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EXAM > Resp 7.5 > Flashcards

Resp 7.5 Flashcards

1
Q

Group 1 pulmonary HTN

A

(1ry) idiopathic, familial, or persistent pulm HTN of the newborn
- ass in: collagen vast disease, congenital heart disease with systemic->pulm shunts, HIV, drugs & toxins, sickle cell disease

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2
Q

Group 2 pulmonary HTN

A

= pulm HTN with left heart disease
- left-sided atrial, ventricular or valvular disease e.g. LV systolic & diastolic dysfunction, mitral stenosis & mitral regurgitation

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3
Q

Group 3 pulmonary hypertension?

A

= pulm HTN 2ry to lung disease/hypoxia

- COPD, ILD, sleep apnoea, high altitude

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4
Q

Group 4 pulmonary hypertension?

A

= pulm HTN due to thromboembolic disease

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5
Q

Group 5 pulmonary hypertension?

A

= miscellaneous conditions

- lymphangiomatosis e.g. 2ry to carcinomatosis/sarcoid

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6
Q

Resp manifestations of rheumatoid arthritis?

A
  • pulm fibrosis
  • pleural effusion
  • pulm nodules
  • bronchiolitis obliterans (obstructive)
  • complications of drugs e/g/ MTX pneumonitis
  • pleurisy
  • Caplan’s syndrome - massive fibrotic nodules with occ coal dust exposure
  • infection (may be atypical) 2ry to immunosuppression
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7
Q

%pred of FEV1 in copd?

post-bronchodilator FEV1/FVC <0.7

A

1 mild >80% WITH SYMPTOMS
2 moderate 50-79%
3 severe 30-49%
4 v severe <30%

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8
Q

Rx for low-severity CAP?

A

1st Amoxicillin 5/7 (/macrolide/tetracycline)

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9
Q

Rx for mod-high severity CAP?

What to consider in high-severity?

A
  • Dual Abx: Amoxicillin + Macrolide 7-10/7

- beta-lactamase stable penicillin e.g. co-amoxiclav/ceftriaxone/tazocin + macolide in high severity

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10
Q

What is transfer factor?

A

Rate at which a gas will diffuse from alveoli into blood - CO used to test rate of diffusion
- total gas transfer TLCO or corrected for lung volume transfer coefficient KCO

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11
Q

Conditions that can cause increased KCO with a normal/reduced TLCO?
(KCO also tends to increase with age)

A
  • pneumonectomy/lobectomy
  • neuromuscular weakness
  • scoliosis/kyphosis
  • ankylosis of costovertebral joints
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12
Q

Causes of raised TLCO?

A
  • pulmonary haemorrhage
  • asthma
  • L->R cardiac shunts
  • polycythaemia
  • hyperkinetic states, exercise, males
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13
Q

Causes of a lower TLCO?

A
  • fibrosis
  • pneumonia
  • PE
  • pulm oedema
  • emphysema
  • anaemia
  • low cardiac output
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14
Q

Causes of predominantly Upper zone fibrosis?

A 
Coal workers pneumoconiosis
Histiocytosis/hypersensitivity pneumonitis/EAA
Ank spond (rare)
Radiation
TB
Sarcoid/silicosis
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15
Q

Causes of predominantly lower zone fibrosis?

A
  • idiopathic
  • most CT disorders except ank spend
  • asbestosis
  • drugs: amiodarone, bleomycin, MTX, NSAIDs, nitrofurantoin
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16
Q

Gene ass with bronchiectasis?

A

HLA-DR1

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17
Q

Causes of bronchiectasis?

A
  • post-infective: TB, pneumonia etc
  • CF
  • obstruction e.g. cancer/FB
  • immune deficiency: selective IgA, hypogammaglobulinaemia
  • ABPA
  • ciliary dyskinetic syndromes: Kartagener’s syndrome, Young syndrome
  • yellow nail syndrome
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18
Q

CXR/CT signs in bronchiectasis?

A

tramlines/tram-track & signet rings

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19
Q

5 features of Churg-Strauss syndrome? (small-medium vessel vasculitis)

A
  1. asthma
  2. blood eosinophilia >10%
  3. paranasal sinusitis
  4. monomeuritis multiplex
  5. pANCA +ive in 60%
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20
Q

What drugs can precipitate Churg-strauss syndrome?

A

Leukotriene receptor antagonists e.g. montelukast

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21
Q

Sx of acute mountain sickness?
what may if progress to?
prevention?
Rx?

A
  • headache, nausea, fatigue. Develops gradually over 6-12h and can last a number of days. Starts to occur above 2500-3000m
  • HAPE/HACE
  • prevent with Acetazolamide (carbonic anhydrase inhibitor), gain no more than 500m/day
  • Rx = descent…
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22
Q

Features & Rx of HAPE?

A
  • classic pulm oedema features
  • Descend, O2 if available, drugs can help by reducing systolic pulmonary artery pressure e.g. nifedipine, dexamethasone, acetazolamide, phosphodiesterase V inhibitors)
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23
Q

Features & Rx of HACE?

A
  • headache, ataxia, papilloedema

- Descent & Dexamethason

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24
Q

Hypersensitivity pneumonitis = EAA

  • what is acute presentation?
  • CXR? BAL? FBC? CT?
A
  • SOB, dry cough, fever 4-8h post-exposure
  • CXR upper/midzone fibrosis
  • BAL: lymphocytosis
  • FBC: NO eosinophilia
  • CT: centrilobular ground glass nodules
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25
Q 
Drug Rx in COPD
step 1?
2?
3?
When to start theophylline?
When to consider mucolytics?
A
  1. SABA/SAMA
    2a. FEV1>50%: LABA/LAMA
    2b. FEV1<50%: LABA+ICS/LAMA
  2. Switch LABA to LABA+ICS or Upgrade to a regime of LABA+ICS & LAMA

Theophylline only after trial of above or people who can’t use inhaled therapy - REDUCE DOSE if on macrocode/fluoroquinolone

Mucolytics to consider if chronic productive cough & continued Sx improve

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26
Q

Features of Cor pulmonale?

Rx?

A
  • raised JVP, systolic parasternal heave, peripheral oedema, loud P2
  • loop diuretic for oedema, consider LTOT
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27
Q

Factors which may improve survival in stable COPD?

A
  1. STOP SMOKING
  2. LTOT in those who fit criteria
  3. lung volume reduction surgery in selected pts
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28
Q

Features of ABPA?
5 Ix features?
minor criteria?
Rx?

A
  • bronchiectasis & bronchoconstriction: wheeze, cough, dyspnoea
  1. eosinophilia
  2. raised IgE>1000
  3. CXR e.g. ring shadow/tram track suggestive of bronchiectasis, CT as above or bronchoceles
  4. positive RAST to Aspergillus Ag
  5. positive IgG precipitins (less +ve than in aspergilloma
    - clinical features of asthma

Rx with Steroids. Itraconazole sometimes added 2nd line

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29
Q

NSCLC - Rx options?

A
  • only 20% suitable for surgery
  • mediastinoscopy performed pre-op as CT doesn’t always show mediastinal lymph node involvement
  • curative/palliative RT
  • poor chemo response
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30
Q

NSCLC - what are the contra-indications to surgery? apart from general health

A
  1. stage IIIb/IV (mets)
  2. FEV1 < 1.5L
  3. malignant pleural effusion
  4. tumour near hilum
  5. vocal cord paralysis
  6. SVC obstruction
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31
Q

4 indications for NIV?

A
  1. COPD with resp acidosis pH 7.25-7.35
  2. type II resp failure 2ry to: NMD/OSA/chest wall deformity
  3. cardiogenic pulmonary oedema unresponsive to CPAP
  4. weaning from tracheal intubation
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32
Q

What are the recommended initial settings for BIPAP in COPD?

A
  • EPAP 4-5cm H20
  • IPAP 10-15cm H20
  • back up rate 15breaths/min
  • backup insp:exp ratio 1:3
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33
Q

Causes of cold?

A

Smoking
Alpha-1 antitrypsin deficiency
cadmium, coal, cotton, cement, grain

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34
Q

Patients with COPD who should be assessed for LTOT?

How are they assessed?

A
  • v severe i.e. FEV1<30%
  • cyanosis
  • peripheral oedema
  • polycythaemia
  • raised JVP
  • spO2 <93%

2 ABGs, 3 weeks apart with stable COPD on optimal Rx

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35
Q

When to offer LTOT in COPD patients?

A
  1. pO2 < 7.3 or
2. pO2 7.3-8 +
2ry polycythaemia/
nocturnal hypoxaemia/
peripheral oedema/
pulm HTN
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36
Q

What is Silicosis?
What is a particular feature on imaging??
What are pts at risk of?

A

Fibrosing lung disease (upper zone) caused by silica inhalation

  • RF for TB (silica toxic to macrophages)
  • Egg-shell calcification of hilar lymph nodes
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37
Q

Factors associated with poor prognosis in sarcoidosis?

A
  • insidious onset, Sx > 6m
  • absence of erythema nodosum
  • extra-pulm manifestations e.g. splenomegaly, lupus pernio
  • CXR: stage III-IV features
  • Black people
  • HLA B13
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38
Q

Adverse effects of nicotine replacement therapy?

A

nausea & vomit, headache, flu-like Sx

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39
Q 
MoA of Varenicline?
When to start?
Course of Rx?
Adverse effects?
When is it cautioned &amp; C/I?
A
  • nicotinic receptor partial agonist
  • start 1wk before target stop date
  • course c. 12wks
  • nausea commonest. also headache, insomnia, abn dreams
  • caution in Hx of depression/self-harm
  • C/I in pregnancy & breastfeeding
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40
Q

MoA of Bupropion?
when to start?
When is it cautioned & C/I?

A
  • Norepinephrine & dopamine reuptake inhibitor, and nicotinic antagonist
  • start 1-2wks before target stop date
  • relative C/I if eating disorder
  • C/I in epilepsy, pregnancy & breastfeeding
  • small risk of seizures 1/1000
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41
Q

What would cause a Leftwards shift of the O2 dissociation curve (lower O2 delivery)?

A
  • Low H+ (alkali)
  • Low pCO2
  • Low 2,3-dpg
  • Low temp
  • HbF, metHb, carboxyHb, (lower altitude, less exercise)
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42
Q

Causes of transudate pleural effusion?

<30g/L protein

A
  • heart failure
  • hypoalbuminaemia: liver disease, nephrotic syndrome, malabsorption
  • hypothyroidism
  • Meig’s syndrome
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43
Q

Causes of exudate pleural effusion?

>30g/L protein

A
  • infection: pneumonia, TB, subphrenic abscess
  • neoplasia: lung ca, mesothelioma, mets
  • CT disease: RA, SLE
  • pancreatitis
  • PE
  • Dressler’s syndrome
  • yellow nail syndrome
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44
Q

Major & minor criteria for ABPA?

A
  1. clinical features of asthma
  2. proximal bronchiectasis
  3. eosinophilia
  4. immediate skin reactivity to aspergillum Ag
  5. raised serum IgE >1000

i) fungal elements in sputum
ii) brown flecks in sputum
iii) delayed skin reactivity to fungal Ags

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45
Q

What is alpha1-antitrypsin?

A

protein inhibitor of neutrophil elastase -> protects lungs against functions of this enzyme
- produced by liver

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46
Q

Genetics of alpha1-antitrypsin:
which chromosome?
inheritance?
how are alleles classified?

A
  • chr 14
  • autosomal recessive/co-dominant
  • classed by electrophoretic mobility: M normal, S slow, Z v slow
    normal = PiMM
    homo PiSS 50% normal A1AT levels
    homo PiZZ 10% normal A1AT levels - manifest disease
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47
Q

Features of alpha1-antitrypsin deficiency?

Ix?

A

Lung: panacinar emphysema (esp lower lobes)
Liver: cirrhosis & HCC in adults, cholestasis in children
Ix A1AT concentrations

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48
Q

Rx of alpha1-antitrypsin deficiency?

A

Cons: no smoking
Med: supportive with bronchodilators, PT; then IV A1AT protein concentrates
Surg: volume reduction surgery, lung Tx

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49
Q

CXR stages of sarcoidosis ?

A 
0 = normal
1 = BHL
2 = BHL + interstitial infiltrates
3 = diffuse interstitial infiltrates only
4 = diffuse fibrosis
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50
Q

Role of ACE in sarcoidosis?
Bloods?
spirometry?
tissue Bx?

A
  • ACE can be used in monitoring disease activity (60% sens 70% spec)
  • hypercalcaemia 10%, raised ESR
  • may show restrictive defect
  • non-caseating granulomas
  • also gallium-67 scan, not used routinely
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51
Q

Lung volume inspired/expired with each breath at rest

A

tidal volume

52
Q

Maximum lung volume of air that can be inspired at the end of a normal tidal inspiration

A

inspiratory reserve volume

53
Q

maximum lung volume of air that can be expired at the end of a normal tidal expiration

A

expiratory reserve volume

54
Q

volume of air remaining after maximal expiration

A

residual volume

- inc with age

55
Q

expiratory reserve volume + residual volume

A

functional residual capacity

56
Q

maximum volume of air that can be expired after a maximal inspiration

A

vital capacity

- falls with age

57
Q

tidal volume X (PaCO2 - PeCO2) / PaCO2 = ???

PeCO2 = expired air CO2

A

physiological deadspace Vd

58
Q

Asthma Rx in adults steps?

  1. newly Dx
  2. uncontrolled or newly Dx with Sx 3+/wk or nighttime waking
A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + leukotriene receptor antagonist (LTRA)
  4. SABA + ICS + LABA
    - cont LTRA depending on pt’s response
  5. SABA +/- LTRA
    Switch ICS/LABA for a maintenance & reliever therapy (MART), that includes a ICS
  6. SABA +/- LTRA + medium-dose ICS MART
    or consider changing back to a fixed-dose of a mod-dose ICS and a separate LABA
  7. SABA +/- LTRA + one of the following:
    - increase ICS to high-dose as a part of a fixed-dose regime
    - trial of additional drug e.g. LAMA/theophylline
    - refer…
59
Q

What is MART: Maintenance & reliever therapy in asthma?

A
  • form of combined ICS & LABA Rx where a single inhaler containing both is used for both daily maintenance Rx & relief of Sx prn
  • only available for ICS & LABA combos in which the LABA has a fast-acting component e.g. formoterol
60
Q

Doses in adults of low/mod/high doses of ICS in asthma

A 
Low = <=400 mcg budesonide or equivalent
Mod = 400-800mcg budesonide
High = >800mcg budesonide
61
Q

Acute Severe Asthma Rx?

A

IV magnesium sulphate 1.2-2g over 20mins

If no response, consider IV salbutamol

62
Q

3 imagings in pleural effsuion

A

PA CXR
US (sensitive for detecting pleural fluid separations)
Contrast CT - Ix underlying cause esp exudative effusions

63
Q

Pleural aspiration - what to send?

A

US-guided 21g needle, 50ml syringe

- pH, protein, LDH, cytology, micro

64
Q

Exudate effusion cutoff?
Transudate effusion cutoff?
Light’s criteria to distinguish transudate & exudate pleural effusion?

A 
Exudate >30g/L protein
Transudate < 30
Light's criteria if 25-35
EXUDATE likely if at least 1 of the following:
1. fluid protein/serum protein >0.5
2. fluid LDH/serum LDH >0.6
3. fluid LDH > 2/3 ULN of serum LDH
65
Q

Pleural fluid with low glucose?

A

RA, TB

66
Q

Pleural fluid with raised amylase?

A

Pancreatitis, oesophageal perforation

67
Q

Pleural fluid with heavy blood staining?

A

Mesothelioma, PE, TB

68
Q

When to put a chest drain in for a pleural effusion?

A
  • if purulent/turbid/cloudy fluid

- if fluid clear but pH<7.2

69
Q

Rx of recurrent pleural effusion?

A
  • recurrent aspiration
  • pleurodesis
  • indwelling pleural catheter
  • drug to help alleviate Sx e.g. opioids
70
Q

Significance of nitric oxide in asthma Dx?

Positive FeNO?

A

NO produced by 3 types of NOSynthase

  • iNOS (inducible) levels tend to rise in inflammatory cells esp eosinophils
  • therefore NO levels can correlate with levels of inflammation
  • FeNO is measured (fractional exhaled nitric oxide): adults 40+ ppb or children 35+ ppb is positive
71
Q

Asthma Dx in pts < 5yrs

A

based on clinical judgement

72
Q

Asthma Dx in 5-16yrs

A
  • spirometry with a bronchodilator reversibility test

- If normal spirometry Or obstructive spirometry with negative BDR -> FeNO test

73
Q

Asthma Dx if 17+ yrs

A
  • spirometry with BDR test, And FeNO test

- refer if occupational asthma suspected

74
Q

Positive test in BDR: bronchodilator reversibility testing for asthma?

A

Children: FEV1 improves 12%+
Adults: above + increase in volume of 200ml+

75
Q 
Features of sarcoidosis:
Acute?
Insidious?
Skin?
How does hypercalcaemia occur?
A

Acute: erythema nodosum, BHL, swinging fever, polyarthralgia
Insidious: dyspnoea, non-productive cough, malaise, weight loss
Skin: lupus pernio
High Ca2+: macrophages inside the granulomas have increased activity of 1alpha-hydroxylase -> increased conversion of vit D -> active form (1,26-dihydroxycholecalciferol)

76
Q

What is Lofgren’s syndrome?

A

Acute form of sarcoidosis: BHL, erythema nodosum, fever, polyarthralgia - usually has excellent prognosis

77
Q

What is Mikulicz syndorome?

A

Enlargement of parrots & lacrimal glands due to sarcoidosis/TB/lymphoma
(confusing overlap with Sjogren’s)

78
Q

What is Heerfordt’s syndrome?

A

= Uveoparotid fever:parotid enlargement, fever & uveitis 2ry to sarcoidosis

79
Q

Good prognostic features of sarcoidosis?

A
  • erythema nodosum
  • Lofgren’s syndrome (BHL, EN, polyartritis, fever, typically in young females)
  • HLA-B8
80
Q

Causes of respiratory acidosis?

A
  • COPD
  • sedative drugs: benzos, opiate OD
  • decompensation in other resp conditions e.g. life-threatening asthma/pulm oedema
81
Q

Causes of respiratory alkalosis?

A
  • anxiety -> hyperventilation
  • PE
  • CNS disorders: stroke, SAH, encephalitis
  • salicylate poisoning (early)
  • pregnancy, altitude
82
Q

Causes of a cavitating lung lesion on CXR?

A
  • abscess (staph aureus, klebsiella, pseudomonas)
  • squamous lung ca
  • TB
  • Wegener’s
  • PE
  • RA
  • aspergillosis, histoplasmosis, coccidiodomycosis
83
Q

What is Loffler’s syndrome?

A

Cause of pulmonary eosinophilia thought to be caused by parasites causing an alveolar reaction e.g. Ascaris lumbricoides

  • fever, cough, night sweats often last < 2 wks
  • transient CXR shadowing
  • generally self-limiting
84
Q

Paraneoplastic features of Small cell lung cancer?

A
  • ADH -> hyponatraemia
  • ACTH -> Cushing’s syndrome; can cause BL adrenal hyperplasia; high cortisol can lead to hypokalaemic alkalosis
  • Lambert-Eaton syndrome: Ab to voltage-gated Ca channels cause myasthenia-like syndrome
85
Q

Paraneoplastic features of Squamous cell lung cancer?

A
  • hypercalcaemia 2ry to PTH-rp
  • clubbing
  • HPOA
  • hyperthyroidism 2ry to ectopic TSH
86
Q

Paraneoplastic features of lung adenocarcinoma?

A
  • gynaecomastia

- HPOA

87
Q

Most common organisms isolated from patients with bronchiectasis?

A
  1. Haemophilus infuenzae = most common
  2. Pseudomonas aeruginosa
  3. Klebsiella spp
  4. Streptococcus pneumoniae
88
Q

After assessing treatable causes, how to manage bronchiectasis?

A 
Cons:
- physical training (esp for non-CF)
- postural drainage
- immunisations
Med:
- Abx for exacerbations + long-term rotating Abx in severe cases
- bronchodilators in selected cases
Surgery:
- in selected e.g. localised disease
89
Q

Indications for steroids in sarcoidosis?

A
  • CXR stage 2/3 AND mod-severe/progressive Sx
  • hypercalcaemia
  • eye, heart, neuro involvement
90
Q

What is cryptogenic organising pneumonia?

A

Diffuse interstitial lung disease that affects the distal bronchioles, resp bronchioles, alveolar ducts & alveolar walls

  • Unknown aetiology
  • presents in 50s/60s, not ass with smoking
  • cough, SOB, fever, malaise
  • Non-response to Abx
  • haemoptysis rare
  • clinical exam normal or inspiratory crackles
  • bloods: leukocytosis, raised ESR & CRP
  • BL patchy/diffuse consolidative or ground glass opacities on imaging
  • restrictive lung commonly, but can be obstructive/normal
  • reduced transfer factor
  • clinical Dx
  • Rx watch & wait if mild, oral steroids if severe
91
Q

What cells does small cell lung ca arise from?

A

APUD
Amine - high amine content
PU - precursor uptake - high uptake of amine precursors
Decarboxylase - high content

92
Q

Management of small cell lung ca?

A
  • if v early (T1-2a, N0 M0) can consider surgery
  • but usually metastatic at Dx
  • most with limited disease receive chemo & RT
  • more extensive - palliative chemo
93
Q

Features of idiopathic pulmonary fibrosis?

A

clubbing
dry cough
bibasal crackles
progressive exertional dyspnoea

94
Q

CT scan findings of idiopathic pulmonary fibrosis?

A

honeycombing
reticular opacities
traction bronchiectasis
architectural distortion

95
Q

Rx of idiopathic pulmonary fibrosis?

A

Cons: pulmonary rehabilitation
Med: Pirfenidone (antifibrotic) may be useful in some
Surg: many eventually require O2 & lung Tx

96
Q

What is Kartagener’s syndrome / 1ry ciliary dyskinesia?

A
  • dyne arm defect results in immotile cilia
  • dextrocardia or complete situs inversus
  • bronchiectasts
  • recurrent sinusitis
  • subfertility 2ry to diminished sperm motility & defective ciliary action in fallopian tubes
97
Q

Causes of pulmonary eosinophilia?

A 
Churg-strauss
ABPA
Loffler's syndrome
eosinophilic pneumonia
hypereosinophilic syndrome
tropical pulm eosinophilia: Wuchereia bancrofti infection
nitrofurantoin, sulphonamides
Wegener's less commonly
98
Q

When to do a 2WW referral for suspected lung cancer?

A
  • Suggestive CXR

- 40+ with inexplained haemoptysis

99
Q

When to DO a 2ww CXR to assess for lung cancer in people aged 40+?

A

2+ or 1+ever smoked of the following:

  • cough
  • fatigue
  • SOB
  • chest pain
  • weight loss
  • appetite loss
100
Q

When to CONSIDER a 2ww CXR to assess for lung cancer in people aged 40+?

A

Any of:

  • persistent/rec chest infection
  • clubbing
  • supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  • chest signs consistent with lung ca
  • thrombocytosis
101
Q

What is ARDS?

A

Increased permeability of alveolar capillaries -> fluid accumulation in alveoli
i.e. non-cardiogenic pulmonary oedema
mortality ~40%

Alveolar macrophages release chemotactic cytokines e.g. IL-8 to neutrophils -> neuts transmigrate into alveoli via pulm capillaries -> capillary damage -> leakage of protein-rich fluids -> hyaline membranes

  • > damage to type I pneumocytes -> increasing thickness of alveolar-capillary membrane -> impaired gas exchange (pulm shunt)
  • > damage to type II pneumocytes -> impaired surfactant production, reduced compliance
102
Q

Causes of ARDS?

A
  • sepsis, pneumonia
  • massive blood transfusion
  • trauma
  • smoke inh
  • pancreatitis
  • cardio-pulm bypass
103
Q

Clinical features of ARDS?

A
  • dyspnoea
  • inc RR
  • BL lung crackles
  • low O2 sats
  • usually severe, acute onset
104
Q

4 criteria for ARDS?i

A
  1. Acute onset (within 1wk of a known RF)
  2. pulm oedema with BL infiltrates on CXR (otherwise not explained) - less sensitive, often delayed
  3. non-cardiogenic (PA wedgefsarco pressure is <18mmHg in cardiogenic)
  4. pO2/FiO2 < 40kPa (200mmHg), the lower the ratio the worse the injury i.e. is a continuum; if milder generally termed acute lung injury
105
Q

Rx of ARDS?

A 
ITU
O2/ventilate
Organ support e.g. vasopressors
Rx underlying cause
Prone positioning &amp; muscle relaxation etc may improve outcome
106
Q

What is GPA/Wegener’s?

A

AI condition ass with a necrotising granulomatous vasculitis, affecting upper & lower resp tract and kidneys

107
Q

Features of GPA/Wegener’s?

A

URT: epistaxis, sinusitis, nasal crusting, saddle-shape nose deformity
LRT: dyspnoea, haemoptysis
Kidney: rapidly progressive glomerulonephritis (‘pauci-immune’, 80%)
Other: rash, eyes affected e.g. proptosis, CN lesions

108
Q

Ix in GPA/Wegener’s:
ANCA?
CXR?
Renal biopsy?

A

cANCA +ive in >90%
pANCA +ive 25%
CXR: variety inc cavitating lesions
Renal Bx: Epithelial crescents in Bowman’s capsule

109
Q

Rx of GPA/Wegener’s?

A

Steroids
Cyclophosphamide (90% response)
Plasma exchange
Median survival 8-9yrs

110
Q 
Vast majority of bronchial adenomas are Carcinoid tumours, arising from APUD system like small cell tumours
Features ?
On CXR?
Bronchoscopy?
Rx?
A

Age 40-50yrs, smoking NOT a RF

  • slow-growing e.g. long Hx of cough, recurrent haemoptysis
  • often centrally located/not seen on CXR
  • CHERRY RED LESION often seen on bronch
  • carcinoid syndrome itself is rare (ass with liver mets)

Rx = surgical resection. 90% 5yr survival if no mets

111
Q

3 stages of Churg-Strauss?

A
  1. Allergy/asthma -> nasal inflammation -> Polyps
  2. Eosinophilia
  3. Small & medium vasculitis commonly affecting kidneys, lungs, gut, heart
112
Q

Predisposing factors to OSA?

2 consequences?

A
  • obesity
  • macroglossia: acromegaly hypothyroid, amyloid
  • large tonsils
  • Marfan’s
  • > daytime somnolence, HTN
113
Q

Assessment of sleepiness in OSA?

Dx tests?

A

Epworth questionnaire
MLST: multiple sleep latency test - measures time to fall asleep in a dark room using EEG criteria
Dx sleep studies: Can range from noctural pulse oximetry to full polysomnography measuring EEG, resp airflow, thoraco-abdo movement, snoring, etc

114
Q

Rx of OSA?

A
  • weight loss
  • 1st line CPAP
  • intra-oral devices e.g. mandibular advancement if mild or CPAP not tolerated
115
Q

What is mesothelioma?
Where does it metastasis?
Features?

A
  • ca of pleural mesothelial cells: Right lung affected more often than left
  • mets to CL lung& peritoneum
  • clubbing, weight loss, dyspnoea, chest wall pain
  • 30% present as painless pleural effusion
  • only 20% with pre-existing asbestosis, 85-90% have Hx of asbestos exposure, latency 30-40yrs
116
Q

Ix & Dx in mesothelioma:
CXR?
Next Ix?
Single best Ix for sytology negative exudative effusions?
Ix if area of pleural nodularity seen on CT?

A
  • CXR: e.g. pleural effusion or thickening
  • > then pleural CT
  • send effusion or mcs, biochem, cytology (cytology only helpful in 20-30%)
  • To Ix cytology negative exudative effusions = local anaesthetic thoracoscopy (95% Dx yield)
  • if nodularity on CT can do image-guided pleural Bx
117
Q

Rx of mesothelioma?

A
  • Sx
  • industrial compensation
  • chemo
  • surgery is operable
  • poor Px, median survival 12m
118
Q

Over/Rapid aspiration/drainage of pneumothorax i.e. large volume thoracocentesis can result in what?

A

Re-expansion pulmonary oedema
- uncommon, usually within 1-2h, sometimes 24h later, progresses over 1-2days then resolves

RFs =

  • longer duration lung collapse
  • larger volume lung collapse
  • rapid drainage pleural fluid/air
  • suction
  • younger age
119
Q

Types of EAA/hypersensitivity pneumonitis?

A

bird fanciers lung: avian proteins
famers lung: spores of saccharopolyspora rectivirgula aka micropolyspora faeni
malt workers lung: aspergillus clavatus
mushroom workers lung: thermophilic actinomycetes

120
Q

Ix of choice for upper airway compression?

A

Flow-volume loop

121
Q

Rx of 1ry pneumothorax <2cm or <30% and not SOB?

A

Discharge

122
Q

Rx if 1ry pneumothorax <2cm or <30% and SOB?

A

Aspirate

123
Q

Rx if 1ry pneumothorax >2cm or 30%?

A

Aspirate

124
Q

If after aspirating a 1ry pneumothorax, pt is still SOB or it is still >2cm or 30%?

A

Chest drain

125
Q

Rx of 2ry pneumothorax in someone >50yrs who is SOB or >2cm?

A

Chest drain + admit

126
Q

Rx of 2ry pneumothorax in someone <50yrs old?

A

Aspirate if 1-2cm + admit

127
Q

Rx of 2ry pneumothorax <1cm?

A

Admit, observe

EXAM (21 decks)

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