MRCP Master > Resp General > Flashcards

Resp General Flashcards

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1
Q

Vital capacity/forced vital capacity

A

Volume that can be exhaledafter maximum inspiration
(ie. maximum inspiration to maximum expiration)
IRV + TV + ERV = VC
=4.5L

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2
Q

What does Spirometer measure

A

FCV,
FEV1
Flow vol loop
PEFR

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3
Q

What ratio is used to distinguish between obstructive and restrictive

A
  • FEV1/FVC
    < 0.7 = obstructive
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4
Q

If FEV1/FVC decrease what do you look at next
and what do conclude if that measure is
- Normal
- Low

A

FVC
Normal = Obstructive
Low = Mix
(usually reduced to a lesser extent in obstructive )

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5
Q

If FEV1/FVC in normal or High
you at the FVC again and if
- normal/ High
- Low

What does it indicate

A

FCV Low= restrictive
FCV normal high = normal lung mechanics

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6
Q

In obstructive disease and change of what in FEV1 pre & post bronchodilator is significant ?

A

12-15%

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7
Q

What does this indicate

A

Mild and severe obstruction

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8
Q

What can spirometry not measure and thus can give us TLC ?

A

Residual volumes

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9
Q

What does a pt have if they have a low TLC but normal/high FEV1/FVC?

A

Restrictive disease

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9
Q

If residual volume increased and TLC Increased

A

Obstructive

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10
Q

What does a pt have if they have a low TLC AND low FEV1/FVC?

A

mix restrictive & obstructive

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10
Q

Reduction of all lung volumes

A

restrictive disease

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10
Q

What test are needed to IX asthma in adults

A
  1. spirometry with a bronchodilator reversibility (BDR) test
  2. FeNO test
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11
Q

Decrease DLco (4)

A
  1. Decrease membrane surface area
    (emphysema)
  2. Increase membrane membrane thickness.
  3. PHTN
  4. Anemia
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12
Q

Increase in DLCO

A
  1. Exercise
  2. Asthma
  3. Pul. Hemorrhage
  4. Polycythemia
  5. Mile left HF
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13
Q

Describe moderate Asthma

PEFR
Speech
RR
Pulse

A

PEFR 50-75% best or predicted

Speech normal

RR < 25 / min

Pulse < 110 bpm

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14
Q

Describe Severe Asthma

PEFR
Speech
RR
Pulse

A

PEFR 33 - 50% best or predicted

Can’t complete sentences

RR > 25/min

Pulse > 110 bpm

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14
Q

Life-threatening Asthma

A

PEFR < 33% best or predicted

O2 < 92%

Silent chest, cyanosis or feeble respiratory effort

Bradycardia, dysrhythmia or hypotension

Exhaustion, confusion or coma

‘Normal’ pC02 (4.6-6.0 kPa)

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15
Q

Near-fatal asthma

A

raised pC02
and/or requiring mechanical ventilation with raised inflation pressure

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16
Q

What do SABA’s end in

A
  • buterol
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17
Q

COPD - still breathless despite using SABA/SAMA and no asthma/steroid responsive features

A

add a LABA + LAMA

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18
Q

what is after SABA, low ICS Step 3

A

SABA (ending -ol)
+ low-dose ICS
+ leukotriene receptor antagonist (LTRA) (-kast)
Nb. Caution with LTRA in pregnancy

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19
Q

What medication are used in the Step 4 of asthma

A

SABA
+ low-dose ICS
+ long-acting beta agonist (LABA) (ending in -metrol)

Continue LTRA depending on patient’s response to LTRA

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20
Q

name some long-acting beta agonist

A

relax smooth muscle work on B2
Arformoterol.
Bambuterol.
Clenbuterol.
Formoterol.
Salmeterol.
Protokylol.

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21
Name some LAMA's & Moa
Inhibits binding of ACh to M3 muscarinic receptors; blocks the bronchoconstrictor effects of acetylcholine, leading to bronchodilation. aclidin**ium** (Genuair) glycopyrron**ium** (Breezhaler) tiotrop**ium** (HandiHaler, Respimat) umeclidinium (Ellipta)
22
COPD Indication for LTOT O2
- PaO2 < 7.3 **PaO2 < 8 **if also have: - polycythemia, -peripheral oedema -nocturnal hypoxaemia or - Pul HTN
23
1st step in rx of COPD without asthma
Saba LABA + **LAMA**
24
1st step in rx of COPD with Asthma
SABA **OR** Sama LABA + ICS
25
2nd step of Rx COPD
SABA LABA + ICS +LAMA
26
Asthma rx step 5
SABA +/- LTRA Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS
27
Asthma rx step 6
SABA +/- LTRA + **medium-dose ICS** MART OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA
28
Asthma rx step 6
SABA +/- LTRA + one of the following options: * increase ICS to high-dose (only as part of a fixed-dose regime, not as a MART) * a trial of an additional drug (for example, a long-acting muscarinic receptor antagonist or theophylline) * seeking advice from a healthcare professional with expertise in asthma
29
What is Maintenance and reliever therapy (MART) ?
combined ICS and fast acting LABA treatment in one inhaler This is used as both reliver and maintenance Symbicort®(Budesonide/formoterol ), DuoResp Spiromax® (Budesonide/formoterol )
30
What is Apha 1 Antitrypsin deficiency
protein is a protease inhibitor from the liver that is secreted to inactivate Neutrophils Elastase (which breaks down elastin of bacteria). However, when there is a deficiency Elastase continues to break down the wall of the alveolus = enlargement of the air spaces = 1. pan acinar emphysema (Esp at the bases) 2. Chronic bronchitis 3. Bronchieltasis 4. Cirrhosis
31
Sx of Apha 1 Antitrypsin deficiency
COPD: pan acinar emphysema (Esp at the bases), Chronic bronchitis, Bronchieltasis Cirrhosis - phtn, coagulation deficiency --> hepatocellular carcinoma
32
Apha 1 Antitrypsin deficiency: * heterozygous: PiMZ
o however, if non-smoker low risk of developing emphsema but may pass on A1AT gene to children
33
Apha 1 Antitrypsin deficiency:PiSS
50% normal A1AT levels
34
PiZZ:
10% normal A1AT levels
35
Rx Apha 1 Antitrypsin deficiency
* no smoking * supportive: bronchodilators, physiotherapy * intravenous alpha1-antitrypsin protein concentrates * surgery: lung volume reduction surgery, lung transplantation
36
triangle of safety for chest drain
base of the axilla, lateral edge pectoralis major, 5th intercostal space anterior border of latissimus dorsi
37
common complication of plasma exchange
is hypocalcaemia
38
Indications for placing a chest tube in pleural infection:
1. frankly purulent or turbid/cloudy pleural fluid on sampling 2. organisms identified on G&S and/or culture from a non-purulent pleural fluid sample (indicates that pleural infection is established) 3. Pleural fluid pH < 7.2
39
What causes **exudative pleural effusions**
**exudative pleural effusions** -**inflammation** of the pulmonary capillaries which makes them much more leaky.
40
What causes **transudative pleural effusions**
**transudative** when too much fluid starts to leave the capillaries either because of increased hydrostatic **pressure** or decreased oncotic pressure in the blood vessels.
41
Examples **transudative pleural effusions** (3)
**Transudative** 1LVF 2Cirrhosis 3Nephrotic syndrome Other cause of hypoproteinemia Uncommon: myoedema, sarcoid, peritoneal dialysis
42
Examples **Exudative pleural effusions**(6)
**Exudative** 1. Infections: TB 2. Malignancy 3. PE 4. Connective tissue disorders 5. Sub diaphragmatic: (pancreatitis, sub phrenic abscess ) 6Trauma
43
Effusion with protein level < 25 g/L
Transudative
44
Effusion with protein level >35 g/L
Exudative
45
When do you need Lights criteria ?
When proteins levels are between 25-35 g/L
46
What is Lights criteria
Exudate is likely if one : fluid/serum 1. pleural fluid protein divided by serum **protein >0.5** 2. pleural fluid LDH divided by serum **LDH** >0.6 3. pleural fluid LDH more than 2/3 the upper limits of normal serum LDH
47
Characteristic pleural fluid findings: low glucose:
RA & TB
48
Characteristic pleural fluid findings: raised amylase:
pancreatitis, oesophageal perforation
49
Characteristic pleural fluid findings: heavy blood staining:
mesothelioma, pulmonary embolism, tuberculosis
50
RX Primary pneumothorax
1. Rim of air is < 2cm and pt NOT SOB = discharge 2. Otherwise, aspiration should be attempted 3. if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
51
Rx 2ndary pneumothorax (underlying lung ds)
All patients should be admitted for at least 24 hours - pt is > 50 y.o & rim > 2cm &/or the pt is SOB = chest drain should be inserted. - Otherwise aspiration should be attempted if rim is between 1-2cm. -If aspiration fails (i.e. pneumothorax >1cm) a chest drain should be inserted. if <1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
52
Upper zone fibrosis
CHARTS C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidos
53
Fibrosis predominately affecting the lower zones
1. Idiopathic pulmonary fibrosis 2. Most connective tissue disorders (except ankylosing spondylitis) e.g. SLE 3. Drug-induced: amiodarone, bleomycin, methotrexate, asbestosis
54
Explain the flow volume loop
55
What is happening when the flow volume loop shift to the right
Restrictive (Restrictive =right)
56
Respiratory alkalosis with decreased O2
PE
57
Oxygen dissociation curve shift left
Oxygen dissociation curve shifts Left - Lower oxygen delivery - Lower acidity, temp, 2-3 DPG - also HbF, carboxy/methaemoglobin
58
Oxygen dissociation curve what caused shift Right
shifts Right - Raised oxygen delivery - Raised acidity, temp, 2-3 DPG
59
Oxygen dissociation curve shift to the left means
decreased oxygen delivery to tissues
60
Oxygen dissociation curve shift to the Right means
enhanced oxygen delivery to tissues
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