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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
What is pnuemonia?
An infection of the distal lung parenchyma
26
What is the most common causative organism for community acquired pneumonia?
Streptococcous pneumoniae
27
What is the most common caustive organism in infective exacerbations of COPD?
• Haemophilus influenza
28
Jelly-currant sptum is associated with what type of causative organism pneumonia?
Klebsiella pnuemoniae
29
What colour sputum is streptococcus pnuemoniae?
Rust-coloured
30
What are the risk factors for pnuemonia?
``` Age Smoking Alcohol Pre-existing lung disease Immune deficiency Contact with pneumonia ```
31
What is the presentation of pneumonia
``` Fevers Rigours Sweating Malaise Sputum Breathlessness (Dyspnoea) Pleuritic chest pain ```
32
Describe the cough associated with bacterial pnuemonia?
Mucopurulent sputum
33
Describe the sputum associated with atypical pnuemonia?
Scant or water sputum
34
What are the symptoms of atypical pneumonia?
Headache Myalgia Diarrhoea/abdominal pain
35
What additional antibiotic is associated with the management of atypical pneumonia?
Macrolide
36
Examples of atypical pneumonia
Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophilia
37
What are the examination findings with pneumonia?
Crackles (Coarse crepitations on the affected side) Decreased breath sounds (Bronchial breathing) Dullness to percussion Wheeze Reduced chest expansion
38
What CXR changes are seen in pnuemonia?
Evidence of consolidation (new shadowing) | Pleural effusion
39
Klebsiella pneumonia affects which lobes?
Affects the upper lobes
40
Which scoring criteria are used to assess the severity of pneumonia and subsequent managemetn?
CURB-65
41
What urea parameter scores a point in pneumonia using the CURB-65 score?
Urea >7mmol/L.
42
What parameters are assessed in the CURB-65 score?
Confusion Urea >7 mmol/L Respiratory rate > 30/min BP: <90 mmHg or diastolic <60 mmHg Age > 65 years
43
What is the initial management of pneumonia?
Oral amoxicillin • IV cefuroxime/cefotaxime/co-amoxiclav and erythromycin (>1 Marker)
44
A score of 0-1 on the CURB score equates to what management?
Discharge home with antibiotics
45
A CURB-65 score of 3-5 warrants what management?
Refer to HDU/ICU
46
A CURB-65 score of 2 warrants what management?
Consider hospital referral
47
What is the supportive management for pnuemonia?
``` Oxygen Paraenteral fluids for dehydration shock Analgesia Chest physiotherapy Nebulised saline CPAP, BiPAP or ITU care for respiratory failure ```
48
What is pneumothorax?
Defined as an accumulation of air within the pleural space.
49
What is tension pneumothorax?
Air is continuously entering the pleural space under positive pressure without exiting during expiration
50
What is the management of tension pneumothorax?
Emergency needle decompression
51
What is a spontaneous pneumothorax?
In individual with normal lungs (Tall, thin males), caused by a rupture of a subpleural pleb
52
What are the risk factors for pneumothorax?
* Smoking * Tall and slender build * Male sex * Young age * Marfan’s disease and Ehler’s-Danlos syndrome)
53
What is the presentation of. pneumothorax?
Sudden onset breathlessness or chest pain (pleuritic in nature) Shoulder tip pain in secondary pneumothoraxx Distress with rapid shallow breathing
54
What are the examination findings associated with a pneumothorax?
Reduced chest expansion Hyper-resonance to percussion Ipsilateral decreased breath sounds Ipsilateral hyperinflation
55
What additional examination findings are seen in a tension pneumothorax?
``` Tachycardia Hypotension Cyanosis Distended neck veins Tracheal deviation away from the side of the pneumothorax ```
56
What is the management for a moderate pneumothorax >2cm?
Aspiration using a large bore cannula or cathter with a three-way tap
57
What is the management of a pneumothorax if an aspiration fails?
Chest drain with water seal
58
Define a pulmonary embolism
A pulmonary embolism is defined as a thrombus within the pulmonary vasculature resulting in an occlusion , predominantly because of DVT
59
What is the most common cause of a pulmonary embolism?
DVT (95%)
60
What are the risk factors of a pulmonary embolism?
``` Surgical patients Immobility Obesity OCP Heart failure Malignancy ```
61
What is the presentation of a moderate PE?
``` Sudden onset dyspnoea Cough Haemoptysis Pleuritic chest pain (Localised on one side of the chest) Signs of concurrent DVT ```
62
What is the presentation of a large PE?
Shock Collapse Acute right heart failure Sudden death
63
What are the examination findings seen in a moderate PE?
Tachypnoea Tachycardia Pleural rub Low saturation oxygen
64
What scoring system is used to assess the probability of a PE?
Well's Score
65
What parameters are assessed in the Well's Score?
``` Clinically suspected DVT PE is most likely diagnosis Recent surgery (4 weeks) Immobilisation Tachycardia History of DVT or PE Haemoptysis Malignancy ```
66
A low probability well's score = what investigation?
D-dimer blood test
67
What is D-dimer?
fibrin degradation product – highly sensitive, poor sensitivity
68
How does a CTPA reveal a PE?
Direct visualisation of thrombus in the pulmonary artery.
69
What is the most common ECG finding in a PE?
Sinus tachycardia RBBB Right axis deviation
70
What axis deviation is associated with a PE?
Right-axis deviation
71
What classical ECG pattern is associated with a PE?
S1Q3T3 pattern
72
What other investigation can be performed to diagnose a PE if a CTPA is contraindicated?
VQ scan
73
What is the management of a PE in a stable patient?
Anticoagulation with UFH or LMWH heparin Change to oral Warfarin therapy (INR2-3) for 3 months
74
How long should Warfarin be administered for post-PE?
3 months with target INR-2-3
75
What is the management of PE in an unstable patient?
Thrombolysis with tPA + UFH herpain Embolectomy if contraindicated
76
What is the prophylactic management of PE?
Graduated pressure stockings and heparin prophylaxis
77
What is Sarcoidosis?
A multisytem granulomatous disorder of unknown aetiology Accumulation of lymphocytes and macrophages forming non-caseating granulomas in the lungs
78
What is the lung presentation of sarcoidosis?
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) ```
79
What are the Msk presentation of sarcoidosis?
* Bone cysts (dactylitis in phalanges) * Polyarthralgia * Myopathy
80
What dermatatological findings are seen in sarcoidosis?
* Lupus pernio * Erythema nodosum * Maculopapular eruptions
81
How is sarcoidosis staged in CXR?
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.
82
What is Stage 0 sarcoidosis on a CXR?
Clear
83
What is Stage 1 sarcoidosis on a CXR?
Bilateral hilar lymphadenopathy
84
What is stage 2 sarcoidosis on a CXR?
Bilateral hilar lymphadenopathy w pulmonary infiltration and paratracheal node enlargement
85
What are the three most common causes of bilateral hilar lymphandeopahty?
Sarcoidosis Lymphoma TB
86
What is Stage 3 sarcoidosis on the CXR?
Pulmonary infiltration and fibrosis alone
87
What is stage 4 sarcoidosis on the CXR?
Extensive fibrosis with distortion
88
Which markers are raised in sarcoidosis?
Serum ACE Calcium ESR LFT raised ALP and GGT
89
What would a 24-hour urine collection reveal in sarcoidosis?
Hypercalciuria Due to abnormal calcium and Vitamin d regulation from granulomatous macrophages
90
What scan is used in sarcoidosis to detect areas of inflammation in the parotids and the eyes?
Gallium-67 scan
91
What results are found in pulmonary unction tests in sarcoidosis?
Reduced FEV1 and FVC | Restrictive lung disease
92
What is the essential diagnostic investigation for sarcoidosis of the lung?
Transbronchial lung biopsy
93
What is the management for sarcoidosis?
Oral corticostreoids (Prednisolone)
94
What is the management of lupus pernio in sarcoidosis?
Chloroquine or methotrexate
95
What is TB?
A granulomatous disease caused by mycobacterium tuberculosis
96
What is primary TB?
An initial infection acquired by inhalation from the cough of an infected patient
97
What is miliary TB?
Results when there is haematogenous dissemination
98
What type of bacteria is TB?
Acid-fast bacillus which proliferates and survives after alveolar macrophage phagocytosis
99
What is formed in TB?
A granuloma with caseous necrotic centre
100
What can precipitate latent TB into active TB?
HIV infection | And immunocompromised individuals (+ patients taking systemic corticosteroids)
101
What is the presentation of primary TB?
``` Fever Malaise Cough Wheeze Erythema nodosum Conjunctivitis ```
102
What is the presentation of post-primary TB?
``` Fever/night sweats Malaise Weight loss Breathlessness Cough Sputum Haemoptysis Pleuritic pain ```
103
What is shown in a CXR for TB?
Peripheral consolidation | Hilar lymphadenopathy
104
What is shown in a CXR for TB?
``` Peripheral consolidation Hilar lymphadenopathy Upper lobe shadowing Calcification Pleural effusion ```
105
What diagnostic tests are performed to confirm TB?
Sputum acid-fast bacilli smear
106
What is the management of TB?
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
107
What are the side effects of Rifampicin?
orange body fluids
108
What are the side effects of isoniazid?
Peripheral neuropathy | Pyridoxine deficiency
109
What are the side effects of pyrazinamide?
Increased urate/arthralgia - hepato-toxicity
110
What are the side effects of ethambutol?
Optic neuropathy
111
What is bronchiectasis?
Lung airway disease characterised by chronic bronchial dilation - impaired mucociliary clearance
112
What is the aetiology of bronchiectasis?
Severe inflammation in the lung, fibrosis and dilation of bronchi Pooling of mucous - predisposition to infection, damage, and fibrosis of bronchial walls
113
Which host defence defects are associated with the development of bronchiectasis?
Cystic fibrosis, immunoglobulin deficiency, yellow-nail syndrome, and Kartagener’s syndrome.
114
What is the presentation of bronchiectasis?
Productive cough with purulent sputum Haemoptysis Breathlessness, chest pain, malaise, fever, weight loss Rhinosinusitis
115
What are the examination findings of bronchiectasis?
Finger clubbing Coarse basal crepitations Wheeze rhonchi
116
What type of crepitations are associated with bronchiectasis?
Coarse basal crepitations
117
What common organisms are associated with bronchiectasis?
Pseudomonas aeruginosa, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumonia, Klebsiella, Moraxella catarrhalis, Mycobacteria.
118
What does a CXR reveal in bronchiectasis?
Parallel lines radiating from the hilum to the diaphgram (tramline shadows)
119
What is the gold-standard investigation for diagnosing bronchiectasis?
High-resolution CT
120
What does a high-resolution CT reveal in bronchiectasis?
Dilated bronchi with thickened walls | Signet ring sign
121
Signet ring sign on a CT suggests what diagnosis?
Bronchiectasis
122
What investigation is performed in CF?
Sweat electrolytes
123
What is the management of bronchiectasis?
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)
124
What is COPD?
A chronic progressive lung disorder that is characterised by irreversible airflow obstruction, encompassing both chronic bronchitis and emphysema.
125
What is chronic bronchitis?
Chronic cough and sputum production involving hypertrophy and hyperplasia of the mucous glands
126
What is emphysema?
Permanent destructive enlargement of air spaces distal to the terminal bronchioles.
127
What genetic deficiency is associated with COPD?
Alpha-1-antitrypsin deficiency
128
What is main cause of COPD?
Bronchial and alveolar damage because of environmental toxins (cigarette smoke).
129
What is the presentation of COPD?
* Chronic cough with sputum production * Breathlessness * Wheeze * Decreased exercise tolerance
130
What are the examination findings for COPD?
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
131
What investigations are performed in diagnosing COPD?
PFTs and spirometry CXR ABG
132
What do PFTs reveal in COPD?
• Decreased FEV1: FVC ratio Mild = 60-80% Moderate = 40-60% Severe = <40%
133
What is the characteristic feature for COPD when compared with asthma in terms of bronchodilator?
No bronchodilator reversibility
134
What is seen on a CXR for a patient with COPD?
* Reveals hyperinflation (>6 anterior ribs, flat hemidiaphragm). * Decreased peripheral lung markings * Elongated cardiac silhouette
135
What type of respiratory failure is associated with COPD?
Type 2 respiratory failure
136
What is the lifestyle management for COPD?
Smoking cessation
137
What is the first-line management for COPD?
SABA or SAMA | Salbutamol or ipratropium bromide
138
If there are more than 2 COPD exacerbations per year what is the step-up management for COPD?
Long-acting bronchodilators
139
Describe asthmatic features/steroid responsiveness
Previous diagnosis of asthma/atopy Raised blood eosinophil count Substantial variation in FEV1 over time Substantial diurnal variation in peak expiratory flow
140
What is the long-term management for COPD?
SABA as required | LAMA + LABA
141
What is the long term management for asthma-COPD overlap?
SABA or SAMA as required | LABA + ICS
142
What is the management for acute exacerbations of COPD?
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.
143
What is asthma?
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
144
What are the cardinal features of asthma?
``` Atopy/Allergen sensitization Reversible airflow obstruction Airway inflammation Eosinophilia Type 2 lymphocytes ``` Wheeze/+- dry cough on exertion worse with colds and allergen exposure
145
What type of immune reaction is associated with asthma?
Type 2 immunity in allergic asthma
146
What cytokines are released in Asthma?
* 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.
147
What roles does IL-5 have in asthma?
Maturation and releases of eosinophils in the bone marrow
148
What does role does IL-4 have in asthma?
A prominent lumen mediator that supports the activation of B-cells into plasma cells to release IgE
149
What effect does IgE have in asthma?
Mast-cell degranulation leading to the release of histamines and cytokines
150
What blood test is used to test for allergic sensitiation?
Blood test for specific IgE antibodies to allergens
151
What are the risk factors for asthma?
Family history | Atopy (Tendency for T lymphocytes to drive production of IgE exposure
152
What environmental factors are associated with asthma?
* House dust mites * Pollen * Pets * Cigarette smoke * Viral respiratory tract infections * Aspergillus fugimatus spores * Occupational allergens
153
What is the presentation of asthma?
* Intermittent dyspnoea * Wheeze * Cough (worse in the morning and at night) + sputum. DIURNAL pattern of symptoms. * Nasal polyposis
154
When is the asthma cough worse during the day?
Worse in morning and at night
155
What is the pattern of symptoms for asthma?
Diurnal
156
What are the precipitating factors for asthma?
• 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).
157
What are the examination findings for asthma?
* Tachypnoea * Use of accessory muscles * Prolonged expiratory phase * Polyphonic wheeze * Hyperinflated chest * Hyper-resonant percussion notes * Reduced air entry
158
What defines a moderate asthma attack for PEFR?
PEFR > 50-75% predicted.
159
What parameters are associated with a severe asthma attack?
* PEFR 35-50% predicted * Pulse > 100/min * RR > 25/min * Inability to complete sentences.
160
What parameters are associated with a life-threatening asthma attack?
* PEFR < 33% predicted * Silent chest * Cyanosis – PaO2 < 8 kPa, normal/high PaCO2 > 4.6 kPa, low pH <7.35. * Bradycardia * Hypotension * Confusion * Coma
161
What investigations are performed for the diagnosis of asthma?
Fractional exhaled nitric oxide (FeNO) Spirometry with bronchodilator reversibility test Peak Expiratory flow rate
162
What does a FeNO test reveal in asthma?
Confirm eosinophilic airway inflammation to support an asthma diagnosis in patients Adults >40ppb >35 ppb in children
163
What does a FeNO test reveal in asthma for adults?
>40 ppb
164
What does a FeNo test reveal in asthma for children?
>35 ppb
165
What does a FeNo indicate in a patient with diagnosed asthma?
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.
166
What does a spirometer with a bronchodilator reversibility test reveal?
FEV1/FVC ratio <70% | Defined improvement >12%
167
What is the defined improvement with the administration of a bronchodilator in asthma?
>12%
168
What does an FBC reveal in asthma?
Eosinophillia
169
What are the atypical signs associated with mycoplasma pneumonia?
Transverse myelitis (inflammation of spinal cord) Erythema multiforme (round lesions with bullseye appearance) Associated with autoimmune haemolytic anaemia
170
What does erythema multiforme look like?
Round lesions with bullseye appearance
171
What atypical pnuemonia organism is associated with erythema multiforme?
Mycoplasma pnuemoniae
172
On inspection what signs are seen in pnuemonia?
Respiratory distress | Cyanosis
173
On palpation what is seen in pneumonia?
Reduced chest expansion
174
On percussion what is seen in pnuemonia?
Dull percussion over areas of consolidation
175
What is auscultated in pnuemonia?
Basal coarse crepitations Bronchial breathing Increased vocal resonance
176
What is the most common cause of CAP?
Streptococcus pneumoniae
177
What is the most common cause of atypical pneumonia?
Legionella pneumophilia | Chlamydia psitacci
178
What is the most common cause of HAP?
Staph Aureus Pseudomonas aeruginosa Klebsiella
179
Which pnuemonia is associated with pet birds?
Chlamydia psitacci
180
Which pnuemonia is associated with air conditioning?
Legionella
181
What atypical signs are associated with legionella pneumonia?
Hyponatremia | Abnormal LFTs
182
Hyponatremia is associated with what type of atypical pneumonia?
Legionella
183
What bedside test is used in diagnosing pneumonia?
Sputum MCS
184
What blood tests are used in diagnosis pnuemonia?
FBC (high WCC) CRP (high) ABG (Type 1 resp failure)
185
What invasive tests are used in diagnosing pneumonia?
Pleural fluid MCS via thoracentesis
186
What investigations are performed in diagnosing atypical pneumonia for mycolplasma?
Blood film | Red cell agglutination with cold agglutinin
187
What blood film result i associated with mycoplasma pneumonia?
Red cell agglutination with cold agglutinin
188
What tests should be performed in legionella?
Urinary antigens | LFTs
189
What is lobar pnuemonia?
Consolidation is confined within one lobe
190
What is bronchopneumonia?
Consolidation all over the lungs
191
A score of 1 in CURB-65 =?
GP and oral ABx
192
A score of 2 CURB-65=?
A&E and IV ABx
193
A score of >3 CURB-65 =?
Hospital admission +IV ABx,consider ITU
194
How is confusion assessed in CURB-65?
AMTS <8
195
What RR CURB-65?
30 breaths per minute
196
What systolic BP in CURB-65?
<90 mmHG
197
What Abx is used for typical organisms in pneumonia?
Amoxicillin | Co-Amoxicillin if severe
198
What Abx is used for atypical pneumonia?
Clarithromycin
199
If a patient has a penicillin allergy what Abx is given in pneumonia?
Doxycycline
200
What pneumonia is associated with HIV patients?
Pneumocystis jiroveci
201
Which Abx is given in pneumocystis jiroveci?
Co-trimoxazole (trimethoprim and sulfamethoxazole)
202
What type of resp tract infection is associated with acute bronchitis?
Upper respiratory tract infection
203
What are the typical organisms associated with acute bronchitis?
``` Rhinovirus Parainfluenzae Influenza A or B RSv Covid-19 ```
204
What are the risk factors for acute bronchitis?
Smoking Cystic fibrosis Asthma COPD
205
What type of cough is associated with acute bronchitis?
Non-productive cough | Lasts weeks
206
How is the diagnosis of acute bronchitis made?
Based on clinical presentation
207
What is the management of acute bronchitis in healthy patients?
Paracetamol and ibuprofen as required | Hydration
208
What is the management of 2 week persistent cough in acute bronchitis?
Inhaled corticosteroids
209
In wheezy acute bronchitis what is the management?
Inhaled SABA
210
What should be given in acute bronchitis and history of lung pathology (COPD, asthma)?
Amoxicillin | Doxycycline if penicillin allergy
211
Define a PE
A blockage in one of the pulmonary arteries in the lungs
212
What type of chest pain is associated with a PE?
Pleuritic
213
What is an acute massive PE?
Sudden complete occlusion of pulmonary artery
214
What is the presentation of an acute massive PE?
Collapse Central crushing pain Severe dyspnoea
215
What ECG changes are found in a PE?
S1Q3T3 pattern RAD RBBB Sinus tachycardia
216
What sign is seen on a CXR for a PE?
Westermark's Sign
217
What is an acute small PE?
Sudden incomplete occlusion of pulmonary artery
218
What is the presentation of an acute small PE?
Pleuritic chest pain Haemoptysis Dyspnoea
219
What is a chronic PE?
Chronic occlusion of the pulmonary microvasculature
220
What is the presentation of chronic PE?
Exertional dyspnoea
221
What is S1Q3T3?
S wave in Lead 1 Q wave in Lead 3 Inverted T wave in lead 3
222
What causes Westermark's sign?
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
What score is associated with a CTPA referral in PE?
>4 (or equal)
224
What Well's score is equal to low-risk PE?
<4
225
A score more than 4 warrants what investigation in suspected PE?
CTPA
226
What mnemonic is associated with Well's score?
PE SCORE
227
Alternative to CTPA in pregnant PE?
VQ scan
228
What defines define haemodynamic stability?
SBP >90 mmHG
229
In a haemodynamically stable patient what anticoagulant is used?
Fondaparinux/heparin for 5 days | Warfarin for 3 months
230
What is the first-line management for a massive PE in haemodynamic unstable patients?
Thrombolysis with respiratory support | -Use IV alteplase
231
What thrombolytic therapy is used in PE?
Alteplase (IV) Streptokinase rt-PA
232
What is the second line management for PE if thrombolytic therapy fails?
Embolectomy
233
What pharmacological prophylaxis is given for PE?
Tinzaparin - low molecular weight heparin
234
What is traumatic pneumothorax?
Damage to the parietal pleura
235
What i the normal intrapleural pressure?
-5to-8cm H2O
236
Which pleural is affected in spontaneous pneumothorax?
Damage to the visceral pleura
237
What is the main risk factor for a primary pneumothorax?
Young thin male
238
What are associated with secondary pneumothorax?
Pre-existing lung pathology, CF and COPD
239
What is the management of primary pneumothorax >2cm or SOB?
Needle aspiration (Consider chest drain if unsuccessful)
240
What is the management for a secondary pneumothorax >2cm or SOB?
Chest drain
241
What happens in a tension pneumothorax?
A one-way valve is created, inspiration causes continuous accumulation of air in the pleural space
242
Which type of pneumothorax is associated with tracheal deviation?
Tension pneumothorax, away from the side of the lesion + Reduced expansion -Hyper-resonant chest Mediastinal shift
243
Why is tension pneumothorax an emergency?
The mediastinal shift causes hypotension and tachycardia
244
What is the management for a tension pneumothorax?
Insert large bore cannula in 2nd ICS MCL, place above the third rib to avoid the neurovascular bundle
245
What is the definition of ARDS?
Non-cardiogenic pulmonary oedema
246
Which criteria is used to assess and define ARDS?
Berlin Criteria
247
What is the Berlin criteria?
No alternative cause for pulmonary oedema - cardiac failure Rapid onset <1 week Dyspnoea Bilateral signs on CXR
248
What are the causes of ARDs?
ARDs is caused by hypoaxemia acute lung injury ``` Sepsis Pneumonia Ventilation Severe burns Acute pancreatitis Transfusion reactions Drug overdose COVID-19 ```
249
What happens in ARDs?
Pulmonary alveolar oedema and eventual lung collapse
250
What CXR findings are seen in ARDs?
Bilateral diffuse opacities
251
What is the management of ARDs?
``` Proning - alveolar recruitment ICU Ventilator Diuresis Drainage of effusion ```
252
What is the most common cause of bacterial community acquired pneumonia?
Streptoccocus pneumoniae
253
Which atypical organism is associated with faulty air condition systems?
Legionella Pneumophilia
254
What scoring system is used to assess CAP severity?
CRB-65 | CURB-65
255
What non-invasive bedside tests can be used to identify the causative organism?
Sputum culture Urinary antigen testing
256
What is pneumonia?
Infection of the lung parenchyma
257
What are the risk factors of pneumonia?
Old age Chronic lung condition (Asthma/COPD) Immunosuppression Aspiration risk Smoking Travel
258
What two categorises are CAP divided into?
Typical and Atypical
259
What are the common typical organisms for CAP?
Strep pneumoniae Haemophlius influenzae B Staphyloccous aureus Klebsiella pneumonia Moraxella catarrhalis
260
What are the common atypical organisms for CAP?
Mycoplasma pneumonia Legionella pneumonphilia Chlamydia psitacci Coxiella burnetti Pneumocystitis jirovecii
261
What are the common causes of HAP?
Pseudomonas aeurgonosa
262
What bacterial organism is associated with COPD and bronchiectasis?
Haemophilus Influenzae
263
What bacterial organism i responsible for causing cavitating lesions and abscesses in typical CAP?
Staphyloccous aureus
264
Which type of pneumonia is common amongst chronic alcoholic patients?
Klebsiella pneumonia
265
What dermatological presentation is associated with mycoplasma a pneumoniae?
Target skin lesion | -Erythema multiforme
266
What electrolyte imbalances are associated with legionella?
Hyponatremia and abnormal LFTs
267
What causes Parrot fever?
Chlamydia psittaci
268
Which pneumonia is associated with HIV (AIDs)?
Pneumocystitis jirovecci
269
Which bacteria can cause cavitating lung lesions?
Staph aureus | Klebsiella
270
What are the common causes of cavitating lung lesions?
Malignancy (Squamous cell carcinoma) Wegener's granulomatosis Rheumatoid arthritis Septic embolic TB Abscess
271
What kind of bacteria is strep pneumoniae?
Gram-positive (Diplococci)
272
What type of bacteria is Haemophilus influenzae, klebsiella pneumoniae and pseudomonoas?
Gram-negative
273
What are the clinical symptoms pneumonia?
``` Pleuritic chest pain Productive mucopurulent cough (Green sputum) Fever/Rigors Shortness of breath Confusion (Elderly patients) ```
274
What are the common causes of pleuritic chest pain?
``` Pneumothorax Pulmonary embolism Pericarditis Pneumonia Pleural effusion ```
275
What symptoms are associated with atypical pneumonia?
Dry cough (Inflammation spares the alveoli) Headache Myalgia Hepatitis Low grade fever Diarrhoea
276
What are the clinical signs of typical pneumonia?
``` Reduced chest expansion (asymmetrical) Dullness to percussion Cyanosis Respiratory distress Coarse basal crepitations Bronchial breathing Increased vocal resonance ```
277
What observations are evident in pneumonia?
``` Tachycardia Tachypnoea Low blood pressure indicating sepsis Reduced peripheral oxygen saturation Raised temperature ```
278
What imaging modality is gold-standard for pneumonia?
Chest X-ray
279
What investigation is performed to diagnose for legionella pneumonia?
Urinary antigen testing
280
What two organisms are assessed for urinary antigen testing?
Legionella | Streptococcus pneumonia
281
What investigations are performed to confirm mycoplasma pneumonia?
PCR
282
What are the common features of pneumonia on a CXR?
Alveolar opacificaion Air bronchograms Consolidation
283
What are air bronchograms?
Bronchi being filled with air surrounded by alveoli that are filled with pus
284
What does diffuse patchy infiltrates reveal on XR (Pneumonia)
Interstitial pneumonia (PCP)
285
CURB-65 0 - 1 =
treatment as outpatuent
286
CURB-65 2 =
Consider admission to hospital
287
CURB-63 3 =
ICU admission
288
What 3 ABx are indicated for CAP management?
Amoxicillin Clarithromycin Doxycycline
289
What ABx should be prescribed for typical pneumonia (Allergic to penicillin)?
Doxycycline
290
What ABx is administered for pneumonia in the community (CURB-65 =1)?
Amoxicillin
291
What ABx is administered for CAP with curb-2?
Amoxicillin and clarithroymycin
292
What ABx is prescribed in CAP with CURB-65 >3?
IV co-amoxiclav and clarithryocmyin
293
What ABx should be prescribed in pregnancy for CAP?
Erythromycin
294
First-line ABx for HAP?
Co-amoxiclav
295
ABx for MRSA HAP pneumonia?
IV Vancomycin
296
ABx for pseudomonas HAP?
IV Tazocin + gentamicn
297
ABx for aspiration pneumonia?
Amoxicillin | Metrondazole
298
ABx for PCP?
Co-trimoxazole
299
What CXR findings are observed in PCP?
diffuse patchy infiltrates
300
What is bronchiectasis?
Chronic lung condition defined as the abnormal irreversible dilation of the bronchi and bronchioles
301
What are the two common causes of bronchiectasis ?
TB | Cystic fibrosis
302
What are the risk factors for bronchiectasis?
Post-infection - TB Immunodeficiency Chronic aspiration - GORD/dysphagia Chronic inflammation COPD Congenital - Cystic fibrosis
303
What is the triad of Kartagener's syndrome?
Sinusitis Bronchietasis Situs inversus
304
What is the presentation of bronchiectasis?
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
What examination finding in the hands are associated with bronchiectasis?
Clubbing
306
What are the respiratory causes of clubbing?
``` Bronchiectasis Lung cancer Pulmonary fibrosis TB Cystic fibrosis Empyema Lung abscess ```
307
On auscultation what is heard in bronchiectasis?
Coarse crackles the lower ling zones
308
What sputum is produced in bronchiectasis?
Mucopurulent
309
Beside investigation for productive cough?
Sputum culture - HIB, Pseudomonas aerugonisa, strep pneumoniae
310
What sign is seen in XR for bronchiectasis?
Tram-tracking
311
What is the gold standard investigation for bronchiectasis?
High resolution CT
312
Bronchiectasis + IgE + Eosinophilia is =?
ABP A
313
What investigation i performed for diagnosing cystic fibrosis?
Sweat test
314
Which serum marker is raised in ABPA?
Serum IgE
315
What findings are seen in HRCT in bronchiectasis?
Signet ring sign
316
What is the conservative management for bronchioectasis?
Chest physiotherapy and airway clearance - Postural drainage - Nebulised hypertonic saline
317
What is the pharmacological management for bronchiectasis?
Steroids/bronchodilators | ABx
318
What Abx is used to treat Psueodmonas resp infection?
Ciprofloxacin
319
What complication is associated with ciprofloxacin?
Achille tendon rupture
320
What is the surgical indication for localised resection of bronchiectasis?
For localised disease Indicated in massive haemoptysis
321
What part of the lungs does TB affect?
Upper lobe
322
What bacterium is associated with TB?
Mycobacterium tuberuclosis
323
What is latent TB?
Contained in caseating granulomas (not transmissible)
324
Caseating granulomas in the lung indicate what pathology?
TB
325
Rfx fr TB?
HIV Immunosuppressive Overcrowding
326
What are the signs and symptoms of TB?
``` Productive cough Dyspnoea/SOB haemoptysis Pleural effusion ] FLAWS - low grade fever weight loss ``` Lymphadenopathy Erythema nodosum
327
What skin manifestation is associated with TB?
Erythema nodosum | Lupus vulgaris
328
What TB disease complication affects the spinal cord?
Pott's disease | -osteomyelitis of the spine
329
What are the endocrine complications of TB?
Addison's disease | Sterile pyuria
330
Bed side investigations for TB?
Sputum culture - acid-fast bacilli stain (Ziehl-Neelsen)
331
What staining is done for TB?
acid-fast bacilli stain (Ziehl-Neelsen)
332
What imaging is performed in tb?
CXR - revealing bi-hilar lymphadenopathy
333
What CXR finding is found with TB?
bi-hilar lymphadenopathy Consolidation Upper lobe scarring Cavitating lesions
334
What does a lymph node biopsy reveal in TB?
Caseating granuloma
335
What test is used to determine whether a patient has latent TB?
Mantoux test - Tuberculin skin test -Immune reaction = latent + Interferon Gamma Release Assay
336
What is miliary TB shown on CXR?
Nodular shadowing
337
What is miliary TB?
Lymphohaematageous dissemination of TB
338
What are the four drugs in TB management?
Rifamipicin Isoniazid Pyrazinamide Ethambutol
339
Which TB drug is associated with peripheral neuropathy and vitamin b6 deficiency?
Isoniazid
340
Which TB drug causes gout?
Pyrazinamide
341
Which TB drug causes optic neuritis?
Ethambutol
342
What are the two types of lung cancer?
Small cell lung cancer | Non-small cell lung cancer
343
What type of cells are associated with small cell carcinoma?
Endocrine cells (Kulchitsky)
344
What are the three types of non-small cell lung cancer?
Adenocarcinoma (Goblet cells) Squamous cell carcinoma Large cell carcinoma
345
What is the most common type of lung cancer?
Non-small cell lung cancer
346
What 3 paraneoplastic syndromes are associated with small cell lung cancer?
SIADH ACTH -Cushing's Lambert Eaton Syndrome
347
What cells are associated with adenocarcinoma?
Goblet cells
348
Where do adenocarcinomas arise from in the lung?
Peripheral
349
Squamous cell carcinomas secrete what type of peptide?
PTHrP | Central lung
350
What is the largest risk factor for lung cancer?
Smoking
351
What are the primary symptoms of lung cancer?
Cough (Dry or productive) Haemoptysis SOB FLAWs
352
What signs are seen in lug cancer?
Clubbing Tar staining of fingernails (Smokers) Lymphadenopathy Dull percussion Stony dullness Increased vocal resonance
353
What syndrome is associated with a Pancoast tumour?
Horner syndrome
354
What chain is compressed in Horner syndrome?
Cervical sympathetic chain
355
What is the triad of horner syndrome?
Miosis Partial Ptosis Anhidrosis
356
What is the presentation of an apical lung tumour (Pancoast)?
Horner syndrome Brachial plexus compression - paraesthesia Recurrent laryngeal nerve compression - hoarse voirce and bovine cough
357
What sign is sign in a tumour in the right lung apex? (SVC)
Pemberton's sign | Pooling of blood - oedema
358
What bloods are performed for lung cancer?
Calcium - bone mets and PTHrp ALP - bone mets LFTs - liver mets
359
What is the first-line radiological investigation for lung cancer?
CXR
360
What scan is used to stage lung cancer?
CT chest, abdomen and pelvis and PET
361
How is biopsy performed for lung cancer?
Bronchoscopy with transbronchial resection Or transthoracic needle
362
How does lung cancer mets reveal on CXR?
Cannon ball mets
363
What is a mesothelioma?
Malignant neoplasm of mesothelial cells of the pleura
364
What is the biggest risk factor for mesothelioma?
Asbestos exposure
365
What is the presentation of mesothelioma?
``` Dry cough FLAWS -SOB -Weight loss -loss of appetite -Night sweats ``` Signs - pleural friction rub
366
On auscultation what does mesothelioma sound like?
Pleural friction rub
367
What are the invasive investigations for mesothelioma?
Pleural fluid cytology via thoracentesis (Pleural tap)
368
What X-ray features are associated with a mesothelioma?
Pleural thickening Pleural plaques due to asbestos Pleural effusions
369
How is mesothelioma diagnosed?
Thoracoscopy and histology
370
What spirometry findings are associated with asthma FEV1/FVC?
FEV1/FVC <70% with bronchodilator reversibility
371
Which cells are implicated in the pathophysiology of asthma?
Mast cells and basophils - IgE mast cell degranulations - Eosinophil
372
What is the four pathophysiology steps in asthma?
Epithelial airway damage Vascular smooth muscle hypertrophy Airway hyperrresponsiveness Mucous plugging Reversible airway obstruction with intact lung parenchyma
373
What is the presenting complaint for asthma?
``` SOB Dry cough Chest tightness Variability of symptoms Diurnal - worse at night Wheeze Atopic (Food allergies, eczema and hayfever) ```
374
When are asthma symptoms worse during the day?
During the night
375
What are the signs of asthma?
Expiratory polyphonic wheeze Work of breathing Nasal polyps
376
What is the triad of atopy (asthma)?
Hay fever Food allergy Eczema
377
Which conditions make asthma worse?
GORD -reflux exacerbates asthma
378
What questions asked for suspected asthma?
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
What test is used to assess asthma control?
Asthma control test (ACT)
380
What is the FEV1/FVC ratio or asthma?
<70%
381
What two investigations are indicated for the diagnosis of asthma?
FeNO Spirometry (FEV reduced) Bronchodilator reversibility >12%
382
By what % does bronchodilatory reversibility increase FEV1 in asthma?
12%
383
FeNO result in adults?
>40 ppm
384
What is the first-line management for asthma?
Salbutamol (SABA) | Address triggers, smoking cessation and mediation adherence
385
What colour is a reliever inhaler?
Reliever- SABA -Blue
386
What colour is a preventor inhaler?
Brown - Low dose ICS
387
What are the management indications for beginning Low Dose ICS with SABA?
Not controlled on previous step OR Newly-diagnosed asthma with symptoms >= 3 / week or night-time waking
388
What medication is added if Low Dose ICS and SABA is unresponsive in asthma?
Leukotriene receptor antagonist (montelukast)
389
What class of drug is montelukast?
Leukotriene receptor antagonist
390
Name an ICS?
beclometasone, budesonide, ciclesonide, fluticasone, and mometasone
391
Name a LABA
salmeterol | formoterol
392
Name a SAMA
ipratropium, | tiotropium,
393
What is the step-up management despite the use of LTRAs?
Add LABA
394
What is the step-up management despite the LABA SABA ICS?
Add LABA as MART
395
Why is MART effective in asthma?
LABA and ICS | ICS suppresses inflammation and LABA short-acting to relieve symptoms
396
What is occupational asthma?
Common industrial lung disease, due to inhaled particulates at work -Symptoms improve during work cessation
397
What is COPD?
Small airway obstruction Emphysema Goblet cells hyperplasia - more mucous -Irreversible airway obstruction
398
What is the biggest risk factor for COPD?
Smoking
399
What is the presentation of COPD?
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
What is the gold-standard investigations for COPD?
Spirometry - post-bronchodilator FEV1/FVC <0.7 with no bronchodilator reversibility Low oxygen saturations CXR - hyper-expansion, air trapping Exclude anaemia
401
What test assesses COPD impact on quality of life?
CAT
402
What is the first step of COPD management?
Smoking management | -Offer pneumococcal and influenza vaccines
403
What is the first-line pharmacological management for COPD?
SABA (as required) or SAMA LABA LAMA regularly
404
What is the long-term management for COPD is there are asthmatic features?
LABA + ICS
405
What are asthmatic features in COPD?
FEV1 variability, high eosinophils, peak flow variability
406
``` Diagnosis: dextrocardia or complete situs inversus bronchiectasis recurrent sinusitis subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes) ```
Kartagener's syndrome
407
What type of crepitations are associated with idiopathic pulmonary fibrosis?
Bibasal Fine end inspiratory
408
What is idiopathic pulmonary fibrosis?
Lung scarring of an unknown cause -Fibrosis of the parenchyma stats around the pleura - predominantly in the basal and intersitital pneumonia pattern- subpleura
409
What is the epidemiology of IPF?
Older male >65 years | Smoking and FHx
410
What are the symptos of IPF?
``` Progressive SOB Exertional dyspnoea Dry cough Weight loss, fatigue and malaise Slow insidious onset ``` Bi-basal fine end inspiratory crepitations Clubbing
411
What is the gold-standard investigation for IPF?
High-resolution CT to show pattern of fibrosis
412
What does spirometry reveal in IPF (restrictive)?
FEV1/FVC >70%
413
What is DLCO?
Diffusing capacity for carbon monoxide | -Suggests alveolar pathology
414
Which drugs can cause IPF?
Amiodarone, nitrofuratoin and methotrexate
415
What is the definitive management for IPF?
Pulmonary rehabilitation ``` Consider pirfenidone (an antifibrotic agent) -If FVC is between 50-80% ```
416
What skin features are associated with sarcoidosis?
Erythema nodosum bilaterally on the shins Lupus pernio
417
What X-ray features are associated with sarcoidosis?
Bilateral hilar lymphandenopathy
418
What is the presentation of sarcoidosis?
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
What is epidemiology of sarcoidosis?
Afro-Caribbean female with cough and skin patch on her shin Scandinavian FHx Infections like TB Females 20-40
420
What is the pathology of sarcoidosis?
Non-caseating (Non-necrotic) granulomas deposited around the body
421
What is the presenting complaint of sarcoidosis?
Lungs- - Chronic dry cough - Progressive shortness of breath with exertional dyspnoea - Disproportionate chronic fatigue Eye problems - photophobia, red painful eye/blurry vision
422
What skin lesions arise in sarcoidosis?
Lupus pernio (Rash on face, nose and ears)
423
What eye features are associated with sacoidosis?
Photophobia Red painful eye Blurry vision Anterior or posterior uveittis
424
What respiratory signs are associated with sarcoidosis?
Wheeze | Rhonchi
425
What is Lofgren's syndrome?
Pulmonary manifestation of sarcoidosis - Bilateral hilar lymphandeophathy - Erythema nodosum - Arthralgia - Fever
426
What is stage 1 sarcoidosis?
Bilateral hilar lymphandenopathy
427
What is stage 2 sarcoidosis?
Bilateral hilar lymphandenopathy + pulmonary infiltrates
428
Sarcoid deposits in the parotid gland results in what?
Parotid enlargement manifesting as facial nerve palsy
429
What cardiac complication is associated with sarcoidosis?
Restrictive cardiomyopathies
430
Why is calcium raised in sarcoidoiss?
1-alpha-hydroxylase. -vitamin D elevated due to macrophage release And high ACE enzyme
431
What electrolyte imbalance is associated with sarcoidosis?
Calcium
432
Which enzyme is elevated ins sarcoidosis
ACE
433
What blood test results are consistent with sarcoidosis?
High calcium and high serum ACE low PTH in response to high calcium
434
At what stage of sarcoidosis is prednisolone indicated?
Stage 2/3
435
What is the definitive management of OSA?
CPAP at night
436
What is the presentation sleep apnoea?
Loud snoring Daytime sleepiness Restless sleep
437
What questionnaire is performed for sleep apnoea?
STOP-BANG sscore
438
What are the parameters assessed in the STOP-BANG score?
Snoring Tired Observed apnoea Pressure (BP) BMI>35 Age >35 Neck circumference >40cm Gender -male
439
What is the diagnostic investigation for sleep apnoea?
Polysomnography | -Apnoea and hypopnoea index
440
What is the management for asymptomatic and mild sleep apnoea?
Intra-oral mandibular advancement device
441
What are the indications for ABx therapy in acute bronchitis?
have a CRP of 20-100mg/L (offer delayed prescription) or a CRP >100mg/L (offer antibiotics immediately)
442
What is coal workers pneumocoinosis?
Exertional dyspnoea and cough Coal deposits in the lungs Progressive massive fibrosis +/- black sputum
443
What does a CXR reveal in coal worker's pneumoconiosis?
Large round fibrotic masses in the upper lobes
444
What is the presentation of silicosis?
Upper lobe fibrosis masses with hilar egg shell calcification
445
What X-ray features are found in silicosis?
'egg-shell' calcification of the hilar lymph nodes
446
What occupations are associated with silicosis?
Stonemason Pottery Ceramics
447
What characteristic radiographic findings are associated with asbestosis?
Pleural plaques - Thickening and calcification of the pleura visible -Causes occasionale exertional dyspnoea Asbestos bodies
448
What are the features associated with asbestosis (presentation)?
Progressive dyspnoea Dry cough FLAWs - haemoptysis ``` Clubbing reduced expansion Bibasal crackles RHF Asbestos warts ```
449
What is extrinsic allergic alveolitis?
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
What is the presentation of extrinsic allergic alevolitis?
Dyspnoea Cough +/- sputum Malaise
451
What HRCT findings is associated with EAA?
Ground glass appearance
452
Management for EAA?
avoid precipitating factors | oral glucocorticoids
453
Name a cause of transudative pleural effusion? | Protein level <30g
Nephrotic syndrome Heart failure (Congestive) PE cirrhosis
454
What is a respiratory complication of pancreatitis?
ARDS
455
What are the clinical features of ARDS?
dyspnoea elevated respiratory rate bilateral lung crackles low oxygen saturations
456
Definition of ARDS
non-cardiogenic pulmonary oedema.
457
In what patients is Klebsiella pneumonia common in?
Klebsiella pneumonia is more common in diabetics and patients with a history of alcohol excess. It is also frequently caused by aspiration.
458
Red/Jelly-like sputum is associated with what type of pneumonia?
Klebsiella
459
A negative spirometry testing indicates what further investigation in asthma management?
Fractional exhaled nitric oxide
460
What are the common causes of exudative pleural effusion?
Pneumonia Malignancy Connective tissue disease
461
Hyperventilation causes what blood gas result?
Respiratory alkalosis
462
What is the management for an acute exacerbation of asthma?
``` Oxygen Salbutamol Hydrocortisone Ipratropium bromide Theophylline Magnesium sulphate ```
463
Are pleural plaques in asbestos-related lung disease concerning?
No - are benign and therefore do not require monitoring
464
What are the common causes of upper zone fibrosis?
``` C- Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis ```
465
What parameter is used to assess for COPD severity?
FEV1
466
What is auscultated for a malignancy of the bronchus?
Monomorphic wheeze
467
What type of pleural effusion is malignancy?
Exudative pleural effusion
468
What is the parameter for exudative pleural effusion?
>30g/L

Phase1c Medicine (11 decks)

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