A

If protein is 25-30g/L it is likely to be exudative if any one of the following is true:
-Pleural fluid protein/serum protein >0.5
- Pleural fluid LDH/serum LDH >0.6
- Pleural fluid >2/3 upper limits of normal serum LDH

97
Q

What is the management of empyema?

A

Chest drain and antibiotics

98
Q

What is the presentation of obstructive sleep apnoea

A

*Episodes of apnoea
*Excessive daytime sleepiness
*Chronic snoring
*Morning headache and problems concentrating

99
Q

What are the risk factors of Obstructive Sleep apnoea?

A
  • obesity
  • male
  • smoker
  • maxillomandibular anomalies
100
Q

What are the investigations for suspected obstructive sleep apnoea?

A

Polysomnography

101
Q

Results of polysomnography

A

≥15: diagnose (moderate)
5-15 diagnose if also experiencing symptoms
>30 is severe OSA

102
Q

What are the complications of obstructive sleep apnoea?

A

-Cardiovascular disease
- depression
- impaired glucose metabolism
- motor vehicle accidents

103
Q

What is interstitial lung disease?

A

Umbrella term for lung disease affecting the lung parenchyma causing inflammation and fibrosis

104
Q

What are the different types of interstitial lung disease?

A
  • idiopathic pulmonary fibrosis
  • Drug induced pulmonary fibrosis
  • Asbestosis
  • Hypersensitivity pneumonitis
105
Q

What is idiopathic pulmonary fibrosis?

A

Progressive pulmonary fibrosis with no clear cause

106
Q

What is the presentation of pulmonary fibrosis?

A
  • progressive dyspnoea
  • (non-productive) cough
  • basilar crackles
107
Q

Investigation for idiopathic pulmonary fibrosis

A
  • Chest XRay: opacities
  • High resolution CT scan: honeycombing
108
Q

Management of idiopathic pulmonary fibrosis

A
  • Pirfenidone
109
Q

What are the causes of drug induced pulmonary fibrosis?

A
  • Amiodarone
  • Cyclophosphamide
  • Methotrexate
  • Nitrofuratoin
110
Q

What does asbestosis cause?

A
  • Lung fibrosis
  • Pleural thickening and plaques
  • Adenocarcinoma
  • Mesothelioma
111
Q

What is hypersensitivity pneumonitis?

A

Inflammation of the alveoli and distal bronchioles caused by an immune response to inhaled allergens: avian, mould, chemicals

112
Q

What is the presentation of hypersensitivity pneumonitis?

A
  • cough
  • dyspnoea
  • fevers/chills
  • malaise
  • weight loss
113
Q

Investigation for hypersensitivity pneumonitis

A
  • Chest X-ray
  • CT chest
  • Serum IgG: raised
  • Pulmonary function tests
114
Q

Management of hypersensitvity pneumonitis

A
  • Avoidance of antigen
  • smoking cessation
  • pulmonary rehabilitation
  • oxygen
  • consider steroids
115
Q

What is bronchiectasis?

A

Abnormal dilation of the bronchioles in response to destruction of the elastic and muscular components of the bronchial wall. Usually due to recurrent infection secondary to an underlying disorder

116
Q

What is the presentation of bronchiectasis?

A
  • Cough
  • sputum production (haemoptysis in 50%)
  • crackles, high pitched inspiratory squeaks, rhonci
  • dyspnoea
  • fever
  • fatigue
  • rhinosinusitis (nasal discharge, obstruction and facial pressure)
117
Q

Investigation for bronchiectasis

A
  • High resolution CT chest
  • Chest X-ray
  • FBC, CRP, autoimmune screen, genetic testing
  • Sputum culture and sensitivity
118
Q

Investigation for cystic fibrosis

A

Sweat chloride test

Finals (37 decks)

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