Respiratory Flashcards
(254 cards)
1
Q
Contraindications to NIV?
A
Patient refusal
Facial burns/ trauma
Recent UGI surgery
Fixed airway obstruction
Cant protect airway- low GCS, vomiting
Undrained pneumothorax
2
Q
Uses for CPAP?
A
OSA
Pulmonary oedema
3
Q
Indications for BiPAP?
A
COPD TR2F with pH <7.35
T2RF due to chest wall deformity, NMD, OSA
Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning of tracheal intubation
4
Q
Initial settings for BiPAP?
A
IPAP 12/ EPAP 4-5
40% flow rate
Back up rate 15 breaths a minute
5
Q
Reassessment in BiPAP?
A
60 mins repeat ABG
60 min review after changes
Then 4 hourly
6
Q
Causes of respiratory alkalosis?
A
Anxiety
PE
Salicylate poisoning
Stroke, encephalitis, SAH
Altitude
Pregnancy
7
Q
What is total lung capacity?
A
Vital Capacity + Residual volume
8
Q
What is vital capasity?
A
Sum of max inspiration and expiration (not including residual volume)
9
Q
FEV1/FVC ratio of >0.8?
A
Restrictive
10
Q
Examples of restrictive lung diseases >0.8?
A
Pulmonary fibrosis
Asbestosis
Sarcoidosis
ARDS
NMD
Severe obesity
11
Q
FEV1/FVC <0.8?
A
Obstructive lung disease
12
Q
Examples of obstructive lung diseases <0.8?
A
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
13
Q
Causes of increased total gas transfer (TLOC)?
A
Pulmonary haemorrhage
Polycythaemia
Asthma
L-R cardiac shunts
Hyperkinetic states
Male gender
14
Q
Causes of decreased TLOC?
A
Intersitial fibrosis
Emphysema
Pneumonia
Pulmonary oedema
Low CO
Anaemia
PE
15
Q
Moderate Asthma Attack?
A
PEFR 50-75%
16
Q
Severe Asthma Attack?
A
PEFR 33-50%
RR >25
HR >110
Unable to complete sentences
17
Q
Life threatening asthma?
A
PEFR <33%
Normal PaCO2
PaO2 <8
Silent chest
Tiring/ confusion
Haemodynamically unstable
18
Q
Near fatal asthma attack?
A
Raised PaCO2
Required mechanical ventilation with raised inflation pressures
19
Q
Management of acute asthma attack?
A
Salbutamol neb 5mg Back to back (up to 5)
Ipratropium bromide neb once then QDS
Prednisolone 40mg OD 5 days, or IV hydrocortisone 100mg IV then 50mg QDS
IV abx if needed
IV magnesium sulphate 20 mins
Aminophylline loading and maintenance
ICU
20
Q
Asthma mimic with eosinophillia that is worse with steroids?
A
Strongiolodiasis
21
Q
Chronic asthma investigations?
A
Peak flow diary >20% variability
Spirometry with FEV1/FVC <0.7, reversibility testing >12%
FeNO
22
Q
Chronic asthma treatment ladder:
A
- Low dose ICS/ LABA formoterol PRN if severe symptoms MART
- Low dose MART
- Moderate dose MART
- Check FeNO and blood eosinophils
High- specialist referral
Normal- Leukotriene receptor antagonist or LAMA + Moderate MART - Specialist
23
Q
Action of formoterol?
A
LABA
24
Q
Mechanism of ipratropium bromide?
A
SAMA
25
Name a leukotriene receptor antagonist?
Montelukast
26
FBC in COPD?
Polycythaemia
27
Stages of COPD?
1 Mild - >80%
2- Moderate- 50-79%
3- Severe 30-49%
4- Very severe <30%
28
Chronic management of COPD?
1- SABA/SAMA
2- Asthmatic features: LABA/ICS
No Asthmatic features: LABA/LAMA
3- LAMA/LAMA + ICS
4- Theophylline
29
Name LABA/ICS inhalers?
Seretide
Symbicort
Fostair
30
Name LABA/LAMA inhalers?
Anoro Ellipta
Spiolt Respimart
31
Name a LABA/LAMA/ICS inhalers?
Trelegy
Trimbow
Trixeo
32
Complication of COPD for the heart?
Cor pulmonale
R sided heart failure seen with peripheral oedema, raised JVP
33
What abx if used for exacerbation prophylaxis in COPD?
Azaithromycin
34
Concern of azithromycin?
QTc prolongation
35
In severe COPD with triple therapy and repeated exacerbation X2 ?
Add PDE-e inhibitor Roflumilast
36
Most common organism in IECOPD?
Haemophilus influenzae
37
Top 3 common organisms for IECOPD?
Haemophilus Influenzae
Strep pneumonia
Moraxella catarrhalis
38
Oxygen therapy in unknown COPD patient?
88-92% til ABG
Start on 28% venturi on 4L/min
Til ABG
39
Management of AECOPD?
Salbutamol up to 5 back to back
Ipratropium QDS
Oral pred 30mg 5 days
Abx: amoxicillin, clarithromycin, doxycyline
IV theophylline
40
How long should you use LTOT?
15 hours a day
41
Who do you assess for LTOT in COPD?
FEV1<30%
Cyanosis
Polycythaemia
Cor pulmonale
42
Work up for LTOT?
2 ABGs 3 weeks apart when clinically stable
43
Criteria to start LTOT?
PaO2 <7.3
PaO2 <8 in polycythaemia, cor pulmonale or pulmonary HTN
44
Medications for smoking cessation?
Varenicline
Bupropion
45
Contraindications for varenicline (smoking cessation)?
Breast feeding
Pregnancy
46
Contraindications for Bupropion (smoking cessation)?
Epilepsy
Pregnancy
Breast feeding
47
Inheritance of alpha-1 anti typsin deficiency?
AD
48
What is alpha-1 anti typsin deficiency?
Lack of A1AT leading to unopposed neutrophil elastase causing COPD and cirrhosis
49
Alleles of alpha-1 anti typsin deficiency?
PiMM (normal)
PiMZ (lower risk)
PiSS (50% normal)
PiZZ (10% normal)
50
Management of alpha-1 anti typsin deficiency?
IV A1AT
51
What is bronchiectasis?
Permanent dilation of the bronchi and bronchioles following damage
52
Causes of bronchiectasis?
Post infection
Childhood infections
COPD
Pulmonary fibrosis
Cystic fibrosis
ABPA
HIV
Selective IgA deficiency
Hypogammaglobulinaemia
Kartagener syndrome
Primary ciliary dyskinesia
Young syndrome
Yellow nail syndrome
Obstruction
53
What is Kartagener syndrome?
AR situs inversus, chronic sinusitis, bronchiectasis
54
What is Young syndrome?
Infertility azoospermia
Chronic sinusitis
Bronchiectasis
55
CXR/CT signs of bronchiectasis?
Tramlines
Signet rings
56
Diagnosis of bronchiectasis?
HR CT
57
Common pathogens in braonchiectasis?
Haemophilus influenza
Strep pnuemonia
Pseudomonas
58
Management of bronchiectasis?
Sputum clearance with postural drainage and carbociestine
Prophylaxis if >3 exacerbations a year
Bronchodilators
59
What is bronchiolitis obliterans and what causes it?
Obstructive respiratory function due to destruction of the epithelial lining seen in RA, post lung transplant
60
Management of bronchiolitis obliternans?
Azithromycin and steroids
61
What is allergic bronchopulmonary aspergillosis ABPA?
Type 1 and 3 hypersensitivity reaction to aspergillous fumigatus spores
62
Presentation of allergic bronchopulmonary aspergillosis ABPA?
Bronchiectasis and eosinophillia
Often have a label of asthma
63
Characteristic imaging signs of aspergillosis?
'halo sign' and hyphae have been seen on silver staining
64
Investigations of allergic bronchopulmonary aspergillosis ABPA?
Eosinophillia
Raised IgE
+ve RAST
65
Treatment of allergic bronchopulmonary aspergillosis ABPA?
Prednisolone
Anti fungals second line
66
What is interstitial lung disease?
A group of conditions causing inflammation and fibrosis on the interstitium
67
Presentation of ILD?
SOB
Non productive cough
Fine end inspiratory crackles
68
CXR in ILD?
Reticular and nodular shadowing
69
Spirometry in ILD?
Restrictive with low TLC
70
Gold standard investigation for ILD?
HR CT showing honey combing and ground glass changes
71
Further investigations after HR CT for ILD?
Broncholavage >50% lymphocytes suggests needs immunosuppression
72
Causes of ILD leading to UPPER zone fibrosis?
CHARTS
Coal workers pneumonitits
Hypersensitivity pneumonitis
Ankylosing spondylitits
Radiotherapy
TB
Sarcoidosis/ Silicosis
73
Causes of ILD causing LOWER zone fibrosis?
RAIDS
RA/ SLE
Asbestosis
Idiopathic
Drugs
Scleroderma/ Sjogrens
74
Drugs causing ILD (lower zones)?
Bleomycin
Methotrexate
Amiodarone
Nitrofurantoin
75
What is hypersensitivity pneumonitis AKA extrinsic allergic alveolitis?
Type 3-4 hypersensitivity reaction to environmental allergens
76
What causes bird fancier's lung?
Avian proteins in droppings
77
What causes farmer's lung?
Saccharopolyspora rectivirgula from wet hay
78
What causes malt workers lung?
Aspergillus clavatus
79
What causes mushroom workers lung?
Thermophilic actinomycetes e.g., Micropolyspora faeni
80
Investigations for Hypersensitivity pneumonitis AKA extrinsic allergic alveolitis?
Upper zone fibrosis CXR
Bronchoalveolar lavage: lymphocytosis
IgG antibodies
No eosinophillia
81
Treatment of hypersensitivty pneumonitits AKA extrinsic allergic alveolitis?
Remove causative allergen
If persists corticosteroids
82
What is sarcoidosis?
Non caseating granulomas
83
Presentation of sarcoidosis?
Fatigue
Weight loss
Arthralgia
Uveitis
Erythema nodosum
Hypercalaemia
Bilateral hilar lymphadenopathy
84
What is Lofgrens syndrome?
Acute sarcoidosis with:
- Fever
- Polyarthalgia
- Erythema nodosum
- Bilateral hilar lymphadenopathy
85
Where is the fibrosis in sarcoidosis?
Upper zones
86
Treatment of acute symptoms in sarcoidosis?
NSAID
87
What is Heerfordt's syndrome?
Sarcoidosis with:
- Parotid enlargement
- Fever
- Uveitis
88
Diagnosis of sarcoidosis?
Tissue biopsy- non caseating granulomas
Hypercalcaemia
Raised ESR
ACE
Restrictive spirometry
89
Staging of sarcoidosis CXR/ CT?
Stage 1- Bilateral hilar lymphadenopathy
Stage 2- BHL with peripheral infiltrates
Stage 3- Peripheral infiltrates alone
Stage 4- Pulmonary fibrosis
90
Indications for steroids in sarcoidosis?
Heart/ Neuro involvement
Symptomatic Stage 2-3
Hypercalcaemia
91
What is silicosis?
Fibrosing lung disease caused by inhalation of silica dust (crystalline silicon dioxide)
92
What does silicosis increase the risk of getting?
TB as the silica is toxic to macrophages
93
Who gets silicosis?
Miners
Slate minors
Foundries
Potteries
94
Presentation of silicosis on CXR?
Upper zone fibrosis
Egg shell calcification of the hilar lymph nodes
95
Age of idiopathic pulmonary fibrosis?
50-70
96
Diagnosis of idiopathic pulmonary fibrosis?
HR CT- lower zone fibrosis with bilateral interstitial shadowing, ground glass and honey combing
97
Antibodies in idioapthic pulmonary fibrosis?
ANA
RF
98
Treatment of idiopathic pulmonary fibrosis?
Pirfenidone
or
Nintedanib
99
Pleural plaques in asbestosis management?
No follow up
100
Severity of asbestosis factor?
Length of exposure
101
Management of asbestosis?
Supportive
Consider compensation
102
What cancer is most associated with asbestosis?
Lung ca
103
What is mesothelioma?
Pleural malignancy linked to asbestosis
104
Worst form of asbestosis?
Crocidolite blue
105
Investigations of mesothelioma?
Pleural CT
Pleural aspiration
Biopsy
106
Treatment of mesothelioma?
Surgical debulking
Chemotherapy
Compensation
107
Para-neoplastic features of SCLC?
SIADH
Cushing's- Ectopic ACTH
Lambert-eaton syndrome
108
Para-neoplastic features of Squamous cell carcinoma?
HyperCa- PTHrP
Hyperthyroidism- ectopic TSH
Hypertrophic pulmonary oesteoarthropathy
109
Para-neoplastic features of adenocarcinoma?
Gynaecomastia
Hypertrophic pulmonary oesteoarthropathy
110
What cells does SCLC come from?
Neuroendocrine cells
- Kulchitsky cells
- APD cells
111
Lung squamous cell carcinoma is?
Cavitating
112
Lung adenocarcinoma is?
Spiculated as from brocnhial epithelium affecting the peripheral lung
113
Complications of lung ca?
SVCO
Pancoast tumour
Horner's syndrome
Bronchial/ Tracheal compression causing stridor
114
Management of SVCO?
8mg dexamethasone
CT
Stenting
115
What is a pancoast tumour?
Apical squamous cell carcinoma invading brachial plexus
116
What is horners syndrome?
Apical tumour compressing sympathetic chain with:
- miosis
- Ptosis
- Facial anhidrosis
117
Management of NSCLC?
Stage 1-2: Surgical resection +/- chemo if complete/radio if incomplete
Stage 3-4: chemo
118
Management of SCLC?
Limited (no mets): Cisplatin chemo + radiotherapy
Extensive (with mets) chemo + radio
119
Contraindications to surgery in lung Ca?
Metastasis
FEV1 <1.5L
Malignant pleural effusion
Vocal cord paralysis
SVC obstruction
120
What is the inheritance of Cystic Fibrosis?
Autosomal recessive
121
What is cystic fibrosis?
AR mutation of CFTR gene leading to thicker mucus secretions and impaired cilia function
122
What is the most common mutation in CF?
Delta-F508
123
Diagnosis of cystic fibrosis?
Neonatal heel prick
Sweat test
Faecal elastase
Genetic screening
124
Signs and symptoms of cystic fibrosis?
Meconium ileus
Failure to thrive
Delayed puberty
Nasal and rectal polyps
Pancreatic insufficiency
Malabsoprtion
Male infertility
DM
Short stature
125
Management of cystic fibrosis?
High calorie and fat diet
Chest physio
Postural drainage
ADEK vitamins
Gene specific therapies
Transplant
126
Why avoid other CF patients?
Infections:
Pseudomonas aeruginosa
Burkholderia cepacian
Myobacterium abscesscus
127
How to manage infective exacerbations in CF?
Abx
Hypertonic saline neb
Steroids
Salbutamol
128
What gene specific therapies are available for CF?
Lumacaftor
Ivacaftor
129
Who can receive gene specific therapies in CF?
Homozygous for delta F508 mutation
130
When is lung transplant in CF contraindicated?
Burkholderia cepacia
131
Contraindications to lung transplant?
- Other organ failure
- Untreated CAD
- Malignancy within 5 years
- TB
- Poor support/ FU compliance
132
What is pulmonary HTN?
Mean pulmonary arterial pressure >25
133
Causes of pulmonary HTN?
Idiopathic
Vasculitis
L sided heart disease
COPD/ ILD
OSA
PE
Sarcoidosis
134
Investigations for pulmonary HTN?
ECHO
R heart catherisation
135
Treatment of pulmonary HTN?
Acute vasodilator testing:
- Fall in pulmonary arterial pressure = CCB nifidipine
- No response = Iloprost, sildenafil
Transplant
136
What can RA cause in terms of pulmonary complications?
ILD via RA or Methotrexate toxicity
Nodules
Infection
Bronchiolitis obliterans: obstructive
Pleurisy
137
What is Caplan syndrome?
RA + coal dust pneumoconiosis causing nodules and scarring
138
What are the pulmonary complications of sickle cell disease?
Acute chest syndrome
Pulmonary HTN
139
What is acute chest syndrome?
Acute thrombosis in pulmonary vasculature with fever, SOB, new pulmonary infiltrates
140
Treatment of acute chest syndrome?
O2
Abx as cover
IVF
Analgesia
Anti-coagulation
141
What are the 3 pulmonary vasculatides?
Churg Strauss
Wegener's
Microscopic polyangiitis
142
What is Churg-Strauss AKA?
Eosinophilic granulomatosis with polyangiitis
143
What is Churg-Strauss?
p-ANCA to MPO causing URT/LRT involvement
144
Presentation of Churg-Strauss?
Asthma
Eosinophillia
Sinusitis
Renal involvement
145
What can precipitate Churg-strauss?
Leukotriene receptor antagonists
146
Treatment of Churg-Strauss?
Steroids
If resistant- rituximab
147
What is Wegener's granulomatosis AKA?
Granulomatosis with polyangiitis
148
What is Wegener's grnaulomatosis?
Vasculitis with necrotising granulomatous inflammation with c-ANCA to PR3
149
Presentation of Wegener's granulomatosis?
Epistaxis
Sinusitis
Nasal crusting
Haemoptysis
Saddle shaped nose deformity
150
Renal issues associated with Wegener's granulomatosis?
Rapidly progressive glomerulonephritis
151
Investigations for Wegener's granulomatosis?
C-ANCA to PR3
CXR
Renal biopsy
152
Treatment of Wegener's granulomatosis?
Steroids
Cyclophosphamide long term with corticosteroids
153
What is microscopic polyangiitis?
Small vessel ANCA vasculitis with pANCA or cANCA with renal impairement, haemoptysis and palpable purpura
154
Causes of pulmonary eosinophillia?
Churg-Strauss
Wegener's
Allergic bronchopulmonary aspergillosis
Loffler's syndrome
Eosinophillic pneumonia
Drugs
155
What drugs cause eosinophillia?
nitrofurantoin
Sulphonamide
156
What is loffler's syndrome?
eosinophillia due to parasite ascaris lumbricoides infection
157
What is tropical pulmonary eosinophillia?
Wuchereria bancrofti infection
158
Treatment of acute eosinophillic pneumonia?
Steroids
159
Haemophilus influenza is associated with?
COPD
160
CAP after influenza?
Staph pneumonia
cavitating
161
Alcoholics and aspiration pneumonia CAP?
Klebsiella pneumonia
162
HAP bacteria?
Enterobacteria
Pseudomonas
Staphylococcus
163
Atypical CAP?
Legionella
Mycoplasma
Chlamydia
164
CAP with hypoNa, lymphopenia?
Legionella
165
CAP associated with hameolytic anaemia?
Mycoplasma
166
Aspiration pneumonia seen with?
R lung affected
Anaerobes e.g., strep
167
Staph pneumonia is often?
After influenza and cavitating
168
How is klebsiella seen in alcoholics?
Upper love cavitating
Redcurrent sputum
169
CAP bacteria with target lesions from erythema mutliforme?
Mycoplasma
170
What is chlamydia psittaci?
Bird fanciers disease
171
What is berylloisis?
Aerospace workers with fibrosis, bilateral hilar lymphadenoapthy
172
What is an empyema?
Collection of pus in the pleural space with pH <7.2
173
What organisms are associated with empyema?
Polymicrobial
174
Empyema can often occur after what kind of pneumonia?
Aspiration
175
Lung abscess treatment?
BS IV abx 6-8 weeks
Chest physio
>6cm or >12 weeks CT guided drainage
176
Exudative pleural effusion?
>30 protein
177
Causes of exudative pleural effussions?
* Infections
* Malignancy: including pancreatitis
* RA/SLE, Dressler’s syndrome
* Pulmonary infarction
* Chylothorax
* Oesophageal perforation
* Drugs- methotrexate, phenytoin, amiodarone
178
When is chylothorax seen?
High cholesterol
Post sternotomy
179
Transudative pleural effussions?
<30
180
Causes of transidative pleural effussions?
* Heart failure
* Liver failure
* Renal failure – nephrotic syndrome low albumin
* GI malabsorption – leading to hypoalbuminemia
* Hypothyroidism
* Meig syndrome
181
What is Meig syndrome?
ascites, pleural effusion and benign ovarian tumour
182
Pleural tap with low glucose?
RA
Empyema
TB
183
Raised amylase in pleural tap?
Pancreatitis, oesophageal perforation
184
Low complement in pleural tap?
SLE
185
Blood staining pleural tap in?
Mesothelioma
PE
TB
186
What is Lights criteria?
Use to differentiate transudative and exudative if protein 25-35
187
3 points of Lights criteria?
* Pleural fluid protein divided by serum protein >0.5
* Pleural fluid to serum LDH ratio >0.6
* Pleural fluid LDH >2/3 ULN
188
Iatrogenic causes of pneumothorax?
NIV
Biopsy
CV catheter placement
Thoracentesis
189
What is a catamenial pneumothorax?
Endometriosis causing recurrent pneumothorax
190
Treatment of a pneumothorax with no/ minimal symptoms?
Conservative
191
What are high risk characteristics of a pneumothorax?
Hypoxia
Bilateral
Underlying lung disease
>50 years old and smoking history
Haemothorax
192
Management of symptomatic pneumothorax with high risk features?
Needle aspiration +/- chest drain
193
Management of symptomatic pneumothorax with no high risk features?
Conservative
Ambulatory device
Needle decompression +/- chest drain
194
When can you safely insert a chest drain?
>2cm laterally or apically on CXR
Any size with radiological guidance
195
What is the conservative management of a pneumothorax?
Primary spontaneous- OP 2-4 day FU
Secondary spontaneous- IP and when stable 2-4w OP review
196
What is ambulatory care for a pneumothorax?
Rocket pleural vent
197
FU after needle aspiration of pneumothorax?
2-4 weeks
198
If pneumothorax not responding to chest drain after 48 hours?
Refer to cardiothoracic for VATS (video assisted thoracoscopic surgery with mechanical/ chemical pleurodesis +/- bullectomy)
199
Flying and pneumothorax?
1 week after CXR shows resolution
200
Scuba diving and pneumothorax?
Never
Unless surgical pleurectomy with normal Lung function and CT
201
Contraindications to chest drain?
INR >1.3
Plts <75
Pulmonary bullae
Pleural adhesions
202
Complications of chest drain?
Failure of insertion
Bleeding
Infection
Penetration of the lung
Re-expansion pulmonary oedema
203
Treatment of re-expansion pulmonary oedema following chest drain?
Clamp drain and keep OP <1L over 6h
204
When to remove a chest drain in pleural effusion?
If no Op for >24 hours and imaging shows resolution
205
When to remove chest drain in pneumothorax?
Not bubbling spontaneously or when patient coughs and imaging shows resolution
206
Management of high altitude pulmonary oedema?
Descent
Nifedipine/ dexamethasone/ acetazolamide
207
Treatment of high altitude cerebral oedema?
Descent
Dexamethasone
208
What RA drug can reactivate TB?
Inflixamab
209
Investigations for TB?
CXR
X3 early morning sputum cultures
Early morning urine sample
Mycobacterial blood culture
PCR
HIV test
210
MCS for TB?
Acid fast bacilli on ZH
211
Management of TB?
RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
2 months
212
SE of isoniazid?
Peripheral neuropathy
Liver toxicity
213
SE of rifampicin?
Liver toxicity
Red/orange bodily fluids
214
Treatment of MDT TB?
Amikacin
Macrolides
Quinolones
215
What is PCP?
Pneumocysitis pneumonia from inhaled fungus when CD4 <200
216
PCP on CXR?
Bilateral pulmonary infiltrates in peri hilum distribution
Crushed ping pong ball appearance
217
Diagnosis of PCP when CD4 <200?
Bronchoscopic lavage PCR
218
Bloods in PCP?
High LDH
Lymphopenia
219
Treatment of PCP?
IV co-trimoxazole + steroids if hypoxic
220
IgM shows?
Acute infection
221
IgG shows?
Past infection
222
Who is CMV pneumonitis most common in?
HIV
Post transplant with reactivation
223
Treatment of CMV pneumonitis?
IV ganciclovir
IV foscarnet +/- IV immunoglobulins
224
Diagnosis of OSA?
Polysomnography (sleep study)
225
Diagnosis of OSA?
5 episodes of apnoea or hypopnoea lasting min 10 seconds per hour of sleep
226
Management of OSA?
- Weight loss, stop smoking, alcohol avoidance in evening
- CPAP
- Mandibular advancement devices if CPAP not tolerated
227
What is obesity hypoventilation syndrome (OHS)?
Chronic respiratory acidosis in obesity due to hypoventilation
228
Investigation for lung nodule <5mm?
Discharged
229
Management of solitary lung nodule of >8mm?
Brock model if high risk- CT PET if high uptake biopsy
If low risk CT surveillance
230
Management of 5-6mm solitary lung nodule?
CT surveillance at 1 year, if >6mm 3 months
231
What is ARDS?
Non cardiogenic pulmonary oedema due to increased permeability of capillaries due to sepsis, pancreatitis, COVID-19
232
Diagnosis of ARDS?
Clinical + CXR + pO2/fiO2 < 40kPa
233
Theophylline mode of action?
Non-specific inhibitor of phosphodiesterase resulting in an increase in cAMP
234
What is Kartagener's syndrome?
Primary ciliary dyskinesia causing immobility of cilia
235
How is kartagener's syndrome seen?
Dextrocardia or sinus inversus
Bronchiectasis
Recurrent sinusitis
Subfertility
236
MERS is contracted from?
Camels and camel products including milk
237
Management of MERS?
Supportive treatment
238
Infective causes of caveating lung lesions?
Staph aureus
Klebsiella
Pseudomonas
TB
Aspergillosis
Histoplasmosis
239
Non infectious causes of cavitating lung lesion?
SCC
Wegener's granulomatosis
PE
RA
240
What is histoplasmosis?
Fungal chest infection with histoplasma capsulatum
241
Where is histoplasmosis seen?
USA
242
Features of histoplasmosis?
URTI
Retrosternal pain
243
Life expectancy from diagnosis of idiopathic pulmonary fibrosis?
3-4 years
244
Non tuberculous mycobacterium includes?
Mycobacterium avium complex (MAC) Mycobacterium kansasii
245
Treatment of Mycobacterium avium complex (MAC) ?
Rifampicin, clarithromycin and ethambutol. Treatment should continue until the patients sputum has remained negative for MAC for 12 months
246
Treatment of Mycobacterium kansasii?
Rifampicin, isoniazid and ethambutol. Treatment should continue until the patient has been sputum culture negative for 12 months.
247
Worst prognosis organism in CF?
Burkholderia
248
Most common lung ca in adolescence?
Bronchial carcinoid
249
How can bronchial carcinoma present?
Recurrent pneumonia
250
If pleural tap ? empyema and not frankly purulent?
Centrifugation
251
Mode of action of omalizumab?
Anti- igE
252
Monitoring on aminophylline?
Cardiac monitoring
253
What predicts NSAID exacerbations in asthma?
Nasal polyps
254
Drug causes of pleural effussions?
nitrofurantoin, methotrexate, and amiodarone
