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Resp Flashcards

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1
Q

What is the main target for autoantibodies generated in goodpastures?

A

Type IV collagen

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2
Q

Which of these is NOT a cause of finger clubbing?
A. Empyema
B. Mesothelioma
C. COPD
D. Asthma
E. Cysticfibrosis

A

COPD

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3
Q

What type of hypersensitivity reaction is Goodpasture’s syndrome?

A

Type II

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4
Q

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

A

E. Reduced sweating

Increased sweating is a complication of cystic fibrosis

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5
Q

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?

A

Αlpha 1 antitrypsin deficiency

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6
Q

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?

A

Sarcoidosis

Prednisolone

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7
Q

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?

A

Pulmonary fibrosis.

FEV1:FVC = 0.95 … restrictive NOT obstructive disease. Rules out COPD, asthma, bronchiectasis

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8
Q

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

A

B. Tearing pain radiating to the back

This would indicate AAA

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9
Q

Name 4 antibiotics that can be used to treat TB

A
  • Rifampicin
  • Isoniazid
  • Ethambutol
  • Pyrazinamide
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10
Q

List 4 risk factors for COPD

A
  • smoking
  • asbestos exposure
  • α-1-antitrypsin deficiency
  • occupational exposure
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11
Q

Describe the pathology of cystic fibrosis

A
  • gene mutation in transmembrane conductase regulator (CFTR)
  • dysregulation of salt and fluid movement across cell membranes, causing thickened secretion
  • affects respiratory, GI, reproductive systems
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12
Q

What kind of inheritance is cystic fibrosis?

A

Autosomal recessive

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13
Q

List 4 respiratory features of cystic fibrosis

A
  • wheeze
  • persistent cough, productive of thick mucous
  • exercise intolerance
  • recurrent respiratory infections
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14
Q

List 4 TB drugs and their main side effects

A
  • Rifampicin: red secretion
  • Isoniazid: fever, jaundice, nausea
  • Pyrazinamide: hyperuricaemia (gout), hepatotoxicity
  • Ethambutanol: optic neuritis / eye symptoms including colour blindness
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15
Q

What does tree-in-bud sign on CT indicate?

A

Atypical pneumonia
Bronchialitis
Aspiration pneumonitis

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16
Q

What does a bronchus sign on CT indicate?

A

Bronchogenic malignancy

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17
Q

What does a polo mint sign on CT angiogram indicate?

A

PE

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18
Q

What does a split pleura sign on CT indicate?

A

Emphysema
Malignant effusions

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19
Q

What does a signet ring sign on CT indicate?

A

Bronchiectasis

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20
Q

List 4 obstructive lung diseases

A
  • COPD
  • asthma
  • bronchiectasis
  • bronchiolitis
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21
Q

List 4 restrictive lung diseases

A
  • TB
  • sarcoidosis
  • asbestosis
  • silicosis
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22
Q

What does CURB-65 stand for?

A

Confusion
Urea (>7mmol/L)
Respiratory rate (>30/min)
Blood pressure (<90systolic or <60diastolic)
65 years or older

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23
Q

What are the clinical signs on type 1 respiratory failure ?

A
  • hypoxemia (PaO2 <8kpa)
  • normocapnia (PaCO2 <6kpa)
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24
Q

What are the ABG results expected in type 2 respiratory failure ?

A
  • hypoxemia (PaO2 <8kpa)
  • hypercapnia (PaCO2 >6kpa)
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25
What is the pathology behind type 1 respiratory failure?
V/Q mismatch
26
What is the pathology behind type 2 respiratory failure?
Alveolar hypoventilation -> reduced ability to oxygenate blood and eliminate CO2
27
What is the most common causative organism of hospital acquired pneumonia?
Pseudomonas aeruginosa
28
Give two common causative organisms of community acquired pneumonia
Streptococcus neumoniae Staphylococcus aureus
29
What group is most at risk of spontaneous PE?
Young men with low BMI Marfans syndrome
30
What signs on XR would confirm a diagnosis of TB?
- Ghon focus - Ghon complex - dense homogenous opacity - lymphadenopathy - pleural effusion
31
What type of lesion is usually present in TB?
Caseating granuloma
32
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
33
Give 4 DD for asbestosis
- mesothelioma - silicosis - idiopathic pulmonary fibrosis - coal workers pneumoconiosis
34
Which type of cancer has a strong association with asbestosis?
Mesothelioma
35
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
36
Where are Pancoast tumour located?
Lung apex
37
What symptoms are associated with Pancoast tumour?
- horners syndrome (ptosis, miosis, anhydrosis) - arm pain / weakness - shoulder blade pain - fatigue
38
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.
39
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
40
List 9 precipitations of asthma
- cold air - exercise - smoking - second hand / passive smoking - allergens - infections - pollution - β blockers - NSAIDs
41
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
42
What investigation can be used first to diagnose squamous cell lung cancer?
Chest X ray
43
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
44
What are the DD of bilateral hilar lymphadenopathy?
- sarcoidosis - TB - lymphoma - heart failure - silicosis
45
What kind of lesions does sarcoidosis form?
Non caseating granuloma
46
Describe the epidemiology of sarcoidosis
- young adults - African descent
47
Give 3 extra pulmonary signs of sarcoidosis
- erythema nodosum - lupus pernio - polyarthritis - uveitis - arrhythmia
48
Name 3 potential causes of bronchiectasis
- post infection e.g. TB - cystic fibrosis - idiopathic - bronchial obstruction e.g. mass / foreign object - immunodeficiency
49
Name 2 clinical sign seen on examination in bronchiectasis
- course crackles on inspiration, especially in the lower zones - wheeze - clubbing
50
Give 2 potential complications of bronchiectasis
- respiratory failire - repeated respiratory infection - pneumothorax - emphysema
51
List 3 non-pharmacological management options for bronchiectasis
- smoking cessation - physical exercise - immunisation against influenza
52
Name 2 DD for COPD
- asthma - α1 antitrypsin deficiency - bronchiectasis - cystic fibrosis
53
What initial investigations are appropriate in COPD (except spirometry)
- Chest X ray - FBC - BMI - ABG
54
Name 3 causative organisms of CAP
- streptococcus pneumoniae (most common) - haemophilus influenzae - staphylococcus aureus (post influenza infection)
55
Gram negative coccobicilli causing CAP … ?
Haemophilus influenzae
56
Name 3 RF for pneumothorax
- COPD - smoking - trauma - previous pneumothorax
57
Name 2 symptoms on pneumothorax
- pain (chest pain, often pleuritic) - dyspnoea
58
Name 3 symptoms of pulmonary embolism
- shortness of breath - sweating - palpitation
59
Name an objective risk assessment score for calculating PE risk
Well’s score
60
Describe how a pneumothorax and pleural effusion could be differentiated on a respiratory examination
Pleural effusion = dullness on percussion Pneumothorax = hyperresonant on percussion
61
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,
62
What are the 3 typical characteristics of asthma?
Airflow limitation, airway hyper-responsiveness, bronchial inflammation
63
Give 2 RFs for asthma
- personal history of atopy - family history of atopy - obesity - premature birth - living in an inner city environment
64
Name 2 lung function tests used to diagnose asthma
- spirometry - peak expiratory flow rate
65
Name 3 classes of bronchodilator
- beta 2 agonists - muscarinic antagonists - methyxanthines
66
Give 2 features of a life threatening asthma attach
- silent chest - confusion - exhaustion - cyanosis - bradycardia PEFR <33%
67
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
68
What is the first line treatment for pneumonia?
Oxygen
69
CURB65 score of 2. Where should they be treated?
In hospital
70
What is bronchiectasis?
Permanent dilation of the airways due to chronic inflammation and an inability to clear secretions
71
Give a congenital cause of bronchiectasis
Cystic fibrosis
72
How can infection cause bronchiectasis?
Infection causes release on inflammatory mediators which impair ciliary action, allowing bacterial proliferation and ciliary damage
73
Give 2 possible treatments of bronchiectasis
- antibiotics - bronchodilators - corticosteroids - sputum drainage
74
HAP. Culture: gram positive cocci, found in clusters Positive coagulase test Organism?
Staph aureus
75
What substance causes βeta haemolysis on blood agar?
Biliverdin
76
What kind of airway disease is COPD?
Irreversible and obstructive
77
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
78
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
79
Describe the MOA of Ipatropium bromide
Muscarinic acetylcholine receptor antagonist -> bronchodilator
80
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
81
How does asthma cause airway hypertrophic?
Chronic inflammation of the airway causes remodelling to have a greater smooth muscle content, therefore causing hypertrophy
82
How does COPD cause polycythaemia?
Chronic hypoxia
83
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
84
How does COPD cause peripheral oedema?
hypoxia of the kidney, reduced kidney perfusion, lack of excretion of sodium and water
85
List 4 signs of COPD on examination
- barrel chest - intercostal recession - wheeze - tachycardia
86
What is shown on X-RAY in COPD?
- hyperinflation - air gaps - flat diaphragm
87
Give the three cardinal symptoms of COPD
- productive cough - dyspnoea - chronic cough
88
What two signs found through lung function tests indicate COPD?
FEV1/FVC < 0.7 FEV1 < 80% of predicted value
89
What type of hypersensitivity is hypersensitivity pneumonitis?
Type III
90
Hypersensitivity symptoms?
Increasing dyspnoea, weight loss, exertional dyspnoea
91
Signs of hypersensitivity pneumonitis
Finger clubbing, type 1 respiratory failure, cor pulmonary
92
Define granuloma
Aggregate of epithelioid histiocytes
93
Asthma: 3 tests and their results
Spirometry: FEV1/FVC <0.7 Reversibility testing: increase of FEV1 by >15% Peak flow: diurnal variation
94
Which two pathological features of asthma are caused by histamine?
Bronchoconstriction and mucus production

Phase 2a mocks (11 decks)

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