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yr3 > resp SBAs > Flashcards

resp SBAs Flashcards

1
Q

Decreased air entry
Decreased vocal fremitus
Dull percussion
on R side of chest

A

R sided pleural effusion

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2
Q

Extrapulmonary manifestations of sarcoidosis

A

splenomegaly, uveitis, erythema nodosum, bilateral parotitis and swelling, hepatic granuloma infiltration

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3
Q

Resp causes of clubbing

A 
Abscess
Bronchogenic carcinoma
Bronchiectasis
CF
Fibrosing alveolitis
Empyema
Mesothelioma
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4
Q

PE signs on ECG

S1Q3T3

A

Deep S wave in lead I
Pathological Q wave in lead III
Inverted T wave in lead III
(RAD)

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5
Q

Chronic asthma Rx

A
  1. SABA
  2. Inhaled steroid
  3. increased steroid dose. LABA
  4. Leukotriene receptor antagonists, b2 agonist tablets
    [5. addition of oral low dose steroids]
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6
Q

A 42 year old previously healthy plumber is brought to hospital very confused by his wife with a fever, bradycardia and SOB. Investigations reveal elevated WBC count and Na 127mmol/l, K 4.2mmol/l, urea 6.5mmol/l. The doctor orders a urine sample. What is the diagnosis?

A

Legionella (Gram -ve rod)

Found in lakes, contaminated water systems etc. Smoking is a risk factor.

It can cause confusion, abdo pain, hypoNa+, diarrhoea and bradycardia.

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7
Q

Legionella diagnostic test

A

Urine Ag detection

Legionella does not grow on routine culture media

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8
Q

Pseudomona type of bacteria?

A

Gram -ve bacilli

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9
Q

What is Pott’s disease

A

Presentation of extrapulmonary TB which affects the spine

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10
Q

Mr D is an eco warrior who has spent the last 6 months in India. He has come back very thin with a persistent cough which occasionally produces blood streaked sputum. He has never smoked cigarettes.

A

pulmonary TB

DDx: bronchial carcinoma

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11
Q

Which NSCLC is located peripherally in the lung

A

Adenocarcinoma

Commonest in non-smokers

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12
Q

Gram +ve cocci

A

Streptococcus
Staphylococcus
Enterococcus

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13
Q

Gram +ve bacilli

A

Clostridium

Listeria

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14
Q

Gram -ve cocci

A

Neisseria

Haemophilus

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15
Q

Gram -ve bacilli

A 
Salmonella
Shigella
Pseudomonas
Legionella
Vibrio
ESBL
Proteus
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16
Q

A young adult with a 2 day history of left sided pleuritic chest pain, fever and cough productive of rusty coloured sputum. A CXR was obtained which showed left lower lobe shadowing suggestive of consolidation. On agar the sputum grew gram +ve cocci. What is the diagnosis?

A

Strep pneumoniae

Management is guided by the CURB-65 score.

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17
Q

A 26 year old man presents with severe shortness of breath and a dry cough for several weeks. He is an IV drug user. There are purple patches on the arms and in the mouth. CXR shows reticular perihilar/fine mottling opacities.

A

PCP is caused by Pneumocystis jirovecii, previously called Pneumocystis carinii. It is a fungal organism and an AIDS defining illness

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18
Q

A 51 year old social worker presents to her GP with haemoptysis. On further questioning she admits to having a productive cough for 6 months + to losing 2 stones in weight over the same time. Chest x-ray shows patchy consolidation & scarring in both apices

A

TB

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19
Q

A 20 year old presents with general malaise, severe cough + breathlessness which has not improved with a 7 days of amoxicillin. CXR: patchy shadowing throughout the lung fields. The blood film shows clumping of red cells with suggestion of cold agglutinins.

A

Mycoplasma - cold type agglutinins and a cold AIHA. Humans are the only host for Mycoplasma. Most commonly affected are young adults living in close proximity. PCR can be used in diagnosis.

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20
Q

A 20 year old man with CF presents with haemoptysis. He has had a cold for a fortnight with increased sputum production, fever + rigors. Sputum shows Gram +ve cocci in clusters

A

Staph aureus - post-influenza pneumonia. It causes a cavitating pneumonia on CXR (some abscesses seen). Another risk factor is CF.
Rx of staphyloccocal infection: flucoxacillin or vancomycin

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21
Q

Trachea deviated to left. Dull to percussion + reduced breath sounds at left base.

A

This is a lobar collapse. Collapse pulls the trachea TOWARDS the affected side. There is dullness and reduced/absent breath sounds due to a lack of air filled lung in this space. . A ‘sail sign’ will classically be seen behind the cardiac shadow on CXR with left lower lobe collapse

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22
Q

A 36 year old popstar presents with fever, a cough + an itchy vesicular rash. Chest x-ray shows mottling through both lung fields

A

The pruritic vesicular rash (dewdrop on a rose petal) = VZV. The rash is usually on torso and face; pneumonia is a complication in those with immunosuppression. The lesions are often crusted over by 7-10 days.

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23
Q

Types of aspergillosis

A
  1. Type 1 hypersensitivity reaction causing atopic asthma through inhalation of fungal spores
  2. Allergic bronchopulmonary asperillosis (ABPA) from type 3 hypersensitivity reaction
  3. Aspergilloma – fungus ball in a pre-existing cavity, often caused by TB and sarcoidosis
  4. Invasive aspergillosis – in immunocompromised, SLE, burns, post-broad spectrum Abx
  5. Hypersensitive pneumonitis (EAA)
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24
Q

Bilateral cavitating bronchopneumonia causative organisim…

A

Staph aureus

Rx: flucloxacillin

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25
Q

Extrinsic allergic alveolitis (EAA) definition

[also known as hypersensitivity pneumonitis]

A

Occurs from inhalation of organic allergens e.g. fungal spores or avian proteins that initiate a hypersensitivity reaction. Individuals are commonly exposed to allergens by their occupation or hobbies

26
Q

Acute phase of EAA

A

alveolar infiltration with inflammatory cells, leading to non-caseating interstitial granulomas

4-6hrs post-exposure: fever, rigors, dry cough, SOB, fine inspiratory creps

27
Q

Chronic phase of EAA

A

well-formed granulomas, obliterative bronchiolitis, alveolar destruction (honeycombing on CXR) = fibrosis

wt loss, increasing SOB, T1 resp failure, RHF, fine inspiratory creps.

28
Q

Main causes of EAA

A 
farmer’s lung
mushroom picker’s lung
bird/pigeon fancier’s lung
malt worker’s lung
humidifier's lung (bagassosis)
29
Q

The most common organisms responsible for LRTIs in cystic fibrosis are …

A

Staph aureus, Haem influenza and Pseudomonas aeruginosa.

Chronically: pseudomonas (80%). Rx = ciprofloxacin

30
Q

Diagnosis of CF is made by …

A

NaCl sweat test >60mmol/l

31
Q

Pancoast tumour signs

A

Hoarse voice

Horner’s syndrome

32
Q

A 55 year old smoker presents with rapidly progressing weight loss with severe burning pain in his hands + feet. Chest x-ray shows a small round opacity in the right upper lobe. What is the likely diagnosis?

A

This patient has lung cancer and paraneoplastic syndrome with manifestations of sensory neuropathy associated with small cell lung cancer. Small cell lung cancer is treated with chemotherapy and is also associated with SIADH and ectopic ACTH.

33
Q

Bounding pulse in a patient who is short of breath suggests…

A

Acute rather than chronic CO2 retention

other causes of bounding pulses: hepatic failure, sepsis

34
Q

Mycoplasma pneumonia extra-pulmonary features

A 
Erythema multiforme (rashes)
Myocarditis
Haemolytic anaemia
Meningoencephalitis
Transverse myelitis
GBS
35
Q

Commonest community acquired pneumonia organism

A

Strep pneumoniae (70%)

36
Q

Commonest community acquired pneumonia organisms in COPD/smoking patients

A

Haemophilius influenzae

+Moraxella catarrhalis

37
Q

Community acquired pneumonia organisms with birds/parrot contact

A

Chlamydia pneumoniae

Chlamydia psittaci

38
Q

Hospital acquired pneumonia organisms

A

Gram -ve enterobacteria (Pseudomonas, Klebsiella)
Anaerobes (aspiration pneumonia)

[and staph aureus]

39
Q

Bronchial breathing definition

A

Inspiration phase lasts as long as the expiration phase

present in pneumonia

40
Q

Most definitive investigation for Pneumocystic cariini pneumonia (or when pneumonia fails to resolve or there is clinical progression)

A

Bronchoscopy

+bronchoalveolar lavage

41
Q

Pneumonia 0 markers on guidelines Rx

A

Oral amoxicillin

±O2, IV fluids, drain empyema/abscesses

42
Q

Pneumonia 1 marker on guidelines Rx

A

Oral or IV amoxicillin
Oral or IV erythromycin

(±O2, IV fluids, drain empyema/abscesses)

43
Q

Pneumonia >1 markers on guidelines Rx

A

IV cefuroxime/cefotaxime/co-amoxiclav
IV Erythromycin

(±O2, IV fluids, drain empyema/abscesses, add metronidazole for aspiration pneumonia)

44
Q

Tension pneumothorax Rx

A

Maximum O2
Insert large-bore needle into 2nd ics MCL on side of pneumothorax to relieve pressure
Insert chest drain soon after

45
Q

Complications of pneumonia

A

Spread of infection: pleural effusion, empyema, abscess, septicaemia
Damage to local structures: bronchiectasis, pneumothorax

46
Q

Common causes of chronic cough in non-smokers

A 
Asthma (+atopy, allergies)
Post-nasal drip
GORD
ACEi
Non-smoker lung cancer i.e. NSCLC adenocarcinoma
47
Q

Pleural pH <7.2 when normal blood pH is found in

A

Pleural infection (e.g. pneumonia and empyema)
TB
Malignancy
Oesophageal rupture

n.b. these along with SLE and RhA also have low glucose levels. Exudate pleural fluids have high LDH levels.

48
Q

Exudate pleural fluids (high protein levels in pleural effusion) have high or low LDH levels?

A

High LDH levels

49
Q

CURB-65 score

A 
Confusion
Urea >7mmol/L
RR >30/min
BP <90/60
Age >65

(±hypoxia <8kPa, WCC <4/>20)

50
Q

A 30yr old man presents with repeated episodes of fever, rigors, dry cough and SOB with onset several hours after starting work. CXR shows mid-zone mottling. What is the likely diagnosis?

A

Extrinsic allergic antigens (EAA)

He is a farmer and this is a hypersensitivity reaction to inhaled antigens. In chronic EAA, CXR may show honeycommb lung.

51
Q

Community acquired pneumonia organism common in IVDU users and post-influenza elderly patients

A

Staph aureus

52
Q

A 65yr old dockyard worker presents with weight loss and SOB. He is clubbed and cachectic. CXR shows pleural calcification and lobulated pleural mass. What is the likely diagnosis?

A

Malignant mesothelioma

Due to previous asbestos exposure:
Mass with lobulated margin on CXR
Pleural calcification

53
Q

A 40yr old woman presents with gross clubbing and progressive SOB. O/E: fine end-inspiratory crackles. CXR: ground glass appearance of lungs. What is the likely diagnosis?

A

Idiopathic pulmonary fibrosis

Combination of SOB, clubbing, fine end-insp creps. CXR findings include ground-glass shadowing and chronically, a honeycomb lung.

54
Q

A 35yr old patient on the ward admitted to hospital 10days ago develops a severe pneumonia. What is the appropriate Rx?

A

HAP = Gram-ve organisms e.g. Pseudomonas

Tazocin can be used (b-lactam abx)

55
Q

Fine crepitations suggest

A

Pulmonary oedema

Pulmonary fibrosis

56
Q

Early onset emphysema + liver disease

A

a1-antitrypsin deficiency

57
Q

Fever, cough, SOB
Hours after exposure to antigen
+ve serum precipitins

A

Extrnsic allergic alveolitis

58
Q 
Asymptomatic with BHL
Progressive SOB/dry cough
Non-pulmonary manifestations
High serum ACE
High Ca2+
A

Sarcoidosis

59
Q

Progressive SOB and cyanosis
Gross clubbing
Fine end-inspiratory crackles
CXR groundglass -> honeycomb lung

A

Idiopathic pulmonary fibrosis

60
Q

Swinging fever
Copious foul-smelling sputum
Persistent, worsening pneumonia

A

Lung abscess

yr3 (19 decks)

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