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YEAR 3: Conditions Knowledge > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Recall the 3 different clinical pictures that can be produced by aspergillus spore inhalation

A

Aspergilloma
Allergic bronchopulmonary Aspergillosis
Invasive aspergillosis

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2
Q

What is aspergilloma?

A

Growth of A. fumigatus in pre-existing lung cavity

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3
Q

In which demographic is ABPA most commonly seen?

A

Asthmatics

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4
Q

Recall the pathophysiology of ABPA

A

Regulated by IgG and IgE

Leads to bronchiectasis

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5
Q

In which demographic is invasive aspergillosis most common?

A

Immunosuppressed

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6
Q

What is invasive aspergillosis?

A

Infection and fungal dissemination of aspergillus

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7
Q

Recall the symptoms of aspergilloma

A

Usually asymptomatic but may produce haemoptysis

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8
Q

How does ABPA present?

A

Like a difficult-to-control asthma: irecurrent episodes of pneumonia with wheeze, cough and fever

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9
Q

Describe the presentation of invasive aspergillosis

A

Dyspnoea with rapid deterioration and a septic picture

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10
Q

Which form of aspergillus lung disease will produce a wheeze?

A

ABPA

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11
Q

What would be found upon percussion in aspergillus lung disease?

A

Dullness

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12
Q

Where in the lungs does aspergilloma normally form?

A

Upper lobes

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13
Q

How would aspergilloma appear on CXR?

A

Round mass with crescent of air around it

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14
Q

What is the first choice of imaging for each different form of suspected aspergillus lung disease?

A

Aspergilloma: CXR
ABPA: CXR and CT/MRI
Invasive aspergillosis: CT/MRI

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15
Q

What features on imaging are indicative of ABPA?

A

Looks similar to bronchiectasis

Transient and patchy shadows/ consolidation

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16
Q

Describe the wheeze that is heard upon auscultation in asthmatics?

A

Polyphonic expiratory wheeze

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17
Q

How does HR differ in severe vs life-threatening asthma attacks?

A

Severe: >110

Life-threatening: bradycardia

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18
Q

What would be abnormal on FBC in asthma?

A

Eosinophilia

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19
Q

Recall the 6 steps of chronic asthma management

A
  1. Inhaled SABA PRN (salbutamol)
  2. Add low-dose inhaled steroid (beclomethasone)
  3. Add LABA (salmetarol)
  4. Increase steroid dose
  5. Try a different drug eg leukotriene receptor antagonist
  6. Add prednisolone
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20
Q

Recall the acute management of asthma

A
  1. High flow oxygen
  2. Nebulised salbutamol and ipratroprium
  3. IV hydrocortisone
  4. Continue steriod treatment orally
    - If no improvement: IV magnesium or IV aminophylline
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21
Q

Recall the triad of pathologies that characterise bronchiectasis

A
  1. Chronically dilated airways
  2. Bacterial infections
  3. Decreased mucociliary clearance
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22
Q

What % of cases of bronchiectasis are idiopathic?

A

50%

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23
Q

When in the lifecourse does bronchiectasis usually arise?

A

Childhood

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24
Q

Describe the symptoms of bronchiectasis

A

Productive cough with copious purulent sputum and intermittent haemoptysis

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25
What would be heard upon auscultation in bronchiectasis?
Coarse inspiratory crepitations that shift when coughing
26
What would be seen upon general inspection in bronchiectasis?
Clubbing
27
Recall 2 approaches for medical management in bronchiectasis
Antibiotics for recurrent infection | Bronchodilator
28
Which 2 conditions does COPD comprise?
Emphysema | Chronic bronchitis
29
What would be found upon percussion in COPD?
Resonant percussion notes
30
What would be heard upon auscultation in COPD?
Polyphonic wheeze; crepitations
31
Recall 2 signs of CO2 retention that may be seen in COPD
Asterixis | Bounding pulse
32
What are "pink puffers" and "blue bloaters"?
"Pink puffers" = emphysema dominates | "Blue bloaters" = bronchitis dominates
33
Recall 3 aspects that can differentiate between pink puffers and blue bloaters
Alveolar ventilation: increased in PPs and decreased in BBs Build: PPs are thin with hyperinflation, BBs are stocky Complications: PPs get resp failure, BBs get cor pulmonale
34
What would be seen on FBC in COPD?
Polycythaemia
35
How can you identify hyperinflation on CXR?
>6 anterior ribs seen
36
What is cor pulmonale?
Enlargement of right hand side of heart due to lung disease
37
What sort of drug is ipratropium?
Anti-cholinergic
38
What is extrinsic allergic alveolitis?
Interstitial inflammation of distal parts of lung
39
What would be heard upon auscultation in hypersensitivity pneumonitis?
Fine inspiratory crepitations
40
To what group of diseases do farmer's and pigeon-fancier's lung belong?
Hypersensitivity pneumonitis/ EAA
41
Describe the symptoms, signs and prognosis of idiopathic pulmonary fibrosis
Symptoms: Exertional dyspnoea and dry cough with NO WHEEZE Signs: Clubbing Prognosis: very poor
42
Recall the management of idiopathic pulmonary fibrosis
Azothioprine | Glucocorticoids
43
What are the 2 most important blood tests to do in suspected obstructive sleep apnoea?
TFTs | ABG
44
What is pneumoconiasis?
Group of obstructive lung diseases related to occupation
45
Give 2 examples of pneumoconiasis
Silicosis | Asbestosis
46
Recall 2 signs of pneumoconiasis on CXR
Infiltrative patches | "Honeycombing" (cystic radiolucency)
47
What are the most commonly-implicated pathogens in hospital-acquired pneumonia?
Klebsiella | Pseudomonas
48
What are the most commonly-implicated pathogens in community-acquired pneumonia?
Streptococcus pneumoniae: 70% H. influenzae (COPD) S.aureus (IVDUs) Legionella (air-con)
49
Which pneumonia-causing pathogens may be detected in urine?
Pneumococcus | Legionella
50
What is pneumocystis carinii?
Type of life-threatening fungal pneumonia
51
Recall the medical management of mild, moderate and severe pneumonia
Mild: oral amoxicillin Moderate: amoxicillin + erythromycin Severe: Erythromycin + co-amoxiclav
52
What is co-amoxiclav a combo of?
Amoxicillin | Clavulanic acid
53
Recall 3 signs that could be identified from chest examination in pneumonia
Reduced expansion Increased tactile vocal fremitus Dull percussion
54
When would metronidazole be added to pneumonia medication?
If abscess or empyema is suspected
55
What is empyema?
A collection of pus in the pleural cavity caused by microorganisms, usually bacteria
56
Recall the CURB 65 scoring system
``` Confusion Urea >7 Resp rate >30 BP <90/60 >65 years ```
57
Recall some causes of secondary pneumothorax
Pre-existing lung disease like asthma/ COPD/ lung Ca
58
When would pneumothorax cause tracheal deviation?
Tension pneumothorax
59
What is the management of tension pneumothorax?
Max O2 | Large bore needle into 2nd ICS at MCL
60
What size of pneumothorax is considered small?
<2cm
61
How is a moderate pneumothorax aspirated?
Using a large bore needle with a 3-way cannula
62
If a large-bore needle with a 3-way tap fails to resolve a pneumothorax, how should it be managaed?
Chest drain with water seal
63
Recall 3 symptoms of pulmonary embolism
Sudden onset dyspnoea Pleuritic chest pain Cough with haemoptysis
64
How is pulmonary embolism scored?
Well's score
65
What investigation should be carried out in low-probability pulmonary embolism?
D-dimer
66
What investigation should be done in high-probability pulmonary embolism?
CTPA + CXR
67
Differentiate the medical management of pulmonary embolism whether the pt is haemodynamically stable or unstable
Stable: LMWH and warfarinise Unstable: alteplase
68
Recall the 3 types of TB infection
Primary: first infection, either pulmonary or occasionally GI Miliary: when there is haematogenous dissemination Post-primary: caused by reinfection/reactivation
69
What damage does mycobacterium do to the lungs?
Causes necrosis and caseating granulomas
70
Recall the symptoms of post-primary TB
Drenching night sweats Fevers Haemoptysis Cough
71
What disease does mycobacterium tuberculosis cause in the heart?
Constrictive pericarditis
72
What would be seen on CXR in TB?
Bilateral hilar lymphadenopathy, upper lobe shadowing, potential pleural effusion
73
In which demographic does non-pulmonary TB usually present?
Immunocomprimised
74
Recall one highly specific test for latent TB
Interferon gamma
75
How long should antibiotic therapy be continued in pulmonary TB?
6 months
76
Recall the 4 antibiotics that are combined to treat TB
Rifampicin Isoniazid Ethambutol Pyrazinamide

YEAR 3: Conditions Knowledge (17 decks)

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