Resp Flashcards
1
Q
PEFR in obstructive disease
A
reduced
2
Q
PEFR in restrictive disease
A
normal
3
Q
restrictive or obstructive: asthma
A
obstructive
4
Q
restrictive or obstructive: pulmonary fibrosis
A
restrictive
5
Q
restrictive or obstructive: asbestosis, sarcoidosis
A
restrictive
6
Q
restrictive or obstructive: COPD
A
obstructive
7
Q
restrictive or obstructive: bronchiectasis
A
obstructive
8
Q
what is measured in peak flow
A
peak expiratory flow rate, with variation depending on age height and sex (FVC)
9
Q
what is measured in spirometry
A
forced vital capacity
forced expiratory volume in 1 second (FEV1)
Forced expiratory ratio (FER) - FEV1/FVC
10
Q
FEV1/FVC in restrictive disease
A
normal
11
Q
FEV1/FVC in obstructive disease
A
reduced
12
Q
how can you distinguish between COPD and asthma in spirometry
A
FVC is normal in asthma but decreased in COPD
or do bronchial challenge/reversibility
13
Q
results of bronchial challenge in COPD and asthma
A
asthma > 15% increase
COPD < 15% increase
14
Q
TCLO in asthma
A
normal/raised
15
Q
TCLO in emphysema
A
reduced
16
Q
TCLO in restrictive disease
A
reduced
17
Q
TCLO in Wegeners/good pastures
A
raised
18
Q
TCLO in polycythaemia
A
raised
19
Q
FVC: significantly reduced
FEV1: decreased
FER: > 75% i.e. normal
TCLO: reduced
A
restrictive pattern
20
Q
restrictive spirometry pattern:
FVC, FEV1, FER, TCLO
A
FVC: significantly reduced
FEV1: decreased
FER: > 75% i.e. normal
TCLO - reduced
21
Q
FVC - decreased
FEV1 decreased
FER decreased
TCLO decreased
A
COPD
22
Q
spirometry of COPD
A
FVC - decreased
FEV1 decreased
FER decreased
TCLO decreased
23
Q
what disease FVC - decreased FEV1 decreased FER decreased TCLO decreased
A
COPD
24
Q
spirometry of asthma
A
FVC - normal
FEV1 significantly decreased
FER decreased
TCLO normal/raised
25
FVC - normal
FEV1 significantly decreased
FER decreased
TCLO normal/raised
asthma
26
chronic asthma > 17 YOs
| step 1
SABA
27
chronic asthma > 17 YOs
| step 2
SABA + ICS
28
chronic asthma > 17 YOs
| step 3
NICE - SABA + ICS + LTRA
SIGN - SABA + ICS + LABA
29
chronic asthma > 17 YOs
| step 4
SABA + ICS + LABA
| continue LTRA if there was good response
30
chronic asthma > 17 YOs
| step 5
SABA +/- LTRA + low dose ICS/LABA mart
31
chronic asthma > 17 YOs
| step 6
SABA +/- LTRA + med dose ICS/LABA mart
or
moderate fixed dose ICS and separate laba
32
chronic asthma > 17 YOs
| step 7
SABA +/- LRTA
+ high dose ICS fixed (not mart)
or trial of 4th drug e.g. LAMA or theophylline
seek advice
33
what is considered low dose ICS
< 400mcg
34
what is considered medium dose ICS
400-800mcg
35
what is considered high dose ICS
> 800 mcg
36
SIGN guidelines
| patient on SABA, ICS, LABA poorly controlled asthma
increase ICS or trial another drug - LTRA, theophylline, LAMA
37
what is a common side effect of LTRA
night mares
38
when are LTRAs e.g. montelukast particularly good
allergic phenotypes or exercise induced
39
what drug is good in asthma with SOB without allergy or inflammation
tiotropium
40
why are theophyllines generally considered last line
make people feel sick
| dont work in smokers
41
asthma in kids 5-15 step 1
SABA
42
asthma in kids 5-15 step 2
SABA + paed low dose ICS
43
asthma in kids 5-15 step 3
SABA + paed low dose ICS + LTRA
44
asthma in kids 5-15 step 4
SABA + paed low dose ICS + LABA
| stop the LTRA
45
asthma in kids 5-15 step 5
SABA + PLD ICS Mart
46
asthma in kids 5-15 step 6
SABA + PMD ICS mart
| or fixed dose moderate ICS + separate LABA
47
asthma in kids 5-15 step 7
SABA + one of
- paediatric high dose fixed dose regime or MART
- trial of theophylline
48
asthma kids < 5 step 1
SABA
49
asthma kids < 5 step 2
SABA + 8 week trial of paediatric moderate dose ICS - after 8 weeks stop the ICS and monitor - if symptoms did not resolve during the trial period review diagnosis
if symptoms resolved and reoccurred within 4w of stopping then restart ICS at a low dose
if over 4 weeks and symptoms reoccurred repeat the trial
50
asthma kids < 5 step 3
SABA + PLD ICS + LTRA
51
asthma kids < 5 step 4
stop the LTRA and refer to paediatric asthma specialist
52
acute asthma treatment
- sit up and give high flow O2
- salbutamol neb
- prednisolone oral or hydrocortisone IV + normal ICS
- ipratropium bromide (SAMA) via neb
- IV theophylline
- IV mag sulf
53
how long should prednisolone be continued after an asthma attack
5 days
54
acute asthma acronym
```
O SHIT ME
oxygen
salbutamol
hydrocortisone/prednisolone
ipratropium
theophylline
mag sulf
escalate
```
55
most important intervention in COPD
smoking cessation
56
vaccinations in COPD
annual flu
| once of pneumococcal
57
who should be considered for LTOT
PO2 < 7.3, or 7.3-8 with one of the following:
• Secondary polycythaemia
• Peripheral oedema
• Pulmonary hypertension
58
COPD treatment ladder step 1
SABA or SAMA prn
59
COPD treatment ladder step 2 if patient has no asthma features
SABA + LABA + LAMA
| if pt was taking SAMA as first therapy then switch to SABA
60
COPD treatment ladder step 2 if asthma features
SABA or SAMA + LABA + ICS
61
COPD treatment ladder step 3
SABA + triple therapy of LABA LAMA and ICS
62
COPD treatment ladder step 4
oral theophylline
63
what antibiotic prophylaxis is used in COPD in certain patients
azithromycin
64
acute exac of COPD acronym
```
iTOAPES
- ipratropium
- theophylline
oxygen
amoxicillin
prednisolone
escalate
salbutamol
```
65
acute exac of COPD
- 0xygen
- nebulised salbutamol and ipratropium
- theophylline IV
- oral prednisolone (5 days)
- amoxicillin if infection suspected (doxy if pen al)
- NIV
66
what is the most common cause of acute exacerbations of COPD and bronchiectasis
H influenzae
67
what 3 paraneoplastic syndromes do Small cell lung cancers cause
Lambert eaton
SIADH
cushings
68
most common type of lung cancer
adenocarcinoma
69
two lung cancers found centrally and associated with smoking
small cell and squamous cell
70
where is adenocarcinoma typically found in lung
peripheries
71
what is a sign that can happen in adenocarcinoma
gynaecomastia
72
paraneoplastic syndrome caused by squamous cell carcinoma
PTHrp - hypercalcaemia
| TSH - hyperthyroid
73
1st line IX in lung cancer
CXR
74
gold standard ix in suspected lung cancer
CT
75
what ix is needed for diagnosis of lung cancer
bronchoscopy and biopsy
76
most small cell tumours are _____sensitive
chemo
77
most non-small cell tumours are ____sensitive
radio
78
auscultation of idiopathic pulmonary fibrosis
bibasal fine end inspiratory crackles
79
CT mesothelioma
pleural thickenings
80
interstitial lung disease on XR
ground glass appearance
81
lower zone fibrosis cause
idiopathic pulmonary fibrosis
| asbestosis
82
mid zone fibrosis cause
progressive massive fibrosis
83
idiopathic pulmonary fibrosis gold standard ix and findings
high resolution CT scan
| honeycomb lung and thickened interstitium
84
idiopathic pulmonary fibrosis treatment
lung transplant
supportive
anti-fibrotic - perfenidone
85
granuloma in sarcoidosis
non-caseating
86
sarcoidosis treatment
oral or inhaled steroids +/- immunosuppression
87
extrinsic allergic alveolitis
- acute
- chronic
acute - tapered dose of oral steroids
| chronic - allergen avoidance and long term steroids
88
egg shell calcification at hilar nodes
silicosis
89
treatment of pleural plaques from asbestos exposure
nothing - benign
90
croup cause
parainfluenza virus
91
croup presentation
stridor
barking cough worse at night
fever
coryza
92
croup xray
steeple sign
93
treatment croup
dexamethasone
94
acute epiglottitis cause
haemophilus influenza B
95
acute epiglottitis presentation
```
rapid onset
drooling
fever
stridor
tripod position
```
96
acute epiglottitis CXR
thumb sign
97
acute epiglottitis tx
ceftriaxone IV
98
bronchiolitis cause
RSV
99
tx acute bronchitis
doxycycline or amoxicillin
100
cause of whooping cough
bordetella pertusis
101
key signs of whooping cough
inspiratory whoop
| coughing bouts often ending in vomiting/cyanosis
102
diagnosis whooping cough
nasal swab culture
103
school exclusion of whooping cough
notifiable disease and school exclusion for 48 hours from starting abx or 21 days from cough onset
104
tx whooping cough
erythromycin
105
infective exac of COPD treatment
amoxicillin
prenisolone for 5 days
increase bronchodilator frequency
106
most common cause of CAP and HAP
strep pneumonia
107
1st line for all children with pneumonia
amoxicillin
108
pneumonia associated with cold sores
strep pneumonia
109
pneumonia common in COPD
H influenza
110
pneumonia secondary to viral influenza
S. Aureus
111
pneumonia associated with painful vesicles on tympanic membrane
mycoplasma
112
tx mycoplasma
doxycycline or clarithromycin
113
ix mycoplasma
serology
| positive cold agglutination test
114
pneumonia seen in patients with pet birds
chlamydia psittaci
115
tx chlamydia psittaci
doxycycline
| erythromycin
116
pneumonia from sheep
coxiella burnetti
117
treatment of coxiella
clarithromycin
118
treatment of legionella
levofloxacin or clarithromycin + rifampicin
119
legionella ix
urine antigen
deranged LFT
hyponatraemia
120
red current jelly sputum
klebsiella
121
when is PCP seen
immunocompromised/HIV
| when CD4 < 200
122
ix of PCP
bronchoalveolar lavage
123
tx of PCP
co-trim
| can be given as prophylaxis
124
when is pseudomonas pneumonia seen
CF / bronchiectasis
125
what is the treatment of pseudomonas
ciprofloxacin
126
CURB65 criteria
Confusion (>8/10 abbreviated mental test score), urea > 7, RR > 30, BP < 90 systolic, diastolic < 60, over 65
127
tx mild/moderate CAP
amoxicillin
128
tx mild/moderate CAP pen all
doxycycline
129
tx mild/moderate CAP if NBM
IV clarithromycin
130
tx severe CAP
co-amox IV + doxy
131
tx severe CAP if pen all
levofloxacin
132
tx severe CAP if in ITU
co amox + clarithromycin
or
levofloxacin + clarithromycin
133
tx severe HAP
IV amox and met and gent
134
tx severe HAP step down
co trim and met
135
tx non-severe amox
oral amox and met
136
tx pneumonia assocaited with influenza
co-amoxiclav
137
granuloma in TB
caseating
138
main test for latent TB
mantoux skin test
139
gold standard for TB
sputum culture
140
treatment of active TB
2 months RIPE
| 4 months RI
141
latent TB treatment
3 months R + I (with pyridoxine) or 6 months of I (with pyridoxine)
142
treatment meningeal tuberculosis
12 months RIPE + steroids
143
effusion of < 30g protein is a
transudate
144
effusion of > 30g protein or protein/serum ratio is > 0.5
exudate
145
most common cause of transudate
heart failure
146
1st line IX of effusion
PA CXR
147
D sign on X ray
empyema
148
CF inheritance
AR
149
CF ix
sweat test chloride > 60mmol
150
tx CF
supportive etc
| orkambi
151
ix sleep apnoea diagnostic
polysomnography
152
tx sleep apnoea
CPAP
153
treatment pneumothorax
| primary with < 2cm air and no SOB
discharge
154
treatment pneumothorax primary with > 2cm ring / SOB
aspiration
| then chest drain if needed
155
treatment pneumothorax secondary
| patient > 50 and >2cm air or SOB
chest drain
156
treatment pneumothorax
secondary
1-2cm air
aspirate
157
treatment pneumothorax secondary < 1cm air
admit and give o2 for 24 hours
158
how is aspiration done
Insert 16g cannula into mid clavicular line of 2nd intercostal space
159
tension pneumothorax treatment
```
1st aspirate (MCL, 2ICS)
then chest drain (5ICS MAL)
```
