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Phase1c Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define lung abscess

A

A lung abscess is a well-circumscribed infection within the lung parenchyma.

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2
Q

What is the most common cause of a lung abscess?

A

Aspiration pneumonia

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3
Q

What are the features of a lung abscess?

A 
similar features to pneumonia but generally runs a more subacute presentation
symptoms may develop over weeks
systemic features such as night sweats and weight loss may be seen
fever
productive cough
often foul-smelling sputum
haemoptysis in a minority of patients
chest pain
dyspnoea
signs
dull percussion and bronchial breathing
clubbing may be seen
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4
Q

What kind of productive cough (sputum) is associated with a lung abscess?

A

Foul-smelling sputum

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5
Q

What CXR appearances are associated with a lung abscess?

A

fluid-filled space within an area of consolidation

an air-fluid level is typically seen

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6
Q

What is the management of a lung abscess?

A

ABx

If unresolved consider percutaneous drainage

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7
Q

Which lung cancer is associated with ectopic secretion of ACTH?

A

Small cell lung cancer

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8
Q

What syndromes are associated with small cell lung cancers?

A

Paraneoplastic syndrome

syndrome of inappropriate ADH secretion (SIADH), Lambert-Eaton syndrome and Cushing’s syndrome.

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9
Q

What would a high-dose dexamethasone test reveal in small cell lung cancers (ectopic ACTH secretion)?

A

Not suppressed cortisol or ACTH

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10
Q

What is the definition of stage 1 hypertension?

A

135/85 mmHg

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11
Q

What is the management of steroid-responsiveness COPD?

A

LABA/ICS

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12
Q

In a patient with a large pleural effusion what is the first-line investigation performed after a CXR?

A

A pleural aspirate is often the first step to determine the origin of a pleural effusion. Several markers are tested including pH, protein levels, glucose and amylase. Samples of pleural fluid are also sent for microscopy, culture and sensitivity and cytology if there is a concern regarding malignancy.

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13
Q

What is the most common finding in asbestos-related lung disease?

A

Pleural plaques

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14
Q

Are pleural plaques a concern?

A

No - benign

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15
Q

Idiopathic pulmonary fibrosis is associated with what type of crackles?

A

Fine-inspiratory crackles

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16
Q

What is the definition fo asbestosis?

A

A pneumoconiosis in which diffuse parenchymal lung fibrosis occurs because of prolonged exposure to asbestos

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17
Q

What is the definition fo mesothelioma?

A

An aggressive tumour of mesothelial cells - occuring within the lung pleural

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18
Q

What is the presentation of asbestosis?

A

Insidious onset of shortness of breath and a dry cough

Pleuritic chest pain - Acute asbestos pleurisy (Years after first exposure)

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19
Q

What is the presentation of a mesothelioma?

A 
Shortness of breath
Chest pain (Dull, diffuse, developing) weight loss
Fatigue
Fever
Night sweats
Bone pain 
Abdominal PIUN
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20
Q

What examinatin findings are seen in a mesothelioma?

A

Clubbing

End-inspiratory crepitations

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21
Q

What is the examination of a meothelioma?

A
  • Occasional palpable chest wall mass
  • Finger clubbing – due to underlying pulmonary fibrosis
  • Recurrent pleural effusions
  • Signs of metastases: Lymphadenopathy, hepatomegaly, bone tenderness
  • Abdominal pain
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22
Q

What CXR findings are associated with asbestos-related disease?

A

Reticular nodular shadowing and pleural plaques

Diffuse pleural thickening

Bilateral lower zone

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23
Q

What CXR findings are seen on a mesothelioma?

A

Pleural thickening/effusion and bloody pleural fluid

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24
Q

What is the general management for asbestos related lung disease?

A

Prevention of exposure and smoking cessation

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25
Q

What is pnuemonia?

A

An infection of the distal lung parenchyma

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26
Q

What is the most common causative organism for community acquired pneumonia?

A

Streptococcous pneumoniae

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27
Q

What is the most common caustive organism in infective exacerbations of COPD?

A

• Haemophilus influenza

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28
Q

Jelly-currant sptum is associated with what type of causative organism pneumonia?

A

Klebsiella pnuemoniae

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29
Q

What colour sputum is streptococcus pnuemoniae?

A

Rust-coloured

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30
Q

What are the risk factors for pnuemonia?

A 
Age
Smoking
Alcohol
Pre-existing lung disease
Immune deficiency
Contact with pneumonia
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31
Q

What is the presentation of pneumonia

A 
Fevers
Rigours
Sweating
Malaise
Sputum
Breathlessness (Dyspnoea)
Pleuritic chest pain
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32
Q

Describe the cough associated with bacterial pnuemonia?

A

Mucopurulent sputum

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33
Q

Describe the sputum associated with atypical pnuemonia?

A

Scant or water sputum

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34
Q

What are the symptoms of atypical pneumonia?

A

Headache
Myalgia
Diarrhoea/abdominal pain

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35
Q

What additional antibiotic is associated with the management of atypical pneumonia?

A

Macrolide

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36
Q

Examples of atypical pneumonia

A

Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophilia

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37
Q

What are the examination findings with pneumonia?

A

Crackles (Coarse crepitations on the affected side)
Decreased breath sounds (Bronchial breathing)
Dullness to percussion
Wheeze
Reduced chest expansion

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38
Q

What CXR changes are seen in pnuemonia?

A

Evidence of consolidation (new shadowing)

Pleural effusion

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39
Q

Klebsiella pneumonia affects which lobes?

A

Affects the upper lobes

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40
Q

Which scoring criteria are used to assess the severity of pneumonia and subsequent managemetn?

A

CURB-65

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41
Q

What urea parameter scores a point in pneumonia using the CURB-65 score?

A

Urea >7mmol/L.

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42
Q

What parameters are assessed in the CURB-65 score?

A

Confusion
Urea >7 mmol/L
Respiratory rate > 30/min
BP: <90 mmHg or diastolic <60 mmHg

Age > 65 years

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43
Q

What is the initial management of pneumonia?

A

Oral amoxicillin

• IV cefuroxime/cefotaxime/co-amoxiclav and erythromycin (>1 Marker)

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44
Q

A score of 0-1 on the CURB score equates to what management?

A

Discharge home with antibiotics

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45
Q

A CURB-65 score of 3-5 warrants what management?

A

Refer to HDU/ICU

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46
Q

A CURB-65 score of 2 warrants what management?

A

Consider hospital referral

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47
Q

What is the supportive management for pnuemonia?

A 
Oxygen
Paraenteral fluids for dehydration shock
Analgesia
Chest physiotherapy
Nebulised saline
CPAP, BiPAP or ITU care for respiratory failure
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48
Q

What is pneumothorax?

A

Defined as an accumulation of air within the pleural space.

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49
Q

What is tension pneumothorax?

A

Air is continuously entering the pleural space under positive pressure without exiting during expiration

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50
Q

What is the management of tension pneumothorax?

A

Emergency needle decompression

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51
Q

What is a spontaneous pneumothorax?

A

In individual with normal lungs (Tall, thin males), caused by a rupture of a subpleural pleb

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52
Q

What are the risk factors for pneumothorax?

A
  • Smoking
  • Tall and slender build
  • Male sex
  • Young age
  • Marfan’s disease and Ehler’s-Danlos syndrome)
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53
Q

What is the presentation of. pneumothorax?

A

Sudden onset breathlessness or chest pain (pleuritic in nature)
Shoulder tip pain in secondary pneumothoraxx
Distress with rapid shallow breathing

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54
Q

What are the examination findings associated with a pneumothorax?

A

Reduced chest expansion
Hyper-resonance to percussion
Ipsilateral decreased breath sounds
Ipsilateral hyperinflation

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55
Q

What additional examination findings are seen in a tension pneumothorax?

A 
Tachycardia
Hypotension
Cyanosis
Distended neck veins
Tracheal deviation away from the side of the pneumothorax
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56
Q

What is the management for a moderate pneumothorax >2cm?

A

Aspiration using a large bore cannula or cathter with a three-way tap

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57
Q

What is the management of a pneumothorax if an aspiration fails?

A

Chest drain with water seal

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58
Q

Define a pulmonary embolism

A

A pulmonary embolism is defined as a thrombus within the pulmonary vasculature resulting in an occlusion , predominantly because of DVT

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59
Q

What is the most common cause of a pulmonary embolism?

A

DVT (95%)

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60
Q

What are the risk factors of a pulmonary embolism?

A 
Surgical patients
Immobility
Obesity
OCP
Heart failure
Malignancy
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61
Q

What is the presentation of a moderate PE?

A 
Sudden onset dyspnoea
Cough
Haemoptysis
Pleuritic chest pain (Localised on one side of the chest)
Signs of concurrent DVT
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62
Q

What is the presentation of a large PE?

A

Shock
Collapse
Acute right heart failure
Sudden death

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63
Q

What are the examination findings seen in a moderate PE?

A

Tachypnoea
Tachycardia
Pleural rub
Low saturation oxygen

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64
Q

What scoring system is used to assess the probability of a PE?

A

Well’s Score

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65
Q

What parameters are assessed in the Well’s Score?

A 
Clinically suspected DVT
PE is most likely diagnosis
Recent surgery (4 weeks)
Immobilisation 
Tachycardia
History of DVT or PE
Haemoptysis 
Malignancy
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66
Q

A low probability well’s score = what investigation?

A

D-dimer blood test

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67
Q

What is D-dimer?

A

fibrin degradation product – highly sensitive, poor sensitivity

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68
Q

How does a CTPA reveal a PE?

A

Direct visualisation of thrombus in the pulmonary artery.

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69
Q

What is the most common ECG finding in a PE?

A

Sinus tachycardia
RBBB
Right axis deviation

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70
Q

What axis deviation is associated with a PE?

A

Right-axis deviation

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71
Q

What classical ECG pattern is associated with a PE?

A

S1Q3T3 pattern

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72
Q

What other investigation can be performed to diagnose a PE if a CTPA is contraindicated?

A

VQ scan

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73
Q

What is the management of a PE in a stable patient?

A

Anticoagulation with UFH or LMWH heparin

Change to oral Warfarin therapy (INR2-3) for 3 months

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74
Q

How long should Warfarin be administered for post-PE?

A

3 months with target INR-2-3

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75
Q

What is the management of PE in an unstable patient?

A

Thrombolysis with tPA + UFH herpain

Embolectomy if contraindicated

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76
Q

What is the prophylactic management of PE?

A

Graduated pressure stockings and heparin prophylaxis

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77
Q

What is Sarcoidosis?

A

A multisytem granulomatous disorder of unknown aetiology

Accumulation of lymphocytes and macrophages forming non-caseating granulomas in the lungs

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78
Q

What is the lung presentation of sarcoidosis?

A

Fever, malaise, weight loss, bilateral parotid swelling, lymphadenopathy, hepatosplenomegaly.

Lungs
•	Breathlessness
•	Cough (usually unproductive)
•	Chest discomfort
•	Reduced exercise tolerance 
•	Ronchi (Bronchospasm due to airway sensitivity)
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79
Q

What are the Msk presentation of sarcoidosis?

A
  • Bone cysts (dactylitis in phalanges)
  • Polyarthralgia
  • Myopathy
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80
Q

What dermatatological findings are seen in sarcoidosis?

A
  • Lupus pernio
  • Erythema nodosum
  • Maculopapular eruptions
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81
Q

How is sarcoidosis staged in CXR?

A

Stage 0: May be clear
Stage 1: Bilateral hilar lymphadenopathy
Stage 2: Stage 1 with pulmonary infiltration and paratracheal node enlargement.
Stage 3: Pulmonary infiltration and fibrosis alone
Stage 4: Extensive fibrosis with distortion.

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82
Q

What is Stage 0 sarcoidosis on a CXR?

A

Clear

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83
Q

What is Stage 1 sarcoidosis on a CXR?

A

Bilateral hilar lymphadenopathy

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84
Q

What is stage 2 sarcoidosis on a CXR?

A

Bilateral hilar lymphadenopathy w pulmonary infiltration and paratracheal node enlargement

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85
Q

What are the three most common causes of bilateral hilar lymphandeopahty?

A

Sarcoidosis
Lymphoma
TB

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86
Q

What is Stage 3 sarcoidosis on the CXR?

A

Pulmonary infiltration and fibrosis alone

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87
Q

What is stage 4 sarcoidosis on the CXR?

A

Extensive fibrosis with distortion

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88
Q

Which markers are raised in sarcoidosis?

A

Serum ACE
Calcium
ESR
LFT raised ALP and GGT

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89
Q

What would a 24-hour urine collection reveal in sarcoidosis?

A

Hypercalciuria Due to abnormal calcium and Vitamin d regulation from granulomatous macrophages

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90
Q

What scan is used in sarcoidosis to detect areas of inflammation in the parotids and the eyes?

A

Gallium-67 scan

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91
Q

What results are found in pulmonary unction tests in sarcoidosis?

A

Reduced FEV1 and FVC

Restrictive lung disease

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92
Q

What is the essential diagnostic investigation for sarcoidosis of the lung?

A

Transbronchial lung biopsy

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93
Q

What is the management for sarcoidosis?

A

Oral corticostreoids (Prednisolone)

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94
Q

What is the management of lupus pernio in sarcoidosis?

A

Chloroquine or methotrexate

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95
Q

What is TB?

A

A granulomatous disease caused by mycobacterium tuberculosis

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96
Q

What is primary TB?

A

An initial infection acquired by inhalation from the cough of an infected patient

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97
Q

What is miliary TB?

A

Results when there is haematogenous dissemination

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98
Q

What type of bacteria is TB?

A

Acid-fast bacillus which proliferates and survives after alveolar macrophage phagocytosis

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99
Q

What is formed in TB?

A

A granuloma with caseous necrotic centre

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100
Q

What can precipitate latent TB into active TB?

A

HIV infection

And immunocompromised individuals (+ patients taking systemic corticosteroids)

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101
Q

What is the presentation of primary TB?

A 
Fever
Malaise
Cough
Wheeze
Erythema nodosum
Conjunctivitis
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102
Q

What is the presentation of post-primary TB?

A 
Fever/night sweats
Malaise 
Weight loss
Breathlessness
Cough
Sputum
Haemoptysis
Pleuritic pain
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103
Q

What is shown in a CXR for TB?

A

Peripheral consolidation

Hilar lymphadenopathy

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104
Q

What is shown in a CXR for TB?

A 
Peripheral consolidation
Hilar lymphadenopathy 
Upper lobe shadowing
Calcification 
Pleural effusion
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105
Q

What diagnostic tests are performed to confirm TB?

A

Sputum acid-fast bacilli smear

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106
Q

What is the management of TB?

A

Rifampicin – Orange body fluids, enzyme-inducing
Isoniazid (+pyridoxine) – Pyridoxine deficiency, peripheral neuropathy
Ethambutol – Optic neuropathy
Pyrazinamide - ↑ Urate/arthralgia, hepato-toxicity
Streptomycin – Only for highly resistant organisms

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107
Q

What are the side effects of Rifampicin?

A

orange body fluids

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108
Q

What are the side effects of isoniazid?

A

Peripheral neuropathy

Pyridoxine deficiency

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109
Q

What are the side effects of pyrazinamide?

A

Increased urate/arthralgia - hepato-toxicity

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110
Q

What are the side effects of ethambutol?

A

Optic neuropathy

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111
Q

What is bronchiectasis?

A

Lung airway disease characterised by chronic bronchial dilation - impaired mucociliary clearance

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112
Q

What is the aetiology of bronchiectasis?

A

Severe inflammation in the lung, fibrosis and dilation of bronchi

Pooling of mucous - predisposition to infection, damage, and fibrosis of bronchial walls

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113
Q

Which host defence defects are associated with the development of bronchiectasis?

A

Cystic fibrosis, immunoglobulin deficiency, yellow-nail syndrome, and Kartagener’s syndrome.

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114
Q

What is the presentation of bronchiectasis?

A

Productive cough with purulent sputum
Haemoptysis
Breathlessness, chest pain, malaise, fever, weight loss
Rhinosinusitis

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115
Q

What are the examination findings of bronchiectasis?

A

Finger clubbing
Coarse basal crepitations
Wheeze rhonchi

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116
Q

What type of crepitations are associated with bronchiectasis?

A

Coarse basal crepitations

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117
Q

What common organisms are associated with bronchiectasis?

A

Pseudomonas aeruginosa, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumonia, Klebsiella, Moraxella catarrhalis, Mycobacteria.

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118
Q

What does a CXR reveal in bronchiectasis?

A

Parallel lines radiating from the hilum to the diaphgram (tramline shadows)

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119
Q

What is the gold-standard investigation for diagnosing bronchiectasis?

A

High-resolution CT

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120
Q

What does a high-resolution CT reveal in bronchiectasis?

A

Dilated bronchi with thickened walls

Signet ring sign

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121
Q

Signet ring sign on a CT suggests what diagnosis?

A

Bronchiectasis

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122
Q

What investigation is performed in CF?

A

Sweat electrolytes

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123
Q

What is the management of bronchiectasis?

A

Treat acute exacerbations with IV ABx (Amoxicillin, flucloxacillin ,doxycycline)

Airway clearance therapy - Oral hydration
Bronchodilators - Salbutamol, ipratropium
Mucoactive agents - Nebulised hypertonic saline

Inhaled corticoteorids (fluticasone)

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124
Q

What is COPD?

A

A chronic progressive lung disorder that is characterised by irreversible airflow obstruction, encompassing both chronic bronchitis and emphysema.

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125
Q

What is chronic bronchitis?

A

Chronic cough and sputum production involving hypertrophy and hyperplasia of the mucous glands

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126
Q

What is emphysema?

A

Permanent destructive enlargement of air spaces distal to the terminal bronchioles.

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127
Q

What genetic deficiency is associated with COPD?

A

Alpha-1-antitrypsin deficiency

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128
Q

What is main cause of COPD?

A

Bronchial and alveolar damage because of environmental toxins (cigarette smoke).

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129
Q

What is the presentation of COPD?

A
  • Chronic cough with sputum production
  • Breathlessness
  • Wheeze
  • Decreased exercise tolerance
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130
Q

What are the examination findings for COPD?

A

Signs of respiratory distress, use of accessory muscles, cyanosis

Barrel-shaped overinflated chest

Percussion: Hyperresonant chest

Auscultation: Quiet breath sounds, prolonged expiration wheeze, rhonchi and crepitations

Signs of CO2 retention: Bounding pulse, warm peripheries, flapping tremor

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131
Q

What investigations are performed in diagnosing COPD?

A

PFTs and spirometry
CXR
ABG

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132
Q

What do PFTs reveal in COPD?

A

• Decreased FEV1: FVC ratio
Mild = 60-80%
Moderate = 40-60%
Severe = <40%

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133
Q

What is the characteristic feature for COPD when compared with asthma in terms of bronchodilator?

A

No bronchodilator reversibility

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134
Q

What is seen on a CXR for a patient with COPD?

A
  • Reveals hyperinflation (>6 anterior ribs, flat hemidiaphragm).
  • Decreased peripheral lung markings
  • Elongated cardiac silhouette
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135
Q

What type of respiratory failure is associated with COPD?

A

Type 2 respiratory failure

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136
Q

What is the lifestyle management for COPD?

A

Smoking cessation

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137
Q

What is the first-line management for COPD?

A

SABA or SAMA

Salbutamol or ipratropium bromide

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138
Q

If there are more than 2 COPD exacerbations per year what is the step-up management for COPD?

A

Long-acting bronchodilators

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139
Q

Describe asthmatic features/steroid responsiveness

A

Previous diagnosis of asthma/atopy
Raised blood eosinophil count
Substantial variation in FEV1 over time
Substantial diurnal variation in peak expiratory flow

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140
Q

What is the long-term management for COPD?

A

SABA as required

LAMA + LABA

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141
Q

What is the long term management for asthma-COPD overlap?

A

SABA or SAMA as required

LABA + ICS

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142
Q

What is the management for acute exacerbations of COPD?

A

increase frequency of bronchodilator use and consider giving via a nebuliser
give prednisolone 30 mg daily for 5 days

They recommend giving oral antibiotics ‘if sputum is purulent or there are clinical signs of pneumonia’
the BNF recommends one of the following oral antibiotics first-line: amoxicillin or clarithromycin or doxycycline.

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143
Q

What is asthma?

A

Asthma is a chronic inflammatory disease characterised by reversible airway obstruction
-Initial trigger releases inflammatory mediators

Lumen is reversibly folded due to smooth muscle bronchoconstriction and mucous hypersecretion

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144
Q

What are the cardinal features of asthma?

A 
Atopy/Allergen sensitization
Reversible airflow obstruction 
Airway inflammation
Eosinophilia
Type 2 lymphocytes

Wheeze/+- dry cough on exertion worse with colds and allergen exposure

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145
Q

What type of immune reaction is associated with asthma?

A

Type 2 immunity in allergic asthma

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146
Q

What cytokines are released in Asthma?

A
  • IL-5 – Responsible for the maturation and release of eosinophils in the bone marrow.
  • IL-4 is a prominent immune mediator that supports the activation of B-cells into plasma cells to release IgE.
  • IL-15 is a central regulator in IgE synthesis, goblet cell hyperplasia, mucous hypersecretion, and airway hyperresponsiveness.
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147
Q

What roles does IL-5 have in asthma?

A

Maturation and releases of eosinophils in the bone marrow

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148
Q

What does role does IL-4 have in asthma?

A

A prominent lumen mediator that supports the activation of B-cells into plasma cells to release IgE

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149
Q

What effect does IgE have in asthma?

A

Mast-cell degranulation leading to the release of histamines and cytokines

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150
Q

What blood test is used to test for allergic sensitiation?

A

Blood test for specific IgE antibodies to allergens

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151
Q

What are the risk factors for asthma?

A

Family history

Atopy (Tendency for T lymphocytes to drive production of IgE exposure

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152
Q

What environmental factors are associated with asthma?

A
  • House dust mites
  • Pollen
  • Pets
  • Cigarette smoke
  • Viral respiratory tract infections
  • Aspergillus fugimatus spores
  • Occupational allergens
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153
Q

What is the presentation of asthma?

A
  • Intermittent dyspnoea
  • Wheeze
  • Cough (worse in the morning and at night) + sputum. DIURNAL pattern of symptoms.
  • Nasal polyposis
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154
Q

When is the asthma cough worse during the day?

A

Worse in morning and at night

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155
Q

What is the pattern of symptoms for asthma?

A

Diurnal

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156
Q

What are the precipitating factors for asthma?

A

• Cold air – Induced bronchospasm
• Viral infection
• Drugs (E.g., beta-blockers, NSAIDs)
• Exercise
• Emotions
• Allergens – House dust mite, pollen, fur, pets – query.
• Smoking/passive smoking
• Pollution
• Ask if symptoms remit at weekend – may be triggered at work.
N.B: Check for history of atopic disease (Allergic rhinitis, urticaria, eczema).

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157
Q

What are the examination findings for asthma?

A
  • Tachypnoea
  • Use of accessory muscles
  • Prolonged expiratory phase
  • Polyphonic wheeze
  • Hyperinflated chest
  • Hyper-resonant percussion notes
  • Reduced air entry
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158
Q

What defines a moderate asthma attack for PEFR?

A

PEFR > 50-75% predicted.

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159
Q

What parameters are associated with a severe asthma attack?

A
  • PEFR 35-50% predicted
  • Pulse > 100/min
  • RR > 25/min
  • Inability to complete sentences.
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160
Q

What parameters are associated with a life-threatening asthma attack?

A
  • PEFR < 33% predicted
  • Silent chest
  • Cyanosis – PaO2 < 8 kPa, normal/high PaCO2 > 4.6 kPa, low pH <7.35.
  • Bradycardia
  • Hypotension
  • Confusion
  • Coma
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161
Q

What investigations are performed for the diagnosis of asthma?

A

Fractional exhaled nitric oxide (FeNO)

Spirometry with bronchodilator reversibility test

Peak Expiratory flow rate

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162
Q

What does a FeNO test reveal in asthma?

A

Confirm eosinophilic airway inflammation to support an asthma diagnosis in patients

Adults >40ppb
>35 ppb in children

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163
Q

What does a FeNO test reveal in asthma for adults?

A

> 40 ppb

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164
Q

What does a FeNo test reveal in asthma for children?

A

> 35 ppb

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165
Q

What does a FeNo indicate in a patient with diagnosed asthma?

A

A non-invasive biomarker of the airway (Type-2 inflammation) – can be used to determine adherence and steroid response. An elevation in NO is indicative that the asthma is not adequately controlled or unresponsive to steroids.

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166
Q

What does a spirometer with a bronchodilator reversibility test reveal?

A

FEV1/FVC ratio <70%

Defined improvement >12%

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167
Q

What is the defined improvement with the administration of a bronchodilator in asthma?

A

> 12%

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168
Q

What does an FBC reveal in asthma?

A

Eosinophillia

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169
Q

What are the atypical signs associated with mycoplasma pneumonia?

A

Transverse myelitis (inflammation of spinal cord)

Erythema multiforme (round lesions with bullseye appearance)

Associated with autoimmune haemolytic anaemia

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170
Q

What does erythema multiforme look like?

A

Round lesions with bullseye appearance

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171
Q

What atypical pnuemonia organism is associated with erythema multiforme?

A

Mycoplasma pnuemoniae

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172
Q

On inspection what signs are seen in pnuemonia?

A

Respiratory distress

Cyanosis

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173
Q

On palpation what is seen in pneumonia?

A

Reduced chest expansion

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174
Q

On percussion what is seen in pnuemonia?

A

Dull percussion over areas of consolidation

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175
Q

What is auscultated in pnuemonia?

A

Basal coarse crepitations
Bronchial breathing
Increased vocal resonance

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176
Q

What is the most common cause of CAP?

A

Streptococcus pneumoniae

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177
Q

What is the most common cause of atypical pneumonia?

A

Legionella pneumophilia

Chlamydia psitacci

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178
Q

What is the most common cause of HAP?

A

Staph Aureus
Pseudomonas aeruginosa
Klebsiella

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179
Q

Which pnuemonia is associated with pet birds?

A

Chlamydia psitacci

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180
Q

Which pnuemonia is associated with air conditioning?

A

Legionella

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181
Q

What atypical signs are associated with legionella pneumonia?

A

Hyponatremia

Abnormal LFTs

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182
Q

Hyponatremia is associated with what type of atypical pneumonia?

A

Legionella

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183
Q

What bedside test is used in diagnosing pneumonia?

A

Sputum MCS

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184
Q

What blood tests are used in diagnosis pnuemonia?

A

FBC (high WCC)
CRP (high)
ABG (Type 1 resp failure)

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185
Q

What invasive tests are used in diagnosing pneumonia?

A

Pleural fluid MCS via thoracentesis

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186
Q

What investigations are performed in diagnosing atypical pneumonia for mycolplasma?

A

Blood film

Red cell agglutination with cold agglutinin

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187
Q

What blood film result i associated with mycoplasma pneumonia?

A

Red cell agglutination with cold agglutinin

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188
Q

What tests should be performed in legionella?

A

Urinary antigens

LFTs

189
Q

What is lobar pnuemonia?

A

Consolidation is confined within one lobe

190
Q

What is bronchopneumonia?

A

Consolidation all over the lungs

191
Q

A score of 1 in CURB-65 =?

A

GP and oral ABx

192
Q

A score of 2 CURB-65=?

A

A&E and IV ABx

193
Q

A score of >3 CURB-65 =?

A

Hospital admission +IV ABx,consider ITU

194
Q

How is confusion assessed in CURB-65?

195
Q

What RR CURB-65?

A

30 breaths per minute

196
Q

What systolic BP in CURB-65?

197
Q

What Abx is used for typical organisms in pneumonia?

A

Amoxicillin

Co-Amoxicillin if severe

198
Q

What Abx is used for atypical pneumonia?

A

Clarithromycin

199
Q

If a patient has a penicillin allergy what Abx is given in pneumonia?

A

Doxycycline

200
Q

What pneumonia is associated with HIV patients?

A

Pneumocystis jiroveci

201
Q

Which Abx is given in pneumocystis jiroveci?

A

Co-trimoxazole (trimethoprim and sulfamethoxazole)

202
Q

What type of resp tract infection is associated with acute bronchitis?

A

Upper respiratory tract infection

203
Q

What are the typical organisms associated with acute bronchitis?

A 
Rhinovirus
Parainfluenzae
Influenza A or B
RSv
Covid-19
204
Q

What are the risk factors for acute bronchitis?

A

Smoking
Cystic fibrosis
Asthma
COPD

205
Q

What type of cough is associated with acute bronchitis?

A

Non-productive cough

Lasts weeks

206
Q

How is the diagnosis of acute bronchitis made?

A

Based on clinical presentation

207
Q

What is the management of acute bronchitis in healthy patients?

A

Paracetamol and ibuprofen as required

Hydration

208
Q

What is the management of 2 week persistent cough in acute bronchitis?

A

Inhaled corticosteroids

209
Q

In wheezy acute bronchitis what is the management?

A

Inhaled SABA

210
Q

What should be given in acute bronchitis and history of lung pathology (COPD, asthma)?

A

Amoxicillin

Doxycycline if penicillin allergy

211
Q

Define a PE

A

A blockage in one of the pulmonary arteries in the lungs

212
Q

What type of chest pain is associated with a PE?

213
Q

What is an acute massive PE?

A

Sudden complete occlusion of pulmonary artery

214
Q

What is the presentation of an acute massive PE?

A

Collapse
Central crushing pain
Severe dyspnoea

215
Q

What ECG changes are found in a PE?

A

S1Q3T3 pattern
RAD
RBBB
Sinus tachycardia

216
Q

What sign is seen on a CXR for a PE?

A

Westermark’s Sign

217
Q

What is an acute small PE?

A

Sudden incomplete occlusion of pulmonary artery

218
Q

What is the presentation of an acute small PE?

A

Pleuritic chest pain
Haemoptysis
Dyspnoea

219
Q

What is a chronic PE?

A

Chronic occlusion of the pulmonary microvasculature

220
Q

What is the presentation of chronic PE?

A

Exertional dyspnoea

221
Q

What is S1Q3T3?

A

S wave in Lead 1
Q wave in Lead 3
Inverted T wave in lead 3

222
Q

What causes Westermark’s sign?

A

Hypovolaemia distal to the pulmonary artery that has been occluded by the PE. Blood cannot reach this region causing ischaemia and infarction - this increases transluceny of the region

223
Q

What score is associated with a CTPA referral in PE?

A

> 4 (or equal)

224
Q

What Well’s score is equal to low-risk PE?

225
Q

A score more than 4 warrants what investigation in suspected PE?

226
Q

What mnemonic is associated with Well’s score?

227
Q

Alternative to CTPA in pregnant PE?

228
Q

What defines define haemodynamic stability?

A

SBP >90 mmHG

229
Q

In a haemodynamically stable patient what anticoagulant is used?

A

Fondaparinux/heparin for 5 days

Warfarin for 3 months

230
Q

What is the first-line management for a massive PE in haemodynamic unstable patients?

A

Thrombolysis with respiratory support

-Use IV alteplase

231
Q

What thrombolytic therapy is used in PE?

A

Alteplase (IV)
Streptokinase
rt-PA

232
Q

What is the second line management for PE if thrombolytic therapy fails?

A

Embolectomy

233
Q

What pharmacological prophylaxis is given for PE?

A

Tinzaparin - low molecular weight heparin

234
Q

What is traumatic pneumothorax?

A

Damage to the parietal pleura

235
Q

What i the normal intrapleural pressure?

A

-5to-8cm H2O

236
Q

Which pleural is affected in spontaneous pneumothorax?

A

Damage to the visceral pleura

237
Q

What is the main risk factor for a primary pneumothorax?

A

Young thin male

238
Q

What are associated with secondary pneumothorax?

A

Pre-existing lung pathology, CF and COPD

239
Q

What is the management of primary pneumothorax >2cm or SOB?

A

Needle aspiration (Consider chest drain if unsuccessful)

240
Q

What is the management for a secondary pneumothorax >2cm or SOB?

A

Chest drain

241
Q

What happens in a tension pneumothorax?

A

A one-way valve is created, inspiration causes continuous accumulation of air in the pleural space

242
Q

Which type of pneumothorax is associated with tracheal deviation?

A

Tension pneumothorax, away from the side of the lesion

+ Reduced expansion
-Hyper-resonant chest
Mediastinal shift

243
Q

Why is tension pneumothorax an emergency?

A

The mediastinal shift causes hypotension and tachycardia

244
Q

What is the management for a tension pneumothorax?

A

Insert large bore cannula in 2nd ICS MCL, place above the third rib to avoid the neurovascular bundle

245
Q

What is the definition of ARDS?

A

Non-cardiogenic pulmonary oedema

246
Q

Which criteria is used to assess and define ARDS?

A

Berlin Criteria

247
Q

What is the Berlin criteria?

A

No alternative cause for pulmonary oedema - cardiac failure

Rapid onset <1 week

Dyspnoea

Bilateral signs on CXR

248
Q

What are the causes of ARDs?

A

ARDs is caused by hypoaxemia acute lung injury

Sepsis
Pneumonia
Ventilation 
Severe burns
Acute pancreatitis
Transfusion reactions
Drug overdose
COVID-19
249
Q

What happens in ARDs?

A

Pulmonary alveolar oedema and eventual lung collapse

250
Q

What CXR findings are seen in ARDs?

A

Bilateral diffuse opacities

251
Q

What is the management of ARDs?

A 
Proning - alveolar recruitment 
ICU
Ventilator 
Diuresis 
Drainage of effusion
252
Q

What is the most common cause of bacterial community acquired pneumonia?

A

Streptoccocus pneumoniae

253
Q

Which atypical organism is associated with faulty air condition systems?

A

Legionella Pneumophilia

254
Q

What scoring system is used to assess CAP severity?

A

CRB-65

CURB-65

255
Q

What non-invasive bedside tests can be used to identify the causative organism?

A

Sputum culture

Urinary antigen testing

256
Q

What is pneumonia?

A

Infection of the lung parenchyma

257
Q

What are the risk factors of pneumonia?

A

Old age
Chronic lung condition (Asthma/COPD)

Immunosuppression

Aspiration risk
Smoking
Travel

258
Q

What two categorises are CAP divided into?

A

Typical and Atypical

259
Q

What are the common typical organisms for CAP?

A

Strep pneumoniae

Haemophlius influenzae B

Staphyloccous aureus

Klebsiella pneumonia

Moraxella catarrhalis

260
Q

What are the common atypical organisms for CAP?

A

Mycoplasma pneumonia
Legionella pneumonphilia

Chlamydia psitacci
Coxiella burnetti
Pneumocystitis jirovecii

261
Q

What are the common causes of HAP?

A

Pseudomonas aeurgonosa

262
Q

What bacterial organism is associated with COPD and bronchiectasis?

A

Haemophilus Influenzae

263
Q

What bacterial organism i responsible for causing cavitating lesions and abscesses in typical CAP?

A

Staphyloccous aureus

264
Q

Which type of pneumonia is common amongst chronic alcoholic patients?

A

Klebsiella pneumonia

265
Q

What dermatological presentation is associated with mycoplasma a pneumoniae?

A

Target skin lesion

-Erythema multiforme

266
Q

What electrolyte imbalances are associated with legionella?

A

Hyponatremia and abnormal LFTs

267
Q

What causes Parrot fever?

A

Chlamydia psittaci

268
Q

Which pneumonia is associated with HIV (AIDs)?

A

Pneumocystitis jirovecci

269
Q

Which bacteria can cause cavitating lung lesions?

A

Staph aureus

Klebsiella

270
Q

What are the common causes of cavitating lung lesions?

A

Malignancy (Squamous cell carcinoma)

Wegener’s granulomatosis

Rheumatoid arthritis

Septic embolic

TB

Abscess

271
Q

What kind of bacteria is strep pneumoniae?

A

Gram-positive (Diplococci)

272
Q

What type of bacteria is Haemophilus influenzae, klebsiella pneumoniae and pseudomonoas?

A

Gram-negative

273
Q

What are the clinical symptoms pneumonia?

A 
Pleuritic chest pain 
Productive mucopurulent cough (Green sputum)
Fever/Rigors
Shortness of breath
Confusion (Elderly patients)
274
Q

What are the common causes of pleuritic chest pain?

A 
Pneumothorax
Pulmonary embolism
Pericarditis
Pneumonia
Pleural effusion
275
Q

What symptoms are associated with atypical pneumonia?

A

Dry cough (Inflammation spares the alveoli)

Headache

Myalgia
Hepatitis

Low grade fever
Diarrhoea

276
Q

What are the clinical signs of typical pneumonia?

A 
Reduced chest expansion (asymmetrical)
Dullness to percussion
Cyanosis
Respiratory distress 
Coarse basal crepitations
Bronchial breathing
Increased vocal resonance
277
Q

What observations are evident in pneumonia?

A 
Tachycardia
Tachypnoea
Low blood pressure indicating sepsis
Reduced peripheral oxygen saturation 
Raised temperature
278
Q

What imaging modality is gold-standard for pneumonia?

A

Chest X-ray

279
Q

What investigation is performed to diagnose for legionella pneumonia?

A

Urinary antigen testing

280
Q

What two organisms are assessed for urinary antigen testing?

A

Legionella

Streptococcus pneumonia

281
Q

What investigations are performed to confirm mycoplasma pneumonia?

282
Q

What are the common features of pneumonia on a CXR?

A

Alveolar opacificaion
Air bronchograms
Consolidation

283
Q

What are air bronchograms?

A

Bronchi being filled with air surrounded by alveoli that are filled with pus

284
Q

What does diffuse patchy infiltrates reveal on XR (Pneumonia)

A

Interstitial pneumonia (PCP)

285
Q

CURB-65 0 - 1 =

A

treatment as outpatuent

286
Q

CURB-65 2 =

A

Consider admission to hospital

287
Q

CURB-63 3 =

A

ICU admission

288
Q

What 3 ABx are indicated for CAP management?

A

Amoxicillin
Clarithromycin
Doxycycline

289
Q

What ABx should be prescribed for typical pneumonia (Allergic to penicillin)?

A

Doxycycline

290
Q

What ABx is administered for pneumonia in the community (CURB-65 =1)?

A

Amoxicillin

291
Q

What ABx is administered for CAP with curb-2?

A

Amoxicillin and clarithroymycin

292
Q

What ABx is prescribed in CAP with CURB-65 >3?

A

IV co-amoxiclav and clarithryocmyin

293
Q

What ABx should be prescribed in pregnancy for CAP?

A

Erythromycin

294
Q

First-line ABx for HAP?

A

Co-amoxiclav

295
Q

ABx for MRSA HAP pneumonia?

A

IV Vancomycin

296
Q

ABx for pseudomonas HAP?

A

IV Tazocin + gentamicn

297
Q

ABx for aspiration pneumonia?

A

Amoxicillin

Metrondazole

298
Q

ABx for PCP?

A

Co-trimoxazole

299
Q

What CXR findings are observed in PCP?

A

diffuse patchy infiltrates

300
Q

What is bronchiectasis?

A

Chronic lung condition defined as the abnormal irreversible dilation of the bronchi and bronchioles

301
Q

What are the two common causes of bronchiectasis ?

A

TB

Cystic fibrosis

302
Q

What are the risk factors for bronchiectasis?

A

Post-infection - TB
Immunodeficiency
Chronic aspiration - GORD/dysphagia

Chronic inflammation
COPD
Congenital - Cystic fibrosis

303
Q

What is the triad of Kartagener’s syndrome?

A

Sinusitis
Bronchietasis
Situs inversus

304
Q

What is the presentation of bronchiectasis?

A

Chronic daily productive cough (>8 weeks)

Large amounts of mucopurulent sputum

Foul-smelling
Green/yellow - otherwose mucoid
Haemoptysis
Dyspnoea
Weight-loss
Non-pleuritic chest pain

Recurrent pneumonia/chest infections

305
Q

What examination finding in the hands are associated with bronchiectasis?

306
Q

What are the respiratory causes of clubbing?

A 
Bronchiectasis
Lung cancer
Pulmonary fibrosis
TB
Cystic fibrosis
Empyema
Lung abscess
307
Q

On auscultation what is heard in bronchiectasis?

A

Coarse crackles the lower ling zones

308
Q

What sputum is produced in bronchiectasis?

A

Mucopurulent

309
Q

Beside investigation for productive cough?

A

Sputum culture - HIB, Pseudomonas aerugonisa, strep pneumoniae

310
Q

What sign is seen in XR for bronchiectasis?

A

Tram-tracking

311
Q

What is the gold standard investigation for bronchiectasis?

A

High resolution CT

312
Q

Bronchiectasis + IgE + Eosinophilia is =?

313
Q

What investigation i performed for diagnosing cystic fibrosis?

A

Sweat test

314
Q

Which serum marker is raised in ABPA?

315
Q

What findings are seen in HRCT in bronchiectasis?

A

Signet ring sign

316
Q

What is the conservative management for bronchioectasis?

A

Chest physiotherapy and airway clearance

  • Postural drainage
  • Nebulised hypertonic saline
317
Q

What is the pharmacological management for bronchiectasis?

A

Steroids/bronchodilators

ABx

318
Q

What Abx is used to treat Psueodmonas resp infection?

A

Ciprofloxacin

319
Q

What complication is associated with ciprofloxacin?

A

Achille tendon rupture

320
Q

What is the surgical indication for localised resection of bronchiectasis?

A

For localised disease

Indicated in massive haemoptysis

321
Q

What part of the lungs does TB affect?

A

Upper lobe

322
Q

What bacterium is associated with TB?

A

Mycobacterium tuberuclosis

323
Q

What is latent TB?

A

Contained in caseating granulomas (not transmissible)

324
Q

Caseating granulomas in the lung indicate what pathology?

325
Q

Rfx fr TB?

A

HIV
Immunosuppressive
Overcrowding

326
Q

What are the signs and symptoms of TB?

A 
Productive cough
Dyspnoea/SOB
haemoptysis
Pleural effusion ]
FLAWS - low grade fever weight loss

Lymphadenopathy
Erythema nodosum

327
Q

What skin manifestation is associated with TB?

A

Erythema nodosum

Lupus vulgaris

328
Q

What TB disease complication affects the spinal cord?

A

Pott’s disease

-osteomyelitis of the spine

329
Q

What are the endocrine complications of TB?

A

Addison’s disease

Sterile pyuria

330
Q

Bed side investigations for TB?

A

Sputum culture - acid-fast bacilli stain (Ziehl-Neelsen)

331
Q

What staining is done for TB?

A

acid-fast bacilli stain (Ziehl-Neelsen)

332
Q

What imaging is performed in tb?

A

CXR - revealing bi-hilar lymphadenopathy

333
Q

What CXR finding is found with TB?

A

bi-hilar lymphadenopathy

Consolidation

Upper lobe scarring

Cavitating lesions

334
Q

What does a lymph node biopsy reveal in TB?

A

Caseating granuloma

335
Q

What test is used to determine whether a patient has latent TB?

A

Mantoux test - Tuberculin skin test
-Immune reaction = latent

+ Interferon Gamma Release Assay

336
Q

What is miliary TB shown on CXR?

A

Nodular shadowing

337
Q

What is miliary TB?

A

Lymphohaematageous dissemination of TB

338
Q

What are the four drugs in TB management?

A

Rifamipicin
Isoniazid
Pyrazinamide
Ethambutol

339
Q

Which TB drug is associated with peripheral neuropathy and vitamin b6 deficiency?

340
Q

Which TB drug causes gout?

A

Pyrazinamide

341
Q

Which TB drug causes optic neuritis?

A

Ethambutol

342
Q

What are the two types of lung cancer?

A

Small cell lung cancer

Non-small cell lung cancer

343
Q

What type of cells are associated with small cell carcinoma?

A

Endocrine cells (Kulchitsky)

344
Q

What are the three types of non-small cell lung cancer?

A

Adenocarcinoma (Goblet cells)
Squamous cell carcinoma
Large cell carcinoma

345
Q

What is the most common type of lung cancer?

A

Non-small cell lung cancer

346
Q

What 3 paraneoplastic syndromes are associated with small cell lung cancer?

A

SIADH
ACTH -Cushing’s
Lambert Eaton Syndrome

347
Q

What cells are associated with adenocarcinoma?

A

Goblet cells

348
Q

Where do adenocarcinomas arise from in the lung?

A

Peripheral

349
Q

Squamous cell carcinomas secrete what type of peptide?

A

PTHrP

Central lung

350
Q

What is the largest risk factor for lung cancer?

351
Q

What are the primary symptoms of lung cancer?

A

Cough (Dry or productive)
Haemoptysis
SOB
FLAWs

352
Q

What signs are seen in lug cancer?

A

Clubbing
Tar staining of fingernails (Smokers)
Lymphadenopathy

Dull percussion
Stony dullness
Increased vocal resonance

353
Q

What syndrome is associated with a Pancoast tumour?

A

Horner syndrome

354
Q

What chain is compressed in Horner syndrome?

A

Cervical sympathetic chain

355
Q

What is the triad of horner syndrome?

A

Miosis
Partial Ptosis
Anhidrosis

356
Q

What is the presentation of an apical lung tumour (Pancoast)?

A

Horner syndrome
Brachial plexus compression - paraesthesia

Recurrent laryngeal nerve compression - hoarse voirce and bovine cough

357
Q

What sign is sign in a tumour in the right lung apex? (SVC)

A

Pemberton’s sign

Pooling of blood - oedema

358
Q

What bloods are performed for lung cancer?

A

Calcium - bone mets and PTHrp
ALP - bone mets
LFTs - liver mets

359
Q

What is the first-line radiological investigation for lung cancer?

360
Q

What scan is used to stage lung cancer?

A

CT chest, abdomen and pelvis and PET

361
Q

How is biopsy performed for lung cancer?

A

Bronchoscopy with transbronchial resection

Or transthoracic needle

362
Q

How does lung cancer mets reveal on CXR?

A

Cannon ball mets

363
Q

What is a mesothelioma?

A

Malignant neoplasm of mesothelial cells of the pleura

364
Q

What is the biggest risk factor for mesothelioma?

A

Asbestos exposure

365
Q

What is the presentation of mesothelioma?

A 
Dry cough
FLAWS
-SOB
-Weight loss
-loss of appetite
-Night sweats

Signs - pleural friction rub

366
Q

On auscultation what does mesothelioma sound like?

A

Pleural friction rub

367
Q

What are the invasive investigations for mesothelioma?

A

Pleural fluid cytology via thoracentesis (Pleural tap)

368
Q

What X-ray features are associated with a mesothelioma?

A

Pleural thickening
Pleural plaques due to asbestos
Pleural effusions

369
Q

How is mesothelioma diagnosed?

A

Thoracoscopy and histology

370
Q

What spirometry findings are associated with asthma FEV1/FVC?

A

FEV1/FVC <70% with bronchodilator reversibility

371
Q

Which cells are implicated in the pathophysiology of asthma?

A

Mast cells and basophils

  • IgE mast cell degranulations
  • Eosinophil
372
Q

What is the four pathophysiology steps in asthma?

A

Epithelial airway damage
Vascular smooth muscle hypertrophy
Airway hyperrresponsiveness
Mucous plugging

Reversible airway obstruction with intact lung parenchyma

373
Q

What is the presenting complaint for asthma?

A 
SOB
Dry cough
Chest tightness
Variability of symptoms
Diurnal - worse at night
Wheeze
Atopic (Food allergies, eczema and hayfever)
374
Q

When are asthma symptoms worse during the day?

A

During the night

375
Q

What are the signs of asthma?

A

Expiratory polyphonic wheeze
Work of breathing
Nasal polyps

376
Q

What is the triad of atopy (asthma)?

A

Hay fever
Food allergy
Eczema

377
Q

Which conditions make asthma worse?

A

GORD -reflux exacerbates asthma

378
Q

What questions asked for suspected asthma?

A

Are the problems always there?
Do you wake up at night breathless or coughing?
Are there noises when they breath?
Any triggers? Dusty environment, pets, smoking, exercise

Previous hospital admission and care?

379
Q

What test is used to assess asthma control?

A

Asthma control test (ACT)

380
Q

What is the FEV1/FVC ratio or asthma?

381
Q

What two investigations are indicated for the diagnosis of asthma?

A

FeNO
Spirometry (FEV reduced)
Bronchodilator reversibility >12%

382
Q

By what % does bronchodilatory reversibility increase FEV1 in asthma?

383
Q

FeNO result in adults?

384
Q

What is the first-line management for asthma?

A

Salbutamol (SABA)

Address triggers, smoking cessation and mediation adherence

385
Q

What colour is a reliever inhaler?

A

Reliever- SABA -Blue

386
Q

What colour is a preventor inhaler?

A

Brown - Low dose ICS

387
Q

What are the management indications for beginning Low Dose ICS with SABA?

A

Not controlled on previous step
OR
Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking

388
Q

What medication is added if Low Dose ICS and SABA is unresponsive in asthma?

A

Leukotriene receptor antagonist (montelukast)

389
Q

What class of drug is montelukast?

A

Leukotriene receptor antagonist

390
Q

Name an ICS?

A

beclometasone, budesonide, ciclesonide, fluticasone, and mometasone

391
Q

Name a LABA

A

salmeterol

formoterol

392
Q

Name a SAMA

A

ipratropium,

tiotropium,

393
Q

What is the step-up management despite the use of LTRAs?

394
Q

What is the step-up management despite the LABA SABA ICS?

A

Add LABA as MART

395
Q

Why is MART effective in asthma?

A

LABA and ICS

ICS suppresses inflammation and LABA short-acting to relieve symptoms

396
Q

What is occupational asthma?

A

Common industrial lung disease, due to inhaled particulates at work
-Symptoms improve during work cessation

397
Q

What is COPD?

A

Small airway obstruction
Emphysema
Goblet cells hyperplasia - more mucous
-Irreversible airway obstruction

398
Q

What is the biggest risk factor for COPD?

399
Q

What is the presentation of COPD?

A

Dyspnoea (persistent)

  • Exercise induced
  • Progressive

Chronic cough +/- sputum
Concurrent wheeze
Increased respiratory effort - Flared nostrils, accessory muscles

Hypercapnia - Co2 retention flap and bounding pulse

Tachypnoea
Barrel chest - loss of percussion dullness over heart and liver - resonance
-Reduced cricosternal distance

Cor pulmonale - RV heave, JVP elevated and ankle oedema

Hoover’s sign

400
Q

What is the gold-standard investigations for COPD?

A

Spirometry - post-bronchodilator FEV1/FVC <0.7 with no bronchodilator reversibility

Low oxygen saturations

CXR - hyper-expansion, air trapping

Exclude anaemia

401
Q

What test assesses COPD impact on quality of life?

402
Q

What is the first step of COPD management?

A

Smoking management

-Offer pneumococcal and influenza vaccines

403
Q

What is the first-line pharmacological management for COPD?

A

SABA (as required) or SAMA

LABA LAMA regularly

404
Q

What is the long-term management for COPD is there are asthmatic features?

A

LABA + ICS

405
Q

What are asthmatic features in COPD?

A

FEV1 variability, high eosinophils, peak flow variability

406
Q 
Diagnosis: 
dextrocardia or complete situs inversus
bronchiectasis
recurrent sinusitis
subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
A

Kartagener’s syndrome

407
Q

What type of crepitations are associated with idiopathic pulmonary fibrosis?

A

Bibasal Fine end inspiratory

408
Q

What is idiopathic pulmonary fibrosis?

A

Lung scarring of an unknown cause
-Fibrosis of the parenchyma stats around the pleura - predominantly in the basal and intersitital pneumonia pattern- subpleura

409
Q

What is the epidemiology of IPF?

A

Older male >65 years

Smoking and FHx

410
Q

What are the symptos of IPF?

A 
Progressive SOB
Exertional dyspnoea
Dry cough 
Weight loss, fatigue and malaise
Slow insidious onset

Bi-basal fine end inspiratory crepitations

Clubbing

411
Q

What is the gold-standard investigation for IPF?

A

High-resolution CT to show pattern of fibrosis

412
Q

What does spirometry reveal in IPF (restrictive)?

A

FEV1/FVC >70%

413
Q

What is DLCO?

A

Diffusing capacity for carbon monoxide

-Suggests alveolar pathology

414
Q

Which drugs can cause IPF?

A

Amiodarone, nitrofuratoin and methotrexate

415
Q

What is the definitive management for IPF?

A

Pulmonary rehabilitation

Consider pirfenidone (an antifibrotic agent) 
-If FVC is between 50-80%
416
Q

What skin features are associated with sarcoidosis?

A

Erythema nodosum bilaterally on the shins

Lupus pernio

417
Q

What X-ray features are associated with sarcoidosis?

A

Bilateral hilar lymphandenopathy

418
Q

What is the presentation of sarcoidosis?

A

acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
skin: lupus pernio
hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

419
Q

What is epidemiology of sarcoidosis?

A

Afro-Caribbean female with cough and skin patch on her shin

Scandinavian

FHx
Infections like TB

Females 20-40

420
Q

What is the pathology of sarcoidosis?

A

Non-caseating (Non-necrotic) granulomas deposited around the body

421
Q

What is the presenting complaint of sarcoidosis?

A

Lungs-

  • Chronic dry cough
  • Progressive shortness of breath with exertional dyspnoea
  • Disproportionate chronic fatigue

Eye problems - photophobia, red painful eye/blurry vision

422
Q

What skin lesions arise in sarcoidosis?

A

Lupus pernio (Rash on face, nose and ears)

423
Q

What eye features are associated with sacoidosis?

A

Photophobia
Red painful eye
Blurry vision

Anterior or posterior uveittis

424
Q

What respiratory signs are associated with sarcoidosis?

A

Wheeze

Rhonchi

425
Q

What is Lofgren’s syndrome?

A

Pulmonary manifestation of sarcoidosis

  • Bilateral hilar lymphandeophathy
  • Erythema nodosum
  • Arthralgia
  • Fever
426
Q

What is stage 1 sarcoidosis?

A

Bilateral hilar lymphandenopathy

427
Q

What is stage 2 sarcoidosis?

A

Bilateral hilar lymphandenopathy

+ pulmonary infiltrates

428
Q

Sarcoid deposits in the parotid gland results in what?

A

Parotid enlargement manifesting as facial nerve palsy

429
Q

What cardiac complication is associated with sarcoidosis?

A

Restrictive cardiomyopathies

430
Q

Why is calcium raised in sarcoidoiss?

A

1-alpha-hydroxylase. -vitamin D elevated due to macrophage release

And high ACE enzyme

431
Q

What electrolyte imbalance is associated with sarcoidosis?

432
Q

Which enzyme is elevated ins sarcoidosis

433
Q

What blood test results are consistent with sarcoidosis?

A

High calcium and high serum ACE

low PTH in response to high calcium

434
Q

At what stage of sarcoidosis is prednisolone indicated?

435
Q

What is the definitive management of OSA?

A

CPAP at night

436
Q

What is the presentation sleep apnoea?

A

Loud snoring
Daytime sleepiness
Restless sleep

437
Q

What questionnaire is performed for sleep apnoea?

A

STOP-BANG sscore

438
Q

What are the parameters assessed in the STOP-BANG score?

A

Snoring
Tired
Observed apnoea
Pressure (BP)

BMI>35
Age >35
Neck circumference >40cm
Gender -male

439
Q

What is the diagnostic investigation for sleep apnoea?

A

Polysomnography

-Apnoea and hypopnoea index

440
Q

What is the management for asymptomatic and mild sleep apnoea?

A

Intra-oral mandibular advancement device

441
Q

What are the indications for ABx therapy in acute bronchitis?

A

have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)

442
Q

What is coal workers pneumocoinosis?

A

Exertional dyspnoea and cough

Coal deposits in the lungs

Progressive massive fibrosis
+/- black sputum

443
Q

What does a CXR reveal in coal worker’s pneumoconiosis?

A

Large round fibrotic masses in the upper lobes

444
Q

What is the presentation of silicosis?

A

Upper lobe fibrosis masses with hilar egg shell calcification

445
Q

What X-ray features are found in silicosis?

A

‘egg-shell’ calcification of the hilar lymph nodes

446
Q

What occupations are associated with silicosis?

A

Stonemason
Pottery
Ceramics

447
Q

What characteristic radiographic findings are associated with asbestosis?

A

Pleural plaques - Thickening and calcification of the pleura visible
-Causes occasionale exertional dyspnoea

Asbestos bodies

448
Q

What are the features associated with asbestosis (presentation)?

A

Progressive dyspnoea
Dry cough
FLAWs - haemoptysis

Clubbing
reduced expansion
Bibasal crackles
RHF
Asbestos warts
449
Q

What is extrinsic allergic alveolitis?

A

Inhaled microscopic allergens that deposit in small airways and alveoli - leads to allergic response in small airways and alveoli

-Farmer’s lungs
-Bird fancier’s lungs
Maltworker’s lung

450
Q

What is the presentation of extrinsic allergic alevolitis?

A

Dyspnoea
Cough +/- sputum
Malaise

451
Q

What HRCT findings is associated with EAA?

A

Ground glass appearance

452
Q

Management for EAA?

A

avoid precipitating factors

oral glucocorticoids

453
Q

Name a cause of transudative pleural effusion?

Protein level <30g

A

Nephrotic syndrome
Heart failure (Congestive)
PE cirrhosis

454
Q

What is a respiratory complication of pancreatitis?

455
Q

What are the clinical features of ARDS?

A

dyspnoea
elevated respiratory rate
bilateral lung crackles
low oxygen saturations

456
Q

Definition of ARDS

A

non-cardiogenic pulmonary oedema.

457
Q

In what patients is Klebsiella pneumonia common in?

A

Klebsiella pneumonia is more common in diabetics and patients with a history of alcohol excess. It is also frequently caused by aspiration.

458
Q

Red/Jelly-like sputum is associated with what type of pneumonia?

A

Klebsiella

459
Q

A negative spirometry testing indicates what further investigation in asthma management?

A

Fractional exhaled nitric oxide

460
Q

What are the common causes of exudative pleural effusion?

A

Pneumonia
Malignancy
Connective tissue disease

461
Q

Hyperventilation causes what blood gas result?

A

Respiratory alkalosis

462
Q

What is the management for an acute exacerbation of asthma?

A 
Oxygen
Salbutamol
Hydrocortisone
Ipratropium bromide
Theophylline
Magnesium sulphate
463
Q

Are pleural plaques in asbestos-related lung disease concerning?

A

No - are benign and therefore do not require monitoring

464
Q

What are the common causes of upper zone fibrosis?

A 
C- Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
465
Q

What parameter is used to assess for COPD severity?

466
Q

What is auscultated for a malignancy of the bronchus?

A

Monomorphic wheeze

467
Q

What type of pleural effusion is malignancy?

A

Exudative pleural effusion

468
Q

What is the parameter for exudative pleural effusion?

Phase1c Medicine (11 decks)

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