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YEAR 3 CORRECTIONS > Respiratory > Flashcards

Respiratory Flashcards

1
Q

When is theophylline offered to COPD patients?

A

After COPD patients are offered SABA/LABA or offered to people who cannot tolerate inhaled therapy

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2
Q

What does nice recommend to check in patients starting theophylline?

A
  • U&Es and LFTs
  • reduce dose if macrolide/ fluroquinoline is co-prescribed
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3
Q

What do the symptoms: fever, pleuritic chest pain, dull to percuss, no breath sounds and signs of sepsis suggest?

A

consolidation of the lungs

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4
Q

What is the next step for an asthmatic with a lower respiratory tract infection who is not responding to amoxicillin monotherapy?

A

Add or switch to a macrolide e.g. clarithromycin

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5
Q

Do you give oral prednisolone in an asthmatic with a lower respiratory tract infection?

A

No. Give oral prednisolone in an acute exacerbation of asthma

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6
Q

A smoker presents with SOB, productive cough, clubbing and a lung collpase on CXR. What do they most likely have?

A

Lung cancer

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7
Q

What gene is mutated in cystic fibrosis?

A

CFTR

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8
Q

What way does the trachea deviate in a right lung collpase?

A

Right tracheal deviation (same side as collapse)

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9
Q

Describe resonance in pneumothorax or in an asthmatic

A

high resonance to percussion

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10
Q

What are the two top differentials for a patient with painless palpable inguinal lymphadenopathy, fevers, weight loss and abdominal distension?

A
  1. disseminated TB
  2. Sarcoidosis (dx of exclusion after TB)
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11
Q

What do 3 months of B symptoms with bilateral hilar lymphadenopathy on CXR suggest?

A

Lymphoma

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12
Q

Is a D dimer or a CTPA more sensitive for a PE?

A

D Dimer

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13
Q

A patient has dull percussion, low breath sounds, bilateral pleural plaques on CXR. What does this suggest and what investigation is needed for diagnosis?

A

Cancer causing pleural effusion. USS guided pleural fluid aspiration needed for diagnosis

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14
Q

Is smoking or hand surgery a bigger risk for a DVT?

A

Smoking as hand surgery does not make you bed bound

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15
Q

A patient has a history of asthma, lung infections where antibiotics provide no relief and high eosinophils on FBC. What do they have/

A

Allergic bronchopulmonary aspergillosis

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16
Q

A patient has a primary pneumothorax that is >2cm on CXR. What is the first line treatment?

A

Aspiration

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17
Q

A CXR shows scattered pleural plaques, hyperinflation and flattened diaphragms. What does this suggest?

A

COPD

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18
Q

A patient has a cough, is a non smoker and their CXR shows reticular shadowing. What does this suggest?

A

IPF

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19
Q

What is the triad for Lofgren’s syndrome?

A

A specific acute clinical presentation of systemic sarcoidosis, consisting of a classic triad of fever, erythema nodosum, and bilateral hilar adenopathy

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20
Q

A patient has Horner’s syndrome and hoarseness. What do they have?

A

Paranglioma - a carotid body tumour which can compress the recurrent laryngeal nerve.

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21
Q

A patient has fever, diarrhoea, headache and a dry cough. What investigation is indicated to find the pathogen?

A

Urinary antigen for atypical pneumonia

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22
Q

What sign is seen in an upper right lobe collapse?

A

golden S sign

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23
Q

What sign is seen in a left lower lobe collapse?

A

Sail sign

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24
Q

In pregnant patients with signs of PE, why is D dimer not used and what is done instead?

A

D dimer is already raised in pregnancy so do a V/Q scan

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25
Q

What does symbicort consist of?

A

ICS and LABA

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26
Q

What does a young person with widespread bronchiectasis, purulent sputum and situs invertus have ?

A

Kartegener’s syndrome

27
Q

What should a patient with recurrent pulmonary embolisms be screened for?

A

Thrombophilia screen e.g. factor V Leiden

28
Q

What pulse can be seen in severe asthma and why?

A

Pulsus paradoxus as there is decreased left atrial filling pressures on inspiration

29
Q

For an empyema pleural aspirate describe:
- pH
- LDH
- glucose

A

pH <7.2
raised LDH
decreased glucose

30
Q

What pathogens are people in early cystic fibrosis most susceptible to?

A

Staph aureus
Haemophilus influenzae

31
Q

What pathogens are people in late cystic fibrosis most susceptible to?

A

Pseudomonas aureginosa

32
Q

Which atypical pneumonia can cause dry cough and deranged LFTs?

A

Legionella

33
Q

How do you treat pulmonary Aspergillosis ?

A

Amphotericin B

34
Q

What bronchodilator can decrease serum potassium?

A

salbutamol

35
Q

What is the pulmonary capillary wedge pressure and refractory hypoxaemia like in ARDS?

A

pulmonary capillary wedge pressure: <18
refractory hypoxaemia PaO2:FiO2 < 200

36
Q

What antibiotics are used to treat aspiration pneumoniae?

A

IV metronidazole and cefuroxime

37
Q

What are the target oxygen saturations in an asthma attack?

A

94-98%

38
Q

What symptoms suggest an acute exacerbation of COPD and what medication is prescribed if not admitted to hospital?

A

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

39
Q

What can be seen on a CXR of a TB patient?

A

scarring at the apices

40
Q

What can a bloody aspiration of a pleural effusion suggest and what investigation is warranted next?

A

Mesothelioma
Pleural biopsy

41
Q

What can two months of meningitis like symptoms suggest and what treatment is indicated?

A

TB
RIPE

42
Q

What is Caplan’s syndrome?

A

Rheumatoid pneumoniosis
RA+ peripheral fibrous nodules in the lungs of coal workers

43
Q

If symptoms suggest pneumonia but no consolidation on the CXR what does this mean?

A

a lower respiratory tract infection

44
Q

If bronchodilators don’t help in an acute asthma attack what other medication can be considered?

A

IV Magnesium sulphate

45
Q

Which attacks is IV theophylline used in?

A

Acute asthma attacks

46
Q

Which lung cancer can cause a monophonic wheeze?

A

Non small cell lung cancers e.g squamous cell cancers

47
Q

How is stage 1-2 NSCLC managed? (4cm)

A

Lobectomy +/- chemotherapy
Unfit-> radiotherapy

48
Q

How do you manage a pneumothorax <2cm in a COPD patient who is not breathless?

A

Needle aspiration

49
Q

Name a mucolytic

A

carbocysteine

50
Q

How can sun exposure worsen sarcoidosis?

A

Sarcoid granulomas can activate vitamin D increasing serum calcium

51
Q

When is non invasive ventilation contraindicated and what is given instead?

A

Reduced consciousness
High flow nasal oxygen therapy

52
Q

What effect does salbutamol have on serum lactate

A

Increase serum lactate

53
Q

What can a raised troponin in PE show?

A

right sided heart strain

54
Q

What condition causes non specific interstitial pneumonia?

A

SLE

55
Q

What condition causes usual interstitial pneumonia?

A

IPF

56
Q

What criteria decides whether further investigation for PE is needed?

A

PE rule out criteria

57
Q

In lung fibrosis which way does the trachea deviate?

A

Towards the affected side

58
Q

In pneumothorax which way does the trachea deviate?

A

Away from the affected site

59
Q

In patients with raised ICP what kind of ventilation may help?

A
  1. sit patient up
  2. mechanical hyperventilation decreased CO2 eading to vasoconstriction
60
Q

What imaging is always done first in suspected PE?

A

CXR to rule out any other differentials

61
Q

In myasthenic crisis what is important to measure?

A

FVC <1L = resp failure

62
Q

What anticoagulation is indicated in a submassive PE (thrombus in both pulmonary arteries)

A

IV unfractionated heparin

63
Q

What is the likely cause of breathlessness after chest drain insertion?

A

Iatrogenic pneumothorax secondary to chest drain insertion

YEAR 3 CORRECTIONS (16 decks)

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