Resp Flashcards
(135 cards)
1
Q
What is pulmonary hypertension defined as?
A
> 25mmHg
2
Q
Give 3 signs of pulmonary hypertension on X-ray.
A
Enlargement of pulmonary arteries
Enlarged right atrium
Elevated cardiac apex
3
Q
Give 6 side effects of chemotherapy.
A
Nausea and vomiting Alopecia Peripheral neuropathy Anaemia Fatigue Constipation or diarrhoea
4
Q
Name 4 causing of pleural effusion with exudate.
A
Infection
Inflammatory
Pulmonary embolism
Asbestos related
5
Q
What is the most common histological type of non-small cell lung cancer?
A
Adenocarcinoma
6
Q
Which two conditions constitute COPD?
A
Chronic bronchitis
Emphysema
7
Q
What bacteria causes TB?
A
Mycobacterium tuberculosis
8
Q
What stain would you use to detect TB?
A
Ziehl-Neelson stain
9
Q
What other bacteria does Ziehl-Neelson stain for?
A
Mycobacterium leprae (leprosy)
10
Q
What is a CURB-65 score?
A
Assesses mortality of community-acquired pneumonia to determine whether community or secondary care treatment is most appropriate
11
Q
What makes up the CURB-65 score?
A
Confusion Urea > 7 Respiratory rate > 30 BP < 60/90 Age > 65
12
Q
What CURB-65 score constitutes admission to hospital?
A
2 or more
13
Q
Which antibiotics are used to treat community acquired pneumonia?
A
Amoxicillin and clarithromycin
14
Q
Give 5 features of bronchiectasis.
A
Persistent cough Purulent sputum Haemoptysis Dyspneoa Clubbing
15
Q
Name 2 tests used to diagnose CF?
A
Faecal elastase
Genetic testing
Sweat test
16
Q
What is a positive sweat test?
A
High level of chloride in the sweat (>60mmol/L)
17
Q
What is indicative of type 1 respiratory failure?
A
Low O2, normal or low CO2
18
Q
What is type 2 respiratory failure?
A
Low O2, high CO2
19
Q
What is the most effective way of improving FEV1 in COPD?
A
Smoking cessation
20
Q
What is the most common type of lung cancer?
A
Adenocarcinoma
21
Q
What is a common cause of bacterial otitis media?
A
Haemophilus influenzae
22
Q
What scale is used to grade breathlessness?
A
MRC dyspnoea scale
23
Q
Describe the MRC dyspnoea scale.
A
Grade 1 - Breathless with strenuous exercise
Grade 2 - Short of breath when hurrying or running up a hill
Grade 3 - Walks slower than most people of that age or stops for breath when walking on flat
Grade 4 - Stops for breath after walking 100m on flat
Grade 5 - Too breathless to leave the house
24
Q
Give 3 red flag respiratory symptoms.
A
Weight loss
Haemoptysis
Night sweats
25
What is the first line investigation for suspected lung cancer
Chest X-ray
26
What kind of percussion is seen in pleural effusion?
Stony/dull
27
What antibody is granulomatosis with polyangitis associated with?
c-ANCA
28
What inheritance pattern is seen in von-willebrand disease?
Autosomal dominant
29
What inheritance pattern is seen in cystic fibrosis?
Autosomal recessive
30
What is atelectasis?
Complete or partial collapse of a lobe of the lung, or the whole lung
31
What are pneumoconioses?
A group of lung disorders - reaction of the lung to inhaled dusts
32
Give 3 examples of pneumoconiosis?
Silicosis, asbestosis, coal workers lung
33
Give 2 examples of extrinsic allergic alveolitis
Farmers lung, bird fanciers lung
34
What is extrinsic allergic alveolitis?
Lung inflammation as a cause of inflamed microorganisms, or plant/animal proteins or chemicals
35
Define bronchiectasis.
Permenant dilation of the bronchi due to chronic lung disease or infection
36
What are the main infective organisms involved in bronchiectasis?
Psuedomonas aeruginosa, haemopholis influenzae, strep pneumoniae
37
When should an inhaled corticosteroid be added to asthma treatment?
Has asthma symptoms > 3 times per week
Uses SABA > 3 times per week
Woken up in the night by symptoms > once per week
38
What is the first line treatment of asthma?
Short acting beta-2 agonist
39
What is the second line treatment of asthma?
Inhaled corticosteroid (beclametasone)
40
What is the gold standard investigation of sarcoidosis?
Tissue biopsy
41
What type of hypersensitivity reaction is hypersensitivity pneumonitis?
Type 3
42
What symptoms can preceed goodpasture's syndrome?
Upper respiratory tract symptoms - runny nose, sneezing, fever
43
What is the commonest cause of an infective exacerbation in COPD?
Haemophilus influenzae
44
What are other common causes of infective exacerbations in COPD?
Streptococcus pneumoniae
| Moraxella Catarrhalis
45
What is the most common viral cause of COPD exacerbations?
Rhinovirus
46
What are the features of a moderate asthma attack?
PEF 50-75% of predicted
47
What are the features of a severe acute asthma attack?
PEF 33-50% of predicted
Heart rate > 110
Respiratory rate > 25
Inability to complete sentences in one breath
48
What are the features of a life threatening asthma attack?
```
SpO2 < 92
PEF < 33% of predicted
Altered conscious level
Silent chest
Cyanosis
```
49
Give two side effects of salbutamol inhalers.
Fine tremor, hypokalaemia
50
Where are small cell lung cancers typically located?
Centrally
51
Where are squamous cell lung cancers typically located?
Centrally
52
What paraneoplastic syndromes are associated with small cell lung cancer?
ADH secretion - hyponatraemia
ACTH secretion
Lambert-eaton syndrome
53
What paraneoplastic syndrome is associated with squamous cell lung cancer?
Hypercalacaemia due to PTH related peptide secretion
54
Which type of lung cancer is associated with asbestos exposure?
Mesothelioma
55
What CURB-65 score is needed to consider urgent care?
3 or more
56
What is the second line investigation for PE?
Echocardiogram
57
When would echocardiogram be used to investigate PE?
If the patient is haemodynamically unstable
58
What is the gold standard investigation for PE?
CT pulmonary angiography
59
What are the most common causes of pneumonia in under 3 month olds?
Group B streptococci
E coli
Listeria monocytogenes
60
What is the treatment plan for a CURB-65 score of 0-1?
Oral amoxicillin
61
What is the treatment plan for a CURB-65 score of 2?
Oral amoxicillin and clarithromycin
62
First line COPD medication
SABA
63
Second line COPD medication
LABA
64
Third line COPD medication
Inhaled corticosteroids
65
What is the appearance of TB on X-ray?
Ghon complex
66
What type of lesion is TB?
Caseating granuolma
67
What stain is used for TB?
Ziehl-Neelsen stain
68
What 4 antibiotics are used to treat TB?
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
69
How long is the treatment for TB given?
Rifamipicin and isoniazid for 6 months
| Pyrazinamide and ethambutol for the first 2 months
70
Give 3 differential diagnoses of a patient who has had past asbestos exposure.
Mesothelioma, asbestosis, sarcoidosis
71
What cancer is asbestos exposure likely to cause?
Mesothelioma
72
What is Horner's syndrome?
Ptosis, pupillary constriction, no sweating on the affected side
73
What type of tumour can cause Horner's syndrome?
Pancoast tumour (on the same side as the affected face)
74
What is a pancoast tumour?
A tumour of the apex of the lung
75
Why do pancoast tumours cause Horner's syndrome?
Pancoast tumours can grow and invade the apical chest wall, affecting nearby structures such as the sympathetic chain
76
What is the pathophysiology of asthma?
Narrowing of the airways due to smooth muscle contraction, thickening of the airway due to cellular infiltration, and the presence of secretions in the airway
77
Name a long acting beta agonist.
Salmeterol
78
Give an example of an antimuscarinic bronchodilator.
Ipratropium bromide
79
Give an example of an inhaled corticosteroid.
Beclometasone diproprionate
80
What type of lung cancer is the most common in smokers?
Squamous cell carcinoma
81
What is the first line investigation for lung cancer?
Chest X-ray
82
Which types of cancer are most likely to metastasise to the lung?
Breast
Prostate
Colon
Bladder cancer
83
What condition is Lambert-Eaton syndrome associated with?
Small cell lung cancer
84
What is sarcoidosis characterised by?
Small non-caseating granulomas forming in the lungs, lymph nodes, and other organs
85
Give 5 extrapulmonary symptoms of sarcoidosis.
```
Erythema nodosum
Adenopathy
Polyarthritis
Uveitis
Arrhythmia
```
86
Give 3 differentials of bilateral lymphadenopathy.
Sarcoidosis
Lymphoma
Tuberculosis
87
Give 3 causes of bronchiectasis.
Cystic fibrosis
Post-infection
Idiopathic
88
Give 3 features of bronchiectasis on examination.
Wheeze
Clubbing
Coarse crackles on early inspiration
89
Give 5 complications of bronchiectasis.
```
Recurring infection
Haemoptysis
Pneumothorax from coughing
Empyema
Lung abscess
```
90
Give 4 differentials of COPD.
Asthma
Alpha-1 antitrypsin deficiency
Cystic fibrosis
Bronchiectasis
91
What is the most appropriate antibiotic to treat haemophilus influenzae?
Co-amoxiclav or doxycycline
92
Give 3 differentials of a COPD exacerbation.
Pleural effusion
Pneumothorax
Heart failure
93
Which groups of patients are more at risk of respiratory infection?
Infants
Elderly
Immunocompromised
Patients with chronic lung conditions e.g COPD
94
Give 4 risk factors for pneumothorax.
Smoking
Trauma
Previous pneumothorax
Previous invasive procedure
95
What are the two classic features of pneumothorax?
Pleuritic chest pain and dyspnoea
96
How can pneumothorax and pleural effusion be differentiated between on examination?
Pneumothorax - hyperresonant on percussion
| Pleural effusion - dull on percussion
97
Which has faster onset - pleural effusion or pneumothorax?
Pneumothorax
98
What is the action of ipratropium?
Muscarinic receptor antagonist that acts as a bronchodilator
99
How are neutrophils involved in COPD?
They release proteases that cause tissue destruction
100
Define bronchiectasis.
Permenant dilation of bronchi and bronchioles.
101
What is the treatment plan in a severe acute asthma attack?
Salbutamol
Nebulised ipratropium bromide
Oral prednisolone
102
Give 4 signs of good asthma control.
Not needing inhaler at night
Inhaler used no more than 3 times per week
No breathing difficulties or wheeze on most days
Able to exercise without symptoms
103
What type of hypersensitivity reaction is anaphylaxis?
Type 1
104
What is the action of IM adrenaline?
Beta adrenergic receptor agonist
105
What is the physiological response during anaphylactic shock?
Vasodilation
Tachycardia
Hypotension
106
How is sarcoidosis diagnosed?
Diagnosis of exclusion of other granulomatous lung diseases
107
What is the first line treatment of sarcoidosis?
IV corticosteroids - methylprednisolone
108
What are the differentials of sarcoidosis?
Lymphoma, TB, non-small cell lung cancer
109
What is the most common cause of bronchiectasis?
Due to previous recurring infections
110
What are the three most common infective exacerbations of COPD? (in order)
Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis
111
Give 2 CXR findings in COPD.
Barrel chest
| Flat hemidiaphragm
112
What are the three treatments offered in COPD? (progressively)
SABA
LAMA
Inhaled corticosteroids
113
How is the severity of COPD classified?
Stage 1 - FEV1 > 80%
Stage 2 - FEV1 < 80%
Stage 3 - FEV1 < 50%
Stage 4 - FEV1 < 30%
114
What is the fourth line treatment of asthma?
If a leukotriene receptor antagonist doesn't bring asthma under control, stop the LRA and switch to a LABA
115
What type of reaction is hypersensitivity pneumonitis?
Type 3 hypersensitivity
116
What is the first line management of a pneumothorax?
Needle aspiration
117
What indicates a tension pneumothorax?
Deviation of the trachea
118
What conditions cause upper lobe fibrosis?
Sarcoidosis
Silicosis
Ankylosing spondylitis
Hypersensitivity pneumonitis
119
What is the definition of AIDS?
CD4 count < 200
120
What are the differences between emphysema and chronic bronchitis?
Smaller amount of sputum in emphysema
Older age at presentation with emphysema
Lower weight in emphysema
Small heart/hyperinflated lungs/barrel chest in emphysema, normal heart and diaphragm in chronic bronchitis
121
What mutation is seen in CF?
F508 mutation of the CFTR gene on chromosome 7
122
What advice should be given to CF patients?
```
Stop smoking
Wash hands regularly
Get flu vaccine every year
Increase calorie and fat intake
Exercise regularly
```
123
What types of effusions are there?
Exudative and transudative
124
Give 3 examples of exudative effusions.
TB, pneumonia, lung cancer
125
Give 3 examples of transudative effusions.
Congestive heart failure, liver cirrhosis, nephrotic syndrome
126
What are the protein levels in transudative and exudative effusions?
Transudative < 30g/L
| Exudative > 30g/L
127
Give 2 investigations that can confirm pleural effusion.
Chest X-ray
| Pleural fluid aspiration
128
What are the first line managements for pleural effusion?
Loop diuretics
| Therapeutic thoracentesis
129
What side effect is seen with pyrazinamide?
Joint pain
130
What are the symptoms of pulmonary embolism?
```
Tachypnoea
Tachycardia
Pleuritic chest pain
Dyspnoea
Haemoptysis
```
131
What should you do before adding new asthma treatment or changing doses?
Check inhaler technique and adherance
132
Is TB obstructive or restrictive?
Restrictive
133
What is a common cause of hospital acquired pneumonia?
Pseudomonas aeruginosa
134
Who is most likely to suffer from a spontaneous pneumothorax?
Young, thin males
135
Where would a needle thoracostomy be placed?
2nd intercostal space, mid clavicular line on the same side as the pneumothorax
