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Medicine > Respiratory đŸ« > Flashcards

Respiratory đŸ« Flashcards

1
Q

What is Samter’s Triad?

A

Asthma
Aspirin sensitivity
Nasal polyps

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2
Q

Causes of upper lobe fibrosis

A 
CHARTS
C- Coal miner’s pneumoconiosis
H- Histocytosis / Hypersensitivity pneumonia
A- Ankylosing spondylitis 
R- Radiation
T- TB
S- Silicosis / Sarcoidosis
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3
Q

What abx combination do you use for TB?

A

RIPE

Rifampicin
Isoniazid
Pyrazinamide (this is just vit B6, give as Isonazid is B6 inhibitor)
Ethambutol

If active, give all for 2 months, then R + I for 4 months
If latent, give R + I for 2 months

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4
Q

What inhalers can give you oral thrush?

A

ICS

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5
Q

What is pleurodesis?

A

A procedure that adheres a lung to your chest wall using a sclerosing agent (like chalk) to prevent fluid or air from continually building up around lungs.

Used for recurrent pneumothoraces or pleural effusions

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6
Q

What is a bleb?

A

A bleb is a collection of air within the layers of visceral pleura.

*NOTE: in breasts it is a milk blister

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7
Q

What is a transudate?

A

An effusion containing <30g/L of protein.

Excess fluid production of low protein and low cell count

Occurs in non-inflammatory conditions

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8
Q

What causes transudative pleural effusions?

A

Increased venous pressure —> heart failure, fluid overload, constrictive pericarditis (push out into pleura)

Low oncotic pressure —> hypoproteinaemia, cirrhosis, nephrotic syndrome, malabsorption (can’t pull out of pleura)

Hypothyroidism

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9
Q

What is Meig’s syndrome?

A

The triad of:

  1. Ovarian benign tumours causing
  2. Pleural effusion +
  3. Ascites

Occurs when the thoracic duct is disrupted and chyle accumulates in the pleural space.
Can be due to trauma or tumours (Chylothorax)

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10
Q

What are exudative effusions?

A

Effusions containing >30g of protein

EXudate —> EXcess protein

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11
Q

What causes exudative pleural effusion?

A

Reduced removal of fluid from lymphatic system due to infection/lymphoma

Increased leakiness of pleural capillaries 2* to infection, inflammation or malignancy

Also: pneumonia, TB, SLE, RA, carcinoma or mets

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12
Q

What is the Px of pleural effusion?

A
  • SOB
  • Pleuritic chest pain
  • Reduced O2
  • Cyanotic
  • Reduced air sounds
  • Stony dull percussion
  • Reduced tactile / vocal fremitus
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13
Q

What is the max vol of pulmonary oedema you can remove via pleural tap at once?

A

2L

Due to risk of re-expansion pulmonary oedema if greater vols

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14
Q

What is re-expansion pulmonary oedema?

A

An uncommon complication of drainage of a pneumothorax or pleural effusion.

Px: cough, chest discomfort, hypoxaemia. If severe, shock + death.

Usually within 24hrs of thoracentesis

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15
Q

What is a chylothorax?

A

Occurs when the thoracic duct is disrupted and chyle accumulates in the pleural space due to trauma in the thoracic duct, tumours or TB

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16
Q

Pulmonary oedema Px?

A

Dyspnoea
Haemoptysis
Bibasal crackles and S3 heart sound

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17
Q

TB Px?

A 
Feer
Night sweats
Anorexia
Weight loss
Haemoptysis
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18
Q

What cause of haemoptysis is strongly associated with an acute history of purulent cough?

A

Lower respiratory tract infection

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19
Q

What type of coughs seen in Bronchiectasis?

A

Long history of cough and daily purulent sputum production.

May also have haemoptysis.

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20
Q

Px of Aspergilloma (clump of fungus in pre-existing lung cavity - caused by Aspergillus fungi)?

A

PMH of TB, lung cancer or CF
Cough
Severe haemoptysis
Chest XR shows rounded opacity

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21
Q

Px of Granulomatosis with polyangiitis?

A
  • Upper resp tract: epistaxis, sinusitis, nasal crusting
  • Lower resp tract: dyspnoea + haemoptysis
  • Glomerulonephritis
  • Saddle-shape nose deformity
  • Also: vasculitic rash, eye involvement, CN lesions
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22
Q

Goodpastures Px:

A
  • Haemoptysis
  • Systemically unwell: fever, nausea
  • Glomerulonephritis
23
Q

If a pt with COPD is breathless on SABA/SAMA + LABA = ICS, what do you do?

A

Add a LAMA Eg Tiotropium.

24
Q

What type of drug is Formoterol

A

LABA

25
Q

What type of drug is Beclamethasone?

A

ICS

26
Q

What do we prescribe as prophylaxis against chest infections in pts with COPD?

A

Oral Azithromycin

For its on optimum treatment but get frequent infective exacerbations.

27
Q

When do we give theophylline in COPD pts?

A

Uncontrolled COPD - only if cannot tolerate inhaled therapy

28
Q

What is the routine drug management in COPD pts with asthmatic features?

A

LABA + ICS regularly

SABA or SAMA prn

29
Q

What is the routine drug management in COPD pts w/o asthmatic features?

A

SABA prn

LABA + LAMA regularly

30
Q

What is the FEV1/FVC of a normal lung?

A

70-80%

31
Q

In what conditions do you see a raisedFEV1/FVC?

A
  • Pulmonary fibrosis

- Pulmonary oedema

32
Q

Why do you see a raised total gas transfer (TLCO) in asthma or a left-to-right cardiac shunt?

A

The problem is not affecting the alveoli directly or gas exchange and so the lungs try to compensate for the problem by improving gas exchange

33
Q

What are the causes of a raised TLCO (total gas transfer)in pulmonary function tests?

A
  • Asthma
  • Pulmonary haemorrhage (Wegener’s, Goodpasture’s)
  • Left-to-right cardiac shunts
  • Polycythaemia
  • Hyperkinetic states
  • Male + exercise
34
Q

What are the causes of a low TLCO (total gas transfer)in pulmonary function tests?

A
  • Pulmonary fibrosis
  • Pneumonia
  • Pulmonary embolism
  • Pulmonary oedema
  • Emphysema
  • Anaemia
  • low CO
35
Q

What is Granulomatosis with polyangiitis (Wegener’s granulomatosis)?

A

An autoimmune condition assoc. with necrotising granulomatous vasculitis, affecting upper + lower resp tracts + kidneys.

36
Q

Granulomatosis with polyangiitis (Wegener’s granulomatosis) Ix results?

A
  • cANCA +ve
  • CXR: caveatting lesions
  • Renal biopsy: epithelial crescents in Bowman’s
37
Q

Granulomatosis with polyangiitis (Wegener’s granulomatosis) Rx?

A
  • Steroids
  • Cyclophosphamide
  • Plasma exchange
38
Q

What is Bronchiectasis?

A

Bronchiectasis is a permanent dilation of the airways secondary to chronic infection or inflammation.

39
Q

What are the causes of Bronchiectasis?

A
  • Post-infectie: TB, measles, pertussis, pneumonia
  • Cystic fibrosis
  • Bronchial obstruction Eg lung ca
  • IgA immunodeficiency
  • Hypogammaglobulinaemia
  • Allergic bronchopulmonary aspergillosis (ABPA)
  • Yellow nail syndrome
  • Young’s syndrome
  • Kartagener’s syndrome
40
Q

What is the management of Bronchiectasis?

A
  • Inspiratory muscle training
  • Postural drainage
  • Abx for exacerbations
  • Surgery in localised dx
41
Q

Common infection causative organisms in pts wit Bronchiectasis?

A
  • H. Inflenzae (most common)
  • Pseudomonas aeruginosa
  • Klebsiella spp- Streptococcus pneumoniae
42
Q

What is Kartagener’s syndrome?

A

AKA Primary Ciliary Dyskinesia.
Immotile cilia.
Associated with dextrocardia (often described in Qs as ‘quiet heart sounds’ and ‘small volume complexes in lateral leads’)

43
Q

What are the features of Kartagener’s syndrome?

A
  • Dextrocaria or complete situs inversus
  • Bronchiectasis
  • Recurrent sinusitis
  • Subfertility (2* traduced spermmotility + defective ciliary action in Fallopian tubes)
44
Q

What is Allergic Bronchopulmonary Aspergillosis?

A

Results from an allergy to Aspergillus spores.

Often have history of Bronchiectasis and eosinophilia.

45
Q

Rx of Allergic Bronchopulmonary Aspergillosis?

A

Oral glucocorticoids

Itraconazole is 2nd line

46
Q

What is Whooping cough (pertussis)?

A

Pertussis is an infectious dx caused by the Gram -ve bacterium Boretella pertussis.

Typically presents in kids.

47
Q

When are children vaccinated against Whooping cough (pertussis)?

A

2,3,4 months and 3-5yrs

48
Q

What is the diagnostic criteria for Whooping cough (pertussis)?

A

If a pt has an acute cough for over 14 days w/o apparent cause + 1 or more of the following:

  • Paroxysmal cough
  • Inspiratory whoop
  • Post-tussive (post-cough) vomiting
  • Undiagnosed apnoea attacks in young infants
49
Q

Management of Whooping cough (pertussis)?

A
  • Admit if <6months old
  • Oralmacrolide (Eg Clarithromycin) if onset within 21 days
  • Household given prophylactic abx
50
Q

Complications of Whooping cough (pertussis)?

A
  • Subconjunctial haemorrhage
  • Pneumonia
  • Bronchiectasis
  • Seizures
51
Q

What are the pulmonary function test results in obstructive lung dx?

A

FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced

52
Q

What are the pulmonary function test results in restrictive lung dx?

A

FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased

53
Q

What are the most common bacterial organisms that cause infective exacerbations of COPD?

A
  • H.Influenzae (most common)
  • Streptococcus pneumoniae
  • Moraxella catarrhalis
54
Q

What abx do you give in infectious exacerbations of COPD?

A

Amoxicillin or Clarithromycin or Doxycycline

*NOTE: only give if purulent sputum orclinical signs of pneumonia

Medicine (16 decks)

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