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Internal Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Lung malignancy associated with asbestos

A

Mesothelioma

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2
Q

Presentation of lung cancer

A

SOB
Cough
Haemoptysis
Finger clubbing
Lymphadenopathy
Weight loss
Recurrent pneumonia

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3
Q

Clubbing causes

A

Respiratory
- Pulmonary fibrosis
- Lung Cancer
- Bronchiectasis
- Tb
not COPD?

Cardio
- Heart failure
- Endocarditis

Gastro
-IBD

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4
Q

SIADH presentation

A

Syndrome of inappropriate ADH

Ectopic ADH secreted by small-cell lung cancer - presents with hyponatremia

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5
Q

Cushing’s syndrome small cell lung cancer

A

Ectopic ACTH secretion

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6
Q

Hypercalcaemia lung cancer

A

Ectopic parathyroid hormone secreted by squamous cell carcinoma

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7
Q

Lung cancer bloods don’t forget

A

Electrolytes
- Ca - PTH secretion
- Na - ADH secretion

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8
Q

Thrombocytosis causes - raised platelet count

A

Blood loss, cancer, infections, bone marrow damage, recent surgery, splenectomy

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9
Q

Thrombocytopenia causes

A

Bleeding, infections, immune thrombocytopenia, blood cancers.

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10
Q

Lung cancer syspected - investigation first?

A

CXR

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11
Q

CXR findings suggestive of cancer

A

Hilar enlargement, peripheral opacity, pleural effusion (unilateral), collapse

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12
Q

CXR suggests lung cancer - then what

A

Staging CT chest abdo & pelvis, PET CT

Bronchoscopy with endobronchial ultrasound

Biopsy - percutaneous or via bronchospy

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13
Q

Treatment lung cancer

A

Surgery, radiation, chemo.

Stents if obstruct

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14
Q

Pneumonia is

A

Infection of the lung tissue, causing inflammation of the alveolar space

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15
Q

Acute bronchitis is

A

Infection and inflammation in the bronchi & bronchioles

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16
Q

LRTI includes

A

Pneumonia & Acute bronchitis

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17
Q

LRTI vs URTI causative organism

A

The lower down in the respiratory tract the more likely to be bacterial

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18
Q

Pneumonia classifications

A

Community acquired
Hospital acquired
Ventilator acquired
Aspiration pneumonia

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19
Q

Aspiration pneumonia is associated with which bacteria

A

Anaerobic

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20
Q

Pneumonia symptoms

A

Cough
Sputum production
SOB
Fever
Malaise
Haemoptysis
Pleuritic chest pain
Delirium - acute confusion

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21
Q

Chest examination of pneumonia

A

Bronchial Breath sounds
Focal coase crackles
Dullness to percussion

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22
Q

CURB-65 predicts

A

Mortality with pneumonia - use to determine treatment at home, hospital, ICU

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23
Q

CURB-65 stands for

A

Confusion
Urea >7
Resp rate >30
Blood pressure <90 systolic, <60 diastolic
age 65

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24
Q

Top causes of typical bacterial pneumonia (2)

A

Streptococcus pneumoniae

Haemophilus influenzae

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25
Q

Cystic fibrosis or bronchiectasis pneumonia causative organism

A

Pseudomonas aeruginosa

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26
Q

Hospital acquired pneumonia organism

A

MRSA

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27
Q

Immunocompromised patients, chronic pulmonary disease - pneumonia causative organism

A

Moraxella catarrhalis

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28
Q

Atypical pneumonia caused by

A

organisms that cannot be culture in the nomal way, or detected using a gram stain.

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29
Q

Atypical pneumonia treatment with penicillin is

A

Ineffective - use macrolides - clarithromycin, tetracycline - doxycline

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30
Q

Causes atypical pneumonia

A

Legionella, Mycoplasma pneumoniae.

Pneumocystis jirovecii - fungal

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31
Q

Legionella

A

The typical exam patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia. A urine antigen test can be used as an initial screening test.

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32
Q

Patients with low CD4 in HIV are prescribed prophylacted co-trimoxazole to protect against

A

Pneumocytis jiovecii pneumonia - PCP - a fungal pneumonia

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33
Q

Pneumonia investigations

A

CRP
CBC
Renal profile - urea level for CURB-65 score, and AKI
CXR

For moderate or severe infection
-Sputum cultures
-Blood cultures

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34
Q

Pneumonia management

A

Typical - ABx amoxicillin, doxycycline

Moderate may need IV ABx first.

Respirator support - Oxygen, intubation and ventilation

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35
Q

Complications pneumonia

A

Sepsis, acute respiratory distress syndrome, pleural effusion, empyema, lung abscess, death

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36
Q

Empyema

A

Collection of pus in a cavity in the body

Infected pleural effusion

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37
Q

ABG normal value for pH

A

7.35-7.45

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38
Q

ABG normal value for HCO3

A

22-26

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39
Q

Type 1 respiratory failure

A

low o2, normal co2

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40
Q

Type 2 respiratory failure

A

low o2, high co2

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41
Q

Causes of respiratory alkalosis

A

hyperventilation - anxiety, PE

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42
Q

Causes of metabolic acidosis

A

DKA, diarrhoea, renal failure, hypoxia raised lactate

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43
Q

Metabolic alkalosis causes

A

Vomiting

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44
Q

Acute respiratory distress syndrome is

A

Severe inflammatory reaction of the lungs often secondary to pneumonia or trauma

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45
Q

Acute respiratory distress syndrome clnical findings

A

Atalectasis, pulmonary oedema, decreased lung compliance, fibrosis of lung tissue

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46
Q

Acute respiratory distress syndrome symptoms

A

Respiratory distress, hypoxia

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47
Q

PEEP

A

Positive end-expiratory pressure - keeps airway from collapsing

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48
Q

CPAP

A

Provides Peep

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49
Q

Obstructive disease diagnosis

A

FEV1/FVC < 70%

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50
Q

Obstructive lung disease examples

A

Asthma, COPD

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51
Q

Restrictive lung disease diagnosis

A

FEV1 and FVC equally reduced
FEV1 and FVC ratio greater than 70%

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52
Q

Restrictive lung disease examples

A

Interstitial lung disease
Sarcoidosis
Obesity

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53
Q

Peak flow reduced in

A

Obstructive lung disease, especially asthma

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54
Q

Asthma - other atopic conditions

A

Eczema, hay fever, allergies

55
Q

Asthma presentation

A

Dyspnoea, chest tightness, dry cough, wheeze

Symptoms should improve with bronchodilators

56
Q

Asthma examination

A

Normal when patient is well
Polyphonic expiratory wheeze

57
Q

localised wheeze differentials

A

Inhaled foreign body, tumour, thick sticky mucus plug obstructing airway

CXR next step

58
Q

Typical triggers of asthma

A

Infection, night time or early morning, exercise, animals, cold damp air, strong emotions.

59
Q

Asthma investigations

A

Spirometry, reversibility testing (give bronchodilator & expect 12 % increase in FEV1)

60
Q

SMART therapy

A

Formoterol + ?

61
Q

Asthma management additional

A

Yearly flu jab, regular exercise, avoid smoking, avoid triggers, careful when sick change dose

62
Q

Acute exacerbation of asthma grading

A

Proportion of peak flow compared to predicted or best

63
Q

COPD is

A

Long-term, progressive condition involving airway obstruction, chronic bronchitis and emphysema.

64
Q

Chronic bronchitis is the

A

long-term symptoms of a cough

65
Q

Emphysema is

A

damage and dilation of the alveolar sacs and alveoli, decreasing the surface area for gas exchange.

66
Q

COPD salbutamol

A

Minimally reversible

67
Q

COPD

A

Shortness of breath, cough, sputum, wheeze, recurrent respiratory infections especially in winterr

68
Q

COPD investigations

A

CXR especially to exclude other pathology.
FBC
Sputum culture
ECG, Echo
Serum alpha-1-antitrypsin deficiency

69
Q

SAMA example

A

Ipratropium

70
Q

COPD long term management

A

Annual flu vaccine
SMOKING Cessation

71
Q

Cor pulmonale is

A

Right sided heart failure caused by respiratory disease (pulmonary hypertension).

COPD, PE, interstitial lung disease, cystic fibrosis.

72
Q

Cor pulmonale signs on examination

A

Hypoxia, Raised JVP, Peripheral oedema

parasternal heave
Murmurs
Hepatomegaly

73
Q

Acute exacerbation of COPD typically causes respiratory acidosis or alkalosis

A

Acidosis - CO2 retaining

74
Q

IE COPD investigations

A

CXR, ECG, FBC, Us&Es to check electrolytes, Sputum culture, blood culture

75
Q

O2 therapy in COPD

A

Tend to retain CO2 when treated with oxygen - target o2 sats of 88-92%

76
Q

COPD management of acute exacerbation

A

Inhalers or nebulisers
steroids
antibiotics
Respiratory physiotherapy
Monitor - ABGs

77
Q

Bronchiectasis is

A

Involves permanent dilation of the bronchi

78
Q

Causes of bronchiectasis

A

Damage to airways
- idiopathic
- pneumonia
- whooping cough
- Tb
- Cystic fibrosis
- RA

79
Q

Symptoms bronchiectasis

A

SOB
Chronic productive cough
Recurrent chest infections
Weight loss

80
Q

Bronchiectasis clinical signs

A

Clubbing, Cor pulmonale, Scattered crackles that clear with coughing, scattered wheezes and squeaks.

81
Q

Common infective organisms bronchiectasis

A

Haemophilus influenza, pseudomonas aeruginosa

82
Q

Test of choice for bronchiectasis

A

high resolution CT

83
Q

Management bronchiectasis

A

Vaccines
Respiratory physiotherapy
Long term antibiotics for frequent exacerbations
Long acting bronchodilators for breathlessness
Long term oxygen therapy
Lung transplant end stage

nfective exacerbations require:

Sputum culture (before antibiotics)
Extended courses of antibiotics, usually 7–14 days
Ciprofloxacin is the usual choice for exacerbations caused by Pseudomonas aeruginosa

84
Q

Interstitial lung disease is

A

Inflammation and fibrosis of the lung parenchyma - fibrosis involves the replacement of elastic and functional lung tissue with non-functional scar tissue.

85
Q

Symptoms of interstitial lung disease

A

Shortness of breath on exertion, dry cough, fatigue

86
Q

Idiopathic pulmonary fibrosis findings on examination

A

Bibasal inspiratory crackles, finger clubbing, reduced chest expansion

87
Q

Diagnosis of intersitial lung disease involves

A

Clinical features, high resolution CT, spirometry showing restrictive pattern

88
Q

Management interstitial lung disease

A

Poor prognosis & limited options

  • remove or treat underlying cause
  • home oxygen
  • stop smoking
  • flu vaccine
  • advanced care planning
89
Q

Respiratory ask about

A

Asbestos
Home damp

90
Q

Idiopathic pulmonary fibrosis

A

No apparent cause
2-5 year life expectancy from diagnosis

Pirfenidone reduces fibrosis and inflammation through various mechanisms
Nintedanib reduces fibrosis and inflammation by inhibiting tyrosine kinase

91
Q

Secondary Pulmonary Fibrosis

A

Several drugs can cause pulmonary fibrosis:

Amiodarone (also causes grey/blue skin)
Cyclophosphamide
Methotrexate
Nitrofurantoin

Pulmonary fibrosis can occur secondary to other conditions:

Alpha-1 antitrypsin deficiency
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Systemic sclerosis
Sarcoidosis

92
Q

Hypersensitivity Pneumonitis

A

Allergic alveolitis - hypersensitivity to environmental allergen.
Raised lymphocytes

93
Q

Two types of pleural effusion

A

Exudative (high protein)
Transudative (low protein)

94
Q

Exudative causes of pleural effusion (3)

A

Related to inflammation
- lung cancer
- infection - pneumonia or TB
- RA

95
Q

Transudative causes of pleural effusion (3)

A

Heart failure, hypoalbuminaemia, hypothyroid

96
Q

Pleural effusion symptoms

A

Shortness of breath

97
Q

Examination findings pleural effusion

A

-Dullness to percussion over the effusion
-Reduced breath sounds
- tracheal deviation away from the effusion in very large effusions

98
Q

Pleural effusions investigations

A

CXR - blunting of costophrenic angle
- fluid in the lung fissures
- larger effusions will a meniscus - a curving upwards where it meets the chest wall and mediastinum
- tracheal deviation away from effusion

99
Q

Pleural effusion small

A

Ultrasound and CT

100
Q

Treatment pleural effusion

A

-Conservative management
- Pleural aspiration - drain
- Chest drain - drain and prevent recur

101
Q

Pneumothorax is

A

Air enters the pleural space - separating the lung from the chest wall

102
Q

Pneumothorax causes

A

Spontaneous, trauma, iatrogenic e.g. lung biopsy
Lung pathologies such as infection, asthma or COPD

103
Q

Pneumothorax investigation

A

CXR

104
Q

Pneumothorax management

A

No SOB - spontaneously resolve

SOB - Aspiration, or chest drain

105
Q

Chest drain insertion point

A

Triangle of Safety
- 5th ICS
- Mid-axillary line
- Anterior axillary line (pec major edge)

106
Q

Chest drain complications

A

Subcutaneous emphysema

107
Q

Tension pneumothorax

A

Trauma - creates one way valve air in but not out of pleural space - pressure on mediastinum cardiorespiratory arrest

108
Q

Management of tension pneumothorax

A

pressure relieved with cannula
then chest drain

109
Q

Signs of tension pneumothorax

A

Tracheal deviation away, reduced air entry, increased resonance to percussion, tachycardia, hypotension

110
Q

PE risks

A

Immobility, recent surgery, pregnancy, hormone therapy with oestrogen, malignancy, thrombophilia, long haul flights.

111
Q

VTE prophylaxis

A

Enoxaparin
TEDS (unless PAD)

112
Q

Presentation PE

A

SOB
Cough
Haemoptysis
Pleuritis chest pain
Hypoxia
Tachycardia
Raised resp rate
Low grade fever

+ may be signs DVT

113
Q

PE tools online

A

PERC - pulmonary embolism rule out criteria
Wells score - predicts probability of patient having a PE

114
Q

Diagnosis PE

A

CXR - usually normal, rule out other pathology
Wells score
D-dimer
CTPA

114
Q

Conditions raised D-dimer

A

Pneumonia, malignancy, HF, surgery, pregnancy

115
Q

PE management

A

Hospital admission, oxygen, analgesia, monitoring for deterioration

Anticoagulation

Thrombolysis (risk of bleeding)

116
Q

PE long term anticoagulation

A

3 months if a reversible cause otherwise longer

117
Q

Pulmonary hypertension refers to

A

Increased resistance and pressure in pulmonary arteries - causes strain on the right side of the heart

118
Q

Causes of pulmonary hypertension

A

Left heart failure
Chronic lung disease - COPD or pulmonary fibrosis
PE

119
Q

Signs and symptoms Pulmonary hypertension

A

SOB mainly

Also raised JVP, peripheral oedema

120
Q

Investigations pulmonary htn

A

ECG - right axis deviation, R bundle branch block
CXR - R ventricular hypertrophy
proBNP
Echo

121
Q

Pulmonary HTN management

A

CCB
Treat underlying cause
Supportive treatments - oxygen and diuretics

122
Q

Sarcoidosis

A

Chronic granulomatous disorder

123
Q

Sarcoidosis skin features

A

Erythema nodosum - appear kind of like bruises

124
Q

Sarcoidosis imaging & bloods

A

Raised ACE - screening test, hypercalcaemia
- CXR - hilar lymphadenopathy
- CT

+ histology

125
Q

Sarcoidosis management

A

Conservative if mild, oral steroids

Sarcoidosis spontaneously resolves 1/2 time, otherwise progress to pulmonary fibrosis

126
Q

OSA risk factors

A

Middle age, male, obesity, alcohol, smoking

127
Q

Presentation OSA

A

Snoring, morning headache, waking up unrefreshed, daytime sleepiness and concentration problems

Severe can cause HTN & HF

128
Q

OSA investigations

A

STOP BANG
Epworth sleepiness scale

Then sleep study

129
Q

Management

A

CPAP machine, reduce risk factors

130
Q

Signs and symptoms of pleural effusion

A

Signs - reduced chest expansion, reduced breath sounds, reduced vocal resonance, tracheal deviation away, stony dull to percussion
Symptoms - dry cough, dyspnoea, orthopnoea, chest pain

131
Q

HFrEF which of will not reduce mortality

A

Aldosterone agonist, ACEi, loop diuretic or B blocker
Loop diuretic

132
Q

Large QRS complexes

A

LV hypertrophy

133
Q
A

Internal Medicine (6 decks)

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