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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
Treatment for goodpasture's?
Plasma exchange and corticosteroids
26
What antibody is associated with Wegener's granulomatosis?
cANCA (90%)
27
A patient with penumonia and a past history of COPD, what is the most likely organism?
Haemophilus influenzae
28
Causes of respiratory alkalosis
``` PE Hyperventilation Altitude Pregnancy CNS disorders e.g. stroke ```
29
Causes of respiratory acidosis
COPD Life threatneing asthma opiate overdose
30
What is the paraneoplastic syndorme associated with non-small cell lung carcinoma?
Hypercalcaemia due to incresased parathyroid hormone
31
What is beclometasone dipropionate?
Inhaled corticosteroid
32
Side effect of inhaled corticosteroid?
Growth retardation in children, oral candidiasis
33
First line treatment for COPD?
SABA or SAMA
34
2nd line treatment for COPD if there are no asthmatic features?
Add a LABA and a LAMA
35
2nd line treatment for COPD if there ARE asthmatic features?
Add a LABA and an ICS
36
What is added to a SABA in asthmatics poorly controlled?
Low dose ICS
37
3rd step in asthma control?
(SABA + low dose ICS) + LTRA
38
Small cell lung carcinoma is associated with what paraneoplastic syndrome?
Hyponatraemia secondary to ADH secretion
39
Describe the features of klebsiella pneumonia?
Upper lobes | more common in alcoholics and diabetics
40
Red currant jelly sputum indicates?
Klebsiella pneumonia
41
Pneumonia following flu is most likely caused by?
staph aureus
42
Which part of the lung is affected in sarcoidosis?
Upper lobes
43
Blood gas in life threatening asthma?
Alkalosis
44
What causes fibrosis of the upper lobes?
``` Coal worker's pneumoconiosis Histiocyotis Radiation Tuberculosis Silicosis ```
45
What causes fibrosis of the lower lobes?
Idiopathic pulmomary fibrosis SLE asbestosis
46
Which lung cancer causes cushing's syndrome?
Small cell lung cancer
47
Blood abnormality in sarcoidosis?
Hypercalacaemia
48
How is asthma diagnosed in adults?
Fractional exhaled Nitric Oxide (FENO) testing
49
primary pneumothorax,rim of air is < 2cm and the patient is not short of breath.. treatment?
Discharge
50
Primary pneumothorax >2cm and symptomatic, treatment?
aspiration, followed by chest drain f that doesn't work
51
prevention of pneumothorax?
Stop smoking
52
1st line treatment of secondary pneumothorax in a patient >50 and an air rim >2cm?
chest drain, not aspiration
53
What features of an aspirate make you think empyema?
pH <7.2, low glucose, high LDH (lactate dehydrogenase)
54
What features in COPD suggest a patient may have good response to steroids?
Asthmatic features
55
What are the asthmatic features which suggest a patient with COPD will have a good response to steroids?
Previous asthma HIgh eosinophils in blood Dirunal variation
56
How is idiopathic pulmonary fibrosis diagnosed?
High resolution CT scan
57
What is the scoring system to assess severity of pneumonia?
CURB 65
58
What are the features of a CURB 65 assessment?
``` Confusion Urea > 7mmol Resp rate >30 Blood pressure <90/60 65 - Age 65+ ```
59
If the CURB 65 score is 0-1 how is a patient managed?
Home antibiotics
60
If the CURB 65 score is 2 how is a patient managed?
Consider hospital admission
61
If the CURB 65 score is 3 how is a patient managed?
Consider intensice care assessment
62
What is 1st line treatment for moderate-high severity pneumonia?
Amoxicillin + macrolide, 7-10 day course
63
Treatment of secondary pneumothorax <2cm?
Aspiration
64
Treatment of secondary pneumothorax <1cm?
Admit on oxygen
65
Treatment for sleep apnoea?
Overnight CPAP
66
Waht conditions give a RAISED TLCO? (Total lung CO carrying)
Asthma | Left to right cardiac shunt
67
COPD symptoms in a young non smoker may point to a diagnosis of...
Alpha-1 antitrypsin deficiency
68
Causes of exudative pleural effusion? (high protein)
``` pneumonia connective dissue disease cancer TB Pancreatitis ```
69
Causes of transudative pleural effusion?
Heart failure Hypoalbuminaemia Hypothyroidism
70
Features of Kartagener's syndrome/primary ciliary dyskinesia
Bronchiectasis Subfertility in males Dextrocardia Recurrent sinusitis
71
Asthmatics not well controlled on salbutamol and inhaled corticosteroid. What should be added?
LTRA
72
Exudate vs transudate?
Exudate exudes PROTEIN. Effusion fluid protein/serum protein ratio >0.5
73
What are indications for steroids in sarcoidosis?
hypercalcaemia | eye, heart or neuro involvement
74
Paraneoplastic syndromes caused by Small Cell Lung cancer?
SiADH - hyponatraemia ACTH - Cushing's Lambert eaton syndrome
75
Paraneoplastic syndromes caused by Squamous cell cancer?
Hypercalcaemia | Hyperthyroidism
76
Name a respiratory complication seen in acute pancreatitis?
Acute Respirastory Distress Syndrome
77
Causes of acute respiratory distress syndrome?
Sepsis Massive Blood transfusion Trauma
78
What is given in an acute severe asthma attack not responding to o2,salbutamol, ipratropium bromide inhaler and IV hydrocortisone?
Magnesium sulphate
79
Name drugs linked to pulmonary fibrosis
``` Amiodarone bleomycin Cyclophosphamide Nitrofurantoin methotrexate penicillamine ```
80
Anxiety induced hyperventilation would show wha ton blood gas
Resp alkalosis, low CO2, normal O2
81
Describe the features of klebsiella?
Upper lobes, history of alcoholism or diabetes | red currant jelly sputum

Phase 3b/finals (19 decks)

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