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Year 6 > Resp > Flashcards

Resp Flashcards

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
Q

What is TLCO and when is it raised or lower

A

TLCO- CO test to represent O2 uptake
Raised TLCO- raised CO in blood- increased perfusion – asthma

Reduced- damage to parenchyma – COPD, PE

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26
Q

Criteria for ARDS

A

Acute
Non cariogenic pulmonary oedema- no leg swelling, HF history, normal pulmonary capillary wedge pressure
PaO2/FiO2- <40kPa

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27
Q

Hyperinfalted lungs on CXR

A

> 10 posterior
6 anterior

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28
Q

Bacteria in empyema

A

Klebiella

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29
Q

CF testing

A

CFTR gene- Cl pumping
Sweat test- high Cl
Faecal elastase- pancreatic insufficiency
CXR

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30
Q

Tx of CF

A

MDT
Mucolytics, bronchodilators, antimicrobials

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31
Q

Asbestosis features

A

Worse symptoms if increased exposure

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32
Q

What can’t you do after pneumothorax

A

Scuba diving- indefinitely
Flying- 2-6 weeks

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33
Q

Bronchitiis Mx

A

If CRP 20-100- delayed Abx
>100 or if significant co morbidities- Abx
Doxyxycline

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34
Q

Criteria for discharge after asthma attack

A

PEF >75%
Inhaler technique checked
Stable on meds for at least 12-24 hours

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35
Q

Bronchiectasis pneumonia organism

A

Haemophillus Influenza

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36
Q

When should NIV be started in COPD

A

PaCO2 >6
pH <7.35

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37
Q

Inhalier technique

A

Shake
Breath out
Lips on
Press and breath in
Hold for 10
Repeat after 30 secs

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38
Q

Pleural effusion aspiration testing

A

If ratio to serum >0.5 or above 30
LDH >0.6

Exudate- PE, malignancy, infection

Trasudative- HF

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39
Q

Chest infection with HIV

A

Pneumocystic Jirovecii
Bilateral infiltrates
Reduced exercise tolerance

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40
Q

PCP Ix and Tx

A

CXR- bilateral infiltrates
Exercise desaturation

Co-trimoxazole

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41
Q

If PE is suspected and Wells </=4 and D dimer -ve what do you do

A

Stop anti coagulation
Consider alternate diagnosis

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42
Q

When to perform an ABG in asthma

A

When sats <92

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43
Q

Most common Organism causing infective exacerbations in COPD

A

H influenza

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44
Q

Tx of sarcoidosis

A

Monitoring

If high Ca, lung disease, neuro or cardio involvement
CS

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45
Q

If COPD exacerbation with low sats what Tx

A

High flow O2 first since hypoxia kills
Then titrate down

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46
Q

Ix of TB

A

Sputum culture

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47
Q

Mantoux test results

A

> 15mm- positive
10- IVDU
5- HIV

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48
Q

Surgery for bronchiectasis

A

Localised to one lobe

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49
Q

Types of disease pattern for asbestosis

A

Restrictive
FEV1- reduced
FEV1/FVC- increased

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50
Q

Tx of ABPA

A

Oral GC
Prednisilone
Itraconazole 2nd

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51
Q

Features of cluster headaches

A

Last 15 min-2 hours
Clusters- 4-12 weeks
Lacrimation, redness
Nasal stuffiness

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52
Q

Severe asthma feartures

A

PEF 33-50
Cant complete sentences
RR >25
Pulse >110

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53
Q

Severity of COPD

A

FEV1
Mild- normal, but FEV/FVC <0.87
Mod- 50-70
Severe 30-50
V severe <30

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54
Q

Things that cause upper lobe fibrosis

A

CHARTS

Coal worker- pneumoconiosis
Hypersensititve pneumonitis
AS
Radiation
TB
Sarcoid

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55
Q

Young person with liver failure and lung problems

A

a1 anti trypsin

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56
Q

Mx of A1AT

A

Bronchodilators, physio
Lung reduction surgery

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57
Q

Causes of caveatting lung lesion

A

Abscess
Staph, klebsiella
TB
Squamous lung cancer

58
Q

Pleural effusion tx

A

After CXR
Pleural aspiration with USS
If cloudy or pH <7.20 chest tube

If cytology neg- CT- guided biopsy

59
Q

When to use surgery/chemo/radio in lung cancer

A

If in situ- surgery
If spread to nodes- chemo and radio

60
Q

First line drug for IE of COPD

A

Amoxicillin, clarithromycin and doxycycline

61
Q

Causes of clubbing in resp

A

Cancer
Chronic infection- BE, CF
Fibrosis

62
Q

Respiratory cause of raised JVP

A

Cor pulmonale

63
Q

Different scars and what procedure it means was done

A

Mid sternotomy- CABG, lung transplant

Thoracotomy- lobectomy, pneumonectomy, transplant

Side- effusion, PTX

VATS scar- biopsy, effusion, pleurodesis

64
Q

Heart signs on palpation for resp exam

A

Displaced or heave
RVH
Secondary to Pul HTN, COPD, ILD

65
Q

Breath sound findings

A

Quiet breaths- pleural effusion
Bronchial- pneumonia
Coarse crackles- pneumonia, BE
Fine end- fibrosis, oedema

66
Q

Effusion vs pneumonia OE

A

Stony dull
Quiet breath sounds
Decreased vocal remits

Dull
Bronchial/coarse
Increase vocal remits

67
Q

Types of pneumonia and they signs

A

Aspiration- right more likely
Staph- elderly, IVDU, after influenza
Klebsiella- red curran, alcholic
Mycoplasma- arthlagia, myalgia, erythema multiforme
Legionella- hyponatraemia

68
Q

FLAWS symptoms, increase urine, constiapted

A

Squamous cell
Producing PTH
HPOA- clubbing and periostitis

69
Q

How to treat paroxysmal AF

A

Flecanide one off
Sotalol

70
Q

Tx of severe sleep apnea

A

CPAP

71
Q

When is Mantoux test used

A

Vaccinated patients in close contact with those. with TB

72
Q

Tx of aspirational pneumonia

A

Broad spectrum- e.g co-amox

73
Q

What can Small cell lung cancer cause

A

SIADH
Cushing
LEMS
Cerebellar degeneration

74
Q

Mx of PE if end stage renal failure

A

Unfractionated heparin

75
Q

Threshold for invasive ventilation in COPD

A

<7.25

if 7.25-35- NIV

76
Q

Near fatal Asthma classification

A

Raised CO2

77
Q

If frequent exacerbations of COPD what should you do

A

Home stash of ABx
>3 in a year
Only take ABx when sputum is purulent

78
Q

Exacerbation of COPD tx

A

Neb salbutamol and ipratroprium
PO prednisolone and IV HC
IV co amor

Then IV aminophylline
Then NIV

79
Q

Ix of occupational asthma

A

PEF in and out of work

80
Q

Renal transplant patient with cough

A

CMV pneumonitis

81
Q

How to know if chest drain is in pleural cavity

A

Water seal will sing
Will go up in inspiration and down in expiration

82
Q

Complication of draining pleural effuison

A

Re expansion pulmonary oedema

83
Q

CXR finding of PE

A

Wedge shaped opacification on CXR

84
Q

How to tell if carcinoma

A

Nuclear enlargement
Pleomorphism
Hyperchromasia

85
Q

Analgesia in post op gastric surgery with COPD

A

Epidural
To avoid opioid

86
Q

Lung cancer with caveatting lesion

A

Squamous cell

87
Q

Aspergilloma features

A

Arises where TB once was
Target shaped lesion with air crescent sign

88
Q

Tx of legionella

A

Clarithromycin

89
Q

What do you find on observations with OSA

A

Hypertension

90
Q

Additional Ix for COPD

A

Spirometry
FBC- polycyth
ABG
CXR
ECG- RAD, p pulmonale

91
Q

Treatment response in COPD

A

Most useful is symptomatic- reduced breathless, increased exercise and sleep

92
Q

Causes of lobe collapse

A

Bronchial carcinoma
Extrinsic compression
Mucus plug
Foreing body

93
Q

Cause of BE

A

Idiopathic
Post infectious
Immunodeficiency
ABPA

94
Q

Adenocarcinoma sx

A

Gynaecomastia
HPOA- clubbing and periostitis

95
Q

X ray after pneumonia

A

6 weeks after

96
Q

BE sx

A

Clubbing
Purulent sputum- large amount in sputum pot
Haemoptysis
Coarse Creps
Wheeze

97
Q

Tx of BE

A

AB in exacerbations
Physical training
Bronchodilators
Surgery

98
Q

Tx of ARDS

A

Low tidal volume mechanical ventilation

99
Q

Lung cancer ix order

A

CXR
CT scan
Biopsy

100
Q

Sx of lung abscess

A

Recurrent fever
Foul smelling sputum
Clubbing
Aspiration RF §

101
Q

Tx of staph aureus pneumonia

A

Flucloxacillin

102
Q

Mycoplasma pneumonia sx

A

Erythema multiforme- multiple erythematous papule with deeply erythematous borders

Cold AIHA- blue fingers and toes when go outside

103
Q

Ix of ABPA

A

Clinical
Aspergillus IgE and IgG
Asthma history
High eosinophils
May have BE- CT

104
Q

Ix for IPF

A

CXR
Oximetry
Spirometry
Bloods
CT

105
Q

Fibrosis on CT

A

Ground glass

106
Q

Fibrosis sx

A

Clubbing
Dry cough
On medication/ inflammatory
Fine late crackles

107
Q

Sx of lung transplant

A

Thoracotomy scar
Clubbing- CF, IPF
Cushings- side effects of suppressants

108
Q

Mesothelioma gold standard

A

Thoracoscopic biopsy

109
Q

PE can cause what change on ECG

A

RBBB

109
Q

AS spirometry results

A

Restrictive picture due to apical fibrosis

FVC low, FEV1 low, Ratio normal

110
Q

Sx of emphysematous bullae

A

Similar to PTX
Smoker
Lucent on CXR with thin wall

111
Q

Bronchitis symptoms

A

Clear sputum, clear CXR, less systemic features, high CRP, low grade fever, cough

112
Q

Pathogen for infection in CF

A

Psuedomonas

113
Q

What is the step down of asthma

A

If good asthma control test
Step down by 25-50%

114
Q

Prophylaxis for flights fro DVT

A

Anti embolic stockings

115
Q

RF for aspergillosis

A

HIV
TNFa inhibitor
Leukaemia
Broad spec ABx

116
Q

O2 target if CO2 not raised

A

94-98

117
Q

If getting oral candiasis with steroid inhaler what should you switch to

A

Spacer

118
Q

If massive PE and CI to thrombolysis tx

A

IV unfractionated heparin

119
Q

Features of asthma in COPD

A

Diurnal or >20% variability
Large response to bronchodilators

120
Q

Where should chest drains be places in ICS

A

Just above rib at bottom of space you want

So for chest drain- just above 6th rib

120
Q

Where should chest drains be places in ICS

A

Just above rib at bottom of space you want

So for chest drain- just above 6th rib

121
Q

SOB, hyponatraemia and clear CXR mx

A

Urgent referral to chest clinic

122
Q

If suspicion of PE but CTPA neg but signs of DVT what do you do

A

USS leg

123
Q

Dx of mycoplasma

A

Serology

124
Q

DVT pathway mx

A

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
Q

When should you refer down lung cancer 2ww referral

A

Lung cancer on CXR
or haemoptysis >40

126
Q

Pneumonia causing HSV reactivation

A

S pneumonia

127
Q

Which lung cancer is found near the large airways

A

Small cell

128
Q

DOAC time with DVT/PE with active cancer ?

A

3-6 months

129
Q

High suspicion of PE but CTPA delayed

A

Give apixiban

130
Q

Why nephrotic syndrome causes PE

A

Due to antithrombin deficiency

131
Q

When to step up asthma to ICS

A

> 3 times per week symptoms
Or night waking

132
Q

Prognosis score of COPD

A

BODE
BMI
Output FEV1
Dyspnoea
Exercise

133
Q

Cause of BE

A

Idiopathic
Infection
CF, Kartangers
RhA

134
Q

Suspected PE but has CKD investigation

A

V/Q scan

135
Q

Cancers causing raised Plt

A

LEGO C
Lung
Endo
Gastric
Oesophageal
Colorectal

136
Q

If pneumothorax persists despite appropriate treatment mx

A

Persistent air leak or recurrent episodes → consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy

137
Q

Tx of EAA

A

Avoid triggers
CS

138
Q

Silicosis X ray

A

upper zone fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes§

139
Q

Ix of lesion in chest

A

CXR
Contrast CT- due to high vascular

140
Q

AB for COPD prophylaxis

A

Azithromycin

4 in last year
No smoking

Year 6 (28 decks)

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