Respiratory Week 1 Flashcards
(98 cards)
1
Q
6 main symptoms of respiratory diseases
A
Cough Sputum Haemoptysis Chest pain Dyspnea Tachypnea
2
Q
Why does cough syncope happen
A
Fainting after coughing too much happens because of the build up in intrathoracic pressure which reduces venous return to the heart
3
Q
What conditions can cause creamy sputum?
A
COPD
4
Q
What causes frothy white sputum?
A
Pulmonary edema
5
Q
What is the definition of massive haemoptysis
A
Over 600ml in 24 hours of blood
6
Q
Describe pleuritic pain
A
Sharp pain, stabbing, worse on inspiration
7
Q
Clarification questions about dyspnea
A
When it came out, does it come at a particular time, pattern, weekday/weekend?
Exercise tolerance, relief and exacerbation
ADLs
8
Q
What does PND indicate?
A
Heart failure
9
Q
What is cheyne stokes breathing
A
Waxing an waning breaths, shallow intermittent breathing
10
Q
What is stridor?
A
High pitched sound on inspiration due to large airway obstruction
11
Q
Possible drugs that cause coughing
A
ACEI or methotrexate
12
Q
What is finger clubbing associated with
A
Lung cancer, bronchiectasis, fibrosing alveolitis
13
Q
What causes bronchial breath sounds?
A
Consolidation
14
Q
2 variants of cough asthma?
A
Eosinophilic vs non-eosinophilic type
15
Q
Acute management plan for someone coming in with SOB and low o2 sats, wheeze,
A
Give O2, neb SABA
16
Q
Investigations of someone coming in with high RR, low sats, dyspnea and high BP
A
CXR, ABG,
17
Q
Management of chronic asthma
A
Remove allergens SABA LABA Theophylline, montelukast Steroids
18
Q
Difference between COPD and asthma
A
Asthma is reversible, COPD isn’t
19
Q
What is Hoover’s sign in emphysema?
A
Flattened diaphragm due to over inflation.
20
Q
How to differentiate obstructive VS restrictive lung disease?
A
FEV1/VC ratio if less than 70% is obstructive
21
Q
What stage of copd is someone with
FEV1/VC = 57%
FEV 45% of predicted
A
Severe obstructive COPD
22
Q
Differentiation between bronchial and vesicular breath sounds
A
Bronchial sounds heart on both inspiration and expiration
Whereas vesicular sounds are mostly heard during inspiration
23
Q
What 3 patient identifier is required in writing a prescription
A
Patient name
Patient number
DOB
24
Q
What information is required when prescribing PRN
A
Max 24 hour dose
Min Interval between dose
Indications for medication
25
Difference between type 1 and 2 respiratory failure
Type 1 RF is hypoxaemia but normal CO2
Type 2 RF is hypoxaemia and high CO2
26
What is measured in an ABG?
```
PO2
PCO2
PH
HCO3
BE
```
27
How to tell if respiratory or metabolic acidosis/alkalosis
See if CO2 or HCO3 is abnormal.
28
4 steps to interprete ABG
Look at PH, acidosis/alkalosis or normal
Look at PCO2
Look at HCO3
Look at oxygenation
29
At what PO2 is patient in respiratory failure
<8
30
Pulmonary embolism will cause metabolic acidosis, true or false?
False
PE usually associated with respiratory alkalosis due to increased ventilation.
31
List these in order of doubling time
SCLC
Squamous cell carcinoma
Adenocarcinoma
SCLC
SCC
Adenocarcinoma
32
On a CXR, what can a raised diaphragm indicate?
Phrenic nerve palsy and muscle wasting of diaphragm
33
What would a SCC CXR feature
Necrosis and cavitation lesions shown as air and fluid.
Can be mistaken for an abscess
34
Classical presentations of lung cancer
```
Cough
Dyspnea
Chest pain
Haemoptysis
Weight loss
Finger clubbing
```
35
What is a "sail sign" on a CXR?
Lower left lobe collapse dorsal to the heart, showing a straight line parallel to cardiac shadow
36
What causes hoarseness in lung cancer?
Recurrent laryngeal nerve compression
37
Symptoms and cause of horners syndrome in lung cancer
Ptosis, miosis and anhidrosis
Pancost tumor compressing sympathetic nerves at apex of lung
38
What can SVC obstruction present as
Swollen face, skin discoloration due to venous distension
39
What does a large globular heart on CXR indicate
Pericardial effusion
40
What does a spinal metastasis present with
Urinary changes, back pain, leg numbness
41
Why can lung cancer cause cushing's syndrome
Paraneoplastic effects of cancer cells can cause ACTH overproduction.
42
How does SIADH present
Low plasma Na, low plasma osmolality, high urine Na, lethargy and anorexia. caused by too much ADH causing resorption of kidney filtrate
43
Difference between AP and PA view
AP view is taken with tube in front of patient and film plate at the back, this causes heart to be enlarged, scapular to be more visible and sometimes clavicles to be raised above lung apex.
44
What on a CXR indicates hyperinflation of lungs
Hyper lucent lung fields (decreased bronchial markings)
More than 10 posterior ribs visible or more than 6 anterior ribs visible at mid-clavicular lines
Flattened hemidiaphragms
45
What should the width of the cardiac shadow be in relation to the thorax
On PA film, half or less
46
What does a meniscus sign indicate on a CXR
Pleural effusion
47
How does a hydro-pneumothorax present
Straight line across the lung field separating gas and fluid
48
How does a pneuomthorax appear on a CXR
Increased lucency, visible lung field edges within thorax, possible deviated trachea
49
What does a collapsed lung do to the trachea
Pulls it towards the collapsed side
50
What does increased lung markings indicate?
Interstitial lung diseases/ fibrosis
51
What can cavitation in CXRs indicate
Lung cancer, TB, pneumonia, sarcoidosis, infection causing abscess (will have air-fluid level)
52
progression of clinical features in asthma attack
tachypnea
tachycardia
reduced PEF
low sats
cyanosis
silent chest
53
Risk factors for fatal asthma
Previous attacks, ITU admissions
Dhx - are they on 3 or more types of asthma meds
Repeated AnE attendance
High SABA use recently?
54
Acute management of asthma attack
O SHIT ME
oxygen
```
salbutamol
hydrocortisone
ipratropium
theophylline
magnesium sulphate
```
escalate care
55
Presentation and signs of Pulm embolism
Pleuritic chest pain
Cough and haemoptysis
Haemodynamic collapse
signs:
Tachycardia, hypoxia, tricuspid rigurg, DVT, raised JVP
DVT
Hypotension
56
How to diagnose PE
Wells score
CTPA is diagnostic
57
Acute management of PE
ABC
oxygen
Thrombolysis
Anticoag
58
Possible causes of massive haemoptysis
```
Bronchial tumor
Bronchiecstasis
CF
Active TB
Pneumonia
Pulmonary thromboembolic disease
Pulmonary vasculitis
Warfarin
```
59
Acute management of massive haemoptysis
```
Airway support
IV access
group and save
Fluids
fix clotting abnormality
```
Neb adrenaline
Oral or IV tranexamic acid
60
Difference between primary and secondary pneumothorax
Primary occurs in apparently normal lungs
Secondary is due to underlying lung disease
61
Difference between tension pneumothorax and normal pneumothorax
In tension pneumothorax, thoracic cavity fills with air with every breath taken "one way valve"
This compresses the lung and can be fatal
62
Presentation of pneumothorax
Pleuritic chest pain
| Dyspnea
63
O/E of pneumothorax
Deviated trachea
Reduced chest expansion
Hyper resonant percussion
Reduced breath sounds
64
Management of pneumothorax
If tension pneumothorax - aspiration + chest drain
If small simple pneumothorax - observation
65
If tension pneumothorax is suspected, a CXR should be done to confirm diagnosis - true or false
FALSE. Do not wait for CXR if tension pneumothorax is suspected
Insert large bore needle into 2nd intercostal space mid clavicular line to aspirate.
66
Common causative organisms of LRTI
Strep pneumonia
Haemophilus influenza
Staph aureus
Moraxella carrhalis
67
Symptoms of LRTI
```
Cough, productive, purulent
Fever
Sob
Pleuritic chest pain
Confusion
Rigors, night sweats
```
68
How to investigate suspected pneumonia
```
CXR
Sputum, blood, urine culture
ABG
Blood test - FBC, CRP, U+E, LFT
ECG
Antigen testing
```
69
CXR signs of pneumonia
patchy opacification, consistent with consolidation
70
3 requirements to diagnose pneumonia
1) signs and symptoms
2) xray with consistent findings
3) no better explanation
71
Describe CURB65 scoring
C - confusion yes or no
Urea - more than 7 mmol/L
R - RR of >30
B - BP <90 systolic or <60 diastolic
Over 65?
72
Management of pneumonia based on CURB65 score
0 to 5
0-1 can be treated at home with antibiotics (amoxicllin)
2 - hospital stay, oral abtx per guidelines for 7 days
>3 - ITU, 2 IV atbx per guidelines e.g. IV co-amoxiclav + IV clarithromycin
Oxygen if required (low sats)
Fluids, analgesia, neb saline
73
What MDT involvement is suggested for pneumonia?
Chest physio
| Specialist nurse
74
Who should be given follow up CXR ? When?
>65 YO
Smoker
6 weeks later to see if consolidation has settled.
75
What history is important in diagnosis legionnaire's disease
Travel history
76
Antibiotic management of legionnaire's disease
14-21 days of atbc
77
Most common lobe affected in aspiration pneumonia
Lower right lobe
78
What is in a rescue pack for COPD patients
Antibiotics - amoxicillin
Steroids - prednisolone
79
Acute management of infective COPD exacerbation
ONAB
Oxygen
Nebulised salbutamol
Antibiotics - doxycycline
Prednisolone
MDT involvement
NIV
80
Classical presentation of TB
Haemoptysis
Weight loss
Fever
Night sweats
81
CXR presentation of TB
Round cavitation with consolidations
82
drug treatment of TB
Notifiable disease
2 months of rifampicin, isoniazide, ethambutol, pyrazinamide
4 months of rifampicin and isoniazide
83
What does rifampicin cause
Orange sweat, urine, tears
84
what kind of conditions are more likely to cause coarse crackles
airway disease such as bronchiectasis, usually caused by fluid
85
what kind of conditions are more likely to cause fine crackles
disease involving interstitial process like fibrosis, congestive heart failure, atelectasis
86
how long is the test for CO2 flap usually done for
1 min
87
what is d dimer and what is it indicative of
part of coagulation pathway
| can be raised in blood clot
88
in someone with fibrotic lungs and pneumothorax, would u put a chest drain in?
no
89
would organism causes a rust coloured sputum in an LRTI
strep pneumoniae
90
CXR presentation of emphysema COPD exacerbation
hyperinflated with flattened diaphragm
91
what is bronchiectasis
chronic infection of airways leading to damage of bronchi causing permanent dilation of airways giving rise to colonisation by bacteria
92
presentation of someone with bronchiectasis
```
recurrent cough
copious sputum
+/- haemoptysis
dyspnea
chest pain
```
93
signs of bronchiectasis
finger clubbing
coarse crackles
wheeze
94
what is the "bat wing" sign on a cxr
caused by pulmonary edema usually from heart failure
increased hilar opacities due to fluid secretion
95
What 2 types of fluid can you get from pleural effusion
Transudate and exudate
96
Whats the difference between transudate and exudate in terms of contents
Exudate has more protein, dead cells, neutrophils “pus”
Transudate has very little to no protein and is generally clear
97
What is the difference in origin of transudate and exudate in a pleural effusion
Transudates usually caused by hypoalbunimea which is caused by an organ failure e.g liver, kidney; or heart failure
Exudate is usually caused by inflammatory or infective causes e.g. pneumonia, TB, malignancy
98
investigations and reasons for suspected PE
```
CTPA is main diagnostic tool
CXR to rule out others
ECG - T wave inversion and sinus tachy
VQ scan - more useful in ruling out PE
ABG - O2 often low, CO2 normal or low
Troponin - commonly raised in PE due to strain on heart
Echo - look at RV function
```
