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Flashcards in Respiratory Medicine 1 Deck (55):
1

What is the FEV1/FVC ratio in obstructive lung disease?

Markedly reduced -

2

What are the features of an obstructive lung disease?

Poorly recoiling lung tissue (floppy) so quick to inflate but poor deflation
So TLC is normal or high but FVC is reduced and FEV1 is markedly reduced

3

What defines severity in obstructive lung disease spirometry?

FEV1 % of expected
0.8-0.5 = mild
0.3-0.5 = moderate

4

3 examples of obstructive lung disease?

COPD, asthma, Bronchiectasis

5

What is a restrictive lung disease?

'Stiff' lungs which are difficult to inflate but quick to deflate
FVC and FEV1 are both reduced

6

What happens to the FEV1/FVC ratio in restrictive lung disease?

Often unaffected

7

2 examples of restrictive lung disease?

Pulmonary fibrosis
Sarcoidosis

8

What is the pathophysiological background of bronchiectasis?

Irreversible dilatation of the bronchi with wall thickening
Increased mucus production, poor trachebronchial clearance and resultant chronic airway infection

9

What sort of things can predispose to bronchiectasis? (4)

Severe childhood asthma
TB
Pertussis
Measles

10

Chronic congenital condition linked with Bronchiectasis?

Cystic fibrosis

11

Enzyme deficiency often implicated in respiratory disease?

a1 antitrypsin deficiency

12

Immunodeficiency syndrome linked to bronchiectasis?

Hypogammaglobulinaemia

13

Describe the sputum associated with bronchiectasis?

Chronic sputum production in large amounts
May be purulent, often dark or green
May be bloodstained

14

2 upper airway conditions linked with bronchiectasis?

Nasal polyps
Chronic sinusitis

15

Management strategies for bronchiectasis?

Bronchodilators, O2, nutritional support
Chest physio - active cycle breathing
Long term azithromycin

16

What Abx can be given long term in bronchiectasis?

Azithromycin

17

Surgical management options for bronchiectasis?

Lung resection
Massive haemoptysis - bronchial artery embolization
Lung transplant

18

Abx for bronchiectasis (and generally infection) confirmed to be with pseudomonas aeruginosa?

Ciprofloxacin

19

Abx for general bronchiectasis management or those colonised with h. Influenzae?

Amoxicillin or clarithromycin

20

3 subtypes of bronchiectasis?

Cylindrical (commonest)
Varicose
Cystic - worst, associated with CF

21

What underlying condition should be considered in bronchiectasis patient with no identifiable pre-infection and/or unusual colonisations?

Immunocompromise/HIV

22

CAPT Kangaroo has Mounier Kuhn of bronchiectasis causes?

Congenital - CF, connective tissue disorders,
Allergic bronchopulmonary aspergillosis
Post-infection - Measles, pneumonia, RSV (bronch), pertussis, flu
TB and other granulomatous disease
Kartagener's disease (PCD)
Mounier-Kuhn syndrome (tracheobronchomegaly)

23

What is Williams-Campbell syndrome?

Bronchial cartilage deficiency -> congenital cystic bronchiectasis
Deficiency typically from 4th-6th order bronchial cartilage

24

Common findings on auscultation for bronchiectasis?

Course early-inspiratory crackles
Large airway rhonchi (low pitched snore)
Wheeze

25

Gold standard Ix for diagnosing bronchiectasis?

HRCT

26

What is the definition of pneumonia?

Infection of the lung parenchyma with airway consolidation

27

What is the role of air bronchograms in pneumonia CXR?

If present, suggestive of a pneumonia type consolidation. If absent, indicates more likely a blockage or solid something restricting the airway (e.g. Tumour)

28

In addition to a high CURB65, what other clinical features may make you consider escalation of care in a pneumonia patient?

Hypoxaemia
Number of lobes involved
Comorbidities

29

What organ abnormality predisposes to pneumococcal pneumonia as well as other capsulated bacterial infection?

Asplenism

30

Lobar vs bronchopneumonia on CXR?

Lobar is consolidation confined to a lobe
Bronchopneumonia is often consolidation of lung bases

31

3 common bacterial causes of atypical pneumonia syndromes?

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila

32

What does coxiella burnettii cause?

Q fever

33

Apart from the 3 main bacterial causes what are some other causes of atypical pneumoniae?

Coxiella burnettii - Q fever
Viruses - adenovirus, influenza, RSV etc.

34

Main differentiating factors of mycoplasma pneumonia from pneumococcal pneumonia?

Non-productive, hacking cough
Systemic features - erythema multiforme etc.
Neurological features - Guillain-Barre, cerebellar ataxia
Haematological features - cold agglutinin disease -> haemolytic anaemia
GI features - diarrhoea, abdo pain etc.

35

Which is the most severe atypical pneumonia and what is outbreaks of it often associated with?

Legionella pneumophila
Air conditioning system failure or poor maintenance

36

Rx for atypical pneumonia?

Start on amoxicillin as per typical CAP
Can also use macrolides
Legionella may require Rifampicin

37

3 criteria for diagnosing pneumonia without CXR?

Cough and at least 1 other LRTI Sx or fever
New focal signs on chest exam
No other better explanation for illness

38

3 criteria for diagnosing pneumonia with CXR?

Cough and at least 1 other LRTI Sx or fever
New radiographic infiltrates
No better explanation for illness

39

What Ix are required to identify atypical pneumoniae?

Serology (paired sera - Ab and Ag)

40

Rx for CAP of unknown causative organism?

Amoxicillin and clarithromycin - covers pneumococcus as well as atypicals

41

Ix for pulmonary embolism?

WELLS score for probability.
Low risk -> D dimer (very sensitive but non-specific)
High risk -> V/Q scan and CTPA

42

What does a COPD rescue pack consist of?

Oral corticosteroids (7-14 days)
Antibiotics if sputum is purulent

43

First line management of COPD?

SABA or SAMA

44

What 2 inhaled drugs can't be taken together in COPD long term management?

SAMA and LAMA

45

Which type of lung cancer typically causes clubbing?

Non-small cell

46

If a lung cancer occurs in a non-smoker what type is it likely to be?

NSCLC - adenocarcinoma

47

What type of lung cancer typically presents with metastasis having already occurred?

Small cell

48

4 most common symptoms of lung cancer?

Chronic cough
Haemoptysis
SOB
CP

49

What constitutes a transudate?

Low protein content (

50

3 causes of a transudative pleural effusion?

Heart failure
Liver cirrhosis
Nephrotic syndrome

51

What constitutes an exudate?

High protein content (>30g/L)

52

3 causes of exudative pleural effusion?

Infection
Malignancy
Pulmonary embolism

53

3 places to send off pleural tap?

Chemistry (transudate vs exudate)
Cytology (cancer)
Microbiology (infection)

54

What type of pleural effusions need drainage?

exudates

55

Type of pneumonia which may persist for a while, proving difficult to treat with normal Abx?

Haemophilus