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3 FoCP > Respiratory Week 1 > Flashcards

Respiratory Week 1 Flashcards

1
Q

6 main symptoms of respiratory diseases

A 
Cough
Sputum
Haemoptysis
Chest pain
Dyspnea
Tachypnea
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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

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3
Q

What conditions can cause creamy sputum?

A

COPD

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4
Q

What causes frothy white sputum?

A

Pulmonary edema

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5
Q

What is the definition of massive haemoptysis

A

Over 600ml in 24 hours of blood

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6
Q

Describe pleuritic pain

A

Sharp pain, stabbing, worse on inspiration

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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

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8
Q

What does PND indicate?

A

Heart failure

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9
Q

What is cheyne stokes breathing

A

Waxing an waning breaths, shallow intermittent breathing

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10
Q

What is stridor?

A

High pitched sound on inspiration due to large airway obstruction

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11
Q

Possible drugs that cause coughing

A

ACEI or methotrexate

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12
Q

What is finger clubbing associated with

A

Lung cancer, bronchiectasis, fibrosing alveolitis

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13
Q

What causes bronchial breath sounds?

A

Consolidation

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14
Q

2 variants of cough asthma?

A

Eosinophilic vs non-eosinophilic type

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15
Q

Acute management plan for someone coming in with SOB and low o2 sats, wheeze,

A

Give O2, neb SABA

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16
Q

Investigations of someone coming in with high RR, low sats, dyspnea and high BP

A

CXR, ABG,

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17
Q

Management of chronic asthma

A 
Remove allergens
SABA
LABA
Theophylline, montelukast
Steroids
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18
Q

Difference between COPD and asthma

A

Asthma is reversible, COPD isn’t

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19
Q

What is Hoover’s sign in emphysema?

A

Flattened diaphragm due to over inflation.

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20
Q

How to differentiate obstructive VS restrictive lung disease?

A

FEV1/VC ratio if less than 70% is obstructive

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21
Q

What stage of copd is someone with

FEV1/VC = 57%
FEV 45% of predicted

A

Severe obstructive COPD

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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

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23
Q

What 3 patient identifier is required in writing a prescription

A

Patient name
Patient number
DOB

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24
Q

What information is required when prescribing PRN

A

Max 24 hour dose
Min Interval between dose
Indications for medication

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25
Q

Difference between type 1 and 2 respiratory failure

A

Type 1 RF is hypoxaemia but normal CO2

Type 2 RF is hypoxaemia and high CO2

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26
Q

What is measured in an ABG?

A 
PO2
PCO2
PH
HCO3
BE
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27
Q

How to tell if respiratory or metabolic acidosis/alkalosis

A

See if CO2 or HCO3 is abnormal.

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28
Q

4 steps to interprete ABG

A

Look at PH, acidosis/alkalosis or normal

Look at PCO2

Look at HCO3

Look at oxygenation

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29
Q

At what PO2 is patient in respiratory failure

A

<8

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30
Q

Pulmonary embolism will cause metabolic acidosis, true or false?

A

False

PE usually associated with respiratory alkalosis due to increased ventilation.

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31
Q

List these in order of doubling time

SCLC
Squamous cell carcinoma
Adenocarcinoma

A

SCLC
SCC
Adenocarcinoma

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32
Q

On a CXR, what can a raised diaphragm indicate?

A

Phrenic nerve palsy and muscle wasting of diaphragm

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33
Q

What would a SCC CXR feature

A

Necrosis and cavitation lesions shown as air and fluid.

Can be mistaken for an abscess

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34
Q

Classical presentations of lung cancer

A 
Cough
Dyspnea
Chest pain
Haemoptysis
Weight loss
Finger clubbing
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35
Q

What is a “sail sign” on a CXR?

A

Lower left lobe collapse dorsal to the heart, showing a straight line parallel to cardiac shadow

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36
Q

What causes hoarseness in lung cancer?

A

Recurrent laryngeal nerve compression

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37
Q

Symptoms and cause of horners syndrome in lung cancer

A

Ptosis, miosis and anhidrosis

Pancost tumor compressing sympathetic nerves at apex of lung

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38
Q

What can SVC obstruction present as

A

Swollen face, skin discoloration due to venous distension

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39
Q

What does a large globular heart on CXR indicate

A

Pericardial effusion

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40
Q

What does a spinal metastasis present with

A

Urinary changes, back pain, leg numbness

41
Q

Why can lung cancer cause cushing’s syndrome

A

Paraneoplastic effects of cancer cells can cause ACTH overproduction.

42
Q

How does SIADH present

A

Low plasma Na, low plasma osmolality, high urine Na, lethargy and anorexia. caused by too much ADH causing resorption of kidney filtrate

43
Q

Difference between AP and PA view

A

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
Q

What on a CXR indicates hyperinflation of lungs

A

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
Q

What should the width of the cardiac shadow be in relation to the thorax

A

On PA film, half or less

46
Q

What does a meniscus sign indicate on a CXR

A

Pleural effusion

47
Q

How does a hydro-pneumothorax present

A

Straight line across the lung field separating gas and fluid

48
Q

How does a pneuomthorax appear on a CXR

A

Increased lucency, visible lung field edges within thorax, possible deviated trachea

49
Q

What does a collapsed lung do to the trachea

A

Pulls it towards the collapsed side

50
Q

What does increased lung markings indicate?

A

Interstitial lung diseases/ fibrosis

51
Q

What can cavitation in CXRs indicate

A

Lung cancer, TB, pneumonia, sarcoidosis, infection causing abscess (will have air-fluid level)

52
Q

progression of clinical features in asthma attack

A

tachypnea
tachycardia
reduced PEF

low sats
cyanosis
silent chest

53
Q

Risk factors for fatal asthma

A

Previous attacks, ITU admissions

Dhx - are they on 3 or more types of asthma meds
Repeated AnE attendance
High SABA use recently?

54
Q

Acute management of asthma attack

A

O SHIT ME

oxygen

salbutamol
hydrocortisone
ipratropium
theophylline
magnesium sulphate

escalate care

55
Q

Presentation and signs of Pulm embolism

A

Pleuritic chest pain
Cough and haemoptysis
Haemodynamic collapse

signs:

Tachycardia, hypoxia, tricuspid rigurg, DVT, raised JVP
DVT
Hypotension

56
Q

How to diagnose PE

A

Wells score

CTPA is diagnostic

57
Q

Acute management of PE

A

ABC

oxygen

Thrombolysis

Anticoag

58
Q

Possible causes of massive haemoptysis

A 
Bronchial tumor
Bronchiecstasis
CF
Active TB
Pneumonia
Pulmonary thromboembolic disease
Pulmonary vasculitis
Warfarin
59
Q

Acute management of massive haemoptysis

A 
Airway support
IV access
group and save
Fluids
fix clotting abnormality

Neb adrenaline

Oral or IV tranexamic acid

60
Q

Difference between primary and secondary pneumothorax

A

Primary occurs in apparently normal lungs

Secondary is due to underlying lung disease

61
Q

Difference between tension pneumothorax and normal pneumothorax

A

In tension pneumothorax, thoracic cavity fills with air with every breath taken “one way valve”

This compresses the lung and can be fatal

62
Q

Presentation of pneumothorax

A

Pleuritic chest pain

Dyspnea

63
Q

O/E of pneumothorax

A

Deviated trachea
Reduced chest expansion
Hyper resonant percussion
Reduced breath sounds

64
Q

Management of pneumothorax

A

If tension pneumothorax - aspiration + chest drain

If small simple pneumothorax - observation

65
Q

If tension pneumothorax is suspected, a CXR should be done to confirm diagnosis - true or false

A

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
Q

Common causative organisms of LRTI

A

Strep pneumonia
Haemophilus influenza
Staph aureus
Moraxella carrhalis

67
Q

Symptoms of LRTI

A 
Cough, productive, purulent
Fever
Sob
Pleuritic chest pain
Confusion
Rigors, night sweats
68
Q

How to investigate suspected pneumonia

A 
CXR
Sputum, blood, urine culture
ABG
Blood test - FBC, CRP, U+E, LFT
ECG
Antigen testing
69
Q

CXR signs of pneumonia

A

patchy opacification, consistent with consolidation

70
Q

3 requirements to diagnose pneumonia

A

1) signs and symptoms
2) xray with consistent findings
3) no better explanation

71
Q

Describe CURB65 scoring

A

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
Q

Management of pneumonia based on CURB65 score

0 to 5

A

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
Q

What MDT involvement is suggested for pneumonia?

A

Chest physio

Specialist nurse

74
Q

Who should be given follow up CXR ? When?

A

> 65 YO

Smoker

6 weeks later to see if consolidation has settled.

75
Q

What history is important in diagnosis legionnaire’s disease

A

Travel history

76
Q

Antibiotic management of legionnaire’s disease

A

14-21 days of atbc

77
Q

Most common lobe affected in aspiration pneumonia

A

Lower right lobe

78
Q

What is in a rescue pack for COPD patients

A

Antibiotics - amoxicillin

Steroids - prednisolone

79
Q

Acute management of infective COPD exacerbation

A

ONAB

Oxygen
Nebulised salbutamol
Antibiotics - doxycycline
Prednisolone

MDT involvement

NIV

80
Q

Classical presentation of TB

A

Haemoptysis
Weight loss
Fever
Night sweats

81
Q

CXR presentation of TB

A

Round cavitation with consolidations

82
Q

drug treatment of TB

A

Notifiable disease
2 months of rifampicin, isoniazide, ethambutol, pyrazinamide

4 months of rifampicin and isoniazide

83
Q

What does rifampicin cause

A

Orange sweat, urine, tears

84
Q

what kind of conditions are more likely to cause coarse crackles

A

airway disease such as bronchiectasis, usually caused by fluid

85
Q

what kind of conditions are more likely to cause fine crackles

A

disease involving interstitial process like fibrosis, congestive heart failure, atelectasis

86
Q

how long is the test for CO2 flap usually done for

A

1 min

87
Q

what is d dimer and what is it indicative of

A

part of coagulation pathway

can be raised in blood clot

88
Q

in someone with fibrotic lungs and pneumothorax, would u put a chest drain in?

A

no

89
Q

would organism causes a rust coloured sputum in an LRTI

A

strep pneumoniae

90
Q

CXR presentation of emphysema COPD exacerbation

A

hyperinflated with flattened diaphragm

91
Q

what is bronchiectasis

A

chronic infection of airways leading to damage of bronchi causing permanent dilation of airways giving rise to colonisation by bacteria

92
Q

presentation of someone with bronchiectasis

A 
recurrent cough
copious sputum
\+/- haemoptysis
dyspnea
chest pain
93
Q

signs of bronchiectasis

A

finger clubbing
coarse crackles
wheeze

94
Q

what is the “bat wing” sign on a cxr

A

caused by pulmonary edema usually from heart failure

increased hilar opacities due to fluid secretion

95
Q

What 2 types of fluid can you get from pleural effusion

A

Transudate and exudate

96
Q

Whats the difference between transudate and exudate in terms of contents

A

Exudate has more protein, dead cells, neutrophils “pus”

Transudate has very little to no protein and is generally clear

97
Q

What is the difference in origin of transudate and exudate in a pleural effusion

A

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
Q

investigations and reasons for suspected PE

A 
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

3 FoCP (11 decks)

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