Respiratory Flashcards
What is atelectasis?
Collapse of lung tissue with loss of lung volume.
What is atelectasis caused by?
The partial or complete reversible collapse of the small airways resulting in impaired exchange of O2 and CO2
When does atelectasis occur post op?
Within 72h
What is seen on CXR in atelectasis?
Platelike, horizontal lines in the area of atelectatic lung tissue
How does salicylate poisoning present?
Nausea, vomiting, tinnitus, lethargy or dizziness
Moderate = dehydration, restlessness, sweating, warm extremities w/ bounding pulses, increased RR, hyperventilation and deafness
How do we manage salicylate poisoning?
Gastric lavage if within one hour
If plasma levels are high (peak concns at 7hrs), urine alkalinisation and dialysis may be required
What are paraneoplastic syndromes?
Rare disorders that are triggered by an abnormal immune response to a neoplasm
Give three examples of paraneoplastic syndromes
Cushing syndrome (ACTH)
Lambert-Eaton Syndrome
Myasthenic syndrome
Hypercalcaemia (PTH)
SIADH
What is SIADH?
Paraneoplastic syndrome
Cause of hyponatraemia
Linked with SCLC
What is Lambert-Eaton Syndrome?
Autoimmune disorder characterised by muscle weakness of the lower limbs. Most commonly linked with SCLC.
What is the pathophysiology of Lambert-Eaton Syndrome?
It is the result of antibodies against presynaptic calcium channels in the neuromuscular junction.
What is the pathophysiology of myasthenia gravis?
Antibodies that block or destroy nicotinic acetylcholine receptors (AChR) at the neuromuscular junction, leading to varying levels of muscle weakness. Associated with thymomas
What is Pancoast’s syndrome?
An apical malignant neoplasm of the lung. It invades surrounding tissues and produces an ipsilateral invasion of the cervical sympathetic plexus leading to Horner’s syndrome. Brachial plexus invasion can cause shoulder & arm pain, wasting of the intrinsic muscles of the hand and paresthesia in the medial aspect of the arm.
How does carbon monoxide poisoning present?
Headache
Vertigo
N&V
Alteration in consciousness
Subjective weakness
Cherry red skin colour
What is mesothelioma?
Malignant neoplasm originating from pleural or peritoneal surfaces associated with asbestos exposure
What is a moderate acute asthma exacerbation?
PEFR >50-75% of maximum
Normal speech
No aspects of severe or life-threatening asthma attack
What is a severe acute asthma exacerbation?
PEFT 33-50% predicted, RR >25/min, Tachy, inability to complete sentences in one breath, accessory muscle use
What is first-line empirical treatment for non-severe HAP?
Co-amox
What is lupus vulgaris?
Painful cutaneous skin lesions with nodular appearance
Are a consequence of:
BCG vaccination
Direct extension of underlying tuberculous foci
Treated with antitubercular regimen
How do we treat TB?
Isoniazid 16w
Rifampicin 16w
Pyrazinamide 8w
Ethambutol 8w
Which cancer is hypercalcaemia most suggestive of?
Squamous cell carcinoma or multiple myeloma
What is first line in IE COPD?
Steroids (obvs)
Amoxi or doxy or clari
What is bird-fanciers lung?
Psittacosis - caused by infection by Chlamydophila psittaci
Presents as respiratory tract infection
How does oral candidiasis present?
Thick white or cream-coloured deposits
The lesions can be painful and will become tender if rubbed or scraped
Can cause cracking at the corners of the mouth and also cause temporary loss of taste
In which gender is OSA more common?
Men by 2x
What is the initial mx of suspected asthma?
Trial beta agonist and ICS
What is the triad in Goodpasture’s syndrome?
Diffuse pulmonary haemorrhage, glomerulonephritis and circulating anti-GBM antibodies
Usually occurs in young men
What is Wegener’s granulomatosis?
Granulomatosis with polyangitis
What is the most common cause of CAP?
Strep pneumoniae
What are carcinoid tumours?
Most common neuroendocrine tumours, two-thirds of which occur in the GI tract
How do carcinoid tumours present?
Often indolent asymptomatic tumours. Can present with non-specific sx. Can cause carcinoid syndrome if secretes various bioactive compounds
How does carcinoid syndrome present?
Bronchospasm, diarrhoea, flushing, & R-sided valvular heart lesions
How do we dx carcinoid syndrome?
Urinary 5-HIAA, or chromogranin A in liver mets
How do we mx carcinoid syndrome
Medically - somatostatin analogues or radionuclide therapies
Surgically
What are the most common causative organisms of HAP?
Pseudomonas aeroginusa, staph A and enterobacteriae (more specifically Klebsiella, E. coli or Enterobacter spp.)
How do we diagnose COPD?
Post-bronchodilator spirometry
What is haemothorax?
Collection of blood within the pleural cavity
How does haemothorax present?
Most common aetiology is blunt or penetrating trauma
How does haemothorax differ to pneumothorax OE?
Dull to percussion with haemothorax
Hyperresonant in pneumothorax
What is bronchiectasis?
Localised, irreversible dilation of part of the bronchial tree
What causes bronchiectasis?
Usually necrotising bacterial infections eg. staph, klebsiella or bordetella pertussis
What is the most common cause of bronchiectasis, other than encapsulating infection?
CF
What is the triad in bronchiectasis?
Chronic cough, excessive sputum production and repeated infections. Sputum is typically mucoid or purulent with a rancid odour
How do we confirm dx of bronchiectasis?
HRCT
Where do you see barrel chest?
COPD
What is the most common lung injury following blunt chest trauma?
Pulmonary contusion
What is the first-line mx of sarcoidosis?
Steroid for 6-24/12 + oral bisphosphonate
What is Caplan’s syndrome?
Pulmonary fibrosis, most commonly seen in coal miners who have RA. CXR shows multiple well-rounded nodules. Tx = steroids
How does sarcoidosis present?
Young, black woman 20-40
Some asymptomatic, some constitutional sx
On XR you see bilateral hilar lymphadenopathy, or sometimes ILD
Why do you see hypercalcaemia in sarcoidosis?
Produced by calcitriol hypersensitivity of macrophages
Where do you see reticular infiltrates on CXR?
ILD
How do we remove a chest drain?
It should not be removed during inspiration as this creates a pressure gradient which could suck air in and cause a pneumothorax
Where do we use Ziehl-Nielsen stain?
Sputum for acid-fast bacilli, such as TB
How do we manage poorly controlled asthma in a pt taking SABA and ICS?
From a NICE (ie. cost perspective): add LTRA
From a BTS (i.e. effectiveness perspective): add inhaled LABA
What is farmers lung?
A form of hypersensitivity pneumonitis or extrinsic allergic alveolitis where there is a hypersensitivity reaction within the lungs to the spores of thermophilic actinomycetes
What is bullous myringitis?
Present on ear examination, seen in mycoplasma pneumoniae infection
How common is mesothelioma?
Rare - asbestos exposure most commonly causes lung cancer
Which organ system in the body is most commonly affected by sarcoidosis?
Pulmonary
When pleural effusions are aspirated, what are the commonest cause?
Malignancy.
HF is the most common cause of pleural effusions, but these are usually too small to be aspirated
Where do you see Reed-Sternberg cells?
Hodgkin’s lymphoma
How does Hodgkin’s lymphoma present?
Asymptomatic lymphadenopathy
B symptoms (constitutional sx)
Intermittent fevers
CP, cough, SOB
Alcohol-induced pain at sites of nodal disease
How do we stage Hodgkin’s lymphoma?
Ann Arbor staging
Where does the exhaled air go when using a non-rebreathing mask?
Through the one-way valves, not into the reservoir bag
What can be done to reduce the risk of your child developing asthma?
Breast feed!
What is Baker’s lung?
A form of occupational asthma
Where do you see rust-coloured, blood-tinged sputum?
Strep pneumoniae
What causes silicosis?
Inhalation of silica particles (e.g. metal mining, sand blasting)
How do we treat silicosis?
Only cure is lung transplant
Which workers does berylliosis impact?
Aerospace, nuclear, telecommunications, semi-conductor and electrical industries
Where do you see “eggshell” calcification of lymph nodes on CT?
Silicosis, alongside lung nodules predominantly in the upper lobes
What are theophyllines?
PO/IV medications which inhibit phosphodiesterase and block adenosine receptors. It is used to treat chronic obstructive pulmonary disease and asthma.
