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Respiratory Flashcards

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1
Q

What is asthma?

A

Chronic inflammatory airway disorder

Characterised by recurrent episodes of SOB, cough, wheeze and chest tightness

Due to reversible airway obstruction

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2
Q

What are the 3 factors that contribute to airway obstruction in asthma?

A
  1. Bronchial muscle contraction
  2. Increased mucous secretion
  3. Mucosal swelling/ inflammation
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3
Q

What are the possible SYMPTOMS of asthma?

A
  1. SOB/ dyspnoea
  2. Cough
  3. Wheeze
  4. Chest tightness
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4
Q

Give 3 or more possible SIGNS of asthma on examination.

A
  1. Tachycardia
  2. Tachypnoea
  3. Reduced air entry
  4. Widespread polyphonic wheeze
  5. Chest hyperinflation
  6. Hyper-resonant percussion
  7. Accessory muscle use
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5
Q

Which drug is used initially to treat newly diagnosed asthma?

SAMA
SABA
ICS

A

SABA eg. Salbutamol/ Terbutaline

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6
Q

Which drug is used 2nd after SABAs in the treatment of chronic asthma?

LTRA
ICS
SAMA

A

ICS eg. Beclametosone/ Budesonide/ Fluticasone

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7
Q

Which drug is used 3rd after using SABAs and ICS in the treatment of chronic asthma?

LTRA
MART (LABA and ICS)
SAMA

A

LRTA eg. oral Monteleukast

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8
Q

Which drugs are given initially in the treatment of acute severe or life threatening asthma?

A
  1. Oxygen- aim sats 94-98%
  2. Salbutamol nebuliser (5mg with oxygen)
  3. Ipratropium nebuliser (0.5mg QDS)
  4. Steroids- either Prednisolone oral 40-50mg OR Hydrocortisone 100mg IV
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9
Q

Give 3 or more potential complications of COPD.

A
  1. Pulmonary hypertension
  2. Cor pulmonale
  3. Respiratory failure
  4. Lung cancer
  5. Acute exacerbations/ infectious exacerbations
  6. Polycythaemia (increased RBCs)
  7. Pneumothorax (due to ruptured bullae)
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10
Q

What 4 tests/ investigations should be done as recommended by NICE in diagnosing COPD?

A
  1. Spirometry with bronchodilator reversibility
  2. CXR- Exclude other pathologies
  3. FBC- Identify any secondary polycythaemia
  4. Calculate BMI
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11
Q

Give 2 or more side effects of B2 agonists used in asthma/COPD management.

A
  1. Tremor
  2. Anxiety
  3. Tachycardia
  4. Arrythmias
  5. Hypokalaemia
  6. Bronchospasm
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12
Q

What treatments options can be used in the management of Acute Exacerbations of COPD?

A
  1. Oxygen- aim sats 88-92%
  2. Nebulisers- Salbutamol 5mg 4hr,
    Ipratropium 500mg QDS
  3. Steroids- oral Prednisolone or IV hydrocortisone
  4. Antibiotics- if evidence of infection
  5. Oral Theophylline- if no response to nebulisers and steroids
  6. NIV- Non invasive ventilation- if pH <7.35 or PaCO2 >6kPa
  7. Intubation and ventilation- if pH <7.26 or PaCO2 rising despite trial of NIV.
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13
Q

Which antibiotic is given for low severity CAP?

Co-Amoxiclav
Amoxicillin
Metronidazole

A

Amoxicillin 500mg TDS 5 days

or Doxycyline/ Clarithromycin/ Erythromycin

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14
Q

Which 2 antibiotics are given for medium severity CAP?

Amoxicillin + Metronidazole
Amoxicillin + Doxycycline/ Clarithromycin
Doxycycline + Co-Amoxiclav

A

Amoxicillin + Doxycycline/ Clarithromycin

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15
Q

Which 2 antibiotics are given for high severity CAP?

Co-Amoxiclav and clarithromycin/erythromycin
Amoxicillin and Co-Amoxiclav
Metronidazole and Amoxicillin

A
  1. CoAmoxiclav
    Plus
  2. Clarithromycin/ Erythromycin
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16
Q

Which antibiotic is given 1st line for non-severe HAP?

A
  1. Co-Amoxiclav
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17
Q

Suggest 2 or more antibiotics which may be used 1st line for severe HAP?

A
  1. Tazocin
  2. Meropenem
  3. Ceftriaxone
  4. Levofloxacin
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18
Q

Suggest 3 or more potential complications of pneumonia.

A
  1. Para-pneumonic effusion
  2. Empyema
  3. Respiratory failure (Type 1)
  4. Lung abscess
  5. Atrial fibrillation
  6. Hypotension- due to sepsis
  7. ARDS
  8. Sepsis
  9. Pneumothorax
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19
Q

Pneumonia, pulmonary oedema, asthma and emphysema can cause which type of respiratory failure?

A

Type 1- PaO2 below 8kPa, Co2 levels normal or low.

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20
Q

COPD, GBS, Myasthenia gravis and opiods can cause which type of respiratory failure?

A

Type 2- PaO2 below 8kPa, CO2 levels above 6kPa.

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21
Q

Give 2 or more clinical features of hypercapnia.

Study These Flashcards
A
  1. Flapping tremor
  2. Bounding pulse
  3. Headache
  4. Peripheral vasodilation
  5. Tachycardia
  6. Papiloedema
  7. Confusion
22
Q

Give 2 or more clinical features of hypoxia.

Study These Flashcards
A
  1. Central cyanosis
  2. Dyspnoea
  3. Restlessness
  4. Confusion
  5. Polycythaemia
  6. Cor pulmonale
  7. Pulmonary HTN
23
Q

If a person in type 1 respiratory failure is on 60% oxygen for management, and their PaO2 remains below 8kPa, what is the next management option?

Study These Flashcards
A

Assisted ventilation- NIV or intubation.

24
Q

Patients in Type 2 respiratory failure should be started on ___% oxygen via Venturi mask.

25
Which respiratory condition is characterised by chronic inflammation of bronchi and bronchioles leading to airway thinning and dilatation?
Bronchiectasis
26
Which syndrome is an autosomal recessive disorder and has a triad of features including- 1. Bronchiectasis 2. Chronic sinusitis 3. Sinus invertus? Kartagener's syndrome Young's syndrome Marfan's syndrome
Kartagener's syndrome
27
Name 5 or more causes of haemoptysis.
1. Infections- TB, Bronchiectasis, Pneumonia, Aspergillosis 2. Parenchymal- Goodpasture's syndrome, Interstitial Fibrosis, Sarcoidosis, CF 3. Malignancy 4. Vascular- PE, Vasculitis 5. Cardiac- Pulmonary HTN, Mitral stenosis 6. Trauma/ foreign body 7. Warfarin
28
Which syndrome is characterised by male infertility (azoospermia), bronchiectasis and chronic sinusitis? Kartagener's syndrome Young's syndrome Marfan's syndrome
Young's syndrome
29
Give 4 or more clinical features of Cystic Fibrosis.
1. Neonatal- bowel obstruction (meconium ileus), failure to thrive 2. Resp- recurrent infections, bronchiectasis, haemoptysis 3. GI- pancreatic insufficiency, malabsorption, diabetes, bowel obstruction, gallstones 4. Male infertility 5. Female subfertility 6. Short stature 7. Rectal prolapse 8. Delayed puberty 9. Nasal polyps
30
Bronchiectasis is characterised by ______ inspiratory crepitations.
Coarse
31
ARDS is characterised by bilateral _____ inspiratory crepitations.
Fine
32
What are the possible ECG findings in a patient having a PE?
1. Normal ECG 2. Right BBB 3. Sinus tachycardia 4. S1 Q3 T3= Large S wave in lead 1, Q wave in lead 3, inverted T wave in lead 3.
33
Which of these therapies for smoking cessation is contraindicated in patients with epilepsy? Nicotine replacement therapy Varenicline Buproprion
Buproprion
34
In a tension pneumothorax, which way will the trachea deviate?
AWAY from the side of the pneumothorax
35
Name 5 or more causes of Cor Pulmonale (Think resp, vascular, neuromuscular etc)
1. Lung disease- COPD, Bronchiectasis, Fibrosis, Severe asthme 2. Pulmonary vascular disease- primary pulmonary HTN, vasculitis, PE, Sickle Cell 3. Neuromuscular disease- Myasthenia, MND 4. Sleep apnoea 5. Cardiovascular disease 6. Thoracic wall deformity- scoliosis, kyphosis
36
A patient has the following results from investigations: FBC shows raised Hb and haematocrit CXR shows right ventricular enlargement ECG shows right axis deviation and right ventricular hypertrophy What condition are they most likely to have?
Cor pulmonale
37
Describe 2 or more possible clinical signs of cor pulmonale.
1. Raised JVP 2. Peripheral oedema 3. Cyanosis 4. Tachycardia 5. Tricuspid regurgitation 6. Right ventricular heave 7. Hepatomegaly
38
What happens to serum calcium levels in sarcoidosis?
Hypercalcaemia
39
Which of these conditions causes fibrosis of the UPPER lung zones? SLE Drugs eg. Bleomycin TB Idiopathic Pulmonary Fibrosis
TB
40
Which of these conditions causes fibrosis of the LOWER lung zones? Asbestosis TB Coal worker's pneumoconiosis Hypersensitivity pneumonitis
Asbestosis
41
Name 2 or more causes of UPPER zone fibrosis of the lung.
1. Hypersensitivity pneumonitis (EAA) 2. Coal worker's pneumoconiosis 3. Silicosis 4. TB 5. Ankylosing spondylitis 6. Radiation
42
Name 1 or more drugs that can cause lung fibrosis.
1. Bleomycin 2. Methotrexate 3. Sulfasalazine 4. Amiodarone 5. Nitrofurantoin
43
Which type of ILD is characterised by "egg shell calcification" of the hilar lymph nodes?
Silicosis
44
Which antibiotic used for treating TB has a potential side effect of peripheral neuropathy so should be given with Vit B6 (Pyridoxine)?
Isoniazid
45
Name 4 or more causes of respiratory acidosis.
Hypoventilation- 1. Respiratory causes- COPD, asthma, pneumonia 2. Sleep apnoea 3. Drugs- opiods, sedatives 4. Central respiratory depression- CVA, tumour 5. Neurological- GBS, Myasthenia Gravis
46
Name 4 or more causes of respiratory alkalosis.
1. Hyperventilation- pain, anxiety 2. Hypoxia leading to compensatory increase in ventilation- altitude, severe anaemia, PE, pulmonary oedema 3. Increased mechanical ventilation
47
Give 3 or more causes of OBSTRUCTIVE lung disease.
``` COPD Asthma Emphysema Bronchiectasis CF ```
48
Give 3 or more causes of RESTRICTIVE lung disease.
``` Pulmonary oedema Pneumoconiosis Pleural effusion Fibrosis/ILD Obesity Pregnancy Connective tissue disorders Sarcoidosis Scoliosis Neuromuscular- MND, GBS, Myaesthenia ```
49
What happens to the FEV1, FVC and FEV1/FVC ratio in OBSTRUCTIVE lung disease when compared to normal?
FEV1 low FVC low/normal FEV1/FVC ratio low
50
What happens to the FEV1, FVC and FEV1/FVC ratio in RESTRICTIVE lung disease when compared to normal?
FEV1 low FVC low FEV1/FVC ratio normal
51
Kussmaul respiration is seen in which acid base disturbance?
Metabolic acidosis Deep fast sighing breaths used to expire excess Co2.
52
Name 3 respiratory and 3 other causes of finger clubbing.
Respiratory- 1. Lung cancer 2. Mesothelioma 3. Bronchiectasis 4. Idiopathic pulmonary fibrosis 5. Cystic fibrosis 6. TB Non-respiratory- 1. IBD- especially Crohns 2. Congenital cyanotic heart disease 3. Atrial myxoma 4. Endocarditis 5. Cirrhosis 6. Grave's disease 7. GI lyphoma

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