Respiratory Flashcards
When is theophylline offered to COPD patients?
After COPD patients are offered SABA/LABA or offered to people who cannot tolerate inhaled therapy
What does nice recommend to check in patients starting theophylline?
- U&Es and LFTs
- reduce dose if macrolide/ fluroquinoline is co-prescribed
What do the symptoms: fever, pleuritic chest pain, dull to percuss, no breath sounds and signs of sepsis suggest?
consolidation of the lungs
What is the next step for an asthmatic with a lower respiratory tract infection who is not responding to amoxicillin monotherapy?
Add or switch to a macrolide e.g. clarithromycin
Do you give oral prednisolone in an asthmatic with a lower respiratory tract infection?
No. Give oral prednisolone in an acute exacerbation of asthma
A smoker presents with SOB, productive cough, clubbing and a lung collpase on CXR. What do they most likely have?
Lung cancer
What gene is mutated in cystic fibrosis?
CFTR
What way does the trachea deviate in a right lung collpase?
Right tracheal deviation (same side as collapse)
Describe resonance in pneumothorax or in an asthmatic
high resonance to percussion
What are the two top differentials for a patient with painless palpable inguinal lymphadenopathy, fevers, weight loss and abdominal distension?
- disseminated TB
- Sarcoidosis (dx of exclusion after TB)
What do 3 months of B symptoms with bilateral hilar lymphadenopathy on CXR suggest?
Lymphoma
Is a D dimer or a CTPA more sensitive for a PE?
D Dimer
A patient has dull percussion, low breath sounds, bilateral pleural plaques on CXR. What does this suggest and what investigation is needed for diagnosis?
Cancer causing pleural effusion. USS guided pleural fluid aspiration needed for diagnosis
Is smoking or hand surgery a bigger risk for a DVT?
Smoking as hand surgery does not make you bed bound
A patient has a history of asthma, lung infections where antibiotics provide no relief and high eosinophils on FBC. What do they have/
Allergic bronchopulmonary aspergillosis
A patient has a primary pneumothorax that is >2cm on CXR. What is the first line treatment?
Aspiration
A CXR shows scattered pleural plaques, hyperinflation and flattened diaphragms. What does this suggest?
COPD
A patient has a cough, is a non smoker and their CXR shows reticular shadowing. What does this suggest?
IPF
What is the triad for Lofgren’s syndrome?
A specific acute clinical presentation of systemic sarcoidosis, consisting of a classic triad of fever, erythema nodosum, and bilateral hilar adenopathy
A patient has Horner’s syndrome and hoarseness. What do they have?
Paranglioma - a carotid body tumour which can compress the recurrent laryngeal nerve.
A patient has fever, diarrhoea, headache and a dry cough. What investigation is indicated to find the pathogen?
Urinary antigen for atypical pneumonia
What sign is seen in an upper right lobe collapse?
golden S sign
What sign is seen in a left lower lobe collapse?
Sail sign
In pregnant patients with signs of PE, why is D dimer not used and what is done instead?
D dimer is already raised in pregnancy so do a V/Q scan
What does symbicort consist of?
ICS and LABA
What does a young person with widespread bronchiectasis, purulent sputum and situs invertus have ?
Kartegener’s syndrome
What should a patient with recurrent pulmonary embolisms be screened for?
Thrombophilia screen e.g. factor V Leiden
What pulse can be seen in severe asthma and why?
Pulsus paradoxus as there is decreased left atrial filling pressures on inspiration
For an empyema pleural aspirate describe:
- pH
- LDH
- glucose
pH <7.2
raised LDH
decreased glucose
What pathogens are people in early cystic fibrosis most susceptible to?
Staph aureus
Haemophilus influenzae
What pathogens are people in late cystic fibrosis most susceptible to?
Pseudomonas aureginosa
Which atypical pneumonia can cause dry cough and deranged LFTs?
Legionella
How do you treat pulmonary Aspergillosis ?
Amphotericin B
What bronchodilator can decrease serum potassium?
salbutamol
What is the pulmonary capillary wedge pressure and refractory hypoxaemia like in ARDS?
pulmonary capillary wedge pressure: <18
refractory hypoxaemia PaO2:FiO2 < 200
What antibiotics are used to treat aspiration pneumoniae?
IV metronidazole and cefuroxime
What are the target oxygen saturations in an asthma attack?
94-98%
What symptoms suggest an acute exacerbation of COPD and what medication is prescribed if not admitted to hospital?
increase in dyspnoea, cough, wheeze
increase in sputum suggestive of an infective cause
patients may be hypoxic and in some cases have acute confusion
-> increase bronchodilator use, give prednisolone and Abx only if purulent sputum/ signs of pneumonia
What can be seen on a CXR of a TB patient?
scarring at the apices
What can a bloody aspiration of a pleural effusion suggest and what investigation is warranted next?
Mesothelioma
Pleural biopsy
What can two months of meningitis like symptoms suggest and what treatment is indicated?
TB
RIPE
What is Caplan’s syndrome?
Rheumatoid pneumoniosis
RA+ peripheral fibrous nodules in the lungs of coal workers
If symptoms suggest pneumonia but no consolidation on the CXR what does this mean?
a lower respiratory tract infection
If bronchodilators don’t help in an acute asthma attack what other medication can be considered?
IV Magnesium sulphate
Which attacks is IV theophylline used in?
Acute asthma attacks
Which lung cancer can cause a monophonic wheeze?
Non small cell lung cancers e.g squamous cell cancers
How is stage 1-2 NSCLC managed? (4cm)
Lobectomy +/- chemotherapy
Unfit-> radiotherapy
How do you manage a pneumothorax <2cm in a COPD patient who is not breathless?
Needle aspiration
Name a mucolytic
carbocysteine
How can sun exposure worsen sarcoidosis?
Sarcoid granulomas can activate vitamin D increasing serum calcium
When is non invasive ventilation contraindicated and what is given instead?
Reduced consciousness
High flow nasal oxygen therapy
What effect does salbutamol have on serum lactate
Increase serum lactate
What can a raised troponin in PE show?
right sided heart strain
What condition causes non specific interstitial pneumonia?
SLE
What condition causes usual interstitial pneumonia?
IPF
What criteria decides whether further investigation for PE is needed?
PE rule out criteria
In lung fibrosis which way does the trachea deviate?
Towards the affected side
In pneumothorax which way does the trachea deviate?
Away from the affected site
In patients with raised ICP what kind of ventilation may help?
- sit patient up
- mechanical hyperventilation decreased CO2 eading to vasoconstriction
What imaging is always done first in suspected PE?
CXR to rule out any other differentials
In myasthenic crisis what is important to measure?
FVC <1L = resp failure
What anticoagulation is indicated in a submassive PE (thrombus in both pulmonary arteries)
IV unfractionated heparin
What is the likely cause of breathlessness after chest drain insertion?
Iatrogenic pneumothorax secondary to chest drain insertion
