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Respiratory Flashcards

1
Q

Describe asthma

A

a type of obstructive lung disease that involves bronchial hyperresponsiveness that yields reversible bronchoconstriction

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2
Q

Name an inhaled β2-agonist that is commonly used to treat asthma exacerbations

A

Salbutamol

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3
Q

Which drug is a mast cell stabilizer used for asthma prophylaxis as it prevents mast cell degranulation and who is in used for?

A

cromoglycate- no SE so good for children

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4
Q

Which muscarinic agonist is used in bronchial provocation challenges to diagnose asthma?

A

methacholine

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5
Q

Which monoclonal antibody used to treat allergic asthma that is resistant to inhaled steroids and long-acting β2-agonists?

A

Omalizumab

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6
Q

Name an antileukotriene used in asthma that inhibits the 5-lipoxygenase pathway, blocking the conversion of arachidonic acid to leukotrienes

A

Zileuton

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7
Q

Name a methylxanthine drug used to treat asthma and give some side effects…

A

Theophylline = narrow therapeutic index and causes cardiotoxicity and neurotoxicity

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8
Q

What is status asthmaticus?

A

a severe, unrelenting state of asthma where medication and therapies are ineffective

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9
Q

Name an anti-leukotrienes particularly useful in treating aspirin-induced asthma…

A

Montelukast

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10
Q

What is the inspiratory: expiratory ratio seen in asthma?

A

Decreased
In adults I:E = 1:2
In young children I:E = 1:3

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11
Q

What is the action of theophylline in asthma patients?

A

cause bronchodilation by inhibiting phosphodiesterase thereby increasing cAMP levels due to diminished cAMP hydrolysis

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12
Q

Which asthma drug can cause tachycardia?

A

Salbutamol
Although it acts mainly on beta-2-receptors to relax bronchial smooth muscle, it does have cross-reactivity and can cause tachycardia.

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13
Q

Which beta blocker should not be given to asthmatics and why?

A

Propranolol is a nonselective B-blocker (antagonising both beta-1 and beta-2 receptors). Asthmatics should not be prescribed anything that blocks beta-2 receptors. Blocking this receptor may lead to bronchoconstriction and therefore a worsening of respiratory symptoms.

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14
Q

Which type of beta blockers should be used when treating a patient with a history of lung disease (e.g. asthma, COPD, emphysema)?

A

beta-1 selective agent e.g. atenolol, bisoprolol, metoprolol

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15
Q

What would you see on an ECG in hyperkalaemia?

A

Hyperkalemia causes tall, peaked T-waves on ECG

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16
Q

What would you see on an ECG in hypokalaemia?

A

Increased amplitude and width of the P-wave, prolongation of the PR interval, T-wave flattening and inversion, ST-depression, and Prominent U-waves

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17
Q

What is the classic finding for a pulmonary embolism on an ECG?

A

S1Q3T3 (an S-wave in Lead I, and Q-waves and T-wave inversions in Lead III)

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18
Q

What is mesothelioma?

A

a cancer of the pleura that may present as hemorrhagic pleural effusions and pleural thickening

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19
Q

What is seen on histology in mesothelioma?

A

Psammoma bodies

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20
Q

Which two markers are present in almost all mesotheliomas?

A

Cytokeratin and calretinin

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21
Q

In a tension pneumothorax what would you see on X-ray?

A

trachea deviates AWAY from pneumothorax

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22
Q

Patients with what syndrome are prone to recurrent pneumothoraces?

A

Marfans syndrome

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23
Q

In a pneumothorax what are the signs on examination?

A

Absent breath sounds and hyperresonnance on percussion

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24
Q

What is vocal fremitus and in what conditions is it increased and decreased?

A

vocal fremitus (VF) transmission of the spoken voice to the chest wall, detectable by auscultation or palpation; it is increased with lung consolidation and decreased with pleural effusion, pneumothorax, and airway obstruction.

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25
What is a tennis pneumothorax?
where air can enter the pleural space but cannot exit, therefore, increasing the amount of trapped air with each breath >> hyper inflated chest that doesn't move on respiration
26
What is the immediate treatment for a pneumothorax?
The immediate treatment for a tension pneumothorax is needle aspiration at the second-intercostal space at the midclavicular line
27
In a pneumothorax if a patients neck veins are distended. In which of the structure is pressure most likely increased?
This collapse creates an obstruction that increases resistance (and therefore pressure) proximally along the path of flow, and decreases volume (and therefore pressure) distally. The increased resistance impedes normal right-sided flow, and causes blood to back up into the systemic circulation, resulting in a dilation of the neck veins. This results in increased pressures in the pulmonary artery and right heart and decreased pressures in the pulmonary veins and left heart.
28
What is acute cardiac tamponade and how is it characterised?
Acute cardiac tamponade occurs when blood accumulates in the pericardial sac. It is characterized by the Beck triad which consists of low arterial blood pressure, distended neck veins, and distant, muffled heart sounds.
29
How is a tension pneumothorax characterised?
hemodynamic instability, tracheal shift, pulse >135/min, and jugular venous distention.
30
Which lung cancer is treated upfront with surgical resection (does not respond well to chemotherapy).
NSCLC
31
Which drugs can be used to effectively treat solid tumors such as testicular and small cell cancer of the lung.
Etoposide and teniposide
32
Which paraneoplastic syndrome is typically associated with small cell carcinoma of the lung and ADH secretion?
Syndrome of inappropriate ADH secretion (SIADH)
33
What drugs can be used for the treatment of small cell lung carcinoma.
Topotecan and irinotecan- topoisomerase I inhibitors
34
Where is SCLC located within the lung?
central location
35
What is the most important carcinogen associated with small cell, squamous cell, and large cell carcinoma?
Cigarette smoke
36
Hyponatraemia is commonly found in which lung cancer and why?
Hyponatremia is a common finding in small cell lung carcinoma and is produced by SIADH
37
Which lung cancer is a neoplasm of neuroendocrine Kulchitsky cells, which resemble small dark blue cells on histology?
SCLC
38
Which lung cancer occurs almost exclusively in smokers
SCLC
39
In a patient that presents with Cushing syndrome as a paraneoplastic syndrome how would they present?
round appearing face and a highly elevated waist circumference, with purple markings on the abdomen, excessive sweating, and increased fatigue
40
What is the gold standard test for diagnosing a pulmonary embolism?
CTPA
41
What are Lines of Zahn?
are interdigitating areas of pink and red representing platelets, fibrin, and red blood cells; they are characteristic of a pre-mortem pulmonary embolism
42
Patients who are pregnant can present with what type of pulmonary embolism and what might it cause?
amniotic fluid PE >> disseminated intravascular coagulation (DIC)
43
What emboli are associated with scuba divers who ascend quickly from deep depths?
AIR emboli
44
What is Homan sign?
a clinical feature of a deep vein thrombosis that involves calf pain upon dorsiflexion of the foot
45
Which emboli are associated with long bone fractures and liposuction; they usually present with the classic triad of hypoxemia, neurologic abnormalities, and petechial rash.?
Fat emboli
46
In a PE what previous condition would lead to a CT scan being contraindicated? What scan would be performed instead?
Chronic renal failure | Would do a V:Q perfusion test
47
Name a major risk factor for a PE?
cancer
48
What would you see on a CXR in a patient with a PE?
- raised hemidiaphragm (loss of vol.) | - decreased vascular margins
49
What would you see on ECG with a patient who has a PE?
- sinus tachycardia - new onset AF - RH strain >> peaked P in lead II, R. axis deviation, RBBB
50
What rare pattern would you see on an ECG in a patient with a PE?
S1Q3T3
51
When is CURB65 used and what does it stand for?
``` Estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment C = confusion U = uraemia >7mmol R = resp rate >30 B = blood pressure <90/60 65 = 65 years or older ``` Score: 0-1 = outpatient care >2 may need hospital admission 3 or more = Inpatient admission with consideration for ICU admission with score of 4 or 5
52
What are the two most common causes of pneumonia in neonates?
Group B streptococci and Escherichia coli
53
What is the most common cause of CAP?
S. pneumoniae
54
What causes atypical pneumonia?
Mycoplasma, Chlamydia or Legionella.
55
What are the complication of bacterial pneumonia?
include pleural effusion, empyema, pneumatoceles, necrotizing pneumonia, and lung abscesses
56
Atypical pneumonia is also know as what?
Walking pneumonia
57
What are the three patterns of pneumonia classically seen on chest x-ray?
lobar pneumonia, bronchopneumonia, and interstitial pneumonia.
58
What is the second most common cause of atypical pneumonia in young adults?
Chlamydia pneumoniae
59
Atypical pneumonia is also know as .......
Interstitial pneumonia
60
What is the classic presentation of community-acquired pneumonia
fever, productive cough (with/without) with purulent sputum, dyspnea, and pleuritic chest pain.
61
Mucopurulent sputum production is most frequently associated with what type of pneumonia?
bacterial pneumonia
62
cant or watery sputum production in pneumonia is more suggestive of...
an atypical pathogen
63
Where is nosocomial pneumonia acquired?
Hopsital
64
Most common cause of pneumonia in the elderly/immunocompromised?
influenza virus
65
Empiric antibiotic therapy for presumed bacterial pneumonia in hospitalized children should include coverage for what?
S.pneumoniae

Phase 2a (7 decks)

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