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Medicine Finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is seen on spirometry in restrictive airways disease?

A

FEV1/FVC ratio>0.7

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2
Q

What is seen on spirometry for obstructive airways disease?

A

FEV1/FVC ratio < 0.7

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3
Q

Which conditions cause restrictive airways disease?

A 
Pulmonary fibrosis
Asbestosis
Sarcoidosis
ARDS
Ankylosing spondylitis
Neuromuscular disorders (e.g. Myasthenia gravis/MND)
Obesity
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4
Q

Which conditions cause obstructive airways disease?

A

COPD
Asthma
Bronchiectasis
Cystic fibrosis

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5
Q

What is pulmonary fibrosis?

A

Diseases which cause interstitial lung damage and eventually fibrosis

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6
Q

How does pulmonary fibrosis present?

A 
Dry cough
Shortness of breath
Fatigue
Arthralgia
Weight loss
Fatigue
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7
Q

What are signs seen in pulmonary fibrosis?

A

Cyanosis
Clubbing
Fine end-inspiratory crackles
Reduced chest expansion

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8
Q

What are causes of pulmonary fibrosis?

A 
Lung damage - pneumonia, TB, infarction
Irritants - e.g. coal dust, silica
Idiopathic
Extrinsic allergic alveolitis
Connective tissue diseases
Hypersensitivity pneumonitis
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9
Q

How is pulmonary fibrosis diagnosed?

A

CT showing ground glass opacification

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10
Q

What are causes of upper lobe fibrosis? (Non drug)

A

CHARTS

Coal workers pneumonitis, hypersensitivity pneumonitis, ankylosing spondylitis, radiation, tuberculosis, sarcoidosis

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11
Q

What are causes of lower lobe fibrosis?

A

Idiopathic
Asbestosis
All other connective tissue disorders (except ankylosing spondylitis)
Drugs - eg. Amiodarone/Methotrexate

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12
Q

Which drugs can cause pulmonary fibrosis?

A

MADNeSs

Methotrexate, Amiodarone, dopamine agonists, Nitrofurantoin, sulfasalazine

Amiodarone

Methotrexate

Sulfasalazine

Nitrofurantoin

Dopamine agonists (bromocriptine/cabergoline)

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13
Q

What is type 1 respiratory failure?

A

Low oxygen, co2 normal

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14
Q

Why does type 1 respiratory failure occur?

A

Ventilation-perfusion mismatch (V/Q mismatch)

Asthma, congestive heart failure, PE, pneumonia, pneumothorax

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15
Q

What is type 2 respiratory failure?

A

Low oxygen, high co2

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16
Q

Why does type 2 respiratory failure occur?

A

Alveolar hypoventilation

COPD, pulmonary fibrosis, opiates, neuromuscular disease

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17
Q

What is acute respiratory distress syndrome (ARDS)?

A

Non cardiogenic pulmonary oedema and diffuse lung inflammation, usually secondary to an underlying illness

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18
Q

What are pulmonary causes of ARDS?

A

Chest sepsis

Aspiration

Inhalation injury

Pulmonary contusion (bruise in or on lungs caused by force to the chest)

TRALI

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19
Q

What are non-pulmonary causes of ARDS?

A

Sepsis from a non-pulmonary cause

Acute pancreatitis

DIC

Drug overdose

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20
Q

How does ARDS present?

A

Acute onset respiratory failure which does not respond to supplementary oxygen

Dyspnoea
Tachypnoea
Bilateral crackles
Low sats

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21
Q

What shows on chest x-ray in ARDS?

A

Bilateral infiltrates (pulmonary oedema)

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22
Q

What is asthma?

A

A condition of reversible airway obstruction

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23
Q

What are symptoms of asthma?

A

Wheeze

Dyspnoea

Cough

Diurnal variation of 20%

Personal or family history of atopy

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24
Q

What are signs of asthma?

A

Tachypnoea

Hyper-inflated chest

Wheeze on auscultation

Reduced PEFR

SOB

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25
Q

How is asthma diagnosed?

A

Spirometry - obstructive picture (low FEV1)

fractional exhaled inhaled nitric oxide (FeNO) - high result

Bronchodilator reversibility of at least 12% on spirometry

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26
Q

What is the step-wise management for asthma? (NICE guidance)

A

1) SABA (salbutamol)
2) low dose ICS (Beclometasone/mometsone etc)
3) Montelukast
4) LABA (Salmeterol)
5) increase ICS to moderate dose
6) increase ICS to high dose

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27
Q

What is a moderate exacerbation of asthma?

A

PEFR 50-75% of predicted

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28
Q

How is a moderate exacerbation of asthma managed?

A

Salbutamol inhaler with spacer (short pause between puffs)

If worsening despite Salbutamol - consider admission

Quadruple ICS dose for 14 days (or add oral prednisolone)

If not admitting to hospital - follow up in 48 hours

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29
Q

How does a severe exacerbation of asthma present?

A

PEFR = 33-50% of predicted

Resp rate >25

Heart rate >110

Inability to complete sentences or accessory muscle use

Oxygen sats of at least 92%

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30
Q

When is oxygen given in an acute asthma exacerbation and what oxygen is given?

A

If sats drop below 94%

15L via non-rebreather mask

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31
Q

How is a severe exacerbation of asthma managed?

A
  1. Initial bronchodilator treatment (use of SABA Inhaler)
  2. If no improvement -> admit to hospital
  3. Nebulised salbutamol + Nebulised ipratropium bromide
  4. IV Magnesium sulphate if no response

Oral prednisolone (to everyone)

If low sats -> oxygen

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32
Q

What is the management of acute asthma exacerbations in hospital?

A

Everyone who is admitted gets salbutamol nebs, ipratropium bromide nebs + oral pred

If needed - oxygen

If no improvement - senior review for consideration of IV mag sulphate/ IV hydrocortisone

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33
Q

What is a life threatening asthma exacerbation?

A 
PEFR = <33%
Silent chest
Altered consciousness
Exhaustion
Cardiac arrhythmia
Hpotension
Cyanosis
Oxygen sats less than 92%

ONLY NEED ONE OF ABOVE TO BE LIFE THREATENING

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34
Q

How is a life threatening asthma exacerbation managed?

A

Needs admission

Oxygen if needed

Salbutamol and ipratropium bromide nebs

Quadruple ICS

If no improvement - IV hydrocortisone/IV magnesium sulphate

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35
Q

What suggests a near fatal exacerbation of asthma?

A

Normal or raised CO2

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36
Q

What is Samter’s triad?

A

Asthma

Nasal polyps

Aspirin sensitivity

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37
Q

What should you not prescribe in a patient with a history of asthma and nasal polyps?

A

Aspirin

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38
Q

What is COPD? What are the two components?

A

COPD is an umbrella term which includes conditions which cause irreversible airway obstruction

Comprising of chronic bronchitis (hypertrophy and hyperplasia of the mucus glands in the bronchi) –> Chronic cough + sputum

And emphysema (enlargement of the air spaces and destruction of alveolar walls) –> Chronic SOB

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39
Q

What are symptoms of COPD?

A

Productive cough

Wheeze

Dyspnoea

Reduced exercise tolerance

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40
Q

What are signs of COPD?

A

Tachypnoea

Hyperinflated chest

Reduced chest expansion

Wheeze

Cyanosis

Cor pulmonale (heart failure caused by pulmonary hypertension)

Hyperresonant percussion

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41
Q

What is seen on spirometry in COPD?

A

Obstructive picture (ratio <0.7)

FEV1 = less than 80% of predicted

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42
Q

What is seen on chest x-ray in COPD?

A

Hyperinflated chest (can see more than 6 ribs)

Decreased peripheral markings

Flattened diaphragm

Bullae

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43
Q

What is the stepwise management of COPD?

A

1) SABA or SAMA
2) if asthmatic features - add LABA and ICS
2) if no asthmatic features - add LABA and LAMA (if on a SAMA, switch to SABA)
3) SABA + LABA + LAMA + ICS

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44
Q

What can you do if someone is still having continued exacerbations for COPD despite being on SABA + LABA + LAMA + ICS?

A

Specialist referral for Azathioprine

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45
Q

What are indications for long term oxygen in COPD?

A

PaO2 < 7.3 on two readings more than 3 weeks apart

PaO2 7.3-8 plus one of:
Nocturnal hypoxia, polcythaemia, peripheral oedema, pulmonary HTN

PATIENT NEEDS TO BE A NON-SMOKER

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46
Q

What vaccines are needed in COPD?

A

Annual influenza vaccine

One off pneumococcal vaccine

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47
Q

What antibiotic prophylaxis can be given in COPD?

A

Azithromycin (make sure to check ECG to exclude long QT as Azithromycin can prolong QT)

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48
Q

What is the most common organism responsible for COPD exacerbations?

A

Haemophilius influenzae

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49
Q

How are COPD exacerbations managed?

A

If patient is well enough to be at home - 30mg prednisolone, inhalers, and antibiotics ( only if sputum is purulent)

If sputum is not purulent - oral prednisolone only

If admission is needed - nebulisers, oxygen is <94%

Choice of Abx = Doxycycline/Amoxicillin/Clarithromycin

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50
Q

Which are first line antibiotics for COPD exacerbations?

A

Amoxicillin/doxycycline/Clarithromycin

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51
Q

Which are second line antibiotics for COPD exacerbation?

A

Co-amoxiclav/levofloxacin

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52
Q

What is pulmonary hypertension?

A

Hypertension of the pulmonary arteries

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53
Q

What are features of pulmonary hypertension?

A

Shortness of breath

Fatigue

Syncope

Raised JVP

Pansystolic murmur (tricuspid regurgitation)

End-diastolic murmur (pulmonary regurgitation)

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54
Q

What are causes of pulmonary hypertension?

A

COPD, Asthma, interstitial lung disease, Bronchiectasis, cystic fibrosis

Idiopathic

PE

Sleep apnoea

Neuromuscular conditions

Heart problems

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55
Q

What is seen on ECG in pulmonary hypertension?

A

P pulmonale (increased amplitude of P wave)

Right axis deviation

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56
Q

How is pulmonary hypertension diagnosed?

A

Right heart catheterisation

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57
Q

What is cor pulmonale?

A

Right sided heart failure caused by respiratory disease

Respiratory disease -> pulmonary hypertension -> RV cannot pump blood into pulmonary arteries -> leads to backflow into the vena cava

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58
Q

What are causes of cor pulmonale?

A

Most common = COPD

Others = PE, cystic fibrosis, idiopathic pulmonary HTN

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59
Q

How does cor pulmonale present?

A

Same as right sided heart failure

Peripheral oedema

Raised JVP

Hepatomegaly

Cyanosis

SOB

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60
Q

What is Bronchiectasis?

A

Permanent dilation of the bronchi and bronchioles - usually due to chronic infection

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61
Q

How does Bronchiectasis present?

A

Productive cough with purulent sputum

Haemoptysis

Finger clubbing

Coarse inspiration crackles

Wheeze

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62
Q

What is seen on spirometry in Bronchiectasis?

A

An obstructive pattedn

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63
Q

How is Bronchiectasis managed?

A

Chest physio

Antibiotics

Bronchodilators

Prednisolone

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64
Q

What is acute bronchitis?

A

A self-limiting chest infection which is usually viral

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65
Q

How does acute bronchitis present?

A

Cough - may be productive

Sore throat

Rhinorrhoea

Wheeze

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66
Q

How is acute bronchitis managed?

A

Supportive mainly

If CRP >100 = doxycycline (Amoxicillin in pregnancy)

If systemically unwell or any co-morbidities also give antibiotics

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67
Q

What organisms most commonly cause pneumonia?

A

Strep pneumonia / haemophilius influenzae

In alcoholics/diabetics - klebsiella pneumoniae

Hospital-acquired - pseudomonas/staph aureus

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68
Q

What is suggestive of a klebsiella cause of pneumonia?

A

Red currant sputum

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69
Q

What are symptoms of pneumonia?

A

Fever, malaise, rigours

Cough with purulent sputum

Pleuritic chest pain

May be haemopytsis

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70
Q

What are signs of pneumonia?

A

Tachycardia

Tachypnoea

Pyrexia

Hypotension

Confusion

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71
Q

What cause of pneumonia should you consider if LFTs are deranged?

A

Legionella or Mycoplasma

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72
Q

Which risk score is used to determine management of pneumonia?

A

CURB-65

Confusion - 1
Urea >7 - 1
Resp rates >30 - 1
BP <90 systolic or <60 diastolic - 1
Aged >65 - 1
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73
Q

How is pneumonia managed?

A

Low Severity
CRB65 of 0 or CURB65 of 0/1 = Oral Amox/Doxy/Clarithro/Erythro (outpatient care)

Moderate Severity
CRB65 of 1/2 or CURB65 of 2 = Amox + Clarithro/Erythro (consider admission)

High Severity
CRB65 of 3/4 or CURB65 of 3-5 = IV Co-amox + Clarithro/Erythro (admission)

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74
Q

What causes aspiration pneumonia?

A

Occurs in patients with an unsafe swallow

Stroke

Myasthenia gravis

Bulbar palsy

Achalasia

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75
Q

Which lobes are most commonly affected by aspiration pneumonia?

A

Right lower lobe

76
Q

How is aspiration pneumonia treated?

A

IV Cephalosporin (Cefotaxime/Ceftriaxone/Cefuroxime)

And IV Metronidazole

77
Q

What are the two main subtypes of lung cancer?

A

Small cell and non small cell

78
Q

What is the most common type of non-small cell lung cancer? What is the most common type in NON SMOKERS?

A

Squamous cell carcinoma

In non-smokers = Adenocarcinoma

79
Q

What are symptoms of lung cancer?

A

Cough

Haemoptysis

Dyspnoea

Chest pain

Weight loss

80
Q

What are signs of lung cancer?

A

Finger clubbing

Anaemia

Lymphadenopathy

Evidence of paraneoplastic syndromes

81
Q

Where does lung cancer most commonly metastasise?

A

Brain

Breast

Bone

Adrenals

82
Q

What might be seen on an x-ray in lung cancer?

A

Nodules

Pleural effusion

Consolidation

Lung collapse

Hilar lymphadenopathy

83
Q

How is non-small cell lung cancer treated?

A

Lobectomy

84
Q

How is small cell lung cancer treated?

A

Palliative chemo

85
Q

Which lung cancer has the worst prognosis?

A

Small cell

86
Q

What paraneoplastic syndromes are associated with small cell lung cancer?

A

Raised ACTH -> Cushing’s symptoms

Raised ADH -> hyponatraemia due to water retention

Lambert Eaton syndrome (leg and arm weakness)

87
Q

What paraneoplastic features are associated with squamous cell lung cancer?

A

Hypercalcaemia due to raised PTH

HPOA (Hypertrophic pulmonary osteoatrhopathy) -> clubbing, arthropathy

88
Q

What paraneoplastic feature is associated with Adenocarcinoma of the lung?

A

Gynaecomastia

HPOA

89
Q

What does a hoarse voice in lung cancer suggest?

A

Laryngeal nerve palsy

90
Q

What does facial swelling, difficulty breathing and distended veins in lung cancer suggest?

A

Superior vena cava obstruction

91
Q

What are symptoms of a pulmonary embolism?

A

Sudden onset SOB

Pleuritic chest pain

Haemoptysis

Tachypnoea

92
Q

What are signs of a pulmonary embolism?

A

Tachypnoea

Tachycardia

Respiratory alkalosis (due to tachypnoea)

93
Q

What is the textbook ECG finding seen in a PE?

A

S1Q3T3

Deep S in lead I

Pathological Q in lead III

Inverted T in lead III

Main finding = sinus tachycardia

94
Q

What is found on chest x-ray in PE?

A

Normal

95
Q

How do you investigate a suspected PE?

A

Well’s score >4 = CTPA (V/Q scan in renal failure)

Well’s score of 4 or less = D-dimer -> CTPA if positive

If D-dimer = raised but CTPA = negative, stop anticoagulation and recheck CTPA in 1 week

96
Q

What do you do whilst the patient is waiting for a CTPA in PE investigation?

A

Start anticoagulation (apixaban/rivaroxaban)

97
Q

Should you do a CTPA in renal impairment?

A

No, do a V/Q scan insteac

98
Q

How long should you continue anticoagulation for in a confirmed PE?

A

Identifiable cause - 3 months

No identifiable cause - 6 months

99
Q

What anticoagulation is used in PE?

A

If outpatient - DOAC

If inpatient - Heparin

If any contraindications to DOAC - Warfarin usually used instead

Pregnancy - LMWH

100
Q

What is a pneumothorax?

A

Air within the pleural space

101
Q

What is a primary pneumothorax?

A

Pneumothorax with no history of any respiratory disease

102
Q

What is a secondary pneumothorax?

A

Pneumothorax with previous diagnosed respiratory disease - asthma/COPD/pneumonia/TB

103
Q

How does a pneumothorax present?

A

Shortness of breath

Pleuritic chest pain

Tachypnoea

104
Q

How is a pneumothorax seen on chest x-ray?

A

Absence of lung markings

105
Q

How is a primary pneumothorax managed?

A

Patient not SOB and pneumothorax <2cm -> no treatment needed

Patient SOB or pneumothorax >2cm -> aspiration with 16-18G cannula. If this fails - chest drain

106
Q

How is a secondary pneumothorax managed?

A

If patient not SOB and pneumothorax <1cm -> observe for 24 hours

If patient not SOB and pneumothorax 1-2cm -> aspiration

If patient SOB / pneumothorax >2cm -> chest drain

107
Q

What is a tension pneumothorax?

A

Air can get into the pleural space but can’t get out, pressure will lead to a cardiac arrest

108
Q

How does a tension pneumothorax present?

A

Worsening symptoms (SOB, chest pain)

Reduced breath sounds

Hyperresonance to percussion

Tracheal deviation (AWAY from site of pneumothorax)

109
Q

How is a tension pneumothorax treated?

A

Insert a large bore cannula into the second intercostal space in the midclavicular line

110
Q

Where do you place the needle to decompress a pneumothorax?

A

2nd intercostal space at the mid-clavicular line

111
Q

What is a pleural effusion?

A

Abnormal build up of fluid in the pleural cavity

112
Q

What are the two types of pleural effusion?

A

Exudative (high protein) or transudative (low protein)

113
Q

What are exudative causes of pleural effusion?

A

Exudative = due to increased capillary permeability (usually due to inflammation). Usually unilateral

Infection = Pneumonia, TB

Malignancy

Trauma

Connective tissue disease = SLE, RA

114
Q

What are transudative causes of pleural effusion?

A

Transudative = due to imbalance of forces. Usually bilateral

CHF, CKD, Nephrotic syndrome

115
Q

What is seen on CXR in pleural effusion?

A

A white out

Meniscus

Blunting of the costophrenic angle

116
Q

How can you differentiate between an exudative and transudative pleural effusion?

A

Pleural fluid analysis = >35 = exudative, <25 = transudative

For 25-35, use Light’s criteria

Fluid to serum protein ratio >0.5 = exudative
Fluid to serum LDH ratio >0.6 = exudative

117
Q

How does pleural effusion present?

A

Dyspnoea

Chest pain

Reduced/absent breath sounds over effusion

Dull to percussion

May be signs of underlying cause

118
Q

How is a pleural effusion managed?

A

If obvious heart failure - furosemide

Aspirate under ultrasound and do a culture to rule out infection

If large/infected/organisms found on culture - chest drain

119
Q

What is an empyema?

A

An infected pleural effusion

120
Q

How does an empyema often present?

A

Patient with improving pneumonia but new/ongoing fever

121
Q

What are causes of bilateral hilar lymphadenopathy?

A

Sarcoidosis

TB

Bronchial carcinoma

122
Q

What is sarcoidosis?

A

A multi system disease characterised by non-caseating granuloma formation

123
Q

Who is most affected by sarcoidosis?

A

Black females

124
Q

What lab results are seen in sarcoidosis?

A

Raised ACE

Raised calcium

Raised CRP

Raised serum soluble interleukin-2 receptor

125
Q

What is seen on CXR in sarcoidosis?

A

Bilateral hilar lymphadenopathy

126
Q

What is seen on tissue biopsy in sarcoidosis?

A

Non-caseating granulomas with epithelioid cells

127
Q

How does acute sarcoidosis present?

A

Fever

Polyarthralgia

Erythema nodosum

Cough

Bilateral hilar lymphadenopathy

128
Q

How does chronic sarcoidosis present?

A

Pulmonary: cough, Dyspnoea

Systemic: fatigue, weight loss, Arthralgia, fever, lymphadenopathy

Ocular: uveitis, conjunctivitis, optic neuritis

Dermatological: erythema nodosum, lupus pernio (purple rash on face)

129
Q

How is sarcoidosis managed?

A

If mild symptoms only - no treatment

If hypercalcaemia or eye/heart/neuro involvement - oral steroids

Acute sarcoidosis - NSAIDs

130
Q

How is sarcoidosis staged?

A 
0 = Normal
1 = Bilateral hilar lymphadenopathy
2 = BHL + interstitial infiltrates
3 = diffuse infiltrates
4 = diffuse fibrosis
131
Q

What organism is responsible for tuberculosis?

A

Mycobacterium tuberculosis

132
Q

What is primary TB?

A

There is a small lung lesion called the Ghon focus

Encapsulated by granulation tissue

133
Q

What is secondary TB?

A

When primary TB becomes active

In immunocompromised patients

Presents with classical symptoms of TB

Can also present in other organs

134
Q

What is miliary TB?

A

When the primary TB is not contained and it disseminates via the bloodstream

135
Q

How does pulmonary TB present?

A

Cough with purulent sputum and possibly Haemoptysis

Night sweats

Fever

Weight loss

136
Q

How can active TB be diagnosed?

A

Ziehl-Neelsen stain

Sputum culture – for PCR and smear

137
Q

How can latent TB be diagnosed?

A

Mantoux test

Interferon gamma release assay

138
Q

How is active TB treated?

A

RIPE

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

For 2 months

Continue rifampicin and isoniazid for another 4 months

139
Q

What are adverse effects of rifampicin?

A

Hepatitis

Red bodily secretioms

140
Q

What are adverse affects of isoniazid?

A

Peripheral neuropathy

141
Q

What are adverse effects of pyrazinamide?

A

Hyperuricaemia -> gout

Arthralgia

Myalgia

142
Q

What are adverse effects of ethambutol?

A

Optic neuritis (check visual acuity before and after treatment)

143
Q

How are pleural plaques managed?

A

No follow up needed, benign

144
Q

What is obstructive sleep apnoea?

A

Apnoea episodes during sleep due to collapse of pharyngeal airway

145
Q

How does obstructive sleep apnoea present?

A

Snoring

Morning headache

Waking up unrefreshed from sleep

Daytime sleepiness

146
Q

How is obstructive sleep apnoea diagnosed?

A

Epworth sleepiness scale

Sleep studies - Polysomnography

147
Q

What are features of eosinophilic granulomatosis with polyangitis? (Churg-Strauss Syndrome)

A

Asthma

Raised eosinophils

Paranasal sinusitis

Mononeuritis multiplex

Pulmonary infiltrates

Nasal polyps

148
Q

Which marker is raised in eosinophilic granulomatosis with polyangitis?

A

pANCA

149
Q

What are features of granulomatosis with polyangitis? (Wegener’s)

A

Kidney and respiratory tract problems

Chronic sinusitis

Epistaxis

Saddle-nose deformity

Cough

Haemoptysis

Pleuritic

Haematuria

Proteinuria

150
Q

What are long term complications of pulmonary fibrosis?

A

Respiratory failure

Increased risk of lung cancer

Pulmonary hypertension and cor pulmonale

151
Q

What is seen on CXR in pulmonary fibrosis?

A

Interstitial shadowing

May be normal

152
Q

What is seen on CT in pulmonary fibrosis?

A

Ground-glass pacification

Honeycombing

Mosaicism

153
Q

Which markers may be raised in pulmonary fibrosis?

A

Depends on cause of pulmonary fibrosis….

ESR

Rheumatoid factor

ANA

154
Q

Someone with lung cancer presents with muscle weakness?

A

Lambert Eaton Syndrome

155
Q

Someone with lung cancer presents with symptoms of Cushing’s ?

A

Most likely to be increased ACTH due to Small cell lung cancer

156
Q

What causes hyponatraemia in small cell lung cancer?

A

SIADH

157
Q

How is COPD staged?

A

By FEV1

> 80% = stage 1, mild (symptoms needed)

50-79% = stage 2, moderate

30-49% = stage 3, severe

< 30% = stage 4, very severe

158
Q

Who needs admitting during an acute asthma exacerbation?

A

Anyone with life-threatening asthma attack

Severe asthma attack persisting after initial bronchodilator treatment

Moderate asthma attach with worsening symptoms despite bronchodilator treatment or who heave had a previous newr fatal asthma attack

159
Q

What is interstitial lung disease? how is it seen on CT?

A

Umbrella term of conditions which affect lung tissue causing inflammation and fibrosis.

CT = Ground-glass appearance.

160
Q

What is hypersensitivity pneumonitis?

A

Type II Hypersensitivity reaction

Causes upper lobe lung fibrosis

Dry cough, dyspnoea

161
Q

What is cryptogenic organising pneumonia?

A

Presents similarly to pneumonia

Type of lung fibrosis

Not infectious

162
Q

What is atelectasis? What can cause it?

A

Basal alveolar collapse

Common post-operative complication

Dyspnoea + Hypoxia at around 72 hrs post-op

163
Q

What is Kartagener’s syndrome?

A

AKA Primary ciliary dyskinesia

Complete sinus invertus

Bronchiectasis

Recurrent sinuitis

Subfertility

Right testicle hangs lower than left

164
Q

What are contraindications to a DOAC?

A 
Pregnancy/Breastfeeding
Metallic heat valve
Liver disease
Active malignancy
Antiphospholipid syndrome
165
Q

What type of oxygen therapy is used in an AECOPD?

A
  1. Non-rebreather
  2. NIV - BiPAP

Venturi??

166
Q

What is the most common cause of an exudative pulmonary effusion?

A

Pneumonia

167
Q

What is the most common cause of transudative pulmonary effusion?

A

Heart failure

168
Q

What is Kyphoscoliosis?

A

A cause of restrictive airways disease
Hunched posture
Caused by Ankylosing spondylitis

169
Q

What is a possible complication of COPD seen on FBC?

A

Secondary polycythaemia

170
Q

Why does polycythaemia occur in COPD?

A

To compensate for long term hypoxaemia

171
Q

How long should deep sea diving be avoided after pneumothorax?

A

Indefinitely

172
Q

Pneumonia with red currant jelly sputum?

A

Klebsiella

173
Q

Which patients should have Abx therapy for acute bronchitis? Which Abx should be given?

A

Systemically very unwell
Pre-existing co-morbidites
CRP >100

Abx = Doxycycline (Amoxicilin if CI)

174
Q

Gold standard diagnosis for Asthma?

A

FeNO + Spirometry with bronchodilator reversibility

175
Q

What are features that suggest steroid responsiveness in COPD?

A

Previous diagnosis of asthma/atopy
Eosinophilia
Diurnal variation

176
Q

Where should a chest drain be placed?

A

5th intercostal space midaxillary line

177
Q

What is the correct inhaler technique?

A

Remove cap and shake
Breathe out gently
Put mouthpiece in mouth, as you begin to breathe in , slow and deep, press canister down and continue to inhale steadily
Hold breath for 10 seconds
For a second dose wait for approx 30 seconds

178
Q

What can worsen a tension pneumothorax?

A

Ventilation

Acute deterioration following ventilation

179
Q

How to calculate pack years?

A

1 pack = 20 cigaretts

1 pack year = 20 cigarettes per day for 1 year

180
Q

What are Cis to lung cancer surgery?

A

SVC obstruction
FEV <1.5
Malignant pleural effusion
Vocal cord paralysis

181
Q

How is SVC obstruction managed?

A

Sit them up
Stat dose of steroids
Stenting

182
Q

What is the 2WW criteria for lung cancer?

A

Any age with CXR findings suggestive of lung cnacer

>40 with unexplained haemoptysis

183
Q

Which pleural effusions need draining with a chest drain?

A

If the fluid is purulent or turbid/cloudy

if the fluid is clear but the pH is less than 7.2

184
Q

How is atelectasis managed?

A

Chest physio

185
Q

What is the stepwise progression of care in acute asthma?

A
  1. Oxygen
  2. Salbutamol nebulisers
  3. Ipratropium bromide nebulisers
  4. Hydrocortisone IV OR Oral Prednisolone
  5. Magnesium Sulfate IV
  6. Aminophylline/ IV salbutamol
186
Q

What does a blood gas look like in metabolic alkalosis due to hyperventilation

A

Low pH
Low co2
Normal oxygen

Type 1 resp failure
(V/Q mismatch)

Medicine Finals (32 decks)

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