Core Respiratory Flashcards by Jo Nkonge

Type 1 respiratory failure = PC02 > 6.3

T/F?

PC02 less than 6.3 kPa

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Name general respiratory symptoms that you would ask in OSCE.

Cough
Sputum
SOB = dyspnoea
Wheeze
Stridor
Haemoptysis
Chest pain
Pleuritic pain - worse on inspiration
Clubbing
Weight loss

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Classification of lung Ds?

Neoplasms
Infections
Obstructive
Restrictive
Vascular
Pleural D
Interstitial D
Occupational

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Lung cancers have a HIGH MORTALITY in the UK. Where are they mostly found in the lung?

Centrally

near main bronchioles

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Lung tumours are often 2”, How would you distinguish it from a 1” tumour in tests?

immunohistochemistry

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Lung tumours can either be Carcinomas, Carcinoid tumours or other malignant tumours. What are the subgroups of the carcinomas?

NSCLC - 85%

SCLC

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The most common lung carcinoma is…? What hormone does it often secrete?

Squamous cell carcinoma (central)

PTH –> hypercalcaemia

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Which other NSCLC apart from Squamous carcinoma is seen more peripherally?

Adenocarcinoma

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Whats the name of the worst NSCLC which has severe atypia and is neuroendocrine?

Large cell neuroendocrine carcinoma

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What lung tumours are neuroendocrine?

Large cell neuroendocrine carcinoma

SCLC

Carcinoid tumours

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99% of those with SCLC are smokers. What hormones does this neuroendocrine release?

How aggressive is it?

ACTH, ADH

Rapidly progressive &; invasive

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Carcinoid tumours consist of typical and atypical groups. Which one has low malignnt potential? Presentation?

Typical

Chronic cough
Unresolved pneumonia
Haemoptysis

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Other malignant tumours in lungs could be?

Lymphomas

Sarcomas

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Lymphangitis Carcinomatosa is a rare presentation of what?

Lung cancer

= inflammation of lymph nodes from lunG mets

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Treatment of lung cancer uses Gefitinib, Tarcera, Crizotinib

= inhibit EGFR-TK

GF in lung tumours

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Paraneoplstic effects of lung cancer happen causing?

Cachexia
Clubbing
Coagulopathies
Skin - darkened/thick
Endocrine effects - PTH in SCC, ACTH/ADH in SCLC

Lambert Eaton myasthenic syndrome
- autoimmune attack of NMJ

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Pneumonia, TB, Lung infarct or Lung tumour can cause Pleurisy. Which pleural effusion has high protein content?

Exudate - inflammatory

(trasudate - non-inflammatory e.g CHF

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Fibroma of pleura is rare. What tumour is common?

2” Adenocarcinoma

mets from lung/breast

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What rare cancer of pleura can be acquired from high asbestos exposure?

1” Malignant Mesothelioma

Fatal: 1-3 yrs

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Are fibrous plueral plaques pre-malignant or not?

NOT

common - low asbestos exposure

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In URTI, what are the 3 usual suspects?

Haemophilus Influenzae
Streptococcus pneumoniae
Moraxella Catarrhalis

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URTI are most common in whom?

Children/Teens

Usual viral/bacterial

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A patient presents with facial pain, nasal blockage and decreased smell. What do they have? Cause?

Rhino-sinusitis.

3 usual suspects

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A patient has a sore throat, fever, cervical lymphadenopathy. You find Ig in there blood for EBV. Diagnosis?

Glandular fever

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Symptoms of dysphagia, fever, headache, red uvula +/- exudate is characteristic of what? How would you investigate?

Pharyngitis (S.pyrogenes) Tonsilitis Throat swab

Group A Strep URTI can cause complications such as rheumatic fever, scarlet fever and acute glomerularnephritis. What is the treatment?

Penicillins

Which antibiotics are safe for those with penicillin allergies?

Monobactams - Aztreonam (AZT)

What MEDICAL EMERGENCY is assoicated with "hot potato speech" and "cherry red" look? Treatment?

Epiglottis Cefotaxime

Acute larngitis presents as...?

``` Hoarse voice Fever Globus pharyngeas Dysphagia Myalgia ```

What is another word for Acute Laryngotracheobronchitis? Common in whom?

Croup children after URTI

What are the two phases of whooping cough? Treatment?

1. Catarrhal phase: runny nose, malaise, fever 2. 1 week later: dry whooping cough Erythromycin

State the name given to infammation of the external acoustic canal?

Otitis Externa

Otitis externa can be acute/chronic/malignant. However, they all present the same. How?

``` Pain Swelling Redness Itching Otorrhoea ```

Who are most suspectible to malignant Otitis externa?

Elderly Diabetics Immunocompromised

Otitis media is common in children and can be viral/3 usual suspects. how would you treat it?

If well: symptomatically if unwell: Amoxiciillin

What condition presents the same as Otitis media + pain/swelling over mastoid? Treatment?

Mastoiditis Co-amoxiclav

Name common investigations done in URTI.

Throat/pus swabs blood culture Serology: Ig Sensitivity testing

Common antibiotics used in URTI?

Erythromycin - Whooping Cough, Diphtheria Amoxicillin - Otitis media Penicillin - Step A, Diphtheria

LRTI include?

``` Tracheitis Bronchitis - A/C Bronchiolitis Pneumonia ( diff types) Pulmonary TB ```

1" LRTI occur n healthy people, whereas 2" infections occur in...?

Those with weakened defence: - immunocompromised - Mucociliary dysfunction - pulmonary oedema

Acute bronchitis often occurs in kids and during winter. Its self-limting What are tthe symptoms?

Croup Dry Cough SOB Tachypnoea

What condition is defined as productive cough + sputum > 3 months > 2 consecutive years?

Chronic Bronchitis

Cause of chronic bronchitis?

Irritation from foreign particles - smoking - pollution - allergens

What virus commonly causes Bronchiolitis in kids?

RSV

How would you diagnose bronchiolitis?

Chest x-ray FBC Snot sample

What condition is defined as infection of distal airways and alveoli forming inflammatory exudate --> CONSOLIDATION?

Pneumonia

Which type of pneumonia is the most commonly acquired? How is it assessed?

Commuity acquired Pneumonia (CAP) CURB-65 score

What organisms tend to cause CAP?

3 usual suspects S. Aureas Atypical bacteria (4)

Name the 2 pneumonias based on anatomical site. Which is more common?

Bronchopneumonia* Lobar pneumonia - S. pneumonia

State the type of pneumonia caused often by those who have impaired cough/swallow reflex/elderly.

Apsiration Pneumonia

Signs of CAP?

High RR High pulse Low BP Low SATS

Symptoms of CAP?

rapid onset + fever + productive cough + mucopurulent sputum + pleuritic chest pain + malaise

Which atypical mycobacteria is associated with water outbreaks and abnormal LFT/na+ in CAP?

Legionella pneumophillia

1" viral pneumonia is often seen in patients with pre-exisitng heart/lung D. What are the symptoms?

Cough SOB Cyanosis

Mycobacteria are gram -VE intraceullar organisms. T/F?

State 2 conditions that are caused by mycobacteria?

TB | Leprosy

What are the 2 clinical forms of leprosy?

Tuberculoid Lepromatous

Whats the most common site of TB?

Lung

TB has 3 phases/manifestations. What are they?

Flu-like Dissesminated D Latent phase

State the treatment for TB.

6 months DOTS: 2 months - 1 tablet 4 months

What investigations are neccessary in moderate/severe CAP?

(OBS, Blood, Chest x-ray) ``` Microbiological: Sputum gram stain/culture Blood culture Pneumococcal urinary antigen Legionella PCR serology ```

State the standard treatment for CAP

If low severity: PENICILLIN If high: PENICILLIN + CLARITHROMYCIN

What fraction of world are INFECTED with TB?

1/3

Sarcoidosis, Pneumonconiosis, Silicosis, Asbestosis and Hypersensitivity Pneumonitis are examples of what?

CHRONIC INTERSTITIAL LUNG D

Pneumoconiosis is also called what and a common occupational D?

Dust D

Define Sarcoidosis

= non-caseating granulmoas - hypercalcaemia - Inceased serum ACE - Reanl dysfunction - Neurological

Silicosis causes lung fribrosis by inhalation of what?

Silica in sand/dust

Asbestosis causes lung oedema. T/F?

False Causes lung fibrosis

CF presents as..?

Recceurrent infections Failure to thrive (child) Pancreatic insufficiency Abnormal viscous secretions

Whats the management of CF?

Mucolytics Physio Digestive enzymes Heart/Lung Transplant

Define interstitial lung D.

= inflammation/fibrosis of alveolar-capillary wall A/C

Which chronic interstitial lung D is more common in women and presents with hypercalcaemia?

Sarcoidosis

A P02 of less than what signifies respiratory failure?

P02 less than 8 kPa

Cynanosis = ?

Decreased oxygenation of Hb

Ziehl-neelsen is a specific stain used to detect what organism?

Mycobacteria

Gene mutation giving sensitivity to new lung cancer drugs codes for..?

Epidermal GF receptor

Name the rare autoimmune disease that attacks the lung and kidneys causing pulmonary bleeding & glomerulonephritis (Anti-GBM D)

Good pastures syndrome