Respiratory Flashcards
Lung cancer associations. Small cell, squamous cell, Adeno
Small cell = SVC obstruction! Squamous cell = Cavity! Adenocarcinoma = trousseau syndrome and clubbing
CI to Lung transplant in malignancy (ROPE)
Reduced FEV1 < 1.5/ Obstruction of SVC/ Paralysis of vocal cord/ Effusion (malignant)
HLA associations:
HLA-DR1:
Bronchiectasis
HLA-DR2:
Systemic Lupus Erythematous (SLE)
HLA-DR3:
Autoimmune hepatitis, primary Sjogen syndrome, T1DM, SLE
HLA-DR4:
Rheumatoid arthritis, T1DM
HLA-B27:
Ankylosing Spondylitis, Postgonoccocal arthritis, acute anterior uveitis
Mx of asymptomatic primary pneumothorax
Discharge + F/U outpatient
Mx of asymptomatic secondary pneumothorax
Monitor IP
Mx of Symptomatic pneumothorax with high risk features?
Chest drain
Mx of symptomatic pneumothorax with no high-risk features?
Conservative care, Needle aspiration, Ambulator device
Inhaled pathogen causing Bird fanciers lung?
Avian proteins
Inhaled pathogen causing farmers lung?
Saccharopolyspora rectivirgula
Inhaled pathogen causing Malt workers lung?
Aspergillus Clavatus
Inhaled pathogen causing mushroom workers lung?
Thermophilic actinomycetes
Features of Kartageners syndrome (Caused by dynein arm defect immotile cilia)
Dextrocardia, Bronchiectasis, Sinusitis, Subfertility
Upper zone lung fibrosis causes?
CHARTS:
Coal Worker Pneumoconiosis
Histiocytosis X (Langerhans cell histiocytosis)
Ankylosing Spondylitis
Radiation
Tuberculosis
Silicosis/Sarcoidosis
Lower zone lung fibrosis causes?
BAD RASH:
Bronchiectasis
Asbestosis
Drugs (methotrexate, Amiodarone, Nitrofurantoin)
Rheumatoid Arthritis
Aspiration
Scleroderma/Systemic Sclerosis
Hypersensitivity Pneumonitis
Mx of aspiergillus growth post TB?
Surgical Resection
What are the causes of a raised Transfer Factor (TLCO)?
Asthma, Haemorrhage, Left to right shunts, Polycythaemia
Indication for corticosteroids in sarcoidosis?
PUNCH: Parenchymal lung disease/ Uveitis/ Neurological Involvement/ Cardiac Involvement/ Hypercalcaemia
Triad for Meigs syndrome?
Ascites, Pleural Effusion, Benign Ovarian Tumour
34 year old women with right sided chest pain, currently mensturating, and a spontaneous pneumothorax?
Catamenial pneumothorax
T/F Silica exposure increases incidence of developing TB?
True
Paraneoplastic features of squamous cell lung Ca?
PTHrp, Clubbing, HPOA
Paraneoplastic features of small cell lung Ca?
ADH, ACTH, Lambert-Eaton Syndrome
3 ways to diagnose Asthma in Adults (Assuming symptoms are there)?
1) Eosinophilia
2) FeNO > 50 ppb
3) Spirometry
-FEV1 increases 12% or more after bronchodilator
-FEV1 > 200ml higher after bronchodilator
-FEV1 is 10% or more higher than the predicted FEV1
4 ways to diagnose asthma in children aged 5-16?
1) FeNO level above 35 ppb
2) FEV1 increase 12% or higher post bronchodilation
3) 14 days worth of PEF diary demonstrating diurnal variation
1st Line management of Asthma for adults aged 12 and over? (2024 guidelines)
Low dose ICS + LABA PRN
-Budesonide/Formoterol
1st Line management of asthma for adults aged 12 and over who present highly symptomatic? (2024 guidelines)
MART therapy OD
-Low dose ICS + Laba
-e.g. Budesonide/formoterol
Asthma management for adults, where symptoms are no controlled by moderate dose MART (and FeNo2 and eosinophils are not raised)?
MART + LRTA (Montelukast) OR LAMA (Tiotropium)
MOI Montelukast?
blocks leukotriene receptors (specifically, the cysteinyl leukotriene receptor CysLT1) to prevent bronchoconstriction, inflammation, and mucus production associated with asthma
MOI Lama Tiotropium?
Tiotropium blocks muscarinic receptors (M3 subtype) in the airway smooth muscle, preventing acetylcholine-induced bronchoconstriction and promoting bronchodilation
Alpha-1 Antitrypsin deficiency
-Spirometry
-Transfer factor for carbon monoxide
-Pathophysiology
-Most severe phenotype
-Obstructive
-Low
-Deficiency of AAT (protease inhibitor) leads to unchecked elastase activity and alveolar damage
-PiZZ phenotype
