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Phase 3b > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Causes of community acquired pneumonia

A 
Streptococcus pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Staph aureus
Legionella
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2
Q

Risk factors for pneumonia

A 
>65 years old
COPD
Smoking
Alcohol
Immunosuppression
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3
Q

Causes of hospital acquired pneumonia

A

Gram negative enterobacteria
Staph aureus
Pseudomonas aeruginosa
Klebsiella

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4
Q

Symptoms of pneumonia

A 
Cough
Fever
Sputum (rusty in strept pneumoniae CAP)
Dyspnoea
Haemoptysis
Pleuritic chest pain
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5
Q

Signs of pneumonia

A 
Confusion
Tachypnoea
Tachycardia
Hypotension (shock)
Signs of consolidation - bronchial breath sounds, dull to percussion, crackles, vocal resonance
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6
Q

What tool is used to measure severity of pneumonia?

A

CURB-65

Confusion
Urea >7mmol/L
Resp rate >30
Blood pressure <90 systolic, <60 diastolic
Age >65
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7
Q

What do different CURB-65 scores mean?

A

Score 0-1 = consider treatment at home
Score >2 = Consider hospital admittance
Score >3= Consider intensive care assessment

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8
Q

Name the types of atypical pneumonia

A 
Legionella pneumophila
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Chlamydia psittaci
Coxiella burnetti - Q fever

MCQ

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9
Q

Describe legionella pneumophila

A

Infected water supplies/air conditioning

Can cause hyponatraemia (low sodium) by causing SIADH

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10
Q

Desrcibe mycoplasma pneumoniae

A

Erythema multiforme

Dry cough

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11
Q

How do you treat fungal pneumonia (pneumocystis jiroveci)?

A

Oral co-trimoxazole

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12
Q

Investigations for pneumonia

A 
Chest X-ray - consolidation
FBC - raised WCC
CRP - raised
Sputum culture
Blood culture
ABG
U&amp;E's
Legionella and pneumonoccal urinary antigens
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13
Q

How do you treat low risk 0-1 CAP?

A

Oral Amoxicillin or macrolide (clarithromycin/azithromycin)

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14
Q

How do you treat moderate 2 CAP?

A

Oral Amoxicillin + clarithromycin (doxycycline if allergic)

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15
Q

How do you treat high risk 2+ CAP?

A

Co-amoxiclav + clarithromycin IV

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16
Q

Treatment for HAP

A

Cefotaxime + gentamicin

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17
Q

Treatment for legionella

A

Clarithromycin + fluoroquinolone

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18
Q

Complications of pneumonia

A

Sepsis
Pleural effusion + empyema
Lung abscess
Death

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19
Q

What organism causes TB?

A

Mycobacterium tuberculosis

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20
Q

Risk factors for TB

A 
Homelessness
Overcrowding
IV drug use
Alcoholics
Immunocompromised - HIV
Exposure to known contacts
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21
Q

Symptoms of TB

A 
Cough
Haemoptysis
Fever
Weight loss
Night sweats
Lethargy
Erythema nodosum
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22
Q

Signs of TB

A

Crackles

Bronchial breathing

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23
Q

What stain do you use to investigate TB?

A

Ziehl-Neelsen stain for acid fast bacilli - turns red/pink

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24
Q

Investigations for TB

A

Sputum culture
Chest X-ray: Primary TB - consolidation, hilar lymphadenopathy
Mantoux test
Interferon

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25
Q

How do you treat TB?

A 
RIPE
Rifampicin - 6 months
Isoniazid - 6 months
Pyramzinamide - 2 months
Ethambutol - 2 months
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26
Q

Side effects of Rifampicin

A

Red/orange urine
Tears
Inactivation of the pill

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27
Q

Side effects of Isoniazid

A

Peripheral neuropathy (give with Pyridoxine B6)

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28
Q

What other drug do you give with Isoniazid?

A

Pyridoxine B6

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29
Q

Side effects of pyrazinamide

A

Hepatitis
Arthralgia
Gout

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30
Q

Side effects of ethambutol

A

Optic neuritis

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31
Q

How do you treat latent TB?

A

Isoniazid + rifamipicin for 3 months
OR
Isoniazid for 6 months

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32
Q

Extrapulmonary TB

A 
Bone TB - Pott's disease, vertebral collapse
Lymph nodes - swelling and discharge
GU - frequency, dysuria, haematuria
Brain - TB meningitis
Abdomen - Ascites
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33
Q

Define pleural effusion

A

Fluid in the pleural space

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34
Q

Protein count for exudate

A

High, >35g/L

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35
Q

Protein count for transudate

A

Lower, <25g/L

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36
Q

What are causes of exudate?

A 
INFLAMMATION
Pneumonia
Lung cancer
TB
Rheumatoid arthritis
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37
Q

What are causes of transudate?

A 
Cardiac failure
Hypothyroidism
Meig's syndrome
Hypoalbyminaemia
Nephrotic syndrome
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38
Q

What is Meig’s syndrome?

A

Triad:
Ovarian tumour
Pleural effusion (right sided)
Ascites

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39
Q

Symptoms of pleural effusion

A

Dyspnoea
Chest pain
Cough

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40
Q

Signs of pleural effusion

A

Dullness on percussion
Decreased breath sounds
Tracheal deviation away from effusion if large

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41
Q

Investigations for pleural effusion

A

Chest x-ray: blunted costophrenic angle, fluid in lung fissures, tracheal and medistinal deviation
Ultrasound - identify pleural fluid
Aspiration - protein count, pH, glucose, cell count

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42
Q

Treatment for pleural effusion

A

Drainage
Pleural aspiration
Pleurodesis

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43
Q

What is empyema?

A

Infected pleural effusion - shows pus

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44
Q

What is haemothorax?

A

Blood in plural space

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45
Q

What is chylothorax?

A

Chyle in pleural space

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46
Q

Define pneumonthorax

A

Accumulation of air in the pleural space

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47
Q

Risk factors for primary spontaneous pneumothorax

A

Young, tall, thin male

Playing sports

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48
Q

Risk factors for secondary spontaneous pneumothorax

A 
Asthma
COPD
TB
Pneumonia
Trauma
CF
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49
Q

General risk factors for pneumothorax

A

Smoking

Family history

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50
Q

Symptoms of pneumothorax

A

Pleuritic chest pain (on same side on breathing in)

Dyspnoea

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51
Q

Signs of pneumothorax

A

Reduced expansion
Hyper-resonant
Decreased breath sounds

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52
Q

Investigations for pneumothorax

A

Chest x-ray: Visceral pleural line identified, no lung markings

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53
Q

Management for primary pneumothorax

A

Rim of air<2cm/no SOB = Discharge as it resolves

Rim of air >2cm/SOB = Chest drain/aspirate in 2nd intercostal space, mid-clavicular line

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54
Q

Management for secondary pneumothorax

A

Rim of air<1cm = High flow oxygen + admitting
Rim of air 1-2cm = aspirate then chest drain
Rim of air >2cm= chest drain

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55
Q

Define tension pneumothorax

A

Trauma to the chest wall that creates a one way valve, lets air in but not out. Air is drawn in during inspiration. This creates pressure and will push the mediastinum across

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56
Q

Signs of tension pneumothorax

A

Tracheal deviation away from side of pneumothorax
Reduced air entry to affected side
Increased resonant to percussion on affected side
Tachycardia
Hypotension

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57
Q

Chest X-ray signs for tension pneumothorax

A

Increased intercostal space
Contralateral mediastinal shift
Depressed hemidiaphragm

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58
Q

Management of tension pneumothorax

A

Insertion of a large bore cannula into the 2nd intercostal space in the midclavicular line
Then chest drain

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59
Q

Where are chest drains entered?

A

Triangle of safety

5th intercostal space/inferior nipple line
Mid axillary line/lateral edge of latissimus dorsi
Anterior axillary line/lateral edge of pectoris major

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60
Q

Define bronchiectasis

A

Permanent dilatation of the airways (bronchi/bronchioles)

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61
Q

Causes of bronchiectasis

A

Congenital: CF, Young’s syndrome, Kartagener’s syndrome, primary ciliary dyskinesia
Post infection: TB, measles, pertussis, pneumonia, HIV
Bronchial obstruction: Lung cancer/foreign body
Allergic bronchopulmonary aspergillosis (ABPA)
Hypogammaglobulinaemia
Rheumatoid arthritis
Ulcerative collitis

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62
Q

Symptoms of bronchiectasis

A

Persistent cough
Excessive sputum - mild=yellow, moderate = khaki
Haemoptysis

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63
Q

Signs of bronchiectasis

A

Clubbing
Coarse inspiratory crackles
Wheeze
High pitched inspiratory squeaks

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64
Q

Organisms causing bronchiectasis

A 
H. influenzae
Strep pneumoniae
Staph aureus
Pseudomonas aeruginosa
Aspergillus fumigatus
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65
Q

Investigations for bronchiectasis

A 
Sputum culture
Chest x-ray: Cysts + thickened bronchial walls
FBC: high eosinophils in ABPA
Sweat test
Serum immunoglobulins
Skin prick test
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66
Q

Treatment for bronchiectasis

A

Postural drainage 2x daily/chest physiotherapy/exercise
Inhaled bronchodilators e.g. nebulised salbutamol
Pseudomonas = nebulised abx/ciprofloxacin

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67
Q

Define allergic bronchopulmonary aspergillosis (ABPA)

A

Hypersensitivty to aspergillus fumigatus that has colonised airway of patient with asthma or CF

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68
Q

Symptoms of ABPA

A 
Increased cough/mucus plugs
Wheeze
Fever (>38.5)
Pleuritic chest pain
History of Asthma
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69
Q

Investigations for ABPA

A

Skin test for aspergillus fumigatus sensitivity
Serum IgE elevated
FBC - eosinophils elevated
Chest x-ray: upper or middle lobe infiltrates

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70
Q

Management for ABPA

A

Oral corticosteroid - Prednisolone

Azole antifungal - itraconazole, co-trimoxazole

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71
Q

Define idiopathic pulmonary fibrosis

A

Progressive pulmonary fibrosis with no clear cause

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72
Q

Symptoms of pulmonary fibrosis

A

Dry cough
Dyspnoea
Weight loss

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73
Q

Signs of pulmonary fibrosis

A

Cyanosis
Clubbing
Fine end inspiratory crackles

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74
Q

Name occupational lung disorders

A 
Coal worker's pneumoconiosis
Silicosis
Asbestosis
Malignant mesothelioma
Bird fancier's lung
Farmer's lung
Mushroom worker's ung
Malt worker's lung
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75
Q

Investigations for pulmonary fibrosis

A

Chest x-ray: Reticular shadowing, shaggy heart border
High resolution CT: Ground glass appearance, honeycombing
Spirometry: Restrictive
ABG: Decreased PaO2, increased PaCO2
Lung biopsy

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76
Q

Management for pulmonary fibrosis

A

Supportive - Oxygen, physiotherapy, exercise and weight loss, pulmonary rehabilitation
Medications - Pirfenidone = Antifibrotic, Nintedanib = monoclonal antibody
Lung transplant

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77
Q

Causes of drug induced pulmonary fibrosis

A

Methotrexate
Cyclophophamide
Amiodarone
Nitrofuratoin

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78
Q

Define extrinsic allergic alveolitis (EAA)

A

Inhalation of allergens (fungal spores or avian proteins) provokes a hypersensitivity reaction

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79
Q

What type of hypersensitivity reaction is in EAA?

A

Type 3 hypersensitivity

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80
Q

Causes of EAA

A

Bird/pigeon fancier’s lung
Farmer’s lung
Mushroom workers lung
Malt workers lung

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81
Q

Symptoms of EAA

A

Occur 4-8 hours after exposure: Fever, cough, dyspnoea, crackes

Chronic: Increasing dyspnoea, weight loss, cor pulmonale, type 1 respiratory failure

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82
Q

Investigations for EAA

A

Chest x-ray: Upper/mid zone fibrosis/consolidation
Bronchoalveolar lavage - raised lymphocytes and mast cells
FBC - no eosinophils
Lung function tests - reversible restrictive defect

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83
Q

Management for EAA

A

Remove allergen
Oxygen
Oral prednisolone

If chronic: low dose corticosteroids

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84
Q

What is the most fibrogenic type of asbestos?

A

Crocidolite (blue asbestos)

Chrysotile (white asbestos) is the least fibrogenic

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85
Q

Symptoms of asbestosis

A

Dry cough
Dyspnoea
Fine-end inspiratory crackles
Clubbing

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86
Q

Investigations for asbestosis

A

Lung function test - restrictive
Chest x-ray: ground glass opacification, small nodular opacities, shaggy cardiac sillhouette
Sputum microscopy

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87
Q

Management for asbestosis

A

Avoid exposure

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88
Q

Symptoms of pleural mesothelioma

A 
Pleuritic chest pain
Dyspnoea
Weight loss
Clubbing
Pleural effusions (recurrent): Diminished breath sounds &amp; Dull to percussion
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89
Q

Invesitgations for pleural mesothelioma

A

Chest x-ray: pleural thickening, pleural effusion
CT scan - pleural thickening, pleural plaques
Pleural biopsy
Thoracocentesis

90
Q

Management for pleural mesothelioma

A

Chemotherapy - Pemetrexed + cisplatin

Surgery

91
Q

What jobs are associated with silicosis?

A

Metal mining
Stone quarrying
Sandblasting
Pottery

92
Q

Symptoms of silicosis

A

Dyspnoea
Dry cough
Black sputum

93
Q

Investigations for silicosis

A

Chest x-ray: nodular pattern in upper/mid zones

Spirometry - restrictive

94
Q

Management for silicosis

A

Avoid exposure

95
Q

Symptoms of coal worker’s pneumoconiosis

A

Dry cough

Dyspnoea

96
Q

Management for coal worker’s pneumoconiosis

A

Avoid exposure

97
Q

Define sarcoidosis

A

A multisystem disorder of unknown aetiology characterised by non-caseating granulomas

98
Q

Risk factors for sarcoidosis

A

Younger people (20-40 year old)
Women
Afro-Carribbeans

99
Q

What are the acute symptoms of sarcoidosis?

A

Erythema nodosum (nodules on shins)
Polyarthralgia
Bilateral hilar lymphadenopathy

100
Q

What organs are affected in sarcoidosis?

A

Lungs: Dry cough, dyspnoea, pulmonary fibrosis, mediastinal lymphadenopathy
Systemic: fever, fatigue, weight loss
Liver: Liver nodules, cirrhosis, cholestasis
Eyes: Uveitis, conjunctivitis, optic neuritis, glaucoma
Skin: Erythema nodosum (red nodules on the skin), lupus pernio (purple lesions on cheeks and nose), granulomas in scar tissue
Heart: BBB, heart block
Kidneys: Kidney stones, nephrocalcinosis, interstitial nephritis
CNS: Encephalopathy, Diabetes insipidus
Peripheral nervous system: Facial nerve palsy
Bones: Arthralgia, arthritis, myopathy

101
Q

What is Lofgren’s syndrome?

A

Triad of:
Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia (joint pain in multiple joints)

102
Q

Investigations for sarcoidosis

A

Bloods: Increased serum ACE, Calcium, CRP, ESR, Immunoglobulins
Chest x-ray: Hilar lymphadenopathy
Tissue biopsy - Gold standard: non-caseating granulomas
Spirometry: restrictive defect
Bronchoalveolar lavage: Increase in lymphocytes and neutrophils
ECG
Ultrasound

103
Q

Management for sarcoidosis

A

Best rest/NSAIDs
1st line: Oral steroids e.g. Prednisolone
Bisphosphonates - to protect against osteoporosis
2nd line: Methotrexate

104
Q

Define COPD

A

Progressive disorder characterised by airway obstruction
FEV1 <80% ; FEV1/FVC < 0.7
With little or no reversibility

105
Q

What two diseases make up COPD?

A

Emphysema

Chronic bronchitis

106
Q

Symptoms of COPD

A

Cough
Sputum
Wheeze
Dyspnoea

107
Q

Signs of COPD

A 
Tachypnoea
Use of accessory muscles
Hyperinflation
Hyperresonance to percussion
Quiet breath sounds
Cyanosis
Cor pulmonale
108
Q

Define pink puffer

A

Emphysema
Normal PaO2, normal or low PaCO2
May progress to type 1 respiratory failure

109
Q

Define blue bloater

A

Low PaO2, high PaCO2
Cyanosis
May develop cor pulmonale

110
Q

Investigations for COPD

A

Spirometry - obstructive pattern - non-reversible to Beta-2-agonists e.g. Salbutamol
FEV1/FVC <0.7

ABG - hypoxia, hypercapnia
Chest X-ray: Hyperinflation, flat hemidiaphragm, bullae
FBC
ECG
Sputum culture
Serum alpha-1 antitrypsin
111
Q

Define the severity stages for COPD

A

Stage 1 mild = FEV1 >80%
Stage 2 moderate = FEV1 50-79%
Stage 3 severe = 30 - 49 %
Stage 4 very severe = <30%

112
Q

Define the dyspnoea scale

A

Grade 1 = breathless on strenuous exercise
Grade 2= breathless walking up hill
Grade 3=breathless that slows walking on flat
Grade 4=stop to catch breath after 100m on flat
Grade 5=Unable to leave house due to breathlessness

113
Q

Supportive Treatment for COPD

A

Stop smoking
Exercise
Diet advice
Influenza and pneumococcal vaccination

114
Q

Medication treatment for COPD

A

Short-acting antimuscarinic (ipratropium) or Beta2 agonist
Mild/moderate = LAMA + LABA e.g. formoterol
Severe = LABA + ICS e.g. budesonide = ‘Fostair’
If remain breathless = LAMA + LABA + ICS

Consider: Theophylline, home nebulisers, mucolytics, long term oxygen therapy

115
Q

Define exacerbation of COPD

A

Triggered by viral or bacterial infection

116
Q

Symptoms of COPD exacerbation

A

Increase in dyspnoea, cough, wheeze, sputum

117
Q

Causative organisms for a COPD exacerbation

A

H. influenzae
Strep pneumoniae
Moraxella catarrhalis

118
Q

Treatment for a COPD exacerbation

A 
SABA + SAMA
Oxygen
Oral prednisolone
Antibiotics
Airway clearance - mucolytics + physio
119
Q

Define asthma

A

Chronic inflammatory airway disease charactersied by intermittent obstruction and hyperreactivity (type 1 hypersensitivity) -> bronchoconstriction
Reversible

120
Q

Triggers of asthma

A 
Exercise
Infection
Animals/fur
Dust/pollen
Cold/damp
Smoking
Emotion
121
Q

What drug is contraindicated in asthma?

A

Beta blockers - Beta 2 agonists cause airway constriction

NSAIDs or aspirin block COX-1 -> decrease prostaglandins

122
Q

Symptoms of asthma

A 
Intermittent dyspnoea
Wheeze - polyphonic
Cough (dry)
Sputum
Diurnal variation - typically worse at night/morning
123
Q

What two other conditions occur simultaneously with asthma?

A 
Eczema (atopic dermatitis)
Hay fever (allergic rhinitis)
124
Q

Questions to ask someone with asthma?

A 
How often shortness of breath?
How often wake up from sleep?
How often do you use your reliver?
How often does it interfere with normal activities?
What is your exercise tolerance like?
How well is your asthma controlled?
What is your inhaler technique like?
125
Q

Investigations for asthma

A 
Spirometry - obstructive defect; FEV1<80% + FEV1/FVC <0.7
FEV1 improves by 15% with SABA
PEFR diary (peak flow rate)
Chest x-ray: hyperinflation
FBC - eosinophilia
Skin-prick test
126
Q

Management for asthma

A
  1. SABA e.g. Salbutamol -> reliver inhaler (blue)
  2. ICS e.g. Budesonide
  3. Oral leukotriene receptor antagonist e.g. Montelukast
  4. Add LABA e.g. Salmeterol
  5. Consider MART regime
  6. Increase ICS dose to moderate (from 400mg to 400-800mg)
  7. Oral theophylline
127
Q

Criteria for moderate asthma

A

PEFR 50-75%
Speech normal
Resp rate <25
Pulse <110

128
Q

Criteria for severe asthma

A

PEFR 33-50%
Can’t complete sentences
Resp rate >25
Pulse >110

129
Q

Criteria for life-threatening asthma

A 
ONLY REQUIRES ONE OF THE CRITERIA
PEFR <33%
Oxygen sats <92%
Silent chest
Cyanosis
Exhaustion, confusion, coma
130
Q

Treatment for acute asthma

A 
Oxygen aim 94-98%
Salbutamol - nebulised
Hydrocortisone IV/oral prednisolone
Ipratropium bromide - nebulised
Theophylline IV
Magnesium sulphate IV
Salbutamol IV
Intubate and ventilate
131
Q

Define deep vein thrombosis

A

The development of a blood clot (thrombosis) in the venous circulation

132
Q

Risk factors for a DVT

A

Surgery
Immobility
Long haul flights
Malignancy
Hormone therapy with oestrogen - HRT/COCP
Pregnancy
Thrombophilia e.g. antiphospholipid syndrome

133
Q

Define thrombophilias and name them

A

Antiphospholipid syndrome
Antithrombin deficiency
Protein C or S deficiency
Factor V Leiden

134
Q

What makes up Virchow’s triad (the clot forming triad)?

A

Venous stasis
Vessel injury
Activation of clotting system (hypercoaguable state)

135
Q

Symptoms of a DVT

A 
Unilateral calf swelling
Dilated superficial veins
Tenderness to the calf
Oedema
Colour changes to the leg
136
Q

What tool predicts the risk of a DVT?

A

Well’s score

137
Q

What makes up the Well’s score?

A 
Active cancer = +1
Signs/symptoms of a DVT = +3
Likely diagnosis = +3
Heart rate >100= +1.5
Recently bed-ridden/immobilisation = +1.5
Previous DVT/PE = +1.5
Haemoptysis = +1
138
Q

What Well’s scores indicate probability of a PE?

A

Score <4 = PE unlikely

Score >4 = PE likely

139
Q

What investigation with a negative result excludes a DVT/PE?

A

D-dimer

140
Q

What other conditions could a positive D-dimer indicate?

A

Pneumonia, malignancy heart failure, surgery, pregnancy

141
Q

Investigations for a DVT

A

D-dimer
Ultrasound doppler of the leg
CT pulmonary angiogram for PE
Ventilation/perfusion (V/Q) scan for PE

142
Q

What treatment for a DVT is given initially?

A

Low molecular weight heparin - start immediately before diagnosis is known e.g. Enoxaparin & Dalteparin.

Continue for 5 days or until INR is above 2 for at least 24 hours

143
Q

What treatment do you give after LMWH?

A

Warfarin/NOAC’s/DOAC’s e.g. Apixaban, rivaroxaban or dabigatron given within 24 hours
For 3 months

144
Q

What treatment is given for a DVT where the patient is either pregnant or has cancer?

A

Low molecular weight heparin for 6 months if active cancer

145
Q

Define pulmonary embolism

A

When a thrombosis embolises it can travel through the right side of the heart and into the lungs where it becomes lodged in the pulmonary arteries

146
Q

Risk factors for a PE

A 
Long haul flight
Immobility
Recent surgery
Malignancy
Thrombophilia
Pregnancy
Hormone therapy - HRT/COCP
Previous PE
147
Q

Causes of a PE

A 
Right ventricular thrombus (Post MI)
Septic emboli
Fat embolus
Air embolus
Amniotic fluid embolus
148
Q

Symptoms of a PE

A

Pleuritic chest pain
Dyspnoea
Haemoptysis
Syncope

149
Q

Signs of a PE

A

Tachypnoea
Tachycardia
Signs of a DVT (calf swelling etc)

150
Q

What investigations do you do for a PE depending on the Well’s score?

A

CTPA if Well’s score >4 points

D-dimer if Well’s score <4 points - if the D-dimer is positive then do a CTPA

151
Q

Other investigations for a PE?

A

V/Q scan if renal impairment (instead of a CTPA)
ECG - sinus tachycardia, RBBB, S1Q3T3 pattern
Chest x-ray: wedge shape infarction
ABG: low PaO2

152
Q

Treatment for a PE

A

Low weight molecular heparin initially - continued for 5 days or until INR is 2 for at least 24 hours

Warfarin given within 24 hours

LMWH for 6 months if active cancer

153
Q

Prevention for a PE

A

Stockings
Encourage mobilisation
Heparin - dalteparin

154
Q

What type of inheritance is cystic fibrosis?

A

Autosomal recessive

155
Q

What chromosome and gene is the CF mutation on?

A

Chromosome 7 - delta F508 mutation

156
Q

What are the respiratory symptoms of CF?

A 
Recurrent infections
Nasal polyps
Dyspnoea
Haemoptysis
Cough
Wheeze
Thick mucus - sputum
157
Q

What are the GI symptoms of CF?

A

Meconium ileus
Steatorrhoea - loose, grey stools
Gallstones
Cirrhosis

158
Q

Other symptoms of CF (other than respiratory and GI)?

A 
Failure to thrive
Diabetes mellitus
Absent vas deferens - infertility
Malnutrition
Clubbing
Osteoporosis
159
Q

Causes of clubbing in children?

A 
CF
Infective endocarditis
TB
Inflammatory bowel disease
Cirrhosis
160
Q

Investigations for CF

A

Sweat test: Na & Cl >60mmol/L with Cl>Na - Gold standard
Newborn blood spot test - immunoreactive trypsinogen
Genetic testing - amniocentesis/chronic villous sampling
Faecal elastase

161
Q

Causative organisms of CF

A 
Staph aureus - take flucloxacillin
Psuedomonas aeruginosa - ciprofloxacin/tobramycin
E.coli
H.influenzae
Klebsiella pneumoniae
Burkhodheria cepacia
162
Q

Management of CF

A 
MDT approach:
Chest physiotherapy
Exercise
Bronchodilators - salbutamol
Mucolytics - DNase
Prophylactic flucloxacillin - prevents spread of staph aureus
Pancreatic enzyme replacement
Lung transplantation
163
Q

What members of the MDT team are involved in the treatment of CF?

A 
Nurse
Doctor
Phyisotherapist
Dietician
GP
164
Q

Complications of CF

A 
Diabetes
Male infertility
Pneumonia
Pneumothorax
Cirrhosis
Gallstones
165
Q

Define pulmonary hypertension

A

Increased resistance and pressure of blood in the pulmonary arteries. It causes strain on the right side of the heart. It also causes a back pressure of blood into the systemic venous system.

166
Q

Define pulmonary hypertension pressure

A

Resting mean pulmonary artery pressure of >= 25 mmHg

167
Q

Causes of pulmonary hypertension

A 
SLE
CREST
COPD
PE
Sarcoidosis
MI
168
Q

Symptoms of pulmonary hypertension

A

Dyspnoea
Syncope
Peripheral oedema

169
Q

Signs of pulmonary hypertension

A

Loud P2
Tricuspid regurgitation
Raised JVP

170
Q

Investigations for pulmonary hypertension

A

ECG: RVH, RAD, RBBB
Chest x-ray: RVH, dilated pulmonary arteries
Transthoracic echo

171
Q

Management for pulmonary hypertension

A

Calcium channel blockers - Nifedipine/amlodipine
Phosphodiesterase inhibitors - Sildenafil
Endothelin receptor antagonists - Macitentan
Exercise

172
Q

Commonest causes of cancer?

A

1st. Breast
2nd. Prostate
3rd. Lung

173
Q

Risk factors for lung cancer

A

Smoking
Asbestos
Radiation (radon gas)
Iron oxides

174
Q

Histology of lung cancer

A 
Non-small cell (85%): Squamous, adenocarcinoma, large cell
Small cell (15%)
175
Q

Symptoms of lung cancer

A 
Dyspnoea
Cough
Haemoptysis
Weight loss
Chest pain
Pneumonia
176
Q

Signs of lung cancer

A

Clubbing
Anaemia
Lymphadenopathy (supraclavicular nodes)

177
Q

Paraneoplastic features of small cell lung cancer

A

SIADH - hyponatraemia
ACTH - hypertension, muscle weakness, hyperglycaemia, hypokalaemia
Lambert-Eaton syndrome

178
Q

Paraneoplastic features of squamous lung cancer

A

Clubbing
Hyperthyroidism
Hypercalcaemia

179
Q

Paraneoplastic features of adenocarcinoma lung cancer

A

Gynaecomastia

180
Q

Complications of lung cancer

A

Recurrent laryngeal nerve palsy - hoarse voice
Horner’s syndrome - myosis, ptosis, anhydrosis
Pericarditis
AF
Seizures

181
Q

Where can lung cancer metastasise to?

A

Liver
Bone
Brain
Adrenals

182
Q

Investigations for lung cancer

A 
Chest x-ray: hilar enlargement, pleural effusion, lung collapse, peripheral opacity
Staging CT scan - contrast enhanced
Cytology sputum and pleural fluid
Bronchoscopy
PET-CT scan
Biopsy
183
Q

Treatment for non-small cell lung cancer

A

For stages 1-2 = Excision- labectomy, radiotherapy

For stages 3-4= + chemotherapy

184
Q

Side effects of chemotherapy

A 
Alopecia
Nausea and vomiting
Diarrhoea
Fatigue
Anaemia
185
Q

Treatment for small cell lung cancer

A

Chemotherapy and radiotherapy
Not surgery
Stents or debulking

186
Q

Define acute respiratory distress syndrome (ARDS)

A

Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli e.g. pulmonary oedema (non cardiogenic)

187
Q

Risk factors for ARDS

A 
Sepsis
Pancreatitis
Pneumonia
Trauma
Smoke inhalation
Heart/lung bypass
188
Q

Symptoms of ARDS

A

Dyspnoea
Tachycardia
Bilateral lung crackles
Low oxygen saturations

189
Q

Investigations for ARDS

A

Chest x-ray: Bilateral pulmonary infiltrates

ABG

190
Q

Diagnostic criteria for ARDS

A

Acute onset (within 1 week)
Chest x-ray: bilateral infiltrates
Non cardiogenic/pulmonary artery wedge pressure <19mmHg
PaO2 : FiO2 < 200

191
Q

Management for ARDS

A

Admit to ITU
Oxygenation/ventilation
Vasosuppression

192
Q

Define type 1 respiratory failure

A

Hypoxia (PaO2 <8kPa) without hypercapnia

193
Q

Define type 2 respiratory failure

A

Hypoxia (PaO2 <8kPa) with Hypercapnia (PaCO2>6kPA)

194
Q

Causes of type 1 respiratory failure

A 
Pneumonia
Pulmonary oedema
Asthma
PE
Fibrosis
Emphysema
ARDS
195
Q

Symptoms of type 1 respiratory failure

A 
Dyspnoea
Restlessness
Cyanosis
Cor pulmonale
Confusion
196
Q

Causes of type 2 respiratory failure

A 
Asthma 
COPD
Pneumonia
Obstructive sleep apnoea
Polyneuropathy
Mysasthenia gravis
Guillain-Barre syndrome
197
Q

Symptoms of type 2 respiratory failure

A 
Headache
Tachycardia
Papilloedema
Drowsiness
Coma
Confusion
198
Q

Management for type 1 respiratory failure

A

Oxygen - 35-60%

Ventilation

199
Q

Management for type 2 respiratory failure

A

Oxygen

200
Q

Investigations for respiratory failure

A 
ABG
FBC
Chest x-ray
Spirometry
Sputum
201
Q

Define Goodpasture’s disease

A

Associated with both pulmonary haemorrhage and rapidly progressive glomerulonephritis

202
Q

What causes Goodpasture’s disease

A

Anti-glomerular basement membrane (anti-GBM) antibodies against type IV collagen

203
Q

Risk factors for Goodpasture’s disease

A

Smoking

Young males

204
Q

Symptoms of Goodpasture’s disease

A

Cough
Haemoptysis
Dyspnoea
Fever

Oedema
Reduced urine output -> likely had recent URTI

205
Q

Investigations for Goodpasture’s disease

A

Chest x-ray: lower zone pulmonary infiltratres
Renal biopsy: crescentic glomerulonephritis
Urinalysis

206
Q

Treatment for Goodpasture’s disease

A

Plasmapheresis (plasma exchange)
Corticosteroids
Cyclophosphamide

207
Q

Define Wegener’s granulomatosis

A

Multisystem disorder of unknown cause characterised by necrotising granulmatous inflammation and vasculitis of small and medium vessels

208
Q

What systems does Wegener’s granulomatosis affect?

A

Upper and lower respiratory tract
Lungs
Kidneys

209
Q

Symptoms of Wegener’s granulomatosis

A 
Epistaxis
Nasal crusting
Sinusitis
Saddle shaped nose deformity
Nasal septum perforation

Cough
Dyspnoea
Wheeze
Haemoptysis

Rapidly progressing glomerulonephritis
Rashes
Proptosis
Arthralgia
Neuropathy
210
Q

What autoantibody is involved in Wegener’s granulomatosis?

A

c-ANCA

211
Q

Investigations for Wegener’s granulomatosis

A

c-ANCA positive (anti-PR3)
Urinalysis - haematuria + proteinuria
Renal biopsy
Chest x-ray

212
Q

Management for Wegener’s granulomatosis

A

Methylprednisolone
Cyclophosphamide
Plasma exchange
Methotrexate

213
Q

Triad involved in Churg-Strauss syndrome?

A

Asthma
Eosinophilia
Vasculitis

214
Q

Symptoms in Churg-Strauss syndrome

A 
Rhinitis
Sinusitis
Glomerulonephritis
Peripheral neuropathy
Purpura
215
Q

Investigations in Churg-Strauss syndrome

A

p-ANCA
FBC - raised eosinophils, anaemia, raised ESR/CRP
Chest x-ray: pulmonary infiltrates

216
Q

Management for Churg-Strauss syndrome

A

Corticosteroids

Asthma management

217
Q

Complications of bronchiectasis

A 
Pneumonia
Pleural effusion
Pneumothorax
Cerebral abscess
Amyloidosis
218
Q

Features of Kartagener’s syndrome

A

Dextrocardia (quiet heart sounds) or complete situs inversus
Bronchiectasis
Recurrent sinusitis
Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)

219
Q

Causes of upper lobe fibrosis

A 
SCART
Sarcoidosis
Coal worker's pneumoconiosis
Ankylosing spondylosis
Radiation
TB
220
Q

Who is Klebsiella pneumonia seen in?

A

Alcoholics
Aspiration pneumonia
Abscesses

221
Q

What features are seen in Klebsiella pneumonia?

A

‘red-currant jelly’ sputum

222
Q

Causes of lower lobe fibrosis

A 
RASCO
RA
Asbestosis
SLE/Systemic sclerosis
Cryptogenic fibrosing alveolitis
Other (drugs)

Phase 3b (18 decks)

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