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Respiratory Flashcards

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1
Q

State 4 risk factors of pneumonia in any patient?

A

Elderly
Smoking
Underlying respiratory disease
Immunosuppression

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2
Q

Name 4 conditions often associated with asthma?

A

Eczema
Allergic rhinitis
Peanut/food allergies
Hay fever

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3
Q

Give 4 strategies you can use to prevent relapse of an asthmatic attack?

A

Education on inhaler technique
Avoidance of triggers
Check medication compliance
Encourage exercise to increase lung capacity

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4
Q

What is atopy?

A

Group of disorders that often runs in families caused by an IgE related hypersensitivity reaction.

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5
Q

What are the pathological changes seen in bronchitis? 4 things

A

Narrowed airways
Reduced airflow
Hypertrophy
Mucous gland hyperplasia

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6
Q

Name 2 accessory muscles of respiration?

A

Sternocleidomastoid
Abdominal muscles
Scalene muscles

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7
Q

Name 3 typical organisms that cause community acquired pneumonia?

A

Streptococcus pneumonia
Haemophilus influenza
Mycoplasma pneumonia

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8
Q

Give 5 symptoms of pneumonia?

A 
Fever
Rigors
Malaise
Anorexia
Dyspnoea
Cough
Haemoptysis
Pleuritic pain
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9
Q

Suggest 5 signs seen in pneumonia?

A 
Fever
Cyanosis
Tachypnoea
Tachycardia
Hypotension
Consolidation (dull percussion, low expansion, bronchial breathing)
Pleural rub
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10
Q

What is the CURB65 score, what is the criteria and how do you respond to the score?

A

Assessment of severity of pneumonia

Confusion
Urea >7mmol/L
Respiratory rate >30
BP 65

0-1 = Home treatment
1-2 = Hospital treatment
>3 = Severe pneumonia
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11
Q

What medication would you prescribe in community acquired pneumonia?

A

Amoxicillin and Clarithromycin

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12
Q

What are the possible complications of pneumonia? 4 things

A 
Pleural effusion
Empyema
Lung abscess
Respiratory failure
Pericarditis
Brain abscess
Death
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13
Q

Give 4 key questions you would ask about in an asthmatic?

A 
Precipitants
Exercise tolerance
Disturbed sleep
Home environment
Occupation
Days off
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14
Q

Give 3 signs of an asthma attack?

A 
Tachypnoea
Audible wheeze
Hyper inflated chest
Hyper resonant percussion
Low air entry
Polyphonic wheeze
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15
Q

What clinical features will make you think of acute severe asthma? 4 things

A

Peak flow 33-50%
Respiratory >25
Heart >110
Unable to complete sentences in one breath

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16
Q

What clinical features would point towards life threatening asthma? 5 things

A 
Disturbed consciousness
Exhaustion
Low BP
Cyanosis
Silent chest

Peak flow <8kPa

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17
Q

What clinical features would make you think near fatal asthma attack?

A

High PaCO2 or requiring mechanical ventilation

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18
Q

What is the management in an acute severe attack of asthma?

A

15L O2 via non rebreathe mask
Salbutamol + ipratropium bromide nebulized
Hydrocortisone IV/Prednisalone PO
CXR rule out pneumothorax
Add IV magnesium sulphate if deteriorating
Senior review/Contact ITU

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19
Q

What are the steps in the BTS guidelines for managing chronic asthma?

A
  1. SABA
  2. Add inhaled steroid (beclometasone)
  3. Add LABA (salmeterol)
  4. Add theophylline or leukotriene receptor antagonist (monteleukast)
  5. Add prednisalone PO
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20
Q

What are the possible complications of COPD? 4 things

A 
Acute exacerbation +/- infection
Polycythaemia
Respiratory failure
Cor pulmonale
Pneumothorax
Lung carcinoma
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21
Q

Name 2 signs and 2 symptoms of COPD?

A 
Tachypnoea
Use of accessory muscles
Hyperinflation
Decreased expansion
Wheeze
Cyanosis

Cough
Sputum production
Dyspnoea
Wheeze

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22
Q

What are the X-ray changes seen in COPD? 5 things

A 
Hyperinflation
Flat hemidiaphragms
Large central pulmonary arteries
Decreased peripheral markings
Bullae
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23
Q

What are the acute changes seen in asthma? 4 things

A

Airway (smooth muscle) constriction
Micro vascular leakage/oedema
Vasodilation
Mucus hyper secretion

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24
Q

What are the chronic changes seen in asthma? 4 things

A
  • Subepithelial fibrosis
  • Smooth muscle hyperplasia/hypertrophy
  • Goblet cell hyperplasia
  • New vessel formation
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25
Give 4 conservative managements of COPD?
``` Smoking cessation Exercise Treat poor nutrition Lose weight Vaccinations (influenzae, pneumococcal) Pulmonary rehabilitation/palliative care ```
26
What are the steps in treating stable COPD? 3 steps
1. Life style changes/ conservative management 2. Antimuscarinic (ipratropium) or B2 agonist PRN 3. Regular anticholinergic or LABA + inhaled corticosteroids 4. LABA + inhaled steroid + anticholinergic
27
What is the acute management of COPD?
* Controlled O2 therapy 24-28% * Nebulized salbutamol and ipratropium * Steroids hydrocortisone and prednisalone * Antibiotics if evidence of infection
28
Give 5 risk factors for a PE?
``` Recent surgery Leg fracture Prolonged bed rest Malignancy Pregnancy Previous PE ```
29
What is the acute management of a PE?
``` O2 100% Morphine + antiemetic Thrombolyse or surgery (massive emboli with haemodynamic compromise) LMWH Warfarin ```
30
What are the management options for a pneumothorax? 5 things
Primary: 2cm air rim or symptoms = Aspiration No response to aspiration = Chest drain Secondary Anytime = Aspiration SOB, >50y/o, rim of air >2cm, unsuccessful aspiration = Chest drain Bilateral pneumothoracies, Failure of drain, Hx of prev. pneumotharcies = Surgery
31
What are the respiratory causes of clubbing?
``` Abscess Bronchiectasis Cancer Decreased O2 Empyema Fibrosing alveolitis ```
32
Give 5 causes of bronchiectasis?
``` CF Kartageners syndrome Bronchiolitis Pneumonia TB Obstruction Rheumatoid arthritis ```
33
Give 3 signs and 3 symptoms of bronchiectasis?
Symptoms: Persistent cough Loads of purulent sputum Haemoptysis Signs: Finger clubbing Inspiratory crepitations Wheeze
34
Give 3 complications of bronchiectasis?
Pneumonia Pleural effusion Pneumothorax Cerebral abscess
35
What 3 investigations can you do in Bronchiectasis?
``` Sputum culture CXR HRCT chest Spirometry Bronchoscopy ```
36
Give 5 symptoms of Tuberculosis?
``` Cough Haemoptysis Malaise Lethargy Weight loss Night sweats Anorexia ```
37
What are CXR signs seen in tuberculosis? 4 things
``` Consolidation Cavitation Fibrosis Calcification Pleural effusion ```
38
What 4 investigations would you request for tuberculosis?
``` CXR Ziehl-Nielsen sputum stain for AFB Sputum culture Bronchoscopy Mantoux test Biopsy/histology CT scan ```
39
Give the 4 drugs used for tuberculosis and regime
Rifampicin Isoniazid Pyrazinamide Ethambutol 4 drugs for 2 months R & I for 4 months
40
Give 3 public health measures put in place for tuberculosis?
BCG for any person who is high risk Screening of immigrants Isolation of confirmed cases Notification of the HPA
41
Give 2 different types of pleural effusion and their causes?
Transudate-cardiac failure, hypothyroid, nephrotic syndrome, renal failure Exudate-pneumonia, lung carcinoma, PE, TB
42
What do you test for in pleural fluid?
``` Protein count Bacterial culture and sensitivity Cytology Cell count Glucose ```
43
What is the location for aspiration in a pneumothorax?
2nd intercostal space | Mid clavicular line
44
Give 3 CXR changes in a pneumothorax?
Tracheal shift Decreased lung markings Raised hemidiaphragm Unequal chest expansion
45
Give the definition of asthma?
Hyper-responsiveness of the bronchi to various ‘broncho-constricting’ agents that results in reversible airway obstruction which is ether spontaneous or following treatment and airway inflammation
46
Give 3 possible complications of COPD?
Respiratory failure Cor pulmonale Lung carcinoma Pneumothorax
47
What 4 signs can you see on CXR of a COPD patient?
``` Hyperinflation (>6 anterior ribs) Flat hemidiaphragms Large central pulmonary arteries Fewer peripheral vascular markings Bullae ```
48
Name 3 atypical organisms that cause community acquired pneumonia?
Staph Aureus Legionella spp Moraxella catarrhalis Chlamydia
49
Give 3 organisms that can cause hospital acquired pneumonia?
Gram negative enterobacteria Staph.aureus Pseudomonas Klebsiella
50
Name 3 patient groups at risk of aspiration pneumonia?
Stroke patients Myasthenia gravis Unconscious Poor dental hygiene
51
Name 4 signs seen in consolidation?
``` Reduced chest expansion Dull percussion note Increased tactile fremitus Increased vocal resonance Bronchial breathing ```
52
Give 4 management steps for pneumonia?
IV fluids (dehydrated => shock) O2 therapy (>92%/>8kPa O2) Analgesia (pleuritic chest pain) Abx (empirical)
53
State 4 possible complications of pneumonia?
``` Respiratory failure Pleural effusion Lung abscess Septicaemia CVS complications (AF, hypotension) ```
54
In the tuberculin skin test, give a reason why a result might be false negative?
Immunocompromised patients (AIDS, steroids, Splenectomy, Malignancy)
55
Before treatment of tuberculosis occurs, what assessments must be made? 2 things
Renal/Liver function tests | Visual/Colour acuitity
56
Give one side effect each for the drugs used in the treatment of tuberculosis?
Rifampicin - tears/urine orange Isoniazide - peripheral neuropathy Pyrazinamide - arthralgia Ethambutol - optic neuritis
57
How do you manage Obstructive sleep apnoea? 3 things
Simple measures: weight reduction, increase exercise, improving diet. Avoidance of alcohol and tobacco. Assisted non-invasive ventilation (CPAP via nasal mask) Surgery: tonsillectomy, tracheostomy
58
What are the 2 complications associated with Idiopathic pulmonary fibrosis?
Type 1 respiratory failure | Increased risk of lung cancer
59
How would you manage an acute exacerbation of COPD? 3 things
Oxygen therapy - controlled starting with 24% Triple therapy - nebs bronchodilators, steroids, Abx (evidence of infection) ?Physio for expulsion of sputum
60
How do you manage acute pulmonary oedema?
``` OMFG Oxygen Morphine Furosemide GTN ```
61
What is the scoring system used in PE and give 4 components of it?
Well's score ``` Localized tenderness along venous system Entire leg swollen Pitting oedema > assymptomatic leg Collateral superfical veins Major surgery in last month ```

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