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Respiratory > Revision > Flashcards

Revision Flashcards

1
Q

what can cause an acute wet cough (2)

A

LRTI, pneumonia

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2
Q

what can cause an chronic wet cough (2)

A

chronic bronchitis, bronchiectasis

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3
Q

what are the three types of onset of wet cough

A

acute, sub acute

(in-between), chronic

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4
Q

how long does a viral infection last

A

few days- self limiting

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5
Q

how long does a bacterial infection last

A

10+ days, longer if not treated

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6
Q

how long do mycobacterial infections last

A

months- TB and others can last for years

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7
Q

how long does pertussis last

A

‘100 day cough’

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8
Q

what are the associated features of a wet cough

A

fever, weight loss, pain, haemoptysis, breathlessness

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9
Q

what are the two onsets of fever

A

chronic, intermittent

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10
Q

what types of pain are commonly associated with wet cough

A

pleuritic, chronic

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11
Q

what conditions could be associated with the associated features of a wet cough

A

TB, associated PE, BXT, lung cancer

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12
Q

what does SPUR stand for

A

severe, persistent, unresponsive to treatment, resistant

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13
Q

when does cancer cause a cough

A

if it is big or close to the carina

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14
Q

who mostly gets a dry cough

A

post menopausal woman

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15
Q

what can trigger a dry cough

A

external factors

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16
Q

what are the differentials for a dry cough

A

drug reaction, ‘serious pathology’ (cancer, ILD), perennial rhinitis, cough variant asthma, reflux

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17
Q

what is the primary abnormality in a chronic dry cough

A

heightened cough reflex

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18
Q

what is a cough reflex heightened due to

A

lower threshold ot increased stimulation in resp tract

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19
Q

what are the red flags for cancer

A

weight loss, haemoptysis, pain, night sweats

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20
Q

what is the prognosis for a chronic dry cough

A

resolution unlikely especially when over a year

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21
Q

what can pulmonary fibrosis cause in terms of coughing

A

persistent cough

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22
Q

what is the definition of a chronic dry cough

A

non productive cough or 8 weeks or more

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23
Q

how is a chronic dry cough treated

A

smoking cessation, stop ACE inhibitors (drug reaction), lansoprazole, qvar, nasal steroid

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24
Q

what are the signs of ILD

A

cough and crackles in the chest

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25
Q

what does a chronic dry cough mostly start as

A

LRTI

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26
Q

what is cough variant asthma also known as

A

eosinophilic bronchitis

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27
Q

why are secondary treatments not regularly used to treat chronic dry cough

A

as toxic and very poorly tolerated

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28
Q

what can cause breathlessness

A

heart failure, asthma and lung diseases, PE, angina equivalent +more

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29
Q

what is the functional categorisation of breathlessness

A

oxygen transport,
mechanical disadvantage (restriction/weakness),
respiratory drive (signals from brain),
perception of breathing (hyperventilation)

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30
Q

what is the fick equation and what does it show

A

oxygen uptake

VO2= CO x (CaO2 - CvO2)

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31
Q

does breathlessness mean lack of oxygen

A

no

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32
Q

what should be asked in a history of breathlessness

A

onset and duration, severity, exacerbating or relieving factors, associated symptoms, FH, SH

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33
Q

what could cause instant onset breathlessness

A

pneumothorax, PE

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34
Q

what could cause acute onset breathlessness

A

asthma, pneumonia, acute MI, cardiac tapmonade

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35
Q

what could cause sub-acute onset breathlessness (days)

A

PE, pulmonary vasculitis, SVCO (superior vena cava obstruction)

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36
Q

what could cause chronic breathlessness

A

COPD, ILD, pulmonary hypertension, anaemia

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37
Q

what tests can be used to assess breathlessness

A

spirometry, peak flow meter, body box, CXR

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38
Q

what are the three sizes of haemoptysis

A

massive (250ml- enough to cause airway obstruction), submassive (100ml), minimal (streaks, clots)

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39
Q

how is haemoptysis managed

A

maintain airway, ensure adequate oxygenation, fluid/blood resuscitation, stabilise the patient, look for cause

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40
Q

what can cause haemoptysis

A

lung cancer, bronchiectasis, PE, tuberculosis, (rarities; trauma, goodpastures, AVMS)

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41
Q

how can lung cancer cause haemoptysis

A

neovascularisation, eorsion through bronchial vessels, fragile vessels

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42
Q

how can bronchiectasis cause haemoptysis

A

erosions of vessels due to infection, aspergilloma, abscess formation

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43
Q

how can a PE cause haemoptysis

A

obstruction of pulmonary vessels (build up of blood pressure), infarction of lung (bleeds when it dies), alveolar haemorrhage (bronchial and pulmonary bleeding)

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44
Q

how can TB cause haemoptysis

A

cavitation, erosion through bronchial blood vessels

45
Q

what is cavitation

A

gas filled areas

46
Q

how is lung cancer treated

A

diathermy, cryotherapy, radiotherapy, surgery

47
Q

how is bronchiectasis treated

A

antibiotics/fungals, embolism of bronchial artery- lung devoid pf blood from this vessel forever

48
Q

how is a PE treated

A

anticoagulants, lung resection

49
Q

how is TB treated

A

quadruple therapy, bronchial embolisation

50
Q

what can cause minor haemoptysis

A

‘big 4’ (LC, BXT, PE, TB), acute infection trauma

51
Q

IMPORTANT

what are the severity markers for a severe asthma exacerbation

A
  • if they can finish a sentence in a single breath
  • peak flow less than 60%
  • resp rate of more than 30
  • tachycardia
52
Q

IMPORTANT

what are the severity markers for a life threatening asthma attack

A
  • lower level of consciousness
  • bradycardia
  • silent chest
  • peak flow less than 30%
53
Q

IMPORTANT

what is the most common pneumonia and how is it treated

A

streptococcus- amoxicillin

54
Q

what is the likely type of cancer in a proximal tumour in a woman

A

adeno-

55
Q

what is the likely type of cancer in a proximal tumour in a man

A

squamous

56
Q

small mass cancer =?

A

small cell

57
Q

IMPORTANT

what does ROME mean

A

respiratory opposite
metabolic equal

Respiratory= Opposite:

  • pH is high, PCO2 is down (Alkalosis).
  • pH is low, PCO2 is up (Acidosis).

Metabolic= Equal:

  • pH is high, HCO3 is high (Alkalosis).
  • pH is low, HCO3 is low (Acidosis).
58
Q

in blood gases what two should you compare

A

FiO2 to pO2

59
Q

IMPORTANT

what is type 1 resp failure

A

hypoxemic- failure of oxygen exchange

60
Q

IMPORTANT

what is type 2 resp failure

A

hypercapnic- failure to exchange or remove carbon dioxide

61
Q

what are the resp causes of pleuritic chest pain

A

pneumonia or PE

62
Q

what causes stony dullness

A

fluid outside of the lungs, pleural effusion

63
Q

what is pulmonary oedema and what are the symptoms

A

fluid within the lungs; basal crackles, orthopnoea, pink frothy sputum,

64
Q

59 year old smoker, male, presents with weight loss, haemoptysis, cough, SOB. He has finger clubbing, is anaemic and apyrexial

A

lung caner

65
Q

65 y/o female with SOB and right sided pleuritic chest pain. has a pleural rub

A

pulmonary embolus, pleural rub due to inflammation

66
Q

62 y/o female presents with one day history of fever, rigors, SOB and right sided pleuritic chest pain. on exam decreased expansion, dullness to percussion, bronchial breathing on the right side

A

pneumonia

67
Q

25 y/o male presents after falling from 6ft. has SOB, right sided chest pain, worse on inspiration, localised tenderness on right side of chest, equal air entry

A

fractured rib

68
Q

65 year old man, life time smoker, dyspnoea, decreased chest expansion, stony dullness, decreased air entry into left base

A

pleural effusion

69
Q

85 y/o female, SOB, bilateral pitting ankle oedema to mid shin, bilateral basal crackles, CXR: kerly B lines, prominent upper lobe vessels, cardiomegaly

A

pulmonary oedema

70
Q

what do kerly B lines show

A

fluid tracking

71
Q

58 year old man presents with 18 months history of increasing SOB, is tachypnoeic, has finger clubbing, fine end inspiratory crackles

A

cryptogenic fibrosing alveolitis (idiopathic interstitial lung disease)

72
Q

what type of disease is goodpastures syndrome

A

autoimmune

73
Q

35 y/o female, fever, night sweats, weight loss, productive cough with haemoptysis. ziehl-neelson stain is pos for acid fast bacilli

A

tuberculosis

74
Q

female 76, presents with SOB, productive cough with pink frothy sputum, is peripherally cyanosed, tachycardic, tachypnoeic, bilateral inspiratory crackles

A

pulmonary oedema

75
Q

female 65, cough and haemoptysis, hoarsening of the voice, supraclavicular lymphadenopathy

A

bronchial carcinoma

76
Q

man 34, short history of haemoptysis, cough for a fortnight, ankles swelling 5 days ago, high creatinine, antibody screen in pos for p-ANCAand anti-glomerular basement membrane antibodies

A

goodpastures syndrome (damaged kidneys, coughing up blood)

77
Q

female 45, has ovarian carcinoma, 12 hr history of haemoptysis, dyspnoea and pleuritic chest pain, is apyrexial, right sided pleural rub, CXR shows wedge shaped infarct peripherally on the right

A

Pulmonary embolis- predisposed from cancer

78
Q

man 60, dry cough, confusion, diarrhoea, been on business trip to spain

A

pneumonia- legionella pneumophilla

79
Q

women, 35, 10 year history of HIV, poorly compliant to medication, progressive SOB and dry cough

A

pneumonia - pneumocystis carni (more common in HIV)

80
Q

male 42, fever, arthralgia and mucoid sputum. neg blood cultures, CXR had patchy consolidation in right lung, recently bought a parrot

A

pneumonia - chlamydia psittici

81
Q

female 31, sore throat, cough, malaise, throat erythematous, chest sounds vesicular

A

pneumonia - rhinovirus (sore throat, URTI)

82
Q

female 24, cystic fibrosis, chest infection resistant to large amount of antibiotics

A

pneumonia - pseudomonas aeroginosa (resistant to many antibiotics, common in CF)

83
Q

how do you treat: boy 4, mild intermittent attacks of wheeze and cough early in the morning, on no other medications

A

asthma- SABA (salbutamol)

84
Q

how do you treat: girl 8, 5 year history of asthma poorly controlled, taking low dose inhaled beclometasone and salbutamol PRN

A

beclometasone= becotide= steroid

review inhaler technique, if that doesn’t increase steroid or give LABA

85
Q

how do you treat: girl 12, asthma attack, RR 30, cant complete sentences, no relief from blue inhaler

A

high flow oxygen and nebulised salbutamol

86
Q

what is the acute treatment for asthma

A 
OhSHITMan
O-oxygen 
S-salbutamol 
H-hydrocortisone 
I- Ipratropium bromide
T - Theophylline
M- magnesium sulphate
87
Q

‘how do you treat: girl 12, asthma attack, RR 30, cant complete sentences, no relief from blue inhaler’ now drowsy, feeble resp effort, peak flow not recordable, has been given salbutamol and prednisolone

A

prednisolone= oral steroid, anti inflammatory

get senior help, intubate the patient

88
Q

how do you treat: girl 15, getting asthma review, well controlled on inhaled beclometasone and salbutamol, wakes once a week with cough and wheeze

A

increases steroid or give LABA (salmeterol)

89
Q

what is the first line management: woman 58, 4 month history of weight loss, malaise, night sweats, back pain, 3 week history of SOB, dry cough. Radiography demonstrates loss of intervertebral disc space between T12 and L1, with partial wedge of collapse of L1 and large right pleural effusion

A

pleural biopsy, and aspirate then bronchoscopyand bronchial aspirate

90
Q

what is the first line management: women 87, wheelchair dependant, SOB at rest, pleuritic chest pain, D-Dimer elevated

A

CXR, CT pulmonary angiogram for PE, ventillation perfusion scan

(d-dimer goes up with inflammation)

91
Q

what is the first line management: boy 15, nocturnal and post exercise cough, chest exam clear, peak expiratory flow rate just below median

A

peak expiratory flow rate diary, spirometry

92
Q

what is the first line management: man 74, COPD, started on new inhaler, measure of response needed

A

peak expiratory flow rate diary, spirometry

93
Q

what is the first line management: unkempt male, pinpoint pupils, RR of 6

A

ABG: check if resp failure, check O2 sats, show severity

94
Q

what is the first line of treatment for asthma

A

SABA, add on steroids if worsens

95
Q

how do you asses the severity of an asthma attack

A

peak flow %, RR, HR, ability to complete sentences

96
Q

what are the side effects of rifampicin

A

orange wee

97
Q

what are the side effects of isoniazid

A

peripheral neuropathy

98
Q

what are the side effects of pyrazinamide

A

nausea

99
Q

what are the side effects of ethanbutol

A

colour blindness

100
Q

what is bronchitis

A

thickening of bronchi due to inflammation

101
Q

what can cause rusty coloured sputum

A

pneumococcal pneumonia, cancer

102
Q

what condition is likely if you cant see the diaphragm in a CXR

A

lower lobe pneumonia

103
Q

describe lower lobe collapse

A

loss of volume shown by mediastinal shift, hilum pulled down from normal position to supply remaining lower lobe

104
Q

what lobe of the lung is affected if there is loss of outline of the right heart border

A

middle lobe

105
Q

what lobe of the lung is affected if there is loss of outline of the left heart border

A

lingula

106
Q

does stridor happen on in or expiration

A

inspiration

107
Q

is wheeze on inspiration or expiration

A

expiration

108
Q

what is cachexia

A

underweight

109
Q

what is consolidation

A

when anything denser than air fills the air spaces in the lung

Respiratory (26 decks)

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