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Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Bilateral hilar lymphadenopathy is most commonly seen in which conditions?

A

Sarcoidosis

TB

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2
Q

A px presents with dyspnoea and a primary pneumothorax of 1.5cm is diagnosed. How should this be managed?

A

Attempt aspiration as they are symptomatic

Only aspirate primary pneumothorax if >2cm or if px symptomatic, if this fails then insert a chest drain

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3
Q

How should a secondary pneumothorax be managed in patients if it is:

i) less than 1cm
ii) 1-2cm
iii) more than 2cm

A

i) if less than 1cm give Ow and admit for 24 hours
ii) aspirate if 1-2cm and admit for at least 24 hours, insert chest drain if aspiration fails
iii) if >50 years old and air is >2cm and/or px is symptomatic, chest drain should be inserted

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4
Q

Why can primary TB become reactivated in the host?

A

If they become immunocompromised e.g. use of steroids, HIV, malnutrition

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5
Q

Cannonball metastases in the lungs are most commonly seen with which cancer?

A

Renal cell carcinoma

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6
Q

With a tension pneumothorax, will the trachea deviate towards or away from the affected side?

A

Pushed away from affected side

Only with tension, not simple, pneumothorax

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7
Q

What organism is the most common cause of infective exacerbation of COPD?

A

Haemophilius influenzae

Then strep pneumoniae and moraxella

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8
Q

What is severity of COPD based upon?

A

FEV1

NOT FEV1/FVC ratio

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9
Q

What is the investigation of choice to confirm a diagnosis of idiopathic pulmonary fibrosis?

A

HRCT

Can show shadowing and honeycombing

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10
Q

What pathology can cause the trachea to deviate away from the affected lung?

A

Tension pneumothorax

Pleural effusion

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11
Q

What pathology can cause the trachea to deviate towards the affected lung?

A

Collapsed lung

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12
Q

What is the pathophysiology behind the airway obstruction in the bronchi that is seen in asthma?

A
  • bronchial smooth muscle contraction due to triggering stimuli
  • mucosal swelling due to inflammatory mediators
  • mucous plugging due to increased number of goblet cells
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13
Q

What spirometry pattern would asthma show?

A

FEV1/FVC <70%

Will show reversibility, 12% improvement after a bronchodilator

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14
Q

What features characterise a severe attack of asthma?

A

RR > 25
Pulse > 110
Can’t complete sentences

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15
Q

What features characteristic of a life threatening attack of asthma?

A 
Exhaustion
Cyanosis
Silent chest 
Sats <92 
Bradycardia
PEF < 33% predicted
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16
Q

What is the first step of the BTS stepladder to manage asthma?

A

PRN SABA

Move to next step if using more than 3x per week

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17
Q

What is the 2nd step of the BTS asthma management step ladder?

A

Add low dose ICS e.g. beclametasone

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18
Q

What are some examples of LABAs?

A

Salmeterol

Formoterol

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19
Q

What are some side effects of beta agonists?

A

Fine tremor
Headache
Tachyarrhythmias

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20
Q

If an asthmatics symptoms fail to be controlled using a SABA and low dose ICS, what treatment is next?

A

Change to LABA with ICS

usually a combination inhaler e.g. symbicort

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21
Q

If a symbicort inhaler is failing to control symptoms in an asthmatic patient, what treatment option can be trialled next?

A

Higher dose ICS

Can consider adding LTRA, theophylline, LAMA, or beta agonist tablet

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22
Q

How would you manage an acute asthma attack?

A

ABCDE
Salbutamol 5mg nebulised with O2 (every 15 minutes)
100% O2 (aim for sats >94)
Hydrocortisone IV 10pmg, or prednisolone orally 40mg
If rising CO2, refer to ITU
If life threatening severity, give magnesium sulphate IV

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23
Q

What is the spirometry pattern in COPD?

A

FEV1/FVC <0.7

FEV1 <80%

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24
Q

What are some signs of COPD that may be visible of examination?

A 
Pursed lip breathing
Hyperinflated chest
Reduced chest expansion
Accessory muscle use when breathing
Hyperresonant percussion
Quiet breath sounds
Tachypnoea
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25
Q

What is the FVC1 value in mild COPD?

A

> 80%

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26
Q

What is polycythaemia?

A

An increased concentration of Hb in the blood

Either due to reduced plasma volume, or increased number of red cells

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27
Q

Why does polycythaemia result due to conditions e.g. COPD and obstructive sleep apnoea?

A

Due to chronic hypoxaemia, so increased EPO production by the kidneys is stimulated

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28
Q

What is the long term management of COPD?

A

Conservative: smoking cessation, pulmonary rehabilitation, exercise, weight loss if obese, annual influenza and one of pneumococcal vaccinations

Medical: PRN SABA or SAMA, if still symptomatic try LAMA, then if not try LABA + ICS, if not try LAMA+LABA+ICS

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29
Q

How is long term oxygen therapy given?

A

For 15 hours per day

Via a 2L/min nasal cannula

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30
Q

When should a COPD px be recommended oxygen therapy?

A

When Disease is stage 3 severe (FEV1 30-49% of predicted)

Hypoxic

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31
Q

What is ipatropium?

A

Short acting muscarinic antagonist

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32
Q

What is an example of a LAMA?

A

Tiotropium

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33
Q

How would you manage an exacerbation of Asthma?

A 
“O SHIT”
Oxygen (CONTROLLED at 24-28%)
Salbuatmol 5mg nebuliser
Hydrocortisone or prednisolone course
Ipatropium nebuliser
Theophylline IV
(consider NIV if O2 on ABG not improving)
34
Q

When should Light’s criteria be applied?

A

For pleural fluid samples with a protein content between 25-35g/L

(Exudate likely if LDH is high)

35
Q

Where would you insert a large bore cannula to decompress a tension pneumothorax?

A

2nd ICS MCL

36
Q

What is the FEV1 of somebody who has moderate COPD?

A

50-79% of predicted

37
Q

Which type of pneumonia has a vaccine available?

A

Strep pneumoniae, pneumococcal vaccine

38
Q

Which organism is likely to cause pneumonia in patients with HIV?

A

Pneumocystitis jiroveci

PCP = pneumocystitis pneumonia

39
Q

What are common causes of HAP?

A

Staph aureus

Pseudomonas aeruginosa

40
Q

Which is a common causative organism of pneumonia in COPD patients?

A

Haemophilius infleuenzae

41
Q

What investigations would you do a px with suspected pneumonia?

A 
CXR 
FBC (WCC, CRP usually Raised)
U&amp;Es (look for dehydration, Raised urea is scored for in CURB65)
O2 sats
ABG if sats are low
Sputum culture
Legionella urine antigen
42
Q

What is looked at in the CURB65 score?

A

Confusion scoring 8 or above on mini mental exam
Urea above 7mmol/L
Resp rate above 30
Blood pressure below 90 systolic, 60 diastolic
65 (aged above)

43
Q

What Abx are used in community acquired pneumonia?

A

Amoxicillin and clarithromycin (a macrolide) or doxycycline

Course of 5 days
Add meropenem IV if very severe

(If mild CAP, 5 day course of oral amoxicillin will do, or use doxy if pen allergic)

44
Q

What Abx are used to treat HAP?

A

Meropenem and co-amoxiclav or tazocin

45
Q

What are some symptoms of TB?

A 
Weight loss
Fever
Night sweats
Productive cough
\+/- haemoptysis 
Fatigue
46
Q

How many sputum samples must be sent off for suspected respiratory TB?

A

3

One to be an early morning sample (reflects overnight secretions that accumulated in the chest)

47
Q

What drugs are used in TB and for how long?

A

Rifampicin and isoniazid for 6/12

Pyrazinamide and ethambutamol for 3/12

48
Q

Which TB drug can cause optic neuritis?

A

Ethambutamol

49
Q

What are some side effects of Rifampicin?

A 
Orange secretion
Liver toxicity (monitor LFTs)
CYP450 inducer
50
Q

Which TB drug can cause arthralgia and myalgic as a known wide effect?

A

Pyrazinamide

51
Q

Which TB can cause agranulocytosis?

A

Isoniazid

52
Q

What are some causes of type 1 respiratory failure?

A

V/Q mismatch: PE, pneumonia, pulmonary oedema, fibrosis, high altitude, asthma, COPD

53
Q

What are some causes of type 2 respiratory failure?

A 
Sedative drugs
Flail chest
Guillain Barre syndrome
Kyphoscoliosis 
Severe COPD, asthma
54
Q

What are some signs of hypercapnia?

A 
Confusion
Drowsiness
Flapping tremor
Headache
Bounding pulse
55
Q

How would you treat type 1 respiratory failure?

A

Tx cause
Oxygen 24-60% via a face mask
(CPAP if sats still low despite oxygen)

56
Q

How would you tx type 2 respiratory failure?

A

controlled oxygen therapy as respiration may now be driven by hypoxia and we want to avoid further hypercapnia!

Tx cause
Controlled oxygen starting at 24%, check ABG after 20 mins and if CO2 steady or reduced, up oxygen to 28%)
Try assisted ventilation
If not, intubation and ventilation

57
Q

What is the Epworth scale used to assess?

A

Completed by px +/- partner to assess sleepiness

Score >9 indicates obstructive sleep apnoea

58
Q

How can obstructive sleep apnoea be managed?

A 
Weight loss
Smoking cessation
Reduce alcohol
Mandibular advancement device
If severe, CPAP
Remove tonsils if enlarged
59
Q

What is the protein content in transudates and exudates?

A

Transudate <25g/L

Exudate>35g/L

60
Q

What are some causes of a transudate pleural effusion?

A

Heart failure
Hypoalbuminaemia (Liver cirrhosis, nephrotic syndrome, malabsorption)
Hypothyroidism

61
Q

What are some causes of an exudate pleural effusion?

A

Infection: pneumonia, TB
Malignancy (lung Ca, mesothelioma, metastases)
CT disease: SLE, RA

62
Q

What signs on examination would indicate pleural effusion?

A

Stony dull percussion
Reduced breath sounds
Reduced vocal resonance
Reduced chest expansion

63
Q

How are pleural effusions managed?

A

Tx underlying cause
Aspiration for diagnosis
Drainage if persistent
If recurrent, pleurodesis with talc

64
Q

What drugs can cause pulmonary fibrosis?

A

Amiodarone
Methotrexate
Azathioprine

65
Q

Extrinsic allergic alveolitis affects which lung zones?

A

Upper zones

66
Q

Idiopathic pulmonary fibrosis predominantly affects which lung zones?

A

Lower zones

67
Q

Drug induced pulmonary fibrosis predominantly affects which lung zones?

A

Lower zones

68
Q

What are some features usually present on examination for a patient with idiopathic pulmonary fibrosis?

A 
Clubbing
Dry cough
Exertional dyspnoea
Bibasal crackles
Restrictive spirometry pattern
69
Q

What is bronchiectasis?

A

Permanent dilation of the airways causing chronic infection and inflammation

70
Q

What signs on HRCT are indicative of bronchiectasis?

A

Tram track signs

Signet ring signs

71
Q

What are some causes of bronchiectasis?

A
  • post infection: TB, pneumonia, measles
  • cystic fibrosis
  • bronchial obstruction e.g. lung Ca
  • yellow nail syndrome
  • immune deficiency
72
Q

How is bronchiectasis managed?

A

Tx cause
Pulmonary physio to clear mucus
Postural drainage
Abx for infection

73
Q

How would a patient with bronchiectasis typically present?

A 
Productive cough
Purulent sputum 
Haemoptysis 
Dyspnoea 
Inspiratory crepitations
\+/- clubbing
74
Q

What spirometry pattern would bronchiectasis show?

A

Obstructive

75
Q

What is the inheritance pattern of cystic fibrosis?

A

Autosomal recessive

76
Q

What gene is mutated in cystic fibrosis?

A

CFTR gene (regulating a Cl- channel)

77
Q

What are some effects of cystic fibrosis on the body?

A 
Frequent chest infections
Bronchiectasis
Steatorrhea
Diabetes Mellitus
Male infertility
78
Q

How can cystic fibrosis be diagnosed?

A

Sweat test will have abnormally high chloride
Can also genetically screen
Faecal elastase can test for exocrine pancreas dysfunction

79
Q

How is cystic fibrosis managed?

A 
At least 2x day cheats physio and postural drainage 
Vitamin supplements
Pancreatic enzyme replacement 
Mucolytics
No smoking
Avoid other CF px
Abx for acute infective exacerbations
80
Q

What is sails sign?

A

Indicates left lower lobe collapse on CXR

Appears like a double left heart border, and the left hemidiaphragm can’t be followed to the spine

Medicine (7 decks)

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