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Year 6 > Resp > Flashcards

Resp Flashcards

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1
Q

Ix for Pe

A

Wells score >4
CXR
CTPA
If CTPA - consider doppler for leg

<4- D dimer if + arrange CTPA

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2
Q

Mx of PE

A

Wells- >4- CTPA
<4- D dimer

DOAC whilst waiting for scan if high clinical suspicion
DOAC 3m/6m if unprovoked if stable
Thrombolyse is hypotensive- unfractionated heparin if CI to thrombylysis

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3
Q

Tension pneumothorax Tx

A

14G cannula in pleural space

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4
Q

Sx of sarcoidosis

A

Affects face- lupus pernio
Hypercalcaemia- constipated, polyuria ect

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5
Q

Ix and diagnosis of asthma

A

FEV/FVC1- <70%
If negative but high suspicion - FeNO
Both for adult

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6
Q

Tx of COPD

A

SABA/SAMA then
LABA +LAMA with SABA PRN
Then add ICS

But if asthmatic features/steroid responsive i.e peanut allergy - eosinophilia, prev asthma LABA + ICS

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7
Q

O2 treatment of COPD

A

If retainer- high CO2
Aim for Sats- 88-92
24-28% venturi if exacerbation
If not retainer- high Flow

LTOT- non smoker- if PO2- <7.3 or between 7.3-8- high HB/oedema/pulHTN
NIV- resp acidosis- 7.25-7.35

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8
Q

Scoring for OSA

A

Epworth scale

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9
Q

Causes of ARDS

A

Trauma, infection-sepsis, pancreatitis

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10
Q

Sign of ARDS on CXR

A

Bilateral lung infiltrates

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11
Q

Sign of bronchiectasis on CXR and CT

A

Parallel, linear densities in the lower zones) is consistent with ‘tram-tracks’

Signet sign

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12
Q

Signs of each lung lobe consolidation

A

Right upper- pulled up lung
Middle- loss of horizontal fissure
Lower- loss of heart border

Left lingula- loss of heart border

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13
Q

Life threatening asthma signs

A

CHEST
Cyanosed
Hypotension
Exhausted, confused
Silent chest
Tachyarrhythmia

Normal CO2

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14
Q

When to admit asthma attack

A

Severe- if no response to treatment
Moderate- if previous life threatening
If pregnant with severe even if responding to initial treatement

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15
Q

Signs and symptoms of sarcoidosis

A

Usually black African Caribbean
Joint pain
Erythema nodosum
Respiratory
Lupus pernio
High calcium feature- high 1a hydroxylase
High ACE levels
Non caseating

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16
Q

Tension Pneumo cannula size

A

14G cannula

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17
Q

COPD chronic treatment

A

SABA/SAMA

If asthmatic features- change SAMA to SABA and LABA and ICS
No- LABA and LAMA

3- all 3

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18
Q

Asthma diagnosis

A

Spirometry
Reversibility 12% or 200ml of FEV1

FeNO- >40- do if adult

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19
Q

Diagnosis of OSA

A

Overnight pulse oximetry then
Polysomnography

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20
Q

Diagnosis of bronchiectasis

A

High resolution CT
Tran tacks

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21
Q

Fibrosis causes

A

Drugs- amiodarone, sulfalazine, methotrexate
Post TB- apical
Hypersensitivity pneumonitis
Systemic- lupus, RA

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22
Q

ABPA vs EAA

A

ABPA- lumen affected, typically have CF or asthma
High IgE
BE on CT or CXR

EAA- interstitium affected due to breathed in material, low grade fever, mould, occupational cause
Worse at end of day, sx after few hrs of exposure
No IgE

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23
Q

Cause of white out on CXR

A

Pleural effusion- meniscus, trachea away
Collapse- trachea towards

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24
Q

Sx of Kartageners syndrome

A

Dextrocardia
Bronchiectasis
Recurrent infections

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25
What is TLCO and when is it raised or lower
TLCO- CO test to represent O2 uptake Raised TLCO- raised CO in blood- increased perfusion – asthma Reduced- damage to parenchyma – COPD, PE
26
Criteria for ARDS
Acute Non cariogenic pulmonary oedema- no leg swelling, HF history, normal pulmonary capillary wedge pressure PaO2/FiO2- <40kPa
27
Hyperinfalted lungs on CXR
>10 posterior >6 anterior
28
Bacteria in empyema
Klebiella
29
CF testing
CFTR gene- Cl pumping Sweat test- high Cl Faecal elastase- pancreatic insufficiency CXR
30
Tx of CF
MDT Mucolytics, bronchodilators, antimicrobials
31
Asbestosis features
Worse symptoms if increased exposure
32
What can't you do after pneumothorax
Scuba diving- indefinitely Flying- 2-6 weeks
33
Bronchitiis Mx
If CRP 20-100- delayed Abx >100 or if significant co morbidities- Abx Doxyxycline
34
Criteria for discharge after asthma attack
PEF >75% Inhaler technique checked Stable on meds for at least 12-24 hours
35
Bronchiectasis pneumonia organism
Haemophillus Influenza
36
When should NIV be started in COPD
PaCO2 >6 pH <7.35
37
Inhalier technique
Shake Breath out Lips on Press and breath in Hold for 10 Repeat after 30 secs
38
Pleural effusion aspiration testing
If ratio to serum >0.5 or above 30 LDH >0.6 Exudate- PE, malignancy, infection Trasudative- HF
39
Chest infection with HIV
Pneumocystic Jirovecii Bilateral infiltrates Reduced exercise tolerance
40
PCP Ix and Tx
CXR- bilateral infiltrates Exercise desaturation Co-trimoxazole
41
If PE is suspected and Wells
Stop anti coagulation Consider alternate diagnosis
42
When to perform an ABG in asthma
When sats <92
43
Most common Organism causing infective exacerbations in COPD
H influenza
44
Tx of sarcoidosis
Monitoring If high Ca, lung disease, neuro or cardio involvement CS
45
If COPD exacerbation with low sats what Tx
High flow O2 first since hypoxia kills Then titrate down
46
Ix of TB
Sputum culture
47
Mantoux test results
>15mm- positive >10- IVDU >5- HIV
48
Surgery for bronchiectasis
Localised to one lobe
49
Types of disease pattern for asbestosis
Restrictive FEV1- reduced FEV1/FVC- increased
50
Tx of ABPA
Oral GC Prednisilone Itraconazole 2nd
51
Features of cluster headaches
Last 15 min-2 hours Clusters- 4-12 weeks Lacrimation, redness Nasal stuffiness
52
Severe asthma feartures
PEF 33-50 Cant complete sentences RR >25 Pulse >110
53
Severity of COPD
FEV1 Mild- normal, but FEV/FVC <0.87 Mod- 50-70 Severe 30-50 V severe <30
54
Things that cause upper lobe fibrosis
CHARTS Coal worker- pneumoconiosis Hypersensititve pneumonitis AS Radiation TB Sarcoid
55
Young person with liver failure and lung problems
a1 anti trypsin
56
Mx of A1AT
Bronchodilators, physio Lung reduction surgery
57
Causes of caveatting lung lesion
Abscess Staph, klebsiella TB Squamous lung cancer
58
Pleural effusion tx
After CXR Pleural aspiration with USS If cloudy or pH <7.20 chest tube If cytology neg- CT- guided biopsy
59
When to use surgery/chemo/radio in lung cancer
If in situ- surgery If spread to nodes- chemo and radio
60
First line drug for IE of COPD
Amoxicillin, clarithromycin and doxycycline
61
Causes of clubbing in resp
Cancer Chronic infection- BE, CF Fibrosis
62
Respiratory cause of raised JVP
Cor pulmonale
63
Different scars and what procedure it means was done
Mid sternotomy- CABG, lung transplant Thoracotomy- lobectomy, pneumonectomy, transplant Side- effusion, PTX VATS scar- biopsy, effusion, pleurodesis
64
Heart signs on palpation for resp exam
Displaced or heave RVH Secondary to Pul HTN, COPD, ILD
65
Breath sound findings
Quiet breaths- pleural effusion Bronchial- pneumonia Coarse crackles- pneumonia, BE Fine end- fibrosis, oedema
66
Effusion vs pneumonia OE
Stony dull Quiet breath sounds Decreased vocal remits Dull Bronchial/coarse Increase vocal remits
67
Types of pneumonia and they signs
Aspiration- right more likely Staph- elderly, IVDU, after influenza Klebsiella- red curran, alcholic Mycoplasma- arthlagia, myalgia, erythema multiforme Legionella- hyponatraemia
68
FLAWS symptoms, increase urine, constiapted
Squamous cell Producing PTH HPOA- clubbing and periostitis
69
How to treat paroxysmal AF
Flecanide one off Sotalol
70
Tx of severe sleep apnea
CPAP
71
When is Mantoux test used
Vaccinated patients in close contact with those. with TB
72
Tx of aspirational pneumonia
Broad spectrum- e.g co-amox
73
What can Small cell lung cancer cause
SIADH Cushing LEMS Cerebellar degeneration
74
Mx of PE if end stage renal failure
Unfractionated heparin
75
Threshold for invasive ventilation in COPD
<7.25 if 7.25-35- NIV
76
Near fatal Asthma classification
Raised CO2
77
If frequent exacerbations of COPD what should you do
Home stash of ABx >3 in a year Only take ABx when sputum is purulent
78
Exacerbation of COPD tx
Neb salbutamol and ipratroprium PO prednisolone and IV HC IV co amor Then IV aminophylline Then NIV
79
Ix of occupational asthma
PEF in and out of work
80
Renal transplant patient with cough
CMV pneumonitis
81
How to know if chest drain is in pleural cavity
Water seal will sing Will go up in inspiration and down in expiration
82
Complication of draining pleural effuison
Re expansion pulmonary oedema
83
CXR finding of PE
Wedge shaped opacification on CXR
84
How to tell if carcinoma
Nuclear enlargement Pleomorphism Hyperchromasia
85
Analgesia in post op gastric surgery with COPD
Epidural To avoid opioid
86
Lung cancer with caveatting lesion
Squamous cell
87
Aspergilloma features
Arises where TB once was Target shaped lesion with air crescent sign
88
Tx of legionella
Clarithromycin
89
What do you find on observations with OSA
Hypertension
90
Additional Ix for COPD
Spirometry FBC- polycyth ABG CXR ECG- RAD, p pulmonale
91
Treatment response in COPD
Most useful is symptomatic- reduced breathless, increased exercise and sleep
92
Causes of lobe collapse
Bronchial carcinoma Extrinsic compression Mucus plug Foreing body
93
Cause of BE
Idiopathic Post infectious Immunodeficiency ABPA
94
Adenocarcinoma sx
Gynaecomastia HPOA- clubbing and periostitis
95
X ray after pneumonia
6 weeks after
96
BE sx
Clubbing Purulent sputum- large amount in sputum pot Haemoptysis Coarse Creps Wheeze
97
Tx of BE
AB in exacerbations Physical training Bronchodilators Surgery
98
Tx of ARDS
Low tidal volume mechanical ventilation
99
Lung cancer ix order
CXR CT scan Biopsy
100
Sx of lung abscess
Recurrent fever Foul smelling sputum Clubbing Aspiration RF §
101
Tx of staph aureus pneumonia
Flucloxacillin
102
Mycoplasma pneumonia sx
Erythema multiforme- multiple erythematous papule with deeply erythematous borders Cold AIHA- blue fingers and toes when go outside
103
Ix of ABPA
Clinical Aspergillus IgE and IgG Asthma history High eosinophils May have BE- CT
104
Ix for IPF
CXR Oximetry Spirometry Bloods CT
105
Fibrosis on CT
Ground glass
106
Fibrosis sx
Clubbing Dry cough On medication/ inflammatory Fine late crackles
107
Sx of lung transplant
Thoracotomy scar Clubbing- CF, IPF Cushings- side effects of suppressants
108
Mesothelioma gold standard
Thoracoscopic biopsy
109
PE can cause what change on ECG
RBBB
109
AS spirometry results
Restrictive picture due to apical fibrosis FVC low, FEV1 low, Ratio normal
110
Sx of emphysematous bullae
Similar to PTX Smoker Lucent on CXR with thin wall
111
Bronchitis symptoms
Clear sputum, clear CXR, less systemic features, high CRP, low grade fever, cough
112
Pathogen for infection in CF
Psuedomonas
113
What is the step down of asthma
If good asthma control test Step down by 25-50%
114
Prophylaxis for flights fro DVT
Anti embolic stockings
115
RF for aspergillosis
HIV TNFa inhibitor Leukaemia Broad spec ABx
116
O2 target if CO2 not raised
94-98
117
If getting oral candiasis with steroid inhaler what should you switch to
Spacer
118
If massive PE and CI to thrombolysis tx
IV unfractionated heparin
119
Features of asthma in COPD
Diurnal or >20% variability Large response to bronchodilators
120
Where should chest drains be places in ICS
Just above rib at bottom of space you want So for chest drain- just above 6th rib
120
Where should chest drains be places in ICS
Just above rib at bottom of space you want So for chest drain- just above 6th rib
121
SOB, hyponatraemia and clear CXR mx
Urgent referral to chest clinic
122
If suspicion of PE but CTPA neg but signs of DVT what do you do
USS leg
123
Dx of mycoplasma
Serology
124
DVT pathway mx
Well 1- D dimer within 4 hours - if + scan, if - alternate >2 - doppler If scan - but dimer + stop AC and repeat US in 6-8d If delay in test give DOAC
125
When should you refer down lung cancer 2ww referral
Lung cancer on CXR or haemoptysis >40
126
Pneumonia causing HSV reactivation
S pneumonia
127
Which lung cancer is found near the large airways
Small cell
128
DOAC time with DVT/PE with active cancer ?
3-6 months
129
High suspicion of PE but CTPA delayed
Give apixiban
130
Why nephrotic syndrome causes PE
Due to antithrombin deficiency
131
When to step up asthma to ICS
>3 times per week symptoms Or night waking
132
Prognosis score of COPD
BODE BMI Output FEV1 Dyspnoea Exercise
133
Cause of BE
Idiopathic Infection CF, Kartangers RhA
134
Suspected PE but has CKD investigation
V/Q scan
135
Cancers causing raised Plt
LEGO C Lung Endo Gastric Oesophageal Colorectal
136
If pneumothorax persists despite appropriate treatment mx
Persistent air leak or recurrent episodes → consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy
137
Tx of EAA
Avoid triggers CS
138
Silicosis X ray
upper zone fibrosing lung disease 'egg-shell' calcification of the hilar lymph nodes§
139
Ix of lesion in chest
CXR Contrast CT- due to high vascular
140
AB for COPD prophylaxis
Azithromycin 4 in last year No smoking

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