Pass Test Flashcards
meigs syndrome describes
association between benign ovarian tumour and a transudate pleural effusion
Ca-125 suggests
could be an ovarian tumour
- penetrating chest trauma
- falling 02 sats
- reduced breath sounds in right hemithorax
- cardiovascular compromise
suggest
tension pneumothorax
treatment for tension pneumothox when haemodynamically unstable
- needle aspirate then chest drain
chest drain is definitve treatment but takes too long to set up so needle immediately - is a temporary measure before chest drain
bilateral, fine, late inspiratory crackles, more marked in the mid zones and lung bases. cxr shows patchy shadowing at lung bases
what and what treatment
IPF and HRCT
breathlessness and tight shiny skin over fingers
Sclerodactyly
erythema nodosum is associated with
inflammatory bowel disease
death from deep vein thromobosis and then PE. what vessel most likely affected to cause the death
PULMONARY ARTERY
tb underlying mechanism
IV Hypersensitivity reaction
is salbutamol a b2 adrenoceptor agonist or antagonist
agonist
broncnhial smooth muscle contains what adrenoceptor
b2
post bone marrow/ heart or lung transplant with obstructive results hints
Bronchiolitis obliterans
– presents with yellow deformed nails, lymphoedema and exudative pleural effusion or other resp involvement
yellow nail syndrome
yellow nail syndrome is associated with
nephrotic syndrome, protein-losing enteropathy, B cell deficiency
sarcoidosis causes what kind of pleural effusion
exudate
sarcoidosis, tb or carcinoma what kind of effusions
exudate
baker presents with rhinitis, breathlessness and wheeze that has gotten worse since returning from 2 week holiday to spain
occupation asthma, not legionella
As bakers asthma commonly caused by allerfy to alpha amylase, enzyme in flour. symptoms of occupational asthma ussually improve when away from work so fact its worsen now hes returned makes sense.
legionella would more present with nausea, vomitting, diarrhoea
- cxr= multiple rounded lesions and alveolar shadowing
- positive for c-ANCA
granulomstosis with polyangiitis
comon cuases of chronic cough with normal cxr and spirometry, no red flags in non somker is
snd what test
cough variant asthma, GORD, post nasal drip
suggests cough variant asthma so bronchial provocation testing
if got dry cough, unable to provide a
sputum sample for sputum culture
operation of one way valve system, drawing air into the pleural space during inspiration and not allowing it out during expiration
tension pneumothorax
left sided chest pain, reduced air entry at left base of the lung, hyper-resonant percussion sounds at the left side of the chest.tender abdomen, then becomes cyanosed
Tension pneumothorax
if pH between 7.25 and 7.35 should consider
non-invasive ventilation
most common lobe affected in klebsiella
right upper lobe
klebsiella is best treated with
carbapenams eg metropenem
atypical epithelial tubules in a sarcomatous background or carcinomatous
Mesothelioma
malignant mesothelioma in electron microscopy
epithelial cells have long thin microvilli
pleomorphic cells in a cluster with keratin pearls and intercellular bridges
squamous cell carcinoma of the lung
large undifferentiated anaplastic cells
large cell carcinoma of the lung
neoplastic cells forming mucinous glands
pulmonary adenocarcinoma
next treatment for acute asthma attack after sablutamol, ipratropium, hydrocortisone
magnesium sulphate
got asthma and gotten worse due to a cold what do you do to treat and peak flow dropped significantly
oral steriod - prednisolone
first treatment for asthma in kids 5-12
salbutamol
if had overdose, check
salicylate levels
hyperventillating few days after fracture of femur in car crash. he is cyanosed what test
ABG
smell pear drops
diabetes so measure blood glucose levels
if suspect chest infection do
CXR
shaking epsiodes is common in
infections - pneumonia, cholangitis, empyema, some abscesses
history of sibling being unwell and history of repeated hospital admisssions with features such as severe chest pain, difficulty breathing can suggest
hereditary disease and so do blood count and film
sickle cell anameia
in pneumonia chest expansion is likely to be
normal
stony dull is
effusion and not pneumonia
V/Q scan may be preferred over CTPA for pE when
renal impairment
pregnacy and contrast allergy
CTPA uses radiocontrast which is nephrotoxic
upper lobe bronchiectasis could be due to
middle lobe
lower lobe
central
Cf, tb
immotile cilia sydrome, myobacterium avium
interstitial lung disease, aspiration
ABPA
ocassionally balck sputum, high eosinophills, raised igE suggests allergic bronchopulmonary aspergilosis and on CT you will find
Central cystic/ varicose bronchiectasis in multiple lobes
-bronchiectasis mainly in upper lobes and mainly in a single lobe associated with
asthma
tb is frequently in the lung
apices
pneumonia is typically affects the elderly, typically after influenza
staph. aureus
can cause meningitis and pneumonia
h. influenzae
what orgainsms are foul smelling
anaerobes
Long term oxyge therapy can be used inn – patients
COPD
signs of hypercapnia
flapping tremor, bounding pulse, palmar erythema
hypercalcaemia is typically seen in
squamous cell bronchial carcinoma
associated with pleural thickening on CXR
mesothelioma
SOB, palitations,, syncope,exertional asthma and bilateral ankle swelling
Familial Primary Pulmonary Hypertension
air-crescent sign on CT
Aspergillus
where would you do thoracentesis
above the 5th rib in the mid axillary line
lung bipsy shows non caseating granulomas
sarcoidosis
confirm diagnosis of sarcoidosis
Lung biopsy
what can you develop from amiodarone
pulmonary fibrosis
actinomycetes thrive in
mouldy hay
Contralateral tracheal deviation, reduced chest expanisons , increased resonance on percussion, absent breath sounds
tension pneumothorax
Gold standard investigation for pulmonary fibrosis
High resolution CT
Gold standard investigatio for PE
CTPA
each lung has how many bronchopulmonary segments
10
The lungs recieve a dual blood supply by the
pulmonary artery and bronchial arteries
stop for breath after about 100m of walking on level ground is what on the MRC dynspnoea scale
3
Best investigation for a effusion is a
pleural aspirate as it measures protein content and determines whether the fluid is an exudate or a transudate
Low serum calcium, phosphate and high ALP
Vitamin D deficincey (VDD)
what 2 drugs cause vitamin D deficinecy
Rifampicin and isoniazid
V leiden mutation and smoking predisposes to
clotting
V leiden mutation, SOb , chest pain, erythematous , swollen left lower extremity
DVT and PE
CXR- wedge shaped opacity representing occlusion of a vessel within the lung parenchyma supplying a lung segment
PE
like an exacerbation of cystic fibrosis
bronchiectasis
treatmetn for cf patient with Pseudomoans aeruginosa
ciprofloxacin
clubbing, cyanosis and florid crepitations at both bases
bronchiectasis
what is contraindicated in massive haemoptysis
NON-INVASIVE VENTILLATION
(increased risk of aspiration of blood if a ventillation mask is worn)
immediate treatment for tension pneumothorax
high flow 02
aspirate using a 16-18G cannila into teh second anterior intercostal space mid clavicular line
if primary penumothorax and less than 2cm but still breathless then do
aspirated and if fails then chets drain
if primary pneumothorax less than 2 cm and asymptomatic then
discharge home
to be considered for lung transplant patients with COPD should have FEV1
<25%
contraindications to lung transplant
Fev1<25%
BMI>35
Active infection of tb
>65 years old
malignancy in the past 2 years
Interstitial inflammation, chronic bronchiolitis, non-necrozing granuloma
Hypersensitivity pneumonitis
hypersensitivity pneumonitits or
farmers lung
Lung biopsy of aspergillosis shows
hyphae with vascular invasion and surrounding tissue necrosis
several epsiodes of pneumonia as a child and then now developing cough with sputum and SOB
Bronchiectasis
patient had cough with green sputum and fever and rigors and now increased Resp rate and HR and bronchial breathing at left lung base
Sepsis secondary to pneumonia and new onset of atrial fibrillatio is secondary to sepsis. so treat sepsis with IV antibitoics
despite having normal cxr, patient has tiredness, persisitent cough (>3weeks) , haemoptysis in a smoker could still indicate underlying lung cancer and so
refer patient urgently to chest physician with suspected lung cancer
Smoker presenting with a cough first investigation?
also if suggests horners syndrome
CXR
CT-pet scan is used
for staging when cancer is confirmed
Primary tb causes a – in the lungs, reactivation of which leads to secondary tb
ghon focus
tb sytoms with high eosinpihil count
eosinophilia
eosinophilia investigation and treatment
definitive diagnosis - lung biopsy
therapy -steriods - prednisolone
adult onset asthma or atopy, fever, weight loss,
eosinophilia
tb does not give
eosinophilia
for severe copd oxygen should be
24-28%venturi mask or 2-4 litres via simple mask but prefereably venturi
pulmonary manifestation of aspergillus infection
allergic asthma
hypersensitivity pneumonitis or extrinsic allergic alveolitis are type — hypersensitivity reactions
3
5 y/o w asthma on ICS and SABA next step is
add LTRA then Add LABA then icnrease dose of ICS
first choice for community acquired pneumonia
amoxicillin
flucloxacillin added if there is associated influenza or other reason to susspect a staph infection
bronchial carcinoma with low sodium
hypercalcaemia
Small cell
squamous
women w asthma want to know why she continues to wheeze hours after exposure to pollen
inflammation followed by mucosal oedema
young person with dysnpnoea after previosu pneumothorax and bone fracture, smokes, cxr- infiltration in both upper zones
Pulmonary histiocytes
primary pneumothorax . 2cm and tension pneumothorax should recieve
needle thoracentesis
in traumatic pneumothorax(stabbing) needle aspiration is not recommended and a — should be inserted
chest drain
primary pneumothorax less than 2 cm not breathless but causing discomfort=
discharged and cxr in 2-4 weeks
should not be advised to fly fo at least 1 week and not allowed to dive unless peurodesis or pleurectomy is performed
cavitating tumours most commonly occur in what kind of carcinomas
squamous cell
hoarsness of voice is caused by invasion of what nerve
recurrent laryngeal nerve
what nerve involvement causes a raised hemidiaphragm
phrenic nerve
ACTH may occur in
small cell carcinomas
Reduction of FEV1 by 20-30% and PEFR by about 30% is consistent with
normal ageing
episodes of breathless after being treated w steriods for sarcoidosis. what would be initial test
Pulmonary fucntion tests with transfer factor
typically has reduced transfer factor. Transfer factor is a goood initial test for response to treatment. It is a good initial but not always the best so chec wording of question
not check ace levels
ABG will help guide
oxygen therapy
appears with asthma like symptoms 24 hrs after exposure to irritant gases/ vapours or fumes.
RADS and do metacholine challenge test
Low sodium in small cell cancer patients is because of
Sydrome of inappropriate antidiuretic hormone secretion
treatment for Reactive airway dysfunction sydrome
Inhaled bronchodilators eg salbutamol
what does not cause mesothelioma
smoking
investigation for diagnosis of mesothelioma is
CT
ground glass opacity surrounded by denser lung tissue is known as
atoll sign
signet ring sign is found in
bronchiectasis
tree bud sign is typical of
endobrocnhial tb
halo signs are found in
angioinvasive aspergillosis
first choice for occupation asthma
redemployment to another role is possibel
patient having asthma attack - unable to talk in full sentences. despite 02 being 96% and other things being normal , peak flow is make it life threatening and so should give
oral prednisolone, commence salbutamol nebuliser and high flow o2, and call ambulance
unilateral pleural effusions are usually caused by local pathology such as
trauma, tumour or infection
pleural effusion on cxr
dependent area with lateral meniscus- ican t quite see this
where put chest drain
THE BOTTOM OF THE 5TH INTERCOSTAL SPACE IN THE MID AXILLARY LINE
CURB65 3 OR GREATER
INTESIVE CARE
CURB65 0 OR 1
HOME
husband owns pigeon
idiopathic pulmonary fibrosis
idiopathic pulmonary fibrosis tends to be – of lung
hypersensitivity pneumonitis tends to be lung –
lower zone predominance
apices
airborne irritants tend to affect lung –
apices
affecting base of lung =
apices=
IPF
hypersensitivity pneumonititis
causes of pulmonary fibrosis
blecomycin, azathioprine, pneumoconisosis, occupational lung disease
treatment for kid with OSA
adenotonsillectomy
no evidence that oxygen helps copd patients who are breathless unless breathless is accompanied by
hypoxia
LTOT is recommended when copd patient pa02 is less than — when stable
7.3
what should not be prescribed to patients that experience seizures
Bupropion
Cf causes
pancreatic insufficiency
kartagener syndrome
- recurrent resp infections
- chronic sinusitis
- infertility
- dextrocardia
fluid level in a retrocardiac structure can indicate
hiatus hernia ( stomach slips through the diaphragm) may cause reflux
in chest drain what is not penetrated
visceral pleura
order of structures encountered when chest tube inserted
skin, external intercostal muscle, internal intercostal muscle, innermost intercostal muscle, parietal pleura
what causes symptoms of asthma at night
lower levels of cortisol
bilateral crackles and wheeze on auscultation, right sided heart failure( raised JVP and peripheral oedema),
congestive cardiac failure
in type 1 resp failrue
pa02 is low and paco2 is normal
type 2 resp failure
pa02 is low anad paco2 is elevated
Guillian-barre syndrome presents with
ascending weakness, loss of sensation and abscence of deep tendon relfexesand patient can develop resp failure
often secondary to resp tract infections
and cause type 2 resp failure
hypoxia, hypercapnia and acidosis
type 2 resp failure
pleural rub occasionaly found in
PE
difference between typical and mycoplasma pneumonia on cxr
typical- consolidation and mycoplasma- patchy reticulonodular opacities
fever and breathless after surgery on urogenital or GI tract. early diastolic murmur. urine dipstick positivce for blood. clubbing
Infective endocarditis
young or middle agesd person most common cause of clubbing is
broncheictasis
despite asbestos exposure evidence of horners syndrome suggests
squamous cell cancer
what cancer is not associated with clubbing
small cell bronchial carcinoma
cystic fibrosis, – and crohns disease can all cause malabsorption, growth delay and clubbing.
coeliac disease
coeliac is most common at 15 as CF normally diagnosed when young childre or at birth
children with coeliac are often pale skinned with pale hair
unilateral clubbing can occur in
axillary artery aneurysm and coartication of the aorta
in IPF, the diffusion pattern for carbon monoxide is usually –
reduced
cxr of mesothelioma
pleural thickening
you can get — secondary to asthma
pneumothorax
what happens in complete right to left shunt
the alveolar po2 is normal but the arterial blood pa02 will be markably reduced and increasing inspired oxygen will have no effect on arterial pa02
fingers going white to blue then to red in cold weather
finger calcinosis and facial telangiectasia
pulmonary hypertension
Scleroderma
Patients with systemic lupus erythematosus may have a —-tendency due to antiphospholipid syndrome
thrombophilic
– is a risk factor for persistent pulmonary hypertension
Recurrent thromboembolic disease
sudden onset SOB post surgery, chest discomfort
PE
classical feature of p.jirovecii is
desaturation on exercise
p.jirovecii is a
fungal
rare complicatio of pulmonary fibrosis
rounded atelectasis where the scarred visceral and parietal pleura fold on themselves and trap the underlying lung
Most men with – are infertile but may still haev children with assited reproductive techniques
CF
sweat test, cf is indicated by
high levels of sodium chloride
tobacco workers lung
hypersensitivity pneumonitits
treatment for hypersensitivity pneumonitis
change job role
what antibiotics for chlamydia psittaci infection
tetracycline eg doxycycline
symptoms of chlamydia psittaci infection
maculopapular rash, lobar pneumonia, mild hepatitis( raised ALT,AST and bilirubin)
CT) Honeycombing gof the lung with parenchymal bands and pleural plaque , increased intralobular septae
Asbestosis
CXR bilateral reticulonodular opacities in the lower zones
asbestosis
prescence of pleural plaques helps confirm
asbestos exposure
hilar lymphadenopathy, upper zone fibrosis, eggshell calcification of nodes
silicosis
diffuse fibrotic bands with ground glass opacity
interstitial lung diseases
cavitation of upper zones
classic of tb but also ankylosing spondylitis
mutiple nodules in upper and mid zones with lower zone emphysema
Pneumoconiosis
combo of azoospermia and bronchiectasis (implied by history of long standing cough productive of purulent sputum)
CF
most common causative organism of colds
rhinovirus
high clinical suspicion of PE and has sinus tachycardia then next step is ——before diagnostic confirmation on CTPA
DOAC such as rivaroxaban or apixabanor LMWH
chronic exposure to asbestos increases the risk for – and mesothelioma. Alothough, mesothelioma is associated with asbestosis, it is rare and the risk of developing lung cancer is significantly higher than the risk fo developing mesothelioma
primary bronchogenic carcinoma
asbestos exposure with dyspnoea, haemoptysis and weight loss are more likely due to
primary lung cancer
Malgingant pleural effusions are
exudative
protein pleural : protein serum ratio>0.5
LDH pleural: LDH serum ratio>0.6
exudative
frank pus suggests there is a
empyema
aspiration of pus means there will be an — upon analysis
exudate
needle decompression site for tension pneumothorax
2nd intercostal space on the affected side
blood in thoracic cavity and rib fractures
haemothorax
in absence of frank pus early empyema can be suggested by
cloudy aspirate, neutrophilia
what is first line management for women who are pregnant or recently given birth who are trying to stop smoking
behavioural therapy
if got alpha 1 antitrypsin and receieves liver transplant increased risk fo what kind of emphsema
panacinar
what happens in the panacinar form of emphysema
entire acinus is enlarged from the resp bronchiole to the distal alveoli
centriacinar emphyema is related to exposure of
coal dust and tobacco products
centracinar emphysema is characterised by
enlargement of the central portion of the acinus
what emphysema’s are associated with scarring
paraseptal and compensatory
emphysema resulting from rib fracture( lung parenchyma) or whooping cough
interstitial
imobilasation after fracture particularly in elderly is significant risk for
DVT and then PE
coughing out gelatinous or or rigid casts is called
plastic bronchitis
acute presentation of sarcoidosis
lofgren syndrome
6month - 3year old presents with stridor
croup
accumulation of eosinophills in the lung secondary to passage of parasite alrvaes such as ascaris or strongyloides. charcotlyden crystals in sputum
loeffler syndrome
cardiac asthma produces
pink frothy sputum
smoking, cavitating lung lesion in middle lobe, weight loss, haemoptysis
squamous cell - centrally located and most commonly cavitates
small cell lung cancer does not commonly
cavitate
adenoncarcinoma usually originates in the
peripheral lung tissue, can cavitate but cavitataing is more common in squamous
large cell carcinoma does not commonly
cavitate
- worked with stone
- clubbed
- bilateral late inspiratory crackles at both lung bases
- upper zone nodular opacities
OCCUPATIONAL INTERSTITIAL LUNG DISEASE
not idiopathic plumonary fibrosis as strong association of working with stone suggest silica and silicosis
investigation for occupational interstital lung disease
HRCT
treatment for copd patient with acidotic type 2 resp failure
28%venturi mask and not go above 4L
CPAP CAN BE RESP FAILURE TYPICALLY DUE TO
PULMONARY OEDEMA ASSOCIATED WITH LEFT VENTRICUALR FAILURE
BiPAP can be used to treat resp acidosis due to exacerbation of copd but is not
first line
has breast cancer, suddenly collapses and wakes up with chest pain and breathlessness. Loud 2nd heart sound, ECG shows right axis deviation.
Right ventricular hypertrophy and pulmonary hypertension( loud P2). as suddenly collapses and has reduced exercise capacity cause is likely multiple emboli and cancer increased risk of dvt
-aspirating peanut, SOB, CXR shoes complete white out of right lung where peanut went and trachea moves towards that lung
atelectasis
pleural effusion causes – mediastinal shift
contralateral
CXR of pneumothorax
line in the lung space representing the visceral pleura and decreased lunk markings peripherally
crackles on ausculatioin
pulmonary oedema
chemical pneumonitis can be caused from exposure to
- body embalmers
- plastic,batteries, leather, rubber
oily susbstance aspirated caused chemical pneumonitis called
lipoid pneumonia
chemical pneumonia due to aspiration of gastric contents particualrly from analgesia
Mendelson syndrome
formaldahyde fumes can cause
chemical pneumonia, ARDS, asthma like symptoms
high concs can cause larygitis or chronic bronchitis
prolonged exposure- nasopharyngeal carcinoma
pulmonary haemorrhage can occur in diseases like
SLE
in hypersensitivity pneumonitis — is not a feature
eosinophilia
granulomatous reaction of lung parenchyma ooccurs after exposure to
berrylium
pain radiating to shoulder can be in
pnuemothorax
needles aspirated is put in where
2nd intercostal space on the affected side
type 2 resp failure and acidosis secondary exacerbation of copd should be given
non invasive ventilation eg BiPAP
if highly suspect PE after fligth and patietn is unstable give
AND IF STABLE GIVE
UNSTABLE- THROMBOLYSIS
STABLE-LMWH
some extra pulmonary mainfestations of mycoplasma pneumonia
haemolytic anaemia, erythema multiforme, guillian barres syndrome, myocarditis or cerebellar ataxia
COPD is diagnosed as FEV1<
and
80%
