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Revision Qs > Respiratory Medicine 1 > Flashcards

Respiratory Medicine 1 Flashcards

1
Q

What is the FEV1/FVC ratio in obstructive lung disease?

A

Markedly reduced -

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2
Q

What are the features of an obstructive lung disease?

A

Poorly recoiling lung tissue (floppy) so quick to inflate but poor deflation
So TLC is normal or high but FVC is reduced and FEV1 is markedly reduced

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3
Q

What defines severity in obstructive lung disease spirometry?

A

FEV1 % of expected

  1. 8-0.5 = mild
  2. 3-0.5 = moderate
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4
Q

3 examples of obstructive lung disease?

A

COPD, asthma, Bronchiectasis

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5
Q

What is a restrictive lung disease?

A

‘Stiff’ lungs which are difficult to inflate but quick to deflate
FVC and FEV1 are both reduced

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6
Q

What happens to the FEV1/FVC ratio in restrictive lung disease?

A

Often unaffected

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7
Q

2 examples of restrictive lung disease?

A

Pulmonary fibrosis

Sarcoidosis

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8
Q

What is the pathophysiological background of bronchiectasis?

A

Irreversible dilatation of the bronchi with wall thickening

Increased mucus production, poor trachebronchial clearance and resultant chronic airway infection

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9
Q

What sort of things can predispose to bronchiectasis? (4)

A

Severe childhood asthma
TB
Pertussis
Measles

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10
Q

Chronic congenital condition linked with Bronchiectasis?

A

Cystic fibrosis

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11
Q

Enzyme deficiency often implicated in respiratory disease?

A

a1 antitrypsin deficiency

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12
Q

Immunodeficiency syndrome linked to bronchiectasis?

A

Hypogammaglobulinaemia

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13
Q

Describe the sputum associated with bronchiectasis?

A

Chronic sputum production in large amounts
May be purulent, often dark or green
May be bloodstained

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14
Q

2 upper airway conditions linked with bronchiectasis?

A

Nasal polyps

Chronic sinusitis

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15
Q

Management strategies for bronchiectasis?

A

Bronchodilators, O2, nutritional support
Chest physio - active cycle breathing
Long term azithromycin

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16
Q

What Abx can be given long term in bronchiectasis?

A

Azithromycin

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17
Q

Surgical management options for bronchiectasis?

A

Lung resection
Massive haemoptysis - bronchial artery embolization
Lung transplant

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18
Q

Abx for bronchiectasis (and generally infection) confirmed to be with pseudomonas aeruginosa?

A

Ciprofloxacin

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19
Q

Abx for general bronchiectasis management or those colonised with h. Influenzae?

A

Amoxicillin or clarithromycin

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20
Q

3 subtypes of bronchiectasis?

A

Cylindrical (commonest)
Varicose
Cystic - worst, associated with CF

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21
Q

What underlying condition should be considered in bronchiectasis patient with no identifiable pre-infection and/or unusual colonisations?

A

Immunocompromise/HIV

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22
Q

CAPT Kangaroo has Mounier Kuhn of bronchiectasis causes?

A

Congenital - CF, connective tissue disorders,
Allergic bronchopulmonary aspergillosis
Post-infection - Measles, pneumonia, RSV (bronch), pertussis, flu
TB and other granulomatous disease
Kartagener’s disease (PCD)
Mounier-Kuhn syndrome (tracheobronchomegaly)

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23
Q

What is Williams-Campbell syndrome?

A

Bronchial cartilage deficiency -> congenital cystic bronchiectasis
Deficiency typically from 4th-6th order bronchial cartilage

24
Q

Common findings on auscultation for bronchiectasis?

A

Course early-inspiratory crackles
Large airway rhonchi (low pitched snore)
Wheeze

25
Q

Gold standard Ix for diagnosing bronchiectasis?

A

HRCT

26
Q

What is the definition of pneumonia?

A

Infection of the lung parenchyma with airway consolidation

27
Q

What is the role of air bronchograms in pneumonia CXR?

A

If present, suggestive of a pneumonia type consolidation. If absent, indicates more likely a blockage or solid something restricting the airway (e.g. Tumour)

28
Q

In addition to a high CURB65, what other clinical features may make you consider escalation of care in a pneumonia patient?

A

Hypoxaemia
Number of lobes involved
Comorbidities

29
Q

What organ abnormality predisposes to pneumococcal pneumonia as well as other capsulated bacterial infection?

A

Asplenism

30
Q

Lobar vs bronchopneumonia on CXR?

A

Lobar is consolidation confined to a lobe

Bronchopneumonia is often consolidation of lung bases

31
Q

3 common bacterial causes of atypical pneumonia syndromes?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila

32
Q

What does coxiella burnettii cause?

A

Q fever

33
Q

Apart from the 3 main bacterial causes what are some other causes of atypical pneumoniae?

A

Coxiella burnettii - Q fever

Viruses - adenovirus, influenza, RSV etc.

34
Q

Main differentiating factors of mycoplasma pneumonia from pneumococcal pneumonia?

A

Non-productive, hacking cough
Systemic features - erythema multiforme etc.
Neurological features - Guillain-Barre, cerebellar ataxia
Haematological features - cold agglutinin disease -> haemolytic anaemia
GI features - diarrhoea, abdo pain etc.

35
Q

Which is the most severe atypical pneumonia and what is outbreaks of it often associated with?

A

Legionella pneumophila

Air conditioning system failure or poor maintenance

36
Q

Rx for atypical pneumonia?

A

Start on amoxicillin as per typical CAP
Can also use macrolides
Legionella may require Rifampicin

37
Q

3 criteria for diagnosing pneumonia without CXR?

A

Cough and at least 1 other LRTI Sx or fever
New focal signs on chest exam
No other better explanation for illness

38
Q

3 criteria for diagnosing pneumonia with CXR?

A

Cough and at least 1 other LRTI Sx or fever
New radiographic infiltrates
No better explanation for illness

39
Q

What Ix are required to identify atypical pneumoniae?

A

Serology (paired sera - Ab and Ag)

40
Q

Rx for CAP of unknown causative organism?

A

Amoxicillin and clarithromycin - covers pneumococcus as well as atypicals

41
Q

Ix for pulmonary embolism?

A

WELLS score for probability.
Low risk -> D dimer (very sensitive but non-specific)
High risk -> V/Q scan and CTPA

42
Q

What does a COPD rescue pack consist of?

A 
Oral corticosteroids (7-14 days)
Antibiotics if sputum is purulent
43
Q

First line management of COPD?

A

SABA or SAMA

44
Q

What 2 inhaled drugs can’t be taken together in COPD long term management?

A

SAMA and LAMA

45
Q

Which type of lung cancer typically causes clubbing?

A

Non-small cell

46
Q

If a lung cancer occurs in a non-smoker what type is it likely to be?

A

NSCLC - adenocarcinoma

47
Q

What type of lung cancer typically presents with metastasis having already occurred?

A

Small cell

48
Q

4 most common symptoms of lung cancer?

A

Chronic cough
Haemoptysis
SOB
CP

49
Q

What constitutes a transudate?

A

Low protein content (

50
Q

3 causes of a transudative pleural effusion?

A

Heart failure
Liver cirrhosis
Nephrotic syndrome

51
Q

What constitutes an exudate?

A

High protein content (>30g/L)

52
Q

3 causes of exudative pleural effusion?

A

Infection
Malignancy
Pulmonary embolism

53
Q

3 places to send off pleural tap?

A

Chemistry (transudate vs exudate)
Cytology (cancer)
Microbiology (infection)

54
Q

What type of pleural effusions need drainage?

A

exudates

55
Q

Type of pneumonia which may persist for a while, proving difficult to treat with normal Abx?

A

Haemophilus

Revision Qs (28 decks)

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