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FINALS > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is COPD?

A

A progressive obstructive lung disease, characterised by airflow limitations which are not fully reversible

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2
Q

What are histological changes you would find in COPD

A

Increased goblet cells

Enlargement of mucus secreting glands

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3
Q

What WBC are involved in COPD

A

macrophages but not eosinophils

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4
Q 
A 70 year old male with an extensive smoking history presents to you.
He has
- productive cough
- SOB on excessive
- feeling tiered
- Wheeze

What is his diagnosis?

A

COPD

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5
Q

What changes cause the increased resistance in the airways in COPD

A

decreased elasticity
fibrotic changes
luminal obstruction

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6
Q

What type of respiratory failure is characteristic in COPD

A

Type 2

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7
Q

What test is diagnostic for COPD and

What is the diagnostic cut off?

A

Spirometry, an FEV:FVC <0.7 post bronchodilator

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8
Q

What are possible consequences of COPD

A

pneumonia
pneumothorax
pulmonary hypertension

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9
Q

What investigation is most useful in a COPD exacerbation (excluding PFT). What may that show?

A

CXR may show hyperinflation (not linked to exacerbation) also pneumonia or pneumothorax.
Signs of:
Flattened diaphragm and increased retrosternal air space volume, indicating lung hyperinflation
Hyperlucency of the lungs
Rapid tapering of vascular markings

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10
Q

A patient has an FEV1 (% predicted) of >80 what is his GOLD grade

A

GOLD 1

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11
Q

A patient has an FEV1 (% predicted) of 50-70 what is his GOLD grade

A

GOLD 2

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12
Q

A patient has an FEV1 (% predicted) of 30-49 what is his GOLD grade

A

GOLD 3

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13
Q

A patient has an FEV1 (% predicted) of <30 what is his GOLD grade

A

GOLD 4

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14
Q

BREAK CARD - LOOK OVER ALL OF COPD QUICKLY

A

TAKE 5 MINUTES

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15
Q

A Patient has a mMRC=2+/ CAT >10 (mod-sev symptoms)and has had 0-1 exacerbations in the last year not requiring hospitalisation. What is his ABCD score (GOLD ABCD for COPD)

A

B

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16
Q

A Patient has a mMRC=0-1 / CAT <10 (mild-mod symptoms) and has had 2 + exacerbations in the last year or 1+ requiring hospitalisation. What is his ABCD score (GOLD ABCD for COPD)

A

C

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17
Q

A Patient has a mMRC=2+/ CAT >10 (mod-sev symptoms)and has had 2 + exacerbations in the last year or 1+ requiring hospitalisation. What is his ABCD score (GOLD ABCD for COPD)

A

D

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18
Q

How would you manage a patient in group A of (GOLD ABCD COPD)

A

SABA or LA Bronchodilator depending on effects of bronchodilator

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19
Q

How would you manage a patient in group B of (GOLD ABCD COPD)

A

LA Bronchodilator, if that is ineffective dual LA Bronchodilator therapy (SABA PRN)

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20
Q

How would you manage a patient in group C of (GOLD ABCD COPD)

A

Start on LA Bronchodilator, second line is dual LA Bronchodilator. If that is ineffective LABA + ICS (SABA PRN)

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21
Q

How would you manage a patient in group D of (GOLD ABCD COPD)

A

Start on dual LA Bronchodilator, if that is ineffective LABA + LAMA + ICS (triple therapy) and then LABA + ICS (SABA PRN)

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22
Q

What other therapies (not medical) are used regardless of GOLD ABCD in COPD

A

smoking cessation

Patient Vaccines

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23
Q

When would pulmonary rehabilitation be used in COPD

A

from group B-D

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24
Q

What is Theophalline (and aminophylline) and when would it be used in COPD

A

a xanthine, used to treat wheezing and SOB in chronic lung conditions.
In COPD it is an adjunct from group C-D

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25
Q

When would a phosphodiasterase 4 inhibitor be used in COPD, what does it do

A

group D and down regulates inflammation

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26
Q

when would a macrolide antibiotic be used in COPD, give two examples

A

in group D.

Examples would be Azithromycin or Clarithromycin

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27
Q

In what groups of COPD patients is O2 therapy indicated

A

group B - D

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28
Q

How would you investigate an exacerbation of COPD

A 
FBC
ECG
CXR
ABG
Pulse Ox
Sputum Cultures
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29
Q

How would you manage a COPD patient with exacerbation causing, fever, increase SOB, low O2 on air, and an increase in sputum (green colour) but no acidosis

A

Empirical antibiotics until more specific antibiotics can be used

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30
Q

What ventilation is indicated in COPD patients

A

NIV - BiPAP

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31
Q

Wha are the indications for ventilation in a COPD exacerbation

A

very low O2 sats
Respiratory acidosis
haemodynamic instability

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32
Q

What pathogens most commonly cause the common cold

A

rhinovirus (50%)

then: 
Coronavirus
influenza
parainfluenza
RSV
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33
Q

A 5year old child presents to you with acute onset (1-2d) rhinitis, sore that, fever 38’c. On examination the back of his treat is red and inflamed
he is otherwise well
what is the diagnosis?

A

Common cold

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34
Q

What is the Fever Pain/ Centor criteria

A

criteria to determine if tonisitis is most likely bacterial

FeverPAIN criteria

Fever (during previous 24 hours)
Purulence (pus on tonsils)
Attend rapidly (within 3 days after onset of symptoms)
Severely Inflamed tonsils
No cough or coryza (inflammation of mucus membranes in the nose)

Centor criteria

Tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever (over 38°C)
Absence of cough

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35
Q

What pathogens commonly cause tonsillitis

A

rhinovirus
coronavirus
adenovirus

Group A streptococcus (B haemolytic)

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36
Q

What investigations might you like to carry out if you suspect bacterial tonsillitis

A

throat culture

rapid streptococcal antigen test

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37
Q

What is the management of viral tonsillitis

A

analgesia

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38
Q

What is the management of bacterial tonsillitis

A

analgesia
phenoxymethylpenicillin, 2ry Abx choice is azythromyocin
+/- dexamethasone if a patient has severe swelling

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39
Q

What is the criteria needed to get a tonsillectomy

A

7+ in one year
5+ in 2 years
3+ in 3 years

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40
Q

What is pharyngitis

A

can be difficult to distinguish from tonsilitis

is an acute onset of sore throat and pharyngeal inflammation

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41
Q

What pathogens can cause pharyngitis commonly

A

EBV, adenovirus, enterovirus

Group A strep, ghonnorhea, chlamydia

candida - immunocompromised

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42
Q

A 10 year old child presents to you.
They present to you with a very sore throat, on further examination you notice there is conjunctivitis and the beginning of a maculopapular rash.
You notice on their history that have not had Imms
What is the diagnosis? What sign would you find inspecting the mouth?

A

Measles

Koplick spots

Conjunctivitis and kopeck spots suggest easy stages of measles

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43
Q

A 14 year old child presents to you after having recently immigrated from India.
They have a high fever, barking cough, sore throat and lymphadenopathy. On inspection of the mouth you notice a grey adherent pseudomembrane.

What is the diagnosis?

A

Diptheria

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44
Q

What are the diagnostic investigations for diphtheria?

A 
bacterial culture (throat)
and microscopy
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45
Q

What is the treatment of Diptheria?

A

admit to hospital
diphtheria antitoxin
plus Benzylpenicillin sodium

Airway protection/intubation may be needed

Imms given

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46
Q

What do close contacts of someone diagnosed with dipheria require

A

erythromycin base

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47
Q

What is sinusitis?

A

symptomatic inflammation of the mucosal lining of the nasal cavity and paranasal sinuses. Usually symptoms last less than 4 weeks

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48
Q

What pathogens cause sinusitis?

A

Viral:
Rhinoviruses, influenza viruses, and parainfluenza viruses

Bacterial causes :
S. Pneumoniae and H Influenza

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49
Q

A patient presents to you with purulent nasal discharge, nasal congestion, facial pain and pressure by eyes/nose.
What is the diagnosis?

A

Viral sinusitis

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50
Q

A patient presented to you 5 days ago with what was thought to be viral sinusitis. They said that after their initial visit to you it has been getting worse.

What do you suspect? And what is the treatment?

A

its bacterial sinusitis

Amoxicillin/clavalanate

2ry option is clyndamycin

plus decongestants/iintranasal corticosteroids (mometasone) and ipatropium (anticholinergic) for rhinorrhea

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51
Q

What is the treatment for viral sinusitis

A

supportive therapy:
decongestants
intranasal corticosteroids (mometasone)
and ipatropium (anticholinergic) for rhinorrhea

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52
Q

what is asthma?

A

A chronic inflammatory airway disease with intermittent reversible airway obstruction and hyperactivity

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53
Q

A young patient comes in. They have been experiencing SOB, particularly worse in the morning and evening. They have noticed that cold air and exercise make symptoms worse and they develop a cough/

What is the most likely diagnosis?

A

Asthma

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54
Q

What kind of wheeze is associated with asthma ?

A

expiratory

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55
Q

What are risk factors for having asthma?

A

family history
eczema
Hayfece
(atopty)

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56
Q

what is FVC?

A

The force of air which can be forcibly and maximally expired out of the lungs after having filled the lungs with air. It is all of the air in the lungs apart from the residual volume.

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57
Q

What is FEV1?

A

The total amount of air which can be forcibly expired in one second after having maximally inspired.

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58
Q

what is the FVC/FEV1 ratio in asthma?

A

Should be less than 80% of the predicted value for the individual’s age height weight and ethnicity.

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59
Q

What is the first line diagnostic test in asthma?

A

Bronchodilator trial

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60
Q

What results would you expect to see in an asthmatic during a bronchodilator trial?

A

For the diagnosis of asthma there has to be a 12% improvement in FVC/FEV1 after bronchodilator therapy

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61
Q

how are lung functions measured?

A

Using spirometry

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62
Q

How is asthma monitored?

A

Peak expiratory flow rate

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63
Q

How would you classify the following symptoms of asthma:
symptoms less than twice a week
asymptomatic and normal peak expiratory flow rate between the attacks
attacks are brief with varying intensity
night-time symptoms occur less than twice a month
FEV1 or PEFR greater than 80% of predicted
PEFR variability is less than 20

A

Mild intermediate asthma

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64
Q

How you classify the following symptoms of asthma:
symptoms more than twice a week but usually less than once a day
when exacerbations are present they affect daily activities
the night-time symptoms more than twice a month
FEV1 is greater than 80% of predicted value
PEFR variability is between 20 and 30

A

Mild persistent asthma

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65
Q

How would you classify the following symptoms of asthma:
daily symptoms
use of SA BA daily
attacks affect daily activity
exacerbations are more than twice a week and may last for days
night-time symptoms present more than once a week
FEV1 is between 60 to 80% of predicted
PEFR variability is over 30

A

Moderate persistent asthma

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66
Q 
How would you classify the following  symptoms of asthma:
 continual symptoms
Limited physical activity
frequent exacerbations
frequent nighttime symptoms
FEV1 is less than 60% of predicted
 PEFR variability is over 60%
A

Severe persistent asthma

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67
Q

Describe a stepwise management of asthma

A
  1. SABA PRN
  2. ICS (low) (alternative cromolyn or montelukast)
  3. ICS (med)
  4. ICS (med) + LABA or Monetleukast
  5. ICS (high) + LABA or Monetleukast
  6. ICS (high) + LABA or Monetleukast + PO CS
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68
Q

What is the definition of an asthma exacerbation

A

An acute or subacute episode of progressive worsening symptoms and decreased baseline pulmonary function tests

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69
Q

What causes asthma exacerbations

A

Exposure to irritants
viral or bacterial infections
non-compliance to medication

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70
Q

How does an asthma exacerbation present

A 
Presents with worsening of previous symptoms those are:
 cough
 wheeze
chest tightness
sleep disturbances
signs of respiratory distress
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71
Q

What are some signs of respiratory distress

A 
Use of accessory muscles 
tachyopnea
tachycardia
 poor air movement 
diminished breath sounds
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72
Q

How would you investigate an exacerbation

A

do pulmonary function tests (peak flow is quick and safe)
measure O2 saturations

in severe exacerbations the following may be used
ABG
chest x-ray
+ cultures

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73
Q

A patient with an asthma exacerbation comes in with:
shortness of breath with activity
their PEF is over 70% of the predicted or personal-best

what is the severity of their exacerbation

A

Mild

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74
Q

A patient with an asthma exacerbation comes in with:
shortness of breath that interferes with usual activity
PEF is between 40 to 69% of predicted

what is the severity of their exacerbation

A

Moderate

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75
Q

A patient with an asthma exacerbation comes in with:
shortness of breath at rest
unable to complete a full sentence
pulmonary function tests are less than 40% of predicted

what is the severity of their exacerbation

A

Severe

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76
Q 
A patient with an asthma exacerbation comes in with:
severe shortness of breath 
possible reduction in consciousness 
too short of breath to speak perspiring
PEF is less than 25% of the predicted

what is the severity of their exacerbation

A

Life threatening

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77
Q

How do manage a mild exacerbation (asthma)

A

Give 4-8 puffs of inhaled salbutamol every 20 minutes in four hours and then slowly decrease

you can give an adjunct per oral steroid- prednisolone for five days or until resolution

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78
Q

How do you manage a moderate to severe exacerbation?

A

Gives nebuliser salbutamol ideally nebulised with oxygen
give per oral steroids
give ipratropium bromide
give magnesium sulphate
if you suspect an impending respiratory failure data ICU and consider mechanical ventilation
if life-threatening cortical Hydro steroid IV can also be given

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79
Q

What is hypersensitivity pneumonitis?

A

Inflammation of the alveoli and distal bronchioles caused by an immune response to inhaled allergens

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80
Q

What are the causes of hypersensitivity pneumonitis

A 
Bird droppings – bird fancier's lung
compost lung
farmers  lung
 chemical workers lung
 lab work as lung
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81
Q

What are the three types of hypersensitivity pneumonitis?

A

Acute – occurring hours after exposure
subacute – developing weeks to months following exposure
chronic – developing months to years after exposure

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82
Q

What are the symptoms of hypersensitivity pneumonitis?

A 
Flulike:
 shortness of breath
non-productive cough (acute) or productive cough (sub acute or chronic)
 fever
malaise
weight loss especially in chronic

on examination you might find bibasilar rails, diffuse rails, clubbing.

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83
Q

A patient presents to you with progressively worsening shortness of breath, weight loss and productive cough.
They say they occasionally get fevers and that symptoms get worse
they also say that their work is of a farmer
what is the diagnosis?

A

Hypersensitivity pneumonitis

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84
Q

How would you investigate hypersensitivity pneumonitis

A

pulmonary function tests
Blood tests checking for immunological responses to causative antigen
chest x-ray or CT
full blood test (+WCC) ESR(+)

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85
Q

What might you find on a chest x-ray for hypersensitivity pneumonitis?

what about on CT?

A

X-rays show modular patchy infiltrates

CT shows ground glass shadowing central though bar nodules with relative basal sparing

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86
Q

What pattern would you see on the pulmonary function tests of hypersensitivity pneumonitis?

A

Acute tends to be restrictive

subacute and chronic have a mixed restrictive obstructive pattern

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87
Q

How do you treat hypersensitivity

pneumonitis?

A

Avoiding triggers

corticosteroids, prednisolone, either short-term if acute or subacute or long-term chronic

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88
Q

What is occupational asthma?

A

Asthma caused by workplace and may result from immunological or non-immunological stimuli

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89
Q

What are the two types of occupational asthma?

A

Sensitiser induced which is immunological

irritant induced which is non-immunological

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90
Q

Which type of occupational asthma has a latency period?

A

Sensitiser induced i.e. immunological

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91
Q

what is the typical causative agent of community-acquired pneumonia?

What are other causes?

A

Streptococcus pneumonias

haemophilus influenza
Staphylococcus aureus
group A Streptococcus

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92
Q

What are the causative agents of atypical pneumonia?

A

Mycoplasma pneumoniae

Legionella

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93
Q

What tool is used to help assess whether or not to admit the patient to hospital with community-acquired pneumonia?

A

CURB 65

94
Q

What a risk factors for community-acquired pneumonia?

A 
Over 65
residents in a nursing home
contact with children
respiratory chronic diseases
alcohol and smoking misuse
poor oral hygiene
PPI and H2 antagonists
95
Q

what might the presentation be with pneumonia community acquired?

A 
Cough
increased sputum
shoppers of breath
chest pain pleuritic
rigors
night sweats
fever
confusion
myalgia
malaise
96
Q

What is the most predictive feature on examination for community acquired pneumonia?

A

tachypnea

97
Q

for community-acquired pneumonia what findings would you find on examination of the lungs?

A 
tachypnea
Crackles
decreased breath sounds
dullness on percussion
wheeze
98
Q

Apart from lung examinations what else would you like to do on initial assessment when assessing a patient with community-acquired pneumonia?

A

Check pulse oximetry anything less than 94% on air would require O2

99
Q

What is the gold standard for diagnosing community-acquired pneumonia?

A

chest x-ray: showing consolidation

100
Q

What is the management of a low curb score for community-acquired pneumonia?

A

Start empirical oral antibiotic treatment
encourage fluids and paracetamol

only consider hospital if particularly stable have severe risk factors all namesake peril medications

101
Q

What is the management of moderate curb Score for community-acquired pneumonia?

A

Make a hospital referral

in-hospital supportive care and empirical IV antibiotics

102
Q

what is the management of a severe curb score for community-acquired pneumonia?

A

Urgent hospital admission and starting oral empirical antibiotics prior to hospital admission
it
once in hospital supportive care and continue empirical antibiotics Ivy and consider fluoroquinolone

103
Q

What antibiotics are typically used for Streptococcus pneumonia in community-acquired pneumonia?

A

amoxicillin – oral, benzylpenicillin – IV

104
Q

What is the management of MRSA community-acquired pneumonia?

A

Vancomycin IV with or without rifampicin ( oral or IV)

105
Q

What antibiotics would use for H influenza community-acquired pneumonia?

A

AmoxicillinIf beta lacks in producing ad in clavulanate

106
Q

what antibiotics are used for staphyylococcus pneumonia?

A

Flucloxacillin with or without rifampicin

107
Q

Why is fluroquinolone used in broad-spectrum severe community acquired pneumonia?

A

It covers atypical Pneumonias mostly Legionella

another antibiotic which Legionella is responsive to is azithromycin

108
Q

When does Legionella typically occur?

A

After exposure to contaminated air conditioning

109
Q

Describe the CRUB 65 score?

A 
Confusion  (1)
 urea elevated  (1)
 respiratory rate over 30 (1)
 blood pressure, low (1)
 aged over 65  (1)

low = 0-1
moderate=2
severe=3-5

110
Q

What is hospital-acquired pneumonia?

A

and acute lower respiratory tract infection acquired after at least 48 hours of admission to hospital. And wasn’t incubating at the time of admission

111
Q

What pathogen is usually because hospital-acquired pneumonia?

A

Mainly gram-negative bacteria

commonly Pseudomonas Aeruginosa, E.Coli, Kebisella pneumonia or staph. Aureus inc MRSA

112
Q

What risk factors are associated with hospital-acquired pneumonia?

A

Poor infection control and intubation

113
Q

Diagnostic criteria for hospital-acquired pneumonia?

A

Positive imaging on x-ray +2 clinical features of:
fever over 38°C
leucocytosis or leukopenia
purulent secretions

114
Q

While investigations might you like to perform in hospital-acquired pneumonia?

A

chest x-ray showing consolidation
white cell count (+)
pulse oximetry(-)
culture of lower respiratory tract sample during bronchoscopy

115
Q

What is the management of hospital-acquired pneumonia?

A
  1. X rays and bloods
  2. take cultures
  3. start broad-spectrum empirical IV antibiotics (cefepime)
116
Q

If hospital-acquired pneumonia is not severe what antibiotics could you give?

A

Oral indicated if non-surveyor and there is low risk of resistance

give Comox a glove or doxycycline if allergic to penicillin’s

117
Q

What antibiotics would you give to cover Enterobacters?

A

Meropenem

118
Q

What is a bronchiectasis?

A

The permanent sanitation of the bronchitis you to the destruction of elastic and muscular components of bronchial wall. Often caused as a consequence to recurrent chest infections and secondary to an underlying disorder.

119
Q

What is the presentation of bronchiectasis?

A

Most commonly presenting with a productive cough
cough may get worse and lying down
fatigue shortness of breath, haemoptysis
history of underlying lung disorder or chronic infections

120
Q

What is the most common identifiable risk factor for bronchiectasis?

A

Cystic fibrosis

121
Q

What is a diagnostic test for bronchiectasis?

A

Chest CT

122
Q

What would a chest CT show in bronchiectasis?

A

Airway dilatation with or without airway thickening
fluid
cysts - in a tree bud pattern
varicose constrictions

123
Q

What would pulmonary function tests show in bronchiectasis?

A

A decrease in FEV1

an increase in RV and TLC

124
Q

What other underlying chest pathologies apart from cystic fibrosis predisposed to bronchiectasis and what other diagnostic tests?

A

A1 ATD - cerium A1AT
ciliary dyskinesia - nasal nitric oxide
lung infections- sputum culture

125
Q

How do you manage bronchiectasis?

A

Healthy lifestyle and pulmonary rehab
as ABA with or without meuco active agents (nebulised saline)

in an exacerbation manage that

126
Q

What is cystic fibrosis?

A

A severely life shortening genetic disease resulting from abnormalities in the CF TR gene.

Most commonly affecting the lungs but also causes pancreatic involvement and liver involvement and intestinal involvement and reproductive involvement

127
Q

What is the pathophysiology of cystic fibrosis?

A

Mutations are caused by abnormal salt transportation (Na+, Cl-)
this causes a thickening of secretions and a reduction in our liquid layer with impaired ciliary function.

In the lungs: causes of mucus retention leading to chronic infection and inflammation resulting the destruction of lung tissue
in the intestines: bulky stores lead to intestinal blockage
in the pancreas: blockage of exocrine ducts occur. This causes the early activation of pancreatic enzymes and auto-destruction of pancreas

128
Q

When is the diagnosis of cystic fibrosis usually made?

What is a test?

A

Usually made on a positive newborn heel prick screen

129
Q

If undiagnosed at the newborn heel prick screen what is the presentation of cystic fibrosis?

A

Failure to pass meconium
Male genital abnormalities (no vaster variance)

failure to thrive
insatiable appetites (due to pancreatic insufficiency)

chronic sinusitis
prolonged severe coughs and colds which are wet sounding
recurrent chest infections

130
Q

Apart from the heel prick screen test what other diagnostic test is that for cystic fibrosis?

A

Sweat test

the ultimate diagnosis is made by genetic testing

131
Q

What is the lung management of cystic fibrosis?

A
  1. chest physiology with S ABA and new politically agents
    adj. inhaled tobramycin ( and antibiotic given to children over six years for chronic pseudomonas infections)
  2. anti-inflammatory agents: azithromycin/fibre proven or prednisolone or inhaled corticosteroids
  3. CFT art modulator: Ivacaftor
  4. bilateral lung transplantation
132
Q

How do you manage the GI manifestations of cystic fibrosis?

A

Monitor and optimise nutrition

if affecting pancreas…
using pancreatic enzymes, fat-soluble vitamins supplements

If causing gord…
Ranitidine or lansoprazole

Urodeoxycolic acid acid

133
Q

What are the complications which can arise in neonates due to cystic fibrosis?

A

Meconium ileus
distal intestinal obstruction
peritonitis

134
Q

What is the management of meconium ileum or intestinal obstruction?

A

Insert nasogastric tube for decompression
close fluid and at electrolyte balance with Ivy
water-soluble contrast enema plus an oral osmotic agent (lactulose) - only if not complete obstruction or peritonitis. hasn’t occurred
surgery

135
Q

how would you manage acute respiratory failure caused by a mild exacerbation of cystic fibrosis?

A 
Oral antibiotics (amoxicillin)
increasing chess physio
 SABA
 inhaled mutilated
adjunct inhaled tobramycin
136
Q

How would you merge acute respiratory failure caused by a severe exacerbation of cystic fibrosis?

A 
Iv tobramycin
antibiotics for specific pathogens
chest physic increase
S ABA
Inhaled mucolytic
137
Q

How often do you have to monitor patients with cystic fibrosis?

A

Every three months with a CF care team

138
Q

what is involved in the monitoring of cystic fibrosis?

A

History
exam respiratory
and spirometry

yearly there should be test x-rays bloods and full pulmonary function tests

139
Q

What is tuberculosis?

A

An infectious disease caused by Mycobacterium tuberculosis

it is a notifiable disease

140
Q

What is the biological history of tuberculosis?

A

Droplets and hills and they get deposited in the alveoli

macrophages engulf mycoplasma tuberculosis however it survives and replicates within the macrophage

the M TB kills host macrophages and then is released causing an immune response

T cells and macrophages form a granuloma with necrotic KCS centre trapping MTB here begins the dormant phase

10% of individuals progress to active disease usually after a new no compromise Asian

141
Q

What are the risk factors involved in tuberculosis?

A

poor living conditions

exposure to TB

but an endemic country (Asia, Latin America, Africa)

HIV infection

immunosuppressant

silicosis

apical fibrosis

142
Q

What is the to presentation of tuberculosis?

A

Cough

low-grade fever

anorexia

weight loss

malaise

night sweats

haemoptysis

143
Q

What investigations are required in Tuberculosis?

A 
Chest x-ray
sputum acid-fast bacilli smear (+)
sputum culture (+)
FBC ( - HB, + WCC)
nucleic acid amplification test
144
Q

What test is used for latent TB?

A

Mantoux test

145
Q

What would you find on x-ray in tuberculosis patient?

A

Nodular opacities in the upper lobes

146
Q

When is a Mantoux test positive if the swell is greater or equal to 5 mm?

A

HIV positive
recent contact with an active TB patient
nodular or fibrotic changes on chest x-rays
organ transplant

147
Q

When is a Mantoux test positive if the swell is greater or equal to 10 mm?

A

Recent arrivals (less than five years) from home: countries
IV drug users
resident or employee of a high-risk setting
mycobacterial lab personnel
comorbidity
children under four years old
adolescents and anyone younger exposed to high-risk categories

148
Q

When is a Mantoux test positive if the swell is greater or equal to 15 mm?

A

Persons with no known risk factors for TB

149
Q

How do you treat active TB?

A

Rifampicin - 6m
Isoniazid - 6m
pyrazinamide - 2m
ethambutol - 2m

150
Q

What are the side effects for rifampicin?

A

Red orange bodily fluids

GI side effects
rash
cytopenias

151
Q

What are the side effects for Isoniazid?

A

Neurotoxicity

hepatotoxicity

152
Q

What are the side effects for Pyrazinamide?

A

Hepatotoxicity

hyperuricemia

153
Q

What are the side effects for ethambutol?

A

Optic neuropathy

154
Q

What is interstitial lung disease?

A

An umbrella term for a number of diseases which cause scarring and fibrosis of the intercession a can be idiopathic or secondary.

155
Q

What is idiopathic pulmonary fibrosis?

A

The most common primary – idiopathic cause of interstitial lung disease however it is still rare. It is a chronic and life-threatening disease occurring over the course of years causing the formation of scar tissue in the lungs and progressive shortness of breath.

156
Q

What Are characteristic features on a history of idiopathic pulmonary fibrosis?

A

Progressive shortness of breath
weight loss
fever
malaise

occurring in patients who are older, smokers, male, have a positive family Hx

157
Q

In idiopathic pulmonary fibrosis what can be heard in the lungs on physical examination?

A

Crackles

158
Q

What investigations are required for idiopathic pulmonary fibrosis?

A 
pulmonary function tests
Chest x-ray
CT
ANA
(antipsychotic citruttinated peptide and myosistitis panel show a collagen cause)
159
Q

What is a characteristic feature found on CT to do with idiopathic pulmonary fibrosis?

A

Honeycomb lung

160
Q

What is the management of idiopathic pulmonary fibrosis?

A 
pulmonary rehabilitation
Anti-fibrinolytic therapy - pirfenidone
 stopping smoking
PPI (relationship is unknown)
ambulatory oxygen if indicated by hypoxia

Lung transplant

161
Q

What management is required in the acute exacerbation of idiopathic pulmonary fibrosis?

A

Admitted to hospital
oxygen
prednisolone high dose

you can also give cytotoxic therapy

162
Q

What is sarcoidosis?

A

A secondary cause of interstitial lung disease.
A chronic granulomatous disorder of unknown aetiology affecting lungs, lymph most commonly but is a multi system disease, by creating non-sating granulomas

163
Q

When does sarcoidosis usually present?

A

Aged 30 to 50 years

164
Q

What is the presentation of sarcoidosis?

A

Usually pulmonary:
shortness of breath, non-productive cough, wheezing

can be renal:
hypercalcaemia symptoms, hypercalceuria, renal insufficiency

ocular:
pain and redness and I can cause uveitis, keratoconjunctivitis, glaucoma, cataracts

neurological:
seizures, deficits, cranial nerve palsies, peripheral neuropathy, hypothalamic or pituitary lesions,

cutaneous:
erythematous

165
Q

How would you diagnose sarcoidosis?

A

Chest x-ray and lungs usually shows adenopathy and fibrosis
pulmonary function tests
biopsy shows non-key sating granulomas

liver enzymes AST, ALC: elevated
hypercalcaemia
two by killing PPD test: negative
urea and creatinine elevated if renal involvement

166
Q

What is the management of Pulmonary sarcoidosis?

A

Do not manage until symptomatic

oral or inhaled corticosteroids

oral or inhaled corticosteroids plus adjunct cytotoxic drugs plus oxygen

at the end stage lung transplant is needed

167
Q

How would you manage cutaneous sarcoidosis?

A

Topical or PO corticosteroids

secondary: cytotoxic

168
Q

How would you manage ocular sarcoidosis?

A

If anterior uveitis or optic neuritis present:
topical corticosteroids moving on to oral corticosteroids

caution in glaucoma

169
Q

what is rheumatic lung?

A

A recognised complication of rheumatoid arthritis and in some cases can be caused by the treatment of rheumatoid arthritis (methotrexate)

170
Q

How do you manage rheumatic lung?

A

Either treat the rheumatic arthritis or discontinue treatment if treatment is because

171
Q

How does SLE cause interstitial lung disease?

A

Can cause pleural inflammationAnd various other lung disorders

172
Q

what is asbestosis?

A

Interstitial fibrosis of the long occurring from exposure to asbestos rather than a connective tissue disorder

173
Q

How does asbestos cause lung disease?

A

Fibres cause plaques, pleural thickening, and benign pleural effusions.

174
Q

How long after asbestos exposure does asbestosis present?

What is the symptoms of asbestosis?

A

After 10 years

shortness of breath (usually on exertion)
cough
crackles in the chest

175
Q

What investigations are there for asbestosis?

A

CT /XR

pulmonary function tests showing restrictive changes

176
Q

What would you find on CT for asbestosis?

A

showing lower zone linear fibrosis (at the start)

more diffuse fibrosis later on

finally pleural thickening

177
Q

What is a treatment for asbestosis?

A

Smoking cessation
early antibiotics if there is a lung infection
if there is an obstructive pattern (usually as a smoker to) start COPD management

pulmonary rehab and O2 are adjunct to treatment

pleural decortication or lung transplant is second line

178
Q

What is pneumoconiosis?

A

A group of interstitial lung diseases mostly of occupational origins caused by inhalation of mineral or metal dust

usually occupations which have exposure to silica coal or beryllium

179
Q

what is the presentation of pneumoconiosis

A

Shortness of breath and cough later progressing to findings on examination of the chest such as crackles

180
Q

What is seen on x-ray for pneumoconiosis?

A

Hundreds of rounded opacities seen in upper zones in silicosis and co-workers lungs which then join up Forming egg shell calcifications

181
Q

What test can be done if you suspect beryllium exposure?

A

The really lymphocyte proliferation test

182
Q

How do you manage chronic pneumoconiosis?

A 
Remove from exposure
smoking station
corticosteroids
pulmonary rehab
supplementary O2 if hypoxic
COPD management if obstructive pattern

advise on entitlement compensation!

183
Q

How do you manage acute disease of pneumoconiosis?

A

Silicosis : lung lavage

berylliosis: corticosteroids

184
Q

what is pulmonary hypertension?

A

An increase in arterial blood pressure in the lungs Which can lead to right-sided heart failure

185
Q

What causes pulmonary hypertension?

A

Left sided heart failure
chronic lung disorders
portal hypertension
Blood clots

186
Q

What are the features of pulmonary hypertension?

A 
Shortness of breath
 chest pain
 peripheral oedema
 syncope
 tachycardia
187
Q

What other characteristic lung findings of pulmonary hypertension on chest x-ray?

A

Increased pulmonary vascular markings

188
Q

how to manage pulmonary hypertension?

A

Calcium channel blocker
diuretics
anticoagulants
digoxin

189
Q

What is a pleural effusion?

A

A collection of fluid between parietal wall and visceral surfaces of the thorax, occurring when too much fluid is produced or too little fluid is removed

190
Q

What are the two categories of pleural effusion?

A

Exudative: local factors altered ie inflammation
Transudative: systemic factors altered eg LSHF. RSHS, Cihrossis

191
Q

What can cause pleural effusion?

A

Local infection such as pneumonia
malignancy
recent cardiac surgery
congestive heart failure (both sided)

192
Q

A patient presents with dysnopea, dullness and percussion, 30 chest pain, diminished breath sounds and non-productive cough what are these symptoms characteristic of?

A

pleural effusion

193
Q

What investigations would you want to perform in a pleural effusion?

A

Chest x-ray
ultrasound of the pleural space

finding cause:
pleural fluid culture: effusion or empyema?
pleural fluid cytology (?malignancy)
 pleural fluid analysis
 infection markers(FBC, CRP, ESR)
 heart failure markers (NT pro BNP)
194
Q

What Is an empyema

A

defined as a collection of pus in the pleural cavity, gram-positive, or culture from the pleural fluid. Empyema is usually associated with pneumonia

195
Q

What finding would you find on chest x-ray for pleural effusion?

A

blunting of costo phrenic angles

196
Q

What is the management of the pleural effusion?

A

Underlying cause

diuretics in congestive heart failure

antibiotics in infection

thoracoscentesis in recurrent for malignancy

197
Q

what is a pneumothorax?

A

An accumulation of in the pleural space

198
Q

What are the types of pneumothorax?

A

open ( simple)
closed
tension

199
Q

What is an open pneumothorax?

A

Open pneumothorax is when there is a hole between the outside and the pleural cavity meaning that the pressure outside inside the cavity is the same
meaning air from outside the body moves into the pleural space and can move back out

200
Q

What is a closed pneumothorax?

A

The pressure in the pleural cavity is less than external pressure meaning air from the lung moves into the pleural space and can move back in

201
Q

What is a tension pneumothorax?

A

The pressure of the pleural cavity is greater than the atmospheric pressure meaning that gets sucked into the pleural space and cannot leave

202
Q

What is the presentation of a pneumothorax?

A

Unless presenting in an acute situation it can be asymptomatic and insidious

in acute situations also their pneumothorax there is:
tachycardia
decreased breath sounds unilaterally
hyper- resonant unilaterally
hyperaemia hypotension
tracheal deviation is a late sign in tension pneumothorax and is close to death

203
Q

what is the investigation of a pneumothorax?

A

any situation all acute trauma getting multiple IV lines is important. assessing the front and back of the patient. Getting a fast scan.

a chest x-ray or ultrasound can show a pneumothorax

204
Q

What is the management of tension pneumothorax

A

Cannula needle decompression - 2nd intercostal mid clavicular unless if large pt then 5h clavicular space mid axillary line

thoracostomy and chest drain.

O2 therapy

205
Q

what is the management of an open pneumothorax?

A

A three sided closed because creating a valve

206
Q

what is the management of Simple pneumothorax that is small?

A

02 an observation

207
Q

What is the management of a simple pneumothorax that is large?

A

thoracotomy and chest drain

208
Q

What is the management of a heamothorax?

A

chest drain and thoracotostomy + blood

209
Q

What is flail chestAnd how is it managed?

A

When there are multiple broken ribs that when you inspire and expire was further damage to the lungs.

managed with CPAP until surgery as possible and then surgical management

210
Q

What is a small cell lung cancer?

A

An extremely aggressive malignancy which usually at the time of presentation has distant metastases.
A malignant epithelial tumour arising from the lower respiratory tract/

211
Q

What is the main risk factor for small-cell lung cancer?

A

smoking

212
Q

What is the presentation lung cancer?

A 
cough
dysnopea
Shortness of breath
 haemoptysis
 chest pain
 generalised red flags
213
Q

What is the first line investigation in small cell lung cancer?

and what does it show?

A

Chest x-ray

a central mass, hilar lymphadenopathy pleural effusions

214
Q

If you suspect the small-cell lung cancer on chest x-ray what following investigations should you take?

A

CT – chest, liver, adrenal glands
sputum cytology
biopsy

215
Q

What is non-small cell lung cancer?

A

A group of adenocarcinomas and squamous cell carcinomas and large cell epithelial cell tumours

216
Q

Which lung cancer is most common non-small cell or small cell?

A

non Small-cell - 80% of all lung cancers

217
Q

what is mesothelioma?

A

An aggressive epithelial neoplasm arising from the lining of the lungs ( also can arise from abdomen, accordion or tunica vaginalis)

218
Q

What is the major risk factor for mesothelioma?

A

Asbestos

219
Q

What is the presentation of mesothelioma?

A

If in the lungs shortness of breath, cough, chest pain

if in the abdomen: bloating, abdominal pain, bowel changes, lack of appetite

220
Q

How can you diagnose mesothelioma?

A

CT

Biopsy

221
Q

What is a pulmonary embolism?

A

A blood clot in the pulmonary arteries

222
Q

What is Virchows Triad?

A

the three factors which predispose someone to thrombosis:

hyper coagulability
trauma to the endothelium
venous stasis

223
Q

What is the presentation of a pulmonary embolism?

A 
pyrexia
tachycardic
tachyopneic
SOB
pleuritic chest pain
cough and haemoptysis
recent DVT sx – oedema, redness, tenderness, unilateral, thrombophlobitis
low O2 sats
224
Q

What investigation is diagnostic for a pulmonary embolism?

A

CTPA

225
Q

What investigations would you like to perform if you are suspecting a pulmonary embolism but want to exclude other differential diagnoses?

A

ECG – r sided strain/ r axis deviation and rule out coronary syndrome or pericarditis (saddle shaped st elevation and PR depression)
XCR – shows any effusions, pulmonary infarcts (rare) and regional oedema, rules out consolidations etc
ABG – acidosis in infections from hypoxia
FBC – infections
Cardiac troponin – MI but also ++ in massive PE
Echo – pericarditis, IE, efffusion

226
Q

What tests can aid in the diagnosis of pulmonary embolism?

A

D Dimer
Leg USS + doppler : ? DVT
Coag studies

227
Q

What is a treatment for pulmonary embolism is haemodynamically unstable ?

A

Fluid resus
Thrombolysis - altepase
warfarin or LMWH

continue anticoagulants for 3months

228
Q

What is a treatment for pulmonary embolism is haemodynamically stable ?

A

anticoagulants (LMWH/ RIvaroxiban/Warfrin)

continue for 3 months

229
Q

What is a pulmonary infarct?

A

a rare consequence of a Pulmonary embolus where there is localised necrosis of lung tissue due to decreased arterial blood supply

230
Q

What is the management of pulmonary infarct?

A

fibrinolysis or surgical/catheter removal

FINALS (24 decks)

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