Ques for Resp and Notebook Flashcards
Causes of exudative pleural effusion
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
Causes of transudative pleural effusions
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
Which lung cancers are sensitive to chemotherapy?
Small cell lung cancers - often have chemo and radiotherapy combined
(non-small cell are not)
Which pneumonia organism causes deranged LFTs and erythemtamous lesions?
Mycoplasma pneumoniae - causes erythema multiforme
What is criteria for exudative pleural effusion?
- Protein >30g/L
- Pleural protein: serum protein >0.5
- Pleural LDH: serum LDH >0.6
Management of acute bronchtiis if patient stable based on CRP
- 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
When to refer to urgent cancer pathway (2WW resp)?
- Have CXR findings that suggest cancer
- 40 or over with unexplained haemoptysis
What is the most common chemical cause for occupational asthma?
Isocyanates - found in factories producing spray paint and foam moulding using adhesives - should measure peak flow at and away from work
Causes of obstructive spirometry pattern
- COPD
- Asthma
- Bronchiectasis
- Bronchiolitis obliterans
Causes of restrictive pattern on Spirometry
- Pulmonary fibrosis
- Asbestosis
- Sarcoidosis
- ARDs
- IRDs
- Kyphoscoliosis (eg ankylosing spondylitis)
- Neuromuscular diseases
- Severe obesity
At what point should you do an ABG in acute asthma exacerbation?
When O2 sats are below 92%
What advice should all pts following a pneumothorax be given?
Stop smoking if they stop - reduces risk of further episodes (can travel 2 weeks after aspiration or 1 week after successful CXR follow up)
Management for primary pneumothorax
- 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
Management for secondary pneumothorax
- 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
What is the only smoking cessation option for women who are pregnant?
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
3 most common bacterial causes of COPD exacerbations
Haemophilus influenzae
Moraxella catterhalis
Streptococcus pneumoniae
O2 sats targets for CO2 retainers
88-92%
What pleural characteristics are suggestive of an empyema using Lights criteria?
- 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
Management of empyema
Prompt drainage and commence abx therapy
What primary cancer often causes ‘cannon ball mets’ shown on CXR?
Renal cell cancer - but can be choriocarcinoma and prostate cancer too
Indications for admission for asthma exacerbation
- life-threatening asthma, severe asthma with inadequate response to initial treatment
- previous near-fatal attack
- pregnancy
- presentation at night
What is Wolff Chaikoff effect?
- Body rejects large quantities of iodide so prevents thyroid from synthesising large quantities of thyroid hormone –> hypothyroidism
- Iodine induced hypothyroidism
Cause of Wolff Chaikoff effect?
- Diet excess Iodine
- Amiodarone - contains iodine
- Contrast agent
What is Jod-Basedow effect?
- Hyperthyroidism induced by excess exogenous iodine exposure
Causes of Jod-Basedow effect?
Previously seen in iodine deficient patients exposed to more iodine
What is AIT?
Amiodarone induced thyrotoxicosis
AIT type 1 vs Type 2
- 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
Treatment of AIT 1 vs 2
- AIT 1 - Thionamides eg Carbimazole, treat underlying disease of thyroid
- AIT 2 - Steroids
MRCP
Magnetic resonance cholangiopancreatography - non-invasive imaging scanning biliary system
ERCP
Endoscopic retrograde cholangiopancreatography - dye into ducts to scan and can also be therapeutic and remove stones
Which pneumonia organism can cause hyponatraemia?
Legionella pneumophilia
Which organism classically causes red currant sputum?
Klebsiella pneumoniae
Cause of bronchial breathing
Often infections eg pneumonia
Legionella presentation
- History exposure to contaminated water source
- Headaches
- Myalgia
- Lymphopaenia
- Hyponatraemia
Presentation of mycoplasma pneumoniae
- Headaches
- Myalgia
- Erythema multiforme
- Haemolytic anaemia
- Guillian barre syndrome
- Pericarditis
Treatment for legionella and mycoplasma infection
Macrolide eg Azithromycin
Advice for patients on DMARDs worried about flu and pneumocococal vaccine
They should have both - not live vacciens
Classic presentation of pneumocystis jirovecci
- HIV positive
- SOB
- Fever
- Cough
- Exercise induced desaturation
Stain for pneumocystit jirovecci
Silver stain
Which pneumonia organism is associated with blisters on lip?
Streptococcus pneumoniae - herpes labialis
CXR sign of TB
- Fibronodular opacification in bilateral upper zones
- Caseating granulomas in people with chronic disease of TB
