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resp Flashcards

1
Q

what is type 1 hypersensitivity mediated by?

A

IgE

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2
Q

give 3 examples of type 1 hypersensitivity

A

allergy
anaphylaxis
atopy

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3
Q

what is type 2 hypersensitivity mediated by?

A

IgM or IgG

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4
Q

give 3 examples of type 2 hypersensitivity?

A

haemolytic disease of the newborn
autoimmune haemolytic anaemia
goodpastures syndrome

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5
Q

what is type 3 hypersensitivity mediated by?

A

antigen - antibody immune complexes

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6
Q

what is type 4 hypersensitivity mediated by?

A

T cells

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7
Q

give 3 examples of type 3 hypersensitivity

A

serum sickness
SLE
post streptococcal glomerulonephritis

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8
Q

what is the timeframe for a type 4 hypersensitivity reaction?

A

delayed reaction (24-72 hrs)

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9
Q

give 1 example of a type 4 hypersensitivity reaction

A

contact dermatitis

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10
Q

what are interstitial lung diseases?

A

conditions that cause inflammation and fibrosis of the lung parenchyma

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11
Q

how do interstitial lung diseases present?

A

SOB
dry cough
fatigue

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12
Q

what are the typical examination findings of idiopathic pulmonary fibrosis?

A

basal fine end inspiratory crackles

finger clubbing

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13
Q

what is the characteristic CT finding of interstitial lung disease?

A

ground glass appearance

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14
Q

what is the spirometry pattern in interstitial lung disease?

A

restrictive

FEV1 and FVC equally reduced

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15
Q

what is hypersensitivity pneumonitis?

A

type 3 and 4 allergic reactions to environmental allergens that cause an immune response leading to inflammation and damage to the lung tissue

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16
Q

what is asthma?

A

a chronic inflammatory airway disease leading to variable airway obstruction

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17
Q

what are the typical symptoms of asthma?

A

SOB
chest tightness
dry cough
wheeze

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18
Q

which 2 drug classes can worsen asthma?

A

beta blockers
NSAIDs

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19
Q

what is the spirometry picture seen in asthma?

A

obstructive

FEV1:FVC ratio <70%

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20
Q

what are the 2 initial investigations for asthma?

A

spirometry w/ bronchodilator reversibility

fractional exhaled nitric oxide

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21
Q

explain the stepwise approach for treating asthma?

A
  1. SABA
  2. add low dose inhaled corticosteroid
  3. add LABA or trial of leyukotrine receptor antagonists (LTRA)
  4. inhaled corticosteroid increased to medium dose or trial LTRA
  5. inhaled corticosteroid dose increased to high
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22
Q

what is the spirometry picture seen in COPD?

A

obstructive

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23
Q

what is the inheritance pattern of cystic fibrosis?

A

autosomal recessive

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24
Q

what are the centor criteria?

A

presence of tonsillar exudate
lymphadenopathy
fever
absence of cough

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25
Q

what should be considered if a pt has recurrent pneumothoraces?

A

video assisted thoracoscopic surgery to allow for pleurodesis

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26
Q

what is the management of idiopathic pulmonary fibrosis?

A

antifibrotics e.g. ninedanib or pirfenidone

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27
Q

what is bronchiectasis?

A

a chronic respiratory disease characterised by permanent bronchial dilation due to irreversible damage to the bronchial wall

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28
Q

why do bronchiectasis pts get recurrent infections?

A

because dilated bronchi are predisposed to persistent microbial colonisation

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29
Q

what is the most common cause of bronchiectasis?

A

post infectious

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30
Q

what is the gold standard diagnostic investigation for bronchiectasis?

A

high resolution CT chest

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31
Q

what is the most common cause of bronchiolitis?

A

RSV

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32
Q

what is the definition of pneumonia?

A

acute inflammation of the lung parenchyma

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33
Q

what is the most common cause of community acquired pneumonia?

A

streptococcus pneumonia

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34
Q

what is the definition of hospital acquired pneumonia?

A

lower respiratory tract infection acquired after 48hrs of hospital admission

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35
Q

how does pneumonia caused by mycoplasma pneumoniae present?

A

slow onset history over days - weeks

persistent dry and hacking cough

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36
Q

what are the criteria for CURB65 for pneumonia?

A

C - confusion
U - urea >7mmol
R - resp rate >30
B - <90 systolic or <60 diastolic
65 - >65 y/o

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37
Q

what is the first line treatment for low risk community acquired pneumonia?

A

amoxicillin 500mg - 1g 3x daily

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38
Q

what are the alternative antibiotics used in the treatment for low risk community acquired pneumonia?

A

doxycycline
clarithromycin

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39
Q

what is the first line treatment for moderate risk community acquired pneumonia?

A

combination of amoxicillin and clarithromycin

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40
Q

what is the first line treatment for high risk community acquired pneumonia?

A

combination of coamoxicalv and clarithromycin

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41
Q

what is a pneumothorax?

A

air in the pleural space

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42
Q

what is the difference between a primary and secondary pneumothorax?

A

a primary pneumothorax is in a pt w/ no known respiratory disease

a secondary pneumothorax is in a pt w/ known respiratory disease

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43
Q

explain the management of a tension pneumothorax

A

emergency decompression - large bore cannula second intercostal space mid clavicular line

chest drain insertion immediately after decompression

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44
Q

how does a pneumothorax present?

A

ipsilateral chest pain and dyspnoea

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45
Q

what are the 2 classifications of lung cancer?

A

non-small cell carcinoma
small cell carcinoma

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46
Q

what is the most common type of lung cancer?

A

non small cell carcinoma

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47
Q

what are the 3 types of non small cell carcinoma?

A

adenocarcinoma
squamous cell carcinoma
large cell carcinoma

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48
Q

which lung cancer is most common in non smokers?

A

adenocarcinomas

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49
Q

what is the management of non small cell lung cancer?

A

surgery in the early disease

chemotherapy +/- targeted therapy in advanced disease

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50
Q

what is needed for the definitive diagnosis of PE?

A

CTPA

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51
Q

what wells score means PE is likely?

A

> 4

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52
Q

what is the management if a PE is likely (wells score >4)?

A

CTPA immediately

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53
Q

what is the management if a PE is unlikely (wells score <4)?

A

d dimer

if d dimer +ve then CTPA

if d dimer -ve then PE unlikely

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54
Q

what is the management of a PE if there is haemodynamic instability?

A

IV tissue plasminogen activator (e.g. alteplase)

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55
Q

what is the management of a PE if there is no haemodynamic instability?

A

anticoagulation

frist line: DOAC (apixaban or rivaroxaban)

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56
Q

what is used for anticoagulation in a pregnant woman who has had a PE and why?

A

low molecular weight heparin

because DOACs and warfarin are contraindicated

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57
Q

what is sarcoidosis?

A

a chronic granulomatous disorder

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58
Q

what are the extra pulmonary manifestations of sarcoidosis?

A

erythema nodosum
lymphadenopathy
lupus perino

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59
Q

what are the pt demographics that sarcoidosis is more common in?

A

women
20-40 y/o
black ethnic origin

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60
Q

what is erythema nodosum?

A

nodules of inflamed subcutaneous fat on the shins

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61
Q

what is lupus perino?

A

raised purple lesions on the cheeks and nose

specific to sarcoidosis

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62
Q

what are the blood test findings of sarcoidosis?

A

raised angiotensin converting enzyme (ACE)

raised calcium

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63
Q

what is the first line treatment for sarcoidosis when treatment is required?

A

oral steroids for 6 - 24 months

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64
Q

if a sputum culture grows acid fast bacilli which stain red w/ zeihl neelsen staining what is the likely causative organism and diagnosis?

A

causative organism: mycobacterium tuberculosis

diagnosis: TB

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65
Q

what does the appearance of millet seeds uniformly distributed across the lung fields on CXR indicate?

A

disseminated miliary TB

66
Q

what is the treatment for latent TB?

A

either:

  • isoniazid and rifampicin for 3 months

or

  • isoniazid for 6 months
67
Q

what is the treatment for active TB?

A

R - rifampicin for 6 months
I - isoniazid for 6 months
P - pryazinamide for 2 months
E - ethambutol for 2 months

68
Q

what is commonly prescribed with RIPE in the treatment of TB and why?

A

pyridoxine (vitamin B6) because pryazinamide causes peripheral neuropathy

69
Q

what is a common side effect of ethambutol?

A

reduction in visual acuity and colour blindness

70
Q

what is a common side effect of rifampicin?

A

red / orange secretions (tears and urine)

71
Q

what is the most common causative organism for infective exacerbations of COPD?

A

haemophilus influenzae

72
Q

what does sudden clinical deterioration in a mechanically ventilated pt indicate?

A

development of a tension pneumothorax

73
Q

what does a low pH and a high PaCO2 indicate?

A

respiratory acidosis

remember ROME (respiratory opposite, metabolic equal)

74
Q

what does a high pH and a low PaCO2 indicate?

A

respiratory alkalosis

remember ROME (respiratory opposite, metabolic equal)

75
Q

what does a high pH and a high bicarb indicate?

A

metabolic alkalosis

remember ROME (respiratory opposite, metabolic equal)

76
Q

what does a low pH and a low bicarb indicate?

A

metabolic acidosis

remember ROME (respiratory opposite, metabolic equal)

77
Q

what is the most common chest examination finding of idiopathic pulmonary fibrosis?

A

fine end inspiratory crepitations

78
Q

what respiratory rate constitutes severe asthma?

79
Q

what should be suspected if there is hypercalcaemia and bilateral hilar lymphadenopathy?

A

sarcoidosis

80
Q

what is the paraneoplastic syndrome associated with squamous cell lung cancer?

A

parathyroid hormone related protein secretion

81
Q

which 2 paraneoplastic syndromes are associated with small cell lung cancer?

A

SIADH
cushings syndrome

82
Q

what is the paraneoplastic syndrome associated with adenocarcinoma lung cancer?

A

gynaecomastia

83
Q

what is the definition of a transudate pleural effusion?

A

protein <30

84
Q

what is the definition of an exudate pleural effusion?

A

protein >30

85
Q

what is the most common cause of transudate pleural effusion?

A

heart failure

86
Q

what is the most common cause of exudate pleural effusion?

A

infection - pneumonia

87
Q

does malignancy cause a transudate or exudate pleural effusion?

88
Q

what pleural fluid / serum protein ratio is an exudate?

89
Q

which two patient groups are more likely to have klebsiella pneumonia?

A

alcoholics and diabetics

90
Q

what are the causes of upper lobe fibrosis?

A

C - coal workers pneumonitis

H - histocytosis / hypersensitivity pneumonitis

A - ankylosing spondylitis

R - radiation

T - TB

S - sarcoidosis / silicosis

91
Q

what facial deformity is seen w/ granulomatosis w/ polyangitis?

A

saddle shaped nose deformity

92
Q

how are most pts w/ small cell lung cancer treated?

A

chemo and radiotherapy

93
Q

what is 1 pack year defined as?

A

20 cigarettes a day for 1 year

94
Q

what are the features of heart failure on CXR?

A

A - alveolar oedema (bat wing opacities)

B - Kerley B lines

C - cardiomegaly

D - dilated upper lobe vessels

E - pleural effusion

95
Q

sudden deterioration w/ ventilation indicates what?

A

tension pneumothorax

96
Q

which lobes are most commonly affected by aspiration pneumonia?

A

the right middle and lower lobes

97
Q

what is the severity of COPD categorised based on?

98
Q

what is mild COPD / stage 1?

99
Q

what is moderate COPD / stage 2?

A

FEV1 50 - 79

100
Q

what is severe COPD / stage 3?

A

FEV1 30 - 49

101
Q

what is very severe COPD / stage 4?

102
Q

what is an indication for surgery in bronchiectasis?

A

disease localised to one lobe

103
Q

SIADH is a paraneoplastic syndrome of which lung cancer?

A

small cell lung cancer

104
Q

what is the likely lung cancer when a pt presents w/ a low Na and why?

A

small cell lung cancer

because SIADH is a paraneoplastic syndrome of small cell lung cancer and so causes hyponatraemia

105
Q

how does alpha 1 antitrypsin deficiency present?

A

as emphysema (COPD) in young pts who are non smokers

106
Q

what is the surgical management of late stage alpha 1 antitrypsin deficiency?

A

lung volume reduction surgery

107
Q

what is the management of a pt w/ COPD who is still breathless despite SABA / SAMA treatment and has no asthmatic / steroid responsiveness?

A

add LABA / LAMA

108
Q

a post bronchodilator improvement in FEV1 of what is indicative of asthma?

A

12% or more

109
Q

gynaecomastia is assoc w/ which lung cancer?

A

adenocarcinoma

110
Q

what is type 1 respiratory failure?

A

low pO2, no CO2 retention

111
Q

what is type 2 respiratory failure?

A

low pO2, high pCO2

112
Q

what are the causes of transudative pleural effusions?

A

heart failure
cirrhosis w/ ascites
hypoalbuminemia

113
Q

what are the causes of exudative pleural effusions?

A

cancer
infection
inflammatory processes

114
Q

how do transudative and exudative fluids differ on thoracentesis?

A

transudtive fluids are clear
exudative fluids are cloudy

115
Q

what are the auscultation findings of idiopathic pulmonary fibrosis?

A

bibasal fine end-inspiratory crepitations

116
Q

what are the imaging findings of idiopathic pulmonary fibrosis?

A

ground glass appearance

progresses to honeycombing

117
Q

what imaging modality is required to make a diagnosis of idiopathic pulmonary fibrosis?

A

high resolution CT

118
Q

what are the causes of upper lobe fibrosis?

A

C - coal workers pneumonitis
H - histiocytosis
A - ankylosing spondylitis
R - radiation
T - tuberculosis
S - sarcoidosis, silicosis

119
Q

all pts w/ pneumonia should have a repeat chest X-ray when?

A

6 wks after clinical resolution

120
Q

what is the management for all acute exacerbations of COPD regardless of cause?

A

oral prednisolone 30mg for 5 days

121
Q

in acute asthma which pts should get ABGs?

A

only if sats are <92%

122
Q

what are the xray features of silicosis?

A

upper zone fibrosing lung disease

egg shell calcification of the hilarious lymph nodes

123
Q

what is the most common underlying malignancy in pts w/ lambert eaton syndrome?

A

small cell lung cancer

124
Q

what is the likely diagnosis when there is persistent productive cough +/- haemoptysis in a young person w/ a history of respiratory problems?

A

bronchiectasis

125
Q

what are the 3 ANCA associated vasculitis?

A

granulomatosis w/ polyangitis

microscopic polyangitis

eosiniophilic granulomatosis w/ polyangitis (churg strauss syndrome)

126
Q

what is the most common ANCA assoc vasculitis?

A

granulomatosis w/ polyangitis (wegner syndrome)

127
Q

what is the wegners triad (granulomatosis w/ polyangitis)?

A

upper resp tract involvement
lower resp tract involvement
renal involvement

128
Q

which antibody is most likely associated w/ eosinophilia granulomatosis w/ polyangitis?

129
Q

what are the 3 phases of eosinophilic granulomatosis w/ polyangitis?

A

allergy - many pts having a history of asthma or allergic rhinitis which can lead to the development of nasal polyps

eosinophilia

vasculitis - affecting medium and large vessels

130
Q

what is the most likely causative organism of cavitating pneumonia in an alcoholic or diabetic pt?

A

klebsiella

131
Q

the combination of bronchiectasis and dextocardia is highly suggestive of what?

A

kartageners syndrome

132
Q

what is the first line treatment for acute bronchitis if treatment is needed?

A

oral doxycycline

133
Q

what does a normal pCO2 indicate in a severe asthma attack?

A

exhaustion and therefore life-threatening asthma

134
Q

what is used for the diagnosis of sleep apnoea?

A

polysomnography

135
Q

how can it be confirmed that NG tubes are safe to use?

A

pH <5.5 on aspirate

136
Q

what should be done if the pH of aspirate from an NG tube is >5.5.?

A

get an CXR to confirm the correct location of the NG tube

137
Q

what does eosinophilia in a COPD pt indicate?

A

asthmatic features therefore steroid responsiveness

138
Q

what is the first line pharmacological treatment for COPD?

A

SABA / SAMA

139
Q

what class of drug is ipratropium?

140
Q

what does diurnal variation indicate in COPD?

A

asthmatic features

141
Q

what are the most common causes of bilateral hilar lymphadenopathy?

A

TB
sarcoidosis

142
Q

what is the likely diagnosis when there is a pt w/ a mining occupation, upper zone fibrosis and egg shell calcification of the hiilar nodes?

143
Q

gynaecomastia is assoc w/ which lung cancer?

A

adenocarcinoma

144
Q

what is the management of bilateral pneumothoraces?

A

chest drain insertion

145
Q

what is the management of legionella?

A

macrolides such as clarithromycin

146
Q

which antibiotic is used for COPD prophylaxis?

A

azithromycin

147
Q

what is the next step in the management of severe asthma when other measures haven’t worked?

A

IV magnesium sulphate

148
Q

what is the most common cause of an infective COPD exacerbation?

A

haemophilus influenzae

149
Q

what is the next investigation of children who have normal spirometry but high clinical suspicion of asthma?

150
Q

what is the most common organism in bronchiectasis?

A

haemophilus influenzae

151
Q

which medication used in the treatment of asthma can cause oral candidiasis?

A

inhaled ICS

152
Q

what is the first line, following weight loss, for moderate to severe sleep apnoea?

153
Q

what is the management of allergic bronchopulmonary aspergillosis?

A

corticosteroids (prednisolone)

154
Q

what is the difference between the granulomas seen in TB and sarcoidosis?

A

TB = caseating granulomas

sarcoidosis = non caseating granulomas

155
Q

why does a chest ray need to be done before starting biologics for rheumatoid arthritis?

A

to look for TB because biologics can reactivate TB

156
Q

what is the likely diagnosis of atypical pneumonia in a younger pt who has erythema multiforme?

A

mycoplasma pneumoniae

157
Q

cavetating lesions are most commonly seen in which type of lung cancer?

A

squamous cell lung cancer

158
Q

what are the causes of erythema nodosum?

A

NO - idiopathic
D - drugs (penicillins)
O - oral contraceptives / pregnancy
S - sarcoidosis
U - ulcerative colitis, crohns
M - microbiology

finals (25 decks)

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