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[EDITED] ICSM Year 6 + edits > Passmed: Resp > Flashcards

Passmed: Resp Flashcards

(80 cards)

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1
Q

Moderate asthma

A

PEFR 50-75
Speech normal
RR <25
Pulse < 110

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2
Q

Severe Asthma

A

PEFR 33-50
Can’t complete sentences
RR >25
Pulse >110

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3
Q

Life-threatening Asthma

A

PEFR < 33
O2 < 92
Normal pC02
Silent chest, cyanosis, low resp effort, bradycardia, dysrhythmia, hypotension
exhaustion, confusion or coma

near fatal = raised C02 or mechanical ventilation

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4
Q

ABG indication in acute asthma

A

O2 < 92

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5
Q

CXR indications in Asthma

A

life-threatening
Pneumothorax
failure to respond to treatment

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6
Q

Who should be admitted with acute asthma

A

Life threatening
severe - if not respond to intital treatment
previous near fatal
pregnancy
attack despite using oral CS that night

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7
Q

Acute asthma patients that need oxygen

A

Hypoxaemic
acutely unwell - 15L - 94/98

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8
Q

How should SABA be delivered in LT A asthma

A

neb

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9
Q

What is given post A asthma

A

40-50mg pred PO - 5 days
continue normal meds as well

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10
Q

Treatment options in ITU for A asthma and indications

A

failure to respond to treatments - give senior critical care support

intubation and ventilation + ECMO

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11
Q

Criteria for A asthma discharge

A

stable (no additional meds) - 12/24 hrs
inhaler technique checked
PEF > 75%

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12
Q

Signs of acute bronchitis

A

cough
sore throat
rhinorrhoea
wheeze - only chest sign

clinical diagnosis - CRP testing

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13
Q

Mx of Acute bronchitis

A

analgesia
fluid
AB if:
- systemic
- - pre-existing co morbidities
- CRP 20/100 delay - above 100 give AB

AB = doxycycline, give amoxicillin in children / pregnant women

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14
Q

Post A COPD treatment

A

increase BD use + neb
pred 30mg 5 days
purulent sputum / pneumonia - ABS
- amox / clari / doxy

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15
Q

A COPD admission criteria

A

breathlessness
confusion
cyanosis
90> sats
social reasons
comorbidity

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16
Q

Initial oxygen therapy COPD

A

28% venturi mask 4 litres - no history resp acidosis

if co2 normal adjust target range

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17
Q

T2Rf in A COPD

A

NIV
- 7.25-7.35

then use BiPaP

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18
Q

What is ARDS

A

increased permeability of alveoli = fluid accumulation
- non cardiogenic PO

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19
Q

Causes of ARDS

A

infection
blood transfusion
trauma
smoke
acute pancreatitis
covid-19
cardio-pulmonary bypass

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20
Q

Features of ARDS and Ix

A

dyspnoea
resp rate raised
bilateral lung crackles
low oxygen sats

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21
Q

Specific features of ARDS

A

acute onset - within 1 week of factor
PO
non cardiogenic -check wedge pressure
pO2/fio2 < 40 /300

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22
Q

Mx of ARDS

A

ITU
treat hypoxaemia
organ support e.g vasopressors
underlying cause
prone and muscle relaxation

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23
Q

Where is bronchiectasis in ABPA

A

proximal

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24
Q

Ix for ABPA

A

eosinophilia
CXR
+ve RAST test
raised IgE

glucocorticoids

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25
How to interpret a blood gas
hypoxaemic acidaemic or alklaemic PaCO2 Metabolic component (base excess high or low)
26
Treatment of pleural plaques
benign and no malignant change
27
Features of asbestos exposure
pleural thickening plaques asbestosis - lower zone fibrosis, reduced exercise tolerance
28
Features of mesothelioma
progressive sob chest pain pleural effusion palliative chemo | lung cancer more common with asbestos - smoking increase further
29
RF for aspiration pneumonia
poor dental hygiene swallowing prlonged hospitalisation impaired consciousness impaired mucociliary clearance
30
Most common site for aspiration pneumonia
right middle right lower | larger and more vertical
31
Test for asthma over 17 and under
>17 - ask about work for occupational, spirometry (less than 70) with BDR & FeNO <17 - spirometry with BDR, FeNO only if normal (child 35 not 40)
32
BDR results
adults - FEV1 12% or 200ml Child - 12% improvement
33
Occupational asthma causes and work up
Isocyanates - spray paint serial measurements of peak expiratory flow - go to specialist
34
Asthma step down
every 3 months 25-50% of inhaled steroids
35
Atelectasis
basal alveolar collapse post operation bronchial secretions leading to hypoxaemia and dyspnoea 72 hrs postoperatively position upright and breathing exercises
36
Causes of Bilateral hilar lymphadenopathy
Sarcoid and TB lymphoma pneumoconiosis fungi
37
Causes of bronchiectasis
permanent dilatation of airways in response to infection / inflammation - post infective - CF - obstruction - immune def - ABPA - Ciliary dyskinetic e.g kartageners - yellow nail syndrome tramlines and signet ring
38
Mx of Bronchiectasis
physio postural drainage ABs bronchodilators immunise
39
Contraindications for chest drain
INR > 1.3 platelet count < 75 Pulmonary bullae pleural adhesions
40
Chest drain features
45 angle 5th intercostal space, MAL, lidocaine seldinger technique - aspirate fluid, go up on inspiration
41
Complications of chest drain
failure to insert bleeding infection penetration re-expansion pulomonary oedema - clamp and urgent CXR ( avoid rapid fluid output)
42
Removal of chest drain
no output > 24 hrs no longer bubbling penetrating chest injury review by specialist
43
Causes of lobar collapse
lung cancer - adults asthma foreign body trachea towards, media towards, elevation of hemidiaphragm
44
Cannonball mets from where
Renal cell carcinoma
45
Causes of mediastinal widening
patient rotation acute: AAA, lymphoma, goitre, teratoma, thymus tumour
46
CXR pulmonary oedema
bat wing upper lobe diversion kerley b pleural effusion cardiomegaly - if cardiogenic
47
Causes of white lung lesions
Trachea toward - pneumonectomy, lung collapse, hypoplasia Central - consolidation, PO, mesothelioma Away - effusion, diaphragmatic hernia, thoracic mass
48
Features of pneumoconiosis
coal dust immune response simple - asymp, some opacities, normal lung marking and no lung markings progressive massive fibrosis - mixed lung picture upper zone fibrosis, avoid coal, chronic bronchitis treatment and get compensation
49
Features of COPD
CXR - hyperinflation, bullae, flat hemidiaphragm Bloods - secondary poly staging - 80, 50-79, 30-49, 30 (very severe) - FEV1
50
Asthmatic features of COPD
LABA + LAMA + ICS on triple exclude lama if first time swap sama to saba | theophylline if cannot inhale, reduce if macrolide co-prescribe
51
What should be done before prescribing azithromycin
ecg - qt prolongation
52
PDE-4 and COPD
reduce exacerbations e.g roflumilast severe - less than 50% 2 or more exacerbations in previous 12 months despite triple therapy of LAMA< LABA and ICS
53
Churg strauss syndrome
asthma blood eosinophilia paranasal sinusitis mononeuritis pANCA | Gran with P - renal failure + epistaxis + cANCA - steroids
54
Aspergilloma and haemoptysis
past history of TB
55
Inhaler technique
remove cap and shake breathe out gently put in mouthpiece as breath in slow and depp, inhale steadiliy hold breath for 10 seconds second dose wait 30 seconds - repeat only use number of doses on label
56
Features of kartageners
primary ciliary dyskinesia dextrocardia bronchiectasis recurrent sinusitis subfertility
57
Klebsiella
gram neg following aspiration and uti alcoholic and diabetics red current jelly upper lobe lung abcess and empyema
58
Features of lung abscess
aspiration pneumonia staph / kleb subacute -slow symptoms and systemic features CXR - fluid filled space IV ABs then percutaneous drainage
59
Features of each lung cancer
small cell - adh, acth, lambert eaton (weak on use) scc - parathyroid, clubbing, hypertrophic pulmonary osteoarthropathy, hypert ectopic tsh adeno - gynaecomastia, hpoa
60
Ix for lung cancer
CXR - then ct bronchoscopy for histology raised platelets on blood
61
Referral criteria for lung cancer
cxr of LC aged 40 unexplained lung cancer - 2ww urgent cxr in 2 weeks over 40 and 2 / smoked / 1 - cough, fatigue, etc consider if 40 over with - recurrent chest infection, clubbing, chest signs, thrombocytosis
62
Lung fibrosis zones
upper - hypersen pneumonitis, coal, silicosis, sarcoid, anklyosing, tbf, radiation induced lower - ipf, connective tissue e.g. sle, drugs, asbestosis
63
cytology negative exudative effusions
local anaesthetic thoracoscopy chemo for meso
64
Cons of OSA
daytime somnolence resp acidosis hypertension
65
Oxygen therapy indications
critically ill - anaphylais, shock - 15litre | no for MI, stroke, obstetirc, anxiety
66
Pleural effusion causes
trans - failures, heart most common exudate (high protein above 30) - infection e.g. pneumonia, connecitve tissue, neoplasia, pancreaitis, pe, dressler
67
Ix and Mx of Pleural Effusion
PA CXR USS on aspiration 21G and 50ml syndrine lights: exudate likely if one - pleural fluid protein > 0.5, LDH pleural / serum ldh > 0.6, pleural ldh 2/3 upper limit of normal serum ldh
68
characterisitc pleural fluid
low glucose - RA and TB raised amylase - pancreatitis and oesophageal perforation heavy blood staining - mesothelioma, pe, tb
69
No symptoms with pneumothorax
conservative care regardless of size
70
high risk characteristics of pneumothorax
haemodynamic compromise (suggesting a tension pneumothorax) significant hypoxia bilateral pneumothorax underlying lung disease ≥ 50 years of age with significant smoking history haemothorax | always chest drain, Video (VATS) - persisent for pleurodesis
71
Pneumothorax discharge advice
smoking - avoid flying - 2 weeks after if no air no scube diving - unless bilateral surgical pleurectomy and normal lung function and CT scane
72
Causes of restrictive lung disease
PF Asbestosis sarcoidosis ards kyphoscoliosis neuromuscular severe obesity
73
Causes of resp acidosis
copd asthma neuromuscular obesity sedative - benzo / opiate overdose
74
Causes of resp alkalosis
anxiety pe salicylate poisoning cns disorder: stroke altitude pregnancy
75
Resp tract infection features
centor: exudate, lymphadeno, fever, absence of cough
76
Sarcoidosis features
non-caseating erythema nodosum, lupus pernio, uveitis Indications for steroids: CXR staging (2 or 3 - BHL + interstitial infilitrates), hypercalcaemia, eye, heart or neuro involvement | fibrosis
77
Poor prognosis with Sarcoid
insidious > 6 months no erythema nodosum extrapulmonary features - lupus pernio, spelnomegaly, stage III or more on CXR black african
78
Silicosis
mining, slate, silica inhalation - develop to TB upper zone fibrosing lung disease, egg shell calcification
79
Smoking cessation
nicotine replacement therapy - 2 weeks to stop date not offer re prescription in next 6 months varenicline - nicotinic rec partial agonist - 1 week before stop date - 12 weeks , no for depresion and pregancy / breast feeding bupropion - nor and dop reuptake inhibitor - 1 before stop, seizures and epilepsy + breast
80
Transfer factor
rate at which gas diffuse into blood raised - asthma, pulmonary haemorrhage, polycythamia, hyperkinetic, male gender, exercise lwoer - pf, pneumonia, pe, po, emphysema, anaemia, low cardiac output

[EDITED] ICSM Year 6 + edits (28 decks)

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