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Y 3 Medicine > Respiratory key points > Flashcards

Respiratory key points Flashcards

1
Q

Questions to ask about breathlessness

A

MRC score, exercise tolerance, triggers, relieving factors, diurnal variation, Orthopnoea, PND

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2
Q

Questions to ask about chest pain

A

Site, severity, radiation, triggers, relieving factors, associated symptoms

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3
Q

Questions to ask about wheeze

A

Triggers, relieving factors, diurnal variation, associated cough

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4
Q

Questions to ask about cough

A

Dry or productive, triggers, relieving factors, diurnal variation, association with eating or dyspepsia, positional, nasal secretions, associated fever

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5
Q

Questions to ask about sputum

A

How much over 24 hours, colour, consistency

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6
Q

Questions to ask about haemoptysis

A

Quantity and frequency, fever/night sweats, appetite, weight loss

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7
Q

What appearance of CT scan suggests infection

A

Ground glass

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8
Q

How do you treat pseudomonas

A

Piperacillin

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9
Q

Principles of PE treatment

A

Look for cause, lifelong anticoagulants, check for cancer

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10
Q

Can you see pulmonary hypertension on CT scan

A

Yes

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11
Q

What drug can help bad ILD

A

Morphine

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12
Q

Features of bronchiectasis

A

Airway dilatation and mucous plugs

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13
Q

What can help people cough up mucous

A

Mucolytics e.g. NaCl nebulised and Carbocisteine, salbutamol helps as can dilate airways further to increase amount of mucous coughed up

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14
Q

Tips for resp exam

A

Don’t need to percuss in more than 3 areas, chest expansion important for thumbs to hover, with tracheal deviation check for empty space either side of trachea before localising centrally, ensure when auscultating back you are not listening over spine or scapula, check for clubbing by lowering down to height of nails, check RR tricking for pulse, remember lymph nodes

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15
Q

What usually causes COPD/ILD

A

COPD usually smoking, ILD more commonly occupational or allergy related

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16
Q

Examination in ILD

A

Fine crackles, especially at lung bases, inspiratory

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17
Q

Explanation of ILD appearance on spirometry

A

Restrictive pattern due to fibrosis as less air able to enter lungs

FEV1/FVC ratio normal as both are proportionately lower

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18
Q

Causes of delirium

A

M is also metabolic

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19
Q

target O2 sats

A

92%

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20
Q

Gold standard answer for giving oxygen

A

Controlled oxygen and assess patient response

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21
Q

How to present investigations

A

Start with bedside and do most invasive at the end

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22
Q

What 2 asthma drugs should not be given together in acute asthma attack

A

IV aminophylline and IV salbutamol

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23
Q

Why is hyperventilation a good sign in asthma

A

Shows good respiratory muscle function (CO2 is low), as time goes on the respiratory muscles begin to fatigue and the CO2 increases or becomes normal which is a worry as clearly the patient no longer has the physiological reserve to compensate

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24
Q

SOB and pleuritic chest pain key differentials

A

Pericarditis and pneumothorax, PE

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25
Q

What clinical finding defines a tension pneumothorax

A

Hypotension (haemodynamic instability). hemidiaphragm depressed

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26
Q

COPD exacerbation investigations

A

CXR and ABG (to check for high CO2 indicating type 2 respiratory failure especially if GCS not normal)

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27
Q

What do you call respiratory acidosis if not compensated

A

Acute rather than chronic

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28
Q

NIV is only for

A

T2 respiratory failure in context of respiratory acidosis and after you gave tried with medical therapy. CPAP is next step before intubation

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29
Q

Type 1 and 2 resp failure modes of oxygen as final step before intubation

A

T1 needs CPAP T2 needs BIPAP

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30
Q

Contraindications to NIV

A

Untreated pneumothorax, impaired conscious level, upper airway secretions, facial injury, life threatening hypoxia, vomiting, agitated

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31
Q

How does fibrosis show on CXR

A

Fine reticular Nodular shadowing

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32
Q

What should you check before you send someone for a CT scan

A

Us and Es for kidney function to check they can handle contrast

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33
Q

PE classification

A

PE can be provoked or unprovoked, haemodynamically stable or unstable

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34
Q

Treatment for different PE types

A

Thrombolysis for haemodynamically unstable, routine anticoagulation if stable

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35
Q

Treatment for asthma attack

A

Steroids 1st line
IV aminophylline/salbutamol
nebulised salbutamol/ipratropium bromide

Urgent ITU or anaesthetist assessment , admit patient, portable CXR

36
Q

T1 and T2 resp failure O2 sats aim

A

T1 = above 94%
T2 = 88-92%

37
Q

What is a safe asthma discharge bundle

A

PEFR > 75%, stopped regular nebs for over 24 hours, inhaler technique and adherance assessed, PEFR meter and asthma action plan

At least 5 days oral pred, GP follow up within 2 working days, resp clinic follow up within 4 weeks

38
Q

Principle of asthma management

A

Step up and down treatment

39
Q

Causes of COPD

A

Smoking, inherited alpha 1 antitrypsin deficinecy, industrial exposure such as sooty air pollution

40
Q

What is COPD

A

Airflow obstruction which is progressive and not fully reversible. Encompasses emphysema and chronic bronchitis

41
Q

ECG changes with electrolyte disturbance

A
42
Q

What to check when prescribing furosemide

A

Us and Es for eGFR as can impact kidney function and K+ to check for hypokalaemia

43
Q

Risk factors for heart failure

A

Previous MI, A fib, HTN

44
Q

Raised Troponin in someone with Afib

A

Can be due to Afib, if not chest pain then not major concern, send for repeat perhaps

45
Q

What are possible clinical signs when examining a patient with COPD

A

Tachypnoea, wheeze, pursed lip breathing, barrel chest, peripheral cyanosis, CO2 retention flap, oedema, accessory muscle use

46
Q

COPD care bundle

A

Smoking cessation and pulmonary rehab

Bronchodilators, anti muscarinics, steroids and mucolytics

Diet

LTOT

47
Q

What interventions alter prognosis for patients with COPD

A

LTOT for 16 hours a day, smoking cessation, pulmonary rehab, vaccination

48
Q

Why may uncontrolled oxygen be potentially dangerous in someone with COPD

A

Could cause hypercapnia due to loss of hypoxic pulmonary vasoconstriction and respiratory drive (T2 resp failure)

49
Q

What is the role of pulmonary rehabilitation in COPD

A

To increase social activities and exercise to help symptoms. MDT 6-12 week programme of supervised exercise, unsupervised home exercise, nutritional advice and disease education

50
Q

Common causes of cough

A

Pneumonia, asthma, COPD, bronchitis, acid reflux, bronchiectasis

51
Q

What drugs can cause cough

A

ACEi, sitagliptin, CCB, fentanyl, latanoprost, methotrexate, phenytoin, mycophenolate mofetil, omeprazole

52
Q

LRTI CXR changes

A

None

53
Q

Investigations for cough

A

Lung function tests if chronic

Sputum sample, CXR, (pneumonia), FBC, CRP

54
Q

CAP pathogens

A

Strep pn, H Influenzae, Moraxella Catarrhalis

55
Q

Atypical pneumonia organisms

A

Legionella, pneumophila, chlamydia, mycoplasma

Considered when not common on sputum sample or normal antibiotics not helping, high CURB65

56
Q

What features help differentiate CAP from TB

A

TB

Fever and nocturnal sweats in TB, weight loss over months, malaise, purulent sputum. May have skin/joint/Miliary TB, known TB contact or country

Longer history and upper zones on CXr affected

57
Q

HAP pathogens

A

E. coli, MRSA, pseudomonas, staph/strep/acinobacter

58
Q

Hap and cap antibiotics

A

HAP Coamox if non severe (broad spectrum), Piperacillin or levofloxacin if severe

CAP amox or azithro

59
Q

What follow up arrangements should be made for a patient with pneumonia

A

HIV test, immunoglobulins, pneumococcal IgG serotypes, Haemophilus influenzae, 6 week CXR to check for resolution/cancer

60
Q

What 3 clinical features do patients requiring hospital admission for COVID have

A

Hypoxia, bilateral lower zone changes on CXR, lymphopaenia (eosinopaenia)

61
Q

COVID treatment

A

Oxygen, dexamethasone if on O2, tocilizumab/remdesivir, antibiotics, anticoagulation with heparin, CPAP

62
Q

Co morbid conditions with lung cancer

A

TB scars, ILD, CAD, COPD

63
Q

Clinical findings in lung cancer

A

Finger clubbing, dullness to percussion, cervical lymphadenopathy, wheeze, pallor, cachexia

64
Q

What sites do lung cancer commonly metastasise to

A

Brain bones liver adrenals other lung

Nearby lymph nodes

65
Q

Paraneoplastic syndromes associated with lung cancer

A

Clubbing - increased blood flow to finger area leading to accumulation of fluid, xs growth factors encourage growth of blood vessels
Hypercalcaemia - increased bone resorption as PTHrP has a similar action to PTH
Anaemia - impaired EPO stimulation and production
SIADH - cancer cells can produce ADH
Cushing’s - Small cell lung cancer due to XS production of cortisol
Lambert Eaton myasthenia syndrome - small cell lung cancer (development of autoantibodies due to antigens expressed by lung tumour, which cross react with channels at the neuromuscular junction)

66
Q

CXR abnormalities in lung cancer

A

Single or multiple opacities, pleural effusion, lung collapse

67
Q

How do you stage lung cancer

A

Staging CT

NSCLC is better than SC

68
Q

Why is lung cancer prognosis generally poor

A

Present with advanced or metastatic disease as symptoms can be masked by COPD etc

69
Q

Opacification due to pleural effusion in lung cancer

A

Bad sign as suggests pleural involvement

70
Q

Further imaging to diagnose pleural effusion

A

USS

71
Q

Clinical signs in pleural effusion

A

Reduced chest expansion, tracheal deviation away, reduced vocal resonance, stony dull percussion, breath sounds reduced

Nicotine staining, clubbing, RA joint deformity, fluid overload due to HF

72
Q

How much is pleural fluid aspiration

A

50ml

73
Q

How do you distinguish pleural fluid

A

Lights criteria

Exudate if pleural fluid protein divided by serum protein is greater than 0.5

74
Q

Symptoms in ILD

A

Progressive SOBOE, dry cough, connective tissue disease symptoms (arthralgia, dysphagia, dry eyes), general fatigue and malaise

75
Q

Clinical signs in ILD

A

Bilateral fine end inspiratory crackles, dullness to percussion, finger clubbing, reynauds, arthritis causing crepitus

76
Q

Common types of ILD

A

Usual interstitial pneumonia: idiopathic pulmonary fibrosis

Non specific interstitial pneumonia: hypersensitivity pneumonitis

Sarcoidosis

77
Q

Recognised drugs causing ILD

A

Amiodarone, bleomycin, methotrexate, nitrofurantoin

78
Q

ILD CXR appearance

A

Like a web- diffuse alveolar shadowing, reticular opacities, fibrosis

79
Q

Which test confirms bronchiectasis

A

High resolution CT thorax

80
Q

Common causes of bronchiectasis

A

Post infecting (whooping cough, TB), pulmonary disease (COPD/asthma), congenital CF, connective tissue disease, ABPA,

81
Q

Common pathogens in bronchiectasis sputum

A

Haemophilus inf., pseudomonas Aeruginosa, moraxella catarrhalis, strep pn

82
Q

Key principles of managing bronchiectasis

A

Treat underlying cause, physio for mucous clearance, sputum for routine culture as well as non TB bacteria

10 - 14 days antibiotics according to sputum culture

83
Q

Pathology of CF

A

Autosomal recessive disease leading to mutations in CFTR gene (chromosome 7). Leads to multisystem disease (mostly resp and GI), caused by thickened secretions

84
Q

Common multi systemic complications of CF

A

Respiratory infections, low body weight due to pancreatic insufficiency, distal intestinal obstruction syndrome due to thick dehydrated faeces/insufficient pancreatic enzymes, CF related diabetes, male infertility

85
Q

Name an ICS, SABA and LABA

A

ICS beclomethasone
SABA salbutamol
LABA salmeterol

Y 3 Medicine (6 decks)

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