resp notes Flashcards
1
Q
spirometry contraindications
A
- active infection e.g. TB
- aortic aneurysm, pneumothorax, recent surgery (forced exhalation will worsen)
- chest infection
2
Q
what is bronchiectasis?
A
- widening of bronchioles due to chronic infection
3
Q
most common organisms in bronchiectasis
A
- haemophilus influenzae, most common
- pseudomonas
- step pneumoniae
4
Q
causes bronchiectasis
A
- post infective e.g. TB, HIV
- obstruction
- congenital e.g. cystic fibrosis
5
Q
best investigation bronchiectasis
A
- high resolution CT - widened bronchioles, signet ring sign
6
Q
most common causative agent bronchiolitis
A
- RSV
7
Q
presentation bronchiolitis
A
- < 1 year old
- cough, wheeze, breathlessness, feeding difficulties (often why they’re admitted)
8
Q
COPD consists of which two conditions?
A
chronic bronchitis and emphysema
9
Q
causes of centriacinar, panacinar and distal acinar emphysema
A
- centri (proximal), smoking
- panacinar (all), alpha-1 antitrypsin deficiency
- distal, atelectasis
10
Q
investigations COPD
A
spirometry - obstructive
CXR - hyperinflation, bullae, flat hemidiaphragm
FBC - polycythaemia
11
Q
management acute exacerbation COPD
A
oxygen therapy with 24% venturi mask - aim for sats of 88-92%
nebulised salbutamol + ipratropium
steroids
abx if infection
consider aminophylline IV
NIV (BiPAP) if acidotic
12
Q
long term management COPD - asthmatic features
A
LABA + ICS
13
Q
long term management COPD - non-asthmatic features
A
LABA + LAMA
if already on a SAMA - switch to SABA
14
Q
which antibiotic can be used in COPD prophylaxis (what do you need to do before prescribing)
A
- azithromycin
- check ECG (can prolong QT interval)
15
Q
inheritance pattern cystic fibrosis
A
autosomal recessive
16
Q
pathophysiology cystic fibrosis
A
- mutation in chromosome 7
- in CFTR protein
- abnormal chloride secretion + thickening of mucous secretions
17
Q
presentation cystic fibrosis
A
neonates - meconium ileus
recurrent chest infections
pancreatic insufficiency - diabetes, malabsorption, steatorrhoea
infertility
18
Q
diagnosis cystic fibrosis
A
sweat test - increased chloride in sweat (>60)
19
Q
presentation + examination idiopathic pulmonary fibrosis
A
- dry cough + SOB insidious onset > 3months
- fine bibasal end-inspiratory crackles + clubbing
20
Q
medical management idiopathic pulmonary fibrosis
A
- pirfenidone (antifibrotic, anti-inflam)
- nintedanib (targets tyrosine kinase)
21
Q
drugs that cause drug induced pulmonary fibrosis
A
- amiodarone
- methotrexate
- nitrofurantoin
- chemo drugs e.g. cyclophosphamide
22
Q
hypersensitivity reactions in extrinsic allergic alveolitis/hypersensitivity pneumonitis
A
type III + type IV
23
Q
investigations hypersensitivity pneumonitis
A
imaging - fibrosis in upper areas
bronchoalveolar lavage - lymphocytosis
assays for IgG
24
Q
causes of upper pulmonary fibrosis
A
CHARTS
Coal
Hypersensitivity pneumonitis
Ank spond
Radiation
Tuberculosis
Sarcoidosis
25
causes of lower pulmonary fibrosis
CAID
- connective tissue disorders
- asbestosis
- idiopathic pulmonary fibrosis
- drugs (methotrexate, amiodarone, nitrofurantoin, cyclophosphamide)
26
most common type of lung cancer
adenocarcinoma
27
lung cancer most associated with non-smokers
adenocarcinoma
28
paraneoplastic features squamous cell carcinoma of lung
hypertrophic pulmonary osteoarthropathy - clubbing
PTHrp - hypercalcaemia + bone destruction
29
lung cancer that most commonly cavitates
squamous cell carcinoma
30
what is lambert-eaton syndrome
due to small cell lung cancer
antibodies against pre-synaptic voltage-gated calcium channel in motor neurons
weakness, better with repetition
31
paraneoplastic features of small cell carcinoma
ADH
ACTH
lambert-eaton
32
investigations lung cancer
- sputum cytology
- CXR
- contrast CT
- bronchoscopy
- EBUS
33
2ww referral for CXR criteria
>40 + unexplained haemoptysis
2 or more of these symptoms if >40 and not smoked
1 or more of these symptoms if >40 and have smoked
- weight loss
- fatigue
- cough
- SOB
- appetite loss
- chest pain
34
features OSA
- daytime sleepiness
- morning headache
- snoring
- concentration problems
35
features klebsiella pneumonia
- common in alcoholics (klebsiSTELLA) and diabetics
- can occur following aspiration
- 'red-currant jelly' sputum
- affects upper lobes
- empeyema risk
36
which pneumonia is common in patients with cystic fibrosis
pseudomonas aeruginosa
37
management tension pneumothorax
16G bore needle at second intercostal space, mid-clavicular line
38
CXR signs PE
typically normal
hamptoms hump - peripheral wedge opacity
39
investigation in PE when CTPA contraindicated
VQ scan
40
management PE
DOAC
any contraindications - LMWH
if massive - thrombolysis
41
features sarcoidosis
- erythema nodosum, bilateral hilar lymphadenopathy, fever, arthralgia
- breathlessness, cough, weight loss
- lupus pernio
- hypercalcaemia
42
lofgrens syndrome (triad in sarcoidosis)
erythema nodosum
polyarthralgia
bilateral hilar lymphadenopathy
43
management sarcoidosis
oral steroids + bisphosphonates to protect against osteoporosis
second line - methotrexate, azathioprine
44
investigations active tuberculosis
CXR - upper lobe consolidation
sputum culture - acid fast bacilli
NAAT (nucleic acid amplification test)
45
investigations latent TB
mantoux test
interferin gamma release assays (IGRA)
46
management TB
rifampicin
iosiniazid
pyrazinamide
ethambutol
all for first 2 months
top two for 4 months
47
side effects rifampicin
orange secretions
flu-like symptoms
48
side effects iosinazid
peripheral neuropathy (im so numb-azid)
hepatitis, agranulocytosis
49
side effects pyrazinamide
uric acid - gout
arthralgia, myalgia
hepatitis
50
side effect ethambutol
optic neuritis
EYEthambutol
51
what is the flow rate of a nasal cannula
2-4L/minute
52
differentials in a 'white out' of hemi-thorax if trachea deviated towards white out
pneumonectomy
complete lung collapse
53
differentials in a 'white out' of hemi-thorax if trachea central
consolidation
pulmonary oedema
mesothelioma
54
differentials in a 'white out' of hemi-thorax if trachea deviated away from white out
pleural effusion
diaphragmatic hernia
large thoracic mass
55
causes lower lobe fibrosis
CAID
Connective tissue disorders
Asbestos
Idiopathic pulmonary fibrosis
Drugs
56
features moderate acute asthma
PEFR 50-75%
normal speech
RR <25
HR < 110
57
features severe acute asthma
PEFR 33-50%
can't complete sentences
RR >25
HR >110
58
features life-threatening acute asthma
PEFR <33%
sats <92%
normal pCO2
silent chest, cyanosis, feeble resp effort
haemodynamic instability
exhaustion, confusion, coma
59
features superior vena cava syndrome
symptoms:
swelling of your face, neck, upper body, and arms
trouble breathing or shortness of breath
coughing
causes:
lung cancer
non-hodgkins lymphoma
60
indication ABG asthma
sats <92%
61
features mycoplasma pneumonia
symptoms - flu, arthralgia, myalgia, dry cough, headache
auto-immune haemolytic anaemia due to cold agglutinins
erythema multiforme
62
follow up pleural plaques
benign - no malignant change - no follow up needed
63
what do patients need for discharge after acute asthma attack
PEFR >75% of expected,
inhaler technique checked
stable on discharge medications (i.e. no longer requiring acute asthma treatment) for at least 12-24 hours.
64
indications long term oxygen therapy COPD
PaO2 < 7.3 kPa + non-smokers
PaO2 7.3 - 8 AND nocturnal hypoxia, polycythaemia, peripheral oedema + pulmonary hypertension
65
management acute exacerbation COPD
5 day course oral pred
66
stages COPD
FEV1 of predicted
stage 1 - >80%
stage 2 - 50-79%
stage 3 - 30-49%
stage 4 - <30%
67
commonest cause pneumonia after influenza
staph aureus
68
management covid 19
hospitalised + hypoxia - dexamethasone + remdesivir
ventilation - tocilizumab
molnupiravor - inhibits cov2 replication (use within 5 days)
69
significant FeNO result
>50 ppb in adults or >35 ppb in children
70
significant bronchodilator reversibility result
>12%
71
paraneoplastic features adenocarcinoma
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)
72
first line management COPD
SABA or SAMA (e.g. ipratropium)
73
management asthma (non-acute)
1. AIR - low dose ICS + LABA when needed
2. low dose MART -> ICS + LABA daily
3. moderate MART
4. test eosinophil + FeNO - if raised ->> refer to asthma specialist
if not raised -> trial LTRA or LAMA
74
management suspected occupational asthma
peak flow diary in and out of work
referral to secondary care
75
examination findings bronchiectasis
coarse crackles and high-pitched inspiratory squeaks
76
management bronchitis
supportive
abx (doxicycline) if - comorbid, systemically unwell, CRP raised
77
features ABPA
eosinophilia + bronchiectasis
treat with oral steroids
78
examination findings pulmonary hypertension
- S3 -> rapid ventricular filling
- end diastolic murmur -> pulmonary regurg
- pansystolic murmur -> tricuspid regurg
- loud P2 - pulmonary valve snap
- raises JVP, parasternal heave
79
PERC criteria
- age >50
- HR >100
- sats <94%
- previous DVT or PE
- recent surgery or trauma in past 4 weeks
- haemoptysis
- unilateral leg swelling
- oestrogen use
80
well's criteria and points
3 points
- symptoms and signs PE
- most likely diagnosis
1.5 points
- immobile 3 days or surgery within 1 month
- previous PE/DVT
- tachycardia
1 point
- haemoptysis
- active malignancy
81
what well's score indicates likely PE?
>4
82
chlaymidia psittaci features
pneumonia from infected birds
- atypical
- Flu-like symptoms (90%): fever, headache and myalgia
Respiratory symptoms (82%): dyspnoea, dry cough and chest pain
83
features pneumocystis jiroveci
- immunocompromised, e.g. HIV
- exertional dyspnoea - specific sign for pneumocystis
- dry cough, fever
84
management pneumocystis jiroveci
- prophylaxis if CD4 count <200/mm3
- co-trimaxazole acute management
85
complication pneumocystis
pneumothorax
86
CRB/CURB65 score criteria and meaning?
Urea in hospital based setting
C -> confusion (AMT<8)
U -> urea >7
R -> resp rate >30
B -> BP <90 systolic and/or 60 diastolic
87
what is HPOA + what is seen on x-ray
- stiffness and pain in wrists
- proliferative periostitis at ends of long bones, ‘onion skin’ appearance on x-ray
88
where is lung cancer likely to metastasise to?
- brain
- breast
- adrenals
- bone
89
2ww CXR considered if >40 and which symptoms?
Persistent or recurrent chest infection
Finger clubbing
Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
Chest signs consistent with lung cancer
Thrombocytosis
90
causes secondary pulmonary fibrosis
- alpha-1-antitrypsin
- systemic sclerosis
- RA
- SLE
91
contraindications live child's flu vaccine
- immunocompromised
- aged < 2 years
- current febrile illness or blocked nose/rhinorrhoea
- current wheeze (e.g. ongoing viral-induced wheeze/asthma) or history of severe asthma (BTS step 4)
- egg allergy
- pregnancy/breastfeeding
- if the child is taking aspirin (e.g. for Kawasaki disease) due to a risk of Reye's syndrome
92
which gene therapy drug is available to which people with CF?
Orkambi for those homozygous for delta F508 mutation
93
CF contraindication to lung transplant
chronic infection with Burkholderia cepacia
94
management life threatening asthma attack adults
oxygen, nebulised salbutamol 5mg, nebulised ipratropium bromide 0.5mg
oral pred 40-50mg or IM methylpred 160 mg or IV hydrocortisone 100 mg
95
how long to continue pred after asthma attack
minimum 5 days
96
paeds asthma management - all patients have and what dose?
- steroids for minimum 3 days
- 2-5 years, 20 mg od
- > 5 years, 30 - 40 mg od
97
stages of COPD - done how and what are they
via FEV1
stage 1 - >80% - mild
stage 2 - 50-79% - moderate
stage 3 - 30-49% - severe
stage 4 - <30% - very severe
98
pneumonia follow up
repeat CXR at 6 weeks
99
asthma first line investigation
- eosinophil count or FeNO
100
first line asthma management child aged 5-11
twice daily low-dose ICS + SABA as needed
