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CP1 > from oxford clinical handbook > Flashcards

from oxford clinical handbook Flashcards

1
Q

What do the different colours of sputum mean?

A 
Clear - chronic bronchitis
Green/yellow - pulmonary infection
Black - smoke, coal dust
Red - haemoptysis
Frothy white/pink - pulmonary oedema
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2
Q

Role of US in respiratory medicine

A

Mostly in guiding drainage of pleural effusions/empyema

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3
Q

When are radionuclide scans used in chest medicine?

A

V/Q mismatch - occasionally in PE.

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4
Q

What is used to stage lung cancer?

A

CT

Also for diagnosis and for guiding biopsies

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5
Q

What is the use of HRCT in lung diseases

A

Diagnosis of interstitial lung disease and bronchiectasis.

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6
Q

When are the different types of lung biopsy indicated?

A

Percutaneous needle aspiration: in peripheral lung, under radiological guidance.

Transbronchial biopsy - during bronchoscopy for diagnosing diffuse lung diseases.

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7
Q

Causes of bronchiectasis

A

CF
Kartagener’s syndrome

Post infection: measles, pertussis, pneumonia, TB, HIV

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8
Q

Clinical features of bronchiectasis

A

Persistent cough, purulent sputum, haemoptysis.

Finger clubbing, coarse inspiratory crepitations.
Wheeze!

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9
Q

CXR signs of bronchiectasis

A

Thickened bronchial walls (upper lobes if CF).
Otherwise more common in lower.
Ring shadows.

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10
Q

Investigations for bronchiectasis

A 
Sputum culture
CXR
HRCT
Spirometry (often obstructive)
Bronchoscopy (site of haemoptysis, exclude obstruction)

Serum immunoglobulins, CF sweat test (elevated Na and Cl)

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11
Q

What is the aetiology of carcinomas of the bronchus?

A

19% of all cancers
(basically 1/5)

40,000 deaths per year

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12
Q

Which hormones are can be secreted by small cell cancers of the lung?

A

SIADH

ACTH

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13
Q

Which lung tumours can secrete PTH? (hypercalcaemia)

A

Usually squamous cell carcinoma

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14
Q

What are the clinical markers for a severe asthma attack?

A

Inability to complete sentences
Pusle > 110
RR > 25/min
PEF 35-50% of predicted

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15
Q

How is chronic bronchitits defined?

A

Clinically, as cough and sputum production on most days for 3 months of 2 successive years.
Symptoms improve with cessation of smoking

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16
Q

Why is chronic bronchitis more dangerous than emphysema?

A

Patients rely on hypoxic drive (there is no breathlessness), yet they are cyanosed.
Insensitivity to hypercapnia.
May develop cor pulmonale.

17
Q

What are the signs of COPD on CXR?

A

Hyperinflation
Flat hemidiaphragms
Large central pulmonary arteries
Bullae

18
Q

What are signs of COPD on ECG?

A

Right atrial and ventricular tachycardia due to cor pulmonale.

19
Q

What are the stages of COPD?

A

Stage 1 - FEV1 > 80% of predicted
Stage 2 - FEV 50-79
Stage 3 severe - 30-49
Stage 4 very severe - < 30% of predicted.

FVC alway < 0.7

20
Q

Is it possible to see pleural effusion in a supine CXR?

A

only if very large, usually not

21
Q

What are the clinical features of hypercapnia?

A 
Headache
Vision problems
Peripheral vasodilation
Bounding pulse and tachycardia
Tremor/flap
Papilloedema
Confusion, drowsy, coma
22
Q

Which conditions cause transudates

A

Cardiac failure, constrictive pericarditis, fluid overload
Hypoproteinamia due to nephrotic syndrome, cirrhosis or diet
Meig’s syndrome
Hypothyroidism

23
Q

Exudates are caused by

A

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

24
Q

Differentials for bilateral hilar lymphadenopathy on CXR

A 
TB
Metastatic disease
Sarcoidosis
Lymphoma
Pneumoconioses
25
Q

WHO criteria for diagnosing DM

A

Symptoms of hyperglycaemia (plydypsia, polyuria, unexplained weight loss, visual blurring, lethargy)
AND raised venous glucose detected:

1) once fasting > 7mmol/L or random > 11.1mmol/L
2) Raised venous glucose on 2 separate occasions (fasting or random or OGTT)
2) Hba1c > 448mmol/L (6.5%). But below does not exclude DM

26
Q

Which muscles are affected by diabetic amyotrophy?

A

Painful wasting of quadriceps and other pelvifemoral muscles.

27
Q

What are the features of autonomic neuropathy in DM

A

Postural hypotension
Gastroparesis (early satiety, post-prandial bloating, n+v)
Urine retention
Erectile dysfunction

28
Q

Which test is useful in monitoring thyroid carcinoma?

A

Serum thyroglobulin

29
Q

What is the use of ultrasound in thyroid disease? What else might be done?

A

Distinguishes benign cyst from solid, possibly malignant nodules

If a solitary/dominant hard nodule - do a FNA to look for thyroid cancer

30
Q

How are isotope scans used in thyroid disease?

A

123Iodine and 99Technetium pertechnetate
Useful for determining the cause of hyperthyroidism.
Grouped into hot, neutral and cold.

Few neutral and almost no hot nodules are malignant (hot means they take up much of the isotope, and thus are metabolically active)
20% of cold nodules are malignant

31
Q

With which conditions are thyroid abnormalities more likely?

A

AF
Hyperlipidiaemia
DM
On amiodarone or lithium

32
Q

Signs of Graves disease

A

Exophthalmos
Pretibial myxoedema
Thyroid acropachy (extreme manifestation)

33
Q

What are the symptoms and signs of hypercalcaemia due to hyperparathyroidism?

A 
Bones (pain, fractures)
Groans (abdo pain and ulcers)
Thrones (polyuria and thirsty)
Stones (renal)
Psychic moans (fatigue, depressed, tired)

Also HTN

34
Q

In which cause of hypercalcaemia is PO4 elevated?

A

Renal failure - not excreted

35
Q

Which cancers can cause hyperparathyroidism due to PTHrP release?

A

Squamous cell carcinoma of lung
Breast
Renal cell carcinomas

PTH would be low due to negative feedback

36
Q

What is the overall effect of PTH on Ca and PO4

A

Increase Ca

Decrease PO4

37
Q

What are features of ectopic ACTH production by a tumour (eg. small cell cancer of lung)

A

Classical features of Cushing’s are often ABSENT.

Hyperpigmentation
Hypokalaemia
Weight loss
Hyperglycaemia

38
Q

Which test is most sensible next, if serum ACTH is low in the presence of Cushing’s syndrome

A

Primary adrenal tumour is likely = CT

CP1 (6 decks)

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