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General Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Features of Pancoast syndrome

A

Horners syndrome
Compression of major vessels in the thoracic inlet
Wasting of intrinsic muscles of hand
Pain in shoulder radiating towards axillary and scapula

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2
Q

Signs of PE

A 
Tachypnoea
Chest pain - worse on inspiration
Haemoptysis
Peripheral cyanosis 
Raised JVP
Gallop rhythm - 3rd HS
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3
Q

Who most commonly gets spontaneous pneumothoraces

A

Men

20-40 yo

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4
Q

Symptoms of spontaneous pneumothorax

A

Sudden SOB

pleuritic chest pain

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5
Q

What is Goodpasture’s disease?

syx + signs

A 
Anti-glomerular basement Antibody disease
Glomerulo-nephritis
Haematuria
Decreased urine output
Raised BP
Dry cough
SOB
Haemoptysis
Anaemia
Resp failure
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6
Q

Management of PE

A

15L O2 NRB
Enoxaparin 1.5mg/kg S/C OD
paracetamol, TEDS
Saline if required

Stop COCP / HRT

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7
Q

What organism commonly causes acute exacerbations in CF pts?

A

Pseudomonas

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8
Q

Features of CF

A 
Bronchiectasis
Recurrent resp inf
Pancreatic insufficiency 
Malabsorption + steatorrhoea 
DM
Delayed growth and puberty 
Male infertility (absent vas deferens) 
High sweat NaCl
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9
Q

What genetic abnormality causes CF

A

Autosomal recessive (1 in 2500 caucasians)
CFTR gene
Chromosome 7

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10
Q

Respiratory causes of clubbing

A 
Bronchial carcinoma
Mesothelioma
Bronciectasis
Abscess
Empyema
Cryptogenic fibrosing alveolitis
CF
TB
Idiopathic pulmonary fibrosis
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11
Q

Features suggesting lung consolidation

A

Reduced expansion
Dullness to percussion
Increased tactile vocal fremitus
Bronchial breathing

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12
Q

Most common cause of lung consolidation

A

Pneumonia

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13
Q

What causes a honey comb lung appearance?

A

Extrinsic allergic alveolitis

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14
Q

What people commonly get staph aureus pneumonia?

A

IVDU
elderly
People recovering from Influenza

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15
Q

What Type of pneumonia is caught from parrots

A

Chlamydia psittaci

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16
Q

What type of pneumonia can occur in HIV patients

A

Pneumocystis jiroveci

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17
Q

Features of mycoplasma pneumonia

A 
Most common CAP
Automimmune haemolytic anaemia - presence of cold agglutinins
Erythema multiforme
Myopericarditis
Meningioencephalitis
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18
Q

Antibiotic for atypical pneumonia

A

Clarithromycin 500mg IV BD

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19
Q

Features of legionnaires disease

A 
Preceding flu-like illness
Dry cough
Dyspnoea
Hyponatraemia
Lymphopenia
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20
Q

Examples of pulmonary-renal syndromes

A

Wegeners granulomatosis
Microscopic polyangiitis
Goodpastures disease

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21
Q

What is caplans syndrome

A

Pulmonary manifestation of RA
–> pulmonary nodules

Commonly occurs in RA patients exposed to coal / other dusts.

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22
Q

Syx of caplans syndrome

A

Cough,
shortness of breath,
Haemoptysis

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23
Q

Respiratory manifestations of RA

A

caplans syndrome
Fibrosing alveolitis
Pleural effusion
Obliterative bronchiolitis

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24
Q

CXR features suggesting LVF

A

Kerley B lines
Bat-wing shadows
Prominent upper lobe vessels
Cardiomegaly

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25
Q

CXR features of R upper lobe collapse

A

Trachea deviated to R
Horizontal fissure displaced upwards
R hilum displaced upwards

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26
Q

CXR features of L upper lobe collapse

A

Hazy white L lung field
Tracheal deviation to the L
Elevated L hilum
Preservation of costophrenic angle

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27
Q

Causes of multiple small calcified nodules on CXR

A

Varicella pneumonitis
TB
Histoplasmosis
Chronic renal failure

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28
Q

Causes of hilar enlargement

A 
Malignancy
TB
Sarcoidosis
Organic dust diseases
Extrinsic allergic alveolitis
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29
Q

CXR shows ring shadows with tram-lining

A

Bronchiectasis

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30
Q

CXR appearance of malignant mesothelioma

A

Pleural calcification

Lobulated pleural mass

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31
Q

CXR showing ground glass appearance

A

Idiopathic pulmonary fibrosis

Progresses to honey comb appearance

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32
Q

Causes of pulmonary fibrosis

A 
Idiopathic 
RA
Sclerosis
UC
Methotrexate 
Amiodarone 
Chemotherapy
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33
Q

Management of acute exacerbation of COPD

A 
Oxygen
Nebulised salbutamol and ipratropium bromide 
Oral prednisolone or IV hydrocortisone 
BiPAP
Intubate and ventilate
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34
Q

Lifestyle recommendations for COPD

A

Stop smoking
Exercise
Reduce obesity

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35
Q

1st line treatment for COPD

A

Inhaled bronchodilators

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36
Q

When is home oxygen considered in COPD patients?

A

Clinically stable non-smokers
PaO2 <7.3kPa when stable.

Or PaO2 7.3 - 8 kPa AND secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or pulmonary hypertension.

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37
Q

Standard treatment for community-acquired pneumonia not requiring hospital admission?

A

Oral amoxicillin 1g PO TDSOral clarithromycin 500mg PO BD if penicillin allergic.

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38
Q

Treatment for severe hospital-acquired pneumonia?

A

Tazocin ( piperacillin tazobactam) 4.5g IV QDS
Ciprofloxacin 400 mg IV BD

If pen allergic = cipro and gentamicin 5mg/kg IVI OD

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39
Q

Treatment for severe community-acquired pneumonia with atypical pathogens?

A

Clarithromycin 500mg IV BD

Co-amoxiclav 1.2g IV TDS

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40
Q

Treatment of proven chlamydia pneumonia

A

Oral Tetracycline

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41
Q

What does stridor indicate

A

Upper airway obstruction

E.g. foreign body, croup

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42
Q

Positive cold agglutinins suggests what pathogen?

A

Mycoplasma

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43
Q

Which pneumonia pathogens are cavitating?

A

TB
Staphylococcal pneumonia
Klebsiella pneumonia

44
Q

What type of pneumonia occurs in HIV-positive patients?

A

Pneumocystis jiroveci Pneumonia

45
Q

Side-effects of isoniazid?

A

Peripheral neuropathy
Hepatitis
Pyridoxine (B6) deficiency

46
Q

Side-effects of rifampicin?

A 
Orange tears/urine
Deranged LFTs
Hepatitis
Enzyme inducer (drug interactions)
47
Q

Side effects of ethambutol?

A

Retrobulbar (optic) neuritis (pain, loss of vision, colour vision impaired 1st)

48
Q

Side effects of pyrazinamide?

A

Gout (arthralgia)

Hepatitis

49
Q

Side-effects of salbutamol?

A

Tremor

Tachycardia

50
Q

Side effect of inhaled corticosteroids?

A

Oral or pharyngeal candidiasis

51
Q

Weightloss, anaemia and haemoptysis in a smoker suggests what?

A

Bronchial carcinoma

52
Q

Causes of T2 respiratory failure?

A

COPD
Decreased respiratory drive
Neuromuscular disease
Thoracic wall disease

53
Q

Causes of T1 respiratory failure?

A 
Pneumonia
Pulmonary oedema
PE
Asthma
Emphysema
fibrosing alveolitis
ARDs
54
Q

Diagnostic criteria for ARDs

A

Acute
Bilateral infiltrates in CXR
Not in CCF
Hypoxia

55
Q

What is the oxygen delivery with a NRB mask

A

60-90%

56
Q

What is chronic bronchitis?

A

Cough + sputum
On most days
>3m per year
>2 years

57
Q

What is a Pancoast tumour

A

Tumour at the lung apex

Can interfere with the sympathetic chain –> Horner’s syndrome.

58
Q

Clinical features of primary lung tumour

A 
Cough, 
haemoptysis, 
dyspnoea, 
stridor, 
pneumonia, 
weight loss
Clubbing
Monophonic unilateral wheeze
59
Q

Investigation of suspected bronchial tumour?

A 
Chest x-ray 
CT thorax
Bronchoscopy
Biopsy
Bronchoalveolar Lavage
60
Q

Investigation for CF?

A

Sweat test - pilocarpine iontophoresis

61
Q

Management of CF?

A

Physiotherapy
antibiotic Prophylaxis and treatment
Pancreatic enzyme supplements

62
Q

Complications of CF

A 
DM
Hepatic cirrhosis 
Bronchiectasis
Male infantility 
severe pulmonary hypertension 
Cor pulmonale 
chronic lung infections
63
Q

What does the Guthrie card use to detect CF?

A 
Immunoreactive trypsin (IRT) 
(A pancreatic enzyme raised in CF)
64
Q

Congenital And acquired causes of bronchiectasis

A 
Congenital = CF, cillary dyskinesia 
Acquired = Whooping cough, measles, TB
65
Q

Presentation of mesothelioma?

A

Chest pain

Pleural efusion - Usually bloodstained

66
Q

Diagnosis of mesothelioma

A

Pleural biopsy

67
Q

What is asbestosis?

A

Diffuse fibrosis of the lungs and plura

68
Q

What are the three main types of asbestos?

A

White - chrysotile
blue -crocidolite
Brown - amosite

69
Q

Clinical features asbestosis?

A

Progressive dyspnoea,
Clubbing,
Lower zone inspiratory crepitations
Reticulonodular shadowing on x-ray

70
Q

What causes genetic emphysema

A

Alpha-1 antitrypsin deficiency
Early onset emphysema
Also causes chronic liver disease

71
Q

Presentation of post-primary TB

A 
Subacute illness
Cough
Haemoptysis 
Dyspnoea
Fever
Night sweats
Anorexia
72
Q

CXR features of TB

A

Upper lobe lesions - consolidation / cavities

+/- hilar lymphadenopathy

73
Q

Features of sarcoidosis

A

Multi-system disease
Caeseating granulomas

Dyspnoea 
Dry cough 
Erythema nodosum 
Lupus pernio
Arthralgia
Lymphadenopathy
74
Q

CXR features of sarcoidosis

A

Bilateral Hilar lymphadenopathy

Lung fibrosis

75
Q

Cause of aspergillosis

A

Aspergillus fumigatus - fungus

76
Q

Presenting symptoms of pneumonia

A

Cough - initially dry, becomes productive
Sputum may be blood stained
Fever
Pleuritic chest pain

77
Q

Signs of pneumonia

A

Bronchial breathing
Coarse crepitations
Pyrexia

78
Q

Presentation of pulmonary embolism (PE)

A

Acute onset pleuritic chest pain
SOB
Fever
Tachycardia

79
Q

Management of a confined pulmonary embolus

A

Enoxaprain 1.5m g /kg

Warfarin for 6m

80
Q

Diagnosis of COPD

A

Lung function tests

FEV1 <70%
Little variation in peak flow

81
Q

What culture media is needed to culture TB

A

Lowenstein-Jensen media

82
Q

What stain is used to detect TB

A

Ziehl-neelsen stain

83
Q

Complications of lung cancer

A 
Pleural effusion
Haemoptysis.
pneumothorax
bronchial obstruction
pneumonia.
Pericardial effusion
metastases 
PE
Recurrent laryngeal nerve palsy
Horners syndrome
84
Q

What causes holly leaf shaped lesions on CXR

A

Calcified pleural thickening
Associated with previous asbestos exposure
Asymptomatic

86
Q

Rusty coloured sputum occurs in what disease

A

Streptococcus pneumonia

87
Q

Syx of legionnaires pneumonia

A

Dry cough
Myalgia
Malaise
GI syx

88
Q

Features of pneumonia + fever, arthralgia, diarrhoea, conjunctivitis, headache, hepatosplenomegally and patchy lower lobe consolidation is….n

A

Chlamydiophila psittaci pneumonia

89
Q

Features of pneumonia plus fluid filled cavities on CXR suggests what?

A

Staphylococcus aureus pneumonia abscesses

90
Q

Components of the CURB score

A

Confusion - AMTS 7mmol/L
Respiratory rate - >30
BP - systolic 65 yo

91
Q

What do curd scores 1-5 indicate

A

0-1 - low mortality - manage at home
2 - intermediate mortality - hospital admission
3 + - high risk of mortality - hospital with IV abx

92
Q

Congenital causes of bronchiectasis

A

CF
Primary ciliary dyskinesia
Kartageners syndrome

93
Q

What is an abrams needle used for

A

Pleural biopsy

94
Q

Common organisms in community acquired pneumonia

A

Strep pneumoniae
H. Influenza
Mycoplasma pneumonia
(Staph aureus / legionella / chalmydophilia / moraxella catarrhalis)

95
Q

Organisms causing hospital acquired pneumonia

A

E. coli
Pseudomonas
Klebsiella
Anaerobes

96
Q

Complications of pneumonia

A 
Paraneumonic effusion
Abscess
Empyema
Respiratory failure 
Septicaemia
Brain abscess
97
Q

SE of streptomycin

A

Irreversible vestibular nerve damage

Allergic reactions

98
Q

Multi drug resistant TB is resistant to what

A

Rifampicin and isoniazid

99
Q

Extensively drug resistant TB is resistant to what

A

Rifampicin
Isoniazid
Quinolones
+ at least 1 2nd line agent

100
Q

What is military TB

A

Haemotogenous dissemination of TB

101
Q

What is oseltamivir

A

Tamiflu

102
Q

Triad in meigs syndrome

A

Pleural effusion
Ascites
Ovarian fibroma (benign)

103
Q

Signs of ARDS

A 
Cyanosis
Tachypnoea
Tachycardia
Widespread inspiratory crepitations 
Hypoxia refractory to O2
Pulmonary oedema
104
Q

Causes of ARDS

A 
Sepsis
Aspiration pneumonia 
Trauma
Burns
Pancreatitis 
Transfusion related lung injury 
Drug overdose
Acute drug reaction
105
Q

What respiratory disease is less common in smokers

A

Sarcoidosis

106
Q

Causes of respiratory alkalosis

A

Hypventilation

Low CO2

107
Q

Management of a flail chest

A

Analgesia

Respiratory support

108
Q

Causes of atelectasis

A

Bronchial obstruction - cancer / foreign body / mucous plug

Non-obstructive - pneumothorax / reduced surfactant (ARDS) / parenchymal scarring

General Medicine (25 decks)

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