resp 1 Flashcards
what is the main treatment choice for allergic bronchopulmonary aspergillosis?
- oral glucocorticoids
- e.g. high dose prednisolone
asthma, eosinophilia, raised serum IgE and fungal hyphae on sputum examination would point towards a diagnosis of?
- allergic bronchopulmonary aspergillosis
asbestosis gives what result on pulmonary function testing?
- restrictive
- reduced FEV1, increased FEV1/FVC ratio
life threatening asthma is defined as…
peak expiratory flow reading < 33% best or predicted
what type of lung cancer can cause independent secretion of ACTH?
- small cell lung cancer
- patients may have central weight gain, buffalo hump, , moon facies and skin thinning
small cell lung cancers are frequently responsible for paraneoplastic syndromes including SIADH, Lambert-Eaton, Cushings
small cell lung cancers are frequently responsible for paraneoplastic syndromes including SIADH, Lambert-Eaton, Cushings
pathogenesis of kartagener’s syndrome
dynein arm defect
results in immotile cilia
features of kartagener’s syndrome (4)
- dextrocardia , or complete situs inversus
- bronchiectasis
- recurrent sinusitis
- sub fertility
dextrocardia
rare heart conditions
heard points towards the right instead of left
interpreting ABGs
ROME
- respiratory opposite (low pH, high PaCO2) (high pH, low PaCO2)
- metabolic equal (low pH, low bicarb) (high pH + high bicarb)
type 1 respiratory failure
- 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
type 2 respiratory failure
- occurs when alveolar ventilation insufficient to excrete CO2 being produced
- affects lung as a whole
- CO2 accumulates, hypercapnia
what two features are indicative of life threatening asthma ?
- confusion
- normocapnia
how would lung malignancy would appear on chest radiography?
- lucency with a thick wall >3mm
- unexpected weight loss, night sweats, haemoptysis
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?
acute sarcoidosis
management of atelectasis
- chest physiotherapy
- with mobilisation and breathing exercise
what is atelectasis caused by?
- basal alveolar collapse
- due to airway obstruction by bronchial secretions
In primary pneumothorax A PATIENT that has either shortness of breath or >2cm rim of air
management:
aspiration should be attempted
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?
hypercalcaemia
sarcoidosis
what condition presents with an
- increased FEV1/FVC ratio
- reduced transfer factor
idiopathic pulmonary fibrosis
what kind of spirometry picture does pulmonary fibrosis cause?
restrictive picture
FEV1:FVC > 70%
decreased FVC
impaired gas exchange (reduced TLCO)
What is TCLO ?
transfer factor for carbon monoxide
- measure of how much oxygen diffuses from lung alveoli to blood in capillaries
71 y/o female presents with
- dyspnoea
- haemoptysis
clinical examination
- loud first heart sound
- diastolic murmur
- new onset AF
haemoptysis in mitral stenosis
thought to occur secondary to rupture of bronchial veins
caused by raised left atrial pressure
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
ankle oedema
which scale is used in the identification of obstructive sleep apnoea?
- the epworth sleepiness scale
what is the main cause of exudative pleural effusion?
- pneumonia
heart failure and renal failure are both transudative thus can be ruled out
which prophylaxis is recommended in COPD patients who meet certain criteria and continue to have exacerbations of COPD?
azithromycin
hyperventilation will result in…
alkalosis
is gynaecomastia associated with small cell carcinoma
true / false
gynaecomastia associated with adenocarcinoma
clarithromycin should be avoided in patients with…
- congenital long QT syndrome
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
tuberculosis
- most common cause of bilateral hilarity lymphadenopathy
what would a resp examination reveal In patients with pneumonia
- decreased breath sounds
- bronchial breathing
- reduced chest expansion
CXR = consolidation
what drug, when used longterm may lead to pulmonary fibrosis development?
amiodarone
bleomycin, cyclophosphamide, nitrofurantoin, methotrexate and penicillamine.
hydoxychloroquine is used to treat what?
- systemic lupus erythematous and rheumatoid arthritis
fibrosis predominantly affecting upper zones (5)
CHARTS
C- coal workers pneumoconiosis
H - histiocytosis/ hypersensitivity pneumonitis
A- ankylosing spondylitis
R- radiation
T- tuberculosis
S- silicosis/ sarcoidosis
most common organism to cause bronchiectasis
haemophilia influenza
klebsiella pneumonia also valid but less commonly seen. associated causing pneumonia in patients with alcohol dependence
what is Alpha-1 antitrypsin (A1AT) deficiency?
- lack of protease inhibitor
- produced by the liver
- A1AT role is to protect cells from enzymes like neutrophil elastase
A1AT deficiency typically causes what in young patients?
emphysema
4 key features of idiopathic pulmonary fibrosis?
- progressive exertional dyspnoea
- bibasal fine end-inspiratory crepitations on auscultation
- dry cough
- clubbing
opiate overdose leads to what respiratory picture?
- leads to respiratory depression
- hence respiratory acidosis
idiopathic pulmonary fibrosis tends to affect what zone of lung?
lower zones of lung
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?
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
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
tension pneumothorax
what is a tension pneumothorax, when might it occur and what happens?
- 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
treatment of tension pneumothorax
- needle decompression
- chest tube insertion
target oxygen saturations in COPD patients suffering suspected infective exacerbation of COPD
88-92%
when using an inhaler for second dose, how long should you wait before repeating?
30 seconds!
what is bronchiectasis
permanent dilatation of airways
secondary to chronic infection or inflammation
aspiration pneumonia more common in which lobe
right lower lobe
recurrent chest infections + sub fertility - think!
primary ciliary dyskinesia syndrome
Kartagener’s syndrome
investigation of choice for COPD
spirometry
investigation of choice for asthma
peak flow
which cancer is strongly associated with asbestos exposure?
- mesothelioma is cancer of mesothelial layer of pleural cavity
- strongly associated with asbestos exposure
in COPD is there an increase or decrease in TLCO?
- decrease
- due to decrease in capillary bed
- alveolar wall destruction
- v/q mismatch
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?
physiotherapy for inspiratory muscle training and postural drainage
what is carbocisteine and when is it recomended?
- mucoactive agent
- in patients who have difficulty coughing up sputum
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?
- antinuclear antibody (ANA) titre test
- SLE
- SLE can cause exudative pleural effusion
weakness often relieved temporarily after exertion
MG or LES
Lambert Eaton Syndrome
- antibodies formed against pre-synaptic VG[ca2+]
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?
klebsiella
- can cause empyema formation
what is an important test to do before starting a patient to on azithromycin and why?
ECG and baseline LFTs
to rule out prolonged QT interval
examples of differential diagnoses for early postoperative shortness of breath
- atelectasis
- pneumonia
- pulmonary embolism
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?
ANCA
- anti-neutrophil cytoplasmic antibody
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?
CT chest
vpancoast tumours can suppress recurrent laryngeal nerve
causing hoarseness of voice
COPD symptoms in a young patient think!
alpha-1-antitrypsin A1AT deficiency
