Respiratory Flashcards
1
Q
What is the acceptable oxygen saturation range for COPD
A
88-92%
2
Q
What is the first line treatment for COPD ?
A
SABA (salbutamol) or SAMA (ipatropium)
3
Q
Still breathless with SABA/SAMA?? Asthmatic history? What treatment?
A
LABA (formoterol/salmeterol) + ICS (beclomethasone/budesonide)
4
Q
Still breathless without asthmatic history - what is the next steps for treatment?
A
Stay on SABA/SAMA add LABA + LAMA (tiotropium/aclidinium)
5
Q
Taken second step treatment for breathlessness with COPD still not relieved symptoms? What do you take?
A
LABA + LAMA + ICS
6
Q
What is asthmatic symptoms defined as in terms of CODP
A
- History of asthma
- Increased eosinophils
- Diurnal variation
- FEVC1 disruption
7
Q
What is defined as ongoing problems or indications to go to third step combination therapy in COPD?
A
- Breathless every day
- 1 Sever exacerbation (hospitalisation with breathlessness)
- 2 moderate exacerbations in the past year
8
Q
What is the acceptable oxygen saturation range for non-COPD patients
A
94-98%
9
Q
What is classified as moderate asthma
A
- PEFR of 50-75%
- RR <25
- HR <110
10
Q
What is classified as a severe asthmatic case?
A
- PEFR 33-50%
- RR>25
- HR>110
11
Q
What is the classification from life-threatening asthma
A
- PEFR <33%
- Oxygen saturation <92%
- Cyanosis and silent breathing
- Systemic unwellness (bradycardia, dysrhythmia, hypotension
- Mental state impacted (exhaustion, confusion, coma)
12
Q
What is near fatal asthma
A
Raised CO2
13
Q
When is ABG recommended in those patients with asthma
A
Ox saturation <92% not COPD
14
Q
How should the SABA be administered
A
General inhaler if systemically stable otherwise ocygen driven nebuliser or 15L non-rebreathe oxygen driven nebs then titrated down
15
Q
How much should be given of SABA nebs?
A
5mg adults 2.5mg child
16
Q
How much corticosteroid should be given in an acute asthma attack
A
40mg adults prednisolone orally.
Normal meds continued including inhaled corticosteroids
17
Q
If no response to SABA, PREDNISOLONE, OXYGEN then what/
A
Ipatropium bromide nebs
18
Q
When else would you give ipatropium nebs?
A
To anyone who is in severe or life-threatening asthma attack
19
Q
Final steps of treatment for acute asthma attacks if nothing is working?
A
- IV mag sulphate
- IV aminophylline (senior)
- Senior referral to critical care for intubation/ventialtion or ECMO
20
Q
When can a patient be discharged post asthma attack
A
- Stable on discharge drugs without nebs and oxygen for at least 12-24 hours
- PEFR ideally of 75%+
- Inhaler technique checked
21
Q
RIPE ONGO Meaning?
A
Side effects to the drugs used to treat tuberculosis
22
Q
What does RIPE ONGO stand for?
A
R- Rifampicin
I - Isoniazid
P- Pyrazinamide
E - Ethambutol
O: Orange Secretions
N: Neuropthay
G: Gout
O: Optic neuritis
23
Q
What is the first line management in someone with a strong cough with Bronchiectasis?
A
Physiotherapy
Antibiotics only if exacerbation and long-term prevention if recurrent infections
24
Q
What is carbocisteine?
A
Mucolytic agent
25
When would you use a mucolytic agent in Bronchiectasis?
If their sputum expectoration (coughing) isn’t adequate - theyre struggling to get things off their chest
26
What does NIV mean?
Non-invasive ventilation
27
When is BiPAP indicated?
COPD with respiratory acidosis.
28
What is type 2 respiratory failure and what NIV would be given?
ALVEOLAR HYPOVENTILATION = LOW oxygen but HIGH carbon dioxide
BiPAP (Bi = 2)
*Increased airway resistance due to airway obstruction*
- COPD
*reduced compliance of lung tissue or chest wall*
- pneumonia
- rib fracture
- obesity
*reduced strength of resp muscles*
- guillian barre
- MND
*drugs depressing resp system*
- opiates (morphine/heroine)
29
What is type 1 respiratory failure?
VQ MISMATCH = LOW oxygen levels but NORMAL/LOW carbon dioxide
Type 1 = CPAP
*reduced ventilation and normal perfusion*
- pulmonary oedema
- broncho constriction (asthma)
*reduced perfusion and normal ventialtion*
- pulmonary embolism
30
CF patients are at risk with which bacteria?
Pseudomonas aeruginosa
Burkholderi cepacia
31
What to CF take with meals?
Pancreatic enzyme supplementation - creon
32
What treatment is given to ‘Provoked’ pulmonary embolism patients at discharge?
Rivaroxaban for 3 months
33
What categories of lung cancer are there?
Small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC)
34
What lung cancer is worse?
Small cell lung cancer
35
Examples of Non-Small Cell Lung Cancer?
1. Adenocarcinoma (most common in NON-SMOKERS)
2. Squamous cell lung cancer (cavitating)
3. Large cell
4. Alveolar cell carcinoma
5. Bronchial adenoma
36
How to tackle cows milk intolerance in pregnant women who breastfeed?
Continue breastfeeding, reduce/avoid dairy product intake and take calcium supplementation
37
What is PERC
Pulmonary embolism rule out criteria
It is used to rule out the possibility of PE as it would be <2% chance of them having a PE if thhey are PERC negative
38
What is the PERCriteria
They need to all be absent to be deemed as PERC negative
1. >/- 50
2. Heart rate >/- 100
3. Oxygen Saturation
39
What is the Wells score
Used to assess possibility of potential PE - used prior to PERC system
40
What is the Wells criteria
1. Any clinical signs or symptoms of DVT (unilateral leg swelling, erythema, pain with palpation) - leg needs to be at least 3cm swollen (3)
2. An alternative diagnosis is less likely than PE (3)
3. Sinus tachy (HR>100) (1.5)
4. Immobilisation of over 3 days or surgery in the previous 4 weeks (1.5)
5. Previous DVT/PE (1.5)
6. Haemoptysis (1)
7. Malignancy (1)
41
How many points is needed to say a PE is likely from the wells score?
4
42
What is the process for suspected PE?
1. Wells score to see if 4 or more points if no D-Dimer if yes straight to CTPA
2. CTPA (if d-dimer and wells positive+)
3. Interim anticoagulation (DOAC)
4. If CTPA negative - USS of proximal leg vein
43
If PE is unlikely what is the process?
1. D-dimer test
2. Positive result = CTPA referral then USS if CTPA negative
3. Negative result = stop anticoagulation and consider alternative diagnosis
44
CTPA vs V/Q?
V/Q for renal impaired patients due to no contrast
CTPA uses contrast
45
ECG changes in PE?
S1Q3T3
- large S wave in lead 1
- large Q wave in lead 1
- inverted T wave in lead 3
S1Q3 waves look LONG
46
Ptosis and Miosis with a lung malignancy suggests what?
Pancoast tumour secondary to Horners syndrome
Symptoms are ipsilateral
47
What drug is used for smoking cessation ?
Bupropion
48
What is contraindicated with bupropion?
History of seizures (epilepsy_
49
Breathlessness and ox sats of <88%/ 7.3kpa and on max treatment calls for what?
LTOTS - long term oxygen therapy
50
What indicates LTOT for COPD patients?
2 PaO2 readings at <7.3Kpa more than 3 weeks apart
51
What is found on lab tests in someone with sarcoidosis
Raised serum ACE
Hypercalcaemia
52
What pneumonia bacterium is affected by HIV or other immunocompromised conditions
Pneumocystitis jiroveci
53
What pressure is intrapleural pressure normally?
Negative
54
Examples of pneumothorax?
Spontaneous - primary/secondary
Traumatic - gun shot or stab wound
Iatrogenic - medicinal in cause (NIV/Ventilation/Catheter etc)
Tension - air gets stuck in pleural space, opening acts as one way valve not allowing air to escape causing further damage and harm.
55
What are the high risk characteristics in a suspected pneumothorax?
1. Haemothorax
2. Haemodynamic instability
3. 50+ with a significant smoking history
4. Pre-existing lung problems
5. Bilateral pneumothorax suspected
6. Significant hypoxia
56
How is safety in intervention assessed in pneumothorax ?
Up to 2cm laterally or apically on CXR
Able to be guided by radiological assistant = any size
57
If deemed high risk pneumothorax what is the first line intervention and steps?
1. Assess safety of intervention using CXR (size or radiological guidance)
2. Chest drain insertion
58
If the patient isn’t or is minimally symptomatic with their pneumothorax then what is the first line interventions?
Conservative management
If PSP - outpatient review every 2-4 days
If SSP - inpatient review
If stable follow up in 2-4 weeks
59
If a patient is having a symptomatic pneumothorax but is not high risk what is the first line intervention?
1. Ambulatory device - regular outpatient review 2-3days - remove then follow up2-4weeks
2. Needle aspiration then discharge if resolved in OPD in 2-4 weeks
(Dependent on patient preference)
60
What multisystem sign sare seen in people with sarcoidosis?
Erythema nodosum
Lymphedema
LUPUS PERNIO - radiated purple coloured skin lesions across nose+cheeks
Uveitis/ optic neuritis/ conjunctivitis
Liver problems
Heart
Kidneys (kidney stones) - hypercalcaemia
61
What is Lofgrens Syndrome?
1. Bilateral hilar lymphadenopathy
2. Polyarthralgia
3. Erythema nodosum
62
What investigations do you use for sarcoidosis
Serum ACE (RAISED)
Serum calcium (RAISED)
CXR for hilar lymphadenopathy
MRI for neuro involvement
63
What is the gold standard way to diagnose sarcoidosis
BIOPSY OF ANY IMPACTED AREA
- bronchoscopy
- skin biopsy
NON-CASEATING GRANULOMAS WITH EPITHELIOD CELLS)
64
EPIDEMIOLOGY FOR SARCOIDOSIS
YOUNG PEOPLE
60S
AFROCARRIBEAN
65
Management for sarcoidosis
No treatment if no/mild symptoms
1. Oral prednisolone + bisphosphonates
2. Immuno suppressants - methotrexate/azithioprine \
3. Severe cases = lung transplant
66
When will children be milk tolerant by?
If Ig-E mediated then 5 Years
If non Ig-E mediated then 3 years
67
When is asthma attack not indicated usually?
Symptoms may be present but no chest sounds like wheeze etc
68
What test should all people diagnosed with TB received?
HIV test
69
What bacterium causes tuberculosis?
Mycobacterium tuberculosis
70
What is a Ghon complex
Ghon focus + hilar lymph nodes
71
What is primary and secondary tuberculosis
Primary is the development of a small lesion known as Ghon complex (non-immune host develops disease)
In Immunocompetent people, the lesion will heal and fibrose.
In immunosuppressed patients it will lead to military tuberculosis
Secondary is when the TB reactivates due to immunocompromisation occurs at lung apex but can spread.
72
What is the standard first line management of chest infection with no allergies or previous pulmonary illness?
Oral amoxicillin
73
Chest infection management but allergic to penicillin?
Oral doxycycline
74
Paraneoplastic syndrome features related to small cell lung cancer?
ADH = euvolemic hyponatraemia
ACTH = hypertension, hypokalaemia, hyperglycaemia, alkalosis
Lambert Eaton syndrome
75
Squamous cell lung cancer paraneoplastic symptoms
PTH
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism
76
Adenocarcinoma paraneoplastic feature?
Gynaecomastia
Hypertrophic pulmonary osteoarthropathy
77
What is paraneoplastic syndrome?
Tumour secreating specific chemicals that develop into certain symptoms
78
Pulmonary embolism is indicative after surgery if the surgery was how long ago?
4 weeks
79
What screening tool is used for latent tuberculosis?
Mantoux test
Interferon gamma if mantoux is positive
80
What are the margins for the Mantoux test?
<6mm - negative
6-15mm - positive to tuberculin protein (not be given BCG may have had before)
15m + - tuberculosis infection immediate.
81
How does HIV impact TB testing?
False negative on Mantoux test
82
What is the gold standard investigation for TB?
Sputum culture
83
What is advised in well managed asthmatics who are on an additional steroid?
Step down treatment
Every 3 months consider reducing dose of steroid
84
What dose of steroid should be give in children over 5 with asthmatic problem?
40mg prednisolone orally
20mg prednisolone orally in 2-5 years old
85
Fine end respiratory crackles are often associated with what?
Pulmonary fibrosis
86
What acute infective type respiratory condition is associated with hepatic dysfunction?
Legionnaires
87
What inhaler is symbicort?
Budenoside - ICS
88
What is seen in haemolysis?
High reticulocyte count, low RBC/HB count
89
Signs of mycoplasma pneumoniae infection?
Erythema multiforme (annular lesions across trunk)
Cough
Haemolysis
Positive Coombs test
90
What is the first line investigation with someone with potential mycoplasma pneumoniae??
Blood serology
