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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
are pleural plaques concerning
no they're benign
26
imaging for pulmonary fibrosis
high resolution CT
27
auscultation in IPF
fine end inspiratory crepitations
28
auscultation in asbestosis
inspiratory crackles
29
2 causes of lower zone fibrosis
amiodarone asbestosis
30
cause of upper zone fibrosis
coal workers pneumonitis
31
causative organism of pneumonia in bird keepers
chlamydia psittari
32
treatment of allergic bronchopulmonary aspergillus
oral glucocorticoids (eosinophilia)
33
gold standard investigation for mesothelioma
thorascopic biopsy
34
platelets in lung cancer
increased
35
most common cancer in non smoker
adenocarcinoma
36
which lung cancer causes gynaecomastia (nipple discharge)
adenocarinoma
37
which lung cancer causes paraneoplastic syndromes
SCLC
38
4 contraindications to surgery in lung cancer
SVC obstruction FEV less than 1.5 malignant pleural effusion vocal cord paralysis
39
4 causes of an anterior mediastinum mass
Teratoma Terrible lymphadenopathy Thymic mass Thyroid mass
40
major cause of a widened mediastinum (which conditions?)
bilateral hilar lymphadenopathy TB/LYMPHOMA
41
how do you calculate pack years
20 x years
42
MOA of bupropion
nicotinic antagonist and norepinephrine and dopamine reuptake inhibitor
43
contraindication for bupropion
epilepsy (reduces seizure threshold)
44
MOA of varenicline
nicotinic partial receptor agonist
45
management of smoking in pregnancy
nicotine replacement therapy drugs are contraindicated
46
what can prevent pneumothoraxx
smoking cessation
47
CURB-65 score
Confusion Urea above 7 Resp rate above 30 BP below 90/65 Age above 65
48
auscultation in pneumonia
bronchial breathing
49
low severity CAP 1st line Abx
amoxicillin
50
CXR post pneumonia
repeat 6w after clinical resolution
51
most common cause of aspiration pneumonia and which lobe does it affect
lower lobe klebsiella
52
loss of left heart border on CXR
left lingual consolidation
53
ABx in bronchitis?
determined by CRP
54
ABx in sinusitis?
no
55
auscultation in bronchiectasis
coarse crackles and high pitched inspiratory squeaks
56
CXR in bronchiectasis
parallel line shadows
57
subacute productive cough, foul smelling sputum and night sweats
lung abscess
58
borders of a chest drain insertion
base of axilla lateral edge of pectoralis major 5th intercostal space anterior border of latissimus dorsi
59
swinging chest drain - inspiration/expiration
RISE on inspiration FALL on expiration
60
3 indications for chest tube in pleural effusion
turbid/cloudy fluid presence of organism pH below 7.2
61
3 criteria in meig's syndrome
ascites pleural effusion benign ovarian tumour
62
complication of draining an effusion too quickly
re-expansion pulmonary oedema
63
auscultation of pulmonary oedema
bilateral fine crackles
64
tracheal deviation in: pneumonectomy pulmonary hypoplasia complete collapse (endobronchial intubation)
trachea deviates towards the white out
65
tracheal deviation in: consolidation mesothelioma pulmonary oedema (bilateral)
trachea central
66
tracheal deviation in: pleural effusion diaphragmatic hernia large thoracic mass
trachea deviates away from the white out
67
management of a primary pneumothorax
less than 2cm and no SOB: discharge and review otherwise: Aspiration failure of aspiration/SOB/more than 2cm: CHEST DRAIN
68
management of secondary pneumothorax
increased 2cm and SOB CHEST DRAIN 1ST LINE less than 1cm admit for 24 hrs with oxygen
69
management of tension pneumothorax
immediate needle decompression with a large bore cannula into the 2nd intercostal space midclavicular line do NOT wait for the CXR
70
dextrocardia, bronchiectasis, recurrent sinusitis, subfertility
Kartagener's (primary ciliary dyskinesia)
71
SOB, cough, sinusitis, epistaxis and renal sx
granulomatosis with polyangitis (cANCA)
72
obstructvie lung disease with lower lobe emphysema liver cirrhosis, hepatocellular carcinoma, cholestasis
alpha 1 antitrypsin deficiency
73
management of alpha 1 antitrypsin deficiency
stop smoking bronchodilators physio transplant surgery to reduce lung volume
74
fever, arthralgia, lymphadenopathy and lupus pernio
Sarcoidosis
75
what is lupus pernio
red purple rash on face
76
CXR in sarcoidosis
bilateral hilar lymphadenopathy pulmonary infiltrates
77
levels of Ca and ACE in sarcoidosis
increased
78
management of sarcoidosis
supportive steroids if increased Ca, neuro/cardiac complications, uveitis, parenchymal disease
79
management of atelectasis
chest physio, mobilisation, breathing exercises
80
name one complication of acute pancreatitis
acute respiratory distress syndrome
81
do neuromuscular disorders cause obstructive or restrictive disease
resitrictive
82
ABG in DKA
metabolic acidosis with raised anion gap
83
ABG in cocaine overdose
respiratory acidosis due to hypoventilation
84
scale to assess sleep apnoea
epworth sleepiness scale
85
management of sleep apnoea
weight loss CPAP
86
can sleep apnoea cause HTN
yes
87
signs of heart failure on CXR
Alveolar oedema (bat wings) kerley B lines Cardiomegaly Dilated upper lobe vessels Effusion (pleural)

Medicine Year 5 (27 decks)

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