Respiratory Flashcards
(169 cards)
1
Q
What is a common organism which causes pneumonia in bird owners?
A
chlamydia psittaci
2
Q
cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics suggest what?
A
Klebsiella pneumoniae
3
Q
Long term use of what can precipitate restrictive lung disease?
A
Nitrofurantoin
4
Q
Which condition is immune deficiencies such as hypogammaglobulinemia associated with?
A
Bronchiectasis
5
Q
What type of picture do you get on pulmonary function testing in asbestosis?
A
Restrictive - FEV1 goes down, FVC goes down A LOT therefore overall FEV1/FVC increases
6
Q
What is the investigation of choice for occupational asthma?
A
Peak flows at work and home
7
Q
What is the pathogen involved in Farmer’s lung?
A
Saccharopolyspora rectivirgula
8
Q
Chlamydophila psittaci is associated with what?
A
Contact with birds
9
Q
How should any critically ill patient be managed with oxygen?
A
15L high flow oxygen via non-rebreather as hypoxia kills before hypercapnia
10
Q
What should you aim for in step down treatment of asthma?
A
reduction of 25-50% in the dose of inhaled corticosteroids
11
Q
pulmonary fibrosis predominantly affecting the lower zones
A
Asbestosis
12
Q
How would opiate overdose present on blood gas?
A
Respiratory acidosis
13
Q
Redcurrant jelly sputum is found in what?
A
Klebsiella pneumonia
14
Q
What is the COPD exacerbation treatment?
A
- Oxygen sats 88-92%
- Nebulised bronochodilators
- Steroid therapy
- IV Theophylline
- Non invasive ventilation e.g. BIPAP
15
Q
Why does hypotension occur in tension pneumothorax?
A
Cardiac outflow obstruction
16
Q
Most common organism causing infective exacerbation of COPD?
A
H influenzae
17
Q
30-40 year old with basal emphysema and abnormal LFTs
A
Alpha-1-antitrypsin deficiency
18
Q
Fine end-inspiratory crepitations
A
pulmonary fibrosis
19
Q
Investigation of choice for sleep apnoea?
A
Polysomnography
20
Q
Coal workers’ pneumoconiosis causes what?
A
Upper zone fibrosis
21
Q
What should be sent with diagnostic pleural taps?
A
- Biochemistry to determine protein
- Cytology
- Microbiology for gram staining and culture
22
Q
What is important to remember about lung cancers?
A
Lesion can sometimes be too small to see on CXR
23
Q
Paratracheal lymph nodes should raise alarm bells for?
A
Lung cancer
24
Q
Sarcoidosis can cause what?
A
Hypercalcaemia
25
What is atelectasis?
A post op complication when the airways become blocked by bronchial secretions leading to respiratory collapse
- Managed with chest physio and positioning the patient upright
26
Normal/raised total gas transfer with raised transfer coefficient
Asthma
27
Lung collapse vs pleural effusion on CXR?
Lung collapse - trachea pulled towards the side of the white out
Pleural effusion - trachea pulled away from the side of the white out
28
Management of bronchiectasis?
Muscle training + postural drainage techniques
29
Patients who have frequent COPD exacerbations should have home supply of what?
Abx plus prednisolone
30
Investigation of choice for pulmonary fibrosis?
High res CT
31
Pack years formula
No of packs per day (1 pack is 20) x no of years smoking
32
Everyone over the age of 5 should have what to diagnose asthma?
Spirometry with bronchodilator reversibility testing
33
ENT, respiratory and kidney involvement
Think of Granulomatosis with polyangiitis
34
A negative result on spirometry does not what?
Exclude asthma -> FeNO testing needed
35
What pattern on lung function does bronchiectasis have?
Obstructive
36
When should Abx be given for COPD exacerbation?
- If purulent sputum or signs of pneumonia
37
Facial rash plus lymphadenopathy
Sarcoidosis
38
Cavitating lesions are associated with what?
Squamous cell carcinoma
39
increased FEV1/FVC ratio and reduced transfer factor
Pulmonary fibrosis
40
Which paraneoplastic syndrome is associated with squamous cell carcinoma?
Parathyroid hormone related protein secretion
41
Decrease in pO2/FiO2 in poorly patient with non-cardiorespiratory presentation
ARDS
42
Neuromuscular disorders present how on pulmonary function tests?
Restrictive pattern
43
How is asthma diagnosed on spirometry?
Improvement in FEV1 by > 15% following administration of bronchodilator
44
How does salbutamol work?
Stimulates ß2 receptors of respiratory tract, which increases sympathetic activity and relaxes bronchial smooth muscle.
45
What physiological measurement is used to determine the severity
of COPD?
FEV1
46
What must patients do to qualify for long term oxygen therapy?
Stop smoking
47
What are some examination signs of consolidation?
Reduced chest expansion, dull percussion note, increased tactile
vocal fremitus, increased vocal resonance, bronchial breathing.
48
Why should statins and macrolides not be given together?
Increased risk of myositis
49
What are some complications of pneumonia?
- Resp failure
- Sepsis
- Empyema
- Lung abscess
- Shock
50
How would pleural effusion present on examination?
- Reduced chest expansion
- Stony dull to percuss
- Reduced breath sounds
51
How would pneumothorax present on examination?
- Reduced chest expansion
- Hyper resonant on percussion
- Reduced breath sounds
52
What is an indication for surgery in bronchiectasis?
If the disease is localised to one lobe
53
Massive PE + hypotension
Thrombolysis
54
What is used to guide if patients need Abx with acute bronchitis?
CRP levels - if >100 -> offer Abx
55
multiple lip telangiectases
Think hereditary haemorrhagic telangiectasia -> strong association with epistaxis
56
Investigation of choice for suspected PE in someone with renal impairment?
V/Q scan
57
When should LTOT be started for COPD patients?
When 2 measurements of pO2 are < 7.3
pO2 of 7.3 - 8 AND polycythaemia/peripheral oedema/pulmonary HTN
58
Causes of upper zone fibrosis
C - coal workers pneumoconiosis
H - histiocytosis
A - ankylosing spondylitis
R - radiation
T - TB
S - Silicosis/Sarcoidosis
59
Causes of lower zone fibrosis
D - drugs
A - asbestosis
I - idiopathic
M - Most connective tissue disorders except AS
60
Non-obs based admission criteria for asthma?
- Previous near fatal attack
- Pregnancy
- Oral steroids not helping with symptoms
61
Bilateral parotid gland swelling can be indicative of what?
Sarcoidosis
62
What are some complications of bronchiectasis?
Pneumonia, sepsis, recurrent infections, resp failure
63
What is the mechanism of PE?
T1 Resp failure due to V/Q mismatch
64
Pemberton's test
Test for SVC obstruction - raise arms above head and they go cyanosed
65
Non respiratory causes of pulmonary fibrosis
- Amiodarone, methotrexate
- RA
- SLE
- Sjogrens
- UC
66
ECG signs of cor pulmonale
- right axis deviation
- P pulmonale
67
Causes of bilateral hilar lymphadenopathy
Lymphoma, TB, Sarcoidosis, bronchial carcinoma
68
What are extra-pulmonary manifestations of sarcoidosis?
- Erythema nodosum
- Anterior uveitis
- Neuropathy
- Cardiomyopathy
- CN palsies
69
Where should pleural tap needle be inserted?
Above rib to avoid neurovascular bundle
70
What could an area of dull to percuss in someone with a pneumothorax suggest?
Haemothorax -> needs chest drain
71
Lung cancer can present as what?
SVC obstruction
72
What helps to reduce mortality in someone with ARDS?
Low tidal volume mechanical ventilation
73
Uncompensated type 2 resp failure with pH <7.35
Think about non invasive ventilation
74
Radiation exposure can cause what?
Lung cancer
75
What is the pathophysiology of ARDS?
Diffuse bilateral alveolar injury due to inflammation
76
Previous history of haemorrhagic stroke at any time is a C/I to what?
Thrombolysis
77
Excessive daytime sleepiness with visual hallucinations
Narcolepsy -> multiple sleep latency test needed
78
What is PERC criteria used for?
To rule out PE
79
What are indications for steroids in sarcoidosis?
PUNCH
Parencymal lung disease
Uveitis
Neuro involvement
Cardio involvement
Hypercalcaemia
80
Large round well circumscribed masses in the lungs?
Cannonball metastases -> renal cell carcinoma
81
Investigations for lung cancer?
1. CXR
2. CT with contrast
3. Bronchoscopy
82
Raised platelets can be a sign of what?
Lung cancer
83
When are Abx used in acute bronchitis?
If there are existing co-morbidities
84
Preceding influenza predisposes you to what?
Staph aureus pneumonia
85
What is the treatment for latent TB?
3 months of isoniazid and rifampicin or 6 months of isoniazid
86
How should patients with acute asthma who do not respond to medical treatment and become acidotic be managed?
Intubation and Ventilation
87
Where should needle thoracostomy be placed?
cannula into the second intercostal space in the midclavicular line on the affected side
88
egg shell calcification of lymph nodes?
Silicosis
89
What are causes of resp alkalosis?
- Anxiety
- PE
- Stroke, sub arachnoid
- Altitude
90
What are causes of resp acidosis?
- COPD
- Neuromuscular disease
- Sedating drugs like benzos/opiates
91
Pneumothorax management
1. Asymptomatic -> conservative care
2. If symptoms and high risk -> chest drain
3. If symptoms and not high risk -> can manage conservatively/needle aspiration
92
How should pneumothorax be followed up when managed conservatively?
1. If primary -> review every 2-4 days as outpatient
2. If secondary -> monitor as inpatient
3. Everyone should be reviewed in outpatients in 2-4 weeks
93
CURB65 criteria
Confusion
Urea > 7
RR > 30
BP <90 systolic or <60 diastolic
Aged > 65
94
Community acquired pneumonia treatment
0 - treat at home - Amoxicillin/Clarithromycin
1-2 - consider hospital - Amoxicillin + Clarithromycin
3-4 - urgent hospital - Co-amoxiclav or
+ Clarithromycin
95
Hospital acquired pneumonia treatment
No severe signs: Co-amoxiclav
Sever signs: Piperacillin with Tazobactam
96
Exudate vs Transudate pleural effusion
Exudate - >30
Transudate - <30
97
What are exudative causes of pleural effusion?
- Pneumonia
- RA/SLE
- Neoplasia
98
What are transudative causes of pleural effusion?
- HF
- Liver disease
- Hypothyroidism
99
How to diagnose mesothelioma?
- CXR
- Pleural CT with biopsy
- Thoracoscopy can be used
100
Types of non small cell lung cancer?
- Large cell
- Squamous cell
- Adenocarcinoma
101
What paraneoplastic features do lung cancers have?
Small cell
- SIADH
- Cushings
- Lambert-Eaton
Squamous
- PTHrP
- Hypercalcaemia
- Hypertrophic pulmonary osteoarthropathy
Adenocarcinoma
- Gynaecomastia
102
How long should patients hold breath when taking inhaler?
10 seconds after pressing down on cannister
Wait 30 seconds before repeating next dose
103
What is Churg Strauss syndrome?
Eosinophilic granulomatosis with polyangiitis -> asthma features with pANCA positive
104
What is the triangle of safety?
- Located in the mid axillary line of the 5th intercostal space
- Bordered by anterior edge of latissimus dorsi, lateral border of pectoralis major, line superior to the horizontal level of the nipple
105
Where is aspiration pneumonia most common?
- Right middle and lower lobes
106
How is alpha 1 antitrypsin deficiency inherited?
Autosomal recessive
107
How can A1AD be managed?
- Obstructive picture on spirometry
- Supportive treatment with bronchodilators
- Lung volume reduction surgery can be done in severe cases
108
Moderate asthma features
PEFR 50-75% best or predicted
Speech normal
RR < 25
Pulse < 110
109
Severe asthma features
PEFR 33-50%
Can't complete sentences
RR > 25
Pulse > 110
110
Life threatening asthma features
PEFR < 33%
Sats <92%
Normal PCO2
Silent chest, cyanosis or poor resp effort
Bradycardia/Hypotension
Exhaustion/Confusion/Coma
111
What are some blood tests for sarcoidosis?
- elevated ACE, ESR, calcium, immunoglobulins
- Deranged LFTs
112
ECG signs of PE
- Sinus tachycardia
- Right BBB
- S1 Q3 T3
113
Complications of recurrent or untreated PE?
- Pulmonary HTN
- Right sided heart failure
114
Surgical interventions for COPD?
- Bullectomy
- Lung reduction surgery
115
Extra-respiratory manifestations of cystic fibrosis
- Pancreatic insufficiency
- DM
- Cirrhosis
- Nasal polyps
- Sinusitis
- Male infertility
- Osteoporosis
116
Over rapid aspiration/drainage of pneumothorax can result in what?
Reexpansion pulmonary oedema
117
What test should be offered to all patients with TB?
HIV
118
What size of pneumothorax would be indicated to do a needle aspiration?
>2cm
119
Bilateral, mid-to-lower zone patchy consolidation in an older patient
Legionella
120
Deranged LFTs, hyponatraemia, low lymphocytes?
Legionella
121
Mycoplasma pneumonia can cause what?
Immune mediated neurological diseases e.g Guillan Barre
122
Pneumonia + red cell agglutination?
Mycoplasma
123
Large bullae in COPD can mimic what?
Pneumothorax
124
Why should intranasal decongestants not be used for prolonged periods?
Risk of tachyphylaxis -> increasing doses are needed
125
What is the Abx of choice for acute bronchitis?
Doxycycline
126
When to use NIV vs IV?
NIV - 7.25 - 7.35
IV - <7.25
127
What is used to assess drug sensitivities in TB?
Sputum culture
128
Staph aureus pneumonia is associated with what?
Cavitating lesions
129
What is the gold standard test for TB?
Sputum culture
130
HIV decreases what?
Sensitivity to sputum smear for TB
131
Investigation to diagnose mesothelioma?
Thoracoscopy with histology
132
Pneumonia with cold sores?
Strep pneumoniae
133
Marked volume loss of the lung with thickening of the pleura?
Think mesothelioma
134
What is the management of empyema?
Chest drain insertion for drainage + IV Abx
135
What is the advice around air travel following pneumothorax?
No travel until full resolution on CXR
136
Acute asthma steps
- Oxygen
- Nebulised salbutamol
- Oral steroids
- Nebulised Ipratropium
- IV Mag Sulph
- IV Aminophylline -> discuss with seniors
- Intubation and Ventilation in HDU/ITU
137
What is criteria for discharge following asthma exacerbation?
- Stable on discharge meds for 12-24 hours
- Inhaler technique checked
- PEFR > 75%
138
Asthma stepwise management for adults
1. SABA
2. SABA + ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA (+LTRA if helping)
5. SABA + MART (ICS+LABA) (+LTRA if helping)
6. SABA + medium dose MART (+LTRA if helping)
7. Seek help from secondary care
139
Asthma stepwise management for children
1. SABA
2. SABA + ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA
5. SABA + MART
6. SABA + medium dose MART
7. Seek help from secondary care
140
COPD stepwise Management
1. SABA / SAMA
2. SABA + LABA + LAMA if no asthma features OR SABA + LABA + ICS if asthma features
3. SABA + LAMA + LABA + ICS (even if no asthma features)
4. Seek help from secondary care
141
What would chronic bronchitis COPD show on V/Q?
Low V/Q due to decreased ventilation
142
What would emphysema COPD show on V/Q?
High V/Q due to loss of alveolar surface area causing more ventilation per available perfusion area
143
CXR signs for COPD
- Hyperinflated chest
- Bullae
- Decreased peripheral vascular markings
- Flattened diaphragm
144
Where will pancoast tumours be?
- Same side as the Horner's signs
- At the lung apex
145
Heart sounds
1st - mitral/tricuspid
2nd - aortic/pulmonary
146
Split second heart sound with loud pulmonary component?
Cor pulmonale
147
TB Treatment
RIPE - 2 months
RI - 4 more months
148
Management of secondary pneumothorax which is not improving post chest-drain insertion?
Discuss with cardiothoracic
149
Diffuse alveolar damage with hyaline membrane formation
Acute respiratory distress syndrome
150
Pleural effusions due to rheumatoid arthritis have what?
Low glucose levels
151
massive haemoptysis
Think lung abscess
152
What does a pancoast tumour invade when it causes Horners?
Cervical sympathetic plexus
153
bilateral pulmonary infiltrates
Think ARDS
154
Patient with swallowing difficulties/previous stroke with resp pathology?
Think lung abscess
155
What is the initial management of hypercalcaemia?
IV Fluids
156
What pharmacological therapy can be used for idiopathic pulmonary fibrosis?
Pirfenidone / Nintedanib
157
What is a pneumothorax?
Air in the pleural cavity which is the potential space between the visceral and parietal pleura
158
Where do you measure for pneumothorax?
Chest wall to the outer edge of the lung at level of hilum
159
What are surgical options for recurrent pneumothorax?
Video assisted thorascopic surgery
Surgical pleurodesis
160
PE like symptoms following a percutaneous vertebroplasty?
Pulmonary cement embolism
161
diffuse bilateral opacities on x ray?
Think ARDS
162
Management of solitary pulmonary nodules?
CT guided needle aspiration biopsy if >8mm
163
Unilateral pleural effusion?
Rule out malignancy
164
Why can people with carbon monoxide poisoning have?
Normal O2 sats as monitors cannot differentiate between the 2
165
Investigation of choice for pnemocystitis jiroveci?
Bronchoalveolar lavage
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