Respiratory Flashcards
(87 cards)
1
Q
the first line for pneumocystis carnii is………..
A
co-trimoxazole (trimethopreim- sulpha)
2
Q
the 2nd line for pneumocystis carnii is………..
A
Atovaquuone
3
Q
Ix of choice for pneumocystis carnii is………..
A
bronchoscopy with broncho-alveolar lavage
4
Q
Tx of acute exacerbation of COPD?
A
1- Antibiotics if purulent sputum
2-prednisolon 30mg/day for 7-14 day
3- Inhaled or nebulized bronchodilator
4- Controlled O2 therapy 24% to maintain saturation 88-92%
5- IV Aminophylline………..> beneficial if wheezy
6-Non- invasive ventilation if all of the above are ineffective
5
Q
the most common cause of community-aquired pneumonia is………
A
streptococcus pneumonia
6
Q
Rusty sputum. the organism is ……….
tX??
A
streptococcus pneumonia
penicillin
if allergic …..> doxycyclin or clarithromycin
7
Q
purulent sputum .the organism is ……….
A
staph.aureus
8
Q
green sputum
A
psudomonus
9
Q
current jelly
A
klebsiella
10
Q
airconditioner or spa + neurological signs + pneumonia + LOW Na + lymphocytopenia
the organism is………..
A
legionela
11
Q
fever+ murmur+ pneumonia
the organism is…….?
A
coxilla burentti
12
Q
bilateral hilar lymphadenopathy + shin lesion + arthralgia
A
sarcoidosis
lofgren $ (distinct sarcoid $)
13
Q
fever +parotid enlargment+ facial palsy+ uveitis+ hilar adenopathy
A
Heerfordt-waldenstorm $ ( sarcoid $)
14
Q
respiratory alkalosis + hypoxia
A
pulmonary embolism
15
Q
respiratory alkalosis +No hypoxia
A
panic attack
16
Q
pneumonia+ target lesion (erythema multiform)
whats the organism ?
A
Mycoplasma
17
Q
tram track opacity in CXR + clubbing + smoking
A
bronchiactasis
18
Q
difinitive diagnosis of bronchiactasis ?
A
CT
19
Q
Tall athelets playing sport + sudden dysnea+ decreased breath sounds on one side
A
spontaneous pneumothorax
CXR
20
Q
pulmonary function test in COPD
A
1-All volumes increase except vital capacity and DLCO
2- FEV1 decrease less than 80%
3- FVC……> Normal
4- FEV1/FVC ……..> Less than 70%
21
Q
TX of acute asthma
A
1- O2 with nabilused salbutamol
2- IV hydrocortison or oral prednisolone سؤال
3-ibratropium nabiluser
4- Mgso4
22
Q
COPD + Incresed dyspnea = secretion
A
1- prednisolon
2- nabilused normal salin
23
Q
builder+ smoker + loss weight
A
asbestosis…………> methothelioma
24
Q
the best investigation of methothelioma is
A
plueral biopsy
25
recent surgery or long flight + dyspnea ........
either PE or atelectasis
26
best next step if atelectasis is........
chest physiotherapy
27
the best follow up after pneumonia
CXR up to 6 weeks following recovery
28
when to refer to coroner
1- unexplained death
2- death in police
3- industrial disease ( mesothelioma )
4- death after 24hes hospital admission
29
the best Ix to diagnose Asthma
spirometry
| not peak flow rate .............> to assess the medications
30
CURP 65 score
Confusion
Urea > 7mmol
RR > 30
Pressure ........ systole less than 90 / 60
score =3........ admission
31
farmer + chest symptoms
extrinsic allergic alveolitis
32
farmer + chest symptoms
extrinsic allergic alveolitis = hypersensitivity pneumonitis
33
coal miner + chest symptoms
progressive massive fibrosis
34
piobsy show keratin in polygonal cells
| what is the type og this lung cancer?
squamous cell ca
35
wills criteria for PE
Can Not Treat If PE Help Me p97
| C
36
excercise- induced asthma not controlled by saba and steroid wht to add.......
inhaled steroid
LTRA
Na cromoglcate
37
Tx of leigonella
clarithromycin or azithromycin
38
blood results of leigonella
1- hypo Na
2- Lymphocytopenia
3- hypoabluminemia
4- elevated liver enzymes
39
1-the Ix of choice To confirm obstrucrive sleep apnea is.........
2- Ix to monitor OSAS is........
1-polysomnography
| 2- over night pulse oxymetry
40
on asthma medication + developed decreased vision. why?
oral steroid cause cataract
41
sleep apnea + decreased tidal volume and vital capacity
| Diagnosis?
MND cause poor respiration.........> sleep apnea
42
flu like symptoms+ gradual onset of chest symptoms + bilateral patchy consolidation
organism ??
Mycoplasma
| cold agglutinins
43
drug abuser + symptoms of pneumonia + productive cough
organism?
staph
44
drug abuser + symptoms of pneumonia +dry cough + clear chest + normal O2 saruration that drop on exercise
organism?
pneumocyctis carnii
| normal O2 saruration that drop on exercise (characteristic)
45
What is the Ix of choice in severe asthma ?
ABG to show acidosis and the need of assisted ventilation
46
the most common electrolyte abnormality in squamous cell ca?
hyper Ca
| or hypo Na due to SIADH
47
COPD + no improvement with O2
| what is the next step?
ABG
48
child + recurrent chest infection + not thriving well+ pneumonia
ORganism ??
pseudomonus commonly associated with cystic fibrosis
49
Sheets of polygonal with giant multinuclear cells
| type of cancer is..............
large cell ca
50
ACE levels are normally high with.........
sarcoidosis
51
the most important factor when determining whether a chest tube is placed?
pH is less than 7.2 in patients with suspected pleural infection a chest tube should be placed
52
Tx of spontaneous pneumothorax
1- if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
otherwise aspiration should be attempted
2-if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
53
Adults with suspected asthma and normal spirometry should have..... for diagnosis
FeNO test and spirometry with reversibility
54
COPD - still breathless despite using SABA/SAMA and a LABA + ICS → add.............
LAMA (Inhaled tiotropium
| )
55
1-COPD - still breathless despite using SABA/SAMA and asthma/steroid responsive features → add ........
2-COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features
1-LABA + ICS
2-LABA + LAMA
56
COPD chronic managemnt
1- SABA OR SAMA
2- LABA+ ICS
3- LAMA
57
What other features of the aspirate would strongly suggest this lady has developed an empyema?
Turbid effusion with pH<7.2, Low glucose, High LDH
58
the most common organism cause pneumonia in COPD IS.........
Haemophilus influenzae.
Haemophilus influenzae is the most common cause of infective exacerbations of COPD. The patient should be treated with a course of amoxicillin or a tetracycline together with prednisolone.
59
COPD Should take - LTOT if ............
2 measurements of pO2 < 7.3 kPa
60
Which intervention is most likely to increase survival in patients with COPD?
What is the single most important piece of advice to reduce his risk of further pneumothoraces?
smoking cessation
61
FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased
obstructive or restrictive?
restrictive
62
FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced
obstructive
63
Paraneoplastic manifestations of small cell lung cancer
ectopic production of ACTH and ADH.
64
Paraneoplastic manifestations of Squamous cell lung cancers
parathyroid hormone related protein, leading to hypercalcaemia.
65
A-Which factors should prompt an assessment for long-term oxygen therapy in COPD?
B-At what pH is the patient most likely to receive benefit from non-invasive ventilation?
1-very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be 'considered' for patients with severe airflow obstruction (FEV1 30-49% predicted)
2-cyanosis
3-polycythaemia
4-peripheral oedema
5-raised jugular venous pressure
6-oxygen saturations less than or equal to 92% on room air
B-COPD with respiratory acidosis pH 7.25-7.35*
66
What is the investigation of choice to help confirm the diagnosis OF IPF?
CT
67
Contraindications to lung cancer surgery include ......
SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
68
plural effustion + stable
| . what is the next step?
Aspiration
69
plural effustion + unstable
| . what is the next step?
drainage
70
NICE recommendation FOR tpatients who have frequent exacerbations of COPD
home supply of corticosteroids and antibiotics
71
What are the boundaries of the 'safe triangle' for chest drain insertion?
Bounded by latissimus dorsi, pectoralis major, line superior to the nipple and apex at the axilla
72
pt with acute asthma .. treated and now she is ok
| What is the most appropriate further action to ensure that this current exacerbation settles?
Prescribe prednisolone 40mg od for 5 days (with a stat dose now) + a beclometasone inhaler 200mcg bd
73
patients at risk of hypercapnia (e.g. COPD patients):
| Oxygen saturation targets is......
88-92%
74
Symptom control in non-CF (cystic fibrosis) bronchiectasis............
inspiratory muscle training + postural drainage
75
what criteria should be used to determine whether patients who are having an excerbation of COPD require antibiotics?
Those with purulent sputum or clinical signs of pneumonia
76
The features of acute severe asthma are
PEFR 33-50% best or predicted, inability to complete full sentences, RR >25/min and pulse >110 bpm
77
The features of Life-threatening
```
PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
```
78
presentation of acute breathlessness following this acute injury (as pancreatitis) , the most likely diagnosis is
acute respiratory distress
79
pt has been on long-term drug therapy to control her rheumatoid arthritis .
Chest x-ray Bilateral interstitial shadowing
Which drug is most likely to be responsible for her symptoms?.
Methotrexate
80
You are reviewing a patient with COPD. Which one of the following best describes the vaccinations they should receive?
Annual influenza + one-off pneumococcal
81
Centor criteria to assess the likelihood of a bacterial cause?
1-presence of tonsillar exudate
2-tender anterior cervical lymphadenopathy or lymphadenitis
3-history of fever
4-absence of cough
82
Which organism most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics?
Klebsiella
83
pharmacological treatment of choice in pregnancy for smoking cessation ?
Nicotine replacement therapy
84
Tx of lung cancer
1-patients with very early stage disease (T1-2a, N0, M0) are now considered for surgery.
2-most patients with limited disease receive a combination of chemotherapy and radiotherapy
3-patients with more extensive disease are offered palliative chemotherapy
85
Can COPD cause finger clubbing???
COPD is not a cause of finger clubbing
86
Male pt. 70 Yo with exertional dyspnoea and a dry cough. Weight loss
Dx??
idiopathic pulmonary fibrosis.
87
Which one of the following is the first line treatment for moderate sleep apnoea?
CPAP is first line for moderate or severe OSAHS
