resp Flashcards
(145 cards)
1
Q
when do abg in acute asthma attack
A
when ox sats below 92%
2
Q
what should titrate oxygen to if asthma attack
A
94-98
3
Q
steroid for asthma attack
A
pred orally for 5 days
4
Q
after Saba and steroid for acute asthma
A
ipratropium bromide
5
Q
if need antibiotic for acute bronchitis
A
doxy
6
Q
what mask for oxygen given to cold pt
A
venturi mask
7
Q
meds for copd attack
A
salbutamol/ ipratropium
8
Q
give what for 5 days like in asthma attack
A
oral pred
9
Q
dyspnoea
elevated respiratory rate
bilateral lung crackles
low oxygen saturations
A
acute respiratory distress syndrome
10
Q
what can improve outcomes in acute respiratory distress
A
prone positioning and muscle relaxation
11
Q
what can make u sure a cause is non cariogenic
A
pulmonary artery wedge pressure not raised
12
Q
acute respiratory distress occurs within how long to known risk factor
A
1 week
13
Q
exam q with history of bronchiectasis and eosinophilia
A
Allergic bronchopulmonary aspergillosis
14
Q
oral steroids are first line for allergic bronchopulmonary aspergillosis
A
antifungals are second lien
15
Q
alpha 2 antitrypsin protects cells from
A
neutrophil elastase - these cause emphysema
16
Q
in COPD emphysema is more prominent in upper lobes whereas in alpha 1 antitrypsin def more prominent in
A
lower lobes
17
Q
alpha 1 antitripsin def is associated with cirrohsosi and
A
hepatocellular carcinoma
18
Q
what is given to prevent acute mountain sickness
A
acetozolamide
19
Q
most common form of asbestos related lung disease
A
pleural plaques - benign AND DO NOT UNDERGO MALIGNANT CHANGE
20
Q
Mesothelioma isn’t but asbestosis severity is related to
A
exposure
21
Q
asbestosis typically affects
A
lower lobe
22
Q
most dangerous form of mesothelioma
A
Crocidolite
23
Q
Whilst mesothelioma is in some ways synonymous with asbestos, — is actually the most common form of cancer associated with asbestos exposure.
A
lung cancer
24
Q
asthma pts are sensitive to aspirin and may have
A
nasal polyps
25
first line ix for asthma
eosinophil count or fractional nitric oxide
26
next step for asthma if eosinophils not above the range of FeNO is not above 50
bronchodilator reversibility with spirometry
27
how to diagnose asthma in kids
fractional nitric oxide
28
diagnose asthma in kids if FeNo above
35
29
4th line ix for asthma if not diagnosed with FeNO, BDR, PEF
skin prick testing to host mite r measure total IgE level and blood eosinophil count
30
a cytokine that eosinophil are activated by
IL-5
31
bronchial challenge test uses
methacholine or histamine
32
as asthma is worse at night a variation of >20% in PEF between morning and evening values supports
diagnosis
33
what distinguishes asthma from COPD
bronchodilator reversibility testing with spirometry
34
mepolizumab targets
IL5
35
mx of asthma
MART - ICS and formoterol (LABA)- for when symptomatic
2. MART when needed and as maintenance
3. Increase dose of MART
4. check eosinophil or FeNO if either raised refer to asthma specialist
if not - add LTRA/LAMA
5 refer to asthma specialist
36
isocyanates are the most common cause of occupational asthma seen in what occupations
spray paining and foam moulding
37
what diagnoses occupational asthma
serial measurements of peak expiratory flow at work and at home
38
how often should we be considering stepping down treatment for asthma
every 3 months
39
how much should you reduce inhaled steroids when reducing for asthma
25-50% at a tiem
40
what should be suspected if dyspnoea and hypoxaemia around 72 hours post op
atelectasis
41
mx of ateclatasis
position pt upright
chest physio:breathing exercises
42
most common causes of bilateral hilarity lymphadenopathy
sarcoid and tb
43
most common organism in brocnhiectasisi
H influenza
44
complication from chest drain
re expansion pulomary oedema
45
where should chest drain be inserted
5th intercostal space in mid axillary line
46
cofirm positioning of chest drain
aspiration fluid or swinging the fluid when inspired on car
47
re expansion pulmonary oedema
chest drain should be clamped and urgent car
48
In cases of fluid drainage from the pleural cavity, the drain should be removed when there has been no output for > 24 hours and imaging shows resolution of the fluid collection.
In cases of pneumothorax, the drain should be removed when it is no longer bubbling spontaneously or when the patient coughs and ideally when imaging shows resolution of the pneumothorax.
49
most common cause of lobar collapse
lung cancer
50
multiple round well defined lung referred to as cannonball metastases most commonly seen with
renal cell cancer
51
interstitial oedema
bat's wing appearance
upper lobe diversion (increased blood flow to the superior parts of the lung)
Kerley B lines
pleural effusion
cardiomegaly may be seen if there is cardiogenic cause
pulmonary oedema
52
coal workers penumoconiosis has
upper lobe fibrosis
53
in severe case of COPD what might develop
right heart failure causign peripheral oedema
54
hyperinflation, bullae(may mimic pneumothorax), flat hemidiaphragm
COPD
55
ix for COPD
post bronhodialtroy spirometry
cxr
abc (exclude seondary polycythaemia)
BMI
56
what determines the severity in COPD
FEV1
57
Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
assessment of this by doing 2 and 3 weeks apart
58
long term oxygen therapy for COPD should breathe supplementary oxygenn for how much each day
15hrs
59
general mx of COPD
flu vaccine, pneumococall vaccine
pulmonary rehab
60
first lien treatment for COPD
SABA or SAMA
61
next line for COPD after SABA/SAMA ( if no asthma component )
change to SABA + LABA +LAMA
62
copd 2nd line if asthma component
LABA +ICS
if still breathless
triple therapy = LAMA+LABA +ICS
63
COPD next line or cannot used inhaled therapy
oral theophylline
64
dose of theophylline should be reduced if what is also being prescribed
fluoroquinolone or macrolide
65
prophylaxis with what in copd
azithromycin
66
azithromycin cna
prolong QT so do ecg before
67
Standby medication: NICE recommend offering a short course of oral corticosteroids and oral antibiotics to keep at home if: NICE
have had an exacerbation within the last year
understand how to take the medication, and are aware of associated risks and benefits
know to when to seek help and when to ask for replacements once medication has been used
68
another treatment for COPD if severe
Phosphodiesterase inhibitors
69
features include peripheral oedema, raised jugular venous pressure, systolic parasternal heave, loud P2
cor pulmonale
70
what can result from COPD
cor pulmoanel
71
long acting version of salbutamol
salmeterol
72
long acting version of ipratropium
tiotropium
73
montelukast useful in
aspirin induced asthma
74
pANCA
eosinophilic granulomatosis with polyangitis
75
extrinsic allergic alveoli's is due to
inhaled organic particles
76
farmer lung from wet hay
saccharopolyspora rectivirgula
77
EAA - dyspoea, dry cough and fever
4-8hrs after exposure
78
is there eosinophilia in EAA
nope
79
upper fibrosis is
EAA
80
GPA also has
kidney involvement
81
renal biopsy shows epithelial crescents in bowman capsule
GPA
82
past history of tb
cxr shows rounded opacity
aspergilloma
83
what makes a definitive diagnosis if idiopathic pulmonary fibrosis
CT
84
anti firbtoci that can be used in IPF
pirfenidone
85
in inhaler after taking hold breath for how long
10 seconds
86
how long wait for second dose of inhaler
30secs
87
kartageners syndrom has quiet heart sounds and is associated with
dextrocardia
88
lung abscess most commonly forms secondary to
aspiration pneumonia
89
fluid filled space within an area of consolidation
lung abscess
90
gynaecomastic in what lung cancer
adeno
91
adh, acth, Lambert eaton
small cell
92
what might be seen on bloods in lung cancer
thrombocytosis (raised platelets)
93
ix of choice for lung cancer
CT
94
is typically done in non-small cell lung cancer to establish eligibility for curative treatment
PET scanning
95
in lamest eaton syndrom what limb are usually worse affected
leg
96
HPOA affects
squamous and andeocarcinoam
97
too much ADH in small cell can cause
hyponatraemia
98
to much ACTH in small cell can cause
cushings syndrome
99
most common type of lung cancer
adenocarcinoma
100
caveatting lesions
squamous
101
what makes mesothelioma a suspicion
pleural effusion or pleural thickening
102
highest yield for looking at pleural effusion
throacocscopy
103
microscopic polyangitis has
renal impairment
pulpurable rash
104
aan indication for NIV
COPD with respect acidosis between 7.25-7.35
105
acutely ill pts ox sats between
94-98%
106
in CPOD if PCO2 is normal then oxygen sats
94-98
107
prior to blood gas for COPD what oxygen
28% venturi at 4l/min
108
most common cause of exudatvi pleural effusion
pneumonia
109
connective tissue counts as
exudative
110
pleural aspirate for pleural effusion and what criteria for transudate vs exudate
lights criteria
111
pleural fluid with low complement suggest
SLE
112
cold sores associated with what pneumonia
strep pneumo
113
pneumonia following flu vaccine
aureus
114
Autoimmune haemolytic anaemia and erythema multiforme may be seen
mycoplasma pneumonia
115
bronchiolitis as a ersultof RA or amiodarone
cryptogenic organising pneumonia
116
classic finding on CXR ofpenumonia is
consolidation
117
ix for pneumonia
CXT
blood and sputum cultures
pneumococcal and regional urianry antigen test
crp
118
mx of community pneumonia
amox in mild
amox and macrolide in more severe
more severe
co amox and macrol
119
Catamenial pneumothorax is the cause of 3-6% of spontaneous pneumothoraces occurring in -- women. It is thought to be caused by endometriosis within the thorax.
menstruating
120
mx of asymaptic pneumothorax regardless of size
conservative
121
high risk features of pneumothorax
haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax
(do chest drain) if no high risk features then needle aspirate
122
patients with a primary spontaneous pneumothorax that is managed conservatively should be reviewed every 2-4 days as an outpatient
patients with a secondary spontaneous pneumothorax that is managed conservatively should be monitored as an
inpatient
123
absolute contraindication, the CAA suggest patients may travel 2 weeks after successful drainage if there is no residual air.
124
what should be permenanetly avoided after pneumothorax
scuba diving
125
what doesn't rspkns to penicillin based antibiotics so need to sue doxy
Psittacosis
126
FVC is normal in
OBSTRUCTIVE
127
early response alkalosis then metabolic acidosis
salicylate overdose
128
expiratory reserve is significantly reduced in
obesity
129
RV increases with age
volume of air remaining after maximal expiration
130
acute otitis media: 4 days
acute sore throat/acute pharyngitis/acute tonsillitis: 1 week
common cold: 1 1/2 weeks
acute rhinosinusitis: 2 1/2 weeks
acute cough/acute bronchitis: 3 weeks
131
non caveating granuloma
sarcoid
132
Lofgren's syndrome is an acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis
Heerfordt's syndrome (uveoparotid fever) there is -----enlargement, fever and uveitis secondary to sarcoidosis
parotid
133
Progressive shortness of breath may be the only symptom
Fine bibasal crackles are typical
Spirometry shows a restrictive pattern
pulmonary fibrosis
134
ciliary dyskinetic syndrome eg karageers predispose to
cnronchiectasis
135
Bibasal crackles and a third heart sound (S3) are the most reliable features of left-sided failure
Right heart failure causes peripheral oedema and a raised JV
136
silicosis rf
mining, slate worker, pottery
137
egg shell calcification of hilarious lymph nodes
silicosis
138
stoping smoking options
nicotine replacement therapy - patches, gum...
varenicline
bupropion
139
has a small risk in seizures so is contraindicated in epileptics
bupropion
140
first line smoking cessation in preg women
CBT
141
what smoking cessation things are contraindicated in preg
varenicline, bupropion
142
should not wait for imaging in
tension pneumothorax
143
needle throacostomy for tension pneumothorax is done where
5th intercostal space mid axillary lien (same place as chest drain) then put chest drain
144
raised total gas transfer due to
asthma
145
