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Respiratory Qs Flashcards

1
Q

Differentiate refeeding syndrome features from congestive cardiac failure?

A

Both may have pulmonary oedema and peripheral oedema

New onset arrythmia + deranged electrolyes = refeeding

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2
Q

What do give a patient with penumonia who have a pmh of COPD

A

Prednisolone
give corticosteroids for vibes doesnt matter if COPD is acting up or not

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3
Q

[HIV] patient with pneumocystis jiroveci pneumonia 1st line tx?

A

Co-trimoxazole - mix of trimethoprim and sulfamethoxazole

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4
Q

A patient with bronchiectasis has an acute exacerbation, what is the most common causative agent?

A

Haemophilius influenzae

then you consider strep.a and psuedomonas aueruginosa

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5
Q

If a patient has indication that they have severe asthma, what PCO2 will determine that it is actually life-threatening?

A

A normal CO2, it should be low due to the fact she is hopefully hyperventilating

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6
Q

What types of asbestos are there?

A

Blue - Crocidolite - most fibrogenic

Brown - amosite - intermediate

White - chrysotile - least fibrogenic

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7
Q

Are asbestosis plaques a stage of pre-malignancy?

A

No, they are benign and having plaques does not put someone at a higher risk of mesothelioma any different from having asbestos exposure

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8
Q

transudative vs exudative pleural fluid (e.g. pleural effusion fluid analysis)

A

Transudative (changes in the pressures and pleural permeability)

  • Congestive heart failure
  • Liver cirrhosis
  • Severe hypoalbuminemia
  • Nephrotic syndrome

Exudative (changes to local factors)
- malignancy
- infection - pneumonia (most common exudative)
- trauma
- PE

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9
Q

If a pleural effusion fluid protein/serum protein ratio is
>0.5?
<0.5?

A

More than = exudate effusion
Less than = transudate effusion

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10
Q

On Xray you see the whole right lung area is white-out, is it massive pleural effusion or a lung collapse?

A

Lung collapse = trachea deviation
( also a pneumonectomy)

Pleural effusion = trachea pushed away

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11
Q

Pleural fluid with a protein level of what is indicative of exudate?

A

30+

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12
Q

Definitive diagnostic investigation for mesothelioma?

A

Thoracoscopy and histology

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13
Q

What score following polysomnography is diagnostic for OSA?

A

Apnoea-hypopnea index of 15+

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14
Q

Drug therapy for fibrotic lung disease?

A

Pirfenidone

Nintedanib

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15
Q

Which drugs can cause lung fibrosis (ACID - lower lung fibrosis)

A

Methotrexate
Amiodarone
Nitrofurantoin (+ other abx)
Chemotherapy

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16
Q

Which drugs can cause lung fibrosis (ACID - lower lung fibrosis)

A

Methotrexate
Amiodarone
Nitrofurantoin (+ other abx)
Chemotherapy

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17
Q

Lung transfer factor and transfer coefficient reduced in fibrosis?

A

How well oxygen is passing from lungs to blood

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18
Q

Spirometry picture in fibrosis?

A

Restrictive = FEV1/FVC ratio increased 70%+ with FVC decreased

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19
Q

Manage cov19 patient with hypoxia

A

oxygen
dexamethasone
remdesivir

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20
Q

Manage severe covid 19

A

monoclonal therapy with tocilizumab

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21
Q

hepatomegaly and jaundice in lung cancer?

A

Sign of mets

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22
Q

Headache and seizures in lung cancer?

A

sign of mets

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23
Q

Clubbing, cavitating lesions, hypercalcaemia?

A

Squamous cell lung cancer

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24
Q

What is lambert eaton syndrome?

A

Paraneoplastic syndrome in Small cell lung cancer

waddling gait, muscle tenderness, hyporeflexia, antibodies against voltage gated calcium channels at NMJ

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24
What is lambert eaton syndrome?
Paraneoplastic syndrome in Small cell lung cancer waddling gait, muscle tenderness, hyporeflexia, antibodies against voltage gated calcium channels at NMJ
25
How to stage COPD? (GOLD classification system)
dependent if symptomatic + FEV1/FVC ratio <0.7 = atleast stage 1 (have COPD) stage 1 = FEV1 80%+ of prediction stage 2 = FEV1 50-79% of prediction stage 3 = FEV1 30-49% of prediction stage 4 = FEV1 < 30% of prediction
26
can you have a dry cough pneumonia?
atypical organisms as cause
27
can you have haemoptysis in an infection?
yeah, severe pneumonia bronchiectasis (post infections all the time)
28
CURB65, R?
30+ RR
29
CURB65, B?
Systolic BP <90 (+/or) diastolic BP <60
30
Empirical tx for pneumonia mild moderate severe
mild - oral amoxicillin moderate - oral/IV amoxicillin + clarithromycin severe - IVco-amoxiclav + clarithromycin
31
tx abx for aspirate pneumonia
IV cephalosporin IV metronidazole
32
penicillin allergy and pneumonia?
cephalosporin instead of amoxicillin
33
tx for legionella pneumonia?
++ levofloxacin + rifampicin
34
red current sputum upper lobe cavitating pneumonia alcoholics, elderly, diabetic
klebsiella pneumonia
35
what pneumonia is linked with autoimmune haemolytic anaemia?
mycoplasma - if patient is anaemic, raised LDH, messed up LFTs (increased bili, unconjugated etc) * the pnuemonia causes the anaemia 2-3 weeks in
36
preceeding influenza predisposes to which pneumonia?
staphylococcus aureus penumonia
37
what prophylaxis may a HIV px need against Pneumocystis jiroveci pneumonia
give co-trimoxazole (usually tx) if their CD4 count is lower than 200!
38
'RIPE' TB tx side effects?
Rifampicin = hepatitis, red/orange secretion, lower INR despite warfarin use Isoniazid = hepatitis, peripheral neuropathy so give PYRIDOXINE Pyrazinamide = hepatitis, gout Ethambutol = optic neuritis * so need to check LFTS monthly
39
What disease test is offered to all TB patients?
HIV
40
Acute bronchitis summary?
Usually viral 2 weeks hx productive cough, runny nose, wheeze inflammation rather than consolidation (no consolidation signs on examination) do not give abx right away as mostly viral
41
when are abx indicated in acute bronchitis?
immediate if CRP 100+ consider in comorbid/very sick patients
42
investigation for adults with suspected asthma?
Adults with suspected asthma should have both a FeNO test and spirometry with reversibility
43
If a COPD px is breathless despite being on a SABA (salbutemol) / SAMA (ipratropium bromide) then what? *if show signs of asthmatic features
Add a ICS and a LABA (salmetrol)
44
After smoking what intervention really improves survival in copd px?
Long term oxygen therapy consider in px with cor pulmonale as well as loop diuretic
45
If a COPD px is breathless despite being on a SABA (salbutemol) / SAMA (ipratropium bromide) then what? *no signs of asthmatic features
LAMA) (tiotropium) and LABA e.g formetorol A SABA should be given instead for short-acting relief
46
abx prophylaxis in which COPD px?
Those who have too many exacerbations = azithromycin
47
Sarcoidosis skin signs? Eye signs?
Lupus pernio erythema nodosum maculopapular eruptions Anterior uveitis, keratoconjunctivitis sicca, glaucoma, papilloedema
48
Sarcoidosis staging (based on CXR)
Stage 1 - Bilateral hilar lymphadenopathy Stage 2 - Bilateral H.L + infiltrates Stage 3 - Only pulmonary infiltrates Stage 4 - Extensive fibrosis
49
pneumonia typical vs atypical organism
strep pnumoniae !! - most common, rusty sputum Haemophillus influenzae - gram- , COPD px Staph Aureus - post influenza, gram+, cavitating lesions Klebsiella - alcoholics, diabetics, red current sputum, cavitating lesions mycoplasma legionella chlamidya Pneumocystis Jirovecii
50
Adenocarcinoma of the lung summary
A NSCLC Peripherally located Most common and in non -smokers Gyncaecomastia
51
Squamous cell carcinoma lung summary
A NSCLC Centrally located Associated with smoking released PTHrP = hypercalcaemia Cavitating lesions on Xray
52
Small cell lung cancer summary?
Centrally located ectopic ADH + ACTH secretion which can result in cushings Kulchitsky cell involvement SVC obstruction = pembertons test
53
what paraneoplastic features may be seen in Small cell lung cancers?
SIADH/ Cushings Lambert Eaton syndrome = LEMS ⇒ difficulty walking (waddling gait), muscle tenderness, hyporeflexia. Muscle weakness that improves with exercise (as opposed to myasthenia gravis). Antibodies against the pre-synaptic voltage-gated calcium channels at the NMJ
54
Coal workers pneumoconiosis summary
coal miner exposure to coal dust usually asymptomatic but puts at risk of progressive massive fibrosis = exertion SOB, cough (black sputum) , upper lobes restrictive pattern
55
Silicosis summary
SOB + cough, fibrotic condition due to silica inhalation (stonemason, pottery, ceramics) puts you at risk of TB 'egg shell' calcification of hilar lymph nodes on CXR
56
Resp failure summary?
Type 1 = hypoxaemic, low Oxygen and normal CO2 Type 2 = Hypercapnic, low Oxygen and high CO2 (6+) (COPD exacerbations, neurological causes) IX = ABG MX: Oxygen to correct hypoxaemia first then T1 = CPAP then T2 = BiPAP
57
Patient with acute exacerbation of COPD who are in resp acidosis - resp failure mx? patient with COPD who are hypoxic but not yet in resp acidosis?
Non invasive ventilation 28% venturi mask
58
Influenza A - science
classified into various subtypes based on glycoproteins of viral envelope - haemaglutinin (H) and neuraminidase (N) causes annual and the larger intensity pandemics
59
Detected of the influenza virus?
Reverse transcriptase - polymerase chain reaction
60
Covid 19 Ix severe mx + leading cause of death?
Real time reverse transcriptase polymerase chain reaction VTE prophylaxis, oxygen therapy, mechanical ventilation -> ARDS resp failure
61
Pott's disease?
when tuberculosis spreads to bones e.g. spine
62
Cystic fibrosis - bronchiectasis summary
autosomal recessive, viscous secretions due to CFTR (cystic fibrosis transmembrane conductance regular gene) which codes Cl channels - recurrent infection, delayed puberty, malabsorption Ix - sweat test Mx - chest physio
63
Primary ciliary dyskinesia / karagener's syndrome - bronchiectasis summary
bronchiectasis + dextrocardia + recurrent sinusitis
64
Allergic bronchopulmonary aspergillosis - bronchiectasis summary
eosinophilia + raised IgE tx - oral prednisolone
65
Most common organism sputum bronchiectasis in CF and non CF patient
CF bronchiectasis = psueodmonas aeruginosa Non CF = haemophilus influenzae
66
extrinsic allergic alveolitis (fibrotic lung)
px with chronic exposure to bird droppings Type III hypersensitiity = lung damage
67
4 ds of fibrotic lung
dyspnoea - progressive digital clubbing diffuse inspiratory crackles dry cough
68
C in CURB 65
Confusion = AMTS of 8 or less
69
COPD infective exacerbation medication?
Amoxicillin if allergic - doxycycline / clarithromycin
70
Pneumonia with low Na+ and LFT deranged?
Legionella
71
erythema multiforme with chest infection?
mycoplasma pneumonia
72
hospital acquired pneumonia tx?
tazocin
73
Gold standard sarcoidosis mx?
Bronchoscopy + biopsy = caseating granulona
74
pleural fluid features if infected?
Prurlent, cloudy, acidic pH, but clear insert a chest drain
75
first line ix bronchiectasis? gold standard ix bronchiectasis?
CXR = tram lines CT = dilated bronchi, signet ring sign, tram track
76
what do cannonball rounded lesiosn suggest on X-ray?
Renal cell cancer mets
77
tension pnumothroax tx?
large bore 14-16G cannula = decompression in 2nd ICS MCL
78
antifibrotic agent?
Pirfenidone
79
what is bronchodilator reversibility?
FEV1 12% improvement
80
asthma management
1. SABA(Salbutamol) 2. SABA + ICS 3. SABA + ICS + LTRA (Montelukast) 4. SABA + ICS + LABA (Salmeterol)
81
given adrenaline twice but still anaphylaxis?
IV chlorphenamine 10mg + IV hydrocortisone 200mg
82
OSA mild, mod, severe?
Depending on episodes per hr 5-15 - mild 15-30 - mod 30+ - severe
83
hypertension type in OSA?
Can cause hypertension with widened pulse pressure as a complication as well ass low mood, low libido,
84
hyponatraemia in what cancer?
Small cell lung cancer
85
poor prognosis in sarcoidosis?
Increased calcium - indicates renal failure
86
Tb first line x Tb gold standard ix Tb latency ix
CXR - consolidation and bi-hilar lymphadenopathy. May see cavitating lesion in upper lobe Sputum Culture → Sputum acid-fast bacilli smear → Ziehl-Neelson stain, AFB positive Mantoux test (for contacts of infected)
87
what is resp arrest? extra-pul causes pulmonary causes
Cessation of breathing but do have a pulse opioid CNS depression, Myasthenia gravis, ALS, drowning airway obstruction - asthma/copd bronchospasm, impaired alveolar diffusio
88
metabolic acidosis mx metabolic alkalosis mx
IV Sodium Bicarbonate Acetazolamide

Year 3 (14 decks)

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