Respiratory Flashcards
(120 cards)
1
Q
How is a massive PE (hypotensive) managed?
A
Alteplase (thrombolysis)
2
Q
What organism causes pneumonia in COPD?
A
H. influenzae
3
Q
When should you use NIV in an acute exacerbation of COPD?
A
Resp acidosis, Type 2 resp failure
4
Q
Who gets Klebsiella pneumonia?
A
Alcoholic and diabetics
5
Q
Who gets pneumocystis jiroveci pneumonia?
A
HIV/AIDS
6
Q
What are the parameters of CURB-65?
A
Confusion, Urea > 7 RR > 30 BP systolic <90, diastolic < 60, Age over 65
7
Q
How do you treat CAP with a CURB of 0-2?
A
amoxicillin
8
Q
Which organisms causes rusty sputum?
A
Strep pneumoniae
9
Q
What is the buzzword for silicosis?
A
Stonemasons, Pottery
10
Q
What is seen on the CXR in ILD?
A
Diffuse infiltrates
11
Q
What are the common causes of exudate?
A
PE Lung infections Cancers CTDs
12
Q
What is the management of acute asthma?
A
Nebs: salbutamol & ipratropium, Steroids: oral pred/IV hydrocortisone
13
Q
What should be given for an acute exacerbation of COPD if there is no response?
A
Iv aminophylline
14
Q
What pH of a pleural effusion suggests an epyema?
A
< 7.2
15
Q
What is the buzzword for byssinosis?
A
Cotton
16
Q
What does this CXR show?
A
Left lower lobe consolidation
17
Q
What pneumonia organisms causes haemolytic anaemia + erythema multiforme/nodosum?
A
Mycoplasma
18
Q
How is an exacerbation of ILD managed?
A
Steroids
19
Q
What are the features of a life threatening asthma attack?
A
Silent chest, Exhaustion Hypoxaemia PEFR < 33% Features of shock
20
Q
What is the step 2 in the treatment of chronic COPD?
A
SABA or SAMA (salbutamol or ipratropium)
21
Q
Asthma + eosinophilia + mono neuritis complex?
A
Churg Strauss Vasculitis
22
Q
What is the management of a secondary spontaneous pneumothorax if 0-1cm + asymptomatic?
A
Oxygen + admit for 24hr obs
23
Q
What is the management of a primary spontaneous pneumothorax if <2cm + asymptomatic?
A
Discharge
24
Q
What is seen on ABG in COPD?
A
Compensated type 2 resp failure
25
How does ILD present?
Dry cough, SOBOE, myalgia, fine inspiratory crackles
26
How do you treat HAP/aspiration pneumonia?
IV amox, met and gent
27
What is step 4 in the management of chronic asthma?
SABA + ICS + LABA +/- LTRA (salbutamol + beclametasone + salmeterol +/- montelukast)
28
What is seen on CXR in COPD?
Hyperinflation, flattened hemidiaphragms
29
How is asthma investigated?
Peak flow Spirometry
30
When does staph aureus pneumonia usually occur?
After influenza A
31
What investigations are done in a PE?
Bloods incl D dimer, ABG, ECG, CXR (exclusion) CTPA / V/Q
32
What is seen on ABG in PE?
Resp alkalosis
33
What is the step 3 in the treatment of chronic COPD if FEV1 \< 50%?
LABA + ICS (folmeterol + beclometasone) or LAMA (tiotropium)
34
What treatment does small cell lung cancer respond well to?
Chemo
35
What is the buzzword for hypersensitivity pneumonitis?
Farmers, Bird fanciers
36
What is the presentation os asthma?
Recurrent episodes of cough, wheeze, SOB Worse in morning and at night
37
How is ILD investigated?
CXR, Spirometry, ABG
38
What does this CXR show?
Pulmonary oedema
39
What is the typical presentation of pneumonia?
SOB, productive cough, chest pain, fever, confusion, myalgia
40
What biopsy is done in a central lung cancer?
Bronchoscopy
41
What is the management of a secondary spontaneous pneumothorax if \>2cm or symptomatic?
Chest drain
42
What is the management of a primary spontaneous pneumothorax if \>2cm or symptomatic?
Admit for aspiration If this fails \> chest drain
43
What are the risk factors for a PE?
Immobility, post-op, malignancy, pregnancy, COCP, HRT
44
What investigation is done for a PE in pregnancy?
perfusion only V/Q scan
45
What are the features of a pneumothorax?
Asymptomatic, SOB, chest pain Young, thin tall male
46
What is step 3 in the management of chronic asthma?
SABA + ICS + LTRA (salbutamol + beclametasone + montelukast)
47
Who gets legionella?
Travel/water
48
What is the pathophysiology of cor pulmonale in COPD?
Chronic cascade \> hypoxia \> pulm vasoconstriction \> pulm hypertension \> cor pulmonale
49
What is seen on the ABG in ILD?
Type 1 resp failure
50
What does this CXR show?
Right upper lobe consolidation
51
What is FVC?
Total volume of gas expired on forced expiration from maximal inspiration
52
What does this CXR show?
Right pneumothorax
53
What is seen on spirometry in ILD?
Restrictive pattern, FEV1:FVC ratio \> 0.7
54
How is an unprovoked PE managed?
6 months of rivaroxaban
55
What level of protein in a pleural effusion indicates an exudate?
\> 30g/L
56
How is a provoked PE managed?
3 months of rivaroxaban
57
What is the normal FEV1:FVC ration?
0.7-0.8
58
What investigations are done in lung cancer?
CXR, CT staging scan
59
What are the features of COPD for diagnosis?
Sputum production and cough for most days for 3 months of 2 consecutive years
60
What are features of an acute severe asthma attack?
Speech impairment (can't complete sentences), Tachy Resp rate \> 25 PEFR 33-50%
61
What are the specific features in small cell carcinoma?
SIADH, Cushing's + Lambert Eaton
62
What are common causes of transudates?
LVF liver cirrhosis Nephrotic syndrome Acute GN
63
What does this CXR show?
Air under diaphragm - perforation
64
What causes a reduction in FVC and FEV1?
Restriction - pulmonary fibrosis, neuromuscular disorders, obesity, pleural disease
65
What is the management of a secondary spontaneous pneumothorax if 1 - 2cm + asymptomatic?
Aspiration
66
How is legionella diagnosed?
Urinary antigen
67
What is given if there is no improvement or if the asthma attack is life threatening?
IV mag sulph
68
What is seen on spirometry in asthma?
Reduced FEV1, normal FVC
69
What is step 2 in the management of chronic asthma?
SABA + ICS (salbutamol + beclametasone)
70
What are the features of lung cancer?
SOB, cough, haemoptysis, chest pain, hoarseness, stridor, weight loss, recurrent pneumonia, Horner's, pain and weakness in arms and hands
71
What is the step 4 in the treatment of chronic COPD?
Combo of LABA + ICS + LAMA
72
What are common precipitants for asthma?
Cold air, Dust mites, Exercise, NSAIDs, Beta blockers
73
When should you use intubation in an acute exacerbation of COPD?
pH \< 7.26
74
What electrolyte imbalance does legionella cause?
Hyponatraemia
75
What is the commonest type of lung cancer?
Adenocarcinoma
76
What is the step 1 in the treatment of chronic COPD?
STOP SMOKING
77
What biopsy is done in peripheral lung cancer?
Percutaneous transthoracic needle biopsy
78
What is seen on peak flow in asthma?
\> 20% diurnal variation for at least 3 days for 2 weeks
79
What is FEV1?
Volume of gas expired in the first second of forced expiration
80
What is the most common organism that causes pneumonia?
Strep pneumoniae
81
What are the specific features of squamous cell carcinoma?
PTH related protein \> hypercalcaemia
82
What is the gold standard investigation for a PE?
CTPA
83
How is ILD managed?
Conservative, O2, Pulmonary rehab
84
What pH in a pleural effusion indicates an exudate?
\< 7.1
85
What is seen on spirometry in COPD?
Obstructive pattern: FEV1:FVC ratio \< 0.7
86
What is the step 3 in the treatment of chronic COPD if FEV1 \> 50%?
LABA or LAMA (salmeterol or tiotropium)
87
How do you investigate pneumonia?
CXR, Bloods, Blood cultures
88
What is the buzzword for idiopathic pulmonary fibrosis?
Honey combing on CT
89
What causes a reduction in FEV1?
Obstruction: COPD, asthma
90
How do you treat CAP with a CURB of 3+?
IV co-amoxiclav + IV clarithromycin
91
How is mycoplasma pneumonia treated/?
Clarithromycin
92
What is the atypical presentation of pneumonia?
dry cough, SOB, flu like symptoms
93
What ABG sign is VERY worrying in acute asthma?
Normal/high CO2 - they are getting tired and starting to retain CO2
94
What are the ECG changes seen in cor pulmonale?
Peaked P waves and RVH
95
What follow up is needed in pneumonia and in whom?
CXR in 6 weeks for those at risk of lung cancer
96
How does a PE present?
SOB, pleuritic chest pain, dizziness, syncope, haemoptysis
97
How is COPD investigated?
CXR, ABG, Spirometry
98
How is pneumocystis jiroveci treated?
Cotrimoxazole
99
What is step 1 in the management of chronic asthma?
SABA (salbutamol)
100
What is the management of an acute exacerbation of COPD?
nebulisers: salbutamol and ipratropium, steroids: oral red/IV hydrocortisone, Antibiotics (amoxicillin/doxuy)
101
Asthma + nasal polyps + aspirin sensitivity?
Samter's triad
102
What is the buzzword for asbestosis?
Ship builders, dock workers
103
What is lupus pernio?
Raised plaque of purple indurated skin
104
In which condition is lupus pernio a feature?
Sarcoidosis
105
When is pulmonary rehab recommended in COPD?
As soon as patients become short of breath with regular activties
106
How can asthma be diagnosed with spirometry?
\> 12% improvement in FEV1 after SABA
107
What metabolic abnormality does sarcoidosis cause?
Hypercalcaemia
108
How is alpha 1 antitrypsin deficiency inherited?
Autosomal recessive
109
Can alpha 1 antitrypsin be diagnosed prenatally?
Yes
110
In which zones does coal workers pneumoconiosis cause fibrosis?
Upper
111
What condition is buproprion contraindicated in?
Epilepsy
112
What lung defect does Kartgeners cause?
Primary ciliary dyskinesia
113
Recurrent chest infections + subfertility + dextrocardia
Kartgeners
114
What are the target sats in COPD?
88 - 92%
115
What antibody is tested for in Churg-Strauss?
pANCA
116
What is the main side effect of rifampicin?
Orange stuff - urine, tears, sweat
117
What is the main side effect of iosinazid?
Agranulocytosis, neuropathy
118
What are side effects of Pyra.... (the TB one)?
Hepatic stuff, photosensitivity, arthralgia
119
What is the main side effect of ethambutol?
Eye stuff
120
What is a histological finding in TB granulomas?
Epitheloid histocytes
