Respiratory Flashcards
(189 cards)
1
Q
What does rhinovirus cause?
A
Common cold
Bronchitis
Sinusitis
2
Q
What does influenza A virus cause ?
A
Flu
3
Q
List some common respiratory viruses
A
Rhinovirus
Influenza A virus
Coronavirus
Adenovirus
4
Q
Pulmonary hypertension is defined as a pressure over how many mmHg?
A
25mmHg
5
Q
Give 2 signs of Pulmonary Hypertension on chest X-ray?
A
- Enlargement of the pulmonary arteries,
- Lucent lung fields,
- Enlarged right atrium,
- Elevated cardiac apex due to right ventricular hypertrophy
6
Q
Chemotherapy is a management option for patients with extensive lung cancer, what are the side effects of chemotherapy?
A
Alopecia, Nausea and Vomiting, Peripheral neuropathy, Constipation or Diarrhoea, Mucositis, Rash, Bone Marrow Suppression Anaemia, Fatigue, Anaphylaxis
7
Q
Name 3 causes of a pleural effusion consisting of exudate
A
- Malignancy (lung, breast, mesothelioma),
- Infection (lung, pleural, abdominal),
- Inflammatory (RA, SLE),
- Pulmonary embolism,
- Benign asbestos related,
- Traumatic (haemothorax/chylothorax),
- Drug reaction
8
Q
What is the most common histological type of a non-small cell lung cancer?
A
Adenocarcinoma (40%)
9
Q
Name the 2 conditions that constitute COPD?
A
- Emphysema
- Chronic Bronchitis
10
Q
Which specific blood marker supports the diagnosis of pulmonary embolism i.e. a negative test excludes a diagnosis of PE
A
Plasma D-Dimer
11
Q
A 60 year old male presents to his GP with a four month history of a productive cough with bloodstained sputum. He reports feeling fatigued, has night sweats and thinks his clothes are loose on him, He’s a charity worker and recently visited Nigeria 6 months ago. On examination of his neck you palpate enlarged lymph nodes. Sputum sample reveals a growth of acid-fast bacilli.
What is the causative organism and what stain would you use to determine the causative organism obtained from a sputum sample?
A
Organism= Mycobacterium - tuberculosis, (1)
- Stain= Ziehl-Neelsen stain.
12
Q
Giving values where appropriate state what the components of CURB 65
A
- Confusion
- Urea > 7mmol/L
- Respiratory Rate > 30/min
- Low BP (Systolic < 90 / Diastolic 60)
- Age <65
13
Q
What CURB65 score constitutes a hospital admission?
A
2
14
Q
What is CURB65?
A
A measure of the severity of pneumonia
15
Q
How should a CURB65 score of 2 be treated?
A
IV Amoxicillin and clarithromycin for 7-10 days
16
Q
Name 3 clinical features of bronchiectasis
A
- Persistent cough,
- Purulent sputum
- Clubbing,
- Dyspnoea .
- No history of smoking + young age of onset = raises suspicion of BE,
- Haemoptysis,
- Recurrent pulmonary infections
17
Q
What is the management of severe acute extrinsic allergic alveolitis?
A
- Remove/avoid exposure to allergen
- Oxygen to treat hypoxaemia
- Corticosteroids/ prednisolone
18
Q
Asthma symptoms are caused by a narrowing of the airways, give 3 factors that contribute to the narrowing of the airways?
A
- Inflammation of mucosa
- Smooth muscle contraction leading to bronchoconstriction
- Increased mucus production
19
Q
Short-acting beta agonists (SABA) are prescribed from the management of asthma, give an example of a SABA and describe the method of action of this drug
A
- SABA= Salbutamol
- Action= Binds to beta-2 adrenoceptors present in the lungs leading to smooth muscle relaxation and therefore bronchodilation
20
Q
Describe the blood gasses of type 1 and type 2 respiratory failure
A
- Type 1 has hypoxaemia/Low O2 without hypercapnia/normal CO2
- Type 2 has both hypoxaemia /Low O2 and hypercapnia/raised CO2
21
Q
Name 2 tests you would use to diagnose cystic fibrosis?
A
- Sweat test
- Genetics F
- Faecal elastase
22
Q
What is an antigenic drift?
A
When there is a minor antigenic variation causing a seasonal epidemic
23
Q
Give an example of an obstructive lung disease
A
COPD
Asthma
24
Q
Give an example of a restrictive lung disease
A
Idiopathic pulmonary fibrosis
Sarcoidosis
25
A patient's x Ray shows unusual interstitial pneumonia. What is it likely to be?
Idiopathic pulmonary fibrosis
26
What are the two main drugs for idiopathic pulmonary fibrosis?
Nintedanib
| Pirfenidone
27
What type of hypersensitvity reaction is hypersensitivity pneumonitis?
III
28
If there is high lymphocytes on bronchoalveolar lavage, what does the patient likely have?
Hypersensitivity pneumonitis
29
What is the acronym CREST used for?
Systemic sclerosis
30
What does CREST stand for?
```
Calcinosis
Raynauds pnenomenon
Oesophageal dysmotilitiy
sclerodactily
telangiectasia
```
31
What are common culprits for drug induced interstitial lung disease?
Nitrofurantoin
Methotrexate
Amiodarone
Bleomycin
32
What is type 1 resp failure?
Low PaO2 with normal or low PaCO2
33
What is type 2 resp failure?
Low PaO2 with a high PaCO2
34
```
Which of the following causes a raised alveolar-arterial gradient?
Hypoventilation
V/Q mismatch
Anaemia
Diffusion impairment
Shunt (right to left)
```
V/Q Mismatch
Diffusion impairment
Shunt
35
```
Which of these is a well-recognised response to hypoxia?
A) Bradycardia
B) Atrial fibrilation
C) Systemic vasoconstriction
D) Pulmonary Vasoconstriction
E) Syncope
```
D
36
What are the functions of the lung?
```
Gas exchange
Acid-base balance
Defense
Hormones
Heart exchange
```
37
What gene is affected in cystic fibrosis?
CFTR
38
How common is cystic fibrosis?
1 in 2500 live births in Northern Europe
39
What indicates airways obstruction?
A FEV1/FVC ratio (less than 0.7)
40
What indicates airways restriction?
A FVC below 80% of predicted
41
What does a low TLCO indicate?
Thickening of the alveolar-capillary membrane or reduced lung volume
42
What does a high TLCO indicate?
Increased capillary blood volume or pulmonary haemorrhage
43
Give 5 causes of respiratory failure
1. Low oxygen delivery
2. Airways obstruction
3. Gas exchange limitation
4. Ventilation mismatch
5. Alveolar hypoventilation
44
What is an example of something that causes low oxygen delivery?
Altitude
| Hypobaric chamber
45
What is an example of something that causes gas exchange limitation?
Lung fibrosis
| Asbestosis
46
What is an example of something that causes ventilation mismatch?
Pneumonia
Pulmonary embolism
Pulmonary hypertension
47
What is an example of something that causes alveolar hypoventilation?
Emphysema
Muscular weakness
Reduced respiratory drive
Obesity
48
How is obstructive sleep apnoea usually treated?
Continuous positive airway pressure machine
49
How would neuromuscular disease leading to type 2 resp failure be treated?
BiPAP
| Bilevel Positive Airway Pressure machine
50
A pregnant lady presents with hypocapnia and breathlessness, but no other gas abnormalities. She is hyperventilating, but her Aa shows low alveolar diffusion. What is it likely to be?
Pregnancy
51
Hypercapnia is associated with what symptom?
Headache
52
Are features of respiratory failure aggravated in the day time or at night?
Night
53
What are the 2 major types of asthma?
Eosinophillic asthma
| Non eosinophillic asthma
54
What are the two types of eosinophilic asthma?
Atopic
| Non atopic
55
What is the typical presenting complaint of asthma?
Episodic wheeze
| Cough, breathlessness; typically worse in the morning
56
What is the difference between presentation in asthma and COPD?
Asthma typically is episodic with recovery periods in between, whereas COPD typically
gets worse gradually
57
What are the RCP3 questions?
Asthma severity
- Recent nocturnal waking?
- Usual asthma symptoms in a day?
- Interference with ADLs?
58
What is Samter's triad?
Asthma, sinus inflammation with recurring nasal polyps, and sensitivity to aspirin
59
What is Cushing's triad indicative of?
Increased ICP
60
What is Cushing's triad?
Bradycardia
Irregular respirations
Widened pulse pressure
61
Is a unilateral wheeze present in asthma?
No
62
Are crackles present in asthma?
No
63
Is asthma or COPD more reversible in testing?
Asthma
64
What is the first line treatment for asthma?
Mild SABA (Salbutamol)
65
What is the second line treatment for asthma?
Mild SABA (Salbutamol) + ICS (beclomethasone)
66
What is the third line treatment for asthma?
Milkd SABA (Salbutamol) + ICS (Beclomethasone) + LABA (Salmetrol)
67
Would biologicals be indicated in eosinophilic or non eosinophilic asthma?
Eosinophilic (only if severe and during an atopic attack)
68
What should be given in an acute asthma attack?
- Oxygen therapy if needed
- Nebulised 5mg salbutamol (SABA)
- Ipratropium if life threatening
- Predinisolone 30-60 mg with/without hydrocortisone IV
69
What would indicate a uncontrolled/ moderate asthma attack?
PEFR more than 50%
RR less than 25
Pulse less than 110
Normal speech, no other severe markers
70
What would indicate a severe asthma attack?
Any one of...
- PEFR between 33-50% predicted
- Resp rate over 25
- Heart rate over 110
- Inability to complete sentences
71
What would indicate a life-threatening asthma attack?
Any one of...
- PERF less than 33%
- SaO2 less than 92% or PaO2 less than 8kPa
- Normal PaCO2
- Altered consciousness
72
List the atypical pathogens that can cause community acquired pneumonia
Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, Coxiella burnetti
73
What is the most common identifiable cause of pneumonia
S. pneumoniae
74
What is the first line treatment for atypical community acquired pneumonia?
Clarithromycin
75
What is the first line treatment for pneumonia due to H. Influenzae?
Amoxicillin and doxycycline
76
What bacterial infection is likely in a pathogen that doesn't grow on blood agar, grows on chocolate agar, and grows in the presence of factor X and V?
Haemophilius influenzae.
77
List some methods of rapid testing for TB?
- Mycobacteria growth indicator tube
- PCR of culture
- Xpert
78
What is the most common cause of pneumoniae in a HIV patient?
P. jiroveci
79
How is P. Jiroveci infection treated?
co-trimoxazole (trimethoprim/sulfamethoxazole)
80
How would you treat an exacerbation of bronchiectasis due to pseudomonas?
An anti-pseudomonal beta lactam (e.g. piperacillin-tazobactam or ceftazidime) or fluoroquinolone (e.g. ciprofloxacin)
81
What investigations should be done in a patient with suspected pneumonia?
```
Chest X ray
FBC
Blood gasses
Sputum culture
Blood culture
Serology if viral infection suspected
Urine if legionella is suspected
```
82
What does a "-sone" drug indicate?
Corticosteroids
83
What does a "-terol" drug indicate?
Bronchodilators
84
What does a "-nib" drug indicate?
Kinase inhibitors
85
Where in the lungs has the slowest absorption?
Trachea and upper airway
86
Give some examples of delivery systems for inhaled drugs?
Pressurized metered-dose inhalers
Spacer devices
Dry powder inhalers
Nebulizers
87
What diseases are associated with bronchoconstriction?
Asthma
| COPD
88
What are the two types of bronchodilators?
Adrenergic
| Anticholinergics
89
Give an example of a SABA?
Salbutamol
90
Give an example of a LABA
Formoterol and salmeterol
91
Give an example of an anticholinergic bronchodilator
Ipratropium
| Atropine
92
List some inflammatory respiratory diseases
Pneumonia
Asthma
COPD
IPF
93
What is the main type of anti-inflammatory drug used in the respiratory system
Inhaled corticosteroids e.g. Beclomethasone
94
Are inhaled corticosteroids better in asthma or COPD?
Asthma
95
What corticosteroid is used in covid-19?
Dexamethasone
96
Give some common side effects of ICS
Loss of bone density
Adrenal suppression
Cataracts, glaucoma
97
What does nintedanib inhibit?
Vascular endothelial growth factor receptor
98
Is the aorta in the posterior or anterior aspect of the thorax?
Posterior
99
What are the causes of lower lobe fibrosis?
IPF
Connective tissue disease
Drug induced
Rheumatoid arthritis.
100
What are the causes of upper lobe fibrosis?
TB
Ank spon
sarcoidosis
Drug induced
101
What would a "whiteout" on chest x ray indicate?
Fluid presence
102
How much fluid is there usually in the pleural space?
5-10ml
103
What is the function of pleural fluid?
Lubrication
104
What is pneumothorax?
Presence of air in the pleural space
105
Where should a cannula be inserted in a tension pneumothorax?
2nd IC space on same side as the pneumothorax
106
What are the signs of pneumothorax?
```
Tachypnoea
Hypoxia
Unilateral chest wall expansion
Reduced breath sounds
Hyper-resonant percussion note
```
107
What are the 4 methods of treatment of pneumothorax?
1. No intervention, high flow oxygen
2. Pleural aspiration
3. Chest drain
4. Surgery
108
What is a pleural effusion?
A collection of fluid in the pleural space
109
What are the causes of transudate pleural effusions?
```
Heart failure
Cirrhotic liver disease
Renal failure
Hypoalbinaemia
Myoedema
```
110
What are the causes of exudate pleural effusions
```
Pneumonia
Cancer
TB
Autoimmune disease
PE
```
111
What is Meig's syndrome?
benign ovarian tumor with ascites and pleural effusion
112
What are the signs of a pleural effusion?
Reduced chest wall expansion
Quiet breath sounds
Stony dull percussion
Mediatational shift away from affected side
113
What are the symptoms of pleural effusion?
```
Asymptomatic
Breathlessness
Cough
Pain
Fever
```
114
How is pleural effusion usually diagnosed?
Pleural fluid aspiration and chest x ray
115
Where should a chest drain be inserted?
Under the armpit
116
What is the male:female ratio of lung cancer?
2:1
117
What are the symptoms of lung cancer?
```
Cough
Recurrent chest infections
Haemoptysis
Increasing shortness of breath
Extra-pulmonary changes
General malaise
Weight loss
```
118
What is a lung carcinoid?
A malignant tumour that has neuroendocrine secreting cells. They are less aggressive and may produce hormones.
119
How are lung cancers staged?
TNM
120
How are bronchial lymphoma treated?
Chemotherapy
121
What type of lung cancer is most strongly associated with cigarette smoking?
Squamous cell carcinoma
122
What type of lung cancer is most strongly associated with asbestos?
Mesothelioma
123
Are pleural fibromas typically malignant or benign?
Benign
124
What is asbestos typically linked with?
Plaques
Asbestosis
Mesothelioma
Effusion
125
What is the typical life expectancy for mesothelioma?
8-12 months
126
What is atelectasis?
Lung collapse
127
What are the ways that asthma causes obstruction?
- Mucus plugging of bronchi
- Inflammation
- Increased contraction of smooth muscle
128
What is bronchiectasis?
Permenant dilation and thickening of the airways
129
Does bronchiectasis typically affect upper or lower lobes?
Lower lobes
130
What are the complications of bronchiectasis?
```
Recurrent infection
Respiratory failure
Amyloid formation
Cor pulmonale
Metastatic abscesses
```
131
What are "pink puffers" ?
Individuals with emphysematous damage leading to hyperventilation
132
What are "blue bloaters"?
Individuals with chronic bronchitis leading to hypoxia and increased residual lung volume
133
What is emphysema?
Enlargement of alveolar air spaces with destruction of the elastin in walls
134
What are the 3 types of emphysema?
Centri-acinar
Pan-acinar
Irregular emphysema
135
What are the classic features of IPF?
- Breathlessness, non-productive cough
- Clubbing
- Malaise
- Inspiratory basal crackles
136
What is anthracosis?
The presence of coal dust pigment in the lung resulting in black sputum
137
What condition is caplan's syndrome associated with?
Rheumatoid arthritis
138
What are giant cells associated with?
Granulomatous disorders such as sarcoidosis
139
Give some immune defence mechanisms against resp tract infection
- Mucociliary escalator
- Cough and sneeze reflex
- Cellular responses (Defensins, collectins, macrophages, B and T cells)
140
What are crepitations?
Crackles
141
Who is at risk of pneumonia?
- Infants and the elderly
- Pre existing lung disease
- Immunocompromised
- Impaired swallow
- Diabetics
- Congestive heart disease
- Alcoholics and IV drug users
142
What are strep pneumoniae?
Gram positive diplococci that are the main cause of pneumonia
143
What usually causes pneumonia in cystic fibrosis patients?
pseudomonas aeruginosa
144
What is lung consolidation?
When the air in the lungs is replaced with something else
145
What is rusty sputum typical of?
S. Pneumoniae pneumonia
146
What are the classic symptoms of pneumonia?
- Fever, sweats and rigor
- Cough with sputum
- Shortness of breath
- Pleuritic chest pain
147
What are the signs of lung consolidation?
Dull to percussion
Decreased air entry
Crackles
148
How would you diagnose legionella?
Urine antigen
149
How would you treat pneumonia with a CURB65 score of 0-1?
Oral Amoxicillin
150
How would you treat pneumonia with a CURB65 score of 2?
Oral Amoxicillin with clarithromycin
151
How would you treat pneumonia with a CURB65 score of 3+?
IV Co-amoxiclav with clarithromycin
152
What would a raised urea indicate?
Insulin resistance, iron overload, hypertension, hypothyroidism, chronic kidney disease, obesity, diet, thiazides, loop diuretics, pneumonia, and alcohol
153
What is the urea limit for CURB65?
7 or over
154
What is the resp rate limit for CURB65?
30 or over
155
What is the blood pressure limit for CURB65?
Systolic under 90, or diastolic under 60
156
What are the sepsis 6?
blood cultures, check full blood count and lactate, IV fluid challenge, IV antibiotics, monitor urine output and give oxygen if needed
157
What CURB65 score needs to be admitted to hospital?
2 or above
158
How would you treat legionella?
Fluoroquinolone with clarithromycin
159
What is bronchitis typically caused by?
Viruses such as rhinovirus, adenovirus, influenza A and B
160
What is the commonest cause of urti?
Viruses (rhinovirus)
161
What is the commenest cause of flu?
Influenza A
162
What is the commonest cause of pharyngitis?
Viral- rhinovirus, EBV
163
What does a thick greyish membrane on the tonsils indicate?
Diphtheria
164
What is the centor criteria?
Indicator for whether a sore throat is due to bacterial infection
165
What does a thumb sign on X ray indicate?
Epiglottitis
166
What bacteria causes whooping cough?
Bordetella pertussis
167
What is a green throat swab for?
Viral infection
168
How is TB treated?
RIPE
| Rifampicin for 6 months, Isoniazid for 6 months, Pyrazinamide for 2 months, ethambutol for 2 months
169
How is TB spread?
Spread in aerosol droplets
| M Bovis is spread enterally (through cows milk)
170
What is latent TB?
When there is no clinical disease. There may be tiny granulomata that become calcified- primary infection is contained but CMI persists
171
How is latent TB diagnosed?
Tuberculin skin test "Mantoux" or IGRAs
172
What percentage of people with TB will develop clinically evident pulmonary disease?
2-5%
173
What disease is a primary ghon focus assocaited with?
TB
174
What are the side effects of rifampicin?
Red urine, hepatitis, drug interactions
175
What are the side effects of isoniazid?
Hepatitis, neuropathy
176
What are the side effects of Pyrazinamide?
Hepatitis arthralgia/ gout, rash
177
What are the side effects of ethambutol?
Optic neuritis (blurred vision)
178
How is latent TB treated?
6 months of isoniazid, or 3 months of rifampicin+isoniazid
179
What is classified as mild COPD?
FEV1 >80%
180
What would a barrel shaped chest indicate?
COPD
181
What is a MRC dyspnoea score of 1 indicate?
SOB on marked exertion
182
What does a MRC dyspnoea score of 2 indicate?
SOB on hills
183
What does a MRC dyspnoea score of 3 indicate?
Slow or stop on flat
184
What does a MRC dyspnoea score of 4 indicate?
Exercise intolerance 100-200 yards on flat (have to stop to catch breath)
185
What does a MRC dyspnoea score of 5 indicate?
Housebound/ SOB on minor tasks (getting dressed)
186
What is the best method for reducing COPD progression?
Smoking cessation
187
What is the first line pharmacological treatment of COPD?
SABA (Salbutamol)
188
What is the second line pharmacological treatment of COPD?
SABA+ LABA
189
What would a broncheoalveolar lavage with increased lymphocytes be indicative of?
Hypersensitivity pneumonitis
