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Pocket MSRA - Book 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the most common obstructive lung disease?

A

Asthma
COPD
CF
Bronchiectasis

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2
Q

What is the main finding on examination for obstructive lung disease?

A

Wheeze +/- crackles if added infection

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3
Q

What are the spirometry findings for obstructive lung disease?

A

FEV1:FVC <0.7

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4
Q

What patient factors increase the likelihood of asthma in the case of diagnostic uncertainty?

A

Sx - wheeze, SOB, chest tightness
Diurnal variation
Response to exercise, allergen or cold air
Year-year variation, no progression
Sx after ASA or BB
PHx/FHx atopy/asthma
Widespread wheeze
Low FEV1/PEF during sx (normal at rest)
Eosinophilia
Age onset <20
Normal CXR
Immediate response to bronchodilators

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5
Q

What patient factors lower the likelihood of asthma in the case of diagnostic uncertainty?

A

Prominent dizziness/light headedness/tingling
Chronic productive cough
Lack of wheeze
Sx w/ colds only
Progressively worsening
Change in voice
Cardiac disease
Smoking hx > 20PY
Normal PEF during sx OR abnormal b/w sx
Age onset >40
CXR - hyperinflated lungs
Limited response to bronchodilators

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6
Q

What investigation should be done if there is intermediate probability of asthma?

A

Test for bronchodilator reversibility with spirometry

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7
Q

What % improvement in spirometry should be seen for a diagnosis of asthma?

A

> 15%

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8
Q

What alternative diagnoses might need to be considered?

A

COPD
Eosiniophilic inflammation (bloods, FeNO)
Atopy (IgE)
Methacholine challenge

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9
Q

What is the key feature of occupational asthma?

A

Worse during work, remits when away from work (w/e or holidays)

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10
Q

How should occupational asthma be diagnosed?

A

Peak flow diary to assess trends

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11
Q

What occupations does occupational asthma commonly occur in?

A

Food processors
Animal handlers
Welders
Paint sprayers

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12
Q

What are the treatment steps on the asthma ladder?

A

Step 1 - SABA prn
Step 2 - SABA prn + low-dose ICS maintenance
Step 3 - SABA prn + ICS + LTRA
Step 4 - SABA prn + LABA + ICS (review LTRA)
Step 5 - SABA prn + MART (ICS + LABA) + LTRA

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13
Q

When should patients be moved up or down the asthma ladder?

A

If >/< 3x episodes of sx/week

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14
Q

When should patients be automatically started on Step 2 of the asthma ladder?

A

If sx occuring >3x/week or waking at night in adults >17

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15
Q

What type of drug is Salbutamol and how is it used in asthma management?

A

SABA
Works acutely

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16
Q

What type of drug is Salmeterol and how is it used in asthma management?

A

LABA
Delayed onset
Reduces nocturnal sx

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17
Q

What are the side effects of B2 agonists?

A

Tachycardia
Tremor/anxiety
Cramps
Paradoxical bronchospasm
Hypokalaemia
Hyperglycaemia
Hyperlactataemia

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18
Q

How are steroids used in asthma management?

A

ICS or PO/IV
5-7 in acute flares
Chronic PO if uncontrolled by ICS
Aim to be at lowest dose

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19
Q

What additional protections are required in patients on long-term steroids for asthma management?

A

Bone/GI protection

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20
Q

What are the side effects/risks of steroids in asthma management?

A

Thrush (rinse mouth after usage of ICS)
Adrenal suppression (may need steroid card)
Psychoses (high dose acute treatments)
Reactive leucocytosis BUT immunosuppressed

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21
Q

What are MART inhalers and why are they used?

A

LABA + ICS
Helps w/ comliance

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22
Q

What are LRTAs?

A

Leukotriene receptor antagonists
Montelukast

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23
Q

Why are LRTAs used in asthma management?

A

Additive effect w/ ICS

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24
Q

What are the side effects of LRTAs?

A

Abdo pain
Thirst
Headache
Churg-Strauss syndrome (v. rare)

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25
Q

What are the features of Churg-Strauss syndrome?

A

Eosinophilia
Vasculitic rash
Pulmonary-renal syndrome

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26
Q

Why is Theophylline given at night?

A

To prevent morning dipping of PEF

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27
Q

Why is Theophylline rarely used in 1o care?

A

Zero-order kinetics = saturable and metabolised by liver
-variation in smokers, liver/heart failures
Affected by inducers
Narrow therapeutic index

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28
Q

What are the features of Theophylline toxicity?

A

GI upset (N)
Tachycardia
Seizures
Hypokalaemia
Hyperglycaemia

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29
Q

What type of drug is Sodium Cromoglicate and why is it used in asthma management?

A

INH mast cell stabilisers
Prophylaxis in mild/exercise-induced asthma (esp. paeds)

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30
Q

What type of drug is Iptratropium?

A

SAMA (anticholinergic)

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31
Q

What type of drug is Tiatropium?

A

LAMA (anticholinergic)

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32
Q

What type of drug is Omalizumab and why is it used in asthma management?

A

Anti-IgE Mab
Used in persistent allergic asthma in 2o care

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33
Q

What type of drug is Mepolizumab and why is it used in asthma management?

A

Anti-IL5 Mab
Used in refractory eosinophilic asthma in 2o care

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34
Q

What PEF is seen in a moderate asthma exacerbation?

A

PEF >50-75%

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35
Q

What is the management of a moderate asthma exacerbation?

A

SABA nebs
PO Prednisolone

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36
Q

What are the features of a severe asthma exacerbation?

A

Cannot speak in full sentences
HR >110bpm
RR >25/min
PEFR 33-50%

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37
Q

What is the management of a severe asthma exacerbation?

A

SABA nebulisers
PO Prednisolone
Consider single dose IV Mg
Admit

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38
Q

What are the features of a life threatening asthma exacerbation?

A

Silent chest
Confused
Cyanotic
Bradycardia
RR low (exhaustion)
PaCO2 raised
PEFR <33%

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39
Q

What is the management of a life threatening asthma exacerbation?

A

SABA nebulisers
PO Prednisolone
IV Mg
Admit and likely need ventilatory support
SAMA
NOT FOR NIV

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40
Q

What is the Samter triad?

A

Asthma
Nasal polyp
Aspirin sensitivity

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41
Q

What drug is contraindicated in sever asthma?

A

Beta-blockers
-10% intolerant

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42
Q

What acute respiratory event are asthmatics at increased risk of developing?

A

Pneumothorax

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43
Q

What are the GOLD categories for COPD severity?

A

Mild - FEV1 >80%
Moderate - FEV1 50-79%
Severe - FEV1 30-49%
V. severe - FEV1 <30%

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44
Q

What are the treatment steps on the COPD ladder?

A

Step 1 - SABA or SAMA
Step 2 - LABA + LAMA or ICS
(ICS if asthmatic sx or steroid responsiveness, LAMA if neither of these)
Step 3 - 3/12 trial of LABA + LAMA + ICS
-if no improvement rever to LABA/LAMA

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45
Q

Why should ICS not be given alone in COPD?

A

Increase mortality as risk of pneumonia

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46
Q

What are the common side effects of antimuscarinics?

A

Dry mouth
Nausea
Headache

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47
Q

What are the rare side effects of antimuscarinics?

A

Constipation
Tachycardia
Retention
Confusion
Blurred vision (dilated pupils)
Angle-closure glaucoma
Hypersensitivity

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48
Q

In which patient groups should caution be taken when prescribing antimuscarinics?

A

BPH and glaucoma prone patients

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49
Q

What are the features of anticholinergic toxicity?

A

Hyperactive delirium (mad as hatter)
Mydriasis/reduced vision (blind as bat)
Retention (full as flask)
Dry skin (dry as bone)
Hot to touch (hot as hare)
Flushed apperance (red as beet)

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50
Q

What additional treatments should be considered in COPD management?

A

Annual Flu + PC vaccine
Pulmonary rehab
Mucolytics
SMOKING CESSATION
LTOT

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51
Q

What are the requirements for starting LTOT?

A

Non-smoker
PaO2 <7.3 persistently DESPITE maximum rx OR
PaO2 <8 AND evidence of pulmonary HTN (RVH, peripheral oedema), polcythaemia, nocturnal hypoxia OR
Palliative

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52
Q

What is the immediate management of a COPD exacerbation?

A

Neb SAMA + SABA
Controlled O2
Target SpO2 88-92%
Steroids
If infective exacerbation - add Amox/Doxy

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53
Q

What additional management steps may be required in a severe/refractory COPD exacerbation?

A

IV Aminophylline loading dose
NIV
Intubation

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54
Q

When should NIV be considered in a COPD exacerbation?

A

RR >30
pH <7.35
PaCO2 rising despite adequate treatment (T2RF)

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55
Q

When should intubation be considered in a COPD exacerbation?

A

If pH <7.26
PaCO2 rising despite NIV

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56
Q

What is the inheritance pattern of cystic fibrosis?

A

Autosomal recssive

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57
Q

Which gene is affected in cystic fibrosis?

A

Ch7 CFTR

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58
Q

What is the carrier rate of the Ch7 CFTR gene in caucasians?

A

1:25

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59
Q

How are UK neonates screened for CF?

A

Heel-prick (raised immunoreactive trypsin)
-follow on CFTR PCR screen

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60
Q

What findings on the sweat test are suggestive of CF?

A

High Na + Cl (defective NaCl CFTR channels)

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61
Q

What are the features of a neonatal presentation of CF?

A

Failure to thrive
Meconium ileus
Rectal prolapse

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62
Q

What are the features of a respiratory presentation of CF?

A

Recurrent LRTIs
Nasal polyps
Bronchiectasis (eventually)

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63
Q

What are the features of a GI presentation of CF?

A

Pancreatic insufficiency (DM + steatorrhea)
Distal intestinal obstruction
Gallstones
Cirrhosis

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64
Q

What systems are commonly affected by CF?

A

Respiratory
GI
Reproductive

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65
Q

What are the reproductive sx of CF?

A

Male infertility (undeveloped vas + epididymis)
Female subfertility

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66
Q

What is the management of CF?

A

Physiotherapy
Abx for acute infective exacerbations
Mucolytics
Bronchodilators
Immunisation
Yearly CXR surveillance
O2/diuretics/NIV if cor pulmonale –> b/l lung-heart transplant
Creon
Ursodeoxycholic acid if cirrhotic –> liver translant
DM management (yearly OGTT)

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67
Q

What organisms commonly cause infective exacerbations in CF?

A

Staph aureus
Pseudomonas
Burkholderia cepacia

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68
Q

Which infective organism is a contraindication for lung-heart transplant in CF?

A

Burkholderia cepacia

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69
Q

What type of drug is Ivacaftor?

A

CFTR potentiator for G551D mutation

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70
Q

What type of drug is Lumacaftor?

A

CFTR corrector for classic F508 mutation

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71
Q

What is Bronchiectasis?

A

Permanent thinning and dilatation of the airways

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72
Q

What are the presenting features of Bronchiectasis?

A

Persistent cough
Copious sputum
Intermittent haemoptysis
Constitutional sx (wt loss)

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73
Q

What are the causes of Bronchiectasis?

A

Extrinsic narrowing
Blockage
Congenital
Infective
Inflammatory

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74
Q

What are the congenital causes of Bronchiectasis?

A

Young syndrome
1o ciliary dyskinesis (Kartagener’s syndrome)

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75
Q

What are the features of Young syndrome?

A

Obstructive azoospermia
Chronic sino-pulmonary infections –> Bronchiectasis

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76
Q

What are the features of 1o ciliary dyskinesis (Kartagener’s syndrome)?

A

Paranasal sinusitis
Bronchiectasis
Hearing loss
Situs inversus
Infertility

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77
Q

What are the CXR features of Bronchiectasis?

A

Tramline & ring shadows (thickened bronchial walls)

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78
Q

What are the high-res CT features of Bronchiectasis?

A

Small airway dilatation > nearby vessels
-signet ring sign = dilated bronchus w/ pulm aa nearby
Cysts
Mucous plugging

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79
Q

What is the management of Bronchiectasis?

A

Airway clearance (PT, mucolytics)
Bronchodilators
Long-term abx/prophylactic
Steroids
Surgery (if localised)

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80
Q

What antibiotic is commonly used prophylactically in CF and Bronchiectasis?

A

Azithromycin
-anti-inflammatory in nature

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81
Q

What are the common restrictive lung conditions?

A

Interstitial lung disease
Sarcoidosis
Occupational lung disease

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82
Q

What is the main finding on examination for restrictive lung disease?

A

Fine crackles that do not change on inspiration/expiration, coughing or movement
Bronchial sounds

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83
Q

What are the spirometry findings for restrictive lung disease?

A

FEV1:FVC >0.7

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84
Q

What is the underlying pathological process in ILD?

A

Diffuse, chronic, progressive inflammation

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85
Q

How dose ILD present?

A

Dry cough
Exertional SOB
Clubbing

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86
Q

In which respiratory conditions is clubbing commonly present?

A

CF
Bronchiectasis
ILD
TB

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87
Q

What is the gold standard investigation for suspected ILD?

A

High-res CT

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88
Q

What is the management of ILD?

A

Steroids
Cyclophosphamide +/- Azithromycin if refractory

89
Q

What are the major complications of ILD?

A

Cor pulmonale (requires LTOT)
Infections
Lung cancer (10x increased risk)

90
Q

What is cor pulmonale?

A

RHF 2o pulmonary disease

91
Q

What is Sarcoidosis?

A

Multi-system granulomatous inflammation

92
Q

What are the stages of respiratory Sarcoidosis based on CT findings?

A

Stage 0 - no changes
Stage 1 - bilateral hilar lymphadenopathy (BHL)
Stage 2 - BHL + peripheral pulmonary infiltrates
Stage 3 - SOLELY peripheral pulmonary infiltrates
Stage 4 - progressive fibrosis, honeycombing (bullae), pleural involvement

93
Q

What are the non-respiratory manifestations of Sarcoidosis?

A

Endocrine - hypercalcaemia, hypercalcuria (renal stones)
ENT/eyes - uveitis, sicca, parotid gland enlargement
Cardiomyopathy
Bone cyst
Hepatosplenomegaly
Neuropathies (Bell’s)
Skin manifestations

94
Q

What are the skin manifestations of Sarcoidosis?

A

Erythema nodosum (painful red shin nodules)
Lupus pernio (purple-blue lesions on distal parts)
Subcutaneous nodules

95
Q

What is Lofgren’s syndrome?

A

Acute clinical presentation of sarcoidosis

96
Q

What are the features of Lofgren’s syndrome?

A

Fever
Erythema nodosum
Polyarthralgia (esp. ankles)
BHL

97
Q

What biochemical findings may be present in Sarcoidosis?

A

Hypercalcaemia
High serum ACE
Lymphopenia
High ESR

98
Q

What is the management of Sarcoidosis?

A

Steroids +/- NSAIDs

99
Q

Which conditions are associated with apical fibrosis?

A

BREAST PX
-bronchopulmonary aspergillosis
-radiotherapy
-EAA (hypersensitivity pneumonitis)
-ankylosing spondylitis
-sarcoidosis
-TB
-pneumconiosis
-histiocytosis X

100
Q

Which conditions are associated w/ basal fibrosis?

A

RACIST
-rheumatoid arthritis
-asbestosis
-connective tissue disease/cryptogenic fibrosing alveolitis
-idiopathic pulmonary fibrosis (most common)
-scleroderma
-treatments (drugs)

101
Q

What drugs are associated w/ basal fibrosis?

A

Bulsuphan
Bleomycin
Nitrofurantoin
Hydralazine
Methotrexate
Amidoarone

102
Q

What is Pneumoconiosis?

A

Group of ILD caused by breathing in certain kinds of dust particles
-asbestosis
-silicosis
-coal-worker’s lung

103
Q

What is Asbestosis?

A

ILD/lung ca 2o asbestos exposure

104
Q

What are the two types of lung ca seen in Asbestosis?

A

Mesothelioma - coloured asbestos
Bronchial adenocarcinoma - white asbestos

105
Q

What is Berylliosis and what industries is it seen in?

A

ILD
Aerospace/nuclear industries

106
Q

What is Silicosis and what industries is it seen in?

A

ILD
Pottery, sandblasting, quarrying (clay)

107
Q

What is Coal-worker’s lung and what features might be seen?

A

ILD caused by inhalation of coal dust
Numerous small nodules, black sputum/lung

108
Q

What is Caplan’s disease?

A

Coal-worker’s lung + rheumatoid arthritis + pulmonary rheumatoid nodules (cavities)

109
Q

What types of EAA/hypersensitivity pneumonitis are linked to workplace exposure?

A

Malt-worker’s lung
Farmer’s lung
Mushroom-worker’s lung
Sugar-worker’s lung
Bird-fancier’s lung

110
Q

What organism is implicated in Malt-worker’s lung?

A

Aspergillus clavatus

111
Q

Which organisms are implicated in Farmer’s lung?

A

Saccharaopolyspora rectivirgula
Actinomyces
Micropolyspora

112
Q

What organism is implicated in Mushroom-worker’s lung?

A

Thermophilic actinomyces

113
Q

What organism is implicated in Sugar-worker’s lung?

A

Thermoactinomyces sacchari

114
Q

What is the insulting agent in Bird-Fancier’s lung?

A

Avian antigens

115
Q

What scoring system is used to assess severity in CAP?

A

CURB-65
-confusion (AMT <8)
->65 y/o
-urea >6
-RR >30
-sys BP <90 OR dias BP <60

0-1 - discharge w/ PO abx
>1 - admit for IV abx

116
Q

What are the features of atypical pneumonia?

A

Insidious onset (walking pneumonia)
Malaise
Headache
Myalgia
Arthralgia
Dry-ish cough

117
Q

What is the most common causative pathogen in pneumonia?

A

Strep pneumoniae

117
Q

How may Strep pneumoniae present?

A

Herpes labialis
Lobar consolidation on CXR
+ve urinary antigens

118
Q

Which class of antibiotics has good action against Strep pneumoniae?

A

Penicillins

119
Q

Which patient groups are at risk of Staph aureus pneumonia?

A

Complicates flu infection
IVDU

120
Q

What CXR findings are suggestive of staph aureus pneumonia?

A

Bilateral cavitations

121
Q

Which antibiotics have good action against staph aureus?

A

Flucloxacillin
Vanc if MSRA
Linezolid/Clindamycin if PVL

122
Q

Which patient groups are at risk of Klebsiella pneumonia?

A

Elderly
Diabetic
Alcoholic

123
Q

How may Klebsiella pneumonia present?

A

Redcurrant sputum
CXR - cavitating upper lobe lesion
Usually drug-resistant

124
Q

Which patient groups are at risk of aspiration pneumonia?

A

Patients w/ unsafe swallow

125
Q

Which antibiotics may be required in aspiration pneumonia?

A

Add in gram neg/anaerobe cover (Metronidazole)

126
Q

Where is Legionella commonly found?

A

Water systems
-air-cons
-showers
-cruise ships

127
Q

What features may Legionella pneumonia present with?

A

Hyponatraemia
Confusion
D/V
Deranged LFTs
AKI
Lymphopenia
CXR - bibasal consolidation

128
Q

Which classes of antibiotics are used to treat Legionella pneumonia?

A

Macrolides
Fluoroquinolones

129
Q

When is Mycoplasma pneumonia seen?

A

Winter epidemics

130
Q

What features may Mycoplasma pneumonia present with?

A

Erythmea multiforme
Cold agglutinin (anaemia)
Myocarditis
Glomerulonephritis
Meningoencephalitis

131
Q

Which classes of antibiotics are used to treat Mycoplasma pneumonia?

A

Macrolides
Fluroquinolones
Tetracyclines
NOT PENICILLIN - no cell wall

132
Q

When is Chlamydia psittaci seen?

A

Pt contact w/ infected birds (parrots)

133
Q

What features may Chlamydia pssitaci pneumonia present with?

A

Meningo-encephalitis
Infective endocarditis (culture neg)
Hepatitis
AKI
Splenomegaly
+ve serology

134
Q

Which classes of antibiotics are used to treat Chlamydia pssitaci pneumonia?

A

Tetracyclines
Macrolides

135
Q

Which patient groups are at risk of Pseudomonas pneumonia?

A

Bronchiectasis/CF
Hospital-acquired (ITU)

136
Q

Which antibiotics are used to treat Pseudomonas pneumonia?

A

Limited effective options
Tazocin
Ciprofloxacin
Meropenem
Gentamicin
Ceftazidime

137
Q

Which patients are at risk of Pneuomcystis Pneumonia (PCP)?

A

Immunosuppressed

138
Q

What features may Pneuomcystis Pneumonia (PCP) present with?

A

SOBOE w/ low PaO2
CXR - ground glass opacification, b/l perihilar interstitial shadowing

139
Q

Which investigation is used to diagnose Pneuomcystis Pneumonia (PCP)?

A

Bronchoalveolar lavage

140
Q

Which antibiotic is used to treat Pneuomcystis Pneumonia (PCP)?

A

Co-trimoxazole

141
Q

What are the presenting sx of TB?

A

General - pyrexia, night sweats, malaise, anorexia, clubbing, haemoptysis, cough
Cardiac - pericarditis
CNS - meningitis, Pott’s disease (vertebral collapse)
GI/GU - colicky abdo pain, loin pain, sterile pyuria, haematuria
Derm - erythema nodosum, lupus vulgaris (red-brown apple-jelly nodule)

142
Q

What is Milliary TB?

A

Disseminated TB due to haematogenous spread

143
Q

What test is used to diagnose latent TB?

144
Q

Which other infective disease should be screened for if latent TB is diagnosed?

145
Q

Which patients should be offered prophylactic BCG vaccination?

A

Living/visiting a high risk area
TB in parents/grandparents/family
Children <15 vaccinated as newborns AND high risk
Adults <35, negative mantoux test, high risk
HIV sufferers

146
Q

What is the management of active TB?

A

Rifampicin
Isoniazid (with Pyroxine)
Pyrazinamide
Ethambutol

RIPE for 2/12 then IR for 4/12

147
Q

What are the side effects of Rifampicin?

A

INDUCER
Orange-red urine/tears
Transient hepatitis

148
Q

What are the side effects of Isoniazid?

A

Peripheral neuropathy
-given w/ prohylactic pyridoxine (B6)
Hepatiits
Drug-induced lupus

149
Q

What are the side effects of Pyrazinamide?

A

Hepatitis
Rash
Arthralgia
Gout

150
Q

When are steroids used in TB management?

A

TB Pericarditis/Meningitis

151
Q

What are the side effects of Ethambutol?

A

Red-green colour blindness
Nystagmus
Optic neuritis
Peripheral neuropathy

152
Q

Which patient groups are at risk of fungal pneumonia?

A

Immunosuppressed

153
Q

Which organisms are seen in fungal pneumonia, what patient groups do they affect, and what investigations are indicated?

A

Aspergillus –> serology
Candida - ICU patients –> cultures & PCR
Histoplasmosis - bats, bird’s –> Urine Ag, serology
Blastomycosis - compost (USA) –> KOH culture
Cryptococcus - pigeon droppings –> india ink stain & serology

154
Q

What are the common causes of viral pneumonia?

A

Influenza
Covid
Swine flu (H1N1)
Bird flu

155
Q

Which patient groups should be offered routine flu vaccination?

A

> 50 y/o
Pregnant
HCW
Co-morbid
Immunosuppressed

156
Q

What should patients with complicated flu/requiring prophylaxis be offered?

A

Oseltamivir (neuraminidase inhibitor)

157
Q

What medication can be used to treat swine flu?

A

Zanamivir (oseltamivir resistance)

158
Q

How should avian flu be treated?

A

Antivirals
-7-10/7 after known exposure OR 2/7 post sx

159
Q

What are the five ways in which aspergillus can affect the lungs?

A

1 - Asthma (Type 1 hypersensitivity)
2 - Allergic bronchopulmonary aspergillosis (Types 1 & 3 hypersensitivity)
3 - Extrinsic allergic alveolitis (Types 3 & 4 hypersensitivity)
4 - Aspergilloma
5 - Invasive aspergillosis

160
Q

What lab findings are suggestive of allergic bronchopulmonary aspergillosis and how should it be treated?

A

IgE RAST +ve
Eosinophilia
Raised IgE
Treat w/ steroids

161
Q

How does EAA present?

A

Atypical pneumonia (4-6hrs post exposure)
Chronically restrictive lung disease

162
Q

How should EAA be treated?

A

Avoid exposure
O2
Steroids

163
Q

What are the CXR findings of an Aspergilloma?

A

Fungus ball in pre-existing lung cavity

164
Q

How should Aspergilloma be treated?

A

Excision (if massive haemoptysis)
PO anti-fungals (poor penetration)

165
Q

Which patient groups are at risk of invasive aspergillosis?

A

Sick patients w/ weak immunity

166
Q

What investigations are used to diagnose invasive aspergillosis?

A

Beta-glucan
Serology
Radiology

167
Q

How should invasive aspergillosis be treated?

A

Azoles
Amphotericin

168
Q

What are the two main types of lung ca?

A

Small cell (oat) - 15-20%
Non-small cell - 80-85%

169
Q

What is the main risk factor for small cell lung ca?

170
Q

What are the paraneoplastic manifestations of small cell lung ca?

A

SIADH (hyponatraemia)
Cushing’s (ectopic ACTH)
Lambert-Eaton syndrome

171
Q

Describe Lambert-Eaton syndrome?

A

Peripheral neuropathy
Weakness relieved by exertion

172
Q

What is the treatment for small cell lung ca?

A

Chemo/radiotherapy
too SMALL for surgery

173
Q

What are the main types of non-small cell lung ca?

A

Squamous cell ca
Adenocarcinoma (most common)
Large cell ca
Carcinoid tumour

174
Q

How does squamous cell lung ca present?

A

Central tumours causing bronchial obstruction –> infection
Hypercalcaemia

175
Q

How does squamous cell lung ca spread?

A

Local spread common
Metastasizes relatively late

176
Q

In which patients does adenocarcinoma lung ca present?

A

Non-smokers
Females
<45
Hypertrophic osteoarthropathy
Asbestos exposure

177
Q

How does adenocarcioma lung ca spread?

A

Peripheral so often invade pleura/mediastinal lymph nodes
Metastasizes to brain/bone

178
Q

How does large cell lung ca spread?

A

Metastasize early

179
Q

What are carcinoid tumours?

A

Slow-growing tumours arising in neuro-endocrine cells

180
Q

What are the sx of carcinoid syndrome?

A

Flushing
Diarrhoea
Wheeze
all 2o 5-HT release

181
Q

What are cannonball mets and what is the likely 1o?

A

Large cannonball like lesions on CXR/CT
Commonly metastasize from RCC

182
Q

What 1o cancers commonly metastasize to the lungs?

A

Breast
Colon ca

183
Q

What is a Pancoast tumour?

A

Tumour at the apex of the lung
-commonly NSCLC

184
Q

How do Pancoast tumours commonly present?

A

Incidental finding
Horner’s syndrome
-ipsilateral ptosis
-miosis
-anhidrosis

185
Q

What is a mesothelioma?

A

Pleural cell tumour
-primarily related to asbestos exposure
-no relationship to smoking

186
Q

How do mesotheliomas present?

A

Recurrent pleural effusions/pleurisy

187
Q

How are mesotheliomas treated?

A

Chemotherapy
Pleurodesis/drainage
POOR PROGNOSIS

188
Q

How are NSCLC treated?

189
Q

What factors suggest a solitary pulmonary nodule may be cancerous?

A

Female
Older
FHx
Larger (>5mm)
Emphysema
Upper lobe
Spiculated
Sub-solid (ground glass)

190
Q

How should solitary pulmonary nodules be followed up?

A

If no prev. imaging - CT scan in 3/12
If stable over 2 years - discharge

191
Q

What are the risk factors for PE?

A

Embolic hx
Pregnant/recent birth
Oestrogen
Obesity
Immobility
Surgery/Trauma
Malignancny

192
Q

What is the Well’s score?

A

Pre-test likelihood score for PE (>4 = likely)
DVT sx +3
Likely PE +3
Tachycardia +1.5
>3/7 immobilisation OR w/i 30/7 surgery +1.5
PHx VTE +1.5
Haemoptysis +1
Cancer +1

193
Q

What investigations are commonly used to diagnose PE?

A

D-dimer (rules out, non-specific, age adjusted)
CTPA (gold-standard)
V/Q
Lower limb USS (if DVT suspected)

194
Q

When should V/Q scan be used over CTPA?

A

If CTPA absolutely contraindicated - renal impairment, contrast allergy
If pregnant AND CXR normal

195
Q

How should PEs be managed?

A

IVI
LMW
Bridge to warfarin or DOAC
Thrombolysis if haemodynamically unstable w/ evidence of RHS
Vena cava filter if anticoagulation contraindicated

196
Q

What are the contraindications to thrombolysis?

A

Recent bleeding
Recent high-risk events (spinal surgery, major trauma)
Known hx of haemorrhagic stroke
Uncontrolled HTN
Severe liver disease

197
Q

How long should anticoagulation be continued for following a PE?

A

Unprovoked - 3-6/12 to lifelong
-LOOK FOR CANCER
Provoked - 3/12

198
Q

What are the two main types of pleural effusions?

A

Exudate (>3-3.5g/dL)
Transudate (<2.5g/dL)

199
Q

What are the causes of an exudative pleural effusion?

A

Inflammation/infection
Empyema
Parapneumonic
TB
Cancers

200
Q

What are the causes of a transudative pleural effusion?

A

Failures - heart, liver, renal
Hypothyroidism
Meig’s syndrome

201
Q

What is Meig’s syndrome?

A

Unilateral transudative effusion (RIGHT) w/ ascites associated w/ ovarian fibroma

202
Q

What are the features of an exudative pleural effusion?

A

Protein >3-3.5g/dL
Effusion protein:Serum protein >0.5
Effusion LDH:Serum LDH >0.6
Effusion LDH >2/3 upper limit normal

203
Q

What are the features of a transudative pleural effusion?

A

Protein <2.5g/dL
Effusion protein:Serum protein <0.5
Effusion LDH:Serum LDH <0.6
Effusion LDH <2/3 upper limit normal

204
Q

How should 1o pneumothorax be managed?

A

SOB +/- rim of air >2cm –> aspirate –> if fail for chest drain
ASx +/- rim of air <2cm –> discharge and r/v in 1/12

205
Q

How should 2o pneumothorax be managed?

A

SOB +/- rim of air >2cm –> chest drain
ASx AND 1-2cm –> aspirate + admit to observe for 24hrs (CXR)
ASx AND <1cm - admit to observe for 24hrs (CXR_

206
Q

How is the size of a pneumothorax measured?

A

From 1st visible lung margin to chest wall at level of hilum

207
Q

What is a tension pneumothorax and how should it be managed?

A

Pneumothorax w/ haemodynamic compromise/mediastinal shift/tracheal deviation
NEEDLE THORACOCENTESIS

208
Q

When should surgical treatment of pneumothorax be considered?

A

Bilateral pneumothoraces
Failure of lung expansion 2/7 after drain
3x episodes same side
Previous contralateral PTx

209
Q

What is Obesity Hypoventilation Syndrome?

A

Daytime hypercapnia +/- actual airway obstruction

210
Q

What is Obstructive Sleep Apnoea?

A

Intermittent and repeated UA collapse during sleep
Results in daytime somnolence and irregular breathing at night

211
Q

What risk factors are there for OHS/OSA?

A

Obesity
Alcohol
Smoking

212
Q

How does OHS/OSA present?

A

Daytime sleepiness (Epworth)
Cognitive effect
Decreased libido

213
Q

How should OHS/OSA be managed?

A

Lifestyle advice
Sleeping/positioning technique
Nocturnal CPAP
-routine referral

214
Q

How is an orophrayngeal airway measured?

A

From incisor to angle of jaw

215
Q

When should an oropharyngeal airway be used?

A

If no cough/gag reflex
-otherwise can cause laryngospasm/vomiting

216
Q

When should a nasopharyngeal airway be used?

A

If cough/gag reflex intact
Seizing patients

217
Q

When should a nasopharyngeal airway not be used?

A

Facial trauma/base of skull fractures

218
Q

When should an LMA/iGel be used?

A

If BVM unsuccessful at restoring O2 despite prior adjunct use
If fails –> intubation/surgical airway

Pocket MSRA - Book 1 (7 decks)

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