RESPIRATORY PASTEST Flashcards
UNKNOWN AND EASILY FORGETTABLE KNOWLEDGE
WHAT IS MACLEOAD SYNDROME
CHILDHOOD BRONCHIOLITIS/MEASLES ETC LEADING TO UNILATERAL EMPHYSEMA LATER IN LIFE.
for central or cardiophrenic lung cancers which type of biopsy is preferred
endobronchial ultasound guided biopsy
EPSWORTH SLEPINESS SCORE SEVERITY
greater than 10 is positive.more than 16 is severe.
Brit hogg dube BHD manifestations
pneumothorax
lung cysts
renal cancer
skin fibrofolliculomas
Do genetic testing.
pulmonary and bone manifestations of langerhancell histiocytosis
pulmonary = upper zone cystic lesions in smokers.
bone= punched out lytic lesions.
endo = diabetes
monoclonal proliferation of langerhan cells which are a type of dentritic cells.
choroid lesion in which diseases
millary tb
pcp pneumonia
on ripe regimen what is the ULN threshold of alt
5x.stop ALL anti tb meds if ALT is 5x.restart later with one drug at a time.mostly ethambutol.
cause of hypoxia in PPH
intra pulmonary shunting
reduced diffusion capacity due to fibromuscular hyperplasia.
long term solution for liver capsule pain in case of mets
radiotherapy
stridor in RA cause and diagnosis
cricoaretenoid arthritis.can flare post surgery.diagnose by flow volume loop,laryngoscopy and ct larynx.
strongest prognostic factors in copd
age
baseline fev1 and post bronchodilator fev1 [more useful]
low dlco
1st line tx of leiogenella pneumonia with a curb65 score of 3 or more along with pencillin allergy.
fluoroquinolone like cipro monotherapy.clarithro for curb score of 2 or less.
how many ml is normal physiological dead space
150 ml
aspiration pneumonia vs klebsiella in alcoholics e risks of aspiration
aspiration pneumonia occur mostly in RIGHT superior segment of lower lobe or posterior segment of upper lobe.leads to BRONCHOPNEUMONIA mostly.i,e patchy infilterates tc.
Kleibsiella leads to LOBAR poneumonia e cavitations mostly in upper lobe but also in lower lobe.
investigation of choice for intrathracic lymph node involvement in CA lungs
CT with or without contrast [better than mri]
PET scan is best but not widely available.
most significant contraindication to radical radiotherapy in NSCLC is
malignant pleural effusion [signifies stage 4 disease]
stages of occupational pneumoconiosis
1 = few opacities
2 = large number of opacities but lung marking are still visible
3 = large number of opacities with barely visible lung markings
mesothelioma vs asbestosis
mesothelioma = pleural effusion
asbestosis = parenchymal infilterate like other pneumoconisis
4 features of yellow nail syndrome
yellow nails
bronchiectasis
lymphedema
pleural effusisons
limitation of ctpa
can miss emboli in peripheral segmental arteries
massive PE with hemodynamic unstability tx
IV fluids
heparin infusion
thrombolysis if no improvement
psittacosis/ornithosis feature resemble which disease initailly
typhoid fever
=rash on abdomen simmilar to rose spots called horder spot.other features like fever,headahe[can mimic meningitis],artharagia,diarrhea and hepatospenomegaly.
ornithosis is same but word is given when it is caused by other species than parrots.
most common presentation of NSCLC
cough 45
breathlessness 37
most striking feature of diaphragmatic pasly
breahtlessness in supine position.reduced fvc from standing to supine position.
can occur secondary to cbag.
functional criteria for pneumonectomy
fev1 more 1.8 L
fev1/fvc more than 0.5
normal Pco2 at rest
histology of lung carcinoid
small polygonal cells e eosinophilic cytoplasm.Highly vascular pink red color.
2 conditions associated e OSA
HTN
DM 2
These can lead to stroke etc.
in chest drain what does these signify
1 bubbling on cough
2 fluid in tube swinging
1 air is draining
2 drain is in right place and working
radiotherapy vs chemotherapy induced pneumonitis
diffuse in chemo
focal to radiotherapy site is radiotherapy pneumonitis
which lung disease is a contributory factor to OSA
COPD
how many apnea/hypoapnea episode are diagnositic of OSA during polysomnography
15 or more/hour
silica is toxic to what and predisposes to which disease
macrophages
TB
effect of pulmonary AV malformations on tlco
reduced tlco dur to R to L shunt
which of following causes clubing
lung abcess or
copd
Lung abscess
what is a typical feature CTEPH
increased A a gradient on exercise.
role of pul rehabiliation in copd
increase exercise capacity
reduce hosp admissions
indication of immunotherapy for allergy or anaphylaxis
patient cant refrain from exposure like his job etc.
feature of carcinoid that are other than carcinoid syndrome
1 recurrent hemoptysis
2 lobar collapse or recurrent lobar pneumonia
carcinoids are typical for their central bronchial loacation kleading to obstruction of bronchi thus leading to collapse and lobar pneumonuia.also there are highly vascular leading to hemoptysis
which value of chloride in sweat is diagnostic of cystic fibrosis
more than 60 mmol/L.If value is bw 30 to 60 genetic testing for CFTR should be performed.
some rare diseases that cause granulomatous disease in lungs
berrylliosis [ causes simillar pictute to sarcoid]
histoplasmosis
histiocytosis X [occurs in young patients]
pysiology of IPF in relation to recoil and compliance
decrease compliance but increased recoil.as these are inversely related.
also widening of Aa gradient on exercise.[desaturation on minimal effort etc]
patern of inheritance of familail PPH [6 percent case]
AD e incomplete penetrance
is there any role of PEFR in copd
yes.it can predict prognosis as smoking cessation halts the fall in pefr.but major role is in asthma where it can guide tx of acute asthma as it reflects flow rate in LARGER airways.
in good-pasture anti-gbm antibodies are directed against
a3 chain of type 4 collagen
causes of false positive anti gbm antibodies
inhaled oils,hydrocarbons and solvents
PCP pneumonia in HIV.
any genetic component associated with mesothlioma
loss of material from chromosome 22 in mesothelioma cell lines.this region that is lost may code for some tumor supressor genes.
what are only tx options in asbestosis
stop smokin [50x risk of ca in combos]
stop working in asbestos
NO role of steroids or other drugs in asbestosis.
what is mendelson syndrome
pneumonia caused by aspiration stomach content in particular the gastric juice.Lead to BRONCHOSPASM and rapid onset pneumonia e MINIMAL sputum.seen in anesthesized pts with absent gag or during epilectic seizures.
which vitamin supplimentations are recomended in cystic fibrosis
vit A
or B12
if given the option choose ADEK fat soluble options.no significant role of b12
definite diagnosis of anerobic aspiration pneumonia
culture from direct specimen obtained either thru bronchoscopy or transcurtaneous route.remember kleibsiella is a gram negative AEROBE causing cavitatory lesions.
alogrithym for diagnostic pleural aspiration vs ct chest.which to perform first.
in case of CANCER lungs or pulmonary patholgy like ild,first perform CT
in case of systemic diseases like nephrotic syndrome where effusion is not resolving and no chest signs are mentioned in the vingette,go ahead for pleural aspiration and analysis.
investigation of choice for UNILATERAL diaphragm paralysis
FLUROSCOPY e SNIFF TEST.parodoxical upward movement of paralysed side due to raised intradominal pressure.NOT for bilateral paralysis.
occupations associated with silicosis and asbestosis
ASBESTOSIS = Plumbers,electricians,engineers and shipyard workers.
SILICOSIS = quartz,sandblasting,mining,foundery,pottery,slate workers,tunelling.
what is the typical stethoscope finding in case of bronchial cancer [ xray showing hilar mass]
WHISPERING PECTORILOQUY = signifies consolidation.
which finding will favour a diagnosis of ARDS
increased elastic recoil of lungs due to alvelor damage and subsequent loss of surfectan increaing surface tnesion and recoil.also eventually the lung compliance can decrease later as these are inversely related.Remember PAWP will be normal or decreased in contrast to HF.
most common blood biochemical finding in PCP
raised LDH
manifestation and typical feature of hepatopulmonary syndrome
in CLD there is reduced clearance of vasodilators like NO.These lead to p.vasodilation.Ultimately PAVM forms in the lower lobes causing R to L shunt secondary to increased angiogenesis.
typical feature is platypnea-orhtodeoxia syndrome i.e reduced saturation on errect position as compared to lying supine.This is due to AVMs in the lower lobes as in standing position blood goes to lower lobes,there is R to L shunt in these lower lobes so lower oxygenated blood goes to blood and low saturations
most common sequale of sarcoidosis with BHL and erythema nodosum
Complete resolution without treatment.
what are the features of crytogenic pulmonary eosinophilia
no cause
raised eosinophils
systemic features like fever,weight loss,malaise
asthma in 50 percent
raised ESR
tx is steroids.
investigation of choice for churgh starus
skin biopsy showing granlumatous arteriopathy
lung or kidney biopsy
MDR TB
TB resistant to isoniazid and rifampicin with or without other drugs resistance.HIV is a risk factor.
tx should be with 5 anti tb drugs to which person is susceptible.it should continue until sputum samples are negative.Than 3 drug tx for further 9 to 24 months after negative sputum.
typical feature of cryptogenic organizing pneumonia
migratory opacities/consolidations.
tx of radiation pneumonitis
no tx if mild.
steroids if severe.
diagnosis of cough variant asthama [asthma e cough in the morning and on walking etc]
NOTHING.we will do pfts and spirometry but it will be normal as there is minimal bronchoconstriction.Ultimately a trial of TX is required to show reversible bronchoconstriction and symptomatic relief at the same time.
tx of hypercalcemia associated e sarcoidosis
Steroids.
causes of decrease VOCAL resonance
Pleural effusion
pneumothorax
empyema
atelectasis
causes of increased vocal resonance
pneumonia
fibrosis
cancer
carrier frequency of Cystic fibrosis
1 in 25 in white populations
which investigation is best for lymph node for mediastinal involvement assesment in NSCLC
mediastinoscopy or PET scan.
ct can miss.
alveolar structure is preserved in which common lung disease
Asthma
tlco in idiopathic pulmonary heimosiderosi
raised.
characterized by occurence in young pts.pallor,lethargy,dry cough and occasional hemotypsis
when should running,contact sports and other things like blowing trumpet can restart
after 2 months.
never scuba dive
air travel after 1 week of resolution
