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Alice's finals cards > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Which type of lung cancer is responsible for multiple paraneoplastic syndromes and why?

A

SCLC because the cells contain neurosecretory hormones which secrete neuroendocrine hormones

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2
Q

What are the signs and symptoms of lung cancer?

A

Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy

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3
Q

What investigations should be done for lung cancer?

A

Chest x-ray

Staging CT scan

PET-CT

Bronchoscopy

Histology

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4
Q

What may be seen on a chest x-ray of lung cancer?

A

Hilar enlargement
Peripheral opacity
Pleural effusion
Collapse

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5
Q

What can a hoarse voice in the context of lung cancer suggest?

A

Recurrent laryngeal palsy

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6
Q

What is pemberton’s sign and what does it suggest?

A

When raising hands over the head causes facial congestion and cyanosis. It is a sign of superior vena cava obstruction

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7
Q

Which tumour causes Horner’s syndrome?

A

Pancoast’s tumour. Presses on the sympathetic ganglion

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8
Q

Why can small cell lung cancer cause lambert-eaton?

A

Antibodies are produced against the SCLC, they also target and damage voltage-gated calcium channels on the presynaptic terminals in the motor neurones. This leads to weakness, particularly in the proximal muscles but can also affect intraocular muscles causing diplopia (double vision), levator muscles in the eyelid causing ptosis and pharyngeal muscles causing slurred speech and dysphagia (difficulty swallowing).

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9
Q

How is pneumonia seen on chest x-ray?

A

Consolidation

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10
Q

How is pneumonia labelled as either community or hospital?

A

If it is acquired outside of hospital then it is labelled as community. If it is acquired >48 hours after admission to hospital then it is hospital acquired pneumonia

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11
Q

What are the chest signs of pneumonia?

A

bronchial breath sounds
Focal coarse crackles
Dullness to percussion

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12
Q

What scoring assessment is used in pneumonia to estimate the mortality?

A

CURB-65

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13
Q

What are the common pathogens of pneumonia?

A

Streptococcus pneumoniae (50%)
haemophilus influenzae (20%)

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14
Q

How does legionella pneumonia present?

A

Hyponatraemia because it causes SIADH

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15
Q

Which bacteria causes a pneumonia which presents alongside target lesions?

A

Mycoplasma pneumoniae. Causes erythema multiforme which leads to the target lesions on the skin. May also cause neurological symptoms in a younger patient

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16
Q

What can cause pneumonia in those who are immunocompromised?

A

Pneumocystis jirovecii (PCP). Usually occurs in those who have poorly controlled or new HIV with a low CD4 count

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17
Q

What does obstructive lung disease show on spirometry?

A

FEV1 less than 75%, FEV1:FVC <75%

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18
Q

What does restrictive lung disease show on spirometry?

A

FEV1 and FVC are equally reduces so the FEV1:FVC is >75%

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19
Q

Is asthma obstructive or restrictive?

A

Obstructive

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20
Q

Give some examples of typical triggers for asthma

A

Infection
Night time or early morning
Exercise
Animals
Cold/damp
Dust
Strong emotions

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21
Q

What type of wheeze is heard in asthma?

A

Bilateral widespread “polyphonic” wheeze

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22
Q

What are the first line investigations for asthma?

A

Fractional exhaled nitric oxide
Spirometry with bronchodilator reversibility

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23
Q

Give an example of a LABA

A

Salmeterol

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24
Q

Give an example of a LAMA

A

Tiotropium

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25
Q

Give an example of a leukotriene receptor antagonist

A

Montelukast

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26
Q

What is the monitoring for theophylline?

A

Levels after 5 days and 3 days after any dose changes

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27
Q

What is the stepwise management of asthma (8 steps)

A
  1. SABA
  2. SABA+ ICS
    • leukotrine receptor agonist
  4. +LABA
  5. Change to MART
  6. Increase ICS to moderate dose
  7. Increase ICS to high or theophylline or LAMA
  8. Refer to specialist
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28
Q

What is MART regime?

A

A combination inhaler containing a low dose inhaled ICS and a fast acting LABA

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29
Q

What does a PEFR of 50-75% of predicted suggest?

A

Moderate acute asthma

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30
Q

What does a PEFR of 33-50% of predicted suggest?

A

Severe acute asthma

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31
Q

What does a PEFR of <33% suggest?

A

Life threatening asthma

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32
Q

How is moderate acute asthma managed?

A

Nebulised salbutamol
Nebulised ipratropium bromide
Steroids
Oxygen

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33
Q

How is severe acute asthma managed?

A

Oxygen to maintain sats at 94-98%
Prednisolone
Aminophylline infusion (started by senior medical staff)
Nebulised salbutamol

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34
Q

How is life threatening asthma managed?

A

IV magnesium sulphate
Intubation

35
Q

What does an ABG in acute asthma show?

A

Respiratory alkalosis due to tachypnoea causing a drop in CO2

36
Q

What needs to be monitored when salbutamol is used?

A

Serum potassium. Causes serum hypokalaemia

Also causes tachycardia

37
Q

What are the 5 stages of the MRC dyspnoea scale?

A

1- breathless on strenuous exercise
2- breathless on walking up hill
3- breathless that slows walking on the flat
4- stop to catch breath after 100m on the flat
5- unable to leave house due to breathlessness

38
Q

How is a diagnosis of COPD made?

A

By clinical presentation and spirometry
FEV1:FVC <0.7

39
Q

What is the management of COPD?

A

SABA or short acting antimuscarinics (ipatropium bromide)

Plus either:
LABA and LAMA if no asthmatic features

OR

LABA and ICS if asthmatic features

40
Q

What are the features of type 1 respiratory failure?

A

Normal pCO2 with low PO2

41
Q

What are the features of type 2 respiratory failure?

A

Raised pCO2 and low PO2

42
Q

What is the O2 sats target in patients who are retaining CO2?

A

88-92%

43
Q

What is a contraindication for biPAP?

A

Pneumothorax

44
Q

Which investigation is used to diagnose interstitial lung disease? What is the finding?

A

HRCT and it shows a ground glass appearance - later progressing to ‘honeycomb’ appearance

45
Q

What can be found on examination in idiopathic pulmonary fibrosis?

A

Bibasal fine inspiratory crackles and finger clubbing

46
Q

Which two medications can be used to slow the progression of idiopathic pulmonary fibrosis?

A

Pifenidone
Nintedanib

47
Q

Which drugs can cause pulmonary fibrosis?

A

Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin

48
Q

What type of hypersensitivity reaction in hypersensitivity pneumonitis?

A

Type III

49
Q

How is hypersensitivity pneumonitis diagnosed

A

Bronchoalveolar lavage which shows raised lymphocytes and mast cells

50
Q

What are the two types of pleural effusion and what is the difference?

A

There is exudative and transudative

Exudative means there is a high protein count >3g/dL

Transudative means there is a lower protein count <3g/dL

51
Q

What causes exudative pleural effusion?

A

Lung cancer
Pneumonia
Rheumatoid arthritis
Tuberculosis

52
Q

What causes transudative pleural effusion?

A

Congestive cardiac failure
Hypoalbuminaemia
Hypothyroidism
Meig’s syndrome

53
Q

What is the presentation of pleural effusion?

A

SOB
Dullness to percussion
Reduces breath sounds
Tracheal deviation away from the effusion

54
Q

What is seen on a chest X-ray of a pleural effusion?

A

Blunting of the costophrenic angle
Fluid in the lung fissures
Larger effusions have a meniscus
Tracheal deviation

55
Q

What is the management of pleural effusion?

A

Conservative if small

Pleural aspiration

Chest drain

56
Q

What is seen on pleural aspiration in empyema?

A

Pus, acidic pH (<7.2), low glucose, high LDH

57
Q

What is the investigation of choice in pneumothorax?

A

Erect chest x-ray

58
Q

What is the management for a pneumothorax with a <2cm rim of air

A

No treatment is required, should resolve spontaneously

59
Q

What is the management for a pneumothorax with a >2cm rim of air and SOB?

A

Aspiration

If aspiration fails twice then chest drain

60
Q

What are the signs of tension pneumothorax?

A

Tracheal deviation away from the side of the pneumothorax
Reduces air entry to affected side
Increased resonance on affected side
Tachycardia
Hypotension

61
Q

What is the management of a tension pneumothorax?

A

Insert a large bore cannula into the second intercostal space in the midclavicular line

62
Q

Where should chest drains be inserted?

A

The triangle of safety made up by:
5th intercostal space
Mid axillary line
anterior axillary line

63
Q

What is the main contraindication for compression stockings?

A

Peripheral arterial disease

64
Q

What should patients at risk of DVT or PE be given?

A

LMWH for example enoxaparin

65
Q

What is the presentation of PE?

A

SOB
Cough, woith or without haemoptysis
Pleuritic chest pain
Hypoxia
Tachycardia
Raised respiratory rate
Low grade fever

66
Q

What does the outcome of a well’s score suggest?

A

If likely do a CT pulmonary angiogram/ proximal vein ultrasound, if unlikely to a d-dimer and if positive do a CTPA/ proximal vein ultrasound

67
Q

Which investigation for PE should be done if a CTPA is contraindicated?

A

Ventilation-perfusion scan (VQ scan)

68
Q

What is the initial recommended treatment for PE?

A

Apixaban or rivaroxaban

69
Q

In which disease are DOACs contraindicated?

A

Antiphospholipid syndrome. LMWH should be used instead

70
Q

How long should anticoagulation be continued after PE?

A

3 months if there is an obvious reversible cause

Beyond 6 months if the cause is unclear, there is recurrent VTE or there is an irreversible underlying cause

6 months in active cancer

71
Q

What is seen on an ECG in pulmonary hypertension?

A

Right ventricular hypertrophy
Right axis deviation
RBBB

72
Q

What is seen on x-ray in pulmonary hypertension?

A

Dilated pulmonary arteries
Right ventricular hypertrophy

73
Q

How can primary pulmonary hypertension be managed?

A

IV prostanoids
Endothelin receptor agonists
Phosphodiesterase-5 inhibitors (sildenafil)

74
Q

What are granulomas?

A

Nodules of inflammation full of macrophages

75
Q

What are the extra-pulmonary manifestations of sarcoidosis?

A

Erythema nodosum and lymphadenopathy
Fever
Fatigue
Weight loss

76
Q

What are the pulmonary manifestations of sarcoidosis?

A

Lymphadenopathy
Pulmonary fibrosis
Pulmonary nodules

77
Q

What is the presentation of lofgren’s syndrome?

A

Bilateral hilar lymphadenopathy
Polyarthralgia
Erythema nodosum

78
Q

What is seen on bloods in someone with sarcoidosis?

A

Raised serum ACE
Hypercalcaemia
raised serum soluable interleukin-2 receptor
Raised CRP
Raised IgG

79
Q

What is the gold standard test for sarcoidosis and what does it show?

A

Histology showing non-caseating granulomas with epitheliod cells

80
Q

What is the management of sarcoidosis?

A

Often resolves in 6 months
Oral steroids
Lung transplant in very serious lung disease

81
Q

What causes obstructive sleep apnoea?

A

Collapse of the pharyngeal airway during sleep

82
Q

Which scale is used to assess OSA?

A

Epworth sleepiness scale

83
Q

What is the management of OSA?

A

lose weight

CPAP or surgery

Alice's finals cards (23 decks)

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