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MSRA- my cards > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What would FEV1, FVC and FEV1/FVC ratio be in a RESTRICTIVE disease?

A

FEV1 and FVC reduced. But FEV1/FVC ratio is normal or increased

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2
Q

Management of Primary Pneumothorax

A

If less 2cm and asymptomatic- discharge
If less 2cm and symptomatic- aspirate
If over 2cm- chest drain

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3
Q

Management of Secondary Pneumonthorax

A

If less than 1cm- oxygen and admit
1-2cm- Aspiration
If over 2cm, and over 50 yo, and SOB- Chest drain

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4
Q

How would a CXR differ in mesothelioma vs asbestosis?

A

Mesothelioma is the cancer- associated with peripheral Masses and pleural plaques.
Asbestosis- fibrosis and pleural plaques. Doesn’t cause big masses.

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5
Q

What are the components of CURB 65

A

Confusion
Urea >7
RR >30
BP 90/60

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6
Q

At what pH should a suspected pleural effusion that’s infected have a chest drain inserted?

A

pH less 7.2

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7
Q

What is a restrictive pattern look like on spirometry?

A

FEV1 reduced
FVC more reduced
FEV1/FVC normal > 70%

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8
Q

What/ how does Aspergillioma present?

A

Past history of TB/ rounded opacity surrounded by air. History of haemopytsis.

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9
Q

What is the antibiotic for prophylaxis in COPD?

A

Azithromycin

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10
Q

In obstructive respiratory disease what happens to the FEV1/ FVC ratio?

A

Obstructive ratio = under 0.7 eg 0.49 would = obstructive picture.

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11
Q

What is the first line management of COPD?

A

SABA/SAMA as required
LABA/ LAMA

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12
Q

If a patient has COPD with asthmatic features what is the management?

A

SABA/SAMA as required
LABA + ICS

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13
Q

What are the general drug principles of Asthma management- in adults?

A

SABA
SABA + ICS
SABA+ICS / Monteluekast
LABA

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14
Q

Alpha anti 1 defiency causes what type of lung disease, obstructive or restricitive?

A

Obstructed

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15
Q

What would the ABG show in COPD with chronic CO2 retention?

A

Normal pH, High co2 and high bicarbonate.

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16
Q

What is the acute management of asthma?

A
  1. Neb salbutamol
  2. Neb ipratropium
  3. Prednisolone PO
  4. Magnesium IV
  5. Amiophylline IV
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17
Q

Pneumocystis jiroveci pneumonia is treated with?

A

Co-trimoxazole

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18
Q

What is the PESI score useful for ?

A

Determining which patients with a PE can be management as an outpatient.

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19
Q

What is the second line management of COPD?

A

2nd line- if asthma features LABA+ICS.
If no asthma features then LABA+LAMA

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20
Q

When would a child say ‘mama’?

A

9 months

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21
Q

What are the findings in asbestosis?

A

Diffuse intersistial fibrosis

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22
Q

What are the findings in mesothelioma?

A

Pleural thickening

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23
Q

What are the features of Klebsiella pneumonia?

A

Alcoholics/ diabetics.
Gram neg
Red current jelly sputum
Cavitating lesions

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24
Q

Side effect of Pyrazinamide? and what is the drug used for?

A

TB drug
Can cause arthralgia/ flare of gout (raising urate)

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25
Q

Side effect of Infiximab?

A

Decompensated of HF. therefore contraindicated in CCF

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26
Q

What rash is associated with Sarcoidosis ?

A

Lupus Pernio- described as blue rash on nose

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27
Q

What are the features of idiopathic pulmonary fibrosis?

A

Clubbing, End respiratory creps, RESTRICTIVE DISEASE

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28
Q

What circumstances can lead to a Staph aureus pneumonia?

A
  1. IVDU
  2. Post influenza infection
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29
Q

What is a moderate dose steroid for Asthma in adults?

A

= 400 micrograms budesonide or equivalent = low dose

400 micrograms - 800 micrograms budesonide or equivalent = moderate dose

> 800 micrograms budesonide or equivalent= high dose.

30
Q

Summarise Asthma guidelines adults

A
  1. SABA
  2. SABA + ICS
  3. SABA+ ICS + LRTA
  4. ICS + LABA (+/- LRTA)
  5. ICS (mod dose) + LABA (+/- LRTA)
31
Q

What is the spectrum of disease for asbestos exposure?

A
  1. Pleural plaques- benign
  2. Pleural thickening
  3. Asbestosis- lower lobe fibrosis + restrictive disease. (conservative management)
  4. Mesothelioma- malignant ca of pleural
    - pal chemo
  5. Lung ca.
32
Q

Histoplasmosis - caused by ?

A

Caused by inhalation of fungus spores-commonly a/w bat droppings

33
Q

What is the COPD stable management (no asthmatic features)

A

SABA/ SAMA PRN
LAMA+ LABA
LAMA+ LABA+ ICS

34
Q

What is the COPD stable management (WITH asthmatic features)

A

SABA/ SAMA PRN
LABA+ ICS
LABA+ LAMA+ ICS

35
Q

What are the different types of lung ca and which ones are a/w smoking?

A

Non small cell (non smokers)- most common adenocarcinoma

Small cell carcinoma -(smoking).

36
Q

What are some examples of Extrinsic allergic alveolitis?

A

bird fanciers’ lung: avian proteins

farmers lung: spores of Saccharopolyspora rectivirgula (formerly Micropolyspora faeni)

malt workers’ lung: Aspergillus clavatus

mushroom workers’ lung: thermophilic actinomycetes*

37
Q

What are the investigations for idiopathic pulmonary fibrosis?

A

Spirometry AND diffusion testing
CXR
CT thorax including high resolution

38
Q

What is a radiological feature of pulmonary fibrosis?

A

Honeycombing

39
Q

What makes up Lights criteria?

A

Protein, glucose and LDH of the pleural fluid and serum.

NB pleural pH is NOT part of lights criteria!- but still important**

40
Q

Non small cell lung ca vs small small- treatment principles?

A

Non small cell= surgery! and chemo/ radio. Remember non small cell= non smokers.

Small cell= chemo and radio (NOT SURGERY)

41
Q

Colours of sputum:
Streptococcus pneumonia
Psudeomonas aurgenisoa
Haemophilus Influenza
Klebsiella

A

Streptococcus pneumonia - red coloured/ rust
Psudeomonas aurgenisoa - green
Haemophilus Influenza- green
Klebsiella- red currant jelly

42
Q

Silicosis- what are the radiological features?

A

Bilateral hilar lymphadenopathy calcification
AND
upper lobe zone fibrosis

43
Q

Complications of Lung ca.
How does Pancoast tumour present?

A

Pancoasts- destruction of brachial plexus. Tinging in hands and wasting of muscles of hand.

44
Q

Severity of asthma: how do you characterise severity according to PEF?

A

Life threatening- less than 33%
Severe: 33-50%
Moderate 50-75%

45
Q

ABG- what happens to the CO2 in respiratory acidosis/alkalosis

A

Respiratory acidosis = CO2 raised
Respiratory alkalosis= CO2 low

46
Q

What are the causes of a respiratory alkalosis?

A

Hyperventilation
Panic attack
PE
Pneumothorax

47
Q

What is seen in acute respiratory acidosis and causes?

A

pH LOW (acidosis)
CO2 high
HCO3 low

Exacerbation of COPD

48
Q

What is seen on respiratory alkalosis?

A

PH high (alkalosis)
CO2 low
HCO3 low/ normal

49
Q

What are the bloods for metabolic acidosis ?

A

pH low
CO2 low
Bicarb low

50
Q

What is the definitive diagnosis for Sarcoidosis?

A

Tissue biopsy: non-caseating granulomas

51
Q

What pH on a pleural tap is diagnostic for empyema?

A

Less than 7.2

52
Q

What test is diagnostic in COPD?

A

POST bronchodilator therapy spirometry

Obstructive disease FEV1/FVC less than 0.7

53
Q

Causes of OBSTRUCTIVE lung disease?

A

COPD/ Asthma/ Emphysema/ Bronchiectiasis/ CYSTIC FIBROSIS

54
Q

What causes a restrictive disease? FEV1/FVC > 0.7

A

Pregnancy/ Pulmonary oedema/ Pulmonary fibrosis/ Neuromuscular diseases/ Interstitial lung disease

55
Q

SIADH - what are the bloods/ urine investigations?

A

Inappropriate ADH secretion

  • Hyponatraemia
  • Concentrated urine (high urine osmolality)
  • Decreased serum osmolality
56
Q

What are the lung complications a/w methotrexate

A

Pulmonary fibrosis

Pneumonitis (acute reaction. usually during first year. cough/ dyspnoea and fever)

57
Q

CAP Abx

A

Amoxillin for low/ moderate severity
Doxcycline if pen allergic

High severity CURB 3+- co amoxiclav+ Clarithromycin/ erythromycin

58
Q

Paraneoplastic features of lung ca (small cell vs squamous cell)

A

Small cell (NON smokers) ACTH and ADH
Squamous cell- HYPERCALCAEMIA (PTH like peptide)

59
Q

What are the features of Mycoplasma pneumonia?

A

Children (innate immune systems)
Atypical pnuemonia
Haemolytic anaemia
Thrombocytopenia
COLD agglutinins
COLD autoimmune haemolytic anaemia
Tx) Doxycycline/ erythromycin

60
Q

Pnuemocystits Jirovi is what type of organism?

A

Fungus

61
Q

How to diagnose an exudative effusion?

A

Exudative pleural effusion due to pneumonia/ malignany

Increased protein ratio
Increased LDH ratio

62
Q

Features of alpha anti1 tripysin?

A

Affects lungs and liver
Obstructive disease
Deranged LFTs
(similar symptoms to COPD)

63
Q

Management of exacerbation of COPD?

A

Increase short acting bronchodilator
Prednisolone 30mg 5/7
If Abx indicated Amoxicillin first line (5 days)

64
Q

How is the wells score used for Ix of PE?

A

Score of 4 is the cut off!
Over 4= straight to CTPA
Under 4= Ddimer

65
Q

Antibiotics for atypical CAP eg legionella

A

Amoxicillin with macrolide (clarithromycin/ erythromycin)

66
Q

Facts about: Pneumocystis jiroveci

A

Most common infection in immuncompromised
Dry cough, fever, bilateral pulmonary infiltrates.
May not be cultured on sputum sample
BUT would be sampled with bronchoalveolar lavage

TX- COTRIMOXAZOLE

67
Q

Classic features of each of these types of pnuemonia
- Streptococcus pnumonia
- HIB
- Mycoplasma pneumonia
-Legionella
- Klebsiella
- Staph aureus
-Pnuemocystitis Jirovi
- Pseudomonas aurginosa

A
  • Streptococcus pneumonia- most common. Rust colour sputum
  • HIB - common in COPD exacerbations- green sputum
  • Mycoplasma pneumonia - LFTs/haemolytic anaemia/ erythema multiforme- treat with macrolide
    -Legionella- Hyponatraemia. Treat with macrolide
  • Klebsiella - alocholics or diabetics. Red sputum
  • Staph aureus- common in CF/ post influenza. Flucoxacillin
    -Pnuemocystitis Jirovi - HIV. Co trimoxazole
  • Pseudomonas aurginosa - CF. Green sputum
68
Q

What pneumonia is associated with bullous myringitis?

A

Mycoplasma pneumonia (atypical pnuemonia)
Needs treatment with macrolide.

69
Q

What scale measures breathlessness in COPD?

A

MRC scale of breathlessness
Stage 1-5
Stage 1: Not troubled by SOB unless strenuous exercise

Stage 5:Cannot leave the house

70
Q

When do you need to add extra asthma management/ what is considered inadequate control?

A

If using SABA (Salbutamol) more than 3 times a week!!

71
Q
A

MSRA- my cards (15 decks)

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