New respiratory learn Flashcards
What is Caplan’s syndrome
combination of rheumatoid disease and pneumoconiosis
- you’ll see massive fibrotic nodules and patient has history of coal dust exposure
Recurrent chest infections and infertility
Kartagner’s syndrome/ cystic fibrosis
Investigation for suspected lung cancer
Chest x-ray
CT with contrast
(biopsy should not be performed before a CT)
When would you do PET scan?
In suspected non-small cell cancer
Moderate asthma attack
PEFR 50-75% of best
Speech normal
RR <25
Pulse <110
Severe asthma attack
PEFR 33-50% of best
Can’t complete sentences
RR >25
Pulse >110
Life-threatening asthma attack
PEFR <33% Oxygen <92% Silent chest, cyanosis, feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma
Klebsiella can cause pneumonia in alcoholics, what other lung symptoms may it cause?
Commonly causes lung abscesses and pleural empyema
What is Pott’s disease?
TB in the vertebrae
Treatment of small cell lung cancer
Chemotherapy and radiotherapy
Which testicle normally hangs lower?
Left testicle
remember may be opposite in Kartagener if they have situs invertus
Low glucose in pleural fluid
Rheumatoid arthritis
Tuberculosis
Raised amylase in pleural fluid
Pancreatitis, oesophageal perforation
Heavy blood stained pleural fluid
Mesothelioma, pulmonary embolism, tuberculosis
What can improve survival in COPD?
1) smoking cessation - this is THE most important thing
2) long-term oxygen therapy
pO2 in hyperventilation
pO2 normal because no problem with gas exchange
Low pCO2 cos blowing it off
Where is the “safe triangle” for chest drain insertion?
5th intercostal space, mid-axillary line
Borders - lat dorsi, pec major and line superior to axilla and nipple
Histological finding in TB
Epitheliod histiocytes
COPD symptoms in a young person, what diagnosis should you think of?
Alpha-1-antitrypsin deficiency
Which antibodies might you see in idiopathic pulmonary fibrosis?
ANA
Symptoms and signs of pulmonary oedema
Bibasal crackles and S3 are the most reliable signs
What can you tell me about aspergilloma?
Often past history of TB
Haemoptysis may be severe
CXR shows rounded opacity
Emphysema in which lobe zone in COPD?
Upper lobe
Emphysema in which lobe in alpha-1-antitrypsin
Lower lobes
What is Meig’s syndrome?
OAP
Ovarian tumour
Ascites
Pleural effusion
How does pulmonary TB spread?
Through the pulmonary venous system
If patients are taking inhaled steroids, what should they do after they’ve used them?
Rinse mouth straight after so you don’t get thrush
COPD FEV1 >50%
LABA or LAMA
COPD FEV1 <50%
LABA + ICS
or LAMA
Commonly causes a cavitating pneumonia in alcoholics and diabetics
Klebsiella (more common in upper lobes)
Klebsiella - upper or lower lobes?
Upper lobes (think of window sills, they are higher - windowsiella)
COPD and bronchodilators
COPD doesn’t really improve after bronchodilators (in response to asthma)
Symptom control in non-CF bronchiectasis
Inspiratory muscle training and postural drainage
Why do you use inhaled corticosteroids in COPD?
To reduce the FREQUENCY of exacerbations
Causes of upper zone fibrosis?
- Coal worker’s pneumoconiosis
- Histiocytes/hypersensitivity pneumonia
- Ankylosing spondylitis
- Radiation
- Tuberculosis
- Silicosis/sarcoidosis
Idiopathic pulmonary fibrosis - which lobe?
Lower zones
When is bupropion contrindicated
Epilepsy
What are the boundaries of the safe triangle?
Latissimus dorsi
Pectoralis major
Line superior to nipple and apex at the axilla
Bupropion mechanism of action?
Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist.
Recognised feature of renal adenocarcinoma?
Polycythaemia
