Respiratory Flashcards
Features of Pancoast syndrome
Horners syndrome
Compression of major vessels in the thoracic inlet
Wasting of intrinsic muscles of hand
Pain in shoulder radiating towards axillary and scapula
Signs of PE
Tachypnoea Chest pain - worse on inspiration Haemoptysis Peripheral cyanosis Raised JVP Gallop rhythm - 3rd HS
Who most commonly gets spontaneous pneumothoraces
Men
20-40 yo
Symptoms of spontaneous pneumothorax
Sudden SOB
pleuritic chest pain
What is Goodpasture’s disease?
syx + signs
Anti-glomerular basement Antibody disease Glomerulo-nephritis Haematuria Decreased urine output Raised BP Dry cough SOB Haemoptysis Anaemia Resp failure
Management of PE
15L O2 NRB
Enoxaparin 1.5mg/kg S/C OD
paracetamol, TEDS
Saline if required
Stop COCP / HRT
What organism commonly causes acute exacerbations in CF pts?
Pseudomonas
Features of CF
Bronchiectasis Recurrent resp inf Pancreatic insufficiency Malabsorption + steatorrhoea DM Delayed growth and puberty Male infertility (absent vas deferens) High sweat NaCl
What genetic abnormality causes CF
Autosomal recessive (1 in 2500 caucasians)
CFTR gene
Chromosome 7
Respiratory causes of clubbing
Bronchial carcinoma Mesothelioma Bronciectasis Abscess Empyema Cryptogenic fibrosing alveolitis CF TB Idiopathic pulmonary fibrosis
Features suggesting lung consolidation
Reduced expansion
Dullness to percussion
Increased tactile vocal fremitus
Bronchial breathing
Most common cause of lung consolidation
Pneumonia
What causes a honey comb lung appearance?
Extrinsic allergic alveolitis
What people commonly get staph aureus pneumonia?
IVDU
elderly
People recovering from Influenza
What Type of pneumonia is caught from parrots
Chlamydia psittaci
What type of pneumonia can occur in HIV patients
Pneumocystis jiroveci
Features of mycoplasma pneumonia
Most common CAP Automimmune haemolytic anaemia - presence of cold agglutinins Erythema multiforme Myopericarditis Meningioencephalitis
Antibiotic for atypical pneumonia
Clarithromycin 500mg IV BD
Features of legionnaires disease
Preceding flu-like illness Dry cough Dyspnoea Hyponatraemia Lymphopenia
Examples of pulmonary-renal syndromes
Wegeners granulomatosis
Microscopic polyangiitis
Goodpastures disease
What is caplans syndrome
Pulmonary manifestation of RA
–> pulmonary nodules
Commonly occurs in RA patients exposed to coal / other dusts.
Syx of caplans syndrome
Cough,
shortness of breath,
Haemoptysis
Respiratory manifestations of RA
caplans syndrome
Fibrosing alveolitis
Pleural effusion
Obliterative bronchiolitis
CXR features suggesting LVF
Kerley B lines
Bat-wing shadows
Prominent upper lobe vessels
Cardiomegaly
CXR features of R upper lobe collapse
Trachea deviated to R
Horizontal fissure displaced upwards
R hilum displaced upwards
CXR features of L upper lobe collapse
Hazy white L lung field
Tracheal deviation to the L
Elevated L hilum
Preservation of costophrenic angle
Causes of multiple small calcified nodules on CXR
Varicella pneumonitis
TB
Histoplasmosis
Chronic renal failure
Causes of hilar enlargement
Malignancy TB Sarcoidosis Organic dust diseases Extrinsic allergic alveolitis
CXR shows ring shadows with tram-lining
Bronchiectasis
CXR appearance of malignant mesothelioma
Pleural calcification
Lobulated pleural mass
CXR showing ground glass appearance
Idiopathic pulmonary fibrosis
Progresses to honey comb appearance
Causes of pulmonary fibrosis
Idiopathic RA Sclerosis UC Methotrexate Amiodarone Chemotherapy
Management of acute exacerbation of COPD
Oxygen Nebulised salbutamol and ipratropium bromide Oral prednisolone or IV hydrocortisone BiPAP Intubate and ventilate
Lifestyle recommendations for COPD
Stop smoking
Exercise
Reduce obesity
1st line treatment for COPD
Inhaled bronchodilators
When is home oxygen considered in COPD patients?
Clinically stable non-smokers
PaO2 <7.3kPa when stable.
Or PaO2 7.3 - 8 kPa AND secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or pulmonary hypertension.
Standard treatment for community-acquired pneumonia not requiring hospital admission?
Oral amoxicillin 1g PO TDSOral clarithromycin 500mg PO BD if penicillin allergic.
Treatment for severe hospital-acquired pneumonia?
Tazocin ( piperacillin tazobactam) 4.5g IV QDS
Ciprofloxacin 400 mg IV BD
If pen allergic = cipro and gentamicin 5mg/kg IVI OD
Treatment for severe community-acquired pneumonia with atypical pathogens?
Clarithromycin 500mg IV BD
Co-amoxiclav 1.2g IV TDS
Treatment of proven chlamydia pneumonia
Oral Tetracycline
What does stridor indicate
Upper airway obstruction
E.g. foreign body, croup
Positive cold agglutinins suggests what pathogen?
Mycoplasma
Which pneumonia pathogens are cavitating?
TB
Staphylococcal pneumonia
Klebsiella pneumonia
What type of pneumonia occurs in HIV-positive patients?
Pneumocystis jiroveci Pneumonia
Side-effects of isoniazid?
Peripheral neuropathy
Hepatitis
Pyridoxine (B6) deficiency
Side-effects of rifampicin?
Orange tears/urine Deranged LFTs Hepatitis Enzyme inducer (drug interactions)
Side effects of ethambutol?
Retrobulbar (optic) neuritis (pain, loss of vision, colour vision impaired 1st)
Side effects of pyrazinamide?
Gout (arthralgia)
Hepatitis
Side-effects of salbutamol?
Tremor
Tachycardia
Side effect of inhaled corticosteroids?
Oral or pharyngeal candidiasis
Weightloss, anaemia and haemoptysis in a smoker suggests what?
Bronchial carcinoma
Causes of T2 respiratory failure?
COPD
Decreased respiratory drive
Neuromuscular disease
Thoracic wall disease
Causes of T1 respiratory failure?
Pneumonia Pulmonary oedema PE Asthma Emphysema fibrosing alveolitis ARDs
Diagnostic criteria for ARDs
Acute
Bilateral infiltrates in CXR
Not in CCF
Hypoxia
What is the oxygen delivery with a NRB mask
60-90%
What is chronic bronchitis?
Cough + sputum
On most days
>3m per year
>2 years
What is a Pancoast tumour
Tumour at the lung apex
Can interfere with the sympathetic chain –> Horner’s syndrome.
Clinical features of primary lung tumour
Cough, haemoptysis, dyspnoea, stridor, pneumonia, weight loss Clubbing Monophonic unilateral wheeze
Investigation of suspected bronchial tumour?
Chest x-ray CT thorax Bronchoscopy Biopsy Bronchoalveolar Lavage
Investigation for CF?
Sweat test - pilocarpine iontophoresis
Management of CF?
Physiotherapy
antibiotic Prophylaxis and treatment
Pancreatic enzyme supplements
Complications of CF
DM Hepatic cirrhosis Bronchiectasis Male infantility severe pulmonary hypertension Cor pulmonale chronic lung infections
What does the Guthrie card use to detect CF?
Immunoreactive trypsin (IRT) (A pancreatic enzyme raised in CF)
Congenital And acquired causes of bronchiectasis
Congenital = CF, cillary dyskinesia Acquired = Whooping cough, measles, TB
Presentation of mesothelioma?
Chest pain
Pleural efusion - Usually bloodstained
Diagnosis of mesothelioma
Pleural biopsy
What is asbestosis?
Diffuse fibrosis of the lungs and plura
What are the three main types of asbestos?
White - chrysotile
blue -crocidolite
Brown - amosite
Clinical features asbestosis?
Progressive dyspnoea,
Clubbing,
Lower zone inspiratory crepitations
Reticulonodular shadowing on x-ray
What causes genetic emphysema
Alpha-1 antitrypsin deficiency
Early onset emphysema
Also causes chronic liver disease
Presentation of post-primary TB
Subacute illness Cough Haemoptysis Dyspnoea Fever Night sweats Anorexia
CXR features of TB
Upper lobe lesions - consolidation / cavities
+/- hilar lymphadenopathy
Features of sarcoidosis
Multi-system disease
Caeseating granulomas
Dyspnoea Dry cough Erythema nodosum Lupus pernio Arthralgia Lymphadenopathy
CXR features of sarcoidosis
Bilateral Hilar lymphadenopathy
Lung fibrosis
Cause of aspergillosis
Aspergillus fumigatus - fungus
Presenting symptoms of pneumonia
Cough - initially dry, becomes productive
Sputum may be blood stained
Fever
Pleuritic chest pain
Signs of pneumonia
Bronchial breathing
Coarse crepitations
Pyrexia
Presentation of pulmonary embolism (PE)
Acute onset pleuritic chest pain
SOB
Fever
Tachycardia
Management of a confined pulmonary embolus
Enoxaprain 1.5m g /kg
Warfarin for 6m
Diagnosis of COPD
Lung function tests
FEV1 <70%
Little variation in peak flow
What culture media is needed to culture TB
Lowenstein-Jensen media
What stain is used to detect TB
Ziehl-neelsen stain
Complications of lung cancer
Pleural effusion Haemoptysis. pneumothorax bronchial obstruction pneumonia. Pericardial effusion metastases PE Recurrent laryngeal nerve palsy Horners syndrome
What causes holly leaf shaped lesions on CXR
Calcified pleural thickening
Associated with previous asbestos exposure
Asymptomatic
Rusty coloured sputum occurs in what disease
Streptococcus pneumonia
Syx of legionnaires pneumonia
Dry cough
Myalgia
Malaise
GI syx
Features of pneumonia + fever, arthralgia, diarrhoea, conjunctivitis, headache, hepatosplenomegally and patchy lower lobe consolidation is….n
Chlamydiophila psittaci pneumonia
Features of pneumonia plus fluid filled cavities on CXR suggests what?
Staphylococcus aureus pneumonia abscesses
Components of the CURB score
Confusion - AMTS 7mmol/L
Respiratory rate - >30
BP - systolic 65 yo
What do curd scores 1-5 indicate
0-1 - low mortality - manage at home
2 - intermediate mortality - hospital admission
3 + - high risk of mortality - hospital with IV abx
Congenital causes of bronchiectasis
CF
Primary ciliary dyskinesia
Kartageners syndrome
What is an abrams needle used for
Pleural biopsy
Common organisms in community acquired pneumonia
Strep pneumoniae
H. Influenza
Mycoplasma pneumonia
(Staph aureus / legionella / chalmydophilia / moraxella catarrhalis)
Organisms causing hospital acquired pneumonia
E. coli
Pseudomonas
Klebsiella
Anaerobes
Complications of pneumonia
Paraneumonic effusion Abscess Empyema Respiratory failure Septicaemia Brain abscess
SE of streptomycin
Irreversible vestibular nerve damage
Allergic reactions
Multi drug resistant TB is resistant to what
Rifampicin and isoniazid
Extensively drug resistant TB is resistant to what
Rifampicin
Isoniazid
Quinolones
+ at least 1 2nd line agent
What is military TB
Haemotogenous dissemination of TB
What is oseltamivir
Tamiflu
Triad in meigs syndrome
Pleural effusion
Ascites
Ovarian fibroma (benign)
Signs of ARDS
Cyanosis Tachypnoea Tachycardia Widespread inspiratory crepitations Hypoxia refractory to O2 Pulmonary oedema
Causes of ARDS
Sepsis Aspiration pneumonia Trauma Burns Pancreatitis Transfusion related lung injury Drug overdose Acute drug reaction
What respiratory disease is less common in smokers
Sarcoidosis
Causes of respiratory alkalosis
Hypventilation
Low CO2
Management of a flail chest
Analgesia
Respiratory support
Causes of atelectasis
Bronchial obstruction - cancer / foreign body / mucous plug
Non-obstructive - pneumothorax / reduced surfactant (ARDS) / parenchymal scarring
