HERMES Adult Respiratory Medicine flashcards

34 cards. Read the term and the definition here. The deck at the top of this page is optional.

Asthma diagnostic criterion

Variable expiratory airflow limitation with compatible symptoms, demonstrated by FEV1 improvement of more than 12% and more than 200 mL after inhaled salbutamol, or by peak flow variability over time.

GOLD COPD spirometry threshold

A post-bronchodilator FEV1 to FVC ratio below 0.70 confirms persistent airflow obstruction in a patient with symptoms and relevant exposure such as tobacco smoke or biomass fuel.

Acute severe asthma magnesium dose

Intravenous magnesium sulfate 2 g infused over 20 minutes is used for severe asthma not responding to inhaled bronchodilators and systemic corticosteroids in the first hour of treatment.

NIV in COPD exacerbation

Non-invasive ventilation reduces intubation and mortality in acute hypercapnic COPD exacerbation with pH 7.25 to 7.35 and PaCO2 above 45 mmHg, when no contraindication exists.

Cystic fibrosis sweat chloride

A sweat chloride concentration above 60 mmol/L confirms CFTR dysfunction when combined with compatible clinical features; values of 30 to 59 mmol/L are intermediate and require further testing.

Usual interstitial pneumonia pattern

High-resolution CT shows subpleural and basal-predominant reticulation, honeycombing, and traction bronchiectasis with minimal ground-glass change, supporting a diagnosis of idiopathic pulmonary fibrosis.

Acute exacerbation of IPF

New bilateral ground-glass opacities or consolidation on CT within one month of a respiratory decline, after excluding infection, heart failure, and pulmonary embolism; mortality exceeds 50 percent.

Sarcoidosis radiographic staging

Stage I is bilateral hilar lymphadenopathy, stage II adds parenchymal infiltrates, stage III is parenchymal infiltrates alone, and stage IV is pulmonary fibrosis with architectural distortion.

Antifibrotic monitoring requirements

Pirfenidone and nintedanib slow lung function decline in IPF but require baseline and periodic liver enzyme testing, plus attention to gastrointestinal side effects and photosensitivity.

BAL lymphocytosis significance

Bronchoalveolar lavage lymphocytosis above 25 to 30 percent suggests hypersensitivity pneumonitis or sarcoidosis, while eosinophils above 25 percent suggest eosinophilic pneumonia; results are supportive rather than diagnostic.

Bronchiolitis management principles

Infant bronchiolitis, usually caused by respiratory syncytial virus, is managed with supportive oxygen and feeding support; routine bronchodilators, corticosteroids, and antibiotics are not recommended.

Croup corticosteroid treatment

A single dose of oral dexamethasone 0.15 to 0.6 mg/kg treats croup; nebulised adrenaline is added for moderate to severe cases with stridor at rest.

Primary ciliary dyskinesia features

Neonatal respiratory distress, chronic wet cough, recurrent otitis media, and situs inversus in about half of patients, with low nasal nitric oxide and abnormal ciliary beat pattern.

CF newborn screening pathway

Elevated immunoreactive trypsinogen triggers CFTR mutation panel testing, followed by sweat chloride testing; sweat chloride above 60 mmol/L is diagnostic in an infant with compatible features.

Pulmonary hypertension definition

Mean pulmonary arterial pressure above 20 mmHg at rest defines pulmonary hypertension; precapillary disease also requires pulmonary vascular resistance of at least 3 Wood units and wedge pressure of 15 mmHg or less.

PE haemodynamic risk stratification

Haemodynamic instability defines high-risk pulmonary embolism requiring systemic thrombolysis or embolectomy; stable patients are stratified by sPESI, right ventricular function, and troponin.

Chronic thromboembolic pulmonary hypertension

Persistent perfusion defects on ventilation-perfusion scanning after at least three months of anticoagulation, with mean pulmonary arterial pressure above 20 mmHg; pulmonary endarterectomy is the preferred treatment.

PAH vasoreactivity testing

Acute vasoreactivity testing during right heart catheterisation identifies the roughly 10 percent of idiopathic PAH patients who may be treated with high-dose calcium channel blockers.

ARDS Berlin definition

Acute onset within one week, bilateral opacities not explained by effusion or collapse, and PaO2/FiO2 of 300 mmHg or less on PEEP of at least 5 cmH2O.

Lung-protective ventilation targets

Tidal volume of 6 mL/kg predicted body weight, plateau pressure of 30 cmH2O or less, and monitoring of driving pressure reduce mortality in acute respiratory distress syndrome.

Rapid shallow breathing index

Respiratory rate divided by tidal volume in litres; a value below 105 during a spontaneous breathing trial predicts successful extubation from mechanical ventilation.

Predicted body weight formula

For males, 50 plus 0.91 times height in centimetres minus 152.4; for females, 45.5 plus the same term. Used to set lung-protective tidal volumes.

Prone positioning indication

In moderate to severe ARDS with PaO2/FiO2 below 150 mmHg, prone positioning for at least 16 hours daily reduces mortality when applied early in the disease course.

CURB-65 components

Confusion, urea above 7 mmol/L, respiratory rate of 30 or more, low systolic or diastolic blood pressure, and age 65 or older; each scores one point for CAP severity.

Latent tuberculosis regimens

Options include four months of daily rifampicin, three months of weekly isoniazid plus rifapentine, or six to nine months of isoniazid; choice depends on interactions and liver risk.

Pneumocystis prophylaxis threshold

Co-trimoxazole prophylaxis is indicated when the CD4 count falls below 200 cells per microlitre; treatment doses are higher and adjunctive corticosteroids are added when PaO2 is below 70 mmHg.

Complicated parapneumonic effusion

Pleural fluid pH below 7.20, glucose below 2.2 mmol/L, or loculation indicates need for chest drainage; intrapleural fibrinolytics with DNase may be used for complex collections.

OSA severity by AHI

The apnoea-hypopnoea index grades obstructive sleep apnoea: mild is 5 to 15, moderate 15 to 30, and severe above 30 events per hour of sleep.

CPAP adherence definition

CPAP use of at least four hours per night on at least 70 percent of nights is the conventional threshold for adequate adherence and for expected cardiovascular benefit.

Obesity hypoventilation syndrome

Body mass index of 30 or more, daytime PaCO2 above 45 mmHg while awake, and sleep-disordered breathing without another cause of hypoventilation; treated with weight loss and nocturnal non-invasive ventilation.

STOP-BANG screening score

Snoring, tiredness, observed apnoea, pressure, body mass index, age, neck circumference, and gender; a score of 3 or more indicates high risk of obstructive sleep apnoea.

NSCLC molecular testing panel

Advanced non-squamous NSCLC requires testing for EGFR, ALK, ROS1, BRAF, KRAS, MET, RET, and PD-L1; a driver mutation directs targeted therapy rather than chemotherapy.

SCLC staging and treatment

Small cell lung cancer is staged as limited or extensive; limited-stage disease is treated with concurrent chemoradiotherapy, and prophylactic cranial irradiation is considered in responders.

Paraneoplastic hypercalcaemia in cancer

Squamous cell lung carcinoma secretes PTH-related peptide causing hypercalcaemia; small cell carcinoma instead causes SIADH and ectopic ACTH, so the histology guides the expected syndrome.