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Module 2 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What becomes blocked in a PE?

A

Pulmonary arteries

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2
Q

Most common cause of a PE

A

A clot from the leg (DVT) embolising through the venous blood via the right-side of the heart into the pulmonary arteries

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3
Q

10 PE RF

A
  1. Malignancy
  2. Previous DVT/PE/varicose veins
  3. Surgery/leg fracture
  4. Immobility
  5. Pregnancy
  6. Oestrogen containing medication
  7. Thrombophilia
  8. SLE
  9. Polycythaemia
  10. I.E/post-MI
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4
Q

Pleuritic chest pain and a cough can be a sign of a

A

PE

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5
Q

ABG finding in someone with a PE

A

Respiratory alkalosis (low O2, low CO2)

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6
Q

Wedge-shaped markings on a CXR indicates

A

PE

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7
Q

Inverted T in V1-V4 on an ECG could suggest

A

PE - right ventricular strain

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8
Q

Gold-standard diagnosis for a PE

A

CT-PA

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9
Q

Contraindications for a CT-PA in suspected PE and what scan is recommended?

A
  1. Renal impairment
  2. Fertile women
  3. Contrast allergy

VQ scan

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10
Q

Management of a life-threatening PE

A

IV or catheter-directed thrombolysis of thrombolytic agents alteplase/tenecteplase

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11
Q

A patient develops a PE post-hip surgery. How long should they be anticoagulated for?

A

3 months as this is a reversible cause of a PE

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12
Q

A patient develops a PE with no known cause. How long must they be anti coagulated for?

A

Life-long as unknown cause

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13
Q

A person has recurrent PEs. How long must they be anti coagulated for?

A

Life-long

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14
Q

Anticoagulant for someone who is pregnant or has active cancer?

A

LMWH

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15
Q

A 30 year old woman develops a PE. What common medication must be stopped?

A

COCP

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16
Q

Cor pulmonale can be defined as

A

Pulmonary heart disease - Pulmonary artery hypertension that causes right-sided heart dysfunction + failure.

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17
Q

Acute cause of cor pulmonale

A

PE

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18
Q

Chronic cause of cor pulmonale

A

Inefficient gaseous exchange at alveoli - blood is directed away from alveoli backing up towards PA and right ventricle.

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19
Q

5 causes of cor pulmonale

A
  1. Lung disease - COPD, bronchiectasis, pulmonary fibrosis.
  2. PE
  3. Deformities (i.e. scoliosis, rib removal surgery)
  4. Neuromuscular disease (MG, MND)
  5. Hypoventilation (sleep apnoea)
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20
Q

General signs/symptoms of cor pulmonale

A

Systemic fluid congestion

  • Oedema
  • Raised JVP
  • Hepatomegaly
  • Dyspnoea
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21
Q

Cor pulmonale raises EPO levels leading to

A

Secondary polycythaemia

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22
Q

Raised Hb and haemocrit can be a sign of

A

Cor pulmonale

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23
Q

Raised P-wave in leads 2, 3 and aVF with right-axis deviation can indicate

A

Cor pulmonale

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24
Q

If haemocrit/erythrocyte levels rise too much in cor-pulmonale, what is the management?

A

Venesection - remove blood

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25
Q

Pulmonary hypertension is when the pulmonary artery pressure is > ?

A

25 mmHg

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26
Q

5 causes of PPH

A
  1. Idiopathic
  2. Drugs - Appetite suppressant pills, toxic rapeseed oil, amphetamines
  3. Collagen disorders (SLE, RA)
  4. Portal hypertension
  5. HIV
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27
Q

Secondary PH is caused by what 2 main conditions

A
  1. Left heart disease (back-flow of blood to the lungs)

2. Lung diseases (impaired gaseous exchange result in hypoxia pulmonary vasoconstriction)

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28
Q

What is a method of measuring pulmonary artery pressure?

A

Right heart catheterisation

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29
Q

Most common type of lung cancer

A

NSCLC

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30
Q

Most common type of NSCLC

A

Squamous

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31
Q

What lung cancer is commonly seen in ex-smokers?

A

Adenocarcinoma

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32
Q

What does SCLC promote the release of?

A

Neuroendocrine hormones leading to paraneoplastic syndromes

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33
Q

4 mets sites for lung Ca

A
  1. Brain
  2. Bone
  3. Liver
  4. Adrenal glands
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34
Q

The lungs are often the secondary met site in what cancer?

A

Breast, renal, thyroid

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35
Q

Loss of appetite and supraclavicular lymphadenopathy can be a sign of

A

Lung cancer

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36
Q

If someone with suspected lung cancer cannot undergo a biopsy, what investigation is recommended?

A

Cytology of sputum and/or pleural fluid

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37
Q

Automatic referral criteria for suspected lung cancer (2 points)

A
  1. CXR findings suggestive of lung cancer

2. Unexplained haemoptysis > 40 years

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38
Q

Recommended referral criteria for suspected lung cancer (5 points)

A

History of smoking/asbestos exposure and > 40 years

  1. Loss of appetite
  2. Unexplained chest pain
  3. Unexplained cough
  4. Unexplained dyspnoea
    +/- other respiratory/malignancy-like symptoms

Anyone: Finger clubbing > 40 years

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39
Q

Considerations for 2-week lung cancer referral pathway (4 points)

A
  1. Persistent/recurrent chest infections > 40 years
  2. Chest signs consistent with lung cancer/pleural disease
  3. Unexplained fatigue in someone with a smoking/asbestos history
  4. Lymphadenopathy
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40
Q

What type of lung cancer can be managed with surgery?

A

NSCLC

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41
Q

5 complications of lung cancer

A
  1. Nerve palsy - i.e. laryngeal and phrenic
  2. SVC obstruction
  3. Horner’s syndrome
  4. SCLC ectopic secretion
  5. Hypercalcaemia
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42
Q

Laryngeal nerve palsy in lung cancer presents with

A

Hoarseness/dysphonia

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43
Q

Phrenic nerve palsy in lung cancer presents with

A

Diaphragm weakness and SOB

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44
Q

SVC obstruction in lung cancer presents with (3 points)

A
  1. Pemberton’s sign: Facial congestion and cyanosis
  2. Facial swelling
  3. Distended veins in neck/upper chest
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45
Q

Horner’s syndrome triad

A

Partial ptosis/eyelid drooping, anhidrosis/no sweating, mitosis/constricted pupil

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46
Q

Horner’s syndrome is caused by what type of pulmonary apex tumour pressing on the sympathetic ganglion?

A

Pancoast

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47
Q

3 complications of SCLC ectopic secretion

A
  1. SIADH - ADH - hyponatraemia.
  2. Cushing’s syndrome - ACTH
  3. Anti-Hu antibodies - Limbic encephalitis - hallucinations/short term memory problems
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48
Q

SCC causes hypercalcaemia by the excess secretion of what hormone?

A

PTH

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49
Q

Mesothelial cells are what type of cell?

A

Squamous

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50
Q

Mesothelial cells are found in what 4 areas

A
  1. Pleura
  2. Peritoneum
  3. Pericardium
  4. Testicle sac
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51
Q

Recurrent pleural effusions alongside weight loss and chest pain could indicate

A

Mesothelioma

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52
Q

Carcinoid tumours are a type of neuroendocrine tumour of what cell type?

A

Enterochromaffin cell - neural crest - produce serotonin

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53
Q

What size are pulmonary nodules?

A

< 3cm

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54
Q

4 types of pulmonary nodules

A
  1. Malignant
  2. Infectious - varicella pneumonia, abscess
  3. Granulomas - TB, sarcoidosis
  4. Pneumoconiosis - dust inhalation inflammation
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55
Q

Fluid in a pleural effusion is trapped between which h2 pleural surfaces?

A

Parietal and visceral

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56
Q

Transudative pleural effusions are caused by

A

Excess fluid entering due to increased capillary pressure

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57
Q

3 causes of transudative pleural effusions

A
  1. CHF
  2. Cirrhosis/hypalbuminaemia
  3. Meig’s Syndrome
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58
Q

Transudative pleural effusions have a … protein count?

A

Low < 3 g/dL

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59
Q

Exudative pleural effusions have a… protein count?

A

High > 3 g/dL

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60
Q

Exudative pleural effusions are caused by

A

Inflammation causing leaky capillaries

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61
Q

3 causes of exudative pleural effusions

A
  1. Malignancy
  2. Pneumonia
  3. Inflammatory conditions - TB, RA
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62
Q

3 signs of pleural effusion

A
  1. Stony dullness on percussion
  2. Reduced breath sounds
  3. Tracheal deviation if pleural effusion is large
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63
Q

Pleural effusion CXR finding

A

Costophrenic angle blunting

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64
Q

Complication of a pleural effusion and what 3 aspiration results do you see?

A

Empyhema - acidic pH, low glucose, high LDL

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65
Q

A primary pneumothorax is caused by

A

Spontaneous rupture of a sub pleural bleb allowing air into pleural space

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66
Q

A secondary pneumothorax is caused by

A

Underlying pulmonary disease

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67
Q

Traumatic pneumothorax is caused by

A

Trauma i.e. stabbing

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68
Q

3 complications of a tension pneumothorax

A
  1. Lung collapse
  2. Tracheal deviation
  3. IVC kinking - reduced cardiac output/cardiorespiratory arrest

This is because the pneumothorax creates a one-way valve for air to enter but not escape, increasing lung pressure.

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69
Q

Management for a tension pneumothorax

A

Urgent needle decompression with a large bore cannula into 2nd intercostal space

Chest drain into triangle of safety

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70
Q

What is the triangle of safety and what does it avoid?

A

5th ICS, mid-axillary line, anterior-axillary line. Avoids neuromuscular bundle.

71
Q

Primary/secondary pneumothorax management

A
  1. No SOB and < 2cm - Spontaneous resolution with follow up
  2. SOB +/- > 2 cm - Aspiration and follow up
  3. If aspiration fails, chest drain
72
Q

Most common causative agent of pleurisy

A

Virus

73
Q

Management of viral pleurisy

A

NSAIDs

74
Q

Management of PPH (3 drugs)

A
  1. Prostanids - Epoprostenol
  2. Endothelin receptor antagonists - Macitentan
  3. Phosphodiestase-5 inhibitors
75
Q

Sarcoidosis can affect the…

A

Lungs, liver, eyes, skin, kidney, CNS, heart

76
Q

3 sarcoidosis lung manifestations

A
  1. Dry cough
  2. Mediastinal lymphadenopathy
  3. Pulmonary nodules
77
Q

3 skin manifestations of sarcoidosis

A
  1. Erythema nodosum - tender red nodules on shin
  2. Lupus pernio - Purple lesions on cheeks/nose
  3. Granulomas in scar tissue
78
Q

Lofgren’s syndrome triad

A
  1. Erythema nodosum
  2. Bilateral hilar lymphadenopathy
  3. Polyarthalgia
79
Q

Gold-standard for sarcoidosis diagnosis

A

Histology of biopsy taken from mediastinal lymph nodes in bronchoscopy

80
Q

3 blood test findings in sarcoidosis

A
  1. Raised ACE
  2. Raised soluble interleukin-2 receptor
  3. Raised Ca2+
81
Q

Management of sarcoidosis (3 points)

A
  1. Await spontaneous resolution (60% cases in 6 months)
  2. Corticosteroids and bisphosphonates
  3. DMARDs - Methotrexate or azathioprine
82
Q

Extrinsic allergic alveolitis is also known as

A

Hypersensitivity pneumonitis

83
Q

3 causes of extrinsic allergic alveolitis

A
  1. Bird exposure (bird-fanciers)
  2. Mould (AC units or hay/wood) - mushroom workers or farmers lung (hay mould) or malt workers (Barley mould)
  3. Chemicals (epoxy resin, spray-paint)
84
Q

3 types of pneumoconiosis

A
  1. Silicosis
  2. Coal workers’ pneumoconiosis/black lung disease
  3. Chronic beryllium disease
85
Q

4 drugs that cause pulmonary fibrosis

A
  1. Amiodarone
  2. Cyclophosphamide
  3. Methotrexate
  4. Nitrofurantoin
86
Q

CT findings in ILD

A

Ground-glass appearance

87
Q

3 signs/symptoms of ILD

A
  1. Exertional dyspnoea
  2. Non-productive cough
  3. Fine inspiratory crackles
88
Q

Most common causative agent for CAP?

A

Strep. pneumoniae

89
Q

Most common HAP causative agent

A

Staph. aureus

90
Q

Common bacteria that colonises the lungs of those with CF/bronchiectasis and causes pneumonia

A

Pseudomonas aeruginosa

91
Q

Staph aureus causes pneumonia in what group of immunocompromised patients?

A

CF patients

92
Q

Patient with long-standing bronchiectasis and COPD develops pneumonia. What is a likely causative agent?

A

Moraxella catarrhalis

93
Q

Fungal pneumonia is caused by?

A

Pneumocystis jiroveci

94
Q

3 signs/symptoms in a newly-diagnosed HIV+ patient with fungal pneumonia

A
  1. Non-productive dry cough
  2. Exertional dyspnoea
  3. Night sweats
95
Q

A young man complains of exertion dyspnoea and night sweats. He has been experiencing flu-like symptoms for some weeks now. What must be ruled out?

A

HIV

96
Q

Legionnaire’s Disease causes what electrolyte imbalance?

A

Hyponatraemia - SIADH

97
Q

What type of pneumonia causes erythema multiform (pink rings with pale centres - ‘target lesions’)?

A

Mycoplasma pneumoniae

98
Q

What type of pneumonia is caused by contact with animal bodily fluids?

A

Coxiella burnetti

99
Q

What type of pneumonia is caused by contact with infected birds?

A

Chlamydia psittaci

100
Q

What does CURB-65 stand for?

A 
Confusion
Urea > 7
RR > 30
BP < 90 or < 60
65 YO
101
Q

What CURB-65 will lead to hospital admission?

A

2+

102
Q

Legionnaire’s and pneumococcal pneumonias can be detected through what investigation

A

Urinalysis of urinary antigens

103
Q

1st line treatment for CAP (with and without penicillin allergy)

A

Amoxicillin or doxycycline

104
Q

1st line treatment for HAP

A

Piperacillin with tazobactam

105
Q

1st line treatment for fungal pneumonia

A

Co-trimaxazole

106
Q

Croup causes oedema/inflammation in the

A

Larynx

107
Q

Common cause of croup

A

Parainfluenza

108
Q

Lack of what vaccine can cause croup +/- epiglottitis?

A

Diphtheria

109
Q

What group of children is croup common in and what time of year?

A

< 3 years, autumn

110
Q

A barking cough and a hoarse cry are signs of

A

Croup

111
Q

Management for croup

A
  1. Supportive
  2. Dexamethasone
  3. Nebulised adrenalin
112
Q

RSV is caused by what family of viruses?

A

Pneumoviridae

113
Q

An expiratory wheeze throughout the chest alongside viral symptoms (fever, cough, dyspnoea) could be a sign of

A

RSV

114
Q

Whooping cough is caused by

A

Gram -ve Bordetella pertussis

115
Q

Whooping cough begins with

A

URTI symptoms

116
Q

The second phase of whooping cough involves

A

Paroxysmal severe coughing fits with inspiratory whooping, after around 1-2 weeks, may cause fainting or vomiting

117
Q

Whooping cough can last up to

A

100 days

118
Q

Complication of whooping cough

A

Bronchiectasis

119
Q

Most common cause of bronchiolitis

A

RSV

120
Q

Most common cause of epiglottitis

A

Haemophilus influenza B

121
Q

3 signs/symptoms of epiglottitis

A
  1. Stridor
  2. Odynophagia/sore throat
  3. Tripod position
122
Q

Neck XR findings in a child with epiglottitis

A

Thumbprint sign

123
Q

Empyema is defined as

A

Pus in the pleural space

124
Q

Haemagglutinin facilities

A

Viral entry

125
Q

Neuraminidase facilities

A

Virion release

126
Q

5 signs/symptoms of the flu

A
  1. Fever
  2. Headache
  3. Malaise
  4. Anorexia
  5. Myalgia
127
Q

2 drugs that can trigger asthmatic symptoms

A

NSAIDs and b-blockers

128
Q

FeNO score suggestive of asthma

A

> 40 ppb

129
Q

Spirometry (FEV1/FVC) score suggestive of obstructive airway disease

A

< 70%

130
Q

Peak flow score suggestive of asthma

A

> 20% variability after 2/day monitoring for 2-4 weeks

131
Q

1st line treatment for asthma

A

SABA (relieves symptoms)

132
Q

2nd line treatment for asthma

A

SABA and ICS

133
Q

3rd line treatment for asthma

A

SABA + ICS + LTRA

134
Q

4th line treatment for asthma

A

SABA + ICS + LABA +/- LTRA

135
Q

5th line treatment for asthma

A

SABA + MART + low ICS

136
Q

5 side effects of SABAs/LABAs (beta-adrenergic receptor agonists)

A
  1. Fine tremor
  2. Anxiety
  3. Dizziness
  4. Tachycardia
  5. Headache
137
Q

3 side effects from ICS

A
  1. Recurrent URTI
  2. Oral candidiasis
  3. Sore throat
138
Q

Example of a SAMA

A

Ipratopium bromide

139
Q

Side effect of ipratopium bromide

A

Acute glaucoma

140
Q

Side effect of the LAMA tiotropium

A

Cardiac arrhythmia risk

141
Q

A moderate asthma exacerbation is defined as

A

PEFR > 50-75% predicted with normal speech/no features of severe asthma

142
Q

Reasons for admission in someone with moderate asthma attack

A
  1. Past history of near-fatal asthma attack
  2. Recent asthma admission
  3. Live alone/learning disability/unsafe to be left
  4. Pregnancy
  5. Symptoms occurring in afternoon or night
143
Q

Define a severe asthma exacerbation

A

Oxygen sats > 92% with either

  • PEFR 33-50% predicted
  • RR > 25/min
  • HR > 110 bpm
  • Inability to complete sentences
  • Accessory muscle use
144
Q

Define a life-threatening asthma exacerbation

A 
33 92 CHEST
PEFR < 33%
O2 < 92%
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia
Confusion/altered consciousness
145
Q

3 symptoms in chronic bronchitis

A

Blue bloaters

  • Dyspnoea
  • Cyanosis
  • Productive cough
146
Q

2 symptoms in emphysema

A

Pink puffers

  • Facial flushing
  • Dyspnoea
147
Q

2 overall symptoms of COPD

A

Exertional dyspnoea and chronic productive cough

148
Q

Define acute COPD

A

Sustained worsening of a person’s symptoms from their usual stable state, usually due to viral infection

149
Q

2 FBC findings in someone with COPD

A

Anaemia and polycythaemia

150
Q

2 CXR findings in someone with COPD

A

Hyperinflation and flat hemidiaphragms

151
Q

ECG finding in someone with COPD

A

Right ventricular hypertrophy (cor pulmonale)

152
Q

ABG finding in someone with COPD

A

Low PaO2 +/- hypercapnia

153
Q

Management of a COPD patient with no asthmatic symptoms

A

SABA, LABA and LAMA

154
Q

Management of COPD patient with asthma

A

SABA, LABA and ICS

155
Q

5 complications of COPD

A
  1. Recurrent chest infections
  2. Cor pulmonale
  3. Polycythaemia due to excess EPO/hypoxia
  4. Type II respiratory failure
  5. Pneumothorax
156
Q

The MRC dyspnoea scale defines Grade 1 as

A

No trouble with breathlessness unless exercising strenuously

157
Q

The MRC dyspnoea scale defines Grade 3 as

A

Unable to walk at same pace as others, or stopping for a breath at own pace

158
Q

The MRC dyspnoea scale defines Grade 5 as

A

Breathless doing daily activity

159
Q

Sleep apnoea is defined as

A

Temporary pause in breathing to disrupt sleep

160
Q

3 causes of sleep apnoea

A
  1. Obstructive - pharyngeal muscles relax and occlude airway
  2. Central - brain stem becomes insensitive to rising CO2
  3. Mixed
161
Q

3 signs/symptoms of sleep apnoea

A
  1. Slow shallow breathing
  2. Snoring
  3. Daytime fatigue with headache
162
Q

Complications of sleep apnoea

A

HTN, MI, stroke

163
Q

Bronchiectasis can be defined as

A

Permanent dilation of bronchi due to destruction of the elastic and muscular components in the bronchial wall

164
Q

5 causes of bronchiectasis

A
  1. Severe LRTI - Whooping cough, TB, measles
  2. Congenital conditions - Cystic fibrosis
  3. HIV
  4. Asthma
  5. IBD
165
Q

Bronchiectasis CXR findings

A

Honeycombing, tram-lines, dilation of bronchi

166
Q

5 signs/symptoms of bronchiectasis

A
  1. Purulent sputum
  2. Productive cough
  3. Haemoptysis
  4. Coarse crackles
  5. Inspiratory squeaks
167
Q

Gold-standard for CF diagnosis

A

Sweat test

168
Q

CF is what type of genetic condition?

A

Autosomal recessive

169
Q

5 complications of CF

A
  1. Bacterial colonisation therefore frequent RTI
  2. Failure to thrive
  3. Malnutrition
  4. Pancreatic insufficiency
  5. Liver disease
170
Q

What is commonly seen in boys with CF?

A

Absence of vas deferens

171
Q

Most common CF mutation

A

deltaF508

172
Q

Alpha-1 antitrypsin deficiency causes what 3 health issues

A
  1. Liver cirrhosis
  2. Emphysema
  3. Premature COPD
173
Q

Biggest risk factor for developing alpha-1 antitrypsin deficiency complications

A

Smoking

174
Q

Management of a life-threatening asthma attack (7 steps)

A
  1. Admission to HDU/ITU
  2. Oxygen sats 94-98%
  3. O2-driven nebs - salbutamol and ipratropium bromide
  4. 50 mg prednisolone or 100 mg IV hydrocortisone
  5. IV MgSO4 over 20 mins
  6. Aminophylline over 20 mins
  7. IV salbutamol if unable to inhale

Module 2 (7 decks)

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