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Alice's finals cards > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Which type of lung cancer is responsible for multiple paraneoplastic syndromes and why?

A

SCLC because the cells contain neurosecretory hormones which secrete neuroendocrine hormones

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2
Q

What are the signs and symptoms of lung cancer?

A 
Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy
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3
Q

What investigations should be done for lung cancer?

A

Chest x-ray

Staging CT scan

PET-CT

Bronchoscopy

Histology

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4
Q

What may be seen on a chest x-ray of lung cancer?

A

Hilar enlargement
Peripheral opacity
Pleural effusion
Collapse

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5
Q

What can a hoarse voice in the context of lung cancer suggest?

A

Recurrent laryngeal palsy

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6
Q

What is pemberton’s sign and what does it suggest?

A

When raising hands over the head causes facial congestion and cyanosis. It is a sign of superior vena cava obstruction

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7
Q

Which tumour causes Horner’s syndrome?

A

Pancoast’s tumour. Presses on the sympathetic ganglion

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8
Q

Why can small cell lung cancer cause lambert-eaton?

A

Antibodies are produced against the SCLC, they also target and damage voltage-gated calcium channels on the presynaptic terminals in the motor neurones

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9
Q

How is pneumonia seen on chest x-ray?

A

Consolidation

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10
Q

How is pneumonia labelled as either community or hospital?

A

If it is acquired outside of hospital then it is labelled as community. If it is acquired >48 hours after admission to hospital then it is hospital acquired pneumonia

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11
Q

What are the chest signs of pneumonia?

A

bronchial breath sounds
Focal coarse crackles
Dullness to percussion

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12
Q

What scoring assessment is used in pneumonia to estimate the mortality?

A

CURB-65

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13
Q

What are the common causes of pneumonia?

A 
Streptococcus pneumoniae (50%)
haemophilus influenzae (20%)
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14
Q

How does legionella pneumonia present?

A

Hyponatraemia because it causes SIADH

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15
Q

Which bacteria causes a pneumonia which presents alongside target lesions?

A

Mycoplasma pneumoniae. Causes erythema multiforme which leads to the target lesions on the skin. May also cause neurological symptoms in a younger patient

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16
Q

What can cause pneumonia in those who are immunocompromised?

A

Pneumocystis jirovecii (PCP). Usually occurs in those who have poorly controlled or new HIV with a low CD4 count

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17
Q

What does obstructive lung disease show on spirometry?

A

FEV1 less than 75%, FEV1:FVC <75%

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18
Q

What does restrictive lung disease show on spirometry?

A

FEV1 and FVC are equally reduces so the FEV1:FVC is >75%

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19
Q

Is asthma obstructive or restrictive?

A

Obstructive

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20
Q

Give some examples of typical triggers for asthma

A 
Infection
Night time or early morning
Exercise
Animals
Cold/damp
Dust
Strong emotions
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21
Q

What type of wheeze is heard in asthma?

A

Bilateral widespread “polyphonic” wheeze

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22
Q

What are the first line investigations for asthma?

A

Fractional exhaled nitric oxide

Spirometry with bronchodilator reversibility

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23
Q

Give an example of a LABA

A

Salmeterol

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24
Q

Give an example of a LAMA

A

Tiotropium

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25
Q

Give an example of a leukotriene receptor antagonist

A

Montelukast

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26
Q

What is the monitoring for theophylline?

A

Levels after 5 days and 3 days after any dose changes

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27
Q

What is the stepwise management of asthma (8 steps)

A
  1. SABA
  2. SABA+ ICS
    • leukotrine receptor agonist
  4. +LABA
  5. Change to MART
  6. Increase ICS to moderate dose
  7. Increase ICS to high or theophylline or LAMA
  8. Refer to specialist
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28
Q

What is MART regime?

A

A combination inhaler containing a low dose inhaled ICS and a fast acting LABA

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29
Q

What does a PEFR of 50-75% of predicted suggest?

A

Moderate acute asthma

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30
Q

What does a PEFR of 33-50% of predicted suggest?

A

Severe acute asthma

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31
Q

What does a PEFR of <33% suggest?

A

Life threatening asthma

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32
Q

How is moderate acute asthma managed?

A

Nebulised salbutamol
Nebulised ipratropium bromide
Steroids
Oxygen

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33
Q

How is severe acute asthma managed?

A

Oxygen to maintain sats at 94-98%
Aminophylline infusion
IV salbutamol

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34
Q

How is life threatening asthma managed?

A

IV magnesium sulphate

Intubation

35
Q

What does an ABG in acute asthma show?

A

Respiratory alkalosis due to tachypnoea causing a drop in CO2

36
Q

What needs to be monitored when salbutamol is used?

A

Serum potassium. Causes serum hypokalaemia

Also causes tachycardia

37
Q

What are the 5 stages of the MRC dyspnoea scale?

A

1- breathless on strenuous exercise
2- breathless on walking up hill
3- breathless that slows walking on the flat
4- stop to catch breath after 100m on the flat
5- unable to leave house due to breathlessness

38
Q

How is a diagnosis of COPD made?

A

By clinical presentation and spirometry

FEV1:FVC <0.7

39
Q

What is the management of COPD?

A

SABA or short acting antimuscarinics (ipatropium bromide)

Plus either:
LABA and LAMA if no asthmatic features

OR

LABA and ICS if asthmatic features

40
Q

What are the features of type 1 respiratory failure?

A

Normal pCO2 with low PO2

41
Q

What are the features of type 2 respiratory failure?

A

Raised pCO2 and low PO2

42
Q

What is the O2 sats target in patients who are retaining CO2?

A

88-92%

43
Q

What is a contraindication for biPAP?

A

Pneumothorax

44
Q

Which investigation is used to diagnose interstitial lung disease? What is the finding?

A

HRCT and it shows a ground glass appearance

45
Q

What can be found on examination in idiopathic pulmonary fibrosis?

A

Bibasal fine inspiratory crackles and finger clubbing

46
Q

Which two medications can be used to slow the progression of idiopathic pulmonary fibrosis?

A

Pifenidone

Nintedanib

47
Q

Which drugs can cause pulmonary fibrosis?

A

Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin

48
Q

What type of hypersensitivity reaction in hypersensitivity pneumonitis?

A

Type III

49
Q

How is hypersensitivity pneumonitis diagnosed

A

Bronchoalveolar lavage which shows raised lymphocytes and mast cells

50
Q

What are the two types of pleural effusion and what is the difference?

A

There is exudative and transudative

Exudative means there is a high protein count >3g/dL

Transudative means there is a lower protein count <3g/dL

51
Q

What causes exudative pleural effusion?

A

Lung cancer
Pneumonia
Rheumatoid arthritis
Tuberculosis

52
Q

What causes transudative pleural effusion?

A

Congestive cardiac failure
Hypoalbuminaemia
Hypothyroidism
Meig’s syndrome

53
Q

What is the presentation of pleural effusion?

A

SOB
Dullness to percussion
Reduces breath sounds
Tracheal deviation away from the effusion

54
Q

What is seen on a chest X-ray of a pleural effusion?

A

Blunting of the costophrenic angle
Fluid in the lung fissures
Larger effusions have a meniscus
Tracheal deviation

55
Q

What is the management of pleural effusion?

A

Conservative if small

Pleural aspiration

Chest drain

56
Q

What is seen on pleural aspiration in empyema?

A

Pus, acidic pH (<7.2), low glucose, high LDH

57
Q

What is the investigation of choice in pneumothorax?

A

Erect chest x-ray

58
Q

What is the management for a pneumothorax with a <2cm rim of air

A

No treatment is required, should resolve spontaneously

59
Q

What is the management for a pneumothorax with a >2cm rim of air and SOB?

A

Aspiration

If aspiration fails twice then chest drain

60
Q

What are the signs of tension pneumothorax?

A 
Tracheal deviation away from the side of the pneumothorax
Reduces air entry to affected side
Increased resonance on affected side
Tachycardia
Hypotension
61
Q

What is the management of a tension pneumothorax?

A

Insert a large bore cannula into the second intercostal space in the midclavicular line

62
Q

Where should chest drains be inserted?

A

The triangle of safety made up by:
5th intercostal space
Mid axillary line
anterior axillary line

63
Q

What is the main contraindication for compression stockings?

A

Peripheral arterial disease

64
Q

What should patients at risk of DVT or PE be given?

A

LMWH for example enoxaparin

65
Q

What is the presentation of PE?

A 
SOB
Cough, woith or without haemoptysis
Pleuritic chest pain
Hypoxia
Tachycardia
Raised respiratory rate
Low grade fever
66
Q

What does the outcome of a well’s score suggest?

A

If likely do a CT pulmonary angiogram/ proximal vein ultrasound, if unlikely to a d-dimer and if positive do a CTPA/ proximal vein ultrasound

67
Q

Which investigation for PE should be done if a CTPA is contraindicated?

A

Ventilation-perfusion scan (VQ scan)

68
Q

What is the initial recommended treatment for PE?

A

Apixaban or rivaroxaban

69
Q

In which disease are DOACs contraindicated?

A

Antiphospholipid syndrome. LMWH should be used instead

70
Q

How long should anticoagulation be continued after PE?

A

3 months if there is an obvious reversible cause

Beyond 6 months if the cause is unclear, there is recurrent VTE or there is an irreversible underlying cause

6 months in active cancer

71
Q

What is seen on an ECG in pulmonary hypertension?

A

Right ventricular hypertrophy
Right axis deviation
RBBB

72
Q

What is seen on x-ray in pulmonary hypertension?

A

Dilated pulmonary arteries

Right ventricular hypertrophy

73
Q

How can primary pulmonary hypertension be managed?

A

IV prostanoids
Endothelin receptor agonists
Phosphodiesterase-5 inhibitors (sildenafil)

74
Q

What are granulomas?

A

Nodules of inflammation full of macrophages

75
Q

What are the extra-pulmonary manifestations of sarcoidosis?

A

Erythema nodosum and lymphadenopathy
Fever
Fatigue
Weight loss

76
Q

What are the pulmonary manifestations of sarcoidosis?

A

Lymphadenopathy
Pulmonary fibrosis
Pulmonary nodules

77
Q

What is the presentation of lofgren’s syndrome?

A

Bilateral hilar lymphadenopathy
Polyarthralgia
Erythema nodosum

78
Q

What is seen on bloods in someone with sarcoidosis?

A 
Raised serum ACE
Hypercalcaemia
raised serum soluable interleukin-2 receptor
Raised CRP
Raised IgG
79
Q

What is the gold standard test for sarcoidosis and what does it show?

A

Histology showing non-caseating granulomas with epitheliod cells

80
Q

What is the management of sarcoidosis?

A

Often resolves in 6 months
Oral steroids
Lung transplant in very serious lung disease

81
Q

What causes obstructive sleep apnoea?

A

Collapse of the pharyngeal airway during sleep

82
Q

Which scale is used to assess OSA?

A

Epworth sleepiness scale

83
Q

What is the management of OSA?

A

lose weight

CPAP or surgery

Alice's finals cards (21 decks)

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