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Z MD 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

4 main causes of typical pneumonia

A

pneumococcus

haemophilus influenza

gram neg bacilli

staph aureus

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2
Q

when do you use antibiotics in patients presenting with cough

A

when you have 2 out of 3 symptoms

  • sputum purulence
  • increase in sputum volume
  • increase in dyspnoea
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3
Q

what are parasomnias

A

undesirable behaviour or experiences in sleep or in transition to or from sleep

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4
Q

what is REM behaviour disorder

A

dream enactment behaviour during REM sleep

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5
Q

which common viruses can cause pneumonia

A

influenza, adenovirus, parainfluenza, RSV

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6
Q

4 main drugs for TB treatment and the time course

A

isoniazid

rifampicin

pyrazinamide

ethambutol

  • 6 months (4 drugs for first 2 months and then drop to 2 for the rest of the time)
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7
Q

what are 2 common GI causes of clubbing

A

IBD

primary biliary cirrhosis

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8
Q

which lung cancer is the most common

A

adenocarcinoma

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9
Q

where is the “safety triangle” for chest drainage

A

between pec major, level of the nipple (4th intercostal space), and lat dorsi

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10
Q

signs of right heart failure

A

elevated JVP

elevated V waves

tricuspid regurgitation

significant ankle oedema

ascites

pulsatile liver (tricuspid regurg)

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11
Q

what pathology causes bronchial breath sounds

A

consolidation

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12
Q

how is pneumonia different from other LRTI

A

other LRTIs dont involve the parenchyma, dont have CXR infiltrates, and are most often due to viral infections

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13
Q

why does someone having an exacerbation of asthma purse lip breathe

A

it increases the end expiratory pressure - helps splint the airways open to try and minimise gas trapping and helps empty the lungs

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14
Q

explain the usefullness of D-dimer in confirming PE

A

if negative - high probability it is NOT a PE (good NPP)

if positive - may or may not be a PE (poor PPP)

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15
Q

how does a PE cause hypotension

A

PE –> obstruction to right ventricular outflow –> systemic hypotension

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16
Q

describe the fluctuation of CO with respiration

A

inspiration = pooling of blood on inspiration –> decreased venous return to left heart –> reduced CO

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17
Q

treatment of REM behaviour disorder

A

clonazepam

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18
Q

where does VRE normally live

A

GI tract

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19
Q

What is in seretide

A

fluticasone and salmeterol

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20
Q

explain the histological features and typical location of squamous cell carcinoma

A

keratin swirls

intracellular bridges

central location

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21
Q

management of empyema

A

drainage - Major

antibiotics (to treat underlying cause)

supportive measures treat underlying causes

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22
Q

what should we measure on a sample of aspirated pleural effusion fluid

A

biochemistry - protein, glucose, LDH, pH

cytology

MCS

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23
Q

risk factors for aspiration pneumonia

A

impaired gag reflex (CVA, neuromusclar disease, unconsciousness post overdose, alcohol abuse)

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24
Q

what is the typical pattern of alpha1-AT def COPD on xray

A

LOWER zone emphysema

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25
Q

anaerobic pneumonia is associated with which subset of patients

A

alcohol use

aspiration

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26
Q

gold standard test for PE and actual most commonly used test to confirm PE

A

gold standard = pulmonary angiogram

common = CTPA

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27
Q

how do you optimise function in a COPD patient

A

pulmonary rehab

inhaled therapies

identify and correct hypoxia and/or pHT

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28
Q

what is in symbicort

A

budesonide and eformoterol

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29
Q

2 bacteria and 2 viruses examples of pathogens that are transmitted from indirect contact

A

bacteria - MRSA, VRE

viruses - influenza, norovirus

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30
Q

what causes pleural rub

A

inflammation tumour

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31
Q

lung function confirmation of asthma

A

20% variation day to day of PEF 200ml AND 12% improvement in FEV1 with bronchodilator

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32
Q

what part of the ABG tells you that the acute exacerbation of asthma is very very bad

A

normal CO2 –> means that they are getting respiratory fatigue

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33
Q

how do pulmonary hypertension affect the heart

A

causes right ventricular dilatation and hypertrophy leading to reduced systemic venous pressure and poor cardiac output

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34
Q

how do you treat latent TB

A

one drug for 9 months (isoniazid) - dont give it to those people over 35

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35
Q

explain the difference in presentation between viral and bacterial pneumonia

A

bacterial is often MUCH faster (within hours) while viral can take days

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36
Q

when do you give surgical antibiotic prophylaxis

A
  • if there is significant risk of infection
  • infection has devastating consequences
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37
Q

major causes of haemoptysis

A

chest infection - bronchitis, pneumonia, bronchiectasis, TB

Lung carcinoma

Pulmonary embolus

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38
Q

what pathologies cause reduced breath sounds

A
  • pneumothorax
  • airflow obstruction
  • pleural effusion
  • thick chest wall
  • lung collapse
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39
Q

what is a typical presentation in a pt with MRSA pneumonia

A

cavitatory pneumonia and crash quickly

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40
Q

which pathogens are most associated with abscess formation with CAP

A

staph aureus

klebsiella

polymicrobial

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41
Q

main features of narcolepsy

A

excessive daytime sleepiness

sleep paralysis

cataplexy

hypnagogic/hypnopompic hallucinations

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42
Q

which lung cancer has the worst prognosis

A

small cell carcinoma

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43
Q

what is montelukast (Singulair)

A

luekotriene receptor antagonist)

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44
Q

common respiratory causes of clubbing

A

suppurative lung disease (bronchiectasis, TB, abscess)

lung cancer (NSCLC)

pulmonary fibrosis

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45
Q

investigations ordered for probable lung cancer

A

CXR –> CT –> bronchoscopy –> PET scan –> +/- biopsy

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46
Q

what is the idea behind putting someone on 100% FiO2 during a procedure involving the lungs

A

incase they get a pneumothoraces –> will get easier and faster to resorb the gas

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47
Q

4 main causes of atypical pneumonia

A

mycoplasma pneumonia

Chlamydia

legionella

pneumophila

Coxiella burnetti

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48
Q

standard Tx of stage 2 lung cancer

A

lobectomy and mediastinal lymph node dissection + adjuvant chemotherapy

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49
Q

how does alpha1-AT deficiency increase risk of COPD

A

lungs unable to remove the action of elastase (usually breaks down protein when you injure your lungs in order to allow new protein to be made). If no removal –> ongoing destruction of the lung by elastase

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50
Q

what ECG pattern do you get with PE

A

S1Q3T3 - prominent S wave in lead I, and Q and T wave inversion in Lead III

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51
Q

medical treatment of narcolepsy

A

stimulants - modafinil, amphetamines

REM suppressing drugs - SSRIs, tricyclics

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52
Q

when do you use combination inhalers

A

when monotherapy is not adequately controlling asthma - move to combination therapy before increasing the dose of CS

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53
Q

primary mode of spread of VRE

A

contaminated hands of HCW

environment also important

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54
Q

which organisms should you wash your hands over alcohol rub

A

norovirus C. diff

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55
Q

diffuse lung disease is…

A

a number of lung conditions featuring dyspnoea, cough and a chest xray showing diffuse lung involvement

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56
Q

4 patterns of interstitial lung diseases on CXR

A

linear - Kerley lines

reticular - lines in all directions

nodular - discrete opacities

reticulonodular

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57
Q

difference between primary and secondary spontaneous pneumothorax

A

primary - no underlying lung pathology

secondary - develops in someone with underlying lung pathology

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58
Q

common causes of pleural effusions

A

heart failure

inflammation (pneumonia)

malignancy

lymphatic injury

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59
Q

what are the CORB prediction tools for severe pneumonia

A

>=2/4 of following

  • confusion
  • oxygen sats
  • RR >30 min
  • BP systolic
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60
Q

explain the histology and typical location of adenocarcinoma

A

form glands (lumenal channels with papilla) more in the periphery

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61
Q

difference between apnoea and hypopnoea

A

apnoea - complete cessation of airflow for 10 seconds or longer regardless of oxygen desat

hypopnoea - 30% or more reduction in airflow associated with at least 3% oxygen desat or an alpha wave arousal from sleep

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62
Q

3 examples of pathogens that are transmitted by airborne

A

TB

measles

varicella

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63
Q

diagnosis of OSA

A

AHI >5 events per hour

64
Q

pharmacological Tx of insomnia

A

benzodiazepines

non-benzodiazepines

antidepressants, valerian, anti-histamines

65
Q

standard Tx of stage 3a lung cancer

A

no standard treatment!

  • Chemo + radiation OR
  • resection then chemo OR
  • chemo + radiation then resection
66
Q

What kind of ILD does methotrexate cause

A

bibasal fibrosis

67
Q

what kind of symptoms can you get with paraneoplastic syndrome from lung cancer

A

hypercalcaemia

clubbing of fingers

hypertrophic pulmonary osteoarthropathy

athralgia

68
Q

most common interstitial lung disease

A

idiopathic pulmonary fibrosis

69
Q

What is in Sodium Cromoglycate (Intal)

A

mast cell stabiliser

70
Q

what is the definition of a nosocomial infection

A

onset of symptoms >48 hours after admission or within 2 weeks of discharge from a hospital

71
Q

causes of secondary restless legs syndrome

A

Fe deficiency

renal failure

peripheral neuropathy

lumbosacral radiculopathy

pregnancy

72
Q

explain the classification of OSA

A

mild = 5-15 AHI

moderate = 15-30 AHI

severe = more than 30 AHI

73
Q

treatment for severe pneumonia

A

ceftriaxone 1g IV daily (good for gram negatives) PLUS azithromycin 500mg IV daily (+vancomycin if suspect MRSA) (+oseltamavir in pts in ICU or in flu season)

74
Q

why is nocturia a symptom of sleep apnoea

A

upper airway blockage –> increased intrathoracic pressure –> cardiac stretch –> increased secretion of ANP

75
Q

what sign is characteristic of ILD progression on HRCT

A

subpleural fibrotic change = basal honeycombing

76
Q

treatment of acute exacerbation of asthma

A

O SHIT

Oxygen

Salbutamol

Hydrocortisone

Ipratropium

Theophylline/MgSO4

77
Q

what is the fancy word for palpable breath sounds

A

vocal fremitus

78
Q

adverse effects of anticholinergics

A

dry mouth

79
Q

complications of CAP

A

abscess formation

pleural space infection

bacteraemic dissemination

80
Q

what are the CURB prediction tools for severe pneumonia

A

> or = 2/4 of following

  • confusion
  • urea >=7mmol/L
  • respiratory rate >30/min
  • BP systolic
81
Q

what are the causes of a unilateral pleural effusion

A

infection

malignancy

inflammatory

heart failure - not common

82
Q

primary mode of transmission of MRSA

A

contaminated hands of HCW

83
Q

what ABs does atypical pneumonia respond to

A

macrolides, doxycycline and quinolones

84
Q

why do you get reduced heart sounds during an exacerbation of asthma

A

gas trapping and hyperinflation –> increases the distance between the heart and the chest wall also due to reduced venous return to the heart by the lungs due to pulmonary stasis

85
Q

what is the fancy name for wheeze

A

rhonchi

86
Q

what other tests can be useful for diagnosing PE (other than CTPA)

A

VQ scan

Echo D-dimer

87
Q

standard Tx of stage 3b lung cancer

A

chemo and radiation only

No surgical treatment

88
Q

standard Tx of Stage 1 lung cancer

A

lobectomy and mediastinal lymph node dissection

89
Q

directed therapy for gram negative bacilli pneumonia

A

ceftriaxone (consider broader spectrum if severe eg. antipseudomonal agents (eg. piptaz))

90
Q

precautions in people with VRE

A

contact precautions and single room

91
Q

5 examples of pathogens that are transmitted by droplets

A

influenza pertussis SARS Neisseria meningitidis rhinovirus

92
Q

which type of lung cancer pretty much never is cured by surgery

A

small cell lung cancer

93
Q

What are the Well’s criteria

A

the criteria that you go through to see if a presentation in a patient is PE

94
Q

what are the light’s criteria

A

any following criteria met = exudative pleural effusion

  • pleural fluid protein:serum protein ratio >0.5
  • LDH of pleural fluid:serum LDH >0.6
  • pleural fluid LDH >2/3 times the normal upper limit for serum
95
Q

pneumonic for diseases causing changes in upper zone of lungs

A

SCHART

S - sarcoidosis, silicosis

C - coal miners pneumoconiosis

H - histiocytosis X/Langerhans

A - ankylosing spondylitis

R - radiation

T - TB

96
Q

treatment of nosocomial pneumonia

A

oral: amoxycillin-clavulanate

IV: ceftriaxone +/- metronidazole

97
Q

what are bronchial breath sounds

A

Increased breath sounds

I:E = equal

pause between I and E

blowing sound in I and E

98
Q

atypical pneumonia presentation

A

systemic symptoms predominate - headache, diarrhoea, abdominal pain cough often dry indolent presentation with longer history fever, malaise, myalgia FAILURE TO RESPOND TO PENICILLIN

99
Q

how do you diagnose latent TB

A

Mantoux test

Quantiferon-gold

100
Q

what are some conservative treatments for OSA

A

weight loss

avoid alcohol/tobacco/sedatives

body position

treat nasal congestion

treat medical disorders - hypothyroidism

101
Q

what is the mean arterial pressure and systolic pressure in the pulmonary circulation

A

15mmHg - mean

systolic - 25mmHg

102
Q

pneumonic for diseases causing changes in the lower zone of lugns

A

RASID

R - rheumatoid arthritis

A - asbestosis

S - scleroderma

I - IPF

D - drugs

103
Q

diagnosis of narcolepsy

A
  • excessive daytime sleepiness
  • cataplexy
  • MSLT
  • mean sleep latency less than 8 minutes and 2 or more SOREMs
104
Q

which groups of patients are more likely to get resistant gram negative pneumonia infection

A

patients with chronic suppurative lung diseases (CF, bronchiectasis) heavily antibiotic exposed

105
Q

when is the highest risk of reactivation of TB

A

within the first 2 years of primary infection

106
Q

red flags in a physical examination in someone with asthma

A

quiet chest

cyanosis

respiratory rate >25

107
Q

what is pulsus paradoxus

A

>10mmHg drop in systolic blood pressure with inspiration

108
Q

where does MRSA normally colonise

A

nose, throat, groin, axilla, GI tract

109
Q

which cancer does asbestos exposure predispose to

A

mesothelioma

110
Q

what signs would you get on a resp exam with pleural effusion

A
  • reduced breath sounds
  • decreased percussion note (stony)
  • decreased vocal resonance
111
Q

which respiratory conditions can cause a decreased percussion note

A
  • consolidation
  • collapse
  • dense fibrosis
  • pleural fluid/thickening
  • elevated hemidiapragm
112
Q

why are examination of the supraclavicular nodes so important in a respiratory examination

A

lung cancer often goes into the apex of the upper lobe

113
Q

what causes increased retrosternal lucency in someone with COPD

A

hyperinflation

causing herniation of the upper lobe infront of the heart

114
Q

precautions for MRSA

A

contact precautions and single room

115
Q

high pitch and low pitch wheeze - suggests what

A

high pitch = small airways

low pitch = large airways

116
Q

what is the strongest predictor of a COPD patients’ prognosis

A

BODE index

117
Q

what investigations do you do to work out if the patient is even fit enough for lung cancer surgery

A

respiratory function tests - enough lung

  • cardiopulmonary exercise testing
  • global function stress echo, angio - if particular cardiac concerns
118
Q

standard Tx of stage 4 lung cancer

A

palliative Tx only

119
Q

main types of lung cancers:

A
  • non small cell carcinoma: adenocarcinonma, squamous cell carcinoma, large cell carcinoma
  • small cell carcinoma
120
Q

adverse effects of ICS

A

dysphonia

oral candidiasis

121
Q

pathophysiology of acute asthma

A

mediator release from mast cells and eosinophils causing bronchoconstriction, oedema and mucous hypersecretion

122
Q

Directed therapy for staph aureus pneumonia

A

MSSA - flucloxacillin

MRSA - vancomycin

123
Q

2 examples of pathogens that are transmitted direct person-to-person contact

A

scabies

HSV

124
Q

what signs would you get on a resp exam with pneumothorax

A
  • decreased breath sounds
  • increased percussion note
  • decreased vocal resonance
  • decreased chest expansion sometimes
125
Q

definition of empyema

A

purulent pleural effusion

126
Q

what does C diff cause

A

diarrhoea –> pseudomembranous colitis –> toxic megacolon

127
Q

treatment for moderate pneumonia if admitted

A

benzylpenicillin 1.2 g qid IV (or amoxycillin 1g tds orally) PLUS doxycycline 100mg bd orally (or clarithromycin 500mg bd)

128
Q

most common place of lymphadenopathy with lung cancer

A

supraclavicular

129
Q

treatment for mild pneumonia

A

amoxycillin 1g tds orally Or doxycycline 100mg bd orally (treats both typical and atypical pathogens) If unable to return for review - dual therapy

130
Q

causes of hypoventilation

A

reduced respiratory centre activity

neuromuscular disease

chest wall deformity

obesity (gross)

increased ventilatory requirements (eg COPD)

131
Q

what signs would you get on a resp exam with consolidation

A

decreased percussion note

increased vocal resonance

bronchial sounds (increased breath sounds) +/- crepitations

132
Q

directed therapy for pneumococcus pneumoni

A

penicillin

133
Q

cardinal symptoms of sleep apnoea

A

heavy snoring

excessive daytime sleepiness

witnessed apnoeas

134
Q

what abnormal heart sound can you hear in someone with severe COPD

A

loud P2

pulmonary hypertension

RV heave

135
Q

explain the histology and typical location of SCC

A

central location small, blue, densely stained cells (no cytoplasm) with granular chromatin

136
Q

what is light’s criteria used for

A

to determine if a pleural effusion is an exudate or transudate

137
Q

which fungal pneumonia is associated with immunocompromised patients

A

Pneumocystis jirovecii

138
Q

which CT diseases are associated with pulmonary fibrosis

A

scleroderma

rheumatoid arthritis

SLE

polymyositis

139
Q

what symptoms do you get with psychogenic dyspnoea

A

“air hunger”

yawning

hypo-carbic symptoms - light headedness, tingly periphery and lips

chest tightness

dissociation from exercise

140
Q

which respiratory conditions can cause an increased percussion note

A

(increased air)

  • pneumothorax
  • hyperinflation (emphysema, acute asthma)
  • lung cyst
141
Q

which mutations are mostly associated with adenocarcinoma

A

KRAS EGFR

142
Q

causes of central sleep apnoea

A

cardiac failure (Cheyne Stokes respiration)

high altitude

CNS disorders

idiopathic

143
Q

what is the presentation that will ring alarm bells for PE

A

collapse and hypoxaemia with tachycardia, tachypnoea and clear lungs +/- pleuritic chest pain

144
Q

definition of narcolepsy

A

intrusion of some REM sleep into wakefulness caused by deficiency in orexin

145
Q

signs of pulmonary hypertension

A

right ventricular heave

loud P2, 4th heart sound

prominent v wave in JVP

146
Q

mechanisms of crackles/crepitations

A
  • bubbling of air through secretions
  • popping open of small airways and alveoli with rapid equalisation of pressures
147
Q

major treatment of PE

A

anticoagulation - warfarin or LMWH

  • newer agents
148
Q

local symptoms of lung cancer

A

cough

SOB/wheeze

haemoptysis

pneumonia

chest pain

pancoast - Horner’s, T1 neuralgia dysphagia dysphonia

149
Q

what is decolonisation

A

reduce the colonization of somebody immediately prior to a procedure

150
Q

what is the difference in pathology between peripheral and central cyanosis

A

peripheral - circulatory insufficiency –> decreased oxygen extraction of oxygen

central - respiratory insufficiency –> decreased oxygen saturation of Hb

151
Q

risk factors for PE

A

stasis hypercoagulable states:

  • genetic
  • factor 5 leiden, antiphospholipid syndrome, factor C and S deficiency
  • malignancy
  • polycythaemia
  • pregnancy
  • medication

Abnormal vessels

152
Q

typical histology and location of large cell carcinoma

A

doesnt look like sqCC, SCC, adenoC variable location

153
Q

what feature in the hands do we see with a C8-T1 lesion

A

wasting of the small muscles of the hand –> unable to abduct the fingers

154
Q

direct and indirect bronchoprovocation tests

A

direct - methacholine, histamine

indirect - hypertonic saline, eucapneic hyperventilation, mannitol

155
Q

pathological and clinical definitions of pneumonia

A

pathological = infection of lung parenchyma

clinical= acute onset of respiratory symptoms plus new CXR infiltrate

Z MD 2 (15 decks)

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