Resp Flashcards
What are the clinical features of sarcoidosis?
- fever, wt loss, anorexia
- eye symptoms: uveitis
- nasal congestion
- facial nerve palsy
- erythema nodosum, arthralgia
- lupus pernio: nose swelling
- lymphadenopathy
- pulmonary fibrosis
Signs of sarcoidosis on CXR?
- hilar lymphadenopathy
Investigations for sarcoidosis?
- FBC: lymphocytopenia, eosinophilia
- ESR
- ACE level
- CXR, CT chest
- PFT, ABG
- bronchoscopy and biopsy
- LN biopsy
Treatment for sarcoidosis?
- prednisone
- if long term Rx needed: MTX, AZA
- hydroxychloroquine for skin disease
- infliximab
What are causes of clubbing?
- resp: lung ca, bronchiectasis, CF, Idiopathic pulmonary fibrosis
- cardiac: cyanotic congenital heart disease, IE
- GI: cirrhosis, IBD, Coeliac
- thyrotoxicosis
What is Lights criteria for exudate?
Pleural:serum Protein >0.5
Pleural:serum LDH >0.6
LDH > 2/3 upper limit of normal
What are causes of transudative pleural effusion?
- heart failure
- liver failure
- nephrotic syndrome
What are causes of exudative pleural effusion?
- infection: pneumonia, TB
- malignancy
- pulmonary infarction
What investigations on pleural fluid?
- pH:
What us the differential for bilateral crackles?
- pulmonary edema/cardiac failure
- bronchiectasis
- atelectasis
- bilateral pneumonia
- pulmonary fibrosis (fine crackles)
How many posterior ribs visible to say a CXR is hyperexpanded?
More than 9 posterior ribs, flattened diaphragm
Or >6 anterior ribs at diaphragm
What is the differential for a lung mass on imaging?
- carcinoma - primary or metastatic
- lung abscess
- TB
- pulmonary infarct
- granuloma: I.e. Fungal
What are causes of cavitating lung lesion?
- lung abscess: staph, klebsiella
- carcinoma
- TB
- fungus
What are the signs of asthma severity?
- symptoms throughout day
- nightly symptoms >7x/week
- SABA use several times a day
- extreme interference with normal activity
- FEV1
How to investigate asthma?
- spirometry: obstructive, reversible 12%
- bronchial challenge testing if normal spiro
- PEF for monitoring
- allergen skin testing
How would you manage asthma? (Maintenance Rx)
Non pharm: - allergen avoidance, smoking cessation - asthma action plan Pharm: - vaccinations - SABA - ICS alone - ICS/LABA combination - prednisone - treat GORD, if present
What are causes of upper lobe lung fibrosis?
SCART
- silicosis
- coal worker pneumoconiosis
- ank. spond
- radiation
- tuberculosis
What are causes of lower lobe lung fibrosis?
RASIO
- RA
- asbestosis
- scleroderma
- idiopathic
- other: drugs (MTX, bleomycin, amiodarone)
What are symptoms of OSA?
- snoring/apneas/waking gasping for air
- excessive daytime sleepiness
- decreased concentration
- cognitive impairment
What are complications of OSA?
- HTN
- pulmonary HTN
- increased CAD and stroke
- polycythemia
- cognitive impairment
How to diagnose sleep apnea?
- sleep study: apnea-hypopnea index (severe >60)
- ABG
What are some adjuvants for NSCLC lung cancer treatment?
VEGF: bevacizumab
EGFR: cetuximab, gefitinib, erlotonib (adenocarcinoma)
What is treatment for SCLC?
Local: combined chemo (etoposide + cisplatin) + RTx
Advanced: combined chemo
Prophylactic cranial irradiation
What are paraneoplastic manifestations of SCLC?
- eaton-lambert
- SIADH
- ectopic ACTH
- carcinoid
What is the PAP for dx of pulmonary HTN?
> 25 at rest
Or
30 with exercise
What investigations for pulmonary HTN?
- CXR
- PFT
- ECG
- ABG
- CTPA or VQ
- HRCT
- TTE
- R heart cath
- 6min walk test (
What are the types/classes of pulm HTN?
- Pulmonary arterial HTN
- From L heart disease
- Due to lung disease
- Due to chronic PE
- Unclear multifactorial mechanisms
How to determine pharmacological treatment in pulm HTN?
If reversibility: calcium channel blockers Otherwise, - endothelin receptor antag: bosentan - PDE5i: sildafenil - prostacyclins: iloprost, epoprostenol
What are some symptoms/presentations of sarcoidosis?
Systemic: fever, wt loss Pulmonary: cough, sob, abnormal CXR Eye: uveitis Skin: erythema nodosum Nerve: neuropathy/palsied Cardiac: arrhythmia
How to manage sarcoidosis?
Treat if:
- increasing symptoms or worsening lung function
- Neuro/renal/cardiac complications
- major eye disease
Use:
- prednisone 1mg/kg, 1 year taper
- steroid sparing: MTX, AZA
- hydroxychloroquine for skin disease
- infliximab: 3rd line
What investigations for sarcoidosis?
- Bloods: FBC, ESR
- ACE level
- calcium level (hyperCa)
- Imaging: CXR, CT, PET
- biopsy: granulomas
What gene and chromosome involved with CF?
Autosomal recessive CFTR gene mutation
(Most common is delta F508)
Chromosome 7
1:25 carrier rate
What are the various manifestations of CF?
- GI baby: meconium ileum, failure to thrive
- Resp: cough, haemoptysis, wheeze, SOB
- Cardiac: cor pulmonale
- Gastro: diarrhea, steatorrhea, pancreatic insufficiency, intestinal obstruction, ADEK deficiency
- Liver: cirrhosis/fibrosis, cholelithiasis
- DM
- infertility: CBAVD
What organisms associated with CF?
- Staph and h. influenzae
- Nosocomial e.coli and proteus
- Pseudomonas***
- Burkholderia = poor prognosis
What investigations for CF?
- sputum MCS
- bloods: FBC (anaemia, infection), LFT/alb, coags
- CXR
- CT chest
- PFT
What is your management of pulmonary CF?
- neb. Antibiotics (tobramycin)
- bronchodilators
- mucolytics: neb NS, DNase
- mutation specific drugs: ivacaftor(G551D), lumacaftor-ivacaftor(DF508)
Non Pharm: - postural drainage, chest Physio
- medical devices: oscillating devices
- exercise
What is indication for lung transplant in CF?
- FEV1
How would you manage gastro manifestations of CF?
- high protein/fat diet
- nutritional supplements
- pancreatic enzyme replacement
How do you manage pregnancy with CF?
- acknowledge fertility issues; in women, mainly due to malnutrition
- if FEV1 > 60%, should be OK
- pulmonary HTN is contraindication to pregnancy
- genetic counselling
- screen for GDM
- increased prematurity
How would you approach pre transplant work up?
Lungs: PFT, imaging, 6MWT
Heart: TTE, ECG, angio, R heart cath
Infection status: CMV, EBV, HIV, Hep, sputum
Vaccinations
Malignancy: 5yrs cancer free
Social/mental: psych review, social supports, living, finance, compliance
Education
