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Y 3 Medicine > Respiratory key points > Flashcards

Respiratory key points Flashcards

1
Q

Questions to ask about breathlessness

A

MRC score, exercise tolerance, triggers, relieving factors, diurnal variation, Orthopnoea, PND

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2
Q

Questions to ask about chest pain

A

Site, severity, radiation, triggers, relieving factors, associated symptoms

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3
Q

Questions to ask about wheeze

A

Triggers, relieving factors, diurnal variation, associated cough

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4
Q

Questions to ask about cough

A

Dry or productive, triggers, relieving factors, diurnal variation, association with eating or dyspepsia, positional, nasal secretions, associated fever

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5
Q

Questions to ask about sputum

A

How much over 24 hours, colour, consistency

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6
Q

Questions to ask about haemoptysis

A

Quantity and frequency, fever/night sweats, appetite, weight loss

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7
Q

What appearance of CT scan suggests infection

A

Ground glass

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8
Q

How do you treat pseudomonas

A

Piperacillin

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9
Q

Principles of PE treatment

A

Look for cause, lifelong anticoagulants, check for cancer

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10
Q

Can you see pulmonary hypertension on CT scan

A

Yes

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11
Q

What drug can help bad ILD

A

Morphine

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12
Q

Features of bronchiectasis

A

Airway dilatation and mucous plugs

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13
Q

What can help people cough up mucous

A

Mucolytics e.g. NaCl nebulised and Carbocisteine, salbutamol helps as can dilate airways further to increase amount of mucous coughed up

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14
Q

Tips for resp exam

A

Don’t need to percuss in more than 3 areas, chest expansion important for thumbs to hover, with tracheal deviation check for empty space either side of trachea before localising centrally, ensure when auscultating back you are not listening over spine or scapula, check for clubbing by lowering down to height of nails, check RR tricking for pulse, remember lymph nodes

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15
Q

What usually causes COPD/ILD

A

COPD usually smoking, ILD more commonly occupational or allergy related

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16
Q

Examination in ILD

A

Fine crackles, especially at lung bases, inspiratory

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17
Q

Explanation of ILD appearance on spirometry

A

Restrictive pattern due to fibrosis as less air able to enter lungs

FEV1/FVC ratio normal as both are proportionately lower

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18
Q

Causes of delirium

A

M is also metabolic

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19
Q

target O2 sats

A

92%

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20
Q

Gold standard answer for giving oxygen

A

Controlled oxygen and assess patient response

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21
Q

How to present investigations

A

Start with bedside and do most invasive at the end

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22
Q

What 2 asthma drugs should not be given together in acute asthma attack

A

IV aminophylline and IV salbutamol

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23
Q

Why is hyperventilation a good sign in asthma

A

Shows good respiratory muscle function (CO2 is low), as time goes on the respiratory muscles begin to fatigue and the CO2 increases or becomes normal which is a worry as clearly the patient no longer has the physiological reserve to compensate

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24
Q

SOB and pleuritic chest pain key differentials

A

Pericarditis and pneumothorax, PE

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25
What clinical finding defines a tension pneumothorax
Hypotension (haemodynamic instability). hemidiaphragm depressed
26
COPD exacerbation investigations
CXR and ABG (to check for high CO2 indicating type 2 respiratory failure especially if GCS not normal)
27
What do you call respiratory acidosis if not compensated
Acute rather than chronic
28
NIV is only for
T2 respiratory failure in context of respiratory acidosis and after you gave tried with medical therapy. CPAP is next step before intubation
29
Type 1 and 2 resp failure modes of oxygen as final step before intubation
T1 needs CPAP T2 needs BIPAP
30
Contraindications to NIV
Untreated pneumothorax, impaired conscious level, upper airway secretions, facial injury, life threatening hypoxia, vomiting, agitated
31
How does fibrosis show on CXR
Fine reticular Nodular shadowing
32
What should you check before you send someone for a CT scan
Us and Es for kidney function to check they can handle contrast
33
PE classification
PE can be provoked or unprovoked, haemodynamically stable or unstable
34
Treatment for different PE types
Thrombolysis for haemodynamically unstable, routine anticoagulation if stable
35
Treatment for asthma attack
Steroids 1st line IV aminophylline/salbutamol nebulised salbutamol/ipratropium bromide Urgent ITU or anaesthetist assessment , admit patient, portable CXR
36
T1 and T2 resp failure O2 sats aim
T1 = above 94% T2 = 88-92%
37
What is a safe asthma discharge bundle
PEFR > 75%, stopped regular nebs for over 24 hours, inhaler technique and adherance assessed, PEFR meter and asthma action plan At least 5 days oral pred, GP follow up within 2 working days, resp clinic follow up within 4 weeks
38
Principle of asthma management
Step up and down treatment
39
Causes of COPD
Smoking, inherited alpha 1 antitrypsin deficinecy, industrial exposure such as sooty air pollution
40
What is COPD
Airflow obstruction which is progressive and not fully reversible. Encompasses emphysema and chronic bronchitis
41
ECG changes with electrolyte disturbance
42
What to check when prescribing furosemide
Us and Es for eGFR as can impact kidney function and K+ to check for hypokalaemia
43
Risk factors for heart failure
Previous MI, A fib, HTN
44
Raised Troponin in someone with Afib
Can be due to Afib, if not chest pain then not major concern, send for repeat perhaps
45
What are possible clinical signs when examining a patient with COPD
Tachypnoea, wheeze, pursed lip breathing, barrel chest, peripheral cyanosis, CO2 retention flap, oedema, accessory muscle use
46
COPD care bundle
Smoking cessation and pulmonary rehab Bronchodilators, anti muscarinics, steroids and mucolytics Diet LTOT
47
What interventions alter prognosis for patients with COPD
LTOT for 16 hours a day, smoking cessation, pulmonary rehab, vaccination
48
Why may uncontrolled oxygen be potentially dangerous in someone with COPD
Could cause hypercapnia due to loss of hypoxic pulmonary vasoconstriction and respiratory drive (T2 resp failure)
49
What is the role of pulmonary rehabilitation in COPD
To increase social activities and exercise to help symptoms. MDT 6-12 week programme of supervised exercise, unsupervised home exercise, nutritional advice and disease education
50
Common causes of cough
Pneumonia, asthma, COPD, bronchitis, acid reflux, bronchiectasis
51
What drugs can cause cough
ACEi, sitagliptin, CCB, fentanyl, latanoprost, methotrexate, phenytoin, mycophenolate mofetil, omeprazole
52
LRTI CXR changes
None
53
Investigations for cough
Lung function tests if chronic Sputum sample, CXR, (pneumonia), FBC, CRP
54
CAP pathogens
Strep pn, H Influenzae, Moraxella Catarrhalis
55
Atypical pneumonia organisms
Legionella, pneumophila, chlamydia, mycoplasma Considered when not common on sputum sample or normal antibiotics not helping, high CURB65
56
What features help differentiate CAP from TB
TB Fever and nocturnal sweats in TB, weight loss over months, malaise, purulent sputum. May have skin/joint/Miliary TB, known TB contact or country Longer history and upper zones on CXr affected
57
HAP pathogens
E. coli, MRSA, pseudomonas, staph/strep/acinobacter
58
Hap and cap antibiotics
HAP Coamox if non severe (broad spectrum), Piperacillin or levofloxacin if severe CAP amox or azithro
59
What follow up arrangements should be made for a patient with pneumonia
HIV test, immunoglobulins, pneumococcal IgG serotypes, Haemophilus influenzae, 6 week CXR to check for resolution/cancer
60
What 3 clinical features do patients requiring hospital admission for COVID have
Hypoxia, bilateral lower zone changes on CXR, lymphopaenia (eosinopaenia)
61
COVID treatment
Oxygen, dexamethasone if on O2, tocilizumab/remdesivir, antibiotics, anticoagulation with heparin, CPAP
62
Co morbid conditions with lung cancer
TB scars, ILD, CAD, COPD
63
Clinical findings in lung cancer
Finger clubbing, dullness to percussion, cervical lymphadenopathy, wheeze, pallor, cachexia
64
What sites do lung cancer commonly metastasise to
Brain bones liver adrenals other lung Nearby lymph nodes
65
Paraneoplastic syndromes associated with lung cancer
Clubbing - increased blood flow to finger area leading to accumulation of fluid, xs growth factors encourage growth of blood vessels Hypercalcaemia - increased bone resorption as PTHrP has a similar action to PTH Anaemia - impaired EPO stimulation and production SIADH - cancer cells can produce ADH Cushing’s - Small cell lung cancer due to XS production of cortisol Lambert Eaton myasthenia syndrome - small cell lung cancer (development of autoantibodies due to antigens expressed by lung tumour, which cross react with channels at the neuromuscular junction)
66
CXR abnormalities in lung cancer
Single or multiple opacities, pleural effusion, lung collapse
67
How do you stage lung cancer
Staging CT NSCLC is better than SC
68
Why is lung cancer prognosis generally poor
Present with advanced or metastatic disease as symptoms can be masked by COPD etc
69
Opacification due to pleural effusion in lung cancer
Bad sign as suggests pleural involvement
70
Further imaging to diagnose pleural effusion
USS
71
Clinical signs in pleural effusion
Reduced chest expansion, tracheal deviation away, reduced vocal resonance, stony dull percussion, breath sounds reduced Nicotine staining, clubbing, RA joint deformity, fluid overload due to HF
72
How much is pleural fluid aspiration
50ml
73
How do you distinguish pleural fluid
Lights criteria Exudate if pleural fluid protein divided by serum protein is greater than 0.5
74
Symptoms in ILD
Progressive SOBOE, dry cough, connective tissue disease symptoms (arthralgia, dysphagia, dry eyes), general fatigue and malaise
75
Clinical signs in ILD
Bilateral fine end inspiratory crackles, dullness to percussion, finger clubbing, reynauds, arthritis causing crepitus
76
Common types of ILD
Usual interstitial pneumonia: idiopathic pulmonary fibrosis Non specific interstitial pneumonia: hypersensitivity pneumonitis Sarcoidosis
77
Recognised drugs causing ILD
Amiodarone, bleomycin, methotrexate, nitrofurantoin
78
ILD CXR appearance
Like a web- diffuse alveolar shadowing, reticular opacities, fibrosis
79
Which test confirms bronchiectasis
High resolution CT thorax
80
Common causes of bronchiectasis
Post infecting (whooping cough, TB), pulmonary disease (COPD/asthma), congenital CF, connective tissue disease, ABPA,
81
Common pathogens in bronchiectasis sputum
Haemophilus inf., pseudomonas Aeruginosa, moraxella catarrhalis, strep pn
82
Key principles of managing bronchiectasis
Treat underlying cause, physio for mucous clearance, sputum for routine culture as well as non TB bacteria 10 - 14 days antibiotics according to sputum culture
83
Pathology of CF
Autosomal recessive disease leading to mutations in CFTR gene (chromosome 7). Leads to multisystem disease (mostly resp and GI), caused by thickened secretions
84
Common multi systemic complications of CF
Respiratory infections, low body weight due to pancreatic insufficiency, distal intestinal obstruction syndrome due to thick dehydrated faeces/insufficient pancreatic enzymes, CF related diabetes, male infertility
85
Name an ICS, SABA and LABA
ICS beclomethasone SABA salbutamol LABA salmeterol

Y 3 Medicine (6 decks)

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