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Year 4 General Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

clear and colourless sputum?

A

chronic bronchitis

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2
Q

yellow green sputum?

A

pneumonia

COPD exacerbation

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3
Q

frothy white/pink sputum?

A

pulmonary oedema

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4
Q

tidal volume

A

volume of air breathed in and out in a normal quiet breath

~500ml

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5
Q

inspiratory reserve volume

A

extra volume that can be inspired over and above the tidal volume

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6
Q

expiratory reserve volume

A

extra volume that can be expired over and below the tidal volume

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7
Q

residual volume

A

volume of air remaining in lungs after a maximal expiration

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8
Q

(forced) vital capacity

A

volume of air that can be exhaled after a maximal inspiration
TV + IRV + ERV

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9
Q

inspiratory capacity

A

TV + IRV

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10
Q

functional residual capacity

A

volume remaining in lungs after a quiet expiration

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11
Q

total lung capacity

A

total volume of air the lungs can hold

ie sum of all volumes

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12
Q

https://teachmephysiology.com/respiratory-system/ventilation/lung-volumes/

A

lung volumes

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13
Q

what is a normal FEV1/FVC ratio

A

~80%

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14
Q

what happens to the FEV1/FVC ratio in obstructive disease

A

FEV1 is reduced but FVC is normal so the ratio is <70%

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15
Q

what happens to the FEV1/FVC ratio in restrictive disease

A

FEV1 and FVC are both reduced but the ratio is >70%

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16
Q

what is the normal O2 sat target range for most people

A

94-98%

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17
Q

what is the normal O2 sat target for people with COPD

A

88-92%

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18
Q

describe type 1 resp failure

A

hypoxia

normal CO2

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19
Q

describe type 2 resp failure

A

hypoxia

hypercapnia

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20
Q

TLC and RV are increased/decreased in obstructive lung disease

A

increased in obstructive lung disease

decreased in restrictive lung disease

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21
Q

indications for bronchoalveolar lavage (BAL)

A

malignancy
pneumonia in immunosuppressed
TB
ILD

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22
Q

OSA can cause hyper/hypotension

A

hypertension

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23
Q

what is pneumonia

A

acute lower respiratory tract infection

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24
Q

what is community acquired pneumonia CAP and what are common causes

A

acquired in the community
most common cause - strep pneumoniae
HiB
mycoplasma

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25
Q

what are less common causes of CAP

A 
staph 
legionella 
moraxella 
chlamydia 
coxiella 
anaerobes 
viral
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26
Q

what is hospital acquired penumonia HAP

A

pneumonia >48hr after hospital admission

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27
Q

what bugs cause HAP

A 
gram negative enterobacteria 
staph 
pseudomonas 
klebsiella 
bacteroides 
clostridium
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28
Q

what is aspiration pneumonia

A

aspiration of gastric contents which enters the resp tract causing infection

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29
Q

RF for aspiration pneumonia

A 
stroke 
myasthenia gravis
bulbar palsies 
low GCS 
oesophageal disease
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30
Q

what bugs can cause pneumonia in immunocompromised people

A

PJP
fungi
viral

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31
Q

what bug is most likely to be the cause of pneumonia in a HIV patient and what is the treatment

A

PJP

co-trimoxazole

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32
Q

what bug is most likely to be the cause of pneumonia in PWID and what is the treatment

A

Staph A
flucloxacillin
(causes a bilateral cavitating bronchopneumonia)

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33
Q

what bug is most likely to be the cause of pneumonia in homeless/alcoholic/returned traveller/from asia and what is the treatment

A

TB

2 RIPE 4 RI antibiotics

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34
Q

what bug is most likely to be the cause of pneumonia in homeless/alcoholic/DM and what is the treatment

A

Klebsiella
cefotaxime / imipenem
causes a cavitating pneumonia

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35
Q

what bug is most likely to be the cause of pneumonia in bronchiectasis/CF/frequently hospitalised and what is the treatment

A 
pseudomonas 
ticarcillin
ciprofloxacin + gentamicin
ceftazidine 
meropenem
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36
Q

what bug is most likely to be the cause of pneumonia in returned travellers (from spain) and what is the treatment

A

legionella
levofloxacin
clarithromycin

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37
Q

what bug is most likely to be the cause of pneumonia in someone with pet bird/parrot and what is the treatment

A

chlamydophila psittaci

tetracyclines

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38
Q

what bug is most likely to be the cause of pneumonia in children and young adults and what is the treatment

A

mycoplasma pneumoniae
macrolides / tetracyclines / fluoroquinolone
‘walking wounded’

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39
Q

what bug is most likely to be the cause of pneumonia in farmers

A

coxiella burnetti

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40
Q

symptoms and signs of pneumonia

A 
fever 
cough 
malaise 
SOB
purulent sputum 
pleuritic chest pain 
haemoptysis 
cyanosis 
confusion (delirium) 
tachycardia 
bronchial breathing 
signs of consolidation
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41
Q

potential investigations for pneumonia

A 
ABCDE
O2 if hypoxic 
IV access for FBC, U+E, LFT, CRP, blood cultures, amylase, troponins
ECG 
erect CXR 
sputum culture 
CURB 65
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42
Q

tests for legionella pneumonia

A

sputum culture

urinary antigen / culture

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43
Q

what is the CURB 65 score

list its components

A 
used to assess severity of pneumonia, one point for each of the following: 
Confusion 
Urea >7 
RR >30 
BP S <90 or D <60 
65yr or older
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44
Q

approach to pneumonia depending on CURB 65 score

A

0-1: at home
2: hospital
>=3: severe, hospital admission and IV treatment

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45
Q

management of pneumonia in hospital

A 
PO/IV antibiotics 
IV fluids 
antiemetics 
analgesia 
oxygen if hypoxic 
CXR (and follow up at 6 weeks)
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46
Q

complications of pneumonia

A 
sepsis 
pleural effusion 
empyema 
lung abscess 
resp failure - type 1 
hypotension 
AF
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47
Q

who is eligible for the pneumococcal vaccine

A 
elderly 
immunocompromised - chemo, HIV, steroids
chronic heart/liver/renal/lung disease 
COPD 
asthma 
hyposplenism 
DM
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48
Q

what antibiotics should those with a CURB65 score of 0-2 for CAP receive

A

amoxicillin PO 5 days

allergic: doxycycline or clarithromycin

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49
Q

what antibiotics should those with a CURB65 score of 3-5 for CAP receive

A

IV co-amoxiclav + doxycycline

allergic: levofloxacin

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50
Q

what antibiotics should those with non-severe HAP receive

A

PO amoxicillin 5 days

allergic: doxycycline

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51
Q

what antibiotics should those with severe HAP receive

A

IV amoxicillin and gentamicin

allergic: IV co-trimoxazole + gentamicin

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52
Q

what antibiotics should those with non-severe aspiration pneumonia receive

A

PO amoxicillin + metronidazole

allergic: doxycycline + metronidazole

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53
Q

what antibiotics should those with severe aspiration pneumonia receive

A

IV amoxicillin + metronidazole + gentamicin

allergic: replace amox with doxycycline/clarithromycin

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54
Q

when do you give antibiotics for COPD exacerbations

A

increased purulent sputum and symptomatic

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55
Q

antibiotics for COPD exacerbation

A

amoxicillin

allergic: doxycycline

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56
Q

what is the most common type of pneumonia

A

pneumococcal pneumonia (strep pneumoniae)

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57
Q

diagnosis of mycoplasma pneumoniae

A

PCR sputum or serology

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58
Q

complications of mycoplasma pneumoniae

A

erythema multiforme
SJS
meningoencephalitis
GBS

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59
Q

features of legionnaire’s disease

A 
dry cough 
SOB 
water tank coloniser 
flu like symptoms 
bi basal consolidation 
deranged LFTs
abdominal pain
hyponatraemia
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60
Q

commonest viral cause of pneumonia

A

influenza

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61
Q

features of PJP pneumonia

A

SOB
dry cough
insidious onset
exertional dyspnoea

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62
Q

features of COVID-19 virus

A 
SOB 
cough 
ansomia 
loss of taste 
fatigue
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63
Q

what is SARS

A

severe acute respiratory syndrome

caused by SARS-CoV virus

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64
Q

features of empyema on aspiration

A

bright yellow
pH <7.2
low glucose and high LDH

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65
Q

flucloxacillin and co-amoxiclav can cause jaundice, true or false

A

true

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66
Q

what is bronchiectasis

A

persistent abnormal dilatation of the airways

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67
Q

features of bronchiectasis

A 
recurrent infections with: HiB, strep pneumoniae, staph a, pseudomonas
copious purulent sputum 
haemoptysis 
finger clubbing 
wheeze
68
Q

causes of bronchiectasis

A 
idiopathic 
CF 
Primary ciliary dyskinesia 
post infection 
ABPA 
RA 
UC
69
Q

in bronchiectasis, spirometry shows an obstructive/restrictive pattern

A

obstructive

70
Q

what is cystic fibrosis

A

AR condition causing a mutation in the CFTR gene on chromosome 7 leading to defective chloride secretion and increased Na absorption across airway epithelium
changes in airway surface liquid predispose to recurrent chronic infections and bronchietasis

71
Q

features of CF

A 
meconium ileus 
failure to thrive 
cough 
wheeze 
nasal polyps 
recurrent infections 
resp failure 
haemoptysis 
pancreatic insufficiency - DM, failure to absorb fat
gallstones 
male infertility 
osteoporosis 
sinusitis 
finger clubbing
72
Q

how can aspergillus affect the lungs

A
  1. asthma - type 1 hypersensitivity to fungal spores
  2. allergic bronchpulmonary aspergillosis - type 1 + 3 hypersensitivity
  3. aspergilloma
  4. invasive aspergillosis
  5. extrinsic allergic alveolitis
73
Q

RF for lung cancer

A

smoking
age
asbestos
radiation

74
Q

what are the different types of lung cancer

A 
Small cell (SCLC)
Non-small cell (NSCLC)
- squamous 
- adenocarcinoma 
- large cell
75
Q

symptoms of lung cancer

A 
chronic cough >3months 
SOB 
chest pain 
haemoptysis 
lethargy, malaise, fatigue 
weight loss 
hoarse voice (RLN palsy)
76
Q

signs of lung cancer

A 
cachectic 
anaemia 
finger clubbing 
paraneoplastic syndromes
lymphadenopathy
77
Q

small cell lung cancer is a neuroendocrine type tumour?

A

yes

78
Q

paraneoplastic syndromes associated with SCLC

A

SIADH: hyponatraemia
^ACTH secretion: Cushing’s syndrome
LEMS: antiCa channel Ab

79
Q

paraneoplastic syndromes associated with squamous cell lung cancer

A

PTHrp

80
Q

paraneoplastic syndromes associated with adenocarcinoma

A

HPOA

hypertrophic pulmonary osteoarthropathy

81
Q

pathophysiology behind squamous cell lung cancer

A

smoking results in metaplasia of columnar glandular lung tissue to stratified squamous cells (protective) which then becomes cancerous

82
Q

complications of lung cancer

A 
recurrent laryngeal nerve palsy - from compression of nerve hooking around hilum/aorta 
phrenic nerve palsy 
SVC obstruction 
Horner's syndrome 
rib erosion 
AF 
metastases: brain, bone, liver, lungs
83
Q

what is a Pancoast tumour and what is a potential complication

A

apical lung cancer

Horner’s syndrome from compression of the sympathetic nerves

84
Q

what is Horner’s syndrome

A

ptosis - partial
miosis - pupil constriction
anhydrosis - ipsilateral

85
Q

adenocarcinomas are more likely to be found centrally/peripherally

A

peripherally

86
Q

management of the following lung cancers:
SCLC
NSCLC

A

SCLC - chemotherapy

NSCLC - excision for peripheral tumours, radiotherapy, chemotherapy

87
Q

small cell lung cancer is more likely to metastasise fast/slow

A

fast

more likely to have disseminated disease early on

88
Q

what lung diseases can asbestos cause

A

pleural plaques

mesothelioma

89
Q

D.Dx of a lung nodule in a CXR

A 
malignancy 
abscess 
granuloma 
carcinoid tumour 
cyst 
hamartoma
90
Q

symptoms of asthma

A 
SOB 
dry cough 
nocturnal/early morning symptoms 
wheeze 
atopy 
tight chest
triggers: cold weather, exercise, NSAIDs, allergens
91
Q

stepwise approach to asthma therapy

A
  1. inhaled SABA - salbutamol
  2. ICS
  3. inhaled LABA
  4. increase dose of ICS
  5. consider leukotriene antagonist
92
Q

management for exercise induced asthma

A

leukotriene receptor antagonist
LABA
sodium cromoglicate
theophyllines

93
Q

when would you consider stepping up treatment wise in asthma

A

if using SABA >3 times a week

94
Q

asthma shows a restrictive/obstructive pattern on spirometry

A

obstructive

95
Q

management of acute asthma

A 
ABCDE
PEFR to determine severity 
O2 if hypoxic 
nebulised SABA
steroid: PO pred / IV hydrocortisone
nebulised ipratropium bromide
IV magnesium sulphate 
IV aminophylline
96
Q

symptoms of COPD

A

exertional dyspnoea
chronic cough (productive)
wheeze
exacerbations

97
Q

what red flags must you ask about in COPD

A 
unintentional weight loss 
chest pain 
peripheral oedema 
fatigue 
occupational hazards
haemoptysis
98
Q

investigations for COPD

A

spirometry
CXR
FBC
BMI

99
Q

what comprises COPD

A

emphysema and chronic bronchitis

100
Q

management of COPD

A 
lifestyle modifications: smoking cessation, exercise, pulmonary rehab, vaccination
SABA/SAMA
ICS
LAMA/LABA - non-asthmatic features
ICS/LABA - asthmatic features 
ICS/LABA/LAMA
PO steroids 
PO theophylline
101
Q

antibiotic of choice for prophylaxis in COPD

A

azithromycin

102
Q

indications for long term O2 therapy in COPD

A 
FEV1<30% 
cyanosis 
polycythaemia 
peripheral oedema 
raised JVP 
SaO2 <92% 
MUST NOT BE A SMOKER
103
Q

what is a cardiac complication of COPD

A

cor pulmonale

right heart failure secondary to lung disease

104
Q

what is acute respiratory distress syndrome ARDS

A

acute lung injury which may be caused by direct lung injury or secondary to systemic disease
lung damage and release of inflammatory mediators results in a non-cardiogenic pulmonary oedema often accompanied by multi-organ failure

105
Q

causes of ARDS

A 
pneumonia 
vasculitis 
contusion 
shock
sepsis 
DIC 
pancreatitis 
acute liver failure 
eclampsia 
drugs
106
Q

what is respiratory failure

A

inadequate gas exchange results in hypoxia

107
Q

what is type 1 resp failure

A

hypoxia only

108
Q

what is type 2 resp failure

A

hypoxia and hypercapnia

109
Q

T1RF is mainly caused by?

A 
VQ mismatch e.g. 
pneumonia 
pulmonary oedema 
PE 
asthma 
emphysema 
pulmonary fibrosis 
ARDS
110
Q

T2RF is mainly caused by?

A

alveolar hypoventilation e.g.
pulmonary disease: asthma, COPD, OSA, pneumonia
reduced resp drive: opiates, CNS tumour, trauma
neuromuscular disease
thoracic wall disease

111
Q

clinical features of hypoxia

A 
SOB 
restlessness 
agitation
confusion 
cyanosis
112
Q

clinical features of hypercapnia

A 
headache 
peripheral vasodilatation 
tachycardia 
bounding pulse 
tremor / flap 
papilloedema 
confusion
113
Q

what is a pulmonary embolus (PE) and list its causes

A 
clot that has broken off and lodged in the pulmonary circulation 
can arise from: 
DVT - most common
right ventricular thrombus 
septic emboli 
fat 
air 
amniotic fluid
tumour
114
Q

RF for PE/DVT

A 
immobility
recent surgery 
pregnancy 
contraception 
long haul flight 
cancer 
thrombophilia 
previous PE
115
Q

clinical features of PE

A 
swollen hot leg 
SOB 
chest pain 
haemoptysis 
dizziness 
tachycardia 
tachypnoea 
hypotension 
hypoxia
116
Q

investigations for PE

A 
FBC, U+E, LFT, CRP, d dimer, coagulation screen
ABG 
ECG 
CXR 
leg USS 
CTPA / VQ scan 
ECHO
117
Q

d dimer is a good test for DVT/PE?

A

no

it is sensitive but not specific ie if it is raised it does not confirm PE but if it is low it can exclude

118
Q

What is the Wells score

A

scoring system to estimate the probability of a PE

119
Q

a Wells score of ? is likely to be a PE

what is the management

A

> 4

arrange hospital admission for CTPA

120
Q

a Wells score of ? is not likely to be a PE

what is the management

A

<=4

arrange a d dimer with results available within 4 hours

121
Q

ECG patterns in PE

A

tachycardia
S1Q3T3
RBBB

122
Q

treatment of PE in hospital

A
  1. DOAC

2. thrombolysis (alteplase) for a massive PE and patient is haemodynamically unstable

123
Q

what is a pneumothorax

A

air in the pleural space

124
Q

RF for pneumothorax

A 
tall thin men 
CTD - Marfan's, Ehler-Danlos
smokers 
asthma 
COPD 
trauma 
iatrogenic - chest drain
125
Q

clinical features of pneumothorax

A

acute SOB
pleuritic chest pain
reduced breath sounds
hyperresonant percussion

126
Q

what makes a tension pneumothorax different from a pneumothorax

A

tracheal deviation

mediastinal shift

127
Q

with a tension pneumothorax, the trachea will be deviated away/towards the affected side

A

AWAY!!!

128
Q

management of a spontaneous pneumothorax >2cm

A

chest aspiration with cannula

if not improving or is a secondary pthx, insert a chest drain and admit

129
Q

small vs large pneumothorax?

A

small <2cm

large >2cm

130
Q

management of a tension pneumothorax

A

immediate call for help
needle decompression in 2nd ICS mid clavicular line on affected side
then a chest drain

131
Q

what is a pleural effusion

A

fluid in the pleural space

132
Q

pleural effusions can be transudate or exudate, what does this mean

A

transudate: <30g protein
organ failure, fluid overload, hypoproteinaemia, hypothyroidism, Meig’s syndrome
exudate: >30g protein
infection, cancer, inflammation

133
Q

what is a:
haemothorax
empyema
chylothorax

A

blood in the pleural space
pus in the pleural space
chyle in the pleural space

134
Q

clinical features of pleural effusion

A

asymptomatic
pleuritic chest pain
stony dull to percuss
reduced breath sounds

135
Q

large effusions can cause the trachea to deviate away/towards the affected side on CXR

A

away from affected side

136
Q

CXR feature of pleural effusion

A

blunting of costophrenic angle

137
Q

management of pleural effusion

A

chest drain / aspiration

138
Q

what is sarcoidosis

A

a multisystem non-caseating granulomatous disorder of unknown origin

139
Q

clinical features of sarcoidosis

A 
asymptomatic 
SOB 
cough 
erythema nodosum 
arthralgia 
bihilar lymphadenopathy 
hepatomegaly 
hypercalcaemia 
high serum ACE
140
Q

management of sarcoidosis

A

BHL alone - nothing
acute - bed rest, NSAIDs
Steroids: symptomatic, eye disease, ^Ca, neuro/cardiac involvement

141
Q

D.Dx for bihilar lymphadenopathy BHL

A

Cancer
sarcoidosis
infection - TB, mycoplasma
EAA

142
Q

what is ILD

A

interstitial lung disease is a generic term to describe diffuse lung disease / fibrosis / inflammation

143
Q

clinical features of ILD

A

SOB
cough non productive
abnormal breath sounds

144
Q

ILD is restrictive/obstructive

A

restrictive

145
Q

classification of ILD

A

known cause
associated with systemic disease
idiopathic

146
Q

known causes of ILD

A 
occupational e.g. asbestosis, silicosis 
drugs e.g. nitrofurantoin, bleomycin, amiodarone, sulfasalazine 
hypersenstivity e.g. EAA 
infection 
GORD
147
Q

systemic diseases causing ILD

A 
RA 
sarcoidosis 
SLE 
SS 
MCTD 
Sjogrens 
UC
148
Q

idiopathic causes of ILD

A

idiopathic pulmonary fibrosis

149
Q

What is Caplan’s syndrome

A

associated with RA, pneumoconiosis, and pulmonary rheumatoid nodules

150
Q

what is OSA

A

obstructive sleep apnoea is characterised by intermittent closure of pharyngeal airway causing episodes of apnoea during sleep

151
Q

RF for OSA

A

Male
obesity
macroglossia
Downs syndrome

152
Q

clinical features of OSA

A 
daytime somnolence 
loud snoring 
poor sleep quality 
morning headache 
decreased cognitive performance
HTN
change in personality
153
Q

complications of OSA

A

pulmonary HTN
type 2 resp failure
HTN

154
Q

Scoring system for OSA

A

Epworth sleepiness scale

155
Q

management of OSA

A

weight loss
avoid smoking and alcohol
CPAP at night

156
Q

what is cor pulmonale

A

right heart failure caused by chronic arterial pulmonary hypertension

157
Q

ABCDE of heart failure on CXR

A 
A - Alveolar oedema (Batwing opacities)
B - kerley B lines (interstitial oedema)
C - Cardiomegaly 
D - Dilated prominent upper lobe vessels 
E - pleural Effusions
158
Q

what is the TLCO test

A

Transfer factor for CO

assesses gas transfer of oxygen from lungs into blood

159
Q

idiopathic pulmonary fibrosis will have a low/high FEV1/FVC ratio and a low/high TLCO

A

high ratio

low TLCO

160
Q

what does a reduced TLCO mean?

A

reduced ability of the lungs to perform gas exchange

161
Q

what test is widely used for latent TB

A

Mantoux / tuberculin skin test

162
Q

if you have had the BCG vaccine, can you have a reaction to the Mantoux test?

A

yes, you may have a mild reaction

this does not necessarily mean you have TB

163
Q

what is IGRA

A

blood test for TB used following a positive Mantoux test

164
Q

causes of haemoptysis

A 
lung cancer / metastases 
lung abscess 
PE 
bronchiectasis / CF 
vasculitides: GPA, EGPA, Goodpasture's 
trauma 
AVM 
post surgery
165
Q

pulmonary causes of breathlessness

A

airway obstruction - tumour, infection, foreign body, asthma, COPD, bronchiectasis, cancer
parenchyma - fibrosis, sarcoid, TB, tumour, pneumonia
circulation - PE, vasculitis, pul HTN
pleural - effusion, pneumothorax
chest wall - scoliosis, kyphosis
neuromuscular - MG, GBS, MND

166
Q

non-pulmonary causes of breathlessness

A 
anaemia 
obesity 
pregnancy 
metabolic acidosis (DKA)
left HF 
psychogenic

Year 4 General Medicine (16 decks)

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