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PACES - Final Week Revision > Respiratory > Flashcards

Respiratory Flashcards

(55 cards)

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1
Q

I would complete my resp examination by checking

A

Sputum culture
Pulse oximetry
Observation charts
X-rays (recent)

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2
Q

Causes of apical fibrosis

A

ROAAST:
Radiation
Occupational exposure diseases
Allergic reactions (ABPA, EAA)
Ankylosing spondylitis
Sarcoidosis
Tuberculosis

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3
Q

Causes of lower zone fibrosis

A

Idiopathic pulmonary fibrosis
Rheumatoid arthritis
Scleroderma, Sjogren, SLE
Asbestosis
Drugs (methotrexate, amiodarone, nitrofurantoin)

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4
Q

Light’s criteria for Exudate pleural effusion?

A

Pleural fluid to serum protein > 0.5
Pleural fluid to serum LDH > 0.6
Pleural fluid LDH value > 2/3 of the upper limit of the normal serum value

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5
Q

Causes of Exudate pleural effusion

A

Pneumonia
Pulmonary embolism
Cancer
Tuberculosis
Autoimmune conditions

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6
Q

Causes of Transudate pleural effusion

A

Liver cirrhosis
Congestive cardiac failure
Nephrotic syndrome

Because they create an increase in the hydrostatic pressure or low plasma oncotic pressure

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7
Q

Alpha-1-antitrypsin deficiency

A

COPD/Emphysema —> bronchiectasis
Liver cirrhosis
Necrotising panniculitis

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8
Q

Kartagener’s syndrome

A

Bronchiectasis (from primary ciliary dyskinesia)
Situs inversus / dextrocardia
Sinusitis
Azoospermia

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9
Q

Causes of pulmonary hypertension

A

Primary
Aortic & Mitral valve pathology
Chronic PEs
ILD
COPD

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10
Q

Treatment of Idiopathic Pulmonary Fibrosis

A

Nindetanib (tyrosine protein kinase inhibitor)
Pirfenidone
Consider Sildenafil

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11
Q

Indications for VATS

A

Lung/pleura/LN biopsy
Wedge resection
Lobectomy
Pleurodesis

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12
Q

Management of Resp conditions, to include

A

Multidisciplinary approach including specialist physicians, OT, PT, patient’s GP
Patient education
Lifestyle modification including smoking
Vaccines
Pulmonary rehab

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13
Q

Indications for pneumonectomy

A

Malignancy
Bronchiectasis
Tuberculosis

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14
Q

Indications for lobectomy

A

Non-small cell lung cancer
Bronchiectasis
Tuberculosis or abscess
Lung volume reduction

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15
Q

Indications for thoracoplasty

A

= removal of ribs

Tuberculosis
Empyema

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16
Q

Types of lung cancer

A

Small cell carcinoma

Non-small cell includes:
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma

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17
Q

Typical features of squamous cell lung cancer

A

Central cavitating lesion
Heavy smoker
Paraneoplastic syndromes:
- Hypercalcaemia (PTHrP)
- Hyperthyroidism (TSH)

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18
Q

Characteristics of adenocarcinoma lung cancer

A

Most common type of lung cancer 40%
Common in women & non-smokers
Peripheral solid lesion
Metastasises early
Hypertrophic pulmonary osteoarthropathy

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19
Q

Typical features of large cell carcinoma

A

Start in the bronchial tubes
Early mets
Copious sputum

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20
Q

Characteristics & Complication of small cell lung cancers

A

Central cavitating lesion
Associated with smoking
Early mets
Paraneoplastic endocrine phenomena:
- Hypercalcaemia from PTHrP release
- Lambert-Eaton myasthenia gravis

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21
Q

Management of non-small cell lung cancer

A

Surgery
Radical radiotherapy
Platinum-based chemotherapy

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22
Q

Management of small cell lung cancer

A

Likely to have metastasised and cause endocrine complications

Radiotherapy or chemotherapy may be offered.
No surgery.

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23
Q

Management of tuberculosis

Study These Flashcards
A

Quadruple therapy for 2 months (including pyrazinamide and ethambutol)
Then continue Rifampicin & Isoniazid

Alongside pyridoxine

24
Q

Side-effects of TB drugs

Study These Flashcards
A

Rifampicin - drug interactions, orange fluids
Isoniazid - peripheral neuropathy (treat with Pyridoxine)
Pyrazinamide - gout
Ethambutol - retrobulbar neuritis

All are hepatotoxic

25
Problems following transplant:
GARLIC T: Graft dysfunction Acute or chronic rejection Recurrence of original disease Lymphoproliferative disease Infections Cancers Toxicity from immunosuppressant drugs
26
Causes of clubbing
Idiopathic Interstitial lung disease Bronchiectasis Lung cancer Cyanotic congenital heart disease Infective endocarditis Chronic liver disease Inflammatory bowel disease Thyroid acropachy
27
Causes of Bronchiectasis
CCCCBA: Cystic fibrosis and Kartagener’s COPD Cancer of the bronchus Congenital immunodeficiency ABPA Autoimmune
28
Management of Bronchiectasis
Regular postural drainage Antibiotic prophylaxis with pseudomonas cover Mucolytics Inhalers with steroids
29
Cystic fibrosis mutation
CFTR gene on chromosome 7 (delta 508)
30
Cystic fibrosis extra-pulmonary manifestations
Pancreatic insufficiency (steatorehoea, gallstones) Méconium ileus Distal intestinal obstruction syndrome Infertility Insulin-dependent diabetes
31
Respiratory causes of finger clubbing
Lung cancer Interstitial lung disease Chronic suppurative lung disease such as CF, Bronchiectasis and lung empyema
32
Most common type of lung cancer
Adénocarcinoma of the lung
33
Indications for lung transplant (4)
ILD (single) COPD (double) Cystic fibrosis (double) Primary Pulmonary hypertension (with heart)
34
Criteria for lung transplant
1) >50% risk of death due to lung disease within 2 years if lung transplantation is not performed; 2) > 80% likelihood of surviving at least 90 days after lung transplantation; 3) >80% likelihood of 5-year post-transplant survival from a general medical perspective
35
Differentials for bibasal crepitations
Bronchiectasis ILD Bilateral pneumonias Congestive heart failure
36
Spirometer results for ILD
Restrictive pattern with: Reduced FEV1 Reduced FVC Maintained FEV1/FVC ratio Reduced total lung capacity Reduced transfer factor
37
Para pneumonic effusion management
Antibiotics Chest drain if tap showed: - pH <7.2 - Frank pus - Positive cultures
38
Mutated gene of cystic fibrosis
CFTR gene (chromosome 7) leads to increase sodium excretion causing thicker mucus
39
Cystic fibrosis manifestations
Bronchiectasis Chronic pancreatic insufficiency Liver failure Gallstones Constipation and distal intestinal obstruction Kidney stones Infertility
40
Treatment of cystic fibrosis
MDT approach Prophylactic Azithromycin Chest physio Nebulisers and mucolytics Fat-soluble vitamins Creon Nutritional supplements via peg-tubes
41
Severity grading for COPD
Mild - FEV1 >80% Moderate - FEV1 50-80% Severe - FEV1 30-50% Very severe - FEV1 <30%
42
Spirometry findings for COPD
Obstructive pattern FEV1 <80% FVC normal FEV1/FVC ratio <0.7
43
COPD CXR findings
Hyperinflation Flattened Hemi-diaphragms
44
Bronchiectasis CT findings
Signed ring sign (bronchi larger than vasculature) Bronchial wall thickening
45
Blood tests for Bronchiectasis
Immunoglobulins Aspergillus IgE HIV RF Alpha-1antitrypsin deficiency CF genetic mutation analysis
46
Bronchiectasis examination findings
Clubbing Inspiration clicks Coarse inspiration crepitations Large airway ronchi
47
Suitability for surgical lung resection
FEV1 >1.5L for lobectomy FEV1 >2L for pneumonectomy
48
Complications of Asbestos exposure
Pleural plaques Diffuse pleural thickening Pleural effusions Asbestosis Increased risk of lung cancer and mesothelioma
49
Extrinsic allergic alveolitis examples
Bird fanciers lungs Hot tub lung Mushroom workers lung Malt workers lung
50
Extrinsic allergic alveolitis hypersensitivity type
Acute —> type 3 (immune complex mediated) Chronic —> type 4 (cell mediated)
51
Occupational lung disease examples
Silicosis Berylliosis Coal worker’s pneumoconiosis
52
Examples of interstitial lung disease
UIP NSIP Cryptogenic organising pneumonia
53
Management of interstitial lung disease
Lifestyle Immunisations Steroid Oxygen at home Trials
54
Types of Bronchiectasis
Cylindrical Varicose Cystic
55
Criteria for LTOT (2)
2 ABGs at least 2 weeks apart with either: - PaO2 <7.3 - PaO2 <8 and Polycythaemia or nocturnal hypoxaemia or peripheral oedema or pulmonary hypertension

PACES - Final Week Revision (7 decks)

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