Resp Flashcards by D W

What are the clinical features of sarcoidosis?

fever, wt loss, anorexia
eye symptoms: uveitis
nasal congestion
facial nerve palsy
erythema nodosum, arthralgia
lupus pernio: nose swelling
lymphadenopathy
pulmonary fibrosis

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Signs of sarcoidosis on CXR?

hilar lymphadenopathy

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Investigations for sarcoidosis?

FBC: lymphocytopenia, eosinophilia
ESR
ACE level
CXR, CT chest
PFT, ABG
bronchoscopy and biopsy
LN biopsy

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Treatment for sarcoidosis?

prednisone
if long term Rx needed: MTX, AZA
hydroxychloroquine for skin disease
infliximab

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What are causes of clubbing?

resp: lung ca, bronchiectasis, CF, Idiopathic pulmonary fibrosis
cardiac: cyanotic congenital heart disease, IE
GI: cirrhosis, IBD, Coeliac
thyrotoxicosis

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What is Lights criteria for exudate?

Pleural:serum Protein >0.5
Pleural:serum LDH >0.6
LDH > 2/3 upper limit of normal

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What are causes of transudative pleural effusion?

heart failure
liver failure
nephrotic syndrome

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What are causes of exudative pleural effusion?

infection: pneumonia, TB
malignancy
pulmonary infarction

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What investigations on pleural fluid?

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What us the differential for bilateral crackles?

pulmonary edema/cardiac failure
bronchiectasis
atelectasis
bilateral pneumonia
pulmonary fibrosis (fine crackles)

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How many posterior ribs visible to say a CXR is hyperexpanded?

More than 9 posterior ribs, flattened diaphragm

Or >6 anterior ribs at diaphragm

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What is the differential for a lung mass on imaging?

carcinoma - primary or metastatic
lung abscess
TB
pulmonary infarct
granuloma: I.e. Fungal

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What are causes of cavitating lung lesion?

lung abscess: staph, klebsiella
carcinoma
TB
fungus

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What are the signs of asthma severity?

symptoms throughout day
nightly symptoms >7x/week
SABA use several times a day
extreme interference with normal activity
FEV1

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How to investigate asthma?

spirometry: obstructive, reversible 12%
bronchial challenge testing if normal spiro
PEF for monitoring
allergen skin testing

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How would you manage asthma? (Maintenance Rx)

Non pharm: 
- allergen avoidance, smoking cessation
- asthma action plan
Pharm:
- vaccinations
- SABA
- ICS alone
- ICS/LABA combination
- prednisone
- treat GORD, if present

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What are causes of upper lobe lung fibrosis?

SCART

silicosis
coal worker pneumoconiosis
ank. spond
radiation
tuberculosis

What are causes of lower lobe lung fibrosis?

RASIO

RA
asbestosis
scleroderma
idiopathic
other: drugs (MTX, bleomycin, amiodarone)

What are symptoms of OSA?

snoring/apneas/waking gasping for air
excessive daytime sleepiness
decreased concentration
cognitive impairment

What are complications of OSA?

HTN
pulmonary HTN
increased CAD and stroke
polycythemia
cognitive impairment

How to diagnose sleep apnea?

sleep study: apnea-hypopnea index (severe >60)

- ABG

What are some adjuvants for NSCLC lung cancer treatment?

VEGF: bevacizumab
EGFR: cetuximab, gefitinib, erlotonib (adenocarcinoma)

What is treatment for SCLC?

Local: combined chemo (etoposide + cisplatin) + RTx
Advanced: combined chemo
Prophylactic cranial irradiation

What are paraneoplastic manifestations of SCLC?

eaton-lambert
SIADH
ectopic ACTH
carcinoid

What is the PAP for dx of pulmonary HTN?

>25 at rest Or >30 with exercise

What investigations for pulmonary HTN?

- CXR - PFT - ECG - ABG - CTPA or VQ - HRCT - TTE - R heart cath - 6min walk test (

What are the types/classes of pulm HTN?

1. Pulmonary arterial HTN 2. From L heart disease 3. Due to lung disease 4. Due to chronic PE 5. Unclear multifactorial mechanisms

How to determine pharmacological treatment in pulm HTN?

``` If reversibility: calcium channel blockers Otherwise, - endothelin receptor antag: bosentan - PDE5i: sildafenil - prostacyclins: iloprost, epoprostenol ```

What are some symptoms/presentations of sarcoidosis?

``` Systemic: fever, wt loss Pulmonary: cough, sob, abnormal CXR Eye: uveitis Skin: erythema nodosum Nerve: neuropathy/palsied Cardiac: arrhythmia ```

How to manage sarcoidosis?

Treat if: - increasing symptoms or worsening lung function - Neuro/renal/cardiac complications - major eye disease Use: - prednisone 1mg/kg, 1 year taper - steroid sparing: MTX, AZA - hydroxychloroquine for skin disease - infliximab: 3rd line

What investigations for sarcoidosis?

- Bloods: FBC, ESR - ACE level - calcium level (hyperCa) - Imaging: CXR, CT, PET - biopsy: granulomas

What gene and chromosome involved with CF?

Autosomal recessive CFTR gene mutation (Most common is delta F508) Chromosome 7 1:25 carrier rate

What are the various manifestations of CF?

- GI baby: meconium ileum, failure to thrive - Resp: cough, haemoptysis, wheeze, SOB - Cardiac: cor pulmonale - Gastro: diarrhea, steatorrhea, pancreatic insufficiency, intestinal obstruction, ADEK deficiency - Liver: cirrhosis/fibrosis, cholelithiasis - DM - infertility: CBAVD

What organisms associated with CF?

1. Staph and h. influenzae 2. Nosocomial e.coli and proteus 3. Pseudomonas*** 4. Burkholderia = poor prognosis

What investigations for CF?

- sputum MCS - bloods: FBC (anaemia, infection), LFT/alb, coags - CXR - CT chest - PFT

What is your management of pulmonary CF?

- neb. Antibiotics (tobramycin) - bronchodilators - mucolytics: neb NS, DNase - mutation specific drugs: ivacaftor(G551D), lumacaftor-ivacaftor(DF508) Non Pharm: - postural drainage, chest Physio - medical devices: oscillating devices - exercise

What is indication for lung transplant in CF?

- FEV1

How would you manage gastro manifestations of CF?

- high protein/fat diet - nutritional supplements - pancreatic enzyme replacement

How do you manage pregnancy with CF?

- acknowledge fertility issues; in women, mainly due to malnutrition - if FEV1 > 60%, should be OK - pulmonary HTN is contraindication to pregnancy - genetic counselling - screen for GDM - increased prematurity

How would you approach pre transplant work up?

Lungs: PFT, imaging, 6MWT Heart: TTE, ECG, angio, R heart cath Infection status: CMV, EBV, HIV, Hep, sputum Vaccinations Malignancy: 5yrs cancer free Social/mental: psych review, social supports, living, finance, compliance Education