Respiratory Flashcards

1
Q

What is the organism responsible for TB?

A

Mycobacterium tuberculosis (rod shaped acid fast bacilli)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What stain is used to detect TB?

A

Zeihl Neelsen (bright red against blue background)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the sx of TB?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the GS Ix for TB?

A

Sputum culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the SE of Isoniazid?

A

Neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

Pyridoxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the SE of Rifampicin?

A

Red/orange coloured urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the SE of Ethambutol?

A

Optic neuritis (colour vision first to be affected)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the SE of Pyrazinamide?

A

Hepatitis, Arthralgia, Gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the sx of CF?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the mx of CF?

A

Genetic counselling
Chest physiotherapy
Exercise
High calorie diet
CREON tablets
Bronchodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the GS ix for CF?

A

Sweat test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the 1st line Ix for CF?

A

Newborn screening and genetic testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a pneumothorax?

A

When air gains access and accumulates in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the most common organism that causes CAP?

A

Streptococcus pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

List the sx of pneumonia?

A

Fever
Cough with increasing sputum
Rigors
Dyspnoea
Pleuritic Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

List the signs of pneumonia?

A

Dullness to percussion
Diminished expansion
Hypotension
Tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

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

A

CURB-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

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

A

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

GS- CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

In which patient population is the likelihood of klebsiella pneumonia prevalent?

A

Typically, following aspiration or UTIs

More common in alcoholics and diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is a key feature of klebsiella pneumonia?

A

Red currant jelly sputum
and
Often affects upper lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

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

A

Haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

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

A

Mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the causative organism of whooping cough?

A

Bordetella pertussis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is Bronchiolitis?

A

Inflammation and infection in the bronchioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the most common causative organism for bronchiolitis?

A

RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is Bronchiectasis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

List 5 causes of bronchiectasis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the GS of bronchiectasis?

A

HRCT Chest-thickened dilated airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the mx of Bronchiectasis?

A

Cx:
Postural drainage BD

Rx-
Treat with antibiotics tailored to sputum cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

List the sx of whooping cough?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the gold standard Ix for whooping cough?

A

Culture of nasopharyngeal aspirate/swab from posterior pharynx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

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

A

Decreases total lung capacity
Decreases FVC
Decreases FEV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

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

A

TB
Hypersensitivity pneumonitis
Fibrosis
Silicosis
Sarcoidosis
Ankylosing spondylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

List the sx of IPF?

A

Cough
SOB
End expiratory Crackles
Digital clubbing
WL
Fatigue
Resp failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

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

A

Pirfenidone
Nintedanib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is sarcoidosis?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How do the granulomas of TB and sarcoidosis differ?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the GS Ix for sarcoidosis?

A

Tissue Biopsy/Histology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

List the signs of respiratory distress?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the prophylaxis drug for bronchiolitis?

A

Pavlizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is a pleural effusion?

A

Fluid collection between the parietal and visceral pleural of the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How is an exudative and transudative pleural effusion categorised?

A

Exudative- high protein content >30g/L

Transudative- lower protein content <30g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

List the sx of a pleural effusion?

A

Dyspnoea
Pleuritic chest pain
Cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

136
Q

What are the paraneoplastic features in adenocarcinomas of the lung?

A

Gynaecomastia
HPOA

137
Q

What are the paraneoplastic features in asquamous cell of the lung?

A

parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH

138
Q

What are the features of an aspergillioma?

A

Often past history of tuberculosis.
Haemoptysis may be severe
Chest x-ray shows rounded opacity

139
Q

What is the mx of a patient with CAP and a curb score of 0?

A

Oral amoxicillin

140
Q

What are the high risk features in pneumothorax that would warrant the need for a chest drain?

A

Haemodynamic compromise (suggesting a tension pneumothorax)
Significant hypoxia
Bilateral pneumothorax
Underlying lung disease
≥ 50 years of age with significant smoking history
Haemothorax

141
Q

What is the most common infective organism in bronchiectasis?

A

Haemophilus influenzae

142
Q

What is the most appropriate diagnostic ix for occupational asthma?

A

serial peak flow measurements at work and at home

143
Q

What medications can worsen sx of asthma?

A

Aspirin
BB

144
Q

What is the first line abx for HAP?

A

Co-amoxiclav

145
Q

What findings on blood test would support a diagnosis of lung cancer?

A

Raised platelets

146
Q

Patients with suspected bronchiectasis should be tested for what allergy?

A

Allergic bronchopulmonary aspergillosis

147
Q

What can be heard upon auscultation of bronchiectasis?

A

Coarse inspiratory crepitations & wheeze

148
Q

What initial investigations should be done for patients with suspected bronchiectasis?

A

Sputum culture
CXR
Spirometry
FBC

149
Q

What is the most common viral organism that causes COPD exacerbations?

A

Rhinovirus

150
Q

Why is a FBC done in COPD patients?

A

To rule out secondary polycythaemia- EPO is increased due to chronically low O2 levels resulting in increased RBC production

151
Q

How should an acute exacerbation of COPD be managed if it doesn’t respond to bronchodilators?

A

Acute exacerbations of COPD that dont respond to nebulised bronchodilators may be treated with IV theophylline

152
Q

What is the criteria fro admitting an exacerbation of COPD in hospital?

A

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
Q

How is COPD exacerbations managed in secondary care?

A

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
Q

What additional test should be considered in a patient <40 with COPD?

A

Alpha antitrypsin deficiency

155
Q

What should be offered to patients with COPD who continue to have exacerbations while on standard treatments?

A

Prophylactic Abx- Azithromycin

can cause QT prolongation, so an ECG must be performed before administering

156
Q

If prescribed theophylline, what should be done to dose if co-prescribed macrolides/fluoroquinolones?

A

Dose of theophylline should be reduced- Interaction with macrolides can cause cardiac complications including (torsades de pointes - type of VT)

157
Q

What investigations should be done for suspected COPD?

A

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
Q

What is the management of Cor Pulmonale in COPD patients?

A

Loop diuretic::For oedema

159
Q

What is the out of hospital management of COPD exacerbations?

A

Increase bronchodilators,
prednisolone (5 days),
consider ABX (if there are signs of pneumonia)
1st line Abx- Doxycyline

160
Q

Which lung cancers require bronchoscopy and which need percutaneous needle biopsy (General rule of thumb)?

A

Central = bronchoscopy; peripheral = percutaneous

Central = SCLC & squamous cell cancer
Peripheral = adenocarcionma & large cell cancer

161
Q

What is the mx of NSCLC?

A

mainly managed with :
radiotherapy.

162
Q

What is the first-line investigation for suspected asbestosis?

A

CXR
- Pleural plaques
- Pleural thickening
- Potential lung cancer

163
Q

What is the management for asbestosis?

A

Conservative, monitor for lung cancer. STOP SMOKING!!!

164
Q

What Ix should be done in patients post- pneumonia and why?

A

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
Q

What are the most common causative organisms of HAP?

A

Pseudomonas aeuriginosa

166
Q

What organism causes pneumonia associated with cold sores, high fever and rapid onset of symptoms?

A

Streptococcus pneumoniae

167
Q

Which pneumonia-causing organism infects patients after an influenza infection

A

Staphylococcus aureus

168
Q

Which pneumonia-causing organism is seen in alcoholics?

A

Klebsiella pneumoniae

169
Q

Which pneumonia-causing organism is seen in COPD?

A

Haemophilus influenzae