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Difficult Passmed- MLA > Resp > Flashcards

Resp Flashcards

1
Q

Squamous NSCLC paraneoplastic lesions

A

PTH secretion -> ↑Ca2+, clubbing, HPOA, Hyperthyroid (ectopic TSH), Cavitation lesions

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2
Q

Adenocarcinoma SCLC paraneoplastic syndrome

A

gynaecomastia, HPOA, non smokers

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3
Q

SCLC Paraneoplastic syndrome

A

SIADH + ↑ACTH (cushings)
Lambert Eaton Myasthenic syndrome - muscle weakness, diplopia, dysphagia, speech

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4
Q

Mining occupation, upper zone fibrosis, egg shell calcification hilar nodes

dx

A

silicosis

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5
Q

Extertional dyspnea, dry cough, inspiratory crackles
Fine reticular/honeycomb appearance on CXR, lower lobes
Restrictive - ↓ FEV1, ↑FEV1/FVC

dx

A

asbestosis

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6
Q

Mx extrinsic allergic alveoli’s

A

Avoid + glucocorticoids

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7
Q

Clubbing, fine insp crackles
Exertional dyspnea, dry cough, weight loss. Typically men 50-70
Spirometry - FEVR N/ ↓, ↓ TLCO, ground glass-> honeycoming. CT is best for diagnosis
Lif expect 3-4 years

Dx

A

Idiopathic pulmonary fibrosis

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8
Q

Erythema nodosum, plaques on face, cough, ↑Ca, ↑ESR ↑ACEi, LNS. Can cause facial paralysis

dX

A

Sarcoidosis

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9
Q

UPPER ZONE FIBROSIS

A

Hypersensitivity pneumonitis, coal workers pneumoconciosis, silicosis, sarcoidosis, ankylosing spondylitis, TB,

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10
Q

Lower zone fibrosis

A

Drug induced - amiodarone, methotrexate, asbestosis, idiopathic

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11
Q

Symptoms and diagnosis of mesothelioma

A

Dyspnea, weight loss, chest wall pain, clubbing.
Dx - thoracoscopy and histology for Dx

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12
Q

Type pneumonia in bronchiectasis

A

Haemophilus influenza

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13
Q

Type pneumonia in alcohol and DM with caveatting lesions

A

Klebsiella pneumona

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14
Q

Type pneumonia in influenza

A

Staph aureus

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15
Q

hotel air con + ↓Na
type pneumonia

A

Legionella

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16
Q

Pneumonia organism with erythema multiforme

A

Mycoplasma Pneumoniae

17
Q

Tx HAP vs CAP

A

HAP - CO-amox
CAP - DOxy

18
Q

CURB65 score and Abx choice

A

Confusion
Urea >7
RR>/30
BP <90/60
Age >/65

Amoxicillin
Macrolide if mod-severe

19
Q

Surgery type in A1 Antitrypsin def

A

If bad - surgery - Lung/liver transplant or lung vol reduction surgery

20
Q

COPD MX

A

SAMA(ipatropium)/SABA
No asthma - LABA/LAMA
Asthma - LABA + ICS..

21
Q

LTOT in COPD - when

A

LTOT = PaO2 <7.3 or secondary polycythaemia/pulm HTN

22
Q

Tx for exacerbation in COPD

A

Azithromycin for prophylaxis if lots recurrent exacerbations

Exacerbation -
At home needs prednisolone/inhaler/Abx (doxy for CAP).
Only give Ab if purulent sputum/clinical signs pneumonia.
In hospital - neb bronchs, steroids, Abx

23
Q

Asthma chronic mx

A

SABA
+ICS
+LABA (if child <12 then LRTA)
Consider others

24
Q

Acute asthma mx

A

SABA
SABA/Ipatropium bromide neb 5mg
Prednisolone PO or iV hydrocortisone 100mg
MgS04-…

25
Q

Mod, severe and life threatening asthma

A

Mod = PEFR 50-75%
Severe = PEFR 33-50%, RR>25, HR>110,Can’t complete sentences
Life threatening = silent chest, hypotension…

26
Q

Smoking cess in pregnancy

A

NRT

27
Q

What pattern spirometery and examples
FEV1/FVC ratio N/↑
FVC ↓ ↓
FEV1 ↓

A

Restrictive

FEV1/FVC ratio N/↑
FVC ↓ ↓
FEV1 ↓

Pulm fibrosis, asbestosis, sarcoidosis, ARDS, Kyphoscoliosis, neuromuscular disorders

28
Q

What pattern spirometry and examples

FEV1/FVC ratio <75%
FEV1 ↓

A
29
Q

Persistent cough, sputum, exertional breathlessness
Coarse crackles + low pitched wheeze
High pitched inspiratory squeeks

dx

A

Bronchiectasis

30
Q

Pleural effusion transudative vs exudative

A

Exudative = ↑ protein (lung cancer/pathologies), protein/serum protein ratio >0.5

Transudative = ↓ protein (congenital HF…)
Empyema - ph<7.3, low glucose, ↑ LDH

31
Q

Primary vs secondary mx pneumothorax

A

primary:No SOB and <2cm = No TxSOB +/- >2cm = Aspiration

Secondary: 1-2cm or SOB = aspirate>2cm drain

32
Q

Persistent air leak or recurrent episodes of pneumothorax mx

A

consider referral for VATS to allow for mechanical/chemical pleurodesis +/- bullectomy

33
Q

Sinusitis mx

A

Intranasal corticosteroids if >10d. If severe then Abx (Pen V)

34
Q

Acute bronchitis vs pneumonia

A

Differentiating acute bronchitis from pneumonia
History: Sputum, wheeze, breathlessness may be absent in acute bronchitis whereas at least one tends to be present in pneumonia.
Examination: No other focal chest signs (dullness to percussion, crepitations, bronchial breathing) in acute bronchitis other than wheeze. Moreover, systemic features (malaise, myalgia, and fever) may be absent in acute bronchitis, whereas they tend to be present in pneumonia.

35
Q

Acute bronchitis symptoms and mx

A

Cough (may/may not be productive), sore throat, rhinorrhoea, wheeze

18+ = doxy/ <18 = amoxicillin
Only Abx if high risk/co-morbidities/systemically unwell or CRP>100. If CRP 20-100 maybe delayed prescription)

36
Q

Epistaxis, sinusitis, dyspnea, haemoptysis, rapidly progressive glomerulonephritis, saddle shape nose, vasculitis rash…

dx, ab on bloods and mx

A

Granulomatosis with polyangitis

cANCA
Mx - steroids, cyclophosphamide, plasma exchange…

37
Q

In children 5-16 with obstructive spirometry is this enough for asthma dx or need more?

A

Need bronchodilator reversibility testing with improvement 14%

Difficult Passmed- MLA (26 decks)

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