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%
2
Q
What colour are Venturi masks delivering 24-28% O2?
A
Blue- 24%
White- 28%
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
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.
5
Q
Accessory muscle usage suggests what 3 things?
A
Small airway disease- asthma or COPD
Pneumothorax
Pleural effusion
6
Q
3 respiratory causes of central cyanosis:
A
- Cor pulmonale
- Idiopathic fibrosis
- Bronchiectasis
7
Q
Causes of lymphadenopathy in the respiratory exam:
A
Carcinoma
TB
Lymphoma
Sarcoidosis
8
Q
Which muscles are the accessory muscules used in respiratory distress?
A
From front to back- sternocleidomastoid, scalene, trapezius
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
10
Q
What is the normal cricosternal angle height and cause of a shortened one?
A
3cm- shortened when chest is hyperexpanded in COPD
11
Q
5 causes of reduced chest expansion:
A
External aspects restricting expansion:
- Effusion
- Consolidation
- Pneumothorax
Parenchymal aspects restricting:
- Fibrosis
- Collapse
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)
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
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)
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)
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
17
Q
Causes of basal fibrosis of lung:
A
RAAID
Rheumatoid arthritis Autoimmune disease Asbestosis Idiopathic pulmonary fibrosis Drugs- amiodarone, nitrofurantoin, methoxtrexate, crystal meth)
18
Q
Commonest cause of interstitial lung disease?
A
Idiopathic pulmonary fibrosis
19
Q
What causes early inspiratory crackles?
A
Asthma + COPD
20
Q
What causes mid/end expiratory crackles?
‘Fine’
A
Mid- bronchiectasis
End- pulmonary oedema, pneumonia, fibrosis
21
Q
Causes of bronchial breathing:
A
Increased solids:
Consolidation
Fibrosis
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
23
Q
Drug causes of fibrosis:
A
Methotrexate (rheum)
Amiodarone (anti-arrhythmic)
Nitrofurantoin (UTIs)
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
25
Causes of ARDs
| BEAT ARDS
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
26
Loss of lung volume, with bilateral lower reticulonodular shadowing on xray is due to:
Interstitial processes:
Idiopathic pulmonary fibrosis
Sarcoid
Fibrosis (connective tissue disease, radiotherapy, drugs etc)
27
Patient has tender bruises on shins, a dry cough with SOB and a raised ESR. What is the diagnosis?
Sarcoid- erythema nodosum + multisystem granulomatous disorder
28
Investigations suggestive of sarcoid:
High calcium + high 24h urine calcium
High ESR, low lymphocytes, high Ig
CXR- bilateral hilar lymphadenopathy
Diagnostic- tissue biopsy (non-caseating granuloma)
29
What is obstructive sleep apnoea?
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
30
How is significant sleep apnoea defined?
>15 episodes of apnoea or hypoapnoea during 1 hour of sleep
31
Management of obstructive sleep apnoea?
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
32
What is cor pulmonale and what causes it?
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
33
What is the difference between coal worker's pneumoconiosis and progressive massive fibrosis?
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
34
What is Caplan's syndrome?
Rheumatoid arthritis
+ rheumatoid pulmonary nodules
+ pneumoconiosis (occupational inhaled lung disease)
Those with RA are more likely to develop pneumoconiosis
35
What does asbestos cause?
Pleural plaques
Asbestosis- basal fibrosis
Mesothelioma
Bronchial adenocarcinoma
36
Management of malignant mesothelioma?
Pemetrexed: folate antimetabolite
37
Blood and imaging findings of idiopathic pulmonary fibrosis?
Raised CRP, immunoglobulins
30% ANA +ve
CXR:
Reticulo-nodular shadows in lower zones
Honeycomb lung
can resemble pulmonary oedema, but no cardiomegaly
38
Rx of idiopathic pulmonary fibrosis?
Conservative: pulmonary rehabilitation, palliative care input
Medical: opioids, oxygen
Surgical: lung transplant
39
Causes of interstitial lung disease:
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)
40
What is extrinsic allergic alveolitis and how is it different from asbestosis or pneumoconiosis?
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)
41
What 4 types of extrinsic allergic alveolitis are there?
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
42
Features of sarcoid:
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)
43
Which sarcoid patients need steroids?
Parenchymal lung disease
Uveitis
Hypercalcaemia
Neuro or cardiac involvement
44
Causes of bilateral hilar lymphadenopathy?
STONE on the xray
Sarcoid
TB
Organic dust disease- silicosis, berylliosis
Neoplasm- lymphoma, carcinoma, mediastinal tumours
Extrinsic allergic alveolitis
45
Cause of transudates:
<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
46
What are the stages of sarcoid on CXR?
0. Normal
1. Bilateral hilar lymphadenopathy
2. BHL + peripheral pulmonary infiltrates
3. Pulmonary infiltrates alone
4. Progressive fibrosis, bulla formation (honeycombing), pleural involvement
47
Non-pulmonary signs:
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
48
Causes of exudates in pleural effusions?
Increased leakiness of pleural capillaries:
Infection- pneumonia, TB
Inflammation- RA, SLE, pulmonary infarction
Malignancy- bronchial carcinoma, mets, lymphoma, mesothelioma, lymphangitis carcinomatosis (lymph gland obstruction)
49
Signs of pleural effusion:
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)
50
How should a diagnostic aspiration of pleural effusion fluid be performed?
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)
51
Management of pleural effusions:
Drainage- if symptomatic, remove fluid slowly, if empyema- chest drain
Pleurodesis- talc for malignant effusions
Surgery- if persistent and increasing pleural thickness
52
What does a raised amylase on a pleural effusion indicate?
Pancreatitis
Carcinoma
Bacterial pneumonia
Oesophageal rupture
53
What is a parapneumonia effusion?
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
What are the rare causes of pulmonary embolism?
Right ventricular thrombus- post MI
Septic emboli- infective endocarditis
Fat, air or amniotic fluid
Neoplastic cells, parasites
55
Management of PE?
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
Signs of pneumothorax?
Reduced expansion
Hyper-resonance to percussion
Diminished breath sounds
± tracheal deviation
57
How does use of the 2 level Wells score differ for managing DVT vs PE?
PE: score of 4 makes it likely
Opt for CTPA
DVT: score of 2 makes it likely
Opt for USS of leg vein
58
What is the cause of type 1 and type 2 respiratory failure?
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
What is Acute Respiratory Distress Syndrome:
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
Patient has fluffy pulmonary shadowing in a perihilar distribution, no cardiomegaly and patient is suspected of aspiration. What is the diagnosis?
Acute respiratory distress syndrome
| Patient may be cyanosed, tachypnoeic, tachycardic, vasodilated with fine bilateral crackles
61
What are the 4 criteria of ARDS:
Acute onset
Refractory hypoxaemia (PaO2:Fi02 <200)
Diffuse bilateral pulmonary infiltrates on CXR
Small pulmonary capillary wedge pressure aka not-cardiogenic
62
Aspects of acute respiratory distress syndrome management:
Respiratory: CPAP + 60% oxygen, ventilation
Circulatory: arterial line, inotropes, vasodilators, blood transfusion, haemofiltration
Sepsis: antibiotics
Nutrition: enteral is best, high fat
63
Spirometry features of COPD:
FEV1/FVC < 0.7
FEV1 < 0.8
Forced expiratory volume, full vital capacity
64
Definition of chronic bronchitis:
Cough + sputum production of most days for 3 months, over 2 successive years
65
Definition of emphysema?
Histologically defined as enlarged air spaces distal to the terminal bronchioles with destruction of alveolar walls
66
Difference between pink puffers and blue bloaters and their respective risks in COPD?
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
Complications of COPD and their signs:
```
Coarse crackles- infective exacerbation
Facial plethora- polycythaemia
Accessory muscle use- resp failure
Loud P2, ankle oedema- cor pulmonal
Hyper-resonant- pneumothorax
```
68
Indications for long term O2 therapy:
Smoking cessation
PaO2 <7.3kPa
On two occasions, 3 weeks apart
```
PaO2 <8kPa AND:
Pulmonary hypertension
Polycythaemia
Peripheral oedema
Nocturnal hypoxia
```
69
What are the different stages of COPD?
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
Management of COPD:
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
What does theophylline cause outside it's therapeutic window?
Arrhythmias, fits, GI upset
72
Which biologic is used in asthma?
Omalizumab- Anti IgE Ab
73
What 3 factors contribute to airway narrowing in asthma?
Bronchial muscle contraction
Mucosal swelling + inflammation- mast cells + basophils
Increased mucus production
74
Which medicines need to be avoided in asthma patients?
NSAIDs
b-blockers
Adenosine- SVT
75
Questions to ask when taking an asthma history?
PC: diurnal variation, number of disturbed nights of sleep, exercise tolerance, acid reflux (40-60%)
PMH: atopy
SHx: pets, carpet, feather pillows, job
76
Signs of severe asthma
A: inability to complete sentences
B: RR >25, PEF 33-50%
C: HR >110
77
Signs of life-threatening asthma:
A: Sp02 <92%, cyanosis (Pa02 <8kPa)
B: silent chest, PEF <33%
C: bradycardia
D: confusion, exhaustion
Near fatal: rise in PaCO2
78
Differential diagnosis of asthma:
Pulmonary oedema- cardiac asthma
COPD, bronchiectasis, obliterative bronchiolitis
Large airway obstruction- foreign body, tumour
SVC obstruction- wheeze, dyspnoea
Pneumothorax, PE
79
What hormones do the different types of lung cancer secrete?
Small cell: SIADH or ACTH or Lambert Eaton (anti Ca-channel)
Squamous cell: PTH
80
Name the different types of lung cancer:
Squamous cell
Adenocarcinoma
Small cell- smoking associated
Large cell- anaplastic, may secrete bHCG
Alveolar cell carcinoma
81
Local complications of lung cancer that may be evident on respiratory exam?
Dysphonia- recurrent laryngeal nerve
Horner's- Pancoast tumour
Facial swelling- SVC obstruction
Tender palpation- rib erosion
82
Tests for lung cancer:
```
Cytology- sputum and pleural fluid
CXR
Biopsy of lymph nodes
CT staging
Bronchoscopy ± endobronchial USS or biopsy
Radionucleotide bone scan, LFTs
```
83
How does management of non-small cell lung cancers (squamous, large, adenocarcinoma) differ from small cell lung cancers?
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
What is the difference between an aspergilloma and aspergillosis?
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
What is the difference between allergic bronchopulmonary aspergillosis and extrinsic allergic alveolitis?
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
What blood test can differentiate allergic bronchopulmonary aspergillosis from extrinsic allergic alveolitis (malt-worker's lung = Aspergillus sensitivity)
IgE raised- ABPA
| +ve Aspergillus skin test and IgE radioallergosorbent (RAST) test
87
What two things come together to cause bronchiectasis?
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)
2. Post infection- measles, pertussis, pneumonia, TB, HIV
3. Autoimmune- RA, UC, ABPA
4. Immune- hypogammaglobulinaemia
Infections:
Strep pneumo, staph aureus, haemophilus influenzae, pseudomonas
88
Test and imaging findings of bronchiectasis:
CXR: tram lining- thickened bronchioles
CT- signet ring sign
Spirometry- obstructive findings
89
Management of bronchiectasis:
Conservative: Postural drainage, chest physio
Medical: Antibiotics, bronchodilators, steroids (for ABPA)
Surgical: rarely for controlling severe haemoptysis
90
What is the inheritance of cystic fibrosis?
Autosomal recessive
CF transmembrane conductance regulator (CFTR) gene
Chromosome 7
91
Features of cystic fibrosis:
Arthritis, hypertrophic pulmonary osteoarthropathy
Nasal polyps, sinusitis
Pancreatic insufficiency, cirrhosis, gallstones, intestinal obstruction
Osteoporosis
Male infertility
92
Tests for cystic fibrosis:
Sweat test
Gene test: CFTR chromosome 7
Faecal elastase: screening tool for exocrine pancreatic dysfunction
93
Tests for complications in cystic fibrosis:
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
Management of CF:
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
Why do pleural effusions form?
Inflammation of pleura leads to fluid production, if this accumulates faster than it is removed, it forms an effusion
96
Patient with a resolving pneumonia has recurrent fever, CXR shows a pleural effusion. What may it be, and how can you prove this?
Empyema- aspirated fluid may have
Low pH (<7.2)
High LDH
97
What things cause lung abscesses?
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
What microorganisms cause the following types of pneumonia:
A. Lobar
B. Bronchopneumonia
C. Cavitating
D. Reticular nodular shadowing (interstitial)
A. Strep pneumo, legionella (bibasal)
B. Staph aureus
C. Staph aureus, klebsiella
D. Mycoplasma, chlamydia psittaci, viruses
99
A patient has a severe pneumonia, which you suspect is due to strep pneumo (lobar), how can this be proved?
Urinary antigen
100
Tests to do to determine whether a patient has mycoplasma?
Diagnosis: PCR sputum or serology
| Cold agglutinin test + FBC
101
Complications of mycoplasma pneumoniae pneumonia?
May get myalgia, arthralgia typically
Erythema multiforme, Stephens-Johnson syndrome
Myelitis, Guillain-Barré syndrome
Meningoencephalitis
Autoimmune haemolysis
102
Extra-pulmonary features of Legionella:
Typically myalgia
```
Others: anorexia, D+V
Hepatitis + LFTs
Renal failure
Confusion, coma
FBC: lymphopenia
U+E: hyponatraemia
```
103
Viruses affecting the lung:
Influenza
Measles
CMV
Varicella zoster
At younger ages:
Parainfluenza
Respiratory syncytial virus
104
Rx of atypical pneumonias:
Macrolides- clarithryomycin
105
How is pneumocystic jiroveci pneumonia diagnosed?
Microscopic visualisation from:
Sputum sample
Bronchoalveolar lavage
Lung biopsy
106
How can viral pneumonias caused by avian influenza be diagnosed?
Viral culture ± reverse transcriptase PCR for H5 and H1
107
What prophylaxis is needed for patients who have been in contact with someone diagnosed with avian flu?
Oseltamivir 75mg OD for 7 days
108
Commonest causes of community acquired pneumonia:
Strep pneumo
Haemophilus influenzae (especially if COPD)
Moraxella catarrhalis
Mycoplasma, legionella, chlamydia
Staph aureus
109
When is a pneumonia classified as hospital acquired?
>48 hours after admission
110
What type of organisms are associated with hospital acquired pneumonia?
Gram negative enterobacteria- E Coli, enterobacter, bacteroides
Staph aureus
111
CURB 65?
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
How does the CURB score predict further management needs?
Score:
0-1 home Rx possible
2 hospital therapy
3 ITU
May underscore the young who compensate well
113
Who is eligible for pneumococcal vaccine?
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
How do obstructive vs restrictive lung diseases affect the total lung capacity and residual volume differently?
Obstructive: increased lung capacity (hyperinflation) + residual volume (air trapping)
Restrictive: reduced lung capacity (honeycombing) + residual volume
115
When is high resolution CT needed for lung disease?
Bronchiectasis
| Interstitial lung disease
116
What is the alveolar-arterial gradient and what is it used for?
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
Yellow nail syndrome features?
Affects lymphatic system:
Lymphoedema
Exudative pleural effusions
Bronchiectasis
Complications:
Malignancy, rheum conditions
118
Loss of silhouette in which areas suggests opacities in the
A. Lingula (part of upper L lung lobe)
B. L upper lobe
A. Left heart border
| B. Aortic knuckle
119
Review areas in a chest xray?
```
Apices- pneumothorax
Bones/soft tissues- fractures/ sclerosis
Cardiac shadow- concealed masses or consolidation
Diaphragm- pneumoperitoneum
Edge of the image
```
120
What benign tumours can someone get in the lung?
Adenoma
| Hamartoma
121
What is the stepwise progression that leads to development of a tumour?
```
Normal epithelium
Hyperplasia
Squamous metaplasia
Dysplasia
Carcinoma in situ
Invasive carcinoma
```
122
Which type of lung cancer has the strongest link to smoking?
Squamous cell carcinoma
| Occurs in the central lung
123
What is a large cell cancer in lung cancer terms?
A squamous or adenocarcinoma that is unrecognisable, lack of differentiation.
High grade by definition
124
What index is used to denote wall thickening from mucus accumulation in bronchitis?
Reid Index
125
How is total lung capacity affected in COPD?
Increased with hyperinflation of the lungs + air trapping
126
Type of hypersensitivity reaction in:
A. Asthma
B. Organic pneumoconiosis (farmer's lung, bird fancier's)
A. Type 1 + 3 (IgE + immune complex)
B. Type 3 + 4 (immune complex + T cell)
Organic pneumoconisis = extrinsic allergic alveolitis and hypersensitivity pneumonitis
127
Features that can occur with sarcoid:
```
Skin- erythema nodosum, lupus pernio
CNS- 7th nerve palsy
Ocular- uveitis, sicca, conjunctivitis
Joints- polyarthritis
Heart- myositis, arrhythmias, heart block
```
