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Phase 3b > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

Causes of community acquired pneumonia

A 
Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Staph aureus
Legionella
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2
Q

Risk factors for pneumonia

A 
>65 years old
COPD
Smoking
Alcohol
Immunosuppression
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3
Q

Causes of hospital acquired pneumonia

A

Gram negative enterobacteria
Staph aureus
Pseudomonas aeruginosa
Klebsiella

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4
Q

Symptoms of pneumonia

A 
Cough
Fever
Sputum (rusty in strept pneumoniae CAP)
Dyspnoea
Haemoptysis
Pleuritic chest pain
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5
Q

Signs of pneumonia

A 
Confusion
Tachypnoea
Tachycardia
Hypotension (shock)
Signs of consolidation - bronchial breath sounds, dull to percussion, crackles, vocal resonance
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6
Q

What tool is used to measure severity of pneumonia?

A

CURB-65

Confusion
Urea >7mmol/L
Resp rate >30
Blood pressure <90 systolic, <60 diastolic
Age >65
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7
Q

What do different CURB-65 scores mean?

A

Score 0-1 = consider treatment at home
Score >2 = Consider hospital admittance
Score >3= Consider intensive care assessment

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8
Q

Name the types of atypical pneumonia

A 
Legionella pneumophila
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Chlamydia psittaci
Coxiella burnetti - Q fever

MCQ

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9
Q

Describe legionella pneumophila

A

Infected water supplies/air conditioning

Can cause hyponatraemia (low sodium) by causing SIADH

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10
Q

Desrcibe mycoplasma pneumoniae

A

Erythema multiforme

Dry cough

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11
Q

How do you treat fungal pneumonia (pneumocystis jiroveci)?

A

Oral co-trimoxazole

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12
Q

Investigations for pneumonia

A 
Chest X-ray - consolidation
FBC - raised WCC
CRP - raised
Sputum culture
Blood culture
ABG
U&amp;E's
Legionella and pneumonoccal urinary antigens
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13
Q

How do you treat low risk 0-1 CAP?

A

Oral Amoxicillin or macrolide (clarithromycin/azithromycin)

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14
Q

How do you treat moderate 2 CAP?

A

Oral Amoxicillin + clarithromycin (doxycycline if allergic)

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15
Q

How do you treat high risk 2+ CAP?

A

Co-amoxiclav + clarithromycin IV

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16
Q

Treatment for HAP

A

Cefotaxime + gentamicin

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17
Q

Treatment for legionella

A

Clarithromycin + fluoroquinolone

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18
Q

Complications of pneumonia

A

Sepsis
Pleural effusion + empyema
Lung abscess
Death

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19
Q

What organism causes TB?

A

Mycobacterium tuberculosis

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20
Q

Risk factors for TB

A 
Homelessness
Overcrowding
IV drug use
Alcoholics
Immunocompromised - HIV
Exposure to known contacts
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21
Q

Symptoms of TB

A 
Cough
Haemoptysis
Fever
Weight loss
Night sweats
Lethargy
Erythema nodosum
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22
Q

Signs of TB

A

Crackles

Bronchial breathing

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23
Q

What stain do you use to investigate TB?

A

Ziehl-Neelsen stain for acid fast bacilli - turns red/pink

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24
Q

Investigations for TB

A

Sputum culture
Chest X-ray: Primary TB - consolidation, hilar lymphadenopathy
Mantoux test
Interferon

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25
How do you treat TB?
``` RIPE Rifampicin - 6 months Isoniazid - 6 months Pyramzinamide - 2 months Ethambutol - 2 months ```
26
Side effects of Rifampicin
Red/orange urine Tears Inactivation of the pill
27
Side effects of Isoniazid
Peripheral neuropathy (give with Pyridoxine B6)
28
What other drug do you give with Isoniazid?
Pyridoxine B6
29
Side effects of pyrazinamide
Hepatitis Arthralgia Gout
30
Side effects of ethambutol
Optic neuritis
31
How do you treat latent TB?
Isoniazid + rifamipicin for 3 months OR Isoniazid for 6 months
32
Extrapulmonary TB
``` Bone TB - Pott's disease, vertebral collapse Lymph nodes - swelling and discharge GU - frequency, dysuria, haematuria Brain - TB meningitis Abdomen - Ascites ```
33
Define pleural effusion
Fluid in the pleural space
34
Protein count for exudate
High, >35g/L
35
Protein count for transudate
Lower, <25g/L
36
What are causes of exudate?
``` INFLAMMATION Pneumonia Lung cancer TB Rheumatoid arthritis ```
37
What are causes of transudate?
``` Cardiac failure Hypothyroidism Meig's syndrome Hypoalbyminaemia Nephrotic syndrome ```
38
What is Meig's syndrome?
Triad: Ovarian tumour Pleural effusion (right sided) Ascites
39
Symptoms of pleural effusion
Dyspnoea Chest pain Cough
40
Signs of pleural effusion
Dullness on percussion Decreased breath sounds Tracheal deviation away from effusion if large
41
Investigations for pleural effusion
Chest x-ray: blunted costophrenic angle, fluid in lung fissures, tracheal and medistinal deviation Ultrasound - identify pleural fluid Aspiration - protein count, pH, glucose, cell count
42
Treatment for pleural effusion
Drainage Pleural aspiration Pleurodesis
43
What is empyema?
Infected pleural effusion - shows pus
44
What is haemothorax?
Blood in plural space
45
What is chylothorax?
Chyle in pleural space
46
Define pneumonthorax
Accumulation of air in the pleural space
47
Risk factors for primary spontaneous pneumothorax
Young, tall, thin male | Playing sports
48
Risk factors for secondary spontaneous pneumothorax
``` Asthma COPD TB Pneumonia Trauma CF ```
49
General risk factors for pneumothorax
Smoking | Family history
50
Symptoms of pneumothorax
Pleuritic chest pain (on same side on breathing in) | Dyspnoea
51
Signs of pneumothorax
Reduced expansion Hyper-resonant Decreased breath sounds
52
Investigations for pneumothorax
Chest x-ray: Visceral pleural line identified, no lung markings
53
Management for primary pneumothorax
Rim of air<2cm/no SOB = Discharge as it resolves Rim of air >2cm/SOB = Chest drain/aspirate in 2nd intercostal space, mid-clavicular line
54
Management for secondary pneumothorax
Rim of air<1cm = High flow oxygen + admitting Rim of air 1-2cm = aspirate then chest drain Rim of air >2cm= chest drain
55
Define tension pneumothorax
Trauma to the chest wall that creates a one way valve, lets air in but not out. Air is drawn in during inspiration. This creates pressure and will push the mediastinum across
56
Signs of tension pneumothorax
Tracheal deviation away from side of pneumothorax Reduced air entry to affected side Increased resonant to percussion on affected side Tachycardia Hypotension
57
Chest X-ray signs for tension pneumothorax
Increased intercostal space Contralateral mediastinal shift Depressed hemidiaphragm
58
Management of tension pneumothorax
Insertion of a large bore cannula into the 2nd intercostal space in the midclavicular line Then chest drain
59
Where are chest drains entered?
Triangle of safety 5th intercostal space/inferior nipple line Mid axillary line/lateral edge of latissimus dorsi Anterior axillary line/lateral edge of pectoris major
60
Define bronchiectasis
Permanent dilatation of the airways (bronchi/bronchioles)
61
Causes of bronchiectasis
Congenital: CF, Young's syndrome, Kartagener's syndrome, primary ciliary dyskinesia Post infection: TB, measles, pertussis, pneumonia, HIV Bronchial obstruction: Lung cancer/foreign body Allergic bronchopulmonary aspergillosis (ABPA) Hypogammaglobulinaemia Rheumatoid arthritis Ulcerative collitis
62
Symptoms of bronchiectasis
Persistent cough Excessive sputum - mild=yellow, moderate = khaki Haemoptysis
63
Signs of bronchiectasis
Clubbing Coarse inspiratory crackles Wheeze High pitched inspiratory squeaks
64
Organisms causing bronchiectasis
``` H. influenzae Strep pneumoniae Staph aureus Pseudomonas aeruginosa Aspergillus fumigatus ```
65
Investigations for bronchiectasis
``` Sputum culture Chest x-ray: Cysts + thickened bronchial walls FBC: high eosinophils in ABPA Sweat test Serum immunoglobulins Skin prick test ```
66
Treatment for bronchiectasis
Postural drainage 2x daily/chest physiotherapy/exercise Inhaled bronchodilators e.g. nebulised salbutamol Pseudomonas = nebulised abx/ciprofloxacin
67
Define allergic bronchopulmonary aspergillosis (ABPA)
Hypersensitivty to aspergillus fumigatus that has colonised airway of patient with asthma or CF
68
Symptoms of ABPA
``` Increased cough/mucus plugs Wheeze Fever (>38.5) Pleuritic chest pain History of Asthma ```
69
Investigations for ABPA
Skin test for aspergillus fumigatus sensitivity Serum IgE elevated FBC - eosinophils elevated Chest x-ray: upper or middle lobe infiltrates
70
Management for ABPA
Oral corticosteroid - Prednisolone | Azole antifungal - itraconazole, co-trimoxazole
71
Define idiopathic pulmonary fibrosis
Progressive pulmonary fibrosis with no clear cause
72
Symptoms of pulmonary fibrosis
Dry cough Dyspnoea Weight loss
73
Signs of pulmonary fibrosis
Cyanosis Clubbing Fine end inspiratory crackles
74
Name occupational lung disorders
``` Coal worker's pneumoconiosis Silicosis Asbestosis Malignant mesothelioma Bird fancier's lung Farmer's lung Mushroom worker's ung Malt worker's lung ```
75
Investigations for pulmonary fibrosis
Chest x-ray: Reticular shadowing, shaggy heart border High resolution CT: Ground glass appearance, honeycombing Spirometry: Restrictive ABG: Decreased PaO2, increased PaCO2 Lung biopsy
76
Management for pulmonary fibrosis
Supportive - Oxygen, physiotherapy, exercise and weight loss, pulmonary rehabilitation Medications - Pirfenidone = Antifibrotic, Nintedanib = monoclonal antibody Lung transplant
77
Causes of drug induced pulmonary fibrosis
Methotrexate Cyclophophamide Amiodarone Nitrofuratoin
78
Define extrinsic allergic alveolitis (EAA)
Inhalation of allergens (fungal spores or avian proteins) provokes a hypersensitivity reaction
79
What type of hypersensitivity reaction is in EAA?
Type 3 hypersensitivity
80
Causes of EAA
Bird/pigeon fancier's lung Farmer's lung Mushroom workers lung Malt workers lung
81
Symptoms of EAA
Occur 4-8 hours after exposure: Fever, cough, dyspnoea, crackes Chronic: Increasing dyspnoea, weight loss, cor pulmonale, type 1 respiratory failure
82
Investigations for EAA
Chest x-ray: Upper/mid zone fibrosis/consolidation Bronchoalveolar lavage - raised lymphocytes and mast cells FBC - no eosinophils Lung function tests - reversible restrictive defect
83
Management for EAA
Remove allergen Oxygen Oral prednisolone If chronic: low dose corticosteroids
84
What is the most fibrogenic type of asbestos?
Crocidolite (blue asbestos) Chrysotile (white asbestos) is the least fibrogenic
85
Symptoms of asbestosis
Dry cough Dyspnoea Fine-end inspiratory crackles Clubbing
86
Investigations for asbestosis
Lung function test - restrictive Chest x-ray: ground glass opacification, small nodular opacities, shaggy cardiac sillhouette Sputum microscopy
87
Management for asbestosis
Avoid exposure
88
Symptoms of pleural mesothelioma
``` Pleuritic chest pain Dyspnoea Weight loss Clubbing Pleural effusions (recurrent): Diminished breath sounds & Dull to percussion ```
89
Invesitgations for pleural mesothelioma
Chest x-ray: pleural thickening, pleural effusion CT scan - pleural thickening, pleural plaques Pleural biopsy Thoracocentesis
90
Management for pleural mesothelioma
Chemotherapy - Pemetrexed + cisplatin | Surgery
91
What jobs are associated with silicosis?
Metal mining Stone quarrying Sandblasting Pottery
92
Symptoms of silicosis
Dyspnoea Dry cough Black sputum
93
Investigations for silicosis
Chest x-ray: nodular pattern in upper/mid zones | Spirometry - restrictive
94
Management for silicosis
Avoid exposure
95
Symptoms of coal worker's pneumoconiosis
Dry cough | Dyspnoea
96
Management for coal worker's pneumoconiosis
Avoid exposure
97
Define sarcoidosis
A multisystem disorder of unknown aetiology characterised by non-caseating granulomas
98
Risk factors for sarcoidosis
Younger people (20-40 year old) Women Afro-Carribbeans
99
What are the acute symptoms of sarcoidosis?
Erythema nodosum (nodules on shins) Polyarthralgia Bilateral hilar lymphadenopathy
100
What organs are affected in sarcoidosis?
Lungs: Dry cough, dyspnoea, pulmonary fibrosis, mediastinal lymphadenopathy Systemic: fever, fatigue, weight loss Liver: Liver nodules, cirrhosis, cholestasis Eyes: Uveitis, conjunctivitis, optic neuritis, glaucoma Skin: Erythema nodosum (red nodules on the skin), lupus pernio (purple lesions on cheeks and nose), granulomas in scar tissue Heart: BBB, heart block Kidneys: Kidney stones, nephrocalcinosis, interstitial nephritis CNS: Encephalopathy, Diabetes insipidus Peripheral nervous system: Facial nerve palsy Bones: Arthralgia, arthritis, myopathy
101
What is Lofgren's syndrome?
Triad of: Erythema nodosum Bilateral hilar lymphadenopathy Polyarthralgia (joint pain in multiple joints)
102
Investigations for sarcoidosis
Bloods: Increased serum ACE, Calcium, CRP, ESR, Immunoglobulins Chest x-ray: Hilar lymphadenopathy Tissue biopsy - Gold standard: non-caseating granulomas Spirometry: restrictive defect Bronchoalveolar lavage: Increase in lymphocytes and neutrophils ECG Ultrasound
103
Management for sarcoidosis
Best rest/NSAIDs 1st line: Oral steroids e.g. Prednisolone Bisphosphonates - to protect against osteoporosis 2nd line: Methotrexate
104
Define COPD
Progressive disorder characterised by airway obstruction FEV1 <80% ; FEV1/FVC < 0.7 With little or no reversibility
105
What two diseases make up COPD?
Emphysema | Chronic bronchitis
106
Symptoms of COPD
Cough Sputum Wheeze Dyspnoea
107
Signs of COPD
``` Tachypnoea Use of accessory muscles Hyperinflation Hyperresonance to percussion Quiet breath sounds Cyanosis Cor pulmonale ```
108
Define pink puffer
Emphysema Normal PaO2, normal or low PaCO2 May progress to type 1 respiratory failure
109
Define blue bloater
Low PaO2, high PaCO2 Cyanosis May develop cor pulmonale
110
Investigations for COPD
Spirometry - obstructive pattern - non-reversible to Beta-2-agonists e.g. Salbutamol FEV1/FVC <0.7 ``` ABG - hypoxia, hypercapnia Chest X-ray: Hyperinflation, flat hemidiaphragm, bullae FBC ECG Sputum culture Serum alpha-1 antitrypsin ```
111
Define the severity stages for COPD
Stage 1 mild = FEV1 >80% Stage 2 moderate = FEV1 50-79% Stage 3 severe = 30 - 49 % Stage 4 very severe = <30%
112
Define the dyspnoea scale
Grade 1 = breathless on strenuous exercise Grade 2= breathless walking up hill Grade 3=breathless that slows walking on flat Grade 4=stop to catch breath after 100m on flat Grade 5=Unable to leave house due to breathlessness
113
Supportive Treatment for COPD
Stop smoking Exercise Diet advice Influenza and pneumococcal vaccination
114
Medication treatment for COPD
Short-acting antimuscarinic (ipratropium) or Beta2 agonist Mild/moderate = LAMA + LABA e.g. formoterol Severe = LABA + ICS e.g. budesonide = 'Fostair' If remain breathless = LAMA + LABA + ICS Consider: Theophylline, home nebulisers, mucolytics, long term oxygen therapy
115
Define exacerbation of COPD
Triggered by viral or bacterial infection
116
Symptoms of COPD exacerbation
Increase in dyspnoea, cough, wheeze, sputum
117
Causative organisms for a COPD exacerbation
H. influenzae Strep pneumoniae Moraxella catarrhalis
118
Treatment for a COPD exacerbation
``` SABA + SAMA Oxygen Oral prednisolone Antibiotics Airway clearance - mucolytics + physio ```
119
Define asthma
Chronic inflammatory airway disease charactersied by intermittent obstruction and hyperreactivity (type 1 hypersensitivity) -> bronchoconstriction Reversible
120
Triggers of asthma
``` Exercise Infection Animals/fur Dust/pollen Cold/damp Smoking Emotion ```
121
What drug is contraindicated in asthma?
Beta blockers - Beta 2 agonists cause airway constriction | NSAIDs or aspirin block COX-1 -> decrease prostaglandins
122
Symptoms of asthma
``` Intermittent dyspnoea Wheeze - polyphonic Cough (dry) Sputum Diurnal variation - typically worse at night/morning ```
123
What two other conditions occur simultaneously with asthma?
``` Eczema (atopic dermatitis) Hay fever (allergic rhinitis) ```
124
Questions to ask someone with asthma?
``` How often shortness of breath? How often wake up from sleep? How often do you use your reliver? How often does it interfere with normal activities? What is your exercise tolerance like? How well is your asthma controlled? What is your inhaler technique like? ```
125
Investigations for asthma
``` Spirometry - obstructive defect; FEV1<80% + FEV1/FVC <0.7 FEV1 improves by 15% with SABA PEFR diary (peak flow rate) Chest x-ray: hyperinflation FBC - eosinophilia Skin-prick test ```
126
Management for asthma
1. SABA e.g. Salbutamol -> reliver inhaler (blue) 2. ICS e.g. Budesonide 3. Oral leukotriene receptor antagonist e.g. Montelukast 4. Add LABA e.g. Salmeterol 5. Consider MART regime 6. Increase ICS dose to moderate (from 400mg to 400-800mg) 7. Oral theophylline
127
Criteria for moderate asthma
PEFR 50-75% Speech normal Resp rate <25 Pulse <110
128
Criteria for severe asthma
PEFR 33-50% Can't complete sentences Resp rate >25 Pulse >110
129
Criteria for life-threatening asthma
``` ONLY REQUIRES ONE OF THE CRITERIA PEFR <33% Oxygen sats <92% Silent chest Cyanosis Exhaustion, confusion, coma ```
130
Treatment for acute asthma
``` Oxygen aim 94-98% Salbutamol - nebulised Hydrocortisone IV/oral prednisolone Ipratropium bromide - nebulised Theophylline IV Magnesium sulphate IV Salbutamol IV Intubate and ventilate ```
131
Define deep vein thrombosis
The development of a blood clot (thrombosis) in the venous circulation
132
Risk factors for a DVT
Surgery Immobility Long haul flights Malignancy Hormone therapy with oestrogen - HRT/COCP Pregnancy Thrombophilia e.g. antiphospholipid syndrome
133
Define thrombophilias and name them
Antiphospholipid syndrome Antithrombin deficiency Protein C or S deficiency Factor V Leiden
134
What makes up Virchow's triad (the clot forming triad)?
Venous stasis Vessel injury Activation of clotting system (hypercoaguable state)
135
Symptoms of a DVT
``` Unilateral calf swelling Dilated superficial veins Tenderness to the calf Oedema Colour changes to the leg ```
136
What tool predicts the risk of a DVT?
Well's score
137
What makes up the Well's score?
``` Active cancer = +1 Signs/symptoms of a DVT = +3 Likely diagnosis = +3 Heart rate >100= +1.5 Recently bed-ridden/immobilisation = +1.5 Previous DVT/PE = +1.5 Haemoptysis = +1 ```
138
What Well's scores indicate probability of a PE?
Score <4 = PE unlikely | Score >4 = PE likely
139
What investigation with a negative result excludes a DVT/PE?
D-dimer
140
What other conditions could a positive D-dimer indicate?
Pneumonia, malignancy heart failure, surgery, pregnancy
141
Investigations for a DVT
D-dimer Ultrasound doppler of the leg CT pulmonary angiogram for PE Ventilation/perfusion (V/Q) scan for PE
142
What treatment for a DVT is given initially?
Low molecular weight heparin - start immediately before diagnosis is known e.g. Enoxaparin & Dalteparin. Continue for 5 days or until INR is above 2 for at least 24 hours
143
What treatment do you give after LMWH?
Warfarin/NOAC's/DOAC's e.g. Apixaban, rivaroxaban or dabigatron given within 24 hours For 3 months
144
What treatment is given for a DVT where the patient is either pregnant or has cancer?
Low molecular weight heparin for 6 months if active cancer
145
Define pulmonary embolism
When a thrombosis embolises it can travel through the right side of the heart and into the lungs where it becomes lodged in the pulmonary arteries
146
Risk factors for a PE
``` Long haul flight Immobility Recent surgery Malignancy Thrombophilia Pregnancy Hormone therapy - HRT/COCP Previous PE ```
147
Causes of a PE
``` Right ventricular thrombus (Post MI) Septic emboli Fat embolus Air embolus Amniotic fluid embolus ```
148
Symptoms of a PE
Pleuritic chest pain Dyspnoea Haemoptysis Syncope
149
Signs of a PE
Tachypnoea Tachycardia Signs of a DVT (calf swelling etc)
150
What investigations do you do for a PE depending on the Well's score?
CTPA if Well's score >4 points | D-dimer if Well's score <4 points - if the D-dimer is positive then do a CTPA
151
Other investigations for a PE?
V/Q scan if renal impairment (instead of a CTPA) ECG - sinus tachycardia, RBBB, S1Q3T3 pattern Chest x-ray: wedge shape infarction ABG: low PaO2
152
Treatment for a PE
Low weight molecular heparin initially - continued for 5 days or until INR is 2 for at least 24 hours Warfarin given within 24 hours LMWH for 6 months if active cancer
153
Prevention for a PE
Stockings Encourage mobilisation Heparin - dalteparin
154
What type of inheritance is cystic fibrosis?
Autosomal recessive
155
What chromosome and gene is the CF mutation on?
Chromosome 7 - delta F508 mutation
156
What are the respiratory symptoms of CF?
``` Recurrent infections Nasal polyps Dyspnoea Haemoptysis Cough Wheeze Thick mucus - sputum ```
157
What are the GI symptoms of CF?
Meconium ileus Steatorrhoea - loose, grey stools Gallstones Cirrhosis
158
Other symptoms of CF (other than respiratory and GI)?
``` Failure to thrive Diabetes mellitus Absent vas deferens - infertility Malnutrition Clubbing Osteoporosis ```
159
Causes of clubbing in children?
``` CF Infective endocarditis TB Inflammatory bowel disease Cirrhosis ```
160
Investigations for CF
Sweat test: Na & Cl >60mmol/L with Cl>Na - Gold standard Newborn blood spot test - immunoreactive trypsinogen Genetic testing - amniocentesis/chronic villous sampling Faecal elastase
161
Causative organisms of CF
``` Staph aureus - take flucloxacillin Psuedomonas aeruginosa - ciprofloxacin/tobramycin E.coli H.influenzae Klebsiella pneumoniae Burkhodheria cepacia ```
162
Management of CF
``` MDT approach: Chest physiotherapy Exercise Bronchodilators - salbutamol Mucolytics - DNase Prophylactic flucloxacillin - prevents spread of staph aureus Pancreatic enzyme replacement Lung transplantation ```
163
What members of the MDT team are involved in the treatment of CF?
``` Nurse Doctor Phyisotherapist Dietician GP ```
164
Complications of CF
``` Diabetes Male infertility Pneumonia Pneumothorax Cirrhosis Gallstones ```
165
Define pulmonary hypertension
Increased resistance and pressure of blood in the pulmonary arteries. It causes strain on the right side of the heart. It also causes a back pressure of blood into the systemic venous system.
166
Define pulmonary hypertension pressure
Resting mean pulmonary artery pressure of >= 25 mmHg
167
Causes of pulmonary hypertension
``` SLE CREST COPD PE Sarcoidosis MI ```
168
Symptoms of pulmonary hypertension
Dyspnoea Syncope Peripheral oedema
169
Signs of pulmonary hypertension
Loud P2 Tricuspid regurgitation Raised JVP
170
Investigations for pulmonary hypertension
ECG: RVH, RAD, RBBB Chest x-ray: RVH, dilated pulmonary arteries Transthoracic echo
171
Management for pulmonary hypertension
Calcium channel blockers - Nifedipine/amlodipine Phosphodiesterase inhibitors - Sildenafil Endothelin receptor antagonists - Macitentan Exercise
172
Commonest causes of cancer?
1st. Breast 2nd. Prostate 3rd. Lung
173
Risk factors for lung cancer
Smoking Asbestos Radiation (radon gas) Iron oxides
174
Histology of lung cancer
``` Non-small cell (85%): Squamous, adenocarcinoma, large cell Small cell (15%) ```
175
Symptoms of lung cancer
``` Dyspnoea Cough Haemoptysis Weight loss Chest pain Pneumonia ```
176
Signs of lung cancer
Clubbing Anaemia Lymphadenopathy (supraclavicular nodes)
177
Paraneoplastic features of small cell lung cancer
SIADH - hyponatraemia ACTH - hypertension, muscle weakness, hyperglycaemia, hypokalaemia Lambert-Eaton syndrome
178
Paraneoplastic features of squamous lung cancer
Clubbing Hyperthyroidism Hypercalcaemia
179
Paraneoplastic features of adenocarcinoma lung cancer
Gynaecomastia
180
Complications of lung cancer
Recurrent laryngeal nerve palsy - hoarse voice Horner's syndrome - myosis, ptosis, anhydrosis Pericarditis AF Seizures
181
Where can lung cancer metastasise to?
Liver Bone Brain Adrenals
182
Investigations for lung cancer
``` Chest x-ray: hilar enlargement, pleural effusion, lung collapse, peripheral opacity Staging CT scan - contrast enhanced Cytology sputum and pleural fluid Bronchoscopy PET-CT scan Biopsy ```
183
Treatment for non-small cell lung cancer
For stages 1-2 = Excision- labectomy, radiotherapy | For stages 3-4= + chemotherapy
184
Side effects of chemotherapy
``` Alopecia Nausea and vomiting Diarrhoea Fatigue Anaemia ```
185
Treatment for small cell lung cancer
Chemotherapy and radiotherapy Not surgery Stents or debulking
186
Define acute respiratory distress syndrome (ARDS)
Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli e.g. pulmonary oedema (non cardiogenic)
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Risk factors for ARDS
``` Sepsis Pancreatitis Pneumonia Trauma Smoke inhalation Heart/lung bypass ```
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Symptoms of ARDS
Dyspnoea Tachycardia Bilateral lung crackles Low oxygen saturations
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Investigations for ARDS
Chest x-ray: Bilateral pulmonary infiltrates | ABG
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Diagnostic criteria for ARDS
Acute onset (within 1 week) Chest x-ray: bilateral infiltrates Non cardiogenic/pulmonary artery wedge pressure <19mmHg PaO2 : FiO2 < 200
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Management for ARDS
Admit to ITU Oxygenation/ventilation Vasosuppression
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Define type 1 respiratory failure
Hypoxia (PaO2 <8kPa) without hypercapnia
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Define type 2 respiratory failure
Hypoxia (PaO2 <8kPa) with Hypercapnia (PaCO2>6kPA)
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Causes of type 1 respiratory failure
``` Pneumonia Pulmonary oedema Asthma PE Fibrosis Emphysema ARDS ```
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Symptoms of type 1 respiratory failure
``` Dyspnoea Restlessness Cyanosis Cor pulmonale Confusion ```
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Causes of type 2 respiratory failure
``` Asthma COPD Pneumonia Obstructive sleep apnoea Polyneuropathy Mysasthenia gravis Guillain-Barre syndrome ```
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Symptoms of type 2 respiratory failure
``` Headache Tachycardia Papilloedema Drowsiness Coma Confusion ```
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Management for type 1 respiratory failure
Oxygen - 35-60% | Ventilation
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Management for type 2 respiratory failure
Oxygen
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Investigations for respiratory failure
``` ABG FBC Chest x-ray Spirometry Sputum ```
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Define Goodpasture's disease
Associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis
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What causes Goodpasture's disease
Anti-glomerular basement membrane (anti-GBM) antibodies against type IV collagen
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Risk factors for Goodpasture's disease
Smoking | Young males
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Symptoms of Goodpasture's disease
Cough Haemoptysis Dyspnoea Fever Oedema Reduced urine output -> likely had recent URTI
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Investigations for Goodpasture's disease
Chest x-ray: lower zone pulmonary infiltratres Renal biopsy: crescentic glomerulonephritis Urinalysis
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Treatment for Goodpasture's disease
Plasmapheresis (plasma exchange) Corticosteroids Cyclophosphamide
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Define Wegener's granulomatosis
Multisystem disorder of unknown cause characterised by necrotising granulmatous inflammation and vasculitis of small and medium vessels
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What systems does Wegener's granulomatosis affect?
Upper and lower respiratory tract Lungs Kidneys
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Symptoms of Wegener's granulomatosis
``` Epistaxis Nasal crusting Sinusitis Saddle shaped nose deformity Nasal septum perforation ``` Cough Dyspnoea Wheeze Haemoptysis ``` Rapidly progressing glomerulonephritis Rashes Proptosis Arthralgia Neuropathy ```
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What autoantibody is involved in Wegener's granulomatosis?
c-ANCA
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Investigations for Wegener's granulomatosis
c-ANCA positive (anti-PR3) Urinalysis - haematuria + proteinuria Renal biopsy Chest x-ray
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Management for Wegener's granulomatosis
Methylprednisolone Cyclophosphamide Plasma exchange Methotrexate
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Triad involved in Churg-Strauss syndrome?
Asthma Eosinophilia Vasculitis
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Symptoms in Churg-Strauss syndrome
``` Rhinitis Sinusitis Glomerulonephritis Peripheral neuropathy Purpura ```
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Investigations in Churg-Strauss syndrome
p-ANCA FBC - raised eosinophils, anaemia, raised ESR/CRP Chest x-ray: pulmonary infiltrates
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Management for Churg-Strauss syndrome
Corticosteroids | Asthma management
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Complications of bronchiectasis
``` Pneumonia Pleural effusion Pneumothorax Cerebral abscess Amyloidosis ```
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Features of Kartagener's syndrome
Dextrocardia (quiet heart sounds) or complete situs inversus Bronchiectasis Recurrent sinusitis Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
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Causes of upper lobe fibrosis
``` SCART Sarcoidosis Coal worker's pneumoconiosis Ankylosing spondylosis Radiation TB ```
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Who is Klebsiella pneumonia seen in?
Alcoholics Aspiration pneumonia Abscesses
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What features are seen in Klebsiella pneumonia?
'red-currant jelly' sputum
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Causes of lower lobe fibrosis
``` RASCO RA Asbestosis SLE/Systemic sclerosis Cryptogenic fibrosing alveolitis Other (drugs) ```

Phase 3b (18 decks)

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