Resp Flashcards
What is pulmonary hypertension defined as?
> 25mmHg
Give 3 signs of pulmonary hypertension on X-ray.
Enlargement of pulmonary arteries
Enlarged right atrium
Elevated cardiac apex
Give 6 side effects of chemotherapy.
Nausea and vomiting Alopecia Peripheral neuropathy Anaemia Fatigue Constipation or diarrhoea
Name 4 causing of pleural effusion with exudate.
Infection
Inflammatory
Pulmonary embolism
Asbestos related
What is the most common histological type of non-small cell lung cancer?
Adenocarcinoma
Which two conditions constitute COPD?
Chronic bronchitis
Emphysema
What bacteria causes TB?
Mycobacterium tuberculosis
What stain would you use to detect TB?
Ziehl-Neelson stain
What other bacteria does Ziehl-Neelson stain for?
Mycobacterium leprae (leprosy)
What is a CURB-65 score?
Assesses mortality of community-acquired pneumonia to determine whether community or secondary care treatment is most appropriate
What makes up the CURB-65 score?
Confusion Urea > 7 Respiratory rate > 30 BP < 60/90 Age > 65
What CURB-65 score constitutes admission to hospital?
2 or more
Which antibiotics are used to treat community acquired pneumonia?
Amoxicillin and clarithromycin
Give 5 features of bronchiectasis.
Persistent cough Purulent sputum Haemoptysis Dyspneoa Clubbing
Name 2 tests used to diagnose CF?
Faecal elastase
Genetic testing
Sweat test
What is a positive sweat test?
High level of chloride in the sweat (>60mmol/L)
What is indicative of type 1 respiratory failure?
Low O2, normal or low CO2
What is type 2 respiratory failure?
Low O2, high CO2
What is the most effective way of improving FEV1 in COPD?
Smoking cessation
What is the most common type of lung cancer?
Adenocarcinoma
What is a common cause of bacterial otitis media?
Haemophilus influenzae
What scale is used to grade breathlessness?
MRC dyspnoea scale
Describe the MRC dyspnoea scale.
Grade 1 - Breathless with strenuous exercise
Grade 2 - Short of breath when hurrying or running up a hill
Grade 3 - Walks slower than most people of that age or stops for breath when walking on flat
Grade 4 - Stops for breath after walking 100m on flat
Grade 5 - Too breathless to leave the house
Give 3 red flag respiratory symptoms.
Weight loss
Haemoptysis
Night sweats
What is the first line investigation for suspected lung cancer
Chest X-ray
What kind of percussion is seen in pleural effusion?
Stony/dull
What antibody is granulomatosis with polyangitis associated with?
c-ANCA
What inheritance pattern is seen in von-willebrand disease?
Autosomal dominant
What inheritance pattern is seen in cystic fibrosis?
Autosomal recessive
What is atelectasis?
Complete or partial collapse of a lobe of the lung, or the whole lung
What are pneumoconioses?
A group of lung disorders - reaction of the lung to inhaled dusts
Give 3 examples of pneumoconiosis?
Silicosis, asbestosis, coal workers lung
Give 2 examples of extrinsic allergic alveolitis
Farmers lung, bird fanciers lung
What is extrinsic allergic alveolitis?
Lung inflammation as a cause of inflamed microorganisms, or plant/animal proteins or chemicals
Define bronchiectasis.
Permenant dilation of the bronchi due to chronic lung disease or infection
What are the main infective organisms involved in bronchiectasis?
Psuedomonas aeruginosa, haemopholis influenzae, strep pneumoniae
When should an inhaled corticosteroid be added to asthma treatment?
Has asthma symptoms > 3 times per week
Uses SABA > 3 times per week
Woken up in the night by symptoms > once per week
What is the first line treatment of asthma?
Short acting beta-2 agonist
What is the second line treatment of asthma?
Inhaled corticosteroid (beclametasone)
What is the gold standard investigation of sarcoidosis?
Tissue biopsy
What type of hypersensitivity reaction is hypersensitivity pneumonitis?
Type 3
What symptoms can preceed goodpasture’s syndrome?
Upper respiratory tract symptoms - runny nose, sneezing, fever
What is the commonest cause of an infective exacerbation in COPD?
Haemophilus influenzae
What are other common causes of infective exacerbations in COPD?
Streptococcus pneumoniae
Moraxella Catarrhalis
What is the most common viral cause of COPD exacerbations?
Rhinovirus
What are the features of a moderate asthma attack?
PEF 50-75% of predicted
What are the features of a severe acute asthma attack?
PEF 33-50% of predicted
Heart rate > 110
Respiratory rate > 25
Inability to complete sentences in one breath
What are the features of a life threatening asthma attack?
SpO2 < 92 PEF < 33% of predicted Altered conscious level Silent chest Cyanosis
Give two side effects of salbutamol inhalers.
Fine tremor, hypokalaemia
Where are small cell lung cancers typically located?
Centrally
Where are squamous cell lung cancers typically located?
Centrally
What paraneoplastic syndromes are associated with small cell lung cancer?
ADH secretion - hyponatraemia
ACTH secretion
Lambert-eaton syndrome
What paraneoplastic syndrome is associated with squamous cell lung cancer?
Hypercalacaemia due to PTH related peptide secretion
Which type of lung cancer is associated with asbestos exposure?
Mesothelioma
What CURB-65 score is needed to consider urgent care?
3 or more
What is the second line investigation for PE?
Echocardiogram
When would echocardiogram be used to investigate PE?
If the patient is haemodynamically unstable
What is the gold standard investigation for PE?
CT pulmonary angiography
What are the most common causes of pneumonia in under 3 month olds?
Group B streptococci
E coli
Listeria monocytogenes
What is the treatment plan for a CURB-65 score of 0-1?
Oral amoxicillin
What is the treatment plan for a CURB-65 score of 2?
Oral amoxicillin and clarithromycin
First line COPD medication
SABA
Second line COPD medication
LABA
Third line COPD medication
Inhaled corticosteroids
What is the appearance of TB on X-ray?
Ghon complex
What type of lesion is TB?
Caseating granuolma
What stain is used for TB?
Ziehl-Neelsen stain
What 4 antibiotics are used to treat TB?
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
How long is the treatment for TB given?
Rifamipicin and isoniazid for 6 months
Pyrazinamide and ethambutol for the first 2 months
Give 3 differential diagnoses of a patient who has had past asbestos exposure.
Mesothelioma, asbestosis, sarcoidosis
What cancer is asbestos exposure likely to cause?
Mesothelioma
What is Horner’s syndrome?
Ptosis, pupillary constriction, no sweating on the affected side
What type of tumour can cause Horner’s syndrome?
Pancoast tumour (on the same side as the affected face)
What is a pancoast tumour?
A tumour of the apex of the lung
Why do pancoast tumours cause Horner’s syndrome?
Pancoast tumours can grow and invade the apical chest wall, affecting nearby structures such as the sympathetic chain
What is the pathophysiology of asthma?
Narrowing of the airways due to smooth muscle contraction, thickening of the airway due to cellular infiltration, and the presence of secretions in the airway
Name a long acting beta agonist.
Salmeterol
Give an example of an antimuscarinic bronchodilator.
Ipratropium bromide
Give an example of an inhaled corticosteroid.
Beclometasone diproprionate
What type of lung cancer is the most common in smokers?
Squamous cell carcinoma
What is the first line investigation for lung cancer?
Chest X-ray
Which types of cancer are most likely to metastasise to the lung?
Breast
Prostate
Colon
Bladder cancer
What condition is Lambert-Eaton syndrome associated with?
Small cell lung cancer
What is sarcoidosis characterised by?
Small non-caseating granulomas forming in the lungs, lymph nodes, and other organs
Give 5 extrapulmonary symptoms of sarcoidosis.
Erythema nodosum Adenopathy Polyarthritis Uveitis Arrhythmia
Give 3 differentials of bilateral lymphadenopathy.
Sarcoidosis
Lymphoma
Tuberculosis
Give 3 causes of bronchiectasis.
Cystic fibrosis
Post-infection
Idiopathic
Give 3 features of bronchiectasis on examination.
Wheeze
Clubbing
Coarse crackles on early inspiration
Give 5 complications of bronchiectasis.
Recurring infection Haemoptysis Pneumothorax from coughing Empyema Lung abscess
Give 4 differentials of COPD.
Asthma
Alpha-1 antitrypsin deficiency
Cystic fibrosis
Bronchiectasis
What is the most appropriate antibiotic to treat haemophilus influenzae?
Co-amoxiclav or doxycycline
Give 3 differentials of a COPD exacerbation.
Pleural effusion
Pneumothorax
Heart failure
Which groups of patients are more at risk of respiratory infection?
Infants
Elderly
Immunocompromised
Patients with chronic lung conditions e.g COPD
Give 4 risk factors for pneumothorax.
Smoking
Trauma
Previous pneumothorax
Previous invasive procedure
What are the two classic features of pneumothorax?
Pleuritic chest pain and dyspnoea
How can pneumothorax and pleural effusion be differentiated between on examination?
Pneumothorax - hyperresonant on percussion
Pleural effusion - dull on percussion
Which has faster onset - pleural effusion or pneumothorax?
Pneumothorax
What is the action of ipratropium?
Muscarinic receptor antagonist that acts as a bronchodilator
How are neutrophils involved in COPD?
They release proteases that cause tissue destruction
Define bronchiectasis.
Permenant dilation of bronchi and bronchioles.
What is the treatment plan in a severe acute asthma attack?
Salbutamol
Nebulised ipratropium bromide
Oral prednisolone
Give 4 signs of good asthma control.
Not needing inhaler at night
Inhaler used no more than 3 times per week
No breathing difficulties or wheeze on most days
Able to exercise without symptoms
What type of hypersensitivity reaction is anaphylaxis?
Type 1
What is the action of IM adrenaline?
Beta adrenergic receptor agonist
What is the physiological response during anaphylactic shock?
Vasodilation
Tachycardia
Hypotension
How is sarcoidosis diagnosed?
Diagnosis of exclusion of other granulomatous lung diseases
What is the first line treatment of sarcoidosis?
IV corticosteroids - methylprednisolone
What are the differentials of sarcoidosis?
Lymphoma, TB, non-small cell lung cancer
What is the most common cause of bronchiectasis?
Due to previous recurring infections
What are the three most common infective exacerbations of COPD? (in order)
Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis
Give 2 CXR findings in COPD.
Barrel chest
Flat hemidiaphragm
What are the three treatments offered in COPD? (progressively)
SABA
LAMA
Inhaled corticosteroids
How is the severity of COPD classified?
Stage 1 - FEV1 > 80%
Stage 2 - FEV1 < 80%
Stage 3 - FEV1 < 50%
Stage 4 - FEV1 < 30%
What is the fourth line treatment of asthma?
If a leukotriene receptor antagonist doesn’t bring asthma under control, stop the LRA and switch to a LABA
What type of reaction is hypersensitivity pneumonitis?
Type 3 hypersensitivity
What is the first line management of a pneumothorax?
Needle aspiration
What indicates a tension pneumothorax?
Deviation of the trachea
What conditions cause upper lobe fibrosis?
Sarcoidosis
Silicosis
Ankylosing spondylitis
Hypersensitivity pneumonitis
What is the definition of AIDS?
CD4 count < 200
What are the differences between emphysema and chronic bronchitis?
Smaller amount of sputum in emphysema
Older age at presentation with emphysema
Lower weight in emphysema
Small heart/hyperinflated lungs/barrel chest in emphysema, normal heart and diaphragm in chronic bronchitis
What mutation is seen in CF?
F508 mutation of the CFTR gene on chromosome 7
What advice should be given to CF patients?
Stop smoking Wash hands regularly Get flu vaccine every year Increase calorie and fat intake Exercise regularly
What types of effusions are there?
Exudative and transudative
Give 3 examples of exudative effusions.
TB, pneumonia, lung cancer
Give 3 examples of transudative effusions.
Congestive heart failure, liver cirrhosis, nephrotic syndrome
What are the protein levels in transudative and exudative effusions?
Transudative < 30g/L
Exudative > 30g/L
Give 2 investigations that can confirm pleural effusion.
Chest X-ray
Pleural fluid aspiration
What are the first line managements for pleural effusion?
Loop diuretics
Therapeutic thoracentesis
What side effect is seen with pyrazinamide?
Joint pain
What are the symptoms of pulmonary embolism?
Tachypnoea Tachycardia Pleuritic chest pain Dyspnoea Haemoptysis
What should you do before adding new asthma treatment or changing doses?
Check inhaler technique and adherance
Is TB obstructive or restrictive?
Restrictive
What is a common cause of hospital acquired pneumonia?
Pseudomonas aeruginosa
Who is most likely to suffer from a spontaneous pneumothorax?
Young, thin males
Where would a needle thoracostomy be placed?
2nd intercostal space, mid clavicular line on the same side as the pneumothorax
