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Finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the three major characteristics of asthma

A

Airflow obstruction
Bronchial hyper-responsiveness
Inflammation

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2
Q

What is the difference between atopic and non-atopic asthma

A

Atopic has allergic triggers, is extrinsic, usually develops in childhood, is a type 1 hypersensitivity reaction
Non-atopic usually develops later and is triggered by cold/exercise/virus

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3
Q

Which immunoglobulin is associated with asthma

A

IgE

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4
Q

What will asthma show as on spirometry

A

Obstructive picture
Low FEV1
Low FEV1/FVC ratio
Bronchodilator reversibility

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5
Q

Bronchodilator reversibility in spirometry is an increase in FEV1 of X?

A

12% or 200ml

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6
Q

Management of asthma

A 
Annual review
Vaccinations - pneumococcal, flu
Self monitor PEFR
1. SABA 
2. Add low dose ICS
3. Add LABA 
4. Increase ICS or add LTRA (consider stopping LABA)
5. Refer to specialist
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7
Q

Side effects of beta-2 agonists (Salbutamol, Salmeterol)

A

Tachycardia
Tremor
Hypokalaemia

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8
Q

Montelukast belongs to which class of medications?

A

Leukotriene receptor antagonists

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9
Q

Ipratropium belongs to which class of medications?

A

Antimuscarinics

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10
Q

Side effects of antimuscarinics (Ipratropium)

A

Dry mouth
Nausea
Headache

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11
Q

Theophylline belongs to which class of medications?

A

Phosphodiesterase inhibitors

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12
Q

Side effects of PDE inhibitors (theophylline)

A

Tachycardia
Arrhythmias
Agitation
Hypokalaemia

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13
Q

Features of severe acute asthma

A

PEF 33-50%
RR 25+
HR 110+
Cant complete sentences

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14
Q

Features of life threatening acute asthma

A 
PEF <33%
SpO2 <92%
PaO2 <8
Normal CO2
Silent chest
Cyanosis
Poor effort
Arrhythmia
Hypotension
Exhaustion
Altered conscious level
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15
Q

Features of near-fatal acute asthma

A

Raised CO2 and/or requiring mechanical ventilation

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16
Q

Management of acute asthma

A 
Oxygen - keep sats 94-98%
Nebulised SABA driven by oxygen
Steroids (and continue for 5 days)
Nebulised ipratropium bromide
Consider IV MgSO4
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17
Q

Acute asthma criteria for admission

A

Severe that isnt responding to treatment

Any life-threatening or near fatal

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18
Q

Acute asthma criteria for discharge

A

PEF >75% 1hr at treatment

No significant sx or concerns

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19
Q

How soon after an acute asthma attack should patients inform/see their GP

A

Inform GP within 24hrs of discharge

See GP 48hrs after

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20
Q

COPD can be seen as the combination of which 2 diseases

A

Chronic bronchitis

Emphysema

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21
Q

Which genetic disorder can lead to COPD

A

Alpha-1-antitrypsin deficiency

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22
Q

What may you find on percussion and auscultation in COPD

A

Hyper-resonant percussion due to hyperinflation
Inspiratory coarse crackles and wheeze
Decreased breath sounds if advanced

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23
Q

Describe the pathophysiology of cor pulmonale

A

Alveolar hypoventilation → hypoxic pulmonary vasoconstriction → pulmonary hypertension → cor pulmonale

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24
Q

Features of hypercapnia

A 
Dilated pupils
Bounding pulse
Hand flap
Myoclonus
Confusion
Drowsiness
Coma
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25
Q

What are the spirometry findings of COPD

A

Obstructive picture
Low FEV1
Low FEV1/FVC ratio (<70%)
No bronchodilator reversibility

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26
Q

Which classification system can be used to assess severity of COPD

A

GOLD

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27
Q

GOLD Severity of COPD

A

Mild 80+
Moderate 50-79%
Severe 30-49%
Very severe <30%

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28
Q

Management of COPD

A 
Smoking cessation
Vaccinations - pneumococcal, flu
Pulmonary rehab + physio
SABA, LABA, Ipratropium, Theophylline
ICS only if severe
Mucolytics (Carbocysteine)
Oxygen therapy
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29
Q

Hoe do you define HAP?

A

Develops >48hrs after being admitted or within 10 days of discharge

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30
Q

Typical bacteria that cause CAP

A

Strep.pneumoniae

H.influenzae

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31
Q

Bacteria that cause HAP

A

Pseudomonas aeruginosa
Enterobacteria
Staph aureus

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32
Q

Which organism typically causes VAP

A

Pseudomonas aeruginosa

33
Q

How does a typical pneumonia present

A 
Severe malaise
Fever/chills
Productive cough
Crackles
Dull to percussion
Pleuritic chest pain - often associated pleural effusion
34
Q

How may atypical pneumonia present

A 
Slower onset
Dry cough
SOB
Fatigue
Headache
Myalgia
Less remarkable auscultation
35
Q

CURB-65 score

A

Confusion (disorientation, impaired consciousness)
Urea > 7 mmol/L (20 mg/dL)
Respiratory rate ≥ 30/min
Blood pressure: systolic BP ≤ 90 mm Hg or diastolic BP ≤ 60 mm Hg
Age ≥ 65 years

36
Q

CURB score of ? indicated hospital treatment needed

A

2+

37
Q

Complications of pneumonia

A 
Pleural effusion
Pleuritis
Sepsis
Respiratory failure
ARDS
38
Q

How long after a pneumonia should you follow up and do CXR

A

6 weeks

39
Q

Time frames for symptoms resolving after a pneumonia

A

1 week: fever should have resolved
4 weeks: chest pain and sputum production should have substantially reduced
6 weeks: cough and breathlessness should have substantially reduced
3 months: most symptoms should have resolved but fatigue may still be present
6 months: most people will feel back to normal.

40
Q

What is the chance of getting primary TB if exposed to an infectious case

A

30%

41
Q

What percentage of patients with primary TB get

a) progressive TB disease
b) containment

A

a) 5-10%

b) 90-95%

42
Q

What percentage of patients who develop containment after primary TB infection get reactivation of the disease?

A

10%

43
Q

Two organisms that can cause TB

A 
Mycobacterium tuberculosis
Mycobacterium bovis (cows milk)
44
Q

What is latent TB

A

A condition in which a person is infected with Mycobacterium tuberculosis but does not have any symptoms of disease (e.g., fever, night sweats, weight loss, productive cough) and is not infectious. The tuberculin skin test or interferon-gamma release assay are positive.

45
Q

What is active TB

A

A condition in which the infection with Mycobacterium tuberculosis becomes symptomatic, often due to the patient being immunocompromised. Symptoms may include fever, night sweats, weight loss, and/or productive cough (if the lungs are affected). The patient is contagious.

46
Q

Treatment regimen for active TB

A

Isoniazid, Rifampin, Pyrazinamide, and Ethambutol for the first 2 months. Treatment is then continued with Isoniazid and Rifampin alone for 4 months.

47
Q

Symptoms of active TB (primary or reactivated)

A

Fever, weight loss, night sweats
Fatigue, lymphadenopathy
Dyspnea
Productive cough +/- haemoptysis lasting >3 weeks

48
Q

What are the potential sites of extrapulmonary TB

A 
Most common:
Bones
Pleura
Lymphatics
Liver
Other:
Urogenital
Skin
Heart
CNS
GI
49
Q

What is a Ghon complex on CXR?

A

A finding of primary TB
Particularly common in children.
Calcified granuloma usually in the middle to lower lobes with an associated lymph node; retains TB bacteria and therefore is a source of reinfection

50
Q

CXR findings of

a) Primary TB
b) Reactivated TB

A

a) Hilar lymphadenopathy, pleural effusions, Ghon complex

b) Upper lobe cavitating lesion

51
Q

What stain do you use to identify TB on sputum microscopy

A

Acid fast stain (Ziehl-Neelsen)

52
Q

How is the tuberculin skin test (Mantoux) used?

A

A test to assess for latent TB, in which 5 units of purified protein derivative tuberculin is injected intradermally. The diameter of the induration at the injection site is measured after 48–72 hours, and determines if further TB testing is necessary. The test only becomes positive 6–8 weeks after infection. A healthy individual without any risk factors for TB infection who has an induration smaller than 15 mm is considered negative for TB

53
Q

How is the IGRA (interferon gamma release assay) used in the assessment of TB?

A

An ELISA test that measures the level of interferon-γ expressed by T cells after coming into contact with Mycobacterium tuberculosis. Used to diagnose latent tuberculosis infection in at-risk populations. Elevated interferon-γ levels indicate a positive result. In contrast to tuberculin skin testing, there are no false-positive results with IGRA in patients who received the bacillus Calmette-Guérin (BCG) vaccine.

54
Q

Treatment for latent TB

A

Isoniazid monotherapy for 9 months in patients with positive interferon-γ and/or PPD test but without clinical signs of active TB
Alternative regimens: 6 months of isoniazid, 4 months of rifampin, or 3 months of isoniazid and rifapentine

55
Q

Side effects of Isoniazid

A

Hepatotoxicity (acute hepatitis, chronic liver failure).
Peripheral polyneuropathy and other symptoms of pyridoxine deficiency (e.g., stomatitis, glossitis, convulsions, and anemia).

56
Q

How can you reduce the side effects of Isoniazid?

A

Simultaneous pyridoxine (vitamin B6) administration

57
Q

Side effects of Rifampicin

A

Hepatotoxicity
Red or orange body fluids (e.g., urine, tears).
Thrombocytopenia.
Flu/GI sx.

58
Q

Side effects of Pyrazinamide

A

Hepatotoxicity
Hyperuricemia
Arthralgia
Myopathy

59
Q

Side effects of Ethambutol

A

Optic neuritis

60
Q

Poly-resistance to TB meds is resistance to….

A

More than one medication other than both Rifampicin and Isoniazid

61
Q

Multi-drug resistant TB is resistant to….

A

Both Rifampicin and Isoniazid

62
Q

What are the 3 types of non-small cell lung cancer

A

Adenocarinoma
Squamous cell carcinoma
Large cell carcinoma

63
Q

Which type of lung cancer occurs idiopathically/without strong smoking history?

A

Adenocarcinoma

64
Q

What is SVC syndrome

A

Full sensation in head, oedema of upper extremities and face, prominent veins on chest/face/upper extremities, worse in the mornings
Can be caused by lung cancer obstructing the SVC

65
Q

Paraneoplastic syndromes associated with small cell lung cancer

A

Cushing’s syndrome
SIADH
Lamber-Eaton syndrome
Peripheral neuropathy

66
Q

Paraneoplastic syndromes associated with non-small cell lung cancer

A

Hypertrophic osteoarthropathy (clubbing and arthralgia)
Hypercalcaemia + PTHrP (SCC)
Gynaecomastia (LCC)
VTE, thrombophlebitis, verrucous endocarditis (adenocarcinoma)

67
Q

What is a pancoast tumour and what symptoms/signs may it cause?

A

An apical lung cancer
Severe localised pain in the axilla and shoulder
Horner syndrome (miosis, partial ptosis, facial anhidrosis)
Hand/arm muscle atrophy
SVC syndrome
Loss of/filling of supraclavicular fossa

68
Q

What tool can be used to assess cancer risk of a lung nodule

A

Brock calculator

69
Q

Which lung cancers tend to be centrally located

A

SCLC

Squamous cell carcinoma

70
Q

When lung cancers tend to be peripherally located

A

Adenocarcinoma

Large cell carcinoma

71
Q

Causes of transudative pleural effusion

A

Congestive HF
Hepatic cirrhosis
Nephrotic syndrome
CKD

72
Q

Causes of exudative pleural effusin

A 
Infection
Malignancy
PE
Vasculitis/SLE/RA/Sarcoid
Pancreatitis
Haemothorax
Chylothorax
73
Q

Thoracocentesis findings in transudative pleural effusion

A 
Doesn't froth or clot
Low specific gravity (<1.016)
Low cholesterol (<60)
Low total protein (<30)
High glucose (60+)
Low-ish pH (7.4-7.55)

Lights criteria:
Fluid:serum protein <0.5
Fluid:serum LDH <0.6
Low fluid LDH (<2/3 upper limit of normal serum LDH)

74
Q

Thoracocentesis findings in exudative pleural effusion

A 
Cloudy/straw coloured/froths/clots
High specific gravity (>1.016)
High cholesterol (>60)
High total protein (>30)
Low glucose (<60)
Really low pH (7.3-7.45)

Lights criteria:
Fluid:serum protein >0.5
Fluid:serum LDH >0.6
High fluid LDH (>2/3 upper limit of normal serum LDH)

75
Q

Differentials of white out on CXR

A

Trachea pulled towards;
Collapse
Pneumonectomy
Pulmonary agenesis/hypoplasia

Trachea central;
Pulmonary oedema/ARDS
Consolidation
Mesothelioma

Trachea pushed away;
Pleural effusion

76
Q

Causes of type 1 respiratory failure

A

Pneumonia
Pulmonary oedema/ARDS
Pulmonary fibrosis
PE

77
Q

Causes of type 2 respiratory failure

A

Asthma
COPD
NMJ/Chest wall disease

78
Q

Causes of raised anion gap metabolic acidosis

A 
MUDPILES
Methanol
Uraemia
Diabetic ketoacidosis
Propylene glycol
Iron tables/Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
79
Q

Causes of normal anion gap metabolic acidosis

A 
HARD-ASS
Hyperalimentation
Addisons disease
Renal tubular acidosis
Diarrhoea
Acetazolamide
Spironolactone
Saline infusion

Finals (32 decks)

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