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Year 4 Final > Respiratory > Flashcards

Respiratory Flashcards

1
Q

First line for acute bronchitis

A

Doxycyline

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2
Q

What is pneumoconiosis?

A

Accumulation of dust in the lungs and the response of the bodily tissue to its presence, most commonly used in relation to coal worker’s pneumoconiosis

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3
Q

What do you hear in lung auscultation in pulmonary oedema?

A

Fine crackles as a result of fluid in the alveolar space

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4
Q

Features of pulmonary oedema on a chest X-ray

A

Interstital oedema
Bat wing appearance
Upper lobe diversion
Kerley B line
PE
Cardiomegaly may be seen if cardiogenic cause

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5
Q

When should you consider azithromycin in people with COPD?

A

Do not smoke and
have optimised non-pharmacological management and inhaled therapies, relevant vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and continue to have 1 or more of the following, particularly if they have significant daily sputum production:
frequent (typically 4 or more per year) exacerbations with sputum production
prolonged exacerbations with sputum production
exacerbations resulting in hospitalisation.

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6
Q

What are the parneoplastic manifestations of small cell lung cancer?

A

Ectopic production of ACTH and ADH

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7
Q

What are the parneoplastic manifestations of squamous cell lung cancer?

A

Parathyroid hormone related proteins are produced leading to hypercalcaemia

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8
Q

Most common organism causing infective exacerbation of COPD

A

Haemophilus influenza

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9
Q

What is a pack year

A

20 cigarettes per day for 1 year

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10
Q

NICE guidelines recommend prescribing what for patients with COPD who have had >3 exacerbations requiring steroid therapy and at least one exacerbation requiring hospital admission in the previous year

A

Azithromycin

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11
Q

What is A1AT deficiency?

A

Common inherited condition caused by a lack of a protease inhibitor (Pi) normally produced by the liver. The role of A1AT is to protect cells from enzymes such as neutrophil elastase

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12
Q

What can transudates indicate?

A

heart failure (most common transudate cause)
hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption)
hypothyroidism
Meigs’ syndrome

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13
Q

What can exudates indicate?

A

infection: pneumonia (most common exudate cause), TB, subphrenic abscess
connective tissue disease: RA, SLE
neoplasia: lung cancer, mesothelioma, metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome

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14
Q

Parneoplastic syndromes most associated with adenocarcinoma?

A

Gynaecomastia
Hypertrophic pulmonary osteoarthropahy

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15
Q

Mneumonic for LTOT

A

The 4 Bs
Blue (cyanosis, sp02 <92%)
Breathing (severe airway obstruction, FEV1 <30%)
Blood (secondary polycythaemia)
Ballooning (peripheral oedema, raised JVP, hepatomegaly)

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16
Q

Triangle of safety for chest drain insertion

A

base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi

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17
Q

NICE only recommend giving oral antibiotics in an acute exacerbation of COPD in the presence of

A

Purulent sputum or signs of pneumonia

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18
Q

Most common sites of aspiration pneumonia?

A

Right middle and lower lung lobes

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19
Q

First line after weight loss in sleep apnoea treatment?

A

CPAP

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20
Q

Why does polycythemia occur in COPD?

A

Secondary polycythemia can be caused by a high secretion of erythropoietin (EPO) in response to chronic hypoxia or as a consequence of an EPO-secreting tumor [3]. Theoretically, secondary polycythemia can be attributed to chronic obstructive pulmonary disease (COPD) in response to chronic hypoxia.

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21
Q

What are canon ball metastasis?

A

Refer to well-defined spherical nodules scattered over both lungs, being a classical presentation of hematogenous tumor spreading.

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22
Q

How much protein points to an exudate?

A

More than 30g/L protein

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23
Q

Most common causes of bilateral hilar lymphadenopahty?

A

Sarcoidosis
TB

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24
Q

What test can help make chug strauss diagnosis?

A

ANCA

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25
How can small vessel vasculitis be divided?
ANCA associated vasculitis Immune complex mediated vasculitis
26
ANCA associated vasculitis types?
Microscpic polyangiitis Granulomatosis with polyangitis Eosinophilic granulomatosis with polyangitis
27
What is atelectasis?
Common postoperative complication in which basal alveolar collapse can lead to respiratory difficulty. It is caused when airways become obstructed by bronchial secretions.
28
Management of atelectasis?
Positioning the patient upright chest physiotherapy: breathing exercises
29
Parneoplastic features of SCC LC>
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia clubbing hypertrophic pulmonary osteoarthropathy (HPOA) hyperthyroidism due to ectopic TSH
30
Fibrosis predominately affecting the upper zones
hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis) coal worker's pneumoconiosis/progressive massive fibrosis silicosis sarcoidosis ankylosing spondylitis (rare) histiocytosis tuberculosis radiation-induced pulmonary fibrosis
31
Fibrosis predominately affecting the lower zones
idiopathic pulmonary fibrosis most connective tissue disorders (except ankylosing spondylitis) e.g. SLE drug-induced: amiodarone, bleomycin, methotrexate asbestosis
32
Features of idiopathic pulmonary fibrosis?
progressive exertional dyspnoea bibasal fine end-inspiratory crepitations on auscultation dry cough clubbing
33
Criteria for discharge after an asthma attack?
been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours inhaler technique checked and recorded PEF >75% of best or predicted
34
Why can elevated calcium occur in sarcoidosis?
sarcoidosis can lead to hypercalcaemia due to the increased production of 1,25-dihydroxy vitamin D3 by activated macrophages and granulomas
35
Features of acute sarcoidosis?
erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia insidious: dyspnoea, non-productive cough, malaise, weight loss
36
Features of primary ciliary dyskinesia?
dextrocardia or complete situs inversus bronchiectasis recurrent sinusitis subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes) | q
37
CXR features in COPD?
hyperinflation flattened hemidiaphragms hyperlucent lung fields
38
LTOT in COPD mneuomic
lungS POP Secondary polycythaemia Peripheral oedema Oxygen 7.3-8 Pulmonary hypertension
39
Which Oral prophylactic antibiotic therapy is used for COPD patients
Azithromycin
40
An increase in the FEV1 of what after inhalation of a short-acting bronchodilator is indicative of asthma
12% or more
41
Features of kartenger's syndrome?
dextrocardia or complete situs inversus bronchiectasis recurrent sinusitis subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
42
Causes of actual mediastinal widening include:
vascular problems: thoracic aortic aneurysm lymphoma retrosternal goitre teratoma tumours of the thymus
43
What is acute respiratory distress syndrome?
acute condition characterized by bilateral pulmonary infiltrates and severe hypoxemia (PaO2/FiO2 ratio < 200) in the absence of evidence for cardiogenic pulmonary oedema (clinically or pulmonary capillary wedge pressure of less than 18 mm Hg).
44
Causes of adult respiratory distress syndrome?
Sepsis Direct lung injury Trauma Acute pancreatitis Long bone fracture or multiple fractures (through fat embolism) Head injury (causes sympathetic nervous stimulation which leads to acute pulmonary hypertension)
45
How is a diagnosis of mesothelioma made?
histology, following a thoracoscopy
46
First line bronchodilator therapy for asthma?
a short-acting beta2-agonist (SABA) or short-acting muscarinic antagonist (SAMA) is first-line treatment
47
A number of conditions predominantly cause fibrosis of the upper lobes. They can be summarised with the mnemonic CHARTS:
C- Coal worker's pneumoconiosis H - Histiocytosis/ hypersensitivity pneumonitis A - Ankylosing spondylitis R - Radiation T - Tuberculosis S - Silicosis/sarcoidosis
48
NSCLC surgery contraindications?
assess general health stage IIIb or IV (i.e. metastases present) FEV1 < 1.5 litres is considered a general cut-off point* malignant pleural effusion tumour near hilum vocal cord paralysis SVC obstruction
49
Indications for steroids in sarcoidosis?
patients with chest x-ray stage 2 or 3 disease who are symptomatic. Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment hypercalcaemia eye, heart or neuro involvement
50
What is TLCO?
overall measure of gas transfer for the lungs from the alveoli into the capillaries and reflects how much oxygen is taken up into the red cells
51
What is KCO?
TLCO divided by the alveolar volume, which makes it a measure of how efficient gas exchange is in relation to the alveolar-capillary surface to volume ratio.
52
What is klebsiella pneumonia?
Gram-negative rod that is part of the normal gut flora. It can cause a number of infections in humans including pneumonia (typically following aspiration) and urinary tract infections.
53
Features of Klebsiella pneumonia
more common in alcoholic and diabetics may occur following aspiration 'red-currant jelly' sputum often affects upper lobes
54
Complications that may occur and which the patient should be advised of in the process of obtaining consent:
Failure of insertion - the drain may be abutting the apical pleura, in which case it should be pulled back, or may be subcutaneous or in rare cases could enter the abdominal cavity. In both latter cases, the drain should be removed and re-sited. Bleeding - around the site of the drain or into the pleural space Infection Penetration of the lung Re-expansion pulmonary oedema
55
Mneumonic for asthma management?
'Oh Shit, I Hate My Asthma' oxygen, salbutamol, hydrocortisone, ipratropium, magnesium, aminophylline
56
Pathophysiology of lung abscesses?
Polymycrobial in nature
57
Commonest causes of an anterior mediastinum mass can be remembered by the 4 T's:
teratoma, terrible lymphadenopathy, thymic mass and thyroid mass
58
conditions that cause an increased KCO with a normal or reduced TLCO
pneumonectomy/lobectomy scoliosis/kyphosis neuromuscular weakness ankylosis of costovertebral joints e.g. ankylosing spondylitis
59
Best pH for NIV?
7.25-7.35
60
COPD staging criteria
61
What is ipraprotium?
SAMA
62
What is Eosinophilic granulomatosis with polyangiitis?
ANCA associated small-medium vessel vasculitis.
63
Light's criteria state that a pleural effusion is an exudate if:
Effusion lactate dehydrogenase (LDH) level greater than 2/3 the upper limit of serum LDH Pleural fluid LDH divided by serum LDH >0.6 Pleural fluid protein divided by serum protein >0.5
64
Hospital acquired pneumonia first line management?
co-amoxiclav
65
Signs of a lung abscess?
dull percussion and bronchial breathing clubbing may be seen
66
Bloods in lung cancer?
raised platelets may be seen
67
What is bupropion?
norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
68
COPD symptoms in a young person - think what?
alpha-1 antitrypsin (A1AT) deficiency
69
Liver features in alpha 1 anti tirpsin deficinecy?
cirrhosis and hepatocellular carcinoma in adults, cholestasis in children
70
Why would opu prescribe LABA and LAMA over LABA and ICS?
If patient has no asthma/steroi responsiveneness
71
Squamous cell cancer features?
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia clubbing hypertrophic pulmonary osteoarthropathy (HPOA) hyperthyroidism due to ectopic TSH
72
A normal PCO2 in an acute ashtma attack indicates what?
exhaustion and should, therefore, be classified as life-threatening.
73
What type of lung cancer is gynaecomastia associated with?
Adenocarcinoma
74
Mnemonic: assessing for LTOT - The 4 Bs
Blue (cyanosis, sp02 <92%) Breathing (severe airway obstruction, FEV1 <30%) Blood (secondary polycythaemia) Ballooning (peripheral oedema, raised JVP, hepatomegaly)
75
Management of a primary pneumothorax?
aspiration should be attempted if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
76
What is varenicline?
nicotinic receptor partial agonist
77
What does a hyperexpaned middle and lower lobe look like?
hyperlucent- Blacker
78
Acute features of sarcoidosis?
erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
79
Chest drain swinging
Rises in inspiration, falls in expiration
80
Management of alpha 1 antitrypsin deificiency?
no smoking supportive: bronchodilators, physiotherapy intravenous alpha1-antitrypsin protein concentrates surgery: lung volume reduction surgery, lung transplantation
81
Pack per year equation?
1 pack/day X1 year
82
What is Legionnaire's disease?
Lung infection you can get from inhaling droplets of water from things like air conditioning or hot tubs. It's uncommon but it can be very serious.
83
Symptoms of legionnaires disease?
Symptoms of Legionnaires' disease include:a cough difficulty breathing chest pain a high temperature flu-like symptoms
84
If insufficient air expansion despite chest drain insertion what is next?
video-assisted thoracoscopic surgery (VATS) should be considered to allow for mechanical/chemical pleurodesis +/- bullectomy.
85
What does the pleural effusion fluid proein/serum protein ratio have to be for PE fluid to be an exudate?
More than 0.5
86
What is the henderson hasselbach equation
87
What is lactate?
Source of hydrogen ions
88
What does high lactate indicate?
Tissue ischaemia
89
Why can you stil clear CO2 in pneumonia?
More soluble so unless you have ventilation problem can still clear it
90
What is usual cut off to give blood transfusion?
70
91
How long does bicarbonate take to get chronically raised?
Days to weeks so important to think is this chronic when looking at COPD patient
92
If give oxygen what is important to think about with CO2
CO2 bind to haemoglobin if given oxygen knocks it off so then more CO2 in the body

Year 4 Final (39 decks)

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