PACES__Respiratory Flashcards
What phase of respiration is prolonged in COPD?
Expiration
What are the 6 key points of COPD management
- Smoking cessatioN
- SABA
- LAMA/LABA
- Inhaled corticosteroids
- Pneumococcal and influenza vaccination
- Pulmonary rehabilitation
Name 4 common bacterial causes of pneumonia.
- Strep pneumoniae
- Staph aureus
- Haemophilus influenzae
- Mycoplasma pneumonia
What 3 bacteria are associared with atypical pneumonia?
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Legionella
What are the 7 respiratory causes of clubbing (A-F)
Abscess and asbestosis
Bronchiectasis
Cystic fibrosis
‘Dirty tumours’
Empyema
Fibrosing alveolitis
What are the congenital causes of bronchiectasis? (5)
- CF
- Young’s syndrome
- Kartageners syndrome
- Yellow nail syndrome
- Abnormal anatomy
What additional feature to bronchiectasis can be elicited to support a diagnosis of Kartageners syndrome?
Dextrocardia/situs invertus
What 3 additional featires on exam support a diagnosis of yellow nail syndrome?
- Yellow nails
- Pleural effusion
- Lymphoedema
What 3 childhood infections predispose to bronchiectasis?
- Pertussis
- Measles
- TB
Give one cause of an overactive immune system and 3 causes of an underactive immune system which may pre-dispose to bronchiectasis.
Overactive- Allergic bronchopulmonary aspergillosis
Underactive- Hypogammaglobulinaemia, HIV, leukaemia
What is the pathogenesis of CF?
-Autosomal recessive defect due to mutation in the CFTR gene. Most common cause is dF508.
-This deletion prevents chloride moving out of the cell and leads to thick secretions in the airways
What are the 3 major pathogens associated with bronchiectasis?
Pseudomonas aeruginosa
Haemophilus influenza
Steptococcus
What are the 4 main pulmonary complications of bronchiectasis?
- Recurrent infection
- Haemoptysis
- Empyema/abscess
- Cor pulmonale
What are the 3 main extrapulmonary complications of bronchiectasis?
- Anaemia
- Metastatic infection
- Secondary amyloidosis
What 4 other conditions are known to be associated with bronchiectasis?
- CTD
- Chronic sinusitis
- IBD
- Marfan’s syndrome
TB cause predominantly basal or apical signs?
Apical
What staining investigation is indicated in suspected TB?
Ziehl-Neelsen/auramine staining of 3 sputum samples
What are the main side effects of TB medications?
Rifampicin: CYP450 Inducer, red discolouration of secretions and urine
Isoniazid: Hepatitis, peripheral neuropathy
Pyrazinamide: Hepatitis, peripheral neuropathy, gout
Ethambutol: Optic neuritis
What 5 examination findings are consistent with pulomonary hypertension?
- Parasternal heave
- Palpable P2
- Raised JVP
- Hepatomegaly
- Peripheral oedema
What are the 8 causes of upper zone pulmonary fibrosis?
- Coal workers pneumoconiosis
- Hypersensitivity pneumonitis
- Ankylosing spondylitis/ABPA
- Radiation
- TB
- Silicosis/Sarcoidosis
What is Hamman-Rich syndrome?
An acute rapidly progressive lung fibrosis also known as acute interstitial pneumonia (AIP). It may respond to steroids but has a poor overall outcome.
What is the major drawback of high resolution CT?
HRCT is a form of non-continuous cross sectional imaging. Small lesions may be missed between slices.
What are the 6 main categories of treatment for pulmonary fibrosis?
- Corticosteroids
- Immunosuppressives (cyclophosphamide, azathioprine, methotrexate and ciclosporin)
- Anti-fibrotics
- Anti-oxidant (N-acetylcysteine in conjunction with with corticosteroids and azathioprine)
- Supplemental oxygen (PaO2 7.3kpa or 8kPa with cor pulmonale)
- Lung transplantation</div>
Describe the 5 possible respiratory manifestations of rheumatoid arthritis
- Pleural effusions/pleurisy
- Pulmonary nodules
- Fibrotic lung disease
- Caplan syndrome (coal worker pneumoconiosis and RA)
- Obliterative bronchiolitis
Give 4 causes of transudative pleural effusion
Congestive cardiac failure
Hypoalbuminaemia/hypothyroidism
All failures (cardiac, renal, hepatic)
Meig’s syndrome
**Mechanism:
Increased Hydrostatic Pressure: Imagine water being pushed through a garden hose with high pressure—fluid leaks out. This is what happens in heart failure where blood pressure builds up in lung vessels.
Decreased Oncotic Pressure: Think of oncotic pressure as a sponge keeping fluid inside blood vessels. Low protein levels mean a weaker “sponge,” so fluid escapes.
Fluid Composition: The fluid is watery and low in proteins.
Give 5 causes of exudative pleural effusion
Think PINTS of eggs
Pneumonia
Infarction
Neoplasm
TB
Sarcoidosis/Scleroderma
**Mechanism:
Inflammation damages the blood vessel walls, making them more permeable, like a net with big holes. This lets proteins and immune cells leak out with fluid.
Fluid Composition: The fluid is thick, cloudy, and high in proteins and cells.
What is Light’s criteria?
Light’s Criteria help distinguish between transudative and exudative effusions by analyzing the pleural fluid and comparing it to blood. If any one of the following is true, it’s considered exudative:
- Pleural fluid protein/serum protein ratio > 0.5 (Is the pleural fluid protein significantly higher than expected? In exudates, yes.)
- Pleural fluid LDH/serum LDH ratio > 0.6 (LDH is an enzyme released with tissue damage; higher ratios indicate exudative effusion.)
- Pleural fluid LDH > two-thirds the upper limit of normal serum LDH
Outline 5 major processes that lead to pleural effusions.
- Increased hydrostatic pressure or decreased oncotic pressure (transudates)
- Increased capillary permeability (exudates)
- Disruption of lymphatic duct (chylothorax)
- Infection of pleural space (empyema)
- Bleeding into pleural space (haemothorax)
Are there weaknesses of Light’s criteria in differentiating transudates and exudates?
Yes, 25% of patients with transudates are mistakenly identified as having exudates by Light’s criteria.
What is the triad of Horner’s syndrome?
- Unilateral ptosis: Drooping of the upper eyelid due to weakness of the muscle that lifts the eyelid (Müller’s muscle).
- Unilateral miosis: Constricted pupil due to unopposed parasympathetic activity.
- Anhidrosis: Loss of sweating on the affected side of the face (sometimes only in a part of the face, depending on the site of nerve damage).
What 2 MSK paraneoplastic syndromes are associated with lung malignancy?
- Hypertrophic pulmonary osteoarthropathy (clubbing and pain and swelling at wrists and ankles)
- Polymyositis
Name 4 neurological paraneoplastic syndromes associated with lung cancer
- Lambert-Eaton syndrome
- Proximal myopathy
- Peripheral neuropathy
- Cerebellar syndrome
Name 4 endocrine paraneoplastic syndromes associated with lung cancer
- SIADH
- Hypercalcaemia
- Cushing’s syndrome (Ectopic ACTH release)
- Gynaecomastia (HCG secreting tumour)
Name 4 dermatological paraneoplastic conditions in lung cancer.
- Thrombophlebitis migrans
- Acanthosis nigrans
- Erythema gyratum repens
- Dermatomyositis
Name 4 procedures which may leave someone with a thoracotomy scar
- Pneumonectomy
- Lobectomy
- Open lung biopsy
- Oesophagectomy
What is post-pneumonectomy syndrome? How is it treated?
-Post-pneumonectomy syndrome occurs to extrinsic compression of the distal trachea due to mediastinal shifting and hyperinflation of the remaining lung.
-Treatment involves surgical repositioning of the mediastinum.
-Condition can be fatal if left untreated.
Is there a discrepancy in morbidity/mortality between right and left sided pneumonectomies?
Yes. Right sided pneumonectomies are associated with much higher rates of complication. The cause for this is unclear.
What is the definition of pulmonary hypertension?
Mean pulmonary arterial pressure >25mmHg with a pulmonary capillary or left atrial pressure <15mmHg
Name 4 common causes of cor pulmonale
- COPD
- Interstitial lung disease
- OSA
- Hypoventilation disorders (obesity related, neuromuscular disorders, kyphoscoliosis)
What are the 5 subtypes of pulmonary hypertension?
- Pulmonary arterial hypertension
- Pulmonary venous hypertension
- Pulmonary hypertension associated with hypoxaemia
- Pulmonary hypertension due to chronic thrombotic or embolic disease
- Pulmonary hypertension associated with miscellaneous disorders such as sarcoidosis and Langerhans cell histiocytosis
The combination of chronic shortness of breath + pleuritic chest pain and features of right sided heart failure should make you think of what condition?
Pulmonary hypertension
