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Barts Final Year > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the 4 lung volumes? (not capacities that are made up of 2 or more lung volumes)

A
  • Tidal Volume
  • Inspiratory Reserve Volume
  • Expiratory Reserve Volume
  • Residual/Reserve Volume
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2
Q

What is the volume that can be exhaled after maximum inspiration called? (IRV + TV + ERV)

A

Vital capacity (forced vital capacity)

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3
Q

What is the volume breathed in from quiet expiration to maximum inspiration called? (TV + IRV)

A

Inspiratory capacity

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4
Q

What is the volume remaining in the lungs after quiet expiration called? (ERV + RV)

A

Functional Residual Capacity

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5
Q

What conditions cause an obstructive lung pattern disease?

A
  • Asthma
  • COPD
  • Bronchiectasis
  • Bronchiolitis obliterans
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6
Q

What conditions cause a restrictive pattern of lung disease?

A
  • Pulmonary fibrosis
  • Asbestosis
  • Sarcoidosis
  • ARDS
  • Infant respiratory distress syndrome
  • Kyphoscoliosis (e.g. Ank Spondylitis)
  • NM disorders
  • Severe obesity
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7
Q

What are the different subtypes of lung fibrosis?

A
  • Idiopathic
  • Connective tissue disorders (e.g SLE)
  • Drug-induced
  • Asbestosis
  • Hypersensitivity pneumonitis (allergic alveolitis)
  • Coal workers pneumoconiosis/progressive massive fibrosis
  • Silicosis
  • Ank Spond
  • Histiocytosis
  • TB
  • Radiation induced
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8
Q

What conditions cause upper lobe Pulmonary Fibrosis?

A

CHHARTSS
- Coal workers pneumoconiosis/progressive massive fibrosis
- Hypersensitivity pneumonitis (allergic alveolitis)
- Histiocytosis
- Ank Spond
- Radiation induced
- TB
- Silicosis
- Sarcoidosis

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9
Q

What conditions cause lower lobe Pulmonary Fibrosis?

A
  • Idiopathic
  • Connective tissue disorders (e.g SLE)
  • Drug-induced (e.g bleomycin, methotrexate, amiodarone)
  • Asbestosis
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10
Q

What drugs cause pulmonary fibrosis (lower lobes)

A
  • Bleomycin
  • Amiodarone
  • Methotrexate
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11
Q

What part of the lung does Klebsiella affect

A

Upper usually

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12
Q

What is heard on auscultation in pulmonary fibrosis?

A

Bibasal fine end-inspiratory crackles

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13
Q

Inhaler technique:
- How long should you hold breath for after breathing in the gas
- How long should you wait before administering a second dose

A
  • Hold breath for 10 seconds
  • Wait approximately 30 seconds before repeating
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14
Q

High risk pneumothorax (not tension) what is the management?

A

Chest drain insertion

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15
Q

What are the options for a simple pneumothorax > 2 cm and/or SOB?

A
  • Needle aspiration (if this fails twice -> chest drain)
  • Chest drain
  • Ambulatory device
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16
Q

How is a spontaneous pneumothorax managed if less than 2cm or no SOB?
- 2 management options

A

Conservatively
- Primary pneumothorax -> outpatient review every 2-4 days
- Secondary pneumothorax -> monitored as an inpatient

If stable, follow-up in outpatients department every 2-4 weeks

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17
Q

When are patients followed up after pneumothorax resolution?

A

2 -4 weeks

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18
Q

What procedure may be done if a patient has recurrent pneumothoraxes or insufficient lung rexpansion despite chest drain insertion?

A

VATS (video assisted thoracoscopy surgery)
- Mechanical/chemical pleurodesis
- +/- Bullectomy

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19
Q

When can a patient fly after pneumothorax?

A
  • 2 weeks after no residual air and sufficient drainage
  • 1 week post CXR
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20
Q

What is the most commonly used oxygen administration on COPD patients?

A

28% Venturi

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21
Q

A patient wants to quit smoking but is pregnant or is breast-feeding what treatment can you offer her?

A
  • CBT, motivational interviewing, structured self-help NHS stop smoking services
  • NRT - Nicotine patches
  • NOT Bupropion or Varenicline (teratogens)
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22
Q

What smoking cessation drug is a NE, dopamine Reuptake inhibitor and nicotinic antagonist?

A

Bupropion

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23
Q

What smoking cessation drug is a nicotinic receptor partial agonist?

A

Varenicline

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24
Q

What smoking cessation drug is contraindicated in epilepsy?

A

Bupropion

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25
Q

What chemicals are the number 1 cause of occupational asthma?

A

Isocyanates

26
Q

What sign on FBC is a sign of lung cancer?

A

Raised platelets

27
Q

What are the factors that make up the CURB-65 score?

A
  • Confusion
  • Urea > 7
  • RR >= 30
  • BP <= 90 / 60
  • > = 65
28
Q

Surgery is indicated in bronchiectasis when?

A
  • Disease is localized to one lobe
  • Uncontrollable haemoptysis
29
Q

What kind of lung cancer may feature Gynaecomastia?

A

Adenocarcinoma

30
Q

What types of lung cancer may feature Hypertrophic pulmonary osteoarthropathy (HPOA)

A
  • Squamous cell
  • Adenocarcinoma
31
Q

What type of lung cancer causes PTH-rp and ectopic TSh secretion (hyperthyroidism)

A

Squamous

32
Q

What type of lung canccer typically features clubbing?

A

Squamous

33
Q

What lung condition can feature polycythemia

A

COPD

34
Q

When are antibiotics indicated in bronchitis?
- What blood result and above what level

A

CRP > 100 (Doxy or Amox)
- CXR can be normal

35
Q

What is a feature of near-fatal asthma

A

Raised pCO2

36
Q

What are pneumatoceles?
- What do they look like?
- What are they resultant of usually?

A
  • Intra-pulmonary air filled cystic spaces =
  • Lucency with a thin wall on radiography
  • Usually from ventilator-induced lung injury
37
Q

What type of pleural effusion may result from pulmonary embolism?

A

Exudative

38
Q

Peripheral clustered cystic air spaces with ‘honeycombing’ appearance is likely to describe what type of lung condition?

A

Pulmonary fibrosis

39
Q

What can mimic pneumothorax with air spaces in lung >1cm in diameter and is common in smokers and emphysema?

A

Emphysematous bullae

40
Q

What are the target sats in acute asthma?

A

94-96%

41
Q

What is the usual treatment of sarcoid?

A

Nothing

42
Q

Lights criteria: (3)

A

An exudate is likely if at least one of the following criteria are met:
- Protein >0.5
- LDH >0.6
- Pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

43
Q

Acute Asthma attack pneumonic

A

O SHIT ME
- Oxygen
- Salbutamol
- IV hydrocortisone
- Ipratropium
- Theophylline
- Magnesium sulphate
- Escalate (ITU -> Ventialtor)

44
Q

COPD initial management

A

SABA or SAMA (ipratropium)

45
Q

2nd line management of COPD with asthmatic features?

A

SABA + LABA + ICS (fostair is LABA + ICS)

46
Q

What can be added in a patient with COPD taking SABA + LABA + ICS?

A

LAMA (trimbow: LABA + LAMA + ICS)

47
Q

What is the second line management of COPD w/o asthmatic features?

A

SABA + LABA + LAMA (Tiotropium)

48
Q

Give an example of a SAMA

A

Ipratropium

49
Q

GIve an example of a LAMA

A

Tiotropium

50
Q

What is the initial management of COPD?

A

SAMA or SABA
- Ipratropium or Salbutamol

51
Q

Target sats for COPD patients when CO2 is normal

A

94 - 98%

52
Q

COPD severity categories
- how many stages
- what is it based off of

A

Based off of FEV1
- Stage 1 (mild) >80%
- Stage 2 (moderate) 50 - 79%
- Stage 3 (severe) 30 - 49%
- Stage 4 (v. severe) <30%

53
Q

When should a repeat chest XR be done after pneumonia resolution?

A

6 weeks after (may be abit longer)

54
Q

Cavitating lesions are more common in what lung cancer?

A

Squamous

55
Q

When reducing steroids how much at a time?

A

Drop 25 - 50% at a time

56
Q

What must be measured before starting azithromycin?

A
  • ECG
  • LFTs
57
Q

Long-term oxygen is considered in COPD patients with O2 below what level on 2 ABGs? (they also must not smoke)

A

< 7.3 kPa

58
Q

Egg shell calcification on hilar nodes is a sign of what condition?

A

Silicosis

59
Q

Pregnancy may cause what acid base abnormality?

A

Resp alkalosis

60
Q

What are the 2 main tests to daignose asthma?

A
  • Spirometry w. a bronchodilator reversibilty test
  • FeNO test (> 40, >=35 kids)
    All patients should have both, in children this is different
61
Q

Reversibility testing must show an improvement of what to diagnose asthma?

A

FEV1: >=12% or 200ml or more
(only use percentages in kids)

Barts Final Year (13 decks)

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