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Year 3 Conditions > Resp > Flashcards

Resp Flashcards

1
Q

COPD risk factors

A 
Smoking
Working with coal
advanced age
genetic factors
white ancestry
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2
Q

What factors in history would make you consider TB

A

African Asian origin

HIV positive

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3
Q

Airway obstruction leading to bronchiectasis

A

Tumours

Foreign objects which lead to pneumonia and chronic inflammation

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4
Q

Why does lung appear as white out in atelectasis

A

Normally lung appears black due to proportion of air to tissue being much higher however in collapse there is no air

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5
Q

Causes of T2 resp failure

A

Local
CNS- spinal chord lesions, drug overdose, tumour, trauma
NMJ-Myasthenia gravis

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6
Q

What is most thing to ensure when administering ABx for CAP

A

Strep pneumoniae included

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7
Q

Eye involvement of sarcoid

A

Uveitis

Papilloedema

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8
Q

What can mainly give cannonball metastases in lungs

A

Renal cell carcinomas

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9
Q

Gastro cause of cough

A

GORD

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10
Q

When is only time you thrombolyse a PE

A

When very haemodynamically compromised

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11
Q

Why is CT done in lung cancer

A

Identify nature and location

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12
Q

Features of asthma cough

A

Chronic non productive cough
Nocturnal cough
Precipitated by common triggers
Most times comes before wheeze

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13
Q

Prognosis of invasive aspergillosis

A

Poor

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14
Q

What is fanncy name for collapsed lung

A

Atelectasis

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15
Q

What are miliary small nodules

A

Innumerable small nodules seen around lung hilum

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16
Q

Immediate investigations for PE

A

CXR
ECG
ABG

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17
Q

What type of drug is ipatropium bromide

A

Anit muscarinic

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18
Q

Long term management of pneumothorax

A

Pleurodesis

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19
Q

What is key investigation with suspected pneumonia

A

Get sputum and blood cultures to determine type of ABx to be given

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20
Q

What is main sign of worsening active sarcoid

A

Any sign of active inflammation

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21
Q

Very common cause of mixed rf

A

Acute asthma

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22
Q

Aetiology of tension pneumothorax

A

Ventilation
Trauma
Blocked chest drain
Lung conditions

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23
Q

Danger of tension pneumothorax in young people for doctors

A

Can appear fine but then drastically deteriorate

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24
Q

How does pneumothorax happen

A

When air from either alveoli or atmosphere gains access to pleural space. Pleural space has lower pressure than both of these so air will flow in until obstruction blocked or pressure equalises

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25
Q

Investigations for cancer post CXR

A

Bronchoscopy with biopsy

CT chest and abdo

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26
Q

Pathology of mesothelioma

A

Inhalation of asbestos fibres end up in pleural space leading to growth of pleural mesothelium that grows and encases lungs

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27
Q

How long should you be on warfarin post PE

A

3-6 months however permenant if recurrent PEs

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28
Q

What is FEV/FCV in obstructive resp diseases

A

Reduced- less than normal .7 or .8

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29
Q

Presentation of lung fibrosis

A

Dry cough
Clubbing
SOB

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30
Q

Symptoms of pneumothorax

A

Chest pain

SOB

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31
Q

Risk factors pneumothorax

A

Tall and slim
Male
Smoking
Underlying lung conditions

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32
Q

Auscultation sign of lung fibrosis

A

Late inspiratory creps

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33
Q

What part of resp system is responsible for T2 rf

A

Respiratory apparatus bringing air in and out

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34
Q

Key factor in nature of asthma

A

Temperamental, you see a lot of variation in sx depending on season for example

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35
Q

Management of PE

A

Anticoagulation
Oxygen if low sats
IV fluids

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36
Q

Risk factors for CAP

A 
Over 65
Asthma and COPD
Smoker
Living in nursing home
Alcohol use
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37
Q

Symptoms and signs of asbestos

A

Dyspnoea on exertion first sign
Non productive cough
Crackles at lung bases
Clubbing

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38
Q

How to definitively diagnose pneumothorax

A

PA erect CXR- identify rim and measure

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39
Q

Presentation of TB

A

Cough
Sputum
Weight loss
Night sweats

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40
Q

When will co2 be low in T1 rf

A

When hyperventilating

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41
Q

Brain stem T2 rf causes

A

Cva
Sol
Opiates
Benzodiazepine

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42
Q

What is defining feature of obstructed airway

A

Stridor

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43
Q

How does sarcoid present

A 
Malaise
Pyrexia
Arthralgia
Arthritis
Erythema nodosum
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44
Q

What differentiates pneumonia from a LRTI

A

Consolidation on CXR

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45
Q

Investigations of bronchopulmonary aspergillosis

A

Positive aspergillus skin test
Raised IgE
Eosinophilia
Serum precipitins

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46
Q

Where do you do aspiration

A

2nd ICS MCL

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47
Q

What method can be used to prevent recurrence of pleural effusions

A

Installation of sclérosants into pleural space

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48
Q

What are diagnostic methods for mesotheliomas

A

Thoracoscopy with biopsy and histology of pleura

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49
Q

Investigations for asbestosis

A

Lung function tests- restrictive findings

CXR pa and lateral- show pleural thickening and interstitial fibrosis in lower zones bilaterally

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50
Q

What does reticular nodular shadowing

A

Nodular means nodule shaped

Reticular means net appearance

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51
Q

CAP on examination

A

Reduced air entry in affected lungs
Crackling on auscultation too
Dullness on percussion

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52
Q

Pathophysiology of T2 resp failure

A 
Alveolar hypoventilation with or without VQ mismatch
Reduced CNS output
NMJ problems
Chord lesions
Thoracic wall problems
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53
Q

What is name of anti IgE AB in asthma treatment

A

Omalizumab

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54
Q

What condition is identical to sarcoid

A

Berylliosis

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55
Q

What could hypercalcaemia be confused with in sarcoid when lymphadenopathy

A

Lymphoma

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56
Q

Management of pneumonia patients

A 
Use CURB 65 to assess mortality risk
Confusion
Urea over 7mmol/L
RR over 30
Blood pressure below 90 SBP or 60DBP
65 age
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57
Q

Common asthma triggers

A

Exercise
Smoking
Cold air
Infections

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58
Q

What is FEV/FCV in restrictive diseases

A

Normal but FCV and FEV1 are reduced

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59
Q

What are 3 most common causes of atypical pneumonia

A

Legionella
Chlamydia
Mycoplasma

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60
Q

Haem findings sarcoid

A

Lymphocytosis
ACE
Alpha 1 hydroxylase
Calcium

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61
Q

Worse prognosis signs on HRCT

A

Honeycombing

Groundglass findings

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62
Q

Treatment of choice for mycetoma

A

Surgical removal

Drugs not helpful

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63
Q

How can resp failure be classified

A

Acute vs chronic

Type 1 vs type 2

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64
Q

Other name for pancoast tumour

A

Superior sulcus tumour

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65
Q

Prognostic factors sarcoid

A

Fibrosis extent
Pulmonary HTN
Lung function impairment

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66
Q

What would cause mediastinum to shift towards pneumothorax side

A

Lobar collapse on that side

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67
Q

What can cause fibrosis of lung bases

A

Asbestos
Connective tissue disorder
Idiopathic
Drugs such as methotrexate, amiodarone and nitreo- some antibiotic

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68
Q

What is alpha 1 antitrypsin

A

Protease inhibitor which inhibits elastase commonly produced by neutrophils. Neutrophils activity acting on lungs and liver have their activity increased therefore in the deficiency damage is caused

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69
Q

What test is used to determine if patient PE likely or not

A

WELLS

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70
Q

Peripheral examination sign of bronchiectasis

A

Clubbing due to hypoxia

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71
Q

How to differentiate sarcoid from TB

A

Cough is productive in TB

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72
Q

Treatment aim of sarcoid

A

Prevent fibrotic disease progression to

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73
Q

2 categories that lead to bronchiectasis

A

Airway obstruction

Primary ciliary dyskinesia

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74
Q

What to consider with calcified object obstructing airway

A

Swallowing bone from food

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75
Q

How does GORD present

A 
Chronic dry cough
Heart burn
Indigestion
Weird taste in mouth
Remember to ask about these other Sx in cough history
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76
Q

What can treatment be escalated to after failure to respond to amoxicillin in relation to CAP

A

Include other bacteria so use erithomycin

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77
Q

Signs on examination of pneumothorax

A

Ipsilateral reduced air sounds

Ipsilateral hyper-resonant percussions and hyperinflations

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78
Q

What can give multiple ill defined focal opacities across the lung

A

Pulnomsry infarcts
Pulnomsry metastases
Rheumatoid arthritis
Septic emboli

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79
Q

How would Bullae appear on CXR

A

Can be bilateral

Air fluid level visible

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80
Q

What can cause a cavitating mass

A 
Carcinoma of bronchus
Squamous cell carcinoma metastasis
Pulmonary infarct
Bacterial lung abscess
Fibrosing
Wegners
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81
Q

What do coarse crackles indicate

A

Phlegm in airways

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82
Q

What would be indicated in recurrent pneumonia

A

Carcinoma

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83
Q

What would you suspect in a non smoker young person presenting with a chronic cough

A

Alpha 1 antitrypsin deficiency

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84
Q

Causes of T1 resp failure, 2 categories

A

Right to left cardiac shunt where deoxygenated blood bypasses pulmonary system
V/Q mismatch

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85
Q

After RIP what must do

A

Compare zones left to right looking if theyre the same and then if opacifications are either of the 4 possibiliites

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86
Q

Important thing to remember when thinking about possible lung cancer

A

Could be métastases from alternate site

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87
Q

What blood parameters can you use to monitor response to CAP treatment

A

WCC
Renal function
CRP

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88
Q

Distinguish between T1 and T2 resp failure

A

T1 low or normal co2

T2 high co2

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89
Q

Dangers of pneumothoraces

A

Air can collapse lung and compress mediastinum reducing flow into and out of heart. Collapse of lung leads to hypoxaemia and RDS

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90
Q

Management for mesothelioma

A

Symptoms treatment
Chemo can improve prognosis
Pleuroidesis or intra- pleural drain will also help with effusion

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91
Q

When is cough worse asthma

A

Nocturnal

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92
Q

Causes of deaths sarcoid

A

RF

Arrythmias

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93
Q

NMJ causes of T2 rf

A

Myasthenia gravis

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94
Q

Signs of cardiac sarcoid

A

AV block
Ectopics
Ventricular tachycardias
Wall abnormailities

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95
Q

Resp muscle causes of T2 rf

A

Mnd

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96
Q

Sx mycetoma

A

Haemoptysis
Weight loss
SOB

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97
Q

What is allergic bronchopulmonary aspergillosis

A

Type 1 and 3 hypersensitivity leading to recurrent asthma, bronchial damage and bronchiectasis

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98
Q

Symptoms of CAP

A 
Dyspnoea
Increasing productive cough
Night sweats
Fever
Tachypnoea
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99
Q

What can cause pleuritic chest pain in lung cancer

A

Rib métastases and chest wall infiltration or inflammation affecting pleurs

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100
Q

What would reticular nodular shadowing be

A

Fibrosis

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101
Q

Main risk and danger with PE

A

Right ventricular failure with hyoptension

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102
Q

Treatting of sarcoid

A

High dose OCS
Low dose pred
Sometimes azathioprine or methotrexate
Hydroxychloroquine

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103
Q

Predictors of mortality sarcoid

A

Pulnomary HTN
Extensive fibrosis
Age

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104
Q

What can upper airway obstruction mimic

A

Asthma- can be treated in this manner originally

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105
Q

Pathology of asbestos

A

Asbestos fibres when inhaled deposit as alveolar bifurcations and cause alveolitis réaction leading to fibrosing reaction

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106
Q

In CAP what would you be worried about with a persistent fever

A

Empyema

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107
Q

What are most common lung cancers

A

Adenocarcinomas 40%
Squamous cell carcinoma 25-30%
Small cell carcinoma 15%
Large cell undifferentiated 10%

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108
Q

How long does it take for mesothelioma to develop after exposure

A

At least 20 years therefore important in history to identify specific job before then if want to help family get compensation

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109
Q

What is main cause of death with mesothelioma

A

Lung and pleural involvement

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110
Q

2 biggest causes of HAP

A

Staph aureus

Pseudomonas

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111
Q

Management of patient with consolidation seen in pneumonia

A

Order CXR for 6 weeks as pnuemonia can cover cancer

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112
Q

Defining mucous feature of bronchiectasis

A

It is bad smelling

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113
Q

How to differentiate obstructive causes

A

Salbutamol dependant

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114
Q

How often are ECG changes seen in PE

A

85%

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115
Q

Symptoms of mesothelioma

A

Chest pain
SOB
Récurrent pleural effusions

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116
Q

Whats FVC

A

Forced volume capacity- total amount of air produced in full effort expiration

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117
Q

What can cause fibrosis on lung apices

A 
Berryliosis
Radiation- common after breast cancer treatment
Extrinsic allergic alveolitis
Ankylosing spondylitis
Sarcoid
Tb
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118
Q

Cardinal respiratory symptoms

A 
Cough
Wheeze
SOB
Haemoptysis
Chest pain
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119
Q

How do you differentiate between mass and nodule on lung

A

Mass is over 3cm

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120
Q

Name of TB mass

A

Cavitating coin lesion

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121
Q

DDx of sarcoid

A

Lymphoma

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122
Q

Important thing to do before administering TB drugs

A

Check sensitivities

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123
Q

Risk factors for sarcoid

A 
Infectious
Transplanted organs
Bioaerosol inhalation
Insecticides
Agricultural exposures
Hereditary
North Europe
Black people
Autoimmune conditions such as SLE, UC
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124
Q

Signs of bronchiectasis

A

High pitched wheeze and crackles throughout inspiration
Rhonchi
Clubbing

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125
Q

What test must be done when cavitating mass evidence

A

CT to evaluate nature of mass for drainage

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126
Q

5 ways aspergillus can affect lung

A 
Asthma- type 1 hypersensitivity
Extrinsic allergic alveolitis
Mycetoma
Invasive aspergillosis
Allergic bronchopulmonary aspergillosis
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127
Q

Can PE elevate troponin

A

Yes

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128
Q

Test for allergic bronchopulmonary aspergillosis

A

Aspergillus skin test

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129
Q

Why would you consider HIV infection in TB cases

A

Immunocompromised as should defend against it

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130
Q

Protective factors for sarcoid

A

Smoking

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131
Q

What are 4 approaches to managment of asthma

A

Controlled
Partly controlled
Uncontrolled
Exacerbation

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132
Q

Resp conditions associated with erythema nodosum

A

Strep infection
Sarcoid
Mycoplasma pneumonia
Psittacosis

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133
Q

What does worse pain on inspiration suggest

A

Pleuritic pain

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134
Q

How to diagnose chronic bronchitis

A

Productive cough of more than 3 months for over 2 annum

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135
Q

COPD symptoms

A 
progressive shortness of breath
wheeze
cough
sputum production
haemoptysis
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136
Q

First line community approach to treating CAP

A

Amoxicillin

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137
Q

What are the hallmarks of TB

A 
Cervical lymphadenopathy
Erythema nodosum
From endemic country
Upper lobes affected
Hilar lymphadenopathy
Haemoptysis
Weight loss
Productive cough
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138
Q

What is problem with mantoux test

A

Cant differentiate between latent and active TB

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139
Q

Conditions causing cervical lymphadenopathy

A

Infective mononucleosis
TB
Sarcoid
Lymphoma

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140
Q

Pathophysiology of T1 resp failure

A

Ventilation perfusion mismatch

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141
Q

What bacteria does abcess formation in CAP suggest

A

Staph aureus

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142
Q

Symptoms of bronchiecstasis

A

Productive cough with copious amounts mucous- purulent

SOB

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143
Q

What test should be discussed with patient when has TB

A

HIV

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144
Q

What is most likely diagnosis of someone with COPD with sudden onset SOB

A

Pneumothorax

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145
Q

Problem with lung function declining over time

A

Get hypoxia so pulnomary vasculature constricts to divert blood away to un damaged parts of lungs however if damage widespread then get widespread constriction leading to pulmonary hypertension so cor pulmonale

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146
Q

What do you have to give with chest drain and aspiration

A

Paracetemol 1g or Ibupofen QDS

Oxygen if needed

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147
Q

Suggested aetiology of sarcoid

A 
Infectious
Transplanted organs
Bioaerosol inhalation
Insecticides
Agricultural exposures
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148
Q

What does bright green phlegm indicate

A

Pseudomonas infection

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149
Q

How would bullae present

A

Chronic SOB
Cough
Pain
Heavy smoker

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150
Q

Things need to know about a previous TB infection

A

Sensitvities of drugs
Adherance
What drugs

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151
Q

Why is abdominal CT done for suspected lung cancer

A

Staging

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152
Q

What are categories of things affecting resp apparatus

A 
Brain stem
Nervous system
NMJ
Resp muscle 
Chest wall movement
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153
Q

Whats FEV1

A

The forced expiratory volume in 1 second

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154
Q

Tests needed for acute severe asthma attack

A

ECG
Peak flow
BG

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155
Q

UAO on spirometry

A

Straight diagonal line

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156
Q

What are most common causes of CAP

A 
Strep pneumoniae 40%
Chlamydia pneumoniae 13%
Viral 13%
Mycoplasma pneumoniae 11%
H influenzae 5%
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157
Q

Contraindications of thrombolytics

A 
Recent surgery
Recent trauma and bleed anywhere
Suspected aortic dissection
Severe HTN
Peptic ulcer disease
Allergy to streptokinase
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158
Q

How does lyme disease present initially

A

Rash and then get arthritis afterwards

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159
Q

Lung conditions causing clubbing

A

Cancer
Fibrosis
Bronchiectasis
Empyema

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160
Q

When is peak flow worse asthma

A

Morning

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161
Q

Daignosies of sarcoid

A

Right clinical pattern such as eryhtema nodosum
Histology non caseating granulomas
Compatible radiological findings
Exclusion of other diagnoses

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162
Q

Why is co2 normal in T1 rf

A

More soluble than o2 so even if exchange impaired will still be able to be exchanged more readily

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163
Q

What electrolyte is elevated in sarcoid

A

calcium

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164
Q

Main complications of sarcoid

A

Progressive lung fibrosis which leads to shortened life expectancy
Aspergillosis

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165
Q

Diagnosis for mesothelioma

A

Thoracoscopy with biopsy- histology for complete diagnosis

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166
Q

Differentiation between TB and sarcoid

A

TB unilateral lymph node calcified whereas sarcoid bilateral

Histologically TB is caseating

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167
Q

Where can mesotheliomas spread

A

Often spread through one pleural cavity to another so from pleural to peritoneal and pericardial.
Can spread to hilar nodes via lymphatics
MAINLY SPREAD TO LUNGS AND LIVER

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168
Q

What finding on CXR in CAP would indicate an underlying pathology

A

Reduced lung volume on affected side

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169
Q

What disease type is Bird fanciers disease

A

Extrinsic allergic alveolitis

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170
Q

When is S1 Q3 T3 seen

A

Acute massive PE not minor

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171
Q

How many sputum samples for TB

A

3

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172
Q

2 fates of sarcoid granulomas

A

Chronic fibrosis

Resolves completely

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173
Q

Treatment for PE

A

Give LMWH, do CTPA then start warfarin and only remove LMWH when INR in range.

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174
Q

Tests done to check hyperreactivity to antigens

A

Skin prick test

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175
Q

PE ECG changes

A 
A fib
Sinus tachy
1st degree heart block
RBBB
S1 Q3 T3
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176
Q

What does nocturnal cough indicate

A

Asthma

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177
Q

Questions to ask in asthma history

A

Night time awakenings
Interference with every day life
How often use medication
Peak flow if known

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178
Q

How does lymphoma of lung appear on CXR

A

Mediastinal node enlargement

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179
Q

What to think if in question says keeps pidgeons

A

Either psittacosis- chlamydia infection that is an atypical pneumonia
Or bird fanciers disease- a type of EAA that presents with fibrosis

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180
Q

How does mycoplasma tend to present

A

Fatigue

Dry cough

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181
Q

Invasive effects of pancoast tumour

A

Horners syndrome from sympathetic chain involvement
Brachial plexus involvement
Cord compression
Invasion of recurrent laryngeal nerve- hoarse voice

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182
Q

What would be Homogenous shadowing

A

Effusion- can be bilateral or unilateral

Pneumectomy

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183
Q

4 opacities on CXR types

A

Alveolar shadowing
Reticular nodular shadowing
Homogenous shadowing
Masses

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184
Q

Which occupations were put at risk of asbestosis

A

Boilermakers
Heating engineers
Electrical engineers or anyone in building work

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185
Q

Signs of patient deteriorating from PE

A

Any sign on right sided heart failure of cardiac arrest

Hyoptenion, syncope and tachycardia

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186
Q

Other organs involved in sarcoid

A

Cardiac
Skin
Lymphatics

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187
Q

Nervous system causes of T2 rf

A

Guillain barre

Trauma

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188
Q

What else could present with numerous masses across lungs other than metastases

A

Vasculitis

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189
Q

Who does invasive aspergillosis occur in

A

Immunocompromised

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190
Q

Textbook chlamydia pneumonia presentation

A

Sx feeds birds in spare time
Confused
Diarrohoea

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191
Q

Factors showing how well asthma is controlled

A 
Limits activity
Daytime sx
Nightime sx
Need for relief
Lung function- less than 80% predicted or best
Exacerbations
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192
Q

What can lead to changing your asthma classification

A

Exposure to allergens
Incorrect medication or use
Poor adherance

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193
Q

What enzyme is elevated in sarcoid

A

Alpha 1 hydroxylase

ACE

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194
Q

Risk factors PE

A 
Age
Obesity
Previous surgery recently
Bed ridden and lack of activity
DVT diagnosis recently
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195
Q

What is name for chlamydia psittaci disease

A

Psittacosis- parrot fever

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196
Q

Differentials for singular masses

A

Primary malignancy
Abcess
Infarct
Metaseses

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197
Q

What are granulomas in sarcoid

A

Non-caseating

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198
Q

Other investigations for a PE

A

D-dimer
Right ventricle showing signs of enlargement on Echo
FBC to determine if thrombocytopaenic or anaemic

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199
Q

What is a tension pneumothorax

A

Medical emergency that occurs when pressure in pleura becomes greater than that of atmosphere so air can only flow into pleura in a valve like mechanism

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200
Q

What is a common non lung related cause of chest pain in lung cancer

A

presence of metastases in the rib bones causing a ‘pleuritic’ type of pain, which may be sharp, well localised and is worse with movement.

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201
Q

What cancer causes cavitating mass

A

Squamous cell cancer

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202
Q

How to describe percussion for pleural effusion

A

Stony dull

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203
Q

Symptoms of PE

A 
Pleuritic chest pain due to infarct- normally on one side of chest not central
Tachypnoea
Signs of DVT
Hypoxaemia
Haemoptysis
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204
Q

Treatment for asthma

A

Steroids
Salbutamol
Long term b2 agonist

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205
Q

How can TB present on CXR

A

Diffuse nodular infiltrates
Cavitation
Lymphadenopathy
Nodular densities

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206
Q

What will atelectasis presnent with

A

Wheeze
Dry cough
SOB

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207
Q

What could alveolar shadowing be

A

Fluid- HF oedema bilaterally
Pus- pneumonia
Blood- vasculitis haemorrhage rare

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208
Q

Abdo exam finding sarcoid

A

Hepatosplenomegaly

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209
Q

What is used to monitor sarcoid progression

A

FDG PET

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210
Q

What is main risk of chest drain

A

Re-expansion pulmonary oedema

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211
Q

Drugs used in asthma treatment

A 
Short acting beta agonists
Long acting eta agonists
Muscarinic antagonists
GCS
Leukotriene receptor antagonists
Theophylline oral pills
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212
Q

Complications associated with asbestosis

A

Increased adénocarcinoma risk
Mesothelioma
Pleural plaques

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213
Q

What is respiratory failure

A

Where the blood doesn’t have enough O2 or too much CO2
PaO2 of less than 8kPa
PaCO2 of greater than 6.7kPa

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214
Q

Signs of COPD on examination

A

Barrel chest
Wheeze
Reduced air entry
Coarse crackles

215
Q

What is a pneumothorax

A

When air accumulates or gains access to pleural space

216
Q

What conditions can show miliary shadowing

A

Sarcoidosis
Métastases
Occupational lung diseases
Extrinsic allergic alveolitis

217
Q

Management of COPD

A 
Bronchodilators
Corticosteroid treatment
Comination of 2^
Cessate smoking
Influenza and pnuemonococcal vaccines
218
Q

What is different about treating patients with severe CAP in relation to administration

A

Must be IV

219
Q

What does pleurodesis do

A

Seals pleura to chest wall or lung

220
Q

Coarse crackles vs fine crackles

A

Coarse sounds like bubbling- much more low pitched

Fine crackles sounds like fire crackling- higher pitched

221
Q

What would you suspect in a non drinker young person presenting with cirrhosis

A

Alpha 1 antitrypsin deficiency

222
Q

What conditions are included within COPD

A

Emphysema

Chronic bronchitis

223
Q

Chest drain site

A

4-6th ICS MAL

224
Q

How to investigate mesothelioma

A

CXR or CT that will show pleural thickening and effusion quite often bloody effusion

225
Q

CXR findings TB

A

Upper lobes affected
Cavitating lesion
Bilateral lymphadenopathy

226
Q

Complications of mycoplasma pneumonia

A

Transverse myelitis

RBC agglutination

227
Q

What can cause atelectasis

A
  • blockage of bronchus

- reduced surfactant

228
Q

How to see collapsed lung CXR

A

Mediastinal shift and appears as white out or air

229
Q

What is affected in type 1 resp failure

A

Gas exchange

230
Q

RFx for mycetoma

A

Cancer
Sarcoid
TB

231
Q

What is test for TB in clinical setting

A

Acid fast bacillus test- Ziehl–Neelsen stain. Only takes 48 hours

232
Q

How to differentiate between inhaled object and bronchus obstruction on CXR

A

CXR shows consolidation for obstruction of bronchus

233
Q

Investigations for COPD

A

Spirometry
Pulse oximetry
ABG

234
Q

Causes of V/Q mismatch

A 
Not well ventilated
Acute asthma
Pulnomary oedema 
Ards 
Pneumonia 
Pneumothorax 
Fibrosing alveolitus

Not well perfused
PE

235
Q

What does cavitation on chest indicate about patients health

A

Immunocompromised

236
Q

Differentiate between asthma and COPD

A

Symptomatically COPD much more continuous whereas asthma is related to attacks of coughing and wheezing.
COPD gets progressively worse
COPD responds better to anti-cholinergic drugs and asthma to B2 agonists

237
Q

What area of lungs does TB affect

A

Upper lobe

238
Q

Textbook legionella presentation

A

Sx plumber or stays in hotels a lot with ACed rooms

239
Q

Other than rheumatic fever what is another complication post strep infection

A

Post strep reactive arthritis

240
Q

Tests to confirm asthma

A

Spirometry with salbutamol and ipatropium
CXR
Skin prick demonstrating atopy
Trial them on budenoside and see if Sx improve or peak flow

241
Q

Non lung symptoms of mesothelioma

A

Métastases
Hepatomegaly
Bone pain
Abdo pain and obstruction from peritoneal malignant mesothelioma

242
Q

How to tell if something consolidation

A

Will see air filled bronchus which appears as a black line- air bronchogram

243
Q

Principles of asthma management

A

Well controlled asthma should lead to better control and the ability to move to a lower stage

244
Q

Define sarcoid

A

Systeminc disorder of unkown cause leading to noncaseating granulomas in majortiy of cases

245
Q

What is best test for likely PE

A

CTPA

246
Q

What does bronchial breathing sound like

A

High pitch, louder sounds where inspiration and expiration sound the same

247
Q

Immediate management of PE

A

Depends on size
CTPA required then if massive immediate thrombolysis or thrombectomy if available
If small sub cut LMWH

248
Q

Risk factors PE

A

Immobility
Malignancy
Recent surgery
FH of clot

249
Q

Differences in pain PE central vs lateral

A

Central implies massive PE affecting main arteries

Lateral will be smaller artery and will get pleuritic pain

250
Q

What does persistent type 3 HS reaction to aspergillus lead to

A

Bronchiectasis

251
Q

Bronchectasis on CXR

A

Crowded bronchial markings extending to lung peripheries

Reduced volume

252
Q

What is another cause of hyperesonant breath sounds

A

Bullae- where walls between alveoli break down thus forming multiple to join together

253
Q

Investigations of sarcoid

A

CT
CXR
Bronchoscopic histology

254
Q

What does type 1 hypersensitivity reaction to aspergillus lead to

A

Asthma

255
Q

What would you be thinking with eye problems in a resp case

A

Sarcoid

256
Q

Commonest PE ECG finding

A

RBBB and RAD

May also see large R in V1

257
Q

What is mixed resp failure

A

Progression of T1 to T2 rf from hyperventilation leading to tiring of muscles

258
Q

When will consolidation have disappeared in 95 % of CAP

A

6 weeks

259
Q

Where is appropriate place for TB patient

A

Negative pressure isolation room

260
Q

Signs of tension pneumothorax

A

Signs of cardiac deterioration- hypotension, hypoxic, tachycardia and resp distress

261
Q

What is ICS

A

Inhaled corticosteroid

262
Q

Causes of bronchiectasis

A

UK- Cystic fibrosis

Worldwide- TB

263
Q

What happens when is V/Q mismatch

A

Either alveoli are getting a good air supply but not a good blood supply or vice versa

264
Q

How does mass within cavity appear

A

Air surrounding opacification

265
Q

What do fine crackles indicate

A

exudates in airways such as fluid from pneumonia

266
Q

Why is calcium elevated in sarcoid

A

Ectopic alpha 1 hydroxylase produced

267
Q

Can you get contralateral lobar collapse tension pneumthorax

A

Yes

268
Q

What is a mycetoma

A

Or aspergilloma. Fungus ball forming in a pre existing cavity

269
Q

How do arterio- venous malformations appear on CXR

A

Smaller well defined masses

270
Q

Possible complications of bronchectasis

A

Infections recurrently
Cor pulmonale
Haemoptysis

271
Q

How does GORD cause a cough

A

When reaches pharynx

272
Q

Features of GORD cough

A

Dry

Nocturnal

273
Q

Infections causing cavitating mass

A

TB
Klebsiella
Staph aureus

274
Q

Which infection probably is causing cavitating mass in alcoholics

A

Klebsiella

275
Q

What does bilateral basal lung opacities suggest of the aetiology

A

Of blood borne source as this is where perfusion is greatest

276
Q

What to do in management of effusion

A

Take sample and send off for cytology, protein count and micro

277
Q

How to differentiate between consolidation and effusion on examination

A

Consolidation increases vocal fremitus whereas effusion reduced

278
Q

Difference between COPD and asthma

A

Asthma shows reversibility with 2 week steroid reversibility

279
Q

What is fast test for legionella

A

Urinary antigen

280
Q

Tests used to diagnose all atypical pneumonias

A

Serology

281
Q

Categories of exudate pleural effusion

A

Malignancy
Inflammation- rheum, SLE, vasculitis
Infection

282
Q

Rare PE ECG finding

A

S1 Q3 T3

283
Q

S1 Q3 T3 on ECG

A

Deep S wave in lead I
Pathological Q in lead III
Inverted T wave in lead III

284
Q

Why do we aim for a lower oxygen target range in COPD patients

A

These patients rely on hypoxic drive to drive respiration as resp centre insensitve to CO2. Too much oxygen will cause drop in respiratory drive so deterioration

285
Q

What do COPD patients present with on ABG

A

T2 RF due to respiratory drive insensitivity to CO2

Resp acidosis with long term metabolic compensation as hypercapnic

286
Q

Resp causes of clubbing

A 
Cancer
Mesothelioma
Fibrosis
Bronchiectasis
Abcess
287
Q

Most common lung cancer seen in non-smokers

A

Adenocarcinoma

288
Q

Auscultation finding lung fibrosis

A

Bilateral reduced air entry

Fine crackles inspiratory

289
Q

Causes of pneumothorax

A 
Spontaneous in young men
Lung pathology
Connective tissue disorder
Iatrogenic
Trauma
290
Q

Management of PE

A

Even when just suspected subcut LMWH and warfarin with INR range 2-3

291
Q

Management of recurrent PEs

A

Warfarin lifelong

If from malignancy heparin

292
Q

Classifications of causes of cor pulmonale

A 
Lung disease
Pulmonary vascular disease
Thoracic cage abnormality
Neuromuscular
Hypoventilation
293
Q

Why does in asthma exacerbations volume in pulse falls

A

Decreased left atrial filling- compromised airways exacerbate negative pressure in chest so blood pools in lungs

294
Q

What happens in EEA

A

Hypersensitivity to inhlalation of organic allergens that leads to hypersensitivity reactions in alveoli. Chronic leads to fibrosis

295
Q

What are formed in EEA

A

Non caseating granulomas

296
Q

Main causes of EEA

A

Farmers lung- mouldy hay
Bird fanciers
Mushroom pickers lung
Malt workers lung- barley

297
Q

Acute EEA presentation

A

Fever
Rigors
Dry cough
SOB

298
Q

Chronic EEA presentation

A

Weight loss
Exertional SOB
Dry cough

299
Q

What is pneumoconiosis

A

Occupational lung diseases caused by inhalation of dust

300
Q

What cells is it thought small cell carcinomas arise from

A

Neuroendocrine cells

301
Q

What do you think when lung Sx and hyponatraemia

A

Small cell carcinoma

302
Q

How is COPD categorised

A 
All less than 0.7 ratio
Mild- FEV1 above 80
Moderate- FEV1 50-80
Severe- FEV1 30-50
Very severe less than 30
303
Q

When should oxygen therapy be started

A 
Evidence of cyanosis
Polycythaemia
Severe airflow obstruction
Peripheral oedema
Raised JVP
304
Q

What asthma drug can cause hypokalaemia

A

Salbutamol

305
Q

What is ARDS

A

Damage to lung results in release of acute ohase proteins leading to increased capillary permeability so get noncardiogenic pulmonary oedema

306
Q

Causes of ARDS classification

A

Pulmonary- any systemic illness or injury to lung

Extra pulmonary- septic shock, DIC, multiple transfusions

307
Q

Diagnosis of ARDS 4 criteria

A

Acute onset
Bilateral CXR infiltrates
Pulmonary capillary wedge pressure under 19
Refractory hypoxaemia

308
Q

What must do with antibiotics when suspect aspiration pneumonia

A

Cover anaerobes

309
Q

How to determine examination needed for PE

A

Do wells score
If under 4 do D-dimer
If 4 or over do CTPA

310
Q

What are categories for acute asthma based on

A

PEF

311
Q

What is fatal sign of asthma attack

A

Raised PaCO2

312
Q

Immediate asthma attack treatment

A 
O2
Neb salbutamol 5mg
Neb ipatropium bromide 0.5mg
100mg hydrocrotisone IV
Then 40-50mg PO pred for 5 days
313
Q

What is senior supportive treatment for asthma attacks

A

IV magnesium sulphate

IV aminophylline

314
Q

What colour is sputum in COPD

A

White

315
Q

What are crackles in COPD

A

Coarse

316
Q

When are coarse crackles heard

A

COPD

Pneumonia

317
Q

When are fine crackles heard

A

Interstitial lung disease

318
Q

What is best way to manage COPD

A

Smoking cessation

319
Q

How does COPD lead to polycythaemia

A

Hypoxia leads to EPO production

320
Q

How can COPD patients present with very low RR

A

Given too much oxygen

321
Q

Managemnt of COPD exacerbation

A

Neb salbutamol 5mg
Neb ipatropium bromide 0.5mg
200mg hydrocrotisone IV
Then 40-50mg PO pred for 5 days

322
Q

Further management of COPD

A

BiPAP

323
Q

Why is BiPAP used for COPD

A

Reduced expiratory pressure allows some CO2 to leave- in COPD patients they chronically retain CO2 so not letting some out would further exacerbate his resp acidosis

324
Q

What is new name of EAA

A

Hypersensitivity pneumonitis

325
Q

Investigations for asthma

A

Peak flow
FeNO
Spirometry

326
Q

What is FeNO

A

Frequency of expired NO- signs of inflammation in lungs

327
Q

Steps to asthma management

A 
SABA
SABA+ICS
SABA+ICS+LTRA
SABA+ICS+LTRA+LABA
SABA+MART+LTRA
328
Q

What is MART

A

Management and reliever therapy- ICS+LABA

329
Q

What is montelukast therapy

A

Leukotriene receptor antagonists

330
Q

CAP pneumonia tx

A

Co-amoxiclav

331
Q

Atypical CAP tx

A

Clarithomycin

332
Q

HAP treatment

A

Tazocin

333
Q

Most common gram pos organisms you are faced with

A

Staph
Strep
C.difficile

334
Q

What is given for gram positive if has penicillin allergy

A

Macrolides

335
Q

Give 2 macrolides

A

Clarithomycin

Erythomycin

336
Q

3 categories of ABx to treat gram pos

A

Beta lactams
Glycopeptides
Oxazolidinones

337
Q

3 beta lactams categories

A

Penicillins
Cephalosporins
Carbapenems

338
Q

Example of cephalosporins

A

Ceftriaxone

339
Q

Examples of carbapenems

A

Meropenem

Ertapenem

340
Q

Examples of glycopeptides

A

Vancomycin

341
Q

Examples of penicillins

A

Amoxicillin
Flucloxacillin
Tazocin

342
Q

Most common gram neg organisms have to deal with

A

Salmonella
E.Coli
Klebsiella pneumoniae
Pseudomonas

343
Q

Who is at risk of aspiration

A

Neurological disorder
Altered mental state
LOC

344
Q

Categories of Abx for gram negs

A

Aminoglycosides

Fluroquinones

345
Q

Examples of aminoglycosides

A

Gentamicin

Amikacin

346
Q

Examples of fluoroquinones

A

Ciprofloxacin

Levofloxacin

347
Q

What abx used for intracellular pathogens

A

Tetracycline

348
Q

Examples of tetracyclines

A

Doxycycline

Tigecyclin

349
Q

Examples of intracellular pathogens

A

Chlamydia

Mycoplasma

350
Q

What abx are used to cover anaerobes

A

Nitroimidazoles

351
Q

Examples of nitroimidazoles

A

Metronidazole

Tinidazole

352
Q

When are you worried about anaerobes

A

STIs

Pneumonia

353
Q

What is nitrofurantonin used for

A

UTIs as concentrates in the bladder

354
Q

Management of PE

A

Immediately give LMWH or DOAC

Then do wells score to determine if D-dimer or CTPA needed

355
Q

How long do you anticoagulate for post PE

A

If provoked 3 months

If unprovoked 6 months

356
Q

What criteria is used to classify pleural effusions

A

Lights criteria

357
Q

What is the lights criteria

A

pleural fluid/serum protein ratio of greater than 0.5

pleural fluid/serum LDH ratio of greater than 0.6

358
Q

What does very elevated LDH in pleural fluid suggest

A

TB or cancer

359
Q

Wheeze in young person differentials

A

Asthma
Foregin object
Antitrypsin

360
Q

What can present with persistent greenish sputum cough and occasional haemoptysis

A

Bronchiectasis

361
Q

What is the chest pain in resp conditions

A

Tight

362
Q

What is the chest pain in cardio conditions

A

Crushing

363
Q

What infections can often precede sarcoidosis

A

Lyme

TB

364
Q

What is uveitis a inflammation of

A

Pigmented layer

365
Q

What is affected in erythema nodosum

A

Fat

366
Q

How can kidney be affected in sarcoid

A

Nephrocalcinosis- so have to do 24hr urine collection

367
Q

Which patients are at specific risk of aspiration pneumonia risk

A

Dementia

368
Q

Which lobe is most commonly affected in aspiration pneumonia

A

Right middle

369
Q

What is use of spirometry

A

Longer term test

370
Q

Differentials of wedge infarct

A

PE

371
Q

What is problem of CTPAs

A

Lots of radiology and contrast

372
Q

Antibiotics for TB given for first 2 months assuming all sensitive

A

Rifampicin
Isoniazad
Pyrazinamide
Ethambutol

373
Q

Management of TB patient

A

Negative pressure room
Cultures to test sensitivity of patients TB to antibiotics- this can take 4 months to come back so start the patient on all 4 abx then if sensitivities all come back positive only keep on the isoniazad and rifampicin

374
Q

What determines if primary or secondary pneumothorax

A

Lung dx

50 year old smoker

375
Q

For primary pneumothoraces what determines if needle aspirate or not

A

If SOB or if greater than 2cm

376
Q

With primary pneumothorax what do you do if asymptomatic or less than 2cm

A

Discharge and outpatient review

377
Q

If aspiration is successful in primary pneumothorax what do you do

A

Observe and give O2

378
Q

If aspiration is unsuccessful in pneumothorax what do you do

A

Put in chest drain

379
Q

In secondary pneumothoraces what determines pathway

A

Greater than 2cm or SOB

380
Q

If greater than 2cm or SOB what do with secondary pneumothoraces

A

Chest drain

381
Q

If between 1-2cm in secondary pneumothoraces what do

A

Needle aspiration
If successful observe and O2
If unsuccessful chest drain

382
Q

If pneumothorax less than 1cm in secondary pneumothoraces what do

A

Observe and O2

383
Q

Presentation of acute massive PE

A

Collapse
Central crushing pain
Severe dyspnoea

384
Q

What can be CXR finding of PE

A

Westermarks sign

Dilation of pulmonary vessels

385
Q

Massive PE on ECG

A

RAD
S1Q3T3
RBBB
In small likely to be kust tachycardia

386
Q

Management of massive PE vs submassive PE

A

Determined by if haemodynamically unstable

Massive
Resp support
1st line thrombolysis
2nd line embolectomy

Submassive
Resp support
Anticoagulation

387
Q

What 2 IV thrombolytics are used in massive PE

A

Alteplase

Streptokinase

388
Q

What can be general inspection finding in asthma

A

Nasal polyps

389
Q

Criteria for diagnosing asthma

A

FEV1/FVC ratio less than 0.7
12% or more reversibility with SABA
FeNO over 40parts per billion

390
Q

If move on from stage 5 asthma what is next step

A

Tiral of-
Theophylline
LAMA

391
Q

If trials of theophylline and LAMA dont work what is given

A

Oral corticsteroids

392
Q

Name of LTRA

A

Montelukast

393
Q

Name of budenoside and formoterol

A

Symbicort

394
Q

What is defined as a moderate acute asthma and waht do you do

A

50-75

Send home

395
Q

What is defined as an acute severe asthma and what do you do

A

33-50

Admit if no response

396
Q

What is defined as a life threatening acute asthma and waht do you do

A

Less than 33

Admit

397
Q

What is defined as a near fatal acute asthma and waht do you do

A

Rised Co2 on ABG

Admit

398
Q

COPD history

A

SOB
Productive cough- white
Some wheeze

399
Q

Treatment for simple COPD infective

A

Amoxicillin

400
Q

Which conditions can cause COPD in younger people

A

Alpha-1-antitrypsin

CF

401
Q

What will post bronchodilator FEV1/FVC be in all COPD categories

A

Less than 0.7

402
Q

Mild severity COPD

A

FEV1 over 80 compared to expected

403
Q

Moderate severity COPD

A

FEV1 50-80% compared to expected

404
Q

Severe severity COPD

A

FEV1 30-49% compared to expected

405
Q

Very severe COPD

A

FEV1 less than 30% compared to expected

406
Q

Initial COPD management

A

SABA or SAMA

407
Q

In second line COPD what determines what drug is given

A

Whether asthma symptoms or not- diurnal cough, wheeze and SOB worsened by triggers

408
Q

If asthmatic signs in COPD what is given

A

LABA and ICS

409
Q

If no asthmatic signs in COPD what is given

A

LABA and LAMA

410
Q

Final line treatment for COPD

A

LABA
LAMA
ICS

411
Q

General management of COPD

A

Smoking cessation
Annual influenza vaccination
Pneumococcal vaccination

412
Q

Improved survival methods for COPD

A

Smoking cessation
Long term O2
Lung volume reduction surgery

413
Q

When is long term O2 given in COPD

A

PO2 of less than 7.3
PO2 7.3-8 and PCV, nocturnal hypoxaemia, peripheral oedeama or pulm HTN
Terminally ill

414
Q

What can cause idiopathic fibrosis

A

Methotrexate

Amiodarone

415
Q

IPF history

A

SOBOE

Dry cough

416
Q

What is gold standard test for IPF

A

Biopsy

417
Q

In first presentation what is first only imaging will see changes

A

HR-CT- ground glass

Later on will see CXR- reticulonodular, cor pulmonale, honeycombing

418
Q

What causes atelectasis in asthma

A

Mucous plugs

419
Q

CXR findings IPF

A

Only seen late

Honey-combing, reticulonodular, cor pulmonale, honeycombing

420
Q

Hypersensitivity pneumonitis history

A

SOBOE
Dry cough
Fever

421
Q

X-ray changes seen in Hypersensitivity pneumonitis

A

Often none but will be superior reticulonodular changes

422
Q

HR-CT early changes hypersensitivity pneumonitis

A

Ground glass

423
Q

Investigations do hypersensitivity pneumonitis

A

CXR
HRCT
BAL
Spirometry

424
Q

What is BAL finding of Hypersensitivity pneumonitis

A

Increased ceullularity

425
Q

Pneumoconiosis history

A

Dry cough

SOBOE

426
Q

How is pneumoconiosis classified

A

Simple

Complicated

427
Q

Investigations for pneumoconiosis

A

CXR
HRCT
Spirometry

428
Q

CXR finding pneumoconiosis

A

In simple disease will see micronodular mottling

429
Q

HRCT finding pneumoconiosis

A

Bilateral lower zone reticulonodular shadowing

Pleural plaques

430
Q

What is different about asbestos HRCT to all other pneumoconiosis’

A

Fibrotic changes seen

431
Q

What is history of sleep apnoea

A

Snoring
Unrefreshed sleep
Chronic fatigue

432
Q

What is common profession seen in sleep apnoea

A

Truck driver who does very little moving

433
Q

Risk factors for sleep apnoea

A

Obesity
Smoker
Alcohol

434
Q

Investigations for sleep apnoea

A 
Sleep study (polysomnography)
TFTs and IGF-1 to rule out acromegaly and goitre
435
Q

What can cause obstructive sleep apnoea

A

Obesity
Goitre
Acromegaly

436
Q

Associations of legionella

A

Hyponatraemia

Abnormal LFTs

437
Q

Pneumonia with abnormal LFTs

A

Legionnella

438
Q

Symptoms of atypical pneumonias

A 
Dry cough
Headache
Diarrorhoea
Myalgia
Hepatitis
439
Q

2 tests for atypical pneumonia legionella

A

Urine antigen test

LFTs

440
Q

Test for mycoplasma atypical pneumonia

A

Blood film- cold agglutins

441
Q

What are 2 types of findings seen on CXR pneumonia

A

Lobar

Bronchopneumonia

442
Q

If patient scores 1 CURB 65 what do

A

GP

443
Q

If patient scores 2 CURB 65 what do

A

Short A&E score

444
Q

If patient scores 3 CURB 65 what do

A

Admission

445
Q

Treatment for pseudomonas pneumonia

A

Tazocin and gentamicin

446
Q

Treatment for MRSA pneumonia

A

Vancomycin

447
Q

Treatment for CAP

A

Amoxicillin

Co-amoxiclav if severe

448
Q

Complications of pneumonia

A

Pleural effusion
Abscess
Sepsis
Empyema

449
Q

How does lung abscess present

A

Swinging fevers
Persistent pneumonia
Foul smelling sputum

450
Q

What is post primary TB

A

When TB is reactivated probably due to immunocompromise- normally presents with severe disease

451
Q

What is miliary TB

A

Lymphohaemaotogenous dissemination of TB

452
Q

Extra pulmonary problems of TB

A 
Addisons
Potts disease
Meningitis
Tuberculomas
Granuolmas in kidney or colon
453
Q

What is potts disease

A

Osteomyelitis and arthrits of spine associated with TB

454
Q

Initial tests for TB

A 
Sputum MCSx3
Ziehl neelsen stain
Blood culture
HIV test
Lymph node biopsy
Mantoux test but cant differentiate between latent and active
455
Q

If question asks for next step management in resp what must always do

A

Look if needs oxygen

456
Q

Non mililary TB findings on CXR

A 
Bi hilar lymphadenopathy
Patchy consolidation
Pleural effusions
Cavitating lesions
Upper lobe scarring
457
Q

Miliary TB finding CXR

A

Nodular shadowing

458
Q

Congenital causes of bronchiectasis

A

Cystic fibrosis
Youngs syndrome
Kartageners (primary ciliary dyskinesia)

459
Q

Acquired causes of bronchiectasis

A 
Recurrent infections
TB
Measles
Pertussis
Lung cancer
Aspergillosis
460
Q

Presentation of bronchiectasis

A 
Chronic cough of copious sputum
Haemoptysis occasionally
SOB
Fever
Weight loss
461
Q

4 things that give basal creps

A

HF
Pneumonia
Bronchiectasis
IPF

462
Q

Investigations for bronchiectasis

A 
Bedside
- sputum sample for microscopy
- sweat test for cystic fibrosis
- genetic testing for PCD and youngs
Bloods
- FBC
- CRP
- ABG
- blood culture
Imaging
- CXR
- HR-CT
463
Q

Classic feature of bronchiectasis HR-CT

A

Signet ring

464
Q

Triad of youngs syndrome

A

Bronchiectasis
Sinusitis
Infertility

465
Q

Management of bronchiectasis

A 
Conservative
- exercise and good diet
- influenza vaccination
- physio
- hypertonic saline nebs
Pharm
- oral prophylactic ABx
- IV if acute infection
Surgical
- resection
466
Q

What is prophylactic antibiotic given in bronchiectasis

A

Azithromycin

467
Q

Complications of bronchiectasis

A

Recurrent infections
Cor pulmonale
Resp failure

468
Q

Common sites of primary tumours causing breast mets

A

Breast

Colorectal

469
Q

Causes of primary lung cancer and %

A 
Non-small cell
- Adenocarcinoma 40
- squamous cell 25
- large cell 5
Small cell
- small cell carcinoma 15
470
Q

Which cells does each lung cancer originate from

A

Adenocarcinoma- goblet cells
Squamous cell carcinoma- squamous epithelial cells
Small cell- NET
Large cell- epithelial cell

471
Q

What can small cell carcinomas produce ectopically

A

SIADH

ACTH

472
Q

Where in lung do adenocarcinomas grow

A

Peripheral

473
Q

Which lung tumour produces PTH

A

SqCC

474
Q

Risk factors for lung cancer

A

Smoking

Asbestos

475
Q

Other than mesothelioma which tumour can asbestos predispose to

A

SqCC

476
Q

What happens to vocal resonance in cancer

A

Increased

477
Q

Local invasions of lung cancer

A

Horners
Left recurrent laryngeal nerve-> bovine cough and hoarse voice
SVC obstruction

478
Q

Where does lung cancer often metastasise to

A

Bone
Brain
Liver

479
Q

Questions for bone mets lung cancer

A

Fractures

Bone pain

480
Q

Questions for brain mets lung cancer

A

Headache

Blurry vision

481
Q

Investigations for lung cancer

A 
Bedside
- sputum cytology
Bloods
- FBC
- U&Es
- calcium 
- LFTs 
Imaging
- CXR
- CTAP
- PET
Biopsy
- bronchoscopy
- transthoracic needle
482
Q

Why measure clacium in lung cancer

A

Bone mets

Ectopic PTH from SqCC

483
Q

Why do LFTs lung cancer

A

ALP for bone mets

Liver mets

484
Q

Complications of lung cancer

A 
Atelectasis
Pleural effusion
Mets
SVC obstruction
Nervous infiltration
485
Q

What is sail sign

A

When LLL collapse

486
Q

Symptoms of mesothelioma

A

Cough dry
LAWS
SOB

487
Q

Sign of mesothelioma on auscultation

A

Pleural friction rub

488
Q

What does pleural friction rub suggest

A

Mesothelioma

489
Q

Investigations for mesothelioma

A 
Bedside
- sputum cytology
- thoracocentesis for pleural fluid cytology
Bloods
- FBC
- U&Es
- calcium 
- LFTs 
Imaging
- CXR
- CTAP
- PET
Biopsy
- thoracoscopy to get pleural lining biopsy
490
Q

Definitive test for mesothelioma

A

Thoracoscopy

491
Q

CXR finding for mesothelioma

A

Pleural thickeing
Effusions
Pleural plaques

492
Q

CXR findnings bronchiectasis

A

Thickened bronchial walls
Volume loss
Ring shadows
Fluid air levels from dilated airways

493
Q

Why do you get volume loss in bronchectasis

A

Mucous plugs

494
Q

What can lead to reduced lung volume

A

Bronchial cancer

Bronchiectasis

495
Q

What is chance patient will have allergic reaction to a cephalosporin if allergic to penicillin

A

10%

496
Q

Sore throat differentials

A 
Cold
Influenza 
Glandular fever
Strep throat
Haematological cancer
497
Q

Presentation of influenza flu

A

headache, weakness, fatigue, myalgia, fever and dry cough

498
Q

Presentation of cold

A

rhinorrhoea, nasal congestion and cough

499
Q

Presentation of strep throat

A

suggested by acute onset, fever, presence of exudate and absence of cough

500
Q

Presentation of EBV

A

sore throat of greater than 7 days’ duration, adenopathy and splenomegaly

501
Q

What would worry you about haem malignancy in sore throat

A

fatigue, weightloss, petechial rash, bruising, adenopathy and fever

502
Q

What would prompt referral to ENT about removal of tonsils

A

7 or more tonsilitis in a year

503
Q

What is delayed prescription of antibiotics

A

Delayed means that can access them after a few days giving them a few days to attempt self care

504
Q

Fever pain score of 2-3

A

Delayed prescription of penicillin

505
Q

Fever pain score of 4-5

A

Immediate prescription of penicillin

506
Q

What to bear in mind with feverpain for vulnerable groups ie on steroids

A

Move the parameters

507
Q

What is main complication of inhaled ICS

A

Thrush

508
Q

Are inhaled ICS ok for pregnancy

A

Yes

509
Q

What is alternative steroid to betclamethasone

A

Fluticasone

510
Q

Significance of sore throat for rheumatic fever

A

Strep A

Scarlet fever also presents with sore throat

511
Q

What is main complication of tonsilitis

A

Peritonsilar abscess

512
Q

What is first thing must establish if presenting with haemoptysis

A

If truly from lungs or from GI, nose or gums

513
Q

Ways to determine if haemoptysis truly haemoptysis

A

Colour- brown suggests GI

History of nosebleeds, nausea, gastric disease or alcoholism

514
Q

INVITED MD for haemoptysis

A 
Infective- TB, abscess, mycetoma, pneumonia
Neoplastic- metastases, primary tumour
Vascular- PE, heart failure
Inflammatory- wegners, goodpastures, microscopic polyangiitis, Lupus, haemorrhagic telengiectasia
Trauma- rib
Endocrine- no
Degenerative- bronchiectasis
Metabolic- no
Drugs- warfarin
515
Q

What does blood streaked sputum suggest

A

Infective cause like pneumonia

Bronchiectasis

516
Q

What does frothy bloody sputum suggest

A

Pulmonary oedema from HF or mitral stenosis

517
Q

What does sudden onset haemoptysis suggest vs chronic

A

Sudden- PE, tumour

Chronic- bronchiectasis

518
Q

What does productive cough alongside haemoptysis suggest

A

Pneumonia

Bronchiectasis

519
Q

What would oligouria suggest about haemoptysis

A

Pulmonary renal syndrome- Lupus, vasculitides, good pastures

520
Q

What does hoarse voice suggest with haemoptysis

A

Lung cancer

521
Q

What does muscle wasting in hand suggest about haemoptysis

A

Pancoast tumour infiltrating the brachial plexus

522
Q

What does a purpuric rash or petechiae suggest about haemoptysis

A

Vasculitide

523
Q

What does swollen face suggest about haemoptysis

A

SVC syndrome

524
Q

What does jaundice or hepatomegaly suggest about haemoptysis

A

Liver cancer thats spread to lungs or vice versa

525
Q

What does tracheal deviation suggest about haemoptysis

A

Collapse of lung secondary to tumour or abscess

Maligant pleural effusion

526
Q

Bloods ordered for haemoptysis

A 
FBC- malignant anaemia, WCC
CRP
Clotting screen- easy bleeding
U&Es- pulmonary renal syndrome
Clacium- hypercalcaemia
LFTs- liver involvement
527
Q

Investigations after lung cancer suggested

A

Sputum for cytology

Biopsy from bronchoscopy or CT guided percutaneous fine needle biopsy

528
Q

What obs recording would discount PE

A

Tachypnoea

529
Q

Why are PCD sufferes infertile

A

Spermatazoa cant swim properly

530
Q

People with primary ciliary dyskinesia often suffer with that conditions

A 
Sinusitis as cant clear noses
Male infertility
Bronchiectasis
Situs invertus
Otitis media as cant clear mucous from middle ear
531
Q

When is lights criteria used

A

If pleural protein less than 25g/L then is exudate
If over 35g/L then is transudate
If between these then do lights criteria

532
Q

Which cancers most commonly metastasise to lung

A

Colon
Renal
Gynae
Breast

533
Q

Extra pulmonary manifestation of lung cancer

A

Bone mets
LEMS
Hypercalcaemia from ectopic PTHrp
Ectopic ACTH

534
Q

DDx for coin lesion

A 
TB
Sarcoid
Abscess
Harmatoma
Foreign object
Tumour
Mycetoma

Year 3 Conditions (33 decks)

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