Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DrFeelGood Stuffs > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Where should the needle be inserted in thoracocentesis in tension pneumothorax?

A

2nd intercostal space, mid-clavicular line

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

What is the discrepency in NICE and BTS/SIGN guidance for stepwise asthma management?

A
  • NICE: SABA –> low dose ICS –> LTRA trial –> + LABA (fixed dose or MART) –> medium dose ICS –> specialist
  • BTS/SIGN: SABA –> low dose ICS –> + LABA (fixed dose or MART) –> medium dose ICS OR LTRA –> specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which type of malignancy is a patient with asbestosis most likely to develop?

A

lung cancer (NOT mesothelioma)

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

What are typical findings of asbestosis on lung function tests?

A

severe restrictive ventilatory defect; reduced gas transfer

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

What 5 things may be recommended in acute bronchitis (not pneumonia)?

A
  1. honey
  2. pelargonium (herbal medicine)
  3. cough medicine containing guaifenesin (expectorant)
  4. cough suppressant (except codeine)
  5. if abx - doxycycline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What abx do NICE recommend for pneumonia?

A
  • CRB65 0 - amoxicillin
  • CRB65 1-2 - amox + clari/erythromycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is a diagnosis of TB confirmed?

A

sputum culture - 3 spontaneous deep cough samples, 1 preferably early morning. send for AFB, mycobacterium culture, genetic testing

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

What is a ghon focus + ghon complex?

A

(seen in TB)
ghon focus = initial caseating granulomatous lesion in upper lung lobe
ghon complex = calcified ghon focus + associated mediastinal lymphadenopathy

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

What is the treatment of active TB?

A
  • RIPE: rifampicin, isoniazid, pyrazinamide, ethambutol 2 months
  • continued treatment: RI 4 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the treatment of latent TB?

A
  • rifampicin + isoniazid for 3 months OR
  • isoniazid for 6 months

+ give pyridoxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What may be seen on CXR in asbestosis?

A

bilateral lower zone interstitial changes, pleural plaques/thickening (may be normal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which occupations are at risk of berylliosis?

A

aerospace, nuclear, telecommunications, semiconductor or electrical industries

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

What are 3 types of lung disease that beryllium exposure can cause?

A
  1. beryllium sensitisation - allergic disease
  2. acute beryllium disease - acute pneumonitis
  3. chronic beryllium disease - chronic granulomatous disease similar to sarcoidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which occupation is affected by silicosis?

A

coal miner (& foundries + sandblasting)

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

What are 2 types of lung disease coal miners can get?

A

silicosis, coal workers’ pneumoconiosis

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

What are 2 types of coal workers’ pneumoconiosis?

A
  1. simple coal workers’ pneumoconiosis (asymptomatic)
  2. progressive massive fibrosis (if associated with RA = Caplan’s syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the management of whooping cough (Bordetella pertussis)?

A

Azithromycin or clarithromycin if onset within last 21 days; admit infants <6 months. Notifiable disease. Prophylaxis to household contacts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 3 phases of whooping cough?

A
  1. Catarrhal phase - similar to viral URTI, 1-2 weeks
  2. Paroxysmal phase - cough worsens, inspiratory whoop 2-8 weeks
  3. Convalescent phase - cough subsides over weeks to months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the school exclusion rules for whooping cough?

A

48h after started antibiotics or 21 days after onset of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the vaccination guidance for whooping cough in pregnancy?

A

All pregnant women 16-32 weeks should be offered vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the inheritance pattern of alpha-1 anti-trypsin deficiency?

A

autosomal recessive / co-dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What will an obstructive picture on spirometry (e.g. COPD) show?

A

reduced FEV1, reduced FEV1/FVC <0.7, normal FVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can the liver be affected in A1AT deficiency?

A

cirrhosis and hepatocellular carcinoma in adults, cholestasis in children

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

What are the different types of alleles and genotypes for A1AT deficiency?

A

alleles classified by electrophoretic mobility - M = normal, S= slow, Z = very slow
PiMM = normal
PiMZ = heterozygous
PiSS = 50% normal A1AT levels
PiZZ = 10% normal A1AT levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the pathophysiology of A1AT deficiency?

A

A1AT is a protease inhibitor normally produced by the liver; protects cells (including alveoli) from enzymes such as neutrophil elastase. When deficient leads to panacinar emphysema most marked in lower lobes

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

What will chest CT often show in silicosis?

A

bilateral upper lobe lung nodules and eggshall calcification of lymph nodes

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

What are 2 cardiac effects of carbon monoxide poisoning?

A
  1. tachyarrhythmias
  2. myocardial ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are 5 neurologic changes seen in carbon monoxide poisoning?

A
  1. hemi- and monoplegia
  2. cerebellar signs
  3. parkinsonism
  4. akinetic mutism
  5. coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What deramtological changes may be seen in carbon monoxide poisoning?

A

cherry-red colour of the skin and mucosa (not cyanosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are 6 risk factors for COPD?

A
  1. tobacco smoking
  2. occupational exposure - dusts, fumes, chemicals
  3. air pollution
  4. genetics - A1ATD
  5. Lung development - maternal smoking, severe RTI in childhood
  6. Asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How is COPD severity categorised?

A
  • Stage 1 - Mild: FEV1 >80%
  • Stage 2 - Moderate: 50-80%
  • Stage 3 - Severe: 30-50%
  • Stage 4 - Very severe - <30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What ENT manifestation can occur with Mycoplasma pneumonia?

A

bullous myringitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which atypical pneumonia may be associated with diarrhoea?

A

Legionella

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

What is the commonest cause of acute bronchitis?

A

virus (rhinovirus, enterovirus, influenza, parainfluenza, coronavirus)

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

What is the recommended antibiotic treatment for low severity CAP?

A

Amoxicillin first-line - 5 days

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

What is the management for moderate to high severity CAP?

A

Amoxicillin + macrolide 7-10 day course (consider co-amoxiclav / ceftriaxone / tazocin if severe)

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

What are the discharge criteria post admission with CAP?

A

Delay discharge if have 2 or more in last 24h of:
* fever > 37.5
* resp rate > 24
* HR > 100
* SBP < 90
* sats < 100% RA
* confusion
* unable to eat without assistance

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

What are 3 factors which may improve survival in COPD?

A
  1. Smoking cessation (number 1)
  2. LTOT
  3. Lung volume reduction surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the benefits of ICS therapy in COPD?

A

Reduces frequency of exacerbations

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

What are the 2 criteria for considering a PDE-4 inhibitor E.g. roflumilast for COPD?

A
  • Severe COPD - FEV1 after bronchodilator < 50%
  • 2 or more exacerbations in past 12 months despite triple therapy with LAMA, LABA and ICS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are 7 criteria for a patient with COPD to be started on azithromycin prophylaxis?

A
  • don’t smoke
  • continued exacerbations
  • on optimum standard therapy
  • CT thorax to exclude brinchiectasis
  • sputum culture to exclude atypical infection and TB
  • ECG for QTc
  • LFTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are 6 CXR findings in mesothelioma?

A
  1. obliteration of diaphragm
  2. nodular thickening of pleura
  3. decreased size of involved chest
  4. radiolucent sheetlike encasement of pleura
  5. loculated effusion >50% of patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How is a diagnosis of mesothelioma made?

A

pleural biopsy

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

What is the management of mesothelioma?

A

symptomatic only - palliative surgery (extrapleural pneumonectomy, plerectomy + decortication)

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

What features may be seen on HRCT in IPF?

A
  • bilateral interstitial shadowing - small, irregular, peripheral opacities ‘ground glass’
  • progresses to honeycombing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are 2 blood tests which may be positive in IPF?

A
  • ANA +ve 30%
  • RF +ve 10%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are 4 aspects of the management of pulmonary fibrosis?

A
  1. pulmonary rehabilitation
  2. antifibrotics - pirfenidone, nintendanib
  3. supplementary O2
  4. lung transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the 3 criteria for a patient with COPD to have a rescue pack (short course oral steroids + oral abx) at home as part of exacerbation action plan?

A
  1. 1 exacerbation in last year + remain at risk of exacerbations
  2. understand + confident re when + how to take, + associated benefits / harms
  3. know to tell healthcare professional when they have used the medicines, + ask for replacements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are 4 organisms commonly implicated in bronchiectasis?

A
  1. Haemophilus influenzae (most common)
  2. Klebsiella
  3. Pseudomonas aeruginosa
  4. Streptococcus pneumoniae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the commonest cause of bronchiectasis today in children + young adults?

A

cystic fibrosis

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

What proportion of patients with bronchiectasis have digital clubbing?

A

50%

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

What may be seen on CXR in bronchiectasis?

A

‘tram tracking’ appearance of dilated lower lobe bronchi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What are 7 things that management of bronchiectasis involves?

A
  1. prolonged use of antibiotics
  2. postural drainage + chest physio
  3. inhaled steroid
  4. surgery to treat localised bronchiectasis
  5. antibiotics - exacerbations + long term
  6. bronchodilators - selected cases
  7. immunisations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the equation used to calculate anion gap?

A

[sodium + potassium] - [bicarbonate + chloride]

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

When is an anion gap useful in interpreting ABGs?

A

metabolic acidosis - normal vs raised have different causes

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

What are 5 causes of a metabolic acidosis with normal anion gap?

A
  1. GI bicarb loss: diarrhoea, ureterosigmoidostomy, fistula
  2. renal tubular acidosis
  3. drugs e.g. acetazolamide
  4. ammonium chloride injection
  5. Addison’s disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are 5 causes of a metabolic acidosis with normal anion gap?

A
  1. lactate: shock, hypoxia
  2. ketones: diabetic ketoacidosis, alcohol
  3. urate: renal failure
  4. acid poisoning: salicylates, methanol
  5. 5-oxoproline: chronic paracetamol use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the range for a normal anion gap?

A

8-14 mmol/L

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

What is the management of primary pneumothorax?

A
  • if rim of air <2cm and no SOB - consider discharge
  • if >2cm OR SOB - needle decompression (aspiration) - if fails chest drain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the management of secondary pneumothorax?

A
  • if <1cm - give O2 and admit for 24h
  • if rim of air 1-2cm, no SOB - aspiration
  • if >2cm or SOB - chest drain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the first line management of iatrogenic pneumothorax?

A

majority resolve with observation - if treatment required, aspiration used

62
Q

What is the management of persistent / recurrent pneumothorax?

A

VATS (video-assisted thoracoscopic surgery) - for mechanical / chemical pleurodesis +- bullectomy

63
Q

What is the guidance for aeroplane travel in PTX?

A
  • patients may travel 2 weeks after successful drainage if no residual air
  • BTS now recommend can fly 1 week post CXR (previously 6 weeks)
64
Q

What is the guidance for scuba driving in PTX?

A

driving should be permanently avoided unless patient has had bilateral surgical plerectomy + normal lung function and chest CT

65
Q

What are 3 indications per the BTS for placing a chest drain in a pleural effusion?

A
  1. frankly purulent or turbid/cloudy fluid on tap
  2. presence of organisms identified by Gram stain and/or culture
  3. pleural fluid pH < 7.2 with suspected pleural infection
66
Q

How should pleural aspiration be performed for a pleural effusion?

A

US guided, use 21G need and 50ml syringe

67
Q

What are 5 things that pleural fluid should be sent for following aspiration of pleural effusion?

A
  1. pH
  2. protein
  3. lactate dehydrogenase (LDH)
  4. cytology
  5. microbiology
68
Q

What are Light’s criteria for exudate/transudate?

A
  • Protein: < 25g/L is transudate, > 35g/L is exudate
  • if 25-35g/L, exudate is:
    1. pleural fluid protein / serum protein >0.5
    2. pleural fluid LDH / serum LDH >0.6
    3. pleural fluid LDH more than 2/3 upper limits of normal serum LDH
69
Q

What are 2 things that a low pleural fluid glucose could suggest is the underlying cause?

A
  1. rheumatoi arthritis
  2. tuberculosis
70
Q

What are 2 things that a raised pleural fluid amylase could suggest is the underlying cause?

A
  1. pancreatitis
  2. oesopahgeal perforation
71
Q

What are 3 things that heavily blood-stained pleural fluid could suggest is the underlying cause?

A
  1. mesothelioma
  2. pulmonary embolism
  3. tuberculosis
72
Q

What are 4 options for managing recurrent pleural effusion?

A
  1. recurrent aspiration
  2. pleurodesis
  3. indwelling pleural catheter
  4. drug maangement to allevaite symptoms e.g. opioids to relieve dyspnoea
73
Q

For how long should nicotine replacement therapy, buproprion or varenicline be prescribed?

A

until 2 weeks after target stop date
* NRT - usually after 2 weeks
* buproprion + varnicline - after 3-4 weeks

74
Q

When should a further prescription of NRT/varenicline/bupropion be provided beyond 2 weeks after the patient’s target stop smoking date?

A

only in patients who have demonstrated their quit attempt is continuing

75
Q

Can combinations of NRT/varenicline/bupropion be used?

A

no - shouldn’t be offered in any combination

76
Q

What are 3 adverse effects of NRT?

A
  1. nausea + vomiting
  2. headaches
  3. flu-like symptoms
77
Q

What type of prescription of NRT do NICE recommend in people with high level of dependence / single form inadequate?

A

combination of patches + another form (e.g. gum, inhalator, lozenge or nasal spray)

78
Q

What is the mechanism of action of varenicline?

A

nicotinic receptor partial agonist

79
Q

When should varenicline be started in relation to the target smoking stop date?

A

1 week before

80
Q

What is the recommended course of treatment of varenicline?

A

12 weeks

81
Q

What are 5 adverse effects of varenicline?

A
  1. use with cation in h/o depression / self-harm ?increase in suicidal behaviour
  2. nausea (commonest)
  3. headache
  4. insomnia
  5. abnormal dreams
82
Q

Which smoking cessation therapy should be used in caution in patients with a history of depression?

A

varenicline

83
Q

When is varenicline contraindicated?

A

pregnancy and breastfeeding

84
Q

What is the mechanism of action of bupropion?

A

noradrenaline and dopamine reuptake inhibitor, and nicotinic antagonist

85
Q

When should bupropion be prescribed for smoking cessation, in relation to target quit date?

A

1-2 weeks before patient’s target stop date

86
Q

What are 4 contraindications of bupropion?

A
  1. epilepsy (risk of seizures)
  2. pregnancy
  3. breast feeding
  4. eating disorder - relative CI
87
Q

Which smoking cessation therapy is contraindicated in epilepsy?

A

bupropion

88
Q

Which smoking cessation therapy should be used in caution in those with an eating disorder?

A

bupropion - relative contraindication

89
Q

What is done to assess for smoking in pregnant women?

A

all women should be tested for smoking using carbon monoxide detectors

90
Q

Which pregnant women should be referred to NHS stop smoking services?

A

all women who smoke, stopped in the last 2 weeks, or with CO Reading 7 ppm or above

91
Q

What are the first-line stop smoking interventions in pregnancy?

A

CBT, motivational interviewing, structured self-help and support from NHS Stop Smoking Services

92
Q

What is the guidance regarding NRT in pregnancy?

A
  • should be used if CBT/MI/structured self help/support don’t work - should remove patches before going to bed
  • evidence is mixed
  • doesn’t affect baby’s birthweight
93
Q

Can varenicline / bupropion be used in pregnancy?

A

no - both CI

94
Q

What are 2 types of metabolic acidosis secondary to high lactate levels?

A
  1. type A: sepsis, shock, hypoxia, burns
  2. type B: metformin
95
Q

Which 3 abx are options to treat exacerbations of chronic bronchitis?

A

amoxicillin or tetracycline or clarithromycin

96
Q

What abx is first line to treat uncomplicated CAP?

A

amoxicillin (doxy or clari if allergic, add fluclox if staph suspected e.g. in influenza)

97
Q

What abx is first line in pneumonia caused by atypical pathogens?

A

clarithromycin

98
Q

What abx is first line first HAP acquired within 5 days of admission?

A

co-amoxiclav or cefuroxime

99
Q

Which abx is first line for HAP acquired >5 days after admission?

A

tazocin OR broad spec cephalosporin (e.g. ceftazidime) OR quinolone e.g. cipro

100
Q

What pathology is seen in sarcoidosis on imaging?

A

non-caseating granulomas

101
Q

What are 2 skin changes seen in sarcoidosis?

A
  • lupus pernio
  • erythema nodosum
102
Q

Why is hypercalcaemia seen in sarcoidosis?

A

macrophages inside granulomas cause increased conversion of vitamin D to its active form (1, 25-dihydroxycholecalciferol)

103
Q

What are 3 syndromes associated with sarcoidosis?

A
  1. Lofgren’s syndrome - bilateral hilar lymphadeompathy, erythema nodosum, fever, polyarthralgia - severe form
  2. Mikulicz syndrome - enlarged parotid + lacrimal glands due to sarcoidosis, TB or lymphoma
  3. Heerfordt’s syndrome (uveoparotid fever) - parotid enlargement, fever + uveitis
104
Q

What follow up is required for pleural plaques?

A

they are not malignant (benign), not associated with increased riks of lung cancer/mesothelioma - no followup necessary

105
Q

What is the mechanism of action of rifampicin?

A

inhibits bacterial DNA dependnet RNA polymerase preventing transcription of DNA into mRNA

106
Q

What are 4 adverse effects of rifampicin?

A
  1. potent liver enzyme inducer
  2. hepatitis
  3. orange secretions
  4. flu-like symptoms
107
Q

What is the mechanism of action of isoniazid?

A

inhibits mycolic acid synthesis

108
Q

What are 4 adverse effects of isoniazid?

A
  1. peripheral neuropathy - B6 deficiency (pyridoxine)
  2. hepatitis
  3. agranulocytosis
  4. liver enzyme inhibitor
109
Q

What is the mechanism of action of pyrazinamide?

A

converted by pyrazinamidase into pyrazinoic acid - inhibits fatty acid synthase (FAS) I

110
Q

What are 4 adverse effects of pyrazinamide?

A
  1. hyperuricaemia causing gout
  2. arthralgia
  3. myalgia
  4. hepatitis
111
Q

What is the mechanism of action of ethambutol?

A

inhibits enzyme arabinosyl transferase which polymerises arabinose into arabinan

112
Q

What is are 2 side effects of ethambutol?

A
  1. optic neuritis - check visual acuity before + during treatment
  2. adjust dose in renal impairment
113
Q

What is a general side effect of starting anti-tuberculous therapy?

A

immune reconstitution disease - occurs 3-6 weeks after starting treatment, presents with enlarging lymph nodes

114
Q

What are 3 groups who are treated for TB with directly observed therapy (3x a week dosing regimen)?

A
  1. homeless with active TB
  2. patients likely to have poor adherence
  3. prisoners with active or latent TB
115
Q

What are normal carboxyhaemoglobin levels depending on patient group?

A
  • <3% non-smokers
  • <10% smokers
  • 10-30% symptomatic CO poisoning: headache, vomiting
  • > 30%: severe CO toxicity
116
Q

For how long should oxygen therapy be continued in CO poisoning?

A

until symptoms have resolved (rather than until CO improves on gases)

117
Q

What most commonly causes lung abscess?

A

aspiration pneumonia

118
Q

Is it more typical for lung abscesses to by polymicrobial or monomicrobial?

A

polymicrobial

monomicrobial causes: staph aureus, klebsiella, pseudomonas

119
Q

What intervention may be required for a lung abscess that is not resolving?

A

percutaneous drainage

120
Q

W

What is the commonest genetic abnormality in cystic fibrosis?

A

delta F508 on long arm chromosome 7

121
Q

What are 4 organisms which colonise cystic fibrosis patients?

A
  1. Staphylococcus aureus
  2. Pseudomonas aeruginosa
  3. Burkholderia cepacia
  4. Aspergillus
122
Q

What will spirometry show in idiopathic pulmonary fibrosis?

A
  • normal or increased FEV1/FVC ratio
  • reduced FVC
  • TLCO reduced (impaired gas exchange)
123
Q

What are 2 blood tests that may be positive in idiopathic pulmonary fibrosis?

A
  • ANA positive 30%
  • Rheumatoid factor positive 10%
124
Q

What are 3 aspects of management in idiopathic pulmonary fibrosis?

A
  1. pulmonary rehabilitation
  2. pirfenidone (antifibrotic) in some patients
  3. supplementary O2 and eventually lung transplant
125
Q

What is the average life expectancy in IPF?

A

3-4 years

126
Q

What are 2 indications for 2ww referral for lung cancer?

A
  1. CXR findings suggesting lung cancer
  2. > 40 years with unexplained haemoptysis
127
Q

What are 6 indications for an urgent CXR (wihtin 2 weeks) to assess for lung cancer in patients over 40?

A

2 or more of the following or ever smoked and 1 or more:
* cough
* fatigue
* SOB
* chest pain
* weight loss
* appetite loss

128
Q

Waht are 5 indications to consider urgent CXR (within 2w) for people aged >40 years?

A
  1. persistent or recurrent chest infection
  2. finger clubbing
  3. supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  4. chest signs consistent with lung cancer
  5. thrombocytosis
129
Q

What are 8 causes of restrictive pulmonary function tests?

A
  1. pulmonary fibrosis
  2. asbestosis
  3. sarcoidosis
  4. ARDS
  5. infant respiratory distress syndrome
  6. Kyphoscoliosis e.g. ankylosing spondylitis
  7. neuromuscular disorders
  8. severe obesity
130
Q

What are 4 causes of obstructive lung function tests?

A
  1. asthma
  2. COPD
  3. bronchiectasis
  4. bronchiolitis obliterans
131
Q

What antibiotic should be added to amoxicillin in CAP if staphylococci are suspected e.g. in influenza?

A

flucloxacillin

132
Q

What type of organism is pneumocystic jiroveci?

A

unicellular eukaryote - generally classified as fungus but some consider it a protozoa

133
Q

What is the most common opportunistic infection in AIDS?

A

PCP - pneumocystis jiroveci

134
Q

What is a common complication of PCP pneumonia?

A

pneumothorax

135
Q

What are 3 extrapulmonary manifestations in PCP pneumonia?

A
  1. hepatosplenomegaly
  2. lymphadenopathy
  3. choroid lesions
136
Q

What investigation is often needed to diagnose PCP?

A

bronchoalveolar lavage (BAL) - often sputum fails to show PCP

137
Q

What is the management of PCP pneumonia?

A
  • co-trimoxazole
  • IV pentamidine in severe cases
  • aerosolised pentamidine is alternative
  • steroids if hypoxic
138
Q

Which type of pneumonia is associated with erythema multiforme and erythema nodosum?

A

mycoplasma pnuemonia

139
Q

What are the symptoms of mycoplasmia pneumonia?

A

prolonged and gradual onset, flu-like symptoms precede dry cough

140
Q

What are 4 situations where oxygen therapy should not be used routinely if there is no evidence of hypoxia?

A
  1. myocardial infarction and ACS
  2. stroke
  3. obstetric emergencies
  4. anxiety-related hyperventilation
141
Q

What are 4 features of pneumococcal pneumonia (e.g. Streptococcus pneumoniae)?

A
  1. rapid onset
  2. high fever
  3. pleuritic chest pain
  4. herpes labialis (cold sores)
142
Q

What are 6 drugs that can cause lung fibrosis?

A
  1. amiodarone
  2. cytotoxic: busulphan, bleomycin
  3. methotrexate
  4. sulfasalazine
  5. nitrofurantoin
  6. dopamine receptor agonists: bromocriptine, cabergoline, pergolide
143
Q

What is the best option for symptom control in non-CF bronchiectasis?

A

inspiratory muscle training + postural drainage

144
Q

How should inhaled steroids be tapered down in well-controlled asthma?

A

reduce dose by 25-50%

145
Q

How can you remember the side effects of bupropion / varenicline?

A

BEVD:
bupropion - CI epilepsy / eating disorder
varenicline - CI in depression

146
Q

What are 9 complicatoins of mycoplasma pneumoniae?

A
  1. cold agglutins - can cause haemolytic anaemia, thrombocytopenia
  2. erythema multiforme / erythema nodosum
  3. meningoencephalitis
  4. GBS
  5. bullous myringitis
  6. pericarditis/ myocarditis
  7. hepatitis
  8. pancreatitis
  9. acute glomerulonephritis
147
Q

How is a diagnosis of mycoplasma pneumonia made?

A

mycoplasma serology

148
Q

What will CXR show in mycoplasma pneumonia?

A

bilateral consolidation

149
Q

How are cold agglutins detected in mycoplasma pneumonia?

A

peripheral blood smear may show red blood cell agglutination

150
Q

What is the management of mycoplasma pneumonia?

A

doxycycline or macrolide e.g. clarithromycin

151
Q

What will be seen on CXR in lung abscess?

A

fluid-filled space within an area of consolidation, air-fluid level

DrFeelGood Stuffs (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions