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Respiratory YR3 > Ques for Resp and Notebook > Flashcards

Ques for Resp and Notebook Flashcards

1
Q

Causes of exudative pleural effusion

A

Infections – pneumonia or TB (ie. parapneumonic effusion)
Malignancy – bronchial carcinoma, mesothelioma or lung metastases
Inflammatory conditions – rheumatoid arthritis, lupus or acute pancreatitis
Pulmonary infarction – secondary to a pulmonary embolism or following trauma
Chylothorax
Oesophageal perforation

IM COPI

change in permeability of vessels

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2
Q

Causes of transudative pleural effusions

A

Increase the capillary hydrostatic pressure – forcing fluid out of the pulmonary capillaries into the pleural space (eg. congestive cardiac failure)

Reduce the capillary oncotic pressure – impairing the reabsorption of fluid from the pleural space into the pulmonary capillaries (eg. cirrhosis, nephrotic syndrome/chronic kidney disease, and gastrointestinal malabsorption/malnutrition as seen in coeliac disease)

Imbalance of starling forces

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3
Q

Which lung cancers are sensitive to chemotherapy?

A

Small cell lung cancers - often have chemo and radiotherapy combined
(non-small cell are not)

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4
Q

Which pneumonia organism causes deranged LFTs and erythemtamous lesions?

A

Mycoplasma pneumoniae - causes erythema multiforme

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5
Q

What is criteria for exudative pleural effusion?

A
  • Protein >30g/L
  • Pleural protein: serum protein >0.5
  • Pleural LDH: serum LDH >0.6
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6
Q

Management of acute bronchtiis if patient stable based on CRP

A
  • CRP 20-100 = delayed prescription
  • CRP >100 = offer prescription (usually doxycycline for 5 days)
  • If no raised CRP and stable, consider analgensia and good oral fluid intake
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7
Q

When to refer to urgent cancer pathway (2WW resp)?

A
  • Have CXR findings that suggest cancer
  • 40 or over with unexplained haemoptysis
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8
Q

What is the most common chemical cause for occupational asthma?

A

Isocyanates - found in factories producing spray paint and foam moulding using adhesives - should measure peak flow at and away from work

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9
Q

Causes of obstructive spirometry pattern

A
  • COPD
  • Asthma
  • Bronchiectasis
  • Bronchiolitis obliterans
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10
Q

Causes of restrictive pattern on Spirometry

A
  • Pulmonary fibrosis
  • Asbestosis
  • Sarcoidosis
  • ARDs
  • IRDs
  • Kyphoscoliosis (eg ankylosing spondylitis)
  • Neuromuscular diseases
  • Severe obesity
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11
Q

At what point should you do an ABG in acute asthma exacerbation?

A

When O2 sats are below 92%

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12
Q

What advice should all pts following a pneumothorax be given?

A

Stop smoking if they stop - reduces risk of further episodes (can travel 2 weeks after aspiration or 1 week after successful CXR follow up)

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13
Q

Management for primary pneumothorax

A
  • If pneumothorax is <2cm and pt is not short of breath - consider discharge
  • If >2cm and/or SOB - aspiration
  • If this fails, insert chest drain
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14
Q

Management for secondary pneumothorax

A
  • If pt is >50 and it is >2cm and/or SOB = chest drain
  • Aspiration if between 1-2cm - if fails, chest drain
  • If less 1cm - oxygen and admit for 24hrs
  • ALL pts should be admitted for 24hrs if secondary
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15
Q

What is the only smoking cessation option for women who are pregnant?

A

Nicotine replacement therpay - vaping is not advised as unknown effects on foetus but NICE says do not discourage if pts have successfully stopped smoking via this

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16
Q

3 most common bacterial causes of COPD exacerbations

A

Haemophilus influenzae
Moraxella catterhalis
Streptococcus pneumoniae

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17
Q

O2 sats targets for CO2 retainers

A

88-92%

18
Q

What pleural characteristics are suggestive of an empyema using Lights criteria?

A
  • Pleural fluid LDH >1000 = empyema
  • Exudate crteria - eg pleural:plasma protein ratio >0.5, pleural to plasma LDH ratipo >.06
  • Pleural fluid pH <7.3
  • Low pleural glucose conc <1.6
19
Q

Management of empyema

A

Prompt drainage and commence abx therapy

20
Q

What primary cancer often causes ‘cannon ball mets’ shown on CXR?

A

Renal cell cancer - but can be choriocarcinoma and prostate cancer too

21
Q

Indications for admission for asthma exacerbation

A
  • life-threatening asthma, severe asthma with inadequate response to initial treatment
  • previous near-fatal attack
  • pregnancy
  • presentation at night
22
Q

What is Wolff Chaikoff effect?

A
  • Body rejects large quantities of iodide so prevents thyroid from synthesising large quantities of thyroid hormone –> hypothyroidism
  • Iodine induced hypothyroidism
23
Q

Cause of Wolff Chaikoff effect?

A
  • Diet excess Iodine
  • Amiodarone - contains iodine
  • Contrast agent
24
Q

What is Jod-Basedow effect?

A
  • Hyperthyroidism induced by excess exogenous iodine exposure
25
Q

Causes of Jod-Basedow effect?

A

Previously seen in iodine deficient patients exposed to more iodine

26
Q

What is AIT?

A

Amiodarone induced thyrotoxicosis

27
Q

AIT type 1 vs Type 2

A
  • AIT 1 - occurs in patients with underlying thyroid pathology eg nodular goitre or Graves disease
  • AIT 2 - normal glands, amiodarone causes subacute thyroiditis –> preformed thyroid hormones into circulation
28
Q

Treatment of AIT 1 vs 2

A
  • AIT 1 - Thionamides eg Carbimazole, treat underlying disease of thyroid
  • AIT 2 - Steroids
29
Q

MRCP

A

Magnetic resonance cholangiopancreatography - non-invasive imaging scanning biliary system

30
Q

ERCP

A

Endoscopic retrograde cholangiopancreatography - dye into ducts to scan and can also be therapeutic and remove stones

31
Q

Which pneumonia organism can cause hyponatraemia?

A

Legionella pneumophilia

32
Q

Which organism classically causes red currant sputum?

A

Klebsiella pneumoniae

33
Q

Cause of bronchial breathing

A

Often infections eg pneumonia

34
Q

Legionella presentation

A
  • History exposure to contaminated water source
  • Headaches
  • Myalgia
  • Lymphopaenia
  • Hyponatraemia
35
Q

Presentation of mycoplasma pneumoniae

A
  • Headaches
  • Myalgia
  • Erythema multiforme
  • Haemolytic anaemia
  • Guillian barre syndrome
  • Pericarditis
36
Q

Treatment for legionella and mycoplasma infection

A

Macrolide eg Azithromycin

37
Q

Advice for patients on DMARDs worried about flu and pneumocococal vaccine

A

They should have both - not live vacciens

38
Q

Classic presentation of pneumocystis jirovecci

A
  • HIV positive
  • SOB
  • Fever
  • Cough
  • Exercise induced desaturation
39
Q

Stain for pneumocystit jirovecci

A

Silver stain

40
Q

Which pneumonia organism is associated with blisters on lip?

A

Streptococcus pneumoniae - herpes labialis

41
Q

CXR sign of TB

A
  • Fibronodular opacification in bilateral upper zones
  • Caseating granulomas in people with chronic disease of TB
42
Q
A

Respiratory YR3 (14 decks)

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