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FCPS Preperation > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Inspiration

A

Downward contraction of diaphragm
Upward and Outward movement of the ribs due to contraction of external intercostal muscle

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2
Q

Expiration

A

Is passive driven by elastic recoil of the lungs

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3
Q

What is the gas exchange unit of the lung

A

Acinus

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4
Q

Acinus composed of

A

Barnching respiratory bronchioles and clusters of alveoli

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5
Q

Most smallest area in the respiratory tract

A

Glottis and trachea

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6
Q

Type 1 pneumocyte

A

√ Flattened epithelial cells
√ Lining of alveoli

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7
Q

Type 2 Pneumocytes

A

√ Fewer than type 1
√ Produce surfactant
√ Can divide to reconstitute type 1 pneumocyte after lung injury

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8
Q

Surfactant

A

√ Mixture of phospholipid
√ Reduce surface tension
√ Counteract the tendency of the alveoli to collaps

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9
Q

How maximum respiratory volume is limited by lung

A

Elastin fibers allow the lung to be easily distended at physiological lung volume. But collagen fibres cause increasing stiffness as full inflation is approached

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10
Q

Small airway patency is maintained by

A

Elastin fibre in alveolar wall by radial traction on the airway walls

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11
Q

Calculation of alveolar ventilation

A

AV= (tidal volume - dead space) × Respiratory rate

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12
Q

Gas exchange occurs by

A

Alveoli which are connected to each other
by the pores of kohn

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13
Q

Acinus

A

The unit of lung supplied by a terminal bronchiole

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14
Q

Pulmonary artery
Bronchial artery

A

PA carries desaturated blood
BA Systemic supply to airway tissue

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15
Q

What is the origin of the respiratory cycle

A

Respiratory neuron in the posterior medulla oblongata

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16
Q

Control of breathing modulated by

A

√ Central chemoreceptor in the ventrolateral medulla senses pH in the CSF and stimulated indirectly by a rise in the arterial Pco2

√ Carotid bodies sense hypoxemia mainly activated by arterial Po2 value less than 8kpa (60mmHg)

√ Muscle spindles in respiratory muscle

√ Vagal sensory fibres in the lung stimulated by stretch, inhaled toxins, disease process in interstitium

√ Cortical (Volitional) and limbic ( Emotional) influences

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17
Q

Disease occurring due to defective mucociiary transport

A

√ Cystic fibrosis
√ Primary ciliary dyskinesia
√ Young syndrome

Which are characterised by repeated sino-pulmonary infections and bronchietesis

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18
Q

Airway secretions contains

A

√ Antimicrobials peptides such as defensins and lysozyme
√ IgA
√ Antiproteinase
√ Anti oxidant

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19
Q

Premature emphysema associated with which deficiency

A

alpha 1 antitrypsin which regulates neutrophil elastase

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20
Q

What is the investigation of choice for pulmonary thromboembolism

A

CT Pulmonary Angiography (CTPA)

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21
Q

Indication of High CT

A
  • Diffuse Parenchymal Lung Disease
  • Identifying airway thickening
  • Bronchiectasis
  • Emphysema
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22
Q

FDG PET indication

A

✓ Staging of mediastinal lymph nodes & distal metastatic disease in lung cancer
✓ Investigation of pulmonary nodules
✓ Differentiate benign from malignant pleural disease
✓ Extent of extrapulmonary disease in sarcoidosis

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23
Q

Causes of consolidation on CXR

A

Inflammation
Infection
Infarction
Bronchoalveolar cell carcinoma

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24
Q

Causes of Multiple Nodule on CXR

A

Miliary Tuberculosis
Dust inhalation
Metastatic malignancy
Healed Vericella Pneumonia
Rheumatoid arthritis

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25
Q

Causes of Cavitating lesion on CXR

A

Tumor
Abscess
Infarct
Pneumonia( staphylococci/ klebsiella)
GPA

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26
Q

Causes of increased translucency On CXR

A

Bullae
Pneumothorax
Oligaemia

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27
Q

Causes of hilar lymph node enlargement

A

Unilateral: TB, Lymphoma, Lung cancer
Bilateral: TB, Lymphoma, Sarcoidosis, Silicosis

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28
Q

What is the point of care investigation in assessing Pleural Space

A

Transthoracic Ultrasound

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29
Q

Transbronchial biopsy ( Taken Using Bronchoscopy) Is the gold standard investigation for

A

Sarcoidosis and Diffuse Malignancy

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30
Q

Rigid Bronchoscopy is used in

A

Massive Haemoptysis
Removal of foreign body

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31
Q

𝗧𝗛𝗢𝗥𝗔𝗖𝗢𝗦𝗖𝗢𝗣𝗬 (Pleuroscopy) is 𝗚𝗼𝗹𝗱 𝘀𝘁𝗮𝗻𝗱𝗮𝗿𝗱 𝗳𝗼𝗿

A

+ Evaluation of pleural surfaces
+ Characterisation of complex pleural effusion
+ Identification of exudate & haemorrhage
+ Analysis of superior sulcus (apical) tumors

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32
Q

What is the first line diagnostic test for respiratory viruses ( influenza, SARS COV-2) and Bacterial Pathogens ( Legionella, Mycoplasma )

A

NAAT ( Nucleic acid amplification Test)

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33
Q

FEV1/FVC less than 70% indicate

A

Airflow obstruction

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34
Q

Lung volume is measured by

A

Body Plethysmography

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35
Q

Dry cough + Inspiratory Crackles suggestive of

A

Interstitial lung disease

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36
Q

Non-respiratory causes of dyspnoea

A

CVS Causes- Pulmonary Oedema
Heart Failure
MI
Others:
Metabolic acidosis
Salicylates overdose
Ethylene glycol Poisoning
Severe Anaemia
Obesity
Deconditioning

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36
Q

Respiratory causes of finger clubbing?

A
  1. Pulmonary TB
  2. Bronchiectasis
  3. Lung Abscess
  4. Empyema
  5. Cystic fibrosis
  6. Pulmonary fibrosis
  7. Lung Cancer
  8. Mesothelioma
  9. Fibroma
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36
Q

Non-respiratory causes of clubbing

A

Cyanotic Heart Disease
Infective endocarditis
Arteriovenous Shunt
IBD
Liver Cirrhosis
Coeliac Disease
Thyrotoxicosis
Primary Hypertrophic Osteoarthropathy

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37
Q

Common Causes of Hemoptysis?

A
  1. Lung cancer
  2. Bronchiectasis
  3. Acute Bronchitis
  4. Pulmonary TB
  5. Pulmonary infarction
  6. Acute LVF
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37
Q

Causes of catastrophic bronchial Haemorrhage/ Haemoptysis ?

A

Lung abscess
Bronchiectasis
Intracavitary Mycetoma

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37
Q

CVS causes of haemoptysis

A

Acute LVF
Mitral Stenosis
Aortic aneurysm

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37
Q

High metabolic activity of nodules in PET CT suggestive of ?

A

Malignancy

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38
Q

Risk of malignancy in pulmonary nodule

A

✓ Age > 40 yr
✓ H/O smoking
✓ Exposure to asbestos, silica, uranium & radon
✓ H/O lung cancer in a first-degree relative
✓ Size > 3 cm
✓ Spiculated margin
✓ Location in upper lobes

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38
Q

Causes of pleural effusion

A
  1. Pneumonia
  2. TB
  3. Malignancy
  4. Pulmonary infarction
  5. HF
  6. Sub diaphragmatic disorder (subphrenic abscess, pancreatitis)
  7. Hypoproteinaemia (Nephrotic syndrome, Liver failure, Malnutrition)
  8. CTD ( SLE, RA)
  9. Myxoedema
  10. Uremia
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38
Q

Features Suggestive empyema in pleural effusion

A

Fluid Is thick and Turbid
Fluid glucose of < 3.3 mmol/L
LDH > 1000 IU/L
PH< 7

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39
Q

Causes of Type I respiratory failure

A

Acute asthma
ARDS
Pneumonia
Pneumothorax
Pulmonary Oedema
Pulmonary Embolism
Lobar Collapse

Chronic:
COPD
Lung Fibrosis
Lymphangitic carcinomatosis
Right to left shunt

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40
Q

Causes of type II respiratory failure

A

Acute Exacerbation of COPD
Acute Severe asthma
Upper airway Obstruction
Narcotic drugs
Acute neuropathies / Paralysis
Flail Chest Injury

COPD
Sleep Apnoea
Kyphoscoliosis
Myopathies/ Muscular dystrophy
Ankylosing Spondylitis

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41
Q

What is the respiratory stimulant drug?

A

Doxapram

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42
Q

Indication for single lung transplantation

A

Advanced emphysema
Lung fibrosis

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43
Q

Contraindication for single lung transplantation

A

Chronic bilateral Pulmonary infection
Such as : Bronchiectasis, cystic fibrosis

Bilateral lung transplantation is standard

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44
Q

Combined hurt lung transplantation is indicated in

A

Advanced congenital heart disease (Eisenmenger syndrome)
Primary Pulmonary hypertension not responsive to medicine

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45
Q

Which drug is used to prevent chronic lung allograft dysfunction (CLAD)

A

Ciclosporin
Mycophenolate
Tacrolimus

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46
Q

Feature of CO2 retention

A

Warm periphery
Bounding pulse
Flapping tremor
Delirium
Morning headache

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47
Q

Which drugs trigger asthma?

A

Beta blockers
Aspirin
NSAIDS
OCP
Cholinergic Agent
Prostaglandin F2@
Betel nuts

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48
Q

Dx criteria of asthma

A

Mostly clinical

Clinical history plus either or

• FEV1 = Or > 12% (and 200ml) increase following administration of bronchodilator / trial of Glucocorticoid. Greater confidence is gained if the increase is >15% and >400 ml

• > 20% diurnal variation on 3 days or more in a week for 2 weeks on PEF diary

• FEV1 15% or more decrease following 6 min of exercise

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49
Q

Features of acute severe asthma

A

★ PEF 33 - 50% predicted (<200L/min)
★ Heart rate >110 bpm
★ Respiratory Rate > 25 breaths/ min
★ Inability to complete sentence in one breath

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50
Q

Features of life threatening asthma

A

★ PEF <33% predicted
★ SpO2 < 92% or PaO2 < 8kpa
★ Normal or raised PaCO2
★ Feeble respiratory effort
★ Silent chest
★ Cyanosis
★ Bradycardia or Arrhythmia
★ Hypotension
★ Exhaustion
★ Delirium
★ Coma

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51
Q

Indication for assisted ventilation in acute severe asthma

A

★ Coma
★ Respiratory Arrest
★ Deterioration of ABG despite optimal therapy
- PaO2 < 8kpa and falling
- PaCO2 > 6Kpa and Rising
- pH low and falling
★ Delirium, Drowsiness, Exhaustion

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52
Q

Extrapulmonary effect of COPD

A

★ Osteoporosis
★ Skeletal muscle dysfunction
★ Weight loss
★ Peripheral Oedema
★ Increased circulating inflammatory markers

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53
Q

Younger pt with predominantly basal emphysema

A

Should asses a1 antitrypsin

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54
Q

What is the central to the mx of breathlessness?

A

Bronchodilator therapy

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55
Q

Prognosis of COPD

A

• It is inversely related to age and directly related to post bronchodilator FEV1
• Additional poor prognostic factors include
- Weight loss
- Pulmonary hypertension

•Scoring for prognosis done by BODE index
Where -
★ Body mass index
★ Airflow obstruction expressed as FEV1
★ Dyspnoea according mMRA scale
★ Exercise

• Highest bode index is 10 a score between 7-10 predict 82% mortality at 4 years

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56
Q

Most common cause of bronchiectasis

A

TB

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57
Q

Bronchiectasis + sinusitis+ transposition of viscera

A

Kartagener syndrome

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58
Q

Recurrent Bronchiectasis + Malabsorption +DM+ Infertility

A

Cystic fibrosis

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59
Q

Bronchiectasis + Asthma

A

Allergic bronchopulmonary aspergillosis

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60
Q

Chronic cough with copious sputum with coarse crakles with or without haemoptysis

A

Bronchiectasis

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61
Q

Rx of bronchiectasis

A

Regular daily physiotherapy

62
Q

CT Scan findings of bronchiectasis

A

Thickening of bronchial wall
Extensive dilation of bronchi
Ring shadows

63
Q

Most men with CF are infertile due to?

A

Failure to development of vas deferens

64
Q

Respiratory features and complications in CF

A
  • Progressive airway obstruction
  • Infective exacerbation of bronchiectasis
  • Respiratory failure
  • Spontaneous Pneumothorax
  • Allergic bronchopulmonary aspergillosis
  • Lobar collapse due to secretion
  • Haemoptysis
  • Pulmonary hypertension
  • Nasal polyp
65
Q

Others defect of CF

A

Malabsorption and steatorrhea
Intestinal obstruction
Increased risk of malignancy
Gallstones
Diabetes
Infertility
Delayed puberty
Osteoporosis

66
Q

Most common causes of lung infection in cystic fibrosis

A

Staph aureus ( child)

Others are-
P. Aeroginosa (adult)
Strentophomonas maltophila
Burkholderia capacia
Aspergillus fumigatus

67
Q

Investigation and Rx for CF

A

Inv: sweat electrolyte testing and genotyping

Rx: chest physiotherapy
CFTR correctors: lumacaftor, ivacaftor
CFTR potentiators: elexacaftor, tezacaftor, ivacaftor

68
Q

What is the most common URTI and causes of it?

A

Acute coryza caused by rhinovirus infection

69
Q

Lobar pneumonia

A

Homogenous consolidation affecting one or more lung lobes

Associated with pleural inflammation

70
Q

Bronchopneumonia

A

Patchy alveolar consolidation affecting both lower lobes

Associated with bronchial and bronchiolar inflammation

71
Q

Virus causing pneumonia

A

• Influenza, parainfluenza
• Measles
• Varicella
• Herpes simplex
• CMV
• Adenovirus
• Coronaviruses

72
Q

What is the most common infecting agent of CAP?

A

Strepto. Pneumoniae

73
Q

Rust coloured sputum / herpes labialis with features of pneumonia caused by

A

Streptococcus pneumoniae

74
Q

Young age + Haemolytic anaemia (comb test +) / jaundice

A

Mycoplasma pneumoniae

75
Q

Old age + underlying lung disease / COPD

A

Hemophilus influenzae

76
Q

Local outbreak in hotel industry or hospital/ history of travel / air-conditioner use / hyponatremia

A

Legionella pneumophila

77
Q

H/O episode of influenza / viral illness/ IV drug users / cavitation

A

Staph aureus

78
Q

Alcohol + DM+ Old age+ severe bacteraemic illness with cavitation

A

Klebsiella pneumoniae

79
Q

Exposure to birds (often parrots)

A

Chlamydia psittaci

80
Q

Farm workers / hide factory workers

A

Coxiella burnetii ( Q fever)

81
Q

Sewage workers, farmers, animal handlers and vet

A

Leptospiral pneumonia

82
Q

Exposure to infected hides, hair, bristle, bonemeal and animal carcases

A

Anthrax ( wool sorter’s disease)

83
Q

Suppurative pneumonia or pulmonary abscess in previously healthy lung

A

Staph aureus / klebsiella pneumoniae

84
Q

What are the markers of severity in pneumonia

A

○Confusion
○Urea > 7 mmol/L
○Respiratory rate > 30/min
○BP : SBP < 90 or DBP < 60 mmHg)
○Age > 65 years
○WBC : > 20 × 109/L or < 4 × 109/L
○Hyponatraemia
○Hypoalbuminemia
○Bacteraemia

85
Q

Multilober shadowing, cavitation, pneumatoceles and abscesses

A

Staphylococcus aureus

86
Q

Indications for referral to icu in pneumonia

A

• CURB score 4 or 5
• Persisting hypoxia
• Progressing hypercapnia
• Severe acidosis
• Circulatory shock
• Reduced conscious level

87
Q

Antibiotic for low severity CAP CURB 0-1

A

Amoxicillin 500mg TDS

If allergic to penicillin
Doxycycline 200mg LD followed by 100mg bd or Clarithromycin 500mg bd

88
Q

Antibiotic for moderate sverity CAP CURB 1-2

A

Amoxicillin 500mg TDS + Clarithromycin 500mg BD

If allergic to penicillin
Doxycycline + Levofloxacin 500mg OD

89
Q

Antibiotic for severe CAP CURB 3-5

A

Co-amoxiclav 1.2 gm IV TDS / Cefuroxim 1.5 gm IV TDS / Ceftriaxone 1-2gm IV OD + Clarithromycin 500mg IV BD

Or,
Benzylpenicillin + levofloxacin

90
Q

Chronic suppurative pulmonary inf + poor dental hygiene

A

Actinomyces sp.
Rx: IV / Oral penicillin for 6-12 months

91
Q

What is the characteristic histological feature of suppurative pneumonia

A

Microabscess formation

92
Q

Causes of progressive necrotising severe pneumonia

A

PVL producing strains of staph aureus

Associated with skin infection mainly

93
Q

Sore throat + painful swollen neck + fever + rigour + haemoptysis + dyspnoea

A

Dx: Lemierre syndrome
C/O: Anaerobe Fusobacterium necrophorum
Rx: B lactum ab, metronidazole, clindamycin and 3rd gen cephalosporin

Its spread into jugular veins leads to thrombosis and metastatic dispersal of organism

94
Q

First choice antibiotic for non severe symptoms in HAP

A

Co-amoxiclav

95
Q

Immunocompromised pt with halo sign in HRCT

A

C/O: Aspergillosis

96
Q

M. Bovis spread by

A

Drinking non-sterilised milk from infected cows

97
Q

Ghon focus

A

Aggregation of numerous granuloma
Pale yellow
caseous nodule
usually a few mm to 1-2 cm in diameter
Situated at the periphery of lung

98
Q

Primary complex Ranke

A

Combination of primary lesion + regional lymph node

99
Q

How long does it take after TB infection to get positive tuberculin test

A

3-8 weeks

100
Q

How long does it take after TB infection to form primary complex

A

3-6 weeks

101
Q

How long does it take after TB infection to affect meninges, pleura and miliary TB

A

3-6 months

102
Q

Which organ affects after 8 years of TB infection which is untreated

A

Renal tract

103
Q

Which organ affects upto 3 years of TB infection which is untreated

A

GIT
Bone and Joint
Lymph node

104
Q

How long does it take after TB infection to reactivate and cause post primary disease?

A

From 3 years onwards

105
Q

Features of primary tuberculosis

A

Infection:
Influenza like illness
Primary complex formation
Skin test conversion

Disease:
Lymphadenopathy : hilar ( often unilateral), paratracheal, mediastinal.
Collapse ( right middle lobe)
Consolidation
Cavitation ( rare)
Obstructive emphysema
Pleural effusion
Meningitis
Pericarditis
Miliary disease

Hypersensitivity reaction:
Erythema nodosum
Phlyctenular conjunctivitis
Dactylitis

106
Q

Miliary TB

A

Blood born dissemination
2-3 weeks of fever anorexia, night sweats, wt loss, dry cough
Hepatosplenomegaly
Headache - indicates coexistent tubercular meningitis
Anaemia and leucopenia : BM involvement
CXR- Fine 1-2 mm lesion (millet seeds) distributed throughout lung fields
Fundoscopy: choroidal tubercle

107
Q

Post primary Pulmonary TB usually occurs on

A

Apex of an upper lobe

108
Q

Causes of consolidation On CXR

A

Pulmonary TB
Pneumonia
Bronchial ca
Pulmonary infarct

109
Q

Causes of miliary diffuse shadowing in CXR

A

Pulmonary TB
Sarcoidosis
Malignancy
Pneumoconiosis
Infection ( histoplasmosis, meliodosis)
Tropical Pulmonary eosinophilia

110
Q

Causes of Cavitation on CXR

A

Pulmonary TB
Pneumonia / lung abscess
Lung carcinoma
Pulmonary infarct
GPA (wegner’s granulomatosis)
Progressing massive fibrosis

111
Q

Causes of pleural effusion on CXR

A

Pulmonary TB
Bacterial pneumonia
Pulmonary infraction
Carcinoma
Connective tissue disease

112
Q

What is the most common extrapulmonary site for TB

A

Lymph node

Cervical and mediastinal glands affect more frequently followed by axillary and inguinal

113
Q

TB Symptoms + Rt iliac fossa mass

A

Dx: GI TB
Most common part: Ileocaecal disease
Inv: obtaining histology either by colonoscopy or mini laparotomy
D/D: crohns disease

114
Q

TB symptoms + chronic back pain

A

Bone and Joint TB
Common site : Spine (lower thoracic and lumber spine)
Joint: Most frequently involves the hip or knee

115
Q

What is the most imp first step for dx of TB

A

Direct microscopy of sputum smear

116
Q

Which investigation is definitive for dx of TB

A

Culture or the detection of M. Tuberculosis DNA

117
Q

Gold standard for drug sensitivity testing for TB

A

Culture

118
Q

How long Rx is required for CNS TB?

A

12 months

119
Q

When Glucocorticoid is recommended in TB

A

Constrictive pericarditis
CNS disease
Children with endobronchial disease

120
Q

Rifampicin interacts with

A

It is a cytochrome P450 inducer, accelerating the metabolism of the following drugs,
Steroid
Oral hypoglycemic agent
Anti-retroviral
Warfarin
Opiates
Contraceptive

121
Q

Isoniazid

A

M/A : Cell wall synthesis inhibitors
A/E: Major
Peripheral neuropathy (reduced by pyridoxine)
Hepatitis ( more common in alcoholics and patients with slow acetylator status)
Rash

Less common
Lupoid reaction
Seizures
Psychosis

122
Q

Rifampicin

A

M/A: DNA transcription
A/E: Major
Hepatitis
Febrile reaction
Rash
GI disturbance

Less common
Interstitial nephritis
Thrombocytopenia
Hemolytic anaemia

All secretions become orange / red coloured

123
Q

Pyrazinamide

A

M/A: Unknown
A/E: Major
Hepatitis (mostly)
GI disturbance
Hyperuricaemia

Less common:
Rash
Photosensitization
Gout

124
Q

Ethambutol

A

M/A: Cell wall synthesis inhibitors
A/E: Major:
Retrobulbar neuritis
Arthralgia

Less common
Peripheral neuropathy
Rash

125
Q

What is the first choice of investigation in LTB

A

IGRA
In the case of children’s Tuberculin test

126
Q

TB IRIS TB- associated immune reconstitution inflammatory syndrome

A

Paradoxical increase in pre-existing. Or development of new, TB signs or symptoms due to ART reviving the immune system.

May be self limiting, but in severe cases steroids are used to reduce symptoms

Patients are advised to continue TB chemotherapy and ART

127
Q

Wheezing / worsening of asthma + Productive cough / Bronchiectasis + ↑Eosinophil and IgE

A

Allergic Bronchopulmonary aspergillosis

Features:
Asthma
Proximal bronchiectasis
Positive skin test to extract A. Fumigatus
↑IgE
Peripheral blood eosinophilia
↑ A. Fumigatus specific IgE or IgG
Recovery of A. Fumigatus from sputum
Presence or H/O CXR abnormality

Mx:
Regular :Low dose oral Glucocorticoid
2nd line: Itraconazole
Exacerbations, Particularly with new CXR changes : Prednisolone (40-60mg)/ Day + physiotherapy

128
Q

Immunocompromised+ new respiratory symptoms (pleural pain, haemoptysis) + fever+ HRCT shows macronodules surrounded by halo of intermediate attenuation

A

Invasive Pulmonary aspergillosis
Causes: severe necrotising pneumonia

Rx: DOC Voriconazole

CT findings:dense, well circumscribed lesion with or without Halo sign
Air cresent sign
Cavity

129
Q

What is the most common form of lung carcinoma?

A

Adenocarcinoma

130
Q

Blood born metastasis of lung ca usually occurs in

A

Liver
Bone
Brain
Adrenal
Skin

131
Q

Which is the worst form of lung carcinoma and why?

A

Small cell carcinoma
Even a small primary tumor may cause widespread metastatic deposit

132
Q

Horner syndrome

A

Features:
S- involvement of sympathetic nerve
A- Anhydrosis / Hypohydrosis of the face
M- Miosis
P- Ptosis (Ipsilateral, partial)
L- Loss of ciliospinal reflex
E- Enophthalmos

Cause: ca in the lung apex

133
Q

Pancoast syndrome

A

Pain in the inner aspect of arms
Small muscle wasting in the hand

Indicate: malignant destruction of the T1 and C8 roots in the lower part of brachial plexus

Cause: Apical lung tumor

134
Q

Non metastatic extrapulmonary manifestations of lung cancer

A

Endocrine:
Inappropriate ADH secretion causing hyponatraemia

Ectopic ACTH secretions

Hypercalcemia due to parathyroid hormone related peptide secretion

Carcinoid syndrome
Gynecomastia

Neurological :
Polyneuropathy
Myopathy
Cerebellar degeneration
Myesthenia (lambert eaton syndrome)

Others:
Digital clubbing
Hypertrophic Pulmonary osteoarthropathy
Neohrotic syndrome
Polymyositis
Dermatomyositis
Eosinophilia

135
Q

Features suggestive of lung cancer in a smoker

A

Changes in characters of cough
Haemoptysis
Pneumonia that recurs at the same site or responds slowly to treatment

136
Q

Investigation of choice for lung CA or Staging

A

CT Scan

137
Q

Common radiological presentation of lung cancer

A
  1. Unilateral hilar enlargement
  2. Peripheral opacity or irregular cavitation
  3. Pleural effusion
  4. Lung, lobe or segmental collapse
    5.:Pericardial effusion
  5. Widening of upper mediastinum
  6. Elevation of hemidiaphragm
  7. Osteolytic rib lesion
138
Q

Which tumors metastasize in lung

A

Breast
Kidney
Uterus
Ovary
Testes
Thyroid
Osteogenic
And other sarcoma

139
Q

DPLD (diffuse parenchymal Lung Disease)

A

Clinical presentation:
Cough: usually dry, persistent, and distressing
Breathlessness: usually slowly progressive; insidious onset; acute in some cases

Examination findings:
●Crackles: typically bilateral and basal Inspiratory
●Clubbing
●Central cyanosis

Radiology
●CXR: typically small lung volumes with reticulonodular shadowing but may be normal in early or limited disease
●HRCT: Combinations of ground glass changes, reticulonodular shadowing, honeycomb cysts, and traction bronchiectasis, depending on the stage of disease

Pulmonary function :
○Typically restrictive ventilatory defect with reduced lung volumes and impaired gas transfer
○Exercise tests assess exercise tolerance and exercise-related fall in SaO2

Confirmatory Dx: Lung Biopsy

140
Q

Persistent dry cough + Clubbing + Bibasal Inspiratory crackles + Restrictive lung function tests age>50 yrs

A

IDIOPATHIC PULMONARY FIBROSIS

Management
●Vital capacity between 50% and 80%: Pirfenidone (an antifibrotic agent) or nintedanib (a tyrosine kinase inhibitor) (SBA)
●Patients taking pirfenidone should be advised to avoid direct exposure to sunlight & use photoprotective clothing and high-protection sunscreens
●Nintedanib may be accompanied by diarrhea

141
Q

Chronic cough + Mediastinal mass + Hypercalcemia + Erythema nodosum + Restrictive lung function

A

𝗦𝗔𝗥𝗖𝗢𝗜𝗗𝗢𝗦𝗜𝗦
Clinical features:
●Considered with other DPLDs, as over 90% of cases affect the lungs (SBA)
●Can involve almost any organ
●Löfgren syndrome: An acute illness characterized by
■Erythema nodosum
■Peripheral arthropathy
■Uveitis
■Bilateral hilar lymphadenopathy (BHL)
■Lethargy & occasionally fever
○Is often seen in young women.
●Fibrosis occurs in around 20% of cases of pulmonary sarcoidosis

●Complications: Bronchiectasis, aspergilloma, pneumothorax, pulmonary hypertension and cor pulmonale

142
Q

Which investigation is used for staging of sarcoidosis?

A

CXR

143
Q

Lymphopenia+ Hypercalcemia + Cobblestone appearance of mucosa found in?

A

Sarcoidosis

144
Q

Erythema Nodosum+ BHL on CXR suggests

A

Sarcoidosis

145
Q

Indication of immediate Prednisolone in sarcoidosis?

A

Dose: 20-40mg/Day

○Hypercalcemia
○Pulmonary impairment
○Renal impairment
○Uveitis

●Patients should be warned that strong sunlight may precipitate hypercalcemia and endanger renal function

146
Q

Poor prognostic factors in sarcoidosis

A

○Age over 40
○African Caribbean ancestry
○Persistent symptoms for more than 6 months
○Involvement of more than three organs
○Lupus pernio
○Stage III/IV chest X-ray

147
Q

Caplan Syndrome

A

Rheumatoid nodules+ Pneumoconiosis

148
Q

Tropical pulmonary eosinophilia

A

●Causative Organism:
Wuchereria bancrofti or Brugia malayi (SBA)
● C/F:
fever, weight loss, dyspnea, and asthma-like symptoms
●Investigation:
○Marked peripheral blood eosinophilia
○Elevation of total IgE.

●Diagnosis may be confirmed by a response to treatment with diethylcarbamazine (6 mg/kg daily for 3 weeks)

149
Q

Eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg–Strauss syndrome) Diagnostic Criteria

A

Eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg–Strauss syndrome), is diagnosed based on four or more of the following features:
○Asthma
○Peripheral blood eosinophilia >1.5 ×109/L (or >10% of a total white cell count)
○Mononeuropathy or polyneuropathy
○Pulmonary infiltrates
○Paranasal sinus disease
○Eosinophilic vasculitis on biopsy of an affected site

150
Q

Byssinosis

A

Occurs in workers of cotton and flax mills exposed to cotton brack (dried leaf and plant debris)

151
Q

Farmer / Bird owner + Influenza like symptoms / Cough, breathlessness & wheeze + End Inspiratory crackles + Restrictive lung function

A

𝗛𝗬𝗣𝗘𝗥𝗦𝗘𝗡𝗦𝗜𝗧𝗜𝗩𝗜𝗧𝗬 𝗣𝗡𝗘𝗨𝗠𝗢𝗡𝗜𝗧𝗜𝗦
(𝗘𝘅𝘁𝗿𝗶𝗻𝘀𝗶𝗰 𝗮𝗹𝗹𝗲𝗿𝗴𝗶𝗰 𝗮𝗹𝘃𝗲𝗼𝗹𝗶𝘁𝗶𝘀)

●Common causes include farmer’s lung and bird fancier’s lung
●Consistent with both type III & type IV immunological mechanisms
●Precipitating IgG antibodies may be detected in serum
●A type III Arthus reaction is believed to occur in the lung

Investigation
●CXR: ill-defined patchy airspace shadowing, pneumonia.
●HRCT: Bilateral ground glass shadowing & areas of consolidation superimposed on small centrilobular nodular opacities with an upper and middle lobe predominance and mosaicism
●Pulmonary function tests: Restrictive
●Positive serum IgG
●BAL fluid: Usually shows an increase in CD8+ T lymphocytes

MX: reduce exposure and prednisolone

152
Q

Causes of pulmonary embolism

A

DVT (venous thromboembolism) most common
Septic emboli (Endocarditis)
Choriocarcinoma
Fat Following Fracture of Long Bones
Air and amniotic fluid following delivery

153
Q

ECG findings on Pulmonary Embolism

A

Most common findings:
Sinus tachycardia and Anterior T-wave inversion

Large emboli cause
S1 Q3 T3 pattern
ST segment and T wave changes
RBBB

154
Q

Mx of Pulmonary thromboembolism

A

Main principle of treatment : anticoagulation therapy
Acute massive PE with hemodynamic instability : thrombolysis
Recurrent VTE/ contraindicated anticoagulation therapy : inferior vena cava filter
In Pregnancy : LMWH

155
Q

Wedge shaped opacity in CXR seen in

A

Pulmonary thromboembolism

156
Q

Pulmonary hypertension

A

Def: Mean Pulmonary arterial pressure (PAP) at least 25 mmHg at rest

Measured by: Right heart catheterization

Most common cause: Respiratory failure due to intrinsic Pulmonary disease

Age: 20-30
Sex: mainly women

157
Q

Clinical features of Pulmonary Hypertension

A

Clinical features
●Typical symptoms: breathlessness, chest pain, fatigue, palpitations, exertional dizziness and syncope
●Important signs
○Elevation of JVP (prominent ‘a’ wave)
○Parasternal heave (right ventricular hypertrophy),
○Loud P2
○Right ventricular third heart sound
○Peripheral edema and ascites

158
Q

What is the confirmatory investigation for Pulmonary Hypertension?

A

Investigation
○ECG: Right ventricular ‘strain’ pattern
○CXR: Enlarged pulmonary arteries, peripheral pruning & right ventricle enlargement
○Transthoracic echocardiography provides a non-invasive estimate of PAP (SBA)
○Right heart catheterization: Confirmatory (SBA)

159
Q
A

Management
● Oxygen Supplement
●Drugs for PH
○Diuretics if Heart Failure
○Anticoagulation
○ Digoxin if Arrhythmia
○With acute vasodilator response: High dose CCB (SBA)
○Endogenous Prostacyclins replaced by: epoprostenol, treprostinil, or iloprost
○Blocking endothelin-mediated vasoconstriction: Bosentan, ambrisentan, or macitentan (SBA)
○Enhancing endogenous nitric oxide-mediated vasodilatation by Phosphodiesterase V inhibitors: Sildenafil or tadalafil
○Or Guanylate cyclase stimulator: Riociguat

160
Q

Obstructive sleep apnoea/hypopnoea syndrome

A

Cause:
Results from recurrent occlusion of the pharynx during sleep, usually at the level of the soft palate

●Predisposing factors
○Male gender, Obesity
○Nasal obstruction or a recessed mandible
○Acromegaly, Hypothyroidism
○Alcohol, Sedatives
○Familial, where the maxilla & mandible are back-set

●Complications
○Marked sympathetic activity > Sustained HTN > Increased risk of coronary events & stroke
○Insulin resistance
○Metabolic syndrome
○Type 2 DM

●Diagnosis: Polysomnography / Overnight studies of breathing, oxygenation, and sleep quality (SBA)

●Gold standard therapy : Continuous positive airway pressure (CPAP) (SBA)

161
Q

Respiratory distress + Normal lung findings + Normal CXR

A

Pulmonary embolism&raquo_space;> CTPA

162
Q
A

FCPS Preperation (5 decks)

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