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Phase 2a > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What does rhinovirus cause?

A

Common cold
Bronchitis
Sinusitis

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2
Q

What does influenza A virus cause ?

A

Flu

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3
Q

List some common respiratory viruses

A

Rhinovirus
Influenza A virus
Coronavirus
Adenovirus

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4
Q

Pulmonary hypertension is defined as a pressure over how many mmHg?

A

25mmHg

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5
Q

Give 2 signs of Pulmonary Hypertension on chest X-ray?

A
  • Enlargement of the pulmonary arteries,
  • Lucent lung fields,
  • Enlarged right atrium,
  • Elevated cardiac apex due to right ventricular hypertrophy
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6
Q

Chemotherapy is a management option for patients with extensive lung cancer, what are the side effects of chemotherapy?

A

Alopecia, Nausea and Vomiting, Peripheral neuropathy, Constipation or Diarrhoea, Mucositis, Rash, Bone Marrow Suppression Anaemia, Fatigue, Anaphylaxis

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7
Q

Name 3 causes of a pleural effusion consisting of exudate

A
  • Malignancy (lung, breast, mesothelioma),
  • Infection (lung, pleural, abdominal),
  • Inflammatory (RA, SLE),
  • Pulmonary embolism,
  • Benign asbestos related,
  • Traumatic (haemothorax/chylothorax),
  • Drug reaction
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8
Q

What is the most common histological type of a non-small cell lung cancer?

A

Adenocarcinoma (40%)

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9
Q

Name the 2 conditions that constitute COPD?

A
  • Emphysema

- Chronic Bronchitis

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10
Q

Which specific blood marker supports the diagnosis of pulmonary embolism i.e. a negative test excludes a diagnosis of PE

A

Plasma D-Dimer

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11
Q

A 60 year old male presents to his GP with a four month history of a productive cough with bloodstained sputum. He reports feeling fatigued, has night sweats and thinks his clothes are loose on him, He’s a charity worker and recently visited Nigeria 6 months ago. On examination of his neck you palpate enlarged lymph nodes. Sputum sample reveals a growth of acid-fast bacilli.
What is the causative organism and what stain would you use to determine the causative organism obtained from a sputum sample?

A

Organism= Mycobacterium - tuberculosis, (1)

- Stain= Ziehl-Neelsen stain.

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12
Q

Giving values where appropriate state what the components of CURB 65

A
  • Confusion
  • Urea > 7mmol/L
  • Respiratory Rate > 30/min
  • Low BP (Systolic < 90 / Diastolic 60)
  • Age <65
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13
Q

What CURB65 score constitutes a hospital admission?

A

2

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14
Q

What is CURB65?

A

A measure of the severity of pneumonia

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15
Q

How should a CURB65 score of 2 be treated?

A

IV Amoxicillin and clarithromycin for 7-10 days

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16
Q

Name 3 clinical features of bronchiectasis

A
  • Persistent cough,
  • Purulent sputum
  • Clubbing,
  • Dyspnoea .
  • No history of smoking + young age of onset = raises suspicion of BE,
  • Haemoptysis,
  • Recurrent pulmonary infections
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17
Q

What is the management of severe acute extrinsic allergic alveolitis?

A
  • Remove/avoid exposure to allergen
  • Oxygen to treat hypoxaemia
  • Corticosteroids/ prednisolone
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18
Q

Asthma symptoms are caused by a narrowing of the airways, give 3 factors that contribute to the narrowing of the airways?

A
  • Inflammation of mucosa
  • Smooth muscle contraction leading to bronchoconstriction
  • Increased mucus production
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19
Q

Short-acting beta agonists (SABA) are prescribed from the management of asthma, give an example of a SABA and describe the method of action of this drug

A
  • SABA= Salbutamol
  • Action= Binds to beta-2 adrenoceptors present in the lungs leading to smooth muscle relaxation and therefore bronchodilation
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20
Q

Describe the blood gasses of type 1 and type 2 respiratory failure

A
  • Type 1 has hypoxaemia/Low O2 without hypercapnia/normal CO2
  • Type 2 has both hypoxaemia /Low O2 and hypercapnia/raised CO2
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21
Q

Name 2 tests you would use to diagnose cystic fibrosis?

A
  • Sweat test
  • Genetics F
  • Faecal elastase
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22
Q

What is an antigenic drift?

A

When there is a minor antigenic variation causing a seasonal epidemic

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23
Q

Give an example of an obstructive lung disease

A

COPD

Asthma

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24
Q

Give an example of a restrictive lung disease

A

Idiopathic pulmonary fibrosis

Sarcoidosis

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25
Q

A patient’s x Ray shows unusual interstitial pneumonia. What is it likely to be?

A

Idiopathic pulmonary fibrosis

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26
Q

What are the two main drugs for idiopathic pulmonary fibrosis?

A

Nintedanib

Pirfenidone

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27
Q

What type of hypersensitvity reaction is hypersensitivity pneumonitis?

A

III

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28
Q

If there is high lymphocytes on bronchoalveolar lavage, what does the patient likely have?

A

Hypersensitivity pneumonitis

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29
Q

What is the acronym CREST used for?

A

Systemic sclerosis

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30
Q

What does CREST stand for?

A 
Calcinosis
Raynauds pnenomenon
Oesophageal dysmotilitiy
sclerodactily
telangiectasia
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31
Q

What are common culprits for drug induced interstitial lung disease?

A

Nitrofurantoin
Methotrexate
Amiodarone
Bleomycin

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32
Q

What is type 1 resp failure?

A

Low PaO2 with normal or low PaCO2

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33
Q

What is type 2 resp failure?

A

Low PaO2 with a high PaCO2

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34
Q 
Which of the following causes a raised alveolar-arterial gradient?
Hypoventilation
V/Q mismatch
Anaemia
Diffusion impairment
Shunt (right to left)
A

V/Q Mismatch
Diffusion impairment
Shunt

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35
Q 
Which of these is a well-recognised response to hypoxia?
A) Bradycardia
B) Atrial fibrilation
C) Systemic vasoconstriction
D) Pulmonary Vasoconstriction
E) Syncope
A

D

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36
Q

What are the functions of the lung?

A 
Gas exchange 
Acid-base balance
Defense
Hormones
Heart exchange
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37
Q

What gene is affected in cystic fibrosis?

A

CFTR

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38
Q

How common is cystic fibrosis?

A

1 in 2500 live births in Northern Europe

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39
Q

What indicates airways obstruction?

A

A FEV1/FVC ratio (less than 0.7)

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40
Q

What indicates airways restriction?

A

A FVC below 80% of predicted

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41
Q

What does a low TLCO indicate?

A

Thickening of the alveolar-capillary membrane or reduced lung volume

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42
Q

What does a high TLCO indicate?

A

Increased capillary blood volume or pulmonary haemorrhage

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43
Q

Give 5 causes of respiratory failure

A
  1. Low oxygen delivery
  2. Airways obstruction
  3. Gas exchange limitation
  4. Ventilation mismatch
  5. Alveolar hypoventilation
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44
Q

What is an example of something that causes low oxygen delivery?

A

Altitude

Hypobaric chamber

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45
Q

What is an example of something that causes gas exchange limitation?

A

Lung fibrosis

Asbestosis

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46
Q

What is an example of something that causes ventilation mismatch?

A

Pneumonia
Pulmonary embolism
Pulmonary hypertension

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47
Q

What is an example of something that causes alveolar hypoventilation?

A

Emphysema
Muscular weakness
Reduced respiratory drive
Obesity

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48
Q

How is obstructive sleep apnoea usually treated?

A

Continuous positive airway pressure machine

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49
Q

How would neuromuscular disease leading to type 2 resp failure be treated?

A

BiPAP

Bilevel Positive Airway Pressure machine

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50
Q

A pregnant lady presents with hypocapnia and breathlessness, but no other gas abnormalities. She is hyperventilating, but her Aa shows low alveolar diffusion. What is it likely to be?

A

Pregnancy

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51
Q

Hypercapnia is associated with what symptom?

A

Headache

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52
Q

Are features of respiratory failure aggravated in the day time or at night?

A

Night

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53
Q

What are the 2 major types of asthma?

A

Eosinophillic asthma

Non eosinophillic asthma

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54
Q

What are the two types of eosinophilic asthma?

A

Atopic

Non atopic

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55
Q

What is the typical presenting complaint of asthma?

A

Episodic wheeze

Cough, breathlessness; typically worse in the morning

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56
Q

What is the difference between presentation in asthma and COPD?

A

Asthma typically is episodic with recovery periods in between, whereas COPD typically
gets worse gradually

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57
Q

What are the RCP3 questions?

A

Asthma severity

  • Recent nocturnal waking?
  • Usual asthma symptoms in a day?
  • Interference with ADLs?
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58
Q

What is Samter’s triad?

A

Asthma, sinus inflammation with recurring nasal polyps, and sensitivity to aspirin

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59
Q

What is Cushing’s triad indicative of?

A

Increased ICP

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60
Q

What is Cushing’s triad?

A

Bradycardia
Irregular respirations
Widened pulse pressure

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61
Q

Is a unilateral wheeze present in asthma?

A

No

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62
Q

Are crackles present in asthma?

A

No

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63
Q

Is asthma or COPD more reversible in testing?

A

Asthma

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64
Q

What is the first line treatment for asthma?

A

Mild SABA (Salbutamol)

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65
Q

What is the second line treatment for asthma?

A

Mild SABA (Salbutamol) + ICS (beclomethasone)

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66
Q

What is the third line treatment for asthma?

A

Milkd SABA (Salbutamol) + ICS (Beclomethasone) + LABA (Salmetrol)

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67
Q

Would biologicals be indicated in eosinophilic or non eosinophilic asthma?

A

Eosinophilic (only if severe and during an atopic attack)

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68
Q

What should be given in an acute asthma attack?

A
  • Oxygen therapy if needed
  • Nebulised 5mg salbutamol (SABA)
  • Ipratropium if life threatening
  • Predinisolone 30-60 mg with/without hydrocortisone IV
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69
Q

What would indicate a uncontrolled/ moderate asthma attack?

A

PEFR more than 50%
RR less than 25
Pulse less than 110
Normal speech, no other severe markers

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70
Q

What would indicate a severe asthma attack?

A

Any one of…

  • PEFR between 33-50% predicted
  • Resp rate over 25
  • Heart rate over 110
  • Inability to complete sentences
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71
Q

What would indicate a life-threatening asthma attack?

A

Any one of…

  • PERF less than 33%
  • SaO2 less than 92% or PaO2 less than 8kPa
  • Normal PaCO2
  • Altered consciousness
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72
Q

List the atypical pathogens that can cause community acquired pneumonia

A

Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, Coxiella burnetti

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73
Q

What is the most common identifiable cause of pneumonia

A

S. pneumoniae

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74
Q

What is the first line treatment for atypical community acquired pneumonia?

A

Clarithromycin

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75
Q

What is the first line treatment for pneumonia due to H. Influenzae?

A

Amoxicillin and doxycycline

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76
Q

What bacterial infection is likely in a pathogen that doesn’t grow on blood agar, grows on chocolate agar, and grows in the presence of factor X and V?

A

Haemophilius influenzae.

77
Q

List some methods of rapid testing for TB?

A
  • Mycobacteria growth indicator tube
  • PCR of culture
  • Xpert
78
Q

What is the most common cause of pneumoniae in a HIV patient?

A

P. jiroveci

79
Q

How is P. Jiroveci infection treated?

A

co-trimoxazole (trimethoprim/sulfamethoxazole)

80
Q

How would you treat an exacerbation of bronchiectasis due to pseudomonas?

A

An anti-pseudomonal beta lactam (e.g. piperacillin-tazobactam or ceftazidime) or fluoroquinolone (e.g. ciprofloxacin)

81
Q

What investigations should be done in a patient with suspected pneumonia?

A 
Chest X ray
FBC
Blood gasses
Sputum culture
Blood culture
Serology if viral infection suspected
Urine if legionella is suspected
82
Q

What does a “-sone” drug indicate?

A

Corticosteroids

83
Q

What does a “-terol” drug indicate?

A

Bronchodilators

84
Q

What does a “-nib” drug indicate?

A

Kinase inhibitors

85
Q

Where in the lungs has the slowest absorption?

A

Trachea and upper airway

86
Q

Give some examples of delivery systems for inhaled drugs?

A

Pressurized metered-dose inhalers
Spacer devices
Dry powder inhalers
Nebulizers

87
Q

What diseases are associated with bronchoconstriction?

A

Asthma

COPD

88
Q

What are the two types of bronchodilators?

A

Adrenergic

Anticholinergics

89
Q

Give an example of a SABA?

A

Salbutamol

90
Q

Give an example of a LABA

A

Formoterol and salmeterol

91
Q

Give an example of an anticholinergic bronchodilator

A

Ipratropium

Atropine

92
Q

List some inflammatory respiratory diseases

A

Pneumonia
Asthma
COPD
IPF

93
Q

What is the main type of anti-inflammatory drug used in the respiratory system

A

Inhaled corticosteroids e.g. Beclomethasone

94
Q

Are inhaled corticosteroids better in asthma or COPD?

A

Asthma

95
Q

What corticosteroid is used in covid-19?

A

Dexamethasone

96
Q

Give some common side effects of ICS

A

Loss of bone density
Adrenal suppression
Cataracts, glaucoma

97
Q

What does nintedanib inhibit?

A

Vascular endothelial growth factor receptor

98
Q

Is the aorta in the posterior or anterior aspect of the thorax?

A

Posterior

99
Q

What are the causes of lower lobe fibrosis?

A

IPF
Connective tissue disease
Drug induced
Rheumatoid arthritis.

100
Q

What are the causes of upper lobe fibrosis?

A

TB
Ank spon
sarcoidosis
Drug induced

101
Q

What would a “whiteout” on chest x ray indicate?

A

Fluid presence

102
Q

How much fluid is there usually in the pleural space?

A

5-10ml

103
Q

What is the function of pleural fluid?

A

Lubrication

104
Q

What is pneumothorax?

A

Presence of air in the pleural space

105
Q

Where should a cannula be inserted in a tension pneumothorax?

A

2nd IC space on same side as the pneumothorax

106
Q

What are the signs of pneumothorax?

A 
Tachypnoea
Hypoxia
Unilateral chest wall expansion
Reduced breath sounds
Hyper-resonant percussion note
107
Q

What are the 4 methods of treatment of pneumothorax?

A
  1. No intervention, high flow oxygen
  2. Pleural aspiration
  3. Chest drain
  4. Surgery
108
Q

What is a pleural effusion?

A

A collection of fluid in the pleural space

109
Q

What are the causes of transudate pleural effusions?

A 
Heart failure
Cirrhotic liver disease
Renal failure
Hypoalbinaemia
Myoedema
110
Q

What are the causes of exudate pleural effusions

A 
Pneumonia
Cancer
TB
Autoimmune disease
PE
111
Q

What is Meig’s syndrome?

A

benign ovarian tumor with ascites and pleural effusion

112
Q

What are the signs of a pleural effusion?

A

Reduced chest wall expansion
Quiet breath sounds
Stony dull percussion
Mediatational shift away from affected side

113
Q

What are the symptoms of pleural effusion?

A 
Asymptomatic
Breathlessness
Cough
Pain
Fever
114
Q

How is pleural effusion usually diagnosed?

A

Pleural fluid aspiration and chest x ray

115
Q

Where should a chest drain be inserted?

A

Under the armpit

116
Q

What is the male:female ratio of lung cancer?

A

2:1

117
Q

What are the symptoms of lung cancer?

A 
Cough
Recurrent chest infections
Haemoptysis
Increasing shortness of breath
Extra-pulmonary changes
General malaise
Weight loss
118
Q

What is a lung carcinoid?

A

A malignant tumour that has neuroendocrine secreting cells. They are less aggressive and may produce hormones.

119
Q

How are lung cancers staged?

A

TNM

120
Q

How are bronchial lymphoma treated?

A

Chemotherapy

121
Q

What type of lung cancer is most strongly associated with cigarette smoking?

A

Squamous cell carcinoma

122
Q

What type of lung cancer is most strongly associated with asbestos?

A

Mesothelioma

123
Q

Are pleural fibromas typically malignant or benign?

A

Benign

124
Q

What is asbestos typically linked with?

A

Plaques
Asbestosis
Mesothelioma
Effusion

125
Q

What is the typical life expectancy for mesothelioma?

A

8-12 months

126
Q

What is atelectasis?

A

Lung collapse

127
Q

What are the ways that asthma causes obstruction?

A
  • Mucus plugging of bronchi
  • Inflammation
  • Increased contraction of smooth muscle
128
Q

What is bronchiectasis?

A

Permenant dilation and thickening of the airways

129
Q

Does bronchiectasis typically affect upper or lower lobes?

A

Lower lobes

130
Q

What are the complications of bronchiectasis?

A 
Recurrent infection
Respiratory failure
Amyloid formation
Cor pulmonale
Metastatic abscesses
131
Q

What are “pink puffers” ?

A

Individuals with emphysematous damage leading to hyperventilation

132
Q

What are “blue bloaters”?

A

Individuals with chronic bronchitis leading to hypoxia and increased residual lung volume

133
Q

What is emphysema?

A

Enlargement of alveolar air spaces with destruction of the elastin in walls

134
Q

What are the 3 types of emphysema?

A

Centri-acinar
Pan-acinar
Irregular emphysema

135
Q

What are the classic features of IPF?

A
  • Breathlessness, non-productive cough
  • Clubbing
  • Malaise
  • Inspiratory basal crackles
136
Q

What is anthracosis?

A

The presence of coal dust pigment in the lung resulting in black sputum

137
Q

What condition is caplan’s syndrome associated with?

A

Rheumatoid arthritis

138
Q

What are giant cells associated with?

A

Granulomatous disorders such as sarcoidosis

139
Q

Give some immune defence mechanisms against resp tract infection

A
  • Mucociliary escalator
  • Cough and sneeze reflex
  • Cellular responses (Defensins, collectins, macrophages, B and T cells)
140
Q

What are crepitations?

A

Crackles

141
Q

Who is at risk of pneumonia?

A
  • Infants and the elderly
  • Pre existing lung disease
  • Immunocompromised
  • Impaired swallow
  • Diabetics
  • Congestive heart disease
  • Alcoholics and IV drug users
142
Q

What are strep pneumoniae?

A

Gram positive diplococci that are the main cause of pneumonia

143
Q

What usually causes pneumonia in cystic fibrosis patients?

A

pseudomonas aeruginosa

144
Q

What is lung consolidation?

A

When the air in the lungs is replaced with something else

145
Q

What is rusty sputum typical of?

A

S. Pneumoniae pneumonia

146
Q

What are the classic symptoms of pneumonia?

A
  • Fever, sweats and rigor
  • Cough with sputum
  • Shortness of breath
  • Pleuritic chest pain
147
Q

What are the signs of lung consolidation?

A

Dull to percussion
Decreased air entry
Crackles

148
Q

How would you diagnose legionella?

A

Urine antigen

149
Q

How would you treat pneumonia with a CURB65 score of 0-1?

A

Oral Amoxicillin

150
Q

How would you treat pneumonia with a CURB65 score of 2?

A

Oral Amoxicillin with clarithromycin

151
Q

How would you treat pneumonia with a CURB65 score of 3+?

A

IV Co-amoxiclav with clarithromycin

152
Q

What would a raised urea indicate?

A

Insulin resistance, iron overload, hypertension, hypothyroidism, chronic kidney disease, obesity, diet, thiazides, loop diuretics, pneumonia, and alcohol

153
Q

What is the urea limit for CURB65?

A

7 or over

154
Q

What is the resp rate limit for CURB65?

A

30 or over

155
Q

What is the blood pressure limit for CURB65?

A

Systolic under 90, or diastolic under 60

156
Q

What are the sepsis 6?

A

blood cultures, check full blood count and lactate, IV fluid challenge, IV antibiotics, monitor urine output and give oxygen if needed

157
Q

What CURB65 score needs to be admitted to hospital?

A

2 or above

158
Q

How would you treat legionella?

A

Fluoroquinolone with clarithromycin

159
Q

What is bronchitis typically caused by?

A

Viruses such as rhinovirus, adenovirus, influenza A and B

160
Q

What is the commonest cause of urti?

A

Viruses (rhinovirus)

161
Q

What is the commenest cause of flu?

A

Influenza A

162
Q

What is the commonest cause of pharyngitis?

A

Viral- rhinovirus, EBV

163
Q

What does a thick greyish membrane on the tonsils indicate?

A

Diphtheria

164
Q

What is the centor criteria?

A

Indicator for whether a sore throat is due to bacterial infection

165
Q

What does a thumb sign on X ray indicate?

A

Epiglottitis

166
Q

What bacteria causes whooping cough?

A

Bordetella pertussis

167
Q

What is a green throat swab for?

A

Viral infection

168
Q

How is TB treated?

A

RIPE

Rifampicin for 6 months, Isoniazid for 6 months, Pyrazinamide for 2 months, ethambutol for 2 months

169
Q

How is TB spread?

A

Spread in aerosol droplets

M Bovis is spread enterally (through cows milk)

170
Q

What is latent TB?

A

When there is no clinical disease. There may be tiny granulomata that become calcified- primary infection is contained but CMI persists

171
Q

How is latent TB diagnosed?

A

Tuberculin skin test “Mantoux” or IGRAs

172
Q

What percentage of people with TB will develop clinically evident pulmonary disease?

A

2-5%

173
Q

What disease is a primary ghon focus assocaited with?

A

TB

174
Q

What are the side effects of rifampicin?

A

Red urine, hepatitis, drug interactions

175
Q

What are the side effects of isoniazid?

A

Hepatitis, neuropathy

176
Q

What are the side effects of Pyrazinamide?

A

Hepatitis arthralgia/ gout, rash

177
Q

What are the side effects of ethambutol?

A

Optic neuritis (blurred vision)

178
Q

How is latent TB treated?

A

6 months of isoniazid, or 3 months of rifampicin+isoniazid

179
Q

What is classified as mild COPD?

A

FEV1 >80%

180
Q

What would a barrel shaped chest indicate?

A

COPD

181
Q

What is a MRC dyspnoea score of 1 indicate?

A

SOB on marked exertion

182
Q

What does a MRC dyspnoea score of 2 indicate?

A

SOB on hills

183
Q

What does a MRC dyspnoea score of 3 indicate?

A

Slow or stop on flat

184
Q

What does a MRC dyspnoea score of 4 indicate?

A

Exercise intolerance 100-200 yards on flat (have to stop to catch breath)

185
Q

What does a MRC dyspnoea score of 5 indicate?

A

Housebound/ SOB on minor tasks (getting dressed)

186
Q

What is the best method for reducing COPD progression?

A

Smoking cessation

187
Q

What is the first line pharmacological treatment of COPD?

A

SABA (Salbutamol)

188
Q

What is the second line pharmacological treatment of COPD?

A

SABA+ LABA

189
Q

What would a broncheoalveolar lavage with increased lymphocytes be indicative of?

A

Hypersensitivity pneumonitis

Phase 2a (31 decks)

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