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Year 6 > Resp > Flashcards

Resp Flashcards

1
Q

name 4 obstructive lung diseases

A

Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans

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2
Q

name 7 restrictive lung diseases

A

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

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3
Q

What does FEV represent

A

how much air you force out in one second

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4
Q

What does FVC represent

A

how much air you can exhale in a single breathe, kinda like air capacity of the lungs

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5
Q

how is FEV/FVC changed in restrictive disease

A

> 75 i.e. normal or increased

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6
Q

how is FEV/FVC changed in obstructive disease

A

<75

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7
Q

how is FEV changed in restrictive disease

A

reduced

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8
Q

how is FVC changed in restrictive disease

A

significantly reduced

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9
Q

how is FEV changed in obstructive disease

A

significantly reduced

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10
Q

how is FVC changed in obstructive disease

A

normal

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11
Q

3 systems involved in Granulomatosis with polyangiitis

A

ENT
resp
kidney

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12
Q

what is the most common organism isolated in patients with bronchiectasis?

A

Haemophilus influenzae (most common)

Pseudomonas aeruginosa

Klebsiella spp.

Streptococcus pneumoniae

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13
Q

what is the prognosis for sarcoidosis?

A

The majority of patients with sarcoidosis get better without treatment
Most only require symptomatic treatment in the form of nonsteroidal anti-inflammatory drugs

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14
Q

what is the diagnostic test for asthma in adults and children?

A

FeNO test and spirometry with reversibility

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15
Q

when should BiPAP be started in COPD [4]

A

COPD with respiratory acidosis pH 7.25-7.35

type II respiratory failure

cardiogenic pulmonary oedema unresponsive to CPAP

weaning from tracheal intubation

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16
Q

admission criteria for acute asthma [5]

A
  • life threatening asthma
  • previous near fatal asthma attack
  • severe asthma that fails to respond to initial medical treatment
  • severe asthma in a pregnant woman
  • an attack occurring despite already using oral corticosteroid and presentation at night
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17
Q

which type of lung cancer is most common?

A

adenocarcinomas

seen in smokers

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18
Q

which lung cancer has the worst prognosis?

A

small cell lung cancer

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19
Q

which lung cancer is characterised by cavitating lesions?

A

squamous cell carinoma

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20
Q

which lung cancer can have Lambert-Eaton syndrome as a paraneoplastic feature?

how will this present?

A

small cell lung cancer

muscle weakness

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21
Q

how often should asthma treatment be stepped down?

How much should the steroid component be reduced?

A

every 3 months or so

When reducing the dose of inhaled steroids the BTS advise us to do this by 25-50% at a time.

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22
Q

which resp infection in common in alcoholics as well as diabetics ?

A

klebsiella

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23
Q

what is the colour of the sputum in klebsiella infection?

A

red currant jelly

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24
Q

what conditions is Klebsiella associated with?

A

lung abscess
empyema

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25
Q

skin feature of sarcoidosis [2]

A

lupus pernio
erythema nodosum

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26
Q

what is the first line treatment of stable COPD

A

SABA/SAMA

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27
Q

After first line treatment for COPD and the pt remains breathless, what is given to someone who has NO asthmatic features?

A

LABA + LAMA added

switch out the SAMA to SABA at this point

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28
Q

After first line treatment for COPD and the pt remains breathless, what is given to someone who has asthmatic features?

What if they are still breathless despite these additions?

A

LABA + ICS

offer triple therapy LABA + LAMA + ICS

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29
Q

examples of LABA

A

Serevent (salmeterol)
Foradil (formoterol)
Striverdi (olodaterol)

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30
Q

examples of SABA

A

Salbutamol - e.g. Ventolin.
Terbutaline - e.g. Bricanyl

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31
Q

examples of LAMA

A

tiotropium

aclidinium
umeclidinium
glycopyrrolate (also called glycopyrronium)

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32
Q

examples of SAMA [2]

A

ipratropium bromide
oxitropium bromide

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33
Q

when is treatment for sarcoidosis indicated?

what is a treatment option

A

involvement of organs like the eye or skin, heart, kidneys etc

steroids

patients with chest x-ray stage 2 or 3 disease who are symptomatic. Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment
hypercalcaemia
eye, heart or neuro involvement

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34
Q

OLD

what should be done in primary pneumothorax if the air rim is < 2cm and not SOB

A

discharge, consider aspiration

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35
Q

OLD

what should be done in primary pneumothorax if air rim is >2cm or SOB

A

chest drain

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36
Q

OLD

what should be done in secondary pneumothorax is air rim is <2 cm

A

if between 1-2cm attempt aspiration

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37
Q

OLD

what should be done in secondary pneumothorax if air rim is > 2cm and/or they are SOB

A

chest drain

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38
Q

OLD

what should be done in secondary pneumothorax if air rim <1 cm

A

oxygen and admit for monitoring for 24 hours

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39
Q

what intervention may be considered in recurrent/persistent pneumothorax?

A

video assisted thoracoscopic surgery (VATS)

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40
Q

causes of bihilar lymphadenopathy [5]

A

TB
sarcoidosis
lymphoma/malignancy
pneumoconiosis
fungi e.g. coccidiodomycoses, histoplasmosis

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41
Q

what is the criteria for discharge for an acute asthma attack

A

P- PEF >75%
S- stable on discharge medication for 12-24 hours
I- inhaler technique is checked

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42
Q

treatment of HACE

A

descent and dexamethasone

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43
Q

medication for the prevention of HACE

A

acetozolamide

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44
Q

treatment of HAPE [3]

A

descent

nifedipine, dexamethasone, acetazolamide, phosphodiesterase type V inhibitors*

oxygen if available

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45
Q

relative contraindications for chest drain [4]

A

INR>1.3
platelets <75
pulmonary bullae
pleural adhesions

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46
Q

what are some contraindications to lung cancer surgery [6]

A
  • stage IIIb or IV (i.e. metastases present)
  • FEV1 < 1.5 litres is considered a general cut-off point*
  • malignant pleural effusion
  • tumour near hilum
  • vocal cord paralysis
  • SVC obstruction
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47
Q

what is the home treatment for someone who is having recurrent exacerbations of COPD

A

home antibiotics and prednisolone

abx only to be taken when there is purulent sputum produced

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48
Q

before starting prophylactic azithromycin for COPD, what baseline tests must be done? [2]

A
  • ECG for prolonged QT
  • liver function
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49
Q

what is a complication of rapid pleural effusion drainage?

how can this be prevented?

A

re-expansion pulmonary oedema

request an urgent chest x-ray

avoided by clamping the drain regularly in the event of rapid fluid output i.e. drain output should not exceed 1L of fluid over a short period of time (less than 6 hours)

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50
Q

what systems can sarcoidosis effect?

A

eyes
skin
facial nerve
parotid

this is a multi system disease

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51
Q

what guides the use of abx in acute bronchitis

A

CRP
20-100 –> delayed abx
>100 –> immediate abx

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52
Q

difference between acute bronchitis and pneumonia [3]

A
  • normal X-ray
  • no sputum sometimes
  • sore throat
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53
Q

treatment of acute bronchitis

A

doxycycline for 5 days

CI: children and pregnancy

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54
Q

what are the paraneoplastic syndromes of small cell lung cancer

A

Cushing’s syndrome and SIADH

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55
Q

what are the paraneoplastic syndromes of squamous cell lung cancers

A

PTHrp and HPOA

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56
Q

Acute asthma escalation:
1.
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

A

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

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57
Q

Acute asthma escalation:
1. Oxygen
2.
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

A

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

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58
Q

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3.
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

A

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

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59
Q

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4.
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

A

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

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60
Q

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5.
6. Aminophylline/ IV salbutamol

A

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamolAcute asthma escalation:

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61
Q

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6.

A

Acute asthma escalation:
1. Oxygen
2. Salbutamol nebulisers
3. Ipratropium bromide nebulisers
4. Hydrocortisone IV OR Oral Prednisolone
5. Magnesium Sulfate IV
6. Aminophylline/ IV salbutamol

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62
Q

two vaccines offered in COPD patients

A

Annual influenza + one-off pneumococcal

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63
Q

4 features of Kartagner’s syndrome

A
  • dextrocardia or complete situs inversus
  • bronchiectasis
  • recurrent sinusitis
  • subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
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64
Q

who is LTOT offered to

A

LTOT should be offered to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
nocturnal hypoxaemia
peripheral oedema
pulmonary hypertension

After smoking cessation, long-term oxygen therapy (LTOT) is one of the few interventions that has been shown to improve survival in COPD.

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65
Q

what are considered high risk characteristics in someone with symptomatic pneumothorax needing chest drain [6]

A

haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax

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66
Q
  1. SABA
  2. SABA + ICS
  4. SABA + ICS+ LABA + (LTRA)
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose ICS MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS+ LABA + (LTRA)
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose ICS MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
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67
Q
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose ICS MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS+ LABA + (LTRA)
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose ICS MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
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68
Q
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS+ LABA + (LTRA)
  6. SABA +/- LTRA + medium-dose ICS MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS+ LABA + (LTRA)
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose ICS MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
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69
Q
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS+ LABA + (LTRA)
  5. SABA +/- LTRA + MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS+ LABA + (LTRA)
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose ICS MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
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70
Q
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS+ LABA + (LTRA)
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose ICS MART
    7.
A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS+ LABA + (LTRA)
  5. SABA +/- LTRA + MART
  6. SABA +/- LTRA + medium-dose ICS MART
  7. SABA +/- LTRA + high-dose ICS/LAMA/theophylline
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71
Q

management for lung abscess not responding to IV abx

A

CT guided percutaneous drainage

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72
Q

protein in exudative effusion

A

> 30 g/L

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73
Q

protein in transudative effusion

A

<30 g/L

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74
Q

management of pleural effusion

A

diagnostic aspiration followed by chest drain

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75
Q

Lights criteria for exudative effusion

A

pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

76
Q

causes of upper zone fibrosis

A

Coal workers’ pneumoconiosis
Histiocytosis X,
Ankylosing Spondylitis,
Radiation,
TB
Sarcoidosis/Silicosis

77
Q

medicines that cause lower zone fibrosis [6]

A

busulfan
bleomycin lung toxicity
nitrofurantoin
hydralazine
methotrexate
amiodarone

78
Q

first line treatment for HAP

A

co-amoxiclav or doxycycline

if severe: Tazocin

79
Q

percussion note in pneumonia

A

dull

80
Q

percussion note in pleural effusion

A

stony dull

81
Q

percussion note in pneumothorax

A

hyper-resonant

82
Q

vocal fremitus in pneumonia

A

increased

83
Q

vocal fremitus in pleural effusion

A

reduced

84
Q

vocal fremitus in pneumothorax

A

reduced

85
Q

causes of tracheal deviation towards affected side [2]

A

pneumothorax/lung collapse
pneumonectomy

86
Q

where are bronchial breath sounds heard

A

over the trachea

87
Q

where are vesicular breath sounds heard

A

best heard posterior lung bases

88
Q

what does Veil sign indicate

A

left UPPER lobe collapse e.g. in malignancy

89
Q

what does Sail sign indicate

A

left LOWER lobe collapse

90
Q

what does Thymus sail sign indicate

A

normal, seen in neonatal CXR

91
Q

symptoms and signs of lung abscess [4]

A
  • foul smelling sputum
  • occurs over weeks
  • systemic: night sweats
  • dull percussion
92
Q

investigation of lung abscess [2]

A

chest x-ray
sputum and blood culture

93
Q

what do lung abscesses occur secondary to most of the time

A

aspiration pneumonia

typically polymicrobial
monomicrobial causes include:
Staphylococcus aureus
Klebsiella pneumonia
Pseudomonas aeruginosa

94
Q

DVT prophylaxis in air travel

A

if medium- high risk–> anti embolism stockings

NO role for aspirin

95
Q

gold standard for diagnosis of COPD

A

spirometry

96
Q

prophylactic treatment of COPD exacerbation

A

azithromycin

97
Q

FEV1% in mild COPD

A

> 80%

98
Q

FEV1% in moderate COPD

A

50-79%

99
Q

FEV1% in severe COPD

A

30-49%

100
Q

FEV1% in very severe COPD

A

<30%

101
Q

FEV1/FVC in asthma

A

< 70% i.e. obstructive

102
Q

FeNO in asthma diagnosis

A

> =40 ppb

103
Q

BDR in asthma

A

> =12% in variability and >200ml increase in volume after SABA administration

104
Q

peak flow variability in asthma

A

> 20%

105
Q

which severities of asthma need admission

A

acute severe with no response
life threatening and near fatal

106
Q

what happens to the ABG in near fatal asthma

A

raised pCO2

107
Q

when should a patient be reviewed after discharge due to asthma attack

A

48 hours

108
Q

PEF in moderate asthma

A

50-75%

109
Q

PEF in acute severe asthma

A

33-50%

110
Q

PEF in life threatening asthma

A

<33%

111
Q

treatment of pneumonia due to legionella

A

erythromycin/clarithromycin + rifampicin

112
Q

treatment of pneumonia due to staph

A

flucloxacillin

113
Q

which organism tends to cause pneumonia in those with pre-existing lung disease

A

H. influenzae

114
Q

which organism causes cavitating lesions on CXR and is associated with a recent viral infection

A

staph aureus

115
Q

C-
U- Urea >7mmol/L
R- RR >30
B- BP <90 sys <60 dia
65 yo +

A

C- Confusion
U- Urea >7mmol/L
R- RR >30
B- BP <90 sys <60 dia
65 yo +

116
Q

C- Confusion
U-
R- RR >30
B- BP <90 sys <60 dia
65 yo +

A

C- Confusion
U- Urea >7mmol/L
R- RR >30
B- BP <90 sys <60 dia
65 yo +

117
Q

C- Confusion
U- Urea >7mmol/L
R-
B- BP <90 sys <60 dia
65 yo +

A

C- Confusion
U- Urea >7mmol/L
R- RR >30
B- BP <90 sys <60 dia
65 yo +

118
Q

C- Confusion
U- Urea >7mmol/L
R- RR >30
B-
65 yo +

A

C- Confusion
U- Urea >7mmol/L
R- RR >30
B- BP <90 sys <60 dia
65 yo +

119
Q

C- Confusion
U- Urea >7mmol/L
R- RR >30
B- BP <90 sys <60 dia
age?

A

C- Confusion
U- Urea >7mmol/L
R- RR >30
B- BP <90 sys <60 dia
65 yo +

120
Q

which organism cause HAP within 48 hours to 4 days usually in hospital

A

strep pneumo

121
Q

which organism causes HAP beyond 4 days of hospital admission

A

enterobacteria mainly
staph aureus
pseudomonas

122
Q

treatment of severe HAP

A

piptazobactam (tazocin)

123
Q

treatment of Klebsiella pneumonia

A

cephalosporin

124
Q

treatment of pseudomonas pneumonia

A

piptazobactam

125
Q

gold standard for diagnosis of TB

A

sputum culture

takes 1-3 w

NAAT will take 24-48 hours

126
Q

which test for TB does NOT cross react with BCG vaccine

A

IGRA

127
Q

3 side effects of rifampicin

A

1) orange secretions
2) raised ALT/AST
3) enzyme inducer

128
Q

3 side effects of isoniazid

A

1) hepatotoxic
2) peripheral neuropathy (therefore give pyridoxine)
3) enzyme inhibitor

129
Q

side effect of pyrazinamide

A

hepatoxicity

130
Q

side effect of ethambutol

A

visual disturbance:optic neuritis

131
Q

how long are each of the TB treatment drugs given for

describe the regime

A

R- 6m
I- 6m
P- 2m
E- 2m

RIPE for 2 months followed by R and I for a further 4 months

132
Q

treatment of MDR TB

A

rifampicin and isoniazid

133
Q

treatment of XDR TB

A

rifampicin, isoniazid, fluoroquinolone and injectable

134
Q

key investigations in pleural effusion

A

CXR, USS guided pleural aspiration with chest drain

EBUS

135
Q

investigation for hypersensitivity pneumonitis

A

bronchoalveolar lavage shows increased cellularity

136
Q

Conditions that cause lower zone lung fibrosis [3]

A

asbestosis
idiopathic pulmonary fibrosis
rheum: RA, SLE, Sjorgrens, CREST

137
Q

lung sounds in idiopathy pulmonary fibrosis

A

fine end-inspiratory creps

138
Q

TCLO in idiopathic pulmonary fibrosis

A

low

139
Q

spirometry image in IPF

A

restrictive

140
Q

diagnostic imaging for IPF

A

HR-CT

141
Q

management of IPF

A

cons: physio; rehab; stop smoking
med: LTOT, anti-tussives

142
Q

treatment of ABPA

A

PO glucocorticoids

143
Q

diagnostic test for cystic fibrosis

A

chloride sweat test >60

144
Q

1st line mucolytic therapy for cystic fibrosis

A

dornase alfa

145
Q

prophylactic abx in cystic fibrosis

A

flucloxacillin and azithromycin

146
Q

nutritional management of cystic fibrosis [3]

A

high calorie
high fat
fat soluble vitamins

147
Q

what percentage of lung cancers are non-small and small

A

85% non small

15% small

148
Q

which lung cancers affect central airways

A

small cell and squamous cell

149
Q

which lung cancers affects peripheral airways

A

adenocarcinoma and large cell carcinoma

150
Q

key investigations for lung cancer [3]

A

CXR
CT, PET for staging
bronchoscopy + EBUS with biopsy

151
Q

which drugs reduce the risk of COPD exacerbations in patients with severe COPD and a history of frequent COPD exacerbations

A

Oral PDE-4 inhibitors such as roflumilast

152
Q

how does the chest drain swing during inspiration and expiration when treating pneumothorax

A

Rises in inspiration, falls in expiration

153
Q

what is Peabody sign

A

found in patients with a deep vein thrombosis (DVT) and a positive test indicated by calf muscle spasm occurring on elevation and foot extension of the affected leg

154
Q

what type of shock does a tension pneumothorax cause

A

obstructive

155
Q

how are pneumothorax patients managed according to 2023 guidelines

A

depending on whether they are symptomatic or not, regardless of pneumothorax size

the BTS define minimal symptoms as ‘no significant pain or breathlessness and no physiological compromise’

if minimal symptoms: conservative care, regardless of pneumothorax siz
if symptomatic: assess for high-risk characteristics

156
Q

how do you treat a symptomatic pneumothorax with no high risk characteristics if it is safe to intervene

A

conservative care
ambulatory device
needle aspiration

157
Q

how should patients with primary and secondary pneumothorax be monitored (conservative care)

A

patients with a primary spontaneous pneumothorax that is managed conservatively should be reviewed every 2-4 days as an outpatient
patients with a secondary spontaneous pneumothorax that is managed conservatively should be monitored as an inpatient

if stable, follow-up in the outpatients department in 2-4 weeks

158
Q

what is used in ambulatory care of pneumothorax

A

an example of an ambulatory device is the Rocket® Pleural Vent™

it includes an 8FG catheter mounted on an 18G needle and a pigtail catheter to minimize the risk of occlusion
ambulatory devices typically have a one-way valve and vent to prevent air and fluid return to the pleural space while allowing for controlled escape of air and drainage of fluid
many devices also have an indication diaphragm that signals when the catheter tip enters the pleural space and continues to fluctuate with respiration, aiding in the assessment of pneumothorax resolution

159
Q

when may patients fly after a pneumothorax

A

may travel 2 weeks after successful drainage if there is no residual air.

160
Q

causes of transudative pleural effusion

A

heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
Meigs’ syndrome

161
Q

causes of exudative pleural effusion

A

infection
pneumonia (most common exudate cause),
tuberculosis
subphrenic abscess
connective tissue disease
rheumatoid arthritis
systemic lupus erythematosus
neoplasia
lung cancer
mesothelioma
metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome

162
Q

2 history features in allergic bronchopulmonary

key investigations

A

history of bronchiectasis and eosinophilia.

eosinophilia
flitting CXR changes
positive radioallergosorbent (RAST) test to Aspergillus
positive IgG precipitins (not as positive as in aspergilloma)
raised IgE

163
Q

treatment of allergic bronchopulmonary aspergillosis

A

oral glucocorticoids

itraconazole 2nd line

164
Q

lung features of Alpha 1 antitrypsin def

A

panacinar emphysema of the lower lobes

165
Q

investigations for Alpha 1 antitrypsin def

A

A1AT concentrations
spirometry: obstructive picture

166
Q

management of Alpha 1 antitrypsin def

A

no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation

167
Q

management of atelectasis

A

positioning the patient upright
chest physiotherapy: breathing exercises

168
Q

respiratory causes of clubbing

A

lung cancer
pyogenic conditions: cystic fibrosis, bronchiectasis, abscess, empyema
tuberculosis
asbestosis, mesothelioma
fibrosing alveolitis

169
Q

causes of respiratory acidosis

A

COPD
decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
neuromuscular disease
obesity hypoventilation syndrome
sedative drugs: benzodiazepines, opiate overdose

170
Q

causes of respiratory alkalosis

A

anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy

171
Q

Predisposing factors to OSA

consequences

A

obesity
macroglossia: acromegaly, hypothyroidism, amyloidosis
large tonsils
Marfan’s syndrome

daytime somnolence
compensated respiratory acidosis
hypertension

172
Q

management of OSA

A

weight loss
continuous positive airway pressure (CPAP) is first line for moderate or severe OSAHS
intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated or for patients with mild OSAHS where there is no daytime sleepiness
the DVLA should be informed if OSAHS is causing excessive daytime sleepiness

173
Q

features of Granulomatosis with polyangitis

A

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

174
Q

extra heart sound in pulmonary oedema

A

S3

175
Q

what can be offered for smoking cessation [3]

A

nicotine replacement therapy (NRT), varenicline or bupropion

176
Q

MoA of vareniciline

A

nicotinic receptor partial agonist

contraindicated in pregnancy and breast feeding

177
Q

MoA of bupriopion

CI?

A

norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

CI: epilepsy, pregnancy and breast feeding

178
Q

most common cause of occupational asthma

A

isocyanates

include spray painting and foam moulding using adhesive

179
Q

what is total gas transfer (TLCO)

A

overall measure of gas transfer for the lungs from the alveoli into the capillaries and reflects how much oxygen is taken up into the red cells.

180
Q

what is transfer coefficient KCO

A

TLCO divided by the alveolar volume, which makes it a measure of how efficient gas exchange is in relation to the alveolar-capillary surface to volume ratio.

181
Q

causes of raised TLCO

A

asthma
pulmonary haemorrhage (e.g. granulomatosis with polyangiitis, Goodpasture’s)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise

182
Q

causes of lower TLCO

A

pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output

183
Q

how does KCO change with age, What conditions can increase it

A

KCO increases with age

pneumonectomy/lobectomy
scoliosis/kyphosis
neuromuscular weakness
ankylosis of costovertebral joints e.g. ankylosing spondylitis

184
Q

investigation for OSA

A

sleep studies (polysomnography)

Epworth Sleepiness Scale - questionnaire completed by patient +/- partner
Multiple Sleep Latency Test (MSLT) - measures the time to fall asleep in a dark room (using EEG criteria)

185
Q

when should LTOT be started

A

2 measurement so pO2 < 7.3

186
Q
A

Year 6 (19 decks)

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