Respiratory medicine Flashcards by Ali Bazroon

Pneumothorax

Feutres of tension pneumothorax?

Distended neck veins, hypotension, tracheal deviation

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Pneumothorax

How to manage Primary spontaneouns pneumothorax?

1) If less than 2 cm, asymptomatic. Discharge with follow up.
2) If more than 2 cm, or symptomatic thoracostomy tube

(If patient has high risk features, it is always safe to intervene)

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Pneumothorax

What are the causes of SPS?

1) COPD.
2) Emphysema.
3) Necrotizing pneumonia.
4) PJP in HIV
5) Langerhan histiocytosis.
6) Barotrauma.
7) Cystic fibrosis.

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Pneumothorax

What are the high risk features of pneumothorax?

1) Age > 50
2) Underlying lung disease.
3) Bilateral pneumothorax
4) Hemothorax.
5) Hemodynamically unstable.

If the patient is symptomatic. First thing to look for is the high risk features.

2) Hemodynamic unstability
3) CXR: Bil

1) History: Age and Background.

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Pneumothorax

How to approach asymptomatic patient with pneumothorax?

1) PSP: Discharge + follow up.
2) SPS: Inpatient admission and observation

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Pneumothorax

When the patient can go to a flight after pneumothorax?

2 weeks after CXR check up

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Pneumothorax

When the patient can go for scuba diving after pneumothorax?

Absolute contraindication life-long. Unless:
- Bilateral surgical pleurectomy done.
- Normal CT and lung function.

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Pneumothorax

Next step if patient symptoms not resolved after needle aspiration?

Chest drain

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ABPA

What are the features of ABPA?

1) Difficult to treat asthma.
2) Central bronchiectasis.
3) esonophilia.
4) Positive IgE (High) and positive IgG

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What are the management options of ABPA?

1) Steroid.
2) Itraconazole (second-line)
3) Prednisone + Omalizumab

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Risk factors for ABPA?

BA and CF

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What are the species of aspergillus + syndrome

Aspergillus fumigitus = ABPA
Aspergillous flavus = Risk factor for HCC
Aspergillosis = HIV with CD4 < 100

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Sputum culture of ABPA patient?

Branching septate hyphae, branch at acute angle < 45.
Aspergillus Ag Skin brisk

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Next step in 55 years old patient with incidental finding of primary pneumothorax 3 cm?

Outpatient follow up
Age is a risk factor but no admission for asymptomatic + no chronic lung diseases.
Treat if:
- Symptomatic + more than 50 + significant smoking history.
Admit and observe if:
- Asymptomatic + older than 50 with significant smoking history

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What is the effect of GPA on DLCO?

Increasing it.

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Risk factors of lung cancer

asbestos - increases risk of lung ca by a factor of 5
arsenic
radon
nickel
chromate
aromatic hydrocarbon
cryptogenic fibrosing alveolitis

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What are the causes of Upper lobe fibrosis?

1) Occupational:
- HSP, CWP, Silicosis, Berylliosis, Histiocytosis
2) Autoimmune: AS only
3) Sarcoidosis.
4) TB

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Charactaristic feature of silicosis?

Upper lobe fibrosis + Eggshell calcification

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Seropositive R.A + Multiple upper lobe pulmonary nodule?

Coal worker pneumoconiosis

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Non-ceaseating granuloma in BAL Ddx?

1) Sarcoidosis.
2) HSP
3) Berylliosis

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Sarcoidosis VS HSP In BAL?

1) HSP: Shows poorly formed non-ceasating granuloma.
2) HSP: Less than 1 % CD4\CD8
3) Berylliosis: shows positive berylliosis lymphocyte

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Indication for antibiotic in COPD exacerbation based on NICE ?

Purelent sputum.
Clinical signs of pneumonia

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When to repeat CT chest in patient found to have pleural plaque due to aspestos plaque in CT?

No follow up needed.

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Mode of inheritance of Cystic fibrosis?

In which chromosome Cystic fibrosis mutation occur? and in which channel?

CFTR gene in long arm of chromosome 7 NaCl channel

What are other features of CF?

1) Failure to thrive 2) Diarrhea and intusseption 3) Diabetes mellitus 4) Pancreatic insuffiecency

What is the screening test for CF?

- Sweat chloride test.

In which mutation you can use the cystic fibrosis medications?

F508 (Most common mutation)

MOA of CF medications?

It is either potentiator: which allows the already formed channel to takes chloride inside or Corrector: correct the misfolded proteins

Examples of CF medications?

1) Potentiator: Ivacaftur 2) Corrector: Lamucaftor, alexacaftur.

# Lung cancer Paraneoplastic syndromes associated with small cell lung cancer?

1) SIADH 2) ACTH 3) Lamber eaton syndrome

# Lung cancer Peripheral lung cancer + Non-smoker + Women

Adenocarcinoma

# Lung cancer Lung cancer + Clubbing?

Adenocarcinoma

# Lung cancer Lung cancer + Hypercalcemia?

Squamos cell carcinoma (Central)

# Lung cancer Lung cancer + hyperthyroidism?

Squamos cell

Syndromes associated with squamos cell carcinoma?

- Hypercalcemia - Hyperthyroidism

# Lung cancer Lung cancer + Gynecomastia?

Adenocarcinoma

Mention three causes of high DLCO?

1) Asthma. 2) Diffuse alveolar hemorrhage 3) Exercise. 4) Increase in age \ male 5) Polycythemia. 6) Left to right shunt

In CURB-65 Urea should be more than?

In CURB-65 RR should be more than?

In CURB 65 Blood pressure should be?

SBP < 90 or DBP < 60

# Sacroidosis Name two syndromes which are sub-types of sarcoidosis?

1) Loffgren syndrome: - painful anterior shin lesion (Erythema nodusum) - Migratory polyarthritis. - Bilateral hilar LAP. 2) Heerfordt: - Parotitis, uveitis and facial nerve palsy.

# Sarcoidosis Indications for steroid in sarcoidosis?

1) Hypercalcemia. 2) Neurological or cardiac ppt. 3) Lung: DLCO < 50 % or progressive within 6 to 12 months

# Sarcoidosis What type of pulmonary HTN associated with sarcoidosis?

Type V

# Sarcoidosis Lab tests in sarcoidosis?

1) Hypercalcemia and nephrocalcinosis. 2) High PO and ALP. 3) High ACE level. (F+ with other granulomatous diseases) 4) High ADA

# Sarcoidosis Other skin manifesations of sarcoid?

Lupus pernio scar sarcoid

# Sarcoidosis Most common neurological manifestation in sarcoidosis?

Facial nerve palsy

# Sarcoidosis Most common eye manifestation in sarcoid?

Anterior uveitis

# Pneumothorax When a patient can travel after pneumothorax?

2 weeks

# COPD Most useful parameter to follow patient with COPD to asses for progression?

FEV1

Mention four contraindications for lung surgery in SCLC

1) FEV 1 < 1.5 L 2) Poor function status. 3) Vocal cord paralysis. 4) SVC Obstruction. 5) Tumor near hilum 6) Malignant pleural effusion

# ILD Type of HSR in HSP?

Type III

# ILD What are the findings in bronchoscopy in ILD?

1) High CD8 2) Low CD4\C8 Ratio 3) Lymphocytosis > 30 % 4) Poorly formed non-caseating granuloma.

# ILD Three differences between sarcoidosis and HSP?

1) High CD8 2) Low CD4\C8 Ratio 3) Lymphocytosis > 30 % 4) Poorly formed non-caseating granuloma

# ILD HSP Diagnostic criteria

1) Clinical picture of HSP. 2) History of exposure to Ag 3) HRCT findings suggest HSP 4) Appropriate cytology or histology.

# Pleural effusion Light criteria?

1) Pleural fluid protein\ serum protein > 0.5 2) Pleural LDH\Serum LDH > 0.6 or more than 2\3 of Upper limit of normal serum LDH

# Lung cancer COPD patient presented with CXR shows lung mass + Na: 128

Small cell lung cancer (SIADH)

Risk factors for re-expansion pulmonary edema?

1. Longer duration of lung collapse 2. Larger volume of lung collapse 3. Rapid drainage of pleural fluid/air 4. Application of negative pleural pressure (suction) 5. Younger age of patient

How much you have to drain to avoid re-expansion pulmonary edema at initial drain?

drainage of more than 1.5 liter is a risk factor for RPE

# ards ARDS criteria?

1) Acute onset within one week 2) Non-cardiogenic pulmonary edema (confirm with CWP if needed) 3) Bilateral infiltrate not fully explained by effusion, nodule or atelactasis. 3) Po2 \ FiO2 < 40 kpa or 300

Dextrocardia, recurrent sinusitis, bronchiectasis, otitis media?

Kartagener syndrome

# Asthma What are the parameters of PEFR in acute asthma attack?

Moderate: PEF 50 To 75 Severe: 33 to 50 Life-threatining: less than 33

roflumilast MOA ?

PDE-4 Inhibitor

Indications for roflumilast in COPD?

1) On triple therapy. 2) FEV1 Less than 50 % 3) Two exacerbation per year

Hypothermia causes shift in O dissociation curve to?

Left

Silicosis has risk for?

HgbF causes shift in O dissociation curve to?

LEFT

High 2,3 DPG causes shift in O dissociation curve to?

RIGHT

Acidosis causes shift in O dissociation curve to?

right

The British Thoracic Society (BTS) classify patients with acute asthma into moderate, severe or life-threatening categories Normal pCO2 indicates?

Life-threatining

Shortness of breath after mensturation then resolve spontaneously?

Catamenial pneumothorax

Meig syndrome triad?

ascites, pleural effusion, ovarian tumor

Ectopic TSH is seen in which cancer?

Squamos lung cancer | Squamos: Hypercalcemia + ectopic TSH ## Footnote Small cell: SIADH, Lambert, cushing

# topic

# Pneumothorax What is your first line option for symptomatic pneumothorax in young healthy adult with no high risk features?

Ambulatory device if available.

# Pneumothorax Management in 48 years old smoker with no lung disease + symptomatic pneumothorax?

Aspiration

First option in tension pneumothorax?

Needle decompression

First option in symptomatic secondary pneumothorax?

Chest drain

# COPD Indications of long term oxygen in COPD patients?

1) Two ABG At least 3 weaks apart showing Po2 < 7.3 2) Or between 7.3 and 8 + one of the following: - Pulmonary hypertension. - Peripheral edema. Polycythaemia.

What lung cancer causes calcification?

Chondrosarcoma or osteosarcoma.

# Sarcoidisois What are the poor prognostic factors for sarcoidosis?

1) Ethnicity: African American. 2) Onset: insidous > 6 months. 3) Extra-pulmonary manifestations: lupus pernio, splenogaly. 4) Absence of erythema nodusum. 5) CXR: Stage III, IV

# Asthma Normal CO2 indicate: moderate or severe or life threatining asthma?

life threatining

# Lung physiology Pulmonary hemorrhage TLCO will be?

High. High TLCO seen in pulmonary hemorrhage, erythrocytosis, asthma attack, hyperkynatic status, male and exercise.

What medication used to avoid acute mountin sickness?

- Acetazolamide

MOA of acetazolamide to prevent AMS?

INCREASE hco3 EXCRETION causeing metabolic acidosis which will increase CO2 retention by increase RR, Compensatory metabolic alkalosis and increase oxygenation.

# Lung cance Bronchoscopy shows cherry red ball. Diagnosis?

Carcnoid tumor. Note: smoking is not a risk factor.

How to calculate functional residual capacity?

ERV + RV

# Sarcoidosis In loffgler syndrome. What medication you will start first?

Actually, they have good prognosis even without starting treatment. Start only if indicated

Most common material associated with occupational asthma?

Isocyanate

Saccharopolyspora rectivirgula exposure. Diagnosis?