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Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is asthma?

A

Chronic inflammatory airway disorder

Characterised by recurrent episodes of SOB, cough, wheeze and chest tightness

Due to reversible airway obstruction

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2
Q

What are the 3 factors that contribute to airway obstruction in asthma?

A
  1. Bronchial muscle contraction
  2. Increased mucous secretion
  3. Mucosal swelling/ inflammation
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3
Q

What are the possible SYMPTOMS of asthma?

A
  1. SOB/ dyspnoea
  2. Cough
  3. Wheeze
  4. Chest tightness
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4
Q

Give 3 or more possible SIGNS of asthma on examination.

A
  1. Tachycardia
  2. Tachypnoea
  3. Reduced air entry
  4. Widespread polyphonic wheeze
  5. Chest hyperinflation
  6. Hyper-resonant percussion
  7. Accessory muscle use
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5
Q

Which drug is used initially to treat newly diagnosed asthma?

SAMA
SABA
ICS

A

SABA eg. Salbutamol/ Terbutaline

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6
Q

Which drug is used 2nd after SABAs in the treatment of chronic asthma?

LTRA
ICS
SAMA

A

ICS eg. Beclametosone/ Budesonide/ Fluticasone

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7
Q

Which drug is used 3rd after using SABAs and ICS in the treatment of chronic asthma?

LTRA
MART (LABA and ICS)
SAMA

A

LRTA eg. oral Monteleukast

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8
Q

Which drugs are given initially in the treatment of acute severe or life threatening asthma?

A
  1. Oxygen- aim sats 94-98%
  2. Salbutamol nebuliser (5mg with oxygen)
  3. Ipratropium nebuliser (0.5mg QDS)
  4. Steroids- either Prednisolone oral 40-50mg OR Hydrocortisone 100mg IV
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9
Q

Give 3 or more potential complications of COPD.

A
  1. Pulmonary hypertension
  2. Cor pulmonale
  3. Respiratory failure
  4. Lung cancer
  5. Acute exacerbations/ infectious exacerbations
  6. Polycythaemia (increased RBCs)
  7. Pneumothorax (due to ruptured bullae)
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10
Q

What 4 tests/ investigations should be done as recommended by NICE in diagnosing COPD?

A
  1. Spirometry with bronchodilator reversibility
  2. CXR- Exclude other pathologies
  3. FBC- Identify any secondary polycythaemia
  4. Calculate BMI
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11
Q

Give 2 or more side effects of B2 agonists used in asthma/COPD management.

A
  1. Tremor
  2. Anxiety
  3. Tachycardia
  4. Arrythmias
  5. Hypokalaemia
  6. Bronchospasm
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12
Q

What treatments options can be used in the management of Acute Exacerbations of COPD?

A
  1. Oxygen- aim sats 88-92%
  2. Nebulisers- Salbutamol 5mg 4hr,
    Ipratropium 500mg QDS
  3. Steroids- oral Prednisolone or IV hydrocortisone
  4. Antibiotics- if evidence of infection
  5. Oral Theophylline- if no response to nebulisers and steroids
  6. NIV- Non invasive ventilation- if pH <7.35 or PaCO2 >6kPa
  7. Intubation and ventilation- if pH <7.26 or PaCO2 rising despite trial of NIV.
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13
Q

Which antibiotic is given for low severity CAP?

Co-Amoxiclav
Amoxicillin
Metronidazole

A

Amoxicillin 500mg TDS 5 days

or Doxycyline/ Clarithromycin/ Erythromycin

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14
Q

Which 2 antibiotics are given for medium severity CAP?

Amoxicillin + Metronidazole
Amoxicillin + Doxycycline/ Clarithromycin
Doxycycline + Co-Amoxiclav

A

Amoxicillin + Doxycycline/ Clarithromycin

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15
Q

Which 2 antibiotics are given for high severity CAP?

Co-Amoxiclav and clarithromycin/erythromycin
Amoxicillin and Co-Amoxiclav
Metronidazole and Amoxicillin

A
  1. CoAmoxiclav
    Plus
  2. Clarithromycin/ Erythromycin
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16
Q

Which antibiotic is given 1st line for non-severe HAP?

A
  1. Co-Amoxiclav
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17
Q

Suggest 2 or more antibiotics which may be used 1st line for severe HAP?

A
  1. Tazocin
  2. Meropenem
  3. Ceftriaxone
  4. Levofloxacin
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18
Q

Suggest 3 or more potential complications of pneumonia.

A
  1. Para-pneumonic effusion
  2. Empyema
  3. Respiratory failure (Type 1)
  4. Lung abscess
  5. Atrial fibrillation
  6. Hypotension- due to sepsis
  7. ARDS
  8. Sepsis
  9. Pneumothorax
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19
Q

Pneumonia, pulmonary oedema, asthma and emphysema can cause which type of respiratory failure?

A

Type 1- PaO2 below 8kPa, Co2 levels normal or low.

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20
Q

COPD, GBS, Myasthenia gravis and opiods can cause which type of respiratory failure?

A

Type 2- PaO2 below 8kPa, CO2 levels above 6kPa.

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21
Q

Give 2 or more clinical features of hypercapnia.

A
  1. Flapping tremor
  2. Bounding pulse
  3. Headache
  4. Peripheral vasodilation
  5. Tachycardia
  6. Papiloedema
  7. Confusion
22
Q

Give 2 or more clinical features of hypoxia.

A
  1. Central cyanosis
  2. Dyspnoea
  3. Restlessness
  4. Confusion
  5. Polycythaemia
  6. Cor pulmonale
  7. Pulmonary HTN
23
Q

If a person in type 1 respiratory failure is on 60% oxygen for management, and their PaO2 remains below 8kPa, what is the next management option?

A

Assisted ventilation- NIV or intubation.

24
Q

Patients in Type 2 respiratory failure should be started on ___% oxygen via Venturi mask.

A

24%

25
Q

Which respiratory condition is characterised by chronic inflammation of bronchi and bronchioles leading to airway thinning and dilatation?

A

Bronchiectasis

26
Q

Which syndrome is an autosomal recessive disorder and has a triad of features including- 1. Bronchiectasis 2. Chronic sinusitis 3. Sinus invertus?

Kartagener’s syndrome
Young’s syndrome
Marfan’s syndrome

A

Kartagener’s syndrome

27
Q

Name 5 or more causes of haemoptysis.

A
  1. Infections- TB, Bronchiectasis, Pneumonia, Aspergillosis
  2. Parenchymal- Goodpasture’s syndrome, Interstitial Fibrosis, Sarcoidosis, CF
  3. Malignancy
  4. Vascular- PE, Vasculitis
  5. Cardiac- Pulmonary HTN, Mitral stenosis
  6. Trauma/ foreign body
  7. Warfarin
28
Q

Which syndrome is characterised by male infertility (azoospermia), bronchiectasis and chronic sinusitis?

Kartagener’s syndrome
Young’s syndrome
Marfan’s syndrome

A

Young’s syndrome

29
Q

Give 4 or more clinical features of Cystic Fibrosis.

A
  1. Neonatal- bowel obstruction (meconium ileus), failure to thrive
  2. Resp- recurrent infections, bronchiectasis, haemoptysis
  3. GI- pancreatic insufficiency, malabsorption, diabetes, bowel obstruction, gallstones
  4. Male infertility
  5. Female subfertility
  6. Short stature
  7. Rectal prolapse
  8. Delayed puberty
  9. Nasal polyps
30
Q

Bronchiectasis is characterised by ______ inspiratory crepitations.

A

Coarse

31
Q

ARDS is characterised by bilateral _____ inspiratory crepitations.

A

Fine

32
Q

What are the possible ECG findings in a patient having a PE?

A
  1. Normal ECG
  2. Right BBB
  3. Sinus tachycardia
  4. S1 Q3 T3= Large S wave in lead 1, Q wave in lead 3, inverted T wave in lead 3.
33
Q

Which of these therapies for smoking cessation is contraindicated in patients with epilepsy?

Nicotine replacement therapy
Varenicline
Buproprion

A

Buproprion

34
Q

In a tension pneumothorax, which way will the trachea deviate?

A

AWAY from the side of the pneumothorax

35
Q

Name 5 or more causes of Cor Pulmonale (Think resp, vascular, neuromuscular etc)

A
  1. Lung disease- COPD, Bronchiectasis, Fibrosis, Severe asthme
  2. Pulmonary vascular disease- primary pulmonary HTN, vasculitis, PE, Sickle Cell
  3. Neuromuscular disease- Myasthenia, MND
  4. Sleep apnoea
  5. Cardiovascular disease
  6. Thoracic wall deformity- scoliosis, kyphosis
36
Q

A patient has the following results from investigations:

FBC shows raised Hb and haematocrit
CXR shows right ventricular enlargement
ECG shows right axis deviation and right ventricular hypertrophy

What condition are they most likely to have?

A

Cor pulmonale

37
Q

Describe 2 or more possible clinical signs of cor pulmonale.

A
  1. Raised JVP
  2. Peripheral oedema
  3. Cyanosis
  4. Tachycardia
  5. Tricuspid regurgitation
  6. Right ventricular heave
  7. Hepatomegaly
38
Q

What happens to serum calcium levels in sarcoidosis?

A

Hypercalcaemia

39
Q

Which of these conditions causes fibrosis of the UPPER lung zones?

SLE
Drugs eg. Bleomycin
TB
Idiopathic Pulmonary Fibrosis

A

TB

40
Q

Which of these conditions causes fibrosis of the LOWER lung zones?

Asbestosis
TB
Coal worker’s pneumoconiosis
Hypersensitivity pneumonitis

A

Asbestosis

41
Q

Name 2 or more causes of UPPER zone fibrosis of the lung.

A
  1. Hypersensitivity pneumonitis (EAA)
  2. Coal worker’s pneumoconiosis
  3. Silicosis
  4. TB
  5. Ankylosing spondylitis
  6. Radiation
42
Q

Name 1 or more drugs that can cause lung fibrosis.

A
  1. Bleomycin
  2. Methotrexate
  3. Sulfasalazine
  4. Amiodarone
  5. Nitrofurantoin
43
Q

Which type of ILD is characterised by “egg shell calcification” of the hilar lymph nodes?

A

Silicosis

44
Q

Which antibiotic used for treating TB has a potential side effect of peripheral neuropathy so should be given with Vit B6 (Pyridoxine)?

A

Isoniazid

45
Q

Name 4 or more causes of respiratory acidosis.

A

Hypoventilation-

  1. Respiratory causes- COPD, asthma, pneumonia
  2. Sleep apnoea
  3. Drugs- opiods, sedatives
  4. Central respiratory depression- CVA, tumour
  5. Neurological- GBS, Myasthenia Gravis
46
Q

Name 4 or more causes of respiratory alkalosis.

A
  1. Hyperventilation- pain, anxiety
  2. Hypoxia leading to compensatory increase in ventilation- altitude, severe anaemia, PE, pulmonary oedema
  3. Increased mechanical ventilation
47
Q

Give 3 or more causes of OBSTRUCTIVE lung disease.

A 
COPD
Asthma
Emphysema
Bronchiectasis
CF
48
Q

Give 3 or more causes of RESTRICTIVE lung disease.

A 
Pulmonary oedema
Pneumoconiosis
Pleural effusion
Fibrosis/ILD
Obesity
Pregnancy
Connective tissue disorders
Sarcoidosis
Scoliosis
Neuromuscular- MND, GBS, Myaesthenia
49
Q

What happens to the FEV1, FVC and FEV1/FVC ratio in OBSTRUCTIVE lung disease when compared to normal?

A

FEV1 low
FVC low/normal
FEV1/FVC ratio low

50
Q

What happens to the FEV1, FVC and FEV1/FVC ratio in RESTRICTIVE lung disease when compared to normal?

A

FEV1 low
FVC low
FEV1/FVC ratio normal

51
Q

Kussmaul respiration is seen in which acid base disturbance?

A

Metabolic acidosis

Deep fast sighing breaths used to expire excess Co2.

52
Q

Name 3 respiratory and 3 other causes of finger clubbing.

A

Respiratory-

  1. Lung cancer
  2. Mesothelioma
  3. Bronchiectasis
  4. Idiopathic pulmonary fibrosis
  5. Cystic fibrosis
  6. TB

Non-respiratory-

  1. IBD- especially Crohns
  2. Congenital cyanotic heart disease
  3. Atrial myxoma
  4. Endocarditis
  5. Cirrhosis
  6. Grave’s disease
  7. GI lyphoma

Medicine (11 decks)

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