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Year 3 - TCD > Other notes > Flashcards

Other notes Flashcards

1
Q

What is pulmonary fibrosis?

A

Thickening and scarring of lung tissue, with gas exchange being affected

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2
Q

What type of lung disease is pulmonary fibrosis?

A

Restrictive

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3
Q

What are the causes of upper zone pulmonary fibrosis? (A TEA SHOP)

A
  • ABPA (allergic broncho-pulmonary aspergillosis)
  • TB
  • Extrinsic allergic alveolitis
  • Ankylosing Spondylitis
  • Sarcoidosis
  • Histiocytosis
  • Occupational (silicosis, berylliosis)
  • Pneumoconiosis (coal-worker’s)
  • Can also be idiopathic
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4
Q

What drugs can cause pulmonary fibrosis?

A
  • Nitrofurantoin (for UTIs)
  • Methotrexate
  • Amiodarone (for arrhythmias)
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5
Q

What are the symptoms of pulmonary fibrosis?

A
  • Exertional dyspnoea
  • Persistent non-productive cough
  • Fatigue
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6
Q

What investigations are done for pulmonary fibrosis?

A
  • Auscultation – bibasilar, fine end-inspiratory crackles or rales
  • Pulmonary function tests – high/normal FEV1/FVC ratio (restrictive lung disease)
  • HR CT is best form of imaging. - CXR may show reticular shadowing
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7
Q

How to treat pulmonary fibrosis?

A
  • Antibiotics (bacterial interstitial pneumonia)

- Corticosteroids

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8
Q

What are the risk factors for a pneumothorax?

A
  • Family history
  • Slim, tall
  • Smoker
  • Male
  • Marfan’s syndrome
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9
Q

What are the symptoms of a pneumothorax?

A
  • Sudden, severe, and/or stabbing, ipsilateral pleuritic chest pain
  • Dyspnoea
  • Reduced, or absent breath sounds
  • Hyper resonant percussion,
  • Decreased fremitus on the ipsilateral side
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10
Q

Which way does the trachea deviate in tension pneumothorax and pleural effusion?

A
  • PUSHES away from affected lung
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11
Q

Which way does the trachea deviate in collapse?

A
  • PULLED towards affected lung §
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12
Q

What is seen on CXR for pneumothorax?

A
  • Reduced/absent lung markings
  • Changes in radiolucency – collection of air will appear darker
  • Deep sulcus signs – dark and deep costophrenic angle on affected side
  • Tracheal deviation in tension
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13
Q

What are respiratory causes of clubbing?

A
  • Fibrotic lung disease e.g. idiopathic pulmonary fibrosis
  • Chronic suppurative (pus producing) lung disease (bronchiectasis, chronic abscesses)
  • Lung cancer (all except small cell)
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14
Q

What are the cardiac causes of clubbing?

A
  • Infective endocarditis
  • Atrial myxoma
  • Congenital cyanotic heart disease
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15
Q

What are the gastro causes of clubbing?

A
  • IBD (not IBS!)
  • Coeliac disease
  • Cirrhosis
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16
Q

What are other causes of clubbing?

A
  • Thyroid acropachy

- Idiopathic/familial

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17
Q

What should be given in allergic reaction?

A

IM adrenaline

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18
Q

What medication should not be given in PAD?

A

Beta blockers

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19
Q

What are the classic features of venous ulcers?

A
  • Red
  • Oozing
  • Irregular margins
  • Shallow
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20
Q

What are the classic features of arterial ulcers?

A
  • Pale
  • Painful
  • Punched out
  • Well defined borders
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21
Q

What are the classic features of neuropathic ulcers?

A
  • Over pressure areas (painless ulcers)
  • Associated with sensory neuropathy
  • Burning, tingling in legs
  • Warm with good pulses
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22
Q

What are the symptoms of appendicitis?

A
  • Progressive fever
  • Anorexia (hamburger sign)
  • Nausea, vomiting, diarrhoea, and/or constipation
  • Initially, dull migratory periumbilical pain, after 4–24 hours, sharp RLQ pain with rebound tenderness
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23
Q

What are the signs of appendicitis?

A
  • McBurney point tenderness: an area one-third of the distance from the right anterior superior iliac spine to the umbilicus (in the RLQ)
  • Rovsing’s sign: deep palpation of the LLQ causes RLQ referred pain
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24
Q

What are the investigations for appendicitis?

A
  • FBC: Raised CRP, Mild leucocytosis
  • Urine analysis: useful to exclude pregnancy in women, renal colic and urinary tract infection.
  • Abdominal and pelvic CT:
    • Abnormal appendix (diameter >6 mm) identified or calcified appendicolith
    • Wall thickening, wall enhancement, and inflammatory changes in the surrounding tissues.
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25
Q

What is the treatment for appendicitis?

A
  • Appendicectomy

- Prophylactic intravenous antibiotics reduces wound infection rate

26
Q
  • What is sarcoidosis?

- Who is more likely to get sarcoidosis?

A
  • Granulomatous inflammatory condition. Granulomas are nodules of inflammation full of macrophages.
  • Women more likely, African people more likely
27
Q

What are the symptoms of acute sarcoidosis?

A
  • General: fever, malaise, lack of appetite, weight loss
  • Pulmonary: dyspnea, cough, chest pain
  • Extrapulmonary: arthritis, anterior uveitis, erythema nodosum
28
Q

What are the pulmonary symptoms of chronic sarcoidosis?

A
  • Dry cough, exertional dyspnoea

- Mild rales on pulmonary auscultation.

29
Q

What are the extrapulmonary symptoms of chronic sarcoidosis?

A
  • Peripheral lymph nodes
  • Eyes: granulomatous uveitis, blurred vision
  • Skin: Lupus pernio, Scar sarcoidosis
  • Musculoskeletal; bone lesions
  • Nervous system (neurosarcoidosis): cranial nerve palsy (7th cranial nerve palsy is the most common), diabetes insipidus, meningitis, hypopituitarism
30
Q

What is Lupus pernio?

A

Pathognomonic, extensive, purple skin lesions on the nose, cheeks, chin, and/or ears

31
Q

What is scar sarcoidosis?

A

Inflamed, purple skin infiltration and elevation of old scars or tattoos

32
Q

What 2 syndromes are associated with sarcoidosis?

A
  • Lofgren’s syndrome

- Heerfordt’s syndrome

33
Q
  • What are the symptoms of Lofgren’s syndrome?

- Which condition does it affect?

A
  • Bilateral hilar lymphadenopathy (BHL)
  • Erythema nodosum: primarily affects the extensor surface of the lower legs
  • Polyarthralgia: symmetrical arthritis that primarily affects the ankles
  • Fever
  • Sarcoidosis
34
Q
  • What are the symptoms of Heerfordt’s syndrome?

- Which condition does it affect?

A
  • Fever
  • Parotitis
  • Uveitis
  • Facial palsy
35
Q

What are the FBC findings for sarcoidosis?

A
  • Raised serum ACE:screening test
  • Hypercalcaemia
  • Raised serum soluble interleukin 2 receptor
  • Raised CRP and ESR
  • Raised immunoglobulins
36
Q

What are imaging findings for sarcoidosis?

A
  • Chest X-ray shows hilar lymphadenopathy
  • High resolution CT thorax shows hilar lymphadenopathy and pulmonary nodules
  • MRI can show CNS involvement
  • PET scan can show active inflammation in affected areas
  • Tissue biopsy (gold standard): non caseating granulomas
  • Spirometry: may show restrictive defect
37
Q

What is the treatment for sarcoidosis?

A
  • Asymptomatic: no treatment
  • 1st line: Glucocorticoids (6-24 months)
  • 2nd line: Methotrexate or azathioprine
38
Q
  • What is methotrexate given for?
  • How often can methotrexate be given?
  • What should be given with methotrexate?
A
  • Chemotherapy and immunosuppressive agent
  • Once a week
  • Folic acidly the days methotrexate isn’t given on as it can lower folic acid levels.
39
Q
  • What is Wernicke’s encephalopathy?
  • What are the features of this?
  • What can it lead to?
A
  • Result from thiamine deficiency due to alcohol excess
  • Confusion
  • Opthalmaplegia (disturbances of eye movements)
  • Ataxia (difficulties with coordinated movements)
  • Korsakoff’s syndrome
40
Q

What are the features of korsakoff’s syndrome?

A
  • Anterograde amnesia: unable to make new memories
  • Retrograde amnesia: unable to recall past memories
  • Confabulation: made-up stories fill in any gaps in memory.
41
Q
  • What is fat embolism?

- What are the causes of this?

A
  • Entry of fat cells into the circulation
  • Long bone fractures
  • Orthopedic surgery
  • Bone marrow transplant
  • Sickle cell crises
42
Q

What is the presentation of a fat embolus?

A
  • Multiple fractures followed by early onset (within 24 hours) of hypoxia, dyspnea, and tachypnea
  • Neurologic manifestations: acute confusional state and altered level of consciousness to seizures and focal deficits
  • A petechial rash: only appears in about a third of cases.
43
Q
  • What Henoch-Schonlein Purpura?
  • Who does it present in?
  • What is it triggered by?
A
  • IgA vasculitis that presents with a purpuric rash affecting the lower limbs and buttocks in children.
  • Most common in children under the age of 10.
  • Upper airway infection or gastroenteritis.
44
Q
  • What are the symptoms of Henoch-Schonlein Purpura?

- What is the onset of these symptoms?

A

The 4 classic features are:

  • Purpura (100%): palpable, non-blanching rash.
  • Common sites: lower extremeities, buttocks, areas of pressure (from socks or clothing)
  • Joint pain (75%): common in ankles and knees
  • Abdominal pain (50%) : colicky abdominal pain, bloddy stools, N+V
  • Renal involvement (50%) : signs and symptoms of nephritic syndrome
  • 1-3 weeks after an infection
45
Q

What is the treatment for Henoch-Schonlein Purpura?

A

Most cases of HSP are self-limiting and only require supportive care (pain management with NSAIDs), rest and adequate hydration.

46
Q

Which type of infection leads to neutrophils to be raised?

A

Bacterial

47
Q

Which type of infection leads to eosinophils to be raised?

A

Allergy and parasitic infection

48
Q

Which type of infection leads to lymphocytes to be raised?

A

Chronic inflammation and acute viral infections

49
Q

What leads to IgE to be raised?

A

Allergic asthma, malaria and type 1 hypersensitivity reactions

50
Q

Which antibody is used to diagnose rheumatoid arthritis?

A

Anti-CCP antibody

51
Q

Which antibody is used to diagnose SLE?

A

Anti nuclear antibodies (ANA) in particular antibodies to dsDNA

52
Q

How to treat primary pneumothorax?

A
  1. If no SOB and there is a < 2cm rim of air then no treatment required.
  2. If SOB and/or there is a > 2cm rim of air, then aspirate.
  3. If aspiration fails twice, then chest drain.
53
Q

How to treat secondary pneumothorax?

A
  1. If the patient is > 50 years old and the rim of air is > 2cm and/or the patient is SOB then so chest drain
  2. Otherwise aspiration should be attempted if the rim of air is between 1-2cm.
  3. If less than 1cm then the give oxygen and admit for 24 hours.
54
Q

How to treat tension pneumothorax?

A
  1. Aspirate prior to CXR

2. Chest drain

55
Q
  • Where is chest aspirated?

- Where is chest drain placed?

A
  • 2nd ICS mid clavicular line (also known as needle thoracostomy)
  • 5th ICS mid axillary line
56
Q
  • What happens in ARDS?
A
  • Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli.
57
Q

What are the causes of ARDS?

A
  • Traume
  • Pneumonia
  • Sepsis
  • Shock
  • Massive blood transfusion
58
Q

What are the signs and symptoms of ARDS?

A

Dyspnoea, tachypnoea, bilateral basal crepitations, low oxygen saturations

59
Q

How to diagnose ARDS?

A
  • Acute onset (within 1 week of known risk factor)
  • PCWP – pulmonary capillary wedge pressure <19 mmHg
  • CXR – bilateral diffuse infiltrates
60
Q

How to treat ARDS?

A
  • Oxygenation/ventilation to treat the hypoxaemia
  • General organ support e.g. vasopressors as needed.
  • Treat underlying cause
61
Q

What is atelectasis?

A

Common postoperative complication in which basal alveolar collapse can lead to respiratory difficulty

62
Q
  • What are the features of atelectasis?

- What is the menagement?

A
  • Dyspnoea and hypoxaemia around 72 hours postoperatively

- Chest physiotherapy

Year 3 - TCD (17 decks)

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