Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 4 > Resp > Flashcards

Resp Flashcards

1
Q

what is asthma?

A

chronic inflammatory disease of airway hypersensitivity and variable, reversible obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are 6 triggers of asthma?

A

viral/bacterial infection
allergen exposure
exercise
Night/early morning
Cold, damp, dust
Strong emotion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are 2 medications that can worsen asthma?

A

Beta blockers
NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are 6 risk factors for asthma?

A

FHx
Atopic Hx
Low birth weight
not breastfed
Second hand smoke
High concentration allergens - dustmites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are 5 presentations of asthma?

A

Diurnal episodic SOB
Dry cough
Chest tightness
Wheeze

Symptoms are reversible with bronchodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are 4 investigations of Asthma?

A

1 - Spirometry - FEV1/FVC ratio - <70% predicted and bronchodilator reversibility (FEV1 increase >12%)

1 - Factional exhaled NO - >40 ppb

Peak expiratory flow rate variability >20%

Direct bronchial challenge testing - histamine or methacholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 2 different types of asthma?

A

Eosinophilic - most common (70%)
non-eosinophilic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is atopy?

A

when an individual readily develops IgE against common environmental antigens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is non-eosinophilic asthma triggered by?

A

exercise, cold air, stress, smoking, obesity, menstrual cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is eosinophilic asthma triggered by?

A

allergens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what drug class should you never give to asthmatics?

A

BETA BLOCKERS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what 4 immune cells are present in asthma?

A

mast cells
eosinophils
dendritic cells
lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is one feature of a moderate asthma atack?

A

peak flow 50-70% best/predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are 4 features of a severe asthma attack?

A

inability to complete sentences
pulse >110
RR >25
PEFR 33-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are 6 features of a life threatening asthma attack?

A

silent chest, cyanosis, poor rest effort
confusion and exhaustion
Bradycardia
O2 Sats <92%
PEFR <33%

Normal pCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the management for a mild asthma exacerbation?

A

INH Salbutamol via spacer

Increased ICS dose/oral prednisolone 40-50mg 5 days

f/u within 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the management of a moderate asthma exacerbation?

A

Hospital

Nebulised salbutamol back to back
Oral/IV pred/hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the management of severe asthma exacerbations?

A

Hospital
O2
Nebulised ipratropium bromide
IV magnesium sulphate
IV salbutamol
IV aminophylline

intubation and ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are 3 criterial needed for discharge after an acute asthma exacerbation?

A

stable on discharge medication for 12-24 hours - no O2 or Nebs
INH technique checked
PEF >75% best or predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are 2 effects of excessive salbutamol administration?

A

hypokalaemia
Lactic acidosis - due to tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how is asthma diagnosed with peak flow?

A

a greater than 15% increase in FEV1 or PEFR following bronchodilator inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how do B2 agonists work?

A

binds to B2 receptor coupled with Gs protein
=> adenyl cyclase converts ATP to cyclic AMP =>
increases in cyclic AMP leads to bronchodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how do muscarinic antagonists work?

A

act on M3 receptors
prevent Ach from binding => no smooth muscle contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are 6 side effects of corticosteroids?

A

susceptibility to infection
osteoporosis and muscle wasting
cataracts
diabetes
skin thinning and bruising
growth retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the stepwise medical management of asthma?

A

1 - SABA
2- SABA + low dose ICS
3 - SABA + low dose ICS + LTRA
4 - SABA + low dose ICS + LABA +/- LTRA
5 - SABA + MART +/- LTRA
6 - SABA + medium ICS dose MART +/- LTRA
7 - SABA + high dose ICS OR LAMA OR REFER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is classed as moderate ICS dose?

A

400-800 micrograms budesonide or equivalent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is classed as high dose ICS?

A

> 800 micrograms budesonide or equivalent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are 3 complications of asthma?

A

severe exacerbation
airway remodelling
candida due to inhaled corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the most common causative pathogen in pneumonia?

A

streptococcus pneumoniae

2 - haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are 4 other pathogens that cause pneumonia?

A

Moraxella catarrhalis
Pseudomonas aeruginosa - CF or bronchiectasis
Staph aureus - CF
MRSA - in HAPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are 6 manifestations of pneumonia?

A

Cough
Sputum production
SOB
pleuritic chest pain
Fever
Haemoptysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are 3 signs of pneumonia on auscultation?

A

Bronchial breath sounds
Focal coarse crackles
Dullness to percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what assessment tool is used to assess pneumonia severity?

A

CURB65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the CURB65 score?

A

predicts mortality in pneumonia

Confusion
Urea ≥7mmol/L
Respiratory rate≥ 30/min
Blood pressure; low systolic < 90mm/Hg or diastolic ≤60mm/Hg
Age ≥ 65

1 - low risk (<3%)
>2 - Intermediate risk (3-15%)
>3 - High risk (>15%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what are 3 risk factors for CA pneumonia?

A

> 65 years
resident in healthcare setting
COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are 6 complications of pneumonia?

A

Sepsis
ARDS
Pleural effusion
Empyema
Lung abscess
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what are 5 risk factors for pneumonia?

A

extremes of age
smoking
Chronic resp diseases
immunosuppression
Aspiration risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is the management of low severity CA pneumonia?

A

1 - Amoxicillin 500mg TDS 5 days

PENICILLIN ALLERGY
- Doxycycline 200mg 1st day the 100mg OD for 4 more days
- Erythryomycin 500mg QDS 5 days - PREGNANCY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the management of moderate severity CA pneumonia?

A

1 - Oral Amoxicillin 500mg TDS
AND
Clarithromycin 500mg BD 5 days
OR
Erythromycin 500mg QDS in pregnancy

PENICILLIN ALLERGY
- Doxycycline 200mg first day then 100mg OD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what is the management of severe CA pneumonia?

A

IV Co-amoxiclav AND Clarithromycin

PEN ALLERGY - doxycycline, clarithromycin, erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

when should adults with previous pneumonia get x-ray follow up?

A

After 6 weeks if

Persistent symptoms despite treatment
higher risk of underlying malignancy - >50 years, smoker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is COPD?

A

a progressive disease state characterised by airflow limitation that is not fully reversible. Contains both emphysema and chronic bronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what are 3 risk factors for COPD?

A

smoking
older age
genetics - alpha-1 antitrypsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

why is there increased mucous secretion in COPD?

A

increased goblet cell size and number

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what are 5 manifestations of COPD?

A

SOB
Cough
Sputum
Wheeze
recurrent resp infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what scale can be used for assessing breathlessness in COPD?

A

MRC Dypnoea scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is the grading of the MRC dyspnoea scale?

A

1 - breathless on strenuous exercise
2 - breathless walking uphill
3 - breathless on flat
4 - breathless <100m
5 - Unable to leave house

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what FEV1/FVC ratio is needed for an obstructive lung disease?

A

<0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what FEV1/FVC ratio is needed for a restrictive lung disease?

A

> 0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what is the 1st line Ix for COPD?

A

spirometry - <0.7 AND non reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what might be seen on CXR in COPD?

A

Hyperinflation
Bullae
Flat hemidiaphragm

Also need to exclude lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is the severity grading of COPD?

A

using FEV1

1 - mild - FEV1 >80% predicted
2 - moderate - FEV1 50-79% predicted
3 - severe - FEV1 30-49% predicted
4 - very severe - FEV1 <30% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what 2 vaccinations should people with COPD get?

A

Pneumococcal
Anual flu

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what is the initial medical management of COPD?

A

1 - SABA + SAMA (ipratropium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what 4 things determine if COPD may have steroid responsive features?

A

previous Dx asthma/atopy
FEV1 variation >400mls
Diurnal variation in peak flow >20%
Raised blood eosinophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what is the 2nd line management of COPD without steroid responsive features?

A

LABA + LAMA

Anoro ellipta
Ultibro breezhaler
Duaklir genuair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is the 2nd line management of steroid responsive COPD?

A

LABA + ICS

Fostair
Symbicort
Seretide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

what is the final inhaler combination in either steroid or non-steroid responsive COPD?

A

Tripple therapy - LABA + LAMA + ICS

Trimbow
Trelegy ellipta
Trixeo aeosphere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

what Abx can be given as prophylaxis in COPD?

A

Azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what are 2 things that need monitoring with azithromycin use?

A

ECG - can cause long QT
LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

who is eligible for rescue medications in COPD?

A

exacerbation within last year
understand how to take and risk and benifits
know when to seek help and ask for replacements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

when are phosphodiesterase-4 inhibitors recomended in COPD?

A

roflumilast

severe disease - FEV1 <50% predicted
AND
2+ exacerbations in past year despite maximal therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

what are 4 criteria for LTOT in COPD?

A

Chronic hypoxia
Polycythaemia
Cyanosis
Cor pulmonale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what is needed on ABG for LTOT?

A

pO2 <7.3

OR

pO2 7.3-8 PLUS polycythaemia, peripheral oedema OR pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what is cor pulmonale?

A

right sided heart failure de to respiratory disease

increased pressure in the pulmonary arteries limits R ventricular action which causes back pressure into R atrium, vena cava and systemic venous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what are 5 causes of cor pulmonale?

A

COPD - most common
PE
Interstitial lung disease
CF
primary pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what are 8 clinical manifestations of cor pulmonale?

A

Hypoxia
Cyanosis
Raised JVP
Peripheral oedema
Raised JVP
Peripheral oedema
Parasternal heave
loud S2
Murmurs - pansystolic - tricusp regurg
Hepatomegally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what are ABGs like in COPD exacerbation?

A

Acidosis
Low pO2 - hypoxia and resp failure
Raised pCO2 - retention
Raised bicarb - if chronic retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what is the O2 concentration of room air?

A

21%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what is the O2 concentration of different venturi?

A

Blue 24%
White 28%
Orange 31%
Yellow 35%
Red 40%
Green 60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what is the management of an acute exacerbation of COPD?

A

INH/Neb - Salbutamol + ipratropium
Prednisolone 30mg 5 days

respiratory physio
Abx - if indicated

IV aminophylline
NIV
Intubation and ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what are 3 first line antibiotics in IE COPD?

A

Amoxicillin, clarithromycin, doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what medication can be used as a respiratory stimulant in COPD if NIV/intubation if not indicated?

A

Doxapram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what are 3 inclusion criteria for NIV in COPD?

A

Persistent resp acidosis despite maximal medical management

potential to recover

acceptable to patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what investigation needs to be done before initiating NIV?

A

CXR - exclude pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what are 3 contraindications to NIV?

A

pneumothorax
structural abnormalities
pathology of face, airways or GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

what is alpha-1 Antitrypsin Deficiency?

A

rare genetic condition causing lung and liver problems
early onset COPD/cirrhosis even without smoking/drinking Hx
autosomal co-dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what is the pharmacological treatment for COPD?

A 
bronchodilators 
- SABA => Salbutamol
- SAMA => ipratropium
- LABA => Salmeterol 
- LAMA => tiotropium
Inhaled corticosteroids

order => SABA/SAMA, LABA + LAMA, ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are the 4 stages of COPD?

A

1 - FEV1 >80% predicted
2 - FEV1 50-79%
3 - FEV1 30-49%
4 - FEV <30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what are 3 complications of COPD?

A

Cor pulmonale
resp failure
pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what is HA pneumonia?

A

an acute lower respiratory tract infection that is acquired after at least 48 hours of admission to hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what is the most common cause of early onset HA pneumonia?

A

pseudomonas aeruginosa

< 5 days after admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

what is the most common late onset HA pneumonia?

A

S. Aureus

> 5 days after admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what are 3 risk factors for HA pneumonia?

A

poor infection control/hand hygiene
intubation and mechanical ventilation
decreased consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what extra tests do you have to do in HA pneumonia?

A

sputum culture
nasopharyngeal swap
tracheal aspirate samples

BEFORE antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is the management of HA pneumonia?

A

7-10 days of

Co-amoxiclav
Ceftriaxone
Pipericillin with tazobactam

PLUS Clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

what is pleural effusion?

A

fluid collection between the parietal and visceral pleural surfaces of the thorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

what is the most common cause of pleural effusion?

A

heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

what are 3 risk factors for pleural effusion?

A

pneumonia
malignancy
PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what are 5 manifestations of pleural effusion?

A 
SOB 
dullness to percussion
pleuritic chest pain and rub
cough 
quieter breath sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what are 3 investigations of pleural effusion?

A

posterior-anterior and lateral CXR - blunt costophrenic angle
pleural ultrasound
microscopy and culture of pleural fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

what are 3 differentials for pleural effusion?

A

pleural thinking
pulmonary collapse
elevated hemidiaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what is the treatment for pleural effusion?

A 
loop diuretics - frusemide 
therapeutic throacentesis 
antibiotics if infective
pleurodesis (talc) 
physio
oxygen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what is the normal amount of pleural fluid?

A

5-10ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

what criteria determines whether something is a transudate or exudate?

A

lights criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

what are 3 complications of pleural effusion?

A

pneumothorax
empyema
trapped lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

what are transudates? what causes?

A

pleural fluid protein < 1/2 serum protein

caused by HF, liver failure, kidney failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

what are exudates? what causes?

A

pleural fluid protein > 1/2 serum protein

caused by pneumonia, cancer, TB, drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what is empyema?

A

a bacterial pussy infection of the pleural fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

what are 4 risk factors for pneumothorax?

A

smoker
FHx
previous pneumothorax
tall and thin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what are 4 causes of pneumothorax?

A

Primary spontaneous - due to rupture of subpleural bleb/bullae

Secondary spontaneous - pre-existing lung condition, due to rupture of pulmonary tissue

Trauma
Iatrogenic - lung biopsy, mechanical ventilation, central line insertion
Pathology - infection, asthma, COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

what are 6 manifestations of pneumothorax?

A

Sudden onset pleuritic chest pain
Sudden onset SOB
Tachycardia and Tachypnoea
Cyanosis
Hyperresonance
Reduces breath sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

what is a tension pneumothorax?

A

severe pneumothorax resulting in displacement of mediastinal structures resulting in severe respiratory distress and haemodynamic collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

what is a catamenial pneumothorax?

A

pneumothorax occuring in menstruating women thought to be due to endometriosis within thorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what are 4 extra clinical manifestations of tension pneumothorax?

A

ipsilateral hyper expansion
contralateral tracheal deviation
hypotension
respiratory distress

shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

what is seen on CXR in pneumothorax?

A

loss of lung markings and shrunken lung edge

in tension - mediastinal shift and tracheal deviation

Should measure size of pneumothorax horizontally from lung edge to inside of chest wall at level of hilum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

what is the gold standard investigation for pneumothorax?

A

CT chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what is the management for low risk small pneumothorax?

A

No/Minimal symptoms (<2cm pneumothorax)

CONSERVATIVE MANAGEMENT

Priamary - r/v every 2-4 days as OP
Secondary - monitor as inpatient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what are 6 features of a high risk pneumothorax?

A

haemodynamic compromise
significant hypoxia
bilateral pneumothorax
Underlying lung disease
>50 years + Smoker
Haemothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what are the management options for pneumothorax without high risk features where it is safe to intervene?

A

Conservative management - if minimal symptoms
Pleural vent ambulatory device
Chest drain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

what is the management of high risk safe to intervene pneumothorax?

A

chest drain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

when is it safe to intervene in a pneumothorax?

A

2cm lateral or apical on CXR
any size on CT which can be safely accessed with radiological support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

what is the follow up of a pneumothorax with needle aspiration/chest drain?

A

OP f/u 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

where are chest drains inserted?

A

triangle of safety
- 5th intercostal space
- mid-axillary line
- anterior axillary line

just above rib to avoid neurovascular bundle

X-ray to check insertion site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

what is a swinging chest drain?

A

aid bubbling trough fluid in drain bottle, rising and falling during respiration

bubbling as swinging reduces as pneumothorax resolves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

what are 2 complications of chest drains?

A

air leaks - around incision site

surgical emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

what is the management of recurrent/unresolving pneumothorax?

A

Video-assisted throascopic surgery - VATS
- Abrasive pleurodesis
- chemical pleurodesis
- pleurectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

when can people with pneumothoraxes fly?

A

BTS suggest - 1 week post check X-ray

used to say 6 weeks post pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

what is one activity that people with pneumothoraxes should never do?

A

Scuba diving

UNLESS - surgical pleurectomy and normal lung function and chest CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

what are 3 causes of tension pneumothorax?

A

Trauma
iatrogenic - thoracentesis, NIV
Spontaneous - underlying lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

what is the management for a tension pneumothorax?

A

14G (orange) cannula into 2nd intercostal space midclavicular line - needle throacostomy

OR (ALTS) /5th intercostal space anterior to midaxillary line

High flow O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

what are 5 signs of a tension pneumothorax?

A

Tracheal deviation - away from pneumothorax
reduced air entry on one side
Hyperressonance of affected side
tachycardia
hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

what is the causative agent for TB?

A

mycobacterium tuberculosis

acid fast bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

what staining is used for mycobacterium tuberculosis?

A

Zeihl-neelson stain

Turns bright red against blue background

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

what are the 4 possible outcomes of TB?

A

Clearance - most people
Primary active TB - active infection after exposure
Latent TB
Secondary TB - reactivation of latent TB to active infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

what is the name of disseminated severe TB?

A

Miliary TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

where is the most common site of TB?

A

lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

where are 8 possible locations for extrapulmonary TB?

A

Lymph nodes
Pleura
CNS
Pericardium
GI system
GU system
Bones and joints
Skin (cutaneous)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

what are tuberculoid abscesses like?

A

‘cold’ abscess - firm painless abscess caused by TB - not hot red and painful like other abscesses

130
Q

what are 5 risk factors for TB?

A

birth in endemic country
exposure to infection
immunosuppression
Homelessness
IVDU

131
Q

what is the pathophysiology of TB?

A

Inhalation of droplet nuclei => engulfed by alveolar macrophages => Multiplies within alveolar macrophage and burst out causing a response from the immune system => either clearance, latent infection or progression to primary disease

132
Q

what kind of granuloma is formed in TB?

A

caseating

133
Q

what is the lesion in the lungs in TB known as?

A

Ghon focus

134
Q

what are 9 presentations of TB?

A

Cough
fever
anorexia/weight loss
lethargy
night sweats
haemoptysis
Lymphadenopathy
Erythema nodosum
Spial pain - spinal TB

135
Q

what are 2 investigations for an immune response to TB?

A

Mantoux test
Interferon-gamma release assay

136
Q

what is the mantoux test?

A

For TB (+ve after BCG)

inject tuberculin into intradermal space in forearm, leave for 72 hours and measure - >5mm = +ve

137
Q

what is the interferon-gamma release assay?

A

For TB

mix blood sample with TB antigens - interferon gamma will be released if previous TB sensitisation

138
Q

what can be seen on CXR in TB?

A

Primary - patchy consolidation, pleural effusions and hilar lymphadenopathy

Secondary - patchy/nodular consolidation, cavitation, typically in upper zones

Disseminated - millet seeds uniformly distributed across lung fields

139
Q

what investigation can be used in TB to determine genetic material of pathogen that is quicker than culture?

A

nucleic acid amplification test

140
Q

what is the gold standard investigation of TB?

A

sputum culture

141
Q

what is the treatment for active TB?

A

RIPE

rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 2 months
Ethambutol - 2 months

142
Q

what is the treatment of latent TB?

A

Isoniazid PLUS rifampicin for 3 months
OR
Isoniazid for 6 months

143
Q

what are 2 side effects of Rifampicin?

A

Rifam-PISSIN
Red/orange bodily secretions
Cytochrome P450 inducer

144
Q

what is one key side effect of isoniazid?

A

Iso-numb-azid

Peipheral neuropathy

145
Q

what is co-prescribed with isoniazid to reduce side effects?

A

Pyridoxine B6

146
Q

what is one key side effect of pyrazinamide?

A

Hyperuricaemia - gout and kidney stones

147
Q

what is one key side effect of ethambutol?

A

E = Eyes!

Colour blindness and reduced visual acuity

148
Q

what 3 TB medications cause hepatotoxicity?

A

Rifampicin
Isoniazid
Pyrazinamide

149
Q

what are 3 complications of TB?

A

transmission
ARDS
pneumothorax

150
Q

what do you have to do when someone is diagnosed with TB?

A

INFORM PUBLIC HEALTH ENGLAND
Isolate patient

151
Q

what are 5 atypical pneumonia pathogens?

A

Legions of psittaci MCQs

Legionella pneumophila - air conditioning, water sources, hyponatraemia, deranged LFTs

Chlamydophila psittaci

Mycoplasma pneumoniae

Chlamydophila pneumoniae

Q fever - Coxiella burnetti

152
Q

How is legionnaire’s disease diagnosed?

A

Urinary legionella antigen

153
Q

what is the management of legionnaire’s disease?

A

Clarithromycin

500mg PO BD 4-14 days
OR
IV 500mg every 12 hours for 5 days

154
Q

what is one complication of legionnaire’s disease?

A

SIADH leading to hyponatraemia

155
Q

what is a presenting feature of mycoplasma pneumoniae pneumonia?

A

Mild pneumonia

Erythema multiforme rash - target lesions of pink rings with pale centres

can also cause neurological symptoms in young patients

156
Q

what pathogen in pneumonia is associated with birds?

A

Chlamyia psittaci

157
Q

what pneumonia causing pathogen is associated with farmers and cattle?

A

Coxiella burnetti - causes Q fever

158
Q

when is S. Aureus normally a causative agent of pneumonia?

A

HAP
after recent influenza
after being on a ventilator

159
Q

what are the signs of ephysema?

A

pink puffers - breathing with pursed lips
barrel chest
flattened diaphragm

160
Q

what are the signs of chronic bronchitis?

A

wheeze
crackles or rales
cyanosis - blue bloaters

161
Q

what is is the name of a focal caseating granuloma in TB shown on X-ray?

A

Ghon complex

162
Q

what kind of hypersensitivity reaction in TB?

A

type 4

163
Q

what are 4 side effects of rifampicin?

A

hepatitis
orange bodily fluids
flu like symptoms
impaired contraceptive pill

164
Q

what are 3 side effects of isoniazid?

A

hepatitis
peripheral neuropathy - pyridoxine prophylaxis
agranulocytosis

165
Q

what are 3 side effects of pyrazinamide?

A

hepatitis
gout
arthralgia and myalgia

166
Q

what are 2 side effects of ethambutol?

A

optic neutritis

renal impairment

167
Q

what bacteria is associated with pneumonia in COPD?

A

Haemophilus influenzae

168
Q

what bacteria is associated with pneumonia as a secondary cause or with access or empyema?

A

s. aureus

169
Q

what fungus can cause pneumonia in immunosuppressed people - usually with HIV?

A

pneumocytitis jiroveci

170
Q

what is the most common opportunistic infection in people with HIV?

A

penumocytitis jiroveci - AIDS defining illness

171
Q

what staining identifies pneumocytitis jiroveci?

A

silver staining - fungi

172
Q

what is the first line management of pneumocytitis jiroveci?

A

1 - Co-trimoxazole - trimethoprim/sulfamethoxazole

2 - IV pentamidine - in severe cases

Steroids if hypoxic

173
Q

when should prophylaxis for pneumocystis jirovecii be given?

A

if CD4 count <200 or Hx of AIDS defining illness

Give co-trimoxazole

174
Q

what kind of disease is sarcoidosis?

A

non-caeseating granulomatous disease of unknown aetiolgy that can affect any organ but primarily affects the lungs and intrathoracic lymph nodes

175
Q

what are granulomas?

A

inflammatory nodules full of macrophages

176
Q

what is the typical sarcoidosis patient?

A

20-40 or around 60 years
Female
Black ethnic origin

177
Q

what 8 systems are affected by sarcoidosis?

A

Skin
Respiratory
Hepatobiliary
Ophthalmic
Cardiac
Renal
Central and peripheral nervous systems
Musculosceletal

Can also have systemic symptoms

178
Q

what are 2 skin presentation in sarcoidosis?

A

Erythema nodosum - nodules of inflamed subcutaneous fat on the shins - red/dusky raised, tender painful subcutaneous nodules on both shins

Lupus pernio - raised purple skin lesions often on cheeks and nose

179
Q

what are 3 presentations of pulmonary sarcoidosis?

A

Bilateral hilar lymphadenopathy - seen on CXR or CT
Obstructive pattern on spirometry - pulmonary fibrosis/nodules

SOB, Dry cough on exertion, chest discomfort

180
Q

what are 3 hepatobiliary presentations of sarcoidosis?

A

Liver nodules
cirrhosis
cholestasis

181
Q

what are 3 ophthalmic presentations of sarcoidosis?

A

Uveitis
conjunctivitis
optic neuritis

182
Q

what are 3 cardiac signs of sarcoidosis?

A

Bundle branch block
Heart block
Myocardial muscle involvement

183
Q

what are 3 renal presentations of sarcoidosis?

A

Kidney stones - due to hypercalcaemia
Nephrocalcinosis
Interstitial nephritis

184
Q

what are 5 neurological presentations of sarcoidosis?

A

nodules
pituitary involvement - diabetes insipidus
encephalopathy
facial nerve palsy
mononeuritis multiplex

185
Q

what are 3 MSK presentations of sarcoidosis?

A

arthritis
arthralgia
myopathy

186
Q

what is the classical presentation of sarcoidosis?

A

Lofgren’s syndrome - triad

erythema nodosum
bilateral hilar lymphadenopathy
Polyarthralgia

187
Q

what electrolyte imbalance does sarcoidosis cause?

A

hypercalcaemia

188
Q

what is the gold standard investigation for sarcoidosis?

A

US guided biopsy of mediastinal lymph nodes on bronchoscopy

189
Q

what enzyme is elevated in sarcoidosis?

A

angiotensin converting enzyme (ACE) - all granulomatous disease

190
Q

what are 6 differentials for sarcoidosis?

A

TB
Lymphoma
HIV
Hypersensitivity pneumonitis
Toxoplasmosis
Histoplasmosis

191
Q

How can bilateral hilar lymphadenopathy be diagnosed in sarcoidosis?

A

CXR/CT chest

192
Q

what is the management for sarcoidosis?

A

Conservative management in mild/asymptomatic

1 - Oral corticosteroids - Prescidolone 20-40mg OD
AND bisphosphonates to protect against bone disease

2 - Methotrexate

Lung transplant may be required in severe disease and progression to pulmonary fibrosis

193
Q

what proportion of the caucasian population is a carrier for CF?

A

1 in 25

194
Q

what value is pulmonary hypertension?

A

> 20 mmHg at rest

195
Q

what is pulmonary hypertension?

A

increased ressitance and pressure in the pulmonary arteries causing strain on R heart

196
Q

what are group 1 causes of pulmonary hypertension?

A

idiopathic pulmonary hypertension or connective tissue disease (SLE)

197
Q

what are group 2 causes of pulmonary hypertension?

A

L disease

Heart failure
valvular heart disease
HOCM

198
Q

what are group 3 causes of pulmonary hypertension?

A

Chronic lung disease - COPD, pulmonary fibrosis
Chronic high altitude or hypoxia

199
Q

what are group 4 causes of pulmonary hypertension?

A

pulmonary vascular disease - PE, pulmonary artery obstruction (sickling, tumours)

200
Q

what are group 5 causes of pulmonary hypertension?

A

Miscellaneous - sarcoidosis, glycogen storage disease, haematological disorders

201
Q

what are 6 manifestations of pulmonary hypertension?

A

SOB
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema

202
Q

what ECG changes are seen in pulmonary hypertension?

A

P pulmonale - peaked P waves
R ventricular hypertrophy - tall R waves in V1/2, deep S waves in V5/6
Right axis deviation
RBBB

203
Q

what is the gold standard for pulmonary hypertension?

A

right heart catheterisation - directly measures pulmonary pressures

204
Q

what is seen on CXR in pulmonary hypertension?

A

Dilate pulmonary arteries
R ventricular hypertrophy

205
Q

what is the management of idiopathic pulmonary hypertension?

A

1 - Calcium channel blockers - nifedipine
Prostaglandins - epoprostenol
Endothelin receptor antagonist - macitentan
Phosphodiesterase-5 inhibitors - sildenafil

206
Q

what type of sensitivity reaction is hypersensitivity pneumonitis?

A

type III/IV

207
Q

what is goodpasture’s syndrome also known as?

A

Anti-glomerular basement membrane disease

208
Q

what’s goodpasture syndrome?

A

Autoimmune disorder which causes IgG antibodies against type IV collagen in glomerular and alveolar basement membranes leading to rapidly progressing glomerulonephritis and pulmonary haemorrhage

209
Q

what are 8 presentations of goodpasture’s syndrome?

A

Haemoptysis
Haematuria
Oliguria
Malaise
Lung crackles
hypertension
peripheral oedema
pallor

210
Q

what are 3 risk factors of goodpastures?

A

HLA-DR15
Male
smoking
infection may be a trigger

211
Q

what antibodies are present in goodpasture’s syndrome?

A

anti-GBM antibodies

212
Q

what is seen on renal biopsy in goodpasture’s syndrome?

A

Cresenteric glomerulonephritis or linear deposition of IgG along glomerular capillaries

213
Q

what is the management of goodpasture’s syndrome?

A

1 -
Corticosteroids
Cyclophosphamide
Plasma exchange

2 - dialysis

214
Q

what are 4 complications of goodpasture’s syndrome?

A

AKI
CKD
resp arrest
Corticosteroids side effects

215
Q

what are 3 differentials for goodpastures?

A

wegener’s granulomatosis
SLE
microscopic polyangitis

216
Q

what is the management of good pastures?

A

immunosuppressants - corticosteroids, cyclophosphamide
plasmapheresis
dialysis
ventilation

217
Q

what is c-ANCA a marker for?

A

Wegener’s granulomatosis

218
Q

what is Wegener’s granulomatosis?

A

A multi-system disorder of unknown causes characterised by necrotising granulomatous inflammation and vasculitis of small vessels.
affects resp tract and kidneys and is treated with steroids and immunosuppression

219
Q

what does pulmonary hypertension look like on CXR?

A

Enlargement of the pulmonary arteries
Lucent lung fields
Enlarged right atrium
Elevated cardiac apex due to right ventricular hypertrophy

220
Q

what kind of lung tumour can cause Horners syndrome?

A

pancoast tumour

221
Q

what does a pancoast tumour press on to cause Horner’s syndrome?

A

the sympathetic chain

222
Q

name an ICS?

A

budesonide

223
Q

what is bronchiectasis?

A

permanent dilation of the bronchi leading to sputum and organism collection resulting in a chronic cough, sputum production and infections

224
Q

what are 8 causes of bronchiectasis?

A

Idiopathic
Pneumonia
Whooping cough
TB
Alpha-1-antitrypsin deficiency
Connective tissue disorders
CF
Yellow nail syndrome

225
Q

what is yellow nail syndrome?

A

Condition causing yellow fingernails, bronchiectasis and, lymphedema

226
Q

what are 4 symptoms of bronchiectasis?

A

SOB
Chronic productive chough
Weight loss

227
Q

what are 4 signs o/e of bronchiectasis?

A

Wt loss/cachexia
Finger clubbing
Signs of cor pulmonal - raised JVP, peripheral oedema
Scattered crackles, wheezes and squeaks

228
Q

what are 2 common infective organisms in bronchiectasis?

A

Haemophilus influenzae
Pseudomonas aeruginosa

229
Q

what can be seen on CXR in bronchiectasis?

A

Tram-track opacities - parallel marking of side view of dilated airways

Ring shadows - dilated airways seen on end

230
Q

what is the investigation of choice for bronchiectasis?

A

High es CT thorax

231
Q

what pattern is seen on spirometry in bronchiectasis?

A

obstructive - <0.7 FEV1:FVC

232
Q

what prophylactic Abx are given in bronchiectasis with >3 exacerbations per year?

A

Azithromycin

233
Q

colonisation with what bacteria in bronchiectasis can be treated with inhaled colistin?

A

pseudomonas aeruginosa

234
Q

what antibiotic is given in pseudomonas aeruginosa pneumonias in bronchiectasis?

A

Ciprofloxacin

usually extended courses of ABx in bronchiectasis - 7-14 days

235
Q

what are 4 complications of bronchiectasis?

A

pneumothorax
empyema
lung abscess
life threatening haemoptysis

236
Q

what is the most common demographic for sarcoidosis?

A

black females

237
Q

what is the name of a leukotriene receptor antagonist?

A

Montelukast

238
Q

what are 6 features of well controlled asthma?

A

no night time symptoms
inhaler used < 3X a week
no breathing difficulties most days
exercise without symptoms
normal lung function test

239
Q

What are pleural plaques?

A

Most common manifestation of asbestos related lung disease after a latent period of 20-40 years

benign pleural plaques

usually seen on CT

240
Q

what is asbestosis?

A

lung fibrosis due to asbestos exposure, exposure related severity

15-30 year latent period

fibrosis picture

241
Q

what are 5 features of mesothelioma?

A

SOB, Wt loss, chest wall pain
CLubbing
painless pleural effusion
20% have pre-existing asbestosis
Hx of asbestos exposure in 85-90%

242
Q

what investigations are used in mesothelioma?

A

CXR
chest CT
Pleural tap if effusions for MC+S
Local anaesthetic thoracoscopy
image guided biopsy

243
Q

what is acute bronchitis?

A

A chest infection which is usually viral and self limiting (3 week course) and causes inflammation of the trachea and major bronchi leading to sputum production

244
Q

what are 4 presentations of acute bronchitis?

A

Cough
sore throat
rhinorrhoea
wheeze

245
Q

what is the difference between acute bronchitis and pneumonia?

A

Sputum, wheeze and breathlessness may be absent in acute bronchititis

O/E - no focal chest signs in acute bronchitis other than wheeze. No malaise, myalgia, fever

246
Q

what is the management of acute bronchitis?

A

Supportive

consider Abx delayed if CRP 20-100 or immediate >200 - doxycycline or amoxicillin

247
Q

what is an upper respiratory tract infection (URTI)?

A

Acute usually viral infection of the upper respiratory tract - nose, sinuses, pharynx or larynx

rhinitis, sinusitis, pharyngitis, laryngitis

248
Q

what are 4 presentations of URTI?

A

Sore throat
Nasal discharge
dry cough
headache
tiredness

usually resolves in 7-10 days but can last up to 3 weeks

249
Q

what are 3 complications of an URTI?

A

sinusitis
otitis media
secondary bacterial infection

250
Q

what are 8 risk factors for pulmonary embolism?

A

Immobility
Recent surgery
Long haul travel
pregnancy
Hormone therapy with oestrogen - HRT, COCP
Malignancy
Polycythaemia
SLE
Thrombophilia

251
Q

what are 9 presentations of pulmonary embolism?

A

SOB
Cough
Haemoptysis
Pleuritic chest pain
Hypoxia
Tachycardia
Raised Resp rate
low grade fever
haemodynamic instability

252
Q

what ECG changes may be present in PE?

A

sinus tachycardia
ST segment and T wave abnormalities
Right axis deviation
RBBB

S1Q3T3 - S wave in lead 1, Q wave in lead 3, T wave inversion in lead 3)

253
Q

what scoring system can be used to rule out PE?

A

Pulmonary embolism rule out criteria - PERC - all -ve = <2% chance of PE

254
Q

What score is used to predict probability of pulmonary embolism?

A

Wells score for PE

255
Q

what are 6 conditions that can cause raised D Dimer?

A

VTE
Pneumonia
Malignancy
Heart failure
Surgery
Pregnancy

256
Q

what is the 1st line imaging for pulmonary embolism?

A

CT pulmonary angiogram

257
Q

what scan is done for pulmonary embolism for patients with renal impairment or contrast allergy?

A

ventilation perfusion (VQ) scan

258
Q

What is usually seen on ABG in pulmonary embolism?

A

respiratory alkalosis - due to blowing off CO2, also hypoxia

259
Q

what is the management of massive PE?

A

Thrombolysis -
Alteplase - 10mg over 1-2mins, then 90mg over 2 hours
Tenecteplase, streptokinase

Unfractioned heparin

260
Q

what is the acute management of pulmonary embolism in patients with no comorbidities?

A

Interim anticoagulation if testing not immediately available

1 - Apixaban 10mg BD 7 days PO
OR
Riveroxaban 15mg BD for 21 days

2 - LMWH for 5 days then dabigatran or edoxaban
OR
LMWH and warfarin for 5 days till INR stable then Warfarin alone
Warfarin induction = 10mg for 2 days then 3-9mg maintenance

261
Q

what is the long term management of pulmonary embolism in patients with no other comorbidities?

A

1 - Continue DOAC for at least 3 months
Apixaban - 5mg BD
Rivaroxaban - 20mg OD

2 - Continue DOAC/Warfarin for 3 months
Edoxaban 60mg OD (30mg if weight <60kg)
Dabigatran - dose based on age
Warfarin - 3-9mg OD maintenance

262
Q

what is the management of pulmonary embolism in renal impairment (creatinine clearance <15 ml/min)?

A

LMWH
Unfractionated heparin
LMWH/UFH then Warfarin

263
Q

what is the management of pulmonary embolism in active cancer?

A

DOAC if suitable for 3-6 months

264
Q

what are 2 interventions for recurrent pulmonary embolism?

A

Inferior vena cava filter
Surgical embolectomy 0 if thrombolysis is contraindicated/failed

265
Q

what is the 1st line anticoagulant in pulmonary embolism in pregnancy?

A

LMWH

266
Q

what are 5 genetic conditions that increase risk of pulmonary embolism?

A

Factor V leiden
Prothrombin gene mutation
Protein C deficiency
Protein S deficiency
Antithrombin

267
Q

what PE well score means that pulmonary embolism is unlikely?

A

<4

268
Q

what PE wells score means that pulmonary embolism is likely?

A

4+

269
Q

what is the next step in pulmonary embolism diagnosis if wells is <4

A

D dimer

270
Q

what is the next step in PE diagnosis if wells score is >4?

A

Immediate CTPA

Interim anticoagulation if CTPA is delayed - DOAC or LMWH

271
Q

what scoring system can be used to assess the severity of PE?

A

Pulmonary embolism severity index

272
Q

what are 5 complications of pulmonary embolism?

A

Cor pulmonale
Pulmonary infarction
Heparin associated thrombocytopaenia
Pleural effusion
Respiratory failure

273
Q

what are 8 causes of occupational lung disease?

A

Silica - mining, quarrying, construction, ceramics
Coal
Asbestos
Sulphur dioxide - burning fossil fuels
Nitrogen oxide - welding
Ozone - photocopying, welding
Moulds and fungi
Bacteria and animal proteins
Radiation

274
Q

what spirometry picture is usually seen in occupational lung disease?

A

restrictive picture FEV1/FVC >0.7

275
Q

what lung condition can be caused by inhalation of inorganic dusts?

A

Pneumoconiosis - accumulation of dust in lungs and the response of bodily tissues to its presence

276
Q

what is the pathophysiology of pneumoconiosis?

A

Dust (usually coal) particles are inhaled and reach terminal bronchi where they are ingested by interstitial and alveolar macrophages - over long periods of time the macrophages are no longer able to expel mucus and accumulate in alveoli resulting in immune activation and tissue damage

277
Q

what are 6 complications of occupational lung disease?

A

Pulmonary fibrosis
COPD
Lung cancer
Pleural disease
Hypoxaemia
Cor pulmonale

278
Q

what are 2 radiological features of silicosis?

A

Upper zone fibrosing lung disease
Egg shell calcification of hilar lymph nodes

279
Q

what condition does silicosis increase risk of?

A

Tuberculosis

280
Q

what is the most common cause of pulmonary fibrosis?

A

idiopathic pulmonary fibrosis

281
Q

what are 7 causes of upper zone pulmonary fibrosis?

A

CHARTS

Coal workers pneumoconiosis

Hypersensitivity pneumonitis (extrinsic allergic alveolitis)

Ankylosing spondylitis

Radiation

Tuberculosis

Silicosis/Sarcoidosis

282
Q

what are 5 causes of lower zone pulmonary fibrosis?

A

Idiopathic pulmonary fibrosis
Asbestosis
Drug induced
Connective tissue disorders - SLE
Radiation

283
Q

what are 5 drugs that can cause pulmonary fibrosis?

A

Amiodarone
Cytotoxic agents - busulphan, bleomycin
Methotrexate
Nitrofurantoin
Ergot derived dopamine receptor agonists

284
Q

what are 5 risk factors for idiopathic pulmonary fibrosis?

A

Older age
Male
Smoking
FHx
Dust exposure - hypersensitivity pneumonitis, occupational exposure

285
Q

what are 5 presentations of pulmonary fibrosis?

A

progressive dyspnoea
Dry cough
Malaise
Bibasal fine end-inspiratory crackles
Clubbing

286
Q

what is seen on imaging in pulmonary fibrosis?

A

Small irregular opacities - ground glass appearance, progressing to honey combing

May be seen on CXR more likely on CT

287
Q

what is found on spirometry in pulmonary fibrosis?

A

FEV1/FVC >0.7
FEV1 = normal/decreased
FVC = decreased

288
Q

what are 5 other conditions associated with pulmonary fibrosis?

A

Alpha-1 antitrypsin
RhA
SLE
systemic sclerosis
Sarcoidosis

289
Q

what is the general management of pulmonary fibrosis?

A

Removal of underlying cause
LTOT
Stop smoking
physio and pulmonary rehab
pneumococcal and flu vaccine
Advanced care planning
Lung transplant

290
Q

what are 2 antifibrotic agents that can be used in pulmonary fibrosis?

A

Pirfendidone
Nintedanib

if FVC 50-80% predicted

291
Q

what investigation can be used to diagnose hypersensitivity pneumonitis?

A

Bronchoalveolar lavage on bronchoscopy

292
Q

What are 4 types of hypersensitivity pneumotitis?

A

Bird fanciers lung
Farmers lung - mouldy hay spores
Mushroom workers lung
Malt workers lung - reaction to barley mould

293
Q

what chromosome is CF carried on?

A

chromosome 7

294
Q

mutations on what gene causes CF?

A

Cystic fibrosis transmembrane conductance regulatory gene

295
Q

what is often the first sign of CF?

A

meconium ileus - not passing meconium in 24 hours, abdo distention, vomiting

296
Q

what are 7 causes of clubbing in children?

A

hereditary
cyanotic heart disease
infective endocarditis
CF
TB
IBD
Liver cirhosis

297
Q

what is the diagnostic chloride concentration on sweat test for CF?

A

> 60 mmol/L

298
Q

which are 2 bacteria which are especially difficult to treat in CF?

A

pseudomonas aeruginosa
Burkholderia cepacia

299
Q

what is the management of CF?

A

multidisciplinary

chest physio
exercise
high calorie diet
CREON tablets - for pancreatic insufficiency
prophylactic flucloxacillin
Tx chest infections
bronchodilators
DNase nebs - help clear secretions
hypertonic saline nebs
vaccinations

300
Q

what does the CF transmembrane conductance regulatory gene code for?

A

Chloride channels

301
Q

what are 3 features of CF?

A

thick pancreatic and biliary secretions causing blockages
low vllume thick airway secretions
congenital bilateral absence of vas deferens

302
Q

what is the inheritance of CF?

A

autosomal recessive

303
Q

what are 3 key tests for CF?

A

newborn blood spot test
sweat test - GOLD
genetic testing

304
Q

what is the diagnostic chloride conc for CF on sweat test?

A

60 mmol/L

305
Q

what is treatment for pseudomonas infection in CF?

A

long termtobramycin nebs

or oral ciprofloxacin

306
Q

what medication can be used in CF patients who are homozygous for the delta F508 mutation?

A

Lumacaftor/Ivacaftor (Orkambi)

307
Q

what is one contraindication to lung transplant in CF?

A

Chronic infection with burkholderia cepacia

308
Q

what are 5 GI complications of CF?

A

Pancreatic insufficiency
Liver disease
meconium ileus
distal intestinal obstruction
GORD

309
Q

what is asthma COPD overlap syndrome?

A

persistent airflow limitation witgh both features of asthma and COPD.

Reversibility, eosinophilic bronchial and systemic inflammation and increased response to ICS

more common in smokers/ex-smokers

310
Q

what is the gold standard test for COVID-19?

A

RT-PCR

311
Q

what is an antiviral that can be given in COVID-19?

A

Remedesivir - for hospital patients requiring O2

312
Q

what are 3 medications that can be used in the management of COVID?

A

Antivirals - remdesivir
dexamethasone
immunomodulators - tocilizumab

313
Q

what are 8 causes of respiratory arrest?

A

Neuromuscular disorders - leading to weak respiratory muscles
Pulmonary disorders - obstructive or restrictive lung disease leading to severely reduced lung function
CNS disorders - stroke, brain injury, tumours
Metabolic alterans - alkalosis/acidosis
Trauma
Anaphylaxis
Toxic ingestions/inhalations
Infections

314
Q

how does hypercapnia and acidosis cause CNS depression?

A

increased CO2 levels causes cerebral vasodilation which increased ICP
Acidosis causes CND functional depression including resp centres

CNS depression reduces responsiveness of respiratory centre leading to decreased respiratory effort

315
Q

what are 2 respiratory patterns that indicate respiratory arrest?

A

Agonal breathing - gasping, laboured infrequent, irregular breaths
Absent breathing

316
Q

what is respiratory failure?

A

when the respiratory system fails to maintain adequate gas exchange resulting in hypoxia and/or hypercapnia

317
Q

what is type 1 respiratory failure?

A

Low paO2 (<8 KPa)

Normal/low paCO2

318
Q

what is type 2 respiratory failure?

A

Low/normal O2 (<8 KPa)

High PaCO2 (>6 KPa)

319
Q

what are 5 causes of type 1 respiratory failure?

A

Pnemonia
Heart failure
Asthma
PE
High altitude pulmonary oedema

320
Q

what are 6 causes of type 2 respiratory failure?

A

opiate toxicity
iatrogenic
neuromuscular disease
reduced chest wall compliance
increased airway resistance - COPD
severe impairment of gas exchange

321
Q

what is the management of type 1 respiratory failure?

A

Oxygen
Positive end expiratory pressure - CPAP
Extracorporeal membrane oxygenation (ECMO)

treat cause

322
Q

what is the management of type 2 respiratory failure?

A

Oxygen failure
NIV
Invasive mechanical ventilation

treat cause

Phase 4 (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions