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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
CXR features of R upper lobe collapse
Trachea deviated to R Horizontal fissure displaced upwards R hilum displaced upwards
26
CXR features of L upper lobe collapse
Hazy white L lung field Tracheal deviation to the L Elevated L hilum Preservation of costophrenic angle
27
Causes of multiple small calcified nodules on CXR
Varicella pneumonitis TB Histoplasmosis Chronic renal failure
28
Causes of hilar enlargement
``` Malignancy TB Sarcoidosis Organic dust diseases Extrinsic allergic alveolitis ```
29
CXR shows ring shadows with tram-lining
Bronchiectasis
30
CXR appearance of malignant mesothelioma
Pleural calcification | Lobulated pleural mass
31
CXR showing ground glass appearance
Idiopathic pulmonary fibrosis | Progresses to honey comb appearance
32
Causes of pulmonary fibrosis
``` Idiopathic RA Sclerosis UC Methotrexate Amiodarone Chemotherapy ```
33
Management of acute exacerbation of COPD
``` Oxygen Nebulised salbutamol and ipratropium bromide Oral prednisolone or IV hydrocortisone BiPAP Intubate and ventilate ```
34
Lifestyle recommendations for COPD
Stop smoking Exercise Reduce obesity
35
1st line treatment for COPD
Inhaled bronchodilators
36
When is home oxygen considered in COPD patients?
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.
37
Standard treatment for community-acquired pneumonia not requiring hospital admission?
Oral amoxicillin 1g PO TDSOral clarithromycin 500mg PO BD if penicillin allergic.
38
Treatment for severe hospital-acquired pneumonia?
Tazocin ( piperacillin tazobactam) 4.5g IV QDS Ciprofloxacin 400 mg IV BD If pen allergic = cipro and gentamicin 5mg/kg IVI OD
39
Treatment for severe community-acquired pneumonia with atypical pathogens?
Clarithromycin 500mg IV BD | Co-amoxiclav 1.2g IV TDS
40
Treatment of proven chlamydia pneumonia
Oral Tetracycline
41
What does stridor indicate
Upper airway obstruction | E.g. foreign body, croup
42
Positive cold agglutinins suggests what pathogen?
Mycoplasma
43
Which pneumonia pathogens are cavitating?
TB Staphylococcal pneumonia Klebsiella pneumonia
44
What type of pneumonia occurs in HIV-positive patients?
Pneumocystis jiroveci Pneumonia
45
Side-effects of isoniazid?
Peripheral neuropathy Hepatitis Pyridoxine (B6) deficiency
46
Side-effects of rifampicin?
``` Orange tears/urine Deranged LFTs Hepatitis Enzyme inducer (drug interactions) ```
47
Side effects of ethambutol?
Retrobulbar (optic) neuritis (pain, loss of vision, colour vision impaired 1st)
48
Side effects of pyrazinamide?
Gout (arthralgia) | Hepatitis
49
Side-effects of salbutamol?
Tremor | Tachycardia
50
Side effect of inhaled corticosteroids?
Oral or pharyngeal candidiasis
51
Weightloss, anaemia and haemoptysis in a smoker suggests what?
Bronchial carcinoma
52
Causes of T2 respiratory failure?
COPD Decreased respiratory drive Neuromuscular disease Thoracic wall disease
53
Causes of T1 respiratory failure?
``` Pneumonia Pulmonary oedema PE Asthma Emphysema fibrosing alveolitis ARDs ```
54
Diagnostic criteria for ARDs
Acute Bilateral infiltrates in CXR Not in CCF Hypoxia
55
What is the oxygen delivery with a NRB mask
60-90%
56
What is chronic bronchitis?
Cough + sputum On most days >3m per year >2 years
57
What is a Pancoast tumour
Tumour at the lung apex | Can interfere with the sympathetic chain --> Horner's syndrome.
58
Clinical features of primary lung tumour
``` Cough, haemoptysis, dyspnoea, stridor, pneumonia, weight loss Clubbing Monophonic unilateral wheeze ```
59
Investigation of suspected bronchial tumour?
``` Chest x-ray CT thorax Bronchoscopy Biopsy Bronchoalveolar Lavage ```
60
Investigation for CF?
Sweat test - pilocarpine iontophoresis
61
Management of CF?
Physiotherapy antibiotic Prophylaxis and treatment Pancreatic enzyme supplements
62
Complications of CF
``` DM Hepatic cirrhosis Bronchiectasis Male infantility severe pulmonary hypertension Cor pulmonale chronic lung infections ```
63
What does the Guthrie card use to detect CF?
``` Immunoreactive trypsin (IRT) (A pancreatic enzyme raised in CF) ```
64
Congenital And acquired causes of bronchiectasis
``` Congenital = CF, cillary dyskinesia Acquired = Whooping cough, measles, TB ```
65
Presentation of mesothelioma?
Chest pain | Pleural efusion - Usually bloodstained
66
Diagnosis of mesothelioma
Pleural biopsy
67
What is asbestosis?
Diffuse fibrosis of the lungs and plura
68
What are the three main types of asbestos?
White - chrysotile blue -crocidolite Brown - amosite
69
Clinical features asbestosis?
Progressive dyspnoea, Clubbing, Lower zone inspiratory crepitations Reticulonodular shadowing on x-ray
70
What causes genetic emphysema
Alpha-1 antitrypsin deficiency Early onset emphysema Also causes chronic liver disease
71
Presentation of post-primary TB
``` Subacute illness Cough Haemoptysis Dyspnoea Fever Night sweats Anorexia ```
72
CXR features of TB
Upper lobe lesions - consolidation / cavities | +/- hilar lymphadenopathy
73
Features of sarcoidosis
Multi-system disease Caeseating granulomas ``` Dyspnoea Dry cough Erythema nodosum Lupus pernio Arthralgia Lymphadenopathy ```
74
CXR features of sarcoidosis
Bilateral Hilar lymphadenopathy | Lung fibrosis
75
Cause of aspergillosis
Aspergillus fumigatus - fungus
76
Presenting symptoms of pneumonia
Cough - initially dry, becomes productive Sputum may be blood stained Fever Pleuritic chest pain
77
Signs of pneumonia
Bronchial breathing Coarse crepitations Pyrexia
78
Presentation of pulmonary embolism (PE)
Acute onset pleuritic chest pain SOB Fever Tachycardia
79
Management of a confined pulmonary embolus
Enoxaprain 1.5m g /kg | Warfarin for 6m
80
Diagnosis of COPD
Lung function tests FEV1 <70% Little variation in peak flow
81
What culture media is needed to culture TB
Lowenstein-Jensen media
82
What stain is used to detect TB
Ziehl-neelsen stain
83
Complications of lung cancer
``` Pleural effusion Haemoptysis. pneumothorax bronchial obstruction pneumonia. Pericardial effusion metastases PE Recurrent laryngeal nerve palsy Horners syndrome ```
84
What causes holly leaf shaped lesions on CXR
Calcified pleural thickening Associated with previous asbestos exposure Asymptomatic
86
Rusty coloured sputum occurs in what disease
Streptococcus pneumonia
87
Syx of legionnaires pneumonia
Dry cough Myalgia Malaise GI syx
88
Features of pneumonia + fever, arthralgia, diarrhoea, conjunctivitis, headache, hepatosplenomegally and patchy lower lobe consolidation is....n
Chlamydiophila psittaci pneumonia
89
Features of pneumonia plus fluid filled cavities on CXR suggests what?
Staphylococcus aureus pneumonia abscesses
90
Components of the CURB score
Confusion - AMTS 7mmol/L Respiratory rate - >30 BP - systolic 65 yo
91
What do curd scores 1-5 indicate
0-1 - low mortality - manage at home 2 - intermediate mortality - hospital admission 3 + - high risk of mortality - hospital with IV abx
92
Congenital causes of bronchiectasis
CF Primary ciliary dyskinesia Kartageners syndrome
93
What is an abrams needle used for
Pleural biopsy
94
Common organisms in community acquired pneumonia
Strep pneumoniae H. Influenza Mycoplasma pneumonia (Staph aureus / legionella / chalmydophilia / moraxella catarrhalis)
95
Organisms causing hospital acquired pneumonia
E. coli Pseudomonas Klebsiella Anaerobes
96
Complications of pneumonia
``` Paraneumonic effusion Abscess Empyema Respiratory failure Septicaemia Brain abscess ```
97
SE of streptomycin
Irreversible vestibular nerve damage | Allergic reactions
98
Multi drug resistant TB is resistant to what
Rifampicin and isoniazid
99
Extensively drug resistant TB is resistant to what
Rifampicin Isoniazid Quinolones + at least 1 2nd line agent
100
What is military TB
Haemotogenous dissemination of TB
101
What is oseltamivir
Tamiflu
102
Triad in meigs syndrome
Pleural effusion Ascites Ovarian fibroma (benign)
103
Signs of ARDS
``` Cyanosis Tachypnoea Tachycardia Widespread inspiratory crepitations Hypoxia refractory to O2 Pulmonary oedema ```
104
Causes of ARDS
``` Sepsis Aspiration pneumonia Trauma Burns Pancreatitis Transfusion related lung injury Drug overdose Acute drug reaction ```
105
What respiratory disease is less common in smokers
Sarcoidosis
106
Causes of respiratory alkalosis
Hypventilation | Low CO2
107
Management of a flail chest
Analgesia | Respiratory support
108
Causes of atelectasis
Bronchial obstruction - cancer / foreign body / mucous plug | Non-obstructive - pneumothorax / reduced surfactant (ARDS) / parenchymal scarring

General Medicine (25 decks)

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