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Respiratory > Pulmo > Flashcards

Pulmo Flashcards

1
Q

Define the 3 different types of pneumonia and differentiate between atypical and typical pneumonia .

A

Community acquired
Hospital acquired >48 hrs after admission
Aspiration pneumonia

Typical

  • classic symptoms
  • typical findings on exam
  • Lobar or bronchopneumonia

Atypical

  • less distinct symptoms ( no chills, low fever )
  • unremarkable exam
  • interstitial pneumonia ok X-ray
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2
Q

Risk factors for pneumonia

A 
Age
COPD , asthma , CF
Smoking 
Immunocomprimised 
Season
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3
Q

Classical symptoms of pneumonia

A 
Fever 
SoB
Rigors, ache 
Productive cough 
Pleuritic chest pain
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4
Q

Signs of pneumonia

A 
Fever 
Tachypnoea
Crackles 
Cyanosis 
Dullness on percussion
Bronchial breathing

Leukocytosis
High CRP
Infiltrate on X-ray

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5
Q

What’s the most common organism causing pneumonia in the community?
And others ?

A

Streptococcus pneumonia

H. Influenza
M. Cartarrhalis

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6
Q

Name 3 atypical organisms that cause pneumonia in the community

A

Mycoplasma pneumonia
Chlamydia
Legionella

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7
Q

Give 4 organisms causing hospital acquired pneumonia

A

Klebsiella
Gram - e.g pseudomonas , enterobacteriae
Staphylococcus aureus

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8
Q

Streptococcus pneumonia
Is what type of bacteria?
What are is features ?

A

Gram + diplococci

Lobar consolidation
Usually penicillin sensitive
Rusty sputum
Often preceeded viral infection

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9
Q

Which organism is most commonly responsible for COPD excacerbation

A

H influenza

Gram - rods

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10
Q

Which organism causes pus formation in pneumonia and commonly leads to complications?

A

Staphylococcus aureus

Gram + cocci

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11
Q

Name a organism that causes pneumonia in CF patients

A

Pseudomonas aeruginosa

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12
Q

Which score is used to classify severity of pneumonia and treatment indications ?

A

CURB 65
Confusion , urea >7, RR >30 , BP <90 , age > 65

One point for each
0-1 - mild and home treatment
2 - hospital treatment
3-5 severe , consider ICU

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13
Q

Give 2 types of pneumonia that you could expect in an immunocomprimised patient !

A

Think opportunistic !

Pneumocystis jiroveci

Aspergillus fumigates

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14
Q

Explain the classic triad of pneumonia

A
  1. Evidence of infection (fever, chills, leukocytosis )
  2. Signs / symptoms localised to respiratory tract ( cough, sob, low 02, high RR)
  3. New / changed infiltrates on X-ray
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15
Q

What’s the treatment of community acquired pneumonia ?

A

Penicillin + macrolide

E.g benzilpenicillin / amoxicillin
+ clarithromycin / azithromicin/ erythromycin

Oral ( combine and IV if moderate )
For 5-7 days

Penicillin allergy : cephalosporin e.g cefuroxime

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16
Q

Complications of pneumonia

A 
Empyema
Pleural effusion
Lung abscess 
Respiratory failure
Myocarditis , pericarditis 
Cholestasis 
AF
Sepsis
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17
Q

Prevention of pneumonia

A

Stop smoking

Pneumococccus vaccination and influenza vaccination in immunocomprimised and old people and if COPD or other chronic conditions

C/I pregnancy

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18
Q

What is bronchiectasis and what are the causes ?

A

Abnormal dilatation of bronchi and bronchioles , irreversible + thinning of these airways

CF
Kartegeners sydrome
Young syndrome
Primary ciliary dyskinesia
Chronic infections - pneumonia
HIV, TB
obstruction with tumour or foreign most 
Allergic bronchopulmonary aspergillosis
RA
Chrohns
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19
Q

Which pathogens are commonly associated with bronchiectasis ?

A

Staph aureus
H influenzae
Strep pneumonia
Pseudomonas

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20
Q

Classical features of bronchiectasis

A 
Persistent chronic cough
Lots of mucopurulent ( fouly smelling ) sputum
Unpleasant breath feotor
Cyanosis
Clubbing
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21
Q

Which test would you perform to confirm bronchiectasis ?

And what does it show ?

A

CT

Signet ring sign (thick bronchus wall, lumen wider than vessel)

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22
Q

How to manage bronchiectasis ?

A 
Airway clearance techniques ( Physiotherapie )
Smoking cessation 
Vaccinations 
AB if excacerbation
Bronchodilators
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23
Q

What is cystic fibrosis and what is it causes by?

A

Autosomal recessive
Multi system condition

Mutation in CFTR ( cystic fibrosis transmembrane conductance regulator ) gene ( chromosome 7)
-> abnormal iron transport across chloride channels

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24
Q

Explain the effects of cystic fibrosis on multiple organs

A

Lungs :
Recurrent chest infections (impaired ciliary function, retention of secretions )
Pancreas :
Malabsorption , steatorrhea
Failure to thrive ( ducts blocked by thick secretions )
Intestine :
Meconium ileus in neonates ( thick viscous meconium production )

Sweat glands
High Na and Cl in sweat

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25
Q

How to diagnose CF?

A

Sweat test
High chloride

Gene testing
CFTR Gene

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26
Q

How to manage a patient with cystic fibrosis ?

A

Multidisciplinary

Lung
- Physio
- monitor via sporometry
- prophylactic antibiotics
Eg flucoxacillin
If pseudomonas : ciprofloxacin, gentamicin, ceftazidime

Nutritional
Pancreatic enzyme replacement
High calorie diet
Vitamins EDKA

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27
Q

Complications of cystic fibrosis in adults

A

Diabetes mellitus
Liver disease ( cirrhosis )
Distal intestinal obstruction
Infertility in men

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28
Q

What is acute respiratory distress syndrome ?

What is it causes by ?

A

It’s an acute injury to the lung either directly or due to systemic illness

Pulmonary

  • pneumonia
  • Inhalation
  • contusion

Other

  • multiple transfusions
  • sepsis
  • shock
  • malaria
  • drugs : Aspirin, Heroin
  • pancreatitis
  • liver failure
  • haemorrhage
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29
Q

Explain how injury can lead to ARDS ?

What are the clinical features of ARDS?

A

Lung damage -> release of inflammatory mediators -> increased capillary permeability & non-cardiogenic pulmonary oedema

Dyspnoea
Cynoasis
Bilateral crackles
Peripheral vasodilation

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30
Q

Which 4 diagnostic criteria have to be present in order to diagnose ARDS ?

A
  1. Acute onset
  2. High oxygen demand with refractory hypoxia
  3. Lack of clinical congestive heart failure / PCWP < 19 mmHg
  4. Bilateral infiltrates on X-ray
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31
Q

A patient presents with haemoptysis , a long history of smoking and weight loss and anorexia .
Most likely diagnosis ?

A

Lung cancer

DD: tuberculosis

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32
Q

Patient presents with pink frothy haemoptysis , disponier and bibasal crackles heart on examination .
Most likely diagnosis ?

A

Pulmonary oedema

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33
Q

A patient presents with pleuritic chest pain, tachycardia , tachypnoea and haemoptysis .

What could be a DD?

A

Pulmonary embolism

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34
Q

Patient presents with history of purulent , persistent cough and now haemoptysis . Likely diagnosis ?

A

Lower respiratory tract infection

If chronic and lots of purulent sputum think bronchiectasis

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35
Q

A patient has a history of tuberculosis 8 years ago. He know presents with haemoptysis and the x rays shows rounded opacity

A

Aspergilloma

Fungi in pre excisting cavity

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36
Q

Patients presents systemically unwell with haemoptysis , haematuria + hypertension + acute kidney failure .
What’s the diagnosis ?

A

Goodpasture syndrome
( anti GBM disease )
Lung + glomerulonephritis

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37
Q

A patient with AF presents with a Malar flush on his cheeks, a mid-diastolic murmur , dyspnoea and haemoptysis .
Likely diagnosis ?

A

Mitral stenosis

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38
Q

A patient with a saddle nose deformity presents with a lower respiratory tract infection with haemoptysis ,sinusitis and glomerulonephritis.
What’s the diagnosis ?

A

Granulomatosis with
Polyangiits
= Wegeners disease

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39
Q

Define pulmonary hypertension

A

Mean pulmonary artery pressure > 25 mmHg at rest

Normal = 10-14

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40
Q

Chronic pulmonary hypertension can cause ?

A

Cor pulmonale

Right heart dilatation / hypertrophy and failure

41
Q

Causes of acute and chronic cor pulmonale

A

Acute usually causes bei Pulmonary embolism

Chronic
-COPD, asthma, lung fibrosis eg interstitial lung disease ,
-PE, pulmonary vasculitis , ARDS, primary pulmonary hypertension ,
Sickle cell.

  • neurology: myasthenia gravis, motor neuron disease ,
  • sleep apnoea
  • kyphosis, scoliosis
42
Q

Symptoms of cor pulmonale

A

Asymptomatic

Fatigues , dyspnoea on excretion
Tachycardia
Arrhythmia
Right hear failure :
- peripheral oedema 
- raised JVP
- hepatomegaly 
- raised BNP
-palpitations 
-graham steel murmur 
-parasternal heave
43
Q

Which investigation can indicate cor pulmonale ?

A

ABG: hypoxia +- hypercapnia

ECG
right heart hyperteophy -> right axis deviation , S1 Q3 T3 
P-pulmonale ( high p wave ) 
RBBB 
Tachycardia 
Arrhythmia

Chest x ray

  • produced pulmonary arteries
  • right heart hyperteophy
  • signs of underlying disease

Echo - hyperteophy

Confirmatory test : right heart catheter and then measure pressure

44
Q

What type of hypersensitivity reaction is allergic asthma ?

A

Type 1 hypersensitivity

IgE mediated

45
Q

Name the two types of asthma and their causes .

A

Extrinsic / allergic asthma

  • develops typically in childhood
  • biggest risk factor : atopy
  • environmental : Pollen, animals , mould
  • dust

Intrinsic / non allergic asthma

  • cold air
  • develops late > 40
  • exercise induced
  • gastric reflux
  • stress
  • irritants like smoke
  • Aspirin !!
46
Q

Asthma is caused by airway narrowing. Which factors contribute to that?

A

Bronchial muscle contraction

Mucosal swelling & inflammation
- Mast cell degeneration with inflammatory mediator release

Increased mucous production

—> bronchial hyperreaponsiveness

47
Q

Classical symptoms of asthma

A 
Wheeze 
Dyspnoea
Dry cough, worse at night and with exercise and exposure 
Allergic rhinitis 
Chest tightness
48
Q

You are examining a patient with asthma . What are your findings?

A

Hyperinflation of chest
Wheeze ( polymorph ) end expiration
Hyperresonant on percussion

Reduced PEFR

49
Q

Typical spirometry findings of patients with asthma

A

Obstructive pattern
Decrease FEV1/FVC RATIO < 70% !!!

Low FEV1 -> 15% improvement after salbutamol inhalation
( reversible obstruction )

Normal FVC

50
Q

Explain general measures as well as pharmacological

Options in asthma therapy

A
  • avoid triggers
  • quit smoking
  • teach / monitor inhaler technique , PEFR
  • written action plan
  1. SABA salbutamol + ICS ( eg beclomethasone 200 mcg / day)
  2. Add LABA salmeterol
    3 stop LABA and increase ICS or leave LABA and increase ICS
    Trial of theophylline, LAMA
  3. Trial of ICS high dose
    Add 4th drug : Leukotriene recep antagonis, b-agonist, LAMA
    5 oral prednisone
51
Q

A asthmatic patient becomes pregnant . What is Important to advice her in terms of her medication?

A

inhales drugs

Theophylline and presnisolone are all safe in pregnancy and breast feeding

52
Q

Side effects of salbutamol ?

A

SHORT ACTING B AGONIST

  • tremor
  • hypokalaemia
  • hyperglycaemia
53
Q

Give an example for inhaled steroids and their Side effects

A

Beclomethasone
Fluticasone
Budesonide

  • oral candidiasis
  • stunted growth in children
54
Q

How does patient with acute asthma attack present?

A

Unable to complete sentences
Tachycardia
Tachypnoea

Life threatening : silent chest

55
Q

How to treat acute severe asthma ?

A 
Salbutamol 5mg nebulised
\+ 
Oxygen high flow 
\+ 
Prednisolone  30mg PO
56
Q

Causes of COPD

A 
Smoking 
Passive smoking
Alpha antitrypsin decifiency 
Asbestosis 
Occupation with fine dust
57
Q

Classical symptoms & signs of COPD

A 
Productive cough
Dyspnoea
Cyanosis / tachypnoea / tachycardia 
Weight loss
Clubbing 
Crackles and where 
Hyperinflation
58
Q

COPD can be classified into 4 stages . How?

A

By FEV1 (of predicted )

  1. Mild - > 80%
  2. Moderate 50-79 %
  3. Severe 30-49%
  4. Very severe <30%
59
Q

How to investigate a patient with COPD and what do the tests show ?

A

Spirometry

  • obstructive , non reversible
  • FEV1/FVC ratio < 70%
  • FEV1 < 80
  • high TLC
  • high residual volume

Chest X-ray

  • -> hyperinflation
  • flattened diaphragm
  • horizontal ribs
  • increased intercostal space
  • increase retrosternal space

FBC

  • check for secondary polycythaemia (hypoxia increases EPO)
  • -> high Hb, red cell count and PCV packed cell volume

BGA
Hypoxia or type 2 respiratory failure

60
Q

Management of COPD

A
  1. General : smoking cessation , vaccination ( influenza, pneumococcal) , physical activity
  2. Bronchodilators
    SABA OR SAMA
  3. FEV1 > 50 LAMA or LABA
    FEV1 < 50 LAMA OR LABA + ICS
  4. If LABA switch to LABA + ICS
    Or LAMA+LABA+ICS
61
Q

How to treat a acute excacerbation of asthma ?

A

Nebulised salbutamol + ipatropium

Controlled oxygen therapy
( if hypercapnic only up to 88-92% )

if unresponsive
IV hydrocortisone or oral presnisolone

Antibiotics
Eg amoxicillin or clarythromicin

62
Q

Define hypoxia

A

PaO2 < 8 kPa

63
Q

Explain the two types of respiratory failure and it’s causes

A

Type 1
Hypoxia plus normal or low Ca02
Cause : Ventilation - perfusion mismatch (-> impaired gas exchange due to consolidation of lung )
Eg Pneumonia, PE. Pulmonary oedema , fibrosis , Asthma

Type 2
Hypoxia and hypercapnia 
Due to hypoperfusion 
- asthma, COPD , pneumonia , obstructive sleep apnoea 
- sedative drugs , tumour , trauma 
- GBS, myasthenia gravis 
- kyphoscoliosis
64
Q

A patient underwent hip replacement surgery. On the Ward he presents with sudden onset dyspnoea , pleuritic chest pain and haemoptysis .
What’s the diagnosis ?

A

Pulmonary embolism

65
Q

Risk factors for pulmonary embolism

A 
Surgery , esp bone , pelvic, abdominal 
Leg fractures
Prolonged bed rest / reduced
Mobility 
Pregnancy / pill/ post partum/ HRT
Thrombophilia
66
Q

Signs of pulmonary embolism

A 
Hypotension
Tachycardia
Tachypnoea
Cyanosis
Raises JVP
Pleural effusion
Pleural rub

DVT - swollen leg

67
Q

What investigations would you run in a patient with suspected pulmonary embolism ?

A

Bloods
-> D-Dimer ( - results exclude diagnosis )

ECG
Maybe normal , tachycardia (sinus)
Sometimes AF

Chest X-ray
Normal ,
Small effusion can show blunted costophrenic angle , linear atelectasis

CT angiography
Shows emboli in arteries

68
Q

Treatment of pulmonary embolism

A
  • oxygen
  • LMW heparin followed by warfarin

If massive : thrombolysis with altepase

(Analgesia, fluids )

69
Q

Prevention of PE

A

Ted stockings
Early mobilisation
S.c LMW heparin e.g Dalteparin 2500 units / 24 hrs

70
Q

Which score assesses risk of DVT and therefor PE ?

A

Wells score

71
Q

Which people are at risk of asbestos exposure ?

A

Shipyard worker at the docks
Industrial worker
Fire fighter
Construction worker

72
Q

What can asbestos cause ? What is it a risk factor for?

A

Risk factor for lung cancer

Can cause
pleural plaques
Pleural thickening

Asbestosis (fibrosis )

mesothelioma (pleural cancer )

73
Q

Which organ does the myobacterium tuberculosis most commonly affect ?

Which type of bacteria is it ?

A

The lungs
Gram +
Acid fast bacilli , survives in gastric acid

74
Q

How may a patient with suspected TB present with?

A 
In acute:
Productive cough and haemoptysis 
Exertional dyspnoea 
Night sweats 
Low fever

If not acute probably asymptomatic

75
Q

Name the biggest risk factor for getting TB?

Think the 4 As

A

HIV
Immunosuppression

Ausland
Armut
AIDS
Alkohol

76
Q

What would you find in a patient with active / primary TB?

A

The primary complex
= caseous granuloma
+
mediastinal Lymph nodes

77
Q

What happens in latent TB?

A

There has been a prior infection but bacterium stays ( can get deactivates )
+ quantiferon test
But NO CURRENT infection

78
Q

What happens in reactive TB?

A

Reactivation of bacterium due to

Immune down regulation e.g chemo

79
Q

In an severely immunocomprimised patient with tuberculosis , which sepsis can occur ?

A

Landouzy sepsis

80
Q

What is an open TB?

A

When cavitations are connected to bronchus !

81
Q

Classical X-ray findings

Of a patient with TB

A

Finronodular linear opacities ( upper lobe)

Cavitations

Caseous granuloma

Miliary disease ( all over lung )

82
Q

Which tests could you perform in a patient with suspected TB?

A 
Quantiferon test ( Interferon Gamma release test )
( which is - in vaccinated people)

Tuberculin skin test

83
Q

Treatment of tuberculosis

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

84
Q

Differentiate between the different types of pleural effusions

A

Transudate
( protein <25g /L )

Exudate
( protein > 35 g/L)

85
Q

What are causes for transudate pleural effusion?

A 
Cardiac failure
Fluid overload 
Hypoproteinuria (cirrhosis nephrotic syndrome)
Hypothyroidism 
Meigs syndrome
86
Q

What are causes for exudate pleural effusion ?

A 
Pneumonia
TB
Pulmonary infarction 
RA 
SLE
Carcinoma 
Metastasis 
Mesothelioma
87
Q

Investigations of pleural effusion

A

Uss

Thorocentesis
( diagnostic or therapeutic )

Xray

88
Q

If a pleural effusion is caused by malignancy , what type of fluid would I suspect ?

A

Exudate , cell rich

89
Q

What is sarcoidosis ?

A

Multi system disorder characterized by non- caseating granulomatous inflammation

90
Q

Name two conditions that have both granulomas but different types of it

A

Non-casaeting granuloma in sarcoidosis

Casaeting granuloma ( central necrosis) in TB

91
Q

What organs are involved in sarcoidosis and how?

A

Lung : dyspnoea , cough , chest pain

Arthritis
Anterior uveitis
Erythema nodosum

General : fever malaise

92
Q

Sarcoidosis is classified in 4 types / stages , which ones ?

A
  1. Bilateral hilar lymphadenopathy
  2. Ground glass opacities + hilar lymphadenopathy
  3. Ground glass opacities but not hilar l.
  4. Lung fibrosis
93
Q

How to confirm the suspected diagnosis of sarcoidosis ?

A

Lung biopsy

Non casaeting granuloma

94
Q

What is interstitial lung disease and what’s the pathophysiology?

A

Fibrosis and remodelling of lung interstitium with chronic inflammation type 2 epithelial cells and type 2 pneumocyte hyperplasia

95
Q

What’s the most common cause of interstitial lung disease ?

A

Idiopathic pulmonary fibrosis

96
Q

What clinical features can be seen in interstitial lung disease ?

A

Dyspnoea on excretion
Dry paroxysmal cough
Bilateral crackles

97
Q

Name 3 common CT or X-ray findings in interestitial lung disease ?

A

Honey combing
Bronchiectasis
Thickened interlobular septa

98
Q

Which systemic disorders can cause interstitial lung disease ?

A 
SLE 
RA
Systemic sclerosis
Sarcoidosis
UC
Autoimmune thyroid

Respiratory (2 decks)

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