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Year 5 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Name 3 pathological features of asthma

A

bronchial plugging
bronchial hypersensitivity
oedema of bronchi

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2
Q

name 3 features of a moderate asthma attack

A

PEFR 50-75% Best/ predicted
HR>110
RR <25

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3
Q

Name 3 features of a severe asthma attack

A

PEFR 33-50% best/ predicted
can’t complete full sentences
tachycardia (HR>110)
tachypnoea (>25)

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4
Q

Name 3 features of life threatening asthma

A

PEFR< 33% best/ predicted
SpO2 <92%
hypotension

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5
Q

what constitutes near-fatal asthma

A

rise in PaCO2/ needing mechanical ventilation

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6
Q

what is the dose of medications in acute asthma attack?

A

Salbutamol neb 5mg 15 minutely
Ipratropium bromide 0.5mg 4-6hrly
prednisolone 40-50mg/ hydrocortisone 200mg IV

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7
Q

how long should you continue prednisolone for after an acute asthma attack?

A

5 days

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8
Q

when can you discharge after an acute asthma attack?

A

peak flow >75% best/ predicted

+ <25% diurnal variation in peak flow

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9
Q

what in spirometry would suggest asthma

A

an improvement of at least 15% in FEV1/FVC after salbutamol

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10
Q

How often would a patient be using salbutamol if considering moving up the treatment ladder?

A

3+ doses a week/ nocturnal symptoms

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11
Q

what is the first asthma preventer used in adults?

A

inhaled ICS

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12
Q

what is the first add-on therapy to an ICS in asthma?

A

LABA

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13
Q

If asthmatic is on LABA and ICS but still requiring salbutamol 3+/ week what would the next step be?

A

if benefit LABA continue
increase ICS
consider trial of LTRA, SR theophylline, LAMA

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14
Q

when would an asthmatic require referral to specialist care?

A

if more than 3 treatments required

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15
Q

how do you calculate pack years?

A

(no smoked/20) x no of years smoked

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16
Q

what 2 pathological features make up COPD?

A

chronic bronchitis and emphysema

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17
Q

what advice should be given before spirometry?

A

> 24hrs- no smoking/ alohol
few hours before- no large meals, strenuous exercise or inhaler
during- wear loose fitting clothing and nose clip

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18
Q

what are 3 contraindications to spirometry?

A

Recent MI
angina
recent surgery
pneumothorax

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19
Q

what picture on spirometry would indicate restrictive lung disease?

A

both FEV1 and FVC reduced

FEV1/FVC normal or high

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20
Q

give 3 examples of restrictive lung disease

A 
Interstitial lung disease (idiopathic pulmonary fibrosis)
Sarcoidosis
Obesity
Scoliosis
Neuromuscular disease
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21
Q

give 3 examples of obstructive lung disease

A

asthma
COPD
bronchiectasis

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22
Q

what picture on spirometry would indicate obstructive lung disease?

A

FEV1 reduced more than FVC

FEV1/FVC low (<0.7)

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23
Q

what is the BODE index used to predict?

A

survival in COPD patients

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24
Q

what makes up the BODE index?

A

BMI
Obesity
Dyspnoea scale (MRC)
Exercise tolerance (distance walked in 6 minutes)

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25
Q

list the stages of MRC dyspnoea scale

A
  1. breathless on strenuous exercise
  2. walking uphill
  3. more breathless than peers
  4. walking short distance
  5. rest/ minimal exertion
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26
Q

what compromises mild COPD?

A

FEV1 >80% predicted and symptoms

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27
Q

what compromises moderate COPD?

A

FEV1 50-79% Predicted

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28
Q

what compromises severe COPD?

A

FEV1 30-49% Predicted

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29
Q

what compromises very severe COPD?

A

FEV1 <30% predicted

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30
Q

when would you recommend pulmonary rehab for COPD patients?

A

MRC dyspnoea scale 3+
recent admission
describes self as functionally disabled

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31
Q

what is LTOT used for in COPD?

A

to prevent cor pulmonale/ polycythaemia

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32
Q

what is the first step in treatment for COPD?

A

SABA/ SAMA

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33
Q

What it the second step in treatment for COPD if SABA/ SAMA have failed?

A

FEV1 >50%: add LABA/ LAMA (+ discontinue SAMA) then if no improvement add ICS to LABA
FEV1 <50%: add LABA+ICS/ LAMA (discontinue SAMA)

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34
Q

Name 3 complications of COPD

A 
infections
pneumothorax
psych- depression and anxiety
cor pulmonale
resp failure
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35
Q

what is the most O2 can give through nebuliser?

A

6L, if requiring more can add in 2L via NC

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36
Q

dose of prednisolone in COPD?

A

30mg for 7-14 days

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37
Q

If a patient with COPD doesn’t respond to salbutamol/ ipratropium/ steroids and controlled O2 what should be considered?

A

NIPPV (BiPAP)

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38
Q

what is the usual aetiology of acute bronchitis?

A

viral- rhinovirus, influenza, RSV

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39
Q

Who is more at risk of tension pnumothorax?

A

ventilated patients
trauma patients
patients with underlying lung disease- asthma COPD

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40
Q

Is vocal resonance increased or reduced in a pneumothorax?

A

reduced

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41
Q

what features suggest a tension pneumothorax?

A

Raised JVP
tracheal deviation
hypotension

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42
Q

what pneumothoraces can be left to self-resolve?

A

<2cm, primary pneumothorax

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43
Q

when should aspiration in triangle of safety for pneumothorax

A

primary pneomothorax >2cm

secondary pneumothorax <2cm

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44
Q

how should a secondary pneumothorax >2cm be treated?

A

chest drain

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45
Q

what is the most common ECG finding in a PE?

A

sinus tachycardia

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46
Q

what is S1Q3T3?

A

Large S wave in I
large Q wave in III
Inverted T wave in III
may also show RV strain. diagnostic of PE

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47
Q

What is PESI?

A

PE severity score- determines need for thrombolysis

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48
Q

what is the treatment for PE?

A

LMWH- e.g. dalteparin,

long term continue DOAC/ warfarin for at least 3 months depending on cause

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49
Q

what would suggest a massive PE?

A

SBP <90 or drop of >40 for at least 15 minutes

50
Q

define CURB65

A 
Confusion (AMTS<8)
Urea >7
RR >30
BP <90
age >65
51
Q

What CURB score can be treated at home?

A

0-1

52
Q

true or false: all patients with pneumonia should have a follow up Xray

A

True- 6 weeks after symptoms resolved to check for underlying lung disease e.g. cancer

53
Q

pneumonia + diarrhoea + deranged LFTs (low sodium)

A

legionella pneumophilia

54
Q

pneumonia + cold sores

A

pneumococcal pneumonia

55
Q

pneumonia + rash + neuro symptoms + ear pain

A

mycoplasma pneumoniae

56
Q

treatment for mild pneumonia

A

500mg amoxicillin TDS for 7 days

57
Q

treatment for moderate to severe pneumonia

A

co-amox for 7-10 days

+clarythromycin

58
Q

if a patient with pneumonia had received 5 days treatment but was still pyrexic and had a raised WCC what should you suspect?

A

empyema

59
Q

what causes croup

A

parainfluenza

60
Q

what size effusion is required to show on Xray?

A

> 300ml

61
Q

what should pleural effusion aspirate be sent for?

A

clinical biochem (glucose/ protein/ pH/ amylase/ LDH)
Bacteria culture
cytology
immunology (if indicated)

62
Q

which have a higher protein content- transudates/ exudates?

A

exudates- protein >35g/L

63
Q

what would you expect to see in a transudate?

A 
lower protein <25g/L
mononuclear cells (macrophages/ lymphocytes)
64
Q

what causes an exudate?

A

areas of inflammation leading to leaky capillaries

65
Q

what causes a transudate?

A

high pressure in vessels forcing plasma and some blood products across the membrane

66
Q

If protein content of a pleural effusion is 25-35g/L what can be used to differentiate?

A

Light’s criteria, exudate if:
[Plerual Protein : serum protein] ratio >0.5
[Pleural LDH : serum LDH] ratio >0.6
Pleural LDH > 200

67
Q

Name 3 causes of a transudate

A

low albumin (liver failure/ nephrotic syndrome)
hypothyroid
CVD (fluid overload, HF)

68
Q

Name 3 causes of an exudate

A

inflammation (SLE/ RA)
Malignancy
Infection (incl TB, exclude empyema)

69
Q

what would indicate an empyema rather than an exudate?

A

pH<7.2

70
Q

if a drain is required for pleural effusion what is a risk?

A

pulmonary odoema- do not remove more than 1.5L per 24hrs to reduce risk

71
Q

what is pleurodesis?

A

removal of the pleural space with talc/ chemicals (tetracycline/ bleomycin) to prevent recurring pleural effusions e.g. in malignancy

72
Q

what are the 2 categories of lung cancer?

A

small cell lung cancer

non-small cell lung cancer

73
Q

which type of lung cancer is more common?

A

NSCLC

74
Q

Which type of lung cancer has a worse prognosis?

A

SCLC- aggressive and fast-growing
associated with cushing’s, SIADH, Lambert-eaton syndrome
often metastasised by diagnosis

75
Q

name 2 types of NSCLC

A

SCC- close to bronchi

Adenocarcinoma- slightly more common, peripherally

76
Q

where do lung cancers metastasise to?

A 
lymph nodes
liver
bone
adrenals
CNS
skin
77
Q

what is Horner’s and how is it related to lung cancer?

A

partial ptosis, miosis, reduced sweating on 1/2 face

caused by reduced sympathetic supply to eye- can be due to apical tumour

78
Q

When can a hoarse voice be indicative of lung cancer?

A

compression of recurrent laryngeal nerve by mediastinal tumour, causes breathy voice and dysphagia

79
Q

how might a biopsy be obtained in potential lung cancer?

A

EBUS- endobronchial US for mediastinal lymph nodes

bronchoscopy with bronchial wash

80
Q

which cancers commonly metastasise to the lungs?

A 
bladder
colon
breast
head and neck SCC
renal
81
Q

what cancer would you suspect in cannonball mets?

A

renal cell

82
Q

which cancer may metastasise to lungs in a miliary pattern?

A

thyroid
malignant melanoma
osteosarcoma
renal cell carcinoma

83
Q

what would non-caseating granulomata in the lungs suggest?

A

sarcoidosis

84
Q

what would caseating granulomata in the lungs suggest?

A

TB

85
Q

name 3 organs most commonly affected by sarcoidosis?

A

lungs
skin
eyes

86
Q

Name a skin presentation of sarcoidosis?

A

erythema nodusom (large red lumps, often on shin) note these can also appear in TB, pregnancy/ COCP/ throat infections- streptococcus

87
Q

name an eye presentation of sarcoidosis

A

anterior uveitis

88
Q

what might you see on a CXR in sarcoidosis?

A

hilar lymphadenopathy

89
Q

what is the first line of treatment for sarcoidosis?

A

glucocorticoids (remember PPI + bisphosphonates)

90
Q

what causes CF?

A

autosomal recession on CF transmembrane regulator causing defective Cl- transport

91
Q

what test is used to test for CF?

A

it is screened for in Guthrie test, but if missed sweat test (look for 2 results >60mmol/L Cl-)

92
Q

Name 3 treatments for CF lung disease

A

effective sputum clearance- physio
inhaled hypertonic saline
prophylactic antibiotics
often require lung transplant

93
Q

Name 3 complications of CF

A

diabetes
osteoporosis
infertility in males

94
Q

name 3 causes of bronchiectasis

A

CT (most common in UK)
whooping cough (bordetella pertussis)
TB

95
Q

what imaging is best for bronchiectasis?

A

CT- shows signet ring sign

96
Q

Name 3 symptoms of CO poisoning

A

Confusion
blurred vision
headache

97
Q

What is the treatment for CO poisoning?

A

O2

98
Q

What are the 4 main symptoms of idiopathic pulmonary fibrosis?

A

dry cough
dyspnoea
digital clubbing
diffuse respiratory crackles

99
Q

what age does idiopathic pulmonary fibrosis occur?

A

45-65

100
Q

Name a complication of idiopathic pulmonary fibrosis

A

cor pulmonale

101
Q

describe the 2 types of coal worker’s pneumoconiosis

A

simple- small nodular lesions in upper lobes of CXR, avoidance of dust stops progression
progressive massive fibrosis- as a result of simple, pregresses despite avoidance of dust. large nodules on CXR, cor pulmonale

102
Q

how might a mesothelioma present?

A

restrictive pattern on pulmonary function test
pleural effusion
progressive dyspnoea
pleuritic nodules on CXR

103
Q

what is a complication of lung abscesses?

A

local necrosis

104
Q

how would a lung abscess present?

A

recent infection
unresolving and systemic symptoms- including night sweats
CXR- large abscess with fluid level

105
Q

what happens after primary TB infection?

A

macrophages engulf TB and travel to hilar lymph nodes->
80% self resolve
reactived as secondary TB
travel via bloodstream-> miliary TB

106
Q

what tests should sputum samples be sent for if ?TB?

A

Ziehl-Neelsen stain

rapid direct microscopy for acid/ alcohol-fast bacilli

107
Q

how many sputum samples should be sent for TB?

A

3 samples on 3 separate days, pre Abx

108
Q

what test can be used to screen close contacts of people with TB

A

Mantoux- note +ve if BCG vaccine so if +ve -> interferon gamma test

109
Q

which 4 medications are used for TB

A

isoniazid
rifampicin
pyrazinamide
ethambutol

110
Q

which TB treatments affect liver function?

A

isoniazid
rifampicin
pyrazinamide

111
Q

what is a side effect of rifampicin?

A

dark urine

p450 inducer

112
Q

what is a side effect of isoniazid?

A

peripheral neuropathy

113
Q

which TB drug should be avoided in reduced kidney function?

A

ethambutol

114
Q

what is an adverse effect of ethambutol?

A

visual impairment

115
Q

which scoring system is used for sleep apnoea?

A

Epworth sleepiness scale:

>10 refer

116
Q

what are problems with CPAP in obstructive sleep apnoea?

A

disturbance to partner
rhinitis/ nasal irritation
claustrophobic

117
Q

what is the most effective medication for people looking to stop smoking?

A

varenicline (champix)

118
Q

when is veranicline contraindicated?

A

pregnancy/ BF

kidney problems

119
Q

What drug can be used when veranicline is contraindicated?

A

bupropion

120
Q

who is buproprion contraindicated in?

A

pregnant/ BF
epilepsy
bipolar/ eating disorders

Year 5 (12 decks)

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