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Resp Flashcards

1
Q

What changes in the lungs can amiodarone/ methotrexate lead to?

A

Pleural effusions, interstitial lung disease

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2
Q

What lung condition is common in miners, and how does it present?

A

Pneumoconiosis –> inflammation, coughing, fibrosis

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3
Q

What would be the results of spirometry in a patient with COPD:

  • FEV 1
  • FEV 1/FVC
  • Bronchodilator reversibility
  • Total lung volume
  • FRC
  • Residual volume
  • Gas transfer (TLCO & kCO)
A
  • decreased FEV 1
  • decreased FEV 1/FVC
  • minimal Bronchodilator reversibility (<15%)
  • increased Total lung volume
  • increased FRC
  • increased Residual volume
  • decreased Gas transfer (TLCO & kCO)
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4
Q

What treatments should patients experiencing a COPD exacerbation be considered for?

A

EDIT - PAGE 813

  • Nebulized salbutamol + ipratropium w/ air
  • Oral steroids
  • Consider IV aminophylline if not improving with nebulisers
  • NIV in pts w/ respiratory acidosis despite max medical TX
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5
Q

What is the definition of asthma?

A

Diurnal variation >20% on 3 or more days per week for 2 weeks

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6
Q

What would be the results of spirometry in a patient with asthma?

A

Obstructive pattern

  • Decreased FEV1/FVC
  • Increased RV
  • > 15% increase in FEV after b2 agonists/ steroids
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7
Q

When should steroids be prescribed to a pt suffering from asthma?

A

Pts with an FEV less than 60% predicted who have had 2+ exacerbations per year requiring treatment with Abx or oral steroids. Use in combo w/ bronchodilator.

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8
Q

What is the treatment of an acute asthma attack?

A
  • Supplementary oxygen (maintain at 94-98%)
  • Salbutamol nebulised with oxygen
  • If severe/life-threatening: add ipratropium to nebulisers
  • Hydrocortisone IV or prednisolone PO
  • If poor initial response: give single dose of magnesium sulfate IV the next day
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9
Q

What conditions must be met before a patient who has had an asthma attack is discharged?

A
  • Must be stable on meds for 24 hours
  • Peak flow rate >75% predicted
  • Follow up appointments arranged
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10
Q

How does extrinsic allergic alveolitis present?

A

4 - 6 hours post-exposure: fevers, rigors, myalgia. dry cough, dyspnoea, crackles (NO wheeze!)

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11
Q

Is extrinsic allergic alveolitis obstructive or restrictive?

A

Restrictive

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12
Q

Name 3 things that might occur in chronic extrinsic allergic alveolitis.

A
  • Type 1 respiratory failure
  • Granuloma formation
  • Obliterative bronchiolitis
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13
Q

What would you see on an CXR of someone with chronic extrinsic allergic alveolitis?

A

Upper-zone fibrosis; honeycomb lung

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14
Q

What would you see on an CXR of someone with acute extrinsic allergic alveolitis?

A

Upper zone mottling/ consolidation

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15
Q

A patient with resolving pneumonia develops a recurrent fever - what should you suspect? What would you see on CXR? How would you treat it?

A

Empyema. CXR suggests pleural effusion. Chest drain to treat.

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16
Q

How would empyema look like if you were to take a sample? Comment on other features it has

A

Yellow and turbid, pH <7.2, low glucose, LDH high

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17
Q

What would you hear on auscultation of someone with bronchiectasis?

A

Coarse, inspiratory crepitations.

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18
Q

What sort of pattern would bronchiectasis give on spirometry?

A

Obstructive pattern

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19
Q

Name 4 of the main organisms involved in bronhciestasis?

A
  • H. influenzae
  • Strep. pneumoniae
  • Staph aureus
  • Pseudomonas aeruginosa
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20
Q

What would you hear on auscultation of someone with cystic fibrosis?

A

Bilateral coarse crackles

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21
Q

How could you test pancreatic function in someone with cystic fibrosis?

A

Faecal elastase

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22
Q

What type of pattern would cystic fibrosis give on spirometry?

A

Obstructive pattern

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23
Q

How high would you expect sodium and chloride to be in the sweat of someone with cystic fibrosis?

A

> 60 mmol/L

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24
Q

Name some extra-pulmonary manifestations of cystic fibrosis?

A

DM, gallstones, cirrhosis, infertility, osteoporosis, arthritis, vasculitis, sinusitis, chronic pancreatitis

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25
Q

What treatments should be given to someone with cystic fibrosis?

A
  • Physio (postural drainage)
  • Mucolytics
  • Bronchodilators
  • Pancreatic enzyme replacement
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26
Q

Name the 3 most common organisms that cause community acquired pneumonia

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Mycoplasma pneumoniae
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27
Q

Name the 2 most common causes of hospital acquired pneumoniae

A

Gram negative enterobacteria

Staph aureus

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28
Q

What is the initial phase of TB treatment?

A

RIPE: 2 months on 4 drugs: rifampicin; isoniazid; pyrazinamide; ethambutol

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29
Q

What is the continuation phase of TB treatment?

A

RI: 4 months on 2 drugs: rifampicin and isoniazid

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30
Q

What are the side effects of rifampicin?

A

Raised LFTs (stop if bilirubin is raised)
Decreased platelets
Orange discolouration of urine, tears and contact lenses
Inactivation of the Pill
Flu symptoms

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31
Q

What are the side effects of isoniazid?

A

Raised LFTs
Decreased WCC
Stop if neuropathy

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32
Q

What are the side effects of ethambutol? What must you test as a result before and during treatment?

A 
Optic neuritis (colour vision is 1st to deteriorate).
Must test colour vision and acuity before and during treatment
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33
Q

Name 2 side effects of pyrazinamide

A

Hepatitis, arthalgia

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34
Q

Name 2 contraindications to a patient taking pyrazinamide

A

Acute gout; porphyria

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35
Q

A patient who is currently receiving treatment for TB presents to GP with orange urine - which medication is the likely cause?

A

Rifampicin

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36
Q

A patient who is currently receiving treatment for TB presents to GP and is pregnant despite being on the Pill! - which medication is the likely cause?

A

Rifampicin

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37
Q

A patient who is currently receiving treatment for TB presents to GP with deteriorating colour vision - which medication is the likely cause?

A

Ethambutol

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38
Q

A patient who is currently receiving treatment for TB presents to GP with joint pains - which medication is the likely cause?

A

Pyrazinamide

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39
Q

What signs would you see in a patient with pleural effusion?

A
  • Decreased expansion
  • Stony dull to percuss
  • Decreased breath sounds
  • Decreased tactile vocal fremitus
  • ## Decreased vocal resonance (“repeat 99”)
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40
Q

What value of protein (in g/L) must a pleural effusion have below to be considered transudate?

A

Less than 25 g/L

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41
Q

Cardiac failure - does this cause a transudate or exudate pleural effusion?

A

Transudate

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42
Q

Constrictive pericarditis - does this cause a transudate or exudate pleural effusion?

A

Transudate

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43
Q

Cirrhosis - does this cause a transudate or exudate pleural effusion?

A

Transudate

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44
Q

Nephrotic syndrome - does this cause a transudate or exudate pleural effusion?

A

Transudate

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45
Q

Hypothyroidism - does this cause a transudate or exudate pleural effusion?

A

Transudate

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46
Q

Pneumonia - does this cause a transudate or exudate pleural effusion?

A

Exudate

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47
Q

Rheumatoid arthritis - does this cause a transudate or exudate pleural effusion?

A

Exudate

48
Q

Mesothelioma - does this cause a transudate or exudate pleural effusion?

A

Exudate

49
Q

SLE - does this cause a transudate or exudate pleural effusion?

A

Exudate

50
Q

Bronchogenic carcinoma - does this cause a transudate or exudate pleural effusion?

A

Exudate

51
Q

Generally, what is the cause of transudate pleural effusions?

A

Increased venous pressure or hypoproteinaemia

52
Q

Generally, what is the cause of exudate pleural effusions?

A

Mostly due to increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy

53
Q

Generally, what is the cause of type 1 respiratory failure?

A

V/Q mismatch

54
Q

Generally, what is the cause of type 2 respiratory failure?

A

Alveolar hypoventilation E.g. decreased respiratory drive (e.g. sedative drugs), neuromuscular disease (e.g. MG), thoracic wall disease

55
Q

A patient gets short of breath when they walk up a hill but is otherwise fine - what is their MRC score?

A

2

56
Q

What does an MRC score of 3 mean?

A

Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace

57
Q

A patient has to stop for breath after walking around 100m - what is their MRC score?

A

4

58
Q

What does an MRC score of 5 mean?

A

The patient is too breathless to leave the house, or is breathless when dressing or undressing

59
Q

Define chronic bronchitis

A

Cough, sputum production on most days for 3 months of 2 successive years.

60
Q

How does the sputum in chronic bronchitis look like?

A

Clear and colourless

61
Q

What is the pathophysiology behind emphysema?

A

Enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls

62
Q

What does ABG of someone from an acute attack of asthma look like?

A

Usually shows normal/decreased PaO2 but decreased PaCO2 due to hyperventilation

63
Q

Based on ABG, when should you consider transferring a patient suffering from an acute asthma attack to ITU?

A

If PaCO2 is normal or raised as this signifies failing respiratory effort

64
Q

Name 4 side effects of salbutamol

A

Tachycardia, arrhythmias, tremor, hypokalaemia

65
Q

What pattern on spirometry does interstitial lung disease give?

A

Restrictive pattern

66
Q

In interstitial lung disease, which cells undergo hyperplasia?

A

Type II epithelial cells/pneumocytes

67
Q

How does a pleural abscess present?

A

Swinging fever; purulent cough; pleuritic chest pain; haemoptysis; weight loss

68
Q

What are the treatments available for pleural abscess?

A
  • Abx (4-6 weeks)
  • Postural drainage
  • Repeated aspiration or surgical excision
69
Q

What is the pathophysiology behind bronchiectasis?

A

Chronic infection of bronchi and bronchioles leading to permanent dilatation

70
Q

How does bronchiectasis present?

A

Persistent cough; copious purulent sputum; intermittent haemoptysis; wheeze

71
Q

What would you hear on auscultation of someone with bronchiectasis?

A

Coarse inspiratory crepitations

72
Q

What would you see on the CXR of someone with bronchiectasis?

A

Thickened bronchial walls - tramline and ring shadows

73
Q

What pattern would you see on spirometry of someone with bronchiectasis?

A

Obstructive

74
Q

Why might you do bronchoscopy on someone with bronchiectasis?

A

To locate the site of haemoptysis and obtain samples for culture

75
Q

What treatment is recommended for allergic bronchopulmonary aspergillosis (ABPA)?

A

Corticosteroids

76
Q

What would happen to tactile vocal fremitus/ vocal resonance in pneumonia?

A

Increased

77
Q

In severe cases of pneumonia, what might you check for and which investigations would you do?

A
  • Legionella: sputum culture, urine antigen
  • Atypical organism/ viral serology (PCR sputum)
  • Check for pneumococcal antigen in urine
78
Q

What does CURB 65 stand for?

A

Confusion (abbreviated mental test 8 or less)
Urea over 7 mmol/L
Respiratory rate 30 or more/min
BP 90 or less systolic +/- 60 or less diastolic
65: if over this age

79
Q

If someone scores 1 of CURB 65, where should the patient be treated?

A

At home

80
Q

If someone scores 2 of CURB 65, where should the patient be treated?

A

Hospital

81
Q

If someone scores 3 of CURB 65, where should the patient be treated?

A

Consider ITU

82
Q

List 7 groups that should be offered the pneumococcal vaccine

A
  • Over 65 year olds
  • Those suffering from chronic heart/ liver/ renal or lung conditions
  • DM
  • Immunosuppression
83
Q

What investigations should be done on patients with suspected active TB?

A

CXR
Sputum samples (3 or more with 1 early morning sample before starting TX if possible) and send for MC&S and AFB
PCR allows rapid identification of rifampicin resistance

84
Q

What test can you do to check for latent TB? If the result is positive, what should you then consider doing?

A

Mantoux test

If positive - consider interferon gamma testing

85
Q

How should you treat someone with asymptomatic TB?

A

Prophylaxis: 1/2 anti-TB drugs for shorter periods of time

86
Q

How is the tuberculin skin test carried out?

A

TB antigen is injected intradermally. There is a cell-mediated response @ 48 - 72 hours. Positive result = immunity or previous exposure.
Strong positive result = active TB

87
Q

When might you get a false negative result for a tuberculin skin test?

A

In immunosuppression

88
Q

A patient with suspected TB gets the results back from their sputum culture and it is negative - what should you do?

A

Continue if histology and clinical picture are consistent with TB

89
Q

Is public health notification necessary for TB?

A

Yes

90
Q

Is contact tracing necessary for TB?

A

Yes

91
Q

By what means does military TB occur?

A

Haematogenous spread

92
Q

What should you look out for in bone TB?

A

Vertebral collapse and Pott’s vertebrae

93
Q

What effect can TB have on the pericardium?

A

Chronic pericardial effusion and constrictive pericarditis

94
Q

What is the pathophysiology of spontaneous pneumothoraxes in young thin men?

A

Rupture of a subpleural bulla

95
Q

What first treatment should be offered to someone with a 3cm primary pneumothorax that is short of breath?

A

Aspiration

96
Q

What first treatment should be offered to a 30 year old man that is short of breath with a 4cm secondary pneumothorax?

A

Aspiration

Would be a chest drain if he was 50 or older

97
Q

What treatment should be offered to someone with a 1cm primary pneumothorax that is not short of breath?

A

Consider discharge

98
Q

What treatments and investigation should you do with someone with a tension pneumothorax?

A

1) Insert large-bore needle with syringe into 2nd ICS midclavicular line
2) Then CXR
3) Then chest drain

99
Q

How does a large pleural effusion look like on chest x ray?

A

Water-dense shadows with concave upper borders

100
Q

How does a pneumothorax look on CXR?

A

Completely flat horizontal upper border

101
Q

What options are there for recurrent pleural effusions?

A

Pleurodesis (e.g. with tetracycline/talc) for recurrent effusions, surgery

102
Q

How would the pleural fluid look like in someone with mesothelioma?

A

Bloody

103
Q

What treatment can you offer someone with mesothelioma?

A

Pleurodesis and indwelling intra-pleural drain

Chemo can improve survival

104
Q

Name 3 consequences of long-term hypoxia?

A

Polycythaemia; pulmonary HTN; cor pulmonale

105
Q

List some symptoms of hypercapnia

A

Headache; peripheral vasodilation; tachycardia; bounding pulse; tremor/flap; papilledema; confusion

106
Q

How can sarcoidosis present?

A

Erythema nodosum, non-productive cough, arthralgia, bilateral hilar lymphadenopathy, hypercalcaemia

107
Q

Which measurement in spirometry is significantly reduced in obstructive lung disease?

A

FEV 1

108
Q

Which measurement in spirometry is significantly reduced in restrictive lung disease?

A

FVC

109
Q

Which pattern would you see on spirometry of someone with Acute Respiratory Distress Syndrome?

A

Restrictive lung disease

110
Q

What is KCO?

A

KCO AKA transfer coefficient
= TLCO (Transfer Factor of the Lung for Carbon Monoxide) / alveolar volume
It measures how efficient gas exchange is relative to the alveolar-capillary surface to volume ratio

111
Q

What would the KCO be in someone with chest wall disease?

A

It would be increased as there is a small alveolar volume, so in proportion to the alveolar volume, there is increased pulmonary blood flow (SA to volume ratio)

112
Q

Which pattern would you see on spirometry of someone with Alpha-1 antitrypsin deficiency?

A

Obstructive

113
Q

What would you see on chest x-ray of someone with ARDS?

A

Bilateral pulmonary infiltrates

114
Q

What causes atelectasis?

A

Airways becoming obstructed by bronchial secretions

115
Q

What treatment is available for someone with Atelectasis?

A

Chest physio with mobilisation and breathing exercises

116
Q

What would you hear on auscultation of someone with Atelectasis?

A

Fine crackles

Medicine (15 decks)

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