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Respiratory Flashcards

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1
Q

Which part of the lung is most likely affected in aspiration pneumonia and why?

A

Right middle/lower lobes

Because the right bronchus is straighter and more vertical than the left so aspiration is most likely to affect lungs on the right
Lower lobes if patient sitting upright (gravity)

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2
Q

Components of CURB-65

A

Confusion
Urea > 7
Respiratory rate > 30
Systolic BP < 90 or Diastolic BP < 60

Age > 65

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3
Q

How many weeks after clinical resolution of pneumonia should patient have repeat chest X-ray?

A

6 weeks

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4
Q

Community Acquired Pneumonia: Common causative agents

A

Strep Pneumoniae (80%)
H. Influenzae (more common in COPD)

Viral: RSV, COVID-19 (15%), Influenza

Atypical:
Mycoplasma pneumoniae (younger patients)
Chlamydia pneumoniae (Elderly patients)
Legionella pneumoniae

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5
Q

Hospital Acquired Pneumonia: Common causative agents

A

Gram negatives:
- Klebsiella
- E. Coli
- Pseudomonas

MRSA
Staph Aureus

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6
Q

When to consider antibiotics in acute bronchitis?

A

Systemically unwell
Pre-existing co-morbidities
CRP of 20-100 (offer delayed prescription)
CRP > 100 (offer antibiotics immediately)

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7
Q

Antibiotic for acute bronchitis

A

Doxycycline

Pregnant or aged 12-17: Amoxicillin

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8
Q

Define Pneumonia

A

Signs of respiratory tract infection + New shadowing on CXR

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9
Q

Asthma DIAGNOSTIC tests

A

Spirometry and bronchidilator reversibility test

If > 17 yrs or still unsure in children:
FeNO test

All adults with suspected asthma should have both of the above tests

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10
Q

At what age can you test for asthma

A

> 5 years

Under 5 diagnosis made on clinical judgement

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11
Q

Positive FeNO test result

A

> = 40 ppb = positive test for asthma

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12
Q

Spirometry test positive result for asthma

A

FEV1 : FVC ratio < 70%

This is considered OBSTRUCTIVE

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13
Q

Bronchodilator reversibility testing positive result (asthma)

A

Positive test = improvement of FEV1 of of 12% or more

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14
Q

What is the relevance of testing for fractional expired nitrous oxide?

A

NO is produced in response to inflammation and expired

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15
Q

Uncontrolled asthma

Current meds: Salbutamol INH PRN
Using 3 x per week

What next?

A

+ ICS
E.g. beclometasone

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16
Q

Uncontrolled asthma

Current meds: Salbutamol + ICS

What next?

A

+ Long acting beta-2 agonist (LABA)
E.g. salmeterol/formoterol

** Can’t use LABA without ICS
They come in combined inhaler - Symbicort/Fostair (= MAST regimen)

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17
Q

Uncontrolled asthma

Current meds: Salbutamol + ICS/LABA (Symbicort)

What next?

A

+ LTRA (leukotriene receptor antagonist)
E.g. Montelukast

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18
Q

Uncontrolled asthma

Current meds: Salbutamol + ICS/LABA + Montelukast

What next?

A

Increase dose of ICS

If this doesn’t help refer to specialist and consider long term oral steroids (e.g. prednisolone)

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19
Q

Signs of poor control of asthma

A

Using SABA (reliever) >= 3 x per week
Night symptoms >= 1 x per week
Interfering with daily activities
Chest tightness, wheeze
Exacerbation in the last 2yrs

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20
Q

Signs of severe asthma attack

A

PEF 33-50% of best
RR >= 25
HR >= 110

Incomplete sentences
Accessory muscles
Hyper inflated chest
Pulses paradoxus (Decrease in sBP with inspiration)

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21
Q

Signs of life threatening asthma attack

A

PEF < 33% of best
SpO2 < 92%
Decreased HR and BP

Exhaustion / confusion
Silent chest
Cyanosis

ABG: Increased CO2, O2 < 8, acidotic

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22
Q

Management of Atelectasis

A

Position the patient upright
Chest physiotherapy

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23
Q

Types and causes of Atelectasis

A

Obstructive - e.g. mucus plug (COPD, CF), foreign body, tumour

Non-obstructive
- most commonly caused by anaesthesia
- compressive - pneumothorax, hernia, pleural effusion
- contraction - scar tissue
- adhesive - surfactant deficiency

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24
Q

What is atelectasis?

A

Collapse of alveoli and lung tissue

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25
Escalation of care in acute asthma
1. Oxygen 2. Salbutamol Nebs 3. Ipratropium bromide nebs 4. Hydrocortisone IV or PO prednisolone 5. Magnesium Sulphate IV 6. Aminophylline/ IV salbutamol
26
Admission to hospital criteria for acute asthma exacerbation
All patients with life-threatening asthma Severe asthma + fail to respond to initial treatment Previous near fatal asthma attack Pregnancy An attack occurring despite already using oral steroids and present at night
27
Lights Criteria: Transudate
Used if: protein content is 25-30 g/L Pleural:serum protein < 0.5 Pleural: serum LDH <0.6 Pleural fluid LDH <2/3 upper limit of normal
28
Light’s Criteria: Exudate
Used if: protein content is 25-30 g/L Pleural:serum protein > = 0.5 Pleural: serum LDH > = 0.6 Pleural fluid LDH >2/3 upper limit of normal
29
Conditions that causes of transudate pleural effusion (4)
Congestive heart failure Renal failure Liver failure Hypothyroidism
30
Conditions that cause exudate pleural effusion (I I I M M)
Inflammation: Trauma, RA, sarcoidosis, SLE Infection: Pneumonia, TB Infarction: PE, post-MI (dressler’s) Malignancy (25% of effusions) Medications: amiodarone, phenytoin
31
Pathophysiology of transudate pleural effusion
Movement of fluid from circulation —> pleural space Caused by: Increased hydrostatic pressure Decreased capillary pressure
32
Pathophysiology of exudate pleural effusion
Production and secretion of fluid into pleural space Increased capillary permeability
33
Pleural Tap/Aspiration: what should be tested for?
Microbiology Cytology (80% sensitive for malignancy) Clinical chemistry: - Glucose - LDH - Protein - pH
34
Organisms causing empyema
Strep Milleri H. Influenzae E. Coli Staph Aureus Pseudomonas
35
Management of a pleural infection (empyema)
1. PLEURAL TAP - pH < 7.2 - Low glucose - High LDL Parapneumonic effusion - straw colour with no organisms Loculated empyema - pockets of semi-solid pus 2. IV Abx for 2 weeks 3. CHEST DRAIN if symptomatic and: - Frank pus (puruent/cloudy appearance) OR - pH < 7.2 OR - organisms cultured 4. DECORTICATION (thorascopy) - to remove restrictive layer of fibrous tissue, if long standing pus/thickened pleura
36
What is meant by transfer factor?
Aka - diffusing capacity Result of a gas transfer test that measures how the lungs take up oxygen Capacity to transfer gas from alveolar spaces into the alveolar capillary blood
37
Relevance of PaCO2 in acute asthma exacerbation
You would expect a low PaCO2 as the patient is hyperventilating A normal or raised PaCO2 indicates the patient is tiring, and this suggests asthma is life-threatening
38
Serious side effect of salbutamol
Hypokalaemia - salbutamol drive potassium into cells
39
Features suggesting steroid responsiveness in COPD
Previous diagnosis of asthma Higher blood eosinophil count Substantial variation in FEV1 over time (> 400ml) Substantial diurnal variation in peak expiratory flow (> 20%)
40
What is the relevance of the FEV1 / FVC ratio
Forced expiratory volume in the first second / the forced vital capacity of the lung Normal = > 80 (age dependent) <70 suggests airflow limitation (obstructive) Normal/High suggests restrictive lung disease
41
Signs of COPD on CXR
Hyperinflation Flat diaphragms Decreased peripheral markings
42
What is COR PULMONALE ?
Abnormal enlargement (hypertrophy or dilation) of the right side of the heart as a result of lung disease or pulmonary vessel disease
43
Methods of smoking cessation
1. Nicotine replacement 2. Varenicline (nicotine receptor partial agonist) 3. Bupropion (noradrenaline/dopamine reuptake inhibitor) 4. E-cigs
44
Mucolytic medication used in COPD
Carbocisteine R/v in 4 weeks - if not benefit stop Used for chronic productive cough
45
Vaccinations needed in COPD patients
Pneumococcal Flu vaccine
46
What is in a “COPD rescue pack”
STEROIDS - Prednisolone ANTIBIOTICS
47
MRC Dyspnoea Scale
1 = only SOB on strenuous exercise 2 = SOB if hurrying / walking up hill 3 = SOB on flat 4 = Stops for breath after 100m 5 = SOB on dressing
48
Contraindications to chest drain insertion
INR > 1.3 Platelet count <75 Pulmonary Bullae Pleural adhesions
49
Most common organism isolated form patients with bronchiectasis
Haemophilus influenzae
50
What condition has “signet ring” sign on CT?
Bronchiectasis Dilated bronchus and accompanying pulmonary artery
51
Most common causes of an anterior mediastinum mass (4)
4 Ts Teratoma Thymic mass Thyroid mass Terrible Lymphadenopathy
52
TB drugs
RIPE Rifampicin Isoniazid Pyrazinamide Ethanbutol
53
Important SE of Rifampicin
Hepatitis Orange urine and tears Enzyme inducer (e.g. OCP)
54
Important SE of Isoniazid
Hepatitis Neuropathy Enzyme inducer (e.g. COCP)
55
Important SE of Pyrazinamide
Hepatitis Arthralgia
56
Important SE of Ethambutol
Optic neuritis (starts with loss of colour vision)
57
How long does sputum culture and microscopy take for TB
6 weeks
58
What is a Ghon focus and where is it found?
Radiologically detectable finding characteristic of primary TB = caseating granuloma (tuberculoma) predominantly in the upper part of the lower lobe and lower part of the middle or upper lobe
59
Most common organism causing COPD exacerbation
Haemophilus influenzae
60
Treatment of community aquired pneumonia following influenza infection
Flucloxacillin + amoxicillin - this is because Straph aureus is common cause of CAP after influenza infection
61
When to admit someone with a pneumothorax
Primary pneumothorax and >2cm or <2cm and patient SOB Secondary pneumothorax - All patients should be admitted for at least 24 hours (even if <1cm)

FINALS (19 decks)

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