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Resp Flashcards

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1
Q

What causes upper lobe fibrosis?

A

Coal workers pneumonitis
Hypersensitivity
Ankylosing spondylitis
Radiation
Tuberculosis
Sarcoidosis

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2
Q

management of acute COPD exacerbation

A
  • increase bronchodilator use; can give via nebs
  • corticosteroid for 30 days
  • oral antibiotics ‘if sputum is purulent or there are clinical signs of pneumonia’; clarithromycin, doxycycline or amoxicillin
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3
Q

most likely cause of pneumonia if recent influenza

A

staphlycoccus aureus

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4
Q

treatment for sinusitis

A

intranasal corticosteroids

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5
Q

Stepwise asthma treatment

A

SABA
ICS
LTRA
LABA and review LTRA
MART therapy
Increase to high dose ICS or try additional drug

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6
Q

Spirometry of COPD

A

Obstructive non reversible picture

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7
Q

GOLD stages COPD

A

I FEV1>80%
II 50-80%
III 30-50%
IV <30%

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8
Q

Criteria for assessment for oxygen therapy in COPD

A

FEV1 <30% predicted
Cyanosis
Polycythaemia
Peripheral oedema
Raise JVP
Oxygen sats <92 on air

Must not smoke

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9
Q

Offer LTOT to patients with…

A

PO2 <7.3kpa
Or PO2 7.3-8kpa and one of secondary polycythaemia, peripheral oedema, pulmonary hypertension

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10
Q

pharamcological COPD treatment

A
  1. SABA(salbutamol) or SAMA (ipratropium)
  2. no asthmatic features; add LABA or LAMA (stop SAMA if starting LAMA)
  3. with asthmatic features; add LABA and ICS.
    if still breathless add LAMA
  4. oral theophylline under specialist
  5. consider prophylactic azithromycin if lots of exacerbations
  6. can try mucolytics if lots of mucus e.g. carbocisteine
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11
Q

non-pharmacological COPD treatment

A

smoking cessation
annual flu vaccine
one off pneumococcal
pulmonary rehabilitation

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12
Q

What cause of pneumonia is associated with erythema multiforms

A

Mycoplasma pneumonia

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13
Q

active TB treatment

A

pyrazinamide + ethambutol for first 2 months
isoniazid + rifampicin for the whole 6 months

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14
Q

important side effects of TB drugs

A

rifampicin - orange bodily fluids, toxicity and interactions
isoniazid - neuropathy, hepatitis
pyrazinamide - hepatotoxicty, arthralgia, sideroblastic anaemia
ehtambutol - optic neuritis

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15
Q

where does lung cancer tend to metastasise to

A

Bones
Liver
Adrenals
Brain

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16
Q

treatment/prognosis of SCLC

A

treatment not curative
classified as limitied or extensive
worse prognosis than NSCLC

responsible for the paraneoplastic syndromes

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17
Q

treatment/prognosis of NSCLC

A

based on TNM staging
stage 1 operable
2 & 3 mixed
stage 4 chemo only

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18
Q

types of NSCLCs

A

adenocarcinoma (most common 40%)
sqamous carcinoma (20%)
large cell (10%)
others (10%)

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19
Q

Non metastatic manifestations of lung cancer

A

Lambert Eaton syndrome
Myasthenia graves
(Both related to Ach in the synapse)

SIADH

hypertrophic osteoarthropathy (more common is nsclc)

Cushing syndrome

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20
Q

What is pancoast syndrome

A

Malignant neoplasm in the thoracic inlet disrupting the brachial plexus and cervical sympathetic nerves

causes Horner’s syndrome; ptosis, anhidrosis and miosis

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21
Q

what is the treatment for small cell lung cancer

A

combination of chemotherapy and radiotherapy

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22
Q

treatment of Non Small Cell LCas

A

mainstay is surgery + radiotherapy

later chemotherapy can be added

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23
Q

characteristic chest signs of pneumonia

A

bronchial breath sounds

focal course crackles

dullness to percussion

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24
Q

CURB-65

A

Confusion
Urea >7
Resp rate 30+
Blood pressure <90 systolic or <60 diastolic
>65 years

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25
hospital investigations pneumonia
CXR FBC U+Es CRP +/- sputum and blood cultures depending on severity
26
pneumonia complications
acutely; reps failure, hypotension, AF empyema pleural effusion sepsis lung abscess kidney or liver failure
27
mild CAP treatment
5-7 days antibiotics can usually be managed in the community
28
moderate to severe CAP treatment
7-10 days of dual antibiotics will need admission
29
what key drugs can induce pulmonary fibrosis
methotrexate nitrofurantoin amiodarone cyclophosphamide
30
classical signs idiopathic pulmonary fibrosis
bibasal fine end inspiratory crackles finger clubbing progressive symptoms
31
what conditions can cause secondary pulmonary fibrosis
SLE rheumatoid arthritis systemic sclerosis a1-antitrypsin deficiency
32
what is sarcoidosis epidemiology
a granulomatous inflammatory condition two age spikes - 20s and 60s more common in women more common in black people
33
main symptoms and systems affected in sarcoidosis
chest symptoms but also has multiple extra-pulmonary manifestations such as erythema nodosum and lymphadenopathy lungs; fibrosis, nodules, mediastinal lymphadenopathy systemic; fever, fatigue, weight loss liver; nodules, cirrhosis, cholestasis eyes; uveitis, conjunctivitis, optic neuritis skin; erythema nodosum, granulomas in scar tissue each of heart, kidneys and nervous system can also be affected in about 1 in 20
34
sarcoidosis investigations
serum ACE; diagnostics and screening calcium in often raised CRP can be raised raised serum IL-2 receptor histology is gold standard for confirming diagnosis
35
sarcoidosis treatment
can often conservatively manage initially when treatment required start oral steroids for 6 to 24 months second line are azathioprine and methotrexate
36
what is pulmonary hypertension
increased resistance and pressure of blood in the pulmonary arteries which causes strain on the right side of the heart and eventually back pressure into the venous system
37
causes of pulmonary hypertension
primary pulmonary hypertension CTDs such as lupus chronic lung disease such as COPD pulmonary vascular disease e.g. PE others; haematological, sarcoidosis
38
action if PE Well's score - likely (4+) - unlikely
likely; immediate CTPA and anticoagulant unlikely; interim anticoagulate, D-dimer and if positive CTPA, if negative PE very unlikely
39
exudative pleural effusion
fluid has: high protein high LDH high cholesterol causes are related to inflammation; cancer, pneumonia, rheumatoid arthritis, TB
40
transudative pleural effusion
fluid has: low protein low LDH low cholesterol caused by fluid shifts e.g from heart failure, hypoalbuminaemia, hypothyroidism, Meig's (R sided due to Ovarian Ca)
41
what is an empyema?
infected plural effusion suspect in improving pneumonia but new or ongoing fever. Pleural aspiration shows pus, acidic pH (pH < 7.2), low glucose and high LDH
42
types of non-invasive ventilation
BiPAP - used in type 2 RF CPAP - used in obstructive sleep apnoea, congestive cardiac failure, acute pulmonary oedema
43
what is the diagnostic investigation in obstructive sleep apnoea
Polysomnography
44
features of obstructive sleep apnoea
daytime sleepiness compensated respiratory acidosis hypertension
45
assessment of sleepiness
Epworth Sleepiness Scale - completed by pt +/- partner Multiple Sleep Latency Test (MSLT) - measures time to fall asleep using EEG
46
management obstructive sleep apnoea
weight loss CPAP DVLA informed if excessive sleepiness
47
most common cause of COPD exacerbation pneumonia
Haemophilus influenzae. Other bacterial causes include Streptococcus pneumoniae and Moraxella catarrhalis. Respiratory viruses account for around 30% of exacerbations
48
most common pneumonia seen in alcoholics
Klebsiella pneumoniae
49
COPD exacerbation management
increased freq bronchodilator use and consider nebulisers 5 days oral prednisolone 30mg antibiotics is sputum purulent or clinical signs of pneumonia - amoxicillin, clarithromycin or doxycycline
50
what antibiotic is used for prophylaxis in COPD patients who meet the criteria
azithromycin 250mg 3 times a week >3 exacerbations requiring steroid therapy and at least one exacerbation requiring hospital admission in the previous year non smoker trial for minimum of 6-12 months
51
what type of fibrosis tends to affect the lower zones
idiopathic pulmonary fibrosis CTDs drug induced asbestosis
52
indications for surgery in bronchiectasis
uncontrolled haemoptysis localised disease
53
management of atelectasis
chest physiotherapy with mobilisation and breathing exercises
54
Acute Respiratory Distress Syndrome
1) acute onset dyspnoea, increased RR, bilateral lung crackles, desaturating 2) signs of non-cardiogenic pulmonary oedema 3) reduced PaO2/FiO2 of <300 mmHg (or <40 kPa) mortality around 40%
55
are pleural plaques malignant
no benign and do not undergo malignant change
56
life threatening asthma features
PEFR <33% sats <92% normocapnic exhaustion
57
severe asthma features
PEFR 33-50% HR >110 bpm RR >25 can't complete sentences
58
discharge criteria asthma exacerbation
stable on discharge medication for 12-24 hrs PEF>75% best or predicted inhaler technique checked and recorded
59
trachea pulled toward a whiteout CXR
pneumonectomy complete lung collapse pulmonary hypoplasia
60
trachea central complete white out CXR
consolidation pulmonary oedema mesothelioma
61
trachea pushed away from whiteout CXR
pleural effusion large thoracic mass diaphragmatic hernia
62
features of allergic bronchopulmonary aspergillosis management
bronchiectasis + symptoms of bronchoconstriction eosinophilia managed with oral steroids sometimes with itraconazole
63
smoking cessation help in pregnancy women
nicotine replacement therapy bupropion and varenicline are contraindicated!
64
what do lung abscesses usually occur secondary to management
aspiration pneumonia are typically polymicrobial due to this needs IV antibiotics
65
what paraneoplastic syndromes squamous cell lung ca
hypercalcemia secondary to PTH clubbing hypertrophic pulmonary osteoarthropathy hyperthyroidism
66
what paraneoplastic syndromes small cell lung cancer
hyponatramia secondary to SIADH ACTH --> cushings Lambert Eaton
67
what drug class is montelukast an example of
Leukotrine Receptor Antagonists
68
what blood gas abnormality does a neuromuscular disease usually cause
a respiratory acidosis
69
primary pneumothorax management
if <2cm and no SoB discharge and follow up if >2cm or SoB needle aspiration chest drain if not resolved
70
secondary pneumothorax management
if >50 yrs old or rim >2cm then chest drain should be inserted if 1-2cm aspirate all patients even if <1cm should be admitted with oxygen for 24 hrs
71
pleural plaques
large plaques seen on X-ray appear 2-40 yrs after asbestos exposure benign and do not undergo malignant transformation
72
asbestosis
related to length of exposure causes lower lobe fibrosis with symptoms of dyspnoea and reduced exercise tolerance, clubbing, end inspiratory crackles, restrictive lung function tests
73
mesothelioma
malignancy of the pleura presenting with progressive SoB, chest pain and pleural effusion poor prognosis

Clinical Years / Progress Test (24 decks)

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