Respiratory Flashcards
1
Q
What becomes blocked in a PE?
A
Pulmonary arteries
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
3
Q
10 PE RF
A
- Malignancy
- Previous DVT/PE/varicose veins
- Surgery/leg fracture
- Immobility
- Pregnancy
- Oestrogen containing medication
- Thrombophilia
- SLE
- Polycythaemia
- I.E/post-MI
4
Q
Pleuritic chest pain and a cough can be a sign of a
A
PE
5
Q
ABG finding in someone with a PE
A
Respiratory alkalosis (low O2, low CO2)
6
Q
Wedge-shaped markings on a CXR indicates
A
PE
7
Q
Inverted T in V1-V4 on an ECG could suggest
A
PE - right ventricular strain
8
Q
Gold-standard diagnosis for a PE
A
CT-PA
9
Q
Contraindications for a CT-PA in suspected PE and what scan is recommended?
A
- Renal impairment
- Fertile women
- Contrast allergy
VQ scan
10
Q
Management of a life-threatening PE
A
IV or catheter-directed thrombolysis of thrombolytic agents alteplase/tenecteplase
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
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
13
Q
A person has recurrent PEs. How long must they be anti coagulated for?
A
Life-long
14
Q
Anticoagulant for someone who is pregnant or has active cancer?
A
LMWH
15
Q
A 30 year old woman develops a PE. What common medication must be stopped?
A
COCP
16
Q
Cor pulmonale can be defined as
A
Pulmonary heart disease - Pulmonary artery hypertension that causes right-sided heart dysfunction + failure.
17
Q
Acute cause of cor pulmonale
A
PE
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.
19
Q
5 causes of cor pulmonale
A
- Lung disease - COPD, bronchiectasis, pulmonary fibrosis.
- PE
- Deformities (i.e. scoliosis, rib removal surgery)
- Neuromuscular disease (MG, MND)
- Hypoventilation (sleep apnoea)
20
Q
General signs/symptoms of cor pulmonale
A
Systemic fluid congestion
- Oedema
- Raised JVP
- Hepatomegaly
- Dyspnoea
21
Q
Cor pulmonale raises EPO levels leading to
A
Secondary polycythaemia
22
Q
Raised Hb and haemocrit can be a sign of
A
Cor pulmonale
23
Q
Raised P-wave in leads 2, 3 and aVF with right-axis deviation can indicate
A
Cor pulmonale
24
Q
If haemocrit/erythrocyte levels rise too much in cor-pulmonale, what is the management?
A
Venesection - remove blood
25
Pulmonary hypertension is when the pulmonary artery pressure is > ?
25 mmHg
26
5 causes of PPH
1. Idiopathic
2. Drugs - Appetite suppressant pills, toxic rapeseed oil, amphetamines
3. Collagen disorders (SLE, RA)
4. Portal hypertension
5. HIV
27
Secondary PH is caused by what 2 main conditions
1. Left heart disease (back-flow of blood to the lungs)
| 2. Lung diseases (impaired gaseous exchange result in hypoxia pulmonary vasoconstriction)
28
What is a method of measuring pulmonary artery pressure?
Right heart catheterisation
29
Most common type of lung cancer
NSCLC
30
Most common type of NSCLC
Squamous
31
What lung cancer is commonly seen in ex-smokers?
Adenocarcinoma
32
What does SCLC promote the release of?
Neuroendocrine hormones leading to paraneoplastic syndromes
33
4 mets sites for lung Ca
1. Brain
2. Bone
3. Liver
4. Adrenal glands
34
The lungs are often the secondary met site in what cancer?
Breast, renal, thyroid
35
Loss of appetite and supraclavicular lymphadenopathy can be a sign of
Lung cancer
36
If someone with suspected lung cancer cannot undergo a biopsy, what investigation is recommended?
Cytology of sputum and/or pleural fluid
37
Automatic referral criteria for suspected lung cancer (2 points)
1. CXR findings suggestive of lung cancer
| 2. Unexplained haemoptysis > 40 years
38
Recommended referral criteria for suspected lung cancer (5 points)
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
39
Considerations for 2-week lung cancer referral pathway (4 points)
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
40
What type of lung cancer can be managed with surgery?
NSCLC
41
5 complications of lung cancer
1. Nerve palsy - i.e. laryngeal and phrenic
2. SVC obstruction
3. Horner's syndrome
4. SCLC ectopic secretion
5. Hypercalcaemia
42
Laryngeal nerve palsy in lung cancer presents with
Hoarseness/dysphonia
43
Phrenic nerve palsy in lung cancer presents with
Diaphragm weakness and SOB
44
SVC obstruction in lung cancer presents with (3 points)
1. Pemberton's sign: Facial congestion and cyanosis
2. Facial swelling
3. Distended veins in neck/upper chest
45
Horner's syndrome triad
Partial ptosis/eyelid drooping, anhidrosis/no sweating, mitosis/constricted pupil
46
Horner's syndrome is caused by what type of pulmonary apex tumour pressing on the sympathetic ganglion?
Pancoast
47
3 complications of SCLC ectopic secretion
1. SIADH - ADH - hyponatraemia.
2. Cushing's syndrome - ACTH
3. Anti-Hu antibodies - Limbic encephalitis - hallucinations/short term memory problems
48
SCC causes hypercalcaemia by the excess secretion of what hormone?
PTH
49
Mesothelial cells are what type of cell?
Squamous
50
Mesothelial cells are found in what 4 areas
1. Pleura
2. Peritoneum
3. Pericardium
4. Testicle sac
51
Recurrent pleural effusions alongside weight loss and chest pain could indicate
Mesothelioma
52
Carcinoid tumours are a type of neuroendocrine tumour of what cell type?
Enterochromaffin cell - neural crest - produce serotonin
53
What size are pulmonary nodules?
< 3cm
54
4 types of pulmonary nodules
1. Malignant
2. Infectious - varicella pneumonia, abscess
3. Granulomas - TB, sarcoidosis
4. Pneumoconiosis - dust inhalation inflammation
55
Fluid in a pleural effusion is trapped between which h2 pleural surfaces?
Parietal and visceral
56
Transudative pleural effusions are caused by
Excess fluid entering due to increased capillary pressure
57
3 causes of transudative pleural effusions
1. CHF
2. Cirrhosis/hypalbuminaemia
3. Meig's Syndrome
58
Transudative pleural effusions have a ... protein count?
Low < 3 g/dL
59
Exudative pleural effusions have a... protein count?
High > 3 g/dL
60
Exudative pleural effusions are caused by
Inflammation causing leaky capillaries
61
3 causes of exudative pleural effusions
1. Malignancy
2. Pneumonia
3. Inflammatory conditions - TB, RA
62
3 signs of pleural effusion
1. Stony dullness on percussion
2. Reduced breath sounds
3. Tracheal deviation if pleural effusion is large
63
Pleural effusion CXR finding
Costophrenic angle blunting
64
Complication of a pleural effusion and what 3 aspiration results do you see?
Empyhema - acidic pH, low glucose, high LDL
65
A primary pneumothorax is caused by
Spontaneous rupture of a sub pleural bleb allowing air into pleural space
66
A secondary pneumothorax is caused by
Underlying pulmonary disease
67
Traumatic pneumothorax is caused by
Trauma i.e. stabbing
68
3 complications of a tension pneumothorax
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.
69
Management for a tension pneumothorax
Urgent needle decompression with a large bore cannula into 2nd intercostal space
Chest drain into triangle of safety
70
What is the triangle of safety and what does it avoid?
5th ICS, mid-axillary line, anterior-axillary line. Avoids neuromuscular bundle.
71
Primary/secondary pneumothorax management
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
Most common causative agent of pleurisy
Virus
73
Management of viral pleurisy
NSAIDs
74
Management of PPH (3 drugs)
1. Prostanids - Epoprostenol
2. Endothelin receptor antagonists - Macitentan
3. Phosphodiestase-5 inhibitors
75
Sarcoidosis can affect the...
Lungs, liver, eyes, skin, kidney, CNS, heart
76
3 sarcoidosis lung manifestations
1. Dry cough
2. Mediastinal lymphadenopathy
3. Pulmonary nodules
77
3 skin manifestations of sarcoidosis
1. Erythema nodosum - tender red nodules on shin
2. Lupus pernio - Purple lesions on cheeks/nose
3. Granulomas in scar tissue
78
Lofgren's syndrome triad
1. Erythema nodosum
2. Bilateral hilar lymphadenopathy
3. Polyarthalgia
79
Gold-standard for sarcoidosis diagnosis
Histology of biopsy taken from mediastinal lymph nodes in bronchoscopy
80
3 blood test findings in sarcoidosis
1. Raised ACE
2. Raised soluble interleukin-2 receptor
3. Raised Ca2+
81
Management of sarcoidosis (3 points)
1. Await spontaneous resolution (60% cases in 6 months)
2. Corticosteroids and bisphosphonates
3. DMARDs - Methotrexate or azathioprine
82
Extrinsic allergic alveolitis is also known as
Hypersensitivity pneumonitis
83
3 causes of extrinsic allergic alveolitis
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
3 types of pneumoconiosis
1. Silicosis
2. Coal workers' pneumoconiosis/black lung disease
3. Chronic beryllium disease
85
4 drugs that cause pulmonary fibrosis
1. Amiodarone
2. Cyclophosphamide
3. Methotrexate
4. Nitrofurantoin
86
CT findings in ILD
Ground-glass appearance
87
3 signs/symptoms of ILD
1. Exertional dyspnoea
2. Non-productive cough
3. Fine inspiratory crackles
88
Most common causative agent for CAP?
Strep. pneumoniae
89
Most common HAP causative agent
Staph. aureus
90
Common bacteria that colonises the lungs of those with CF/bronchiectasis and causes pneumonia
Pseudomonas aeruginosa
91
Staph aureus causes pneumonia in what group of immunocompromised patients?
CF patients
92
Patient with long-standing bronchiectasis and COPD develops pneumonia. What is a likely causative agent?
Moraxella catarrhalis
93
Fungal pneumonia is caused by?
Pneumocystis jiroveci
94
3 signs/symptoms in a newly-diagnosed HIV+ patient with fungal pneumonia
1. Non-productive dry cough
2. Exertional dyspnoea
3. Night sweats
95
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?
HIV
96
Legionnaire's Disease causes what electrolyte imbalance?
Hyponatraemia - SIADH
97
What type of pneumonia causes erythema multiform (pink rings with pale centres - 'target lesions')?
Mycoplasma pneumoniae
98
What type of pneumonia is caused by contact with animal bodily fluids?
Coxiella burnetti
99
What type of pneumonia is caused by contact with infected birds?
Chlamydia psittaci
100
What does CURB-65 stand for?
```
Confusion
Urea > 7
RR > 30
BP < 90 or < 60
65 YO
```
101
What CURB-65 will lead to hospital admission?
2+
102
Legionnaire's and pneumococcal pneumonias can be detected through what investigation
Urinalysis of urinary antigens
103
1st line treatment for CAP (with and without penicillin allergy)
Amoxicillin or doxycycline
104
1st line treatment for HAP
Piperacillin with tazobactam
105
1st line treatment for fungal pneumonia
Co-trimaxazole
106
Croup causes oedema/inflammation in the
Larynx
107
Common cause of croup
Parainfluenza
108
Lack of what vaccine can cause croup +/- epiglottitis?
Diphtheria
109
What group of children is croup common in and what time of year?
< 3 years, autumn
110
A barking cough and a hoarse cry are signs of
Croup
111
Management for croup
1. Supportive
2. Dexamethasone
3. Nebulised adrenalin
112
RSV is caused by what family of viruses?
Pneumoviridae
113
An expiratory wheeze throughout the chest alongside viral symptoms (fever, cough, dyspnoea) could be a sign of
RSV
114
Whooping cough is caused by
Gram -ve Bordetella pertussis
115
Whooping cough begins with
URTI symptoms
116
The second phase of whooping cough involves
Paroxysmal severe coughing fits with inspiratory whooping, after around 1-2 weeks, may cause fainting or vomiting
117
Whooping cough can last up to
100 days
118
Complication of whooping cough
Bronchiectasis
119
Most common cause of bronchiolitis
RSV
120
Most common cause of epiglottitis
Haemophilus influenza B
121
3 signs/symptoms of epiglottitis
1. Stridor
2. Odynophagia/sore throat
3. Tripod position
122
Neck XR findings in a child with epiglottitis
Thumbprint sign
123
Empyema is defined as
Pus in the pleural space
124
Haemagglutinin facilities
Viral entry
125
Neuraminidase facilities
Virion release
126
5 signs/symptoms of the flu
1. Fever
2. Headache
3. Malaise
4. Anorexia
5. Myalgia
127
2 drugs that can trigger asthmatic symptoms
NSAIDs and b-blockers
128
FeNO score suggestive of asthma
> 40 ppb
129
Spirometry (FEV1/FVC) score suggestive of obstructive airway disease
< 70%
130
Peak flow score suggestive of asthma
> 20% variability after 2/day monitoring for 2-4 weeks
131
1st line treatment for asthma
SABA (relieves symptoms)
132
2nd line treatment for asthma
SABA and ICS
133
3rd line treatment for asthma
SABA + ICS + LTRA
134
4th line treatment for asthma
SABA + ICS + LABA +/- LTRA
135
5th line treatment for asthma
SABA + MART + low ICS
136
5 side effects of SABAs/LABAs (beta-adrenergic receptor agonists)
1. Fine tremor
2. Anxiety
3. Dizziness
4. Tachycardia
5. Headache
137
3 side effects from ICS
1. Recurrent URTI
2. Oral candidiasis
3. Sore throat
138
Example of a SAMA
Ipratopium bromide
139
Side effect of ipratopium bromide
Acute glaucoma
140
Side effect of the LAMA tiotropium
Cardiac arrhythmia risk
141
A moderate asthma exacerbation is defined as
PEFR > 50-75% predicted with normal speech/no features of severe asthma
142
Reasons for admission in someone with moderate asthma attack
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
Define a severe asthma exacerbation
Oxygen sats > 92% with either
- PEFR 33-50% predicted
- RR > 25/min
- HR > 110 bpm
- Inability to complete sentences
- Accessory muscle use
144
Define a life-threatening asthma exacerbation
```
33 92 CHEST
PEFR < 33%
O2 < 92%
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachycardia
Confusion/altered consciousness
```
145
3 symptoms in chronic bronchitis
Blue bloaters
- Dyspnoea
- Cyanosis
- Productive cough
146
2 symptoms in emphysema
Pink puffers
- Facial flushing
- Dyspnoea
147
2 overall symptoms of COPD
Exertional dyspnoea and chronic productive cough
148
Define acute COPD
Sustained worsening of a person's symptoms from their usual stable state, usually due to viral infection
149
2 FBC findings in someone with COPD
Anaemia and polycythaemia
150
2 CXR findings in someone with COPD
Hyperinflation and flat hemidiaphragms
151
ECG finding in someone with COPD
Right ventricular hypertrophy (cor pulmonale)
152
ABG finding in someone with COPD
Low PaO2 +/- hypercapnia
153
Management of a COPD patient with no asthmatic symptoms
SABA, LABA and LAMA
154
Management of COPD patient with asthma
SABA, LABA and ICS
155
5 complications of COPD
1. Recurrent chest infections
2. Cor pulmonale
3. Polycythaemia due to excess EPO/hypoxia
4. Type II respiratory failure
5. Pneumothorax
156
The MRC dyspnoea scale defines Grade 1 as
No trouble with breathlessness unless exercising strenuously
157
The MRC dyspnoea scale defines Grade 3 as
Unable to walk at same pace as others, or stopping for a breath at own pace
158
The MRC dyspnoea scale defines Grade 5 as
Breathless doing daily activity
159
Sleep apnoea is defined as
Temporary pause in breathing to disrupt sleep
160
3 causes of sleep apnoea
1. Obstructive - pharyngeal muscles relax and occlude airway
2. Central - brain stem becomes insensitive to rising CO2
3. Mixed
161
3 signs/symptoms of sleep apnoea
1. Slow shallow breathing
2. Snoring
3. Daytime fatigue with headache
162
Complications of sleep apnoea
HTN, MI, stroke
163
Bronchiectasis can be defined as
Permanent dilation of bronchi due to destruction of the elastic and muscular components in the bronchial wall
164
5 causes of bronchiectasis
1. Severe LRTI - Whooping cough, TB, measles
2. Congenital conditions - Cystic fibrosis
3. HIV
4. Asthma
5. IBD
165
Bronchiectasis CXR findings
Honeycombing, tram-lines, dilation of bronchi
166
5 signs/symptoms of bronchiectasis
1. Purulent sputum
2. Productive cough
3. Haemoptysis
4. Coarse crackles
5. Inspiratory squeaks
167
Gold-standard for CF diagnosis
Sweat test
168
CF is what type of genetic condition?
Autosomal recessive
169
5 complications of CF
1. Bacterial colonisation therefore frequent RTI
2. Failure to thrive
3. Malnutrition
4. Pancreatic insufficiency
5. Liver disease
170
What is commonly seen in boys with CF?
Absence of vas deferens
171
Most common CF mutation
deltaF508
172
Alpha-1 antitrypsin deficiency causes what 3 health issues
1. Liver cirrhosis
2. Emphysema
3. Premature COPD
173
Biggest risk factor for developing alpha-1 antitrypsin deficiency complications
Smoking
174
Management of a life-threatening asthma attack (7 steps)
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
