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Year 3 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Oxygen saturation targets for patients at risk of hypercapnia (e.g., COPD patients)?

A

= 88-92%

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2
Q

What is the assessment tool used to assess severity of pneumonia called?

A

CRB-65 (used out of hospital)
CURB-65 (in hospital)

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3
Q

What does CURB-65 stand for?

A

C - confusion
U - urea > 7 mmol/L
R - RR >/= 30
B - BP </= 90 systolic, </= 60 diastolic
65 - >/= 65 year old

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4
Q

What CURB-65 score advises hospital admission?

A

> /= 2

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5
Q

Most common cause of bacterial pneumonia?

A

= Streptococcus pneumoniae

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6
Q

Alongside Streptococcus pneumoniae, what is the second to most common cause of bacterial pneumonia?

A

= Haemophilus influenzae

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7
Q

Pneumonia: Pseudomonas aeruginosa as a causative organism commonly associated with which patients?

A

= those with cystic fibrosis or bronchiectasis

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8
Q

Pneumonia: Staphylococcus aureus as a causative organism is commonly associated with which patients?

A

= those with cystic fibrosis

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9
Q

Legionella pneumophilia is caused by?

A

= inhaling water from infected systems such as air conditioning

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10
Q

Which of the following is the causative organism of a milder pneumonia, and is associated with a rash called erythema multiforme, and can cause neurological symptoms

  • Mycoplasma pneumonia
  • Chlamydophilia pneumoniae
  • Coxiella burnetii (or Q-fever)
  • Chlamydia psittaci
  • Pneumocystis juroveci pneumonii (PCP)
A
  • Mycoplasma pneumonia
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11
Q

Which of the following causes of atypical pneumonia is associated with a mild-moderate chronic pneumonia which can cause wheezing in school-age children?

  • Mycoplasma pneumonia
  • Chlamydophilia pneumoniae
  • Coxiella burnetii (or Q-fever)
  • Chlamydia psittaci
  • Pneumocystis juroveci pneumonii (PCP)
A
  • Chlamydophilia pneumoniae
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12
Q

Which of the following causes of atypical pneumonia is linked to exposure to bodily fluids of animals?

  • Mycoplasma pneumonia
  • Chlamydophilia pneumoniae
  • Coxiella burnetii (or Q-fever)
  • Chlamydia psittaci
  • Pneumocystis juroveci pneumonii (PCP)
A
  • Coxiella burnetii (or Q-fever)
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13
Q

Which of the following causes of atypical pneumonia is associated with contact with infected birds?

  • Mycoplasma pneumonia
  • Chlamydophilia pneumoniae
  • Coxiella burnetii (or Q-fever)
  • Chlamydia psittaci
  • Pneumocystis juroveci pneumonii (PCP)
A
  • Chlamydia psittaci
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14
Q

Which of the following causes of atypical pneumonia is associated with immunocompromised patients?

  • Mycoplasma pneumonia
  • Chlamydophilia pneumoniae
  • Coxiella burnetii (or Q-fever)
  • Chlamydia psittaci
  • Pneumocystis juroveci pneumonii (PCP)
A
  • Pneumocystis juroveci pneumonii (PCP)
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15
Q

How long should a patient with mild-community acquired pneumonia typically be treated for?

A

= 5 days

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16
Q

First-line treatment for mild-community acquired pneumonia?

A

= Amoxicillin

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17
Q

If patient is allergic to Penicillin what should be used instead to treat pneumonia?

A

= macrolide (e.g., Clarithromycin) or Tetracycline (e.g., Doxycycline)

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18
Q

Drugs: -cycline

A

= tetracycline antibiotics

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19
Q

Drugs: -mycin/ -micin

A

= aminoglycoside antibiotics

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20
Q

Drugs: -floxacin

A

= fluoroquinolone antibiotics

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21
Q

What is reversibility testing?

A

= involves giving a bronchodilator (e.g., Salbutamol), before repeating spirometry to see if this impacts the results

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22
Q

What is forced expiratory volume in 1 second (FEV1)?

A

= air a person can forcefully exhale in 1 second

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23
Q

FVC + FEV1 in restrictive lung disease?

A

FVC - low
FEV1 - low

(equally reduced)

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24
Q

FVC + FEV1 in obstructive lung disease

A

FVC - normal
FEV1 - low

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25
Q

FEV1:FVC ratio < 70% is suggestive of which of the following

  • obstructive lung disease
  • restrictive lung disease
A
  • obstructive lung disease
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26
Q

FEV1:FVC ratio > 70% is suggestive of which of the following

  • obstructive lung disease
  • restrictive lung disease
A
  • restrictive lung disease
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27
Q

What does a low FVC and a low FEV1:FVC ratio indicate?

A

= indicates a combination of obstructive + restrictive lung disease

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28
Q

What is the ‘atopic triad’ made up of?

A
  • atopic asthma
  • eczema
  • allergies (hay fever, food etc.)
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29
Q

Drugs to avoid in patients with asthma? (2)

A

= beta-blockers + NSAIDs

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30
Q

Recommended initial investigations for asthma (2)

A
  • Fractional exhaled nitric oxide (FeNO)
  • Spirometry with bronchodilator reversibility
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31
Q

What is FeNO a marker of?

A

= airway inflammation

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32
Q

In which patients may FeNO testing not be very useful when diagnosing asthma?

A

= smokers, smoking can lower FeNO making results unreliable

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33
Q

What is first-line in treating a patient with newly diagnosed asthma?

A

= short-acting beta-2 agonist (SABA) e.g., Salbutamol

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34
Q

Salmeterol

A

= long-acting beta-2 agonists

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35
Q

Montelukast

A

= leukotriene receptor antagonist (LTRA)

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36
Q

What are the steps in treating asthma?

A
  1. SABA, as required
  2. Inhaled corticosteroid, ICS (low dose), take regularly
  3. Leukotriene receptor antagonists (LTRA), taken regularly
  4. LABA (e.g., Salmeterol), taken regularly
  5. Consider changing to a maintenance and reliever therapy (MART) regime
  6. Increase the ICS to a moderate dose
  7. Consider high-dose ICS or additional drugs (e.g., LAMA or theophylline)
  8. Specialist management (e.g., oral corticosteroids)
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37
Q

Is a monophonic wheeze suggestive of an asthma diagnosis?

A

= no

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38
Q

Is a polyphonic expiratory wheeze suggestive of an asthma diagnosis?

A

= yes

39
Q

What may a monophonic wheeze suggest? (3)

A

= foreign body, tumour or thick sticky mucus plug

40
Q

First-line medical treatment in COPD?

A

= SABA

41
Q

What is a pneumothorax?

A

= occurs when air enters the pleural space, separating the lung from the chest wall

42
Q

What is a primary vs secondary pneumothorax?

A

Primary - occurs without underlying lung disease

Secondary - occurs in patients with pre-existing lung disease

43
Q

What is an iatrogenic pneumothorax?

A

= pneumothorax caused by a complication of a medical procedure

44
Q

Investigation of choice for a patient with a suspected simple pneumothorax?

A

= erect CXR

45
Q

Management of a PRIMARY pneumothorax?

A

If rim air < 2cm, AND not SOB - can discharge home
Other, aspiration should be inserted
If this fails, chest drain should be inserted

46
Q

Management of a SECONDARY pneumothorax?

A

SOB OR rim air > 2cm - insert chest drain
Otherwise (1-2cm) - aspiration
If < 1cm - oxygen at admit for 24 hours

(all require admission for at least 24 hours)

47
Q

Where is a chest drain inserted?

A

= 5th intercostal space mid-axillary line (triangle of safety)

48
Q

What does ‘swinging’ mean, in regards to chest drains?

A

= this is when the water in the drain rises and falls due to pressure changes in the chest

49
Q

Surgical management for treating recurrent pneumothorax?

A

= video-assisted thoracoscopic surgery (VATs)

Options: abrasive pleurodesis, chemical pleurodesis or pleurectomy (removal of pleura)

50
Q

What is pleurodesis?

A

= involves creating an inflammatory reaction in pleural lining so pleura stick together and pleural space becomes sealed

This prevents further pneumothoraxes from developing

51
Q

How does a tension pneumothorax form?

A

= caused by trauma to the chest wall and creates a one-way valve that lets air in, but not out the pleural space

52
Q

Signs of a tension pneumothorax (5)

A
  • tracheal deviation
  • reduced air entry on affected side
  • increased resonance on percussion
  • tachycardia
  • hypotension
53
Q

Management of a tension pneumothorax?

A

= insert a large bore cannula into the second intercostal space in the mid-clavicular line

54
Q

Patient presents with recurrent venous thromboembolism and also recurrent miscarriages. What may be worth excluding?

A

= antiphospholipid syndrome

55
Q

What is the Well’s Score used for?

A

= predicts the risk of patient presenting with symptoms having a DVT or PE

56
Q

What Well’s score indicates a DVT is likely?

A

= 2 points or more

57
Q

If a DVT is likely (according to Wells score), what is the next step?

A

Within 4 hours: proximal leg vein USS OR,

D-dimer (if not done) + anticoagulation + scan within 24 hours

58
Q

If a DVT is unlikely (according to Wells score), what is the next step?

A

Within 4 hours: d-dimer OR,

Anticoagulation whilst awaiting d-dimer

59
Q

Initial treatment for a DVT?

A

= anticoagulation with DOAC (e.g., Apixaban or Rivaroxaban)

60
Q

Choice of anticoagulant for DVT treatment in patient with cancer?

A

= DOAC (e.g., Apixaban or Rivaroxaban)

61
Q

Choice of anticoagulant for DVT treatment in patient with severe renal impairment?

A

= LMWH

62
Q

Choice of anticoagulant for DVT treatment in patient that has antiphopholipid syndrome?

A

= LMWH

63
Q

If VTE is provoked, when can treatment be stopped?

A

= after initial 3 months

64
Q

If VTE is provoked and patient has active cancer, when can treatment be stopped?

A

= after 3-6 months

65
Q

If VTE is unprovoked when can treatment be stopped?

A

= after 6 months

66
Q

If VTE is unprovoked when can treatment be stopped?

A

= after 6 months

67
Q

What bacteria causes TB?

A

= mycobacterium tuberculosis

68
Q

Zeihl-Neelsen stain is used to stain bacteria in which condition?

A

= TB

69
Q

What is secondary TB?

A

= when TB is reactivated from a latent form

70
Q

What is miliary TB?

A

= when immune system cannot control TB disease, this causes a disseminated, severe disease referred to as miilary TB

71
Q

What is BCG vaccine for protection against?

A

= TB

72
Q

Before BCG vaccine can be given what test is done prior?

A

= Mantoux test

73
Q

What is Mantoux test?

A

= looks for previous immune responses to TB

74
Q

If Mantoux test is positive, and patient has no features of TB, what test can be used to confirm latent TB?

A

= interferon-gamma release test

75
Q

Pharmacological treatment for acute pulmonary TB?

A

RIPE
R - Rifampicin - 6 months
I - Isoniazid - 6 months
P - Pyrazinamide - 2 months
E - Ethambutol - 2 months

76
Q

What may be co-prescribed with Isoniazid to prevent side-effects? (in TB treatment)

A

= Pyridoxine (vit. B6)

77
Q

Side-effect associated with Rifampicin

A

= red/ orange pee

(red-an-orange-pissin)

78
Q

Side-effect associated with Isoniazid

A

= peripheral neuropathy

(im-so-numb-azid)

79
Q

Side-effect associated with Pyrazinamide

A

= hyperuricaemia, gout

80
Q

Side-effect associated with Ethambutol

A

= colour blindness + reduced visual acuity

(eye-thambutol)

81
Q

What is Pott’s disease of the spine?

A

= spinal TB

82
Q

Which is more common:

  • small-cell lung cancer
  • non-small cell lung cancer
A
  • non-small cell lung cancer
83
Q

Most common type of non-small cell lung cancer?

A

= adenocarcinoma

84
Q

Type of lung cancer which is mostly due to smoking?

A

= small-cell lung cancer

85
Q

Which type of non-small cell lung cancer is most associated with smokers?

A

= squamous cell carcinoma

86
Q

Mesothelioma is strongly associated with?

A

= asbestos inhalation/ exposure

87
Q

Referral criteria for URGENT CXR in suspected lung cancer

A

> 40 with,
- clubbing
- lymphadenopathy
- recurrent or persistent chest infections
- thrombocytosis
- chest signs of lung cancer

88
Q

2 key examination findings that automatically indicate urgent CXR for suspected lung cancer?

A
  • finger clubbing
  • supraclavicular lymphadenopathy
89
Q

In patients >40, how many unexplained symptoms do you need to have to warrant a CXR (in suspected lung cancer), if you have
- never smoked
- have smoked OR had asbestos exposure

A

Never smoked: 2 or more
Smoked or had asbestos exposure: 1 or more

90
Q

First-line investigation in suspected lung cancer?

A

= CXR

91
Q

First-line treatment option in non-small cell lung cancer? if not tolerated what next?

A

= surgery

if not radiotherapy

92
Q

Small-cell lung cancer is usually treated with what 2 things?

A

= radio- and chemotherapy

93
Q

Which has a worse prognosis?

-small cell lung cancer
- non-small cell lung cancer

A
  • small cell lung cancer

Year 3 (10 decks)

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