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Resp Conditions Flashcards

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1
Q

What is the cause of Asbestosis?

Most and least fibrogenic?

A

Inhalation of asbestos fibres

Chyrosotile (white) least fibrogenic
Crociodolite (blue) most fibrogenic

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2
Q

Presentation of asbestosis

A

Progressive dyspnoea
Clubbing
Fine end-inspiratory crackles
Pleural plaques

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3
Q

What are some complications and treatments of Asbestosis?

A
  • Increases risk of bronchial adenocarcinoma and mesothelioma

Symptomatic treatment

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4
Q

What is Berylliosis?

A

Chronic allergic-type lung response and chronic lung disease cause be exposue to beryllium
Occupational lung disease (aerospace manufacturing)

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5
Q

Presentation of Berylliosis and diagnostic test?

A 
Cough
SOB
Chest pain
Joint aches
Weight loss
Fever
  • Spirometry (restrictive pattern)
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6
Q

What is Asthma?

A

Recurrent episodes of dyspnoea, cough and wheeze caused by reversible airway obstruction

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7
Q

Presentation of asthma:

A

Intermittent dyspnoea, wheeze, cough (nocturnal)

Signs - tachypnoea, audible wheeze, hyperinflated chest, hyper resonant percussion, diminished air entry,

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8
Q

Characteristic signs of severe or life-threatening asthma attack?

A

Severe - can’t finish sentences

Life-threatening - silent chest, cyanosis, bradycardia

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9
Q

Treatment for Asthma (aged <17)

A

1) SABA reliever (newly diagnosed)
1. 5) low dose ICS (symp. indicate need for maintenance therapy)
3) ICS + LTRA (review 4-8wks)
4) ICS + LABA

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10
Q

Acute treatment for asthma attack

A

1) Oxygen
2) SABA (neb)
3) Hydrocortisone/prednisolone
4) Ipratropium bromide
5) Theophylline
OSHIT

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11
Q

Presentation of Bronchial Carcinoma

A 
Cough, haemoptysis
Dyspnoea, stridor
Chest pain
Recurrent or slowly resolving pneumonia
Anorexia, weight loss

Signs - cachexia, anaemia, clubbing, consolidation, collapse, pleural effusion

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12
Q

Investigations for Bronchial Carcinoma?

A

FBC, CXR, coagulation screen,, thorax CT
Spirometry
Bronchscopy
Aspiration of pleural fluid

NOT sputum cytology

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13
Q

What are some serious complication from local invasion of Bronchial carcinoma?

A

Local invasion to:

  • Recurrent laryngeal nerve (hoarse)
  • Pericardium (SOB, AF, pericardial effusion)
  • Oesophagus (dysphagia)
  • Brachial Plexus (weakness in left hand)
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14
Q

Treatment of bronchial carcinoma (non-small vs. small cell)?

A

N-S = excision (peripheral tumours with no mets)

S = nearly always disseminated at presentation (chemo but usually relapse)
Palliation

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15
Q

What is Bronchiectasis?

A

Abnormal fixed dilation of the bronchi, usually due to fibrous scarring following infection (pneumonia, TB, cystic fibrosis)

Dilated airways accumulate purulent secretions

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16
Q

Presentation of Bronchiectasis?

A

Persistent cough
Copious purulent sputum
Intermittent haemoptysis

Signs - finger clubbing, coarse inspiratory creps, wheeze

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17
Q

Treatment for Bronchiectasis?

A

Postural drainage twice daily

Antibiotics according to pathogen sensitivities

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18
Q

What is Bronchiolitis?

A

Bronchial inflammation and occlusion

> 90% cases due to respiratory syncytial virus

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19
Q

Presentation of Bronchiolitis?

A 
1st or 2nd year of life
Fever
Coryza
Cough
Wheeze
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20
Q

Investigation of Bronchiolitis?

A

PCR on throat or perinasal swabs

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21
Q

Complications and treatment of Bronchiolitis?

A

Resp. + Cardiac failure
Prematurity

Supportive

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22
Q

What is Caplan’s Syndrome?

A

Multiple lung nodules in coal workers with RA

Caused by inflammatory reaction of an external antigen

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23
Q

Coal Worker’s Pneumoconiosis?

A

Due to inhalation of coal dust particles

Ingested by macrophages which die and release their enzyme causing fibrosis

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24
Q

Diagnosis sign on CXR of coal worker’s pneumoconiosis?

A

Upper lob round opacities on CXR

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25
What is COPD?
SMOKERS Combined effect of chronic bronchitis and emphysema causing ==> loss of elasticity, mucus secretion, inflammation and scarring = Airway obstruction with little or no reversibility
26
Presentation of COPD
SMOKER Chronic dyspnoea, wheeze Sputum production Minimal day-to-day FEV1 variation Sign - tachypnoea, use of accessory muscles, hyperinflation, hyper/resonant , cyanosis, cor pulmonale
27
Diagnosis of COPD
Pulmonary function tests = Obstructive pattern
28
Treatment for Chronic COPD?
1) SAMA 2) LAMA 3) LABA + ICS (combo inhaler)
29
Treatment for Acute attack of COPD?
1) 2-28% oxygen 2) High dose Salbutamol + ipratropium bromide (neb) 3) Prednisolone (oral) 4) Amoxicillin 5) Respiratory stimulant (doxapram) + may need intubation
30
What is the treatment for an acute exacerbation of COPD?
Antibiotics if increased sputum purulence If not - no ABs unless consolidation on CXR or sign of pneumonia ``` 1st = amoxicillin 2nd = doxycycline ```
31
What is Cor Pulmonale?
Right sided heart failure caused by chronic pulmonary arterial hypertension
32
Presentation of Cor pulmonale?
Dyspnoea Fatigue or syncope Signs - cyanosis, tachycardia, raised JVP RV heave pansystolic murmur (tricuspid regurg.)
33
Investigations for cor pulmonale?
ABG - hypoxia without hypercapnia CXR - enlarged right atrium + ventricle, prominent pulmonary arteries
34
Treatment for cor pulmonale
Treat underlying cause Heart failure - diuretics Pulmonary failure - 24% oxygen
35
What is the presentation and treatment of Croup (viral laryngotracheobronchitis)?
Stridor, barking cough Oral steroid to reduce inflammation
36
What is the presentation of Cystic Fibrosis (neonates vs. children + young adults)?
Neonates - failure to thrive, meconium ileus (blocked bowel) + rectal prolapse Children/YA: Resp - cough, wheeze, recurrent infections, bronchiectasis, pneumothorax, haemoptysis, resp failure, cor pulmonale GI - pancreatic insufficiency, gallstones, cirrhosis
37
What is Empyema and when should it be suspected?
= pus in pleural space Patient with resolving pneumonia who develops a recurrent fever
38
What is Epiglottis?
= severe croup in children (2-7) may progress to respiratory obstruction (most commonly caused by haemophilus influenze)
39
Investigations and treatment of Epiglottis?
Blood culture, CXR (Thumbprint sign) ITU and ceftriaxone
40
What is Extrinsic Allergic Alveolitis?
In sensitised patients, inhalation of allergens (fungal spores or avian proteins) provoke hypersensitivity reaction ``` Acute = alveoli are infiltrated with acute inflammatory cells Chronic = granuloma formation + obliterative bronchiolitis occur ```
41
Presentation of EAA?
4-6 hours after exposure ==> Fever, rigors, dry cough, dyspnoea, crackles (no wheeze)
42
Investigations and treatment of EAA?
PFC (neurophilia), restrictive lung function tests, chronic inflamm cells in airways Remove allergen + give oxygen, then oral prednisolone
43
What is Idiopathic pulmonary fibrosis?
Type of idiopathic interstitial pneumonia Inflammatory cell infiltrate + pulmonary fibrosis of unknown cause Commonest cause of interstitial lung disease
44
Presentation of idiopathic pulmonary fibrosis?
Dry cough Exceptional dyspnoea Malaise, weight loss, arthralgia Signs - cyanosis, finger clubbing, fine end inspiratory creps
45
Investigation of idiopathic pulmonary fibrosis and treatment?
Bloods = increased CRP, Ig, CXR = decreased lung volue, bilateral lower zone reticulo-nodular shadows, honeycomb lung (advanced) Restrictive spirometry Best supportive care
46
What is the presentation of Mesothelioma?
``` ( = tumour of mesothelioma cells in pleura) Chest pain Dyspnoea Weight loss Finger clubbing Recurrent pleural effusion Signs of metastases ```
47
Diagnosis of mesothelioma?
Sign on pleural thickening on CXR Bloody pleural fluid DIAGNOSIS on histology of pleural fluid Treatment = CHEMO
48
What is Obstructive Sleep Apnoea?
Intermittent closure/collapse of pharyngeal airway causing apnoeic episode during sleep - terminated by partial arousal
49
Presentation of OSA?
``` Loud snoring Daytime somnolence Poor sleep quality Morning headache Decreased libido Decreased cognitive performance ```
50
Investigation/diagnosis of OSA and treatment options?
Ix - pulse oximetryy, POLYSOMOGRAPHY Mx - weight loss, avoid tobacco + alcohol CPAP via nasal mask for moderate disease Surgery to relieve pharyngeal obstruction if needed
51
What is Pertussis? | Presentation -
= Whooping cough, Bordetella pertussis - Cold like symptoms - Paroxysmal cough for 2 weeks (repeated violent exhalation with severe inspiratory whoop) - Vomiting (common)
52
Diagnosis and treatment of Pertussis/whooping cough?
Perinasal swab, serology Erythromycin (1st line)
53
General presentation of pneumonia?
Fever, rigors Malaise, anorexia Dyspnoea, cough, purulent sputum, haemoptysis Pleuritic pain Signs - fever, cyanosis, confusion, tachypnoea, hypotension, consolidation, pleural rub
54
Treatment of Pneumonia (CAP score):
``` 0-2 = Amoxicillin (doxycycline) 3-5 = Co-amoxiclav IV + either Clarithromycin IV OR doxycycline IV ``` HAP or Acquired: Severe - IV amoxicillin, metronidazole + gentamicin Non-severe = amoxicillin + metronidazole
55
What is a Lung Abscess and possible causes?
= cavitating area of localised supparitive (pus) infection within the lung Causes - inadequately treated pneumonia, aspiration (e.g. alcoholism), bronchial obstruction, pulmonary infarction, septic emboli
56
Presentation of lung abscess?
``` Swinging fever Cough Foul smelling sputum Pleuritic chest pain Haemopytsis Malaise Weight loss ```
57
Presentation of Spontaneous Pneumothorax?
May be no symptoms (young fit people with small one) ==> sudden onset of dyspnoea and/or pleuritic chest pain Asthma/COPD - rapid deterioration Signs = reduced expansion, hyper resonance, diminished breath sounds
58
Presentation of Tension Pneumothorax?
Same as spontaneous BUT trachea may be deviated from affected side
59
Investigations for Pneumothorax (spontaneous vs. tension)?
Spon. - CXR (area devoid of lung markings peripheral to edge of collapsed lung), ABGs Tension - NO CXR, will delay treatment
60
Treatment of pneumothorax (spontaneous vs. tension)
Spon. - NONE if small and asymptomatic Due to trauma or mechanical ventilation requires chest drain Tension - high flow oxygen, needle decompression (large bore venflon, 2nd ICS, mid clavicular)
61
What is Sarcoidosis?
Multisystem granulomatous disorder of unknown cause Causes pulmonary fibrosis (upper lobes)
62
Presentation of Sarcoidosis? 1) Acute - 2) Pulmonary disease - 3) Non-pulmonary -
1) Erythema nodosum + polyarthralgia 2) dry cough, progressive dyspnoea, reduced exercise tolerance, chest pain 3) lymphadenopathy, hepatomegally, splenomegaly, uveitis, conjunctivitis
63
What is Silicosis? Presentation? Diagnosis?
= caused by inhalation of silica particle (VERY fibrogenic) Progressive dyspnoea CXR - diffuse military or nodular pattern in mid/upper zone with egg shell calcification of hilar nodes
64
Presentation of Tuberculosis?
Gradual onset, cough, sputum, malaise, weight loss, night sweats, haemoptysis, breathlessness, upper zone crackles Other - headache, drowsy, fits, GI pain/obstruction, spinal pain or deformity, lymphadenopathy, pericardial tamponade, renal failure, hypoadrenalism
65
Diagnosis of TB?
ZN stain, gamma interferon test, sputum culture, bronchoscopy, PCR CXR - caseous necrosis, fibrosis + calcification in upper lobes
66
Treatment of TB?
2 months of Rifampicin, Isoniazid, Pyrazinamide, Ethambutol 4 months of R (orange fluid) + I (peripheral neuropathy)
67
What is Pulmonary Oedema?
Collection o watery fluid in lungs making it difficult to breath Causes - HF (common), high altitude, acute resp distress syndrome, kidney failure, lung damage
68
Presentation of pulmonary oedema?
Coughing up bloody froth Paroxysmal nocturnal dyspnoea SOB Needs extra pillows at night (or sleeps sitting up)
69
Investigations and treatment of pulmonary oedema?
Ix - CXR, ECHO, ECG, pulse oximetry Mx - underlying cause, oxygen, diuretics (furosemide), nitrates
70
Presentation of Legionella Pneumonia?
Prodromal symptoms for couple of days Cough with green or bloodstained sputum GI symptoms (N&V, diarrhoea, anorexia) Confirm using urinary antigen ERYTHRMYCIN
71
Presentation of Pulmonary Embolism?
SOB, collapse Pleuritic chest pain, haemopytsis, sudden death Signs - tachypnoea, hypotension, cardiorespiratory arrest, tachycardia 4th heart sound Pleural rub, pleural effusion, consolidation
72
Treatment for PE? | Massive, Major (w/w.o RV dysfunction) and Minor
Massive (shock or syncope) - thrombolysis or surgery Major w. - anticoagulants + thrombolysis Major w/o - anticoagulants Minor - anticoagulants
73
Gold standard investigation for Pulmonary Embolism?
CTPA
74
Which lung cancer involve expression of TTP?
Adenocarcinoma + Small cell carcinoma
75
True or False: | Ashmann focus in the apices of the lung is assoc. with secondary TB?
True
76
True or False: | Large cell carcinoma is a PTH secreting tumour?
FALSE Squamous cell carcinoma is PTH secreting
77
What would be the expected spirometry for COPD?
FEV1 reduced, FVC reduced, FEV1/FVC ratio reduced, PEFR reduced
78
True or False: | Small cell carcinoma is an ACTH secreting tumour
TRUE

Y1 Medicine (6 decks)

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