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Nick's MD2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define pleurodesis

A

Pleural space is artificially obliterated by adhering the pleural surfaces

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2
Q

What does VATS stand for?

A

Video assisted thoracoscopic surgery

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3
Q

What is the key feature of COPD on spirometry?

A

FEV1/FVC

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4
Q

What is the key feature of restrictive lung diseaes on spirometry?

A

FVC

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5
Q

What happens to FEV1 in COPD?

A

It is decreased

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6
Q

How will pleural effusion sound on percussion?

A

Dull

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7
Q

How will pneumothorax sound on percussion?

A

Hyper-resonant

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8
Q

How will haemothorax sound on percussion?

A

Dull

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9
Q

How will empyema sound on percussion?

A

Dull

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10
Q

How will asthma sound on percussion?

A

Hyper-resonant

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11
Q

How will consolidation sound on percussion?

A

Dull

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12
Q

How will COPD with hyperinflation sound on percussion?

A

Hyper-resonant

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13
Q

How are breath sounds over consolidation?

A

Increased

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14
Q

How are breath sounds over pneumothorax?

A

Decreased

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15
Q

How are breath sounds over empyema?

A

Decreased

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16
Q

What are possible causes of reduced percussion at a lung base?

A

Consolidation
Collapsed lung
Pleural effusion or thickening
Elevated diaphragm

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17
Q

What are the signs of severe COPD?

A

Prolonged expiratory phase
Accessory muscles of breathing
Pursed lip breathing
Hyperinflation with reduced chest expansion and hyperresonance

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18
Q

What is the most common group of pathogens for nosocomial pneumonia?

A

Gram negative enterobacteria

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19
Q

In which populations should you have an increased index of suspicion for klebsiella pneumonia?

A

Alcoholics and nosocomial

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20
Q

What are the 3 most common pathogens for mild community acquired pneumonia?

A

Pneumococcus>HiB>mycoplasma pneumoniae

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21
Q

What is empirical treatment for mild community acquired pneumonia?

A

Amoxycillin 1g tds orally OR doxycycline 100mg bd orally

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22
Q

What is empirical treatment for moderate community acquired pneumonia?

A

Benzylpenicillin IV (or amoxycillin PO)
PLUS
Doxycycline 100mg bd orally (or clarithromycin 500mg bd)

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23
Q

What is best empirical treatment for severe community acquired pneumonia?

A

Ceftriaxmone 1g IV PLUS azithromycin 500mg IV

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24
Q

What is the most common pathogen for nosocomial pneumonia?

A

Pneumococcus

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25
Q

How would assess severity of pneumonia?

A

CURB-65

Confusion, urea elevated, RR>30, blood pressure low, age>65

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26
Q

What is the single most important predictor of severity of pneumonia?

A

Resp rate

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27
Q

What is the nature of onset of Sxs in bacterial pneumonia?

A

Fulminant/rapid acute onset

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28
Q

In which population should you have an increased index of suspicion for moraxella catarhalis pneumonia?

A

Elderly

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29
Q

signs of pulmonary hypertension

A

right ventricular heave
loud P2, 4th heart sound
prominent v wave in JVP

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30
Q

What test is most commonly used to Dx PE?

A

CTPA

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31
Q

what ECG pattern do you get with PE

A

S1Q3T3 - prominent S wave in lead I, and Q and T wave inversion in Lead III

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32
Q

Rx of TB

A 
RIPE
rifampicin
isoniazid
pyrazinamide
ethambutol
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33
Q

3 examples of pathogens that are transmitted by airborne

A

TB
measles
varicella

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34
Q

Dx of asthma on respiratory function tests

A

FEV1/FVC below expected
AND
200ml AND 12% improvement in FEV1 with bronchodilator

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35
Q

which lung cancer is the most common?

A

adenocarcinoma

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36
Q

which lung cancer has the worst prognosis?

A

Small cell carcinoma

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37
Q

which mutations are mostly associated with adenocarcinoma?

A

KRAS and EGFR

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38
Q

Do squamous cell carcinomas of the lung tend to be located peripherally or centrally?

A

Central

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39
Q

Do adenocarcinomas of the lung tend to be located peripherally or centrally?

A

Peripheral

40
Q

standard Tx of Stage 1 lung cancer

A

lobectomy and mediastinal lymph node dissection

41
Q

standard Tx of stage 2 lung cancer

A

lobectomy and mediastinal lymph node dissection + adjuvant chemotherapy

42
Q

standard Tx of stage 3a lung cancer

A 
no standard treatment!
- Chemo + radiation 
OR
- resection then chemo 
OR
- chemo + radiation then resection
43
Q

standard Tx of stage 3b lung cancer

A

chemo and radiation only

No surgical treatment

44
Q

standard Tx of stage 4 lung cancer

A

Palliative Rx only

45
Q

What drug should be given for MRSA pneumonia?

A

Vancomycin

46
Q

At what vertebral level does the trachea begin?

A

C6

47
Q

What is a typical tidal volume?

A

500ml

48
Q

If the lung is full of fluid, how will vocal resonance sound?

A

Louder

49
Q

What is the majority of acute epiglottitis caused by?

A

HiB

50
Q

What level must PaO2 drop below before it has an effect on ventilation?

A

~50mmHg

51
Q

What is the double fold of pleura inferior to the hilum called?

A

Pulmonary ligament

52
Q

Inhaled foreign bodies tend to travel where?

A

Right main bronchus to right lung

53
Q

What is the most viral common causes of croup?

A

Parainfluenza

54
Q

What are the 4 most common viral causes of pneumonia?

A

Parainfluenza 3
Respiratory syncytial virus
Influenza virus
Adenovirus

55
Q

What clinical feature particularly distinguishes influenza from other respiratory tract infections?

A

Muscle aches

56
Q

What is a normal pulmonary artery sys/dias blood pressure?

A

25/8 mmHg

57
Q

Where are peripheral chemoreceptors that contribute to respiratory regulation?

A

Carotid bodies and aortic arch

58
Q

What percentage of acute sore throats are caused by viruses?

A

70%

59
Q

What is a typical total lung capacity?

A

5.7L

60
Q

What is the most common viral cause of pharyngitis?

A

Adenovirus

61
Q

What’s the most common bacterial cause of a sore throat?

A

Strep pyogenese

62
Q

What are the most common pathogenic agents for acute exacerbation of chronic bronchitis?

A

Haemophilius influenzae

Streptococcus pneumoniae

63
Q

An unconscious supine patient who vomits will most likely have fluid in which lung segment?

A

Apical segment of the lower lobe of the right lung

64
Q

What changes are there in ABG in Type 2 respiratory failure?

A

Low PaO2 and high PaCO2

65
Q

What is the incubation period of influenza?

A

1-5 days

66
Q

What is a typical minute ventialtion?

A

7-8 L/min

67
Q

What are the 3 most common viral causes of URTI?

A

Rhinovirus
Corona virus
Adenovirus

68
Q

Where would painful irritation of the costal parietal pleura be experienced?

A

Thoracic wall (because parietal pleura is innervated by branches from intercostal nerves)

69
Q

What percentage of people have viridans streptococci in their URT?

A

100%

70
Q

What are the side effects of short acting beta 2 agonists?

A

tachycardia,
tremor and
hypokalemia

71
Q

Define cor pulmonale

A

Right sided heart failure caused by pulmonary hypertension

72
Q

What are 3 distinguishing features of the right main bronchus compared with the left main bronchus?

A

Shorter, wider and more vertical

73
Q

What percentage of pneumonia is due to bacteria?

A

85%

74
Q

What are the 2 most common causes of the common cold?

A

Rhinovirus and coronavirus

75
Q

How is Type 1 respiratory failure diagnosed?

A

PaO2 less than 50 mmHg, with evidence of respiratory compensation.

76
Q

How could you assess whether alveolar ventilation is adequate?

A

PaCO2

77
Q

Sleep deprivation of how long will result in cognitive performance equivalent to BAC of 0.05?

A

18-24 hours

78
Q

How many sleep cycles are there in a night typically?

A

4-6

79
Q

Which nerve passes in front of the lung root?

A

Phrenic nerve

80
Q

Which nerve passes behind the lung root?

A

Vagus nerve

81
Q

GOLD criteria for staging COPD?

A

Mild = FEV1 80-100%
Moderate = FEV1 50-80%
Severe = FEV1 30-50%
Very severe = FEV1 less than 30% or less than 50% plus chronic respiratory failure

82
Q

What is the single most effective thing you can do to improve long term outcome in asthma?

A

Written asthma action plan

83
Q

What colour are all SABAs?

A

Blue/grey

84
Q

What colour are all LABA/steroid inhalers?

A

Purple or red

85
Q

What colour are all anticholinergic inhalers?

A

Green

86
Q

What are the criteria for long term oxygen therapy?

A

PaO2 less than 55mmHg
OR
PaO2 less than 60mmHg and RHF or increased haematocrit

87
Q

What are the criteria for portable O2 therapy?

A

Increased distance in 6-minute walk test
AND
Improvement in SpO2% sats

88
Q

Treatment for mild hospital acquired pneumonia

A

Amoxycillin + clavulonic acid

89
Q

Treatment for moderate hospital acquired pneumonia

A

Ceftriaxone
or
Cefotaxime

90
Q

Treatment for severe hospital acquired pneumonia

A

Piperacillin
AND
Tazocin

91
Q

Treatment for hospital acquired pneumonia in ICU (or at risk for multi drug resistance)

A

Piperacillin
PLUS
Tazocin

92
Q

Which ABx should be given for an acute exacerbation of COPD?

A

Amoxycillin
OR
Doxycycline

93
Q

Management of acute asthma attack

A 
O SHIT ME!
Oxygen
SABA
Hydrocortisone
Ipratropium bromide (Anticholinergic)
Theophyline 
Magnesium
Everything else (chest physio, intubation)
94
Q

Mx of acute exacerbation of COPD

A

Steroids (prednisilone 37.5mg for 5 days)
O2 with target 88-92% SpO2
Nebulised salbutamol/ipratropium
Abx (amoxycillin or doxycyclin)

95
Q

Pharmacological Mx of COPD

A

1 Short acting bronchodilator (SABA or ipratropium)
2 Add a long acting bronchodilator (LABA or LAMA)
3 Add an inhaled GCS
Consider low dose theophyline
Consider prophylactic Abx (macrolide)

Nick's MD2 (21 decks)

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