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1st Year Medicine > Resp > Flashcards

Resp Flashcards

1
Q

Haemoptysis?

A

Coughing blood

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2
Q

Uveitis sign of?

A

UC, TB, sarcoid

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3
Q

Papilloedema?

A

Chronically raised pCO2

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4
Q

Where does trachea deviate in collapse, consolidation, effusion?

A

Towards collapse, consolidation + away from effusion

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5
Q

Reduced chest expansion unilaterally? Bilaterally?

A
  • Uni: pneumothorax, effusion, diaphragm palsy

* Bilateral: restrictive lung disease, hyperinflation

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6
Q

Hyper-resonance?

A

Emphysema, pneumothorax

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7
Q

Impaired resonance?

A

Consolidation, raised hemi-diaphragm

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8
Q

Stony dull?

A

Pleural effusion

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9
Q

Normal breath sounds?

A

Vesicular

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10
Q

Reduced breath sounds?

+ decreased vocal resonance

A

Effusion, collapse, emphysema

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11
Q

Transmitted (bronchial) breath sounds?

+ increased vocal resonance

A

Pneumonia, pulmonary fibrosis

whispering pectoriloquy

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12
Q

Localised wheeze vs generalised wheeze?

A
  • Localised = tumour

* Generalised = asthma/COPD

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13
Q

Squeaks + crackles?

A

Bronchiolitis

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14
Q

Crepitations? (4)

A

Fibrosis, oedema, consolidation, bronchiectasis

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15
Q

Pleural rub?

A

PE, pneumonia

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16
Q

Pleural click?

A

Pneumothorax

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17
Q

Dx asthma?

A

Diurnal variation of PEF, FEV1/FVC <75%, reversibility to salbutamol, provocation testing

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18
Q

Ax interstitial lung disease? (9)

A

Fluid in alveolar spaces, consolidation, granulomatous alveolitis, drug-induced, toxic gas, fibrosis, autoimmune, pneumoconiosis, eosinophillic

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19
Q

s/s ILD?

A

breathless on exertion, cough (no wheeze), clubbing, crackles, cyanosis

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20
Q

Dx ILD?

A

FEV/FVC >75%, normal peak flow, DLCO reduced, reduced SaO2, bilateral infiltrates on CXR

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21
Q

Dx sarcoid?

A

Raised serum ACE

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22
Q

Dx pulmonary fibrosis?

A

Ground-glass on CXR

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23
Q

Tx ILD?

A
  • 1st line = prednisolone

* 2nd line = azathioprine

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24
Q

Tx IPF?

A

Pirfenidone, nintendanib

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25
Q

Asthma Tx pyramid?

A
  • SABA
    • ICS
    • LABA
    • LTRA/LAMA/theophylline/anti-IgE/anti-IL5
    • oral steroid
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26
Q

Comp of corticosteroids?

A

Can cause pneumonia in COPD

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27
Q

Acute asthma Tx?

A

OSHITMAN

* Oxygen, salbutamol, hydrocortisone, ipratropium, theophylline, magnesiu sulphate, aminophylline

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28
Q

COPD Tx pyramid?

A

A - SAMA/SABA
B - LABA/LAMA
C - ICS/LABA/LAMA
D - ICS/LABA/LAMA

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29
Q

Acute COPD Tx?

A

ISOAP

* Ipratropium, salbutamol, oxygen, amoxicillin, prednisolone

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30
Q

COPD divided into?

A

Emphysema and bronchitis

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31
Q

s/s lung cancer? (9)

A
  • Cough >3 weeks, breathless, recurrent chest infection, haemoptysis, weight loss, chest/shoulder pain, fatigue, hoarseness, stridor
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32
Q

Lung cancer metastasis to pericardium?

A

Breathlessness, AF, pericardial effusion

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33
Q

Lung cancer metastasis to oesophagus?

A

Dysphagia

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34
Q

Lung cancer metastasis to SVC?

A

Puffy eyelids, headache, collaterals to IVC

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35
Q

Paraneoplastic effects lung cancer? (7)

A

Finger clubbing, HPOA, weight loss, thrombophlebitis, hypercalcaemia, hyponatraemia (SIADH), weakness (Eaton Lambert syndrome)

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36
Q

Hypercalcaemia s/s?

A

stones, bones, groans, thrones (polyuria), psychiatric overtones

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37
Q

Hypercalcaemia associated with?

SIADH?

A
  • hypercal = SQUAMOUS cell

* SIADH = SMALL cell

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38
Q

Hyponatraemia s/s?

A

nausea/vom, myoclonus, lehargy, confusion, seizures, coma

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39
Q

Ix lung cancer?

A

FBC, Na, Ca, spirometry, CXR, CT, PET, bronchoscopy, EBUS

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40
Q

Feature of squamous? Adenocarcinoma?

A
  • Squamous = keratinizing

* Adeno = gland forming

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41
Q

Worst prognosis lung cancer?

A

Small cell

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42
Q

Tx lung cancer?

A

Small cell = chemo

Squamous + adeno = surgery or radiotherapy

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43
Q

Staging for lung cancer surgery?

A

Bronchoscopy, mediastinoscopy, CT brain + thorax, PET scan

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44
Q

Surgery for lung cancer?

A

Pneumonectomy/lobotomy via thoracotomy/minimal access VATS

45
Q

SABR?

A

Much higher dose to tumour delivered through hundreds of small beams

46
Q

Co-morbitities for lung cancer?

A

COPD, ischaemic heart disease

47
Q

URT infections? (4)

A

Coryza, pharyngitis, sinusitis, epiglottitis

48
Q

LRT infections? (4)

A

acute bronchitis, chronic bronchitis, pneumonia, influenza

49
Q

Coryza can cause?

A

Sinusitis + acute bronchitis

50
Q

Ax coryza?

A

Rhinovirus, adenovirus, RSV

51
Q

s/s acute bronchitis?

A

Productive cough, fever, normal CXR, normal chest exam

52
Q

s/s pneumonia? (8)

A

malaise, anorexia, sweats rigors, haemoptysis, dyspnoea, cough, headache

o/e = herpes labialis tachyopnoea, crackles, pleural rub, cyanosis, hypotension

53
Q

Ix pneumonia?

A

Blood culture, serology, urea, FBC, CXR

54
Q

Pneumonia severity?

55
Q

Most common pathogen in pneumonia? (4)

A
  • CAP = s.pneumoniae
  • COPD = H.influenzae
  • Bird exposure = chlamydia psitacci
  • Mycoplasmae = young people
56
Q

Tx pneumonia?

A
  • CAP - amoxicillin/doxycycline
    (severe = co-amoxiclav, doxycycline)
  • HAP - amoxicillin, metronidazole, gentamicin
    (step down to co-trimoxazole + metronidazole)
  • Aspiration pneumonia - amoxicillin, gentamicin, metronidazole
  • Legionella - macrolides, levafloxacin
57
Q

Flu comps?

A

Secondary bacterial pneumonia, bronchitis, otitis media

58
Q

Bronchiolitis epidemiology?

A

1st or 2nd year of life

59
Q

Ax bronchiolitis?

60
Q

Tx bronchiolitis?

A

Supportive

61
Q

Ax coxiella burnetti (Q fever)?

A

Zoonosis sheep + goats

62
Q

Comp Q fever?

A

Endocarditis

63
Q

s/s TB?

A

Weight loss, malaise, night sweats, cough, haemoptysis, SOB, UPPER zone crackles

64
Q

Cold monoarthritis of large joints?

A

TB or sarcoid

NEVER inject steroids!!

65
Q

Dx TB?

A

ZN stain, PCR, CXR (upper zone, cavities, scarring, heals with CALCIFICATION)

66
Q

Histology TB?

A

Caseating necrosis, granulomas

67
Q

Tx TB?

A

2RIPE 4RI

  • 2 moths rifampacin, isoniazid, pyrazinamide, ethambutol
  • 4 months rifampacin, isoniazid
68
Q

Tx latent TB?

A

6 months isoniazid/3 months rifampacin + isoniazid

69
Q

All TB cases offered?

A 
HIV test
(all HIV cases offered CXR)
70
Q

Most common bacteria in COPD exacerbation?

A

Haemophilus influenzae

71
Q

Ax whooping cough (pertussis)?

A

Bordatella pertussis

72
Q

Tx whooping cough?

A

antibiotics if <21 day cough (after 21 days no point)

73
Q

Legionella dx?

A

PCR, legionella urinary antigen (serogroup 1 only)

74
Q

Ax legionella?

A

NO PERSON-PERSON SPREAD

* AC, hot tubs, plumbing

75
Q

Tx mycoplasma pneumoniae?

A

Macrolide + tetracycline

76
Q

s/s walking pneumonia (mycoplasma)?

A

Dry cough, malaise, myalgia, target lesion (erythema multiforme)

77
Q

Bronchiectasis?

A

Abnormal fixed dilation of bronchi

78
Q

CXR TB?

A

Ghon focus at periphery, large hilar nodes

79
Q

TB hypersensitivity?

80
Q

Stridor?

A

Inspiratory wheeze

81
Q

Tracheomalacia?

A

Inflammatory condition causing collapse of trachea

82
Q

Cafe coronary syndrome?

A

Foreign body inhalation

83
Q

Sleep apnoea assessment?

A

Epworth sleepiness scale

84
Q

Ax sleep apnoea?

A

Obesity, enlarged tonsils, retrognathia, acromegaly, drugs (benzo, opiates)

85
Q

Tx obstructive sleep apnoea?

86
Q

Kartagener syndrome?

A

Ciliary dysfunction

87
Q

Youngs syndrome?

A

Recurrent sinobronchial infections

88
Q

S/s intrapulmonary abscess? (3)

A

Weight loss, lethargy, cough

89
Q

Cavitating pneumonia?

A

Staph (common after flu)

90
Q

Septic emboli Ax?

A

Right sided endocarditis, infected DVT, PWID

91
Q

Empyema Ax? Dx?

A

Mostly pneumonia

dx: CXR (D sign), USS, CT

92
Q

Tx empyema?

A

Drainage, amoxicillin, metronidazole

93
Q

s/s bronchiectasis?

A

recurrent chest infections, sputum

94
Q

dx bronchiectasis?

A

HRCT (signet rings)

95
Q

Chronic bronchial sepsis?

A

All hallmarks of bronchiectasis except no bronchiectasis on HRCT!!!

96
Q

Bronchiectasis tx?

A

Smoking cessation, flue vaccine, pneumococcal vaccine, antibiotics

(Severe = nebulised gentamicin, IV antibiotics)

97
Q

Comps CF?

A

Bronchiectasis, biliary obstruction, infertility, psychological issues

98
Q

Tx cystic fibrosis?

A

antibiotics, CREON, insuli, laxido (DIOS), fluids, TIPSS (portal hypertension)

99
Q

Specific tx CF?

A 
G551D = ivacaftor
F508del = lumacaftor
100
Q

Hypersensitivty pneumonitis?

A

EAA

* Farmer’s, bird breeder’s, cheese worker’s

101
Q

Dx EAA?

A

CXR (honey-combing and air-trapping)

102
Q

Pneumoconiosis?

A

Asbestosis, silicosis, coal worker’s lung

103
Q

Exudative pleural effusion?

A

Malignant cancer (meso), PE, rheumatoid, TB, pneumoni, connective tissue disease

104
Q

Transudative pleural effusion?

A

Caused by ‘failures’ = cardiac, renal, liver, endocrine, nutritional, atelectasis

105
Q

PE causes?

A

DVT, air embolism, fat embolism, amniotic fluid embolism, foreign material

106
Q

s/s PE?

A

Dyspnoea, tachycardia, tachyopnoea, pleuritic pain, cyanosis, haemoptysis

107
Q

Dx PE?

A

CTPA!!! (low d-dimer = exclude PE)

108
Q

Tx PE?

A

Acute = O2, IV fluids, thrombolysis, LMWH

Long term = anticoagulation, IVC filter

109
Q

Silicosis CXR?

A

Eggshell calcification in hilar region (“snow storm” appearance)

1st Year Medicine (3 decks)

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