Respiratory Flashcards
1
Q
Common causative organism of TB
A
Mycobacteriun tuberculosis
2
Q
Sx TB
A
fever, night sweats, weight loss
3
Q
Tx TB
A
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
4
Q
What is sarcoidosis?
A
Multisystem granulomatous disorder
5
Q
Sx sarcoidosis
A
Many are asymptomatic
Dry cough
Chest pain
Erythema
Hypercalcaemia
6
Q
What is a granuloma?
A
Collection of WBCs surrounded by collagen
7
Q
CXR for sarcoidosis
A
Hilar lymphadenopathy
8
Q
Tx sarcoidosis
A
Low stage may self-resolve or need NSAIDs
Severe cases need steroids and immunosuppressants
9
Q
Where does TB most frequently reactivate ?
A
Apex of lung
10
Q
Side effect of rifampicin
A
Red/orange tears/urine
11
Q
Isoniazid side effects
A
Numbness
12
Q
Ethambutol side effects
A
Visual changes
13
Q
What is the name of the area you insert a chest drain?
A
Safe triangle
14
Q
How is TB transmitted?
A
Droplet spread
15
Q
How does TB move around the body?
A
Pulmonary venous system
16
Q
CXR TB
A
Shadows in upper lobes
17
Q
Ethambutol MOA
A
Interferes with cell wall synthesis
18
Q
Pyrazinamide MOA
A
Stops fatty acid production
19
Q
Isoniazid MOA
A
Prevents cell wall synthesis
20
Q
Rifemycin MOA
A
Stops DNA transcription
21
Q
Sx carbon monoxide poisoning
A
pyrexia, headache, pink mucosae
22
Q
Tx carbon monoxide poisoning
A
High flow oxygen
23
Q
apple green birefringence
A
Amyloidosis
24
Q
/Which medications are contra-indicated in EBV
A
Amoxicillin and penicillin
25
Why should you avoid penicillin in EBV
Rash
26
Sx mononucleosis
Sore throat, pyrexia, lymphadenopathy
27
Dx mononucleosis
Monospot test
28
Tx mononucleosis
No sport for a month (spleen)
29
Sx tonsillitis
Sore throat, fever, lymphadenopathy, pustular tonsils
30
Causative organism tonsillitis
Strep progenies
31
Tx tonsillitis
Penicillin
32
What is a quinsy?
A pocket of pus between the tonsils and the throat wall
33
Sx quinsy
Similar to tonsillitis but affect the arch of the throat and deviate uvula
34
causative organism epiglottitis
Hameophilus influenza B
35
Sx epiglottitis
Dysphagia, drooling, distress
(rapid onset pyrexia and stridor)
36
most common place for obstruction
right mainstream bronchus
37
which nerve supplies pericardium
phrenic
38
where does IVC perforate diaphragm
T8
39
where does oesophagus perforate diaphragm
t10
40
where does aorta perforate diaphragm
t12
41
which nerve is damaged when an object lodges in the piriform recess
internal laryngeal
42
where does stapes come into contact with cochlea
oval window
43
which lobe of the lungs do objects commonly lodge in
right lower
44
why do you get referred pain to your shoulder in pericarditis?
phrenic nerve
45
nerve roots ansa cervicales
c1-3
46
what does ansa cervicalis innervate
omohyoid, sternothyroid and sternohyoid
47
what is a cervical rib?
elongation of transverse process of c7
48
why are cervical ribs dangerous
causes thoracic outlet syndrome
49
sx thoracic outlet syndrome
absent radial pulse
50
where do you insert a chest drain + borders
safe triangle
superior border: base of axilla
lateral border: lat dorsi
medial border: pec major
inferior border: line horizontal to t4 nipple
51
what is the umbo
malleus articulates with tympanic membrane
52
structures at l1 (transpyloric plane)
kidney hila
SMA
portal vein
duodenum
spleen
53
At which level does SMA leave aorta
l1
54
where is the larynx between
c3-6
55
through which bone does the external ear pass
temporal
56
which nerve passes through the middle ear
chorda tympani
57
damaged sub scapular nerve
no abduction of shoulder
58
normal ICP
<15
59
Alpha-1 antitrypsin deficiency
Lack of protease inhibitor (from liver) which normally protects body from neutrophil elastase
Chromosome 14
60
conditions caused by alpha-1 antitrypsin deficiency
emphysema, liver cirrhosis/carcinoma, cholestasis
61
What is cystic fibrosis
Defective CFTR which encodes cAMP chloride channel
62
Inheritance of CF
autosomal recessive
63
Sx CF
- Recurrent chest infections
- Malabsorption - steatorrhoea
- Liver disease
- Shoot stature
- Diabetes
- Delayed puberty
- Infertility
64
Obstructive disease spirometry
FEV1 and FVC both reduced
Ration decreases
65
E.g. obstructive disease
Asthma
Bronchiectasis
Bronchiolitis
COPD
66
Restrictive disease spirometry
FEV1 reduced, FVC very reduced
Ration same or increased
67
Example restrictive disease
Pulmonary fibrosis
Asbestosis
Sarcoidosis
NM disorders
68
Drugs causing restrictive lung disease
Amiodarone and methotrexate
69
Causes of acidosis
COPD
NM disease
Obesity
Sedatives (opiates and benzodiazepines)
70
Causes of alkalosis
Anxiety = hyperventilation
PE
Salicylate poisoning
CNS - stroke/haemorrhage
Pregnancy
71
What is an empyema?
Collection of pus in pleural cavity
72
Most common cause of empyema
pneumonia
73
sensory laryngeal nerve
interna;
74
which structure is supplied by external laryngeal nerve
cricothyroid
75
through which sinus can you access the pituitary
sphenoid
76
Side effect isoniazid
peripheral neuropathy
77
Paraneoplastic syndromes small cell lung cancer
ADH and ACTH secretion = hyponatraemia and cushings
Lambert eaton
78
types of non-small cell lung cancer
squamous and adenocarcinoma
79
adenocarcinoma
gynaecomastia, non-smokers
most common !!
80
squamous non-small cell lung cancer
increased PTH = increased calcium
clubbing
obstruct bronchus
81
What is TLCO>
A measure of how quickly diffusion occurs between aleoli and blood
82
Cause of high TLCO
Asthma
Male gender and exercise
polycythaemia
83
Cause of low TLCO
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
84
What is a pleural effusion
Collection of fluid in pleural cavity
85
Sx pleural effusion
SOB, chest pain, dullness to percussion
86
CXR pleural effusion
Blunt costophrenic angles
Fluid in lung fissures
Trachea deviation
87
What is exudate?
High protein content - leaks from tissues into pleural space
88
What is transudate
Low protein content
89
Exudate causes of pleural effusion
Pneumonia
Neoplasia - cancer
Pancreatitis
PE
TB
90
Transudate causes of pleural effusion
Heart failure
Hypoalbuminaemia
Hypothyroidism
91
Meig's syndrome
Right sides pleural effusion
Ascites
Ovarian cancer
92
Treatment for pleural effusion
Transudate: treat cause
Exudate: treat cause and drain
93
where is respiration controlled
medulla
94
what do central chemoreceptors respond to ?
H+
95
what happens to pulmonary arteries in hypoxia
vasoconstriction
96
Sx pneumonia
- SOB
- Productive cough
- Pleuritic chest pain
- Delirium
- Increased WBC and CRP
97
Treatment CAP
amoxicillin and clarithromycin
98
Treatment HAP
co-amoxiclav and taxocin
99
pathogen causing pneumonia in COPD patients
haemophilus influenzae
100
pathogen causing pneumonia in air conditioning units
legionella
101
pathogen causing pneumonia in alcoholics
klebsiella
102
patzigen causing pneumonia in pts with HIV
jiroveci
103
CURB 65
- Confusion
- Urate >7
- RR>30
- BP >90 (S) or <60 (D)
- 65+
If CURB>2 then hospitalise
104
Acute asthma exacerbation flow chart
- O2
- Salbutamol
- Hydrocortisone
- Ipratropium bromide
- IV magnesium sulphate
105
chronic asthma prophylaxis
- SABA - salbutamol
- ICS - hydrocortisone/beclamethasone
- LTRA - monteleukast
- LABA - salmeterol
106
Sx asthma
- Nocturnal cough
- Dyspnoea
- Chest tightness
- Wheeze
- Decreased FEV1/FVC
107
which two conditions make up COPD
chronic bronchitis and emphysema
108
Sx COPD
pursed lips, sputum, SOB, cough/wheeze
109
prophylaxis COPD
SAMA/SABA, LABA + LAMA, LABA+LAMA+ICS
110
tx exacerbation of COPD
prednisolone (home)
inhaled bronchodilators (hospital)
111
Which respiratory condition is caused by respiratory syncytial virus
bronchiolitis
112
difference between bronchiectasis and bronchitis
bronchitis is temporary, bronchiectasis is airways permanently widened and scarred
113
treatment for primary pneumothorax
<2cm = discharge
>2cm = aspirate
114
treatment for secondary pneumothorax
<1cm = watch and wait
1-2cm = aspirate
>2cm = chest drain
115
treatment for tension pneumothorax
aspirate 2nd intercostal space
116
paraneoplastic syndromes from SCLC
Recurrent laryngeal nerve
Horner's syndrome
phrenic nerve palsy
117
What is bronchitis?
Inflammation of trachea and main bronchi, normally viral in cause
118
How to differentiate bronchitis and pneumonia
pneumonia has SOB, sputum and systemic sx
119
management acute bronchitis
analgesia, if co-morbid or systemically infected give doxyxycline
120
Management sleep apnoea
Inform DVLA if tired, lose weight and give CPAP
121
What is sarcoidosis?
Multisystem granulomatous disorder - granulomas made of macrophages
Commonly affects 20-40 year old black women
122
sx sarcoidosis
- Erythema nodosum (nodules on shins)
- SOB
- Dry cough
- Mediastinal lymphadenopathy
- Non-caseating granuloma on biopsy/histology
123
Tx sarcoidosis
If severe, give steroids or immunosuppressants
124
'egg-shell' calcification of hilarious lymph nodes
silicosis
125
why does silicosis pre-dispose you to TB?
silicon is toxic to macrophages
126
how do you administer salbutamol
nebuliser/spacer
4-6 puffs every 10-20 mins
127
chronic asthma treatment pathway
SABA
SABA + ICS
SABA + ICS + LTRA
SABA + ICS + LABA
128
causes of occupational asthma
- Isocyanates - spray painting and adhesives
- Flour
- Epoxy resins
129
how do you test for asthma?
spirometry
bronchodilator test
FeNO tes
130
target o2 sats for COPD pt
88-92
131
most common cause of COPD exacerbation
flu
132
which vaccines should people with COPD have?
influenza (yearly)
pneumococcal (one-off)
133
what is extrinsic allergic alveolitis
Hypersensitivity (t3/4) induced lung damage
- Bird fancier’s lung (particles from bird poo)
- Farmer’s lung (particles from hay)
134
sx extrinsic allergic alveolitis
dyspnoea, cough, fever
135
management extrinsic allergic alveolitis
avoidance/glucocorticoids
136
when should you refer pts for suspected lung cancer?
- CXR changes suggesting LC
- over 40 with unexplained haemoptysis
137
what is pulmonary fibrosis?
fibrosis of pleural interstitial
138
sx pulmonary fibrosis
exertion dyspnoea
dry cough
clubbing
139
management pulmonary fibrosis
poor prognosis - 3/4 years
o2 supplement
lung transplant
140
inhaler technique
1) Remove cap and shake
2) Breathe out gently
3) Put mouthpiece in mouth and press canister down as you begin to breathe in
4) Hold breath for 10 seconds
5) Wait 30 seconds before the next dose
141
common cause of dextrocardia
kartagener's syndrome
142
what does the Epworth scale measure?
daytime sleepiness - sleep apnoea
143
RF sleep apnoea
- Obesity
- Big tongue
- Big tonsils
144
investigating sleep apnoea
epworth sleepiness scale
polysomnography (sleep studies)
145
management sleep apnoea
weight loss
CPAP
DVLA must be informed, no driving
146
discharge advice pneumothorax
- No smoking
- 2 weeks no flying
- Diving should be permanently avoided
147
erythema nodosum + bilateral hilar lymphadenopathy
sarcoidosis
