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Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How is ARDS defined clinically?

A

Berlin Definition;
- Onset <7 days
- PaO2:FiO2 ratio <300 (with PEEP or CPAP >5cm H2O)
- Bilateral infiltrates
- Alveolar oedema not explained by fluid overload or cardiogenic causes

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2
Q

What are the 3 phases of ARDS?

A

Exudative
Proliferative
Fibrotic

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3
Q

What sort of wheeze is found in asthmatic patients?

A

Widespread polyphonic expiratory wheeze

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4
Q

Name 3 differentials for a localised wheeze

A

Inhaled foreign body
Tumour
Thick sticky mucus plus

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5
Q

Which 2 types of drugs can worsen asthma?

A

Beta blockers
NSAIDs

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6
Q

What 2 methods are used to investigate asthma?

A

FeNO
Spirometry with bronchodilator reversibility

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7
Q

How do you classify acuteasthma?

A

Moderate - <75%
Severe - <50%
Life-threatening - <33%
Near-fatal - ^PaCO2

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8
Q

What is ‘complete control’ of asthma?

A

Only some minimal SEs, no symptoms / signs of disease

FEV1 and/or PEF >80% of predicted or best

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9
Q

How is Chronic Asthma managed?

A

SABA PRN

1 - Low dose ICS
2 - +LABA
3 - ^ICS / +LTRA, consider stopping LABA if no response
4 - specialist care

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10
Q

What are the options for managing severe acute asthma?

A

O2
Salbutamol and Ipratropoium nebs back to back
IV magnesium sulphate

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11
Q

What is yellow nail syndrome?

A

Triad
- Yellow nails
- Bronchiectasis
- Lymphoedema

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12
Q

What are the signs of bronchiectasis on auscultation?

A

Scattered crackles
Scattered wheezes and squeaks

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12
Q

What are the most common infective organisms found in bronchiectasis?

A

H. Influenza
Pseudomonas aeruginosa

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13
Q

What are the HRCT findings in bronchiectasis?

A

Tram-track opacities
Ring shadows

(both signs of dilated airways from different perspectives)

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14
Q

How would you treat a pseudomonas aeruginosa infection?

A

Ciprofloxacin 7-14 days

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15
Q

Who gets bronchiolitis?

A

<1 year
Ex-premature babies ith chronic lung disease may have it up to 2 years

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16
Q

How does bronciolitis present?

A

Coryza
Respiratory distress
Apnoeas

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17
Q

What airway sounds might you hear in bronchiolitis?

A

Wheezing (expiratory)
Grunting
StridorW

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18
Q

What are the steps in ventilatory support in bronchiolitis?

A

Nasal cannulae
CPAP
Intubation

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19
Q

Who is at high risk of bronchiolitis caused by RSV?

How might you prevent this?

A

Ex-remature babies
Congenital heart disease

Palivizumab monthly injection

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20
Q

What are the 2 forms of COPD and how do they present differently?

A

Chronic bronchitis (mucus hypersecretion) - Blue Bloater (low PaO2, ^PaCO2)

Emphysema (alveolar wall destruction) - Pink Puffer (normal PaO2, normal or low PaCO2)

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21
Q

What is the relationship between COPD and hypoxic drive?

A

In Chronic Bronchitis, respiratory centres are relatively insensitive to CO2 and rely on hypoxic drive to maintian respiratory effort

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22
Q

How does asthma-COPD overlap syndrome present?

A

Partially reversible airflow obstruction

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23
Q

How would you classify SOB in COPD?

A

MRC Dyspnoea Scale

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24
Q

How might you grade COPD severity?

A

FEV1
1 (mild) >80%
2 (moderate) 50-79%
3 (severe) 30-49%
4 (very severe) <30%

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25
Q

Deficiency of what is associated with COPD?

A

Alpha-1-antitrypsin (AAT)

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26
Q

What vaccines should COPD patients be offered?

A

Pneumococcal
Annual flu

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27
Q

What is the treatment algorithm for COPD?

A

SABA / SAMA

Consider adding a LABA+LAMA regularly, ICS if asthmatic or steroid responsive

Use a LABA + LAMA + ICS in all cases if previous stage fails

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28
Q

What Abx might you offer a COPD patient prophylactically?

What do you need to consider here?

A

Azithromycin

Need ECG and liver function monitoring before and during treatment

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29
Q

How would you manage a severe acute exacerbation of COPD?

A

Regular inhalers / nebs
Steroids
Abx

IV aminophylline
NIV
Intubation if really bad bro

Doxapram (respiratory stimulant) if NIV or intubation inappropriate

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30
Q

How might you differentiate an Exudative from a Transudative Pleural Effusion?

A

E - protein count >30g/L

T - protein count <30g/L

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31
Q

How might Light’s criteria be used to confirm an exudative pleural effusion?

A

Pleural fluid protein / serum protein >0.5

Pleural fluid LDH / serum LDH >0.6

Pleural fluid LDH >2/3 of the normal upper limit of the serum LDH

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32
Q

Name 4 causes of exudative pleural effusion

A

Lung cancer
Pneumonia
RA
Tb

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33
Q

Name 4 causes of transudative pleural effusion

A

Congestive HF
Hypoalbuminaemia
Hypothyroid
Meig’s syndrome

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34
Q

How much fluid is yoinked out in a pleural fluid analysis?

A

30-50ml

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35
Q

How would you manage a pleural effusion?

A

Conservative
Pleural aspiration
Chest drain
Pleurodesis

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36
Q

What is an Empyema and how would you manage it?

How does this differ to a para-pneumonic effusion?

A

Infected pleural effusion

Abx 6-8 weeks
Chest drain

Para-pnuemonic effusion give Abx 4-6 weeks

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37
Q

How would you treat recurrent malignant pleural effusion?

A

Pleurodesis (insert chest drain or 24-48 hours, 4g talk into space)

Intrapleural catheter (although risks inflammation)

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38
Q

On CXR, how can you estimate the size of a pneumothorax?

A

2cm represents a 50% collapse

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39
Q

How would you manage a primary pneumothorax?

A

<2cm FUCK OFF
>2cm aspirate

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40
Q

How would you manage a secondary pneumothorax?

A

<1cm FUCK OFF
1-2cm aspirate
>2cm chest drain, O2

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41
Q

What are the boundaries of the triangle of safety?

A

5th intercostal space
Midaxillary line
Anteiror axillary line

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42
Q

What are the 2 main complications of chest drains?

A

Air leaks
Surgical emphysema

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42
Q

What ar ethe surgical options for pnuemothorax

A

Abrasive pleurodesis
Chemical pleurodesis
Pleurectomy

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43
Q

How do you respond to a tension pneumothorax?

A

Large bore cannula triangle of safety

High flow O2

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44
Q

What are the typical findings of idiopathic pulmonary fibrosis on examination?

A

Bibasal fine end-inspiratory crackles

Finger clubbing

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45
Q

What are the key methods of investigation in interstitial lung disease?

A

HRCT - ground glass
spirometry - FEVR:FVC ratio >70% or equally reduced

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46
Q

What 2 medications might slow the progression of Idiopathic Pulmonary FIbrosis?

A

Pirfenidone
Nintedanib

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47
Q

What is the prognosis in idiopathic pulmonary fibrosis?

A

life expectancy 2-5 years from diagnosis

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48
Q

What drugs might cause secondary pulmonary fibrosis?

A

Amiodarone (also grey/blue skin)
Cyclophosphamide
Methotrextae
Nitrofurantoin

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49
Q

What conditions might cause secondary pulmonary fibrosis?

A

AAT deficiency
RA
SLE
Systemic Sclerosis
Sarcoidosis

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50
Q

What type of hypersensitivity reaction is involved in Hypersensitivity Pneumonitis?

A

Type 3/4

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51
Q

Name 4 specific causes of Hypersensitivity Pneumonitis

A

Bird-fancier’s lung - bird droppings
Farmer’s lung - mouldy spores in hay
Mushroom worker’s lung
Malt worker’s lung - mould on barley

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52
Q

What is Cryptogenic Organising Pneumonia?

How is it managed?

A

Focal area of inflammation of hte lung tissue

Systemic corticosteroids

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53
Q

What are the two spikes in incidence in
Sarcoidosis?

A

Young adulthood
60 years

54
Q

What are the pulmonary features of Sarcoidosis?

A

Lymphadenopathy
Pulmonary Fibrosis
Granuloma

55
Q

What are the opthalmological features of Sarcoidosis?

A

Uveitis
Conjunctivitis
Optic Neuritis

56
Q

What are the hepatic features of Sarcoidosis?

A

Nodules
Cirrhosis
Cholestasis

57
Q

What are the dermatological features of Sarcoidosis?

A

Erythema Nodosum
Lupus Pernio
Granuloma

58
Q

What are the cardiac manifestations of sarcoidosis?

A

BBB
Heart block
Myocyte involvement

59
Q

What is Lofgren’s Syndrome?

A

Specific presentation of sarcoidosis

Triad;
- Erythema nodosum
- BIlateral hilar lymphadenopathy
- Polyarthralgia

60
Q

What is the gold standard diagnostic method for sarcoidosis?

A

Histology biopsy - non-caseating granulomas with epitheloid cells

61
Q

Name 3 types of non-small cell lung cancers

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

62
Q

Name 3 types of lung neuroendocrine tumours

A

Small cell lung cancer
Large cell neuroendocrine tumour
Carcinoid

63
Q

Why can’t you gram stain M. tuberculosis?

A

waxy coating

64
Q

What are the different outcomes once Tb has entered the body?

A

Immediate cleareance
Primary active Tb
Latent Tb
Secondary Tb

65
Q

What test do you perform before offering the BCG vaccine?

What else do you have to assess for?

A

Mantoux test, only vaccinate if negative

Assess for immunosuppression and HIV

66
Q

What are the dermatological and spinal manifestations of Tuberculosis?

A

Erythema nodosum

Pott’s disease of the spine

67
Q

What two tests might you use to test for an immune response to Tb?

A

Mantoux test
IGRA (interferon-gamma release assay)

68
Q

What are the 3 presentations of Tb on CXR?

A

Primary Tb - patchy consolidation, pleural effusions and hilar lymphadenopathy

Reactivated Tb - patchy and nodular consolidation with cavitation

Disseminated miliary Tb - millet seeds

69
Q

How do you stain for Tb?

A

Auramine - fluorescent
Ziehl Neelsen - red on blue

Auramine first

70
Q

How do you manage active Tb?

A

R+I 6 months
P+E 2 months

71
Q

How do you manage latent Tb?

A

R+I 3 months
OR
I 6 months

72
Q

What problem is associated with isoniazid and how might it be overcome?

A

Peirpheral neuropahty

Co-prescribe pyridoxine (vitamin B6)

73
Q

What are the SEs of Rifampicin?

A

Red/orange wee / tears

Induces cytochrome P450 enzymes so rudeces the effects of drugs metabolised by this system, like the COCP

74
Q

What are the SEs of Rifampicin?

A

Hyperuricaemia -> gout, kidney stones

75
Q

What are the SEs of Ethambutol?

A

Colour blindness
Reduced visual acuity

76
Q

What are the genetics of CF?

A

AR

Mutation of cystic fibrosis transmembrane conductance regulatory (CTFR) gene on chromosome 7

Most commonly delta-F508 mutation, coding for chloride channels

77
Q

What are the key consequences of CF?

A

ABC
Airway secretions

Biliary secretions

Congenital bilateral absence of the vas deferens

78
Q

How is CF screened for at birth?

A

Newborn bloodspot test

79
Q

What is the first sign of CF in the newborn?

A

Meconium ileus

80
Q

How would you test for CF in the non-newborn?

A

Sweat test (gold stantard, pilocarpine, chloride concentration >60mmol/l)

81
Q

How would you test for CF in the fetus?

A

Genetic testing for CTFR gene by amniocentesis or chorionic villous sampling

82
Q

What is the median life expectancy for CF patients?

A

47

83
Q

Where are small cell carcinoma located?

What problem is assoicated with them?

A

Large airways from Kultschitsky cells (neurendocrine)

Highly aggressive, inopreable, median survival 6 weeks

84
Q

Where are adenocarcinoma located?

A

Peripherally, mucous cells in bronchial epithelium

85
Q

What is the association between lung cancer and smoking?

A

Small cell carcinoma - smokers

Adenocarcinomas - non-smokers

86
Q

What genetic mutations are associated with adenocarcinoma?

A

EGFR
ALK
KRAS

87
Q

What 2 things do we need to assess when investigating lung cancer?

A

Resectability
Operability

88
Q

How might you manage non-small cell lung cancers?

A

Lobectomy, consider anti-EGFR (cetuximab)

89
Q

How might you treat small cell lung cancers?

A

More palliative I think idk

90
Q

What are the 2 surgical options for managing pleural (mesothelioma?

A

EEP (extra-pleural pneumonectomy)

Pleurectomy with decortication

91
Q

What proportion of mesothelioma cases are pleural?

A

90%

92
Q

What are the chest sounds associated with peumoniae?

A

Bronchial breathing (harsh inspiratory and expiratory sounds)
Focal coarse crackles
Dullness ot percussion

93
Q

Describe CURB 65

A

Confusion (new disorientation in person, place or time)

Urea > 7 mmol/L

RR ≥ 30

BP < 90 systolic or ≤ 60 diastolic.]

Age ≥ 65

0/1 - treatment at home
2 - hospital
3 - ICU

94
Q

How would you manage a CAP caused by strep-pnuemoniae?

A

Amoxicillin 500mg TDS PO 5 days

Mild - oral monotherapy

Moderate - oral dual therapy, IV penicillin + macrolide

Severe - IV broad spectrum stable beta-lactamase and macrolide

95
Q

What is the difference between an early and late HAP?

A

Early (first 5-7 days) - E.coli / Klebsiella
Give Co-amoxiclav

Late - Pseudomonas
Tends to occur in those with CF or bronchiectasis
Give Pip-Tazo :D

96
Q

How would you treat a haemophilus influenza infection?

A

Neuraminidase inhibitors

Oseltamivir (oral)
Zanamivir (inhaled)

97
Q

How might you manage a Pneumocystis jirovecii infection?

A

Co-trimoxazole

98
Q

How might you manage a Legionella pneumophila infection?

A

Levofloxacin

99
Q

How might you manage a Mycoplasma pneumoniae infection?

A

Clarithromycin

100
Q

Why don’t you give aspirin to paediatric patients with a cold?

A

Reye’s syndrome (severe developmental delay)

101
Q

What is the criteria for discharge following an acute asthma attack?

A

Inhaler technique checked and recorded

Being stable on discharge medication for 12-24 hours

PEF >75% of best or predicted

102
Q

How might recurrent PE affect TLCO?

A

Reduces it

Recurrent PE causes ventilation - perfusion mismatch. This reduces gas exchange

103
Q

What is TLCO?

A

Transfer factor of the lung for carbon monoxide

104
Q

What is the treatment for ABPA?

A

1st line - Oral prednisolone
2nd line - Itraconazole

104
Q

What 2 investigations should all adults suspected of asthma receive?

A

Spirometry with a bronchodilator reversibility test

Fractional exhaled nitric oxide (FeNO) test

105
Q

An INR of what is a relative contraindication to chest drain insertion?

A

> 1.3

106
Q

What serology is associated with Churg-Strauss syndrome?

A

pANCA +

107
Q

What are the 3 stages of Churg-Strauss disease?

A

Allergy
Eosinophilia
Vasculitis

108
Q

When draining a pneumothorax, how long do you persist with a chest drain which doesn’t work before seeking an opinion from thoracic surgeons?

A

3-5 days

109
Q

How should cases of pneumonia treated in hospital be followed up?

A

CXR at 6-12 after resolution of symptoms

110
Q

How would you manage pleural plaques?

A

Nothing, they are benign

111
Q

What are the 6 high risk characteristics determining the need for a chest drain in pnuemothorax?

A

1) Haemodynamic compromise (suggesting a tension pneumothorax)

2) Significant hypoxia

3) Bilateral pneumothorax

4) Underlying lung disease

5) >/= 50 years of age with significant smoking history

6) Haemothorax

112
Q

What is the significance of PaCO2 in severe asthma?

A

A normal pCO2 in a patient with acute severe asthma is an indicator that it’s actually life-threatening

They are getting tired from compensating -> need ICU

113
Q

What agent may cause occupational asthma in patients in contact with spray painting, and foam moulding using adhesives?

A

Isocyanates

114
Q

Which areas of the lung are affected by fibrosis caused by radiotherapy and asbestos?

A

Radiotherapy - upper zones

Asbestos - lower zones

115
Q

What finding on FBC is characteristic of ABPA?

A

Eosinophilia

116
Q

What is bupropion used for?

A

Smoking cessation

117
Q

When is bupropion contraindicated?

Why?

A

PMHx epilepsy

Reduces seizure threshold

118
Q

How do you step down asthma treatment?

A

Aim for a reduction of 25-50% in the dose of inhaled corticosteroids

119
Q

What test is diagnostic of OSA?

A

Polysomnography

120
Q

What should patients with pneumonia who have COPD also be prescribed?

A

Prednisolone

121
Q

What positioning is helpful in ventilated patients with ARDS?

A

Prone

122
Q

What type of picture will IPF show on spirometry?

A

Restrictive

123
Q

What would you hear on auscultation of a patient with IPF?

A

Bibasal fine end inspiratory crepitations

124
Q

What is the investigation of choice for diagnosis IPF?

A

High-res CT

125
Q

What is the management of choice for IPF?

A

Pulmonary rehabilitation

126
Q

What are the target O2 saturations in COPD?

A

88-92%

94-98% if CO2 normal on ABG

127
Q

How might you prevent high altitude cerebral oedema?

A

Acetazolamide

128
Q

How might you treat high altitude cerebral oedema?

A

Dexamethasone

129
Q

What are the 3 features of Meig’s syndrome?

A

Benign ovarian tumour
Ascites
Pleural effusion

130
Q

What are the target O2 saturations in acute asthma?

A

94-98%

131
Q

When using an inhaler, for a second dose how long should you wait before repeating?

A

30 seconds

132
Q

What are the 2 presentations caused by coal dust exposure?

A

Simple pneumoconiosis
Progressive Massive Fibrosis (PMF)

133
Q

How might you investigate a patient with coal dust exposure?

What might your findings be?

A

CXR: upper zone fibrosis

Spirometry: restrictive lung function tests - a normal or slightly reduced FEV1 and a reduced FVC

134
Q

What legal thingy thang might offer patients compensation if exposed to coal dust?

A

Industrial Injuries Act

Medicine (22 decks)

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