Clinical handbook Flashcards
1
Q
How many lobes does the
a) left lung have?
b) right lung have?
A
a) two
b) three
2
Q
What might frothy white pink sputum indicate?
A
pulmonary oedema
3
Q
What is the most common bacterial pneumonia?
A
pneumococcal
4
Q
Symptoms of pneumococcal pneumonia
A
fever
pleurisy
herpes labalis
5
Q
treat pneumococcal pneumonia
A
amoxicillin
6
Q
Which type of pneumonia is bilateral cavitating bronchopneumonia?
A
staphylococcal
7
Q
Name some complications of pneumonia
A
type 1 respiratory failure hypotension atrial fibrillation pleural effusion empyema lung abscess
8
Q
clinical features of a lung abscess
A
swinging fever cough smelly sputum pleurisy haemoptysis malaise finger clubbing anaemia crepitations
9
Q
What is the most important distinction between types of bronchial carcinoma?
A
small cell and non-small cell
10
Q
Which division of bronchial carcinoma is not resectable and has a poor prognosis?
A
small cell
11
Q
How does bronchial carcinoma present?
A
cough haemoptysis dyspnoea chest pain recurrent pneumonia lethargy weight loss
12
Q
What are the signs of bronchical carcinoma?
A
cachexia anaemia clubbing hypertrophic pulmonary osteoarthropathy --> wrist pain supraclavicular or axillary nodes
13
Q
What signs indicate mets in bronchial carcinoma?
A
bone tenderness hepatomegaly confusion fits focal CNS signs cerebellar signs proximal myopathy peripheral neuropathy
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
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
16
Q
What sign of recurrent laryngeal nerve palsy can occur in lung cancer?
A
hoarse voice
17
Q
Signs of bronchial carcinoma on CXR
A
peripheral nodule hilar enlargement consolidation lung collapse pleural effusion bone mets
18
Q
treat peripheral non-small cell tumour with no mets
A
excision
19
Q
treat bronchial obstruction
A
radiotherapy
20
Q
What is the prognosis for non-small cell lung cancer?
A
50% survive 2 years if no spread
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
22
Q
Symptoms of asthma
A
intermittent dyspnoea
wheeze
cough
sputum
23
Q
Signs of asthma
A
tachypnoea wheeze hyperinflated chest hyperresonant percussion dec. air entry
24
Q
Signs of a severe asthma attack
A
cannot finish sentence
pulse > 110bpm
resp rate>25bpm
low PEF (33-50% predicted)
25
What 3 factors contribute to airway narrowing in asthma?
bronchial muscle contraction
mucosal inflammation
increased mucus production
26
What causes mucosal inflammation in asthma?
mast cell and basophil degranulation cause inflammatory mediators to be released
27
Steps in asthma treatment
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)
28
What is the most effective preventer drug for adults and older children with asthma?
inhaled corticosteroid
29
What do B2 adrenoceptor agonists do?
relax bronchial smooth muscle, increase cAMP
30
Give side effects of B2 adrenoceptor agonists
tachyarrythmia
hypokalaemia
tremor
anxiety
31
Give an example of
a) SABA
b) LABA
c) ICS
d) anticholinergic
e) leukotriene receptor antagonist
a) salbutamol
b) salmeterol
c) beclometasone
d) ipratropium
e) montelukast
32
What does theophylline do?
inhibits phosphodiesterase to increase cAMP and reduce bronchoconstriction
33
SE of theophylline
low therapeutic window so can be toxic
GI upset
arrythmia
34
Why are anticholinergics used in asthma?
decrease muscle spasm
35
What characterises COPD?
irreversible airway obstruction
36
What 2 parts does COPD have?
chronic bronchitis
| emphysema
37
What is chronic bronchitis?
cough, sputum production onmost days for 3 months of 2 years
38
What is emphysema?
enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls
39
Describe a pink puffer
increased alveolar ventilation
near normal PaO2
normal/low PaCO2
breathless but not cyanosed
40
What might a pink puffer progress to?
type 1 resp failure
41
Describe a blue bloater
decreased alveolar ventilation
low PaO2
high PaCO2
cyanosed but not breathless
42
What might a blue bloater progress to?
cor pulmonale
43
Symptoms of COPD
cough
sputum
dyspnoea
wheeze
44
Signs of COPD
```
tachypnoea
accessory muscle use
hyperinflated
reduced cricosternal distance
reduced expansion
resonant or hyperresonant percussion
quiet breath sounds
cyanosis
```
45
Signs of COPD on CXR
hyperinflation
flat hemidiaphragm
large central pulmonary artery
decreased peripheral vascular markings
46
What might an ECG of someone with COPD show?
right atrial and ventricular hypertrophy --> cor pulmonale
47
What PaO2 level indicates respiratory failure?
less than 8kPa
48
What differentiates between the two types of respiratory failure?
PaCO2 level
49
What is the PaCO2 in type 1 respiratory failure?
normal or low
50
What causes type 1 respiratory failure?
V/Q mismatvh
eg pnuemonia, pulmonary oedema, PE, asthma, emphysema, pulmonary fibrosis, ARDS
51
What is the PaCO2 in type 2 respiratory failure?
high (>6 kPa)
52
What causes type 2 respiratory failure?
alveolar hypoventilation
due to resp disease (asthma, COPD, fibrosis, obstructive sleep apnoea), reduced respiratory drive, neuromuscular disease, thoracic wall disease
53
clinical features of hypoxia
```
dyspnoea
restlessness
agitation
confusion
central cyanosis
```
54
clinical features of hypercapnia
```
headache
peripheral vasodilation
tachycardia
bounding pulse
tremor
papilloedema
confusion
drowsiness
coma
```
55
In which type of resp failure does oxygen need to be given with care?
type 2
56
Where do pulmonary embolisms usually arise from?
venous thrombosis in the pelvis or legs
57
Symptoms of PE
```
acute breathlessness
pleuritic chest pain
haemoptysis
dizziness
syncope
```
58
Signs of PE
```
pyrexia
cyanosis
tachypnoea
tachycardia
hypotension
raised JVP
pleural rub
pleural effusion
```
59
In which patients should D-dimer test be carried out?
patient doesnt have high probability of PE
60
Symptoms of pneumothorax
suddent onset dyspnoea and pleuritic chest pain
61
Signs of pneumothorax
reduced expansion
hyperresonant
red breath sounds
62
What sign shows a tension pneumothorax?
trachea deviates away from affected side
63
Why might a spontaneous pneumothorax occur in a young, thin man?
rupture of subpleural bulla
64
manage tension pneumothorax
insert large bore needle with syringe with 0.9% saline into 2nd intercostal space midclavicular line
65
How can pleural effusions be divided?
by protein content
low = transudates
high = exudates
66
What can cause a transudate pleural effusion?
- increased venous pressure (cardiac failure, constrictive pericarditis, fluid overload)
- hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption)
67
What can cause an exudative pleural effusion?
increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy
68
Signs of a pleural effusion
decreased expansion
stony dull percussion
diminished breath sounds
69
What is sarcoidosis?
a multisystem granulomatoud disorder of unknown cause
70
How does acute sarcoidosis present?
erythema nodosum +/- polyarthralgia
71
What sign is seen on CXR in patients with sarcoidosis?
bilateral hilar lymphadenopathy
| +/- infiltrates, fibrosis
72
Give some pulmonary symptoms of sarcoidosis
dry cough
progressive dyspnoea
reduced exercise tolerance
chest pain
73
Give some non-pulmonary signs of sarcoidosis
lymphadenopathy
hepatomegaly
splenomegaly
uveitis
74
What does tissue biopsy of sarcoidosis show?
non-caseating granuloma
75
How is sarcoidosis treated?
acute: rest + NSAIDs
mild: leave alone
mod: steroid therapy
76
What is interstitial lung disease?
number of conditions characterised by chronic inflammation and/or progressive interstitial fibrosis of lung parenchyma
77
give some clinical features of interstitial lung disease
dyspnoea on exertion
non-productive paroxysmal cough
abnormal breath sounds
restrictive spirometry
78
give pathological features of interstitial lung disease
fibrosis
remodelling of interstitium
chronic inflammation
hyperplasia of type 2 pneumocytes
79
How is interstitial lung disease categorised?
1. known cause eg occupational
2. part of systemic disease eg. sarcoidosis
3. idiopathic
80
What is extrinsic allergic alveolitis?
a type of interstitial lung disease caused by inhalation of allergens causes a hypersensitivity reaction
81
What characterises
a) the acute stage
b) the chronic stage
of extrinsic allergic alveolitis?
a) infiltration of acute inflammatory cells
| b) granulomas form and obliterative bronchiolitis occurs
82
Give some causes of allergic alveolitis & the relevant name
bird dropping proteins --> bird fancier's lung
aspergillus --> malt worker's lung
fungal spores --> farmer's lung
83
Symptoms of acute extrinsic allergic alveolitis
```
fever
rigors
myalgia
dry cough
dyspnoea
crackles
```
84
Symptoms of chronic extrinsic allergic alveolitis
```
increasing dyspnoea
weight loss
exertional dyspnoea
type 1 resp failure
cor pulmonale
```
85
What blood cell characterises acute extrinsic allergic alveolitis
neutrophils
86
manage acute extrinsic allergic alveolitis
remove cause
give o2
PO prednisolone
87
What causes fibrotic shadowing on a CXR in the
a) upper lung?
b) mid lung?
c) lower lung?
a) TB, extrinsic allergicalveolitis, ank spond, radio
b) sarcoidosis
c) idiopathic pulmonary fibrosis, asbestosis
88
What is the most common cause of interstitial lung disease?
idiopathic pulmonary fibrosis
89
Symptoms of idiopathic pulmonary fibrosis
```
dry cough
exertional dyspnoea
malaise
weight loss
arthralgia
```
90
Signs of idiopathic pulmonary fibrosis
cyanosis
finger clubbing
fine-end inspiratory creps
91
What does CXR show in idiopathic pulmonary fibrosis?
```
dec lung volume
bilateral lower zone shadows
honeycomb lung (advanced disease)
```
92
In idiopathic pulmonary fibrosis is
a) increased lymphocytes
b) increased eosinophils
indicative of a good or poor prognosis?
a) good
| b) poor
93
What is the prognosis of idiopathic pulmonary fibrosis?
50% 5 year survival
94
Describe coal worker's pneumoconiosis
inhaled coal dust is ingested by macrophages which die and release their enzymes causing fibrosis
95
What are the symptoms of coal worker's pneumoconiosis?
asymptomatic
96
What does coal worker's pneumoconiosis progress to?
progressive massive fibrosis
97
What characterises progressive massive fibrosis?
dyspnoea
fibrosis
cor pulmonale
98
What can exposure to asbestos cause?
pleural plaques
| risk of bronchial adenocarcinoma and mesothelioma
99
Clinical features of mesothelioma
```
chest pain
dyspnoea
weight loss
finger clubbing
recurrent pleural effusion
```
100
What does mesothelioma look like on CXR?
```
thickened pleura
pleural effusion (bloody)
```
101
Manage mesothelioma
pemetrexed and cisplatin
102
What is obstructive sleep apnoea?
intermittent closure/collapse of the pharyngeal airways during sleep
103
Describe the typical sleep apnoea patient
obese middle aged man presenting with snoring or daytime somnolence
104
What are the complications of sleep apnoea?
hypertension
pulmonary hypertension
type 2 respiratory failure
105
What can diagnose sleep apnoea?
polysomnography
106
Management of sleep apnoea
weight loss
reduce alcohol and caffeine
CPAP
surgery to relieve pharyngeal obstruction
107
What is cor pulmonale?
right heart failure caused by chronic pulmonary arterial hypertension
108
Name some causes of cor pulmonale
- 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
clinical features of cor pulmonale
dyspnoea
fatigue
syncope
110
signs of cor pulmonale
cyanosis
tachycardia
raised JVP
pan-systolic murmur
111
What does cor pulmonale show on a CXR?
enlarged right heart
| prominent pulmonary arteries
112
Manage cor pulmonale
treat cause
treat resp failure with low O2
treat cardiac failure with diuretics eg furosemide
venesect if high haematocrit
113
What is the prognosis for cor pulmonale?
poor
| 50% die in 5 years
114
How is TB treated?
2 months of 4: isoniazid, rifampicin, ethambutol, pyrazinamide
4 months of 2: isoniazid and rifampicin
115
Which TB drug causes optic neuritis?
ethambutol
116
Which TB drug causes peripheral neuropathy?
isoniazide
117
Which TB drug causes body fluids to turn orange?
rifampicin
