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Respiratory Flashcards

1
Q

investigation of PE

A

wells score
>1 = CTPA and give LMWH
<1 = D-dimer

ECG: sinus tachycardia, S1,T3,Q3, RBBB, RAD

V/Q scan if cant have contrast (pregnancy/renal impairment)

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2
Q

definition and causes of transudative Pleural effusion

A

<30 g/L protein

HF, low albumin (malabsorption, liver disease, nephrotic syndrome, HF, fluid overload) hypothyroidism

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3
Q

definition and causes of exudative Pleural effusion

A

> 30g/L protein

infection, connective tissue disorders, neoplasia, pancreatitis, PE, dresslers

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4
Q

describe the score used to assess severity of pneumonia

A 
Confusion
Urea >7
Resp rate >30
BP <90 systolic/<60 diastolic
65 years old <

1= home, 2/3 = hospital, >3 = ICU

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5
Q

most typical organism in HAP

A

staph aureus

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6
Q

typical organisms causing CAP

A

strep pneumoniae

HIB in COPD, group B strep/RSV in children

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7
Q

list some atypical organisms causing pneumonia and their associations

A

legionella (low sodium, detected in urine - antigen)
klebsiella (alcoholics)
Pneumocystis jiroveci/PCP (HIV)
mycoplasma (erythema multiforme)

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8
Q

what is pulsus paradoxus and causes

A

drop >10mg/Hg on inspiration

asthma, COPD, tamponade

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9
Q

what wheeze do you get in asthma

A

expiratory

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10
Q

describe the types of respiratory failure and common conditions causing each

A

Type 1: hypoxia (<8), normal or low CO2 (<6)
failure of gas exchange - asthma, pneumonia, fibrosis

Type 2: hypoxia (<8) with hypercapnia (>6)
ventilation failure- COPD, myasthenia , GBS

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11
Q

describe the spirometry in asthma

A

obstructive
FVC:FEV1 <0.7
FVC <80%
FEV1 improves by 12% with SABA

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12
Q

describe spirometry in airway restriction

A

FEV1:FVC = 1

FEV1 <80%

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13
Q

what are the FEV1 ranges in mild, moderate and severe asthma

A

mild 65-80
moderate 50-65
severe <50

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14
Q

what questions to ask in assessing asthma severity

A

how many days a week do you get symptoms
how often does it wake you at night
does it interfere with ADLs

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15
Q

management of acute asthma

A

Oxygen (15L NRB mask aim for 94-98%)
Salbutamol nebuliser (2.5-5mg back to back/ every 15 mins)
Hydrocortisone IV (100mg) or oral prednisolone (40mg)
ipratropium bromide neb (4 hourly)

escalate/ get senior help
aminophylline, magnesium sulphate, ITU

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16
Q

management of chronic asthma ladder

A 
SABA
\+ ICS
\+LTRA (if <5 refer to specialist)
\+LABA 
increase ICS
oral steroid
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17
Q

definition of COPD

A

cough most days lasting > 3 month period for 2 years

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18
Q

symptoms of hypercapnia

A

papilledema, confusion, tachycardia, vasodilation, pins and needles, asterixis

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19
Q

indications for spirometry - COPD

A

over 35
smoker/ex smoker
chronic cough

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20
Q

investigations for COPD

A

spirometry - obstructive (FEV1 <80%, FEV1:FVC <0.7) non reversible
CXR: flat hemi diaphragm, bullae, hyper expansion
sputum culture
FBC (polycythaemia)

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21
Q

chronic management of COPD

A 
SABA/SAMA
>50% FEV1 = LAMA/LABA
<50% FEV1 = LAMA/LABA + ICS
triple therapy:  LABA, LAMA, ICS
pulmonary rehab
22
Q

indications for LTOT

A 
cyanosis
sats <92%
polycythaemia
FEV1 <30%
peripheral oedema (= pulmonary HTN)
raised JVP (= pulmonary HTN)
23
Q

how do you assess how effective LTOT is in COPD

A

ABG’s 3 weeks apart

24
Q

common causes of COPD exacerbation and management

A

strep pneumonia, HIB, RSV
increase SABA (?nebs)
oral prednisolone 7-14 days
sputum culture (doxycycline if positive)

25
most common type of lung Ca in smokers
squamous cell | small cell
26
most common lung Ca in non smokers
adenocarcinoma
27
associated features of squamous cell lung cancer
clubbing, hypercalcaemia due to high PTH, raised TSH | obstruction of central airways
28
paraneoplastic syndromes of small cell lung cancer
SIADHS cushings (ectopic ACTH) lambert eaton syndrome (MG)
29
paraneoplastic syndromes of large cell lung cancer
beta HCG secretion | carcinoid syndrome - serotonin = flushing
30
investigations in Lung cancer
``` sputum culture and cytology CXR biopsy of lymph nodes CT, bronchoscopy and biopsy PET scan isotope bone scan / bone profile ```
31
local complications of lung cancer
recurrent laryngeal nv palsy phrenic nv palsy SVCO horners syndrome (Pancoast tumour)
32
what is horner's syndrome / pancoast tumour
apical lung tumours cause damage to sympathetic nerves of face when they exit the spinal cord causing: 1) miosis 2) partial ptosis 3) anhidrosis
33
immediate management of tension pneumothorax
14 gage cannula (orange) into 2nd ICS mid clavicular line
34
management of pneumothorax
if small discharge/ monitor O2 aspirate chest drain
35
what is and what causes respiratory alkalosis
resp alkalosis is a pH >7.45 withlow arterial CO2 <4.5 due to hyperventilation ~ blowing CO2 off neurological disorders, PE, pregnancy, pneumonia, asthma
36
what is and what causes respiratory acidosis
pH <3.5 normal/ high CO2 (44.5-6.5) due to inadequate ventilation ~ retaining CO2 COPD, opiates, decompensated asthma, benzos
37
causes of pulmonary fibrosis
idiopathic occupational : silicosis, asbestosis sarcoidosis infection: TB, pneumonia EAA connective tissue disease (SLE, RA, scleroderma, GPA, ankylosing spondylitis) drugs: amioderone , methotrexate, nitrofurantoin
38
causes of bilateral hilar lymphadenopathy
``` sarcoid infection - TB, mycoplasma malignancy - lymphoma, carcinoma, mediastinal ca silicosis EAA ```
39
presentation of acute sarcoidosis
``` erythema nodosum and polyarthralgia cough and SOB hepato/splenomegaly eye signs (-itis's) lupus pernio cardiomegaly and arrhythmias hypercalcaemia ```
40
investigations in sarcoidosis
serum ACE , ESR, LFT's, Calcium, Ig's 24h urine test for calcium CXR - honeycombing, bilateral hilar lymphadenopathy, bullae tissue biopsy - granulomas non caseating
41
list some extrapulmonary manifestations of TB
pott's disease (spine and skull) meningitis sterile dysuria/ pyuria (urinary) lupus vulgaris (mucocutaneous - face)
42
investigations in TB
CXR (consolidation, cavitation, fibrosis, calcification) 3 sputum samples - one early morning - ziehl nelson stain - acid fast bacilli - lowenstein johnson culture
43
management of pulmonary TB (+side effects and monitoring)
2 months: ethambutol - optic neuritis and decline in renal function. check colour vision with ischihara chart and do U&E's pyazidamide - anaemia. FBC (also U&E's for renal function) 6 months: Rifampicin - orange secretions and deranged LFT's. stop if increased bilirubin. Isoniazid - peripheral neuropathy. monitor LFT's. also contact tracing and public health notification
44
what is the prophylaxis of TB
3 months rifampicin and isoniazid
45
management of meningeal TB
1 year RIPE + prednisolone
46
side effects of steroids
``` Cataracts, cushingoid Ulcers Skin thinning, bruising, striae Hyperglycemia, hypertension, hirsutism Immunosuppression Necrosis (femoral head) Growth suppression, glaucoma Osteoporosis, obesity Illness - mental (psychosis, depression) Diabetes ``` Peripheral oedema and proximal myopathy
47
explain pathophysiology of cystic fibrosis
AR - chromosome 7 affects CFTR protein Cl- not transported out of cells so secretions more viscous affects pancreatic ducts, lungs and sex organs often presents with meconium ileus
48
investigation for cystic fibrosis
``` Guthrie test - immunoreactive trypsinogen sweat test (high NaCl) fecal elastase reduced ```
49
what bug often infects cystic fibrosis patients
pseudomonas aureginosa
50
management of cystic fibrosis
``` dont smoke flu jab nutrition physio sputum thinners (recombinant DNAase) mucolytics and broncho dilators Abx if +ve sputum sample ```
51
what is sail sign indicative of in CXR
left lower lobe collapse

Finals (18 decks)

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