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Year 6 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Asthma Ix?

A

Lung function tests - peak flow, spirometry
Bronchial challenge test
Measure FENO and blood eosinophils
Blood tests: FBC, IgE
(can do skin prick test, Chest x-ray should be normal)

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2
Q

Asthma sx?

A

Wheeze, nocturnal cough, allergy to house dust mites, pets

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3
Q

Wheeze in asthma?

A

Polyphonic wheeze

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4
Q

Treatment for asthma?

A

SABA, ICS low-dose, low-dose ICS + LABA (bronchodilator) + LTRA or up ICS to medium-dose, refer to specialist care

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5
Q

Asthma treatment (hollistic)?

A

Inhalers + inhaler technique
Trigger avoidance
Annual review
Vaccination - flu, covid
Asthma action plan

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6
Q

Treatment for severe asthma?

A

Biologics, anti-IL-5

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7
Q

Ix for COPD?

A

Spirometry with reversibility

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8
Q

Asthma differentials for finals?

A

COPD, allergic bronchopulmonary aspergillosis (ABPA), bronchiectasis, bronchiolitis

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9
Q

ABPI symptoms?

A

Wheeze, recurrent chest infections, mucus plugs, haemoptysis

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10
Q

Ix for ABPI?

A

Must have evidence of hypersensitivity to aspergillus fumigatus
IgE and IgG raised to aspergillus
High eosinophils
Flitting changes on X-ray
Signs of bronchiectasis on High resolution CT scan

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11
Q

Treatment for ABPA?

A

Oral corticosteroids
Chest physio
Antifungals (itraconazole) may also be required

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12
Q

Cause of pneumonia in COPD?

A

Moraxella catarrhalis

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13
Q

What signs insidcate atypical pneumonia?

A

Headache, low grade fever, malaise

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14
Q

Treatment for Legionnaire’s disease?

A

Ciprofloxacin

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15
Q

COPD in <40 y/o: what could be the cause?

A

Alpha-1-antitrypsin deficiency

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16
Q

How is the obstructive picture in COPD shown in spirometry?

A

FEV1/FVC ratio <0.7

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17
Q

Severity of COPD obstruction?

A

> 80% = mild
50-79% = moderate
30-49% = severe
<30% = Very severe

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18
Q

COPD allergic features?

A

History of asthma/atopy
High eosinophils

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19
Q

COPD treatment?

A

Inhalers, smoking, vaccinations, pulmonary rehabilitation

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20
Q

Type 1 respiratory failure?

A

Low oxygen
Normal/low carbon dioxide

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21
Q

Type 2 respiratory failure?

A

Low oxygen
High carbon dioxide

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22
Q

Which spirometry pattern indicates restrictive lung disease?

A

FEV1/FVC > 0.7

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23
Q

Features of interstitial lung disease?

A

Inflammation and fibrosis
Progressive breathlessness and dry cough
Clubbing, find-end inspiratory crackles,

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24
Q

Causes of interstitial lung disease?

A

Idiopathic pulmonary fibrosis, asbestosis, methotrexate, RA, silicosis

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25
Q

Ix for interstitial lung disease?

A

History, high resolution CT thorax (honeycombing, ground glass appearance), lung biopsy, pulmonary function tests (reduced lung volume)

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26
Q

Treatment for interstitial lung disease?

A

Anti-fibrinotics (nintedanib)
Smoking cessation
vaccinate, exercise
Long term oxygen therapy
Transplant
Palliative care

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27
Q

TB treatment side effects?

A

Rifampicin = orange secretions, enzyme inducer
Isoniazid = peripheral neuropathy due to B6 deficiency
Pyrazinimde = Gout, arthralgia, liver toxicity
Ethambutol = Colour vision

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28
Q

Pneumonia chest x-ray guidelines?

A

Do a chest x-ray 6 weeks post pneumonia to ensure there’s nothing behind the consolidation on chest x-ray

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29
Q

Signs of lung cancer?

A

Cough, haemoptysis, chest pain, unresolving pneumonia

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30
Q

Hypertrophic pulmonary osteoarthropathy

A

Periosteal bone proliferation, clubbing, large joint inflammation

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31
Q

Diagnosis of bronchiectasis?

A

high resolution CT scan (signet ring)

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32
Q

Mx of bronchiectasis?

A

Chest physio, prophylactic antibiotics

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33
Q

Causes of secondary pneumothorax?

A

COPD, TB, malignancy

34
Q

Ix for pneumothorax?

A

CXR, ABG

35
Q

Diagnosing TB imaging?

A

CT thorax

36
Q

Transudative pleural effusions?

A

Liver cirrhosis, congestive heart failure, hypoalbuminaemia, nephrotic syndrome

37
Q

Exudative pleural effusion causes?

A

Malignancy, infection, PE

38
Q

Prophylactic abx in copd?

A

azithromycin

39
Q

Surgery in COPD?

A

 Bullectomy
 Lung reduction surgery (indication: heterogenous emphysema)
 Endobronchial valve placement (valve placed in part of lung  iatrogenic distal collapse)
 Lung transplant

40
Q

Medical mx of COPD?

A

 1, PRN  SAMA OR SABA:
* Short-acting muscarinic antagonist / SAMA e.g. ipratropium
* Short-acting beta-agonist / SABA e.g. salbutamol
 2  LABA + LAMA (no asthmatic features) OR LABA + inhaled corticosteroid (asthmatic features):
* Long-acting muscarinic antagonist / LAMA e.g. tiotropium
* Long-acting beta-agonist / LABA e.g. salmeterol, formeterol
* Symbicort (LABA + ICS = Symbicort)
 Asthmatic features:
* History of asthma or atopy Eosinophilia (FBC in workup)
* FEV1 variation over time (>400mL) Diurnal variation in PEFR (>20%)
 3  LABA + LAMA + ICS

41
Q

Asthma investigations in >17 year old?

A

FeNO test then spirometry

42
Q

o Positive test thresholds asthma:

A

 FEV1/FVC ratio <70% (obstructive)
 FeNO ≥40 parts per billion
 BDR (FEV1) ≥12% variability and >200mL increase in volume after SABA administration
 Peak flow variability (PFV) >20% PEFR variability
 Bronchial challenge (BC) PC20 ≤8mg/mL (with methacholine or histamine challenge)

43
Q

Differentials for a Wheeze

A

Respiratory: asthma, COPD

Rheumatological: GPA (obliterative bronchiolitis), rheumatoid arthritis

Cardiac: heart failure

44
Q

Asthma mangement long-term

A

SABA
SABA and ICS
SABA and ICS + LTRA
Increase ICS dose
Refer to specialist - trial LAMA or theophylline

45
Q

Asthma A&E sent home: follow-up

A

Treated in A&E, better in 1 hour  discharge, TAME T
T Technique, Avoidance (triggers), Monitor (PEFR), Educate

(1) Review in GP in 2 days

46
Q

o Acute severe asthma?

A

 PEFR 33-50%
 Not completing full sentences
 RR >25, HR >110, pO2 >92%

47
Q

Oral corticosteroids following asthma exacerbation?

A

Prednisolone 40mg, OD, PO, 5 days; OR

48
Q

When to admit asthma exacerbation?

A

Acute severe if no response and above

49
Q

Dose of nebulised salbutamol asthma exacerbation?

A

5mg

50
Q

Dose of nebulised ipatropium bromide asthma exacerbation?

A

0.5mg

51
Q

Rusty sputum pneumonia bacteria?

A

Streptococcus pneumoniae

52
Q

Red-currant jelly sputum, alcoholism, DM, elderly, haemoptysis, aspiration, cavitating upper lobes

A

K. pneumoniae

53
Q

Air travel, air conditioner, water towers, hepatitis, hyponatraemia, urinary antigen

A

L. pneumophilia (Legionella)

54
Q

CURB-65 cut-offs

A

Confusion (AMTS ≤8)
Urea ≥7mmol/L
RR ≥30
BP ≤90/60mmHg
Age ≥65yo

55
Q

HAP causative organisms?

A

 Early-onset (48 hours to 4 days)  streptococcus pneumoniae
 Late onset (>4 days)  Enterobacteria (E. coli, K. pneumoniae) > S. aureus (MRSA) > Pseudomonas

56
Q

o Klebsiella tx?

A

Cephalosporin (resistant to most penicillin)

57
Q

Ix for TB?

A

 Bedside exam, obs, TST, sputum (MC&S), sputum smear + ZH / auramine stain
 Bloods baseline (FBC, U&Es), CRP, IGRA
 Imaging CXR
 Special tests EBUS (histology)

58
Q

Treatment of PCP?

A

 Mild-moderate: co-trimoxazole
 Severe: IV pentamidine
 Hypoxia: steroids

59
Q

Chest-drain complications

A

 Immediate  failure, pain, haemorrhage, pneumothorax
 Early  infection, haematoma, long thoracic nerve damage ( winged scapula), blockage
 Late  scar formation

60
Q

Ix for pleural effusion?

A
  • Investigations:
    o Bedside exam, obs, urine dip (protein)
    o Bloods baseline bloods (FBC, U&Es), LFTs, CRP, clotting, blood culture
    o Imaging CXR  contrast-CT (esp. for exudative causes), echo (CCF)
    o Special tests USS-guided pleural aspiration ± chest drain, BAL (cellularity), EBUS (sarcoid, TB)

USS + pleural tap (21G needle + 50mL syringe) – do even for massive effusions - chest drain

Exudate = >30g/L protein; transudate = <30g/L protein
Use Light’s criteria if 25-35g/L protein (helps differentiate causes) … an exudate is likely if…
* Pleural fluid protein / serum protein >0.5
* Pleural fluid LDH / serum LDH >0.6
* Pleural fluid LDH > 2/3rds ULN serum LDH

Other characteristic findings:
* Low glucose RhA, infection (TB)
* Raised amylase pancreatitis, oesophageal perforation
* Heavy blood staining mesothelioma, PE, TB, iatrogenic (pneumothorax)

61
Q

Mx of pleural effusion?

A

(1) Pleural effusion with aspirate… * turbid/cloudy, tests +ve on MC&S, pH <7.2 - chest drain
N.B. can use an ABG to ascertain if the pH is acidic quickly

(2) Treat underlying cause (i.e. ABx for pneumonia, furosemide for AHF, etc.)

Recurrent pleural effusion:
 Recurrent aspiration
- Pleurodesis
 Indwelling pleural catheter
Drug management (i.e. opioids for SOB)

62
Q

Bronchiectasis Ix?

A

o Bedside exam, obs, sputum sample (MC&S), sweat testing
o Bloods baseline bloods (FBC, U&Es), CRP, immunoglobulins, CF genetic testing, aspergillus markers
o Imaging CXR, HR-CT
o Special tests spirometry
Diagnostic is high-res CT

63
Q

Treatment of bronchiectasis?

A

o Prophylaxis:
 Physiotherapy, pulmonary rehabilitation
 Smoking cessation
 Prophylactic rescue packs (ABx), education about when to use them
 Bronchodilators
 Immunisations

o Acute exacerbation:
 ABx
 Bronchodilators

64
Q

Interstitial lung disease causes?

A

o Idiopathic pulmonary fibrosis (IPF)
o Hypersensitivity pneumonitis (formerly EAA): S/S: mild fever; ix: BAL cellularity
o Sarcoidosis
o Pneumoconiosis (simple = asymptomatic; complicated = symptomatic)

65
Q

o Upper lobe fibrosis = TAPE:

A

 T TB
 A ABPA
 P Pneumoconiosis (silica, coal)
 E EAA (hypersensitivity pneumonitis) (mid-zone)

66
Q

o Lower lobe fibrosis = STAIR:

A

 S Sarcoid (mid-zone)
 T Toxins (BANS Me)
* B Bleomycin, Busulfan
* A Amiodarone
* N Nitrofurantoin
* S Sulfasalazine
* Me Methotrexate
 A Asbestosis
 I Idiopathic pulmonary fibrosis (IPF; diagnosis of exclusion)
 R Rheumatology (RhA, SLE, Sjogren’s, scleroderma / CREST)

67
Q

HR-CT in ILD?

A

Honeycombing, ground glass appearance

68
Q

S/S IPF?

A

o Progressive exertional dyspnoea
o Dry cough
o Clubbing (not often in EAA)
o Bibasal fine end-inspiratory crepitations on auscultation

69
Q

Ix in ILD

A

o Bedside exam, obs
o Bloods baseline bloods (FBC, U&Es), SLE screen (complement, AI screen), serum IgE, ABG
o Imaging CXR, HR-CT, echo (pul. HTN)
o Special tests spirometry (restrictive), TLCO (low), BAL (cellularity in EAA), EBUS (sarcoid, TB)

70
Q

Mx of sarcoidosis?

A

Steroids

71
Q

restrictive spirometry picture?

A

o >70%, FEV1 reduced, FVC very reduced

72
Q

Spirometry obstructive picture?

A

o <70% = obstructive, FVC very reduced/normal, FEV1 very reduced

73
Q
  • TLCO/DLCO in obstructive/restrictive?
A

Reduced

74
Q

S/S of CF?

A

o Meconium ileus (surgery may be needed) Growth faltering (difficulty putting on weight)
o Recurring chest infections, wheezing, coughing, SoB Damage to the airways (bronchiectasis)
o ABPA, nasal polyps, sinusitis
Jaundice (cirrhosis, portal HTN)
o Diarrhoea or constipation
Diabetes mellitus
o Male sterility (absence of the vas deferens) CLUBBING FINGERS

75
Q

Investigations for CF?

A

o Guthrie heel prick test for IRP / Immunoreactive Trypsinogen (if +ve, further tests are done):
 Sweat test (abnormally high NaCl in sweat) – normal (10-40mmol/L), CF (60-115mmol/L)
 Genetic tests (see below)
o CXR (hyperinflation, peri-bronchial shadowing, bronchial wall thickening, ring shadows)

76
Q

Mx of CF?

A

Very routine reviews (specialist CF centres):
 Physiotherapy twice a day → airway clearance manoeuvres and devices + encourage physical activity
 Mucolytic therapy:
* 1st line: Dornase alfa
* 2nd line: rhDNase + hypertonic saline, mannitol dry powder (INH)
* Orkambi: Lumacaftor with Ivacaftor (potentiators and correctors)  may be effective in treating (prolonging life) CF caused by the F508 mutation (78% of CF sufferers)

 Prophylaxis oral antibiotics (flucloxacillin and azithromycin to reduce exacerbation chance)
 Rescue packs (for prompt IV ABx with any symptoms or signs of infection)

77
Q

Small cell lung cancer (SCLC) associations?

A

smokers, central, SIADH, ACTH, Lambert-Eaton Myasthenic Syndrome (LEMS)

78
Q

Adenocarcinoma associations?

A

Non-smokers, peripheral, early metastasis, gynaecomastia, hypertrophic pulmonary osteoarthropathy HPOA

79
Q

squamous cell carcinoma associations?

A

smokers, central, spread locally, late metastasis, PTHrP, ectopic TSH, HPOA

79
Q

Which tumours metastasise most to bone?

A

Particular tumours love killing bone
Prostate, testicular, lung, kidney, breast

79
Q

CXR 2ww guidelines

A

 Age <40yo AND ≥2 symptoms OR current/past smoker and ≥1 symptom/s:
* Cough Fatigue SOB
* Chest pain WL Appetite loss
 Age >40yo AND ≥1 symptom/s:
* Persistent/recurrent chest infection
* Clubbing
* Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
* Chest signs consistent with lung cancer
* Thrombocytosis

80
Q
A

Year 6 (26 decks)

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