Respiratory Flashcards
1
Q
Most common cause of URTI
A
Rhinovirus
2
Q
Most common viral cause of URTI
A
Streptococcus pyogenes
3
Q
Common causes URTI
A
Rhinovirus, Coronavirus, Enterovirus, Parainfluenza virus, Strep pyogenes
4
Q
Risk factors for URTI
A
Smoking, oral steroids, asthma
5
Q
Management of URTI
A
Fluids, rest, paracetamol, ibuprofen
Abx only if proven bacterial
6
Q
Presentation of COPD
A
SOB, cough, sputum production, wheeze, recurrent resp infection
7
Q
Scale used for COPD
A
MRC Dyspnoea scale 1-5
8
Q
Describe the spirometry in COPD
A
Obstructive picture
FEV1:FVC < 0.7
No significant reversibility
9
Q
Secondary prevention measures in COPD
A
Pneumococcal and annual flu vaccine
10
Q
Management of COPD
A
SMOKING CESSATION Step 1: short-acting bronchodilator- Beta-2-agonist (Salbutamol) or Muscarinic (Ipratropium bromide) Step 2: long-acting beta agonist + LAMA OR LABA + ICS Step 3: LABA + LAMA + ICS Step 4: Long-term O2 therapy Pneumococcal and annual flu vaccine
11
Q
Management of Acute exacerbation of COPD
A
At home: Prednisolone, inhalers + nebs, Abx
In hospital:
- Nebulised bronchodilators: Salbutamol + Ipratropium
- Steroids- prednisolone
- Abx
- Physiotherapy
Severe: IV Aminophylline etc
12
Q
What is the aetiology of alpha-1-antitrypsin deficiency?
A
A1AT balances action of neutrophil-protease enzymes in lungs
Deficiency –> elastase can break down elastin –> destruction of alveolar walls and emphysematous change
Predisposes to early COPD
13
Q
Where is alpha-1-antitrypsin mainly produced?
A
Liver
14
Q
Presentation of alpha-1-antitrypsin deficiency
A
Same as COPD: SOB, cough, sputum, wheeze, recurrent respiratory infections
Some develop liver disease: hepatitis, cirrhosis, fibrosis, liver failure, HCC
15
Q
How is alpha-1-antitrypsin deficiency managed?
A
Same as normal COPD
16
Q
What is the aetiology of asthma?
A
Hypersensitivity of airways –> Bronchoconstriction –> obstructive defect
Reversible airways obstruction
17
Q
Triggers for asthma
A
Infection, exercise, animals, cold/damp, dust, strong emotions
18
Q
At what times of day is asthma the worst?
A
Diurnal variation: early morning and night-time
19
Q
Symptoms of asthma
A
Dry cough, polyphonic wheeze, SOB
20
Q
Investigations in asthma
A
Fractional exhaled nitric oxide > 40
Spirometry w/ bronchodilator reversibility: obstructive pattern: FEV1:FVC < 0.7
Improvement in FEV1 of > 12% or 200ml
21
Q
Management of Chronic Asthma
A
- SABA- Salbutamol
- Inhaled corticosteroid- Beclometasone
- Leukotriene receptor agonist- Montelukast
- LABA- Salmeterol
22
Q
Features of an Acute exacerbation of asthma
A
Worsening SOB, use of accessory muscles, tachypnoea, expiratory wheeze, reduced air entry
23
Q
How is life-threatening asthma classified?
A
33/92/CHEST PEFR < 33% Sats < 92% Cyanosis Hypotension Exhaustion Silent chest Tachycardia
24
Q
Management of Acute exacerbation of asthma
A
OSHI(T)ME Oxygen Salbutamol nebs Hydrocortisone IV Ipratropium bromide nebs Magnesium sulphate IV Escalate
25
What is the blood gas picture in acute exacerbation of asthma?
Initially respiratory alkalosis then acidosis
26
What is the main aetiology of Cystic Fibrosis?
Production of abnormally viscid secretions by exocrine glands & mucus-secreting glands
Impaired mucociliary clearance --> recurrent infections and bronchiectasis
Pancreatic duct obstruction --> pancreatic fibrosis and obstruction
27
What is the inheritance pattern of Cystic Fibrosis?
Autosomal recessive
28
What gene mutation is responsible for Cystic Fibrosis?
Defect in chromosome 7, CFTR
29
Clinical features of Cystic Fibrosis
Meconium ileus, FTT, greasy stools, malabsorption
Recurrent resp infections, bronchiectasis
Almost all males infertile- atrophy of vas
Females thick cervical mucus- subfertile
Diabetes, bone disease
30
Investigations for Cystic Fibrosis
Guthrie newborn blood spot
CVS/Amniocentesis
Sweat test- raised Na and Cl
Immunoreactive trypsin test
31
What spirometry pattern in Cystic Fibrosis?
Obstructive defect
32
Management of Cystic Fibrosis
```
Respiratory physio
Abx + imms
Mucolytics- DNAase
Bronchodilators
Nutritional support
```
33
What is the aetiology behind Pulmonary Hypertension?
Increased resistance and pressure of blood in pulmonary arteries
Causes strain on right side of heart and back pressure in systemic venous system
34
Causes of Pulmonary Hypertension
1. Primary PH or connective tissue disease eg SLE
2. Left heart failure secondary to MI or systemic HTN
3. Chronic lung disease eg COPD
4. Pulmonary vascular disease eg PE
5. Other- sarcoidosis, glycogen storage disease, haematological disorder
35
Presentation of Pulmonary Hypertension
SOB, syncope, tachycardia, raised JVP, hepatomegaly, peripheral oedema
36
ECG findings in Pulmonary Hypertension
RV hypertrophy: large R in V1-3, large S in V4-6
| Right axis deviation, RBBB
37
CXR findings in Pulmonary Hypertension
Dilated pulmonary arteries, RV hypertrophy
38
Management of Pulmonary Hypertension
IV Prostanoids
Endothelin receptor antagonists
Phosphodiesterase-5 inhibitors- Sildenafil
39
What type of hypersensitivity reaction is Hypersensitivity pneumonitis/EAA?
Type 3
40
Causes of Hypersensitivity pneumonitis/EAA
Asbestosis, Bird fancier's lung, farmer's lung
41
Presentation of Hypersensitivity pneumonitis/EAA
4-6hrs post-exposure
| Fever, rigors, dry cough, crackles, dyspnoea
42
Investigations for Hypersensitivity pneumonitis/EAA
Acute: neutrophilia, raised ESR, CXR consolidation
Chronic: CXR upper zone fibrosis
Spirometry: restrictive defect
BAL: lymphocytes and mast cells
43
What is found on CXR of Hypersensitivity pneumonitis/EAA?
Acute: consolidation
Chronic: upper zone fibrosis
44
What spirometry defect found in Hypersensitivity pneumonitis/EAA?
Restrictive defect
45
What found in BAL of Hypersensitivity pneumonitis/EAA?
Lymphocytes and mast cells
46
Management of Hypersensitivity pneumonitis/EAA
Remove allergen
| Oxygen, Prednisolone
47
Causes of Obstructive spirometry pattern
Asthma
COPD
Emphysema
Bronchiectasis/CF
48
Causes of Restrictive spirometry pattern
Pulmonary causes: Pulmonary fibrosis, Pneumoconiosis, Pulmonary oedema, Lobectomy/Pneumonectomy, Parenchymal lung tumours
Non-Pulmonary causes: Skeletal abnormalities (eg kyphoscoliosis), Neuromuscular causes (MND, MG, GBS), Connective tissue disease, obesity/pregnancy
49
Define community-acquired and hospital-acquired pneumonia
CAP: acquired outside hospital
HAP: acquired >48hrs after admission
50
Symptoms of pneumonia
SOB, productive cough, fever, haemoptysis, pleuritic chest pain, delirium, sepsis
51
Signs on examination of pneumonia
Bronchial breath sounds, focal coarse crackles, dullness to percussion
52
What is the CURB65 score?
```
Predicts mortality in pneumonia
Confusion
Urea > 7
RR > 30
BP < 90/60
Age > 65
```
53
What risk score is used in pneumonia?
```
CURB65:
Predicts mortality in pneumonia
Confusion
Urea > 7
RR > 30
BP < 90/60
Age > 65
```
54
Most common organisms in pneumonia
H influenzae, Strep pneumoniae
CF: Pseudomonas aeruginosa, Staph aureus
Atypical: Legionella pneumophilia, Mycoplasma pneumoniae
Farmer: Coxiella burnetti
Birds: Chlamydia psittaci
Fungal: pneumocystis jivoreci (PCP)- immunocompromised
55
What blood test suggests that Legionella pneumophilia may be causing a pneumonia?
Hyponatraemia
56
What skin feature may accompany a Mycoplasma pneumoniae pneumonia?
Erythema multiforme
57
Management of pneumonia
Supportive
Mild CAP: Amoxicillin/Macrolide
Moderate/severe: both
Fungal: Co-trimoxazole
58
Complications of pneumonia
Sepsis, pleural effusion, empyema, lung abscess, death
59
What is Bronchiectasis?
Persistent/progressive dilated thick-walled airways
60
Causes of Bronchiectasis
Post-infective, A1AT, Kartagener's, CF, RA
61
Presentation of Bronchiectasis
Cough, daily purulent sputum, recurrent exacerbations, dyspnoea, wheeze, haemoptysis, chest pain, coarse inspiratory crackles
62
Chest auscultation in Bronchiectasis
Coarse inspiratory crackles
63
Spirometry pattern in Bronchiectasis
Obstructive pattern due to inflammation & scarring
64
CXR findings in Bronchiectasis
Cystic shadows
| Thickened bronchial walls
65
Management of Bronchiectasis
Mucociliary clearance: chest physio, mucolytics, hypertonic saline nebs
Steroids, Bronchodilators
Abx when needed
66
What is the organism responsible for TB?
Mycobacterium tuberculosis
67
Histology/Lab results for TB
Acid-fast bacilli- can stain with Ziehl-Neelsen stain
68
Risk factors for TB
South Asian, Immunocompromised, Close contacts
69
How is TB spread?
Inhaling saliva droplets
70
Types of TB
1. Active TB
2. Latent TB
3. Secondary TB- when reactivated
4. Disseminated TB- when immune system unable to control
71
Prevention of TB
BCG vaccine- Mantoux test before
72
Extra-pulmonary sites of TB
Lymph nodes, pleura, CNS, pericardium, GI, GU, bones and joints, cutaneous
73
Presentation of TB
Lethargy, fever, night sweats, weight loss, cough, haemoptysis, lymphadenopathy, erythema nodosum, spinal pain
74
How do you test for TB?
Interferon gamma release assay- confirms latent TB
| Mantoux test- previous, latent or active TB
75
CXR findings in TB
Primary: patchy consolidation, pleural effusions, hilar lymphadenopathy
Secondary: patchy/nodular consolidation and cavitation in upper zones
Disseminated Miliary TB: millet seeds throughout
76
Management of Acute TB infection
```
RIPE
Rifampicin 6mths
Isoniazid 6mths
Pyrazinamide 2mths
Ethambutol 2mths
+ Pyroxidine for peripheral neuropathy from Isoniazid
```
77
Management of Latent TB
Isoniazid 6mths
| Rifampicin 3mths
78
Side effects from TB medications
Rifampicin- red urine/tears, interactions ++
Isoniazid- peripheral neuropathy
Pyrazinamide- hyperuricaemia
Ethambutol- colour blindness
79
Aetiology of Sarcoidosis
Granulomatous inflammatory condition with nodules of inflammation and macrophages
80
RFs for Sarcoidosis
Young adults + Age 60+
W>M
Black ethnicity
81
Pulmonary features of Sarcoidosis
Mediastinal lymphadenopathy, Pulmonary fibrosis, Pulmonary nodules
82
Hepatic features of Sarcoidosis
Liver nodules, cirrhosis, cholestasis
83
Eye features of Sarcoidosis
Uveitis, Conjunctivitis, Optic neuritis
84
Skin features of Sarcoidosis
Erythema nodosum, Granulomas
85
CNS features of Sarcoidosis
Nephritis, Encephalopathy, Mononeuritis multiplex
86
Non-specific features of Sarcoidosis
Arthritis, fever, fatigue, weight loss
87
What is Lofgren's syndrome?
An acute form of sarcoidosis
1. Erythema nodosum
2. Bilateral hilar lymphadenopathy
3. Polyarthralgia
88
CXR findings in Sarcoidosis
Hilar lymphadenopathy
89
What is the gold standard investigation for diagnosis of Sarcoidosis and what does it show?
Biopsy
| Non-caseating granulomas with epithelioid cells
90
Management of Sarcoidosis
1. Oral steroids (+ bisphosphonates)
2. Methotrexate/Azathioprine
3. Lung transplant
91
CT finding in Interstitial lung disease
Ground-glass appearance
92
What type of Hypersensitivity reaction is Goodpasture's syndrome?
Type 2
93
What are the 2 main features of Goodpasture's syndrome?
Glomerulonephritis and Pulmonary haemorrhage
94
Blood test for Goodpasture's syndrome
Anti-glomerular basement membrane antibody
95
Clinical features of Goodpasture's syndrome
URTI then haematuria, haemoptysis, anaemia
96
CXR findings in Goodpasture's syndrome
Infiltrates due to haemorrhage
97
Investigations in Goodpasture's syndrome
Blood: Anti-glomerular basement membrane antibody
CXR: infiltrates due to haemorrhage
Kidney biopsy: crescenteric glomerulonephritis
98
Management of Goodpasture's syndrome
Corticosteroids/Plasmapheresis to remove Abs
99
What is the aetiology of granulomatosis with polyangiitis?
Necrotising granulomatous inflammation and vasculitis of unknown origin affecting small vessels
100
Which antibodies are present in 90% of granulomatosis with polyangiitis?
ANCA
101
Clinical features of granulomatosis with polyangiitis
Respiratory tract infections- rhinorrhoea, cough, haemoptysis, dysonoea, pleuritis
Skin rash, jt pains, saddle-nose deformity,
Glomerulonephritis, proteinuria, haematuria
Uveitis
102
CXR findings in granulomatosis with polyangiitis
Nodules +/- fluffy infiltrates of pulmonary haemorrhage
103
CT findings in granulomatosis with polyangiitis
Diffuse alveolar haemorrhage
104
Management of granulomatosis with polyangiitis
Corticosteroids + Cyclophosphamide
Then maintain with Azathioprine + MTX
Plasma exchange for severe renal disease
Co-trimoxazole prophylaxis
105
Risk factors for PE
Immobility, recent surgery, long haul flights, pregnancy, HRT, malignancy, polycythaemia, SLE, thrombophilia
106
Prophylaxis of PE
LMW Heparin- Enoxaparin + TEDs
107
Presentation of PE
SOB, cough, haemoptysis, pleuritic chest pain, hypoxia, tachycardia, tachypnoea, low grade fever, hypotension
108
Risk score for PE
Wells score
109
Diagnosis of PE
CTPA
| Ventilation-perfusion scan (esp if renal disease)
110
Management of PE
Oxygen, analgesia
LMW Heparin: Enoxaparin/Dalteparin
Thrombolysis: Alteplase
111
Long-term prevention of PE
LMW Heparin/Warfarin/NOAC (Apix/Rivaroxaban)
112
What is the most common cause of lung cancer?
Smoking
113
Types of lung cancer
Small cell- cause paraneoplastic syndromes
| Non-small cell- SCC or Adenocarcinoma
114
Presentation of lung cancer
SOB, cough, haemoptysis, clubbing, recurrent pneumonia, weight loss, lymphadenopathy
115
Investigations of lung cancer
CXR
CT for staging
Histology
116
Management of Non small cell lung cancer
Surgery 1st line
| Chemo + Radiotherapy
117
Management of small cell lung cancer
Chemo + Radiotherapy
118
Extra-pulmonary manifestations of lung cancer
- SVCO
- Recurrent laryngeal nerve palsy- hoarse voice
- Phrenic nerve palsy- diaphragm weakness- SOB
- Horner's syndrome- Pancoast's tumour
- SiADH or Cushing's from SCLC
- Hypercalcaemia (PTH from SCLC)
- Limbic encephalitis
- Lambert-Eaton myasthenic syndrome (SCLC - Sx of MG)
119
Presentation of idiopathic pulmonary fibrosis
SOB, dry cough
120
Signs on examination of idiopathic pulmonary fibrosis
Bilateral fine inspiratory crackles, finger clubbing
121
Management of idiopathic pulmonary fibrosis
Pirfenidone- anti-fibrotic and anti-inflammatory
| Nintedanib- monoclonal Ab on tyrosine kinase
122
Drug causes of Pulmonary Fibrosis
Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin
123
Causes of secondary Pulmonary Fibrosis
A1AT deficiency, RA, SLE, SSc
| Drugs: amiodarone, cyclophosphamide, MTX, nitrofurantoin
124
What is Asbestosis?
Lung fibrosis related to the inhalation of asbestos- fibrogenic and oncogenic
125
What is the disease process in Asbestosis
Asbestos inhalation
- -> Lung fibrosis
- -> Pleural thickening + plaques
- -> Adenocarcinoma
- -> Mesothelioma
126
2 Types of Pleural effusion
1. Exudative: protein > 3g/dL
| 2. Transudative: protein < 3g/dL
127
Causes of exudative pleural effusion
Lung cancer, pneumonia, TB, RA
128
Causes of transudative pleural effusion
Congestive cardiac failure, hypoalbuminaemia, hypothyroidism, Meig's syndrome
129
What is Meig's syndrome?
Right pleural effusion + ovarian cancer
130
Examination findings of pleural effusion
SOB, dull to percussion, reduced breath sounds, tracheal deviation away from effusion
131
CXR findings in pleural effusion
Blunting of costophrenic angle, Fluid in lung fissures, tracheal and mediastinal deviation
132
Management
Conservative if small
| Pleural aspiration, chest drain
133
What is Empyema?
An infected pleural effusion
134
Presentation of Empyema
Improving pneumonia with ongoing fever
135
Management of Empyema
Chest drain
| Antibiotics
136
Causes of pneumothorax
Spontaneous, Trauma, Iatrogenic eg central line, Infection, Asthma, COPD
137
Management of pneumothorax
No SOB <2cm: follow up in 2-4wks
SOB >2cm: aspiration and reassessment
If aspiration fails twice- chest drain
138
Aetiology of tension pneumothorax
Caused by direct trauma to chest wall that creates a one-way valve that lets air in but not out of pleural space
Can cause cardiorespiratory arrest
139
Examination findings of tension pneumothorax
Tracheal deviation away from pneumothorax, reduced air entry to affected side, hyperresonant to percussion affected side, Tachycardia, hypotension
140
Management tension pneumothorax
Large bore cannula into 2nd IC space in mid-clavicular line then chest drain
141
What 3 things make up the triangle in which you insert a chest drain?
1. 5th IC space
2. Midaxillary line
3. Anterior axillary line
142
Presentation of Mesothelioma
Chest pain, dyspnoea, weight loss, finger clubbing
143
Management of Mesothelioma
Resistant to most treatment
| Palliative chemo
