Respiratory Flashcards
What characterises bronchiectasis?
Permanent dilation of the bronchi and bronchioles, leading to chronic cough, sputum production, and recurrent respiratory infections.
What are the common causes of bronchiectasis?
Cystic fibrosis, recurrent lung infections, immunodeficiency, allergic bronchopulmonary aspergillosis (ABPA), and primary ciliary dyskinesia.
How is bronchiectasis diagnosed?
High-resolution CT (HRCT) scan is the gold standard. Clinical features include chronic cough, purulent sputum production, and recurrent infections.
What is the genetic basis of cystic fibrosis?
Autosomal recessive mutation in the CFTR (cystic fibrosis transmembrane conductance regulator) gene.
What are the common manifestations of cystic fibrosis?
Respiratory symptoms (bronchiectasis, chronic cough), pancreatic insufficiency, malabsorption, and salty sweat.
How is cystic fibrosis managed?
Pancreatic enzyme replacement, respiratory physiotherapy, mucolytic agents, antibiotics for infections
What characterizes sarcoidosis?
Granulomatous inflammation affecting multiple organs, commonly the lungs and lymph nodes.
What are the clinical features of sarcoidosis?
Bilateral hilar lymphadenopathy (BHL), pulmonary infiltrates, skin lesions, eye involvement (uveitis), and hypercalcemia.
How is sarcoidosis diagnosed?
Biopsy showing non-caseating granulomas. Elevated angiotensin-converting enzyme (ACE) and hypercalcemia are supportive but not specific
What is interstitial lung disease (ILD)?
A group of disorders characterized by inflammation and scarring of the lung tissue (interstitium).
What are common causes of ILD?
Idiopathic pulmonary fibrosis (IPF), connective tissue diseases (like rheumatoid arthritis), environmental exposures, and drug-induced.
What are the clinical features of ILD?
Progressive dyspnea, dry cough, and fine inspiratory crackles on auscultation.
How is obstructive sleep apnoea diagnosed?
Polysomnography (sleep study) is the gold standard
What is pulmonary hypertension (PH)?
Elevated blood pressure in the pulmonary arteries, often leading to right heart failure (cor pulmonale).
What are common causes of pulmonary hypertension?
Chronic obstructive pulmonary disease (COPD), interstitial lung disease, pulmonary embolism, and connective tissue diseases
How can pleural effusion be classified based on pH, protein, LDH, and glucose levels?
pH >7.2, Protein >35g/L, LDH high, Glucose normal → Exudative. pH >7.2, Protein <25g/L, LDH low, Glucose low → Transudative.
What is the significance of the FEV1/FVC ratio in obstructive and restrictive lung diseases?
In obstructive diseases (e.g., COPD), the ratio is reduced. In restrictive diseases (e.g., interstitial lung disease), the ratio is typically normal or increased.
What are common symptoms of lung cancer?
Persistent cough, hemoptysis, chest pain, weight loss, fatigue, and respiratory symptoms.
What is a lung abscess, and what are common causes?
A localised collection of pus within the lung parenchyma. Aspiration of oral contents, especially in the setting of impaired consciousness, is a common cause.
How is the severity of COPD determined based on spirometry results?
FEV1
How can tuberculosis (TB) be differentiated from other lung infections?
TB often presents with chronic cough, weight loss, and night sweats. Diagnosis involves acid-fast bacilli staining of sputum and chest X-ray.
What most commonly causes a cavitating pneumonia in the upper lobes
Klebsiella pneumonia
Who tends to be affected by klebsiella pneumonia
diabetics and alcoholics
Which condition may arise in a lung cavity that developed secondary to previous tuberculosis
Aspergiloma
Ignoring upper lobe cavitation, which pathogen most commonly causes cavitating lesions when it causes pneumonia?
Staph aureus
When do we use a chest drain in primary pneumothorax > 2 cm in size?
Only if needle aspiration fails first
What is the management of a massive PE with hypotension
Thrombolyse (alteplase)
Which type of patient and X-ray findings should make you suspect legionella
Bilateral, mid-to-lower zone patchy consolidation in an older patient
How are acute COPD exacerbations managed in community?
5 day course of oral prednisolone
What effect do steroids have on WCC
Raised WCC due to neutrophilia
Life-threatening asthma criteria
PEFR < 33% best or predicted
Oxygen sats < 92%
PC02 4.6-6.0 kPa
Silent chest
Cyanosis
Reduced respiratory effort
Bradycardia or hypotension
Exhaustion, confusion or coma
Virchow’s triad for DVT
Hypercoagulability, stasis of blood-flow, endothelial injury
Which medication is used in community acquired pneumonia
Amoxicillin
Most common causative organism of pneumonia and what is seen on staining?
Streptococcus pneumonia - blue / purple staining (gram positive)
Symtoms of PE
- (Pleuritic) chest pain / chest tightness
- SOB
- Haemoptysis
- Cough
- Dizziness/ syncope / blackout / loss of consciousness
- Palpitations
DVT prevention in total hip replacement
compression stockings / prophylactic LMWH / early mobilisation
Things to examine for in an acute asthma presentation
Mental Status / Signs of Confusion
- Signs of Exhaustion
- HR
- RR
- Presence of Breath Sounds
- Presence or lack of Cyanosis
- Use of Accessory Muscles
- Respiratory Effort
- Pulsus Paradoxus
- Ability to Speak in Full Sentences
Drugs and doses urgently given in asthma
- Oxygen 15L/minute (non-rebreather mask) (1 mark)
- 5mg Salbutamol nebuliser (oxygen driven, can be given back to back) (1 mark)
- Steroid therapy: 40mg oral Prednisolone / 20mg IV Hydrocortisone (1 mark)
Contraindications to lung cancer surgery
SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
Most common pathogen to cause infection in bronchiectasis
Haemophilus influenzae
When do we repeat a chest X-ray in all pneumonia patients?
6 weeks after clinical resolution
Tonsilitis antibiotic
Phenoxymethylpenicillin
Tuberculosis on CXR
Upper zone fibrosis
Why do we repeat CXR in pneumonia after 6 weeks in the elderly?
Rule out malignancy
Which patients do we not urine dip?
Older than 65 - MC&S instead
