respiratory Flashcards
what does Goodpastures disease attack and what type of hypersensitivity reaction is it?
- anti-glomerular basement membrane (glomerulus and pulmonary basement membranes) - type IV collagen
- type II hypersensitivity reaction
which electrolyte disturbance is a key finding of sarcoidosis?
hypercalcaemia
list key features of sarcoidosis
- dry cough,
- SOB,
- rash,
- bilateral hilar lymphadenopathy on XR,
- biopsy showing non-caseating granulomas with epithelioid cells -
- HYPERCALCAEMIA
how do long acting muscarinic antagonists work?
cause bronchodilation by blocking acetylcholine receptors (which normally cause contraction of bronchial smooth muscle)
what is the immediate treatment for a spontaneous pneumothorax?
immediate decompression via large bore canula
what is the treatment for a moderate PE (stable patient)?
- DOAC e.g. apixaban / rivaroxaban,
- if contraindicated (e.g. in liver disease) then LMWH e.g. dalteparin
what is the treatment for a severe PE (unstable patient)?
thrombolysis
Which cause of pneumonia is most typically associated with AIDS?
pneumocystis jirovecii
describe the CURB-65 criteria
- score 1 for each of: Confusion; Urea > 7mmol/L; Resp rate >30/min; Blood pressure (Sys <90mmHg, Dia <60mmHg); Age >65.
- Score 0-1: Treat as outpatient; score 2: Admit to hospital; score ≥3: Severe, may require step up to ITU
what is sarcoidosis?
- chronic disease of unknown cause
- enlargement of lymph nodes in many parts of the body
- widespread appearance of granulomas derived from the reticuloendothelial system
list 4 risk factors for COPD
smoking, asbestos exposure, alpha-1 antitrypsin deficiency, occupational exposure
which gene is mutated in cystic fibrosis?
transmembrane conductance regulator gene (CFTR)
Which drug is used in the treatment of tuberculosis and may cause red tears / sweat / saliva?
rifampicin
what is the mode of inheritance of cystic fibrosis?
autosomal recessive
what is the most common type of lung cancer?
adenocarcinoma - also most common in non-smokers
what is the most common type of lung cancer in smokers?
squamous cell carcinoma
in bronchiectasis, what’s the common finding on CT?
signet ring sign
name 4 obstructive lung diseases
asthma, COPD, bronchiectasis, bronchiolitis
name 4 restrictive lung diseases
TB, pulmonary fibrosis, asbestosis, bronchiolitis
what is the most common organism to cause hospital acquired pneumonia?
pseudomonas aeruginosa
what is the most common organism to cause community acquired pneumonia?
strep pneumoniae and staph aureus
Which type of patients are most likely to develop a spontaneous pneumothorax?
young males (20-40), low BMI
What is the most appropriate site for a needle thoracostomy to treat a tension pneumothorax?
2nd intercostal space, midclavicular line, on the same side as the pneumothorax
what signs would support a diagnosis of tension pneumothorax?
- Tracheal deviation away from the affected lung
- hypotension
- hypoxia
- “bubble wrap” like texture under skin of neck (subcut emphysema),
- PMH chest trauma
What is the Gold-standard imaging technique for diagnosing a PE?
CT pulmonary angiography (CTPA)
how do you differentiate between squamous cell carcinoma and small cell carcinoma?
SCLC can present with paraneoplastic syndromes e.g. Lambert-eaton syndrome - muscle weakness in truncal distribution which improves after exertion
treatment for hospital acquired pneumonia?
co-amoxiclav and clarithromycin IV
what is the gold standard investigation for TB?
nucleic acid amplification tests (NAAT)
what is seen on an XR for TB?
Ghon complex - predominantly in upper part of lower lobe
list 4 complications of cystic fibrosis?
T2DM, infertility in males, mucous retention in the lungs, meconium ileus
first line management of sarcoidosis?
prednisolone
how do you treat a COPD exacerbation?
OSHIT:
- O2 at ~24-28%
- Salbutamol
- Hydrocortisone
- Ipratropium
- Theophylline
what signs on an XR would confirm a diagnosis of TB?
- Ghon’s complex
- dense homogenous opacity
- pleural effusion
- hilar lymphadenopathy
what type of lesion is usually present in TB?
caseating granuloma
What is the most likely causative organism of TB?
mycobacterium tuberculosis
What stain should be used with mycobacterium tuberculosis?
Ziehl-Neelson stain
what antibiotics are used to treat TB?
rifampicin, isoniazid, pyrazinamide, ethambutol
what 2 tests are used to detect cystic fibrosis?
heel prick test and sweat test
list some differentials for resp conditions caused by asbestos exposure?
asbestosis, mesothelioma, silicosis, idiopathic pulmonary fibrosis, coal worker’s pneumoconiosis
which type of cancer has a very strong association with asbestos exposure?
mesothelioma
what is Horner’s syndrome?
rare condition classically presenting with partial ptosis, miosis, and facial anhidrosis due to a disruption in the sympathetic nerve supply
pathophysiology of a pancoast tumour?
a cancer that starts in the apex of the lung -> invades apical chest wall -> grows and affects nearby structures e.g. intercostal nerves or brachial plexus and sympathetic chain
What is the pathophysiology of chronic asthma?
- narrowing of the airway due to smooth muscle contraction
- thickening of the airway wall by cellular infiltration and inflammation
- and the presence of secretions within the airway lumen
name 5 things that can precipitate asthma flare ups
- cold air,
- exercise,
- emotion,
- allergens,
- infection,
- smoking,
- pollution,
- NSAIDs,
- beta-blockers
1 investigation used to confirm asthma diagnosis?
spirometry
name 3 classes of drugs used in the management of asthma and give one example of each
- Short acting beta2-Adrenoceptor agonists - salbutamol / terbutaline
- longer-acting - salmeterol and formoterol.
- Antimuscarinic bronchodilators - ipratropium bromide
- Inhaled corticosteroids - beclomethasone
- Anti-inflammatory agents, e.g. sodium cromoglicate
- Cysteinyl leukotriene receptor antagonists (LTRAs) - montelukast, are (given orally).
gold standard investigation for a lung cancer?
chest XR
list 5 cancers that can metastasise to lung
breast, colon, prostate, bladder, sarcoma
what hormone is produced by small cell lung cancer?
ACTH
what kind of lesions does sarcoidosis form on the body?
non-caseating granulomas
name 4 extrapulmonary signs of sarcoidosis
- erythema nodosum
- polyarthritis
- lupus penio
- arrhythmias
name 4 differentials that present with bilateral hilar lymphadenopathy on XR
lymphoma, silicosis, TB, HF, sarcoidosis
name 3 potential causes of bronchiectasis
CF, post infection, airway obstruction, congenital ciliary defect
name 3 signs you could notice on examination of bronchiectasis
- clubbing,
- wheeze,
- course crackles heard on early inspiration
Name 3 potential complications of bronchiectasis
emphysema, repeated infections, respiratory failure, PT
name 2 non-pharmacological managements of bronchiectasis
healthy diet, physical exercise, smoking cessation
what is the FEV1/FVC ratio in obstructive lung diseases?
< 0.7
what is the FEV1/FVC ratio in restrictive lung diseases?
> 0.7
4 important differential diagnoses for COPD?
asthma, A1AT deficiency, CF, bronchiectasis
Aside from spirometry, what other initial investigations would be appropriate for COPD?
chest XR, FBC (anaemia, polycythaemia), BMI, ABG
most appropriate antibiotic for haemophilus influenzae?
co-amoxiclav
Give 2 differential diagnoses for a COPD exacerbation.
pneumonia, pneumothorax
Name 5 groups of patients most at risk of respiratory infections.
Infants, elderly, COPD / chronic lung conditions, immunocompromised (HIV, diabetes)
What tool is used to assess the severity of resp infections?
CURB-65
Name 3 risk factors for a pneumothorax
smoking, previous PT, COPD, trauma
Name 2 symptoms of a pneumothorax
chest pain, dyspnoea (maybe asymptomatic)
Name 3 symptoms of a pulmonary embolism
chest pain, dizziness, dyspnoea
Name an objective risk assessment score for calculating PE risk?
Well’s score
Describe how a pneumothorax and pleural effusion could be differentiated on a respiratory examination
- PE: dull on percussion
- PT: hyper-resonant on percussion
Describe how a pneumothorax and pleural effusion could be differentiated through a history
- PE: congestive HF, pulmonary embolism, cancer, pneumonia
- PT: trauma, family history, smoking
What aspect of chest pain differentiates pericarditis and an MI?
Does NOT radiate to the jaws and teeth in pericarditis
Name 4 features elicited on clinical examination that would make you suspect pericarditis
pericardial rub, sinus tachycardia, fever, effusion signs
What would you expect on an ECG of a patient with pericarditis
Saddle shaped ST elevation
How long should colchicine be given for in patients who have had acute pericarditis?
6-8 weeks
What is the first line treatment for pneumonia?
Oxygen
describe streptococcus pneumoniae
gram positive bacilli chains
What is bronchiectasis?
The permanent dilation of the airways caused by chronic inflammation / and inability to clear secretions.
How can an infection cause bronchiectasis?
The infection causes release of inflammatory mediators (IgE), impairing ciliary action allowing bacterial proliferation and tissue damage.
Give two possible treatments of bronchiectasis
antibiotics, bronchodilators, corticosteroids
What is the term given to describe “a tendency to develop allergies”?
atopy
Eczema, asthma and allergic rhinitis are a classical atopic triad of what syndrome?
Hyper IgE syndrome
What are the most common sites for eczema?
Flexor surfaces, Backs of knees/front of elbows, cheeks, hands and feet, buttocks, behind the ears
How does an allergen lead to histamine release?
An allergen stimulates a cascade that leads to IgE antibody secretion by B cells. The IgE binds to mast cells causing them to degranulate and release histamine
How does histamine cause inflammation?
causes blood vessels to dilate and leak
describe the pathophysiology of chronic bronchitis
Inflammation causes mucociliary dysfunction, leading to lower ventilation
describe the pathophysiology of emphysema
Inflammation causes loss of elastic recoil of alveoli, causing air trapping and lower gas transfer
Give the three cardinal symptoms of COPD
sputum production in cough, dyspnoea, chronic cough
What two signs found through lung function tests indicate COPD?
FEV1/FVC < 0.7
FEV1 < 80% of predicted value
Give 3 characteristics of asthma.
airflow limitation, airway hyper-responsiveness, bronchial inflammation
What is the action of beta-2-agonists?
bronchodilator
How long do short acting beta-agonists (SABAs) last?
4 hours
What makes LABAs last longer in tissues?
lipophilic
What can happen if beta-2-agonists are used at high concentrations in badly controlled asthma?
B2-receptor desensitisation
Give three risk factors for asthma.
- PMH of atopy
- family history of asthma/atopy
- obesity
- socio-economic deprevation
give the 3 typical characteristics of asthma
airflow limitation, airway hyper-responsiveness, bronchial inflammation
give 2 classes of bronchodilators
beta-2-agonists, muscarinic antagonists
What is the commonest cause of an infective exacerbation of COPD?
haemophilus influenzae
which medication for asthma is most associated with a fine tremor?
salbutamol inhaler
mechanism of action of ipratropium bromide?
muscarinic acetylcholine receptor antagonist that acts as a bronchodilator
give 3 differential diagnoses for pericarditis
aortic dissection, pneumonia, acute coronary syndrome, MI, PE
main investigation and results in pericarditis?
ECG -> saddle shaped ST elevation, PR depression
what drug can be given to reduce the chance of recurrence of pericarditis?
colchicine
give 3 complications of pericarditis
pericardial effusion, cardiac tamponade, constrictive pericarditis
what is the symptomatic management of asbestosis?
corticosteroids
what is the survival rate of lung cancer?
10 year survival of 5.5%
what is an acute test for diagnosing asthma?
peak expiratory flow
What cell is responsible for presenting an asthma causing allergen to Th2 cells?
dendritic cell
List 3 potentially triggering substances for asthma
- air pollution e.g. cigarette smoke
- allergens e.g. dust, cats, mould
- medications e.g. beta blockers
list 4 signs of a severe asthma attack
- PEFR 33-50% predicted
- RR > 25
- HR > 110
- Inability to complete sentences
list 4 signs of a life threatening asthma attack
- PEFR <33%
- SaO2 <92% or PaO2 < 8 kPa
- Normal PaCO2 4.6-6 kPa
- Altered conscious level, exhaustion, arrhythmia, hypotension, silent chest, poor effort, cyanosis
gram positive, alpha-haemolytic optochin negative bacteria?
strep viridans
how can COPD lead to peripheral oedema?
hypoxic kidney is not perfused so no sodium and water is excreted leading to peripheral oedema
give 3 signs that may be seen in COPD
barrel chest, intercostal recession, wheeze, tachycardia
what is the FEV value for COPD?
< 80% predicted
what would an asthmatic’s lungs sound like on percussion?
hyper-resonant
what is the correct stepwise pharmacological
management for an adult diagnosed with asthma?
SABA -> low ICS -> LTRA -> LABA -> MART -> mod ICS -> high ICS
does lung cancer commonly metastesis to breasts?
NO - commonly brain, liver, bone, adrenal glands
name 3 organisms that can cause atypical pneumonia?
- mycoplasma pneumonia,
- legionella pneumophila,
- chlamydophila pneumoniae
Cystic fibrosis is an inherited autosomal recessive disease caused by genetic mutations, but which chromosome is affected?
7
describe moderate asthma
- PEFR more than 50-75% best or predicted
- normal speech
- no features of acute severe or life-threatening asthma
describe acute severe asthma
- PEFR 33-50% best or predicted
- or respiratory rate of at least 25/min
- or pulse rate of at least 110/min
- or inability to complete sentences in one breath / or accessory muscle use / or inability to feed (infants), with oxygen saturation of at least 92%
describe life threatening asthma
- PEFR less than 33% best or predicted,
- or oxygen saturation of less than 92%,
- or altered consciousness, poor respiratory effort / silent chest, or confusion.
state the acute severe asthma attack pathway
- salbutamol
- ipratropium bromide nebuliser
- oral prednisolone or IV hydrocortisone
give 3 indicators of good asthma control
- no night time symptoms
- inhaler used < 3 times a week
- no breathing difficulties, cough or wheeze on most days
- able to exercise without symptoms
- normal lung function test
Give 2 causes of exudative effusions
pneumonia, TB, RA, lung cancer
Give 2 causes of transudative effusions
heart failure, hypoalbuminaemia, hypothyroidism
how do you differentiate between transudative and exudative effusions?
If the pleural fluid protein is greater than 35g/L the fluid is an exudate
why does dyspnoea occur in pneumonia?
alveoli are filled with pus/neutrophils/inflammatory exudate which impairs gas exchange
