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UKMLA > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the definition of emphysema?

A

Alveolar wall destruction leads to enlargement of distal airspaces - without sufficient antiprotease enzymes , proteases break down walls of alveoli causing bigger airspaces and reduce surface area available for gas exchanges

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2
Q

What is chronic bronchitis?

A

Persistent or recurrent productive cough due to mucus hypersecretion from goblet cells

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3
Q

Which lung function measure is lowered in COPD?

A

FEV1

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4
Q

Which enzyme usually counters inflammation in the lungs?

A

Antiproteases such as alpha-1-antitrypsin

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5
Q

What are the grades of COPD?

A

Mild: 80% or more than of predicted post bronchodilator FEV1
Moderate: 50-79%
Severe: 30 - 49%
Very severe: under 30%

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6
Q

What is the FEV1/FVC ratio in COPD?

A

Less than 0.7

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7
Q

What would be a sign in blood that there is COPD?

A

Polycythaemia
Anaemia

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8
Q

Which heart condition is associated with late stage COPD?

A

Cor pulmonale - right sided heart failure

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9
Q

What happens to hemidiaphragms in COPD?

A

They get flattened

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10
Q

Why is there an increase of VTE in COPD?

A

There can be increased blood viscosity due to polycythaemia which occurs because of chronic hypoxia and as a compensatory mechanism the body over produces erythropoietin which leads to increase in red cell production

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11
Q

What is empyema? + how would temp present?

A

Pus collects in pleural space - present with swinging fever

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12
Q

What is acute respiratory distress syndrome?

A

Non cardiogenic pulmonary oedema and diffuse lung inflammation may be secondary to lung injury

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13
Q

What criteria is used to define Acute respiratory distress syndrome (ARDS)?

A

Acute onset - less than a week
Chest - xray showing bilateral opacity
PaO2/FiO2 i 300 or less

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14
Q

What is pathophysiology of ARDS?

A

Diffuse bilateral alveolar injury so endothelial is disrupted and fluid leaks into the alveoli from pulmonary capillaries
Surfactant production decreases

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15
Q

What’s the presentation of ARDS?

A

Severe tachypnoea
Severe dyspnoea
Confusion/ presyncope
Creps
Use of accessory muscles

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16
Q

What anti-viral therapy can be used against influenza in COPD - and when is it best intiated?

A

Oseltamivir - within 48 hours of symptom onset

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17
Q

What is the definition of interstitial lung disease?

A

Group of diseases that cause inflammation and fibrosis of lung interstium

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18
Q

What are the two most common types of interstitial lung disease?

A

Idiopathic pulmonary fibrosis
Hypersensitivity pneumonia

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19
Q

What is hypersensitivity pneumonia?

A

Repeated exposures leads to ongoing inflammation and fibrosis
Triggers like: chemicals, agricultural dusts, woods, animal , fungi

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20
Q

What is farmer’s lung?

A

Type of hypersensitivity pneumonitis caused by mould spores an hay or straw

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21
Q

How is ILD classified?

A

By the zones it affects mainly
Upper zones: HART
Hypersensitivity pneumonitis
Ankylosing spondylitis
Radiotherapy
TB

Lower zones: RAIDS
Rheumatoid
Asbestosis
Idiopathic
Drugs
Sarcoidosis

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22
Q

How does ILD present?

A

Dry cough
SOB
reduced exercise tolerance
Fatigue
Anorexia
Weight loss
Clubbing
Fine end inspiratory crackles

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23
Q

What is seen with ILD on imaging?

A

Nodular shadowing
Honeycombing
Ground glass changes
Traction bronchiectasis

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24
Q

What is treatment of idiopathic Interstitial lung disease?

A

Antifibrotic: Pirfenidone and nintedanib

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25
Q

What’s the mechanism of action for nintedanib?

A

Tyrosine kinase inhibitor

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26
Q

What’s the mechanism of action for pirfenidone?

A

Reduces fibroblast proliferation

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27
Q

What is treatment for hypersensitivity pneumonitis?

A

Steroids
If steroids don’t work then: immunosuppression: cyclophosphamide and azathioprine

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28
Q

Which is correct stain for pneumonitis jirovecci pneumonia?

A

Silver stain

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29
Q

Which stain is for amyloid deposits?

A

Congo red

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30
Q

Which stain is for TB?

A

Ziehl - neelsen

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31
Q

Which stain is for cryptococcus neoformans?

A

India ink

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32
Q

What is a complication of amiodarone?

A

Inflammatory pneumonitis followed by chronic pulmonary fibrosis

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33
Q

Which drugs can cause pulmonary fibrosis?

A

Amiodarone
Nitrofurantoin
Methotrexate
Bleomycin
Busulfan
Sulfalazine

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34
Q

If pleural plaques are noted what can this indicate?

A

Asbestos exposure

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35
Q

What is the most common site of GI TB?

A

Ileocecal TB - which can present with the presence of a Right lower quadrant mass and abdo pain

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36
Q

How many apnoeic episodes per hour allows for a diagnosis of sleep apnea?

A

5 or more

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37
Q

What is the definition of a lung abscess?

A

Necrosis of lung tissue

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38
Q

Which smoking cessation drug is contraindicated in epileptics? and why?

A

Bupropion - decreases the seizure threshold

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39
Q

What is mechanism of bupropion?

A

Inhibits reuptake of dopamine and noradrenaline

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40
Q

How is bupropion taken?

A

Once a day for 6 days then twice a day 7-9 weeks

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41
Q

When is bupropion contraindicated?

A

Epilepsy
Bipolar
pregnant
breast feeding
Brain tumour
Eating disorder

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42
Q

What is the mechanism of action of varenicline?

A

Partial nicotinic receptor agonist

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43
Q

How is varenicline taken?

A

Started 1-2 weeks before quit date, then continued for 12 weeks

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44
Q

What are key side effects to be aware of with varenicline?

A

Suicidal ideation, depression, hallucination

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45
Q

When is varenicline contraindicated?

A

Pregnant
End stage renal failure

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46
Q

What’s a classic finding on chest x-ray in patients with sarcoidosis?

A

Bilateral hilar lymphadenopathy

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47
Q

What is the inheritance pattern of primary ciliary dyskinesia?

A

Autosomal recessive

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48
Q

What is primary ciliary dyskinesia?

A

Dysfunctional cilia

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49
Q

What is a key feature of primary ciliary dyskinesia that means that left lung base would be dull?

A

Situs invertus

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50
Q

What type of pneumonia is common from contaminated water, air conditioning - esp in hotels.?

A

Legionnaire’s disease

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51
Q

What type of bacteria is legionella?

A

Gram negative bacilli

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52
Q

How does legionnaire’s disease present?

A

Dry cough
Confusion
Hyponatraemia
Lethargy
Muscle aches

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53
Q

What must the ABG results be in order to meet criteria for long term oxygen therapy?

A

PaO2 less than 7.3 on two separate readings more than 3 weeks apart - non smokers
OR PaO2 of 7.3-8 WITH nocturnal hypoxia, polycythaemia, peripheral oedema and pulmonary hypertension

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54
Q

What is caplan’s syndrome?

A

Multiple pulmonary nodules that rapidly occur in lung periphery in patients with rheumatoid - causes swelling and scarring of lungs

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55
Q

Why can idiopathic pulmonary arterial hypertension be exacerbated in pregnancy?

A

Because the pulmonary vascular resistance can’t be reduced to accommodate increasing Cardiac output like in normal pregnant women therefore causing a early diastolic murmur - pulmonary regurg

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56
Q

What causes type 2 respiratory depression?

A

Can be due to opiate overdose
Causing:
Decreased paO2 but increased paCO2 due to alveolar hypoventilation

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57
Q

What is treatment of T1RF vs T2RF?

A

T1: CPAP
T2: NIV (BIPAP)

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58
Q

What is a complication type 2 diabetics are at risk of getting post influenza?

A

Pneumococcal pneumonia

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59
Q

What chemical is in contract for CTPA that people may be allergic to?

A

Iodine

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60
Q

Other than iodine allergy when else may a V/Q be preferred over CTPA?

A

Pregnant
Renal impairment

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61
Q

What is gold standard investigation for allergies?

A

Food challenge test

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62
Q

What is heparin induced thrombocytopenia?

A

Life threatening auto-immune reaction to heparin whereby patients have reduced platelets and hypercoagulable state

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63
Q

How is heparin induced thrombocytopenia treated?

A

Cessation of heparin
Argatroban

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64
Q

What type of bacteria can cause pneumonia after influenza?

A

Staph aureus

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65
Q

What bacteria is a common cause of hospital acquired pneumonia?

A

Klebsiella

66
Q

What does sputum of klebsiella look like?

A

Red-currant jelly

67
Q

Which patients are more likely to get pseudomonas aeruginosa?

A

CF
COPD

68
Q

What is treatment for TB?

A

RIPE for 2 months followed by RI (or called rifinah) for 4 months
R:ifampicin
Isoniazid
Pyrazinamide
Ethambutol

69
Q

Which intervention can reduce mortality in ARDS?

A

Low tidal volume mechanical ventilation

70
Q

Which medication is usually given for aspiration pneumonia?

A

IV metronidazole as aspiration pneumonia is most likely due to oropharyngeal anaerobes

71
Q

Which anti-microbial can cause INR to rise?

A

Metronidazole

72
Q

Which sound is heard on COPD lungs?

A

Wheeze

73
Q

Is MS obstructive or restrictive lung disease?

A

Restrictive so a normal FEV1/FVC - more than 0.7 and normal BUT reduced FEV1 and FVC values

74
Q

When is spironolactone used vs furosemide?

A

Furosemide is used first then if symptoms persist then spironolactone is used

75
Q

What type of hypersensitivity reaction is farmer’s lung (a type of extrinsic allergic alveolitis)?

A

Type 3 its a hypersensitivity pneumonitis

76
Q

What’s the most common form of lung cancer in non smokers?

A

Adenocarcinoma

77
Q

What’s the most common subtype of lung cancer?

A

SCC

78
Q

What can cause wrist pain in lung adenocarcinoma?

A

hypertrophic pulmonary osteoarthropathy

79
Q

Which nerves are invaded in pancoast tumour that can cause horner’s?

A

Brachial plexus

80
Q

What AMTS score in setting of pneumonia and calculating CURB-65 indicates confusion?

A

Less than 8

81
Q

How is CURB65 calculated?

A

C: confusion?
Urea over 7
Resp rate: 30 or over
B: BP systolic under 90 or diastolic under 60
65 - are they 65 or older

82
Q

What does a CURB-65 score of over 3 indicate?

A

Mortality within 30 days

83
Q

What is p pulmonale on ecg?

A

Right atrial abnormality on ecg seen as tall peaked p waves can be due to pulmonary hypertension as it’s a cause of right atrial enlargement

84
Q

What size cannula should be used to aspirate pneumothorax?

A

18-18G

85
Q

Where is cannula placed in pneumothorax on chest?

A

2ICS on affected side if this fails do an open thoracostomy
After initial emergency decompression a chest drain should be inserted

86
Q

Which patients would require a chest drain over a 16-18G cannula for pneumothorax first?

A

High risk feature patients:
Significant hypoxia
Bilat penumothoraces
Underlying lung disease
50 or older with significant smoking history
Haemopneumothorax

87
Q

What is a normal cardiothoracic ration?

A

Less than 0.5 - above 0.5 can indicate cardiomegaly

88
Q

What is best diagnostic investigation for heart failure?

A

Transthoracic echo

89
Q

What would a pH of below 7.2 in pleural fluid indicate?

A

Empyema

90
Q

What’s a common form of pneumonia in young adults?

A

Mycoplasma pneumonia

91
Q

What rash can be seen with mycoplasma pneumonia?

A

Erythema multiforme

92
Q

How would mycoplasma pneumonia present?

A

Haemolysis
Elevated reticulocytes
Cold agglutinin and positive coombs
Erythema nodusm rash

93
Q

What does a positivie coomb’s test indicate?

A

Antibodies that act against red blood cells

94
Q

What is cold agglutinin test show?

A

Detects presence of cold agglutinins which are antibodies that cause RBC to clump together in cold temperatures

95
Q

Which asthma patients should be offered preventer therapy?

A

Patients with symptoms more than twice a week
History of exacerbations in the past year
Pt who need SABA more than 3 times a week

96
Q

What is 1st line treatment for COPD patient with breathless on activity?

A

SABA or SAMA

97
Q

Give me an example of a SAMA?

A

Ipratropium

98
Q

If after a SABA or LAMA things are not improving in copd what else is given?

A

LABA + ICS OR LABA + LAMA - use this combo first

99
Q

What ICS is used in COPD?

A

Beclamethasone

100
Q

What LAMA is used in COPD?

A

Tiotropium

101
Q

What is bronchiectasis?

A

Chronic lung disease characterised by irreversible dilation of bronchi and bronchioles due to chronic inflammation and infection

102
Q

What’s the initial management of bronchiectasis?

A

Chest physio - helps removes secretions
Inhaled bronchodilators - improve airflow
Antibiotics

103
Q

When is metronidazole helpful in treating pneumonia?

A

Gram negative infections

104
Q

When is vancomycin used in pneumonia?

A

If there is concern for MRSA

105
Q

What is treatment for TB meningitis?

A

RIPE for 2 months
RI for 10 months

106
Q

What is the gram staining of klebsiella?

A

Gram negative anaerobic rod

107
Q

Which electrolyte imbalance is present in legionella?

A

Hyponatraemia

108
Q

What is the gram staining of legionella?

A

Gram negative aerobic rods

109
Q

What is a transudate vs exudate?

A

Transudate are pleural fluids with a protein level less than 25g/L
Exudates are pleural fluid with protein level more than 35g/L

110
Q

What does light’s criteria say about exudates?

A

Ratio of pleural to serum protein is more than 0.5
Ratio of pleural to serum LDH is more than 0.6
Pleural fluid LDH is more than 2/3s the upper limit of normal value

111
Q

What are transudative causes of effusions?

A

Heart failure - usually bilat
Nephrotic syndrome
Cirrhosis
Hypoalbuminaemia

112
Q

What are exudative causes of pleural effusions?

A

Pneumonia - so a parapneumonic effusion
Malignancy
TB
PE
RA
SLE
Pancreatitis
Trauma

113
Q

How many days would a chest drain be expected to clear and allow for chest re-expansion?

A

3-5 days of chest drain insertion

114
Q

What is important to remember about methotrexate?

A

It can cause pneumonitis - fibrosis, restrictive lung disease

115
Q

Which pneumonia is associated with alcoholics?

A

Klebsiella - highly associated with lung abscesses in alcoholic patients

116
Q

When is vocal resonance reduced?

A

Pleural effusion or lung collapse

117
Q

What about spirometry would allow for a diagnosis of asthma?

A

Reversibility of 12% or more in the FEV1 with bronchodilator use

118
Q

Which is the diagnostic investigation for chronic thromboembolism pulmonary hypertension?

A

Right heart catheterisation

119
Q

Which measure should be monitored monthly when starting bosentan (endothelin A receptor antagonist)

A

LFTs

120
Q

What medication can be prescribed for pulmonary hypertension?

A

Bosentan

121
Q

What would empyema present with?

A

Persistent foul smelling sputum and low pleural fluid pH

122
Q

What is defined as pulmonary hypertension?

A

Pressure over 25

123
Q

What happens to residual lung volume in COPD?

A

There is an increase in residual lung volume as body can’t exhale all air properly due to dynamic hyperinflation

124
Q

What feature on the hands can be seen with recurrent lung abscesses?

A

Finger clubbing

125
Q

What’s the best diagnostic investigation for mycoplasma pneumonia?

A

Blood serology

126
Q

Which pneumonia is urinary antigens useful in?

A

Legionnaire’s disease

127
Q

Which heart sound can indicate right sided heart failure due to long term lung disease?

A

Split second heart sound with loud pulmonary component

128
Q

What is percussion like in pleural effusion?

A

Stony dull

129
Q

What is meig syndrome triad?

A

Ovarian benign tumour
Ascites
Pleural effusion

130
Q

Which side do pleural effusions usually happen in Meig’s syndrome?

A

Right sided

131
Q

Which organism causes pneumonia with rust coloured sputum?

A

Streptococcus

132
Q

What is acute bronchitis normally caused by?

A

Respiratory virus

133
Q
A
134
Q

Why is D dimer not useful in pregnancy?

A

Because D dimer is naturally increased in pregnancy - so the test would produce false positives

135
Q

Which pneumonia is most commonly associated with cold haemolytic anaemia?

A

Mycoplasma pneumonia

136
Q

How does cold haemolytic anaemia present?

A

Fatigue
Blue fingers and toes when cold
Sweating
Weakness
Pale
Drained skin

137
Q

When someone has had a stroke and come in with pneumonia like symptoms what should you start thinking?

A

Aspiration pneumonia - bcos impaired swallow

138
Q

Which type of bacteria is most commonly causing lung abscess?

A

Anaerobic bacteria

139
Q

What is most likely test for pulmonary fibrosis?

A

CT of chest

140
Q

Which UTI medication can cause pulmonary fibrosis if multiple courses are taken?

A

Nitrofurantoin

141
Q

What is seen on chest X-ray for PE?

A

Wedge shaped opacification in left middle zone

142
Q

What is common sighting on X-ray for TB?

A

Upper zones - patchy opacifications - can be described as fibronodular

143
Q

What well’s score indicated high likelihood of PE?

A

Over 4

144
Q

What is Spirometry values in osbstructive disease?

A

Low FEV1
Reduced FEV1/FVC
Preserved FVC

145
Q

What is the oral antibiotic regime for patients with CAP?

A

Amoxicillin 500mg 3 times a day for 5 days

146
Q

What follow up do patients with pneumonia need?

A

Repeat chest X-ray 6-8 weeks after to screen for underlying lung cancer

147
Q

Which lung lobes does farmer’s lung (extrinsic allergic alveolitis) tend to go got?

A

Upper lobes

148
Q

What FVC must a patient have to consider an anti-fibrinolytic?

A

50-80%

149
Q

Which pneumonia patients are suitable for home treatment?

A

CURB65 - is 0 or 1 .
Any CRUB over 2 needs hospital admission

150
Q

What is seen with an INITIAL ABG in aspirin overdose?

A

Respiratory alkalosis

151
Q

What is the most common gram positive aerobic bacteria that causes aspiration pneumonia?

A

Streptococcus

152
Q

What indications make a COPD patient suitable for lung reduction surgery?

A

Predominant upper lobe emphysema

153
Q

What’s the definitive test for pneumocystis pneumonia?

A

Bronchoscopy with bronchoalveolar lavage

154
Q

Which drug should be held when clarithromycin is used and why?

A

Simvastatin - statins are metabolised by the CYp3a4 pathways and clarithromycin increases plasma levels of statins - increases the risk of myopathy

155
Q

What type of hypersensitivity reaction is asthma?

A

Type 1

156
Q

What does signet ring sign on CT signify?

A

Bronchiectasis - bronchus is dilated

157
Q

What is postural drainage?

A

Type of chest physio - done twice a day to help drain mucous to prevent infective exacerbations of bronchiectasis

158
Q

What’s recommended first line antibiotic for HAP? why what does it act against?

A

Pip and taz
Pseudomonas cover and MRSA cover

159
Q

What type of fibrosis does TB cause?

A

Apical fibrosis

160
Q
A

UKMLA (12 decks)

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