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Y4 Respiratory > Cough, Pneumonia, Lung Cancer > Flashcards

Cough, Pneumonia, Lung Cancer Flashcards

1
Q

Is a COPD exacerbation a type of pneumonia?

A

No

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2
Q

What scoring system is used for community acquired pneumonia?

A 
CURB-65
C confusion
U urea >7
RR >30
BP sBP <90 or dBP <60
65 over 65yr
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3
Q

What is the management of pneumonia with a CURB-65 of 0-1?

A

Manage at home unless high risk
Antibiotics
1st line PO amoxicillin 1mg TDS for 5d
2nd line PO doxycycline for 5d

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4
Q

What is the management of pneumonia with a CURB-65 of 2?

A

Usually treat at home

Consider hospital referral, use clinical judgment

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5
Q

What is the management of pneumonia with a CURB-65 of 3?

A

Severe CAP = admit
1st line IV co-amoxiclav + PO doxycycline
2nd line IV levofloxacin
Step down to PO doxycycline

(If transferring from primary care give single dose oral amoxicillin before transfer)
(Review need for IVs daily)

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6
Q

What is the management of pneumonia with a CURB-65 of 4?

A

Severe CAP = admit to ICU/HDU
1st IV co-amoxiclav + IV clarithromycin
2nd line IV levofloxacin

(If transferring from primary care, give single dose oral amoxicillin before transfer)
(Review need for IVs daily)

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7
Q

Why isn’t alcohol recommended with amoxicillin?

A

Causes N+V

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8
Q

What follow up investigation is done after discharging patients with inpatient pneumonia?

A

Repeat CXR 6wk after

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9
Q

What is the test for legionella?

A

Urinary legionella antigen tests

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10
Q

What investigations are done for all inpatient pneumonias?

A 
Bloods
Blood culture
CXR
Sputum culture
Throat swab culture
Legionella urine Ag
Virology PCR
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11
Q

What is the commonest infective agent in CAP?

A

Strep pneumoniae

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12
Q

What infectious agent in CAP is cultured on chocolate agar?

A

Haemophilus influenzae

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13
Q

What infectious agent in CAP is associated with air conditioning units?

A

Legionella

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14
Q

What infectious agent in CAP is associated with sheep / goats?

A 
Coxiella burneti
(Also associated with endocarditis)
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15
Q

What infectious agent in CAP is associated with alcoholics and in upper lobes?

A

Klebsellia

Strep pneumoniae is also associated with alcoholics

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16
Q

What infectious agent in CAP is associated with herpes labialis?

A

Strep pneumonia

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17
Q

What infectious agent in CAP is associated with birds?

A

Chlamydophilia psittaci

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18
Q

What infectious agent in CAP is associated with HIV?

A

PCP pneumocystis

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19
Q

Is increased white cell count associated with increased severity of pneumonia

A

No

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20
Q

By definition for HAP how long must the patient have been in hospital for?

A

At least 5 days

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21
Q

What is an empyema?

A

Pus in the pleural space

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22
Q

How would an empyema present following CAP?

A

Poor response to antibiotics

Persisting effusion on CXR

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23
Q

What is the management of a empyema? When do you drain it?

A

Pleural tap

Check pH of aspirate, if <7.2 = infected = drain

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24
Q

What is Pemberton’s test?

A

For SVCO, raise arms, positive if facial flushing face goes red

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25
Q

What is the management of SVCO caused by a tumour?

A

High flow oxygen + dexamethasone

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26
Q

“Permanent dilatation and thickening of airways, chronic airway inflammation” describes what disease?

A

Bronchiectasis

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27
Q

Is smoking a RF for bronchiectasis?

A

No

CF, immunodeficiency and asthma are RFs

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28
Q

Pneumonia with what infectious agent should raise suspicion of bronchiectasis?

A

Pseudomonas

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29
Q

What is the CXR appearance of bronchiectasis?

A

No specific changes

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30
Q

What is the gold standard investigation for bronchiectasis?

A

HRCT - signet ring sign (bronchial lumen diameter greater than pulmonary artery)

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31
Q

Does bronchiectasis cause fine or coarse crackles? In inspiration or expiration? In lower or upper zones?

A

Coarse inspiratory crackles in lower zones

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32
Q

What is a pleural effusion?

A

Fluid in pleural space between lung and chest wall

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33
Q

What is a haemothorax?

A

Blood in pleural space

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34
Q

Bilateral pleural effusions and cardiomegaly on CXR is a sign of what?

A

Heart failure

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35
Q

What are the signs and symptoms of a pleural effusion?

A 
May be asymptomatic
Stony dull percussion
Reduced chest expansion
Breathlessness
Pleuritic chest pain
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36
Q

What are the 2 types of pleural effusion?

A

Transudate and exudate

37
Q

Transudate or exudate - which is due to high venous pressures?

A

Transudate

38
Q

Transudate or exudate - which has high / low cell count?

A

Transudate low cell count

Exudate cell rich

39
Q

Transudate or exudate - which has high / low protein count?

A

Transudate low protein count <30

Exudate protein rich >30

40
Q

Transudate or exudate - which has high LDH?

A

Exudate

41
Q

Benign ovarian tumour with ascites + transudate pleural effusion is what syndrome?

A

Meigs syndrome

42
Q

What is the diagnostic criteria for exudate pleural effusion?

A

Protein ratio >0.5 or fluid: LDH ratio >0.6

43
Q

Metastatic cancer causes what type of pleural effusion?

A

Exudate

44
Q

Heart failure causes what type of pleural effusion?

A

Transudate

45
Q

Fluid overload causes what type of pleural effusion?

A

Transudate

46
Q

Pneumonia causes what type of pleural effusion?

A

Exudate

47
Q

What is the CXR appearance of a pleural effusion?

A

Blunting of the costophrenic angles

If large - white out

48
Q

Does the trachea deviate towards or away from a pleural effusion?

A

Away

49
Q

What is the management of a pleural effusion?

A

Pleural aspiration thoracentesis

50
Q

What test are done on the pleural aspirate of a pleural effusion?

A

Cytology, protein, LDH, gram stain culture sensitivity

51
Q

If pleural aspiration thoracentesis doesn’t relieve symptoms in the Mx of a pleural effusion, what is the next step?

A

Chest drain

can’t drain more than 1.5L in a single procedure

52
Q

Pleurodesis involves injecting a sclerosing agent - is it used in the Mx of what type of pleural effusion?

A

Malignant pleural effusion

53
Q

90% of TB is latent or active?

TB affects the lung bases or apex?

A

90% latent

Apex

54
Q

Caseating granulomas are due to what infection?

A

TB

55
Q

Night sweats, weight loss, malaise, cough, haemoptysis, SOB and upper zone crackles are all features of what?

A

TB

56
Q

What investigation is done for latent TB?

A

Mantoux skin test

57
Q

What investigation is done for active TB?

A

CXR + sputum culture (ZN stain acid fast bacilli)

58
Q

What is the management of active TB?

A

2 months RIPE + 4 months RI

59
Q

What is the management of latent TB?

A

6 months isoniazid or 3 months isoniazid + rifampicin

60
Q

Which TB drug causes optic neuritis?

A

Ethambutol

61
Q

Which TB drug causes orange urine/tears?

A

Rifampicin

62
Q

Which TB drug causes gout?

A

Pyrazinamide

63
Q

Which TB drug causes neuropathy?

A

Isoniazid

64
Q

Miosis, ptosis, anhydrosis describes what syndrome

A

Horner’s syndrome
(due to cervical sympathetic plexus disruption)
(associated with pancoast tumours)

65
Q

What type of lung cancer is commonest in non-smokers?

A

Adenocarcinoma

66
Q

What type of lung cancer is commonest?

A

Adenocarcinoma

67
Q

A patient with known lung cancer presenting with acute breathlessness, headache, swollen neck with distended veins and racial reddening - what is the Dx

A

SVC obstruction

68
Q

What type of lung cancer is associated with pancoast tumours?

A

Small cell

69
Q

What is the management of metastatic malignant raised ICP?

A

IV dexamethasone

70
Q

What type of scan do you do if you suspect metastatic bone disease?

A

Bone scan

71
Q

Are bone mets from lung cancer lytic or sclerotic?

A

Lytic

72
Q

You suspect someone has lung cancer, what investigation do you order next?

A

CXR

73
Q

What type of lung cancer is associated with gynaecomastia?

A

Adenocarcinoma

74
Q

What type of lung cancer is associated with LEMS Eaton Lambert?

A

Small cell

75
Q

What type of lung cancer is associated with hypertrophic osteoarthropathy

A

Squamous

76
Q

What type of lung cancer is associated with paraneoplastic Cushing syndrome?

A

Small cell through ectopic ACTH secretion

77
Q

What type of lung cancer is associated with paraneoplastic hypercalcemia and through what mechanism?

A

Squamous
Ectopic PTH secretion
Bones stones groans moans

78
Q

What type of lung cancer is associated with: SIADH secretion

A

Small cell

79
Q

What type of lung cancer is associated with paraneoplastic hyponatremia and through what mechanism?

A

Ectopic ADH secretion

Small cell

80
Q

Clubbing and onion skin XR are signs of what paraneoplastic syndrome in lung cancer?

A

Hypertrophic osteoarthropathy

81
Q

Proximal weakness that improves with muscle use, diplopia, ptosis, haemoptysis, weight loss, chronic cough and breathlessness - what is the diagnosis?

A

Eaton Lambert LEMS paraneoplastic small cell lung cancer

82
Q

When investigating lung cancer, after a positive CXR, what investigation is done next

A

CT + biopsy

Biopsy bronchoscopy EBUS central lesions, CT guided biopsy if peripheral

83
Q

Does small cell lung cancer have a poor or good prognosis?

A

Small cell poor prognosis

84
Q

What type of lung cancer is second commonest?

A

Squamous

85
Q

What type of lung cancer is more chemo responsive?

A

Small cell

86
Q

What type of lung cancer is suitable for surgery?

A

Stage 1 or 2 non-small cell lung cancer

87
Q

Does a normal CXR exclude lung cancer?

A

No

88
Q

What treatment is used in conjunction with surgery for lung cancer?

A

Radiotherapy

89
Q

What is the function of a radiotherapy simulator?

A

To plan the area for treatment

Y4 Respiratory (5 decks)

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