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RACGP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Causes of chronic cough

A 
A. adult and children
     1. Pertussis (whooping cough)
     2. Asthma
     2. Active/passive smoker
     3. GORD
     4. OSA
     5. TB
B. Adults
     1. ACEIs
     2. post nasal drip / chronic sinusitis
     3. COPD
     4. chronic bronchitis
     5. lung cancer
     6. Bronchiectasis
     7. Sarcoidosis
     8. interstitial lung disease
C. Children
     1. post-viral cough
     2. habitual / Psychogenic cough
     3. cystic fibrosis
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2
Q

History of chronic cough (8)

A
  1. exposure contact with pertussis/contact with animals
  2. Pertussis immunisation
  3. history of asthma
  4. occupational/environmental exposure
  5. drug history
  6. smoking history
  7. sweating/fever/ weight loss
  8. recent travel
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3
Q

Pertussis investigation

A

< 4 weeks –> NPS for pertussis PCR and culture

> 4 weeks –> Pertussis serology

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4
Q

bronchiectasis - Why ATSI (5)

A

Living in overcrowded house
Lack of access to antibiotics for infection
Poor compliance with antibiotic treatment
Low immunisation rate
High rate of exposure to smoke

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5
Q

Bronchiectasis- C/F and Ix

A

cough with ++++ sputum
> 2 consecutive years

HRCT

  • bronchial wall thickening
  • diatled bronchiols = lack of tapering = Signet (ring) sign
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6
Q

Bronchiectasis- management (7)

A
  1. Early recognition and treatment of exacerbation with antibiotic
  2. Routine immunisation (influenza/pneumonia)
  3. avoid exposure to patient of respiratory infection
  4. Pulmonary rehabilitation for mucus clearance by chest physiotherapist
  5. Regular exercise 30 min per day
  6. Annual follow up
  7. Smoking cessation if smoker
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7
Q

DDx of acute cough in adult (7)

A
  1. asthma
  2. viral URTI
  3. pertussis
  4. acute bronchitis
  5. atypical pneumonia / Mycoplasma/Leoginella/ Chlamydia
  6. post nasal drip/acute rhino-sinusitis.
  7. Psittacosis (working with animals/Pets)
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8
Q

DDx of acute cough in children (6)

A
  1. asthma
  2. Upper RTI
  3. pertussis
  4. croup
  5. foreign body inhalation
  6. pneumonia / atypical
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9
Q

most common causes of atypical pneumonia

dy cough >5 days, Headache, Bilateral chest finding

A
  1. mycoplasma (most common)
  2. legionella (confusion/diarrhea/pneumonia)
  3. Chlamydia
  4. Psittacosis (Pet shop /birds)
  5. Q fever (Farm/animals)
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10
Q

DDX chronic cough in adults

A 
Asthma
Smoking / passive smoker
GORD
OSA
Pertussis / check pertussis immunisation history
TB
COPD
Chronic sinusitis
Chronic bronchitis
ACEIs induce asthma
Lung cancer
Bronchiectasis
Sarcoidosis
Interstitial lung disease
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11
Q

DDx chronic cough in children

A 
Asthma
Smoking / passive smoker
GORD
OSA
Pertussis / check pertussis immunisation history
TB
Post viral cough
Habitual / psychogenic cough 
Cystic fibrosis
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12
Q

interstitial lung disease - sarcoidosis

A

Bilateral hilar LAP masses
No clubbing of fingers

Treatment

  • Self limiting
  • If SOB: Prednisolone 50mg Po daily for 4 weeks
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13
Q

Lung cavitation DDx (6)

A
  • Bronchogenic Ca / Pancost tumor
  • TB (tuberculosis)
  • Fungal infection/pneumonia
  • Lung abscess
  • Sarcoidosis
  • Lymphoma
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14
Q

Risk factors for pneumonia (9)

A
  1. Age > 65
  2. Smoking history
  3. Alcohol consumption
  4. malnutrition
  5. Lack of pneumococcal /influenza vaccination
  6. Viral URTI
  7. Living in overcrowded environment
  8. Undiagnosed medical condition - COPD/lung cancer
  9. Recurrent aspiration
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15
Q

Pneumonia - assessment

A

SMART-COP

SPO2<90
Multiple lobe pneumonia
Albumin < 35
RR
    < 50y → > 25
    > 50y → > 30
Tachycardia > 125
Confusion
O2 
     < 50y → SPO2 < 93%
      > 50y → SPO2 < 90%
Ph < 7.35
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16
Q

Pneumonia - treatment

A 
A. LOW severity CAP
1. no allergy: 
   Amoxicillin Po 1g TDS for 7/7, if no improvement after 
   48 hr, add
   Doxycycline PO 100mg BD 7/7
2. mild allergy
   Cefuroxime PO 500mg 
   Clarithromycin 500g BD 
3. Severe allergy
    Moxifloxacin PO 400mg daily
B. moderate severity CAP
1. no allergy:
    Benzylpenicillin 1.2g IV QID
    \+
    Doxycycline PO100mg BD
2. mild allergy
   Ceftriaxone 1g IV daily
3. Severe allergy
    Moxifloxacin PO 400mg daily
severe CAP
1. no allergy: 
    Ceftriaxone 2g IV daily
    \+
    Azithromycin 500mg IV daily
2. mild allergy
    Moxifloxacin IV 400mg daily
17
Q

Pleural effusion - causes

A

A. Transudate - systemic

 1. Heart failure
 2. Liver failure
 3. Renal failure
 4. hypo-proteinaemia
 5. Hypothyroidism
 6. Ovarian  tumor (R sided pleural effusion) - Meigs syndrome

B. Exudate

 1. Infection: pneumonia, empyema, TB
 2. Malignancy: Lung cancer, mesothelioma,      metastasis
 3. Connective tissue diseases: SLE
 4. Lymphoma
 5. Sarcoidosis
18
Q

Sarcoidosis (ILD) - examination finding (8 except 1)

A 
Erythema nodosum
Polyarthralgia
LAP
Splenic enlargement
Hepatomegaly
Parotid gland swelling
Heart failure
Uveitis

NO Clubbing

19
Q

restrictive lung disease DDX (8)

A 
idiopathic pulmonary fibrosis
sarcoidosis
hypersensitivity pneumonitis
coal worker pneumoconiosis
lymphatic interstitial pneumonitis
asbestosis
obesity
eosinophilic pneumonia
20
Q

interstitial lung disease- Investigation

A

spirometry
CXray
HRCT

21
Q

interstitial lung disease- C/F

A

dry cough
exertional dyspnea
clubbing except in sarcoidosis

22
Q

interstitial lung disease- Management

A

Prednisolone 50mg Po daily for 4 weeks

23
Q

interstitial lung disease- Examination finding

A 
fine crepitation
hypoxia on exercise
pulmonary hypertension and R side heart failure
- peripheral oedema
- raised JVP
24
Q

ILD- Dx

A
  1. Idiopathic pulmonary fibrosis - most common in elderly
  2. Sarcoidosis - most common in young
    Multisystemic disease
    non-caseating granuloma
    (note: TB is a caseating granuloma)
  3. Hypersensitive pneumonitis
  4. Connective tissue disease ILD
    SLE / RA / Scleroderma / Mixed connective tissue
    disease
  5. Occupational ILD
    a. Coal worker pneumoconiosis
    b. asbestosis
    c. Silicosis
  6. obesity
25
Q

Bronchiectasis - oral antibiotics

A

if change is sputum volume or colour, start immediately

  • Amoxycillin 500mg PO TDS for 14 days
  • if allergy: doxycycline 200mg STAT then 100mg daily for 14 days
26
Q

Pneumothorax

A
  • Less than 2 cm & pt stable–> home management
  • > 2 cm OR pt unstable–> refere to hospital

Pt stability

  • no SOB
  • full sentence
  • HR < 120
  • RR < 24
  • normal BP

RACGP (19 decks)

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