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AMK > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Common causative organism of TB

A

Mycobacteriun tuberculosis

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2
Q

Sx TB

A

fever, night sweats, weight loss

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3
Q

Tx TB

A

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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4
Q

What is sarcoidosis?

A

Multisystem granulomatous disorder

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5
Q

Sx sarcoidosis

A

Many are asymptomatic
Dry cough
Chest pain
Erythema
Hypercalcaemia

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6
Q

What is a granuloma?

A

Collection of WBCs surrounded by collagen

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7
Q

CXR for sarcoidosis

A

Hilar lymphadenopathy

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8
Q

Tx sarcoidosis

A

Low stage may self-resolve or need NSAIDs
Severe cases need steroids and immunosuppressants

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9
Q

Where does TB most frequently reactivate ?

A

Apex of lung

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10
Q

Side effect of rifampicin

A

Red/orange tears/urine

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11
Q

Isoniazid side effects

A

Numbness

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12
Q

Ethambutol side effects

A

Visual changes

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13
Q

What is the name of the area you insert a chest drain?

A

Safe triangle

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14
Q

How is TB transmitted?

A

Droplet spread

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15
Q

How does TB move around the body?

A

Pulmonary venous system

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16
Q

CXR TB

A

Shadows in upper lobes

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17
Q

Ethambutol MOA

A

Interferes with cell wall synthesis

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18
Q

Pyrazinamide MOA

A

Stops fatty acid production

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19
Q

Isoniazid MOA

A

Prevents cell wall synthesis

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20
Q

Rifemycin MOA

A

Stops DNA transcription

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21
Q

Sx carbon monoxide poisoning

A

pyrexia, headache, pink mucosae

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22
Q

Tx carbon monoxide poisoning

A

High flow oxygen

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23
Q

apple green birefringence

A

Amyloidosis

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24
Q

/Which medications are contra-indicated in EBV

A

Amoxicillin and penicillin

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25
Q

Why should you avoid penicillin in EBV

A

Rash

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26
Q

Sx mononucleosis

A

Sore throat, pyrexia, lymphadenopathy

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27
Q

Dx mononucleosis

A

Monospot test

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28
Q

Tx mononucleosis

A

No sport for a month (spleen)

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29
Q

Sx tonsillitis

A

Sore throat, fever, lymphadenopathy, pustular tonsils

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30
Q

Causative organism tonsillitis

A

Strep progenies

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31
Q

Tx tonsillitis

A

Penicillin

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32
Q

What is a quinsy?

A

A pocket of pus between the tonsils and the throat wall

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33
Q

Sx quinsy

A

Similar to tonsillitis but affect the arch of the throat and deviate uvula

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34
Q

causative organism epiglottitis

A

Hameophilus influenza B

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35
Q

Sx epiglottitis

A

Dysphagia, drooling, distress
(rapid onset pyrexia and stridor)

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36
Q

most common place for obstruction

A

right mainstream bronchus

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37
Q

which nerve supplies pericardium

A

phrenic

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38
Q

where does IVC perforate diaphragm

A

T8

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39
Q

where does oesophagus perforate diaphragm

A

t10

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40
Q

where does aorta perforate diaphragm

A

t12

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41
Q

which nerve is damaged when an object lodges in the piriform recess

A

internal laryngeal

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42
Q

where does stapes come into contact with cochlea

A

oval window

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43
Q

which lobe of the lungs do objects commonly lodge in

A

right lower

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44
Q

why do you get referred pain to your shoulder in pericarditis?

A

phrenic nerve

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45
Q

nerve roots ansa cervicales

A

c1-3

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46
Q

what does ansa cervicalis innervate

A

omohyoid, sternothyroid and sternohyoid

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47
Q

what is a cervical rib?

A

elongation of transverse process of c7

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48
Q

why are cervical ribs dangerous

A

causes thoracic outlet syndrome

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49
Q

sx thoracic outlet syndrome

A

absent radial pulse

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50
Q

where do you insert a chest drain + borders

A

safe triangle
superior border: base of axilla
lateral border: lat dorsi
medial border: pec major
inferior border: line horizontal to t4 nipple

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51
Q

what is the umbo

A

malleus articulates with tympanic membrane

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52
Q

structures at l1 (transpyloric plane)

A

kidney hila
SMA
portal vein
duodenum
spleen

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53
Q

At which level does SMA leave aorta

A

l1

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54
Q

where is the larynx between

A

c3-6

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55
Q

through which bone does the external ear pass

A

temporal

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56
Q

which nerve passes through the middle ear

A

chorda tympani

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57
Q

damaged sub scapular nerve

A

no abduction of shoulder

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58
Q

normal ICP

A

<15

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59
Q

Alpha-1 antitrypsin deficiency

A

Lack of protease inhibitor (from liver) which normally protects body from neutrophil elastase
Chromosome 14

60
Q

conditions caused by alpha-1 antitrypsin deficiency

A

emphysema, liver cirrhosis/carcinoma, cholestasis

61
Q

What is cystic fibrosis

A

Defective CFTR which encodes cAMP chloride channel

62
Q

Inheritance of CF

A

autosomal recessive

63
Q

Sx CF

A
  • Recurrent chest infections
  • Malabsorption - steatorrhoea
  • Liver disease
  • Shoot stature
  • Diabetes
  • Delayed puberty
  • Infertility
64
Q

Obstructive disease spirometry

A

FEV1 and FVC both reduced
Ration decreases

65
Q

E.g. obstructive disease

A

Asthma
Bronchiectasis
Bronchiolitis
COPD

66
Q

Restrictive disease spirometry

A

FEV1 reduced, FVC very reduced
Ration same or increased

67
Q

Example restrictive disease

A

Pulmonary fibrosis
Asbestosis
Sarcoidosis
NM disorders

68
Q

Drugs causing restrictive lung disease

A

Amiodarone and methotrexate

69
Q

Causes of acidosis

A

COPD
NM disease
Obesity
Sedatives (opiates and benzodiazepines)

70
Q

Causes of alkalosis

A

Anxiety = hyperventilation
PE
Salicylate poisoning
CNS - stroke/haemorrhage
Pregnancy

71
Q

What is an empyema?

A

Collection of pus in pleural cavity

72
Q

Most common cause of empyema

73
Q

sensory laryngeal nerve

74
Q

which structure is supplied by external laryngeal nerve

A

cricothyroid

75
Q

through which sinus can you access the pituitary

76
Q

Side effect isoniazid

A

peripheral neuropathy

77
Q

Paraneoplastic syndromes small cell lung cancer

A

ADH and ACTH secretion = hyponatraemia and cushings
Lambert eaton

78
Q

types of non-small cell lung cancer

A

squamous and adenocarcinoma

79
Q

adenocarcinoma

A

gynaecomastia, non-smokers
most common !!

80
Q

squamous non-small cell lung cancer

A

increased PTH = increased calcium
clubbing
obstruct bronchus

81
Q

What is TLCO>

A

A measure of how quickly diffusion occurs between aleoli and blood

82
Q

Cause of high TLCO

A

Asthma
Male gender and exercise
polycythaemia

83
Q

Cause of low TLCO

A

pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output

84
Q

What is a pleural effusion

A

Collection of fluid in pleural cavity

85
Q

Sx pleural effusion

A

SOB, chest pain, dullness to percussion

86
Q

CXR pleural effusion

A

Blunt costophrenic angles
Fluid in lung fissures
Trachea deviation

87
Q

What is exudate?

A

High protein content - leaks from tissues into pleural space

88
Q

What is transudate

A

Low protein content

89
Q

Exudate causes of pleural effusion

A

Pneumonia
Neoplasia - cancer
Pancreatitis
PE
TB

90
Q

Transudate causes of pleural effusion

A

Heart failure
Hypoalbuminaemia
Hypothyroidism

91
Q

Meig’s syndrome

A

Right sides pleural effusion
Ascites
Ovarian cancer

92
Q

Treatment for pleural effusion

A

Transudate: treat cause
Exudate: treat cause and drain

93
Q

where is respiration controlled

94
Q

what do central chemoreceptors respond to ?

95
Q

what happens to pulmonary arteries in hypoxia

A

vasoconstriction

96
Q

Sx pneumonia

A
  • SOB
  • Productive cough
  • Pleuritic chest pain
  • Delirium
  • Increased WBC and CRP
97
Q

Treatment CAP

A

amoxicillin and clarithromycin

98
Q

Treatment HAP

A

co-amoxiclav and taxocin

99
Q

pathogen causing pneumonia in COPD patients

A

haemophilus influenzae

100
Q

pathogen causing pneumonia in air conditioning units

A

legionella

101
Q

pathogen causing pneumonia in alcoholics

A

klebsiella

102
Q

patzigen causing pneumonia in pts with HIV

103
Q

CURB 65

A
  • Confusion
  • Urate >7
  • RR>30
  • BP >90 (S) or <60 (D)
  • 65+

If CURB>2 then hospitalise

104
Q

Acute asthma exacerbation flow chart

A
  • O2
  • Salbutamol
  • Hydrocortisone
  • Ipratropium bromide
  • IV magnesium sulphate
105
Q

chronic asthma prophylaxis

A
  • SABA - salbutamol
  • ICS - hydrocortisone/beclamethasone
  • LTRA - monteleukast
  • LABA - salmeterol
106
Q

Sx asthma

A
  • Nocturnal cough
  • Dyspnoea
  • Chest tightness
  • Wheeze
  • Decreased FEV1/FVC
107
Q

which two conditions make up COPD

A

chronic bronchitis and emphysema

108
Q

Sx COPD

A

pursed lips, sputum, SOB, cough/wheeze

109
Q

prophylaxis COPD

A

SAMA/SABA, LABA + LAMA, LABA+LAMA+ICS

110
Q

tx exacerbation of COPD

A

prednisolone (home)
inhaled bronchodilators (hospital)

111
Q

Which respiratory condition is caused by respiratory syncytial virus

A

bronchiolitis

112
Q

difference between bronchiectasis and bronchitis

A

bronchitis is temporary, bronchiectasis is airways permanently widened and scarred

113
Q

treatment for primary pneumothorax

A

<2cm = discharge
>2cm = aspirate

114
Q

treatment for secondary pneumothorax

A

<1cm = watch and wait
1-2cm = aspirate
>2cm = chest drain

115
Q

treatment for tension pneumothorax

A

aspirate 2nd intercostal space

116
Q

paraneoplastic syndromes from SCLC

A

Recurrent laryngeal nerve
Horner’s syndrome
phrenic nerve palsy

117
Q

What is bronchitis?

A

Inflammation of trachea and main bronchi, normally viral in cause

118
Q

How to differentiate bronchitis and pneumonia

A

pneumonia has SOB, sputum and systemic sx

119
Q

management acute bronchitis

A

analgesia, if co-morbid or systemically infected give doxyxycline

120
Q

Management sleep apnoea

A

Inform DVLA if tired, lose weight and give CPAP

121
Q

What is sarcoidosis?

A

Multisystem granulomatous disorder - granulomas made of macrophages

Commonly affects 20-40 year old black women

122
Q

sx sarcoidosis

A
  • Erythema nodosum (nodules on shins)
  • SOB
  • Dry cough
  • Mediastinal lymphadenopathy
  • Non-caseating granuloma on biopsy/histology
123
Q

Tx sarcoidosis

A

If severe, give steroids or immunosuppressants

124
Q

‘egg-shell’ calcification of hilarious lymph nodes

125
Q

why does silicosis pre-dispose you to TB?

A

silicon is toxic to macrophages

126
Q

how do you administer salbutamol

A

nebuliser/spacer
4-6 puffs every 10-20 mins

127
Q

chronic asthma treatment pathway

A

SABA
SABA + ICS
SABA + ICS + LTRA
SABA + ICS + LABA

128
Q

causes of occupational asthma

A
  • Isocyanates - spray painting and adhesives
  • Flour
  • Epoxy resins
129
Q

how do you test for asthma?

A

spirometry
bronchodilator test
FeNO tes

130
Q

target o2 sats for COPD pt

131
Q

most common cause of COPD exacerbation

132
Q

which vaccines should people with COPD have?

A

influenza (yearly)
pneumococcal (one-off)

133
Q

what is extrinsic allergic alveolitis

A

Hypersensitivity (t3/4) induced lung damage

  • Bird fancier’s lung (particles from bird poo)
  • Farmer’s lung (particles from hay)
134
Q

sx extrinsic allergic alveolitis

A

dyspnoea, cough, fever

135
Q

management extrinsic allergic alveolitis

A

avoidance/glucocorticoids

136
Q

when should you refer pts for suspected lung cancer?

A
  • CXR changes suggesting LC
  • over 40 with unexplained haemoptysis
137
Q

what is pulmonary fibrosis?

A

fibrosis of pleural interstitial

138
Q

sx pulmonary fibrosis

A

exertion dyspnoea
dry cough
clubbing

139
Q

management pulmonary fibrosis

A

poor prognosis - 3/4 years
o2 supplement
lung transplant

140
Q

inhaler technique

A

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
Q

common cause of dextrocardia

A

kartagener’s syndrome

142
Q

what does the Epworth scale measure?

A

daytime sleepiness - sleep apnoea

143
Q

RF sleep apnoea

A
  • Obesity
  • Big tongue
  • Big tonsils
144
Q

investigating sleep apnoea

A

epworth sleepiness scale
polysomnography (sleep studies)

145
Q

management sleep apnoea

A

weight loss
CPAP
DVLA must be informed, no driving

146
Q

discharge advice pneumothorax

A
  • No smoking
  • 2 weeks no flying
  • Diving should be permanently avoided
147
Q

erythema nodosum + bilateral hilar lymphadenopathy

A

sarcoidosis

AMK (33 decks)

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