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Medicine > Respiratory > Flashcards

Respiratory Flashcards

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
Q

Give 4 conservative managements of COPD?

A 
Smoking cessation
Exercise
Treat poor nutrition
Lose weight
Vaccinations (influenzae, pneumococcal)
Pulmonary rehabilitation/palliative care
26
Q

What are the steps in treating stable COPD? 3 steps

A
  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
Q

What is the acute management of COPD?

A
  • Controlled O2 therapy 24-28%
  • Nebulized salbutamol and ipratropium
  • Steroids hydrocortisone and prednisalone
  • Antibiotics if evidence of infection
28
Q

Give 5 risk factors for a PE?

A 
Recent surgery
Leg fracture
Prolonged bed rest
Malignancy
Pregnancy
Previous PE
29
Q

What is the acute management of a PE?

A 
O2 100%
Morphine + antiemetic 
Thrombolyse or surgery (massive emboli with haemodynamic compromise)
LMWH
Warfarin
30
Q

What are the management options for a pneumothorax? 5 things

A

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
Q

What are the respiratory causes of clubbing?

A 
Abscess
Bronchiectasis
Cancer
Decreased O2
Empyema
Fibrosing alveolitis
32
Q

Give 5 causes of bronchiectasis?

A 
CF
Kartageners syndrome
Bronchiolitis
Pneumonia
TB
Obstruction
Rheumatoid arthritis
33
Q

Give 3 signs and 3 symptoms of bronchiectasis?

A

Symptoms:
Persistent cough
Loads of purulent sputum
Haemoptysis

Signs:
Finger clubbing
Inspiratory crepitations
Wheeze

34
Q

Give 3 complications of bronchiectasis?

A

Pneumonia
Pleural effusion
Pneumothorax
Cerebral abscess

35
Q

What 3 investigations can you do in Bronchiectasis?

A 
Sputum culture
CXR
HRCT chest
Spirometry
Bronchoscopy
36
Q

Give 5 symptoms of Tuberculosis?

A 
Cough
Haemoptysis
Malaise
Lethargy
Weight loss
Night sweats
Anorexia
37
Q

What are CXR signs seen in tuberculosis? 4 things

A 
Consolidation
Cavitation
Fibrosis
Calcification
Pleural effusion
38
Q

What 4 investigations would you request for tuberculosis?

A 
CXR
Ziehl-Nielsen sputum stain for AFB
Sputum culture
Bronchoscopy
Mantoux test
Biopsy/histology
CT scan
39
Q

Give the 4 drugs used for tuberculosis and regime

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

4 drugs for 2 months
R & I for 4 months

40
Q

Give 3 public health measures put in place for tuberculosis?

A

BCG for any person who is high risk
Screening of immigrants
Isolation of confirmed cases
Notification of the HPA

41
Q

Give 2 different types of pleural effusion and their causes?

A

Transudate-cardiac failure, hypothyroid, nephrotic syndrome, renal failure
Exudate-pneumonia, lung carcinoma, PE, TB

42
Q

What do you test for in pleural fluid?

A 
Protein count
Bacterial culture and sensitivity
Cytology
Cell count
Glucose
43
Q

What is the location for aspiration in a pneumothorax?

A

2nd intercostal space

Mid clavicular line

44
Q

Give 3 CXR changes in a pneumothorax?

A

Tracheal shift
Decreased lung markings
Raised hemidiaphragm
Unequal chest expansion

45
Q

Give the definition of asthma?

A

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
Q

Give 3 possible complications of COPD?

A

Respiratory failure
Cor pulmonale
Lung carcinoma
Pneumothorax

47
Q

What 4 signs can you see on CXR of a COPD patient?

A 
Hyperinflation (>6 anterior ribs)
Flat hemidiaphragms
Large central pulmonary arteries
Fewer peripheral vascular markings
Bullae
48
Q

Name 3 atypical organisms that cause community acquired pneumonia?

A

Staph Aureus
Legionella spp
Moraxella catarrhalis
Chlamydia

49
Q

Give 3 organisms that can cause hospital acquired pneumonia?

A

Gram negative enterobacteria
Staph.aureus
Pseudomonas
Klebsiella

50
Q

Name 3 patient groups at risk of aspiration pneumonia?

A

Stroke patients
Myasthenia gravis
Unconscious
Poor dental hygiene

51
Q

Name 4 signs seen in consolidation?

A 
Reduced chest expansion
Dull percussion note
Increased tactile fremitus
Increased vocal resonance
Bronchial breathing
52
Q

Give 4 management steps for pneumonia?

A

IV fluids (dehydrated => shock)
O2 therapy (>92%/>8kPa O2)
Analgesia (pleuritic chest pain)
Abx (empirical)

53
Q

State 4 possible complications of pneumonia?

A 
Respiratory failure
Pleural effusion
Lung abscess
Septicaemia
CVS complications (AF, hypotension)
54
Q

In the tuberculin skin test, give a reason why a result might be false negative?

A

Immunocompromised patients (AIDS, steroids, Splenectomy, Malignancy)

55
Q

Before treatment of tuberculosis occurs, what assessments must be made? 2 things

A

Renal/Liver function tests

Visual/Colour acuitity

56
Q

Give one side effect each for the drugs used in the treatment of tuberculosis?

A

Rifampicin - tears/urine orange
Isoniazide - peripheral neuropathy
Pyrazinamide - arthralgia
Ethambutol - optic neuritis

57
Q

How do you manage Obstructive sleep apnoea? 3 things

A

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
Q

What are the 2 complications associated with Idiopathic pulmonary fibrosis?

A

Type 1 respiratory failure

Increased risk of lung cancer

59
Q

How would you manage an acute exacerbation of COPD? 3 things

A

Oxygen therapy - controlled starting with 24%

Triple therapy - nebs bronchodilators, steroids, Abx (evidence of infection)

?Physio for expulsion of sputum

60
Q

How do you manage acute pulmonary oedema?

A 
OMFG
Oxygen
Morphine
Furosemide
GTN
61
Q

What is the scoring system used in PE and give 4 components of it?

A

Well’s score

Localized tenderness along venous system
Entire leg swollen
Pitting oedema > assymptomatic leg
Collateral superfical veins
Major surgery in last month

Medicine (17 decks)

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