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first year med > resp conditions > Flashcards

resp conditions Flashcards

1
Q

what would a CXR of someone with asbestosis look like?

A

pulmonary fibrosis
dense calcified pleural plaques
pleural thickening

(restrictive defects)

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2
Q

asthma drug therapy

A

1 - SABA (salbutamol) as required + low dose ICS (beclomethasone)

2 - + LABA (salmeterol)

3 - 4th drug - leuketriene (montelukast), methylxanthines (theophylline), LAMA (tiotropium), sodium cromoglicate in kids

4 - increase ICS dose or oral steriod (prednisolone) - used in primary exacerbation

5 - consider trials of anti-IgE (omalizumab)

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3
Q

how do you diagnose bronchiectasis?

A

HRCT showing -
dilation of airways - larger than accompanying pulmonary artery
thickening of bronchial walls
lack of tapering airways

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4
Q

who does bronchiolitis usually affected and what are the common causes?

A

viral respiratory condition that affects those ages 0-2 + causes inflammation of the bronchioles obstructing them

80% = respiratory syncytial virus (RSV)
metapneumovirus

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5
Q

drug therapy in COPD exacerbation

A

oxygen 24-28% - keep SaO2 between 88-92%
nebulised high dose salbutamol (SABA) + ipratropium (SAMA)
antibiotics if infection

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6
Q

when is triple therapy recommended for COPD patients?

A

LABA/LAMA/ICS

if frequent exacerbator or high eosinophilic count (>300)

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7
Q

what is Cor pulmonale?

A

right heart failure secondary to lung disease caused by chronic pulmonary hypertension

most common cause = COPD

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8
Q

clinical presentation of cor pulmonale

A 
SOB
peripheral oedema
syncope
hypoxia, cyanosis
raised JVP
3rd heart sound
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9
Q

name 2 anti-fibrotic drugs

A

pirfenidone - also anti-inflammatory

nintedanib - monoclonal antibody targeting tyrosine kinase

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10
Q

signs + symptoms of pulmonary fibrosis

A 
progressive breathlessness
exertional dyspnoea
dry cough
cyanosis, clubbing
fine-end inspiratory crackles
reduced lung volume (restrictive)
honeycomb lung on CT - advanced
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11
Q

whats the difference between transudates + exudates?

A

transudates = <30 g/L
–> fluid moving across into pleural space (congestive HF, hypoalbuminaemia, hypothyroidism)

exudates = >30g/L
–> increase leakiness of tissues into pleural space (malignancy, infection, inflammation)

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12
Q

signs + symptoms of pleural effusion

A

pleuritic chest pain
stoney dull to percuss
diminished breath sounds on affected side
blunting of costophrenic angles

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13
Q

management of pneumothorax

A

no SOB + <2cm = no treatment - follow up in 2-4weeks
SOB and/or >2cm = aspiration

if aspiration fails twice - chest drain

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14
Q

where do you insert a chest drain?

A

triangle of safety

  • 5th ICS
  • mid axillary line
  • anterior axillary line
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15
Q

management of tension pneumothorax

A

insert large bore cannula to 2nd ICS in midclavicular line

once pressure relieved, insert chest drain

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16
Q

will the aspiration of empyema be acidic or alkalotic?

A

acidic

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17
Q

what is first line treatment for patients with non small cell lung cancer?

A

surgery - if isolated to a single area

lobectomy, segmentectomy

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18
Q

name some extrapulmonary manifestations associated with lung cancer

A

recurrent laryngeal nerve palsy - hoarse voice, cancer pressing on recurrent laryngeal nerve

phrenic nerve palsy - weak diaphragm, SOB, ^ same cause

SVC obstruction - facial swelling, bulging neck + chest veins
–> pembertons sign

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19
Q

what is pembertons sign?

A

raising hands over head causes facial congestion + cyanosis

due to SVC obstruction - potential extra-pulmonary manifestation of lung cancer

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20
Q

name some paraneoplastic syndromes associated with small cell lung cancer

A

syndrome of inappropriate ADH (SIAD)

cushing’s syndrome - excessive cortisol

limbic encephalitis

lambert-eaton syndrome - autoimmune @ neuromuscular junctions

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21
Q

what is horner’s syndrome and what causes it?

A

triad of -
partial ptosis (drooping eyelid)
anhidrosis (difficulty sweating)
miosis (excessive constriction of pupil)

caused by pancoast tumour = tumour in pulmonary apex
–> presses on sympathetic ganglion

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22
Q

what causes SIADH?

A

SIADH = syndrome of inappropriate ADH (anti-diuretic hormone)

caused by ectopic ADH secretion by small cell lung cancer
–> presents with hyponatraemia

23
Q

what is cushings syndrome? how does it present?

A

high levels of cortisol

ectopic ACTH (stimulation of cortisol) secretion by a small cell cancer

weight gain, easy brusing, stretch marks, depression

24
Q

name some paraneoplastic syndromes associated with non-small cell lung cancer

A

horner’s syndrome - pancoast tumour

hypercalcaemia - caused by ectopic parathyroid hormone
–> from squamous cell carcinome

25
Q

what is lambert-eaton syndrome?

A

paraneoplastic syndrome from SMALL cell lung cancer

a result of antibodies produced by immune system against cancer but also target + damage voltage-gated calcium channel @ presynaptic terminals in motor neurones

symptoms - muscle weakness, ptosis, slurred speech, blurred vision

26
Q

what are 3 auscultatory features you’d see in someone with pneumonia?

A

bronchial breath sounds - harsh breath sounds, equally loud on inspiration + expiration –> due to consolidation of tissue around airway

focal coarse crackles - air passing through sputum

dullness to percussion - lung tissue collapse and/or consolidation

27
Q

what does CURB 65 predict?

A

predicts mortality
1 = <5%
3 = 15%
4/5 = > 25%

treatment based on score
0/1 - home
>=2 - hospital
>= 3 - ICU assessment

28
Q

what parameters does CURB65 involve?

A

Confusion

Urea > 7

Respiratory rate >=30

BP - <90 systolic / <= 60 diastolic

65 or older

29
Q

2 most common causes of pneumonia

A

streptococcus pneumoniae

haemophilus influenzae

30
Q

clinical features of mycoplasma pneumoniae

A

erythema multiforme - target lesions (pink rings with pale centres)

31
Q

how do you diagnoses interstitial lung disease?

A

clinical features + HRCT (ground class appearance)

if unclear - biopsy

32
Q

what is hypersensitivity pneumonitis (extrinsic allergic alveolitis)? causes?

A

type III hypersensitivity reaction to environmental allergen that causes parenchymal inflammation + destruction

causes - 
bird-fanciers lung - bird droppings
farmers lung - mouldy hay spores
mushroom workers lung
malt workers lung - mould on barely
33
Q

how is hypersensitivity pneumonitis diagnosed?

A

bronchoalveolar lavage
– involves collecting cells from airway during bronchoscopy by washing with fluid then collecting fluid for testing

–> shows raised lymphocytes + mast cells

34
Q

why do patients with a PE commonly have a respiratory alkalosis when an ABG is performed?

A

high respiratory rate causes them to blow off extra CO2

low CO2 = alkalotic

PE pO2 = low

35
Q

initial management of PE

A

first line = apixaban or rivaroxaban (factor Xa inhibitors)

LMWH (enoxaparin) where not suitable (antiphospholipid syndrome)

–> given before diagnosis if DVT / PE suspected

36
Q

long term anticoagulation

A

warfarin - target INR = 2-3

NOACs/DOACs - apixaban, dabigatran, rivaroxaban

LMWH = first line in pregnancy + cancer

37
Q

how long should you anticoagulate for post PE?

A

obvious reversible cause = 3 months

unclear cause, recurrent VTE, thrombophilia = >3 months

active cancer = 6 months then review

38
Q

when would you use thrombolysis for a PE?

A

where there is a massive PE with haemodynamic compromise

thrombolytic agents = streptokinase, alteplase

39
Q

what type of bacteria causes tuberculosis?

A

myobacterium tuberculosis

gram positive aerobic bacillus - acid-fast characteristics (resistant to staining)

transmission = respiratory droplets

40
Q

investigations for TB

A

ziehl-neelson stain - TB bacteria goes red against blue background

CXR - linear opacities in upper lobe, lymphadenopathy, calcification, miliary disease, effusion, cavitation (reactivated)

skin test - for LATENT TB

41
Q

what would a CXR of someone with silicosis look like?

A

egg-shell calcification of hilar lymph nodes

inhalation of silica particles

42
Q

what type of hypersensitivity reaction is TB?

A

type IV (cell-mediated - delayed)

caseating granuloma

43
Q

what is the treatment for active + latent TB?

A

rifampicin
isoniazid
pyrazinamide
ethambutol

active = RIPE for 2 months + RI for further 4 months

latent = RI for 3 months

44
Q

what are the side effects of the medication given for TB?

A

rifampicin - orange urine + tears

isoniazid - neuropathy

pyrazinamide - hyperuricaemia (excess uric acid in blood), V+D

ethambutol - colour blindness

RIP - all associated with hepatotoxicity

45
Q

a patient is started on 4 medications to treat their TB. They start experiencing symptoms of neuropathy, what medication should be prescribed?

A

pyridoxine (vitamin B6) - usually prescribed prophylactically

isoniazid causes neuropathy

46
Q

how can latent TB become reactivated?

A

becoming immunocompromised

–> HIV

47
Q

clinical features of sarcoidosis

A

non-caseating - type IV hypersensitivity

dry cough
erythema nodosum
uveitis
bilateral hilar lymphadenopathy
fever, malaise, weight loss

increase serum ACE + Ca2+

peripheral nodular infiltration

48
Q

what is the gold standard for confirming diagnosis of sarcoidosis?

A

US guided biopsy of mediastinal lymph nodes

–> non-caseating granulomas with epithelioid cells

49
Q

what causes alpha-1 antitrypsin deficiency? what can it cause?

A

common inherited conditon caused by lack of protease inhibitor produced by liver

role of A1AT is to protect cells from enzymes such as neutrophil elastase
–> causes emphysema (COPD) in young, non-smokers

50
Q

how would you differentiate between acute tonsillitis and quinsy?

A

quinsy = a complication of tonsillitis

trismus (difficulty opening the mouth) = a feature of quinsy (peritonsillar abscess)

51
Q

what would an ABG of someone with long standing COPD look like?

A

type 2 resp failure (low pO2 + high pCO2)
respiratory acidosis - over time becomes compensated by HCO₃

patients with longstanding COPD rely on hypoxic drive in order to drive respiration because the respiratory centre in their brain is insensitive to CO₂. Patients are therefore hypercapnic and exhibit type 2 respiratory failure. The longstanding hypercapnia eventually causes a respiratory acidosis which over time becomes compensated by HCO₃. These patients classically have a low % O2 and high CO2.

52
Q

Which organism commonly causes pneumonia in immunocompromised patients?

A

Pneumocystis jiroveci

53
Q

What is the pattern of inheritance shown by alpha-1 antitrypsin deficiency?

A

autosomal recessive

first year med (15 decks)

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