Respiratory Flashcards
(150 cards)
1
Q
Epigastric pain and vomiting
Chest X-ray reveals bilateral infiltrates and a normal-sized cardiac silhouette
Heavy drinker, high lipase, high RR, low sats
What is feature of this complication the patient has developed?
A
ARDS - Diffuse alveolar damage with hyaline membrane formation (from acute pancreatitis)
2
Q
Cardiothoracic ratio in ARDS with no signs of HF
A
<0.5
3
Q
Anti-microbial causing high INR
A
Metronidazole (IV)
4
Q
What is this asthma patient’s acid-base balance?
Low pH, low O2, high CO2, normal bicarb
A
Resp acidosis w no metabolic compensation
5
Q
Conditions for discharge after acute asthma attack?
A
Stable on salbutamol inhaler for 24h
6
Q
What type of hypersensitivity is asthma?
A
Type 1
7
Q
Next step in asthma after using salbutamol v often
A
ICS 200mg
8
Q
First-line asthma treatment if patient reports symptoms 2/3x week/night time waking
A
SABA + ICS
9
Q
What position should you take peak flow in?
A
Sitting/standing
10
Q
3rd line asthma treatment after SABA and ICS
A
LABA
11
Q
Features of life-threatening asthma
A
O2 sats <90%
PEFR <33%
Silent chest, bradycardia, hypotension, exhaustion
12
Q
Who gets pneumococcal vaccine?
A
Chronic heart failure
>65 y/o
13
Q
What vaccines should patient with RA on methotrexate, folic acid, hydroxychloroquine receive?
A
Influenza and pneumococcal
14
Q
What type of pneumonia is common in caves and Mid West US that causes bilateral hilar lymphadenopathy?
A
Histoplasma capsulatum
15
Q
What is the treatment for someone w 3/more infective exacerbations per year already on optimal meds?
A
Long term prophylactic antibios
16
Q
Management in bronchiectasis patient w high fever and raised resp rate
A
IV antibiotics
17
Q
Cause of bronchiectasis in patient w dull on exp and resonant on insp and left lung base
A
Primary ciliary dyskinesia (normal percussion changes are right sided)
18
Q
CF can cause issues w what organs?
A
All of them!!!!!!
19
Q
O2 treatment in COPD exacerbation with CO2 retention
A
4/L min Venturi mask - target sats 88-92%
20
Q
Why would you not use a nasal cannula in someone w type 2 resp failure?
A
It can’t supply controlled level of O2 (unlike Venturi mask)
21
Q
Use of 15L/min non rebreathe?
A
Critically ill/severely hypoxic patients (<75-80% in COPD patient)
22
Q
Right axis deviation/right vent heave/hypertrophy on ECG
A
Neg deflection lead 1
Pos deflection lead 2
23
Q
What heart condition can result from long-term hypoxia e.g. COPD?
A
Right vent hypertrophy
24
Q
COPD second-line treatment
A
LABA (+ICS if patient has asthmatic features or suggests steroid responsiveness)
25
Common ECG changes in COPD
```
RA deviation
Prominent P waves in inf leads
Inv P waves in high lateral leads (I, aVL)
Low voltage QRS
Delayed R/S transmission in V1-6
P pulmonale
RV strain pattern
RBBB
Mutlifocal atrial tachycardia
```
26
Next step in COPD CO2 retainer acute exac
28% O2 Venturi mask - to prevent over-oxygenating
27
COPD w CO2 retention in ABGs
Incr HCO3
| Base excess
28
Signs of CO2 narcosis
Reduced work of breathing
| Looking calmer
29
Criteria for LTOT
PaO2 <7.3 or 7.3-8 PLUS periph oedema, pulm HT, nocturnal hypoxaemia, secondary polycythaemia
30
Second line treatment for COPD patients w asthma or steroid resp w persistent exac
LABA + ICS (budesonide + formeterol)
31
What test can confirm COPD diagnosis?
Spirometry
32
Chloride level indicating CF in sweat test?
>60mmol/L
33
Drug to prescribe if patient has excess airway secretions that they are struggling to clear
Hyoscine butlbromide SC (anticholinergic agent)
34
Cause of massive haemoptysis, previous aspiration pneumo, foul sputum, fever
CXR right lower lobe consolidation and central cavitation w air-fluid level
Lung abscess
35
Features of aspergilloma
Secondary to chronic lung disease
| Target-shaped lesion (upper lobe)
36
What are the features of Horner's syndrome?
Miosis
Partial ptosis
Anhidrosis
(Caused by pancoast tumour in left apex invading symp chain)
37
Key features of SCLC
Perihilar and central lesions
| Paraneoplastic syndrome e.g. Cushing's excreting ACTH
38
Horner's syndrome
38
Horner's syndrome
38
Horner's syndrome
39
Signs of compression of sympathetic chain
Partial ptosis and miosis of right eye
40
What lung cancer causes hypercalcaemia?
Squamous
41
What antibodies are commonly present in SCLC w paraneoplastic syndrome?
Voltage-gated Ca channel antibodies (VGCC)
42
Symptoms of Cushing's
Hyperpigmentation
Hypertension
Impaired glucose tolerance
Perhaps hypokalaemia
43
Most common occupational exposure pleual tumour
Asbestos
44
Features of mesothelioma on CXR
Pleural thckening
| Some distinct plaques
45
Where would a cancer with monophonic wheeze be?
Central (squamous cell)
46
Common symptoms w lung adenocarcinoma
Clubbing
| Hypertrophic pulm osteoarthropathy (painful wrist swelling)
47
Drug for reduction of swelling in SVCO caused by lung cancer
Dexamethasone
48
First line treatment of hypercalcaemia
IV fluids and then IV phosphates as they take 2-4 days to respond
49
Carcinoid syndrome features
Facial flushing
Diarrhoea
Asthma
Lung nodule (demarcated opacification)
50
Investigation for carcinoid syndrome
Urinary 5-HIAA excretion (ID serotonin metabolite)
51
Which lung cancer causes hyponatraemia?
Small cell (SIADH)
52
How can stroke influence lung abscess?
Risk of aspiration due to impaired swallow causing infection in lung
53
Most common microbe in abscesses
Anaerobic bacteria esp w impaired swallow
54
Which sex is more affected by OSA?
Males
55
What scoring is used for OSA?
Epworth Sleepiness Scale
56
What test may be used before polysomnography in OSA?
Overnight pulse oximetry
57
What is Meig's syndrome?
Ovarian tumour + pleural effusion + ascites
58
What change in pulm cap pressure can cause pleural effusion?
High pressure
| Leads to transudation of fluid into pleural cavity
59
Causes of transudate vs exudate
Transudate (incr intravasc pressure/reduced osmotic pressure)
Exudate (inflam, infection, neoplasm)
60
Exudative pleural effusion w fatigue/MSK pain/rash/erythemous rash of nose/oral ulcers
Systemic lupus erythematosus
Incr ANA
Low complement
61
What type of effusion can hypothyroidism cause?
Transudative
62
What type of effusion can lung adenocarcinoma cause?
Exudative
63
Light's criteria
Exudative effusion if:
The ratio of pleural fluid to serum protein is greater than 0.5
The ratio of pleural fluid to serum LDH is greater than 0.6
The pleural fluid LDH value is greater than two-thirds of the upper limit of the normal serum value
64
Glucose levels in patient w pleural effusion secondary to RA
Low glucose (<3.3mmol/L)
65
First line investigation of pleural fluid in empyema
pH analysis
| <7.2 suggests empyema
66
Fevers following pneumonia
Empyema
67
Positive hepato-jugular reflex indicates?
Congestive heart failure
68
First line HF treatment w pleural effusion
Furosemide (treat the cause!!!!!)
69
When is pleural fluid aspirate not required in PEff?
When there is clear evidence of congestive HF
70
Best diagnostic test for HF
Transthoracic echocardiogram
71
Pneumonia causing low sodium
Legionella
72
HAP due to pseudomonas treatment?
IV Ciprofloxacin
73
Treatment of severe pneumonia from staph areus
IV co-amoxiclav + clarithromycin + flucloxacillin
74
Stain to use in pneumocystis diagnosis
Silver stain
75
Signs of pneumonia on auscultation
Incr tactile vocal fremitus
| Dull precussion note
76
Gm+ cocci in clusters pneumonia?
Staphylococcus aureus pneumonia
77
First line antibio for staph pneumonia
Flucloxacillin
78
Antibio for gm- pneumonia e.g. strep
Amoxicillin
79
First line investigation for legionella
Urine antigen enzyme immunoassay test
80
Hotel air conditioning pneumonia?
Legionella
81
Confusion score on CURB-65
<8/10
82
Antibio if penicillin allergy
Clarithromycin
83
CURB-65 score 2 means?
Immediate risk of death
| Admit to hosp for treatment and close observation
84
Microbe causing flu-like illness, erythema (target-shaped), and anaemia symptoms in pneumonia
Mycoplasma pneumonia
85
Lymphopenia plus hyponatraemia in pneumonia?
Legionella
86
CAP with rusty sputum, fast onset symptoms, high fever
Strep pneumonia
87
Treatment of empyema
Chest drain under radiological guidance
88
Pneumonia assoc w AI haemolytic anaemia?
Mycoplasma pneumonia
89
What type of pneumothorax if patient has asthma?
Secondary pneumothorax
90
Marfan's increases risk of which aortic pathology?
Acute aortic dissection
91
What recreational drug can incr risk of pneumothorax?
Cannabis
92
Pneumothroax management if there is mediastinal shift or haemodynamic compromise
Needle aspiration
93
Immediate management of tension pneumo with noisy breathing and GCS 8
Airway manoeuvres (intubate if this fails)
94
V/Q ratio in pneumothorax?
Lowered ratio
95
Standard length of PE treatment
3 months
96
Length of treatment in provoked/unprovoked PE
3 months provoked if cause is treated
| >3 months if unprovoked
97
Investigation to confirm(!!!!) PE
CT pulm angio (CTPA)
98
Prescription of anticoag for PE post-op
LMWH as it is shorter acting in case there's pos-op bleeding
99
Absolute contraindication to thrombolysis
Past haemorrhagic stroke AT ANY TIME
100
Anti-phospholipid syndrome incr risk of...
Venous thromboembolism/PE and prg-related morbidity
101
Treatment of symptomatic suspected PE
DOAC (direct oral anticoag) instead of waiting until investigation results
102
IPF spirometry results
Restrictive
103
Treatment of UTIs that can cause pulm fibrosis
Nitrofuratoin
104
Changes in FVC and FEV1 in PF
Both decr
105
Gradual symp onset, clubbing, fine insp crackles
IPF
106
RA causes fibrosis in what area of lungs?
Lower lobes
107
Lower lobe fibrosis caused by...
```
RA
IPF
Asbestosis
SLE
Scleroderma
Drugs e.g. methotrexate and bleomycin
```
108
TLCO in IPF
Reduced
109
Disease-modifying drug for IPF (long-term management)
Pirfenidone and nintedinab
110
Cor pulmonale features
Pulm HT symptoms plus RH failure symptoms
111
Investigation for pulm HT due to chronic thromboembolism (recurrent PEs)
Right heart catheterisation
112
Auscultation signs in cor pulmonale
Split S2 w loud pulm component
113
Bosentan side effects
Deranged LFTs
114
What ABG result would panic attack cause?
Resp alkalosis w good O2 sats
115
Treatment of type 2 resp failure w low pH and rising PaCO2
Non-invasive vent (NIV)
116
Raised serum ACE indicates
Sarcoidosis
117
Which ion is incr in sarcoidosis?
Calcium (hypercalcaemia)
118
Treatment of symptomatic sarcoidosis
Oral prednisolone
119
Bilateral parotid gland swelling?
Sarcoidosis
120
Diagnostic test for sarcoidosis
Bronchoscopy w transbronchial lung biopsy
121
Drug which can cause pulm fibrosis and restrictive spirometry
Methotrexate
122
IgE mediated activ of mast cells type hypersensitivity
Type 1 hypersensitivity (asthma)
123
Red urine side effect of which urine treatment?
Rifampicin (R for red)
124
Best investigation for TB diag
Early morning sputum samples
125
Best investigation for TB diag
Early morning sputum samples
126
Peripheral neuropathy side effect of which TB drug?
Isoniazid (nia=neuro)
127
Stain used in TB testing
Sputum acid-fast bacilli smear (AFB)
128
Visual disturbance side effect of which TB drug?
Ethambutal (E for eyes)
129
TB on CXR
Patchy opacification across both upper zones
130
Treatment of theophylline toxicity
Activated charcoal
131
The Haldane Effect
Oxygenated Hb releases CO2 more readily
132
Lower V/Q in bases compared to apices means that base PO2 and PCO2 are..
Lower PO2
| Higher PCO2
133
Increase in ventilation rate causes alveolar ventilation rate to...
Decrease by same proportion
134
Hypercalcaemia has what effect on muscle and nervous system?
Depresses both
135
PTH secreting tumour has what effect?
Incr abs of Ca and phosphate
136
Limb weakness improving with movement assoc with lung cancer?
Lambert-Eaton syndrome
- small cell cancer
- voltage-gated calcium channel (VGCC) antibodies
137
Characteristic finding of mesothelioma on CXR
Plaque formation and pleural thickening
138
CXR findings in asthma
Nothing specific
Hyperinflation
139
COPD/asthma patient with acute exacerbation and chest infection with penicillin allergic?
Theophylline and macrolide antibiotics can interact and cause arrhythmias
- monitor theophylline levels v closely
140
Bronchiectasis would show which spirometry pattern
Obstructive pattern (decr ratio)
141
Low FEV1 and low FVC but normal FEV1/FVC ratio is suggestive of?
Restrictive lung disease
142
IRA causes of pulmonary fibrosis
Idiopathic
Rheumatoid arthritis
Amiodarone/asbestosis
143
First line investigation of cor pulmonale
Echocardiogram
144
How would you manage CA pneumonia with a penicillin allergy?
IV levofloxacin 500mg bd
145
Which lung cancer of the mid-zone is most common in non-smokers?
Adenocarcinoma
146
Cushing's syndrome is caused by which lung cancer?
Small cell lung cancer
147
Diagnosis of asthma
Peak flow: variability >20%
Fractional exhaled nitric oxide (FeNO): >40 ppb adults or >35 ppb children
Spirometry: FEV1/FVC <70% (obstructive spirometry)
148
Gold standard diagnostic test for PCP
Bronchoalveolar lavage
