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Year 4 PT > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the first line diagnostic test for a PE?

A

CTPA (V/Q scan if renal impairment or pregnant) then a D-dimer

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2
Q

What is the first line antibiotic for pneumonia?

A

low CURB score (0/1) = Amoxicillin BUT if allergic to penicillin then give doxycycline

moderate CURB (1/2) = amoxicillin and clarithromycin

high CURB (3/4/5) = coamoxiclav and clarithromycin

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3
Q

What does an antigenic shift cause?

A

Pandemic
SHIFT->SHIT-> what the pandemic is

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4
Q

What is the ginkgo leaf’ sign?

A

If the anterior chest wall is affected air can outline the pectoralis major muscle on x-ray.

caused by subcutaneous (surgical) emphysema which is a known complication of laparoscopic surgery.

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5
Q

What is the most likely cause of effusion in someone who used to work with asbestos and what is seen on a chest CT?

A

mesothelioma

pulmonary LOWER ZONE FIBROSIS is seen on CT

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6
Q

What is the treatment for acute asthma?

A
  1. inhalers- nebulized salbutamol (SABA) USE A SPACER IN CHILDREN
  2. nebulized ipratropium bromide (M3 antagonist- SAMA)
  3. predisolone - steroids
  4. if these don’t work then IV magnesium sulphate
  5. IV aminophylline
  6. intubation and ventilation
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7
Q

What is the difference between a pneumothorax and a pulmonary embolism (PE)?

A

PE = blood clot in the lung that could have travelled from anywhere in the body

pneumothorax = collapsed lung due to air trapped inbetween the lungs and chest cavity –> tracheal deviation away from injury side –> needle in to remove air

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8
Q

What conditions cause the trachea to remain central?

A

My Carla Hates Olives

mesothelioma
consolidation
haemothorax
oedema

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9
Q

What does TB look like on a chest x-ray?

A

-advanced stage is mostly in the upper and posterior areas of the lungs
-consolidation
-tree-in-bud appearance (looks like branches coming off a tree)

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10
Q

What is subcutaneous emphysema?

A

air trapped underneath the skin mostly in the face, chest and neck

caused by many things e.g. infection, surgery, pneumothorax

symptoms: swelling, crepitus when touching area, difficulty swallowing/breathing

management: oxygen, chest drain/infraclavicular blow holes

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11
Q

What is hypersensitivity pneumonitis?

A

an immune system disorder in which your lungs become inflamed as an allergic reaction to inhaled microorganisms, plant and animal proteins or chemicals e.g. Bird fancier’s lung (birds as pets), farmer’s lung (hay/straw) etc.

can sometimes lead to Pigeon Chest (pectus carinatum)

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12
Q

What is the long-term management for COPD?

A

-smoking cessation: offering nicotine replacement therapy
-annual influenza vaccination
-one-off pneumococcal vaccination
-pulmonary rehab

-SABA or SAMA if have asthma and symptoms continue add to ^:
1) LABA + ICS
2) LABA + ICS + LAMA
3) if already taking a SAMA, discontinue and switch to a SABA

if NO asthma and symptoms continue add to^
1) LABA + LAMA
2) if already taking a SAMA, discontinue and switch to a SABA

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13
Q

What is acute bronchitis?

A

cough: may or may not be productive
sore throat
rhinorrhoea
wheeze

Sputum, wheeze, breathlessness and fever may be absent in acute bronchitis whereas at least one tends to be present in pneumonia

treatment –> doxycycline

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14
Q

How do you pharmacologically manage breathlessness in advanced disease?

A

Opioids
benzos
oxygen (less than 91%)

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15
Q

What is the treatment for a pneumothorax?

A

If asymptomatic:
Conservative care regardless of size and reviewed every 2-4 days

If symptomatic:
-High risk = chest drain
-low risk = conservative (reviewed every 2-4 days. If secondary pneumothorax then admit or if stable review in 2-4 weeks), needle aspiration or ambulatory care = patient choice

High risk = tension, hypoxia, bilateral, underlying lung disease, >50 and smokes, haemopneumothorax

If it’s a TENSION pneumothorax (deviated trachea) –> urgent needle aspiration —> DO NOT wait for an x-ray

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16
Q

What are the main types of lung cancer and what are the differences between them?

A

Squamous cell cancer:
typically central
hypercalcaemia —> dry mucous membranes
finger clubbing
HPOA- painful arthropathy of wrists, ankles and knees

Adenocarcinoma:
typically peripheral
gynaecomastia
most common type of lung cancer in non-smokers, although the majority of patients who develop lung adenocarcinoma are smokers

Large cell lung carcinoma:
typically peripheral
anaplastic, poorly differentiated tumours with a poor prognosis
may secrete β-hCG

small cell:
central
associated with Cushing’s, hyponatraemia and Lambert-Eaton syndrome

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17
Q

What prophylactic abx do you give to COPD patients?

A

azithromycin prophylaxis

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18
Q

What scoring system is used for pneumonia?

A

CURB-65

U = urea thats why it is so important to run U+E tests when someone with suspected pneumonia comes in confused
urea - more than 7

resp rate more than 30

blood pressure systolic less than 90 or diastolic less than 60

65 - over 65

only give abx if CRP > 100

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19
Q

What is sarcoidosis?

A

RESTRICTIVE lung condition common in young adults and in people of African descent

-erythema nodosum, arthritis, bilateral hilar lymphadenopathy (seen in chest x-ray), swinging fever
-dyspnoea, non-productive cough, malaise, weight loss
-lupus pernio: reddish-purple plaques and nodules on the nose, cheeks, lips, ears
-hypercalcaemia

give steroids if have hypercalcaemia or stage 2/3 disease

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20
Q

What would the diagnosis of a young person, who is a non-smoker, presenting with COPD (shortness of breath, persistent chesty cough with phlegm that does not go away, frequent chest infections, persistent wheezing) and how do you treat it?

A

Alpha-1 antitrypsin (A1AT) deficiency–> bronchodilators, physio, lung volume REDUCTION/lung transplant surgery

Can be diagnosed prenatally

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21
Q

What are the common causes of these types of pneumonia:
strep
haemophilus
staph
mycoplasma
legionella
klebsiella
Pneumocystis jiroveci?

A

strep = most common, cold sores

haemophilus = seen in COPD

staph = seen after an influenza infection

mycoplasma = dry cough, erythema multiforme/nodosum

legionella = Hyponatraemia and lymphopenia common, classically seen secondary to infected air conditioning units

klebsiella = alcoholics, red jelly

Pneumocystis jiroveci = dry cough and HIV

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22
Q

What could the malignancy of pleura suggest?

A

related to asbestos –> mesothelioma

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23
Q

How do you work out metabolic/resp acidosis/alkalosis?

A

-pH and CO2 levels first
-SMOR
-look at the HCO3
- if this is in normal ranges then there is only the one problem. If it is not normal, then there will be metabolic acidosis/alkalosis depending on the level of HCO3 (low is acidosis)
-is there type 1/2 Resp failure: low oxygen type 1, low oxygen and high carbon dioxide type 2

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24
Q

How do prevent and treat altitude-related disorders?

A

prevent = acetazolamide

treat = oxygen, descent, dexamethasone

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25
Q

What can be seen on a chest x-ray that is suggestive of pleural effusion/pulmonary oedema?

A

bat’s wing appearance

Kerley B lines

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26
Q

How do you manage asthma long term for adults and children?

A

1) SABA
2) SABA + ICS
3) SABA + ICS + leukotriene receptor antagonist (LTRA)
4) SABA + ICS + LABA

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27
Q

Where, anatomically, is a chest drain inserted?

A

mid axillary line of the 5th intercostal space

above the rib

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28
Q

On a chest x-ray if there are multiple large, round, well circumscribed masses in both lung, what diagnosis are you thinking?

A

renal cell carcinoma that has metastasised to the lungs causing ‘cannonball mets’

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29
Q

When can you refer COPD patients to pulmonary rehab?

A

when they have a breathlessness scale of 3 or more

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30
Q

What is shown in the X-ray?

A

Pleural plaques - a normal finding - no follow up needed

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31
Q

How can you tell the difference between severe and life-threatening asthma?

A

severe = can’t complete sentences, PEFR 33-50%

life-threatening = confusion, PEFR<33%

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32
Q

How would you treat an acute exacerbation of COPD?

A

-increase the frequency of bronchodilator use and consider giving via a nebuliser
-give prednisolone 30 mg daily for 5 days
-amoxicillin or clarithromycin or doxycycline ONLY if sputum of pneumonia signs
-NIV or BIPAP

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33
Q

Can people with asthma take ibuprofen?

A

yes, but with caution.

try not to

34
Q

What is the management for snoring?

A

weight loss
CPAP
DVLA must be informed if causing excessive daytime sleepiness

35
Q

What abx is used to treat hospital acquired penumonia?

A

non-severe = oral co-amoxiclav

severe (sepsis) = IV tazocin

36
Q

What do ALL cases of pneumonia need to have?

A

a repeat chest x-ray at 6 weeks after clinical resolution

37
Q

What is obstructive sleep apnoea/hypopnoea syndrome?

A
  • Loud snoring.* Episodes in which you stop breathing during sleep — which would be reported by another person/partner
  • Gasping for air during sleep
  • Awakening with a dry mouth
  • Morning headache
  • Difficulty staying asleep, known as insomnia
  • Excessive daytime sleepiness, known as hypersomnia

sleep studies (polysomnography)

38
Q

What is seen and how do you treat idiopathic pulmonary fibrosis?

A

bibasal fine end-inspiratory creps
dry cough

high resolution CT

–> pulmonary rehab

39
Q

What results from a pleural aspiration would suggest an exudate, such as cancer?

A

fluid protein/serum protein ratio is >0.5O

protein level >30g/l

40
Q

How can you tell the difference between bronchitis and pneumonia?

A

mostly the same symptoms apart from:

pneumonia = muscle aches and fatigue

bronchitis = wheeze

41
Q

What is the treatment for pleural effusion?

A

ultrasound and aspirate

remember to check trachea for any deviation as might be penumoectomy/lung collapse

42
Q

What is the scoring system for suspected obstructive sleep apnoea?

A

Epworth

43
Q

How do you manage persistent air leak or recurrent pneumothorax?

A

refer for video-assisted thoracoscopic surgery (VATS)

44
Q

If an adult (includes pregnant woman) cannot manage asthma with a SABA, what should be done?

A

add a low dose inhaled corticosteroid

45
Q

What are the signs of bronchiectasis and the management?

A

Most commonly caused by haemophilus influenzae

persistent productive cough
dyspnoea
haemoptysis
clubbing
wheeze and coarse crackles

CT scan

physical training
postural drainage
abx for exacerbations

46
Q

What is the difference between CPAP and BiPAP/NIV?

A

CPAP = sleep apnoea, type 1 resp failure, pneumonia

BiPAP/NIV = type 2 resp failure, COPD exacerbation

47
Q

What causes mediastinal widening on an chest x-ray?

A

most likely thoracic aortic aneurysm, however if the patient is younger, such as 30, it could be lymphoma

48
Q

What are the medication options for smoking cessation if CBT does not work?

A

NRT e.g. patches, gum
-nausea, vomiting, headaches

OR

Varenicline:
-nicotinic receptor agonist
-12 weeks and should be started one week before stop date
-nausea
-caution in depressed/self-harm patients
-cannot give in pregnancy/breast feeding

OR

Bupropion:
-norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
-seizures
-caution in eating disorder patients
-cannot give in epilepsy, pregnancy/breast feeding

49
Q

What is alpha-1-antitrypsin deficiency a risk factor for?

A

Hepatocellular carcinoma

50
Q

What situations should oxygen therapy NOT be used only if there’s NO evidence of hypoxia?

A

MI
Stroke
Obstetric emergencies
anxiety related hyperventilation

51
Q

What conditions cause the trachea to be pulled TOWARDS and AWAY from the white out on a chest x-ray?

A

TOWARDS:
-pneumonectomy
-lung collapse
-hypoplasia

AWAY:
-effusion
-hernia
-thoracic mass

52
Q

How do you diagnose asthma?

A

-rule out occupational asthma
-bronchodilator reversibility test
-FeNO test (even if above is negative) (fractional exhaled nitric oxide)

53
Q

How can you tell the difference between tuberculosis, COPD, bronchiectasis, lung abscess, and idiopathic, pulmonary fibrosis (IPF)?

A

TB = productive cough, haemoptysis, night sweats, weight loss

COPD = productive cough, dyspnoea, wheeze, smoking

bronchiectasis = productive cough, wheeze, childhood Resp infections

lung abscess = productive cough, pleuritic chest pain, haemoptysis, weight loss, swinging fever

IPF = clubbing, exertional dyspnoea, dry cough, weight loss, bibasal inspiratory crackles

54
Q

When can you discharge a patient who was admitted for an asthma attack?

A

-been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours

-inhaler technique checked and recorded

-PEF >75% of best or predicted

55
Q

What is Acute respiratory distress syndrome (ARDS)?

A

fluid accumulation in alveoli
- 40% mortality

Causes:
-sepsis, penumonia
-massive blood transfusion
-acute pancreatitis
-trauma
-smoke inhalation

symptoms:
-dyspnoea
-elevated respiratory rate
-bilateral lung crackles
-low oxygen saturations

management:
ITU
prone position
oxygen/ventilation –> treat hypoxia
vasopressors
treatment for underlying cause

56
Q

What lung lobes are most commonly affected by aspiration pneumonia?

A

right middle and lower lobes due to the larger right main bronchus

57
Q

What type of chemicals most commonly cause occupational asthma?

A

isocyanates e.g. spray painting, foam moulding etc

58
Q

What is atelectasis?

A

common POSTOPERATIVE complication leading to respiratory difficulty –> hypoxaemia

management:
-position patient upright
-chest physio

59
Q

What is coal worker’s pneumoconiosis (black lung disease)?

A

occupational lung disease caused by long term exposure to coal

60
Q

What are the main causes of resp/metabolic acidosis/alkalosis?

A

metabolic acidosis = surgery

metabolic alkalosis = vomiting, aspiration, diuretics, hypokalaemia, cushing’s

resp acidosis = COPD, asthma, sedative drugs, NMD, type 2 resp failure!

resp alkalosis = anxiety –> hyperventilation, CNS stroke, pregnancy, PE

61
Q

What is the technique for using inhalers?

A

1.Remove cap and shake
2. Breathe out gently
3. Put mouthpiece in mouth and as you begin to breathe in, which should be slow and deep, press canister down and continue to inhale steadily and deeply
4. Hold breath for 10 seconds, or as long as is comfortable
5. For a second dose wait for approximately 30 seconds before repeating

62
Q

What are the causes of upper and lower zone lung fibrosis?

A

Upper: CHARTS
-coal worker pneumoconiosis
-hypersensitivity pneumonitis
-ankylosing spondylitis
-radiation
-TB
-silicosis
-sarcoidosis

Lower: RASIO
-rheumatoid arthritis
-asbestosis
-SLE, Sjogren’s
-idiopathic pulmonary fibrosis
-Others: drug induced e.g. amiodarone

63
Q

When can you go on a plane and scuba dive again after a pneumothorax?

A

plane = one week post x-ray check (6 weeks after)

scuba diving = permanently avoided

64
Q

Can anaemia present with SOB?

A

Yes.

65
Q

What is total gas transfer (TLCO) or that corrected for lung volume (transfer coefficient, KCO)?

A

rate which gas diffuses from alveoli to blood

raised TLCO:
asthma
pulmonary haemorrhage polycythaemia

lower TLCO:
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia

66
Q

What are the target sats for a patient with COPD?

A

88-92% BUT ….. 94-98% if CO2 is normal on ABG

67
Q

When can you not put in a chest drain?

A

INR > 1.3 or a platelet count < 75

68
Q

What is Kartagener’s syndrome?

A

dextrocardia/situs inversus with bronchiectasis
subfertility
left testicle hangs lower than the right

69
Q

Can you continue taking steroids for asthma if you’re pregnant/breastfeeding?

A

Yes

70
Q

What is the next step in a pneumothorax if the needle aspiration is unsuccessful?

A

Chest drain and follow up in clinic in 2-4 weeks when removed

71
Q

What would different FEV1/FVC ratios indicate?

A

> 0.7 restrictive e.g. fibrosis, Asbestosis, Sarcoidosis, Acute respiratory distress syndrome, obesity, neuromuscular disorders

<0.7 obstructive e.g. asthma, COPD, Bronchiectasis, cystic fibrosis

72
Q

What drug can cause lower zone lung fibrosis?

A

amiodarone

73
Q

What are the features of silicosis?

A

Mining and slate workers are at risk of this

-Upper zone, lung disease
-‘egg-shell’ calcification of hilar lymph nodes

74
Q

What is shown in these images and how would you manage them?

A

LEFT: pleural effusion- ultrasound and aspirate

RIGHT: pulmonary oedema- treat underlying cause:
Sit up
Oxygen
Fluid balance
Diuretics - furosemide
CPAP

75
Q

Can you offer long term oxygen therapy to people who currently smoke?

A

No

76
Q

What are the main CT findings of Covid?

A

Ground glass opacities
Consolidation
Bronchovascular thickening

77
Q

What are the main side effects of beta-2-agonists e.g. salbutamol?

A

Tremor in hands
Headaches
Palpitations

78
Q

How do you investigate and treat interstitial lung disease?

A

most common type is idiopathic pulmonary fibrosis
other causes: sarcoidosis, SLE, asbetosis, drug induced (methotrexate), rheumatoid arthritis

-Bilateral fine end-inspiratory creps
-pleural effusion
-Finger clubbing
-Raynaud’s phenomenon
-Arthritis

obs
urine dipstick
lung function: restrictive pattern
FBC, U+Es, CRP
Autoimmune antibodies: anti-CCP suggests rheumatoid arthritis, ANA suggests SLE

chest x-ray
High resolution CT

conservative: smoking cessation, vaccines, pulmonary rehab
medical: depends on the cause
long term oxygen
lung transplant (very severe)

79
Q

What are the indications for long term oxygen?

A

Resting PaO2 ≤ 7.3kPa
Resting PaO2 ≤ 8.0kPa with peripheral oedema

have to be a NON-SMOKER

80
Q

What are the causes of clubbing?

A

Congenital cyanotic heart disease
Infective endocarditis

Bronchiectasis
Squamous cell lung cancer

Cystic fibrosis
Inflammatory bowel disease

81
Q

What are the symptoms of interstitial lung disease?

A

Shortness of breath, especially with activity.
Dry, hacking cough that does not produce phlegm.
Extreme tiredness and weakness.
Loss of appetite.
Unexplained weight loss.

82
Q

What bedside test must you always check in a respiratory station?

A

peak flow and reversibility

Year 4 PT (14 decks)

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