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Medicine Year 5 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what is a healthy FEV1/FVC

A

70-80%

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2
Q

FEV1/FVC in obstructive and restrictive conditions

A

increased in restrictive and reduced in obstructive

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3
Q

what is TLCO
what happens to it in asthma

A

overall measure of gas transfer
increased in asthma as the issue is not in the alveoli so the lungs compensate

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4
Q

what is KCO

A

TLCO / alveolar volume
measures gas exchange efficiency

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5
Q

what are the 4 stages of COPD related to their FEV1

A

Stage 1 - mild - FEV1 above 80% (need sx to diagnose)
Stage 2 - moderate - FEV1 50-79%
Stage 3 - severe - FEV1 30-49%
Stage 4 - very severe - FEV1 below 30%

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6
Q

can FVC be normal in COPD and asthma

A

Yes
But the FEV1/FVC ratio is reduced

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7
Q

target saturations in COPD

A

88-92
BUT 94-98 if CO2 normal on ABG

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8
Q

15L in COPD

A

IN EMERGENCY YES

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9
Q

Vaccinations for COPD

A

once pneumococcal
annual flu

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10
Q

when would you consider NIV/invasive ventilation in COPD

A

NIV if pH 7.25-7.35
invasive ventilation if pH less than 7.25

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11
Q

most common organism causing infective exacerbation in COPD and bronchiectasis

A

H.influenzae

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12
Q

auscultation in COPD

A

wheeze and reduced breath sounds

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13
Q

what 2 things can increase survival in COPD

A
  1. smoking cessation
  2. LTOT
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14
Q

requirements for LTOT in COPD

A

2 pO2 readings below 7.3kpa

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15
Q

what must you stop if you commence a LABA in COPD

A

stop SAMA and switch it to a SABA

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16
Q

are mucolytic drugs e.g. carbocystine routinely prescribed in COPD

A

no

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17
Q

criteria for moderate, severe and life threatening asthma attack

A

moderate: PEFR 50-70%, normal speech, RR below 25, HR below 110
severe: PEFR 33-50%, can’t complete sentences, RR above 25, HR above 100
life threatening, PEFR below 33%, sats below 92%, CO2 normal, silent chest, cyanosis, reduced resp, HR and BP, exhaustion, confusion, coma

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18
Q

what must the PEFR be before discharge in asthma

A

75% predicted

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19
Q

how long must you wait inbetween inhaler puffs

A

30 seconds

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20
Q

mag sulphate then aminophylline

A
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21
Q

MOA of montelukast

A

leukotrine receptor antaginist

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22
Q

MOA of montelukast

A

leukotriene receptor antagonist

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23
Q

most common cause of occupational asthma

A

isocyantes

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24
Q

how do you step down the treatment in asthma

A

25-50% reduction in ICS dose

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25
Q

are pleural plaques concerning

A

no they’re benign

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26
Q

imaging for pulmonary fibrosis

A

high resolution CT

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27
Q

auscultation in IPF

A

fine end inspiratory crepitations

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28
Q

auscultation in asbestosis

A

inspiratory crackles

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29
Q

2 causes of lower zone fibrosis

A

amiodarone
asbestosis

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30
Q

cause of upper zone fibrosis

A

coal workers pneumonitis

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31
Q

causative organism of pneumonia in bird keepers

A

chlamydia psittari

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32
Q

treatment of allergic bronchopulmonary aspergillus

A

oral glucocorticoids (eosinophilia)

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33
Q

gold standard investigation for mesothelioma

A

thorascopic biopsy

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34
Q

platelets in lung cancer

A

increased

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35
Q

most common cancer in non smoker

A

adenocarcinoma

36
Q

which lung cancer causes gynaecomastia (nipple discharge)

A

adenocarinoma

37
Q

which lung cancer causes paraneoplastic syndromes

A

SCLC

38
Q

4 contraindications to surgery in lung cancer

A

SVC obstruction
FEV less than 1.5
malignant pleural effusion
vocal cord paralysis

39
Q

4 causes of an anterior mediastinum mass

A

Teratoma
Terrible lymphadenopathy
Thymic mass
Thyroid mass

40
Q

major cause of a widened mediastinum (which conditions?)

A

bilateral hilar lymphadenopathy
TB/LYMPHOMA

41
Q

how do you calculate pack years

A

20 x years

42
Q

MOA of bupropion

A

nicotinic antagonist and norepinephrine and dopamine reuptake inhibitor

43
Q

contraindication for bupropion

A

epilepsy (reduces seizure threshold)

44
Q

MOA of varenicline

A

nicotinic partial receptor agonist

45
Q

management of smoking in pregnancy

A

nicotine replacement therapy
drugs are contraindicated

46
Q

what can prevent pneumothoraxx

A

smoking cessation

47
Q

CURB-65 score

A

Confusion
Urea above 7
Resp rate above 30
BP below 90/65
Age above 65

48
Q

auscultation in pneumonia

A

bronchial breathing

49
Q

low severity CAP 1st line Abx

A

amoxicillin

50
Q

CXR post pneumonia

A

repeat 6w after clinical resolution

51
Q

most common cause of aspiration pneumonia and which lobe does it affect

A

lower lobe
klebsiella

52
Q

loss of left heart border on CXR

A

left lingual consolidation

53
Q

ABx in bronchitis?

A

determined by CRP

54
Q

ABx in sinusitis?

A

no

55
Q

auscultation in bronchiectasis

A

coarse crackles and high pitched inspiratory squeaks

56
Q

CXR in bronchiectasis

A

parallel line shadows

57
Q

subacute productive cough, foul smelling sputum and night sweats

A

lung abscess

58
Q

borders of a chest drain insertion

A

base of axilla
lateral edge of pectoralis major
5th intercostal space
anterior border of latissimus dorsi

59
Q

swinging chest drain - inspiration/expiration

A

RISE on inspiration
FALL on expiration

60
Q

3 indications for chest tube in pleural effusion

A

turbid/cloudy fluid
presence of organism
pH below 7.2

61
Q

3 criteria in meig’s syndrome

A

ascites
pleural effusion
benign ovarian tumour

62
Q

complication of draining an effusion too quickly

A

re-expansion pulmonary oedema

63
Q

auscultation of pulmonary oedema

A

bilateral fine crackles

64
Q

tracheal deviation in:
pneumonectomy
pulmonary hypoplasia
complete collapse (endobronchial intubation)

A

trachea deviates towards the white out

65
Q

tracheal deviation in:
consolidation
mesothelioma
pulmonary oedema (bilateral)

A

trachea central

66
Q

tracheal deviation in:
pleural effusion
diaphragmatic hernia
large thoracic mass

A

trachea deviates away from the white out

67
Q

management of a primary pneumothorax

A

less than 2cm and no SOB: discharge and review

otherwise: Aspiration
failure of aspiration/SOB/more than 2cm: CHEST DRAIN

68
Q

management of secondary pneumothorax

A

increased 2cm and SOB
CHEST DRAIN 1ST LINE

less than 1cm admit for 24 hrs with oxygen

69
Q

management of tension pneumothorax

A

immediate needle decompression with a large bore cannula into the 2nd intercostal space midclavicular line

do NOT wait for the CXR

70
Q

dextrocardia, bronchiectasis, recurrent sinusitis, subfertility

A

Kartagener’s
(primary ciliary dyskinesia)

71
Q

SOB, cough, sinusitis, epistaxis and renal sx

A

granulomatosis with polyangitis (cANCA)

72
Q

obstructvie lung disease with lower lobe emphysema
liver cirrhosis, hepatocellular carcinoma, cholestasis

A

alpha 1 antitrypsin deficiency

73
Q

management of alpha 1 antitrypsin deficiency

A

stop smoking
bronchodilators
physio
transplant
surgery to reduce lung volume

74
Q

fever, arthralgia, lymphadenopathy and lupus pernio

A

Sarcoidosis

75
Q

what is lupus pernio

A

red purple rash on face

76
Q

CXR in sarcoidosis

A

bilateral hilar lymphadenopathy
pulmonary infiltrates

77
Q

levels of Ca and ACE in sarcoidosis

A

increased

78
Q

management of sarcoidosis

A

supportive
steroids if increased Ca, neuro/cardiac complications, uveitis, parenchymal disease

79
Q

management of atelectasis

A

chest physio, mobilisation, breathing exercises

80
Q

name one complication of acute pancreatitis

A

acute respiratory distress syndrome

81
Q

do neuromuscular disorders cause obstructive or restrictive disease

A

resitrictive

82
Q

ABG in DKA

A

metabolic acidosis with raised anion gap

83
Q

ABG in cocaine overdose

A

respiratory acidosis due to hypoventilation

84
Q

scale to assess sleep apnoea

A

epworth sleepiness scale

85
Q

management of sleep apnoea

A

weight loss
CPAP

86
Q

can sleep apnoea cause HTN

A

yes

87
Q

signs of heart failure on CXR

A

Alveolar oedema (bat wings)
kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Effusion (pleural)

Medicine Year 5 (27 decks)

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