AAAMedicine > Resp quick > Flashcards

Resp quick Flashcards

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1
Q

When to give abx for acute bronchitis?

A

Considered if systemically unwell, pre existing co morbidities

CRP 20-100 = delayed
>100 =immediate

Give doxycycline, if pregnant amoxicillin

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2
Q

ARDS criteria

A

Acute onset pulmonary oedema, bilateral infiltrates on CXR, non cardiogenic, PO2/FiO@ <40kPA

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3
Q

Bronchiectasis most common organisms

A

H. influenzae
Klebsiella spp
pseudomonas aeruingosa

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4
Q

Upper lung fibrosis causes?

A

CHARTS -
Coal workers,
Hypersensitivity
Ank spon
Radiation
TB
Silicosis and sarcoid

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5
Q

Lower lung fibrosis causes

A

IPF, SLE, drug induced, asbestosis

Drug induced = Amiodarone, methotrexate, nitro, bromocriptine

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6
Q

Where do you see pleural plaques in asbestosis>

A

Midzones

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7
Q

What is IPF?
What is the investigation and what do you see?

A

Restrictive progressive exertion duspnoeea

Honey comb/ ground glass on CT

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8
Q

Treatment of IPF?

A

Pirefenidone
Nitedanib
Pulmon. rehab

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9
Q

Hypersensitivity pneumonitis!?
What to do?

A

Type 3 reaction
Remove the allergen and give o2 adn steroids

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10
Q

Small cell lung cancer

A

Smokers
Central
APUD cells
ADH and ACTH secretion
Hyponatraemia, cushings, hypokalaemia acidosis

Lambert eaton!

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11
Q

Adenocarcinoma lung cancer

A

Gynaecomastia and HPOA

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12
Q

Squamous lung cancer

A

Cavitating legions, PtH, HPOEA, hypercalcaemai

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13
Q

Large cell lung cancer

A

Peripheral. B-HCG

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14
Q

Bronchial adenoma

A

Carcinoid. 5HT

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15
Q

Surgical contraindications for lung cancer?

A

FEV <1.5
Malignant pleural effusion
Tumour near the hilum
Vocal cord paralysis
SVC obstruction

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16
Q

Referral for lung cancer?

A

2WW CXR in 40+ if:
- persistent or recurrent chest infection, clubbing, lymphadenopathy

If haemopytsis

If 2 of (or 1 + smoker) – cough, fatigue, sob, chest pain etc etc, weight loss

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17
Q

What do you do for lung cancer investigations wise?

A

CXR and CT
Mediastinoscopy before surgery to see lymph node involvement

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18
Q

What is Lambert eaton?

A

Antibodies against small cell lung cancer
Target voltage gated Ca channels on presynaptic terminals in motor neurones

Weakness of proximal muscles!!!
Reduced tendon reflex

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19
Q

Cancers that commonly metastasise to the lungs

A

Breast, colorectal, renal, bladder and prostate

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20
Q

EXUdative pleural effusion?

A

> 30
INFLAMMATION
Infective, SLE,RA, neoplasia, pancreatic, PE, dressers etc

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21
Q

Transudative pleural effusion?

A

<30. HF, hypoalbuminaemia, hypothyroid, Meigs

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22
Q

Investigations for pleural effusion

A

PA CXR
Pleural aspiration - 21g needle and 50mg syringe
If teh protein is between 25-35 use lights!

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23
Q

What is lights?

A

exudate more likely if/…

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24
Q

If low glucose/ high amylase/ low complement on pleural aspiration what does it indicate?

A

Glucose low - RA, TB
Low complement - SLE
High amylase - Pancreatitis, oesphageal perforation

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25
OSA investigations
Epworth sleepiness scale, MSLT Polysomnography
26
Pneumonia- mycoplasma
Dry cough, atypical signs, may get autoimmune haemolytic anaemia
27
Legionella signs - pneumonia
Hyponatraemia and lymohopenia
28
Klebisella pneumonia
Alcoholics, aspiration
29
HAP criteria
48 Hours or more
30
Low severity CAP treatment
Amox 5 days or macrolide/ tetracycline
31
Moderate to high severity CAP treatment?
Amox and macrolide for 7-10 days
32
HAP treatment?
Within 5 days of admission- co amox/ cefuloxime 5 days+ --- piperacllin with taz
33
CURB65 score results
Home based care if 0-1 Hospital if 2 or more Intestive care if 3 or more
34
Pneumocystitis jivoreci?
Opportunistic Bilateral pulmonary infiltrates, exercise induced desaturations adn bronchoalveolar lavage
35
Treatment for pneumoncystitis jivoreci?
Co trimaxazole
36
Pneumothorax management
No or minimal symptoms = conservative If high risk characteristics = chest drain If no high risk bu symptomatic = needle aspiration, chest drain if uncessefful
37
Persistent/ recurrent pnumothorax?
VATS
38
What are the high risk characteristics with pneumothorax?
Haemodynamic compromise Significant hypoxia Bilateral pneumothorax Underlying lung disease >50 + and smoking history Haemothroax
39
Tension pneumothorax treatment?
Decompression of pleural space Needle thoracotomy.
40
Increase TLCO causes?
Asthma, pulmonary haemorrhage, polycythaemia, male, exercise
41
Reduced TLCO causes?
Pulmonary fibrosis, pneumonia, PE, anaemia
42
TB treatment
Latent TB if risk of activation = isoniazid and rifampicin for 6 months if active - + pyranizime and ethubutamol for 2 months
43
What is gold standard for TB?
Sputum culture
44
Ethambutamol side effects
Optic neuritis
45
Purazamide side effets
Hyperaemia, gout, arthralgia
46
Rifampicin side effects
Hepatitis, orange tears
47
Isoniazid side effects
Peripheral neuropathy
48
Steroids indication in sarcoid?
Parenchymal lung disease, uveitis, hypercalcaemia, neuro or cardiac involvement
49
Sarcoid signs?
increase in ACE and ca. Hilar lymphadenopathy Can get CNS involvement
50
Treatment of sarcoid?
Oral steroids Methotrexate 2nd line
51
most common cause of COPD exacerbation?
h. influenzai
52
Treatment for infective exacerbation of COPD/
Increase the frequency of bronchodilator use and consider giving via a nebuliser prednisolone 30 mg daily for 5 days giving oral antibiotics 'if sputum is purulent or there are clinical signs of pneumonia' amoxicillin or clarithromycin or doxycycline.
53
Atelectasis? what is it and treatment?
Common post op complication where you get alveolar collapse Hyperaemia and dyspnoea 72 hours post op. Positioning and chest physio!!!!
54
Anterior mediastinum mass?
Teratoma, terrible lymphadenoaptjy, thymic mass, thyroid mass
55
What is granulomatosis with polyangiiitis?
Autoimmune associated with necrotising granulomatous vasculitis ENT - saddle shaped nose URT - epistaxis, sinusitis
56
COPD first line treatment
SABA or SAMA
57
COPD second line treatment?
if asthmatic features = LABA + ICS (add a lama third line) if none - LABA + LAMA
58
Other things to give with COOD?
Standby short course of corticosteroids and abx at home if; - exacerbation in last year - understand how to take AZITHROMYCIN Also one off pnuemococcal and annual influenza
59
Asthma in adults investigations?
Eosinophil or FeNO Diagnose if FeNO >50 or esophil is high If not confirmed do bronchodilator reversibility with spirometry If not confirmed do bronchial challenge test
60
Children 5-16 diagnosis asthma?
FeNO >35 If not confirmed - bronchodilator reversibility with spirometry If not confirmed - skin prick testing and total IGE and esophil
61
Children <5 diagnosing asthma?
Just give them corticosteroids
62
Management of asthma - 12+
1.Low dose ICS 2.Low Dose MART 3.Moderate dose MART 4.Check FeNO - if raised --- specialist, if not triad LAMA
63
Management of asthma <12
Twice daily paediatric low dose inhaled corticosteroid and SABA
64
Asthma <5 management?
8-12 w trial of low dose ICS and SABA as required
65
Step down of steroids?
25-50% at a time
66
FEV1 significantly reduced FVC reduced or normal FEV1% (fev1/fvc) -- reduce
OBSTRUCTIVE
67
FEV1 - reduced FVC - significantly reduced FEV1% ( FEV1/FVC)- normal or increased
RESTRICTIVE
68
Causes of obstructive FEV?
Asthma COPD Bronchiectasis Bronchiolitis obliterans
69
Causes of restrictive FEV?
Pulmonary fibrosis Asbestosis Sarcoidosis ARDS Infant respiratory distress syndrome Kyphoscoliosis e.g. ank spon Neuromuscular disorders Severe obesity
70
Resp acidosis causes?
COPD decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema neuromuscular disease obesity hypoventilation syndrome sedative drugs: benzodiazepines, opiate overdose
71
Life threatening asthma signs?
PEFR < 33% best or predicted Oxygen sats < 92% 'Normal' pC02 (4.6-6.0 kPa) Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma
72
Alpha 1 antitrypsan features?
Panacinar emphysema, COPD, cirrhosis, HCC, cholestasis in children
73
COPD on CXR features?
hyperinflation flattened hemidiaphragms hyperlucent lung fields
74
Cannon ball on CXR
?RCC
75
Sarcoidosis
Bilateral hilar lymphadenopathy HYPERcalcaemia High ACE
76
Triangle of safety
base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi
77
Chest drain drained too quick?
Can get pulmonary oedema !
78
DO PLEURAL PLAQUES undergo change?
nO
79
What causes oral thrush?
Inhaled beclometasone Oral candidiasis, also known as thrush, is caused most commonly by the fungal organism Candida albicans . It produces white spots on the mucous membranes of the mouth and it can lead to a loss of taste sensation. They are mostly painless although can be accompanied by a burning sensation. Predisposing factors include: immunosuppression, endocrine disorders such as diabetes, use of broad-spectrum antibiotics and also inhaled steroid use.
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