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Respiratory Flashcards

1
Q

Which type of lung cancer is responsible for multiple paraneoplastic syndromes and why?

A

SCLC because the cells contain neurosecretory hormones which secrete neuroendocrine hormones

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2
Q

What are the signs and symptoms of lung cancer?

A 
Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy
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3
Q

What investigations should be done for lung cancer?

A

Chest x-ray

Staging CT scan

PET-CT

Bronchoscopy

Histology

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4
Q

What may be seen on a chest x-ray of lung cancer?

A

Hilar enlargement
Peripheral opacity
Pleural effusion
Collapse

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5
Q

What can a hoarse voice in the context of lung cancer suggest?

A

Recurrent laryngeal palsy

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6
Q

What is pemberton’s sign and what does it suggest?

A

When raising hands over the head causes facial congestion and cyanosis. It is a sign of superior vena cava obstruction

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7
Q

Which tumour causes Horner’s syndrome?

A

Pancoast’s tumour. Presses on the sympathetic ganglion

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8
Q

Why can small cell lung cancer cause lambert-eaton?

A

Antibodies are produced against the SCLC, they also target and damage voltage-gated calcium channels on the presynaptic terminals in the motor neurones

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9
Q

How is pneumonia seen on chest x-ray?

A

Consolidation

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10
Q

How is pneumonia labelled as either community or hospital?

A

If it is acquired outside of hospital then it is labelled as community. If it is acquired >48 hours after admission to hospital then it is hospital acquired pneumonia

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11
Q

What are the chest signs of pneumonia?

A

bronchial breath sounds
Focal coarse crackles
Dullness to percussion

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12
Q

What scoring assessment is used in pneumonia to estimate the mortality?

A

CURB-65

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13
Q

What are the common causes of pneumonia?

A 
Streptococcus pneumoniae (50%)
haemophilus influenzae (20%)
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14
Q

How does legionella pneumonia present?

A

Hyponatraemia because it causes SIADH

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15
Q

Which bacteria causes a pneumonia which presents alongside target lesions?

A

Mycoplasma pneumoniae. Causes erythema multiforme which leads to the target lesions on the skin. May also cause neurological symptoms in a younger patient

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16
Q

What can cause pneumonia in those who are immunocompromised?

A

Pneumocystis jirovecii (PCP). Usually occurs in those who have poorly controlled or new HIV with a low CD4 count

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17
Q

What does obstructive lung disease show on spirometry?

A

FEV1 less than 75%, FEV1:FVC <75%

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18
Q

What does restrictive lung disease show on spirometry?

A

FEV1 and FVC are equally reduces so the FEV1:FVC is >75%

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19
Q

Is asthma obstructive or restrictive?

A

Obstructive

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20
Q

Give some examples of typical triggers for asthma

A 
Infection
Night time or early morning
Exercise
Animals
Cold/damp
Dust
Strong emotions
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21
Q

What type of wheeze is heard in asthma?

A

Bilateral widespread “polyphonic” wheeze

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22
Q

What are the first line investigations for asthma?

A

Fractional exhaled nitric oxide

Spirometry with bronchodilator reversibility

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23
Q

Give an example of a LABA

A

Salmeterol

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24
Q

Give an example of a LAMA

A

Tiotropium

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25
Give an example of a leukotriene receptor antagonist
Montelukast
26
What is the monitoring for theophylline?
Levels after 5 days and 3 days after any dose changes
27
What is the stepwise management of asthma (8 steps)
1. SABA 2. SABA+ ICS 3. + leukotrine receptor agonist 4. +LABA 5. Change to MART 6. Increase ICS to moderate dose 7. Increase ICS to high or theophylline or LAMA 8. Refer to specialist
28
What is MART regime?
A combination inhaler containing a low dose inhaled ICS and a fast acting LABA
29
What does a PEFR of 50-75% of predicted suggest?
Moderate acute asthma
30
What does a PEFR of 33-50% of predicted suggest?
Severe acute asthma
31
What does a PEFR of <33% suggest?
Life threatening asthma
32
How is moderate acute asthma managed?
Nebulised salbutamol Nebulised ipratropium bromide Steroids Oxygen
33
How is severe acute asthma managed?
Oxygen to maintain sats at 94-98% Aminophylline infusion IV salbutamol
34
How is life threatening asthma managed?
IV magnesium sulphate | Intubation
35
What does an ABG in acute asthma show?
Respiratory alkalosis due to tachypnoea causing a drop in CO2
36
What needs to be monitored when salbutamol is used?
Serum potassium. Causes serum hypokalaemia Also causes tachycardia
37
What are the 5 stages of the MRC dyspnoea scale?
1- breathless on strenuous exercise 2- breathless on walking up hill 3- breathless that slows walking on the flat 4- stop to catch breath after 100m on the flat 5- unable to leave house due to breathlessness
38
How is a diagnosis of COPD made?
By clinical presentation and spirometry | FEV1:FVC <0.7
39
What is the management of COPD?
SABA or short acting antimuscarinics (ipatropium bromide) Plus either: LABA and LAMA if no asthmatic features OR LABA and ICS if asthmatic features
40
What are the features of type 1 respiratory failure?
Normal pCO2 with low PO2
41
What are the features of type 2 respiratory failure?
Raised pCO2 and low PO2
42
What is the O2 sats target in patients who are retaining CO2?
88-92%
43
What is a contraindication for biPAP?
Pneumothorax
44
Which investigation is used to diagnose interstitial lung disease? What is the finding?
HRCT and it shows a ground glass appearance
45
What can be found on examination in idiopathic pulmonary fibrosis?
Bibasal fine inspiratory crackles and finger clubbing
46
Which two medications can be used to slow the progression of idiopathic pulmonary fibrosis?
Pifenidone | Nintedanib
47
Which drugs can cause pulmonary fibrosis?
Amiodarone Cyclophosphamide Methotrexate Nitrofurantoin
48
What type of hypersensitivity reaction in hypersensitivity pneumonitis?
Type III
49
How is hypersensitivity pneumonitis diagnosed
Bronchoalveolar lavage which shows raised lymphocytes and mast cells
50
What are the two types of pleural effusion and what is the difference?
There is exudative and transudative Exudative means there is a high protein count >3g/dL Transudative means there is a lower protein count <3g/dL
51
What causes exudative pleural effusion?
Lung cancer Pneumonia Rheumatoid arthritis Tuberculosis
52
What causes transudative pleural effusion?
Congestive cardiac failure Hypoalbuminaemia Hypothyroidism Meig's syndrome
53
What is the presentation of pleural effusion?
SOB Dullness to percussion Reduces breath sounds Tracheal deviation away from the effusion
54
What is seen on a chest X-ray of a pleural effusion?
Blunting of the costophrenic angle Fluid in the lung fissures Larger effusions have a meniscus Tracheal deviation
55
What is the management of pleural effusion?
Conservative if small Pleural aspiration Chest drain
56
What is seen on pleural aspiration in empyema?
Pus, acidic pH (<7.2), low glucose, high LDH
57
What is the investigation of choice in pneumothorax?
Erect chest x-ray
58
What is the management for a pneumothorax with a <2cm rim of air
No treatment is required, should resolve spontaneously
59
What is the management for a pneumothorax with a >2cm rim of air and SOB?
Aspiration If aspiration fails twice then chest drain
60
What are the signs of tension pneumothorax?
``` Tracheal deviation away from the side of the pneumothorax Reduces air entry to affected side Increased resonance on affected side Tachycardia Hypotension ```
61
What is the management of a tension pneumothorax?
Insert a large bore cannula into the second intercostal space in the midclavicular line
62
Where should chest drains be inserted?
The triangle of safety made up by: 5th intercostal space Mid axillary line anterior axillary line
63
What is the main contraindication for compression stockings?
Peripheral arterial disease
64
What should patients at risk of DVT or PE be given?
LMWH for example enoxaparin
65
What is the presentation of PE?
``` SOB Cough, woith or without haemoptysis Pleuritic chest pain Hypoxia Tachycardia Raised respiratory rate Low grade fever ```
66
What does the outcome of a well's score suggest?
If likely do a CT pulmonary angiogram/ proximal vein ultrasound, if unlikely to a d-dimer and if positive do a CTPA/ proximal vein ultrasound
67
Which investigation for PE should be done if a CTPA is contraindicated?
Ventilation-perfusion scan (VQ scan)
68
What is the initial recommended treatment for PE?
Apixaban or rivaroxaban
69
In which disease are DOACs contraindicated?
Antiphospholipid syndrome. LMWH should be used instead
70
How long should anticoagulation be continued after PE?
3 months if there is an obvious reversible cause Beyond 6 months if the cause is unclear, there is recurrent VTE or there is an irreversible underlying cause 6 months in active cancer
71
What is seen on an ECG in pulmonary hypertension?
Right ventricular hypertrophy Right axis deviation RBBB
72
What is seen on x-ray in pulmonary hypertension?
Dilated pulmonary arteries | Right ventricular hypertrophy
73
How can primary pulmonary hypertension be managed?
IV prostanoids Endothelin receptor agonists Phosphodiesterase-5 inhibitors (sildenafil)
74
What are granulomas?
Nodules of inflammation full of macrophages
75
What are the extra-pulmonary manifestations of sarcoidosis?
Erythema nodosum and lymphadenopathy Fever Fatigue Weight loss
76
What are the pulmonary manifestations of sarcoidosis?
Lymphadenopathy Pulmonary fibrosis Pulmonary nodules
77
What is the presentation of lofgren's syndrome?
Bilateral hilar lymphadenopathy Polyarthralgia Erythema nodosum
78
What is seen on bloods in someone with sarcoidosis?
``` Raised serum ACE Hypercalcaemia raised serum soluable interleukin-2 receptor Raised CRP Raised IgG ```
79
What is the gold standard test for sarcoidosis and what does it show?
Histology showing non-caseating granulomas with epitheliod cells
80
What is the management of sarcoidosis?
Often resolves in 6 months Oral steroids Lung transplant in very serious lung disease
81
What causes obstructive sleep apnoea?
Collapse of the pharyngeal airway during sleep
82
Which scale is used to assess OSA?
Epworth sleepiness scale
83
What is the management of OSA?
lose weight CPAP or surgery

Alice's finals cards (21 decks)

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