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Rhi’s MSRA > Respiratory > Flashcards

Respiratory Flashcards

(61 cards)

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1
Q

What does a FEV1/FVC ratio <70% imply?

A

OBSTRUCTIVE disease
(Slowing of exploratory flow, so FEV1 is lower, so FEV1/FVC ratio is lowered)

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2
Q

What does spirometry show for a restrictive airway disease?

A

FEV1 and FVC are both low but IN PROPORTION
Therefore FEV1/FVC ratio remains normal (>75%)

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3
Q

What causes hyper resonant percussion?

A

Pneumothorax
Emphysema

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4
Q

Most common lung injury following blunt chest trauma?

A

Pulmonary contusion

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5
Q

How many ribs can you count if hyperinflated CXR?

A

> 6 anterior OR
10 posterior

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6
Q

Most common examples of:
-Transudative effusion?
-Exudative effusions?

A

Transudative:
-heart failure
-cirrhosis
-hypoalbuminaemia
-peritoneal dialysis

Exudative
-pneumonia
-malignancy

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7
Q

LIGHT criteria for exudative effusion?

A

-pleural fluid to serum protein ratio >0.5
-pleural fluid to serum LDH ratio >0.6
-pleural fluid LDH concentration >2/3 upper limit of normal for serum LDH

If 1 or more criteria met = exudative

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8
Q

Bird fancier with fever, malaise, cough. Mild hepatomegaly.
Dx and causative organism?

A

Psittacosis
Chlamydia psittaci

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9
Q

Symptoms of carbon monoxide toxicity?

A

Headache
Vertigo
N&V
Altered consciousness
Subjective weakness
confusion
Cardiac - tachyarrhythmias
Neurologic deficits
Cherry red skin colour

NB does NOT cause cyanosis

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10
Q

Triad of Goodpasture’s syndrome
Who typically gets it?

A

G = glomerulonephritis, anti Gbm

-diffuse pulmonary haemorrhage
-glomerulonephritis
-anti-glomerular basement membrane (anti-GBM) antibodies

Usually young men! (‘Good looking young men!)

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11
Q

Where to perform needle thoracocentesis for tension pneumothorax?

A

2nd intercostal space, mid-clavicular line

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12
Q

What are the characteristic cells of Hodgkin’s lymphoma?

A

Reed-Sternberg cells

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13
Q

Alcohol-induced pain at sites of nodal disease is specific for what disease?

A

Hodgkin’s disease

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14
Q

Staging system for Hodgkin’s?

A

ANN ARBOR

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15
Q

50 y/o with myasthenia gravis has mass on CXR behind sternum. Dx?

A

Thymoma

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16
Q

Only thing parents can do to reduce child’s risk of asthma?

A

BREAST FEED!

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17
Q

First choice antibiotics options for IECOPD (no allergies) 3 options

A

Amoxicillin
Doxycycline
Clarithromycin

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18
Q

Younger patient with chronic cough, excess sputum production and repeated infections.
Dx?

A

Bronchiectasis

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19
Q

25 y/o, hyperventilating, nausea, tinnitus. Dx?

A

Salicylate poisoning!

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20
Q

MRC scale for SOB Grades 1-5 are?

A

1 - no SOB except strenuous exercise
2 - SOB when walking up slight hill or hurrying on a level
3 - walk slower than contemporaries, or stop for breath when walking own pace
4 - stops for breath after walking 100m or after few mins on level ground
5 - too SOB to leave house, or SOB when dressing & undressing

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21
Q

Common organisms of HAP?

A

Strep pneumoniae
Haemophilus influenzae
Pseudomonas aeruginosa

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22
Q

Characteristic CXR finding for sarcoidosis?

A

Bilateral hilar lymphadenopathy

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23
Q

What test to confirm diagnosed of COPD?

A

POST-bronchodilator spirometry

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24
Q

Suspected asthma- what is the initial most appropriate management plan?

A

Trial of short acting B2 agonist and inhaled corticosteroid

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25
White coating on tongue from inhaler steroid. Bleeds when scraped off. Cause?
Candida Albicans
26
Lobar pattern of infection and Rust coloured sputum. Organism causing pneumonia?
Streptococcus pneumoniae
27
Site for chest drain?
5th intercostal space, mid-axillary line
28
Which cancer are you most at risk of developing with asbestosis?
LUNG cancer
29
Chronic cough, excess petulant sputum and repeated chest infections - Dx?
Tried for BRONCHIECTASIS!
30
First drug choice for HAP?
Co-amoxiclav (Augmentin) 500/125mg TDS
31
Best method for biopsy of suspected lung cancer?
Bronchoscopy and biopsy
32
Retired miner with SOB. CXR shows upper lobe nodules and CT shows ‘eggshell’ calcification of lymph nodes. Dx?
Silicosis
33
In asthma, what happens to FEV1 FVC FEV1/FVC
Obstructive- both FEV1 disproportionately reduced, therefore FEV1/FVC ratio decreased
34
Type of cancer that can cause flushing?
Carcinoid tumour
35
Post-op patient, pyrexial, tachypnoeic, reduced breath sounds bibasally. Dx?
Postoperative basal atelectasis
36
Which lung cancer is most associated with hypercalcaemia?
Squamous cell carcinoma
37
Painful cheek lesions after BCG vaccine at school, Dx?
Lupus vulgaris
38
30 y/o Afro-Caribbean pt with cough and ‘BL hilar lymphadenopathy’ Dx?
Sarcoidosis (Commonest in black women aged 20-40)
39
Retired miner, with ‘multiple nodules of varying sizes throughout lung fields’ Dx?
Caplan’s syndrome (Pulmonary fibrosis, usually in coal miners who have rheumatoid arthritis!)
40
Examples of atypical pneumonia causative organisms?
Mycoplasma pneumoniae Chlamydia pneumoniae Legionella pneumoniae Common in young adults living in close proximity ie uni students !
41
Common causative organisms for HAP / ventilation-associated pneumonia?
Pseudomonas aeruginosa E. coli
42
1st line treatment for COPD?
SABA ie salbutamol or SAMA ie ipratropium
43
2nd line of treatment for COPD if still symptomatic with SABA/SAMA -if not asthmatic features -if asthmatic features
If NO asthmatic features - LABA ie formeterol & LAMA ie tiotropium If asthmatic features - LABA ie salmeterol & ICS ie fluticasone
44
Patient with small cell lung carcinoma, has weakness in proximal arms which improves with exercise. Absent reflexes in upper limbs. Dx?
Lambert-Eaton syndrome! (Due to abnormality in acetylcholine release) ‘Improves with eating’ = Lambort-Eaten!
45
Differences between sarcoidosis and idiopathic pulmonary fibrosis on CXR?
Sarcoidosis - bilateral pulmonary infiltrates - predominantly UPPER lobes IPF - bibasal, reticular shadowing
46
What syndrome can a Pancoast’s tumour lead to and what are the symptoms?
Pancoast’s tumour = apical lung neoplasm Invades surrounding tissues - ipsilateral invasion of cervical sympathetic plexus - HORNER’s syndrome - miosis, enopthalmos, ptosis May get brachial plexus invasion - shoulder/arm pain, wasting of intrinsic hand muscles, paraesthesia More rarely - recurrent laryngeal nerve palsy - hoarse voice
47
First line treatment for COPD?
SABA ie Salbutamol Or SAMA ie Ipratropium bromide
48
First line treatment for COPD?
SABA ie Salbutamol Or SAMA ie Ipratropium bromide
49
2nd line treatment for COPD after SABA/SAMA if still getting symptoms
-If NO FEATURES OF ASTHMA: LABA (ie Salmeterol/formeterol) + LAMA (ie Tiotropium) If FEATURES OF ASTHMA: LABA + ICS
50
2 scores for sleep apnoea
Epworth sleepiness scale And STOP-Bang questionnaire
51
Causes of respiratory alkalosis
4 Ps! Panic attack Pain PE Pneumothorax
52
Causes of respiratory acidosis?
Hypoventilation, secondary to: -resistance from obstruction ie COPD -reduced compliance ie obesity, rib #s, pneumonia -reduced strength of Resp muscles ie MND, Guillain-Barré -Drugs that reduce respiratory drive ie opiates
53
Causes of metabolic acidosis with: -high anion gap? -normal anion gap? Anion gap formula ?
High anion gap (usually due to increased production or reduced extraction of H+): -DKA -Lactic acidosis -Aspirin overdose -Renal failure Normal anion gap (normally due to loss of HCO3- which is replaced by Cl): -GI loss is diarrhoea/ileostomy -Renal tubular disease -Addison’s disease Anion gap formula = (Na + K) - (Cl + HCO3)
54
Causes of metabolic alkalosis?
-GI loss ie vomiting -Renal loss of H+ ions, ie diuretics, heart failure, nephrotic syndrome, cirrhosis
55
When (in terms of how much patience is using their SABA) should you go up a stage of the asthma treatment?
If using more than 3 doses of SABA per week
56
Steps of asthma treatment
1) as needed SABA 2) Add low-dose ICS 3) Add LABA (fixed dose or MART) 4) Add LRTA or increase ICS
57
Most common inherited disease in white populations?
Cystic fibrosis !
58
What happens to sweat in CF?
High SODIUM
59
Difference in mechanism between type 1 and type IV reactions? Examples?
1 (IgE) rapid within 30 mins ie atopic disorders, allergies to pollen Type 4 - (lymphocytes) secondary cellular response , ‘ 48-72 hours after exposure or allergic contact dermatitis
60
First line tx for ADHD in children?
Methylphenidate
61
Triad of symptoms in ADHD?
Inattention Hyperactivity Impulsivity

Rhi’s MSRA (13 decks)

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