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4th Year General Medicine > Diseases of the Respiratory System > Flashcards

Diseases of the Respiratory System Flashcards

1
Q

What viruses commonly cause coryza?

A

Rhinoviruses, coronaviruses and adenoviruses

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2
Q

What ear condition can be a complication of coryza?

A

Otitis media

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3
Q

In sinusitis, what is the treatment for someone who has had symptoms for 10 days or less?

A

Advise that acute sinusitis is usually caused by a virus it takes 2–3 weeks to resolve.

Symptoms, including fever, can be managed with self-care measures such as paracetamol or ibuprofen for pain or fever. Some people may want to consider a trial of nasal saline or nasal decongestants (although evidence is lacking to support their use)

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4
Q

In sinusitis, what is the recommendation if a person has had symptoms for around 10 days or more with no improvement?

A

Consider prescribing a high-dose nasal corticosteroid for 14 days

Reserve antibiotics for severe/deteriorating cases of >10 days duration. 1st line = penicillin V

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5
Q

What severe complications can be caused by sinusitis?

A

Intraorbital or periorbital complications - periorbital oedema/cellulitis/displaced eyeball/double vision/ophthalmoplegia/newly reduced visual acuity

Intracranial complications - swelling over the frontal bone/meningitis/severe frontal headache/focal neurological signs.

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6
Q

How is rhinitis classed by type and by timeframe?

A

Type = allergic or non-allergic

Timeframe = seasonal/intermittent or perennial/persistent

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7
Q

What is the treatment for allergic rhinitis?

A
  • Allergen avoidance
  • Nasal irrigation with saline

Mild-to-moderate intermittent, or mild persistent symptoms = intranasal antihistamines (azelastine) or oral antihistamine (loratadine or cetirizine)

Moderate-to-severe persistent symptoms = regular intranasal corticosteroid (eg fluticasone propionate or beclomethasone)

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8
Q

What is the most common viral vs bacterial cause of pharyngitis?

A

Viral - endemic adenovirus

Bacterial - Streptococcus pyogenes (Group A Beta Haemolytic Strep) aka strep throat

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9
Q

What are the complications associated with pharyngitis

hint - 1 ear, 2 throat, 1 skull

A
  • Otitis media
  • Peri-tonsillar abscess (quinsy)
  • Parapharyngeal abscess
  • Mastoiditis
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10
Q

What is acute laryngotracheobronchitis (croup)

A

A viral or bacterial infection of the larynx and/or the trachea that causes swelling and airway obstruction

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11
Q

What causes acute laryngotracheobronchitis (croup)

A

Commonly - viruses such as parainfluenza, influenza, measles, adenovirus and respiratory syncytial virus (RSV)

Rarely - bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

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12
Q

What is the treatment for acute laryngotracheobronchitis (croup)

A

Oral dexamethasone (all) and oxygen support/nebulized adrenaline/fluids (if needed)

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13
Q

What age group is at risk of acute laryngotracheobronchitis (croup)

A

6 months- 5 years

May rarely be seen in children as old as fifteen

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14
Q

What causes acute epiglottis?

A

H. influenzae

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15
Q

What is it critical NOT to do in acute epiglottitis

A

Inspect the epiglottis until the airway is patent

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16
Q

Which type of influenza causes pandemics and which type causes localised outbreaks?

A

Influenza A = pandemics

Influenza B = localised outbreaks

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17
Q

A “cold that goes to the chest” is the colloquial way of referring to what?

A

Acute bronchitis

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18
Q

What are the common causes of acute bronchitis?

A

Strep. pneumoniae/H. influenzae infections, or in people with COPD

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19
Q

What is the treatment of acute bronchitis?

A

NO antibiotics unless there is underlying chronic lung disease (amoxicillin)

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20
Q

What is the most common cause of pneumonia?

A

Streptococcus pneumoniae - 80% of cases

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21
Q

What organism commonly causes pneumonia in COPD patients?

A

Haemophilus influenzae

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22
Q

What organism commonly causes pneumonia following an influenza infection?

A

Staphlococcus aureus

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23
Q

What organism commonly causes pneumonia that presents with a dry cough and stypical CXR findings +/- autoimmune haemolytic anaemia and erythema multiforme?

A

Mycoplasma pneumoniae

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24
Q

What organism commonly causes atypical pneumonia that often presents with hyponatraemia and lymphopenia

A

Legionella pneumophilia

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25
Q

What organism commonly causes pneumonia in alcoholics that classically presents with bloody or yellow sputum

A

Klebsiella pneumoniae

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26
Q

What organism typically causes pneumonia in patients with HIV

A

Pneumocystis jiroveci

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27
Q

What does CURB 65 stand for?

A 
C - confusion
U - urea >7mmol/L
R - respiratory rate >30
B - Blood pressure <90 systolic or <60 systolic 
65 - 65 years or older

Predicts mortality in community acquired pneumonia

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28
Q

What is the antibiotic treatment for mild/moderate CAP?

A

Amoxicillin PO

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29
Q

What is the antibiotic treatment for mild/moderate CAP in penicillin allergic patients?

A

Doxycycline PO

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30
Q

What is the antibiotic treatments for severe CAP?

A

IV co-amoxiclav + PO doxycycline

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31
Q

What is the antibiotic treatments for severe CAP who are penicillin allergic?

A

IV Levofloxacin

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32
Q

What is the antibiotic treatments for severe HAP?

A

IV Amoxicillin + Gentamicin

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33
Q

What is the antibiotic treatments for severe HAP who are penicillin allergic?

A

IV Co-trimoxazole + Gentamicin

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34
Q

What are the 4 C antibiotics?

A

Clindamycin, cephalosporins (eg ceftriaxone), co-amoxiclav and ciprofloxacin

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35
Q

What antibiotic that starts with a C is not part of the 4C antibiotics but you keep thinking it is you dumb bitch?

A

Co-trimoxazole

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36
Q

What is the antibiotic treatments for non-severe HAP

A

PO amoxicillin

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37
Q

What is the antibiotic treatments for non-severe HAP who are penicillin allergic?

A

PO doxycycline

38
Q

How long do you have to be in hospital before an infection can be diagnosed as a hospital acquired/healthcare associated infection?

A

48 hours

39
Q

What 2 things is COPD comprised of

A

Chronic bronchitis and emphysema

40
Q

What 2 major heart related complications are associated with COPD

A

Hypertension and cor pulmonale

41
Q

What is the first line pharmacological treatment for someone with stable COPD?

A

A SABA (eg salbutamol) or SAMA (eg ipratropium)

42
Q

What are the second and third line pharmacological treatments for someone with stable COPD?

A

2nd line = SABA or SAMA + LABA (salmeterol)+ LAMA (tiotropium)

3rd line = above + Inh. corticosteroid (eg beclometasone)

43
Q

What does iSOAP in an acute exacerbation of COPD stand for?

A 
I - ipratropium (nebulised)
S - salbutamol (nebulised)
O- Oxygen
A - antibiotics (amox or doxy)
P - prednisolone (PO)
44
Q

What ranges of PEFR are classified as moderate, severe and life threatening in asthma?

A
  • Mod = <80%
  • Severe = <50%
  • Life-threatening = <30%
45
Q

What does FEV1 stand for?

A

Forced expiratory volume in 1s - the volume exhaled in the first second after deep inspiration and forced expiration

46
Q

What does FEV stand for?

A

Forced vital capacity – the total volume of air that the patient can forcibly exhale in one breath

47
Q

What would an obstructive pattern (eg COPD/asthma etc) show on spirometry?

A
  • FEV1 reduced
  • FVC normal/reduced to a lesser extent
  • FEV1/FVC ratio reduced
48
Q

What would a restrictive pattern (eg pulmonary fibrosis/pulmonary oedema etc) show on spirometry?

A
  • FEV1 reduced
  • FVC
  • FEV1/FVC ratio normal
49
Q

What is the first line treatment for asthma?

A

SABA inhaler (eg salbutamol)

50
Q

What is added to asthma treatment if a SABA does not provide adequate control

A

Inhaled corticosteroid (eg beclometasone)

51
Q

What scale is used to in the diagnosis sleep apnoea?

A

Epworth Sleepiness Scale

52
Q

What is the most common cause of bronchiectasis?

A

CF

53
Q

In which gene is there a defect in CF?

A

CFTR

54
Q

What are the 4 main causes of haemoptysis?

A
  • Cancer
  • PE
  • Infection eg TB, bronchitis, pneumonia etc
  • CF
55
Q

What GI issue prompts the diagnosis a large percentage of CF infants

A

Meconium ileus (SI obstruction)

56
Q

What type of granulomas are seen in TB

A

Caseating granulomas

57
Q

What stain is used in the diagnosis of TB?

A

ZN stain

58
Q

What are the 2 main drugs in the treatment of TB?

A

Rifampicin and isoniazide

59
Q

What type of granulomas are present in sarcoidosis?

A

Non-caseating granulomas

60
Q

What type of hypersensitivity is sarcoidosis?

A

Type 4

61
Q

What is the treatment for sarcoidosis?

A

Corticosteroids (oral prednisolone)

62
Q

What relatively rare condition should a nasal mucosa ulcer combined with other resp symptoms make you think of

A

Granulomatosis with polyangiitis (Wegener’s)

63
Q

What condition with respiratory symptoms can cause s necrotising microvascular glomerulonephritis?

A

Granulomatosis with polyangiitis (Wegener’s)

64
Q

A high eosinophil count combined with respiratory and systemic vasculitis (fever, sweats, fatigue, weight loss, rash) symptoms should make you suspicious of what condition?

A

Eosinophilic Granulomatosis with Polyangiitis (EGPA/Churg-Strauss)

65
Q

What is the treatment for granulomatosis with polyangiitis (Wegener’s)

A

Cyclophosphamide

66
Q

What is the treatment for eosinophilic granulomatosis with polyangiitis (EGPA/Churg-Strauss)

A

Corticosteroids

67
Q

What type of ANCA does GPA show

A

cANCA

68
Q

What type of ANCA does EGPA show

A

pANCA

69
Q

What type of hypersensitivity is lupus?

A

Type 3

70
Q

What features in a cxr would indicate idiopathic pulmonary fibrosis?

A

Patchy scarring of lung with collagen deposition and ground-glass/honeycombing

71
Q

What is extrinsic allergic alveolitis (hypersensitivity pneumonitis)?

A

Widespread diffuse inflammatory reaction in small airways and alveoli due to inhalation of foreign antigens

72
Q

What type of hypersensitivity is extrinsic allergic alveolitis (hypersensitivity pneumonitis)?

A

Type 3

73
Q

What are the classic features of extrinsic allergic alveolitis (hypersensitivity pneumonitis) on imaging?

A
  • CXR = fluffy upper zone nodular shadows

- CT = ground glass opacity

74
Q

What kind of crackles are heard in extrinsic allergic alveolitis (hypersensitivity pneumonitis)?

A

Coarse end-inspiratory crackles

75
Q

Where should you needle aspirate in pnemothorax?

A

2nd IC space, midclavicular line

76
Q

Where should a chest drain be placed?

A

5th intercostal space in the mid-axillary line

77
Q

What is empyema usually a complication of?

A

Pneumonia

78
Q

What is a transudate?

A

Transudate = pleural effusions that are caused by factors that alter hydrostatic pressure, pleural permeability, and oncotic pressure

Eg Congestive heart failure, liver cirrhosis etc

79
Q

What is an exudate

A

Exudate = pleurql effusions caused by changes to the local factors that influence the formation and absorption of pleural fluid

eg Malignancy,
infection etc

80
Q

What is the difference between a transudate and an exudate

A

Transudate =
Pprotein <30 g/L

Exudate= protein >30 g/L

81
Q

What is the difference between type 1 and type 2 respiratory failure?

A

Typw 1 = hypoxia with normal or low PaCO2

Type 2 = hypoxia + hypercapnia

82
Q

Give some examples of direct and indirect causes of ARDS

A

Direct = pneumonia, aspiration, inhalational lung injury, chest trauma, and near-drowning

Indirect causes = sepsis, shock, pancreatitis, trauma

83
Q

What kind of crackles are heard in ARDS?

A

Fine bilateral crackles

84
Q

What is the definition of cor pulmomale?

A

Cor pulmonale = right heart failure due to pulmonary hypertension.

Can occur in advanced COPD: alveolar collapse (emphysema) results in hypoxia which causes vasoconstriction, increasing pressure in the right side of the heart

85
Q

What signs on a cardiac examination would point to cor pulmonale?

A

Ankle oedema, elevated JVP, parasternal heave and tricuspid regurgitation

86
Q

What is Virchow’s triad?

A

Virchow’s triad = endothelial damage, abnormal blood flow or hypercoagulable blood

87
Q

What is the most common type of lung cancer?

A

Bronchial carcinoma / squamous cell carcinoma

88
Q

What nerve might be affected in a lung cancer causing hoarseness?

A

Recurrent laryngeal nerve

89
Q

Invasion of which nerve in lung cancer can cause dysphagia?

A

Phrenic nerve

90
Q

What hormone does small cell carcinoma produce?

A

ACTH

91
Q

What lung cancer is common in non-smokers?

A

Adenocarcinoma

92
Q

Which type of lung cancer is chemotherapy effective against?

A

Small cell lung cancer

4th Year General Medicine (6 decks)

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