Respiratory Flashcards
1
Q
4 main causes of typical pneumonia
A
pneumococcus
haemophilus influenza
gram neg bacilli
staph aureus
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
3
Q
what are parasomnias
A
undesirable behaviour or experiences in sleep or in transition to or from sleep
4
Q
what is REM behaviour disorder
A
dream enactment behaviour during REM sleep
5
Q
which common viruses can cause pneumonia
A
influenza, adenovirus, parainfluenza, RSV
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)
7
Q
what are 2 common GI causes of clubbing
A
IBD
primary biliary cirrhosis
8
Q
which lung cancer is the most common
A
adenocarcinoma
9
Q
where is the “safety triangle” for chest drainage
A
between pec major, level of the nipple (4th intercostal space), and lat dorsi
10
Q
signs of right heart failure
A
elevated JVP
elevated V waves
tricuspid regurgitation
significant ankle oedema
ascites
pulsatile liver (tricuspid regurg)
11
Q
what pathology causes bronchial breath sounds
A
consolidation
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
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
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)
15
Q
how does a PE cause hypotension
A
PE –> obstruction to right ventricular outflow –> systemic hypotension
16
Q
describe the fluctuation of CO with respiration
A
inspiration = pooling of blood on inspiration –> decreased venous return to left heart –> reduced CO
17
Q
treatment of REM behaviour disorder
A
clonazepam
18
Q
where does VRE normally live
A
GI tract
19
Q
What is in seretide
A
fluticasone and salmeterol
20
Q
explain the histological features and typical location of squamous cell carcinoma
A
keratin swirls
intracellular bridges
central location
21
Q
management of empyema
A
drainage - Major
antibiotics (to treat underlying cause)
supportive measures treat underlying causes
22
Q
what should we measure on a sample of aspirated pleural effusion fluid
A
biochemistry - protein, glucose, LDH, pH
cytology
MCS
23
Q
risk factors for aspiration pneumonia
A
impaired gag reflex (CVA, neuromusclar disease, unconsciousness post overdose, alcohol abuse)
24
Q
what is the typical pattern of alpha1-AT def COPD on xray
A
LOWER zone emphysema
25
anaerobic pneumonia is associated with which subset of patients
alcohol use
aspiration
26
gold standard test for PE and actual most commonly used test to confirm PE
gold standard = pulmonary angiogram
common = CTPA
27
how do you optimise function in a COPD patient
pulmonary rehab
inhaled therapies
identify and correct hypoxia and/or pHT
28
what is in symbicort
budesonide and eformoterol
29
2 bacteria and 2 viruses examples of pathogens that are transmitted from indirect contact
bacteria - MRSA, VRE
viruses - influenza, norovirus
30
what causes pleural rub
inflammation tumour
31
lung function confirmation of asthma
20% variation day to day of PEF 200ml AND 12% improvement in FEV1 with bronchodilator
32
what part of the ABG tells you that the acute exacerbation of asthma is very very bad
normal CO2 --\> means that they are getting respiratory fatigue
33
how do pulmonary hypertension affect the heart
causes right ventricular dilatation and hypertrophy leading to reduced systemic venous pressure and poor cardiac output
34
how do you treat latent TB
one drug for 9 months (isoniazid) - dont give it to those people over 35
35
explain the difference in presentation between viral and bacterial pneumonia
bacterial is often MUCH faster (within hours) while viral can take days
36
when do you give surgical antibiotic prophylaxis
- if there is significant risk of infection
- infection has devastating consequences
37
major causes of haemoptysis
chest infection - bronchitis, pneumonia, bronchiectasis, TB
Lung carcinoma
Pulmonary embolus
38
what pathologies cause reduced breath sounds
- pneumothorax
- airflow obstruction
- pleural effusion
- thick chest wall
- lung collapse
39
what is a typical presentation in a pt with MRSA pneumonia
cavitatory pneumonia and crash quickly
40
which pathogens are most associated with abscess formation with CAP
staph aureus
klebsiella
polymicrobial
41
main features of narcolepsy
excessive daytime sleepiness
sleep paralysis
cataplexy
hypnagogic/hypnopompic hallucinations
42
which lung cancer has the worst prognosis
small cell carcinoma
43
what is montelukast (Singulair)
luekotriene receptor antagonist)
44
common respiratory causes of clubbing
suppurative lung disease (bronchiectasis, TB, abscess)
lung cancer (NSCLC)
pulmonary fibrosis
45
investigations ordered for probable lung cancer
CXR --\> CT --\> bronchoscopy --\> PET scan --\> +/- biopsy
46
what is the idea behind putting someone on 100% FiO2 during a procedure involving the lungs
incase they get a pneumothoraces --\> will get easier and faster to resorb the gas
47
4 main causes of atypical pneumonia
mycoplasma pneumonia
Chlamydia
legionella
pneumophila
Coxiella burnetti
48
standard Tx of stage 2 lung cancer
lobectomy and mediastinal lymph node dissection + adjuvant chemotherapy
49
how does alpha1-AT deficiency increase risk of COPD
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
50
what ECG pattern do you get with PE
S1Q3T3 - prominent S wave in lead I, and Q and T wave inversion in Lead III
51
medical treatment of narcolepsy
stimulants - modafinil, amphetamines
REM suppressing drugs - SSRIs, tricyclics
52
when do you use combination inhalers
when monotherapy is not adequately controlling asthma - move to combination therapy before increasing the dose of CS
53
primary mode of spread of VRE
contaminated hands of HCW
environment also important
54
which organisms should you wash your hands over alcohol rub
norovirus C. diff
55
diffuse lung disease is...
a number of lung conditions featuring dyspnoea, cough and a chest xray showing diffuse lung involvement
56
4 patterns of interstitial lung diseases on CXR
linear - Kerley lines
reticular - lines in all directions
nodular - discrete opacities
reticulonodular
57
difference between primary and secondary spontaneous pneumothorax
primary - no underlying lung pathology
secondary - develops in someone with underlying lung pathology
58
common causes of pleural effusions
heart failure
inflammation (pneumonia)
malignancy
lymphatic injury
59
what are the CORB prediction tools for severe pneumonia
\>=2/4 of following
- confusion
- oxygen sats
- RR \>30 min
- BP systolic
60
explain the histology and typical location of adenocarcinoma
form glands (lumenal channels with papilla) more in the periphery
61
difference between apnoea and hypopnoea
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
62
3 examples of pathogens that are transmitted by airborne
TB
measles
varicella
63
diagnosis of OSA
AHI \>5 events per hour
64
pharmacological Tx of insomnia
benzodiazepines
non-benzodiazepines
antidepressants, valerian, anti-histamines
65
standard Tx of stage 3a lung cancer
no standard treatment!
- Chemo + radiation OR
- resection then chemo OR
- chemo + radiation then resection
66
What kind of ILD does methotrexate cause
bibasal fibrosis
67
what kind of symptoms can you get with paraneoplastic syndrome from lung cancer
hypercalcaemia
clubbing of fingers
hypertrophic pulmonary osteoarthropathy
athralgia
68
most common interstitial lung disease
idiopathic pulmonary fibrosis
69
What is in Sodium Cromoglycate (Intal)
mast cell stabiliser
70
what is the definition of a nosocomial infection
onset of symptoms \>48 hours after admission or within 2 weeks of discharge from a hospital
71
causes of secondary restless legs syndrome
Fe deficiency
renal failure
peripheral neuropathy
lumbosacral radiculopathy
pregnancy
72
explain the classification of OSA
mild = 5-15 AHI
moderate = 15-30 AHI
severe = more than 30 AHI
73
treatment for severe pneumonia
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
why is nocturia a symptom of sleep apnoea
upper airway blockage --\> increased intrathoracic pressure --\> cardiac stretch --\> increased secretion of ANP
75
what sign is characteristic of ILD progression on HRCT
subpleural fibrotic change = basal honeycombing
76
treatment of acute exacerbation of asthma
O SHIT
Oxygen
Salbutamol
Hydrocortisone
Ipratropium
Theophylline/MgSO4
77
what is the fancy word for palpable breath sounds
vocal fremitus
78
adverse effects of anticholinergics
dry mouth
79
complications of CAP
abscess formation
pleural space infection
bacteraemic dissemination
80
what are the CURB prediction tools for severe pneumonia
\> or = 2/4 of following
- confusion
- urea \>=7mmol/L
- respiratory rate \>30/min
- BP systolic
81
what are the causes of a unilateral pleural effusion
infection
malignancy
inflammatory
heart failure - not common
82
primary mode of transmission of MRSA
contaminated hands of HCW
83
what ABs does atypical pneumonia respond to
macrolides, doxycycline and quinolones
84
why do you get reduced heart sounds during an exacerbation of asthma
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
what is the fancy name for wheeze
rhonchi
86
what other tests can be useful for diagnosing PE (other than CTPA)
VQ scan
Echo D-dimer
87
standard Tx of stage 3b lung cancer
chemo and radiation only
No surgical treatment
88
standard Tx of Stage 1 lung cancer
lobectomy and mediastinal lymph node dissection
89
directed therapy for gram negative bacilli pneumonia
ceftriaxone (consider broader spectrum if severe eg. antipseudomonal agents (eg. piptaz))
90
precautions in people with VRE
contact precautions and single room
91
5 examples of pathogens that are transmitted by droplets
influenza pertussis SARS Neisseria meningitidis rhinovirus
92
which type of lung cancer pretty much never is cured by surgery
small cell lung cancer
93
What are the Well's criteria
the criteria that you go through to see if a presentation in a patient is PE
94
what are the light's criteria
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
pneumonic for diseases causing changes in upper zone of lungs
SCHART
S - sarcoidosis, silicosis
C - coal miners pneumoconiosis
H - histiocytosis X/Langerhans
A - ankylosing spondylitis
R - radiation
T - TB
96
treatment of nosocomial pneumonia
oral: amoxycillin-clavulanate
IV: ceftriaxone +/- metronidazole
97
what are bronchial breath sounds
Increased breath sounds
I:E = equal
pause between I and E
blowing sound in I and E
98
atypical pneumonia presentation
systemic symptoms predominate - headache, diarrhoea, abdominal pain cough often dry indolent presentation with longer history fever, malaise, myalgia FAILURE TO RESPOND TO PENICILLIN
99
how do you diagnose latent TB
Mantoux test
Quantiferon-gold
100
what are some conservative treatments for OSA
weight loss
avoid alcohol/tobacco/sedatives
body position
treat nasal congestion
treat medical disorders - hypothyroidism
101
what is the mean arterial pressure and systolic pressure in the pulmonary circulation
15mmHg - mean
systolic - 25mmHg
102
pneumonic for diseases causing changes in the lower zone of lugns
RASID
R - rheumatoid arthritis
A - asbestosis
S - scleroderma
I - IPF
D - drugs
103
diagnosis of narcolepsy
- excessive daytime sleepiness
- cataplexy
- MSLT
- mean sleep latency less than 8 minutes and 2 or more SOREMs
104
which groups of patients are more likely to get resistant gram negative pneumonia infection
patients with chronic suppurative lung diseases (CF, bronchiectasis) heavily antibiotic exposed
105
when is the highest risk of reactivation of TB
within the first 2 years of primary infection
106
red flags in a physical examination in someone with asthma
quiet chest
cyanosis
respiratory rate \>25
107
what is pulsus paradoxus
\>10mmHg drop in systolic blood pressure with inspiration
108
where does MRSA normally colonise
nose, throat, groin, axilla, GI tract
109
which cancer does asbestos exposure predispose to
mesothelioma
110
what signs would you get on a resp exam with pleural effusion
- reduced breath sounds
- decreased percussion note (stony)
- decreased vocal resonance
111
which respiratory conditions can cause a decreased percussion note
- consolidation
- collapse
- dense fibrosis
- pleural fluid/thickening
- elevated hemidiapragm
112
why are examination of the supraclavicular nodes so important in a respiratory examination
lung cancer often goes into the apex of the upper lobe
113
what causes increased retrosternal lucency in someone with COPD
hyperinflation
causing herniation of the upper lobe infront of the heart
114
precautions for MRSA
contact precautions and single room
115
high pitch and low pitch wheeze - suggests what
high pitch = small airways
low pitch = large airways
116
what is the strongest predictor of a COPD patients' prognosis
BODE index
117
what investigations do you do to work out if the patient is even fit enough for lung cancer surgery
respiratory function tests - enough lung
- cardiopulmonary exercise testing
- global function stress echo, angio - if particular cardiac concerns
118
standard Tx of stage 4 lung cancer
palliative Tx only
119
main types of lung cancers:
- non small cell carcinoma: adenocarcinonma, squamous cell carcinoma, large cell carcinoma
- small cell carcinoma
120
adverse effects of ICS
dysphonia
oral candidiasis
121
pathophysiology of acute asthma
mediator release from mast cells and eosinophils causing bronchoconstriction, oedema and mucous hypersecretion
122
Directed therapy for staph aureus pneumonia
MSSA - flucloxacillin
MRSA - vancomycin
123
2 examples of pathogens that are transmitted direct person-to-person contact
scabies
HSV
124
what signs would you get on a resp exam with pneumothorax
- decreased breath sounds
- increased percussion note
- decreased vocal resonance
- decreased chest expansion sometimes
125
definition of empyema
purulent pleural effusion
126
what does C diff cause
diarrhoea --\> pseudomembranous colitis --\> toxic megacolon
127
treatment for moderate pneumonia if admitted
benzylpenicillin 1.2 g qid IV (or amoxycillin 1g tds orally) PLUS doxycycline 100mg bd orally (or clarithromycin 500mg bd)
128
most common place of lymphadenopathy with lung cancer
supraclavicular
129
treatment for mild pneumonia
amoxycillin 1g tds orally Or doxycycline 100mg bd orally (treats both typical and atypical pathogens) If unable to return for review - dual therapy
130
causes of hypoventilation
reduced respiratory centre activity
neuromuscular disease
chest wall deformity
obesity (gross)
increased ventilatory requirements (eg COPD)
131
what signs would you get on a resp exam with consolidation
decreased percussion note
increased vocal resonance
bronchial sounds (increased breath sounds) +/- crepitations
132
directed therapy for pneumococcus pneumoni
penicillin
133
cardinal symptoms of sleep apnoea
heavy snoring
excessive daytime sleepiness
witnessed apnoeas
134
what abnormal heart sound can you hear in someone with severe COPD
loud P2
pulmonary hypertension
RV heave
135
explain the histology and typical location of SCC
central location small, blue, densely stained cells (no cytoplasm) with granular chromatin
136
what is light's criteria used for
to determine if a pleural effusion is an exudate or transudate
137
which fungal pneumonia is associated with immunocompromised patients
Pneumocystis jirovecii
138
which CT diseases are associated with pulmonary fibrosis
scleroderma
rheumatoid arthritis
SLE
polymyositis
139
what symptoms do you get with psychogenic dyspnoea
"air hunger"
yawning
hypo-carbic symptoms - light headedness, tingly periphery and lips
chest tightness
dissociation from exercise
140
which respiratory conditions can cause an increased percussion note
(increased air)
- pneumothorax
- hyperinflation (emphysema, acute asthma)
- lung cyst
141
which mutations are mostly associated with adenocarcinoma
KRAS EGFR
142
causes of central sleep apnoea
cardiac failure (Cheyne Stokes respiration)
high altitude
CNS disorders
idiopathic
143
what is the presentation that will ring alarm bells for PE
collapse and hypoxaemia with tachycardia, tachypnoea and clear lungs +/- pleuritic chest pain
144
definition of narcolepsy
intrusion of some REM sleep into wakefulness caused by deficiency in orexin
145
signs of pulmonary hypertension
right ventricular heave
loud P2, 4th heart sound
prominent v wave in JVP
146
mechanisms of crackles/crepitations
- bubbling of air through secretions
- popping open of small airways and alveoli with rapid equalisation of pressures
147
major treatment of PE
anticoagulation - warfarin or LMWH
- newer agents
148
local symptoms of lung cancer
cough
SOB/wheeze
haemoptysis
pneumonia
chest pain
pancoast - Horner's, T1 neuralgia dysphagia dysphonia
149
what is decolonisation
reduce the colonization of somebody immediately prior to a procedure
150
what is the difference in pathology between peripheral and central cyanosis
peripheral - circulatory insufficiency --\> decreased oxygen extraction of oxygen
central - respiratory insufficiency --\> decreased oxygen saturation of Hb
151
risk factors for PE
stasis hypercoagulable states:
- genetic
- factor 5 leiden, antiphospholipid syndrome, factor C and S deficiency
- malignancy
- polycythaemia
- pregnancy
- medication
Abnormal vessels
152
typical histology and location of large cell carcinoma
doesnt look like sqCC, SCC, adenoC variable location
153
what feature in the hands do we see with a C8-T1 lesion
wasting of the small muscles of the hand --\> unable to abduct the fingers
154
direct and indirect bronchoprovocation tests
direct - methacholine, histamine
indirect - hypertonic saline, eucapneic hyperventilation, mannitol
155
pathological and clinical definitions of pneumonia
pathological = infection of lung parenchyma
clinical= acute onset of respiratory symptoms plus new CXR infiltrate
