Respiratory Flashcards
What does a FEV1/FVC ratio <70% imply?
OBSTRUCTIVE disease
(Slowing of exploratory flow, so FEV1 is lower, so FEV1/FVC ratio is lowered)
What does spirometry show for a restrictive airway disease?
FEV1 and FVC are both low but IN PROPORTION
Therefore FEV1/FVC ratio remains normal (>75%)
What causes hyper resonant percussion?
Pneumothorax
Emphysema
Most common lung injury following blunt chest trauma?
Pulmonary contusion
How many ribs can you count if hyperinflated CXR?
> 6 anterior OR
10 posterior
Most common examples of:
-Transudative effusion?
-Exudative effusions?
Transudative:
-heart failure
-cirrhosis
-hypoalbuminaemia
-peritoneal dialysis
Exudative
-pneumonia
-malignancy
LIGHT criteria for exudative effusion?
-pleural fluid to serum protein ratio >0.5
-pleural fluid to serum LDH ratio >0.6
-pleural fluid LDH concentration >2/3 upper limit of normal for serum LDH
If 1 or more criteria met = exudative
Bird fancier with fever, malaise, cough. Mild hepatomegaly.
Dx and causative organism?
Psittacosis
Chlamydia psittaci
Symptoms of carbon monoxide toxicity?
Headache
Vertigo
N&V
Altered consciousness
Subjective weakness
confusion
Cardiac - tachyarrhythmias
Neurologic deficits
Cherry red skin colour
NB does NOT cause cyanosis
Triad of Goodpasture’s syndrome
Who typically gets it?
G = glomerulonephritis, anti Gbm
-diffuse pulmonary haemorrhage
-glomerulonephritis
-anti-glomerular basement membrane (anti-GBM) antibodies
Usually young men! (‘Good looking young men!)
Where to perform needle thoracocentesis for tension pneumothorax?
2nd intercostal space, mid-clavicular line
What are the characteristic cells of Hodgkin’s lymphoma?
Reed-Sternberg cells
Alcohol-induced pain at sites of nodal disease is specific for what disease?
Hodgkin’s disease
Staging system for Hodgkin’s?
ANN ARBOR
50 y/o with myasthenia gravis has mass on CXR behind sternum. Dx?
Thymoma
Only thing parents can do to reduce child’s risk of asthma?
BREAST FEED!
First choice antibiotics options for IECOPD (no allergies) 3 options
Amoxicillin
Doxycycline
Clarithromycin
Younger patient with chronic cough, excess sputum production and repeated infections.
Dx?
Bronchiectasis
25 y/o, hyperventilating, nausea, tinnitus. Dx?
Salicylate poisoning!
MRC scale for SOB Grades 1-5 are?
1 - no SOB except strenuous exercise
2 - SOB when walking up slight hill or hurrying on a level
3 - walk slower than contemporaries, or stop for breath when walking own pace
4 - stops for breath after walking 100m or after few mins on level ground
5 - too SOB to leave house, or SOB when dressing & undressing
Common organisms of HAP?
Strep pneumoniae
Haemophilus influenzae
Pseudomonas aeruginosa
Characteristic CXR finding for sarcoidosis?
Bilateral hilar lymphadenopathy
What test to confirm diagnosed of COPD?
POST-bronchodilator spirometry
Suspected asthma- what is the initial most appropriate management plan?
Trial of short acting B2 agonist and inhaled corticosteroid
White coating on tongue from inhaler steroid. Bleeds when scraped off. Cause?
Candida Albicans
Lobar pattern of infection and Rust coloured sputum. Organism causing pneumonia?
Streptococcus pneumoniae
Site for chest drain?
5th intercostal space, mid-axillary line
Which cancer are you most at risk of developing with asbestosis?
LUNG cancer
Chronic cough, excess petulant sputum and repeated chest infections - Dx?
Tried for BRONCHIECTASIS!
First drug choice for HAP?
Co-amoxiclav (Augmentin) 500/125mg TDS
Best method for biopsy of suspected lung cancer?
Bronchoscopy and biopsy
Retired miner with SOB. CXR shows upper lobe nodules and CT shows ‘eggshell’ calcification of lymph nodes. Dx?
Silicosis
In asthma, what happens to
FEV1
FVC
FEV1/FVC
Obstructive- both FEV1 disproportionately reduced, therefore FEV1/FVC ratio decreased
Type of cancer that can cause flushing?
Carcinoid tumour
Post-op patient, pyrexial, tachypnoeic, reduced breath sounds bibasally. Dx?
Postoperative basal atelectasis
Which lung cancer is most associated with hypercalcaemia?
Squamous cell carcinoma
Painful cheek lesions after BCG vaccine at school, Dx?
Lupus vulgaris
30 y/o Afro-Caribbean pt with cough and ‘BL hilar lymphadenopathy’ Dx?
Sarcoidosis
(Commonest in black women aged 20-40)
Retired miner, with ‘multiple nodules of varying sizes throughout lung fields’ Dx?
Caplan’s syndrome
(Pulmonary fibrosis, usually in coal miners who have rheumatoid arthritis!)
Examples of atypical pneumonia causative organisms?
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumoniae
Common in young adults living in close proximity ie uni students !
Common causative organisms for HAP / ventilation-associated pneumonia?
Pseudomonas aeruginosa
E. coli
1st line treatment for COPD?
SABA ie salbutamol or SAMA ie ipratropium
2nd line of treatment for COPD if still symptomatic with SABA/SAMA
-if not asthmatic features
-if asthmatic features
If NO asthmatic features - LABA ie formeterol & LAMA ie tiotropium
If asthmatic features - LABA ie salmeterol & ICS ie fluticasone
Patient with small cell lung carcinoma, has weakness in proximal arms which improves with exercise. Absent reflexes in upper limbs. Dx?
Lambert-Eaton syndrome!
(Due to abnormality in acetylcholine release)
‘Improves with eating’ = Lambort-Eaten!
Differences between sarcoidosis and idiopathic pulmonary fibrosis on CXR?
Sarcoidosis - bilateral pulmonary infiltrates - predominantly UPPER lobes
IPF - bibasal, reticular shadowing
What syndrome can a Pancoast’s tumour lead to and what are the symptoms?
Pancoast’s tumour = apical lung neoplasm
Invades surrounding tissues - ipsilateral invasion of cervical sympathetic plexus - HORNER’s syndrome - miosis, enopthalmos, ptosis
May get brachial plexus invasion - shoulder/arm pain, wasting of intrinsic hand muscles, paraesthesia
More rarely - recurrent laryngeal nerve palsy - hoarse voice
First line treatment for COPD?
SABA ie Salbutamol
Or
SAMA ie Ipratropium bromide
First line treatment for COPD?
SABA ie Salbutamol
Or
SAMA ie Ipratropium bromide
2nd line treatment for COPD after SABA/SAMA if still getting symptoms
-If NO FEATURES OF ASTHMA:
LABA (ie Salmeterol/formeterol)
+
LAMA (ie Tiotropium)
If FEATURES OF ASTHMA:
LABA
+
ICS
2 scores for sleep apnoea
Epworth sleepiness scale
And
STOP-Bang questionnaire
Causes of respiratory alkalosis
4 Ps!
Panic attack
Pain
PE
Pneumothorax
Causes of respiratory acidosis?
Hypoventilation, secondary to:
-resistance from obstruction ie COPD
-reduced compliance ie obesity, rib #s, pneumonia
-reduced strength of Resp muscles ie MND, Guillain-Barré
-Drugs that reduce respiratory drive ie opiates
Causes of metabolic acidosis with:
-high anion gap?
-normal anion gap?
Anion gap formula ?
High anion gap (usually due to increased production or reduced extraction of H+):
-DKA
-Lactic acidosis
-Aspirin overdose
-Renal failure
Normal anion gap (normally due to loss of HCO3- which is replaced by Cl):
-GI loss is diarrhoea/ileostomy
-Renal tubular disease
-Addison’s disease
Anion gap formula = (Na + K) - (Cl + HCO3)
Causes of metabolic alkalosis?
-GI loss ie vomiting
-Renal loss of H+ ions, ie diuretics, heart failure, nephrotic syndrome, cirrhosis
When (in terms of how much patience is using their SABA) should you go up a stage of the asthma treatment?
If using more than 3 doses of SABA per week
Steps of asthma treatment
1) as needed SABA
2) Add low-dose ICS
3) Add LABA (fixed dose or MART)
4) Add LRTA or increase ICS
Most common inherited disease in white populations?
Cystic fibrosis !
What happens to sweat in CF?
High SODIUM
Difference in mechanism between type 1 and type IV reactions? Examples?
1 (IgE) rapid within 30 mins ie atopic disorders, allergies to pollen
Type 4 - (lymphocytes) secondary cellular response , ‘ 48-72 hours after exposure or allergic contact dermatitis
First line tx for ADHD in children?
Methylphenidate
Triad of symptoms in ADHD?
Inattention
Hyperactivity
Impulsivity
