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Year 3 Medicine > Resp > Flashcards

Resp Flashcards

1
Q

What pH is considered Alkalaemia?

A

pH>7.45

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2
Q

What can Alkalaemia cause?

A

Reduces free calcium causing Ca2+ ions to come out of solution, increasing neuronal excitability

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3
Q

What symptoms can Alkalaemia cause?

A

Paraesthesia and Tetany

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4
Q

What pH is considered Acidaemia?

A

pH<7.35

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5
Q

What can Acidaemia cause?

A

Increases plasma K+ concentration giving a risk of Arrythmia.
Also increases H+ concentrations, denaturing enzymes

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6
Q

Which ratio determines pH?

A

CO2:HCO3

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7
Q

What does arterial pCO2 depend on?

A

Respiration, controlled by chemoreceptors

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8
Q

What can disturb arterial pCO2?

A

Respiratory disease

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9
Q

What does arterial HCO3 depend on?

A

Renal excretion

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10
Q

What can disturb arterial HCO3?

A

Metabolic and Renal diseases

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11
Q

What is the primary role of HCO3 ions?

A

To buffer acids produced as a by-product of metabolism

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12
Q

Why aren’t HCO3 ions depleted when maintaining arterial pH?

A

The Kidneys both recover and produce HCO3

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13
Q

How is HCO3 produced in the PCT?

A

From amino acids, adding NH4 to urine

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14
Q

How is HCO3 produced in the DCT?

A

From CO2 and H2O

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15
Q

How does Metabolic Acidosis present?

A

pH <7.35
Lowered PaCO2
Lowered HCO3

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16
Q

How does Metabolic Alkalosis present?

A

pH>7.45
Increased PaCO2
Increased HCO3

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17
Q

How does Respiratory Acidosis present?

A

pH<7.35
Increased PaCO2
Increased HCO3

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18
Q

How does Respiratory Alkalosis present?

A

pH>7.45
Reduced PaCO2
Reduced HCO3

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19
Q

What are some causes of a low PaO2?

A

Hypoventilation
Diffusion Impairment
Shunt
V/Q Mismatch

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20
Q

When can it be useful to calculate the Alveolar - Arterial gradient?

A

If there is a suspected respiratory problem.

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21
Q

How is Alveolar O2 calculated?

A

P(Room Air) - (PaCO2/0.8)

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22
Q

What is the normal value for the partial pressure of room air?

A

20kPa

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23
Q

What should the A-a gradient be in healthy individuals?

A

<2kPa in younger patients

<4kPa IN OLDER PATIENTS

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24
Q

What does an A-a gradient of >4kPa suggest?

A

Lung pathology

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25
Q

What is a Pulmonary Embolus?

A

Thrombus entering the Right side of the heart and pulmonary arteries

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26
Q

Where do Pulmonary Emboli normally originate from?

A

DVT in the Popliteal/Pelvic veins

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27
Q

What are some risk factors for a PE?

A 
Pregnancy
Prolonged immobilisation
Previous VTE
Long haul travel
Cancer
HF 
Obesity
Smoking
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28
Q

What are some symptoms of a PE?

A

Pleuritic CP
SOB
Haemoptysis
Low Cardiac Output leading to collapse

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29
Q

What are some physical signs of a PE?

A

Obvious Dyspnoea
Tachycardia
Low BP
Raised JVP

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30
Q

A PE presents with RV overload. What is the pathophysiology behind this presentation?

A

Pulmonary artery pressure rises giving RV dilatation and strain. Inotropes are also released giving pulmonary vasoconstriction

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31
Q

When should an ABG be performed with a suspected PE?

A

Evidenc of Hypoxia needing Oxygen

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32
Q

What is a CXR needed for with a suspected PE?

A

To exclude other diagnoses

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33
Q

What may an ECG show with a PE?

A

RV Strain

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34
Q

What is D-Dimer?

A

A fibrin degredation product

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35
Q

When can a normal D-Dimer rule out PE?

A

In patients at low risk of a PE

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36
Q

When should a D-Dimer not be used?

A

If the patient is high risk

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37
Q

What is the investigation of choice for a suspected PE?

A

CT-PA

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38
Q

What are some recommended management steps for a confirmed PE?

A 
ABCDE
O2 if Hypoxic
Fluid resuscitation if Hypotensive
Anticoagulation
Thrombolysis if signs of massive PE
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39
Q

Which Thrombolytic agent is recommended with a massive PE?

A

IV Alteplase

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40
Q

What are some Absolute contraindications to Thrombolysis with a massive PE?

A 
Stroke less than 6 months ago
CNS Neoplasia
Recent Trauma/Surgery
GI bleed less than 1 month ago
Bleeding disorder
Aortic Dissection
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41
Q

What are some Relative contraindications to Thromboysis with a massive PE?

A

Warfarin
Pregnancy
Advanced liver disease
Infective endocarditis

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42
Q

What is Pneumonia?

A

Inflammation of lung alveoli due to a respiratory tract infection

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43
Q

What are some cardinal symptoms of Pneumonia?

A

Fever
Cough
Pleuritic CP
SOB

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44
Q

What are the two primary types of Pneumonia?

A

Community Acquired Pneumonia (CAP)

Hospital Acquired Pneumonia (HAP)

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45
Q

What is Community Acquired Pneumonia (CAP)?

A

Pneumonia that was acquired prior to admission

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46
Q

What is Hospital Acquired Pneumonia (HAP)?

A

Pneumonia that develops over 48h post admission

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47
Q

What are some symptoms of CAP?

A 
SOB
Cough +/- Yellow/Brown sputum
Fever
Rigors
Pleuritic CP
Malaise
N+V
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48
Q

What are some signs of CAP?

A 
Pyrexia
Tachycardia
Tachypnoea
Cyanosis
Dullness to Percussion
Tactile Vocal Fremitus
Bronchial Breathing
Crackles
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49
Q

What are some appropriate investigations for CAP?

A 
FBC
U+E
CRP
ABG
CXR
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50
Q

Which samples are appropriate in suspected CAP?

A 
Sputum
Blood cultures
Bronchoalveolar Lavage
Nose and Throat swabs
Urine
Serum antibodies
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51
Q

Which score can be used to assess suspected CAP?

A

CURB - 65

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52
Q

Which CURB-65 score suggests admittance would be appropriate with CAP?

A

> 2

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53
Q

What is the “C” of CURB-65?

A

Confusion - MMT score 2 or more worse than their usual score

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54
Q

What is the “U” of CURB-65?

A

Urea >7mmol/L

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55
Q

What is the “R” of CURB-65?

A

Respiratory Rate >30/min

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56
Q

What is the “B” of CURB-65?

A

Blood Pressure:
<90mmHg Systolic
<60mmHg Diastolic

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57
Q

What is the “65” in CURB-65?

A

65 years of age or older

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58
Q

For every positive CURB-65 factor, how many points does the patient get?

A

1

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59
Q

What management is appropriate for confirmed CAP?

A

ABCDE
If septic, commence sepsis 6
Use local guidelines and CURB-65 score to guide choice of Abx

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60
Q

What are some common causative organisms of CAP?

A

S.pneumonia
H.influenzae
Legionella

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61
Q

What are some common causative organisms of HAP?

A 
Staph Aureus
Enterobacteriaciae
Pseudomonas
H. Influenzae
Fungi
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62
Q

What is Anaphylaxis?

A

A serious allergic reaction as a result of a sensitised individual being exposed to a specific antigen

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63
Q

Where can anaphylactic antigens come from?

A

Insect bites/stings
Foods
Medications

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64
Q

What is the immunological response responsible for anaphylaxis?

A

Mast Cell and Basophil production in response to an antigen leading to increased Histamines giving the symptoms seen.

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65
Q

What are some signs/symptoms of anaphylaxis?

A 
Pruritis
Urticaria and Angioedema
Hoarseness
Stridor and Bronchial Obstruction
Wheeze
Chest Tightness
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66
Q

What should the immediate management of suspected anaphylaxis be?

A

Seek immediate help - crash call if appropriate
Removal of trigger, maintainance of airway
100% O2

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67
Q

What Pharmacological intervention for anaphylaxis is appropriate?

A

IM Adrenaline 0.5mg every 5 mins as required
IV Hydrocortisone 200mg
IV Chlorpheniramine 10mg

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68
Q

If a patient in anaphylaxis is hypotensive, what is the recommended treatment?

A

Lie them flat and fluid resuscitate

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69
Q

Which treatment is recommended for Bronchospasm due to anaphylaxis?

A

Nebulised Salbutamol

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70
Q

Which treatment is recommended for Laryngeal oedema due to anaphylaxis?

A

Nebulised Adrenaline

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71
Q

How is massive Haemoptysis defined?

A

> 240mls of Blood in 24h

>100ml of blood per day for consecutive days

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72
Q

What is the management of massive haemoptysis

A

ABCDE assessment
If the site of lesion is known, lie the patient on the affected side
Stop NSAIDS, Aspirin, Anticoagulants

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73
Q

What pharmacological intervention can be indicated with massive haemoptysis?

A

Tranexamic Acid PO for 5/7 or IV

Vitamin K

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74
Q

Which imaging is indicated in cases of massive haemoptysis?

A

CT - Aortagram with a view to possible interventional Bronchial artery embolisation.

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75
Q

What does the WHO performance status help to quantify?

A

Lung Ca status

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76
Q

How many stages are there in the WHO performance status for Lung Ca?

A

6

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77
Q

What criteria for Stage 0 of the WHO Lung Ca Performance status are there?

A

Patient is fully active without restriction

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78
Q

What criteria for Stage 1 of the WHO Lung Ca Performance status are there?

A

Patient is restricted in physically strenuous activity, but ambulatory and able to carry out light work

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79
Q

What criteria for Stage 2 of the WHO Lung Ca Performance status are there?

A

Ambulatory and capable of all self-care, but unable to carry out any work activities. Up and about more than 50% of waking time

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80
Q

What criteria for Stage 3 of the WHO Lung Ca Performance status are there?

A

Capable of only limited self-care, confined to bed or chair more than 50% of waking hours

81
Q

What criteria for Stage 4 of the WHO Lung Ca Performance status are there?

A

Completely disabled. Cannot care for self. Totally confined to bed or chair.

82
Q

What criteria for Stage 5 of the WHO Lung Ca Performance status are there?

A

Patient is deceased as a result of Lung Ca

83
Q

What is Asthma?

A

A chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

84
Q

Which cells are activated in asthma?

A

Th2 cells

85
Q

How does the activation of Th2 cells in asthma lead to symptoms?

A

Th2 cells produce Cytokines which activate mast cells and eosinophils, giving inflammation

86
Q

What does the inflammation in Asthma lead to?

A

Mucosal oedema due to vascular leakage
Bronchial wall thickening
Mucous over-production leading to mucosal plugs
Smooth muscle contraction

87
Q

What are some triggers of Asthma?

A 
Allergens
Cold air
Exercise
Fumes
Cigarette smoke
Perfumes
Chemicals
NSAIDs
Beta blockers
Emotional distress
88
Q

What are some clinical features of asthma?

A 
Acute breathlessness +/- Wheeze/Cough
Reduced Peak Flow/FEV1
Tachypnoea
Tachycardia
Anxiety
89
Q

How is the body able to compensate for mild asthma?

A

Through hyperventilation of better ventilated areas

90
Q

How does mild asthma present?

A

Low pCO2 and pO2 - Type 1 Respiratory Failure

91
Q

How does Severe/Life threatening asthma present?

A

Low pO2, raised pCO2 - Type 2 Respiratory Failure

92
Q

What pattern does asthma demonstrate on a Flow-Volume Loop?

A

Obstructive pattern

93
Q

How will FEV1 change in asthmatic patients after administration of Bronchodilators?

A

Improve

94
Q

What is the first stage in Pharmacological management of asthma?

A

Short Acting β2 Agonist

95
Q

What is an example of a Short-Acting β2 Agonist?

A

Salbutamol

96
Q

How do short-acting β2 agonists improve symptoms in asthma?

A

Reverses/Prevents bronchoconstriction

97
Q

Why should short-acting β2 agonists only be used infrequently?

A

Regular use can increase mast cell degranulation, worsening symptoms

98
Q

What are some common side-effects of short-acting β2 agonists?

A

Tachycardia
Palpitations
Tremor

99
Q

What is the second stage in Pharmacological management of asthma?

A

Regular Preventer therapy through inhaled corticosteroids

100
Q

Name a commonly used Inhaled Corticosteroid in treatment of asthma?

A

Beclamethasone

101
Q

When is use of a regular preventer corticosteroid in asthma indicated??

A

If using β2 agonist >3 times a week
If getting symptoms >3 times a week
If waking with symptoms >once a week
If they’ve had an exacerbation needing steroids in the last two years

102
Q

How do inhaled corticosteroids improve symptoms in asthma?

A

Reduce inflammation

103
Q

What can be added on to inhaled corticosteroids in asthma if symptoms persist?

A

Long-Acting β2 agonist

104
Q

Name a long-acting β2 agonist for asthma?

A

Formoterol

105
Q

When is a long-acting β2 agonist indicated in asthma?

A

If symptoms are not being controlled with 400mcg per day of inhaled corticosteroid

106
Q

Can Formoterol be prescribed on its’ own?

A

No, must be prescribed with an inhaled corticosteroid i.e. Beclamethosone + Formoterol

107
Q

What are some alternatives to Formoterol as an add-in therapy for Asthma?

A

Leukotriene Antagonists - Montelukast
Long Acting Anticholinergics - Tiotropium Bromide
Methylxanthines - Theophylline

108
Q

What biological therapies are available for the treatment of asthma?

A

Anti IgE - Omalizumab

Anti IL5 - Mepolizumab

109
Q

Which symptoms indicate an acute severe asthma attack in adults?

A 
Any one of:
Unable to complete sentences
Pulse >110bpm
RR>25/min
Peak Flow
110
Q

Which features of an asthma attack suggest it is life-threatening?

A 
SpO2<92%
PaO2<8kPa
PaCO2>4.5kPa
Silent chest
Cyanosis
Feeble respiratory effort
Hypotension
Bradycardia 
Arrythmia
111
Q

What is the recommended treatment for an acute severe/life threatening asthma attack?

A

High Flow O2 - Aim for sats of 94-98
Nebulised Salbutamol
40mg Prednisolone PO for 10-14 days
Nebulised Ipratroprium/IV Aminophylline if needed

112
Q

What is COPD?

A

An umbrella term encompassing both Emphysema and Chronic Bronchitis

113
Q

How is COPD characterised?

A

Progressive airway obstruction, usually due to smoking

114
Q

What is Emphysema?

A

Pathological destruction of terminal bronchioles and distal air spaces reducing alveolar surface area and leading to development of bullae.

115
Q

How does the destruction of bronchioles in COPD affect gaseous diffusion?

A

Destruction of supporting tissues of small airways leads to collapse during expiration
Also gives lung hyperinflation

116
Q

What is Chronic Bronchitis?

A

Inflammation of large airways leading to mucus hypersecretion through proliferation of mucus producing cells. Leads to airway narrowing and obstruction

117
Q

What are some common causes of COPD?

A

Smoking
Alpha-1-Antitrypsin deficiency
Occupational exposure
Pollution

118
Q

What are some symptoms of COPD?

A

Cough and Sputum Production

Progressive breathlessness

119
Q

How are COPD patients assessed?

A

MRC Dyspnoea score

120
Q

What are some clinical signs of COPD?

A 
Pursed-lip breathing to prevent small airway collapse
Tachypnoea
Use of accessory muscles
Hyperinflation
Wheeze on auscultation
Cyanosis and signs of CO2 retention
Reduced FEV1
121
Q

How can the airway obstruction in COPD be characterised?

A

Mild
Moderate
Severe

122
Q

How is FEV1 affected in Mild COPD?

A

50-80% of predicted best

123
Q

How is FEV1 affected in Moderate COPD?

A

30-49% of predicted best

124
Q

How is FEV1 affected in Severe COPD?

A

<30% of predicted best

125
Q

What are some management options for COPD?

A 
Smoking cessation
Pulmonary rehabilitation
Bronchodilators
Anti-muscarinics
Steroids
Mucolytics
Diet modification
Flu Vaccine
Long-Term Oxygen Therapy
Lung Volume reduction
Non-invasive ventilation
126
Q

What is MRC Dyspnoea score 1?

A

Not troubled by breathlessness except on strenuous exercise

127
Q

What is MRC Dyspnoea score 2?

A

SOB when hurrying/walking uphill

128
Q

What is MRC Dyspnoea score 3?

A

Walks slower than contemporaries on level ground due to breathlessness, or must stop for breath when walking at own pace

129
Q

What is MRC Dyspnoea score 4?

A

Stops for breath after walking 100m or a few minutes on level ground

130
Q

What is MRC Dyspnoea score 5?

A

Too breathless to leave the house

131
Q

How can COPD exacerbations be qualified?

A

Infective

Non-Infective

132
Q

How do infective exacerbations of COPD present?

A

Change in sputum colour/volume
Fever
Raised WCC +/- CRP

133
Q

What are the generalised management steps for a COPD exacerbation?

A

ABCDE
Oxygen
Bronchodilators
Steroids

134
Q

How should Oxygen be given to COPD exacerbation patients?

A

Through a fixed performance mask due to the risk of CO2 retention

135
Q

What are the target SATS of COPD patients?

A

88-92%

136
Q

What nebulisers should be given to patients with an exacerbation of COPD?

A

Nebulised Salbutamol and Ipratroprium

137
Q

How much steroids should be given to patients with an exacerbation of COPD?

A

30mg Prednisolone Stat, OD for 7/7

138
Q

When should NIV be considered with an exacerbation of COPD?

A

Type 2 Respiratory failure and pH 7.25-7.35

139
Q

When should an exacerbation of COPD be referred to ITU?

A

If pH <7.25

140
Q

What is TB?

A

A respiratory infection caused by bacteria of the Mycobacterium Tuberculosis complex

141
Q

How is TB transmitted?

A

Droplets produced during coughing, sneezing.

Must be prolonged exposure

142
Q

What are the two forms of TB infection?

A

Clinical - Primary/Active TB

Subclinical - Latent TB

143
Q

How does TB present pathologically?

A

Caseating Granulomas within lung parenchyma/mediastinal lymph nodes.

144
Q

What are some risk factors for TB?

A

PMHx TB
Known history of TB contact
Originally from a country of high TB incidences
Foreign travel to a country with a high incidence of TB
Evidence of immunosuppression

145
Q

What are some symptoms of TB?

A 
Fever
Night sweats
W/loss and anorexia
Tiredness and Malaise
Cough
Haemoptysis
Breathlessness
146
Q

Which investigations are appropriate with suspected TB?

A 
CXR
3 sputum samples - Test via Ziel-Niellson stain
Induced sputum
Bronchoscopy
Routine bloods inc LFTs, HIV, Vitamin D
CT Chest
147
Q

What are some non-respiratory manifestations of TB?

A 
Skin
Lymphadenopathy
Bone/Joint
Abdominal
CNS
Genitourinary
Miliary
148
Q

What are some management steps for TB?

A

ABCDE approach
Send samples/cultures
If high suspicion and patient unwell, commence anti TB treatment once samples are sent
Notify TB nurses

149
Q

Which medications are the treatment of choice for TB

A

Rifampicin, Isoniazide - 6 month course

Pyazinamide, Ethambutol - 2 month course initially

150
Q

What are some important side effects of TB treatment?

A

Rifampicin - Orange/Red secretions
Ethambutol - Retrobulbar Neuritis
Hepatitis
Peripheral neuropathy

151
Q

What is important to consider before starting TB treatment?

A

Baseline visual acuity and LFTs, then monitor throughout treatment

152
Q

What is Bronchiectasis?

A

Chronic dilatation of 1/more bronchi. These exhibit poor mucus clearance and there is a predisposition to recurrent/chronic bacterial infection

153
Q

What are some causes of Bronchiectasis?

A 
Post-Infective - Whooping Cough/TB
Primary Immune Deficiency
Secondary Immune Deficiency - HIV, Malignancy
Genetic - CF
Obstruction - FB, Tumour
Toxic Insult - Gastric aspiration, inhalation of gases
Bronchopulmonary Aspergillosis
RA
154
Q

What are some common organisms that can cause infection in Bronchiectasis?

A

Haemophilus Influenzae
Pseudomonas aeruginosa
Aspergillus
Candida

155
Q

What is the investigation of choice with suspected Bronchiectasis?

A

High Resolution CT

156
Q

What are some management steps for Bronchiectasis/Infection?

A 
Treat underlying cause
Physio - Mucus clearance
Abx of sensitive organism 
Flu Vaccine, Bronchodilators
Pulmonary Rehab if MRC >3
157
Q

What is Cystic Fibrosis?

A

An autosomal recessive disease leading to mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene leading to a multisystem disease characterised by thickened secretions

158
Q

How is Cystic Fibrosis diagnosed?

A

1/more phenotypic features, Hx of CF in sibling or +ve screening test

AND

Increased Sweat Cl- concentration of 60mmol/L
Identification of 2 CF mutations
Demonstration of abnormal nasal epithelial ion transport

159
Q

What are some common presentations suggestive of Cystic Fibrosis?

A

Meconium Ileus
Intestinal Malabsorption
Recurrent Chest Infections
Newborn Screening

160
Q

What is Meconium Ileus?

A

Newborn patients present with an intestinal obstruction due to thick secretions.
Found in 15-20% of newborn CF patients

161
Q

What are some clinical features suggestive of CF?

A 
Chronic Sinusitis
Nasal polyps
Recurrent LRTIs
Abnormal sweat secretions
Bronchiectasis
Liver disease
Diabetes
Finger Clubbing
Steatorrhoea
Osteoporosis
Male infertility
Arthropathy
162
Q

How are Respiratory Infections in CF patients managed?

A

Aggressive Physio and Abx

Often given Prophylactic Abx

163
Q

How is low body weight in CF patients managed?

A

Careful monitoring

High calorie intake and additional supplements

164
Q

What is Distal Intestinal Obstruction Syndrome (DIOS)?

A

Faecal obstruction in ileocaecum due to thick contents in distal ileum.
Presents as a palpable RIF mass in CF patients

165
Q

What lifestyle advice should be given to CF patients?

A 
No smoking
Avoid other CF patients
Avoid friends with colds/infections
Avoid Jacuzzis - Pseudomonas
Clear and dry nebulisers thoroughly
Avoid stables, compost and rotting vegetation
Annual Flu Vaccine
NaCl tablets in hot weather/after vigorous exercise
166
Q

What are some causes of a Non-Resolving Pneumonia?

A 
Complication - Empyema, lung abscess
Host - Immunocompromised
Antibiotic - Inadequate dose, poor absorption
Organism - Resistant, unexpected course
Second Diagonsis - PE/Cancer
167
Q

What are some infective causes of Haemoptysis?

A

Pneumonia
TB
Bronchiectasis/CF
Cavitating lung lesion

168
Q

What are some malignant causes of Haemoptysis?

A

Lung Ca

Metastases

169
Q

What are some haemorrhagic causes of Haemoptysis?

A

Bronchial Artery erosis
Vasculitis
Coagulopathy

170
Q

What is the Pleural Cavity?

A

A potential space created by pleural surfaces which contains pleural fluid

171
Q

What is a Pneumothorax?

A

Air in the Pleural cavity

172
Q

What is a Pleural Effusion?

A

Fluid in the Pleural cavity

173
Q

What is an Empyema?

A

Infected fluid in the pleural cavity

174
Q

What types of Pneumothorax are there?

A

Spontaneous
Traumatic
Tension
Iatrogenic - Post central line/pacemaker

175
Q

What types of Spontaneous Pneumothorax are there?

A

Primary - No Lung Disease

Secondary - Lung Disease

176
Q

What are some risk factors for a Pneumothorax?

A 
Pre-existing lung disease
Height
Smoking/Cannabis
Diving
Trauma/Chest procedure
Other conditions e.g Marfans
177
Q

What is the recommended management for a Primary Pneumothorax?

A

If symptomatic and the rim of air measures more than 2cm on CXR then give O2 and aspirate. Insert a chest drain if unsuccessful

178
Q

What is the recommended management for a Secondary Pneumothorax?

A

Consider a drain insertion earlier than with a Primary Pneumothorax

179
Q

What advice should a Pneumothorax patient be given?

A

No flying or diving until resolved

180
Q

What investigations are appropriate with a suspected Pleural Effusion?

A 
CXR
ECG
FBC, U+E, LFTs, CRP, Bone Profile
ECHO if ?HF
Staging CT if ?Malignancy
USS Guided Pleural aspiration
181
Q

What defines a Transudate Effusion?

A

Protein content <30g/L

182
Q

What are some causes of a transudate pleural effusion?

A 
HF
Cirrhosis
Hypoalbuminaemia
PE
Hypothyroid
183
Q

What treatment is recommended for a transudate pleural effusion?

A

Treat underlying cause

If effusion persists, then aspirate/drain

184
Q

What defines an Exudate Effusion?

A

Protein content >30g/L

185
Q

What are some causes of an exudate pleural effusion?

A 
Malignancy
Infection
Inflammatory
Fungal infections
Drugs
186
Q

What does Lights Criteria determine?

A

Whether the fluid is a transudate or exudate

187
Q

What is Interstitial Lung Disease?

A

An umbrella term describing a number of conditions that affect the lung parenchyma in a diffuse manner

188
Q

What are some examples of interstitial lung diseases?

A

Usual Interstitial Pneumonia (UIP)
Non-Specific Interstitial Pneumonia (NSIP)
Extrinsic Allergic Alveolitis

189
Q

How do Interstiatial lung diseases affect Peak Flow?

A

Usually demonstrate a restrictive pattern

190
Q

How does Usual Interstitial Pneumonia present?

A

Clubbing
Reduced chest expansion
Fine Inspiratory Crepitations (Velcro)
Features of Pulmonary Hypertension

191
Q

What is Extrinsic Allergic Alveolitis?

A

Inhalation of an organic antigen to which the individual has been sensitised

192
Q

How can Extrinsic Allergic Alveolitis present?

A

Acute - Short period from exposure, usually reversible

Chronic - Less reversible, longer exposure

193
Q

What is Sarcoidosis?

A

Multisystem inflammatory condition of unknown cause. Forms non-caseating granulomas, leads to an immunological response

194
Q

What investigations are useful with suspected Sarcoidosis?

A 
Peak Flow
CXR
Renal Function and Calcium
ECG, ECHO, Cardiac MRI if ?Cardiac Involvement 
CT/MRI head if headaches
195
Q

What are some treatment options for interstitial lung diseases?

A 
Remove exposure
Stop causative drug
Stop smoking
Lung transplantation
Treatment of infections
Oxygen 
Palliation
196
Q

What are some risk factors for Lung Ca?

A 
Large number of Pack Years
Airflow Obstruction
Increasing Age
FHx
Exposure to carcinogens e.g. Asbestos
197
Q

What are some clinical features of Lung Ca?

A 
Asymptomatic - Incidental finding
Respiratory symptoms
SVC obstruction
Horners Syndrome
Paraneoplastic - SIADH
198
Q

What are some appropriate investigations for suspected Lung Ca?

A 
FBC, U+E, Calcium, LFTs, INR
CXR
Staging CT Chest and Upper Abdo
CT Biopsy
PET Scan
199
Q

What are the most common histological types of Lung Ca?

A

Small-Cell Lung Ca

Non-Small Cell Lung Ca - Squamous Cell, Adenocarcinoma, Large cell Carcinoma

Year 3 Medicine (8 decks)

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