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FINALS: PASSMED/QUESMED > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is a common organism which causes pneumonia in bird owners?

A

chlamydia psittaci

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2
Q

cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics suggest what?

A

Klebsiella pneumoniae

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3
Q

Long term use of what can precipitate restrictive lung disease?

A

Nitrofurantoin

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4
Q

Which condition is immune deficiencies such as hypogammaglobulinemia associated with?

A

Bronchiectasis

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5
Q

What type of picture do you get on pulmonary function testing in asbestosis?

A

Restrictive - FEV1 goes down, FVC goes down A LOT therefore overall FEV1/FVC increases

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6
Q

What is the investigation of choice for occupational asthma?

A

Peak flows at work and home

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7
Q

What is the pathogen involved in Farmer’s lung?

A

Saccharopolyspora rectivirgula

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8
Q

Chlamydophila psittaci is associated with what?

A

Contact with birds

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9
Q

How should any critically ill patient be managed with oxygen?

A

15L high flow oxygen via non-rebreather as hypoxia kills before hypercapnia

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10
Q

What should you aim for in step down treatment of asthma?

A

reduction of 25-50% in the dose of inhaled corticosteroids

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11
Q

pulmonary fibrosis predominantly affecting the lower zones

A

Asbestosis

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12
Q

How would opiate overdose present on blood gas?

A

Respiratory acidosis

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13
Q

Redcurrant jelly sputum is found in what?

A

Klebsiella pneumonia

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14
Q

What is the COPD exacerbation treatment?

A
  1. Oxygen sats 88-92%
  2. Nebulised bronochodilators
  3. Steroid therapy
  4. IV Theophylline
  5. Non invasive ventilation e.g. BIPAP
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15
Q

Why does hypotension occur in tension pneumothorax?

A

Cardiac outflow obstruction

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16
Q

Most common organism causing infective exacerbation of COPD?

A

H influenzae

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17
Q

30-40 year old with basal emphysema and abnormal LFTs

A

Alpha-1-antitrypsin deficiency

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18
Q

Fine end-inspiratory crepitations

A

pulmonary fibrosis

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19
Q

Investigation of choice for sleep apnoea?

A

Polysomnography

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20
Q

Coal workers’ pneumoconiosis causes what?

A

Upper zone fibrosis

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21
Q

What should be sent with diagnostic pleural taps?

A
  • Biochemistry to determine protein
  • Cytology
  • Microbiology for gram staining and culture
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22
Q

What is important to remember about lung cancers?

A

Lesion can sometimes be too small to see on CXR

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23
Q

Paratracheal lymph nodes should raise alarm bells for?

A

Lung cancer

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24
Q

Sarcoidosis can cause what?

A

Hypercalcaemia

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25
Q

What is atelectasis?

A

A post op complication when the airways become blocked by bronchial secretions leading to respiratory collapse
- Managed with chest physio and positioning the patient upright

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26
Q

Normal/raised total gas transfer with raised transfer coefficient

A

Asthma

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27
Q

Lung collapse vs pleural effusion on CXR?

A

Lung collapse - trachea pulled towards the side of the white out
Pleural effusion - trachea pulled away from the side of the white out

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28
Q

Management of bronchiectasis?

A

Muscle training + postural drainage techniques

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29
Q

Patients who have frequent COPD exacerbations should have home supply of what?

A

Abx plus prednisolone

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30
Q

Investigation of choice for pulmonary fibrosis?

A

High res CT

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31
Q

Pack years formula

A

No of packs per day (1 pack is 20) x no of years smoking

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32
Q

Everyone over the age of 5 should have what to diagnose asthma?

A

Spirometry with bronchodilator reversibility testing

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33
Q

ENT, respiratory and kidney involvement

A

Think of Granulomatosis with polyangiitis

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34
Q

A negative result on spirometry does not what?

A

Exclude asthma -> FeNO testing needed

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35
Q

What pattern on lung function does bronchiectasis have?

A

Obstructive

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36
Q

When should Abx be given for COPD exacerbation?

A
  • If purulent sputum or signs of pneumonia
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37
Q

Facial rash plus lymphadenopathy

A

Sarcoidosis

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38
Q

Cavitating lesions are associated with what?

A

Squamous cell carcinoma

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39
Q

increased FEV1/FVC ratio and reduced transfer factor

A

Pulmonary fibrosis

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40
Q

Which paraneoplastic syndrome is associated with squamous cell carcinoma?

A

Parathyroid hormone related protein secretion

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41
Q

Decrease in pO2/FiO2 in poorly patient with non-cardiorespiratory presentation

A

ARDS

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42
Q

Neuromuscular disorders present how on pulmonary function tests?

A

Restrictive pattern

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43
Q

How is asthma diagnosed on spirometry?

A

Improvement in FEV1 by > 15% following administration of bronchodilator

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44
Q

How does salbutamol work?

A

Stimulates ß2 receptors of respiratory tract, which increases sympathetic activity and relaxes bronchial smooth muscle.

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45
Q

What physiological measurement is used to determine the severity
of COPD?

A

FEV1

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46
Q

What must patients do to qualify for long term oxygen therapy?

A

Stop smoking

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47
Q

What are some examination signs of consolidation?

A

Reduced chest expansion, dull percussion note, increased tactile
vocal fremitus, increased vocal resonance, bronchial breathing.

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48
Q

Why should statins and macrolides not be given together?

A

Increased risk of myositis

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49
Q

What are some complications of pneumonia?

A
  • Resp failure
  • Sepsis
  • Empyema
  • Lung abscess
  • Shock
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50
Q

How would pleural effusion present on examination?

A
  • Reduced chest expansion
  • Stony dull to percuss
  • Reduced breath sounds
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51
Q

How would pneumothorax present on examination?

A
  • Reduced chest expansion
  • Hyper resonant on percussion
  • Reduced breath sounds
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52
Q

What is an indication for surgery in bronchiectasis?

A

If the disease is localised to one lobe

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53
Q

Massive PE + hypotension

A

Thrombolysis

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54
Q

What is used to guide if patients need Abx with acute bronchitis?

A

CRP levels - if >100 -> offer Abx

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55
Q

multiple lip telangiectases

A

Think hereditary haemorrhagic telangiectasia -> strong association with epistaxis

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56
Q

Investigation of choice for suspected PE in someone with renal impairment?

A

V/Q scan

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57
Q

When should LTOT be started for COPD patients?

A

When 2 measurements of pO2 are < 7.3
pO2 of 7.3 - 8 AND polycythaemia/peripheral oedema/pulmonary HTN

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58
Q

Causes of upper zone fibrosis

A

C - coal workers pneumoconiosis
H - histiocytosis
A - ankylosing spondylitis
R - radiation
T - TB
S - Silicosis/Sarcoidosis

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59
Q

Causes of lower zone fibrosis

A

D - drugs
A - asbestosis
I - idiopathic
M - Most connective tissue disorders except AS

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60
Q

Non-obs based admission criteria for asthma?

A
  • Previous near fatal attack
  • Pregnancy
  • Oral steroids not helping with symptoms
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61
Q

Bilateral parotid gland swelling can be indicative of what?

A

Sarcoidosis

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62
Q

What are some complications of bronchiectasis?

A

Pneumonia, sepsis, recurrent infections, resp failure

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63
Q

What is the mechanism of PE?

A

T1 Resp failure due to V/Q mismatch

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64
Q

Pemberton’s test

A

Test for SVC obstruction - raise arms above head and they go cyanosed

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65
Q

Non respiratory causes of pulmonary fibrosis

A
  • Amiodarone, methotrexate
  • RA
  • SLE
  • Sjogrens
  • UC
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66
Q

ECG signs of cor pulmonale

A
  • right axis deviation
  • P pulmonale
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67
Q

Causes of bilateral hilar lymphadenopathy

A

Lymphoma, TB, Sarcoidosis, bronchial carcinoma

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68
Q

What are extra-pulmonary manifestations of sarcoidosis?

A
  • Erythema nodosum
  • Anterior uveitis
  • Neuropathy
  • Cardiomyopathy
  • CN palsies
69
Q

Where should pleural tap needle be inserted?

A

Above rib to avoid neurovascular bundle

70
Q

What could an area of dull to percuss in someone with a pneumothorax suggest?

A

Haemothorax -> needs chest drain

71
Q

Lung cancer can present as what?

A

SVC obstruction

72
Q

What helps to reduce mortality in someone with ARDS?

A

Low tidal volume mechanical ventilation

73
Q

Uncompensated type 2 resp failure with pH <7.35

A

Think about non invasive ventilation

74
Q

Radiation exposure can cause what?

A

Lung cancer

75
Q

What is the pathophysiology of ARDS?

A

Diffuse bilateral alveolar injury due to inflammation

76
Q

Previous history of haemorrhagic stroke at any time is a C/I to what?

A

Thrombolysis

77
Q

Excessive daytime sleepiness with visual hallucinations

A

Narcolepsy -> multiple sleep latency test needed

78
Q

What is PERC criteria used for?

A

To rule out PE

79
Q

What are indications for steroids in sarcoidosis?

A

PUNCH
Parencymal lung disease
Uveitis
Neuro involvement
Cardio involvement
Hypercalcaemia

80
Q

Large round well circumscribed masses in the lungs?

A

Cannonball metastases -> renal cell carcinoma

81
Q

Investigations for lung cancer?

A
  1. CXR
  2. CT with contrast
  3. Bronchoscopy
82
Q

Raised platelets can be a sign of what?

A

Lung cancer

83
Q

When are Abx used in acute bronchitis?

A

If there are existing co-morbidities

84
Q

Preceding influenza predisposes you to what?

A

Staph aureus pneumonia

85
Q

What is the treatment for latent TB?

A

3 months of isoniazid and rifampicin or 6 months of isoniazid

86
Q

How should patients with acute asthma who do not respond to medical treatment and become acidotic be managed?

A

Intubation and Ventilation

87
Q

Where should needle thoracostomy be placed?

A

cannula into the second intercostal space in the midclavicular line on the affected side

88
Q

egg shell calcification of lymph nodes?

A

Silicosis

89
Q

What are causes of resp alkalosis?

A
  • Anxiety
  • PE
  • Stroke, sub arachnoid
  • Altitude
90
Q

What are causes of resp acidosis?

A
  • COPD
  • Neuromuscular disease
  • Sedating drugs like benzos/opiates
91
Q

Pneumothorax management

A
  1. Asymptomatic -> conservative care
  2. If symptoms and high risk -> chest drain
  3. If symptoms and not high risk -> can manage conservatively/needle aspiration
92
Q

How should pneumothorax be followed up when managed conservatively?

A
  1. If primary -> review every 2-4 days as outpatient
  2. If secondary -> monitor as inpatient
  3. Everyone should be reviewed in outpatients in 2-4 weeks
93
Q

CURB65 criteria

A

Confusion
Urea > 7
RR > 30
BP <90 systolic or <60 diastolic
Aged > 65

94
Q

Community acquired pneumonia treatment

A

0 - treat at home - Amoxicillin/Clarithromycin
1-2 - consider hospital - Amoxicillin + Clarithromycin
3-4 - urgent hospital - Co-amoxiclav or
+ Clarithromycin

95
Q

Hospital acquired pneumonia treatment

A

No severe signs: Co-amoxiclav
Sever signs: Piperacillin with Tazobactam

96
Q

Exudate vs Transudate pleural effusion

A

Exudate - >30
Transudate - <30

97
Q

What are exudative causes of pleural effusion?

A
  • Pneumonia
  • RA/SLE
  • Neoplasia
98
Q

What are transudative causes of pleural effusion?

A
  • HF
  • Liver disease
  • Hypothyroidism
99
Q

How to diagnose mesothelioma?

A
  • CXR
  • Pleural CT with biopsy
  • Thoracoscopy can be used
100
Q

Types of non small cell lung cancer?

A
  • Large cell
  • Squamous cell
  • Adenocarcinoma
101
Q

What paraneoplastic features do lung cancers have?

A

Small cell
- SIADH
- Cushings
- Lambert-Eaton

Squamous
- PTHrP
- Hypercalcaemia
- Hypertrophic pulmonary osteoarthropathy

Adenocarcinoma
- Gynaecomastia

102
Q

How long should patients hold breath when taking inhaler?

A

10 seconds after pressing down on cannister
Wait 30 seconds before repeating next dose

103
Q

What is Churg Strauss syndrome?

A

Eosinophilic granulomatosis with polyangiitis -> asthma features with pANCA positive

104
Q

What is the triangle of safety?

A
  • Located in the mid axillary line of the 5th intercostal space
  • Bordered by anterior edge of latissimus dorsi, lateral border of pectoralis major, line superior to the horizontal level of the nipple
105
Q

Where is aspiration pneumonia most common?

A
  • Right middle and lower lobes
106
Q

How is alpha 1 antitrypsin deficiency inherited?

A

Autosomal recessive

107
Q

How can A1AD be managed?

A
  • Obstructive picture on spirometry
  • Supportive treatment with bronchodilators
  • Lung volume reduction surgery can be done in severe cases
108
Q

Moderate asthma features

A

PEFR 50-75% best or predicted
Speech normal
RR < 25
Pulse < 110

109
Q

Severe asthma features

A

PEFR 33-50%
Can’t complete sentences
RR > 25
Pulse > 110

110
Q

Life threatening asthma features

A

PEFR < 33%
Sats <92%
Normal PCO2
Silent chest, cyanosis or poor resp effort
Bradycardia/Hypotension
Exhaustion/Confusion/Coma

111
Q

What are some blood tests for sarcoidosis?

A
  • elevated ACE, ESR, calcium, immunoglobulins
  • Deranged LFTs
112
Q

ECG signs of PE

A
  • Sinus tachycardia
  • Right BBB
  • S1 Q3 T3
113
Q

Complications of recurrent or untreated PE?

A
  • Pulmonary HTN
  • Right sided heart failure
114
Q

Surgical interventions for COPD?

A
  • Bullectomy
  • Lung reduction surgery
115
Q

Extra-respiratory manifestations of cystic fibrosis

A
  • Pancreatic insufficiency
  • DM
  • Cirrhosis
  • Nasal polyps
  • Sinusitis
  • Male infertility
  • Osteoporosis
116
Q

Over rapid aspiration/drainage of pneumothorax can result in what?

A

Reexpansion pulmonary oedema

117
Q

What test should be offered to all patients with TB?

A

HIV

118
Q

What size of pneumothorax would be indicated to do a needle aspiration?

A

> 2cm

119
Q

Bilateral, mid-to-lower zone patchy consolidation in an older patient

A

Legionella

120
Q

Deranged LFTs, hyponatraemia, low lymphocytes?

A

Legionella

121
Q

Mycoplasma pneumonia can cause what?

A

Immune mediated neurological diseases e.g Guillan Barre

122
Q

Pneumonia + red cell agglutination?

A

Mycoplasma

123
Q

Large bullae in COPD can mimic what?

A

Pneumothorax

124
Q

Why should intranasal decongestants not be used for prolonged periods?

A

Risk of tachyphylaxis -> increasing doses are needed

125
Q

What is the Abx of choice for acute bronchitis?

A

Doxycycline

126
Q

When to use NIV vs IV?

A

NIV - 7.25 - 7.35
IV - <7.25

127
Q

What is used to assess drug sensitivities in TB?

A

Sputum culture

128
Q

Staph aureus pneumonia is associated with what?

A

Cavitating lesions

129
Q

What is the gold standard test for TB?

A

Sputum culture

130
Q

HIV decreases what?

A

Sensitivity to sputum smear for TB

131
Q

Investigation to diagnose mesothelioma?

A

Thoracoscopy with histology

132
Q

Pneumonia with cold sores?

A

Strep pneumoniae

133
Q

Marked volume loss of the lung with thickening of the pleura?

A

Think mesothelioma

134
Q

What is the management of empyema?

A

Chest drain insertion for drainage + IV Abx

135
Q

What is the advice around air travel following pneumothorax?

A

No travel until full resolution on CXR

136
Q

Acute asthma steps

A
  • Oxygen
  • Nebulised salbutamol
  • Oral steroids
  • Nebulised Ipratropium
  • IV Mag Sulph
  • IV Aminophylline -> discuss with seniors
  • Intubation and Ventilation in HDU/ITU
137
Q

What is criteria for discharge following asthma exacerbation?

A
  • Stable on discharge meds for 12-24 hours
  • Inhaler technique checked
  • PEFR > 75%
138
Q

Asthma stepwise management for adults

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA (+LTRA if helping)
  5. SABA + MART (ICS+LABA) (+LTRA if helping)
  6. SABA + medium dose MART (+LTRA if helping)
  7. Seek help from secondary care
139
Q

Asthma stepwise management for children

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA
  5. SABA + MART
  6. SABA + medium dose MART
  7. Seek help from secondary care
140
Q

COPD stepwise Management

A
  1. SABA / SAMA
  2. SABA + LABA + LAMA if no asthma features OR SABA + LABA + ICS if asthma features
  3. SABA + LAMA + LABA + ICS (even if no asthma features)
  4. Seek help from secondary care
141
Q

What would chronic bronchitis COPD show on V/Q?

A

Low V/Q due to decreased ventilation

142
Q

What would emphysema COPD show on V/Q?

A

High V/Q due to loss of alveolar surface area causing more ventilation per available perfusion area

143
Q

CXR signs for COPD

A
  • Hyperinflated chest
  • Bullae
  • Decreased peripheral vascular markings
  • Flattened diaphragm
144
Q

Where will pancoast tumours be?

A
  • Same side as the Horner’s signs
  • At the lung apex
145
Q

Heart sounds

A

1st - mitral/tricuspid
2nd - aortic/pulmonary

146
Q

Split second heart sound with loud pulmonary component?

A

Cor pulmonale

147
Q

TB Treatment

A

RIPE - 2 months
RI - 4 more months

148
Q

Management of secondary pneumothorax which is not improving post chest-drain insertion?

A

Discuss with cardiothoracic

149
Q

Diffuse alveolar damage with hyaline membrane formation

A

Acute respiratory distress syndrome

150
Q

Pleural effusions due to rheumatoid arthritis have what?

A

Low glucose levels

151
Q

massive haemoptysis

A

Think lung abscess

152
Q

What does a pancoast tumour invade when it causes Horners?

A

Cervical sympathetic plexus

153
Q

bilateral pulmonary infiltrates

A

Think ARDS

154
Q

Patient with swallowing difficulties/previous stroke with resp pathology?

A

Think lung abscess

155
Q

What is the initial management of hypercalcaemia?

A

IV Fluids

156
Q

What pharmacological therapy can be used for idiopathic pulmonary fibrosis?

A

Pirfenidone / Nintedanib

157
Q

What is a pneumothorax?

A

Air in the pleural cavity which is the potential space between the visceral and parietal pleura

158
Q

Where do you measure for pneumothorax?

A

Chest wall to the outer edge of the lung at level of hilum

159
Q

What are surgical options for recurrent pneumothorax?

A

Video assisted thorascopic surgery
Surgical pleurodesis

160
Q

PE like symptoms following a percutaneous vertebroplasty?

A

Pulmonary cement embolism

161
Q

diffuse bilateral opacities on x ray?

A

Think ARDS

162
Q

Management of solitary pulmonary nodules?

A

CT guided needle aspiration biopsy if >8mm

163
Q

Unilateral pleural effusion?

A

Rule out malignancy

164
Q

Why can people with carbon monoxide poisoning have?

A

Normal O2 sats as monitors cannot differentiate between the 2

165
Q

Investigation of choice for pnemocystitis jiroveci?

A

Bronchoalveolar lavage

166
Q
A
167
Q
A
168
Q
A
169
Q
A

FINALS: PASSMED/QUESMED (22 decks)

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