Respiratory Flashcards

1
Q

severe obesity causes what kind of lung function test?

A

Restrictive lung function test

as the forced vital capacity is reduced

mechanically compresssed chest

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2
Q

VATS pleurodesis?

is what?

what is is treatment for?

A

primary spon pneumothorax

video assisted thoracoscopic surgergy pleurodesis

drainage of air/fluid
bullae are excised
talc used to promote adhesion

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3
Q

mx options for pneumothorax

A

conservative ; 2-4 days as outpatient

inpatient if secondary pneumothorax

ambulatory
8FG catheter mounted to an 18G needle and pigtail catheter

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4
Q

first line Mx of COPD?

A

SABA / SAMA

short acting bronchodilator

salbutamol
ipratropium

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5
Q

Oral theophylline

A

methylxanthines

bronchodilator
anti-inflammatory
modulates respiratory function

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6
Q

Churg strauss disease

A

allergy
asthma / allergic rhinitis

nasal polyps

eosinophilia

vasculitis

pANCA

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7
Q

granulomatosis with polyangitis

A

renal failure
epistaxis

vasculitis
sinusitis
dyspnoea

cANCA

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8
Q

3 criteria for discharge for an asthma attack?

A

stable for 12-24 hours
ensure good inhaler technique

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9
Q

how long does metabolic compensation take?

A

days/ weeks

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10
Q

is prednisolone ok in breastfeeding?

A

30mg yes

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11
Q

Mx of acute asthma attack?

A

admit
>Life threaten
>severe and not responding
> pregnant
>prev near fatal

O2 - 15l via non rebreath mask
94-98%

bronchodilate:
SABA; inhaled/neublised
pMDI / o2 driven nebuliser

corticosteroid
40/50mg

Ipratropium bromide
IV magnesium sulphate
IV aminophylline

intubate / ventilate
ECMO

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12
Q

Diagnostic Criteria for ARDS?

A

clinical and
CXR and
po2/fiO2 <40kPa

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13
Q

what is ARDS?

A

non cardiogenic pulmonary oedema
pulmonary capillary wedge then is normal <19mmHg

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14
Q

Mx of ARDS?

A

principles
ITU
o2/ventilate
general organ support
Tx underlying abx

prone positioing

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15
Q

rare but important complication of pleural effusion?

A

if drained too quickly
re expansion pulmonary oedema

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16
Q

Extrinsic allergic alveolitis

mx

A

avoid trigger
oral glucocorticoids

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17
Q

Ix for Extrinsic allergic alveolitis

A

imaging: upper/mid-zone fibrosis

lavage: lymphocytosis
IgG

no eosinophilai tho

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18
Q

A1AT deficiency

A

causes an emphysema like illness

lack of protease inhibitor

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19
Q

When using an inhaler, for a second dose you should wait for approximately?

A

30 seconds

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20
Q

_____ paraneoplastic feature of SCLC?

A

SIADH

hyponatraemia
localised wheeze ; bronchial obstruction

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21
Q

upper lobe zone fibrosis
CHARTS

A

coal workers pneumonconiosis
histiocytosis
ankylosing spondylitis
radiation
TB
silicosis
sarcoid

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22
Q

nasogastric tubes are safe to use when pH is?

A

<5.5

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23
Q

asthma diagnosis
adults

A

eosinophil count / fractional nitric oxide
FeNO

1) bronchodilator reversibility with spirometry

FEV1 >12%
PEF variability

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24
Q

asthma diagnosis in children

A

feNO
>35 ppb

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25
Q

acute asthma
1st line management

A

nebulised salbutamol w o2
15l non rebreath mask

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26
Q

mx of acute asthma principles?

A

Deliver o2
give salbutamol nebulised

give steroids - oral prednisolone 40-50

nebulised ipratropium bromide
IV magnesium sulphate
IV aminophylline

27
Q

Bupropion should not be used in epilepsy why?

A

reduces seizure threshold

noradrenaline and dopamine reuptake inhibitor, shares structural similarities with amphetamines, which can increase neuronal excitability and thereby risk seizures

28
Q

Non-invasive ventilation - key indications

A

copd respiratory acidosis 7.25-7.35

pH <7.25

cardiogenic pulmonary oedema
T2RF

29
Q

Recommended initial settings for bi-level pressure support in COPD
EPAP
IPAP

A

4-5 cm H2O
10 cm H20
12-15 cm H2O (BTS suggest)

1:3 inspiration to expiration ratio

30
Q

Bupropion

A

norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist

31
Q

Varenicline

A

nicotinic receptor partial agonist
12 weeks

32
Q

___________ are the treatment of choice for allergic bronchopulmonary aspergillosis

A

Oral glucocorticoid

33
Q

Atelectasis

A

basal alveolar collapse
> bronchial secretions
>dyspnoea

34
Q

reduced TLCO what does this mean?

A

transfer factor for CO - monoxide
how much oxygen diffuses from lung > capillaries

reduced in any condition where the surface area is reduced

35
Q

what is an example of a SAMA?

A

ipratropium inhaler

= reduces bronchoconstriction and improves symptoms such as wheezing and breathlessness

36
Q

asthma diagnosis requires what change in FEV1?

A

12%
200mL post bronchodilator

37
Q

why does haemoptysis occur in mitral stenosis?

A

rupture of bronchial veins
caused by left atrial pressure

38
Q

aspergilloma

A

rounded opacity
TB hx
haemoptysis

39
Q

main 2 indications for surgery in bronchiectasis

A

uncontrollable haemoptysis
localised disease

40
Q

why does bronchiectasis occur?

A

permanent dilatation of the airways
> chronic infection
> inflammation (smoker / COPD ect)

41
Q

Lung Cancers
Gynaecomastia is associated with?

A

adenocarcinoma
oestrogen / androgen ratio

42
Q

SCLC - associated wiht?

A

lambert eaton
SIADH
ACTH - cushing

43
Q

Squamous cell carcinoma associated?

A

pTHr hypercalcaemia

44
Q

what are pleural plaques?

A

asbestos related lung changes
localized thickening / scarring on the pleura

45
Q

what is mesothelioma?

A

malignant disease of the pleura

> chest pain
pleural effusion
SOB

46
Q

Mx. of mesothelioma?

A

palliative chemo
median survival 8-14 months

47
Q

step down treatment for asthma
ICS

A

decrease dose by 25-50%

BTS reccomen every 3 month review

48
Q

prophylaxis of exarcebations in COPD?

A

Azithromycin

49
Q

first line mx for exarcerbations of COPD?

A

amoxicillin
doxy
clarithromycin

50
Q

when does CO2 start to worry you with an asthma attack and why ?

A

RR of 33 or raised you expect the CO2 to be low due to it being lost when you are hyperventilating

so if they have asthma and their CO2 is raised or normal that is worrying as theyre tiring and hypoventilating

suggests impending respiratory failure

51
Q

use of ambulatory devices in pneumothorax management?

A

Recent intervention
>portable chest drainage systems

52
Q

severe asthma RR is above?

A

25/min

53
Q

PEFR - severe / life threatening?

A

PEFR 33-50 % is severe

<33% is life threatening

54
Q

how to manage allergic bronchopulmonary aspergillosis

A

aspergillus spores

1) bronchocostriction
2) bronchiectasis

eosinophilia
CXR findings
positive radioallergosorbent test

IgG
raised IgE

oral glucocrticoids
itraconazole

55
Q

contraindications for lung cancer

A

SVC obstruction
FEV <1.5
malignant pleural effusion
vocal cord paralysis

tumour near hilum

56
Q

oxygen requirements in COPD

A

88-92%

adjust to 94-98 if pCO2 is normal

57
Q

low severity pneumonia

A

amoxicillin 5 days

58
Q

moderate - high pneumonia?

A

dual antibiotic therapy
amoxicillun and macrolide

7-10 day course

59
Q

NICE recommends for suspected lung cancer?

A

CXR
contrast enhanced CT scan

bronchoscopy- biopsy and histology

PET scan
NSCLC
18-flurodeoxygenase

60
Q

transfer factor

A

rate which gas will diffuse from alveoli into blood

carbon monoxide used to test the rate of diffusion

61
Q

Silicosis

A

mining
upper zone fibrosis
egg shell calcification of hilar nodes

62
Q

what is silicosis?

A

lung disease caused by breathing tiny bits of silica

  • stuck in lungs cause damage
  • hard to breath
  • permanent scarring
63
Q

what is silica found in?

A

mineral found in sand
rock
clay

64
Q
A