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Memorising Medicine - Mnemonics > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Respiratory causes of clubbing

A
  1. Cancer: Bronchial, mesothelioma
  2. Cystic fibrosis and other Chronic supperative disease: lung abscess, bronchiectasis, empyema, TB
  3. Cryptogenic fibrosing alveolitis
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2
Q

Cardiac causes of clubbing

A
  1. Congenital cyanotic heart disease
  2. Infective endoCarditis
  3. Cancer: myxoma
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3
Q

GIT causes of clubbing

A

Cirrhosis

Crohns

Coeliac disease

Cancer: GI lymphoma

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4
Q

Other causes of clubbing

A

Congenital

T4

Local brachial AVM

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5
Q

Causes of cyanosis

A

Atmosphere: high altitude, nitrate contaminated water, cold

Respiratory: ventilation, diffusion, VQ mismatch

Cardiac: congenital, cardiac output, vascular

Red blood cells: hereditary, acquired, polycythaemia

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6
Q

Causes of obstructive airway disease

A

C.A.B.B.I.E

Small airways.
1.COPD

  1. Asthma
  2. Bronchiectasis
  3. Bronchiolitis

Large airways
5. Intrathoracic: fixed obstruction e.g. bronchial carcinoma, lymph-node, foreign body

  1. Extrathoracic: Inspiration Only E.G. Laryngeal Carcinoma, Epiglottiditis, Foreign Body and Throat, Goitre, Obstructive Sleep Apnoea
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7
Q

Causes of restrictive airway disease

A

Intraparenchymal

  1. Fibrosing alveolitis
  2. Pulmonary oedema
  3. Pulmonary hypertension

Extraparenchymal

  1. Neuromuscular: Guillain-Barre syndrome, MND, spinal cord injury
  2. Chest wall: ankylosing spondylitis
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8
Q

CXR – reticulonodular shadowing

A

F.I.N.E.shadows

Fibrosis:

a) upper zones: pneumoconioses, extrinsic alveolitis, TB, aspergillosis, seronegative arthropathies
b) middle zones: sarcoid
c) lower zones: SLE, cryptogenic fibrosing alveolitis, asbestosis, radiotherapy, drugs

Infection

a) atypical pneumonia
b) viral

Neoplasia

a) lymphangitis carcinomatosis
b) thyroid carcinoma

Edema

a) pulmonary oedema: Kerley B lines
b) long-standing pulmonary oedema/haemosiderosis

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9
Q

CXR - coin lesions and cavities

A

F.A.N.G.S

Fibrosis

Abscess: bacterial, Aspergillus, cyst

Neoplasia: primary or secondary

Granulomatous: rheumatoid arthritis, wegener’s

Structural: pulmonary infarction, traumatic haematoma

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10
Q

CXR – opacification

A

Consolidation: fluid, cells

Collapse: lobar, segmental atelectasis, pneumonectomy, thoracoplasty

Pleural disease: effusion, plaques

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11
Q

Mediastinal masses

A

Thyroid (retrosternal goitre).

Thyoma

Teratoma

TB or sarcoid lymph nodes

Terrible diagnoses e.g. lymphoma, aneurysm, dissection

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12
Q

Community-acquired pneumonia

Typical pathogens

A
  1. Lobar
    a) Streptococcus pneumoniae (rapid onset, rusty sputum, rigors, plural, pericardial effusion, MR
    b) gram-negative: haemophilus influenzae type b (rods) or Moraxella catarrhalis (cocci)
  2. Cavities and empyema - patients are pretty SicK
    a) Staphylococcus aureus (IVD users, cystic fibrosis, measles)
    b) Klebsiella (short, plump, capsulated, gram-negative bacilli) - Alcoholics, diem, COPD, S.Africa. Bloody sputum
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13
Q

Community-acquired pneumonia atypical pathogens

A

Mycoplasma pneumoniae

Legionella pneumophila

Chlamydia pneumoniae

Coccinella burnetii

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14
Q

Hospital-acquired pneumonia

A
  1. Gram-positive (30%)

Staphylococcus aureus inc MRSA.
Streptococcus faecalis inc VRE.
Streptococcus pneumoniae

  1. Gram-negative (50%)

Pseudomonas aeruginosa
Acinetobacter.
Legionella.
Enterobacteria: Proteus, Enterobacter

  1. Anaerobes: Bacteroides
  2. Fungi
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15
Q

Causes of asthma

A

A.S.T.H.M.A

Atopy

Stress: exercise, emotion, viral URTI, cold, premenses, GO reflux

Toxins: smoking, allergens, drugs

Helminth

Malignancy: carcinoid

Autoimmune: Churg Strauss, Addison’s

Aspergillosis: allergic bronchopulmonary (ABPA)

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16
Q

Asthma management

A

T.A.M.E

Technique for inhaler

Avoidance: allergens etc

Monitor: peak flow

Educate: asthma nurse, plan

17
Q

Asthma drugs

A

1.bronchospasm
A) beta-2 agonists
B) muscarinic antagonists
C) methylxanthines

  1. Inflammation
    A) steroids
    B) mast cell stabilisers
    C) leukotriene receptor antagonists
18
Q

Pathophysiology of chronic bronchitis

A

Smoke particles and repeated bacterial or viral infections–>

Squamous metaplasia, cillia inhibition, macrophage and lymphocyte infiltration–>

1) bronchospasm
2) mucus gland hyperplasia, goblet cell hyperplasia
3) inflammation: mucosal oedema, fibrosis, emphysema
4) hypersecretion–> bronchiole plugging –> obstruction + infection

19
Q

Pathophysiology of emphysema

A

Cigarette tar/nicotine or alpha-1 antitrypsin deficiency –>

neutrophil chemotaxis recruitment and activation or decreased elastase–>

Alveolar wall proteolysis: a) centroacinar (smoke) or b) pancacinar (alpha1)

20
Q

Sarcoidosis – PC

A

G.R.A.N.U.L.O.M.A.S

General: fever, weight loss, fatigue, lymphadenopathy (Lofgren syndrome = acute fever + arthralgia + cough+ erythema nodosum)

Respiratory: otitis, sinusitis, rhinitis, laryngitis, bihilar lymphadenopathy, parenchymal infiltration, fibrosis

Arthralgia

Neurological: bilateral seventh cranial nerve palsy, myopathy, seizures, dementia

Urine: polyuria, interstitial nephritis, renal stones

Liver: cholestatic LFTs

Ophthalmological: enlarged Lacrimal and salivary glands

Myocardial: pericardial effusion, restrictive cardiomyopathy secondary to myocardial granuloma’s and fibrosis leading to third-degree heart block or VT

Amenorrhoea etc. hypopituitarism

Skin: lupus pernio, Boeck’s sarcoid, scar infiltration, erythema nodosum

21
Q

Causes a bronchiectasis

A

Chronic infection – inhalation e.g. bacteria, viral, aspergillosis, toxic gas

Bronchial obstruction – foreign body, lymph node, tumour, sarcoid

Host defences decreased – secretions e.g. cystic fibrosis, structural e.g. Marfan’s syndrome and Kartagener’s syndrome, immune e.g. HIV

22
Q

Causes of lung abscess

A

Sputum tends to STI NK (due to anaerobes)

  1. Infection
Staphylococcus aureus
TB
Intestinal bacteria
Nocardia
Klebsiella
  1. Bronchial obstruction
  2. Host defences decreased
23
Q

Causes a pneumothorax

A

STRIP

Spontaneous

Trauma

Ruptured oesophagus

Iatrogenic

Pulmonary disease

24
Q

Causes of pleural effusion –transudate

A

C.H.E.S.T.

Cardiac failure

Hypoalbuminaemia – plasma oncotic pressure low e.g. cirrhosis nephrosis malnutrition malabsorption

Embolism, pulmonary

Superior venacaval obstruction

Subclavian or jugular vein catheter misplacement

Thyroid low: due to myxoedema

25
Q

Causes of pleural effusion – exudate

A

I.N.S.U.L.A.T.I.O.N.

Infection e.g. strep pneumoniae, Mycoplasma, TB, viruses (EBV, Coxsackie), rheumatic fever

Neoplasia: bronchial carcinoma, pleural mesothelioma or fibroma, breast, ovarian, lymphoma

Surgery or trauma: CABG, mastectomy, radiotherapy

Uraemia

Liver, pancreatic, ovarian disease

Autoimmune: SLE, rheumatoid arthritis, scleroderma

Toxins: B.A.N.M.E – bromocriptine, amiodarone, nitrofurantoin, methysergide, environmental: asbestos

Infarction: pulmonary, myocardial (Dressler syndrome)

Suffered your rupture

Nail syndrome, yellow: due to lymphatic hyperplasia

26
Q

Definition of adult respiratory distress syndrome

A

Common inflammatory response to various long insults resulting in:

T.O.X.I.C

Tachypnoea
Oxygen decreased : progressive resp failure
X-ray: bilateral pulmonary infiltrates
Intersitial fluid increase
Cardiac function is normal
27
Q

Obstructive sleep apnoea – definition

A

O.S.A

Obstruction: obstruction of the upper airways occurs at night loss of muscle tone in sleep

Sleep: sleep disruption, snoring, sleepiness during day

Apnoea: apnoeic spells: decreased O2, patient wakes from sleep

28
Q

Causes of OSA

A

OSA

Obesity, central

Structural features of upper airway e.g. nasal obstruction large tonsils macroglossia, jaw shape, cervical masses, laryngeal stenosis

Smoking

Sex: Male

Atony: neuromuscular, CNS, connective tissue laxity

Alcohol

29
Q

Causes of pulmonary hypertension

A

1) pulmonary disease: cor pulmonale, recurrent PE, primary pulmonary hypertension
2) systemic: autoimmune e.g. SLE, infection e.g. HIV, drugs e.g. amphetamine
3) Mitral valve disease
4) left-to-right shunt (Eisenmenger syndrome)

30
Q

Pathophysiology of asthma

A

Acute (30 mins):
Mast cell-antigen interaction –> histamine release
Bronchoconstriction, mucus plugs, mucosal swelling

Chronic (12h):
Th2 cells release IL 3, 4, 5 –> mast cell eosinophil and B cell recruitment

Airway remodelling

31
Q

Life threatening asthma - PC

A

Any one:

PEFR <33%
SpO2 <92%, PCO2>4.6, PaO2<8kPa

CHEST-
Cyanosis
Hypotension
Exhaustion/confusoin
Silent chest, poor respiratory effort
Tachy/brady/arrhythmia
32
Q

Risk factors for PE

A

SPASMODICAL

Sex: F
Pregnancy
Age
Surgery
Maligancy
Oral contraceptive
DVT/PE previously
Immobility
Colossal size
Antiphospholipid antibodies
Lupus anti-coagulant
33
Q

Causes of a non-resolving pneumonia

A

CHAOS

Complication - Empyema, lung abscess

Host – immunocompromised

Antibiotic – inadequate dose, poor oral absorption

Organism – resistant or unexpected organism not covered by empirical antibiotics

Second diagnosis – PE, cancer, organising pneumonia

34
Q

Major side-effects of TB treatment

A

Rifampicin – hepatitis, brushes, febrile reaction, orange/red secretions, many drug interactions including warfarin and OCP

Isoniazid - hepatitis, rashes, peripheral neuropathy, psychosis

Pyrazinamide – hepatitis, rashes, vomiting, arthralgia

Ethambutol – retrobulbar neuritis

Therefore, MUST to a baseline visual acuity test and LFTs which must be monitored closely

35
Q

CF definition

A

CF autosomal recessive disease leading to mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). This can lead to a multisystem disease (most commonly affect the respiratory and gastrointestinal systems) characterised by thick secretions.

36
Q

Bronchiectasis Causes

A

P.I.G

Post infective – whooping cough, TB

Immune deficiency – Hypogammaglobulinaemia

Genetic / Mucociliary clearance defects – Cysticfibrosis, primary ciliary dyskinesia, Young’s
syndrome (triad of bronchiectasis, sinusitis, and
reduced fertility), Kartagener syndrome (triad of
bronchiectasis, sinusitits, and situs inversus)

Memorising Medicine - Mnemonics (23 decks)

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