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Resp Flashcards

1
Q

What is pulmonary hypertension defined as?

A

> 25mmHg

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2
Q

Give 3 signs of pulmonary hypertension on X-ray.

A

Enlargement of pulmonary arteries
Enlarged right atrium
Elevated cardiac apex

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3
Q

Give 6 side effects of chemotherapy.

A 
Nausea and vomiting 
Alopecia 
Peripheral neuropathy 
Anaemia 
Fatigue
Constipation or diarrhoea
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4
Q

Name 4 causing of pleural effusion with exudate.

A

Infection
Inflammatory
Pulmonary embolism
Asbestos related

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5
Q

What is the most common histological type of non-small cell lung cancer?

A

Adenocarcinoma

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6
Q

Which two conditions constitute COPD?

A

Chronic bronchitis

Emphysema

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7
Q

What bacteria causes TB?

A

Mycobacterium tuberculosis

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8
Q

What stain would you use to detect TB?

A

Ziehl-Neelson stain

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9
Q

What other bacteria does Ziehl-Neelson stain for?

A

Mycobacterium leprae (leprosy)

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10
Q

What is a CURB-65 score?

A

Assesses mortality of community-acquired pneumonia to determine whether community or secondary care treatment is most appropriate

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11
Q

What makes up the CURB-65 score?

A 
Confusion 
Urea > 7
Respiratory rate > 30
BP < 60/90
Age > 65
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12
Q

What CURB-65 score constitutes admission to hospital?

A

2 or more

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13
Q

Which antibiotics are used to treat community acquired pneumonia?

A

Amoxicillin and clarithromycin

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14
Q

Give 5 features of bronchiectasis.

A 
Persistent cough 
Purulent sputum 
Haemoptysis
Dyspneoa
Clubbing
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15
Q

Name 2 tests used to diagnose CF?

A

Faecal elastase
Genetic testing
Sweat test

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16
Q

What is a positive sweat test?

A

High level of chloride in the sweat (>60mmol/L)

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17
Q

What is indicative of type 1 respiratory failure?

A

Low O2, normal or low CO2

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18
Q

What is type 2 respiratory failure?

A

Low O2, high CO2

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19
Q

What is the most effective way of improving FEV1 in COPD?

A

Smoking cessation

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20
Q

What is the most common type of lung cancer?

A

Adenocarcinoma

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21
Q

What is a common cause of bacterial otitis media?

A

Haemophilus influenzae

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22
Q

What scale is used to grade breathlessness?

A

MRC dyspnoea scale

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23
Q

Describe the MRC dyspnoea scale.

A

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

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24
Q

Give 3 red flag respiratory symptoms.

A

Weight loss
Haemoptysis
Night sweats

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25
Q

What is the first line investigation for suspected lung cancer

A

Chest X-ray

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26
Q

What kind of percussion is seen in pleural effusion?

A

Stony/dull

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27
Q

What antibody is granulomatosis with polyangitis associated with?

A

c-ANCA

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28
Q

What inheritance pattern is seen in von-willebrand disease?

A

Autosomal dominant

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29
Q

What inheritance pattern is seen in cystic fibrosis?

A

Autosomal recessive

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30
Q

What is atelectasis?

A

Complete or partial collapse of a lobe of the lung, or the whole lung

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31
Q

What are pneumoconioses?

A

A group of lung disorders - reaction of the lung to inhaled dusts

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32
Q

Give 3 examples of pneumoconiosis?

A

Silicosis, asbestosis, coal workers lung

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33
Q

Give 2 examples of extrinsic allergic alveolitis

A

Farmers lung, bird fanciers lung

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34
Q

What is extrinsic allergic alveolitis?

A

Lung inflammation as a cause of inflamed microorganisms, or plant/animal proteins or chemicals

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35
Q

Define bronchiectasis.

A

Permenant dilation of the bronchi due to chronic lung disease or infection

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36
Q

What are the main infective organisms involved in bronchiectasis?

A

Psuedomonas aeruginosa, haemopholis influenzae, strep pneumoniae

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37
Q

When should an inhaled corticosteroid be added to asthma treatment?

A

Has asthma symptoms > 3 times per week
Uses SABA > 3 times per week
Woken up in the night by symptoms > once per week

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38
Q

What is the first line treatment of asthma?

A

Short acting beta-2 agonist

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39
Q

What is the second line treatment of asthma?

A

Inhaled corticosteroid (beclametasone)

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40
Q

What is the gold standard investigation of sarcoidosis?

A

Tissue biopsy

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41
Q

What type of hypersensitivity reaction is hypersensitivity pneumonitis?

A

Type 3

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42
Q

What symptoms can preceed goodpasture’s syndrome?

A

Upper respiratory tract symptoms - runny nose, sneezing, fever

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43
Q

What is the commonest cause of an infective exacerbation in COPD?

A

Haemophilus influenzae

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44
Q

What are other common causes of infective exacerbations in COPD?

A

Streptococcus pneumoniae

Moraxella Catarrhalis

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45
Q

What is the most common viral cause of COPD exacerbations?

A

Rhinovirus

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46
Q

What are the features of a moderate asthma attack?

A

PEF 50-75% of predicted

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47
Q

What are the features of a severe acute asthma attack?

A

PEF 33-50% of predicted
Heart rate > 110
Respiratory rate > 25
Inability to complete sentences in one breath

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48
Q

What are the features of a life threatening asthma attack?

A 
SpO2 < 92
PEF < 33% of predicted
Altered conscious level 
Silent chest 
Cyanosis
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49
Q

Give two side effects of salbutamol inhalers.

A

Fine tremor, hypokalaemia

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50
Q

Where are small cell lung cancers typically located?

A

Centrally

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51
Q

Where are squamous cell lung cancers typically located?

A

Centrally

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52
Q

What paraneoplastic syndromes are associated with small cell lung cancer?

A

ADH secretion - hyponatraemia
ACTH secretion
Lambert-eaton syndrome

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53
Q

What paraneoplastic syndrome is associated with squamous cell lung cancer?

A

Hypercalacaemia due to PTH related peptide secretion

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54
Q

Which type of lung cancer is associated with asbestos exposure?

A

Mesothelioma

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55
Q

What CURB-65 score is needed to consider urgent care?

A

3 or more

56
Q

What is the second line investigation for PE?

A

Echocardiogram

57
Q

When would echocardiogram be used to investigate PE?

A

If the patient is haemodynamically unstable

58
Q

What is the gold standard investigation for PE?

A

CT pulmonary angiography

59
Q

What are the most common causes of pneumonia in under 3 month olds?

A

Group B streptococci
E coli
Listeria monocytogenes

60
Q

What is the treatment plan for a CURB-65 score of 0-1?

A

Oral amoxicillin

61
Q

What is the treatment plan for a CURB-65 score of 2?

A

Oral amoxicillin and clarithromycin

62
Q

First line COPD medication

A

SABA

63
Q

Second line COPD medication

A

LABA

64
Q

Third line COPD medication

A

Inhaled corticosteroids

65
Q

What is the appearance of TB on X-ray?

A

Ghon complex

66
Q

What type of lesion is TB?

A

Caseating granuolma

67
Q

What stain is used for TB?

A

Ziehl-Neelsen stain

68
Q

What 4 antibiotics are used to treat TB?

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

69
Q

How long is the treatment for TB given?

A

Rifamipicin and isoniazid for 6 months

Pyrazinamide and ethambutol for the first 2 months

70
Q

Give 3 differential diagnoses of a patient who has had past asbestos exposure.

A

Mesothelioma, asbestosis, sarcoidosis

71
Q

What cancer is asbestos exposure likely to cause?

A

Mesothelioma

72
Q

What is Horner’s syndrome?

A

Ptosis, pupillary constriction, no sweating on the affected side

73
Q

What type of tumour can cause Horner’s syndrome?

A

Pancoast tumour (on the same side as the affected face)

74
Q

What is a pancoast tumour?

A

A tumour of the apex of the lung

75
Q

Why do pancoast tumours cause Horner’s syndrome?

A

Pancoast tumours can grow and invade the apical chest wall, affecting nearby structures such as the sympathetic chain

76
Q

What is the pathophysiology of asthma?

A

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

77
Q

Name a long acting beta agonist.

A

Salmeterol

78
Q

Give an example of an antimuscarinic bronchodilator.

A

Ipratropium bromide

79
Q

Give an example of an inhaled corticosteroid.

A

Beclometasone diproprionate

80
Q

What type of lung cancer is the most common in smokers?

A

Squamous cell carcinoma

81
Q

What is the first line investigation for lung cancer?

A

Chest X-ray

82
Q

Which types of cancer are most likely to metastasise to the lung?

A

Breast
Prostate
Colon
Bladder cancer

83
Q

What condition is Lambert-Eaton syndrome associated with?

A

Small cell lung cancer

84
Q

What is sarcoidosis characterised by?

A

Small non-caseating granulomas forming in the lungs, lymph nodes, and other organs

85
Q

Give 5 extrapulmonary symptoms of sarcoidosis.

A 
Erythema nodosum
Adenopathy
Polyarthritis
Uveitis
Arrhythmia
86
Q

Give 3 differentials of bilateral lymphadenopathy.

A

Sarcoidosis
Lymphoma
Tuberculosis

87
Q

Give 3 causes of bronchiectasis.

A

Cystic fibrosis
Post-infection
Idiopathic

88
Q

Give 3 features of bronchiectasis on examination.

A

Wheeze
Clubbing
Coarse crackles on early inspiration

89
Q

Give 5 complications of bronchiectasis.

A 
Recurring infection 
Haemoptysis
Pneumothorax from coughing
Empyema
Lung abscess
90
Q

Give 4 differentials of COPD.

A

Asthma
Alpha-1 antitrypsin deficiency
Cystic fibrosis
Bronchiectasis

91
Q

What is the most appropriate antibiotic to treat haemophilus influenzae?

A

Co-amoxiclav or doxycycline

92
Q

Give 3 differentials of a COPD exacerbation.

A

Pleural effusion
Pneumothorax
Heart failure

93
Q

Which groups of patients are more at risk of respiratory infection?

A

Infants
Elderly
Immunocompromised
Patients with chronic lung conditions e.g COPD

94
Q

Give 4 risk factors for pneumothorax.

A

Smoking
Trauma
Previous pneumothorax
Previous invasive procedure

95
Q

What are the two classic features of pneumothorax?

A

Pleuritic chest pain and dyspnoea

96
Q

How can pneumothorax and pleural effusion be differentiated between on examination?

A

Pneumothorax - hyperresonant on percussion

Pleural effusion - dull on percussion

97
Q

Which has faster onset - pleural effusion or pneumothorax?

A

Pneumothorax

98
Q

What is the action of ipratropium?

A

Muscarinic receptor antagonist that acts as a bronchodilator

99
Q

How are neutrophils involved in COPD?

A

They release proteases that cause tissue destruction

100
Q

Define bronchiectasis.

A

Permenant dilation of bronchi and bronchioles.

101
Q

What is the treatment plan in a severe acute asthma attack?

A

Salbutamol
Nebulised ipratropium bromide
Oral prednisolone

102
Q

Give 4 signs of good asthma control.

A

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

103
Q

What type of hypersensitivity reaction is anaphylaxis?

A

Type 1

104
Q

What is the action of IM adrenaline?

A

Beta adrenergic receptor agonist

105
Q

What is the physiological response during anaphylactic shock?

A

Vasodilation
Tachycardia
Hypotension

106
Q

How is sarcoidosis diagnosed?

A

Diagnosis of exclusion of other granulomatous lung diseases

107
Q

What is the first line treatment of sarcoidosis?

A

IV corticosteroids - methylprednisolone

108
Q

What are the differentials of sarcoidosis?

A

Lymphoma, TB, non-small cell lung cancer

109
Q

What is the most common cause of bronchiectasis?

A

Due to previous recurring infections

110
Q

What are the three most common infective exacerbations of COPD? (in order)

A

Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis

111
Q

Give 2 CXR findings in COPD.

A

Barrel chest

Flat hemidiaphragm

112
Q

What are the three treatments offered in COPD? (progressively)

A

SABA
LAMA
Inhaled corticosteroids

113
Q

How is the severity of COPD classified?

A

Stage 1 - FEV1 > 80%
Stage 2 - FEV1 < 80%
Stage 3 - FEV1 < 50%
Stage 4 - FEV1 < 30%

114
Q

What is the fourth line treatment of asthma?

A

If a leukotriene receptor antagonist doesn’t bring asthma under control, stop the LRA and switch to a LABA

115
Q

What type of reaction is hypersensitivity pneumonitis?

A

Type 3 hypersensitivity

116
Q

What is the first line management of a pneumothorax?

A

Needle aspiration

117
Q

What indicates a tension pneumothorax?

A

Deviation of the trachea

118
Q

What conditions cause upper lobe fibrosis?

A

Sarcoidosis
Silicosis
Ankylosing spondylitis
Hypersensitivity pneumonitis

119
Q

What is the definition of AIDS?

A

CD4 count < 200

120
Q

What are the differences between emphysema and chronic bronchitis?

A

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

121
Q

What mutation is seen in CF?

A

F508 mutation of the CFTR gene on chromosome 7

122
Q

What advice should be given to CF patients?

A 
Stop smoking
Wash hands regularly 
Get flu vaccine every year 
Increase calorie and fat intake 
Exercise regularly
123
Q

What types of effusions are there?

A

Exudative and transudative

124
Q

Give 3 examples of exudative effusions.

A

TB, pneumonia, lung cancer

125
Q

Give 3 examples of transudative effusions.

A

Congestive heart failure, liver cirrhosis, nephrotic syndrome

126
Q

What are the protein levels in transudative and exudative effusions?

A

Transudative < 30g/L

Exudative > 30g/L

127
Q

Give 2 investigations that can confirm pleural effusion.

A

Chest X-ray

Pleural fluid aspiration

128
Q

What are the first line managements for pleural effusion?

A

Loop diuretics

Therapeutic thoracentesis

129
Q

What side effect is seen with pyrazinamide?

A

Joint pain

130
Q

What are the symptoms of pulmonary embolism?

A 
Tachypnoea
Tachycardia
Pleuritic chest pain
Dyspnoea 
Haemoptysis
131
Q

What should you do before adding new asthma treatment or changing doses?

A

Check inhaler technique and adherance

132
Q

Is TB obstructive or restrictive?

A

Restrictive

133
Q

What is a common cause of hospital acquired pneumonia?

A

Pseudomonas aeruginosa

134
Q

Who is most likely to suffer from a spontaneous pneumothorax?

A

Young, thin males

135
Q

Where would a needle thoracostomy be placed?

A

2nd intercostal space, mid clavicular line on the same side as the pneumothorax

Random Revision Note Questions (10 decks)

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