Respiratory Flashcards by Abigail Houghton

What is the most common causative organism in an infective exacerbation of COPD?

Haemophilus influenzae

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Name 3 organisms which commonly cause infective exacerbations of COPD.

Haemophilus influenzae (most common)
Strep pneumoniae
Moraxella catarrhalis

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Name the diagnostic investigation for occupational asthma.

Serial peak flow measurements at work and at home

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In COPD, what is the main benefit of inhaled corticosteroids?

Reduced frequency of exacerbations

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What is first line medical treatment in COPD?

Bronchodilator, one of:

short acting beta agaonist, e.g. salbutamol
short acting muscarinic antagonist, e.g. ipratropium

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Outline the medical management in COPD.

Bronchodilator - salbutamol OR salmeterol
If still breathless but no asthmatic features/no features suggesting steroid responsiveness:
- add long-acting beta agonist, e.g. salmeterol + long-acting muscarinic antagonist, e.g. tiotropium
If breathless after SABA/SAMA and asthmatic features/features suggesting steroid responsiveness:
- add long-acting beta agonist + inhaled corticosteroid, e.g. beclomethasone

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If a patient with COPD is developing signs of Cor Pulmonale, what treatment should be added?

Loop diuretic (for oedema)

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Outline the medical management of asthma.

Short-acting beta agonist, e.g. salbutamol
SABA + inhaled corticosteroid, e.g. beclomethasone
SABA + ICS + leukotriene receptor antagonist, e.g. montelukast
SABA + ICS + long-acting beta agonist, e.g. salmeterol

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What is acute respiratory distress syndrome (ARDS)?

Increased permeability of the alveolar capillaries leading to fluid accumulation in the alveoli
(non-cardiogenic pulmonary oedema)

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Name 6 causes of ARDS (acute respiratory distress syndrome).

Infection: sepsis
Massive blood transfusion
Trauma
Smoke inhalation
Acute pancreatitis
Cardio-pulmonary bypass

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Give 4 clinical features of ARDS (acute respiratory distress syndrome).

Dyspnoea
Elevated respiratory rate
Bilateral lung crackles
Low O2 saturations

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Give 2 key investigations (and findings) of ARDS?

CXR - bilateral alveolar shadowing

ABG

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What is an empyema?

A pus-filled pocket that most commonly develops in the pleural space.

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What is the difference between transudate and exudate?

Light’s criteria

Transudates have protein level <30g/L
Exudates have protein level >30g/L

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How is a pleural effusion managed?

Diagnostic tap and diagnostic aspiration

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When is long-term oxygen therapy given for a patient with COPD?

pO2 <7.3, OR
pO2 7.3 - 8 + 1 of:
 - secondary polycythaemia
 - peripheral oedema
 - pulmonary hypertension

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What are target O2 saturations in an acutely unwell patient?

94-98%

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What are target O2 saturations in a patient with COPD?

88-92%

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What is FEV1?

The volume of air exhaled at the end of the 1st second of forced expiration

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What is FVC?

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Maximum volume of air a person can exhale after maximum inhalation, given as much time as they require.

What is the FEV1/FVC of normal healthy lungs?

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70-80%

What is thoracic kyphosis?

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A restrictive chest wall disease –> high FEV1 (air can leave quickly) and low FVC (not much air can enter as chest can’t expand)
–> FEV1/FVC is high, 85%

What is Lambert Eaton syndrome?

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Weakness in proximal muscle of arms and legs (legs worse affected).
A paraneoplastic feature of small cell lung cancer

When are pulmonary rehabilitation classes indicated in a patient with COPD?

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When patients start getting short of breath during regular activities, e.g. walking to the shops

What is the CURB-65 score?

Measure of pneumonia severity to estimate mortality. ``` Confusion Urea Resp rate Blood pressure Age >65 ```

Name 3 common differentials for post-op SOB.

Atelectasis PE Pneumonia

What is atelectasis?

A common post-op complication in which basal alveolar collapse results in difficulty breathing. It is caused by airways becoming obstructed by respiratory secretions

What is the management of a primary pneumothorax?

If rim of air <2cm and no SOB then discharge | Otherwise aspiration

What is the management of a secondary pneumothorax?

If rim of air <1cm and no SOB then admit and observe for 24hrs If rim of air 1 - 2cm and no SOB then aspirate If rim of air >2cm or SOB then chest drain

What is pulmonary capillary wedge pressure a measure of?

Left atrial pressure (ARDS cannot be diagnosed if it is raised)

What is transfusion-related lung injury?

ARDS which occurs within 6hrs of transfusion

Give 4 features which suggest steroid-responsiveness in a patient with COPD.

Dx of asthma/atopy Higher blood eosinophil count Substantial variation in FEV1 over time (>400ml) Substantial diurnal variation in peak expiratory flow (>20%)

What is the causative organism of TB?

Mycobacterium tuberculosis

What is a Ghon focus?

A small lung lesion that develops during primary infection of TB. It is composed of tubercle-laden macrophages

What is a Ghon complex?

The combination of Ghon focus and hilar lymph nodes

Erythema nodosum, non-productive cough, arthralgia and bilateral hilar lymphadenopathy are indicative of what condition?

Sarcoidosis

What is sarcoidosis?

Abnormal collections of inflammatory cells that form granulomas. Commonly begins in the lungs, skin or lymph nodes.

What is the management of atelectasis?

Chest physiotherapy with mobilisation and breathing exercises

Which antibiotics might be given in an acute exacerbation of COPD?

Amoxicillin, tetracycline, or clarithromycin

Which antibiotics are given in an exacerbation of chronic bronchitis?

Amoxicillin, tetracycline or clarithromycin

Which antibiotic is given in an uncomplicated CAP?

Amoxicillin

Which antibiotic is given in pneumonia which is likely caused by atypical pathogens?

Clarithromycin

Which antibiotic is given in a HAP?

<5 days since admission = co-amoxiclav or cefuroxime | >5 days since admission = piperacillin with tazobactam OR b-s cephalosporin (ceftazidime) OR quinolone (ciprofloxacin)

What would the blood gas findings be during a panic attack?

Hyperventilation --> respiratory alkalosis (blows off CO2, O2 normal, no metabolic compensation because short-lived)

Patient with CF and developed a HAP. Ground glass attenuation seen on CT scan. What is the causative organism?

Pseudomonas aeruginosa

Alcoholic / diabetic patient with cavitating pneumonia seen in the upper lobes on CXR. Red-current jelly sputum What is the causative organism?

Klebsiella pneumoniae

Patient has flu-like symptoms (headache, arthralgia, myalgia) followed by a dry cough. CXR shows patchy consolidation in one lower lobe. What is the causative organism?

Mycoplasma pneumoniae

A patient has flu-like symptoms, along with extra-pulmonary symptoms such as hepatitis, D & V. Bi-basal consolidation is seen on CXR. What is the causative organism?

Legionella pneumophillia

Respiratory Flashcards

(48 cards)