Respiratory Flashcards

1
Q

which conditions cause a predomnant apical distribution of fibrosis

A
S CHART P
S: sarcoidosis, silicoiss
C: coal worker's pneumonconiosis
H: hypersensitivity penumonitis
A: Aspergillosis, ankylosing spondylitis
R: radiation
T: Tuberculosis
P: psoriasis
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2
Q

which conditions causes a predominant basal fibrosis

A

IDC AR , D: HAM
Idiopathic pulmonary fibrosis
Drugs:amioderon, hydralazine, methotrxate
Connective tissue disease
Asbestosis
Rheumatological disease (except ankylosing spondylitis and psoriasis)

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3
Q

causes of clubbing

A
Respiratory: 
1. lung carcinoma( usually not small cell carcinoma)
2. chronic pulmonary suppuration(bronchiectaiss, lung abscess, empyema)
3. pulmonary fibrosis, asbestosi
4. cystic fibrosis
5. pleural fibroma or mesothelioma
6. mediastinal disease (lymphoma, carcinoma)
Cardiovascular:
1. infective endocarditis
2. cyanotic congenital heart disease
other:
inflammatory bowel disease
cirrhoissi
coeliac disease
thyrotoxicosis
brachial arteriovenous aneurysm
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4
Q

causes of transudate pleural effusion (pleural:serum protein <0.6)

A

cardiac failure, nephrotic syndrome, liver failure, hypothyroidism

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5
Q

causes of exudate pleural effusion (pleural:serum protein >0.5, or pleural LDH>2/3 upper limit of normal or pleural :serum >0.6

A

pneumonia, neoplasm, TB, sarcoidosis, pulmonary infarction, subphrenic abscess, pancreatitis, connective tissue disease-RA, SLE, drugs,radiation

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6
Q

Durgs approved for the treatment of PAH

A
  1. endothelin receptor antagonist: bosentan,and ambrisentan
  2. the phosphodiesterase inhibitors, sldenafil and tadalafil
  3. the prostanoids, intravenous epoprostanol and inheled iloprost
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7
Q

What are the radiologic signs of ILD

A

Chest X ray IPF
volume loss, reticulation with a lower lobe and peripheral preference.
HRCT findings in Interstitial Fibrosis
• Honeycombing , multilayered thick-walled cysts.
• Architectural distortion with traction bronchiectasis due to fibrosis.
• Predominance in basal and subpleural region.
• Mild mediastinal lymphadenopathy

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8
Q

What are the radiologic signs of PAH

A

Pulmonary HT
Pulmonary arterial hypertension is defined as a mean pulmonary arterial pressure exceeding 25 mmHg at rest 11 or >30 mmHg with exercise and pulmonary capillary wedge pressure ≤15 mmHg measured by cardiac catheterisation
X ray
• enlarged pulmonary arteries
• pruning of peripheral pulmonary vessels

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9
Q

what are the radiologic sings of bronchiectasis

A

bronchus visualised within 1 cm of pleural surface
lack of tapering
increased bronchoarterial ratio (diameter of a bronchus >artery>1.5 indicate bronchiectasis)
ancillary findings:
bronchial wall thickening (normally wall of bronchus

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10
Q

treatment of interstitial lung disease

A

1 prednisolone, 1mg/kg/day, half this after 4-12 weeks

  1. immunosuppressive, azathioprine with low does steroids, may benefit
  2. antifibrotic agents are under trial: pirfenidone reduces lung decline
  3. colchicine 0.6mg inhibits macrophage production of fibroblast growth factor, efficacy is controversial
  4. N-acetylcystine in combination iwth immunosuppression reduces deterioration o flund funtion
  5. treat underlying GORD
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11
Q

what is the differential diagnosis of dullness and dull percussion note at a lung base?

A
pleural effusion
pleural thickening
collapse
consolidation
raised hemidiaphragm
lower lobe lobectomy(in the presence of thoracotomy scar)
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12
Q

what are the cause of a haemorrhagic pleural effusion

A

malignancy
pulmonary embolus
Tuberculosis
chest trauma

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13
Q

if the pleural fluid LDH>1000IU/L, what would be that suggest

A

Empyema
malignant effusion
rheumatoid effusion

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14
Q

what are the causes of low glucose concentration in pleural fluid?

A
malignancy
empyema
Tuberculosis
oesophageal rupture
rheumatoid arthritis
SLE
(same as the PH
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15
Q

what are the causes of a chylothorax

A

lymphatic obstruciton
lymphatic damage
Nephrotic syndrome
cirrosis

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16
Q

what are the differenctial diagnosis of productive cough, coarse crackles and clubbing

A

bronchiectasis
carcinoma of the lung
lung abcess
pulmonary fibrosis

17
Q

where the bronchial breath sound present? (brachial breath sound has prolonged expiratory phase and has a blowing quality)

A

nomral: over the trachea and right, left main bronchi
causes:
lobar pneumonia
localised fibrosis or collapse
above a pleural effsuion
large lung cavity

18
Q

what are the causes of bronchiectasis?

A
respiratory childhood infections
- pertussis
- measles
- tuberculosis
bronchial obstrucitons
-foreighn body
- chronic aspiration
- endobronchial tumour
- lymph nodes
- granulomata
fibrosis
- long standing pulmonary fibrosis
fibrosis complicating TB and sarcoidosis
- fibroiss complicating unresolved or suppurative pneumonia
Muco-cilliary clearanc defects
- cystic fibrosis
-immotile cilia syndorme
immunodeficiency
- hypogammaglobulinaemia
- acquired immunodeficiency syndrome
allergic bronchopulmonary aspergillosis
autoimmune disease
- rheumatoid arthritis
-sjogren syndrome
-inflammatory bowel diseaes
congenital anatomical defects
idiopathic
19
Q

what are the possible indications for a lobectomy

A
bronchiectasis 
malignancy
solitary pulmonary nodule
cystic fibrosis
tuberculosis
lung abscess
20
Q

what are the possible indicaitons for pneumonectomy?

A

bronchiectasis
malignancy
tuberculosis

21
Q

waht are the causes of a cavitating lung lesion?

A
infectious cuases:
- staphlococcus aureus
- klebsiella pneumonia
- TB
- aspergilloma
- pseudomonas aeruginosa
- Anaerobic infections
Non-infectious causees:
- Malignancy
- Granulomatosis with polyangiitis
- pulmonary rheumatoid nodule
22
Q

what are the extrapulmonary manifestation of mycoplasma pneumonia?

A
Neuological
- aseptic menigitis
- encephalitis
-transverse myelitis
-Guillain- barre sydnrome
- cranial and peripheral neuropathy
cardiac
- myocaiditis
- pericarditis
rheumatological
- arthralgia
-myalgia
-myositis
haematological
-thrombocytopenia
-cold autoimmune haemolytic anaemia
- DIC
gastrointestinal
- diarrhoea
- vomiting
- hepatitis
- pancreatitis
dermatological
- eyrthema nodosum
- erythema mulfiform
- steven-johnson syndrome
endocrine
- SIADH
renal
- glomerulonephritis
-interstitial nephritis
23
Q

what are the eCG features of PE

A
sinus tachycardia
tall R in V1
right ventricular strain
right bundle branch block
T wave inversion in V1-V3
S1Q3T3
inferior ST elevation
24
Q

what are possible cause of collapse?

A

malginancy(cachexia, clubbing, nicotine staining, lymphadenopathy
tuberculosis (apical signs,lymphadenopathy)
Hilar lymphadenopathy (sarcoidosis, erythema nodosum,
Mucus plugs ( features of asthma, COPD, or bronchiectasis)

25
Q

Hyper inflated lung

A
Reduced chest expansion
Distance reduced
Hyper Resonance on percussion
Intercostal recession
Distant heart 
Barrel shape chest 
Chest x Ray: 
Flattered diaphragm 
Increased intercostal space
More than 6 anterior ribs