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Respiratory Flashcards

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1
Q

Allergic bronchopulmonary aspergillosis presentation

A

Young male with bronchiectasis and eosinophilia

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2
Q

Management of allergic bronchopulmonary aspergillosis

A

oral glucocorticods and itraconazole can b used as a second line agent

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3
Q

Eosinophilic granulomatosis with polyangitis

A

AKA Churg-Strauss

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4
Q

Define eoshinophilic granulomatosis with polyangitis

A

pANCA associated small vessel vasculitis

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5
Q

Features of eosinophilic granulomatosis with polyangitis

A

asthma, blood eosinophilia, paranasal sinusitis, mononeuritis multiplexr

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6
Q

Small cell carcinoma presentation

A

Clubbing
Hyponatraemia
Lambert-Eaton syndrome

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7
Q

OSA: investigations

A

Epworth sleep study
Multiple sleep latency test

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8
Q

Diagnostic test for OSA

A

Sleep studies (polysomnography)

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9
Q

OSA: management

A

Weight loss
Stop smoking
CPAP
DVLA should be informedP

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10
Q

Paraneoplatic syndrome: small cell

A

ADH
ACTH (Cushings)
Lambert Eaton

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11
Q

Paraneoplastic syndrome: squamous cell

A

PTHpr release
Clubbing
Hypertrophic pulmonary osteoarthropathy
Hyperthyroidism

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12
Q

Paraneoplastic syndrome: adenocarcinoma

A

Gynaecomastia
HPOA (note seen more in SCC)

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13
Q

LTOT criteria COPD

A

Can increase survival

pO2 <7.3 or
pO2 7.3-8.0 and secondary polycythaemia, nocturnal hypoxia, peripheral oedema, pulmonary hypertension

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14
Q

Sarcoidosis staging

A

Stage 0: no CXR changes
Stage 1: bialteral hilar lymphadenopathy
Stage 2: BHL + infiltrates
Stage 3: infiltrates
Stage 4: fibrosis

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15
Q

Investigations for sarcoid

A

ACE levels are high
CXR - bilateral hilar lymphadenopathy
Hypercalcaemie, ESR raised
Non-caseating granulomas

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16
Q

Lights criteria for a pleural effusion

A

when protein is 25-30g/L

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17
Q

Exudate pleural effusion criteria

A

> 30g/L

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18
Q

Transudate pleural effusion criteria

A

<30g/L

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19
Q

Exudate is likely when

A

Pleural fluid protein divided by serum protein >0.5

Pleural fluid LDH divided by serum LDH >0.6

Pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

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20
Q

Low glucose on pleural effusion

A

RA, TB

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21
Q

Raised amylase

A

Pancreatitis, oesophageal pancreatitis

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22
Q

Heavy blood staining

A

mesothelioma, PE, TB

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23
Q

Pleural effusion cloudy/turbid

A

Need to put in a chest drain

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24
Q

Clear pleural fluid but pH <7.2 mx

A

Need to insert a chest drain

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25
Management of recurrent pleural effusion
- Recurrent aspiration - Pleurodesis - Indwelling pleural catheter - Drug management to alleviate symptoms e.g. opioids to relieve dyspnoea
26
What can montelukast uncover
Eosinophilic granulomatosis with polyangitis
27
ARDS diagnosis
CXR and ABG
28
Criteria for ARDS
1. Acute onset (within 1 week of a known risk factor) 2. Pulmonary oedema: bilateral infiltrates on chest x-ray ('not fully explained by effusions, lobar/lung collapse or nodules) 3. Non-cardiogenic (pulmonary artery wedge pressure needed if doubt) 4. pO2/FiO2 < 40kPa (300 mmHg)
29
Management of ARDS
1. ITU 2. Organ support
30
COPD biPAP criteria
1. COPD with respiratory acidosis pH 7.25-7.35 (if <7.25 may need to be on ITU and lower threshold for intubation)
31
BiPAP settings for COPD
Expiratory Positive Airway Pressure (EPAP): 4-5 cm H2O Inspiratory Positive Airway Pressure (IPAP): RCP advocate 10 cm H20 whilst BTS suggest 12-15 cm H2O back up rate: 15 breaths/min back up inspiration:expiration ratio: 1:3
32
Cherry red spot on bronchoscopy
Lung carcinoid
33
Bronchiectasis most common organism
H influenzae
34
Acute asthma diagnosis: moderate
PEFR 50-75% best or predicted Speech normal RR < 25 / min Pulse < 110 bpm
35
Acute asthma diagnosis: severe
PEFR 33 - 50% best or predicted Can't complete sentences RR > 25/min Pulse > 110 bpm
36
Acute asthma diagnosis: life threatening
PEFR < 33% best or predicted Oxygen sats < 92% 'Normal' pC02 (4.6-6.0 kPa) Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma
37
Management of acute exacerbation of asthma
1. O2 if <92% sats 2. High dose SABA 3. PO pred (40mg) 4. Nebulised ipratropium bromide 5. IV MgSO4 6. IV aminophylline
38
Criteria for discharge
Stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours Inhaler technique checked and recorded PEF >75% of best or predicted
39
Chest drain insertion primary <2cm
If asymptomatic discharge, if symptomatic for needle aspiration
40
Chest drain insertion primary >2cm
Aspiration if still symptomatic for chest drain
41
Chest drain insertion secondary >2cm
chest drain
42
Chest drain insertion secondary 1-2cm
aspiration if fails for chest drain
43
Chest drain insertion secondary <1cm
O2 and admission for 24 hours
44
4 key features of kartagners syndrome
1. Dextrocardia or complete situs inversus 2. Bronchiectasis 3. Recurrent sinusitis 4. Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
45
High altitude cerebral oedema management
Descent and dexamethasone
46
Alpha 1 antitrypsin genetics
Chromosome 14 autosomal recessive/co-dominant
47
Alpha 1 antitrypsin mobility
Alleles classified by their electrophoretic mobility M: normal S: slow Z: very slow
48
Alpha 1 antitrypsin management
- bronchodilators - IV alpha 1 antitryripsin protein - surgery: lung volume reduction
49
Buprion MOA When is it CI
MOA: norephrine and dopamine reuptake inhibitor and nicotinic receptor antagonist Epilepsy (can lower seizure threshold)
50
Activities post pneumothorax
Stop smoking Do not fly for 2 weeks (can wait 1 week post XR check up) Scuba diving CI unless bilateral surgical pleurectomy, normal lung function and chest CT post op
51
Indications for steroids
Chest x-ray stage 2 or 3 disease who are symptomatic. If not symptomatic: hypercalcaemia eye, heart or neuro involvement
52
COPD O2 sats
If pCO2 normal then 94-98%
53
Cystic fibrosis - genes
Autosomal recessive Defect in the cystic fibrosis transmembrane conductance regulator gene (CFTR), which codes a cAMP-regulated chloride channel Delta F508 on the long arm of chromosome 7
54
Organisms that commonly colonise in CF
Staphylococcus aureus Pseudomonas aeruginosa Burkholderia cepacia Aspergillus
55
Cannonball mets
Commonly renal cancer Others: cholangiocarcinoma, prostate cancer
56
When do you get calcified lung mets?
Chondrosarcoma or osteosarcoma
57
Occupational asthma management
Serum peak flow at work and at home
58
Chlamydia psttachi abx
Doxycycline
59
Stages of COPD
FEV1/FVC <0.7 1: Mild (symptoms need to be present) - FVC >80% 2: Moderate - FVC 50-79% 3. Severe 30-49% 4. Very severe <30%
60
Most common cause of IECOPD
H. influenzae
61
Common cause of aspiration pneumonia
Klebsiella
62
Catamenial pneumothorax
Seen in menstruating women To do with hormones
63
Lofgrens syndrome
Acute form sarcoidosis characterised by bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia.
64
Loffler's syndrome
A cause of pulmonary eosinophilia thought to be caused by parasites such as Ascaris lumbricoides
65
Elevated hemidiaphragm investigation
Fluroscopy (inaccurate for bilateral elevated hemidiaphragm)
66
Narcolepsy symptoms
Typical onset in teenage years Hypersomnolence Cataplexy (sudden loss of muscle tone often triggered by emotion) Sleep paralysis Vivid hallucinations on going to sleep or waking up
67
Narcolepsy management
Modafanil (can use sodium oxybate at night)
68
Cataplexy symptoms
sudden and transient loss of muscular tone caused by strong emotion (e.g. laughter, being frightened)
69
Cataplexy management
SNRI
70
Cause of pneumonia in Spain/air con
Legionella urinary antigen mx: erythromycin
71
Minimum amount of time on LTOT?
15 hours a day
72
Bronchiectasis management
Airway clearance
73
Latent pulmonary TB management
RI for 3 months (isoniazid with pyroxidine) I for 6 months (with pyroxidine)
74
Active TB management
RIPE (with pyroxidine) for 2 months, 4 months of RI (+pyridoxine)
75
SE: rifampicin
potent liver enzyme inducer hepatitis, orange secretions flu-like symptoms
76
SE: isoniazid
peripheral neuropathy: prevent with pyridoxine (Vitamin B6) hepatitis, agranulocytosis liver enzyme inhibitor
77
SE: pyrazinamide
hyperuricaemia causing gout arthralgia, myalgia hepatitis
78
SE: ethambutol
optic neuritis: check visual acuity before and during treatment
79
PJP management
Co-trimoxazole
80
Antibody Scl-70?
Diffuse cutaenous systemic sclerosis
81
Anti-centromere?
Limited cutaneous systemic sclerosis - associated with pulmonary artery hypertension
82
Mycobacterium malmoense diagnosis
Requires 2 samples from 2 different areas to be clinically significant
83
Sniff test for unilateral paralysis of the diaphragm
One goes up and one goes down, seen on fluoroscopy
84
Aspergilloma symptoms
Usually asymptomatic may have mild haemoptysis
85
Invasive aspergillosis
Fever, lots of sputum, pleuritic chest pain
86
Allergic pulmonary aspergillosis
Productive cough, wheeze, SOB
87
Chronic pulmonary aspergillosis
chronic productive cough and SOB
88
When to see raised transfer factor
When there is increased contents of the alveoli into the bloodCau
89
Causes of raised transfer factor
Pulmonary haemorrhage Polycythaemia Early left heart failure Exercise
90
What to monitor for mortality in COPD
FEV1
91
Pleural effusion transudative criteria
Increase in hydrostatic pressure or decrease in oncotic pressire - HF - cirrhosis - PE low levels of protein
92
Pleural effustion exudative criteria
inflammation of capillaries, makes them leaky = big proteins like LDH present - trauma - lupus - infection - malignant
93
Lights criteria
Exudative if: fluid protein : serum protein >0.5 fluid LDH: serum LDH >0.6 fluid LDH >/= 2/3 serum LDH
94
When to drain a pleural effusion
If pH<7.2 as likely an empyema
95
Meigs syndrome
Ovarian fibroma + ascites + pleural effusion
96
Pleural effusion investigation §
1. US guided aspiration 2. If appears to be malignant for CT thorax
97
Most important vitamin to replace in CF
ADEK
98
Eosinophilic pneumonia treatment
Systemic steroids
99
Rheumatoid arthritis rare resp complication
Bronchiolitis obliterans
100
Which way does the trachea move in a pneumothorax
Away from the pneumothorax
101
Criteria for LTOT in COPD
paO2 < 7.3 Or pao2<8 AND - pulmonary hypertension (RHF) - secondary polycythaemia - periphaeral oedema - nocturnal hypoxia

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