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Finals > Respiratory > Flashcards

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
Q

most common type of lung Ca in smokers

A

squamous cell

small cell

26
Q

most common lung Ca in non smokers

A

adenocarcinoma

27
Q

associated features of squamous cell lung cancer

A

clubbing, hypercalcaemia due to high PTH, raised TSH

obstruction of central airways

28
Q

paraneoplastic syndromes of small cell lung cancer

A

SIADHS
cushings (ectopic ACTH)
lambert eaton syndrome (MG)

29
Q

paraneoplastic syndromes of large cell lung cancer

A

beta HCG secretion

carcinoid syndrome - serotonin = flushing

30
Q

investigations in Lung cancer

A 
sputum culture and cytology
CXR
biopsy of lymph nodes
CT, bronchoscopy and biopsy
PET scan
isotope bone scan / bone profile
31
Q

local complications of lung cancer

A

recurrent laryngeal nv palsy
phrenic nv palsy
SVCO
horners syndrome (Pancoast tumour)

32
Q

what is horner’s syndrome / pancoast tumour

A

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
Q

immediate management of tension pneumothorax

A

14 gage cannula (orange) into 2nd ICS mid clavicular line

34
Q

management of pneumothorax

A

if small discharge/ monitor O2
aspirate
chest drain

35
Q

what is and what causes respiratory alkalosis

A

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
Q

what is and what causes respiratory acidosis

A

pH <3.5
normal/ high CO2 (44.5-6.5)
due to inadequate ventilation ~ retaining CO2
COPD, opiates, decompensated asthma, benzos

37
Q

causes of pulmonary fibrosis

A

idiopathic
occupational : silicosis, asbestosis
sarcoidosis
infection: TB, pneumonia
EAA
connective tissue disease (SLE, RA, scleroderma, GPA, ankylosing spondylitis)
drugs: amioderone , methotrexate, nitrofurantoin

38
Q

causes of bilateral hilar lymphadenopathy

A 
sarcoid
infection - TB, mycoplasma
malignancy - lymphoma, carcinoma, mediastinal ca
silicosis
EAA
39
Q

presentation of acute sarcoidosis

A 
erythema nodosum and polyarthralgia
cough and SOB
hepato/splenomegaly
eye signs (-itis's)
lupus pernio
cardiomegaly and arrhythmias
hypercalcaemia
40
Q

investigations in sarcoidosis

A

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
Q

list some extrapulmonary manifestations of TB

A

pott’s disease (spine and skull)
meningitis
sterile dysuria/ pyuria (urinary)
lupus vulgaris (mucocutaneous - face)

42
Q

investigations in TB

A

CXR (consolidation, cavitation, fibrosis, calcification)

3 sputum samples - one early morning

  • ziehl nelson stain - acid fast bacilli
  • lowenstein johnson culture
43
Q

management of pulmonary TB (+side effects and monitoring)

A

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
Q

what is the prophylaxis of TB

A

3 months rifampicin and isoniazid

45
Q

management of meningeal TB

A

1 year RIPE + prednisolone

46
Q

side effects of steroids

A 
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
Q

explain pathophysiology of cystic fibrosis

A

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
Q

investigation for cystic fibrosis

A 
Guthrie test - immunoreactive trypsinogen
sweat test (high NaCl)
fecal elastase reduced
49
Q

what bug often infects cystic fibrosis patients

A

pseudomonas aureginosa

50
Q

management of cystic fibrosis

A 
dont smoke
flu jab
nutrition
physio
sputum thinners (recombinant DNAase)
mucolytics and broncho dilators
Abx if +ve sputum sample
51
Q

what is sail sign indicative of in CXR

A

left lower lobe collapse

Finals (18 decks)

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