Resp Flashcards by Sam Skerritt

Acute severe asthma symptoms?

PEF 33-50

resp 25

HR 110

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Life threatening asthma features?

PEF <33%

spo2 <92%

Normal PaC02

Silent chest

cyanosis

arrhythmia

hypotension

poor effort

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Near fatal Asthma features

Raised PaC02 and or mechanical ventilation needed

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Differentials for asthma?

Foreign body

Anaphylaxis

Pneumothorax

Bronchiolitis in children

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Treatment of acute ashtma attack?

Salbutamol 5 mg nebulised with O2 (repeat 15-20 minute intervals)

Ipratropium bromide 500 mcg nebulised with O2 (4-6 hourly)

Hydrocortisone 100 mg IV or prednisolone 40 mg orally

Magnesium sulphate 2 g IV over 20 minutes

CXR for pneumonia/pneumothorax

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Acute exacerbation COPD treatment?

Similar to asthma:

Controlled 02 88-92%

Arterial blood gas (decreased PaO2, raised PaCO2 and raised bicarbonate if chronic disease)

Chest X-ray (to exclude pneumothorax/infection)

ECG (might show evidence of cor pulmonale)

Salbutamol 5 mg nebuliser

Ipratropium bromide 500 mcg nebuliser

Hydrocortisone 100 mg intravenously or prednisolone 30 mg orally (7 days)

Antibiotics if evidence of infection

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Steroid doses for asthma and for copd and length?

COPD 30mg 7-14days

Asthma 40-50mg 5 days

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Infective exacerbation of COPD?

Increased volume, colour sputum or cough, no x rays signs

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Acute bronchitis ABX dose if unwell?

Amox 500mg TDs, or Doxy 200mg then 100mg 5 days for both

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When to sent for urgent Chest Xray?

in people aged 40 and over if they have two or more of the following unexplained symptoms

Cough

Fatigue

Shortness of breath

Chest pain

Weight loss

Appetite loss

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Cough lasting how long for CXR?

>3 weeks

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Wells score >4 suspected PE what to do?

CTPA

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Suspected PE wells score 4 or less what to do?

D-dimer and if +ve CTPA

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Consider what in patients with unprovoked PE?

Offer investigations to assess the possibility of an undiagnosed cancer

Consider arranging hereditary thrombophilia testing or antiphospholipid

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VTE in pregnancy or Cancer what to use?

LMWH- 6 months minimum or until end of cancer treatment

or end of preggers

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What chadsvasc score would make you not consider anticoagulation ?

Score of 0 in men and of 1 in women

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When would you consider treatment of AF which chadsvasc scores?

>2 start in all people and consider if 1 in men

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What does CHA₂DS₂VASc mean ?

C- CCF

H- Hypertension

A2- Age >75

D- Diabetes-

S2- Stroke

V- Vascular

A- Age 64-75

S- Sex female

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Risk of falls, should we anticoagulate?

Yes, no evidence that falls induce bleeds

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What classifies someone as having a secondary pneumothorax?

Age >50 significant smoking history

Evidence of underlying lung disease on history, exam or CXR

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You have diagnosed a secondary pneumothorax which is >2cm what is your management?

Admit and insert a chest drain

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You have diagnosed a secondary pneumothorax which is between 1-2cm what do you do?

Initially aspirate and if it is <1cm admit for observation and high flow 02, if not insert a chest drain

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All secondary pneumothoraces require….?

Admission to hospital for a least 24hrs and usually high flow 02

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Bilateral pneumothoraces management assume any size?

Proceed to chest drain, also consider if haemodynamic instability

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Diagnose a primary pneumothorax of 2.5cm what is your initial management?

Aspirate 16-18g cannula (\<2.5l)

You aspirate a 2.5cm primary pneumothorax how is it considered succesful? What will you do if it is or is not?

Considered a succes if \<2cm and breathing improvement you can consider discharge and OPD 2-4 weeks, if no or limited success admit for chest drain.

Primary pneumothorax of 1cm management?

Consider discharge and safety netting.

Where is size of pneumothorax measured?

Interpleural distance at level of the hilum

Which way does the trache deviate in a Tension pneumothorax?

Away from affected side as pressure builds and pushes it away

What si the curb 65 score? what do the results mean?

Confusion or \<8/10 amts Urea \>7 Resp \>30 BP \<90sys or \<60 dia 65 years or more Score out of 5 0-1 low 2 intermediate 3-5 high 0-1 home care, 2 hospital care higher consider intensive interventions

ABX therapy for curb score of 2?

Consider dual therapy and IV 7-14 days Amoxicillin plus a macrolide

Pneumonia in alcoholics and which other group? classic sign? What seen on CXR?

Klebsiella, Diabetics red currant jelly Often causes abscess and empyema in upper lobes

Exercise inducte desaturation, bilateral interstitial infiltrates? Treatment?

PCP Co-Trimoxazole Steroids if hypoxic

PCP symptoms?

Dry cough, dyspnoea, fever, few chest signs

Flu like symptos preceeding a dry cough, bilateral consolidation- thrombocytopenia and erythema multiforme?

Mycoplasma pneumoniae

Legionella pneumonia signs?

Hyponatraemia, dry cough, recent travel, possible lft problems

Pneumonia screen?

Urinary antigen for legionella and pneumococcus Sputum culture

Patient had flu a few weeks ago and presents with pneumonia, ?organism

Staph aureus

COPD exacerbation organism?

Haemophillus

Organism which likes to grow and cause pneumonia in bronchiectasis?

Pseudomonas

Bronchiectasis causes?

post-infective: tuberculosis, measles, pertussis, pneumonia cystic fibrosis bronchial obstruction e.g. lung cancer/foreign body Kartageners

Bronchiectasis CT sign?

Signet ring

CXR signs bronchiectasis?

Tramlines

Most common cause of pneumonia?

Strep pneumoniae

Characteristic symptoms of strep pneumoniae?

Rapid onset High fever herpes labialis pleuritc chest pain

What to include in asthma history?

wheeze, cough or breathlessness, and any daily or seasonal variation in these symptoms any triggers that make symptoms worse a personal or family history of atopic disorders. Occupational history

Fraction of expired FENO to diagnose asthma and improvement of what on use of peak flow after bronchdilator?

\>40ppb and 12% or greater improvement and \>200ml volume

% significant peak flow variability?

20%

What should you measure first if suspecting asthma?

FENO and spirometry with bronchodilator reversability

Initial and add on treatment for asthma?

SABA for everyone, but can start ICS immediately if symptoms \>3 times a week at diagnosis.

Asthma not contolled on SABA and low dose ICS?

Add LTRA

SABA, ICS and LTRA not controlled?

Add in LABA and consider improvement that LTRA gave consider stopping

SABA and LABA and ICS +/- LTRA not controlled?

Low dose ICS plus MART

Initial COPD treatments?

Stop smoking, pneumococcal and influenza vaccines Pulmonary rehab, optimise comorbidities

COPD with exercise limitation and conservative management implimented?

Offer SABA or SAMA

COPD takes SABA or SAMA still feeling breathless?

Asthmatic features- LABA+ICS No asthmatic features- LABA + LAMA

COPD takes LABA+ICS still problematic?

Offer LAMA+LABA+ICS

What suggests steroid responsiveness or asthma features in COPD?

Substantial variation in FEV1 overtime or diurnal peak flows \>20%

First investigation in pleural effusion? WHat should be tested?

Aspiration guided by ultrasound. Send for pH protein, LDH cytology and micro

When should lights criteria be used?

Protein 25-35g/l

Exudate is likely if pleural fluid protein/serum is \>? Pleural LDH/Serum LDH \>? Or Pleural fluid LDH more than what the upper limit of normal serum LDH?

\>0.5 \>0.6 \>2/3 upper limits of serum LDH

Low gluocse \<2.2 in pleural effusion?

Glucose \< 2.2 mmol/L is associated with an emphysema, rheumatoid arthritis, tuberculosis or malignancy.

Low pH in pleural effusion seen with?

A pH \< 7.3 is seen with emphysema, tuberculosis, malignancy, collagen vascular disease or oesophageal rupture.

Transudative causes of pleural effusion?

Heart failure- most common Liver disease Hypothyroidism

Ecudative causes of Effusion?

Infection most common Lunc cancer Pancreatitis Rheumatoidćonnective tissue

Pleural effusion, aspirate is clear in presumed infection when to place tube?

If pH \<7.2

Important to ask about this in asthma history if having acute exacerbation?

Previous ICU or hospital admissions how many exacerbations and triggers etc

Investigation of choice in fibrosis?

High res CT

Strongest association with smoking cancer?

Squamous cell carcinoma

SCC of lungs tyically where?

Centrally affecting main bronchi and obstructing

Most common cancer of lung in non smoker? Where does it often metastasise to?

Adenocarcinoma, often ends up in bones and brain

Lung cancers associated with ectopic ADH and ACTH ? Lambert eaton syndrome

Small cell cancers ADH-SIADH ACTH-cushings

Long term prevention of infection in bronciectasis?

Azithroymycin

29 year old, cough blurred vision and this xray?

Sarcoidosis Hilar lymphadenopathy seen on CXR

What is this skin condition associated with sarcoidosis?

Erythema nodosum

Skin condition associated with sarcoidosis?

Lupus pernio

Treatment of sarcoidosis?

Corticosteroids, cytotoxics and lung transplant

What does the CT show?

Pulmonary fibrosis (honeycombing) and ground glass opacities

Treatment of Idiopathic pulmonary fibrosis?

Limited- pirfenidone, rehab and transplant supplementary 02

WHat is this person doing and why?

Pursed lip breathing splints airways keeps a PEEP

How to remember which drugs taken only for 2 months in TB?

PERI Pyrazinimide and Ehtambutol initially with the others and then the other two continued

Ethambutol side effect?

Optic neuritis

Best test for cystic fibrosis?

Sweat test

Genetics of cystic fibrosis?

Autosomal recessive

Chance of two carriers passing on CF? and carrier plus affected?

25% and 50%

Respiratory causes of clubbing?

Lung cancer, CF, Idiopathic fibrosis, TB

What is a negative mantoux?

\<6mm

Signs and symptoms of CF?

Failure to thrive, frequent infections, does not pass meconium, absent vas deferens, increased appetite, sinusitis, polyps

CF treatments? Resp and GI?

Chest physiotherapy, Bronchodilators, Tobramycin, mucolytics, transplant etc Creon, nutrition optimisation PPI

History of night sweats and weight loss?

How many samples to diagnose pulmonary TB?

3 preferably one early morning

Which Tb drug can cause peripheral neuropathy? What can you give to help?

Isonizid give B6

Gout caused by which TB drug?

Pyrazinamide

Yellow orange fluids caused by what drug?

Rifamp

Latent TB treatment choices?

3 Months isoniazid and rifamp or 6 months of isoniazid (if rifamp contraindicated)

Risks for developing active TB ?

Anti TNF, renal failure, HIV, Transplant, malignancy of blood

TB vaccine not given to which age group?

\>35 doesnt work

Contraindications to TB vaccine?

previous BCG vaccination a past history of tuberculosis HIV pregnancy positive tuberculin test (Heaf or Mantoux)

FEV1 below 30% indicates what type of COPD?

Very severe

Severe COPD FEV1 of?

30-49%

50-79% FEV1?

Moderate COPD

\>80% FEV1 in obstructive pattern?

Mild COPD

What type of pattern does the spirometry show?

Normal result

What type of pattern does the spirometry show?

Obstructive

What type of pattern does the spirometry show?

Restrictive

What is trastuzumab?

Herceptin

Best test for obstrutive sleep apnoea?

Polysomnography \>15 episodes per hour

\>5 episodes on polysomnography and any of HTN, ischaemic cardiac disease, history of stroke, excessive daytime sleepiness, insomnia, mood disorder, or cognitive dysfunction.

Can say is sufficient to say it is OSA

Spirometry values in restrictive disease?

FEV1 low FVC low Ration \>0.7

Spirometry values in obstructive pattern?

FEV1 reduced \<80% FVC reduced (not as much as FEV1) FEV1/FVC ration \<0.7

Resp Flashcards

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