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Y4S2 Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What pCO2 is incompatible with life?

A

80 mmHg (normal 35-45 mmHg)

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2
Q

What is glycopyrrolate?

A

Antimuscarinic (bronchodilator)

Used for COPD

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3
Q

What are the stages of pneumonia?

A
  1. Congestion
  2. Red hepatisation
  3. Grey hepatisation
  4. Resolution
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4
Q

What are the 4 Ts of a mediastinal mass

A

Thymoma

Teratoma (and other germ cell tumors )

Thyroid neoplasm

Terrible lymphoma

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5
Q

What causes an increased residual volume in COPD?

A

Reduced alveoli recoil

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6
Q

How does hyperinflation help preserve maximal expiratory airflow in COPD?

A

Pressures generated by elastic recoil increase

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7
Q

At which oxygen saturation do patients become centrally cyanosed?

A

≤85 percent

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8
Q

Name a SAMA

A

Ipratropium

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9
Q

Name a LAMA

A

Tiotropium

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10
Q

What is theophylline?

A

A methylxanthine

Inhibits metabolism of cAMP by phosphodiesterases

cAMP stimulates B-adrenoceptors, causing bronchoconstriction

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11
Q

What FEV1/FVC is diagnostic for COPD?

A

< 0.7

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12
Q

How does CO diffusing capacity help differentiate emphysema and chronic bronchitis?

A

Decreased CO diffusing capacity suggests emphysema

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13
Q

What is alpha-1-antitrypsin?

A

Inhibitor of the proteolytic enzyme elastase

ATT protects against the proteolytic degradation of elastin

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14
Q

What is the most common cause of SVC syndrome?

A

Lung cancer

  • Compression of the SVC reduces venous return to the right atrium*
  • Feeling of fullness in the head, dyspnoea, oedema of the upper extremities and face*
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15
Q

How is acute pulmonary oedema managed?

A

LMNOP

Loop diuretic/lasix

Morphine

Nitroglycerin

Oxygen

Position/prop up the patient

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16
Q

What is the definition of pulmonary hypertension?

A

mPAP > 25 mmHg (normal 10-14 mmHg)

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17
Q

What is the definition of cor pulmonale?

A

Altered structure (hypertrophy/dilation) or function of the right ventricle due to pulmonary hypertension from a primary disorder of the respiratory or pulmonary artery system

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18
Q

How does COPD cause cor pulmonale?

A

Hypoxia → pulmonary vasoconstriction → increased pulmonary vascular resistance → cor pulmonale

(RV has to push against a higher resistance)

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19
Q

What does bronchial breathing suggest?

A

Consolidation

Sounds from the bronchi are able to be transmitted to the lung fields

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20
Q

What do bronchial breath sounds sound like?

A

Equal duration of inspiration and expiration (expiration usually 1/3 of the time)

Gap between the two phases

Tubular, hollow sound

Normally heard over the trachea

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21
Q

What are the two types of respiratory failure?

A
  1. Hypoxaemic (low PaO2)
    * V/Q mismatch, high altitude, hypoventilation, poor diffusion*
  2. Hypercapnic (high PaCO2 and low PaO2)
    * Airway resistance, neuromuscular disorders, reduced respiratory effort*
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22
Q

What does a monophonic wheeze suggest?

A

Obstruction of large airways e.g. tumour, foreign body

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23
Q

What are the 5 mechanisms of hypoxaemia?

A
  1. Hypoventilation
  2. V/Q mismatch
  3. Right to left shunt
  4. Diffusion limiting
  5. Reduced inspired oxygen tension
24
Q

What is V/Q mismatch?

A

An imbalance between blood flow and ventilation

25
Q

What happens if you over-oxygenate someone with COPD?

A

Excess O2 inhibits peripheral chemoreceptors, decreasing their respiratory drive

26
Q

Which 4 drugs can be used for TB?

A

Rifampicin

Isoniazid

Pyrazinamide

Ethambutol

RIPE

27
Q

How do you differentiate a stridor from a wheeze?

A

Wheezes are musical

28
Q

Where is the obstruction in an inspiratory stridor?

A

Above the glottis

  • Negative pressure with inspiration further narrows the airway, causing stridor*
  • Expiratory = below the thoracic inlet*
29
Q

Where is the obstruction in an expiratory stridor?

A

Lower airways below the thoracic inlet

Inspiratory = above the glottis

30
Q

Where is the obstruction in a biphasic stridor?

A

Subglottal/glottic down to the tracheal ring

31
Q

What does stony dullness on percussion of the lungs suggest?

A

Pleural effusion

32
Q

Where is the obstruction in an inspiratory stridor?

A

Laryngeal/supraglottic

33
Q

Where is the obstruction in an expiratory stridor?

A

Tracheobronchial - below the thoracic inlet

34
Q

Which lung volume equates the volume of air that can still be breathed in after normal inspiration?

A

Inspiratory reserve volume (IRV)

35
Q

Which lung volume equates the volume of air that moves into the lungs with each quiet inspiration?

A

Tidal volume (TV)

36
Q

Which lung volume equates to the volume of air that can still be breathed out after normal expiration?

A

Expiratory reserve volume (ERV)

37
Q

Which lung volume equates to the volume of air that remains in the lung after maximal expiration?

A

Residual volume (RV)

38
Q

Which lung volume cannot be measured on spirometry?

A

Residual volume

39
Q

What is functional vital capacity (FVC)?

A

The maximum volume of air that can be expired after a maximal inspiration

40
Q

What does the A-a gradient reflect?

A

The integrity of oxygen diffusion across the alveolar and pulmonary arterial membranes

PAO2 - PaO2

Useful for determining the cause of hypoxemia. E.g. at high altitudes the A-a gradient will be normal because the alveolar oxygen concentration is low

A = alveolar

a = arterial

41
Q

What is the PERC criteria?

A

Pulmonary Embolism Rule Out Criteria

42
Q

What is this?

A

Westermark sign

Peripheral lucency due to a hypoperfused area secondary to PE

43
Q

What is this?

A

Hampton hump

Secondary to PE/pulmonary infarction

44
Q

What is the most specific sign of PE on ECG?

A

V1 + V3 T wave inversion

45
Q

What is a massive PE?

A

PE with haemodynamic instability

46
Q

What is a submassive PE?

A

Haemodynamically stable PE with right ventricular strain

47
Q

Which tools can be used to decide whether a patient with pneumonia should be admitted to hospital?

A

CRB-65

CURB-65

48
Q

Which tools can be used to identify patients with pneumonia who are at a higher risk of death or requiring intensive care support?

A

SMART-COP

CORB

49
Q

How is a CURB-65 score calculated?

50
Q

How is a CORB score calculated?

51
Q

How is a SMART-COP score calculated?

52
Q

How is mild CAP empirically treated?

A

Oral amoxycillin OR doxycycline

Outpatient

53
Q

How is moderate CAP empirically treated?

A

IV benzylpenicillin PLUS oral doxycycline

Inpatient

54
Q

How is severe CAP empirically treated?

A

IV benzylpenicillin + IV gentamicin + IV azithromycin (HNE)

OR

IV ceftriaxone/cefotaxime + IV azithromycin (eTG)

55
Q

What is the difference between a transudative and an exudative pleural effusion?

A

Transudative

Permeation of fluid through walls of intact pulmonary vessels

Low protein (<50% of serum) and cell count

  • Increased hydrostatic pressure (CHF)
  • Decreased oncotic pressure

Exudative

Exudation of fluid through lesions in blood and lymph

Cloudy fluid with a high protein (> 50% of serum) and cell count

Pneumonia, tuberculosis

Malignancy

Pleural empyema

Pulmonary embolism

Vasculitis

Y4S2 Medicine (18 decks)

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