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Clinical > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How do you classify massive haemoptysis?

A

Massive bleeding from the airways below the glottis:
- >400ml/24 hours
- >150-200ml in one episode
- 3 episodes in one week >100ml

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2
Q

How do you manage a primary or secondary pneumothorax?

A

Assessment of whether or not pt is symptomatic.
Asymptomatic = conservative care
Symptomatic = assess whether or not there are high risk features if there is then intervene. If there isn’t then ask pt priority and act based on this (e.g., ambulatory, quick resolution, etc).

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3
Q

How do you manage a tension pneumothorax?

A

Large bore cannula into 5th intercostal space mid-axillary line

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4
Q

What is the signs of tension pneumothorax?

A

1st Sign is haemodynamic instability.
Later signs include distended neck veins, tracheal deviation, no audible breath signs

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5
Q

What is the pathophysiology behind ARDS?

A

Alveolar damage causes fluid infiltration and therefore impaired oxygenation.

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6
Q

What are the signs/sx of ARDS?

A

Dyspnoea, tachycardia, confusion, presyncope/syncope, non-cardiogenic pulmonary oedema and diffuse bilateral opacities on CXR.

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7
Q

What conditions cause ARDS? How is it managed?

A

Pneumonia, sepsis, trauma, aspiration.
Mx: mechanical ventilation with a low tidal volume and limited pressure to avoid ventilator associated injury.

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8
Q

Why does hyperventilation cause the sensation of numbness in the hands, feet, and around the mouth?

A

Hyperventilation = reduced arterial CO2 = incease in blood pH (respiratory alkalosis) = promotes calcium binding to albumin which reduces circulating calcium = symptoms.

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9
Q

How do you differentiate between transudative and exudation pleural effusions?

A

T: <25 protein
E: >35
In between use light’s criteria

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10
Q

What causes transudative and exudative pleural effusions?

A

T: increased pressure e.g., heart failure, liver cirrhosis
E: infection, malignancy, rheumatological conditions

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11
Q

What is the mx for a PE?

A
  • Unprovoked: 6 months anticoagulant (DOAC)
  • Provoked: 3 months of anticoagulant (DOAC)
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12
Q

What is thrombembolic pulmonary HeTN?

A

CTEPH: complication of PE, diagnosed with a right heart catheter to measure pressures. Can lead to right sided heart failure.

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13
Q

What is pulmonary atelectasis? How does it present clinically?

A

Excessive bronchial secretions causes collapse of the lung.
Tachycardia, fever, tachypnoea, dull ling bases, reduced fremitus.

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14
Q

What sx do you get with carbon monoxide poisoning? What happens to the oxy-Hb curve?

A

N+V, headaches, confusion.
Severe toxicity: temperatures, arrhythmias, pink skin.
Left shift of the curve.

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15
Q

Presentation of TB?

A

Nights sweats, fever, weight loss, chronic cough, different organ system symptoms.
Often travelled form an endemic country.

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16
Q

What do you see on CXR of TB?

A

Upper lobe opacification known as a ‘ fibronodular appearance’ or ‘fibrocavitary lesions’

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17
Q

How do you diagnose TB?

A

Sputum acid-fast bacilli smear: must have 3 early morning +ve results to confirm diagnosis.
Auramine O and Ziehl-Neelsen are types of stains used for this.

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18
Q

How is TB managed?

A

2 months: isoniazid, rifampicin, pyrazinamide, and ethambutol.
Further 4 months: rifampicin and isoniazid.

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19
Q

If there is CNS involvement, how do you manage TB?

A

2 months of quadruple therapy, 10 further months of double therapy (just rifampicin and isoniazid)

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20
Q

What complications can result from TB?

A
  • Aspergilloma
  • Pott’s disease (degradation of vertebrae due to infiltration of mycobacterium)
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21
Q

What are the elements of the CURB65 score?

A
  • Confused? AMTS less than or equal to 8
  • Urea >7mmol
  • RR >30
  • BP systolic <90, diastolic <60
  • > 65 y/o
    0/1= manage at home
    2= admit for abx and observation
    3/4= consider escalation to critical care
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22
Q

A CURB65 score of 1 can be managed at home, what would you prescribe for them?

A

1g amoxicillin TD for 5 days

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23
Q

Mycoplasma pneumoniae is an atypical pneumonia, what are its complications?

A
  • cold autoimmune haemolytic anaemia,
  • erythema multiforme (after antibiotics you get red raised lesions all over the body)
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24
Q

How does klebsiella gram stain?

A

gram -ve rod

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25
Q

Who is klebsiella pneumonia seen in? How does it present?

A

Immunocompromised pts.
You get an upper lobe cavitating pneumonia and a ‘redcurrant’ sputum.

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26
Q

What is seen on CXR for Klebsiella pneumonia?

A

Consolidation with a discrete area of low attenuation with an air-filled level within it (cavity).

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27
Q

How do you manage an empyema?

A

Insert chest drain via USS guidance.

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28
Q

What is the most common cause of epiglottitis?

A

Haemophilus influenza

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29
Q

What are the signs of epiglottitis?

A

Tripoding, drooling, inability to speak/swallow/drink, respiratory distress.

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30
Q

What are the components of the centor criteria?

A
  • Fever
  • No cough
  • tender cervical LNs
  • tonsillar exudate
    3-4 = give abx as there is an increased risk for GABS
31
Q

Your Centro criteria has dictated that that your pt needs abx, what are you giving them? What if they are penicillin allergic?

A

Phenoxymethylpenicillin or clarithromycin in pen allergic

32
Q

What bacteria causes Legionnaires disease? How does it gram stain?

A

Legionella pneumophilia: gram -ve aerobic rod.

33
Q

How can you diagnose Legionnaires disease?

A

urinary antigen enzyme immunoassay

34
Q

Where is legionella pneumophilia found?

A

Water based environments such as hot tubs, air conditioning units, heating, showers.

35
Q

Who may meet criteria for RSV prophylaxis? What is given?

A

Children with haemodynamically significantly heart disease.
Palivizumab given SC once/month during RSV season.

36
Q

What is popcorn lung?

A

Bronchiolitis obliterans caused by adenovirus causes destruction of bronchioles due to inflammation.

37
Q

From where can you get histoplasma Capsulatum infection? What signs do you get on CXR?

A

Fungi endemic to Missouri river in Mississippi.
Bilateral hilar lymphadenopathy with calcified granulomas (healed focal infiltrates).

38
Q

How does histoplasma Capsulatum affect immunocompromised pts?

A

Acute respiratory histoplasmosis (influenza-like sx) and disseminated disease.
Whereas in immunocompetent pts it may be asymptomatic.

39
Q

What causes PCP pneumonia? How do we investigate for it?

A

Pneumocystis jiroveci fungi.
Bronchiolar lavage and silver stains.
CXR: bilateral hilar interstitial infiltrates (may also be clear).

40
Q

Management for PCP?

A

Co-trimoxazole oral of IVs.
Some hypoxic pts may benefit from steroids.

41
Q

What are the signs of COPD?

A

‘Pink Puffer’
Thin, severe dyspnoea, hyperinflation of airways (emphysema), repeated infection leading to dilated distal airways (bronchiectasis).

42
Q

What is a sign of bronchiectasis on imaging?

A

Signet ring

43
Q

How do you manage an acute presentation of COPD?

A

Salbutamol and ipratropium nebs, steroids, aim to improve oxygen sats.
Hypoxic pts can be put on 15L via on rebreathe aiming for 94-98 then once this is achieved titrate down to 88-92 if they are CO2 retainers.

44
Q

What are the stages of COPD using FEV1?

A

1: >80%
2: 50-79%
3: 30-49%
4: <30%

45
Q

What are the signs that a COPD pt has developed pulmonary hypertension and right heart failure?

A

PH: Loud S2 heart sound due to loud closure of the pulmonary valve.
Cor Pulmonale: peripheral swelling, fatigue, raised JVP, organomegally.

46
Q

What is the role of volume reduction surgery in COPD pts? What is the criteria?

A

Removal of the most damage areas to help the healthier parts function better.
Predominant emphysema, FEV1 >20%, PaCO2 <7.3, TICO >20%.

47
Q

Why might someone develop signs of COPD at a younger age alongside signs of liver cirrhosis?

A

Alpha 1 antitrypsin deficiency - unchecked quantities of neutrophil elastase and increased attack of alveolar an liver tissues.

48
Q

What ECG changes might you see in COPD?

A

R axis deviation (right heart strain), prominent P waves in inferior leads (P pulmonale: RA enlargement), inverted Ps in high lateral leads, low voltage QRS, delayed R/S transmission in V1-6. RBBB, multifocal tachycardia.

49
Q

What is the risk of intubating a patient with COPD?

A

Reflex bronchoconstriction during intubation causing collapse of peripheral airways and incomplete alveolar emptying.

50
Q

Cystic Fibrosis is caused by what mutation?

A

Autosomal recessive mutation in the CFTR gene.

51
Q

How do you investigate for CF?

A
  • Genetic analysis/blood spot test
  • Sweat test (salt >60)
  • Immunoreactive trypsinogen (raised in CF)
52
Q

What are the categories of an acute asthma exacerbation?

A

Moderate: PEF >50%, able to talk, SO2 >92%
Acute-Severe: PEF 35-50%, too breathless to talk, SO2 <92%, use of accessory muscles
Life threatening: PEF <33%, SO2<92%, CHEST (cyanosis, hypotension, exhaustion, silent chest, tachyarrhythmias)
Fatal: CO2 starts to fall.

53
Q

How do you manage an acute asthma exacerbation?

A

Moderate: bronchodilator via spacer, consider oral prednisolone
Acute Severe: bronchodilator via nebuliser, oral prednisolone
Life-threatening: bronchodilator and ipratropium nebs, oral prednisolone or IV hydrocortisone.
Fatal: intubation

54
Q

How can you diagnose asthma?

A
  • FEV1 improvement of 15% with beta 2 agonist
  • FEV1/FVC ratio <0.7
55
Q

What are the steps of management of chronic asthma? When should they be referred to a specialist?

A
  • Step 1: short acting beta 2 agonist (salbutamol)
  • Step 2: low dose ICS
  • Step 3: long acting beta 2 agonist (salmeterol)
  • Step 4: leukotriene receptor antagonist, high dose steroid, oral beta 2 agonist, oral theophylline.

Waking at night once/week or having more than 3x day time episodes per week then move to next step.
Refer for those on step 3 or 4.

56
Q

What is chronic Bronchitis?

A

Chronic inflammation of small and large airways, daily productive cough for 3 months or more in the last two consecutive years.
These patients are known as ‘blue bloaters’: overweight, cyanotic, peripheral oedema, wheezy.

57
Q

Why does chronic bronchitis cause a low V/Q ratio?

A

Long term hypoxaemia and reduced RR causes pt to be under ventilated. To compensate, the body to increase cardiac output.
This means there is less ventilation and increased perfusion = low V/Q ratio.

58
Q

What are the cause of ILD in the upper lobes?

A

SCHAART:
- Silicosis
- Coal worker’s pneumoconiosis
- Histiocytosis
- Ankylosing spondylitis
- Allergic bronchopulmonary aspergillosis
- Radiation
- Tuberculosis

59
Q

What are the causes of lower lobe ILD?

A

RASCO:
- Rheumatoid arthritis
- Asbestosis
- Scleroderma
- Cryptogenic fibrosing alveolitis
- Other (drugs, idiopathic)

60
Q

What are the signs/symptoms of Asbestosis?

A

Dyspnoea, chronic cough, crepitations, clubbing cyanosis, reduced chest expansion, history of work in building sites/shipyards.

61
Q

What are the signs/sx of idiopathic pulmonary fibrosis?
What happens to FEV1, FVC, ratio, and TLCO?

A

Fine end bi-basal end inspiratory crackles, reduced chest expansion, clubbing,
Reduced FEV1 and FVC, ratio >70%, TLCO reduced.

62
Q

What medications are used for IPF?

A

Pirfenidone, nintedanib.

63
Q

What are the paraneoplastic syndromes associated with small cell lung cancer?

A
  • SIADH: hyponatraemia, reduced plasma osmolality, increased urinary osmolality
  • Cushing’s: hypertension, high blood glucose, central obesity, buffalo hump, etc
  • LEMs: +ve anti-voltage gated calcium channel antibodies causing muscle weakness, constipation, dysphagia, etc
  • Cerebellar degeneration: perkinjee cell degeneration due to autoimmune attack causing speech, balance, etc problems
  • HPOA: periostitis, digital clubbing, osteoarthropathy of the larger joints
64
Q

What type of lung cancer is most commonly associated with smoking?

A

Squamous cell

65
Q

Why might someone with squamous cell carcinoma of the lung get hypercalcaemic?

A

SCC secretes PTH related peptide which leads to hypercalcaemia (polyuria, polydipsia, constipation, confusion), this is paraneoplastic hyperparathyroidism.

66
Q

What are the complications of a Pancoast Tumour?

A

Tumour at the apex of the lung:
- Horner’s syndrome (loss of innervation of sympathetic chain causing myosis, ptosis and potentially anhidrosis)
- Brachial plexus disorders
- Hoarseness of voice

67
Q

What is the role of aminophylline in COPD pts? SEs?

A

Non-selective adenosine receptor antagonist and phosphodiesterase inhibitor used IV in exacerbations of COPD to relax smooth muscle in airways, and reduce responsiveness to histamine and other inflammatory substances.
SEs: headaches, nausea, palpitations, seizures.

68
Q

What is the most common type of lung cancer in non-smokers? Why does it cause pleuritic chest pain?

A

Adenocarcinoma - often affects the peripheries and invades pleura.

69
Q

What are the criteria for ARDS?

A
  • Acute lung (onset <1 week)
  • Bilateral pulmonary infiltrates (CT/XR)
  • PaO2/FiO2 ratio <300
70
Q

How should someone with Covid-19 be managed if they are requiring supplemental O2?

A

Dex and remdesivir.

71
Q

How do you measure severity of obstructive sleep apnoea?

A

AHI score from polysomnography:
- <5 / hr is normal
- 5-14 / hr is mild
- 15-29 / hr is moderate
- >30 / hr is severe

72
Q

What are the criteria for long term oxygen therapy?

A
  • paO2 <7.3
  • PaO2 7.3-8 with one of: secondary polycythaemia, peripheral oedema, pulmonary HeTN.
73
Q

What adults are eligible for RSV vaccination?

A

Pregnant women, and those aged 75-79.

74
Q
A

Clinical (27 decks)

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