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PACES > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Causes of increased vocal resonance

A

Consolidation, collapse, tumour, scar tissue (TB)

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2
Q

Causes of pleural effusion?

A

Exudate (protein >30g/l)

  • cancer
  • infection
  • infarction
  • connective tissue disease (RA or SLE)

Transudate (proetin <30g/l)

  • congestive cardiac failure
  • chronic renal failure
  • chronic liver disease (hydrothorax)
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3
Q

How to investigate a pleural effusion

A 
pulse oximetry
temperature
CXR
pleural aspiration to send for proteins and albumin (paired with serum albumin), LDH, glucose, pH, microscopy and culture, cytology
CT thorax
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4
Q

How to treat a pleural effusion?

A

Treat the cause.
Drain effusion
Pleurodesis for recurrent effusions

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5
Q

Signs of cor pulmonale

A

Ankle swelling, raised JVP, RV heave

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6
Q

Signs of bronchiectasis

A

Sputum production +++
clubbing
cachexia
mixed character crackles that change after coughing. Occasional squeak and wheeze.

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7
Q

Differential diagnosis of respiratory crackles and clubbing

A

Bronchiectasis
Pulmonary fibrosis
Cancer
Chronic lung abscess

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8
Q

Investigation for bronchiectasis

A 
sputum culture 
CXR (tramlines and ring shadows)
HRCT (signet ring sign)
also test immunoglobulins (? hypogammaglobulinaemia)
rheumatoid serology
aspergillus serology
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9
Q

what is the definition of bronchiectasis.

A

abnormal irreversible dilation of the bronchi from chronic inflammation.

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10
Q

causes of bronchiectasis

A

congenital (Kartageners/primary cillary dysmotility, cystic fibrosis)
mechanical (bronchial carcinoma)
childhood infection (TB)
immune OVER activity (allergic bronchopulmonary aspergillosis, or associated with inflammatory bowel disease)
immune UNDERacitivity - hypogammaglobulinaemia

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11
Q

treatment of bronchiectasis

A

physiotherapy
antibiotics for exacerbation
low dose azithromycin three times per week
bronchodilatory and inhaled corticosteroids
surgery for localised disease

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12
Q

Investigation of pulmonary fibrosis

A 
CRP, Rheumatoid factor, ANA
CXR
ABG
PFTs (FEV1/FVC > 0.8), low TLC
HRCT
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13
Q

PFT pattern in fibrosis?

A

FEV1/FVC >0.8, low TLC

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14
Q

Causes of pulmonary fibrosis

A

Idiopathic pulmonary fibrosis
Hypersensitivity pneumonitis (Farmer’s lung, bird fanciers lung - Type III hypersensitivity reaction)
Occupational interstitial lung disease (pneumoconiosis, silicosis, asbestosis)
Connective tissue disease (RA, Sjogrens, scleroderma, sarcoid)
Drug induced (bleomycin, amiodarone, methotrexate, nitrofurantoin
Radiation

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15
Q

Treatment of pulmonary fibrosis

A 
Pulmonary rehab, physiotherapy
Home oxygen
For IPF: pirfenidone and nintedanib, 
Steroids
N-acetyl cyteine
Lung transplant
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16
Q

What changes are seen on CXR and CT in pulmonary fibrosis?

A 
CXR = bilateral reticulonodular changes
CT = honeycombing, ground glass infiltrate
17
Q

Causes of apical fibrosis

A 
Old TB
Pneumoconiosis and silicosis
Sarcoid
Ankylosing spondylitis 
radiation
histoplasmosis
18
Q

What is the genetics of cystic fibrosis?

A

Autosomal recessive defect in chromosome 7 within gene encoding CFTR (CF transmembrane conductance regulator).

19
Q

Complications of CF

A 
bronchiectasis
cor pulmonale
recurrent chest infections
male infertility, reduced female fertility
chronic pancreatitis
distal intestinal obstruction syndrome
20
Q

treatment of CF

A 
physiotherapy
pancrease/creon
mucolytics
immunisations
double lung transplant
21
Q

diagnosis of COPD;

A

chronic bronchitis is a clinical diagnosis - productive cough most days for 3/12 over 2 consecutive years
emphysema is a pathological diagnosis of alveolar wall destruction
FEV1/FVC <0.7, low TLCO

22
Q

investigations for COPD

A

CXR
oxygen sats/ ABG
FBC, test alpha-1-antitrypsin in young patients

23
Q

how to classify COPD severity?

A

GOLD criteria;
mild FVC>0.8
mod FVC 0.4-0.6
severe FVC <0.4or frequent exacerbations

24
Q

criteria for LTOT

A

paO2<7.3 on air when well
non smoker
CO2 does’t rise dangerously with O2
PaO2 <8 and cor pulmonary

25
Q

Complications of lung cancer

A

SVCO
recurrent laryngeal nerve palsy
Horner’s syndrome and wasting of small muscles of the hand (T1)
LEMS, peripheral neuropathy, proximal myopathy, paraneoplastic cerebellar syndrome
dermatomyositis

26
Q

dermatomyositis signs

A

heliotrope rash, Gottron’s papules on knuckles

PACES (5 decks)

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