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finals - MT > respiratory > Flashcards

respiratory Flashcards

1
Q

define chronic with regards to chronic bronchitis

  • potential DDx for chronic cough?
A

a productive cough for 3 consecutive months across 2 consecutive years

DDx - bronchiectasis

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2
Q

COPD: causes?

A

smoking!!
alpha-1-antitrypsin (inhibits neutrophil elastases)

other: 4 Cs
Cadmium (used in smelting)
Coal
Cotton
Cement

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3
Q

what could be the potential cause in a young pt presenting with features of COPD

A

alpha-1-antitrypsin deficiency

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4
Q

describe how COPD can lead to cor pulmonale

A
  1. Chronic hypoxia causes vasocontriction of pulmonary arteries
  2. This leads to elevated pulmonary arterial pressure.
  3. The chronic elevation of pulmonary arterial pressure subsequently leads to right heart failure
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5
Q

How does Cor pulmonale present

A

This presents with classical features including raised JVP, cyanosis, ankle (peripheral) oedema, left parasternal heave due to RV hypertrophy and hepatomegaly

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6
Q

signs of COPD

A

tachypnoea
barrel chest
coarse crackles
hyperresonance on percussion
pursed lip breathing
loss of cardiac dullness
tar staining
peripheral cyanosis

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7
Q

symptoms of COPD

A

cough (often productive)
dyspnoea (on exertion)
wheeze

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8
Q

general management of COPD

A

smoking cessation
ANNUAL influenza vaccine + ONE OFF pneumococcal vaccine
pulmonary rehabilitation (> MRC grade 3 - “functionally disabled” )

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9
Q

what are the asbestos-related lung diseases (5)

A

pleural plaques
pleural thickening
mesothelioma
asbestosis
lung cancer

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10
Q

pleural plauques
-benign/malignant
-latent period

A

benign and DO NOT undergo malignant change
latent period 20-40 yrs
seen as discrete circumscribed areas of fibrosis on the parietal pleura

almost always asymptomatic
do not impair lung function

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11
Q

pleural thickening

A

diffuse pleural fibrosis that follows the pattern of haemothorax or empyema

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12
Q

mesothelioma
- where does it metastasise to

A

Malignant disease of the pleurathat commonly metastasises to the contralateral lung and peritoneum, affecting the RIGHT LUNG more than the left

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13
Q

does mesothelioma develop with long/short term exposure

A

short term (around 40 yrs)

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14
Q

management of mesothelioma

A

palliative chemo

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15
Q

mesothelioma - features

A

progressive dyspnoea
chest pain
pleural effusions

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16
Q

asbestosis
-which lung lobes are affected
- latent period
- presentation
-treatment

A

LOWER lobes (opposites - ceiling)
15-30 yrs
dyspnoea, reduced exercise tolerance
conservative

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17
Q

what is the relationship between asbestos and cancer

A

Asbestos exposure is a risk factor for lung cancer and also has a synergistic effect with cigarette smoke.

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18
Q

what is Lofgren’s syndrome

A

acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia

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19
Q

features of acute sarcoidosis

A

swinging fever
polyarthralgia
erythema nodosum

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20
Q

features of insidious sarcoidosis

A

cough (non-productive)
fatigue
dyspnoea

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21
Q

Sx of sarcoidosis

A
  • cough (non-productive)
  • dyspnoea (gradual onset)
  • polyarthritis
  • uveitis
    • red eye
    • photophobia
  • constitutional symptoms
    • swinging fever
    • fatigue
    • weight loss
22
Q

signs of sarcoidosis

A

cervical and submandibular lymphadenopathy
erythema nodosum
lupus pernio

23
Q

what is sarcoidosis

A

Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas.

24
Q

What is Heerfodt’s syndrome

A

Heerfordt’s syndrome: causes facial nerve palsy, fever, uveitis and parotitis

25
Q

Indication for steroids in Sarcoidosis

A

stage 2/3 x-ray stage AND symptomatic

26
Q

ACE levels in sarcoidosis

A

elevated (used to monitor disease)

27
Q

Ca levels in sarcoidosis

A

HYPERCALCAEMIA (macrophages have 1 alpha hydroxylase activity which converts vit D to its active form)

28
Q

respiratory complications of sarcoidosis

A

pulmonary HTN
resp failure
UPPER zone fibrosis

29
Q

cardiovascular complications of sarcoidosis

A

cor pulmonale
heart block

30
Q

CNS complications of sarcoidosis

A

cranial nerve palsies e.g. facial nerve, meningeal disease

31
Q

occular complications of sarcoidosis

A

keratoconjunctivitis sicca, uveitis

32
Q

symptoms of bronchiectasis

A

productive cough - often producing copious amounts of sputum
dyspnoea
haemoptysis

33
Q

signs of bronchiectasis

A

clubbing
auscultation
coarse crackles on inspiration
high-pitched squeaking on inspiration
rhonchi (snoring like low pitch)

34
Q

infectious causes of bronchiectasis

A

TB, whooping cough, measles, pneumonia

35
Q

congenital causes of bronchiectasis

A

CF, Kartagener’s syndrome, Young’s syndrome, Yellow nail syndrome

36
Q

allergic and inflammatory causes of bronchiectasis

A

RA, IBD, ABPA, Sjogren syndrome

37
Q

most common cause of bronchiectasis

A

idiopathic

38
Q

what is the gold standard Ix for bronchiectasis and what does it show

A

HRCT - shows tram track lines and signet ring pattern

39
Q

first line management of bronchiectasis

A

identify the underyling cause
chest physiotherapy (draining mucus) - e.g. inspiratory muscle training
annual flu vaccine
Abx for acute exacerbations + long-term rotating antibiotics in severe cases

*AA Abx - Amoxicillin (acute like pneumonia) → Azithromycin (longer name - long-term for recurrent episodes)

40
Q

2nd line Mx of bronchiectasis

A

mucolytics e.g. Carbocystine
bronchodilators
saline
LTOT
surgery

41
Q

what are the 4 most common bacteria that are isolated from pts with bronchiectasis

A

Most common organisms isolated from patients with bronchiectasis:
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

42
Q

when (after) is the follow up x-ray for pneumonia and what is it for

A

X-ray after 6 weeks to look for any residual consolidation (esp in the elderly) to look for any underlying malignancy

43
Q

signs of pneumonia

A

reduced breath sounds
dull percussion
bronchial breathing (high pitch)

pyrexia
hypoxia
tachycardia

44
Q

symptoms of pneumonia

A

productive cough
dyspnoea
fever
pleuritic chest pain

45
Q

pneumonia Ix

A

CXR
FBC
Us+Es
ABG
Sputum cultures

46
Q

what is the discharge criteria for pneumonia

A

As per NICE, do not discharge patients with CAP if in the last 24 hours they have had 2 or more of the following:

Temperature > 37.5°C
RR ≥ 24
HR ≥ 100
SBP ≤ 90 mmHg
SpO2 ≤ 90% on room air
Abnormal mental status
Inability to eat without assistance

47
Q

CURB score mortality %

A

0-1: > 3%
2: 3-15%
3+: < 15%

0 = 0.7
1 = 2.1
2 = 9.2
3 = 14.5
4 = 40
5 = 57

48
Q

pneumonia complications

A

ARDS
empyema
sepsis
lung abcesses (Klebsiella, Staph Aureus)

49
Q

What are the symptoms of PHT

A
  • progressive breathlessness
    • Exertional dizziness
    • Fatigue
    • Hemoptysis (chronic thromboembolic PHT)
50
Q

What are the signs of PHT

A
  • right parasternal heave
  • loud second heart sound
  • tricuspid/ pulmonary regurgitation
  • raised JVP
  • signs of an underling conditions
51
Q

What are the 5 different categories for the causes of PHT

A
  • PHT due to left heart disease
  • PHT due to chronic conditions/hypoxia
  • PHT due to obstruction of the pulmonary artery
  • PAH (pulmonary arterial)
  • PHT due to miscellaneous causes

finals - MT (9 decks)

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