Respiratory Medicine Flashcards
1
Q
Calculate the atmospheric pressure of Oxygen (kPa).
A
Oxygen makes up 21% of the atmosphere.
At sea level, pressure is 760mmHg.
21/100 x 760 = 21.3kPa
2
Q
State the relationship between barometric pressure and altitude.
A
Inversely proportional.
As altitude increases, barometric pressure decreases
3
Q
Calculate the pO2 of alveolar gas (kPa).
A
Alveolar gas saturated with water vapour (-47mmHg).
Atmospheric gas pressure is 760mmHg.
(760-47) x (21/100)= 150mmHg
150/7.5= 20kPa
4
Q
State the partial pressure of oxygen in the alveoli compared to the blood in the pulmonary arteries.
A
150mmHg (alveoli) vs 40mmHg (blood)
5
Q
State the equation for pulmonary ventilation.
A
(VE) = TV x RF
6
Q
Outline the components of the respiratory control system
A
- Stimuli
- Sensors (Central + Peripheral Chemoreceptors)
- Central Control (PONS, Medulla)
- Effectors (Respiratory Muscles)
7
Q
State 3 inputs to the medullary control centres.
A
1) Voluntary Control: Cerebral cortex
• Bypass respiratory control centres in brainstem via cerebral cortex, sending signals directly to motor neurons in spinal cord which innervate respiratory muscles
2) Reflex modification
a) Pulmonary Stretch Receptors: Hering-Breuer reflex: Inspiration ≈ ∆ pulmonary stretch receptors ≈ afferent discharge inhibits inspiration
b) Irritant receptors: Irritants (Smoke, dust, noxious gases…) ≈ detected by irritant receptors (free nerve endings between airway epithelial cells) ≈ initiate reflex bronchial + laryngeal constriction
c) Juxta-Capillary Receptors: Change in interstitial fluid volume ≈ J-receptors detect ∆ in alveolar walls (close to capillaries) ≈ afferent impulses up Vagus never in slow conducting myelinated fibres ≈ rapid, shallow breathing
d) Upper Airway Receptors: Mechanical + chemical stimuli ≈ upper airway receptors detect ∆ ≈ deep inspiration + closure of glottis ≈ pressure builds then expel via sneeze or cough
8
Q
What is the term for the reflex in which inspiration inhibits further inspiration via negative feedback from stretch receptors?
A
Hering-Breuer Reflex
9
Q
State the 4 generators of respiratory rhythm. Which 2 originate in the PONS and which 2 originate in the MO?
A
Pneumotaxic Centre - DRG fire thus Stimulation of Pneumotaxic Centre thus Terminates inspiration (tax) ≈ reduced inspiration depth but increased rate (as frequency is higher)
Apneustic Area - Stimulation excites DRG thus prolong inspiration with long + deep breathes to control intensity of breathing thus increase tidal volume and reduce RR
Inspiratory Centre - Pre-Botzinger complex thus DRG thus contraction of diaphragm, external intercostal, SCM and anterior scalene thus inspiration thus firing ceases ≈ expiration
Expiratory Centre - DRG excites VRG thus VRG ≈ contraction: internal intercostals + abdominals ≈ forceful respiration
10
Q
Outline the hierarchical structure of the respiratory tree.
A
- 1º Bronchus
- 2º Bronchus
- 3º Bronchus
- Bronchioles
- Terminal bronchioles
- Respiratory bronchioles
- Alveoli
- Pulmonary surfactant
- Lobular
- Pleura (Visceral, parietal, pleural cavity)
11
Q
State 4 cells present in the alveolar components.
A
1) Type I Cells
• Simple squamous epithelia
2) Type II Cells
• Septal cells
• Surfactant secretin cells
• Microvilli
3) Alveolar Dust Cells
• Migrating macrophages
4) Pores of Kohn
• Collateral airflow between alveoli
12
Q
What is the name of the cells providing collateral airflow between alveoli?
A
Pores of Kohn
13
Q
Outline Fick’s Law.
A
Principle that rate of diffusion is proportional to diffusion co-efficient, surface area and partial pressure whilst inversely proportional to wall thickness
Q = D A (P2-P1)/L
14
Q
State the law of Laplace.
A
T = PR/2
15
Q
Outline the process of inspiration.
A
- Contraction of diaphragm + external intercostal muscles
- Chest wall and lungs stretched + ribs up and out
- Increased size thus increased volume thus intra-alveolar pressure falls -> Boyle’s Law
- Air enters lungs down pressure gradient until intra-alveolar pressure
16
Q
Outline the process of expiration.
A
- Relaxation of inspiratory muscles -> passive
- Chest wall + stretched lungs recoil -> return to pre-inspiratory size due to elastic properties
- Intra-alveolar pressure rises as molecules contained in smaller volume
- Air leaves lungs down pressure gradient until intra-alveolar pressure -> atmospheric pressure
17
Q
Define the FEV1.
A
Volume expelled after 1 second (≈ PEFR) ≈ > 80%
18
Q
State the FEV5 (FVC)
A
Volume of air expired after one breath ≈ 80%
19
Q
Outline the different values derived from spirometry.
A
- FEV1
- FEV5 (FVC)
- TV
- IRV
- IC (TV + IRV)
- ERV
- RV
- FRC (ERV + RV)
VC (IC + ERV)
TLC (IC + FRC)
20
Q
What is dead space? How much is usually present in the lung?
A
Air remaining in conducting airways where no GE occurs ≈ anatomical dead space ≈ airway dead space ≈ 150mL
21
Q
Calculate the alveolar ventilation.
TV = 500mL RF = 12
DS = 150
A
(500-150) x 12 = 4.2L/min
22
Q
State 3 indications for a CXR.
A
Dyspnea
Acute Chest Pain
Chronic cough (6 weeks)
Trauma
23
Q
State the 5 densities observed in an XR.
A
- Air
- Fat
- Water (soft tissues)
- Bone
- Metal
24
Q
Outline the Silhouette sign in XR.
A
• Object in close contact with material of same density ≈ borders obliterated ≈ difficult to distinguish.
25
Outline summation in XR.
Object of same radiographic density overlap but not in contact ≈ summatio
26
Outline your process for interpreting CXR.
1. ID and Oritentation
2. Summary: lines, devices, catheters, masks, NG tube etc etc
3. Airways: Trachea, Carina, Bronchi
4. Breathing: S approach of lung field, lung volume, costophrenic angle, costomediastinal recess, cardiac borders
5. Circulation: position, size, shape, width
6. Disability: ribs, clavicles, shoulders, vertebral bodies
7. Everything else: gas under diaphragm, subcutaneous emphysema, hiatus hernia, lung apexes
27
Outline the stages of change.
1) Pre-contemplation = No need to change behaviour
2) Contemplation = Consider behaviour is problematic
3) Preparation = Evaluate how to make a change
4) Action = Engage in real efforts to change
5) Maintenance = Successful at changing behaviour and attempting to maintain new skills
6) Termination = Eradicated old behaviours through adopted behavioural changes and continue to maintain these positive changes
28
Outline the presentation of RDS.
* Tachyopneoa
* Grunting
* Intercostal recessions
* Nasal flaring
* Cyanosis
29
How do you manage RDS?
* Maternal steroid
* Surfactant as needed
* Ventilation (non-invasive/invasive) depending on levels needed
30
What is Transient Tachypnoea of the Newborn? Outline the presentation.
Respiratory fluid (which normally goes away before birth) remaining after birth
* Tachyopnoea (resp rate >60)
* Nasal flaring
* Grunting
* Intercostal/subcostal recessions
* Crackles
31
What gene defect causes CF?
CFTR
32
What enzyme can aid your diagnosis of CF? Why is this?
Serum trypsinogen.
Trypsinogen produced in pancreas and converted to active form of trypsin in SI. CF mucous blocks exocrine tubes of pancreas thus high trypsinogen but low trypsin.
33
Outline the general management of Acute Asthma.
* O- oxygen
* S- nebulised salbutamol
* H- hydrocortisone 100mg IV (or prednisolone PO 40mg)
* I- ipratropium 500mcg
* T- theophylline 1g/1L at 0.5mL/kg/hour
* M- magnesium sulphate 2g over 2 mins
* E- escalate care
34
What pathogen causes Bronchiolitis.
RSV
35
What age does Bronchiolitis usually occur?
Under 18 months
36
How do you treat Bronchiolitis?
Supportive
37
How may pneumonia present in a child?
* Cough with sputum production
* Fever
* Dullness on percussion
* Bronchial breathing
38
What type of cough is pathognomonic in croup?
Seal-bark cough
39
State 3 causes of stridor.
* Neoplasms- most commonly- larynx, trachea, bronchus
* Anaphylaxis
* Goitre
* Foreign body
* Trauma
40
Describe Tracheomalacia.
This is when the cartilaginous rings keeping the airway patent are soft meaning the trachea partly collapses especially during expiration and increased airflow.
41
How may tracheomalacia present.
Presents with stridor, SOB, cyanotic spells, worse on activity
42
What immunoglobulin mediates anaphylaxis?
IgE
43
How may anaphylaxis present.
* Flushing
* Priuritis
* Urticaria
* Angioneurotic oedema- face, lips, tongue, larynx, bronchi
* Abdo pain and vomiting
* Hypotension
* Stridor, wheeze, eventual respiratory failure
44
How would you manage anaphylaxis?
* IM adrenaline (500mcg/300mcg/150mcg) at 1:1000 concentration
* IV antihistamine
* IV corticosteroid
* High flow O2, nebulised bronchodilators
* Intubation if necessary
- IV Fluids: 500mL or 10mL/kg (child)
45
What dose of IM adrenaline is given for an adult?
500mcg thus 0.5mL of 1mg/mL at 1:1000 concentration
46
What dose of IM adrenaline is given for an child 6-12 years?
300mcg thus 0.3mL of 1mg/mL 1:1000 concentration
47
What dose of IM adrenaline is given for children under the age of 6?
150mcg so 0.15mL of 1mg/mL (1:1000)
48
What volume of IV fluid do you use to resuscitate an adult?
500-1000mL
49
What volume of IV fluid do you use to resuscitate a child?
10mL/kg
50
How much IV fluids would you use to resuscitate a 45kg child?
10mL/kg thus 45 x 10 = 450mL
51
Describe OSA.
Relaxation of pharyngeal dilator muscles during sleep (especially REM) causing intermittent upper airway collapse. This causes upper airway narrowing, turbulent airflow and vibration of the soft palate and tongue base.
52
State 3 RFs for OSA.
* Enlarged tonsils and adenoids
* Obesity
* Retrognathia
* Acromegaly, hypothyroidism
* Oropharyngeal deformity
* Neurological disorder e.g. stroke
* Drugs e.g. benzos
53
What investigation may you use to diagnose OSA.
Epworth score
54
How do you manage SA?
* Remove underlying cause
* Continuous positive pressure airway (CPAP)- works by blowing air into the airways keeping the pressure positive, meaning the airway doesn’t close.
55
Describe a Pulmonary Embolism?
Thrombus formation in a deep vein (DVT), formed by ∑ venous stasis, hypercoagulability and trauma (Virchow’s Triad), which translocated to the pulmonary vasculature causing a spectrum of disease.
56
Which eponymous triad seeks to outline thrombus formation.
Virchow's Triad:
- Hypercoagulability
- Venous stasis
- Endothelial damage
57
Outline the 3 types of PE.
- Massive = shock or hypotension
- Submassive = pulmonary trunk or main PA with RV strain but no hypotension
- Small = lobar or segmental arteries only
58
Which tool is used to calculate the risk of PE?
Wells score
59
How do you calculate a Wells Score?
DAMN BC
- DVT Sx
- Mobility reduced (> 3 days) or surgery (within 4 weeks)
- Known history of DVT/PE
- Blood in cough (haemoptysis)
- Cancer
- Pregnancy or 6 weeks postpartum
- COCP
- FHx
60
How may a PE present?
* Cough
* Dyspnoea
* Cx pain
* Hypoxemia
• DVT Sx: Skin ∆, tenderness, temperature, venous distension
61
What is the first line diagnostic imaging test for a suspected PE?
If they are pregnant does this change?
CT-PA
VQ Scintigraphy
62
How do you manage a PE?
• Anticoagulation: Apixaban/ Rivaroxaban
OR (Pregnant)
• Anticoagulant: LMWH
-> DOACs may cross placenta
If in shock, Thrombolysis
63
Why do you not give DOACs in pregnancy?
They may cross the placenta
64
Describe acute bronchitis.
Self-limiting LRTI caused by viral infection (or bacterial) resulting in bronchial inflammation characterised by cough (worse at night) + 1 or more LRTI Sx (∑ wheezing, sputum, chest pain)
65
What pathogen is the primary cause of acute bronchitis in the military/college?
M pneumoniae
C pneumoniae
66
How may acute bronchitis present?
* Fever
* Productive cough
* Sputum: clear/white/discoloured
* Wheeze
* Rhonchi (continuous, low-pitched rattling = ‘snoring’)
67
How would you manage Acute Bronchitis?
• Supportive: Observe + Antipyretic (Paracetamol) ± SABA (Salbutamol)
68
Describe COPD.
Umbrella term (∑ Emphysema + Chronic Bronchitis) for preventable and treatable disease state featuring airflow limitation which is irreversible characterised by cough, sputum production, and dyspnoea.
69
State 3 RFs for COPD.
- Cigarette smoking
- Environmental exposures: chemical/ physical/ biological/ cultural
- Infections
- Advanced age
- Genetic factors: Anti-alpha trypsin
70
What genetic mutation may cause COPD?
AAT
71
How may COPD present?
* Productive cough (morning, productive)
* Dyspnea
* Sputum
* Barrel chest (AP diameter increased)
* Increased work of breathing: Leaning forward/Accessory muscle recruitment/ Intercostal recession / Tracheal tug/Nasal flare
* Hyper-resonance on percussion
* Distant breath sounds on auscultation
* Poor air movement on auscultation (loss of lung elasticity and lung tissue breakdown)
* Wheezing on auscultation
* Coarse crackles (mucous and inflammation)
72
What investigations would you order in a patient with suspected COPD?
* FBC: Raised Hct (polycythemia), possible raised WBC
* Sputum culture: Infective pathogen
* Spirometry: FEV1/FEVC < 0.7 = Obstructive picture; FEV1/FEVC < 0.7 and FEVC < 0.8 = Mixed picture
* SpO2: Low saturation -
* CXR: Hyperinflation and hyperlucent lungs; increased AP ratio; flattened diaphragm; increased ICS Target is 88-92%
* ECG: Signs of RV hypertrophy, arrhythmia, ischemia
73
What does your management of COPD depend on?
GOLD Criteria
74
What constitutes GOLD A criteria for COPD?
0-1 exacerbations per year
CAT <10
75
What constitutes GOLD B criteria for COPD?
0-1 exacerbations
CAT > 10
76
Outline your management for COPD.
• Conservative: Smoking cessation + Vaccinations (Influenza + S. pneumoniae)
+
• SABA: Salbutamol
+
• LABA: Salmeterol
+
• LAMA: Tiotropium/ Umeclidinium/ Aclidinium/ Glycopyrronium
```
IF GOLD C/D
+
• ICS: Fluticasone/Budesonide
+
• Pulmonary Rehabilitation: Aerobic exercise; Strength training; Education
±
• Long-term Oxygen therapy
-> PaO2 < 7.3kPa or 55mmHg (room air)
```
77
Outline your management of an acute exacerbation of COPD.
* Long-term Oxygen therapy
* Mucolytic: Acetylcysteine
* PDE inhibitors: Theophylline
* ABX: Amoxicillin
78
What criteria is used to assess air-flow limitation in COPD?
GOLD criteria (FEV1)
79
Outline the categories of GOLD criteria for air flow limitations.
GOLD 1 = FEV > 80%
GOLD 2 = FEV 50-79%
GOLD 3 = FEV 30-49%
GOLD 4 = FEV < 30%
80
Outline the MRC Dyspnoea scale and its stages.
Grade 0 = only in strenuous exercise
Grade 1 = walk up hill
Grade 2 = stop for breath when walking at own pace
Grade 3 = walk for 100m
Grade 4 = breathless at rest/ doing ADLs
Grade 1 = strenuous exercise
Grade 2 = walking up inclines
Grade 3 = walk for 100m
Grade 4 = breathless at rest/ADLs
81
Which is the most common lung cancer?
AC
82
Which cancer commonly presents as an obstructive lesion leading to infection?
Squamous cell carcinoma
83
Which form of lung cancer tends to secrete PTHrp?
Squamous cell carcinoma
84
Give 5 potential extrapulmonary manifestations of Lung cancer.
Horner's Syndrome
SVCO
Phrenic nerve palsy
Recurrent laryngeal nerve palsy
SIADH
Limb encephalitis (anti-Hu)
Lambert-Eaton myasthenic syndrome
Hyperprolactinaemia
Cushing's syndrome
Hyperparathyroidism
PHOA (periostitis + arthropathy + clubbing)
85
A patient presents with SOB 6/12. They have had a cough which is productive for 6/52. The cough produces sputum which is tinged with dark red blood.
They have been experiencing some diplopia and a droopy eyelid. On top of this, their throat feels weaker with difficulty swallowing.
They have COPD and a pack history of 30 years.
What is your diagnosis?
A. Large cell lung cancer
B. Adenocarcinoma
C. Limb encephalitis
D. Lambert-Eaton Myasthenic Syndrome
D
86
What are the key differences between Lambert-Eaton Syndrome and Myaesthenia Gravis?
Lambert-Eaton Syndrome:
- Abs to CaVg
- Presynaptic
- ANS involvement
- Weakness improves with contraction
Myaesthenia Gravis:
- Abs to ACh
- Post-synaptic
- No alterations of ANS
- Associated with thyroid disease
- Weakness worsens with contractions
87
What is the biggest risk factor for mesothelioma?
Asbestos exposure - can follow up to 45 years
88
How may you classify pneumonia?
Location acquired
CAP
HAP
Aspiration
Immunocompromised
89
Which of the following is a cause in nosocomial pneumonia?
A. S aureus
B. Legionella
C. C trachomatis
D. C difficile
D
90
Which of the following is a cause in nosocomial pneumonia?
A. S aureus
B. Legionella
C. Klebsiella
D. C trachomatis
C
91
Why would a patient be more at risk of aspiration pneumonia?
Impaired swallow or immunocompromised
Neurological conditions
Reduced consciousness
Oesophageal disease
Poor dental hygiene
92
Which decision-making tool could be used in a CAP? Outline it.
CURB65
* Confusion
* Urea (≥ 7mmol/L)
* Respiration rate (> 30)
* Blood pressure
* 65 ≥
93
A 70 year old patient in primary care presents with a cough 3/7; fever of 37.8 degrees and feels generally unwell.
O/E their HR is 100bpm; BP 110/58mmHg; RR 32.
What is your management?
CURB Score = 2
Hospital admission
+
Co-amoxiclav PO
94
How do you treat Pneumocystis pneumonia?
Co-trimoxazole 2/52
95
What are the potential complications of a pneumonia?
Sepsis
Empyema
Lung abscess
96
What is the most common cause of pneumonia?
S pneumoniae (50%)
H influenzae (20%)
97
Which atypical pneumonia is likely to present with hyponatraemia?
Legionella pneumophila
98
Which atypical pneumonia is commonly contracted from birds?
C psittaci
99
Which atypical pneumonia is contracted from the bodily fluids of animals?
Coxiella burnetti (Q fever)
100
Which atypical pneumonia is associated with erythema multiforme?
Mycoplasma pneumoniae
101
A FEV1/FEVC Ratio <0.7 is?
Obstructive
102
A FEV1/FEVC ratio >0.7 is?
Restrictive
103
How do you choose a PEF reading of the 3 taken?
Choose the best
104
What are the triggers for asthma?
```
Exercise
Smoking
Allergens
Damp
Dust
Strong emotions
```
105
What is the gold-standard test for asthma?
There is no gold standard test for asthma.
Tests:
PEF
Spirometry
FeNO
106
What is the management for asthma?
Adults:
SABA ± ICS ± LRTA ± LABA ± Increased ICS ± Referral (biologics)
Children: SABA ± low-dose ICS ± LTRA ± LABA ± increase ICS dose ± Referral (biologics)
<5 years old
SABA ± moderate dose ICS trial (8 wks) ± low-dose ICS + LTRA ± Refer to paediatric asthma specialist
107
What is considered low dose ICS?
200mcg budesonide
108
What is considered paediatric moderate dose ICS?
200-400mcg budesonide
109
What is considered paediatric high dose ICS?
>400mcg budesonide
110
What is considered low dose ICS in adults?
<400mcg budesonide
111
What is considered moderate dose ICS in adults?
400-800mcg budesonide
112
What is considered high dose ICS?
>800mcg budesonide
113
What are the clinical features of acute severe asthma?
* PEF: 33-50% predicted
* Cannot complete sentences in one breath
* RR > 25 breaths/min ≈ tachypnoea
* HR > 110 beats/min ≈ tachycardia
114
What are the clinical features of life-threatening asthma?
* PEF < 33% predicted or best
* SpO2 <92%
* Silent chest, cyanosis, feeble respiratory effort
* Arrhythmia or hypotension
* Exhaustion, altered consciousness
115
What is the management for an acute exacerbation of asthma?
Mnemonic O SHIT MAn
Oxygen 10-15L via non-rebreather
Salbutamol: 5mcg
Hydrocortisone IV: 100mg OR Prednisolone 40-50mg
Ipratropium: 500mcg
Theophylline 1kg in 1L at 0.5mL/kg/h
Magnesium Sulphate: 2g over 20 minutes
Anaesthetist nearby
116
What gene mutation may predispose you to COPD?
AAT1 ∆
117
How may COPD be classified?
GOLD Criteria of GOLD A, B, C or D
Gold A = 0-1 exacerbations and CAT <10
GOLD B = 0-1 exacerbations and CAT >10
GOLD C = >2 exacerbations or 1 in Hospital + CAT <10
GOLD D = >2 exacerbations or 1 in Hospital + CAT >10
118
What are the management options for COPD?
SABA
LABA
LAMA
±
ICS
+
ABX
±
Acetylcysteine
/
Theophylline
119
What is the target oxygen saturation in COPD?
88-92%
120
How do you manage an acute exacerbation of COPD?
Usual medication: SABA + LABA ± LAMA ± ICS
* Long-term Oxygen therapy
* Mucolytic: Acetylcysteine
* PDE inhibitors: Theophylline
* ABX: Amoxicillin
121
What are the two forms of NIV?
BiPAP
CPAP
122
Which form of NIV is used if there is a low Oxygen and high CO2?
BiPAP
123
On CT-Chest, what radiographic find is observed in interstitial lung disease?
Hazy shadowing known as ground glass opacification (GGO)
124
Which drugs may cause Drug-Induced Pulmonary Fibrosis?
Mnemonic: CBA MaN
Cyclophosphamide
Bleomycin
Amiodarone
Methotrexate
Nitrofurantoin
125
What type of hypersensitivity reaction causes Hypersensitivity Pneumonitis?
Type III Hypersensitivity reaction
126
Which pathogen is tested in Farmer's Lung?
A. M. faeni
B. Avian protein antigen
C. A. clavatus
D. Botrytis
A
127
Which pathogen is tested in Wine maker's Lung?
A. M. faeni
B. Avian protein antigen
C. A. clavatus
D. Botrytis
D
128
Which pathogen is tested in Bird Fancier's Lung?
A. M. faeni
B. Avian protein antigen
C. A. clavatus
D. Botrytis
B
129
Which pathogen is tested in Cheese washer's Lung?
A. M. faeni
B. Avian protein antigen
C. A. clavatus
D. Botrytis
C
130
What is the management for Hypersensitivity Pneumonitis?
Avoid antigen
+
Corticosteroid taper
131
What are the two types of pulmonary effusion?
Exudative (protein >3g/dL)
or
Transudative (<3g/dL)
132
Which of the following is not an exudative cause of Pulmonary Effusion?
A. Lung cancer
B. Pneumonia
C. RA
D. Congestive cardiac failure
D
133
Which of the following is not a transudative cause of Pulmonary Effusion?
A. Hypothyroidism
B. Meig's Syndrome
C. RA
D. Congestive cardiac failure
C
134
What radiographic finds may you see on a CXR with pleural effusion?
Blunting of costophrenic angle
Fluid in lung fissures
Meniscus
Tracheal and mediastinal deviation (if massive effusion)
135
How do you measure the size of a pneumothorax? Explain.
BTS Guidelines from 2010
Find hilum, measure horizontally from lung edge to inside of chest wall.
136
How do you manage a pneumothorax?
No SOB/<2cm = supportive management + FU in 4 weeks
SOB/>2cm = aspiration and reassessment
Aspiration fails twice = chest drain
137
How do you manage a tension pneumothorax?
Aspiration with large bore cannula in 2nd ICS in MCL
Once inserted, definitive management is with a chest drain.
Insert above rib, into triangle of safety of AAL-MAL-5th ICS
138
What is used as VTE prophylaxis?
LMWH
±
Compression stockings
139
What decision-making criteria can be used to determine requirement for imaging following a DVT?
Wells Score
4> = Unlikely thus D-Dimer
>4 = Likely thus CT-PA
140
What would the ABG show in a patient with Pulmonary Embolism?
Respiratory alkalosis
141
How is a PE managed?
Acute: DOAC
- consider switch
IV Alteplase (if massive PE)
or
Antiphospholipid syndrome: LMWH
Continue anticoagulation for 3 months
3+ months if cause unclear or irreversible
6 months if Cancer
142
What should the INR be when using warfarin to treat a PE?
2-3
143
What determines use of thrombolysis in PE?
Haemodynamic instability
144
If a pregnant woman experiences a PE, what is your management?
Admission; monitoring; fluids;
+
LMWH
145
What factors make up a Wells Score?
Mnemonic: DAMN BC
DVT Sx
Another DDx unlikely
Mobility reduced
Known history of VTE
Blood in cough
Cancer
146
What is the management for OSA?
Weight loss; CPAP
±
Maxfax referral/surgery
147
What is the gold-standard test for CF?
Chloride sweat test >60mmol/L
148
What breath sounds may be heard in TB upon auscultation?
* Bronchial breathing
| * Amphoric breath sounds (distant hollow breath sounds heard over cavities)
149
What is the management for TB?
Mnemonic: RIPPE
```
Rifampin
Isoniazid
Pyrazinamide
Pyridoxine
Ethambutol
```
150
What are the side effects of Rifampicin?
Red/pink body secretions
Liver enzyme inducer
Elevated LFTs
151
What are the side effects of isoniazid?
Polyneuropathy
| Allergic reactions
152
What are the side effects of pyrazinamide?
Gout
Rash/arthralgia
Hepatitis
153
What are the side effects of Ethambutol?
Optic neuritis
154
Presence of Migratory polyarthritis, bilateral hilar lymphadenopathy and erythema nodosum is called?
Lofgren Syndrome
155
Presence of Parotitis, Uveitis and Facial palsy in Sarcoidosis is known as?
Heerfordt Syndrome
156
What are your differentials for an anterior mediastinum mass noted on CXR?
```
Thymoma
Thyroid (goitre, mass)
Terrible lymphoma
Thoracic aneurysm
Teratoma
```
