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Medicine finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Give some risk factors for pulmonary embolism

A 
Previous VTE
Over 60
Obesity
Immobility, prolonged travel
Pregnancy
OCP/HRT
Malignancy
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2
Q

How may a non-massive PE present?

A 
Pleuritic pain
SOB
Tachypnoeic
Haemoptysis
Fever
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3
Q

How may a massive PE present?

A

Central chest pain
Collapse
Haemodynamic compromise
Raised JVP

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4
Q

Give some Ddx for a PE

A 
ACS
Pneumothorax
Pneumonia
Aortic Dissection
Cardiac tamponade
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5
Q

What score can be used to assess the probability of a PE?

A

Well’s score

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6
Q

If a Well’s score gives a low/moderate probability of a PE, what additional test should be performed?

A

D-dimer

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7
Q

If a Well’s score gives a high probability of a PE, what additional test/investigation should be performed?

A

CTPA/VQ scan (both require a CXR)

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8
Q

When does a VQ scan need to be performed over a CTPA?

A

Young age
Pregnancy
Renal failure

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9
Q

What picture may be identified on ABG if a patient has a PE?

A

Respiratory alkalosis (low pCO2, low H, low pO2)

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10
Q

Define a massive PE

A

Embolus in the RV outflow tract

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11
Q

Define a non-massive PE

A

Embolus in a terminal vessel

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12
Q

What is the initial management of a PE?

A 
ABCDE assessment
Oxygen
IV access
Bloods - Including ?D-dimer, clotting and troponin
ECG and CXR

Analgesia

Thrombolysis if haemodynamically compromise (usually alteplase)

Anticogulation

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13
Q

What are further management options of PE

A

Oral anticoagulation
IVC filter
Embolectomy

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14
Q

Give some complications of a PE

A

Post-thrombotic syndrome
Recurrence
Chronic thromboembolic pulmonary hypertension
Right heart failure

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15
Q

Define bronchiectasis

A

Abnormal and permanent dilatation of the airways leading to mucus accumulation increasing the susceptibility to infection

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16
Q

What signs are associated with Kartagener’s syndrome?

A

Primary ciliary dyskinesia
Dextrocardia
Situs inversus

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17
Q

What are the signs associated with primary ciliary dyskinesia?

A

Sinusitis
Bronchiectasis
Azospermia

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18
Q

What are the symptoms of bronchiectasis?

A 
Cough
SOB
Excessive sputum production
Recurrent chest infections
Haemoptysis
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19
Q

What are the signs of bronchiectasis?

A

Cachexia and lymph nodes
Clubbing
Hyperinflation
Auscultation - coarse cracks, squeaks and wheeze, inspiratory clicks

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20
Q

What are the Ddx of bronchiectasis?

A

Pulmonary fibrosis
Bronchial carcinoma
Chronic lung abscess
Asbestosis

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21
Q

Give some causes of bronchiectasis

A

Congenital - CF, Primary ciliary dyskinesia, Kartagener’s syndrome

Mechanical obstruction - foreign body, bronchial carcinoma, lymph node

Post-infective - measles, TB, Pertussi, bacterial/viral pneumonia

Granulomatous disease - sarcoidosis, TB

Immune over-activity - IBD, RA, Sjorgen’s

Immune deficiency - hypogammaglobulinaemia, Secondary to HIV/malignancy

Aspiration - chronic alcoholics, GORD

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22
Q

How should bronchiectasis be investigated?

A

Sputum culture and cytology

CXR - tramlines, ring shadows

High Resolution CT - Signet ring sign

Spirometry - normal/restrictive pattern

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23
Q

What signs are typically seen on CXR if a patient has bronchiectasis?

A

Tramlines, ring shadows

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24
Q

What sign is typically seen on HRCT if a patient has bronchiectasis

A

Signet ring

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25
Q

How should bronchiectasis be managed?

A

Non pharmacological - MDT, physio, smoking cessation, vaccines

Medical - antibiotics (amoxicillin or clarithromycin)

Long term antibiotics if have > 3 exacerbations per year (azithromycin)

Bronchodilators/imhaled corticosteroids

Surgery - resection, heart/lung transplant

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26
Q

What are the complications of bronchiectasis?

A 
Progressive respiratory failure
Cor pulmonale
Pneumonia
Pneumothorax
Empyema
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27
Q

Define an acute asthma attack

A

Rapid deterioration in symptoms due to a localised type 1 hypersensitivity reaction

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28
Q

How can an acute asthma attack present?

A

Progressive worsening SOB
Use of accessory muscles
Tachypnoea
Symmetrical expiratory wheeze

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29
Q

Define a moderate asthma attack

A

PEFR 50-75% predicted

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30
Q

Define a severe asthma attack

A

PEFR 33-50% predicted
RR >25
HR >110
Unable to complete sentences

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31
Q

Define a life-threatening asthma attack

A 
PEFR <33% predicted
Sats <92%
Becoming tired
Silent chest 
Haemodynamic instability
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32
Q

How should a moderate asthma attack be managed?

A

Neb b2 agonists (salbutamol 5mg)
Neb ipratropium bromide
Steroids (continued for 5/7)

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33
Q

How should severe asthma attack be managed?

A

Oxygen if required to maintain sats 94-98%
Aminophylline infusion
Consider IV salbutamol

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34
Q

How should life threatening asthma attack be managed?

A

IV magnesium sulphate infusion
HDU/ITU
Consider early intubation

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35
Q

What is a worrying sign on an ABG in a patient having an acute asthma attack?

A

Respiratory acidosis (due to high pCO2)

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36
Q

In patients who are requiring salbutamol as part of their management of asthma attacks, what needs to be monitored closely?

A

Serum K

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37
Q

What investigations are important in patients presenting with asthma attacks?

A 
Peak flow
ABG
FBC
U&amp;Es
CXR
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38
Q

What are complications of an acute asthma attack?

A

Pneumothorax
Respiratory failure
Respiratory arrest
Cardiac arrest

39
Q

How can pneumonia present?

A 
SOB
Productive cough 
Fever
Haemoptysis
Pleuritic chest pain 
Delirium
Sepsis
40
Q

What are the characteristic chest signs of pneumonia?

A

Bronchial breath sounds
Focal coarse crackles
Dullness to percussion

41
Q

What severity score can be used in pneumonia?

A

CURB-65

Confusion
Urea >7
RR > 30
BP <90 systolic or <60 diastolic
65
42
Q

What does the CURB-65 score predict?

A

Mortality

Helps guide admission to hospital

43
Q

What are the most common causes of CAP?

A 
Streptococcus pneumoniae (50%)
Haemophilus influenzae (20%)
44
Q

What is often the most common cause of pneumonia in patients who are immunocompromised or have chronic pulmonary disease?

A

Moraxella catarrhalis

45
Q

What is the most common cause of pneumonia in patients with CF or bronchiectasis?

A

Pseudomonas aeruginosa

46
Q

What is a common cause of pneumonia in a patient with CF?

A

Staphylococcus aureus (also pseudomonas aeruginosa)

47
Q

Define an atypical pneumonia

A

Pneumonia that is caused by an organism which cannot be cultured in the normal way or detected by a gram stain

48
Q

How should atypical pneumonias be treated?

A

Macrolides (clarithrymicin)
Fluoroquines (levofloxacin)
Tetracyclines (doxycyline)

49
Q

If a patient presents with pneumonia following a recent hotel holiday, what might the causative agent be?

A

Legionella pneumophilia

50
Q

In a patient with Legionnaire’s disease, what electrolyte disturbance might they present with?

A

Hyponatraemia (causing an SIADH)

51
Q

If a younger patient has a milder pneumonia with neurological symptoms, what is the causative agent?

A

Mycoplasma pneumoniae

52
Q

In mycoplasma pneumoniae, what is the associated rash?

A

Erythema multiforme (varying sized target lesions)

53
Q

What is the potential causative agent if a school aged child presents with a mild to moderate chronic pneumonia and wheeze?

A

Chlamydophilia pneumoniae

54
Q

What type of pneumonia is linked to exposure to animals?

A

Coxiella burnetii (Q fever)

55
Q

What type of pneumonia is associated to birds?

A

Chlamydia psittaci

56
Q

What are the five causes of atypical pneumonia?

A 
Legionella pneumophilia
Chlamdyia psittaci 
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Q fever (coxiella burnetii)

(Legions of Psittaci MCQs)

57
Q

What type of pneumonia is associated in patients with HIV?

A

Pneumocystis jiroveci (PCP)

58
Q

How does PCP present?

A

Dry cough without sputum
SOB on exertion
Night sweats

59
Q

How is PCP treated?

A

Co-trimoxozole

60
Q

If a patient has a low CD4 count, what should they be prescribed to prevent PCP?

A

Co-trimoxazole

61
Q

How should pneumonia be investigated?

A

CXR
FBCs
U&Es
CRP

Moderate/severe:
Sputum cultures
Blood cultures
Legionella and pneumococcal urinary antigen

62
Q

How should non-severe CAP pneumonia should be managed?

A

Oral amoxicillin TDS

Or

Oral doxycycline

for 5 days

63
Q

How should severe CAP pneumonia be managed?

A

IV/oral Clarithrymicin

PLUS IV amoxicillin

For 7-10 days

64
Q

What are the associated complications of pneumonia?

A 
Sepsis
Pleural effusion
Empyema
Lung abscess
Death
65
Q

What are the different types of lung cancers?

A

Non-Small cell lung cancer
(squamous cell carcinoma
adenocarcinoma)

Small cell lung cancer

66
Q

What type of lung cancer contains neurosecretory granules?

A

Small cell lung cancer

67
Q

What type of lung cancer is responsible for multiple paraneoplastic syndromes?

A

Small cell lung cancer

68
Q

What type of lung cancer, is not necessarily associated with smoking?

A

adenocarcinoma

69
Q

What are the frequent sites of metastasis in small cell lung cancer?

A

Liver
Bones
Adrenals
Brain

70
Q

What are the signs and symptoms of lung cancer?

A 
SOB
Cough
Haemoptysis 
Finger clubbing
Recurrent pneumonia
Weight loss
Lymphadenopathy 
Hoarse voice 
Raised hemidiaphragm
71
Q

What are some risk factors for lung cancer?

A

Smoking
Scarring
Asbestos

72
Q

What type of lung cancer causes hypercalcaemia?

A

Squamous cell due to ectopic parathyroid hormone

73
Q

What type of lung cancer causes SIADH?

What do these patients present with?

A

Small cell lung cancer

Hyponatraemia

74
Q

What type of lung cancer causes Cushing’s? Why?

A

Small cell lung cancer

Ectopic ACTH productioN

75
Q

What findings might be present on CXR in a patient with suspected lung cancer?

A

Hilar lymphadenopathy
Peripheral opacity
Pleural effusion - usually unilateral
Collapse

76
Q

What type of CT can be used to stage Lung Cancer?

A

CT CAP (with contrast)

77
Q

What investigations can be used in the diagnosis of lung cancer?

A

Bloods - FBC, U&Es, LFT, Ca, Clotting

Sputum cytology - SCLC and squamous

CXR
CT CAP (with contrast)
PET-CT
Bronchoscopy with endobronchial ultrasound

78
Q

What staging system is used in lung cancer?

79
Q

What is generally offered as first line treatment in NSCLC?

A

Surgery (lobectomy)

80
Q

What are the contraindications of surgery in NSCLC?

A

SVC obstructing
Tumour within 2cm of main bronchus
FEV1 <1.5

81
Q

In what type of lung cancer can radiotherapy be curative?

A

NSCLC (if caught early enough)

82
Q

How is SCLC usually treated?

A

Chemotherapy and radiotherapy

83
Q

What can be used as part of palliative treatment to relieve bronchial constriction?

A

Stents and debunking as part of endobronchial treatment

84
Q

If a patient presents with lung cancer and a hoarse voice, what is the cause of this?

A

Recurrent laryngeal nerve palsy

85
Q

What extrapulmonary manifestation can cause diaphragm weakness and shortness of breath?

A

Phrenic nerve palsy

86
Q

What palliative treatments can be offered in lung cancer?

A

Palliative chemotherapy
Prednisolone - improve appetite
Morphine for pain
Laxatives

87
Q

How can superior vena cava obstruction present?

A

Facial swelling
Difficulty breathing
Distended veins in neck and chest

88
Q

What is Pemberton’s sign?

A

Raising hands over the head causes facial congestion and cyanosis

89
Q

What is the triad of Horner’s syndrome?

A

Ptosis
Anhydrosis
Miosis

90
Q

What can cause Horner’s syndrome?

A

Compression of the sympathetic ganglion by a Pancoast tumour

91
Q

What antibodies are associated with Limbic encephalitis?

92
Q

Describe limbic encephalitis in regards to lung cancer

A 
Associated with SCLC
Anti-Hu antibodies target the limbic system
Short term memory impairment
Hallucinations
Confusion
Seizures
93
Q

What is Lamber-Eaton myasthenic syndrome?

A

SCLC produces antibodies against voltage-gated Ca channels situated on the presynaptic terminal in motor neurons

Weakness in proximal muscles
Diplopia
Ptosis
Slurred speech and dysphagia

Weakness gets worse with prolonged use

Medicine finals (12 decks)

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