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
Eosinophilic Granulomatosis - Churg Strauss
Nasal polyps, unmasked by montelukast
Granulomatosis with Polyangitis
Sinus pain and nephrotic syndrome
Occupational asthma causes
Flour, Isocyanates, Cadmium, Platinum Salts
Acute mountain sickness prevention
Acetazolamide
HACE treatment
Descent, Dexamethasone
HAPE treatment
Descent, Nifedipine, Dexamethasone, Acetazolamide
Transfer factor raised conditions
Asthma, haemorrhage, left to right shunts, polycythaemia
Transfer factor low conditions
Everything else
Most common organism in bronchiectasis
Haemophilus influenza
Spirometry pattern in rheumatoid dyspnoea
Obstructive pattern, bronchiolitis obliterans
Sarcoidosis inheritance
AR such as CF = 50% chance of carrier, 25% chance of having
Alpha 1 antitrypsin genotypes
PiZZ = Emphysema, PiMM = Normal, PiMZ = Carrier
Malt workers lung causative agent
Aspergillus clavatus
NIV in bronchiectasis
NIV won’t work due to too many secretions
Kartagener’s syndrome symptoms
Primary ciliary dyskinesia, male subfertility, recurrent sinusitis, malabsorption, dextrocardia
Post smoking intervention improving COPD survival
LTOT
LTOT criteria
Po2 of <7.4 or above with secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or pulmonary hypertension
Contraindications to lung cancer surgery
SVC obstruction, FEV <1.5, malignant pleural effusion, vocal cord paralysis
Treatment for alpha-1-antitrypsin deficiency
Lung volume reduction surgery
Obesity effect on lung function
Raised KCO and restrictive picture
EAA causative agent
Hypersensitivity pneumonitis, thermophilic actinomycetes (saccharopolyspora rectivirgula)
Bupropion mechanism
Inhibition of norepinephrine-dopamine reuptake and antagonism of nicotinic acetylcholine receptors
Recurrent chest infections and subfertility
Primary ciliary dyskinesia (Kartagener’s syndrome)
BiPAP pressures
E comes before I. E=5, I=10
Diagnostic test for OSA
Polysomnography (PSG)
Granulomatosis with polyangitis affected systems
ENT, respiratory and kidney
COPD stages
> 80% mild stage 1, 50-79 moderate stage 2, 30-49 severe stage 3, <30 very severe stage 4
Sarcoidosis treatment necessity
Most improve without treatment
Urea in pneumonia prognosis
Linked with poor prognosis
Squamous cell lung cancer markers
PTHrp, clubbing, HPOA
Small cell lung cancer markers
ADH, ACTH, Lambert Eaton
Azithromycin precautions
Requires LFTs and baseline ECG as can cause long QT
Occupational asthma monitoring
Serial peak flows at home and work
ARDS characteristics
Non-cardiogenic sudden onset pulmonary oedema with hypoxaemia and Po2/fio2 <300
Varenicline usage
Partial nicotine agonist, started 1 week before stop date and continued for 12 weeks. Not to be used in depression. Most common SE is nausea
Asthma treatment based on features
No asthmatic features - LAMA; Asthmatic features - ICS
Indications for steroids in sarcoidosis
Hypercalcaemia, cardio or neuro involvement, uveitis or parenchymal lung disease
Common infection in alcoholics
Klebsiella
Lung metastases calcification
Only osteosarcoma or chondrosarcoma undergo calcification
Peak flow utility in COPD
Of no use
Most common cause of occupational asthma
Isocyanates
Non-CF bronchiectasis treatment
Inspiratory muscle training and postural drainage
Scuba diving and pneumothorax
Avoid for life following pneumothorax; flying for 1 week post XR or 2 weeks if no XR
OSA management
Weight loss then CPAP
Coal dust cancer risk
Does not cause cancer
Chlamydia psittaci infection source
Bird keepers
Catamenial pneumothorax definition
Endometrial tissue in the lungs
Asthma eosinophil count
Raised eosinophil count of 0.6 x 10^9/l or feNO >= 50
Silicosis characteristics
Foundry, multiple and small well-rounded nodules, particularly in the upper zone
Amyloidosis and bronchiectasis
Does not cause bronchiectasis
Asymptomatic secondary haemothorax management
Always conservative management
LTOT effect on COPD survival
Does improve survival
ICD implications
Loss of HGV licence, 1 year off driving for normal drivers
Hyponatraemia association
SCLC