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Year 3 ICSM COPY > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Recall the 3 different clinical pictures that can be produced by aspergillus spore inhalation

A

Aspergilloma
Allergic bronchopulmonary Aspergillosis
Invasive aspergillosis

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2
Q

What is aspergilloma?

A

Growth of A. fumigatus in pre-existing lung cavity

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3
Q

In which demographic is ABPA most commonly seen?

A

Asthmatics

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4
Q

Recall the pathophysiology of ABPA

A

Regulated by IgG and IgE

Leads to bronchiectasis

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5
Q

In which demographic is invasive aspergillosis most common?

A

Immunosuppressed

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6
Q

What is invasive aspergillosis?

A

Infection and fungal dissemination of aspergillus

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7
Q

Recall the symptoms of aspergilloma

A

Usually asymptomatic but may produce haemoptysis

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8
Q

How does ABPA present?

A

Like a difficult-to-control asthma: irecurrent episodes of pneumonia with wheeze, cough and fever

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9
Q

Describe the presentation of invasive aspergillosis

A

Dyspnoea with rapid deterioration and a septic picture

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10
Q

Which form of aspergillus lung disease will produce a wheeze?

A

ABPA

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11
Q

What would be found upon percussion in aspergillus lung disease?

A

Dullness

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12
Q

Where in the lungs does aspergilloma normally form?

A

Upper lobes

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13
Q

How would aspergilloma appear on CXR?

A

Round mass with crescent of air around it

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14
Q

What is the first choice of imaging for each different form of suspected aspergillus lung disease?

A

Aspergilloma: CXR
ABPA: CXR and CT/MRI
Invasive aspergillosis: CT/MRI

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15
Q

What features on imaging are indicative of ABPA?

A

Looks similar to bronchiectasis

Transient and patchy shadows/ consolidation

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16
Q

Describe the wheeze that is heard upon auscultation in asthmatics?

A

Polyphonic expiratory wheeze

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17
Q

How does HR differ in severe vs life-threatening asthma attacks?

A

Severe: >110

Life-threatening: bradycardia

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18
Q

What would be abnormal on FBC in asthma?

A

Eosinophilia

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19
Q

Recall the 6 steps of chronic asthma management

A
  1. Inhaled SABA PRN (salbutamol)
  2. Add low-dose inhaled steroid (beclomethasone)
  3. Add LABA (salmetarol)
  4. Increase steroid dose
  5. Try a different drug eg leukotriene receptor antagonist
  6. Add prednisolone
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20
Q

Recall the acute management of asthma

A
  1. High flow oxygen
  2. Nebulised salbutamol and ipratroprium
  3. IV hydrocortisone
  4. Continue steriod treatment orally
    - If no improvement: IV magnesium or IV aminophylline
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21
Q

Recall the triad of pathologies that characterise bronchiectasis

A
  1. Chronically dilated airways
  2. Bacterial infections
  3. Decreased mucociliary clearance
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22
Q

What % of cases of bronchiectasis are idiopathic?

A

50%

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23
Q

When in the lifecourse does bronchiectasis usually arise?

A

Childhood

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24
Q

Describe the symptoms of bronchiectasis

A

Productive cough with copious purulent sputum and intermittent haemoptysis

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25
Q

What would be heard upon auscultation in bronchiectasis?

A

Coarse inspiratory crepitations that shift when coughing

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26
Q

What would be seen upon general inspection in bronchiectasis?

A

Clubbing

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27
Q

Recall 2 approaches for medical management in bronchiectasis

A

Antibiotics for recurrent infection

Bronchodilator

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28
Q

Which 2 conditions does COPD comprise?

A

Emphysema

Chronic bronchitis

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29
Q

What would be found upon percussion in COPD?

A

Resonant percussion notes

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30
Q

What would be heard upon auscultation in COPD?

A

Polyphonic wheeze; crepitations

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31
Q

Recall 2 signs of CO2 retention that may be seen in COPD

A

Asterixis

Bounding pulse

32
Q

What are “pink puffers” and “blue bloaters”?

A

“Pink puffers” = emphysema dominates

“Blue bloaters” = bronchitis dominates

33
Q

Recall 3 aspects that can differentiate between pink puffers and blue bloaters

A

Alveolar ventilation: increased in PPs and decreased in BBs
Build: PPs are thin with hyperinflation, BBs are stocky
Complications: PPs get resp failure, BBs get cor pulmonale

34
Q

What would be seen on FBC in COPD?

A

Polycythaemia

35
Q

How can you identify hyperinflation on CXR?

A

> 6 anterior ribs seen

36
Q

What is cor pulmonale?

A

Enlargement of right hand side of heart due to lung disease

37
Q

What sort of drug is ipratropium?

A

Anti-cholinergic

38
Q

What is extrinsic allergic alveolitis?

A

Interstitial inflammation of distal parts of lung

39
Q

What would be heard upon auscultation in hypersensitivity pneumonitis?

A

Fine inspiratory crepitations

40
Q

To what group of diseases do farmer’s and pigeon-fancier’s lung belong?

A

Hypersensitivity pneumonitis/ EAA

41
Q

Describe the symptoms, signs and prognosis of idiopathic pulmonary fibrosis

A

Symptoms: Exertional dyspnoea and dry cough with NO WHEEZE
Signs: Clubbing
Prognosis: very poor

42
Q

Recall the management of idiopathic pulmonary fibrosis

A

Azothioprine

Glucocorticoids

43
Q

What are the 2 most important blood tests to do in suspected obstructive sleep apnoea?

A

TFTs

ABG

44
Q

What is pneumoconiasis?

A

Group of obstructive lung diseases related to occupation

45
Q

Give 2 examples of pneumoconiasis

A

Silicosis

Asbestosis

46
Q

Recall 2 signs of pneumoconiasis on CXR

A

Infiltrative patches

“Honeycombing” (cystic radiolucency)

47
Q

What are the most commonly-implicated pathogens in hospital-acquired pneumonia?

A

Klebsiella

Pseudomonas

48
Q

What are the most commonly-implicated pathogens in community-acquired pneumonia?

A

Streptococcus pneumoniae: 70%
H. influenzae (COPD)
S.aureus (IVDUs)
Legionella (air-con)

49
Q

Which pneumonia-causing pathogens may be detected in urine?

A

Pneumococcus

Legionella

50
Q

What is pneumocystis carinii?

A

Type of life-threatening fungal pneumonia

51
Q

Recall the medical management of mild, moderate and severe pneumonia

A

Mild: oral amoxicillin
Moderate: amoxicillin + erythromycin
Severe: Erythromycin + co-amoxiclav

52
Q

What is co-amoxiclav a combo of?

A

Amoxicillin

Clavulanic acid

53
Q

Recall 3 signs that could be identified from chest examination in pneumonia

A

Reduced expansion
Increased tactile vocal fremitus
Dull percussion

54
Q

When would metronidazole be added to pneumonia medication?

A

If abscess or empyema is suspected

55
Q

What is empyema?

A

A collection of pus in the pleural cavity caused by microorganisms, usually bacteria

56
Q

Recall the CURB 65 scoring system

A 
Confusion
Urea >7
Resp rate >30
BP <90/60
>65 years
57
Q

Recall some causes of secondary pneumothorax

A

Pre-existing lung disease like asthma/ COPD/ lung Ca

58
Q

When would pneumothorax cause tracheal deviation?

A

Tension pneumothorax

59
Q

What is the management of tension pneumothorax?

A

Max O2

Large bore needle into 2nd ICS at MCL

60
Q

What size of pneumothorax is considered small?

A

<2cm

61
Q

How is a moderate pneumothorax aspirated?

A

Using a large bore needle with a 3-way cannula

62
Q

If a large-bore needle with a 3-way tap fails to resolve a pneumothorax, how should it be managaed?

A

Chest drain with water seal

63
Q

Recall 3 symptoms of pulmonary embolism

A

Sudden onset dyspnoea
Pleuritic chest pain
Cough with haemoptysis

64
Q

How is pulmonary embolism scored?

A

Well’s score

65
Q

What investigation should be carried out in low-probability pulmonary embolism?

A

D-dimer

66
Q

What investigation should be done in high-probability pulmonary embolism?

A

CTPA + CXR

67
Q

Differentiate the medical management of pulmonary embolism whether the pt is haemodynamically stable or unstable

A

Stable: LMWH and warfarinise
Unstable: alteplase

68
Q

Recall the 3 types of TB infection

A

Primary: first infection, either pulmonary or occasionally GI
Miliary: when there is haematogenous dissemination
Post-primary: caused by reinfection/reactivation

69
Q

What damage does mycobacterium do to the lungs?

A

Causes necrosis and caseating granulomas

70
Q

Recall the symptoms of post-primary TB

A

Drenching night sweats
Fevers
Haemoptysis
Cough

71
Q

What disease does mycobacterium tuberculosis cause in the heart?

A

Constrictive pericarditis

72
Q

What would be seen on CXR in TB?

A

Bilateral hilar lymphadenopathy, upper lobe shadowing, potential pleural effusion

73
Q

In which demographic does non-pulmonary TB usually present?

A

Immunocomprimised

74
Q

Recall one highly specific test for latent TB

A

Interferon gamma

75
Q

How long should antibiotic therapy be continued in pulmonary TB?

A

6 months

76
Q

Recall the 4 antibiotics that are combined to treat TB

A

Rifampicin
Isoniazid
Ethambutol
Pyrazinamide

Year 3 ICSM COPY (17 decks)

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