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Resp Flashcards

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1
Q

Causes of consolidation

A

Pneumonia
Pulmonary haemorrhage
Malignancy
Pulmonary oedema

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2
Q

Signs of COPD

A
  • CO2 retention tremor

- Hyperexpanded ‘Barrel’ chest

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3
Q

Signs of pneumothorax

A
  • Tracheal deviation (away from side)
  • Reduced chest expansion
  • Hyper-resonance on percussion
  • absent breath sounds
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4
Q

Signs of lobar collapse/lobectomy

A
  • Trachial deviation (towards side)
  • Reduced expansion
  • Absent breath sounds
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5
Q

Indications for lobectomy

A
  • Cancer
  • Trauma
  • Bronchiectasis (lung volume reduction)
  • TB
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6
Q

Signs of pleural effusion

A
  • Reduced expansion
  • Stony dull percussion
  • Reduced breath sounds
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7
Q

Signs of consolidation

A
  • Reduced expansion
  • Dull percussion
  • Bronchial breathing on auscultation
  • Coarse crackles
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8
Q

Causes of interstitial lung disease

A

Inhaled antigen (organic)

  • Bird fancier’s lung
  • Farmer’s lung

Inhaled irritant (inorganic)

  • Asbestosis
  • Pneumoconiosis e.g. Coal miner’s lung
  • Silicosis

Idiopathic

Associated with systemic disease

  • RA
  • SLE
  • Sarcoidosis

Iatrogenic

  • Methotrexate
  • Amiodarone (basal fibrosis)
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9
Q

Interstitial lung disease Mx

A

Conservative

  • Chest physiotherapy
  • Pneumococcal and flu vaccines
  • Stop smoking
  • Stop causative medications

Surgical
- Lung transplantation

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10
Q

Spirometry interpretation

A

Predicted FEV1/FVC ratio can be calculated based on age, height, sex, ethnicity

FEV1/FVC normal = 80%

FEV1/FVC ratio <0.7 = obstructive airway disease (both FEV1 and FVC reduced, FEV1 more drastically) - FEV1 determines severity

FEV1/FVC ratio >0.7 = restrictive airway disease (both reduced, FVC more than FEV1) - TLC determines severity

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11
Q

Causes of coarse crackles

A

Aspiration
Pneumonia
Pulmonary oedema

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12
Q

Causes of fine crepitations

A

Interstitial lung fibrosis

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13
Q

Additional airway sounds

A 
Pleural rub (rubbing sound heard on inspiration)
Wheeze (polyphonic or monophonic)
Fine crepitations (late inspiratory)
Coarse crepitations (early inspiratory)
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14
Q

Chronic asthma Mx

A

MDT

Conservative
Avoid triggers
Inhaler technique
Regular asthma review
No smoking
Flu vaccines 
Medical
SABA + ICS
SABA + ICS + LRTA
SABA + ICS + LABA (stop LRTA if ineffective)
SABA + (ICS + LABA) = (MART)
Increase ICS dose
Specialist referral
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15
Q

Causes of bronchiectasis

A 
A1 antitrypsin deficiency
Systemic disease e.g. RA
Severe respiratory infections e.g. TB
CF
PCD
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16
Q

COPD classification based on FEV1 percentage predicted

Study These Flashcards
A

50-79%: Mild
30-49%: Moderate
Less than 30%: Severe

17
Q

Stable COPD Mx

Study These Flashcards
A

Conservative

  • Pulmonary rehabilitation
  • Pneumococcal and flu vaccines
  • Stop smoking

Medical
- SABA or SAMA

  • SABA + LABA + ICS (if steroid responsive)
  • SABA + LABA + LAMA+ ICS
  • Specialist referral
  • SABA + LABA + LAMA (if not steroid responsive)
  • SABA + LABA + LAMA + ICS
  • Specialist referral
  • LTOT
  • Prophylactic antibiotics (azithromycin - if multiple exacerbations)
18
Q

LTOT criteria

Study These Flashcards
A 
Have a PaO2 < 7.3 kPa 
Have a PaO2 7.3 - 8 kPa and one or more of the following:
					® Secondary polycythaemia 
					® Peripheral oedema 
					® Pulmonary hypertension
19
Q

Ix for interstitial lung disease

Study These Flashcards
A

Bedside
PEFR
Spirometry

Bloods
FBC, U&Es
Antibody screen - Anti-CCP, RF, dsDNA

Imaging
High resolution CT chest
CXR

Lung biopsy (diagnostic, not normally done)

20
Q

Types of lung cancer and paraneoplastic syndromes

Study These Flashcards
A

Small cell carcinoma (ACTH, SIADH, LEMS) - Associated with smoking

Non-small cell carcinoma

  • Large cell carcinoma
  • Lung adenocarcinoma (most common in non-smokers)
  • Squamous cell carcinoma (PTHrp) - associated with smoking, most common
21
Q

Lung cancer Ix

Study These Flashcards
A

Bloods

Imaging
CXR
2ww CT PET

Interventional
EBUS- guided biopsy

22
Q

2ww criteria for lung cancer

Study These Flashcards
A 
Presenting symptoms for CXR:
Cough 
SOB
Fatigue
Weight loss
Chest pain
Appetite loss

Refer if:
Over 40 + 2 symptoms
Smoker + 1 symptom

23
Q

Lung cancer Mx

Study These Flashcards
A

Conservative
MDT (Macmillan, psych support)
Smoking cessation

Chemotherapy (especially for small cell carcinoma)
Radiotherapy

Lobectomy
Pneumonectomy

NSCLC: Surgery (20% suitable) or curative/palliative radiotherapy

SCLC: Surgery (early disease), Chemoradiotherapy (advanced disease)

24
Q

TB drug SEs

Study These Flashcards
A

Rifampicin: Orange secretions
Isoniazid: Peripheral neuropathy, Liver injury
Pyrazinamide: Liver injury
Ethambutol: Visual disturbance

25
Causes of upper lobe fibrosis (TAP)
TB ABPA Pneumoconiosis
26
Contraindications to surgery for lung cancer
``` Poor health Vocal cord paralysis SVCO Malignant pleural effusions FEV <1.5L (so have to do spirometry beforehand) ```
27
Indications for draining a pleural effusion
Frankly purulent fluid pH <7.1 Bacteria on gram stain and culture Loculated effusions
28
Variants of asthma
``` Atopic Seasonal Exercise induced Occupational (adult onset, and improve on days off) Cough variant ```
29
Asthma diagnostic tests
1a. Spirometry + bronchodilator reversibility test: FEV1/FVC ratio <0.7 + bronchodilator FEV1 reversibility >12% is suggestive of asthma 1b. FeNO test (use in primary care if possible) >40 in steroid naive adult is suggestive of asthma 2. Peak flow variability studies (BD PF monitoring) Do regardless of spirometry result if FeNO <40 Variability >20% over 2-4 weeks is suggestive of asthma 3. Bronchial histamine challenge test
30
Asthma diagnostic criteria adults
FeNO >40 PLUS one of: - Positive bronchodilator reversibility - Positive peak flow variability OR Positive bronchodilator reversibility AND Positive peak flow variability OR FeNO 25-39 PLUS Positive bronchial challenge test
31
Causes of obstructive lung disease
Asthma COPD Bronchiectasis
32
Causes of restrictive lung disease
Pulmonary fibrosis Sarcoidosis Neuromuscular disorders
33
Causes of polyphonic wheeze
Asthma COPD Bronchiectasis
34
Causes of monophonic wheeze
Airway obstruction - Tumour - Lymph nodes - Secretions
35
What is bronchial breathing?
Sign of consolidation - inspiratory and expiratory phases sound equal in length and volume (normally inspiration is louder than expiration)
36
Types of lung cancer
Small cell carcinoma (smoking, bronchial) Non-small cell carcinoma Adenocarcinoma (non-smokers, lobar, most common) Squamous cell carcinoma (smokers, bronchial) Large cell carcinoma

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