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PACES week > Resp > Flashcards

Resp Flashcards

1
Q

Mx of Acute Asthma (6)

A

ABC, contact senior

100% O2
Neb Salbutamol & Neb Ipratropium
IV hydrocortisone & Oral Prednisolone
IV MgSO4
IV salbutamol
IV aminophylline

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2
Q

How long between nebulised salbutamol back to back doses in acute asthma

A

15 minutes

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3
Q

Examination findings in COPD

A

Decreased Expansion
Decreased Breath Sounds (QUIET)
Decreased vocal resonance
Hyper-resonant percussion

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4
Q

Key hint that patient has COPD

A

Quiet Breath sounds

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5
Q

Complication of COPD

A

Cor pulmonale; COPD + RHF signs

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6
Q

Outline the stages of COPD

A

Predicted PEFR

Stage 1 - Mild: >80%

Stage 2 - Moderate: 50-80%.

Stage 3 - Severe: 30-50%.

Stage 4 - Very Severe: <30%

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7
Q

What to suspect in young COPD patient

A

a1 antitrypsin deficiency

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8
Q

Ventilation used in acute exacerbation of COPD if needed

A

BiPAP

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9
Q

What must COPD patients do before being offered Oxygen therapy

A

Stop smoking!

Flammable

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10
Q

Difference between Emphysema and Chronic Bronchitis

A

Emphysema - Pink Puffers
Breathless but not cyanosed, T1 resp failure

Chronic Bronchitis
Cyanosed but not breathless, T2 resp failure (High CO2)

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11
Q

What is yellow nail syndrome

A

Yellow dystrophic nails
Bronchiectasis
Pleural Effusions

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12
Q

Ix of bronchieactasis

A

High-resolution CT

–> signet ring sign

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13
Q

Mx of Bronchieactasis

A

Chest physiotherapy
Inhaled salbutamol, ICS

Abx if exacerbation

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14
Q

Causes of apical pulmonary fibrosis

A

Sacroidosis

Coal workers pneumoconiosis

Ankylosing Spondylitis

Tuberculosis

Extrinsic allergic alveolitis

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15
Q

Causes of Basal pulmonary fibrosis

A

Rheumatoid arthritis
Asbestosis
Scleroderma (SLE)
Drugs - amiodarone, nitrofurantoin, methotrexate, bleomycin

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16
Q

Sx of idiopathic pulmonary fibrosis

A

Breathlessness on exertion
Dry chronic cough (no wheeze)
Clubbing

Reduced breath sounds
Fine late inspiratory crepitations

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17
Q

How are FEV and FVC affected in pulmonary fibrosis?

A

Both decreased, ratio >0.8

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18
Q

CXR signs of pulmonary fibrosis

A

Ground glass

Honeycombing (advanced)

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19
Q

Tx of idiopathic pulmonary fibrosis

A

Pulmonary Rehabilitation Therapy
Smoking cessation

Pirfenidone
Long term Oxygen Therapy

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20
Q

Mx of Anaphylaxis

A

IM Adrenaline 0.5mg = 0.5ml 1:1000 solution. This can be repeated every 10 min

IV Fluids: 500ml Bolus

IV Hydrocortisone 100mg

IV Chlorpheniramine 10mg

–> Nebulised bronchodilators, IV adrenaline, Intubation

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21
Q

Most common cause of community-acquired pneumonia?

A

Strep. pneumoniae
Haemophilus Influenzae
Mcyoplasma pneumoniae

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22
Q

Halo sign on CT Thorax

A

Aspergillus

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23
Q

Mx of aspergillus

A

Amphoteracin B

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24
Q

What is a very strong indicator that something is pneumonia rather than an URTI?

A

Tachypnoea

25
Q

Pneumonia Sx?

A

Breathlessness
Reduced Chest Expansion
Bronchial Breathing
Late inspiratory crepitations
Dull Percussion

26
Q

Indications for lobectomy/pneumonectomy?

A

Non-Disseminated Bronchial Carcinoma in 90% of cases

Bronchiectasis
COPD

27
Q

Mx of OSA

A

Advise on sleeping positions and weight loss

Mandibular advancement splints

CPAP

28
Q

Causes of transudate pleural effusion?

A

HF
Cirrhosis
Nephrotic syndrome

29
Q

Causes of exudative pleural effusion

A

Infection
Malignancy
Pneumonia

30
Q

Causes of clubbing

A

Lung carcinoma
Bronchiectasis
Empyema
Pulmonary fibrosis
Mesothelioma
Lung Abscess

31
Q

Examination findings in interstitial lung disease

A

Clubbing
Reduced chest expansion
Fine late end-inspiratory crepitations (do not clear with coughing but do quieten/disappear on leaning forwards)

32
Q

What should you comment on if you think it is interstitial lung disease

A

The possible underlying cause:

Rheumatoid arthritis
Ankylosing spondylitis
Radiation
Connective tissue disease (lupus, dermatomyositis, systemic sclerosis)

33
Q

What are your differentials for clubbing and crepitations?

A

Interstitial lung disease
Bronchiectasis
Lung Cancer
Abscess
Cystic fibrosis

34
Q

Sx of Bronchieactasis

A

Clubbing
Reduced chest expansion
Wheeze

Early coarse inspiratory crepitations that alter with coughing but do not quieten/disappear on leaning forwards

35
Q

Key difference in presentation of Bronchiectasis and interstitial lung disease

A

Both have early coarse inspiratory crepitations

In Bronchiectasis they alter with coughing but do not quieten/disappear on leaning forwards

In interstital lung disease they do not clear with coughing but do quieten/disappear on leaning forwards

36
Q

CXR signs of bronchiectasis

A

Tramlines
Hyperinflation
Ring shadows

37
Q

Sx of cystic fibrosis

A

Young, short, thin
Clubbing
Chronic productive cough

38
Q

Sx of pleural effusion

A

Reduced expansion
Trachea displaced away from side of the effusion
Apex beat shifted away from effusion

Stony dull percussion note
Decreased vocal resonance
Reduced air entry/breath sounds
Bronchial breathing

39
Q

What to look for if you suspect a lung transplant

A

Signs of steroid use, gum hypertrophy, tremor - immunosuppressive therapy
Abnormal lung on other side

40
Q

Examination findings in COPD

A

Reduced chest expansion
Hyper-resonant percussion note
Expiratory wheeze
CO2 retention flap
Pursed lip breathing (using accessory muscles)

41
Q

Differentials for wheeze

A

COPD
Asthma
Heart Failure
Bronchiectasis and mucus plugging

42
Q

How does trachea shift in effusion

A

Away from lesion

43
Q

dDx of Dull lung base

A

Consolidation: bronchial breathing + crackles
Collapse: ↑ VR
Pleural effusion

44
Q

Ix of pleural effusion?

A

CXR
Bloods: FBC, U&E, LFTs
Diagnostic pleurocentesis

45
Q

Causes of bronchiectasis

A

CF
PCD
Kartagener’s
Malignancy
Post infectious: pertussis, TB, measles

46
Q

Abx which can be used in bronchiectasis

A

Exacerbations: cipro for 7-10 days

Prophylactic azithromycin

47
Q

Cystic fibrosis Mx

A

MDT
Chest physio: postural drainage, active cycle breathing
Abx prophylaxis
Segregate from other CF pts.: risk of transmission - pseudomonas

Pancreatic enzyme replacement: pancreatin
ADEK supplements

48
Q

Cause of
Bronchiectasis
Rhinosinusitis
Azoospermia

A

Young’s syndrome

49
Q

Causes of upper and lower pulmonary fibrosis

A

Upper:

Asperillosis: ABPA
Pneumoconicosis: coal, silica
Extrinsic allergic alveolitis
TB

Lower:

Sarcoidosis
Drugs
Asbestos
Rheum: RA, SLE, Sjorgen’s

50
Q

Complication of COPD

A

Cor pulmonale

51
Q

Single most important intervention in COPD

A

Smoking cessation

52
Q

What improvement in FEV1 with a β-agonist indicates asthma

A

≥15%

53
Q

Features of severe asthma (4)

A

PEFR <50%
Can’t complete sentence in one breath
RR >25
HR >110

54
Q

Features of life threatening asthma (7)

A

PEFR <33%
SpO2 <92%, PCO2 >4.6kPa, PaO2 <8kPa
Cyanosis
Hypotension
Exhaustion, confusion
Silent chest, poor respiratory effort
Tachy-/brady-/arrhythmias

55
Q

When to discharge following acute severe asthma

A

Been stable on discharge meds for 24h
PEFR >75% with diurnal variability <20%

56
Q

Indications for lobectomy/pneumonectomy

A

90% for non-disseminated bronchial carcinoma

Bronchiectasis
COPD: lung-reduction surgery
TB: historic, upper lobe

57
Q

Lobes affected in TB

A

Lower

58
Q

Pneumonia follow up?

A

CXR at 6 weeks
Pneumovax every 6 years

59
Q

Outline curb-65 score

A

Confusion (AMT ≤8)
Urea >7mM
Resp. rate >30/min
BP <90/60
≥65 y/o

0-1 → home Rx
2 → hospital Rx
≥ 3 → consider ITU

PACES week (8 decks)

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