Resp Flashcards
(120 cards)
1
Q
OSA diagnostic tests?
A
Epworth Sleepiness Scale
Polysomnography (e.g. night time SpO2 monitoring for apnoeic episodes)
2
Q
OSA Rx?
A
Weight loss, stop smoking, stop drinking
CPAP
Intra-oral devices e.g. mandibular advancers
Inform DVLA if severe daytime somnolence
3
Q
Cavitating lung lesion DDx? (x7)
A
Abscess (Staph, Kleb, Pseudomonas) Squamous lung cell cancer TB Wegener's granulomatosis RA PE Weird stuff (aspergil/histoplas/coccidiodomycosis)
4
Q
Centor Criteria?
A
Absence of cough
Tender anterior lymphadenopathy
History of fever (>38)
Tonsillar exudate
5
Q
Should uncomplicated acute URTIs be treated with antibiotics?
A
No, unless Centor score 3 or more OR are a child
6
Q
A 52-year-old man who was born in India presents with episodic haemoptysis. His only history is tuberculosis as an adolescent. Chest x-ray shows a rounded opacity in the right upper zone surrounded by a rim of air.
A
Aspergilloma
7
Q
Fx of mitral stenosis?
A
Dyspnoea
MDM
Malar flush
AF
8
Q
How does mitral stenosis cause haemoptysis?
A
Raised left atrial pressure causes bronchial vein rupture leading to haemoptysis
9
Q
GwP vs. Goodpastures?
A
GwP is classic triad of glomerulonephritis, haemoptysis (+- epistaxes/sinusitis), saddle shaped nose.
Goodpastures comprises haemoptysis, glomerulonephritis and the patient is SYSTEMICALLY unwell
10
Q
Klebsiella pneumonia Fx?
A
Alcoholics and diabetics pper lobe cavitating lesions Often the agent of aspiration pneumonia Red currant sputum 30-50% mortality
11
Q
General + medical COPD management?
A
Stop smoking
Annual influenza vaccine + one off PCV vaccine
Home O2 therapy
Bronchodilators (SABA/SAMA/LABA/LAMA/oral theophyline)
12
Q
What is cor pulmonale?
A
Right sided heart failure secondary to pulmonary hypertension
13
Q
What are the features of cor pulmonale
A
Loud P2 Breathlessness/cough Peripheral oedema Raised JVP Systolic parasternal heave
14
Q
Factors which improve survival of stable COPD patients?
A
- Smoking cessation
- Home O2 therapy
- Lung volume reduction surgery
15
Q
Light’s criteria?
A
Used to distinguish between transudative and exudative pleural effusions.
Exudative: pleural fluid protein >30, Transudative: <30.
If fluid protein between 25-35 then use Light’s criteria:
- Pleural fluid protein:serum protein >0.5 -> exudative
- Pleural fluid LDH: serum LDH >0.6
- Pleural fluid LDH >2/3 the upper limit of normal serum LDH
16
Q
Pleural effusion causes?
A
Exudative: Pneumonia, cancer, TB, PE, viral infection, autoimmune
Transudative: CCF, cirrhosis, nephrotic syndrome, hypoalbuminaemia
17
Q
IPF clinical Fx?
A
Progressive exertional dyspnoea
Dry cough
Clubbing
Fine bibasal end inspiratory crackles
18
Q
IPF Ix?
A
Exam +Hx
spirometry (FEV1/FVC restrictive picture)
High resolution CT thorax is gold standard imaging - shows ground glass opacification progressing to honeycomb lung.
30% are ANA positive
19
Q
Small cell lung cancer paraneoplastic Fx?
A
Lambert Eaton
ADH
ACTH
20
Q
Squamous cell lung cancer paraneoplastic Fx?
A
PTHrp, ectopic TSH, clubbing, hypertrophic pulmonary osteoarthropathy
21
Q
Occupational asthma Dx?
A
Serial peak flow measurments at home and at work
22
Q
Commonest cause of IE COPD? +Rx?
A
H. influenza
Amoxicillin/Doxy + steroid
23
Q
Role of steroids in COPD management?
A
Prevent frequency of exacerbations
24
Q
What is ARDS?
A
Acute respiratory distress syndrome
Increase alveolar capillary permeability leads to fluid accumulation in the alveoli (non-cardiogenic pulmonary oedema)
40% mortality
25
Causes of ARDS?
```
Infection
acute pancreatitis
trauma
massive blood transfusion
cardio-pulmonary bypass
```
26
CFx of ARDS?
```
Features are acute in onset and severe:
Dyspnoea
High RR
Bilateral crackles
Desaturations
```
27
Criteria for ARDS?
Acute onset (<1 week of known RF)
Pulmonary oedema on CXR
Non-cardiogenic
p)2/FiO2 <40kPa
28
First Ix for a large pleural effusion?
Diagnostic tap (to determine if infective or metastatic)
29
BTS asthma guidelines?
1. SABA
2. SABA+low dose ICS (<400mcg)
3. SABA + ld ICS + LTRA
4. SABA + ld ICS + LABA
5. SABA +- LTRA + MART (ICS/LABA combined)
6. SABA + LTRA + mdICS MART (4-800mcg)
7. SABA + LTRA +...
a) hdICS MART (>800mcg)
b) theophylline/aminophylline/MgSO4
c) Specialist review
30
Examples of and pulmonary function test results in obstructive lung disease?
COPD, asthma, bronchiectasis
FEV1 Significantly reduced
FVC Reduced/Normal
FEV1/FVC Reduced
31
Examples of and pulmonary function tests results in restrictive lung disease
Pulmonary fibrosis, Asbestosis, Sarcoidosis, ARDS
FEV1 Reduced
FVC Significantly reduced
FEV1/FVC Normal/Raised
32
Causes of clubbing?
Cardiac: Congenital heart disease, Bacterial endocarditis, Arial myxoma
Respiratory: IPF, lung cancer, CF, TB, fibrosing alveolitis, mesothelioma/asbestosis, bronchiectasis
Other: IBD (Crohn's>UC), Graves disease, Whipple's disease), cirrhosis, PBC
33
Fx of sarcoidosis?
Acute: Erythema nodosum, bihilar lymphadenopathy, swinging fever, polyarthralgia
Insidious: Dyspnoea, cough, malaise, weight loss
Derm: Lupus pernio
Hypercalcaemia
Can also cause facial palsies, parotid enlargment and ocular problems
34
Objective tests for asthma?
Fraction of expired Nitric Oxide
Spirometry with bronchodilator reversibility
(Ask about symptom variability e.g. at work/weekends)
35
CXR signs of bronchiectasis?
Tramlines
| Signet rings
36
Paraneoplastic syndromes associated SCLC?
Lambert Eaton
Cushing's
SIADH
37
Which investigations should be done before commencing azithromycin
ECG (QT prolongation) and baseline LFTs
38
Two commonest causes of bihilar lymphadenopathy?
Sarcoid & TB
39
Consequences of OSA?
Hypertension
Compensated respiratory acidosis
Daytime somnolescence
40
Contraindications to surgery for SCLC
```
SVC obstruction
FEV1<1.5
Hilar malignancy
Presence of metastases
Malignant pleural effusion
```
41
Mild and severe CAP Rx?
Mild: Oral amox
Severe: Coamox + macrolide
42
COPD Rx guidelines
1. SABA or SAMA
2. Determine steroid responsiveness:
Prev Hx atopy
Eosinophilia
Substantial FEV1 variation
>20% diurnal PEF variation
3a. If no steroid responsiveness; add LABA+LAMA
3b. If steroid responsiveness; Add LABA +ICS
THEN
LAMA +LABA+ICS
43
Emphysema prominence in A1AT def vs. COPD
A1AT - lower zone predominence
| COPD - upper zone predominence
44
What is Caplan Syndrome?
Lung nodules in the context of RA
45
When should NIV be considered in COPD?
In T2RF where PaCO2<6 and pH 7.25-7.35
46
Which RA drug causes pneumonitis?
Methotrexate
47
FEV1/FVC in restrictive lung disease? WHY?
Normal/Raised
| FVC is affected to a greater extent than FEV1, which is often normal
48
Commonest agent in IE COPD?
H. influenzae
49
When would you see red currant jelly sputum?
Klebsiella
50
COPD staging?
Stage 1- mild: post bronchodilator FEV1/FVC < 0.7, FEV1 >80%
Stage 2- mod: FEV1/FVC < 0.7, FEV1 50-79%
Stage 3- sev: FEV1/FVC < 0.7, FEV1 30-49%
Stage 4- v. sev FEV1/FVC <0.7, FEV1 <30%
51
Features of a severe asthma attack?
Unable to complete sentences
PEFR 33-50% exp
HR >110
RR >25
52
What are two medications available for nicotine replacement therapy, and what are their mechanisms?
Buproprion: Norepinephrine and dopamine reuptake inhibitor AND nicotine antagonist
Varenicline: Dopamine receptor partial agonist
53
Which agents are associated with aspiration pneumonia?
Staph aureus
Strep pneumo
Pseudomonas
Haemophilus
54
Features of Kartagener's syndrome?
1. Complete situs invertus
2. Bronchiectasis
3. Impaired fertility due to impaired ciliary function
4. Recurrent sinusitis
55
Factors which suggest steroid responsive COPD
```
PMH of atopy
Eosinophilia
Significant diurnal variation
in PEF (>20%)
Substantial variation in FEV1 over time
```
56
Indications for steroids in sarcoidosis?
X-ray changes
Hypercalcaemia
Eye, heart, brain involvement
57
Under what circumstances should antibiotics be prescribed for an IE COPD?
If they have purulent sputum or clinical signs suggestive of pneumonia
58
Which anterior mediastinal mass is seen in myasthenia gravis?
Thymoma
59
Which blood test should be performed in all patients with TB?
HIV
60
Under what scenarios should oxygen therapy not be used routinely if there is no evidence of hypoxia?
Stroke
MI
Obstetric emergencies
61
What is Light's criteria?
Used to distinguish transudate from exudate pleural effusion
Exudates have protein >30, transudates hae protein <30
If protein is between 25-35 then Light's criteria is applied (involves serum protein and LDH levels)
62
What are the 3 BTS indications for chest tube insertion in pleural infection?
1. Frankly purulent pleural fluid
2. Presence of microorganisms
3. pH <7.2
63
What is the management of a primary pneumothorax?
Rim <2cm and asymptomatic - discharge
Otherwise -> aspiration
If this fails OR >2cm OR SOB) -> chest drain should be inserted
Stop smoking
64
What is the management of a secondary pneumothorax?
If pt over 50 and rim is >2cm and/or SOB -> chest drain +admit
If rim 1-2cm -> aspirate -> Chest drain if failure +admit
If rim <1cm - Admit and give O2
65
What should patients on inhaled steroids immediately after use and why?
Rinse their mouth to prevent development of oral candidiasis
66
What are the general signs of lobar collapse on CXR?
Tracheal deviation towards the side of collapse
Mediastinal shift towards side of collapse
Elevation of hemidiaphragm
Increased opacity in relevant zone
67
What is a Ghon focus and what does it indicate?
A (+-calcified) nodule indicating latent (i.e. a primary TB infection in the past which has become contained in a granuloma)
68
What is Bupropion used for and when is it contraindicated?
An SNRI used for smoking cessation. It is contraindicated in epilepsy, pregnancy and breast feeding
69
What is the latent period of asbestos exposure causing mesothelioma?
30-40 years
70
What is the investigative protocol for ?mesothelioma?
CXR - may show effusion or pleural thickening
CT
Thoracoscopic biopsy and histology is gold standard for diagnosis
71
What are the pulmonary features of SLE?
Pleuritis with exudative effusion
72
What are some causes of pleural effusion?
Transudate: CCF, hypoalbuminaemia (liver, nephrotic, malabsorption), hypothyroid
Exudate: Infection, CTD, Neoplasia, PE, pancreatitis
73
What are the CXR findings of heart failure/
ABCDE
```
Alveolar oedema (batswings)
B lines (kerley)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion
```
74
What is the next step in management of an acute asthma attack following: 100% 02, neb salb, neb ipra, IV hydrocortisone
IV MagSulph
75
Which paraneoplastic syndromes are associated with SCLC?
Cushings
SIADH
LEMS
76
Which lung cancer typically causes paraneoplastic hypercalcaemia?
Squamous cell
77
How might you differentiate the causes of a white-out hemithorax?
Tracheal position
Towards whiteout - pneumonectomy, complete lung collapse
Central - Consolidation, pulm oedema, mesothelioma
Away from whiteout - Effusion, diaphragmatic hernia, large mass
78
What is atelectasis and when is it most common?
Basal alveolar collapse which may lead to respiratory difficulty. It is caused by airway obstruction due to bronchial secretions.
It is commonest in patients with dyspnoea and hypoxaemia who are 72 hours post op.
79
What is the management of atelectasis?
Chest physio and breathing exercises
80
Which three body systems are involved in granulomatosis with polyangiitis?
URT: Epixtaxis, sinusitis
LRT: Dyspnoea, haemoptysis
Pauci immune glomerulonephritis
Saddle nose
81
Swinging chest drain - rises on _____, falls on _____
Rises on inspiration, falls on expiration
82
What are the Centor criteria?
Presence of tonsillar exudate
Absence of cough
History of fever
Tender anterior cervical lymphadenopathy
83
What is indicated by 3 or more positive Centor criteria?
40-60% chance of Group A beta haemolytic strep
84
What are the Pulmonary function results of a restrictive lung disease?
Reduced/normal FEV1
Reduced FVC
Raised FEV1:FVC
85
What is the management of non-steroid responsive COPD?
1. SABA
| 2. LABA + LAMA
86
What are the iatrogenic causes of pulmonary fibrosis?
```
Bleomycin
Cyclophosphamide
Nitrofurantoin
Methotrexate
Penicillamine
Amiodarone
```
87
What are the adverse effects of statins?
Myopathy
| Hepatic impairment
88
What type of pleural effusion does a PE cause?
Exudative
89
What is the most important intervention to start in early stages of COPD?
Pulmonary rehabilitation
90
What are the clinical and biochemical features of Eosinophilic graunulomatosis with polyangiitis?
```
Asthma
Eosinophilia
Paranasal sinusitis
Mononeuritis multiplex
pANCA positive serology
```
91
What is the management approach for bronchiectasis?
```
Physiotherapy
Postural drainage
Antibiotics
Bronchodilators
Immunisations
Surgery
```
92
What are the indications for surgery in bronchiectasis?
```
Localised disease (confined to 1 lobe)
Haemoptysis
```
93
What is hypertrophic pulmonary osteoarthropathy/
A triad of periostitis, clubbing and osteoarthritis of the large joints, commonly secondary to lung adenocarcinoma
94
Which type of lung cancer is associated with gynaecomastia?
Adenocarcinoma
95
What are the acute, insidious and skin manifestations of Sarcoidosis?
Acute: Erythema nodosum, BHL, swinging fever, polyarthralgia
Insidious: Dyspnoea, non-productive cough, malaise, weight loss, lymphadenopathy
Skin: Lupus pernio
Also: Hypercalcaemia
96
What are the stages of COPD severity, and how is this determined?
Mild: FEV1 >80% pred, post bronchodilater FEV1/FVC (pbF/F) <0.7
Moderate: FEV1 50-79%, pbF/F <0.7
Severe: FEV1 30-49%, pbF/F <0.7
Very severe: FEV1 <30%, pbF/F
97
What is an indicator that a patient with acute asthma may need invasive ventilation?
A normal PaCO2
98
True or false - Pleural plaques secondary to asbestos exposure do not undergo malignant change
True
99
What are some causes for upper zone fibrosis?
CHARTS
```
Coal worker's pneumoconiosis
Histocytosis
AnkSpon
Radiation
TB
Sarcoid
```
100
What are some causes of lower zone pulmonary fibrosis?
Drug causes
| IPF
101
What is an indication for BiPAP in an acute exacerbation of COPD?
Type two respiratory failure with respiratory acidosis
102
What are some diagnostic criteria for asthma?
FeNO >40
Post bronchodilator improvement in lung volume of >200ml
Post bronchodilator improvement in FEV1 of 12% or more
PEF Variability of 20% or more
FEV1/FVC <70%
103
Steroid responsive COPD patients managmenet?
1. SABA/SAMA
| 2. Add LABA + ICS
104
Which pharmacological smoking cessation aid can be prescribed in pregnancy?
Nicotine patch only
105
What is the most common infective agent in acute exacerbations of COPD?
H influenza
106
What should the target SpO2 of a COPD patient with normal CO2 be?
94-98%
107
What PFTs are seen in obstructive lung disease?
FEV1 significantly reduced
FVC low/ normal
FEV1/FVC - reduced
108
What PFTs are seen in restrictive lung disease?
FEV1 reduced
FVC significantly reduced
FEV1/FVC normal/increased
109
When is Azithromycin prophylaxis recommended for COPD patients?
In those who do not smoke and have optimal pharmacological management yet continue to have more than 4 exacerbations per year
110
What are the features of Kartagener's syndrome?
Dextrocardia/situs invertus
Bronchiectasis
Recurrent sinusitis
Subfertility
111
When should LTOT be considered in COPD patients?
Those with two readings of PaO2 <7.3 and one of:
Pulmonary hypertension
Secondary polycythaemia
Peripheral oedema
112
What are the Xray signs of right upper lobe consolidation?
Abnormal opacificication in the RUZ abutting the horizontal fissure
113
Can ARDS be diagnosed if there is concomitant cardiac pathology?
No
114
True or false: Alpha 1 antitrypsin deficiency is a risk factor for HCC development
True
115
Which medications are used for the prevention of vs. the treatment of high altitude cerebral oedema?
Prevention: Acetazolomide
Treatment: Dexamethasone
116
True or false: BHL alone is not an indication to begin treatment of sarcoidosis.
True
117
How does Miliary TB spread throigh the lungs?
Through the pulmonary venous system
118
What are the indications for commencement of treatment for sarcoidosis, and what is the first line treatment?
Hypercalcaemia
Parenchymal lung disease
Uveitis
Neurological or cardiac involvement
Corticosteroids
119
As well as weight loss, what is the best treatment option for obstructive sleep apnoea?
CPAP
120
What are the features of superior vena cava syndrome?
Dyspnoea
Facial/upper limb swelling
Venous distention in chest and arms
