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Clinical Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

list the bedside tests in respiratory?

A

Sputum examination

Peak Expiratory Flow

Pulse oximetry

ABG

Spirometry

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2
Q

what happens to the FEV1/FVC in restrictive and obstructive airway disease?

A

Normal, 75-80%

>70% normal

<70% predicted

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3
Q

pneumonia can be classified as what?

A

Community aqcuired

Hospital acquired

Aspiration

immunocomprimised pt

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4
Q

clinical features of pneumonia?

A

Symptoms: fever, rigor, malaise, anorexia, dyspnoea, cough, purulent sputum, pleuritic chest pain

Signs: pyrexia, cyanosis, tachyponeic, tachycardic, signs of consolidation, pleural rub

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5
Q

how is severity assessed in pneumonia?

A

CURB65

Confusion

Urea

Resp rate >30/min

BP <90 systolic +/- 60 diastolic

>65yrs of age

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6
Q

how many points does each element of CURB65 score?

A

1pt for each

0-1, antibiotic/ home treatment

2, hospital therapy

3, severe pneumonia consider ITU

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7
Q

complications of pneumonia?

A

respiratory failure, hypotension, atrial fibrillation, pleural effusion, empyema lung abscess, septiceamia, pericarditis/ myocarditis, jaundice

repeat CXR/CRP in thsoe not responding to treatment to look for complications/progression

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8
Q

which is the most common bacterial pneumonia?

A

pneumococcal pneumonia

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9
Q

which pneumonia occurs as an epidemic every 4yrs?

A

mycoplasma pneumonia- presents insidiously with flu like symtpoms followed by dry cough

complications include skin rash, stevens johnson syndrome,

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10
Q

which population goups are more likely to suffer klebsiella pneumonia?

A

diabetics, alcoholics, elderly

particularly affects upper lobes

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11
Q

which pneumonia causes a bilateral cavitating bronchopneumonia?

A

staphylococcal pneumonia: may complicate influenze infection or occur in elderly/young, IVDU, those with underlying disease

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12
Q

hwo is leionella pneumonia diagnosed?

A

urine antigen/ culture

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13
Q

which pneumonia colonizes in water <60C?

A

legionella pneumonia

(typical in pools/ air conditioning)

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14
Q

which respiratory illness is acquired from infected birds (typically parrots)?

A

chlamydial psittaci

headache, fever, dry cough, patchy consolidation on CXR

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15
Q

which pneumonia commonly presents in the imunocompromised patient?

A

pneumocystitis pneumonia

dry cough, fever, bilateral crepitations, exertional dyspnoea

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16
Q

which organsism is responsile for pneumocystis pneumonia?

A

pneumocystis jiroveci

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17
Q

what is empyema?

A

pus in the pleural space

suspect if a pt with resolving pneumonia presents with recurring fever

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18
Q

chronic inflammation of the bronchi and bronchioles resulting in permanent dilation and thinning fo these airways is known as?

A

bronchiectasis

19
Q

what are the main organisms responsible for bronchiectasis?

A

H. influenzae, strep pneumoniae, staph aureus, pseudonmonas aeruginosa

20
Q

clinical features of bronchiectasis?

A

symptoms: persistent cough, purulent sputum, intermittent haemoptysis
signs: figner clubbing, crepitations, wheeze,

21
Q

how do you bronchiectasis?

A

airway clearance techniques: chest physiotherapy, mucolytics

Antibiotics (consider longterm if >3 exacerbations a year)

bronchodilators/ corticosteroids

22
Q

what is seen on this CT?

A

Bronchiectasis

23
Q

how many people carry a copy of the faulty gene for Cystic Fibrosis?

A

1:25 people

24
Q

Cystic fibrosis is caused by a mutation in which gene?

A

CFTR gene on chromosome 7

(CF transmembrane conductance regulator)

causes defective chloride secretion and increased sodium absoprtion across the airway epithelium

25
Q

CF features in neonates and young children

A

Neonates: failure to thrive, meconium ileus, rectal prolapse

young children: cough/wheeze, recurrent infections, pancreatic insufficiency (DM, steatorrhoea), dital intestinal obstruction syndrome,

26
Q

how is CF diagnosed?

A

sweat test: sodium and chloride >60mmol/L

genetic screening

further tests include: FBC, LFTs, annual glucose tolerance test, sputum cultures, CXR, Abdo US, Spirometry

27
Q

describe the management of CF?

A

Chest: physiotherapy, drainage, antibiotics, bronchodilatros, annual CXR

GI: look for any evidence of malabsoption, GORD, pancreatic dysfunction

28
Q

what are some mutation specific therapies for CF?

A

Ivacaftor

Lumacaftor

29
Q

symptoms of lung tumour?

A

cough, haemoptysis, dyspnoea, chest pain, lethargy, anorexia, wgt loss

30
Q

how are lung tumours differentiated?

A

Small cell lung cancer (SCLC)

Non-small cell lung cancer (NSCLC): Squamous, adenocarcinoma, large cell

31
Q

SCLC or NSCLC is more likely disseminated at presentation?

A

SCLC (70%) laready disseminated at presentation

32
Q

complications of lung tumours?

A

recurrent laryngeal nerve palsy, phrenic nerve palsy, SVC obstruction, Horners syndrome,

metastases to brain, bone, liver, adrenals

33
Q

describe a bronchial adenoma

A

rare, slow growing, 90% are carcinoid tumours

treat w surgery

34
Q

lung malignancy asocc w asbestos exposure?

A

mesothelioma: occurs in pleura

latent period of up to 45yrs fro time of exposure

35
Q

how is mesothelioma diagnosed?

A

Pleural thickening, effusion on CXR/CT

diagnosed with hisotology

36
Q

how is mesothelioma managed?

A

pemtrexed + cisplatin therapy can improve survival

pleurodesis/ indwelling intra pleural drain may help

(overall poor prognosis <2yrs)

37
Q

differential dagnoses of lung nodule on CXR?

A

malignancy primary/secondary, abscess, granuloma, carcinoid tumour, AVM, cyst

38
Q

if surgery is being considered with curative intent in lung cancer what should be carried out beforehand?

A

PET-CT

39
Q

treatment options for NSCLC and SCLC?

A

NSCLC: lobectomy for localised disease with curative intent. Radical radiotherapy for stage I,II,III. Chemo +/- Radiotherapy for more advanced disease i.e. cetuximab

SCLC: surgery if limited stage disease, Chemo +/- Radiotherapy if well enough, palliative radiotherapy/ drainage/drug therapy

40
Q

list the 5 ways aspergillus fungi affects the lungs?

A
  1. Asthma (Type I hypersensitivity)
  2. Allergic bronchopulmonary aspergillosis (ABPA, Type I +II hypersensitivity
  3. Aspergilloma (mycetoma), fungus ball within pre-existing cavity (i.e. TB/sarcoidosis)
  4. Invasive aspergillosis
  5. Extrinsic allergic alveolitis
41
Q

what three factors contribute to the airway narrowing seen in asthma?

A

bronchial muscle contraction, mucosal swelling/inflammation, inc musous production

42
Q

what symtpoms pattern is seen inasthma?

A

diurnal variation: symtpoms vary throughout the day

mornign dip of peak flow is common

43
Q

what are the treatment steps in asthma?

A

Clinical Medicine (1 decks)

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