Respiratory Flashcards
What % FEV predicted is required to be eligible for lung transplant?
<25%
Contra-indication to NIV
Massive haemoptysis
What does the air-crescent sign mean on high-res chest CT?
Aspergillus (occasionaly pneumocystis pneumonia or neoplasms if necrosis occurs)
What does the monad sign mean on high-res chest CT?
Aspergillus (occasionaly pneumocystis pneumonia or neoplasms if necrosis occurs)
What causes large pleural effusion and adnexal mass?
Meig’s syndrome
Skin manifestations of sarcoidosis
Erythema nodosum
Lupus pernio
Macular or papular sarcoidosis
Causes of bilateral hilar enlargement
Sarcoidosis
Tuberculosis
Lymphoma
Lymph node mets
Which group of patients are more commonly effected by sarcoidosis?
Black women aged between 20 and 30
Causes of erythema nodosum
Tuberculosis IBD Streptococcal infections Sarcoidosis Drugs (OCP and sulphonamides)
What are maximal inspiratory and expiratory pressures used to test for?
Respiratory muscle weakness e.g neuromuscular disorders
what is the direction of the external intercostal muscles?
Downwards and medial
What FeNO level is indicative of asthma?
Over 40 parts per billion
What % improvement of FEV1 post nebulised bronchodilator in indicative of asthma?
12% or higher
What volume improvement of FEV1 post nebulised bronchodilator in indicative of asthma?
200ml or greater
What % peak flow variability is indicative of asthma?
20% or more
Signs of tension pneumothorax
Severe respiratory comprimise, asymmetrical chest movement, tracheal deviation, hyper-resonant hemithorax, absent breath sounds, cardiac arrest
Site of emergency decompression for tension pneumothorax
2nd intercostal space mi-clavicular line
Lung biopsy sign of preumocystis jirovecii infection
Foamy, vaculoated exudates. Can also effect thyroid, lymph nodes, liver and bone marrow
X-ray appearance of preumocystis jirovecii
Bat wing pattern of diffuse infiltrates - can lead to pneumothorax. Usually in IVDU
ECG sign of PE
S wave in lead 1, Q wave in lead iii and T wave inversion in lead iii. Most commonly just sinus tachy though
Most common type of bacterial organisms causing post asipration pneumonias
Gram negative anaerobes from the oral flora or gastric contents
Are anaerobes or aerobes genrally worse smelling?
Anaerobes - produce short chain fatty acids
Classical clinical feature of preumocystis jirovecii infection
Desaturation on exercise
Symptoms of chemical pneumonitis
Fever, chills, malaise/body aches, along with dyspnoea/wheezing
What is Mendelson syndrome?
Chemical pnuemonia/pneumonitis due to aspiration of gastric contents, epcecially under GA - symotoms such as hypoxia and hypertension become evident 2-5 hours aftwe aspiration
Exposure to what substance causes Granulomatous reaction of lung parenchyma?
Beryllium. Condition is similar to sarcoidosis.
What is Loeffler syndrome?
Eosinophillic infiltraion of lungs in response to parasitic infection
In what patients would a V/Q scan be preferable to a CTPA?
Patients with renal impairment, contrast allergies or those who are pregnant
What does loud p2 heart sound indicate?
Pulmonary hypertension
Light’s criteria for pleural transudate
Pleural to serum protein ratio of <0.5, pleural to serum LDH of <0.6 and pleural LDH of less than 2/3 upper limit of normal for serum
Most common organism causing CAP and its gram stain
Streptococcus pneumoniae (gram positive)
Occular manifestation of sarcoidosis
Anterior uveitis
Treatment of sarcoidosis
Acute - usually self resolves spontaneously over 2 years
Chronic - steroids and monitor lung function, ESR, CRP and serum ACE levels (all usually raised)
Which lung cancer is associated with hypercalcaemia prior to bone mets and its mechanism
Sqaumous cell bronchial carcinoma - produces PTH
Which paraneoplastic syndromes can be caused by small cell lung cancer
ACTH and ADH
Symptoms of horner’s syndrome
Miosis of pupil, ptosis of eyelid and anhidrosis of face
3 histological subtypes of mesothelioma
Sarcomatous, epithelial and mixed
What is plastic bronchitis?
Formation of gelatinous or rigid casts in airways, and their subsequent coughing out. Can cause lobar collapse due to blockage of airway.
What conditions are plastic bronchitis associated with?
Asthma, bronchiectasis, CF and some resp infections.
Treatment of plastic bronchitis
Induction of sputum, bronchial washing and prevention of infections. Bronchoscopy is required.
What is lofgren’s syndrome?
Acute presentation of sarcoidosis with hilar lymphadenopathy and erythema nodosum. Usually self-resolving.
What is cardiac asthma?
Acute pulmonary oedema where peribronchial fluid causes bronchoconstriction and wheezing
What does rib-notching on CXR indicate?
Dilated upper vessels obscuring ribs in coarctication of aorta
Non resp symptom of legionnaire’s disease
N&V, diarrhoea, hyponatraemia, elevated transaminases, failure to respond to beta-lactam antibiotics and high CRP (>100mg/L)
Histological appearance of malignant mesothelioma
Has sarcomatous (Neoplastic spindle cells) and carcinomatous (tubules or cysts often - the epithelial cells appear like pulm adenocarcinoma but have long thin microvilli) characterisitics
Histopathological appearance of pulmonary TB
Caseating granuloma with giant cells
Cells found in BAL for sarcoidosis
High CD4 count
Cells found in BAL for ILD
High neutrophil count
Cells found in BAL for hypersensitivity pneumonitis
Marked lymphocytosis
Gold standard imaging for pulmonary fibrosis
High resolution CT scan
MRC dyspnoea scale
0 = No breathlessness except strenuous exercise 1 = Breathlessness when hurrying on the level or walking up a slight hill 2 = Walks slower then contemparies on level due to breathlessness, or has to stop for own breath when walking at own pace 3 = Stops for breath after walking about 100m or after a few mins on level ground 4 = Too bretahless to leave house or breathless when getting dressed
Features of ABPA
High serum IgE
Peripheral eosinophilia
Positive skin tests for aspergillus protein
Recurrent pulmonary infiltrates on x-ray
Causes central cystic/varicose brochiectasis in multiple lobes on x-ray
What conditions cause middle lobe bronchiectasis
Immotile ciliary syndrome and mycobacterium avium
What type of emphysema is related to alpha 1 anti-trypsin deficiency?
Panacinar
