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Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Community Acquired Pneumonia - bacterial causes

A

Streptococcus pneumoniae (80%)
Haemophilus influenzae
Staphylococcus aureus: commonly after the ‘flu
Atypical pneumonias (Mycoplasma pneumonia)
Alcoholics get Klebsiella

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2
Q 
Characteristic features:
rapid onset
high fever
pleuritic chest pain
herpes labialis
A

Streptococcus pneumoniae

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3
Q

CURB-65

A

Confusion - AMT 7
RR > 30
BP 65 years

Severe if 3 or more.

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4
Q

Permanent dilatation of the airways due to chronic infection or inflammation

Tramlines on CXR, and signet rings on CT.

A

Bronchiectasis

Causes:
Post-infective: TB, CF, measles, pertussis
Bronchial obstruction
Immune deficiency: selective IgA, hypogammaglobulinaemia
Allergic bronchopulmonary aspergillosis (ABPA)
Ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome

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5
Q

White out on CXR:

Trachea central

A

Consolidation
Pulmonary oedema (usually bilateral)
Mesothelioma

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6
Q

White out on CXR:

Trachea deviated towards white out
volume loss

A

Pneumonectomy
Complete lung collapse e.g. endobronchial intubation
Pulmonary hypoplasia

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7
Q

White out on CXR:

Trachea deviated away
volume gain

A

Pleural effusion
Diaphragmatic hernia
Large thoracic mass

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8
Q

Bilateral hilar lymphadenopathy

A 
Sarcoidosis
TB
Lymphoma/malignancy
Pneumoconiosis
Fungi
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9
Q

Oral amoxicillin or clarithromycin or doxycycline

A

Mild CAP (S.pneumo or Hib)

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10
Q

Oral amoxicillin AND clarithromycin or doxycycline

A

Moderate CAP (S.pneumo, Hib or mycoplasma)

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11
Q

IV co-amoxiclav or IV cefuroxime AND IV clarithromycin

A

Severe CAP (S.pneumo, Hib or mycoplasma)

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12
Q

Fluoroquinolone with clarithromycin, or rifampicin, if severe.

A

Atypical species e.g. Legionella, Clamydophila or PCP

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13
Q

IV aminoglycoside + antipseudomonal penicillin or 3rd gen cephalosporin IV

A

HAP (Gram neg bacilli (e.g. enterococcus), Pseudomonas or anaerobes)

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14
Q

IV cephalosporin and IV metronidazole

A

Aspiration pneumonia (S.pneumo, anaerobes)

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15
Q

Bacteria commonly associated with bronchiectasis and CF

Also causes HAI, particularly on ITU or after surgery

A

Pseudomonas aeruginosa

Gram-negative rod
Multi-drug resistant

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16
Q

Swinging fever
cough with purulent, foul smelling sputum
pleuritic chest pain and haemoptysis
malaise, weight loss

CXR: walled cavity, often with fluid level

A

Lung abscess
Can be a complication of pneumonia, aspiration, bronchial obstruction, subphrenic/hepatic abscess.

Tx = antibiotics according to sensitivities, continued for 4-6 weeks, postural drainage

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17
Q

Jaundice as a complication of pneumonia

A

Cholestatic

May be secondary to sepsis or antibiotic therapy (esp. flucloxacillin and co-amoxiclav)

18
Q

Mx of Bronchiectasis

A 
Postural drainage BD
Chest physio
ABX according to sensitivities (cipro if pseudo)
?Long term ABX if >3 exacerbations pa.
Bronchodilators and steroids
19
Q

Autosomal recessive: CFTR gene mutation on chrom 7

Defective chloride secretion and increased sodium absorption across endothelium

Dx by sweat test, genetic tests and faecal elastase

A

Babies: FTT, meconium ileus
Children/YA:
Resp - cough, wheeze, recurrent bilateral infections
GI - pancreatic insufficiency (DM, steatorrhoea), gallstones, cirrhosis, obstruction
other - male infertility, osteoporosis, nasal polyps

20
Q

CF ON CXR

A

Hyperinflation

Bronchiectasis: tramlines from thickened bronchial walls, cystic shadows

21
Q

Apical lung lesions

A 
TB
Sarcoidosis
Aspergillosis
Radiotherapy changes
Extrinsic allergic alveolitis
22
Q

Coarse crackles

A

CF

Bronchiectasis

23
Q

CF on Abdo USS

A

Fatty liver
Cirrhosis
Chronic pancreatitis

24
Q

Obstructive disease on spirometry

FEV1 reduced more than FVC
FEV1/FVC >75%

A

COPD
Asthma
CF

25
Q

Restrictive disease on spirometry

FVC is reduced; FEV1/FVC may be normal

A 
Fibrosis
Sarcoidosis
Interstitial pneumonia
Pleural effusion
Connective Tissue Disease
Neuromuscular Disorder
26
Q

Aspergillus

Causes 5 different disease patterns

A
  1. Asthma
  2. Allergic Bronchopulmonary Aspergillosis (ABPA)
  3. Aspergilloma
  4. Invasive aspergillosis
  5. Extrinsic allergic alveolitis
27
Q

Proportions of lung tumours:

Squamous
Adenocarcinoma
Small cell
Large cell
Alveolar cell
A 
Squamous - 35%
Adenocarcinoma - 27%
Small cell - 20%
Large cell - 10%
Alveolar cell - rare
28
Q

Treatment of NSCLC

A

Excision of early tumours
Curative radio for those with poor respiratory reserve
Chemo +/- radio for late presenters

29
Q

Treatment of SCLC

A

Almost always disseminated at presentation
May respond to chemo but relapse rate is high
Palliative radio

Often associated with paraneoplastic syndromes e.g SIADH, Cushing’s.

30
Q

DDX of lung nodule on CXR

A 
Malignancy
Abscess
Granuloma
Carcinoid tumour
AV malformation
Cyst
Foreign body
31
Q

Lung cancer prognosis
NSCLC:
SCLC:

A

NSCLC = 50% 2 year survival if no spread; 10% with spread

SCLC = 3 months if untreated; 12-18 months if treated.

32
Q

Recurrent episodic dyspnoea, cough and wheeze caused by reversible airway obstruction:

  1. Bronchial muscle contraction
  2. Mucosal swelling/inflammation
  3. Increased mucous production
A

Asthma

33
Q

Things to ask in Asthma

A 
Precipitants
Diurnal variation
Exercise tolerance
Disturbed sleep
Acid-reflux
Atopy
School/job
34
Q

Non-cardiogenic pulmonary oedema

Pulmonary hypertension: hypoxic vasoconstriction redirects blood to areas of greater oxygenation

A

ARDS

Tachypnoea, dyspepsia, cyanosis, peripheral vasodilation and fine inspiration crackles

35
Q

Pulmonary causes of ARDS

A 
Trauma/shock
Infection eg pneumonia 
Gas inhalation
Aspiration of gastric contents
Near drowning
Mechanical ventilation
36
Q

Extra pulmonary causes of ARDS

A 
Gram negative septicaemia 
Pancreatitis 
Burns
Cardiopulmonary bypass 
Perforated viscus
DIC
OD (opiates)
37
Q

Bilateral diffuse shadowing in CXR

Tachypnoeic, cyanosis patient
Bilateral fine inspiratory crackles

A

ADRS

Do an ABG

Mx: PEEP and steroids

38
Q

Causes of type 1 respiratory failure

PaO2

A

Severe acute asthma
Pneumonia
Pulmonary embolism
Pulmonary oedema

V/Q mismatch

39
Q

Causes of type 2 respiratory failure

PaO2 6.5

A 
COPD exacerbation 
Asthma
Sedatives
Fibrosis
NMD
40
Q

Management of T1RF

A

High flow oxygen via NRM

Consider assisted ventilation (CPAP) if PaO2 remains below 8 despite 60% oxygen

41
Q

Management of T2RF

A

Titrate oxygen up from 24%

Recheck PaCO2 on ABG after 20 mins

If CO2 stable, increase oxygen
If CO2 is rising, consider NIV e.g. BiPAP

Medicine (9 decks)

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