Respiratory Flashcards

Question

BODE index?

Answer 1

Assesses prognosis in COPD * BMI (Airflow) * Obstruction (FEV1 %) * Dyspnoea * Exercise capacity index (6 minute walk)

Answer 2

1. SABA/SAMA 2. LABA/LAMA 3. (LABA + ICS) or (LAMA + LABA)

Answer 3

1. SABA or SAMA 2. (LABA + ICS) or (LAMA + LABA) 3. Triple therapy (LABA + ICS + LAMA)

Answer 4

7 days amoxicillin 7 days pred 30 mg

Answer 5

* Male, tall, thin * Marfan’s * Recent central line * Pleural aspiration or chest drain

Answer 6

**In the presence of underlying lung disease/trauma** * COPD * Asthma * Infection * Trauma * Mechanical ventilation * NIV

Answer 7

**_Large_** 50% of lung volume lost – lung margin \>2cm from chest margin on CXR **_Small_** Lung margin \<2cm from chest wall on CXR

Answer 8

**_Small_** Discharge + safety netting + follow-up · **_Large/symptomatic_** Aspiration with 16-18G cannula --\> chest drain/discharge

Answer 9

**_Small_** Aspiration with 16-18G cannula **_Large_** Chest drain (5th intercostal space midclavicular line)

Answer 10

\<30g/L or \<3 g/100mL A transudate results from abnormal accumulation of pleural fluid (excessive oncotic or not enough hydrostatic pressure)

Answer 11

\>30g/l or \>3 g/100mL An exudate results from an inflammatory and malignant processes which alter the permeability of the local capillary and pleural membrane or causes lymphatic blockage

Answer 12

* Heart failure * Liver failure * Low albumin * Peritoneal dialysis **_Rare_** Hypothyroidism, nephrotic syndrome, mitral stenosis, PE

Answer 13

* Pneumonia * Malignancy (lung in men, breast in women) **_Less common_** Pulmonary infarction (from PE), automimmune disease, asbestos exposure, pancreatitis, dressler’s syndrome, TB

Answer 14

* SOB, cachexia, accessory muscles of respiration, clubbing. * Reduced chest expansion on side of the effusion * Trachea away from the lesion * Mediastinal shift * Stony dullness on percussion * Breath sounds diminished or absent over an effusion

Answer 15

Diagnostic aspiration (thoracentesis) --\> to determine whether transudate or exudate **Lab testing for...** * Clinical chemistry (protein, glucose, LDH, amylase, pH) * MC+S (TB) * Cytology and immunology (RF, ANA)

Answer 16

* Drainage (use intercostal drain - 1-1.5L/24 hours) * Pleurodesis with talc in recurrent effusions * Thorascopic (VATS) for malignant effusion, epyemas: chest drain under USS/CT guidance.

Answer 17

1. Squamous (35%) 2. Adenocarcinoma (27%) 3. Large cell carcinoma (10%)

Answer 18

* Arise from endocrine cells (Kulchitsky) and secrete hormones * Paraneoplastic syndromes: ACTH, cushing’s syndrome

Answer 19

Pancoast's tumour * Ptosis * Anhydrosis * Miosis (fixed)

Answer 20

Multisystem granulomatous disorder of unknown cause. * Highest prevalence in northern Europe * Adults aged 20-40 * F\>M * Afro-carribean population more frequently and severely affected

Answer 21

Often incidental finding in 40% after routine CXR **_ACUTE_** * Fever * Erythema nodosum * Polyarthralgia * Bilateral hilar lymphadenopathy (Lofgren syndrome) **_PULMONARY_** * Dry cough * Progressive SOB * Reduced Exercise tolerance * Chest pain * 20% have a deterioration in lung function.

Answer 22

Lung infection, cataracts, glaucoma, CKD

Answer 23

**_CXR_** * Bilateral Hilar Lymphadenopathy **_Tissue biopsy_** * Non-caseating granulomata = DIAGNOSTIC **_Bloods_** * High ESR, low white cells, LFTs, high calcium 24 hr **_Urine_** * High calcium **_Lung function tests_** * Normal/reduced lung volumes (restrictive picture) **_Bronchiolar lavage_** * High lymphocytes in active disease

Answer 24

* Sarcoidosis * TB * Lymphoma * Pneumoconiosis, * Metastatic disease

Answer 25

**_ISOLATED_** Do not need treatment, most resolve spontaneously **_ACUTE_** Bed rest, NSAIDS

Answer 26

* Parenchymal lung disease * Uveitis * Hypercalcamia * Neuro/cardiac involvement 40mg OD PO for 4-6 weeks then decrease dose gradually

Answer 27

60% with thoracic disease resolve over 2 years.

Answer 28

CFTR (ch7) - dF 508 Autosomal recessive - 1 in 25 All screened at birth

Answer 29

* FTT * Meconium ileus * Rectal prolapse

Answer 30

**_RESP_** Cough, wheeze, recurrent infection, bronchiectasis, pneumothorax, haemoptysis, resp failure, cor pulmonale. **_GI_** Pancreatic insufficiency, obstruction, gallstones, cirrhosis **_Other_** Male infertility, osteoporosis, arthritis, vasculitis, sinusitis, nasal polyps, HPOA

Answer 31

Sweat test (Na/Cl \>60 mmol)

Answer 32

**_Bedside_** * Sputum culture * Nasopharyngeal swab for influenza * Pneumococcal and legionella urinary antigen **_Bloods_** * FBC, U+E, CRP, LFTs, blood cultures **_Imaging_** * CXR (repeat 6 weeks after recovery)

Answer 33

**Exudative pleural effusion** has one or more of these criteria * Pleural fluid protein / Serum protein \>0.5. * Pleural fluid LDH / Serum LDH \>0.6. * Pleural fluid LDH \> 2/3 \* Serum LDH Upper Limit of Normal (/ = divided by)

Answer 34

**_Effective cough?_** * Encourage coughing **_Ineffective cough?_** * Conscious: 5 back blows, 5 abdominal thrusts * Unconscious: Open airway, start CPR.

Answer 35

**_Active infection_** * When containment by the immune system is inadequate * Can result from primary infection, or reactivation of latent disease * Patient is infectious **_Latent TB_** * Infection without disease due to adequate containment in granuloma * Positive blood or skin testing with no symptoms and non-infectious * 1/3 of world’s population thought to have latent TB * Lifetime reactivation risk = 5-10%

Answer 36

* New infection * HIV * Organ transplant * Immunosuppression (inc. steroids) * High risk setting * Low socio-economic status * Malnutrition * Dialysis

Answer 37

Initial infection in lung apices * Body fights with white cells + macrophages * Body cannot win so walls off infection with granulation tissue * Ends up with bacteria and WCC death causing caseating core (necrotic) * **_Ghon Complex_** as seen on chest X ray

Answer 38

Gohn complex - calcified focus of infection and associated LN

Answer 39

Some TB bacteria remains active inside granuloma * Results in body on alert = Systemic B sx (weight loss, night sweats) * Breakdown of cells in lung paranchyma and haemoptysis

Answer 40

Caused by infection with Mycobacterium Tuberculosis. Transmission of TB via inhalation of aerosol droplets – only pulmonary disease is infective

Answer 41

**Systemic** * Clubbing (bronchiectasis), erythema nodosum **Pulmonary** * Pleural effusion **Spinal** * Bony destruction, vertebral collapse, soft tissue abscess (Pott’s vertebrae)

Answer 42

**_Systemic_** * Fever, anorexia, weight loss, night sweats, **_Pulmonary_** * Cough, pleurisy, haemotypsis **_Lymph_** * Painless enlargement of cervical/supraclavicular nodes * Firm to touch and not acutely inflamed. Needs FNA biopsy. **_Gastro_** * Colickly abdo pain, * Obstruction due to wall thickening, stricture or adhesions. **_Spinal_** * Local pain and bony tenderness for weeks/months **_Milliary_** * Dissemination of granulomatous tissue * Do LP, check for involvement (high protein, high neutrophils, normal glucose. * Frontotemporal spread = personality change **_Also_** * CNS, Genitourinary, Cardiac, Skin * Lupus vulgaris = progressive cutaneous TB

Answer 43

**_Active TB_** * **CXR** - may show gohn complex or active milliary TB * **Sputum smear** - (3 specimens, early morning sample). Stained for presence of **acid fast bacilli**. If found, commence treatment and isolate patient * **NAAT** - to detect rapidly in \<8 hours. Good for drug resistance **_Extrapulmonary_** * Investigate if pulmonary disease co-exists * Aspiration or biopsy for staining or NAAT (on any sterile body fluid) HIV test for all - 12% concurrent infection.

Answer 44

**Isolate Patient!!** **_Medical_** * RIPE * Rifampicin (6M) * Isoniazid (6M) * Pyrazinamide (2m) * Ethambutol (2m) * Adherence v.important - directly observed therapy if doubts. **_Screening of Contacts_** * Mantoux test; house * Active test: if with all day, very close contact * Only treat if high risk exposure and any symptoms **_Other_** * Notifiable disease

Answer 45

Intermittent closure/collapse of pharynx causing apnoeic episode during sleep, terminated by patient partially waking up.

Answer 46

Overweight, older, male

Answer 47

**_Symptoms_** * Loud snoring, day time tiredness, poor sleep quality, decreased libido, nocturia, morning headache, reduced cognitive impairment **_Complications_** * Pulonary hypertension, type II resp failure. * Sleep apnoea = RF for hypertension

Answer 48

**_Investigations_** * Pulse oximetry and video recordings. * 15 or more episodes of apnoea in 1hr of sleep = significant disease **_Management_** * Weight reduction, avoidance of smoking and alcohol * Mandibular advancement devise * CPAP via nasal mask during sleep, recommended by NICE for mod-severe disease * Surgery if pharangeal/nasal obstruction present.

Answer 49

Chronic inflammation of the bronchi and bronchioles leading to permanent dilatation and thinning of these airways. Main organisms: H. influenzae; Strep. pneumoniae; Staph. aureus; Pseudomonas aeruginosa

Answer 50

**_Symptoms_** Persistent cough; copious purulent sputum; intermittent haemoptysis. **_Signs_** Finger clubbing; coarse inspiratory crepitations; wheeze (asthma, COPD, ABPA). **_Complications_** Pneumonia, pleural effusion; pneumothorax; haemoptysis; cerebral abscess; amyloidosis

Answer 51

Headache, vomiting, high pulse, tachypnoea, and, if COHb \>50%, fits, coma, and cardiac arrest. Remove the source and treat with 100% O2 until COHb \<10%

Answer 52

* Despite hypoxaemia skin is pink (or pale), not blue, as carboxyhaemoglobin (COHb) displaces O2 from Hb binding sites. * For the same reasons SpO2 from a pulse oximeter may be normal. Check ABG in a co-oximeter which will show low SaO2 and high COHb (normal \<5%)

Answer 53

Symptoms * Dry cough, exertional SOB, malaise, weight loss, arthralgia Signs * Cyanosis, clubbing, fine end inspiratory crepitations Complications * Resp. failure, increase risk of lung Ca.

Answer 54

Occurs in the pleura, related to occupational exposure to asbestos, although only 20% have pulmonary asbestosis. Latent period until development of tumour may be up to 45 years

Answer 55

Chest pain, SOB, weightloss, clubbing, recurrent pleural effusions. Metastatic: * Lymphadenopathy, hepatomegaly, bone pain/tenderness, abdo pain or obstruction (peritoneal mesothelioma) Characteristically **bloody pleural fluid** if aspirated.

Answer 56

Pulmonary fibrosis caused by inhalation of asbestos fibres Asbestos was commonly used in the building trade for fireproofing, pipe lagging, electrical wire insulation, and roofing felt

Answer 57

Similar to other fibrotic lung diseases with progressive dyspnoea, clubbing, and fi ne end-inspiratory crackles. Also causes pleural plaques, risk of bronchial adenocarcinoma and mesothelioma **_Management_** * Symptomatic. Patients are often eligible for compensation through the UK Industrial Injuries Act

Answer 58

* A common dust disease in countries that have or have had underground coal-mines. * It results from inhalation of coal dust particles (1–3μm in diameter) over 15–20yrs. * These are ingested by macrophages which die, releasing their enzymes and causing fibrosis

Answer 59

* Asymptomatic, but coexisting chronic bronchitis is common. * CXR: many round opacities (1–10mm), especially in upper zone. **_Management_** Avoid exposure to coal dust; treat co-existing chronic bronchitis; claim compensation (in the UK, via the Industrial Injuries Act).

Answer 60

A cavitating area of localised, suppurative infection within the lung * Inadequately treated pneumonia * Aspiration (eg alcoholism, oesophageal obstruction, bulbar palsy) * Bronchial obstruction (tumour, foreign body) * Pulmonary infarction * Septic emboli (septicaemia, right heart endocarditis, IV drug use) * Subphrenic or hepatic abscess

Answer 61

**_Symptoms_** * Swinging fever; cough; purulent, foul-smelling sputum; pleuritic chest pain; haemoptysis; malaise; weight loss **_Signs_** * Finger clubbing; anaemia; crepitations **Empyema develops in 20-30%**

Answer 62

Pus in the pleural space. It should be suspected if a patient with a resolving pneumonia develops a recurrent fever. CXR indicates a pleural effusion. The aspirated pleural fluid is typically yellow and turbid with an acidic pH (\<7.2) * May need VATS procedure if loculated and not easily drainable.

Respiratory Flashcards

(88 cards)