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Progress > respiratory > Flashcards

respiratory Flashcards

1
Q

drugs causing fibrosis

A 
methotrexate
amiodarone
sulfasalazine
gold
nitrofurantoin
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2
Q

COPD - general management

A

smoking cessation
annual flu jab
one-off pneumococcal

LTOT, lung volume reduction surgery in selected pts

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3
Q

first line bronchodilator for COPD?

how do you determine next step?

A

SABA or SAMA

next step determined by FEV1

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4
Q

2nd line COPD inhaler if FEV1 > 50%

A

LABA (eg salmeterol), or LAMA (eg tiotropium)

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5
Q

what kind of drug is salmeterol?

A

LABA

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6
Q

what kind of drug is tiotropium?

A

LAMA

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7
Q

2nd line COPD inhaler if FEV1 < 50%

A

LABA + ICS (combo inhaler), or

LAMA

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8
Q

when to use theophylline for COPD?

A

if bronchodilators don’t work or if they can’t use inhalers

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9
Q

what can you use in COPD patients with a chronic productive cough?

A

mucolytics

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10
Q

symptoms of cor pulmonale

A

peripheral oedema
raised JVP
systolic parasternal heave
loud P2

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11
Q

management of cor pulmonale

A

loop diuretic for oedema
consider LTOT

ACEis, CCBs NOT recommended

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12
Q

what is a saddle embolus characteristic of?

A

PE

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13
Q

what are common symptoms of PE?

A

tachypnoea
crackles
tachycardia
low-grade fever

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14
Q

textbook triad of PE symptoms

A

pleuritic chest pain
dyspnoea
haemoptysis

but can present with any cardioresp symptom/sign

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15
Q

investigations if PE is ‘likely’

A

immediate CTPA - if delayed give LMWH in meantime

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16
Q

investigations if PE is ‘unlikely’

A

D dimer

if positive then immediate CTPA - if delayed give LMWH in meantime

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17
Q

PE wells scores

A

5+ - likely

0-4 - unlikely

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18
Q

CURB-65

A 
confusion
urea 8+
RR 30+
BP 90/60-
65+
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19
Q

care of CAP based on CURB65

A

0-1 - low - home care
2+ - intermediate - hosp
3+ - high - ICU

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20
Q

pneumonia - investigations

A

CXR
CURB65 2+ - blood + sputum cultures; pneumococcal + legionella urinary antigen tests
CRP monitoring to determine response to treatment

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21
Q

management of low-severity CAP (CURB65 0-1)

A

amoxicillin 5 days

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22
Q

management of moderate-high severity CAP (CURB65 2+)

A

dual abx: amoxicillin + macrolide (-mycin) 7-10 days

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23
Q

potential PE - investigations

A

CXR to rule out other causes

if still suspected then do wells

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24
Q

where does reactivation of TB tend to occur?

A

apex of lungs

25
Q

what triggers reactivation of TB?

A

becoming immunocompromised

26
Q

what type of cancer makes up the majority of non-small cell lung cancers?

A

squamous - 35%
adenocarcinoma - 30%

(non-small cell is more common than small cell)

27
Q

what is obstructive lung disease?

A

hard to exhale air - comes out slower + some may linger

28
Q

what is restrictive lung disease?

A

hard to expand lungs with air

29
Q

pulmonary function tests in obstructive lung disease

A

FEV1 - v reduced
FVC - reduced or normal
FEV1/FVC - reduced

30
Q

pulmonary function tests in restrictive lung disease?

A

FEV1 - reduced
FVC - v reduced
FEV1/FVC - normal or increased

31
Q

when is BIPAP used?

A

type II resp failure

esp COPD exac

32
Q

when is CPAP used?

A

type I resp failure

esp pulmonary oedema

33
Q

organism that most commonly causes COPD exacerbation?

A

haem influenzae

34
Q

diagnosis of asthma

A

FeNO (fractional exhaled nitric oxide) + spirometry with bronchodilator reversibility (BDR) test

35
Q

relationship between asthma and NO (nitric oxide)

A

NO is made by 3 types of NOsynthases. one of the types’ levels rises in inflammatory cells, esp eosinophils. thus NO levels correlate with inflammation levels.

36
Q

when to give objective tests for asthma?

A

age 5+

age < 5 - clinical diagnosis

37
Q

asthma - diagnosis age 17+

A

ask if better away from work
spirometry with BDR
FeNO test

38
Q

asthma - diagnosis age 5-16

A

spirometry with BDR

FeNO test if normal/obstructive spirometry with a negative BDR

39
Q

asthma management - if SABA isn’t working?

A

add low dose ICS

40
Q

asthma management - if SABA + ICS isn’t working?

A

add leukotriene receptor antagonist (eg montelukast)

41
Q

what are the options for first line smoking cessation therapy?

A

nicotine replacement therapy
varenicline
bupropion

to last 2 weeks after target stop date

42
Q

what is used to categorise COPD severity?

A

FEV1

43
Q

RFs for pneumothorax

A

Marfan’s

asthma

44
Q

pneumothorax - presentation

A

sudden onset dyspnoea + pleuritic chest pain

45
Q

Pancoast’s syndrome - what is it? features?

A 
T1 root lesion with:
horner's
upper lobe carcinoma
wasting of hand small muscles, claw hand
axilla pain
46
Q

3 causes of obstructive picture in resp

A

asthma
COPD
bronchiectasis

47
Q

what constitutes obstruction? (resp)

A

FEV1/FVC <75%

48
Q

interstitial lung disease - spirometry

A

FEV1 and FVC reduced, ratio normal or increased

49
Q

what is interstitial lung disease?

A

disorders that cause scarring (fibrosis) of the lungs

50
Q

bronchiectasis - main 2 features

A

chronic cough with mucopurulent sputum

51
Q

what tends to cause pneumonia following flu?

A

staphylococcus

52
Q

complications of pneumonia

A

sepsis
lung abscess
pleural effusion
empyema

53
Q

sarcoidosis - acute presentation + prognosis

A

erythema nodosum
joint pains - typ ankle + knee
+- fever
hilar lymphadenopathy on CXR

benign + self-limiting in 90%
takes 4-6wk to settle
generally doesn’t progress to chronic illness

54
Q

sarcoidosis - chronic presentation

A 
restrictive lung disease - hilar lymphadenopathy + fibrotic lung disease due to a lymphocytic alveolitis
tender swellings of fingers +- bone cysts
facial rash
anterior uveitis attacks
retinal problems
parotitis
facial nerve palsy
hypercalcaemia
55
Q

causes of erythema nodosum

A 
sarcoidosis
strep infection
TB
IBD
sulphonamides, OCP
56
Q

LDH in LP - significance?

A

high - bacterial

low - viral

57
Q

what is total gas transfer? (TLCO)

when is it affected?

A

measure of gas transfer from alveoli to capillaries

raised in asthma - as problem isn’t affecting alveoli directly, or gas exchange, so lungs try to compensate by improving gas exchange

reduced in COPD, fibrosis, pulmonary oedema etc

58
Q

transfer coefficient (KCO) - what is it?

A

transfer factor corrected for lung volume

total gas transfer/alveolar volume

measures how efficient gas exchange is in relation to the alveolar-capillary surface-volume ratio

increased in asthma due to increased pulmonary blood flow

59
Q

what is transfer factor?

A

the rate at which a gas will diffuse from alveoli into blood

Progress (20 decks)

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