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year 3 conditions > respiratory > Flashcards

respiratory Flashcards

1
Q

asbestosis
what is the type of disease, what is its pattern, which area is most affected

A

ILD - lower lobe fibrosis
restrictive pattern
Pleura are most affected

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2
Q

CXR findings in asbestosis

A

bilateral lower lobe fibrosis

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3
Q

HRCT findings in asbestosis

A

pleural thickening
pleural plaques

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4
Q

symptoms of asbestosis

A

progressive exertion dyspnea
dyr cough –> productive cough
digital clubbing
FLWAS + haemoptysis

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5
Q

ABG findings in asbestosis

A

type 1 resp failure

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6
Q

management of asbestosis

A

no cure
oxygen therapy
immunisation: influenza, pneumococcal pneumonia

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7
Q

what is a mesothelioma

A

malignant tumour of the mesothelial cells of the lung pleura, complication of asbestosis

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8
Q

symptoms of mesothelioma

A

chronic dry cough
chest pain
SOB
weight loss
clubbing

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9
Q

CXR findings of mesothelioma

A

pleural thickening
pleural plaques
pleaural mass
pleural effusion

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10
Q

Ix for mesothelioma

A

pleural tap
thoracoscopy + histology

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11
Q

diagnostic Ix for mesothelioma

A

thoracoscopy + histology

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12
Q

average incubation days of covid

A

5 days

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13
Q

Ix for covid

A

RT-PCR from nasopharyngeal swab
pulse oximetry
CXR of suspect pneumonia

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14
Q

3 important parts of management for severe covid

A

VTE propylaxis (LMWH, compression stockings)
O2 therapy
mechanical ventilation

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15
Q

is acute bronchitis usually viral or bacterial

A

viral

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16
Q

which type of infection does acute bronchitis usually follow

A

it is a LRTI which follows a URTI

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17
Q

describe the cough in acute bronchitis

A

productive - CLEAR sputum

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18
Q

describe CXR in acute bronchitis

A

no radiological changes

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19
Q

describe change in pulmonary function test over time in acute bronchitis vs asthma

A

improves over time in acute bronchitis
dissent in asthma

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20
Q

Tx for acute bronchitis

A

if high CRP or pre existing conditions
- oral doxycycline
(or amoxicillin in pregnant women/children)

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21
Q

is influenza a URTI or LRTI

A

both

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22
Q

is tonsillitis a URTI or LRTI

A

URTI

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23
Q

which test can diagnose influenza

A

RT-PCR

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24
Q

which medication can be given if the influenza is more severe and requires more than just supportive therapy

A

neuraminidase inhibitors:
- oseltamivir (tamiflu)
- ranamivir

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25
Q

which medication can be given if the influenza progresses to become bacterial pneumonia

A

ceftriaxone (broad spectrum abx)

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26
Q

what type of hypersensitivity reaction causes extrinsic allergic alveolitis aka hypersensitivity pneumonitis

A

type 3 hypersensitivity

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27
Q

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

A

hypersensitivity pneumonitis
aka extrinsic allergic alveolitis

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28
Q

typical pt population for idiopathic pulmonary fibrosis

A

men
50-70 years

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29
Q

causes of ILD/pulmonary fibrosis causing UPPER zone fibrosis

A

CHARTS
Coal workers pneumonitis
histiocytosis / hypersensitivity pneumonitis
ankylosing spondylitis
radiation
TB
sarcoidosis / silicosis

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30
Q

causes of ILD/pulmonary fibrosis causing LOWER zone fibrosis

A

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)

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31
Q

symptoms of ILD/Pulmonary fibrosis

A

chronic dry cough
progressively worsening dyspnea (exertion –> at rest)
digital clubbing
bilateral inspiratory crackles

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32
Q

what do you hear on auscultation in ILD/Pulmonary fibrosis

A

bilateral inspiratory crackles

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33
Q

disease pattern in ILD/Pulmonary fibrosis

A

restrictive (v reduced FVC, FEV1/FVC is increased, >0.7)

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34
Q

TLCO change in ILD/Pulmonary fibrosis

A

reduced

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35
Q

CT scan findings in ILD/Pulmonary fibrosis

A

honeycombing, ground glass appearance

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36
Q

CXR findings in IPF

A

Bilateral lower zone reticulonodular shadowing

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37
Q

which antifibrotic agent can be used to slow disease progression in IPF

A

pirfenidone

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38
Q

only definitive treatment for end stage ILD

A

lung transplant

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39
Q

which gene is mutated in cystic fibrosis and what does this cause

A

CTFR mutation
causes defective Cl- channels
this causes increased viscosity of mucus

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40
Q

how is Cystic fibrosis diagnosed

A

sweat test - will have high sweat chloride

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41
Q

Mx for Cystic fibrosis bronchiectasis

A

chest physiotherapy

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42
Q

what disease pattern is bronchiectasis

A

obstructive

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43
Q

what is the likely diagnosis if a person has chronic cough, recurrent chest infections, inspiratory coarse crackles, dextrocardia an recurrent sinusitis

A

Kartagener’s syndrome (primary ciliary dyskinesia) causing bronchiectasis

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44
Q

what is the likely diagnosis if a person has chronic cough, recurrent chest infections, inspiratory coarse crackles in response to contact with mould

A

allergic bronchopulmonary aspergillosis causing bronchiectasis

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45
Q

Tx for allergic bronchopulmonary aspergillosis causing bronchiectasis

A

oral prednisolone

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46
Q

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

A

bronchiectasis

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47
Q

what is the FEV1/FVC ratio for OBSTRUCTIVE pattern

A

< 0.7

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48
Q

most common infective agent found in sputum MCS of a non-CF bronchiectasis pt and a CF bronchiectasis pt

A

non CF: haemophilus influenza
CF: pseudomonas aeruginosa

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49
Q

gold standard diagnostic test for bronchiectasis

A

HRCT

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50
Q

which medicine can be used to clear the airway in bronchiectasis

A

mucoactive agents: eg nebulised hypertonic saline

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51
Q

indications for lobectomy in brochiectasis

A

uncontrollable haemoptysis
localised disease

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52
Q

what is bronchiectasis

A

permanent and irreversible dilated of the bronchi

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53
Q

what is seen on CXR in bronchiectasis

A

thin walled ring shadows (cysts), some with fluid levels
tram lines (depicts the thickened bronchi)
tubular / ovoid opacities (depicts the thickened bronchi)
obscured hemidiaphragm

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54
Q

what is seen on HRCT in brocnhiectasis

A

cysts / tree in bud pattern
signet ring sign - bronchus is wider in diameter than pulmonary artery next to it
tram track sign

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55
Q

what changes are seen on a CXR in silicosis of stonesmen/pottery workers/ceramic workers

A

egg shell calcification of hilar lymph nodes

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56
Q

what does black sputum indicate

A

coal workers pneumoconiosis

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57
Q

which type of lung cancer causes clubbing

A

NSCLC esp squamous cell carcinoma –> secrets a PTHrP which cases hypercalcaemia, clubbing, cavitating lesions, hyperthyroidism

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58
Q

what are the types of lung cancer

A

NSCLC
- Adenocarcinoma
- squamous cell carcinoma

SCLC

Pancoast tumour

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59
Q

most common type of lung cancer

A

adenocarcinoma

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60
Q

which type of lung cancer is most common in non smokers

A

adenocarcinoma

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61
Q

which type of lung cancer is most common in smokers

A

squamous cell carninoma
SCLC
pancoast tumour

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62
Q

which paraneoplastic syndrome can adenocarcinoma of lung cause

A

gynaecomastia

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63
Q

which paraneoplastic syndrome can squamous cell carcinoma of lung cause

A

the tumour secrets a PTHrP
this causes hypercalcaemia, clubbing, cavitating lesions, hyperthyroidism

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64
Q

which paraneoplastic syndrome can SCLC cause

A

SIADH
Cushings
Lambert Eaton syndrome
SVCO

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65
Q

how does muscle weakness in Lambert Eaton syndrome compare to myasthenia gravis

A

it improves with exercise in Lambert Eaton syndrome

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66
Q

describe Lambert Eaton syndrome symptoms

A

waddling gait, difficulty walking, muscle tenderness, hyporeflexia
improves on exercise

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67
Q

which type of lung cancer causes hyponatraemia

A

SCLC

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68
Q

what does raised ALP indicate in lung cancer

A

bony mets

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69
Q

1st line Ix for lung cancer

A

CXR

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70
Q

Ix to look for mets and lymph node involvement in lung cancer

A

PET-CT

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71
Q

diagnostic Ix that’s also used for staging for lung cancer

A

bronchoscopy with biopsy

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72
Q

which conditions cause Horners syndrome

A

pancoast tumour
carotid artery dissection (causes partial horners syndrome - no anhidrosis)
stroke

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73
Q

main 3 symptoms of Horners syndrome

A

ipsilateral miosis
ptosis
anhidrosis

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74
Q

which lung cancer can cause hoarseness of voice and why

A

pancoast tumour
recurrent laryngeal nerve damage/paralysis

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75
Q

which lung cancer causes SVCO

A

tumour in right lung apex (SCLC or pancoast tumour)

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76
Q

symptoms/signs of SVCO

A

dyspnea
face/neck/arm swelling
raised JVP
headaches worse in morning
visual disturbances

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77
Q

which test shows SVCO

A

pembertons test

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78
Q

immediate treatment needed for SVCO

A

oral dexamethasone

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79
Q

does SCLC or NSCLC have worse prognosis

A

SCLC

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80
Q

NSCLC first line Tx

A

lobectomy
- can use curative radiotherapy for stages 1,2,3

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81
Q

Tx for advanced NSCLC

A

EGFR inhibitors
ALK tyrosine kinase inhibitors

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82
Q

Tx for SCLC

A

palliative chemo

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83
Q

what is a pneumothorax without underlying disease called

A

primary spontaneous

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84
Q

what is a pneumothorax as a complication of an underlying disease called

A

secondary spontaneous

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85
Q

how can tension pneumothorax cause hypotension

A

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

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86
Q

what is sudden deterioration following intubation a sign of

A

tension pneumothorax

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87
Q

pneumothorax breath sounds

A

reduced

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88
Q

pneumothorax percussion resonance

A

hyper resonant

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89
Q

pneumothorax fremitus

A

decreased

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90
Q

fist line Ix for pneumothorax

A

CXR
- erect PA on inspiration

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91
Q

first line Ix for pneumothorax in to who can’t sit up

A

chest ultrasound

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92
Q

pneumothorax CXR findings

A

clear rim between lung margin and chest wall
no lung markings visible between lung margin and chest wall

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93
Q

area for aspiration in pneumothorax

A

2nd ICS

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94
Q

area for chest drain in pneumothorax

A

between anterior border of latissimus dorsi and lateral border of pec major
at 4/5th ICS at mid- or anterior- axillary line

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95
Q

Tx for tension pneumothorax

A

large bore cannula
into 2nd ICS at MCL

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96
Q

Tx for primary pneumothorax w/o SOB and <2cm

A

discharge and follow up in 2/4 weeks

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97
Q

Tx for primary pneumothorax w/o SOB and >2cm

A

aspirate, if doesn’t work chest drain

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98
Q

Tx for secondary pneumothorax w/o SOB and 1-2cm

A

aspirate

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99
Q

Tx for secondary pneumothorax w/o SOB and <1cm

A

oxygen therapy and admit

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100
Q

Tx for secondary pneumothorax w/o SOB and >2cm or secondary pneumothorax with SOB

A

chest drain

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101
Q

which condition is most lily to cause bilateral hilar lymphadenopathy on chest X-ray

A

sarcoidosis

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102
Q

most common site of lung cancer metastasis

A

brain

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103
Q

most common causes of inspiratory bibasal lung crackles

A

pneumonia
pulmonary oedema
bronchitis
pulmonary fibrosis

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104
Q

likely diagnosis in a pt with lung cancer and worsening headaches, double vision and ataxic gait

A

raised ICP due to brain metastases

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105
Q

best scan for brain mets

A

contrast enhanced CT of the brain

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106
Q

which conditions can contrast used in a contrast enhanced CT worsen

A

the contrast is nephrotoxic - don’t use in pts with kidney issues

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107
Q

which condition are voltage gated calcium channel (VGCC) antibodies present in

A

Lambert eaton myasthenic syndrome

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108
Q

what sweat chloride level is diagnostic for CF

A

> 60 mmol/L

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109
Q

which lung cancers cause cavitating lesions

A

squamous cell carcinomas

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110
Q

what does central cavitation with air fluid level on CXR indicate

A

lung abcess

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111
Q

what does a target shaped lesion in the upper lobe on CXR indicate

A

aspergilloma

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112
Q

what is right sided heart failure in response to pulmonary HTN called

A

cor pulmonale

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113
Q

if you have a suspicion that a chest drain may be blocked what should you do

A

check the drain to see if the fluid is shining - ie moving up and down the tube on inspiration and expiration

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114
Q

what is a polyphonic wheeze on auscultation associated with

A

exacerbation asthma

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115
Q

what is bronchial breathing associated with

A

infection+ consolidation
- pneumonia
- bronchitis

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116
Q

what is stoney dull percussion at base associated with

A

pleural effusion

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117
Q

pt has pulmonary fibrosis and has recently had many UTIs. which drug has caused the fibrosis

A

nitrafurotonin - used to treat UTIs

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118
Q

causes of fibrosis in lung apices

A

ARTS
- Ankylosing spondylitis
- Radiation
- TB
- Sarcoidosis

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119
Q

classic cause of fine inspiratory crackles vs coarse inspiratory crackles

A

fine (basal) = fibrosis
coarse = consolidation / pneumonia

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120
Q

what does honeycombing on CT indicate

A

fibrosis

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121
Q

what do signet rings on CT indicate

A

bronchiectasis

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122
Q

what do diffuse ground glass opacities on CT indicate

A

PCP (pneumocytis penumonia)

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123
Q

what is the typical build of a person susceptible to a spontaneous pneumothorax

A

tall and slender body

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124
Q

in which conditions is a hyper inflated chest seen

A

asthma
copd

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125
Q

what does unilateral pitting oedema in calf suggest

A

DVT –> pulmonary embolism

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126
Q

likely diagnosis: foul smelling sputum, fever, history of stroke, finger clubbing

A

lung abscess
–> history of stroke: impaired swallowing
–> aspiration

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127
Q

what does hepatomegaly suggest in context of heart

A

right sided heart failure / cor pulmonale (due to blood congestion in liver)

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128
Q

what does reduced DLCO suggest

A

reduced diffusion across thinned fibrotic alveoli –> fibrosis

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129
Q

Tx for community acquired pneumonia with CURB score of 0/1

A

oral amoxicillin

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130
Q

Tx for exacerbation of COPD

A

salbutamol nebulised through air

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131
Q

initial Tx step for acute pulmonary oedema

A

IV furosemide

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132
Q

In what condition is a polyphonic wheeze heard

A

asthma

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133
Q

causes of bibasal crackles

A

fluid / mucus / infection in lungs

  • pneumonia
  • bronchitis
  • pleural effusion
  • heart failure (causes fluid to pool in lungs)
  • pulmonary fibrosis
  • bronchiectasis
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134
Q

main differentials for reduced FEV1/FVC ratio

A

asthma
copd
bronchiectasis

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135
Q

FEV1/FVC in restrictive lung disease

A

normal (as both FEV1 and FVC are reduced)

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136
Q

what is a pulmonary hamartoma

A

benign mass in lung

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137
Q

how does pneumothorax affect V/Q ratio

A

reduced V/Q

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138
Q

Tx for lung abscess

A

IV abx

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139
Q

FEV1/FVC in bronchiectasis

A

reduced, as its an obstructive disease pattern

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140
Q

what is a pyopneumothorax

A

a pleural collection of pus and air - has a visible fluid level on CXR

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141
Q

what is a pneumatocele

A

structure in lung which contains single or multiple air filled cysts

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142
Q

main cause of pneumatocele

A

complication of acute pneumonia caused by staph A

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143
Q

what is an empyema

A

pus collection - pleural empyema can be a complication of pneumonia

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144
Q

pleural empyema on cxr

A

lateral
makes an obtuse angle with the chest wall (so goes downwards along chest wall - not sideways into the lung)

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145
Q

does horners syndrome cause ipsilateral or contralateral ptosis / miosis

A

ipsilateral - the sympathetic chain on that side is being compressed by the tumour

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146
Q

a pt with lung cancer presents with abdominal pain and constipation. what type of lung cancer do they have

A

squamous cell carcinoma - the abdo pain and constipation is due to hypercalcaemia - PTHrP secretion)

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147
Q

diagnosis: pt has rheumatoid arthritis and productive cough of green sputum with red specks

A

bronchiectasis - rheumatoid arthritis can cause bronchiectasis

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148
Q

most likely diagnosis of fever, cough, pleuritic chest pain

A

lung abscess

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149
Q

in which pts is pseudomonas aeruginosa most likely to cause lung infections

A

cystic fibrosis pts

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150
Q

klebsiella pneumonia is highly associated with lung abscesses in which pts

A

alcoholic pts

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151
Q

what is the inheritance pattern of cystic fibrosis

A

autosomal recessive

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152
Q

for what is DNase given to CF pts

A

to break down mucus

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153
Q

for what is creon given to CF pts

A

for pancreatic exocrine insufficiency - causes steatorrhea
creon is aka pancrelipase

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154
Q

does copd present with clubbing

A

no

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155
Q

what does pleura rub sound indicate

A

pleurisy

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156
Q

which parts of the lungs are most affected in TB

A

upper lobes

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157
Q

TB medication

A

Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RIPE) for 2 months
followed by isoniazid + rifampicin (aka Rifinah 300) for 4 months

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158
Q

most common cause of bilateral hilarity lymphadenopathy

A

sarcoidosis

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159
Q

skin manifestation of sarcoidosis

A

erythema nodosum - raised painful red shin rash

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160
Q

management for pneumothorax > 2cm

A

chest drain

161
Q

what does a monophonic wheeze indicate, in terms of obstruction

A

indicates that one airway is being obstructed rather than multiple

162
Q

initial managment for pt with hypercalcaemia due to lung cancer

A

Iv NaCl fluids
then give IV bisphosphonate

163
Q

which bacteria are most commonly associated with lung abscess

A

anaerobic bacteria

164
Q

what is bronchiolitis obliterans

A

causes inflammation in the small airways causing them to become scarred, resulting in permanent narrowing.

165
Q

which crackles are heard on auscultation in bronchiectasis

A

coarse

166
Q

likely diagnosis: wheezing/SOB (asthma), diarrhoea, facial flushing

A

carcinoid syndrome

167
Q

first line investigation for carcinoid syndrome

A

urinary 5-HIAA excretion

168
Q

how can having breast cancer in the past increase the risk of developing lung cancer

A

the radiotherapy used to treat breast cancer increases the risk for further lung cancer

169
Q

where is aspiration done for pneumothorax

A

5th intercostal space mid-axillary line

170
Q

what are the target groups for pneumococcal vaccine

A

over 65s
pts with chronic lung conditions eg COPD

171
Q

initial step total if pt is asymptomatic but has reduced air entry and is hyper resonant on one side

A

urgent chest xray

172
Q

contrast the inflammation in sarcoidosis vs tb

A

sarcoidosis = non caseating granulomas
TB = caseating granulomas / cavitating lesions

173
Q

in which pt population is sarcoidosis most prevalent

A

African American women

174
Q

skin manifestations of sarcoidosis

A

lupus pernio
maculopapular rash
erythema nodosum

175
Q

sarcoidosis symptoms/signs

A

wheeze
dry cough
SOB
arthralgia
anterior uveitis
lupus pernio
maculopapular rash
erythema nodosum

176
Q

MSK manifestation of sarcoidosis

A

arthralgia

177
Q

first line Ix for sarcoidosis and what does it show

A

CXR
bi-hilar lymphadenopathy

178
Q

gold standard diagnostic Ix for sarcoidosis

A

bronchoscopy + biopsy
non caseating granulomas

179
Q

stages 1-4 on CXR for sarcoidosis

A

1 - bi-hilar lymphadenopathy
2 - bi-hilar lymphadenopathy + pulmonary infiltrates
3 - only pulmonary infiltrates
4 - pulmonary fibrosis with distortion

180
Q

what does spirometer show for sarcoidosis

A

restrictive

181
Q

2 significant lab findings in sarcoidosis

A

high CD4/CD8 ratio in bronchoalveolar lavage
high ACE levels in serum

182
Q

1st line Tx for sarcoidosis

A

corticosteroids : prednisolone, hydrocortisone

183
Q

what are chloroquine, hydroxychloroquine

A

anti malarial drugs

184
Q

what to give for sarcoidosis symptomatic relief

A

NSAIDs

185
Q

severe disease last resort Tx for sarcoidosis

A

lung transplant

186
Q

if a sarcoidosis pt can’t have corticosteroids what do you give

A

immunosuppression - methotrexate, azathioprine

187
Q

in which pt population is TB most prevalent

A

immunosuppressed
born in india / Bangladesh / sub-saharan africa
previous TB exposure
silicosis

188
Q

what would a biopsy for TB show

A

caseating granulomas
langhans giant cells
epithelioid macrophages
acid fast mycobacterium tuberculosis

189
Q

which part of the lungs does TB usually affect

A

upper lobes

190
Q

contrast primary and secondary TB

A

primary: when a non-immune pt is exposed to TB - normal non-immunocompromised ppl would usually recover
usually asymptomatic

secondary: if the pt becomes immmunocompromised, the initial infection can become reactivated

191
Q

TB symptoms

A

productive cough - doesn’t heal w abx
haemoptysis
weight loss
fever
night sweats
malaise
SOB
anorexia
pleuritic chest pain
cervical and hilar lymphadenopathy

192
Q

describe a TB cough

A

productive
haemoptysis
doesn’t heal w abx

193
Q

contrast TB and sarcoidosis cough

A

TB - productive, haemoptysis
sarcoidosis - non productive, chronic dry cough

194
Q

MSK manifestation of TB

A

Potts disease - spread of TB to the bones

195
Q

first line Ix for TB and what does it show

A

CXR
bi-hilar lymphadenopathy
caseating granulomas / cavitating lesions esp in the upper lobes

196
Q

gold Standard diagnotsic Ix for TB

A

sputum culture - Ziehl Nielsen test: positive for acid fast bacillus (AFB)

197
Q

screening test for latent TB given to contacts of an infected person

A

Mantoux test

198
Q

latent TB Tx

A

Rifampicin and Isoniazid

199
Q

active TB Tx

A

RIPE
Rifampicin + Isoniazid + pyrazinamide + ethambutol
for 2 months

then
Rifampicin + Isoniazid
for 4 months

200
Q

Rifampicin side effects

A

red/orange secretions

201
Q

Isoniazid side effects

A

drug induced lupus
peripheral neuropathy - give vit B6 (pyridoxine) to prevent

202
Q

Pyrazinamide side effects

A

gout (hyperuriceamia)

203
Q

ethambutol side effects

A

optic neuritis
avoid in CKD

204
Q

what is virchows triad

A

vessel wall damage
venous stasis
hypercoagluation

205
Q

signs and symptoms of PE

A

tachypnoea - MOST COMMON SIGN
sudden onset one sided pleuritic chest pain
dyspnoea
tachycardia
DVT - unilateral leg swelling
cough / hameptysis / fever

206
Q

which criteria is used to determine investigations for PE

A

wells criteria

207
Q

Ix if wells criteria > 4

A

CTPA (CT pulmonary angiography)
if positive - confirms diagnosis
if negative - look further down for leg swelling / DVT

208
Q

Ix if wells criteria <= 4

A

D-dimer
if positive - do CTPA
if negative - look for other diagnoses

209
Q

what scan do to instead of CTPA for PE if pt is haemodynamically unstable

A

echocardiography

210
Q

what scan do to instead of CTPA for PE if pt is renal impaired / contrast allergy / pregnant

A

V/Q scan

211
Q

what does an ECG show in PE

A

sinus tachycardia
right heart strain
S1Q3T3 (S waves in lead 1, q waves in lead 3, inverted t waves in lead 3)

212
Q

Tx for haemodynamically stable PE pts

A

DOAC (apixaban or rivaroxaban)
- unprovoked (idiopathic) PE: for 6 months
- provoked PE: for 3 months

if can’t take DOAC, give heparin

213
Q

Tx for haemodynamically unstable PE pts (systolic <90)

A

thrombolysis - alteplase

214
Q

what counts as pulmonary hypertension

A

mean pulmonary arterial pressure >= 25 mmHg

between 20 and 25 is still considered abnormal, but 25 is definitely pulmonary htn

215
Q

what is cor pulmonale

A

right sided heart failure secondary to long standing pulmonary disease resulting in pulmonary arterial hypertension

216
Q

signs and symptoms (including heart sounds/murmurs) for pulmonary hypertension

A

dyspnoea
RHF signs: raised JVP, peripheral oedema, hepatomegaly
parasternal heave: RVH
loud P2
pan systolic murmur (tricuspid regurgitation) ad early diastolic murmur (pulmonary regurgitation)

217
Q

first line Ix for pulmonary HTN

A

transthoracic echocardiogram

218
Q

gold standard diagnostic Ix for pulmonary HTN

A

right heart catheterisation - shows => 25 mmHg

between 20 and 25 is still considered abnormal, but 25 is definitely pulmonary htn

219
Q

ECG finings in pulmonary HTN

A

RVH - tall S waves in V1
right axis deviation
p pulmonale - peaked p waves in lead 2

220
Q

first line Tx for pulmonary htn that is idiopathic or no signs of RHF

A

CCB’s (act as pulmonary vasodilators)

221
Q

2 main cardiac complications of pulmonary htn

A

cor pulmonale
SVT

222
Q

define type 1 resp failure

A

hypoxaemia
PaO2 < 8kpa

223
Q

define type 2 resp failure

A

hypercapnia
PaCO2 > 6kpa

224
Q

what type of resp is due to neurological condition causing respiratory muscle weakness

A

type 2

225
Q

what type of resp failure is due to copd exacerbation

A

type 2

226
Q

type 1 resp failure symptoms

A

tachypnoea
dyspnea
cyanosis
pleuritic chest pain

227
Q

type 2 resp failure symptoms

A

hypoventilation
headache
anxiety
papilloedema
asterixis
drowsiness
confusion
unusual jerking or shaking

228
Q

first line in management of resp failure

A

check for airway obstruction and clear it (head tilt, chin lift, jaw thrust)

229
Q

which mechanical ventilation is used for type 1 resp failure

A

CPAP

230
Q

which mechanical ventilation is used for type 2 resp failure

A

BiPAP

231
Q

when is invasive mechanical ventilation used (endotracheal intubation)

A

pt is unconscious and supplemental o2 didnt work

232
Q

which type of ventilation is useful in pulmonary oedema due to heart failure

A

CPAP

233
Q

types of ventilation

A

non mechanical : o2 support, nasal cannula or face mask (doesn’t correct hypercapnia)

mechanical: invasive = endotracheal intubation
non invasive = CPAP, BiPAP

234
Q

describe the inflammation in asthma

A

IgE mediated type 1 hypersensitivity –> mast cell degranulation, release of histamine –> bronchial hyper responsiveness, bronchial inflammation, endobrocnhial obstruction

235
Q

clinical features of asthma including O/E on resp exam

A

persistent dry cough - worse at night, exercise, exposure to irritants
dynspoea
chest tightness
end expiratory wheeze
hyper resonance on percussion
prolonged expiratory phase on auscultation

236
Q

how do NSAIDs affect asthma symptoms

A

worsen

237
Q

Asthma: moderate vs severe vs life threatening acute attack

A

Moderate ⇒ peak flow 50-75%, normal speech, RR <25, pulse <110

Severe ⇒ peak flow 33-50%, can’t complete sentences, RR >25, pulse >110

Life Threatening ⇒ peak flow <33%, oxygen <92%, normal CO2, confusion, bradycardia

Near Fatal Asthma ⇒ raised CO2

238
Q

primary diagnostic test for asthma and results

A

spirometry (FEV1/FVC < 0.7) - FEV1 is significantly reduced but FVC is same or slightly reduced
BUT THERE IS BRONCHODILATOR REVERSIBILITY: upon inhalation of SABA (salbutamol), FEV1 increases by 12% or more

–> OBSTRUCTIVE SPIROMETRY WITH BRONCHODILATOR REVERSIBILITY

239
Q

what can you measure in asthma to show degree of eosinophilic inflammation

A

FeNO

240
Q

what is measured in asthma to track progression

A

peak expiratory flow rate

241
Q

CXR in asthma

A

hyper inflated lungs

242
Q

inhaler advice

A

Remove cap and shake
Breathe out gently
Put mouthpiece in mouth and as you begin to breathe in, which should be slow and deep, press canister down and continue to inhale steadily and deeply
Hold breath for 10 seconds, or as long as is comfortable
For a second dose wait for approximately 30 seconds before repeating steps 1-4.

243
Q

NICE lines of treatment for asthma

A
  1. SABA (Salbutamol)
  2. SABA + ICS (Beclomethasone or Budesonide) ⇒ if patient reports symptoms 3 or more times per week, or night-time waking either at initial diagnosis or review
  3. SABA + ICS + LTRA (Montelukast)
  4. SABA + ICS + LABA (Salmeterol)
  5. SABA + MART (ICS/LABA switched out for a MART, which includes a low dose ICS)

BTS guidlines do LABA then LTRA

244
Q

what is a blue inhaler, when is it taken and what is that main side effect

A

salbutamol
reliever
take when needed
causes tremors

245
Q

what is a brown inhaler, when is it taken and what is that main side effect

A

Beclomethasone
maintainer
taken in morning and night regardless of symptoms
causes oral candidiasis

246
Q

acute asthma attack Tx

A

Oxygen (target sats 94-98%)
Salbutamol Nebulisers(+ipatropium bromdie)
Oral Prednisolone
(or IV Hydrocortisone if severe/if patient unable to swallow)- CONTINUE ICS ALONGSIDE THIS TX

consider
IV Magnesium Sulfate (only in asthma exacerbation, not COPD)

IF LIFE THRETENING AND DONT RESPOND TO STEROIDS, START VENTILATION - INTUBATION

NIV shouldn’t be used in acute asthma exacerbations. If needed, mechanical ventilation should be used.

247
Q

define chronic bronchitis

A

chronic narrowing of the airways defined clinically as a productive cough on most days for at least 3 months per year for 2 consecutive years

248
Q

define emphysema

A

defined histologically as permanent destructive enlargement of air spaces distal to the terminal bronchioles

249
Q

what is asthma

A

reversible airflow obstruction

250
Q

what is COPD

A

airflow obstruction with little or no reversibility

251
Q

what is the usual cause of COPD in a young non smoker

A

alpha 1 antitrypsin deficiency

252
Q

clinical features of COPD including O/E in resp exam

A

chronic productive cough - clear sputum
tachypnoea and dyspnea
pursed lips breathing
end expiratory wheeze
hyper resonance on percussion
reduced breath sounds
coarse crackles
Barrel Chest → anteroposterior diameter of chest is increased, suggests hyperinflation

253
Q

what does it mean if sputum changes colour in COPD

A

exacerbation / infection

254
Q

CXR findings in COPD

A

hyperinflated lungs (>6 anterior ribs seen above diaphragm),
bullae (lucency without a visible wall),
flat hemidiaphragm

255
Q

spirometry findings in COPD

A

FEV1/FVC <0.7 (no bronchodilator reversibility, unlike asthma)

Significantly reduced FEV1, slightly reduced/normal FVC

256
Q

COPD Severity (Based on FEV1)

A

○ Stage 1 (Mild) ⇒ >80%
○ Stage 2 (Moderate) ⇒ 50-79%
○ Stage 3 (Severe) ⇒ 30-49%
○ Stage 4 (Very Severe) ⇒ <30%
All = FEV1/FVC <0.7

257
Q

first step of COPD management (non pharmacological)

A

smoking cessation
vaccinations - pneumococcal and influenza
pulmonary rehab

258
Q

first line pharmacological management for COPD

A

bronchodilators: SABA (salbutamol) or SAMA (ipratropium bromide)

259
Q

what is the most common organism which causes acute exacerbations of COPD

A

haemophilus influenza

260
Q

what is the criteria for LTOT (long term oxygen therapy ) for COPD

A

pO2 <7.3kPa or 7.3-8.0kPa + secondary polycythaemia/peripheral oedema/pulmonary hypertension.

(Assessment is done by measuring arterial blood gases on 2 occasions at least 3 weeks apart).

261
Q

what is the correlation between FeV1 and risk of COPD exacerbation

A

significant correlation between increased FEV1 and lower risk of COPD exacerbation

262
Q

what is the risk with supplemental o2 given to COPD pts

A

reduces respiratory drive causing hypoventilation, leading to more CO2 retention

263
Q

acute exacerbation of COPD: management

A

STEP 1: GIVE O2 IF THEY’RE HYPOXAEMIC
24% Oxygen (blue venturi mask)

STEP 2: GIVE BRONCHODILATORS
Nebulised Bronchodilators (salbutamol + ipratropium bromide nebulisers)

STEP 3: GIVE CORTICOSTEROIDS
Corticosteroids (oral prednisolone for 5 days or IV hydrocortisone)

STEP 4: GIEV ANTIBIOTICS
Antibiotics (only if evidence of infection such as green sputum - amoxicillin/doxycycline/clarithromycin)

NIV (BiPAP) If high CO2 and resp acidosis despite medical treatment

(IV Theophyllines may be given in conjungtion with meds)

264
Q

what is given to COPD pts if they meet the criteria for recurrent exacerbations

A

prophylactic azithromycin (monitor QT interval)

265
Q

contrast COPD and asthma

A

asthma
- dry cough
- end expiratory wheeze
- hyperinflated lungs
- reversible airflow obstruction
- FEV1 increases after salbutamol inhalation
- eosinophilic inflammation
- variability in obstruction eg at night, exercise, irritant exposure

COPD
- productive cough
- end expiratory wheeze
- hyperinflated lungs - but also bullae, flattened hemidiaphragm
- irreversible airflow obstruction
- FEV1 unchanged after salbutamol inhalation
- no eosinophilic inflammation
- no variability in obstruction

266
Q

what criteria counts for COPD overlap syndrome
(asthmatic features / steroid responsiveness)

A

hx of asthma or atopy
eosinophilia
FEV1 variability (min. 400ml)
diurnal variation in peak flow (min. 20%)

267
Q

lines of treatment for COPD without asthmatic features

A

SABA/SAMA

SABA + LABA + LAMA

SABA/SAMA + LABA + LAMA + ICS

268
Q

lines of treatment for COPD with asthmatic features

A

SABA/SAMA

SABA/SAMA + LABA + ICS

SABA/SAMA + LABA + LAMA + ICS

269
Q

what is salmeterol

A

LABA

270
Q

what is tiotropium

A

LAMA

271
Q

what is beclamethasone

A

ICS

272
Q

what is salbutamol

A

SABA

273
Q

what is ipratropium bromide

A

SAMA

274
Q

3 features which distinguish COPD and ACOS (asthma copd overlap syndrome)

A

more of a response to bronchodilators
increased reversibility of airflow
eosinophilic inflammation

275
Q

what is the likely diagnosis: acute resp failure, non cardiogenic pulmonary oedema, bilateral opacities/infiltrates on X-ray

A

ARDS (acute respiratory distress syndrome)

276
Q

best form of management for ARDS

A

low tidal volume mechanical ventilation

277
Q

what is a normal AMTS score

A

8 and above

278
Q

what is coryza

A

Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip.

279
Q

what is KCO and whats is it used to measure

A

Carbon monoxide transfer coefficient
assesses the efficiency of alveolar transfer of carbon monoxide by measuring the pulmonary gas exchange across the alveolar–capillary membrane

280
Q

is residual volume increased or decreased in COPD

A

increased
(Pts have hyperinflated lungs)

281
Q

how is DLCO affected by emphysema

A

reduced
as there is less SA for diffusion due to the destruction the alveolar walls

282
Q

pt has COPD and atopic dermatitis. what is next step in management after salbutamol

A

LABA
+ ICS

283
Q

what is itraconazole

A

anti fungal - used for fungal pneumonia

284
Q

likely diagnosis: pneumonia with a recurrent fever despite abx, with pleural fluid aspirate pH <7.2

A

empyema

285
Q

empyema management

A

chest drain
and antibiotics

286
Q

what does widespread bilateral crepitations with hypoxaemia indicate

A

ARDS (resp failure and pleural effusion)

287
Q

can CPAP or BiPAP be used in ARDS

A

CPAP

288
Q

what does consolidation on X-ray suggest

A

infection

289
Q

what is the severity of an asthma attack if the pts CO2 is high

A

“Near Fatal” asthma attack
immediately take to ITU, endotracheal intubation

290
Q

pt has COPD exacerbation nd low O2. After being given this their sats adjust but their ventilation work reduces, and CO2 goes up. what should you do

A

reduce the O2 being given to a fraction of the amount
deliver through a Venturi mask

291
Q

first line PREVENTER therapy in asthma

A

ICS

292
Q

what infections does E coli usually cause

A

UTIs

293
Q

gram positive causative organism of aspiration pneumonia

A

strep pneumoniae

294
Q

gram negative causative organism of aspiration pneumonia

A

bacteroides
klebsiella pneumoniae

295
Q

which GCS indicates coma

A

8 or below

296
Q

most likely diagnosis: pt has HIV and is desaturating (oxygen wise) with minimal exertion

A

PCP (pneumocystis pneumonia)

297
Q

PCP diagnostic test

A

silver stain

298
Q

which antibiotics can be given for infective exacerbation of COPD

A

amoxicillin
clarithromycin
doxycycline

299
Q

which medication do you give to someone who is allergic to penicillin and is experiencing an infective exacerbation of their COPD

A

doxycycline

300
Q

what investigation do you do if a pt comes in with what seems like a COPD exacerbation

A

ABG

301
Q

ARDS diagnostic criteria

A

A: Acute respiratory failure, within 1 week of trigger (e.g. pneumonia)
- R: Really bad chest x-ray (bilateral opacities)
- D: Decreased PaO2
- S: Should not be CHF or fluid overload

302
Q

list some symptoms of respiratory alkalosis

A

SOB
light headed
numbness

  • resp alkalosis means low CO2 so they’re hypoventilating - need more oxygen therefore OSB, dizzy etc
303
Q

if COPD pt has a high level of CO2 and low oxygen bt has a normal pH what method of oxygen delivery do you use

A

thus shows that they are chronic retainers of CO2 and that their ‘normal’ O2 level is lower.
for these people, hypoxia causes a respiratory drive, not hypercapnia.
so you need to be careful not to give them too much oxygen so you dont dampen the respiratory drive.
the Venturi mask is the best way to administer this as it allows you to change the amount

304
Q

diagnostic test for COPD

A

spirometry - check for obstructive pattern and for reversibility - should be irreversible

305
Q

which pneumonia causes a ring shaped rash (erythema multiform)

A

mycoplasma pneumoniae

306
Q

what is GOLD criteria for COPD severity

A

GOLD A
0-1exacerbations per year + fewer symptoms

GOLD B
0-1 exacerbations per year + more symptoms

GOLD C
2 or more exacerbations per year + fewer symptoms

GOLD D
2 or more exacerbations per year + more symptoms

307
Q

which GOLD criteria classifies for COPD pulmonary rehab

A

GOLD B or higher

308
Q

what is the aim of pulmonary rehab for COPD

A

dealing with emotional aspect of diagnosis
improve quality of life

309
Q

pt has asthma and is on SABA and ICS, what is next line of treatment according to BTS (British thoracic society)

A

LABA

310
Q

mortality risk for pneumonia pt from score 0-5 in CURB 65

A

0 – 0.7%
1 – 3.2%
2 - 13%
3 - 17%
4 - 41.5%
5 - 57%

311
Q

how should you obtain your reading for your peak flow diary (asthma)

A

take 3 readings and note down the highest of the 3

312
Q

what position should the pt be in to take a peak flow reading

A

standing up, sitting upright
NOT lying down

313
Q

what is seen on CXR for ARDS

A

bilateral pulmonary infiltrates

314
Q

how does hyperventilation change pH

A

causes respiratory alkalosis
(hyperventilation –> hypocapnia –> resp alkalosis)

315
Q

does pneumonia cause resp acidosis or alkalosis

A

respiratory acidosis
(causes CO2 retention due to impaired exchange of o2 and co2)

316
Q

does COPD cause resp acidosis or alkalosis

A

respiratory acidosis
(causes CO2 retention)

317
Q

COPD indications for lung reduction surgery

A

Patients with severe COPD who remain breathless despite maximal medical therapy should be considered for lung volume reduction surgery if:

they have upper lobe-predominant emphysema
FEV1 >20% predicted
paCO2 <7.3 kPa
TLCO >20% predicted

318
Q

likely diagnosis for immunocompromised pt (eg with HIV, or just had transplant and taking immunosuppressants) and presents with fever, non productive cough and SOB on exertion

A

PCP

319
Q

definitive diagnostic investigation for PCP

A

bronchoscopy with bronchoalveolar lavage

320
Q

what investigation should be done 6 weeks after clinical resolution in pneumonia

A

chest xray

321
Q

if a pt doesn’t fast before surgery what are they at risk of

A

aspiration pneumonia

322
Q

how long before surgery must a pt fast from clear fluids, and from non clear fluids + food

A

clear fluids (fruit juice w/o pop, coffee, tea, milk, water
—> 2 hr before op

non clear liquids and foods
–> 6 hr before op

323
Q

what should you do to the O2 when a pt is in type 2 resp failure

A

decrease O2

324
Q

what ecg change can COPD cause

A

prominent P waves in inferior lead (lead 2)
–> (COPD causes pulmonary hTN which causes cor pulomonale which causes p pulmonate)

325
Q

what is a chylothroax

A

fluid from your lymphatic system (chyle) leaks into the space around your lungs
type of pleural effusion

326
Q

pneumonia pt begins to deteriorate with spiking temperatures for the last 24 hrs, what is most likely cause if deterioration and what is the DEFINITIVE investigation to reveal the cause

A

empyema
pleural aspirate

327
Q

are LAMAs (eg tiotropium) used for copd or asthma

A

copd

328
Q

what is tiotropium

A

LAMA

329
Q

what is the likely cause of slightly higher O2 and lower CO2

A

hyperventilation - anxiety / panic attack

330
Q

what is a blue boater

A

another word for chronic bronchitis copd pt
cyanosed
decreased ventilation so V/Q ratio is reduced

331
Q

what is a pink puffer

A

another word for emphysema copd pt
short quick breaths
pink in the face

332
Q

what is samter’s triad

A

3 conditions which commonly cluster together:
asthma
nasal polyps
aspirin sensitivity

333
Q

which 2 allergic conditions do asthma pts usually have

A

allergic rhinitis (hay fever)
atopic dermatitis (eczema)

334
Q

lung abscess symptoms vs empyema symptoms

A

lung abscess
- swinging fever
- cough
- foul purulent sputum
- haemoptysis
- pleuritic chest pain

empyema
- swinging fever
- pleuritic chest pain
- large pleural effusion on chest xray

335
Q

pt reports breathlessness when exercising and is disturbing his sleep
his spirometry shows reversibility airway obstruction
what medication should he be started on

A

SABA + ICS
(if to reports symptoms 3 or more times per week or disturbs sleep give ICS)

336
Q

pt has CAP with CURB65 score of 4
what is next steps of action

A

1) administer amoxicillin (or cefotaxime/ceftriaxone) + clarithromycin
2) discuss moving to ITU

337
Q

pt has acute asthma exacerbation and is relieved by salbutamol in A&E. what should you give them as a prescription

A

prednisolone 40-50mg for 5+ days to reduce risk of relapse of the exacerbation

338
Q

contrast coarse crackles and crepitations

A

crepitations aka fine crackles =short, high pitched
coarse crackles = longer, lower pitched

339
Q

what is FiO2

A

an estimate of the oxygen content a person inhales

340
Q

ARDS PO2 /FiO2 ratio

A

< 40

341
Q

nasal congestion, adult onset asthma, peripheral neuropathy, glomerulonephritis
likely diagnosis?

A

Churg strauss syndrome aka eosinophilic granulomatosis with polyangiitis (EGPA).

342
Q

antibodies found in churg Strauss syndrome

A

MPO-ANCA
P-ANCA

343
Q

coughing, asthma, low fever, weight loss, splenomegaly, travel to Africa / Asia / South America
likely diagnosis?

A

filarial infection causing pulmonary eosinophilia

344
Q

what is Reid index

A

ratio of gland layer to wall ratio of bronchus

345
Q

which condition has reed index > 50%

A

chronic bronchitis

346
Q

which condition has curschmann spirals on histology

A

asthma

347
Q

which condition has psammoma bodies

A

Papillary thyroid cancer

348
Q

which condition has intra alveolar exudate

A

lobar pneumonia

349
Q

what is a likely cause of exertional desaturation in a HIV pt or IVDU

A

PCP

350
Q

which medication can be used as a last line option in acute COPD exacerbation if the pt is not suitable for mechanical ventilation

A

Doxapram

351
Q

which pneumonia comply affects the right middle and lower lobes

A

aspiration pneumonia

352
Q

PCP xray

A

often normal

353
Q

what is the criteria for discharge from hospital after acute asthma attack

A

stable on salbutamol INHALER for 24hrs

354
Q

management of a symptomatic pleural effusion

A

thoracocentesis and therapeutic aspirations of the effusion

355
Q

which condition is associated with lupus vulgaris (painless facial red/brown nodules)

A

TB

356
Q

which condition is associated with lupus pernio (indurated purple facial lesions)

A

sarcoidosis

357
Q

treatment for obstructive sleep apnoea

A

CPAP

358
Q

treatment for obstructive sleep apnoea with coexisting rest failure

A

BiPAP

359
Q

most likely cause barking cough in babies / young children

A

croup (usually caused by a parainfleunza virus)

360
Q

management for mild croup - ie without resp distress (using external voluntary muscles to breathe)

A

reassure
give single dose of dexamethasone
send home

361
Q

management for severe croup - with resp distress

A

oxygen
nebulised budesonide

362
Q

what is elevated in pleural effusions caused by TB

A

pleural fluid adenosine deaminase (ADA)

363
Q

which pleural effusions have LDH < 0.5 relative to serum LDH

A

transudative pleural effusions

364
Q

which pleural effusions have low protein level

A

transudative pleural effusions

365
Q

what are the glucose levels in pleural effusions due to rheumatoid arthritis

A

low

366
Q

which syndrome links benign ovarian tumour, pleural effusion and ascites

A

Meigs syndrome

367
Q

which lung is more affected in Meigs syndrome

A

right

368
Q

how does pleural effusion affect vocal fremitus

A

causes reduced vocal fremitus

369
Q

which scoring system is used to categorise daytime somnolence in relation to OSA

A

Epworth sleepiness scale

370
Q

likely diagnosis: productive cough, pyrexia, reduced breath sounds, bronchial breathing, blunting of costophrenic angle

A

parapneumonic effusion

371
Q

what is an exudative pleural effusion according to lights criteria

A

protein content > 35 g/L
ratio of plural fluid LDH to serum LDH >0.6

372
Q

describe the pleural effusion’s caused by SLE

A

exudative
raised ANA
low complement

373
Q

what are the most common causes of exudative pleural effusions

A

infection
malignancy

374
Q

gold standard investigation for diagnosis of OSA

A

polysomnography

375
Q

what is the investigation for pulmonary embolism for a pregnant woman

A

V/Q scan regardless of the wells score
- can have CTPA or D Dimer

376
Q

what is the most likely ecg finding in a pulmonary embolism

A

sinus tachycardia
(S1Q3T3 is rare)

377
Q

for which pts can conservative managment for sarcoidosis be considered instead of corticosteroids

A

stage 0 - normal xcr
stage 1 - bilateral hilar lymphadenopathy with no extra pulmonary features

378
Q

initial treatment of pleural effusion due to heart failure

A

treat the cause –> give furosemide

379
Q

what does a negative gran stain indicate

A

no bacteria found

380
Q

contra indications to thrombolysis for pE

A

pts with orevious bleeding in CNS
recent trama / sirgery
bleeding disorder

381
Q

which condition is swan neck deformity pathognomonic of

A

rheumatoid arthiritis

382
Q

what is lofgrens syndrome and which condition does it relate to

A

triad of fever, erythema nodosum and bilateral hilarity lymphadenopathy
relates to sarcoidosis

383
Q

pt presents with reduced breath sounds bilaterally, raised JVP, dullness to percussion, history of ischaemic heart disease
which investigation do you do

A

transthoracic echo
(usually for pleural effusion you do a pleural aspiration UNLESS there is clear evidence that the cause is HF, then you do echo)

384
Q

what is the cause of a pleural effusion with multinucleate giant cells

A

rheumatoid arthiritis

385
Q

gold standard investigation for sleep apnoea

A

polysomnography (a limited sleep study)
the diagnosis of OSA requires at least five episodes of apnoea or hypopnoea lasting a minimum of 10 seconds per hour of sleep

can do overnight pulse oximetry first, then polysomnography as the gold standard diagnostic test

386
Q

likely diagnosis: recently resolved pneumonia new fever and a pleural effusion

A

empyema

387
Q

first line quick investigation to do to confirm an empyema

A

pH
pH < 7.2 suggests empyema

388
Q

empyema treatment/management

A

urgent drainage
IV abx

389
Q

paroxysmal nocturnal dyspnoea vs OSA

A

paroxysmal nocturnal dyspnoea: patient wakes up gasping for air because lying supine worsens pulmonary oedema - would have background / other features consistent with HF

OSA: middle aged, overweight men, upper airway obstruction, morning headaches and daytime sleepiness

390
Q

why does anti phospholipid syndrome increase risk of PE

A

it increases risk of venous thromboembolism

391
Q

what is an absolute contraindication for thrombolysis for PE

A

history of a hemorrhagic stroke at any time

392
Q

are antiplatelets such as aspirin contraindicated thrombolysis

A

no

393
Q

what does auramine O test for

A

acid fast bacilli - like ziehl neelsen stain

394
Q

what type of pleural effusion can hypothyroidism cause

A

transudate pleural effusion

395
Q

how long can patients with active cancer take DOAC for PE

A

6 + months as its an ongoing risk faction

396
Q

what medication can you give immediately for a post operative pt with PE

A

LMWH, then give DOAC or warfarin for 3 months

397
Q

what to make sure you look for in a Ix question for PE

A

DO THEY HAVE KINDEY IMPAIRMENT or ARE THEY PREGNANT
–> Wells >4 : V/Q scan for both
–> Wells =<4: V/Q for pregnant, D dimer for renal impairment - check that???

398
Q

what should you rule out in unilateral pleural effusion

A

malignancy

399
Q

best medication for smoking cessation in a patient with psychiatric illness

A

NRT

year 3 conditions (17 decks)

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