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Flashcards in Respiratory Deck (107):
1

Features of Pancoast syndrome

Horners syndrome
Compression of major vessels in the thoracic inlet
Wasting of intrinsic muscles of hand
Pain in shoulder radiating towards axillary and scapula

2

Signs of PE

Tachypnoea
Chest pain - worse on inspiration
Haemoptysis
Peripheral cyanosis
Raised JVP
Gallop rhythm - 3rd HS

3

Who most commonly gets spontaneous pneumothoraces

Men
20-40 yo

4

Symptoms of spontaneous pneumothorax

Sudden SOB
pleuritic chest pain

5

What is Goodpasture's disease?
syx + signs

Anti-glomerular basement Antibody disease
Glomerulo-nephritis
Haematuria
Decreased urine output
Raised BP
Dry cough
SOB
Haemoptysis
Anaemia
Resp failure

6

Management of PE

15L O2 NRB
Enoxaparin 1.5mg/kg S/C OD
paracetamol, TEDS
Saline if required

Stop COCP / HRT

7

What organism commonly causes acute exacerbations in CF pts?

Pseudomonas

8

Features of CF

Bronchiectasis
Recurrent resp inf
Pancreatic insufficiency
Malabsorption + steatorrhoea
DM
Delayed growth and puberty
Male infertility (absent vas deferens)
High sweat NaCl

9

What genetic abnormality causes CF

Autosomal recessive (1 in 2500 caucasians)
CFTR gene
Chromosome 7

10

Respiratory causes of clubbing

Bronchial carcinoma
Mesothelioma
Bronciectasis
Abscess
Empyema
Cryptogenic fibrosing alveolitis
CF
TB
Idiopathic pulmonary fibrosis

11

Features suggesting lung consolidation

Reduced expansion
Dullness to percussion
Increased tactile vocal fremitus
Bronchial breathing

12

Most common cause of lung consolidation

Pneumonia

13

What causes a honey comb lung appearance?

Extrinsic allergic alveolitis

14

What people commonly get staph aureus pneumonia?

IVDU
elderly
People recovering from Influenza

15

What Type of pneumonia is caught from parrots

Chlamydia psittaci

16

What type of pneumonia can occur in HIV patients

Pneumocystis jiroveci

17

Features of mycoplasma pneumonia

Most common CAP
Automimmune haemolytic anaemia - presence of cold agglutinins
Erythema multiforme
Myopericarditis
Meningioencephalitis

18

Antibiotic for atypical pneumonia

Clarithromycin 500mg IV BD

19

Features of legionnaires disease

Preceding flu-like illness
Dry cough
Dyspnoea
Hyponatraemia
Lymphopenia

20

Examples of pulmonary-renal syndromes

Wegeners granulomatosis
Microscopic polyangiitis
Goodpastures disease

21

What is caplans syndrome

Pulmonary manifestation of RA
--> pulmonary nodules

Commonly occurs in RA patients exposed to coal / other dusts.

22

Syx of caplans syndrome

Cough,
shortness of breath,
Haemoptysis

23

Respiratory manifestations of RA

caplans syndrome
Fibrosing alveolitis
Pleural effusion
Obliterative bronchiolitis

24

CXR features suggesting LVF

Kerley B lines
Bat-wing shadows
Prominent upper lobe vessels
Cardiomegaly

25

CXR features of R upper lobe collapse

Trachea deviated to R
Horizontal fissure displaced upwards
R hilum displaced upwards

26

CXR features of L upper lobe collapse

Hazy white L lung field
Tracheal deviation to the L
Elevated L hilum
Preservation of costophrenic angle

27

Causes of multiple small calcified nodules on CXR

Varicella pneumonitis
TB
Histoplasmosis
Chronic renal failure

28

Causes of hilar enlargement

Malignancy
TB
Sarcoidosis
Organic dust diseases
Extrinsic allergic alveolitis

29

CXR shows ring shadows with tram-lining

Bronchiectasis

30

CXR appearance of malignant mesothelioma

Pleural calcification
Lobulated pleural mass

31

CXR showing ground glass appearance

Idiopathic pulmonary fibrosis
Progresses to honey comb appearance

32

Causes of pulmonary fibrosis

Idiopathic
RA
Sclerosis
UC
Methotrexate
Amiodarone
Chemotherapy

33

Management of acute exacerbation of COPD

Oxygen
Nebulised salbutamol and ipratropium bromide
Oral prednisolone or IV hydrocortisone
BiPAP
Intubate and ventilate

34

Lifestyle recommendations for COPD

Stop smoking
Exercise
Reduce obesity

35

1st line treatment for COPD

Inhaled bronchodilators

36

When is home oxygen considered in COPD patients?

Clinically stable non-smokers
PaO2 <7.3kPa when stable.

Or PaO2 7.3 - 8 kPa AND secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or pulmonary hypertension.

37

Standard treatment for community-acquired pneumonia not requiring hospital admission?

Oral amoxicillin 1g PO TDSOral clarithromycin 500mg PO BD if penicillin allergic.

38

Treatment for severe hospital-acquired pneumonia?

Tazocin ( piperacillin tazobactam) 4.5g IV QDS
Ciprofloxacin 400 mg IV BD

If pen allergic = cipro and gentamicin 5mg/kg IVI OD

39

Treatment for severe community-acquired pneumonia with atypical pathogens?

Clarithromycin 500mg IV BD
Co-amoxiclav 1.2g IV TDS

40

Treatment of proven chlamydia pneumonia

Oral Tetracycline

41

What does stridor indicate

Upper airway obstruction
E.g. foreign body, croup

42

Positive cold agglutinins suggests what pathogen?

Mycoplasma

43

Which pneumonia pathogens are cavitating?

TB
Staphylococcal pneumonia
Klebsiella pneumonia

44

What type of pneumonia occurs in HIV-positive patients?

Pneumocystis jiroveci Pneumonia

45

Side-effects of isoniazid?

Peripheral neuropathy
Hepatitis
Pyridoxine (B6) deficiency

46

Side-effects of rifampicin?

Orange tears/urine
Deranged LFTs
Hepatitis
Enzyme inducer (drug interactions)

47

Side effects of ethambutol?

Retrobulbar (optic) neuritis (pain, loss of vision, colour vision impaired 1st)

48

Side effects of pyrazinamide?

Gout (arthralgia)
Hepatitis

49

Side-effects of salbutamol?

Tremor
Tachycardia

50

Side effect of inhaled corticosteroids?

Oral or pharyngeal candidiasis

51

Weightloss, anaemia and haemoptysis in a smoker suggests what?

Bronchial carcinoma

52

Causes of T2 respiratory failure?

COPD
Decreased respiratory drive
Neuromuscular disease
Thoracic wall disease

53

Causes of T1 respiratory failure?

Pneumonia
Pulmonary oedema
PE
Asthma
Emphysema
fibrosing alveolitis
ARDs

54

Diagnostic criteria for ARDs

Acute
Bilateral infiltrates in CXR
Not in CCF
Hypoxia

55

What is the oxygen delivery with a NRB mask

60-90%

56

What is chronic bronchitis?

Cough + sputum
On most days
>3m per year
>2 years

57

What is a Pancoast tumour

Tumour at the lung apex
Can interfere with the sympathetic chain --> Horner's syndrome.

58

Clinical features of primary lung tumour

Cough,
haemoptysis,
dyspnoea,
stridor,
pneumonia,
weight loss
Clubbing
Monophonic unilateral wheeze

59

Investigation of suspected bronchial tumour?

Chest x-ray
CT thorax
Bronchoscopy
Biopsy
Bronchoalveolar Lavage

60

Investigation for CF?

Sweat test - pilocarpine iontophoresis

61

Management of CF?

Physiotherapy
antibiotic Prophylaxis and treatment
Pancreatic enzyme supplements

62

Complications of CF

DM
Hepatic cirrhosis
Bronchiectasis
Male infantility
severe pulmonary hypertension
Cor pulmonale
chronic lung infections

63

What does the Guthrie card use to detect CF?

Immunoreactive trypsin (IRT)
(A pancreatic enzyme raised in CF)

64

Congenital And acquired causes of bronchiectasis

Congenital = CF, cillary dyskinesia
Acquired = Whooping cough, measles, TB

65

Presentation of mesothelioma?

Chest pain
Pleural efusion - Usually bloodstained

66

Diagnosis of mesothelioma

Pleural biopsy

67

What is asbestosis?

Diffuse fibrosis of the lungs and plura

68

What are the three main types of asbestos?

White - chrysotile
blue -crocidolite
Brown - amosite

69

Clinical features asbestosis?

Progressive dyspnoea,
Clubbing,
Lower zone inspiratory crepitations
Reticulonodular shadowing on x-ray

70

What causes genetic emphysema

Alpha-1 antitrypsin deficiency
Early onset emphysema
Also causes chronic liver disease

71

Presentation of post-primary TB

Subacute illness
Cough
Haemoptysis
Dyspnoea
Fever
Night sweats
Anorexia

72

CXR features of TB

Upper lobe lesions - consolidation / cavities
+/- hilar lymphadenopathy

73

Features of sarcoidosis

Multi-system disease
Caeseating granulomas

Dyspnoea
Dry cough
Erythema nodosum
Lupus pernio
Arthralgia
Lymphadenopathy

74

CXR features of sarcoidosis

Bilateral Hilar lymphadenopathy
Lung fibrosis

75

Cause of aspergillosis

Aspergillus fumigatus - fungus

76

Presenting symptoms of pneumonia

Cough - initially dry, becomes productive
Sputum may be blood stained
Fever
Pleuritic chest pain

77

Signs of pneumonia

Bronchial breathing
Coarse crepitations
Pyrexia

78

Presentation of pulmonary embolism (PE)

Acute onset pleuritic chest pain
SOB
Fever
Tachycardia

79

Management of a confined pulmonary embolus

Enoxaprain 1.5m g /kg
Warfarin for 6m

80

Diagnosis of COPD

Lung function tests

FEV1 <70%
Little variation in peak flow

81

What culture media is needed to culture TB

Lowenstein-Jensen media

82

What stain is used to detect TB

Ziehl-neelsen stain

83

Complications of lung cancer

Pleural effusion
Haemoptysis.
pneumothorax
bronchial obstruction
pneumonia.
Pericardial effusion
metastases
PE
Recurrent laryngeal nerve palsy
Horners syndrome

84

What causes holly leaf shaped lesions on CXR

Calcified pleural thickening
Associated with previous asbestos exposure
Asymptomatic

86

Rusty coloured sputum occurs in what disease

Streptococcus pneumonia

87

Syx of legionnaires pneumonia

Dry cough
Myalgia
Malaise
GI syx

88

Features of pneumonia + fever, arthralgia, diarrhoea, conjunctivitis, headache, hepatosplenomegally and patchy lower lobe consolidation is....n

Chlamydiophila psittaci pneumonia

89

Features of pneumonia plus fluid filled cavities on CXR suggests what?

Staphylococcus aureus pneumonia abscesses

90

Components of the CURB score

Confusion - AMTS 7mmol/L
Respiratory rate - >30
BP - systolic 65 yo

91

What do curd scores 1-5 indicate

0-1 - low mortality - manage at home
2 - intermediate mortality - hospital admission
3 + - high risk of mortality - hospital with IV abx

92

Congenital causes of bronchiectasis

CF
Primary ciliary dyskinesia
Kartageners syndrome

93

What is an abrams needle used for

Pleural biopsy

94

Common organisms in community acquired pneumonia

Strep pneumoniae
H. Influenza
Mycoplasma pneumonia
(Staph aureus / legionella / chalmydophilia / moraxella catarrhalis)

95

Organisms causing hospital acquired pneumonia

E. coli
Pseudomonas
Klebsiella
Anaerobes

96

Complications of pneumonia

Paraneumonic effusion
Abscess
Empyema
Respiratory failure
Septicaemia
Brain abscess

97

SE of streptomycin

Irreversible vestibular nerve damage
Allergic reactions

98

Multi drug resistant TB is resistant to what

Rifampicin and isoniazid

99

Extensively drug resistant TB is resistant to what

Rifampicin
Isoniazid
Quinolones
+ at least 1 2nd line agent

100

What is military TB

Haemotogenous dissemination of TB

101

What is oseltamivir

Tamiflu

102

Triad in meigs syndrome

Pleural effusion
Ascites
Ovarian fibroma (benign)

103

Signs of ARDS

Cyanosis
Tachypnoea
Tachycardia
Widespread inspiratory crepitations
Hypoxia refractory to O2
Pulmonary oedema

104

Causes of ARDS

Sepsis
Aspiration pneumonia
Trauma
Burns
Pancreatitis
Transfusion related lung injury
Drug overdose
Acute drug reaction

105

What respiratory disease is less common in smokers

Sarcoidosis

106

Causes of respiratory alkalosis

Hypventilation
(Low CO2)

107

Management of a flail chest

Analgesia
Respiratory support

108

Causes of atelectasis

Bronchial obstruction - cancer / foreign body / mucous plug
Non-obstructive - pneumothorax / reduced surfactant (ARDS) / parenchymal scarring