Respiratory Flashcards
Stony dull to percuss
Pleural effusion
Right side pleuritic chest pain
Most likely pneumonia
Alveolar bat’s wings, Kerley Blines, Cardiomegaly, Dilated prominent upper lobe vessels, pleural Effusion
Pulmonary Oedema
Ground glass-like appearance on CXR
Pulmonary Fibrosis or respiratory distress syndrome of the newborn
Ziehl-neelsen stain positive for acid fast bacilli
TB
Caseous necrosis
TB
What is Apical disease most likely caused by?
Most likely (secondary) TB
What is an apical lesion called?
Assmann focus
Miliary TB?
Widespread dissemination of infection through blood stream
In miliary TB, where does dissemination occur if organism spread through:
- Pulmonary artery
- Pulmonary vein
- lungs
- liver, spleen and kidneys
Positive anti-glomerular basement membrane antibodies
Goodpasture’s syndrome
What bacteria causes a chest infection with a parrot/pigeon as a pet?
chlamydophila psittaci
What bacteria causes a Dry cough and diarrhoea after a holiday abroad, some indication of water spread?
What would you test for antigens?
Legionella Pneumophila
Urine
“Tall thin young man who indulges in marijuana”
Probably pneumothorax (Marfan’s)
Bronchiole wider than neighbouring arteriole on CT?
What is this called?
Bronchiectasis
Signet ring sign
Bilateral hilar lymphadenopathy, erythema nodosum, granulomas, fatigue, uveitis, weight loss
Sarcoidosis
D sign on x-ray
Empyema
Steeple sign on Chest x-ray
Laryngotracheobronchitis/ croup
Child with barking cough
Croup
What patients do Pneumocystis pneumonia frequently occur in?
Treatment?
HIV
Co-tramoxazole (+ prednisolone if severe)
Which triad is asthma + nasal polyps + salicylate sensitivity
Samter’s triad
What bacteria tends to cause pneumonia in alcoholics (danger of aspirating vomit)?
Klebsiella Pneumoniae
Red jelly sputum?
Klebsiella Pneummoniae
Mucoid Sputum?
Chlamydia psitaci
Rusty sputum?
Pneumococcal Pneumonia
Cannonball metastases (also weight loss and haematuria) - where from?
Primary renal cell carcinoma
Morning headaches?
Hypercapnia or side effect of organic nitrates
ACTH secreting lung tumour
Small cell carcinoma of the lung
PTH secreting lung tumour
Squamous cell carcinoma of the lung
What type of tumour is neuroendocrine, highly malignant and may be associated with ectopic endocrine conditions?
Small cell carcinoma
Increased serum ACE and Ca2+
Sarcoidosis
Eggshell calcification at hilar region
Silicosis
What are “heart failure cells” found in alveolar spaces?
Found in?
Macrophages that have absorbed haemosiderin
Chronic pulmonary oedema and associated (severe) left ventricular heart failure
Also seen in long standing pulmonary hypertension
What is Ghon focus?
Found in what type of infection?
What happens if the Ghon focus ruptures through the visceral pleura into the pleural cavity?
Area of infection and caseous necrosis at the periphery of the lung, beneath the pleura
TB
Tuberculosis Pleurisy is produced
What is a “coin lesion” on a chest x-ray?
Common causes of this (6)
A rounded solitary lesion Primary bronchial carcinoma Metastatic tumour (especially of kidney) Bronchial Hamartoma Carcinoid tumour Granulomatous inflamation Lung abscess
What is Horner’s syndrome?
Caused by?
Symptoms? (4)
Group of symptoms caused by damage to the cervical sympathetic chain.
Local spread of cancer to the intrathoracic nodes or a Pancoast’s tumour
Ptosis (drooping of the eyelid), enophthalmos (sunken eye), miosis (small pupil), and lack of sweating on the ipsilateral (same side as invasion) side of the face
Acute management of asthma
Oxygen 100% through a non-rebreather mask Salbutamol nebulised back to back Hydrocortisone IV or Prednisolone PO Ipraptropium Bromide nebulised hourly Thiophylline IV or Aminophylline IV Magnesium and call an Anaesthetist OSHIT MAN
Thumbprint sign on head x-ray
Epiglottitis
Inspiratory whoop/ barking cough
Pertussis
Snow storm appearance on x-ray
Baritosis/ silicosis
Management of infective exacerbation of COPD
ipratropium Salbutamol Oxygen Amoxicillin Prednisolone
Non-smoker and lung cancer
(peripheral) adenocarcinoma
Location of squamous and small cell lung cancer
Central
High d-dimers, suspect what?
Pulmonary embolism (send for CTPA or V/Q scan)
What can you exclude if low d-dimer?
Pulmonary Embolism
Treatment for large PE?
Small PE?
Thrombolysis
Low molecular weight heparin
TB drugs?
2months Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, 4months Rifampicin, Isoniazid
(2 RIPE, 4 RI)
PE risk factors
Hereditary eg factor V Leiden History - previous DVT or PE Hypomobility eg fracture or long trip Hypovolaemia eg dehydration Hypercoagulability eg smoking Hormones eg oestrogen Hyperhomocysteinemia Hyperviscosity states eg malignancy, post-surgery (8 H's)
1 side effect for each TB drug
Rifampicin = orange coloured tears/ urine Isoniazid = peripheral neuropathy/ hepatitis Ethambutol = colour blindness Pyrazinamide = gout Streptomycin = hearing problems
Features of sarcoidosis?
G-Granulomas E-Erythema nodosum R-Restrictive lung defect (PFTs) M-Multiple systemic manifestations A-Asteroid bodies (inclusions) N-Noncaseating granuloma, Negative TB test (GERMAN)
