resp Flashcards
1
Q
what is type 1 hypersensitivity mediated by?
A
IgE
2
Q
give 3 examples of type 1 hypersensitivity
A
allergy
anaphylaxis
atopy
3
Q
what is type 2 hypersensitivity mediated by?
A
IgM or IgG
4
Q
give 3 examples of type 2 hypersensitivity?
A
haemolytic disease of the newborn
autoimmune haemolytic anaemia
goodpastures syndrome
5
Q
what is type 3 hypersensitivity mediated by?
A
antigen - antibody immune complexes
6
Q
what is type 4 hypersensitivity mediated by?
A
T cells
7
Q
give 3 examples of type 3 hypersensitivity
A
serum sickness
SLE
post streptococcal glomerulonephritis
8
Q
what is the timeframe for a type 4 hypersensitivity reaction?
A
delayed reaction (24-72 hrs)
9
Q
give 1 example of a type 4 hypersensitivity reaction
A
contact dermatitis
10
Q
what are interstitial lung diseases?
A
conditions that cause inflammation and fibrosis of the lung parenchyma
11
Q
how do interstitial lung diseases present?
A
SOB
dry cough
fatigue
12
Q
what are the typical examination findings of idiopathic pulmonary fibrosis?
A
basal fine end inspiratory crackles
finger clubbing
13
Q
what is the characteristic CT finding of interstitial lung disease?
A
ground glass appearance
14
Q
what is the spirometry pattern in interstitial lung disease?
A
restrictive
FEV1 and FVC equally reduced
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
16
Q
what is asthma?
A
a chronic inflammatory airway disease leading to variable airway obstruction
17
Q
what are the typical symptoms of asthma?
A
SOB
chest tightness
dry cough
wheeze
18
Q
which 2 drug classes can worsen asthma?
A
beta blockers
NSAIDs
19
Q
what is the spirometry picture seen in asthma?
A
obstructive
FEV1:FVC ratio <70%
20
Q
what are the 2 initial investigations for asthma?
A
spirometry w/ bronchodilator reversibility
fractional exhaled nitric oxide
21
Q
explain the stepwise approach for treating asthma?
A
- SABA
- add low dose inhaled corticosteroid
- add LABA or trial of leyukotrine receptor antagonists (LTRA)
- inhaled corticosteroid increased to medium dose or trial LTRA
- inhaled corticosteroid dose increased to high
22
Q
what is the spirometry picture seen in COPD?
A
obstructive
23
Q
what is the inheritance pattern of cystic fibrosis?
A
autosomal recessive
24
Q
what are the centor criteria?
A
presence of tonsillar exudate
lymphadenopathy
fever
absence of cough
25
what should be considered if a pt has recurrent pneumothoraces?
video assisted thoracoscopic surgery to allow for pleurodesis
26
what is the management of idiopathic pulmonary fibrosis?
antifibrotics e.g. ninedanib or pirfenidone
27
what is bronchiectasis?
a chronic respiratory disease characterised by permanent bronchial dilation due to irreversible damage to the bronchial wall
28
why do bronchiectasis pts get recurrent infections?
because dilated bronchi are predisposed to persistent microbial colonisation
29
what is the most common cause of bronchiectasis?
post infectious
30
what is the gold standard diagnostic investigation for bronchiectasis?
high resolution CT chest
31
what is the most common cause of bronchiolitis?
RSV
32
what is the definition of pneumonia?
acute inflammation of the lung parenchyma
33
what is the most common cause of community acquired pneumonia?
streptococcus pneumonia
34
what is the definition of hospital acquired pneumonia?
lower respiratory tract infection acquired after 48hrs of hospital admission
35
how does pneumonia caused by mycoplasma pneumoniae present?
slow onset history over days - weeks
persistent dry and hacking cough
36
what are the criteria for CURB65 for pneumonia?
C - confusion
U - urea >7mmol
R - resp rate >30
B - <90 systolic or <60 diastolic
65 - >65 y/o
37
what is the first line treatment for low risk community acquired pneumonia?
amoxicillin 500mg - 1g 3x daily
38
what are the alternative antibiotics used in the treatment for low risk community acquired pneumonia?
doxycycline
clarithromycin
39
what is the first line treatment for moderate risk community acquired pneumonia?
combination of amoxicillin and clarithromycin
40
what is the first line treatment for high risk community acquired pneumonia?
combination of coamoxicalv and clarithromycin
41
what is a pneumothorax?
air in the pleural space
42
what is the difference between a primary and secondary pneumothorax?
a primary pneumothorax is in a pt w/ no known respiratory disease
a secondary pneumothorax is in a pt w/ known respiratory disease
43
explain the management of a tension pneumothorax
emergency decompression - large bore cannula second intercostal space mid clavicular line
chest drain insertion immediately after decompression
44
how does a pneumothorax present?
ipsilateral chest pain and dyspnoea
45
what are the 2 classifications of lung cancer?
non-small cell carcinoma
small cell carcinoma
46
what is the most common type of lung cancer?
non small cell carcinoma
47
what are the 3 types of non small cell carcinoma?
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
48
which lung cancer is most common in non smokers?
adenocarcinomas
49
what is the management of non small cell lung cancer?
surgery in the early disease
chemotherapy +/- targeted therapy in advanced disease
50
what is needed for the definitive diagnosis of PE?
CTPA
51
what wells score means PE is likely?
>4
52
what is the management if a PE is likely (wells score >4)?
CTPA immediately
53
what is the management if a PE is unlikely (wells score <4)?
d dimer
if d dimer +ve then CTPA
if d dimer -ve then PE unlikely
54
what is the management of a PE if there is haemodynamic instability?
IV tissue plasminogen activator (e.g. alteplase)
55
what is the management of a PE if there is no haemodynamic instability?
anticoagulation
frist line: DOAC (apixaban or rivaroxaban)
56
what is used for anticoagulation in a pregnant woman who has had a PE and why?
low molecular weight heparin
because DOACs and warfarin are contraindicated
57
what is sarcoidosis?
a chronic granulomatous disorder
58
what are the extra pulmonary manifestations of sarcoidosis?
erythema nodosum
lymphadenopathy
lupus perino
59
what are the pt demographics that sarcoidosis is more common in?
women
20-40 y/o
black ethnic origin
60
what is erythema nodosum?
nodules of inflamed subcutaneous fat on the shins
61
what is lupus perino?
raised purple lesions on the cheeks and nose
specific to sarcoidosis
62
what are the blood test findings of sarcoidosis?
raised angiotensin converting enzyme (ACE)
raised calcium
63
what is the first line treatment for sarcoidosis when treatment is required?
oral steroids for 6 - 24 months
64
if a sputum culture grows acid fast bacilli which stain red w/ zeihl neelsen staining what is the likely causative organism and diagnosis?
causative organism: mycobacterium tuberculosis
diagnosis: TB
65
what does the appearance of millet seeds uniformly distributed across the lung fields on CXR indicate?
disseminated miliary TB
66
what is the treatment for latent TB?
either:
- isoniazid and rifampicin for 3 months
or
- isoniazid for 6 months
67
what is the treatment for active TB?
R - rifampicin for 6 months
I - isoniazid for 6 months
P - pryazinamide for 2 months
E - ethambutol for 2 months
68
what is commonly prescribed with RIPE in the treatment of TB and why?
pyridoxine (vitamin B6) because pryazinamide causes peripheral neuropathy
69
what is a common side effect of ethambutol?
reduction in visual acuity and colour blindness
70
what is a common side effect of rifampicin?
red / orange secretions (tears and urine)
71
what is the most common causative organism for infective exacerbations of COPD?
haemophilus influenzae
72
what does sudden clinical deterioration in a mechanically ventilated pt indicate?
development of a tension pneumothorax
73
what does a low pH and a high PaCO2 indicate?
respiratory acidosis
remember ROME (respiratory opposite, metabolic equal)
74
what does a high pH and a low PaCO2 indicate?
respiratory alkalosis
remember ROME (respiratory opposite, metabolic equal)
75
what does a high pH and a high bicarb indicate?
metabolic alkalosis
remember ROME (respiratory opposite, metabolic equal)
76
what does a low pH and a low bicarb indicate?
metabolic acidosis
remember ROME (respiratory opposite, metabolic equal)
77
what is the most common chest examination finding of idiopathic pulmonary fibrosis?
fine end inspiratory crepitations
78
what respiratory rate constitutes severe asthma?
>25
79
what should be suspected if there is hypercalcaemia and bilateral hilar lymphadenopathy?
sarcoidosis
80
what is the paraneoplastic syndrome associated with squamous cell lung cancer?
parathyroid hormone related protein secretion
81
which 2 paraneoplastic syndromes are associated with small cell lung cancer?
SIADH
cushings syndrome
82
what is the paraneoplastic syndrome associated with adenocarcinoma lung cancer?
gynaecomastia
83
what is the definition of a transudate pleural effusion?
protein <30
84
what is the definition of an exudate pleural effusion?
protein >30
85
what is the most common cause of transudate pleural effusion?
heart failure
86
what is the most common cause of exudate pleural effusion?
infection - pneumonia
87
does malignancy cause a transudate or exudate pleural effusion?
exudate
88
what pleural fluid / serum protein ratio is an exudate?
>0.5
89
which two patient groups are more likely to have klebsiella pneumonia?
alcoholics and diabetics
90
what are the causes of upper lobe fibrosis?
C - coal workers pneumonitis
H - histocytosis / hypersensitivity pneumonitis
A - ankylosing spondylitis
R - radiation
T - TB
S - sarcoidosis / silicosis
91
what facial deformity is seen w/ granulomatosis w/ polyangitis?
saddle shaped nose deformity
92
how are most pts w/ small cell lung cancer treated?
chemo and radiotherapy
93
what is 1 pack year defined as?
20 cigarettes a day for 1 year
94
what are the features of heart failure on CXR?
A - alveolar oedema (bat wing opacities)
B - Kerley B lines
C - cardiomegaly
D - dilated upper lobe vessels
E - pleural effusion
95
sudden deterioration w/ ventilation indicates what?
tension pneumothorax
96
which lobes are most commonly affected by aspiration pneumonia?
the right middle and lower lobes
97
what is the severity of COPD categorised based on?
FEV1
98
what is mild COPD / stage 1?
FEV1 >80
99
what is moderate COPD / stage 2?
FEV1 50 - 79
100
what is severe COPD / stage 3?
FEV1 30 - 49
101
what is very severe COPD / stage 4?
FEV1 <30
102
what is an indication for surgery in bronchiectasis?
disease localised to one lobe
103
SIADH is a paraneoplastic syndrome of which lung cancer?
small cell lung cancer
104
what is the likely lung cancer when a pt presents w/ a low Na and why?
small cell lung cancer
because SIADH is a paraneoplastic syndrome of small cell lung cancer and so causes hyponatraemia
105
how does alpha 1 antitrypsin deficiency present?
as emphysema (COPD) in young pts who are non smokers
106
what is the surgical management of late stage alpha 1 antitrypsin deficiency?
lung volume reduction surgery
107
what is the management of a pt w/ COPD who is still breathless despite SABA / SAMA treatment and has no asthmatic / steroid responsiveness?
add LABA / LAMA
108
a post bronchodilator improvement in FEV1 of what is indicative of asthma?
12% or more
109
gynaecomastia is assoc w/ which lung cancer?
adenocarcinoma
110
what is type 1 respiratory failure?
low pO2, no CO2 retention
111
what is type 2 respiratory failure?
low pO2, high pCO2
112
what are the causes of transudative pleural effusions?
heart failure
cirrhosis w/ ascites
hypoalbuminemia
113
what are the causes of exudative pleural effusions?
cancer
infection
inflammatory processes
114
how do transudative and exudative fluids differ on thoracentesis?
transudtive fluids are clear
exudative fluids are cloudy
115
what are the auscultation findings of idiopathic pulmonary fibrosis?
bibasal fine end-inspiratory crepitations
116
what are the imaging findings of idiopathic pulmonary fibrosis?
ground glass appearance
progresses to honeycombing
117
what imaging modality is required to make a diagnosis of idiopathic pulmonary fibrosis?
high resolution CT
118
what are the causes of upper lobe fibrosis?
C - coal workers pneumonitis
H - histiocytosis
A - ankylosing spondylitis
R - radiation
T - tuberculosis
S - sarcoidosis, silicosis
119
all pts w/ pneumonia should have a repeat chest X-ray when?
6 wks after clinical resolution
120
what is the management for all acute exacerbations of COPD regardless of cause?
oral prednisolone 30mg for 5 days
121
in acute asthma which pts should get ABGs?
only if sats are <92%
122
what are the xray features of silicosis?
upper zone fibrosing lung disease
egg shell calcification of the hilarious lymph nodes
123
what is the most common underlying malignancy in pts w/ lambert eaton syndrome?
small cell lung cancer
124
what is the likely diagnosis when there is persistent productive cough +/- haemoptysis in a young person w/ a history of respiratory problems?
bronchiectasis
125
what are the 3 ANCA associated vasculitis?
granulomatosis w/ polyangitis
microscopic polyangitis
eosiniophilic granulomatosis w/ polyangitis (churg strauss syndrome)
126
what is the most common ANCA assoc vasculitis?
granulomatosis w/ polyangitis (wegner syndrome)
127
what is the wegners triad (granulomatosis w/ polyangitis)?
upper resp tract involvement
lower resp tract involvement
renal involvement
128
which antibody is most likely associated w/ eosinophilia granulomatosis w/ polyangitis?
pANCA
129
what are the 3 phases of eosinophilic granulomatosis w/ polyangitis?
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
what is the most likely causative organism of cavitating pneumonia in an alcoholic or diabetic pt?
klebsiella
131
the combination of bronchiectasis and dextocardia is highly suggestive of what?
kartageners syndrome
132
what is the first line treatment for acute bronchitis if treatment is needed?
oral doxycycline
133
what does a normal pCO2 indicate in a severe asthma attack?
exhaustion and therefore life-threatening asthma
134
what is used for the diagnosis of sleep apnoea?
polysomnography
135
how can it be confirmed that NG tubes are safe to use?
pH <5.5 on aspirate
136
what should be done if the pH of aspirate from an NG tube is >5.5.?
get an CXR to confirm the correct location of the NG tube
137
what does eosinophilia in a COPD pt indicate?
asthmatic features therefore steroid responsiveness
138
what is the first line pharmacological treatment for COPD?
SABA / SAMA
139
what class of drug is ipratropium?
SAMA
140
what does diurnal variation indicate in COPD?
asthmatic features
141
what are the most common causes of bilateral hilar lymphadenopathy?
TB
sarcoidosis
142
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?
silicosis
143
gynaecomastia is assoc w/ which lung cancer?
adenocarcinoma
144
what is the management of bilateral pneumothoraces?
chest drain insertion
145
what is the management of legionella?
macrolides such as clarithromycin
146
which antibiotic is used for COPD prophylaxis?
azithromycin
147
what is the next step in the management of severe asthma when other measures haven't worked?
IV magnesium sulphate
148
what is the most common cause of an infective COPD exacerbation?
haemophilus influenzae
149
what is the next investigation of children who have normal spirometry but high clinical suspicion of asthma?
FeNO
150
what is the most common organism in bronchiectasis?
haemophilus influenzae
151
which medication used in the treatment of asthma can cause oral candidiasis?
inhaled ICS
152
what is the first line, following weight loss, for moderate to severe sleep apnoea?
CPAP
153
what is the management of allergic bronchopulmonary aspergillosis?
corticosteroids (prednisolone)
154
what is the difference between the granulomas seen in TB and sarcoidosis?
TB = caseating granulomas
sarcoidosis = non caseating granulomas
155
why does a chest ray need to be done before starting biologics for rheumatoid arthritis?
to look for TB because biologics can reactivate TB
156
what is the likely diagnosis of atypical pneumonia in a younger pt who has erythema multiforme?
mycoplasma pneumoniae
157
cavetating lesions are most commonly seen in which type of lung cancer?
squamous cell lung cancer
158
what are the causes of erythema nodosum?
NO - idiopathic
D - drugs (penicillins)
O - oral contraceptives / pregnancy
S - sarcoidosis
U - ulcerative colitis, crohns
M - microbiology
159
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