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Phase 3b/finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are blue bloaters and pink puffers?

A

Blue bloater = Chronic bronchitis

Pink puffer = emphysema

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2
Q

What pattern would you see on spirometry in airways obstruction?

A

reduced FEV1, reduced FEV1:FVC ratio

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3
Q

What would you see on spirometry in airways restriction?

A

Reduced FEV1 and FVC

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4
Q

What signs might you see on CXR in a patient with COPD/emphysema?

A

hyperinflation of lungs
prominant hilar vascular shadow
darker/blacker lung fields

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5
Q

What is silent chest?

A

Sign of a life threatening asthma attack, patient can not exhale

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6
Q

What medicaiton is contraindicated in asthma?

A

Beta blockers

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7
Q

What test to distinguish asthma and COPD?

A

Reversibility testing

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8
Q

Describe reversibility testing

A

if there is an increase of 400ml in FEV1 with 4-8 weeks of an inhaler than asthma is likely

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9
Q

What to do if a low dose ICS is not sufficiently managing the asthma?

A

Add long acting beta agonist

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10
Q

If the LABA and inhaled steroid is insufficient what is the next step?

A

Increase dose of LABA if some effect is seen

Stop LABA and increase ICS if no effect from LABA is seen

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11
Q

Signs of a “life threatening” asthma attack

A

silent chest
sats < 92
altered consciousness

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12
Q

Sign of a “severe” asthma attack?

A

Inability to complete full sentences

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13
Q

What is the immediate management of an asthma attack?

A

Oxygen
Salbutamol
Prednisolone

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14
Q

Describe what happens to the airway in bronchiectasis?

A

Widened airway lumen
Thick airway wall
Increased mucous

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15
Q

What radiological signs appear in bronchiectasis?

A

tram track appearance on CXR

Signet ring apearance on CT

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16
Q

What organism causes exacerbations in CF bronchiectasis?

A

pseudomonas

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17
Q

Antibiotic against pseudomonas?

A

Macrolide e.g. erythromycin

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18
Q

How is CF diagnosed?

A

Sweat test

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19
Q

Blood test result in sarcoidosis

A

Increased ACE

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20
Q

What is the gold satandard investigation for sarcoidosis?

A

biopsy of lung tissue/skin/swollen lymph nodes

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21
Q

What is seen on CT in idiopathic pulmonary fibrosis?

A

Honeycombing

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22
Q

What medication is used to slow the progression of idiopathic lung disease?

A

Perfenidone

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23
Q

What is affected in goodpasture’s syndrome?

A

Lungs & kidneys: haemoptysis and haematuria

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24
Q

What antibody is responsible for goodpasture’s syndrome?

A

Anti GBM (glomerular basement membrane)

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25
Q

Treatment for goodpasture’s?

A

Plasma exchange and corticosteroids

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26
Q

What antibody is associated with Wegener’s granulomatosis?

A

cANCA (90%)

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27
Q

A patient with penumonia and a past history of COPD, what is the most likely organism?

A

Haemophilus influenzae

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28
Q

Causes of respiratory alkalosis

A 
PE
Hyperventilation
Altitude 
Pregnancy
CNS disorders e.g. stroke
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29
Q

Causes of respiratory acidosis

A

COPD
Life threatneing asthma
opiate overdose

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30
Q

What is the paraneoplastic syndorme associated with non-small cell lung carcinoma?

A

Hypercalcaemia due to incresased parathyroid hormone

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31
Q

What is beclometasone dipropionate?

A

Inhaled corticosteroid

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32
Q

Side effect of inhaled corticosteroid?

A

Growth retardation in children, oral candidiasis

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33
Q

First line treatment for COPD?

A

SABA or SAMA

34
Q

2nd line treatment for COPD if there are no asthmatic features?

A

Add a LABA and a LAMA

35
Q

2nd line treatment for COPD if there ARE asthmatic features?

A

Add a LABA and an ICS

36
Q

What is added to a SABA in asthmatics poorly controlled?

A

Low dose ICS

37
Q

3rd step in asthma control?

A

(SABA + low dose ICS) + LTRA

38
Q

Small cell lung carcinoma is associated with what paraneoplastic syndrome?

A

Hyponatraemia secondary to ADH secretion

39
Q

Describe the features of klebsiella pneumonia?

A

Upper lobes

more common in alcoholics and diabetics

40
Q

Red currant jelly sputum indicates?

A

Klebsiella pneumonia

41
Q

Pneumonia following flu is most likely caused by?

A

staph aureus

42
Q

Which part of the lung is affected in sarcoidosis?

A

Upper lobes

43
Q

Blood gas in life threatening asthma?

A

Alkalosis

44
Q

What causes fibrosis of the upper lobes?

A 
Coal worker's pneumoconiosis
Histiocyotis
Radiation
Tuberculosis
Silicosis
45
Q

What causes fibrosis of the lower lobes?

A

Idiopathic pulmomary fibrosis
SLE
asbestosis

46
Q

Which lung cancer causes cushing’s syndrome?

A

Small cell lung cancer

47
Q

Blood abnormality in sarcoidosis?

A

Hypercalacaemia

48
Q

How is asthma diagnosed in adults?

A

Fractional exhaled Nitric Oxide (FENO) testing

49
Q

primary pneumothorax,rim of air is < 2cm and the patient is not short of breath.. treatment?

A

Discharge

50
Q

Primary pneumothorax >2cm and symptomatic, treatment?

A

aspiration, followed by chest drain f that doesn’t work

51
Q

prevention of pneumothorax?

A

Stop smoking

52
Q

1st line treatment of secondary pneumothorax in a patient >50 and an air rim >2cm?

A

chest drain, not aspiration

53
Q

What features of an aspirate make you think empyema?

A

pH <7.2, low glucose, high LDH (lactate dehydrogenase)

54
Q

What features in COPD suggest a patient may have good response to steroids?

A

Asthmatic features

55
Q

What are the asthmatic features which suggest a patient with COPD will have a good response to steroids?

A

Previous asthma
HIgh eosinophils in blood
Dirunal variation

56
Q

How is idiopathic pulmonary fibrosis diagnosed?

A

High resolution CT scan

57
Q

What is the scoring system to assess severity of pneumonia?

A

CURB 65

58
Q

What are the features of a CURB 65 assessment?

A 
Confusion
Urea > 7mmol
Resp rate >30
Blood pressure <90/60
65 - Age 65+
59
Q

If the CURB 65 score is 0-1 how is a patient managed?

A

Home antibiotics

60
Q

If the CURB 65 score is 2 how is a patient managed?

A

Consider hospital admission

61
Q

If the CURB 65 score is 3 how is a patient managed?

A

Consider intensice care assessment

62
Q

What is 1st line treatment for moderate-high severity pneumonia?

A

Amoxicillin + macrolide, 7-10 day course

63
Q

Treatment of secondary pneumothorax <2cm?

A

Aspiration

64
Q

Treatment of secondary pneumothorax <1cm?

A

Admit on oxygen

65
Q

Treatment for sleep apnoea?

A

Overnight CPAP

66
Q

Waht conditions give a RAISED TLCO? (Total lung CO carrying)

A

Asthma

Left to right cardiac shunt

67
Q

COPD symptoms in a young non smoker may point to a diagnosis of…

A

Alpha-1 antitrypsin deficiency

68
Q

Causes of exudative pleural effusion? (high protein)

A 
pneumonia
connective dissue disease
cancer
TB
Pancreatitis
69
Q

Causes of transudative pleural effusion?

A

Heart failure
Hypoalbuminaemia
Hypothyroidism

70
Q

Features of Kartagener’s syndrome/primary ciliary dyskinesia

A

Bronchiectasis
Subfertility in males
Dextrocardia
Recurrent sinusitis

71
Q

Asthmatics not well controlled on salbutamol and inhaled corticosteroid. What should be added?

A

LTRA

72
Q

Exudate vs transudate?

A

Exudate exudes PROTEIN. Effusion fluid protein/serum protein ratio >0.5

73
Q

What are indications for steroids in sarcoidosis?

A

hypercalcaemia

eye, heart or neuro involvement

74
Q

Paraneoplastic syndromes caused by Small Cell Lung cancer?

A

SiADH - hyponatraemia
ACTH - Cushing’s
Lambert eaton syndrome

75
Q

Paraneoplastic syndromes caused by Squamous cell cancer?

A

Hypercalcaemia

Hyperthyroidism

76
Q

Name a respiratory complication seen in acute pancreatitis?

A

Acute Respirastory Distress Syndrome

77
Q

Causes of acute respiratory distress syndrome?

A

Sepsis
Massive Blood transfusion
Trauma

78
Q

What is given in an acute severe asthma attack not responding to o2,salbutamol, ipratropium bromide inhaler and IV hydrocortisone?

A

Magnesium sulphate

79
Q

Name drugs linked to pulmonary fibrosis

A 
Amiodarone
bleomycin
Cyclophosphamide
Nitrofurantoin
methotrexate
penicillamine
80
Q

Anxiety induced hyperventilation would show wha ton blood gas

A

Resp alkalosis, low CO2, normal O2

81
Q

Describe the features of klebsiella?

A

Upper lobes, history of alcoholism or diabetes

red currant jelly sputum

Phase 3b/finals (19 decks)

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