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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

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2
Q

sx lung cancer

A

sob
cough
haemoptysis
clubbing
recurrent pneumonia
wt loss
supraclavicular lymphadenopathy

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3
Q

CXR findings lung cancer

A

hilar enlargement
peripheral opacity
pleural effusion
collapse

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4
Q

ix lung cancer

A

CXR
CT chest abdo pelvis
PET-CT
bronchoscopy with bronchial US
histology

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5
Q

mx non small cell lung cancer

A

surgery
radiotherapy
+/- chemo

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6
Q

mx small cell lung cancer

A

worse prognosis
chemo and radio

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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

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8
Q

what does recurrent laryngeal nerve palsy cause

A

hoarse voice

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9
Q

what does phrenic nerve plasy cause

A

weak diaphragm-> sob

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10
Q

features SVC obstruction

A

facial swelling, sob, distended neck veins
pembertons sign: raising hands over head leads to facial congestio and cyanosis

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11
Q

cause of horners syndrome in lung cancer

A

pancoast tumour on sympathetic ganglion

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12
Q

features horners syndrome

A

partial ptosis
anydrosis
miosis

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13
Q

how does sclc cause siadh

A

ca releases ectopic ADH ->hygponatraemia

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14
Q

how does sclc cause cushings

A

ca releases ectopic acth

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15
Q

how does lung ca increase calcium

A

squamous cell carcinoma releases ectopic pth

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16
Q

how does sclc cause limbic encephalitis

A

ca makes ab (anti-hu) to limbic system -> memory impairment, hallucinations, confusion, seizures

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17
Q

how does sclc lead to lambert eaton myasthenic syndrome

A

ab made against sclc which attack body

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18
Q

what is mesothelioma

A

pleura ca

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19
Q

cause mesothelioma

A

asbestos

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20
Q

mx mesothelioma

A

palliative chemo

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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

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22
Q

CXR pneumonia

A

consolidation

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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 >/=

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24
Q

CURB 65 interpretation

A

0/1=home
2=hosp
3=ICU assess

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25
Q

CURB 65 in community

A

CRB 65 (no urea)

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26
Q

common causes pneumonia

A

50% = strep pneumoniae
20% = h.influenza

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27
Q

causes pneumonia in CF

A

moraxella catarrhalis
psesudomonas
staph aureus

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28
Q

what is atypical pneumonia

A

cant culture with gram stain, dont respond to penicillin
need macrolides/fluroquines/tetracyclines

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29
Q

organisms causing atypical pneumonia

A

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

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30
Q

atypical pneumoniea from aircon/water

A

legionnaires

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31
Q

atypical pneumonia from infected birds

A

chlamydia psittaci

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32
Q

atypical pneumonia causing erythema multiforme target lesions

A

mycoplasma pneumoniae

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33
Q

atypitcal pneumonia from animal exposure

A

coxiella burnetti

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34
Q

atypical pneumonia causing hyponatraemia

A

legionella pneumophillia

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35
Q

fungal causes pneumonia

A

pneumocystis jiroveci

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36
Q

cause pneumonia in bronchiectasis

A

pseudomonas aeruginosa

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37
Q

tx fungal pneumonia

A

co-trimoxazole

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38
Q

abx for mild pnuemonia

A

5d oral amoxicillin or macrolide

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39
Q

abx mod/sev pneumonia

A

7-10d dual amox and macrolide

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40
Q

complications pneumonia

A

sepsis
pleural effusion
empyema
lung abscess
death

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41
Q

ix findingd obstructive lung disease

A

FEV1:FVC ration <75%

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42
Q

differentiating brtween causes obstructive lung disease

A

reversibilty testing with broncbodilator
reversibility on asthma not copd

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43
Q

causes restrictive lung disease

A

intersitital disease (pulmonary fibrosis)
sarcoidosis
obesity
MND
scoliosis

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44
Q

ix findings restrictive lung disease

A

FEV1:FVC ration >75%
reduced FVC

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45
Q

peak flow technique

A

stand tall
deep breath
good seal
blow hard and fast
best of 3

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46
Q

what is asthma

A

reversible airways obstruction
bronchoconstriction

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47
Q

sx asthma

A

episodic
worse at night
dry cough
wheeze and sob
atopy hx
fhx
bilateral widespread polyphonic wheeze

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48
Q

common asthma triggers

A

infection
exercise
cold
dust
strong emotiions

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49
Q

diagnosis asthma

A

clinical
reversibility testing and spirometry
fractional exhaled NO
peak flow diary for 2-4w

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50
Q

mx asthma according to BTS/SIGN

A
  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)
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51
Q

NICE mx chronic asthma

A
  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)
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52
Q

features moderate acute asthma

A

PEFR 50-75%

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53
Q

features sev acute asthma

A

PEFR 33-50%
RR>25
HR>110
cant complete full sentences

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54
Q

features life threatening asthma

A

PEFR <33%
sats <92%
silent chest
tired
haemodynamically unstable
ABG=normal pCO2/hypoxia

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55
Q

mx moderate acute asthma

A

nebulised salbutamol
nebulised ipratropium bromide
oral pred or hydrocortisone
+/- abx

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56
Q

mx severe acute asthma

A

+/- oxygen
nebulised salbutamol
nebulised ipratropium bromide
aminophylline infusion
IV salbutamol

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57
Q

mx severe acute asthma

A

nebulised salbutamol
nebulised ipratropium bromide
aminophylline infusion
IV salbutamol
Iv magnesium sulphate
HDU/ICU
intubation

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58
Q

what to monitor when on salbutamol neb

A

K
also increases HR

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59
Q

what is COPD

A

chronic non-reversible obstruction

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60
Q

sx COPD

A

chromic sob
cough
sputum
wheeze
recurrent chest infections
reduced TLCO
polycythaemia due to hypoxia

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61
Q

MRC breathlessness scale

A
  1. strenuous exercise
  2. walking up hill
  3. walking on flat
  4. stop after 100m flat
  5. unable to leave house
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62
Q

severity obstruction COPD

A
  1. FEV1 >80%
  2. FEV1 50-79%
  3. FEV1 30-49%
  4. FEV1 <30%
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63
Q

mx COPD

A
  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
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64
Q

cause of copd exacerbation

A

often infection

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65
Q

mx copd exacerbation

A

nebulised salbutamol/ipratropium
steroids (pred)
abx
physio

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66
Q

ABG of acute retainer in COPD

A

low pH, high co2

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67
Q

ABG chronic retainer COPD

A

normal pH
high bicarb

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68
Q

oxygen in chronic retainer copd

A

titrate sats to 88-92%
not too much oxygen as depresses resp drive

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69
Q

what is BiPAP

A

helps with inspiration and expiration

70
Q

uses BiPAP

A

T2RF with low pH and co2 over 6

71
Q

Ci BiPAP

A

untx pemothorax

72
Q

what is CPAP

A

helps keep airways expanded

73
Q

uses CPAP

A

obstructive sleep apnoea
congestive HF
acute pulmonary oedema

74
Q

what is interstitial lung disease

A

effects parenchyma->inflammation and fibrosis

75
Q

ix interstitial lung disease

A

high resolution CT=ground glass
lung biopsy and histology

76
Q

sx idiopathic pulmonary fibrosis

A

sob
dry cough
clubbing
bibasal fine crackles
poor prognosis

77
Q

mx idiopathic pulmonary fibrosis

A

pirifenidone: antifibrotic and antiinflammatory
nintedanib: monoclonal ab to tyrosine kinase

78
Q

causes drug induced pulmonary fibrosis

A

amiodarone
cyclophosphamide
methotrexate
nitrofurantoin

79
Q

causes secondary pulmonary fibrosis

A

alpha 1 antitrypsin deficiency
RA
SLE
systemic sclerosis

80
Q

what is hypersensitivity pneumonitis

A

extrinsic allergic alveolitis
type 3 hypersensitivity rxn

81
Q

ix hypersensitivity pneumonitis

A

bronchoalveolar lavage=increased lymphocytes and mast cells

82
Q

causes hypersensitivity pneumonitis

A

bird fanciers=droppings
farmers=moulder hay

83
Q

mx hypersensitivity pneumonitis

A

remove allergen
+/- oxygen
+/- steroids

84
Q

what is cryptogenic organising pneumonia

A

bronchiolitis obliterans organising pneumonia

85
Q

causes bronchiolitis obliterans organising pneumonia

A

idiopathic
infection
inflammation
medication
allergic

86
Q

ix cryptogenic organising pneumonia

A

lung biopsy

87
Q

features cryptogenic organising pneumonia

A

SOB
cough
fever lethargy

88
Q

what does asbestos lead to

A

fibrogenic and oncogenic
fibrosis, pleural thickening and plaques, adenocarcinoma, mesothelioma

89
Q

types pleural effusion

A

exudative: protein >3
transudative: protein <3

90
Q

causes exudative pleural effusion

A

lung ca
pneumonia
RA
TB

91
Q

causes transudative pleural effusion

A

congestive HF
hypoalbuminaemia
hypothyroid
meigs syndrome

92
Q

sx pleural effusion

A

sob
dull percussion
decreased breath sounds
tracheal deviation away

93
Q

CXR in pleural effusion

A

blunted costophrenic angle
fluid in lung fissures

94
Q

mx pleural effusion

A

conservative if small
pleural aspiration
chest drain

95
Q

what is empyema

A

infected pleural effusion

96
Q

ix empyema

A

pleural aspiration=pus, pH</=7.2, low glucose, increased LDH

97
Q

mx empyema

A

chest drain and abx

98
Q

what is pneumothorax

A

air in pleural space

99
Q

causes pneumothorax

A

spontaenous
trauma
iatrogenic: biopsy, venilation
infection
asthma

100
Q

ix pneumothorax

A

CXR

101
Q

sx pneumothorax

A

sudden SOB
pleuritc chest pain

102
Q

mx pneumothorax

A

if no sob and <2cm=none
aspiration
if unstable=chest drain

103
Q

what is a tension pneumothorax

A

air can only enter not leave, keeps increasing

104
Q

features tension pneumothorax

A

tracheal deviation
reduced air entry
hyperresonant percussion
increased HR
decreased BP

105
Q

mx tension pneumothorax

A

large bore cannula into 2nd IC soace midclavicular line then chest drain

106
Q

chest drain triangle of safety

A

5th IC space
mid axillary line
ant axillary line

just above rib

107
Q

sx PE

A

SOB
cough +/- haemoptysis
pleuritic chest pain
hypoxia
increased HR and RR
low grade fever
haemodynamic instability-reduced BP

108
Q

ABG in PE

A

resp alkalosis

109
Q

mx PE

A

wells score
if unlikey do a d-dimer if positive then ctpa
if likely then ctpa
LMWH (dalteparin) then long term anticoag

110
Q

long term anticoag after PE

A

3m if obvious cause and reversible
6m if recurrent/unsure
6m in ca

111
Q

mx massive PE with haenodynamic compromise

A

thrombolysis - alteplase, streptokinase

112
Q

types pulmonary HTN

A
  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
Q

features pulmonary HTN

A

SOB
increased HR
syncope
increased JVP
hepatomegaly
oedema

114
Q

ECG pulmonary HTN

A

RVH (large RV1, SV4-6)
R axis deviation
RBBB

115
Q

CXR pulmonary HTN

A

dilated PA
RVH

116
Q

ix pulmonary HTN

A

ECG
CXR
increased NT-proBNF
echo

117
Q

mx pulmonary HTN

A

IV prostanoids (epoprostinol)
endothelin receptor antagonists (macifentan)
phosphodiesterase type 5 inhibitors (sildenafil)

118
Q

what is sarcoidosis

A

granulomatous inflammation

119
Q

RF sarcoidosis

A

young adults or 60y
F
black

120
Q

lung features sarcoidosis

A

mediastinal lymphadenopathy
pulmonary fibrosis
pulmonary nodules

121
Q

systemic features sarcoidosis

A

fever
fatigue
wt loss

122
Q

liver features sarcoidosis

A

nodules
cirrhosis
cholestasis

123
Q

eye features sarcoidosis

A

uveitis
conjunctivitis
optic neuritis

124
Q

skin features sarcoidosis

A

erythema nodosum
lupus pernio
granuloma

125
Q

cardiac features sarcoidosis

A

BBB
heart block

126
Q

renal features sarcoidosis

A

stones
nephrocalcinosis
nephritis

127
Q

CNS features sarcoidosis

A

nodules
pituitary
encephalopthy

128
Q

PNS features sarcoidosis

A

bells palsy
mononeuritis multiplex

129
Q

bone features sarcoidosis

A

arthralgia
arthritis
myopathy

130
Q

lofgrens

A

erythema nodosum
bilateral hilar lymphadenopathy
polyarthralgia

131
Q

ix sarcoidosis

A

bloods: increased ACE, increased ca, increased IL2 receptor, increased CRP, increased Ig
CXR
biopsy and histology

132
Q

CXR sarcoidosis

A

hilar lymphadenopathy

133
Q

histology sarcoidosis

A

non caseating granuloma with epithelioid cells

134
Q

mx sarcoidosis

A

resolves spontaneously
oral steroids
methotrexate
azathioprine

135
Q

what may sarcoidosis progress to

A

pulmonary fbrosis
pulmonary HTN

136
Q

features obstructuve sleep apnoea

A

apnoea in sleep
snoring
morning headache
unrefreshing sleep
daytime sleepiness
reduced concentration
low oxygen sats in sleeo

137
Q

what can obstructive sleep apnoea cause

A

HTN
HF
MI
stroke

138
Q

ix obstrucitve sleep apnoea

A

sleep studis

139
Q

mx obstrucitve sleep apnoea

A

reduce RF - wt, alcohol, smoking
CPAP
surgery

140
Q

features chronic retainer COPD

A

increased carbon dioxide and bicarb and normal pH on ABG

141
Q

oxygen sats goal chronic retainer COPD

A

88-92%

142
Q

oxygen sats goal in someone with COPD who doesnt chronicly retain

A

normal goal

143
Q

vaccines for people with COPD

A

pneumococcal one off
annual influenza

144
Q

Wells PE criteria

A

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
Q

interpretation wells PE

A

0-4=unlikely, do d-dimer, if raised ctpa
4+ = likely do do ctpa

146
Q

saddle PE

A

important to recognise as leads to RHF and death
large, straddles bifurcation of pulmonary trunk

147
Q

complete occlussion PE

A

completely blocks artery

148
Q

segmental PE

A

affects distal arterial branches

149
Q

chronic PE

A

peripheral not central

150
Q

silhouette sign CXR

A

loss usual clear differentiation

151
Q

L lower lobe collapse features CXR

A

sail sign=double L heart border

152
Q

R upper lobe collapse features CXR

A

horizontal fissure and R diaphragm shifted up

153
Q

R lower lobe collapse features CXR

A

double R heart border

154
Q

L upper lobe collapse features CXR

A

veil over L upper lobe and L diaphragm shifted up

155
Q

R middle lobe collapse features CXR

A

lost R heart border

156
Q

R middle and lower lobe collapse features CXR

A

lost R heart border and R hemidiaphragm

157
Q

causes lobar collapse

A

paeds: snot, foreign body
adults: cancer, infection, snot

158
Q

effusion with pH <7.2

A

empyema

159
Q

features pneumothorax CXR

A

can see a lung edge
too black
lung markings not to edge

160
Q

features bullous emphysema CXR

A

no lung edge
too black
no lung markings
is chronic change usualy due to smoking

161
Q

pulmonary mets CXR

A

multiple bilateral soft tissue nodules

162
Q

abscess or cavitating tumout features CXR

A

solitary well circumscribed lesion dense in middle then white around it

163
Q

commonest cause HAP

A

aerobic gram negative bacilli - pseudomonas aeruginosa, klebsiella pneumoniae

164
Q

commonest cause COPD exacerbation

A

h. influenzae

165
Q

CXR TB

A

patchy nodal shadows
cavitating lesions
air space consolidations
nodules

166
Q

how to check if TB rifampicin resistant

A

molecular assay

167
Q

how does rifampicin work

A

inhibits DNA transcription

168
Q

how does isoniazid work

A

inhibits synthesis cell wall

169
Q

how does pyrazinamide work

A

lowers intracellular pH - disrupting synthesis fattu acids

170
Q

how does ethambutol work

A

interferes with cell wall synthesis

finals (31 decks)

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