Respiratory Flashcards
What is the most common organism causing exacerbations of COPD?
Infective: s.pneumoniae
Non-infective: h.influenzae
What are the symptoms of A1AT?
Panacinar/lower lobe emphysema
Cirrhosis and HCC adults, cholestasis children
What is the criteria for LTOT?
Blood gases on 2 occasions at least 3 weeks apart:
pO2<7.3kPa
pO2 7.3-8 AND secondary polycythaemia, peripheral oedema, or pulmonary hypertension
What are the indications for lung transplant in cystic fibrosis?
Life threatening exacerbation requiring ICU admission, pulmonary hypertension, FEV1<30% predicted, recurrent exacerbations requiring antibiotic therapy, recurrent/refractory pneumothorax
Recurrent haemoptysis not controlled by emobolisation
What is a contraindication to lung transplant in CF?
Colonisation with burkholderia cepacia
What is Orkambi?
Lumacaftor/Ivacaftor
For CF pts who are homozygous for delta F508 mutation
Lumacaftor increases the number of CFTR proteins that are transported to the cell surface
Ivacaftor is a potentiator of CFTR is already at the cell surface, increases the probability that the defective channel will be open and allow chloride ions to pass through the channel pore
What is pulmonary hypertension?
Sustained elevation in mean pulmonary arterial pressure >25mmHg at rest
What are the causes of Group 1 PAH?
Idiopathic
Familial
Associated with HIV, drugs, vascular disease, congenital heart disease with systemic to pulmonary shunts
Persistent PHTN of the newborn
What is group 2 pulmonary hypertension?
Related to left heart disease
What is group 3 pulmonary hypertension?
Secondary to lung disease/hypoxia, includes high altitude
What is group 4 pulmonary hypertension?
Due to thromboembolic disease
What is the inheritance of alpha-1 anti-trypsin deficiency?
Autosomal recessive/co-dominant
Chromosome 14
How are alleles classified in A1AT?
Alleles classified according to electrophoretic mobility: M for normal, for slow, Z for very slow
What are the genotypes in A1AT and which one is most likely to manifest disease?
PiMM - normal
PiSS - 50% normal A1AT
PiZZ - 10% normal A1AT
What are the symptoms of PiMZ genotype?
Unlikely to develop clinically significant symptoms
Increased risk of liver and lung disease therefore should avod smoking
What are the causes of occupational asthma?
Isocyanates (spray painting) Platinum salts Flour Soldering flux resin Glutaraldehyde
How is occupational asthma diagnosed?
Serial PEFR measurements
What is the FeNO test?
Fractional exhaled nitric oxide
Levels of NO rise in inflammatory cells particularly eosinophils
What is the treatment of primary pneumothorax?
<2cm and not SOB - discharge
>2cm: aspiration –> still >2cm/SOB –> chest drain
What is the treatment of secondary pneumothorax over 50 years?
<1cm –> oxygen and admit 24h
1-2cm –> aspiration –> chest drain
>2cm/SOB –> chest drain
What are the causes of a transudate pleural effusion?
<30g/L protein Heart failure Hypoalbuminaemia e.g. liver disease, nephrotic syndrome, malabsorption Hypothyroidism Meig's syndrome
What are the causes of an exudate pleural effusion?
Infection CTD Malignancy Pancreatitis PE Yellow nail syndrome
What is the cause of ARDS?
Increased permeability of the alveolar capillaries leading to fluid accumulation in the alveoli
Which patients are more likely to develop Klebsiella pneumonia?
Diabetes
Alcoholism
Immunocompromised
IVDU
What is aspergilloma?
Mycetoma that colonises an existing lung cavity e.g. secondary to TB, cancer, or CF
How is aspergilloma diagnosed?
CXR: round opacity, crescent sign
Aspergillus IgG precipitins
What are the symptoms of psittacosis?
History of bird contact Flu like symptoms Pneumonia with dry cough and chest pain Headache Organomegaly Failure to respond to penicillin
What is the treatment of psittacosis?
1st line tetracyclines e.g. doxycycline
What are the paraneoplastic features of squamous cell lung cancer?
PTH-rp
Hypertrophic pulmonary osteoarthropathy
TSH secretion
What are the paraneoplastic features of small cell lung cancer?
ADH
ACTH
Lambert-Eaton syndrome
What are 4 risk factors for lung cancer?
Smoking - 10x
Asbestos - 5x
Arsenic/radon/nickel/chromate
Cryptogenic fibrosing alveolitis
What are the indications for steroids in sarcoidosis?
Uveitis
Neuro/cardiac involvement
Parenchymal lung disease
Hypercalcaemia
What are the stages of sarcoidosis?
I - bilateral hilar lympad
II - bilateral hilar lympah + infiltrates
III - infiltrates
IV - fibrosis
What are 5 poor prognostic features of sarcoidosis?
Insidious onset Absence of erythema nodosum Lupus pernio Stage III or IV on CXR Afro-Caribbean
How is sarcoidosis diagnosed?
EBUS
ACE sensitivity 60%, specificity 70%
Spirometry - restrictive
What is the cause of hypercalcaemia in sarcoidosis?
Increased concentrations of calcitriol as a result of increased activity of 1a hydroxylase produced by sarcoid macrophages
What subtype of sarcoidosis is characterised by parotid enlargement, fever, and anterior uveitis?
Heerfordt syndrome
What is Lofgren’s sydrome
Acute form of sarcoidosis
Name the causes of upper zone fibrosis.
CHARTS
Coal worker's pneumoconiosis Histocytosis/hypersensitivity pneumonitis Ankylosing spondylitis Radiation Tuberuclosis Sarcoidosis/silicosis
Name the causes of lower zone fibrosis
CADI
CTDs except ankylosing spondylitis
Asbestosis
Drugs e.g. amiodarone, bleomycin, methotrexate
Idiopathic pulmonary fibrosis
What type of hypersensitivity reaction is EAA?
Type III
What are the symptoms of EAA?
Acute (4-8 hours):
Dyspnoea, dry cough, fever
Chronic:
Dyspnoea, productive cough, lethargy, anorexia, WAL
How is EAA diagnosed?
Upper/midzone fibrosis
BAL - lymphocytosis
No eosinophils
Sillicosis is a risk factor for what?
TB - silica is toxic to macrophages
How is ABPA diagnosed?
Eosinophilia
Positive RAST test to aspergillus
Positive IgG precipitins
Raised IgE >1000IU/ml
What are the symptoms of ABPA?
Asthma features
Proximal bronchiectasis
Fungal elements/brown flecks in sputum
What is the management of ABPA?
Oral steroids
Itraconazole 2nd line
What are the symptoms of Churg-Strauss syndrome?
Asthma Eosinophilia Mono/polyneuropathy Flitting pulmonary infiltrates Paranasal sinus abnormalities Extravascular eosinophils
What is the unmasking agent in Churg-Strauss syndrome?
Montelukast
Name 5 respiratory manifestations of rheumatoid arthritis
Bronchiolitis obliterans (obstructive picture) Pulm fibrosis Pleural effusion Pulm nodules Methotrexate pneumonitis Caplan's syndrome
What is cryptogenic organising pneumonia?
Diffuse interstitial lung disease that affects the distal bronchioles, respiratory bronchioles, alvolear ducts and walls
How is IPF diagnosed?
Restrictive spirometry Reduced TLCO Ground glass --> honeycombing High res CT ANA +ve in 30%, RF +ve in 10%
What is the treatment of IPF?
Pulm rehanb
Pirfenidone
O2
Lung Tx
What are the symptoms of acute mountain sickness?
Headache
Nausea Fatigue
Develops above 2500-3000m, over 6-12 hours
What is the cause of AMS?
Chronic hypobaric hypoxia
What is the prophylaxis for AMS?
Acetazolamide
What is the treatment of HACE and HAPE?
HACE: descent, dexamethasone
HAPE: decent, nifedipine, acetazolamide, oxygen
What are the features of carbon monoxide poisoning?
Lactic acidosis Dizziness, vertigo, vomiting Headache Ataxia Severe- pink skin and mucosa, hyperpyrexia, arrhythmias, extra-pyramidal
How is CO poisoning diagnosed?
Elevated carboxyhaemoglovin >3% non smoker, >10% smoker
Normal pO2, reduced SaO2
Pulse ox may be high
What is the pathophysiology of CO poisoning?
Co has 210 times the affinity for Hb than oxygen
Impaired O2 delivery to tissues
Left shift of dissociation curve
Hypoxia
What is the treatment of CO poisoning?
100% high flow O2 minimum 6 hours
Target saturations 100%
Decreases the half life of COHb
