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CP3 Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the restrictive / obstructive patterns for FEV1 + FVC

A

Obstructive: FEV1 reduced / FEV1:FVC reduced

Restrictive: FVC and FEV1 reduced / FEV1:FVC normal

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2
Q

What is Kco + TLco?

What can reduced Kco/TLco indicate?
What can it exclude?

A

Kco = diffusion capacity of lung per unit area for CO

TL = diffusion capacityt for total lung capacity for CO

A reduction can indicate a problem with gas exchange
= alveolar or vascular disease
= rules out chest wall / diaphragm probs

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3
Q

What patient groups is pneumonia more common in? (5)

A 
Male
Elderly
Smokers
Alcoholics
Chronic disease
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4
Q

What are the clinical S+S of pneumonia? (5+8)

A

Acute systemic illness: fever/rigors/vom
Cough: initially dry then mucopurulent
SOB
Pleuritic pain (+ poss referred to shoulder / anterior abdo wall)
Confusion/delirium - in elderly pts (who may have v few symptoms)

Tachypnoea
Reduced chest expansion (affected side)
Dullness to percussion (affected side)
Coarse crackles
Bronchial breathing
Increased vocal resonance
?Pleural rub
?Upper abdo tenderness (if lower lobe)
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5
Q

What is the definition of HAP?

A

Pneumonia developing 48hrs after admission (with no signs of incubation on admission)
OR
Someone hospitalised in the past 10d

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6
Q

List the causative organisms for CAP (6)

A

Typical bact (60-80%):
S.Pneumoniae
H.influenzae

Atypical (10-20%):
mycoplasma / chlamydia / legionella

Viruses (10-20%):
influenza / parainfluenza

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7
Q

What is seen on CXR for pneumococcal pneumonia?
Which patient group is most susceptible?

Which patient group is most susceptible to H.Influenzae

A

Classical lobar pneumonia + rust-coloured sputum
Immunosuppressed - vaccine given

COPD pts (the encapsulated strain)

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8
Q

What is seen on CXR of mycoplasma pneumonia?
What patient group?
How does it present?

A

Widespread patchy consolidation across multiple lobes
Younger pts

Long H/o extra-pulm features:
Rash, Hepatitis, D+V, Pericarditis, Meningoencephalitis

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9
Q

What is seen on CXR of legionella pneumonia?
What pt group?
What are some other features? (3)

A

Bilateral consolidation on lung bases

Smokers / recently returned from holiday (air conditioning units)

Proteinuria/haematuria (common)
Neuro involvement (CN palsies)
Hypernatraemia (SIADH)

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10
Q

What pt groups are susceptible to Chlamydia pneumonia?

A

Infants (URTI) + Elderly (CAP)

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11
Q

What Ix are done in pneumonia? (6+2)

A 
Obs / sats assessment
FBC/UEs/CRP/LFTs
Blood cultures
Sputum sample (culture +/- mycoplasma PCR)
CXR
Urine in mod/severe (for L/S.pneumonia)

Serum mycoplasma IgG if suspect
Throat swab in viral transport medium if severe/suspect viral

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12
Q

Describe the CURB65

Classify the severities

A 
Confusion: AMT < 8
Urea >7
Resp rate >30
BP <90 SBP or <60 DBP
65yrs+
0-1 = non-severe
2 = moderately severe
>2 = severe
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13
Q

Describe the treatment for CAP at diff severities

A

Non-severe: oral amoxi / doxi as outpatient

Mod severe: admit + oral amoxi/doxy + clarithro

Severe: admit HDU + IV co-amoxi + clarithro OR levofloxacin + vanco

ADD Metronidazole if aspiration suspected

PLUS chest physio for all for effective coughing

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14
Q

Describe the management for HAP

A

Assess MRSA RFs:
Known/previous
Longterm indwelling line/catheter
From nursing home w. skin breaks

Mild = oral doxy
Severe = oral co-trimoxazole
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15
Q

What are some complications of pneumonia? (4)

A

Parapneumonic effusion / empyema
Lung abscess (clubbing)
Bronchiectasis
Sepsis

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16
Q

How and why are pts followed up after a pneumonia?

A

CXR 6wks after

Ensure resolved and not due to obstrn e.g. lung cancer

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17
Q

What are the S+S of TB? (7+2)

A 
Malaise / wt loss / anorexia / night sweats
Later: 
Mucoid wet cough
Pleural pain
Small haemoptysis

Fever / Apical crackles

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18
Q

How is a pt with suspected active TB investigated? (4)

A

Sputum:
Microscopy - acid-fast bacilli (24hrs)
PCR
Culture - 6wks

IF sputum samples -ve
Bronchoscopy + biopsy
OR Broncho-alveolar lavage

CXR - upper lobe cavities / pleural effusions / lymphadenopathy

Ix extra-pulm if suspect

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19
Q

How is latent TB investigated (eg contact tracing)? (3)

A 
Mantoux test (inject TB Ag + size of reaction)
Interferon-y release assay (IGRA)
Standard bloods (FBC/UEs/LFTs) - rule out other causes/baseline
20
Q

How is a pt with active TB managed?

A

If admitting - isolation
If not - specialist TB service
Assess RFs (prev TB Tx / adherence / contacts / HIV)

2m isoniazid (+pyridoxine) + rifampicin 
\+ ethambutol + pyrazinamide 
4m isoniazid (+pyridoxine) + rifampicin
21
Q

How is latent TB managed?

A

3m - isoniazid (+ pyridoxine) + rifampicin

22
Q

How is contact tracing done in confirmed cases of TB?

A

All household - trace / assess for latent

Casuals - only trace if infectious (10%+ of close develop TB) or if contact eg HIV

23
Q 
What are the main SEs for:
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
A

Ison - neuropathy/enceph (pyridoxine prevents)
Rifamp- deranged LFTs
Etham- optic neuritis
Pyraz- hepatotoxic

24
Q

What are the common sites + features of non-pulmonary TB (6)

A 
Joints/spinal - mono arthritis
Cutaneous - lupus vulgaris/erythema nodosum
Meningitic TB
Renal - sterile pyuria 
Pericarditis - chest pain
25
Q

What are the S+S of a pneumothorax

A

Asymp (small one + young)
Sudden unilateral pleuritic pain w. Progressive dyspnoea

Reduced expansion
Hyperesonance on percussion
Reduced vocal resonance
Reduced breath sounds

26
Q

How is a tension pneumothorax clinically differentiated from a normal?

A

Trachea deviated from affected side
Neck veins dilated (venous return)
+ poss haemodynamic compromise
NB check chest drain - could be blocked

27
Q

How is a tension pneumothorax treated?

A

100% oxygen
Large bore cannula ics2 mid-clav
CXR
Insert chest drain

28
Q

How is a pneumothorax treated?

A

If <2cm air rim or not SOB:
discharge + fortnightly CXR + advise smoking cessation

If >2cm or SOB:
Aspirate or chest drain if fails

If recurrent (>2) or not resolving within 5d - surgery indicated (pleurectomy/ talc pleurodesis)

29
Q

List the causes of transudative pleural effusion (5)

A

Cardiac failure: hydrostatic backpressure from LHF
Liver failure: reduced protein prodn = reduced oncotic pressure
Renal failure: nephrotic synd reduced oncotic pressure
Peritoneal dialysis
Hypothyroidism (rare)
Ovarian tumours (Meig’s)

30
Q

List the causes of exudative pleural effusion (5 - A PAIN)

A 
Infections
Neoplasm
PE (pulm infarct)
Autoimmune (RA/SLE)
Abdo disease: pancreatitis, subphrenic abscess
31
Q

Describe the S+S of pleural effusion (3+6)

A

Asymp
SOB
Pleuritic pain

Reduced expansion
Dull to percussion
Reduced vocal resonance
Reduced breath sounds
Bronchial breathing
32
Q

List the RFs for COPD (6)

A 
SMOKING
Occupational dust exposure
a1-antitrypsin defc
Recurrent childhood chest infections
Low socioeconomic status
Asthma / atopy
33
Q

Describe the typical presenting features of COPD (3)

A

Productive morning cough (after yrs of smokers cough)
Increased freq of LRTIs
Slow progressive dyspnoea w. wheeze

34
Q

What may be seen O/E in mild/severe?

A

Mild: widespread wheeze
Severe:
O - tachypnoea / cyanosis / flap
I - hyperinflation / recession / tug / pursing / accessorys
P - poor expansion
P - hyperresonant
A - reduced breath sounds / prolonged expiration / polyphonic wheeze

35
Q

List the complications of COPD (6)

A 
Acute exacerbations
Polycythaemia
Resp failure
Cor pulmonale
Pneumothorax (ruptured bullae)
Lung carcinoma
36
Q

What Ix/Further tests will be done in suspected COPD (3+4) and why is each one done

A

Post-bronchodilator spirometry (Dx / severity)
CXR (exclude other pathology)
FBC (ID anaemia / polycythaemia)

Sputum culture (abnormal orgs suggest bronchiectasis)
ECG (RA/RVH)
ABG (resp failure)
DLCO (diffusion capacity of lung for CO - reduced in emphysema)

37
Q

Describe the management for stable COPD (4)

A

Specialist referral if Dx uncertain / deteriorating

Patient education
Action plan for exacerbations (steroids/Abx)
Lifestyle advice (diet / exercise / smoking)
Meds/inhalers

38
Q 
What is the main SE of:
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
A

R: deranged LFTs
I: neuropathy/enceph
P: hepatotoxic
E: optic neuritis

39
Q

Causes of a normal anion gap in metabolic acidosis (4)

Causes of a raised anion gap in metabolic acidosis (4)

A 
Normal = HCO3- loss
Renal tubular acidosis
Diarrhoea
Intestinal fistula
Drugs (acetozolamide)
Raised = Acid prodn
DKA
Urate (renal failure)
Lactic (hypoxia/shock)
Drugs (NSAIDs/metformin/ethanol)
40
Q

What are the features of Pancoast syndrome (4)

A

Horners
Shoulder pain → arm
Hand/arm mm atrophy
Oedema (vv congestion)

41
Q

List some metastatic manifestations specific to lung cancer

A 
Recurrent laryngeal nn palsy
Phrenic nn palsy
SVC obstrn
Adrenal mets (Addison's)
Pericarditis
AF
Pancoast syndrome (Horners/brachial neuralgia/oedema)
Dermatomyositis
Acanthosis nigracans
Lambert-Eaton
SIADH
Cushing
HyperPTH/Cal
Hypertrophic pulmonary osteoathropathy
42
Q

Causes of Restrictive lung disease

A

ENDOGENOUS:
Idiopathic**
Autoimm/CTDs

EXOGENOUS:
Drugs
Infections (weird) / Hypersensitivity (EAA)
Occupational

43
Q

What Ix can be done in restrictive lung disease of unknown cause?

A

Bloods: FBC / ANA / RF
Orifices: Spirometry
Imaging: CXR / CT
Invasive: Bronchoalv lavage / Biopsy

44
Q

What are the complications of lung fibrosis (restrictive disease)? (3)

A

Pulm HTN
T2RF
Lung cancer risk

45
Q

How can lung fibrosis (restrictive disease) be managed?

A

Most unresponsive

O2 – for attacks
Prednisolone (20% respond)
Lung transplant

46
Q

What are the complications of OSAS? (3)

A

Cor pulmonale
HTN
T2RF

47
Q

What are the indications for Lobectomy? (4)

A

Lung cancer
TB / Chronic abscess
Fungal infection
Bronchiectasis (localised)

CP3 Medicine (7 decks)

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