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Yr 4 - PassMed Corrections > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Prior to discharge, following an acute asthma attack, how long should patients be stable on their discharge medication (i.e. no nebulisers or oxygen)?

A

12-24h

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2
Q

Decrease in pO2/FiO2 in poorly patient with non-cardiorespiratory presentation → condition?

A

ARDS

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3
Q

Pneumothorax management: what are the high-risk characteristics that determine the need for a chest drain?

A

1) Haemodynamic compromise (suggesting a tension pneumothorax)

2) Significant hypoxia

3) Bilateral pneumothorax

4) Underlying lung disease

5) ≥ 50 years of age with significant smoking history

6) Haemothorax

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4
Q

Mx of pleural plaques?

A

Benign - no follow up

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5
Q

What is often seen on CXR in bronchiectasis?

A

Parallel line shadows (often called tram-lines) are common in bronchiectasis and indicate dilated bronchi due to peribronchial inflammation and fibrosis.

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6
Q

1st line Abx for prophylaxis of COPD exacerbations?

A

Azithromycin

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7
Q

Who should LTOT be offered to in COPD?

A

Patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:

1) secondary polycythaemia

2) peripheral oedema

3) pulmonary hypertension

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8
Q

Prognosis of sarcoidosis?

A

The majority of patients with sarcoidosis get better without treatment

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9
Q

What class of drug is ipratropium?

A

SAMA

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10
Q

Mx of minimally symptomatic pneumothorax, regardless of size?

A

conservative treatment / regular follow-up

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11
Q

1st line for mx of high altitude cerebral oedema?

A

Dexamethasone

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12
Q

1st line for prevention of high altitude cerebral oedema?

A

Acetazolamide

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13
Q

total gas transfer (TLCO) in asthma?

A

Normal or raised

This is because the problem is not affecting the alveoli directly or gas exchange and so the lungs try to compensate for the problem by improving gas exchange.

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14
Q

In what 2 conditions would you see raised TLCO?

A

1) Asthma

2) L to R cardiac shunt

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15
Q

How can kyphoscoliosis (e.g. caused by ankylosing spondylitis) affect lung function tests?

A

Can cause a restrictive picture on spirometry (i.e. normal or increased FEV1/FVC ratio).

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16
Q

What is hypogammaglobulinemia?

A

A disorder caused by low serum immunoglobulin or antibody levels i.e. an immune deficiency.

This is known to cause a range of conditions such as bronchiectasis and IBD.

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17
Q

What is the main complication for a patient with hypogammaglobulinemia?

A

Development of bronchiectasis

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18
Q

PTH level in 1ary hyperparathyroidism?

A

May be raised or normal

Normal PTH still indicates 1ary hyperparathyroidism as level should be reduced by high calcium level.

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19
Q

What is the severity of COPD based on?

A

FEV1 spirometry reading

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20
Q

Describe the 4 stages of COPD severity

A

Stage 1 (mild) - FEV1 >80%

Stage 2 (mod) - 50-79%

Stage 3 (severe) - 30-49%

Stage 4 (very severe) - FEV1 <30%

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21
Q

At what age should a patient presenting with unexplained haemoptysis be referred under the 2WW for suspected lung cancer?

A

≥40 y/o

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22
Q

Does a negative result on spirometry exclude asthma?

A

No - do further investigations (e.g. FeNO)

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23
Q

What is FVC

A

The volume of air in the lungs that can be exhaled following a deep inhalation

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24
Q

What is FEV1

A

A measure of how much air can be exhaled in one second following a deep inhalation

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25
Q

What is TCLO (Transfer factor for carbon monoxide, also known as diffusing capacity for carbon monoxide or DLCO)?

A

A measure of how much O2 diffuses from the lung alveoli to blood in the capillaries.

Reduced TCLO indicates impaired gas exchange.

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26
Q

What are the 3 first line Abx for an infective exacerbation of COPD?

A

1) amoxicillin
2) clarithromycin
3) doxycycline

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27
Q

What are the adverse effects of amiodarone use?

A

1) thyroid dysfunction: both hypo- and hyper-

2) corneal deposits

3) pulmonary fibrosis/pneumonitis

4) liver fibrosis/hepatitis

5) peripheral neuropathy

6) photosensitivity

7) ‘slate-grey’ appearance

8) thrombophlebitis and injection site reactions

9) bradycardia

10) lengths QT interval

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28
Q

Why should IV amiodarone be ideally given into central veins?

A

As is a common cause of thrombophlebitis

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29
Q

What 4 investigations are required prior to amiodarone treatment?

A

1) TFTs

2) LFTs

3) U&Es

4) CXR

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30
Q

What 2 investigations are required every 6 months whilst on amiodarone treatment?

A

1) LFTs

2) TFTs

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31
Q

In COPD patients, if they are still breathless despite using SABA/SAMA and a LABA + ICS, what is next step?

A

Add a LAMA

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32
Q

How does sarcoidosis cause hypercalcaemia?

A

Due to the uncontrolled synthesis of 1,25-dihydroxyvitamin D3 (i.e. vitamin D) by macrophages.

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33
Q

Key investigation in ILD/pulmonary fibrosis? What does it show?

A

High resolution CT of thorax - shows ‘ground glass’ appearance.

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34
Q

What are 2 congenital causes of bronchiectasis?

A

1) CF

2) A1AT deficiency

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35
Q

What are 3 connective tissue causes of bronchiectasis?

A

1) RA

2) SLE

3) Sarcoidosis

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36
Q

What are 3 drugs that can cause bronchiectasis?

A

1) Nitrofurantoin

2) Methotrexate

3) Amiodarone

37
Q

What is the test of choice for establishing a bronchiectasis diagnosis?

A

High resolution CT

38
Q

What is the most common cause of bronchiectasis in developed countries?

What about in developing countries?

A

Developed - CF

Developing - TB

39
Q

What are the 2 most common organisms causing infection in bronchiectasis?

A

1) Pseudomonas aeruginosa

2) Haemophilus influenzae

40
Q

What should be done before prescribing Abx in bronchiectasis?

A

Sputum culture

41
Q

What 2 medications are licensed that can slow the progression of pulmonary fibrosis

A

1) Pirfenidone

2) Nintedanib

42
Q

What long term Abx can be given in bronchiectasis for frequent exacerbations?

A

Azithromycin

43
Q

What is the Abx of choice for bronchiectasis exacerbations caused by Pseudomonas aeruginosa?

A

Ciprofloxacin

44
Q

TLCO in pulmonary fibrosis?

A

reduced

45
Q

Which lung has 3 lobes?

A

R (L doesn’t have middle lobe due to presence of heart)

46
Q

How does CT appearance progress in idiopathic pulmonary fibrosis?

A

‘Ground glass’ appearance in early stages.

Progresses to ‘honeycombing’.

47
Q

What picture does asbestosis give on lung function tests?

A

Restrictive

48
Q

What is a parapneumonic effusion?

A

Pleural effusion 2ary to a pneumonia

49
Q

What is Young’s syndrome?

A

A rare condition characterised by:

1) azoospermia (absence of motile sperm)

2) sinusitis

3) bronchiectasis

50
Q

What are 4 key causes of LOWER zone fibrosis?

A

1) Drugs e.g. amiodarone, methotrexate

2) Connective tissue e.g. RA, SLE

3) Asbestosis

4) Idiopathic pulmonary fibrosis

51
Q

Does idiopathic pulmonary fibrosis cause upper or lower zone fibrosis?

A

Lower

52
Q

Does asbestosis cause upper or lower zone fibrosis?

A

Lower

53
Q

What 4 features can be seen in Kartagener’s syndrome (AKA primary ciliary dyskinesia)?

A

1) dextrocardia or complete situs inversus
bronchiectasis

2) recurrent sinusitis

3) subfertility (secondary to diminished

4) sperm motility and defective ciliary action in the fallopian tubes)

54
Q

What is the most common cause of occupational asthma?

A

Isocyanates e.g. factories producing spray painting, foam moulding using adhesives

55
Q

Pleural fluid findings of raised amylase may indicate what?

(2)

A

1) pancreatitis

2) oesophageal perforation

56
Q

Give some common causes of respiratory alkalosis

(6)

A

1) Anxiety (leading to hyperventilation)

2) PE

3) Altitude

4) Salicylate OD

5) Pregnancy

6) CNS disorders e.g. stroke, SAH, encephalitis

57
Q

What pCO2 indicates near-fatal asthma?

A

Raised >6.0 kPa

58
Q

How can a stroke lead to respiratory alkalosis?

A

Results from hyperventilation due to the effect of the stroke on the respiratory centre.

59
Q

In which type of pneumonia can you see ‘red currant jelly’ sputum?

A

Klebsiella

60
Q

Which organism causing pneumonia is classically seen in alcoholics?

A

Klebsiella

61
Q

What does lung abscess most commonly form 2ary to?

A

Aspiration pneumonia

62
Q

How can C. diff present on a FBC?

A

Marked neutrophilia

63
Q

When is Abx prophylaxis required in COPD patients?

A

> 3 exacerbations requiring steroid therapy in 1 year, with at least 1 exacerbation requiring hospital admission.

64
Q

Features of Cushing’s syndrome?

A
  • Weight gain, moon face, buffalo hump
  • HTN
  • Hyperglycaemia
  • Hypokalaemia
  • Striae
  • Proximal muscle weakness & muscle fatigue
65
Q

What Abx prophylactic is recommended in COPD patients who meet certain criteria and who continue to have exacerbations?

A

Macrolide e.g. azithromycin

66
Q

Most common causes of bullae? (2)

A

1) smoking

2) emphysema

67
Q

Where in the lungs does asbestosis cause fibrosis?

A

Lower zone fibrosis

68
Q

1st line Abx in infective exacerbation of COPD?

(3)

A

Amoxicillin
Doxycycline
Clarithromycin (caution as can cause long QT)

69
Q

Where in the lungs does idiopathic pulmonary fibrosis cause fibrosis?

A

Lower zones

70
Q

Where is emphysema in A1AT most prominent?

What about in COPD?

A

A1AT - lower lobes

COPD - upper lobes

71
Q

What should you aim for in the step down treatment of asthma?

A

Reduction in ICS 25-50% (consider every 3 months or so)

72
Q

What is there often a history of in aspergilloma?

A

TB

73
Q

What is silicosis a risk factor for?

A

Developing TB

74
Q

In terms of smoking, what is the NICE advice for LTOT in COPD?

A

Can offer if pO2 <7.3 kPa

Or if pO2 7.3-8kPa plus one of the following:
1) 2ary polycythaemia
2) pulmonary HTN
3) peripheral oedema

75
Q

Gold standard investigation to diagnose mesothelioma?

A

Thoracoscopic biopsy –> histology performed

76
Q

Which type of pneumonia can cause cavitating lesions in the upper lobes on a CXR?

A

Klebsiella

77
Q

What are high-risk characteristics in a pneumothorax?

A

1) Haemodynamic instability (may indicate tension pneumothorax)

2) Underlying lung disease

3) Significant hypoxia

4) Bilateral pneumothorax

5) >/= 50 years of age with significant smoking history

6) Haemothorax

78
Q

Following a splenectomy, what infections are patients particularly at risk from? (3)

A

1) pneumococcus

2) haemophilus

3) meningococcus

79
Q

What Abx prophylaxis can be given in a splenectomy?

A

penicillin V - protects against Strep. pneumoniae

80
Q

What are the main 2 indications for surgery in bronchiectasis?

A

1) uncontrollable haemoptysis

2) localised disease

81
Q

What cancer can cause ‘cannonball’ mets in the lungs?

A

Renal cell carcinoma

82
Q

What type of lung cancer is gynaecomastia most commonly associated with?

A

Adenocarcinoma

83
Q

What is the treatment of choice for allergic bronchopulmonary aspergillosis?

A

Prednisolone

84
Q

what is the most common organism causing infective exacerbation in bronchiectasis?

A

H. influenzae

85
Q

How can obstructive sleep apnoea affect BP?

A

HTN

86
Q

What is the gold standard investigation to confirm the diagnosis of mesothelioma?

A

Thoracoscopy & biopsy

87
Q

Mx of a secondary pneumothorax <1cm?

A

Admit & O2 for 24 hours

88
Q
A

Yr 4 - PassMed Corrections (36 decks)

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