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Respiratory Flashcards

1
Q

stony dull to percuss

A

pleural effusion

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2
Q

what investigation should be done for a pleural effusion on CXR

A

pleural aspirate

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3
Q

what investigations should be done for an exudative effusion

A

CT

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4
Q

describe exudative effusion and its causes

A

bilateral, cloudy/bloody, protein >30 g/l, LDH> 0.6

malignancy, TB

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5
Q

what investigations should be done into a transudative effusion

A

echocardiogram, liver scan

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6
Q

describe a transudative effusion and what causes it

A

unilateral, clear, protein <30 g/l, LDH <0.6

caused by failures- heart, liver, endocrine (Hypothyroidsm, nutritional (hypoalbuminaemia)

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7
Q

what are the causes of a PE

A 
DAFAF
DVT
Air embolism 
Fat embolism 
Amniotic fluid embolism
Foreign material (PWIDS)
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8
Q

what are the S/S of PE

A

dyspnoea, tachycardia/pnoeam pleuritic chest pain, cyanosis, haemoptysis

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9
Q

what can cause

loud S2, hypotension, pulsus paradoxicus, elevated JVP

A

PE (rare)

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10
Q

what are the investigations for PE and what do they usually show

A

D Dimer (low exclude PE, high send for CTPA),
CXR (normal/ small pleural effusion),
ECG (sinus tach, right ventricular strain, RBBB),
ABG (hypoxaemia),
CTPA
V/Q

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11
Q

what is the treatment for an acute PE

A

O2
IV fluids
Thrombolysis (altepase for massive PE)
LMWH (e.g. dalteparin)

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12
Q

what is the long term treatment for a PE

A

anticoagulation, IVC filter

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13
Q

what are the complications of a PE

A 
sudden death, 
arrhythmia,
pulmonary infarct,
PE, 
pulmonary hypertension
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14
Q

what is the acute management of asthma

A 
OSHITMAN
Oxygen 
Salbutamol
Hydrocortisone IV or prednisolone PO
Ipatropium (neb)
Theophylline 
Magnesium sulfate IV
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15
Q

how is long term asthma managed

A 
SABA
\+
ICS
(belcometasone)
\+
LTRA
(monteleukast)
\+
LABA
\+
oral prednisolone
\+
theophylline
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16
Q

what are the parameters of mild asthma

A

PEFR >75%

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17
Q

what are the parameters of moderate asthma

A

PEFR <75%

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18
Q

what are the parameters of acute severe asthma

A

unable to complete sentences
RR> 25
pulse > 110
PEFR < 50%

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19
Q

what are the parameters of life threatening asthma

A 
PEFR < 33%
bradycardia 
hypotension 
silent chest
exhaustion 
confusion 
com 
ABG;
-PaCO2 > 5
-PaO2 < 8 or acidosis
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20
Q

dyspnoea that improves away from work

A

occupational asthma

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21
Q

polyphonic wheeze

A

asthma, COPD

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22
Q

what are heart failure cells

A

seen in alveolar spaces- macrophages that have absorbed haemosiderin, seen in chronic pulmonary oedema with associated LV failure

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23
Q

what is a loud P2

A

part of S2= A2 + P2

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24
Q

heart failure cells + loud P2

A

pulmonary hypertension

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25
Q

what is cor pulmonale

A

right sided heart failure due to pulmonary hypertension

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26
Q

eggshell calcification at hilar region

A

silicois

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27
Q

small numerous opacities in upper lung zones

A

silicosis

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28
Q

hilar lymphadenopathy

A

silicosis

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29
Q

snow storm X ray

A

sillicosis

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30
Q

morning head ache (hypercapnia)

A

COPD

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31
Q

what is the treatment for an exacerbation of COPD

A 
ISOAP
Ipatropium 
Salbutamol 
Oxygen 
Amoxicillin 
Prednisolone
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32
Q

panacinar emphysema

A

alpha-1-antitrypsin deficiency

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33
Q

centriacinar emphysema

A

coal dust and tobacco

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34
Q

what are the causes of COPD

A 
GASES
Genetics (alpha 1 antitrypsin deficiency)
Air pollution 
Smoking 
Exposure (occupation)
Second hand smoke exposure
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35
Q

what are the complications of COPD

A 
CLIPPeR
Cor pulmonale 
Lung cancer 
INfections 
Pneumothorax 
Polycythaemia (high red blood cells)
e
Resp failure
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36
Q

what is the long term treatment for COPD

A

SABA/ SAMA

FEV1 > 50%
LABA/LAMA
LABA + ICS

FEV1 <50%
LAMA/ LABA + ICS

LABA
\+
ICS
\+
LAMA

smoking cessation

O2 therapy long term

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37
Q

tiotropium

A

LAMA

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38
Q

when do you give antibiotics in an acute exacerbation of COPD

A

if increased sputum purulence

or
consolidation on CXR/ signs of pneumonia

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39
Q

antiobiotics for acute exacerbation of COPD

A

1st- amoxicillin

2nd- doxycycline

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40
Q

pink puffer, hypoventilating, V+Q mismatch, thin + hyperinflated

A

type 1 resp failure

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41
Q

causes of type 1 resp failure

A

pneumonia, PE, pulmonary oedema, fibrosing alveolitis

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42
Q

signs of type 1 RF

A

central cyanosis

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43
Q

treatment for Type 1 RF

A

O2 replacement, treat underlying cause

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44
Q

blue bloater, hypoventilating + V/Q mismatch, strong build + wheezy

A

type 2 RF

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45
Q

causes of type 2 resp failure

A

COPD, asthma, Cerebrovascular disease, opiate overdose, myaesthenia gravis, motor neurone disease

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46
Q

signs of type 2 RF

A

ABC
A flapping tremor
bounding pulse
cyanosis

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47
Q

treatment for type 2 resp failure

A

non invasive ventilationm underlying cause

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48
Q

symptoms of both type 1 and 2 resp failure

A 
ABCD-F
Agitation 
Breathlessness
Confusion
Drowsiness 
Fatigue
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49
Q

signs of type 1 and 2 resp failure

A

decreased PaO2

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50
Q

Complications of type 1 and 2 resp failure

A

Nosocomial infections (pneumonia),
Heart failure,
Arrhythmia,
Pericarditis

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51
Q

cannonball metastases, weight loss, haematuria

A

renal cell carcinoma

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52
Q

lung cancer at apex with horner’s syndrome

A

pancoast

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53
Q

what is horners syndrome

A

ptosis, sunken eye, miosis (small pupil), lack of sweating

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54
Q

central lung cancer in smokers, producing PTH and with keratin pearls on histology

A

squamous cell

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55
Q

role of PTH

A

control of Ca”+ in blood (hypercalcaemia)

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56
Q

central lung cancer producing ACTH with kulchitsky cells

A

small cell

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57
Q

v aggressive lung cancer

A

small cell

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58
Q

role of ACTH

A

mediates release of cortisol at bottom of HPA (hypothalamic pituitary adrenal) axis

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59
Q

what happens when cortisol is released

A

increases blood glucose via gluconeogenesis

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60
Q

cancer in the pleura with psammoma bodies

A

mesothelioma- asbestosis

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61
Q

peripheral lung cancer in non smoking women

A

adenocarcinoma

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62
Q

peripheral lung cancer with poor outcome that has anapastic cells with high cytoplasm: nucleus ration

A

large cell

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63
Q

laryngotracheobronchitits

A

croup

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64
Q

steeple sign on X-ray, child with barking cough

A

croup

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65
Q

what is seen on a CXR of pulmonary oedema

A 
ABCDE
Alveolar bats wings 
kerley B lines
Cardiomegaly 
Dilated prominant upper lobe vessels 
pleural Effusion
66
Q

bilateral hilar lymphadenopathy, erythema nodosum, lupus pernio, non caseating granuloma, fatigue, uveitis, weight loss

A

sarcoidosis

67
Q

increased serum ACE and Ca2+

A

sarcoidosis

68
Q

what are the skin manifestations of sarcoidosis

A

erythema nodosum,
lupus pernio,
macular of popular sarcoidosis

69
Q

+ve for anti-glomerular basement membrane ABS

A

good pastures syndrome

70
Q

who gets good pastures syndrome

A

young men in late 20s/ women in 60s-70s

71
Q

what is seen on x ray of newborn with respiratory distress syndrome

A

ground glass

72
Q

samter’s triad- asthma, nasal polyps, salicylate sensitivity

A

aspirin induced asthma

73
Q

side effect of organic nitrates

A

morning headache due to hypercapnia

74
Q

coin lesion on CXR (rounded solitary lesion)

A 
primary bronchial/ lung carcinoma,
metastatic tumour (esp kidney),
bronchial hamartoma (benign),
carcinoid tumour,
granulomatous inflammation,
lung abcess
75
Q

thumbprint sign on HEAD x ray

A

epiglottitis

76
Q

inspiratory whoop/ barking cough

A

pertussis (whooping cough)

77
Q

snow storm on CXR

A

baritosis, silicosis

78
Q

granulomatous lung reaction

A

exposure to beryllium

79
Q

pleural rub

A

pleurisy- inflammation of pleura

80
Q

yellow nail syndrome

A

2 of: yellow deformed nails, lymphoedema, exudatitive pleural effusion/ resp involvement

nephrotic syndrome, protein losing enteropathy, thyroid deficiency, B cell deficiency

81
Q

causes of ARDS

A 
driving accident, 
Pre-eclampsia (high BP and protein in urine in pregnancy),
Acute pancreatitis,
raised ICP,
Pneumonia,
O2 toxicity
82
Q

what is ARDS

A

widespread inflammation in the lungs

83
Q

granulomatous with polyangitis (GPA)

84
Q

symptoms of wegeners

A

constitutional symptoms of resp tract, kidney, lung

85
Q

how to diagnose wegeners

A

c-ANCA+ and biopsy

86
Q

what can cause erythema nodosum

A 
TB
IBD
strep infections
sarcoidosis 
drugs (the pill, sulphonamides)
87
Q

fibrosis at bases, pulmonary nodules

A

rheumatoid arthritis

88
Q

what is the order of the contents in the intercostal spaces

A

VAN
vein outermost
artery
Nerve innermost

89
Q

air crescent sign

A

invasive aspergillosis

90
Q

diffuse alveolar haemorrhage, sudden dyspnoea, fall in haematocrit

A

complication of SLE

91
Q

what is seen in chest X ray for diffise alveolar haemorrhage as a complications of SLE

A

diffuse infiltrates, high diffusing capacity of the lungs for CO

92
Q

causes of bilateral hilar enlargement

A

sarcoidosis, TB, lymphoma, lymph node metastases

93
Q

what drugs affect vitamin D causing bone pain/ weakenss

A

anti-TB, statins (controversial), laxatives

94
Q

atoll sign

A

region of ground glass opacity surrounded by a denser lung tissue

95
Q

halo sign

A

aspergillosis

96
Q

tree in bud sign

A

endobronchial pathologies (endobroncheal TB)

97
Q

what causes pneumoconiosis

A

coal miners, coal dust

98
Q

histoplasmosis

A

pigeon dropppings, pulmonary nodules, mediastinal lymph nodes +/- cavitation

99
Q

what is farmers lung

A

hypersensitivity pneumonitis

100
Q

crackles upper zones, interstitial inflammation, chronic bronchitis, NON NECROTISING GRANULOMA

A

hypersensitivity pneumonitis

101
Q

how do you treate epiglottis

A

Ceftriaxone IV

102
Q

in a non pneumonic LRTI when do you give antibiotics

A

if increased sputum purulence or consolidation/ signs of pneumonia

103
Q

D sign on CXR

104
Q

history of pulmonary histiocytosis

A

diabetes insipidus, young adults, smokers, pneumothorax, broken bones

105
Q

right sided pleuritic chest pain

A

most likely pneumonia

106
Q

dull percussion, crackles, bronchial breathing, increased vocal resonance, consolidation

107
Q

birds as pets

A

chlamydophila psittiaci

108
Q

dry cough an diarrhoea after holiday

A

legionella pneumophila

109
Q

how do you diagnose for legionella

A

urine test for Ag

110
Q

HIV pneumonia

A

pneumocystis pneumonia/ pneumocystis jiroveci

111
Q

how are pneumocystis pneumonias treated

A

co-tramoxazole +/- prednisolone

112
Q

alcoholic pneumonia

A

klebsiella pneumonia (aspiration)

113
Q

mucoid sputum

A

chlamydia psittaci

114
Q

rusty sputum

A

pneumococcal pneumonia

115
Q

matched V/Q test

A

abnormal pneumonia/ infection

116
Q

interstitial pneumonias

A

pneumocystis, myocplasma, RSV, CMV, fungal

117
Q

alveolar pneumonia

A

staph, pneumococcus, klesiella, haemophilus, E coli

118
Q

when do you get mycoplasma pneumonia

A

haemolytic anaemia, erythema multiforme, guillan barre syndrome, myocarditis, cerebellar ataxia

119
Q

when do you get CMV pneumonia

A

infectious mononuclear syndrome (retinitis, colitis, myelitis, hepatitis, myocarditis)

120
Q

who gets RSV pneumonia

A

mainly infants and children- presents and common cold, maybe bronchiolitis

121
Q

how do you treat pneumonias in general

A

maintain SaO2,
antibiotics,
analgesia,
pneumococcal vaccines (if diabetic, immunosuppressed, >65)

122
Q

red jelly sputum

A

klebsiella pneumoniae

123
Q

how do you treat a mild to mod CAP (0-2)

A

amoxicillin IV/PO

ig penicillin allergic doxycyline PO

124
Q

how do you treat a severe CAP (3-5)

A

co amoxiclav IV + doxycycline PO/ clarithromycin IV

if penicillin allergic IV levofloxacin

125
Q

how do you treat a severe hospital acquired pneumonia/ aspiration

A

IV: amoxicillin + metronidazole + gentamicin

if penicillin allergic IV co-trimoxazole + metronidazole +/- gentamicin

126
Q

how do you treat a non severe HAP/ aspiration P

A

PO: amoxicillin + metronidazole

if penicillin allergic PO co-trimoxazole + metronidazole

127
Q

signet ring sign

A

bronchietasis

128
Q

what is bronchiectasi

A

when bronchiole wider than neighbouring arteriole on CT

129
Q

what can cause bronhiectasis

A

TB, histoplasmosis, measles, pertussis, allergic broncho pulmonary aspergillosis (mushroom workers lung)

130
Q

what can cause upper lobe bronchiectasis

131
Q

what can cause middle lobe bronchiectasis

A

immotile cilia syndrome, myobac avium complex infection

132
Q

what can cause lower lobe bronchietatasis

A

interstitial lung disease, PID, recurrent aspiration

133
Q

what can cause central bronchiectasis

A

allergic bronchopulmonary aspergillosis

134
Q

how much of lung does bronchiectasis in asthma involve

A

1 or 2 lobes

135
Q

how do you treat bronchiectasis

A 
ABCDS
antibiotics 
bronchodilators 
corticosteroids
postural Drainage
surgery (if indicated)
136
Q

ground glass, atoll sign

A

pulmonary fibrosis

137
Q

clubbing, basal crepitations, dry cough

A

pulmonary fibrosis

138
Q

causes of pulmonary fibrosis

A 
BREAST CA
bleomycin 
radiation 
EAA
ankylosing spodylitis 
sarcoidosis
TB
cryptogenic fibrosing alveolitis (IPF)
asbestosis

azathioprine, pneumoconiosis, occupational lung diease

139
Q

sign of idiopathic pulmonary fibrosis

A

opacities in lower zones of the lung

140
Q

what does a zeihl neelsen stain show in TB

A

+ve for acid fast bacilli

141
Q

caseous necorsis

142
Q

assmann focus

A

apical lesion in (usually) secondary TB

143
Q

millilary TB

A

spread of TB into blood stream- milliary dissemination into lungs is by pulomary artery
systemic dissemination= pulmonary vein

144
Q

ghon focus

A

area of infection and caseous necrosis at periphery of lung, beneath pleura

145
Q

what happens when ghon focus rupture (rare)

A

produce tuberculous pleurisy

146
Q

drugs for active TB

A

RIPE 2 months RI 4

147
Q

drugs for active TB involving the CNS

A

RIPE 2 months RI 1 months

148
Q

what can cause a pneumothorax

A

ruptured pleural bleb, COPD, TB, sarcoidosis, IPF, rheumatoid arthritis, ankylosing spondylitis, lung CA, trauma (tension)

149
Q

what are the symptoms of a pneumothorax

A

ipsilateral (same side) chest pain, shoulder tip pain, dyspnoea, tachypnoea, hypoxia, cyanosis, auscultation decreased on left side, percussino hyper-resonant/ normal

150
Q

how do you investigate a pnuemothorax

A

CXR (pleural line +/- tracheal deviation), CT, ABG (hypoxia)

151
Q

when do you treat a pneumothorax

A

when more than 2cm on CXR

152
Q

how do you treat a pneumothorax

A

needle aspiration of air +/- intercostal drain

153
Q

how do you treat a tension pneumothorax

A

decompression with large bore needle into 2nd IC space mid clavicular line

154
Q

how do you treat recurrent pneumothoraxes

A

pleurodiesis

155
Q

who gets spontaneous pneumothorax

A

tall thin man who smokes weed (snoop dogg)- marfans

156
Q

honeycombing of the lungs with parenchymal bands and pleural plaques

A

asbestosis

157
Q

what type of cancer does asbestosis cause

A

malignant mesothelioma

158
Q

what types of asbestos fibre is bad

159
Q

what are the components of virchows triad

A

hypercoagulable state (surgery, trauma, pill), venous stasis (immobility, pregnant, heart failure), trauma (inflammation, prev thrombosis)

160
Q

symptoms of DVT

A

none, pain, oedema, erythema/ discolouration, affect leg increase temp, engorgement of surface veins

161
Q

how is a DVT treated

A

anticoagulants (Hep, LMWH, warfarin(

162
Q

what is the complication of DVT

A

PE, varicose veins

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