Respiratory Flashcards
(160 cards)
1
Q
What is the definition of emphysema?
A
Alveolar wall destruction leads to enlargement of distal airspaces - without sufficient antiprotease enzymes , proteases break down walls of alveoli causing bigger airspaces and reduce surface area available for gas exchanges
2
Q
What is chronic bronchitis?
A
Persistent or recurrent productive cough due to mucus hypersecretion from goblet cells
3
Q
Which lung function measure is lowered in COPD?
A
FEV1
4
Q
Which enzyme usually counters inflammation in the lungs?
A
Antiproteases such as alpha-1-antitrypsin
5
Q
What are the grades of COPD?
A
Mild: 80% or more than of predicted post bronchodilator FEV1
Moderate: 50-79%
Severe: 30 - 49%
Very severe: under 30%
6
Q
What is the FEV1/FVC ratio in COPD?
A
Less than 0.7
7
Q
What would be a sign in blood that there is COPD?
A
Polycythaemia
Anaemia
8
Q
Which heart condition is associated with late stage COPD?
A
Cor pulmonale - right sided heart failure
9
Q
What happens to hemidiaphragms in COPD?
A
They get flattened
10
Q
Why is there an increase of VTE in COPD?
A
There can be increased blood viscosity due to polycythaemia which occurs because of chronic hypoxia and as a compensatory mechanism the body over produces erythropoietin which leads to increase in red cell production
11
Q
What is empyema? + how would temp present?
A
Pus collects in pleural space - present with swinging fever
12
Q
What is acute respiratory distress syndrome?
A
Non cardiogenic pulmonary oedema and diffuse lung inflammation may be secondary to lung injury
13
Q
What criteria is used to define Acute respiratory distress syndrome (ARDS)?
A
Acute onset - less than a week
Chest - xray showing bilateral opacity
PaO2/FiO2 i 300 or less
14
Q
What is pathophysiology of ARDS?
A
Diffuse bilateral alveolar injury so endothelial is disrupted and fluid leaks into the alveoli from pulmonary capillaries
Surfactant production decreases
15
Q
What’s the presentation of ARDS?
A
Severe tachypnoea
Severe dyspnoea
Confusion/ presyncope
Creps
Use of accessory muscles
16
Q
What anti-viral therapy can be used against influenza in COPD - and when is it best intiated?
A
Oseltamivir - within 48 hours of symptom onset
17
Q
What is the definition of interstitial lung disease?
A
Group of diseases that cause inflammation and fibrosis of lung interstium
18
Q
What are the two most common types of interstitial lung disease?
A
Idiopathic pulmonary fibrosis
Hypersensitivity pneumonia
19
Q
What is hypersensitivity pneumonia?
A
Repeated exposures leads to ongoing inflammation and fibrosis
Triggers like: chemicals, agricultural dusts, woods, animal , fungi
20
Q
What is farmer’s lung?
A
Type of hypersensitivity pneumonitis caused by mould spores an hay or straw
21
Q
How is ILD classified?
A
By the zones it affects mainly
Upper zones: HART
Hypersensitivity pneumonitis
Ankylosing spondylitis
Radiotherapy
TB
Lower zones: RAIDS
Rheumatoid
Asbestosis
Idiopathic
Drugs
Sarcoidosis
22
Q
How does ILD present?
A
Dry cough
SOB
reduced exercise tolerance
Fatigue
Anorexia
Weight loss
Clubbing
Fine end inspiratory crackles
23
Q
What is seen with ILD on imaging?
A
Nodular shadowing
Honeycombing
Ground glass changes
Traction bronchiectasis
24
Q
What is treatment of idiopathic Interstitial lung disease?
A
Antifibrotic: Pirfenidone and nintedanib
25
What's the mechanism of action for nintedanib?
Tyrosine kinase inhibitor
26
What's the mechanism of action for pirfenidone?
Reduces fibroblast proliferation
27
What is treatment for hypersensitivity pneumonitis?
Steroids
If steroids don't work then: immunosuppression: cyclophosphamide and azathioprine
28
Which is correct stain for pneumonitis jirovecci pneumonia?
Silver stain
29
Which stain is for amyloid deposits?
Congo red
30
Which stain is for TB?
Ziehl - neelsen
31
Which stain is for cryptococcus neoformans?
India ink
32
What is a complication of amiodarone?
Inflammatory pneumonitis followed by chronic pulmonary fibrosis
33
Which drugs can cause pulmonary fibrosis?
Amiodarone
Nitrofurantoin
Methotrexate
Bleomycin
Busulfan
Sulfalazine
34
If pleural plaques are noted what can this indicate?
Asbestos exposure
35
What is the most common site of GI TB?
Ileocecal TB - which can present with the presence of a Right lower quadrant mass and abdo pain
36
How many apnoeic episodes per hour allows for a diagnosis of sleep apnea?
5 or more
37
What is the definition of a lung abscess?
Necrosis of lung tissue
38
Which smoking cessation drug is contraindicated in epileptics? and why?
Bupropion - decreases the seizure threshold
39
What is mechanism of bupropion?
Inhibits reuptake of dopamine and noradrenaline
40
How is bupropion taken?
Once a day for 6 days then twice a day 7-9 weeks
41
When is bupropion contraindicated?
Epilepsy
Bipolar
pregnant
breast feeding
Brain tumour
Eating disorder
42
What is the mechanism of action of varenicline?
Partial nicotinic receptor agonist
43
How is varenicline taken?
Started 1-2 weeks before quit date, then continued for 12 weeks
44
What are key side effects to be aware of with varenicline?
Suicidal ideation, depression, hallucination
45
When is varenicline contraindicated?
Pregnant
End stage renal failure
46
What's a classic finding on chest x-ray in patients with sarcoidosis?
Bilateral hilar lymphadenopathy
47
What is the inheritance pattern of primary ciliary dyskinesia?
Autosomal recessive
48
What is primary ciliary dyskinesia?
Dysfunctional cilia
49
What is a key feature of primary ciliary dyskinesia that means that left lung base would be dull?
Situs invertus
50
What type of pneumonia is common from contaminated water, air conditioning - esp in hotels.?
Legionnaire's disease
51
What type of bacteria is legionella?
Gram negative bacilli
52
How does legionnaire's disease present?
Dry cough
Confusion
Hyponatraemia
Lethargy
Muscle aches
53
What must the ABG results be in order to meet criteria for long term oxygen therapy?
PaO2 less than 7.3 on two separate readings more than 3 weeks apart - non smokers
OR PaO2 of 7.3-8 WITH nocturnal hypoxia, polycythaemia, peripheral oedema and pulmonary hypertension
54
What is caplan's syndrome?
Multiple pulmonary nodules that rapidly occur in lung periphery in patients with rheumatoid - causes swelling and scarring of lungs
55
Why can idiopathic pulmonary arterial hypertension be exacerbated in pregnancy?
Because the pulmonary vascular resistance can't be reduced to accommodate increasing Cardiac output like in normal pregnant women therefore causing a early diastolic murmur - pulmonary regurg
56
What causes type 2 respiratory depression?
Can be due to opiate overdose
Causing:
Decreased paO2 but increased paCO2 due to alveolar hypoventilation
57
What is treatment of T1RF vs T2RF?
T1: CPAP
T2: NIV (BIPAP)
58
What is a complication type 2 diabetics are at risk of getting post influenza?
Pneumococcal pneumonia
59
What chemical is in contract for CTPA that people may be allergic to?
Iodine
60
Other than iodine allergy when else may a V/Q be preferred over CTPA?
Pregnant
Renal impairment
61
What is gold standard investigation for allergies?
Food challenge test
62
What is heparin induced thrombocytopenia?
Life threatening auto-immune reaction to heparin whereby patients have reduced platelets and hypercoagulable state
63
How is heparin induced thrombocytopenia treated?
Cessation of heparin
Argatroban
64
What type of bacteria can cause pneumonia after influenza?
Staph aureus
65
What bacteria is a common cause of hospital acquired pneumonia?
Klebsiella
66
What does sputum of klebsiella look like?
Red-currant jelly
67
Which patients are more likely to get pseudomonas aeruginosa?
CF
COPD
68
What is treatment for TB?
RIPE for 2 months followed by RI (or called rifinah) for 4 months
R:ifampicin
Isoniazid
Pyrazinamide
Ethambutol
69
Which intervention can reduce mortality in ARDS?
Low tidal volume mechanical ventilation
70
Which medication is usually given for aspiration pneumonia?
IV metronidazole as aspiration pneumonia is most likely due to oropharyngeal anaerobes
71
Which anti-microbial can cause INR to rise?
Metronidazole
72
Which sound is heard on COPD lungs?
Wheeze
73
Is MS obstructive or restrictive lung disease?
Restrictive so a normal FEV1/FVC - more than 0.7 and normal BUT reduced FEV1 and FVC values
74
When is spironolactone used vs furosemide?
Furosemide is used first then if symptoms persist then spironolactone is used
75
What type of hypersensitivity reaction is farmer's lung (a type of extrinsic allergic alveolitis)?
Type 3 its a hypersensitivity pneumonitis
76
What's the most common form of lung cancer in non smokers?
Adenocarcinoma
77
What's the most common subtype of lung cancer?
SCC
78
What can cause wrist pain in lung adenocarcinoma?
hypertrophic pulmonary osteoarthropathy
79
Which nerves are invaded in pancoast tumour that can cause horner's?
Brachial plexus
80
What AMTS score in setting of pneumonia and calculating CURB-65 indicates confusion?
Less than 8
81
How is CURB65 calculated?
C: confusion?
Urea over 7
Resp rate: 30 or over
B: BP systolic under 90 or diastolic under 60
65 - are they 65 or older
82
What does a CURB-65 score of over 3 indicate?
Mortality within 30 days
83
What is p pulmonale on ecg?
Right atrial abnormality on ecg seen as tall peaked p waves can be due to pulmonary hypertension as it's a cause of right atrial enlargement
84
What size cannula should be used to aspirate pneumothorax?
18-18G
85
Where is cannula placed in pneumothorax on chest?
2ICS on affected side if this fails do an open thoracostomy
After initial emergency decompression a chest drain should be inserted
86
Which patients would require a chest drain over a 16-18G cannula for pneumothorax first?
High risk feature patients:
Significant hypoxia
Bilat penumothoraces
Underlying lung disease
50 or older with significant smoking history
Haemopneumothorax
87
What is a normal cardiothoracic ration?
Less than 0.5 - above 0.5 can indicate cardiomegaly
88
What is best diagnostic investigation for heart failure?
Transthoracic echo
89
What would a pH of below 7.2 in pleural fluid indicate?
Empyema
90
What's a common form of pneumonia in young adults?
Mycoplasma pneumonia
91
What rash can be seen with mycoplasma pneumonia?
Erythema multiforme
92
How would mycoplasma pneumonia present?
Haemolysis
Elevated reticulocytes
Cold agglutinin and positive coombs
Erythema nodusm rash
93
What does a positivie coomb's test indicate?
Antibodies that act against red blood cells
94
What is cold agglutinin test show?
Detects presence of cold agglutinins which are antibodies that cause RBC to clump together in cold temperatures
95
Which asthma patients should be offered preventer therapy?
Patients with symptoms more than twice a week
History of exacerbations in the past year
Pt who need SABA more than 3 times a week
96
What is 1st line treatment for COPD patient with breathless on activity?
SABA or SAMA
97
Give me an example of a SAMA?
Ipratropium
98
If after a SABA or LAMA things are not improving in copd what else is given?
LABA + ICS OR LABA + LAMA - use this combo first
99
What ICS is used in COPD?
Beclamethasone
100
What LAMA is used in COPD?
Tiotropium
101
What is bronchiectasis?
Chronic lung disease characterised by irreversible dilation of bronchi and bronchioles due to chronic inflammation and infection
102
What's the initial management of bronchiectasis?
Chest physio - helps removes secretions
Inhaled bronchodilators - improve airflow
Antibiotics
103
When is metronidazole helpful in treating pneumonia?
Gram negative infections
104
When is vancomycin used in pneumonia?
If there is concern for MRSA
105
What is treatment for TB meningitis?
RIPE for 2 months
RI for 10 months
106
What is the gram staining of klebsiella?
Gram negative anaerobic rod
107
Which electrolyte imbalance is present in legionella?
Hyponatraemia
108
What is the gram staining of legionella?
Gram negative aerobic rods
109
What is a transudate vs exudate?
Transudate are pleural fluids with a protein level less than 25g/L
Exudates are pleural fluid with protein level more than 35g/L
110
What does light's criteria say about exudates?
Ratio of pleural to serum protein is more than 0.5
Ratio of pleural to serum LDH is more than 0.6
Pleural fluid LDH is more than 2/3s the upper limit of normal value
111
What are transudative causes of effusions?
Heart failure - usually bilat
Nephrotic syndrome
Cirrhosis
Hypoalbuminaemia
112
What are exudative causes of pleural effusions?
Pneumonia - so a parapneumonic effusion
Malignancy
TB
PE
RA
SLE
Pancreatitis
Trauma
113
How many days would a chest drain be expected to clear and allow for chest re-expansion?
3-5 days of chest drain insertion
114
What is important to remember about methotrexate?
It can cause pneumonitis - fibrosis, restrictive lung disease
115
Which pneumonia is associated with alcoholics?
Klebsiella - highly associated with lung abscesses in alcoholic patients
116
When is vocal resonance reduced?
Pleural effusion or lung collapse
117
What about spirometry would allow for a diagnosis of asthma?
Reversibility of 12% or more in the FEV1 with bronchodilator use
118
Which is the diagnostic investigation for chronic thromboembolism pulmonary hypertension?
Right heart catheterisation
119
Which measure should be monitored monthly when starting bosentan (endothelin A receptor antagonist)
LFTs
120
What medication can be prescribed for pulmonary hypertension?
Bosentan
121
What would empyema present with?
Persistent foul smelling sputum and low pleural fluid pH
122
What is defined as pulmonary hypertension?
Pressure over 25
123
What happens to residual lung volume in COPD?
There is an increase in residual lung volume as body can't exhale all air properly due to dynamic hyperinflation
124
What feature on the hands can be seen with recurrent lung abscesses?
Finger clubbing
125
What's the best diagnostic investigation for mycoplasma pneumonia?
Blood serology
126
Which pneumonia is urinary antigens useful in?
Legionnaire's disease
127
Which heart sound can indicate right sided heart failure due to long term lung disease?
Split second heart sound with loud pulmonary component
128
What is percussion like in pleural effusion?
Stony dull
129
What is meig syndrome triad?
Ovarian benign tumour
Ascites
Pleural effusion
130
Which side do pleural effusions usually happen in Meig's syndrome?
Right sided
131
Which organism causes pneumonia with rust coloured sputum?
Streptococcus
132
What is acute bronchitis normally caused by?
Respiratory virus
133
134
Why is D dimer not useful in pregnancy?
Because D dimer is naturally increased in pregnancy - so the test would produce false positives
135
Which pneumonia is most commonly associated with cold haemolytic anaemia?
Mycoplasma pneumonia
136
How does cold haemolytic anaemia present?
Fatigue
Blue fingers and toes when cold
Sweating
Weakness
Pale
Drained skin
137
When someone has had a stroke and come in with pneumonia like symptoms what should you start thinking?
Aspiration pneumonia - bcos impaired swallow
138
Which type of bacteria is most commonly causing lung abscess?
Anaerobic bacteria
139
What is most likely test for pulmonary fibrosis?
CT of chest
140
Which UTI medication can cause pulmonary fibrosis if multiple courses are taken?
Nitrofurantoin
141
What is seen on chest X-ray for PE?
Wedge shaped opacification in left middle zone
142
What is common sighting on X-ray for TB?
Upper zones - patchy opacifications - can be described as fibronodular
143
What well's score indicated high likelihood of PE?
Over 4
144
What is Spirometry values in osbstructive disease?
Low FEV1
Reduced FEV1/FVC
Preserved FVC
145
What is the oral antibiotic regime for patients with CAP?
Amoxicillin 500mg 3 times a day for 5 days
146
What follow up do patients with pneumonia need?
Repeat chest X-ray 6-8 weeks after to screen for underlying lung cancer
147
Which lung lobes does farmer's lung (extrinsic allergic alveolitis) tend to go got?
Upper lobes
148
What FVC must a patient have to consider an anti-fibrinolytic?
50-80%
149
Which pneumonia patients are suitable for home treatment?
CURB65 - is 0 or 1 .
Any CRUB over 2 needs hospital admission
150
What is seen with an INITIAL ABG in aspirin overdose?
Respiratory alkalosis
151
What is the most common gram positive aerobic bacteria that causes aspiration pneumonia?
Streptococcus
152
What indications make a COPD patient suitable for lung reduction surgery?
Predominant upper lobe emphysema
153
What's the definitive test for pneumocystis pneumonia?
Bronchoscopy with bronchoalveolar lavage
154
Which drug should be held when clarithromycin is used and why?
Simvastatin - statins are metabolised by the CYp3a4 pathways and clarithromycin increases plasma levels of statins - increases the risk of myopathy
155
What type of hypersensitivity reaction is asthma?
Type 1
156
What does signet ring sign on CT signify?
Bronchiectasis - bronchus is dilated
157
What is postural drainage?
Type of chest physio - done twice a day to help drain mucous to prevent infective exacerbations of bronchiectasis
158
What's recommended first line antibiotic for HAP? why what does it act against?
Pip and taz
Pseudomonas cover and MRSA cover
159
What type of fibrosis does TB cause?
Apical fibrosis
160
