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Phase 4 > Respiratory 2 > Flashcards

Respiratory 2 Flashcards

1
Q

List some differentials for finger clubbing:

A

Increased soft tissue swelling, with loss of the hyponychial angle

Thoracic :

  • TB
  • Emphysema
  • Cystic fibrosis
  • Lung cancer
  • Pulmonary fibrosis

Cardio:

  • Infective heart disease
  • Congenital heart disease

G.I

  • Inflammatory bowel disease
  • Cirrhosis
  • celiac disease
  • lymphoma

Endocrine:
- thyroid disease

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2
Q

List some causes of haemoptysis:

A 
Lung cancer 
Acute bronchitis 
TB 
Pulmonary infarction 
Goodpastures disease 
Granulomatous polyangiitis
Acute left ventricular failure
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3
Q

What investigations should be done into haemoptysis?

A

Bloods:

  • FBC
  • Coagulation screen

Orifices:
- sputum smear

  • Bronchoscopy

X-ray:

  • CXR
  • CT
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4
Q

Following an x-ray of a pleural infusion, what next test should be done to establish it?

A

Ultrasound

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5
Q

What is light’s criteria?

A

> 30g protein
Pleural protein: Serum Protein >0.5
Pleural LDH: Serum LDH >0.6
Pleural LDH upper 1/3rd of normal

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6
Q

What are the general causes of restrictive lung diseases?

A

Interstitial disease

Thoracic cage reduction
- Kyphosis

Neuromuscular conditions

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7
Q

Name some symptoms and clinical signs that are seen with interstitial lung disease:

A

Progressive dyspnoea

Dry cough

Reduced exercise capacity

Finger clubbing

Restrictive pattern

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8
Q

Prior to discharge of an asthma attack what must the patient have?

A 
>75% PEF 
On discharge medication for 24 hours 
Inhaler technique checked 
GP follow up in 2 days 
Respiratory clinic in 1 month
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9
Q

When diagnosing COPD and there is evidence of Cor pulmonale, what additional tests should be ordered?

A

Echocardiogram

ECG

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10
Q

When can long term O2 therapy be started in COPD?

A

kPa O2 <7.3
- need 2 separate occasions to be seen for this

kPa O2 <8 + polycythemia, cor pulmonale,

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11
Q

What are some features of cor pulmonale?

A

Peripheral oedema
Raised JVP
Right ventricular heave
Second heart sound

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12
Q

When someone comes in with an exacerbation of COPD what questions do you want to know?

A

usual treatment at home and adherence

Normal exercise tolerance

Allergies to medication

Has this occurred before - and if so what was the treatment course?

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13
Q

Signs of hypercapnia?

A 
Hand flapping 
Flushing 
Vasodilation 
Bounding pulse 
confusion 
Coma 
Papilloedema
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14
Q

What is the target PEF for asthma?

A

> 80%

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15
Q

What is the lung cancer called the develops in the apex of the lung and may cause lung erosion:

A

Pancoast tumour

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16
Q

What may cause round lesions to appear on the lung xray?

A 
Primary lung cancer 
Metastatic lung cancer - renal cell carcinoma 
Rheumatoid nodules 
TB 
Sarcoidosis 
Abscess
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17
Q

What investigations should be done to diagnose lung cancer?

A

Bloods:

  • LFTs (Mets in liver and bone)
  • U&Es (hyponatramia)
  • Bone profile (mets + Ca2+ level for paraneoplastic)

X-rays:
CT/ US guided biopsy

Bronchoscopy for biopsy or wash for cytology

PET Scan

CT Chest/ Abdo/ Pelvis
- check adrenals

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18
Q

List the causes of atypical pneumonia:

A

Legionella Pneumophila

Chlamydia Psittaci (birds)

Chlamydia Pneumoniae

Mycoplasma Pneumoniae

Coxiella Burnetii

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19
Q

What are the indications that lung tumours are operable?

A

Unilateral
No involvement of the major vessels
Non - distant metastasis
Not within 2cm of the main bronchus

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20
Q

What are the clinical finding of sarcoidosis?

A 
Lupus Pernio 
Erythema nodosum
Anterior uveitis 
Lymphadenopathy 
Hepatosplenomegaly 
Cor pulmonale
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21
Q

What features are taken into account when assessing lung function?

A

Height
sex
Age

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22
Q

Why are investigations are necessary in lung cancer?

A
  • Stage the extent of lung cancer
  • To make tissue diagnosis
  • To assess fitness of patient - for treatment
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23
Q

Whats the most common cancer to metastasis to the lung?

A

No.1 Breast

Colon cancer

Renal cell carcinoma

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24
Q

What are some signs of primary lung cancer?

A 
Dyspnea 
Finger clubbing 
Weight loss
Weakness 
Horner syndrome 
Shoulder pain 
Chest pain
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25
Q

Where does lung cancer spread to?

A 
Hilar lymph nodes 
Brain 
Adrenals 
Bone 
Liver
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26
Q

What is the staging for lung cancer and what does the TNM staging in lung cancer refer to?

A

Squamous cell: TNM

Small cell: Limited, Extensive

Tumour size
Nodal status
Metastasis

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27
Q

What are the symptoms of horners?

A

Miosis
Ptosis
Anhidrosis

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28
Q

How is superior vena cava syndrome managed?

A

Head elevation + diuretics

Stents + radiotherapy

palliative

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29
Q

What are some signs of cor pulmonale?

A 
Oedema 
Right ventricular heave 
Loud Pulmonary second sound 
Raised JVP 
Enlarged liver
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30
Q

What drugs can be used to reduce secretion/ mucus production? and are especially helpful with COPD?

A

Carbocysteine

Physiotherapy chest

Neb Saline
- used short term and usually in hospital

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31
Q

What is pulmonary rehabilitation?

A

Retraining how someone breathes. usually in obstructive conditions people breath shallow and fast.
Retraining to take deep inhaled breathes and slow down the breathing

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32
Q

When can long term oxygen therapy be started in COPD?

A

PaO2 <7.3
or
paO2 7.3-8 with polycythemia, pulmonary oedema or hypertension

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33
Q

What are some additional therapeutics effects for COPD outwith inhalers?

A

Vaccines

Sensation of breathlessness

  • Pulmonary rehabilitation
  • Dihydrocodeine

Secondary polycythemia
- venesection

Surgery

  • bullectomy
  • Lung reduction volume surgery
34
Q

Why are COPD patients more likely to get pneumothoraces?

A

due to the bullae formation - which is essentially large amounts of alveoli clumped together. this increase tension and leads to an increased likelihood of rupture.

35
Q

During COPD exacerbation what should the venturi mask oxygen sats be at?

A

24%

36
Q

What are poor prognostic factors in COPD?

A

Age

FEV1

37
Q

What drug can be used as a CNS stimulator in obstructive sleep apnea?

A

Modafinil

38
Q

List some causes of restrictive lung disease:

A

Parenchymal:

  • IPF
  • Sarcoidosis

Pleural:
- Pleural effusion

Chest wall:

  • Kyphoscoliosis
  • AS

Neuromuscular:

  • Myasthenia gravis
  • MND
  • Guillain Barre syndrome

Vascular:
- Vasculitis - Anti- GBM

39
Q

What are the histological findings on sarcoidosis?

A

Non-caseating granulomas with well defined borders

40
Q

How does a pleuritic rub differ from a pericardial rub?

A

It only has a biphasic rub whereas cardiac has triphasic

41
Q

What are the complications of sarcoidosis?

A

Interstitial lung disease

Cor pulmonale

42
Q

What is the acute presentation of sarcoidosis?

A

Lofgren syndrome

Bilateral lymphadenopathy
Fever
Poly arthropathy
Eyrthema nodosa

43
Q

What is described to have egg-shell hilar lymph nodes on x-ray?

A

Silicosis

44
Q

What are the contraindications to BiPAP?

A

Facial trauma
Pneumothorax
Patient wishes

+/-
Cardiac disease
Excessive sputum production

45
Q

Which type of empysema is most associatted with COPD?

A

Centroacinar - dilation is more centred around the terminal bronchioles

Panacinar is more associated with Alpha 1 antitrypsin deficiency

46
Q

What are the three mechanisms by which there is airflow limitation in COPD?

A

Loss of elasticity
Mucus plugging
Inflammation and scarring of the small airways

47
Q

What are the signs of COPD?

A

Tachypnoeic
Prolonged expiration
Intercostal indrawing during inspiration
Pursing of lips during exhalation
Poor chest expansion
Loss of normal cardiac and liver dullness

48
Q

Findings of cor pulmonale:

A

Right Ventricular Heave

Loud pulmonary second sound

JVP raised

Tall P wave

49
Q

How long does oxygen therapy need to be given for in COPD to provide a significant impact on mortality?

A

19 hours daily

50
Q

What are the mechanisms behind reduced oxygen saturations during sleep - which can significant impact on COPD patients?

A

Inhibition of accessory muscles such as the intercostals and sternocleidomastoid muscle during REM

Shallow breathing - especially during REM

Increased upper airway obstruction due to loss of tone

51
Q

What are the guidelines regarding receiving oxygen?

A

COPD <7.3paO2

Cystic fibrosis <7.3 paO2

Neuromuscular disorders

Pulmonary malignancy

Heart failure <7.3paO2

52
Q

What two sets of people get obstructive sleep apnea?

A

Overweight middle aged men

Children with enlarged adenoids

53
Q

Symptoms of sleep apnea?

A 
Snoring 
Daytime sleepiness 
Unrefreshed sleep 
Restless sleep 
Morning headache 
Nocturnal choking 
Morning drunkness
54
Q

What endocrine disorder may be implicated with obstructive sleep apnea?

A

Acromegaly

55
Q

On a pulse oximetry used for sleep apnea, what would you expect to see?

A

Saw tooth appearance

56
Q

What is a differential for obstructive sleep apnea?

A

Central Sleep apnea

57
Q

What may be seen on CXR of bronchiectasis?

A

Tram track lining

Ring shadows

Cysts

58
Q

Name a drug used to help quit smoking and its mechanism of action:

A

Varenicline

  • partial nicotinic partial receptor agonist
  • contraindicated in pregnancy and breast feeding

Bupropion

  • noradrenaline and Serotonin uptake inhibitor
  • contraindicated in pregnancy and epilepsy
59
Q

Which two types of pneumonia have antigens in the urine?

A

Pneumococcal

Legionella

60
Q

How long following pneumonia are people usually back to normal?

A

6 months

61
Q

What are the three main types of asthma?

A

Extrinsic

  • childhood
  • atopy

Intrinsic

  • Adulthood
  • does not repsond well to treatment

Occupational

62
Q

What are the key features of asthma?

A

Hyperresponsiveness of the bronchi

Bronchi inflammation

Airflow limitation

63
Q

What are some triggers for asthma:

A

Beta blockers
Aspirin

Cold

Exercise

Dust

Infection **

Perfumes

Cold Damp

64
Q

What are the associated symptoms of asthma?

A

Atopy

  • eczema
  • Hayfever

Night time symptoms

Acid reflux

Disturbed sleep

65
Q

What are the main investigations into asthma?

A

Fractional Exhaled Nitric oxide (eosinophils produce lots of NO)
Spirometry with reversibility

PEF variability - diurnal variation
Histamine provocation

66
Q

Outwith inhalers and medication what other treatments should be given to patients with asthma?

A 
Yearly flu jab
Education / inhaler technique 
Stop smoking 
Avoidance of triggers 
exercise programs
67
Q

What are the side effects of ICS?

A

Oral Candidiasis
Hoarseness
Throat infection
Osteoporosis - in high dose

68
Q

What are your differentials for acute asthma?

A 
Pulmonary oedema - cardiac wheeze 
P.E
Pneumothorax 
Pneumonia 
COPD
69
Q

What factors is PEF flow based upon?

A

Age
Height
Sex

70
Q

What is a new inhaler can be used as maintain and reliever and what does it contain?

A

Maintenance and reliever therapy inhaler

  • LABA
  • ICS
71
Q

If there is a lung tumour is within a certain distance of the main bronchi it is deemed inoperable, what is this distance and how is it viewed?

A

2cm proximity of the main bronchus deems the node inoperable.

View via bronchoscope usually

72
Q

What is the main complication of percutaneous biopsy?

A

Pneumothorax

73
Q

What investigations are wanted into lung cancer?

A

Bloods:

  • FBC - anaemia
  • U&Es - Hyponatraemia
  • Calcium - Hypercalcaemia

Orifices:
- Bronchial lavage with cytology

X-rays:

  • CXR
  • CT - staging. Includes adrenals
  • PET Scan

Special tests:
- Bronchoscopy with biopsy
0r
- CT guided biopsy

Assessment of fitness for surgery:

  • Stress Echo
  • Lung functioning - for other lung to deal with
74
Q

What are the treatment options for lung cancer?

A

Surgery
- with curative intent

Radiation therapy for cure

  • used in early NSCLC
  • Continually hyperfractionated accelerated Regimes (CHARTS)

Chemotherapy
- biological therapy

75
Q

What therapeutic interventions can be done for lung cancer in patients that are palliative?

A

Laser therapy
- vaporise parts of protruding tumour

Tracheobronchial stenting
- metal springs

Endobronchial brachytherapy
- used from compressional symptoms

76
Q

Name some benign tumours of the lungs:

A

Pulmonary hamartoma

Bronchial carcinoid

Tracheal tumours

77
Q

What investigations are done on pleural fluid?

A

Biochemistry
Immunology
Cytology
Cultures

78
Q

What FBC would you find in sarcoidosis?

A

Leukopenia
- markedly reduced T cell circulation.

This has no effect on immunity

79
Q

What are the differentials for perihilar mass?

A

Lymphoma
Sarcoidosis
TB
Bronchial carcinoma

80
Q

Main differentials for sarcoidosis:

A

Idiopathic pulmonary fibrosis
Tuberculosis
Pneumoconiosis
Lung cancer

81
Q

What are the drugs that can cause interstitial lung disease:

A

Nitrofurantoin

Methotrexate

Sulphasalazine

Amiodarone

ACE inhibitors

Methadone

Radiotherapy

Phase 4 (49 decks)

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