Respiratory Flashcards Preview

Medicine > Respiratory > Flashcards

Flashcards in Respiratory Deck (56):
1

Which are the most common organisms causing pneumonia?

Strep pneumonia
Haemophilus influenza
Staph aureus

2

What are the CURB 65 criteria?

Confusion
Urea >7
Resp rate at least 30
BP systolic no more than 90 or diastolic no more than 60
Age 65 or over

3

How does the CURB 65 score inform management?

If scoring 0, then manage in community
If 1, do sats and CXR. If sats lower than 92 or multiple areas of shadowing then admit to hospital
If 2 or above then admit to hospital

4

What antibiotics should be used for mild pneumonia?

Amoxicillin

5

What antibiotics should be used for sever pneumonia?

Clarithromycin plus either benzylpenicillin, co amoxiclav, cefuroxime or cefotaxime
IV

6

Give 3 complications of pneumonia?

Sepsis
Pericarditis
Pleural effusion
Empyema
Lung abscess
Brain abscess
Respiratory failure
Myocarditis
Cholestasis

7

What are the criteria for starting long term oxygen therapy in COPD?

pO2 <7.3 on 2 separate occasions or
between 7.3 and 8 if there is also one of:
Secondary polycythaemia
Peripheral oedema
Nocturnal hypoxaemia
Pulmonary hypertension

8

What are the criteria for starting non-invasive ventilation?

COPD with respiratory acidosis
Type 2 respiratory failure secondary to neuromuscular disease, chest wall deformity, or OSA
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation

9

What is the difference between CPAP and BIPAP?

CPAP is not ventilatory support but splints open airways with constant pressure of oxygen
BIPAP has different pressures for inspiration and expiration with rescue breaths set up so it acts as ventilatory support

10

Give 3 risk factors for obstructive sleep apnoea

Obesity
Alcohol before bed
Smoking
Male
Neck circumference >43 cm
Family history
Supine sleeping
Hypothyroidism
Craniofacial abnormalities
Acromegaly

11

What are the two main causes of Obstructive Sleep Apnoea?

Small pharyngeal size with normal relaxation eg large tonsils or fatty infiltration
Normal size with excessive narrowing on relaxation eg with alcohol and increasing age

12

What are the general principles of managing obstructive sleep apnoea?

Conservative measures eg weight loss
Mandibular advancement devices
Nasal CPAP

13

What are the spirometry results in COPD?

Reduced FEV1
Reduced FEV1/FVC (<70& predicted)

14

What is MRC dyspnoea scale stage 1?

Untroubled by breathlessness except on strenuous exercise

15

What is MRC dyspnoea scale stage 2?

Breathlessness when hurrying or walking up slight hill

16

What is MRC dyspnoea scale stage 3?

Unable to keep up with contemporaries on the flat due to shortness of breath
Or
Having to stop for breath when walking at own pace

17

What is MRC dyspnoea scale stage 4?

Having to stop for breath after walking for 100m or a few minutes on the flat

18

What is MRC dyspnoea sclae stage 5?

Breathlessness on dressing or being unable to leave the house due to breathlessness

19

What medical management is used for stable COPD FEV1 >50% predicted?

Either SABA or SAMA
Either add LABA or swap SAMA for LAMA
If on a LABA and its not enough, add combined ICS or a LAMA
Triple therapy: LABA+ICS and LAMA

20

What medical management is used for stable COPD FEV1<50% predicted?

SABA or SAMA
Add either LABA+ICS or LABA+LAMA or have LAMA alone
Triple therapy: LABA+ICS and LAMA

21

When should someone be sent for an assessment of oxygen therapy?

If sats <92% on air
If FEV1<30% predicted
If secondary polycythaemia
If peripheral oedema
Cyanosis
Raised JVP

22

What is the purpose of pulmonary rehabilitation?

Improve quality of life
Safely increase exercise capacity
Reduce breathlessness

23

Give 3 causes of a pleural transudate

Heart failure
Hypoalbuminaemia
Cirrhosis
Periotneal dialysis
Nephrotic syndrome
Mitral stenosis
Pulmonary embolism
SVC obstruction
COnstrictive pericarditis
Meig's syndrome

24

Give 3 causes of pleural exudate

Malignancy
Infection
PE
RA
Asbestos exposure
Pancreatitis
Dressler's syndrome
Drugs
Fungal infection

25

What is light's criteria?

Way of distinguishing between transudate and exudate in a pleural effusion if protein content is borderline. Looks at serum and effusion LDH and protein

26

What is the difference between a primary and secondary spontaneous pneumothorax?

Primary occurs when there is no underlying lung disease present

27

Give three risk factors for developing a pneumothorax

Tall height
Underlying lung disease
SMoking
Diving
Trauma or chest procedure
Marfan's

28

How should a primary pneumothorax be managed?

Aspirate and give oxygen if rim of air is >2cm and patient is symptomatic
If rim of air is <2cm and patient is asymptomatic then discharge
If unsuccessful then insert a chest drain

29

What patient advice should be given on discharge from a pneumothorax

Avoid diving
Avoid flying until complete resolution
Stop smoking

30

How should a secondary pneumothorax be managed?

If patient is over 50 with rim of air over 2cm or symptomatic then insert a chest drain
If rim of air is <2cm then aspirate
Admit for at least 24 hours

31

Give 3 causes of type 1 respiratory failure

Pneumonia
ARDS
PE
Asthma (Life threatening)
Emphysema
Fibrosing alveolitis
Pulmonary oedema

32

Give 3 causes of type 2 respiratory failure

Asthma (near-fatal)
COPD
OSA
Reduced respiratory drive eg CNS lesion
Neuromuscular disease eg Guillain Barre
Kyphoscoliosis
Flail chest

33

Give 3 features of hypoxia

Agitation
Dyspnoea
Restlessness
Confusion
Central cyanosis
Polycythaemia if chronic

34

Give 3 features of hypercapnia

Confusion
Headache
Peripheral vasodilatation
Tachycardia
Tremor/flap
Bounding pulse
Drowsiness
Papilloedema
Coma

35

How is type 1 respiratory failure managed?

Treat cause
Controlled oxygen therapy
NIV if still hypoxic despite oxygen

36

How is type 2 respiratory failure managed?

Treat cause
Controlled oxygen, guided by CO2 levels on ABG
NIV if retaining CO2 still
Intubation if NIV fails

37

How is a pulmonary embolism managed?

Oxygen if hypoxic
Fluid resuscitation if hypotensive
If massive PE, then 10,000 units unfractionated heparin IV and thrombolyse with alteplase
If not a massive PE, then LMWH

start warfarin andCOntinue herparin therapy until INR = 2

38

What are the features of a massive pulmonary embolism?

Hypotension or signs of imminent cardiac arrest
Signs of right heart strain

39

What ECG changes may be seen in pulmonary embolism?

Tachycardia
S1 = large s wave in lead 1
Q3 = large q wave in lead 3
T3 = inverted T wave in lead 3
+RBB and right axis deviation

40

What is bronchiectasis?

Chronic dilatation of one or more bronchi, secondary to chronic infection or inflammation. There is poor mucus clearance and so are predisposed to recurrent or chronic bacterial infections

41

Give 3 causes of bronchietasis?

Post-infective eg from pneumonia or TB
Immune deficiency
Genetic eg cystic fibrosis
Mucociliary clearance deficit eg primary ciliary dyskinesia
Obstruction eg by foreign body
Toxic insult eg gastricaspiration
Allergic bronchopulmonary aspergillosis
HIV
Rheumatoid arthritis

42

What investigations are done in suspected bronchiectasis?

Sputum culture
CXR
HRCT
Spirometry
Bronchoscopy

43

What chest x ray findings are there in bronchiectasis?

Thickened bronchial walls
Tramlining

44

What are the features of bronchiectasis?

Persistent cough
Persistent purulent sputum
Intermittent haemoptysis
Finger clubbing
Coarse inspiratory crepitations
Wheeze

45

How is bronchiectasis managed?

Treat underlying cause
Physio
Training of inspiratory muscles
Antibiotics according to sensitivities
Flu vaccine
Bronchodilators
Pulmonary rehab if MRC >/= 3

46

What are the features of Horner's syndrome?

Anhydrosis
Miosis
Ptosis

47

How is non-small cell lung cancer managed?

Rarely surgery
Radiotherapy (curative or palliative)

48

How is small cell lung cancer managed?

Surgery if T1-T2
Chemo and radiotherapy (curative or palliative)

49

What is the WHO cancer status 0?

Normally and fully active with no restrictions

50

What is the WHO cancer status 1?

Difficulty with strenuous activity but able to carry out light work

51

What is the WHO cancer status 2?

Ambulatory. Able to self care but can't carry out work. Active for >50% of the day

52

What is the WHO cancer status 3?

Only able to carry out limited self care. In bed/chair for >50% of the day

53

What is the WHO cancer status 4?

Completely disabled. Can't self care and fully confined to bed or chair

54

What impact does the WHO cancer status have on management?

Generally, radical therapy or chemotherapy won't be considered if stage 3/4

55

Give 3 contraindications for surgery in lung cancer?

Poor general health ie performance status 3 or above
Peri-hilar tumour
Metastases present
Vocal cord paralysis
SVC obstruction
Malignany pleural effusion
FEV1<1.5

56

In general, how is pneumonia treated?

Amoxicillin or co-amoxiclav if severe/hospital acquired +/- doxycycline