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4th year passmed > Resp > Flashcards

Resp Flashcards

1
Q

OSA diagnostic tests?

A

Epworth Sleepiness Scale

Polysomnography (e.g. night time SpO2 monitoring for apnoeic episodes)

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2
Q

OSA Rx?

A

Weight loss, stop smoking, stop drinking
CPAP
Intra-oral devices e.g. mandibular advancers
Inform DVLA if severe daytime somnolence

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3
Q

Cavitating lung lesion DDx? (x7)

A 
Abscess (Staph, Kleb, Pseudomonas)
Squamous lung cell cancer
TB
Wegener's granulomatosis
RA
PE
Weird stuff (aspergil/histoplas/coccidiodomycosis)
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4
Q

Centor Criteria?

A

Absence of cough
Tender anterior lymphadenopathy
History of fever (>38)
Tonsillar exudate

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5
Q

Should uncomplicated acute URTIs be treated with antibiotics?

A

No, unless Centor score 3 or more OR are a child

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6
Q

A 52-year-old man who was born in India presents with episodic haemoptysis. His only history is tuberculosis as an adolescent. Chest x-ray shows a rounded opacity in the right upper zone surrounded by a rim of air.

A

Aspergilloma

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7
Q

Fx of mitral stenosis?

A

Dyspnoea
MDM
Malar flush
AF

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8
Q

How does mitral stenosis cause haemoptysis?

A

Raised left atrial pressure causes bronchial vein rupture leading to haemoptysis

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9
Q

GwP vs. Goodpastures?

A

GwP is classic triad of glomerulonephritis, haemoptysis (+- epistaxes/sinusitis), saddle shaped nose.
Goodpastures comprises haemoptysis, glomerulonephritis and the patient is SYSTEMICALLY unwell

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10
Q

Klebsiella pneumonia Fx?

A 
Alcoholics and diabetics
pper lobe cavitating lesions
Often the agent of aspiration pneumonia
Red currant sputum
30-50% mortality
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11
Q

General + medical COPD management?

A

Stop smoking
Annual influenza vaccine + one off PCV vaccine
Home O2 therapy
Bronchodilators (SABA/SAMA/LABA/LAMA/oral theophyline)

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12
Q

What is cor pulmonale?

A

Right sided heart failure secondary to pulmonary hypertension

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13
Q

What are the features of cor pulmonale

A 
Loud P2
Breathlessness/cough
Peripheral oedema
Raised JVP
Systolic parasternal heave
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14
Q

Factors which improve survival of stable COPD patients?

A
  1. Smoking cessation
  2. Home O2 therapy
  3. Lung volume reduction surgery
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15
Q

Light’s criteria?

A

Used to distinguish between transudative and exudative pleural effusions.
Exudative: pleural fluid protein >30, Transudative: <30.
If fluid protein between 25-35 then use Light’s criteria:
- Pleural fluid protein:serum protein >0.5 -> exudative
- Pleural fluid LDH: serum LDH >0.6
- Pleural fluid LDH >2/3 the upper limit of normal serum LDH

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16
Q

Pleural effusion causes?

A

Exudative: Pneumonia, cancer, TB, PE, viral infection, autoimmune
Transudative: CCF, cirrhosis, nephrotic syndrome, hypoalbuminaemia

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17
Q

IPF clinical Fx?

A

Progressive exertional dyspnoea
Dry cough
Clubbing
Fine bibasal end inspiratory crackles

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18
Q

IPF Ix?

A

Exam +Hx
spirometry (FEV1/FVC restrictive picture)
High resolution CT thorax is gold standard imaging - shows ground glass opacification progressing to honeycomb lung.
30% are ANA positive

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19
Q

Small cell lung cancer paraneoplastic Fx?

A

Lambert Eaton
ADH
ACTH

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20
Q

Squamous cell lung cancer paraneoplastic Fx?

A

PTHrp, ectopic TSH, clubbing, hypertrophic pulmonary osteoarthropathy

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21
Q

Occupational asthma Dx?

A

Serial peak flow measurments at home and at work

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22
Q

Commonest cause of IE COPD? +Rx?

A

H. influenza

Amoxicillin/Doxy + steroid

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23
Q

Role of steroids in COPD management?

A

Prevent frequency of exacerbations

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24
Q

What is ARDS?

A

Acute respiratory distress syndrome
Increase alveolar capillary permeability leads to fluid accumulation in the alveoli (non-cardiogenic pulmonary oedema)
40% mortality

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25
Q

Causes of ARDS?

A 
Infection
acute pancreatitis
trauma
massive blood transfusion
cardio-pulmonary bypass
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26
Q

CFx of ARDS?

A 
Features are acute in onset and severe:
Dyspnoea
High RR
Bilateral crackles
Desaturations
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27
Q

Criteria for ARDS?

A

Acute onset (<1 week of known RF)
Pulmonary oedema on CXR
Non-cardiogenic
p)2/FiO2 <40kPa

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28
Q

First Ix for a large pleural effusion?

A

Diagnostic tap (to determine if infective or metastatic)

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29
Q

BTS asthma guidelines?

A
  1. SABA
  2. SABA+low dose ICS (<400mcg)
  3. SABA + ld ICS + LTRA
  4. SABA + ld ICS + LABA
  5. SABA +- LTRA + MART (ICS/LABA combined)
  6. SABA + LTRA + mdICS MART (4-800mcg)
  7. SABA + LTRA +…
    a) hdICS MART (>800mcg)
    b) theophylline/aminophylline/MgSO4
    c) Specialist review
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30
Q

Examples of and pulmonary function test results in obstructive lung disease?

A

COPD, asthma, bronchiectasis
FEV1 Significantly reduced
FVC Reduced/Normal
FEV1/FVC Reduced

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31
Q

Examples of and pulmonary function tests results in restrictive lung disease

A

Pulmonary fibrosis, Asbestosis, Sarcoidosis, ARDS
FEV1 Reduced
FVC Significantly reduced
FEV1/FVC Normal/Raised

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32
Q

Causes of clubbing?

A

Cardiac: Congenital heart disease, Bacterial endocarditis, Arial myxoma
Respiratory: IPF, lung cancer, CF, TB, fibrosing alveolitis, mesothelioma/asbestosis, bronchiectasis
Other: IBD (Crohn’s>UC), Graves disease, Whipple’s disease), cirrhosis, PBC

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33
Q

Fx of sarcoidosis?

A

Acute: Erythema nodosum, bihilar lymphadenopathy, swinging fever, polyarthralgia
Insidious: Dyspnoea, cough, malaise, weight loss
Derm: Lupus pernio
Hypercalcaemia
Can also cause facial palsies, parotid enlargment and ocular problems

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34
Q

Objective tests for asthma?

A

Fraction of expired Nitric Oxide
Spirometry with bronchodilator reversibility
(Ask about symptom variability e.g. at work/weekends)

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35
Q

CXR signs of bronchiectasis?

A

Tramlines

Signet rings

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36
Q

Paraneoplastic syndromes associated SCLC?

A

Lambert Eaton
Cushing’s
SIADH

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37
Q

Which investigations should be done before commencing azithromycin

A

ECG (QT prolongation) and baseline LFTs

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38
Q

Two commonest causes of bihilar lymphadenopathy?

A

Sarcoid & TB

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39
Q

Consequences of OSA?

A

Hypertension
Compensated respiratory acidosis
Daytime somnolescence

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40
Q

Contraindications to surgery for SCLC

A 
SVC obstruction
FEV1<1.5
Hilar malignancy
Presence of metastases
Malignant pleural effusion
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41
Q

Mild and severe CAP Rx?

A

Mild: Oral amox
Severe: Coamox + macrolide

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42
Q

COPD Rx guidelines

A
  1. SABA or SAMA
  2. Determine steroid responsiveness:
    Prev Hx atopy
    Eosinophilia
    Substantial FEV1 variation
    >20% diurnal PEF variation
    3a. If no steroid responsiveness; add LABA+LAMA
    3b. If steroid responsiveness; Add LABA +ICS
    THEN
    LAMA +LABA+ICS
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43
Q

Emphysema prominence in A1AT def vs. COPD

A

A1AT - lower zone predominence

COPD - upper zone predominence

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44
Q

What is Caplan Syndrome?

A

Lung nodules in the context of RA

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45
Q

When should NIV be considered in COPD?

A

In T2RF where PaCO2<6 and pH 7.25-7.35

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46
Q

Which RA drug causes pneumonitis?

A

Methotrexate

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47
Q

FEV1/FVC in restrictive lung disease? WHY?

A

Normal/Raised

FVC is affected to a greater extent than FEV1, which is often normal

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48
Q

Commonest agent in IE COPD?

A

H. influenzae

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49
Q

When would you see red currant jelly sputum?

A

Klebsiella

50
Q

COPD staging?

A

Stage 1- mild: post bronchodilator FEV1/FVC < 0.7, FEV1 >80%
Stage 2- mod: FEV1/FVC < 0.7, FEV1 50-79%
Stage 3- sev: FEV1/FVC < 0.7, FEV1 30-49%
Stage 4- v. sev FEV1/FVC <0.7, FEV1 <30%

51
Q

Features of a severe asthma attack?

A

Unable to complete sentences
PEFR 33-50% exp
HR >110
RR >25

52
Q

What are two medications available for nicotine replacement therapy, and what are their mechanisms?

A

Buproprion: Norepinephrine and dopamine reuptake inhibitor AND nicotine antagonist
Varenicline: Dopamine receptor partial agonist

53
Q

Which agents are associated with aspiration pneumonia?

A

Staph aureus
Strep pneumo
Pseudomonas
Haemophilus

54
Q

Features of Kartagener’s syndrome?

A
  1. Complete situs invertus
  2. Bronchiectasis
  3. Impaired fertility due to impaired ciliary function
  4. Recurrent sinusitis
55
Q

Factors which suggest steroid responsive COPD

A 
PMH of atopy
Eosinophilia
Significant diurnal variation
in PEF (>20%)
Substantial variation in FEV1 over time
56
Q

Indications for steroids in sarcoidosis?

A

X-ray changes
Hypercalcaemia
Eye, heart, brain involvement

57
Q

Under what circumstances should antibiotics be prescribed for an IE COPD?

A

If they have purulent sputum or clinical signs suggestive of pneumonia

58
Q

Which anterior mediastinal mass is seen in myasthenia gravis?

A

Thymoma

59
Q

Which blood test should be performed in all patients with TB?

A

HIV

60
Q

Under what scenarios should oxygen therapy not be used routinely if there is no evidence of hypoxia?

A

Stroke
MI
Obstetric emergencies

61
Q

What is Light’s criteria?

A

Used to distinguish transudate from exudate pleural effusion
Exudates have protein >30, transudates hae protein <30
If protein is between 25-35 then Light’s criteria is applied (involves serum protein and LDH levels)

62
Q

What are the 3 BTS indications for chest tube insertion in pleural infection?

A
  1. Frankly purulent pleural fluid
  2. Presence of microorganisms
  3. pH <7.2
63
Q

What is the management of a primary pneumothorax?

A

Rim <2cm and asymptomatic - discharge

Otherwise -> aspiration

If this fails OR >2cm OR SOB) -> chest drain should be inserted
Stop smoking

64
Q

What is the management of a secondary pneumothorax?

A

If pt over 50 and rim is >2cm and/or SOB -> chest drain +admit

If rim 1-2cm -> aspirate -> Chest drain if failure +admit

If rim <1cm - Admit and give O2

65
Q

What should patients on inhaled steroids immediately after use and why?

A

Rinse their mouth to prevent development of oral candidiasis

66
Q

What are the general signs of lobar collapse on CXR?

A

Tracheal deviation towards the side of collapse
Mediastinal shift towards side of collapse
Elevation of hemidiaphragm
Increased opacity in relevant zone

67
Q

What is a Ghon focus and what does it indicate?

A

A (+-calcified) nodule indicating latent (i.e. a primary TB infection in the past which has become contained in a granuloma)

68
Q

What is Bupropion used for and when is it contraindicated?

A

An SNRI used for smoking cessation. It is contraindicated in epilepsy, pregnancy and breast feeding

69
Q

What is the latent period of asbestos exposure causing mesothelioma?

A

30-40 years

70
Q

What is the investigative protocol for ?mesothelioma?

A

CXR - may show effusion or pleural thickening
CT
Thoracoscopic biopsy and histology is gold standard for diagnosis

71
Q

What are the pulmonary features of SLE?

A

Pleuritis with exudative effusion

72
Q

What are some causes of pleural effusion?

A

Transudate: CCF, hypoalbuminaemia (liver, nephrotic, malabsorption), hypothyroid

Exudate: Infection, CTD, Neoplasia, PE, pancreatitis

73
Q

What are the CXR findings of heart failure/

A

ABCDE

Alveolar oedema (batswings)
B lines (kerley)
Cardiomegaly
Dilated prominent upper lobe vessels
Effusion
74
Q

What is the next step in management of an acute asthma attack following: 100% 02, neb salb, neb ipra, IV hydrocortisone

A

IV MagSulph

75
Q

Which paraneoplastic syndromes are associated with SCLC?

A

Cushings
SIADH
LEMS

76
Q

Which lung cancer typically causes paraneoplastic hypercalcaemia?

A

Squamous cell

77
Q

How might you differentiate the causes of a white-out hemithorax?

A

Tracheal position

Towards whiteout - pneumonectomy, complete lung collapse

Central - Consolidation, pulm oedema, mesothelioma

Away from whiteout - Effusion, diaphragmatic hernia, large mass

78
Q

What is atelectasis and when is it most common?

A

Basal alveolar collapse which may lead to respiratory difficulty. It is caused by airway obstruction due to bronchial secretions.

It is commonest in patients with dyspnoea and hypoxaemia who are 72 hours post op.

79
Q

What is the management of atelectasis?

A

Chest physio and breathing exercises

80
Q

Which three body systems are involved in granulomatosis with polyangiitis?

A

URT: Epixtaxis, sinusitis
LRT: Dyspnoea, haemoptysis
Pauci immune glomerulonephritis
Saddle nose

81
Q

Swinging chest drain - rises on _____, falls on _____

A

Rises on inspiration, falls on expiration

82
Q

What are the Centor criteria?

A

Presence of tonsillar exudate
Absence of cough
History of fever
Tender anterior cervical lymphadenopathy

83
Q

What is indicated by 3 or more positive Centor criteria?

A

40-60% chance of Group A beta haemolytic strep

84
Q

What are the Pulmonary function results of a restrictive lung disease?

A

Reduced/normal FEV1
Reduced FVC
Raised FEV1:FVC

85
Q

What is the management of non-steroid responsive COPD?

A
  1. SABA

2. LABA + LAMA

86
Q

What are the iatrogenic causes of pulmonary fibrosis?

A 
Bleomycin
Cyclophosphamide
Nitrofurantoin
Methotrexate
Penicillamine
Amiodarone
87
Q

What are the adverse effects of statins?

A

Myopathy

Hepatic impairment

88
Q

What type of pleural effusion does a PE cause?

A

Exudative

89
Q

What is the most important intervention to start in early stages of COPD?

A

Pulmonary rehabilitation

90
Q

What are the clinical and biochemical features of Eosinophilic graunulomatosis with polyangiitis?

A 
Asthma
Eosinophilia
Paranasal sinusitis
Mononeuritis multiplex
pANCA positive serology
91
Q

What is the management approach for bronchiectasis?

A 
Physiotherapy
Postural drainage
Antibiotics
Bronchodilators
Immunisations
Surgery
92
Q

What are the indications for surgery in bronchiectasis?

A 
Localised disease (confined to 1 lobe)
Haemoptysis
93
Q

What is hypertrophic pulmonary osteoarthropathy/

A

A triad of periostitis, clubbing and osteoarthritis of the large joints, commonly secondary to lung adenocarcinoma

94
Q

Which type of lung cancer is associated with gynaecomastia?

A

Adenocarcinoma

95
Q

What are the acute, insidious and skin manifestations of Sarcoidosis?

A

Acute: Erythema nodosum, BHL, swinging fever, polyarthralgia

Insidious: Dyspnoea, non-productive cough, malaise, weight loss, lymphadenopathy

Skin: Lupus pernio

Also: Hypercalcaemia

96
Q

What are the stages of COPD severity, and how is this determined?

A

Mild: FEV1 >80% pred, post bronchodilater FEV1/FVC (pbF/F) <0.7

Moderate: FEV1 50-79%, pbF/F <0.7

Severe: FEV1 30-49%, pbF/F <0.7

Very severe: FEV1 <30%, pbF/F

97
Q

What is an indicator that a patient with acute asthma may need invasive ventilation?

A

A normal PaCO2

98
Q

True or false - Pleural plaques secondary to asbestos exposure do not undergo malignant change

A

True

99
Q

What are some causes for upper zone fibrosis?

A

CHARTS

Coal worker's pneumoconiosis
Histocytosis
AnkSpon
Radiation
TB
Sarcoid
100
Q

What are some causes of lower zone pulmonary fibrosis?

A

Drug causes

IPF

101
Q

What is an indication for BiPAP in an acute exacerbation of COPD?

A

Type two respiratory failure with respiratory acidosis

102
Q

What are some diagnostic criteria for asthma?

A

FeNO >40
Post bronchodilator improvement in lung volume of >200ml
Post bronchodilator improvement in FEV1 of 12% or more
PEF Variability of 20% or more
FEV1/FVC <70%

103
Q

Steroid responsive COPD patients managmenet?

A
  1. SABA/SAMA

2. Add LABA + ICS

104
Q

Which pharmacological smoking cessation aid can be prescribed in pregnancy?

A

Nicotine patch only

105
Q

What is the most common infective agent in acute exacerbations of COPD?

A

H influenza

106
Q

What should the target SpO2 of a COPD patient with normal CO2 be?

A

94-98%

107
Q

What PFTs are seen in obstructive lung disease?

A

FEV1 significantly reduced
FVC low/ normal
FEV1/FVC - reduced

108
Q

What PFTs are seen in restrictive lung disease?

A

FEV1 reduced
FVC significantly reduced
FEV1/FVC normal/increased

109
Q

When is Azithromycin prophylaxis recommended for COPD patients?

A

In those who do not smoke and have optimal pharmacological management yet continue to have more than 4 exacerbations per year

110
Q

What are the features of Kartagener’s syndrome?

A

Dextrocardia/situs invertus
Bronchiectasis
Recurrent sinusitis
Subfertility

111
Q

When should LTOT be considered in COPD patients?

A

Those with two readings of PaO2 <7.3 and one of:
Pulmonary hypertension
Secondary polycythaemia
Peripheral oedema

112
Q

What are the Xray signs of right upper lobe consolidation?

A

Abnormal opacificication in the RUZ abutting the horizontal fissure

113
Q

Can ARDS be diagnosed if there is concomitant cardiac pathology?

A

No

114
Q

True or false: Alpha 1 antitrypsin deficiency is a risk factor for HCC development

A

True

115
Q

Which medications are used for the prevention of vs. the treatment of high altitude cerebral oedema?

A

Prevention: Acetazolomide
Treatment: Dexamethasone

116
Q

True or false: BHL alone is not an indication to begin treatment of sarcoidosis.

A

True

117
Q

How does Miliary TB spread throigh the lungs?

A

Through the pulmonary venous system

118
Q

What are the indications for commencement of treatment for sarcoidosis, and what is the first line treatment?

A

Hypercalcaemia
Parenchymal lung disease
Uveitis
Neurological or cardiac involvement

Corticosteroids

119
Q

As well as weight loss, what is the best treatment option for obstructive sleep apnoea?

A

CPAP

120
Q

What are the features of superior vena cava syndrome?

A

Dyspnoea
Facial/upper limb swelling
Venous distention in chest and arms

4th year passmed (28 decks)

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