Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Give the histological types of lung cancer

A

Non-small cell:
1. Adenocarcinoma
2. Squamous cell carcinoma
3. Large cell carcinoma

Small cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give the presentation of lung cancer

A
  1. SOB
  2. Cough (+/- haemoptysis)
  3. Weight loss
  4. Lymphadenopathy
  5. Finger clubbing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give the investigations for lung cancer

A
  1. CXR (hilar lymphadenopathy, visible tumour, unilateral pleural effusion)
  2. Staging CT scan
  3. PET-CT
  4. Bronchoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give the management of lung cancer

A

Non-small cell:
1. Surgery
2. Radiotherapy
3. Chemotherapy

Small cell:
1. Chemotherapy
2. Radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give the extra-pulmonary manifestations of lung cancer

A
  1. Recurrent laryngeal nerve palsy (hoarse voice)
  2. Phrenic nerve palsy (SOB)
  3. SVC obstruction (facial swelling, difficulty breathing, distended neck veins)
  4. Horner’s syndrome (ptosis, anhidrosis, miosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give the pathophysiology of Lambert-Eaton myasthenic syndrome

A

Caused by antibodies produced in response to small-cell lung cancer cells, which attack motor neurones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give the presentation of Lambert-Eaton myasthenic syndrome

A

Proximal muscle weakness

Ocular muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give the investigations for mesothelioma

A

Diagnosis of a mesothelioma is made on histology, following a thoracoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give the aetiology of mesothelioma

A

Asbestos inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Give the pathophysiology of pneumonia

A

Infection (commonly by Strep. pneumoniae) of the lung tissue causing inflammation, and resulting in sputum filling the airways and alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the classification of pneumonia

A
  1. Community-acquired: develops outside of hospital
  2. Hospital-acquired: develops >48 hours after hospital admission
  3. Aspiration pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Give the causative organisms of pneumonia

A
  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Staphylococcus aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Give the presentation of pneumonia

A
  1. SOB
  2. Productive cough (sputum or blood)
  3. Fever
  4. Pleuritis chest pain (sharp, worse on inspiration)
  5. Delirium
  6. Sepsis
  7. Tachypnoea/tachycardia/hypoxia/hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give the chest signs seen in pneumonia

A
  1. Focal coarse crackles
  2. Bronchial breath sounds
  3. Dullness to percussion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which scoring system is used to assess the severity of community acquired pneumonia?

A

CURB-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the CURB-65 score

A

C- confusion
U- urea > 7
R- resp. rate =/> 30
B- BP =/< 90 systolic or =/< 60 diastolic
65- age =/> 65

Score:
0/1: treat at home
2: hospital management
3: ICU management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the management of atypical pneumonia

A

CLARITHROMYCIN

Pneumonia where the organism can not be cultured.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give the investigations for pneumonia

A
  1. CXR - consolidation
  2. FBC (raised WCC)
  3. U+Es (for urea)
  4. CRP
  5. Sputum/blood cultures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give the management of pneumonia

A
  1. PO amoxicillin (mild)
  2. PO/IV Amoxicillin PLUS clarithromycin (severe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Give the complications of pneumonia

A
  1. Sepsis
  2. Pleural effusion
  3. Empyema
  4. Lung abscess
  5. Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define asthma

A

A chronic inflammatory condition of the airways, causing episodic exacerbations of bronchoconstriction. This causes airway obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Is asthma reversible?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the presentation of asthma

A
  1. Episodic symptoms
  2. Diurnal variability (worse at night)
  3. Dry cough, wheeze, SOB
  4. Hx of atopy
  5. FHx
  6. Bilateral wheeze
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the investigations for asthma

A
  1. Can treat based upon clinical suspicion
  2. Spirometry - shows reversible obstruction
  3. Peak flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe the management of asthma

A
  1. SABA (salbutamol)
  2. ICS (beclometasone)
  3. Leukotriene receptor agonist (montelukast)
  4. LABA (salmeterol)
  5. LAMA (tiotropium)
  6. Theophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe the presentation of an asthma exacerbation

A
  1. SOB
  2. Tachypnoea
  3. Use of accessory muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the grading system used for asthma exacerbation

A

Moderate: PEFR 50-75%

Severe: PEFR 33-50% (RR>25, HR>110, unable to complete sentences)

Life threatening: PEFR <33% (sats <92%, silent chest, haemodynamic instability)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe the management of acute exacerbations of asthma

A
  1. Nebulised salbutamol (IV if severe)
  2. Nebulised ipratropium
  3. Oral prednisolone/IV hydrocortisone
  4. Oxygen (to maintain sats 94-98%)
  5. IV magnesium sulfate
  6. IV aminophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe the ABG changes seen in acute exacerbation of asthma

A

Respiratory alkalosis

(Respiratory acidosis if life-threatening)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Give 1 side effect of salbutamol

A

Hypokalaemia - must monitor U&Es

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Describe reversibility testing

A

Give salbutamol and repeat spirometry to see if the results improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Describe FEV1

A

Forced expiratory volume in 1 second - reduced in obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe FVC

A

Forced vital capacity - reduced in restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Describe the pattern seen on spirometry in obstruction

A

FEV1 <75% of FVC (FEV1:FVC <75%)

Good volume but air is struggling to flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Describe the pattern seen on spirometry in restriction

A

FEV1 and FVC reduced equally (FEV1:FVC >75%)

Inability of lungs to expand and take in air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Define COPD

A

Non-reversible, long-term deterioration of air flow through the lungs (obstruction) - making it more difficult to ventilate, and individuals more prone to infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Describe the presentation of COPD

A
  1. Smoker
  2. Chronic SOB
  3. Productive cough
  4. Wheeze
  5. Recurrent respiratory tract infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Describe the investigations for COPD

A
  1. Spirometry PLUS clinical presentation (shows obstructive pattern)
  2. No dramatic response to reversibility testing
  3. CXR - exclude other causes
  4. Sputum culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Give the management of COPD

A
  1. Stop smoking
  2. Pulmonary rehabilitation
  3. Oxygen therapy where appropriate

Step 1: SABA or SAMA (salbutamol or ipratropium)

Step 2: Add LABA and LAMA (salmeterol and tiotropium) - if asthma/steroid unresponsive
OR
LABA and ICS (salmeterol and beclomethasone) - if asthma/steroid responsive (e.g. Hx atopy, FEV1 variation with time)

Step 3: Add ICS (beclomethasone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Describe a COPD exacerbation

A

Worsening of symptoms due to viral or bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Describe the ABG findings in acute COPD exacerbation

A

Respiratory acidosis

Reduced O2 indicates respiratory failure
Normal pCO2 indicates type 1 resp. failure
Raised pCO2 indicates type 2 resp. failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Give the management of acute COPD exacerbation

A

Aim for 88-92% sats

  1. Salbutamol
  2. Steroids
  3. Abx (amoxicillin, doxycycline, co-amoxiclav)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Describe interstitial lung disease

A

Conditions which affect the lung parenchyma - causing inflammation and fibrosis.

Replacement of normal elastic tissue with scar tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Give the presentation of interstitial lung disease on CT

A

“Ground glass” appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Give the management of interstitial lung disease

A
  1. Remove or treat underlying cause
  2. Home oxygen
  3. Physiotherapy and pulmonary rehab
  4. Advanced care planning and palliative care where appropriate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Give the presentation of idiopathic pulmonary fibrosis

A
  1. Insidious onset SOB and dry cough
  2. Bibasal fine crackles
  3. Finger clubbing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Give the management of idiopathic pulmonary fibrosis

A
  1. Pirfenidone - antifibrotic
  2. Nintedanib - monoclonal antibody

Both act to slow progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Give causes of drug-induced fibrosis

A
  1. Amiodarone
  2. Cyclophosphamide
  3. Methotrexate
  4. Nitrofurantoin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Give causes of secondary causes interstitial fibrosis

A
  1. Alpha-1-antitrypsin deficiency
  2. Rheumatoid arthritis
  3. SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Describe hypersensitivity pneumonitis

A

Type III hypersensitivity reaction to an environmental allergen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Give the management of hypersensitivity pneumonitis

A

Bronchoalveolar lavage

Remove allergen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Give 2 examples of hypersensitivity pneumonitis

A
  1. Bird fancier’s lung
  2. Farmer’s lung
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Describe pleural effusion

A

Collection of fluid in the pleural cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Give the classification of pleural effusion

A
  1. Exudative: high protein count
  2. Transudative: low protein count
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Give the causes of pleural effusion

A

Exudative (inflammation): lung cancer, pneumonia, TB

Transudative (fluid shift): congestive heart failure, hypoalbuminaemia, Meig’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Describe Meig’s syndrome

A

Right sided pleural effusion secondary to ovarian malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Give the presentation of pleural effusion

A
  1. SOB
  2. Dullness to percussion
  3. Reduced breath sounds
  4. Tracheal deviation (away from effusion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Give the investigations for pleural effusion

A

CXR:
1. Blunting of the costophrenic angle
2. Fluid in lung fissures
3. Meniscus (curving upward where lung meets chest wall)
4. Tracheal/mediastinal deviation

Effusion fluid sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Give the management of pleural effusion

A
  1. Conservative if small
  2. Pleural aspiration (relieves pressure but may recur)
  3. Chest drain (definitive)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Define empyema

A

Infected pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Give the presentation of empyema

A
  1. New or ongoing fever despite management on a patient with pneumonia
  2. Pleural aspiration shows pus, pH<7.2, low glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Give the management of empyema

A

Chest drain and antibiotics

63
Q

Define pneumothorax

A

Where air has entered the pleural space, separating the lung from the chest wall.

64
Q

When are antibiotics given in the management of acute exacerbations of COPD?

A

In the presence of purulent sputum or clinical signs of pneumonia

65
Q

Give the causes of pneumothorax

A
  1. Spontaneous (young, tall, thin man playing sports)
  2. Trauma
  3. Iatrogenic (e.g. lung biopsy, mechanical ventilation)
  4. Asthma/COPD
66
Q

Give the investigations for pneumothorax

A
  1. Erect CXR (allows for full expansion of the chest) - area between lung and chest wall with no lung markings
  2. CT thorax - to identify smaller pneumothorax
67
Q

Give the management of pneumothorax

A
  1. If small may spontaneously resolve
  2. If SOB or large pneumothorax: aspiration or chest drain
68
Q

Define tension pneumothorax

A

One way valve created by chest trauma that allows air into, but not out of, the pleural space.

69
Q

Give the pathophysiology of tension pneumothorax

A
  1. Air allowed to enter, but not leave, the pleural space
  2. Pneumothorax enlarges with each breath
  3. Pressure is created which causes mediastinal shift, pressure on the vasculature around the heart, and cardio-respiratory arrest
70
Q

Describe the presentation of tension pneumothorax

A
  1. Tracheal deviation away from pneumothorax
  2. Reduced air entry on affected side
  3. Increased resonance to percussion on affected side
  4. Tachycardia
  5. Hypotension
71
Q

Give the management of tension pneumothorax

A
  1. “Insert a large bore cannula into the second intercostal space at the midclavicular line” to aspirate the pneumothorax - needle decompression
  2. Chest drain - definitive
72
Q

Describe a positive reversibility testing

A

An increase in the FEV1 of 12% or more after inhalation of a short-acting bronchodilator is indicative of asthma

Prescribe SABA +/- ICS

73
Q

Which lung cancer is associated with gynaecomastia?

A

Associated with adenocarcinoma of the lung

74
Q

Which histological variety of lung cancer most commonly causes hypokalaemia

A

SIADH is a paraneoplastic feature of small-cell lung cancer

75
Q

Can breastfeeding women take prednisolone?

A

Yes

76
Q

Define pulmonary embolism

A

Where a thrombus forms in the pulmonary arteries - commonly as a result of DVT. This blocks blood supply to the lung tissue, reducing perfusion and putting strain on the right side of the heart.

77
Q

Give the risk factors for pulmonary embolism

A
  1. Immobilisation
  2. Surgery
  3. Long-haul flights
    4.Oestrogen-based medications
  4. Pregnancy
  5. Malignancy
78
Q

Give the management of DVT risk in hospital

A

LMWH - e.g. enoxaparin

79
Q

Give the presentation of pulmonary embolism

A
  1. SOB
  2. Cough +/- haemoptysis
  3. Pleuritic chest pain
  4. Hypoxia
  5. Tachycardia
  6. Tachypnoea
  7. Hypotension (sign of haemodynamic instability)
80
Q

What does the Wells score assess?

A

The likelihood of venous thromboembolism in those presenting with appropriate symptoms

81
Q

Describe the diagnosis of pulmonary embolism

A

Wells score outcome:
1. PE Likely: CT pulmonary angiogram
2. PE Unlikely: D-Dimer
a) If D-Dimer positive: CTPA

The vast majority of chest x rays in patients with PEs are normal.

If renal impairment (and therefore unsuitable for CTPA - due to contrast) - ventilation perfusion scan. Compares the ratio of ventilation:perfusion - in PE the lungs will be ventilated but not perfused.

82
Q

Give the management of mild pulmonary embolism with no haemodynamic instability

A
  1. Oxygen
  2. Analgesia

Initial management: apixaban/rivaroxaban (LMWH if not suitable - e.g. in antiphospholipid syndrome)

Long term anticoagulation: warfarin, NOAC or LMWH
Continue for:
- 3 months if reversible cause
- >3 months if unsure of cause or irreversible cause
- 6 months in active cancer

83
Q

When switching from LMWH to warfarin, how long should LMWH be continued for

A

5 days

Or until INR 2-3 for 24 hours

84
Q

Describe the management of massive pulmonary embolism with haemodynamic instability

A

Thrombolysis - acts as fibrinolytic

e.g. IV alteplase/streptokinase

85
Q

Define pulmonary hypertension

A

Increased resistance and pressure of blood in the pulmonary arteries - putting strain on the right heart and causing a back log of blood through the systemic venous system

86
Q

Describe the aetiology of pulmonary hypertension

A
  1. Primary pulmonary hypertension
  2. SLE
  3. Left sided heart failure (e.g. due to MI)
  4. COPD
  5. PE
87
Q

Describe the presentation of pulmonary hypertension

A
  1. SOB
  2. Syncope
  3. Tachycardia
  4. Raised JVP
  5. Peripheral oedema
  6. Hepatomegaly
88
Q

Describe the investigations for pulmonary hypertension

A

ECG:
1. Right ventricular hypertrophy
2. Right axis deviation
3. RBBB

CXR:
1. Dilated pulmonary arteries
2. Right ventricular hypertrophy

89
Q

Describe the presentation of right ventricular hypertrophy on ECG

A

Large R waves on V1-V3 (R side leads)

Large S waves on V4-V6 (L side leads)

90
Q

Describe the presentation of right axis deviation on ECG

A

Positive QRS in II, III, aVF

Negative QRS in I, aVL

91
Q

Give the management of pulmonary hypertension

A
  1. Treat underlying cause
  2. IV prostanoids (e.g. epoprosterol)
  3. Endothelin receptor antagonist (e.g. macitentan)
  4. Supportive management - very poor prognosis
92
Q

Define sarcoidosis

A

Granulomatous inflammatory condition with unknown aetiology - usually presenting with respiratory symptoms, but with many extra-pulmonary manifestations

93
Q

Give the presentation of sarcoidosis

A
  1. Erythema nodosum
  2. Lymphadenopathy (mediastinal)
  3. Pulmonary fibrosis
  4. Lupus pernio - raised purple lesions on cheek and nose
94
Q

Define Lofgren’s syndrome

A

Classical presentation of sarcoidosis. Triad of:

  1. Erythema nodosum
  2. Bilateral hilar lymphadenopathy
  3. Polyarthralgia
95
Q

Describe the investigations for sarcoidosis

A
  1. Raised serum ACE
  2. Hypercalcaemia
  3. CXR - hilar lymphadenopathy
  4. Biopsy
96
Q

Give the management of sarcoidosis

A

No treatment - often resolves spontaneously

If symptomatic:
1. Oral steroids (+bisphosphonate)
2. Methotrexate
3. Lung transplant

97
Q

Give the indications for corticosteroid use in sarcoidosis management

A
  1. Parenchymal lung disease
  2. Uveitis
  3. Hypercalcaemia
  4. Neurological/cardiac involvement
98
Q

Define obstructive sleep apnoea

A

Collapse of the pharyngeal airway during sleep, leading to a temporary cessation of breathing

99
Q

Give the risk factors for obstructive sleep apnoea

A
  1. Middle age
  2. Obesity
  3. Male
  4. Alcohol and smoking
100
Q

Give the presentation of obstructive sleep apnoea

A

Often reported by partner as occurs during sleep

  1. Apnoeic episodes during sleeop
  2. Snoring
  3. Morning headache
  4. Daytime tiredness
101
Q

Give the management of obstructive sleep apnoea

A
  1. Address risk factors (e.g. weight, smoking)
  2. ENT/sleep specialist referral for sleep studies
  3. CPAP
  4. Surgery - uvulopalatopharyngoplasty
102
Q

Which landmarks form the triangle of safety for chest drain insertion?

A

The triangle of safety for chest drain insertion involves the base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi

103
Q

Give the presentation, prevention and management of acute mountain syndrome

A

Presentation:
1. headache
2. nausea
3. fatigue

Prevention:
1. Acetazolamide

Management:
1. Descent

104
Q

Give the presentation and management of high altitude pulmonary oedema

A

HAPE presents with classical pulmonary oedema features

Management:
1. descent
2. dexamethasone
3. nifedipine, acetazolamide, phosphodiesterase type V inhibitors
4. oxygen if available

105
Q

Give the presentation and management of high altitude cerebral oedema

A

HACE presents with headache, ataxia, papilloedema

Management:
1. Descent
2. Dexamethasone

106
Q

What management should be offered to those who have frequent COPD exacerbations?

A

A home supply of prednisolone and an antibiotic

107
Q

Which histological subtype of lung cancer is most associated with Cushing’s syndrome?

A

Small cell lung cancer - secrete ACTH

Present with swollen abdomen, fat face, purple stretch marks

108
Q

Define bronchiectasis

A

Permanent dilation of the airways in response to chronic inflammation

109
Q

Give the management of bronchiectasis

A
  1. Inspiratory muscle training
  2. Postural drainage
  3. Antibiotics for exacerbations
  4. Bronchodilators
110
Q

Give the organisms most commonly seen in bronchiectasis exacerbations

A
  1. Haemophilus infleunzae
  2. Klebsiella (presents with upper lobe lesions)
  3. Pseudomonas aeruginosa
  4. Streptococcus pneumoniae
111
Q

Define acute respiratory distress syndrome

A

Increased permeability of the alveoli to their capillaries, resulting in fluid accumulation in the lungs.

112
Q

Give the causes of acute respiratory distress syndrome

A
  1. Infection (sepsis, pneumonia, COVID-19)
  2. Massive blood transfusion
  3. Trauma
  4. Smoke inhalation
  5. Acute pancreatitis
113
Q

Give the presentation of acute respiratory distress syndrome

A
  1. Dyspnoea
  2. Raised respiratory rate
  3. Bilateral crepitations
  4. Low O2 sats
114
Q

Give the investigations for acute respiratory distress syndrome

A
  1. CXR: pulmonary oedema, bilateral infiltrates
  2. ABG: (pO2/FiO2 < 40kPa)
115
Q

Give the management of acute respiratory distress syndrome

A
  1. ITU admission
  2. Oxygenation/ventilation
  3. Vasopressors - general organ support
  4. Treat underlying cause (e.g. Abx in sepsis)
116
Q

Give the most common cause of bronchiolitis

A

RSV

117
Q

Describe the diagnosis of bronchiolitis

A

Clinical

118
Q

Give the management of bronchiolitis

A

Usually self-limiting with minimal treatment required - give O2 and fluids

Indications for hospital admission: O2 sats < 92%, not feeding, increased work of breathing.

119
Q

Give the presentation of bronchiolitis

A

Typically aged <18 months

  1. Coryzal symptoms
  2. Dry cough
  3. Breathlessness
  4. Wheezing
  5. Fever
  6. Difficulty feeding (due to dyspnoea)
120
Q

What is the causative organism of COVID-19

A

Novel coronavirus SARS-CoV-2

121
Q

Describe the presentation of COVID-19

A

Often asymptomatic

  1. Fever
  2. Cough
  3. Fatigue
  4. SOB
  5. Muscle ache
  6. Headache
  7. Sore throat
  8. Loss of tase/smell
122
Q

Describe the investigations for COVID-19

A
  1. PCR - from nasopharyngeal/oropharyngeal swabs
  2. Rapid antigen testing
  3. Serology (for antibodies)
  4. CXR - shows bilateral opacity
123
Q

Describe the complications of COVID-19

A
  1. ARDS
  2. Encephalitis
  3. Cardiomyopathy
  4. AKI
  5. Multi-organ failure
124
Q

Give the management of COVID-19

A
  1. ICS
  2. Oxygen
  3. Vaccination
  4. Self-isolation
125
Q

Give the causative organism for tuberculosis

A

Mycobacterium tuberculosis

126
Q

Describe the pathophysiology of tuberculosis

A

Mycobacterium tuberculosis bacteria enter the lung where they are engulfed by alveolar macrophages - forming granulomas in the lung.

The bacteria remains latent in these granulomas until active infection begins and the bacteria spread throughout the body - forming many more granulomas.

127
Q

Describe the risk factors for tuberculosis

A
  1. HIV
  2. Overcrowding/urban areas
  3. Minority ethnic groups
  4. IVDU
  5. Immunosuppression
128
Q

Give the presentation of tuberculosis

A
  1. Cough +/- haemoptysis
  2. Night sweats
  3. Fever
  4. SOB
  5. Weight loss
  6. Lymphadenopathy
129
Q

Give the diagnosis of tuberculosis

A
  1. CXR - shadows in upper zones
  2. Sputum sample
  3. Biopsy - use Ziehl-Neelsen stain
  4. Mantoux skin test (for latent TB)
  5. Quantiferon test (for latent TB)
130
Q

Give the management of tuberculosis

A

RIPE:
1. Rifampicin
2. Isoniazid
3. Pyrazinamide
4. Ethambutol

Vaccination (BCG)

131
Q

Give the side effects of rifampicin

A
  1. Orange discolouration of excreted bodily fluids
  2. Anorexia
132
Q

Give a side effect of isoniazid

A
  1. Peripheral neuropathy
133
Q

Give the side effects of pyrazinamide

A
  1. Sideroblastic anaemia
  2. Hepatotoxicity
134
Q

Give a side effect of ethambutol

A
  1. Optic neuritis
135
Q

Define emphysema

A

The formation of enlarged airspaces distal to the terminal bronchioles with destruction of the elastin alveolar walls - causing decreased elastic recoil

136
Q

Describe the pathophysiology of emphysema

A
  1. Loss of alveolar elasticity
  2. Inflammation and scarring of lung tissue - decreasing elasticity and the size of the airway lumen
  3. Mucus hypersecretion
137
Q

What are emphysematous bullae?

A

Large closed off air spaces with air trapped inside them.

May mimic a pneumothorax

138
Q

Give the management of emphysema

A
  1. Bullectomy
  2. Lung transplant

Bullae do not respond to aspiration.

139
Q

Give the inheritance pattern seen in cystic fibrosis

A

Autosomal recessive

140
Q

Describe the pathophysiology of cystic fibrosis

A
  1. Cystic fibrosis transmembrane regulator protein - a chloride channel which normally allows Cl- out of cells and into the lumen - is affected
  2. Therefore there is a reduced Cl- level in the lumen, causing increased reabsorption of sodium (and therefore water) from the lumen into the walls
  3. This results in excessively viscous secretions
141
Q

Describe the presentation of cystic fibrosis

A

Commonly diagnosed in children:
1. Meconium ileus (no passage of meconium within 24 hours)
2. Recurrent LRTI
3. Pancreatitis
4. Failure to thrive

Additional symptoms:
1. Chronic cough
2. Steatorrhoea (pancreatic insufficiency)
3. Thick sputum
4. Abdo pain and bloating
5. “Child tastes salty” due to excess salt in sweat

142
Q

Give the investigations for cystic fibrosis

A
  1. Heel prick test on newborn
  2. Sweat test (gold standard) - raised Cl- in sweat
143
Q

Describe the management of cystic fibrosis

A
  1. Chest physiotherapy
  2. Propjhylactic flucloxacillin
  3. Salbutamol
  4. Mucolytic (e.g. dornase alfa)
  5. Oral pancreatic enzymes
144
Q

Describe Wegener’s granulomatosis

A

Autoimmune condition associated with necrotising granulomatous vasculitis - affecting the upper/lower respiratory tract and the kidneys

145
Q

Give the presentation of Wegener’s granulomatosis

A
  1. URTI (epistaxis, sinusitis)
  2. LRTI (dyspnoea, haemoptysis)
  3. Glomerulonephritis
  4. Saddle-shaped nose deformity
  5. Proptosis, cranial nerve lesion
146
Q

Which autoantibody is most associated with Wegener’s granulomatosis?

A

cANCA

147
Q

Give the investigations for Wegener’s granulomatosis

A
  1. cANCA positive
  2. CXR
  3. Renal biopsy
148
Q

Give the management of Wegener’s granulomatosis

A
  1. Steroids
  2. Cyclophosphamide
149
Q

Which autoantibody is most commonly associated with Churg-Strauss syndrome?

A

pANCA

150
Q

Define allergic bronchopulmonary aspergillosis

A

Allergy to aspergillus spores - often with a history of bronchiectasis and eosinophilia

151
Q

Give the management of allergic bronchopulmonary aspergillosis

A
  1. Oral glucocorticoids (e.g. prednisolone)
  2. Itraconazole - second line
152
Q

Give the criteria for long term oxygen therapy in COPD

A

LTOT if 2 measurements of pO2 < 7.3 kPa on ABG

OR if pO2 of 7.3 - 8 kPa AND one of the following:
1. secondary polycythaemia
2. peripheral oedema
3. pulmonary hypertension

153
Q

Give the criteria for hospital admission in moderate severity acute asthma attack

A

‘Admit people with a moderate asthma exacerbation with worsening symptoms despite initial bronchodilator treatment and/or who have had a previous near-fatal asthma attack.’

154
Q

What advice should be given following spontaneous primary pneumothorax?

A

life long ban on deep sea diving

Finals (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions