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Respiratory > Passmedicine > Flashcards

Passmedicine Flashcards

1
Q

How should you investigate pleural effusion?

A

PA CXR
Ultrasound
Contrast CT (underlying cause)
Diagnostic aspiration

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2
Q

Does asbestosis affect upper or lower lobes?

A

Lower lobes

idiopathic pulmonary fibrosis - lower lobes, EAA - upper lobes

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3
Q

Which patients should you avoid varenicline in?

A

Avoid varenicline in patients with a past history of depression

(varenicline can be given to help stop smoking)

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4
Q

What can you offer patients trying to stop smoking?

A

Nicotine replacement therapy
Bupoprion
Varenicline

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5
Q

Adverse effects of nicotine replacement therapy?

A

Nausea and vomiting, headaches and flu-like symptoms

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6
Q

When should you start varenicline

A

Stope 1 week before target date to stop

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7
Q

Recommended length of varenicline treatment?

A

12 weeks

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8
Q

Side effects of varenicline

A

Nausea, headache, insomnia, abnormal dreams

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9
Q

Can you give varenicline in pregnancy/breastfeeding?

A

No - contraindicated

So is bupoprion

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10
Q

When should you take bupoprion?

A

Take 1-2 weeks before target stop date

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11
Q

Weird rare side effect of bupoprion

A

Seizures

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12
Q

When is bupoprion contraindicated?

A

Contraindicated in epilepsy, pregnancy and breast feeding.

Having an eating disorder is a relative contraindication

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13
Q

Treatment of mesothelioma

A

Platinum chemotherapy (e.g. cisplatin)

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14
Q

Which lung is more commonly affected in mesothelioma?

A

Right lung

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15
Q

CXR mesothelioma

A

Pleural effusion/pleural thickening

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16
Q

When should you prescribe antibiotics for someone having an acute exacerbation of COPD?

A

Prescribe if they have purulent sputum/clinical signs of pneumonia

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17
Q

Most common cause of COPD exacerbation?

A

Haemophilus influenza

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18
Q

Bupoprion mechanism of action?

A

Noradrenaline and dopamine reuptake inhibitor, nicotonic antagonist

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19
Q

How does miliary TB spread?

A

Through the pulmonary venous system

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20
Q

What is a ghon focus?

A

A small lung lesion that develops when a person develops TB for the first time (ghon focus is made of macrophages)

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21
Q

What is Potts disease?

A

When TB spreads to the vertebrae

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22
Q

Causes of upper zone fibrosis?

A 
CHARTS
Coal workers pneumoconiosis
Histiocytosis
Ank spon/allergic bronchopulmonary aspergillus
Radiation
Tuberculosis
Silicosis, Sarcoidosis
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23
Q

Someone has a CXR and it is suggestive of lung cancer, what investigation should be offered next?

A

Contrast enhanced CT

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24
Q

Epithelial crescents in Bownman’s capsule

A

Wegeners (granulomatosis with polyangitis)

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25
Q

Managment of Wegeners

A

Steroids
Cyclophosphamide (90% response)
Plasma exchange

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26
Q

Which organism can cause empyema formation?

A

Klebsiella

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27
Q

Which conditions are associated with Klebsiella?

A

Pneumonia in alcoholics (red jelly sputum - often affects upper lobes)
Empyema
Ascending cholangitis

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28
Q

Addisons disease can be associated with which other disease?

A

TB

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29
Q

Which type of lung cancer would show a cavitating lung lesion on CXR?

A

Sqaumous cell

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30
Q

CPAP or BiPAP for sleep apnoea?

A

CPAP (keeps airway open)

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31
Q

How does varenicline work?

A

Nicotonic receptor partial agonist

32
Q

Risk factors for aspiration pneumonia?

A 
Recent intubation
Poor dental hygiene
Swallowing difficulties
Prolonged hospitalisation or surgical procedures
Impaired consciousness
Impaired mucociliary clearance
33
Q

Difference between CRB65 and CURB65?

A

CRB65 for primary care setting

CURB65 for secondary care setting

34
Q

Why would do you use corticosteroids in COPD?

A

Reduce exacerbations

35
Q

What interventions improve survival in COPD?

A

Smoking cessation

Oxygen therapy

36
Q

Emphysema in COPD

A

At the apices

37
Q

Emphysema in alpha-1 antitrypsin

A

At the bases

38
Q

What is Meigs syndrome

A

Ovarian tumour
Pleural effusion
Ascites

39
Q

What is alpha-1 antitrypsin deficiency commonly misdiagnosed as?

A

COPD

40
Q

Biggest risk factor for pneumothorax

A

Stop smoking

41
Q

Treatment of small cell lung cancer

A

Chemotherapy with adjuvant radiotherapy

42
Q

What can you offer to COPD patients with frequent exacerbations of COPD?

A

Offer a home supply of prednisolone and an antibiotic

43
Q

Metabolic acidosis with large anion gap

A

Diabetic ketoacidosis

44
Q

When might you see a high anion gap?

A

Diabetic ketoacidosis

45
Q

When might you see a low anion gap?

A

Multiple myeloma

46
Q

“multiple large, round, well-circumscribed masses”

A

Cannon ball mets

Seen in renal cell carcinoma

47
Q

More common in diabetics and alcoholics?

A

Klebsiella

48
Q

How might Klebsiella look on CXR?

A

Consolidation which may cavitate in upper lobe

Commonly causes lung abscesses and empyema

49
Q

If someone develops a cough after recent immunosuppression therapy,, what should you do?

A

Do a CXR ASAP - could be reactivation of TB or smoething

50
Q

A 35-year-old man is seen due to an extensive petechial rash on his lower legs for the last 2 weeks. He has minimal past medical history other than asthma and surgical removal of nasal polyps aged 23 and 29 years.

A

Churg Strauss

51
Q

Organism most likely to cause COPD exacerbation

A

Haemophilus influenzae

52
Q

Treatment of COPD exacerbations?

A

Amoxicillin or a tetracycline with a prednisolone

53
Q

An ex-smoker with SOB, weight loss and hyponatraemia with a normal CXR?

A

Urgent referral to the chest clinic

54
Q

Safe triangle for chest drain insertion

A

5th intercostal space, mid axillary line

borders = latissimus dorsi, lateral border of pectoralis and nipple line

55
Q

How would you control symptoms in non-CF bronchiectasis?

A

Inspiratory muscle training and postural drainage

56
Q

What is bronchiectasis?

A

Permanent dilatation of the airways secondary to chronic inflammation or infection

57
Q

How to minimise oral effects of inhaled steroids?

A

Brushing teeth or rinsing mouth straight after use

58
Q

What is the transfer coefficient?

A

The rate at which a gas will diffuse from alveoli into the blood

59
Q

Persistent hoarseness in a smoker should raise suspicion of what?

A

Either lung cancer or laryngeal cancer

60
Q

Tests for occupational asthma

A

Serial measurements of peak expiratory flow at work and away from work

61
Q

Asthma medications and pregnancy?

A

Women should have good control of asthma in pregnancy!! Inhaled drugs, theophylline and prednisolone can be taken as normal during pregnancy and breast feeding

62
Q

Investigation of choice for asthma?

A

Peak flow

63
Q

Investigation of choice for COPD?

A

Spirometry

- a diagnosis of COPD can be made when the FEV/FVC ratio is <0.7

64
Q

What characterises adult respiratory distress syndrome?

A

Bilateral pulmonary infiltrates and hypoxaemia

65
Q

Sweat test

A

Cystic fibrosis

66
Q

Epithelioid histiocytes

A

Tuberculosis

67
Q

Psammoma bodies

A

Papillary thyroid cancer

68
Q

Owls-eye nucleus

A

CMV infection

69
Q

Reed-Sternberg cells

A

Hodgkins lymphoma

70
Q

Histiological finding in patients with granulomas resulting from TB infection?

A

Epithelioid histiocytes (macrophages which become elongated to look like an epithelial cell)

71
Q

Contraindications to lung cancer surgery

A

SVC compression
FEV <1.5
MALIGNANT pleural effusion
Vocal cord paralysis

72
Q

Boot shaped heart

A

Tetralogy of fallot

73
Q

Deviated trachea

A

Tension pneumothorax

74
Q

Widened mediastinum

A

Aortic dissection or aneurysm

75
Q

ABCDE of heart failure

A 
Alveolar oedema (bats wings)
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion (pleural)
76
Q

A 24-year-old female presents with facial weakness, fever and painful red eyes. On examination you note a left sided facial palsy and tender swelling of the parotid glands. Laboratory results reveal a calcium level of 2.82 mmol/L.

A

Sarcoidosis

Respiratory (13 decks)

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