Respiratory Medicine Flashcards
How is COPD diagnosed?
Post bronchodilator FEV1/FVC < 0.7
What is the first line treatment for COPD?
SABA/SAMA
What is the second line treatment for COPD if no features of asthma/steroid responsiveness are present?
Add LABA + LAMA
(If already taking SAMA, switch to SABA)
What is the second line treatment for COPD if features of asthma/steroid responsiveness are present?
LABA + ICS + LAMA
What is the third line treatment for COPD?
Triple therapy - ICS + LABA + LAMA
What are the treatment options for COPD?
Physical training
Postural drainage
Antibiotics for exacerbations
Bronchodilators
Immunisations
Surgery
Which parameters make up a CURB 65 score?
Confusion
Urea >7
RR > 30
BP SBP <= 90mmHg and/or diastolic <= 60mmHg
65 - Age >= 65
Which acute features are seen in sarcoidosis?
Erythema nodosum
Bilateral hilar lymphadenopathy
Swinging fever
Polyarthralgia
Which insidious features are seen in sarcoidosis?
Dyspnoea
Non productive cough
Malaise
Weight loss
Which skin rashes/lesions are associated with sarcoidosis?
Lupus pernio
Erythema nodosum
Which triad are features are characteristic in Granulomatosis with polyangiitis (GPA)?
Haemoptysis
Renal impairment
Saddle nose
Which features are seen in moderate acute asthma?
PEFR 50-75%
Speech normal
RR < 25
HR <110 bpm
Which features are seen in severe acute asthma?
PEFR 33-50%
Can’t complete sentences
RR > 25
HR >110 bpm
Which features are seen in life threatening acute asthma?
PEFR < 33%
SpO2 <92%
Which features suggest asthmatic features/steroid responsiveness in COPD?
Asthma/atopy
Eosinophilia
Substantial variation in FEV1
Diurnal variaration in PEF
Which antibiotic is given for COPD exacerbation prophylaxis?
Azithromycin
Which ABG features are suggestive of chronic CO2 retention in COPD?
Normal pH
Increased PaCO2
Increased bicarb (chronic renal compensation)
Low PO2
Which features of Light’s criteria suggest that a pleural effusion is exudative?
LDH >2/3rds upper limit of serum
Pleural fluid LDH/ serum LDH >0.6
Pleural protein / serum protein >0.5
How should asthma treatment be stepped down?
Reduced ICS dose by 25-50%
How is a primary pneumothorax <2cm with no SOB managed?
Discharge
How is a primary pneumothorax <2cm with SOB managed?
Aspiration
How is a primary pneumothorax <2cm with SOB managed if initial management fails?
Chest drain
How is a secondary pneumothorax >2cm, with SOB, in a patient >50 years managed?
Chest drain
How is a secondary pneumothorax with a rim of 1-2cm managed?
Aspiration
What can cause anterior mediastinum masses?
Thymoma, thymic mass, thyroid mass, lymphadenopathy.
What is the commonest cause of bronchiectasis in children/young people?
Cystic fibrosis
What is the second line treatment for asthma?
SABA + ICS + LABA
Which features are seen on examination in a haemothorax?
Dull percussion of affected side with absent breath sounds?
What is lupus vulgaris?
Painful cutaneous TB lesions. Nodular in appearance
Which ABG features are seen in T1RF?
Hypoxia
Normal/low PaO2
Which ABG features can be seen in PE?
Low Co2, increased pH (respiratory alkalosis)
V/Q mismatch - increased respiratory drive
What is the commonest lung injury following blunt trauma?
Pulmonary contusion
Which condition can cause hyper-resonance on percussion?
Pneumothorax
Emphysema
How does Strep. pneumoniae pneumonia typically present?
CAP
Rust coloured “blood tinged” sputum
Lobar pattern of infection
What is the first line management for HAP?
Co-amoxiclav
What is the second line management for HAP?
Doxycycline
What are the top 3 causes of pleural effusion?
Malignancy
Heart failure
Pneumonia
Define mild COPD
FEV1 >80%
What is the rationale for prescribing ICS in COPD patients?
Reduces frequency of exacerbations
