Pass Test Flashcards
1
Q
meigs syndrome describes
A
association between benign ovarian tumour and a transudate pleural effusion
2
Q
Ca-125 suggests
A
could be an ovarian tumour
3
Q
- penetrating chest trauma
- falling 02 sats
- reduced breath sounds in right hemithorax
- cardiovascular compromise
suggest
A
tension pneumothorax
4
Q
treatment for tension pneumothox when haemodynamically unstable
A
- needle aspirate then chest drain
chest drain is definitve treatment but takes too long to set up so needle immediately - is a temporary measure before chest drain
5
Q
bilateral, fine, late inspiratory crackles, more marked in the mid zones and lung bases. cxr shows patchy shadowing at lung bases
what and what treatment
A
IPF and HRCT
6
Q
breathlessness and tight shiny skin over fingers
A
Sclerodactyly
7
Q
erythema nodosum is associated with
A
inflammatory bowel disease
8
Q
death from deep vein thromobosis and then PE. what vessel most likely affected to cause the death
A
PULMONARY ARTERY
9
Q
tb underlying mechanism
A
IV Hypersensitivity reaction
10
Q
is salbutamol a b2 adrenoceptor agonist or antagonist
A
agonist
11
Q
broncnhial smooth muscle contains what adrenoceptor
A
b2
12
Q
post bone marrow/ heart or lung transplant with obstructive results hints
A
Bronchiolitis obliterans
13
Q
– presents with yellow deformed nails, lymphoedema and exudative pleural effusion or other resp involvement
A
yellow nail syndrome
14
Q
yellow nail syndrome is associated with
A
nephrotic syndrome, protein-losing enteropathy, B cell deficiency
15
Q
sarcoidosis causes what kind of pleural effusion
A
exudate
16
Q
sarcoidosis, tb or carcinoma what kind of effusions
A
exudate
17
Q
baker presents with rhinitis, breathlessness and wheeze that has gotten worse since returning from 2 week holiday to spain
A
occupation asthma, not legionella
As bakers asthma commonly caused by allerfy to alpha amylase, enzyme in flour. symptoms of occupational asthma ussually improve when away from work so fact its worsen now hes returned makes sense.
legionella would more present with nausea, vomitting, diarrhoea
18
Q
- cxr= multiple rounded lesions and alveolar shadowing
- positive for c-ANCA
A
granulomstosis with polyangiitis
19
Q
comon cuases of chronic cough with normal cxr and spirometry, no red flags in non somker is
snd what test
A
cough variant asthma, GORD, post nasal drip
suggests cough variant asthma so bronchial provocation testing
20
Q
if got dry cough, unable to provide a
A
sputum sample for sputum culture
21
Q
operation of one way valve system, drawing air into the pleural space during inspiration and not allowing it out during expiration
A
tension pneumothorax
22
Q
left sided chest pain, reduced air entry at left base of the lung, hyper-resonant percussion sounds at the left side of the chest.tender abdomen, then becomes cyanosed
A
Tension pneumothorax
23
Q
if pH between 7.25 and 7.35 should consider
A
non-invasive ventilation
24
Q
most common lobe affected in klebsiella
A
right upper lobe
25
klebsiella is best treated with
carbapenams eg metropenem
26
atypical epithelial tubules in a sarcomatous background or carcinomatous
Mesothelioma
27
malignant mesothelioma in electron microscopy
epithelial cells have long thin microvilli
28
pleomorphic cells in a cluster with keratin pearls and intercellular bridges
squamous cell carcinoma of the lung
29
large undifferentiated anaplastic cells
large cell carcinoma of the lung
30
neoplastic cells forming mucinous glands
pulmonary adenocarcinoma
31
next treatment for acute asthma attack after sablutamol, ipratropium, hydrocortisone
magnesium sulphate
32
got asthma and gotten worse due to a cold what do you do to treat and peak flow dropped significantly
oral steriod - prednisolone
33
first treatment for asthma in kids 5-12
salbutamol
34
if had overdose, check
salicylate levels
35
hyperventillating few days after fracture of femur in car crash. he is cyanosed what test
ABG
36
smell pear drops
diabetes so measure blood glucose levels
37
if suspect chest infection do
CXR
38
shaking epsiodes is common in
infections - pneumonia, cholangitis, empyema, some abscesses
39
history of sibling being unwell and history of repeated hospital admisssions with features such as severe chest pain, difficulty breathing can suggest
hereditary disease and so do blood count and film
sickle cell anameia
40
in pneumonia chest expansion is likely to be
normal
41
stony dull is
effusion and not pneumonia
42
V/Q scan may be preferred over CTPA for pE when
renal impairment
pregnacy and contrast allergy
CTPA uses radiocontrast which is nephrotoxic
43
upper lobe bronchiectasis could be due to
middle lobe
lower lobe
central
Cf, tb
immotile cilia sydrome, myobacterium avium
interstitial lung disease, aspiration
ABPA
44
ocassionally balck sputum, high eosinophills, raised igE suggests allergic bronchopulmonary aspergilosis and on CT you will find
Central cystic/ varicose bronchiectasis in multiple lobes
45
-bronchiectasis mainly in upper lobes and mainly in a single lobe associated with
asthma
46
tb is frequently in the lung
apices
47
pneumonia is typically affects the elderly, typically after influenza
staph. aureus
48
can cause meningitis and pneumonia
h. influenzae
49
what orgainsms are foul smelling
anaerobes
50
Long term oxyge therapy can be used inn -- patients
COPD
51
signs of hypercapnia
flapping tremor, bounding pulse, palmar erythema
52
hypercalcaemia is typically seen in
squamous cell bronchial carcinoma
53
associated with pleural thickening on CXR
mesothelioma
54
SOB, palitations,, syncope,exertional asthma and bilateral ankle swelling
Familial Primary Pulmonary Hypertension
55
air-crescent sign on CT
Aspergillus
56
where would you do thoracentesis
above the 5th rib in the mid axillary line
57
lung bipsy shows non caseating granulomas
sarcoidosis
58
confirm diagnosis of sarcoidosis
Lung biopsy
59
60
what can you develop from amiodarone
pulmonary fibrosis
61
actinomycetes thrive in
mouldy hay
62
Contralateral tracheal deviation, reduced chest expanisons , increased resonance on percussion, absent breath sounds
tension pneumothorax
63
Gold standard investigation for pulmonary fibrosis
High resolution CT
64
Gold standard investigatio for PE
CTPA
65
each lung has how many bronchopulmonary segments
10
66
The lungs recieve a dual blood supply by the
pulmonary artery and bronchial arteries
67
stop for breath after about 100m of walking on level ground is what on the MRC dynspnoea scale
3
68
Best investigation for a effusion is a
pleural aspirate as it measures protein content and determines whether the fluid is an exudate or a transudate
69
Low serum calcium, phosphate and high ALP
Vitamin D deficincey (VDD)
70
what 2 drugs cause vitamin D deficinecy
Rifampicin and isoniazid
71
V leiden mutation and smoking predisposes to
clotting
72
V leiden mutation, SOb , chest pain, erythematous , swollen left lower extremity
DVT and PE
73
CXR- wedge shaped opacity representing occlusion of a vessel within the lung parenchyma supplying a lung segment
PE
74
like an exacerbation of cystic fibrosis
bronchiectasis
75
treatmetn for cf patient with Pseudomoans aeruginosa
ciprofloxacin
76
clubbing, cyanosis and florid crepitations at both bases
bronchiectasis
77
what is contraindicated in massive haemoptysis
NON-INVASIVE VENTILLATION
(increased risk of aspiration of blood if a ventillation mask is worn)
78
immediate treatment for tension pneumothorax
high flow 02
aspirate using a 16-18G cannila into teh second anterior intercostal space mid clavicular line
79
if primary penumothorax and less than 2cm but still breathless then do
aspirated and if fails then chets drain
80
if primary pneumothorax less than 2 cm and asymptomatic then
discharge home
81
to be considered for lung transplant patients with COPD should have FEV1
\<25%
82
contraindications to lung transplant
Fev1\<25%
BMI\>35
Active infection of tb
\>65 years old
malignancy in the past 2 years
83
Interstitial inflammation, chronic bronchiolitis, non-necrozing granuloma
Hypersensitivity pneumonitis
84
hypersensitivity pneumonitits or
farmers lung
85
Lung biopsy of aspergillosis shows
hyphae with vascular invasion and surrounding tissue necrosis
86
several epsiodes of pneumonia as a child and then now developing cough with sputum and SOB
Bronchiectasis
87
patient had cough with green sputum and fever and rigors and now increased Resp rate and HR and bronchial breathing at left lung base
Sepsis secondary to pneumonia and new onset of atrial fibrillatio is secondary to sepsis. so treat sepsis with IV antibitoics
88
despite having normal cxr, patient has tiredness, persisitent cough (\>3weeks) , haemoptysis in a smoker could still indicate underlying lung cancer and so
refer patient urgently to chest physician with suspected lung cancer
89
Smoker presenting with a cough first investigation?
also if suggests horners syndrome
CXR
90
CT-pet scan is used
for staging when cancer is confirmed
91
Primary tb causes a -- in the lungs, reactivation of which leads to secondary tb
ghon focus
92
tb sytoms with high eosinpihil count
eosinophilia
93
eosinophilia investigation and treatment
definitive diagnosis - lung biopsy
therapy -steriods - prednisolone
94
adult onset asthma or atopy, fever, weight loss,
eosinophilia
95
tb does not give
eosinophilia
96
for severe copd oxygen should be
24-28%venturi mask or 2-4 litres via simple mask but prefereably venturi
97
pulmonary manifestation of aspergillus infection
allergic asthma
98
hypersensitivity pneumonitis or extrinsic allergic alveolitis are type --- hypersensitivity reactions
3
99
5 y/o w asthma on ICS and SABA next step is
add LTRA then Add LABA then icnrease dose of ICS
100
first choice for community acquired pneumonia
amoxicillin
flucloxacillin added if there is associated influenza or other reason to susspect a staph infection
101
bronchial carcinoma with low sodium
hypercalcaemia
Small cell
squamous
102
women w asthma want to know why she continues to wheeze hours after exposure to pollen
inflammation followed by mucosal oedema
103
young person with dysnpnoea after previosu pneumothorax and bone fracture, smokes, cxr- infiltration in both upper zones
Pulmonary histiocytes
104
primary pneumothorax . 2cm and tension pneumothorax should recieve
needle thoracentesis
105
in traumatic pneumothorax(stabbing) needle aspiration is not recommended and a --- should be inserted
chest drain
106
primary pneumothorax less than 2 cm not breathless but causing discomfort=
discharged and cxr in 2-4 weeks
should not be advised to fly fo at least 1 week and not allowed to dive unless peurodesis or pleurectomy is performed
107
cavitating tumours most commonly occur in what kind of carcinomas
squamous cell
108
hoarsness of voice is caused by invasion of what nerve
recurrent laryngeal nerve
109
what nerve involvement causes a raised hemidiaphragm
phrenic nerve
110
ACTH may occur in
small cell carcinomas
111
Reduction of FEV1 by 20-30% and PEFR by about 30% is consistent with
normal ageing
112
episodes of breathless after being treated w steriods for sarcoidosis. what would be initial test
Pulmonary fucntion tests with transfer factor
typically has reduced transfer factor. Transfer factor is a goood initial test for response to treatment. It is a good initial but not always the best so chec wording of question
not check ace levels
113
ABG will help guide
oxygen therapy
114
appears with asthma like symptoms 24 hrs after exposure to irritant gases/ vapours or fumes.
RADS and do metacholine challenge test
115
Low sodium in small cell cancer patients is because of
Sydrome of inappropriate antidiuretic hormone secretion
116
treatment for Reactive airway dysfunction sydrome
Inhaled bronchodilators eg salbutamol
117
what does not cause mesothelioma
smoking
118
investigation for diagnosis of mesothelioma is
CT
119
ground glass opacity surrounded by denser lung tissue is known as
atoll sign
120
signet ring sign is found in
bronchiectasis
121
tree bud sign is typical of
endobrocnhial tb
122
halo signs are found in
angioinvasive aspergillosis
123
first choice for occupation asthma
redemployment to another role is possibel
124
patient having asthma attack - unable to talk in full sentences. despite 02 being 96% and other things being normal , peak flow is make it life threatening and so should give
oral prednisolone, commence salbutamol nebuliser and high flow o2, and call ambulance
125
unilateral pleural effusions are usually caused by local pathology such as
trauma, tumour or infection
126
pleural effusion on cxr
dependent area with lateral meniscus- ican t quite see this
127
where put chest drain
THE BOTTOM OF THE 5TH INTERCOSTAL SPACE IN THE MID AXILLARY LINE
128
CURB65 3 OR GREATER
INTESIVE CARE
129
CURB65 0 OR 1
HOME
130
husband owns pigeon
idiopathic pulmonary fibrosis
131
idiopathic pulmonary fibrosis tends to be -- of lung
hypersensitivity pneumonitis tends to be lung --
lower zone predominance
apices
132
airborne irritants tend to affect lung --
apices
133
affecting base of lung =
apices=
IPF
hypersensitivity pneumonititis
134
causes of pulmonary fibrosis
blecomycin, azathioprine, pneumoconisosis, occupational lung disease
135
treatment for kid with OSA
adenotonsillectomy
136
no evidence that oxygen helps copd patients who are breathless unless breathless is accompanied by
hypoxia
137
LTOT is recommended when copd patient pa02 is less than --- when stable
7.3
138
what should not be prescribed to patients that experience seizures
Bupropion
139
Cf causes
pancreatic insufficiency
140
kartagener syndrome
- recurrent resp infections
- chronic sinusitis
- infertility
- dextrocardia
141
fluid level in a retrocardiac structure can indicate
hiatus hernia ( stomach slips through the diaphragm) may cause reflux
142
in chest drain what is not penetrated
visceral pleura
143
order of structures encountered when chest tube inserted
skin, external intercostal muscle, internal intercostal muscle, innermost intercostal muscle, parietal pleura
144
what causes symptoms of asthma at night
lower levels of cortisol
145
bilateral crackles and wheeze on auscultation, right sided heart failure( raised JVP and peripheral oedema),
congestive cardiac failure
146
in type 1 resp failrue
pa02 is low and paco2 is normal
147
type 2 resp failure
pa02 is low anad paco2 is elevated
148
Guillian-barre syndrome presents with
ascending weakness, loss of sensation and abscence of deep tendon relfexesand patient can develop resp failure
often secondary to resp tract infections
and cause type 2 resp failure
149
hypoxia, hypercapnia and acidosis
type 2 resp failure
150
pleural rub occasionaly found in
PE
151
difference between typical and mycoplasma pneumonia on cxr
typical- consolidation and mycoplasma- patchy reticulonodular opacities
152
fever and breathless after surgery on urogenital or GI tract. early diastolic murmur. urine dipstick positivce for blood. clubbing
Infective endocarditis
153
young or middle agesd person most common cause of clubbing is
broncheictasis
154
despite asbestos exposure evidence of horners syndrome suggests
squamous cell cancer
155
what cancer is not associated with clubbing
small cell bronchial carcinoma
156
cystic fibrosis, -- and crohns disease can all cause malabsorption, growth delay and clubbing.
coeliac disease
coeliac is most common at 15 as CF normally diagnosed when young childre or at birth
children with coeliac are often pale skinned with pale hair
157
unilateral clubbing can occur in
axillary artery aneurysm and coartication of the aorta
158
in IPF, the diffusion pattern for carbon monoxide is usually --
reduced
159
cxr of mesothelioma
pleural thickening
160
you can get --- secondary to asthma
pneumothorax
161
what happens in complete right to left shunt
the alveolar po2 is normal but the arterial blood pa02 will be markably reduced and increasing inspired oxygen will have no effect on arterial pa02
162
fingers going white to blue then to red in cold weather
finger calcinosis and facial telangiectasia
pulmonary hypertension
Scleroderma
163
Patients with systemic lupus erythematosus may have a ----tendency due to antiphospholipid syndrome
thrombophilic
164
-- is a risk factor for persistent pulmonary hypertension
Recurrent thromboembolic disease
165
sudden onset SOB post surgery, chest discomfort
PE
166
classical feature of p.jirovecii is
desaturation on exercise
167
p.jirovecii is a
fungal
168
rare complicatio of pulmonary fibrosis
rounded atelectasis where the scarred visceral and parietal pleura fold on themselves and trap the underlying lung
169
Most men with -- are infertile but may still haev children with assited reproductive techniques
CF
170
sweat test, cf is indicated by
high levels of sodium chloride
171
tobacco workers lung
hypersensitivity pneumonitits
172
treatment for hypersensitivity pneumonitis
change job role
173
what antibiotics for chlamydia psittaci infection
tetracycline eg doxycycline
174
symptoms of chlamydia psittaci infection
maculopapular rash, lobar pneumonia, mild hepatitis( raised ALT,AST and bilirubin)
175
CT) Honeycombing gof the lung with parenchymal bands and pleural plaque , increased intralobular septae
Asbestosis
176
CXR bilateral reticulonodular opacities in the lower zones
asbestosis
177
prescence of pleural plaques helps confirm
asbestos exposure
178
hilar lymphadenopathy, upper zone fibrosis, eggshell calcification of nodes
silicosis
179
diffuse fibrotic bands with ground glass opacity
interstitial lung diseases
180
cavitation of upper zones
classic of tb but also ankylosing spondylitis
181
mutiple nodules in upper and mid zones with lower zone emphysema
Pneumoconiosis
182
combo of azoospermia and bronchiectasis (implied by history of long standing cough productive of purulent sputum)
CF
183
most common causative organism of colds
rhinovirus
184
high clinical suspicion of PE and has sinus tachycardia then next step is ------before diagnostic confirmation on CTPA
DOAC such as rivaroxaban or apixabanor LMWH
185
chronic exposure to asbestos increases the risk for -- and mesothelioma. Alothough, mesothelioma is associated with asbestosis, it is rare and the risk of developing lung cancer is significantly higher than the risk fo developing mesothelioma
primary bronchogenic carcinoma
186
asbestos exposure with dyspnoea, haemoptysis and weight loss are more likely due to
primary lung cancer
187
Malgingant pleural effusions are
exudative
188
protein pleural : protein serum ratio\>0.5
LDH pleural: LDH serum ratio\>0.6
exudative
189
frank pus suggests there is a
empyema
190
aspiration of pus means there will be an --- upon analysis
exudate
191
needle decompression site for tension pneumothorax
2nd intercostal space on the affected side
192
blood in thoracic cavity and rib fractures
haemothorax
193
in absence of frank pus early empyema can be suggested by
cloudy aspirate, neutrophilia
194
what is first line management for women who are pregnant or recently given birth who are trying to stop smoking
behavioural therapy
195
if got alpha 1 antitrypsin and receieves liver transplant increased risk fo what kind of emphsema
panacinar
196
what happens in the panacinar form of emphysema
entire acinus is enlarged from the resp bronchiole to the distal alveoli
197
centriacinar emphyema is related to exposure of
coal dust and tobacco products
198
centracinar emphysema is characterised by
enlargement of the central portion of the acinus
199
what emphysema's are associated with scarring
paraseptal and compensatory
200
emphysema resulting from rib fracture( lung parenchyma) or whooping cough
interstitial
201
imobilasation after fracture particularly in elderly is significant risk for
DVT and then PE
202
coughing out gelatinous or or rigid casts is called
plastic bronchitis
203
acute presentation of sarcoidosis
lofgren syndrome
204
6month - 3year old presents with stridor
croup
205
accumulation of eosinophills in the lung secondary to passage of parasite alrvaes such as ascaris or strongyloides. charcotlyden crystals in sputum
loeffler syndrome
206
cardiac asthma produces
pink frothy sputum
207
smoking, cavitating lung lesion in middle lobe, weight loss, haemoptysis
squamous cell - centrally located and most commonly cavitates
208
small cell lung cancer does not commonly
cavitate
209
adenoncarcinoma usually originates in the
peripheral lung tissue, can cavitate but cavitataing is more common in squamous
210
large cell carcinoma does not commonly
cavitate
211
- worked with stone
- clubbed
- bilateral late inspiratory crackles at both lung bases
- upper zone nodular opacities
OCCUPATIONAL INTERSTITIAL LUNG DISEASE
not idiopathic plumonary fibrosis as strong association of working with stone suggest silica and silicosis
212
investigation for occupational interstital lung disease
HRCT
213
treatment for copd patient with acidotic type 2 resp failure
28%venturi mask and not go above 4L
214
CPAP CAN BE RESP FAILURE TYPICALLY DUE TO
PULMONARY OEDEMA ASSOCIATED WITH LEFT VENTRICUALR FAILURE
215
BiPAP can be used to treat resp acidosis due to exacerbation of copd but is not
first line
216
has breast cancer, suddenly collapses and wakes up with chest pain and breathlessness. Loud 2nd heart sound, ECG shows right axis deviation.
Right ventricular hypertrophy and pulmonary hypertension( loud P2). as suddenly collapses and has reduced exercise capacity cause is likely multiple emboli and cancer increased risk of dvt
217
-aspirating peanut, SOB, CXR shoes complete white out of right lung where peanut went and trachea moves towards that lung
atelectasis
218
pleural effusion causes -- mediastinal shift
contralateral
219
CXR of pneumothorax
line in the lung space representing the visceral pleura and decreased lunk markings peripherally
220
crackles on ausculatioin
pulmonary oedema
221
chemical pneumonitis can be caused from exposure to
- body embalmers
- plastic,batteries, leather, rubber
222
oily susbstance aspirated caused chemical pneumonitis called
lipoid pneumonia
223
chemical pneumonia due to aspiration of gastric contents particualrly from analgesia
Mendelson syndrome
224
formaldahyde fumes can cause
chemical pneumonia, ARDS, asthma like symptoms
high concs can cause larygitis or chronic bronchitis
prolonged exposure- nasopharyngeal carcinoma
225
pulmonary haemorrhage can occur in diseases like
SLE
226
in hypersensitivity pneumonitis --- is not a feature
eosinophilia
227
granulomatous reaction of lung parenchyma ooccurs after exposure to
berrylium
228
pain radiating to shoulder can be in
pnuemothorax
229
needles aspirated is put in where
2nd intercostal space on the affected side
230
type 2 resp failure and acidosis secondary exacerbation of copd should be given
non invasive ventilation eg BiPAP
231
if highly suspect PE after fligth and patietn is unstable give
AND IF STABLE GIVE
UNSTABLE- THROMBOLYSIS
STABLE-LMWH
232
some extra pulmonary mainfestations of mycoplasma pneumonia
haemolytic anaemia, erythema multiforme, guillian barres syndrome, myocarditis or cerebellar ataxia
233
COPD is diagnosed as FEV1\<
and
80%
