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Respiratory Flashcards

1
Q

FEV1 in obstructive lung disease

A

Significantly reduced

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2
Q

FVC in obstructive lung disease

A

reduced or normal

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3
Q

FEV1% in obstructive lung disease

A

reduced

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4
Q

Examples of obstructive lung disease

A

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

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5
Q

Pulmonary function tests in obstructive lung disease

A

FEV1 - reduced
FVC - reduced or normal
FEV1% - reduced

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6
Q

FEV1 in restrictive lung disease

A

reduced

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7
Q

FVC in restrictive lung disease

A

significantly reduced

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8
Q

FEV1% in restrictive lung disease

A

normal or increased

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9
Q

Examples of restrictive lung disease

A 
pulmonary fibrosis
asbestosis
sarcoidosis
ARDS
infant respiratory distress
kyphoscoliosis
neuromuscular disorders
severe obesity
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10
Q

Pulmonary function tests in restrictive lung disease

A

FEV1 - reduced
FVC - reduced
FEV1% - normal or increased

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11
Q

COPD causes

A 
Smoking
Alpha-1 antitrypsin deficiency
Cadmium
Coal
Cotton
Cement
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12
Q

Cardiac causes of clubbing

A

Cyanotic heart disease
Bacterial endocarditis
Atrial myxoma

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13
Q

Respiratory causes of clubbing

A 
Lung ca
Cystic fibrosis
Bronchiectasis
Empyema
TB
Asbestosis, mesothelioma
Fibrosing alveolitis
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14
Q

What did Eosinophilic granulomatosis with polyangiitis used to be called?

A

Churg Strauss syndrome

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15
Q

What is Eosinophilic granulomatosis with polyangiitis?

A

ANCA associated small vessel vasculitis

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16
Q

Features of eosinophilic granulomatosis with polyangiitis

A 
Asthma
Eosinophilia >10%
Paranasal sinusitis
Mononeuritis multiplex
pANCA positive
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17
Q

Features of klebsiella pneumonia

A

Occurs in alcoholics and diabetics
May occur after aspiration
Red-currant jelly sputum
Often affects upper lobes

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18
Q

Complications and prognosis of klebsiella pneumonia

A

Causes lung abscesses and empyema

30-50% mortality

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19
Q

Respiratory manifestations of rheumatoid arthritis

A

Pulmonary fibrosis
Pleural effusion
Pulmonary nodules
Bronchiolitis obliterans

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20
Q

Is coal dust a risk factor for lung cancer?

A

No

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21
Q

What is bronchiectasis?

A

Permanent dilation of the airways secondary to chronic infection or inflammation

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22
Q

Management of bronchiectasis

A 
Physical training 
Postural drainage
Antibiotics for exacerbations
Bronchodilators
Immunisations
Surgery in some cases
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23
Q

Preventing acute mountain sickness

A

No increase in altitude more than 500 metres per day

Acetazolamide

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24
Q

Treatment of acute mountain sickness

A

Descent

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25
Q

Presentation of high altitude cerebral oedema

A

Headache
Ataxia
Papilloedema

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26
Q

Treatment of high altitude pulmonary oedema

A 
Descent
Oxygen
Nifedipine
Dexamethasone
Acetazolamide
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27
Q

Treatment of high altitude cerebral oedema

A

Descent

Dexamethasone

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28
Q

Three most common causes of infective exacerbations of COPD

A

1) Haemophilus influenzae
2) Streptococcus pneumoniae
3) Moraxella catarrhalis

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29
Q

Management of acute exacerbation of COPD

A

Increase bronchodilator frequency

30mg pred for 5 days

Antibiotics if purulent sputum or clinical signs of pneumonia

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30
Q

Antibiotics for acute exacerbations of COPD

A

Amoxicillin or clarithromycin or doxycycline

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31
Q

In which cases of otitis media should antibiotics be immediately precribed?

A

Children <2 with bilateral acute otitis media

Children with otorrhoea and acute otitis media

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32
Q

In which cases of sore throat should antibiotics be immediately prescribed?

A

3 or more centor criteria

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33
Q

Centor criteria

A

Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough

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34
Q

How long does acute otitis media generally last?

A

4 days

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35
Q

How long does acute sore throat/tonsillitis/pharyngitis generally last?

A

1 week

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36
Q

How long does the common cold generally last?

A

1.5 weeks

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37
Q

How long does acute rhinosinusitis generally last?

A

2.5 weeks

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38
Q

How long does acute cough/acute bronchitis generally last?

A

3 weeks

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39
Q

Why do we give antibiotics if the centor criteria gives a score of 3?

A

40-60% chance sore throat is caused by group A beta haemolytic streptococcus

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40
Q

Criteria for moderate acute asthma

A

PEFR 50-75% best or predicted
Speech normal
RR <25
Pulse <110

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41
Q

Criteria for severe acute asthma

A

PEFR 33-50% best or predicted
Can’t complete sentences
RR >25
Pulse >110

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42
Q

Criteria for life threatening acute asthma

A 
PEFR <33% best or predicted
Oxygen <92
Silent chest, cyanosis or poor resp effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
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43
Q

Criteria for near fatal acute asthma

A

Normal or raised pCO2

Requiring mechanical ventilation

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44
Q

Management of acute asthma

A 
Oxygen
Bronchodilators via neb
40-50mg prednisolone daily
Ipratropium bromide
IV magnesium sulphate
IV aminophylline
ITU options = ventilation, ECMO
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45
Q

Asthma - when is reversibility testing positive?

A

Adults = improvement in FEV1 of 12% and increase in volume of 200ml

Children = improvement in FEV1 of 12%

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46
Q

Asthma - when is FeNO considered positive?

A

Adults = ≥40 parts per billion

Children = ≥35 parts per billion

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47
Q

Recommendations from the national review of asthma deaths

A

Refer secondary care if >2 courses systemic steroids in 1 year

Urgent review if 12+ salbutamol in 1 year

Assess and document inhaler technique

Encouraged combination inhalers

Poor compliance with ICS suggested poor control

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48
Q

Most common cause of occupational asthma

A

Isocyanates found in spray painting and foam moulding

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49
Q

How to reduce the dose of ICS in asthma

A

By 25-50% at a time

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50
Q

What is considered low dose ICS?

A

<400 micrograms budesonide

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51
Q

What is considered medium dose ICS?

A

400 to 800 micrograms budesonide

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52
Q

What is considered high dose ICS?

A

> 800 micrograms budesonide

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53
Q

Criteria for starting azithromycin in COPD

A

Not smoking

Optimised standard therapy

Continue to have exacerbations

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54
Q

What investigations are done prior to starting azithromycin in COPD?

A

CT thorax to exclude bronchiectasis

Sputum culture to exclude atypical infections and TB

ECG to exclude QT prolongation

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55
Q

Which FEV1 values should prompt assessment for LTOT in COPD?

A

FEV1 <30%

Consider if 30-49%

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56
Q

Which clinical findings should prompt assessment for LTOT in COPD?

A 
Cyanosis
Polycythaemia
Peripheral oedema
Raised JVP
O2 sats <92%
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57
Q

How should adults with suspected asthma be investigated?

A

FeNO and spirometry/bronchodilator reversibility testing

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58
Q

Features suggesting that a patient with COPD has asthma or steroid responsive features

A

Asthma or atophy diagnosis
High blood oesinophil
Substantial variation in FEV1 over time
Substantial diurnal variation in peak expiratory flow (20+%)

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59
Q

What are the CURB65 criteria?

A 
Confusion
Urea >7
Resp rate ≥30
BP <90 systolic and/or <60 diastolic
Age ≥65
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60
Q

Acute bronchitis - features

A

Cough - may or may not be productive
Sore throat
Rhinorrhoea
Wheeze

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61
Q

What is acute bronchitis?

A

Inflammation of trachea and major bronchi

62
Q

Acute bronchitis - when to give antibiotics

A

Systemically unwell
Co-morbidities
CRP >100
If CRP 20-100 then give delayed prescription

63
Q

Acute bronchitis - antibiotic choice

A

1st line doxycycline

If not then amoxicillin

64
Q

Alpha-1 antitrypsin deficiency - genetics

A

autosomal dominant

65
Q

Alpha-1 antitrypsin deficiency - features

A

panacinar emphysema
liver cirrhosis
HCC
cholestasis

66
Q

Alpha-1 antitrypsin deficiency - investigations

A

spirometry - obstructive

A1AT concentrations

67
Q

Alpha-1 antitrypsin deficiency - management

A 
Stop smoking
Bronchodilators
Physiotherapy
IV A1AT protein concentrates
lung volume reduction surgery
lung transplant
68
Q

What is mesothelioma?

A

malignant disease of the pleura

69
Q

Mesothelioma - features

A

SOB
chest pain
pleural effusion

70
Q

Mesothelioma - treatment

A

palliative chemotherapy

71
Q

Mesothelioma - prognosis

A

median survival 8-14 months after diagnosis

72
Q

Asbestosis - management

A

conservative

73
Q

Suspected lung cancer - criteria for urgent 2WW referral to respiratory

A

CXR changes suggesting lung cancer

Age >40 with unexplained haemoptysis

74
Q

Suspected lung cancer - criteria for urgent 2WW chest xray referral

A

age >40 with 2 unexplained symptoms
ever smoked with 1 unexplained symptom

Symptoms: cough, SOB, weight loss, appetite loss, fatigue, chest pain

75
Q

Suspected lung cancer - criteria to consider urgent 2WW for chest xray referral

A

Age >40 with:

  • persistent/recurrent chest infection
  • finger clubbing
  • supraclavicular lymphadenopathy
  • persistent cervical lymphadenopathy
  • chest signs consistent with lung ca
  • thrombocytosis
76
Q

What is silicosis?

A

Fibrosing lung disease caused by inhalation of fine particles of silica (crystalline silicon dioxide)

77
Q

What major disease is silicosis a risk factor for?

78
Q

Occupations at risk of silicosis

A

mining
slate works
foundries
potteries

79
Q

Silicosis - investigations

A

Fibrosing lung disease

‘Egg shell’ calcification of hilar lymph nodes

80
Q

What is the key characteristic of sarcoidosis?

A

Non-caseating granulomas

81
Q

Acute features of sarcoidosis

A

Erythema nodosoum
Bilateral hilar lymphadenopathy
Swinging fever
Polyarthralgia

82
Q

Insidious features of sarcoidosis

A 
Dysphoea
Non-productive cough
Malaise
Weight loss
Lupus pernio
Hypercalcaemia
83
Q

What is heerfordt’s syndrome?

A

Parotid enlargement, fever, and uveitis

secondary to sarcoidosis

84
Q

What is Lofgren’s syndrome?

A

Acute form of sarcoidosis with a good prognosis

85
Q

Primary pneumothorax - criteria for discharge

A

Rim of air <2cm and not breathless

86
Q

Primary pneumothorax - management if breathless or rim of air >2cm

A

Aspirate

If aspiration not successful then chest drain

87
Q

Secondary pneumothorax - when to use chest drain

A

> 50 years and rim of air >2cm and/or patient is breathless

88
Q

Secondary pneumothorax - management if 1-2cm

A

Aspirate

Observe for 24 hours

89
Q

Secondary pneumothorax - management if <1cm

A

Observe for 24 hours

90
Q

Secondary pneumothorax - management if >2cm

A

Chest drain

91
Q

Obstructive sleep apnoea - predisposing factors

A

Obesity
Macroglossia
Large tonsils
Marfan’s syndrome

92
Q

Obstructive sleep apnoea - consequences

A

Daytime somnolence
Compensated respiratory acidosis
Hypertension

93
Q

Obstructive sleep apnoea - how to assess sleepiness

A

Epworth sleepiness scale

Multiple sleep latency test

94
Q

Obstructive sleep apnoea - diagnostic test

A

Polysomnography

95
Q

Obstructive sleep apnoea - management

A

Weight loss
CPAP
Intraoral devices e.g. mandibular advancement

DVLA needs to be informed and stop driving if excessive daytime somnolence

96
Q

What is the other name for primary ciliary dyskinesia?

A

Kartagener’s syndrome

97
Q

What is the other name for Kartagener’s syndrome?

A

primary ciliary dyskinesia

98
Q

Features of Kartagener’s syndrome (also called primary ciliary dyskinesia)

A

Dextrocardia or complete sinus inversus
Bronchiectasis
Recurrent sinusitis
Subfertility

99
Q

Idiopathic pulmonary fibrosis - features

A

Progressive exertional dyspnoea
Bibasal fine end-expiratory creps
Dry cough
Clubbing

100
Q

Idiopathic pulmonary fibrosis - diagnosis

A

Spirometry - restrictive
Reduced transfer factor (TLCO)
High resolution CT - ground glass / honeycombing

101
Q

Idiopathic pulmonary fibrosis - management

A

pulmonary rehab
LTOT
lung transplant

102
Q

Idiopathic pulmonary fibrosis - life expectancy from diagnosis

103
Q

What is granulomatosis with polyangiitis also called?

A

Wegener’s granulomatosis

104
Q

What is the other name for Wegener’s granulomatosis?

A

granulomatosis with polyangiitis

105
Q

What is granulomatosis with polyangiitis?

A

Autoimmune condition with necrotising granulomatous vasculitis

106
Q

Where does granulomatosis with polyangiitis affect?

A

Upper respiratory tract
Lower respiratory tract
Kidneys

107
Q

Granulomatosis with polyangiitis - features

A 
Epistaxis, sinusitis, nasal crusting
Dyspnoea, haemoptysis
Rapidly progressive glomerulonephritis
Saddle shaped nose
Vasculitic rash
108
Q

Granulomatosis with polyangiitis - investigations

A

cANCA in >90%

renal biospy

109
Q

Granulomatosis with polyangiitis - management

A

Steroids
Cyclophosphamide
Plasma exchange

110
Q

Granulomatosis with polyangiitis - median survival from diagnosis

111
Q

What type of hypersensitivity is extrinsic allergic alveolitis?

A

Mostly type III

type IV has role in chronic phase

112
Q

Extrinsic allergic alveolitis - acute features

A

After 4-8 hours

Dysphoea, dry cough, fever

113
Q

Extrinsic allergic alveolitis - chronic features

A

After weeks to months

Lethargy, dyspnoea, productive cough, weight loss

114
Q

Extrinsic allergic alveolitis - investigations

A

Imaging - upper/mid zone fibrosis
Serology for specific IgG antibodies
Lymphocytosis
No eosinophilia

115
Q

Extrinsic allergic alveolitis - management

A

Avoid precipitating factors

Oral glucocorticoids

116
Q

Criteria for stage 1 (mild) COPD

A

FEV1 >80% of predicted

FEV1/FVC <0.7

117
Q

Criteria for stage 2 (moderate) COPD

A

FEV1 50-79%

FEV1/FVC <0.7

118
Q

Criteria for stage 3 (severe) COPD

A

FEV1 30-49%

FEV1/FVC <0.7

119
Q

Criteria for stage 4 (very severe) COPD

A

FEV1 <30%

FEV1/FVC <0.7

120
Q

COPD on CXR

A

Hyperinflation
Bullae
Flat hemidiaphragm

121
Q

When to offer LTOT to COPD patients

A

If pO2 <7.3

If pO2 7.3-7.8 and one of:

  • secondary polycythaemia
  • peripheral oedema
  • pulmonary hypertension
  • nocturnal hypoxaemia
122
Q

Vaccinations for COPD patients

A

Influenza yearly

One off pneumococcal

123
Q

1st line treatment for COPD patients

A

Short acting beta 2 agonist or short acting muscarinic antagonist

124
Q

Example of a short acting muscarinic antagonist

A

ipatropium

125
Q

Example of a short acting beta 2 agonist

A

salbutamol

126
Q

2nd line treatment for COPD patients with no asthma/steroid responsive features

A

Long acting beta 2 agonist + long acting muscarinic antagonist

Change SAMA to SABA

127
Q

Example of a long acting beta 2 agonist

A

salmeterol

128
Q

Example of a long acting muscarinic antagonist

A

tiotropium

129
Q

2nd line treatment for COPD patients with asthma or steroid responsive features

A

long acting beta 2 agonist + inhailed corticosteroids
LABA + ICS

IF STILL BREATHLESS then add long acting muscarinic antagonist
+ LAMA

130
Q

Nicotine replacement therapy - how long to prescribe for

A

Give 2 week prescription
Review and continue if still trying to stop
If doesn’t work don’t prescribe again for 6 months

131
Q

Nicotine replacement therapy - side effects

A

Nausea + vomiting
Headaches
Flu like symptoms

132
Q

How does varenicline work?

A

Nicotine receptor partial agonist

Used in smoking cessation

133
Q

When to start varenicline?

A

1 week before date planned to stop smoking

134
Q

Varenicline side effects

A

Nausea
Headache
Insomnia
Abnormal dreams

135
Q

Varenicline contraindications

A

Pregnancy

Breastfeeding

136
Q

Varenicline cautions

A

Depression

Self harm

137
Q

How does bupropion work?

A

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

used in smoking cessation

138
Q

When to start bupropion?

A

1-2 weeks before planned date to stop smoking

139
Q

Bupropion contraindications

A

Epilepsy
Pregnancy
Breastfeeding
Eating disorders

140
Q

Asthma management - step 1

141
Q

Asthma management - step 2

A

SABA + low dose ICS

142
Q

Asthma management - step 3

A

SABA + low dose ICS + leukotriene receptor antagonist

143
Q

Example of a leukotriene receptor antagonist

A

Montelukast

144
Q

Asthma management - step 4

A

SABA + low dose ICS + LABA

Continue leukotriene receptor antagonist if good response

145
Q

Asthma management - step 5

A

SABA +/- leukotriene receptor antagonist

Switch ICS/LABA for maintenance and reliever therapy (MART) with low dose ICS

146
Q

Asthma management - step 6

A

SABA +/- leukotriene receptor antagonist + medium dose ICS MART

147
Q

Asthma management - step 7

A

SABA +/- leukotriene receptor antagonist

+ one of:
high dose ICS
theophylline
secondary care referral

148
Q

What type of drug is ipatropium?

A

short acting muscarinic antagonist

149
Q

What type of drug salmeterol?

A

long acting beta 2 agonist

150
Q

What type of drug is tiotropium?

A

long acting muscarinic antagonist

151
Q

What type of drug is montelukast?

A

leukotriene receptor antagonist

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