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Lectures final revision > Respiratory for PACEs > Flashcards

Respiratory for PACEs Flashcards

1
Q

What p02 to be centrally cyanosed?

A

<6`

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2
Q

Resp causes of clubbing

A

Infection
Fibrosis
Cancer

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3
Q

Obstructive breathing pattern

A

fastest exhalation lasts 6 seconds

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4
Q

What chest deformity in long term T2 resp failure

A

Kyphosis

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5
Q

How to discuss percussion>

A

Symmetrical or asymmetrical

then resonant/hyperresonant

dull/stony dull

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6
Q

Breathing on auscultation - spectrum of findings

A

decreased resonance - consolidation (less air due to pus)

no resonance - pleural effusion (acts as dampener)

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7
Q

What does increased vocal resonance mean?

A

More solid pathology

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8
Q

When auscultating - what is bronchial breathing

A

Seen in collapsed or consolidated lung

Timing of ins and exp similar with a gap in the middle

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9
Q

Causes of monophonic wheeze

A

mucus or narrowing

or listening over the trachea

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10
Q

What types of crackles are there?

A

Coarse or fine

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11
Q

Coarse

A

bubbles sound

bronchiectasis or pulm oedema

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12
Q

Fine crackles

A

Like velcro

opening of fibrosed alveoli

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13
Q

Why check the ankles and sacrum

A

Look for complications

pHT and RHF
Shins for Erythema Nodosum

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14
Q

reduced air entry
Dull percussion
reduced VR

A

Effusion

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15
Q

Effusion - signs

A

reduced air entry
Dull percussion
reduced VR

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16
Q

Bronchial breathing
dull percussion
increased VR

A

Collapse or consolidation

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17
Q

Collapse or consolidation

A

Bronchial breathing
dull percussion
increased VR

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18
Q

Fine crackles, clubbed, sputum

A

Bronchiectasis

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19
Q

What are the common resp investigations?

A 
Bloods
Sputum culture
CXR
Spirometry
Echo - pHT and cardiac failure
CT - difference between HRCT and Volime CT
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20
Q

Lung function: Gas Transfer - what does it measure

A

Uptake of CO

Lower lung surface area and decreased transfer factor

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21
Q

Volume CT

A

3mm slices for nodules and cancer

22
Q

HRCT

A

10-15mm slices

lower amount of radiation

interstitial lung disease

23
Q

Resp MDT

A

SMOKING CESSATION

Dietician
Physio
NIV
Surgery
Psych
Palliative
24
Q

Asthma on resp examination

A

If well controlled can be completely normal

25
Q

Invesitigations in Asthma

A

Spirometry (obstructive with reversibility)
Exhaled NO - if increased then asthmatic and should be on steroids

Histamine challenge

Peak flow diary for variability

Skin tests/ IgE / Eosinophils

26
Q

Asthma Rx

A

INhaled steroids + Montelukast + LABA

Writeen asthma plan involving the nursing team

27
Q

Bronchiectasis complications

A 
Pulm HTN
Cachexia
Lobar collapse
Massive haemoptysis
T2 RF / asterixis
Situs inversus / Kartaageners (Swapped liver and heart on wrong side)
28
Q

Causes of Bronchiectesis

A 
Idiopathic
Post infective (measles, pertussis, TB)
Immunodeficency (hypogammaglobulinaemia / CVID (low IgG) / Spec polysaccharide ad deficiency
CF
PCD, Youngs, Kartageners
ABPA
Obstruction / foreign body / tumour
RheumA, IBD
29
Q

ix in bronchiectasis

A 
Volume CT / HRCT - shows ring shadows and tram lines
Immunoglobulins
CF testing
Spirometry
Cultures
30
Q

Management for bronchiectasis

A 
Airway Clearance through PHYSIO
Smoking cessation
Abx more than 3 infection/year
Rx any cause
Pulm Rehab
Bronchodilaters
31
Q

Complications of lung cancer

A

SVCO, Horners

32
Q

Example of non-small cell

A

adenocarcino,ma and squamous

33
Q

Lung cancer Ix

A

Volume CT
Lung function for rx ability and resectability
PET CT
Biopsy lymph and liver

34
Q

Rx of small cell lung cancer

A

Rarely resection mostly chemo and radiation

35
Q

Non-small cell cancer

A

Resection
Radiotherapy
Chemo
Palliative

36
Q

Sign of COPD

A

Airflow obstruction - prolonged exp phase
pursed lip breathing
wheeze/inhalers

Hyperexpansion - reduced cricosternal distance
Loss of cardiac dullness
Displaced liver

Causes signs - Tar staining!

37
Q

Cx of COPD

A

Bruising/steroid therapy
pHT
Co2 retention
Hyperinflation - loss of cardiac dullness and displaced liver edge. Reduced cricosternal distance)

38
Q

Ix in COPD

A 
FBC - polycythaemia
A1AT
Lung function
ABG
CT
Echo for pHT
39
Q

What is the modified MRC for breathlessness

A 
0 - hard exercise
1 - moderate exercise
2 - slow
3 - rest after minuetes
4- on dressing
40
Q

Mx of COPD

A 
Bronchodilaters
Pulm Rehab
Dietician
SMOKING CESSATION
Steroids/Abx
oxygen if pO2 is less than 7.8
41
Q

Signs in Effusion

A

Decreased expansion
decreased air entry
decreased Vocal resonance

42
Q

Ax conditions to effusion

A

Transudative - liver and cardiac pathology

Exudative - malignancy, infection TB, RA, yellow nail

use lights criteria

43
Q

Ix in effusion

A

CXR
CT later on
US guided drain

send to lab
Chemistry
Micriscopy
Immunology

44
Q

Ax conditions to Fibrosis

A

RA

45
Q

Sign of fibrosis

A

fine late inspiratory crackles

46
Q

causes of fibrosis

A

idiopathic
connective tissue associated - scleroderma, RA, SLE
Sarcoid
increased sensitivity pneumonitis
drugs - amioderone, nitrofurantoin, bleomycin, methatrexate

47
Q

Ix in Fibrosis

A 
FBC, complement, autoimmune screen, preceptins
CXR, HRCT
Lung function
Echo
BAL
ABG
48
Q

Mx of Fibrosis

A

Physio/rehab
nurse specialist
anti-tussive
smokingcessation

Profenidone?

49
Q

Lung surgery normally for?

A

Cancer
TB
Bronchiectasis

50
Q

Signs of penumonectomy

A 
Scar
Chest wall deformity
shifted trachea
decreased expansion
no breath sounds (in lobectomy will be decreased)
51
Q

Signs in penuomonia/collapse

A

decreased expansion
dull
reduced or no air entry
increased vocal resonance

Lectures final revision (10 decks)

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