respiratory Flashcards
asbestosis
what is the type of disease, what is its pattern, which area is most affected
ILD - lower lobe fibrosis
restrictive pattern
Pleura are most affected
CXR findings in asbestosis
bilateral lower lobe fibrosis
HRCT findings in asbestosis
pleural thickening
pleural plaques
symptoms of asbestosis
progressive exertion dyspnea
dyr cough –> productive cough
digital clubbing
FLWAS + haemoptysis
ABG findings in asbestosis
type 1 resp failure
management of asbestosis
no cure
oxygen therapy
immunisation: influenza, pneumococcal pneumonia
what is a mesothelioma
malignant tumour of the mesothelial cells of the lung pleura, complication of asbestosis
symptoms of mesothelioma
chronic dry cough
chest pain
SOB
weight loss
clubbing
CXR findings of mesothelioma
pleural thickening
pleural plaques
pleaural mass
pleural effusion
Ix for mesothelioma
pleural tap
thoracoscopy + histology
diagnostic Ix for mesothelioma
thoracoscopy + histology
average incubation days of covid
5 days
Ix for covid
RT-PCR from nasopharyngeal swab
pulse oximetry
CXR of suspect pneumonia
3 important parts of management for severe covid
VTE propylaxis (LMWH, compression stockings)
O2 therapy
mechanical ventilation
is acute bronchitis usually viral or bacterial
viral
which type of infection does acute bronchitis usually follow
it is a LRTI which follows a URTI
describe the cough in acute bronchitis
productive - CLEAR sputum
describe CXR in acute bronchitis
no radiological changes
describe change in pulmonary function test over time in acute bronchitis vs asthma
improves over time in acute bronchitis
dissent in asthma
Tx for acute bronchitis
if high CRP or pre existing conditions
- oral doxycycline
(or amoxicillin in pregnant women/children)
is influenza a URTI or LRTI
both
is tonsillitis a URTI or LRTI
URTI
which test can diagnose influenza
RT-PCR
which medication can be given if the influenza is more severe and requires more than just supportive therapy
neuraminidase inhibitors:
- oseltamivir (tamiflu)
- ranamivir
which medication can be given if the influenza progresses to become bacterial pneumonia
ceftriaxone (broad spectrum abx)
what type of hypersensitivity reaction causes extrinsic allergic alveolitis aka hypersensitivity pneumonitis
type 3 hypersensitivity
a pt develops a chronic dry cough, digital clubbing and worsening dysnpnea. they own a bird farm so have lots of exposure to bird droppings. what is the likely diagnosis
hypersensitivity pneumonitis
aka extrinsic allergic alveolitis
typical pt population for idiopathic pulmonary fibrosis
men
50-70 years
causes of ILD/pulmonary fibrosis causing UPPER zone fibrosis
CHARTS
Coal workers pneumonitis
histiocytosis / hypersensitivity pneumonitis
ankylosing spondylitis
radiation
TB
sarcoidosis / silicosis
causes of ILD/pulmonary fibrosis causing LOWER zone fibrosis
DIAL
Drugs (amiodarone, bleomycin, methotrexate, nitrafuratonin)
Idiopathic pulmonary fibrosis
asbestosis
lupus (most connective tissue disorders cause lower zone fibrosis except ankylosing spondylitis - upper zone fibrosis)
symptoms of ILD/Pulmonary fibrosis
chronic dry cough
progressively worsening dyspnea (exertion –> at rest)
digital clubbing
bilateral inspiratory crackles
what do you hear on auscultation in ILD/Pulmonary fibrosis
bilateral inspiratory crackles
disease pattern in ILD/Pulmonary fibrosis
restrictive (v reduced FVC, FEV1/FVC is increased, >0.7)
TLCO change in ILD/Pulmonary fibrosis
reduced
CT scan findings in ILD/Pulmonary fibrosis
honeycombing, ground glass appearance
CXR findings in IPF
Bilateral lower zone reticulonodular shadowing
which antifibrotic agent can be used to slow disease progression in IPF
pirfenidone
only definitive treatment for end stage ILD
lung transplant
which gene is mutated in cystic fibrosis and what does this cause
CTFR mutation
causes defective Cl- channels
this causes increased viscosity of mucus
how is Cystic fibrosis diagnosed
sweat test - will have high sweat chloride
Mx for Cystic fibrosis bronchiectasis
chest physiotherapy
what disease pattern is bronchiectasis
obstructive
what is the likely diagnosis if a person has chronic cough, recurrent chest infections, inspiratory coarse crackles, dextrocardia an recurrent sinusitis
Kartagener’s syndrome (primary ciliary dyskinesia) causing bronchiectasis
what is the likely diagnosis if a person has chronic cough, recurrent chest infections, inspiratory coarse crackles in response to contact with mould
allergic bronchopulmonary aspergillosis causing bronchiectasis
Tx for allergic bronchopulmonary aspergillosis causing bronchiectasis
oral prednisolone
likely diagnosis: chronic cough with large amounts of rusty/green sputum - made worse by lying flat
recurrent chest infections
clubbing
SOB on exertion
fever
weight loss, fatigue
wheezing
bronchiectasis
what is the FEV1/FVC ratio for OBSTRUCTIVE pattern
< 0.7
most common infective agent found in sputum MCS of a non-CF bronchiectasis pt and a CF bronchiectasis pt
non CF: haemophilus influenza
CF: pseudomonas aeruginosa
gold standard diagnostic test for bronchiectasis
HRCT
which medicine can be used to clear the airway in bronchiectasis
mucoactive agents: eg nebulised hypertonic saline
indications for lobectomy in brochiectasis
uncontrollable haemoptysis
localised disease
what is bronchiectasis
permanent and irreversible dilated of the bronchi
what is seen on CXR in bronchiectasis
thin walled ring shadows (cysts), some with fluid levels
tram lines (depicts the thickened bronchi)
tubular / ovoid opacities (depicts the thickened bronchi)
obscured hemidiaphragm
what is seen on HRCT in brocnhiectasis
cysts / tree in bud pattern
signet ring sign - bronchus is wider in diameter than pulmonary artery next to it
tram track sign
what changes are seen on a CXR in silicosis of stonesmen/pottery workers/ceramic workers
egg shell calcification of hilar lymph nodes
what does black sputum indicate
coal workers pneumoconiosis
which type of lung cancer causes clubbing
NSCLC esp squamous cell carcinoma –> secrets a PTHrP which cases hypercalcaemia, clubbing, cavitating lesions, hyperthyroidism
what are the types of lung cancer
NSCLC
- Adenocarcinoma
- squamous cell carcinoma
SCLC
Pancoast tumour
most common type of lung cancer
adenocarcinoma
which type of lung cancer is most common in non smokers
adenocarcinoma
which type of lung cancer is most common in smokers
squamous cell carninoma
SCLC
pancoast tumour
which paraneoplastic syndrome can adenocarcinoma of lung cause
gynaecomastia
which paraneoplastic syndrome can squamous cell carcinoma of lung cause
the tumour secrets a PTHrP
this causes hypercalcaemia, clubbing, cavitating lesions, hyperthyroidism
which paraneoplastic syndrome can SCLC cause
SIADH
Cushings
Lambert Eaton syndrome
SVCO
how does muscle weakness in Lambert Eaton syndrome compare to myasthenia gravis
it improves with exercise in Lambert Eaton syndrome
describe Lambert Eaton syndrome symptoms
waddling gait, difficulty walking, muscle tenderness, hyporeflexia
improves on exercise
which type of lung cancer causes hyponatraemia
SCLC
what does raised ALP indicate in lung cancer
bony mets
1st line Ix for lung cancer
CXR
Ix to look for mets and lymph node involvement in lung cancer
PET-CT
diagnostic Ix that’s also used for staging for lung cancer
bronchoscopy with biopsy
which conditions cause Horners syndrome
pancoast tumour
carotid artery dissection (causes partial horners syndrome - no anhidrosis)
stroke
main 3 symptoms of Horners syndrome
ipsilateral miosis
ptosis
anhidrosis
which lung cancer can cause hoarseness of voice and why
pancoast tumour
recurrent laryngeal nerve damage/paralysis
which lung cancer causes SVCO
tumour in right lung apex (SCLC or pancoast tumour)
symptoms/signs of SVCO
dyspnea
face/neck/arm swelling
raised JVP
headaches worse in morning
visual disturbances
which test shows SVCO
pembertons test
immediate treatment needed for SVCO
oral dexamethasone
does SCLC or NSCLC have worse prognosis
SCLC
NSCLC first line Tx
lobectomy
- can use curative radiotherapy for stages 1,2,3
Tx for advanced NSCLC
EGFR inhibitors
ALK tyrosine kinase inhibitors
Tx for SCLC
palliative chemo
what is a pneumothorax without underlying disease called
primary spontaneous
what is a pneumothorax as a complication of an underlying disease called
secondary spontaneous
how can tension pneumothorax cause hypotension
in a tension pneumothorax it is a one way valve - air can enter pleural space but can’t leave it
this causes tracheal shifts and presses on heart
this causes cardiac outflow obstruction - hypotension
what is sudden deterioration following intubation a sign of
tension pneumothorax
pneumothorax breath sounds
reduced
pneumothorax percussion resonance
hyper resonant
pneumothorax fremitus
decreased
fist line Ix for pneumothorax
CXR
- erect PA on inspiration
first line Ix for pneumothorax in to who can’t sit up
chest ultrasound
pneumothorax CXR findings
clear rim between lung margin and chest wall
no lung markings visible between lung margin and chest wall
area for aspiration in pneumothorax
2nd ICS
area for chest drain in pneumothorax
between anterior border of latissimus dorsi and lateral border of pec major
at 4/5th ICS at mid- or anterior- axillary line
Tx for tension pneumothorax
large bore cannula
into 2nd ICS at MCL
Tx for primary pneumothorax w/o SOB and <2cm
discharge and follow up in 2/4 weeks
Tx for primary pneumothorax w/o SOB and >2cm
aspirate, if doesn’t work chest drain
Tx for secondary pneumothorax w/o SOB and 1-2cm
aspirate
Tx for secondary pneumothorax w/o SOB and <1cm
oxygen therapy and admit
Tx for secondary pneumothorax w/o SOB and >2cm or secondary pneumothorax with SOB
chest drain
which condition is most lily to cause bilateral hilar lymphadenopathy on chest X-ray
sarcoidosis
most common site of lung cancer metastasis
brain
most common causes of inspiratory bibasal lung crackles
pneumonia
pulmonary oedema
bronchitis
pulmonary fibrosis
likely diagnosis in a pt with lung cancer and worsening headaches, double vision and ataxic gait
raised ICP due to brain metastases
best scan for brain mets
contrast enhanced CT of the brain
which conditions can contrast used in a contrast enhanced CT worsen
the contrast is nephrotoxic - don’t use in pts with kidney issues
which condition are voltage gated calcium channel (VGCC) antibodies present in
Lambert eaton myasthenic syndrome
what sweat chloride level is diagnostic for CF
> 60 mmol/L
which lung cancers cause cavitating lesions
squamous cell carcinomas
what does central cavitation with air fluid level on CXR indicate
lung abcess
what does a target shaped lesion in the upper lobe on CXR indicate
aspergilloma
what is right sided heart failure in response to pulmonary HTN called
cor pulmonale
if you have a suspicion that a chest drain may be blocked what should you do
check the drain to see if the fluid is shining - ie moving up and down the tube on inspiration and expiration
what is a polyphonic wheeze on auscultation associated with
exacerbation asthma
what is bronchial breathing associated with
infection+ consolidation
- pneumonia
- bronchitis
what is stoney dull percussion at base associated with
pleural effusion
pt has pulmonary fibrosis and has recently had many UTIs. which drug has caused the fibrosis
nitrafurotonin - used to treat UTIs
causes of fibrosis in lung apices
ARTS
- Ankylosing spondylitis
- Radiation
- TB
- Sarcoidosis
classic cause of fine inspiratory crackles vs coarse inspiratory crackles
fine (basal) = fibrosis
coarse = consolidation / pneumonia
what does honeycombing on CT indicate
fibrosis
what do signet rings on CT indicate
bronchiectasis
what do diffuse ground glass opacities on CT indicate
PCP (pneumocytis penumonia)
what is the typical build of a person susceptible to a spontaneous pneumothorax
tall and slender body
in which conditions is a hyper inflated chest seen
asthma
copd
what does unilateral pitting oedema in calf suggest
DVT –> pulmonary embolism
likely diagnosis: foul smelling sputum, fever, history of stroke, finger clubbing
lung abscess
–> history of stroke: impaired swallowing
–> aspiration
what does hepatomegaly suggest in context of heart
right sided heart failure / cor pulmonale (due to blood congestion in liver)
what does reduced DLCO suggest
reduced diffusion across thinned fibrotic alveoli –> fibrosis
Tx for community acquired pneumonia with CURB score of 0/1
oral amoxicillin
Tx for exacerbation of COPD
salbutamol nebulised through air
initial Tx step for acute pulmonary oedema
IV furosemide
In what condition is a polyphonic wheeze heard
asthma
causes of bibasal crackles
fluid / mucus / infection in lungs
- pneumonia
- bronchitis
- pleural effusion
- heart failure (causes fluid to pool in lungs)
- pulmonary fibrosis
- bronchiectasis
main differentials for reduced FEV1/FVC ratio
asthma
copd
bronchiectasis
FEV1/FVC in restrictive lung disease
normal (as both FEV1 and FVC are reduced)
what is a pulmonary hamartoma
benign mass in lung
how does pneumothorax affect V/Q ratio
reduced V/Q
Tx for lung abscess
IV abx
FEV1/FVC in bronchiectasis
reduced, as its an obstructive disease pattern
what is a pyopneumothorax
a pleural collection of pus and air - has a visible fluid level on CXR
what is a pneumatocele
structure in lung which contains single or multiple air filled cysts
main cause of pneumatocele
complication of acute pneumonia caused by staph A
what is an empyema
pus collection - pleural empyema can be a complication of pneumonia
pleural empyema on cxr
lateral
makes an obtuse angle with the chest wall (so goes downwards along chest wall - not sideways into the lung)
does horners syndrome cause ipsilateral or contralateral ptosis / miosis
ipsilateral - the sympathetic chain on that side is being compressed by the tumour
a pt with lung cancer presents with abdominal pain and constipation. what type of lung cancer do they have
squamous cell carcinoma - the abdo pain and constipation is due to hypercalcaemia - PTHrP secretion)
diagnosis: pt has rheumatoid arthritis and productive cough of green sputum with red specks
bronchiectasis - rheumatoid arthritis can cause bronchiectasis
most likely diagnosis of fever, cough, pleuritic chest pain
lung abscess
in which pts is pseudomonas aeruginosa most likely to cause lung infections
cystic fibrosis pts
klebsiella pneumonia is highly associated with lung abscesses in which pts
alcoholic pts
what is the inheritance pattern of cystic fibrosis
autosomal recessive
for what is DNase given to CF pts
to break down mucus
for what is creon given to CF pts
for pancreatic exocrine insufficiency - causes steatorrhea
creon is aka pancrelipase
does copd present with clubbing
no
what does pleura rub sound indicate
pleurisy
which parts of the lungs are most affected in TB
upper lobes
TB medication
Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RIPE) for 2 months
followed by isoniazid + rifampicin (aka Rifinah 300) for 4 months
most common cause of bilateral hilarity lymphadenopathy
sarcoidosis
skin manifestation of sarcoidosis
erythema nodosum - raised painful red shin rash