Passmed Respiratory Mushkies Flashcards
1
Q
Resp causes of clubbing?
A
- Infection = TB
- Pyogenic conditions = CF, bronchiectasis, abscess, empyema
- Malignany = cancer, mesothelioma
- Fibrosing alveolitis
- Asbestosis
2
Q
Response to treatment and recovery of pneumonia timeframes?
A
- Week 1 = fever should resolve
- Week 4 = CP and sputum should have significantly reduced
- Week 6 = cough and SOB should have reduced
- Month 3 = most sx should have resolved except for tiredness
- Month 6 = should be returned to normal
3
Q
CURB-65?
A
- Confusion (AMTS <=10)
- Urea >7mmol/l
- RR >= 30/min
- BP = SBP <90mmHg and/or DBP 60mmHg
- Aged >=65y/o
4
Q
CURB-65 interpretation?
A
- CURB >=2 –> hospital
2. CURB >=3 –> intensive care
5
Q
Pneumonia Ix?
A
- Bedside = sputum cultures, urinary antigens
- Blood cultures, CRP
- Imaging = CXR
6
Q
Mx of low severity CAP?
A
Amoxicillin 5 days
7
Q
Most common surgical acid base disorder?
A
Metabolic acidosis
8
Q
Pneumonia in Birdkeepers?
A
Chlamydia Psittaci
9
Q
C. psittaci classical picture?
A
- Resp infection + acute/chronic conjunctivitis
2. Can lead to multi-organ failure
10
Q
Mx of C.psittaci?
A
- 1st line = tetracyclines e.g. doxycycline
2. 2nd line = macrolides e.g. erythromycin
11
Q
Are abx recommended for uncomplicated sinusitis?
A
No
12
Q
Dx of mesothelioma?
A
Histology following a thoracoscopy
13
Q
Mesothelioma defn?
A
Malignancy of the mesothelial cells of the pleura
14
Q
Mesothelioma prognosis?
A
Median survival 12m
15
Q
Tram-lines on CXR?
A
Bronchiectasis (indicate dilated bronchi due to peribronchial inflammation and fibrosis)
16
Q
Large amounts of purulent sputum?
A
Bronchiectasis
17
Q
O2 sats target in COPD?
A
88-92%
18
Q
O2 mx of CPOD pts?
A
- 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
- Adjust target range to 94-98% if the pCO2 is normal
19
Q
Pneumothorax classification?
A
- Primary = no underlying disease
2. Secondary = underlying disease
20
Q
Primary pneumothorax mx?
A
- If rim of air is < 2cm and the pt is not SOB then discharge considered
- Otherwise aspiration should be attempted
- If this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
- 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
21
Q
Secondary pneumothorax mx?
A
- 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.
- 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
- If the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
22
Q
Adult asthma Mx stages?
A
- SABA
- SABA + LD ICS
- SABA + LD ICS + LTRA
- SABA + LD ICS + LABA +/- LTRA
- SABA +/- LTRA + MART
- SABA +/- LTRA + medium dose inhaled MART
- SABA +/- LTRA + high dose ICS/theophylline/professional
23
Q
What is MART?
A
- Maintenance and reliever therapy
2. Inhaler containing both ICS and fast acting LABA
24
Q
Low dose ICS?
A
- <= 400mcg budesonide or equivalent
- 400-800mcg budesonide or equivalent
- . >800mcg budesonide or equivalent
25
IPF defn?
Intersitial pulmonary fibrosis, a condition characterised by progressive fibrosis of the interstitium of the lungs
26
IPF demographic?
50-70y/o, 2M:1F
27
4 features of IPF?
1. Progressive exertional dyspnoea
2. Bibasal fine end-inspiratory crackles on auscultation
3. Dry cough
4. Clubbing
28
IPF Dx?
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%
29
Mx of IPF?
1. Conservative = pulmonary rehabilitation
2. Medical = supplementary oxygen, pirfenidone (antifibrotic agent)
3. Surgical = lung transplant
30
IPF Prognosis?
Poor, average life expectancy around 3-4 years
31
Most important risk factor for aspiration pneumonia?
Recent intubation (neuromuscular agents, intubation can cause regurgitation, can damage trachea/airway)
32
Aspiration pneumonia defn?
1. Pneumonia that develops due to foreign materials gaining entry to the bronchial tree
2. Both a chemical and a bacterial pneumonitis can occur
33
ARDS defn?
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).
34
ARDS mortality?
40%
35
Causes of ARDS?
1. Infection = sepsis, pneumonia
2. Massive blood transfusion
3. Trauma
4. Smoke inhalation
5. Acute pancreatitis
6. Cardio-pulmonary bypass
36
Criteria for ARDS Mx?
1. Acute onset
2. Pulmonary oedema
3. Non-cardiogenic
4. pO2/FiO2 < 40kPa (200mmHg)
37
ARDS Mx?
1. ITU
2. Oxygenation/ventilation to treat hypoxaemia
3. General organ support e.g. vasopressors
4. Tx of underlying cause
38
Where should NG tube be positioned on X ray?
Subdiaphragmatic
39
ENT, resp and kidney involvement?
GPA (Wegener's)
40
Renal disease with hearing impairment?
Alport's
41
GPA Mx?
1. Steroids
2. Cyclophosphamide
3. Plasma exchange
42
GPA Mx?
Median survival 8-9 years
43
6 causes of respiratory alkalosis?
1. Anxiety
2. PE
3. Salicylate poisoning
4. CNS disorders = stroke, SAH, encephalitis
5. Altitude
6. Pregnancy
44
Salicylate overdose ABG?
Mixed respiratory alkalosis and metabolic acidosis
45
Lung cancer 5 Ix?
1. CXR
2. CT
3. Bronchoscopy +/- EBUS
4. PET (typically NSCLC to establish eligibility for curative tx)
5. Bloods = raised platelets
46
Most common cause of cannonball metastases?
Renal cell cancer
47
5 origins for lung mets?
1. Breast
2. Colorectal
3. Renal
4. Bladder
5. Prostate
48
3 causes of cannonball metastases?
1. RCC
2. Choriocarcinoma
3. Prostate
49
2 causes of calcification in lung metastases?
1. Chondrosarcoma
| 2. Osteosarcoma
50
Target O2 in pts with COPD whose CO2 is known to be normal?
94-98%
51
Post-bronchodilator FEV1/FVC of COPD?
< 0.7
52
COPD staging?
1. Stage 1 = mild = FEV1 > 80%
2. Stage 2 = moderate = 50-79%
3. Stage 3 = severe = 30-49%
4. Stage 4 = very severe = <30%
53
4 CXR findings of COPD?
1. Hyperinflation
2. Bullae
3. Flat hemidiaphragm
4. Hyperlucent lung fields
54
Complication if pleural effusion is drained too quickly?
Re-expansion pulmonary oedema
55
Pleural aspiration tests?
1. pH
2. protein
3. LDH
4. Cytology
5. Microbiology
56
Exudate pleural effusion protein level?
>30g/L
57
Transudate pleural effusion protein level?
<30g/L
58
When should Light's criteria be applied?
If protein level is 25-35g/L
59
2 causes of low glucose pleural effusion?
1. RhA
| 2, TB
60
2 causes of raised amylase pleural effusion?
1. Pancreatitis
| 2. Oesophageal perforation
61
3 causes of heavy blood staining pleural effusion?
1. Mesothelioma
2. PE
3. TB
62
Mx of recurrent pleural effusion?
1. Recurrent aspiration
2. Pleurodesis
3. Indwelling pleural catheter
4. Drugs to relieve sx e.g. opioids for dyspnoea
63
4 commonest causes of an anterior mediastinum mass?
4 Ts
1. Teratoma
2. Terrible lymphadenopathy
3. Thymic mass
4. Thyroid mass
5. Thoracic aortic aneurysm
64
What is the mediastinum?
The region between the pulmonary cavities, covered by the mediastinal pleura. It extends from the thoracic inlet superiorly to the diaphragm inferiorly
65
Smoking cessation?
1. NRT, varenicline or bupropion, to last only until 2 weeks after the target stop date
66
Nicotine replacement therapy?
Offer a combinaiton of nicotine patches and another form of NRT (e.g. gum, inhalator, lozenge or nasal spray)
67
Varenicline?
1. A nicotinic receptor partial agonist
2. 12 week course ypically
3. C/I in pregnancy and breastfeeding
68
Bupropion?
1. A NA and DA reuptake inhibitor, and nicotinic antagonist
| 2. C/I in epilepsy, pregnancy and breastfeeding
69
Smoking cessation in pregnant women?
1. 1st line = CBT, motivational interviewing, structured self help
2. NRT if above fails
70
Mx of COPD?
1. Conservative = smoking cessation, pulmonary rehabilitation
2. Medical = annual influenza vaccination, one-off pneumococcal vaccination, inhalers
71
1st line bronchodilator for COPD?
SABA or SAMA
72
2nd step for COPD bronchodilator mx is determined by?
If the pt has asthmatic features/features suggesting steroid responsiveness
73
Asthmatic/steroid responsive fx in a COPD pt?
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)
74
2nd line for COPD w/ no asthmatic/steroid responsiveness fx?
Add LABA + LAMA
75
2nd line for COPD w/ asthmatic/steroid responsiveness fx?
1. LABA + ICS
| 2. If pt remains breathless/have exacerbations offer triple therapy = LAMA + LABA + ICS
76
Mx of cor pulmonale?
Use loop diuretic for oedema, consider LTOT
77
Fx which may improve survival in pts with stable COPD?
1. Smoking cessation
2. LTOT if fits criteria
3. Lung volume reduction surgery in some pts
78
Medication that may benefit in IPF?
Pirfenidone (antifibrotic agent)
79
Chest drain swinging?
Rises in inspiration, falls in expiration
80
Most common cause of an exudative pleural effusion?
Pneumonia
81
4 transudate causes of pleural effusion?
<30g/L protein
1. HF (most common)
2. Hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
3. Hypothyroidism
4. Meigs' syndrome
82
Causes of exudate pleural effusion?
>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
83
What is the abx prophylaxis for COPD?
Oral azithromycin 250mg 3x a week
84
Abx prophylaxis for COPD criteria?
1. Dont smoke
2. Optimised pharm mx
3. >=1 of: frequent exacerbations, prolonged exacerbations, exacerbations resulting in hospitalisations
85
Example of mucolytic drug for COPD?
Carbocisteine
86
CXR of a pt with latent TB?
Calcified Ghon complex
87
Mx of latent TB?
1. 3 months Isoniazid and Rifampicin OR
| 2. 6 months Isoniazid
88
LTOT criteria for COPD?
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
LTOT duration every day for COPD?
At least 15 hours a day
90
Classification of TB?
Primary and Secondary
91
Primary TB?
A non-immune host who is exposed to M. tuberculosis may develop primary infection of the lungs
92
What is a Ghon focus composed of?
Tubercle-laden macrophages
93
What is a Ghon complex?
A combination of ghon focus and hilar lymph nodes
94
Secondary (post-primary) TB?
If the host becomes immunocompromised, the initial infection may become reactivated
95
Normally, which testicle hangs lower?
Left
96
In Kartagener's, which testicle hangs lower?
Right
97
Features of Kartagener's syndrome?
First 3 are the classical triad
1. Dextrocardia/complete situs inversus
2. Bronchiectasis
3. Recurrent sinusitis
4. Subfertility
98
MOA of lung volume reduction surgery?
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
Alpha 1 antitrypsin deficiency?
A common inherited condition caused by a lack of protease inhibitor normally produced by the liver
100
Features of A1ATD?
1. Lungs = panacinar emphysema, most marked in lower lobes
| 2. Liver = cirrhosis and HCC in adults, cholestasis in children
101
A1ATD on spirometry?
Obstructive picture
102
A1ATD Dx?
A1AT concentration
103
A1ATD Mx?
1. Conservative = no smoking, physiotherapy
2. Medical = bronchodilators, IV A1AT protein concentrates
3. Surgical = lung volume reduction surgery, lung transplantation
104
CXR in HF?
1. Alveolar oedema (bats wings)
2. Kerley B lines (interstitial oedema)
3. Cardiomegaly
4. Dilated prominent upper lobe vessels
5. Pleural effusion
105
RFs for aspiration pneumonia?
1. Poor dental hygiene
2. Swallowing difficulties
3. Prolonged hospitalisation
4. Impaired consciousness
5. Impaired mucociliary clearance
106
Causes of respiratory acidosis?
1. COPD
2. Life threatening asthma/pulmonary oedema
3. Neuromuscular disease
4. Obesity hypoventilation syndrome
5. Sedative drugs e.g. benzos, opiate OD
107
Acute asthma escalation?
1. O2
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR oral prednisolone
5. IV Magnesium sulphate
6. Aminophylline/IV Salbutamol
108
Moderate acute asthma fx?
1. PEFR 50-75%
2. Speech normal
3. RR < 25
4. Pulse <110bpm
109
Severe acute asthma fx?
1. PEFR 33-50%
2. Cant complete sentences
3. RR > 25
4. Pulse >110bpm
110
Life threatening acute asthma fx?
1. PEFR <33%
2. O2 < 92%
3. Silent chest/cyanosis/feeble resp effort
4. Bradycardia, arryhthmia, hypotension
5. Exhaustion, confusion, coma
111
SCLC Mx?
Chemotherapy + Radiotherapy
112
SCLC paraneoplastic sx?
1. ADH --> hyponatraemia
2. ACTH --> Cushings
3. Lambert-Eaton Syndrome
113
NIV in acute resp failure indications?
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
Recommended initial settings for BiPAP in COPD?
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
Sarcoidosis defn?
A multisystem disorder of unknown aetiology characterised by non-caseating granulomas, more common in young adults and people of African descent
116
Features of sarcoidosis?
1. Acute
2. Insidious
3. Skin
4. Hypercalcaemia
117
Acute fx of sarcoidosis?
1. Erythema nodosum
2. Bihilar lymphadenopathy
3. Swinging fever
4. Polyarthralgia
118
Insidious fx of sarcoidosis?
1. Dyspnoea
2. Non-productive cough
3. Malaise
4. Weight loss
119
Skin fx of sarcoidosis?
Lupus pernio
120
3 syndromes associated with sarcoidosis?
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
Acute pancreatitis resp complications?
ARDS
122
ARDS pathophysiology?
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
Only mx that improves survival rates in ARDS?
Mechanical ventilation using low tidal volumes, as conventional tidal volumes may cause lung injury
124
Lifetime risk of pneumothorax in smoking vs. non-smoking men?
1. 10% in smokers
| 2. 0.1% in non-smokers
125
Reduced FVC, normal FEV1/FVC cause?
IPF
126
3 obstructive lung diseases?
1. Asthma
2. COPD
3. Bronchiectasis
127
6 restrictive lung diseases?
1. IPF
2. Asbestosis
3. Sarcoidosis
4. ARDS
5. Neuromuscular
6. Severe obesity
128
Catamenial definition?
Relating to the menses
129
3-6% of pneumothoraces in women caused by?
Catamenial pneumothorax, due to endometriosis within the thorax
130
5 complications of asbestos exposure?
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
Mesothelioma defn?
Malignant disease of the pleura
132
Most dangerous form of asbestos for mesothelioma?
Crocidolite (blue) asbestos
133
Mx of mesothelioma?
Palliative chemo, limited role for surgery and radio
134
Prognosis of mesothelioma?
Median survival from dx of 8-14 months
135
Dx of OSA?
Polysomnography
136
OSA ABG?
Respiratory metabolic acidosis due to hypoventilation
137
RFs for OSA?
1. Obesity
2. Macroglossia = acromegaly, hypothyroidism, amyloidosis
3. Large tonsils
4. Marfans
138
3 complications of OSA?
1. Daytime somnolescence
2. HTN
3. Resp acidosis
139
MSLT?
Multiple sleep latency test, measures time to fall asleep in a dark room using EEG criteria
140
Mx of OSA?
1. Weight loss
2. CPAP
3. Intra-oral devices e.g. mandibular advancement if CPAP not tolerated/mild OSAHS
141
OSAHS?
Obstructive sleep apnoea/hypopnoea syndrome
142
Causes of white shadowing on CXR?
1. Consolidation
2. Effusion
3. Collapse
4. Pneumonectomy
5. Tumours
6. Oedema
143
3 causes of trachea pulled towards white out?
1. Pneumonectomy
2. Complete lung collapse
3. Pulmonary hypoplasia
144
3 causes of trachea central and white out?
1. Consolidation
2. Pulmonary oedema
3. Mesothelioma
145
3 causes of trachea pushed away from white out?
1. Pleural effusion
2. Large thoracic mass
3. Diaphragmatic hernia
146
3 causes of lobar collapse?
1. Lung cancer
2. Asthma (mucus plugging)
3. Foreign body
147
Signs of lobar collapse on CXR?
1. Tracheal deviation towards collapse
2. Mediastinal shift towards collapse
3. Elevation of hemidiaphragm
148
Squamous cell cancer of lunger paraneoplastic fx?
1. PTHrp --> hypercalcaemia
2. Clubbing
3. HPOA
4. Hyperthyroidism due to ectopic TSH
149
Lung adenocarcinoma paraneoplastic features?
1. Gynaecomastia
| 2. HPOA (hypertrophic pulmonary osteoarthropathy)
150
DDx for cavitating lung lesion on CXR?
1. Infection = TB, abscess (Staph, Klebsiella, Pseudomonas)
2. Inflammation = GPA, RHA
3. Malignancy
4. PE
5. Aspergillosis, histoplasmosis, coccidioidomycosis
151
Exacerbation of COPD Ix?
1. Bedside = ECG, ABG, sputum MC&S
2. Bloods = FBC, U&E, cultures if pyrexial
3. Imaging = CXR
152
Exacerbation of COPD Mx?
1. Conservative = chest physiotherapy
2. Medical = O2, salbutamol, ipratropium, IV hydrocortisone
3. Airway = BiPAP
153
BiPAP?
Bilevel Positive Airway Pressure
154
BiPAP for what type of resp failure?
Type II
155
BiPAP MOA?
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
CPAP for what type of resp failure?
Type I
157
Most common organisms that cause infective exacerbation of COPD?
1. H. influenzae (most common)
2. S. pneumoniae
3. M. catarrhalis
158
COPD exacerbation take home med?
Prednisolone 30mg OD for 7-14 days
159
Tx of acute bacterial infection, what blood marker lags?
CRP lags in decreasing in comparison to WCC
160
Pneumonia defn?
Any inflammatory condition affecting the alveoli of the lungs, most commonly due to infection
161
Does negative spirometry exclude asthma?
No
162
What is the FeNO test?
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
Asthma Dx in >=17/yo>?
1. Spirometry with bronchodilator reversibility (BDR) test
| 2. All pts should have FeNO test
164
Asthma Dx in 5-16 y/o?
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
Asthma reversibility dx?
Improvement in FEV1 of 12% or more and an increase in volume of 200ml or more
166
Before starting azithromycin, what Ix?
ECG and baseline LFTs
167
First line tx for moderate/severe OSA?
CPAP
168
HPOA?
Hyperrtophic pulmonary osteoarthropathy, a proliferative periostitis that typically involves the long bones and is often painful
169
pH range where NIV is most appropriate in COPD Mx?
7.25-7.35
170
pH range where invasive ventilation is most appropriate in COPD Mx?
<7.25
171
Step down tx of asthma?
Aim for reduction of 25-50% in the dose of ICS
172
Emphysema location predominance in COPD?
Upper lobes
173
Emphysema location predominance in A1AT?
Lower lobes
174
Upper zone fibrosis causes?
CHARTS
1. Coal Worker's Pneumoconiosis
2. Histiocytosis
3. Ankylosing spondylitis
4. Radiation
5. TB
6. Sarcoidosis/Silicosis
175
Causes of impalpable apex beat?
COPD
1. COPD
2. Obesity
3. Pericardial effusion
4. Dextrocardia
176
Bronchiectasis defn?
Permanent dilation of the airways secondary to chronic infection or inflammation
177
Bronchiectasis DDx?
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
RhA resp complications?
1. Pulmonary fibrosis
2. Pleural effusions
3. Pulmonary nodules
4. Bronchiolitis obliterans
179
Indications for steroids in sarcoidosis?
1. Hypercalcaemia
2. Eye, heart or neuro involvement
3. Parenchymal lung disease
180
Centor criteria?
3 of:
1. Presence of tonsillar exudate
2. Tender anterior cervical lymphadenopathy/lymphadenitis
3. Hx of fever
4. Absence of cough
181
3 main types of altitude disorders?
1. Acute mountain sickness (AMS)
2. HAPE
3. HACE
182
Features of acute mountain sickness?
1. Occur above 2500-3000m
2. Develop gradually over 6-12 hours, and potentially last a number of days
3. Headache, nausea, fatigue
183
Prevention of Acute mountain sickness?
1. Gain altitude no more than 500m per day
| 2. Acetozolamide
184
Features of HAPE?
1. Above 4000m
| 2. Classic pulmonary oedema fx
185
Features of HACE?
1. Above 4000m
| 2. Headache, ataxia, papilloedema
186
Mx of HACE?
Descent and dexamethasone
187
Mx of HAPE?
1. Descent
2. Oxygen if available
3. Nifedipine, dexamethasone, acetozolamide, PDE-V inhibitors
188
Causes of occupational asthma?
1. Isocyanates (most common cause e.g. spray paint)
2. Flour
3. Epoxy resins
189
Ix of occupational asthma?
Serial measurements of PEFR at work and away from work
190
MOA of haemoptysis in mitral stenosis?
Rupture of bronchial veins caused by raised LA pressure
191
Mx of atelectasis?
Chest physiotherapy with mobilisation and deep breathing exercises
192
Atelectasis defn?
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
What blood test should be offered to all pts with TB?
HIV
194
Most common organism of IECOPD?
H. influenzae
195
Type 1 respiratory failure?
Low pO2
196
Type 2 respiratory failure?
Low pO2, high pCO2
197
When should a chest tube be placed for pleural infection?
1. pH <7.2
| 2. Purulent or turbid/cloudy
198
How long should you wait between inhaler doses?
30 seconds
199
NG tube safe to use pH?
If pH <5.5 on aspirate
200
NG tube pH >5.5 Ix?
CXR to confirm position
201
2 most common causes of bihilar lymphadenopathy?
Sarcoidosis and TB
202
Spread of miliary TB?
Through the pulmonary venous system
203
Black lung disease aka?
Coal worker's pneumoconiosis
204
Pneumoconiosis defn?
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
What is upper lobe diversion?
Increased blood flow to the superior parts of the lungs
206
Facial rash + lymphadenopathy?
Sarcoidosis
207
EAA pathophysiology?
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
4 examples of EAA?
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
EAA classification?
1. Acute = 4-8hrs after exposure, SOB, dry cough, fever
| 2. Cough
210
EAA Ix?
1. CXR = upper/mid zone fibrosis
2. BAL = lymphocytes
3. Blood = no eosinophilia
211
Indication for surgery in bronchiectasis?
1. Localised disease
| 2. Uncontrollable haemoptysis
212
Bronchiectasis Mx?
1. Conservative = physical training, postural drainage
2. Medical = Abx for exacerbations, bronchodilators in selected cases, immunisations
3. Surgical
213
Most common organism isolated in pt with bronchiectasis?
H. influenzae
214
Currant jelly sputum?
Klebsiella
215
A complication of klebsiella?
Commonly causes lung abscess formation and empyema
216
Hoarseness in lung cancer MOA?
Pancoast tumour compressing the recurrent laryngeal nerve
217
Meigs' syndrome features?
Triad of Benign ovarian tumour, ascites and pleural effusion
218
When should abx be given for IECOPD?
If sputum is purulent or there are clinical signs of pneumonia
