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Respiratory Flashcards

1
Q

What 4 symptoms should prompt you to consider a diagnosis of asthma?
What should these symptoms be?

A

Wheeze
Breathlessness
Chest tightness
Cough

EPISODIC!

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2
Q

What features should make you consider a diagnosis of asthma? (6)

A

Diurnal variation
Occur in response to a trigger e.g. cold air, allergen
Occur after taking a beta-blocker or NSAID
Occur in absence of infection
History of atopy
Widespread wheeze

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3
Q

What are the first line tests for asthma? (3)

What tests should you consider if diagnosis not clear? (2)

A 
Spirometry
Bronchodilator reversibility 
FeNO
Peak flow readings 
Direct bronchial challenge
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4
Q

What result would support your diagnosis of asthma for:

  1. Spirometry
  2. Bronchodilator reversibility
A
  1. FEV1/FVC ratio <70%

2. Improvement of 12% or more plus an increase in volume of 200ml (adults) or just an improvement by 12% (children)

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5
Q

What are the features of an acute severe asthma attack? (6)

A 
PEFR 33-50% best or predicted 
Tachycardia
Tachypnoea 
Use of accessory muscles
Inability to complete sentences in one breath
Oxygen sats >92%
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6
Q

What are the features of life-threatening asthma? (7)

A 
Any of the below:
PEFR 33%
Oxygen <92%
Cyanosis or confusion 
Hypotension 
Exhaustion (e.g. normal CO2)
Silent chest
Tachyarrhythmias
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7
Q

What are the stages of the MRC dyspnoea scale?

A
  1. Not troubled by breathlessness except on strenuous exercise
  2. SOB when hurrying or walking up a hill
  3. Walks slower than contemporaries
  4. Stops for breath after about 100m
  5. Too breathless to leave the house or when dressing
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8
Q

What symptoms should make you consider COPD in a smoker? (5)

A 
Exertional breathlessness
Chronic/recurrent cough
Regular sputum production
Frequent lower respiratory tract infections
Wheeze
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9
Q

What test is formally used to diagnose COPD? And what result suggests COPD?

A

Spirometry and bronchodilator reversibility

Post bronchodilator FEV1/FVC <0.7

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10
Q

What are the stages of COPD?

A
  1. Mild - FEV1 80% or more
  2. Moderate - FEV1 50-79%
  3. Severe - FEV1 30-49%
  4. Very severe - FEV1 <30% OR FEV1 <50% with respiratory failure
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11
Q

What other investigations are required apart from spirometry in COPD? (3)

A

CXR - exclude other pathologies
FBC
BMI

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12
Q

How do you manage COPD?

  1. Medication (no asthmatic features v asthmatic)
  2. General (4)
A
  1. SABA or SAMA –> add on LABA + LAMA or LABA + ICS if asthmatic features –> LABA + LAMA + ICS
  2. Pneumococcal and flu vaccinations; pulmonary rehabilitation; self-management plan; stop smoking
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13
Q

What blood test is most important when managing an exacerbation of COPD?

A

ABG - determines whether they are a CO2 retainer and thus guides oxygen management

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14
Q

Is TLCO raised or low in COPD?

A

Raised

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15
Q

What medications cause interstitial lung disease? (5)

A 
Nitrofurantoin 
Amiodarone
Sulfasalazine 
Methotrexate
Cyclophosphamide
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16
Q

What systemic conditions cause interstitial lung disease? (5)

A 
Alpha anti-1-trypsin deficiency
Sarcoidosis 
SLE
Rheumatoid 
Systemic sclerosis
17
Q

What are 3 causes of idiopathic fibrosis?

A

Idiopathic pulmonary fibrosis
Cryptogenic organising pneumonia
Hypersenstivity pneumonitis

18
Q

What blood test, if raised, is indicative of sarcoidosis? What electrolyte abnormality would you expect to see?

A

ACE

Hypercalcaemia

19
Q

What is characteristically seen on high-resolution CT with interstitial lung disease?

A

“ground-glass” appearance

20
Q

What are the typical pathogens for pneumonia?

A

Haemophilus influenzae, streptococcus pneumoniae

21
Q

Name the atypical pathogen for pneumonia:

  1. Vague slow onset, dry cough, erythema multiforme, transverse myelitis
  2. School-aged child, gradual onset, mild to moderate symptoms
  3. Mild headache and myalgia progressing to chills and rigors, unproductive cough, haemoptysis, can cause -itis and hyponatraeia
  4. Farmer who presents with a flu-like illness
  5. Parrot owner who has developed a cough
A
  1. Mycoplasma pneumoniae
  2. Chlamydia pneumoniae
  3. Legionella pneumophilia
  4. Q-fever
  5. Chlamydia psittaci
22
Q

What is the treatment for PCP pneumonia?

A

Co-trimoxazole (Septrin)

23
Q

What special type of staining is used for TB?

What colour does it stain?

A

Zeihl-Neelson staining

Bright red

24
Q

What is the treatment for TB? (4)

What do you need to co-prescribe?

A

Rifampicin - 6m
Isoniazid - 6m
Pyrazinamide - 2m
Ethambutol - 2m

Coprescribe B6 (pyridoxine) to prevent peripheral neuropathy

25
Q

Which TB drug causes the following side effects?

  1. Peripheral neuropathy
  2. Orange skin secretions
  3. Hyperuricaemia
  4. Colour blindness
A
  1. isoniazid
  2. rifampicin
  3. pyrazinamide
  4. ethambutol
26
Q

What is disseminated TB called?

A

Miliary TB

Finals (23 decks)

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