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MSRA > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Restrictive spirometry picture

A

FEV 1 normal or decreased
FVC decreased

FEV1/FVC normal or increased

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2
Q

Obstructive spirometry picture

A

FEV1 decreased
FVC decreased or normal

FEV1/ FVC decreased

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3
Q

When to use BIPAP?

A

Type 2 respiratory failure - COPD

Think BI = 2

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4
Q

When to use CPAP?

A

Type 1 respiratory failure
Pulmonary oedema

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5
Q

What vaccines should COPD patients get?

A

Annual influenza and one off pneumococcal

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6
Q

Which conditions show an obstructive spirometry picture?

A

COPD and Asthma
Bronchiectasis
Bronchiolitis obliterans

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7
Q

Which conditions show a restrictive spirometry picture?

A

Fibrosis
Asbestosis
Sarcoidosis
Ank spon
ARDS
Severe obesity

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8
Q

Small cell lung cancer

A

Features:
ADH - hyponatraemia
ACTH - cushings
Lambert Eaton syndrome

*Chemotherapy and radiotherpay, rarely surgical management if very early disease

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9
Q

Klebsiella pnuemonia

A

Diabetics/ Alcoholics
Cavitating pneumonia of the upper lobes

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10
Q

Legionella pneumonia

A

Contaminated water supplies
Bilateral chest symptoms

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11
Q

Mycoplasma pneumonia

A

Extra-pulmonary features such as: haemolytic anaemia and erythema multiforme

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12
Q

Staph aureus pneumonia

A

Most likely cause of pneumonia following influenza

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13
Q

Strep pneumonia

A

Most common cause of pneumonia

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14
Q

who can’t take bupropion?

A

Epileptics - lowers seizure threshold

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14
Q

What are the criteria for chest drain insertion in patients with a pleural effusion?

A

if the fluid is purulent or turbid/cloudy

if the fluid is clear but the pH is less than 7.2

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15
Q

What type of surgery can be used to manage alpha-1 antitrypsin deficiency?

A

Long volume reduction surgery

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16
Q

What is the mechanism of action of varenicline used in smoking cessation?

A

nicotine receptor partial agonist

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17
Q

What is bronchiectasis?

A

Permanent dilatation of the airways secondary to chronic infection or inflammation.

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18
Q

What is the most common organism associated with bronchiectasis?

A

H.influenza

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19
Q

What are the treatment options for bronchiectasis?

A

physical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
postural drainage
antibiotics for exacerbations + long-term rotating antibiotics in severe cases
bronchodilators in selected cases
immunisations
surgery in selected cases (e.g. Localised disease)

20
Q

How does ABPA present?

A

Wheeze/ cough/ SOB
Eosinophilia
Raised IgE
Positive RAST test to aspergillus
Signs of proximal bronchiectasis on CXR, bronchocoeles on CT

21
Q

What is Goodpasture’s syndrome?

A

Autoimmune disease - antibodies attack the basement membrane in the lungs and kidneys

Smoking is a risk factor

+VE for pANCA and Anti GBM antibodies

Ix with biopsy

Tx with plasmapheresis and steroids

22
Q

Whooping cough - what bug?

A

Bordetella pertussis
Tx - clari/ azithro

23
Q

Bronchiolitis - what bug?

A

RSV or metapneumovirus

24
Q

Investigations for CF?

A

Faecal elastase

HRCT

25
Q

Which type of lung cancer is the most common overall?
Which has the strongest association with smoking?

A

Adenocarcinoma - most common
Small cell carcinoma - mostly in smokers

26
Q

Which type of lung cancer is most likely to arise in the bronchi?

A

Squamous

27
Q

Name the SABAs and the SAMAs

A

SABAs - salbutamol, albuterol, terbutaline

SAMAs - ipratropium, oxitropium

28
Q

Name the LABAs and the LAMAs

A

LABAs - salmeterol, formoterol

LAMAs - tiotropium, glycopyronium

29
Q

Which drugs are the xanthines?

A

Theophylline, aminophylline

30
Q

What is the Boher effect?

A

Increasing the partial pressure of C02 / decreasing pH results in Hb having a lower affinity for 02

31
Q

What is the Haldane effect?

A

Removing 02 from Hb increases its affinity for C02

32
Q

What happens with the 02/ C02 in type 2 respiratory failure?

A

In a chronically hyperaemic patient they have a low 02 Hb saturation. C02 occupies the empty binding sites instead. When 02 is given to the patient, the C02 is pushed off the Hb and into the blood stream.

33
Q

Which vaccines are inactivated?

A

Polio
Hep A

34
Q

Which vaccines are the live attenuated?

A

MMR
BCG
Typhoid

35
Q

What are the type 1 hypersensitivity reactions?

A

IgE Mediated

Asthma, eczema, anaphylaxis

36
Q

What are the type 2 hypersensitivity reactions?

A

Antibodies

Auto-immune
Grave’s
Myaesthenia gravis
Pemphigus

Not auto-immune
Transfusion reactions
Haemolytic disease of the newborn

37
Q

What are the type 3 hypersensitivity reactions?

A

Immune complex mediated

Antibodies bind to antigens which form immune complexes which get trapped in small blood vessels and joints

SLE, farmer’s lung etc

38
Q

What are the type 4 hypersensitivity reactions?

A

T cell mediated

eg sarcoidosis, TB

39
Q

How does adrenaline work on the lungs. Eg in anaphylaxis?

A

Acts on B2 receptors
Constricts arterial smooth muscle
Dilates bronchial smooth muscle - decrease airflow obstruction
Increases BP - limits vascular leakage

40
Q

What is plasmapheresis?

A

A method of removing blood plasma from the body by withdrawing blood, separating it into plasma and cells, and transfusing the cells back into the bloodstream. It is performed especially to remove antibodies in treating autoimmune conditions.

41
Q

How does bronchial challenge testing work?

A

Breathe in metacholine or histamine
- promotes bronchoconstriction
Then check spirometry
Asthmatics will react to lower doses

42
Q

What is aspergilloma?

A

Fungus ball forms in existing lung cavities (eg secondary to TB/ cancer/ fibrosis)

Cough + haemoptysis

Rounded opacity on CXR

43
Q

What is the ‘asthma triad’ ?

A

Obstruction, Inflammation, Hyperresponsiveness

44
Q

Which types of disease affect the upper lung zones?

A

TB
Ank spon
Sarciodosis
Silicosis
Pneumoconiosis (coal worker’s lung)
EAA

45
Q

Which types of disease affect the lower lung zones?

A

Asbestosis
Connective tissue disease
Idiopathic pulmonary fibrosis
Drugs

46
Q

What are the TB drug side effects?

A

Rifampicin - orange urine

Isoniazid - Peripheral neuropathy

Pyrazinamide - hyperuricaemia

Ethambutol - optic neuritis, arthralgia

47
Q
A

MSRA (4 decks)

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