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5th Year > Respiratory Stuff > Flashcards

Respiratory Stuff Flashcards

(104 cards)

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1
Q

What are the 5 causes of a widened mediastinum on CXR?

A 
Lymphoma
Retrosternal goitre
Thoracic aortic aneurysm
Teratoma
Thymus tumour
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2
Q

What should you do if you see a widened mediastinum on CXR?

A

Get a CT

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3
Q

What spirometry will idiopathic pulmonary fibrosis show?

A

Restrictive lung disease

Reduced Transfer Factor Coefficient

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4
Q

What is the management of sleep apnoea?

A

Weight loss

CPAP

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5
Q

How is CURB-65 calculated?

A 
Confusion - AMTS<8
Urea >7
RR >30
BP <90/60
Age >65yrs
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6
Q

Which antibiotics correspond with which CURB-65 scores?

A 
0-1 = amoxicillin
2+ = amoxicillin + clarithromycin
3+ = hospital
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7
Q

What is the treatment sequence for asthma?

A 
SABA
ICS
LTRA
LABA
MART
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8
Q

What is the management of a secondary pneumothorax?

A 
>50yrs/>2cm = chest drain
1-2cm = aspirate
<1cm = admit with oxygen
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9
Q

Which cells are involved in SCLC?

A

APUD cells

Generally central

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10
Q

What are the 3 paraneoplastic syndromes of SCLC?

A

SIADH -> Hyponatraema
ACTH -> Cushing’s +/- hypokalaemia acidosis
LEMS -> muscle weakness

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11
Q

What are the features of Churg-Strauss syndrome?

APE MP

A 
Asthma
Polyps/paranasal sinusitis
Eosinophilia
Mononeuritis multiplex
pANCA +ve (60%)
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12
Q

Which asthma drugs may precipitate Churg-Strauss syndrome?

A

LTRAs

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13
Q

What is the new name for Churg-Strauss syndrome?

A

Eosinophilic granulomatosis with polyangiitis

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14
Q

Which organism is associated with red-currant jelly sputum?

A

Klebsiella

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15
Q

Who gets klebsiella pneumonia?

A

Alcoholics
Those at risk of aspiration
Immunocompromised

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16
Q

What structural lung features is klebsiella associated with?

A

Cavitation
Empyema
Pleural adhesions

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17
Q

What is the death rate of kelbsiella pneumonia?

A

50% with Abx

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18
Q

What two investigations should an adult with suspects asthma receive?

A

FeNO test

Spirometry with reversibility

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19
Q

What are the centor criteria?

A 
Tonsilar exudate
Anterior LNs
Fever
Absence of a cough
3+ = Abx
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20
Q

What is a pancoast tumour?

A

Lung tumour in the left apex

May compress recurrent laryngeal N -> hoarse voice

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21
Q

What is the most likely diagnosis if someone has calcified granulomas on CXR and a travel history?

A

TB

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22
Q

If you suspect lung cancer on a CXR, what imaging should you order?

A

Contrast-enhanced CT chest, liver and adrenals

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23
Q

What are the hallmarks of alpha-1-antitrypsin deficiency?

A

Basal lobe emphysema in young age
Early lung dysfunction and bronchitis
Also causes liver cirrhosis

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24
Q

What is the management of alpha-1-antitrypsin deficiency?

A

Alpha-1-antitrypsin concentrates

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25
What is the next step in management for COPD after SABA?
LABA and LAMA
26
Someone is ventilated, acutely unwell and apyrexial: what is the diagnosis?
Aspiration
27
What CXR features are seen with aspiration?
Patchy consolidation of Right base
28
What are the FEV1 cut-offs for COPD severity?
``` >0.8 = mild 0.5-0.8 = moderate 0.3-0.5 = severe <0.3 = very severe ```
29
What 2 things must be required for COPD diagnosis?
1. Spirometry showing FEV1/FVC <0.7 | 2. COPD symptoms
30
What are the causes of upper zone fibrosis? | CHARTS
``` Coal Histiocytosis Ankylosing spondylitis/aspergillosis Radiation TB Silicosis/sarcodiosis ```
31
What are the borders of the chest drain triangle?
Latissimus dorsi Pec. major Line superior to nipple
32
What are the contraindications for lung cancer surgery? (6)
``` SVC obstruction FEV1 <1.5 (<2.0 for pneumonectomy) Malignant pleural effusion Vocal cord paralysis Hilar tumour Mets ```
33
What the causes of a 'white out' with the trachea TOWARDS the affected side?
Pneumonectomy Endobronchial intubation Pulmonary hypoplasia
34
What the causes of a 'white out' with the trachea CENTRAL?
Consolidation Pulmonary oedema Mesothelioma
35
What the causes of a 'white out' with the trachea AWAY FROM the affected side?
Pleural effusion Diaphragmatic hernia Large thoracic mass
36
What are the features of idiopathic pulmonary fibrosis?
50-70yr old male Exertional dyspnoea Clubbing Restrictive spirometry
37
What does idiopathic pulmonary fibrosis appear as on CXR?
Ground-glass appearance with irregular peripheral opacities Progresses to honey-combing\ Requires CT for diagnosis
38
What is the average life expectancy of someone diagnosed with idiopathic pulmonary fibrosis?
3-4yrs
39
What is the management of idiopathic pulmonary fibrosis?
Pulmonary rehab Oxygen Lung transplant
40
What are the transudate criteria, according to Light's criteria?
Fluid/serum protein <0.5 | Fluid/serum LDH <0.6
41
What are the features of an exudate?
``` Cloudy Protein >3g/100ml pH <7.2 Glucose >40 LDH >200 Cells >1000/mm3 ```
42
What are the causes of an exudate? (6)
``` Infection/penumonia Malignancy PE Pancreatitis Dressler's syndrome Yellow nail syndrome ```
43
What are the causes of a transudate? (4)
Heart failure Hypoalbuminaemia eg. liver disease/nephrotic syndrome Hypothyroidism Meig's syndrome
44
What are the criteria for receiving LTOT?
1. pO2 <7.3 on 2 ABGs 2. pO2 7.3-8.0 on 1 ABG with one of: - Secondary polycythaemia - Nocturnal hyperaemia - Peripheral oedema - Pulmonary hypertension
45
What is PCD/Kartagener's?
Defective dynein arm -> immotile cilia
46
What are the 4 features of PCD? DR BS
Dextrocardia Recurrent sinusitis Bronchiectasis Subfertility
47
How do you distinguish between exudate and transudate?
Exudate = >30g/L protein Transudate = <30g/L protein If 25-35g/L protein, use Light's criteria
48
What is lupus pernio?
Raised purple indurated plaques on nose Not itchy or painful Indicative of sarcoidosis
49
When do you give steroids following an asthma exacerbation?
ALL asthma exacerbations | 40-50mg 5-7 days
50
What are the 3 sarcoid syndromes?
Lofgren's syndrome Mikulicz syndrome (outdated) Heerfardt's syndrome (uveoparotid syndrome)
51
What are the features of Lofgren's syndrome? (4)
``` Bilateral hilar lymphadenopathy Erythema nodosum Fever Polyarthralgia Good prognosis ```
52
What is Mikulicz syndrome?
Large parotid and lacrimal glands | Due to sarcoid, TB or lymphoma
53
What are the features of Heerfardt's syndrome? (3)
Parotid enlargement Fever Uveitis
54
What is varenicline?
Partial nicotinic receptor agonist Causes dopamine release Used in smoking cessation but never in combo with other smoking cessation drugs Only effective for 3-4wks
55
How is varenicline used?
Start 1 week before stop target Continue for 12 week course More effective than bupropion
56
What is bupropion?
Noradrenaline and dopamine reuptake inhibitor and nicotinic antagonist
57
What is the FeNO cut-off for asthma?
>40ppb
58
What is the post-bronchodilator improvement cut-off for asthma?
>12% | >200ml
59
What is the PEFR variability cut-off for asthma?
>20%
60
What is the most common organism in COPD exacerbations?
H. influenzae
61
What are the features of empyema on aspiration?
pH <7.2 Low glucose Increased LDH
62
Which enzyme may be raised in sarcoidosis?
ACE | Angiotensin Converting Enzyme
63
What is the long-term management of sarcoidosis?
Stage 0-1 = no treatment Stage 2-4 = 12-24m steroids (20-40mg pred) Chronic = steroid sparing agents eg. MXT
64
What is the management of refractory sarcoidosis?
Infliximab 3-5mg/kg | At 0, 1 and 2 weeks, then at 1m, then monthly forever
65
What investigation is diagnostic of sleep apnoea?
Polysomnography
66
What is Wernicke's triad?
Ophthalmoplegia Ataxia Confusion
67
What may be heard on auscultation of someone with idiopathic pulmonary fibrosis?
Fine end-inspiratory crepitations | At bases
68
What kind of fibrosis is amiodarone associated with?
Lower zone fibrosis
69
What is the most common lung cancer in non-smokers?
Adenocarcinoma
70
What non-pulmonary features are lung adenocarcinomas associated with?
Gynaecomastia | Hypertophic pulmonary osteoarthritis
71
What is the management of a primary pneumothorax?
<2cm and NOT breathless = discharge | >2cm or breathless = aspirate (CD if fail)
72
What is the management of a secondary pneumothorax?
>50yrs, >2cm or breathless = chest drain 1-2cm = aspirate <1cm = admit for 24hrs
73
Which protein accumulates in hepatocytes alpha-1-antitrypsin deficiency?
Mutant protein Z
74
What is the name for a calcified granuloma containing TB?
Ghon complex
75
What are some features of emphysematous bullae?
Can mimic a pneumothorax for chest drain provides no relief
76
What are pneumatoceles?
Similar to emphysematous bullae but with thin wall | Generally due to ventilator-associated injury
77
What is ARDS?
Acute onset of breathlessness with bilateral pulmonary oedema and low sats despite high O2 NOT cariogenic in origin
78
What increases the total gas transfer (TLCO)?
Asthma and L->R shunts These don't affect alveoli so lungs compensate for hypoxia by increasing gas transfer Also pulmonary haemorrhage, polycythaemia and exercise
79
What is the most common causative organism of pneumonia?
Strep pneumoniae
80
What is the most common causative organism of IECOPD?
H. influenzae | Doesn't show CXR consolidation
81
What is the management of H. influenzae IECOPD?
Amoxicillin + Tetracycline + Pred
82
What organism is associated with bird owners?
C. psittaci
83
How should someone administer a puff of salbutamol?
Hold each for puff for 10 seconds | Wait minimum 30 seconds between puffs
84
What are the 3 indications for steroids in sarcoidosis?
Stage 2/3 with symptoms Hypercalcaemia Eye/heart/neuro involvement
85
Who is at risk of klebsiella pneumonia?
Alcoholics Diabetics Anyone at risk of aspiration
86
Where in the lungs does klebsiella pneumonia usually occur?
Upper lobes
87
What are the 3 common causes of post-operative SoB?
Atelectasis - resonant to percuss Pneumonia PE
88
What is the management of post-op atelectasis?
Deep breathing and chest physio
89
What causes reduced TLCO?
Restrictive conditions and COPD
90
What is Kartagener's syndrome?
Primary Ciliary Dyskinesia
91
What are the features of PCD?
``` Dextrocardia Recurrent sinusitis Bronchiectasis Subfertility (R testicle hangs lower than L) ```
92
Name a contraindication for bupropion
Epilepsy
93
When should you consider stepping down Tx for asthma?
If patient not used salbutamol at all in last 12m | Half ICS dose and review in 6m
94
What is the gold standard investigation for mesothelioma?
Thoracoscopy and histology
95
What vaccinations should COPD patients receive?
Annual influenza | One-off pneumococcal
96
What are pleural plaques?
Benign plaques with no malignant potential Generally due to asbestos exposure Often have 20-40yr lag period
97
What surgical procedure may be used in the management of alpha-1-antitrypsin deficiency?
Lung volum reduction surgery | Removes worst areas of lung to direct air to areas with better exchange
98
What is the management of HACE? | High-altitude cerebral oedema
``` Tx = Dexamethasone Prevention = Acetazolamide ```
99
What does the loss of L heart border on CXR indicate?
Lingula consolidation | No L middle lobe
100
What is an indication for surgery in bronchiectasis?
Confined to single lobe on CT
101
What scoring system is used to identify sleep apnoea?
Epworth sleepiness scale
102
How do you know a chest drain is correctly placed?
Water seal rises with inspiration and falls with expiration
103
How does an aspergilloma appear on CXR?
Rounded opacity surrounded by air rim | Often have TB PMHx
104
When aspirating pleural fluid, what is the main criteria for placing a chest drain?
pH <7.2 indicates bacterial infection -> chest drain inserted

5th Year (8 decks)

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