FINALS > Resp > Flashcards

Resp Flashcards

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1
Q

More common type of lung cancer

A
  • Non small cell lung cancer = 80%
  • SCLC = 20%
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2
Q

types of non small cell lung cancer

A
  • adenocarcinoma
  • squamous cell carcinoma
  • large cell carcinoma
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3
Q

S+S lung cacner

A
  • Cough
  • Haemoptysis
  • SOB
  • Weight loss
  • Supraclavicular LN
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4
Q

Extrapulmonary manifestations

A
  • Recurrent laryngeal nerve palsy = hoarse voice
  • Phrenic nerve palsy = SOB
  • SVC obstruction = face swell, distended neck and upper chest veins = pembertons sign
  • Horners = ptosis, anhidrosis, miosis, pancoast
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5
Q

Paraneoplastic syndromes

A
  • SIADH = SCLC
  • Cushings = SCLC
  • Hypercalcaemia = squamous cell
  • Lambert eaton = SCLC = antibodies against SCLC cells and calcium channels
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6
Q

guidelines for lung cancer 2ww

A

> 40 with
- clubbing
- lymphadenopathy
- recurrent chest infections
- thrombocytosis (increased plt)
- chest signs

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7
Q

CXR for patients over 40 who have

A
  • 2+ unexplained sx in pt who never smoked
  • 1+ unexplained sx in pt that have ever smoked or had asbestos
    UE
  • cough, sob, chest pain, fatigue, weight loss
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8
Q

CXR in lung cancer

A
  • hilar enlargement
  • peripheral opacity (visible lesion)
  • pleural effusion (unilateral)
  • collapse
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9
Q

lung ca ix

A
  • CXR
  • Staging CT (contrast)
  • PET CT (for mets)
  • Bronchoscopy with endobrachial USS
  • histology = bronchoscopy
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10
Q

1st line tx NSCLC

A

surgery
- radiotherapy can also be curative

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11
Q

Tx SCLC

A
  • chemo and radio
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12
Q

CURB65

A
  • Confusion
  • urea >7
  • RR >30
  • BP <90 s or <60 d
  • > 65
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13
Q

Atypical pneumonia treatment

A
  • Macrolides (clarithromycin)
  • fluoroquinolones (levofloxacin)
  • tetracyclines (doxy)
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14
Q

Legionella S+S

A
  • can cause SIADH = hyponatraemia
  • urine antigen test to screen
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15
Q

Mycoplasma pneumoniae

A
  • rash = erythema multiforme
  • target lesions
  • neuro sx in young
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16
Q

PCP

A
  • Fungal pneumonia
  • Immunocompromised patients = steroids
  • Dry cough, SOB, night sweats
  • Prophylactic co-trimoxazole
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17
Q

Spirometry results for obstructive disease

A
  • FEV1 <70%
  • Obstruction is slowing air passage out the lungs
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18
Q

Sprirometry results for restrictive

A
  • FEV1 and FVC are equally reduced
  • FEV1:FVC ratio >70%
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19
Q

Asthma exam finding

A
  • Polyphonic expiratory wheeze
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20
Q

drugs that can worsen asthma

A
  • BB
  • NSAIDs
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21
Q

Asthma Ix

A
  • Spirometry
  • Reversibility testing >12% increase on testing
  • FeNO >40
  • Peak flow variabulity >20%
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22
Q

Asthma Mx

A

1 = SABA
2 = Inhaled corticosteroid (beclametasone)
3 = Leukotrine receptor antagonist
4 = LABA (salmeterol)
5 = MART regime
6 = increase ICS dose

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23
Q

ABG in acute asthma

A
  • initially = respiratory alkalosis as a raised RR caused drop in CO2
  • Normal PCo2 or low O2 = SCARY = getting tired
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24
Q

moderate exacerbation features asthma

A
  • peak flow 50-75%
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25
severe exacerbation features asthma
- peak flow 33-50% - RR >25 - HR >110 - Can't complete sentences
26
life threatening features asthma
- Peak flow <33% - sats <92% - PaO2 <8 - tiredness - confusion - Silent chest - shock
27
asthma exacerbation mx
OSHITME - Oxygen - Salbutamol 5mg nebs 20-30mins - Hydrocortisone=pred 40-50mg oral or 100mg H IV - Ipratropium = 500mcg nebs - T - Magnesium = IV 1.2-2g
28
MRC dyspnoea scale for COPD
1 = SOB on strenuous 2 = SOB uphill 3 = SOB on flat 4 = SOB <100m 5 = cant leave house
29
spirometry in COPD
- FEV1:FVC <70% - no response to reversibility testing
30
FEV1 staging for COPD
1 (mild) = FEV1 >80% predicted 2 (moderate) 50-79% 3 (severe) 30-49% 4 (V severe) <30%
31
Initial COPD tx
- SABA = salbutamol - SAMA = Ip bromide
32
COPD Mx if no asthma/steroid response
- LABA = formoterol and LAMA = tiotropium
33
COPD Mx if are asthma/steroid response
LABA and ICS
34
Chronic bronchitis COPD
- Mucus hypersecretion and airway obstruction Blue bloaters - Alveolar and renal hypoxia - Increased EPO secretion = polycythaemia - Increased renin = fluid retention - cyanosed and bloated
35
Emphysema COPD
- Alveolar trapping Pink puffers - Airway collapse on exhalation = obstruction - Exhale slowly through pursed lips - Increased airway pressure to prevent airway collapse - Flushing and puffing - Well perfused, barrel chest
36
final inhaler step for COPD
LABA, LAMA and ICS
37
when LTOT needed
- Chronic hypoxia <92% - polycythaemia - cyanosis - cor pulmonale
38
what is cor pulmonale
- Right sided HF - Pulmonary HTN limits RV pumping blood into pulmonary arteries - Causes back pressure
39
S+S cor pulmonale
- SOB - Oedema - Syncope - CHest pain - Hypoxia and cyanosis - Raised JVP
40
ABG in acute exacerbation COPD
Resp acidosis - Low pH - Hypoxia - Hypercapnia - Riased bicarb
41
COPD exacerbation mx
- inhalers and nebs - steroids = pred 30mg for 5d - abx if needed - physio Severe - IV aminophylline - NIV - ITU
42
when is NIV considered
- Persistent resp acidosis despite tx - potential to recover - acceptable to patient
43
what is bronchiectasis
- permanent dilation of the bronchi - chronic cough - continuous soutum production - recurrent infections
44
Ix bronchiectasis
- culture = HI and Psued aeruginosa - CXR - tram track opacities, ring shadows
45
Best ix for bronchiectasis
- High resolution CT
46
Mx bronchiectasis
- vaccines - physio - rehab - long term abx - colistin - bronchodilatoers - surgery
47
infective bronchiectasis mx
- cultures - abx extended course - ciprofloxaxin if pseud aer
48
S+S interstitial lung disease
- SOB - Dry cough - fatige - bibasal fine end inspiratory crackles - finger clubbing
49
Ix ILD
- clinical features - HRCT = ground glass - spirometry
50
spirometry for ILD
- restrictive - FEV and FVC equally reduced - FEV1:FVC ration >70% (normal/increased)
51
IDP signs and Mx
- SOB and cough >3 months - >50years old - Pirfenidone reduces fibrosis and imflam - Nintedanib inhibits tyrosine kinase
52
drugs that can cause pulmonary fibrosis
- amiodarone - cyclophosphamide - methotrexate - nitrofurantoin
53
patho hypersensitivity pneumonitis
- also called extrinsic allergic alveolitis - type 2 and 4 hypersensitivity reaction to an environmental allergen
54
Ix for Hypersensitivity Pneumonitis
- brobcheolar lavage = raised lymphocytes
55
causes of Hypersensitivity Pneumonitis
- bird fanciers lung - farmers lung - mushroom worker - malt workers
56
Mx Hypersensitivity Pneumonitis
- remove allergen - Oxygen - Steroids
57
Asbestos causes
- fibrosis - pleural thickening - adenocarcinoma - mesothelioma
58
exudative pleural effusion
- protein >30g/l
59
Transudative effusion
- protein <30g/l
60
Exudative causes
- inflamation - cancer - infeciton - rheumatoid
61
transudative causes
- congestive cardiac failure - hypoalbuminaemia - hypothyroidism - meigs syndrome
62
meigs syndrome
- benign ovarian tumour - pleural effusion - ascites
63
S+S effusion
- SOB - dull percussion - decreased breath sounds - trachea away in large effusions
64
CXR effusion
- blunt CP angle - fluid in fissures - meniscus - tracheal deviation away
65
Mx effusions
- Conservative - pleural aspiration - chest drain
66
empyema
- infected pleural effusion - pus, low oh, low glucose, high ldh - drain and abx
67
lights criteria for exudative
- Exudate = protein >30g/l if between 25-35 use lights criteria - pleural fluid protein/serum protein >0.5 - pleural fluid LDH/serum LDH >0.6 - pleural fluid LDH >2/3 upper limits normal serum LDH
68
Mx pneumothorax
- No SOB and <2cm air rim = no tx, follow up - SOB and >2cm = aspiration, if fails 2 then drain
69
where is drain in pneumothorax
- 5th IC space - mid axillary line - anterior axillary line
70
when surgery in pneumothorax
- chest drain fails to correct - persistent air leak in drain - recurrent pneumothorax
71
tension pneumothorax
- trauma - one way valve that lets air in and not out -
72
signs tension pneumothorax
- deviation away - reduced ae - increased resonance - tachy - hypo
73
mx tension pneumothorax
- large bore cannula into 2nd IC in MC line
74
definition of pulmonary htn
mean pulmonary arterial pressure >20 mmHg
75
5 causes pulmonary htn
1 = idiopathic 2 = left heart failure 3 = chronic lung disease 4 = pulmonary vascular disease 5 = miscellaneous
76
ECG in pul htn
- p pulmonale = peaked p waves - RV hypertrophy - right axis devation - RBBB
77
CXR in PHTN
- dilated pulmonary arteries - rv hypertrophy
78
mx idiopathic PHTN
- CCB - IV prostaglandins - Endothelin receptor antagonists - phosphodiesterae 5 inhibitors
79
epi of sarcoidosis
- 20-39 or 60 - women - black
80
skin features sarcoidosis
- erythema nodosum on shins - lupus pernio = purple lesions on cheeks and nose
81
lungs in sarcoidosis
- mediastinal lymphadenopathy - pulmonary fibrosis - pulmonary nodules
82
other s+s sarcoidosis
- fever, wl, fatigue - liver nodules, cirrhosis, cholestasis - uveitis, conjuncitivitis - optic neuritis - BBB - Kidney stones, neprhitis - DI - nerve palsy - arthralgia
83
lofgrens syndrome
- erythema nodosum - bilateral hilar lymphadenopathy - polyarthralgia
84
blood tests in sarcoidosis
- raised ACE - hypercalcaemia
85
sarcoidosis histology
non caseating granulomas with epithelioid cells
86
mx sarcoidosis
- conservative - oral steroids - bisphosphonates - methotrexate 2nd line
87
TB micro cause
- Mycobacterium tuberculosis - Bacillus - acid fast bacilli
88
staining for TB
Zeihl Neelsen stain - turns them bright red against blue background
89
testing pre TB vacciantion
- mantoux test - only given vaccine if negative
90
S+S TB
- cough - haemoptysis - lethargy - night sweats - weight loss - erythema nodosum
91
TB Ix
- mantoux test - interferon gamma release assay - CSR - cultures
92
what is mantoux
- inject tuberculin into intradermal space on forearm - after 72 hrs, induration 5mm or more = +ve
93
TB CXR
- Primary = patchy consolidation, pleural effusion, hilar lymphadenopathy - reactivated = patchy/nodular consolidation with cavitation - Disseminated = millet seeds
94
when is NAAT used
- diagnosing TB in HIV or <16 - RF for multi drug resistance
95
Latent TB Tx
- Isoniazid and rifampicin for 3 months - Or isoniazid for 5 m
96
RIPE
- Rifampicin 6m - Isonizaid 6m - Pyrazinamide 2m - Ethambutol 2m
97
RIPE and SE
- R = red tears and urine, reduced COCP - I = peripheral neuropathy - P = hyperuricaemia = gout and stones - E = colour blindness and reduced acuity
98
mx if wells score likely
- CTPA
99
mx if wells unlikely
- d dimer - if +ve then CTPA
100
ABG in PE
- resp alkalosis = blow off CO2 therefore alkalotic blood
101
mx PE
- 1st line = rivaroxaban - 2nd = LMWH = enoxaparin
102
how long to anticoagulate for in PE
- 3m if reversible cause - over 3m if unprovoked or irreversible cause - 3-6m active cancer
103
T1RD
- normal CO2 - low O2
104
T2RF
- high CO2 - Low O2
105
does co2 make blood acidic or alkalotic
acidic = breaks down into carbonic acid
106
what causes obstructive sleep apnoea
- collapse of pharyngeal airway
107
S+S apnoea
- apnoea during sleep - snoring - morning headache - unrefreshed - daytime sleepiness - concentration problems - reduced oxygen sats
108
asthma diagnostic testing >17 years
- all pt should have spirometry with bronchodialtor reversibility - all should have FeNO
109
asthma testing 5-16 yrs
- spirometry with BDR - FeNo if normal spirometry or obstructive spirometry with negative BDR
110
what is polysomnography
sleep studies
111
common causes resp alkalosis
- anxiety - PE - CNS disorders - altitude - pregnancy
112
how does SABA work
- stimulates b2 receptors of resp tract - increases sympathetic activity relaxes bronchial smooth muscle
FINALS
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