clinical Flashcards
(69 cards)
1
Q
what is the treatment for sleep apnoea?
A
Underlying factors (weight, alcohol, endocrine) continuous positive airways pressure mandibular repositioning splint
2
Q
OSA Severity scale (desaturation) for sleep apnoea of 0-5 is
A
normal
3
Q
OSA Severity scale (desaturation) for sleep apnoea of >30 is
A
severe
4
Q
OSA Severity scale (desaturation) for sleep apnoea of 15-30is
A
moderate
5
Q
OSA Severity scale (desaturation) for sleep apnoea of 5-15 is
A
mild
6
Q
what are the investigations for sleep apnoea?
A
Pulse oximetry limited sleep study full polysomnography (EEG, adiuovisual recording, EMG, ECG, PSG)
7
Q
what are is this symptomatic of? Breathlessness orthopnoea ankle swelling morning headaches recurrent chest infections disturbed sleep
A
chronic ventilator failure
8
Q
what are the signs of chronic ventilatory failure
A
Elevated bicarbonate pco2<6.0kPa normal blood Ph pO2 <8kPa chest wall abnormality airways disease respiratory muscle weakness central hypoventilation
9
Q
what are the investigations for chronic ventilatory failure
A
Lung function lying/standing mouth pressure early morning ABG oximetry CO2 monitoring fluoroscopic screening of diaphragm
10
Q
what is the treatment for chronic ventilatory failure
A
Non-invasive ventilation
oxygen therapy
t-IPPV
11
Q
what is the treatment for narcolepsy
A
modafinil
clomipramine
sodium oxybate
12
Q
what are these the symptoms of? Pleuritic chest pain cough haemoptysis dyspnoea syncope cardiac arrest
A
pulmonary embolism
13
Q
what are these the symptoms of Dyspnoea, cough
basal crackles, cyanosis, clubbing
A
usual interstitial pneumonitis
14
Q
what are these the symptoms of Fever, dry cough, myalgia, chills, crackles, tachyopnoea, wheeze, antibody
insidious, malaise, shortness of breath
A
hypersensitivity pneumonitis
15
Q
what are these the symptoms of Dyspnoea
heart failure
respiratory failure type 1
A
Diffuse alveolar damage
16
Q
what are these the symptoms of Acute althralgia Erythema nodusum bilateral hilar lymphadenopathy shortness of breath cough
A
sarcoidosis
17
Q
what are these the Chest tightness
exertional dyspnoea
exertional syncope or presyncope
symptoms of
A
pulmonary hypertension
18
Q
what are these the symptoms of Malaise fever Chest pain Cough rusty sputum Dyspnoea
A
pneumonia
19
Q
what are these the symptoms of Lethargy
Weight loss
high swinging fever
A
lung abscess
20
Q
what are these the symptoms of Chest pain
absence of cough
swinging fever
A
empyema
21
Q
what are these the symptoms of Chronic cough daily sputum foul smelling wheeze dyspnoea tiredness chest pains Haemoptysis
A
bronchiectasis
22
Q
what are these the symptoms of Recurrent infections chronic sputum dypnoea haemoptysis pneumothorax
A
cystic fibrosis
23
Q
what are these the symptoms of Shortness of breath wheezing weight loss regular infections haemoptysis pain Neurological Difficulty swallowing raspy voice haematuria fatigue
A
lung cancer
24
Q
what are these the symptoms of Weight loss progressive smoker’s cough wheeze chest tightness breathlessness coughing up sputum muscle loss regular chest infections
A
COPD
25
what are these the symptoms of rhinitis
runny nose
26
what are these the symptoms of ear ache
erythema
bulging ear drum
otitis media
27
what are these the symptoms of Stridor
hoarse voice
signs of common cold
barking cough
croup
28
what are these the symptoms of epiglottis
Stridor
hoarse voice
signs of common cold
barking cough
29
```
what are these the symptoms of
Asymptomatic
increasing breathlessness
pleuritic chest pain
dull ache
dry cough
weight loss
malaise, fevers
night sweats
```
pleural effusion
30
what are these the symptoms of
Coughing
sneezing
primary; erythema nodusm, malaise, fever, rarely chest signs.
secondary; Cough, sputum, haemoptysis, pleuritic pain, breathlessness, malaise, fevers, night sweats
tuberculosis
31
signs of pulmonary embolism
```
Recent surgery
trauma
cancer
cardiopulmonary disease
pregnancy
thrombophilia
Pyrexia
Pleural rub
stony dullness
tachycardia
tachypnoea
hypotension
hypoxia
```
32
treatment for pulmonary embolism
```
Oxygen
Heparin
warfarin
anti-coagulants
Thrombolysis (alteplase)
pulmonary embolectomy
```
33
investigations for pulmonary embolism
```
Pre-test wells score and Geneva score
full blood count, biochemistry and blood gas
CXR
ECG
d-dimer
V/Q
CT scan (angiogram)
echocardiography
thrombophilia testing
```
34
investigations for hypersensitivity pneumonitis
```
Chest x ray
ACE
biopsy
clinical findings
serum CA
```
35
investigations for sarcoidosis
```
Serum Ca
ACE
Biopsy
X-ray
clinical findings
```
36
investigations for pulmonary hypertension
```
ECG
lung function
chest x ray
echocardiography
V/Q scan
CTPA
right heart catheter
```
37
investigations for pneumonia
```
Serum biochemistry, blood count
CXR
blood culture
Throat swav
urinary legionella antigen
sputum microscopy and culture
CURB
```
38
investigations for lung abscess
CT scan
| sputum culture
39
investigations for empyema
CT thorax
pleural ultrasound
pleural aspiration
40
investigations for bronchiectasis
```
HRCT thorax
sputum culture
serum immunoglobulins
Total IgE and aspergillus precipitins
CF genotyping
```
41
investigations for cystic fibrosis
Antenatal and neonatal screening with Guthrie test, sweat test.
42
investigations for lung cancer
```
CRX
PET/CT scan
broncho/mediastinoscopy
EBUS
bone scane
blood test
pulmonary function test
spirometry
V/Q scan
ECG
angiogram
biopsy
thoracotomy
renal and liver function
```
43
investigations for COPD
```
FEV1/FVC ratio <80%
PEFR <400-600ml
carbon monoxide transfer test
BMI
lung volume
limited response to treatment
CXR
blood gas test
full blood count
ECG
sputum culture
pulmonary function test
```
44
investigations for pleural effusion
```
Protein content of fluid (trans/exudate)
CXR (need 200ml)
CT scan of thorax
aspiration
blood culture and samples
look and sniff
blood gas analyser
biochemistry
microbiology
cytology
pleural biopsy (abram, CT) 4 samples in saline and formaldehyde
thoracoscopy
```
45
investigations for tuberculosis
Primary – heaf/tunerclin test of PPD administration.
sputum culture , smear, ziehl neilsen stain. PCR sputum sample. Chest radiograph.
CT scan, bronchoscopy, pleural aspiration and biopsy.
family scan
46
treatment for pulmonary hypertension
```
Oxygen
anticoagulation
Diuretics
calcium channel antagonist
prostacyclin
endothelin receptor antagonists
phosphodiesterase inhibitors
thrombo-endarterectomy
lung/heart transplant
```
47
treatment for pneumonia
```
Curb 1 – amoxycillin or clarithromycin
2 – amoxycillin and clarithromycin
3-5
co-amoxiclav and clarithromycin
Oxygen
I.v. fluids
intubation and ventilation
```
48
treatment for lung abscess
Prolonged antibiotics
| drainage if possible either through bronchial tree or percutaneous
49
treatment for empyema
Chest drain and antibiotic (6 weeks) maybe intrapleural DNase or surgery worst case
50
treatment for bronchiectasis
Chest physiotherapy
antibiotics for infections
inhaled therapy of beta agonist and ICS
51
treatment for cystic fibrosis
```
Infections from pseudomonas eradication with ciprofloxacin and colomycin
lung transplant
beta lactam and aminoglycoside antibiotics
subcutaneous ports
isolation from other CF
ivacaftor
multi management team
enzyme enteric pills, fat soluble vitamins, Proton pump inhibitors
high energy diet.
vaccinations
mucolytic and airway clearance.
reduce inflammation
palliative care
therapy
fertility assistance
```
52
treatment for lung cancer
```
If small enough NSCLC operate
immunotherapy targeting PD1
chemotherapy
radiotherapy
palliativtoe care
```
53
treatment for COPD
```
Smoking cessation
vaccines
pulmonary rehabilitation
inhalers such as bronchodilators and corticosteroids
long term O2 treatment
psychological support
triple therapy
```
54
treatment for tonsillitis
Either nothing or 10 days penicillin
| should last a week
55
treatment for croup
Oral dexamethasone
| should last 4 days
56
treatment for epiglottis
Intubation
| antibiotics
57
treatment for pleural effusion
```
Target underlying cause
TB chemo
Chemotherapy
corticosteroids
palliative care if malignant
pleurodesis (4rth intercostal mid axillary)
```
58
treatment for pneumothorax
Tension – cannula in 2nd intercostal space (IS) in mid-clavicular line – chest drain
small primary just observe
large primary aspirate 2nd IS chest drain
secondary; 4rth is
fail to re-inflate visit surgeon
pleurodesis
pleurotomy
59
treatment for tuberculosis
```
Rifampicin, isoniazid, ethambutol, pyrazinamide
2 months
then rifampicin
isoniazid for
4 months
```
60
signs of pulmonary hypertension
```
Heart disease
chronic respiratory disease
thromboembolic
elevated JVP
right ventricular heave
loud pulmonary heart sound
hepatomegaly
ankle oedema
```
61
signs of pneumonia
```
Pyrexia
Central cyanosis
dullness on percussion
tachypnoea
bronchial breath sounds
inspiratory crepitations
increased vocal resonance
```
62
signs of lung abscess
Recent pneumonia
| certain organisms like staph. Aureus, or pseudomonas
63
signs of bronchiectasis
```
Cystic fibrosis
measles
aspergillosis
hypogammaglobulinemia
finger clubbing
course inspiratory crepitations
```
64
signs of CF
Family history
reoccurring chest infections
nasal polyps, sinusitis, male infertility, failure to thrive
65
signs of lung cancer
```
Brachial plexus palsy
nodules/masses
pleural effusion
hepatomegaly
smoker
occupation
age
finger clubbing
horner’s syndrome
vena cava obstruction
anaemia
```
66
signs of COPD
```
Heart disease
smoker
asthma
A1 antitrypsin deficiency
pursed lips
drug us
barrel chest
CO2 flap
paradoxical chest movement
hepatomegaly
accessory muscles breathing
peripheral oedema
tachypnoea
```
67
signs of pleural effusion
```
Peripheral oedema
liver disease
orthopnoea
PND
one sided expansion
stony dullness
reduced breath sounds
Reduced vocal resonance
tar staining, clubbing
increased JVP
trachea diversion
```
68
signs of pneumothorax
```
Pres-existing lung disease
recent trauma or surgery
tall thin male <45
surgical emphysema
hyper resonant
trachea diversion
absent breathing sounds
```
69
signs of Tb
Look for diabetes, immunosuppressed, prior tb, alcohol, immigrants, alcohol abuse. Signs of bronchial breathing, crackles, finger clubbing.
