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Finals revision > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Give 4 sx of COPD

A

Productive cough
SOB
Wheeze
recurrent infections

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2
Q

How is SOB measured in COPD

A

MRC Dyspnoea scale

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3
Q

Signs of COPD

A

Use of accessory muscles
asterixis
Pursed lip breathing
Tachypnoea
Hyperinflation - barrel chest
decreased cricosternal distance
reduced chest expansion
hyperesonant - percussion
decreased breath sounds
wheeze

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4
Q

How does smoking cause COPD

A

Stimulates neutrophil elastase leading to destruction

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5
Q

Ix COPD

A

CXR
FBC
ABG
ECG
Spirometry

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6
Q

CXR findings in COPD

A

Hyperinflation
bullae
flat hemidiaphragm

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7
Q

Conservative management of COPD

A

Smoking cessation
pulmonary rehab
vaccination

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8
Q

signs of asthma

A

tachypnoea
chest hyperexpansion
hyper resonant
wheeze - polyphonic
Harrisons sulci

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9
Q

Investigations for asthma

A

Spirometry with BDR

FeNO >40ppb - eosinophilic airway inflammation

Peak flow variability >20%

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10
Q

Asthma triggers

A

Animals
infection
meds
cold weather
dust / mould
emotions

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11
Q

conservative asthma management

A

Education
smoking cessation
annual r/v
decrease weight
annual influenza
decrease exposure to triggers

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12
Q

sx of asthma exacerbation

A

worsening SOB
Use of accessory muscles
worsenign wheeze
tachpnoea
reduced air entry

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13
Q

investigations for asthma exacerbation

A

Bloods - FBC / CRP
PEFR
ABG - T2RF
CXR

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14
Q

Signs of life threatneing asthma exacerbation

A

33 92
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia

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15
Q

requirements for hospital discharge following exacerbation

A

PEF > 75% Predicted
inhaler technique checked
stable on meds for 12-24 hours

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16
Q

community management of asthma - adult

A

4 puffs

2 puffs every 2 mins
max 10 puffs

rpt every 20 mins

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17
Q

community management of asthma exacerbation - child

A

1 puff every 30-60s

max 10 puffs

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18
Q

Bronchiectasis causes

A

pneumonia
CF
Idiopathic
TB
Lung cancer

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19
Q

Bronchiectasis features

A

Productive cough
Sputum
dyspnoea
haemoptysis

clubbing
coarse inspiratory crackles
wheeze

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20
Q

Investigations for bronchiectasis

A

CXR - Thickened bronchial walls

Sputum culture + bloods

Spirometry - obstructive

High resolution CT - Diagnostic
Dilated airway and signet rings

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21
Q

Bronchiectasis management

A

smoking cessation
physiotherapy
education

Abx - azithromycin
Bronchodilators - wheeze / sob

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22
Q

RF for lung cancer

A

smoking
silica
coal
asbestos
radiation
HIV

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23
Q

Features of lung cancer

A

cough
SOB
Haemotysis
hoarse voice
fever

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24
Q

Squamous cell carcinoma paraneoplastic syndrome

A

PTH-rp –> Hypercalcaemia

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25
Q

2ww referral criteria for lung cancer

A

CXR suspicious findings

> 40 + unexplained haemoptysis

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26
Q

Causative organisms for CAP

A

Step penumoniae
H influenzae
Moraxella catrhalis

27
Q

causative organisms for a HAP

A

Psudomonas aeruginosa
Staph aureus

28
Q

Features of mycoplasma penumonia

A

cold AIHA
Erythema multiforme

29
Q

Features of legionella pneumophilia

A

SIADH - low sodium
Lymphocytes

30
Q

Features of penumocystisis jivorecci

A

HIV
Excercise induced dyspnoea
Dry cough

31
Q

causative organisms of aspiration pneumonia

A

strep penumoniae
H influenzae

32
Q

RF for aspiration penumoniae

A

stroke
MG
Alcoholics
post-ictal
mechnaical intubation

33
Q

features of pneumoniae

A

productive cough
pleuretic chest pain
haemoptysis
fever
dyspnoea

34
Q

classification of pneumothorax

A

spontaneous
- primary: young tall thin men

  • secondary:
    Asthma
    COPD
    TB
    Penuminae
    Lung cancer

Traumatic

35
Q

what is sarcoidosis

A

multisystem disease characterised by inflammation and granuloma formation

36
Q

What is the classical presentation / syndrome of sarcoidosis

A

Lofgrens syndrome
- erythema nodosum
- BHL
- Polyarthralgia

37
Q

Features of sarcoidosis
- lungs
- heart
- liver
- kidneys
- PNS / CNS
- Eyes
- Derm

A

BHL
Pulmonary fibrosis

BBB/HB

Cirrhosis / cholestasis

Renal stones

Bells palsy

Diabetes insipidus

Uveitis

Lupus pernio

38
Q

causes of BHL

A

Sarcoidosis
TB
Lymphoma
bronchial carcinoma

39
Q

haemoptysis differentials

A

PE
Cancer
TB
Pneumoniae
Bronchiectasis
Goodpastures

40
Q

Investigations for sarcoidosis

A

Bloods - FBC / U+E / CRP / ACE / Ca2+

Urien dipstick

ECG / Spirometry

CXR

Bronchoscopy + biopsy + histology

41
Q

histological finding of sarcoidosis

A

Non caseating granuloma with epithelioid cells

42
Q

Clincial features of sarcoidosis

A

fever
weight loss
SOB
Dry cough

43
Q

What is TB

A

Chronic granulomatous disease caused by mycobacterium TB

44
Q

Causes of re-activation of TB in latent disease

A

Immunosuppresion - steroids
Immunodeficiency
HIV / AIDS
DM
CKD
Lymphoma

45
Q

Who is the BCG vaccine offered to

A

Neonates born in areas of the UK with high rates of TB

Neonates with relatives from countries with a high rate of TB

Neonates with a family history of TB

close contact with TB

Unvaccinated children or young adults that recently arrived from a country with a high rate of TB

Healthcare workers

46
Q

features of TB

A

WEIGHT LOSS
fever
haemoptysis
cough
dyspnoea
night sweats
lymphadenopathy

47
Q

TB investigations

A

Sputum sample and culture - 3 samples

Blood and blood cultures

CXR

48
Q

Specialist tests for TB

A

Mantoux test

Inteferon gamma release assay

49
Q

Causes of exudative PE

A

PE / Pneumoniae
Inflamm - SLE / R.A
Neoplasm
TB

50
Q

Causes of transudative PE

A

HF
Liver cirrhosis
nephrotic syndrome
CKD
Hypoalbuminaemia
Hypothyroid
Meigs syndrome

51
Q

features of PE

A

SOB
Pleuretic CP
Reduced exercise tolerance

52
Q

signs of Pleural effusion

A

tachypnoeic
tahcycradic
tracheal deviation
decreased chest exapnsion
stoney dull percussion
reduced breath sounds
reduced TVF

53
Q

Investigations for Pleural effusion

A

Bloods
- FBC / U+E / LFT - albumin / AST/ALT

CXR

Pleural aspiration and fluid analysis

54
Q

what is measured in a pleural aspirate

A

LDH
Protein
pH
Gram stain
MC&S
Glucose
WCC

55
Q

Outline the lights criteria

A

fluid : serum protein >0.5

fluid : serum LDH > 0.6

Pleural fluid LDH >2/3 upper limit of normal for serum

56
Q

when do you suspect an empeyema

A

improving penumonia but ongoing fever

57
Q

causes of interstitial fibrosis

A

coal / dust / silica
IPF
Medications
lung damage - penumonia / TB
alpha 1 antitrypsin
R.A
SLE
Sjogrens syndrome

58
Q

Medications causing pulmonary fibrosis

A

amiodarone
MXT
Nitrofuranotin

59
Q

features of pulmonary fibrosis

A

dry cough
SOB
Fatigue
clubbing

60
Q

CT chnages of IPF

A

Ground glass
Reticualr opacities

61
Q

Management of IPF

A

Smoking cessation
Pulmonary rehab
Physio
Advanced care plan

O2 therapy
Pirfenidone

Lung transplant

62
Q

consequences of asbestos exposure

A

fibrinogenic
- lung fibrosis - lower lobes
- pleural plaques

carcinogenic
- adenocarcinoma
- mesothelioma

63
Q

causes of hypersenitivity pneumonitis

A

farmers lung
mushroom workers lung
malt workers lung
bird fanciers lung

Finals revision (17 decks)

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