Respiratory Flashcards
1
Q
Name 3 pathological features of asthma
A
bronchial plugging
bronchial hypersensitivity
oedema of bronchi
2
Q
name 3 features of a moderate asthma attack
A
PEFR 50-75% Best/ predicted
HR>110
RR <25
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)
4
Q
Name 3 features of life threatening asthma
A
PEFR< 33% best/ predicted
SpO2 <92%
hypotension
5
Q
what constitutes near-fatal asthma
A
rise in PaCO2/ needing mechanical ventilation
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
7
Q
how long should you continue prednisolone for after an acute asthma attack?
A
5 days
8
Q
when can you discharge after an acute asthma attack?
A
peak flow >75% best/ predicted
+ <25% diurnal variation in peak flow
9
Q
what in spirometry would suggest asthma
A
an improvement of at least 15% in FEV1/FVC after salbutamol
10
Q
How often would a patient be using salbutamol if considering moving up the treatment ladder?
A
3+ doses a week/ nocturnal symptoms
11
Q
what is the first asthma preventer used in adults?
A
inhaled ICS
12
Q
what is the first add-on therapy to an ICS in asthma?
A
LABA
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
14
Q
when would an asthmatic require referral to specialist care?
A
if more than 3 treatments required
15
Q
how do you calculate pack years?
A
(no smoked/20) x no of years smoked
16
Q
what 2 pathological features make up COPD?
A
chronic bronchitis and emphysema
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
18
Q
what are 3 contraindications to spirometry?
A
Recent MI
angina
recent surgery
pneumothorax
19
Q
what picture on spirometry would indicate restrictive lung disease?
A
both FEV1 and FVC reduced
FEV1/FVC normal or high
20
Q
give 3 examples of restrictive lung disease
A
Interstitial lung disease (idiopathic pulmonary fibrosis) Sarcoidosis Obesity Scoliosis Neuromuscular disease
21
Q
give 3 examples of obstructive lung disease
A
asthma
COPD
bronchiectasis
22
Q
what picture on spirometry would indicate obstructive lung disease?
A
FEV1 reduced more than FVC
FEV1/FVC low (<0.7)
23
Q
what is the BODE index used to predict?
A
survival in COPD patients
24
Q
what makes up the BODE index?
A
BMI
Obesity
Dyspnoea scale (MRC)
Exercise tolerance (distance walked in 6 minutes)
25
list the stages of MRC dyspnoea scale
1. breathless on strenuous exercise
2. walking uphill
3. more breathless than peers
4. walking short distance
5. rest/ minimal exertion
26
what compromises mild COPD?
FEV1 >80% predicted and symptoms
27
what compromises moderate COPD?
FEV1 50-79% Predicted
28
what compromises severe COPD?
FEV1 30-49% Predicted
29
what compromises very severe COPD?
FEV1 <30% predicted
30
when would you recommend pulmonary rehab for COPD patients?
MRC dyspnoea scale 3+
recent admission
describes self as functionally disabled
31
what is LTOT used for in COPD?
to prevent cor pulmonale/ polycythaemia
32
what is the first step in treatment for COPD?
SABA/ SAMA
33
What it the second step in treatment for COPD if SABA/ SAMA have failed?
FEV1 >50%: add LABA/ LAMA (+ discontinue SAMA) then if no improvement add ICS to LABA
FEV1 <50%: add LABA+ICS/ LAMA (discontinue SAMA)
34
Name 3 complications of COPD
```
infections
pneumothorax
psych- depression and anxiety
cor pulmonale
resp failure
```
35
what is the most O2 can give through nebuliser?
6L, if requiring more can add in 2L via NC
36
dose of prednisolone in COPD?
30mg for 7-14 days
37
If a patient with COPD doesn't respond to salbutamol/ ipratropium/ steroids and controlled O2 what should be considered?
NIPPV (BiPAP)
38
what is the usual aetiology of acute bronchitis?
viral- rhinovirus, influenza, RSV
39
Who is more at risk of tension pnumothorax?
ventilated patients
trauma patients
patients with underlying lung disease- asthma COPD
40
Is vocal resonance increased or reduced in a pneumothorax?
reduced
41
what features suggest a tension pneumothorax?
Raised JVP
tracheal deviation
hypotension
42
what pneumothoraces can be left to self-resolve?
<2cm, primary pneumothorax
43
when should aspiration in triangle of safety for pneumothorax
primary pneomothorax >2cm
| secondary pneumothorax <2cm
44
how should a secondary pneumothorax >2cm be treated?
chest drain
45
what is the most common ECG finding in a PE?
sinus tachycardia
46
what is S1Q3T3?
Large S wave in I
large Q wave in III
Inverted T wave in III
may also show RV strain. diagnostic of PE
47
What is PESI?
PE severity score- determines need for thrombolysis
48
what is the treatment for PE?
LMWH- e.g. dalteparin,
| long term continue DOAC/ warfarin for at least 3 months depending on cause
49
what would suggest a massive PE?
SBP <90 or drop of >40 for at least 15 minutes
50
define CURB65
```
Confusion (AMTS<8)
Urea >7
RR >30
BP <90
age >65
```
51
What CURB score can be treated at home?
0-1
52
true or false: all patients with pneumonia should have a follow up Xray
True- 6 weeks after symptoms resolved to check for underlying lung disease e.g. cancer
53
pneumonia + diarrhoea + deranged LFTs (low sodium)
legionella pneumophilia
54
pneumonia + cold sores
pneumococcal pneumonia
55
pneumonia + rash + neuro symptoms + ear pain
mycoplasma pneumoniae
56
treatment for mild pneumonia
500mg amoxicillin TDS for 7 days
57
treatment for moderate to severe pneumonia
co-amox for 7-10 days
| +clarythromycin
58
if a patient with pneumonia had received 5 days treatment but was still pyrexic and had a raised WCC what should you suspect?
empyema
59
what causes croup
parainfluenza
60
what size effusion is required to show on Xray?
>300ml
61
what should pleural effusion aspirate be sent for?
clinical biochem (glucose/ protein/ pH/ amylase/ LDH)
Bacteria culture
cytology
immunology (if indicated)
62
which have a higher protein content- transudates/ exudates?
exudates- protein >35g/L
63
what would you expect to see in a transudate?
```
lower protein <25g/L
mononuclear cells (macrophages/ lymphocytes)
```
64
what causes an exudate?
areas of inflammation leading to leaky capillaries
65
what causes a transudate?
high pressure in vessels forcing plasma and some blood products across the membrane
66
If protein content of a pleural effusion is 25-35g/L what can be used to differentiate?
Light's criteria, exudate if:
[Plerual Protein : serum protein] ratio >0.5
[Pleural LDH : serum LDH] ratio >0.6
Pleural LDH > 200
67
Name 3 causes of a transudate
low albumin (liver failure/ nephrotic syndrome)
hypothyroid
CVD (fluid overload, HF)
68
Name 3 causes of an exudate
inflammation (SLE/ RA)
Malignancy
Infection (incl TB, exclude empyema)
69
what would indicate an empyema rather than an exudate?
pH<7.2
70
if a drain is required for pleural effusion what is a risk?
pulmonary odoema- do not remove more than 1.5L per 24hrs to reduce risk
71
what is pleurodesis?
removal of the pleural space with talc/ chemicals (tetracycline/ bleomycin) to prevent recurring pleural effusions e.g. in malignancy
72
what are the 2 categories of lung cancer?
small cell lung cancer
| non-small cell lung cancer
73
which type of lung cancer is more common?
NSCLC
74
Which type of lung cancer has a worse prognosis?
SCLC- aggressive and fast-growing
associated with cushing's, SIADH, Lambert-eaton syndrome
often metastasised by diagnosis
75
name 2 types of NSCLC
SCC- close to bronchi
| Adenocarcinoma- slightly more common, peripherally
76
where do lung cancers metastasise to?
```
lymph nodes
liver
bone
adrenals
CNS
skin
```
77
what is Horner's and how is it related to lung cancer?
partial ptosis, miosis, reduced sweating on 1/2 face
| caused by reduced sympathetic supply to eye- can be due to apical tumour
78
When can a hoarse voice be indicative of lung cancer?
compression of recurrent laryngeal nerve by mediastinal tumour, causes breathy voice and dysphagia
79
how might a biopsy be obtained in potential lung cancer?
EBUS- endobronchial US for mediastinal lymph nodes
| bronchoscopy with bronchial wash
80
which cancers commonly metastasise to the lungs?
```
bladder
colon
breast
head and neck SCC
renal
```
81
what cancer would you suspect in cannonball mets?
renal cell
82
which cancer may metastasise to lungs in a miliary pattern?
thyroid
malignant melanoma
osteosarcoma
renal cell carcinoma
83
what would non-caseating granulomata in the lungs suggest?
sarcoidosis
84
what would caseating granulomata in the lungs suggest?
TB
85
name 3 organs most commonly affected by sarcoidosis?
lungs
skin
eyes
86
Name a skin presentation of sarcoidosis?
erythema nodusom (large red lumps, often on shin) note these can also appear in TB, pregnancy/ COCP/ throat infections- streptococcus
87
name an eye presentation of sarcoidosis
anterior uveitis
88
what might you see on a CXR in sarcoidosis?
hilar lymphadenopathy
89
what is the first line of treatment for sarcoidosis?
glucocorticoids (remember PPI + bisphosphonates)
90
what causes CF?
autosomal recession on CF transmembrane regulator causing defective Cl- transport
91
what test is used to test for CF?
it is screened for in Guthrie test, but if missed sweat test (look for 2 results >60mmol/L Cl-)
92
Name 3 treatments for CF lung disease
effective sputum clearance- physio
inhaled hypertonic saline
prophylactic antibiotics
often require lung transplant
93
Name 3 complications of CF
diabetes
osteoporosis
infertility in males
94
name 3 causes of bronchiectasis
CT (most common in UK)
whooping cough (bordetella pertussis)
TB
95
what imaging is best for bronchiectasis?
CT- shows signet ring sign
96
Name 3 symptoms of CO poisoning
Confusion
blurred vision
headache
97
What is the treatment for CO poisoning?
O2
98
What are the 4 main symptoms of idiopathic pulmonary fibrosis?
dry cough
dyspnoea
digital clubbing
diffuse respiratory crackles
99
what age does idiopathic pulmonary fibrosis occur?
45-65
100
Name a complication of idiopathic pulmonary fibrosis
cor pulmonale
101
describe the 2 types of coal worker's pneumoconiosis
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
how might a mesothelioma present?
restrictive pattern on pulmonary function test
pleural effusion
progressive dyspnoea
pleuritic nodules on CXR
103
what is a complication of lung abscesses?
local necrosis
104
how would a lung abscess present?
recent infection
unresolving and systemic symptoms- including night sweats
CXR- large abscess with fluid level
105
what happens after primary TB infection?
macrophages engulf TB and travel to hilar lymph nodes->
80% self resolve
reactived as secondary TB
travel via bloodstream-> miliary TB
106
what tests should sputum samples be sent for if ?TB?
Ziehl-Neelsen stain
| rapid direct microscopy for acid/ alcohol-fast bacilli
107
how many sputum samples should be sent for TB?
3 samples on 3 separate days, pre Abx
108
what test can be used to screen close contacts of people with TB
Mantoux- note +ve if BCG vaccine so if +ve -> interferon gamma test
109
which 4 medications are used for TB
isoniazid
rifampicin
pyrazinamide
ethambutol
110
which TB treatments affect liver function?
isoniazid
rifampicin
pyrazinamide
111
what is a side effect of rifampicin?
dark urine
| p450 inducer
112
what is a side effect of isoniazid?
peripheral neuropathy
113
which TB drug should be avoided in reduced kidney function?
ethambutol
114
what is an adverse effect of ethambutol?
visual impairment
115
which scoring system is used for sleep apnoea?
Epworth sleepiness scale:
| >10 refer
116
what are problems with CPAP in obstructive sleep apnoea?
disturbance to partner
rhinitis/ nasal irritation
claustrophobic
117
what is the most effective medication for people looking to stop smoking?
varenicline (champix)
118
when is veranicline contraindicated?
pregnancy/ BF
| kidney problems
119
What drug can be used when veranicline is contraindicated?
bupropion
120
who is buproprion contraindicated in?
pregnant/ BF
epilepsy
bipolar/ eating disorders
