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MEDICINE NEW > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Patient’s ABG shows high C02 but normal pH, do they have chronic or acute hypercapnia?

A

Chronic- as compensatory mechanisms are being utilised.

Indicates 02 sats should be aimed at 88-92%

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2
Q

What colour are Venturi masks delivering 24-28% O2?

A

Blue- 24%

White- 28%

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3
Q

Which type of O2 mask should not be used if patient is requiring less than 5L of 02?

A

Face mask, at low flow rates = more C02 rebreathing

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4
Q

A patient is known COPD, so 02 sats of 88-92% are aimed for with venturi mask. What would prompt you to start aiming treatment to 94-98%?

A

ABG shows low PaC02 (under 6)

Unless they have a PMH of needing NIV or IPPV.

If over 6, suggests hypercapnia- keep on lower sats.
If acidic pH <35 consider NIV.

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5
Q

Accessory muscle usage suggests what 3 things?

A

Small airway disease- asthma or COPD
Pneumothorax
Pleural effusion

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6
Q

3 respiratory causes of central cyanosis:

A
  1. Cor pulmonale
  2. Idiopathic fibrosis
  3. Bronchiectasis
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7
Q

Causes of lymphadenopathy in the respiratory exam:

A

Carcinoma
TB
Lymphoma
Sarcoidosis

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8
Q

Which muscles are the accessory muscules used in respiratory distress?

A

From front to back- sternocleidomastoid, scalene, trapezius

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9
Q

Causes of stridor:

A

Heard on inspiration, partial obstruction of upper aiways + larynx

Children- Pertussis, Croup, Epiglottitis
Adults- extubation, vocal cord paralysis, airway foreign body

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10
Q

What is the normal cricosternal angle height and cause of a shortened one?

A

3cm- shortened when chest is hyperexpanded in COPD

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11
Q

5 causes of reduced chest expansion:

A

External aspects restricting expansion:

  1. Effusion
  2. Consolidation
  3. Pneumothorax

Parenchymal aspects restricting:

  1. Fibrosis
  2. Collapse
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12
Q

Cause of dullness on percussion

A 
Increased solid matter:
Consolidation
Effusion
Pleural thickening
Raised hemidiaphragm

Lack of air entry:
Pneumonectomy, lobectomy (fluid and great vessels move to fill the space)

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13
Q

How do you differentiate an exudate from a transudate?

A

Light’s criteria: helpful when fluid protein is 25-35g/L

Pleural:serum protein ratio >0.5 (exudate)
Pleural:serum LDH ratio >0.6 (exudate)
Or pleural LDH 2/3s upper limit of normal serum LDH

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14
Q

Causes of bronchiectasis:

A

Conned by the Postman, had a Measley Tustle, but I Pneu he was TB Obstructive Over this + Underhand:

Congenital (CF, Kartagener’s, primary ciliary dyskinesia)
Post-infection (Measles, Pertussis, Pneumonia, TB)
Bronchial obstruction (tumour, foreign body)
Overactive immune (RA, UC, APBA)
Underactive immune (hypogammaglobulinaemia)

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15
Q

Lung complications of rheumatoid arthritis:

A

Fibrosing alveolitis (due to RA or secondary to methotrexate)
Pleural effusion
Bronchiectasis
Obliterative bronchiolitis (inflamed small airways- terminal)

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16
Q

Causes of Apical fibrosis (BREASTS-X)

A

Berylliosis (beryllium metal allergic response)
Radiation
Extrinsic allergic alveolitis (organic allergens- dust, mushroom, sugar)
Ank spond (HLA B27)
Sarcoidosis
TB
Silicosis
Histiocytosis X (granulomas of dendritic cells

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17
Q

Causes of basal fibrosis of lung:

A

RAAID

Rheumatoid arthritis
Autoimmune disease
Asbestosis
Idiopathic pulmonary fibrosis
Drugs- amiodarone, nitrofurantoin, methoxtrexate, crystal meth)
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18
Q

Commonest cause of interstitial lung disease?

A

Idiopathic pulmonary fibrosis

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19
Q

What causes early inspiratory crackles?

A

Asthma + COPD

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20
Q

What causes mid/end expiratory crackles?

‘Fine’

A

Mid- bronchiectasis

End- pulmonary oedema, pneumonia, fibrosis

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21
Q

Causes of bronchial breathing:

A

Increased solids:
Consolidation
Fibrosis

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22
Q

Which connective tissue diseases are associated with interstitial lung disease (pulmonary fibrosis)?

A

RUTSSS:

Rheumatoid arthritis
Ulcerative colitis
Thyroid (autoimmune)
SLE
Systemic sclerosis
Sjogrëns
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23
Q

Drug causes of fibrosis:

A

Methotrexate (rheum)
Amiodarone (anti-arrhythmic)
Nitrofurantoin (UTIs)

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24
Q

What are the 4 diagnostic criteria for a diagnosis of ARDS?

A

Acute injury or systemic condition = release of inflammatory mediators + ^ capillary permeability = non-cardiogenic pulmonary oedema

ARDS:
Acute onset
Refractory hypoxaemia
Diffuse bilateral infiltrates on CXR 
Small pulmonary capillary wedge pressure <19mmHg (or no CCF clinically)- a high pressure would suggest cardiac failure and blood backing up was the cause instead
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25
Q

Causes of ARDs

BEAT ARDS

A

Lung injury > release of inflammatory mediators > capillary permeability

Blood transfusion/ burns
Embolism (fat/amniotic fluid)
Aspiration (gastric)
Trauma

Acute pancreatitis/liver failure
Radiation, rheum (vasculitis)
DIC/drugs/Drowning/Diffuse pneumonia
Sepsis/shock

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26
Q

Loss of lung volume, with bilateral lower reticulonodular shadowing on xray is due to:

A

Interstitial processes:
Idiopathic pulmonary fibrosis
Sarcoid
Fibrosis (connective tissue disease, radiotherapy, drugs etc)

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27
Q

Patient has tender bruises on shins, a dry cough with SOB and a raised ESR. What is the diagnosis?

A

Sarcoid- erythema nodosum + multisystem granulomatous disorder

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28
Q

Investigations suggestive of sarcoid:

A

High calcium + high 24h urine calcium
High ESR, low lymphocytes, high Ig

CXR- bilateral hilar lymphadenopathy

Diagnostic- tissue biopsy (non-caseating granuloma)

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29
Q

What is obstructive sleep apnoea?

A

Intermittent closure or collapse of pharyngeal airways causing apnoeic episodes during sleep, terminated by partial arousal.

Sx: loud snoring, poor sleep quality
Daytime somnolence, morning headache
Reduced libido and cognitive performance

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30
Q

How is significant sleep apnoea defined?

A

> 15 episodes of apnoea or hypoapnoea during 1 hour of sleep

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31
Q

Management of obstructive sleep apnoea?

A

Can cause pulmonary hypertension, type II respiratory failure

Conservative: weight reduction, avoid tobacco and alcohol

Medical: CPAP if moderate to severe disease
Surgical: relief of pharyngeal obstruction occasionally indicated

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32
Q

What is cor pulmonale and what causes it?

A

Right heart failure caused by chronic pulmonary arterial hypertension

Lung: COPD, severe asthma, bronchiectasis, pulmonary fibrosis, lung resection

Vascular: PE, pulmonary vasculitis, ARDS, sickle-cell, parasites

Thoracic cage: kyphosis, scoliosis
Neuromuscular: myaesthenia gravis, polio, MND
Hypoventilation: sleep apnoea, enlarged adenoids in kids

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33
Q

What is the difference between coal worker’s pneumoconiosis and progressive massive fibrosis?

A

Coal worker’s pneumoconiosis > macrophage ingestion of dust
PC: Asymptomatic
CXR: 0.1-1cm nodules in upper zones

Progressive massive fibrosis
PC: progressive dyspnoea, fibrosis, cor pulmonale eventually
CXR: 1-10cm masses in upper zone

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34
Q

What is Caplan’s syndrome?

A

Rheumatoid arthritis
+ rheumatoid pulmonary nodules
+ pneumoconiosis (occupational inhaled lung disease)

Those with RA are more likely to develop pneumoconiosis

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35
Q

What does asbestos cause?

A

Pleural plaques
Asbestosis- basal fibrosis
Mesothelioma
Bronchial adenocarcinoma

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36
Q

Management of malignant mesothelioma?

A

Pemetrexed: folate antimetabolite

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37
Q

Blood and imaging findings of idiopathic pulmonary fibrosis?

A

Raised CRP, immunoglobulins
30% ANA +ve

CXR:
Reticulo-nodular shadows in lower zones
Honeycomb lung
can resemble pulmonary oedema, but no cardiomegaly

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38
Q

Rx of idiopathic pulmonary fibrosis?

A

Conservative: pulmonary rehabilitation, palliative care input
Medical: opioids, oxygen
Surgical: lung transplant

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39
Q

Causes of interstitial lung disease:

A

A= apical, B= basal

  1. Idiopathic
  2. Occupational- asbestosis (b), silicosis (a), coal worker’s pneumoconiosis
  3. Connective tissue- RA (b), SLE, scleroderma, polymyositis, Srögrens
  4. Immunologic- sarcoid (a), allergic extrinsic alveolitis (a)
  5. Treatment related- radiation, methotrexate, bleomycin, amiodarone, nitrofurantoin (b)
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40
Q

What is extrinsic allergic alveolitis and how is it different from asbestosis or pneumoconiosis?

A

In sensitized individuals, inhalation of organic allergens (fungal spores, avian proteins) causes hypersensitivity reaction.

Acute: alveoli are infiltrated with inflammatory cells
Chronic: granuloma forms > obliterative bronchiolitis (bronchiole inflammation often without CXR findings)

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41
Q

What 4 types of extrinsic allergic alveolitis are there?

A

Apical fine inspiratory fbrosis

  1. Bird-fancier’s
  2. Farmer’s lung, mushroom worker’s lung
  3. Malt worker’s lung
  4. Sugar worker’s lung
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42
Q

Features of sarcoid:

A

PC: progressive dyspnoea, dry cough, chest pain
CXR: bilateral hilar lymphadenopathy ± pulmonary infiltrates

IHX: high ESR, LFTs, Ca, serum ACE, Ig
Diagnostic: tissue biopsy (of lung, liver, lymph gland)

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43
Q

Which sarcoid patients need steroids?

A

Parenchymal lung disease
Uveitis
Hypercalcaemia
Neuro or cardiac involvement

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44
Q

Causes of bilateral hilar lymphadenopathy?

A

STONE on the xray

Sarcoid
TB
Organic dust disease- silicosis, berylliosis
Neoplasm- lymphoma, carcinoma, mediastinal tumours
Extrinsic allergic alveolitis

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45
Q

Cause of transudates:

A

<25g/L

Increased venous pressure:
cardiac failure
constrictive pericarditis
fluid overload

Hypoproteinaemia:
Cirrhosis
Nephrotic syndrome
Malabsorption

Hypothyroidism
Meig’s syndrome- R pleural effusion + ovarian fibroma

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46
Q

What are the stages of sarcoid on CXR?

A
  1. Normal
  2. Bilateral hilar lymphadenopathy
  3. BHL + peripheral pulmonary infiltrates
  4. Pulmonary infiltrates alone
  5. Progressive fibrosis, bulla formation (honeycombing), pleural involvement
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47
Q

Non-pulmonary signs:

A

Subcutaneous nodules, erythema nodosum
Phalangeal bone cysts
Uveitis, conjunctivitis, keratoconjunctivitis sicca, glaucoma
Enlarged lacrimal/parotid glands, lupus pernio
Bell’s palsy
Cardiomyopathy, lymphadenopathy, hepatosplenomegaly
Neuropathy, meningitis, SOL

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48
Q

Causes of exudates in pleural effusions?

A

Increased leakiness of pleural capillaries:

Infection- pneumonia, TB
Inflammation- RA, SLE, pulmonary infarction
Malignancy- bronchial carcinoma, mets, lymphoma, mesothelioma, lymphangitis carcinomatosis (lymph gland obstruction)

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49
Q

Signs of pleural effusion:

A

Decreased expansion
Stony dull percussion note
Diminished breath sounds

Bronchial breathing above the effusion- where the lung is compressed (=turbulent air flow in large airways)

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50
Q

How should a diagnostic aspiration of pleural effusion fluid be performed?

A

Us guidance
Percuss borders of effusion
Lidocaine at the pleural edge
Insert needle with syringe attached just above the upper border of the rib (avoids neuromuscular bundle)

Clinical chemistry, microscopy, cytology, if indicated imunology (RF, ANA, complement)

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51
Q

Management of pleural effusions:

A

Drainage- if symptomatic, remove fluid slowly, if empyema- chest drain
Pleurodesis- talc for malignant effusions

Surgery- if persistent and increasing pleural thickness

52
Q

What does a raised amylase on a pleural effusion indicate?

A

Pancreatitis
Carcinoma
Bacterial pneumonia
Oesophageal rupture

53
Q

What is a parapneumonia effusion?

A

If there is a pleural effusion associated with a pneumonia because of pleural inflammation, but the fluid is not infective.

If inflammation-associated effusion is infected it would be called an empyema instead.

54
Q

What are the rare causes of pulmonary embolism?

A

Right ventricular thrombus- post MI
Septic emboli- infective endocarditis
Fat, air or amniotic fluid
Neoplastic cells, parasites

55
Q

Management of PE?

A

LMWH
for 5 days or until INR >2, whichever comes first
Warfarin
for at least 3 months if provoked, 6 months if unprovoked or active cancer

Thrombolysis
Massive PE + circulatory failure

56
Q

Signs of pneumothorax?

A

Reduced expansion
Hyper-resonance to percussion
Diminished breath sounds

± tracheal deviation

57
Q

How does use of the 2 level Wells score differ for managing DVT vs PE?

A

PE: score of 4 makes it likely
Opt for CTPA

DVT: score of 2 makes it likely
Opt for USS of leg vein

58
Q

What is the cause of type 1 and type 2 respiratory failure?

A

Type 1: ventilation perfusion mismatch
CO2 doesn’t need much blood flow to clear
Pneumonia, pulmonary fibrosis, PE, pulmonary oedema, asthma

Type 2: alveolar hypoventilation
Pulmonary, respiratory drive, neuromuscular disease, thoracic wall disease

59
Q

What is Acute Respiratory Distress Syndrome:

A

Lung damage and release of inflammatory mediators causing increased capillary permeability and pulmonary oedema

May be caused by direct lung injury or secondary to severe systemic illness with multi-organ failure

60
Q

Patient has fluffy pulmonary shadowing in a perihilar distribution, no cardiomegaly and patient is suspected of aspiration. What is the diagnosis?

A

Acute respiratory distress syndrome

Patient may be cyanosed, tachypnoeic, tachycardic, vasodilated with fine bilateral crackles

61
Q

What are the 4 criteria of ARDS:

A

Acute onset
Refractory hypoxaemia (PaO2:Fi02 <200)
Diffuse bilateral pulmonary infiltrates on CXR
Small pulmonary capillary wedge pressure aka not-cardiogenic

62
Q

Aspects of acute respiratory distress syndrome management:

A

Respiratory: CPAP + 60% oxygen, ventilation

Circulatory: arterial line, inotropes, vasodilators, blood transfusion, haemofiltration

Sepsis: antibiotics

Nutrition: enteral is best, high fat

63
Q

Spirometry features of COPD:

A

FEV1/FVC < 0.7
FEV1 < 0.8

Forced expiratory volume, full vital capacity

64
Q

Definition of chronic bronchitis:

A

Cough + sputum production of most days for 3 months, over 2 successive years

65
Q

Definition of emphysema?

A

Histologically defined as enlarged air spaces distal to the terminal bronchioles with destruction of alveolar walls

66
Q

Difference between pink puffers and blue bloaters and their respective risks in COPD?

A

Pink puffers- breathless not cyanosed
increase RR giving normal PaO2 and normal ish PaCO2
May progress to type 1 resp failure

Blue bloaters- cyanosed not breathless
CO2 retainers
May progress to cor pulmonale

67
Q

Complications of COPD and their signs:

A 
Coarse crackles- infective exacerbation
Facial plethora- polycythaemia
Accessory muscle use- resp failure
Loud P2, ankle oedema- cor pulmonal
Hyper-resonant- pneumothorax
68
Q

Indications for long term O2 therapy:

A

Smoking cessation

PaO2 <7.3kPa
On two occasions, 3 weeks apart

PaO2 <8kPa   AND:
  Pulmonary hypertension
  Polycythaemia
  Peripheral oedema
  Nocturnal hypoxia
69
Q

What are the different stages of COPD?

A

Stage 1- mild FEV1 >0.8
Stage 2- moderate FEV1. >0.5
Stage 3- severe FEV1. >0.3
Stage 4- very severe FEV1 <0.3

70
Q

Management of COPD:

A

Conservative: Smoking cessation, yearly flu vaccine, pulmonary rehabilitation, encourage exercise
Pneumococcal vaccine- once only

Medical: SABA or SAMA
FEV1 determines ongoing therapy
FEV1 >0.5 LABA or LAMA
FEV1 <0.5 LABA and steroid or LAMA

NIV if hypercapnic on LTOT

Surgery: recurrent pneumothorax, isolated bullous disease

71
Q

What does theophylline cause outside it’s therapeutic window?

A

Arrhythmias, fits, GI upset

72
Q

Which biologic is used in asthma?

A

Omalizumab- Anti IgE Ab

73
Q

What 3 factors contribute to airway narrowing in asthma?

A

Bronchial muscle contraction
Mucosal swelling + inflammation- mast cells + basophils
Increased mucus production

74
Q

Which medicines need to be avoided in asthma patients?

A

NSAIDs
b-blockers
Adenosine- SVT

75
Q

Questions to ask when taking an asthma history?

A

PC: diurnal variation, number of disturbed nights of sleep, exercise tolerance, acid reflux (40-60%)

PMH: atopy
SHx: pets, carpet, feather pillows, job

76
Q

Signs of severe asthma

A

A: inability to complete sentences
B: RR >25, PEF 33-50%
C: HR >110

77
Q

Signs of life-threatening asthma:

A

A: Sp02 <92%, cyanosis (Pa02 <8kPa)
B: silent chest, PEF <33%
C: bradycardia
D: confusion, exhaustion

Near fatal: rise in PaCO2

78
Q

Differential diagnosis of asthma:

A

Pulmonary oedema- cardiac asthma
COPD, bronchiectasis, obliterative bronchiolitis
Large airway obstruction- foreign body, tumour
SVC obstruction- wheeze, dyspnoea
Pneumothorax, PE

79
Q

What hormones do the different types of lung cancer secrete?

A

Small cell: SIADH or ACTH or Lambert Eaton (anti Ca-channel)

Squamous cell: PTH

80
Q

Name the different types of lung cancer:

A

Squamous cell
Adenocarcinoma
Small cell- smoking associated
Large cell- anaplastic, may secrete bHCG

Alveolar cell carcinoma

81
Q

Local complications of lung cancer that may be evident on respiratory exam?

A

Dysphonia- recurrent laryngeal nerve
Horner’s- Pancoast tumour
Facial swelling- SVC obstruction
Tender palpation- rib erosion

82
Q

Tests for lung cancer:

A 
Cytology- sputum and pleural fluid
CXR
Biopsy of lymph nodes
CT staging 
Bronchoscopy ± endobronchial USS or biopsy
Radionucleotide bone scan, LFTs
83
Q

How does management of non-small cell lung cancers (squamous, large, adenocarcinoma) differ from small cell lung cancers?

A

Non-small cell:
excision if low grade + fit
curative radiotherapy if low grade + unfit
radiotherapy and chemotherapy if advanced

Small cell:
Chemotherapy
Palliative- radiotherapy, stents of SVC, pleurodeisis of effusions

84
Q

What is the difference between an aspergilloma and aspergillosis?

A

Aspergilloma- benign fungus ball within a cavity, usually aymptomatic, can cause haemoptysis. Rx if symptomatic

Aspergillosis- invasive in immunocompromised patients, IV antifungals required, 30% mortality

85
Q

What is the difference between allergic bronchopulmonary aspergillosis and extrinsic allergic alveolitis?

A

Both are hypersensitivity reactions which may be in response to fungal spores.

In ABPA there is bronchoconstriction and eventual bronchiectasis
CXR: lung collapse (mucus plugs) + bronchiectasis
Atopic, IgE raised, fever, obstructed pulmonary function

In EAA there is infiltration of alveoli with inflammatory cells and eventual granuloma formation.
Non-atopic, chills, fever, cough
CXR: upper zone consolidation

86
Q

What blood test can differentiate allergic bronchopulmonary aspergillosis from extrinsic allergic alveolitis (malt-worker’s lung = Aspergillus sensitivity)

A

IgE raised- ABPA

+ve Aspergillus skin test and IgE radioallergosorbent (RAST) test

87
Q

What two things come together to cause bronchiectasis?

A

Chronic infection of bronchi and bronchioles leads to permanent dilatation of the arteries.

Defective mucus clearing:
1. Congenital- CF, Young’s syndrome, primary ciliary dyskinesia, Kartagener’s syndrome (dextrocardia)

  1. Post infection- measles, pertussis, pneumonia, TB, HIV
  2. Autoimmune- RA, UC, ABPA
  3. Immune- hypogammaglobulinaemia

Infections:
Strep pneumo, staph aureus, haemophilus influenzae, pseudomonas

88
Q

Test and imaging findings of bronchiectasis:

A

CXR: tram lining- thickened bronchioles
CT- signet ring sign
Spirometry- obstructive findings

89
Q

Management of bronchiectasis:

A

Conservative: Postural drainage, chest physio

Medical: Antibiotics, bronchodilators, steroids (for ABPA)

Surgical: rarely for controlling severe haemoptysis

90
Q

What is the inheritance of cystic fibrosis?

A

Autosomal recessive
CF transmembrane conductance regulator (CFTR) gene
Chromosome 7

91
Q

Features of cystic fibrosis:

A

Arthritis, hypertrophic pulmonary osteoarthropathy
Nasal polyps, sinusitis
Pancreatic insufficiency, cirrhosis, gallstones, intestinal obstruction
Osteoporosis
Male infertility

92
Q

Tests for cystic fibrosis:

A

Sweat test
Gene test: CFTR chromosome 7
Faecal elastase: screening tool for exocrine pancreatic dysfunction

93
Q

Tests for complications in cystic fibrosis:

A

FBC, U+Es, LFTs (cirrhosis), clotting, vit ADE
Annual glucose tolerance test

Sputum culture, CXR, spirometry (obstructive)
Abdo USS- fatty liver, cirrhosis, chronic pancreatitis
Aspergillus serology/skin test

94
Q

Management of CF:

A

Much like bronchiectasis with some add ons
Conservative: chest physio, dietician, GP

Medical: Mucolytics, antibiotics, bronchodilators, NIV
Creon (Vit ADEK), diuretics (cor pulmonale)

Surgical: heart/lung transplant, liver transplant

95
Q

Why do pleural effusions form?

A

Inflammation of pleura leads to fluid production, if this accumulates faster than it is removed, it forms an effusion

96
Q

Patient with a resolving pneumonia has recurrent fever, CXR shows a pleural effusion. What may it be, and how can you prove this?

A

Empyema- aspirated fluid may have
Low pH (<7.2)
High LDH

97
Q

What things cause lung abscesses?

A

Inadequately treated pneumonia
Aspiration- alcoholics, bulbar palsy
Bronchial obstruction- tumour, foreign body
Pulmonary infarction
Septic emboli- septicaemia, right heart endocarditis, IV drug use
Subphrenic or hepatic abscess

98
Q

What microorganisms cause the following types of pneumonia:

A. Lobar
B. Bronchopneumonia
C. Cavitating
D. Reticular nodular shadowing (interstitial)

A

A. Strep pneumo, legionella (bibasal)
B. Staph aureus
C. Staph aureus, klebsiella
D. Mycoplasma, chlamydia psittaci, viruses

99
Q

A patient has a severe pneumonia, which you suspect is due to strep pneumo (lobar), how can this be proved?

A

Urinary antigen

100
Q

Tests to do to determine whether a patient has mycoplasma?

A

Diagnosis: PCR sputum or serology

Cold agglutinin test + FBC

101
Q

Complications of mycoplasma pneumoniae pneumonia?

A

May get myalgia, arthralgia typically

Erythema multiforme, Stephens-Johnson syndrome
Myelitis, Guillain-Barré syndrome
Meningoencephalitis
Autoimmune haemolysis

102
Q

Extra-pulmonary features of Legionella:

A

Typically myalgia

Others: anorexia, D+V
Hepatitis + LFTs
Renal failure
Confusion, coma
FBC: lymphopenia
U+E: hyponatraemia
103
Q

Viruses affecting the lung:

A

Influenza
Measles
CMV
Varicella zoster

At younger ages:
Parainfluenza
Respiratory syncytial virus

104
Q

Rx of atypical pneumonias:

A

Macrolides- clarithryomycin

105
Q

How is pneumocystic jiroveci pneumonia diagnosed?

A

Microscopic visualisation from:
Sputum sample
Bronchoalveolar lavage
Lung biopsy

106
Q

How can viral pneumonias caused by avian influenza be diagnosed?

A

Viral culture ± reverse transcriptase PCR for H5 and H1

107
Q

What prophylaxis is needed for patients who have been in contact with someone diagnosed with avian flu?

A

Oseltamivir 75mg OD for 7 days

108
Q

Commonest causes of community acquired pneumonia:

A

Strep pneumo
Haemophilus influenzae (especially if COPD)
Moraxella catarrhalis

Mycoplasma, legionella, chlamydia
Staph aureus

109
Q

When is a pneumonia classified as hospital acquired?

A

> 48 hours after admission

110
Q

What type of organisms are associated with hospital acquired pneumonia?

A

Gram negative enterobacteria- E Coli, enterobacter, bacteroides
Staph aureus

111
Q

CURB 65?

A

Confusion <9/10
Urea >7mmol
RR >30
BP <90/ <60

65 years

Other features suggesting severity:
Hypoxia <8kPa of O2
Bilateral or multilobar involvement
Sats <92%

112
Q

How does the CURB score predict further management needs?

A

Score:
0-1 home Rx possible
2 hospital therapy
3 ITU

May underscore the young who compensate well

113
Q

Who is eligible for pneumococcal vaccine?

A

Age >65
PMH:
chronic heart, lung, liver or renal disease (nephrotic syndrome, CKD, post-transplant)
Diabetes mellitus
Immunosupression- asplenia, chemo, HIV, sickle cell

*give every 6 years

114
Q

How do obstructive vs restrictive lung diseases affect the total lung capacity and residual volume differently?

A

Obstructive: increased lung capacity (hyperinflation) + residual volume (air trapping)

Restrictive: reduced lung capacity (honeycombing) + residual volume

115
Q

When is high resolution CT needed for lung disease?

A

Bronchiectasis

Interstitial lung disease

116
Q

What is the alveolar-arterial gradient and what is it used for?

A

Determines in type 2 respiratory failure if it is effort-related or due to lung disease

in hypoventilation- no problem with diffusion so gradient is normal.

117
Q

Yellow nail syndrome features?

A

Affects lymphatic system:

Lymphoedema
Exudative pleural effusions
Bronchiectasis

Complications:
Malignancy, rheum conditions

118
Q

Loss of silhouette in which areas suggests opacities in the
A. Lingula (part of upper L lung lobe)
B. L upper lobe

A

A. Left heart border

B. Aortic knuckle

119
Q

Review areas in a chest xray?

A 
Apices- pneumothorax
Bones/soft tissues- fractures/ sclerosis
Cardiac shadow- concealed masses or consolidation
Diaphragm- pneumoperitoneum
Edge of the image
120
Q

What benign tumours can someone get in the lung?

A

Adenoma

Hamartoma

121
Q

What is the stepwise progression that leads to development of a tumour?

A 
Normal epithelium
Hyperplasia
Squamous metaplasia
Dysplasia
Carcinoma in situ
Invasive carcinoma
122
Q

Which type of lung cancer has the strongest link to smoking?

A

Squamous cell carcinoma

Occurs in the central lung

123
Q

What is a large cell cancer in lung cancer terms?

A

A squamous or adenocarcinoma that is unrecognisable, lack of differentiation.
High grade by definition

124
Q

What index is used to denote wall thickening from mucus accumulation in bronchitis?

A

Reid Index

125
Q

How is total lung capacity affected in COPD?

A

Increased with hyperinflation of the lungs + air trapping

126
Q

Type of hypersensitivity reaction in:
A. Asthma
B. Organic pneumoconiosis (farmer’s lung, bird fancier’s)

A

A. Type 1 + 3 (IgE + immune complex)
B. Type 3 + 4 (immune complex + T cell)

Organic pneumoconisis = extrinsic allergic alveolitis and hypersensitivity pneumonitis

127
Q

Features that can occur with sarcoid:

A 
Skin- erythema nodosum, lupus pernio
CNS- 7th nerve palsy
Ocular- uveitis, sicca, conjunctivitis
Joints- polyarthritis 
Heart- myositis, arrhythmias, heart block

MEDICINE NEW (22 decks)

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