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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
How would assess severity of pneumonia?
CURB-65 | Confusion, urea elevated, RR>30, blood pressure low, age>65
26
What is the single most important predictor of severity of pneumonia?
Resp rate
27
What is the nature of onset of Sxs in bacterial pneumonia?
Fulminant/rapid acute onset
28
In which population should you have an increased index of suspicion for moraxella catarhalis pneumonia?
Elderly
29
signs of pulmonary hypertension
right ventricular heave loud P2, 4th heart sound prominent v wave in JVP
30
What test is most commonly used to Dx PE?
CTPA
31
what ECG pattern do you get with PE
S1Q3T3 - prominent S wave in lead I, and Q and T wave inversion in Lead III
32
Rx of TB
``` RIPE rifampicin isoniazid pyrazinamide ethambutol ```
33
3 examples of pathogens that are transmitted by airborne
TB measles varicella
34
Dx of asthma on respiratory function tests
FEV1/FVC below expected AND 200ml AND 12% improvement in FEV1 with bronchodilator
35
which lung cancer is the most common?
adenocarcinoma
36
which lung cancer has the worst prognosis?
Small cell carcinoma
37
which mutations are mostly associated with adenocarcinoma?
KRAS and EGFR
38
Do squamous cell carcinomas of the lung tend to be located peripherally or centrally?
Central
39
Do adenocarcinomas of the lung tend to be located peripherally or centrally?
Peripheral
40
standard Tx of Stage 1 lung cancer
lobectomy and mediastinal lymph node dissection
41
standard Tx of stage 2 lung cancer
lobectomy and mediastinal lymph node dissection + adjuvant chemotherapy
42
standard Tx of stage 3a lung cancer
``` no standard treatment! - Chemo + radiation OR - resection then chemo OR - chemo + radiation then resection ```
43
standard Tx of stage 3b lung cancer
chemo and radiation only No surgical treatment
44
standard Tx of stage 4 lung cancer
Palliative Rx only
45
What drug should be given for MRSA pneumonia?
Vancomycin
46
At what vertebral level does the trachea begin?
C6
47
What is a typical tidal volume?
500ml
48
If the lung is full of fluid, how will vocal resonance sound?
Louder
49
What is the majority of acute epiglottitis caused by?
HiB
50
What level must PaO2 drop below before it has an effect on ventilation?
~50mmHg
51
What is the double fold of pleura inferior to the hilum called?
Pulmonary ligament
52
Inhaled foreign bodies tend to travel where?
Right main bronchus to right lung
53
What is the most viral common causes of croup?
Parainfluenza
54
What are the 4 most common viral causes of pneumonia?
Parainfluenza 3 Respiratory syncytial virus Influenza virus Adenovirus
55
What clinical feature particularly distinguishes influenza from other respiratory tract infections?
Muscle aches
56
What is a normal pulmonary artery sys/dias blood pressure?
25/8 mmHg
57
Where are peripheral chemoreceptors that contribute to respiratory regulation?
Carotid bodies and aortic arch
58
What percentage of acute sore throats are caused by viruses?
70%
59
What is a typical total lung capacity?
5.7L
60
What is the most common viral cause of pharyngitis?
Adenovirus
61
What's the most common bacterial cause of a sore throat?
Strep pyogenese
62
What are the most common pathogenic agents for acute exacerbation of chronic bronchitis?
Haemophilius influenzae | Streptococcus pneumoniae
63
An unconscious supine patient who vomits will most likely have fluid in which lung segment?
Apical segment of the lower lobe of the right lung
64
What changes are there in ABG in Type 2 respiratory failure?
Low PaO2 and high PaCO2
65
What is the incubation period of influenza?
1-5 days
66
What is a typical minute ventialtion?
7-8 L/min
67
What are the 3 most common viral causes of URTI?
Rhinovirus Corona virus Adenovirus
68
Where would painful irritation of the costal parietal pleura be experienced?
Thoracic wall (because parietal pleura is innervated by branches from intercostal nerves)
69
What percentage of people have viridans streptococci in their URT?
100%
70
What are the side effects of short acting beta 2 agonists?
tachycardia, tremor and hypokalemia
71
Define cor pulmonale
Right sided heart failure caused by pulmonary hypertension
72
What are 3 distinguishing features of the right main bronchus compared with the left main bronchus?
Shorter, wider and more vertical
73
What percentage of pneumonia is due to bacteria?
85%
74
What are the 2 most common causes of the common cold?
Rhinovirus and coronavirus
75
How is Type 1 respiratory failure diagnosed?
PaO2 less than 50 mmHg, with evidence of respiratory compensation.
76
How could you assess whether alveolar ventilation is adequate?
PaCO2
77
Sleep deprivation of how long will result in cognitive performance equivalent to BAC of 0.05?
18-24 hours
78
How many sleep cycles are there in a night typically?
4-6
79
Which nerve passes in front of the lung root?
Phrenic nerve
80
Which nerve passes behind the lung root?
Vagus nerve
81
GOLD criteria for staging COPD?
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
What is the single most effective thing you can do to improve long term outcome in asthma?
Written asthma action plan
83
What colour are all SABAs?
Blue/grey
84
What colour are all LABA/steroid inhalers?
Purple or red
85
What colour are all anticholinergic inhalers?
Green
86
What are the criteria for long term oxygen therapy?
PaO2 less than 55mmHg OR PaO2 less than 60mmHg and RHF or increased haematocrit
87
What are the criteria for portable O2 therapy?
Increased distance in 6-minute walk test AND Improvement in SpO2% sats
88
Treatment for mild hospital acquired pneumonia
Amoxycillin + clavulonic acid
89
Treatment for moderate hospital acquired pneumonia
Ceftriaxone or Cefotaxime
90
Treatment for severe hospital acquired pneumonia
Piperacillin AND Tazocin
91
Treatment for hospital acquired pneumonia in ICU (or at risk for multi drug resistance)
Piperacillin PLUS Tazocin
92
Which ABx should be given for an acute exacerbation of COPD?
Amoxycillin OR Doxycycline
93
Management of acute asthma attack
``` O SHIT ME! Oxygen SABA Hydrocortisone Ipratropium bromide (Anticholinergic) Theophyline Magnesium Everything else (chest physio, intubation) ```
94
Mx of acute exacerbation of COPD
Steroids (prednisilone 37.5mg for 5 days) O2 with target 88-92% SpO2 Nebulised salbutamol/ipratropium Abx (amoxycillin or doxycyclin)
95
Pharmacological Mx of COPD
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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