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Resp Flashcards

1
Q

COPD risk factors

A 
Smoking
Working with coal
advanced age
genetic factors
white ancestry
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2
Q

What factors in history would make you consider TB

A

African Asian origin

HIV positive

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3
Q

Airway obstruction leading to bronchiectasis

A

Tumours

Foreign objects which lead to pneumonia and chronic inflammation

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4
Q

Why does lung appear as white out in atelectasis

A

Normally lung appears black due to proportion of air to tissue being much higher however in collapse there is no air

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5
Q

Causes of T2 resp failure

A

Local
CNS- spinal chord lesions, drug overdose, tumour, trauma
NMJ-Myasthenia gravis

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6
Q

What is most thing to ensure when administering ABx for CAP

A

Strep pneumoniae included

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7
Q

Eye involvement of sarcoid

A

Uveitis

Papilloedema

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8
Q

What can mainly give cannonball metastases in lungs

A

Renal cell carcinomas

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9
Q

Gastro cause of cough

A

GORD

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10
Q

When is only time you thrombolyse a PE

A

When very haemodynamically compromised

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11
Q

Why is CT done in lung cancer

A

Identify nature and location

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12
Q

Features of asthma cough

A

Chronic non productive cough
Nocturnal cough
Precipitated by common triggers
Most times comes before wheeze

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13
Q

Prognosis of invasive aspergillosis

A

Poor

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14
Q

What is fanncy name for collapsed lung

A

Atelectasis

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15
Q

What are miliary small nodules

A

Innumerable small nodules seen around lung hilum

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16
Q

Immediate investigations for PE

A

CXR
ECG
ABG

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17
Q

What type of drug is ipatropium bromide

A

Anit muscarinic

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18
Q

Long term management of pneumothorax

A

Pleurodesis

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19
Q

What is key investigation with suspected pneumonia

A

Get sputum and blood cultures to determine type of ABx to be given

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20
Q

What is main sign of worsening active sarcoid

A

Any sign of active inflammation

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21
Q

Very common cause of mixed rf

A

Acute asthma

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22
Q

Aetiology of tension pneumothorax

A

Ventilation
Trauma
Blocked chest drain
Lung conditions

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23
Q

Danger of tension pneumothorax in young people for doctors

A

Can appear fine but then drastically deteriorate

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24
Q

How does pneumothorax happen

A

When air from either alveoli or atmosphere gains access to pleural space. Pleural space has lower pressure than both of these so air will flow in until obstruction blocked or pressure equalises

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25
Investigations for cancer post CXR
Bronchoscopy with biopsy | CT chest and abdo
26
Pathology of mesothelioma
Inhalation of asbestos fibres end up in pleural space leading to growth of pleural mesothelium that grows and encases lungs
27
How long should you be on warfarin post PE
3-6 months however permenant if recurrent PEs
28
What is FEV/FCV in obstructive resp diseases
Reduced- less than normal .7 or .8
29
Presentation of lung fibrosis
Dry cough Clubbing SOB
30
Symptoms of pneumothorax
Chest pain | SOB
31
Risk factors pneumothorax
Tall and slim Male Smoking Underlying lung conditions
32
Auscultation sign of lung fibrosis
Late inspiratory creps
33
What part of resp system is responsible for T2 rf
Respiratory apparatus bringing air in and out
34
Key factor in nature of asthma
Temperamental, you see a lot of variation in sx depending on season for example
35
Management of PE
Anticoagulation Oxygen if low sats IV fluids
36
Risk factors for CAP
``` Over 65 Asthma and COPD Smoker Living in nursing home Alcohol use ```
37
Symptoms and signs of asbestos
Dyspnoea on exertion first sign Non productive cough Crackles at lung bases Clubbing
38
How to definitively diagnose pneumothorax
PA erect CXR- identify rim and measure
39
Presentation of TB
Cough Sputum Weight loss Night sweats
40
When will co2 be low in T1 rf
When hyperventilating
41
Brain stem T2 rf causes
Cva Sol Opiates Benzodiazepine
42
What is defining feature of obstructed airway
Stridor
43
How does sarcoid present
``` Malaise Pyrexia Arthralgia Arthritis Erythema nodosum ```
44
What differentiates pneumonia from a LRTI
Consolidation on CXR
45
Investigations of bronchopulmonary aspergillosis
Positive aspergillus skin test Raised IgE Eosinophilia Serum precipitins
46
Where do you do aspiration
2nd ICS MCL
47
What method can be used to prevent recurrence of pleural effusions
Installation of sclérosants into pleural space
48
What are diagnostic methods for mesotheliomas
Thoracoscopy with biopsy and histology of pleura
49
Investigations for asbestosis
Lung function tests- restrictive findings | CXR pa and lateral- show pleural thickening and interstitial fibrosis in lower zones bilaterally
50
What does reticular nodular shadowing
Nodular means nodule shaped | Reticular means net appearance
51
CAP on examination
Reduced air entry in affected lungs Crackling on auscultation too Dullness on percussion
52
Pathophysiology of T2 resp failure
``` Alveolar hypoventilation with or without VQ mismatch Reduced CNS output NMJ problems Chord lesions Thoracic wall problems ```
53
What is name of anti IgE AB in asthma treatment
Omalizumab
54
What condition is identical to sarcoid
Berylliosis
55
What could hypercalcaemia be confused with in sarcoid when lymphadenopathy
Lymphoma
56
Management of pneumonia patients
``` Use CURB 65 to assess mortality risk Confusion Urea over 7mmol/L RR over 30 Blood pressure below 90 SBP or 60DBP 65 age ```
57
Common asthma triggers
Exercise Smoking Cold air Infections
58
What is FEV/FCV in restrictive diseases
Normal but FCV and FEV1 are reduced
59
What are 3 most common causes of atypical pneumonia
Legionella Chlamydia Mycoplasma
60
Haem findings sarcoid
Lymphocytosis ACE Alpha 1 hydroxylase Calcium
61
Worse prognosis signs on HRCT
Honeycombing | Groundglass findings
62
Treatment of choice for mycetoma
Surgical removal | Drugs not helpful
63
How can resp failure be classified
Acute vs chronic | Type 1 vs type 2
64
Other name for pancoast tumour
Superior sulcus tumour
65
Prognostic factors sarcoid
Fibrosis extent Pulmonary HTN Lung function impairment
66
What would cause mediastinum to shift towards pneumothorax side
Lobar collapse on that side
67
What can cause fibrosis of lung bases
Asbestos Connective tissue disorder Idiopathic Drugs such as methotrexate, amiodarone and nitreo- some antibiotic
68
What is alpha 1 antitrypsin
Protease inhibitor which inhibits elastase commonly produced by neutrophils. Neutrophils activity acting on lungs and liver have their activity increased therefore in the deficiency damage is caused
69
What test is used to determine if patient PE likely or not
WELLS
70
Peripheral examination sign of bronchiectasis
Clubbing due to hypoxia
71
How to differentiate sarcoid from TB
Cough is productive in TB
72
Treatment aim of sarcoid
Prevent fibrotic disease progression to
73
2 categories that lead to bronchiectasis
Airway obstruction | Primary ciliary dyskinesia
74
What to consider with calcified object obstructing airway
Swallowing bone from food
75
How does GORD present
``` Chronic dry cough Heart burn Indigestion Weird taste in mouth Remember to ask about these other Sx in cough history ```
76
What can treatment be escalated to after failure to respond to amoxicillin in relation to CAP
Include other bacteria so use erithomycin
77
Signs on examination of pneumothorax
Ipsilateral reduced air sounds | Ipsilateral hyper-resonant percussions and hyperinflations
78
What can give multiple ill defined focal opacities across the lung
Pulnomsry infarcts Pulnomsry metastases Rheumatoid arthritis Septic emboli
79
How would Bullae appear on CXR
Can be bilateral | Air fluid level visible
80
What can cause a cavitating mass
``` Carcinoma of bronchus Squamous cell carcinoma metastasis Pulmonary infarct Bacterial lung abscess Fibrosing Wegners ```
81
What do coarse crackles indicate
Phlegm in airways
82
What would be indicated in recurrent pneumonia
Carcinoma
83
What would you suspect in a non smoker young person presenting with a chronic cough
Alpha 1 antitrypsin deficiency
84
Causes of T1 resp failure, 2 categories
Right to left cardiac shunt where deoxygenated blood bypasses pulmonary system V/Q mismatch
85
After RIP what must do
Compare zones left to right looking if theyre the same and then if opacifications are either of the 4 possibiliites
86
Important thing to remember when thinking about possible lung cancer
Could be métastases from alternate site
87
What blood parameters can you use to monitor response to CAP treatment
WCC Renal function CRP
88
Distinguish between T1 and T2 resp failure
T1 low or normal co2 | T2 high co2
89
Dangers of pneumothoraces
Air can collapse lung and compress mediastinum reducing flow into and out of heart. Collapse of lung leads to hypoxaemia and RDS
90
Management for mesothelioma
Symptoms treatment Chemo can improve prognosis Pleuroidesis or intra- pleural drain will also help with effusion
91
When is cough worse asthma
Nocturnal
92
Causes of deaths sarcoid
RF | Arrythmias
93
NMJ causes of T2 rf
Myasthenia gravis
94
Signs of cardiac sarcoid
AV block Ectopics Ventricular tachycardias Wall abnormailities
95
Resp muscle causes of T2 rf
Mnd
96
Sx mycetoma
Haemoptysis Weight loss SOB
97
What is allergic bronchopulmonary aspergillosis
Type 1 and 3 hypersensitivity leading to recurrent asthma, bronchial damage and bronchiectasis
98
Symptoms of CAP
``` Dyspnoea Increasing productive cough Night sweats Fever Tachypnoea ```
99
What can cause pleuritic chest pain in lung cancer
Rib métastases and chest wall infiltration or inflammation affecting pleurs
100
What would reticular nodular shadowing be
Fibrosis
101
Main risk and danger with PE
Right ventricular failure with hyoptension
102
Treatting of sarcoid
High dose OCS Low dose pred Sometimes azathioprine or methotrexate Hydroxychloroquine
103
Predictors of mortality sarcoid
Pulnomary HTN Extensive fibrosis Age
104
What can upper airway obstruction mimic
Asthma- can be treated in this manner originally
105
Pathology of asbestos
Asbestos fibres when inhaled deposit as alveolar bifurcations and cause alveolitis réaction leading to fibrosing reaction
106
In CAP what would you be worried about with a persistent fever
Empyema
107
What are most common lung cancers
Adenocarcinomas 40% Squamous cell carcinoma 25-30% Small cell carcinoma 15% Large cell undifferentiated 10%
108
How long does it take for mesothelioma to develop after exposure
At least 20 years therefore important in history to identify specific job before then if want to help family get compensation
109
What is main cause of death with mesothelioma
Lung and pleural involvement
110
2 biggest causes of HAP
Staph aureus | Pseudomonas
111
Management of patient with consolidation seen in pneumonia
Order CXR for 6 weeks as pnuemonia can cover cancer
112
Defining mucous feature of bronchiectasis
It is bad smelling
113
How to differentiate obstructive causes
Salbutamol dependant
114
How often are ECG changes seen in PE
85%
115
Symptoms of mesothelioma
Chest pain SOB Récurrent pleural effusions
116
Whats FVC
Forced volume capacity- total amount of air produced in full effort expiration
117
What can cause fibrosis on lung apices
``` Berryliosis Radiation- common after breast cancer treatment Extrinsic allergic alveolitis Ankylosing spondylitis Sarcoid Tb ```
118
Cardinal respiratory symptoms
``` Cough Wheeze SOB Haemoptysis Chest pain ```
119
How do you differentiate between mass and nodule on lung
Mass is over 3cm
120
Name of TB mass
Cavitating coin lesion
121
DDx of sarcoid
Lymphoma
122
Important thing to do before administering TB drugs
Check sensitivities
123
Risk factors for sarcoid
``` Infectious Transplanted organs Bioaerosol inhalation Insecticides Agricultural exposures Hereditary North Europe Black people Autoimmune conditions such as SLE, UC ```
124
Signs of bronchiectasis
High pitched wheeze and crackles throughout inspiration Rhonchi Clubbing
125
What test must be done when cavitating mass evidence
CT to evaluate nature of mass for drainage
126
5 ways aspergillus can affect lung
``` Asthma- type 1 hypersensitivity Extrinsic allergic alveolitis Mycetoma Invasive aspergillosis Allergic bronchopulmonary aspergillosis ```
127
Can PE elevate troponin
Yes
128
Test for allergic bronchopulmonary aspergillosis
Aspergillus skin test
129
Why would you consider HIV infection in TB cases
Immunocompromised as should defend against it
130
Protective factors for sarcoid
Smoking
131
What are 4 approaches to managment of asthma
Controlled Partly controlled Uncontrolled Exacerbation
132
Resp conditions associated with erythema nodosum
Strep infection Sarcoid Mycoplasma pneumonia Psittacosis
133
What does worse pain on inspiration suggest
Pleuritic pain
134
How to diagnose chronic bronchitis
Productive cough of more than 3 months for over 2 annum
135
COPD symptoms
``` progressive shortness of breath wheeze cough sputum production haemoptysis ```
136
First line community approach to treating CAP
Amoxicillin
137
What are the hallmarks of TB
``` Cervical lymphadenopathy Erythema nodosum From endemic country Upper lobes affected Hilar lymphadenopathy Haemoptysis Weight loss Productive cough ```
138
What is problem with mantoux test
Cant differentiate between latent and active TB
139
Conditions causing cervical lymphadenopathy
Infective mononucleosis TB Sarcoid Lymphoma
140
Pathophysiology of T1 resp failure
Ventilation perfusion mismatch
141
What bacteria does abcess formation in CAP suggest
Staph aureus
142
Symptoms of bronchiecstasis
Productive cough with copious amounts mucous- purulent | SOB
143
What test should be discussed with patient when has TB
HIV
144
What is most likely diagnosis of someone with COPD with sudden onset SOB
Pneumothorax
145
Problem with lung function declining over time
Get hypoxia so pulnomary vasculature constricts to divert blood away to un damaged parts of lungs however if damage widespread then get widespread constriction leading to pulmonary hypertension so cor pulmonale
146
What do you have to give with chest drain and aspiration
Paracetemol 1g or Ibupofen QDS | Oxygen if needed
147
Suggested aetiology of sarcoid
``` Infectious Transplanted organs Bioaerosol inhalation Insecticides Agricultural exposures ```
148
What does bright green phlegm indicate
Pseudomonas infection
149
How would bullae present
Chronic SOB Cough Pain Heavy smoker
150
Things need to know about a previous TB infection
Sensitvities of drugs Adherance What drugs
151
Why is abdominal CT done for suspected lung cancer
Staging
152
What are categories of things affecting resp apparatus
``` Brain stem Nervous system NMJ Resp muscle Chest wall movement ```
153
Whats FEV1
The forced expiratory volume in 1 second
154
Tests needed for acute severe asthma attack
ECG Peak flow BG
155
UAO on spirometry
Straight diagonal line
156
What are most common causes of CAP
``` Strep pneumoniae 40% Chlamydia pneumoniae 13% Viral 13% Mycoplasma pneumoniae 11% H influenzae 5% ```
157
Contraindications of thrombolytics
``` Recent surgery Recent trauma and bleed anywhere Suspected aortic dissection Severe HTN Peptic ulcer disease Allergy to streptokinase ```
158
How does lyme disease present initially
Rash and then get arthritis afterwards
159
Lung conditions causing clubbing
Cancer Fibrosis Bronchiectasis Empyema
160
When is peak flow worse asthma
Morning
161
Daignosies of sarcoid
Right clinical pattern such as eryhtema nodosum Histology non caseating granulomas Compatible radiological findings Exclusion of other diagnoses
162
Why is co2 normal in T1 rf
More soluble than o2 so even if exchange impaired will still be able to be exchanged more readily
163
What electrolyte is elevated in sarcoid
calcium
164
Main complications of sarcoid
Progressive lung fibrosis which leads to shortened life expectancy Aspergillosis
165
Diagnosis for mesothelioma
Thoracoscopy with biopsy- histology for complete diagnosis
166
Differentiation between TB and sarcoid
TB unilateral lymph node calcified whereas sarcoid bilateral | Histologically TB is caseating
167
Where can mesotheliomas spread
Often spread through one pleural cavity to another so from pleural to peritoneal and pericardial. Can spread to hilar nodes via lymphatics MAINLY SPREAD TO LUNGS AND LIVER
168
What finding on CXR in CAP would indicate an underlying pathology
Reduced lung volume on affected side
169
What disease type is Bird fanciers disease
Extrinsic allergic alveolitis
170
When is S1 Q3 T3 seen
Acute massive PE not minor
171
How many sputum samples for TB
3
172
2 fates of sarcoid granulomas
Chronic fibrosis | Resolves completely
173
Treatment for PE
Give LMWH, do CTPA then start warfarin and only remove LMWH when INR in range.
174
Tests done to check hyperreactivity to antigens
Skin prick test
175
PE ECG changes
``` A fib Sinus tachy 1st degree heart block RBBB S1 Q3 T3 ```
176
What does nocturnal cough indicate
Asthma
177
Questions to ask in asthma history
Night time awakenings Interference with every day life How often use medication Peak flow if known
178
How does lymphoma of lung appear on CXR
Mediastinal node enlargement
179
What to think if in question says keeps pidgeons
Either psittacosis- chlamydia infection that is an atypical pneumonia Or bird fanciers disease- a type of EAA that presents with fibrosis
180
How does mycoplasma tend to present
Fatigue | Dry cough
181
Invasive effects of pancoast tumour
Horners syndrome from sympathetic chain involvement Brachial plexus involvement Cord compression Invasion of recurrent laryngeal nerve- hoarse voice
182
What would be Homogenous shadowing
Effusion- can be bilateral or unilateral | Pneumectomy
183
4 opacities on CXR types
Alveolar shadowing Reticular nodular shadowing Homogenous shadowing Masses
184
Which occupations were put at risk of asbestosis
Boilermakers Heating engineers Electrical engineers or anyone in building work
185
Signs of patient deteriorating from PE
Any sign on right sided heart failure of cardiac arrest | Hyoptenion, syncope and tachycardia
186
Other organs involved in sarcoid
Cardiac Skin Lymphatics
187
Nervous system causes of T2 rf
Guillain barre | Trauma
188
What else could present with numerous masses across lungs other than metastases
Vasculitis
189
Who does invasive aspergillosis occur in
Immunocompromised
190
Textbook chlamydia pneumonia presentation
Sx feeds birds in spare time Confused Diarrohoea
191
Factors showing how well asthma is controlled
``` Limits activity Daytime sx Nightime sx Need for relief Lung function- less than 80% predicted or best Exacerbations ```
192
What can lead to changing your asthma classification
Exposure to allergens Incorrect medication or use Poor adherance
193
What enzyme is elevated in sarcoid
Alpha 1 hydroxylase | ACE
194
Risk factors PE
``` Age Obesity Previous surgery recently Bed ridden and lack of activity DVT diagnosis recently ```
195
What is name for chlamydia psittaci disease
Psittacosis- parrot fever
196
Differentials for singular masses
Primary malignancy Abcess Infarct Metaseses
197
What are granulomas in sarcoid
Non-caseating
198
Other investigations for a PE
D-dimer Right ventricle showing signs of enlargement on Echo FBC to determine if thrombocytopaenic or anaemic
199
What is a tension pneumothorax
Medical emergency that occurs when pressure in pleura becomes greater than that of atmosphere so air can only flow into pleura in a valve like mechanism
200
What is a common non lung related cause of chest pain in lung cancer
presence of metastases in the rib bones causing a ‘pleuritic’ type of pain, which may be sharp, well localised and is worse with movement.
201
What cancer causes cavitating mass
Squamous cell cancer
202
How to describe percussion for pleural effusion
Stony dull
203
Symptoms of PE
``` Pleuritic chest pain due to infarct- normally on one side of chest not central Tachypnoea Signs of DVT Hypoxaemia Haemoptysis ```
204
Treatment for asthma
Steroids Salbutamol Long term b2 agonist
205
How can TB present on CXR
Diffuse nodular infiltrates Cavitation Lymphadenopathy Nodular densities
206
What will atelectasis presnent with
Wheeze Dry cough SOB
207
What could alveolar shadowing be
Fluid- HF oedema bilaterally Pus- pneumonia Blood- vasculitis haemorrhage rare
208
Abdo exam finding sarcoid
Hepatosplenomegaly
209
What is used to monitor sarcoid progression
FDG PET
210
What is main risk of chest drain
Re-expansion pulmonary oedema
211
Drugs used in asthma treatment
``` Short acting beta agonists Long acting eta agonists Muscarinic antagonists GCS Leukotriene receptor antagonists Theophylline oral pills ```
212
Complications associated with asbestosis
Increased adénocarcinoma risk Mesothelioma Pleural plaques
213
What is respiratory failure
Where the blood doesn’t have enough O2 or too much CO2 PaO2 of less than 8kPa PaCO2 of greater than 6.7kPa
214
Signs of COPD on examination
Barrel chest Wheeze Reduced air entry Coarse crackles
215
What is a pneumothorax
When air accumulates or gains access to pleural space
216
What conditions can show miliary shadowing
Sarcoidosis Métastases Occupational lung diseases Extrinsic allergic alveolitis
217
Management of COPD
``` Bronchodilators Corticosteroid treatment Comination of 2^ Cessate smoking Influenza and pnuemonococcal vaccines ```
218
What is different about treating patients with severe CAP in relation to administration
Must be IV
219
What does pleurodesis do
Seals pleura to chest wall or lung
220
Coarse crackles vs fine crackles
Coarse sounds like bubbling- much more low pitched | Fine crackles sounds like fire crackling- higher pitched
221
What would you suspect in a non drinker young person presenting with cirrhosis
Alpha 1 antitrypsin deficiency
222
What conditions are included within COPD
Emphysema | Chronic bronchitis
223
Chest drain site
4-6th ICS MAL
224
How to investigate mesothelioma
CXR or CT that will show pleural thickening and effusion quite often bloody effusion
225
CXR findings TB
Upper lobes affected Cavitating lesion Bilateral lymphadenopathy
226
Complications of mycoplasma pneumonia
Transverse myelitis | RBC agglutination
227
What can cause atelectasis
- blockage of bronchus | - reduced surfactant
228
How to see collapsed lung CXR
Mediastinal shift and appears as white out or air
229
What is affected in type 1 resp failure
Gas exchange
230
RFx for mycetoma
Cancer Sarcoid TB
231
What is test for TB in clinical setting
Acid fast bacillus test- Ziehl–Neelsen stain. Only takes 48 hours
232
How to differentiate between inhaled object and bronchus obstruction on CXR
CXR shows consolidation for obstruction of bronchus
233
Investigations for COPD
Spirometry Pulse oximetry ABG
234
Causes of V/Q mismatch
``` Not well ventilated Acute asthma Pulnomary oedema Ards Pneumonia Pneumothorax Fibrosing alveolitus ``` Not well perfused PE
235
What does cavitation on chest indicate about patients health
Immunocompromised
236
Differentiate between asthma and COPD
Symptomatically COPD much more continuous whereas asthma is related to attacks of coughing and wheezing. COPD gets progressively worse COPD responds better to anti-cholinergic drugs and asthma to B2 agonists
237
What area of lungs does TB affect
Upper lobe
238
Textbook legionella presentation
Sx plumber or stays in hotels a lot with ACed rooms
239
Other than rheumatic fever what is another complication post strep infection
Post strep reactive arthritis
240
Tests to confirm asthma
Spirometry with salbutamol and ipatropium CXR Skin prick demonstrating atopy Trial them on budenoside and see if Sx improve or peak flow
241
Non lung symptoms of mesothelioma
Métastases Hepatomegaly Bone pain Abdo pain and obstruction from peritoneal malignant mesothelioma
242
How to tell if something consolidation
Will see air filled bronchus which appears as a black line- air bronchogram
243
Principles of asthma management
Well controlled asthma should lead to better control and the ability to move to a lower stage
244
Define sarcoid
Systeminc disorder of unkown cause leading to noncaseating granulomas in majortiy of cases
245
What is best test for likely PE
CTPA
246
What does bronchial breathing sound like
High pitch, louder sounds where inspiration and expiration sound the same
247
Immediate management of PE
Depends on size CTPA required then if massive immediate thrombolysis or thrombectomy if available If small sub cut LMWH
248
Risk factors PE
Immobility Malignancy Recent surgery FH of clot
249
Differences in pain PE central vs lateral
Central implies massive PE affecting main arteries | Lateral will be smaller artery and will get pleuritic pain
250
What does persistent type 3 HS reaction to aspergillus lead to
Bronchiectasis
251
Bronchectasis on CXR
Crowded bronchial markings extending to lung peripheries | Reduced volume
252
What is another cause of hyperesonant breath sounds
Bullae- where walls between alveoli break down thus forming multiple to join together
253
Investigations of sarcoid
CT CXR Bronchoscopic histology
254
What does type 1 hypersensitivity reaction to aspergillus lead to
Asthma
255
What would you be thinking with eye problems in a resp case
Sarcoid
256
Commonest PE ECG finding
RBBB and RAD | May also see large R in V1
257
What is mixed resp failure
Progression of T1 to T2 rf from hyperventilation leading to tiring of muscles
258
When will consolidation have disappeared in 95 % of CAP
6 weeks
259
Where is appropriate place for TB patient
Negative pressure isolation room
260
Signs of tension pneumothorax
Signs of cardiac deterioration- hypotension, hypoxic, tachycardia and resp distress
261
What is ICS
Inhaled corticosteroid
262
Causes of bronchiectasis
UK- Cystic fibrosis | Worldwide- TB
263
What happens when is V/Q mismatch
Either alveoli are getting a good air supply but not a good blood supply or vice versa
264
How does mass within cavity appear
Air surrounding opacification
265
What do fine crackles indicate
exudates in airways such as fluid from pneumonia
266
Why is calcium elevated in sarcoid
Ectopic alpha 1 hydroxylase produced
267
Can you get contralateral lobar collapse tension pneumthorax
Yes
268
What is a mycetoma
Or aspergilloma. Fungus ball forming in a pre existing cavity
269
How do arterio- venous malformations appear on CXR
Smaller well defined masses
270
Possible complications of bronchectasis
Infections recurrently Cor pulmonale Haemoptysis
271
How does GORD cause a cough
When reaches pharynx
272
Features of GORD cough
Dry | Nocturnal
273
Infections causing cavitating mass
TB Klebsiella Staph aureus
274
Which infection probably is causing cavitating mass in alcoholics
Klebsiella
275
What does bilateral basal lung opacities suggest of the aetiology
Of blood borne source as this is where perfusion is greatest
276
What to do in management of effusion
Take sample and send off for cytology, protein count and micro
277
How to differentiate between consolidation and effusion on examination
Consolidation increases vocal fremitus whereas effusion reduced
278
Difference between COPD and asthma
Asthma shows reversibility with 2 week steroid reversibility
279
What is fast test for legionella
Urinary antigen
280
Tests used to diagnose all atypical pneumonias
Serology
281
Categories of exudate pleural effusion
Malignancy Inflammation- rheum, SLE, vasculitis Infection
282
Rare PE ECG finding
S1 Q3 T3
283
S1 Q3 T3 on ECG
Deep S wave in lead I Pathological Q in lead III Inverted T wave in lead III
284
Why do we aim for a lower oxygen target range in COPD patients
These patients rely on hypoxic drive to drive respiration as resp centre insensitve to CO2. Too much oxygen will cause drop in respiratory drive so deterioration
285
What do COPD patients present with on ABG
T2 RF due to respiratory drive insensitivity to CO2 | Resp acidosis with long term metabolic compensation as hypercapnic
286
Resp causes of clubbing
``` Cancer Mesothelioma Fibrosis Bronchiectasis Abcess ```
287
Most common lung cancer seen in non-smokers
Adenocarcinoma
288
Auscultation finding lung fibrosis
Bilateral reduced air entry | Fine crackles inspiratory
289
Causes of pneumothorax
``` Spontaneous in young men Lung pathology Connective tissue disorder Iatrogenic Trauma ```
290
Management of PE
Even when just suspected subcut LMWH and warfarin with INR range 2-3
291
Management of recurrent PEs
Warfarin lifelong | If from malignancy heparin
292
Classifications of causes of cor pulmonale
``` Lung disease Pulmonary vascular disease Thoracic cage abnormality Neuromuscular Hypoventilation ```
293
Why does in asthma exacerbations volume in pulse falls
Decreased left atrial filling- compromised airways exacerbate negative pressure in chest so blood pools in lungs
294
What happens in EEA
Hypersensitivity to inhlalation of organic allergens that leads to hypersensitivity reactions in alveoli. Chronic leads to fibrosis
295
What are formed in EEA
Non caseating granulomas
296
Main causes of EEA
Farmers lung- mouldy hay Bird fanciers Mushroom pickers lung Malt workers lung- barley
297
Acute EEA presentation
Fever Rigors Dry cough SOB
298
Chronic EEA presentation
Weight loss Exertional SOB Dry cough
299
What is pneumoconiosis
Occupational lung diseases caused by inhalation of dust
300
What cells is it thought small cell carcinomas arise from
Neuroendocrine cells
301
What do you think when lung Sx and hyponatraemia
Small cell carcinoma
302
How is COPD categorised
``` All less than 0.7 ratio Mild- FEV1 above 80 Moderate- FEV1 50-80 Severe- FEV1 30-50 Very severe less than 30 ```
303
When should oxygen therapy be started
``` Evidence of cyanosis Polycythaemia Severe airflow obstruction Peripheral oedema Raised JVP ```
304
What asthma drug can cause hypokalaemia
Salbutamol
305
What is ARDS
Damage to lung results in release of acute ohase proteins leading to increased capillary permeability so get noncardiogenic pulmonary oedema
306
Causes of ARDS classification
Pulmonary- any systemic illness or injury to lung | Extra pulmonary- septic shock, DIC, multiple transfusions
307
Diagnosis of ARDS 4 criteria
Acute onset Bilateral CXR infiltrates Pulmonary capillary wedge pressure under 19 Refractory hypoxaemia
308
What must do with antibiotics when suspect aspiration pneumonia
Cover anaerobes
309
How to determine examination needed for PE
Do wells score If under 4 do D-dimer If 4 or over do CTPA
310
What are categories for acute asthma based on
PEF
311
What is fatal sign of asthma attack
Raised PaCO2
312
Immediate asthma attack treatment
``` O2 Neb salbutamol 5mg Neb ipatropium bromide 0.5mg 100mg hydrocrotisone IV Then 40-50mg PO pred for 5 days ```
313
What is senior supportive treatment for asthma attacks
IV magnesium sulphate | IV aminophylline
314
What colour is sputum in COPD
White
315
What are crackles in COPD
Coarse
316
When are coarse crackles heard
COPD | Pneumonia
317
When are fine crackles heard
Interstitial lung disease
318
What is best way to manage COPD
Smoking cessation
319
How does COPD lead to polycythaemia
Hypoxia leads to EPO production
320
How can COPD patients present with very low RR
Given too much oxygen
321
Managemnt of COPD exacerbation
Neb salbutamol 5mg Neb ipatropium bromide 0.5mg 200mg hydrocrotisone IV Then 40-50mg PO pred for 5 days
322
Further management of COPD
BiPAP
323
Why is BiPAP used for COPD
Reduced expiratory pressure allows some CO2 to leave- in COPD patients they chronically retain CO2 so not letting some out would further exacerbate his resp acidosis
324
What is new name of EAA
Hypersensitivity pneumonitis
325
Investigations for asthma
Peak flow FeNO Spirometry
326
What is FeNO
Frequency of expired NO- signs of inflammation in lungs
327
Steps to asthma management
``` SABA SABA+ICS SABA+ICS+LTRA SABA+ICS+LTRA+LABA SABA+MART+LTRA ```
328
What is MART
Management and reliever therapy- ICS+LABA
329
What is montelukast therapy
Leukotriene receptor antagonists
330
CAP pneumonia tx
Co-amoxiclav
331
Atypical CAP tx
Clarithomycin
332
HAP treatment
Tazocin
333
Most common gram pos organisms you are faced with
Staph Strep C.difficile
334
What is given for gram positive if has penicillin allergy
Macrolides
335
Give 2 macrolides
Clarithomycin | Erythomycin
336
3 categories of ABx to treat gram pos
Beta lactams Glycopeptides Oxazolidinones
337
3 beta lactams categories
Penicillins Cephalosporins Carbapenems
338
Example of cephalosporins
Ceftriaxone
339
Examples of carbapenems
Meropenem | Ertapenem
340
Examples of glycopeptides
Vancomycin
341
Examples of penicillins
Amoxicillin Flucloxacillin Tazocin
342
Most common gram neg organisms have to deal with
Salmonella E.Coli Klebsiella pneumoniae Pseudomonas
343
Who is at risk of aspiration
Neurological disorder Altered mental state LOC
344
Categories of Abx for gram negs
Aminoglycosides | Fluroquinones
345
Examples of aminoglycosides
Gentamicin | Amikacin
346
Examples of fluoroquinones
Ciprofloxacin | Levofloxacin
347
What abx used for intracellular pathogens
Tetracycline
348
Examples of tetracyclines
Doxycycline | Tigecyclin
349
Examples of intracellular pathogens
Chlamydia | Mycoplasma
350
What abx are used to cover anaerobes
Nitroimidazoles
351
Examples of nitroimidazoles
Metronidazole | Tinidazole
352
When are you worried about anaerobes
STIs | Pneumonia
353
What is nitrofurantonin used for
UTIs as concentrates in the bladder
354
Management of PE
Immediately give LMWH or DOAC | Then do wells score to determine if D-dimer or CTPA needed
355
How long do you anticoagulate for post PE
If provoked 3 months | If unprovoked 6 months
356
What criteria is used to classify pleural effusions
Lights criteria
357
What is the lights criteria
pleural fluid/serum protein ratio of greater than 0.5 | pleural fluid/serum LDH ratio of greater than 0.6
358
What does very elevated LDH in pleural fluid suggest
TB or cancer
359
Wheeze in young person differentials
Asthma Foregin object Antitrypsin
360
What can present with persistent greenish sputum cough and occasional haemoptysis
Bronchiectasis
361
What is the chest pain in resp conditions
Tight
362
What is the chest pain in cardio conditions
Crushing
363
What infections can often precede sarcoidosis
Lyme | TB
364
What is uveitis a inflammation of
Pigmented layer
365
What is affected in erythema nodosum
Fat
366
How can kidney be affected in sarcoid
Nephrocalcinosis- so have to do 24hr urine collection
367
Which patients are at specific risk of aspiration pneumonia risk
Dementia
368
Which lobe is most commonly affected in aspiration pneumonia
Right middle
369
What is use of spirometry
Longer term test
370
Differentials of wedge infarct
PE
371
What is problem of CTPAs
Lots of radiology and contrast
372
Antibiotics for TB given for first 2 months assuming all sensitive
Rifampicin Isoniazad Pyrazinamide Ethambutol
373
Management of TB patient
Negative pressure room Cultures to test sensitivity of patients TB to antibiotics- this can take 4 months to come back so start the patient on all 4 abx then if sensitivities all come back positive only keep on the isoniazad and rifampicin
374
What determines if primary or secondary pneumothorax
Lung dx | 50 year old smoker
375
For primary pneumothoraces what determines if needle aspirate or not
If SOB or if greater than 2cm
376
With primary pneumothorax what do you do if asymptomatic or less than 2cm
Discharge and outpatient review
377
If aspiration is successful in primary pneumothorax what do you do
Observe and give O2
378
If aspiration is unsuccessful in pneumothorax what do you do
Put in chest drain
379
In secondary pneumothoraces what determines pathway
Greater than 2cm or SOB
380
If greater than 2cm or SOB what do with secondary pneumothoraces
Chest drain
381
If between 1-2cm in secondary pneumothoraces what do
Needle aspiration If successful observe and O2 If unsuccessful chest drain
382
If pneumothorax less than 1cm in secondary pneumothoraces what do
Observe and O2
383
Presentation of acute massive PE
Collapse Central crushing pain Severe dyspnoea
384
What can be CXR finding of PE
Westermarks sign | Dilation of pulmonary vessels
385
Massive PE on ECG
RAD S1Q3T3 RBBB In small likely to be kust tachycardia
386
Management of massive PE vs submassive PE
Determined by if haemodynamically unstable Massive Resp support 1st line thrombolysis 2nd line embolectomy Submassive Resp support Anticoagulation
387
What 2 IV thrombolytics are used in massive PE
Alteplase | Streptokinase
388
What can be general inspection finding in asthma
Nasal polyps
389
Criteria for diagnosing asthma
FEV1/FVC ratio less than 0.7 12% or more reversibility with SABA FeNO over 40parts per billion
390
If move on from stage 5 asthma what is next step
Tiral of- Theophylline LAMA
391
If trials of theophylline and LAMA dont work what is given
Oral corticsteroids
392
Name of LTRA
Montelukast
393
Name of budenoside and formoterol
Symbicort
394
What is defined as a moderate acute asthma and waht do you do
50-75 | Send home
395
What is defined as an acute severe asthma and what do you do
33-50 | Admit if no response
396
What is defined as a life threatening acute asthma and waht do you do
Less than 33 | Admit
397
What is defined as a near fatal acute asthma and waht do you do
Rised Co2 on ABG | Admit
398
COPD history
SOB Productive cough- white Some wheeze
399
Treatment for simple COPD infective
Amoxicillin
400
Which conditions can cause COPD in younger people
Alpha-1-antitrypsin | CF
401
What will post bronchodilator FEV1/FVC be in all COPD categories
Less than 0.7
402
Mild severity COPD
FEV1 over 80 compared to expected
403
Moderate severity COPD
FEV1 50-80% compared to expected
404
Severe severity COPD
FEV1 30-49% compared to expected
405
Very severe COPD
FEV1 less than 30% compared to expected
406
Initial COPD management
SABA or SAMA
407
In second line COPD what determines what drug is given
Whether asthma symptoms or not- diurnal cough, wheeze and SOB worsened by triggers
408
If asthmatic signs in COPD what is given
LABA and ICS
409
If no asthmatic signs in COPD what is given
LABA and LAMA
410
Final line treatment for COPD
LABA LAMA ICS
411
General management of COPD
Smoking cessation Annual influenza vaccination Pneumococcal vaccination
412
Improved survival methods for COPD
Smoking cessation Long term O2 Lung volume reduction surgery
413
When is long term O2 given in COPD
PO2 of less than 7.3 PO2 7.3-8 and PCV, nocturnal hypoxaemia, peripheral oedeama or pulm HTN Terminally ill
414
What can cause idiopathic fibrosis
Methotrexate | Amiodarone
415
IPF history
SOBOE | Dry cough
416
What is gold standard test for IPF
Biopsy
417
In first presentation what is first only imaging will see changes
HR-CT- ground glass | Later on will see CXR- reticulonodular, cor pulmonale, honeycombing
418
What causes atelectasis in asthma
Mucous plugs
419
CXR findings IPF
Only seen late | Honey-combing, reticulonodular, cor pulmonale, honeycombing
420
Hypersensitivity pneumonitis history
SOBOE Dry cough Fever
421
X-ray changes seen in Hypersensitivity pneumonitis
Often none but will be superior reticulonodular changes
422
HR-CT early changes hypersensitivity pneumonitis
Ground glass
423
Investigations do hypersensitivity pneumonitis
CXR HRCT BAL Spirometry
424
What is BAL finding of Hypersensitivity pneumonitis
Increased ceullularity
425
Pneumoconiosis history
Dry cough | SOBOE
426
How is pneumoconiosis classified
Simple | Complicated
427
Investigations for pneumoconiosis
CXR HRCT Spirometry
428
CXR finding pneumoconiosis
In simple disease will see micronodular mottling
429
HRCT finding pneumoconiosis
Bilateral lower zone reticulonodular shadowing | Pleural plaques
430
What is different about asbestos HRCT to all other pneumoconiosis'
Fibrotic changes seen
431
What is history of sleep apnoea
Snoring Unrefreshed sleep Chronic fatigue
432
What is common profession seen in sleep apnoea
Truck driver who does very little moving
433
Risk factors for sleep apnoea
Obesity Smoker Alcohol
434
Investigations for sleep apnoea
``` Sleep study (polysomnography) TFTs and IGF-1 to rule out acromegaly and goitre ```
435
What can cause obstructive sleep apnoea
Obesity Goitre Acromegaly
436
Associations of legionella
Hyponatraemia | Abnormal LFTs
437
Pneumonia with abnormal LFTs
Legionnella
438
Symptoms of atypical pneumonias
``` Dry cough Headache Diarrorhoea Myalgia Hepatitis ```
439
2 tests for atypical pneumonia legionella
Urine antigen test | LFTs
440
Test for mycoplasma atypical pneumonia
Blood film- cold agglutins
441
What are 2 types of findings seen on CXR pneumonia
Lobar | Bronchopneumonia
442
If patient scores 1 CURB 65 what do
GP
443
If patient scores 2 CURB 65 what do
Short A&E score
444
If patient scores 3 CURB 65 what do
Admission
445
Treatment for pseudomonas pneumonia
Tazocin and gentamicin
446
Treatment for MRSA pneumonia
Vancomycin
447
Treatment for CAP
Amoxicillin | Co-amoxiclav if severe
448
Complications of pneumonia
Pleural effusion Abscess Sepsis Empyema
449
How does lung abscess present
Swinging fevers Persistent pneumonia Foul smelling sputum
450
What is post primary TB
When TB is reactivated probably due to immunocompromise- normally presents with severe disease
451
What is miliary TB
Lymphohaemaotogenous dissemination of TB
452
Extra pulmonary problems of TB
``` Addisons Potts disease Meningitis Tuberculomas Granuolmas in kidney or colon ```
453
What is potts disease
Osteomyelitis and arthrits of spine associated with TB
454
Initial tests for TB
``` Sputum MCSx3 Ziehl neelsen stain Blood culture HIV test Lymph node biopsy Mantoux test but cant differentiate between latent and active ```
455
If question asks for next step management in resp what must always do
Look if needs oxygen
456
Non mililary TB findings on CXR
``` Bi hilar lymphadenopathy Patchy consolidation Pleural effusions Cavitating lesions Upper lobe scarring ```
457
Miliary TB finding CXR
Nodular shadowing
458
Congenital causes of bronchiectasis
Cystic fibrosis Youngs syndrome Kartageners (primary ciliary dyskinesia)
459
Acquired causes of bronchiectasis
``` Recurrent infections TB Measles Pertussis Lung cancer Aspergillosis ```
460
Presentation of bronchiectasis
``` Chronic cough of copious sputum Haemoptysis occasionally SOB Fever Weight loss ```
461
4 things that give basal creps
HF Pneumonia Bronchiectasis IPF
462
Investigations for bronchiectasis
``` Bedside - sputum sample for microscopy - sweat test for cystic fibrosis - genetic testing for PCD and youngs Bloods - FBC - CRP - ABG - blood culture Imaging - CXR - HR-CT ```
463
Classic feature of bronchiectasis HR-CT
Signet ring
464
Triad of youngs syndrome
Bronchiectasis Sinusitis Infertility
465
Management of bronchiectasis
``` Conservative - exercise and good diet - influenza vaccination - physio - hypertonic saline nebs Pharm - oral prophylactic ABx - IV if acute infection Surgical - resection ```
466
What is prophylactic antibiotic given in bronchiectasis
Azithromycin
467
Complications of bronchiectasis
Recurrent infections Cor pulmonale Resp failure
468
Common sites of primary tumours causing breast mets
Breast | Colorectal
469
Causes of primary lung cancer and %
``` Non-small cell - Adenocarcinoma 40 - squamous cell 25 - large cell 5 Small cell - small cell carcinoma 15 ```
470
Which cells does each lung cancer originate from
Adenocarcinoma- goblet cells Squamous cell carcinoma- squamous epithelial cells Small cell- NET Large cell- epithelial cell
471
What can small cell carcinomas produce ectopically
SIADH | ACTH
472
Where in lung do adenocarcinomas grow
Peripheral
473
Which lung tumour produces PTH
SqCC
474
Risk factors for lung cancer
Smoking | Asbestos
475
Other than mesothelioma which tumour can asbestos predispose to
SqCC
476
What happens to vocal resonance in cancer
Increased
477
Local invasions of lung cancer
Horners Left recurrent laryngeal nerve-> bovine cough and hoarse voice SVC obstruction
478
Where does lung cancer often metastasise to
Bone Brain Liver
479
Questions for bone mets lung cancer
Fractures | Bone pain
480
Questions for brain mets lung cancer
Headache | Blurry vision
481
Investigations for lung cancer
``` Bedside - sputum cytology Bloods - FBC - U&Es - calcium - LFTs Imaging - CXR - CTAP - PET Biopsy - bronchoscopy - transthoracic needle ```
482
Why measure clacium in lung cancer
Bone mets | Ectopic PTH from SqCC
483
Why do LFTs lung cancer
ALP for bone mets | Liver mets
484
Complications of lung cancer
``` Atelectasis Pleural effusion Mets SVC obstruction Nervous infiltration ```
485
What is sail sign
When LLL collapse
486
Symptoms of mesothelioma
Cough dry LAWS SOB
487
Sign of mesothelioma on auscultation
Pleural friction rub
488
What does pleural friction rub suggest
Mesothelioma
489
Investigations for mesothelioma
``` Bedside - sputum cytology - thoracocentesis for pleural fluid cytology Bloods - FBC - U&Es - calcium - LFTs Imaging - CXR - CTAP - PET Biopsy - thoracoscopy to get pleural lining biopsy ```
490
Definitive test for mesothelioma
Thoracoscopy
491
CXR finding for mesothelioma
Pleural thickeing Effusions Pleural plaques
492
CXR findnings bronchiectasis
Thickened bronchial walls Volume loss Ring shadows Fluid air levels from dilated airways
493
Why do you get volume loss in bronchectasis
Mucous plugs
494
What can lead to reduced lung volume
Bronchial cancer | Bronchiectasis
495
What is chance patient will have allergic reaction to a cephalosporin if allergic to penicillin
10%
496
Sore throat differentials
``` Cold Influenza Glandular fever Strep throat Haematological cancer ```
497
Presentation of influenza flu
headache, weakness, fatigue, myalgia, fever and dry cough
498
Presentation of cold
rhinorrhoea, nasal congestion and cough
499
Presentation of strep throat
suggested by acute onset, fever, presence of exudate and absence of cough
500
Presentation of EBV
sore throat of greater than 7 days’ duration, adenopathy and splenomegaly
501
What would worry you about haem malignancy in sore throat
fatigue, weightloss, petechial rash, bruising, adenopathy and fever
502
What would prompt referral to ENT about removal of tonsils
7 or more tonsilitis in a year
503
What is delayed prescription of antibiotics
Delayed means that can access them after a few days giving them a few days to attempt self care
504
Fever pain score of 2-3
Delayed prescription of penicillin
505
Fever pain score of 4-5
Immediate prescription of penicillin
506
What to bear in mind with feverpain for vulnerable groups ie on steroids
Move the parameters
507
What is main complication of inhaled ICS
Thrush
508
Are inhaled ICS ok for pregnancy
Yes
509
What is alternative steroid to betclamethasone
Fluticasone
510
Significance of sore throat for rheumatic fever
Strep A | Scarlet fever also presents with sore throat
511
What is main complication of tonsilitis
Peritonsilar abscess
512
What is first thing must establish if presenting with haemoptysis
If truly from lungs or from GI, nose or gums
513
Ways to determine if haemoptysis truly haemoptysis
Colour- brown suggests GI | History of nosebleeds, nausea, gastric disease or alcoholism
514
INVITED MD for haemoptysis
``` Infective- TB, abscess, mycetoma, pneumonia Neoplastic- metastases, primary tumour Vascular- PE, heart failure Inflammatory- wegners, goodpastures, microscopic polyangiitis, Lupus, haemorrhagic telengiectasia Trauma- rib Endocrine- no Degenerative- bronchiectasis Metabolic- no Drugs- warfarin ```
515
What does blood streaked sputum suggest
Infective cause like pneumonia | Bronchiectasis
516
What does frothy bloody sputum suggest
Pulmonary oedema from HF or mitral stenosis
517
What does sudden onset haemoptysis suggest vs chronic
Sudden- PE, tumour | Chronic- bronchiectasis
518
What does productive cough alongside haemoptysis suggest
Pneumonia | Bronchiectasis
519
What would oligouria suggest about haemoptysis
Pulmonary renal syndrome- Lupus, vasculitides, good pastures
520
What does hoarse voice suggest with haemoptysis
Lung cancer
521
What does muscle wasting in hand suggest about haemoptysis
Pancoast tumour infiltrating the brachial plexus
522
What does a purpuric rash or petechiae suggest about haemoptysis
Vasculitide
523
What does swollen face suggest about haemoptysis
SVC syndrome
524
What does jaundice or hepatomegaly suggest about haemoptysis
Liver cancer thats spread to lungs or vice versa
525
What does tracheal deviation suggest about haemoptysis
Collapse of lung secondary to tumour or abscess | Maligant pleural effusion
526
Bloods ordered for haemoptysis
``` FBC- malignant anaemia, WCC CRP Clotting screen- easy bleeding U&Es- pulmonary renal syndrome Clacium- hypercalcaemia LFTs- liver involvement ```
527
Investigations after lung cancer suggested
Sputum for cytology | Biopsy from bronchoscopy or CT guided percutaneous fine needle biopsy
528
What obs recording would discount PE
Tachypnoea
529
Why are PCD sufferes infertile
Spermatazoa cant swim properly
530
People with primary ciliary dyskinesia often suffer with that conditions
``` Sinusitis as cant clear noses Male infertility Bronchiectasis Situs invertus Otitis media as cant clear mucous from middle ear ```
531
When is lights criteria used
If pleural protein less than 25g/L then is exudate If over 35g/L then is transudate If between these then do lights criteria
532
Which cancers most commonly metastasise to lung
Colon Renal Gynae Breast
533
Extra pulmonary manifestation of lung cancer
Bone mets LEMS Hypercalcaemia from ectopic PTHrp Ectopic ACTH
534
DDx for coin lesion
``` TB Sarcoid Abscess Harmatoma Foreign object Tumour Mycetoma ```

Year 3 Conditions (33 decks)

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