Resp Pass Med Flashcards by EMMA WILLIAMSON

What decreases first CRP or white cells

White cells

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Benign ovarian tumour as cites and plural effusion

Meigs syndrome

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NG tubes are safe to use if the pH is what on aspirate

<5.5

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If pH >5.5 on NG tube aspirate do what

Request a CXR to confirm position of tube

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Pleural fluid with protein > 30 is indicative of an

Exudate

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Give 4 causes of a transudative pleural effusion (protein <30)

HF
Liver disease nephrotic syndrome malabsorption
Hypothyroid
Meigs syndrome

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Give causes of an exudative pleural effusion

Infection CTD neoplasia pancreatitis PE dresslers yellow nail syndrome

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Alpha one antitrypsin causes what type of pattern on spriometry

Obstructive

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What can abx be prescribed for in upper Resp tract infections as exceptions

3 or more of centir criteria
Younger than 2 years with bilateral otitis media
Otorrhoea and acute otitis media in kids

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What are the cantor criteria

Tonsillitis mar exudate
Lymphadenopathy
Fever of history of
No cough

3 or more can prescribe

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When can non invasive ventilation be given in COPD

pH between 7.25 and 7.35

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If in COPD the pH is <7.25 then use

Invasive ventilation

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Parallel line shadows on ct

Tram lines in bronchiectasis

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Collapsing during exertion is associated with what

Aortic stenosis

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Diagnose mesothelioma

Thoracoscopy and histology

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Before starting azithromycin do what

An ECG to rule out prolonged QT interval and also do baseline LFTs

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What is the diagnostic criteria for COPD

FEV1/fvc ratio <70% and symptoms suggestive of COPD

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What features of COPD would make you think that it would be steroid responsive

Previous diagnosis of asthma or atopy
A higher blood eosinophil count
A substantial variation in FEV1 over time (at least 400mls)
Substantial diurnal variation in peak flow (at least 20%)

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How long should you hold your breath after using an inhaler

10 seconds

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How long should you wait between inhaler doses

30 seconds

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What is the triangle of safety for a chest drain

Base of axilla
Lateral edge of pec major
5th ICS
Anterior border of lat Dorsi

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BiPAP is a form of

Non invasive ventilation

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What can mimic a pneumothorax in COPD

Emphysematous Bullae

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What are the biochemical features of an empyema

Turbid effusion with pH <7.2 low glucose high LDH

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First line COPD

Sama or Saba (salbutamol or salmetarol)

Vaccines in COPD

One off pneumococcal and annual flu

Treatment of exacerbation of asthma

Short course of oral pred and daily inhaled corticosteroid to control asthma

Scale used in OSA

Epworth

Are inhalers safe in pregnancy

Yes no need to stop as there is a need for good control throughout

If copd and on Saba/sama and still breathless but is steroid responsive

Add a Laba and ICS

What is chest drain swinging

The water seal rises on inspiration and falls on expiration

What can cause pulmonary fibrosis of the upper lobs

``` CHaRTS Coal workers pneumoconiosis Hypersensitivity pneumonitis Ank spond Radiation TB Silicosis and sarcoidosis ```

What type of fibrosis mainly affects the lower zones

Idiopathic pulmonary fibrosis CTD Drugs (amiodarone methotrexate bleomycin) Asbestosis

Prevent high altitude cerebral oedema with

Acetazolamide

Treat high altitude cerebral oedema with

Dexamethasone

Ground glass on CT

Fibrosis

What are pleural plaques

Benign features of asbestos exposure

What is the most dangerous form of asbestosis

Crocidolite (blue)

How is military TB spread

Through the pulmonary venous system

Sudden deterioration after initiating ventilation suggests

Tension pneumothorax

Indications for steroid treatment for sarcoid are

Parenchyma lung disease Uveitis Hypercalcaemia Neurological or cardiac involvement

Hyponatraemia is seen in what type of lung cancer

Small cell

What does SCC of the lung cause

Hypercalcaemia (increases PtH) or hyperthyroid (increased Tsh)

What is the criteria for a post bronchodilator response indicative of asthma

FEV1 of 12%

How can mitral stenosis cause haemoptysis

Rupture of the bronchial veins caused by raised left atrial pressure

Gynaecomastia is associated with what type of lung cancer

Adenocarcinoma

How can you further investigate asthma if spirometry is negative?

Fractional exhaled nitric oxide testing

A combination of bronchiectasis and dextrocardia is highly suggestive of what syndrome

Kartageners syndrome

Histology and anatomy of a mesothelioma a

Pleural based mass with fibrosis and plaque formation | Mixed sarcomatous and carcinomatous features

Needle into pleural cavity is inserted above or below the rib

Above as the NVB runs below

Tinnitus and overdose

?salicylate poisoning

Treat psittacosis with

Tetracyclines like doxycycline

High calcium and lung cancer

Squamous cc or bony mets

Anti TNF on rheumatoid can do what

Reactivate TB

Air crescent sign on CT

Aspergillosis

What is the sweat test for CF

Give the muscarinic pilocarpine and then measure the chloride content of sweat

Diagnosis of TB is by

Sputum microscopy and culture

What is contraindicated in massive haemoptysis

Non invasive ventilation as may aspirate and positive pressure may prevent clot formation

Dry non productive cough T1RF hyponatraemia and mild renal impairemwnt

A typical pneumonia like legionella or mycoplasma

Bat wing appearance on chest radiograph

Pulmonary oedema

What is another name for farmers lung

Hypersensitivity pneumonitis

What are the signs of a pleural effusion

Reduced chest explanation on the size of the effusion Trachea can be deviated Stony dull to percuss Reduced vocal resonance

Most common cause of pleural effusion in a homeless person apart from trauma

Aspiration pneumonia

Salbutamol is a beta 1/2 agonist

What are the 5 causes of hypoxaemia

``` Hypoventillation Vq mismatch Right to left shunt Low inspired o2 Diffusion abn ```

What is a classic feature of pneumocystis jirovecci

Desaturation on exercise

What is the main cause of malabsorption in Cf and how do you treat it

Pancreatic insufficiency | Replacement pancreatic enzymes

Treatment of stable and unstable PE

Stable - LMWH | Unstable - thrombolysis

Score 0 on MRC dyspnoea scale

No breathlessness except with strenuous exercise

Score 1 on MRC dyspnoea scale

Breathlessness when hurrying on the level or walking up a slight hill

Score 2 on MRC dyspnoea scale

Walk slower than others or has to stop for own breath when walking at own pace

Score 3 on MRC dyspnoea scale

Stops for breath after walking for 100m or a few mins on level ground

Score 4 on MRC dyspnoea scale

Too breathless to leave the house (breathless on dressing and undressing)

Which respiratory pathogen associated with Cf is a contraindication to lung transplant

Burkholderia cenocepacia

Bibasal reticular nodular shadowing on X-ray

IPF

What type of X-ray is used to detect abn that are obscured by the heart or sternum

Lateral

Which X-ray view is used to detect small pleural effusion a

Lateral decubitus view

What type of X-ray is used to study diaphragmatic movement

PA view with fluoroscopy

Patient with normal obs put peak flow of 30% predicted in surgery what do you don

Oral prednisalone salbutamol Neva high flow o2 call ambulance for immediate transfer to hospital

If curb score 0-1

Home

If curb score 2

Hospital

If curb score >3

Consider ITU

What actually is alpha 1 antitrypsin in the body

A glycoproteins

Working in a ceramic factory is a risk factor for the development of

Silicosis

What is used as a marker of disease severity in CoPD

FEV1

How would you treat a non infective exac of CoPD I

Pred

What does the FEV1 need to be for the pt to qualify for a transplant

<25%!

What disorders are associated with IPF

RA SLE SS IBD PBC

High calcium cancer

Squamous

Low na in blood high na in urine cancer

SIADH in small cell cancer

In any size of pneumothorax and the patient is shoet of breath what do you do

Aspirate

RA on immunosuppressive therapy and a cough productive of green sputum and repeated chest infections

Bronchiectasis

What are the three Cs of pulmonary fibrosis

Clubbing cyanosis cough

SOB in a young person with oedema palpitations syncope exertional angina and a murmur

Familia primary pulmonary hypertension

Gold standard for TB diagnosis a

3 separate sputum cultures for culture and microscopy

Describe the blood supply to the lungs

Pulmonary artery and bronchial arteries as dial blood supply so if pulmonary artery blocked then they have an option

What is the eye condition associated with sarcoidosis

Keratoconjunctivitis sicca

How would you investigate for sarcoidosis

``` CXr Trans bronchial biopsy and broncheolar lovage PFT Serum ACE Kveim test Tuberculin test ```

Unilateral pleural effusions are usually caused by

Local pathology such as trauma tumour or infection

Cancer at upper border of lung

Adenocarcinoma

Cancer in centre of lung

SCC associated with smoking

Resp Pass Med Flashcards

(101 cards)