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3B Hospital Specialities > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Types of respiratory disease and examples

A

Obstructive e.g. COPD, asthma, bronchiectasis
Restrictive e.g. sarcoidosis, pulmonary fibrosis
Malignant e.g. small and non small cell carcinomas
Infective e.g. pneumonias, tuberculosis

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2
Q

Difference between obstructive and restrictive lung pathologies

A
  • Obstructive = FEV1 <80% of the predicted value,
    FVC reduced but to a lesser extent than FEV1 and
    FEV1/FVC ratio < 0.7, mainly disease of breathing tubes.
  • Restrictive = FEV1 <80% of the predicted value and FVC proprtioanlly reduced too, FEV1/FVC ratio normal (>0.7), mainly disease of lung paranchyma.
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3
Q

Differentials for chest pain

A 
Resp =
Costochondritis
Tietze syndrome
PE
Pneumonia
Pneumothorax
Pleural effusion
Non resp = MI, angina, GORD, musculoskeletal, pericarditis.
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4
Q

Differentials for shortness of breathe

A 
Resp = 
COPD
Asthma
PE
Pneumothorax
Pneumonia
Interstitial lung disease e.g pulmonary fibrosis
Bronchiectasis
Non resp = severe anaemia, CHF, ACS, shock
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5
Q

Differentials for cough

A 
Resp = 
TB
Pneumonia
Cystic fibrosis
Pulmonary fibrosis
Asthma
COPD
Malignancy
URTI
Non resp = CHF, GORD, ACE inhibitors
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6
Q

Haemoptysis differentials

A 
Lung cancer
Tuberculosis
PE
Bronchiectasis
Mitral stenosis
Aspergilloma
Granulomatosis with polyangiitis
Goodpasture's sydrome
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7
Q

Differentials for wheeze

A 
Asthma
Inhalation of foreign body
COPD
Anaphylaxis
Bronchiolitis (paeds)
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8
Q

Differentials for stridor

A

Croup
Epiglottitis
Inhalation of foreign body
Carcinoma of the larynx

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9
Q

Common causes of CAP

A

Streptococcus pneumoniae
Mycoplasma pneumoniae
Haemophilus influenza

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10
Q

Common causes of HAP

A

Develops 48 hours or more after hospital admission and that was not incubating at hospital admission.
Pseudomona aeruginosa,
E.coli (gram -ve),
Kledsiella pneumoniae

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11
Q

Risk factor for HAP

A

Intubation and ventilation machinery used.

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12
Q

Risk factors for CAP

A 
Over 65yrs
COPD
Resides in care home
Cigarette smoking
Alcohol use
Immunocompromised
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13
Q

Risk stratification for pneumonia

A 
CURB 65
C - confusion
U - urea >7mmol/L
R - Resp rate >30/min
B - SBP <90mmHg or DBP <60mmHg
65 - aged over 65yrs

Score of 0 = low risk. Outpatient care.
Score of 1 or 2 = intermediate risk. Inpatient care.
Score of 3 or 4 = high risk. HDU/ITU care.

Use of CRB65 is increasingly being used as no need to wait for laboratory tests to assess patient’s risk.

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14
Q

History and examination of pneumonia

A 
Hx:
Fever
Productive cough
SOB
Malaise and fatigue
Pleuritic chest pain
Confusion
Presence of risk factors

O/E:
High temp, tachycardiac, tachypnoea, hypotensive.
Reduced chest expansion.
Dull to percuss
Increased tactile vocal resonance.
Crackles and reduced air entry on auscultation.
Pleural friction rub

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15
Q

Atypical pneumonia - Mycoplasma pneumoniae and COMPLICATIONS.

A

Common cause in young adults.
S+S= Dry cough, haemolytic anaemia, lower grade fever, hoarse voice, headache, pharyngitis.
Complications = Steven-Johnson syndrome, Guillian-Barre syndrome, erythema multiforme.
Rx = clarithromycin or doxycycline. (no cell wall so beta-lactams e.g. penicillin are not effective)

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16
Q

Atypical pneumonia - Chlamydia pneumoniae

A

Biphasic illness.
Lower grade fever, headache, hoarse voice, pharyngitis.
Less sudden onset.
Rx = clarithromycin or doxycycline.

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17
Q

Atypical pneumonia - Chlamydia psitacci

A

Bird fanciers!
Fever, headache, dry cough, d&v.
Rx = doxycycline.

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18
Q

Atypical causes of pneumonia in immunocompromised

A 
PCP = pneumocystis jirovecii (fungal) 
S+S = fever, dry cough, exertion dyspnoae, desaaturations on exertion, bilateral creps.
Ix = fine peri-hilar infiltrations on CXR, usually spares the apicies and lower lobes, not as focal as typical pneumonia.
Rx = co-trimoxazole.
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19
Q

Investigating a patient for pneumonia

A

ABG - oxygen saturation, are they in respiratory failure.
CXR - consolidation
Sputum culture - mc&s for appropriate antibiotic use.
Blood culture - sepsis screen.
FBC, CRP - WCC and CRP raised.

CXR for patients with suspected CAP who are over 60 years of age and smoke to rule out Ca.

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20
Q

CXR for atypical pneumonia

A

Diffuse reticular or reticulonodular opacities affecting interstitium.

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21
Q

Complications of pneumonia

A 
Sepsis/Septic shock
pleural effusion
lung abscess
respiratory failure
pericardities
Jaundice
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22
Q

First line treatment for CAP

A

Low-medium severity: Amoxicillin 500mg TDS for 5 days.
If penicillin allergic use Doxycyline 200mg on day 1 then 100mg OD for further4 days.
If high severity (based on CRB65):
Co-amoxiclav + clarithromycin or for penicillin allergic Levofloxacin.

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23
Q

First line treatment for HAP

A 
- Non-severe symptoms and signs:
Co-amoxiclav
If penicillin allergic or high risk of resistance use Doxycycline.
- Severe S+S and needing IV:
Piperacillin + tazobactam.
- Suspected MRSA:
Vancomycin
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24
Q

Types of interstitial lung disease and pathophysiology.

A

Disease of lung interstitium -space between alveolar epithelium and capillary endothelial.
Type of RESTRICTIVE lung disease.
- Idiopathic pulmonary fibrosis.
- Pulmonary fibrosis due to lung disease.
-Pneumoconioses/occupational lung disease.
- Extrinsic allergic alveolitis.

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25
Q

Diseases which cause pulmonary fibrosis

A
  • Connective tissue disease = rheumatoid arthritis, SLE, Sjogren’s syndrome, sarcoidosis.
  • Occupational = asbestos, dust, coal, silica.
    Irritant inhalation = birds, mould.
  • Radiation.
  • Drugs e.g bleomycin, methotrexate.
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26
Q

Over-riding features of ILD

A 
Dry cough.
Digital clubbing
Dyspnoea
Diffuse fine inspiratory crackles.
CXR shadows.
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27
Q

Spirometry result of ILD

A

FVC proportionally lower than FEV1

Ratio of FEV1/FVC is >80%

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28
Q

Peak incidence of idiopathic pulmonary fibrosis

A

45-65yrs

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29
Q

S+S of idiopathic pulmonary fibrosis

A 
Weight loss
Fatigue
Progressive dyspnoea
Dry cough
Digital clubbing
Diffuse fine inspiratory crackles
Reduced chest expansion
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30
Q

Complications of idiopathic pulmonary fibrosis

A

Pulmonary HTN
Cor pulmonale
Cyanosis
Respiratory failure

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31
Q

RFx for idiopathic pulmonary fibrosis

A 
Male
Smoker
Family history
Chronic aspiration e.g. GORD
Dust exposure
ASK ABOUT OCCUPATION!
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32
Q

Investigations for idiopathic pulmonary fibrosis

A

CXR/CT-bilateral reticular nodular shaowing, honeycomb lung if severe.
Spirometry - restrictive pattern.
ABG - PaO2 low.
FBC - raised ESR.
Bronchoalveolar lavage - high neutrophils.
Lung biopsy.
Rheumatoid factor, antinuclear factor.

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33
Q

Management of idiopathic pulmonary fibrosis

A

Oxygen
Pulmonary rehabilitation
Smoking cessation and exercise support
Lung transplant

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34
Q

Caplan’s syndrome

A

Coal worker pneumoconiosis + rheumatoid arthritis.

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35
Q

Coal workers pneumoconiosis

A

S+S: Dry cough, dysnpoea, black sputum, exertional dyspnoea.
OCCUPATIOAL Hx!
Ix: restricitive pattern on spiromtry, CXR shoes large nodular fibrotic masses in UPPER lobes.
Rx: financial compensation, avoid exposure, smoking cessation.

Above is similar for Silicosis.

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36
Q

Types of occupational lung disease

A

Coal workers pneumoconiosis
Asbestosis
Silicosis/ Potter’s rot
Pleural mesothelioma

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37
Q

Asbestosis

A

5-10yrs from exposure.
S+S: dry cough, digital clubbing, dysnpoea, diffuse inspiratory crackles (velcro).
Blue asbesto fibres are the worst :(
Ix: restrictive pattern on spirometry. CXR shows ground-glass opacification, asbestos bodies (small nodular opacities), sputum microscopy shows asbestos bodies/fibres.
Mx: avoid exposure, smoking cessation, financial compensation.
RF for mesothelioma.

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38
Q

Extrinsic allergic alveolitis

A
  • Hypersensitivity pneumonitis
  • Type 3 hypersensitivity reaction, non IgE mediated.
  • Sensitised patients inhale allergenand cause inflammation of alveoli and distal bronchioles.
    -S+S: acute fever, rigors, SOB, cough, malaise. Chronic weight loss, exertional dyspnoea, type 1 resp failure.
    -Ix: raised inflammatory markers, CXR/CT shows diffuse interstitial shadowing, ground-glass, BAL, spirtomtry shows restrictive pattern.
    Mx: remove allergen exposure, oxygen, prednisolone, financial compensation, smoking cessation.
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39
Q

Allergens for EAA

A 
Bird fanciers: bird poo
Farmers: mushroom spores, mouldy hay
Sugar cane fibres
Cotton fibres
Malt worker exposure
Cheese-maker expsoure
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40
Q

FEV1 and FVC definition

A 
FEV1 = the volume exhaled in the first second after deep inspiration and forced expiration.
FVC =  the total volume of air that the patient can forcibly exhale in one breath after maximum inhalation
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41
Q

Origin of thrombi in PE

A

Deep veins of calf or pelvis. Dislodge and travel to to pulmonary arterial tree where they come lodged in narrowing vessels.

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42
Q

Risk factors for PE

A

Immobilisation (long flight, bed rest, post-op)
COCP
Malignancy
Pregnancy and other Hypercoagulable states.
Genetic factors = factor V Leiden, antiphospholipid syndrome, protein C or S deficiency.

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43
Q

Clot formation triad

A

Virchow’s triad:
Blood stasis
Endothelial damage
Hypercoagulablity / Clotting system activation

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44
Q

Types of embolus

A 
Thrombus
Amniotic fluid
Fat
Air
Tumour
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45
Q

Presentation of PE

A 
Sudden onset chest pain
Dyspnoea
Tachycardia
Tachypnoea
Cough
Syncope
Hypotension
Fever
Increased JVP
Signs of shock
Unilateral calf swelling
Haemoptysis
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46
Q

Investigations in suspected PE

A
  • ECG - S1Q3T3, sinus tachycardia, RBBB.
  • ABG - low PaO2 and PaCO2.
  • D-Dimer - elevated but not SPECIFIC.
  • CT pulmonary angiogram - assess clot size, location, number.
  • CXR - exclude other causes, oligaemia of effected area.
    FBC, U&E, Clotting screen
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47
Q

Scoring for DVT and PE

A

Well’s Score

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48
Q

Cause of high d-dimer

A

PE, sepsis, malignancy, pregnancy, post-operative, DIC, VTE.

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49
Q

Management of suspected PE

A
  • A-E assessment and intervene when needed e.g. IV access, oxygen support.
  • Oxygen and analgesia (morphine).
  • Anticoagulate - LMWH e.g dalteparin subcut. Commence oral anticoagulant e.g warfarin.
  • Thrombolysis if haemodynamically unstable e.g. hypotension. IV streptokinase or alteplase.
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50
Q

Anticoagulation post PE

A

3 months of warfarin aiming for INR 2.5-3.

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51
Q

Types of pneumothorax

A

Primary pneumothorax = spontaneous.
Secondary pneumothorax = as a complication of an underlying pulmonary disease.
Traumatic pneumothorax = penetrating or blunt injury to chest e.g. rib fracture, stabbing, poor central venous catheter placement.
Tension pneumothorax = intrapleural pressure > atmospheric pressure. Can occur after any of the above pneumothoraces and is an emergency!

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52
Q

Those at risk of spontaneous pneumothorax

A

Young, slim tall males with +ve family history.

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53
Q

Those at risk of secondary pneumothorax

A 
COPD
Sever asthma
Recent invasive medical procedure
TB
HIV related pneumocystis jirovecii.
Marfan's syndrome
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54
Q

S+S of pneumothorax

A

Sudden onset unilateral pleuritic chest pain.
Extreme and worsening dyspnoea.
Hyper-resonant area on percussion.
Reduced chest expansion.
Absent/diminished breath sounds.
In tension pneumothorax will have trachea deviation and mediastinum shift AWAY from affected side. Hemidiaphragm depression.

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55
Q

Investigations for pneumothorax

A

ABG
CXR - area of increased opacity, mediastinal shift in tension,
ECG

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56
Q

Management of pneumothorax (NOT TENSION)

A

If v small and not symptomatic can leave.

If needs intervention: supplementary O2. try and aspirate, if unsuccessful –> percutaneous aspiration/chest drain.

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57
Q

Management of tension pneumothorax

A

DO NOT CXR - start RX!!!
Immediate needle compression with cannula.
Oxygen therapy.
Chest drain with tube thoracostomy.

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58
Q

Prophylaxis for recurrent pneumothorax

A

Pleurodesis

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59
Q

Pleuritic chest pain differentials

A 
ACS
Aortic dissection
Pneumothorax
PE
Pneumonia
Malignancy
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60
Q

Differentials for bilateral hillar lymphadenopathy on X-ray

A 
TIME Mnemonic
TB
Inorganic dust e.g. silicosis
Malignancy (lymphoma, carcinoma)
EAA (bird fancier's lung)
Sarcoidosis
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61
Q

Safe triangle for chest drain insertion

A

Anterior border of latissimus dorsi
Lateral border of pec major
Horizontal line from nipple.
Axilla apex.

62
Q

Criteria for pleural effusion

A

Light’s criteria

If pleural fluid has a protein concentration of 25-35g/L then the sample must be analysed using Light’s Criteria

63
Q

Light’s Criteria

A

An effusion is considered an exudate if anyone one of the following criteria are met:
- Pleural fluid protein to serum protein ratio greater than 0.5.
- Pleural fluid lactate dehydrogenase to serum LDH ratio
greater than 0.6.
- Pleural fluid level >2/3 of upper value for serum LDH.

64
Q

S+S of pleural effusion

A 
Pleuritic chest pain
SOBOE
Reduced chest expansion (unilateral).
Stony dull percussion.
Decreased breath sounds.
Bronchial breathing.
65
Q

Investigations for pleural effusion

A
  • CXR - blunted costaphrenic angle, ‘white-out’, meniscus at fluid level.
  • US to guide diagnostic tap.
  • Pleural aspiration: cytology, protein, lactate dehydrgensase, pH, gram stain, culture and sensitive.
  • Pleural biopsy.
  • FBC for infection and anaemia.
  • CT thorax
66
Q

Management of pleural effusion

A

Drainage if symptomatic.
Pleurodesis for recurrent effusions.
Transudates return quickly when drained so treat cause before draining them.

67
Q

Pleurodesis

A

Use Bleomycin, tetracyclin or talc.

68
Q

Massive and small haemothorax

A 
Massive = blood volume of >1.5L, Rx with thoracotomy.
Small = blood volume <1.5L, Rx with chest drain or medical management.
69
Q

Causes of transudate effusions

A
  • Increased venous pressure: Heart failure and Renal failure = fluid overload.
  • Hypoproteinaemia: Hepatic failure, malabsorption
  • Hypothyroidism
  • PE
  • Meig’s syndrome (triad of benign ovarian tumour + ascites + pleural effusion).
70
Q

Causes of exudate effusions

A 
More leaky pleura capillaries.
Malignancy, mesothelioma, lymphoma
Infection/pneumonia
Rheumatoid arthritis, SLE, Sarcoidosis
TB
Empyema
71
Q

Pus in pleural space

A

Empyema, fluid if turbid/yellow colour.

72
Q

Fat in pleural space

A

Chylothorax

73
Q

Difference between exudate and transudate pleural effusions

A 
Transudate = protein <25g/L, hydrostatic and oncotic forces dysfunction.
Exudate = protein >35g/L, increased permeability of pleura from inflammation.
74
Q

If multinucleated giant cells in fluid what are the potential causes of the pleural effusion?

A

Rheumatoid arthritis

75
Q

If abnormal mesothelial cells in fluid what are the potential causes of the pleural effusion?

A

Mesothelioma

76
Q

If there are lots of mesothelial cells in the fluid what are the potential causes of the pleural effusion?

A

Pulmonary infarction

77
Q

If there are lymphocytes in the fluid what are the potential causes of the pleural effusion?

A

TB, Rheumatoid arthritis, SLE, Sarcoidosis, malignancy.

78
Q

5 groups who are eligible for pneumococcal vaccine

A

Elderly >65yrs
Heart failure, liver failure, renal failure
Diabetics
Immunocompromised pts (splenectomy, AIDS, chemo)

79
Q

Risk factors for COPD

A 
Smoking
Exposure to dust, chemicals, noxious gases, and particles (such as coal)
Air pollution
Genetics
Male gender
80
Q

Genetic link in COPD

A

alpha1-antitrypsin deficiency. Consider if S+S point to COPD and is under 40yrs.

81
Q

Pathophysiology of COPD

A 
Progressive and non-reversible airway obstruction.
Air is obstructed due to: 
Airway disease (obstructive bronchiolitis)
\+ 
Parenchymal damage (emphysema), resulting from an enhanced inflammatory response.
82
Q

Complications of COPD

A 
Sepsis
Secondary polycythaemia (chronic hypoxia) seen as increased haematocrit on FBC.
Frequent chest infections
Cor pulmonale
Depression/anxiety
83
Q

Cor pulmonale

A

Right heart failure secondary to lung disease.

Mostly due to pulmonary HTN as a consequence of hypoxia.

84
Q

S+S of COPD

A

Chronic, productive cough
Poor exercise tolerance/exertion breathlessness
Frequent chest infections
Wheeze

Dyspnoea
Cyanosis
Use of accessory muscles on respiration
Decreased chest expansion
Audible wheeze
Hyperinflated chest
Decreased breathe sounds
85
Q

Investigating COPD (non-acute)

A 
CXR
Spirometry - FEV1/FVC ratio <0.7
FBC (polycythaemia)
Sputum culture
ECG to assess cardiac function
86
Q

Spirometry measures for severity of obstructive respiratory disease

A

Stage 1 = mild — FEV1 greater or equal to 80%.
Stage 2 = moderate — FEV1 50-79% of predicted value.
Stage 3 = severe — FEV1 30-49% of predicted value.
Stage 4 = very severe — FEV1 <30% of predicted value.

87
Q

What can be used to assess shortness of breath

A

Medical research council dyspnea scale

88
Q

Non-medical parts to management of COPD

A

Smoking cessation advice
Pneumococcal vaccine
COPD education and information
Pulmonary rehabilitation

89
Q

Medical management of COPD (Chronic)

A

1) SABA (salbutamol) or short-acting antimuscarinic (ipratropium bromide).
2) LABA (salmeterol) + ICS (beclometasone)
3) LABA + LAMA + ICS

90
Q

Acute COPD exacerbation management

A

A-E assessment, IV access, Oxygen supplementation (aim for sats 88-92% to prevent hypercapnia).

1) Nebulised salbutamol + ipratropium
2) IV hydrocortisone or oral prednisolone if able to tolerate
3) Consider antibiotics if infective cause
4) IV amiophylline
5) Consider intubation and ventilation

91
Q

Emphysema

A

Histological diagnosis.

Elastin breakdown, permanent destruction and enlargement of alveoli.

92
Q

Chronic bronchitis

A

Clinical diagnosis.

Cough and sputum production for most days of 3 months in 2 successive years.

93
Q

Differences between asthma and COPD (according to NICE)

A

COPD = smokers, over 35yrs, chronic productive cough, persistent and progressive breathlessness, less variation day-to-day and diurnally.

Asthma = Under 35yrs, more variability in symptoms esp at night and day-to-day, more reversibility with bronchodilators.

94
Q

Type 1 resp failure

A

Hypoxia with normal or low PaCO2.

Ventilation / perfusion mismatch

95
Q

Type 2 resp failure

A

Hypoxia + hypercapnia

Alveolar hypoventilation

96
Q

Pink puffers

A
  • Emphysema: pink skin, pursed lips, barrel chest, decreased breath sounds, no cough
  • Tachypnoea + increased minute ventilation
  • CO2 responsive -> compensatory hyperventilation -> T1RF
97
Q

Blue bloaters

A
  • Bronchitis: cyanosis, crackles + wheeze, obesity, peripheral oedema
  • Purulent sputum, chronic productive cough
  • CO2 retention (insensitive to hypercapnia drive)
98
Q

Renal symptoms + respiratory symptoms

A

Goodpasture’s syndrome.
Antiglomerular basement membrane antibodies.
Acute glomerulonephritis + haemoptysis, pulmonary haemorrahge

99
Q

Definition of pulmonary HTN

A

Mean pulmonary artery pressure >25mmHg at rest, or >30mmHg on exercise.

100
Q

S+S of pulmonary HTN

A 
Breathlessness on exertion
Fatigue
Chest pain
Palptiations
Peripheral oedema
Syncope

O/E: cyanosis, clubbing, RHF signs (raised JVP), scleroderma signs

101
Q

Investigating pulmonary HTN

A 
Find cause: rheumatology screen, LFTs.
ECG - right heart hypertrophy (R wave in V1-V3, S wave in V4-V6). RBBB.
Spirometry
Chest XR
Echocardiogram
BNP (high in PHTN)
CTPA
DIAGNOSTIC: Right heart catherisation
102
Q

Some causes of pulmonary HTN

A 
SLE and other connective tissue diseases
Left heart failure (MI, HTN).
COPD
Pulmonary embolism
Sarcoidosis.
103
Q

Management of pulmonary HTN

A

Refer to specialist.
Non-medical = avoid pregnancy/contraception advice, annual flu vaccination, lung transplant.
Medical = 1) Phosphodiesterase-5 inhibitors
e.g. Sildenafil or tadalafil
2) Endothelin recepter antagonists e.g. bosentan
3) Prostanoids e.g. IV epoprostenol

104
Q

Pathophysiology behind bronchiectasis

A

Dilated bronchi and thickening of their walls.

105
Q

Causes of bronchiectasis

A

LRTI and URTI
Congenital: CF, ciliary dyskinesia (Kartagener’s syndrome)
Obstruction: endobronchial tumour, foreign body inhalation.
Infective: URTI and LRTI, TB, HIV, measles
Rheumatoid arthritis
UC
Allergic bronchopulmonary aspergillosis.

106
Q

S+S of bronchiectasis

A

Purulent sputum production - mild = ywlloy, severe = khaki.
Chronic cough
Breathlessness
Intermittent haemoptysis
Non-pleuritic chest pain
O/E: coarse crackles whcih shift on cough, wheeze, rhonchi, finger clubbing.

107
Q

Investigating bronchiectasis

A 
Sputum culture: gram -ve = P.aeruginosa. gram +ve = S.aureas, S.pneumonia.
CXR - thickened bronchial walls, cystic shadows if cysts present.
High resolution CT - imaging of choice.
Post-bronchodilator spirometry (obstructive pattern).
Investigate cause (sweat test for CF, bronchoscopy, IgE skin prick test)
108
Q

Infections which form cysts

A 
S.aurea
H.influenza
S.pneumonia
P.aeruginosa
A.fumigatus
109
Q

Management of bronchiectasis

A

Exercise
Airway clearance physio therapy.
Mucolytics e.g. Carbocisteine
Inhaled bronchodilators + Inhaled hypertonic saline.
Antibiotics for infective episodes (amoxicillin or ciprofloxain if severe)

110
Q

Hypersensitivity reaction especially common in CF or asthma patients

A

allergic bronchopulmonary aspergillosis

111
Q

Mould in Allergic bronchopulmonary aspergillosis

A

Aspergillus fumigatus

112
Q

2 types of hypersensitivity reaction in Allergic bronchopulmonary aspergillosis

A

Type 1 = IgE mediated

Type 3 = IgG mediated

113
Q

Presentation of allergic bronchopulmonary aspergillosis

A 
Hx of asthma or CF
Productive cough
Mucus plugs
Wheeze
FEVER
Pleuritic chest pain
114
Q

Investigating allergic bronchopulmonary aspergillosis

A

Skin test for A.fumigatus sensitivity (+ve)
Serum IgE levels (high)
FBC for eosinophil count (high)
CXR (upper and middle infiltrates)

115
Q

Management of allergic bronchopulmonary aspergillosis

A

Oral corticosteroids e.g. prednisolone.
Antifungal e.g. Itraconazole.
Optimise asthma or CF Mx.
Avoid exposure to mould.

116
Q

Types of lung cancers

A

Non-small cell: Squamous cell carcinoma, Large-cell carcinoma, Adenocarcinoma
Small cell carcinoma
Malignant mesothelioma (pleura tumour)

117
Q

Risk factors for lung tumours

A

Smoking
Passive smoking
Asbestos exposure
Radiation (radon)

118
Q

Which lung tumour, if untreated, has the best survival time

A

Squamous cell carcinoma. Least like to metastasise too.

119
Q

S+S of a lung tumour

A 
Cough
Haemoptysis
Dysnpnoea
Chest pain
Weight loss

Anaemic
Clubbing
Can have normal resp examination
Palpable supraclavicular or axillary nodes.

120
Q

What does a hoarse voice mean in the presence of a suspected lung tumour

A

Compression of the recurrent laryngeal nerve

121
Q

Pancoast’s tumour

A

Causing Horner’s syndrome - miosis, ptosis, anhydrosis. Can be caused by any histological type of lung tumour by mostly adenocarcinomas and sqamous cell carcinomas

122
Q
  1. Common substance secreted by squamous cell carcinomas.
  2. Common substance secreted by small cell tumours.
  3. Common substance/disorder from carcinoid tumours.
A
  1. Parathyroid hormone leading to hypercalcaemia and bone destruction.
  2. ACTH leading to Cushing’s
  3. Carcinoid syndrome from excessive serotonin.
123
Q

CXR of a squamous cell carcinoma

A

Hilar mass

Cavitation

124
Q

What disease is associated with adenocarcinomas

A

Pulmonary fibrosis and honeycomb lung

125
Q

What cells to adenocarcinomas arise from

A

Golbet cells, type 2 pneymocytes and other glandular cells

126
Q

Common sites for lung adenocarcinomas to metastasise to

A

Pancreas, GI tract and ovaries

127
Q

What cells do small cell carcinomas arise from

A

Neuroendocrine cells, high occurence of paraneoplastic syndrome

128
Q

Complications of lung tumours

A

Paraneoplastic syndrome
Recurrent laryngeal nerve palsy (hoarse voice)
Horner’s syndrome
SVC obstruction
Hypertrophic pulmonary osteoarthropathy - Painful arthropathy of the wrists, ankles, and knees

129
Q

Investigating a lung tumour

A

2 week referral CXR.
CT scan for diagnosis and staging
PET-CT
Endobronchial ultrasound transbronchial needle aspiration for biopsy

130
Q

Management of a lung tumour

A

Smoking cessation
Education, information and support (macmillan)
Non-small cell carcinomas - excision + postop chemotherapy +/- radiotherapy.
Small cell carcinomas - platinum based chemotherapy if later staged or excision if early stage.

131
Q

What substance is associated with malignant mesothelioma

A

Asbestos

132
Q

S+S of malignant mesothelioma

A

Dyspnoea
Chest pain
Weight loss

Clubbing
Pleural effusion
Signs of met

133
Q

Ix for mesothelioma and treatment

A

CXR - pleural effusion, unilateral pleural thickening
Thoracoscopy biopsy to confirm.
No cure - pallative care

134
Q

Signs on an CXR that it is a metastatic lesion rather than a primary tumour

A

No cavitation, well circumscribed.
If large = cannonball e.g. kindey, bowel, uterus, testis
If small nodules = snowstorm e.g. breast, bladder, prostate, thyroid.

135
Q

Granulomatosis with polyangiitis

A

Wegener’s granulomatosis

136
Q

Organs invovled in granulomatosis with polyangiitis and signs + symptoms

A

ENT, Lungs and Kidneys
Lung = rhinorrhoea, epitaxis, sinus pain, cough, haemoptysis, dyspnoea, rhonchi, saddel-shaped nose from chronic rhinorrhoea.
ENT = conjunctivits, uveitis, periorbital oedema from kidneys
Kidneys = glomerulonephritis, proteinuria, haematuria, oedema.

137
Q

Ix and Mx in granulomatosis with polyangiitis

A

serum cANCA
Lung = CT chest
Kidney = urinalysis and microscopy
Mx = methylprednisolone + cyclophosphamide

138
Q

Severe acute respiratory syndrome

A

SARS CoV Virus
Persistent fever, rigors, myalgia, dry cough, diarrhoea, headache.
Low WCC, abnormal CXR. Blood cultures
Supportive maangement. Contact trace. Isolate patient. Antivirals e.g. Lopinavir

139
Q

Pathophysiology behind acute respiratory distress syndrome

A

Non-cardiogenic pulmonary oedema + diffuse lung inflammation

140
Q

Risk factors for ARDS

A 
Sepsis
Gastric aspiration
Pneumonia
Severe trauma
Blood transfusion
Pancreatitis
Smoke inhalation
Burns
141
Q

S+S for acute respiratory distress syndrome and diagnostic criteria

A 
Fever, cough, pleuritic chest pain.
Tachycardic, tachypnoeac, hypoxic, cyanotic, bilateral fine inspiratory crackles.
To diagnose:
- Acute onset of symptoms (<1week)
- Bilateral opacitiy on CXR
- PaO2/FiO2 < 300 on PEEP or CPAP
- Lack of CHF as diagnosis.
142
Q

Investigations for ARDS

A

ABG
CXR - BILATERAL INFILTRATES.
Bloods - FBC, U+E, LFT, CRP, blood cultures, amylase, clotting screen.

143
Q

Management of ARDS

A 
A-E
CPAP Oxygen, mechanical ventilation.
Fluids
Arterial line in situ.
Consider ABx for infective cause.
144
Q

Which bug can cause pneumonia and haemolytic anemia, Steven-Johnson Syndrome, Guillian-Barre syndrome?

A

Mycoplasma pneumonia

145
Q

Meaning of PE S1Q3T3 ECG

A

Prominent S wave in lead I

Q wave and inverted T wave in lead III

146
Q

Acute asthma treatment

A

1) A-E resuscitation including oxygen supplementation (target sats 94-98%)
2) Beta2-agonist bronchodilator
3) IV Hydrocortisone
4) Ipratropium bromide (nebulised)
5) Consider IV magnesium sulphate

147
Q

Management of chronic asthma (adults)

A

1) short acting beta agonist e.g salbutamol.
2) + low dose ICS e.g. beclametasone.
3) + leukotriene receptor antagonist e.g. Montelukast.
4) + long acting beta-agonist e.g. salmeterol with or without the Montelukast.
5) MART regime with specialist.

148
Q

When to give a sore throat Abx

A

FeverPAIN:

  • Fever
  • Purulence (pus on tonsils)
  • Attend rapidly (within 3 days after onset of symptoms)
  • Severely Inflamed tonsils
  • No cough or coryza (inflammation of mucus membranes in the nose)

Score of 4-5 will benefit form ABx e.g. Phenoxymethylpenicillin

149
Q

A non-caseating granuloma with multinucleate giant cells. Commonly causing respiratory symptoms?
Good ∆∆ for TB?

A

Sarcoidosis.

150
Q

5 places where sarcoidosis commonly involve and the presentations of each?

A
  1. Pulmonary = cough, shortness of breathe, wheeze, lymphadenopathy.
  2. Cutaneous = lupus pernio, papular plaques on nose, cheeps, lips and ears.
  3. Ocular = anterior uveitis, photophobia, red painful eye, blurred vision.
  4. Cardiac = heart block, pulmonary HTN (haemoptysis)
  5. Neurosarcoidosis = headache, seizures, CN palsy.

Non-specific symptoms = chronic fatigue, weight loss, low fever.

151
Q

Pathognomonic of sarcoidosis

A

Lupus pernio

152
Q

Ix and Rx for sarcoidosis

A

CXR = hilar lymphadenopathy and bilateral infiltrations. bronchoalveolar lavage/biopsy.
FBC = anaemia, U+E = raised urea and creatinine, LFT = raised enzymes, Metabolic profile = Raised Ca, LyFT = restrictive pattern, ECG.
Exclude TB = QUANTIferon test.

Mx = prednisolone, methotrexate, anti-TNF.

3B Hospital Specialities (17 decks)

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