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Finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is gold standard for asthma

A

Spirometry with bronchodilator reversibility
AND
Fractional inhaled nitric oxide

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2
Q

What causes pleural plaques

A

Asbestos

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3
Q

What do if patient has pleural plaques on CXR

A

Nothing as do not undergo malignant transformation

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4
Q

What suggests a COPD patient will be steroid responsive

A
  • previous diagnosis of asthma or atopy
  • a higher blood eosinophil count
  • substantial variation in FEV1 over time (at least 400 ml)
  • substantial diurnal variation in peak expiratory flow (at least 20%)
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5
Q

MOst common organism found in bronchiectasis

A

Haemophilus

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6
Q

What do if have lung abscess not responding to IV abx

A

Arrange CT guided percutaneous drainage

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7
Q

What is included in kartageners syndyome

A

Dextrocardia
Situs invertus
Bronchiectasis
Recurrent sinusitis
Subfertility

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8
Q

Atelectasis management

A

Chest physiotherapy with mobilisation and breathing exercise

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9
Q

If have a pleural effusion in pneumonia/sepsis, what are criteria for inserting a chest drain

A

Must take a fluid sample
- if it is cloudy or purulent
- pH less than 7.2
Then insert chest drain

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10
Q

Resp causes of clubbing

A

TB
Bronchiectasis
Cancer
Fibrosis
Asbestos

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11
Q

Differeniating between right upper and middle lobe pneumonia

A

Upper is above the horizontal fissure
Middle is below the horizontal fissure
Picture is of middle lobe pneumonia

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12
Q

Cause of white out lung

A

Lung collapse
Pneumonectomy
Pleural effusion
Consolidation
Mass

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13
Q

When determining cause of white out in lung, what is useful to look at to help determine cause

A

Trachea position

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14
Q

Cause of white out lung with trachea central

A

Consolidation
Pulmonary oedema
Mesothelioma

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15
Q

Cause of white out lung with trachea deviated away from white out

A

Pleural effusion
Diaphragmatic hernia
Large thoracic mass

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16
Q

Cause of white out lung with trachea pulled towards white out

A

Pneumonectomy
Complete lung collapse

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17
Q

When have to do an ABG in asthma

A

If sats less than 92%

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18
Q

Other than alcoholics, who else is klebsiella pneumonia seen in

A

Diabetics

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19
Q

What pneumonia is red currant jelly sputum seen in

A

Klebsiella

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20
Q

What is management of a chest infection productive of yellow sputum with rhinosinusitis

A

Likely viral so self limiting

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21
Q

Patient with unilateral pneumonia develops bilateral crackles, what is cause

A

ARDS

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22
Q

Causes of ARDS

A

infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
Covid-19
cardio-pulmonary bypass

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23
Q

What is a cough worse after taking aspirin

A

Asthma

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24
Q

What blood result can indicate cancer (nothing to do with paraneoplastic syndromes)

A

Raised platelets

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25
Q

Gold standard for OSA

A

polysomnography (PSG)

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26
Q

Prophylactic antibiotic choice in COPD

A

Azithromycin

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27
Q

Triad for youngs syndrome

A

Bronchiectasis
Sinusitis
Azoospermia

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28
Q

Immediate atelectasis management

A

Sit patient upright
Then refer to physio

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29
Q

Who do aspergillomas tend to occur in

A

People who have hx of TB

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30
Q

Presentation of goodpastures

A

Haemoptysis
Systemically unwell: fever, nausea
Glomerulonephritis

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31
Q

Exudative causes of pleural effusion

A

infection (e.g. pneumonia)
inflammation (e.g. rheumatoid arthritis / SLE / pancreatitis)
malignancy

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32
Q

First line management of pleural effusion

A

Pleural diagnostic aspirate
Do this before any chest drain is inserted

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33
Q

What is a mycetoma/aspergilloma

A

Fungus ball forming in a pre existing cavity

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34
Q

What is allergic bronchopulmonary aspergillosis

A

Where get hypersensitivity to aspergillus spores in the airways leading to an eosinophilic asthma

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35
Q

Management of ABPA

A

Oral prednisolone
2nd line oral itraconazole

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36
Q

Presentation of ABPA

A

Typically will have previous cystic fibrosis or bronchiectasis
Bronchoconstriction- wheeze, cough, dyspnoea
Mucous plugs

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37
Q

CXR findings of ABPA

A

Central bronchiectasis
Fleeting changes

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38
Q

Investigations for ABPA

A

Bloods
- eosinophilia + high IgE
- RAST positive for aspergillus
- positive IgE and IgG preciptins for aspergillus

CXR
- central bronchiectasis

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39
Q

Management of latent TB

A

6 months of isoniazid with pyridoxine

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40
Q

Management of primary pneumothorax

A

If less than 2cm and non-dyspnoeic= discharge and review
If over 2cm or dyspnoeic= aspiration

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41
Q

What is the management of recurrent pneumothoraxes

A

Video assisted thorascopic surgery for pleurodesis (obliterates the pleural space)

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42
Q

Management of alpha 1 antitrypsin

A

no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation

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43
Q

Presentation of alpha-1-antitrypsin

A

Emphysema in a young non-smoker
Jaundice and liver disease

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44
Q

Difference in liver presentation of alpha-1-antitrypsin in children vs adults

A

Children- cholestasis
Adults- cirrhosis and HCC

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45
Q

Investigations for alpha-1-antitrypsin

A

A1AT levels
Spirometry shows obstructive picture
Chest imaging shows lower zone fibrosis

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46
Q

Presentation of acute bronchitis

A

White/clear sputum cough
Fever
Smoker

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47
Q

Differentiating pneumonia from acute bronchitis on CXR

A

Bronchitis CXR will be clear

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48
Q

Management of acute bronchitis

A

Doxycycline
CI in children and pregnant women so use amoxicillin

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49
Q

When treat acute bronchitis

A

CRP over 100
Pre-existing co-morbidities
Systemically unwell

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50
Q

How are most mesotheliomas picked up

A

CXR showing pleural thickness or effusion
Pleural effusion

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51
Q

Presentation of mesothelioma

A

Chest pain
SOB
Wt loss
Clubbing
Asbestos- 30 years prior

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52
Q

Investigations for mesothelioma

A

CT
Confirmed on histology with biopsy from thoracoscopy

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53
Q

Gold standard for mesothelioma

A

Thoracoscopy for pleural biopsy

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54
Q

What are options for smoking cessation

A

Nicotine replacement
Varenicline
Bupoprion

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55
Q

Risk of using bupropion

A

Seizure risk

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56
Q

Bupropion contraindications

A

Epilepsy
Pregnancy
Breast feeding

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57
Q

Contraindications to varenicline

A

Pregnancy
Breastfeeding

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58
Q

Management of smoking cessation in pregnancy

A

CBT first line
NRT might be used

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59
Q

Side effecrs of varenicline

A

Nausea and vomiting
Suicide

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60
Q

Management of smoking cessation

A

Motivational interview
Identify target stop date
NRT then use either varenicline or bupropion in lead up to target stop date

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61
Q

Management of small cell lung cancer

A

If T1 then can consider surgery
If more extensive then radio or chemo
Palliative chemo

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62
Q

How differentiate exudate from transudate

A

In principal if protein under 30= transudate
If protein over 30 = exudate
If 25-35 use lights criteria

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63
Q

What is in lights criteria

A

If meets one of these then is exudate
- pleural protein/serum protein >0.5
- pleural LDH/ serum LDH >0.6
- pleural LDH > 2/3 upper limits LDH serum level
LDH=6 to remember

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64
Q

Causes of high amylase in pleural fluid

A

Oesophageal perforation
Pancreatitis

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65
Q

Causes of very bloody pleural fluid

A

Mesothelioma
PE
TB

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66
Q

Causes of low glucose in pleural fluid

A

TB
RA
Empyema

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67
Q

Causes of lower lobe fibrosis

A

ACID
Asbestosis
Connective tissue diseases- RA, scleroderma
Idiopathic
Drugs- amiodarone, methotrexate, bleomycin, cyclophosphamide, nitrofurantoin

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68
Q

Which drugs cause lower lobe fibrosis

A

Amiodarone
Methotrexate
Bleomycin
Cyclophosphamide
Nitrofurantoin

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69
Q

Borders of triangle of safety

A

Base of axilla
Anterior border of latissimus dorsi
5th intercostal space
Lateral edge of pectoralis major

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70
Q

First line for OSA

A

Weight loss
CPAP if moderate/severe

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71
Q

What is next line for mild OSA after weight loss

A

Overnight CPAP

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72
Q

In COPD what is main measure to increase survival

A

Stop smoking

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73
Q

Lung abscess presentation

A

Subacute presentation over a few weeks
Productive cough of smelly sputum
Haemoptysis
Chest pain
SOB
Systemic upset-fever, weight loss, night sweats

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74
Q

Risk factors/causes of lung abscess

A

Most commonly from aspiration
- stroke
- LOC
- poor dental hygiene
Empyema
Haematogenous

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75
Q

What bacteria tend to be involved in lung abscesses

A

Mainly polymicrobial
Monomicrobial
- s.aureus
- klebsiella
- pseudomonas

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76
Q

Investigations for lung abscess

A

Blood and sputum cultures
CXR

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77
Q

CXR finding in lung abscess

A

Fluid filled area of consolidation
Air fluid level

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78
Q

Management of lung abscess

A

IV abx
If these fail then percutaneous draninage
May consider rarely surgical resection

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79
Q

How assess OSA

A

Assess sleepiness with ESS
Diagnose using PSG

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80
Q

What can be used for OSA if CPAP not tolerated

A

Intra oral devices like mandibular advancement

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81
Q

Target oxygen saturations if asthmatic

A

94-98%

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82
Q

What vaccinations should COPD patients recieve

A

Annual influenza
One off pneumococcal

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83
Q

Difference in tests for asthma in under 16s vs over 16s

A

Under 16s= spirometry and bronchodilator reversibility test
Over 16s= spirometry with a bronchodilator reversibility test AND FeNO

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84
Q

What happens if overoxygenate a COPD patient

A

Lose hypoxic drive for O2 therefore hypoventilate, retain CO2 and go into T2RF

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85
Q

Lung cancer with gynaecomastia- what subtype

A

Adenocarcinoma

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86
Q

If identify cannonball mets on CXR, what is next investigation

A

CT abdomen

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87
Q

What determines satisfactory NG tube placement on CXR

A

If subdiaphragmatic position

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88
Q

What effect does OSA have on blood pressure

A

HTN

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89
Q

CURB65 score

A

AMTS < 8
RR >30
Raised UREA
Sys <90 or dias <60

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90
Q

What can you not do after a pneumothorax

A

Fly for 2 weeks
Scuba dive unless surgical pleurodesis

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91
Q

What is most common cause of occupational asthma

A

Isocyanates from spray paininting

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92
Q

How investigate occupational asthma

A

Serial peak flow measurements

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93
Q

Is it normal to still have pneumonia sx at 4 weeks

A

Yes NICE recommends cough and SOB have reduced substantially but still be there
Have CXR at 6weeks

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94
Q

What causes restrictive lung spirometry in ank spond

A

Kyphoscoliosis
Fibrosis can too but rarer

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95
Q

Management of sarcoidosis

A

Steroids if
- hypercalcaemia
- lung parenchymal involvement
- eye involvement
- heart involvement
- neuro involvement

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96
Q

What is management of oxygen in all COPD patients acutely

A

Initially aim for 88-92% with venturi mask at 4L/min
Once do a blood gas aim for 94-98% if know pCO2 is normal

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97
Q

What do if pCO2 is normal on blood gas of COPD patient

A

Change oxygen to 94-98% target saturations

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98
Q

When do you not give oxygen acutely unless there is evidence of hypoxia

A

MI
Stroke
Obstetric emergency
Anxiety related hyperventilation

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99
Q

What do oxygen wise if COPD patient comes in acutely unwell

A

Give high flow 15L as hypoxia kills before hypercapnia

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100
Q

When can acute asthma patients be discharged

A

Allof
- PEF >75% of best or predicted
- Stable on their discharge medication for 12-24 hours
- Inhaler technique checked and recorded

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101
Q

What would cause a ventilated patient to drastically deteriorate

A

Tension pneumothorax

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102
Q

Presentation of acute mountain sickness

A

Headache
Nausea
Fatigue

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103
Q

What causes acute mountain sickness

A

Fitter you are increases risk
Gain 500m a day

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104
Q

How prevent acute mountain sickness

A

Acetazolamide

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105
Q

How treat acute mountain sickness

A

Descent

106
Q

Presentation of high altitude cerebral oedema

A

Confusion
Ataxia
Papilloedema
Headache

107
Q

Presentation of high altitude pulmonary oedema

A

Normal lung oedema presentation

108
Q

Management of high altitude pulmonary oedema

A

Descent
Oxygen
Nifedipine or dexamethasone

109
Q

Management of high altitude cerebral oedema

A

Descent
Dexamethasone

110
Q

What causes egg shell calcification of hilar nodes and upper zone shadowing in a miner

A

Silicosis

111
Q

In asymptomatic patient, what does right testicle hanging lower than left suggest

A

Kartageners due to situs inversus

112
Q

What does a normal PCO2 classify an asthma attack as

A

Life threatening

113
Q

Management of secondary pneumothorax

A

> 2cm/SOB and over 50 then chest drain
1-2cm aspiration
<1cm then admit and oxygen for 24 hours

114
Q

Examination findings of idiopathic pulmonary fibrosis

A

Fine end-inspiratory crepitations
Clubbing

115
Q

Wedge shaped infarct on CXR

A

PE

116
Q

Which lung cancer causes a cavitating lesion

A

Squamous cell

117
Q

What is the lingula

A

Projection of left lung over the where heart is
Homologous with right middle lobe

118
Q

What is key CXR finding of left lingula consolidation

A

Cant see left border of heart clearly

119
Q

Calcified plaques on CXR

A

Pleural plaques from asbestos

120
Q

Causes of bullae in the lung

A

Smoking
COPD

121
Q

How do bullae appear on CXR

A

Lucent area

122
Q

What is diagnosis if in COPD patient do a chest drain on suspected pneumothorax but is no improvement

A

Bullae

123
Q

What does high pulmonary capillary wedge pressure suggest about cause of pulmonary oedema

A

Is cardiac in nature

124
Q

What use to guide pleural tap

A

USS

125
Q

Contraindications to chest drain

A

INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions

126
Q

Management of tension pneumothorax

A

Insertion of 14G cannula into 2nd intercostal space

127
Q

What is normal FEV1/FVC

A

Above 0.7

128
Q

Restrictive spirometry findings

A

Reduced FEV1 and FVC
Maintained or increased FEV1/FVC

129
Q

Obstructive spirometry findings

A

Reduced FEV1/FVC ratio

130
Q

Obstructive spirometry causes

A

COPD
Asthma
Alpha-1-antitrypsin
Bronchiectasis

131
Q

Restrictive spirometry causes

A

Anything that causes fibrosis
Sarcoid
Kyphoscoliosis
ARDS
Neuromuscular conditions
Severe obesity

132
Q

What is the transfer factor

A

Rate at which gas will diffuse from alveoli into blood

133
Q

What is used to measure transfer factor

A

Carbon monoxide

134
Q

Causes of increased TLCO

A

Asthma
Pulmonary haemorrhage
Polycythaemia
Left to right cardiac shunts

135
Q

Causes of reduced TLCO

A

pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output

136
Q

What would cause a restrictive spirometry with a normal TLCO

A

Obesity

137
Q

What is TLCO vs KCO

A

TLCO is the overall measure of gas transfer
KCO is a coefficient where gas transfer is measured according to total lung volume

138
Q

What is threshold for asthma diagnosis FENO

A

Above 40 parts per billion

139
Q

What are looking for spirometry and reversibility test to diagnose asthma

A

Spirometry
- FEV1/FVC less than 70%= obstructive
Reversibility
- improvement of 12% or more or increase in volume over 200ml

140
Q

What is given to newly diagnosed asthma

A

SABA PRN
OR
Add low dose ICS if with symptoms over 3x a week or night-time waking

141
Q

Step wised asthma

A

1=SABA or SABA+ low dose ICS if sx 3x a week or night waking
2= SABA + LD ICS if not already on
3= add LTRA
4= add LABA +/- LTRA depending on response
5= add low dose MART +/- LTRA depending on response
6= change low dose MART to medium
7= cange to high dose MART/trial long acting muscarinic or theophylline/seek advice from expert

142
Q

What would be a low, medium and high dose steroid inhaler

A

Low= <400mg budenoside
Medium= 400-800mg budenoside
High= >800mg budenoside

143
Q

PEFR for classifying asthma attacks

A

Moderate= >50%
Severe= 33-50%
Life threatening= 33%>

144
Q

Moderate asthma attack features

A

PEFR >50%
No features of severe or life threatening

145
Q

Severe asthma attack features

A

PEFR 33-50%
Incomplete sentences
RR>25
HR>110

146
Q

Life threatening asthma attack features

A

PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
Normal or high PCO2

147
Q

What determines a near fatal asthma attack

A

Raised PCO2

148
Q

When do a CXR for an asthma attack

A

Life threatening
Suspected pneumothorax
Failure to respond to treatment

149
Q

Who admit for an asthma attack

A

Previous near fatal attack
Pregnant
All life threatening attack
Severe or moderate that are not responding to treatment

150
Q

How is salbutamol given in asthma attack

A

Life threatening- nebulised
Severe or better= pressure metred dose inhlaer or oxygen driven

151
Q

MOA of theophylline

A

Phosphodiesterase inhibitor

152
Q

Oxygen therapy in an asthma attack

A

If acutely unwell start on 15L nonrebreathe
Aim for 94-98%

153
Q

Acute asthma attack

A

Salbutamol and oxygen if needed
Oral steroids pred 40mg
Ipatropium if severe or life threatening that is not responding to salbutamol and steroids
IV mag sulp, salbutamol and aminophylline all options then

154
Q

If trialled all medications what are options for asthma attack

A

Intubation and ventillation
ECMO
ITU

155
Q

Options after nebulised medications

A

IV aminophylline, mag sulphate and salbutamol

156
Q

What is alternative to salbutamol in acute asthma

A

Terbutaline

157
Q

Risk factors for aspiration pneumonia

A

Recent intubation
Stroke
Neuromuscular deficit

158
Q

How step down asthma treatment

A

Not just to go from step 3 to 2 etc
Reduce steroid doses by 25-50%

159
Q

How often can step down asthma treatment

A

3 monthly basis

160
Q

What do with daily asthma medications while in hospital for attack

A

Keep taking them as per

161
Q

In seretide 500/50, what does each number suggest

A

500 is the steroid dose
25 is the laba dose

162
Q

What does not getting asthma symptoms on holiday or at weekends suggest

A

Occupational asthma

163
Q

What should do if asthma patient says they do not get symptoms at weekend or on holiday

A

Likely occupational asthma so refer to specialist

164
Q

Patient comes in with suspected asthma attack for last few days, what do

A

Prescribe prednisolone 40mg for 5 days

165
Q

What is extrinsic allergic alveolitis/hypersensitivty pneumonitis

A

Hypersensitivty caused by inhalation of organic spores

166
Q

Immune response in hypersensitivty pneumonitis

A

Type III but then can become 4 when chronic

167
Q

Examples of hypersensitivity pneumonitis

A

Bird fanciers lung
Farmers lung
Malt workers
Mushroom workers lung

168
Q

Management of EAA

A

Avoid triggers
Can use steroids

169
Q

Investigations for EAA

A

imaging: upper/mid-zone fibrosis
bronchoalveolar lavage: lymphocytosis

170
Q

Acute EAA presentation

A

dyspnoea
dry cough
fever
A few hours after exposure

171
Q

Long term EAA presentation

A

lethargy
dyspnoea
productive cough
anorexia and weight loss

172
Q

What determines COPD severity

A

FEV1 of predicted

173
Q

COPD severity categories

A

Stage 1 (mild)- FEV1 >80% with mild symptoms
Stage 2 (moderate)- 50-79%
Stage 3 (severe)- 30-49%
Stage 4 (very severe)- <30%

174
Q

What must post bronchodilator FEV1/FVC be for COPD diagnosis

A

<0.7

175
Q

Investigations for COPD

A

CXR
FBC to exclude polycythaemia
BMI
Post bronchodilator spirometry

176
Q

General COPD management for all patients

A

Smoking cessation
Annual influenza vaccine
One off pneumococcal vaccination

177
Q

What can be done for COPD patients who are functionally disabled by COPD

A

Pulmonary rehabilitation- education and exercise programme

178
Q

First line for COPD

A

SABA or SAMA

179
Q

Second line for COPD if steroid responsive

A

LABA + ICS

180
Q

Third line for COPD if steroid responsive

A

SABA as required (must change SAMA to SABA)
Triple therapy
- LABA
- LAMA
- ICS
Use combined inhalers where possible

181
Q

Second line for COPD if not steroid responisve

A

Add LABA and LAMA
SABA as required (must change SAMA to SABA)

182
Q

What do if all inhalers are not working or not feasible in COPD

A

Oral theophylline

183
Q

Management of cor pulmonale in COPD

A

Loop diuretic and consider long term oxygen

184
Q

What need to do before starting long term azithromycin for COPD

A

CT thorax to exclude bronchiectasis
Sputum culture to exclude chronic infections
ECG to look for long QT
Baseline LFTs

185
Q

What is a LABA example

A

Salmeterol

186
Q

What is a LAMA example

A

Tiotropium

187
Q

How does assessment of COPD patients for long term oxygen work

A

People are assessed if
- FEV1 <30%
- cyanosis
- polycythaemia
- oedema
- raised JVP
- sats less than 92% on air
Assessment involves having 2 ABGs 3 weeks apart

188
Q

Who assess for long term oxygen therapy

A
  • FEV1 <30%
  • cyanosis
  • polycythaemia
  • oedema
  • raised JVP
  • sats less than 92% on air
189
Q

How assess people for long term oxygen

A

Take 2 ABGs 3 weeks apart

190
Q

Based off 2 ABGs who should get long term oxygen

A

2 measurements pO2 less than 7.3kPa
OR
pO2 7.3-8kPa and 1 of
- polycythaemia
- peripheral oedema
- pulmonary HTN

191
Q

How would tell if chest drain is in the right place based off the water seal

A

It would rise on inspiration and fall on expiration

192
Q

Long term options for COPD (non-inhaler)

A

Azithromycin
Oxygen therapy
Smoking cessation

193
Q

Patient is recovering from pneumonia but CRP has risen, why

A

CRP shows a lag in decreasing in comparison to the white cell count in treatment of acute bacterial infection

194
Q

Organisms localised in bronchiectasis

A

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Staph aureus

195
Q

Long term bronchiectasis management for all patients

A

Physio
Vaccines
Exacerbation management

196
Q

What should be given to all COPD exacerbation patients

A

Prednisolone 30mg for 5 days

197
Q

When give abx in COPD exacerbations

A

Purulent sputum
Pneumonia signs like focal area of consolidation or reduced air entry

198
Q

Reasons for COPD admission

A

severe breathlessness
acute confusion or impaired consciousness
cyanosis
oxygen saturation less than 90% on pulse oximetry.
social reasons e.g. inability to cope at home (or living alone)
significant comorbidity (such as cardiac disease or insulin-dependent diabetes)

199
Q

Acute management of COPD exacerbation

A

Oxygen based off CO2
Nebulised salbutamol and ipratropium
Oral or IV steroids
IV theophylline if needed

200
Q

What use if acute COPD patients fail to respond to bronchodilators

A

IV theophylline

201
Q

What need to do if COPD patient becomes acidotic

A

pH 7.25-7.35= BiPAP
pH<7.25= BiPAP with more regular monitoring in HDU or consider ventilation

202
Q

When consider non-invasive ventilation in COPD patients

A

Failed to respond to all medical treatments
pH<7.35

203
Q

What can give for patient to take home if frequent COPD exacerbations

A

Rescue packs- prednisolone and abx
need to contact someone however before taking them

204
Q

What is required to start long term oxugen therapy in COPD

A

Must have stopped smoking

205
Q

What is used to assess risk in PE patients

A

Pulmonary embolism severity index
PESI score which will determine if outpatient care possible, depends on haem stability, comorbidities and support at home

206
Q

How treat PE if haem unstable

A

Thrombolysis
Consider invasive procedures if available at centre

207
Q

What can do for people with recurrent PEs

A

Inferior vena cava filters which trap any emboli

208
Q

Choice of investigation for suspected PE if renal failure

A

V/Q scan

209
Q

How interpret wells score

A

4 or less= d-dimer
More than 4= CTPA or DOAC if delay

210
Q

What are signs on examination of tension pneumothorax that arent trachea deviation

A

Absent lung sounds
Hypotension
Elevated JVP

211
Q

What is blood marker of PE severity

A

Troponin

212
Q

What is a patients with asthma predicted PEFR

A

Above 80% of their best

213
Q

Management of pneumonia based off CURB 65

A

0= outpatient with oral amox
1= outpatient with oral amox unless severe comorbidities
2= admit with amox and clari
>3= admit with IV co amox and clari

214
Q

What must do for patients with CURB65 2 and above

A

Microbiological testing
- sputum cultures
- legionella etc antigen tests

215
Q

Which investigation in GP can be done to guide pneumonia management

A

Point of care CRP which available at some sites and can guide abx
- 20> do not give abx
- 20-100 give delayed
- >100 give abx

216
Q

What do if strongly suspect legionella in pneumonia management

A

Add levofloxacin to regime

217
Q

Low, intermediate and high risk based off CURB65

A

0/1- LOW
2- INTERMEDIATE
3 and above- HIGH

218
Q

Hospital acquired pneumonia antibiotics

A

Non-severe- Co-amox
Severe- tazocin or vancomycin if MRSA

219
Q

Flu like illness in a farmer

A

Coxiella

220
Q

Pancoast tumour extra pulmonary signs

A

Horners syndrome
Recurrent laryngeal nerve infiltration-> hoarseness
Brachial plexus infiltration

221
Q

Small cell lung cancer paraneoplastic syndromes

A

ACTH
SIADH
Lambert-eaton
Limic encephalitis from anti-Hu abs

222
Q

What is limbic encephalitis

A

Paraneoplastic syndrome in small cell lung cancer where get anti-hu antibodies produced which target limbic areas leading to confusion, seizures and memory loss

223
Q

What is pembertons sign

A

Seen in SVC obstruction
Raising hands above head leads to facial flushing and cyanosis

224
Q

What is done under NICE 2ww lung cancer referral

A

CXR within 2 weeks

225
Q

What need to do if identify supraclavicular nodes or clubbing in an over 40

A

Urgent CXR in 2 weeks for lung cancer

226
Q

NICE lung cancer referral guidelines for CXR in 2 weeks

A

If over 40 and 1 of;
- clubbing
- supraclavicular lymph nodes
- thrombocytosis
- chest signs of cancer
- recurrent chest infections
If over 40 and never smoked with 2 of or smoked and asbestos exposure with 1 of;
- weight loss
- fatigue
- SOB
- cough
- no appetite

227
Q

What scan do after lung cancer identified on CXR

A

CT CAP

228
Q

What non-resp specific symptoms if identified in over 40 require urgent CXR

A

Clubbing
Supraclavicular lymp nodes
Thrombocytosis

229
Q

Which cancers do asbestos lead to

A

Adenocarcinoma of lung most common
Mesothelioma

230
Q

Idiopathic pulmonary fibrosis management

A

Prognosis very poor- 3-5 years
Can give 2 drugs to reduce inflammation and fibrosis
- Pirfenidone
- Nintedanib- tyrosine kinase inhibitor

231
Q

What is cryptogenic organising pneumonia

A

Where in response to infection, inflammatory disorders, medications, radiation, environmental toxins, or allergens can get area of focal inflammation presenting in similar way to pneumonia

232
Q

How diagnose and management of cryptogenic organising pneumonia

A

Lung biopsy
Systemic steroids

233
Q

General management of lung fibrosis

A

Stop smoking
Control or avoid trigger
Oxygen therapy
Lung physio and rehab
Can consider lung transplant

234
Q

What do if CTPA negative

A

Do duplex USS if suspect DVT

235
Q

When cant use DOAC for PE

A

GFR under 15

236
Q

First and second line for PE

A

1st- apixaban and rivaroxaban
2nd- LMWH followed by dabigatran or edoxaban OR LMWH followed by warfarin

237
Q

PE management if antiphospholipid syndrome

A

LMWH followed by warfarin

238
Q

What is pneumoconiosis

A

Where get lung fibrosis in response to inhalation of dust and other particles includes coal workers lung, berryliosis etc

239
Q

Pneumoconiosis imaging features

A

Nodules of fibrosis with reticulonodular shadowing- most commonly in upper lobes

240
Q

Causes of bronchiectasis

A

CF
TB
Pertussis
PCD syndromes
Yellow nail syndrome
Post pneumonia

241
Q

Yellow nail syndrome features

A

Bronchiectasis
yellow nails
Lymphoedema

242
Q

Signs on examination of bronchiectasis

A

Clubbing
Cor pulmonale signs- oedema, JVP up
Diffuse coarse crackles which alter with coughing
Scattered wheeze

243
Q

When consider lung transplant for bronchiectasis

A

Under 65
FEV1 under 30% or rapid deterioration despite medical tx

244
Q

How manage a bronchiectasis exacerbation

A

Sputum culture
14 day course of abx
Consider salbutamol inhaler if wheeze or particularly breathless

245
Q

When escalate bronchiectasis management

A

If over 3 exacerbations a year then stepwise approach
1st- physio reassessment and give mucoactive agents
2nd- long term abx

246
Q

Severe bronchiectasis management

A

If numerous exacerbations and failure to respond to medical tx then consider
- mucoactive agents
- long term abx
- lung transplant

247
Q

Imaging findings for bronchiectasis

A

Tram lines
Proximal dilation of bronchus

248
Q

Sarcoid features
- cardiac
- neuro
- ENT
- ocular
- skin
- resp

A

Cardiac- HB, dialted CM, constrictive pericarditis
Neuro- cranial diabetes inspiduus
ENT- parotid (facial nerve palsy, xerostomia)
Ocular- anterior uveitis
Skin- erythema nodosum, lupus pernio
Resp- bilateral hilar lymphadenopathy, fibrosis of upper lobes

249
Q

Main diagnostic investigation for sarcoid

A

Bronchoscopy guided biopsy of lymph nodes showing non-caseating granulomas

250
Q

Diagnostic investigation for COPD

A

Spirometry showing obstructive picture with no salbutamol reversibility

251
Q

Features of cor pulmonale on examination

A

Raised JVP
Parasternal heave
Oedema

252
Q

Who is eligible for COPD prophylactic azithromycin

A

Do not smoke
Medical therapy but continue to have continuous exacerbations
Must have CT thorax to exclude bronchiectasis and sputum culture to exclude chronic infections

253
Q

What must do prior to initiating NIV

A

CXR to rule out pneumothorax

254
Q

If spirometry or FeNO is inconclusive for asthma what use to investigate

A

Serial peak flow measurements for 4 weeks
Measure 4x a day and if variation over 20% then confirms diagnosis

255
Q

What are serial peak flow measurements

A

Measure peak flow at various points across day for a month and if over 20% variability then indicates asthma

256
Q

Transudative causes of pleural effusion

A

HF, LF, Nephrotic syndrome
Meigs syndrome
Hypothyroidism

257
Q

Exudative cause of pleural effusion

A

Pneumonia
Cancer
Pancreatitis
PE
RA

258
Q

What investigations do for pleural effusion

A

PA CXR
USS guided pleural aspirate
CT if exudative cause

259
Q

SOB after insertion of sublcavian line

A

Pneumothorax

260
Q

What does FeNO indicate

A

Eosinophilic inflammation

261
Q

When refer people under 2WW straight to oncology for lung cancer

A

Lung cancer like signs on CXR
Over 40 with unexplained haemoptysis

Finals (29 decks)

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