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Finals - Abi Houghton > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the most common causative organism in an infective exacerbation of COPD?

A

Haemophilus influenzae

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2
Q

Name 3 organisms which commonly cause infective exacerbations of COPD.

A

Haemophilus influenzae (most common)
Strep pneumoniae
Moraxella catarrhalis

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3
Q

Name the diagnostic investigation for occupational asthma.

A

Serial peak flow measurements at work and at home

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4
Q

In COPD, what is the main benefit of inhaled corticosteroids?

A

Reduced frequency of exacerbations

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5
Q

What is first line medical treatment in COPD?

A

Bronchodilator, one of:

  • short acting beta agaonist, e.g. salbutamol
  • short acting muscarinic antagonist, e.g. ipratropium
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6
Q

Outline the medical management in COPD.

A
  1. Bronchodilator - salbutamol OR salmeterol
  2. If still breathless but no asthmatic features/no features suggesting steroid responsiveness:
    - add long-acting beta agonist, e.g. salmeterol + long-acting muscarinic antagonist, e.g. tiotropium
  3. If breathless after SABA/SAMA and asthmatic features/features suggesting steroid responsiveness:
    - add long-acting beta agonist + inhaled corticosteroid, e.g. beclomethasone
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7
Q

If a patient with COPD is developing signs of Cor Pulmonale, what treatment should be added?

A

Loop diuretic (for oedema)

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8
Q

Outline the medical management of asthma.

A
  1. Short-acting beta agonist, e.g. salbutamol
  2. SABA + inhaled corticosteroid, e.g. beclomethasone
  3. SABA + ICS + leukotriene receptor antagonist, e.g. montelukast
  4. SABA + ICS + long-acting beta agonist, e.g. salmeterol
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9
Q

What is acute respiratory distress syndrome (ARDS)?

A

Increased permeability of the alveolar capillaries leading to fluid accumulation in the alveoli
(non-cardiogenic pulmonary oedema)

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10
Q

Name 6 causes of ARDS (acute respiratory distress syndrome).

A 
Infection: sepsis
Massive blood transfusion
Trauma
Smoke inhalation
Acute pancreatitis
Cardio-pulmonary bypass
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11
Q

Give 4 clinical features of ARDS (acute respiratory distress syndrome).

A

Dyspnoea
Elevated respiratory rate
Bilateral lung crackles
Low O2 saturations

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12
Q

Give 2 key investigations (and findings) of ARDS?

A

CXR - bilateral alveolar shadowing

ABG

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13
Q

What is an empyema?

A

A pus-filled pocket that most commonly develops in the pleural space.

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14
Q

What is the difference between transudate and exudate?

A

Light’s criteria

  • Transudates have protein level <30g/L
  • Exudates have protein level >30g/L
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15
Q

How is a pleural effusion managed?

A

Diagnostic tap and diagnostic aspiration

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16
Q

When is long-term oxygen therapy given for a patient with COPD?

A 
pO2 <7.3, OR
pO2 7.3 - 8 + 1 of:
 - secondary polycythaemia
 - peripheral oedema
 - pulmonary hypertension
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17
Q

What are target O2 saturations in an acutely unwell patient?

A

94-98%

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18
Q

What are target O2 saturations in a patient with COPD?

A

88-92%

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19
Q

What is FEV1?

A

The volume of air exhaled at the end of the 1st second of forced expiration

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20
Q

What is FVC?

A

Maximum volume of air a person can exhale after maximum inhalation, given as much time as they require.

21
Q

What is the FEV1/FVC of normal healthy lungs?

A

70-80%

22
Q

What is thoracic kyphosis?

A

A restrictive chest wall disease –> high FEV1 (air can leave quickly) and low FVC (not much air can enter as chest can’t expand)
–> FEV1/FVC is high, 85%

23
Q

What is Lambert Eaton syndrome?

A

Weakness in proximal muscle of arms and legs (legs worse affected).
A paraneoplastic feature of small cell lung cancer

24
Q

When are pulmonary rehabilitation classes indicated in a patient with COPD?

A

When patients start getting short of breath during regular activities, e.g. walking to the shops

25
Q

What is the CURB-65 score?

A

Measure of pneumonia severity to estimate mortality.

Confusion
Urea
Resp rate
Blood pressure
Age >65
26
Q

Name 3 common differentials for post-op SOB.

A

Atelectasis
PE
Pneumonia

27
Q

What is atelectasis?

A

A common post-op complication in which basal alveolar collapse results in difficulty breathing.
It is caused by airways becoming obstructed by respiratory secretions

28
Q

What is the management of a primary pneumothorax?

A

If rim of air <2cm and no SOB then discharge

Otherwise aspiration

29
Q

What is the management of a secondary pneumothorax?

A

If rim of air <1cm and no SOB then admit and observe for 24hrs
If rim of air 1 - 2cm and no SOB then aspirate
If rim of air >2cm or SOB then chest drain

30
Q

What is pulmonary capillary wedge pressure a measure of?

A

Left atrial pressure (ARDS cannot be diagnosed if it is raised)

31
Q

What is transfusion-related lung injury?

A

ARDS which occurs within 6hrs of transfusion

32
Q

Give 4 features which suggest steroid-responsiveness in a patient with COPD.

A

Dx of asthma/atopy
Higher blood eosinophil count
Substantial variation in FEV1 over time (>400ml)
Substantial diurnal variation in peak expiratory flow (>20%)

33
Q

What is the causative organism of TB?

A

Mycobacterium tuberculosis

34
Q

What is a Ghon focus?

A

A small lung lesion that develops during primary infection of TB. It is composed of tubercle-laden macrophages

35
Q

What is a Ghon complex?

A

The combination of Ghon focus and hilar lymph nodes

36
Q

Erythema nodosum, non-productive cough, arthralgia and bilateral hilar lymphadenopathy are indicative of what condition?

A

Sarcoidosis

37
Q

What is sarcoidosis?

A

Abnormal collections of inflammatory cells that form granulomas. Commonly begins in the lungs, skin or lymph nodes.

38
Q

What is the management of atelectasis?

A

Chest physiotherapy with mobilisation and breathing exercises

39
Q

Which antibiotics might be given in an acute exacerbation of COPD?

A

Amoxicillin, tetracycline, or clarithromycin

40
Q

Which antibiotics are given in an exacerbation of chronic bronchitis?

A

Amoxicillin, tetracycline or clarithromycin

41
Q

Which antibiotic is given in an uncomplicated CAP?

A

Amoxicillin

42
Q

Which antibiotic is given in pneumonia which is likely caused by atypical pathogens?

A

Clarithromycin

43
Q

Which antibiotic is given in a HAP?

A

<5 days since admission = co-amoxiclav or cefuroxime

>5 days since admission = piperacillin with tazobactam OR b-s cephalosporin (ceftazidime) OR quinolone (ciprofloxacin)

44
Q

What would the blood gas findings be during a panic attack?

A

Hyperventilation –> respiratory alkalosis (blows off CO2, O2 normal, no metabolic compensation because short-lived)

45
Q

Patient with CF and developed a HAP.
Ground glass attenuation seen on CT scan.
What is the causative organism?

A

Pseudomonas aeruginosa

46
Q

Alcoholic / diabetic patient with cavitating pneumonia seen in the upper lobes on CXR.
Red-current jelly sputum
What is the causative organism?

A

Klebsiella pneumoniae

47
Q

Patient has flu-like symptoms (headache, arthralgia, myalgia) followed by a dry cough.
CXR shows patchy consolidation in one lower lobe.
What is the causative organism?

A

Mycoplasma pneumoniae

48
Q

A patient has flu-like symptoms, along with extra-pulmonary symptoms such as hepatitis, D & V. Bi-basal consolidation is seen on CXR.
What is the causative organism?

A

Legionella pneumophillia

Finals - Abi Houghton (17 decks)

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