MSRA > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

COPD still breathless despite SABA/SAMA next step if no steroid responsive features

A

LABA and LAMA

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2
Q

COPD features suggestive of steroid responsiveness

A

previous asthma diagnosis
eosinophilia
diurnal variation

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3
Q

4 parts of COPD general management

A

smoking cessation
annual flu vaccine
one off pneumococcal vaccine
pulmonary rehab

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4
Q

COPD vaccines

A

annual flu
once off pneumococcal

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5
Q

Which COPD patients suitable for pulmonary rehab?

A

functionally disabled by COPD
MRC 3+

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6
Q

first line treatment COPD

A

SAMA or SABA

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7
Q

if no asthmatic features, COPD - what to do when starting LABA and LAMA

A

change SAMA to SABA

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8
Q

COPD - escalating treatment from SABA and has steroid responsive features

A

LABA and ICS

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9
Q

What is in triple therapy COPD

A

LABA+LAMA+ICS

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10
Q

COPD - what patients for theophylline

A

cannot use inhalers
trialled short and long acting bronchodilator

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11
Q

What to do with theophylline dose if macrolide or fluoroquinolone prescribed?

A

reduce dose

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12
Q

COPD - prophylactic antibiotic

A

azithromycin

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13
Q

pre-requisistes azithromycin for COPD

A

not smoke
optimised treatments
exacerbations
CT thorax
sputum culture
LFT and ECG

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14
Q

Why do you need an ecg before azithromycin?

A

QT prolongation

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15
Q

Why CT thorax before azithromycin?

A

exclude bronchiectasis

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16
Q

what are rescue meds COPD

A

oral CCS and oral antibiotics

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17
Q

COPD - who is for rescue meds

A

exacerbation in last year
understand risks and how to take it
know when to seek help

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18
Q

COPD - when to consider mucolytics

A

chronic productive cough

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19
Q

features cor pulmonale

A

peripheral oedema
raised jvp
parasternal heave
loud P2

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20
Q

cor pulmonale treatment

A

loop diuretic
LTOT

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21
Q

ACE-I, CCB and alpha blockers for cor pulmonale?

A

not recommended

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22
Q

Who is affected by aspergilloma?

A

immunocompromised
TB
emphysema

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23
Q

Aspergilloma symptoms

A

fever, cough, haemoptysis

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24
Q

Treatment aspergilloma

A

itraconazole

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25
List some causes of haemoptysis
lung ca PE aspergilloma goodpastures, granulomatosis with polyangitis pulmonary oedema TB LRTI bronchiectasis mitral stenosis
26
miner, egg shell opacification of hilar nodes, upper zone fibrosis - diagnosis?
silicosis
27
occupations at risk of silicosis
miner slate worker potteries
28
features silicosis
upper zone fibrosis egg shell opacification hilar LN
29
can mitral stenosis cause haemoptysis?
yes
30
underlying mechanism haemoptysis mitral stenosis
rupture of bronchial veins due to raised left atrial pressure
31
4 criteria moderate severe asthma
PEFR 50-75% speech normal RR<25 HR <110
32
cant complete sentences - what type of acute asthma
severe
33
severe asthma features
HR >110 RR>25 PEFR 33-50% can't complete sentences
34
list some life-threatening acute asthma features
sats <92% silent chest bradycardia, enhaustion normal PaCO2 PEFR <33%
35
near fatal asthma
raised PCO2, mechanical ventilation
36
Assessing acute asthma
abg if sats <92% Consider CXR
37
CXR in acute asthma indications
life threatening pneumothorax suspected fail to respond to treatment
38
treatment acute asthma
oxygen salbutamol neb hydrocortisone ipratropium bromide Magnesium sulfate Theophylline intubation and ventilation
39
acute asthma criteria for discharge
stable on discharge meds (no nebs) for 12-24hrs inhaler technique checked and recorded PEF>75% best or predicted
40
gold standard investigation for pulmonary fibrosis
high res CT
41
HRCT findings pulmonary fibrosis
ground glass honeycombing reticular abnormalities basal parts of lung
42
patient group pulmonary fibrosis
50-70yrs, men
43
features pulmonary fibrosis
progressive exertional dyspnoea bibasal fine end-inspiratory crepitations on auscultation dry cough clubbing
44
investigations IPF
spirometry high res CT ANA
45
spirometry IPF
restrictive picture FEV1 normal/decreased FVC decreased
46
TLCO in IPF - increased or decreased
reduced
47
treatment IPF
pulmonary rehab pirfenidone O2 and lung transplant
48
medication used in IPF and mode of action
pirfenidone antifibrotic
49
2 most common causes of bilateral hilar lymphadenopathy
TB sarcoidosis
50
main 2 indications for surgery in bronchiectasis
uncontrollable haemoptysis localised disease
51
What is bronchiectasis?
permanent dilatation of airways secondary to chronic infection or inflammation
52
managing bronchiectasis
inspiratory muscle training antibiotics bronchodilator immunisation surgery
53
4 most common organisms bronchiectasis
H influenzae pseudomonas klebsiella strep pneumoniae
54
classic presentation of Alpha-1 antitrypsin (A1AT) deficiency
emphysema in young, non-smokers
55
inheritance Alpha-1 antitrypsin (A1AT) deficiency
autosomal recessive Chr 14
56
genotype most people who manifest Alpha-1 antitrypsin (A1AT) deficiency
PiZZ
57
investigations Alpha-1 antitrypsin (A1AT) deficiency
A1AT concentration spirometry - obstructive
58
managing Alpha-1 antitrypsin (A1AT) deficiency
no smoking bronchodilator, physio IV A1AP conc surgery - lung volume reduction, transplant
59
predisposing factors OSA
obesity macroglossia large tonsils marfans
60
consequence of OSA
daytime somnolence compensated resp acidosis HTN
61
How to assess sleepiness OSA
Epworth scale multiple sleep latency test
62
diagnostic test OSA
sleep studies
63
managing OSA
weight loss CPAP Intra oral devices Inform DVLA if excessive daytime somnolence
64
Asthma - when do BTS recommend to step down treatment?
every 3 months
65
By how much to reduced ICS in asthma?
25-50% at a time
66
Critically ill patients oxygen therapy
15L NRBM
67
target sats acutely unwell pt
94-98
68
patients at risk of hypercapnia target sats
88-92
69
oxygen mask for COPD patient
28% venturi prior to abg at 4L/min
70
Should oxygen be routinely used in MI and stroke?
no
71
patient groups affected by klebsiella pneumonia
alcoholic diabetic
72
sputum in klebsiella pneumonia
red currant jelly
73
klebsiella pneumonia upper or lower lobes
upper
74
mortality klebsiella pneumonia
30-50%
75
causes of white areas on CXR
consolidation pleural effusion pneumonectomy pulmonary oedema
76
white out of thorax with trachea pulled towards it
pneumonectomy complete lung collapse
77
white out of lung with central trachea
consolidation pulmonary oedema
78
white out of lung with trachea pushed away
pleural effusion large thoracic mass
79
most common organism exacerbation COPD
H influenzae
80
treating exacerbation COPD
increase SABA nebs pred 5 days antibiotics if purulent sputum
81
COPD first line antibiotics exacerbation
amox or clari or doxy
82
Next step if COPD patient has type 2 resp failure
NIV
83
neuromuscular disease - spirometry
restrictive
84
causes of obstructive spirometry
COPD Asthma bronchiectasis
85
causes of restrictive picture - spirometry
pulmonary fibrosis ARDS, sarcoidosis severe obesity
86
most common type of lung ca
adenocarcinoma
87
what are pleural plaques
benign do not undergo malignant change asbestos exposure
88
most dangerous asbestos
blue crocidolite
89
next investigation after CXR for suspected lung ca
contrast enhanced CT
90
acute features of sarcoidosis
erythema nodosum, bilateral hilar LN, swinging fever, polyarthralgia
91
sarcoidosis - caseating or non caseating grnulomas?
non caseating
92
skin disorder sarcoidosis
erythema nodosum lupus pernio
93
CURB65
Confusion AMT<8 urea >7 RR>30 bp <90 or <60 >65
94
CRB65 of 0
can treat at home
95
CRB65 of 1 or 2
consider hospital
96
CRB 3 or 4
urgent admission
97
Investigations CAP
CXR Bloods and sputum cultures CRP
98
treatment CAP
amoxocillin clarithromycin
99
What should all cases of pneumonia have 6 weeks later?
CXR
100
salmeterol class
LABA
101
most important in the long term control of his symptoms in brocnhiectasis
postural drainage inspiratory muscle training
102
investigations for COPD
spirometry pst bronchodilator CXR FBC BMI
103
FEV1>80% predicted COPD
mild COPD
104
FEV1 60% in COPD is
moderate
105
ABG - rome
resp opposite metabolic equal
106
Spirometry restrictive picture and reduced TLCO...
pulmonary fibrosis
107
Management of atelectasis
position upright chest physio
108
definition HAP
pneumonia occurs >48 hours after admission
109
List some causative organisms of HAP
staph aureus MRSA pseudomonas gram -ve bacilli MDR pathogens
110
Treatment HAP
oral co-amoxiclav IV taz or IV meropenem MRSA - vanc
111
first line investigations suspected lung ca
CXR
112
first line treatment new asthma diagnosis
Low dose ICS and LABA
113
What is formoterol?
LABA
114
What is MART?
ICS and LABA regularly and as required
115
5 steps managing asthma treatment
ICS+LABA Low dose MART moderate dose MART Check FeNO and eosinophil refer to specialist
116
In asthma if FeNO and eosinophils raised or not raised what to do?
raised - refer not raised - trial LTRA or LAMA in addition to moderate dose MART
117
What has replaced as required SABA?
Low dose ICS/formoterol as required
118
risk factors for lung abscess
poor dental hygiene previous stroke reduced consciousness
119
Other sources of lung abscess
haematogenous spread eg IE direct extension bronchial obstruction
120
clinical features lung abscess
night sweats and weight loss fever foul smelling sputum chest pain, SOB
121
signs lung abscess
dull percussion bronchial breathing
122
investigation lung abscess
CXR - fluid filled space with area of consolidation sputum and blood cultures
123
management lung abscess
IV antibiotics not resolving - percutaneous draininage
124
diagnostic criteria for ARDS
Acute onset CXR - bilateral infiltrates pO2/fiO2 <40kPa Non-cardiogenic
125
Pathophysiology of ARDS?
increased permeability of alveolar capillaries fluid accumulation in alveoli
126
causes of ARDS
Infection massive blood transfusion trauma smoke inhalation acute pancreatitis covid-19
127
clinical features of ARDS
SOB elevated RR bilateral lung crackles low O2 sats
128
key investigations ARDS
CXR and abg
129
management of ARDS
ITU oxygen/ventilation organ support treat underlying cause prone positioning muscle relaxation
130
can alpha 1 antitrypsin deficiency be diagnosed prenatally?
yes
131
A1AT deficiency spirometry
obstructive picture
132
Imaging pleural effusion
PA chest x-ray USS Contrast CT
133
What should pleural aspirate be sent for?
pH, protein, LDH, cytology and microbiology
134
What is lights criteria used for?
transudate vs exudate
135
When is lights critera used?
protein between 25-35
136
protein level exudates and transudates
transudates <30 exudate >30
137
What does lights criteria preface?
likely to be an exudate if...
138
Lights criteria
likely to be exudate if pleural fluid protein divided by serum protein >0.5 pleural fluid LDH divided by serum LDH >0.6 pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
139
pleural fluid - low glucose
rheumatoid arthritis TB
140
raised amylase - pleural aspirate
pancreatitis, oesophageal aspiration
141
low complement pleural aspirate
SLE
142
pleural aspirate - heavy blood staining
mesothelioma, PE, TB
143
When to place a chest tube in pleural infection
purulent/turbid/cloudy clear but pH <7.2
144
managing recurrent pleural effusions
recurrent aspiration pleurodesis indwelling pleural catheter opioids for SOB
145
managing bronchitis
analgesia fluid intake consider antibiotics
146
bronchitis - when would you prescribe antibiotics?
systematically unwell co-morbidities CRP 20-100 (delayed) or >100 (immediately)
147
first line antibiotic bronchitis
doxy alternative amox
148
Is it safe to breasfeed while taking prednisolone?
yes
149
Reason for using inhaled CCS in COPD
reduced frequency of exacerbations
150
paraneoplastic features - small cell lung ca
ADH ACTH - HTN, hypokalaemia
151
squamous cell lung ca - paraneoplastic
PTHrP secretion causes hypercalcaemia Low PTH
152
small cell lung ca ADH ACTH
ADH - hyponatraemia ACTH - cushings
153
Lambert Eaton syndrome
small cell lung ca
154
management small cell lung ca
If very early, no nodal involvement surgery otherwise chemo/radio
155
If people cannot complete sentences in acute asthma it is..
acute severe
156
abg triad for chronic CO2 retention
normal pH high PCO2 High HCO3
157
First thing to assess in PTX management
symptomatic?
158
pneumothorax symptoms
significant pain SOB physiological compromise
159
asymptomatic PTX
conservative care regardless of pneumothorax size
160
PTX high risk characteristics
haemodynamic compromise significant hypoxia underlying lung disease bilateral PTX >50 with significant smoking hx haemothorax
161
PTX with high risk features
chest drain
162
recurrent PTX management
VATS
163
PTX discharge advice
stop smoking do not fly until 1 week post CXR Scuba diving
164
symotomatic PTX with no high risk features
conservative ambulatory device needle aspiration
165
antibodies in Lambert Eaton syndrome
voltage gated calcium channels
166
x-ray findings in heart failure
Alveolar oedema Bat wing/kerley B lines Cardiomegaly Dilated upper lobe vessels Effusion
167
common causes resp alkalosis
anxiety PE salicylate poisoning CNS disorders pregnancy altitude
168
commonest causes of anterior mediastinum mass
4Ts teratoma terrible LNs thymic mass thyroid mass
169
first line treatment exacerbation COPD
amoxicillin
170
immediate management tension pneumothorax
needle throacostomy
171
landmark - tension PTX
midaxillary line, 5th intercostal space
172
PTHrP associated with what type of lung ca
squamous cell
173
gram negative bacilli causing late onset HAP
E coli
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