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Year 1 > Respiratory 3 > Flashcards

Respiratory 3 Flashcards

1
Q

What are the key respiratory related symptoms?

A

Dyspnoea, Cough, Wheeze, Pleuritic Chest Pain, Sputum Production, Haemoptysis, Systemic Symptoms (Fever, Weight Loss, Fatigue)

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2
Q

The 4 common presenting symptoms associated with a Deep Vein Thrombosis (DVT)

A

Leg (commonly calf) pain, Swelling, Warm to touch, Erythema

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3
Q

Common presenting symptoms of a Pulmonary Embolism (PE)

A

Pleuritic Chest Pain, Sudden Onset SOB, Cough +/- Haemoptysis, Dizziness/Syncope, Tachycardia

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4
Q

What are the three elements of Virchows Triad?

A

Vessel Wall Injury, Stasis of Blood Flow (Immobility), Hypercoagulability

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5
Q

What is the Well’s Score?

A

Criteria scoring system when suspecting a Pulmonary Embolism or a DVT. Score 4 or more = PE Likely. Score 2 or more = DVT likely

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6
Q

What (7) elements does the Well’s PE Score consist of?

A

(1) Clinical Signs of a DVT (3 points)
(2) PE #1 diagnosis, alternative diagnosis unlikely (3 points)
(3) Tachycardia (1.5 points)
(4) Immobilisation of 3 days/surgery in previous 4 weeks (1.5 points)
(5) History of DVT or PE (1.5 points)
(6) Haemoptysis (1 point)
(7) Malignancy (treatment <6 months ago or palliative) (1 point)

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7
Q

What is the CURB-65 score?

A

CAP severity score used in predicting mortality and assessing the need for hospital admission.

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8
Q

What is the MOA of Unfractionated Heparin?

A

Found naturally in the body, activates Antithrombin III which inhibits Factor Xa and Thrombin. Giving more enhances this effect.

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9
Q

How is Unfractionated Heparin administered?

A

IV Infusion or S/C Injection

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10
Q

Apart from Haemorrhage, what are the two other side effects of Unfractionated Heparin/LMWH?

A

Hyperkalemia

Thrombocytopenia

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11
Q

What is the name of the blood test used to monitor Unfractionated Heparin?

A

Activated Partial Thromboplastin Time (aPTT)

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12
Q

What is the MOA of Low Molecular Weight Heparin (LMWH)?

A

Similar mode of action to unfractionated heparin but preferentially inhibits factor Xa.

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13
Q

What are the main advantages of using Low Molecular Weight Heparin (LMWH) instead of Unfractionated Heparin (UFH)?

A

Low Molecular Weight Heparin (LMWH) has a more predictable response and greater duration of action - this means that it is administered less frequently (OD or BD) and does not require monitoring.

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14
Q

What is the MOA of Warfarin?

A

Vitamin K Antagonist. Inhibits vitamin K epoxide reductase (enzyme), thereby preventing activation of Vit K and synthesis of factors.

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15
Q

What is the normal INR value and what INR target would be expected in a patient who is taking Warfarin?

A

Normal INR = 1. Target for Warfarin pts = 2-3

Unless PE/DVT at this target, then 3-4

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16
Q

Name some of the main disadvantages of using Warfarin

A

Many food and drug interactions

Teratogenic

Low therapeutic index and unpredictable, hence requiring INR blood test monitoring

Takes 48-72 hours to work

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17
Q

What is the MOA of NOACs and DOACs? What are the drug names?

A

DOAC = Dabigatran, which is a direct thrombin inhibitor.

NOACs = Rivaroxaban, Apixaban, Edoxaban, which directly inhibit factor Xa.

18
Q

In the event of the treatment of a PE/DVT, how long can the patient expect to be taking anticoagulants?

A

Minimum of 3 months

19
Q

When treating a DVT/PE what (4) main practical considerations should you consider?

A
  1. Hemodynamically unstable or stable?
  2. Body weight
  3. Active Cancer?
  4. Renal function
20
Q

A patient has a confirmed PE/DVT, they have a blood pressure of 90/50. What interventions should be done or considered?

A

Continuous IV infusion of Unfractionated Heparin, consider thrombolytic intervention.

21
Q

What is the most common LMWH name?

A

Enoxaparin (Clexane)

22
Q

A patient has a confirmed PE/DVT. They are hemodynamically stable and have no comorbidities. What is the first line medication should they be given?

A

Apixaban or Rivaroxaban (NOACs)

23
Q

A patient has a confirmed PE/DVT. They have severe renal impairment (CrCl <15ml/min). What is the first line medications should they be given?

A

LMWH/UFH + Warfarin for at least 5 days until INR 2 on two consecutive readings, then Warfarin alone.

24
Q

A patient has a confirmed PE/DVT. They have active cancer. What medication should they be given?

A

Dibigatran (DOAC). If not appropriate, LMWH + Warfarin for at least 5 days until INR 2 on two consecutive readings, then Warfarin alone.

25
Q

A patient has a confirmed PE/DVT. They have Antiphospholipid syndrome. What medication should they be given?

A

LMWH + Warfarin for at least 5 days until INR 2 on two consecutive readings, then Warfarin alone.

26
Q

What does the CURB-65 score comprise?

A 
C - Confusion
U - Urea >7 mmol/L
R - Respiratory Rate > 30 
B - Blood Pressure (<90 systolic or <60 diastolic)
Over 65
27
Q

An 85 year old man develops shortness of breath and sharp pleuritic chest pain. He recently underwent surgery for a dynamic hip screw, however, he has had poor mobility post-op. He has had 2 episodes of haemoptysis since the onset of symptoms. What is the most likely diagnosis?

A

Pulmonary Embolism

28
Q

The name of another anticoagulant medication that is chemically related to LMWH, and is an indirect inhibitor of factor Xa, but it does not inhibit thrombin at all.

A

Fondaparinux

29
Q

Define: Primary/Spontaneous Pneumothorax

A

Abnormal collection of air within the pleural space. Occurs without cause. Usually occurs in the absence of significant lung disease.

30
Q

Define: Tension pneumothorax

A

Abnormal/Large collection of air within the pleural space. Occurs when a large amount of air is present within the lung causing the lung to deflate. One way air entry, air can collect on each inspiration, but cannot escape.

31
Q

Define: Traumatic pneumothorax

A

Abnormal collection of air within the pleural space. Occurs as a result of trauma, e.g. knife wound, blunt trauma

32
Q

What is the most common bacteria associated in community acquired pneumonia (CAP) in an otherwise healthy individual who is over 60 with consolidation changes on chest x-ray?

A

Streptococcus Pneumoniae still remains the common cause of CAP in over 60s.

33
Q

What (3) atypical bacteria can be responsible for community acquired pneumonia (CAP)

A

Mycoplasma pneumoniae, Haemophilus influenzae, Legionella pneumophila

34
Q

What are the 3 main viruses causing viral pneumonia?

A

Influenza A, B, C, Respiratory syncytial virus (RSV), SARS-CoV-2 (COVID-19)

35
Q

In treating a pneumothorax, what is the criteria for conservative management/no treatment?

A

If no SOB and < 2cm rim of air on the chest x-ray then

no treatment required.

36
Q

In treating a pneumothorax, what is the criteria for treating with needle aspiration?

A

If SOB and/or > 2cm rim of air on the chest x-ray = aspiration.

37
Q

In treating a pneumothorax, how is needle aspiration performed?

A

Wide bore cannula, 2nd intercostal space, midclavicular line to decompress/aspirate.

38
Q

In treating a pneumothorax, in what (3) circumstances/pathologies require a chest drain?

A

Unstable patients, bilateral or secondary pneumothoraces require a chest drain.

39
Q

What are the two main classes of lung cancer? Which type is the most common.

A

Small cell lung cancer (SMLC) and Non small cell lung cancer (NSCLC). NSCLC are the most common, accounting for 85% of cases.

40
Q

What are some of the risk factors for developing lung cancer?

A

Smoking, PMH or family history, occupational exposure (asbestos, silica), existing lung disease, radiation of non-lung cancer treatment

Year 1 (16 decks)

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