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Hark and Paul's clinical review > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Interstitial Lung Disease

What are the causes of interstitial lung disease?

A
  • Idiopathic (IPF/Cryptogenic fibrosing alveolitis)
  • Inhaled agents (Hypersenitivity pneumonitis/EAA, Astestosis, Berylliosis, Silicosis)
  • Rheumatological (RA, SLE, SS sclerosis, DM, PM, MCTD, Ankylosing spondylitis)
  • Vasculitic (PAN, GPA, EGPA)
  • Granulomatous (Sarcoidosis)
  • Infectious (TB, ABPA)
  • Drugs (Amiodarone, Nitrofurantoin, Busulphan, Bleomycin, Methotrexate)
  • Radiation
  • Genetic (NF, Tuberous sclerosis)
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2
Q

Interstitial Lung Disease

What are the causes of apical fibrosis?

A

SCHART

  • Silicosis, Sarcoidosis
  • Coal Worker’s Pneumoconiosis
  • Histiocytosis
  • Ankylosing Spondylitis, ABPA
  • Radiation
  • Tuberculosis
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3
Q

Interstitial Lung Disease

What are the causes of basal fibrosis?

A

RASIO

  • Rheumatoid Arthritis
  • Asbestosis
  • Systemi Sclerosis
  • Idiopathic pulmonary fibrosis and Hamman-Rich syndrome
  • Other (Drugs: busulphan, bleomycin, nitrofurantoin, hydralazine, MTX, amiodarone)
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4
Q

Pleural Effusion

What are Light’s Criteria?

A

Light’s criteria for an exudate:
1)Pleural protein: Serum protein >0.5
2)Pleural LDH: Serum LDH >0.6
3)Pleural LDH >2/3 upper limit of normal serum value
Require 1 criteria to diagnose as exudate

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5
Q

Pleural Effusion

What are the causes of an exudative pleural effusion?

A
  • Infection: Pneumonia, Tuberculosis.
  • Inflammation: :RA, SLE, Sarcoidosis.
  • Ischaemia/Infarction: PE
  • Malignancy: Lung carcinoma, Mesothelioma, Secondary malignancy, Lymphoma, Meig’s syndrome (ovarian fibroma).
  • Drugs: Methysergide, Methotrexate, Bromocriptine, Nitrofurantoin
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6
Q

Pleural effusion

What are the causes of a transudative pleural effusion?

A
  • Cardiac: CCF, Constrictive pericarditis
  • Liver: Cirrhosis, Hypoalbuminaemia
  • Renal: Nephrotic syndrome, Uraemia.
  • Hypothyroidism
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7
Q

Pleural Effusion

What are the criteria for a complicated parapneumonic pleural effusion?

A

A complicated parapneumonic effusion requires chest drainage:

  • > 50% Hemithorax
  • Loculated
  • Turbid
  • pH < 7.2
  • LDH >1000
  • Glucose <3.4
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8
Q

Pleural Effusion

What are the criteria for an empyema?

A

An empyema requires chest drainage:

  • Positive culture
  • Frank pus on pleural tap
  • > 50% Hemithorax
  • pH <7.2
  • LDH >1000
  • Glucose <3.4
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9
Q

Bronchiectasis

What are the causes of bronchiectasis?

A
  • Respiratory Childhood Infections: Measles, Pneumonia, TB, ABPA
  • Bronchial Obstruction: Foreign body, Endobronchial tumour
  • Immunodeficiency: Congenital & Acquired Hypogammaglobulinaemia, AIDS
  • Autoimmune Diseases, RA, SS, IBD
  • Mucociliary Clearance Defects: CF, Immotile cilia syndrome, Kartagener’s syndrome, Young syndrome, Yellow Nail Syndrome
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10
Q

SVC Obstruction

What are the causes of SVC obstruction?

A
  • Malignancy: Lymphoma (NHL>HL), Bronchial carcinoma (SCLC)
  • Mediastinal Masses: Goitre, Thymoma, Mediastinal fibrosis, Thoracic aortic aneurysm
  • Central Venous Thrombosis: Complication of central venous catheters, Thrombophilic disorders
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11
Q

Lung Consolidation

What are the causes of a cavitating lung lesion?

A

Infection, Malignancy, Vasculitis

  • Infection/lung abscess: TB, Aspergilloma, Histoplasmosis, Coccidiomycosis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Anaerobic infections
  • Non-Infectious: Malignancy, GPA, Pulmonary rheumatoid nodule, Caplan’s syndrome
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12
Q

What are the clinical features of sarcoidosis?

A

Systemic: fever, wt loss
Pulmonary: cough, sob, nasal congestion
CXR: hilar lymphadenopathy, pulmonary fibrosis
Eye: uveitis
Skin/arthralgia: erythema nodosum; lupus pernio nose
Nerve: neuropathy/palsied; facial nerve palsy
Cardiac: arrhythmia

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13
Q

Investigations for sarcoidosis?

A
  • FBC: lymphocytopenia, eosinophilia
  • ESR
  • ACE level
  • CXR, CT chest
  • PFT, ABG
  • bronchoscopy and biopsy
  • LN biopsy
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14
Q

Treatment for sarcoidosis?

A
  • indications: - increasing symptoms, worsening lung function, Neuro/renal/cardiac/eye complications
  • prednisone 1mg/kg 1 yr taper
  • if long term Rx needed: MTX, AZA
  • hydroxychloroquine for skin disease
  • infliximab: 3rd line
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15
Q

What are causes of clubbing?

A
  • resp: lung ca, bronchiectasis, CF, Idiopathic pulmonary fibrosis
  • cardiac: cyanotic congenital heart disease, IE
  • GI: cirrhosis, IBD, Coeliac
  • thyrotoxicosis
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16
Q

What us the differential for bilateral crackles?

A
  • pulmonary edema/cardiac failure
  • bronchiectasis
  • atelectasis
  • bilateral pneumonia
  • pulmonary fibrosis (fine crackles)
17
Q

What is the differential for a lung mass on imaging?

A
  • carcinoma - primary or metastatic
  • lung abscess
  • TB
  • pulmonary infarct
  • granuloma: I.e. Fungal
18
Q

What are the signs of asthma severity?

A
  • symptoms throughout day
  • nightly symptoms >7x/week
  • SABA use several times a day
  • extreme interference with normal activity
  • FEV1
19
Q

How to investigate asthma?

A
  • spirometry: obstructive, reversible 12%
  • bronchial challenge testing if normal spiro
  • PEF for monitoring
  • allergen skin testing
20
Q

How would you manage asthma? (Maintenance Rx)

A 
Non pharm: 
- allergen avoidance, smoking cessation
- asthma action plan
Pharm:
- vaccinations
- SABA
- ICS alone
- ICS/LABA combination
- prednisone
- treat GORD, if present
21
Q

How to diagnose sleep apnea?

A
  • sleep study: apnea-hypopnea index (severe >60)

- ABG

22
Q

What is the PAP for dx of pulmonary HTN?

A

> 25 at rest
Or
30 with exercise

23
Q

What investigations for pulmonary HTN?

A
  • CXR
  • PFT
  • ECG
  • ABG
  • CTPA or VQ
  • HRCT
  • TTE
  • R heart cath
  • 6min walk test
24
Q

What are the types/classes of pulm HTN?

A
  1. Pulmonary arterial HTN
  2. From L heart disease
  3. Due to lung disease
  4. Due to chronic PE
  5. Unclear multifactorial mechanisms
25
Q

How to determine pharmacological treatment in pulm HTN?

A 
If reversibility: calcium channel blockers
Otherwise,
- endothelin receptor antag: bosentan
- PDE5i: sildafenil
- prostacyclins: iloprost, epoprostenol
26
Q

What gene and chromosome involved with CF?

A

Autosomal recessive CFTR gene mutation
(Most common is delta F508)
Chromosome 7
1:25 carrier rate

27
Q

What are the various manifestations of CF?

A
  • GI baby: meconium ileum, failure to thrive
  • Resp: cough, haemoptysis, wheeze, SOB
  • Cardiac: cor pulmonale
  • Gastro: diarrhea, steatorrhea, pancreatic insufficiency, intestinal obstruction, ADEK deficiency
  • Liver: cirrhosis/fibrosis, cholelithiasis
  • DM
  • infertility: CBAVD
28
Q

What organisms associated with CF?

A
  1. Staph and h. influenzae
  2. Nosocomial e.coli and proteus
  3. Pseudomonas***
  4. Burkholderia = poor prognosis
29
Q

What investigations for CF?

A
  • sputum MCS
  • bloods: FBC (anaemia, infection), LFT/alb, coags
  • CXR
  • CT chest
  • PFT
30
Q

What is your management of pulmonary CF?

A
  • neb. Antibiotics (tobramycin)
  • bronchodilators
  • mucolytics: neb NS, DNase
  • mutation specific drugs: ivacaftor(G551D), lumacaftor-ivacaftor(DF508)
    Non Pharm:
  • postural drainage, chest Physio
  • medical devices: oscillating devices
  • exercise
31
Q

What is indication for lung transplant in CF?

A

-FEV1 <30%; Severe hypoxaemia &/or hypercapnoea
-Increasing functional impairment (↑ing frequency & duration hospitalisations)
-Major life-­‐threatening pulmonary complns (e.g. recurrent massive haemoptysis)
-Also: If 5-­‐year survival <30% - clear survival benefit; if 30-50% equivocal; and >50% no benefit apart from QOL
>Contraindications:
- Cx infection with Burkholderia cenocepacia MDR Pseudomonas
-Intubated patients in Acute Resp failure
-Symptomatic osteoporosis (relative Contraind)

32
Q

How would you manage gastro manifestations of CF?

A
  • high protein/fat diet
  • nutritional supplements
  • pancreatic enzyme replacement
33
Q

How do you manage pregnancy with CF?

A
  • acknowledge fertility issues; in women, mainly due to malnutrition
  • if FEV1 > 60%, should be OK
  • pulmonary HTN is contraindication to pregnancy
  • genetic counselling
  • screen for GDM
  • increased prematurity
34
Q

How would you approach pre transplant work up?

A

Lungs: PFT, imaging, 6MWT
Heart: TTE, ECG, angio, R heart cath
Infection status: CMV, EBV, HIV, Hep, sputum
Vaccinations
Malignancy: 5yrs cancer free
Social/mental: psych review, social supports, living, finance, compliance
Education

Hark and Paul's clinical review (12 decks)

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