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Year 1 Incorrect Questions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Epigastric pain and vomiting
Chest X-ray reveals bilateral infiltrates and a normal-sized cardiac silhouette
Heavy drinker, high lipase, high RR, low sats
What is feature of this complication the patient has developed?

A

ARDS - Diffuse alveolar damage with hyaline membrane formation (from acute pancreatitis)

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2
Q

Cardiothoracic ratio in ARDS with no signs of HF

A

<0.5

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3
Q

Anti-microbial causing high INR

A

Metronidazole (IV)

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4
Q

What is this asthma patient’s acid-base balance?

Low pH, low O2, high CO2, normal bicarb

A

Resp acidosis w no metabolic compensation

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5
Q

Conditions for discharge after acute asthma attack?

A

Stable on salbutamol inhaler for 24h

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6
Q

What type of hypersensitivity is asthma?

A

Type 1

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7
Q

Next step in asthma after using salbutamol v often

A

ICS 200mg

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8
Q

First-line asthma treatment if patient reports symptoms 2/3x week/night time waking

A

SABA + ICS

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9
Q

What position should you take peak flow in?

A

Sitting/standing

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10
Q

3rd line asthma treatment after SABA and ICS

A

LABA

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11
Q

Features of life-threatening asthma

A

O2 sats <90%
PEFR <33%
Silent chest, bradycardia, hypotension, exhaustion

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12
Q

Who gets pneumococcal vaccine?

A

Chronic heart failure

>65 y/o

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13
Q

What vaccines should patient with RA on methotrexate, folic acid, hydroxychloroquine receive?

A

Influenza and pneumococcal

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14
Q

What type of pneumonia is common in caves and Mid West US that causes bilateral hilar lymphadenopathy?

A

Histoplasma capsulatum

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15
Q

What is the treatment for someone w 3/more infective exacerbations per year already on optimal meds?

A

Long term prophylactic antibios

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16
Q

Management in bronchiectasis patient w high fever and raised resp rate

A

IV antibiotics

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17
Q

Cause of bronchiectasis in patient w dull on exp and resonant on insp and left lung base

A

Primary ciliary dyskinesia (normal percussion changes are right sided)

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18
Q

CF can cause issues w what organs?

A

All of them!!!!!!

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19
Q

O2 treatment in COPD exacerbation with CO2 retention

A

4/L min Venturi mask - target sats 88-92%

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20
Q

Why would you not use a nasal cannula in someone w type 2 resp failure?

A

It can’t supply controlled level of O2 (unlike Venturi mask)

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21
Q

Use of 15L/min non rebreathe?

A

Critically ill/severely hypoxic patients (<75-80% in COPD patient)

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22
Q

Right axis deviation/right vent heave/hypertrophy on ECG

A

Neg deflection lead 1

Pos deflection lead 2

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23
Q

What heart condition can result from long-term hypoxia e.g. COPD?

A

Right vent hypertrophy

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24
Q

COPD second-line treatment

A

LABA (+ICS if patient has asthmatic features or suggests steroid responsiveness)

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25
Q

Common ECG changes in COPD

A 
RA deviation
Prominent P waves in inf leads
Inv P waves in high lateral leads (I, aVL)
Low voltage QRS
Delayed R/S transmission in V1-6
P pulmonale
RV strain pattern
RBBB
Mutlifocal atrial tachycardia
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26
Q

Next step in COPD CO2 retainer acute exac

A

28% O2 Venturi mask - to prevent over-oxygenating

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27
Q

COPD w CO2 retention in ABGs

A

Incr HCO3

Base excess

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28
Q

Signs of CO2 narcosis

A

Reduced work of breathing

Looking calmer

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29
Q

Criteria for LTOT

A

PaO2 <7.3 or 7.3-8 PLUS periph oedema, pulm HT, nocturnal hypoxaemia, secondary polycythaemia

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30
Q

Second line treatment for COPD patients w asthma or steroid resp w persistent exac

A

LABA + ICS (budesonide + formeterol)

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31
Q

What test can confirm COPD diagnosis?

A

Spirometry

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32
Q

Chloride level indicating CF in sweat test?

A

> 60mmol/L

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33
Q

Drug to prescribe if patient has excess airway secretions that they are struggling to clear

A

Hyoscine butlbromide SC (anticholinergic agent)

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34
Q

Cause of massive haemoptysis, previous aspiration pneumo, foul sputum, fever
CXR right lower lobe consolidation and central cavitation w air-fluid level

A

Lung abscess

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35
Q

Features of aspergilloma

A

Secondary to chronic lung disease

Target-shaped lesion (upper lobe)

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36
Q

What are the features of Horner’s syndrome?

A

Miosis
Partial ptosis
Anhidrosis
(Caused by pancoast tumour in left apex invading symp chain)

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37
Q

Key features of SCLC

A

Perihilar and central lesions

Paraneoplastic syndrome e.g. Cushing’s excreting ACTH

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38
Q

Horner’s syndrome

A
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38
Q

Horner’s syndrome

A
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38
Q

Horner’s syndrome

A
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39
Q

Signs of compression of sympathetic chain

A

Partial ptosis and miosis of right eye

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40
Q

What lung cancer causes hypercalcaemia?

A

Squamous

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41
Q

What antibodies are commonly present in SCLC w paraneoplastic syndrome?

A

Voltage-gated Ca channel antibodies (VGCC)

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42
Q

Symptoms of Cushing’s

A

Hyperpigmentation
Hypertension
Impaired glucose tolerance
Perhaps hypokalaemia

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43
Q

Most common occupational exposure pleual tumour

A

Asbestos

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44
Q

Features of mesothelioma on CXR

A

Pleural thckening

Some distinct plaques

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45
Q

Where would a cancer with monophonic wheeze be?

A

Central (squamous cell)

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46
Q

Common symptoms w lung adenocarcinoma

A

Clubbing

Hypertrophic pulm osteoarthropathy (painful wrist swelling)

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47
Q

Drug for reduction of swelling in SVCO caused by lung cancer

A

Dexamethasone

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48
Q

First line treatment of hypercalcaemia

A

IV fluids and then IV phosphates as they take 2-4 days to respond

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49
Q

Carcinoid syndrome features

A

Facial flushing
Diarrhoea
Asthma
Lung nodule (demarcated opacification)

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50
Q

Investigation for carcinoid syndrome

A

Urinary 5-HIAA excretion (ID serotonin metabolite)

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51
Q

Which lung cancer causes hyponatraemia?

A

Small cell (SIADH)

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52
Q

How can stroke influence lung abscess?

A

Risk of aspiration due to impaired swallow causing infection in lung

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53
Q

Most common microbe in abscesses

A

Anaerobic bacteria esp w impaired swallow

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54
Q

Which sex is more affected by OSA?

A

Males

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55
Q

What scoring is used for OSA?

A

Epworth Sleepiness Scale

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56
Q

What test may be used before polysomnography in OSA?

A

Overnight pulse oximetry

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57
Q

What is Meig’s syndrome?

A

Ovarian tumour + pleural effusion + ascites

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58
Q

What change in pulm cap pressure can cause pleural effusion?

A

High pressure

Leads to transudation of fluid into pleural cavity

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59
Q

Causes of transudate vs exudate

A

Transudate (incr intravasc pressure/reduced osmotic pressure)
Exudate (inflam, infection, neoplasm)

60
Q

Exudative pleural effusion w fatigue/MSK pain/rash/erythemous rash of nose/oral ulcers

A

Systemic lupus erythematosus
Incr ANA
Low complement

61
Q

What type of effusion can hypothyroidism cause?

A

Transudative

62
Q

What type of effusion can lung adenocarcinoma cause?

A

Exudative

63
Q

Light’s criteria

A

Exudative effusion if:
The ratio of pleural fluid to serum protein is greater than 0.5
The ratio of pleural fluid to serum LDH is greater than 0.6
The pleural fluid LDH value is greater than two-thirds of the upper limit of the normal serum value

64
Q

Glucose levels in patient w pleural effusion secondary to RA

A

Low glucose (<3.3mmol/L)

65
Q

First line investigation of pleural fluid in empyema

A

pH analysis

<7.2 suggests empyema

66
Q

Fevers following pneumonia

A

Empyema

67
Q

Positive hepato-jugular reflex indicates?

A

Congestive heart failure

68
Q

First line HF treatment w pleural effusion

A

Furosemide (treat the cause!!!!!)

69
Q

When is pleural fluid aspirate not required in PEff?

A

When there is clear evidence of congestive HF

70
Q

Best diagnostic test for HF

A

Transthoracic echocardiogram

71
Q

Pneumonia causing low sodium

A

Legionella

72
Q

HAP due to pseudomonas treatment?

A

IV Ciprofloxacin

73
Q

Treatment of severe pneumonia from staph areus

A

IV co-amoxiclav + clarithromycin + flucloxacillin

74
Q

Stain to use in pneumocystis diagnosis

A

Silver stain

75
Q

Signs of pneumonia on auscultation

A

Incr tactile vocal fremitus

Dull precussion note

76
Q

Gm+ cocci in clusters pneumonia?

A

Staphylococcus aureus pneumonia

77
Q

First line antibio for staph pneumonia

A

Flucloxacillin

78
Q

Antibio for gm- pneumonia e.g. strep

A

Amoxicillin

79
Q

First line investigation for legionella

A

Urine antigen enzyme immunoassay test

80
Q

Hotel air conditioning pneumonia?

A

Legionella

81
Q

Confusion score on CURB-65

A

<8/10

82
Q

Antibio if penicillin allergy

A

Clarithromycin

83
Q

CURB-65 score 2 means?

A

Immediate risk of death

Admit to hosp for treatment and close observation

84
Q

Microbe causing flu-like illness, erythema (target-shaped), and anaemia symptoms in pneumonia

A

Mycoplasma pneumonia

85
Q

Lymphopenia plus hyponatraemia in pneumonia?

A

Legionella

86
Q

CAP with rusty sputum, fast onset symptoms, high fever

A

Strep pneumonia

87
Q

Treatment of empyema

A

Chest drain under radiological guidance

88
Q

Pneumonia assoc w AI haemolytic anaemia?

A

Mycoplasma pneumonia

89
Q

What type of pneumothorax if patient has asthma?

A

Secondary pneumothorax

90
Q

Marfan’s increases risk of which aortic pathology?

A

Acute aortic dissection

91
Q

What recreational drug can incr risk of pneumothorax?

A

Cannabis

92
Q

Pneumothroax management if there is mediastinal shift or haemodynamic compromise

A

Needle aspiration

93
Q

Immediate management of tension pneumo with noisy breathing and GCS 8

A

Airway manoeuvres (intubate if this fails)

94
Q

V/Q ratio in pneumothorax?

A

Lowered ratio

95
Q

Standard length of PE treatment

A

3 months

96
Q

Length of treatment in provoked/unprovoked PE

A

3 months provoked if cause is treated

>3 months if unprovoked

97
Q

Investigation to confirm(!!!!) PE

A

CT pulm angio (CTPA)

98
Q

Prescription of anticoag for PE post-op

A

LMWH as it is shorter acting in case there’s pos-op bleeding

99
Q

Absolute contraindication to thrombolysis

A

Past haemorrhagic stroke AT ANY TIME

100
Q

Anti-phospholipid syndrome incr risk of…

A

Venous thromboembolism/PE and prg-related morbidity

101
Q

Treatment of symptomatic suspected PE

A

DOAC (direct oral anticoag) instead of waiting until investigation results

102
Q

IPF spirometry results

A

Restrictive

103
Q

Treatment of UTIs that can cause pulm fibrosis

A

Nitrofuratoin

104
Q

Changes in FVC and FEV1 in PF

A

Both decr

105
Q

Gradual symp onset, clubbing, fine insp crackles

A

IPF

106
Q

RA causes fibrosis in what area of lungs?

A

Lower lobes

107
Q

Lower lobe fibrosis caused by…

A 
RA
IPF
Asbestosis
SLE
Scleroderma
Drugs e.g. methotrexate and bleomycin
108
Q

TLCO in IPF

A

Reduced

109
Q

Disease-modifying drug for IPF (long-term management)

A

Pirfenidone and nintedinab

110
Q

Cor pulmonale features

A

Pulm HT symptoms plus RH failure symptoms

111
Q

Investigation for pulm HT due to chronic thromboembolism (recurrent PEs)

A

Right heart catheterisation

112
Q

Auscultation signs in cor pulmonale

A

Split S2 w loud pulm component

113
Q

Bosentan side effects

A

Deranged LFTs

114
Q

What ABG result would panic attack cause?

A

Resp alkalosis w good O2 sats

115
Q

Treatment of type 2 resp failure w low pH and rising PaCO2

A

Non-invasive vent (NIV)

116
Q

Raised serum ACE indicates

A

Sarcoidosis

117
Q

Which ion is incr in sarcoidosis?

A

Calcium (hypercalcaemia)

118
Q

Treatment of symptomatic sarcoidosis

A

Oral prednisolone

119
Q

Bilateral parotid gland swelling?

A

Sarcoidosis

120
Q

Diagnostic test for sarcoidosis

A

Bronchoscopy w transbronchial lung biopsy

121
Q

Drug which can cause pulm fibrosis and restrictive spirometry

A

Methotrexate

122
Q

IgE mediated activ of mast cells type hypersensitivity

A

Type 1 hypersensitivity (asthma)

123
Q

Red urine side effect of which urine treatment?

A

Rifampicin (R for red)

124
Q

Best investigation for TB diag

A

Early morning sputum samples

125
Q

Best investigation for TB diag

A

Early morning sputum samples

126
Q

Peripheral neuropathy side effect of which TB drug?

A

Isoniazid (nia=neuro)

127
Q

Stain used in TB testing

A

Sputum acid-fast bacilli smear (AFB)

128
Q

Visual disturbance side effect of which TB drug?

A

Ethambutal (E for eyes)

129
Q

TB on CXR

A

Patchy opacification across both upper zones

130
Q

Treatment of theophylline toxicity

A

Activated charcoal

131
Q

The Haldane Effect

A

Oxygenated Hb releases CO2 more readily

132
Q

Lower V/Q in bases compared to apices means that base PO2 and PCO2 are..

A

Lower PO2

Higher PCO2

133
Q

Increase in ventilation rate causes alveolar ventilation rate to…

A

Decrease by same proportion

134
Q

Hypercalcaemia has what effect on muscle and nervous system?

A

Depresses both

135
Q

PTH secreting tumour has what effect?

A

Incr abs of Ca and phosphate

136
Q

Limb weakness improving with movement assoc with lung cancer?

A

Lambert-Eaton syndrome
- small cell cancer
- voltage-gated calcium channel (VGCC) antibodies

137
Q

Characteristic finding of mesothelioma on CXR

A

Plaque formation and pleural thickening

138
Q

CXR findings in asthma

A

Nothing specific
Hyperinflation

139
Q

COPD/asthma patient with acute exacerbation and chest infection with penicillin allergic?

A

Theophylline and macrolide antibiotics can interact and cause arrhythmias
- monitor theophylline levels v closely

140
Q

Bronchiectasis would show which spirometry pattern

A

Obstructive pattern (decr ratio)

141
Q

Low FEV1 and low FVC but normal FEV1/FVC ratio is suggestive of?

A

Restrictive lung disease

142
Q

IRA causes of pulmonary fibrosis

A

Idiopathic
Rheumatoid arthritis
Amiodarone/asbestosis

143
Q

First line investigation of cor pulmonale

A

Echocardiogram

144
Q

How would you manage CA pneumonia with a penicillin allergy?

A

IV levofloxacin 500mg bd

145
Q

Which lung cancer of the mid-zone is most common in non-smokers?

A

Adenocarcinoma

146
Q

Cushing’s syndrome is caused by which lung cancer?

A

Small cell lung cancer

147
Q

Diagnosis of asthma

A

Peak flow: variability >20%
Fractional exhaled nitric oxide (FeNO): >40 ppb adults or >35 ppb children
Spirometry: FEV1/FVC <70% (obstructive spirometry)

148
Q

Gold standard diagnostic test for PCP

A

Bronchoalveolar lavage

Year 1 Incorrect Questions (7 decks)

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