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resp conditions Flashcards

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1
Q

what would a CXR of someone with asbestosis look like?

A

pulmonary fibrosis
dense calcified pleural plaques
pleural thickening

(restrictive defects)

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2
Q

asthma drug therapy

A

1 - SABA (salbutamol) as required + low dose ICS (beclomethasone)

2 - + LABA (salmeterol)

3 - 4th drug - leuketriene (montelukast), methylxanthines (theophylline), LAMA (tiotropium), sodium cromoglicate in kids

4 - increase ICS dose or oral steriod (prednisolone) - used in primary exacerbation

5 - consider trials of anti-IgE (omalizumab)

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3
Q

how do you diagnose bronchiectasis?

A

HRCT showing -
dilation of airways - larger than accompanying pulmonary artery
thickening of bronchial walls
lack of tapering airways

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4
Q

who does bronchiolitis usually affected and what are the common causes?

A

viral respiratory condition that affects those ages 0-2 + causes inflammation of the bronchioles obstructing them

80% = respiratory syncytial virus (RSV)
metapneumovirus

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5
Q

drug therapy in COPD exacerbation

A

oxygen 24-28% - keep SaO2 between 88-92%
nebulised high dose salbutamol (SABA) + ipratropium (SAMA)
antibiotics if infection

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6
Q

when is triple therapy recommended for COPD patients?

A

LABA/LAMA/ICS

if frequent exacerbator or high eosinophilic count (>300)

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7
Q

what is Cor pulmonale?

A

right heart failure secondary to lung disease caused by chronic pulmonary hypertension

most common cause = COPD

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8
Q

clinical presentation of cor pulmonale

A 
SOB
peripheral oedema
syncope
hypoxia, cyanosis
raised JVP
3rd heart sound
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9
Q

name 2 anti-fibrotic drugs

A

pirfenidone - also anti-inflammatory

nintedanib - monoclonal antibody targeting tyrosine kinase

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10
Q

signs + symptoms of pulmonary fibrosis

A 
progressive breathlessness
exertional dyspnoea
dry cough
cyanosis, clubbing
fine-end inspiratory crackles
reduced lung volume (restrictive)
honeycomb lung on CT - advanced
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11
Q

whats the difference between transudates + exudates?

A

transudates = <30 g/L
–> fluid moving across into pleural space (congestive HF, hypoalbuminaemia, hypothyroidism)

exudates = >30g/L
–> increase leakiness of tissues into pleural space (malignancy, infection, inflammation)

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12
Q

signs + symptoms of pleural effusion

A

pleuritic chest pain
stoney dull to percuss
diminished breath sounds on affected side
blunting of costophrenic angles

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13
Q

management of pneumothorax

A

no SOB + <2cm = no treatment - follow up in 2-4weeks
SOB and/or >2cm = aspiration

if aspiration fails twice - chest drain

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14
Q

where do you insert a chest drain?

A

triangle of safety

  • 5th ICS
  • mid axillary line
  • anterior axillary line
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15
Q

management of tension pneumothorax

A

insert large bore cannula to 2nd ICS in midclavicular line

once pressure relieved, insert chest drain

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16
Q

will the aspiration of empyema be acidic or alkalotic?

A

acidic

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17
Q

what is first line treatment for patients with non small cell lung cancer?

A

surgery - if isolated to a single area

lobectomy, segmentectomy

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18
Q

name some extrapulmonary manifestations associated with lung cancer

A

recurrent laryngeal nerve palsy - hoarse voice, cancer pressing on recurrent laryngeal nerve

phrenic nerve palsy - weak diaphragm, SOB, ^ same cause

SVC obstruction - facial swelling, bulging neck + chest veins
–> pembertons sign

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19
Q

what is pembertons sign?

A

raising hands over head causes facial congestion + cyanosis

due to SVC obstruction - potential extra-pulmonary manifestation of lung cancer

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20
Q

name some paraneoplastic syndromes associated with small cell lung cancer

A

syndrome of inappropriate ADH (SIAD)

cushing’s syndrome - excessive cortisol

limbic encephalitis

lambert-eaton syndrome - autoimmune @ neuromuscular junctions

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21
Q

what is horner’s syndrome and what causes it?

A

triad of -
partial ptosis (drooping eyelid)
anhidrosis (difficulty sweating)
miosis (excessive constriction of pupil)

caused by pancoast tumour = tumour in pulmonary apex
–> presses on sympathetic ganglion

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22
Q

what causes SIADH?

Study These Flashcards
A

SIADH = syndrome of inappropriate ADH (anti-diuretic hormone)

caused by ectopic ADH secretion by small cell lung cancer
–> presents with hyponatraemia

23
Q

what is cushings syndrome? how does it present?

Study These Flashcards
A

high levels of cortisol

ectopic ACTH (stimulation of cortisol) secretion by a small cell cancer

weight gain, easy brusing, stretch marks, depression

24
Q

name some paraneoplastic syndromes associated with non-small cell lung cancer

Study These Flashcards
A

horner’s syndrome - pancoast tumour

hypercalcaemia - caused by ectopic parathyroid hormone
–> from squamous cell carcinome

25
what is lambert-eaton syndrome?
paraneoplastic syndrome from SMALL cell lung cancer a result of antibodies produced by immune system against cancer but also target + damage voltage-gated calcium channel @ presynaptic terminals in motor neurones symptoms - muscle weakness, ptosis, slurred speech, blurred vision
26
what are 3 auscultatory features you'd see in someone with pneumonia?
bronchial breath sounds - harsh breath sounds, equally loud on inspiration + expiration --> due to consolidation of tissue around airway focal coarse crackles - air passing through sputum dullness to percussion - lung tissue collapse and/or consolidation
27
what does CURB 65 predict?
predicts mortality 1 = <5% 3 = 15% 4/5 = > 25% treatment based on score 0/1 - home >=2 - hospital >= 3 - ICU assessment
28
what parameters does CURB65 involve?
Confusion Urea > 7 Respiratory rate >=30 BP - <90 systolic / <= 60 diastolic 65 or older
29
2 most common causes of pneumonia
streptococcus pneumoniae haemophilus influenzae
30
clinical features of mycoplasma pneumoniae
erythema multiforme - target lesions (pink rings with pale centres)
31
how do you diagnoses interstitial lung disease?
clinical features + HRCT (ground class appearance) if unclear - biopsy
32
what is hypersensitivity pneumonitis (extrinsic allergic alveolitis)? causes?
type III hypersensitivity reaction to environmental allergen that causes parenchymal inflammation + destruction ``` causes - bird-fanciers lung - bird droppings farmers lung - mouldy hay spores mushroom workers lung malt workers lung - mould on barely ```
33
how is hypersensitivity pneumonitis diagnosed?
bronchoalveolar lavage -- involves collecting cells from airway during bronchoscopy by washing with fluid then collecting fluid for testing --> shows raised lymphocytes + mast cells
34
why do patients with a PE commonly have a respiratory alkalosis when an ABG is performed?
high respiratory rate causes them to blow off extra CO2 low CO2 = alkalotic PE pO2 = low
35
initial management of PE
first line = apixaban or rivaroxaban (factor Xa inhibitors) LMWH (enoxaparin) where not suitable (antiphospholipid syndrome) --> given before diagnosis if DVT / PE suspected
36
long term anticoagulation
warfarin - target INR = 2-3 NOACs/DOACs - apixaban, dabigatran, rivaroxaban LMWH = first line in pregnancy + cancer
37
how long should you anticoagulate for post PE?
obvious reversible cause = 3 months unclear cause, recurrent VTE, thrombophilia = >3 months active cancer = 6 months then review
38
when would you use thrombolysis for a PE?
where there is a massive PE with haemodynamic compromise thrombolytic agents = streptokinase, alteplase
39
what type of bacteria causes tuberculosis?
myobacterium tuberculosis gram positive aerobic bacillus - acid-fast characteristics (resistant to staining) transmission = respiratory droplets
40
investigations for TB
ziehl-neelson stain - TB bacteria goes red against blue background CXR - linear opacities in upper lobe, lymphadenopathy, calcification, miliary disease, effusion, cavitation (reactivated) skin test - for LATENT TB
41
what would a CXR of someone with silicosis look like?
egg-shell calcification of hilar lymph nodes | inhalation of silica particles
42
what type of hypersensitivity reaction is TB?
type IV (cell-mediated - delayed) caseating granuloma
43
what is the treatment for active + latent TB?
rifampicin isoniazid pyrazinamide ethambutol active = RIPE for 2 months + RI for further 4 months latent = RI for 3 months
44
what are the side effects of the medication given for TB?
rifampicin - orange urine + tears isoniazid - neuropathy pyrazinamide - hyperuricaemia (excess uric acid in blood), V+D ethambutol - colour blindness RIP - all associated with hepatotoxicity
45
a patient is started on 4 medications to treat their TB. They start experiencing symptoms of neuropathy, what medication should be prescribed?
pyridoxine (vitamin B6) - usually prescribed prophylactically isoniazid causes neuropathy
46
how can latent TB become reactivated?
becoming immunocompromised --> HIV
47
clinical features of sarcoidosis
non-caseating - type IV hypersensitivity ``` dry cough erythema nodosum uveitis bilateral hilar lymphadenopathy fever, malaise, weight loss ``` increase serum ACE + Ca2+ peripheral nodular infiltration
48
what is the gold standard for confirming diagnosis of sarcoidosis?
US guided biopsy of mediastinal lymph nodes --> non-caseating granulomas with epithelioid cells
49
what causes alpha-1 antitrypsin deficiency? what can it cause?
common inherited conditon caused by lack of protease inhibitor produced by liver role of A1AT is to protect cells from enzymes such as neutrophil elastase --> causes emphysema (COPD) in young, non-smokers
50
how would you differentiate between acute tonsillitis and quinsy?
quinsy = a complication of tonsillitis trismus (difficulty opening the mouth) = a feature of quinsy (peritonsillar abscess)
51
what would an ABG of someone with long standing COPD look like?
type 2 resp failure (low pO2 + high pCO2) respiratory acidosis - over time becomes compensated by HCO₃ patients with longstanding COPD rely on hypoxic drive in order to drive respiration because the respiratory centre in their brain is insensitive to CO₂. Patients are therefore hypercapnic and exhibit type 2 respiratory failure. The longstanding hypercapnia eventually causes a respiratory acidosis which over time becomes compensated by HCO₃. These patients classically have a low % O2 and high CO2.
52
Which organism commonly causes pneumonia in immunocompromised patients?
Pneumocystis jiroveci
53
What is the pattern of inheritance shown by alpha-1 antitrypsin deficiency?
autosomal recessive

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