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Resp Flashcards

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1
Q

What are the common organisms of community acquired pneumonia?

A

Streptococcus pneumoniae (gram pos), H.influenzae (gram neg coccobacillus), mycoplasmum pneumoniae (rod, acid fast stain)

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2
Q

What is a common cause of pneumonia in immunocompromised patients?

A

pneumocystitis jiroveci

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3
Q

Whats the treatment for s.pneumoniae?

A

amoxicillin

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4
Q

What is the treatment for m.pneumoniae?

A

erythromycin

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5
Q

what’s the tx for chlamydia pneumoniae?

A

erythromycin

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6
Q

what is the tx for legionella spp.?

A

clarithromycin

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7
Q

What is the difference between restrictive and obstruction lung disease?

A
  • FEV1/FVC = <0.7 in obstructive
  • obstructive: airway related
  • restrictive: parenchyma and pleura related
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8
Q

What is the pattern in flow loop seen in asthma and other obstructive diseases?

A

scalloping

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9
Q

What gene mutation causes A1A1 deficiency?

A

SERPEINA 1

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10
Q

What is a A-A gradient and what is it useful for?

A

alveolar-arterial gradient. Can help narrow down causes of hypoxia.

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11
Q

What are the causes of type 1 resp failure? (there are 3 categories)

A
  1. low O2 delievery (eg, altitude: high altitude pulmonary oedema)
  2. gas exchange/diffusion limitation (ILD and asbestosis)
  3. ventilation/perfusion mismatching (pneumonia, PE, pulmonary HTN)
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12
Q

What are the causes of type 2 resp failure?

A
  1. obstruction (asthma and COPD)

2. alevolar hypotension (emphysema, MND, mscular weakness, reduced medulla resp drive, obesity)

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13
Q

What is acute coryza? what virus causes it?

A

Permanent dilation of airways. caused by rhinovirus

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14
Q

What is the Geneva score used for?

A

Predicting the probability of PE

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15
Q

What is the difference in treatment of haemodynamically stable and unstable PE patients?

A
  • Stable: apixaban with CTPA (CT pulmonary angiogram)

- instable: alteplase

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16
Q

What are the varying underlying pathology of the two types of COPD?

A
  • Pink puffer: emphysema. Hyperventilation prevents hypoxia
  • Blue bloaters: chronic bronchitis. Respond to increased obstructions by decreasing ventilation and increasing cardiac output. :eads to hypoxia
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17
Q

What is the aetiology of TB?

A

mycobacterium tuberculosis

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18
Q

How is TB Dx?

A

Latent: Mantoux test.
Active/miliary: CXR- pleural effusion. Patchy/nodular shadows. Sputum smear for acid fast bacilli. NAAT (PCR) can detect drug resistance

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19
Q

How is TB treated?

A

4 for 2 and then 2 for 4 (6 months)

isonizid, rifampricin, pyrazinamide, ethambutol

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20
Q

What cells are involved in asthma?

A

Eosinophils, IgE produced. Hypersensitvity reaction

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21
Q

What is the treatment cascade for asthma?

A

SABA (B2 agonist) –> corticosteroids –> LABA –> increased dose of corticosteroids –> prednisolone –> hospital

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22
Q

What sPO2 defines asthma as life threatening?

A

<92%

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23
Q

What are the different PEFRs for asthma classes?

A
  • uncontrolled: >50%
  • severe: 35-50%
  • life threatening: <33%
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24
Q

Where is most affected with idiopathic pulmonary fibrosis?

A

periphery and base. This is where crackles will be heard

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25
What is the pathophysiology of IPF?
patchy fibrosis of interstitium, minimal or absent inflammation. Fibroblasts resistant to apoptosis. Proliferate and form fibroblastic foci. Thickened tissue: less gas exchange in lungs. Leads to honey comb lungs
26
What is the tx for IPF?
- pirfenidone (reduces fibroblast damage) | - nintedanib (inhibits tyrosine kinase). Neither cure, but reduce FVC rate of decline
27
What is extrinsic allergic alveolitis?
Form of ILD. Inflammatory type III hypersensitivity reaction. IgG deposits in the lung
28
What lung cancer is most strongly associated with asbestos?
Non small cell adenoma and mesothelioma
29
What lung cancer is most common in non smokers?
Non small cell adenoma --> adenocarcinoma
30
what is the gold standard dx for mesothelioma?
pleural biopsy
31
What's the difference between transudate and exudate in pleural effusion?
- transudate: <30g/L of protein. Due to change in systemic conditions (increased hydrostatic or decreased osmotic) - exudate: >30g/l of protein. Due to cellular elements that ooze out of blood vessels due to inflammation or local damage. increased permeability of pleural surface and capillaries due to inflammation
32
What are the causes of a transudate pleural effusion?
heart failure, cirrhosis, hypoalbuminaemia
33
What are the causes of exudate pleural effusion?
cancer, pneumonia, autoimmune conditions, post cardiac surgery Dressler syndrome
34
What is sarcoidosis?
multisystem chronic inflammatory condition. Formation of non caseating epitheliod granulomata (aggregation of macrophages as a result of inflammation). Form of ILD. Normally an incidental finding.
35
What is CURB 65:
- used for scoring severity of pneumonia: 1. confusion 2. urea (>7mmol/L) 3. resp rate (>30/min) 4. BP <90/60 mmHg
36
What is antigenic drift?
gene mutation leading to flu being able to reinfect people every year
37
what is antigenic shift?
2 strains of flu combining to form a new strain
38
in portal hypertension, what are the investigations and findings?
- CXR: enlarged pulmonary arteries | - ECG: ventricular hypertrophy
39
what antibodies are cirulating in Good Pasture's syndrome?
against the basement membrane of both the glomerulus and lung. Thus can also cause AKI injury due to nephritic syndrome.
40
What is the commonest cause of infective exacerbation of COPD?
haemophilus influenza
41
What is the 1st line investigation in a COPD flare up?
ABG
42
What asthma tx can be associated with a fine tremor?
SABA
43
What do each of the CURB 65 scores indicate
- 1 or 0: treat as outpatient - 2: inpatient - 3: inpatient ICU
44
What can cause polycythaemia? What other compx ca this aetiology have?
prolonged hypoxia. This can also lead to pulmonary hypertension (due to reactive pulmonary vasoconstriction)
45
What causes early onset COPD, with no smoking?
A1AT deficiency
46
What two systems have symptoms in A1AT def?
liver and lungs
47
What are the following a typical presentation of?Dry cough, dyspnoea, bibasal crackles
IPF
48
What is the gold standard dx for IPF? what is shown?
High res CT. ground glass apperance
49
What is the dx for EAA?
bronchoalveolar lavage. show increased mast cells, and evidence of type III hypersensitivity reaction
50
What acronym is associated with granulomatosis w/ polyangitiis?
ELK! these are the areas affected. ENT, lung, kidney
51
How is good pastures diagnosed?
lung and kidney biopsy
52
What ICS is used in asthma?
beclametasone.
53
what LTRA is used in asthma? When must it be taken?
montelukast. Must be taken at night
54
What LABA is used in asthma?
salmeletrol
55
What LAMA is used in asthma?
Titropium
56
How do you diagnose TB (like which stain, etc)
Acid fast bacilli will stain red/pink w/ Ziehl Neelsen stain
57
What triad is typical of TB?
weightloss, low grade fever, night sweats
58
How does TB appear on a xray?
fibronodular opacities on upper nodes
59
What are the side effects of each of the TB Abx?
R: rifampicin: red urine I: isoniazid: neuropathy P: gout/ hepatitis E: ethambutol: optic issues
60
how can you quickly differentiate pneumonia from TB?
far shorter Hx!
61
What is the characteristic symptom of s.pneumoniae?
rusty red sputum
62
What is the wells score?
Severity of PE
63
How long does a patient need to take thrombolytic medication after event?
- provoked: 3 months | - unprovoked: >3 months
64
What causes pulmonary hypertension?
anything that increases pulmonary vascular resistance or pulmonary blood flow
65
What can be heard with pulmonary HTN?
tricuspid regurg murmur
66
What is diagnostic for pulmonary HTN?
right heart catheterisation
67
What size of pneumothorax is the point where needle aspiration occurs? What other factor affects tx?
- 2cm | - always needle aspitation if short of breath
68
What does the trachea do in pneumothorax?
deviates to the opposite side
69
What size, gender and age are most likely to have a spontatenous pneumothorax?
young, male, low BMI
70
What is the most common lung cancer?
squamous cell carcinoma
71
What is the best treatment for penicillin allergic severe pneumonia?
levofloxacin
72
Where should a large bore be inserted in a tension pneumothorax?
2nd IC space, midclavicular line
73
What is a mneomnic for remember the criteria for life threatening asthma?
33 92 CHEST - 33: PEFR <33% - 92: pulse oximetry below 92% - cyanosis - H: hypotension - E: exhausation - S: silent chest - tachycardia
74
What is classic presentation of epiglottitis, and what is a common cause (and why has incidence decreased)
- fever, upright sitting position and drooling | - caused by haemophilus influenza. Decreased due to vaccination
75
What bacteria can be detected via a urine test?
Legionella.
76
What is a common ECG presentation of PE
sinus tachycardia
77
What is a key finding with sarcoidosis?
hypercalcaemia
78
What condition presents with tramline opacities and ring shadows on CXR?
bronchiectasis
79
What are the classic signs and symptoms of granulomatous with polyangiitis?
- Classic sign on exams: saddle shaped nose - Epistaxis - Crusty nasal/ ear secretions 🡪 hearing loss - Sinusitis - Cough, wheeze, haemoptysis
80
What is the action of ipratropium and atropine?
- muscarinic ACh receptor antagonist | - also acts as a bronchodilator

GI P2a (12 decks)

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