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Finals Revision > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Most common cause of URTI

A

Rhinovirus

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2
Q

Most common viral cause of URTI

A

Streptococcus pyogenes

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3
Q

Common causes URTI

A

Rhinovirus, Coronavirus, Enterovirus, Parainfluenza virus, Strep pyogenes

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4
Q

Risk factors for URTI

A

Smoking, oral steroids, asthma

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5
Q

Management of URTI

A

Fluids, rest, paracetamol, ibuprofen

Abx only if proven bacterial

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6
Q

Presentation of COPD

A

SOB, cough, sputum production, wheeze, recurrent resp infection

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7
Q

Scale used for COPD

A

MRC Dyspnoea scale 1-5

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8
Q

Describe the spirometry in COPD

A

Obstructive picture
FEV1:FVC < 0.7
No significant reversibility

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9
Q

Secondary prevention measures in COPD

A

Pneumococcal and annual flu vaccine

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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
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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

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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

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13
Q

Where is alpha-1-antitrypsin mainly produced?

A

Liver

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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

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15
Q

How is alpha-1-antitrypsin deficiency managed?

A

Same as normal COPD

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16
Q

What is the aetiology of asthma?

A

Hypersensitivity of airways –> Bronchoconstriction –> obstructive defect
Reversible airways obstruction

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17
Q

Triggers for asthma

A

Infection, exercise, animals, cold/damp, dust, strong emotions

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18
Q

At what times of day is asthma the worst?

A

Diurnal variation: early morning and night-time

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19
Q

Symptoms of asthma

A

Dry cough, polyphonic wheeze, SOB

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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

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21
Q

Management of Chronic Asthma

A
  1. SABA- Salbutamol
  2. Inhaled corticosteroid- Beclometasone
  3. Leukotriene receptor agonist- Montelukast
  4. LABA- Salmeterol
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22
Q

Features of an Acute exacerbation of asthma

A

Worsening SOB, use of accessory muscles, tachypnoea, expiratory wheeze, reduced air entry

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23
Q

How is life-threatening asthma classified?

A 
33/92/CHEST
PEFR < 33%
Sats < 92%
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia
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24
Q

Management of Acute exacerbation of asthma

A 
OSHI(T)ME
Oxygen
Salbutamol nebs
Hydrocortisone IV
Ipratropium bromide nebs
Magnesium sulphate IV
Escalate
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25
Q

What is the blood gas picture in acute exacerbation of asthma?

A

Initially respiratory alkalosis then acidosis

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26
Q

What is the main aetiology of Cystic Fibrosis?

A

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

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27
Q

What is the inheritance pattern of Cystic Fibrosis?

A

Autosomal recessive

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28
Q

What gene mutation is responsible for Cystic Fibrosis?

A

Defect in chromosome 7, CFTR

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29
Q

Clinical features of Cystic Fibrosis

A

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

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30
Q

Investigations for Cystic Fibrosis

A

Guthrie newborn blood spot
CVS/Amniocentesis
Sweat test- raised Na and Cl
Immunoreactive trypsin test

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31
Q

What spirometry pattern in Cystic Fibrosis?

A

Obstructive defect

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32
Q

Management of Cystic Fibrosis

A 
Respiratory physio
Abx + imms
Mucolytics- DNAase
Bronchodilators
Nutritional support
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33
Q

What is the aetiology behind Pulmonary Hypertension?

A

Increased resistance and pressure of blood in pulmonary arteries
Causes strain on right side of heart and back pressure in systemic venous system

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34
Q

Causes of Pulmonary Hypertension

A
  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
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35
Q

Presentation of Pulmonary Hypertension

A

SOB, syncope, tachycardia, raised JVP, hepatomegaly, peripheral oedema

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36
Q

ECG findings in Pulmonary Hypertension

A

RV hypertrophy: large R in V1-3, large S in V4-6

Right axis deviation, RBBB

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37
Q

CXR findings in Pulmonary Hypertension

A

Dilated pulmonary arteries, RV hypertrophy

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38
Q

Management of Pulmonary Hypertension

A

IV Prostanoids
Endothelin receptor antagonists
Phosphodiesterase-5 inhibitors- Sildenafil

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39
Q

What type of hypersensitivity reaction is Hypersensitivity pneumonitis/EAA?

A

Type 3

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40
Q

Causes of Hypersensitivity pneumonitis/EAA

A

Asbestosis, Bird fancier’s lung, farmer’s lung

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41
Q

Presentation of Hypersensitivity pneumonitis/EAA

A

4-6hrs post-exposure

Fever, rigors, dry cough, crackles, dyspnoea

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42
Q

Investigations for Hypersensitivity pneumonitis/EAA

A

Acute: neutrophilia, raised ESR, CXR consolidation
Chronic: CXR upper zone fibrosis
Spirometry: restrictive defect
BAL: lymphocytes and mast cells

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43
Q

What is found on CXR of Hypersensitivity pneumonitis/EAA?

A

Acute: consolidation
Chronic: upper zone fibrosis

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44
Q

What spirometry defect found in Hypersensitivity pneumonitis/EAA?

A

Restrictive defect

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45
Q

What found in BAL of Hypersensitivity pneumonitis/EAA?

A

Lymphocytes and mast cells

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46
Q

Management of Hypersensitivity pneumonitis/EAA

A

Remove allergen

Oxygen, Prednisolone

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47
Q

Causes of Obstructive spirometry pattern

A

Asthma
COPD
Emphysema
Bronchiectasis/CF

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48
Q

Causes of Restrictive spirometry pattern

A

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

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49
Q

Define community-acquired and hospital-acquired pneumonia

A

CAP: acquired outside hospital
HAP: acquired >48hrs after admission

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50
Q

Symptoms of pneumonia

A

SOB, productive cough, fever, haemoptysis, pleuritic chest pain, delirium, sepsis

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51
Q

Signs on examination of pneumonia

A

Bronchial breath sounds, focal coarse crackles, dullness to percussion

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52
Q

What is the CURB65 score?

A 
Predicts mortality in pneumonia
Confusion
Urea > 7
RR > 30
BP < 90/60
Age > 65
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53
Q

What risk score is used in pneumonia?

A 
CURB65:
Predicts mortality in pneumonia
Confusion
Urea > 7
RR > 30
BP < 90/60
Age > 65
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54
Q

Most common organisms in pneumonia

A

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

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55
Q

What blood test suggests that Legionella pneumophilia may be causing a pneumonia?

A

Hyponatraemia

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56
Q

What skin feature may accompany a Mycoplasma pneumoniae pneumonia?

A

Erythema multiforme

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57
Q

Management of pneumonia

A

Supportive
Mild CAP: Amoxicillin/Macrolide
Moderate/severe: both
Fungal: Co-trimoxazole

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58
Q

Complications of pneumonia

A

Sepsis, pleural effusion, empyema, lung abscess, death

59
Q

What is Bronchiectasis?

A

Persistent/progressive dilated thick-walled airways

60
Q

Causes of Bronchiectasis

A

Post-infective, A1AT, Kartagener’s, CF, RA

61
Q

Presentation of Bronchiectasis

A

Cough, daily purulent sputum, recurrent exacerbations, dyspnoea, wheeze, haemoptysis, chest pain, coarse inspiratory crackles

62
Q

Chest auscultation in Bronchiectasis

A

Coarse inspiratory crackles

63
Q

Spirometry pattern in Bronchiectasis

A

Obstructive pattern due to inflammation & scarring

64
Q

CXR findings in Bronchiectasis

A

Cystic shadows

Thickened bronchial walls

65
Q

Management of Bronchiectasis

A

Mucociliary clearance: chest physio, mucolytics, hypertonic saline nebs
Steroids, Bronchodilators
Abx when needed

66
Q

What is the organism responsible for TB?

A

Mycobacterium tuberculosis

67
Q

Histology/Lab results for TB

A

Acid-fast bacilli- can stain with Ziehl-Neelsen stain

68
Q

Risk factors for TB

A

South Asian, Immunocompromised, Close contacts

69
Q

How is TB spread?

A

Inhaling saliva droplets

70
Q

Types of TB

A
  1. Active TB
  2. Latent TB
  3. Secondary TB- when reactivated
  4. Disseminated TB- when immune system unable to control
71
Q

Prevention of TB

A

BCG vaccine- Mantoux test before

72
Q

Extra-pulmonary sites of TB

A

Lymph nodes, pleura, CNS, pericardium, GI, GU, bones and joints, cutaneous

73
Q

Presentation of TB

A

Lethargy, fever, night sweats, weight loss, cough, haemoptysis, lymphadenopathy, erythema nodosum, spinal pain

74
Q

How do you test for TB?

A

Interferon gamma release assay- confirms latent TB

Mantoux test- previous, latent or active TB

75
Q

CXR findings in TB

A

Primary: patchy consolidation, pleural effusions, hilar lymphadenopathy
Secondary: patchy/nodular consolidation and cavitation in upper zones
Disseminated Miliary TB: millet seeds throughout

76
Q

Management of Acute TB infection

A 
RIPE
Rifampicin 6mths
Isoniazid 6mths
Pyrazinamide 2mths
Ethambutol 2mths
\+ Pyroxidine for peripheral neuropathy from Isoniazid
77
Q

Management of Latent TB

A

Isoniazid 6mths

Rifampicin 3mths

78
Q

Side effects from TB medications

A

Rifampicin- red urine/tears, interactions ++
Isoniazid- peripheral neuropathy
Pyrazinamide- hyperuricaemia
Ethambutol- colour blindness

79
Q

Aetiology of Sarcoidosis

A

Granulomatous inflammatory condition with nodules of inflammation and macrophages

80
Q

RFs for Sarcoidosis

A

Young adults + Age 60+
W>M
Black ethnicity

81
Q

Pulmonary features of Sarcoidosis

A

Mediastinal lymphadenopathy, Pulmonary fibrosis, Pulmonary nodules

82
Q

Hepatic features of Sarcoidosis

A

Liver nodules, cirrhosis, cholestasis

83
Q

Eye features of Sarcoidosis

A

Uveitis, Conjunctivitis, Optic neuritis

84
Q

Skin features of Sarcoidosis

A

Erythema nodosum, Granulomas

85
Q

CNS features of Sarcoidosis

A

Nephritis, Encephalopathy, Mononeuritis multiplex

86
Q

Non-specific features of Sarcoidosis

A

Arthritis, fever, fatigue, weight loss

87
Q

What is Lofgren’s syndrome?

A

An acute form of sarcoidosis

  1. Erythema nodosum
  2. Bilateral hilar lymphadenopathy
  3. Polyarthralgia
88
Q

CXR findings in Sarcoidosis

A

Hilar lymphadenopathy

89
Q

What is the gold standard investigation for diagnosis of Sarcoidosis and what does it show?

A

Biopsy

Non-caseating granulomas with epithelioid cells

90
Q

Management of Sarcoidosis

A
  1. Oral steroids (+ bisphosphonates)
  2. Methotrexate/Azathioprine
  3. Lung transplant
91
Q

CT finding in Interstitial lung disease

A

Ground-glass appearance

92
Q

What type of Hypersensitivity reaction is Goodpasture’s syndrome?

A

Type 2

93
Q

What are the 2 main features of Goodpasture’s syndrome?

A

Glomerulonephritis and Pulmonary haemorrhage

94
Q

Blood test for Goodpasture’s syndrome

A

Anti-glomerular basement membrane antibody

95
Q

Clinical features of Goodpasture’s syndrome

A

URTI then haematuria, haemoptysis, anaemia

96
Q

CXR findings in Goodpasture’s syndrome

A

Infiltrates due to haemorrhage

97
Q

Investigations in Goodpasture’s syndrome

A

Blood: Anti-glomerular basement membrane antibody
CXR: infiltrates due to haemorrhage
Kidney biopsy: crescenteric glomerulonephritis

98
Q

Management of Goodpasture’s syndrome

A

Corticosteroids/Plasmapheresis to remove Abs

99
Q

What is the aetiology of granulomatosis with polyangiitis?

A

Necrotising granulomatous inflammation and vasculitis of unknown origin affecting small vessels

100
Q

Which antibodies are present in 90% of granulomatosis with polyangiitis?

A

ANCA

101
Q

Clinical features of granulomatosis with polyangiitis

A

Respiratory tract infections- rhinorrhoea, cough, haemoptysis, dysonoea, pleuritis
Skin rash, jt pains, saddle-nose deformity,
Glomerulonephritis, proteinuria, haematuria
Uveitis

102
Q

CXR findings in granulomatosis with polyangiitis

A

Nodules +/- fluffy infiltrates of pulmonary haemorrhage

103
Q

CT findings in granulomatosis with polyangiitis

A

Diffuse alveolar haemorrhage

104
Q

Management of granulomatosis with polyangiitis

A

Corticosteroids + Cyclophosphamide
Then maintain with Azathioprine + MTX
Plasma exchange for severe renal disease
Co-trimoxazole prophylaxis

105
Q

Risk factors for PE

A

Immobility, recent surgery, long haul flights, pregnancy, HRT, malignancy, polycythaemia, SLE, thrombophilia

106
Q

Prophylaxis of PE

A

LMW Heparin- Enoxaparin + TEDs

107
Q

Presentation of PE

A

SOB, cough, haemoptysis, pleuritic chest pain, hypoxia, tachycardia, tachypnoea, low grade fever, hypotension

108
Q

Risk score for PE

A

Wells score

109
Q

Diagnosis of PE

A

CTPA

Ventilation-perfusion scan (esp if renal disease)

110
Q

Management of PE

A

Oxygen, analgesia
LMW Heparin: Enoxaparin/Dalteparin
Thrombolysis: Alteplase

111
Q

Long-term prevention of PE

A

LMW Heparin/Warfarin/NOAC (Apix/Rivaroxaban)

112
Q

What is the most common cause of lung cancer?

A

Smoking

113
Q

Types of lung cancer

A

Small cell- cause paraneoplastic syndromes

Non-small cell- SCC or Adenocarcinoma

114
Q

Presentation of lung cancer

A

SOB, cough, haemoptysis, clubbing, recurrent pneumonia, weight loss, lymphadenopathy

115
Q

Investigations of lung cancer

A

CXR
CT for staging
Histology

116
Q

Management of Non small cell lung cancer

A

Surgery 1st line

Chemo + Radiotherapy

117
Q

Management of small cell lung cancer

A

Chemo + Radiotherapy

118
Q

Extra-pulmonary manifestations of lung cancer

A
  • 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
Q

Presentation of idiopathic pulmonary fibrosis

A

SOB, dry cough

120
Q

Signs on examination of idiopathic pulmonary fibrosis

A

Bilateral fine inspiratory crackles, finger clubbing

121
Q

Management of idiopathic pulmonary fibrosis

A

Pirfenidone- anti-fibrotic and anti-inflammatory

Nintedanib- monoclonal Ab on tyrosine kinase

122
Q

Drug causes of Pulmonary Fibrosis

A

Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin

123
Q

Causes of secondary Pulmonary Fibrosis

A

A1AT deficiency, RA, SLE, SSc

Drugs: amiodarone, cyclophosphamide, MTX, nitrofurantoin

124
Q

What is Asbestosis?

A

Lung fibrosis related to the inhalation of asbestos- fibrogenic and oncogenic

125
Q

What is the disease process in Asbestosis

A

Asbestos inhalation

  • -> Lung fibrosis
  • -> Pleural thickening + plaques
  • -> Adenocarcinoma
  • -> Mesothelioma
126
Q

2 Types of Pleural effusion

A
  1. Exudative: protein > 3g/dL

2. Transudative: protein < 3g/dL

127
Q

Causes of exudative pleural effusion

A

Lung cancer, pneumonia, TB, RA

128
Q

Causes of transudative pleural effusion

A

Congestive cardiac failure, hypoalbuminaemia, hypothyroidism, Meig’s syndrome

129
Q

What is Meig’s syndrome?

A

Right pleural effusion + ovarian cancer

130
Q

Examination findings of pleural effusion

A

SOB, dull to percussion, reduced breath sounds, tracheal deviation away from effusion

131
Q

CXR findings in pleural effusion

A

Blunting of costophrenic angle, Fluid in lung fissures, tracheal and mediastinal deviation

132
Q

Management

A

Conservative if small

Pleural aspiration, chest drain

133
Q

What is Empyema?

A

An infected pleural effusion

134
Q

Presentation of Empyema

A

Improving pneumonia with ongoing fever

135
Q

Management of Empyema

A

Chest drain

Antibiotics

136
Q

Causes of pneumothorax

A

Spontaneous, Trauma, Iatrogenic eg central line, Infection, Asthma, COPD

137
Q

Management of pneumothorax

A

No SOB <2cm: follow up in 2-4wks
SOB >2cm: aspiration and reassessment
If aspiration fails twice- chest drain

138
Q

Aetiology of tension pneumothorax

A

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
Q

Examination findings of tension pneumothorax

A

Tracheal deviation away from pneumothorax, reduced air entry to affected side, hyperresonant to percussion affected side, Tachycardia, hypotension

140
Q

Management tension pneumothorax

A

Large bore cannula into 2nd IC space in mid-clavicular line then chest drain

141
Q

What 3 things make up the triangle in which you insert a chest drain?

A
  1. 5th IC space
  2. Midaxillary line
  3. Anterior axillary line
142
Q

Presentation of Mesothelioma

A

Chest pain, dyspnoea, weight loss, finger clubbing

143
Q

Management of Mesothelioma

A

Resistant to most treatment

Palliative chemo

Finals Revision (13 decks)

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