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Year 6 Cross Section > Respiratory > Flashcards

Respiratory Flashcards

1
Q

important Q’s to ask about in asthma

A

triggers
smoking

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2
Q

key aspects to diagnose asthma

A
  1. obstruction: FEV1/FVC ratio <0.7
  2. reversibility: after bronchodilation FEV1 increase by 12%
  3. peak flow diurnal variation (>20%)
  4. FeNO >40 ppb in adults
  5. blood tests = inc eosinophil
  6. hyperreactivty: bronchial challenge tests
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3
Q

possible differentials for asthma

A

COPD
ABPA
Bronchiectasis
Bronchiolitis

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4
Q

ABPA features

A
  • bronchiectasis + eosinophils
  • hypersensitivity to aspergillus fumigatus
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5
Q

ABPA management

A

steroids
antifungals
chest physio

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6
Q

COPD definition

A

airway abnormalities (bronchitis) +/- alveoli abnormalities (emphysema)
= persistent airflow obstruction

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7
Q

how to diagnose COPD

A

spirometry
obstruction post-bronchodilation

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8
Q

how is severity of COPD measured?

A

FEV1
<30% = very severe
30-49 = severe
50-79 = moderate

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9
Q

management of COPD

A

symptoms
exacerbation
smoking
vaccination history
pulmonary rehab

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10
Q

T1RF findings and causes

A

low oxygen, normal CO2
cause: pneumonia, effusion, fibrosis

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11
Q

treat T1RF

A

oxygenate

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12
Q

T2RF findings and causes

A

low oxygen, high CO2
cause: COPD, resp muscle weakness, CNS depression

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13
Q

treat T2RF

A

ventilate (NIV)

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14
Q

interstitial lung disease key history findings

A

occupation
hobbies
asbestos
smoking
connective tissue disease

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15
Q

investigations in ILD

A

high res CT
pulmonary function tests
AI screen

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16
Q

management of ILD

A

oxygen
antifibrotics
stop smoking
vaccination
exercise

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17
Q

squamous cell appearance on CXR

A

mass, can cavitate

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18
Q

treatment of SCLC

A

chemo and radiosensitive

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19
Q

causes of bronchiectasis

A

idiopathic
post-infection
CF
congenital
asthma
COPD

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20
Q

transudate definition and causes

A

normal serum protein and pleural protein <30g/L
LVF
CLD
nephrotic syndrome
PE

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21
Q

exudate definition and causes

A

think eggs –> protein
normal serum protein and pleural protein >40g/L
malignancy
pneumonia
TB

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22
Q

when is Light’s criteria used?

A

if pleural protein between 30-40g/L
to determine if exudate

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23
Q

what is Light’s criteria?

A

exudate if:
- pleural fluid protein/serum protein ratio >0.5
- pleural fluid LDH/serum LDH ratio >0.6
- pleural fluid LDH >2/3 upper limit of normal serum LDH

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24
Q

diagnosing asthma in 5-16 year olds

A

-spirometry with BDR test +/- FeNO test

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25
Q

diagnosing asthma in adults

A

FeNO test
spirometry +/- BDR

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26
Q

what to counsel asthma patient on before discharge?

A

TAME
Technique (inhalers)
Avoidance (of triggers_
Monitor (PEFR)
Educate

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27
Q

common pneumonia in pre-existing lung disease

A

H. influenzae

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28
Q

flail chest x-ray features

A

rib fractures
subcut emphysema
pneumothorax
mediastinal shift if tension

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29
Q

when to insert a chest drain in pleural effusion?

A

aspirate:
- if turbid/cloudy
- if tests +ve on MC&S
- if pH < 7.2

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30
Q

causes of upper lobe pulmonary fibrosis

A

TAPE
- TB
- ABPA
- pneumoconiasis
- EAA

31
Q

causes of lower lobe pulmonary fibrosis

A

STAIR
- sarcoidosis
- toxins
- asbestosis
- idiopathic PF
- rheumatological

32
Q

triad of Kartagener’s syndrome

A

situs inversus
bronchiectasis
chronic sinusitis

33
Q

triad of Young’s syndrome

A

bronchiectasis
chronic sinusitius
male infertility

34
Q

CF CXR findings

A

hyperinflation
peri-bronchial shadowing
bronchial wall thickening
ring shadows

35
Q

lung cancer that causes gynaecomastia

A

adenocarcinoma

36
Q

lung cancer that releases beta HCG

A

large cell cancer

37
Q

2ww referral guidelines in <40s

A

2 in smokers, 1 in ex/current smokers
- cough
- chest pain
- fatigue
- weight loss

38
Q

2ww referral guidelines in >40s

A

least one of INTEL
- infections (recurrent chest)
- nail clubbing
- thrombolysis
- exam signs
- lympahdenopathy

39
Q

treatment of late stage small cell lung cancer

A

limited = combo chemorad
extensive =palliative chemo

40
Q

treatment of non-small cell not suitable for surgery

A

palliative/curative radio
(poor chemo response)

41
Q

GIT causes of clubbing

A

cirrhosis
Chron’s/UC
Coeliac
Cancer: GI lymphoma

42
Q

signs of pneumonia on examination

A

dec expansion
bronchial breathing
inc vocal resonance

43
Q

3 causes of bronchiectasis

A

idiopathic
congenital
post-infection

44
Q

CXR in bronchiectasis

A

thickened bronchial walls
(tramlines and rings)

45
Q

which lung cancer can release PTHrP

A

squamous CC

46
Q

ARDS definition

A

non-cardiogenic pulmonary oedema
inc capillary permeability

47
Q

management of ARDS

A

admit to ITU for organ support and treat underlying cause

48
Q

pulmonary causes of ARDS

A

pneumonia
aspiration
inhalation injury

49
Q

systemic causes of ARDS

A

shock
sepsis
trauma
pancreatitis
DIC

50
Q

issue in T1RF

A

V/Q mismatch and diffusion failure

51
Q

causes of T1RF

A

Vascular (PE)
Asthma (early)
Pneumothorax
Atelectasis

52
Q

issue in T2RF

A

alveolar hypoventilation

53
Q

causes of T2RF

A

obstructive (COPD, Asthma, Bronchiectasis)
restrictive (dec resp drive e.g. CNS sedation, NM disease)

54
Q

chronic bronchitis definition

A

cough and sputum production on most days for 3 months over 2 successive years

55
Q

emphysema definition

A

histological diagnosis of enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

56
Q

severity of COPD

A

FEV1
mild: >80%
moderate: 50-79%
severe: 30-49%
very severe: <30%

57
Q

indications for LTOT

A

PaO2 < 7.3
or 7.3-8 with complication

58
Q

antibiotic for bacterial exacerbation of COPD

A

Doxy

59
Q

pleural effusion transudate vs exudate

A

<25g/L = transudate
>35g/L = exudate

60
Q

what are Light’s criteria?

A

exudate if
effusion: serum protein ratio >0.5
effusion: serum LDH ratio >0.6
effusion LDH = 0.6 x ULN

61
Q

exudative effusion causes

A

infection
neoplasm
inflammation (RA, SLE)
infarction

62
Q

ILD causes

A

Env: asbestosis
Drugs: Bleomycin, amiodarone
Hypersensitity: EAA
Infection: TB, viral
Systemic: sarcoid, RA
Idiopathic

63
Q

cause of EAA

A

acute allergen exposure in sensitised patients
chronic exposure = granuloma formation and obliterative bronchiolitis

64
Q

acute and chronic symptoms of EAA

A

acute: fevers, malaise, dry cough
chronic: SOB, weight loss, T1RF, cor-pulmonale

65
Q

symptoms and signs of idiopathic pulmonary fibrosis

A

dry cough, SOB, malaise, arthralgia
clubbing, crackles, cyanosis
honeycombing

66
Q

causes of pulmonary HTN

A
  1. L Heart disease: mitral stenosis/regurg, LVF
  2. L parencyhmal disease: COPD, asthma, ILD
  3. pulomonary vascular disease: idiopathic, vasculitis, PE
  4. hypoventilation: OSA, MND
67
Q

investigations in pulmonary HTN

A

R heart catheterisation

68
Q

cause of cor-pulmonale

A

RHF due to chronic pulmonary HTN

69
Q

symptoms of cor pulmonale

A

dyspnoea
fatigue
syncope

70
Q

management of cor pulmonale

A

dec pulmonary vascular resistance (LTOT, sildenafil, CCB)
treat cardiac failure

71
Q

complications of pneumonia

A

hypotension
pleural effusion
empyema

72
Q

signs of CF on exam

A

clubbing
cyanosis
bilateral coarse creps

73
Q

what hormone does squamous CC release?

A

PTHrP (inc Ca)

74
Q

small cell Ca treatment

A

very chemosensitive but very poor prognosis

Year 6 Cross Section (23 decks)

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