Respiratory Flashcards
How is a massive PE (hypotensive) managed?
Alteplase (thrombolysis)
What organism causes pneumonia in COPD?
H. influenzae
When should you use NIV in an acute exacerbation of COPD?
Resp acidosis, Type 2 resp failure
Who gets Klebsiella pneumonia?
Alcoholic and diabetics
Who gets pneumocystis jiroveci pneumonia?
HIV/AIDS
What are the parameters of CURB-65?
Confusion, Urea > 7 RR > 30 BP systolic <90, diastolic < 60, Age over 65
How do you treat CAP with a CURB of 0-2?
amoxicillin
Which organisms causes rusty sputum?
Strep pneumoniae
What is the buzzword for silicosis?
Stonemasons, Pottery
What is seen on the CXR in ILD?
Diffuse infiltrates
What are the common causes of exudate?
PE Lung infections Cancers CTDs
What is the management of acute asthma?
Nebs: salbutamol & ipratropium, Steroids: oral pred/IV hydrocortisone
What should be given for an acute exacerbation of COPD if there is no response?
Iv aminophylline
What pH of a pleural effusion suggests an epyema?
< 7.2
What is the buzzword for byssinosis?
Cotton
What does this CXR show?

Left lower lobe consolidation
What pneumonia organisms causes haemolytic anaemia + erythema multiforme/nodosum?
Mycoplasma
How is an exacerbation of ILD managed?
Steroids
What are the features of a life threatening asthma attack?
Silent chest, Exhaustion Hypoxaemia PEFR < 33% Features of shock
What is the step 2 in the treatment of chronic COPD?
SABA or SAMA (salbutamol or ipratropium)
Asthma + eosinophilia + mono neuritis complex?
Churg Strauss Vasculitis
What is the management of a secondary spontaneous pneumothorax if 0-1cm + asymptomatic?
Oxygen + admit for 24hr obs
What is the management of a primary spontaneous pneumothorax if <2cm + asymptomatic?
Discharge
What is seen on ABG in COPD?
Compensated type 2 resp failure
How does ILD present?
Dry cough, SOBOE, myalgia, fine inspiratory crackles
How do you treat HAP/aspiration pneumonia?
IV amox, met and gent
What is step 4 in the management of chronic asthma?
SABA + ICS + LABA +/- LTRA (salbutamol + beclametasone + salmeterol +/- montelukast)
What is seen on CXR in COPD?
Hyperinflation, flattened hemidiaphragms
How is asthma investigated?
Peak flow Spirometry
When does staph aureus pneumonia usually occur?
After influenza A
What investigations are done in a PE?
Bloods incl D dimer, ABG, ECG, CXR (exclusion) CTPA / V/Q
What is seen on ABG in PE?
Resp alkalosis
What is the step 3 in the treatment of chronic COPD if FEV1 < 50%?
LABA + ICS (folmeterol + beclometasone) or LAMA (tiotropium)
What treatment does small cell lung cancer respond well to?
Chemo
What is the buzzword for hypersensitivity pneumonitis?
Farmers, Bird fanciers
What is the presentation os asthma?
Recurrent episodes of cough, wheeze, SOB Worse in morning and at night
How is ILD investigated?
CXR, Spirometry, ABG
What does this CXR show?

Pulmonary oedema
What is the typical presentation of pneumonia?
SOB, productive cough, chest pain, fever, confusion, myalgia
What biopsy is done in a central lung cancer?
Bronchoscopy
What is the management of a secondary spontaneous pneumothorax if >2cm or symptomatic?
Chest drain
What is the management of a primary spontaneous pneumothorax if >2cm or symptomatic?
Admit for aspiration If this fails > chest drain
What are the risk factors for a PE?
Immobility, post-op, malignancy, pregnancy, COCP, HRT
What investigation is done for a PE in pregnancy?
perfusion only V/Q scan
What are the features of a pneumothorax?
Asymptomatic, SOB, chest pain Young, thin tall male
What is step 3 in the management of chronic asthma?
SABA + ICS + LTRA (salbutamol + beclametasone + montelukast)
Who gets legionella?
Travel/water
What is the pathophysiology of cor pulmonale in COPD?
Chronic cascade > hypoxia > pulm vasoconstriction > pulm hypertension > cor pulmonale
What is seen on the ABG in ILD?
Type 1 resp failure
What does this CXR show?

Right upper lobe consolidation
What is FVC?
Total volume of gas expired on forced expiration from maximal inspiration
What does this CXR show?

Right pneumothorax
What is seen on spirometry in ILD?
Restrictive pattern, FEV1:FVC ratio > 0.7
How is an unprovoked PE managed?
6 months of rivaroxaban
What level of protein in a pleural effusion indicates an exudate?
> 30g/L
How is a provoked PE managed?
3 months of rivaroxaban
What is the normal FEV1:FVC ration?
0.7-0.8
What investigations are done in lung cancer?
CXR, CT staging scan
What are the features of COPD for diagnosis?
Sputum production and cough for most days for 3 months of 2 consecutive years
What are features of an acute severe asthma attack?
Speech impairment (can’t complete sentences), Tachy Resp rate > 25 PEFR 33-50%
What are the specific features in small cell carcinoma?
SIADH, Cushing’s + Lambert Eaton
What are common causes of transudates?
LVF liver cirrhosis Nephrotic syndrome Acute GN
What does this CXR show?

Air under diaphragm - perforation
What causes a reduction in FVC and FEV1?
Restriction - pulmonary fibrosis, neuromuscular disorders, obesity, pleural disease
What is the management of a secondary spontaneous pneumothorax if 1 - 2cm + asymptomatic?
Aspiration
How is legionella diagnosed?
Urinary antigen
What is given if there is no improvement or if the asthma attack is life threatening?
IV mag sulph
What is seen on spirometry in asthma?
Reduced FEV1, normal FVC
What is step 2 in the management of chronic asthma?
SABA + ICS (salbutamol + beclametasone)
What are the features of lung cancer?
SOB, cough, haemoptysis, chest pain, hoarseness, stridor, weight loss, recurrent pneumonia, Horner’s, pain and weakness in arms and hands
What is the step 4 in the treatment of chronic COPD?
Combo of LABA + ICS + LAMA
What are common precipitants for asthma?
Cold air, Dust mites, Exercise, NSAIDs, Beta blockers
When should you use intubation in an acute exacerbation of COPD?
pH < 7.26
What electrolyte imbalance does legionella cause?
Hyponatraemia
What is the commonest type of lung cancer?
Adenocarcinoma
What is the step 1 in the treatment of chronic COPD?
STOP SMOKING
What biopsy is done in peripheral lung cancer?
Percutaneous transthoracic needle biopsy
What is seen on peak flow in asthma?
> 20% diurnal variation for at least 3 days for 2 weeks
What is FEV1?
Volume of gas expired in the first second of forced expiration
What is the most common organism that causes pneumonia?
Strep pneumoniae
What are the specific features of squamous cell carcinoma?
PTH related protein > hypercalcaemia
What is the gold standard investigation for a PE?
CTPA
How is ILD managed?
Conservative, O2, Pulmonary rehab
What pH in a pleural effusion indicates an exudate?
< 7.1
What is seen on spirometry in COPD?
Obstructive pattern: FEV1:FVC ratio < 0.7
What is the step 3 in the treatment of chronic COPD if FEV1 > 50%?
LABA or LAMA (salmeterol or tiotropium)
How do you investigate pneumonia?
CXR, Bloods, Blood cultures
What is the buzzword for idiopathic pulmonary fibrosis?
Honey combing on CT
What causes a reduction in FEV1?
Obstruction: COPD, asthma
How do you treat CAP with a CURB of 3+?
IV co-amoxiclav + IV clarithromycin
How is mycoplasma pneumonia treated/?
Clarithromycin
What is the atypical presentation of pneumonia?
dry cough, SOB, flu like symptoms
What ABG sign is VERY worrying in acute asthma?
Normal/high CO2 - they are getting tired and starting to retain CO2
What are the ECG changes seen in cor pulmonale?
Peaked P waves and RVH
What follow up is needed in pneumonia and in whom?
CXR in 6 weeks for those at risk of lung cancer
How does a PE present?
SOB, pleuritic chest pain, dizziness, syncope, haemoptysis
How is COPD investigated?
CXR, ABG, Spirometry
How is pneumocystis jiroveci treated?
Cotrimoxazole
What is step 1 in the management of chronic asthma?
SABA (salbutamol)
What is the management of an acute exacerbation of COPD?
nebulisers: salbutamol and ipratropium, steroids: oral red/IV hydrocortisone, Antibiotics (amoxicillin/doxuy)
Asthma + nasal polyps + aspirin sensitivity?
Samter’s triad
What is the buzzword for asbestosis?
Ship builders, dock workers
What is lupus pernio?
Raised plaque of purple indurated skin
In which condition is lupus pernio a feature?
Sarcoidosis
When is pulmonary rehab recommended in COPD?
As soon as patients become short of breath with regular activties
How can asthma be diagnosed with spirometry?
> 12% improvement in FEV1 after SABA
What metabolic abnormality does sarcoidosis cause?
Hypercalcaemia
How is alpha 1 antitrypsin deficiency inherited?
Autosomal recessive
Can alpha 1 antitrypsin be diagnosed prenatally?
Yes
In which zones does coal workers pneumoconiosis cause fibrosis?
Upper
What condition is buproprion contraindicated in?
Epilepsy
What lung defect does Kartgeners cause?
Primary ciliary dyskinesia
Recurrent chest infections + subfertility + dextrocardia
Kartgeners
What are the target sats in COPD?
88 - 92%
What antibody is tested for in Churg-Strauss?
pANCA
What is the main side effect of rifampicin?
Orange stuff - urine, tears, sweat
What is the main side effect of iosinazid?
Agranulocytosis, neuropathy
What are side effects of Pyra…. (the TB one)?
Hepatic stuff, photosensitivity, arthralgia
What is the main side effect of ethambutol?
Eye stuff
What is a histological finding in TB granulomas?
Epitheloid histocytes