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REVISION > RESPIRATORY > Flashcards

RESPIRATORY Flashcards

1
Q

What causes psittacosis?

A

An infection by chlamydia psittaci
Usually from a bird contact

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2
Q

What are the causes of upper lobe fibrosis?

A

CHARTS:
Coal workers pneumoconiosis
Histiocytosis and hypersensitivity pneumonitis
Ankylosing spondylitis
Radiation
TB
Sarcoidosis and silicosis

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3
Q

Pts with pleural effusions will require diagnostic pleural fluid sampling. What from this would indicate that a chest tube should be placed?

A

If the fluid is clear but pH is <7.2
If the fluid is purulent or turbid/cloudy

These factors suggest likely infection, maybe empyema

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4
Q

How should children ages 5-17 be diagnosed with asthma?

A

Spirometry with a bronchodilator reversibility test - >12%

If normal then FeNo

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5
Q

How is a diagnosis of asthma made in a child <5?

A

Based on clinical judgement

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6
Q

Likely diagnosis of an Afro-Caribbean lady with erythema nodosum and hypercalcaemia?

A

Sarcoidosis

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7
Q

What facial rash is seen in sarcoidosis?

A

Lupus pernio

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8
Q

What are indications for long term oxygen therapy in a pt with COPD?

A

PO2 <7.3kPa

Or those with pO2 of 7.3-8.0 and one of the following:
Secondary polycthemia
Peripheral oedema
Pulmonary hypertension

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9
Q

What are the manifestations of Alpha 1 antitrypsin deficinecy?

A

Panacinar emphysema
Cirrhosis and hepatocellular carcinoma (cholestasis in childen)

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10
Q

What is the 4 Centor criteria?

A

presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough

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11
Q

How does an aspergilloma present?

A

Episodic haemoptysis which can be severe!
SOB, weight loss
On the background of TB

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12
Q

What are the 2 most common causes of B/L hilar lymphadenopathy?

A

Sarcoidosis and TB

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13
Q

What is the triad of Meig’s syndrome?

A

Benign ovarian tumour
Ascites
Pleural effusion

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14
Q

Within what time of a transfusion do symptoms of TRALI occur?

A

Within 6 hours

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15
Q

How to remmeber transudate vs exudate causes of pleural effusions?

A

TRANSient pressure & EXpert leaks
Transudates protein <30 - caused by increased hydrostatic pressure or reduced oncotic pressure
Exudates protein >30 - caused by leaky capillaries due to infection, inflammation or malignancy

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16
Q

What is stage 1 COPD?

A

Mild COPD
Symptoms present but FEV1 >80%
(And of course FEV1/FVC must be <0.7 showing an obstructive pattern)

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17
Q

What is stage 2 COPD?

A

Moderate COPD
FEV1 50-79% of predicted

18
Q

What is stage 3 COPD?

A

Severe COPD
30-49% of predicted

19
Q

What is stage 4 COPD?

A

Very severe COPD
FEV1 <30% of predicted

20
Q

What questionnaire can be used to assess the impact of COPD on wellbeing nd daily life?

A

The COPD assessment test (CAT)

21
Q

Investigations for COPD?

A

FBC for anaemia or polycthemia
Post-bronchodilator spirometry to confirm diagnosis by demonstrating FEV1/FVC <0.7
CXR to rule out other causes e.g. ca and to see COPD signs

Others:
If infective -> sputum culture
If any heart symptoms -> ECG and serum BNP for cor pulmonale
If very young or FHx then consider serum alpha-1-anti trypsin

22
Q

CXR findings in COPD?

A

Hyperinflation
Bullae
Flat hemidiaphragm
Barrel chest - widened AP diameter
Saber-sheath trachea - marked coronal narrowing of intrathoracic trachea with concomitant sagittal widening

23
Q

What is the transfer coefficient ?

A

KCO
The value of the transfer factor divided by the alvoler volume
It expresses the gas transfer ability per unit volume of lung i.e. its transfer factor corrected for lung volume

24
Q

What is transfer factor?

A

The rate at which a gas will diffuse from alveoli into the blood
Results given as TLCO or corrected for lung volume as the transfer coefficient (KCO)

25
Q

What can cause a reduced TLCO/transfer factor but an increased KCO/transfer coefficient?

A

Diseases where there is a decrease in lung volume due to an inability to expand the thorax e.g. lobectomy, scoliosis, neuromuscular disorder or ankylosing spondylitis
KCO also increases with age!

26
Q

Which diseases cause an increased TLCO?

A

Conditions where there is increased exposure of alveolar contents to blood

Chronic asthma
Pulmonary haemorrhage e.g. GPA
Left-to-right cardiac shunts
Polycthemia
Hyperkinetic states
Male gender

27
Q

Which diseases cause an decreased TLCO?

A

Any cause of reduced capacity for gas exchange in the lungs

Pulmonary fibrosis
Pneumonia
PE
Pulmonary oedema
Emphysema
Anaemia
Low CO

28
Q

What can cause iatrogenic pneumothorax?

A

NIV or lung biopsy
Thoracentesis
CVC placement

29
Q

In pts with primary spontaneous pneumothorax, what is usually the underlying cause?

A

Rupture of subpleural blebs or Bullae

30
Q

Why are tall, young men at highest risk for primary spontaneous pneumothoraces?

A

rapid growth of the chest during growth spurts may increase the likelihood of forming blebs which is the underlyign pathophysiology for a pneumothorax as they can rupture and release air into the pleural space

31
Q

Screening questionnaires available for extent and severity of OSA/

A

STOP-Bang questionnaire
EPWORTH sleepiness scale

32
Q

Investigations for obstructive sleep apnoea?

A

Epworth sleep scale
Multiple sleep latency test - a person is given 4-5 opportunities to sleep every two hours during normal wake times - measures the extent of daytime sleepiness
Polysomnography is diagnostic

33
Q

What causes acute respiratory distress syndrome?

A

Increased per ability of alveolar capillaries leading to fluid accumulation in the alveoli

Infections
Massive blood transfusions
Trauma
Smoke inhalation
Acute pancreatitis
Cardio-pulmonary bypass

34
Q

Criteria for diagnosing ARDS?

A

Acute onset (within 1 week of risk factor)
Pulmonary oedema
Non-carcinogenic i.e. not a raised pulmonary artery wedge pressure
PO2 or FiO2 <40kPa

35
Q

Clinical features of ARDS?

A

Dyspnoea
Raised RR
B/L lung crackles
Low oxygen sats

36
Q

Why can acute pancreatitis cause ARDS?

A

Pancreatitis causes release of key enzymes e.g. amylase, lipase, proteases etc
These are released into the blood stream and cause release of cytokines and other inflamamtory mediators -> can cause systemic inflammation -> ARDS

37
Q

Causes of acute mediastinal widening? (5 Ts!!)

A

Thoracic aortic aneurysm
Terrible Lymphoma
Thyroid goitre
Teratomas
Thymus tumours

38
Q

Investigations for ?asthma?

A

Bedside: Peak flow, ?sputum sample if productive cough
Lab: WCC, CRP, eosinophil count, total IgE
CXR to rule out lung pathology

Diagnostic:
Spirometry with bronchodilator reversibility - improvement in FEV1 of 12% of more
Fractional exhaled nitric oxide testing of 40ppb or more

Variable peak flows if diagnostic uncertainty - more than 20% variability after monitoring at least twice daily for 2-4 weeks = positive

Specialist referral:
Direct bronchial challenge test if diagnostic uncertainty
If they have ?occupation asthma then refer to specialist straight away

39
Q

Presentation of bronchiectasis?

A

Daily productive cough
Haemoptysis in 50%
Exertional dyspnoea which may progress to resting dyspnoea
Fatigue
Rhinosinusitis symptoms due to mucociliary impairment
History of childhood LRTI
FHx of congenital and autoimmune conditions

40
Q

What can cause a white-out of a hemithorax and the trachea pulled towards the side of the white out?

A

Pneumonectomy
Complete lung collapse
Pulmonary hypoplasia

41
Q

What can cause a white-out of a hemithorax and the trachea pulled away from the side of the white out?

A

Pleural effusions
Diaphragmatic hernia
Large thoracic mass

42
Q

What can cause a white-out of a hemithorax with a central trachea?

A

Consolidation
Pulmonary oedema
Mesothelioma

REVISION (25 decks)

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