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3a > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is bronchiectasis?

A

Chronic inflammation of bronchi and bronchioles leading to permanent bronchial dilation.

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2
Q

Which infections cause bronchiectasis?

A
  • Measles
  • Pertussis
  • Bronchiolitis
  • Pneumonia
  • TB
  • HIV
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3
Q

What are the non infectious causes of bronchiectasis?

A
  • Cystic fibrosis
  • Tumour
  • RA
  • UC
  • Allergic bronchopulmonary aspergillosis
  • COPD
  • Asthma
  • Idiopathic
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4
Q

What are the symptoms of bronchiectasis?

A
  • Persistent cough
  • Copious purulent sputum
  • Haemoptysis
  • Dyspnoea
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5
Q

What are the signs of bronchiectasis?

A
  • Finger clubbing
  • Coarse inspiratory crepitations
  • Wheeze
  • Rhonchi
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6
Q

What are the complications of bronchiectasis?

A
  • Pneumonia
  • Pleural effusion
  • Pneumothorax
  • Haemoptysis
  • Cerebral abscess
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7
Q

What Ixs would you do if you suspect bronchiectasis?

A
  • Sputum culture
  • CXR
  • CT - gold standard, shows bronchial dilation
  • Bronchoscopy
  • Spirometry
  • Serum IgE if suspecting ABPA
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8
Q

How would bronchiectasis present on CXR?

A

Ring shadows

Thickened bronchial walls

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9
Q

How would bronchiectasis present in spirometry?

A

Obstructive pattern FEV1/FVC <70%

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10
Q

How would you treat bronchiectasis?

A
  • Physiotherapy
  • Mucolytics
  • Antibiotics
  • Salbutamol
  • Corticosteroids
  • Smoking cessation
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11
Q

What are the risk factors for bronchiectasis?

A
  • Age >70
  • Female
  • Smoking history
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12
Q

What are the differentials of bronchiectasis?

A
  • COPD
  • Asthma
  • Pneumonia
  • Chronic sinusitis
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13
Q

Which virus most commonly causes coryza (common cold)?

A

Rhinovirus

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14
Q

What are the symptoms of coryza?

A
  • Malaise
  • Pyrexia
  • Sore throat
  • Watery nasal discharge
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15
Q

Which pathogens cause sinusitis?

A

Strep. pneumoniae and H.influenzae

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16
Q

What are the symptoms of sinusitis?

A
  • Frontal headache
  • Facial pain
  • Nasal discharge
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17
Q

What is the treatment of sinusitis?

A
  • Broad spectrum abx e.g. co-amoxiclav

- Topical corticosteroids

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18
Q

What are the symptoms of rhinitis?

A
  • Nasal discharge
  • Sneezing
  • Itchy eyes
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19
Q

What is the treatment of rhinitis?

A
  • Avoid allergens
  • Antihistamine
  • Steroid nasal spray
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20
Q

Which virus causes pharyngitis?

A

Adenovirus

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21
Q

What are the symptoms of pharyngitis?

A
  • Sore throat

- Fever

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22
Q

Severe pharyngitis implies bacterial infection. Which bacteria causes pharyngitis?

A

Haemolytic strep

Staph aureus

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23
Q

What is another term for acute laryngo-tracheobronchitis?

A

Croup

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24
Q

Which viruses cause croup?

A

Parainfluenza or RSV

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25
Q

Croup is characterised by a barking cough and stridor due to inflammatory oedema in the larynx. How can you treat this?

A
  • Oxygen
  • Oral/IM corticosteroids
  • Nebulized adrenaline
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26
Q

What are the signs of croup?

A
  • Intercostal and sternal recession
  • Agitation
  • Lethargy
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27
Q

Which antibodies are produced in asthma?

A

IgE

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28
Q

What are the three broad mechanisms of asthma?

A
  1. Inflammation
  2. Remodelling - smooth muscle hypertrophy
  3. Airway thickening + narrowing
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29
Q

What are the symptoms of asthma?

A
  • Diurnal variation (worse early morning + night)
  • Wheeze
  • Cough
  • Sputum
  • Dyspnoea
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30
Q

Which factors precipitate asthma?

A
  • Pollution
  • Infections
  • Cold air
  • Exercise
  • Stress
  • Allergens
  • Infection
  • Smoking
  • Beta blockers
  • NSAIDs
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31
Q

What are the signs of asthma?

A
  • Hyperinflated chest
  • Tachypnoea
  • Hyper-resonant percussion
  • Cyanosis
  • Confusion
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32
Q

What pattern would you expect to see on spirometry for someone with asthma?

A

Obstructive - FEV1/FVC <70%

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33
Q

Apart from spirometry, what other investigations can you do for asthma?

A
  • Peak flow
  • ABG
  • CXR
  • Skin prick test
  • Histamine challenge
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34
Q

Which lifestyle changes can you recommend to someone with asthma?

A
  • Smoking cessation
  • Avoid precipitants
  • Lose weight
  • Correct inhaler technique
  • Up to date vaccinations
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35
Q

Name the medications used to treat asthma.

A
  • SABA - salbutamol
  • Inhaled steroid - beclomethasone
  • LABA - salmeterol
  • Leukotriene receptor agonist - montelukast
  • Aminophylline
  • Oral prednisolone
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36
Q

What are the side effects of beta agonists?

A
  • Tachycardia
  • Low potassium
  • Tremor
  • Anxiety
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37
Q

Why are patients advised to rinse their mouth out after inhaling steroids?

A

To prevent oral candidiasis

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38
Q

What are the risk factors for developing asthma?

A
  • FH
  • Male sex
  • Prematurity and LBW
  • Exposure to tobacco smoke
  • Obesity
  • Social deprivation
  • Childhood infections
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39
Q

What are the complications of asthma?

A
  • Pneumonia
  • Pneumothorax
  • Respiratory failure
  • Status asthmaticus
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40
Q

What are the two pathophysiological factors which make up COPD?

A
  1. Chronic bronchitis - cough + sputum on most days for 3 months
  2. Emphysema - enlarged distance between alveoli and capillaries due to destruction of alveolar wall
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41
Q

Which factors suggest COPD over asthma?

A
  • Age of onset >35
  • Smoking
  • Chronic dyspnoea
  • Sputum
  • Minimum diurnal variation
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42
Q

What are the risk factors for developing COPD?

A
  • Smoking
  • Chronic exposure to pollutants
  • Alpha-1 antitrypsin deficiency (leads to alveolar destruction)
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43
Q

What are the symptoms of COPD?

A
  • Cough
  • Sputum
  • Wheeze
  • Dyspnoea
  • Recurrent lower resp infections
  • Fatigue
  • Headache due to CO2 retention
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44
Q

What are the signs of COPD?

A
  • Tachypnoea
  • Hyperinflation
  • Decreased expansion
  • Resonant percussion
  • Wheeze on auscultation
  • Cyanosis
  • Pursed lip breathing
  • Use of accessory muscles of respiration
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45
Q

What term is given to severe emphysema?

A

Pink puffer

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46
Q

What term is given to severe chronic bronchitis?

A

Blue bloater

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47
Q

How can you differentiate between pink puffers and blue bloaters?

A

Pink puffer:

  • Normal PaO2 and PaCO2
  • Breathless but not cyanosed

Blue bloater:

  • Low PaO2 and high PaCO2
  • Cyanosed but not breathless
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48
Q

What are the complications of COPD?

A
  • Infection
  • Polycythaemia
  • Respiratory failure
  • Cor pulmonale
  • Pneumothorax
  • Lung cancer
  • Bronchiectasis
  • Osteoporosis (chronic steroid use)
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49
Q

Which investigations would you do in COPD?

A
  • FBC - raised PCV
  • CXR - hyperinflation, flattened diaphragm
  • ABG
  • Sputum culture
  • Spirometry - obstructive
  • CT
  • ECG - cor pulmonale
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50
Q

What lifestyle advice would you give someone with COPD?

A
  • Smoking cessation

- Annual flu vaccine

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51
Q

How would you manage an acute exacerbation of COPD?

A
  • Oxygen to maintain sats 88-92% without increasing CO2
  • Salbutamol + ipratropium bromide
  • Oral steroids
  • Antibiotics
52
Q

Outline the stepwise approach for treating COPD.

A
  1. SABA or SAMA (ipratropium bromide)
  2. If no asthmatic features, give LABA and LAMA
  3. If there are asthmatic features, give LABA and ICS
  4. If still worsening, combine LABA, LAMA and ICS
53
Q

What are the indications for long term oxygen therapy for someone with COPD?

A
  1. SpO2 <88%

2. PaO2 <7.3kPa

54
Q

Which organism causes TB?

A

Mycobacterium tuberculosis

55
Q

How is TB transmitted?

A

Aerosol droplets

56
Q

What are the risk factors for re-activating latent TB?

A
  • New TB infection
  • HIV
  • Organ transplant
  • Immunosuppression
  • Malnutrition
  • Haemodialysis
57
Q

What are the symptoms of TB?

A
  • Fever
  • Weight loss
  • Night sweats
  • Malaise
  • Clubbing
  • Enlarged and tender lymph nodes
58
Q

Which organs can extrapulmonary TB present in?

A
  • Heart - pericarditis
  • Brain - meningitis
  • GI - peritonitis
59
Q

What are the signs of TB?

A
  • Purulent sputum
  • Haemoptysis
  • Enlarged and tender lymph nodes
  • Bronchial breathing
  • Dullness to percussion
60
Q

What are the differential diagnoses of TB?

A
  • Bacterial pneumonia
  • Viral respiratory tract infection
  • Interstitial lung disease
  • Malignancy
  • Sarcoidosis
61
Q

What investigations can you do for active TB?

A
  • Sputum culture and microscopy
  • CXR
  • Urine dip - sterile pyuria
  • ECG
  • HIV test
62
Q

Mycobacterium are acid fast bacilli. Which stain is used to detect this?

A

Ziehl-Neelson stain

63
Q

Which culture media is used for mycobacterium?

A

Lowenstein-Jensen

64
Q

How would a CXR appear in someone with TB?

A
  • Lobar consolidation
  • Nodular opacities
  • Miliary TB nodules
  • Caseating granuloma
  • Pleural effusion
65
Q

What test is given to detect latent TB?

A

Mantoux test

66
Q

What is the drug regime to treat active TB?

A

First 2 months: Isoniazid, rifampicin, pyrazinamide and ethambutol

Followed by: Isoniazid and rifampicin for a further 4 months

67
Q

What is the drug regime to treat latent TB?

A

Three months of isoniazid + rifampicin OR six months of isoniazid only

68
Q

What is the drug regime to treat TB with CNS involvement?

A

First 2 months: Isoniazid, rifampicin, pyrazinamide and ethambutol

Followed by: Isoniazid and rifampicin for a further 10 months

69
Q

What are the side effects of rifampicin?

A

Orange discolouration of urine
Low platelets
Raised LFT

70
Q

What are the side effects of isoniazid?

A

Neuropathy - always give vitamin B6 (pyridoxine) to prevent this
Low WCC

71
Q

What is the side effect of ethambutol?

A

Optic neuritis

72
Q

What are the side effects of pyrazinmide?

A

Hepatitis

Arthralgia

73
Q

What are the complications of TB?

A
  • Pleural effusion
  • Pneumothorax
  • Bronchiectasis
  • Respiratory failure
74
Q

What is pulmonary hypertension?

A

Elevated pulmonary artery pressure >25mmHg and secondary RV failure

75
Q

What is the normal mean pulmonary artery pressure?

A

10-14 mmHg

76
Q

What is the normal mean systemic arterial pressure?

A

90 mmHg

77
Q

Pulmonary hypertension occurs due to an increase in pulmonary vascular resistance or an increase in pulmonary blood flow. What are the primary causes?

A
  • Hereditary
  • Chronic haemolytic anaemia
  • SLE
  • RA
  • SSRIs
  • HIV
  • Schistosomiasis
78
Q

What are the secondary causes of pulmonary hypertension?

A
  • COPD
  • Sarcoidosis
  • Chronic PE
  • Left heart disease
79
Q

What are the risk factors for pulmonary hypertension?

A
  • Obesity and sleep apnoea

- Prolonged exposure to high altitude

80
Q

What are the symptoms of pulmonary hypertension?

A
  • Breathlessness
  • Fatigue
  • Chest pain
  • Syncope
81
Q

What are the signs of pulmonary hypertension?

A
  • Peripheral oedema
  • Elevated JVP
  • Hepatomegaly
  • Pulsatile liver
  • Ascites
82
Q

What is the gold standard Ix for pulmonary hypertension?

A

Echo - can calculate pulmonary pressure

Right heart catheterisation

83
Q

What conservative management is advised for those with pulmonary hypertension?

A
  • Flu vaccine

- Contraceptive advice (pregnancy is associated with mortality)

84
Q

Which medications are given for pulmonary hypertension?

A
  • Diuretics
  • Oxygen
  • Digoxin
  • Anticoagulation
  • CCBs
  • Sildenafil
85
Q

What are the risk factors for lung cancer?

A
  • Smoking
  • Asbestos
  • Iron oxides
  • Chromium
  • Radon gas
  • FH
86
Q

Lung cancer is split into small cell and non-small cell carcinoma. What are the types of non-small cell carcinoma?

A
  1. Adenocarcinoma
  2. Squamous cell
  3. Large cell carcinoma
87
Q

What do small cell carcinomas secrete?

A

ACTH - Cushings

ADH - SIADH

88
Q

What are the symptoms of lung cancer?

A
  • Cough
  • Haemoptysis
  • Weight loss
  • New onset breathlessness
  • Chest pain
  • Bone pain
  • Fatigue
89
Q

What is 1 pack year?

A

Smoking one pack (20 cigs) a day, for a year

90
Q

What are the signs of lung cancer?

A
  • Cachexia
  • Clubbing
  • Hepatomegaly
  • Cervical lymphadenopathy
  • Wheeze on auscultation
91
Q

What are the differentials of lung cancer?

A
  • TB
  • Sarcoidosis
  • Wegener’s disease
  • Non-Hodgkin lymphoma
92
Q

Which blood tests would you do for lung cancer?

A
  • FBC: anaemia of chronic disease
  • LFTs: raised ALP + GGT = hepatic mets, raised ALP = bone mets
  • U&Es
  • Serum calcium
93
Q

What are the signs of lung cancer on a CXR?

A
  • Opacities
  • Pleural effusion
  • Collapsed lung
94
Q

What is the gold standard Ix to identify lung cancer?

A

Bronchoscopy with biopsy

95
Q

How would you manage stage I-III non-small cell lung cancer?

A
  • Lobectomy
  • Chemo
  • Radiotherapy if unsuitable for surgery
96
Q

How would you manage stage IV non-small cell lung cancer?

A
  • Targeted drug therapy
  • Immunotherapy
  • Chemo
  • Palliative radiotherapy
97
Q

How would you manage small cell lung cancer?

A
  • Chemo
  • Radiotherapy

Surgery is rare as most patients present with advanced disease

98
Q

Horner’s syndrome is a complication of lung cancer due to a Pancoast tumour. What are the features of this?

A

Ptosis
Miosis
Anhidrosis
Enophthalmos

99
Q

What are the complications of lung cancer?

A
  • SVC obstruction

- SIADH

100
Q

What causes byssnosis?

A

Endotoxins in bacteria in raw cotton

101
Q

What causes berylliosis?

A

Beryllium copper

102
Q

In interstitial lung disease, the diffusion distance in the interstitium becomes greater, impairing gas exchange. Is this reversible or irreversible?

A

Irreversible

103
Q

What is the primary cause of interstitial lung disease?

A

Idiopathic pulmonary fibrosis

104
Q

What are the secondary causes of interstitial lung disease?

A
  • RA
  • SLE
  • Asbestosis
  • Methotrexate
105
Q

What are the symptoms of interstitial lung disease?

A
  • Progressive exertional dyspnoea
  • Dry cough
  • Malaise
  • Fatigue
106
Q

What are the signs of interstitial lung disease?

A
  • End-inspiratory crepitations
  • Dullness to percussion
  • Clubbing
  • Raynaud’s
107
Q

What is the spirometry pattern in interstitial lung disease?

A

Restrictive - normal FEV1/FVC ratio. Reduced FEV1 + FVC

108
Q

What is the CXR pattern in interstitial lung disease?

A

-Fine opacities

109
Q

What is the CT pattern in interstitial lung disease?

A

-Honeycombing

110
Q

What is the medical management for interstitial lung disease?

A
  • Prednisolone

- Oxygen

111
Q

What are the complications of interstitial lung disease?

A
  • Respiratory failure

- Pulmonary hypertension

112
Q

What are the most 3 common causes of community acquired pneumonia?

A
  1. Strep. pneumoniae
  2. H.influenzae
  3. Mycoplasma
113
Q

Some patients acquire pneumonia via aspiration. Which patients are at risk of this?

A
  • Stroke
  • Myasthenia
  • Bulbar palsies
  • Poor dental hygiene
114
Q

What are the symptoms of pneumonia?

A
  • Chest pain
  • Purulent sputum
  • Fever
  • Weight loss
  • Breathlessness
  • Cough
  • Haemoptysis
115
Q

What are the signs of pneumonia?

A
  • Cyanosis
  • Tachypnoea
  • Tachycardia
  • Hypotension
  • Crackles
116
Q

What are the signs of consolidation (no air movement)?

A
  • Diminished expansion
  • Dull percussion
  • Bronchial breathing
  • Pleural rub
  • Increased vocal resonance
117
Q

How would pneumonia present on a CXR?

A
  • Lobar infiltrates

- Pleural effusion

118
Q

Which investigations are needed to diagnose pneumonia?

A
  • Sputum culture
  • WBC
  • Blood cultures
  • Pulse oximetry
  • Urine dip
  • Pleural aspiration
119
Q

CURB65 is used to assess severity of pneumonia. What are the components of this score?

A 
Confusion
Urea >7 mmol/L
Resp rate >30/min
BP <90 mmHg systolic
Age >65
120
Q

What does a CURB65 score of 2 indicate?

A

Admission

121
Q

What does a CURB65 score of 3+ indicate?

A

ITU

Mortality

122
Q

How would you treat mild community acquired pneumonia?

A

Oral amoxicillin or erythromycin

123
Q

How would you treat severe community acquired pneumonia?

A

Oxygen

IV clarithromycin and IV cefuroxime

124
Q

What are the complications of pneumonia?

A 
Pericarditis
Pleural effusion
Lung abscess
Sepsis
Myocarditis
125
Q

Which groups are offered the pneumonia vaccination?

A
  • Age >65 years
  • Diabetics
  • Immunosuppressed
  • Chronic renal, heart, lung or liver disease

3a (13 decks)

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