Yr5 Revision Flashcards
What reflex is absent in acoustic neuroma
corneal reflex
What is normal FEV1/FVC ratio in spirometry? What result for obstructive and what for restrictive? What diseases go into these categories?
What further test can you do to differentiate the diagnosis?
> 75%
obstructive <75% - asthma, COPD, bronchiectasis, emphysema, CF
Restrictive - normal ratio. Fibrosis, Oedema
Reversibility testing with bronchodilators
Causes of dyspnoea
PE
Pneumonia
Pneumothorax
COPD
Pulmonary oedema
Lung cancers
Heart failure
Foreign body
MI
Asthma
Effusion
Scoring system for dyspnoea
MRC dyspnoea scale
0 - no breathlessness
1 - when hurrying or slight hill
2 - slower than people of same age
3- when walking <100m
4 - doing ADLs, can’t leave house
describe a wheeze
high pitched continuous sound on expiration that can be polyphonic (COPD, asthma) or monophonic (larger airway narrowing eg large mucus plug or tumour)
Causes of airway obstruction - within lumen, within wall, extrinsic
lumen - foreign body, tumour
wall - anaphylaxis, laryngospasm, tumour, epiglottis and croup
Extrinsic - goitre, after neck surgery, lymphadenopathy
causes of haemoptysis
lung cancer
TB
cause of pink frothy sputum
pulmonary oedema
Pleural effusion examination findings
stony dull percussion
elevated rr
reduced breath sounds
decreased vocal resonance
bronchial breathing
reduced/asymmetric expansion
Consolidation examination findings
coarse crackles
reduced expansion
vocal resonance increased
bronchial breathing
dull percussion
difference between coarse and fine crackles
coarse are heard throughout both stages of respiration. lower pitch. Sound like blowing air through straw in drink
fine are heard in mid-late stage of inspiration. higher pitch, sound like fire crackling softly
rx of COPD
SABA or SAMA PRN
Then - consider if asthmatic features or steroid responsiveness
If no - SABA PRN + LABA + LAMA
If yes - SABA or SAMA PRN + LABA + ICS
Then everything
What features are suggestive of asthmatic or steroid responsiveness in copd pts
significant diurnal variation in PEFR
known asthma or atopy
raised blood eosinophils
what is the severity of cold based on
FEV1 readings not symptoms
what could be the diagnosis if a young person has symptoms of copd
alpha 1 antitrypsin deficiency
all its with pneumonia should have an outpatient cxr organised. At what week post discharge should this take place
6 weeks
rx of acute exacerbation of copd, clear sputum
prednisolone 5 day course
Not recommended to use abx unless purulent sputume
A 67-year-old female attends the emergency department with a 3-week history of cough productive of clear sputum and intermittent low-grade fever. She denies shortness of breath, chest pain, weight loss or haemoptysis. She has no history of respiratory illness, but takes metformin for type 2 diabetes and has a 25-pack-year smoking history. She has no known drug allergies.
A chest x-ray is performed in the emergency department which is normal. Blood tests are taken which show:
CRP >100
WBC normal
What is the diagnosis and what is the rx
acute bronchitis
Rx with oral doxycycline first line
features of acute sarcoidosis
erythema nodosum, swinging fever, BHL on CXR, polyartralgia, cough, hypercalcaemia
what ix are done for pulmonary fibrosis once spirometry confirms a restrictive pattern and what is seen on this
High resolution CT chest
honeycombing
SLE antibodies
ANA and anti dsDNA
SLE blood results
pancytopenia (haemolytic anaemia)
lowcomplements
anti dsDNA and ANA
SLE presentation
SOAP BRAIN
SLE Rx
Sun cream
NSAIDs
Steroids if organ involvements for flare ups
Hydroxychloroquine
monitoring sle
complements low during active disease
pancytopenias
anti ds dna titres
Sjogrens presentation acronym
MAD FRED
Myalgia
Arthralgia
Dry mouth/skin/vagina
Fatigue
Raynauds/renal tubular acidosis
Enlarged parotids
Dry eyes
antibodies in sjogrens
anti-ro and anti-la
May have RF and anti dsdna
May have ANA
rx of sjogrens
Artificial tears
pilocarpine - stimulates saliva production
Vag lube
skin emollients
Pain meds for msk sx
K+ for RTA
complications of sjogrens
b Cell lymphoma
RTA
Corneal ulcerations
pulmonary fibrosis
peripheral neuropathies
Scleroderma/systemic slerosis sx
CREST
calcinosis
raynauds
Eosophogeal dysmotility
Sclerodactyly
Talengiectasia
Electrolyte abnormalities (inc glucose) in acute pancreatitis
hypocalcaemia, hypokalaemia
hyperglycaemia (not producing insulin)
What TB drug causes peripheral neuropathy and what do you give to prevent it
isoniazid
give pyridoxine (Vit B6)
Presentation of neonatal hypoglycaemia
jittery, irritable, not feeding, tachypnoea
preemies
beyond what bp reading would you admit a pregnancy lady for observation and antihypertensives
160/110
