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Pass Med finals pack > resp 1 > Flashcards

resp 1 Flashcards

1
Q

what is the main treatment choice for allergic bronchopulmonary aspergillosis?

A
  • oral glucocorticoids

- e.g. high dose prednisolone

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2
Q

asthma, eosinophilia, raised serum IgE and fungal hyphae on sputum examination would point towards a diagnosis of?

A
  • allergic bronchopulmonary aspergillosis
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3
Q

asbestosis gives what result on pulmonary function testing?

A
  • restrictive

- reduced FEV1, increased FEV1/FVC ratio

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4
Q

life threatening asthma is defined as…

A

peak expiratory flow reading < 33% best or predicted

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5
Q

what type of lung cancer can cause independent secretion of ACTH?

A
  • small cell lung cancer

- patients may have central weight gain, buffalo hump, , moon facies and skin thinning

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6
Q

small cell lung cancers are frequently responsible for paraneoplastic syndromes including SIADH, Lambert-Eaton, Cushings

A

small cell lung cancers are frequently responsible for paraneoplastic syndromes including SIADH, Lambert-Eaton, Cushings

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7
Q

pathogenesis of kartagener’s syndrome

A

dynein arm defect

results in immotile cilia

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8
Q

features of kartagener’s syndrome (4)

A
  • dextrocardia , or complete situs inversus
  • bronchiectasis
  • recurrent sinusitis
  • sub fertility
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9
Q

dextrocardia

A

rare heart conditions

heard points towards the right instead of left

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10
Q

interpreting ABGs

A

ROME
- respiratory opposite (low pH, high PaCO2) (high pH, low PaCO2)

  • metabolic equal (low pH, low bicarb) (high pH + high bicarb)
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11
Q

type 1 respiratory failure

A
  • hypoxemic
  • associated with damage to lung tissue
  • prevents inadequate oxygenation of blood
  • normal lung still sufficient to excrete CO2
  • results in low oxygen, normal or low co2
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12
Q

type 2 respiratory failure

A
  • occurs when alveolar ventilation insufficient to excrete CO2 being produced
  • affects lung as a whole
  • CO2 accumulates, hypercapnia
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13
Q

what two features are indicative of life threatening asthma ?

A
  • confusion

- normocapnia

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14
Q

how would lung malignancy would appear on chest radiography?

A
  • lucency with a thick wall >3mm

- unexpected weight loss, night sweats, haemoptysis

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15
Q

24 y/o male, 2 week history of widespread swollen and painful joints. large and small joints affected.

affecting job, sudden onset, struggling to walk.

denies recent sexual exposure.

joints are warm to touch, have effusions, cannot see signs of rash or nail changes.

rheumatoid factor and anti CCP are negative.

serum ACE levels twice upper limit.

what is the most likely diagnosis?

A

acute sarcoidosis

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16
Q

management of atelectasis

A
  • chest physiotherapy

- with mobilisation and breathing exercise

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17
Q

what is atelectasis caused by?

A
  • basal alveolar collapse

- due to airway obstruction by bronchial secretions

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18
Q

In primary pneumothorax A PATIENT that has either shortness of breath or >2cm rim of air

management:

A

aspiration should be attempted

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19
Q

40 y/o female

  • painful red bumps over shins
  • erythema nodosum
  • non productive cough
  • recent joint pains
  • CXR shows: bilateral hilar lymphadenopathy

which chemical abnormality is associated with this condition?

A

hypercalcaemia

sarcoidosis

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20
Q

what condition presents with an

  • increased FEV1/FVC ratio
  • reduced transfer factor
A

idiopathic pulmonary fibrosis

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21
Q

what kind of spirometry picture does pulmonary fibrosis cause?

A

restrictive picture

FEV1:FVC > 70%
decreased FVC
impaired gas exchange (reduced TLCO)

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22
Q

What is TCLO ?

transfer factor for carbon monoxide

A
  • measure of how much oxygen diffuses from lung alveoli to blood in capillaries
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23
Q

71 y/o female presents with

  • dyspnoea
  • haemoptysis

clinical examination

  • loud first heart sound
  • diastolic murmur
  • new onset AF
A

haemoptysis in mitral stenosis

thought to occur secondary to rupture of bronchial veins

caused by raised left atrial pressure

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24
Q

which of the following should prompt an assessment for long-term oxygen therapy?

a) failure to respond to inhaled and/or oral corticosteroids
b) FEV1/FVC of 0.47
c) ankle oedema
d) haemoglobin of 10.1 g/dl

A

ankle oedema

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25
Q

which scale is used in the identification of obstructive sleep apnoea?

A
  • the epworth sleepiness scale
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26
Q

what is the main cause of exudative pleural effusion?

A
  • pneumonia

heart failure and renal failure are both transudative thus can be ruled out

27
Q

which prophylaxis is recommended in COPD patients who meet certain criteria and continue to have exacerbations of COPD?

A

azithromycin

28
Q

hyperventilation will result in…

A

alkalosis

29
Q

is gynaecomastia associated with small cell carcinoma

true / false

A

gynaecomastia associated with adenocarcinoma

30
Q

clarithromycin should be avoided in patients with…

A
  • congenital long QT syndrome
31
Q

32 y/o male, 6 week history of weight loss, haemoptysis, night sweats, and cough

cough initially dry now productive

denies recent travel

Mantoux test shows palpable raised hardened area

CXR shows bilateral hilar lymphadenopathy

A

tuberculosis

- most common cause of bilateral hilarity lymphadenopathy

32
Q

what would a resp examination reveal In patients with pneumonia

A
  • decreased breath sounds
  • bronchial breathing
  • reduced chest expansion

CXR = consolidation

33
Q

what drug, when used longterm may lead to pulmonary fibrosis development?

A

amiodarone

bleomycin, cyclophosphamide, nitrofurantoin, methotrexate and penicillamine.

34
Q

hydoxychloroquine is used to treat what?

A
  • systemic lupus erythematous and rheumatoid arthritis
35
Q

fibrosis predominantly affecting upper zones (5)

A

CHARTS

C- coal workers pneumoconiosis

H - histiocytosis/ hypersensitivity pneumonitis

A- ankylosing spondylitis

R- radiation

T- tuberculosis

S- silicosis/ sarcoidosis

36
Q

most common organism to cause bronchiectasis

A

haemophilia influenza

klebsiella pneumonia also valid but less commonly seen. associated causing pneumonia in patients with alcohol dependence

37
Q

what is Alpha-1 antitrypsin (A1AT) deficiency?

A
  • lack of protease inhibitor
  • produced by the liver
  • A1AT role is to protect cells from enzymes like neutrophil elastase
38
Q

A1AT deficiency typically causes what in young patients?

A

emphysema

39
Q

4 key features of idiopathic pulmonary fibrosis?

A
  • progressive exertional dyspnoea
  • bibasal fine end-inspiratory crepitations on auscultation
  • dry cough
  • clubbing
40
Q

opiate overdose leads to what respiratory picture?

A
  • leads to respiratory depression

- hence respiratory acidosis

41
Q

idiopathic pulmonary fibrosis tends to affect what zone of lung?

A

lower zones of lung

42
Q

53 y/o female

  • severe SOB
  • green sputum productive cough
  • PMH of recurrent respect tract infections
  • rapidly progressive glomerulonephritis
  • hypertension
  • gallstones

obs

  • fever
  • t.cardia
  • low o2 sats

examination

  • nasal crusting
  • saddle shaped nasal deformity

most likely underlying disease process?

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

  • ENT, resp and renal involvement raises alarm bells for GPA
  • nasal crusting and saddle shaped nasal deformity are classic features
43
Q

given the clinical picture below what is most likely clinical diagnosis?

  • tracheal deviation
  • resonant to percussion
  • absent breath sounds in context of respiratory distress and shock
A

tension pneumothorax

44
Q

what is a tension pneumothorax, when might it occur and what happens?

A
  • thoracic trauma, when a lung parenchymal flap is created
  • acts as one way valve, allows air pressure to rise
  • trachea shifts
  • hyper-resonance apparent on affected side
  • treatment is with needle decompression and chest tube insertion
45
Q

treatment of tension pneumothorax

A
  • needle decompression

- chest tube insertion

46
Q

target oxygen saturations in COPD patients suffering suspected infective exacerbation of COPD

A

88-92%

47
Q

when using an inhaler for second dose, how long should you wait before repeating?

A

30 seconds!

48
Q

what is bronchiectasis

A

permanent dilatation of airways

secondary to chronic infection or inflammation

49
Q

aspiration pneumonia more common in which lobe

A

right lower lobe

50
Q

recurrent chest infections + sub fertility - think!

A

primary ciliary dyskinesia syndrome

Kartagener’s syndrome

51
Q

investigation of choice for COPD

A

spirometry

52
Q

investigation of choice for asthma

A

peak flow

53
Q

which cancer is strongly associated with asbestos exposure?

A
  • mesothelioma is cancer of mesothelial layer of pleural cavity
  • strongly associated with asbestos exposure
54
Q

in COPD is there an increase or decrease in TLCO?

A
  • decrease
  • due to decrease in capillary bed
  • alveolar wall destruction
  • v/q mismatch
55
Q

54 y/o male, history of recurrent pneumonia. HRCT shows multiple bilateral areas of dilated bronchi consistent with bronchiectasis in lower lobes.

bringing up copious amounts of white sputum.

NKDA

what is most appropriate management for this patient?

A

physiotherapy for inspiratory muscle training and postural drainage

56
Q

what is carbocisteine and when is it recomended?

A
  • mucoactive agent

- in patients who have difficulty coughing up sputum

57
Q

25 y/o female.
2 day hx sob.
pain bilaterally in knees.
alopecia and oral ulcers.

OE

  • rash on cheeks and nose
  • dull percussion notes
  • diminished breath sounds in lower lung fields

Ix
- CXR, bilateral pleural effusion

what do you think is the underlying diagnosis?

what test should be done to confirm this?

A
  • antinuclear antibody (ANA) titre test
  • SLE
  • SLE can cause exudative pleural effusion
58
Q

weakness often relieved temporarily after exertion

MG or LES

A

Lambert Eaton Syndrome

- antibodies formed against pre-synaptic VG[ca2+]

59
Q

56 y/o male.

PC- pleuritic chest pain. dyspnoea, pyrexia.
PMH- significant alcohol abuse

Coughs up currant jelly sputum

been prescribed antibiotics.

what is the causative agent?

A

klebsiella

  • can cause empyema formation
60
Q

what is an important test to do before starting a patient to on azithromycin and why?

A

ECG and baseline LFTs

to rule out prolonged QT interval

61
Q

examples of differential diagnoses for early postoperative shortness of breath

A
  • atelectasis
  • pneumonia
  • pulmonary embolism
62
Q

48 y/o male. PC: 8 week hx epistaxis, nasal stuffiness. evidence of nasal crusting.

CXR - multiple cavitary lesions

what is the most appropriate test from the options below?

A

ANCA

- anti-neutrophil cytoplasmic antibody

63
Q

55 y/o male presenting 2 month history of hoarse voice. TTAT. ENT can’t find cause of hoarse voice.

20 pack year history.

what is investigation likely to be diagnostic in this case?

A

CT chest

vpancoast tumours can suppress recurrent laryngeal nerve

causing hoarseness of voice

64
Q

COPD symptoms in a young patient think!

A

alpha-1-antitrypsin A1AT deficiency

Pass Med finals pack (40 decks)

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