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Year 3 > Respiratory Qs > Flashcards

Respiratory Qs Flashcards

1
Q

Differentiate refeeding syndrome features from congestive cardiac failure?

A

Both may have pulmonary oedema and peripheral oedema

New onset arrythmia + deranged electrolyes = refeeding

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2
Q

What do give a patient with penumonia who have a pmh of COPD

A

Prednisolone
give corticosteroids for vibes doesnt matter if COPD is acting up or not

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3
Q

[HIV] patient with pneumocystis jiroveci pneumonia 1st line tx?

A

Co-trimoxazole - mix of trimethoprim and sulfamethoxazole

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4
Q

A patient with bronchiectasis has an acute exacerbation, what is the most common causative agent?

A

Haemophilius influenzae

then you consider strep.a and psuedomonas aueruginosa

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5
Q

If a patient has indication that they have severe asthma, what PCO2 will determine that it is actually life-threatening?

A

A normal CO2, it should be low due to the fact she is hopefully hyperventilating

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6
Q

What types of asbestos are there?

A

Blue - Crocidolite - most fibrogenic

Brown - amosite - intermediate

White - chrysotile - least fibrogenic

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7
Q

Are asbestosis plaques a stage of pre-malignancy?

A

No, they are benign and having plaques does not put someone at a higher risk of mesothelioma any different from having asbestos exposure

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8
Q

transudative vs exudative pleural fluid (e.g. pleural effusion fluid analysis)

A

Transudative (changes in the pressures and pleural permeability)

  • Congestive heart failure
  • Liver cirrhosis
  • Severe hypoalbuminemia
  • Nephrotic syndrome

Exudative (changes to local factors)
- malignancy
- infection - pneumonia (most common exudative)
- trauma
- PE

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9
Q

If a pleural effusion fluid protein/serum protein ratio is
>0.5?
<0.5?

A

More than = exudate effusion
Less than = transudate effusion

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10
Q

On Xray you see the whole right lung area is white-out, is it massive pleural effusion or a lung collapse?

A

Lung collapse = trachea deviation
( also a pneumonectomy)

Pleural effusion = trachea pushed away

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11
Q

Pleural fluid with a protein level of what is indicative of exudate?

A

30+

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12
Q

Definitive diagnostic investigation for mesothelioma?

A

Thoracoscopy and histology

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13
Q

What score following polysomnography is diagnostic for OSA?

A

Apnoea-hypopnea index of 15+

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14
Q

Drug therapy for fibrotic lung disease?

A

Pirfenidone

Nintedanib

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15
Q

Which drugs can cause lung fibrosis (ACID - lower lung fibrosis)

A

Methotrexate
Amiodarone
Nitrofurantoin (+ other abx)
Chemotherapy

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16
Q

Which drugs can cause lung fibrosis (ACID - lower lung fibrosis)

A

Methotrexate
Amiodarone
Nitrofurantoin (+ other abx)
Chemotherapy

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17
Q

Lung transfer factor and transfer coefficient reduced in fibrosis?

A

How well oxygen is passing from lungs to blood

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18
Q

Spirometry picture in fibrosis?

A

Restrictive = FEV1/FVC ratio increased 70%+ with FVC decreased

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19
Q

Manage cov19 patient with hypoxia

A

oxygen
dexamethasone
remdesivir

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20
Q

Manage severe covid 19

A

monoclonal therapy with tocilizumab

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21
Q

hepatomegaly and jaundice in lung cancer?

A

Sign of mets

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22
Q

Headache and seizures in lung cancer?

A

sign of mets

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23
Q

Clubbing, cavitating lesions, hypercalcaemia?

A

Squamous cell lung cancer

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24
Q

What is lambert eaton syndrome?

A

Paraneoplastic syndrome in Small cell lung cancer

waddling gait, muscle tenderness, hyporeflexia, antibodies against voltage gated calcium channels at NMJ

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24
Q

What is lambert eaton syndrome?

A

Paraneoplastic syndrome in Small cell lung cancer

waddling gait, muscle tenderness, hyporeflexia, antibodies against voltage gated calcium channels at NMJ

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25
Q

How to stage COPD? (GOLD classification system)

A

dependent if symptomatic + FEV1/FVC ratio <0.7 = atleast stage 1 (have COPD)

stage 1 = FEV1 80%+ of prediction
stage 2 = FEV1 50-79% of prediction
stage 3 = FEV1 30-49% of prediction
stage 4 = FEV1 < 30% of prediction

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26
Q

can you have a dry cough pneumonia?

A

atypical organisms as cause

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27
Q

can you have haemoptysis in an infection?

A

yeah, severe pneumonia

bronchiectasis (post infections all the time)

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28
Q

CURB65, R?

A

30+ RR

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29
Q

CURB65, B?

A

Systolic BP <90

(+/or)

diastolic BP <60

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30
Q

Empirical tx for pneumonia

mild
moderate
severe

A

mild - oral amoxicillin

moderate - oral/IV amoxicillin + clarithromycin

severe - IVco-amoxiclav + clarithromycin

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31
Q

tx abx for aspirate pneumonia

A

IV cephalosporin

IV metronidazole

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32
Q

penicillin allergy and pneumonia?

A

cephalosporin instead of amoxicillin

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33
Q

tx for legionella pneumonia?

A

++ levofloxacin + rifampicin

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34
Q

red current sputum

upper lobe cavitating pneumonia

alcoholics, elderly, diabetic

A

klebsiella pneumonia

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35
Q

what pneumonia is linked with autoimmune haemolytic anaemia?

A

mycoplasma

  • if patient is anaemic, raised LDH, messed up LFTs (increased bili, unconjugated etc)
  • the pnuemonia causes the anaemia 2-3 weeks in
36
Q

preceeding influenza predisposes to which pneumonia?

A

staphylococcus aureus penumonia

37
Q

what prophylaxis may a HIV px need against Pneumocystis jiroveci pneumonia

A

give co-trimoxazole (usually tx) if their CD4 count is lower than 200!

38
Q

‘RIPE’ TB tx side effects?

A

Rifampicin = hepatitis, red/orange secretion, lower INR despite warfarin use

Isoniazid = hepatitis, peripheral neuropathy so give PYRIDOXINE

Pyrazinamide = hepatitis, gout

Ethambutol = optic neuritis

  • so need to check LFTS monthly
39
Q

What disease test is offered to all TB patients?

A

HIV

40
Q

Acute bronchitis summary?

A

Usually viral

2 weeks hx productive cough, runny nose, wheeze

inflammation rather than consolidation (no consolidation signs on examination)

do not give abx right away as mostly viral

41
Q

when are abx indicated in acute bronchitis?

A

immediate if CRP 100+

consider in comorbid/very sick patients

42
Q

investigation for adults with suspected asthma?

A

Adults with suspected asthma should have both a FeNO test and spirometry with reversibility

43
Q

If a COPD px is breathless despite being on a SABA (salbutemol) / SAMA (ipratropium bromide) then what? *if show signs of asthmatic features

A

Add a ICS and a LABA (salmetrol)

44
Q

After smoking what intervention really improves survival in copd px?

A

Long term oxygen therapy

consider in px with cor pulmonale as well as loop diuretic

45
Q

If a COPD px is breathless despite being on a SABA (salbutemol) / SAMA (ipratropium bromide) then what? *no signs of asthmatic features

A

LAMA) (tiotropium) and
LABA e.g formetorol

A SABA should be given instead for short-acting relief

46
Q

abx prophylaxis in which COPD px?

A

Those who have too many exacerbations = azithromycin

47
Q

Sarcoidosis skin signs?

Eye signs?

A

Lupus pernio
erythema nodosum
maculopapular eruptions

Anterior uveitis, keratoconjunctivitis sicca, glaucoma, papilloedema

48
Q

Sarcoidosis staging (based on CXR)

A

Stage 1 - Bilateral hilar lymphadenopathy
Stage 2 - Bilateral H.L + infiltrates
Stage 3 - Only pulmonary infiltrates
Stage 4 - Extensive fibrosis

49
Q

pneumonia typical vs atypical organism

A

strep pnumoniae !! - most common, rusty sputum
Haemophillus influenzae - gram- , COPD px
Staph Aureus - post influenza, gram+, cavitating lesions
Klebsiella - alcoholics, diabetics, red current sputum, cavitating lesions

mycoplasma
legionella
chlamidya
Pneumocystis Jirovecii

50
Q

Adenocarcinoma of the lung summary

A

A NSCLC

Peripherally located
Most common and in non -smokers
Gyncaecomastia

51
Q

Squamous cell carcinoma lung summary

A

A NSCLC

Centrally located
Associated with smoking
released PTHrP = hypercalcaemia
Cavitating lesions on Xray

52
Q

Small cell lung cancer summary?

A

Centrally located
ectopic ADH + ACTH secretion which can result in cushings
Kulchitsky cell involvement
SVC obstruction = pembertons test

53
Q

what paraneoplastic features may be seen in Small cell lung cancers?

A

SIADH/ Cushings

Lambert Eaton syndrome = LEMS ⇒ difficulty walking (waddling gait), muscle tenderness, hyporeflexia. Muscle weakness that improves with exercise (as opposed to myasthenia gravis). Antibodies against the pre-synaptic voltage-gated calcium channels at the NMJ

54
Q

Coal workers pneumoconiosis summary

A

coal miner exposure to coal dust
usually asymptomatic but puts at risk of progressive massive fibrosis

= exertion SOB, cough (black sputum) , upper lobes

restrictive pattern

55
Q

Silicosis summary

A

SOB + cough, fibrotic condition due to silica inhalation (stonemason, pottery, ceramics)

puts you at risk of TB

‘egg shell’ calcification of hilar lymph nodes on CXR

56
Q

Resp failure summary?

A

Type 1 = hypoxaemic, low Oxygen and normal CO2
Type 2 = Hypercapnic, low Oxygen and high CO2 (6+) (COPD exacerbations, neurological causes)

IX = ABG

MX:
Oxygen to correct hypoxaemia first
then T1 = CPAP
then T2 = BiPAP

57
Q

Patient with acute exacerbation of COPD who are in resp acidosis - resp failure mx?

patient with COPD who are hypoxic but not yet in resp acidosis?

A

Non invasive ventilation

28% venturi mask

58
Q

Influenza A - science

A

classified into various subtypes based on glycoproteins of viral envelope - haemaglutinin (H) and neuraminidase (N)

causes annual and the larger intensity pandemics

59
Q

Detected of the influenza virus?

A

Reverse transcriptase - polymerase chain reaction

60
Q

Covid 19 Ix

severe mx + leading cause of death?

A

Real time reverse transcriptase polymerase chain reaction

VTE prophylaxis, oxygen therapy, mechanical ventilation -> ARDS resp failure

61
Q

Pott’s disease?

A

when tuberculosis spreads to bones e.g. spine

62
Q

Cystic fibrosis - bronchiectasis summary

A

autosomal recessive, viscous secretions

due to CFTR (cystic fibrosis transmembrane conductance regular gene) which codes Cl channels

  • recurrent infection, delayed puberty, malabsorption

Ix - sweat test

Mx - chest physio

63
Q

Primary ciliary dyskinesia / karagener’s syndrome - bronchiectasis summary

A

bronchiectasis + dextrocardia + recurrent sinusitis

64
Q

Allergic bronchopulmonary aspergillosis - bronchiectasis summary

A

eosinophilia + raised IgE

tx - oral prednisolone

65
Q

Most common organism sputum bronchiectasis in CF and non CF patient

A

CF bronchiectasis = psueodmonas aeruginosa

Non CF = haemophilus influenzae

66
Q

extrinsic allergic alveolitis (fibrotic lung)

A

px with chronic exposure to bird droppings

Type III hypersensitiity = lung damage

67
Q

4 ds of fibrotic lung

A

dyspnoea - progressive
digital clubbing
diffuse inspiratory crackles
dry cough

68
Q

C in CURB 65

A

Confusion = AMTS of 8 or less

69
Q

COPD infective exacerbation medication?

A

Amoxicillin

if allergic - doxycycline / clarithromycin

70
Q

Pneumonia with low Na+ and LFT deranged?

A

Legionella

71
Q

erythema multiforme with chest infection?

A

mycoplasma pneumonia

72
Q

hospital acquired pneumonia tx?

A

tazocin

73
Q

Gold standard sarcoidosis mx?

A

Bronchoscopy + biopsy = caseating granulona

74
Q

pleural fluid features if infected?

A

Prurlent, cloudy, acidic pH, but clear

insert a chest drain

75
Q

first line ix bronchiectasis?

gold standard ix bronchiectasis?

A

CXR = tram lines

CT = dilated bronchi, signet ring sign, tram track

76
Q

what do cannonball rounded lesiosn suggest on X-ray?

A

Renal cell cancer mets

77
Q

tension pnumothroax tx?

A

large bore 14-16G cannula = decompression

in 2nd ICS MCL

78
Q

antifibrotic agent?

A

Pirfenidone

79
Q

what is bronchodilator reversibility?

A

FEV1 12% improvement

80
Q

asthma management

A
  1. SABA(Salbutamol)
  2. SABA + ICS
  3. SABA + ICS + LTRA (Montelukast)
  4. SABA + ICS + LABA (Salmeterol)
81
Q

given adrenaline twice but still anaphylaxis?

A

IV chlorphenamine 10mg + IV hydrocortisone 200mg

82
Q

OSA mild, mod, severe?

A

Depending on episodes per hr

5-15 - mild
15-30 - mod
30+ - severe

83
Q

hypertension type in OSA?

A

Can cause hypertension with widened pulse pressure as a complication

as well ass low mood, low libido,

84
Q

hyponatraemia in what cancer?

A

Small cell lung cancer

85
Q

poor prognosis in sarcoidosis?

A

Increased calcium - indicates renal failure

86
Q

Tb first line x

Tb gold standard ix

Tb latency ix

A

CXR - consolidation and bi-hilar lymphadenopathy. May see cavitating lesion in upper lobe

Sputum Culture → Sputum acid-fast bacilli smear → Ziehl-Neelson stain, AFB positive

Mantoux test (for contacts of infected)

87
Q

what is resp arrest?

extra-pul causes

pulmonary causes

A

Cessation of breathing but do have a pulse

opioid CNS depression, Myasthenia gravis, ALS, drowning

airway obstruction - asthma/copd bronchospasm, impaired alveolar diffusio

88
Q

metabolic acidosis mx
metabolic alkalosis mx

A

IV Sodium Bicarbonate

Acetazolamide

Year 3 (14 decks)

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