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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
Presentation of high altitude cerebral oedema
Headache Ataxia Papilloedema
26
Treatment of high altitude pulmonary oedema
``` Descent Oxygen Nifedipine Dexamethasone Acetazolamide ```
27
Treatment of high altitude cerebral oedema
Descent | Dexamethasone
28
Three most common causes of infective exacerbations of COPD
1) Haemophilus influenzae 2) Streptococcus pneumoniae 3) Moraxella catarrhalis
29
Management of acute exacerbation of COPD
Increase bronchodilator frequency 30mg pred for 5 days Antibiotics if purulent sputum or clinical signs of pneumonia
30
Antibiotics for acute exacerbations of COPD
Amoxicillin or clarithromycin or doxycycline
31
In which cases of otitis media should antibiotics be immediately precribed?
Children <2 with bilateral acute otitis media Children with otorrhoea and acute otitis media
32
In which cases of sore throat should antibiotics be immediately prescribed?
3 or more centor criteria
33
Centor criteria
Presence of tonsillar exudate Tender anterior cervical lymphadenopathy or lymphadenitis History of fever Absence of cough
34
How long does acute otitis media generally last?
4 days
35
How long does acute sore throat/tonsillitis/pharyngitis generally last?
1 week
36
How long does the common cold generally last?
1.5 weeks
37
How long does acute rhinosinusitis generally last?
2.5 weeks
38
How long does acute cough/acute bronchitis generally last?
3 weeks
39
Why do we give antibiotics if the centor criteria gives a score of 3?
40-60% chance sore throat is caused by group A beta haemolytic streptococcus
40
Criteria for moderate acute asthma
PEFR 50-75% best or predicted Speech normal RR <25 Pulse <110
41
Criteria for severe acute asthma
PEFR 33-50% best or predicted Can't complete sentences RR >25 Pulse >110
42
Criteria for life threatening acute asthma
``` PEFR <33% best or predicted Oxygen <92 Silent chest, cyanosis or poor resp effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma ```
43
Criteria for near fatal acute asthma
Normal or raised pCO2 Requiring mechanical ventilation
44
Management of acute asthma
``` Oxygen Bronchodilators via neb 40-50mg prednisolone daily Ipratropium bromide IV magnesium sulphate IV aminophylline ITU options = ventilation, ECMO ```
45
Asthma - when is reversibility testing positive?
Adults = improvement in FEV1 of 12% and increase in volume of 200ml Children = improvement in FEV1 of 12%
46
Asthma - when is FeNO considered positive?
Adults = ≥40 parts per billion Children = ≥35 parts per billion
47
Recommendations from the national review of asthma deaths
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
48
Most common cause of occupational asthma
Isocyanates found in spray painting and foam moulding
49
How to reduce the dose of ICS in asthma
By 25-50% at a time
50
What is considered low dose ICS?
<400 micrograms budesonide
51
What is considered medium dose ICS?
400 to 800 micrograms budesonide
52
What is considered high dose ICS?
>800 micrograms budesonide
53
Criteria for starting azithromycin in COPD
Not smoking Optimised standard therapy Continue to have exacerbations
54
What investigations are done prior to starting azithromycin in COPD?
CT thorax to exclude bronchiectasis Sputum culture to exclude atypical infections and TB ECG to exclude QT prolongation
55
Which FEV1 values should prompt assessment for LTOT in COPD?
FEV1 <30% Consider if 30-49%
56
Which clinical findings should prompt assessment for LTOT in COPD?
``` Cyanosis Polycythaemia Peripheral oedema Raised JVP O2 sats <92% ```
57
How should adults with suspected asthma be investigated?
FeNO and spirometry/bronchodilator reversibility testing
58
Features suggesting that a patient with COPD has asthma or steroid responsive features
Asthma or atophy diagnosis High blood oesinophil Substantial variation in FEV1 over time Substantial diurnal variation in peak expiratory flow (20+%)
59
What are the CURB65 criteria?
``` Confusion Urea >7 Resp rate ≥30 BP <90 systolic and/or <60 diastolic Age ≥65 ```
60
Acute bronchitis - features
Cough - may or may not be productive Sore throat Rhinorrhoea Wheeze
61
What is acute bronchitis?
Inflammation of trachea and major bronchi
62
Acute bronchitis - when to give antibiotics
Systemically unwell Co-morbidities CRP >100 If CRP 20-100 then give delayed prescription
63
Acute bronchitis - antibiotic choice
1st line doxycycline If not then amoxicillin
64
Alpha-1 antitrypsin deficiency - genetics
autosomal dominant
65
Alpha-1 antitrypsin deficiency - features
panacinar emphysema liver cirrhosis HCC cholestasis
66
Alpha-1 antitrypsin deficiency - investigations
spirometry - obstructive | A1AT concentrations
67
Alpha-1 antitrypsin deficiency - management
``` Stop smoking Bronchodilators Physiotherapy IV A1AT protein concentrates lung volume reduction surgery lung transplant ```
68
What is mesothelioma?
malignant disease of the pleura
69
Mesothelioma - features
SOB chest pain pleural effusion
70
Mesothelioma - treatment
palliative chemotherapy
71
Mesothelioma - prognosis
median survival 8-14 months after diagnosis
72
Asbestosis - management
conservative
73
Suspected lung cancer - criteria for urgent 2WW referral to respiratory
CXR changes suggesting lung cancer | Age >40 with unexplained haemoptysis
74
Suspected lung cancer - criteria for urgent 2WW chest xray referral
age >40 with 2 unexplained symptoms ever smoked with 1 unexplained symptom Symptoms: cough, SOB, weight loss, appetite loss, fatigue, chest pain
75
Suspected lung cancer - criteria to consider urgent 2WW for chest xray referral
Age >40 with: - persistent/recurrent chest infection - finger clubbing - supraclavicular lymphadenopathy - persistent cervical lymphadenopathy - chest signs consistent with lung ca - thrombocytosis
76
What is silicosis?
Fibrosing lung disease caused by inhalation of fine particles of silica (crystalline silicon dioxide)
77
What major disease is silicosis a risk factor for?
TB
78
Occupations at risk of silicosis
mining slate works foundries potteries
79
Silicosis - investigations
Fibrosing lung disease | 'Egg shell' calcification of hilar lymph nodes
80
What is the key characteristic of sarcoidosis?
Non-caseating granulomas
81
Acute features of sarcoidosis
Erythema nodosoum Bilateral hilar lymphadenopathy Swinging fever Polyarthralgia
82
Insidious features of sarcoidosis
``` Dysphoea Non-productive cough Malaise Weight loss Lupus pernio Hypercalcaemia ```
83
What is heerfordt's syndrome?
Parotid enlargement, fever, and uveitis secondary to sarcoidosis
84
What is Lofgren's syndrome?
Acute form of sarcoidosis with a good prognosis
85
Primary pneumothorax - criteria for discharge
Rim of air <2cm and not breathless
86
Primary pneumothorax - management if breathless or rim of air >2cm
Aspirate If aspiration not successful then chest drain
87
Secondary pneumothorax - when to use chest drain
>50 years and rim of air >2cm and/or patient is breathless
88
Secondary pneumothorax - management if 1-2cm
Aspirate | Observe for 24 hours
89
Secondary pneumothorax - management if <1cm
Observe for 24 hours
90
Secondary pneumothorax - management if >2cm
Chest drain
91
Obstructive sleep apnoea - predisposing factors
Obesity Macroglossia Large tonsils Marfan's syndrome
92
Obstructive sleep apnoea - consequences
Daytime somnolence Compensated respiratory acidosis Hypertension
93
Obstructive sleep apnoea - how to assess sleepiness
Epworth sleepiness scale | Multiple sleep latency test
94
Obstructive sleep apnoea - diagnostic test
Polysomnography
95
Obstructive sleep apnoea - management
Weight loss CPAP Intraoral devices e.g. mandibular advancement DVLA needs to be informed and stop driving if excessive daytime somnolence
96
What is the other name for primary ciliary dyskinesia?
Kartagener's syndrome
97
What is the other name for Kartagener's syndrome?
primary ciliary dyskinesia
98
Features of Kartagener's syndrome (also called primary ciliary dyskinesia)
Dextrocardia or complete sinus inversus Bronchiectasis Recurrent sinusitis Subfertility
99
Idiopathic pulmonary fibrosis - features
Progressive exertional dyspnoea Bibasal fine end-expiratory creps Dry cough Clubbing
100
Idiopathic pulmonary fibrosis - diagnosis
Spirometry - restrictive Reduced transfer factor (TLCO) High resolution CT - ground glass / honeycombing
101
Idiopathic pulmonary fibrosis - management
pulmonary rehab LTOT lung transplant
102
Idiopathic pulmonary fibrosis - life expectancy from diagnosis
3-4 years
103
What is granulomatosis with polyangiitis also called?
Wegener's granulomatosis
104
What is the other name for Wegener's granulomatosis?
granulomatosis with polyangiitis
105
What is granulomatosis with polyangiitis?
Autoimmune condition with necrotising granulomatous vasculitis
106
Where does granulomatosis with polyangiitis affect?
Upper respiratory tract Lower respiratory tract Kidneys
107
Granulomatosis with polyangiitis - features
``` Epistaxis, sinusitis, nasal crusting Dyspnoea, haemoptysis Rapidly progressive glomerulonephritis Saddle shaped nose Vasculitic rash ```
108
Granulomatosis with polyangiitis - investigations
cANCA in >90% | renal biospy
109
Granulomatosis with polyangiitis - management
Steroids Cyclophosphamide Plasma exchange
110
Granulomatosis with polyangiitis - median survival from diagnosis
8-9 years
111
What type of hypersensitivity is extrinsic allergic alveolitis?
Mostly type III type IV has role in chronic phase
112
Extrinsic allergic alveolitis - acute features
After 4-8 hours Dysphoea, dry cough, fever
113
Extrinsic allergic alveolitis - chronic features
After weeks to months Lethargy, dyspnoea, productive cough, weight loss
114
Extrinsic allergic alveolitis - investigations
Imaging - upper/mid zone fibrosis Serology for specific IgG antibodies Lymphocytosis No eosinophilia
115
Extrinsic allergic alveolitis - management
Avoid precipitating factors | Oral glucocorticoids
116
Criteria for stage 1 (mild) COPD
FEV1 >80% of predicted FEV1/FVC <0.7
117
Criteria for stage 2 (moderate) COPD
FEV1 50-79% FEV1/FVC <0.7
118
Criteria for stage 3 (severe) COPD
FEV1 30-49% FEV1/FVC <0.7
119
Criteria for stage 4 (very severe) COPD
FEV1 <30% FEV1/FVC <0.7
120
COPD on CXR
Hyperinflation Bullae Flat hemidiaphragm
121
When to offer LTOT to COPD patients
If pO2 <7.3 If pO2 7.3-7.8 and one of: - secondary polycythaemia - peripheral oedema - pulmonary hypertension - nocturnal hypoxaemia
122
Vaccinations for COPD patients
Influenza yearly | One off pneumococcal
123
1st line treatment for COPD patients
Short acting beta 2 agonist or short acting muscarinic antagonist
124
Example of a short acting muscarinic antagonist
ipatropium
125
Example of a short acting beta 2 agonist
salbutamol
126
2nd line treatment for COPD patients with no asthma/steroid responsive features
Long acting beta 2 agonist + long acting muscarinic antagonist Change SAMA to SABA
127
Example of a long acting beta 2 agonist
salmeterol
128
Example of a long acting muscarinic antagonist
tiotropium
129
2nd line treatment for COPD patients with asthma or steroid responsive features
long acting beta 2 agonist + inhailed corticosteroids LABA + ICS IF STILL BREATHLESS then add long acting muscarinic antagonist + LAMA
130
Nicotine replacement therapy - how long to prescribe for
Give 2 week prescription Review and continue if still trying to stop If doesn't work don't prescribe again for 6 months
131
Nicotine replacement therapy - side effects
Nausea + vomiting Headaches Flu like symptoms
132
How does varenicline work?
Nicotine receptor partial agonist Used in smoking cessation
133
When to start varenicline?
1 week before date planned to stop smoking
134
Varenicline side effects
Nausea Headache Insomnia Abnormal dreams
135
Varenicline contraindications
Pregnancy | Breastfeeding
136
Varenicline cautions
Depression | Self harm
137
How does bupropion work?
Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist used in smoking cessation
138
When to start bupropion?
1-2 weeks before planned date to stop smoking
139
Bupropion contraindications
Epilepsy Pregnancy Breastfeeding Eating disorders
140
Asthma management - step 1
SABA
141
Asthma management - step 2
SABA + low dose ICS
142
Asthma management - step 3
SABA + low dose ICS + leukotriene receptor antagonist
143
Example of a leukotriene receptor antagonist
Montelukast
144
Asthma management - step 4
SABA + low dose ICS + LABA | Continue leukotriene receptor antagonist if good response
145
Asthma management - step 5
SABA +/- leukotriene receptor antagonist Switch ICS/LABA for maintenance and reliever therapy (MART) with low dose ICS
146
Asthma management - step 6
SABA +/- leukotriene receptor antagonist + medium dose ICS MART
147
Asthma management - step 7
SABA +/- leukotriene receptor antagonist + one of: high dose ICS theophylline secondary care referral
148
What type of drug is ipatropium?
short acting muscarinic antagonist
149
What type of drug salmeterol?
long acting beta 2 agonist
150
What type of drug is tiotropium?
long acting muscarinic antagonist
151
What type of drug is montelukast?
leukotriene receptor antagonist

AKT use (20 decks)

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