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Medicine and Surgery Mushkies > Passmed Respiratory Mushkies > Flashcards

Passmed Respiratory Mushkies Flashcards

1
Q

Resp causes of clubbing?

A
  1. Infection = TB
  2. Pyogenic conditions = CF, bronchiectasis, abscess, empyema
  3. Malignany = cancer, mesothelioma
  4. Fibrosing alveolitis
  5. Asbestosis
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2
Q

Response to treatment and recovery of pneumonia timeframes?

A
  1. Week 1 = fever should resolve
  2. Week 4 = CP and sputum should have significantly reduced
  3. Week 6 = cough and SOB should have reduced
  4. Month 3 = most sx should have resolved except for tiredness
  5. Month 6 = should be returned to normal
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3
Q

CURB-65?

A
  1. Confusion (AMTS <=10)
  2. Urea >7mmol/l
  3. RR >= 30/min
  4. BP = SBP <90mmHg and/or DBP 60mmHg
  5. Aged >=65y/o
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4
Q

CURB-65 interpretation?

A
  1. CURB >=2 –> hospital

2. CURB >=3 –> intensive care

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5
Q

Pneumonia Ix?

A
  1. Bedside = sputum cultures, urinary antigens
  2. Blood cultures, CRP
  3. Imaging = CXR
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6
Q

Mx of low severity CAP?

A

Amoxicillin 5 days

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7
Q

Most common surgical acid base disorder?

A

Metabolic acidosis

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8
Q

Pneumonia in Birdkeepers?

A

Chlamydia Psittaci

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9
Q

C. psittaci classical picture?

A
  1. Resp infection + acute/chronic conjunctivitis

2. Can lead to multi-organ failure

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10
Q

Mx of C.psittaci?

A
  1. 1st line = tetracyclines e.g. doxycycline

2. 2nd line = macrolides e.g. erythromycin

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11
Q

Are abx recommended for uncomplicated sinusitis?

A

No

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12
Q

Dx of mesothelioma?

A

Histology following a thoracoscopy

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13
Q

Mesothelioma defn?

A

Malignancy of the mesothelial cells of the pleura

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14
Q

Mesothelioma prognosis?

A

Median survival 12m

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15
Q

Tram-lines on CXR?

A

Bronchiectasis (indicate dilated bronchi due to peribronchial inflammation and fibrosis)

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16
Q

Large amounts of purulent sputum?

A

Bronchiectasis

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17
Q

O2 sats target in COPD?

A

88-92%

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18
Q

O2 mx of CPOD pts?

A
  1. Prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis
  2. Adjust target range to 94-98% if the pCO2 is normal
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19
Q

Pneumothorax classification?

A
  1. Primary = no underlying disease

2. Secondary = underlying disease

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20
Q

Primary pneumothorax mx?

A
  1. If rim of air is < 2cm and the pt is not SOB then discharge considered
  2. Otherwise aspiration should be attempted
  3. If this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
  4. Patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men
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21
Q

Secondary pneumothorax mx?

A
  1. If the patient is > 50 years old and the rim of air is > 2cm and/or the patient is SOB then a chest drain should be inserted.
  2. Otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. 3. All patients should be admitted for at least 24 hours
  3. If the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
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22
Q

Adult asthma Mx stages?

A
  1. SABA
  2. SABA + LD ICS
  3. SABA + LD ICS + LTRA
  4. SABA + LD ICS + LABA +/- LTRA
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium dose inhaled MART
  7. SABA +/- LTRA + high dose ICS/theophylline/professional
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23
Q

What is MART?

A
  1. Maintenance and reliever therapy

2. Inhaler containing both ICS and fast acting LABA

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24
Q

Low dose ICS?

A
  1. <= 400mcg budesonide or equivalent
  2. 400-800mcg budesonide or equivalent
  3. . >800mcg budesonide or equivalent
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25
Q

IPF defn?

A

Intersitial pulmonary fibrosis, a condition characterised by progressive fibrosis of the interstitium of the lungs

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26
Q

IPF demographic?

A

50-70y/o, 2M:1F

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27
Q

4 features of IPF?

A
  1. Progressive exertional dyspnoea
  2. Bibasal fine end-inspiratory crackles on auscultation
  3. Dry cough
  4. Clubbing
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28
Q

IPF Dx?

A
  1. Spirometry = restrictive pressure (FEV1/FVC ratio increased >70%)
  2. Impaired gas exchange = reduced transfer factor (TLCO)
  3. CT = ground glass shadowing and honeycombing
  4. ANA positive in 30%, RhF positive in 10%
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29
Q

Mx of IPF?

A
  1. Conservative = pulmonary rehabilitation
  2. Medical = supplementary oxygen, pirfenidone (antifibrotic agent)
  3. Surgical = lung transplant
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30
Q

IPF Prognosis?

A

Poor, average life expectancy around 3-4 years

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31
Q

Most important risk factor for aspiration pneumonia?

A

Recent intubation (neuromuscular agents, intubation can cause regurgitation, can damage trachea/airway)

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32
Q

Aspiration pneumonia defn?

A
  1. Pneumonia that develops due to foreign materials gaining entry to the bronchial tree
  2. Both a chemical and a bacterial pneumonitis can occur
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33
Q

ARDS defn?

A

An acute condition characterized by bilateral pulmonary infiltrates and severe hypoxemia (PaO2/FiO2 ratio < 200) in the absence of evidence for cardiogenic pulmonary oedema (clinically or pulmonary capillary wedge pressure of less than 18 mm Hg).

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34
Q

ARDS mortality?

A

40%

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35
Q

Causes of ARDS?

A
  1. Infection = sepsis, pneumonia
  2. Massive blood transfusion
  3. Trauma
  4. Smoke inhalation
  5. Acute pancreatitis
  6. Cardio-pulmonary bypass
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36
Q

Criteria for ARDS Mx?

A
  1. Acute onset
  2. Pulmonary oedema
  3. Non-cardiogenic
  4. pO2/FiO2 < 40kPa (200mmHg)
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37
Q

ARDS Mx?

A
  1. ITU
  2. Oxygenation/ventilation to treat hypoxaemia
  3. General organ support e.g. vasopressors
  4. Tx of underlying cause
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38
Q

Where should NG tube be positioned on X ray?

A

Subdiaphragmatic

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39
Q

ENT, resp and kidney involvement?

A

GPA (Wegener’s)

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40
Q

Renal disease with hearing impairment?

A

Alport’s

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41
Q

GPA Mx?

A
  1. Steroids
  2. Cyclophosphamide
  3. Plasma exchange
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42
Q

GPA Mx?

A

Median survival 8-9 years

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43
Q

6 causes of respiratory alkalosis?

A
  1. Anxiety
  2. PE
  3. Salicylate poisoning
  4. CNS disorders = stroke, SAH, encephalitis
  5. Altitude
  6. Pregnancy
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44
Q

Salicylate overdose ABG?

A

Mixed respiratory alkalosis and metabolic acidosis

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45
Q

Lung cancer 5 Ix?

A
  1. CXR
  2. CT
  3. Bronchoscopy +/- EBUS
  4. PET (typically NSCLC to establish eligibility for curative tx)
  5. Bloods = raised platelets
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46
Q

Most common cause of cannonball metastases?

A

Renal cell cancer

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47
Q

5 origins for lung mets?

A
  1. Breast
  2. Colorectal
  3. Renal
  4. Bladder
  5. Prostate
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48
Q

3 causes of cannonball metastases?

A
  1. RCC
  2. Choriocarcinoma
  3. Prostate
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49
Q

2 causes of calcification in lung metastases?

A
  1. Chondrosarcoma

2. Osteosarcoma

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50
Q

Target O2 in pts with COPD whose CO2 is known to be normal?

A

94-98%

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51
Q

Post-bronchodilator FEV1/FVC of COPD?

A

< 0.7

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52
Q

COPD staging?

A
  1. Stage 1 = mild = FEV1 > 80%
  2. Stage 2 = moderate = 50-79%
  3. Stage 3 = severe = 30-49%
  4. Stage 4 = very severe = <30%
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53
Q

4 CXR findings of COPD?

A
  1. Hyperinflation
  2. Bullae
  3. Flat hemidiaphragm
  4. Hyperlucent lung fields
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54
Q

Complication if pleural effusion is drained too quickly?

A

Re-expansion pulmonary oedema

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55
Q

Pleural aspiration tests?

A
  1. pH
  2. protein
  3. LDH
  4. Cytology
  5. Microbiology
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56
Q

Exudate pleural effusion protein level?

A

> 30g/L

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57
Q

Transudate pleural effusion protein level?

A

<30g/L

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58
Q

When should Light’s criteria be applied?

A

If protein level is 25-35g/L

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59
Q

2 causes of low glucose pleural effusion?

A
  1. RhA

2, TB

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60
Q

2 causes of raised amylase pleural effusion?

A
  1. Pancreatitis

2. Oesophageal perforation

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61
Q

3 causes of heavy blood staining pleural effusion?

A
  1. Mesothelioma
  2. PE
  3. TB
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62
Q

Mx of recurrent pleural effusion?

A
  1. Recurrent aspiration
  2. Pleurodesis
  3. Indwelling pleural catheter
  4. Drugs to relieve sx e.g. opioids for dyspnoea
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63
Q

4 commonest causes of an anterior mediastinum mass?

A

4 Ts

  1. Teratoma
  2. Terrible lymphadenopathy
  3. Thymic mass
  4. Thyroid mass
  5. Thoracic aortic aneurysm
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64
Q

What is the mediastinum?

A

The region between the pulmonary cavities, covered by the mediastinal pleura. It extends from the thoracic inlet superiorly to the diaphragm inferiorly

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65
Q

Smoking cessation?

A
  1. NRT, varenicline or bupropion, to last only until 2 weeks after the target stop date
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66
Q

Nicotine replacement therapy?

A

Offer a combinaiton of nicotine patches and another form of NRT (e.g. gum, inhalator, lozenge or nasal spray)

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67
Q

Varenicline?

A
  1. A nicotinic receptor partial agonist
  2. 12 week course ypically
  3. C/I in pregnancy and breastfeeding
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68
Q

Bupropion?

A
  1. A NA and DA reuptake inhibitor, and nicotinic antagonist

2. C/I in epilepsy, pregnancy and breastfeeding

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69
Q

Smoking cessation in pregnant women?

A
  1. 1st line = CBT, motivational interviewing, structured self help
  2. NRT if above fails
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70
Q

Mx of COPD?

A
  1. Conservative = smoking cessation, pulmonary rehabilitation
  2. Medical = annual influenza vaccination, one-off pneumococcal vaccination, inhalers
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71
Q

1st line bronchodilator for COPD?

A

SABA or SAMA

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72
Q

2nd step for COPD bronchodilator mx is determined by?

A

If the pt has asthmatic features/features suggesting steroid responsiveness

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73
Q

Asthmatic/steroid responsive fx in a COPD pt?

A
  1. Prev. dx of asthma/atopy
  2. Higher blood eosinophil count
  3. FEV1 variation over time (at least 400ml)
  4. Diurnal variation in peak expiratory flow (at least 205)
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74
Q

2nd line for COPD w/ no asthmatic/steroid responsiveness fx?

A

Add LABA + LAMA

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75
Q

2nd line for COPD w/ asthmatic/steroid responsiveness fx?

A
  1. LABA + ICS

2. If pt remains breathless/have exacerbations offer triple therapy = LAMA + LABA + ICS

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76
Q

Mx of cor pulmonale?

A

Use loop diuretic for oedema, consider LTOT

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77
Q

Fx which may improve survival in pts with stable COPD?

A
  1. Smoking cessation
  2. LTOT if fits criteria
  3. Lung volume reduction surgery in some pts
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78
Q

Medication that may benefit in IPF?

A

Pirfenidone (antifibrotic agent)

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79
Q

Chest drain swinging?

A

Rises in inspiration, falls in expiration

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80
Q

Most common cause of an exudative pleural effusion?

A

Pneumonia

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81
Q

4 transudate causes of pleural effusion?

A

<30g/L protein

  1. HF (most common)
  2. Hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
  3. Hypothyroidism
  4. Meigs’ syndrome
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82
Q

Causes of exudate pleural effusion?

A

> 30g/L protein

  1. Infection = pneumonia, TB, subphrenic abscess
  2. Inflammation = RA, SLE
  3. Malignancy = primary/mets
  4. Pancreatitis
  5. PE
  6. Dressler’s syndrome
  7. Yellow Nail syndrome
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83
Q

What is the abx prophylaxis for COPD?

A

Oral azithromycin 250mg 3x a week

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84
Q

Abx prophylaxis for COPD criteria?

A
  1. Dont smoke
  2. Optimised pharm mx
  3. > =1 of: frequent exacerbations, prolonged exacerbations, exacerbations resulting in hospitalisations
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85
Q

Example of mucolytic drug for COPD?

A

Carbocisteine

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86
Q

CXR of a pt with latent TB?

A

Calcified Ghon complex

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87
Q

Mx of latent TB?

A
  1. 3 months Isoniazid and Rifampicin OR

2. 6 months Isoniazid

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88
Q

LTOT criteria for COPD?

A

2 measurements of pO2 <7.3 kPa (3 weeks apart) OR pO2 7.3-8 and 1 of the following:

  1. Secondary polycythaemia
  2. Peripheral oedema
  3. Pulmonary hypertension
89
Q

LTOT duration every day for COPD?

A

At least 15 hours a day

90
Q

Classification of TB?

A

Primary and Secondary

91
Q

Primary TB?

A

A non-immune host who is exposed to M. tuberculosis may develop primary infection of the lungs

92
Q

What is a Ghon focus composed of?

A

Tubercle-laden macrophages

93
Q

What is a Ghon complex?

A

A combination of ghon focus and hilar lymph nodes

94
Q

Secondary (post-primary) TB?

A

If the host becomes immunocompromised, the initial infection may become reactivated

95
Q

Normally, which testicle hangs lower?

96
Q

In Kartagener’s, which testicle hangs lower?

97
Q

Features of Kartagener’s syndrome?

A

First 3 are the classical triad

  1. Dextrocardia/complete situs inversus
  2. Bronchiectasis
  3. Recurrent sinusitis
  4. Subfertility
98
Q

MOA of lung volume reduction surgery?

A

Removes the worst affected part of the lungs in order to improve airflow and alveolar gas exchange in the remaining portion of the lung

99
Q

Alpha 1 antitrypsin deficiency?

A

A common inherited condition caused by a lack of protease inhibitor normally produced by the liver

100
Q

Features of A1ATD?

A
  1. Lungs = panacinar emphysema, most marked in lower lobes

2. Liver = cirrhosis and HCC in adults, cholestasis in children

101
Q

A1ATD on spirometry?

A

Obstructive picture

102
Q

A1ATD Dx?

A

A1AT concentration

103
Q

A1ATD Mx?

A
  1. Conservative = no smoking, physiotherapy
  2. Medical = bronchodilators, IV A1AT protein concentrates
  3. Surgical = lung volume reduction surgery, lung transplantation
104
Q

CXR in HF?

A
  1. Alveolar oedema (bats wings)
  2. Kerley B lines (interstitial oedema)
  3. Cardiomegaly
  4. Dilated prominent upper lobe vessels
  5. Pleural effusion
105
Q

RFs for aspiration pneumonia?

A
  1. Poor dental hygiene
  2. Swallowing difficulties
  3. Prolonged hospitalisation
  4. Impaired consciousness
  5. Impaired mucociliary clearance
106
Q

Causes of respiratory acidosis?

A
  1. COPD
  2. Life threatening asthma/pulmonary oedema
  3. Neuromuscular disease
  4. Obesity hypoventilation syndrome
  5. Sedative drugs e.g. benzos, opiate OD
107
Q

Acute asthma escalation?

A
  1. O2
  2. Salbutamol nebulisers
  3. Ipratropium bromide nebulisers
  4. Hydrocortisone IV OR oral prednisolone
  5. IV Magnesium sulphate
  6. Aminophylline/IV Salbutamol
108
Q

Moderate acute asthma fx?

A
  1. PEFR 50-75%
  2. Speech normal
  3. RR < 25
  4. Pulse <110bpm
109
Q

Severe acute asthma fx?

A
  1. PEFR 33-50%
  2. Cant complete sentences
  3. RR > 25
  4. Pulse >110bpm
110
Q

Life threatening acute asthma fx?

A
  1. PEFR <33%
  2. O2 < 92%
  3. Silent chest/cyanosis/feeble resp effort
  4. Bradycardia, arryhthmia, hypotension
  5. Exhaustion, confusion, coma
111
Q

SCLC Mx?

A

Chemotherapy + Radiotherapy

112
Q

SCLC paraneoplastic sx?

A
  1. ADH –> hyponatraemia
  2. ACTH –> Cushings
  3. Lambert-Eaton Syndrome
113
Q

NIV in acute resp failure indications?

A
  1. COPD w/ resp acidosis pH 7.25-7.35 and PaCO2 > 6kPa
  2. Type II resp failure secondary to chest wall deformity, neuromuscular disease or OSA
  3. Cardiogenic pulmonary oedema unresponsive to CPAP
  4. Weaning frmo tracheal intubation
114
Q

Recommended initial settings for BiPAP in COPD?

A
  1. EPAP 4-5cm H20
  2. IPAP = 12-15cm H20
  3. Back up rate = 15 breaths/min
  4. Back up inspiration:expiration ratio 1:3
115
Q

Sarcoidosis defn?

A

A multisystem disorder of unknown aetiology characterised by non-caseating granulomas, more common in young adults and people of African descent

116
Q

Features of sarcoidosis?

A
  1. Acute
  2. Insidious
  3. Skin
  4. Hypercalcaemia
117
Q

Acute fx of sarcoidosis?

A
  1. Erythema nodosum
  2. Bihilar lymphadenopathy
  3. Swinging fever
  4. Polyarthralgia
118
Q

Insidious fx of sarcoidosis?

A
  1. Dyspnoea
  2. Non-productive cough
  3. Malaise
  4. Weight loss
119
Q

Skin fx of sarcoidosis?

A

Lupus pernio

120
Q

3 syndromes associated with sarcoidosis?

A
  1. Lofgren’s syndrome is an acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis
  2. In Mikulicz syndrome* there is enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma
  3. Heerfordt’s syndrome (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis
121
Q

Acute pancreatitis resp complications?

122
Q

ARDS pathophysiology?

A

Acute respiratory distress syndrome (ARDS) is caused by the increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli, i.e. non-cardiogenic pulmonary oedema.

123
Q

Only mx that improves survival rates in ARDS?

A

Mechanical ventilation using low tidal volumes, as conventional tidal volumes may cause lung injury

124
Q

Lifetime risk of pneumothorax in smoking vs. non-smoking men?

A
  1. 10% in smokers

2. 0.1% in non-smokers

125
Q

Reduced FVC, normal FEV1/FVC cause?

126
Q

3 obstructive lung diseases?

A
  1. Asthma
  2. COPD
  3. Bronchiectasis
127
Q

6 restrictive lung diseases?

A
  1. IPF
  2. Asbestosis
  3. Sarcoidosis
  4. ARDS
  5. Neuromuscular
  6. Severe obesity
128
Q

Catamenial definition?

A

Relating to the menses

129
Q

3-6% of pneumothoraces in women caused by?

A

Catamenial pneumothorax, due to endometriosis within the thorax

130
Q

5 complications of asbestos exposure?

A
  1. Pleural plaques (benign, dont undergo malignant change, most common form of asbestos lung disease)
  2. Pleural thickening
  3. Asbestosis
  4. Mesothelioma
  5. Lung cancer (synergistic effect with smoking)
131
Q

Mesothelioma defn?

A

Malignant disease of the pleura

132
Q

Most dangerous form of asbestos for mesothelioma?

A

Crocidolite (blue) asbestos

133
Q

Mx of mesothelioma?

A

Palliative chemo, limited role for surgery and radio

134
Q

Prognosis of mesothelioma?

A

Median survival from dx of 8-14 months

135
Q

Dx of OSA?

A

Polysomnography

136
Q

OSA ABG?

A

Respiratory metabolic acidosis due to hypoventilation

137
Q

RFs for OSA?

A
  1. Obesity
  2. Macroglossia = acromegaly, hypothyroidism, amyloidosis
  3. Large tonsils
  4. Marfans
138
Q

3 complications of OSA?

A
  1. Daytime somnolescence
  2. HTN
  3. Resp acidosis
139
Q

MSLT?

A

Multiple sleep latency test, measures time to fall asleep in a dark room using EEG criteria

140
Q

Mx of OSA?

A
  1. Weight loss
  2. CPAP
  3. Intra-oral devices e.g. mandibular advancement if CPAP not tolerated/mild OSAHS
141
Q

OSAHS?

A

Obstructive sleep apnoea/hypopnoea syndrome

142
Q

Causes of white shadowing on CXR?

A
  1. Consolidation
  2. Effusion
  3. Collapse
  4. Pneumonectomy
  5. Tumours
  6. Oedema
143
Q

3 causes of trachea pulled towards white out?

A
  1. Pneumonectomy
  2. Complete lung collapse
  3. Pulmonary hypoplasia
144
Q

3 causes of trachea central and white out?

A
  1. Consolidation
  2. Pulmonary oedema
  3. Mesothelioma
145
Q

3 causes of trachea pushed away from white out?

A
  1. Pleural effusion
  2. Large thoracic mass
  3. Diaphragmatic hernia
146
Q

3 causes of lobar collapse?

A
  1. Lung cancer
  2. Asthma (mucus plugging)
  3. Foreign body
147
Q

Signs of lobar collapse on CXR?

A
  1. Tracheal deviation towards collapse
  2. Mediastinal shift towards collapse
  3. Elevation of hemidiaphragm
148
Q

Squamous cell cancer of lunger paraneoplastic fx?

A
  1. PTHrp –> hypercalcaemia
  2. Clubbing
  3. HPOA
  4. Hyperthyroidism due to ectopic TSH
149
Q

Lung adenocarcinoma paraneoplastic features?

A
  1. Gynaecomastia

2. HPOA (hypertrophic pulmonary osteoarthropathy)

150
Q

DDx for cavitating lung lesion on CXR?

A
  1. Infection = TB, abscess (Staph, Klebsiella, Pseudomonas)
  2. Inflammation = GPA, RHA
  3. Malignancy
  4. PE
  5. Aspergillosis, histoplasmosis, coccidioidomycosis
151
Q

Exacerbation of COPD Ix?

A
  1. Bedside = ECG, ABG, sputum MC&S
  2. Bloods = FBC, U&E, cultures if pyrexial
  3. Imaging = CXR
152
Q

Exacerbation of COPD Mx?

A
  1. Conservative = chest physiotherapy
  2. Medical = O2, salbutamol, ipratropium, IV hydrocortisone
  3. Airway = BiPAP
153
Q

BiPAP?

A

Bilevel Positive Airway Pressure

154
Q

BiPAP for what type of resp failure?

155
Q

BiPAP MOA?

A
  1. It works by stenting alveoli open to increase the surface area available for ventilation and gas exchange.
  2. A BIPAP machine alternates between the IPAP (Inspiratory Positive Airway pressure) applied when a patient breathes in and the EPAP (Expiratory Positive Airway Pressure) which is applied between patient triggered breaths.
156
Q

CPAP for what type of resp failure?

157
Q

Most common organisms that cause infective exacerbation of COPD?

A
  1. H. influenzae (most common)
  2. S. pneumoniae
  3. M. catarrhalis
158
Q

COPD exacerbation take home med?

A

Prednisolone 30mg OD for 7-14 days

159
Q

Tx of acute bacterial infection, what blood marker lags?

A

CRP lags in decreasing in comparison to WCC

160
Q

Pneumonia defn?

A

Any inflammatory condition affecting the alveoli of the lungs, most commonly due to infection

161
Q

Does negative spirometry exclude asthma?

162
Q

What is the FeNO test?

A
  1. Fractional exhaled NO test for new adult diagnoses of asthma, and for use in young patients where there is diagnostic uncertainty or negative spirometry/bronchodilator reversibility
  2. Uses exhaled levels of nitric oxide to assess for inflammation in the lungs - it will therefore be elevated in cases of asthma.
163
Q

Asthma Dx in >=17/yo>?

A
  1. Spirometry with bronchodilator reversibility (BDR) test

2. All pts should have FeNO test

164
Q

Asthma Dx in 5-16 y/o?

A
  1. Spirometry with a bronchodilator reversibility (BDR) test
  2. FeNO test should be requested if there is normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test
165
Q

Asthma reversibility dx?

A

Improvement in FEV1 of 12% or more and an increase in volume of 200ml or more

166
Q

Before starting azithromycin, what Ix?

A

ECG and baseline LFTs

167
Q

First line tx for moderate/severe OSA?

168
Q

HPOA?

A

Hyperrtophic pulmonary osteoarthropathy, a proliferative periostitis that typically involves the long bones and is often painful

169
Q

pH range where NIV is most appropriate in COPD Mx?

170
Q

pH range where invasive ventilation is most appropriate in COPD Mx?

171
Q

Step down tx of asthma?

A

Aim for reduction of 25-50% in the dose of ICS

172
Q

Emphysema location predominance in COPD?

A

Upper lobes

173
Q

Emphysema location predominance in A1AT?

A

Lower lobes

174
Q

Upper zone fibrosis causes?

A

CHARTS

  1. Coal Worker’s Pneumoconiosis
  2. Histiocytosis
  3. Ankylosing spondylitis
  4. Radiation
  5. TB
  6. Sarcoidosis/Silicosis
175
Q

Causes of impalpable apex beat?

A

COPD

  1. COPD
  2. Obesity
  3. Pericardial effusion
  4. Dextrocardia
176
Q

Bronchiectasis defn?

A

Permanent dilation of the airways secondary to chronic infection or inflammation

177
Q

Bronchiectasis DDx?

A
  1. Infective = TB, measles, pertussis, pneumonia
  2. Inflammatory
  3. Congenital = CF, Kartagener
  4. Bronchial obstruction e.g. lung cancer/foreign body
  5. Immune deficiency = selective IgA, hypogamaglobulinaemia
178
Q

RhA resp complications?

A
  1. Pulmonary fibrosis
  2. Pleural effusions
  3. Pulmonary nodules
  4. Bronchiolitis obliterans
179
Q

Indications for steroids in sarcoidosis?

A
  1. Hypercalcaemia
  2. Eye, heart or neuro involvement
  3. Parenchymal lung disease
180
Q

Centor criteria?

A

3 of:

  1. Presence of tonsillar exudate
  2. Tender anterior cervical lymphadenopathy/lymphadenitis
  3. Hx of fever
  4. Absence of cough
181
Q

3 main types of altitude disorders?

A
  1. Acute mountain sickness (AMS)
  2. HAPE
  3. HACE
182
Q

Features of acute mountain sickness?

A
  1. Occur above 2500-3000m
  2. Develop gradually over 6-12 hours, and potentially last a number of days
  3. Headache, nausea, fatigue
183
Q

Prevention of Acute mountain sickness?

A
  1. Gain altitude no more than 500m per day

2. Acetozolamide

184
Q

Features of HAPE?

A
  1. Above 4000m

2. Classic pulmonary oedema fx

185
Q

Features of HACE?

A
  1. Above 4000m

2. Headache, ataxia, papilloedema

186
Q

Mx of HACE?

A

Descent and dexamethasone

187
Q

Mx of HAPE?

A
  1. Descent
  2. Oxygen if available
  3. Nifedipine, dexamethasone, acetozolamide, PDE-V inhibitors
188
Q

Causes of occupational asthma?

A
  1. Isocyanates (most common cause e.g. spray paint)
  2. Flour
  3. Epoxy resins
189
Q

Ix of occupational asthma?

A

Serial measurements of PEFR at work and away from work

190
Q

MOA of haemoptysis in mitral stenosis?

A

Rupture of bronchial veins caused by raised LA pressure

191
Q

Mx of atelectasis?

A

Chest physiotherapy with mobilisation and deep breathing exercises

192
Q

Atelectasis defn?

A

A common postoperative complication in which basal alveolar collapse can lead to respiratory difficulty. It is caused when airways become obstructed by bronchial secretions.

193
Q

What blood test should be offered to all pts with TB?

194
Q

Most common organism of IECOPD?

A

H. influenzae

195
Q

Type 1 respiratory failure?

196
Q

Type 2 respiratory failure?

A

Low pO2, high pCO2

197
Q

When should a chest tube be placed for pleural infection?

A
  1. pH <7.2

2. Purulent or turbid/cloudy

198
Q

How long should you wait between inhaler doses?

A

30 seconds

199
Q

NG tube safe to use pH?

A

If pH <5.5 on aspirate

200
Q

NG tube pH >5.5 Ix?

A

CXR to confirm position

201
Q

2 most common causes of bihilar lymphadenopathy?

A

Sarcoidosis and TB

202
Q

Spread of miliary TB?

A

Through the pulmonary venous system

203
Q

Black lung disease aka?

A

Coal worker’s pneumoconiosis

204
Q

Pneumoconiosis defn?

A

Accumulation of dust in the lungs and the response of the bodily tissue to its presence, most commonly used in relation to coal worker’s pneumoconiosis.

205
Q

What is upper lobe diversion?

A

Increased blood flow to the superior parts of the lungs

206
Q

Facial rash + lymphadenopathy?

A

Sarcoidosis

207
Q

EAA pathophysiology?

A

Hypersensitivity induced lung damage due to a variety of inhaled organic particles. It is thought to be largely caused by immune-complex mediated tissue damage (type III hypersensitivity) although delayed hypersensitivity (type IV) is also thought to play a role in EAA, especially in the chronic phase.

208
Q

4 examples of EAA?

A
  1. Bird fancier’s lung = avian proteins
  2. Farmers’ lungs = spores pf Saccharopolyspora rectivirgula
  3. Malt Worker’s lung = Aspergillus Clavatus
  4. Mushroom Workers’ lung = thermophilic actinomycetes
209
Q

EAA classification?

A
  1. Acute = 4-8hrs after exposure, SOB, dry cough, fever

2. Cough

210
Q

EAA Ix?

A
  1. CXR = upper/mid zone fibrosis
  2. BAL = lymphocytes
  3. Blood = no eosinophilia
211
Q

Indication for surgery in bronchiectasis?

A
  1. Localised disease

2. Uncontrollable haemoptysis

212
Q

Bronchiectasis Mx?

A
  1. Conservative = physical training, postural drainage
  2. Medical = Abx for exacerbations, bronchodilators in selected cases, immunisations
  3. Surgical
213
Q

Most common organism isolated in pt with bronchiectasis?

A

H. influenzae

214
Q

Currant jelly sputum?

A

Klebsiella

215
Q

A complication of klebsiella?

A

Commonly causes lung abscess formation and empyema

216
Q

Hoarseness in lung cancer MOA?

A

Pancoast tumour compressing the recurrent laryngeal nerve

217
Q

Meigs’ syndrome features?

A

Triad of Benign ovarian tumour, ascites and pleural effusion

218
Q

When should abx be given for IECOPD?

A

If sputum is purulent or there are clinical signs of pneumonia

Medicine and Surgery Mushkies (52 decks)

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