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Final year > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What % FEV predicted is required to be eligible for lung transplant?

A

<25%

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2
Q

Contra-indication to NIV

A

Massive haemoptysis

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3
Q

What does the air-crescent sign mean on high-res chest CT?

A

Aspergillus (occasionaly pneumocystis pneumonia or neoplasms if necrosis occurs)

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4
Q

What does the monad sign mean on high-res chest CT?

A

Aspergillus (occasionaly pneumocystis pneumonia or neoplasms if necrosis occurs)

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5
Q

What causes large pleural effusion and adnexal mass?

A

Meig’s syndrome

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6
Q

Skin manifestations of sarcoidosis

A

Erythema nodosum
Lupus pernio
Macular or papular sarcoidosis

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7
Q

Causes of bilateral hilar enlargement

A

Sarcoidosis
Tuberculosis
Lymphoma
Lymph node mets

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8
Q

Which group of patients are more commonly effected by sarcoidosis?

A

Black women aged between 20 and 30

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9
Q

Causes of erythema nodosum

A 
Tuberculosis
IBD
Streptococcal infections
Sarcoidosis
Drugs (OCP and sulphonamides)
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10
Q

What are maximal inspiratory and expiratory pressures used to test for?

A

Respiratory muscle weakness e.g neuromuscular disorders

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11
Q

what is the direction of the external intercostal muscles?

A

Downwards and medial

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12
Q

What FeNO level is indicative of asthma?

A

Over 40 parts per billion

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13
Q

What % improvement of FEV1 post nebulised bronchodilator in indicative of asthma?

A

12% or higher

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14
Q

What volume improvement of FEV1 post nebulised bronchodilator in indicative of asthma?

A

200ml or greater

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15
Q

What % peak flow variability is indicative of asthma?

A

20% or more

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16
Q

Signs of tension pneumothorax

A

Severe respiratory comprimise, asymmetrical chest movement, tracheal deviation, hyper-resonant hemithorax, absent breath sounds, cardiac arrest

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17
Q

Site of emergency decompression for tension pneumothorax

A

2nd intercostal space mi-clavicular line

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18
Q

Lung biopsy sign of preumocystis jirovecii infection

A

Foamy, vaculoated exudates. Can also effect thyroid, lymph nodes, liver and bone marrow

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19
Q

X-ray appearance of preumocystis jirovecii

A

Bat wing pattern of diffuse infiltrates - can lead to pneumothorax. Usually in IVDU

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20
Q

ECG sign of PE

A

S wave in lead 1, Q wave in lead iii and T wave inversion in lead iii. Most commonly just sinus tachy though

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21
Q

Most common type of bacterial organisms causing post asipration pneumonias

A

Gram negative anaerobes from the oral flora or gastric contents

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22
Q

Are anaerobes or aerobes genrally worse smelling?

A

Anaerobes - produce short chain fatty acids

23
Q

Classical clinical feature of preumocystis jirovecii infection

A

Desaturation on exercise

24
Q

Symptoms of chemical pneumonitis

A

Fever, chills, malaise/body aches, along with dyspnoea/wheezing

25
Q

What is Mendelson syndrome?

A

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

26
Q

Exposure to what substance causes Granulomatous reaction of lung parenchyma?

A

Beryllium. Condition is similar to sarcoidosis.

27
Q

What is Loeffler syndrome?

A

Eosinophillic infiltraion of lungs in response to parasitic infection

28
Q

In what patients would a V/Q scan be preferable to a CTPA?

A

Patients with renal impairment, contrast allergies or those who are pregnant

29
Q

What does loud p2 heart sound indicate?

A

Pulmonary hypertension

30
Q

Light’s criteria for pleural transudate

A

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

31
Q

Most common organism causing CAP and its gram stain

A

Streptococcus pneumoniae (gram positive)

32
Q

Occular manifestation of sarcoidosis

A

Anterior uveitis

33
Q

Treatment of sarcoidosis

A

Acute - usually self resolves spontaneously over 2 years

Chronic - steroids and monitor lung function, ESR, CRP and serum ACE levels (all usually raised)

34
Q

Which lung cancer is associated with hypercalcaemia prior to bone mets and its mechanism

A

Sqaumous cell bronchial carcinoma - produces PTH

35
Q

Which paraneoplastic syndromes can be caused by small cell lung cancer

A

ACTH and ADH

36
Q

Symptoms of horner’s syndrome

A

Miosis of pupil, ptosis of eyelid and anhidrosis of face

37
Q

3 histological subtypes of mesothelioma

A

Sarcomatous, epithelial and mixed

38
Q

What is plastic bronchitis?

A

Formation of gelatinous or rigid casts in airways, and their subsequent coughing out. Can cause lobar collapse due to blockage of airway.

39
Q

What conditions are plastic bronchitis associated with?

A

Asthma, bronchiectasis, CF and some resp infections.

40
Q

Treatment of plastic bronchitis

A

Induction of sputum, bronchial washing and prevention of infections. Bronchoscopy is required.

41
Q

What is lofgren’s syndrome?

A

Acute presentation of sarcoidosis with hilar lymphadenopathy and erythema nodosum. Usually self-resolving.

42
Q

What is cardiac asthma?

A

Acute pulmonary oedema where peribronchial fluid causes bronchoconstriction and wheezing

43
Q

What does rib-notching on CXR indicate?

A

Dilated upper vessels obscuring ribs in coarctication of aorta

44
Q

Non resp symptom of legionnaire’s disease

A

N&V, diarrhoea, hyponatraemia, elevated transaminases, failure to respond to beta-lactam antibiotics and high CRP (>100mg/L)

45
Q

Histological appearance of malignant mesothelioma

A

Has sarcomatous (Neoplastic spindle cells) and carcinomatous (tubules or cysts often - the epithelial cells appear like pulm adenocarcinoma but have long thin microvilli) characterisitics

46
Q

Histopathological appearance of pulmonary TB

A

Caseating granuloma with giant cells

47
Q

Cells found in BAL for sarcoidosis

A

High CD4 count

48
Q

Cells found in BAL for ILD

A

High neutrophil count

49
Q

Cells found in BAL for hypersensitivity pneumonitis

A

Marked lymphocytosis

50
Q

Gold standard imaging for pulmonary fibrosis

A

High resolution CT scan

51
Q

MRC dyspnoea scale

A 
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
52
Q

Features of ABPA

A

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

53
Q

What conditions cause middle lobe bronchiectasis

A

Immotile ciliary syndrome and mycobacterium avium

54
Q

What type of emphysema is related to alpha 1 anti-trypsin deficiency?

A

Panacinar

Final year (18 decks)

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