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Grace Phase 2 > Resp > Flashcards

Resp Flashcards

1
Q

FEV1 definition?

A

forced expiratory vol in 1 sec

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2
Q

an increase of ? or more in ? 10-20 mins after inhalation of short-acting B2 agonist is compatible with diagnosis of asthma

A

increase of 15% or more in FEV1

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3
Q

name 2 interstitial lung diseases

A 
asbestosis, silicosis etc
drug induced
hypersensitivity pneumonitis
TB, viral, fungi
GORD
sarcoid
RA, SLE, SS, UC
idiopathoic pulm fib
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4
Q

kyphoscoliosis

A

deformity of the spine

curvature in sagittal AND coronal plane

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5
Q

describe FEV1 and FVC in obstructive lung disease

A

FEV1/FVC less than 80%

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6
Q

describe FEV1 and FVC in restrictive lung disease

A

FEV1/FVC >80%

lung volume reduced, most air blown out in 1st second as airways not narrowed

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7
Q

2 conditions under umbrella term of COPD

A

chronic bronchitis

emphysema

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8
Q

bronchiectasis - most obstructive or restrictive?

A

mostly obstructive but can get some restrictive scarring

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9
Q

describe bronchiectasis

A

dilated bronchi w/ pool secretions

copious purulent sputum

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10
Q

3 atopic conditions

A

hay fever
asthma
eczema

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11
Q

major complications of bronchoscopy

A

pneumonia
pneumothorax
heamorrhage

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12
Q

stridor definition

A

harsh vibrating noise when breathing, caused by obstruction of windpipe or larynx

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13
Q

presentation of PE

A

breathlessness/haemoptysis
pleuritic chest pain

acute massive: v. sudden circulatory collapse, life-threatening emergency

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14
Q

describe pleuritic chest pain

A

hurts when patients breathes in or coughs

pain from pleura due to infarct

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15
Q

causes of acute breathlessness

A

asthma
pneumonia
PE
pneumothorax

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16
Q

How many lobes in L and R lungs?

A

left lung 2

right lung 3

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17
Q

normal areas to show up on PET scan

A

heart
kidneys
bladder

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18
Q

what is the CURB-65 score?

A

scoring system in community acquired pneumonia - home Abx/ hospital Abx/ mortality

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19
Q

what are the 5 criteria of CURB-65 score?

A 
confusion
urea >7
resp rate >30
BP >90/60
age >65
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20
Q

RA & the lungs - complications with immunosuppression?

A

PCP

TB reactivation with anti-TNF

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21
Q

lung problems caused by RA

A 
pleural effusions
fibrosing alveolitis
bronchiectasis
obliterative bronchiolitis
methotrexate > lung fibrosis
immunosuppression > TB/PCP
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22
Q

Guillain–Barré syndrome definition

A

acute neuropathy
usually inflammatory demyelinating
often preceded by resp infection [CMV, EBV]
limb weakness, resp failure

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23
Q

ABPA [allergic bronchopulmonary aspergillosis] definition

A

hypersensitivity/exaggerated immune response to aspergillus fungus
[often asthma/ CF patients]

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24
Q

what is goodpastures’s syndrome?

A

antibodies to type 4 collagens in basement membrane of lung & kidney after some viral infections

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25
Q

myaesthenia gravis

A

autoimmune
muscle weakness without atrophy
defect in ACh at neuromuscular jn.s

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26
Q

how do diffuse parenchymal lung diseases present?

A

SOB on exertion

persistent non-productive cough

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27
Q

how does sarcoidosis present & appear on CXR

A

skin or eye lesions
coughing/SOB
bilateral hilar lymphadenopathy &/or pulmonary infiltrations

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28
Q

treatment of sarcoidosis

A

[just hilar lymphadenopathy > no Tx]
prednisolone
steroid sparing/long-term: methotrexate/azathioprine/cyclophosphamide

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29
Q

treatment for wegener’s granulomatosis

A

remission with corticosteroids and cyclophosphamide
[plasmapheresis]
2nd line: rituximab

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30
Q

treatment for microscopic polyangiitis

A

corticosteroids

immunosuppressive drugs: azathioprine, cyclophosphamide

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31
Q

treatment for churg-strauss syndrome

A

corticosteroids

immunosuppressive drugs: azathioprine, cyclophosphamide

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32
Q

microscopic polyangiitis causes what in relation to the kidney?

A

haematuria
proteinuria
renal failure

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33
Q

2 main organs affected by microscopic polyangiitis

A

lungs

kidneys

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34
Q

3 main areas affected by wegener’s granulomatosis lesions

A

lungs
kidneys
upper resp tract

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35
Q

diagnosis of microscopic polyangiitis

A

renal biopsy

serum pANCA

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36
Q

cANCA is associated with which disease?

A

wegener’s

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37
Q

pANCA is associated with which diseases?

A

microscopic polyangiitis
churg-strauss
IBD

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38
Q

what 3 things make up the triad of Churg-Strauss syndrome?

A

eosinophilia
asthma
systemic vasculitis [peripheral nerves & skin]

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39
Q

which infections may trigger Guillain-Barre syndrome?

A

campylobacter jejuni
EBV
CMV

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40
Q

Management of Guillain-Barre syndrome

A

IV immunoglobulin [reduce paralysis duration & severity]
heparin [reduce thrombosis risk]
physio [prevent contracture]

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41
Q

diagnosis of Guillain-Barre syndrome

A

clinical features

nerve conduction studies [slow motor conduction]

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42
Q

mciroorganism that causes PCP

A

pneumocystis jirovecii

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43
Q

individuals susceptible to PCP [opportunistic infection]

A

on immunosuppressive drugs
HIV
cancer
organ transplant

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44
Q

scoring system for PE/ DVT

A

Wells

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45
Q

frothy white-pink sputum indicates what ?

A

pulmonary oedema

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46
Q

commonest organism to cause CAP & one other typical

A

strep pneumoniae

haemophilus influenzae

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47
Q

individuals/ conditions at risk of aspirating

A 
stroke
M gravis
bulbar palsy
post ictal
intoxicated
reflux/ achalasia
poor dental hygiene
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48
Q

give 4 symptoms of pneumonia

A 
SOB
pleuritic chest pain
fever/rigors
cough w/sputum
malaise
anorexia
haemoptysis
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49
Q

give 4 clinical signs of pneumonia

A 
pyrexia
^RR
dull chest percussion
creps / pleural rub / bronchial breathing
tachycardia
hypoTN
confusion
cyanosis
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50
Q

how will the curb65 score affect how you give your Abx?

A

0-1 home Tx, PO unless vomiting
2 hospital, PO unless vomiting
>2 IV
3 = severe - consider ITU

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51
Q

Mx of pneumonia

A 
ABx
O2
VTE prophylaxis
IV fluids
[analgesia if pleurisy]
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52
Q

complications of pneumonia

A 
pleural effusion
empyema [in pleura]
abscess [in lung]
resp failure
sepsis
brain abscess
pericarditis
myocarditis
cholestatic jaundice
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53
Q

Abxs for severe pneumonia (curb65>3) e.g.

A

co-amox + clarithromycin
OR e.g. cefuroxime + clarith
IV

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54
Q

Abxs for aspiration pneumonia

A

IV cephalosporin e.g. cefuroxime

+ metronidazole

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55
Q

at risk groups who should have a pneumococcal vaccine

A

imm comp - AIDS, chemo, steroids
DM [non- diet controlled]
>65
liver/ heart/ renal/ lung chronic disease

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56
Q

commenest patient groups for pneumonia

A 
elderly
post splenectomy
alcoholics
immunosuppressed
HF
lung disease
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57
Q

Mx of type 1 resp failure as a complication of pneumonia

A

high flow O2 60%
ABGs
consider ITU if hypoxia not improving with O2 or PaCO2 >6
aim for sats 94-98%

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58
Q

pneumonia can lead to AF in the elderly. Usually resolves with Tx of the pneumonia. What drugs may be needed to slow the ventricular response rate in the short term

A

BB, digoxin

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59
Q

walled cavity and fluid level seen on xray.
cough, fever, foul smelling purulent sputum.
diagnosis?

A

lung abscess

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60
Q

describe the pathology of bronchiectasis

A

chronic inflammation of bronchi + bronchioles leads to dilatation

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61
Q

causes of bronchiectasis

A 
CF
post infection [bronchiolitis, pneumonia, measles]
RA
UC
bronchial tumour/ foreign body
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62
Q

Sx of bronchiectasis

+ signs

A

cough
^^^ purulent sputum
haemoptysis

clubbing
inspiratory creps, wheeze

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63
Q

name 3 complications of bronchiectasis

A 
pneumonia
pleural effusion
pneumothorax
haemoptysis
cerebral abscess
amyloidosis
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64
Q

CXR findings in bronchiectasis

A

thickened bronchial walls [tramline/ring shadows]

cystic shadows

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65
Q

give 4 Ix in bronchiectasis

A 
sputum
CXR
spirometry [obstructive]
high res CT
bronchoscopy
CF sweat test
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66
Q

Mx of bronchiectasis

A

chest physio/ airway clearance
ABx [based on sensitivities]
bronchodilators [neb salb]

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67
Q

genetic cause of CF

A 
auto rec
mutation of CFTR gene 
on chromosome 7
a Cl- channel. Leads to ^Cl- secretion + Na+ absorption across airway epithelium.
Leads to bronchiectasis.
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68
Q

how is CF diagnosed?

A

newborn screening

sweat test- Na + Cl

common genetic mutations screen
faecal elastase

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69
Q

list 4 complications on CF

A 
meconium ileus
pancreatic insuff
steattorhoea
pancreatitis [acute/chron]
DM
infective exac
haemop
resp failure
male infertility
nasal polyps
clubbing
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70
Q

Tx of CF

A 
fat soluble vitamins
panc enzyme replacement
chest physio
bronchodilators
mucolytic nebs
Abx
lung transplant
[new mutation specific therapies]
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71
Q

small cell lung cancers arise from what type of cells

A

endocrine (Kulchitsky)

72
Q

of small and non-small cell lung cancers, which is the commoner and which is often disseminated at presentation/ worse porgnosis

A

NSCLC more common (80%)

SCLC often disseminated at presentation

73
Q

name 4 Sx of lung cancer

A 
cough
haemoptysis
SOB
weight loss
chest pain
recurrent/not resolving pneumonia
lethargy
anorexia
back pain
74
Q

name 3 examination findings in lung CA

A

supraclavicular/axillary lymph node enlargement
cachexia
CHEST: none/ consolidation/ effusion/ collapse
METS: hepatomeg/ bone tenderness/ confusion/ fits

75
Q

CXR findings in Lung CA

A 
peripheral nodule
consolidation
hilar enlargement
pleural effusion
bony involvement
collapse
76
Q

list 4 local and 4 systemic/metastatic complications of Carcinoma of bronchus

A 
LOCAL:
recurrent laryngeal nerve palsy
phrenic nerve palsy
SVC obstruction
horners syndrome
rib erosion
pericarditis
AF
mets: brain, bone, liver, adrenals
hypercalcaemia
cushings
anaemia
neuro: myopathy, neuropathy, cerebellar degeneration
77
Q

describe the difference between type 1 and type 2 resp failure

A

type 1 = low O2, normal CO2

type 2 = low O2 and high CO2

78
Q

why do you aim for lower O2 targets in type 2 resp failure

A

if you give them lots of O2, then the CO2 keeps rising which just worsens the resp acidosis

79
Q

what non invasive ventilation do you use in type 1 and type 2 resp failure

A

type 1 - CPAP

type 2 - bipap [need to draw out CO2 as well as driving O2 in]

80
Q

what Ix might you consider in lung CA

A 
CXR
pleural fluid aspiration + cytology
sputum cytology
biopsy [lymph node/ bronchoscopy/ peripheral]
CT/PET [staging]
lung fn test
bone scan [mets]
81
Q

clinical features of mesothelioma

A 
SOB
chest pain
weight loss
clubbing
pleural effusion
[mets - lymphadenopathy, hepatomeg, bone pain]
82
Q

differentials of lung nodule on CXR

A 
malignancy - prim/mets
infection
granuloma
abscess
arterio-venous malformation
carcinoid tumour
cyst
foreign body
skin tumour e.g. seb wart
83
Q

non metastatic extrapulm manifestations of bronchial CA - endocrine

A 
ectopic secretion of hormones by the tumour:
cushings (ACTH)
dilutional hyponatraemia (ADH)
hypercalcaemia (PTH)
gynaecomastia (HCG)
84
Q

non metastatic extrapulm manifestations of bronchial CA - neuro

A

cerebellar degeneration
myopathy
polyneuropathy
myasthenic syndrome

85
Q

non metastatic extrapulm manifestations of bronchial CA - vascular/ haem

A

thrombophlebitis migrans
anaemia
DIC

86
Q

Mx of NSCLC

A

lobectomy
radiotherapy
+ chemo for more advanced
cetuximab

87
Q

what manifestations/ complications of palliative SCLC might be helped by palliative radiotherapy?

A 
SVC obstruction
haemoptysis
bronchial obstruction
bone pain
cerebral mets
88
Q

give 5 aspects of SCLC Mx

A 
surgery in less advanced
chemo + radio if well enough
palliative care
SVC stent
tracheal stent
dexamethasone
pleural drainage
analgesia
antiemetics
bronchodilators
antidepressants
89
Q

what is allergic bronchopulmonary aspergillosis

A

type 1 + 3 hypersens rn. to aspergillus fumigatus. affects asthmatics and CF. Caused constriction then bronchiectasis

90
Q

Mx of allergic bronchopulmonary aspergillosis

A

pred
bronchodilators for asthma
itraconazole
bronchoscopic aspiration of mucus plugs

91
Q

difference between asthma and copd

A

asthma is reversible

92
Q

asthma Sx

A 
SOB
wheeze
chest tightness
cough [often nocturnal]
sputum
precipitants e.g. exercise /allergens
93
Q

asthma precipitants

A 
cold air
exercise
emotion
allergens [house dust mite, pollen, fur]
infection
smoking/passive
pollution
NSAIDs
BBs
94
Q

what time of day is it commoner for asthmatics to have worse peak flow

A

morning

95
Q

examination findings/signs in asthma

A 
^RR
wheeze [audible + auscult]
hyperinfated chest
^resonance on percussion
reduced air entry
96
Q

signs that indicate a life threatening asthma attack

A 
silent chest
confusion
cyanosis
exhaustion
bradycardia
97
Q

clinical features that increase probability of asthma

A 
wheeze
chest tightness
SOB
diurnal
precipitants:exercise, cold, allergens
aspirin/BB induced
Hx of atopy
FH of asthma/atopy
wheeze on auscult
low peak flow
eosinophilia
98
Q

Ix in asthma

A 
peak flow/ spirom
CXR
sputum culture
FBC/U&E/CRP
cultures
ABG
99
Q

what might an ABG show in asthma attack

A

normal or low O2 + low CO2 [hypervent]

a normal or raised CO2 indicates failing resp effort > HDU/ITU

100
Q

differentials of asthma

A 
obstruction [foreign body/ CA]
pneumothorax
LRTI
COPD
pulm oedema ["cardiac asthma"]
SVC obstruction
PE
bronchiectasis
obliterative bronchiolitis
101
Q

lifestyle Mx of asthma

A

weight loss
stop smoking
avoid allergens

102
Q

Mx of chronic asthma, stepwise

A
  1. salbutamol inhaler PRN
  2. beclometasone inhaler od
  3. salmeterol inhaler BD / ^beclo dose
    try montelukast (LRA), oral theophylline
  4. ^steroid, oral theoph, oral B2 ag, oral monte
  5. PO pred od
103
Q

in asthma, when would you move from PRN salb to step 2 (inhaled steroid)?

A

used more than od

night time Sx

104
Q

side effects of B2 agonists [salbutamol]

A 
tachyarrhythmias
hypokalaemia
tremor
anxiety
[long acting - paradoxical bronchospasm]
105
Q

mouth should be rinsed after using inhaled steroids for asthma. Why?

A

prevent oral candidiasis

106
Q

aminophylline, metabolised to theophylline, has a narrow therapeutic ratio. What SEs?

A 
arrhythmia
GI upset
fits
anxiety
tremor
107
Q

if IV aminophylline is used in acute asthma, what Ix should you do after administration [bearing in mind its narrow therapeutic ratio]

A

ECG

theophylline levels

108
Q

COPD Sx

A

cough
sputum
SOB
wheeze

109
Q

signs in COPD

A 
wheeze
^RR
accessory muscles
hyperinflation
reduced expansion
resonant/hyperres
cyanosis
quiet breath sounds
110
Q

complications of COPD

A 
infective exacerbation
polycythaemia
resp failure
cor pulmonale [oedema]
pneumothorax
carcinoma
111
Q

Ix in COPD

A 
FBC [^haematocrit]
CXR
CT
ECG [R hypetrophy]
ABG [low O2 +/- ^CO2]
spirom
112
Q

CXR signs in COPD

A 
hyperinflation
flat hemidiaphragms
large central pulm arteries
reduced peripheral vascular markings
bullae
113
Q

Mx of chronic stable COPD

A 
SABA/SAMA [ipratropium]
LABA
LAMA
ICS
home O2
CPAP/BIPAP

SMOKING CESSATION
flu + pneumococcal vaccines

114
Q

what happens to the lungs in acute resp distress syndrome

A

^cap permeability > oedema

115
Q

pulmonary causes of ARDS

A 
pneumonia
aspiration
inhalation
vasculitis
injury/contusion
116
Q

non-pulmonary causes of ARDS

A 
sepsis/shock/haemorrhage/DIC
multiple transfusions
pancreatitis
ALF
trauma
head injury
burns
eclampsia
drugs [aspirin/heroin]
117
Q

clinical features of ARDS

A

^RR
cyanosis
tachycardia
crackles

118
Q

Ix for ARDS

A 
CXR
FBC, U+E, clotting, amylase, CRP, LFT
cultures
ABG
sputum
pulm artery catheter [cap wedge pressure]
119
Q

diagnostic criteria for ARDS

A
  1. acute onset
  2. CXR - bilateral infiltrates
  3. refactory hypoxaemia
120
Q

what is pulmonary capillary wedge pressure?

A

estimate of LA pressure

measured by placing balloon catheter in pulm. artery

121
Q

Mx of ARDS

A 
admit ITU
treat cause e.g. sepsis
O2, CPAP
intubate + ventilate
inotropes [dobutamine]
vasodilators
blood transfusion
122
Q

what is pneumoconiosis

A

industrial lung disease ass. with dust e.g. coal miners

123
Q

give signs / Sx of hypoxia

A 
SOB
restlessness
agitation
confusion
central cyanosis
124
Q

give 4 signs/sx of hypercapnia

A 
headache
peripheral vasodilatation
tachycardia
bounding pulse
tremor/flap
papilloedema
confusion
drowsy
coma
125
Q

Ix in respiratory failure

A 
ABG
CXR
FBC, U+E, CRP
sputum
cultures
spirometry
126
Q

where do PEs usually arise from?

A

a venous thrombosis in the pelvis or legs

127
Q

risk factors for PE

A 
recent surgery (especially abdo/pelvic, hip/knee replacement)
thrombophilia e.g. antiphospholipid syndrome
leg fracture
prolonged bed rest / reduced mobility
malignancy
pregnancy/post partum
COCP, HRT
previous PE
128
Q

PE Sx

A

SOB
pleuritic CP
haemoptysis
dizzy, syncope

129
Q

PE signs

A 
tachypnoea
pyrexia
cyanosis
pleural rub
tachycardia
hypoTN
^JVP
pleural effusion
[DVT- red hot swollen leg]
130
Q

Ix in PE

A 
FBC, U+E, clotting, D-dimer
ABG [low O2, low CO2]
CXR
CTPA
ECG
131
Q

CXR findings in PE

A 
may be normal
oligaemia of affected segment
dilated pulmonary artery
linear atelectasis
small pleural effusion
wedge shaped opacity/ cavitation [rare]
132
Q

ECG findings in PE

A 
may be normal
tachycardia
RBBB
RV strain [R axis deviation, dominant R wave, inverted T wave or ST depression V1-V4]
(rarely SIQIIITIII)
133
Q

PE Mx

A 
O2
morphine + antiemetic
LWWH/ fondaparinux
fluid bolus if low BP
vasopressors e.g. dobutamine/noradrenaline
thrombolysis [alteplase]
long term anticoag [noac]
VC filter
134
Q

what ix.s might you carry out in a Pt with an unprovoked PE [unknown cause]

A

?malignancy - breast exam and mammography,
CXR
FBC, Ca2+, LFTs
urinalysis
abdo-pelvic CT
antiphospholipid + thrombophilia testing if FH +ve

135
Q

name 5 causes of pneumothorax

A 
spontaneous [young thin men]
asthma, COPD
TB
pneumonia
lung abscess
carcinoma
CF
lung fibrosis
sarcoidosis
marfans/EDS
trauma
iatrogenic [biopsy/line]
ventilation
136
Q

presentation of pneumothorax

A

may be asymptomatic
sudden onset SOB, pleuritic CP
asthma/COPD sudden deterioration
hypoxia

137
Q

examination findings in pneumothorax

A

^resonance [percussion]
reduced air entry/ breath sounds
reduced expansion
tracheal deviation in tension

138
Q

Mx pneumothorax

A

aspiration
chest drain
O2 in secondary

139
Q

what is the difference between transudate and exudate pleural effusions?

A

protein concentration

transudate less, exudate more protein

140
Q

what do you call a) pus in the pleural space. b)blood in the pleural space. c) blood and air in the pleural space ?

A

a) empyema
b) haemothorax
c) haemopneumothorax

141
Q

causes of transudate pleural effusion

A

^ venous pressure: [HF, constrictive pericarditis, fluid overload]

low blood protein: [nephrotic syndrome, cirrhosis, malabsorption]

hypothyroidism

142
Q

causes of an exudate pleural effusion

A

pneumonia, TB
pulmonary infarction
RA, SLE
bronchogenic carcinoma, mets, lymphoma, mesothelioma

143
Q

Sx of pleural effusion

A

asymptomatic or

dyspnoea, pleuritic CP

144
Q

exam findings in pleural effusion

A 
reduced expansion
stony dull to percussion
diminished breath sounds
may be bronchial breathing above effusion
large > tracheal deviation
145
Q

Ix in pleural effusion

A

CXR
US
aspiration
pleural biopsy

146
Q

CXR findings in pleural effusion

A

blunting of costophrenic angles

larger > water-dense shadows with cancave upper border

147
Q

Mx of pleural effusion

A

drainage
pleurodesis [with talc]
surgery
treat the cause

148
Q

define obstructive sleep apnoea

A 
intermittent
closure/collapse
of pharyngeal airway
causing apnoeic episodes
during sleep
terminated by partial arousal
149
Q

presentation of ob. sleep apnoea

A 
falling asleep during the day
loud snoring
poor sleep quality
morning headache
reduced libido
nocturia
reduced cognitive performance
150
Q

complications of obstructive sleep apnoea

A

pulm HTN
type 2 resp failure
HTN

151
Q

investigations in obstructive sleep apnoea

A

video recording
pulse ox
polysomnograph [during sleep: O2, airflow, ECG, abdo wall movement, EMG chest]

152
Q

sleep apnoea Mx

A 
weight loss
stop smoking + alcohol
mandibular advancement device
CPAP
surgery [polyectomy/tonsillectomy] rarely
153
Q

causes of cor pulmonale [name 4]

A

COPD, bronchiectais, pulm fibrosis, asthma, resection

PE, vasculitis, pulm HTN, ARDS

myasthenia gravis, MND, stroke

kyphosis, scoliosis

sleep apnoea

154
Q

most common age range, gender and ethnicity affected by sarcoidosis

A

20-40
female
african-caribbean

155
Q

clinical features of sarcoidosis.

Name 2 for acute sarcoidosis, 2 for pulmonary, 5 non-pulmonary.

A

acute: fever, erythema nodosum, hilar lymphadenopathy,polyarthralgia
pulm: SOB, dry cough, CP

non-pulm: 
lymphadenopathy
hepatosplenomeg
uveitis/conjunctivitis/glaucoma
terminal phalynx bone cysts
bells palsy/neuropathy/mengingitis/space-occ lesion
erythema nodosum
renal stones
hypercalcaemia
arrhythmia/cardiomyopathy
156
Q

bloods findings in sarcoidosis

A 
^ESR
lymphopenia
^LFTs
^ACE
^Ca2+
^imm.glob.s
157
Q

what findings in 24 hours urine in sarcoidosis

A

^ urine ca2+

158
Q

CXR findings in sarcoidosis

A 
bilat. hilar lymphadenopathy
infiltrates
fibrosis
bulla
pleural
159
Q

Ix in sarcoidosis

A 
CXR
ECG
lung Fn tests
bloods: ESR, FBC, LFT, Ca2+, imm.globs
tissue biopsy
bronchoalveolar lavage
transbronchial biopsy
UA
bone xray
CT/MRI
160
Q

results found on tissue biopsy in sarcoidosis [lung/liver/lymph node/skin nodule]

A

non-caseating granulomata

161
Q

Mx of sarcoidosis

A

acute: bed rest, nsaids

pred 4-6 weeks

severe: IV methylpred/ methotrex/ hydroxychloroquine/ciclosporin/ cyclophosphamide

anti TNFa
lung transplant

162
Q

name 4 differentials for graulomatous disease

A 
TB, leprosy, syphilis
sarcoidosis
fungi [cryptococcus]
primary biliary cholangitis
extrinsic allergic alveolitis
vasculitis: GCA, polyarteritis nodosa, wegeners]
crohns
silicosis
163
Q

differentials of bilateral hilar lymphadenopathy on CXR

A 
sarcoidosis
TB, mycoplasma
lymphoma
pneumoconiosis
mets
mediastinal tumour
164
Q

Sx of interstitial lung disease

+ spirometry picture

A

dry cough
SOB

restrictive

165
Q

name 3 causes of intersitial lung disease

A

occupational: asbestos, silica
drugs: nitrofurantoin, amiodarone
hypersensitivity rn [pneumonitis]
infection: TB, fungi, viral
GORD
idiopathic pulmonary fibrosis

166
Q

give some systemic disorders which cause, or are associated with, interstitial lung disease

A 
RA, SLE, systemic sclerosis, sjogrens
sarcoidosis
UC
renal tubular acidosis
autoimmune thyroid disease
167
Q

Mx of extrinsic allergic alveolitis

A

remove allergen
give o2
PO pred

168
Q

differentials for upper zone fibrotic shadowing on CXR

A 
TB
hypersensitivity pneumonitis
ank spond
radiotherapy
progressive massive fibrosis
169
Q

Sx of idiopathic pulmonary fibrosis

A 
dry cough
SOB
malaise
weight loss
arthralgia
170
Q

signs of idiopathic pulm. fibrosis

A

cyanosis
fine end-resp creps
clubbing

171
Q

complications of idiopathic pulm. fibrosis

A

resp faulire

^risk of lung CA

172
Q

Ix for idiopathic pulm. fibrosis

A 
ABG
CRP
imm glob
ANA, Rh. factor
CXR, CT
spirom
bronchoalveolar lavage
lung biopsy
173
Q

Mx of idiopathic pulm. fibrosis

A 
O2
pulmonary rehab
opiates
palliative
lung transplant
174
Q

Differentials for bilateral hilar lymphadenopathy

A

Lymphoma (primarily hodgkins)

Sarcoidosis

Silicosis

TB

175
Q

metabolic disturbace caused by aspirin od

A

resp alkalosis [hyperventilaiton]

176
Q

can APTT be used to monitor unfractionated heparins and LMWH

A

yes for unfractionated because its intrinsic, not for LMWH which act on factor Xa

177
Q

causes of COPD other than smoking

A

industrial exposures e.g. coal dust, grain/flour, silica

alpha-1-antitrypsin deficiency

Grace Phase 2 (9 decks)

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