Respiratory Flashcards
(172 cards)
1
Q
What is the organism responsible for TB?
A
Mycobacterium tuberculosis (rod shaped acid fast bacilli)
2
Q
What stain is used to detect TB?
A
Zeihl Neelsen (bright red against blue background)
3
Q
List the sx of TB?
A
Night sweats
Cough, fever, malaise
WL
Haemoptysis
Pleuritic chest pain
Lymphadenopathy
Erythema nodosum
4
Q
What is the GS Ix for TB?
A
Sputum culture
5
Q
What is the mx of TB and for how long?
A
4 drugs for 2 months and 2 drugs for 4 months
Rifampicin (6m)
Isoniazid (6m)
Pyrazinamide (2m)
Ethambutol (2m)
6
Q
What is the SE of Isoniazid?
A
Neuropathy
7
Q
What medication can be prescribed to prevent against the adverse effects of isoniazid?
A
Pyridoxine
8
Q
What is the SE of Rifampicin?
A
Red/orange coloured urine
9
Q
What is the SE of Ethambutol?
A
Optic neuritis (colour vision first to be affected)
10
Q
What is the SE of Pyrazinamide?
A
Hepatitis, Arthralgia, Gout
11
Q
What is Cystic fibrosis?
A
An autosomal recessive disorder caused by a mutation in the CFTR gene on chromosome 7 thus causing increased viscosity of secretions.
12
Q
What is the pathophysiology behind CF?
A
The CFTR gene is a channel protein that pumps Cl- into various secretions.
Cl- ions help draw water into secretions, thus thinning them down.
The mutation in the CFTR gene means the protein gets folded, thus cannot transport ions into secretions to thin them down thus thick.
13
Q
What are the sx of CF?
A
FTT
Steatorrhoea
Recurrent infections
Wet cough
Failure to pass meconium
Digital clubbing
14
Q
What is the mx of CF?
A
Genetic counselling
Chest physiotherapy
Exercise
High calorie diet
CREON tablets
Bronchodilators
15
Q
What is the GS ix for CF?
A
Sweat test
16
Q
What is the 1st line Ix for CF?
A
Newborn screening and genetic testing
17
Q
What is a pneumothorax?
A
When air gains access and accumulates in the pleural space
18
Q
List the causes of pneumothorax?
A
Spontaneous- smoking, tall slender young male
Trauma
Iatrogenic-lung biopsy, central line insertion
Structural abnormalities-Marfans, Ehlers Danlos
Lung pathology- Asthma, COPD
19
Q
List the signs and sx of a pneumothorax?
A
Hyper-resonance on percussion
Diminished breath sounds on affected sign
Reduced expansion
Sx- pleuritic chest pain, SOB
20
Q
List the signs and sx of a tension pneumothorax?
A
Respiratory distress
Tachycardia, hypotension
Distended neck veins
Trachea deviation away from affected side
Increased percussion
21
Q
What is the Ix for pneumothorax, and how is this different to an Ix for tension pneumothorax?
A
1st line- CXR in stable patient
A CXR should not be initiated in a tension pneumothorax as this will delay management
22
Q
What is the mx for a suspected tension pneumothorax?
A
Immediate decompression
Insert large bore cannula into the 2nd intercostal space in midclavicular line or 4th/5th intercostal space in the midaxillary line
+high O2, chest drain + hospital admission
23
Q
What is the mx of a pneumothorax?
A
If no SOB or <2cm rim of air-No tx required. Follow up in 2–4 weeks
if SOB or >2cm air rim-aspiration and reassessment
24
Q
What is the most common organism that causes CAP?
A
Streptococcus pneumonia
25
List 3 causes of typical and atypical pneumonia?
Typical- H.influenza, Staph aureus, Group A streptococci, Moraxella catarrhalis
Atypical-Mycoplasma pneumonia, Legionella, Chlamydophilla
26
List the sx of pneumonia?
Fever
Cough with increasing sputum
Rigors
Dyspnoea
Pleuritic Chest pain
27
List the signs of pneumonia?
Dullness to percussion
Diminished expansion
Hypotension
Tachycardia
28
What is the scoring system used to determine the severity of pneumonia?
CURB-65
29
What is the 1st line and GS Ix for pneumonia?
1st line- FBC, U&Es, CRP, Pulse oximetry
GS- CXR
30
What are the parameters of CURB-65?
Confusion
Urea >7mmol/l
Resp rate >30
Blood pressure <90mmHg systolic or <60mmHg diastolic
Age >65
31
What does a CURB score of 0-1 indicate?
Home-based care, give oral amoxicillin for 5 days (macrolide e.g. clarithromycin, doxycycline or tetracycline if penicillin allergic).
32
What does a CURB score of 2 indicate?
Hospital-based care, 7-10 day course of dual antibiotic therapy with amoxicillin (IV or oral) and a macrolide
33
What does a CURB score of >3 indicate?
Hospital/ITU-based care, 7-10 day course of dual antibiotic therapy with IV co-amoxiclav /ceftriaxone/tazocin and a macrolide.
34
In which patient population is the likelihood of klebsiella pneumonia prevalent?
Typically, following aspiration or UTIs
More common in alcoholics and diabetics
35
What is a key feature of klebsiella pneumonia?
Red currant jelly sputum
and
Often affects upper lungs
36
What organism is the common cause of pneumonia in elderly patients with COPD?
Haemophilus influenzae
37
What organism is responsible for a pneumonia with a gradual onset of a cough?
Mycoplasma
38
What is the causative organism of whooping cough?
Bordetella pertussis
39
What is Bronchiolitis?
Inflammation and infection in the bronchioles
40
What is the most common causative organism for bronchiolitis?
RSV
41
What is Bronchiectasis?
Permanent dilation of bronchi and bronchioles due to chronic inflammation leading to destruction of elastic and muscular components
42
List 5 causes of bronchiectasis?
Congenital-Primary ciliary dyskinesia, Kartageners syndrome
Post infection
COPD
RA, UC
CT disease
Idiopathic
43
List 5 signs and Sx of Bronchiectasis?
Cough with green/yellow sputum
Dyspnoea
Haemoptysis
Chest pain
Fatigue
Weight loss
signs:
Coarse crackles on auscultation
Wheeze
Rhonchi (snoring sounds caused by secretions in the larger airways)
Finger clubbing
44
What is the GS of bronchiectasis?
HRCT Chest-thickened dilated airways
45
What is the mx of Bronchiectasis?
Cx:
Postural drainage BD
Rx-
Treat with antibiotics tailored to sputum cultures
46
List the sx of whooping cough?
Cough
Inspiratory whoop
Rhinorrhoea
Post tussive vomiting
Absent/low grade fever
Decreased appetite
47
What is the gold standard Ix for whooping cough?
Culture of nasopharyngeal aspirate/swab from posterior pharynx
48
What is hypersensitivity pneumonitis?
A non IgE mediated inflammation of alveoli and distal bronchioles caused by immune response to inhaled pathogens (Type 3 HR)
49
What is the mx of hypersensitivity pneumonitis?
1st line- avoid antigen
acute sx- corticosteroid taper
Chronic sx- long term low dose corticosteroids
50
List the 3 causes of drug induced and secondary causes of pulmonary fibrosis?
drugs: Nitrofurantoin, Methotrexate and Amiodarone
Secondary- RA, Alpha-1 alphatrypsin deficeincy, SLE, Systemic sclerosis
51
How does IPF affect spirometry in terms of FEV1 and FVC?
Decreases total lung capacity
Decreases FVC
Decreases FEV1
52
List the causes of fibrosis that predominately affects the upper zone?
TB
Hypersensitivity pneumonitis
Fibrosis
Silicosis
Sarcoidosis
Ankylosing spondylitis
53
List the causes of fibrosis that predominately affects the lower zone?
IPF
Connective tissue disorders e.g. SLE
Drug induced fibrosis
Asbestosis
54
List the sx of IPF?
Dry Cough
SOB
Bibasal fine end inspiratory crepitations
Digital clubbing
WL
Fatigue
Resp failure
55
What are the medications that can slow down the progression of IPF disease?
Pirfenidone
Nintedanib
56
What is sarcoidosis?
A multisystem chronic granulomatous disorder of unknown cause commonly affecting lungs, skin and eyes?
57
How do the granulomas of TB and sarcoidosis differ?
Sarcoidosis granulomas are non-caseating- no tissue necrosis in the centre
58
List the sx and signs of sarcoidosis?
Bilateral hilar lymphadenopathy
Erthema nodosum
Lupus pernio
Facial palsy
Dyspnoea
Non productive cough
swinging fever
Malaise
WL
Hypercalcaemia
Polyarthralgia
59
What is the GS Ix for sarcoidosis?
Tissue Biopsy/Histology
60
What is the mx of sarcoidosis?
no or mild sx- Bed rest + NSAIDs
1st line-oral steroids + bisphosphonates
2nd line- methotrexate or azathioprine
61
List the signs of respiratory distress?
Use of accessory muscles
Nasal flaring
Head bobbing
Tracheal TUGGING
Cyanosis
Intercostal/subcostal recession
62
What is the prophylaxis drug for bronchiolitis?
Pavlizumab
63
What is a pleural effusion?
Fluid collection between the parietal and visceral pleural of the lungs
64
How is an exudative and transudative pleural effusion categorised?
Exudative- high protein content >30g/L
Transudative- lower protein content <30g/L
65
List the pathophysiology and causes of exudative pleural effusion?
Related to inflammation- inflammation leads to increased microvascular permeability, thus drainage may be impaired
Lung cancer
Infection
RA/SLE
Pancreatitis
PE
Trauma
66
List the pathophysiology and causes of transudative pleural effusion?
Where changes in oncotic and hydrostatic pressure causes fluid to leak from vasculature
Heart failure
Hypoalbuminaemia (Liver disease, Nephrotic syndrome, malabsorption)
Hypothyroidism
Meig's syndrome
67
List the sx of a pleural effusion?
Dyspnoea
Pleuritic chest pain
Cough
68
List the signs of a pleural effusion?
Dullness to percussion
Decrease/absent tactile fremitus
Quieter breath sounds
Reduced chest expansion
Loss of vocal resonance over effusion
Large PE may cause tracheal deviation away from effusion
69
What are the CXR signs of a pleural effusion?
Blunting of costophrenic angle
fluid in lung fissures
larger effusion will have meniscus
Tracheal or mediastinal deviation
70
What is the 1st line and GS ix for pleural effusion?
1st- CXR, Diagnostic pleural aspiration of fluid
GS- Pleural uss
71
What is pulmonary HTN?
An increase in BP in the pulmonary circulation (mean pulmonary arterial pressure >25mmHg)
72
Which lung cancer most common in non-smokers
Adenocarcinoma
73
What may you see on a CXR in someone with bronchiectasis
Kerley b lines
74
What lung cancer is strongly associated with smoking
Squamous cell carcinoma
75
Cancer can spread to the lungs from what areas
Kidney
Prostate
Breast
Bowel
Bladder
76
Lung cancer can metastasise to which sites
Brain
Adrenals
Bone
Liver
77
What paraneoplastic syndromes is associated with non small cell lung cancer
Hyperparthyroidism
78
What would be seen on histology of an asthmatic
Charcot Leyden crystals and crushmann spirals
79
What is meigs syndrome
A triad of
- benign ovarian tumour
- Ascites
- pleural effusion
80
What are the signs of TB on CXR
Ghon focus
Dense homogenous opacity
Hilar lymphadenopathy
Pleural effusions
Tree in a bud sign- nodules w/ poorly defined margins
81
List 5 causes of finger clubbing
Bronchiectasis
Cystic fibrosis
VSD
IPF
Lung cancer
82
List 5 differentials for dry cough
Asthma
Gord
Pulmonary fibrosis
Ramipril induced
Sleep apnoea
83
List the differentials for sputum/wet cough
COPD
Bronchiectasis
Acute bronchitis
HF
Cystic fibrosis
84
What paraneoplastic syndromes is small cell lung cancer associated with?
SIADH
CUSHINGS/ADDISON
LEMS
CEREBELLAR DEGENERATION
85
List the sx and signs of pulmonary HTN?
SOB
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema
86
What is the GS Ix for pulmonary HTN?
Right heart catheterisation (>25mHg)
87
What is the medical treatment for pulmonary HTN?
Trial CCB, amlodipine, nifedipine
IV prostanoids
Endothelin receptor antagonists
Phosphodiesterase-5-inhibitors
88
What is mesothelioma?
A cancer of the mesothelial layer of the pleural cavity. Strongly associated with asbestosis
89
What is the GS Ix of mesothelioma?
Video assisted thoroscopic surgery (VATS)
90
What marker can distinguish mesothelioma from other types of tumours?
Mesotheoliomas express alot of Calretinin
91
What is the most common aid defining illness?
Pneumocystis jivorecii
92
What marker will be elevated in a PCP infection?
Serum LDH
93
What is the 1st line medication for PCP?
Trimethoprim/sulfamethoxazole
94
What is type 1 respiratory failure, and how is it characterised?
Hypoxaemic resp failure
(inadequate oxygenation)
Low O2 sats
Normal/low CO2 sats.
95
What is type 2 respiratory failure, and how is it characterised?
Hypercapnic resp failure (inadequate ventilation)
Low O2 sats
High CO2
96
What is the mx of type 1 resp failure?
CPAP
96
What is the mx of type 2 resp failure?
BiPAP
97
What is the mx epiglottitis?
Secure airway
+IV antibiotics + supplemental oxygen +corticosteroid
97
What is the GS of epiglottitis?
Laryngoscopy
97
List the sx or signs of epiglottitis ?
Sore throat
dysphagia
fever
stridor
drooling of saliva
tripod position
muffled voice
98
What is the common causative organism of epiglottitis?
Haemophilus influenzae
99
List the sx and signs of empyema?
Pyrexia
rigors
dullness to percussion
signs of sepsis
Productive cough
Dyspnoea
Pleuritic chest pain
100
Describe the pathophysiology of COPD?
COPD is a progressive obstructive chronic lung disease characterised by airflow limitation.
Inflammation>mucus hypersecretion>Airway Narrowing>Loss of elastic recoil>V/Q mismatch>hypoxia and hypercapnia
101
List 3 causes of COPD?
Smoking
Alpha-1-Antitrypsin deficiency
Coal
Grain
Cement
102
List the features in COPD?
Productive cough
SOB
Wheeze
severe cases- RHS-HF
103
What features of COPD may be seen on CXR?
Hyperinflation
Bullae
flat hemidiaphragm
104
How can breathlessness in COPD be objectively classified?
MRC Dyspnoea scale
105
What spirometry picture will be present in COPD?
FEV1- Low (<80%)
FEV1/FVC- low (<0.7)
Increase/Normal TLC
Decrease DCLO
106
What 2 disease make up COPD?
Chronic Bronchitis
Emphysema
107
What is chronic bronchitis?
Chronic inflammation of bronchi > hypersecretion of mucus and thickening of bronchial walls. Causes chronic productive cough and airway obstruction
108
What is emphysema?
Destruction of alveolar walls and loss of elastic recoil in lungs leading to enlarged air spaces and thus reducing SA for gas exchange thus causing hyperinflation and air trapping
109
What are the features of kartanger's syndrome?
Dextrocardia
Bronchiectasis
Recurrent sinusitis
Subfertility
110
What is kartanger's syndrome?
AKA Primary ciliary dyskinesia-autosomal recessive disorder characterised by immobile cilia
111
Where should a chest drain be placed?
In the triangle of safety-involves:
1. Base of axilla
2. Lateral edge of pectoralis major
3. 5th intercostal space
4. Anterior border of latissimus dorsi
112
How should a pneumothorax be managed conservatively?
Discharge patient with outpatient follow-up every 2-4 days
113
When should LTOT be considered in COPD patients?
if Po2 of 7.2-8 and one of the following:
Secondary polycythaemia
Pulmonary hypertension
Peripheral oedema
114
Which malignancy most commonly causes cannonball mets?
Renal cell carcinoma
other that should be considered is choriocarcinoma and prostate cancer
115
What are the features of allergic bronchopulmonary aspergillosis?
Proximal bronchiectasis
Eosinophilia
Wheeze, Dyspnoea, cough
116
What is the 1st line mx for allergic bronchopulmonary aspergillosis?
Oral prednisolone
117
What is the 2nd line mx for allergic bronchopulmonary aspergillosis?
Oral Itracanazole
118
List the CI of inserting a chest drain?
INR >1.3
Platelet count <75
Pulmonary Bullae
Pleural adhesions
119
What Ix should be considered in a patient with suspected asthma who have a negative bronchodilator reversibility test?
Fractional exhaled Nitric oxide testing (FeNO)
+ve test= >40 parts per billion
120
List 3 causes of respiratory acidosis?
COPD
Decompensation in asthma/pulmonary oedema
Neuromuscular disease
Obesity
Benzodiazepines
Opiate overdose
121
What is the diagnostic test for OSA?
Sleep polysomnography
122
What is the mx for OSA?
Weight loss
CPAP
DVLA should be informed
123
What antibody is most associated with churg Strauss syndrome?
pANCA
124
What antibody is most associated with wagners granulomatosis?
cANCA
125
What prophylactic therapy may be used in patients with COPD who continue to have exacerbations?
Azithromycin (daily or 3x p/w)
126
What is the SE of the prophylactic therapy that is used in patients with COPD who continue to have exacerbations?
QT prolongation (SE of azithromycin)
127
What is the GS Ix for mesothelioma?
Throracoscopic biopsy
128
What is the mx of chronic asthma?
1. SABA
2. Add LD ICS - if symptoms 3x/week or night time symptoms
3. Add LTRA (montelukast)
4. Add LABA (salmeterol, formoterol)
5. LD MART
6. MD MART
129
What is the prophylactic ABX of choice in Bronchiectasis exacerbations?
Considered in patients with 3 or more exacerbations
Azithromycin / erythromycin
130
What is the pH level of a suspected empyema?
pH <7.2
131
What is the1st line mx of choice for Pneumocystic jevorici pneumonia?
Co-trimoxazole
132
What is the GS Ix for a pneumothorax?
C thorax
133
What would the blood work show in a patient with legionella pneumonia?
Low Na+
Deranged LFTs
134
What is the mx of legionella pneumonia?
Macrolide or Fluoroquinolone
135
What would be the findings in the following Ix of patient with suspected bronchiectasis?
a- HRCT
b- Spirometry
c- CXR
a- Signet ring sign
b- FEV1 <0.7
c- Tramlines
136
What are the paraneoplastic features in adenocarcinomas of the lung?
Gynaecomastia
HPOA
137
What are the paraneoplastic features in asquamous cell of the lung?
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH
138
What are the features of an aspergillioma?
Often past history of tuberculosis.
Haemoptysis may be severe
Chest x-ray shows rounded opacity
139
What is the mx of a patient with CAP and a curb score of 0?
Oral amoxicillin
140
What are the high risk features in pneumothorax that would warrant the need for a chest drain?
Haemodynamic compromise (suggesting a tension pneumothorax)
Significant hypoxia
Bilateral pneumothorax
Underlying lung disease
≥ 50 years of age with significant smoking history
Haemothorax
141
What is the most common infective organism in bronchiectasis?
Haemophilus influenzae
142
What is the most appropriate diagnostic ix for occupational asthma?
serial peak flow measurements at work and at home
143
What medications can worsen sx of asthma?
Aspirin
BB
144
What is the first line abx for HAP?
Co-amoxiclav
145
What findings on blood test would support a diagnosis of lung cancer?
Raised platelets
146
Patients with suspected bronchiectasis should be tested for what allergy?
Allergic bronchopulmonary aspergillosis
147
What can be heard upon auscultation of bronchiectasis?
Coarse inspiratory crepitations & wheeze
148
What initial investigations should be done for patients with suspected bronchiectasis?
Sputum culture
CXR
Spirometry
FBC
149
What is the most common viral organism that causes COPD exacerbations?
Rhinovirus
150
Why is a FBC done in COPD patients?
To rule out secondary polycythaemia- EPO is increased due to chronically low O2 levels resulting in increased RBC production
151
How should an acute exacerbation of COPD be managed if it doesn't respond to bronchodilators?
Acute exacerbations of COPD that dont respond to nebulised bronchodilators may be treated with IV theophylline
152
What is the criteria fro admitting an exacerbation of COPD in hospital?
Severe breathlessness
Acute confusion or impaired consciousness
Cyanosis
Oxygen saturation less than 90% on pulse oximetry
Social reasons
Significant comorbiditiy (e.g. insulin dependent diabetic, cardiac disease)
153
How is COPD exacerbations managed in secondary care?
Oxygen (Aim for oxygen sats between 88-92% initially or 94-98% if pCO2 is normal)
Nebulised bronchodilators (SABA and SAMA)
Oral 5 day Predinisolone/IV hydrocortisone
154
What additional test should be considered in a patient <40 with COPD?
Alpha antitrypsin deficiency
155
What should be offered to patients with COPD who continue to have exacerbations while on standard treatments?
Prophylactic Abx- Azithromycin
can cause QT prolongation, so an ECG must be performed before administering
156
If prescribed theophylline, what should be done to dose if co-prescribed macrolides/fluoroquinolones?
Dose of theophylline should be reduced- Interaction with macrolides can cause cardiac complications including (torsades de pointes - type of VT)
157
What investigations should be done for suspected COPD?
Post-bronchodilator spirometry would show an irreversible FEV1/FVC ratio <70%
CXR findings: hyperinflation, bullae, diaphragm flattening
FBC: secondary polycythaemia caused by chronic hypoxia
158
What is the management of Cor Pulmonale in COPD patients?
Loop diuretic::For oedema
159
What is the out of hospital management of COPD exacerbations?
Increase bronchodilators,
prednisolone (5 days),
consider ABX (if there are signs of pneumonia)
1st line Abx- Doxycyline
160
Which lung cancers require bronchoscopy and which need percutaneous needle biopsy (General rule of thumb)?
Central = bronchoscopy; peripheral = percutaneous
Central = SCLC & squamous cell cancer
Peripheral = adenocarcionma & large cell cancer
161
What is the mx of NSCLC?
mainly managed with :
radiotherapy.
162
What is the first-line investigation for suspected asbestosis?
CXR
- Pleural plaques
- Pleural thickening
- Potential lung cancer
163
What is the management for asbestosis?
Conservative, monitor for lung cancer. STOP SMOKING!!!
164
What Ix should be done in patients post- pneumonia and why?
All patient's pneumonia should have a repeat CXR at 6 weeks after symptoms have resolved To confirm that consolidation has resolved and there are no underlying abnormalities (e.g. malignancy)
165
What are the most common causative organisms of HAP?
Pseudomonas aeuriginosa
166
What organism causes pneumonia associated with cold sores, high fever and rapid onset of symptoms?
Streptococcus pneumoniae
167
Which pneumonia-causing organism infects patients after an influenza infection
Staphylococcus aureus
168
Which pneumonia-causing organism is seen in alcoholics?
Klebsiella pneumoniae
169
Which pneumonia-causing organism is seen in COPD?
Haemophilus influenzae
