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respiratory Flashcards

1
Q

what does Goodpastures disease attack and what type of hypersensitivity reaction is it?

A
  • anti-glomerular basement membrane (glomerulus and pulmonary basement membranes) - type IV collagen
  • type II hypersensitivity reaction
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2
Q

which electrolyte disturbance is a key finding of sarcoidosis?

A

hypercalcaemia

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3
Q

list key features of sarcoidosis

A
  • dry cough,
  • SOB,
  • rash,
  • bilateral hilar lymphadenopathy on XR,
  • biopsy showing non-caseating granulomas with epithelioid cells -
  • HYPERCALCAEMIA
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4
Q

how do long acting muscarinic antagonists work?

A

cause bronchodilation by blocking acetylcholine receptors (which normally cause contraction of bronchial smooth muscle)

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5
Q

what is the immediate treatment for a spontaneous pneumothorax?

A

immediate decompression via large bore canula

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6
Q

what is the treatment for a moderate PE (stable patient)?

A
  • DOAC e.g. apixaban / rivaroxaban,
  • if contraindicated (e.g. in liver disease) then LMWH e.g. dalteparin
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7
Q

what is the treatment for a severe PE (unstable patient)?

A

thrombolysis

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8
Q

Which cause of pneumonia is most typically associated with AIDS?

A

pneumocystis jirovecii

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9
Q

describe the CURB-65 criteria

A
  • score 1 for each of: Confusion; Urea > 7mmol/L; Resp rate >30/min; Blood pressure (Sys <90mmHg, Dia <60mmHg); Age >65.
  • Score 0-1: Treat as outpatient; score 2: Admit to hospital; score ≥3: Severe, may require step up to ITU
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10
Q

what is sarcoidosis?

A
  • chronic disease of unknown cause
  • enlargement of lymph nodes in many parts of the body
  • widespread appearance of granulomas derived from the reticuloendothelial system
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11
Q

list 4 risk factors for COPD

A

smoking, asbestos exposure, alpha-1 antitrypsin deficiency, occupational exposure

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12
Q

which gene is mutated in cystic fibrosis?

A

transmembrane conductance regulator gene (CFTR)

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13
Q

Which drug is used in the treatment of tuberculosis and may cause red tears / sweat / saliva?

A

rifampicin

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14
Q

what is the mode of inheritance of cystic fibrosis?

A

autosomal recessive

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15
Q

what is the most common type of lung cancer?

A

adenocarcinoma - also most common in non-smokers

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16
Q

what is the most common type of lung cancer in smokers?

A

squamous cell carcinoma

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17
Q

in bronchiectasis, what’s the common finding on CT?

A

signet ring sign

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18
Q

name 4 obstructive lung diseases

A

asthma, COPD, bronchiectasis, bronchiolitis

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19
Q

name 4 restrictive lung diseases

A

TB, pulmonary fibrosis, asbestosis, bronchiolitis

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20
Q

what is the most common organism to cause hospital acquired pneumonia?

A

pseudomonas aeruginosa

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21
Q

what is the most common organism to cause community acquired pneumonia?

A

strep pneumoniae and staph aureus

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22
Q

Which type of patients are most likely to develop a spontaneous pneumothorax?

A

young males (20-40), low BMI

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23
Q

What is the most appropriate site for a needle thoracostomy to treat a tension pneumothorax?

A

2nd intercostal space, midclavicular line, on the same side as the pneumothorax

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24
Q

what signs would support a diagnosis of tension pneumothorax?

A
  • Tracheal deviation away from the affected lung
  • hypotension
  • hypoxia
  • “bubble wrap” like texture under skin of neck (subcut emphysema),
  • PMH chest trauma
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25
Q

What is the Gold-standard imaging technique for diagnosing a PE?

A

CT pulmonary angiography (CTPA)

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26
Q

how do you differentiate between squamous cell carcinoma and small cell carcinoma?

A

SCLC can present with paraneoplastic syndromes e.g. Lambert-eaton syndrome - muscle weakness in truncal distribution which improves after exertion

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27
Q

treatment for hospital acquired pneumonia?

A

co-amoxiclav and clarithromycin IV

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28
Q

what is the gold standard investigation for TB?

A

nucleic acid amplification tests (NAAT)

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29
Q

what is seen on an XR for TB?

A

Ghon complex - predominantly in upper part of lower lobe

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30
Q

list 4 complications of cystic fibrosis?

A

T2DM, infertility in males, mucous retention in the lungs, meconium ileus

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31
Q

first line management of sarcoidosis?

A

prednisolone

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32
Q

how do you treat a COPD exacerbation?

A

OSHIT:
- O2 at ~24-28%
- Salbutamol
- Hydrocortisone
- Ipratropium
- Theophylline

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33
Q

what signs on an XR would confirm a diagnosis of TB?

A
  • Ghon’s complex
  • dense homogenous opacity
  • pleural effusion
  • hilar lymphadenopathy
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34
Q

what type of lesion is usually present in TB?

A

caseating granuloma

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35
Q

What is the most likely causative organism of TB?

A

mycobacterium tuberculosis

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36
Q

What stain should be used with mycobacterium tuberculosis?

A

Ziehl-Neelson stain

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37
Q

what antibiotics are used to treat TB?

A

rifampicin, isoniazid, pyrazinamide, ethambutol

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38
Q

what 2 tests are used to detect cystic fibrosis?

A

heel prick test and sweat test

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39
Q

list some differentials for resp conditions caused by asbestos exposure?

A

asbestosis, mesothelioma, silicosis, idiopathic pulmonary fibrosis, coal worker’s pneumoconiosis

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40
Q

which type of cancer has a very strong association with asbestos exposure?

A

mesothelioma

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41
Q

what is Horner’s syndrome?

A

rare condition classically presenting with partial ptosis, miosis, and facial anhidrosis due to a disruption in the sympathetic nerve supply

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42
Q

pathophysiology of a pancoast tumour?

A

a cancer that starts in the apex of the lung -> invades apical chest wall -> grows and affects nearby structures e.g. intercostal nerves or brachial plexus and sympathetic chain

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43
Q

What is the pathophysiology of chronic asthma?

A
  • narrowing of the airway due to smooth muscle contraction
  • thickening of the airway wall by cellular infiltration and inflammation
  • and the presence of secretions within the airway lumen
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44
Q

name 5 things that can precipitate asthma flare ups

A
  • cold air,
  • exercise,
  • emotion,
  • allergens,
  • infection,
  • smoking,
  • pollution,
  • NSAIDs,
  • beta-blockers
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45
Q

1 investigation used to confirm asthma diagnosis?

A

spirometry

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46
Q

name 3 classes of drugs used in the management of asthma and give one example of each

A
  • Short acting beta2-Adrenoceptor agonists - salbutamol / terbutaline
  • longer-acting - salmeterol and formoterol.
  • Antimuscarinic bronchodilators - ipratropium bromide
  • Inhaled corticosteroids - beclomethasone
  • Anti-inflammatory agents, e.g. sodium cromoglicate
  • Cysteinyl leukotriene receptor antagonists (LTRAs) - montelukast, are (given orally).
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47
Q

gold standard investigation for a lung cancer?

A

chest XR

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48
Q

list 5 cancers that can metastasise to lung

A

breast, colon, prostate, bladder, sarcoma

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49
Q

what hormone is produced by small cell lung cancer?

A

ACTH

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50
Q

what kind of lesions does sarcoidosis form on the body?

A

non-caseating granulomas

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51
Q

name 4 extrapulmonary signs of sarcoidosis

A
  • erythema nodosum
  • polyarthritis
  • lupus penio
  • arrhythmias
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52
Q

name 4 differentials that present with bilateral hilar lymphadenopathy on XR

A

lymphoma, silicosis, TB, HF, sarcoidosis

53
Q

name 3 potential causes of bronchiectasis

A

CF, post infection, airway obstruction, congenital ciliary defect

54
Q

name 3 signs you could notice on examination of bronchiectasis

A
  • clubbing,
  • wheeze,
  • course crackles heard on early inspiration
55
Q

Name 3 potential complications of bronchiectasis

A

emphysema, repeated infections, respiratory failure, PT

56
Q

name 2 non-pharmacological managements of bronchiectasis

A

healthy diet, physical exercise, smoking cessation

57
Q

what is the FEV1/FVC ratio in obstructive lung diseases?

A

< 0.7

58
Q

what is the FEV1/FVC ratio in restrictive lung diseases?

A

> 0.7

59
Q

4 important differential diagnoses for COPD?

A

asthma, A1AT deficiency, CF, bronchiectasis

60
Q

Aside from spirometry, what other initial investigations would be appropriate for COPD?

A

chest XR, FBC (anaemia, polycythaemia), BMI, ABG

61
Q

most appropriate antibiotic for haemophilus influenzae?

A

co-amoxiclav

62
Q

Give 2 differential diagnoses for a COPD exacerbation.

A

pneumonia, pneumothorax

63
Q

Name 5 groups of patients most at risk of respiratory infections.

A

Infants, elderly, COPD / chronic lung conditions, immunocompromised (HIV, diabetes)

64
Q

What tool is used to assess the severity of resp infections?

A

CURB-65

65
Q

Name 3 risk factors for a pneumothorax

A

smoking, previous PT, COPD, trauma

66
Q

Name 2 symptoms of a pneumothorax

A

chest pain, dyspnoea (maybe asymptomatic)

67
Q

Name 3 symptoms of a pulmonary embolism

A

chest pain, dizziness, dyspnoea

68
Q

Name an objective risk assessment score for calculating PE risk?

A

Well’s score

69
Q

Describe how a pneumothorax and pleural effusion could be differentiated on a respiratory examination

A
  • PE: dull on percussion
  • PT: hyper-resonant on percussion
70
Q

Describe how a pneumothorax and pleural effusion could be differentiated through a history

A
  • PE: congestive HF, pulmonary embolism, cancer, pneumonia
  • PT: trauma, family history, smoking
71
Q

What aspect of chest pain differentiates pericarditis and an MI?

A

Does NOT radiate to the jaws and teeth in pericarditis

72
Q

Name 4 features elicited on clinical examination that would make you suspect pericarditis

A

pericardial rub, sinus tachycardia, fever, effusion signs

73
Q

What would you expect on an ECG of a patient with pericarditis

A

Saddle shaped ST elevation

74
Q

How long should colchicine be given for in patients who have had acute pericarditis?

A

6-8 weeks

75
Q

What is the first line treatment for pneumonia?

A

Oxygen

76
Q

describe streptococcus pneumoniae

A

gram positive bacilli chains

77
Q

What is bronchiectasis?

A

The permanent dilation of the airways caused by chronic inflammation / and inability to clear secretions.

78
Q

How can an infection cause bronchiectasis?

A

The infection causes release of inflammatory mediators (IgE), impairing ciliary action allowing bacterial proliferation and tissue damage.

79
Q

Give two possible treatments of bronchiectasis

A

antibiotics, bronchodilators, corticosteroids

80
Q

What is the term given to describe “a tendency to develop allergies”?

A

atopy

81
Q

Eczema, asthma and allergic rhinitis are a classical atopic triad of what syndrome?

A

Hyper IgE syndrome

82
Q

What are the most common sites for eczema?

A

Flexor surfaces, Backs of knees/front of elbows, cheeks, hands and feet, buttocks, behind the ears

83
Q

How does an allergen lead to histamine release?

A

An allergen stimulates a cascade that leads to IgE antibody secretion by B cells. The IgE binds to mast cells causing them to degranulate and release histamine

84
Q

How does histamine cause inflammation?

A

causes blood vessels to dilate and leak

85
Q

describe the pathophysiology of chronic bronchitis

A

Inflammation causes mucociliary dysfunction, leading to lower ventilation

86
Q

describe the pathophysiology of emphysema

A

Inflammation causes loss of elastic recoil of alveoli, causing air trapping and lower gas transfer

87
Q

Give the three cardinal symptoms of COPD

A

sputum production in cough, dyspnoea, chronic cough

88
Q

What two signs found through lung function tests indicate COPD?

A

FEV1/FVC < 0.7
FEV1 < 80% of predicted value

89
Q

Give 3 characteristics of asthma.

A

airflow limitation, airway hyper-responsiveness, bronchial inflammation

90
Q

What is the action of beta-2-agonists?

A

bronchodilator

91
Q

How long do short acting beta-agonists (SABAs) last?

A

4 hours

92
Q

What makes LABAs last longer in tissues?

A

lipophilic

93
Q

What can happen if beta-2-agonists are used at high concentrations in badly controlled asthma?

A

B2-receptor desensitisation

94
Q

Give three risk factors for asthma.

A
  • PMH of atopy
  • family history of asthma/atopy
  • obesity
  • socio-economic deprevation
95
Q

give the 3 typical characteristics of asthma

A

airflow limitation, airway hyper-responsiveness, bronchial inflammation

96
Q

give 2 classes of bronchodilators

A

beta-2-agonists, muscarinic antagonists

97
Q

What is the commonest cause of an infective exacerbation of COPD?

A

haemophilus influenzae

98
Q

which medication for asthma is most associated with a fine tremor?

A

salbutamol inhaler

99
Q

mechanism of action of ipratropium bromide?

A

muscarinic acetylcholine receptor antagonist that acts as a bronchodilator

100
Q

give 3 differential diagnoses for pericarditis

A

aortic dissection, pneumonia, acute coronary syndrome, MI, PE

101
Q

main investigation and results in pericarditis?

A

ECG -> saddle shaped ST elevation, PR depression

102
Q

what drug can be given to reduce the chance of recurrence of pericarditis?

A

colchicine

103
Q

give 3 complications of pericarditis

A

pericardial effusion, cardiac tamponade, constrictive pericarditis

104
Q

what is the symptomatic management of asbestosis?

A

corticosteroids

105
Q

what is the survival rate of lung cancer?

A

10 year survival of 5.5%

106
Q

what is an acute test for diagnosing asthma?

A

peak expiratory flow

107
Q

What cell is responsible for presenting an asthma causing allergen to Th2 cells?

A

dendritic cell

108
Q

List 3 potentially triggering substances for asthma

A
  • air pollution e.g. cigarette smoke
  • allergens e.g. dust, cats, mould
  • medications e.g. beta blockers
109
Q

list 4 signs of a severe asthma attack

A
  • PEFR 33-50% predicted
  • RR > 25
  • HR > 110
  • Inability to complete sentences
110
Q

list 4 signs of a life threatening asthma attack

A
  • PEFR <33%
  • SaO2 <92% or PaO2 < 8 kPa
  • Normal PaCO2 4.6-6 kPa
  • Altered conscious level, exhaustion, arrhythmia, hypotension, silent chest, poor effort, cyanosis
111
Q

gram positive, alpha-haemolytic optochin negative bacteria?

A

strep viridans

112
Q

how can COPD lead to peripheral oedema?

A

hypoxic kidney is not perfused so no sodium and water is excreted leading to peripheral oedema

113
Q

give 3 signs that may be seen in COPD

A

barrel chest, intercostal recession, wheeze, tachycardia

114
Q

what is the FEV value for COPD?

A

< 80% predicted

115
Q

what would an asthmatic’s lungs sound like on percussion?

A

hyper-resonant

116
Q

what is the correct stepwise pharmacological
management for an adult diagnosed with asthma?

A

SABA -> low ICS -> LTRA -> LABA -> MART -> mod ICS -> high ICS

117
Q

does lung cancer commonly metastesis to breasts?

A

NO - commonly brain, liver, bone, adrenal glands

118
Q

name 3 organisms that can cause atypical pneumonia?

A
  • mycoplasma pneumonia,
  • legionella pneumophila,
  • chlamydophila pneumoniae
119
Q

Cystic fibrosis is an inherited autosomal recessive disease caused by genetic mutations, but which chromosome is affected?

A

7

120
Q

describe moderate asthma

A
  • PEFR more than 50-75% best or predicted
  • normal speech
  • no features of acute severe or life-threatening asthma
121
Q

describe acute severe asthma

A
  • PEFR 33-50% best or predicted
  • or respiratory rate of at least 25/min
  • or pulse rate of at least 110/min
  • or inability to complete sentences in one breath / or accessory muscle use / or inability to feed (infants), with oxygen saturation of at least 92%
122
Q

describe life threatening asthma

A
  • PEFR less than 33% best or predicted,
  • or oxygen saturation of less than 92%,
  • or altered consciousness, poor respiratory effort / silent chest, or confusion.
123
Q

state the acute severe asthma attack pathway

A
  • salbutamol
  • ipratropium bromide nebuliser
  • oral prednisolone or IV hydrocortisone
124
Q

give 3 indicators of good asthma control

A
  • no night time symptoms
  • inhaler used < 3 times a week
  • no breathing difficulties, cough or wheeze on most days
  • able to exercise without symptoms
  • normal lung function test
125
Q

Give 2 causes of exudative effusions

A

pneumonia, TB, RA, lung cancer

126
Q

Give 2 causes of transudative effusions

A

heart failure, hypoalbuminaemia, hypothyroidism

127
Q

how do you differentiate between transudative and exudative effusions?

A

If the pleural fluid protein is greater than 35g/L the fluid is an exudate

128
Q

why does dyspnoea occur in pneumonia?

A

alveoli are filled with pus/neutrophils/inflammatory exudate which impairs gas exchange

past questions (11 decks)

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