Miscellaneous- Resp Flashcards by Humairaa Asmal

What is the pharmacological tx for idiopathic pulmonary fibrosis

Pirfinedone

Nintedanib

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Sign of strep pneumonia infection

Herpes labialis- blisters on lower lip

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Which lung cancer most common in non-smokers

Adenocarcinoma

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CXR signs/appearance of idiopathic pulmonary fibrosis

Honeycombing and ground glass appearance in lung parenchyma

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Sings of sarcoidosis

Erythema nodosum
Bihilar lymphadenopathy
Lupus Pernio- plaques of discolouration on cheeks, ears and nose
Facial palsy
Signs of hypercalcaemia 
Arrhythmias

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Sx of sarcoidosis-

Fever
Dry cough 
Uveitis
Weight loss
Malaise 
Polyarthralgia
SOB

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What is sarcoidosis

A multi system chronic granulamatous disorder affecting skin, eyes and lungs

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Features of Churg-Strauss syndrome

Nasal congestion
Adult onset asthma
Peripheral neuropathy
Glomerulonephritis

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Gs investigation for bronchiectasis

HRCT- high resolution CT

Thickened dilated airways w or w/o fluid levels

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What may you see on a CXR in someone with bronchiectasis

Kerley b lines

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What nature can pleural fluid be off?

Transudative

Exudative

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List 4 causes of transudative pleural fluid effusion

Hypothyroidism
Heart failure
Hypoalbuminaemia
Meigs syndrome

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List causes of an exudative pleural effusion

RIPPELD
Rheumatoid arthritis 
Infections 
Pancreatitis 
PE
Lung cancer 
Dressler’s syndrome

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A stony dull percussion indicates what

Pleural effusion

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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

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Gs investigation for pleural effusion

Pleural ultrasound- more sensitive and specific compared to CXR

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What lung cancer is strongly associated with smoking

Squamous cell carcinoma

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Cancer can spread to the lungs from what areas

Kidney 
Prostate 
Breast 
Bowel 
Bladder

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Lung cancer can metastasise to which sites

Brain
Adrenals
Bone
Liver

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What ECG Changes may you see in COPD

Prominent P wave in inferior leads (II,III, aVF)
Right axis deviation
Low voltage QRS
RBBB

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What would you hear on auscultation in patient with idiopathic pulmonary fibrosis

Fine bi-basal end inspiratory crackles

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What is croup

Laryngotracheobronchitis- URTI characterised by a seal like barky cough, voice horseness, stridor and resp distress

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What is the tx for empyema

Broad spectrum abx- ceftriaxone and metronidazole
Chest tube drainage
Supportive care
Fluid resuscitation

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What is the characteristics of empyema fluid

Yellow, turbid
Ph less than 7.2
Low glucose
High ldh

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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

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