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3rd year medicine > Respiratory guidelines > Flashcards

Respiratory guidelines Flashcards

1
Q

Asthma investigation - what do all adults get - what do children get

A

FeNO and spirometry with reversibility children only get FeNO if spirometry inconclusive

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2
Q

Astham investigation - diagnostic cutoffs reversibility FEV1/FVC ratio FeNO

A

12% reversibility (AND 200ml in adults) ratio of <0.7 FeNO >40ppb (>35 in children)

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3
Q

Asthma treatment escalation ADULTS

A

SABA + low dose ICS + LABA + LRTA or moderate dose ICS (stop LABA if not working) specialist

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4
Q

Asthma treatment escalation CHILDREN

A

SABA + very low dose ICS Step 2 (>5) = LABA or LTRA Step 2 (<5) = LTRA Step 3 = increase to low dose ICS. Add LABA/LRTA and stop LABA if not helpful specialist

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5
Q

Acute asthma attack categories

A

Life threatening = PEFR<33, silent chest, <92%, normal CO2 Acute severe = >110bpm, cant complete sentences, PEFR33-50, RR>25 Moderate = 50-75% PEFR

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6
Q

Acute asthma management standard escalated

A

standard - oxygen driven nebs (salbutamol and ipratropium) give ipra 4-6hourly, salbutamol back to back oral pred/ IV hydrocortisone for at least 5d escalated - 1st: IV magnesium - 2nd: IV aminophylline 3rd: IV salbutamol (rarely used), intubation etc

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7
Q

COPD Ix - if you suspect COPD what 3 things do you get

A

CXR (?mass), FBC (2’ polycythaemia), spirometry/reversibility testing

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8
Q

Grading of COPD cutoffs

A

All based on FEV1 Mild= >80 WITH symptoms and FEV1/FVC <0.7 mod = 50-80 severe = 30-50 very severe = <30

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9
Q

COPD treatment escalation

A

1) SABA or SAMA 2) asthmatic features = LABA+ICS; no asthmatic features = LABA/LAMA 3) oral theophylline

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10
Q

Antibiotic prophylaxis in COPD?

A

Azithromycin

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11
Q

Asthmatic features for COPD step 2???

A

1) previous history of asthma or atopy 2) eosinophilia 3) diurnal variation of PEFR >20% 4) FEV1 variation >400ml

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12
Q

When do you assess someone for LTOT if has COPD

A

FEV1 <30% (i.e. very severe) cyanosis/polycthaemia oedema/raised JVP

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13
Q

How do you assess someone for LTOT?

A

ABGs on two separate occasions

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14
Q

Based on the ABGs, when do you offer LTOT for COPD

A

pO2 <7.3 pO2 7.3-8 + oedema, polycythaemia, pul HTN

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15
Q

COPD exacerbation Mx

A

Nebulised bronchodilators and prednisolone 7-14d Abx if sign of infection –> amox + clari

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16
Q

CURB65 score and meaning

A

Confusion <=8/10 AMTS urea >7 RR >=20 BP <=90/60 65+ 0-1 = home with amox 5d (depending on CRP test) 2-3 = hospital with amox+clari 7d 4-5 = ITU with coamox/tazocin 7d

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17
Q

CRP point of care test in GP for penumonia

A

Helps you decide if Abx are needed if they score CURB0 >100 = yes 20-100 = delayed <20 = no

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18
Q

Abx guideline: - CAP - atypical CAP - HAP

A

CAP = amox atypical CAP = clarithromycin HAP depends on when it has occurred after admission (remember HAP is defined as at least 48 hours after admission): - if within first 5d = coamox, cefurox - if after 5th day of admission = taz, cipro, ceftaz

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19
Q

2ww lung cancer referral for CXR

A

40+ and any of: - cough, fatigue, SOB, pain, weight loss, anorexia need 2 of them if never smoked

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20
Q

2ww lung cancer referral for clinic straight away

A

40+ and haemoptysis or abnormal CXR

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21
Q

best Ix for lung Ca

A

CT (hence why you do it if CXR negative and youre still suspicious)

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22
Q

Difference between SCLC and NSCLC

A

SCLC not usually amenable to surgery, need chemo NSCLC usually amenable to surgery, both have radio

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23
Q

Idiopathic lung fibrosis - gold standard Ix - TLCO and spirometry

A

gold standard- high res CT - ground glass appearance

+ spirometry

+ CXR

restrictive picture on spirometry:

  • FEV1 reduced
  • FVC reduced
  • FEV1/FVC ratio normal

TLCO is low

  • low uptake of O2 from lungs to blood
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24
Q

definitive Tx for idiopathic lung fibrosis

A

lung transplant

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25
Q

Sarcoidosis useful tests (no diagnostic one)

A

raised ACE and ESR restrictive spirometry non-caseating granuloma formation bilateral hilar lymphadenpatphy upper zone fibrosis

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26
Q

Management of sarcoid

A

Don’t treat asymptomatic lymphadenopathy If Sx –> prednisolone

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27
Q

Interpretation of Mantoux test

A

injection of tuberculin into skin - screening for TB

If <6mm = no reaction, immunise If 6-15mm = medium reaction, ?previous TB or previous vaccination, don’t immunise If >15mm = big reaction, active TB

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28
Q

when do you use interferon gamma quantiferon gold test?

A

if Mantoux equivocal or positive If Mantoux inaccurate (sarcoid, military TB, lymphoma HIV)

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29
Q

Drugs for TB and SEs

A

Active = 2m RIPE and 4m RI Latent = 3m RIP or 6m IP Meningeal = 12m RIPE + steroids rifampicin = red piss and hepatitis isoniazid = peripheral neuropathy and hepatitis pyranzinamide = gout and hepatits ethambutol = optic neuritis

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30
Q

Pneumothorax Mx

A

Primary <2cm = clinic in 6/52!! >2cm OR BREATHLESS = aspirate and observe Secondary 0-1 = admit O2 observe 1-2 = aspirate >2 = chest drain

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31
Q

Wells score PE

A

0-4 is unlikely to be PE - D-dimer wihin 4 hrs

if D-Dimer +ve -> immediate CTPA

if D-Dimer -ve -> consider other diagnosis

. 5+ = CTPA` immediately or interim therapeutic anticoag while awaiting CTPA

do V/Q scan instead if contrast allergy or renal failure

PE most likely = 3 DVT present = 3 Recent immobilisation = 1.5 Previous DVT/PE = 1.5 Tachycardia >100 = 1.5 Haemoptysis = 1 Malignancy = 1

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32
Q

Well score DVT just the cutoff Mx based on that

A

0-1 is unlikely –> D-dimer to exclude 2+ is likely ==> USS leg within 4 hours. if cant get one within 4 hours, treat with LMWH assuming its there

DVT Wells score:

cancer: 1

calf swelling >= 3cm (measured 10cm below tibial tuberosity): 1

collateral superficial veins: 1

pitting oedema (in symptomatic leg): 1

swelling of entire leg: 1

localised tenderness along deep venous system: 1

paralysis, paresis, or recent cast immobilisation of legs: 1

recently bedridden >= 3 days, or major surgery in last 12 wks: 1

previous DVT : 1

alternative diagnosis at least as likely as DVT: -2

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33
Q

Do you start LMWH before the CTPA is back

A

yes because it usually takes a number of hours to get done

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34
Q

Tx of PE

A

haemodynamically unstable = thrombolysis (alteplase)

stable = DOAC (apixaban or rivaroxaban) or warfarin

if not suitable then: LMWH (e.g. enoxaparin) for 5d or until INR>2 for 2days whichever is longer.

start warfarin or NOAC witin 24 hours. if warfarin crossover with LMWH, if NOAC just give it 2 hours before dose and don’t carryover.

continue for at least 3 months in primary PE

3-6 months for active cancer

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35
Q

ARDS - how do you exclude thatit is cardiac in origin if unsure

A

pulmonary artery wedge pressure.

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36
Q

obstructive sleep apnoea Best Ix and other Ix

A

Sleep studies is best test Epworth sleepiness scale and multiple sleep latency test also used

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37
Q

Mx of obstructive sleep apnoea

A

If sleepiness in daytime –> CPAP at night If no sleepiness or CPAP not tolerate –> mandibular advancement device

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38
Q

pleural effusions and lights criteria

A

protein >35 = exudate protein <25 = transudate 25-35 use lights criteria exudate if: - pleural protein is >50% the serum protein - pleural LDH >60% serum LDH - pleural LDH >2/3rds NORMAL serum LDH

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39
Q

if pleural fluid is exudate?

A

contrast CT and send off sample to lab

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40
Q

if pleural fluid is purulent or has pH <7.2

A

chest tube

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41
Q

NG tube safety

A

pH <5.5 is happy days Otherwise need to do a CXR

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42
Q

NIV indications in COPD

A

any respiratory acidosis despite maximal therapy

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43
Q

when is an aspirate exudate

A

<25 protein = transudate >35 protein = exudate in between use lights criteria. Exudate if pleural fluid: - protein >50% serum protein - LDH >60% serum LDH - LDH >2/3rds normal serum LDH

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44
Q

should CO2 be normal in ABG in asthma

A

no it should be low - need referral to ITU if normal or high on ABG

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45
Q

safety triangle for pleural tap - pleural fluid aspirate, thoracocentesis

A

not below 5th intercostal space top is base of axilla posterior border of pectorals major anterior border of latissimus dorsi go on superior border of rib to avoid NV bundle

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46
Q

layers that you go through to do a pleural tap

A
  1. skin 2. epidermis 3. intercostal muscles 4. endothoracic fascia 5. parietal pleura
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47
Q

65yr M

progressive SOB

unilateral pleural effusion

pleural aspirate - what type of pleural effusion?

A

transudate

  • low protein
  • low LDH
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48
Q

causes of transudate

A

HF

liver cirrhosis

renal - nephrotic syndrome

ovarian - Meigs syndrome

sarcoidosis

thyroid myxoedema

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49
Q

causes of exudate pleural effusion

A

malignancy

infection

trauma

pulmonary embolus/ infarct

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50
Q
A
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51
Q

78

3 wk hx

dry cough

weight loss

breathlessness at rest

unilateral pleural effusion - type?

A

exudative

most likely due to cancer

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52
Q

monitoring of chest drain

A

bubbling

  • normal in pneumothorax

abnormal in effusion - check for air leaks

swinging

  • should occur with inspiration and expiration - if its not- blockage?
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53
Q

58yr M

routine abdo paracentesis

tender abdo

jaundice

confusion

fever

polymorphic neucleocyte count: 0.3

SA-AG = 15

A

SBP - Spontaneous bacterial peritonitis

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54
Q

indications for ascitic tap

A

diagnosis of new onset ascites

suspected SBP

therapeutic ( usually drainage/ paracentesis)

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55
Q

surface anatomy of ascitic tap

A

15cm lateral to umbilicus - left or right lower quadrant

avoid enlarged liver/ spleen and epigastric arteries

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56
Q

ascitic tap analysis

A

PMNs/neurophil > 250 = diagnostic of SBP

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57
Q

presentation of TB

A

suspected in anyone with cough for >3 wks

especially if accompanied by:

  • haemoptysis
  • SOB
  • loss of appetite
  • weight loss
  • fever and sweating, especially night sweats
  • fatigue and tiredness
  • swollen glands
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58
Q

indication for CXR or referral to specialist for idiopathic pulmonary fibrosis

A

>45yrs

persisent breathlessness on exertion

persistent cough

bilateral inspiratory crackles

clubbing of fingers

normal spirometry or restrictive pattern

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59
Q

investigations if TB suspected

A

for active:

CXR/ CT + deep cough sputum sample (for micro, culture and histology)

for latent TB:

  • Mantoux test - for close contacts with TB patients
  • if Mantoux positive –> interferon-gamma release assay (quantaferon gold)
  • if +ve: assess for active TB
  • if -ve: treat for latent TB
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60
Q

radiological features of TB

A

primary TB:

  • less than half of patients show radiological abnormalities
  • there may be hilar lymph node enlargement

post-primary TB:

  • patchy solid lesions
  • cavitated solid lesions
  • streaky fibrosis
  • flecks of calcification
  • solitary tuberculoma presenting as a coin lesion
  • hilar node enlargement

Miliary TB:

  • millet-sized nodules present throughout the lung fields
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61
Q

diagnosis

A

miliary TB

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62
Q

cough

fatigue

recently moved from developing country

diagnosis?

A

primary TB

upper zone consolidation

+ ipsilateral hilar enlargement

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63
Q

what is this showing in TB

A

healed primary TB

Ghon focus - TB has gone!

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64
Q

cough

HIV

diagnosis

A

TB

  • post primary Tb (secondary or reactivation TB)

apical consolidation

hilar distortion

more common in immunocompromised (HIV)

65
Q

Ix for pneumothorax

A

CXR for pneumothorax

tension pneumothorax should not be seen on CXR - clinical diagnosis (deviated trachea) and chest drain

66
Q

clinical features of ARDS

A

stages:

respiratory distress - but with normal CXR

increasing cyanosis - CXR diffuse bilateral shadowing

hypoxaemia, respiratory acidosis

may be death from hypoxic cardiac arrest

67
Q

Mx of ARDS

A

mechanical ventilation - using high inspired O2

blood gases checked regularly

fluids

Finer assessment using Swan Ganz catheter to measure pulmonary capillary wedge pressure (left atrial pressure)

mortality 50%

usually residual pulmonary disability due to developing pulmonary fibrosis

68
Q

medical management of idiopathic lung fibrosis

A

pirfenidone - antifibrotic and anti-inflammatory

nintedanib - monoclonal antibody targeting tyrosine kinase

69
Q

causes of pulmonary fibrosis (drug induced and secondary)

A

drug induced:

  • amiodarone
  • cyclophosphamide
  • methotrexate
  • nitrofurantoin

secondary:

  • alpha-1 antitripsin deficiency
  • RA
  • SLE
  • systemic sclerosis
70
Q

what does asbestos cause

A

lung cancer - most common

Mesothelioma – rare but if you see it think asbestos

71
Q

what type of hypersensitivity reaction is hypersensitivity pneumonitis (extrinsic allergic alveolitis)

A

type 3 hypersensitivity reaction

to environmental allergen that causes parenchymal inflammtation

can lead to pulmonary fibrosis in later stages

72
Q

Ix for Hypersensitivity Pneumonitis

A

Bronchoalveolar lavage (during bronchoscopy)

  • raised lymphocytes
  • raised mast cells
73
Q

Mx for Hypersensitivity Pneumonitis

A

remove allergen from patients environment

O2

steroids

74
Q

4 causes of Hypersensitivity Pneumonitis

A

bird- fanciers lung - reaction to bird droppings

  • avian proteins

farmers lung - reaction to mouldy spores in hay

  • micropolyspora faeni

mushroom workers’ lung - reaction to specific mushroom antigens

malt workers lung - reaction to mould on barley

  • aspergillus clavatus
75
Q

cause of mesothelioma

A

asbestos

(especially blue asbestos)

can even get it from other peoples clothes

76
Q

diagnostic test for mesothelioma

A

pleural biopsy: diagnostic test

CXR/CT shows pleural thickening and associated pleural effusion

77
Q

Mx for mesothelioma

A

mostly symptomatic treatment

surgery may be possible for stage 1: extrapleural pneumonectomy

chemo - malignany pleural mesothelioma where surgical resection is inappropriate

78
Q

70yr man

used to work on construction sites

diagnosis?

A

mesothelioma

  • cancer of pleura
  • due to asbestos
79
Q

patient is woken by airway obstruction

  • choking/ gasping during sleep

snoring

excessive daytime sleepiness

A
80
Q

clinical presentation of bronchiectasis

A

bronchial wall thickening and dilatation

chronic cough

mucopurulent sputum production

recurrent infections

81
Q

diagnostic test for bronchiectasis:

A

high resolution CT: diagnostic investigation

  • if CXR is unhelpful

features:

  • bronchial wall dilation (internal diameter of lumen bigger than accompanying bronchial artery - signet ring sign)
  • lack of bronchial tapering
82
Q

chronic productive cough

previous frequent infections

cystic fibrosis

diagnosis

A

bronchiectasis

on high res CT

signet ring sign - bronchi bigger than accompanying artery

83
Q

Mx of bronchiectasis

A

physio - airway sputum clearance

abx - if infection

surgical resection if localised

84
Q

aspergillosis Mx

A

caused by aspergillus mould - hypersensitivity reaction

Mx: oral steroids + oral antifungal

85
Q

causes of pleuritic chest pain

A

pain on inspiration

  • PE
  • malignancy
  • infection: TB, pneumonia
  • injury: rib fracture
  • autoimmune: RA and SLE
86
Q

diagnosis

A

pulmonary fibrosis

‘honeycombing’

87
Q

causes of upper zone pulmonary fibrosis

A
88
Q

causes of lower zone pulmonary fibrosis

A

asbestosis

idiopathic pulmonary fibrosis

most connective tissue disorders (except ankylosing spondylitis)

drug induced (amiodarone, methotrexate)

89
Q

pneumonia

high fever

rapid onset

herpes labialis

which bacteria?

A

strep pneumoniae

90
Q

small cell lung cancer paraneoplastic features

A

ADH –> hyponatraemia

91
Q

squamous cell lung cancer paraneoplastic features

A

parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia

92
Q

adenocarcinoma paraneoplastic features

A

gynaecomastia

hypertrophic pulmonary osteoarthropathy (shown in pic)

93
Q

vital capacity

A

vital capacity = inspiratory capacity + expriatory reserve volume

94
Q

opiate overdose ABG

A

respiratory acidosis

95
Q

PE ABG

A

respiratory alkalosis

96
Q

life threatening asthma O2 sats

A

<92%

97
Q

pneumonia with a PMH of COPD

which bacteria

A

H. influenza

98
Q

new diagnosis of COPD

Mx

A

add SABA or SAMA

99
Q

anxiety leading to hyperventilation ABG

A

respiratory alkalosis

100
Q

tiring asthma attack abg

A

respiratory acidosis

as tiring they start retaining CO2

if CO2 normal or high - WORRY -> severe asthma attack

101
Q
A
102
Q

negative result on spirometry for asthma but symptoms of asthma

next step

A

refer for fractional exhaled nitric oxide (FeNO) testing

negative spirometry does not exclude asthma - further investigated

103
Q

most common cause of SVC obstruction

A

lung cancer

due to extrinsic pressure

lung cancer can cause superior vena cava syndrome:

  • visibly distended veins chest and neck

increased breathlessness particulary on exertion

104
Q

SOB and bibasal atelectasis 72hrs postoperatively

Mx

A

Atelectasis: alveolar collapse

Mx: positioning patient upright

chest physiotherapy: breathing exercises

105
Q

cough

fever

A

left lingula consolidation

  • leads to loss of left heart border
106
Q

diagnostic investigation for mesothelioma

A

thoracoscopic biopsy - histology

107
Q

which tyoe of lung cancer is not related to smoking

A

alveolar cell carcinoma

increased sputum production

108
Q

respiratory acidosis, agitated, low O2, high bicarb

after pneumonia patient put on O2 15L

most likely diagnosis

A

over administration of O2 in COPD patient

background of chronic respiratory acidosis with compensatory metabolic acidosis

retain CO and therefore hypoventilate –> respiratory arrest

if the bicarb was normal it would be acute respiratory acidosis 2ndry to pneumonia

109
Q

facial rash + lymphadenopathy

A

sarcoidosis

features:

  • erythema nodosum
  • bilateral hilar lymphadenopathy
  • skin: lupus pernio = sarcoidosis
  • hypercalcaemia
110
Q

most likely lung cancer in non-smokers

A

lung adenocarcinoma:

  • most common in non-smokers
  • peripheral lesion (not seen on bronchoscopy)
111
Q

what can false negatives of mantoux test be caused by

A

miliary TB

sarcoidosis

HIV

lymphoma

very young age (e.g. < 6 months)

112
Q

chest drain swinging

A

rises in inspiration, falls in expiration

113
Q

test for suspected carbon monoxide poisoning

A

ABG

shows hypoxia

114
Q

mx carbon monoxide poisoning

A

100% high flow O2 through non-rebeath

target O2 sats 100%

115
Q

normal/ raised total gas transfer with raised transfer coefficient

A

asthma

pulmonary haemorrhage (Wegener’s, Goodpasture’s)

116
Q

what test should be offered to all patients with TB

A

HIV test

117
Q

trachea pulled toward white-out on cxr

A

pneumonectomy

complete lung collapse

pulmonary hypoplasia

118
Q

trachea central with white out

A

consolidation

pulmonary oedema (usually bilateral)

mesothelioma

119
Q

trachea pushed away from white out

A

pleural effusion

diaphragmatic hernia

large thoracic mass

120
Q

O2 for critically ill COPD patient

A

given 15L/min O2 through non-rebreath then titrated down (hypoxia kills)

aim to raise sats to 94% and over

titrate down:

prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis

adjust target range to 94-98% if the pCO2 is normal

121
Q

paraneoplastic features of small cell lung cancer

A

ADH - hyponatraemia

ACTH - cushings syndrome

lambert-eaton syndrome (weakness of proximal arms and legs - normally worse in legs, slightly better with muscle use)

122
Q

paraneoplastic features of squamous cell lung cancer

A

PTH - secretion causing hypercalcaemia

clubbing

hypertrophic pulmonary osteoarthropathy

hyperthyroidism due to ectopic TSH

123
Q

paraneoplastic features of adenocarcinoma lung cancer

A

gynaecomastia

hypertrophic pulmonary osteoarthropathy

124
Q

acute asthma levels by PEFR

A

75-50% of best: moderate

50-33% of best: severe

<33%: life threatening

125
Q

COPD symptoms in young person

A

alpha -1 antitrypsin (A1AT) deficiency

126
Q
A
127
Q

features of heart failure on cxr

A

ABCDE

A - alveolar oedema (bat’s wings)

B - Kerley B lines

C- Cardiomegaly

D- dilated prominent upper lobe vessels

E- effusion (pleural)

128
Q

intervention most likely to increase survival in patients with COPD

A

smoking cessation

in hypoxic patients - long term O2 therapy

129
Q

what type of O2 do you give to COPD patient with respiratory acidosis

A

COPD with respiratory acidosis 7.25-7.35: NIV

130
Q

main treatment for small cell lung cancer

A

chemotherapy

adjuvant radiotherapy is also given in patients with limited disease

surgery can be used for T1, N0,M0

131
Q

respiratory complication of methotrexate

A

methotrexate pneumonitis - bilateral interstitial shadowing on CXR

132
Q

diagnosis

A

cannon ball mets - from renal cell carcinoma

less common primaries:

choriocarcinoma

endometrial carcinoma

133
Q

benign ovarian tumour + ascites + pleural effusion

A

Meig’s syndrome

134
Q

Alpha 1 anti-trypsin deficiency features

A

alpha1 -antitrypsin made in liver

lungs: panacinar emphysema - lower lobes

can also cause liver disease: cirrhosis and hepatocellular carcinoma

spirometry: obstructive picture

can be diagnosed prenataly

commonly 20-50yrs

chromosome 14

135
Q

latent TB cxr

A

calcified Ghon focus may be seen (lateral calcified nodule)

+ bilateral lymphadenopathy

= Ghon complex

136
Q

latent TB mx

A

either:

  • 3 months isoniazid (with pyridoxine) + rifampicin

or - 6 months isoniazid (with pyridoxine)

137
Q

when should asthma attacks be admitted to hospital

A

life threatening asthma should be admitted

severe asthma attack should be admitted if fail to respond to treatment

any level asthma attack should be admitted when theyve had a previous near-fatal attack

138
Q

side effect of bupropion - for smoking cessation

A

small risk of seizures - contraindicated in epilepsy

also CI in pregnancy and breast feeing

139
Q

bronchiectasis + dextrocardia

A

Kartagener’s syndrome (primary ciliary dyskinesia)

140
Q

features of kartagener’s syndrome

A

primary ciliary dyskinesia - immotile cilia

features:
- dextrocardia

  • bronchiectasis
  • infertility (low sperm motility and defective ciliary action in fallopian tubes)
  • recurrent sinusitis
141
Q

what is 1 pack yr

A

20 cigarettes per day for 1 yr

142
Q

varenicline - smoking cessation

A

nicotinic receptor partial agonist

risk of suicidal behaviour

contraindicated with pregnancy and breast feeding

143
Q

most common causes of anterior mediastinum mass

A

4 T’s:

  • teratoma
  • terrible lymphadenopathy
  • thymic mass
  • thyroid mass
144
Q

what should you look for in the chest with myasthenia gravis

A

thymoma

do CT scan

145
Q

pharmaological treatment of choice for smoking cessation in pregnancy

A

nicotine replacement patch

first line: CBT, motivational interviewing

146
Q

mx for obstructive sleep apnoea

A

weight loss

CPAP = first line for mod/severe OSA

147
Q

ABG picture for opiod toxicity

A

metabolic acidosis

type 2 respiratory failure (O2 low, CO2 high)

148
Q

klebsiella pneumonia

A

commonly due to aspiration

  • e.g. recent stoke causing dysphagia

also common in history of alcoholics and diabetes

red-current jelly sputum

149
Q

coal workers pneumoconiosis

A

coal worker + restrictive picture on spirometry + apical lung fibrosis

150
Q

indications for steroid treatment in sarcoidosis

A
  • cxr stage 2 or 3 + symptoms (parenchymal lung disease)
  • hypercalcaemia
  • eye (uveitis) , heart or neuro involvement
151
Q

what should be done to this NG tube

A

nothing, it is in the correct position

152
Q

what stage is confusion in an asthma attack

A

life-threatening (even if dont have other features)

153
Q

mx pneumonia (CAP)

A

first line for low severity (CURB65 0-1): amoxicillin 5days

moderate and high severity (2 or more): dual abx therapy: amoxicillin + macrolide (e.g erithyromycin, clarithromycin) 7-10 days

154
Q

what should be offered to COPD to start early on as soon as patients start feeling SOB with regular activity

A

pulmonary rehabilitation - to all people who view themselves as functionally disabled by COPD

155
Q

rusty coloured sputum

A

strep pneumoniae

156
Q

respiratory disease and their bacteria/ virus cause

A
157
Q

legionella pneumophila pneumonia features

A

flu-like symptoms

dry cough

relative bradycardia

confusion

hyponatraemia

pleural effusion

diagnosis: urinary antigen
mx: eryth/clarith

158
Q

legionella pneumonia vs mycoplasma pneumonia

A

3rd year medicine (31 decks)

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