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Gen Med and Surg - C.U > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Treatment of acute exacerbation of COPD

A

A 5-day course of prednisolone is part of the treatment given for an acute exacerbation of COPD.

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2
Q

Precipitants for asthma attacks

D
I
P
L
O
M
A
T
s
A 
Drugs - NSAIDs, Beta blockers 
Infections 
Pollutants 
Laughter 
Oesophageal reflux 
Mites 
Allergens 
Temp - COLD 
Some exercise
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3
Q

3 causes of airway narrowing in asthma

A

mucus production
brochoconstriction
mucousal inflammation

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4
Q

Signs of an asthma attack

A 
tachycardia 
tachypnoea 
resontant chest on percussion 
hyperinflated 
decreased chest well movement
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5
Q

Severe asthma

RR
BP 
Peak exp flow rate 
Blood gas CO2 / O2 
General
A 
>25 breaths per min 
>110 
30-50% 
CO2 low / normal, hypoxic 
Anxious
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6
Q

Life threatening asthma

RR
BP
Peak exp flow rate 
Blood gas CO2 / O2 
General

SHOCC

A 
Silent chest 
Hypotension 
One third 
Cyanoised,  CO2 increasing and acidotic 
Confused

NORMAL CO2 INDICATES LIFE THREATENING

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7
Q

Bed side tests for asthma exacerbation

A

Observations - RR, HR, Sat, BP
Peak flow
ECG

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8
Q

When to do an ABG in asthma exacerbation

A

<92% sats

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9
Q

Blood tests in asthma exacerbation

A 
FBC
U&amp;Es 
CRP 
Infectious screen 
ABG
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10
Q

Longer term tests in asthma

A

Lung function

Skin prick

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11
Q

Important social aspects to an asthma hx

A

Occupation
Pets
Smoking
Allergens

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12
Q

HPC in asthma

A

Attacks per week
Exaserbations
Been to ITU?

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13
Q

Acute asthma attack - initial medication

A

Salbutamol inhaler - can give 3 doses 5mg back to back

then doses every 15mins

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14
Q

Severe / life threatening asthma attack - initial medication

A

Impratropium bromide + salbutamol inhaler

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15
Q

Medication to consider in severe / life threatening

A

Hydrocortisone / pred

MgSo4

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16
Q

Who should life threatening asthma be stepped up to?

A

ICU

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17
Q

Asthma long term treatment

Step 1
Step 2
Step 3
Step 4

A

Beta agonist inhaler
+ICS
+Leukotriene receptor antagoist
+ LABA +/- LRA

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18
Q

Orthopnoea =

A

SOB on lying flat

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19
Q

Sudden causes of SOB

A

PE
Inhaled foreign body
Pneumothorax

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20
Q

Acute causes of SOB

A

Asthma exacerbation
COPD exacerbation
Pneumonia

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21
Q

Chronic causes of SOB (resp)

A

Asthma
COPD
Pulmonary fibrosis

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22
Q

Cardiac causes of SOB

A 
HF 
MI
Angina 
Valve disease 
Arrhythmias
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23
Q

Sudden systemic causes of SOB

A

Anaphylaxis
Hyperventilation
Anxiety

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24
Q

Acute on Chronic cause of SOB

A 
Metabolic acidosis 
Thyrotoxicosis 
Fever 
Anaemia 
Obesity 
Neurological disease
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25
Q

CURB65 score

A 
Confusion 
Urea 0 >7 mmol/L 
RR >30 
Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg
Age ≥ 65
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26
Q

What cancers metastasie to the lung?

A

breast, kidney, testes and bladder

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27
Q

Signs on examination for lung cancer

A 
Clubbing 
Cyanosis 
Consolidation
Chest expansion asymmetry?  
Lymphadenopathy
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28
Q

White out on a chest xray may show?

A

pleural effusion

or lobular collapse

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29
Q

Hormone syndromes caused by lung cancers

A 
Hypercalcaemia 
Inappropriate ADH (SCC) 
Ectopic ACTH (SCC)
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30
Q

Ddx for lung cancer

A

TB
Pneumonia
Secondary tumour?

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31
Q

Gold standard investigation for lung cancer ?

A

fiberoptic bronchoscopy

- can take samples and do procedures

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32
Q

Which types of lung carcinoma causes hypercalcaemia?

A

squamous cell carcinoma

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33
Q

Examples of obstructive defects

Important aspect

A

COPD
Asthma
Bronchiectasis

REVERSIBLE

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34
Q

Obstructive condition

FVC ?

FEV1/ FVC

A

FVC same

Ratio reduced

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35
Q

Examples of Restrictive defects

A 
scoliosis 
fibrosis 
post trauma 
Asbestosis 
NM disorders
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36
Q

Restrictive condition

FVC

FEV1/FVC

A

FVC = reduced

increased or normal

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37
Q

What is Atelectasis?

A

Atelectasis is a common post operative complication in which basal alveolar collapse can lead to respiratory difficulty. It is caused when airways become obstructed by bronchial secretions.

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38
Q

Two causes of COPD

A

Smoking and alpha 1 antitrypsin deficiency

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39
Q

Basis of COPD exacerbation treatment

A

O SHIT

7-14 days of steroids - 30mg pred

antibiotics if due to infection

consider chest physio and BiPAP

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40
Q

Where is the alpha 1 antitrypsin enzyme found?

A

liver

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41
Q

Causes of pulmonary fibrosis

A 
Occupational 
Idiopathic 
Medication - amiodarone and methotrexate 
Vasculitis 
CTD
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42
Q

Clinical features of pulmonary fibrosis

A 
Cyanosis 
Inspiratory fine creps 
Cough and SOB 
Finger clubbing 
Weight loss
 Fatigue
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43
Q

Bloods in pulmonary fibrosis

A 
FBC 
UandE 
LFT
CRP 
ANCA 
ACE levels
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44
Q

treatment of idiopathic pulmonary fibrosis

A

steroids and azathioprine

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45
Q

treatment of extrinsic allergic alveolitis

A

steroids and remove from precipitant

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46
Q

Pleural plaques indicates what?

A

exposure to asbestos NOT pulmonary exposure

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47
Q

Special characteristics of pulmonary sarcoidosis?

A

Erythema nodosum and bilateral hilar lymphadenopathy

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48
Q

Bronchiectasis =

A

chronic inflammation and infection of bronchial walls leadings to permanent dilations of the airways

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49
Q

Causes of bronchiectasis

A

Cystic fibrosis
Kartageners syndrome
TB

50
Q

Acute causes of a cough

A

Inhaled foreign object
Goite / tumour pressing on the larynx
Post nasal drip
URTI

51
Q

Causes of a productive cough

Mucus

Blood stained

A

1)
Pneumonia
Bronchiectasis
Exacerbation of COPD

TB
Cancer
Pink frothy - heart failure
PE

52
Q

Causes of a non productive cough

A 
Asthma 
Pulmonary fibrosis 
GORD 
Drugs - ACE inhib 
ANCA +ve
53
Q

Respiratory system questions

A 
SOB 
Cough 
Wheeze 
Chest pain 
Haemoptysis 
Weightloss / fever / nightsweats
54
Q

Blood tests in a chronic cough

A 
FBC 
CRP / ESR 
U&amp;Es 
TFTs 
ANCA
55
Q

Other investigations in a chronic cough

  • Bedside
  • Non bediside
A

Peak flow
Sputum sample and culture

Spirometry
CXR
Echo

56
Q

Causes of central cyanosis

A

Congenital heart disease
PE
Chronic lung disease
Abnormal Hb

57
Q

Peripheral causes of cyanosis

A

Causes of central
Reynauds
Slow circulation
Vascular occlusion

58
Q

Key test in central cyanosis

A

ABG

59
Q

What needs to be excluded in peripheral cyanosis

A

Vascular occlusion

60
Q

Main diagnostic test in Legionella disease

A

urine antigen detection

61
Q

Bilateral lung conditions which are mainly found in the apex of the lung

A

Cystic fibrosis
Ank Spond
Sarcoidosis
TB

62
Q

Bilateral lung conditions which are mainly found in the lower lobe of the lung

A

bronchiectasis
asbestosis
interstitial pneumonia

63
Q

Respiratory causes of haempoytsis

A 
Infection - pneumonia, TB 
Trauma 
PE 
Malinancy 
Foreign body
64
Q

Systemic causes of haempotysis

A

Granulomatus polyangitis

Goodpastures

65
Q

HPC q. in haempotysis

A

How much blood?
What colour?
Mixed with sputum?

B SYMPTOMS

66
Q

PMH q. in haempotysis

A

Kidney disease
Clotting disorders
Occupation
Smoking

67
Q

Associated symptoms to ask about in haemoptysis

A 
Chest pain 
SOB 
Cough 
B symptoms 
Nose bleed-
68
Q

Blood tests in haempotysis

A 
FBC 
U&amp;Es 
CRP 
ANCA 
Clotting screen 
Anti glomerular BM Antibodies
69
Q

Imaging in haempotysis

A

CRX
Echo
Fibre-optic bronchoscopy
CT

CTPA - PE

70
Q

Bedside tests in haempotysis

A

ECG
Urine dip and culture, urinary antigens - atypmical pneumonia
Sputum sample

71
Q

Differentials for hyperventilation

A

Resp

  • Pneumonia
  • Asthma exacerbation
  • PE
  • Pneumothorax

Cardiac

  • Cardiac failure
  • Anaemia
  • Valve failure
  • MI

Metabolic

  • sepsis
  • diabetic ketoacidosis

Anxiety

72
Q

Conditions causing fibrosis in the upper zones

A

CHARTS

Coal workers pneumoconiosis 
Hypersensitivity pneumonitis 
Ank Spond 
Radiation 
TB
Silicosis / Sarcoidosis
73
Q

Conditions causing fibrosis in the lower zones

A

Idiopathic
CTD
Drug induced - amiodarone, methotrexate
Asbestosis

74
Q

Pulmonary fibrosis presentation on CXR

A

bilateral interstitial shadowing (typically small, irregular, peripheral opacities - ‘ground-glass’ -

75
Q

Differentials in bilateral hilar lymphadenopathy

A

sarcoidosis and TB

76
Q

Cardiac causes of clubbing

A

cyanotic congenital heart disease (Fallot’s, TGA)

bacterial endocarditis

77
Q

Respiratory cause of clubbing

A 
Lung cancer 
CF 
Bronchiectasis 
TB
Asbestosis
78
Q

“Other” causes of clubbing

GI/ Endocrine

A

Crohn’s
Cirrhosis
Primary biliary cirrhosis
Graves disease

79
Q

Transudate protein level

Exudate protein level

A

< 30 g/L

> 30g/L

80
Q

If protein level on the boarderline in a pleural effusion what can you use ?

A

Lights criteria

81
Q

Test to see if a pleural effusion is a chylothorax?

A

triglyceride > 1.1g/L

82
Q

Symptoms of a pleural effusion

A

can be asymptomatic
dyspnoea
pleuritic chest pain

83
Q

Signs on exam of a pleural effusion

A 
Decreased chest expansion 
Stony dull to percussion 
decreased breath sounds 
decreased vocal frematus 
mediastinal shift away from a large effusion
84
Q

Imaging needed in a pleural effusion

A

CXR 1st line

85
Q

Test in pleural effusion

A

Aspirate - check protein, glucose, WBC, amylase, cytology, culture, lipids

86
Q

Treatment of pleural effusion

A

Conservative - if small leave to resolve on own

surgical - drainage

87
Q

Causes of primary pneumothorax

A

Trauma

Iatrogenic

88
Q

Causes of secondary pneumothorax

A

COPD / Asthma
Carcinoma
CF
CTD

89
Q

Signs on examination of pneumothorax

A 
Decreased lung expansion 
Tracheal deviation away in tension 
Hyporesonant on percussion
Absent vocal frematus  
Mediastinal shift in tension
90
Q

What denontes a small pneumothorax on CXR?

A

< 2cm

91
Q

Large pneumothorax management

A

Aspiration -> chest drain

92
Q

Klebsiella pneumonia associated with which two patient groups?

A

Diabetes

Alcoholics

93
Q

Inspiratory stridor suggests….

A

Laryngeal obstruction

94
Q

Expiratory stridor suggests

A

tracheobronchial obstruction

95
Q

Bisphasic stridor suggests

A

subglottic or glottic anomaly

96
Q

Stertor definition

A

low pitched snoring sound due to stenosis between nasopharynx and supraglottic region

97
Q

Wheeze defintion

A

polyphonic expiratory airway sound caused by lower airway narrowing

98
Q

Acute management of stridor

A 
Stabalise the patient - high flow O2 
Involve a senior 
Suction secretions / clear foreign body 
Adrenaline + steroids - IV or inhaled 
Bloods including an ABG 
May need a surgical ariway
99
Q

Where in the lungs is emphysema prominant

1) due to ATAT1 deficiency
2) COPD

A

Lower lobes

Upper lobes

100
Q

Caplan syndrome

A

lung nodules in the context of rheumatoid arthritis (RA).

101
Q

Alpha-1 antitrypsin (A1AT) deficiency is?

A

lack of protease inhibitor enzyme produced by the liver

102
Q

role of protease inhibitor

A

protect cells from enzymes e.g. neurtrophil elastase

103
Q

management of Alpha-1 antitrypsin (A1AT) deficiency ?

A

Management
no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: volume reduction surgery, lung transplantation

104
Q

presentation of Alpha-1 antitrypsin (A1AT) deficiency ?

A

Emphysema in the lower lungs
young age
liver derangement

105
Q

Question in PC for asthma / COPD exacerbation

A 
Severity - SOCRATES 
prevision admissions 
Inhaler compliance 
Rescue packs 
Home nebs?
106
Q

Treating asthma attack

O

S
H
I
T 
M
E
A

Oxygen - used to drive nebs
Salbutamol 2.5-5mg
Hydrocortisone 100mg IV (or Pred 40mg PO)
Ipratropium 500microg

(Theophylline )
Magensium sulphate
Escalate care

107
Q

How often should treatment be considered stepping down in asthma?

A

every 3 m

108
Q

how should ICS be reduced when stepping down?

A

by no more than 50%

109
Q

patients with asthma not controlled with salbutamol inhaler and ICS should have what added?

A

Following NICE 2017, patients with asthma who are not controlled with a SABA + ICS should first have a LTRA added, not a LABA

110
Q

Step up of management in COPD

A

After a short-acting beta-2 agonist (SABA) (or short acting muscarinic antagonist (SAMA)):

If FEV1 is >50% predicted offer either a long-acting antimuscarinic bronchodilator (LAMA) or a long-acting beta-2 agonist (LABA)

If FEV1 is <50% predicted offer either a long-acting antimuscarinic bronchodilator (LAMA) or a combination inhaler containing long-acting beta-2 agonist (LABA) and corticosteroid

Any patient that remains breathless or continues to have exacerbations should be offered triple therapy with a combination inhaler containing LABA and corticosteroid plus a LAMA (e.g. tiotropium)

111
Q

COPD LTOT

A

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:

secondary polycythaemia
nocturnal hypoxaemia
peripheral oedema
pulmonary hypertension

112
Q

Assess patient for LTOT

A

Assess patients if any of the following:

very severe airflow obstruction (FEV1 < 30% predicted).

Assessment should be ‘considered’ for patients with

severe airflow obstruction (FEV1 30-49% predicted)
cyanosis
polycythaemia
peripheral oedema
raised jugular venous pressure
oxygen saturations less than or equal to 92% on room air

113
Q

Most common lung cancer in non smokers

A

adenocarcinoma

114
Q

How does mycoplasma pneumonia present?

A

Dry cough
Head ache
Haemolytic anaemia

115
Q

What specific blood test result is found in mycoplasma pneumonia?

A

Cold agglutins on blood test

116
Q

Common cause of pneumonia in dehabilitated and IV drug users

A

Staph aureus

117
Q

Cause of pneumonia from parrots?

A

Chlamydia psittaci

118
Q

double right heart border on c x-ray indicates?

A

advanced mitral stenosis causing left atrial enlargement

119
Q

Pleural mass with lobulated margin on CXR = ?

A

Mesothelioma

120
Q

Fever, cough, shortness of breath hours
after exposure to antigen (usually farmer
after hay exposure) likely to be?

A

Extrinsic allergic alveolitis

Gen Med and Surg - C.U (16 decks)

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