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PACES - Final Week Revision > Respiratory > Flashcards

Respiratory Flashcards

1
Q

I would complete my resp examination by checking

A

Sputum culture
Pulse oximetry
Observation charts
X-rays (recent)

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2
Q

Causes of apical fibrosis

A

ROAAST:
Radiation
Occupational exposure diseases
Allergic reactions (ABPA, EAA)
Ankylosing spondylitis
Sarcoidosis
Tuberculosis

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3
Q

Causes of lower zone fibrosis

A

Idiopathic pulmonary fibrosis
Rheumatoid arthritis
Scleroderma, Sjogren, SLE
Asbestosis
Drugs (methotrexate, amiodarone, nitrofurantoin)

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4
Q

Light’s criteria for Exudate pleural effusion?

A

Pleural fluid to serum protein > 0.5
Pleural fluid to serum LDH > 0.6
Pleural fluid LDH value > 2/3 of the upper limit of the normal serum value

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5
Q

Causes of Exudate pleural effusion

A

Pneumonia
Pulmonary embolism
Cancer
Tuberculosis
Autoimmune conditions

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6
Q

Causes of Transudate pleural effusion

A

Liver cirrhosis
Congestive cardiac failure
Nephrotic syndrome

Because they create an increase in the hydrostatic pressure or low plasma oncotic pressure

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7
Q

Alpha-1-antitrypsin deficiency

A

COPD/Emphysema —> bronchiectasis
Liver cirrhosis
Necrotising panniculitis

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8
Q

Kartagener’s syndrome

A

Bronchiectasis (from primary ciliary dyskinesia)
Situs inversus / dextrocardia
Sinusitis
Azoospermia

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9
Q

Causes of pulmonary hypertension

A

Primary
Aortic & Mitral valve pathology
Chronic PEs
ILD
COPD

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10
Q

Treatment of Idiopathic Pulmonary Fibrosis

A

Nindetanib (tyrosine protein kinase inhibitor)
Pirfenidone
Consider Sildenafil

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11
Q

Indications for VATS

A

Lung/pleura/LN biopsy
Wedge resection
Lobectomy
Pleurodesis

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12
Q

Management of Resp conditions, to include

A

Multidisciplinary approach including specialist physicians, OT, PT, patient’s GP
Patient education
Lifestyle modification including smoking
Vaccines
Pulmonary rehab

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13
Q

Indications for pneumonectomy

A

Malignancy
Bronchiectasis
Tuberculosis

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14
Q

Indications for lobectomy

A

Non-small cell lung cancer
Bronchiectasis
Tuberculosis or abscess
Lung volume reduction

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15
Q

Indications for thoracoplasty

A

= removal of ribs

Tuberculosis
Empyema

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16
Q

Types of lung cancer

A

Small cell carcinoma

Non-small cell includes:
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma

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17
Q

Typical features of squamous cell lung cancer

A

Central cavitating lesion
Heavy smoker
Paraneoplastic syndromes:
- Hypercalcaemia (PTHrP)
- Hyperthyroidism (TSH)

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18
Q

Characteristics of adenocarcinoma lung cancer

A

Most common type of lung cancer 40%
Common in women & non-smokers
Peripheral solid lesion
Metastasises early
Hypertrophic pulmonary osteoarthropathy

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19
Q

Typical features of large cell carcinoma

A

Start in the bronchial tubes
Early mets
Copious sputum

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20
Q

Characteristics & Complication of small cell lung cancers

A

Central cavitating lesion
Associated with smoking
Early mets
Paraneoplastic endocrine phenomena:
- Hypercalcaemia from PTHrP release
- Lambert-Eaton myasthenia gravis

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21
Q

Management of non-small cell lung cancer

A

Surgery
Radical radiotherapy
Platinum-based chemotherapy

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22
Q

Management of small cell lung cancer

A

Likely to have metastasised and cause endocrine complications

Radiotherapy or chemotherapy may be offered.
No surgery.

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23
Q

Management of tuberculosis

A

Quadruple therapy for 2 months (including pyrazinamide and ethambutol)
Then continue Rifampicin & Isoniazid

Alongside pyridoxine

24
Q

Side-effects of TB drugs

A

Rifampicin - drug interactions, orange fluids
Isoniazid - peripheral neuropathy (treat with Pyridoxine)
Pyrazinamide - gout
Ethambutol - retrobulbar neuritis

All are hepatotoxic

25
Q

Problems following transplant:

A

GARLIC T:
Graft dysfunction
Acute or chronic rejection
Recurrence of original disease
Lymphoproliferative disease
Infections
Cancers
Toxicity from immunosuppressant drugs

26
Q

Causes of clubbing

A

Idiopathic
Interstitial lung disease
Bronchiectasis
Lung cancer
Cyanotic congenital heart disease
Infective endocarditis
Chronic liver disease
Inflammatory bowel disease
Thyroid acropachy

27
Q

Causes of Bronchiectasis

A

CCCCBA:
Cystic fibrosis and Kartagener’s
COPD
Cancer of the bronchus
Congenital immunodeficiency
ABPA
Autoimmune

28
Q

Management of Bronchiectasis

A

Regular postural drainage
Antibiotic prophylaxis with pseudomonas cover
Mucolytics
Inhalers with steroids

29
Q

Cystic fibrosis mutation

A

CFTR gene on chromosome 7 (delta 508)

30
Q

Cystic fibrosis extra-pulmonary manifestations

A

Pancreatic insufficiency (steatorehoea, gallstones)
Méconium ileus
Distal intestinal obstruction syndrome
Infertility
Insulin-dependent diabetes

31
Q

Respiratory causes of finger clubbing

A

Lung cancer
Interstitial lung disease
Chronic suppurative lung disease such as CF, Bronchiectasis and lung empyema

32
Q

Most common type of lung cancer

A

Adénocarcinoma of the lung

33
Q

Indications for lung transplant (4)

A

ILD (single)
COPD (double)
Cystic fibrosis (double)
Primary Pulmonary hypertension (with heart)

34
Q

Criteria for lung transplant

A

1) >50% risk of death due to lung disease within 2 years if lung transplantation is not performed;
2) > 80% likelihood of surviving at least 90 days after lung transplantation;
3) >80% likelihood of 5-year post-transplant survival from a general medical perspective

35
Q

Differentials for bibasal crepitations

A

Bronchiectasis
ILD
Bilateral pneumonias
Congestive heart failure

36
Q

Spirometer results for ILD

A

Restrictive pattern with:
Reduced FEV1
Reduced FVC
Maintained FEV1/FVC ratio
Reduced total lung capacity
Reduced transfer factor

37
Q

Para pneumonic effusion management

A

Antibiotics
Chest drain if tap showed:
- pH <7.2
- Frank pus
- Positive cultures

38
Q

Mutated gene of cystic fibrosis

A

CFTR gene (chromosome 7) leads to increase sodium excretion causing thicker mucus

39
Q

Cystic fibrosis manifestations

A

Bronchiectasis
Chronic pancreatic insufficiency
Liver failure
Gallstones
Constipation and distal intestinal obstruction
Kidney stones
Infertility

40
Q

Treatment of cystic fibrosis

A

MDT approach
Prophylactic Azithromycin
Chest physio
Nebulisers and mucolytics
Fat-soluble vitamins
Creon
Nutritional supplements via peg-tubes

41
Q

Severity grading for COPD

A

Mild - FEV1 >80%
Moderate - FEV1 50-80%
Severe - FEV1 30-50%
Very severe - FEV1 <30%

42
Q

Spirometry findings for COPD

A

Obstructive pattern
FEV1 <80%
FVC normal
FEV1/FVC ratio <0.7

43
Q

COPD CXR findings

A

Hyperinflation
Flattened Hemi-diaphragms

44
Q

Bronchiectasis CT findings

A

Signed ring sign (bronchi larger than vasculature)
Bronchial wall thickening

45
Q

Blood tests for Bronchiectasis

A

Immunoglobulins
Aspergillus IgE
HIV
RF
Alpha-1antitrypsin deficiency
CF genetic mutation analysis

46
Q

Bronchiectasis examination findings

A

Clubbing
Inspiration clicks
Coarse inspiration crepitations
Large airway ronchi

47
Q

Suitability for surgical lung resection

A

FEV1 >1.5L for lobectomy
FEV1 >2L for pneumonectomy

48
Q

Complications of Asbestos exposure

A

Pleural plaques
Diffuse pleural thickening
Pleural effusions
Asbestosis
Increased risk of lung cancer and mesothelioma

49
Q

Extrinsic allergic alveolitis examples

A

Bird fanciers lungs
Hot tub lung
Mushroom workers lung
Malt workers lung

50
Q

Extrinsic allergic alveolitis hypersensitivity type

A

Acute —> type 3 (immune complex mediated)
Chronic —> type 4 (cell mediated)

51
Q

Occupational lung disease examples

A

Silicosis
Berylliosis
Coal worker’s pneumoconiosis

52
Q

Examples of interstitial lung disease

A

UIP
NSIP
Cryptogenic organising pneumonia

53
Q

Management of interstitial lung disease

A

Lifestyle
Immunisations
Steroid
Oxygen at home
Trials

54
Q

Types of Bronchiectasis

A

Cylindrical
Varicose
Cystic

55
Q

Criteria for LTOT (2)

A

2 ABGs at least 2 weeks apart with either:
- PaO2 <7.3
- PaO2 <8 and Polycythaemia or nocturnal hypoxaemia or peripheral oedema or pulmonary hypertension

PACES - Final Week Revision (7 decks)

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