Resp Flashcards
what does granulomatous condition mean
nodules of inflammation full of macrophages
Pulmonary manifestations of sarcoid
mediastinal lymphadenop
pulm fibrosis
pulm nodules
What is Lofgren’s syndrome
triad of a specific sarcoid presentation
erythema nodosum
bilat hilar lymphad
polyarthralgia
What does raised serum ACE indicate
sarcoid
sarcoid can cause what electrolyte imbalance
Hypercalcaemia
Gold standard for sarcoid dx
histology from biopsy- shows non-caseating granulomas with epithelioid cells
mx sarcoid
if asymptomatic - nil, often self resolves in 6m
Oral steroids for 6-24m and bisphosphonates
2nd line- mtx/azathioprine
rarely needs a lung transplant
Is most bronchial carcinoma small cell or non small cell
non small cell
Most common cause of CAP
Streptococcus pneumoniae
CAP pathogen COPD
Haemophilus influenzae
CAP pathogen post influenza, or HAP, or IVDU
Staphylococcus aureus
CAP in alcoholics / impaired swallow/ diabetic
Klebsiella pneumoniae
CF/immunocomp CAP pathogen
Pseudomonas aeruginosa
atypical pneumonia affecting young adults with diffuse infiltrates
Mycoplasma pneumoniae
Milder atypical pneumonia
Chlamydophila pneumoniae
Most common viral pneumonia
influenza
most common viral influenza in infants or elderly
RSV
CURB criteria
Confusion (abbreviated mental test score <= 8/10)
(urea >7)
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years
> 2 = hospital
tension ptx management
large bore cannula 2nd IC space MCL (then chest drain)
Drugs causing interstitial lung disease
‘MAN B messing up my lungs’
mtx
amiodarone
nitrofurantoin
bleomycin
Novel drug for ILD
pirfenidone
klebsiella pneumonia is often which lobe and what might complication be
upper
abscess and empyema
mycoplasma pneumonia complications
erythema multiforme
haemolytic anaemia
blood results in legionella
hyponatraemia
lymphopenia
type of pneumonia with bi-basal consolidation
legionella
fungal pneumonia pathogen in HIV - desat on exertion
pneumocytis jiroveci
HAP is after how long in hosp
48h
PE mx if Wells >4
CTPA, if delay start DOAC
If you have low suspicion of PE anyway what can you do
PERC- if negative then probability <2%
PE Mx if Well’s <4
D dimer
Length of treatment for provoked PE
3 months then reassess
Length of treatment for PE with malignancy
6m or until cure of cancer
Length of treatment for PE with pregnancy
until end of pregnancy, nb should have LMWH i think
first-line treatment for massive PE where there is circulatory failure
thrombolysis
COPD sx in a young person - consider
alpha 1 antitrypsin defic
bronchiectasis affects which airways
medium sized
genetic causes of bronchiectasis
CF
PCD/kartageners syndrome
Other causes of bronchiectasis
post infective
aspiration or lung ca obstructing
Allergic bronchopulmonary aspergillosis
COPD
Imaging signs for bronchiectasis
signet ring sign on CT
XR- tram lines and ring shadows
How to diagnose PCD
nasal biopsy
pleural aspirate pH <7.2 suggests
pus- needs chest drain
pleural fluid protein <30g/L
transudate
pleural fluid protein >30g/L
exudate
XR findings in silicosis
upper zone fibrosis
‘egg-shell’ calcification of the hilar lymph nodes
If pleural fluid protein level is between 25-35 g/L what do you do to determine if trans or exudative
Lights criteria
Lights criteria
To be considered an exudate at least one of:
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
when do you definitely put in a chest drain after a pleural tap is done
if the fluid is purulent or turbid/cloudy
if the fluid is clear but the pH is less than 7.2
What is the main therapeutic benefit of inhaled corticosteroids in patients with COPD
reduces exacerbations
what are ‘asthmatic features’ of COPD
prev dx asthma/atopy
eosinophils
diurnal variation in PEFR
variation in FEV1 over time
COPD first line
SABA/SAMA
COPD second line in no asthmatic features
LABA and LAMA
COPD second line in asthmatic features
LABA and ICS
Ipatropium type of drug
SAMA (note tiotripium is LAMA)
FEV1:FVC in COPD
<0.7
when do you give prophylactic abx in COPD patient
non smoker, have optimised standard treatments and continue to have exacerbations
need to exclude bronchiectasis (CT) and atypical cultures
Check LFT and QTc first
Pulm fibrosis picture on spirometry and TLCO
restrictive spirometry picture (FEV1:FVC >70%, decreased FVC) and impaired gas exchange (reduced TLCO)
Are pleural plaques themselves pre-malignant?
No, and they are not associated with an increased risk of lung cancer or mesothelioma.
Difference between asbestosis and mesothelioma
asbestosis- lower lobe fibrosis (not cancerous)
mesothelioma- pleural disease
Is mesothelioma or lung cancer more common in asbestosis exposure?
lung ca
COPD severity scale
FEV1
> 80% mild (stage 1)
> 50% mod (2)
> 30% severe (3)
<30% very severe (4)
Does coal dust increase risk of cancer
no, more coal workers pneumoconiosis or COPD
rounded opacity in the right upper zone surrounded by a rim of air, b/g of TB
Aspergilloma
What valve issue can cause haemoptysis
mitral stenosis
pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum) is characteristic of
granulomatosis with polyangiitis.
Haemoptysis
Systemically unwell: fever, nausea
Glomerulonephritis
Goodpastures
commonest causes of an anterior mediastinum mass
can be remembered by the 4 T’s:
teratoma,
terrible lymphadenopathy,
thymic mass
thyroid mass
