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NMF: Resp > Clinical handbook > Flashcards

Clinical handbook Flashcards

1
Q

How many lobes does the

a) left lung have?
b) right lung have?

A

a) two

b) three

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2
Q

What might frothy white pink sputum indicate?

A

pulmonary oedema

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3
Q

What is the most common bacterial pneumonia?

A

pneumococcal

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4
Q

Symptoms of pneumococcal pneumonia

A

fever
pleurisy
herpes labalis

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5
Q

treat pneumococcal pneumonia

A

amoxicillin

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6
Q

Which type of pneumonia is bilateral cavitating bronchopneumonia?

A

staphylococcal

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7
Q

Name some complications of pneumonia

A 
type 1 respiratory failure
hypotension
atrial fibrillation
pleural effusion 
empyema
lung abscess
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8
Q

clinical features of a lung abscess

A 
swinging fever
cough
smelly sputum
pleurisy
haemoptysis
malaise
finger clubbing
anaemia
crepitations
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9
Q

What is the most important distinction between types of bronchial carcinoma?

A

small cell and non-small cell

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10
Q

Which division of bronchial carcinoma is not resectable and has a poor prognosis?

A

small cell

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11
Q

How does bronchial carcinoma present?

A 
cough
haemoptysis
dyspnoea
chest pain
recurrent pneumonia
lethargy
weight loss
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12
Q

What are the signs of bronchical carcinoma?

A 
cachexia 
anaemia
clubbing
hypertrophic pulmonary osteoarthropathy --> wrist pain
supraclavicular or axillary nodes
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13
Q

What signs indicate mets in bronchial carcinoma?

A 
bone tenderness
hepatomegaly
confusion
fits
focal CNS signs
cerebellar signs
proximal myopathy
peripheral neuropathy
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14
Q

What is Horner’s syndrome?

A

when a pancoast tumour blocks the sympathetic chain causing

  • Small pupil
  • Ptosis (drooping eyelid)
  • Enophthalmos (sunken eyes)
  • Unilateral loss of sweating
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15
Q

What is Lambert-Eaten myasthenic syndrome?

A

caused by small cell lung cancer

presents with gait problems then eye symptoms

gait: hyporeflexia + weakness that improve after exercise

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16
Q

What sign of recurrent laryngeal nerve palsy can occur in lung cancer?

A

hoarse voice

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17
Q

Signs of bronchial carcinoma on CXR

A 
peripheral nodule
hilar enlargement
consolidation
lung collapse
pleural effusion
bone mets
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18
Q

treat peripheral non-small cell tumour with no mets

A

excision

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19
Q

treat bronchial obstruction

A

radiotherapy

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20
Q

What is the prognosis for non-small cell lung cancer?

A

50% survive 2 years if no spread

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21
Q

What is the prognosis for small cell lung cancer

a) with treatment?
b) without treatment?

A

a) 1-1.5 years

b) 3 months

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22
Q

Symptoms of asthma

A

intermittent dyspnoea
wheeze
cough
sputum

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23
Q

Signs of asthma

A 
tachypnoea
wheeze
hyperinflated chest
hyperresonant percussion
dec. air entry
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24
Q

Signs of a severe asthma attack

A

cannot finish sentence
pulse > 110bpm
resp rate>25bpm
low PEF (33-50% predicted)

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25
Q

What 3 factors contribute to airway narrowing in asthma?

A

bronchial muscle contraction
mucosal inflammation
increased mucus production

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26
Q

What causes mucosal inflammation in asthma?

A

mast cell and basophil degranulation cause inflammatory mediators to be released

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27
Q

Steps in asthma treatment

A
  1. SABA as req.
  2. SABA + low-dose ICS
  3. SABA + low-dose ICS + LRTA
  4. SABA + low-dose ICS + LABA (+/- LRTA if response)
  5. SABA + MART (ICS + LABA)
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28
Q

What is the most effective preventer drug for adults and older children with asthma?

A

inhaled corticosteroid

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29
Q

What do B2 adrenoceptor agonists do?

A

relax bronchial smooth muscle, increase cAMP

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30
Q

Give side effects of B2 adrenoceptor agonists

A

tachyarrythmia
hypokalaemia
tremor
anxiety

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31
Q

Give an example of

a) SABA
b) LABA
c) ICS
d) anticholinergic
e) leukotriene receptor antagonist

A

a) salbutamol
b) salmeterol
c) beclometasone
d) ipratropium
e) montelukast

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32
Q

What does theophylline do?

A

inhibits phosphodiesterase to increase cAMP and reduce bronchoconstriction

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33
Q

SE of theophylline

A

low therapeutic window so can be toxic
GI upset
arrythmia

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34
Q

Why are anticholinergics used in asthma?

A

decrease muscle spasm

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35
Q

What characterises COPD?

A

irreversible airway obstruction

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36
Q

What 2 parts does COPD have?

A

chronic bronchitis

emphysema

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37
Q

What is chronic bronchitis?

A

cough, sputum production onmost days for 3 months of 2 years

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38
Q

What is emphysema?

A

enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

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39
Q

Describe a pink puffer

A

increased alveolar ventilation
near normal PaO2
normal/low PaCO2
breathless but not cyanosed

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40
Q

What might a pink puffer progress to?

A

type 1 resp failure

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41
Q

Describe a blue bloater

A

decreased alveolar ventilation
low PaO2
high PaCO2
cyanosed but not breathless

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42
Q

What might a blue bloater progress to?

A

cor pulmonale

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43
Q

Symptoms of COPD

A

cough
sputum
dyspnoea
wheeze

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44
Q

Signs of COPD

A 
tachypnoea
accessory muscle use
hyperinflated
reduced cricosternal distance
reduced expansion
resonant or hyperresonant percussion
quiet breath sounds
cyanosis
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45
Q

Signs of COPD on CXR

A

hyperinflation
flat hemidiaphragm
large central pulmonary artery
decreased peripheral vascular markings

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46
Q

What might an ECG of someone with COPD show?

A

right atrial and ventricular hypertrophy –> cor pulmonale

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47
Q

What PaO2 level indicates respiratory failure?

A

less than 8kPa

48
Q

What differentiates between the two types of respiratory failure?

A

PaCO2 level

49
Q

What is the PaCO2 in type 1 respiratory failure?

A

normal or low

50
Q

What causes type 1 respiratory failure?

A

V/Q mismatvh

eg pnuemonia, pulmonary oedema, PE, asthma, emphysema, pulmonary fibrosis, ARDS

51
Q

What is the PaCO2 in type 2 respiratory failure?

A

high (>6 kPa)

52
Q

What causes type 2 respiratory failure?

A

alveolar hypoventilation

due to resp disease (asthma, COPD, fibrosis, obstructive sleep apnoea), reduced respiratory drive, neuromuscular disease, thoracic wall disease

53
Q

clinical features of hypoxia

A 
dyspnoea
restlessness
agitation
confusion
central cyanosis
54
Q

clinical features of hypercapnia

A 
headache
peripheral vasodilation
tachycardia
bounding pulse
tremor
papilloedema
confusion
drowsiness
coma
55
Q

In which type of resp failure does oxygen need to be given with care?

A

type 2

56
Q

Where do pulmonary embolisms usually arise from?

A

venous thrombosis in the pelvis or legs

57
Q

Symptoms of PE

A 
acute breathlessness
pleuritic chest pain
haemoptysis
dizziness
syncope
58
Q

Signs of PE

A 
pyrexia
cyanosis
tachypnoea
tachycardia
hypotension
raised JVP
pleural rub
pleural effusion
59
Q

In which patients should D-dimer test be carried out?

A

patient doesnt have high probability of PE

60
Q

Symptoms of pneumothorax

A

suddent onset dyspnoea and pleuritic chest pain

61
Q

Signs of pneumothorax

A

reduced expansion
hyperresonant
red breath sounds

62
Q

What sign shows a tension pneumothorax?

A

trachea deviates away from affected side

63
Q

Why might a spontaneous pneumothorax occur in a young, thin man?

A

rupture of subpleural bulla

64
Q

manage tension pneumothorax

A

insert large bore needle with syringe with 0.9% saline into 2nd intercostal space midclavicular line

65
Q

How can pleural effusions be divided?

A

by protein content
low = transudates
high = exudates

66
Q

What can cause a transudate pleural effusion?

A
  • increased venous pressure (cardiac failure, constrictive pericarditis, fluid overload)
  • hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption)
67
Q

What can cause an exudative pleural effusion?

A

increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy

68
Q

Signs of a pleural effusion

A

decreased expansion
stony dull percussion
diminished breath sounds

69
Q

What is sarcoidosis?

A

a multisystem granulomatoud disorder of unknown cause

70
Q

How does acute sarcoidosis present?

A

erythema nodosum +/- polyarthralgia

71
Q

What sign is seen on CXR in patients with sarcoidosis?

A

bilateral hilar lymphadenopathy

+/- infiltrates, fibrosis

72
Q

Give some pulmonary symptoms of sarcoidosis

A

dry cough
progressive dyspnoea
reduced exercise tolerance
chest pain

73
Q

Give some non-pulmonary signs of sarcoidosis

A

lymphadenopathy
hepatomegaly
splenomegaly
uveitis

74
Q

What does tissue biopsy of sarcoidosis show?

A

non-caseating granuloma

75
Q

How is sarcoidosis treated?

A

acute: rest + NSAIDs
mild: leave alone
mod: steroid therapy

76
Q

What is interstitial lung disease?

A

number of conditions characterised by chronic inflammation and/or progressive interstitial fibrosis of lung parenchyma

77
Q

give some clinical features of interstitial lung disease

A

dyspnoea on exertion
non-productive paroxysmal cough
abnormal breath sounds
restrictive spirometry

78
Q

give pathological features of interstitial lung disease

A

fibrosis
remodelling of interstitium
chronic inflammation
hyperplasia of type 2 pneumocytes

79
Q

How is interstitial lung disease categorised?

A
  1. known cause eg occupational
  2. part of systemic disease eg. sarcoidosis
  3. idiopathic
80
Q

What is extrinsic allergic alveolitis?

A

a type of interstitial lung disease caused by inhalation of allergens causes a hypersensitivity reaction

81
Q

What characterises
a) the acute stage
b) the chronic stage
of extrinsic allergic alveolitis?

A

a) infiltration of acute inflammatory cells

b) granulomas form and obliterative bronchiolitis occurs

82
Q

Give some causes of allergic alveolitis & the relevant name

A

bird dropping proteins –> bird fancier’s lung

aspergillus –> malt worker’s lung

fungal spores –> farmer’s lung

83
Q

Symptoms of acute extrinsic allergic alveolitis

A 
fever
rigors
myalgia
dry cough
dyspnoea
crackles
84
Q

Symptoms of chronic extrinsic allergic alveolitis

A 
increasing dyspnoea
weight loss
exertional dyspnoea
type 1 resp failure
cor pulmonale
85
Q

What blood cell characterises acute extrinsic allergic alveolitis

A

neutrophils

86
Q

manage acute extrinsic allergic alveolitis

A

remove cause
give o2
PO prednisolone

87
Q

What causes fibrotic shadowing on a CXR in the

a) upper lung?
b) mid lung?
c) lower lung?

A

a) TB, extrinsic allergicalveolitis, ank spond, radio
b) sarcoidosis
c) idiopathic pulmonary fibrosis, asbestosis

88
Q

What is the most common cause of interstitial lung disease?

A

idiopathic pulmonary fibrosis

89
Q

Symptoms of idiopathic pulmonary fibrosis

A 
dry cough
exertional dyspnoea
malaise
weight loss
arthralgia
90
Q

Signs of idiopathic pulmonary fibrosis

A

cyanosis
finger clubbing
fine-end inspiratory creps

91
Q

What does CXR show in idiopathic pulmonary fibrosis?

A 
dec lung volume
bilateral lower zone shadows 
honeycomb lung (advanced disease)
92
Q

In idiopathic pulmonary fibrosis is
a) increased lymphocytes
b) increased eosinophils
indicative of a good or poor prognosis?

A

a) good

b) poor

93
Q

What is the prognosis of idiopathic pulmonary fibrosis?

A

50% 5 year survival

94
Q

Describe coal worker’s pneumoconiosis

A

inhaled coal dust is ingested by macrophages which die and release their enzymes causing fibrosis

95
Q

What are the symptoms of coal worker’s pneumoconiosis?

A

asymptomatic

96
Q

What does coal worker’s pneumoconiosis progress to?

A

progressive massive fibrosis

97
Q

What characterises progressive massive fibrosis?

A

dyspnoea
fibrosis
cor pulmonale

98
Q

What can exposure to asbestos cause?

A

pleural plaques

risk of bronchial adenocarcinoma and mesothelioma

99
Q

Clinical features of mesothelioma

A 
chest pain
dyspnoea
weight loss
finger clubbing
recurrent pleural effusion
100
Q

What does mesothelioma look like on CXR?

A 
thickened pleura
pleural effusion (bloody)
101
Q

Manage mesothelioma

A

pemetrexed and cisplatin

102
Q

What is obstructive sleep apnoea?

A

intermittent closure/collapse of the pharyngeal airways during sleep

103
Q

Describe the typical sleep apnoea patient

A

obese middle aged man presenting with snoring or daytime somnolence

104
Q

What are the complications of sleep apnoea?

A

hypertension
pulmonary hypertension
type 2 respiratory failure

105
Q

What can diagnose sleep apnoea?

A

polysomnography

106
Q

Management of sleep apnoea

A

weight loss
reduce alcohol and caffeine
CPAP
surgery to relieve pharyngeal obstruction

107
Q

What is cor pulmonale?

A

right heart failure caused by chronic pulmonary arterial hypertension

108
Q

Name some causes of cor pulmonale

A
  • chronic lung disease eg COPD, fibrosis
  • pulmonary vascular disorders eg pulmonary emboli, sickle cell
  • thoracic cage abnormality
  • neuromuscular disease eg myasthenia gravis, MND
  • hypoventilation
109
Q

clinical features of cor pulmonale

A

dyspnoea
fatigue
syncope

110
Q

signs of cor pulmonale

A

cyanosis
tachycardia
raised JVP
pan-systolic murmur

111
Q

What does cor pulmonale show on a CXR?

A

enlarged right heart

prominent pulmonary arteries

112
Q

Manage cor pulmonale

A

treat cause
treat resp failure with low O2
treat cardiac failure with diuretics eg furosemide
venesect if high haematocrit

113
Q

What is the prognosis for cor pulmonale?

A

poor

50% die in 5 years

114
Q

How is TB treated?

A

2 months of 4: isoniazid, rifampicin, ethambutol, pyrazinamide

4 months of 2: isoniazid and rifampicin

115
Q

Which TB drug causes optic neuritis?

A

ethambutol

116
Q

Which TB drug causes peripheral neuropathy?

A

isoniazide

117
Q

Which TB drug causes body fluids to turn orange?

A

rifampicin

NMF: Resp (4 decks)

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