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respiratory Flashcards

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1
Q

drugs causing fibrosis

A 
methotrexate
amiodarone
sulfasalazine
gold
nitrofurantoin
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2
Q

COPD - general management

A

smoking cessation
annual flu jab
one-off pneumococcal

LTOT, lung volume reduction surgery in selected pts

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3
Q

first line bronchodilator for COPD?

how do you determine next step?

A

SABA or SAMA

next step determined by FEV1

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4
Q

2nd line COPD inhaler if FEV1 > 50%

A

LABA (eg salmeterol), or LAMA (eg tiotropium)

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5
Q

what kind of drug is salmeterol?

A

LABA

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6
Q

what kind of drug is tiotropium?

A

LAMA

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7
Q

2nd line COPD inhaler if FEV1 < 50%

A

LABA + ICS (combo inhaler), or

LAMA

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8
Q

when to use theophylline for COPD?

A

if bronchodilators don’t work or if they can’t use inhalers

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9
Q

what can you use in COPD patients with a chronic productive cough?

A

mucolytics

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10
Q

symptoms of cor pulmonale

A

peripheral oedema
raised JVP
systolic parasternal heave
loud P2

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11
Q

management of cor pulmonale

A

loop diuretic for oedema
consider LTOT

ACEis, CCBs NOT recommended

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12
Q

what is a saddle embolus characteristic of?

A

PE

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13
Q

what are common symptoms of PE?

A

tachypnoea
crackles
tachycardia
low-grade fever

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14
Q

textbook triad of PE symptoms

A

pleuritic chest pain
dyspnoea
haemoptysis

but can present with any cardioresp symptom/sign

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15
Q

investigations if PE is ‘likely’

A

immediate CTPA - if delayed give LMWH in meantime

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16
Q

investigations if PE is ‘unlikely’

A

D dimer

if positive then immediate CTPA - if delayed give LMWH in meantime

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17
Q

PE wells scores

A

5+ - likely

0-4 - unlikely

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18
Q

CURB-65

A 
confusion
urea 8+
RR 30+
BP 90/60-
65+
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19
Q

care of CAP based on CURB65

A

0-1 - low - home care
2+ - intermediate - hosp
3+ - high - ICU

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20
Q

pneumonia - investigations

A

CXR
CURB65 2+ - blood + sputum cultures; pneumococcal + legionella urinary antigen tests
CRP monitoring to determine response to treatment

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21
Q

management of low-severity CAP (CURB65 0-1)

A

amoxicillin 5 days

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22
Q

management of moderate-high severity CAP (CURB65 2+)

A

dual abx: amoxicillin + macrolide (-mycin) 7-10 days

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23
Q

potential PE - investigations

A

CXR to rule out other causes

if still suspected then do wells

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24
Q

where does reactivation of TB tend to occur?

Study These Flashcards
A

apex of lungs

25
what triggers reactivation of TB?
becoming immunocompromised
26
what type of cancer makes up the majority of non-small cell lung cancers?
squamous - 35% adenocarcinoma - 30% (non-small cell is more common than small cell)
27
what is obstructive lung disease?
hard to exhale air - comes out slower + some may linger
28
what is restrictive lung disease?
hard to expand lungs with air
29
pulmonary function tests in obstructive lung disease
FEV1 - v reduced FVC - reduced or normal FEV1/FVC - reduced
30
pulmonary function tests in restrictive lung disease?
FEV1 - reduced FVC - v reduced FEV1/FVC - normal or increased
31
when is BIPAP used?
type II resp failure | esp COPD exac
32
when is CPAP used?
type I resp failure | esp pulmonary oedema
33
organism that most commonly causes COPD exacerbation?
haem influenzae
34
diagnosis of asthma
FeNO (fractional exhaled nitric oxide) + spirometry with bronchodilator reversibility (BDR) test
35
relationship between asthma and NO (nitric oxide)
NO is made by 3 types of NOsynthases. one of the types' levels rises in inflammatory cells, esp eosinophils. thus NO levels correlate with inflammation levels.
36
when to give objective tests for asthma?
age 5+ | age < 5 - clinical diagnosis
37
asthma - diagnosis age 17+
ask if better away from work spirometry with BDR FeNO test
38
asthma - diagnosis age 5-16
spirometry with BDR | FeNO test if normal/obstructive spirometry with a negative BDR
39
asthma management - if SABA isn't working?
add low dose ICS
40
asthma management - if SABA + ICS isn't working?
add leukotriene receptor antagonist (eg montelukast)
41
what are the options for first line smoking cessation therapy?
nicotine replacement therapy varenicline bupropion to last 2 weeks after target stop date
42
what is used to categorise COPD severity?
FEV1
43
RFs for pneumothorax
Marfan's | asthma
44
pneumothorax - presentation
sudden onset dyspnoea + pleuritic chest pain
45
Pancoast's syndrome - what is it? features?
``` T1 root lesion with: horner's upper lobe carcinoma wasting of hand small muscles, claw hand axilla pain ```
46
3 causes of obstructive picture in resp
asthma COPD bronchiectasis
47
what constitutes obstruction? (resp)
FEV1/FVC <75%
48
interstitial lung disease - spirometry
FEV1 and FVC reduced, ratio normal or increased
49
what is interstitial lung disease?
disorders that cause scarring (fibrosis) of the lungs
50
bronchiectasis - main 2 features
chronic cough with mucopurulent sputum
51
what tends to cause pneumonia following flu?
staphylococcus
52
complications of pneumonia
sepsis lung abscess pleural effusion empyema
53
sarcoidosis - acute presentation + prognosis
erythema nodosum joint pains - typ ankle + knee +- fever hilar lymphadenopathy on CXR benign + self-limiting in 90% takes 4-6wk to settle generally doesn't progress to chronic illness
54
sarcoidosis - chronic presentation
``` restrictive lung disease - hilar lymphadenopathy + fibrotic lung disease due to a lymphocytic alveolitis tender swellings of fingers +- bone cysts facial rash anterior uveitis attacks retinal problems parotitis facial nerve palsy hypercalcaemia ```
55
causes of erythema nodosum
``` sarcoidosis strep infection TB IBD sulphonamides, OCP ```
56
LDH in LP - significance?
high - bacterial | low - viral
57
what is total gas transfer? (TLCO) | when is it affected?
measure of gas transfer from alveoli to capillaries raised in asthma - as problem isn't affecting alveoli directly, or gas exchange, so lungs try to compensate by improving gas exchange reduced in COPD, fibrosis, pulmonary oedema etc
58
transfer coefficient (KCO) - what is it?
transfer factor corrected for lung volume total gas transfer/alveolar volume measures how efficient gas exchange is in relation to the alveolar-capillary surface-volume ratio increased in asthma due to increased pulmonary blood flow
59
what is transfer factor?
the rate at which a gas will diffuse from alveoli into blood

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