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Phase 4 > Respiratory 2 > Flashcards

Respiratory 2 Flashcards

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1
Q

List some differentials for finger clubbing:

A

Increased soft tissue swelling, with loss of the hyponychial angle

Thoracic :

  • TB
  • Emphysema
  • Cystic fibrosis
  • Lung cancer
  • Pulmonary fibrosis

Cardio:

  • Infective heart disease
  • Congenital heart disease

G.I

  • Inflammatory bowel disease
  • Cirrhosis
  • celiac disease
  • lymphoma

Endocrine:
- thyroid disease

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2
Q

List some causes of haemoptysis:

A 
Lung cancer 
Acute bronchitis 
TB 
Pulmonary infarction 
Goodpastures disease 
Granulomatous polyangiitis
Acute left ventricular failure
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3
Q

What investigations should be done into haemoptysis?

A

Bloods:

  • FBC
  • Coagulation screen

Orifices:
- sputum smear

  • Bronchoscopy

X-ray:

  • CXR
  • CT
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4
Q

Following an x-ray of a pleural infusion, what next test should be done to establish it?

A

Ultrasound

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5
Q

What is light’s criteria?

A

> 30g protein
Pleural protein: Serum Protein >0.5
Pleural LDH: Serum LDH >0.6
Pleural LDH upper 1/3rd of normal

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6
Q

What are the general causes of restrictive lung diseases?

A

Interstitial disease

Thoracic cage reduction
- Kyphosis

Neuromuscular conditions

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7
Q

Name some symptoms and clinical signs that are seen with interstitial lung disease:

A

Progressive dyspnoea

Dry cough

Reduced exercise capacity

Finger clubbing

Restrictive pattern

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8
Q

Prior to discharge of an asthma attack what must the patient have?

A 
>75% PEF 
On discharge medication for 24 hours 
Inhaler technique checked 
GP follow up in 2 days 
Respiratory clinic in 1 month
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9
Q

When diagnosing COPD and there is evidence of Cor pulmonale, what additional tests should be ordered?

A

Echocardiogram

ECG

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10
Q

When can long term O2 therapy be started in COPD?

A

kPa O2 <7.3
- need 2 separate occasions to be seen for this

kPa O2 <8 + polycythemia, cor pulmonale,

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11
Q

What are some features of cor pulmonale?

A

Peripheral oedema
Raised JVP
Right ventricular heave
Second heart sound

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12
Q

When someone comes in with an exacerbation of COPD what questions do you want to know?

A

usual treatment at home and adherence

Normal exercise tolerance

Allergies to medication

Has this occurred before - and if so what was the treatment course?

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13
Q

Signs of hypercapnia?

A 
Hand flapping 
Flushing 
Vasodilation 
Bounding pulse 
confusion 
Coma 
Papilloedema
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14
Q

What is the target PEF for asthma?

A

> 80%

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15
Q

What is the lung cancer called the develops in the apex of the lung and may cause lung erosion:

A

Pancoast tumour

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16
Q

What may cause round lesions to appear on the lung xray?

A 
Primary lung cancer 
Metastatic lung cancer - renal cell carcinoma 
Rheumatoid nodules 
TB 
Sarcoidosis 
Abscess
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17
Q

What investigations should be done to diagnose lung cancer?

A

Bloods:

  • LFTs (Mets in liver and bone)
  • U&Es (hyponatramia)
  • Bone profile (mets + Ca2+ level for paraneoplastic)

X-rays:
CT/ US guided biopsy

Bronchoscopy for biopsy or wash for cytology

PET Scan

CT Chest/ Abdo/ Pelvis
- check adrenals

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18
Q

List the causes of atypical pneumonia:

A

Legionella Pneumophila

Chlamydia Psittaci (birds)

Chlamydia Pneumoniae

Mycoplasma Pneumoniae

Coxiella Burnetii

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19
Q

What are the indications that lung tumours are operable?

A

Unilateral
No involvement of the major vessels
Non - distant metastasis
Not within 2cm of the main bronchus

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20
Q

What are the clinical finding of sarcoidosis?

A 
Lupus Pernio 
Erythema nodosum
Anterior uveitis 
Lymphadenopathy 
Hepatosplenomegaly 
Cor pulmonale
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21
Q

What features are taken into account when assessing lung function?

A

Height
sex
Age

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22
Q

Why are investigations are necessary in lung cancer?

A
  • Stage the extent of lung cancer
  • To make tissue diagnosis
  • To assess fitness of patient - for treatment
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23
Q

Whats the most common cancer to metastasis to the lung?

A

No.1 Breast

Colon cancer

Renal cell carcinoma

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24
Q

What are some signs of primary lung cancer?

A 
Dyspnea 
Finger clubbing 
Weight loss
Weakness 
Horner syndrome 
Shoulder pain 
Chest pain
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25
Where does lung cancer spread to?
``` Hilar lymph nodes Brain Adrenals Bone Liver ```
26
What is the staging for lung cancer and what does the TNM staging in lung cancer refer to?
Squamous cell: TNM Small cell: Limited, Extensive Tumour size Nodal status Metastasis
27
What are the symptoms of horners?
Miosis Ptosis Anhidrosis
28
How is superior vena cava syndrome managed?
Head elevation + diuretics Stents + radiotherapy palliative
29
What are some signs of cor pulmonale?
``` Oedema Right ventricular heave Loud Pulmonary second sound Raised JVP Enlarged liver ```
30
What drugs can be used to reduce secretion/ mucus production? and are especially helpful with COPD?
Carbocysteine Physiotherapy chest Neb Saline - used short term and usually in hospital
31
What is pulmonary rehabilitation?
Retraining how someone breathes. usually in obstructive conditions people breath shallow and fast. Retraining to take deep inhaled breathes and slow down the breathing
32
When can long term oxygen therapy be started in COPD?
PaO2 <7.3 or paO2 7.3-8 with polycythemia, pulmonary oedema or hypertension
33
What are some additional therapeutics effects for COPD outwith inhalers?
Vaccines Sensation of breathlessness - Pulmonary rehabilitation - Dihydrocodeine Secondary polycythemia - venesection Surgery - bullectomy - Lung reduction volume surgery
34
Why are COPD patients more likely to get pneumothoraces?
due to the bullae formation - which is essentially large amounts of alveoli clumped together. this increase tension and leads to an increased likelihood of rupture.
35
During COPD exacerbation what should the venturi mask oxygen sats be at?
24%
36
What are poor prognostic factors in COPD?
Age | FEV1
37
What drug can be used as a CNS stimulator in obstructive sleep apnea?
Modafinil
38
List some causes of restrictive lung disease:
Parenchymal: - IPF - Sarcoidosis Pleural: - Pleural effusion Chest wall: - Kyphoscoliosis - AS Neuromuscular: - Myasthenia gravis - MND - Guillain Barre syndrome Vascular: - Vasculitis - Anti- GBM
39
What are the histological findings on sarcoidosis?
Non-caseating granulomas with well defined borders
40
How does a pleuritic rub differ from a pericardial rub?
It only has a biphasic rub whereas cardiac has triphasic
41
What are the complications of sarcoidosis?
Interstitial lung disease Cor pulmonale
42
What is the acute presentation of sarcoidosis?
Lofgren syndrome Bilateral lymphadenopathy Fever Poly arthropathy Eyrthema nodosa
43
What is described to have egg-shell hilar lymph nodes on x-ray?
Silicosis
44
What are the contraindications to BiPAP?
Facial trauma Pneumothorax Patient wishes +/- Cardiac disease Excessive sputum production
45
Which type of empysema is most associatted with COPD?
Centroacinar - dilation is more centred around the terminal bronchioles Panacinar is more associated with Alpha 1 antitrypsin deficiency
46
What are the three mechanisms by which there is airflow limitation in COPD?
Loss of elasticity Mucus plugging Inflammation and scarring of the small airways
47
What are the signs of COPD?
Tachypnoeic Prolonged expiration Intercostal indrawing during inspiration Pursing of lips during exhalation Poor chest expansion Loss of normal cardiac and liver dullness
48
Findings of cor pulmonale:
Right Ventricular Heave Loud pulmonary second sound JVP raised Tall P wave
49
How long does oxygen therapy need to be given for in COPD to provide a significant impact on mortality?
19 hours daily
50
What are the mechanisms behind reduced oxygen saturations during sleep - which can significant impact on COPD patients?
Inhibition of accessory muscles such as the intercostals and sternocleidomastoid muscle during REM Shallow breathing - especially during REM Increased upper airway obstruction due to loss of tone
51
What are the guidelines regarding receiving oxygen?
COPD <7.3paO2 Cystic fibrosis <7.3 paO2 Neuromuscular disorders Pulmonary malignancy Heart failure <7.3paO2
52
What two sets of people get obstructive sleep apnea?
Overweight middle aged men Children with enlarged adenoids
53
Symptoms of sleep apnea?
``` Snoring Daytime sleepiness Unrefreshed sleep Restless sleep Morning headache Nocturnal choking Morning drunkness ```
54
What endocrine disorder may be implicated with obstructive sleep apnea?
Acromegaly
55
On a pulse oximetry used for sleep apnea, what would you expect to see?
Saw tooth appearance
56
What is a differential for obstructive sleep apnea?
Central Sleep apnea
57
What may be seen on CXR of bronchiectasis?
Tram track lining Ring shadows Cysts
58
Name a drug used to help quit smoking and its mechanism of action:
Varenicline - partial nicotinic partial receptor agonist * contraindicated in pregnancy and breast feeding Bupropion - noradrenaline and Serotonin uptake inhibitor * contraindicated in pregnancy and epilepsy
59
Which two types of pneumonia have antigens in the urine?
Pneumococcal | Legionella
60
How long following pneumonia are people usually back to normal?
6 months
61
What are the three main types of asthma?
Extrinsic - childhood - atopy Intrinsic - Adulthood - does not repsond well to treatment Occupational
62
What are the key features of asthma?
Hyperresponsiveness of the bronchi Bronchi inflammation Airflow limitation
63
What are some triggers for asthma:
Beta blockers Aspirin Cold Exercise Dust Infection ** Perfumes Cold Damp
64
What are the associated symptoms of asthma?
Atopy - eczema - Hayfever Night time symptoms Acid reflux Disturbed sleep
65
What are the main investigations into asthma?
Fractional Exhaled Nitric oxide (eosinophils produce lots of NO) Spirometry with reversibility PEF variability - diurnal variation Histamine provocation
66
Outwith inhalers and medication what other treatments should be given to patients with asthma?
``` Yearly flu jab Education / inhaler technique Stop smoking Avoidance of triggers exercise programs ```
67
What are the side effects of ICS?
Oral Candidiasis Hoarseness Throat infection Osteoporosis - in high dose
68
What are your differentials for acute asthma?
``` Pulmonary oedema - cardiac wheeze P.E Pneumothorax Pneumonia COPD ```
69
What factors is PEF flow based upon?
Age Height Sex
70
What is a new inhaler can be used as maintain and reliever and what does it contain?
Maintenance and reliever therapy inhaler - LABA - ICS
71
If there is a lung tumour is within a certain distance of the main bronchi it is deemed inoperable, what is this distance and how is it viewed?
2cm proximity of the main bronchus deems the node inoperable. View via bronchoscope usually
72
What is the main complication of percutaneous biopsy?
Pneumothorax
73
What investigations are wanted into lung cancer?
Bloods: - FBC - anaemia - U&Es - Hyponatraemia - Calcium - Hypercalcaemia Orifices: - Bronchial lavage with cytology X-rays: - CXR - CT - staging. Includes adrenals - PET Scan Special tests: - Bronchoscopy with biopsy 0r - CT guided biopsy Assessment of fitness for surgery: - Stress Echo - Lung functioning - for other lung to deal with
74
What are the treatment options for lung cancer?
Surgery - with curative intent Radiation therapy for cure - used in early NSCLC - Continually hyperfractionated accelerated Regimes (CHARTS) Chemotherapy - biological therapy
75
What therapeutic interventions can be done for lung cancer in patients that are palliative?
Laser therapy - vaporise parts of protruding tumour Tracheobronchial stenting - metal springs Endobronchial brachytherapy - used from compressional symptoms
76
Name some benign tumours of the lungs:
Pulmonary hamartoma Bronchial carcinoid Tracheal tumours
77
What investigations are done on pleural fluid?
Biochemistry Immunology Cytology Cultures
78
What FBC would you find in sarcoidosis?
Leukopenia - markedly reduced T cell circulation. This has no effect on immunity
79
What are the differentials for perihilar mass?
Lymphoma Sarcoidosis TB Bronchial carcinoma
80
Main differentials for sarcoidosis:
Idiopathic pulmonary fibrosis Tuberculosis Pneumoconiosis Lung cancer
81
What are the drugs that can cause interstitial lung disease:
Nitrofurantoin Methotrexate Sulphasalazine Amiodarone ACE inhibitors Methadone Radiotherapy

Phase 4 (49 decks)

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