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Z IPE > Resp > Flashcards

Resp Flashcards

1
Q

Tx of acute asthma attack

A

OSHITME
Oxygen - oxygen driven nebs, back to backSalbutamol - 2.5-5mg back to backHydrocortisone IVIpatropium - 500mcg nebTheophyllineMagnesium sulphateEscalate care (intubation and ventilation)

TME given if needed with senior input

Do an ABG to assess O2 and CO2

Intensive care indications - requires ventilator, worsening acidosis/hypercapnia/hypoxia, exhaustion, drowsiness and confusion

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2
Q

Tx to settle exacerbation of asthma?

A

Oral pred for 5 days

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3
Q

Classify asthma severity

A 
Life Threatening (PEFR <33%) - 33,92 CHEST:
	• 33 - PEFR <33%
	• 92 - Sats <92%
	• Cyanosis
	• Hypotension
	• Exhaustion
	• Silent chest
	• Tachycardia
Severe (PEFR <50%) - cant complete sentences, RR >25, PR >110
Moderate (PEFR <75%)
Mild (PEFR >75%)
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4
Q

Discharge criteria for asthma

A
  1. Stable on prescribed meds for 24 hrs
    1. Peak flow is 75% of predicted
    2. Discharge with 5 days oral prednisolone and asthma management plan.
      Follow up with GP in 2 days. Follow up in 1 month in clinic.
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5
Q

Asthma LT tx guidelines. Pregnancy?

A

1st line SABA + ICS
2nd line + LABA (salmeterol)
3rd - Increase LABA (if good response) OR (if not good response) increase ICS or add 4th drug (theophylline or LAMA)
4th - Add 4th drug (theophylline, LAMA) OR increase ICS
5th line + oral corticosteroid

Use as usual during pregnancy

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6
Q

S&S that make asthma diagnosis likely?

A

• pt complains of >1 symptoms of :wheeze, SOB, cough, or chest tightness and if:
○ Worse at night and early morning
○ Worse in exercise, allergen or cold air
○ Worse after taking aspirin or beta blockers
• History of atopy
• Family history of atopy
Widespread wheeze on auscultation

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7
Q

S&S that make asthma unlikely?

A

• Prominent dizziness or peripheral tingling
• Chronic productive cough w/o wheeze or SOB
• Normal examination of chest when symptomatic
• Significant smoking history ie >20 pack yrs.
Cardiac disease

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8
Q

Qs to ascertain if asthma is unstable?

A

• Is there a nocturnal cough?
• Are you using the blue inhaler (rescue)?
Is your job impacted?

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9
Q

Ix for asthma?

A

Blood tests:
• Eosinophilia
• Increased IgE

Spirometry findings:
• Obstructive. Reversibility

PEFR - need more than one reading. Peak flow diary

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10
Q

Define occupational asthma

A

Symptoms improve at weekends or when away from work

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11
Q

Chemicals associated with occupational asthma

A

• Isocyanates - most common cause eg spray painting and foam moulding
• Flour
Epoxy resins

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12
Q

Tx of occupational asthma

A

• Serial measurements of PEFR at work and away

Referral to resp specialist for suspected occupational asthma

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13
Q

Tx of COPD exacerbation

A

Management - OSHIT
Oxygen - controlled oxygen (24-28% venturi) driven nebs, back to back. Do ABG after 15 mins to determine further therapy.SalbutamolHydrocortisoneIpatropiumTheophylline

Consider antibiotics and BiPAP if sats persist below 88%. IV abx if blood culture +ve

Intensive care indications - requires ventilator, worsening acidosis/hypercapnia/hypoxia, exhaustion, drowsiness and confusion

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14
Q

Tx for frequent exacerbation sof COPD?

A

Pts who have frequent exacerbations:
• Home supply of corticosteroids and abx eg prednisolone and amox.
• Abx only taken if sputum is purulent.
Contact you if exacerbation

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15
Q

NIV indications for COPD?

A

• COPD with resp acidosis pH 7.25-7.35
• T2RF secondary to chest wall deformity, neuromuscular disease, sleep apnoea
• Cardiogenic pulmonary oedema unresponsive to CPAP
Weaning from tracheal intubation

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16
Q

MOs causing exacerbations in COPD? Tx for each?

A
  • Haemophilus influenzae - most common - treat with amox and prednisolone
    • Strep pneumoniae
    • Moraxella catarrhalis
    • Resp viruses causes 30% with rhinovirus being most common.

To treat - increase bronchodilator use, give prednisolone oral. NO ABX unless sputum is purulent or clinical signs of pneumonia.

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17
Q

Bloods findings for COPD

A

FBC - Polycythemia in COPD pts due to reduced oxygen leading to increased erythropoietin and increased RBCs.

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18
Q

Diagnostic Ix for COPD

A

Spirometry - FEV/FVC ratio is <0.7. Deficit is not more than 15% reversible.

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19
Q

CXR findings for COPD

A 
• to exclude other diagnoses
	• Hyperinflation - >6 anterior ribs
	• Bullae
	• Flat diaphragm
Vertical orientation of heart
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20
Q

Classify severity of COPD

A 
Post-bronchodilator FEV1/FVC	FEV1 (of predicted)	Severity
< 0.7	> 80%	Stage 1 - Mild**
< 0.7	50-79%	Stage 2 - Moderate
< 0.7	30-49%	Stage 3 - Severe
< 0.7	< 30%	Stage 4 - Very severe
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21
Q

ECG findings on COPD? Why might you order an ECG for COPD pts?

A

• If considering LT azithromycin ensure no long QT syndrome as azithromycin causes it.
• Reduced amplitude of QRS complexes due to excess air between electrode and heart
• Cor pulmonale may be evident:
○ Rightward shift of P wave axis
Prominent P waves in inferior leads

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22
Q

Lt medical tx of COPD

A

FEV<50% :
1st line - SABA or SAMA
2nd line - LABA + ICS combo inhaler OR LAMA
3rd line - LABA + ICS combo inhaler + LAMA

FEV>50%:
1st line - SABA or SAMA
2nd line - LABA or LAMA
3rd line - switch LABA to LABA + ICS combo then + LAMA

cannot tolerate inhalers - oral theophylline
Chronic productive cough - mucolytics

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23
Q

General management of COPD

A 
• Smoking cessation
	• Pulmonary rehab
	• Annual influenza vaccine
	• One off pneumococcal vaccine
If 3+ infections a year - Consider prophylactic abx eg azithromycin or erythromycin at low doses (anti inflammatory)
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24
Q

Tx for cor pulmonale in COPD

A

• Use loop diuretic for oedema eg furosemide
• Consider LTOT (long term oxygen therapy)
ACEi, CCBs, alpha blockers not recommended.

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25
Q

Indications for LTOT

A

Pt must have PaO2 of < 7.3 kPa under air when stable OR 7.3-8 kPa under air when stable AND:
○ Secondary polycythemia or
○ Nocturnal hypoxaemia or
○ Peripheral oedema or
○ Pulmonary hypertension
• Assessment of PaO2 done on 2 separate occasions 3 weeks apart
• 15 hours a day of oxygen minimum

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26
Q

S&S of COPD

A 
• Exertional dyspnoea
	• Chronic cough - 3mths +
	• Regular sputum production
	• Regular winter bronchitis
	• Wheeze
	• Peripheral cyanosis
	• Clubbing
Cor pulmonale
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27
Q

Causes of COPD

A

• Smoking
• Pollution
Alpha 1 antitrypsin deficiency

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28
Q

Questions to ask regarding SOB?

A

• How far can you walk?
• How has SOB changed?
• What were you like before SOB?
Why are you here now? What has changed?

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29
Q

Resp Hx - SHx qs?

A

• Asbestos exposure?

Any contact with animals?

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30
Q

Qs about cough?

A

• Diurnal variation?

Is there a nocturnal cough?

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31
Q

Qs about sputum?

A

• Colour?

Always Blood - How much and how often?

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32
Q

What look for in eye son resp?

A

Horners sign could indicate Pancoast tumour (unilateral partial ptosis, miosis, anhydrosis)

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33
Q

What is stridor and wheeze?

A

Stridor - loud and harsh breath sound In inspiration. Large airway obstruction
Wheeze - Small airway obstruction. Musical note heard on expiration.

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34
Q

Signs of SVCO and cause?

A

• SVCO - 90% caused by bronchogenic carcinoma:
○ Swelling of face, neck, arms
Persistent cough and SOB

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35
Q

Crackles - early inspiratory, late or pan inspiratory, fine crackles, medium crackles, coarse crackles?

A
  • Early inspiratory - COPD
    • Late or pan inspiratory - Alveolar disease
    • Fine ‘velcro’ crackles - Pulmonary fibrosis
    • Medium - left ventricular failure
    • Coarse - bronchiectasis
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36
Q

Causes of muffled breathing?

A

• Pleural effusion - Effusion is below lung, therefore decreased sounds.
• Collapse
Pneumothorax

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37
Q

Empyema vs consolidation - difference in bloods?

A

Empyema has v low grade inflammatory markers vs consolidation

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38
Q

Pleurisy causes?

A
  1. Pneumonia or flu
    1. RA
      PE or Lung cancer
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39
Q

Cause of increased vocal resonance/

A

Consolidation - Fluid actually in the lungs therefore increased resonance

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40
Q

Causes of dull, resonant and hyperresonance percussion?

A

Dull - Pleural effusion, Hepatic tissue, consolidation, pleural thickening

Resonant - Normal lung

Hyperresonance - Pneumothorax, COPD

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41
Q

Purulent sputum causes?

A

Pneumonia, bronchiectasis, abscess

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42
Q

White sputum causes?

A

COPD, asthma

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43
Q

Clear frothy sputum causes?

A

Pulmonary oedema

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44
Q

Blood sputum causes?

A

PE, malignancy, clotting disorder, infection, Granulomatosis with polyangiitis

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45
Q

Define massive haemoptysis

A

240ml in 24 hrs

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46
Q

Tx of haemoptysis

A

○ ABCDE
○ Lie on side of lesion
○ Tranexamic acid (antifibrinolytic) for 5 days
Abx if RTI suspected

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47
Q

Type 1 resp failure and causes

A

Type 1 - hypoxia
Ventilation/perfusion mismatch.
e.g. PE, high altitude, pneumonia, shunts

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48
Q

Type 2 resp failure and causes

A

Type 2 - hypercapnia and hypoxia
Inadequate alveolar ventilation.
e.g. COPD, asthma, scoliosis, motor neurone disease

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49
Q

Causes of resp alkalosis

A

• Anxiety –> Hyperventilation
• PE
• Salicylate poisoning - resp alkalosis first then metabolic acidosis
• CNS disorders - stroke, subarach hemorrhage, encephalitis
• Alititude
Pregnancy

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50
Q

Causes of acute cough with normal CXR

A

○ bacterial / viral RTI
○ Inhaled foreign body
Irritation from fumes

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51
Q

Causes of acute cough with abnormal cxr

A

○ Pneumonia
○ Inhaled foreign body
Extrinsic allergic Alveolitis

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52
Q

Causes of chronic cough with normal and abnormal CXR

A 
• Normal CXR:
		○ GORD
		○ Asthma
		○ ACEi - bradykinin
	• Abnormal CXR:
		○ TB
		○ Lung cancer
		○ ILD
Bronchiectasis
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53
Q

Classify upper and lower zone fibrosis ILD

A 
Upper - APENT(house)
	• A - Aspergillosis
	• P - Pneumoconiosis
	• E - Extrinsic Allergic Alveolitis
	• N - Negative Seroarthopathy
	• T - TB
Lower - STAIR BASEMENT
	• S - Sarcoidosis
	• T - Toxins - BASEMENT
	• A - Asbestosis
	• I - IPF
	• R - Rheumatological - RA, SLE
Toxins subtype - BASEMENT
	• B - Bleomycin
	• A - Amiodarone
	• S - Sulfasalazine
	• ME - Methotrexate
	• NT - NitrofuranToin
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54
Q

Ix for pulmonary fibrosis

A

• Spirometry - restrictive picture, reduced transfer factor (TLCO)
• CXR - bilateral interstitial shadowing (typically small, irregular, peripheral opacities - ‘ground-glass’ - later progressing to ‘honeycombing’)
HRCT NEEDED FOR DIAGNOSIS

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55
Q

S&S of pulmonary fibrosis

A

• progressive exertional dyspnoea
• bibasal crackles on auscultation
• dry cough
clubbing

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56
Q

Tx of Pulmonary fibrosis

A 
• Perfenidone
	• Pulmonary rehab
	• Supplementary oxygen
	• Lung transplant
3-4 yr life expectancy
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57
Q

RFs of pulmonary fibrosis

A

RA and Methotrexate. Sulfasalazine

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58
Q

S&S of ILD

A

• Chronic dry cough
• SOB gradual over 3+ months, getting worse
• Multi systemic symptoms eg weight loss or malaise
Eventual right HF.

	• Tachypnoea
	• Clubbing
	• End inspiratory crackles - upper or lower?
	• Cyanosis,
	• T2F
Cor pulmonale
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59
Q

RFs for ILD?

A

Connective tissue diseases - MS, SLE, RA
• Amiodarone and methotrexate - biggest 2
• Sulfasalazine, bleiomycin and cylcophosphamide are others
Nitrofurantoin leads to reversible fibrosis

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60
Q

Bloods for sarcoidosis?

A

Raised serum ACE

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61
Q

Blooods for hypersensitivity pneumonitis

A

Ab to antigen

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62
Q

Bloods for goodpastures

A

Anti-GBM Ab

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63
Q

Bloods for extrinsic alveolitis

A

NO eosinophilia

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64
Q

Pharm Tx for ILD

A

• Steroids in allergies
• NAC
Opioids

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65
Q

Non pharm Tx for ILD

A

• Pulmonary rehab
• Cough syrups
• Stop offending drugs
Lung transplant last resort

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66
Q

Asbestos exposure diseases?

A

• Pleural plaques - non malignant. Most common
• Pleural thickening
• Asbestosis - Increasing severity with length of exposure. Lower lobe fibrosis.
Mesothelioma - Malignancy of pleura. Crocidolite (blue) asbestos is most dangerous form.

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67
Q

TB bacteria

A

Mycobacterium tuberculosis, Mycobacterium bovis, africanum

68
Q

S&S of TB

A 
• Cough - productive or not
	• Weight loss* - rapid and dramatic
	• Fever
	• Night sweats* - drenching
	• Malaise
*Are most important symptoms

If person with latent TB becomes immunocompromised, TB can occur.

69
Q

Ix for TB

A

• Sputum
• CXR - Upper lobe infection usually
Biopsy - if TB in other organs

70
Q

Tx for normal TB

A

Rifampicin + Isoniazid - 6 mths

Pyrazinimide + Ethanbutol - 2 mths

71
Q

Tx for CNS and miliary TB

A

R+I - 12 mths
P+E - 2 mths
Steroids - 8 weeks

72
Q

Tx for latent TB

A

R+I - 3 mths

73
Q

ADRs of RIPE

A

R - P450 inducer, therefore double dose of steroids
I ADR - optic neuritis, peripheral neuropathy (give B6 to counter)
P ADR - v hepatotoxic
E ADR - coloured vision problems

74
Q

S&S suggesting legionella pneumonia

A

Recent travel, confusion, dry cough, flu like symptoms

75
Q

Ix for legionella pneumonia?

A

Urinary antigen

76
Q

Tx for legionella pneumonia

A

Erythromycin

77
Q

CXR of legionella pneumonia

A

Patchy consolidaiton ofmid to lower zones

78
Q

how to assess severity of pneumonia.

A
  • Confusion = 1
    • Urea > 7 = 1
    • Respiratory rate > 30 breaths per minute= 1
    • Systolic blood pressure < 90 mmHg / Diastolic < 60 mmHg = 1
    • Age > 65 = 1
79
Q

Community acquired MOs for pneumonia

A

• Streptococcus pneumoniae(accounts for around 80% of cases)
• Haemophilus influenzae
• Staphylococcus aureus: commonly after the ‘flu
• atypical pneumonias (e.g. Due toMycoplasma pneumoniae)
• Viruses
Klebsiella pneumoniae in alcoholics

80
Q

Define HAP

A

Onset of pneumonia symptoms 48 hrs after admission

81
Q

Hospital acquired pneumonia organisms

A

• Gram negative enterobacteria
• Staph aureus
• Pseudomonas aeruginosa
Clostridia

82
Q

tx of pneumonia HAP and CAP

A

• Low/moderate severity - oral amoxicillin. Add macrolide if admitted to hospital
• high severity CAP: intravenous co-amoxiclav + clarithromycin OR cefuroxime + clarithromycin
HAP - Gentomycin IV and cephalosporin

PT follow up with pneumococcal vaccine and flu vaccine with CXR 6 weeks later

83
Q

Recovery time for pneumonia

A

• Week 1 - fever resolved
• Week 4 - Chest pain and sputum reduced
• Week 6 - Cough and SOB reduced
• Month 3 - Symptoms resolved except tiredness
Month 6 - Normal.

84
Q

Complication sof pneumonia

A 
• Resp failure
	• Sepsis
	• Pleural effusion
	• Empyema
AF
85
Q

Bacteria involved in aspiration pnuemonia

A

• Streptococcus pneumoniae
• Staphylococcus aureus
• Haemophilus influenzae
Pseudomonas aeruginosa

86
Q

RFs of aspiration pnuemonia

A 
○ Poor dental hygiene
		○ Swallowing difficulties
		○ Prolonged hospitalisation
		○ Impaired consciousness
Impaired mucociliary clearance
87
Q

S&S of penumocystitis jivoreci pneumonia

A 
• Desaturation on exertion
	• Affects immunocompromised pts - HIV
	• dyspnoea
	• dry cough
	• fever
very few chest signs
88
Q

Ix for pneumocystitits jivoreci pneumonia

A

• CXR - can be normal. Can have consolidation
• Exercise induced desaturation
BAL to show PCP

89
Q

Tx of pneumocystitits jivoreci pneumonia

A

• Co-trimaxole
• IV pentamidine if severe
Steroids if hypoxic ie pO2 <9.3kPa

90
Q

Censor criteria for URTI

A

THAT centor criteria
T - presence of tonsillar exudate
• H - history of fever
• A - absence of cough
T- Tender anterior cervical lymphadenopathy or lymphadenitis
3+ means sore throat likely due to bacteria.

91
Q

Reasons for Tx non responsive pneumonia

A

CHAOS:
• C - Complication, eg empyema, lung abscess
• H - Host immunocompromised
• A - Abx inadequate dose or poor absorption
• O - Organism resistant or not covered by abx
S - Second diagnosis eg PE, lung cancer etc

92
Q

S&S of lung abscess

A

High swinging temp

93
Q

What test used for heparin and warfarin

A

Warfarin - INR

Heparin - APTT

94
Q

ADRs of heparin, clopidogrel, wafarin, aspirin

A

Heparin - hemorrhage, HIT
Clopidogrel - hemorrhage
Warfarin - hemorrhage, skin necrosis, teratogen
Aspirin - Gi bleeding, Bronchospasm in asthmatics

95
Q

MoA of digoxin

A

Increases force of myocardial contraction and reduces conductivity through AV node

96
Q

ADR of digoxin

A

N&V, diarrhoea (sign of toxicity)

97
Q

ADRs of beta blockers

A

bradycardia, hypotension, HF, bronchospasm, fatigue, peripheral vasoconstriction

98
Q

ACEi ADRs

A

hypotension, renal impairment, persistent dry cough, hyperkalaemia, angioedema

99
Q

examples of ARB

A

candesartan, losartan

100
Q

Loop diuretics egs and ADRs

A

ADR - hypoK, hypotension

Furosemide, bumetanide

101
Q

Aldost antag egs and ADRs

A

ADR - hyperK

Spironolactone

102
Q

ADR of beta 2 agonist

A

fine tremor, headache, cramps, tachycardia, palpitations

103
Q

SABA and LABA egs

A

• SABA - salbutamol, terbutaline

LABA - formoterol, salmeterol

104
Q

Theophylline ADRs

A

N&V, gastric irritation, palpitations, tachycardia

105
Q

Antimuscarinics ADRs

A

Dry everything

ADR - dry mouth, constipation, cough, headache, dizziness

106
Q

Antimuscarinics short acting and long acting egs

A

• Short acting - ipratropium - nebs and inhaler

Long acting - tiotropium inhaler - COPD use

107
Q

Steroids ADRs

A 
CUSHINGOID
C – Cataracts
U – Ulcers
S – Striae, Skin thinning
H – Hypertension, Hirsutism
I – Immunosuppression, Infections
N – Necrosis of femoral heads
G – Glucose elevation
O – Osteoporosis, Obesity
I – Impaired wound healing
D – Depression/mood changes
108
Q

Describing opacification

A

• Alveolar shadowing - poorly defined margins
• Interstitial shadowing - Well defined margins
Nodular shadowing - multiple, small opacities throughout lungs

109
Q

Tx for pleural effusion

A

• Pleural aspiration using USS - 21G needle and 50ml syringe

Send fluid for pH, protein, LDH, cytology and microbiology.

110
Q

Findings on pleural fluid

A

• Low glucose - RA, TB
• Raised amylase - pancreatitis, oesophageal perforation
Heavy blood staining - mesothelioma, PE, TB

111
Q

Indications for prompt chest drain post pleural aspration

A

• Purulent (empyema) - prompt drainage
• Presence of MOs on Gram staining
pH of fluid is <7.2

112
Q

define exudative and transudative fluid

A

• Exudative - >30g protein per litre

Transudative - <25g protein per litre

113
Q

Signs of pulmonayr congestion on CXR?

A 
ABCDE
• Alveolar oedema (bat’s wings)
• kerley B lines (interstitial oedema)
• Cardiomegaly
• Dilated prominent upper lobe vessels - upper lobe becomes more used so blood vessels dilate
Effusion (pleural)
114
Q

Ix for PE

A

CTPA (CT pulmonary angiography) Unless they have renal failure (contrast contraindicated) use V/Q scan.

115
Q

ECG findings for PE

A 
Sinus tachy (most common) and S1Q3T3:
	• Large S wave in lead I
	• Q wave in lead III
	• Inverted T wave in lead III
RBBB, and right axis deviation also can be seen.
116
Q

State Wells score for PE and how to use

A 
Dont Die Tell The Team To Calculate Criteria
Dont - DVT signs
Die - Diagnosis most likely PE
Tell  - Tachycardia
The Team - Three days immobilisation or surgery in past Thirty days
To - Thromboembolism in past
Calculate - Coughing up blood
Criteria - Cancer

2 or more signs = PE likely

117
Q

Signs of PE on CTPA

A

Saddle embolus

118
Q

S&S of PE

A 
• Tachypnoea
	• Crackles
	• Tachycardia
	• Fever - low grade up to 38
SOB

‘Classic’ presentation only 10% of cases:
• Pleuritic chest pain
• Haemoptysis
dyspnoea

119
Q

Tx of PE

A

Anticoagulant:
• Enoxaparin used until the diagnosis confirmed
Then switch to warfarin after INR in target range. There will be drug overlap.

120
Q

How long to anticoag for PE?

A

• If PE precipitated by known event - 3 to 6 months
• If due to unknown event - 6 months minimum.
If due to malignancy - 6 month anticoag

121
Q

Define Massive PE

A

Defined as haemodynamic compromise, ie:
• Decreased BP - systolic below 90 or a 40+ mmHg fall
• BP fall Sustained for 15+ mins
Risk of sudden death

122
Q

Tx of massive PE

A

• Thrombolysis eg alteplase
• Aggressive resus - ABCDE
Anticoagulate with enoxaparin

123
Q

Tx of primary pneumothorax

A

• If rim of air is <2cm and pt is not SOB then discharge
• Otherwise aspiration attempted
If this fails - Chest drain inserted.

124
Q

Tx of secondary pneumothorax

A

• Pt >50 age and rim of air is >2cm or pt is SOB then insert chest drain
• If rim of air is <2cm aspiration. If aspiration fails insert chest drain.
All pts admitted for 24 hrs.

125
Q

S&S of tension pneumo

A

• Pt looks ill
• Mediastinal shift
Haemodynamic instability as tension compresses mediastinum

126
Q

Tx of tension pneumo

A

• ABCDE

Immediate large bore cannula into 2nd ICS MCL.

127
Q

S&S of wegners

A

• Rhinitis is first sign
• Nose - pain, stuffiness, epistaxis, saddle nose deformity, crusting.
LRT - dyspnoea, haemoptysis

128
Q

Patho of wegners

A

Autoimmune attack by ANCAs (ant neutrophil cytoplasmic antibodies) against small and medium sized BVs. Affects upper, lower RTs, and kidneys.

129
Q

Ix for wegners

A

• cANCA positive in >90%
• CXR - wide variety presentations including cavitating lesions
Renal biopsy - epithelial crescents in Bowmans capsule

130
Q

Tx of wegners

A

• Steroids
• Cyclophosphamide
Plasma exchange

131
Q

CXR of wegners

A

Cavitating pulmonary masses

132
Q

Patho of goodpastures

A

Anti-GBM antibodies against type IV collagen.

133
Q

S&S of goodpastures

A

• Pulmonary hemorrhage - haemoptysis and dyspnoea

Followed by rapidly progressive glomerulonephritis

134
Q

Ix for goodpastures

A

• Negative ANCA - If positive more likely Granulomatosis with polyangiitis
• Renal biopsy - Linear IgG deposits along BM
Positive anti-GBM antibody

135
Q

Tx of goodpastures

A

• Plasma exchange (plasmapharesis)
• Steroids
Cyclophosphamide - Immunosuppressive

136
Q

Patho of bronchiectasis

A

Permanent dilatation of airways secondary to chronic infection or inflammation

1. Impaired mucociliary clearance
2. Chronic airways bacterial infection
3. Excessive inflammation
4. Persistent airways infection and inflammation
5. Bronchial wall inflammation and destruction 6. Cycle repeats
137
Q

Causes of bronchiectasis

A

Post infective, CF, Ciliary dyskinetic syndrome

138
Q

CF induced bronchiectasis MOs

A
  1. H. influenzae
    1. Staph aureus
    2. Pseudomonas aeroginosa - Treat with ciprofloxacin
      Burkholderia cepacia
139
Q

Complications of Bronchiectasis

A 
• Deteriorating lung function
	• Empyema
	• Lung abscess 
	• Pneumothorax
	• Resp failure
Cor pulmonale
140
Q

Ix for Bronchiectasis

A

HRCT Chest:
Airways bigger than BVs indicates bronchiectasis

Investigation for cause:
	• CF - Chloride sweat test
	• HIV test
	• Immunoglobin panel (IgA, M, G)
Test for ciliary dyskinesia if no other cause found
141
Q

S&S of bronchiectasis

A 
• Chronic, productive cough
	• Recurrent infections
	• History of severe resp infection as a child
	• Crackles on auscultation
Wheeze
142
Q

Tx of bronchiectasis

A

• Physical training eg inspiratory muscle training
• Postural drainage
• Immunisations - FLU
• Maybe Surgery if disease is localised
Abx for exacerbations + maybe prophylactic if repeated

143
Q

CF gene and pattern of inheritance

A

• Autosomal recessive.
• Carrier rate of 1 in 25.
Mutation in delta F508

144
Q

Ix for CF

A

Investigations:
• Sweat test - Low Cl.

Features on spirometry:
• Restrictive lung disease
• TF reduced due to incomplete alveolar expansion
Transfer coefficient normal

145
Q

Tx of CF

A

• Regular chest physio and postural drainage
• High calorie high fat diet with pancreatic enzyme supplements
• Vitamin supplementation
Heart and Lung transplant

146
Q

S&S of CF

A

Recurrent RTIs, DM, delayed puberty and short stature, malabsorption, failure to thrive

147
Q

Kartagener syndrome S&S

A

• Dextrocardia or complete situs inversus
• Bronchiectasis
• Recurrent sinusitis
Subfertility

148
Q

Allergic bronchopulmonary aspergillosis patho

A

Results from an allergy to Aspergillus spores

149
Q

S&S of Allergic bronchopulmonary aspergillosis

A

• Bronchoconstriction - wheeze, cough, dyspnoea
Bronchiectasis
ASTHMATICS

150
Q

Ix for Allergic bronchopulmonary aspergillosis

A 
• Eosinophilia
	• Flitting CXR changes
	• Positive radioallergosorbent (RAST) rest to aspergillus
	• Positive IgG precipitins
Raised IgE
151
Q

Tx for Allergic bronchopulmonary aspergillosis

A

• Steroids

Itracanzole second line

152
Q

S&S of lung cancer

A 
• Cough
	• Haemoptysis
	• Dyspnoea
	• Chest pain
	• Weight loss - cachexic
	• Anemia 
Clubbing (strongly associated with squamous cell cancer)
153
Q

Lung cancer mets to

A 
• Liver
	• Brain
	• Bone 
	• Adrenal glands
	• Lymph nodes
CAN PRESENT WITH THESE SYMPTOMS
154
Q

RFs for lung cancer

A

• Smoking
• COPD
• Age
Carcinogen exposure - coal is NOT carcinogen

155
Q

Non small cell lung cancer types

A

• Adenocarcinoma
• Squamous cell
• Large cell
Large cell Neuroendocrine

156
Q

S&S of squamous cell cancer lung

A

• Central
• Associated with PTHrP therefore hypercalcemia
• Finger clubbing
Hypertrophic pulmonary oesteoarthropathy - pain in wrists and ankles.

157
Q

Which lunch cancer most common in non smokers

A

adenocarcinoma

158
Q

Ix for lung cancer

A
  1. Xray
    1. Contrast CT
    2. USS guided biopsy
      PET Scan can be considered - Shows spread of non small cell cancers
159
Q

When to refer urgently and 2 week for lung cancer?

A

Referral - 2 week waiting list if:
• Have CXR that suggests lung cancer
• Aged 40+ with unexplained haemoptysis

Urgent CXR within 2 weeks if 2 or more of following unexplained symptoms OR smoking + 1 of following:
	• Cough
	• Fatigue
	• SOB
	• Chest pain
	• Weight loss
	• Appetite loss
160
Q

S&S of mesothelioma

A

• Progressive SOB
• Chest pain
• Pleural effusion
Weight loss

161
Q

RFs for mesothelioma

A

STRONG correlation to asbestos exposure. 30 yrs latent period.

162
Q

Patho of mesothelioma

A

Malignancy of pleural cells

163
Q

Ix for mesothelioma

A
  1. CXR - pleural effusion/thickening
    1. CT pleura - shows pleural nodularity
      Image guided Pleural biopsy of nodularity to diagnose
164
Q

Small cell cancer S&S

A
  • Central
    • Associated with ectopic ADH, ACTH secretion, SIADH
    • ADH –> hyponatreamia
    • ACTH –> Cushings
165
Q

SIADH Ix

A
  • Plasma osmolarity low (hyponatremia)

* Urine osmolarity high

166
Q

SIADH tx

A

• Fluid restriction

Replace sodium slowly

Z IPE (15 decks)

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