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Helena's finals > respiratory medicine > Flashcards

respiratory medicine Flashcards

1
Q

fine crackles causes

A

pulmonary oedema

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2
Q

exudative vs transudative pulmonary effusions

A

transudative - high pressure eg. HF, LV, CKD, cirrhosis, Pulmonary embolism
exudative - high protein & LDH eg. infection, malignancy,

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3
Q

end expiratory BILATERAL wheeze

A

asthma

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4
Q

polyphonic inspiratory and expiratory (biphasic) wheeze

A

COPD

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5
Q

clubbing in COPD?

A

no clubbing in COPD

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6
Q

causes of stridor?

A

Croup
Epiglottitis
Post-extubation laryngeal edema
Foreign body aspiration

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7
Q

breathlessness score?

A

MRC dyspnoea scale

MRC grade 1 - SOB only on strenerous exercise
grade 2 - even when climbing slight hill
5 grades with different statements that patient says when they get breathless

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8
Q

causes of obstructive lung disease

A

Asthma, COPD, bronchiectasis

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9
Q

causes of restrictive lung disease

A

pulmonary fibrosis, asbestos, sacroidosis, obesity, neuromuscular disorders, kyphosis, obesity, acute respiratory distress syndrome

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10
Q

spirometry obstructive vs restrictive

A

obstructive: FEV1 significantly reduced & FVC normal or slightly reduced —-> FEV1:FVC reduced
restrictive: FEV1 slightly reduced & FVC is significantly reduced –> FEV1:FVC increased or normal

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11
Q

investigations for obstructive sleep apnoea

A

ABG: compensated respiratory acidosis
Hypertension
Epworth sleepiness scale questionnaire
Multiple sleep latency test (MSLT) - time to fall asleep in dark room using EEG criteria
sleep studies (polysomnography) with pulse oximetry, EEG, thoraco-abdominal wall movement

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12
Q

COPD patient, pneumothorax 1.5 cm

A

aspirate +/- chest drain
sit up
high flow oxygen but keep an eye on sats
monitor for 24hrs

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13
Q

COPD patient, pneumothorax 0.5cm

A

sit up
high flow high flow oxygen but keep an eye on sats
monitor for 24hrs

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14
Q

cut offs pneumothorax for do nothing vs aspiration vs chest drain

A

primary

  • <2cm monitor and review
  • > 2cm aspirate –> chest drain

secondary
<1cm do nothing
1-2cm aspirate –> chest drain
>2cm chest drain

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15
Q

criteria for LTOT in COPD?

A

measure ABG on 2 occasions, 3 weeks apart on optimum medication
two ABGs pO2 < 7.3kPa
ABG pO2 7.3-8kPa + pulmonary HTN or peripheral oedema or secondary polycythemia

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16
Q

COPD patient, pneumothorax 2.5cm

A

chest drain

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17
Q

which heart murmur can give you haemoptysis?

A

mitral stenosis

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18
Q

cardiac pulmonary oedema vs acute respiratory distress syndrome

A

pulmonary capillary wedge pressure is high then this is due to backlog into veins due to heart failure

ARDS can only be diagnosed in absence of heart failure

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19
Q

Venturi mask in COPD

A

24/28% blue Venturi masks

Sats of 88-92%

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20
Q

Steroid conc acute exacerbation of asthma or copd

A

In asthma, give 100mg IV hydrocortisone

In COPD, give 200mg IV hydrocortisone

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21
Q

Asthma reversibility cut off

A

FEV1 > 12% with SABA

22
Q

site of aspiration in tension pneumothorax

A

2nd ICS mid clavicular line

6th ICS anterior axillary line in safe triangle

23
Q

site of safe triangle

A 
lateral border of pec major
anterior border of lattisimus dorsi
6th ICS (nipple) directly ABOVE the rib
24
Q

what way does the trachea/mediastinum deviate for different pathologies?

A

tension - away
lobal collapse - towards
pleural effusion - away

25
Q

causes of pneumothorax

A

spontaneous
secondary to chronic lung issues: COPD, asthma, Marfans, mechanical ventilation
trauma - rib fractures, central line insertion

26
Q

left lobe collapse on X ray

A
  1. sail sign/ triangle behind the heart + NB. lung field may actually seem normal
  2. aortic -knob sign – the aortic arch is very circular and prominent
  3. reduction of volume on left (can be subtle) + elevation of the left diaphgram!
27
Q

normal ABG values

A

pH 7.35 - 7.45
pCO2 35-45 mmHg
HCO3- 22-26
pO2 80-100 mmHg

28
Q

when do you do V/Q over CTPA for pulmonary embolism?

A

pregnancy
renal failure (can’t deal with contrast)
allergic to contrast

29
Q

where is bifurcation of trachea?

A

T5 to 7 (behind sternum)

30
Q

where is bifurcation of AORTA?

A

L4 just above the junction of the left and right common iliac veins.

31
Q

mx of massive PE

A

local guidelines
intra-arterial: urgent pulmonary angiography and perfusion of thrombolytic drugs into the pulmonary arteries to dissolve the thrombus

OR intravenous: thrombolysis can be done via peripheral IV if radiological expertise is not available or less severely comprised patients

surgical thrombectomy is done at cardiothoracic units

32
Q

examples of thrombolytics

CI to thrombolytic agent use

A

egs. streptokinase, urocinase, recombinant tissue plasminogen activator

CIs: BLEEDING

  • recent haemorrhage, trauma, surgery
  • suspected/known aortic dissection
  • suspected/known peptic ulcer disease
  • previous allergy
  • previous history of intracerebral haemorrhage event
  • severe HTN
33
Q

presenting CXR

A

Rotation - clavicles equidistant from spinous processes
Inspiration - 6 anterior ribs
Peneration - vertebrae (+ see anterior ribs, if over peneterated then will see mainly posterior ribs)
Exposure - can you see entire chest

34
Q

presentation of any imaging/ investigations

A

what is it? orientation eg. PA/AP

patient details
date and time taken
previous images
was the patient symptomatic?

35
Q

how does cystic fibrosis result in chronic renal failure

A

CF –> systemic amyloidosis

36
Q

Hilar enlargement causes

A

Bilateral -

  • infection: TB, HIV
  • inflammation: sarcoidosis, pneumonoconiosis, silicosis,
  • malignancy: (lymphoma, mets)
  • vascular: pulmonary hypertension (COPD, recurrent mets)

Unilateral/asymmetrical - malignancy, TB, pulmonary artery aneurysm

37
Q

TB diagnosis

A
  1. CXR
  2. sputum stain for acid fast bacilli
  3. sputum culture for TB - most specific and sensitive
    - 3 samples, 8 hrs, at least one in the morning
  4. NAAT (nucleic acid amplification test)
    - can use sputum sample or sample from bronchoscopy with broncholavage
    - quick diagnosis but not all centers have it
  5. bloods - low Hb (chronic disease), raised WCC, pancytopenia (disseminated infection)

tuberculin skin test is not so helpful

38
Q

what do you do if you have a patient with acid fast bacilli

A

TB until proven otherwise

  1. negative pressure side room (minimise transmission to other parts of hospital)
  2. tell hospital infection control team
  3. inform local Health Protection Consultant
39
Q

cause of bronchial breath sounds

A

pneumonia

expiratory lasts longer than inspiratory

40
Q

DDx multiple ill defined opacities in CXR

A 
infection
- septic emboli
Inflammation
- rheumatoid arthritis
- granulomatosis with polyangitis 
malignancy
- pulmonary mets
vascular
- pulmonary infarcts (following PE, death of lung tissue)

NB. miliary TB gives much smaller lesions a few mm in diameter

41
Q

MX of mesothelioma

A

no effective treatments

installation of sclerosant substances (dehydrating the pleural cells) to prevent re-accumulation of pleural effusions resulting in breathlessness

typically mets to lungs, hilar, other pleura in the body

42
Q

Miliary shadowing CXR

A

Miliary - few mm blotches everywhere

Tuberculosis!!
Sarcoidosis
Mets
Extrinsic allergic alveolilitis
Occupational lung disease
43
Q

Mx of aspergilloma/ mycetoma

A
  1. IV antifungals

2. surgical resection

44
Q

which lung malignancy causes a horner’s syndrome?

what can it result in?

A

superior sulcus/ apical lung carcinoma aka pancoast tumour

tumours can invade and compress surrounding structures resulting in Pancoast syndrome

invasion of sympathetic chain = Horners
invasion of brachial plexus = shoulder/arm pain
compession of spinal cord
recurrent laryngeal nerve invasion = hoarse voice

45
Q

how does aspergillus species affect the lung?

A
  1. asthma (type 1 hypersensitivity)
  2. allergic bronchopulmonary aspergillosis (type 1 & 3 hypersensitivity) - recurrent asthma and bronchial damage and bronchiectasis
  3. extrinsic allergic alveolitis - reccurent dyspnoea and dry cough and ultimately fibrosis
  4. mycetoma (aspergilloma) - fungus bal forming in a pre-existing lung cavity
  5. invasive aspergillosis in the immunosuppressed with high mortality
46
Q

DDx cavitating mass on chest radiograph

A

infection

  • s.aureus
  • klebsiella
  • mycetoma (aspergillus)
  • TB

wegener’s granulomatosis (granulomatosis with polyangitis)

carcinoma of the bronchus, SCC metastasis

pulmonary infarct

47
Q

diagnosis of aspergillus disease

A

serum preciptins is best

aspergillus skin test is positive in 30% of cases

48
Q

Mx of aspergilloma/ mycetoma

A
  1. IV antifungals

2. surgical resection

49
Q

most common histological subtype of lung cancer

A

adenocarcinoma 40%

50
Q

causes of superior vena cava syndrome

A

malignancy - bronchal ca, lymphoma in hilum

thrombosis secondary to pacing wirses or central venous catheters

51
Q

mx of superior vena cava syndrome

A
  1. oxygen, head elevate
  2. steroids, diuretics to relieve laryngeal/ cerebral oedema
  3. surgical bypass or SVC stenting
52
Q

ddx widespread opacity

A 
pulmonary oedema (bat wing/ hilar)
non-cardiogenic pulmonary oedema

aspiration
pulmonary haemorrhage
pneumocystis pneumonia (ground glass)

Helena's finals (22 decks)

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