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MSRA 2023 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Life threatening asthma

A

PEFR <33% best or predicted
O2 <92%
silent chest/ cyanosis/ feeble resp effort
bradycardia/ dysrhythmia/ HoTN
exhaustion, confusion or coma

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2
Q

Severe asthma

A

Severe asthma 33-50% best or predicted
unable to complete sentences
RR >25/min
pulse > 110

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3
Q

Moderate asthma

A

PEFR 50-75% best/ predicted
speech normal
RR <25/min
HR <110

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4
Q

Near fatal asthma

A

raised pCO2 and or requiring mechanical ventilation with raised inflation pressures

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5
Q

Acute Asthma mx

A

SABA: salbutamol/ terbutaline life threatening nebulised

corticosteroid: ALL asthma 40-50mg prednisolone OD for 5 days or until pt recovers (breastfeeding 30mg OD)

ipratropium (SAMA): nebulised- severe/life threatening or NOT responding to SABA + steroid.

iv MgSO4: severe/life- threatening asthma

iv aminophylline: senior

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6
Q

criteria d/c asthma

A

stable on d/c meds 12-24hrs
check inhaler technique
PEF >75% of best or predicted value

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7
Q

Asthma mx- chronic

A

1.SABA
2. ICS + SABA
3. SABA + low dose ICS + LTRA (monteleukast)
4. SABA +ICS + LABA (continue LTRA)
5. SABA +/- LTRA switch ICS/LABA for maintenance and reliever therapy (MART incl low dose ICS)

  1. SABA +/- LTRA + med dose ICS MART OR consider changing back to fixed dose of mod dose ICS + separate LABA
  2. SABA +/- LTRA + one of
    - increase ICS to high dose part of fixed dose regime not MART
    - trial of addition drug eg. Long acting muscarinic R ATG or theophylline
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8
Q

Stages and dx of COPD

A

Post bronchodilation FEV/FVC is ,0.7

Stages GOLD

  1. FEV1 of predicted >80%
  2. 50-79%
  3. 30-49%
  4. <30%
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9
Q

Which indicates copd severity

A

fEV1 predicted value indicates disease severity

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10
Q

Ptx mx primary and secondary

A

Primary:
If <2cm & no sob: d/c
Otherwise attempt aspiration
If >2cm or SOB: chest drain

Secondary
If >50yrs & 2cm +/- SOB= chest drain
Attempt aspiration if 1-2cm

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11
Q

Typical pneumonia causes & name most common

A

Strep pneumonia most common
Haemophilia influenza
Morexalla catarrhalis
Staph aureus
Group A streptococcus
Aerobic gram negative: Klebisiella, e.coli

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12
Q

Atypical pneumonia causes & mx

A

Legionella
Mycoplasma
Chlamydia
Coxiella

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13
Q

Resp virus causes

A

Influenza A&B
Covid
RSV
parainfluenza
Rhinovirus
Adenovirus

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14
Q

Scoring system for pneumonia & mx

A

CURB-75

confusion
Urea>7mmol/l
Resp rate >30
BP <90/60
Age 75

Score 0-1 low risk 1st line amoxicillin nil hospital admission
2- mod risk
>3 high risk

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15
Q

Ddx exudative vs transudative

A

If protein
>30g/L exudative

If between 25-30g/L
Use light’s criteria. If one is positive then it is an exudative pleural fluid

Pleural Protein/ serum protein >0.5
Pleural LDH/ serum LDH >0.6
If pleural LDH >2/3 upper limits of normal serum LDH

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16
Q

Pleural effusion findings for RA and Tb

A

Low glucose

17
Q

Pleural findings of pancreatitis and oesophageal perforation

A

High amylase

18
Q

Mesothelioma, TB, PE leural findings

A

Heavy blood staining

19
Q

Causes of transudative and exudative pleural findings

A

Transudative: increase hydrostatic and decreased oncotic pressure
CHF, cirrhosis, nephrotic syndrome, PE, hypoalbuminaemia

Exudative due to inflammation induced increased capillary permeability
Infection, cancer, tb, autoimmune, viral infection

20
Q

Electrolyte findings of sarcoidosis

A

Hypercalcaemia as macrophages inside granuloma causes increased conversion of vid D

ACE from T-cells

21
Q

Lofgrens syndrome

A

Acute form of disease.

Bilateral hilar lymphadenopathy, erythema nodosum, fever, polyarthalgis

22
Q

Dx of sarcoidosis

A

Biopsy gold standard

Non-caseating granuloma with epithelium cells

23
Q

What is granuloma

A

Walled off macrophages

24
Q

Bronchitis mx

A

Abx only if unwell, crp>100

1st line doxycycline

25
Q

Inheritance of alpha 1 anti-trypsin deificiency

A

AR
Chromosome 14

MSRA 2023 (22 decks)

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