Resp Flashcards
What are small cell lung cancer associated hormones?
ADH, ACTH, Lambert Eaton
What are squamous lung cancer associated conditions?
PTH, Clubbing, HPOA, Ectopic TSH
What are adenocarcinoma associated conditions?
Gynaecomastia, HPOA
What are the stages of sarcoidosis?
1 BHL, 2 BHL and infiltrates, 3 infiltrates without BHL, 4 fibrosis
What indicates a good prognosis in sarcoidosis?
HLA B8, Erythema Nodosum, polyarthritis, fever
What is the first line investigation for asthma in adults?
FBC for eosinophilia or fractional nitric oxide. Bronchodilator reversibility with spirometry is diagnostic.
What does respiratory alkalosis + normal PaO2 indicate?
Anxiety
What does respiratory alkalosis + reduced PaO2 indicate?
Pulmonary Embolism (PE)
What is the target oxygen saturation for COPD once CO2 is normal?
94-98%
What is the treatment for allergic bronchopulmonary aspergillosis?
Prednisolone
What are the stages of idiopathic pulmonary fibrosis (IPF)?
Small peripheral changes in lower zones -> ground glass -> honeycombing
What do ground glass changes indicate?
Organising pneumonia
What is CURB65 criteria?
RR >30, DBP <60
When is a chest tube indicated?
Purulent fluid, culture or pH <7.2
What causes a left shift in the oxygen dissociation curve?
Lower acidity, temperature, 2-3 DPG, HbF, carboxy/methyhaemoglobin
What causes a right shift in the oxygen dissociation curve?
Raised acidity, temperature, 2-3 DPG
What conditions are associated with bronchiectasis?
CF, Measles, Hypogammaglobulinaemia, Aspergillosis
What happens if you have high EPO due to altitude or marathon running?
Secondary polycythaemia increases stroke risk
What is the cut-off for pulmonary arterial pressure?
> 20
When is NIV indicated in COPD?
In T2RF that does not improve with medical therapy
What happens to TLCO in asbestosis?
It is reduced
What is the treatment for Chlamydia psittaci?
Doxycycline
What is EAA?
Hypersensitivity pneumonitis with a primarily granulomatous inflammatory response
What does normal PCO2 in acute severe asthma indicate?
Life threatening condition
What is the treatment for High Altitude Pulmonary Edema (HAPE)?
Descent, oxygen, nifedipine
What indicates bronchiolitis obliterans in a patient with rheumatoid arthritis?
Dyspnoea and obstructive pattern on spirometry
How much does smoking increase lung cancer risk?
x10, asbestos x5, both x50
What is the association of bronchiectasis with eosinophilia and fungal hyphae?
Allergic bronchopulmonary aspergillosis treated with oral prednisolone
What can oral itraconazole be used for?
As a steroid sparer
What are Light’s Criteria for exudative effusion?
Requires one of the following: Pleural fluid protein / Serum protein >0.5, Pleural fluid LDH / Serum LDH >0.6, Pleural fluid LDH > 2/3 * Serum LDH upper limit of normal
Is glucose used in Light’s Criteria?
No
What are the symptoms of Eosinophilic Granulomatosis (Churg Strauss)?
Nasal polyps, unmasked by Granulomatosis with Polyangitis, sinus pain, and nephrotic syndrome.
What are common occupational asthma triggers?
Flour, Isocyanates, Cadmium, Platinum Salts.
How can acute mountain sickness be prevented?
Acetazolamide prevention.
What is the treatment for HACE?
Descent and Dexamethasone treatment.
What is the treatment for HAPE?
Descent, Nifedipine, Dexamethasone, and Acetazolamide.
What does a raised transfer factor indicate?
Asthma, haemorrhage, left to right shunts, polycythaemia.
What does a low transfer factor indicate?
Everything else.
What is the most common organism in bronchiectasis?
Haemophilus influenza.
What spirometry pattern is seen in patients with rheumatoid and bronchiolitis obliterans?
Obstructive pattern.
What is the chance of being a carrier or having CF in AR conditions?
50% chance of carrier, 25% chance of having.
What are the genotypes for alpha-1 antitrypsin deficiency?
PiZZ= Emphysema, PiMM= Normal, PiMZ= Carrier.
What causes Malt workers lung?
Aspergillus clavatus.
Why won’t NIV work in bronchiectasis?
Too many secretions.
What syndrome causes primary ciliary dyskinesia?
Kartageners syndrome.
What improves survival in COPD after quitting smoking?
LTOT.
What are the criteria for LTOT?
Po2 of <7.4 or above with secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema, or pulmonary hypertension.
What are contraindications to lung cancer surgery?
SVC obstruction, FEV <1.5, malignant pleural effusion, and vocal cord paralysis.
What is the treatment for alpha-1 antitrypsin deficiency?
Lung volume reduction surgery.
What happens to KCO in obesity?
You get a raised KCO and restrictive picture.
What causes EAA?
Hypersensitivity pneumonitis from thermophilic actinomycetes (saccharopolyspora rectivirgula).
What is the mechanism of action of Bupropion?
Inhibition of norepinephrine-dopamine reuptake and antagonism of nicotinic acetylcholine receptors.
What are the symptoms of primary ciliary dyskinesia?
Recurrent chest infections and subfertility.
What are the BiPAP pressures?
E comes before I. E=5, I=10.
What is diagnostic for OSA?
Polysomnography (PSG).
What three systems are involved in granulomatosis with polyangitis?
ENT, respiratory, and kidney.
What are the stages of COPD?
> 80% mild stage 1, 50-79% moderate stage 2, 30-49% severe stage 3, <30% very severe stage 4.
What percentage of sarcoidosis patients improve without treatment?
Most sarcoidosis patients.
What is linked with poor prognosis in pneumonia?
Urea.
What are the characteristics of squamous cell lung cancer?
PTHrp, clubbing, HPOA.
What are the characteristics of small cell lung cancer?
ADH, ACTH, Lambert Eaton.
What does Azithromycin require before use?
LFTs and baseline ECG as it can cause long QT.
How is occupational asthma diagnosed?
Serial peak flows at home and work.
What is ARDS?
Non-cardiogenic sudden onset pulmonary oedema with hypoxaemia and Po2/Fio2 <300.
What is Varenicline used for?
It is a partial nicotine agonist, started 1 week before the stop date and continued for 12 weeks.
What is the first line treatment for OSA?
Weight loss then CPAP.
What does coal dust exposure not cause?
Cancer.
What infection is associated with bird keepers?
Chlamydia psittaci.
What is catamenial pneumothorax?
Endometrial tissue in the lungs.
What eosinophil count indicates asthma in adults?
Raised eosinophil count of 0.6 x 10^9/l or feNO >= 50.
What are the characteristics of silicosis?
Multiple and small well-rounded nodules, particularly in the upper zone.
Does amyloidosis cause bronchiectasis?
No.
What is the management for asymptomatic secondary haemothorax?
Always conservative management.
Does LTOT improve survival in COPD?
Yes.
What is the consequence of ICD?
Loss of HGV licence, 1 year off driving for normal drivers.
What condition is associated with hyponatraemia?
SCLC.
