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Yr 4 - CCC > Respiratory Corrections 3 > Flashcards

Respiratory Corrections 3 Flashcards

1
Q

What appearance of the lung tissue is seen on a high-resolution CT scan in pulmonary fibrosis? (1)

A

‘Ground glass’ appearance

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2
Q

What is the characteristic histology finding in sarcoidosis? (1)

A

Non-caseating granulomas with epithelioid cells

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3
Q

What electrolyte abnormality is commonly seen in sarcoidosis? (1)

A

Hypercalcaemia

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4
Q

How does sarcoidosis cause hypercalcemia?

A

Due to the uncontrolled synthesis of 1,25-dihydroxyvitamin D3 by macrophages (i.e. active form of vitamin D).

Active form of vitamin D results in an increased absorption of calcium in the intestine.

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5
Q

What is the test of choice for diagnosing bronchiectasis? (1)

A

High resolution CT (HRCT)

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6
Q

What is the normal PaO2 of arterial blood? (1)

A

10.7-13.3 kPa

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7
Q

What is the initial medical management of a massive pulmonary embolism with haemodynamic compromise? (2)

A

1) Continuous infusion of UH
2) Consider thrombolysis with alteplase

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8
Q

What type of atypical pneumonia may be contracted from infected birds, including parrots? (1)

A

Chalmydia psittaci

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9
Q

What classes of medication can be used to treat pulmonary hypertension? (4)

A

1) Calcium channel blockers

2) PDE-5 inhibitors e.g. sildenafil

3) IV prostaglandins e.g. epoprostenol

4) Endothelin receptor antagonists e.g. macitentan

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10
Q

What is used as a screening blood test for sarcoidosis? (1)

A

Serum ACE (angiotensin converting enzyme)

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11
Q

What is a serum marker that is increased in sarcoidosis?

A

ACE

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12
Q

Why is ACE raised in sarcoidosis?

A

ACE is produced by the epithelioid cells that are derived rom recently-activated macrophages in granulomas.

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13
Q

What nerve palsy in a patient with lung cancer causes diaphragm weakness and worsened shortness of breath? (1)

A

Phrenic nerve palsy

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14
Q

What scoring system is used to assess sleepiness associated with obstructive sleep apnoea? (1)

A

Epworth sleepiness scale

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15
Q

What is targeted and damaged in patients with Lambert-Eaton myasthenic syndrome? (3)

What type of lung cancer is this associated with? (1)

What is the main presenting feature of this syndrome? (1)

A

Voltage gated calcium channels on the PRE-synaptic terminals of MOTOR neurones.

Small cell lung cancer

Proximal muscle weakness

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16
Q

What two medications are licensed for slowing disease progression in idiopathic pulmonary fibrosis? (2)

A

1) Pirfenidone

2) Nintedanib

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17
Q

Why might a patient with lung cancer develop a hoarse voice? (1)

A

tumour pressing on the recurrent laryngeal nerve

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18
Q

What can determine whether obstructive lung disease is caused by COPD or asthma during routine lung function tests? (1)

A

Reversibility testing (obstruction is reversible in asthma but not COPD)

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19
Q

What is the name for minimally invasive “keyhole” surgery to treat lung pathology, such as cancer? (1)

A

Video assisted thoracoscopic surgery (VATS)

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20
Q

What 2 specific medication options are recommended first-line for treating a pulmonary embolism in stable patients?

A

Apixaban
Rivaroxaban

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21
Q

What is the normal PaCO2 of arterial blood? (1)

A

4.7-6.0 kPa

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22
Q

What is the triad of features of yellow nail syndrome? (3)

A

1) Yellow, hard nails

2) Lymphoedema

3) Bronchiectasis

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23
Q

What term describes the volume of air pushed in per breath during mechanical ventilation? (1)

A

Tidal volume

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24
Q

How might lung cancer cause hypercalcaemia? (2)

A

1) Ectopic production of PTHrP by squamous cell carcinoma

2) Bone mets

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25
Q

What point of care test may be used in primary care to indicate whether a patient presenting with features of a lower respiratory tract infection will benefit from antibiotics? (1)

A

CRP

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26
Q

What type of atypical pneumonia is most associated with hyponatraemia? (1)

A

Legionella pneumophila

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27
Q

What are the top causes of transudative pleural effusions? (4)

A

1) HF
2) Hypoalbuminaemia
3) Meig’s syndrome
4) Hypothyroidism

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28
Q

What is the usual first-line medication for treating sarcoidosis? (1)

A

Oral steroids

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29
Q

What tool can be used when the clinician estimates less than a 15% probability of a pulmonary embolism to decide whether further investigations for a PE are needed? (1)

A

PERC rule (PE rule out criteria)

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30
Q

What genetic condition may be tested for in a non-smoker with early-onset COPD? (1)

What is the screening test for this? (1)

A

Alpha-1 antitrypsin deficiency

Serum alpha-1 antitrypsin

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31
Q

What investigation is required before initiating NIV (other than ABGs)? (1)

A

CXR

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32
Q

What is the usual duration of antibiotics in patients with an infective exacerbation of bronchiectasis? (1)

A

7-14 days

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33
Q

What antibodies are linked with limbic encephalitis as a paraneoplastic syndrome associated with lung cancer? (1)

A

Anti-Hu antibodies

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34
Q

What are the indications for long-term oxygen therapy in severe COPD? (4)

What is the most common contraindication? (1)

A

Indications:
1) Chronic hypoxia (SpO2 <92%)
2) Polycythaemia
3) Cyanosis
4) Cor pulmonale

Contraindication –> Smoking

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35
Q

Who should LTOT be offered to in COPD?

A

1) Patients with a pO2 of <7.3 kPa

or

2) Those with a pO2 of 7.3-8 kPa AND one of:
a) 2ary polycythaemia
b) peripheral oedema
c) pulmonary HTN

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36
Q

What is the second-line medical treatment of COPD where there are no asthmatic or steroid-responsive features?

A

SABA as required

LABA + LAMA

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37
Q

What type of fungal pneumonia typically occurs in immunocompromised patients, such as those with end-stage HIV? (1)

What medication may be taken prophylactically in patients at risk of this condition? (1)

A

Pneumocystic jirovecii pneumonia (PCP)

Co-trimoxazole (trimethorpim + sulfamethoxazole)

38
Q

What blood test finding is an indication for urgent investigation for lung cancer? (1)

A

Thrombocytosis

39
Q

What common classes of medication worsen the symptoms of asthma? (2)

A

NSAIDs & beta blockers

40
Q

What scale can be used for rating breathlessness in a patient with COPD? (1)

A

MRC Dyspnoea Scale (medical research council)

41
Q

What sites are options for inserting a large bore cannula for emergency management of a tension pneumothorax? (2)

A

1) 2nd intercostal space in midclavicular line

2) 4th or 5th intercostal space anterior to the midaxillary line

42
Q

What is the meaning of FiO2? (1)

A

Fraction of inhaled O2 (the O2 concentration of the inhaled gas)

43
Q

What complications is obstructive sleep apnoea strongly associated with?

A

CVS complications e.g. stroke, coronary artery disease, AF, HF and T2DM.

Depression.

Work-related injuries.

RTCs.

44
Q

What is the next step in patients with a solitary pulmonary nodule ≥8mm if the patient is fit for surgery?

A

CT guided percutaneous transthoracic needle aspiration biopsy (TTNB)

45
Q

What is the next step in patients with a solitary pulmonary nodule ≥8mm if the patient is NOT fit for surgery?

A

Serial CT imaging for 2 years

46
Q

What is the next step in patients with a solitary pulmonary nodule <4mm in size?

A

Serial CT imaging for 2 years

47
Q

What is the next step in patients with a solitary pulmonary nodule <3mm in size?

A

Observation with no further workup

48
Q

High resolution CT findings in idiopathic pulmonary fibrosis? (3)

A

1) honeycombing

2) traction bronchiectasis

3) bibasilar reticular opacities

49
Q

Radiological findings in PCP?

A

Bilateral interstitial infiltrates

50
Q

What is P pulmonale ?

A

Right atrial abnormality seen on ECG as tall, peaked P waves

51
Q

What does P pulmonale indicate?

A

Pulmonary HTN (cause of right atrial enlargement)

52
Q

What are some causes of ARDS? (7)

A

1) Pneumonia
2) Sepsis
3) Aspiration
4) Pancreatitis
5) Transfusion reactions (TRLI)
6) Trauma & fractures
7) Fat embolism

53
Q

Signs & symptoms of ARDS?

A
  • Severe SOB
  • Tachypnoea
  • Confusion
  • Presyncope

Exam:
- Fine bibasal crackles but NO other features of HF

54
Q

Management of ARDS?

A

Supportive:
- Low tidal volume mechanical ventilation
- Haemodynamic support to maintain mean arterial pressure >60 mmHg
- DVT prophylaxis
- Nutritional support

55
Q

1st line immediate management of SVCO?

A

Oral dexamethasone

56
Q

Which type of pneumonia is also associated with herpes?

A

Strep. pneumoniae

57
Q

Does RA cause lung fibrosis in the lower or upper zones?

A

Lower zones

58
Q

Name 2 drugs that cause lower zone lung fibrosis

A

Methotrexate & bleomycin

59
Q

Can recurrent lung abscesses cause clubbing?

A

Yes

60
Q

What are 4 indications for lung reduction surgery in chronic COPD?

A

1) they have upper lobe predominant emphysema
2) FEV1 >20% predicted
3) paCO2 <7.3 kPa
4) TLCO >20% predicted

61
Q

What dermatological manifestation is mycoplasma pneumoniae associated with?

A

Erythema multiforme

62
Q

Describe erythema multiforme

A

Multiple erythematous papules with deeply erythematous borders

63
Q

Mx of COPD exacerbation?

A

1) O2 sats, aiming for 88-92%

2) Salbutamol via inhaler or nebuliser (dependent on severity)

3) Muscarinic antagonist (e.g. tiotropium or ipratropium) via inhaler or nebuliser

4) Corticosteroid e.g. oral pred

5) Abx for potential infection

64
Q

How can severe obesity affect lung function tests?

A

Can cause restrictive picture

65
Q

How is gas transfer in lungs affected in severe obesity vs idiopathic pulmonary fibrosis?

A

Severe obesity: normal

IPD: reduced

66
Q

What FeNO criteria is diagnostic of asthma?

A

Exhaled FeNO of ≥40 parts per billion

67
Q

What post-bronchodilator improvement is diagnostic of asthma? (2)

A

1) Improvement in FEV1 ≥12%

2) Improvement in lung volume of 200ml

68
Q

What is the most common form of asbestos-related lung disease?

A

Pleural plaques

69
Q

1st line management of HAP?

A

Co-amoxiclav

70
Q

What condition are ‘cannonball mets’ in the lungs most commolny associated with?

What investigation would you then get?

A

Renal cell cancer

CT abdomen

71
Q

3 aspects of discharge advice following a pneumothorax?

A

1) Smoking cessation

2) Fitness to fly –> can fly 1 week post check XR

3) Scuba diving –> permanently avoid

72
Q

How is a definitive diagnosis of mesothelioma made?

A

Thoracoscopy followed by histology

73
Q

A suspicious lung mass is found on a chest X-ray.

What investigation is most appropriate next?

A

Contrast enhanced CT scan (of chest, liver and adrenals)

74
Q

Why is a contrast CT scan used in investigating lung cancer over a non-contrast CT?

A

Non-contrast CT is less accurate

75
Q

What test is diagnostic for OSA?

A

Polysomnography (PSG)

76
Q

What Abx is indicated as prophylaxis to reduce the frequency of COPD exacerbations (in those that meet the criteria)?

A

Azithromycin

77
Q

What investigation should be done prior to starting azithromycin?

Why?

A

ECG - as azithromycin can cause QT prolongation

78
Q

Role of PDE-4 inhibitors (e.g. roflumilast) in COPD?

A

Reduce the risk of COPD exacerbations in patients with severe COPD and a history of frequent COPD exacerbations

79
Q

What is extrinsic allergic alveolitis (EAA), also known as hypersensitivity pneumonitis?

A

A condition caused by hypersensitivity induced lung damage due to a variety of inhaled organic particles.

80
Q

Give some examples of extrinsic allergic alveolitis (4)

A

1) bird fanciers’ lung: avian proteins from bird droppings

2) farmers lung: spores of Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni)

3) malt workers’ lung: Aspergillus clavatus

4) mushroom workers’ lung: thermophilic actinomycetes*

81
Q

Management of extrinsic allergic alveolitis?

A

Mainly avoidance of triggers

82
Q

Presentation of extrinsic allergic alveolitis?

A

acute (occurs 4-8 hrs after exposure)
- dyspnoea
- dry cough
- fever

chronic (occurs weeks-months after exposure)
- lethargy
- dyspnoea
- productive cough
- anorexia and weight loss

83
Q

Does coal workers’ pneumoconiosis typically cause upper or lower zone fibrosis?

A

Upper

84
Q

How should asthma drugs be adjusted in pregnancy?

A

Keep the same! Importance of good asthma control

85
Q

What condition may a calcified Ghon complex be seen on a CXR?

A

Latent TB

86
Q

Which type of pneumonia is particularly associated with diabetic and alcoholic patients?

A

Klebsiella pneumonia

87
Q

What type of pneumonia causes a cavitating pneumonia in the upper lobes?

A

Klebsiella

88
Q

What is the management plan for latent TB?

A

3 months of isoniazid (with pyridoxine) and rifampicin, or

6 months of isoniazid (with pyridoxine)

89
Q

What vaccinations are women offered during pregnancy?

A

Pertussis (16-32 weeks) and influenza

90
Q
A

Yr 4 - CCC (53 decks)

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