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Theme III > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is Type I Resp Failure?

A

This is when the patient is hypoxemic and and the CO2 is normal

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2
Q

What is the oxygen cut off for Type I Resp failure?

A

PaO2 less than 60mmHg

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3
Q

What are the causes of Type I Resp failure?

A
  1. Low ambient oxygen - high altitude
  2. V/Q mismatch - receive oxygen but not enough blood to absorb it - PE, COPD, Asthma
  3. Alveolar hypoventilation problems - Neuromuscular disease
  4. Diffuse problems - Oxygen cannot enter the capillaries due to parenchymal disease : pneumonia, ARDS
  5. Right to left Shunt - oxygenated blood mixes with non-oxygenated blood
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4
Q

What is type II failure?

A

PaO2 is lost and PaCO2 is raised

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5
Q

Difference between Hypoxic and Hypoxemic?

A

Hypoxic - inadequate oxygen to the body tissue

Hypoxemic - inadequate oxygen levels in the Blood

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6
Q

Symptoms with Resp II failure?

A

headaches, drowsiness, asterixis, plethora, increased ICP (secondary to vasodilation)

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7
Q

Symptoms of Type I failure?

A

Restlessness, confusion, Cyanosis, coma,

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8
Q

What is SaO2?

A

SpO2 stands for peripheral capillary oxygen saturation, an estimate of the amount of oxygen in the blood. More specifically, it is the percentage of oxygenated haemoglobin (haemoglobin containing oxygen) compared to the total amount of haemoglobin in the blood (oxygenated and non-oxygenated haemoglobin

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9
Q

What are the PaCO2 levels and PaO2 levels when hypo ventilating?

A

In a drug overdose for example, there is increased PaCO2 and normal PaO2. Improves with ventialtion and O2 therapy

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10
Q

What are the basic causes of Type II Resp failure?

A
  1. increased CO2 production due to Sepsis, fever, seizure, acidosis, dead space ventilation (COPD, Mucous blocking - rapid shallow breathing)
  2. Hypoventilation - caused by Central cause (brainstem stroke, hypothyroidism, drugs (opiates benzo’s), Neuromuscular disease (MG, Gullian-Barre , phrenic nerve injury), Muscle fatigue
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11
Q

What is the definition of Chronic bronchitis?

A

DEFINED CLINICALLY: There is productive cough on most days for at least 3 consecutive months in 2 successive years. The obstruction is due to the narrowing of the airway lumen by mucosal thickening and excess mucus

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12
Q

What is normal blood pH?

A

7.35-7.45

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13
Q

Normal measurement of PaO2?

A

80-100

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14
Q

Normal measurement for PaCO2?

A

35-45

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15
Q

Normal HCO3?

A

22-26?

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16
Q

What is the definition of Emphysema?

A

DEFINED PATHOLOGICALLY: There is dilation and destruction of air spaces distal to the terminal bronchiole without obvious fibrosis. There is decreased recoil of lung parenchyma causing decreased expiratory driving pressure, airway collapse, and air trapping.

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17
Q

In a metabolic acidoses/alkalosis how do you see if it actually has been compensated?

A

You look at the CO2 and it should roughly be the same as the last two digits of the pH?

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18
Q

What are the two types of Emphysema and who do they occur in?

A
  1. Centri-acinar - respiratory bronchioles predominantly affected. Seen in smokers - affecting the upper lung zones
  2. Pan-acinar: affects respirarty bronchioles, alveolar ducts and sacs.
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19
Q

What are the causes of anion gap?

A 
Lactic
Toxins
Ketacidosis 
Renal (Ureamia)
- Only in metabolic acidosis!
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20
Q

What is alpha-1-antitrypsin deficiency?

A

Inherited disorder - lack of a protein produces by the liver. it normally acts in the lung to inhibit the action of proteases from destroying the alveolar tissue.

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21
Q

What are proto-oncogenes?

A

Promote cell growth, get over expressed e.g. RAS, MYC

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22
Q

What is a sarcoma?

A

malignant cchange in the mesenchymal cell lineage - usually spread via blood

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23
Q

What is the most common lung cancer?

A

Adenocarcinoma

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24
Q

What is the most common lung cancer in non-smokers?

A

Adenocarcinoma

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25
Q

Is adenocarcinoma a peripheral or central lesion?

A

Peripheral and hence seen in pleural effusion

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26
Q

What is a pancoast tumour and which cancer is it associated with?

A

Causes Horner’s syndrome, hoarse voice and ulnar nerve pain - Adnocarcinoma
best on Ct, but detected by CXR by looking for opacity above the clavicles

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27
Q

What is the paraneoplastic syndrome in Adenocarcinoma?

A

HPOA - Hypertrophic pulmonary oesteoarthtropathy

Some have mutations of the epidermal growth factor receptor (EGFR), potential target for therapies (erlotinib, gefitinib, etc.)

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28
Q

What is HPOA?

A

Clubbing and thickening of periosteum and synovium of the long bones of upper and lower extremities causing wrist tenderness (periostitis)
Can be primary/familial, or secondary as a paraneoplastic syndrome of lung adenocarcinoma

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29
Q

Which cancer has the highest association with smoking?

A

Squamous cell carcinoma

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30
Q

Which cancer is usually perihilar, cavitating lesion that often involves a main bronchus?

A

Squamous cell carcinoma

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31
Q

What is the paraneoplastic syndrome associated with Squamous cell carcinoma?

A

Secretion of parathyroid-related protein –> which leads to hypercalcaemia

32
Q

Which cancer?

on histology: keratin pearls in the centre of the tumour?

A

Squamous cell carcinoma

33
Q

Which cancer?
Variants of adenocarcinoma and squamous cell carcinoma but because of poorly differentiated histology cannot be ascribed either:

A

Large cell carcinoma

34
Q

Cancer that is perihilar, always involves the local nodes?

A

Small Cell carcinoma

35
Q

What paraneoplastic syndrome is small cell carcinoma related to?

A

Ectopic ACTH (Cushing’s syndrome), Ectopic ADH ( SIADH, causing hyponaetraemia), labert eaton myasthenic syndrome

(No hypercalcaemia unless bone mets)

36
Q

What is a marker for small cell carcinoma?

A

Neuron specific enolase (NSE)

37
Q

Which cancer: dark small undifferentiated cells, scant cytoplasm

A

Small cell carcinoma

38
Q

What is lambert-eaton Myasthenic syndrome?

A

antibodies to voltage-gated calcium channels (VGCC) - muscle weakness that improves with repetition 9e..g ptosis that improves with 1 min of upward gaze). Can have problems chewing

39
Q

Investigating or suspicious of cancer?

A

CXR, CT, Sputum cytology, Bronchoscopy and biopsy

40
Q

45 year old smoker presents to his GP with weight loss of 10kg in 2 months, chronic cough, and haemoptysis. On examination, he is found to have muscle weakness that improves with repetition.

A

Small cell carcinoma

41
Q

50 year old non-smoker presents to his GP with weight loss of 10kg in 2 months, chronic cough, haemoptysis, clubbing. On examination, he’s found to have a tender right wrist and milt miosis and ptosis of his left eye.

A

Adenocarcinoma

42
Q

65 year old smoker presents to her GP with weight loss of 10kg in 2 months, chronic cough, haemoptysis, clubbing, constipation, vomiting. She also fractured her wrist with minimal trauma last week.

A

Squamous cell carcinoma

43
Q

A young man is found to be jaundiced and severely dyspneic. He has a family history of similar issues, and a genetic test reveals a mutation in the SERPINA1 gene.

A

Alpha1-antitypsin deficiency

44
Q

Features of interstitial pulmonary fibrosis? and spirometry results?

A

Progressive extertional dyspnea, Bibasal crackles on auscultation
Dry cough, Clubbing

Spirometry: classically a restrictive picture (with both decreased FEV1, FVC and normal-increased FEV1/FVC ratio)

45
Q

Bilateral interstitial shadowing (typically small, irregular, peripheral opacities - ‘ground-glass’ - later progressing to ‘honeycombing’) may be seen on a chest x-ray but high-resolution CT scanning

A

Interstital lung disease

46
Q

Difference on CXR between Complete lung collapse and Pleural effusion -

A

Trachea pulled towards the white out in lung collapse whereas pushed away from white out in pleural effusion.

47
Q

pneumonia like symptoms with lymphopaenia, hyponaetraemia, deranged liver function tests?

how to diagnose and treat?

A

Leigionella pneumophila

Diagnose/Ix with Urinary antigen

Mx with erythromycin

48
Q

What type of pneumonia is common in people who have had the flu?

A

Staph Aureus

49
Q

What skin signs is seen in Mycoplasma pneumonia?

A

Target sign - Erythema Multiforme

50
Q

What sort of pneumonia is related to Alcohol use?

A

Leigonella

51
Q

What are the four major contraindication to lung cancer surgery?

A

SVC obstruction, FEV <1.5, Malignant pleural effusion, vocal cord paralysis

52
Q

A newborn presents with “noisy breathing whilst upset”. No intervention has taken place

A

Laryngomalacia

53
Q

Common cause of pneumonia if recent flue infection?

54
Q

Common cause of pneumonia in someone with past medical history of COPD

A

Haemophilus Influenzae

55
Q

Causes of pneumonia in someone with high fever, rapid onset and herpes labialis?

A

Streptococcus pneumonia

56
Q

Cause of pneumonia in someone with dry cough, atypical chest signs, autoimmune haemolytic anaemia and erythema multiforme?

A

Mycoplasma Pneumonia

57
Q

Side effects of ICS?

A

oral candidiasis and stunted growth in children

58
Q

Pneumonia in someone with past history of alcohol excess?

A

Klebsiella

59
Q

Dyspnoea, cough, painful shin lesions, bilateral hilar lymphadenopathy

A

Sarcoidosis

60
Q

Does PE cause resp alkalosis or acidosis?

61
Q

Red currant jelly sputum

A

Klebsiella

62
Q

Sinusitis, asthma, haematuria, eosinophilia

A

Churg strauss Syndrome

63
Q

fever, renal impairment, haemoptysis, palpable purpura, no sinus symptoms

A

Microscopic polyangitis

64
Q

Oxygen Dissociation curve shift to the _____ happens with _____ oxygen delivery and is associated with…..

(4) or CADET (5)

A

Shift to the right is associated with raised oxygen delivery:

  1. Raised H+ (acidic)
  2. Raised temp
  3. Raised pCO2
  4. Riased 2,3-DPG

CO2, Acid, 2,3-DPG, Exercise, temp

65
Q

When would you investigate PE with VQ scan instead of CTPA?

A

When there is a history of CKD Stage 4

66
Q

Granulomatosis with polyangiitis and Churg strauss both present with sinusitis, haematuria and dyspnea.

3 differentiating factors between the two for each condition are:

A

GPA - Epistaxis/Haemoptysis, cANCA and Renal Failure

Churg-Strauss Syndrome - Asthma, Eosinophilia and pANCA

67
Q

Which paraneoplastic syndrome is squamous cell lung carcinoma related to?

A

Hypercalcaemia due to PTH-rp

68
Q

Pneumonia with Alcoholic with red currant jelly sputum

A

Klebsiella Pneumonia

69
Q

Pneumonia in HIV patient

A

Pneumocystitis Jiroveci

70
Q

Pneumonia in an elderly man in air conditioning place + N/v/Diarrhea

A

Leigonella

71
Q

Pneumonia in CF patient -

A

Psudomonas

72
Q

Pneumonia in smoker or COPD?

73
Q

Acid- fast bacilli or Zehl-nelson Stain

74
Q

Pan acinar emphysema -

A

A1 deficieny

75
Q

Centri-acinar emphysema

A

Smoking related

76
Q

Cold agglutin pneumonia with positive Coombs =

A

Mycoplasma

77
Q

Monophonic wheeze

A

Vocal cord paralysis

Theme III (15 decks)

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