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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
How should bronchiectasis be managed?
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
26
What are the complications of bronchiectasis?
``` Progressive respiratory failure Cor pulmonale Pneumonia Pneumothorax Empyema ```
27
Define an acute asthma attack
Rapid deterioration in symptoms due to a localised type 1 hypersensitivity reaction
28
How can an acute asthma attack present?
Progressive worsening SOB Use of accessory muscles Tachypnoea Symmetrical expiratory wheeze
29
Define a moderate asthma attack
PEFR 50-75% predicted
30
Define a severe asthma attack
PEFR 33-50% predicted RR >25 HR >110 Unable to complete sentences
31
Define a life-threatening asthma attack
``` PEFR <33% predicted Sats <92% Becoming tired Silent chest Haemodynamic instability ```
32
How should a moderate asthma attack be managed?
Neb b2 agonists (salbutamol 5mg) Neb ipratropium bromide Steroids (continued for 5/7)
33
How should severe asthma attack be managed?
Oxygen if required to maintain sats 94-98% Aminophylline infusion Consider IV salbutamol
34
How should life threatening asthma attack be managed?
IV magnesium sulphate infusion HDU/ITU Consider early intubation
35
What is a worrying sign on an ABG in a patient having an acute asthma attack?
Respiratory acidosis (due to high pCO2)
36
In patients who are requiring salbutamol as part of their management of asthma attacks, what needs to be monitored closely?
Serum K
37
What investigations are important in patients presenting with asthma attacks?
``` Peak flow ABG FBC U&Es CXR ```
38
What are complications of an acute asthma attack?
Pneumothorax Respiratory failure Respiratory arrest Cardiac arrest
39
How can pneumonia present?
``` SOB Productive cough Fever Haemoptysis Pleuritic chest pain Delirium Sepsis ```
40
What are the characteristic chest signs of pneumonia?
Bronchial breath sounds Focal coarse crackles Dullness to percussion
41
What severity score can be used in pneumonia?
CURB-65 ``` Confusion Urea >7 RR > 30 BP <90 systolic or <60 diastolic 65 ```
42
What does the CURB-65 score predict?
Mortality | Helps guide admission to hospital
43
What are the most common causes of CAP?
``` Streptococcus pneumoniae (50%) Haemophilus influenzae (20%) ```
44
What is often the most common cause of pneumonia in patients who are immunocompromised or have chronic pulmonary disease?
Moraxella catarrhalis
45
What is the most common cause of pneumonia in patients with CF or bronchiectasis?
Pseudomonas aeruginosa
46
What is a common cause of pneumonia in a patient with CF?
Staphylococcus aureus (also pseudomonas aeruginosa)
47
Define an atypical pneumonia
Pneumonia that is caused by an organism which cannot be cultured in the normal way or detected by a gram stain
48
How should atypical pneumonias be treated?
Macrolides (clarithrymicin) Fluoroquines (levofloxacin) Tetracyclines (doxycyline)
49
If a patient presents with pneumonia following a recent hotel holiday, what might the causative agent be?
Legionella pneumophilia
50
In a patient with Legionnaire's disease, what electrolyte disturbance might they present with?
Hyponatraemia (causing an SIADH)
51
If a younger patient has a milder pneumonia with neurological symptoms, what is the causative agent?
Mycoplasma pneumoniae
52
In mycoplasma pneumoniae, what is the associated rash?
Erythema multiforme (varying sized target lesions)
53
What is the potential causative agent if a school aged child presents with a mild to moderate chronic pneumonia and wheeze?
Chlamydophilia pneumoniae
54
What type of pneumonia is linked to exposure to animals?
Coxiella burnetii (Q fever)
55
What type of pneumonia is associated to birds?
Chlamydia psittaci
56
What are the five causes of atypical pneumonia?
``` Legionella pneumophilia Chlamdyia psittaci Mycoplasma pneumoniae Chlamydophila pneumoniae Q fever (coxiella burnetii) ``` (Legions of Psittaci MCQs)
57
What type of pneumonia is associated in patients with HIV?
Pneumocystis jiroveci (PCP)
58
How does PCP present?
Dry cough without sputum SOB on exertion Night sweats
59
How is PCP treated?
Co-trimoxozole
60
If a patient has a low CD4 count, what should they be prescribed to prevent PCP?
Co-trimoxazole
61
How should pneumonia be investigated?
CXR FBCs U&Es CRP Moderate/severe: Sputum cultures Blood cultures Legionella and pneumococcal urinary antigen
62
How should non-severe CAP pneumonia should be managed?
Oral amoxicillin TDS Or Oral doxycycline for 5 days
63
How should severe CAP pneumonia be managed?
IV/oral Clarithrymicin PLUS IV amoxicillin For 7-10 days
64
What are the associated complications of pneumonia?
``` Sepsis Pleural effusion Empyema Lung abscess Death ```
65
What are the different types of lung cancers?
Non-Small cell lung cancer (squamous cell carcinoma adenocarcinoma) Small cell lung cancer
66
What type of lung cancer contains neurosecretory granules?
Small cell lung cancer
67
What type of lung cancer is responsible for multiple paraneoplastic syndromes?
Small cell lung cancer
68
What type of lung cancer, is not necessarily associated with smoking?
adenocarcinoma
69
What are the frequent sites of metastasis in small cell lung cancer?
Liver Bones Adrenals Brain
70
What are the signs and symptoms of lung cancer?
``` SOB Cough Haemoptysis Finger clubbing Recurrent pneumonia Weight loss Lymphadenopathy Hoarse voice Raised hemidiaphragm ```
71
What are some risk factors for lung cancer?
Smoking Scarring Asbestos
72
What type of lung cancer causes hypercalcaemia?
Squamous cell due to ectopic parathyroid hormone
73
What type of lung cancer causes SIADH? | What do these patients present with?
Small cell lung cancer Hyponatraemia
74
What type of lung cancer causes Cushing's? Why?
Small cell lung cancer | Ectopic ACTH productioN
75
What findings might be present on CXR in a patient with suspected lung cancer?
Hilar lymphadenopathy Peripheral opacity Pleural effusion - usually unilateral Collapse
76
What type of CT can be used to stage Lung Cancer?
CT CAP (with contrast)
77
What investigations can be used in the diagnosis of lung cancer?
Bloods - FBC, U&Es, LFT, Ca, Clotting Sputum cytology - SCLC and squamous CXR CT CAP (with contrast) PET-CT Bronchoscopy with endobronchial ultrasound
78
What staging system is used in lung cancer?
TNM
79
What is generally offered as first line treatment in NSCLC?
Surgery (lobectomy)
80
What are the contraindications of surgery in NSCLC?
SVC obstructing Tumour within 2cm of main bronchus FEV1 <1.5
81
In what type of lung cancer can radiotherapy be curative?
NSCLC (if caught early enough)
82
How is SCLC usually treated?
Chemotherapy and radiotherapy
83
What can be used as part of palliative treatment to relieve bronchial constriction?
Stents and debunking as part of endobronchial treatment
84
If a patient presents with lung cancer and a hoarse voice, what is the cause of this?
Recurrent laryngeal nerve palsy
85
What extrapulmonary manifestation can cause diaphragm weakness and shortness of breath?
Phrenic nerve palsy
86
What palliative treatments can be offered in lung cancer?
Palliative chemotherapy Prednisolone - improve appetite Morphine for pain Laxatives
87
How can superior vena cava obstruction present?
Facial swelling Difficulty breathing Distended veins in neck and chest
88
What is Pemberton's sign?
Raising hands over the head causes facial congestion and cyanosis
89
What is the triad of Horner's syndrome?
Ptosis Anhydrosis Miosis
90
What can cause Horner's syndrome?
Compression of the sympathetic ganglion by a Pancoast tumour
91
What antibodies are associated with Limbic encephalitis?
Anti-Hu
92
Describe limbic encephalitis in regards to lung cancer
``` Associated with SCLC Anti-Hu antibodies target the limbic system Short term memory impairment Hallucinations Confusion Seizures ```
93
What is Lamber-Eaton myasthenic syndrome?
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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