Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

3 key features of asthma?

A
  1. airflow limitation which is reversible
  2. airway hyper-responsiveness to a wide range of stimuli
  3. inflammation of the bronchi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

symptoms of asthma

A

cough often worse at night
dyspnoea
wheeze
chest tightness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

signs on spirometry of asthma

A

FEV1 significantly reduced
FVC normal
therefore FEV1/FVC <70%
shows bronchoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mx of asthma

A

SABA e.g. salbutamol

SABA + ICS e.g. budenoside 400mcg OD or beclomethasone

SABA + ICS + LTRA (leukotriene receptor antagonist) e.g. Montelukast

SABA + ICS + LABA e.g. salmeterol (can continue LTRA)

SABA +/- LTRA + MART (maintenance and reliever therapy- contains low dose ICS and LABA)

Trial of long-acting muscarinic antagonist or theophylline
increase ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SEs of ICS?

A

oral candidiasis and stunted growth in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when should children with asthma be given a paediatric ICS?

A

Not controlled with SABA
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the steps after SABA + pICS for childhood asthma?

A
  • add leukotriene receptor antagonist
  • then stop LTRA and add LABA (different to adult guidance)
  • SABA + MART
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is MART

A

a form of combined ICS and LABA

used for both daily maintenance therapy and the relief of symptoms as required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

signs of life-threatening of acute asthma?

A 
PEFR <33%
O2 sats <92%
Silent chest, cyanosis or feeble respiratory effort
bradycardia, dysrhythmia, hypotension
exhaustion, confusion, coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

signs of severe acute asthma?

A

PEFR 33-50%
Can’t complete sentences
RR >25/min
Pulse >110 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

mx of acute severe asthma?

A 
salbutamol nebs
prednisolone or IV hydrocortisone
magnesium sulphate 1.2-2g IV over 20 mins
IV aminophylline 
IV salbutamol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

causes of COPD?

A

Smoking

alpha-1 antitrypsin deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

causes of IECOPD?

A

H.influenza
Strep pneumoniae
Moraxella catarrhalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

features of COPD?

A

Cough: often production
dyspnoea
wheeze
Right heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ix of COPD?

A

airflow obstruction- FEV1/FVC ratio <70%
CXR
FBC-exclude polycythaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

FEV1 severity of COPD?

A 
>80%= stage 1- mild
50-79%= stage 2- moderate
30-49%= stage 3- severe
<30%= stage 4- very severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

general management of COPD?

A

stop smoking
annual influenza vaccination
one-off pneumococcal vaccine
pulmonary rehab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

drug management of COPD

A
  • SABA or SAMA is first line
  • if not steroid responsiveness- LAMA (tiotropium)+ LABA
  • if steroid responsiveness- LABA (salmeterol) + ICS (beclomethasone 200mcg BD)
  • Consider adding theophylline

others- azithromycin (oral prophylactic antibiotic therapy), mucolytics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

who shouldn’t you offer LTOT for COPD?

A

If people continue to smoke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

who should get LTOT?

A

Long-term O2 therapy- >15 hours a day. Used in patients with pO2 <7.3kPa or 7.3-8kPa and one of:

  • very severe airflow obstruction (FEV1 <30%)
  • cyanosis
  • polycythaemia
  • peripheral oedema
  • raised JVP
  • O2 sats <92%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a well’s score?

A

Shows likelihood of DVT

Active cancer (treatment ongoing, within 6 months, or palliative)

  • Paralysis, paresis or recent plaster immobilisation of the lower extremities
  • Recently bedridden for 3 days or more or major surgery within 12 weeks requiring general or regional anaesthesia
  • Localised tenderness along the distribution of the deep venous system
  • Entire leg swollen
  • Calf swelling at least 3 cm larger than asymptomatic side
  • Pitting oedema confined to the symptomatic leg
  • Collateral superficial veins (non-varicose)
  • Previously documented DVT (-2)

> 2= DVT likely
1 or less= unlikely

An alternative diagnosis is at least as likely as DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what to do if DVT is likely?

A

proximal leg vein USS

if negative-> D-dimer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what to do if DVT unlikely?

A

D-dimer
if positive -> arrange USS asap
if can’t do USS in 4 hours -> LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mx of DVT?

A

LMWH or fondaparinux- continued until INR >2 for at least 24 hours
Give a vitamin K antagonist i.e. warfarin for 3 months
At 3 months clinicians should assess the risks and benefits of extending treatment.

If unprovoked DVT- full physical examination, CXR, bloods (FBC, serum calcium, LFTs) and urinalysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what needs doing in patients over 40 with first unprovoked DVT/PE?

A

investigate for malignancy with abdo-pelvic CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

features of PE?

A 
Chest pain (pleuritic)
dyspnoea
haemoptysis
tachycardia
tachypnoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

mx of PE?

A

Same as DVT
thrombolysis if massive PE where there is circulatory behaviour
IVC filters if repeat PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

causes of upper zone fibrosis

A 
CHARTS
Coal worker's pneumoconiosis
Hypersensitivity pneumonitis
Ankylosing spondylitis
Radiation
TB
Silicosis/sarcoidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

diagnosis of lung fibrosis

A

restrictive picture: FEV1 normal/decreased, FVC decreased, FEV1/FVC increased
CXR- ground-glass appearance, progresses to opacities
CT-diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what is coal-workers’ pneumoconiosis?

A

caused by long term exposure to coal dust particles, can be a long lead time 1st exposure and development of disease
caused by accumulation of macrophages in the alveoli which starts an immune response, causing damage to the lung tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what can coal-workers’ pneumoconiosis lead to?

A

Simple pneumoconiosis- opacities in lungs, can be asymptomatic
Progressive massive fibrosis- dust exposure causes patients to develop round fibrotic masses which can be several cms. Symptomatic with SOB, cough, black sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the effects of asbestos on the lung?

A
  1. pleural plaques
  2. pleural thickening
  3. asbestosis- lower lobe fibrosis
  4. mesothelioma- malignant disease of the pleura
  5. lung cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

which type of lung cancer has the worst prognosis?

A

SCLC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the main types of non small cell LC?

A

squamous (35%)
adenocarcinoma (30%)
large cell (10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

features of SCLC?

A

Arises from APUD cells
Associated with ectopic ADH, ACTH secretion
ADH-> hyponatraemia
ACTH -> cushing’s syndrome, bilateral adrenal hyperplasia
Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

mx of SCLC?

A

usually mets at time of diagnosis
surgery
chemoradiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

features of NSCLC?

A

SCC-
typically central, associated with PTHrP secretion -> hypercalcaemia + finger clubbing
HPOA- hypertrophic pulmonary osteoarthropathy

Adenocarcinoma-
typically peripheral
most common type in non-smokers, can cause HPOA and gynaecomastia

large cell- typically peripheral, poorly differentiated tumours with a poor prognosis, may secrete bHCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

mx of NSCLC?

A

Only 20% suitable for surgery

curative or palliative radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

2 week wait criteria for lung cancer

A 
CXR features that suggest lung cancer
over 40 with unexplained haemoptysis
over 40 with 2 of the following:
- cough
- fatigue
- SOB
-chest pain
- weight loss
- appetite loss

Consider if over 40 and persistent chest infections, clubbing, supraclavicular lymphadenopathy, thrombocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is bronchiectasis?

A

a permanent dilatation of the airways secondary to chronic infection or inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

causes of bronchiectasis?

A

post-infective- TB, measles, pertussis, pneumonia
CF
Bronchial obstruction
Immune deficiency- selective IgA, hypogammaglobulinaemia
ABPA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is a transudate and exudate?

A 
transudate= <30g/L of protein
exudate= >30g/L of protein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

causes of transudate pleural effusion?

A

heart failure
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
Meig’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

causes or exudate pleural effusion?

A 
Infection e.g. pneumonia. TB subphrenic abscess
connective tissue disease- RA, SLE
neoplastic
pancreatitis 
PE
Dressler's syndrome
yellow nail syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

features of pleural effusion?

A

dyspnoea

non-productive cough or chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Ix of pleural effusion?

A

CXR
Pleural aspiration- USS guided
contrast CT

47
Q

How to distinguish between transudate and exudate pleural effusion?

A

Light’s criteria if the protein level is between 25-35g/L
an exudate is likely if at least one of the following criteria are met:
- pleural fluid protein/ serum protein >0.5
- pleural fluid LDH/ serum LDH >0.6
- pleural fluid LDH more than 2/3 the upper limits of normal serum LDH

48
Q

what diagnosis is likely if pleural effusion has blood staining?

A

Mespthelioma
PE
TB

49
Q

what diagnosis is likely if pleural effusion is purulent or turbid/cloudy?

A

infection (needs chest drain)

50
Q

how to manage a recurring pleural effusion?

A

recurrent aspiration
pleurodesis
indwelling pleural catheter
opioids to relieve dyspnoea

51
Q

what is sarcoidosis?

A

a multisystem disorder of unknown aetiology characterised by non-caseating granuloma

52
Q

RFs of sarcoidosis?

A

young adults

African descent

53
Q

features of sarcoidosis?

A

Acute- erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
Insidious- dyspnoea, non-productive cough, malaise, weight loss
Skin- lupus pernio
Hypercalcaemia

54
Q

Ix of sarcoidosis

A 
clinical Dx
ACE levels- 60% sensitive and 70% specific
high calcium, high ESR
CXR
Spirometry- restrictive defect
tissue biopsy- non-caseating granuloma
55
Q

mx of sarcoidosis?

A

steroids if CXR stage 2 or 3, hypercalcaemia, eye, heart or neuro involvement

56
Q

common organisms for aspiration pneumonia?

A

Streptococcus pneumoniae
staph aureus
H. influenzae
pseudomonas aeruginosa

57
Q

Common organisms causing pneumonia?

A

Streptococcus pneumoniae
H.influenzae (esp if COPD)
Staph aureus
Mycoplasma pneumoniae- atypical pneumonia- presents as dry cough and atypical chest signs/CXR
Legionella pneumophilia- secondary to air conditioning units. Hyponatraemia and lymphopenia common
Klebsiella pneumoniae
PCP- HIV patients

58
Q

how does PCP present

A

HIV patients

dry cough, exercise-induced desaturations and the absence of chest signs

59
Q

S+S of pneumonia?

A

cough, sputum, dyspnoea, chest pain, fever
reduced breath sounds, bronchial breathing
reduced O2 sats

60
Q

Ix for pneumonia?

A 
CXR
Bloods- FBC, U&amp;Es, CRP
ABG
Blood and sputum cultures
Pneumococcal and legionella urinary antigen tests
61
Q

how are patients assessed for pneumonia?

A 
CURB65
Confusion (AMT <8) 
Urea (>7mmol/L) 
Resp rate >30/min
Blood pressure: SBP <90 or DBP <60
65 years plus

0- manage in community
1- SaO2 assessed which should be >92% to be safely managed in the community and CXR performed
2- manage in hospital

62
Q

mx of low severity CAP?

A

Amoxicillin- 5 days

if allergic macrolide or tetracycline

63
Q

mx of moderate and high severity CAP?

A

Dual abx therapy with amoxicillin and a macrolide -7-10 day course
if high severity- use co-amoxiclav instead

64
Q

what is FEV1?

A

volume of air exhaled in 1 second

65
Q

what is FVC?

A

Maximum volume of air a person can exhale

66
Q

What spirometry readings does thoracic kyphosis produce?

A

restrictive disease

means air can leave the lungs quickly but due to poor lung expansion FVC is low so ratio is higher

67
Q

what is TLCO?

A

Total gas transfer
an overall measure of gas transfer for the lungs from the alveoli into the capillaries and reflects how much O2 is taken up into the red cells

68
Q

what medications are given to help smoking cessation?

A

nicotine replacement therapy
varenicline- nicotine receptor partial agonist (start 1 week before stop date)
bupropion- NA and DA reuptake inhibitors
target stop date needed

69
Q

SEs of NRT?

A

n&v, headaches, flu-like symptoms

70
Q

SEs of varenicline?

A

nausea, headaches, insomnia, abnormal dreams

CI- pregnancy and breast feeding

71
Q

SEs of bupropion?

A

risk of seizures

CI- epilepsy, pregnancy and breast feeding

72
Q

S&S of pneumothorax?

A 
dyspnoea
chest pain: often pleuritic
sweating
tachypnoea
tachycardia
73
Q

what is a tension pneumothorax?

A

lung parenchymal flap is formed following trauma

trachea shift and hyper-resonance on affected side

74
Q

tx of tension pneumothorax?

A

needle decompression and chest tube

75
Q

mx of pneumothorax?

A

if the rim of air is <2cm and the patient is not SOB -> discharge
otherwise, aspiration
chest drain if not successful

76
Q

RFs for pneumothorax?

A

pre-existing lung disease
connective tissue disease- marfan’s, RA
ventilation
catamenial pneumothorax (spontaneous in menstruating women)

77
Q

what meds to give in hospital acquired pneumonia of <5 days?

A

co-amoxiclav or cefuroxime

78
Q

what meds to give in hospital acquired pneumonia of >5 days?

A

piperacillin with tazobactam or broad spec cephalosporin e.g. ceftazidime

79
Q

what is ARDS?

A

Acute respiratory distress syndrome (ARDS) is caused by the increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli, i.e. non-cardiogenic pulmonary oedema

80
Q

causes of ARDS?

A 
infection: sepsis, pneumonia
massive blood transfusion
trauma
smoke inhalation
acute pancreatitis
cardio-pulmonary bypass
81
Q

features of ARDS?

A

dyspnoea
elevated respiratory rate
bilateral lung crackles
low oxygen saturations

82
Q

Ix of ARDS?

A

CXR

ABG

83
Q

mx of ARDS?

A

due to the severity of the condition patients are generally managed in ITU
oxygenation/ventilation to treat the hypoxaemia
general organ support e.g. vasopressors as needed
treatment of the underlying cause e.g. antibiotics for sepsis
certain strategies such as prone positioning and muscle relaxation have been shown to improve outcome in ARDS

84
Q

What are the key indications for non-invasive ventilation?

A

COPD with respiratory acidosis pH 7.25-7.35*
type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation

85
Q

what is tidal volume?

A

volume inspired or expired with each breath at rest

500ml in males, 350ml in females

86
Q

causes of respiratory acidosis?

A

COPD
decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
neuromuscular disease
obesity hypoventilation syndrome
sedative drugs: benzodiazepines, opiate overdose

87
Q

causes of respiratory alkalosis?

A 
anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy
88
Q

criteria for steroid-responsiveness in COPD (asthmatic features)

A

prev diagnosis of asthma
higher blood eosinophil count
sustainable variation in FEV1 over time
substantial diurnal variation in peak expiratory flow (at least 20%)

89
Q

what type of asbestos is the most serious form?

A

crocidolite (blue)

90
Q

what is mesothelioma and symptoms?

A

malignant disease of the pleura

  • progressive SOB
  • chest pain
  • pleural effusion
91
Q

mx of mesothelioma?

A

palliative chemo

92
Q

review areas in a CXR?

A

behind the heart
under diaphragm
apices
costophrenic angles

93
Q

predisposing factors for pneumothorax?

A 
COPD
asthma
pulmonary fibrosis
cystic fibrosis
trauma
iatrogenic- central venous line obstruction, mechanical ventilation
94
Q

description of pulmonary fibrosis on CXR?

A

diffuse reticulonodular shadowing

95
Q

causes of upper lobe fibrosis?

A 
BREAST
Berylliosis
Radiation fibrosis
EAA
AS
Sarcoidosis
TB
96
Q

causes of lower lobe fibrosis?

A

connective tissue disease
asbestosis
cryptogenic fibrosing alveolitis
drug-induced- amiodarone, methotrexate

97
Q

causes of unilateral pleural effusions?

A 
malignant tumours
parapneumonic
PE
infarction
rheumatoid disease
98
Q

3 most common causes of left lower lobe collapse (sail sign)

A
  1. central hilar or endobronchial mass
  2. endobronchial foreign body esp children
  3. endobronchial mucus plug e.g. asthma
    Ix= bronchoscopy and CT thorax
99
Q

scenario: acute on chronic SOB in a young person?

A

cystic fibrosis with new pneumothorax

100
Q

what does pulmonary oedema look like on CXR?

A

bat wing sign

101
Q

causes of pulmonary oedema with and without cardiomegaly?

A

with CM- HF

without CM- acute renal failure, ARDS, after aggressive fluid resuscitation, massive acute PE, SAH

102
Q

differentials for a large globular heart and what to ask about in history?

A

congenital cardiac disease
cardiomyopathy
pericardial effusion
(ask about childhood illness and FH cardiac disease)

103
Q

signs of mitral valve disease on CXR?

A

moderately enlarged heart
prominence of left atrial appendage
double RHB- enlargement of left atrium

104
Q

causes of clubbing?

A

resp- pulmonary fibrosis, LC, abscess, bronchiectasis, CF
cardio- IE, cyanotic heart diseases
GI- IBD, coeliac, cirrhosis
thyroid- hyperthyroidism

105
Q

causes of interstitial lung disease?

A

occupational- asbestosis, sarcoidosis, coal dust, birds, hay, fungus
meds- radiation, methotrexate, amiodarone, nitrofurantoin
idiopathic pulmonary fibrosis
connective tissue disease- RA, systemic sclerosis, AS, dermatomyositis/polymyositis

others but learn these main ones!

106
Q

differential diagnosis of unilateral hilar enlargement vs bilateral hilar enlargement?

A 
Unilateral:
bronchial carcinoma
TB
lymphoma
metastatic mediastinal lymph node disease
Bilateral:
Sarcoidosis
Lymphoma
Pulmonary hypertension
Metastatic nodal disease
107
Q

differential for a cavitating lung lesion?

A 
bronchial carcinoma
TB
cavitating pneumonia
lung abscess
rheumatoid nodule
vasculitic disease e.g. Wegener's granulomatosis
108
Q

signs of left upper lobe collapse on CXR?

A

volume loss of left hemithorax (lung) with veil sign (opacification over whole lung)
may have increased density indicating a mass around the left hilum
trachea and mediastinum may be deviated to the left

109
Q

if there is lobe collapse, is the trachea deviated towards or away?

A

towards

110
Q

If there is a ‘white-out’ of a hemithorax it is useful to assess the position of the trachea - what does central, pushed or pulled tell you?

A
  1. Towards- Pneumonectomy, complete lung collapse e.g. endobronchial intubation, Pulmonary hypoplasia
  2. Central- Consolidation, Pulmonary oedema (usually bilateral), Mesothelioma
  3. Away- Pleural effusion, Diaphragmatic hernia, Large thoracic mass
111
Q

differentials for an anterior mediastinal mass?

A

trachea deviated away
thyroid enlargement, thymoma, teratoma, lymphoma
CT- guided biopsy

112
Q

what cancer can causes cannon-ball mets in a CXR?

A

renal cell carcinoma
others inc testicular malignancy and choriocarcinoma
do CT chest, abdo, pelvis

113
Q

if the R heart border is not visible, what lobe is affected?

A

right middle lobe

114
Q

what follow up to do after a lobar pneumonia?

A

CXR 6 weeks after Abx treatment

could be an underlying carcinoma

finals (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions