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Clinical Medicine > Respiratory 🫁 > Flashcards

Respiratory 🫁 Flashcards

1
Q

describe type 1 resp failure

A

low p02 <8 kPa
normal pco2
Ventilation - perfusion mismatch

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2
Q

describe type 2 respiratory failure

A

low PaO2 < 8kPa
high PaCO2 > 6 kPa
alveolar hypoventilation - fail to effectively oxygenate and blow off co2

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3
Q

what is FEV1

A

forced expiratory volume in 1s
volume exhaled in first second after deep inspiration and forced expiration

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4
Q

what is FVC

A

total volume of air that the patient can forcibly exhale in 1 breath

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5
Q

what would spirometry tell us in an obstructive resp condition

A

FEV1 reduced - <80%
FVC also reduced slightly but not to same extent
so FEV1/FVC ratio is reduced - <0.7

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6
Q

what would spirometry tell us in a restrictive lung disease

A

FEV1 and FVC both reduced so normal ratio

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7
Q

examples of restrictive lung diseases

A

fibrosis
obesity
myasthenia gravis

lungs can’t take as much volume but airway is not narrowed so expiration is normal speed

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8
Q

examples of obstructive lung diseases

A

asthma
COPD
cystic fibrosis

airways narrowed so can’t get air out as quickly but lung tissue is still stretchy so can take in normal volume

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9
Q

presentation that would suggest asthma

A

episodic symptoms
cough worse at night
dyspnoea
expiratory wheeze
hx of other atopic conditions such as eczema
family hx

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10
Q

Ix and Dx of asthma

A

feNO testing + spirometry with bronchodilator reversibility testing => gold standard
feNO will be raised

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11
Q

mx of asthma

A

SABA - reliever
ICS (inhaled corticosteroids) - preventer
LTRA - oral med
LABA - long term reliever
MART - preventer and reliever
LAMA

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12
Q

mx of asthma ladder - NICE guidelines

A

SABA
SABA + low dose ICS
SABA + ICS + LTRA
SABA + ICS +LTRA + LABA
consider changing to MART
increase ICS to moderate dose

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13
Q

signs of moderate acute asthma

A

PEF >50-75%
SpO2 >92%
speech normal
RR<25
pulse <110

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14
Q

signs of acute severe asthma

A

PEF 35-50
SpO2 > 92
can’t complete sentences
RR|>25
pulse > 110

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15
Q

signs of life threatening asthma

A

PEFR <33
SpO2 <92
PaO2 <8kPa
normal C02
silent chest, cyanosis
arrhythmia or hypotension
exhaustion altered consciousness

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16
Q

treatment of acute moderate asthma

A

B2 bronchodilator
if no improvement
salbutamol via nebuliser
give prednisolone

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17
Q

treatment of acute severe asthma

A

oxygen
B2 bronchodilator
prednisolone or IV hydrocortisone

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18
Q

what is COPD

A

characterised by irreversible obstruction of airways
almost always caused by smoking
umbrella term for chronic bronchitis and emphysema

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19
Q

presentation of COPD

A

productive cough
chronic SOB
wheeze
recurrent resp infections
severe : cor pulmonale

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20
Q

Ix COPD

A

spirometry reduced fev1/fvc ratio <0.7
chest x ray : hyperinflation, bullae, flat hemidiaphragm
FBC: secondary polycythaemia

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21
Q

mx COPD

A

smoking cessation + pneumococcal and flu vaccine

bronchodilator therapy
Long term oxygen therapy - non smokers + severe COPD

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22
Q

acute exacerbation of COPD signs and symptoms

A

increased SOB
cough
wheeze
increased sputum
hypoxia
confusion

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23
Q

mx acute exacerbation COPD

A

OABC
Oxygen - high flow
Antibiotics - amoxicillin or clarithomycin
Bronchodilators
Corticosteroids - oral prednisolone or IV hydrocortisone

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24
Q

sx and signs of lung cancer

A

persistent cough, SOB, haemoptysis
weight loss
finger clubbing
lymphadenopathy

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25
Q

when to order urgent cxr for lung cancer suspected case

A

over 40 with 2 or more symptoms or 1 symptom and previous/current smoker

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26
Q

when to use 2WW suspected cancer pathway for lung cancer

A

patients aged over 40 with haemoptysis

x ray findings in keeping with lung cancer

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27
Q

what does paraneoplastic syndrome mean

A

when a range of symptoms in a patient is caused by a hormone secreted by cancer cells
cells that cause lung cancer as they are often functional i.e they can secrete hormones

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28
Q

important features of small cell lung carcinoma

A

can cause presentations of addison’s and cushing’s
spreads very early
poor prognosis
lambert-eaton syndrome
SIADH

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29
Q

features of lung squamous cell carcinoma

A

on CT jagged border seen
often causes hypercalcaemia
often associated with clubbing and hypertrophic pulmonary osteoarthropathy

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30
Q

with adenocarcinoma lung cancer what associated sx would you get

A

most common in non-smokers
gynaecomastia
HPOA

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31
Q

sx hypercalcaemia

A

groans
psychiatric moans
thrones
bones
stones

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32
Q

CURB65 score

A

Confusion - AMTS <8
Urea - >7 mmol
Resp rate - >= 30/min
BP - <= 90/60
65 - over 65?

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33
Q

what is curb65 score used for

A

severity of pneumonia

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34
Q

sx and signs of pneumonia

A

cough, pleuritic chest pain, haemoptysis
sweating, fevers, myalgia
O/E reduced breath sounds/crackles, bronchial breathing

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35
Q

the signet ring sign is pathognomonic for which respiratory condition

A

bronchiectasis

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36
Q

what is bronchiectasis

A

permanent dilation of bronchi and bronchioles due to chronic infection

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37
Q

sx of bronchiectasis

A

productive cough
large amounts of purulent sputum
haemoptysis

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38
Q

what drugs are most likely to cause drug-induced pulmonary fibrosis

A

amiodarone
nitrofurantoin
bleomycin

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39
Q

signs of pleural effusion

A

o/e of chest:
trachea is central or deviated
chest expansion is reduced on affected side
percussion note is stony dull on affected side
reduced/absent breath sounds over the effusion on auscultation

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40
Q

signs of near-fatal asthma

A

raised CO2

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41
Q

first line mx for pt reporting asthma sx 3 or more times per week or night time waking

A

SABA +Inhaled corticosteroid

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42
Q

name an inhaled corticosteroid

A

beclomethasone

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43
Q

for a patient to be discharged from hospital following an asthma attack they must be?

A

stable on their regular asthma regime for 24 hours

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44
Q

if a an asthmatic patient presents with white patches on her tongue what do you suspect

A

oral thrush caused by inhaled corticosteroid

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45
Q

what is the most common form of lung cancer in non-smokers

A

adenocarcinoma

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46
Q

first line ix suspected lung cancer

A

chest x ray

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47
Q

what findings on a chest x ray would suggest lung cancer

A

hilar enlargement
peripheral opacity
pleural effusion
collapse

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48
Q

what is horners syndrome and how is it related to lung cancer

A

triad of partial ptosis, anhidrosis and miosis

caused by a pancoast’s tumour (a tumour in pulmonary apex)

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49
Q

what is mesothelioma

A

rare form of lung cancer strongly linked to asbestos exposure

manifests in pleura

pleura thickens and some areas become plaque like

50
Q

mx of hypercalcaemia

A

IV fluid replacement

51
Q

mx of superior vena cava obstruction

A

IV dexamethasone

52
Q

An 82-year-old man presents to the emergency department with a two-day history of worsening shortness of breath. He has a known history of squamous cell lung cancer.

On examination, the trachea has deviated to the left-hand side, percussion is dull and breath sounds are absent throughout the left side of the chest.

What is the most likely diagnosis?

A

left sided lung collapse

53
Q

What is the most common organism associated with bronchiectasis?

A

Haemophilus influenzae

54
Q

what level is the transpyloric plane

A

L1

55
Q

What investigation confirms the diagnosis of bronchiectasis

A

high-resolution CT
Characteristic features include:
signet ring sign
tram-track sign
string of pearls/ cluster of grapes sign

56
Q

how would pulmonary fibrosis present symptoms

A

dry cough
sob
fatigue
muscle pains

57
Q

how would pulmonary fibrosis present on examination

A

clubbing
cyanosis
fine-end inspiratory crackles

58
Q

on a CT what would you see for pulmonary fibrosis

A

honeycomb lung

59
Q

how do you diganose cystic fibrosis

A

Neonatal heel prick day between day 5 and day 9
Sweat test: sweat sodium and chloride >60mmol/L
Faecal elastase: this can provide evidence for abnormal pancreatic exocrine function.
Genetic screening: This can identify CF mutations

60
Q

signs of bronchiectasis

A

finger clubbing
coarse inspiratory crepitations
dyspneoa
wheeze

61
Q

treatment options for idiopathic pulmonary fibrosis

A

conservative : stop smoking, pulmonary rehab
medical : long term oxygen therapy, pirfenidone
surgical : lung transplant is the only cure

62
Q

complications of idiopathic pulmonary fibrosis

A

type 2 resp failure
increased risk of lung cancer
Cor pulmonale
50% mortality in 5 years

63
Q

what is pneumocystis pneumonia

A

infection with the fungus pneumocystis jiroveci

common with individuals with HIV who are non-compliant

64
Q

clinical features of pneumocystis pneumonia

A

fever
non productive cough
exertional breathlessness associated with onset - specific sign for PCP

65
Q

definitive diagnostic investigation for pneumocystis pneumonia

A

bronchoscopy with bronchoalveolar lavage

66
Q

management of pneumocystis pneumonia

A

antibiotics such as co-trimoxazole

67
Q

indications for long term oxygen therapy - COPD

A

have a PaO2 <7.3kPa on 2 readings more than 3 weeks

or have a Pa02 of 7.3-7.8kPa alongside one of the following: nocturnal hypoxia, polycythaemia (high RBC) , peripheral oedema and pulmonary hypertension

68
Q

indications for surgery in COPD

A

upper lobe predominant emphysema
FEV1>20% predicted
paCO2 below 7.3kPa
TICO above 20% predicted

69
Q

medical management for smoking cessation

A

nicotine replacement therapy - contra-indicated in severe cardiovascular disease

bupropion - contraindicated in epilepsy, eating disorders and bipolar disorders, CNS tumours, pregnancy and breastfeeding, current benzodiazepine or alcohol withdrawal

varenicline - contraindicated in pregnancy

70
Q

are e-cigarettes and vaping used as smoking cessation techniques

A

not currently advocated as a first-line technique

only considered for those who have not been able to quit smoking through conventional techniques

71
Q

what is pulmonary fibrosis

A

describes a group of diseases which lead to interstitial lung damage and ultimately fibrosis

72
Q

causes of lung fibrosis

A

lung damage
irritants
diffuse parenchymal lung disease
connective tissue disease
meds
hypersensitivity pneumonitis

73
Q

what is a pleural effusion

A

abnormal buildup of fluid in pleural cavity

can be exudative, meaning there is a high protein count or transudative, meaning there is a relatively lower protein count

74
Q

exudative causes of pleural effusion (protein content >35g/L)

A

exudative causes are related to inflammation

inflammation results in protein leaking out of the tissues into the pleural space

think of the causes of inflammation:
lung cancer
pneumonia
rheumatoid arthritis
tuberculosis

75
Q

transudative causes of pleural effusion (protein content <35 g/L)

A

relate to fluid moving across into the pleural space

think of causes of fluid shifting:
congestive cardiac failure
hypoalbuminaemia
hypothyroidism
meig’s syndrome

76
Q

investigating pleural effusion

A

chest x-ray shows:
blunting of costophrenic angle
fluid in the lung fissures
larger effusions will have a meniscus
tracheal and mediastinal deviation

taking a sample of the pleural fluid by aspiration or chest drain is required to analyse it for protein count, cell count, pH glucose, LDH and microbiology testing

77
Q

treatment of pleural effusion

A

small effusions - conservative management

larger effusions often need aspiration or drainage

78
Q

what is an empyema

A

infected pleural effusion

suspect empyema in a patient who has improving pneumonia but a new or ongoing fever

79
Q

what would a pleural aspiration show for an empyema

A

shows pus, acidic pH, low glucose and high LDH

80
Q

hows an empyema treated

A

chest drain to remove pus
antibiotics

81
Q

chronic management of COPD
STEP 1

A

step 1. SABA/SAMA
step 4. consider specialist referral

82
Q

chronic management of COPD
STEP 2

A

pts with persistent exacerbations with no asthmatic features - add LABA and LAMA

WITH asthmatic features or evidence of steroid responsiveness - LABA + ICS

83
Q

chronic management of COPD
STEP 2

A

3-month trial of LAMA+LABA+ICS
if this doesn’t work go back to LABA + LAMA

if any patient on step 2 is getting more than one severe or 2 moderate exacerbations in a year then LAMA +LABA + ICS should be started

84
Q

chronic management of COPD step 4

A

consider specialist referral

85
Q

what is a pulmonary embolism

A

when a blood clot in the pulmonary vasculature develops usually from an underlying DVT

86
Q

presentation of a PE - classic triad

A

sudden-onset sob
pleuritic chest pain
haemoptysis

87
Q

presentation of a PE signs

A

tachypnoea, tachycardia + hypoxia

88
Q

initial management of PE

A

apixaban or rivaroxaban (DOACS) should be offered first line

if they are not suitable LMWH followed by dabigatran or edoxaban OR LMWH followed by vitamin K antagonist

89
Q

management of PE if patient has active cancer

A

DOAC unless contraindicated

90
Q

management of PE if renal impairment is severe

A

LMWH, unfractionated heparin or LMWH followed by VKA

91
Q

mx of PE if the patient has antiphospholipid syndrome

A

LMWH followed by a VKA

92
Q

how long should the patient be on anticoagulation following a PE

A

ALL patients at least 3 months

provoked VTE - 3 months

unprovoked VTE - 6 months in total

93
Q

when is thrombolysis used for PE patients

A

first-line treatment for massive PE where there is circulatory failure e.g hypotension

94
Q

patients who have repeat pulmonary embolisms despite adequate anticoagulation what do you do

A

considered for inferior vena cava filter

95
Q

what is obstructive sleep apnoea

A

caused by intermittent airway closure during sleep

96
Q

presentation of obstructive sleep apnoea

A

symptoms can include:
not feeling refreshed on waking
fatigue
morning headache
decreased libido
decreased cognitive performance
nocturia

97
Q

most common demographic for OSA?1

A

overweight middle-aged men

98
Q

mx of OSA

A

weight loss
smoking cessation
alcohol avoidance in evening
CPAP - gold standard

99
Q

how to calculate a WELLs score

A

3 points:
- clinical signs and symptoms of DVT
- if no alternative dx is more likely than a PE

1.5 points
- tachycardia
- immobile for more than 3 days or major surgery in last month
- previous PE or DVT

1 point
- haemoptysis
- active malignancy

100
Q

what is sarcoidosis

A

a multi-system disease characterised by granuloma formation resulting in widespread inflammatory changes and complications

101
Q

acute sarcoidosis features

A

fever
polyarthralgia
erythema nodosum
bilateral hilar lymphadenopathy

102
Q

what cytokine is responsible for stimulating production of eosinophils

A

IL-5

103
Q

most common organism that causes bronchiectasis

A

Haemophilus influenzae

104
Q

most common organism that causes bronchiectasis

A

Haemophilus influenzae

105
Q

what is bronchiectasis

A

describes a permanent dilation of the airways secondary to chronic infection or inflammation

106
Q

scores of CURB65 and their relevant mortality rate

A

0-0.7%
1-3.2%
2-13%
3-17%
4-41.5%
5-57%

107
Q

presentation of pleural effusion - just symptoms

A

general symptoms include:
- dyspnoea
- reduced exercise tolerance
- chest pain

108
Q

presentation of pleural effusion - on examination

A

trachea may be deviated
reduced chest expansion
percussion note is stony dull
reduced breath sounds
reduced vocal resonance

109
Q

A 45-year-old woman has presented to emergency department with shortness of breath and pleuritic chest pain. On examination of the chest, the right lower zone is stony dull to percussion, with reduced air entry and reduced vocal resonance.

what respiratory condition comes to mind

A

pleural effusion

110
Q

what is meigs syndrome and how to spot it

A

an eponymous syndrome classified by a triad of :
- benign ovarian tumour
- pleural effusion
- ascites

111
Q

acute sarcoidosis features

A

fever
polyarthralgia
erythema nodosum
bilateral hilar lymphadenopathy

112
Q

A 30 year old female patient is referred to the respiratory clinic with a 3 month history of shortness of breath, dry cough, and fatigue. She also reports a red painful right eye with blurred vision.

Chest x-ray reveals bilateral hilar lymphadenopathy and pulmonary infiltrates.

what diagnosis is the correct one

A

sarcoidosis - symptoms and chest x ray findings support this diagnosis
also she likely has uveitis which also is a sign of sarcoidosis

113
Q

chronic sarcoidosis features

A

Pulmonary (most common manifestation): dry cough, dyspnoea, reduced exercise tolerance. Examination may reveal crepitations.

Constitutional: fatigue, weight loss, arthralgia, and low-grade fever. General signs include lymphadenopathy and enlarged parotid glands.

Neurological: meningitis, peripheral neuropathy, bilateral Bell’s palsy.

Ocular: uveitis, keratoconjunctivitis sicca.

Cardiac: arrhythmias, restrictive cardiomyopathy.

Abdominal: hepatomegaly, splenomegaly, renal stones.

Dermatological: erythema nodosum, lupus pernio.

114
Q

management of sarcoidosis

A

Bilateral hilar lymphadenopthy alone - usually self-limiting
Acute sarcoidosis - bed rest, NSAIDs
Steroid treatment: oral or IV, depending on severity of disease
Immunosuppressants: in severe disease

115
Q

A 76 year old man is admitted to hospital due recurrent fever, productive cough with foul smelling sputum and dyspnoea. The hospital notes indicate the patient had a past history of a middle cerebral artery stroke.

On examination, he appears tachypneoic and there is a dull percussion note with bronchial breathing on auscultation of the lower right lung zone.

what is the most likely diagnosis

A

lung abscess :
- recurrent fever, productive cough with foul smelling sputum
- history of a middle cerebral artery stroke

116
Q

signs of lung abscess

A

finger clubbing
localised dull percussion note
bronchial breathing

117
Q

symptoms of lung abscess

A

fever
foul-smelling purulent mucus
dyspnoea

118
Q

management of pneumonia - mild and moderate

A

amoxicillin
if penicillin is allergic - doxycycline/clarithromycin

119
Q

management of severe pneumonia

A

co-amoxiclav + clarithromycin/erythromycin
if penicillin allergic - levofloxacin

120
Q

diagnosis of tuberculosis

A

Mantoux test
interferon-gamma release assay
acid-fast staining with Ziehl-Neelsen stain

Clinical Medicine (26 decks)

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