Respiratory Flashcards

Question

Where do you see Tram Track and Signet Ring Signs

Answer 1

Broncheictasis

Answer 2

H. Influenza ( most common) Other causes Pseudomonas aeruginosa Klebsiella spp. Streptococcus pneumoniae

Answer 3

drain tubing should be clamped regularly in the event of rapid fluid output i.e. drain output should not exceed 1L of fluid over a short period of time (less than 6 hours).

Answer 4

abscess (Staph aureus, Klebsiella and Pseudomonas) aspergillosis, histoplasmosis, squamous cell lung cancer tuberculosis Wegener's granulomatosis pulmonary embolism rheumatoid arthritis coccidioidomycosis

Answer 5

>tracheal deviation towards the side of the collapse >mediastinal shift towards the side of the collapse >elevation of the hemidiaphragm Note: Sail sign - right lower lobe collapse Veil Sign - Right Upper Collapse

Answer 6

RCC - most common Note; May also occur secondary to choriocarcinoma and prostate cancer.

Answer 7

Pneumonectomy Complete lung collapse e.g. endobronchial intubation Pulmonary hypoplasia

Answer 8

Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following: secondary polycythaemia peripheral oedema pulmonary hypertension Note: If Pt. is current smoker, LTOT is contraindicated

Answer 9

>regular (at least twice daily) chest physiotherapy and postural drainage. >high calorie diet, including high fat intake* >patients with CF should try to minimise contact with each other to prevent cross infection with Burkholderia cepacia complex and Pseudomonas aeruginosa >vitamin supplementation >pancreatic enzyme supplements taken with meals >lung transplantion >Lumacaftor/Ivacaftor (Orkambi) ****

Answer 10

****chronic infection with Burkholderia cepacia

Answer 11

imaging: upper/mid-zone fibrosis bronchoalveolar lavage: lymphocytosis serologic assays for specific IgG antibodies blood: NO eosinophilia Mx: Steroids Remove precipitants Examples bird fanciers' lung: avian proteins from bird droppings farmers lung: spores of Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni) malt workers' lung: Aspergillus clavatus mushroom workers' lung: thermophilic actinomycetes*

Answer 12

Histoplasmosis Mx: Amphotericin or itraconazole

Answer 13

pirfenidone

Answer 14

Honey Combing

Answer 15

Features dextrocardia or complete situs inversus bronchiectasis recurrent sinusitis subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes) Hint ; (e.g. 'quiet heart sounds', 'small volume complexes in lateral leads')

Answer 16

Klebsiella (Gram-negative rod)

Answer 17

Lofgren's syndrome Note: Loefflers syndorme is a parasitic infection ( raised esinophils) Ascaris lumbricoides

Answer 18

Note- If in GP setting , use CRB-65

Answer 19

Fibrosis predominately affecting the upper zones CHARTS C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis Fibrosis predominately affecting the lower zones idiopathic pulmonary fibrosis most connective tissue disorders (except ankylosing spondylitis) e.g. SLE drug-induced: amiodarone, bleomycin, methotrexate asbestosis

Answer 20

Surgery contraindications assess general health stage IIIb or IV (i.e. metastases present) FEV1 < 1.5 litres is considered a general cut-off point* malignant pleural effusion tumour near hilum vocal cord paralysis SVC obstruction * However if FEV1 < 1.5 for lobectomy or < 2.0 for pneumonectomy then some authorities advocate further lung function tests as operations may still go ahead based on the results

Answer 21

1st- CXR 2nd- CT 3rd- Pleural Biopsy ( to confirm)

Answer 22

MERS CoV (Middle East respiratory syndrome)

Answer 23

M. avium complex (MAC) organisms.

Answer 24

OHS = daytime hypercapnia + obesity + hypoventilation OSA = intermittent airway obstruction + normal daytime PaCO₂ OHS often coexists with OSA but requires BiPAP instead of CPAP due to chronic hypercapnia 🚀

Answer 25

Pneumothorax Management (BTS 2023) – Key Points Step 1: Assess Symptoms Minimal/no symptoms → Conservative care (regardless of size) Symptomatic → Assess for high-risk characteristics Step 2: Assess High-Risk Characteristics ✅ High-risk factors: Haemodynamic compromise (suggests tension pneumothorax) Significant hypoxia Bilateral pneumothorax Underlying lung disease ≥ 50 years + significant smoking history Haemothorax ✅ Management: No high-risk factors → Choose between: Conservative care Ambulatory device Needle aspiration High-risk present → Chest drain (if safe to intervene) Step 3: Determine Safety for Intervention Needle aspiration or chest drain: Safe if ≥ 2 cm on CXR (laterally/apically) Any size on CT scan (if radiologically accessible) Management Options 1️⃣ Conservative Care Primary pneumothorax: Review every 2-4 days (outpatient) Secondary pneumothorax: Monitor inpatient → outpatient follow-up in 2-4 weeks 2️⃣ Ambulatory Care Example: Rocket™ Pleural Vent (8FG catheter + pigtail) One-way valve prevents air/fluid return, allows controlled escape Indicator helps assess resolution 3️⃣ Needle Aspiration If successful → Discharge + follow-up in 2-4 weeks If unsuccessful → Chest drain 4️⃣ Chest Drain Daily inpatient review Remove when resolved → Discharge + follow-up in 2-4 weeks 📌 Key takeaway: Prioritise symptoms + high-risk factors over size! 🚀

Answer 26

✅ Obstructive (↓ Airflow) FEV1 ↓↓↓, FVC ↓/normal, FEV1/FVC ↓ Examples: Asthma, COPD, Bronchiectasis, Bronchiolitis obliterans ✅ Restrictive (↓ Lung Volume) FEV1 ↓, FVC ↓↓↓, FEV1/FVC normal/↑ Examples: Pulmonary fibrosis, Asbestosis, Sarcoidosis, ARDS, IRDS, Kyphoscoliosis, Neuromuscular disorders, Severe obesity

Answer 27

pulmonary fibrosis - lower zone pleural effusion pulmonary nodules bronchiolitis obliterans (progressive dyspnoea ;obstructive pattern on spirometry) centrilobular nodules, bronchial wall thickening is seen on CT complications of drug therapy e.g. methotrexate pneumonitis pleurisy Caplan's syndrome (massive fibrotic nodules with occupational coal dust exposure infection (possibly atypical) secondary to immunosuppression)

Answer 28

Lupus Perinio

Answer 29

Lofgren's syndrome is an acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis In Mikulicz syndrome* there is enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma Heerfordt's syndrome (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis

Answer 30

stage 0 = normal stage 1 = bilateral hilar lymphadenopathy (BHL) stage 2 = BHL + interstitial infiltrates stage 3 = diffuse interstitial infiltrates only stage 4 = diffuse fibrosis

Answer 31

-patients with chest x-ray stage 2 or 3 disease who are symptomatic. - -hypercalcaemia -eye, heart or neuro involvement

Answer 32

Silicosis Features Upper zone fibrosis Egg shell calcifications of Hilar L.N

Answer 33

Smoking Cessation – Key Points ✅ First-line options: NRT, varenicline, or bupropion (no preference among them). ✅ Target stop date: Start medication before quitting (1 week for varenicline, 1–2 weeks for bupropion). Prescribe only until 2 weeks after stop date. No repeat prescriptions within 6 months if unsuccessful. ✅ Medications: 🔹 NRT (Nicotine Replacement Therapy) – Use patches + another form (gum, lozenges, etc.) for heavy smokers. Side effects: nausea, headaches. 🔹 Varenicline (Partial Nicotinic Agonist) – More effective than bupropion. Side effects: nausea, abnormal dreams, insomnia. Avoid in depression, pregnancy. 🔹 Bupropion (Norepinephrine-Dopamine Reuptake Inhibitor) – Risk of seizures (1 in 1,000). Contraindicated in epilepsy, pregnancy, and eating disorders. ✅ Pregnant Women: Screen for smoking with CO detectors. First-line: behavioral therapy (CBT, motivational interviewing). NRT can be used but remove patches at night. Varenicline & bupropion are contraindicated.

Answer 34

Nodule <5mm, or clear benign features, or unsuitable for treatment: can be discharged Nodule =>8mm and high risk*: then CT-PET, and if CT-PET shows high uptake then biopsy Nodule 5-6mm, or =>8mm and low-risk*: then CT surveillance CT surveillance: if 5-6mm then at 1 year, if =>6 then in three months

Answer 35

Features acidosis, hypokalaemia vomiting tachycardia, arrhythmias seizures Management consider gastric lavage if <1 hour prior to ingestion activated charcoal whole-bowel irrigation can be performed if theophylline is sustained release form charcoal haemoperfusion is preferable to haemodialysis

Answer 36

✅ Definition: Measures gas diffusion from alveoli to blood using carbon monoxide. TLCO = Total gas transfer. KCO = Transfer coefficient (TLCO corrected for lung volume). ✅ Causes of ↑ TLCO: Increased blood flow: Asthma, polycythaemia, hyperkinetic states, left-to-right shunts. Alveolar-capillary leak: Pulmonary haemorrhage (e.g., GPA, Goodpasture’s). Others: Male gender, exercise. ✅ Causes of ↓ TLCO: Lung pathology: Pulmonary fibrosis, pneumonia, emphysema. Vascular issues: Pulmonary emboli, pulmonary oedema, low cardiac output. Others: Anaemia. ✅ KCO increases with age. Conditions causing ↑ KCO with normal/↓ TLCO: Reduced lung volume: Pneumonectomy, lobectomy. Chest wall restriction: Scoliosis, kyphosis, ankylosing spondylitis. Neuromuscular weakness.

Respiratory Flashcards

(65 cards)