Respiratory

Front 1

features of acute severe asthma

Back 1

PEF 33-50% best or predicted
SpO2 >92%
Cannot complete sentence
RR >25 breaths/min
Pulse >110 beat/min

Front 2

features of life threatening asthma

Back 2

PEF <33% best of predicted
SpO2 <92%
Silent chest, cyanosis or poor respiratory effort
Arrhythmia or hypotension
Exhaustion, altered consciousness

Front 3

medical management of acute severe / life threatening asthma

Back 3

Oxygen to maintain SpO2 94-98%
Salbutamol 5mg + ipratropium 0.5mg via oxygen-driven nebuliser
Prednisolone 40-50mg orally or IV hydrocortisone 100mg

Front 4

clinical features for PE on Wells' criteria

Back 4

Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins)
An alternative diagnosis is less likely than PE
HR > 100 bpm
Immobilisation (for more than 3 days) or surgery in the previous four weeks
Previous DVT/PE
Haemoptysis
Malignancy (on treatment, treated in the last 6 months, or palliative)

Front 5

clinical probability score required for PE likely on Wells' criteria

Back 5

More than 4 points

Front 6

If PE likely (>4 Wells Score), what's the next line of investigation?

Back 6

CTPA and then treat if positive.

If CTPA negative, consider leg USS for possible DVT

Front 7

If PE unlikely (≤ 4 Wells Score), what's the next line of investigation?

Back 7

1. D-dimer test
2. CTPA, if d-dimer is positive

Front 8

Management of small (<2cm), simple pneumothorax

Back 8

observe in A&E for 4 to 6 hours with supplemental high-flow oxygen
If stable → discharge and follow up as OP
If breathless → consider further intervention

Front 9

Management of large (≥2cm), simple pneumothorax

Back 9

Percutaneous aspiration using cannula and syringe
Supplemental oxygen therapy - 10L/min
If aspiration fails, a chest-tube or small-bire catheter should be inserted

Front 10

Management of acute exacerbation of COPD

Back 10

Controlled oxygen therapy - aim for sats 88-92%
If fever & purulent sputum indicative of bacterial source, antibiotics
Nebulised bronchodilators driven with air
Corticosteroids - prednisolone 30mg/day for 1-2 weeks
Consider IV theophylline if poor response to nebulised bronchodilators
Assess need for non-invasive ventilation (NIV)

Front 11

Causes of interstitial lung disease - groups

Back 11

idiopathic, occupational, chronic allergy (EAA), autoimmune, iatrogenic

Front 12

occupational toxins associated with ILD

Back 12

hairdressing sprays, silica, asbestos, coal dust

Front 13

Causes of chronic Extrinsic Allergic Alveolitis

Back 13

pigeon breeding, mouldy foliage (farmers), wood dust

Front 14

Autoimmune conditions associated with ILD

Back 14

RA, SLE, scleroderma, dermatomyositis, sarcoidosis

Front 15

iatrogenic causes of ILD

Back 15

radiation, methotrexate, bleomycin, nitrofurantoin, amiodarone

Front 16

chest findings in idiopathic pulmonary fibrosis

Back 16

fine, end-inspiratory crackles
no change after coughing

reduced chest expansion bilaterally

Front 17

causes of transudative pleural effusion

Back 17

Cardiac failure
nephrotic syndrome
hepatic cirrhosis
Hypoalbuminemia (malnutrition, chronic disease, malabsorption)

Front 18

causes of exudative pleural effusion

Back 18

Bacterial pneumonia
carcinoma
mesothelioma

Front 19

diagnostic features of pleural tap for exudate

Back 19

protein >30 g/dL, LDH >200 u

Front 20

CURB-65 score

Back 20

confusion, urea >7, respiratory rate >30, BP <90/60, age > 65 years

Front 21

when to consider hospital treatment for pneumonia

Back 21

CURB-65 ≥ 2
CURB-65 ≥ 3 = severe pneumonia (consider ICU admission)

Front 22

commonest pathogen for pneumonia

Back 22

Streptococcus pneumoniae (60-75%)

Front 23

antibiotic management of moderate/severe pneumonia (CURB-65 2-5)

Back 23

Amoxicillin IV + clarithromycin PO for 3-5 days

Front 24

causes of localised bronchiectasis

Back 24

infective - severe pneumonia, TB
obstructive - FB, tumour, TB hilar lymph nodes

Front 25

causes of generalised bronchiectasis

Back 25

Cystic fibrosis
Allergic bronchopulmonaryaspergillosis (ABPA) - linked to asthma
RA
IBD
primary ciliary dyskinesia
Ig/complement deficiency
a1-antitrypsin deficiency

Marfan's

Front 26

features of bronchiectasis on CT

Back 26

bronchial dilation

The signet ring sign

Front 27

criteria for immediate (without CXR) lung cancer referral (2ww)

Back 27

chest X‑ray findings that suggest lung cancer OR

aged 40 and over with unexplained haemoptysis

Front 28

criteria for urgent CXR to assess for lung cancer

Back 28

age >40

≥2 unexplained symptoms

≥1 unexplained symptoms & (ex-)smoker

symptoms:

cough

fatigue

shortness of breath

chest pain

weight loss

appetite loss

Front 29

test used to assist in diagnosis of asthma

Back 29

Bronchial challenge test with methacholine

Asthmatics will react to lower doses of drug

Front 30

Indications for long-term oxygen therapy in patients with COPD

Back 30

1. PaO2< 7.3 kPa when stable OR

2. PaO2 7.3-8 kPa when stable and one of:

secondary polycythaemia

nocturnal hypoxaemia

peripheral oedema

pulmonary hypertension

Front 31

CT thorax

Back 31

bronchiectasis

Front 32

Which lung condition?

Back 32

Pulmonary hypertension - RVH, right axis deviation, p-pulmonale (peaked p waves), tall R waves in V1, right ventricular strain

Front 33

causes of pulmonary hypertension

Back 33

Left heart failure

COPD

Chronic pulmonary emboli

Sickle cell disease

Pulmonary fibrosis

Front 34

causes of type I respiratory failure

Back 34

pneumonia

pneumothorax

pulmonary oedema

pleural effusion

PE

Front 35

causes of type II respiratory failure

Back 35

Acute: asthma, foreign body, Guillan-Barre, opioid toxicity

Chronic: COPD, MND, pulmonary fibrosis

Front 36

type II respiratory failure on ABG

Back 36

respiratory acidosis

low PaO2

Raised PaCO2

Front 37

causes of respiratory alkalosis

Back 37

hyperventilation (anxiety, excess mechanical ventilation, compensatory ventilation in acidosis)

Front 38

Stepwise treatment for asthma

Back 38

1. SABA

2. SABA + ICS (400 mcg/day)

3. SABA + ICS + LABA

3b. if LABA fails, add leukotriene receptor antagonist or theophylline

4. increase ICS up to 2000 mcg/day, consider addition of 4th drug

5. oral steroid + refer

Front 39

definition of COPD in lung function tests

Back 39

FEV1/FVC < 0.7

Front 40

COPD severity according to FEV1

Back 40

Mild: FEV1 >80%

Moderate:FEV1 50-80%

Severe:FEV1 30-50%

Very severe:FEV1 <31% or respiratory or right heart failure

Front 41

treatment of COPD according to severity

Back 41

Mild: SABA/SAMA as required

Moderate (FEV1>50%): LABA

Severe (FEV1<50%): LABA + ICS

Very severe (FEV1<31%): LABA + ICS + LAMA

Front 42

SAMA

Back 42

ipratropium, tiotropium

Front 43

LABA

Back 43

formeterol, salmeterol