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4th year MLA Flashcards > Respiratory Harder Notes > Flashcards

Respiratory Harder Notes Flashcards

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1
Q

‘tram line shadowing’ is associated with what respiratory condition?

A

bronchiectasis

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2
Q

‘Miliary shadowing’ is associated with?

A

TB

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3
Q

What atypical pneumonia is associated with ‘birds/parrots’

A

chlamydia pstacci

p-parrot

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4
Q

What atypical pneumonia is associated with ‘sheep and cattle?’

A

Q fever

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5
Q

What type of hypersensitivity is ‘hypersensitivity pneumoniae’

A

Type 3

(*avian proteins/bird fanciers lung)

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6
Q

What type of hypersensitivity is TB and Sarcoidosis?

A

Type 4

(S and T end of alphabet)

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7
Q

What is the diagnostic investigation for Goodpastures Syndrome

A

diagnostic- serum antibodies - Anti-GBM

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8
Q

What is the management of Goodpastures Syndrome?

A

1st line- plasmapheresis

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9
Q

‘canon ball metastases’ is associated with?

A

metastatic lung cancer

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10
Q

‘blunting of the costraphrenic angle’ is associated with?

A

pleural effusion

-also meniscus, tracheal deviation

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11
Q

Slow to resolve pneumonia may be associated with?

A

Empyema

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12
Q

What is the management of Empyema?

A

1st line- amoxicillin + metronidazole

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13
Q

Frank haematuria + haemoptysis =

A

Goodpastures Syndrome

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14
Q

What is the management of Latent TB?

(include no.months)

A

Option1
Rifampicin + isoniazid- 3 months

Option 2:
isoniazid - 6 months

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15
Q

What is the management of active TB?

A

RIPE then RI - 2 and 6

1st line- RIPE (2 months) then rifampicin and izoniazid (6 months)

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16
Q

What is the management of a recurrent pneumothorax?

A

1st line- video assisted thoraco-scopic surgery

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17
Q

marfans syndrome increased risk of what lung condition?

A

pneumothorax

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18
Q

What is the management of Pneumothorax?
a) asymptomatic
b) symptomatic
low risk
high risk

A

Asymptomatic:
observe and watch

Symptomatic:
low risk- FNA (5th intercostal space mid axillary line- triangle of safety)

high risk:
chest drain

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19
Q

What is the management of a pleural effusion?
a) conservative
b) interventional
c) rapidly occurring

A

Conservative:
analgesia and supportive

Interventional:
symptomatic relief- US guided pleural effusion
larger effusion- chest drain

Rapidly Occuring :
Recurrent aspiration
Pleurodesis

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20
Q

What is the management of rapidly occurring pleural effusions?

A

Rapidly Occuring :
Recurrent aspiration
Pleurodesis

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21
Q

What are blood abnormalities in lung cancer

A

hypercalcemia

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22
Q

What feature in sarcoidosis indicates oral prednisone treatment?

A

hypercalcemia

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23
Q

What are the CXR features in sarcoidosis?

A

-pulmonary infiltrates
-non caveating granulomas

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24
Q

What is the 1st line and diagnostic investigation in mesothelioma?

A

1st line- CXR
diagnostic- CT of pleura

(*pleural damage very common in mesothelioma)

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25
What is an extra-pulmonary feature of bronchiectasis?
finger clubbing
26
What is the definitive diagnostic investigation in pulmonary fibrosis?
diagnostic- High resolution CT
27
What is the main investigation for occupational asthma?
1st line- peak flow measurements at home and work
28
What are features of Acute Respiratory Depression?
-low O2 sats -recent infection -bilateral pulmonary crepitations
29
What is reduced more in obstructive spirometry: FEV1 or FVC?
FEV1 is reduced more- think longer word more to lose
30
What is the management of acute bronchitis?
1st line- conservative Co-Morbidities present (e.g COPD) 1st line- oral doxycycline
31
What is the target Oxygen saturation for COPD patients?
88%–92%
32
What feature in an asthma attack indicates an ABG should be carried out?
O2 sats <92%
33
What is the 1st and 2nd line investigation of Pleural Effusion?
1st line- CXR 2nd line- pleural aspiration guided by US
34
What investigation follows CXR in suspected pleural effusion? b) what is it guided by?
2nd line- pleural aspiration guided by US
35
protein/serum protein ratio mean for transudative and exudative effusions?
<0.5 - transudative >0.5, the effusion is an exudate This is different to protein G <30G- transudative >30- exudative
36
37
What are indications for long term oxygen therapy in a patient with COPD?
very severe airflow obstruction (FEV1 < 30% predicted). Assessment should be 'considered' for patients with severe airflow obstruction (FEV1 30-49% predicted) cyanosis polycythaemia peripheral oedema raised jugular venous pressure oxygen saturations less than or equal to 92% on room air
38
Management for symptomatic pneumothorax is: 1st line- FNA 2nd line- chest drain When is a chest drain preferred over FNA?
Assess for high risk characteristics: haemodynamic compromise (suggesting a tension pneumothorax) significant hypoxia bilateral pneumothorax underlying lung disease ≥ 50 years of age with significant smoking history haemothorax
39
What respiratory conditions cause: -Upper zone fibrosis? -Lower zone fibrosis?
Upper Zone Fibrosis: -sarcoidosis -silicosis -TB Lower Zone fibrosis: -RA -Idoipathic pulmonary fibrosis -mesothelioma/asbestosis -drugs and radiation
40
What is the management of Kidney Stones?
watchful waiting if < 5mm and asymptomatic 5-10mm shockwave lithotripsy 10-20 mm shockwave lithotripsy OR ureteroscopy > 20 mm percutaneous nephrolithotomy
41
What is the management of Gallstones?
laparoscopic cholecystectomy (*same management as acute cholecystitis - this is elective laporocopic cholecystectomy within 1 week according to NICE guidelines)
42
What are Interstitial Lung Diseases?
These are conditions characterised by inflammation and fibrosis of the lung parenchyma. Fibrosis involves replacement of the lung elastic tissue to the non functional fibrotic tissue
43
What are x3 typical symptoms of suspected ILDs?
Dry cough Fatigue SOB
44
What is the investigation for Idiopathic Pulmonary Fibrosis? a) 1st line investigation b) diagnostic investigation
1st- CXR diagnostic- high resolution CT scan (ground glass appearance)
45
What is hypersensitivity pneumonitis?
This is type 3 hypersensitivity where environmental allergens (proteins or antigens) causes inflammation of the lungs.
46
Name X3 examples of hypersensitivity pneumonitis?
-bird fanciers lung- avian proteins trigger -farmers lung- Saccharopolyspora rectivirgula from wet hay -malts workers- aspergillum -mushroom workers lungs- reaction to barley
47
What protein or antigen is an environmental trigger for these sub types of hypersensitivity pneumonitis? -bird fanciers lung -farmers lung -malt worker -mushroom worker
-bird fanciers lung- avian proteins trigger -farmers lung- Saccharopolyspora rectivirgula from wet hay -malts workers- aspergillum -mushroom workers lungs- reaction to barley
48
What type of hypersensitivity reaction is hypersensitivity pnuemonitis?
type 3 hypersensitivity
49
What is the diagnostic investigation for hypersensitivity pneumonitis and associated findings?
diagnostic - bronchoalveolar lavage- elevated lymphocytes
50
What is Cryptogenic Organising Pneumonia?
This is a focal area of lung tissue inflammation, type of ILD
51
Cryptogenic Organising Pneumonia: a) What is the 1st line investigation b) What is the diagnostic investigation?
a) CXR b) lung biopsy
52
What is coal minors lung disease also known as?
-coal minors pnuemocosis -black lung disease
53
Where is fibrosis on a CXR for coal minors pneumonocosis
upper lung fibrosis
54
What is Coal minors pneumoconiosis?
Coal worker's pneumoconiosis*, sometimes referred to as 'black lung disease', is an occupational lung disease caused by long term exposure to coal dust particles. I
55
What is the management of coal minors pneumoconiosis?
Management: Avoid exposure to coal dust and other respiratory irritants (e.g. Smoking).
56
What is Pneumoconiosis?
Pneumoconiosis = accumulation of dust in the lungs and the response of the bodily tissue to its presence, most commonly used in relation to coal worker's pneumoconiosis.
57
What does 'honeycombing' on a high resolution CT scan indicate?
very late stage- idiopathic pulmonary fibrosis
58
Name types of ILDs (interstitial lung diseases)
-mesothelioma/asbestosis -hypersensitivity pneumonitis- birds fanciers lung, mushroom workers lung, malt worker -coal minor pneumonococisis -cryptogenic organising pneumonia (very rare)
59
What is the mnemonic used to name all conditions which causes upper lobe fibrosis on CXR?
CHARTS C - Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis
60
Give examples of a LABA?
folmeterol, salmetarolI
61
Give the most common example of a SAMA?
Ipratropium
62
What are the x2 criteria which must be met before you can discharge a patient after an asthma attack?
1. Must check inhaler technique 2. Must be stable for 24 hours, review in 2 days time
63
What is the gold standard diagnostic investigation for Idiopathic Pulmonary Fibrosis?
diagnostic- high resolution CT scan
64
What is the gold standard management of a tension pneumothorax? (*must know)
1st line- needle thoracotomy (triangle of safety- 5th intercostal space mid axillary line) -using wide bore cannula
65
What is the diagnostic investigation for pneumocystitis jiroveci? (*lung condition associated with HIV)
diagnostic- silver stain (*whereas cryptosporum brain- India stain)
66
What is the diagnostic investigation for sarcoidosis?
diagnostic- bronchoscopy + biopsy
67
What type of lung cancer is associated with a 'cavetating lesion'
squamous cell carcinoma
68
Pneumothorax presents with hypotension, what is your immediate thought?
-tension pneumothorax (has hypotension)
69
What are the 1st to 3rd line investigations in asthma
Asthma investigations: 1st line- FeNo or eosinophil count 2nd lne- spirometyr or bronchidilatory reversiblity testing (>10% indicates asthma) 3rd line- bronchial challenge test*
70
What is Acute Respiratory Distress Syndrome?
This is a syndrome caused by the increased permeability of alveolar capillaries leading to fluid accumulation. -high mortality
71
What are some common causes of Acute Respiratory Distress Syndrome?
-blood transfusion -infection acute pancreatitis
72
What are the x2 main features of Acute Respiratory Distress Syndrome?
-bilateral long crackles -sudden drop in oxygen saturations
73
What is the management of Acute Respiratory Distress Syndrome?
1st line- admit to ITU, ventilation for hypoxia
74
What are the paraneoplastic features associated with small cell carcinoma of the lung? (*important)
-SIADH -Lambert Eaten syndrome- P/Q antibodies produced against the calcium channel receptors- hypocalcemia -Ectopic Cushings Syndrome- excess ACTH
75
What are the paraneoplastic features associated with adenocarcinoma of the lung?
-gynaecomastia -hypertrophic pulmonary osteoarthropathy
76
What are the paraneoplastic features associated with squamous cell carcinoma?
-Parathyroid hormone- related peptide secretion hormone > hypercalcemia -clubbing --hypertrophic pulmonary osteoarthropathy
77
What is the management of a complicated pneumonia (ICU or HDU) admission?
Co-Amoxiclav 1.2g tds IV and Doxycycline 100mg bd orally
78
State the most common bacterial causes of meningitis in these following age groups: a) 0-3 months b) 3 months-6 years c) 6-60 years d) >60 e) alcoholics and immunosupressed
Most Common Bacterial Causes: 0 - 3 months - Group B *Streptococcus* (most common cause in neonates) - *E. coli* - *Listeria monocytogenes* 3 months - 6 years - *Neisseria meningitidis* - *Streptococcus pneumoniae* - *Haemophilus influenzae* 6 years - 60 years - *Neisseria meningitidis* - *Streptococcus pneumoniae* > 60 years - *Streptococcus pneumoniae* - *Neisseria meningitidis* - *Listeria monocytogenes* Immunosuppressed - *Listeria monocytogenes*- amoxicillin covers this organism
79

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