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Final Year - Passmed > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

severe obesity causes what kind of lung function test?

A

Restrictive lung function test

as the forced vital capacity is reduced

mechanically compresssed chest

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2
Q

VATS pleurodesis?

is what?

what is is treatment for?

A

primary spon pneumothorax

video assisted thoracoscopic surgergy pleurodesis

drainage of air/fluid
bullae are excised
talc used to promote adhesion

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3
Q

mx options for pneumothorax

A

conservative ; 2-4 days as outpatient

inpatient if secondary pneumothorax

ambulatory
8FG catheter mounted to an 18G needle and pigtail catheter

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4
Q

first line Mx of COPD?

A

SABA / SAMA

short acting bronchodilator

salbutamol
ipratropium

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5
Q

Oral theophylline

A

methylxanthines

bronchodilator
anti-inflammatory
modulates respiratory function

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6
Q

Churg strauss disease

A

allergy
asthma / allergic rhinitis

nasal polyps

eosinophilia

vasculitis

pANCA

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7
Q

granulomatosis with polyangitis

A

renal failure
epistaxis

vasculitis
sinusitis
dyspnoea

cANCA

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8
Q

3 criteria for discharge for an asthma attack?

A

stable for 12-24 hours
ensure good inhaler technique

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9
Q

how long does metabolic compensation take?

A

days/ weeks

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10
Q

is prednisolone ok in breastfeeding?

A

30mg yes

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11
Q

Mx of acute asthma attack?

A

admit
>Life threaten
>severe and not responding
> pregnant
>prev near fatal

O2 - 15l via non rebreath mask
94-98%

bronchodilate:
SABA; inhaled/neublised
pMDI / o2 driven nebuliser

corticosteroid
40/50mg

Ipratropium bromide
IV magnesium sulphate
IV aminophylline

intubate / ventilate
ECMO

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12
Q

Diagnostic Criteria for ARDS?

A

clinical and
CXR and
po2/fiO2 <40kPa

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13
Q

what is ARDS?

A

non cardiogenic pulmonary oedema
pulmonary capillary wedge then is normal <19mmHg

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14
Q

Mx of ARDS?

A

principles
ITU
o2/ventilate
general organ support
Tx underlying abx

prone positioing

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15
Q

rare but important complication of pleural effusion?

A

if drained too quickly
re expansion pulmonary oedema

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16
Q

Extrinsic allergic alveolitis

mx

A

avoid trigger
oral glucocorticoids

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17
Q

Ix for Extrinsic allergic alveolitis

A

imaging: upper/mid-zone fibrosis

lavage: lymphocytosis
IgG

no eosinophilai tho

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18
Q

A1AT deficiency

A

causes an emphysema like illness

lack of protease inhibitor

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19
Q

When using an inhaler, for a second dose you should wait for approximately?

A

30 seconds

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20
Q

_____ paraneoplastic feature of SCLC?

A

SIADH

hyponatraemia
localised wheeze ; bronchial obstruction

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21
Q

upper lobe zone fibrosis
CHARTS

A

coal workers pneumonconiosis
histiocytosis
ankylosing spondylitis
radiation
TB
silicosis
sarcoid

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22
Q

nasogastric tubes are safe to use when pH is?

A

<5.5

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23
Q

asthma diagnosis
adults

A

eosinophil count / fractional nitric oxide
FeNO

1) bronchodilator reversibility with spirometry

FEV1 >12%
PEF variability

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24
Q

asthma diagnosis in children

A

feNO
>35 ppb

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25
acute asthma 1st line management
nebulised salbutamol w o2 15l non rebreath mask
26
mx of acute asthma principles?
Deliver o2 give salbutamol nebulised give steroids - oral prednisolone 40-50 nebulised ipratropium bromide IV magnesium sulphate IV aminophylline
27
Bupropion should not be used in epilepsy why?
reduces seizure threshold noradrenaline and dopamine reuptake inhibitor, shares structural similarities with amphetamines, which can increase neuronal excitability and thereby risk seizures
28
Non-invasive ventilation - key indications
copd respiratory acidosis 7.25-7.35 pH <7.25 cardiogenic pulmonary oedema T2RF
29
Recommended initial settings for bi-level pressure support in COPD EPAP IPAP
4-5 cm H2O 10 cm H20 12-15 cm H2O (BTS suggest) 1:3 inspiration to expiration ratio
30
Bupropion
norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist
31
Varenicline
nicotinic receptor partial agonist 12 weeks
32
___________ are the treatment of choice for allergic bronchopulmonary aspergillosis
Oral glucocorticoid
33
Atelectasis
basal alveolar collapse > bronchial secretions >dyspnoea
34
reduced TLCO what does this mean?
transfer factor for CO - monoxide how much oxygen diffuses from lung > capillaries reduced in any condition where the surface area is reduced
35
what is an example of a SAMA?
ipratropium inhaler = reduces bronchoconstriction and improves symptoms such as wheezing and breathlessness
36
asthma diagnosis requires what change in FEV1?
12% 200mL post bronchodilator
37
why does haemoptysis occur in mitral stenosis?
rupture of bronchial veins caused by left atrial pressure
38
aspergilloma
rounded opacity TB hx haemoptysis
39
main 2 indications for surgery in bronchiectasis
uncontrollable haemoptysis localised disease
40
why does bronchiectasis occur?
permanent dilatation of the airways > chronic infection > inflammation (smoker / COPD ect)
41
Lung Cancers Gynaecomastia is associated with?
adenocarcinoma oestrogen / androgen ratio
42
SCLC - associated wiht?
lambert eaton SIADH ACTH - cushing
43
Squamous cell carcinoma associated?
pTHr hypercalcaemia
44
what are pleural plaques?
asbestos related lung changes localized thickening / scarring on the pleura
45
what is mesothelioma?
malignant disease of the pleura > chest pain > pleural effusion > SOB
46
Mx. of mesothelioma?
palliative chemo median survival 8-14 months
47
step down treatment for asthma ICS
decrease dose by 25-50% BTS reccomen every 3 month review
48
prophylaxis of exarcebations in COPD?
Azithromycin
49
first line mx for exarcerbations of COPD?
amoxicillin doxy clarithromycin
50
when does CO2 start to worry you with an asthma attack and why ?
RR of 33 or raised you expect the CO2 to be low due to it being lost when you are hyperventilating so if they have asthma and their CO2 is raised or normal that is worrying as theyre tiring and hypoventilating suggests impending respiratory failure
51
use of ambulatory devices in pneumothorax management?
Recent intervention >portable chest drainage systems
52
severe asthma RR is above?
25/min
53
PEFR - severe / life threatening?
PEFR 33-50 % is severe <33% is life threatening
54
how to manage allergic bronchopulmonary aspergillosis
aspergillus spores 1) bronchocostriction 2) bronchiectasis eosinophilia CXR findings positive radioallergosorbent test IgG raised IgE oral glucocrticoids itraconazole
55
contraindications for lung cancer
SVC obstruction FEV <1.5 malignant pleural effusion vocal cord paralysis tumour near hilum
56
oxygen requirements in COPD
88-92% adjust to 94-98 if pCO2 is normal
57
low severity pneumonia
amoxicillin 5 days
58
moderate - high pneumonia?
dual antibiotic therapy amoxicillun and macrolide 7-10 day course
59
NICE recommends for suspected lung cancer?
CXR contrast enhanced CT scan bronchoscopy- biopsy and histology PET scan NSCLC 18-flurodeoxygenase
60
transfer factor
rate which gas will diffuse from alveoli into blood carbon monoxide used to test the rate of diffusion
61
Silicosis
mining upper zone fibrosis egg shell calcification of hilar nodes
62
what is silicosis?
lung disease caused by breathing tiny bits of silica - stuck in lungs cause damage - hard to breath - permanent scarring
63
what is silica found in?
mineral found in sand rock clay
64

Final Year - Passmed (47 decks)

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