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Respiratory Medicine Flashcards

1
Q

Calculate the atmospheric pressure of Oxygen (kPa).

A

Oxygen makes up 21% of the atmosphere.

At sea level, pressure is 760mmHg.

21/100 x 760 = 21.3kPa

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2
Q

State the relationship between barometric pressure and altitude.

A

Inversely proportional.

As altitude increases, barometric pressure decreases

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3
Q

Calculate the pO2 of alveolar gas (kPa).

A

Alveolar gas saturated with water vapour (-47mmHg).

Atmospheric gas pressure is 760mmHg.

(760-47) x (21/100)= 150mmHg

150/7.5= 20kPa

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4
Q

State the partial pressure of oxygen in the alveoli compared to the blood in the pulmonary arteries.

A

150mmHg (alveoli) vs 40mmHg (blood)

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5
Q

State the equation for pulmonary ventilation.

A

(VE) = TV x RF

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6
Q

Outline the components of the respiratory control system

A
  • Stimuli
  • Sensors (Central + Peripheral Chemoreceptors)
  • Central Control (PONS, Medulla)
  • Effectors (Respiratory Muscles)
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7
Q

State 3 inputs to the medullary control centres.

A

1) Voluntary Control: Cerebral cortex
• Bypass respiratory control centres in brainstem via cerebral cortex, sending signals directly to motor neurons in spinal cord which innervate respiratory muscles

2) Reflex modification
a) Pulmonary Stretch Receptors: Hering-Breuer reflex: Inspiration ≈ ∆ pulmonary stretch receptors ≈ afferent discharge inhibits inspiration

b) Irritant receptors: Irritants (Smoke, dust, noxious gases…) ≈ detected by irritant receptors (free nerve endings between airway epithelial cells) ≈ initiate reflex bronchial + laryngeal constriction
c) Juxta-Capillary Receptors: Change in interstitial fluid volume ≈ J-receptors detect ∆ in alveolar walls (close to capillaries) ≈ afferent impulses up Vagus never in slow conducting myelinated fibres ≈ rapid, shallow breathing
d) Upper Airway Receptors: Mechanical + chemical stimuli ≈ upper airway receptors detect ∆ ≈ deep inspiration + closure of glottis ≈ pressure builds then expel via sneeze or cough

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8
Q

What is the term for the reflex in which inspiration inhibits further inspiration via negative feedback from stretch receptors?

A

Hering-Breuer Reflex

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9
Q

State the 4 generators of respiratory rhythm. Which 2 originate in the PONS and which 2 originate in the MO?

A

Pneumotaxic Centre - DRG fire thus Stimulation of Pneumotaxic Centre thus Terminates inspiration (tax) ≈ reduced inspiration depth but increased rate (as frequency is higher)

Apneustic Area - Stimulation excites DRG thus prolong inspiration with long + deep breathes to control intensity of breathing thus increase tidal volume and reduce RR

Inspiratory Centre - Pre-Botzinger complex thus DRG thus contraction of diaphragm, external intercostal, SCM and anterior scalene thus inspiration thus firing ceases ≈ expiration

Expiratory Centre - DRG excites VRG thus VRG ≈ contraction: internal intercostals + abdominals ≈ forceful respiration

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10
Q

Outline the hierarchical structure of the respiratory tree.

A
  • 1º Bronchus
  • 2º Bronchus
  • 3º Bronchus
  • Bronchioles
  • Terminal bronchioles
  • Respiratory bronchioles
  • Alveoli
  • Pulmonary surfactant
  • Lobular
  • Pleura (Visceral, parietal, pleural cavity)
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11
Q

State 4 cells present in the alveolar components.

A

1) Type I Cells
• Simple squamous epithelia

2) Type II Cells
• Septal cells
• Surfactant secretin cells
• Microvilli

3) Alveolar Dust Cells
• Migrating macrophages

4) Pores of Kohn
• Collateral airflow between alveoli

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12
Q

What is the name of the cells providing collateral airflow between alveoli?

A

Pores of Kohn

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13
Q

Outline Fick’s Law.

A

Principle that rate of diffusion is proportional to diffusion co-efficient, surface area and partial pressure whilst inversely proportional to wall thickness

Q = D A (P2-P1)/L

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14
Q

State the law of Laplace.

A

T = PR/2

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15
Q

Outline the process of inspiration.

A
  • Contraction of diaphragm + external intercostal muscles
  • Chest wall and lungs stretched + ribs up and out
  • Increased size thus increased volume thus intra-alveolar pressure falls -> Boyle’s Law
  • Air enters lungs down pressure gradient until intra-alveolar pressure
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16
Q

Outline the process of expiration.

A
  • Relaxation of inspiratory muscles -> passive
  • Chest wall + stretched lungs recoil -> return to pre-inspiratory size due to elastic properties
  • Intra-alveolar pressure rises as molecules contained in smaller volume
  • Air leaves lungs down pressure gradient until intra-alveolar pressure -> atmospheric pressure
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17
Q

Define the FEV1.

A

Volume expelled after 1 second (≈ PEFR) ≈ > 80%

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18
Q

State the FEV5 (FVC)

A

Volume of air expired after one breath ≈ 80%

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19
Q

Outline the different values derived from spirometry.

A
  • FEV1
  • FEV5 (FVC)
  • TV
  • IRV
  • IC (TV + IRV)
  • ERV
  • RV
  • FRC (ERV + RV)

VC (IC + ERV)

TLC (IC + FRC)

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20
Q

What is dead space? How much is usually present in the lung?

A

Air remaining in conducting airways where no GE occurs ≈ anatomical dead space ≈ airway dead space ≈ 150mL

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21
Q

Calculate the alveolar ventilation.

TV = 500mL
RF = 12

DS = 150

A

(500-150) x 12 = 4.2L/min

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22
Q

State 3 indications for a CXR.

A

Dyspnea
Acute Chest Pain
Chronic cough (6 weeks)
Trauma

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23
Q

State the 5 densities observed in an XR.

A
  • Air
  • Fat
  • Water (soft tissues)
  • Bone
  • Metal
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24
Q

Outline the Silhouette sign in XR.

A

• Object in close contact with material of same density ≈ borders obliterated ≈ difficult to distinguish.

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25
Q

Outline summation in XR.

A

Object of same radiographic density overlap but not in contact ≈ summatio

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26
Q

Outline your process for interpreting CXR.

A
  1. ID and Oritentation
  2. Summary: lines, devices, catheters, masks, NG tube etc etc
  3. Airways: Trachea, Carina, Bronchi
  4. Breathing: S approach of lung field, lung volume, costophrenic angle, costomediastinal recess, cardiac borders
  5. Circulation: position, size, shape, width
  6. Disability: ribs, clavicles, shoulders, vertebral bodies
  7. Everything else: gas under diaphragm, subcutaneous emphysema, hiatus hernia, lung apexes
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27
Q

Outline the stages of change.

A

1) Pre-contemplation = No need to change behaviour
2) Contemplation = Consider behaviour is problematic
3) Preparation = Evaluate how to make a change
4) Action = Engage in real efforts to change
5) Maintenance = Successful at changing behaviour and attempting to maintain new skills
6) Termination = Eradicated old behaviours through adopted behavioural changes and continue to maintain these positive changes

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28
Q

Outline the presentation of RDS.

A
  • Tachyopneoa
  • Grunting
  • Intercostal recessions
  • Nasal flaring
  • Cyanosis
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29
Q

How do you manage RDS?

A
  • Maternal steroid
  • Surfactant as needed
  • Ventilation (non-invasive/invasive) depending on levels needed
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30
Q

What is Transient Tachypnoea of the Newborn? Outline the presentation.

A

Respiratory fluid (which normally goes away before birth) remaining after birth

  • Tachyopnoea (resp rate >60)
  • Nasal flaring
  • Grunting
  • Intercostal/subcostal recessions
  • Crackles
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31
Q

What gene defect causes CF?

A

CFTR

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32
Q

What enzyme can aid your diagnosis of CF? Why is this?

A

Serum trypsinogen.

Trypsinogen produced in pancreas and converted to active form of trypsin in SI. CF mucous blocks exocrine tubes of pancreas thus high trypsinogen but low trypsin.

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33
Q

Outline the general management of Acute Asthma.

A
  • O- oxygen
  • S- nebulised salbutamol
  • H- hydrocortisone 100mg IV (or prednisolone PO 40mg)
  • I- ipratropium 500mcg
  • T- theophylline 1g/1L at 0.5mL/kg/hour
  • M- magnesium sulphate 2g over 2 mins
  • E- escalate care
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34
Q

What pathogen causes Bronchiolitis.

A

RSV

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35
Q

What age does Bronchiolitis usually occur?

A

Under 18 months

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36
Q

How do you treat Bronchiolitis?

A

Supportive

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37
Q

How may pneumonia present in a child?

A
  • Cough with sputum production
  • Fever
  • Dullness on percussion
  • Bronchial breathing
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38
Q

What type of cough is pathognomonic in croup?

A

Seal-bark cough

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39
Q

State 3 causes of stridor.

A
  • Neoplasms- most commonly- larynx, trachea, bronchus
  • Anaphylaxis
  • Goitre
  • Foreign body
  • Trauma
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40
Q

Describe Tracheomalacia.

A

This is when the cartilaginous rings keeping the airway patent are soft meaning the trachea partly collapses especially during expiration and increased airflow.

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41
Q

How may tracheomalacia present.

A

Presents with stridor, SOB, cyanotic spells, worse on activity

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42
Q

What immunoglobulin mediates anaphylaxis?

A

IgE

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43
Q

How may anaphylaxis present.

A
  • Flushing
  • Priuritis
  • Urticaria
  • Angioneurotic oedema- face, lips, tongue, larynx, bronchi
  • Abdo pain and vomiting
  • Hypotension
  • Stridor, wheeze, eventual respiratory failure
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44
Q

How would you manage anaphylaxis?

A
  • IM adrenaline (500mcg/300mcg/150mcg) at 1:1000 concentration
  • IV antihistamine
  • IV corticosteroid
  • High flow O2, nebulised bronchodilators
  • Intubation if necessary
  • IV Fluids: 500mL or 10mL/kg (child)
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45
Q

What dose of IM adrenaline is given for an adult?

A

500mcg thus 0.5mL of 1mg/mL at 1:1000 concentration

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46
Q

What dose of IM adrenaline is given for an child 6-12 years?

A

300mcg thus 0.3mL of 1mg/mL 1:1000 concentration

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47
Q

What dose of IM adrenaline is given for children under the age of 6?

A

150mcg so 0.15mL of 1mg/mL (1:1000)

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48
Q

What volume of IV fluid do you use to resuscitate an adult?

A

500-1000mL

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49
Q

What volume of IV fluid do you use to resuscitate a child?

A

10mL/kg

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50
Q

How much IV fluids would you use to resuscitate a 45kg child?

A

10mL/kg thus 45 x 10 = 450mL

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51
Q

Describe OSA.

A

Relaxation of pharyngeal dilator muscles during sleep (especially REM) causing intermittent upper airway collapse. This causes upper airway narrowing, turbulent airflow and vibration of the soft palate and tongue base.

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52
Q

State 3 RFs for OSA.

A
  • Enlarged tonsils and adenoids
  • Obesity
  • Retrognathia
  • Acromegaly, hypothyroidism
  • Oropharyngeal deformity
  • Neurological disorder e.g. stroke
  • Drugs e.g. benzos
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53
Q

What investigation may you use to diagnose OSA.

A

Epworth score

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54
Q

How do you manage SA?

A
  • Remove underlying cause
  • Continuous positive pressure airway (CPAP)- works by blowing air into the airways keeping the pressure positive, meaning the airway doesn’t close.
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55
Q

Describe a Pulmonary Embolism?

A

Thrombus formation in a deep vein (DVT), formed by ∑ venous stasis, hypercoagulability and trauma (Virchow’s Triad), which translocated to the pulmonary vasculature causing a spectrum of disease.

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56
Q

Which eponymous triad seeks to outline thrombus formation.

A

Virchow’s Triad:

  • Hypercoagulability
  • Venous stasis
  • Endothelial damage
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57
Q

Outline the 3 types of PE.

A
  • Massive = shock or hypotension
  • Submassive = pulmonary trunk or main PA with RV strain but no hypotension
  • Small = lobar or segmental arteries only
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58
Q

Which tool is used to calculate the risk of PE?

A

Wells score

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59
Q

How do you calculate a Wells Score?

A

DAMN BC

  • DVT Sx
  • Mobility reduced (> 3 days) or surgery (within 4 weeks)
  • Known history of DVT/PE
  • Blood in cough (haemoptysis)
  • Cancer
  • Pregnancy or 6 weeks postpartum
  • COCP
  • FHx
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60
Q

How may a PE present?

A
  • Cough
  • Dyspnoea
  • Cx pain
  • Hypoxemia

• DVT Sx: Skin ∆, tenderness, temperature, venous distension

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61
Q

What is the first line diagnostic imaging test for a suspected PE?

If they are pregnant does this change?

A

CT-PA

VQ Scintigraphy

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62
Q

How do you manage a PE?

A

• Anticoagulation: Apixaban/ Rivaroxaban

OR (Pregnant)
• Anticoagulant: LMWH
-> DOACs may cross placenta

If in shock, Thrombolysis

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63
Q

Why do you not give DOACs in pregnancy?

A

They may cross the placenta

64
Q

Describe acute bronchitis.

A

Self-limiting LRTI caused by viral infection (or bacterial) resulting in bronchial inflammation characterised by cough (worse at night) + 1 or more LRTI Sx (∑ wheezing, sputum, chest pain)

65
Q

What pathogen is the primary cause of acute bronchitis in the military/college?

A

M pneumoniae

C pneumoniae

66
Q

How may acute bronchitis present?

A
  • Fever
  • Productive cough
  • Sputum: clear/white/discoloured
  • Wheeze
  • Rhonchi (continuous, low-pitched rattling = ‘snoring’)
67
Q

How would you manage Acute Bronchitis?

A

• Supportive: Observe + Antipyretic (Paracetamol) ± SABA (Salbutamol)

68
Q

Describe COPD.

A

Umbrella term (∑ Emphysema + Chronic Bronchitis) for preventable and treatable disease state featuring airflow limitation which is irreversible characterised by cough, sputum production, and dyspnoea.

69
Q

State 3 RFs for COPD.

A
  • Cigarette smoking
  • Environmental exposures: chemical/ physical/ biological/ cultural
  • Infections
  • Advanced age
  • Genetic factors: Anti-alpha trypsin
70
Q

What genetic mutation may cause COPD?

A

AAT

71
Q

How may COPD present?

A
  • Productive cough (morning, productive)
  • Dyspnea
  • Sputum
  • Barrel chest (AP diameter increased)
  • Increased work of breathing: Leaning forward/Accessory muscle recruitment/ Intercostal recession / Tracheal tug/Nasal flare
  • Hyper-resonance on percussion
  • Distant breath sounds on auscultation
  • Poor air movement on auscultation (loss of lung elasticity and lung tissue breakdown)
  • Wheezing on auscultation
  • Coarse crackles (mucous and inflammation)
72
Q

What investigations would you order in a patient with suspected COPD?

A
  • FBC: Raised Hct (polycythemia), possible raised WBC
  • Sputum culture: Infective pathogen
  • Spirometry: FEV1/FEVC < 0.7 = Obstructive picture; FEV1/FEVC < 0.7 and FEVC < 0.8 = Mixed picture
  • SpO2: Low saturation -
  • CXR: Hyperinflation and hyperlucent lungs; increased AP ratio; flattened diaphragm; increased ICS Target is 88-92%
  • ECG: Signs of RV hypertrophy, arrhythmia, ischemia
73
Q

What does your management of COPD depend on?

A

GOLD Criteria

74
Q

What constitutes GOLD A criteria for COPD?

A

0-1 exacerbations per year

CAT <10

75
Q

What constitutes GOLD B criteria for COPD?

A

0-1 exacerbations

CAT > 10

76
Q

Outline your management for COPD.

A

• Conservative: Smoking cessation + Vaccinations (Influenza + S. pneumoniae)
+
• SABA: Salbutamol
+
• LABA: Salmeterol
+
• LAMA: Tiotropium/ Umeclidinium/ Aclidinium/ Glycopyrronium

IF GOLD C/D
\+
•	ICS: Fluticasone/Budesonide 
\+
•	Pulmonary Rehabilitation: Aerobic exercise; Strength training; Education
±
•	Long-term Oxygen therapy
-> PaO2 < 7.3kPa or 55mmHg (room air)
77
Q

Outline your management of an acute exacerbation of COPD.

A
  • Long-term Oxygen therapy
  • Mucolytic: Acetylcysteine
  • PDE inhibitors: Theophylline
  • ABX: Amoxicillin
78
Q

What criteria is used to assess air-flow limitation in COPD?

A

GOLD criteria (FEV1)

79
Q

Outline the categories of GOLD criteria for air flow limitations.

A

GOLD 1 = FEV > 80%

GOLD 2 = FEV 50-79%

GOLD 3 = FEV 30-49%

GOLD 4 = FEV < 30%

80
Q

Outline the MRC Dyspnoea scale and its stages.

A

Grade 0 = only in strenuous exercise

Grade 1 = walk up hill

Grade 2 = stop for breath when walking at own pace

Grade 3 = walk for 100m

Grade 4 = breathless at rest/ doing ADLs

Grade 1 = strenuous exercise

Grade 2 = walking up inclines

Grade 3 = walk for 100m

Grade 4 = breathless at rest/ADLs

81
Q

Which is the most common lung cancer?

A

AC

82
Q

Which cancer commonly presents as an obstructive lesion leading to infection?

A

Squamous cell carcinoma

83
Q

Which form of lung cancer tends to secrete PTHrp?

A

Squamous cell carcinoma

84
Q

Give 5 potential extrapulmonary manifestations of Lung cancer.

A

Horner’s Syndrome

SVCO

Phrenic nerve palsy

Recurrent laryngeal nerve palsy

SIADH

Limb encephalitis (anti-Hu)

Lambert-Eaton myasthenic syndrome

Hyperprolactinaemia

Cushing’s syndrome

Hyperparathyroidism

PHOA (periostitis + arthropathy + clubbing)

85
Q

A patient presents with SOB 6/12. They have had a cough which is productive for 6/52. The cough produces sputum which is tinged with dark red blood.

They have been experiencing some diplopia and a droopy eyelid. On top of this, their throat feels weaker with difficulty swallowing.

They have COPD and a pack history of 30 years.

What is your diagnosis?

A. Large cell lung cancer

B. Adenocarcinoma

C. Limb encephalitis

D. Lambert-Eaton Myasthenic Syndrome

A

D

86
Q

What are the key differences between Lambert-Eaton Syndrome and Myaesthenia Gravis?

A

Lambert-Eaton Syndrome:

  • Abs to CaVg
  • Presynaptic
  • ANS involvement
  • Weakness improves with contraction

Myaesthenia Gravis:

  • Abs to ACh
  • Post-synaptic
  • No alterations of ANS
  • Associated with thyroid disease
  • Weakness worsens with contractions
87
Q

What is the biggest risk factor for mesothelioma?

A

Asbestos exposure - can follow up to 45 years

88
Q

How may you classify pneumonia?

A

Location acquired

CAP

HAP

Aspiration

Immunocompromised

89
Q

Which of the following is a cause in nosocomial pneumonia?

A. S aureus

B. Legionella

C. C trachomatis

D. C difficile

A

D

90
Q

Which of the following is a cause in nosocomial pneumonia?

A. S aureus

B. Legionella

C. Klebsiella

D. C trachomatis

A

C

91
Q

Why would a patient be more at risk of aspiration pneumonia?

A

Impaired swallow or immunocompromised

Neurological conditions
Reduced consciousness
Oesophageal disease
Poor dental hygiene

92
Q

Which decision-making tool could be used in a CAP? Outline it.

A

CURB65

  • Confusion
  • Urea (≥ 7mmol/L)
  • Respiration rate (> 30)
  • Blood pressure
  • 65 ≥
93
Q

A 70 year old patient in primary care presents with a cough 3/7; fever of 37.8 degrees and feels generally unwell.

O/E their HR is 100bpm; BP 110/58mmHg; RR 32.

What is your management?

A

CURB Score = 2

Hospital admission
+
Co-amoxiclav PO

94
Q

How do you treat Pneumocystis pneumonia?

A

Co-trimoxazole 2/52

95
Q

What are the potential complications of a pneumonia?

A

Sepsis
Empyema
Lung abscess

96
Q

What is the most common cause of pneumonia?

A

S pneumoniae (50%)

H influenzae (20%)

97
Q

Which atypical pneumonia is likely to present with hyponatraemia?

A

Legionella pneumophila

98
Q

Which atypical pneumonia is commonly contracted from birds?

A

C psittaci

99
Q

Which atypical pneumonia is contracted from the bodily fluids of animals?

A

Coxiella burnetti (Q fever)

100
Q

Which atypical pneumonia is associated with erythema multiforme?

A

Mycoplasma pneumoniae

101
Q

A FEV1/FEVC Ratio <0.7 is?

A

Obstructive

102
Q

A FEV1/FEVC ratio >0.7 is?

A

Restrictive

103
Q

How do you choose a PEF reading of the 3 taken?

A

Choose the best

104
Q

What are the triggers for asthma?

A 
Exercise
Smoking
Allergens 
Damp
Dust
Strong emotions
105
Q

What is the gold-standard test for asthma?

A

There is no gold standard test for asthma.

Tests:
PEF
Spirometry
FeNO

106
Q

What is the management for asthma?

A

Adults:

SABA ± ICS ± LRTA ± LABA ± Increased ICS ± Referral (biologics)

Children: SABA ± low-dose ICS ± LTRA ± LABA ± increase ICS dose ± Referral (biologics)

<5 years old

SABA ± moderate dose ICS trial (8 wks) ± low-dose ICS + LTRA ± Refer to paediatric asthma specialist

107
Q

What is considered low dose ICS?

A

200mcg budesonide

108
Q

What is considered paediatric moderate dose ICS?

A

200-400mcg budesonide

109
Q

What is considered paediatric high dose ICS?

A

> 400mcg budesonide

110
Q

What is considered low dose ICS in adults?

A

<400mcg budesonide

111
Q

What is considered moderate dose ICS in adults?

A

400-800mcg budesonide

112
Q

What is considered high dose ICS?

A

> 800mcg budesonide

113
Q

What are the clinical features of acute severe asthma?

A
  • PEF: 33-50% predicted 

  • Cannot complete sentences in one breath 

  • RR > 25 breaths/min ≈ tachypnoea

  • HR > 110 beats/min ≈ tachycardia
114
Q

What are the clinical features of life-threatening asthma?

A
  • PEF < 33% predicted or best
  • SpO2 <92%
  • Silent chest, cyanosis, feeble respiratory effort
  • Arrhythmia or hypotension
  • Exhaustion, altered consciousness
115
Q

What is the management for an acute exacerbation of asthma?

A

Mnemonic O SHIT MAn

Oxygen 10-15L via non-rebreather

Salbutamol: 5mcg
Hydrocortisone IV: 100mg OR Prednisolone 40-50mg
Ipratropium: 500mcg
Theophylline 1kg in 1L at 0.5mL/kg/h

Magnesium Sulphate: 2g over 20 minutes
Anaesthetist nearby

116
Q

What gene mutation may predispose you to COPD?

A

AAT1 ∆

117
Q

How may COPD be classified?

A

GOLD Criteria of GOLD A, B, C or D

Gold A = 0-1 exacerbations and CAT <10

GOLD B = 0-1 exacerbations and CAT >10

GOLD C = >2 exacerbations or 1 in Hospital + CAT <10

GOLD D = >2 exacerbations or 1 in Hospital + CAT >10

118
Q

What are the management options for COPD?

A

SABA

LABA

LAMA

±
ICS
+
ABX

±
Acetylcysteine
/
Theophylline

119
Q

What is the target oxygen saturation in COPD?

A

88-92%

120
Q

How do you manage an acute exacerbation of COPD?

A

Usual medication: SABA + LABA ± LAMA ± ICS

  • Long-term Oxygen therapy
  • Mucolytic: Acetylcysteine
  • PDE inhibitors: Theophylline
  • ABX: Amoxicillin
121
Q

What are the two forms of NIV?

A

BiPAP

CPAP

122
Q

Which form of NIV is used if there is a low Oxygen and high CO2?

A

BiPAP

123
Q

On CT-Chest, what radiographic find is observed in interstitial lung disease?

A

Hazy shadowing known as ground glass opacification (GGO)

124
Q

Which drugs may cause Drug-Induced Pulmonary Fibrosis?

A

Mnemonic: CBA MaN

Cyclophosphamide
Bleomycin
Amiodarone

Methotrexate
Nitrofurantoin

125
Q

What type of hypersensitivity reaction causes Hypersensitivity Pneumonitis?

A

Type III Hypersensitivity reaction

126
Q

Which pathogen is tested in Farmer’s Lung?

A. M. faeni

B. Avian protein antigen

C. A. clavatus

D. Botrytis

A

A

127
Q

Which pathogen is tested in Wine maker’s Lung?

A. M. faeni

B. Avian protein antigen

C. A. clavatus

D. Botrytis

A

D

128
Q

Which pathogen is tested in Bird Fancier’s Lung?

A. M. faeni

B. Avian protein antigen

C. A. clavatus

D. Botrytis

A

B

129
Q

Which pathogen is tested in Cheese washer’s Lung?

A. M. faeni

B. Avian protein antigen

C. A. clavatus

D. Botrytis

A

C

130
Q

What is the management for Hypersensitivity Pneumonitis?

A

Avoid antigen
+
Corticosteroid taper

131
Q

What are the two types of pulmonary effusion?

A

Exudative (protein >3g/dL)

or

Transudative (<3g/dL)

132
Q

Which of the following is not an exudative cause of Pulmonary Effusion?

A. Lung cancer

B. Pneumonia

C. RA

D. Congestive cardiac failure

A

D

133
Q

Which of the following is not a transudative cause of Pulmonary Effusion?

A. Hypothyroidism

B. Meig’s Syndrome

C. RA

D. Congestive cardiac failure

A

C

134
Q

What radiographic finds may you see on a CXR with pleural effusion?

A

Blunting of costophrenic angle
Fluid in lung fissures
Meniscus
Tracheal and mediastinal deviation (if massive effusion)

135
Q

How do you measure the size of a pneumothorax? Explain.

A

BTS Guidelines from 2010

Find hilum, measure horizontally from lung edge to inside of chest wall.

136
Q

How do you manage a pneumothorax?

A

No SOB/<2cm = supportive management + FU in 4 weeks

SOB/>2cm = aspiration and reassessment

Aspiration fails twice = chest drain

137
Q

How do you manage a tension pneumothorax?

A

Aspiration with large bore cannula in 2nd ICS in MCL

Once inserted, definitive management is with a chest drain.

Insert above rib, into triangle of safety of AAL-MAL-5th ICS

138
Q

What is used as VTE prophylaxis?

A

LMWH
±
Compression stockings

139
Q

What decision-making criteria can be used to determine requirement for imaging following a DVT?

A

Wells Score

4> = Unlikely thus D-Dimer

> 4 = Likely thus CT-PA

140
Q

What would the ABG show in a patient with Pulmonary Embolism?

A

Respiratory alkalosis

141
Q

How is a PE managed?

A

Acute: DOAC

  • consider switch

IV Alteplase (if massive PE)

or

Antiphospholipid syndrome: LMWH

Continue anticoagulation for 3 months

3+ months if cause unclear or irreversible

6 months if Cancer

142
Q

What should the INR be when using warfarin to treat a PE?

A

2-3

143
Q

What determines use of thrombolysis in PE?

A

Haemodynamic instability

144
Q

If a pregnant woman experiences a PE, what is your management?

A

Admission; monitoring; fluids;
+
LMWH

145
Q

What factors make up a Wells Score?

A

Mnemonic: DAMN BC

DVT Sx
Another DDx unlikely
Mobility reduced
Known history of VTE

Blood in cough
Cancer

146
Q

What is the management for OSA?

A

Weight loss; CPAP

±
Maxfax referral/surgery

147
Q

What is the gold-standard test for CF?

A

Chloride sweat test >60mmol/L

148
Q

What breath sounds may be heard in TB upon auscultation?

A
  • Bronchial breathing

* Amphoric breath sounds (distant hollow breath sounds heard over cavities)

149
Q

What is the management for TB?

A

Mnemonic: RIPPE

Rifampin 
Isoniazid
Pyrazinamide 
Pyridoxine 
Ethambutol
150
Q

What are the side effects of Rifampicin?

A

Red/pink body secretions

Liver enzyme inducer

Elevated LFTs

151
Q

What are the side effects of isoniazid?

A

Polyneuropathy

Allergic reactions

152
Q

What are the side effects of pyrazinamide?

A

Gout
Rash/arthralgia
Hepatitis

153
Q

What are the side effects of Ethambutol?

A

Optic neuritis

154
Q

Presence of Migratory polyarthritis, bilateral hilar lymphadenopathy and erythema nodosum is called?

A

Lofgren Syndrome

155
Q

Presence of Parotitis, Uveitis and Facial palsy in Sarcoidosis is known as?

A

Heerfordt Syndrome

156
Q

What are your differentials for an anterior mediastinum mass noted on CXR?

A 
Thymoma 
Thyroid (goitre, mass) 
Terrible lymphoma 
Thoracic aneurysm 
Teratoma

Medicine (18 decks)

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