Respiratory Medicine — Flashcards
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Stridor in Acute Epiglotitis is a _____
When offering triple therapy in COPD and a patient is already taking a SAMA --> _____
A silent chest is a _____ feature of an asthma attack
First-line antibiotics for infective exacerbation of COPD are _____
Hint: 3
_____ should be given to all children who have an asthma attack
Salmeterol is a _____
Consider _____ if they are feeding 50% of normal amount with suspected bronchiolitis
A pCO2 of 4.9kPa is _____ which indicates this acute asthma attack is life-threatening
What should a temperature of 39.7C in suspected bronchiolitis make you consider? _____
Non-invasive ventilation is indicated in COPD with _____
Respiratory Medicine UK Medical PG Flashcards - Medical Study Cards
Master Respiratory Medicine with OnCourse flashcards. These spaced repetition flashcards are designed for medical students preparing for NEET PG, USMLE Step 1, USMLE Step 2, MBBS exams, and other medical licensing examinations.
Respiratory Medicine Flashcard Deck - 503 Cards
Flashcard 1: Stridor in Acute Epiglotitis is a _____
Answer: high-pitched, inspiratory sound
Flashcard 2: When offering triple therapy in COPD and a patient is already taking a SAMA --> _____
Answer: discontinue and switch to a SABA
Flashcard 3: A silent chest is a _____ feature of an asthma attack
Answer: life-threatening
Flashcard 4: First-line antibiotics for infective exacerbation of COPD are _____
Answer: Amoxicillin, clarithromycin or doxycycline
Flashcard 5: _____ should be given to all children who have an asthma attack
Answer: Steroid therapy
Flashcard 6: Salmeterol is a _____
Answer: LABA
Flashcard 7: Consider _____ if they are feeding 50% of normal amount with suspected bronchiolitis
Answer: referring children to hospital
Flashcard 8: A pCO2 of 4.9kPa is _____ which indicates this acute asthma attack is life-threatening
Answer: normal
Flashcard 9: What should a temperature of 39.7C in suspected bronchiolitis make you consider? _____
Answer: Alternative diagnosis (e.g. Pneumonia)
Flashcard 10: Non-invasive ventilation is indicated in COPD with _____
Answer: Respiratory acidosis (ph7.25-7.35)
Flashcard 11: Severe respiratory distress indicated by _____ would suggest immediate admission via ambulance
Answer: grunting
Flashcard 12: Ankle Oedema in a COPD patient would be an indication for _____
Answer: LTOT
Flashcard 13: _____ is a monoclonal antibody which is used to prevent RSV in children who are at increased risk of severe disease
Answer: Palivizumab
Flashcard 14: Long-term oxygen therapy should not be offered to COPD patients who are _____
Answer: active smokers
Flashcard 15: Bronchiolitis typically presents with _____
Answer: wheezing & fast breathing
Flashcard 16: guidelines recommend that _____ should be used where possible to increase medication compliance
Answer: combination inhalers
Flashcard 17: What is the intervention of choice for a cynaosed patient in CDH _____
Answer: Intubate and Ventilate
Flashcard 18: What would cause the trachea to be pushed away from the white-out? _____ diaphragmatic hernia large thoracic mass
Answer: pleural effusion
Flashcard 19: What would cause the trachea being pulled toward the white-out on CXR? _____ Complete lung collapse e.g. endobronchial intubation Pulmonary hypoplasia
Answer: Pneumonectomy
Flashcard 20: Tiotropium is a _____
Answer: LAMA
Flashcard 21: Patients with Acute Bronchitis typically present with: _____
Answer: cough: may or may not be productive sore throat rhinorrhoea wheeze
Flashcard 22: If needle aspiration of a pneumothorax does not resolve symptoms → _____
Answer: Insert chest drain
Flashcard 23: _____ is the most likely to cause bacterial pneumonia following influenza infection
Answer: Staphylococcus Aureus
Flashcard 24: Management of Adult Patients and children >12 with newly diagnosed asthma: Step 1: _____ Step 2: Regular low-dose regular ICS/formoterol combination inhaler [MART therapy] Step 3: Regular moderate-dose MART therapy Step 4: Refer to a respiratory specialist
Answer: Low-dose ICS/formoterol combination inhaler as needed [AIR therapy]
Flashcard 25: Acute Bronchitis usually resolves before 3 weeks, however _____ of patients will still have a cough beyond this time
Answer: 25%
Flashcard 26: _____ is more common than mesothelioma in patients with asbestos exposure
Answer: Lung cancer
Flashcard 27: MART stands for _____
Answer: Maintenance and Reliever Therapy
Flashcard 28: Adrenaline acts on Beta-2 (β2) receptors to cause _____
Answer: bronchodilation in Lungs Vasodilation in vesels that supply - skeletal muscle & Heart
Flashcard 29: Adenosine should be avoided in _____ due to possible bronchosapsm
Answer: asthmatics
Flashcard 30: What does a patient with a Well's Score >4 indicate?
Answer: • High-Risk Patient • Should undergo a CTPA
Flashcard 31: What Investigations would you order for a suspected PE? 6
Answer: • Chest X-Ray • CTPA -> given Well's Score • D-Dimer • ECG • ABG • Troponin
Flashcard 32: What happens to TLCO in Emphysema?
Answer: • TLCO is reduced • As in emphysema the alveolar walls are destroyed
Flashcard 33: Clinical features of ARDS?
Answer: • Elevated RR • Bilateral Lung Crackles • Low Oxygen Sats
Flashcard 34: An empyema requires?
Answer: Prompt drainage alongside antibiotic drainage
Flashcard 35: Pulse in severe asthma?
Answer: • >110BPM
Flashcard 36: What finding on spirometry would be significantly reduced in obesity patients?
Answer: • Expiratory reserve volume
Flashcard 37: What is the gold-standard investigation for superior vena cava obstruction? _____
Answer: CT thorax with contrast
Flashcard 38: Example of LAMAs?
Answer: • Tiotropium
Flashcard 39: What is the gold-standard investigation for Mesothelioma?
Answer: • Thoracoscopic biospy *histological biopsy
Flashcard 40: What pattern would Emphysema cause on spirometry?
Answer: • Obstructive pattern
Flashcard 41: Next step in acute severe asthma managment if no response to oxygen, SABA, steroids, Ipratropium bromide?
Answer: • IV magnesium sulphate
Flashcard 42: What type of picture would spirometry show for alpha-1 antitrypsin deficiency?
Answer: • Obstructive picture FEV1/FVC <70% FEV1 reduced
Flashcard 43: What is recommeded in acute exacerbation of COPD if there is no purulent sputum or any clinical signs of pneumonia?
Answer: • Oral prednisolone for 5 days
Flashcard 44: What is used to detect occuptational asthma?
Answer: • Serial Peak flow measurements at work and at home
Flashcard 45: What would a CRB65 score of 0 indicate?
Answer: • Treatment at home with oral Abx
Flashcard 46: What syndrome can present with dextrocardia and bronchiectasis?
Answer: • Kartagener's syndrome
Flashcard 47: Type of effusion if fluid protein/serum protein ratio >0.5?
Answer: • Exudative
Flashcard 48: Diagnosis?
Answer: • Lung metastases
Flashcard 49: If eosinophil count/FeNO do not confirm suspected asthma, and spirometry is not available then?
Answer: • Measure PEF twice daily for 2 weeks
Flashcard 50: What pCO2 indicates near-fatal acute asthma?
Answer: • pCO2 > 6.0kPa
Flashcard 51: FEV1/FVC < 70% is?
Answer: • Obstructive condition
Flashcard 52: What is the management of mycoplasma pneumoniae infection?
Answer: Tetracycline (e.g Doxycycline) or a macrolide (e.g. erythromycin in pregnancy) Or fluoroquinolones (e.g. ciprofloxacin) → Mycoplasma pneumoniae does NOT have a cell wall
Flashcard 53: What is the target saturation in COPD if CO2 is normal on ABG?
Answer: • 94-98%
Flashcard 54: Is TLCO raised in asthma?
Answer: • Yes, nothing wrong with the alveoli so lungs try to compensate by improving gas exchange
Flashcard 55: Indications for NIV?
Answer: • COPD wih respiratory acidosis pH 7.25-7.35
Flashcard 56: If No asthmatic features next step if patient is already taking SAMA?
Answer: • Add LABA + LAMA - switch SAMA to a SABA
Flashcard 57: Examples of LABAs?
Answer: • Formoterol • Salmeterol
Flashcard 58: All patients with life-threatening asthma should be?
Answer: • Admitted to hospital
Flashcard 59: What is the next step in management of a Pleural Effusion?
Answer: • Pleural aspirate
Flashcard 60: Example of a SAMA?
Answer: • Ipratropium
Flashcard 61: How does Fat Embolism Syndrome occur?
Answer: • When fat globules are relased from bone, during long bone fractures • These fat globules can travel to the lungs and obstruct pulmonary vessesl
Flashcard 62: What acid base disturbance will a panic attack cause?
Answer: • Respiratory alkalosis
Flashcard 63: What Wells Score would you arrange an immediate CTPA?
Answer: Wells Score >4 points
Flashcard 64: What is the immediate management of a suspected tension pneumothorax?
Answer: Needle decompression – do not wait for investigations
Flashcard 65: Which COPD patients may benefit from azithromycin prophylaxis?
Answer: Those meeting specific criteria with recurrent exacerbations
Flashcard 66: What should be added in patients with severe or life-threatening asthma?
Answer: • Ipratropium bromide
Flashcard 67: What is the first-line antibiotic for low-severity community-acquired pneumonia?
Answer: Amoxicillin
Flashcard 68: How is atelectasis managed?
Answer: Chest physiotherapy, mobilisation, and breathing exercises
Flashcard 69: What spirometry and gas exchange findings are characteristic of pulmonary fibrosis?
Answer: Restrictive spirometry (FEV1:FVC >70%, reduced FVC) and impaired gas exchange (reduced TLCO)
Flashcard 70: After inhaling a dose of medication, how long should the patient hold his breath?
Answer: • 10 seconds
Flashcard 71: First-line investigation for adults with suspected asthma?
Answer: • Eosinophil count OR fractional exhaled nitric oxide (FeNO)
Flashcard 72: Is confusion in an asthma attach a life-threatening feature?
Answer: • Yes
Flashcard 73: What is the definitive management for Pneumothorax?
Answer: • VATS pleurodesis • Video Assisted Thoracoscopic Surgery (VATs)
Flashcard 74: Patient has a cough, low-grade fever and erythema nodosum, what is the diagnosis?
Answer: • Sarcoidosis
Flashcard 75: The biggest risk factor for obstructive sleep apnoea in children is _____
Answer: adenotonsillar hypertrophy
Flashcard 76: The _____ can be used to assess obstructive sleep apnoea
Answer: Epworth Sleepiness Scale
Flashcard 77: What is the most common type of lung cancer in non-smokers?
Answer: • Lung adenocarcinoma
Flashcard 78: What is this?
Answer: Pleural plaque, caused by Asbestos inhalation
Flashcard 79: What organism presents as acid-fast organisms on Ziehl Neelsen stains?
Answer: • Mycobacterium tuberculosis
Flashcard 80: _____ are more commonly affected by obstructive sleep apnoea (2-3x)
Answer: Males
Flashcard 81: Obstructive sleep apnoea has a strong _____ predisposition
Answer: genetic
Flashcard 82: What PEFR is classed as Moderate Asthma?
Answer: • PEFR 50-75%
Flashcard 83: Uncontrolled obstructive sleep apnoea can lead to _____ and eventually cor pulmonale
Answer: pulmonary hypertension
Flashcard 84: What is the management for obstructive sleep apnoea? Lifestyle: _____ Definitive: CPAP Alternative: mandibular advancement splints
Answer: weight loss
Flashcard 85: Patient presents with persistent SOB, basal emphysema and abnormal LFTs, what is the diagnosis?
Answer: • Alpha-1 antitrypsin deficiency
Flashcard 86: _____ is a sleep disorder characterised by repeated upper airway obstruction during sleep, causing intermittent hypoxia & sleep fragmentation
Answer: Obstructive sleep apnoea
Flashcard 87: Obstructive sleep apnoea is caused by reduced↓ tone of _____ during sleep, leading to apnoeic/hypoapnoeic episodes, which result in intermittent hypoxia & arousals from sleep
Answer: pharyngeal dilator muscles
Flashcard 88: Obstructive sleep apnoea is associated with systemic hypertension that is often resistant to treatment due to chronic _____
Answer: sympathetic activation
Flashcard 89: What is the investigation for obstructive sleep apnoea? First-line: Home _____ Gold-standard: polysomnography
Answer: respiratory polygraphy
Flashcard 90: Obstructive sleep apnoea can be triggered/worsened by _____, particularly when consumed before bedtime
Answer: alcohol
Flashcard 91: Do plueral plaques need follow up?
Answer: • No • They are benign and do not undergo malignant change
Flashcard 92: What PEFR is classed as Severe Asthma?
Answer: • PEFR 33-50%
Flashcard 93: How will Tuberculosis present on CXR?
Answer: • Upper Zone Pulmonary Fibrosis
Flashcard 94: The strongest risk factors for obstructive sleep apnoea are _____ followed by (truncal) obesity
Answer: increased neck circumference
Flashcard 95: Obstructive sleep apnoea presents with _____ with collateral history of loud snoring and apnoeic episodes during sleep
Answer: daytime somnolence
Flashcard 96: What causative organism of Pneumonia is associated with cold sores?
Answer: • Streptococcus pneumoniae
Flashcard 97: What PEFR is classed as life-threatening Asthma?
Answer: • PEFR <33%
Flashcard 98: Mixed respiratory and metabolic acidosis: pH: _____ pCO₂: ↑ HCO₃⁻: ↓
Answer: ↓
Flashcard 99: _____ cancer is the most common primary tumour that metastasises to the brain
Answer: Lung
Flashcard 100: _____ is caused by alveolar hypoventilation
Answer: Respiratory acidosis
Flashcard 101: _____ respiratory alkalosis is compensated by decreased HCO3- reabsorption and decreased H+ excretion in the kidneys
Answer: Chronic
Flashcard 102: _____ respiratory acidosis is compensated by increased HCO3- reabsorption and increased H+ excretion in the kidneys
Answer: Chronic
Flashcard 103: _____ is caused by alveolar hyperventilation
Answer: Respiratory alkalosis
Flashcard 104: Mixed respiratory and metabolic alkalosis: pH: _____ pCO₂: ↓ HCO₃⁻: ↑
Answer: ↑
Flashcard 105: What is the normal range for PaCO2 on ABG? _____
Answer: 4.7-6.0 kPa
Flashcard 106: What vaccinations should COPD patients recieve?
Answer: • Annual influenza + one-off pneumococcal
Flashcard 107: What are causes of upper lobe pulmonary fibrosis?
Answer: • C - Coal worker's pneumoconiosis • H - Histiocytosis / hypersensitivity pneumonitis • A - Ankylosing spondylitis • R - Radiation • T - Tuberculosis • S - Silicosis/sarcoidosis
Flashcard 108: Respiratory Acidosis: pH: _____ pCO2: ↑ HCO3-: ↑
Answer: ↓
Flashcard 109: What is the normal range for PaO2 on ABG? _____
Answer: 10 kPa less than the inspired FiO2 (e.g. Room air is 21% so normal PaO2 is 11 kPa)
Flashcard 110: What does a substantial diurnal variation in Peak Expiratory Flow suggest?
Answer: • A patient may have an asthmatic/steroid responsive feature
Flashcard 111: What is the normal value for lactate on ABG? _____
Answer: <2 mmol/L
Flashcard 112: What is the normal range for pH on ABG? _____
Answer: 7.35-7.45
Flashcard 113: Respiratory Alkalosis: pH: _____ pCO2: ↓ HCO3-: ↓
Answer: ↑
Flashcard 114: COPD still breathless despite using SABA/SAMA and asthma/steroid resposive features?
Answer: • Add a LABA + ICS
Flashcard 115: Influenza is transmitted via respiratory droplets more commonly in _____ months
Answer: winter
Flashcard 116: An elderly patient with +ve RT-PCR for influenza A develops worsening SOB, oxygen saturations of 88% and bilateral interstitial infiltrates on CXR, what is the likely diagnosis? _____
Answer: Primary influenza pneumonia
Flashcard 117: Influenza undergoes antigenic _____ due to point mutations in the hemagglutinin (HA) or neuraminidase (NA) genes resulting in seasonal outbreaks & epidemcis
Answer: drift
Flashcard 118: A patient in winter suffers from sudden-onset high fever, cough, headache, & myalgia. O/E patient has a temp. of 39.0°C, tachycardic, & clear lungs. What is the likely diagnosis? _____
Answer: Influenza
Flashcard 119: Antigenic variation of influenza viruses occurs with mutations to viral _____ and neuraminidase (NA)
Answer: hemagglutinin (HA)
Flashcard 120: IM influenza vaccine = _____ Intranasal influenza vaccine = live attenuated
Answer: inactivated (killed)
Flashcard 121: Influenza is a clinical diagnosis, but can be confirmed with _____
Answer: RT-PCR
Flashcard 122: Oral oseltamivir & inhaled zanamivir inhibit _____ of influenza A & B strains
Answer: neuraminidase
Flashcard 123: What is the management of complicated influenza? 1st-line: _____ 2nd-line: Inhaled zanamivir
Answer: Oral oseltamivir
Flashcard 124: Influenza A is named according to _____ & neuraminidase (NA) subtypes
Answer: hemaglutinin (HA)
Flashcard 125: In influenza the antigen _____ facilitates viral release by cleaving sialic acid
Answer: neuraminidase (NA)
Flashcard 126: What is the management of uncomplicated influenza patients at ↑ risk? _____
Answer: Oral oseltamivir within 48 hrs
Flashcard 127: In influenza the antigen _____ facilitates viral entry by binding to sialic acid
Answer: hemagglutinin (HA)
Flashcard 128: _____ is an acute, contagious viral respiratory infection caused by influenza virus A, B, C (rarely)
Answer: Influenza
Flashcard 129: Influenza _____ is the most severe & most common
Answer: A
Flashcard 130: Influenza undergoes antigenic _____ due to genetic reassortment of hemagglutinin (HA) or neuraminidase (NA) genes, resulting in pandemcis
Answer: shift
Flashcard 131: Antigenic _____ necessitates annual influenza vaccine updates to match circulating strains
Answer: drift
Flashcard 132: What is the management of uncomplicated influenza in healthy patients? _____
Answer: Supportive; self-limiting
Flashcard 133: What is the likely diagnosis in an obese patient with resistant hypertension complaining of daytime sleepiness & collateral history of snoring? _____
Answer: Obstructive sleep apnoea
Flashcard 134: _____ is dyspnoea that is exacerbated by lying down
Answer: Orthopnoea
Flashcard 135: _____ is nocturnal episodes of acute dyspnoea ("gasping for air") & coughing
Answer: Paroxysmal nocturnal dyspnoea
Flashcard 136: Acute bronchitis presents with _____ vital signs
Answer: normal
Flashcard 137: What are the respiratory examination findings for acute bronchitis? _____
Answer: Wheeze Low-grade Fever
Flashcard 138: What is the management for acute bronchitis in systemically very unwell patients? _____
Answer: Immediate antibiotic prescription (doxycycline)
Flashcard 139: If a patient presents with recurrent episodes of acute bronchitis, then suspect _____ or COPD as differentials
Answer: asthma
Flashcard 140: Acute bronchitis is caused by _____ organisms in > 90% of instances
Answer: viral
Flashcard 141: Acute bronchitis: CRP < 20 mg/L = _____ CRP 20-100 mg/L = consider delayed antibiotic prescription CRP > 100 mg/L = offer antbiotic therapy
Answer: do not routinely offer antibiotics
Flashcard 142: What is the management for acute bronchitis? _____
Answer: Conservative; analgesia ; good fluid intake
Flashcard 143: _____ is a lower respiratory tract infection characterised by inflamed bronchi
Answer: Acute bronchitis
Flashcard 144: What CXR findings are seen on acute bronchitis? _____
Answer: No significant findings
Flashcard 145: Acute bronchitis is typically preceded by a(n) _____ with a productive or non-productive cough that resolves within 2-3 weeks
Answer: URTI
Flashcard 146: If acute bronchitis presents with a high ↑↑ fever, yellow-green sputum, then suspect _____
Answer: pneumonia (bacterial cause)
Flashcard 147: Acute bronchitis is a _____ diagnosis
Answer: clinical
Flashcard 148: What is the likely diagnosis in a patient with a recent URTI and a persistent productive cough without fever or significant CXR findings? _____
Answer: Acute bronchitis
Flashcard 149: HFNC deliver oxygen/air at a _____ rate than inspiration. This means that air in the residual volume of the lungs is replaced by oxygen/air from HFNC
Answer: faster
Flashcard 150: What are the different types of oxygen therapy? _____ - 24-44% FiO2 Simple face mask - 40-60% FiO2 Venturi mask - 24-60% FiO2 Non-Rebreather mask - 60-95% FiO2
Answer: Nasal cannula
Flashcard 151: Patients with _____capnia may experience cardiovascular features such as peripheral vasodilation, tachycardia and bounding pulse
Answer: hyper
Flashcard 152: What are the different types of respiratory pressure support (least → most invasive)? _____ CPAP NIV (BiPAP) Mechanical ventilation
Answer: High-flow nasal cannula (HFNC)
Flashcard 153: _____ provides a constant pressure to keep the airways expanded
Answer: CPAP
Flashcard 154: What investigation is most useful for monitoring respiratory failure? _____
Answer: ABG
Flashcard 155: Both type 1 & 2 respiratory failure are managed with _____ and by treating the underlying cause
Answer: oxygen
Flashcard 156: _____ is the most extreme respiratory support only used VERY RARELY when intubation with ventilation is not adequate
Answer: Extracorporeal membrane oxygenation (ECMO)
Flashcard 157: _____ helps to prevent airway collapse, improves ventilation and reduces atelectasis in patients who require respiratory support
Answer: Positive end-expiratory pressure (PEEP)
Flashcard 158: Mechanical ventilation is only used when other respiratory support is inadequate. Patients _____ require sedation
Answer: do
Flashcard 159: _____ provides a higher pressure during inspiration AND a lower pressure during expiration
Answer: BiPAP
Flashcard 160: Oxygen therapy in type 2 respiratory failure should be started at a _____ FiO2 as they may be insensitive to CO2 and respiration could be driven by hypoxia
Answer: lower
Flashcard 161: Patients with long-standing hypoxia may have _____, pulmonary hypertension or cor pulmonale
Answer: polycythaemia
Flashcard 162: What pathophysiological mechanisms cause type 1 respiratory failure? _____, hypoventilation, abnormal diffusion, right to left cardiac shunts
Answer: Ventilation/Perfusion (V/Q) mismatch
Flashcard 163: What is the main side effect of bleomycin (chemo)? _____
Answer: Pulmonary fibrosis
Flashcard 164: What pathophysiological mechanism causes type 2 respiratory failure? _____ with or without V/Q mismatch
Answer: hypoventilation
Flashcard 165: Definitions: Type 1 respiratory failure: _____ Type 2 respiratory failure: Hypoxia (<8kPa) AND hypercapnia (>6.0kPa)
Answer: Hypoxia (<8kPa) AND normo/hypocapnia
Flashcard 166: Vaccination against pneumococcal 23 serotypes is given _____
Answer: at 65 years old
Flashcard 167: Superior vena cava obstruction is most commonly caused by _____
Answer: malignancy (mostly lung cancer)
Flashcard 168: A complication of lung cancer is _____ caused by compression of the SVC
Answer: superior vena cava obstruction
Flashcard 169: A patient with known lung cancer presents with facial swelling and a distended jugular vein. What is the most likely diagnosis? _____
Answer: Superior vena cava obstruction
Flashcard 170: Patients with superior vena cava syndrome can present with _____ due to venous congestion of the airway
Answer: dyspnoea
Flashcard 171: Investigations to consider for dyspnoea in palliative patients are _____, pulse oximetry, spirometry, ECG, bloods
Answer: CXR
Flashcard 172: Dyspnoea in palliative patients with a wheeze caused a tumour obstructing the airway may be relieved by _____
Answer: bronchodilators
Flashcard 173: What is the pharmacological management of dyspnoea in palliative patients? _____, benzodiazepines (associated anxiety), bronchodilators
Answer: 2.5mg orapmorph QDS
Flashcard 174: Dyspnoea may be alleviated in palliative patients with COPD by _____
Answer: increasing airflow across the face/body
Flashcard 175: What is the non-pharmacological management of dyspnoea in palliative patients after correcting the correctable? _____, Fans/open window, breathing techniques, Oxygen therapy
Answer: Positioning
Flashcard 176: The anxiety associated with dysopnea may be relieved in palliative patients by using _____
Answer: benzodiazepines
Flashcard 177: The sensation of dysopnea may be relieved in palliative patients by prescribing _____
Answer: oramorph
Flashcard 178: Noisy secretions at the end of life _____ usually distressing to the patients due to reduced consciousness
Answer: are not
Flashcard 179: What is the pharmacological management of secretions in palliative patients? _____
Answer: Antimuscarinics (e.g.1st-line Hyoscine butylbromide (buscopan®))
Flashcard 180: If a PE is likely (≥ 5 points) and CTPA is positive then _____
Answer: give anticoagulation
Flashcard 181: Mantoux test for tuberculosis _____ = Negative → can give BCG vaccine ≥ 5mm = Positive → do not give BCG (previous/latent infection or already vaccinated)
Answer: ≤ 5mm
Flashcard 182: What is the investigation of choice for pulmonary embolism if there is renal impairment? _____
Answer: V/Q scan if 2-level PE Wells score > 4
Flashcard 183: _____ tuberculosis is a non-immune host exposed to Mycobacterium tuberculosis which develops a small lung lesion called Ghon focus
Answer: Primary
Flashcard 184: Two types of tuberculosis - _____ - Secondary (post-primary) TB
Answer: Primary TB
Flashcard 185: What is the management of multidrug-resistant tuberuclosis (MDR-TB)? _____
Answer: ~18-20 months of Rifampicin, Isoniazid (taken with pyridoxine), Pyranzinamide, Ethambutol
Flashcard 186: If a PE is unlikely (≤ 4 points) & a D-dimer is -ve, then _____
Answer: consider alternative diagnosis
Flashcard 187: Extra-pulmonary tuberculosis can cause _____ of the cervical lymph nodes
Answer: scrofuloderma
Flashcard 188: If the Mantoux test is +ve or is uncertain then _____
Answer: interferon-γ release assay can be done
Flashcard 189: RIPE drugs are used to treat active tuberculosis. What is the notable side effect of isoniazid? _____
Answer: Peripheral neuropathy (prevented with pyridozine Vitamin B6)
Flashcard 190: Ghon focus lung lesions (tuberculosis) usually _____ in immunocompetent individuals
Answer: heal
Flashcard 191: The Ghon complex of Primary tuberculosis includes _____ lymphadenopathy with Ghon foci in the middle and lower lobes of the lungs
Answer: hilar
Flashcard 192: A pulmonary embolism can present with _____ pain, dyspnoea, haemoptysis, tachycardia, & tachypnoea
Answer: pleuritic chest
Flashcard 193: What is the management of pulmonary embolism with haemodynamic instability? _____
Answer: Thrombolysis
Flashcard 194: _____ is an infection caused by Mycobacterium tuberculosis that commonly affects the lungs
Answer: Tuberculosis
Flashcard 195: What investigation is done to screen for latent tuberculosis in patients who may produce false negative tests? _____
Answer: Interferon-γ release assay
Flashcard 196: What vaccine is given to prevent tuberculosis? _____
Answer: BCG
Flashcard 197: _____ tuberculosis when the infection is reactivated
Answer: Secondary (post-primary)
Flashcard 198: What is the most important investigation for tuberculosis? _____
Answer: Sputum culture MC&S
Flashcard 199: Patients who have a pulmonary embolism, despite taking anticoagulation, should be considered for _____
Answer: a inferior vena cava filter
Flashcard 200: The Mantoux test is injected _____ and results are observed 2-3 days later
Answer: intradermally
Flashcard 201: The Ghon focus lung lesion (tuberculosis) can _____ in immunocompromised individuals
Answer: develop into disseminated miliary tuberculosis
Flashcard 202: What investigation is done to screen for latent tuberculosis? _____
Answer: Mantoux test
Flashcard 203: _____ may be indicated in homeless, patients with poor compliance, and prisoners for active/latent tuberculosis
Answer: Directly observered therapy
Flashcard 204: Using the _____: ≥ 5 points = PE is likely ≤ 4 points = PE is unlikely
Answer: two-level PE Wells score
Flashcard 205: Patients with _____ are x25 more likely to develop active tuberculosis
Answer: HIV
Flashcard 206: Which type of granuloma is characteristic of tuberculosis and fungal infections? _____
Answer: Caseating granulomas
Flashcard 207: A pulmonary embolism has _____/crackles on auscultation
Answer: clear chest sounds
Flashcard 208: What criteria is used if pulmonary embolism is suspected? _____
Answer: Two-level PE Wells score
Flashcard 209: What investigation is recommended for all patients with suspected pulmonary embolism to exclude other causes? _____
Answer: CXR, typically normal in PE but can present with a wedge-shaped opacification
Flashcard 210: What is the management of latent tuberculosis? _____
Answer: 3 months of isoniazid (taken with pyridoxine) + rifampicin OR 6 months of isoniazid (taken with pyridoxine)
Flashcard 211: Tuberculosis most commonly affects the _____ but can affect other regions in extra-pulmonary tuberculosis
Answer: lungs
Flashcard 212: Below is a CXR of a patient with _____
Answer: reactivation tuberculosis
Flashcard 213: Tuberculosis risk factor includes _____ in areas with high TB prevalence (e.g. South-East Asia, Africa, Western Pacific)
Answer: living
Flashcard 214: What are the initial investigations for tuberculosis? _____, x3 sputum smears
Answer: CXR
Flashcard 215: _____ tuberculosis can result in granuloma formation in the spleen, liver, adrenal gland and meninges (causing meningitis)
Answer: Miliary
Flashcard 216: Patients who are _____ are at risk of tuberculosis
Answer: immunocomprimised
Flashcard 217: What is the investigation of choice for pulmonary embolism? _____
Answer: CTPA if 2-level PE Wells score > 4
Flashcard 218: What is the first-line anticoagulation for pulmonary embolism? _____
Answer: DOACs (Rivaroxaban or Apixaban)
Flashcard 219: Biopsy of tuberculosis reveals _____ granulomas
Answer: caseating
Flashcard 220: RIPE drugs are used to treat active tuberculosis. What is the notable side effect of ethambutol? _____
Answer: Optic neuritis
Flashcard 221: A(n) Ghon focus is a(n) _____ located near the pleura in the middle or lower lobes of the lung (tuberculosis infection)
Answer: caseating granuloma
Flashcard 222: Tuberculosis CXR findings consist of _____ & bilateral hilar lymphadenopathy
Answer: upper lobe cavitation
Flashcard 223: What are the four drugs used in tuberculosis management? _____
Answer: RIPE Rifampicin Isoniazid (take with pyridoxine (vit B6)) Pyrazinamide Ethambutol
Flashcard 224: What rule-out criteria can be used in pulmonary embolism & when is it used? _____
Answer: Pulmonary embolism rule-out critera (PERC) → PERC is done when there is low clinical suspicon of PE, but you want some reassurance. If you suspect a PE, then move straight to the two-level PE Wells score
Flashcard 225: If a PE is likely (≥ 5 points) a _____ is done immediately
Answer: CTPA
Flashcard 226: What pneumoconiosis has an increased risk for tuberculosis (TB)? _____
Answer: Silicosis
Flashcard 227: A PERC score must score _____ to rule-out a pulmonary embolism (<2% chance of PE)
Answer: 0
Flashcard 228: If a PE is unlikely (≤ 4 points) & a D-dimer is +ve, then _____
Answer: arrange an immediate CTPA
Flashcard 229: RIPE drugs are used to treat active tuberculosis. What is the notable side effect of rifampin? _____
Answer: Red/orange bodily secretions/urine
Flashcard 230: If a PE is likely (≥ 5 points) a CTPA is delayed then _____
Answer: give interim anticoagulation until the scan is performed
Flashcard 231: A pulmonary embolism risk factor is recent _____
Answer: surgery
Flashcard 232: What is the management of active tuberculosis? _____
Answer: Initial 2 month phase: Rifampicin, Isoniazid (taken with pyridoxine), Pyranzinamide, Ethambutol Continuation 4 month phase: Rifampicin, Isoniazid (taken with pyridoxine)
Flashcard 233: A _____ lung lesion + hilar lymph nodes is known as a Ghon complex in tuberculosis
Answer: Ghon focus
Flashcard 234: Non-small Cell Lung Cancer consists of 3 main sub-types: 1. _____ 2. Squamous cell cancer (30%) 3. Large cell cancer (15%)
Answer: Adenocarcinoma (40%)
Flashcard 235: The quantitiy of asbestosis exposure _____ correlated to the risk of mesothelioma
Answer: is not
Flashcard 236: _____ lesions are the most common lesions in squamous cell cancer
Answer: Cavitating
Flashcard 237: Lung function tests for asbestosis show a _____ pattern
Answer: restrictive
Flashcard 238: A 19-year old patient with wheezing & dyspnoea has FEV1/FVC ratio of 0.50 that is reversed with bronchodilators. What investigation should be done next? _____
Answer: fractional exhaled nitric oxide (FeNO)
Flashcard 239: Acute asthma exacerbations: Moderate = PEFR _____ best or predicted Severe = PEFR 33-50% best or predicted Life-threatening = PEFR < 33% best or predicted
Answer: 50-75%
Flashcard 240: What investigations must be done to diagnose suspected asthma in ≥ 17 years old? _____
Answer: Spirometry with a bronchodilator reversibility (BDR) test & fractional exhaled nitric oxide (FeNO)
Flashcard 241: What is the initial investigation for suspected lung cancer? _____
Answer: CXR
Flashcard 242: _____ lung cancer almost exclusively occurs in people who smoke
Answer: Small cell
Flashcard 243: What is the required/investigation of choice for pulmonary fibrosis? _____
Answer: High resolution CT
Flashcard 244: Asthma symptoms are often made worse by _____
Answer: exercise
Flashcard 245: What is the next-step for near-fatal, life-threatening, or severe asthma that does not respond to initial treatment? _____
Answer: Admit to hospital
Flashcard 246: What is the definitive treatment for idiopathic pulmonary fibrosis? _____
Answer: Lung transplant
Flashcard 247: Which malignant disease of the lungs associated with asbestos exposure may present with chest/back pain, SOB and chronic dry cough? _____
Answer: Mesothelioma
Flashcard 248: _____ asthma is related to allergens in the workplace
Answer: Occupational
Flashcard 249: What is the first-line investigation for suspected asbestosis? _____
Answer: CXR
Flashcard 250: What can be the initial investigaiton for pulmonary fibrosis? _____, spirometry
Answer: CXR
Flashcard 251: On CXR, asbestosis may show _____, pleural thickening & look out for lung cancer/mesothelioma
Answer: pleural plaques
Flashcard 252: Asbestosis severity _____ correlated to the levels of exposure
Answer: is
Flashcard 253: What is observed on high resolution CT in idiopathic pulmonary fibrosis? Early = _____ Late = "Honeycombing cysts"
Answer: "Ground glass opacities"
Flashcard 254: What are the two main types of lung cancer? _____
Answer: Non-Small Cell Lung Cancer NSCLC (85%) Small Cell Lung Cancer SCLC (15%)
Flashcard 255: Asthma cough is worse at _____
Answer: night
Flashcard 256: Which lung cancer is associated with PTH-rp release as a paraneoplastic syndrome? _____
Answer: Squamous cell carcinoma
Flashcard 257: What investigation is done for non-small cell lung cancer to establish eligibility for curative treatment? _____
Answer: PET scan
Flashcard 258: What is the management for asbestosis? _____
Answer: Conservative, monitor for lung cancer. STOP SMOKING!!!
Flashcard 259: What is the management for asthma exacerbations? _____
Answer: Oxygen, Salbutamol nebuliser, Hydrocortisone/prednisolone, Ipratropium bromide nebuliser, Theophylline/aminophylline (IV), Magnesium sulphate (IV), Escalate
Flashcard 260: Asbestosis typically presents > 50 year old patient with _____, reduced exercise tolerance, clubbing, & bilateral end-insipratory crackles
Answer: dyspnoea
Flashcard 261: Idiopathic pulmonary fibrosis typically affects _____
Answer: the elderly
Flashcard 262: _____ is a lung disease caused by long-term exposure to asbestos fibres that was widely used as an insulating & fireproofing material before disease-causing effects were known
Answer: Asbestosis
Flashcard 263: An acute asthma attack with _____ pCO2 indicates near-fatal asthma
Answer: raised ↑
Flashcard 264: Silent chest, cyanosis, bradycardia, hypotension, exhaustion, or confusion are signs of _____ acute asthma exacerbation
Answer: life-threatening
Flashcard 265: Idiopathic pulmonary fibrosis is more common in _____
Answer: men
Flashcard 266: Which lung cancer is associated with Lambert-Eaton syndrome as a paraneoplastic syndrome? _____
Answer: Small cell carcinoma
Flashcard 267: Patients with asbestosis are advised to stop _____
Answer: Smoking
Flashcard 268: Which common lung cancer is known to present centrally? _____
Answer: Small cell lung cancer & squamous cell cancer
Flashcard 269: A biopsy may be taken for lung cancer via _____ & aided by endotrachial US
Answer: bronchoscopy
Flashcard 270: Which monoclonal antibody can be used to treat allergic asthma, especially in patients refractory to corticosteroids? _____
Answer: Omalizumab
Flashcard 271: One complication associated with lung cancer is _____, which is classically seen with adenocarcinoma
Answer: pleural effusion
Flashcard 272: If a confident diagnosis of idiopathic pulmonary fibrosis cannot be made, what is the next investigation? _____
Answer: Biopsy
Flashcard 273: What is the pharmacological treatment for idiopathic pulmonary fibrosis? _____
Answer: Antifibrotic agents
Flashcard 274: Asbestosis typically causes _____ lobe fibrosis
Answer: lower
Flashcard 275: As a general rule of thumb, which lung cancers require bronchoscopy and which need percutaneous needle biopsy? _____
Answer: Central = bronchoscopy; peripheral = percutaneous
Flashcard 276: What investigations must be done to diagnose suspected asthma in 5-16 years old? _____
Answer: 1. FeNO (>35 ppb) If not then ->> Spirometry with a bronchodilator reversibility (BDR) test
Flashcard 277: On auscultation a _____ may be heard in lung cancer
Answer: fixed, monophonic wheeze
Flashcard 278: On hand inspection, _____ may be present in lung cancer
Answer: clubbing
Flashcard 279: What is the most common type of lung cancer? _____
Answer: Adenocarcinoma (NSCLC)
Flashcard 280: _____ is a rare, progressive, chronic fibrosis of the insterstitium of the lungs with unknown aetiology
Answer: Idiopathic pulmonary fibrosis
Flashcard 281: What investigation is used to monitor asthma overtime? _____
Answer: PEF - peak expiratory flow
Flashcard 282: What investigations must be done to diagnose suspected asthma in < 5 years old? _____
Answer: Clinical diagnosis
Flashcard 283: Approximately 1/3 of patients with idiopathic pulmonary fibrosis test +ve for _____ antibody
Answer: anti-nuclear
Flashcard 284: Asthma is more common in _____ countries because of the "hygiene hypothesis"
Answer: developed
Flashcard 285: Acute asthma exacerbations can be triggered by _____
Answer: respiratory tract infections
Flashcard 286: Diagnosis: _____
Answer: Asbestosis
Flashcard 287: Which lung cancer is associated with hypertrophic pulmonary osteoathropathy (HPOA)? _____
Answer: Non small cell lung cancer
Flashcard 288: What is the best investigation for suspected lung cancer? _____
Answer: CT scan
Flashcard 289: Acute asthma exacerbations: Moderate = pulse _____ Severe = pulse ≥ 110/min Life-threatening = …
Answer: < 110/min
Flashcard 290: Investigations for suspected asthma: ≥ _____yrs = Spirometry w/BDR + FeNO 5-16yrs = Spirometry w/BDR + FeNO if -ve < 5yrs = clinical
Answer: 17
Flashcard 291: What is the management for mesothelioma associated with asbestosis? _____
Answer: Palliative chemotherapy - poor prognosis
Flashcard 292: Lung cancer can present with _____ symptoms; cough, SOB, chest pain, haemoptysis & weight loss
Answer: unexplained
Flashcard 293: Asthma symptoms are often made worse by _____ & beta blockers
Answer: aspirin
Flashcard 294: _____ is heard on auscultation for asthma
Answer: Wheeze
Flashcard 295: Which immune modulator most commonly causes drug-induced pulmonary fibrosis? _____
Answer: Methotrexate
Flashcard 296: Acute asthma exacerbations: Moderate = ... Severe = ... Life-threatening = O2 sats < _____%
Answer: 92
Flashcard 297: One complication associated with lung cancer is _____ due to compression of the recurrent laryngeal nerve
Answer: hoarseness
Flashcard 298: The prognosis of pulmonary fibrosis is _____
Answer: poor
Flashcard 299: An acute asthma attack with _____ pCO2 indicates life-threatening asthma
Answer: normal
Flashcard 300: Asbestosis is commonly seen in _____ workers, shipyard workers, and plumbers
Answer: construction
Flashcard 301: Asthma presents with a _____, dyspnoea, & wheeze / chest tightness
Answer: dry cough
Flashcard 302: Small cell lung cancer is mainly managed with _____
Answer: chemotherapy + radiotherapy
Flashcard 303: Which chemotherapy drugs most commonly cause drug-induced pulmonary fibrosis? _____
Answer: Bleomycin and busulfan
Flashcard 304: _____ is a term used to describe a range of interstitial lung diseases caused by inhalation of mineral dusts, resulting in interstitial fibrosis
Answer: Pneumoconiosis
Flashcard 305: Asbestosis can cause _____, a fatal complication
Answer: mesothelioma
Flashcard 306: What is the first-line non-pharmacological management for idiopathic pulmonary fibrosis? _____ + pulmonary rehabilitation
Answer: Smoking cessation
Flashcard 307: A 15 year old asthmatic patient has worsening dyspnoea, wheeze, & cough that is refractory to their salbutamol inhaler. The patient cannot complete full sentences & has a RR of 29. What is the most likely diagnosis? _____
Answer: Severe asthma exacerbation
Flashcard 308: Which antibiotic most commonly causes drug-induced pulmonary fibrosis? _____
Answer: Nitrofurantoin
Flashcard 309: Idiopathic pulmonary fibrosis can cause _____ hypertension which may result in cor pulmonale over time
Answer: pulmonary
Flashcard 310: Idiopathic pulmonary fibrosis respiratory exam: Inspection: _____ Chest expansion: Reduced Auscultation: Bibasal fine end-inspiratory crepitations
Answer: Clubbing
Flashcard 311: Which common lung cancer is known to present peripherally? _____
Answer: Adenocarcinoma & large cell cancer
Flashcard 312: One complication associated with lung cancer is _____ syndrome due to compression of the SVC
Answer: superior vena cava
Flashcard 313: Idiopathic pulmonary fibrosis often presents with _____, non-productive cough with bibasal fine end-inspiratory crepitations on auscultation, & clubbing on inspection of the hands
Answer: shortness of breath on exertion
Flashcard 314: Acute asthma exacerbations: Moderate = Speech _____ Severe = Speech cannot complete sentences Life-threatening = ...
Answer: normal
Flashcard 315: Acute asthma exacerbations: Moderate = RR _____ Severe = RR ≥ 25/min Life-threatening = …
Answer: < 25/min
Flashcard 316: On lymph node examination _____ or persistent cervical lymphadenopathy may be present in lung cancer
Answer: supraclavicular
Flashcard 317: _____ tends to have a worse prognosis than Non-small Cell Lung Cancer
Answer: Small Cell Lung Cancer
Flashcard 318: Non-small cell lung cancer is mainly managed with _____
Answer: radiotherapy
Flashcard 319: _____ is a multisystem non-caseating granulomatous disorder of unknown aetiology that commonly affects the lungs & lymphatic system, but can affect any organ
Answer: Sarcoidosis
Flashcard 320: Patients with asthma tend to suffer worse at _____ & early mornings
Answer: night
Flashcard 321: What is the management of a _____ pneumothorax without high risk characteristics ≥2cm in a patient that would like rapid symptom relief (ambulatory device unavailable)? → Needle aspiration (if this fails → chest drain)
Answer: symptomatic
Flashcard 322: Signs of a _____ on ultrasound include absent "lung sliding"
Answer: pneumothorax
Flashcard 323: _____ is a common cause of iatrongenic pneumothorax
Answer: Mechanical venilation
Flashcard 324: Pneumothorax presents with _____-lateral chest pain
Answer: uni
Flashcard 325: A tension pneumothorax has _____ breath sounds & hyperresonance on the affected side
Answer: reduced
Flashcard 326: Sarcoidosis bloods may show _____
Answer: ↑ ACE, ↑ Calcium
Flashcard 327: Bronchiectasis usually presents with a _____ which produces a large volume of purulent sputum and occasionally haemoptysis
Answer: productive cough
Flashcard 328: What is the management of a _____ pneumothorax without high risk characteristics ≥2cm in a patient that would like rapid symptom relief AND to go home? → Ambulatory device (review as outpatient)
Answer: symptomatic
Flashcard 329: What initial investigations may be useful in patients with suspected bronchiectasis? _____, CXR, Spirometry, FBC
Answer: Sputum culture
Flashcard 330: What is the likely diagnosis in a patient with COPD who develops sudden-onset dyspnea and chest pain with unilaterally decreased breath sounds (no tracheal deviation)? _____
Answer: Secondary spontaneous pneumothorax
Flashcard 331: Sarcoidosis will show _____ on tissue biopsy
Answer: non-caseating granulomas
Flashcard 332: What is the management in symptomatic sarcoidosis? _____
Answer: Steroids
Flashcard 333: What is the likely diagnosis in a young adult male with one month of shortness of breath, nonproductive cough, and fatigue? The patient is hypercalcaemic and has bilateral hilar fullness on CXR: _____
Answer: Sarcoidosis
Flashcard 334: Asthma is often associated with _____, eczema, and a family history of atopy
Answer: allergic rhinitis
Flashcard 335: A _____ is an abnormal collection of air in the pleural space
Answer: pneumothorax
Flashcard 336: What changes are seen in a CXR of a patient with bronchiectasis? _____, cystic appearance (tramline and ring shadows)
Answer: Thickened bronchial walls
Flashcard 337: A _____ is a one-way valve that causes increased pressure in the affected lung, it is a medical emergency
Answer: tension pneumothorax
Flashcard 338: Sarcoidosis is associated with _____
Answer: intersitial lung disease
Flashcard 339: Patients with suspected bronchiectasis should be tested for what allergy? _____
Answer: Allergic bronchopulmonary aspergillosis
Flashcard 340: What is the scuba diving advice after a pneumothorax? _____
Answer: Absolute contraindication
Flashcard 341: _____ is a chronic, inflammatory, & obstructive respiratory disorder that can cause a cough with wheezing that affects millions of people in the UK
Answer: Asthma
Flashcard 342: Sarcoidosis can present _____, but also present with a wide range of symptoms & signs
Answer: asymptomatically
Flashcard 343: Diagnosis: _____
Answer: Secondary pneumothorax - COPD patient → always look for underlying lung pathology
Flashcard 344: Sudden onset SOB with unilateral pleuritic chest pain with reduced breath sounds & hyperresonance on the affected side. 108bpm & 22 resp rate. What is the likely diagnosis? _____
Answer: Pneumothorax
Flashcard 345: In a tension pneumothorax the mediastinum (and hence, trachea) deviate _____ the affected side
Answer: away from
Flashcard 346: Exacerbations or severe cases of bronchiectasis are treated in 2 main ways: _____ Sputum clearance: mucolytics + postural drainage!
Answer: Antibiotics
Flashcard 347: Sarcoidosis CXR in the worse stages (3&4) may show _____
Answer: interstitial lung disease / diffuse fibrosis
Flashcard 348: What is the management of a tension pneumothorax? _____
Answer: Needle decompression (with a large bore cannula) at the 2nd mid clavicular line → chest drain
Flashcard 349: Pneumothorax presents with _____ breath sounds on the affected side
Answer: diminished
Flashcard 350: What are the initial investigations for sarcoidosis? _____, bloods, & lung function tests
Answer: CXR
Flashcard 351: There are two types of pneumothorax: - _____ = no underlying lung disease - Secondary = underlying lung disease (e.g. COPD, CF, malignancy, pneumonia)
Answer: Primary
Flashcard 352: Bilateral hilar lymphadenopathy is the classical presentation of _____
Answer: sarcoidosis
Flashcard 353: What is the best diagnostic investigation for bronchiectasis? _____
Answer: High resolution CT
Flashcard 354: Tension pneumothoraces are typically caused by _____ or mechanical ventilation
Answer: traumatic chest injuries
Flashcard 355: What are the key signs in tension pneumothorax? _____
Answer: JVD with absent breath signs on the affected side
Flashcard 356: What is the management of a _____ pneumothorax without high risk characteristics ≥2cm in a patient that would like to avoid a procedure? → Conservative management
Answer: symptomatic
Flashcard 357: What is the biggest differentiator between a simple pneumothorax vs tension pneumothorax? _____
Answer: Worsening clinical signs e.g. haemodynamically unstable
Flashcard 358: Conservative management of bronchiectasis involves: patient education, _____ and chest physiotherapy
Answer: smoking cessation
Flashcard 359: Asthma is often triggered by _____; pollen, house dust mite, pollution, pet dander, smoke
Answer: allergens
Flashcard 360: Asthma is an _____ respiratory condition
Answer: obstructive
Flashcard 361: Pneumothorax presents with _____ tactile fremitus on the affected side
Answer: decreased
Flashcard 362: Sarcoidosis is most common in _____ descent then Scandinavian descent
Answer: African
Flashcard 363: Diagnosis: _____
Answer: left tension pneumothorax
Flashcard 364: What is the flying advice after a resolution of a pneumothorax? _____
Answer: flying as an absolute contraindication for 1 week post CXR confirmation
Flashcard 365: Below is a CXR of a patient with _____
Answer: sarcoidosis
Flashcard 366: _____ pneumothorax without high risk characteristics ≤2cm = Conservative management
Answer: Symptomatic
Flashcard 367: What can be heard upon auscultation of bronchiectasis? _____ & wheeze
Answer: Coarse inspiratory crepitations
Flashcard 368: Blood gas for pneumothorax may show hypoxaemia or/and _____
Answer: respiratory alkalosis
Flashcard 369: What is the investigation for pneumothorax? _____
Answer: CXR
Flashcard 370: _____ pneumothorax most frequently seen in tall young adults, especially men
Answer: Primary
Flashcard 371: A major lifestyle risk factor for primary pneumothorax is _____
Answer: smoking
Flashcard 372: Pneumothorax presents with _____resonance to percussion on the affected side
Answer: hyper
Flashcard 373: Tension pneumothorax results in a rapid rise in intra-thoracic pressure, impeding venous return to the heart and potentially leading to _____ if left untreated
Answer: CARDIAC ARREST
Flashcard 374: What is the management of recurrent pneumothorax? _____
Answer: consider video-assisted thoracoscopic surgery (VATS) to allow mechanical/checmical pleurodesis +/- bullectomy
Flashcard 375: The hands of patients with bronchiectasis often have _____
Answer: finger clubbing
Flashcard 376: Patients with bronchiectasis secondary to allergic bronchopulmonary aspergillosis (ABPA) may be treated with _____
Answer: Prednisolone
Flashcard 377: Asthma typically develops in _____
Answer: childhood
Flashcard 378: Sarcoidosis CXR classically shows _____
Answer: bilateral hilar lymphadeonpathy
Flashcard 379: Secondary pneumothorax underlying lung disease includes _____
Answer: COPD, cystic fibrosis, lung malignancy, pneumocystis jiroveci pneumonia, sarcoidosis, TB
Flashcard 380: What is the management of an iatrogenic pneumothorax from ventilation? _____
Answer: Chest drain
Flashcard 381: Asymptomatic primary pneumothorax = _____
Answer: Conservative (regular outpatient review)
Flashcard 382: What is the investigation for tension pneumothorax? _____
Answer: CLINICAL! Do not waste time on waiting for a CXR
Flashcard 383: A risk factor for primary pneumothorax is _____ syndrome
Answer: Marfan
Flashcard 384: Diagnosis: _____
Answer: pneumothorax
Flashcard 385: Sarcoidosis lung function tests may show _____
Answer: restrictive defect from instersitial lung disease
Flashcard 386: _____ pneumothorax with high risk characteristics = Chest drain (if safe e.g. ≥2cm)
Answer: Symptomatic
Flashcard 387: Patients with bronchiectasis who experience wheeze or dyspnoea may be given _____
Answer: bronchodilators
Flashcard 388: Patients with pneumothorax typically present with sudden-onset _____ and pleuritic chest pain that develop at rest
Answer: dyspnoea
Flashcard 389: Asymptomatic secondary pneumothorax = _____
Answer: Conservative (inpatient review)
Flashcard 390: What is the smoking advice after a pneumothorax? _____
Answer: Advised to avoid smoking to reduce further episodes
Flashcard 391: What initial non-bedside investigations should be done for suspected pneumonia? _____, U&Es, CRP, Procalcitonin, CXR
Answer: FBC
Flashcard 392: First-line management for an adult with moderate severity CAP is _____ for 5 days
Answer: amoxicillin + macrolide
Flashcard 393: The first line at home treatment for an adult with CAP is _____ for 5 days
Answer: oral amoxicillin
Flashcard 394: Mycoplasma pneumoniae infection presents with a _____ onset of flu-like symptoms which are typically preceded by a non-productive cough
Answer: gradual
Flashcard 395: Mycoplasma pneumoniae is an _____ pneumonia which is more common in younger patients
Answer: aytipical
Flashcard 396: The _____ scoring system is used to assess the severity of community acquired pneumonia in secondary care (hospital) The CRB-65 scoring system is used to assess the severity of community acquired pneumonia in primary care (GP)
Answer: CURB-65
Flashcard 397: The majority of bacterial pneumonias are caused by _____
Answer: Streptococcus pneumoniae (pneumococcus)
Flashcard 398: Pneumonias may present with signs of systemic inflammation such as _____ and tachycardia
Answer: fever
Flashcard 399: The most common symptoms of pneumonia are _____ & dyspnoea
Answer: productive cough
Flashcard 400: Which pneumonia-causing organism is associated with autoimmune haemolytic anaemia and erythema multiforme in young adults? _____
Answer: Mycoplasma pneumoniae
Flashcard 401: Patients with CAP and a CURB65 score of _____ should have an intensive care assessment
Answer: ≥ 3
Flashcard 402: Patients with CAP and a CURB65 score of _____ should be treated in hospital
Answer: ≥ 2
Flashcard 403: Patients with bronchiectasis are most commonly infected by _____, Pseudomonas aeruginosa, Streptococcus Pneumoniae, Staphylococcus aureus
Answer: Haemophilus influenzae
Flashcard 404: What are the most common causative organisms of HAP? _____, Staphylococcus aureus
Answer: Pseudomonas aeruginosa
Flashcard 405: _____ is the most common type of pneumonia
Answer: Bacterial pneumonia
Flashcard 406: Which pneumonia-causing organism infects patients after an influenza infection? _____
Answer: Staphylococcus aureus
Flashcard 407: The diagnostic investigation for mycoplasma pneumoniae infection is a _____ test
Answer: blood sereology
Flashcard 408: If clubbing is present in COPD then _____
Answer: rule out lung cancer (CXR)
Flashcard 409: First-line managment for an adult with high severity CAP is _____
Answer: co-amoxiclav + macrolide
Flashcard 410: Patients with CAP and a CURB65 score of _____ should be treated at home
Answer: 0-1
Flashcard 411: Which pneumonia-causing organism is seen in HIV patients? _____
Answer: Pneumocystis jiroveci (fungal)
Flashcard 412: Antibiotic therapy for pneumonia based on CRP: _____ mg/L - Do not routinely offer ABx therapy 20-100 mg/L - Consider a delayed ABx prescription >100 mg/L - Give ABx therapy
Answer: <20
Flashcard 413: What investigation should be done for all suspected HAPs? _____
Answer: Sputum culture
Flashcard 414: _____ is a common cause of pneumonia in patients with COPD
Answer: Haemophilus influenzae
Flashcard 415: Pneumonia which develops after _____ of hospital admission is classified as hospital acquired pneumonia
Answer: 48hrs
Flashcard 416: Patients with _____ severity CAP should have what additional investigations? Blood cultures, sputum cultures, pneumococcal & legionella urinary antigen tests
Answer: moderate-high
Flashcard 417: A CXR of mycoplasma pneumoniae may show _____, but sputum culture is the definitive diagnosis
Answer: bilateral consolidation
Flashcard 418: Microbiological tests should not be routinely offered to patients with _____ severity CAP
Answer: low
Flashcard 419: Diagnosis and treatment of CAP should occur within _____ of presentation to hospital
Answer: 4 hours
Flashcard 420: Chest percussion of a pneumonia may reveal focal _____
Answer: dullness
Flashcard 421: Which pneumonia-causing organism is associated with contaminated air conditioning/water systems, hyponatraemia and low levels of lymphocytes on FBC? _____
Answer: Legionella pneumophilia
Flashcard 422: Aspiration pneumonia is most common in people with an _____
Answer: unsafe swallow
Flashcard 423: Patients with pneumonia should have a repeat _____ at ~6 weeks after the first CXR
Answer: CXR
Flashcard 424: Auscultation of a patient with pneumonia may show _____ breath sounds, bronchial breathing and coarse crepitations
Answer: reduced
Flashcard 425: Bronchiectasis is a _____ dilation of the bronchi as a result of permanent damage from inflammation and infection
Answer: permanent
Flashcard 426: What organism causes pneumonia associated with cold sores, high fever and rapid onset of symptoms? _____
Answer: Streptococcus pneumoniae
Flashcard 427: _____ is NOT present in COPD
Answer: Clubbing
Flashcard 428: Classic complications of mycoplasma pneumoniae infections are _____, autoimmune haemolytic anaemia, erythema multiforme
Answer: encephalitis
Flashcard 429: Red-currant sputum is characteristic of _____
Answer: Klebsiella pneumonia
Flashcard 430: Acute exacerbations of COPD that dont respond to nebulised bronchodilators may be treated with _____
Answer: IV theophylline
Flashcard 431: Which pneumonia-causing organism is seen in alcoholics? _____
Answer: Klebsiella pneumoniae
Flashcard 432: _____ pneumonias have non-infective causes
Answer: Idiopathic interstitial
Flashcard 433: Patients with COPD exacerbations may experience _____ if they are hypoxic
Answer: confusion
Flashcard 434: LTOT is not offered to patients who _____
Answer: smoke
Flashcard 435: An FEV1/FVC ratio of _____ is indicative of obstructive lung disease
Answer: <70%
Flashcard 436: COPD patients will recieve and annual _____ vaccination and a one-off pneumococcal vaccination
Answer: influenza
Flashcard 437: What non-pharmacological treatments/lifestyle changes are recommended for COPD patients? _____ & Pulmonary rehabilitation
Answer: Smoking cessation
Flashcard 438: Patients with COPD who have had trials of short and long acting bronchodilators or are unable to use inhaled therapies may be offered _____
Answer: oral theophylline
Flashcard 439: Patients <40 years old OR minimal smoking history with suspected COPD should be tested for _____
Answer: alpha-1 antitrypsin deficiency
Flashcard 440: Post-bronchodilator FEV1 _____ of predicted in COPD is categorised as Moderate (stage 2)
Answer: 50-79%
Flashcard 441: Features of COPD include _____, exertional dyspnoea, wheeze, right-sided heart failure and recurrent chest infections
Answer: chronic productive cough
Flashcard 442: What is the symptomatic management of Cor Pulmonale in COPD patients? _____
Answer: Diuretics (e.g. Loop diuretic)
Flashcard 443: Post-bronchodilator FEV1 _____ of predicted in COPD is categorised as Severe (stage 3)
Answer: 30-49%
Flashcard 444: If an individual experiences exacerbations of COPD or is still limited by symptoms after initial inhaled therapy consider: Patients without asthmatic features or steroid responsiveness: • 1st line: _____ + LAMA • 2nd line (persistent symptoms/exacerbations): triple therapy (LABA + LAMA + ICS)Patients with asthmatic features or steroid responsiveness: • 1st line: LABA + ICS • 2nd line (persistent symptoms/exacerbations): triple therapy (LABA + LAMA + ICS)
Answer: LABA
Flashcard 445: COPD is an umbrella term for _____ and emphysema
Answer: chronic bronchitis
Flashcard 446: Assessment for long term oxygen therapy in patients with COPD involves _____ done 3 weeks apart
Answer: 2x ABG
Flashcard 447: Initial inhaled therapy management of COPD is _____
Answer: SABA or SAMA as needed
Flashcard 448: CXR of a patient with COPD may show: _____, bullae, diaphragm flattening
Answer: hyperinflation
Flashcard 449: The dose of theophylline should be reduced if co-prescribed with _____ or fluoroquinolones
Answer: macrolides
Flashcard 450: COPD patients with a chronic productive cough may be offered _____
Answer: mucolytics
Flashcard 451: COPD exacerbations with an increase in _____ are likely due to an infective cause
Answer: sputum
Flashcard 452: How are COPD exacerbations managed in secondary care? _____
Answer: Oxygen, nebulised bronchodilators, prednisolone (or IV hydrocortisone)
Flashcard 453: A FBC is done in patients with COPD to rule out _____
Answer: secondary polycythemia
Flashcard 454: LTOT must be administered for at least _____ each day for there to be a survival benefit in COPD patients
Answer: 15 hours
Flashcard 455: Oxygen saturation target for exacerbations should be _____. If pCO2 is normal, this should be adjusted to 94-98%
Answer: 88-92%
Flashcard 456: Patients with COPD should be offered LTOT if they have a PO2 _____kPa or PO2 7.3-8kPa and secondary polycythaemia, peripheral oedema or pulmonary hypertension
Answer: <7.3
Flashcard 457: Obstruction in asthma is _____, whereas obstruction in COPD is irreversible
Answer: reversible
Flashcard 458: The main cause of COPD is _____
Answer: smoking
Flashcard 459: Exacerbations of COPD should be treated in hospital if oxygen saturations are less than _____
Answer: 90%
Flashcard 460: Post-bronchodilator FEV1 _____ of predicted in COPD is categorised as Mild (stage 1)
Answer: ≥80%
Flashcard 461: Post-bronchodilator FEV1 _____ of predicted in COPD is categorised as Very severe (stage 4)
Answer: <30%
Flashcard 462: _____ therapies should only be offered to patients with COPD if there is breathlessness and exercise limitation
Answer: Inhaled
Flashcard 463: What genetic change predisposes someone to COPD? _____
Answer: Alpha-1 antitrypsin deficiency
Flashcard 464: Patients with COPD who continue to have exacerbations while on standard treatments may be offered _____
Answer: prophylactic ABX (azithromycin)
Flashcard 465: What investigations may be done for suspected COPD? _____, CXR, FBC
Answer: Post-bronchodilator spirometry
Flashcard 466: What is the out of hospital management of COPD exacerbations? _____
Answer: Increase bronchodilators, prednisolone (5 days), consider ABX (if there are signs of pneumonia)
Flashcard 467: The most common bacterial cause of a COPD exacerbation is _____
Answer: Haemophilus influenzae
Flashcard 468: Nearly half of COPD exacerbations are caused by viruses; the most common is _____
Answer: rhinovirus
Flashcard 469: Croup classification Mild = _____ Moderate = Stridor & thoracic retractions at rest, Westley 3-5 Severe = Stridor & thoracic retractions at rest + agitation, cyanosis, exhaustion or other signs of impending respiratory failure, Westley ≥ 6
Answer: No stridor, Westley 0-2
Flashcard 470: Croup is presents with a sudden onset _____, which may present with stridor, fever, and/or coryzal symptoms
Answer: “seal”-like barking cough
Flashcard 471: Humidified oxygen via a head box is given to manage bronchiolitis if O2 sats are less than: _____% if < 6 weeks old 90% if ≥ 6 weeks old
Answer: 92
Flashcard 472: Bronchiolitis is largely caused by _____ in ~75% of cases
Answer: respiratory syncitial virus RSV
Flashcard 473: What is the management of bronchiolitis? _____
Answer: Supportive - humidified oxygen if O2 sats < 92%
Flashcard 474: Croup is majorly caused by _____
Answer: parainfluenza viruses
Flashcard 475: Croup symptoms worsen at _____ & with agitation
Answer: late evening/night
Flashcard 476: Croup is diagnosed clinically, however, on X-ray there is "_____" present
Answer: steeple sign
Flashcard 477: Croup usually resolves within _____
Answer: 2-7 days
Flashcard 478: _____ is diagnosed in a baby or child that has coryzal prodrome lasting 1 to 3 days followed by: - Persistent cough and - Either tachypnoea or chest recession (or both) and - Either wheeze or crackles on chest auscultation (or both)
Answer: Bronchiolitis
Flashcard 479: What is the pharmacological management of croup? _____
Answer: oral dexamethasone → single dose
Flashcard 480: _____ is the leading cause of severe lower respiratory tract infections in infants < 2 year olds
Answer: Bronchiolitis
Flashcard 481: Bronchiolitis incidence increases in the _____ season
Answer: winter
Flashcard 482: Croup commonly onsets at _____ to 3 years old
Answer: 6 months
Flashcard 483: _____ is an URTI commonly at 6 months - 3 years characterised by a seal-like barking cough, stridor & hoarse voice
Answer: Croup
Flashcard 484: What is the management of severe / life-threatning asthma in children? _____
Answer: Need hospital attention
Flashcard 485: What is the management of epiglottitis after endotracheal intubation has taken place? (2) _____
Answer: Oxygen + IV antibiotics (ceftriaxone & vancomycin)
Flashcard 486: PEF _____% indicates life-threatening asthma
Answer: <33
Flashcard 487: Epiglottitis is _____ and has a rapid onset
Answer: severe
Flashcard 488: What are the features of epiglottitis? _____
Answer: - Fever - Rapid onset - Stridor - Drooling - Tripod position
Flashcard 489: Acute epiglottitis is caused by _____
Answer: Haemophilus influenzae
Flashcard 490: What is the likely diagnosis in a child with fever, drooling, & stridor sitting in a tripod position? _____
Answer: Acute epiglottitis
Flashcard 491: The management of mild to moderate acute asthma in children includes _____ + 3 days oral steroid therapy
Answer: bronchodilator therapy
Flashcard 492: What is the first-line management of suspected acute epiglottitis? _____
Answer: - Immediate senior escalation - Endotracheal intubation to secure the airway
Flashcard 493: If epiglottitis is suspected, do NOT _____ due to the potential risk of acute airway obstruction
Answer: inspect the throat
Flashcard 494: How is epiglottitis diagnosed if suspected? _____
Answer: Made through direct visualisation performed ONLY by senior staff trained in airway management
Flashcard 495: Patients with epiglottitis often present in a _____ position because it faciliatates easier breathing as it optimises mechanics of respiration
Answer: tripod
Flashcard 496: SpO2 < _____% indicates severe/life-threatening asthma attack in children
Answer: 92
Flashcard 497: _____ presents with a "thumb print" sign on a lateral x-ray
Answer: Acute epiglottitis
Flashcard 498: "_____" sign on x-ray = epiglottitis "Steeple" sign on x-ray = croup
Answer: Thumb print
Flashcard 499: SpO2 _____% indicates moderate asthma attack in children
Answer: > 92
Flashcard 500: PEF _____% indicates severe asthma
Answer: 33-50
Flashcard 501: What is the management of mild to moderate acute asthma in children? (2...) _____
Answer: Bronchodilator therapy Beta-2 agonist via a spacer → 1 puff every 30-60 seconds → max. 10 puffs If symptoms not controlled, repeat & refer to hospital Steroid therapy Given to all children with an asthma exacerbation 3 days oral perdnisolone (but can be given longer if necessary) <2yrs = 10 mg OD 2-5yrs = 20mg OD >5yrs = 30-40mg OD
Flashcard 502: Long-term management of asthma for children aged 5-16 is very similar to adults = Step 1 = _____ Step 2 = SABA + paediatric ICS (low dose inhaled corticosteroids) Step 3 = SABA + paediatric ICS + LTRA (leukotrine receptor antagonist)
Answer: SABA
Flashcard 503: PEF _____% indicates moderate asthma attack in children > 5 yrs
Answer: > 50
Keywords: Respiratory Medicine flashcards, medical flashcards, NEET PG preparation, USMLE Step 1 flashcards, Anki alternative, spaced repetition medical, OnCourse flashcards
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