Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pocket MSRA - Book 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the most common obstructive lung disease?

A

Asthma
COPD
CF
Bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

Wheeze +/- crackles if added infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the spirometry findings for obstructive lung disease?

A

FEV1:FVC <0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

Test for bronchodilator reversibility with spirometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

> 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What alternative diagnoses might need to be considered?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the key feature of occupational asthma?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How should occupational asthma be diagnosed?

A

Peak flow diary to assess trends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What occupations does occupational asthma commonly occur in?

A

Food processors
Animal handlers
Welders
Paint sprayers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

If >/< 3x episodes of sx/week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

SABA
Works acutely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

LABA
Delayed onset
Reduces nocturnal sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the side effects of B2 agonists?

A

Tachycardia
Tremor/anxiety
Cramps
Paradoxical bronchospasm
Hypokalaemia
Hyperglycaemia
Hyperlactataemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

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

A

Bone/GI protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are MART inhalers and why are they used?

A

LABA + ICS
Helps w/ comliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are LRTAs?

A

Leukotriene receptor antagonists
Montelukast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why are LRTAs used in asthma management?

A

Additive effect w/ ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the side effects of LRTAs?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the features of Churg-Strauss syndrome?

A

Eosinophilia
Vasculitic rash
Pulmonary-renal syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why is Theophylline given at night?

A

To prevent morning dipping of PEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the features of Theophylline toxicity?

A

GI upset (N)
Tachycardia
Seizures
Hypokalaemia
Hyperglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What type of drug is Iptratropium?

A

SAMA (anticholinergic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What type of drug is Tiatropium?

A

LAMA (anticholinergic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What PEF is seen in a moderate asthma exacerbation?

A

PEF >50-75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the management of a moderate asthma exacerbation?

A

SABA nebs
PO Prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the management of a severe asthma exacerbation?

A

SABA nebulisers
PO Prednisolone
Consider single dose IV Mg
Admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the Samter triad?

A

Asthma
Nasal polyp
Aspirin sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What drug is contraindicated in sever asthma?

A

Beta-blockers
-10% intolerant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

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

A

Pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Why should ICS not be given alone in COPD?

A

Increase mortality as risk of pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are the common side effects of antimuscarinics?

A

Dry mouth
Nausea
Headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the rare side effects of antimuscarinics?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

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

A

BPH and glaucoma prone patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What additional treatments should be considered in COPD management?

A

Annual Flu + PC vaccine
Pulmonary rehab
Mucolytics
SMOKING CESSATION
LTOT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

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

A

IV Aminophylline loading dose
NIV
Intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

When should NIV be considered in a COPD exacerbation?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When should intubation be considered in a COPD exacerbation?

A

If pH <7.26
PaCO2 rising despite NIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the inheritance pattern of cystic fibrosis?

A

Autosomal recssive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Which gene is affected in cystic fibrosis?

A

Ch7 CFTR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

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

A

1:25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How are UK neonates screened for CF?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What findings on the sweat test are suggestive of CF?

A

High Na + Cl (defective NaCl CFTR channels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the features of a neonatal presentation of CF?

A

Failure to thrive
Meconium ileus
Rectal prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What are the features of a respiratory presentation of CF?

A

Recurrent LRTIs
Nasal polyps
Bronchiectasis (eventually)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What are the features of a GI presentation of CF?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What systems are commonly affected by CF?

A

Respiratory
GI
Reproductive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What are the reproductive sx of CF?

A

Male infertility (undeveloped vas + epididymis)
Female subfertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What organisms commonly cause infective exacerbations in CF?

A

Staph aureus
Pseudomonas
Burkholderia cepacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

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

A

Burkholderia cepacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What type of drug is Ivacaftor?

A

CFTR potentiator for G551D mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What type of drug is Lumacaftor?

A

CFTR corrector for classic F508 mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is Bronchiectasis?

A

Permanent thinning and dilatation of the airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the presenting features of Bronchiectasis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the causes of Bronchiectasis?

A

Extrinsic narrowing
Blockage
Congenital
Infective
Inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the congenital causes of Bronchiectasis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the features of Young syndrome?

A

Obstructive azoospermia
Chronic sino-pulmonary infections –> Bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

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

A

Paranasal sinusitis
Bronchiectasis
Hearing loss
Situs inversus
Infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the CXR features of Bronchiectasis?

A

Tramline & ring shadows (thickened bronchial walls)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the management of Bronchiectasis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What antibiotic is commonly used prophylactically in CF and Bronchiectasis?

A

Azithromycin
-anti-inflammatory in nature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are the common restrictive lung conditions?

A

Interstitial lung disease
Sarcoidosis
Occupational lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are the spirometry findings for restrictive lung disease?

A

FEV1:FVC >0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the underlying pathological process in ILD?

A

Diffuse, chronic, progressive inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

How dose ILD present?

A

Dry cough
Exertional SOB
Clubbing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

In which respiratory conditions is clubbing commonly present?

A

CF
Bronchiectasis
ILD
TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the gold standard investigation for suspected ILD?

A

High-res CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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?

A

IGRA

144
Q

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

A

HIV

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?

A

Smoking

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?

A

Surgery

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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions