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resp Flashcards

1
Q

what is the most common organism isolated from a patient with bronchiectasis

A

haemophilus influenza followed by pseudomonas

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2
Q

what can occur following thoracic trauma when a lung parenchymal flap is created

A

tension pneumothorax

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3
Q

management of tension pneumo

A

needle decompression and chest tube insertion

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4
Q

what features suggest a steroid response in COPD

A

previous diagnosis of asthma - atopy
higher blood eosinophil count
substantial variation in FEV1 over time ( 400 ml)
Substantial diurnal variation in peak expiratory flow ( 20%)

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5
Q

gold standard investigation for idiopathic pulmonary fibrosis

A

high resolution CT

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6
Q

symptoms - pulmonary fibrosis

A

exertional dyspnoea
bibasal fine end inspiratory crepitations
dry cough
clubbing

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7
Q

what sign points towards pulmonary fibrosis on CXR

A

ground glass progressing to honeycombing

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8
Q

what is the management of asymptomatic sacroidosis

A

no treatment

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9
Q

sign of sarcoidosis on CXR

A

Bilateral hilar lymphadenopathy

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10
Q

first line treatment of sarcoidosis

A

prednisolone

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11
Q

give 5 causes of ARDS

A

infection - sepsis / pneumonia
blood transfusion
trauma
acute pancreatitis
cardio pulmonary bypass

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12
Q

signs + symptoms of ARDS

A

dyspnoea
inc resp rate
bilateral lung crackles
low o2 sats

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13
Q

signs + symptoms of ARDS

A

dyspnoea
inc resp rate
bilateral lung crackles
low o2 sats

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14
Q

what is the minimum time patient needs to wait between first and second puff of inhaler

A

30 seconds

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15
Q

nature of inheritance of A1AT

A

autosomal recessive

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16
Q

what does positive HBsAB indicate

A

previous infection, now immune/ vaccinated

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17
Q

features of A1AT

A

panacinar emyphysema in lower lobes
liver cirrhosis and HCC in adults, cholestasis in kids

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18
Q

can A1AT be diagnosed prenatally

A

Yes

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19
Q

what is a diagnostic test for asthma

A

bronchodilator reversibility test - improvement of 14%

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20
Q

first line test for obstructive sleep apnoea

A

Epworth

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21
Q

diagnostic test for sleep apnoea

A

polysomnography

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22
Q

when would you manage a pneumothorax with aspiration

A

> 2cm / signs of SOB

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23
Q

triad seen in Meig’s syndrome

A

benign ovarian tumour, ascites, pleural effusion

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24
Q

what activity must be permanently avoided in those with pneumothorax

A

deep sea diving

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25
Q

what test can be used to confirm asthma if there is a negative result on spirometry

A

FeNO testing

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26
Q

what observation makes the diagnosis of tension pneumothorax more likely than simple pneumothorax

A

hypotension

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27
Q

what spirometry tests indicate pulmonary fibrosis

A

reduced FVC
FEV1/FVC normal

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28
Q

what spirometry tests indicate an obstructive pattern of lung disease ?

A

FEV1 = reduced
FVC= reduced or normal
FEV1/ FVC = reduced

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29
Q

expand on CURB 65

A

C - confusion ( <= 8/10 on AMT)
U - > 7 mmol/L
R - rr > - 30
B - 90/60 <=
65 >

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30
Q

Management of low severity CAP

A

500 mg Amoxicillin 5 day course TDS

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31
Q

management of moderate - high severity CAP

A

oral amoxicillin 500 mg TDS for 5 days and oral clarithromycin 500 mg BD for 5 days

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32
Q

what is the follow up procedure for CAP

A

repeat cxr after 6 weeks

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33
Q

gynaecomastia is associated with which type of cancer

A

adenocarcinoma of lung

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34
Q

give 6 features of pulmonary oedema

A

insterstitial oedema
bats wings appearance
kerley b lines
pleural effusion
cardiomegaly if there is a cardiogenic cause
upper lobe diversion

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35
Q

top 2 interventions that improve survival in COPD

A

Smoking cessation
LTOT

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36
Q

what are pleural plaques

A

benign, not requiring follow up
most common cause of asbestosis related lung disease

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37
Q

what are the features of asbestosis

A

symptoms after latent period of 15-30 years

dyspnoea
reduced exercise tolerance
bilateral end inspiratory crackles
restrictive pattern

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38
Q

key sign on examination in idiopathic pulmonary fibrosis

A

fine end inspiratory crackles

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39
Q

most common lung cancer in non smokers

A

Adenocarcinoma

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40
Q

what is the most common organism causing infective exacerbations of COPD

A

H. Influenzae

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41
Q

categorise COPD on the basis of FEV1 readings

A

stage 1 : mild >80%
stage 2 : moderate 50-79%
stage 3 : severe 30-49%
stage 4 : very severe <30%

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42
Q

what is the first line management of acute bronchitis

A

oral doxycycline

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43
Q

what is the criteria for the 2 week wait pathway for lung cancer

A

-chest x-ray findings suggesting lung cancer
- aged 40 and over with unexplained haemoptysis

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44
Q

which type of lung cancer is most associated with cavitating lesions on chest radiograph

A

squamous cell carcinoma

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45
Q

what is the gold standard investigation for a pleural effusion

A

diagnostic aspiration with green 21g needle and 50 ml syringe

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46
Q

what is lights criteria

A

used to distinguish between transudate and exudate :

exudate is likely if one of the following criteria are met -

pleural fluid protein / serum protein > 0.5
pleural fluid LDH / serum LDH > 0. 6
pleural fluid LDH > more than 2/3rds the upper limits of normal serum LDH

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47
Q

which sights are most commonly affected by aspiration pneumonia ?

A

right and lower lung lobes

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48
Q

what is the triangle for safety of insertion of a chest drain ?

A

base of the axilla
lateral edge of pectoralis major
5th intercostal space
anterior border of latissimus dorsi

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49
Q

what type of picture does alpha one anti trypsin deficiency show on spirometry

A

obstructive picture

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50
Q

first line management of hospital acquired pneumonia

A

co -amoxiclav

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51
Q

what can precipitate ARDS

A

She died Having trauma, acute pancreatitis and long bone injury
Sepsis
direct lung injury
head injury
trauma
acute pancreatitis
long bone fracture

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52
Q

what is the treatment of choice for allergic bronchopulmonary aspergillosis ?

A

oral glucocorticoids - Prednisolone

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53
Q

what are the main indications for placing a chest tube in pleural infection?

A

-Purulent or turbid / cloudy pleural fluid
-presence of organisms identified by Gram stain from non purulent pleural fluid
-Pleural fluid with pH < 7.2 with suspected pleural infection

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54
Q

which type of lung cancer causes para-neoplastic syndromes

A

Small cell bronchial carcinoma

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55
Q

which medication is used for COPD prophylaxis

A

Azithromycin

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56
Q

give the SIGN guidelines for escalation of care of asthma

A
  1. Oxygen
  2. Salbutamol nebulisers
  3. Ipatropium bromide nebulisers
  4. Hydrocortisone IV / Oral prednisolone
  5. Magnesium Sulfate IV
  6. Aminophylline / IV Salbutamol
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57
Q

what treatment is offered to pregnant women who smoke

A

Nicotine replacement therapy

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58
Q

which medications can be used to aid smoking cessation ?

A

Varenicline and Bupropion

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59
Q

name 3 organisms that can cause a chest abscess

A

Staph. Aureus
Klebsiella Pneumonia
Pseudomonas aeruginosa

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60
Q

what are the features of a chest abscess ?

A

fever
productive cough ( foul smelling sputum)
chest pain
dyspnoea

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61
Q

give 2 signs of a chest abscess

A

dull to percuss and bronchial breathing
clubbing

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62
Q

what is the management of a chest abscess

A

IV Abx
Percutaneous drainage

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63
Q

gold standard testing for asthma

A

FeNo and spirometry with reversibility

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64
Q

ABG interpretation - low pH + High PaCO2

A

respiratory acidosis

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65
Q

ABG interpretation - high pH and low PaCO2

A

respiratory alkalosis

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66
Q

ABG interpretation - low pH + low bicarb

A

metabolic acidosis

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67
Q

ABG interpretation- high pH + high bicarb

A

metabolic alkalosis

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68
Q

what is the targeted oxygen saturation level in acute asthma

A

15 L high flow oxygen with target saturations of 94-98

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69
Q

what is the criteria for discharge after an acute asthma attack

A
  • stable on discharge medication for 12-24 hours
    -PEFR > 75% of expected
  • inhaler technique should have been checked and recorded
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70
Q

what FEV1/FVC ratio indicates obstruction

A

< 0.7

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71
Q

3 spirometry features of pulmonary fibrosis

A

restrictive spirometry ( FEV1:FVC >70%)
Decreased FVC
Impaired gas exchange ( reduced TLCO)

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72
Q

3 spirometry features for an obstructive pattern

A

FEV1/FVC ( <70%)
FVC normal / reduced
FEV1 Reduced < 80%

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73
Q

what vaccinations should COPD patients be offered ?

A

Annual flu vaccine
Pneumococcal vaccine

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74
Q

above what wells score would a CTPA be recommended

A

4 and above

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75
Q

how long do you prescribe dalteparin for in PE on discharge

A

provoked - 3 months
unprovoked - 6 months
active cancer - 6 months

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76
Q

what is the mechanism of an anaphylactic reaction

A

Type 1 hypersensitivity reaction , IgE stimulates mast cells to rapidly release histamine ( mast cell degranulation)

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77
Q

what is the immediate management and treatment of anaphylaxis

A

securing airway
oxygen
2 large bore peripheral access
adrenaline 300 mcg Im

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78
Q

how long do patients who have suffered an anaphylactic reaction need to observed

A

24-48 hours

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79
Q

what investigation do you need to order in a patient who has suffered with an anaphylactic reaction once they are stable and in what time frame ?

A

serum mast cell tryptase within 6 hours

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80
Q

what is the most common cause of hospital acquired pneumonia

A

pseudomonas aeroginosa

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81
Q

how do you manage a pneumothorax with the rim of air < 2 cm in an asymptomatic patient.

A

consider discharge

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82
Q

what activity must be avoided in a patient who has suffered from a pneumothorax ?
Under what circumstances can this activity be permitted ?

A

Deep sea diving
permitted if patient has undergone bilateral surgical Pleurectomy and has normal lung function and chest CT scan post-operatively.

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83
Q

what is a side effect of over rapid aspiration/ drainage of pneumothorax ?

A

Re-expansion pulmonary oedema

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84
Q

name 2 of the most common causes of bilateral hilar lymphadenopathy

A

sarcoidosis
TB

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85
Q

what test can help diagnose asthma in the case of indeterminate FeNo testing

A

Bronchodilator reversibility testing

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86
Q

what is the most common cause of exudative pleural effusion

A

pneumonia

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87
Q

what’s the difference between primary and secondary pneumothorax

A

no underlying lung disease in Primary pneumothorax

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88
Q

how does Klebsiella pneumoniae show under the microscope ?

A

Gram negative rod

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89
Q

which bacteria causes red currant jelly sputum

A

Klebsiella

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90
Q

Give 4 specific features of Klebsiella Pneumoniae

A
  • more common in alcoholics and diabetics
  • may occur following aspiration
    -red currant jelly sputum
    -often affects upper lobes
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91
Q

what is the management of a primary pneumothorax

A

rim of air > 2 cm –> chest drain
rim of air < 2cm –> consider discharge

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92
Q

what is the management of a tension pneumothorax

A

ABCDE assessment

-high flow oxygen 15 L via non rebreather mask
-open thoracostomy followed by chest drain or needle decompression with 16 gauge cannula inserted at 5th intercostal space, mid axillary line

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93
Q

what are contraindications to bupropion

A

epilepsy
eating disorder
CNS tumours
withdrawal
pregnancy + breastfeeding

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94
Q

what heart sounds are present in pulmonary HTN

A

Split 2nd heart sound with loud pulmonary component

pansystolic murmur - tricuspid regurgitation
end diastolic murmur - pulmonary regurgitation

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95
Q

____________ is associated with lung abscesses in alcoholic patients.

A

Klebsiella Pneumonia

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96
Q

which medication is first line for prevention of asthma

A

Inhaled corticosteroids

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97
Q

give 4 features of a severe asthmatic attack

A

Inability to speak in complete sentences
respiratory rate > 25 breaths / minute
peak flow 33-50% predicted
HR > 110 bpm

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98
Q

give features of a life threatening asthma attack

A

peak flow < 33% of predicted
silent chest
altered consciousness
bradycardia
hypotension
hypoxia
cyanosis

99
Q

4 key features of sarcoidosis

A

fever
polyarthralgia
erythema
nodosum
bilateral hilar lymphadenopathy

100
Q

what is the management of PE with haemodynamic instability

A

thrombolysis

101
Q

2 features of legionella that can be seen on blood tests

A

hyponatraemia and deranged LFT’s

102
Q

what are the features of chlamydophilia psittaci pneumonia

A

from contact with infected birds like parrots, cattle, horse and sheep
lethargy, headache, anorexia

103
Q

what is the management of PE if DOAC is contraindicated due to renal failure

A

unfractionated heparin

104
Q

what happens to the FEV1/ FVC in asthma

A

it is reduced

105
Q

what happens to FEV1 and FVC in asthma

A

low FEV1
preserved FVC

106
Q

what are examples of exudative pleural effusions

A

Cancer
Infection
Autoimmune
PE

107
Q

pneumonia of which lobe characteristically results in loss of right cardiac border

A

right middle lobe

108
Q

when is co-amoxiclav recommended first line in the management of pneumonia

A

in adults with comorbidities such as -

chronic heart disease
liver disease
renal disease
T2DM
Alcoholism
immunosuppression
hospitalization in the past year

109
Q

distinguish between spontaneous and traumatic pneumothorax

A

Spontaneous pneumothorax

Primary: no underlying lung pathology
Secondary : connective tissue disorders, obstructive and infective lung disease, fibrosis and neoplastic disease

Traumatic:
Iatrogenic : insertion of central line / positive pressure ventilation

Non-iatrogenic : penetrating trauma / blunt trauma with rib fracture

110
Q

what is the initial management of hypercalcaemia due to malignancy

A

intravenous fluid replacement to correct dehydration and increase urinary excretion of calcium

111
Q

what is the most likely cause of Horner’s syndrome due to lung cancer ? how would this present ?

A

Apical lung tumour on the side of the syndrome known as Pancoast tumour presenting with unilateral ptosis, miosis and anhidrosis.

112
Q

what is the investigation of choice for PE in a pregnant woman

A

Ventilation Perfusion scan

113
Q

which lobes of the lung are most commonly affected by an aspiration pneumonia

A

right middle and lower lung lobes

114
Q

What are key features of acute respiratory distress syndrome ?

A

acute onset respiratory failure
severe dyspnoea
tachypnoea
confusion
presyncope

115
Q

what sign is indicative of ARDS on chest xray / CT ?

A

Bilateral alveolar infiltrates

116
Q

give 2 risk factors for ARDS

A

Drowning
inhalation of hyperbaric oxygen

117
Q

what are the features of paraneoplastic syndrome associated with squamous cell carcinomas

A

Ectopic production of parathyroid hormone related peptide ( PTHrP) resulting in symptoms such as-

hypercalcaemia causing constipation, myopathy, polydipsia, behavioural changes.

118
Q

what signs are noticed on examination in pleural effusion ?

A

stony dullness to percuss
lymphadenopathy may be present indicating infection or malignancy.
may be reduced/ absent breath sounds

119
Q

what is the first line therapy ( pharmacological ) for idiopathic pulmonary fibrosis ?

A

Pirfenidone

120
Q

what is the most useful non -pharmacological management of bronchiectasis

A

postural drainage twice daily to aid mucus drainage

121
Q

how do you diagnose

mycoplasma pneumonia
legionella and pneumococcal

A

Mycoplasma - PCR
legionella and pneumococcal - urine antigen

122
Q

what is the management of non small cell lung cancer ?

A

1st line : Lobectomy
curative radiotherapy
chemotherapy

123
Q

what is the management of small cell lung cancer

A

Palliative chemotherapy

124
Q

what histological finding can be seen in asthma ?

A

Curschmann spirals

125
Q

what is the criteria for discharge following acute asthma attack ?

A

been stable on discharge medication for 12-24 hours
inhaler technique checked and recorded
PEF > 75% of best or predicted

126
Q

side effect of inhaled steroids

A

oral candidiasis

127
Q

what are the indications for Bipap

A

COPD with respiratory acidosis ( 7.25-7.35)
Type II respiratory failure secondary to chest wall deformity, neuromuscular disease, OSA
Cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation

128
Q

what is atelectasis ? How does it present ? How would you manage it ?

A

Common post-operative complication in which basal alveolar collapse causes respiratory difficulty

should be suspected in the presentation of dysponoea and hypoxaemia around 72 h post operatively

management

positioning patient upright
chest physiotherapy : breathing exercises

129
Q

what is the guidance on inhaler technique for pressured meter dose inhaler

A

Ideally hold your breath for 10 seconds after pressing down on the canister

130
Q

causes of upper zone fibrosis

A

CHARTS

Coal workers pneumoconiosis
Histiocytosis / hypersensitivity pneumonitis
Ankylosing spondylitis
Radiation
TB
Silicosis

131
Q

what are common causes of respiratory alkalosis ?

A

Anxiety causing hyperventilation
PE
Salicylate poisoning
CNS disorders : stroke, SAH, encephalitis
altitude
pregnancy

132
Q

what is the most common cause of occupational asthma

A

Isocyanates

133
Q

how is occupational asthma investigated?

A

Serial measurements of peak expiratory flow

134
Q

how is an asymptomatic pneumothorax managed?

A

Conservative care, regardless of size

135
Q

what are causes of widened mediastinum on chest x-ray?

A

vascular problems: thoracic aortic aneurysm
lymphoma
retrosternal goitre
teratoma
tumours of the thymus

136
Q

what is allergic bronchopulmonary aspergillosis? what are its features? How is it investigated and managed?

A

Allergy to aspergillus spores.
features include :
Bronchoconstriction ( wheeze, cough etc)
bronchiectasis ( proximally)

Investigations :
eosinophilia

management is :
Oral glucocorticoids
Itraconazole

137
Q

what drugs used in the management of asthma can be continued in pregnancy?

A

beclomethasone
salmeterol
theophylline
prednisolone

138
Q

what is the management of non-cystic fibrosis bronchiectasis?

A

Physical training ( inspiratory muscle training) and postural drainage

139
Q

how do skin lesions related to sarcoidosis manifest?

A

lupus pernio: affecting nose, cheeks, lips and digits

140
Q

what type of fibrosis affects the lower zones?

A

A:Asbestosis
C: connective tissue disorders ( SLE)
i: Idiopathic pulmonary fibrosis
D: Drug induced - amiodarone, bleomycin, methotrexate

141
Q

what types of fibrosis affects the upper lobes?

A

C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

142
Q

what are some of the key signs and symptoms of pleural effusion?

A

Pyrexia- suggests infection
cachexia and clubbing - suggests malignancy
JVP and ankle oedema - suggests HF

stony dullness to percuss might be present
reduced / absent breath sounds
bronchial breathing

143
Q

what are the side effects of the drugs involved in the management of TB?

A

Rifampicin : Liver toxicity ,red urine
Isoniazid : peripheral neuropathy
Pyrazinamide : liver toxicity, arthralgia, hyperuricaemia
Ethambutol : visual disturbances

144
Q

what is the diagnostic investigation for sarcoidosis ?

A

Bronchoscopy with transbronchial lung biopsy

145
Q

how does ARDS present on cxr ?

A

Bilateral pulmonary infiltrates and no other features of HF

146
Q

what are the indications for surgery in a patient with COPD

A

they have upper lobe-predominant emphysema
FEV1 >20% predicted
paCO2 <7.3 kPa
TLCO >20% predicted

147
Q

what are the indications for BiPAP ventilation?

A

COPD with respiratory acidosis pH 7.25-7.35
Type II respiratory failure secondary to chest wall deformity, OSA, neuromuscular disease
cardiogenic pulmonary oedema unresponsive to CPAP

148
Q

what are the features of Kartagener’s syndrome?

A

dextrocardia
bronchiectasis
recurrent sinusitis
subfertility

149
Q

what is the admission criteria for asthma exacerbation?

A

Any life-threatening features
features of severe acute asthma
previous near fatal asthma, pregnancy

150
Q

what is the stepwise management of asthma exacerbation

A

start patient on oxygen 15L non re-breathable mask if hypoxaemic.
Bronchodilation with SABA
Corticosteroid 40-50 mg of prednisolone.
Ipratropium bromide
IV Magnesium sulphate
IV Aminophylline

151
Q

how does asbestosis present on CT chest? What is the best management to improve prognosis.

A

Intralobular, small, rounded and branching opacities; thickened interlobular septa; pleural plaques.

Patients should be advised to stop smoking.

152
Q

what are the guidelines for reducing inhaled steroid dose in asthma?

A

reduce dose by 25-50% at a time and consider stepping down treatment every 3 months or so.

153
Q

what patients with COPD are candidates for LTOT?

A

pO2 < 7.3 kPa
pO2 of 7.3-8 kPa and one of
secondary polycythaemia
peripheral oedema
pulmonary hypertension

154
Q

when are patients having COPD exacerbations considered for antibiotics? What medications are used?

A

purulent sputum / clinical signs of pneumonia

medications include : amoxicillin, clarithromycin, doxycycline

155
Q

what is coal worker’s pneumoconiosis ?

A

Sometimes referred to as ‘’ black lung’s disease’’.
It is prevalent in populations with higher levels of exposure.
Upper lobe fibrosis and restrictive picture on lung function tests.

156
Q

what are the risk factors for aspiration pneumonia?

A

Poor dental hygiene
swallowing difficulties
prolonged hospitalization / surgical procedures
impaired consciousness / muco-ciliary clearance

157
Q

what are oxygen targets in a patient with COPD ?

A

CO2 normal : 94-98
otherwise 88-92

158
Q

what features of an aspirate suggest empyema?

A

Turbid effusion with pH<7.2, Low glucose, High LDH

159
Q

what are 2 complications of Klebsiella pneumonia?

A

lung abscess
empyema

160
Q

how do you confirm correct placement of NG Tube?

A

if pH < 5.5 on aspirate

161
Q

what is the action of bupropion ?

A

Norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist.

162
Q

what is the action of varinecline

A

Nicotinic receptor partial agonist

163
Q

what is silicosis ? what are it’s features?

A

fibrosing lung condition caused by inhalation of fine particles in occupations like mining, slate works, foundries, potteries.
features include : upper zone fibrosing lung disease
egg shell calcification of hilar lymph nodes

164
Q

what are the contraindications for chest drain insertion ?

A

INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions

165
Q

what are the complications of chest drain insertion ?

A

Failure of insertion
bleeding
infection
penetration of the lung
re-expansion pulmonary oedema

166
Q

what are the causes and symptoms of a lung abscess? what is the management ?

A

causes include :
Staph. aureus
Klebsiella pneumonia
Pseudomonas aeruginosa

symptoms are similar to pneumonia but fever, productive cough, chest pain and foul smelling sputum are key features.

Management includes :
IV Abx
percutaneous drainage

167
Q

what conditions cause obstructive picture ?

A

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

168
Q

what conditions present as restrictive ?

A

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity

169
Q

what is the management of COPD patient who is not tolerating LABA + LAMA + ICS

A

Oral theophylline

170
Q

what can be used to guide need for antibiotic therapy in patients with acute bronchitis ? what is the recommended therapy ?

A

systemically unwell
pre-existing co-morbidities
CRP of 20-100

doxycycline recommended

171
Q

what medication is used the prophylactic management of pneumocystic jirovecci

A

co-trimoxazole

172
Q

what is the definition of pulmonary HTN

A

MAP > 20 mm Hg

173
Q

what is the triad seen in Lofgrens syndrome

A

erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia

174
Q

What blood test finding is an indication for urgent investigation for lung cancer?

A

raised platelets

175
Q

what features are seen in yellow nail syndrome

A

yellow nails
bronchiectasis
lymphoedema

176
Q

what common abx causes pulmonary fibrosis

A

nitrofurantoin

177
Q

whats a contraindication to anti embolism stockings

A

PAD

178
Q

operation for OSA

A

Uvulopalatopharyngoplasty

179
Q

what pneumonia is associated with erythema multiforme

A

mycoplasma pneumoniae

180
Q

what is the management of latent TB

A

3 months of isoniazid ( with pyridoxine) and rifampicin OR
6 months of isoniazid ( with pyridoxine)

181
Q

what is the main technique used to diagnose latent TB

A

Mantoux test

182
Q

what is the most common form of asbestosis related disease ? How are they managed

A

pleural plaques
no follow up is required

183
Q

which type of pneumonia commonly occurs after influenza

A

staph aureus

184
Q

how does legionella pneumonia present

A

bilateral, mid to lower zone patchy consolidation especially if there is a history of possible contaminated water or soil exposure

decrease in lymphocytes
hyponatraemia
deranged liver function tests
flu like symptoms

185
Q

what are the features of mycoplasma pneumonia? what are its complications ?

A

Prolonged and gradual onset, flu-like symptoms classically precede a dry cough.
bilateral consolidations on x-ray
complications = haemolytic anaemia, thrombocytopenia, erythema, meningoencephalitis.,, pericarditis

186
Q

what are the investigations performed for mycoplasma pneumonia

A

mycoplasma serology, positive cold agglutination test- peripheral blood smear showing red blood cell agglutination

187
Q

how is mycoplasma pneumoniae managed

A

doxycycline /macrolide

188
Q

give the stepwise management of asthma

A

SABA
SABA + ICS
SABA + ICS + LRTA
swap LRTA for LABA
swap ICS/ LABA for MART

189
Q

What is an LRTA

A

Leukotriene receptor antagonist-montelukast

190
Q

what is the stepwise management of COPD with diurnal variation

A

SABA or SABA
LABA + Inhaled ICS
add LAMA

191
Q

Pneumonia, peripheral blood smear showing red blood cell agglutination

A

Mycoplasma pneumonia

192
Q

what is the management of patients with acute asthma who do not respond to full medical treatment

A

intubation and ventilation

193
Q

most common organism causing infective exacerbation of COPD

A

H influenzae

194
Q

Consider referring children with bronchiolitis to hospital if they have any of the following:

A

resp rate > 60
difficulty with breastfeeding / inadequate oral fluid intake
clinical dehydration

195
Q

what antibiotic prophylaxis is offered to COPD patients

A

azithromycin

196
Q

Aspergilloma

A

Often past history of tuberculosis.
Haemoptysis may be severe
Chest x-ray shows rounded opacity

197
Q

Granulomatosis with polyangiitis

A

Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity

198
Q

Mitral stenosis

A

Dyspnoea
Atrial fibrillation
Malar flush on cheeks
Mid-diastolic murmur

199
Q

If a pleural effusion fluid protein/serum protein ratio is >0.5

A

exudate

200
Q

what is the surgical management of A1AT

A

lung volume reduction surgery

201
Q

signs of chlamydia psittaci

A

unilateral crepitations and vesicular breathing
abdomen : hepatomegaly , splenomegaly

202
Q

Treatment of chlamydia psittaci

A

doxycycline
erythromycin

203
Q

management of pneumonia according to CURB score

A

first line : amoxicillin
moderate/ high severity : beta-lactamase stable penicillin such as co-amoxiclav and macrolide

204
Q

an improvement of _________ in FEV1 or more suggests asthma on reversibility testing

A

12%

205
Q

FeNO positive for asthma

A

in adults level of >= 40 parts per billion (ppb) is considered positive
in children a level of >= 35 parts per billion (ppb) is considered positive

206
Q

action of varenicline

A

Nicotinic receptor partial agonist

207
Q

recurrent pneumothorax

A

video-assisted thoracoscopic surgery (VATS)

208
Q

Emphysema is most prominent in _______ in A1AT and ________ in COPD

A

lowerlobes - A1AT
upper lobes - COPD

209
Q

Causes of a raised TLCO

A

Asthma, vasculitis

210
Q

causes of lower TLCO

A

pulmonary fibrosis, pneumonia, pulmonary oedema , emphysema

211
Q

trachea position in =
pleural effusion
lung collapse

A

pleural effusion - away
lung collapse = towards

212
Q

most common cause of exudate pleural effusion

A

pneumonia

213
Q

detection of occupational asthma

A

serial peak flow measurements at work and at home

214
Q

lower zone fibrosis acronym

A

A - asbestos.
C - connective tissue diseases.
I - idiopathic pulmonary fibrosis.
D - drugs e.g. methotrexate, nitrofurantoin.

215
Q

mx of SCLC

A

combination of chemo and radio

216
Q

Trachea pulled toward the white-out

A

Pneumonectomy
Complete lung collapse e.g. endobronchial intubation
Pulmonary hypoplasia

217
Q

Trachea pushed away from the white-out

A

Pleural effusion
Diaphragmatic hernia
Large thoracic mass

218
Q

Trachea central

A

Consolidation
Pulmonary oedema (usually bilateral)
Mesothelioma

219
Q

indications for corticosteroid treatment in sarcoidosis

A

parenchymal lung disease
uveitis
hypercalcaemia
neurological / cardiac involvement

220
Q

allergic bronchopulmonary aspergillosis mx

A

oral prednisolone

221
Q

Extrinsic allergic alveolitis

A

hypersensitivity induced lung damage due to a variety of inhaled organic particles.

222
Q

causes of EAA

A

malt
mushroom
farmer
fly ( bird)

223
Q

ivg for EAA

A

fibrosis, lymphocytosis and IgA
blood - no eosinophilia

224
Q

management of EAA

A

avoiding precipitating factors

225
Q

medications that slow the progress of pulmonary fibrosis

A

pirfenidone and nintedanib

226
Q

medications causing pulmonary fibrosis

A

Amiodarone
cyclophosphamide
methotrexate
nitrofurantoin

227
Q

presentation of pulmonary HTN

A

tachycardia
raised JVP
Hepatomegaly
Peripheral oedema

228
Q

causes of pulmonary HTN

A

primary pulmonary HTN
left sided HF
Chronic lung disease
PE
sarcoidosis

229
Q

ECG changes seen in pulmonary HTN

A

RVH
Right axis deviation
RBBB

230
Q

CXR signs of pulmonary HTN

A

dilated pulmonary veins
right ventricular hypertrophy

231
Q

blood marker of pulmonary HTN

A

NT-PRO BNP

232
Q

what are granulomas

A

nodules of inflammation full of macrophages

233
Q

surgical mx of OSA

A

uvulopalatopharyngoplasty PPP

234
Q

key morning symptom in OSA

A

morning headache

235
Q

d dimer can also be positive in :

A

pneumonia
malignancy
surgery
pregnancy

236
Q

mx of pe in pregnancy

A

LMWH

237
Q

mx of massive pulmonary embolism

A

continuous infusion of unfractionated heparin and consider thrombolysis

238
Q

iatrogenic causes of Pneumothorax

A

lung biopsy
mechanical ventilation
central line insertion

239
Q

main Ivx for pneumothorax

A

erect CXR

240
Q

triangle of safety

A

5th intercostal space
mid-axillary line
anterior axillary line

241
Q

management of tension pneumo

A

4/5th intercostal space, anterior to mid axillary line - needle decompression - remember 2nd intercostal space

242
Q

Pulmonary hypertension is defined as

A

mean pulmonary arterial pressure of more than 20  mmHg

243
Q

Idiopathic pulmonary hypertension may be treated with:

A

Calcium channel blockers
Intravenous prostaglandins (e.g., epoprostenol)

244
Q
A

SBA passmed Flashcards (30 decks)

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