Resp Flashcards
What is the main target for autoantibodies generated in goodpastures?
Type IV collagen
Which of these is NOT a cause of finger clubbing?
A. Empyema
B. Mesothelioma
C. COPD
D. Asthma
E. Cysticfibrosis
COPD
What type of hypersensitivity reaction is Goodpasture’s syndrome?
Type II
Which of these is not a complication of cystic fibrosis in the body?
A. Type 2 Diabetes Mellitus
B. Infertility in males
C. Mucous retention in the lungs
D. Meconium ileus
E. Reduced sweating
E. Reduced sweating
Increased sweating is a complication of cystic fibrosis
22F. SOB on exertion, no other symptoms. Started smoking at same time as symptoms began 2 months ago.
Px liver cirrhosis.
CXR: flattened diaphragm, large lung volumes, basilar predominant emphysema.
LFT shows increased liver enzymes
Most likely diagnosis?
Αlpha 1 antitrypsin deficiency
A 35 year old woman presents to the GP with progressive dyspnoea, chest pain and a persistent dry cough. She also complains of eye pain and excruciating pain that radiates from her waist to her groin.
What is the most most likely diagnosis and most appropriate management?
Sarcoidosis
Prednisolone
44M. Breathing problems for the last month. Smoker, no exposure to industrial chemicals or asbestos.
Px rheumatoid arthritis (on methotrexate)
Spirometry:
FEV1: 2.1 (normal for height and weight = 2.8)
FVC: 2.21 (normal for height and weight = 3.3)
Most likely diagnosis?
Pulmonary fibrosis.
FEV1:FVC = 0.95 … restrictive NOT obstructive disease. Rules out COPD, asthma, bronchiectasis
A man is suffering from a pulmonary embolism.
Which of these is least likely to be seen on examination?
A. Dyspnoea
B. Tearing pain radiating to the back
C. Haemoptysis
D. Tachycardia
E. Loud P2
B. Tearing pain radiating to the back
This would indicate AAA
Name 4 antibiotics that can be used to treat TB
- Rifampicin
- Isoniazid
- Ethambutol
- Pyrazinamide
List 4 risk factors for COPD
- smoking
- asbestos exposure
- α-1-antitrypsin deficiency
- occupational exposure
Describe the pathology of cystic fibrosis
- gene mutation in transmembrane conductase regulator (CFTR)
- dysregulation of salt and fluid movement across cell membranes, causing thickened secretion
- affects respiratory, GI, reproductive systems
What kind of inheritance is cystic fibrosis?
Autosomal recessive
List 4 respiratory features of cystic fibrosis
- wheeze
- persistent cough, productive of thick mucous
- exercise intolerance
- recurrent respiratory infections
List 4 TB drugs and their main side effects
- Rifampicin: red secretion
- Isoniazid: fever, jaundice, nausea
- Pyrazinamide: hyperuricaemia (gout), hepatotoxicity
- Ethambutanol: optic neuritis / eye symptoms including colour blindness
What does tree-in-bud sign on CT indicate?
Atypical pneumonia
Bronchialitis
Aspiration pneumonitis
What does a bronchus sign on CT indicate?
Bronchogenic malignancy
What does a polo mint sign on CT angiogram indicate?
PE
What does a split pleura sign on CT indicate?
Emphysema
Malignant effusions
What does a signet ring sign on CT indicate?
Bronchiectasis
List 4 obstructive lung diseases
- COPD
- asthma
- bronchiectasis
- bronchiolitis
List 4 restrictive lung diseases
- TB
- sarcoidosis
- asbestosis
- silicosis
What does CURB-65 stand for?
Confusion
Urea (>7mmol/L)
Respiratory rate (>30/min)
Blood pressure (<90systolic or <60diastolic)
65 years or older
What are the clinical signs on type 1 respiratory failure ?
- hypoxemia (PaO2 <8kpa)
- normocapnia (PaCO2 <6kpa)
What are the ABG results expected in type 2 respiratory failure ?
- hypoxemia (PaO2 <8kpa)
- hypercapnia (PaCO2 >6kpa)
What is the pathology behind type 1 respiratory failure?
V/Q mismatch
What is the pathology behind type 2 respiratory failure?
Alveolar hypoventilation -> reduced ability to oxygenate blood and eliminate CO2
What is the most common causative organism of hospital acquired pneumonia?
Pseudomonas aeruginosa
Give two common causative organisms of community acquired pneumonia
Streptococcus neumoniae
Staphylococcus aureus
What group is most at risk of spontaneous PE?
Young men with low BMI
Marfans syndrome
What signs on XR would confirm a diagnosis of TB?
- Ghon focus
- Ghon complex
- dense homogenous opacity
- lymphadenopathy
- pleural effusion
What type of lesion is usually present in TB?
Caseating granuloma
Give 3 risk factors for asbestosis
- boiler workers
- electrician
- miner
- living in a house built prior to 1980 / older pts that are likely to have lived in a house that used asbestos in the insulation
Give 4 DD for asbestosis
- mesothelioma
- silicosis
- idiopathic pulmonary fibrosis
- coal workers pneumoconiosis
Which type of cancer has a strong association with asbestosis?
Mesothelioma
In a pt presenting with ptosis, miosis, and anhydrosis of one side, what is your likely diagnosis?
What is this group of symptoms called?
Pancoast tumour.
Horners syndrome
Where are Pancoast tumour located?
Lung apex
What symptoms are associated with Pancoast tumour?
- horners syndrome (ptosis, miosis, anhydrosis)
- arm pain / weakness
- shoulder blade pain
- fatigue
Describe the Pathophysiology of Pancoast tumours symptoms?
Pancoast tumour invades the apical chest wall, and as it grows, it affects surround structures. This included the brachial plexus, causing arm pain, shoulder blade pain, etc. Also affects the sympathetic pathway, causing Horners syndrome.
What is the Pathophysiology of asthma?
Narrowing of the airway due to:
- smooth muscle contraction
- thickening of the airway wall by cellular infiltration and inflammation
- secretions in the airway lumen
List 9 precipitations of asthma
- cold air
- exercise
- smoking
- second hand / passive smoking
- allergens
- infections
- pollution
- β blockers
- NSAIDs
Give 3 drug classes used in asthma and an example of each
- SABA (short acting β 2 agonist) : salbutamol
- LABA (long acting β 2 agonist) : salmeterol
- ICS (inhaled corticosteroid) : beclomethasone diproprionate
What investigation can be used first to diagnose squamous cell lung cancer?
Chest X ray
Give 4 examples of sites that lung cancer is likely to metastasise from
- breast cancer
- colon cancer
- prostate cancer
- bladder cancer
- sarcoma
- neuroblastoma
- wilms tumour
What are the DD of bilateral hilar lymphadenopathy?
- sarcoidosis
- TB
- lymphoma
- heart failure
- silicosis
What kind of lesions does sarcoidosis form?
Non caseating granuloma
Describe the epidemiology of sarcoidosis
- young adults
- African descent
Give 3 extra pulmonary signs of sarcoidosis
- erythema nodosum
- lupus pernio
- polyarthritis
- uveitis
- arrhythmia
Name 3 potential causes of bronchiectasis
- post infection e.g. TB
- cystic fibrosis
- idiopathic
- bronchial obstruction e.g. mass / foreign object
- immunodeficiency
Name 2 clinical sign seen on examination in bronchiectasis
- course crackles on inspiration, especially in the lower zones
- wheeze
- clubbing
Give 2 potential complications of bronchiectasis
- respiratory failire
- repeated respiratory infection
- pneumothorax
- emphysema
List 3 non-pharmacological management options for bronchiectasis
- smoking cessation
- physical exercise
- immunisation against influenza
Name 2 DD for COPD
- asthma
- α1 antitrypsin deficiency
- bronchiectasis
- cystic fibrosis
What initial investigations are appropriate in COPD (except spirometry)
- Chest X ray
- FBC
- BMI
- ABG
Name 3 causative organisms of CAP
- streptococcus pneumoniae (most common)
- haemophilus influenzae
- staphylococcus aureus (post influenza infection)
Gram negative coccobicilli causing CAP … ?
Haemophilus influenzae
Name 3 RF for pneumothorax
- COPD
- smoking
- trauma
- previous pneumothorax
Name 2 symptoms on pneumothorax
- pain (chest pain, often pleuritic)
- dyspnoea
Name 3 symptoms of pulmonary embolism
- shortness of breath
- sweating
- palpitation
Name an objective risk assessment score for calculating PE risk
Well’s score
Describe how a pneumothorax and pleural effusion could be differentiated on a respiratory examination
Pleural effusion = dullness on percussion
Pneumothorax = hyperresonant on percussion
Describe how a pneumothorax and pleural effusion could be differentiated through a history
Pleural effusion: slow onset, Px of congestive heart failure, cancer, pneumonia,
Pneumothorax: rapid onset, Px of trauma, smoking,
What are the 3 typical characteristics of asthma?
Airflow limitation, airway hyper-responsiveness, bronchial inflammation
Give 2 RFs for asthma
- personal history of atopy
- family history of atopy
- obesity
- premature birth
- living in an inner city environment
Name 2 lung function tests used to diagnose asthma
- spirometry
- peak expiratory flow rate
Name 3 classes of bronchodilator
- beta 2 agonists
- muscarinic antagonists
- methyxanthines
Give 2 features of a life threatening asthma attach
- silent chest
- confusion
- exhaustion
- cyanosis
- bradycardia
PEFR <33%
Pneumonia
Upon culturing the patients sputum it is found that the bacteria is resistant to optochin. Name what bacteria this is and what it would look like upon staining and microscopy.
Streptococcus pneumoniae- gram positive bacilli chains
What is the first line treatment for pneumonia?
Oxygen
CURB65 score of 2.
Where should they be treated?
In hospital
What is bronchiectasis?
Permanent dilation of the airways due to chronic inflammation and an inability to clear secretions
Give a congenital cause of bronchiectasis
Cystic fibrosis
How can infection cause bronchiectasis?
Infection causes release on inflammatory mediators which impair ciliary action, allowing bacterial proliferation and ciliary damage
Give 2 possible treatments of bronchiectasis
- antibiotics
- bronchodilators
- corticosteroids
- sputum drainage
HAP.
Culture: gram positive cocci, found in clusters
Positive coagulase test
Organism?
Staph aureus
What substance causes βeta haemolysis on blood agar?
Biliverdin
What kind of airway disease is COPD?
Irreversible and obstructive
Give an example of when long term oxygen therapy can be given for COPD.
- Clinically stable non-smokers with PaO2 <7.3kPa
- If PaO2 7.3-8.0kPa and pulmonary hypertension
- For terminally ill patients
How are severe asthma attacks and life threatening asthma attacks clinically differentiated?
Severe:
- PEF 33-50% predicted
- can’t talk/feed
- use of accessory muscles
Life threatening
- PEF <33%
- silent chest
- cyanosis
- altered consciousness
Describe the MOA of Ipatropium bromide
Muscarinic acetylcholine receptor antagonist -> bronchodilator
Pt presents with vasculitis, sinusitis, and dyspnoea.
What investigation will allow you to differentiate between granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis ?
Bloods: antibodies
If cANCA positive = granulomatosis with polyangiitis
If pANCA positive = eosinophilic granulomatosis with polyangiitis
How does asthma cause airway hypertrophic?
Chronic inflammation of the airway causes remodelling to have a greater smooth muscle content, therefore causing hypertrophy
How does COPD cause polycythaemia?
Chronic hypoxia
What 2 conditions make up COPD? Briefly describe their Pathophysiology
Emphysema: inflammation causes loss of elastic recoil of alveoli, causing air trapping and lower gas transfer
Chronic bronchitis: inflammation causes mucociliary dysfunction, leading to lower ventilation
How does COPD cause peripheral oedema?
hypoxia of the kidney, reduced kidney perfusion, lack of excretion of sodium and water
List 4 signs of COPD on examination
- barrel chest
- intercostal recession
- wheeze
- tachycardia
What is shown on X-RAY in COPD?
- hyperinflation
- air gaps
- flat diaphragm
Give the three cardinal symptoms of COPD
- productive cough
- dyspnoea
- chronic cough
What two signs found through lung function tests indicate COPD?
FEV1/FVC < 0.7
FEV1 < 80% of predicted value
What type of hypersensitivity is hypersensitivity pneumonitis?
Type III
Hypersensitivity symptoms?
Increasing dyspnoea, weight loss, exertional dyspnoea
Signs of hypersensitivity pneumonitis
Finger clubbing, type 1 respiratory failure, cor pulmonary
Define granuloma
Aggregate of epithelioid histiocytes
Asthma: 3 tests and their results
Spirometry: FEV1/FVC <0.7
Reversibility testing: increase of FEV1 by >15%
Peak flow: diurnal variation
Which two pathological features of asthma are caused by histamine?
Bronchoconstriction and mucus production
