resp Flashcards
1
Q
What are the key presentations of asthma?
A
episodic symptoms
dry cough/wheeze
Hx of atopic conditions (eczema)
FH
bilateral widespread polyphonic wheeze
2
Q
What are the first line investigations for asthma?
A
fractional exhaled nitric oxide
spirometry with bronchodilator reversibility
3
Q
What are the second line investigations for asthma?
A
peak flow variability
direct bronchial challenge test
4
Q
What is the 1st line treatment for asthma?
A
SABA
5
Q
What is the 2nd line treatment for asthma?
A
SABA + ICS
6
Q
What is the 3rd line treatment for asthma?
A
SABA + ICS + LTRA
7
Q
What is the 4th line treatment for asthma?
A
SABA + ICS +LABA
8
Q
Give an example of a SABA
A
salbutamol
9
Q
Give and example of an ICS
A
beclometasone
10
Q
Give an example of a LTRA
A
montelukast
11
Q
give and example of a LABA
A
salmeterol
12
Q
How do SABAs work?
A
stimulate beta2 receptors causing smooth muscle relaxation
13
Q
How do ICSs work?
A
reduce inflammation/reactivity of airways
14
Q
How do LTRAs work?
A
blocks leukotriene receptor and prevents inflammation/bronchoconstriction
15
Q
How do LABAs work?
A
stimulate beta 2 receptors causing smooth muscle relaxation
16
Q
Give two more example of medications that could be used for asthma
A
long acting muscarinic antagonists (LAMA)
theophylline
17
Q
What are the typical presentations of COPD?
A
smoker
chronic: cough, SOB, sputum, wheeze, recurrent RTI
18
Q
What would not usually be present in COPD to rule out differentials?
A
clubbing, haemoptysis, chest pain
19
Q
What scale is used to measure severity of dyspnoea?
A
Medical research council (MRC) dyspnoea scale
5 point scale
20
Q
How is COPD diagnosed?
A
clinical signs + spirometry
21
Q
What test is used in spirometry for COPD?
A
FEV1:FVC <0.7
severity can be measured by percentage of FEV1 from predicted (4 stages)
22
Q
What differentials would you want to rule out for suspected COPD?
A
cancer - X ray
anaemia - FBC
fibrosis - CT
23
Q
What is the first line management for COPD?
A
smoking cessation
pneumococcal + influenza vacc
pulmonary rehab
treatment of comorbidities
24
Q
What is the 1st line medical treatment for COPD?
A
SABA/SAMA
25
what is the 2nd line treatment for COPD in patients with steroid responsiveness (features of asthma?
LABA + ICS
26
What is the 2nd line treatment for COPD in patients with no steroid responsiveness?
LABA + LAMA
27
What is the third line treatment for COPD?
LAMA + LABA + ICS
28
Give an example of a SAMA
ipratropium
29
give an example of a LAMA
tiotropium
30
how does an exacerbation of COPD present?
acute worsening of symptoms
31
What is type 1 respiratory failure?
normal pCO2 and low/normal pO2
32
what is type 2 respiratory failure
raised pCO2 and low pO2
33
What investigations might you do in an exacerbation of COPD?
X-ray (pneumonia)
FBC/cultures (infection)
34
what oxygen saturation should a patient with COPD and CO2 retention aim for?
88-92%
35
what is treatment of exacerbations of COPD?
nebulised salbutamol
prednisolone
abx if infection
physio (to clear sputum)
36
What is the treatment of severe exacerbations of COPD?
IV aminophylline
NIV
ventilation/intubation (ICU)
doxapram (resp stimulant)
37
What are the causes of a pneumothorax?
spontaneous
trauma
iatrogenic
lung pathology
38
What is the typical presentation of a pneumothorax?
sudden SOB + pleuritic chest pain
(often young, tall, slim men)
39
what is the 1st investigation for a pneumothorax?
chest X ray
40
What other imaging tool can be used to more accurately assess a pneumothorax?
CT thorax
41
What is the management of a pneumothorax with no SOB and <2cm?
no treatment, 2-4 week follow up
42
What is the management of a pneumothorax with SOB and/or >2cm air gap?
aspiration
43
What intervention may be used if aspiration for a pneumothorax fails or if it is unstable/bilateral?
chest drain
44
What are the signs of a tension pneumothorax?
tracheal deviation away from pneumothorax
reduced air entry to affected side
increased resonant percussion
tachycardia
hypotension
45
What is the management of a tension pneumothorax?
insertion of a large bore catheter into the second intercostal space in the midclavicular line
46
Where is a chest drain performed?
triangle of safety
inferiorly b 5th intercostal space, anteriorly by anterior axillary line and posteriorly by mid axillary line
47
What bacteria causes TB
mycobacterium tuberculosis
48
How is TB stained?
Zeihl-Neelson stain - red
(acid-fastness)
49
what are the different stages of TB?
active
latent
secondary - after latent
miliary - disseminated, severe
50
Apart from the lungs, where else can TB effect?
lymph nodes, cutaneous, CNS, pericardium, bones, GU
51
Who is offered a BCG vaccine?
healthcare workers
people from TB hotspots or with relations with TB
52
What are the presentations of TB?
cough (haemoptysis)
lethargy
fever/night sweats
erythema nodosum
53
What test looks for past or present TB infection?
mantoux test
54
What further test can be done after a mantoux test?
interferon gamma release test
55
What would be seen on chest X ray in TB?
patchy consolidation, pleural effusions, millet seeds (miliary), ghon focus/complex
56
What are the other investigations for TB?
sputum/blood culture
NAAT
57
What is the management for acute pulmonary TB?
RIPE
Rifampicin
Isoniazide
pyrazinamide
ethambutol
(RIP are hepatotoxic)
58
What are the side effects of rifampicin?
red/orange discolouration of urine/tears
induced P450 so effects metabolisation of some drugs (oral contraceptive)
59
What are the side effects of Isoniazide?
peripheral neuropathy - treated with pyridoxine (vit B6)
60
What are the side effects of pyrazinamide?
hyperuricaemia - gout
61
What are the side effects of ethambutol?
colour blindness + reduced VA
62
what inheritance pattern is CF?
autosomal recessive
(chromosome 7)
63
what are the key consequences of CF?
thick pancreatic/biliary secretions
thick airway secretions
congenital bilateral absence of vas deferens
64
How would CF present in a newborn?
meconium ileus (first stool is stuck in the GI colon) causing vomiting/abdo distension
65
How would Cf present in a child?
recurrent LRTIs, failure to thrive, pancreatitis
66
What are some of the signs of CF?
nasal polyps
clubbing
crackles/wheeze on auscultation
67
What are the causes of nail clubbing in kid?
hereditary
cyanotic heart disease
infective endocarditis
CF, TB, IBD
cirrhosis
68
What tests can be done for CF?
newborn blood spot testing
sweat test (gold standard)
genetic testing
69
What infections are patients with CF at risk of?
staphylococcus aureus and psuedomonas (mainly)
70
What is the treatment for pseudonoma aeruginosa in CF patients?
long term nebulised tobramycin
71
What is the general management for CF?
chest physio
exercise
prophylactic flucloxacillin
bronchodilators
vaccines
72
what is bronchiectasis?
permanent dilation of the bronchi due to destruction of muscular/elastic components
73
what can cause bronchiectasis?
CF
primary ciliary dyskinesia
obstruction - tumour
post infection
chronic inflammation
74
Explain the pathophysiology of bronchiectasis
damage to cilia by immune cells
fibroblasts repair with collagen
loss of elasticity
arteriolar constriction
pulmonary hypertension
75
What are the presentations of bronchiectasis?
wheeze, productive cough, khaki sputum, SOB, chest pain, clubbing due to hypoxia
76
What would be seen on a CT scan in bronchiectasis?
dilated/thickened bronchi/oles
77
What other investigations might you do for bronchiectasis?
sputum culture
genetic testing (CF, PCD)
spirometry (obstructive picture)
78
what are the therapeutic managements for bronchiectasis?
chest physio
postural drainage
79
What medications might help in bronchiectasis?
prophylactic abx
bronchodilators
mucolytics
anti-inflammtory drugs
80
Give and example of a mucolytic
acetylcysteine
81
Give and example of an anti-inflammatory drug used to treat bronchiectasis
azithromycin
82
What are the different classifications of pneumonia?
community acquired
hospital acquired
aspiration
atypical pneumonia
pneumonia in immunocompromised
83
What are the typical symptoms of pneumonia?
SOB, productive cough, fever, pleuritic chest pain, delirium, haemoptysis
84
What are the general signs of pneumonia
increased resp and HR
hypoxia/tension
85
What are the chest signs of pneumonia?
bronchial breath sounds (harsh)
focal coarse crackles
dullness to percussion
86
what score is used to determine severity of pneumonia?
CURB-65/CRB-65
Confusion
Urea >7 (only in hospital)
Resp rate >30
Blood pressure <90/60
65 age >65
87
When should patients in the community be referred to the hospital with pneumonia?
CRB-65 >0
88
What are the common pathogens to cause pneumonia?
streptococcus pneumoniae
haemophilus influenzae
89
What pneumonia is common in immunocompromised patients?
moraxella catarrhalis
pneumocystis jiroveci (PCP)
90
What are the 5 causes of atypical pneumonia?
legionella pneumophila
chlamydia psittacci
mycoplasma pneumoniae
chlamidophila pneumoniae
coxiella burnetti (Q fever)
(legions of psittaci MCQs)
91
How are atypical pneumonias treated?
abx:
macrolides, fluoroquinolones, tetracyclines
92
Give an example of a macrolide
clarithromycin, erythromycin, azithromycin
93
Give an example of a fluoroquinolone
levofloxacin
94
Give and example of a tetracycline
doxycycline
95
How is fungal pneumonia (pneumocystis jiroveci) treated?
co-trimoxazole (trimethoprim/sulfamethoxazole)
96
what investigations would be done for pneumonia?
chest x ray
bloods - WCC/CRP
U&Es
97
What would be seen on chest x ray in penumonia?
consolidation
98
What would bloods show in penumonia?
high WCC/CRP (WCC more quickly reactive to infection) - immuncompromised may not show raised WCC
raised urea
99
What is the treatment for mild pneumonia?
amoxicillin or macrolide for 5 days
100
What is the treatment for moderate pneumonia?
amoxicillin+macrolide for 7-10 days
101
what are some of the complications of pneumonia?
sepsis, pleural effusion, empyema, death
102
What are the most common causes of viral pharyngitis?
adenovirus, rhinovirus, EBV
103
What are the most common causes of bacterial pharyngitis?
streptococcus pyogenes (strep A), H. influenzae
104
What scores can be used to assess the likelihood of bacterial infection in tonsillitis?
Centor clinical prediction score
Fever pain score
105
What are the criteria of the fever pain score?
fever in last 24hrs
purulence
attended within 3 days of onset
inflamed tonsils
no cough or coryza
106
What investigation can you do for suspected bacterial tonsillitis?
rapid group A streptococcal (GAS) antigen test
107
What are some of the differential diagnoses for tonsillitis?
glandular fever, epiglottitis
108
What is the 1st line treatment for probable bacterial tonsillitis?
phenoxymethylpenicillin
109
What is used in tonsillitis in patients with a penicillin allergy?
clarithromycin
110
What are the 4 sets of paranasal sinuses?
frontal, maxillary, ethmoidal, sphenoid
111
What are the presentations of sinusitis?
nasal congestion/discharge
facial pain/pressure/swelling
loss of smell
112
What investigations may be done for sinusitis?
nasal endoscopy
CT scan
113
When should sinusitis be treated with medication?
if there is no improvement within 10 days
114
What is the first line treatment for sinusitis?
steroid nasal spray (mometasone)
delayed phenoxymethylpenicillin if not improving after 7 days
115
What are the most common types of non-small cell lung cancer?
adenocarcinoma (non-smokers)
squamous cell (smokers)
large cell
116
what are the symptoms of local lung cancer?
cough
SOB
haemoptysis
clubbing
weight loss
recurrent pneumonia
117
what is the first line investigation for lung cancer?
chest X-ray
118
What would be seen on a chest X ray in lung cancer?
hilar enlargement
peripheral opacity
pleural effusion
collapse
119
How can you take a biopsy of lung cancer?
bronchoscopy or through the skin
120
What imaging methods can be used to stage lung cancer?
staging Ct
PET-CT
121
What is the first line treatment for non-small cell lung cancer?
surgery- lobectomy/segmentectomy
122
How is small cell lung cancer treated?
chemo/radiotherapy
123
What procedure may be done in palliative care for lung cancer?
endobronchial treatment - stent/debulking to relieve symptoms
124
What are some of the extrapulmonary manifestations of lung cancer?
phrenic/recurrent laryngeal nerve palsy
SVC obstruction
Horners syndrome
SIADH
Cushings
hypercalcaemia
limbic encephalitis
lambert-eaton myasthenic syndrome
125
What is the presentation of a recurrent laryngeal nerve palsy?
hoarse voice
126
What does phrenic nerve palsy lead to?
SOB
127
How does SVC obstruction show?
facial swelling, distended veins
Pemberton's sign
128
How does Horners syndrome present?
Tumour presses on the sympathetic ganglion causing ptosis, anhidrosis and miosis
129
How does SIADH present?
hyponatraemia
130
How does limbic encephalitis present?
short term memory loss, hallucinations, confusions (anti-Hu antibodies against limbic system)
131
What is mesothelioma strongly linked to?
asbestos - large latent period (45 yrs)
132
what is the protein content of an exudative pleural effusion?
>3g/L
133
What is the protein content of a transudative pleural effusion?
<3g/L
134
What are the causes of an exudative pleural effusion?
inflammation causing protein leakage
- lung cancer
- pneumonia
- RA
- TB
135
What are the causes of a transudative pleural effusion?
congestive HF
hypoalbuminaemia
hypothyroid
Meig's syndrome
136
What are the typical presentations of a pleural effusion?
SOB, dullness to percussion, reduced breath sounds, tracheal deviation
137
What are the finding in chest X-ray of a pleural effusion?
blunting of costophrenic angle
fluid in fissures
meiscus in larger effusions
tracheal/mediastinal deviation
138
What is the main treatment for pleural effusions?
conservative management (small effusions may resolve on their own)
pleural aspiration
chest drain
139
What is empyema?
infection of a pleural effusion
140
what characteristics would the pleural fluid have in empyema?
pus
pH<7.2
low glucose
high lactate dehydrogenase
141
What is the usual cause of a PE?
a DVT that travels to the pulmonary arteries
142
What are the risk factors for VTE?
immobility, long haul flights, surgery, pregnancy, HRT with oestrogen, SLE, malignancy
143
What is the presentations of a PE?
SOB, cough, pleuritic chest pain, hypoxia, tachycardia/pnoea, low grad fever
144
What score is used to determine the chance of a VTE in a symptomatic patient?
Wells score
145
What should be done if theres a Wells score of more than 4 points (PE likely)
CT pulmonary angiogram
interim coag if not immediate
146
What should be done in Wells score less than 4?
D-dimer - if positive, arrange CTPA
147
Why might a CTPA be contraindicated?
renal impairment, contrast allergy
148
What alternative investigation can be done for PE?
ventilation/perfusion (VQ) scan
149
How might a PE effect blood pH?
alkalosis + low pO2
150
what is the first line management of a PE?
DOAC
151
What is the second line management of a PE or if DOAC contraindicated?
LMWH - if pregnant/antiphospholipid syndrome
152
What is the ideal INR range for warfarin?
2-3s
153
How long should VTE prophylaxis be continued if the cause of PE is unclear?
beyond 3 months (6)
154
What treatment is used for massive PEs?
thrombolysis
155
What medications can be used for thrombolysis?
streptokinase, alteplase, teneclepase
156
How should thrombolysis drugs be administered?
IV - peripheral cannula
catheter directed
157
what is the criteria for a moderate acute exacerbation of asthma?
PEFR 50-75% predicted
158
what is the criteria for a severe acute exacerbation of asthma?
PEFR 33-50%
RR >25
HR >110
unable to complete sentenced
159
what is the criteria for life threatening acute exacerbation of asthma?
PEFR <33%
sats <92%
getting tired
no wheeze
shock
160
What is the treatment for a moderate exacerbation of asthma?
nebulised salbutamol
nebulised ipratropium bromide
oral prednisolone/IV hydrocortisone
abx
161
What is the treatment for a severe exacerbation of asthma?
oxygen
aminophylline
consider IV salbutamol
162
What is the treatment for a life threatening exacerbation of asthma?
IV magnesium sulphate
ICU admission
intubation
163
What is interstitial lung disease?
umbrella term to describe conditions causing inflammation and fibrosis of the lung parenchyma
164
How are interstitial lung diseases diagnosed?
high resolution CT - ground glass appearance
biopsy when unertain
165
How does idiopathic pulmonary fibrosis present?
bibasal fine crackles and clubbing
166
What two medications can slow the progression of idiopathic pulmonary fibrosis?
pirfenidone (antifibrotic/inflammatory)
nintedanib (monoclonal antibody targeting tyrosine kinase)
167
What drugs can cause pulmonary fibrosis?
amiodarone
cyclophosphamide
methotrexate
nitrofurantoin
168
what conditions can cause secondary pulmonary fibrosis?
alpha-1-antitripsin deficiency
RA
SLE
systemic sclerosis
169
what type of hypersensitivity is hypersensitivity pneumotitis?
type 3
170
How does cryptogenic organising pneumonia present?
similar to pneumonia: SOB, cough, fever
171
How is cryptogenic organising pneumonia treated?
corticosteroids
172
What are the properties of asbestos?
fibrogenic + oncogenic
173
What are the group 1 causes of pulmonary hypertension (PH)
primary PH and connective tissue disorders such as SLE
174
What are the group 2 causes of pulmonary hypertension?
left sided heart failure due to MI or hypertension
175
What are the group 3 causes of PH?
chronic lung disease like COPD
176
What are the group 4 causes of PH?
pulmonary vascular disease e.g. PE
177
What are the group 5 causes of PH?
misc
sarcoidosis, glycogen storage disease, haem disorders
178
What are the main symptoms of pulmonary hypertension?
SOB
syncope
tachycardia
raised jVP
hepatomegaly
oedema
179
What would en ECG show in pulmonary hypertension?
RV hypertrophy - large R waves (V1-3)
large S waves on left sided leads (V4-6)
right axis deviation
RBBB
180
What would be seen on chest X-ray in pulmonary hypertension?
dilated pulmonary arteries
RV hypertrophy
181
What other tests might be abnormal in pulmonary hypertension?
raised NT-proBNP
raised pulmonary artery pressure in echo
182
what are the medical treatments for primary pulmonary hypertension?
IV prostanoids (epoprostanol)
endothelin receptor antagonists (macitentan)
phosphodiesterase-5 inhibitors (sildenafil)
183
What is sarcoidosis?
granulomatous inflammatory condition
184
What is the typical presentation of a patient with sarcoidosis?
black woman 20-40yrs old with SOB and cough and erythema nodosum
185
What is the triad of symptoms associated with Lofgrens syndrome?
erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia
186
What would blood tests show in sarcoidosis?
raised ACE, calcium, soluble interleukin-2 inhibitor, CRP and immunoglobulins
187
What would be seen on CT or X ray in sarcoidosis?
hilar lymphadenopathy
188
What is the gold standard test for sarcoidosis?
bronchoscopy + biopsy
non-caseating granulomas with epithelioid cells
189
What is the first line treatment for sarcoidosis?
steroids 6-24m) + bisphosphonates
190
What can severe cases of sleep apnoea cause or increase the risk of?
cause hypertension/heart failure
increase risk of MI/stroke
191
What scale can be used to assess symptoms of apnoea?
Epworth sleepiness scale
192
What is the management of obstructive sleep apnoea?
lifestyle mods
continuous positive airway pressure (CPAP)
surgery
