My Final Day Flashcards
treatment for pulmonary embolism
Admission to hospital
Oxygen
Analgesia
Monitor for deterioration
Apixaban or rivaroxaban
Anticoagulation
Warfarin
NOAC
LMWH
sarcoidosis investigation
CT thorax
Chest X-ray
MRI
PET SCAN
Bloods
could you give oral steroids for sarcoidosis
yes
could heart block be a symptom of sarcoidosis
yes
so see for tomorrow, literally just put any disease they suggest
For long-term symptomatic relief of angina, first-line is with either, or a combination, of:
For long-term symptomatic relief, first-line is with either, or a combination, of:
Beta blocker (e.g., bisoprolol)
Calcium-channel blocker (e.g., diltiazem or verapamil – both avoided in heart failure with reduced ejection fraction)
but GTN for immediate relief
when are: Calcium-channel blockers (e.g., diltiazem or verapamil) for symptomatic relief of angina, avoided
in heart failure with reduced ejection fraction
secondary prevention for angina =
Medications for secondary prevention can be remembered with the “four As” mnemonic:
A – Aspirin 75mg once daily
A – Atorvastatin 80mg once daily
A – ACE inhibitor (if diabetes, hypertension, CKD or heart failure are also present)
A – Already on a beta blocker for symptomatic relief
all those formulas like tidal
all the drugs
valsalva maneouvre
chadvasc
hasbled
whats heparin
vital vs tidal capacity
Vital Capacity describes the largest volume of air that can be voluntarily exhaled after a maximum inhalation.
Tidal = in AND out in one breath
Alveolar ventilation volume is more or less than pulmonary ventilation volume
less- alveolar is what participates in gas exchange
Pulmonary (or minute) ventilation describes the total amount of air breathed in or out per minute (basically tidal volume x respiration rate). Alveolar ventilation accounts for the volume of air that gets stuck in dead space and never reaches the alveoli, so dead space volume must be subtracted from tidal volume before multiplying by respiration rate ((TV-DS) x RR), making alveolar ventilation smaller than pulmonary ventilation i.e. not all the air you breath in reaches the level of the alveoli and participates in gas exchange!
Respiratory acidosis often accompanies severe lung pathology.
True. Most lung pathologies lead to an impairment of gas exchange for one reason or another. This impairment increases CO2 levels in arterial blood. An increase in CO2 leads to an increase in H+ concentration
An increase in 2,3-diphosphoglycerate (DPG) in the red cells will shift the haemoglobin-O2 saturation curve to the right
Yes: DPG:reducing the affinity of haemoglobin for oxygen, and in doing so shifts the curve to the right.
ventilation and perfusion where greatest
There is good correlation with ventilation and perfusion – both are greatest at the base of the lung (in the upright position) and both decrease with height. However blood flow declines faster than ventilation so while blood flow exceeds ventilation at the base of the lung, ventilation exceeds blood flow at the apex
base of lung
blood flow greatest at base
A shift of the oxygen dissociation curve of haemoglobin to the right or left is seen in foetal blood, as compared with adult blood
A shift of the oxygen dissociation curve of haemoglobin to the left is seen in foetal blood, as compared with adult blood
what does hyperventilation do
Hyperventilation will top up oxygen levels but more importantly lower CO2 levels.
how does centric acinar occur
bronchiolar dilation
loss of alveolar tissue
little holes in the lungs
In an acute asthma attack, how are steroids given
steroids should be given orally, or sometimes intravenously.
eg prednisalone
It’s SABA that’s given via nebuliser
For a diagnosis of chronic bronchitis to be given, a patient should have a cough productive of sputum for how long
most days
three months
2 years
An excess of alpha-1-antitrypsin can lead to emphysema, true or false
False
alpha-1 antitrypsin is an enzyme which breaks down other enzymes that break down alveolar tissue. A deficiency of this enzyme tips the balance towards tissue destruction, and can lead to emphysema
So its loss of alpha-1-antitrypsin = emphysema
Washing a spacer does what to static charge
decrease it
washing the spacer device leaves a coating of detergent, which will decrease the static charge. This means the drug is less likely to stick to the spacer, and increases drug delivery to the lungs.
so it’s a good thing
You are more likely to have asthma if your mother is asthmatic than if your father is asthmatic.
true
In assessing severity of acute asthma in adults, subjective parameters (eg. distress) are just as important as observations and blood gases.
this statement is false. Why?
patients and doctors tend to underestimate asthma severity, and a life-threatening attack may not be associated with significant distress. Objective measurements such as vital observations (pulse rate, oxygen saturations, peak flow) and blood gas analysis are most useful.
Female sex is a risk factor for COPD.
explain- considering that there are more males with COPD!
females smokers more likely than male smokers
In spirometry, an FEV1:FVC of 0.5 would be considered obstructive
true
Because normal is 0.7-0.8
Most infections causing exacerbations of COPD are viral.
True – although patients will often receive antibiotics for acute infective exacerbations of COPD, in the majority of cases the pathogen is a virus.
initial treatment for paediatric asthma
very low dose inhaled steroids are the initial treatment for paediatric asthma.
but if more than twice a week then add LABA
A child >5 on a very low dose inhaled corticosteroid who continues to require their reliever inhaler twice a week should have a long-acting beta agonist added on to their treatment.
true
COPD is a cause of finger clubbing
false
What 4 diseases could cause finger clubbing?
lung cancer, lung infections, interstitial lung disease, cystic fibrosis or cardiovascular disease
low oxygen and high CO2
Regular use of a brown inhaler in childhood can restrict adult height by up to what
0.5-1cm
Type 2 respiratory failure is a feature of severe COPD.
True –
An easy way to remember type 1 vs type 2 respiratory failure is that in type 2 failure, the movement of 2 gases is impaired. In type 1 respiratory failure, there is a failure of oxygenation, but ventilation is adequate to clear CO2 (remember that CO2 dissolves much more readily than oxygen).
In type 2 respiratory failure, ventilation is impaired to the point that not only does oxygenation fail, but CO2 isn’t being cleared, and CO2 levels rise. In COPD, this is a sign of advanced disease.
How do we treat latent TB
Latent TB (positive Mantoux or IGRA test in a person who has had contact with TB).
The same antibiotics are used, for a slightly shorter course, usually 3 to 6 months.
does amoxicillin have much action against atypical organisms
no
if atypical, treat with macrolide like co-trimoxazole
Rusty brown sputum is a symptom of staph or strep
strep
side affect of rifampicin
rifampicin causes all bodily fluids to turn orange-red, so it is best to advise patients not to wear contact lenses!
rifampicin is an antibiotic that can be used to treat TB
true
how does flu lead to secondary infections
damage to mucociliary escalator
Name the complication: involves the wide dissemination through the bloodstream of TB granulomata, and commonly involves spread to the brain and meninges.
Miliary TB
CURB-65- what are the guidelines
confused
urea over 7
resp rate OVER 30
bloop pressure under 90/60
and if over age 65
How do we class latent TB
positive Mantoux or IGRA test in a person who has had contact with TB, but is asymptomatic and has a normal CXR
ethambutol can be used to treat TB, true or false
true
Pneumonia caused by Mycoplasma pneumoniae tends to occur in what yearly epidemics.
4-5
Klebsiella pneumoniae infection is typically associated with alcoholism and other causes of aspiration.
true
Moraxella catarrhalis is a typical cause of LRTIs in COPD.
true
what is a typical cause of LRTIs in COPD.
Moraxella catarrhalis
what pneumonia is associated with intravenous drug abuse.
staph
what pneumonia is classically seen following influenza infection.
staph
