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Finals (HV) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the organism responsible for TB?

A

Mycobacterium tuberculosis (rod shaped acid fast bacilli)

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2
Q

What stain is used to detect TB?

A

Zeihl Neelsen (bright red against blue background)

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3
Q

List the sx of TB?

A

Night sweats
Cough, fever, malaise
WL
Haemoptysis
Pleuritic chest pain
Lymphadenopathy
Erythema nodosum

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4
Q

What is the GS Ix for TB?

A

Sputum culture

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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)

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6
Q

What is the SE of Isoniazid?

A

Neuropathy

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7
Q

What medication can be prescribed to prevent against the adverse effects of isoniazid?

A

Pyridoxine

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8
Q

What is the SE of Rifampicin?

A

Red/orange coloured urine

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9
Q

What is the SE of Ethambutol?

A

Optic neuritis (colour vision first to be affected)

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10
Q

What is the SE of Pyrazinamide?

A

Hepatitis, Arthralgia, Gout

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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.

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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.

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13
Q

What are the sx of CF?

A

FTT
Steatorrhoea
Recurrent infections
Wet cough
Failure to pass meconium
Digital clubbing

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14
Q

What is the mx of CF?

A

Genetic counselling
Chest physiotherapy
Exercise
High calorie diet
CREON tablets
Bronchodilators

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15
Q

What is the GS ix for CF?

A

Sweat test

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16
Q

What is the 1st line Ix for CF?

A

Newborn screening and genetic testing

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17
Q

What is a pneumothorax?

A

When air gains access and accumulates in the pleural space

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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

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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

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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

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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

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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

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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

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24
Q

What is the most common organism that causes CAP?

A

Streptococcus pneumonia

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25
Q

List 3 causes of typical and atypical pneumonia?

A

Typical- H.influenza, Staph aureus, Group A streptococci, Moraxella catarrhalis

Atypical-Mycoplasma pneumonia, Legionella, Chlamydophilla

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26
Q

List the sx of pneumonia?

A

Fever
Cough with increasing sputum
Rigors
Dyspnoea
Pleuritic Chest pain

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27
Q

List the signs of pneumonia?

A

Dullness to percussion
Diminished expansion
Hypotension
Tachycardia

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28
Q

What is the scoring system used to determine the severity of pneumonia?

A

CURB-65

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29
Q

What is the 1st line and GS Ix for pneumonia?

A

1st line- FBC, U&Es, CRP, Pulse oximetry

GS- CXR

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30
Q

What are the parameters of CURB-65?

A

Confusion
Urea >7mmol/l
Resp rate >30
Blood pressure <90mmHg systolic or <60mmHg diastolic
Age >65

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31
Q

What does a CURB score of 0-1 indicate?

A

Home-based care, give oral amoxicillin for 5 days (macrolide e.g. clarithromycin, doxycycline or tetracycline if penicillin allergic).

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32
Q

What does a CURB score of 2 indicate?

A

Hospital-based care, 7-10 day course of dual antibiotic therapy with amoxicillin (IV or oral) and a macrolide

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33
Q

What does a CURB score of >3 indicate?

A

Hospital/ITU-based care, 7-10 day course of dual antibiotic therapy with IV co-amoxiclav /ceftriaxone/tazocin and a macrolide.

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34
Q

In which patient population is the likelihood of klebsiella pneumonia?

A

Typically, following aspiration or UTIs

More common in alcoholics and diabetics

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35
Q

What is a key feature of klebsiella pneumonia?

A

Red currant jelly sputum
and
Often affects upper lungs

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36
Q

What organism is the common cause of pneumonia in elderly patients with COPD?

A

Haemophilus influenzae

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37
Q

What organism is responsible for a pneumonia with a gradual onset of a cough?

A

Mycoplasma

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38
Q

What is the causative organism of whooping cough?

A

Bordetella pertussis

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39
Q

What is Bronchiolitis?

A

Inflammation and infection in the bronchioles

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40
Q

What is the most common causative organism for bronchiolitis?

A

RSV

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41
Q

What is Bronchiectasis?

A

Permanent dilation of bronchi and bronchioles due to chronic inflammation leading to destruction of elastic and muscular components

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42
Q

List 5 causes of bronchiectasis?

A

Congenital-Primary ciliary dyskinesia, Kartageners syndrome
Post infection
COPD
RA, UC
CT disease
Idiopathic

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43
Q

List 5 signs and Sx of Bronchiectasis?

A

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

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44
Q

What is the GS of bronchiectasis?

A

HRCT Chest-thickened dilated airways

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45
Q

What is the mx of Bronchiectasis?

A

Cx:
Postural drainage BD

Rx-
Treat with antibiotics tailored to sputum cultures

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46
Q

List the sx of whooping cough?

A

Cough
Inspiratory whoop
Rhinorrhoea
Post tussive vomiting
Absent/low grade fever
Decreased appetite

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47
Q

What is the gold standard Ix for whooping cough?

A

Culture of nasopharyngeal aspirate/swab from posterior pharynx

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48
Q

What is hypersensitivity pneumonitis?

A

A non IgE mediated inflammation of alveoli and distal bronchioles caused by immune response to inhaled pathogens (Type 3 HR)

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49
Q

What is the mx of hypersensitivity pneumonitis?

A

1st line- avoid antigen
acute sx- corticosteroid taper
Chronic sx- long term low dose corticosteroids

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50
Q

List the 3 causes of drug induced and secondary causes of pulmonary fibrosis?

A

drugs: Nitrofurantoin, Methotrexate and Amiodarone

Secondary- RA, Alpha-1 alphatrypsin deficeincy, SLE, Systemic sclerosis

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51
Q

How does IPF affect spirometry in terms of FEV1 and FVC?

A

Decreases total lung capacity
Decreases FVC
Decreases FEV1

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52
Q

List the causes of fibrosis that predominately affects the upper zone?

A

TB
Hypersensitivity pneumonitis
Fibrosis
Silicosis
Sarcoidosis
Ankylosing spondylitis

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53
Q

List the causes of fibrosis that predominately affects the lower zone?

A

IPF
Connective tissue disorders e.g. SLE
Drug induced fibrosis
Asbestosis

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54
Q

List the sx of IPF?

A

Cough
SOB
End expiratory Crackles
Digital clubbing
WL
Fatigue
Resp failure

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55
Q

What are the medications that can slow down the progression of IPF disease?

A

Pirfenidone
Nintedanib

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56
Q

What is sarcoidosis?

A

A multisystem chronic granulomatous disorder of unknown cause commonly affecting lungs, skin and eyes?

57
Q

How do the granulomas of TB and sarcoidosis differ?

A

Sarcoidosis granulomas are non-caseating- no tissue necrosis in the centre

58
Q

List the sx and signs of sarcoidosis?

A

Bilateral hilar lymphadenopathy
Erthema nodosum
Lupus pernio
Facial palsy
Dyspnoea
Non productive cough
swinging fever
Malaise
WL
Hypercalcaemia
Polyarthralgia

59
Q

What is the GS Ix for sarcoidosis?

A

Tissue Biopsy/Histology

60
Q

What is the mx of sarcoidosis?

A

no or mild sx- Bed rest + NSAIDs

1st line-oral steroids + bisphosphonates
2nd line- methotrexate or azathioprine

61
Q

List the signs of respiratory distress?

A

Use of accessory muscles
Nasal flaring
Head bobbing
Tracheal TUGGING
Cyanosis
Intercostal/subcostal recession

62
Q

What is the prophylaxis drug for bronchiolitis?

A

Pavlizumab

63
Q

What is a pleural effusion?

A

Fluid collection between the parietal and visceral pleural of the lungs

64
Q

How is an exudative and transudative pleural effusion categorised?

A

Exudative- high protein content >30g/L

Transudative- lower protein content <30g/L

65
Q

List the pathophysiology and causes of exudative pleural effusion?

A

Related to inflammation- inflammation leads to increased microvascular permeability, thus drainage may be impaired

Lung cancer
Infection
RA/SLE
Pancreatitis
PE
Trauma

66
Q

List the pathophysiology and causes of transudative pleural effusion?

A

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
Q

List the sx of a pleural effusion?

A

Dyspnoea
Pleuritic chest pain
Cough

68
Q

List the signs of a pleural effusion?

A

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
Q

What are the CXR signs of a pleural effusion?

A

Blunting of costophrenic angle
fluid in lung fissures
larger effusion will have meniscus
Tracheal or mediastinal deviation

70
Q

What is the 1st line and GS ix for pleural effusion?

A

1st- CXR, Diagnostic pleural aspiration of fluid

GS- Pleural uss

71
Q

What is pulmonary HTN?

A

An increase in BP in the pulmonary circulation (mean pulmonary arterial pressure >25mmHg)

72
Q

Which lung cancer most common in non-smokers

A

Adenocarcinoma

73
Q

What may you see on a CXR in someone with bronchiectasis

A

Kerley b lines

74
Q

What lung cancer is strongly associated with smoking

A

Squamous cell carcinoma

75
Q

Cancer can spread to the lungs from what areas

A

Kidney
Prostate
Breast
Bowel
Bladder

76
Q

Lung cancer can metastasise to which sites

A

Brain
Adrenals
Bone
Liver

77
Q

What paraneoplastic syndromes is associated with non small cell lung cancer

A

Hyperparthyroidism

78
Q

What would be seen on histology of an asthmatic

A

Charcot Leyden crystals and crushmann spirals

79
Q

What is meigs syndrome

A

A triad of

  • benign ovarian tumour
  • Ascites
  • pleural effusion
80
Q

What are the signs of TB on CXR

A

Ghon focus
Dense homogenous opacity
Hilar lymphadenopathy
Pleural effusions
Tree in a bud sign- nodules w/ poorly defined margins

81
Q

List 5 causes of finger clubbing

A

Bronchiectasis
Cystic fibrosis
VSD
IPF
Lung cancer

82
Q

List 5 differentials for dry cough

A

Asthma
Gord
Pulmonary fibrosis
Ramipril induced
Sleep apnoea

83
Q

List the differentials for sputum/wet cough

A

COPD
Bronchiectasis
Acute bronchitis
HF
Cystic fibrosis

84
Q

What paraneoplastic syndromes is small cell lung cancer associated with?

A

SIADH
CUSHINGS/ADDISON
LEMS
CEREBELLAR DEGENERATION

85
Q

List the sx and signs of pulmonary HTN?

A

SOB
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema

86
Q

What is the GS Ix for pulmonary HTN?

A

Right heart catheterisation (>25mHg)

87
Q

What is the medical treatment for pulmonary HTN?

A

Trial CCB, amlodipine, nifedipine
IV prostanoids
Endothelin receptor antagonists
Phosphodiesterase-5-inhibitors

88
Q

What is mesothelioma?

A

A cancer of the mesothelial layer of the pleural cavity. Strongly associated with asbestosis

89
Q

What is the GS Ix of mesothelioma?

A

Video assisted thoroscopic surgery (VATS)

90
Q

What marker can distinguish mesothelioma from other types of tumours?

A

Mesotheoliomas express alot of Calretinin

91
Q

What is the most common aid defining illness?

A

Pneumocystis jivorecii

92
Q

What marker will be elevated in a PCP infection?

A

Serum LDH

93
Q

What is the 1st line medication for PCP?

A

Trimethoprim/sulfamethoxazole

94
Q

What is type 1 respiratory failure, and how is it characterised?

A

Hypoxaemic resp failure
(inadequate oxygenation)

Low O2 sats
Normal/low CO2 sats.

95
Q

What is type 2 respiratory failure, and how is it characterised?

A

Hypercapnic resp failure (inadequate ventilation)

Low O2 sats
High CO2

96
Q

What is the mx of type 1 resp failure?

A

CPAP

96
Q

What is the mx of type 2 resp failure?

A

BiPAP

97
Q

What is the mx epiglottitis?

A

Secure airway
+IV antibiotics + supplemental oxygen +corticosteroid

97
Q

What is the GS of epiglottitis?

A

Laryngoscopy

97
Q

List the sx or signs of epiglottitis ?

A

Sore throat
dysphagia
fever
stridor
drooling of saliva
tripod position
muffled voice

98
Q

What is the common causative organism of epiglottitis?

A

Haemophilus influenzae

99
Q

List the sx and signs of empyema?

A

Pyrexia
rigors
dullness to percussion
signs of sepsis
Productive cough
Dyspnoea
Pleuritic chest pain

100
Q

Describe the pathophysiology of COPD?

A

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
Q

List 3 causes of COPD?

A

Smoking
Alpha-1-Antitrypsin deficiency
Coal
Grain
Cement

102
Q

List the features in COPD?

A

Productive cough
SOB
Wheeze
severe cases- RHS-HF

103
Q

What features of COPD may be seen on CXR?

A

Hyperinflation
Bullae
flat hemidiaphragm

104
Q

How can breathlessness in COPD be objectively classified?

A

MRC Dyspnoea scale

105
Q

What spirometry picture will be present in COPD?

A

FEV1- Low (<80%)
FEV1/FVC- low (<0.7)
Increase/Normal TLC
Decrease DCLO

106
Q

What 2 disease make up COPD?

A

Chronic Bronchitis
Emphysema

107
Q

What is chronic bronchitis?

A

Chronic inflammation of bronchi > hypersecretion of mucus and thickening of bronchial walls. Causes chronic productive cough and airway obstruction

108
Q

What is emphysema?

A

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
Q

What are the features of kartanger’s syndrome?

A

Dextrocardia
Bronchiectasis
Recurrent sinusitis
Subfertility

110
Q

What is kartanger’s syndrome?

A

AKA Primary ciliary dyskinesia-autosomal recessive disorder characterised by immobile cilia

111
Q

Where should a chest drain be placed?

A

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
Q

How should a pneumothorax be managed conservatively?

A

Discharge patient with outpatient follow-up every 2-4 days

113
Q

When should LTOT be considered in COPD patients?

A

if Po2 of 7.2-8 and one of the following:
Secondary polycythaemia
Pulmonary hypertension
Peripheral oedema

114
Q

Which malignancy most commonly causes cannonball mets?

A

Renal cell carcinoma

other that should be considered is choriocarcinoma and prostate cancer

115
Q

What are the features of allergic bronchopulmonary aspergillosis?

A

Proximal bronchiectasis
Eosinophilia
Wheeze, Dyspnoea, cough

116
Q

What is the 1st line mx for allergic bronchopulmonary aspergillosis?

A

Oral prednisolone

117
Q

What is the 2nd line mx for allergic bronchopulmonary aspergillosis?

A

Oral Itracanazole

118
Q

List the CI of inserting a chest drain?

A

INR >1.3
Platelet count <75
Pulmonary Bullae
Pleural adhesions

119
Q

What Ix should be considered in a patient with suspected asthma who have a negative bronchodilator reversibility test?

A

Fractional exhaled Nitric oxide testing (FeNO)

+ve test= >40 parts per billion

120
Q

List 3 causes of respiratory acidosis?

A

COPD
Decompensation in asthma/pulmonary oedema
Neuromuscular disease
Obesity
Benzodiazepines
Opiate overdose

121
Q

What is the diagnostic test for OSA?

A

Sleep polysomnography

122
Q

What is the mx for OSA?

A

Weight loss
CPAP
DVLA should be informed

123
Q

What antibody is most associated with churg Strauss syndrome?

A

pANCA

124
Q

What antibody is most associated with wagners granulomatosis?

A

cANCA

125
Q

What prophylactic therapy may be used in patients with COPD who continue to have exacerbations?

A

Azithromycin (daily or 3x p/w)

126
Q

What is the SE of the prophylactic therapy that is used in patients with COPD who continue to have exacerbations?

A

QT prolongation (SE of azithromycin)

127
Q

What is the GS Ix for mesothelioma?

A

Throracoscopic biopsy

128
Q

What is the mx of chronic asthma?

A
  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
Q

What is the prophylactic ABX of choice in Bronchiectasis exacerbations?

A

Considered in patients with 3 or more exacerbations
Azithromycin / erythromycin

130
Q

What is the pH level of a suspected empyema?

A

pH <7.2

131
Q

What is the1st line mx of choice for Pneumocystic jevorici pneumonia?

A

Co-trimoxazole

132
Q

What is the GS Ix for a pneumothorax?

A

C thorax

133
Q

What would the blood work show in a patient with legionella pneumonia?

A

Low Na+
Deranged LFTs

134
Q

What is the mx of legionella pneumonia?

A

Macrolide or Fluoroquinolone

135
Q

What would be the findings in the following Ix of patient with suspected bronchiectasis?

a- HRCT
b- Spirometry
c- CXR

A

a- Signet ring sign
b- FEV1 <0.7
c- Tramlines

Finals (HV) (15 decks)

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