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Respiratory > Year 4 > Flashcards

Year 4 Flashcards

1
Q

What are the 2 classifications of a pleural effusion?

A

Transudate
Exudate

Relates to the protein content of the effusion.

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2
Q

What is defined as a transudate?

A

A protein content of <30g/L.

Looks clear on aspiration.

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3
Q

What are the 4 main causes of transudate pleural effusion?

A

Heart failure (most common)
Hypoalbuminaemia
Hypothyroidism
Meig’s syndrome

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4
Q

What is defined as an exudate?

A

A protein content of >30g/L.

Looks cloudy on aspiration.

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5
Q

What are 3 common causes of an exudate?

A

Infection (most common)
Connective tissue disease
Neoplasia

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6
Q

If protein content of pleural effusion is borderline, what can be used to determine if exudate or transudate?

A

Light’s critera

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7
Q

What are the 3 criteria involved in Light’s criteria for determining if a pleural effusion is an exudate?

A

Pleural fluid protein/serum protein is >0.5
Pleural LDH/serum LDH is >0.6
Pleural LDH > 2/3rds of the upper limit of normal serum

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8
Q

Low glucose within pleural fluid is suggestive of which 2 diagnoses?

A

Rheumatoid arthritis
Tuberculosis

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9
Q

Raised amylase within the pleural fluid is suggestive of which diagnoses?

A

Pancreatitis
Oesophageal perforation

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10
Q

Blood-stained pleural aspirate is indicative of which 3 conditions?

A

Mesothelioma
PE
Tuberculosis

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11
Q

What occurs in a transudative pleural effusion?

A

Too much fluid within blood vessels, leading to leakage into the interstitial space.

A result of increased hydrostatic pressure, and decreased oncotic pressure.

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12
Q

What is hydrostatic pressure?

A

The force that blood exerts on the vessel walls. Normally referred to as blood pressure.

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13
Q

What is oncotic pressure?

A

The force by which fluid moves from areas of low solute to high - as per osmosis.

Considers fluid level in relation to highly concentrated the solute (proteins) are.

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14
Q

How does a reduction in oncotic pressure affect fluid levels within blood vessels?

A

As body thinks protein has been diluted, water is removed from vessels into interstitial space.

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15
Q

What causes an exudative pleural effusion?

A

Inflammation of pulmonary capillaries, resulting in friable, leaky vessels.

Allows large proteins (e.g. LDH) into the interstitial fluid.

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16
Q

What is the procedure of aspirating a pleural effusion called?

A

Thoracocentesis

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17
Q

Does COPD cause finger clubbing?

A

No

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18
Q

What is first-line COPD management?

A

SABA/SAMA

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19
Q

What is second-line COPD management in those WITH asthmatic features?

A

Add LABA+ICS to first-line therapy.

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20
Q

What is second-line COPD management in those WITHOUT asthmatic features?

A

Add LABA+LAMA therapy to SABA.

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21
Q

Can LAMA be added to patient on SAMA as first-line management?

A

No, if adding LAMA, change SAMA to SABA.

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22
Q

What is the purpose of carbocisteine therapy in COPD?

A

Acts to break down mucus.

Taken orally.

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23
Q

Which antibiotic can be given prophylactically in COPD?

A

Azithromycin

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24
Q

What does raised bicarbonate, alongside low pH, and raised pCO2 indicate?

A

Respiratory acidosis with metabolic compensation.

Indicates chronic issues as kidneys take a while to respond.

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25
Q

Which ABG sign is seen in both type 1 and type 2 respiratory failure?

A

Low pO2

26
Q

How is type 1 and type 2 respiratory failure differentiated?

A

Type 1 has low pO2 and NORMAL pCO2.

Type 2 has low pO2 and HIGH pCO2.

27
Q

How may O2 therapy be disadvantageous in COPD?

A

In COPD, O2 depletion drives respiration - this cannot be overcome, as always deficient.

When external O2 is introduced, respiratory drive is reduced, thus increasing CO2 retention further.

28
Q

What severity of asthma attack is suggested by a PEFR of 50-75%?

A

Moderate

29
Q

How is speech, pulse and respiratory rate affected in moderate asthma?

A

Speech normal
RR<25/min
Pulse<110bpm

30
Q

What severity of asthma attack is suggested by a PEFR of 33-50%?

A

Severe

31
Q

How is speech, respiratory rate and pulse affected in a severe asthma attack?

A

Can’t complete sentences
RR>25/min
Pulse>110bpm

32
Q

Which form of asthma attack is associated with a PEFR <33%?

A

Life-threatening

33
Q

How are O2 saturations affected in life-threatening asthma?

A

<92%

34
Q

Silent chest, cyanosis, or feeble respiratory effort are associated with which severity of asthma attack?

A

Life-threatening

35
Q

Bradycardia, dysrhythmia or hypotension are associated with which severity of asthma attack?

A

Life-threatening

36
Q

Signs of exhaustion or confusion are associated with which severity of asthma attack?

A

Life-threatening

May lead to coma.

37
Q

In life-threatening asthma, how is pCO2 affected?

A

Will be normal.

Suggests failing respiratory effort.

38
Q

How does salbutamol influence potassium levels?

A

Can cause this to be taken up by cells more eagerly.

39
Q

How does acute asthma present on ABG?

A

Respiratory alkalosis followed by respiratory acidosis.

If normal pCO2, worry about life-threatening severity.

40
Q

What are 3 smoking cessation therapies available on the NHS?

A

Varencicline
Bupropion
Nicotine replacement therapy (NRT)

41
Q

Which smoking cessation therapy is NOT contraindicated in pregnancy?

A

Nicotine replacement therapy (NRT)

42
Q

Which smoking cessation therapy is not contraindicated in those breastfeeding?

A

Nicotine replacement therapy (NRT)

43
Q

How is smoking cessation managed during pregnancy?

A

Self-help and CBT - if this fails give nicotine replacement therapy.

44
Q

What lung manifestation is seen in alpha-1-antitrypsin deficiency?

A

Emphysema

Seen in young, non-smokers.

45
Q

How does alpha-1-antitrypsin deficiency affect spirometry?

A

Produces an obstructive pattern.

46
Q

What other organ system, outwith the lungs, is affected in alpha-1-antitrypsin deficiency?

A

Liver

Causes cirrhosis/malignancy in adults and cholestasis in children.

47
Q

Which organism is most commonly seen in those with bronchiectasis?

A

Haemophilus influenzaeW

48
Q

What is the most common form of CXR?

A

PA

49
Q

Why is a pneumothorax most likely to be seen at the top of a CXR?

A

As CXR usually taken with patient erect, and air rises.

50
Q

What is meant by the meniscus sign on a CXR?

A

If fluid present within a lobe, the lateral wall will appear higher than anterior/posterior regions - looks like a meniscus.

51
Q

At which stage of inspiration should a CXR be taken?

A

At the end of a full inspiration.

52
Q

What does a flatter than expected diaphragm and smaller than expected heart on a CXR indicate?

A

Hyperinflation

53
Q

Is the heart larger on PA or AP CXR?

A

AP

As it lies more anteriorly.

54
Q

How does atelectasis impact the trachea?

A

On CXR, trachea will appear pulled TOWARDS the side of the lesion.

55
Q

How would a tension pneumothorax impact the positioning of the trachea?

A

On CXR, will be pulled AWAY from the side of the lesion.

56
Q

What is the ‘ABCDE’ of pulmonary oedema on a CXR?

A

Alveolar opacification
Batwing oedema
Cardiomegaly
Diffuse interstitial thickening
Effusion

57
Q

Which lung hilum should lie higher than the other?

A

Left

Due to the position of the pulmonary arteries.

58
Q

What may an enlarged heart border indicate?

A

Ventricular enlargement
Pulmonary hypertension
Poor inspiratory effort (hyperinflated)

59
Q

Which diaphragm should lie slightly higher on a CXR?

A

Right diaphragm

60
Q

How much fluid should be present if blunted costophrenic angles are seen on a CXR?

A

Atleast 150ml

61
Q

What does ‘OSHITMAN’ of acute asthma management stand for?

A

Oxygen
Salbutamol nebuliser
Hydrocortisone IV/Prednisolone oral
Ipratropium
Theophylline
Magnesium sulphate
Anaesthetic review

Respiratory (28 decks)

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