Miscellaneous- Resp Flashcards
What is the pharmacological tx for idiopathic pulmonary fibrosis
Pirfinedone
Nintedanib
Sign of strep pneumonia infection
Herpes labialis- blisters on lower lip
Which lung cancer most common in non-smokers
Adenocarcinoma
CXR signs/appearance of idiopathic pulmonary fibrosis
Honeycombing and ground glass appearance in lung parenchyma
Sings of sarcoidosis
Erythema nodosum Bihilar lymphadenopathy Lupus Pernio- plaques of discolouration on cheeks, ears and nose Facial palsy Signs of hypercalcaemia Arrhythmias
Sx of sarcoidosis-
Fever Dry cough Uveitis Weight loss Malaise Polyarthralgia SOB
What is sarcoidosis
A multi system chronic granulamatous disorder affecting skin, eyes and lungs
Features of Churg-Strauss syndrome
Nasal congestion
Adult onset asthma
Peripheral neuropathy
Glomerulonephritis
Gs investigation for bronchiectasis
HRCT- high resolution CT
Thickened dilated airways w or w/o fluid levels
What may you see on a CXR in someone with bronchiectasis
Kerley b lines
What nature can pleural fluid be off?
Transudative
Exudative
List 4 causes of transudative pleural fluid effusion
Hypothyroidism
Heart failure
Hypoalbuminaemia
Meigs syndrome
List causes of an exudative pleural effusion
RIPPELD Rheumatoid arthritis Infections Pancreatitis PE Lung cancer Dressler’s syndrome
A stony dull percussion indicates what
Pleural effusion
What changes may be seen in a CXR in someone with pleural effusion
Blunting of the costophrenic angle
Fluid in lung fissure
Tracheal and mediastinal deviation if big effusion
Large effusions will have meniscus
Gs investigation for pleural effusion
Pleural ultrasound- more sensitive and specific compared to CXR
What lung cancer is strongly associated with smoking
Squamous cell carcinoma
Cancer can spread to the lungs from what areas
Kidney Prostate Breast Bowel Bladder
Lung cancer can metastasise to which sites
Brain
Adrenals
Bone
Liver
What ECG Changes may you see in COPD
Prominent P wave in inferior leads (II,III, aVF)
Right axis deviation
Low voltage QRS
RBBB
What would you hear on auscultation in patient with idiopathic pulmonary fibrosis
Fine bi-basal end inspiratory crackles
What is croup
Laryngotracheobronchitis- URTI characterised by a seal like barky cough, voice horseness, stridor and resp distress
What is the tx for empyema
Broad spectrum abx- ceftriaxone and metronidazole
Chest tube drainage
Supportive care
Fluid resuscitation
What is the characteristics of empyema fluid
Yellow, turbid
Ph less than 7.2
Low glucose
High ldh
Gold standard investigation for mesothelioma
Video assisted thorascopic surgery (VATS)
What paraneoplastic syndromes are associated with small cell lung cancers
ACTH- Cushings
SIADH
Lambert Eaton myasthenia syndrome
What paraneoplastic syndromes is associated with non small cell lung cancer
Hyperparthyroidism
List 5 causes of respiratory alkalosis
Panic attack PE CNS Infection Anaemia Aspirin overdose
List 3 causes of respiratory acidosis
Airway obstruction
Opiate overdose- decreased ventilatory drive
Ventilatory muscle inadequacy- neuromuscular disorders, exhaustion
List 5 causes of metabolic acidosis
DKA Lactic acidosis Renal tubular acidosis Sepsis Metformin poisoning
List 5 causes of metabolic alkalosis
Vomiting Diarrhoea Milk alkali syndrome Liquorice Conns syndrome
What would be seen on histology of an asthmatic
Charcot Leyden crystals and crushmann spirals
which pathology would psommoma bodies be indicative of
Mesothelioma
A Reid index of >50% is an indicator in which disease
Chronic bronchitis
What drug should be given for prophylaxis against the se of isoniazid
Pyridoxine hydrochloride
What is meigs syndrome
A triad of
- benign ovarian tumour
- Ascites
- pleural effusion
What stain can be used to diagnose pneumocystis jivorecii
Silver stain
What are the signs of TB on CXR
Ghon focus Dense homogenous opacity Hilar lymphadenopathy Pleural effusions Tree in a bud sign- nodules w/ poorly defined margins
Differentials for bi-hilar lymphadenopathy
Sarcoidosis Silicosis Hodgkin lymphoma Mycoplasma TB
What tumour causes horners syndrome
Pancost tumour in the apex of the lung
Signs of bronchiectasis
Clubbing
Coarse inspiratory crepitations
Complications of COPD
Respiratory infections
Lung cancer
Pneumothorax
ARDS
Differentials of COPD
Asthma
Bronchiectasis
TB
Congestive HF
What is haemophilius influenzae
A gram negative coccobacillus
Antibiotics used to treat h.influenzae
Co-amoxiclav
Doxycycline
Signs of interstitial pulmonary fibrosis
Cyanosis
Clubbing
Fine end inspiratory crackles
Signs of pleural effusion
Stony dull on percussion
Chest expansion reduced on affected side
Decreased vocal resonance/tactile fremitus on affected Side
Signs of pneumothorax
Hyper-resonant percussion on affected side
Decreased or absent breath sounds on affected side
Decreased vocal resonance/tactile fremitus on affected side
Signs of pneumoniae
Dull percussion
Increased vocal resonance/ tactile fremitus
Pleural rub
Bronchial breathing
Signs of COPD
Hyperinflation
Hyper-resonance on percussion
Reduced chest expansion
Decreased/quiet breath sounds
Most likely HAP organisms
Pseudomonas aureginosa
Staph aureus
Where is the most appropriate site for a needle thoracostamy to treat tension pneumothorax
2nd intercostal space, midclavicular line, same side as pneumothorax
OR
5th intercostal space, anterior axillary line, same side as pneumothorax
Abx to five according to CURB-65
0-1= amoxicillin po
2- amoxicillin and clarithromycin/doxycycline
3-5= iv co-amoxiclav and clarithromycin
What criteria is used to classify cause of Pleural effusion
Lights criteria
What drugs can cause pulmonary fibrosis
Nitrofurnatoin
Amiadorone
Methotrexate
Bleomycin
If PE score is less than 4 what is next line management
D dimer
If PE score is more than or equal to 4 what’s the next step
CTPA and start on DOAC
What is the worst prognosis bases infection that can be acquired by someone with bronchiectasis
Pseudomonas aureginosa
List 5 causes of finger clubbing
Bronchiectasis Cystic fibrosis VSD IPF Lung cancer
What abx is used to treat legionella pneumoniae
Clarithromycin
What is lofgrens triad
Erythema nodusum
Arthralgia
Bilateral hilar lymphadenopathy
What may tests may be high in sarcoidosis
Serum ACE
Hypercalcaemia
List 5 differentials for dry cough
Asthma Gord Pulmonary fibrosis Ramipril induced Sleep apnoea
List t differentials for sputum/wet cough
COPD
Bronchiectasis
Acute bronchitis
HF
Cystic fibrosis
Gs Ix for IPF
HRCT
What prophylaxis abx is given in COPD
Azithromycin
How many cigarettes is 1 pack year equal to
20
A- What is the key tell tale sign of acute apiglottis
B- gs Ix
C- tx
A- Pts lean forward in tripod position and extend their neck
B- laryngscopy
C- secure airway, I’ve antibiotics, supplemental o2 and corticosteroids
What is the most common cause of croup
Parainfluenza virus
What is the key tell tale sign of croup
Seal like barky cough
Tx for croup
Dexamethasone and supportive care
Most common cause of bronchiolitis
RSV
List 5 causes of bronchiectasis
Congenital- primary ciliary dyskinesia, CF Bacterial infection COPD CT disease RA Idiopathic
List 4 causes of hypersensitivity pneumonitis
Malt workers lung
Pigeon fanciers lung
Farmers lung
Cheese workers lung
Associated with jobs and hobbies
What kind of hypersensitivity reaction is hypersensitivity pneumonitis
TYPE 3
2hat paraneoplastic syndromes is small cell lung cancer associated with-
SIADH
CUSHINGS/ADDISON
LEMS
CEREBELLAR DEGENERATION
Give 2 medications that can be used to treat pulmonary hypertension
Phosphodiesterase inhibitors- sildenafil
Calcium channel blocker- amlodipine
Endothelial receptor antagonist
IV prostanoids
