GP FELLOWSHIP EXAM > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

Exam findings in Bronchiectasis

A

Coarse crackles

Clubbing

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2
Q

Features of Bronchiectasis (exam and history and clues)

A
  • Clubbing
  • Coarse crackles
  • Pseudomonas or HIB colonisation
  • Recurrent infections
  • Minimal smoking history
  • Pleuritic chest pain
  • Haemoptysis
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3
Q

Features of ILD

A
  • Similar clinically to CCF
  • Fine inspiratory ‘velcro’ like crackles on exam - usually bibasally
  • Clubbing (30-50%)
  • Cor pulmonary in advanced disease
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4
Q

Spirometry pattern for ILD

A

Restrictive

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5
Q

Restrictive Spirometry possible causes

A
  • ILD
  • Obesity
  • Kyphoscoliosis
  • Neuromuscular disease
  • Pleural disease
  • Pneumonia
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6
Q

Causes of ILD

A

Connective tissue dx

Sarcoidosis

Drugs (nitrofurantoin)

occupational exposures (dust, mould, asbestos, bird, home brewing)

Idiopathic pulmonary fibrosis

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7
Q

Diagnosis for ILD or Bronchiectasis and findings

A

HRCT

Ground glass or honeycombing
reticular pattern

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8
Q

STEP wise approach to COPD puffers

A
  1. SABA or SAMA
    Salbutamol or atrovent

Add
2. LAMA: “Spiriva” tiotropium
“seebri” Gylcopyrronium
LABA:
Indacterol

OR LAMA/LABA
“spiolto” tiotropium /olodaterol
“brimica” Aclidinium /formeterol

add
3. ICS /LAMA/ LABA (combo)
“Trelegy” Fluticasone, umeclidinium, vilanterol

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9
Q

LAMA/LABA common drugs

A

“spiolto”
tiotropium /olodaterol

“brimica”
Aclidinium /formeterol

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10
Q

LAMA

A

Tiotropium
“Spiriva”

Glycopyrronium
“seebri”

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11
Q

LABA

A

“Serevent”
Salmeterol

Formeterol
“oxis”

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12
Q

ICS/LABA
low med high doses
2 examples

A

“Symbicort”
budesonide/formeterol
Low= 200-400
Med= 500-800
High =>800

“Seretide”
Fluticasone/salmeterol
Low dose: 100-200
Med: 250-500
High 500+

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13
Q

ASTHMA STEPWISE

A
  1. SABA prn **almost no on one
  2. ICS/SABA
    (OR BUDESONIDE/FORMETEROL PRN)
  3. ICS/LABA
    (plus prn or SABA prn) LOW dose
  4. ICS/LABA
    (plus prn or SABA prn) medium-high dose
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13
Q

ASTHMA STEPWISE

A
  1. SABA prn
    almost no one
  2. ICS/SABA
    OR ICS/LABA Budesonide & formeterol (symbicort low dose)
  3. ICS/LABA
    (plus prn or SABA prn) LOW dose
  4. ICS/LABA
    (plus prn or SABA prn) medium-high dose
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14
Q

Vague story:
- Young
- Cough and dyspnoea
- Non- acute
- Likely occupational exposure (eg stonemason)
- Possibly other systemic signs (?rash)

DDX

A
  • Interstitial lung disease from occupational exposure (silicosis)
  • Hypersensitivity pneumonitis
  • Work- associated asthma / occupational asthma
  • Sarcoidosis
  • Connective tissue disease (SLE, RA, systemic sclerosis)
  • Emphysema
  • Malignancy
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15
Q

Silicosis increases your risk of:

A

Lung cancer
TB

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16
Q

CRB-65

A

C: Confusion
R: Resp rate >30
B: BP systolic <90
65

1 point each
1-2 consider hospital
3+ - URGENT hospital

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17
Q

Epworth sleepiness scale cut off for concern

A

> 8

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18
Q

Gold standard OSA diagnosis

A

In-laboratory full Polysomnography

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19
Q

Questionnaires for OSA

A

STOP BANG
OSA50

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20
Q

OSA 50 score for testing

A

Obesity (3)
Snoring (3)
Apnoea (2)
Age >50 (2)

> 5

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21
Q

STOP BANG score for testing

A

Snoring
T: tired
O: observed apnoeas
P: Blood Pressure high
B: BMI >35
A: age> 50
N: Neck circ >40
G: Male gender

> 4

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22
Q

Hypersensitivity pneumonitis (common causes)

A
  • Bird fancier’s lung
  • Farmer’s lung
  • Mushroom worker’s lung
  • Humidifier’s lung
  • Grain processing
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23
Q

Stages of TB

A

Primary TB (usually contained by immune system)

Post primary disease (Reactivation) - usually within 5 years of initial infection

Latent
- no signs or symptoms
- Granulomatous lesion

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24
Cystic fibrosis differentials (chronic WET cough in child)
- Protracted bacterial bronchitis - Primary cilliary dyskinesia - Primary immunodeficiency - Congenital cardiac disease - Recurrent aspiration (eg TOF) - A1antitrypsin deficiency - Bronchiectasis - Recurrent bronchiolitis - TB - FB aspiration NOTE: Not GORD or post viral cough = not productive
25
Pattern of inheritance CF
Autosomal recessive Both parents must carry If both then 1/4 chance
26
Manifestations of cystic fibrosis
GI - Meconium ileus - Steatorrhea - Rectal prolapse - Pancreatic exocrine insufficency OTHER - Failure to thrive, faltering growth - Osteoporosis - Hypochloraemic hyponatraemic alkalosis Respiratory - Bronchiectasis - Sinusitis - Nasal polyposis - Chronic cough
27
Pertussis antibiotics
First line: Azithromycin 10mg/kg day 1 (500mg), then 5mg/kg (250mg)for 4 more days or clarithromycin 7.5mg/kg BD (500mg) for 7 days
28
Pertussis: who gets antibiotics
- Infants <6 months - Parents / household members of infants <6 months - If had symptoms for less than 21 days - those in a household with someone in their last month of pregnancy
29
Good control of asthma....
- Daytime symptoms =<2 days - Need SABA =<2 days - No limit to activity - No nocturnal symptoms
30
Children asthma preventers
ICS (flixotide JNR) Montelukast (NO LABAS)
31
Adolescents asthma how to treat (child or adult)
adult use labas EG Symbicort is good
32
Respiratory history questions
- Smoking - Travel - Occupational exposure to possible irritants - Vaccination history - Sputum production - Systemic symptoms eg fever - Asthma history eg wheeze - Medication history eg ACEi - Exposure to birds - Post tussive vomiting
33
Respiratory presentations (don't forget)
- Pertussis (prolonged cough) - TB (overseas, cough, weight loss) - Pulmonary abscess (weight loss)
34
Pertussis investigations (time course)
PCR & culture <4 weeks of cough Serology >4 weeks of cough
35
Pneumothorax rule of criteria for conservative management
TRAUMATIC!!! - if traumatic then not for conservative - BP <90 - Tachycardia - Tachypnoea - Hypoxia - Severe chest pain or breathlessness
36
What is conservative management for pneumothorax?
ED observation 4 hours Then DC home with 2 weekly CXRs
37
Small cell lung cancer radiological features
Central lesion (perihilar mass) Mediastinal LN enlargement
38
Optimising chronic lung disease
- Vaccination - Pulmonary rehabilitation - Early recognition and treatment of infective exacerbations with antibiotics - Regular exercise to maintain weight, muscle mass and strength. - Minimising exposure to respiratory infections
39
Signs of exacerbation of bronchiectasis
- Increased sputum purulence - Increased suputum volume or viscocity - Increased cough (may be associated with wheeze, breathlessness or haemoptysis)
40
Severe exacerbation of bronchiectasis - indications for hospitalisation
- Worsening hypoxaemia (from baseline) - Resp distress - Confusion - Sepsis
41
Contact with birds- what two diagnoses to consider
- Hypersensitivity pneumonitis (bird fancier's disease) - Psittacosis (chlamydia psittaci)
42
Red flags indicating hospital admission for CAP
- RR >22 - HR >100 - SPB <90 - Confusion - O2 <92 - Multi-lobar involvement
43
Types of occupational interstitial lung disease
Pneumoconiosis: - Silicosis - Coal worker's pneumoconiosis, - Asbestosis Hypersensitivity pneumonitis - Farmer's lung, bird fancier's lung Other interstitial disorders - Textile worker's lung
44
Causes of pleural effusion
Transudate - CCF - Liver failure (ascites) - Nephrotic syndrome Exudative - Infection: pneumonia, pleurisy, empyema - Malignancy: bronchial carcinoma, mesothelioma, metastatis -SLE/RA - Pulmonary infarction
45
Legionella pneumonia treatment (cooling systems)
Azithromycin 500mg for 3-7 days
46
Oxygen levels safe for flying
>95%
47
When do you need respiratory specialist clearance to fly (oxygen level)
<95%
48
Investigations for pulmonary TB
CXR Sputum for acid fast bacilli Sputum for Mycobacterium PCR Interferon- gamma release assay (more for latent)
49
Severe croup management (doses)
Adrenalin 1:1000 5ml nebulised, repeat 30 mins PLUS 2mg/kg pred (up to 50)
50
General measures for OSA management (PLUS devices)
- Weight loss 5-10% - Smoking cessation - EtOH cessation - Intranasal corticosteroids - Supine positional therapy (with predominately supine OSA) Devices: - CPAP (moderate to severe) - Mandibular advancement splint
51
Causes of Haemoptysis
Common: - URTI (24%) - Bronchiectasis - Chronic bronchitis - PE - Pneumonia - TB - Bronchogenic carcinoma - Blood from nose or throat
52
Markers of severity of croup
- Tachypnoea or bradypnoea - Marked increased WOB - Decreased level of consciousness/agitation - Stridor at rest
53
Spirometry: 1) Cut off for moderate and severe obstruction for predicted FEV1? 2) % for bronchodilator response & terminology for this
1) >40%-59% <40% predicted 2) 12% "reversible airflow limitation"
54
Indications for specialist review for COPD/Asthma
- Following a life threatening asthma admission - Occupational asthma - Frequent asthma needing repeat urgent GP visits - Moderate obstructive airways disease - Assessment for home O2 - Frequent chest infections
55
Indications for asthma preventer medication (paediatrics)
- Nocturnal symptoms > twice /month - Symptoms restricting activity - Admission - 2 or more ED presentations - 2 or more rounds of oral pred
56
Flixotide junior dose for paeds
Fluticasone propionate 50microg 1-2 puffs BD via spacer
57
Two options for preventer in kids
Montelukast 5mg PO Fluticasone propionate 50microg 1-2 puffs BD via spacer
58
Side effects of montelukast
- Suicidal ideation - Sleep disturbance - Agression - Anxiety
59
Exercise induced asthma management (pharmacological)
Inhaled corticosteroid
60
Pertussis isolation period
After 5 days of anitbiotics OR after 21 days of coughing
61
COPD specific LABA
Indacaterol
62
Size (mm) cut off for parapneumonic effusion needing sampling (instead of just regular CAP treatment)
10mm deep
63
Adult OSA examination
- Retrognathia - Mallampati score or tonsillar hypertrophy - BMI - Neck circumference - Nasal patency - ECG - CVD exam
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