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Finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) - What is it?
Features (5)

A 
Small-medium vessel vasculitis 
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive in 60%
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2
Q

Features of mycoplasma pneumoniae pneumonia

A

flu like symptoms

patchy lower lobe consolidation

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3
Q

features of pseudomonas aeruginosa pneumonia

A

associated with HAP, VAP, CF, bronchiectasis

‘ground-glass’ attenuation on CT

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4
Q

features of klebsiella pneumonia

A

associated with increasing age, alcohol use, diabetes, aspiration
cavitating lesions in upper lobes

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5
Q

features of legionella pneumonia

A

flu like with or without D&V or hepatitis

bi-basal consolidation

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6
Q

Granulomatosis with polyangiitis (Wegener’s granulomatosis)
What is it?
Features?

A

necrotizing granulomatous vasculitis affecting URT, LRT and renal system.
upper respiratory tract: epistaxis, sinusitis, nasal crusting
lower respiratory tract: dyspnoea, haemoptysis
rapidly progressive glomerulonephritis (‘pauci-immune’, 80% of patients)
saddle-shape nose deformity
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions

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7
Q

Bronchodilator therapy for COPD

A 
1st line SABA (or SAMA)
2nd 
WITH asthma features 
   LABA + ICS (then LAMA as required)
WITHOUT asthma features
   LABA+LAMA
Asthmatic features include previous Hx of asthma, FEV1 variation, diurnal variation, eosinophilia
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8
Q

Smoking cessation meds

A

NRT - patch plus another form recommended
Varenicline - partial nicotine agonist
Bupropion - nicotine antagonist, dopamine and NA reuptake inhibitor

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9
Q

Causes of upper lobe fibrosis

A

‘CHARTS’
Coal workers’ pneumoconiosis
Histiocytosis
Ankylosing spondylitis/Allergic bronchopulmonary aspergillosis
Radiation
Tuberculosis
Silicosis (progressive massive fibrosis), sarcoidosis

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10
Q

Causative organisms of infective Ex of COPD

A

Haemophilus influenzae (most common cause)
Streptococcus pneumoniae
Moraxella catarrhalis

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11
Q

Mx of Primary Pneumothorax (no tension)

A

No SOB and <2cm = discharge and review
SOB or >2cm attempt aspiration
If aspiration fails consider chest drain

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12
Q

Mx of Secondary Pneumothorax (no tension)

A

SOB or >2cm = chest drain
No SOB 1 to 2 cm = aspiration, if fails chest drain
Less than 1 cm or aspirated = observe for 24 hours

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13
Q

CURB 65

A

C Confusion (abbreviated mental test score <= 8/10)
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years

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14
Q

Classifying acute asthma attack

A 
Moderate	
   PEFR 50-75% best or predicted
   Speech normal
Severe
   PEFR 33 - 50% best or predicted
   Can't complete sentences
   RR > 25/min
   Pulse > 110 bpm	
Life-threatening
   PEFR < 33% best or predicted
   Oxygen sats < 92%
   Silent chest, cyanosis or feeble respiratory effort
   Bradycardia, dysrhythmia or hypotension
   Exhaustion, confusion or coma
Near-fatal
  raised PaCO2
  requires ventilation
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15
Q 
Features of Sarcoidosis
Acute (4)
Insidious (4)
Skin (1)
Other (1)
A

acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
skin: lupus pernio
hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

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16
Q

Causes of a raised TLCO

A 
asthma
pulmonary haemorrhage (Wegener's, Goodpasture's)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
17
Q

Causes of a reduced TLCO

A 
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
18
Q

Pleural Effusion Mx

A

Chest drain if empyema is present - visibly purulent or pH<7.2
Investigate to determine the cause of the effusion
Bloods, CXR, ECG, ECHO if HF suspected, CT if malignancy is suspected
Biopsy

19
Q

Transudate
definition
causes
Mx

A

<30g/L protein
think third spacing or increased pulmonary pressure
Commonly Heart failure, cirrhosis, hypoalbuminaemia
Treat cause
chest drain if effusion persists

20
Q

Exudate
definition
causes
Mx

A

> 30g/L protein
Think inflammatory processes - protein is exiting the capillaries
commonly Malignancy, infection
diagnosis and treatment of the cause
if purulent or pH <7.2 then insert chest drain as likely infective.

21
Q

Purulent effusions - what’s in em?

A 
High protein content - exudate
may be visibly purulent
low glucose
high LDH
pH<7.2
22
Q

Indications for prophylactic axithromycin in COPD

A

do not smoke, optimised non-pharmacological management and inhaled therapies, relevant vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and continue to have 1 or more of the following, particularly if they have significant daily sputum production:
- 4 or more per year exacerbations with sputum
production
- prolonged exacerbations with sputum production
- exacerbations resulting in hospitalisation.

23
Q

Features of Kartageners syndrome (4)

A

dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility

24
Q

What is ARDS

A

non-cardiogenic pulmonary oedema caused by increased permeability of alveolar capillaries

25
Q

Causes of ARDS (6)

A 
Infection - pneumonia, sepsis
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
cardio-pulmonary bypass
26
Q

Features of ARDS (4)

A

dyspnoea
tachypnea
hypoxia
bibasal crackles on auscultation

27
Q

Diagnostic criteria for ARDS (4)

A

onset within 1 week of trigger
pulmonary oedema on CXR
non-cardiogenic
pO2/FiO2 <40kPa

28
Q

Mx of ARDS (4)

A

ITU involvement
oxygenation and ventilation
organ support e.g. vasopressors
treat underlying cause

29
Q

COPD severity

A 
FEV1	Severity
	> 80%	Stage 1 - Mild**
	50-79%	Stage 2 - Moderate
	30-49%	Stage 3 - Severe
	< 30%	Stage 4 - Very severe

Finals (34 decks)

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