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year 3 conditions > extra resp > Flashcards

extra resp Flashcards

1
Q

if COPD exacerbation pt has v low o2 sats what do u do

A

give high flow o2 through non rebreathe mask, don’t give Venturi bc pt will die of hypoxia before they die of hypercapnia

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2
Q

SOB, insignificant smoking history, abnormal LFTs

A

alpha 1 antitrypsin deficiency

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3
Q

COPD pt with low pH, high CO2, very high bicarb

A

acute on chronic resp acidosis
The HCO3- is high confirming a partially compensating metabolic alkalosis. Since metabolic compensation takes time to occur, the very high level of bicarbonate is suggestive of a chronic respiratory acidosis, most likely due to the patients COPD.

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4
Q

asthma gold standard diagnostic tests

A

FeNO test and spirometry with bronchodilator reversibility

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5
Q

what is BE and what does BE>+3 or <-3 suggest

A

The base excess is defined as the amount of H+ ions that would be required to return the pH of the blood to 7.35 if the pCO2 were adjusted to normal
a base excess > +3 = metabolic alkalosis
a base excess < -3 = metabolic acidosis

base excess also indicates chronic nature of the condition

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6
Q

tx after asthma exacerbation

A

prednisolone for 5 days

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7
Q

what is a specific complication of copd seen on blood count

A

raised haematocrit - copd can cause polycythaemia

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8
Q

if you have asthma suspicion but spirometry and bronchodilator reversibility is insignificant, what is the next step

A

FeNO testing
A negative result on spirometry does not exclude asthma as a diagnosis, and should be further investigated

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9
Q

which asthma exacerbation pts should be admitted into hospital

A

‘Admit people with a moderate asthma exacerbation
with worsening symptoms despite initial bronchodilator treatment and/or
who have had a previous near-fatal asthma attack.’

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10
Q

abg for diabetic ketoacidosis

A

metabolic acidosis with increased anion gap

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11
Q

which exacerbation is IV mgso4 used in

A

asthma not copd

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12
Q

should theophyllines be used for copd exacerbations

A

no
Trials evaluating the effect of IV aminophylline in exacerbations of COPD have failed to show benefits beyond those induced by inhaled bronchodilator and glucocorticoid therapy.

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13
Q

next step in copd exacerbation if doesn’t respond to medical tx

A

NIV

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14
Q

which smoking cessation med should not be used in epilepsy

A

bupropion

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15
Q

what can be sued to asses whether an acute bronchitis pt needs abx, and what is the first line abx for acute bronchitis

A

crp level
doxycycline

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16
Q

what is Carbocisteine

A

mucolytic agent

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17
Q

what medication can be given to reduce the risk of COPD exacerbations in patients with severe COPD and a history of frequent COPD exacerbations

A

Oral PDE-4 inhibitors such as roflumilast

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18
Q

what increase in FEV1 after bronchodilator inhalation is seen in asthma

A

An increase in the FEV1 of 12% or more after inhalation of a short-acting bronchodilator is indicative of asthma

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19
Q

which CURB65 score pts are admitted into hosp

A

score of 2 or more –> admit

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20
Q

what sport is banned for life after a pneuomthroax

A

deep sea diving

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21
Q

advice given after resolution of spontaneous pneumothorax

A

stop smoking
life long ban on deer water diving
can fly 1 week after resolution cxr

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22
Q

tx for moderate or severe sleep apnoea

A

CPAP

23
Q

COPD pts at which pH receive the most benefit from NIV

A

7.25-7.35

24
Q

which cancer is Alpha-1 antitrypsin deficiency a risk for

A

hepatocellular carcinoma

25
Q

pt has abdo pain and multiple large, round, well-circumscribed masses in both lungs
diagnosis

A

cannon ball metastases from renal cell carcinoma

26
Q

further diagnostic test for suspected occupational asthma

A

serial peak flow measurements at work and at home

27
Q

what should be done when draining a pneumothorax, if after 3-5 days there is persistent air leak (e.g. bubbling chest drain) or failure of the lung to re-expand

A

seek a thoracic surgical option

28
Q

where is alpha-1 antitrypsin made

A

liver

29
Q

how early can alpha-1 antitrypsin deficiency be diagnosed

A

can be diagnosed prenatally

30
Q

what are the contraindications to lung cancer surgery

A

SVC obstruction,
FEV < 1.5,
MALIGNANT pleural effusion,
vocal cord paralysis

31
Q

What vaccinations should copd pts receive

A

Annual influenza + one-off pneumococcal

32
Q

what is Acetazolamide used for

A

prevention of high altitude cerebral oedema

33
Q

mech of action of varenicline

A

Nicotinic receptor partial agonist

34
Q

what is Chest drain swinging

A

water seal in chest drain RISES in inspiration, FALLS in expiration

35
Q

what sort of asthma attack does normal co2 indicate

A

life threatening
- suggests tiring resp effort, co2 should be low as the pt should be hyperventilating to correct their hypoxia

36
Q

what sort of asthma attack does raised co2 indicate

A

near fatal

37
Q

sudden deterioration following NIV

A

pneumothorax

38
Q

what can mimic a pneumothorax in car

A

Large bullae

39
Q

what criteria should be used to determine whether patients who are having an exacerbation of COPD require antibiotics?

A

purulent sputum or clinical signs of pneumonia
not positive sputum culture as that takes ages to come back

40
Q

which cancer is Cyclophosphamide exposure associated with

A

bladder TCC

41
Q

which cancer is Benzidine exposure associated with

A

bladder TCC

42
Q

what is Isocyanates exposure associated with

A

occupational asthma
- used in paints, varnish etc

43
Q

what is the risk of over rapid aspiration/drainage of pneumothorax

A

re-expansion pulmonary oedema

44
Q

which valve disease that causes a diastolic murmur frequently causes atrial fibrillation

A

mitral stenosis

45
Q

mech of action of Bupropion

A

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist.

46
Q

what is purulent sputum

A

off-white, yellow or green, and opaque

47
Q

which valve disease causes exertion syncope

A

aortic stenosis

48
Q

causes of bronchial breathing

A

consolidation (pneumonia) or compression/ collapse of the lung

49
Q

causes of coarse crackles

A

pneumonia and pulmonary oedema

50
Q

what procedure can be done for a pt with recurrent pneumothoraces to prevent recurrence

A

VATS pleurodesis

51
Q

what is samters triad

A

asthma
minus disease with recurrent nasal polyps
sensitivity to aspirin and NSAIDs

52
Q

what type of shock does tension pneumothorax on the left cause

A

obstructive shock

53
Q
A

year 3 conditions (17 decks)

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