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Respiratory Flashcards

1
Q

What are the two broad types of lung cancer?

A

Small cell (20%)
Non-small cell (80%)

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2
Q

Name 3 types of non-small cell lung cancers

A

Adenocarcinoma
squamous cell carcinoma
Large-cell carcinoma

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3
Q

What is mesothelioma

A

Lung malignancy affecting mesothelial cells of the pleura
associated with asbestos inhalation

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4
Q

What are some presenting features of lung cancer?

A

Shortness of breath
Cough
Haemoptysis
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy – often supraclavicular nodes are the first to be found on examination

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5
Q

What are some extrapulmonary manifestations of lung cancer?

A

recurrent laryngeal nerve palsy
Phrenic nerve palsy
Superior vena cava obstruction
Horner’s syndrome
SIADH
Cushing’s
Hypercalcaemia
Limbic encephalitis
Lambert-Eaton myasthenic syndrome

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6
Q

How does superior vena cava obstruction present?

A

facial swelling
difficulty breathing
distended neck and upper chest veins

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7
Q

What is Pemberton’s sign?

A

raising the hands over the head causes facial congestion and cyanosis - sign of SVC obstruction

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8
Q

What is the triad of Horner’s syndrome?

A

Ptosis
Anhidrosis
Miosis

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9
Q

What are the referral criteria for offering a CXR within two weeks?

A

over 40
Clubbing
Lymphadenopathy (supraclavicular)
recurrent or persistent chest infections
Thrombocytosis
Chest signs of lung cancer

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10
Q

What findings on x-ray are suggestive of lung cancer?

A

Hilar enlargement
Peripheral opacity (a visible lesion in the lung field)
Pleural effusion (usually unilateral in cancer)
Collapse

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11
Q

When is pneumonia classed as hospital acquired?

A

develops after more than 48 hours in a hospital

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12
Q

What type of bacteria is associated with aspiration pneumonia

A

Anaerobic bacteria

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13
Q

What are some presenting symptoms of pneumonia?

A

Cough
Sputum production
Shortness of breath
Fever
Feeling generally unwell
Haemoptysis
Pleuritic chest pain
Delirium

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14
Q

What are some characteristic chest signs of pneumonia on auscultation?

A

Bronchial breath sounds
Focal coarse crackles
Dullness to percussion

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15
Q

What are the aspects of CURB-65?

A

C – Confusion
U – Urea > 7 mmol/L
R – Respiratory rate ≥ 30
B – Blood pressure < 90 systolic or ≤ 60 diastolic.]
65 – Age ≥ 65

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16
Q

How should you interpret a CURB-65 score?

A

Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care

Predicts mortality. NICE state 0/1 is low risk (under 3%), 2 is intermediate risk (3-15%), and 3-5 is high risk (above 15%)

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17
Q

What are the 2 most common causes of bacterial pneumonia?

A

Streptococcus pneumoniae (most common)
Haemophilus influenzae

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18
Q

What rarer cause of pneumonia is more common in patients with cystic fibrosis or bronchiectasis?

A

Pseudomonas aeruginosa (both)
(Staphylococcus aureus in patients with cystic fibrosis)

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19
Q

What is a rarer cause of pneumonia in immunocompromised or those with chronic pulmonary disease?

A

Moraxella catarrhalis

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20
Q

How can Legionnaires’ disease present and how is it investigated?

A

symptoms of pneumonia + hyponatraemia (due to SIADH)
urine antigen test

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21
Q

What is the rash that mycoplasma pneumoniae may cause?

A

erythema multiforme

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22
Q

What type of atypical pneumonia is associated with exposure to bodily fluids of animals?

A

Coxiella burnetii

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23
Q

What atypical pneumonia is contracted through contact with infected birds?

A

Chlamydia psittaci

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24
Q

Name 4 causes of atypical pneumonia

A

Legions – Legionella pneumophila
Psittaci – Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydophila pneumoniae
Qs – Q fever (coxiella burnetii)

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25
Q

What type of fungal pneumonia is more common in patients with HIV and how is it treated?

A

Pneumocystis jirovecii
co-trimoxazole

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26
Q

What investigations may be done in a patient admitted to hospital with pneumonia?

A

Chest x-ray
Full blood count (raised white cell count)
Renal profile (urea level for the CURB-65 score and acute kidney injury)
C-reactive protein (raised in inflammation and infection)

Patients with moderate or severe infection will also have:

Sputum cultures
Blood cultures
Pneumococcal and Legionella urinary antigen tests

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27
Q

How is mild community-acquired pneumonia treated?

A

5 days of oral antibiotics
refer to local guidelines e.g. amoxicillin, doxycycline, clarithromycin

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28
Q

State 5 complications of pneumonia

A

Sepsis
Acute respiratory distress syndrome
Pleural effusion
Empyema
Lung abscess
Death

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29
Q

What are the normal paO2 values?

A

10.7-13.3 kPa

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30
Q

What are the normal PaCO2 values?

A

4.7-6.0 kPa

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31
Q

What is a normal pH?

A

7.35-7.45

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32
Q

What is a normal lactate?

A

0.5-1

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33
Q

What is the FiO2 of room air?

A

21%

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34
Q

What is the approximate FiO2 with 2L via nasal cannula?

A

28%

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35
Q

What would a ABG show in type 1 respiratory failure?

A

Low PaO2
Normal PaCO2

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36
Q

What would a ABG show in type 2 respiratory failure?

A

Low PaO2
Raised PaCO2

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37
Q

What would an ABG show in respiratory acidosis?

A

pH below 7.35
raised PaCO2

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38
Q

What does a raised bicarbonate level suggest?

A

Patient is chronically retaining CO2

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39
Q

What would an ABG show in respiratory alkalosis?

A

raised pH
low PaCO2

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40
Q

Name 2 conditions that would cause respiratory alkalosis

A

Hyperventilation syndrome
Pulmonary embolism

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41
Q

What would an ABG show in metabolic acidosis?

A

low pH
low HCO3

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42
Q

What is the normal range of HCO3 (bicarbonate) ?

A

22-26 mmol/L

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43
Q

State some possible causes of metabolic acidosis

A

DKA
Renal failure
Rhabdomyolysis
Diarrhoea
Renal tubular acidosis

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44
Q

What would an ABG show in metabolic alkalosis?

A

raised pH
raised HCO

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45
Q

State some causes of metabolic alkalosis

A

Vomiting
Conn’s syndrome
Liver cirrhosis
heart failure
loop diuretics
thiazide diuretics

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46
Q

order the different types of respiratory support from least to most intensive

A

Oxygen therapy
High-flow nasal cannula
Non-invasive ventilation
Intubation and mechanical ventilation
Extracorporeal membrane oxygenation (ECMO)

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47
Q

Acute respiratory distress syndrome presents as an acute onset of:

A

Collapse of the alveoli and lung tissue (atelectasis)
Pulmonary oedema (not related to heart failure or fluid overload)
Decreased lung compliance (reduced lung inflation when ventilated with a given pressure)
Fibrosis of the lung tissue (typically after 10 days or more)

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48
Q

What are the clinical signs of acute respiratory distress syndrome?

A

Acute respiratory distress
Hypoxia with an inadequate response to oxygen therapy
Bilateral infiltrates on a chest x-ray

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49
Q

How is acute respiratory distress syndrome managed?

A

Respiratory support
Prone positioning (lying on their front)
Careful fluid management to avoid excess fluid collecting in the lungs

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50
Q

Positive end-expiratory pressure is added by:

A

High-flow nasal cannula
Non-invasive ventilation (NIV)
Mechanical ventilation

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51
Q

What is IPAP and EPAP in NIV?

A

IPAP (inspiratory positive airway pressure) is the pressure during inspiration – where air is forced into the lungs
EPAP (expiratory positive airway pressure) is the pressure during expiration – stopping the airways from collapsing

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52
Q

When is FEV1 reduced?

A

airflow obstruction

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53
Q

When is FVC reduced ?

A

Restricted lung capacity

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54
Q

What spirometry value can be used to diagnose obstructive lung disease?

A

FEV1:FVC ratio of less than 70%

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55
Q

What will spirometry show in restrictive lung disease?

A

FEV1 and FVC are equally reduced
FEV1:FVC ratio greater than 70%

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56
Q

State 4 types of restrictive lung disease

A

Interstitial lung disease, such as idiopathic pulmonary fibrosis
Sarcoidosis
Obesity
Motor neurone disease
Scoliosis

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57
Q

Describe the technique needed for peak flow tests

A

stand tall, take a deep breath in, make a good seal around the device with the lips and blow as fast and hard as possible into the device. Take three attempts and record the best result.

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58
Q

What are some symptoms of asthma?

A

Shortness of breath
Chest tightness
Dry cough
Wheeze

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59
Q

What is a key finding on auscultation of asthma?

A

widespread “polyphonic” expiratory wheeze

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60
Q

State 4 triggers that can exacerbate the symptoms of asthma

A

Infection
Nighttime or early morning
Exercise
Animals
Cold, damp or dusty air
Strong emotions

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61
Q

Name 2 medications that can worsen asthma

A

beta-blockers
NSAIDs

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62
Q

What investigations can be done for asthma and what would they show?

A

Spirometry (FEV1:FVC <70%) with bronchodilator reversibility
Fractional exhaled nitric oxide

others:
Peak flow (variability >20%)
Direct bronchial challenge testing

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63
Q

What are the steps for long term asthma management?

A
  1. SABA
    • ICS
    • LABA (or MART)
  4. increase ICS or add leukotriene receptor antagonist (montelukast)
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64
Q

What is the peak flow in a moderate asthma exacerbation

A

50 – 75% best or predicted

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65
Q

What are the clinical features of a severe asthma exacerbation?

A

Peak flow 33-50% best or predicted
Respiratory rate above 25
Heart rate above 110
Unable to complete sentences

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66
Q

What are the clinical features of a life-threatening asthma exacerbation?

A

Peak flow less than 33%
Oxygen saturations less than 92%
PaO2 less than 8 kPa
Becoming tired
Confusion or agitation
No wheeze or silent chest
Haemodynamic instability (shock)

67
Q

How would you manage a mild asthma exacerbation?

A

Inhaled beta-2 agonists (e.g., salbutamol) via a spacer
Quadrupled dose of their inhaled corticosteroid (for up to 2 weeks)
Oral steroids (prednisolone) if the higher ICS is inadequate
Antibiotics only if there is convincing evidence of bacterial infection
Follow-up within 48 hours

68
Q

How would you manage a moderate asthma exacerbation?

A

Consider hospital admission
Nebulised beta-2 agonists (e.g., salbutamol)
Steroids (e.g., oral prednisolone or IV hydrocortisone)

69
Q

How would you manage a severe asthma exacerbation?

A

Hospital admission
Oxygen to maintain sats 94-98%
nebulised salbutamol
steroids
Nebulised ipratropium bromide
IV magnesium sulphate
IV salbutamol
IV aminophylline

70
Q

What electrolyte requires monitoring with salbutamol?

A

potassium

71
Q

After an acute asthma attack what management/advice may be given ?

A

Optimising long-term asthma management
Individual written asthma self-management plan
Considering a rescue pack of oral steroids to start early in an exacerbation
NICE suggest referral to a specialist after 2 attacks in 12 month

72
Q

What are the presenting symptoms of COPD?

A

long-term smoker
persistent symptoms:
Shortness of breath
Cough
Sputum production
Wheeze
Recurrent respiratory infections, particularly in winter

73
Q

Describe the grades of the MRC Dyspnoea scale

A

Grade 1: Breathless on strenuous exercise
Grade 2: Breathless on walking uphill
Grade 3: Breathlessness that slows walking on the flat
Grade 4: Breathlessness stops them from walking more than 100 meters on the flat
Grade 5: Unable to leave the house due to breathlessness

74
Q

How is COPD diagnosed?

A

Clinical presentation + Spirometry (FEV1:FVC<70%)

75
Q

How is the severity of COPD measured?

A

Stage 1 (mild): FEV1 more than 80% of predicted
Stage 2 (moderate): FEV1 50-79% of predicted
Stage 3 (severe): FEV1 30-49% of predicted
Stage 4 (very severe): FEV1 less than 30% of predicted

76
Q

What 2 vaccines should be offered to patients with COPD?

A

pneumococcal
flu

77
Q

What is the long term management of COPD?

A

conservative = stop smoking, pulmonary rehab
1. SABA/SAMA
2. LABA + LAMA (if no asthmatic or steroid-responsive features, if are then LABA+ICS)
3. LABA + LAMA + ICS

78
Q

When would long-term oxygen therapy be offered to a patient with COPD?

A

Chronic hypoxia (<92%)
polycythaemia
cyanosis
cor pulmonale

79
Q

State 4 causes of Cor pulmonale

A

COPD (the most common cause)
Pulmonary embolism
Interstitial lung disease
Cystic fibrosis
Primary pulmonary hypertension

80
Q

What is Cor Pulmonale?

A

right-sided heart failure caused by respiratory disease. The increased pressure and resistance in the pulmonary arteries (pulmonary hypertension) limits the right ventricle pumping blood into the pulmonary arteries. This causes back-pressure into the right atrium, vena cava and systemic venous system

81
Q

What are some symptoms of Cor Pulmonale?

A

Shortness of breath
Peripheral oedema
Breathlessness of exertion
Syncope (dizziness and fainting)
Chest pain

82
Q

What are some signs of Cor Pulmonale ?

A

Hypoxia
Cyanosis
Raised JVP
Peripheral oedema
Parasternal heave
Loud second heart sound
Murmurs
Hepatomegaly due to back pressure in the hepatic vein

83
Q

What is the first line medical treatment of an acute exacerbation of COPD?

A

Regular inhalers or nebulisers (e.g., salbutamol and ipratropium)
Steroids (e.g., prednisolone 30 mg once daily for 5 days)
Antibiotics if there is evidence of infection

if severe:
IV aminophylline
Non-invasive ventilation (NIV)
Intubation and ventilation with admission to intensive care

84
Q

What are some causes of bronchiectasis?

A

Idiopathic (no apparent cause)
Pneumonia
Whooping cough (pertussis)
Tuberculosis
Alpha-1-antitrypsin deficiency
Connective tissue disorders (e.g., rheumatoid arthritis)
Cystic fibrosis
Yellow nail syndrome

85
Q

What is the characteristic triad of yellow nail syndrome?

A

yellow fingernails
Bronchiectasis
lymphoedema

86
Q

What are the key presenting symptoms of bronchiectasis?

A

Shortness of breath
Chronic productive cough
Recurrent chest infections
Weight loss

87
Q

What are some signs of bronchiectasis on examination?

A

Sputum pot by the bedside
Oxygen therapy (if needed)
Weight loss (cachexia)
Finger clubbing
Signs of cor pulmonale (e.g., raised JVP and peripheral oedema)
Scattered crackles throughout the chest that change or clear with coughing
Scattered wheezes and squeaks

88
Q

What are the most common infective organisms in bronchiectasis?

A

Haemophilus influenza
Pseudomonas aeruginosa

89
Q

What are the x-ray findings in bronchiectasis?

A

Tram-track opacities (parallel markings of a side-view of the dilated airway)
Ring shadows (dilated airways seen end-on)

90
Q

What is the test of choice for establishing a diagnosis of bronchiectasis?

A

High-resolution CT

91
Q

What is the general management of bronchiectasis?

A

Vaccines (e.g., pneumococcal and influenza)
Respiratory physiotherapy
Pulmonary rehabilitation
Long-term antibiotics (e.g., azithromycin) for frequent exacerbations (e.g., 3 or more per year)
Inhaled colistin for Pseudomonas aeruginosa colonisation
Long-acting bronchodilators may be considered for breathlessness
Long-term oxygen therapy in patients with reduced oxygen saturation
Surgical lung resection may be considered for specific areas of disease
Lung transplant is an option for end-stage disease

92
Q

How should an infective exacerbation of bronchiectasis be managed?

A

Sputum culture (before antibiotics)
Extended courses of antibiotics, usually 7–14 days
Ciprofloxacin is the usual choice for exacerbations caused by Pseudomonas aeruginosa

93
Q

Name 4 types of interstitial lung disease

A

Idiopathic pulmonary fibrosis (the most important to remember)
Secondary pulmonary fibrosis
Hypersensitivity pneumonitis
Cryptogenic organising pneumonia
Asbestosis

94
Q

What are they key presenting features of interstitial lung disease?

A

Shortness of breath on exertion
Dry cough
Fatigue

95
Q

What are the 2 typical findings on examination of a patient with idiopathic pulmonary fibrosis?

A

Bibasal fine end-inspiratory crackles
Finger clubbing

96
Q

What does diagnosis of interstitial lung disease involve?

A

Clinical features
High-resolution CT scan (HRCT) of the thorax (showing a typical “ground glass” appearance)
Spirometry

97
Q

What are the general management options for interstitial lung disease?

A

Remove or treat the underlying cause
Home oxygen where there is hypoxia
Stop smoking
Physiotherapy and pulmonary rehabilitation
Pneumococcal and flu vaccine
Advanced care planning and palliative care where appropriate
Lung transplant is an option, but the risks and benefits need careful consideration

98
Q

What is the prognosis of idiopathic pulmonary fibrosis?

A

2-5 years

99
Q

What are the management options for pulmonary fibrosis?

A

Pirfenidone
Nintedanib

100
Q

what drugs can cause secondary pulmonary fibrosis?

A

Amiodarone (also causes grey/blue skin)
Cyclophosphamide
Methotrexate
Nitrofurantoin

101
Q

What conditions can lead to pulmonary fibrosis?

A

Alpha-1 antitrypsin deficiency
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Systemic sclerosis
Sarcoidosis

102
Q

What type of hypersensitivity reaction causes hypersensitivity pneumonitis?

A

III + IV

103
Q

How is Hypersensitivity pneumonitis diagnosed?

A

Bronchoalveolar lavage

104
Q

What are the 2 categories of pleural effusion?

A

Exudative – a high protein content (more than 30g/L)
Transudative – a lower protein content (less than 30g/L)

105
Q

What is Light’s criteria used for?

A

establishing an exudative effusion using protein or lactate dehydrogenase (LDH):

Pleural fluid protein / serum protein greater than 0.5
Pleural fluid LDH / serum LDH greater than 0.6
Pleural fluid LDH greater than 2/3 of the normal upper limit of the serum LDH

106
Q

State 3 causes of exudative pleural effusion

A

Cancer (e.g., lung cancer or mesothelioma)
Infection (e.g., pneumonia or tuberculosis)
Rheumatoid arthritis

107
Q

State 3 transudative causes of pleural effusion

A

Congestive cardiac failure
Hypoalbuminaemia
Hypothyroidism
Meigs syndrome

108
Q

What is the main presenting symptom of pleural effusion?

A

shortness of breath

109
Q

What are the examination findings of a pleural effusion?

A

Dullness to percussion over the effusion
Reduced breath sounds
Tracheal deviation away from the effusion in very large effusions

110
Q

What are the CXR findings with a pleural effusion?

A

Blunting of the costophrenic angle
Fluid in the lung fissures
Larger effusions will have a meniscus (a curving upwards where it meets the chest wall and mediastinum)
Tracheal and mediastinal deviation away from the effusion in very large effusions

111
Q

What are the treatment options for a pleural effusion?

A

Conservative = small effusions
Pleural aspiration
Chest drain

112
Q

What is an empyema?

A

infected pleural effusion

113
Q

What will a pleural aspiration of an empyema show?

A

pus, low pH, low glucose and high LDH

114
Q

What is a pneumothorax?

A

air in the pleural space

115
Q

state 4 causes of a pneumothorax

A

Spontaneous
Trauma
Iatrogenic, for example, due to lung biopsy, mechanical ventilation or central line insertion
Lung pathologies such as infection, asthma or COPD

116
Q

What is the diagnostic investigation for a pneumothorax ?

A

Erect chest xray

117
Q

How is a pneumothorax managed?

A

high risk = chest drain
lower risk (<2cm) = conservative
lower risk (>2cm) = pleural vent ambulatory device, needle aspiration/chest drain

118
Q

Where is a chest drain inserted?

A

triangle of safety
5th intercostal space (or the inferior nipple line)
Midaxillary line (or the lateral edge of the latissimus dorsi)
Anterior axillary line (or the lateral edge of the pectoralis major)

119
Q

state 2 key complications of a chest drain

A

Air leaks
Surgical emphysema

120
Q

What are some signs of a tension pneumothorax?

A

Tracheal deviation away from the side of the pneumothorax
Reduced air entry on the affected side
Increased resonance to percussion on the affected side
Tachycardia
Hypotension

121
Q

How is a tension pneumothorax managed?

A

Insert a large bore cannula into the second intercostal space in the midclavicular line

122
Q

State 5 risk factors for a DVT/PE

A

Immobility
Recent surgery
Long-haul travel
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia
Systemic lupus erythematosus
Thrombophilia

123
Q

What is used for VTE prophylaxis in hospital?

A

LMWH
anti-embolic compression stockings

124
Q

state 2 contraindications to VTE prophylaxis with LMWH

A

active bleeding
existing anticoagulation e.g. warfarin or DOAC

125
Q

What are some presenting features of a pulmonary embolism?

A

Shortness of breath
Cough
Haemoptysis
Pleuritic chest pain
Hypoxia
Tachycardia
Raised respiratory rate
Low-grade fever
Haemodynamic instability causing hypotension

126
Q

How is a pulmonary embolism diagnosed?

A

Wells score - likelihood
CT pulmonary angiogram if likely
if unlikely then d dimer followed by CTPA if +ve

127
Q

Apart form PE state 3 other causes of a raised d dimer

A

Pneumonia
Malignancy
Heart failure
Surgery
Pregnancy

128
Q

In patients with contraindication to a CTPA for a suspected PE what other investigation can be carried out?

A

Ventilation-perfusion (VQ) scan

129
Q

What is the 1st line medical management of a PE?

A

1st: apixaban or rivaroxaban

130
Q

How is a massive PE treated?

A

continuous infusion of unfractionated heparin and consider thrombolysis

131
Q

What are the options for long term anticoagulation is patients who have had a PE?

A

DOAC (e.g. apixaban)
Warfarin (1st line in pts with antiphospholipid syndrome)
LMWH (1st line in pregnancy)

Continue anticoagulation for:

3 months with a reversible cause (then review)
Beyond 3 months with unprovoked PE, recurrent VTE or an irreversible underlying cause (e.g., thrombophilia)
3-6 months in active cancer (then review)

132
Q

pulmonary hypertension is defined as what?

A

a mean pulmonary arterial pressure of more than 20  mmHg

133
Q

What are the 5 causes of pulmonary hypertension?

A

Group 1 – Idiopathic pulmonary hypertension or connective tissue disease (e.g. SLE)
Group 2 – Left heart failure, usually due to myocardial infarction or systemic hypertension
Group 3 – Chronic lung disease (e.g., COPD or pulmonary fibrosis)
Group 4 – Pulmonary vascular disease (e.g., pulmonary embolism)
Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders

134
Q

What are some signs and symptoms of pulmonary hypertension ?

A

Shortness of breath
Syncope
Tachycardia
Raised JVP
Hepatomegaly
Peripheral oedema

135
Q

What are the ECG changes seen in pulmonary hypertension?

A

P pulmonale (peaked P waves)
Right ventricular hypertrophy (tall R waves in V1 and V2 and deep S waves in V5 and V6)
Right axis deviation
Right bundle branch block

136
Q

What are the xray changes seen in pulmonary hypertension?

A

Dilated pulmonary arteries
Right ventricular hypertrophy

137
Q

What are the treatment options for idiopathic pulmonary hypertension?

A

Calcium channel blockers
Intravenous prostaglandins (e.g., epoprostenol)
Endothelin receptor antagonists (e.g., macitentan)
Phosphodiesterase-5 inhibitors (e.g., sildenafil)

138
Q

What is the epidemiology of sarcoidosis?

A

Aged 20-39 or around 60
Women
Black ethnic origin

139
Q

What are the skin features of sarcoidosis?

A

erythema nodosum
Lupus pernio (raised purple skin lesion often on cheeks and nose)

140
Q

How can sarcoidosis affect the lungs?

A

Mediastinal lymphadenopathy
Pulmonary fibrosis
Pulmonary nodules

141
Q

What are some systemic features of sarcoidosis?

A

Fever
Fatigue
Weight loss

142
Q

What are some liver features of sarcoidosis ?

A

Liver nodules
Cirrhosis
Cholestasis

143
Q

What are some eye features of sarcoidosis?

A

Uveitis
Conjunctivitis
Optic neuritis

144
Q

What are some heart features of sarcoidosis?

A

Bundle branch block
Heart block
Myocardial muscle involvement

145
Q

What are some kidney symptoms of sarcoidosis?

A

Kidney stones (due to hypercalcaemia)
Nephrocalcinosis
Interstitial nephritis

146
Q

What are some neurological symptoms of sarcoidosis?

A

Central nervous system:
Nodules
Pituitary involvement (diabetes insipidus)
Encephalopathy

Peripheral Nervous System:
Facial nerve palsy
Mononeuritis multiplex

147
Q

What are some bone features of sarcoidosis?

A

Arthralgia
Arthritis
Myopathy

148
Q

What is Lofgren’s syndrome?

A

specific presentation of sarcoidosis with a classic triad of symptoms:

Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia (joint pain in multiple joints)

149
Q

State 4 differential diagnosis for sarcoidosis

A

Tuberculosis
Lymphoma
Hypersensitivity pneumonitis
HIV
Toxoplasmosis
Histoplasmosis

150
Q

What is the gold standard for diagnosing sarcoidosis

A

Biopsy with histology

151
Q

What does histology show in sarcoidosis?

A

non-caseating granulomas with epithelioid cells.

152
Q

What two blood tests findings may be raised in sarcoidosis?

A

Raised angiotensin-converting enzyme (ACE) (often used as a screening test)
Raised calcium (hypercalcaemia)

153
Q

What is the first line treatment if required for sarcoidosis?

A

Oral steroids (for 6-24 months) are usually first-line where treatment is required. Bisphosphonates protect against osteoporosis whilst on long-term steroids

2nd: methotrexate

154
Q

What is the prognosis of sarcoidosis?

A

Sarcoidosis spontaneously resolves in around half of patients, usually within two years. In some patients, it progresses to pulmonary fibrosis and pulmonary hypertension. Overall mortality is less than 10%.

155
Q

What causes obstructive sleep apnoea?

A

collapse of the pharyngeal airway

156
Q

State 4 risk factors of obstructive sleep apnoea

A

Middle age
Male
Obesity
Alcohol
Smoking

157
Q

How does obstructive sleep apnoea present?

A

Episodes of apnoea during sleep (reported by a partner)
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
Concentration problems
Reduced oxygen saturation during sleep

158
Q

What scale is used to assess symptoms of sleepiness associated with obstructive sleep apnoea.

A

Epworth sleepiness scale

159
Q

What investigation is used to diagnose obstructive sleep apnoea?

A

sleep study

160
Q

What is the management of obstructive sleep apnoea?

A

manage risk factors
CPAP
Surgery

161
Q

What is the most common causative organism of an infective exacerbation of COPD?

A

Haemophilus influenzae

162
Q

What organism can commonly cause a cavitating pneumonia following an influenza infection?

A

Staphylococcus aureus

163
Q

patient presenting with dry cough, erythema multiforme and bilateral consolidation on x-ray - what is the most likely causative organism?

A

Mycoplasma pneumoniae

Finals (21 decks)

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