Respiratory Flashcards
(95 cards)
1
Q
features of moderate asthma exacerbation
A
- PEFR 50-75%
- speech normal
- RR <25
- pulse <110
2
Q
features of severe asthma exacerbation
A
- PEFR 33-50%
- can’t complete sentences
- RR >25
- pulse >110
3
Q
features of life-threatening asthma exacerbation
A
- PEFR <33%
- sats <92%
- silent chest, cyanosis, poor respiratory effort
- bradycardia, dysrhythmia, or hypotension
- exhaustion, confusion or coma
4
Q
adults - dose of salbutamol nebs in acute asthma
A
5mg (with O2) - 15-20 min intervals
in children - under 5 = 2.5mg, over 5 = 5mg
5
Q
adults - dose of ipratropium bromide in acute asthma
A
500mcg (with O2) - 4-6 hourly
in children - 250mcg every 5 mins
6
Q
adults - dose of hydrocortisone/ prednisolone in acute asthma
A
200mg IV
or prednisolone 40mg PO
in children - 1-2mg per kg per day prednisolone PO
7
Q
adults - dose of magnesium sulphate in acute asthma
A
2g IV over 20 mins
8
Q
when can you discharge someone with acute asthma exacerbation
A
inhalers 4 or more hours apart
9
Q
follow up after acute asthma exacerbation
A
- see GP/asthma nurse in 2 days to review meds
- see resp specialist within 1 month of discharge
10
Q
most common bacterial cause of infective exacerbation of COPD
A
h. influenzae
11
Q
most common viral cause of infective exacerbation of COPD
A
human rhinovirus
12
Q
management of acute COPD exacerbation
A
- venturi to keep oxygen 88-92
- salbutamol nebs 5mg B2B
- ipratropium bromide 500mcg nebs
- prednisolone 30mg PO
- oral abx if infective signs
13
Q
antibiotic to give in infective exacerbation of COPD
A
amoxicillin 500mg TDS 5 days
or doxycycline/ clarithromycin
14
Q
when to give abx in acute bronchitis
A
- systemically very unwell
- signs suggestive of pneumonia
- co-morbidities or immunosuppression
- CRP >100 (offer delayed if 20-100)
- > 65 with acute cough and 2+, or >80 with acute cough and 1+ of: hospitalisation in previous year, diabetes, heart failure or taking steroids
15
Q
abx to give if required in acute bronchitis
A
orał doxycycline (not in pregnancy)
amoxicillin if pregnant or clarithromycin /erythromycin if penicillin allergic
16
Q
management of primary pneumothorax if <2cm and not SOB
A
? discharge (review in outpatients in 2-4 weeks)
17
Q
management of primary pneumothorax if >2cm/SOB
A
- aspirate with 16-18G cannula, <2.5L
- if fails (still >2cm) then insert chest drain and admit
18
Q
management of secondary pneumothorax
A
- > 2cm/SOB - chest drain
- 1-2cm - aspiration 16-18G cannula, <2.5L, if fails (still >1cm), chest drain
- <1cm - O2 and admit for 24 hours
19
Q
where is the triangle of safety (for chest drain insertion)
A
- anterior = pectoralis major
- posterior = latissimus dorsi
- 5th rib
20
Q
do you always put in a chest drain after aspirating a tension pneumothorax
A
yes
21
Q
investigations for suspected PE if wells score <4 or >4
A
- <4 = D-dimer, if positive do CTPA
- >4 = CTPA
22
Q
PERC score (HAD CLOTS)
A
- hormones
- age >50
- DVT/PE history
- coughing blood
- leg swelling
- O2
- tachycardia
- surgery/trauma
if none are met - <2% chance of PE
23
Q
a massive PE is
A
PE + hypotension or cardiac arrest - give alteplase
24
Q
a submassive PE is
A
- hypoxia
- echo/ECG showing right heart strain
- positive cardiac biomarker e.g. troponin
25
management of PE
- ABCDE
- LMWH or fondaparinux for minimum 5 days or until INR >2
- warfarin/DOAC commended within 24 hours
26
how long to give LMWH or fondaparinux after PE
- minimum 5 days or until INR >2
- until end of pregnancy if pregnant
- 6 months in patient with active cancer or IVD
27
when NOT to give LMWH or fondaparinux after PE
- increased risk bleeding
- haemodynamically unstable
- severe renal impairment
28
common cause of HAP in alcoholics
Klebsiella
29
most likely location of aspiration pneumonia
R lower lobe
30
management of VAP
tazocin/levofloxacin
31
type of pneumonia associated with erythema multiforme/nodosum
mycoplasma
32
type of pneumonia which can be caused by exposure to birds
chlamydophila psittaci
33
CURB-65 score
```
AMTS <8
Urea >7
RR >30
BP <90 or <60
Age >65
```
score 1 point for each
```
0-1 = low risk (manage at home0
2 = intermediate risk (hospital)
3 = high risk (ICU?)
```
34
atypical pneumonia screen includes screening for
- mycoplasma
- legionella
- chlamydia
35
when to use flucloxacillin in pneumonia
if staph suspected (e.g. influenza)
36
when to use vancomycin in pneumonia
if ?MRSA
37
treatment of severe pneumonia
IV amoxicillin + macrolide (e.g. clarithromycin) for 7-10 days
consider using co-amoxiclav, ceftriazone or tazocin with a macrolide if highly severe
38
treatment of HAP
not severe = co-amoxiclav 5 days (doxy if penicillin allergic)
tazocin if severe symptoms
39
reversibility of PEFR after bronchodilator in asthma
>60L/min
40
definitions of controlled, partially controlled and uncontrolled asthma
- controlled = <2 symptoms a week in the day
- partially controlled = >2/week, any at night, >1 exacerbation a year
- uncontrolled = 3+ features a week
41
pattern in reducing ICS dose in asthma
consider dose reductions every 3 months - decreasing dose by 25-50% each time
42
what is a positive bronchodilator test
asthma diagnosis - +ve test is improvement in FEV1 of 12% or more
43
what to do if high vs intermediate probability of asthma
- high probability = 6 week trial of treatment
| - intermediate probability = spirometry with BDR (positive = treatment, negative = objective tests)
44
how to carry out spirometry for COPD diagnosis
- no bronchodilator 4-6 hours before, no big meal, no smoking 24 hours before
- best of 3 consistent readings, ensure at least 2 FEV1 within 100ml/5% of each other
45
grades 1-4 of COPD
FEV1%:
- >=80 = stage 1
- 50-79 = stage 2
- 30-49 = stage 3
- <30 = stage 4
46
cardiac complication of COPD
cor pulmonale - right heart failure secondary to lung disease (caused by pulmonary HTN as a consequence of hypoxia)
47
features of cor pulmonale
- peripheral oedema
- raised JVP
- systolic parasternal heave
- loud pulmonary 2nd heart sound
- widening of pulmonary artery on CXR
- RVH on ECG
48
when is pulmonary rehabilitation recommended for COPD
- functionally disabled by COPD
- MRC dyspnoea scale 3+
- recent hospitalisation
49
what prophylactic antibiotics are sometimes used in COPD
azithromycin 3x a week
50
when can you offer LTOT for COPD
- if FEV1 30-49%
- oedema, cyanosis, polycythaemia, raised JVP
- ABG twice at least 3 weeks apart - offer If pO2 <7.3 or pO2 7.3-8 and secondary polycythaemia, peripheral oedema or pulmonary hypertension
- NOT to patients who smoke
51
when is light's criteria used for pleural effusions
when borderline between transudate and exudate - when protein level is 25-35g/L
exudate is likely when one of the following is met:
- pleural fluid protein/serum protein =>0.5
- pleural fluid LDH/serum LDH =>0.6
- pleural fluid LDH >2/3 the upper limits of normal serum LDH
52
causes of a pleural effusion with low glucose (<3.3)
- RA
- TB
- empyema (LDH >1000)
53
causes of a pleural effusion with raised amylase
- pancreatitis
- oesophageal perforation
- malignancy
54
causes of blood stained pleural effusion
- mesothelioma
- PE
- TB
- trauma
55
how much can you aspirate of a pleural effusion
max 1.5L
56
when to drain a pleural effusion
- fluid purulent or turbid
| - empyema/ parapneumonic effusion with ph <7.2
57
paraneoplastic syndromes associated with SCLC
- SIADH
- ACTH (Cushing's)
- LEMS
58
type of NSCLC centrally vs peripherally located
- central = squamous cell (close to bronchi - can present with bronchial obstruction)
- peripheral = adenocarcinoma
59
type of lung cancer which may secrete beta-hCG
large cell
60
type of lung cancer which can secrete PTHrp = malignancy-related hypercalcaemia
squamous cell
61
where can pain be caused in a Pancoast tumour (SCC)
in distribution of nerve root (Pancoast syndrome) - pain in R arm, weakness of muscles of R hand
62
how to biopsy lymph nodes in the mediastinum
end-bronchial ultrasound (EBUS)
63
most common mets of lung cancer
- adrenals
- liver
- brain
- bone
64
what is sarcoidosis
multisystem chronic inflammatory condition - formation of non-caveating epithelioid granulomas
65
how can sarcoidosis affect the eyes
- anterior uveitis
- dry eyes
- glaucoma
66
neuro effects of sarcoidosis
- Bell's palsy
- lesions of cranial nerves
- hoarseness
- headache
67
why can sarcoidosis cause hypercalcaemia
macrophages in granulomas cause increased conversion of vitamin D to its active form
68
what is lupus pernio
chronic raised red lesion on face (looks a bit like butterfly rash - sign of sarcoidosis)
69
pulmonary function tests in sarcoidosis
can be a restrictive pattern (lung fibrosis)
70
when is serum ACE tested
for sarcoidosis
71
1st line management for sarcoidosis
oral glucocorticoids
other treatments include methotrexate, azathioprine, mycophenolate, anti TNF etc.
72
commonest mutation for CF
delta F508 on chromosome 7 (CFTR gene)
73
FEV1 in CF
obstructive - recurrent chest infections = bronchiectasis
74
organisms causing recurrent chest infections in CF
- s. aureus
| - h. influenzae
75
Newborn screening finding in CF
increased immunoreactive trypsin on newborn bloodspot card (Guthrie card)
76
what is diagnostic of CF on sweat test (gold standard)
chloride levels >60mmols - 2 abnormal tests needed for diagnosis (false positive could be caused by malnutrition, thyroid, adrenal insufficiency, skin oedema)
77
liver complication of CF
sluggish bile flow - cirrhosis and portal hypertension
78
most common presentation of TB outside the lungs
sterile pyuria - may be salpingitis, abscesses and infertility in females, epididymis swelling in males
79
MSK presentations of TB
pain, arthritis, osteomyelitis, abscess (of vertebral bodies = Pott's disease)
80
CNS presentations of TB
tuberculosis meningitis and tuberculomas
81
skin presentation of TB
erythema nodosum
82
how does primary TB usually appear on CXR
central apical portion with left lower lobe infiltrate/pleural effusion
83
CXR of reactivated TB
apical lesions
84
contact screening for TB
Mantoux test to household contacts - Mantoux positive if 15mm or greater
85
how long to give abx for active TB without CNS involvement vs TB with CNS involvement
- without CNS = 6 months
| - with CNS = 12 months
86
management of latent TB
- 6 months isoniazid/3 months rifampicin and isoniazid if known not to have HIV
- 6 months isoniazid if HIV
87
what does the Mantoux test show
6-15mm = previous TB/BCG injection
>15mm = TB infection
88
when can you not give BCG vaccine
```
pregnant
previous TB
HIV
positive Mantoux
>35
```
89
why can hypothyroidism and amyloidosis increase risk of obstructive sleep apnoea
both can cause macroglossia
90
how is complete apnoea defined
10 second pause in breathing activity
91
how is partial apnoea defined
(hypopnoea) - 10 second period where ventilation is reduced by at least 50%
92
mild, moderate and severe obstructive sleep apnoea
5 or more respiratory events per hour:
- 5-14 = mild
- 15-30 = mod
- >30 = severe
for mod/severe = CPAP 1st line - must be worn for minimum 4 hours/night
93
most common symptoms of CO poisoning
headache
| N+V
94
what antibody is positive in 30% of IDF cases
ANA
95
potential complication of tricuspid endocarditis
can lead to septic PE = lung abscess?
