repsiratory Flashcards

Question

risk factors for bronchial carcinoma

Answer 1

smoking urban areas passive smoking exposure to asbestos and possibly also contact with arsenic, chromium, ron oxides and products of coal combustion

Answer 2

local effects of tumour - cough, chest pain, haemoptysis, breathlessness spread within chest - pain and bone fractures, pancoasts tumour - horners syndrome, spread to LRL nerve - coarseness and bovine cough, metastatic disease - bone, brain are common non metastatic manifestations, - finger clubbing, malaise, lethargy, weightloss, lymphadenopathy

Answer 3

confirm diagnosis y CXR determine histology by biopsy via bronchoscopy or tranthoracic FNA assess spread of tumour by PET CT

Answer 4

non-small cell lung cancer - surgeyr, neoadjuvant chemo, radiotherapy small cell - chemo and radiotherpay for limited disease, just chemo for extensive disease, very poor prognosis

Answer 5

tension penumothorax - pleural tear acts as one way valve for air. unilateral increase in intrapleural pressure spontaneous - tall, young and thin men, rwuslt of rupture of a pleural bleb (congenital defect in connective tissue of alveolar wall) secondary - pneumothorax associated with underlying lung disease (COPD)

Answer 6

sudden onset of pleuritic chest pain and breathlessness

Answer 7

reduced breath sounds | hyperessonant percussion

Answer 8

standard PA chest XR to confirm diagnosis CT differentiates emphysematous bullae from pneumothoracies and prevent potentially dangerous aspiration CT detects small pneumothoracies

Answer 9

if breathless aspirate air if failure to re-expand lung intercostal tube drainage if still no re expansion after 48hrs , then surgery pleurectomy or pleurodesis

Answer 10

transudate - protein <30g/L - caused by imbalance of hydrostatic forces - heart failure, hypoalbuminaemia, constrictive pericarditis, hypothyroidism, ovarian fibroma exudate >30mg protein - infection, malignancy, PE with infarction, connective tissue disease,

Answer 11

may be asymptomatic if small but breathless if large reduced chest wall movements stony dull to percussion absent breath sounds reduced vocal resonance`

Answer 12

CXR - mensicus visible on erect diagnostic pleural fluid aspiration - appearance noted and sent to cytology contrast enahnced CT if diagnosis remains unclear pleural biopsy - for tissue diagnosis

Answer 13

exudates - drain transudates - treat underlying causes malignant effusions - treat by aspiration followed by installation of sclerosing agent into pleural space - talc, tetracycline, bleomycin

Answer 14

inflammation of lungs caused by bacteria classified anatomically - lobar, bronchopneumonia TB also is cause can be caused by aspiration of vomit and radiotherapy

Answer 15

``` underlying lung disease smoking alcohol abuse immunosuppression other chronic illness ```

Answer 16

pyrexia, respiratory symptoms (cough, sputum, pleurisy, dyspnoea), signs of consolidation and pleural rub,

Answer 17

``` contact with bird (psittacosis) farm animals recent stays in large hotels chronic alcohol abuse IV drug abuse contact with other patients with pneumonia ```

Answer 18

CURB 65 Confusion Urea >7mmol/L Respiratory rate >30/min Blood pressure <90/<60

Answer 19

``` CXR - only this if outpatient sputum blood tests serology ABG urine ```

Answer 20

pleuritic pain = analgesia hypoxaemia = oxygen fluids physiotherapy HAP: coamoxiclav 3x daily or more severe cases use second generatio cephalosporin metronidazole dded in those at risk of anaerobic infection antibiotic treatment adjusted after MC+S results

Answer 21

most common = DVT in lower limb | other sources - tumours, fat, amniotic fluid, sepsis, foreign bodies, air

Answer 22

``` DVT prev DVT or PE active cancer recent surgery hospitalisation lower limb trauma immobilisation pregnancy ```

Answer 23

dyspnoea tachypnoea pleuritic chest pain features of DVT

Answer 24

``` tahcycardia haemoptysis syncope hypotension crepitations cough or fever ```

Answer 25

wells score CXR, ABG, ECG ddimer for exclusion spiral CT with IV contrast radionuclide lung scan (demonstrates areas of ventilated lung with perfusion defects)

Answer 26

high flow oxygen if hypoxemic thrombolysis for massive embolism surgical embolectomy occasionally if thrombolysis contraindicated or ineffective analgesia prevention of further: LMWH, oral warfarin

Answer 27

late 60s | more common in males

Answer 28

restrictive lung disease patchy fibrosis of the interstitium and minimal or absent inflammation, acute fibroblastic proliferation and collagen deposition

Answer 29

cigarette smoking viral infections exposure to environmental pollutants, inc silica and hard metal dusts bacteria and animal proteins and gases and fumes use of certain meds genetics GORD

Answer 30

progressive breathlessness and non-productive cough eventually, resp failure, pul hypertension and cor pulmonale finger clubbing in 2/3 and fine inspiratory basal crackles heard on auscultation acute form = hamman-rich syndrome

Answer 31

CXR appearances are initially of a ground glass appearance progressing to fibrosis and a honeycomb lung changes mostly in lower lung zones high res CT most sensitive imaging blood tests: hypoxaemia with normal PacO2 autoantibodies such as antinuclear factor and rheumatoid factor in 1/3 histological confirmation is required in some patients

Answer 32

large doses of prednisolone daily azathioprine and cyclophosphamide can be tried single lung transplantation now an established treatment in some patients