resp Flashcards
1
Q
how does small cell lung cancer cause paraneoplastic syndromes
A
cell contains neurosecretory granules that can release neuroendocrine hormones leading to paraneoplastic syndromes
2
Q
sx lung cancer
A
sob
cough
haemoptysis
clubbing
recurrent pneumonia
wt loss
supraclavicular lymphadenopathy
3
Q
CXR findings lung cancer
A
hilar enlargement
peripheral opacity
pleural effusion
collapse
4
Q
ix lung cancer
A
CXR
CT chest abdo pelvis
PET-CT
bronchoscopy with bronchial US
histology
5
Q
mx non small cell lung cancer
A
surgery
radiotherapy
+/- chemo
6
Q
mx small cell lung cancer
A
worse prognosis
chemo and radio
7
Q
extrapulmonary manifestations lung cancer
A
recurrent laryngeal nerve palsy
phrenic nerve palsy
SVC ostruction
horners syndrome
SIADH
cushings
increased ca
limbic encephalitis
lambert eaton myasthenic syndrome
8
Q
what does recurrent laryngeal nerve palsy cause
A
hoarse voice
9
Q
what does phrenic nerve plasy cause
A
weak diaphragm-> sob
10
Q
features SVC obstruction
A
facial swelling, sob, distended neck veins
pembertons sign: raising hands over head leads to facial congestio and cyanosis
11
Q
cause of horners syndrome in lung cancer
A
pancoast tumour on sympathetic ganglion
12
Q
features horners syndrome
A
partial ptosis
anydrosis
miosis
13
Q
how does sclc cause siadh
A
ca releases ectopic ADH ->hygponatraemia
14
Q
how does sclc cause cushings
A
ca releases ectopic acth
15
Q
how does lung ca increase calcium
A
squamous cell carcinoma releases ectopic pth
16
Q
how does sclc cause limbic encephalitis
A
ca makes ab (anti-hu) to limbic system -> memory impairment, hallucinations, confusion, seizures
17
Q
how does sclc lead to lambert eaton myasthenic syndrome
A
ab made against sclc which attack body
18
Q
what is mesothelioma
A
pleura ca
19
Q
cause mesothelioma
A
asbestos
20
Q
mx mesothelioma
A
palliative chemo
21
Q
pneumonia features
A
SOB, cough and sputum, fever, haemoptysis, pleuritic chest pain, delirium, sepsis
O/E: tachy HR and RR, low oxygen, fever, bronchail breath sounds, focal course crackles, dull percussion
22
Q
CXR pneumonia
A
consolidation
23
Q
CURB 65
A
see if need hospital for pneumonia
C=confusion
U=urea >7
R= RR>/= 30
B = BP <90 systolic or </= 60 diastolic
65 = age >/=
24
Q
CURB 65 interpretation
A
0/1=home
2=hosp
3=ICU assess
25
CURB 65 in community
CRB 65 (no urea)
26
common causes pneumonia
50% = strep pneumoniae
20% = h.influenza
27
causes pneumonia in CF
moraxella catarrhalis
psesudomonas
staph aureus
28
what is atypical pneumonia
cant culture with gram stain, dont respond to penicillin
need macrolides/fluroquines/tetracyclines
29
organisms causing atypical pneumonia
legionella pneumophillia=legionnaires: from water/aircon, have hyponatraemia
chlamydia psittaci: infected birds
mycoplasma pneumonia: erthema multiforme-target lesions
chlamydia pneumophillia
coxiella burnetti: Q-fever, animal exposure
30
atypical pneumoniea from aircon/water
legionnaires
31
atypical pneumonia from infected birds
chlamydia psittaci
32
atypical pneumonia causing erythema multiforme target lesions
mycoplasma pneumoniae
33
atypitcal pneumonia from animal exposure
coxiella burnetti
34
atypical pneumonia causing hyponatraemia
legionella pneumophillia
35
fungal causes pneumonia
pneumocystis jiroveci
36
cause pneumonia in bronchiectasis
pseudomonas aeruginosa
37
tx fungal pneumonia
co-trimoxazole
38
abx for mild pnuemonia
5d oral amoxicillin or macrolide
39
abx mod/sev pneumonia
7-10d dual amox and macrolide
40
complications pneumonia
sepsis
pleural effusion
empyema
lung abscess
death
41
ix findingd obstructive lung disease
FEV1:FVC ration <75%
42
differentiating brtween causes obstructive lung disease
reversibilty testing with broncbodilator
reversibility on asthma not copd
43
causes restrictive lung disease
intersitital disease (pulmonary fibrosis)
sarcoidosis
obesity
MND
scoliosis
44
ix findings restrictive lung disease
FEV1:FVC ration >75%
reduced FVC
45
peak flow technique
stand tall
deep breath
good seal
blow hard and fast
best of 3
46
what is asthma
reversible airways obstruction
bronchoconstriction
47
sx asthma
episodic
worse at night
dry cough
wheeze and sob
atopy hx
fhx
bilateral widespread polyphonic wheeze
48
common asthma triggers
infection
exercise
cold
dust
strong emotiions
49
diagnosis asthma
clinical
reversibility testing and spirometry
fractional exhaled NO
peak flow diary for 2-4w
50
mx asthma according to BTS/SIGN
1. Short-acting beta-2 agonist inhaler (e.g. salbutamol) as required
2. Inhaled corticosteroid (low dose) e.g. beclometasone
3. Long-acting beta-2 agonists (e.g., salmeterol) or maintenance and reliever therapy (MART)
4. Increase the inhaled corticosteroid or add a leukotriene receptor antagonist (e.g., montelukast)
5. Specialist management (e.g., oral corticosteroids)
51
NICE mx chronic asthma
1. Short-acting beta-2 agonist inhaler (e.g. salbutamol) as required
2. Inhaled corticosteroid (low dose) taken regularly
3. Leukotriene receptor antagonist (e.g., montelukast) taken regularly
4. Long-acting beta-2 agonists (e.g., salmeterol) taken regularly
5. Consider changing to a maintenance and reliever therapy (MART) regime
6. Increase the inhaled corticosteroid to a moderate dose
7. Consider high-dose inhaled corticosteroid or additional drugs (e.g., LAMA or theophylline)
8. Specialist management (e.g., oral corticosteroids)
52
features moderate acute asthma
PEFR 50-75%
53
features sev acute asthma
PEFR 33-50%
RR>25
HR>110
cant complete full sentences
54
features life threatening asthma
PEFR <33%
sats <92%
silent chest
tired
haemodynamically unstable
ABG=normal pCO2/hypoxia
55
mx moderate acute asthma
nebulised salbutamol
nebulised ipratropium bromide
oral pred or hydrocortisone
+/- abx
56
mx severe acute asthma
+/- oxygen
nebulised salbutamol
nebulised ipratropium bromide
aminophylline infusion
IV salbutamol
57
mx severe acute asthma
nebulised salbutamol
nebulised ipratropium bromide
aminophylline infusion
IV salbutamol
Iv magnesium sulphate
HDU/ICU
intubation
58
what to monitor when on salbutamol neb
K
also increases HR
59
what is COPD
chronic non-reversible obstruction
60
sx COPD
chromic sob
cough
sputum
wheeze
recurrent chest infections
reduced TLCO
polycythaemia due to hypoxia
61
MRC breathlessness scale
1. strenuous exercise
2. walking up hill
3. walking on flat
4. stop after 100m flat
5. unable to leave house
62
severity obstruction COPD
1. FEV1 >80%
2. FEV1 50-79%
3. FEV1 30-49%
4. FEV1 <30%
63
mx COPD
1. SABA or ipratropium bromide
2. if not steroid responsive=LABA+LAMA, steroid responsive=LABA+ICS
3. nebs, oral theophylline, oral mucolytics-carbousteine, abx-azithromycin, oxygen
64
cause of copd exacerbation
often infection
65
mx copd exacerbation
nebulised salbutamol/ipratropium
steroids (pred)
abx
physio
66
ABG of acute retainer in COPD
low pH, high co2
67
ABG chronic retainer COPD
normal pH
high bicarb
68
oxygen in chronic retainer copd
titrate sats to 88-92%
not too much oxygen as depresses resp drive
69
what is BiPAP
helps with inspiration and expiration
70
uses BiPAP
T2RF with low pH and co2 over 6
71
Ci BiPAP
untx pemothorax
72
what is CPAP
helps keep airways expanded
73
uses CPAP
obstructive sleep apnoea
congestive HF
acute pulmonary oedema
74
what is interstitial lung disease
effects parenchyma->inflammation and fibrosis
75
ix interstitial lung disease
high resolution CT=ground glass
lung biopsy and histology
76
sx idiopathic pulmonary fibrosis
sob
dry cough
clubbing
bibasal fine crackles
poor prognosis
77
mx idiopathic pulmonary fibrosis
pirifenidone: antifibrotic and antiinflammatory
nintedanib: monoclonal ab to tyrosine kinase
78
causes drug induced pulmonary fibrosis
amiodarone
cyclophosphamide
methotrexate
nitrofurantoin
79
causes secondary pulmonary fibrosis
alpha 1 antitrypsin deficiency
RA
SLE
systemic sclerosis
80
what is hypersensitivity pneumonitis
extrinsic allergic alveolitis
type 3 hypersensitivity rxn
81
ix hypersensitivity pneumonitis
bronchoalveolar lavage=increased lymphocytes and mast cells
82
causes hypersensitivity pneumonitis
bird fanciers=droppings
farmers=moulder hay
83
mx hypersensitivity pneumonitis
remove allergen
+/- oxygen
+/- steroids
84
what is cryptogenic organising pneumonia
bronchiolitis obliterans organising pneumonia
85
causes bronchiolitis obliterans organising pneumonia
idiopathic
infection
inflammation
medication
allergic
86
ix cryptogenic organising pneumonia
lung biopsy
87
features cryptogenic organising pneumonia
SOB
cough
fever lethargy
88
what does asbestos lead to
fibrogenic and oncogenic
fibrosis, pleural thickening and plaques, adenocarcinoma, mesothelioma
89
types pleural effusion
exudative: protein >3
transudative: protein <3
90
causes exudative pleural effusion
lung ca
pneumonia
RA
TB
91
causes transudative pleural effusion
congestive HF
hypoalbuminaemia
hypothyroid
meigs syndrome
92
sx pleural effusion
sob
dull percussion
decreased breath sounds
tracheal deviation away
93
CXR in pleural effusion
blunted costophrenic angle
fluid in lung fissures
94
mx pleural effusion
conservative if small
pleural aspiration
chest drain
95
what is empyema
infected pleural effusion
96
ix empyema
pleural aspiration=pus, pH
97
mx empyema
chest drain and abx
98
what is pneumothorax
air in pleural space
99
causes pneumothorax
spontaenous
trauma
iatrogenic: biopsy, venilation
infection
asthma
100
ix pneumothorax
CXR
101
sx pneumothorax
sudden SOB
pleuritc chest pain
102
mx pneumothorax
if no sob and <2cm=none
aspiration
if unstable=chest drain
103
what is a tension pneumothorax
air can only enter not leave, keeps increasing
104
features tension pneumothorax
tracheal deviation
reduced air entry
hyperresonant percussion
increased HR
decreased BP
105
mx tension pneumothorax
large bore cannula into 2nd IC soace midclavicular line then chest drain
106
chest drain triangle of safety
5th IC space
mid axillary line
ant axillary line
just above rib
107
sx PE
SOB
cough +/- haemoptysis
pleuritic chest pain
hypoxia
increased HR and RR
low grade fever
haemodynamic instability-reduced BP
108
ABG in PE
resp alkalosis
109
mx PE
wells score
if unlikey do a d-dimer if positive then ctpa
if likely then ctpa
LMWH (dalteparin) then long term anticoag
110
long term anticoag after PE
3m if obvious cause and reversible
6m if recurrent/unsure
6m in ca
111
mx massive PE with haenodynamic compromise
thrombolysis - alteplase, streptokinase
112
types pulmonary HTN
1. primary or connective tissue disease (SLE)
2. LHF-MI, HTN
3. chronic lung disease - COPD
4. pulmonary vascular disease-PE
5. other - sarcoidosis, glycogen storage, haem
113
features pulmonary HTN
SOB
increased HR
syncope
increased JVP
hepatomegaly
oedema
114
ECG pulmonary HTN
RVH (large RV1, SV4-6)
R axis deviation
RBBB
115
CXR pulmonary HTN
dilated PA
RVH
116
ix pulmonary HTN
ECG
CXR
increased NT-proBNF
echo
117
mx pulmonary HTN
IV prostanoids (epoprostinol)
endothelin receptor antagonists (macifentan)
phosphodiesterase type 5 inhibitors (sildenafil)
118
what is sarcoidosis
granulomatous inflammation
119
RF sarcoidosis
young adults or 60y
F
black
120
lung features sarcoidosis
mediastinal lymphadenopathy
pulmonary fibrosis
pulmonary nodules
121
systemic features sarcoidosis
fever
fatigue
wt loss
122
liver features sarcoidosis
nodules
cirrhosis
cholestasis
123
eye features sarcoidosis
uveitis
conjunctivitis
optic neuritis
124
skin features sarcoidosis
erythema nodosum
lupus pernio
granuloma
125
cardiac features sarcoidosis
BBB
heart block
126
renal features sarcoidosis
stones
nephrocalcinosis
nephritis
127
CNS features sarcoidosis
nodules
pituitary
encephalopthy
128
PNS features sarcoidosis
bells palsy
mononeuritis multiplex
129
bone features sarcoidosis
arthralgia
arthritis
myopathy
130
lofgrens
erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia
131
ix sarcoidosis
bloods: increased ACE, increased ca, increased IL2 receptor, increased CRP, increased Ig
CXR
biopsy and histology
132
CXR sarcoidosis
hilar lymphadenopathy
133
histology sarcoidosis
non caseating granuloma with epithelioid cells
134
mx sarcoidosis
resolves spontaneously
oral steroids
methotrexate
azathioprine
135
what may sarcoidosis progress to
pulmonary fbrosis
pulmonary HTN
136
features obstructuve sleep apnoea
apnoea in sleep
snoring
morning headache
unrefreshing sleep
daytime sleepiness
reduced concentration
low oxygen sats in sleeo
137
what can obstructive sleep apnoea cause
HTN
HF
MI
stroke
138
ix obstrucitve sleep apnoea
sleep studis
139
mx obstrucitve sleep apnoea
reduce RF - wt, alcohol, smoking
CPAP
surgery
140
features chronic retainer COPD
increased carbon dioxide and bicarb and normal pH on ABG
141
oxygen sats goal chronic retainer COPD
88-92%
142
oxygen sats goal in someone with COPD who doesnt chronicly retain
normal goal
143
vaccines for people with COPD
pneumococcal one off
annual influenza
144
Wells PE criteria
clinical signs or symptoms DVT=3pt
PE number one diagnosis = 3pt
HR>100 = 1.5pt
immobilisation >/=3d or surgery in prev 4 weeks =1.5pt
prev PE/DVT = 1.5pt
haemoptysis = 1pt
malignancy with tx within 6m or palliative =1pt
145
interpretation wells PE
0-4=unlikely, do d-dimer, if raised ctpa
4+ = likely do do ctpa
146
saddle PE
important to recognise as leads to RHF and death
large, straddles bifurcation of pulmonary trunk
147
complete occlussion PE
completely blocks artery
148
segmental PE
affects distal arterial branches
149
chronic PE
peripheral not central
150
silhouette sign CXR
loss usual clear differentiation
151
L lower lobe collapse features CXR
sail sign=double L heart border
152
R upper lobe collapse features CXR
horizontal fissure and R diaphragm shifted up
153
R lower lobe collapse features CXR
double R heart border
154
L upper lobe collapse features CXR
veil over L upper lobe and L diaphragm shifted up
155
R middle lobe collapse features CXR
lost R heart border
156
R middle and lower lobe collapse features CXR
lost R heart border and R hemidiaphragm
157
causes lobar collapse
paeds: snot, foreign body
adults: cancer, infection, snot
158
effusion with pH <7.2
empyema
159
features pneumothorax CXR
can see a lung edge
too black
lung markings not to edge
160
features bullous emphysema CXR
no lung edge
too black
no lung markings
is chronic change usualy due to smoking
161
pulmonary mets CXR
multiple bilateral soft tissue nodules
162
abscess or cavitating tumout features CXR
solitary well circumscribed lesion dense in middle then white around it
163
commonest cause HAP
aerobic gram negative bacilli - pseudomonas aeruginosa, klebsiella pneumoniae
164
commonest cause COPD exacerbation
h. influenzae
165
CXR TB
patchy nodal shadows
cavitating lesions
air space consolidations
nodules
166
how to check if TB rifampicin resistant
molecular assay
167
how does rifampicin work
inhibits DNA transcription
168
how does isoniazid work
inhibits synthesis cell wall
169
how does pyrazinamide work
lowers intracellular pH - disrupting synthesis fattu acids
170
how does ethambutol work
interferes with cell wall synthesis
