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SAQ for finals > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

Give 4 common triggers of asthma

A

House dust mite
Pollen
Domestic pets
Cold air
Exercise
Emotion
Infection
Cigarette smoke
Drugs e.g. NSAIDs, beta-blockers

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2
Q

What pattern is seen on spirometry in asthmatics?

A

Obstructive pattern (reduced FEV1:FVC ratio)

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3
Q

How can asthma be diagnosed using spirometry?

A

Improvement in FEV1 by >12% following administration of bronchodilator

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4
Q

BTS/NICE guidelines for chronic asthma management

A

Step 1: SABA e.g. salbutamol
Step 2: add low-dose ICS e.g. beclometasone
Step 3: discontinue SABA, start MART e.g. beclometasone with formoterol
Step 4: trial LTRA e.g. monteleukast

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5
Q

Excluding asthma, give 2 atopic conditions

A

Eczema
Hayfever
Food allergies
Contact dermatitis

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6
Q

Specifically how does salbutamol improve symptoms in asthmatics?

A

Stimulates beta 2 receptors of respiratory tract, which activates sympathetic activity and relaxes bronchial smooth muscle

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7
Q

Pack year equation

A

No of cigarettes a day x number of years smoking / 20

1 pack year = 20 cigarettes / day for 1 year

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8
Q

Spirometry pattern in COPD

A

Obstructive (reduced FEV1:FVC <70%) with no significant response to reversibility testing

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9
Q

Physiological measurement used to determine severity of COPD

mild:
moderate:
severe:
very severe:

A

FEV1 of predicted

Mild: > 80%
Moderate: 50-79%
Severe: 30-49%
Very severe: <30%

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10
Q

What implications a T2RF ABG result have on oxygen therapy and why?

A

CO2 retention requires controlled oxygen therapy via 28% venturi mask aiming for 88-92% as risk of losing hypoxic drive

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11
Q

Other than oxygen, give 4 aspects of your management plan of infective exacerbation of COPD

A

SARS:

Salbutamol/ipratropium nebs
Antibiotics (amoxicillin, clarithromycin, doxycycline)
Respiratory physiotherapy
NIV (severe)
Steroids (prednisolone 30mg OD for 5 dasy)

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12
Q

Who is long term oxygen therapy not appropriate for?

A

Patients who will continue to smoke

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13
Q

Give 2 signs of lung consolidation on examination

A

Reduced chest expansion
Dull percussion note
Increased tactile vocal fremitus
Increased vocal resonance
Bronchial breathing

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14
Q

Excluding bloods, give 2 further tests for CAP

A

Sputum culture
CXR
ABG
Urine pneumococcal antigen

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15
Q

CURB-65 score components

A

Confusion (AMT score)
Urea (>7, in-patient bloods)
Respiratory rate (>30)
Blood pressure (<90 s, <60 d)
>65 years old

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16
Q

3 most likely organisms to cause CAP

A

Streptococcus pneumoniae (most common cause)
H. influenzae
Mycoplasma pneumoniae

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17
Q

What score of CURB-65 needs hospital admission

A

> 1: outpatient treatment
2: consider inpatient or outpatient with close follow-up
3: urgent inpatient admission

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18
Q

Give 2 possible complications of pneumonia

A

SEALED

Sepsis
Empyema
ARDS
Lung abscess
Effusion (pleural)
Death

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19
Q

Give 2 reasons why cases of TB may be on the rise

A

Multidrug resistance
Use of immunosuppressive drugs
Increased emigration from areas of high prevalence
Poor socioeconomic conditions and overcrowding

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20
Q

Antibiotics for TB and duration

A

6 months:
Rifampicin
Isoniazid

2 months:
Pyrazinamide
Ethambutamol

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21
Q

Why are 4 antibiotics used in TB

A

To combat multidrug resistance

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22
Q

TB antibiotic SEs

A

Rifampicin - red urine
Isoniazid - peripheral neuropathy
Pyrozinomide - gout
Ethambutamol - optic neuritis

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23
Q

Painful, purple nodules on shin in TB patient

A

Erythema nodosum

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24
Q

Name 2 other causes of erythema nodosum other than TB

A

Crohn’s disease
Ulcerative colitis
Sarcoidosis
Drugs (COCP)
Streptococcal infection

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25
What is bronchiectasis
Chronic infection of the large airways causing their abnormal, permanent dilation
26
Give 2 organisms that commonly colonise the lungs of those with CF
Strep pneumoniae H. influenzae P. aeruginosa Burkholderia cepacia
27
Give 3 causes of bronchiectasis, other than CF
Post-infective e.g. pneumonia, TB, whooping cough Alpha 1 antitrypsin deficiency Yellow nail syndrome Rheumatoid arthritis Idiopathic
28
Give 2 complications of bronchiectasis
Pneumonia Septicaemia Respiratory failure Cor pulmonale
29
Give 2 risk factors for pulmonary embolism
*Virchow's triad:* 1. Vessel damage (surgery) 2. Stagnation (immobility, long haul travel) 3. Hypercoagulability (thrombophilia, cancer, pregnancy, COCP, polycythaemia, SLE)
30
normal pH normal CO2 low O2 What abnormality is seen on this ABG?
T1RF
31
What underlying mechanism is responsible for T1RF in a PE
V/Q mismatch: the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lung tissue
32
Name 2 investigations for pulmonary embolism diagnosis
CTPA (1st line) VQ scan (e.g. renal impairment)
33
Warfarin target INR range for long term treatment after PE
2-3
34
Length of treatment for PE where cause is unclear, recurrent VTE, irreversible cause e.g. thrombophilia
Beyond 3 months i.e. indefinitely
35
2 measures to take to reduce risk of DVT/PE in high risk patients in hospital
Prophylactic LMWH SC day before surgery and post-orthopaedic procedures Anti-embolic compression stockings
36
Other than a non-resolving LRTI/pneumonia, give 4 symptoms someone with lung cancer may present with
Cough Haemoptysis Chest pain Dyspnoea Hoarse voice Weight loss Anorexia Horner's syndrome
37
Give 3 sites that lung cancers are most likely to metastasise to
Brain Bone Liver Lung (other sites)
38
Other than CXR, name 2 imaging modalities that may be used to determine the extent of lung cancer
Staging CT scan of chest and abdomen PET-CT scan Bronchoscopy (unless peripheral lesion) Isotope bone scan
39
What staging system is used for squamous cell carcinoma of the lung?
TNM
40
SVCO 4 signs and symptoms
Breathlessness Headache Distended neck/chest veins Lymphadenopathy Facial plethora Cyanosis
41
Clinical test for SVCO
Pemberton manoeuvre (lift both arms until they touch the side of the face, a positive test is presence of facial congestion, cyanosis, respiratory distress after ~1 min)
42
2 abnormalities on HRCT of idiopathic pulmonary fibrosis
Honeycombing Traction bronchiectasis Reticular opacities
43
Spirometry in IPF: FVC FEV1 FEV1:FVC
Restrictive picture: FVC decreased FEV1 decreased FEV1/FVC increased or normal
44
Name 2 causes of hypersensitivity pneumonitis
Bird-fancier’s lung (bird droppings) Farmer’s lung (mouldy spores in hay) Mushroom worker’s lung (specific mushroom antigens) Malt worker’s lung (mould on barley)
45
Name 2 non-respiratory causes of pulmonary fibrosis
Systemic sclerosis Rheumatoid arthritis Drugs e.g. methotrexate, nitrofurantoin SLE
46
Other than pulmonary fibrosis, give 2 other respiratory causes of clubbing
Lung cancer Mesothelioma Bronchiectasis
47
Obstructive sleep apnoea questionnaire
Epworth sleepiness scale
48
Other than obesity, give 2 risk factors for obstructive sleep apnoea
Acromegaly Enlarged tonsils Nasal polyps Alcohol
49
How is obstructive sleep apnoea diagnosed
In-patient sleep study
50
Give 2 aspects of obstructive sleep apnoea management
Weight loss Avoid alcohol Sleep upright CPAP Surgery (e.g. adenoidectomy)
51
What is Cor Pulmonale
Right-sided heart failure secondary to chronic pulmonary HTN (most commonly caused by left-sided heart failure)
52
1 abnormality on CXR of cor pulmonale
Dilation of RA and RV Hypertrophic RV Dilated pulmonary artery
53
1 abnormality on ECG of cor pulmonale
Right axis deviation
54
Other than sarcoidosis, give 2 possible causes of bilateral hilar lymphadenopathy
Lymphoma Lung cancer TB Hypersensitivity pneumonitis
55
Transbronchial biopsy finding in sarcoidosis
Non-caseating granulomas with epithelioid cells
56
4 extrapulmonary manifestations of sarcoidosis
Erythema nodosum Anterior uveitis Optic neuritis BBB Interstitial nephritis Kidney stones
57
2 pieces of advice before starting long term steroids
Carry a steroid safety card Double hydrocortisone during illness Never miss a scheduled dose Do not stop suddenly
58
6 side effects of long term steroids
Hyperglycaemia Fat distribution (central obesity, buffalo hump, moon face) Skin (bruising, skin thinning) MSK (muscle wasting, osteoporosis) Hypertension Increased susceptibility to infection
59
2 signs of pleural effusion on examination of the chest
Reduced chest expansion Dull percussion Reduced breath sounds Tracheal deviation away from effusion (if large)
60
Where should you insert the needle of a pleural tap (above or below rib)
Directly above the rib to avoid neurovascular bundle immediately beneath the rib
61
High protein content (>30d/L) - exudate or transudate
Exudate 'dry' pleural effusion pushing out liquid e.g. cancer, pneumonia, TB
62
Causes of transudate pleural effusion
'wet' pleural effusion crossing the membrane (TRANSmembrane) e.g. heart failure, hypoalbuminaemia
63
Name 2 other tests you would perform on pleural fluid other than protein content and LDH
MC&S Glucose
64
1st line test in asthma diagnosis
Blood eosinophils or FeNO
65
Reason for repeat CXR 6 weeks after pneumonia regardless of symptoms
Ensure the infection has resolved Rule out underlying lung malignancy
66
Name 2 features you would assess for in your history and examination that would be suspicious for potential smoke inhalation
Burning sensation in the nose / throat Hoarse voice Accessory muscle usage Tachypnoea Cyanosis Headache
67
What effect does carbon monoxide have on the oxyhaemoglobin dissociation curve and how does this cause symptoms of carbon monoxide poisoning?
inadequate oxygenation to brain because oxygen held tightly to Hb (CO has greater affinity for Hb) → shift to the left → reduced oxygen release to tissues → headaches / confusion / decreased consciousness
68
Name one difference between stridor and wheeze
Stridor is heard mainly during inspiration, wheeze mainly during expiration Stridor is caused by obstruction or narrowing of upper airway / larynx / trachea, wheeze is caused by obstruction or narrowing of lower airway Stridor occurs due to croup, epiglottitis, foreign body aspiration, laryngeal oedema, wheeze occurs due to asthma, bronchitis, COPD, infections
69
Name the hypersensitivity reaction occurring during anaphylaxis and describe it
Type 1 hypersensitivity reaction IgE stimulates mast cell histamine release
70
Position to counteract hypotension in anaphylaxis
Supine with legs raised
71
How long after first dose can second dose of adrenaline be given in anaphylaxis
5 minutes
72
Next steps in management in refractory anaphylaxis (no improvement after 2 adrenaline doses)
Seek senior support / 2222 Give high-flow oxygen Establish IV/IO access Enact refractory anaphylaxis algorithm Rapid IV 0.9% fluid resuscitation IV adrenaline infusion (by senior)
73
Blood test after stabilisation of anaphylaxis
Serum mast cell tryptase
74
3 clinical signs on resp exam of pneumothorax
Increased resonance Decreased breath sounds Unequal chest expansion
75
Clinical signs that would alert you to a tension pneumothorax
Worsening breathlessness/distress Tracheal deviation Tachycardia Hypotension Distended neck veins
76
Triangle of safety for chest drain
Pectoralis major Latissimus dorsi 5th intercostal space
77
4 key factors to grade severity of acute exacerbation of asthma
Mental Status / Signs of Confusion Signs of Exhaustion HR RR Oxygen saturations / SpO2 Peak expiratory flow rate / PEFR
78
Classification of asthma attack
PEFR >50% moderate >33% severe <33% life threatening
79
Life threatening acute asthma indications
Peak flow < 33% best or predicted Arterial oxygen saturation (SpO2) < 92% Partial arterial pressure of oxygen (PaO2) < 8 kPa Normal partial arterial pressure of carbon dioxide (PaCO2) (4.6–6.0 kPa) Silent chest Cyanosis
80
Components of Well's score for PE
Clinical signs and symptoms PE is #1 diagnosis HR >100 Immobilisation 3 days or surgery in prev 4 weeks Previously diagnosed Haemoptysis Malignancy within 6 mo
81
Thrombus at bifurcation of pulmonary artery
Saddle PE
82
One immediate treatment of hyponatraemia and alternative oral medication to maintain normal sodium
Fluid restriction Tolvaptan
83
Most precise way to monitor progress after furosemide
Urinary catheterisation to monitor urine output
84
Name 3 cardiac causes of acute left ventricular failure / pulmonary oedema
Post myocardial infarction (look for Q waves on ECG) Valvular disease Arrhythmias e.g. heart block
85
Which non-invasive test can establish cause of pulmonary oedema
Echocardiogram - left ventricular ejection fraction
86
2 medications to improve prognosis of HF
ACEi Beta blocker
87
Give 2 indications for considering ICU admission in a deteriorating ward pt with pneumonia
Severe pneumonia (CURB65 3-5) + serious co-morbidities Respiratory or metabolic acidosis - Arterial blood pH <7.26 Hypotension PaO2 <8 despite inspired O2 > 60% PaCO2 >6.5 or progressive hypercapnia on serial ABGs indicating respiratory failure
88
What further test could help confirm the diagnosis of exudative pleural effusion
CT guided biopsy

SAQ for finals (20 decks)

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