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Progress Test Y2 Med > Respiratory Qs > Flashcards

Respiratory Qs Flashcards

1
Q

What are the clinical signs that indicate suspected cancer, meaning that an urgent chest xray within 2 weeks is required?
(Name 7- starting with the 2 main ones)

A

For patients over 40:
1.Clubbing
2.Lymphadenopathy (supraclavicular or persistent abnormal cervical nodes)

3.Recurrent or persistent chest infections
4.Raised platelet count (thrombocytosis)
5.Chest signs of lung cancer
6. 2 or more unexplained symptoms in patients that have never smoked
7.One or more unexplained symptoms in patients that have never smoked AND never had asbestos exposure

Thrombocytosis vs phillia = when another disease or condition causes you to have a high platelet count

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2
Q

What are the ‘unexplained symptoms’ in patients that would recommend an urgent chest xray to investigate suspected cancer?
(Name 6)

A

1.Cough
2.Shortness of breath
3.Chest pain
4.Fatigue
5.Weight loss
6.Loss of appetite

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3
Q

A 50 year old ex-smoker presents feeling “tired all the time” with no other symptoms. What is the red flag diagnosis and first steps?

A

i)Cancer
ii)Urgent Chest Xray

-qualifies as fatigue is an unexplained symptom and the patient is over 40 years old

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4
Q

A woman aged 42 presents with weight loss and general fatigue. She has never smoked. What is the red flag diagnosis and first step?

A

i)Cancer
ii)Urgent Chest Xray

-qualifies as fatigue and weight loss is an unexplained symptom and the patient is over 40 years old

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5
Q

What is the first-line investigation in suspected lung cancer?

A

Chest Xray

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6
Q

List the findings of a Chest Xray that would suggest lung cancer.

A

1.Hilar Enlargement
2.Peripheral Opacity
3.Pleural effusion (usually unilateral in cancer)
4.Collapse

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7
Q

What is Peripheral opacity on a Chest Xray?

A

A visible lesion in the lung field.

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8
Q

What investigation must be used to assess the stage of lung cancer?

A

CT scan : Contrast-enhanced, of the chest, abdomen and pelvis

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9
Q

What investigation is required to assess metastasis of cancer?

A

PET-CT (Positron Emission Tomography)

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10
Q

List all of the investigations required in a patient with suspected lung caner?

A

Initial diagnosis:
Chest Xray

Staging:
CT Scan

Metastasis:
PET-CT

Tumour analysis (histological diagnosis):
Bronchoscopy or Percutaneous Biopsy

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11
Q

What is the most significant lifestyle cause of lung cancer?

A

Smoking

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12
Q

What are the two general types of histological classifications of lung cancer?

A

-Small-Cell lung cancer (20%)
-Non-small cell lung caner (80%)

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13
Q

What are the types of Non-small-cell lung cancer?

A

-Adenocarcinoma (Most common)
-Squamous cell carcinoma
-Large-cell carcinoma
-Other

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14
Q

What type of lung cancer is strongly linked to Asbestos inhalation?

A

Mesothelioma
(of pleura incasing the lung)

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15
Q

What is the prognosis for Meothelioma?

A

Poor prognosis:(
Chemotherapy can improve survival but is mainly palliative

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16
Q

List the general paraneoplastic syndromes syndromes?
(Name 9)

=group of rare disorders that occur when the immune system has a reaction to a cancerous tumor known as a “neoplasm.”

A

-Recurrent Laryngeal Nerve Palsy
-Phrenic Nerve Palsy
-Superior Vena Cava Obstruction
-Horner’s Syndrome
-Syndrome of inappropriate ADH (SIADH)
-Cushing’s syndrome
-Hypercalcaemia
-Limbic Encephalitis
-Lambert Eaton Myasthenic Syndrome

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17
Q

What is Recurrent Laryngeal Nerve Palsy?

A

Presents with hoarse voice caused by a tumour pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.

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18
Q

What is Phrenic Laryngeal Nerve Palsy?

A

Presents with shortness of breath due to diaphragm weakness caused by nerve compression.

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19
Q

What is Superior Vena Cava Obstruction?

A

MEDICAL EMERGENCY!
It is a complication of lung cancer caused by compression of the tumour on the SVC.

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20
Q

What is Pemberton’s sign?

A

Raising the hands over the head causes facial congestion and cyanosis.

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21
Q

Describe a typical presentation of a patient with Superior Vena Cava obstruction.

A

Facial swelling, difficulty breathing and distended neck and upper chest veins. Also note Pemberton’s sign.

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22
Q

What is Horner’s Syndrome?

A

Triad: Partial Ptosis (eyelid drooping), Anhirdosis (inability to sweat) and Miosis (constricted pupils), that is caused by a Pancoast tumour pressing on the sympathetic ganglion.

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23
Q

What is a Pancoast tumour?

A

Tumour in the pulmonary apex (lung)

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24
Q

What is Ptosis?

A

When the upper eyelid droops over the eye which can limit or even completely block normal vision.

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25
Q

What is the meaning of Paraneoplastic syndromes?

A

Group of rare disorders that occur when the immune system has a reaction to a cancerous tumour known as a neoplasm.

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26
Q

What is Anhidrosis?

A

A rare condition in which the sweat glands make little or no sweat and may cause severe burns, infection or inflammation.

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27
Q

What is Miosis?

A

Excessive constriction (shrinking) of pupil.

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28
Q

How would a Pancoast tumour cause Horner’s Syndrome?

A

By pressing on the Sympathetic Ganglion.

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29
Q

What is Syndrome of inappropriate ADH (SIADH)?

A

It presents with hyponatraemia which is caused by ectopic ADH secreted by a small-cell lung cancer.

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30
Q

How can lung cancer cause Cushing’s Syndrome?

A

Ectopic ACTH secretion by a small-cell lung cancer.

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31
Q

How can Hypercalcaemia be caused by lung cancer?

A

Ectopic parathyroid hormone secreted by squamous cell carcinoma.

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32
Q

What type of lung cancer can cause Hypercalcaemia?

A

Squamous Cell Carcinoma

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33
Q

What is the pathophysiology of Limbic Encephalitis?

A

Caused by small-cell lung cancer causing the immune system to make antibodies to tissues in the brain (esp. the limbic system) which caused inflammation in those areas.

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34
Q

How does Limbic Encephalitis present?

A

Short term memory impairment, hallucination, confusion, seizures.

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35
Q

What antibodies is Limbic Encephalitis associated with?

A

Anti-Hu

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36
Q

What is pathophysiology of Lambert Eaton Myasthenic Syndrome?

A

Caused by antibodies against small-cell lung cancer cells. These antibodies also target and damage voltage-gated calcium channels sited on the presynaptic terminals in motor neurones.

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37
Q

How does Lambert-Eaton Myasthenic Syndrome present?

A

-Weakness of proximal muscles
-Diplopia
-Ptosis
-Slurred speech
-Dysphagia

Additional Symptoms:
-Dry mouth
-Blurred vision
-Impotence
-Dizziness

Lambert EYES and MOUTH

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38
Q

What muscle weakness causes Ptosis?

A

Levator muscles

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39
Q

What muscle weakness causes Diplopia?

A

Intraocular muscles

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40
Q

What muscle weakness causes slurred speech?

A

Pharyngeal muscles

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41
Q

What muscle weakness causes dysphagia?

A

Pharyngeal muscles

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42
Q

What is dysphagia?

A

Difficulty swallowing

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43
Q

A patient has been diagnosed with non-small-cell lung cancer with no metastasis. What is the first line treatment to be offered?

A

Surgery - to remove entire tumour
1.Segmentectomy / Wedge resection = remove segment of lung
2. Lobectomy =remove lobe of lung
3.Pneumonectomy =remove entire lung

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44
Q

What type of surgery technique is preferred for treating lung cancer?

A

Video-assisted thoracoscopic surgery (VATS) or Robotic Surgery as they are minimally invasive.

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45
Q

What is the pathophysiology of pneumonia?

A

Infection of the lung tissue, causing inflammation in the alveolar space.

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46
Q

How does Pneumonia present on a Chest Xray?

A

Consolidation

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47
Q

Are upper respiratory tract infections associated with viral or bacterial infections?

A

Viral

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48
Q

Are lower respiratory tract infections associated with viral or bacterial infections?

A

Bacterial

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49
Q

What is the pathophysiology of Acute Bronchitis?

A

Lower respiratory tract infection and inflammation in the bronchi and bronchioles.

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50
Q

What are the 3 types of Pneumonia?

A

1.Community-Acquired Pneumonia
2.Hospital-Acquired Pneumonia
3.Ventilator-Acquired Pneumonia

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51
Q

Define Hospital-acquired pneumonia (HAP).

A

Develops after more than 48hrs in a hospital

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52
Q

Define Ventilator-acquired pneumonia (VAP).

A

Develops in intubated patients in the intensive care unit.

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53
Q

Define Aspiration Pneumonia.

A

When the infection develops due to the aspiration of food or fluids, usually in patients with impaired swallowing (e.g., following a stroke or advanced dementia). Aspiration pneumonia is associated with anaerobic bacteria.

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54
Q

What are the 3 main characteristic chest signs of Pneumonia?

A

1.Bronchial Breath Sounds
2.Focal Coarse Crackles
3.Dullness to percussion

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55
Q

What signs can indicate sepsis secondary to pneumonia?
(Name 6)

A

1.Tachypnoea
2.Tachycardia
3.Hypoxia
4.Hypotension
5.Fever
6.Confusion

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56
Q

What are the presenting symptoms of Pneumonia?
(Name 8)

A

1.Cough
2.Sputum production
3.Shortness of breath
4.Fever
5.Haemoptysis (coughing up blood)
6.Pleuritic chest pain (sharp chest pain, worse on inspiration)
7.Delirium (acute confusion)

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57
Q

Describe a typical presentation of a patient with Acute Bronchitis.

A

Predominant complaint:
-Productive Cough (clear or yellow sputum)

Other Symptoms:
-Malaise
-Difficulty breathing
-Wheezing

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58
Q

What Respiratory rate reading would suggest a respiratory illness?

A

Above or equal to 30 breaths per minute

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59
Q

What are the two top bacteria that cause Pneumonia?

A

-Streptococcus Pneumoniae
-Haemophilius Influenzae

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60
Q

What type of bacteria is Streptococcus pneumoniae?
(Gram positive or negative, shape, Anaerobic or Anarobic)?

A

-Gram positive
-Lancet-Shaped
-Anaerobic

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61
Q

What type of bacteria is Haemophilus influenzae?
(Gram positive or negative, shape, Anaerobic or Anarobic)?

A

-Gram Negative
-Coccobacillus
-Anaerobic

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62
Q

What is general treatment for a patient with Atypical Pneumonia?

A

-Clarithromycin
-Levofloxacin
-Doxycycline

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63
Q

What treatment does Atypical pneumonia NOT respond to?

A

Penicillin

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64
Q

A patient presents with pneumonia symptoms and Hyponatraemia (low sodium), after returning hope from a cheap hotel holiday. What is the most likely diagnosis and initial investigation?

A

i) Legionella Pneumophila infection
=caused by inhaling infected waters (e.g infected aircon unit)

ii) Urine Antigen test

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65
Q

Describe a typical presentation of Mycoplasma Pneumoniae.

A

-Milder form of Pneumonia:
-Erythema Multiforme rash characterised by ‘target’ lesions
-Neurological symptoms in younger patients

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66
Q

A patient has come in presenting with Pneumonia symptoms but there is no result from the Gram staining. He is a Parrot owner. What type of Atypical Pneumonia would this most likely be?

A

Chalmydia Psittaci

=contracted from infected bird

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67
Q

A patient presents with pneumonia symptoms but no bacteria was detected on the Gram Staining. He is a farmer. What type of Atypical Pneumonia is this most likely to be?

A

Coxiella Burnetii / Q fever

=caused by exposure to animal bodily fluids

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68
Q

What type of infection is a patient with poorly controlled HIV and a low CD4 count most at risk of?

A

Pneumocystis jirovecii pneumonia (PCP)

=Fungal Pneumonia

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69
Q

Describe a usual presentation of a patient with Pneumocystis jirovecii pneumonia (PCP).

A

-Affects Immunocompromised patients
-Dry Cough
-Shortness of breath on exertion
-Night sweats

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69
Q

Describe a usual presentation of a patient with Pneumocystis jirovecii pneumonia (PCP).

A

-Affects Immunocompromised patients
-Dry Cough
-Shortness of breath on exertion
-Night sweats

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70
Q

A patient with HIV has been experiencing shortness of breath when walking, a dry cough and night sweats. What is most likely to be prescribed?

A

Co-Tramoxazole (Septrin)

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71
Q

A patient has a low CD4 count. What medication should be prescribed to protect against Pneumocystis jirovecii pneumonia (PCP)?

A

Prophylactic Co-Timoxazole

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72
Q

A patient in primary care is presenting with Pneumonia symtpoms. What investigation will most likely be done here?

A

CRP level check

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73
Q

What investigations will be done for patients presenting with Pneumonia symptoms?

A

-Chest Xray
-Full blood count (look for raised WBCs)
-Renal profile (urea level)
-C-reactive protein - raised in inflammation

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74
Q

What will patients with moderate or severe pneumonia infection also present?

A

-Sputum cultures
-Blood cultures
-Pneumococcal and Legionella Urinary Antigen tests

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75
Q

A patient has been diagnosed with community-acquired pneumonia. What is the treatment?

A

-Amoxicillin
-Doxycycline
-Clarithromycin

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76
Q

A patient has been diagnosed with severe pneumonia. What is initial treatment?

A

-IV Antibiotics
(Step down to oral antibiotics when discharged)
-Respiratory support

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77
Q

Name 6 complications of Pneumonia.

A

-Sepsis
-Acute Respiratory Distress Syndrome
-Pleural effusion
-Empyema
-Lung Abscess
-Death

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78
Q

What is the normal range of PaO2?

A

10.7-13.3 kPa

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79
Q

What is the normal range of PaCO2?

A

4.7 – 6.0 kPa

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80
Q

What is the normal range of HCO3?

A

22 – 26 mmol/L

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81
Q

A patient has a PaCO2 of 9mmol/L. What does this indicate?

A

Hypoxia and Respiratory failure as it is lower than the normal range (10.7-13.3)

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82
Q

A patient has a PaCO2 of 5kPa and a PO2 of 8.3kPa. What does this indicate?

A

Type 1 Respiratory failure

(CO2 is normal while O2 is low)

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83
Q

A patient has a PaCO2 of 7kPa and a PO2 of 7.3kPa. What does this indicate?

A

Type 2 Respiratory Failure

(Raised CO2 and Low O2)

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84
Q

What is the pH value definition for Acidosis?

A

Under 7.35

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85
Q

What is the pH value definition for Alkalosis?

A

Above 7.45

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86
Q

A patient has a pH of 7.2, a PaO2 of 10.8kPA and a PaCO2 of 8kPA. What does this indicate?

A

Respiratory Acidosis

(Patient’s PaCO2 is raised and they have a low pH. This indicates that they are acutely retaining CO2 making the blood acidotic).

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87
Q

What values would you expect to be raised in Respiratory Acidosis?

A

-PaCO2
-Bicarbonate
(Kidneys are producing more to neutralise the raised CO2)

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88
Q

A patient has Respiratory Acidosis. What condition more than like caused this?

A

COPD

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89
Q

A patients presents with a respiratory rate of 40 breaths/ minute, PaCO2 of 3kPa and a pH of 8. What does this indicate?

A

-High resp rate
-Low PaCO2
-High pH (alkalosis)

=Respiratory Alkalosis

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90
Q

What are the two main conditions that cause Respiratory Alkalosis?

A

1.Pulmonary Embolism
2.Hyperventilation (due to anxiety)

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91
Q

A patient presents with a high pH, raised respiratory rate and a low PaO2. What is the most likely underlying cause?

A

Pulmonary Embolism

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92
Q

A patient presents with a high pH, raised respiratory rate and a high PaO2. What is the most likely underlying cause?

A

Hyperventilation (due to anxiety)

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93
Q

A patient presents with a high pH, raised respiratory rate and a high PaO2. What is the most likely underlying cause?

A

Hyperventilation (due to anxiety)

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94
Q

A patient with Type 1 diabetes has the following values:
-Raised Ketones
-Low pH
-Low Bicarbonate

What does this indicate?

A

Metabolic Acidosis due to Diabetic Ketoacidosis

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95
Q

What does a low pH and low bicarbonate indicate?

A

Metabolic acidosis

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96
Q

What are the causes of metabolic acidosis?
(Name 4)

A

1.Tissue Hypoxia =Raised lactate
2. Diabetic ketoacidosis =Raised ketones
3. Renal failure, type 1 renal tubular acidosis or rhabdomyolysis =Increased hydrogen ions
4.Diarrhoea (stools contain bicarbonate), renal failure or type 2 renal tubular acidosis =Reduced bicarbonate

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97
Q

What values would you expect from Metabolic Alkalosis

A

-Raised pH
-Raised Bicarbonate

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98
Q

Metabolic alkalosis results from loss of Hydrogen ions. What are the 2 main causes of this?

A

-GI tract : Vomitting
-Kidney: Increased activity of aldosterone

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99
Q

What can cause an increase of activity of aldosterone?

A

-Conn’s syndrome (primary hyperaldosteronism)
-Liver cirrhosis
-Heart failure
-Loop diuretics
-Thiazide diuretics

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100
Q

Describe the typical presentation of a patient with suspected Asthma.

A

Episodic Symptoms:
-Shortness of breath
-Chest tightness
-Dry Cough
-Wheeze

-If they respond to Bronchodilators (if they don’t then it is unlikely to be Asthma)

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101
Q

Describe the type of wheeze presented for a patient with Asthma.

A

Widespread ‘polyphonic’ expiratory wheeze

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102
Q

After clinical examination, what is the next investigation for suspected Asthma?

A

Chest Xray

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103
Q

What drugs can worsen asthma?

A

Beta blockers, NSAIDs (e.g Ibeprofen and Naproxen)

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104
Q

What results would you expect from a Fractional Exhaled Nitric Oxide test for a patient with Asthma?

A

Positive result = Asthma, Above 40ppb

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105
Q

What lifestyle choice can interfere with the Fractional Exhaled Nitric Oxide test results?

A

Smoking
-it lowers the value

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106
Q

What results would you expect from a Reversibility Test for a patient with Asthma?

A

Greater than 12% increase in FEV1

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107
Q

What results would you expect from a Peak Flow Variability test for a patient with Asthma?

A

Variability of more than 20%

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108
Q

What results would you expect from a Spirometry test for a patient with Asthma?

A

FEV1:FVC ratio less than 70%

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109
Q

Give examples of SABAs.

A

Salbutamol

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109
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
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110
Q

GIve e

A
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111
Q

Give examples of Corticosteroids.

A

Glucacorticosteroids, Prednisone, Methylprednisolone

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112
Q

Give examples of LTRAs.

A

Montelukast

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113
Q

Give examples of LABAs.

A

Salmeterol and Formoterol

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114
Q

When would you add Prednisone to a patients Asthma management?

A

After the first drug: Salbutamol

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115
Q

A patient is taking Salbutamol. What underlying conditions would mean they would need to be carefully monitored and what would they be monitored for?

A

1.Severe Asthma
-Monitor for Hypokalaemia
2.Diabetes
-Monitor for Hyperglycaemia

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116
Q

What are the two common side effects of Salbutamol?

A

1.Muscle cramps
2.Arrythmias

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117
Q

What are the corticosteroids prescribed for in asthma?

A

Prophylactic and Anti-inflammatory

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118
Q

What would you prescribe if a patient on a SABA and Corticosteroid isn’t having their Asthma adequately controlled?

A

Montelukast
(LTRA)

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119
Q

What drug would swap which drug if Asthma isn’t being adequately controlled?

A

Swap out the Salbutamol (SABA) for Salmeterol (LABA)

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120
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
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121
Q

After swapping out the SABA for a LABA, what next management change will be implemented for Asthma that isn’t being adequately controlled?

A

Increase inhaled corticosteroid dose to moderate dose.

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122
Q

After increasing a patient’s inhaled corticosteroids to a moderate dose, what is the next step for asthma that is not adequately controlled?

A

Increase moderate dose to high dose or add additional drug such as LAMA or Theophylline

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123
Q

Describe a typical clinical presentation of a patient with an Acute Exacerbation of their Asthma (incl auscultation)

A

-Progressively shortness of breath
-Use of accessory muscles
-Raised respiratory rate (tachypnoea)

-Auscultation:
-The chest can sound “tight” with reduced air entry throughout
-Symmetrical expiratory wheeze on auscultation

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124
Q

Describe the arterial blood gas analysis findings expected from a patient with Acute Exacerbation of their Asthma.

A

-Respiratory Alkalosis
-Raised Resp. Rate (Tachypnoea)
-Decreased CO2

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125
Q

A patient is in Hospital with an Acute Exacerbation of their Asthma. Their PCO2 is normal. What does this indicate?

A

Life-threatening Asthma

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126
Q

A patient is in Hospital with an Acute Exacerbation of their Asthma. Their PO2 is low. What does this indicate?

A

Life threatening asthma

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127
Q

A patient is in Hospital with an Acute Exacerbation of their Asthma. Their PCO2 is high. What does this indicate?

A

EXTREMELY BAD- CLOSE TO DEATH

128
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
129
Q

dESCRIBE

A
130
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
130
Q

Describe the management for a patient with a mild exacerbation of their asthma.

A
131
Q

Describe the management for a patient with a mild exacerbation of their asthma.

A

-Salbutamol
-Quadrupled dose of Inhaled Corticosteroids (for up to 2 weeks)
-Oral steroids (Prenisolone)
-Antibiotics

132
Q

Describe the management for a patient with a moderate exacerbation of their asthma.

A

-Consider hospital admission
-Salbutamol)
-Steroids (e.g., oral prednisolone or IV hydrocortisone)

133
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
134
Q

Describe the management for a patient with a severe exacerbation of their asthma.

A

-Hospital admission
-Oxygen to maintain sats 94-98%
-Nebulised ipratropium bromide
-IV magnesium sulphate
-IV salbutamol
-IV aminophylline

135
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
136
Q

Describe the management for a patient with a life-threathening exacerbation of their asthma.

A

-Admission to HDU or ICU
-Intubation and ventilation
-Monitoring of Serum potassium with Salbutamol treatment

137
Q

What are the peak flow values for Moderate, Severe and Life-threatening asthma?

A

Moderate : 50-75%
Severe: 33-50%
Life-threatening: Less than 33%

138
Q

A patient with Asthma is becoming tired, is confused, and has no wheeze. What is the most likely cause?

A

Life-threatening exacerbations of their asthma

139
Q

What 3 clinical respiratory signs rule out the possibility of it being COPD?

A

1.Clubbing
2.Haemoptysis
3.Chest pain

140
Q

Describe a typical presentation of a patient with COPD.

A

-Long-term smoker
-Shortness of breath
-Cough
-Sputum production
-Wheeze
-Recurrent respiratory infections, particularly in winter

141
Q

A patient presents with shortness of breath and is therefore given bronchodilators to confirm diagnosis. What are the two main differentials and what differentiates them?

A

-Asthma : Reversed by bronchodilators
-COPD : Minimally reversed by bronchodilators

142
Q

What will the FEV1/FVC be for an obstructive respiratory illness?

A

Less than 70%

143
Q

Is COPD restrictive or obstructive?

A

Obstructive

144
Q

What FEv1/FVC ratio would you expect for a patient with COPD?

A

Less than 70%

145
Q

What does the FEV1 indicate?

A

The severity

146
Q

What are the investigations done for a suspected COPD patient?

A

-BMI
-Chest Xray (exclude pathology)
-Full blood count : Polycythaemia, Anaemia and Infection
-Sputum culture
-ECG and Echo
-CT thorax (for alternative diagnoses such as fibrosis or cancer)
-Serum Alpha-1-Antitrypsin
-Transfer factor for CO

147
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
147
Q

What would you expect to happen to the Transfer factor for CO in patients with COPD.

A

Decrease

148
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
149
Q

What does Polycythaemia mean?

A

Raised Haemoglobin due to chronic hypoxia

150
Q

Describe the first line long term management for patients with COPD.

A

-Pneumococcal and Annual Flu vaccine

-Salbutamol (SABA)
-Ipathropium bromide (SAMA)

151
Q

A patient is currently on their initial medications for their COPD but it is not being adequately controlled. What needs to be considered before making amendments to their management plan?

A

Asthmatic or steroid-responsive features:
-Have they had a previous diagnosis of of asthma?
-Variation in their FEV1 of >400mls?
-Diurnal variability in peak flow of > 20%?
-Raised Eosinophil count

152
Q

A patient with COPD is currently taking Salbutamol and Ipratropium Bromide but their symptoms are still not completely controlled. They have no ‘Asthmatic or Steroid responsive features’. What are the next steps in their management?

A

Switch to:
-LABA and LAMA combination inhalers such as Anoro Ellipta

153
Q

What are some examples of LABA and LAMA combination inhalers?

A

-Anoro Ellipta
-Ultibro Breezhaler and DuaKlir
-Genuair

154
Q

A patient with COPD is currently taking Salbutamol and Ipratropium Bromide but their symptoms are still not completely controlled. They have a FEV1 variation of 300mls, a normal Eosinophil count and a previous diagnosis of Asthma. What are the next steps in their management?

A

Switch to :
LABA and Inhaled Corticosteroid combo inhaler e.g Fostair

155
Q

What are examples of LABA and Inhaled Corticosteroid combination inhalers?

A

-Fostair
-Symbicort
-Seretide

156
Q

What is the final inhaler offered to patients with COPD that is not being adequately controlled?
Give examples.

A

LABA, LAMA and ICS combos:

Trimbow, Trelegy Ellipta and Trixeo Aerosphere

157
Q

List 5 causes of Cor Pulmonale.

A

COPD
Pulmonary Embolism
Interstitial lung disease
Cystic Fibrosis
Primary Pulmonary hypertension

158
Q

What is Cor Pulmonale?

A

Right-sided heart failure caused by respiratory disease increasing the pressure and resistance in the pulmonary arteries limiting the pumping of the right ventricle causing backflow into the right atrium.

159
Q

Where does the backflow of blood back up in Cor Pulmonale?

A

Right atrium, Vena Cava, Systemic Venous system

160
Q

List the general presentation of a patient with Cor Pulmonale.
(Name 6)

A

-Asymptomatic
-Shortness of breath
-Peripheral Oedema
-Breathlessness of exertion
-Syncope (dizziness and fainting)
-Chest pain

161
Q

List the finding of a clinical examination of a patient with Cor Pulmonale.

A

-Hypoxia
-Cyanosis
-Raised JVP (due to a back-log of blood in the jugular veins)
-Peripheral oedema
-Parasternal heave
-Hepatomegaly

162
Q

What would you expect to find on Auscultation on a patient with Cor Pulmonale?

A

-Loud S2
-Murmur (Pan-systolic in tricuspid regurgitation)

163
Q

Describe the management for Cor Pulmonale.

A

1.Treating symptoms
(e.g Oedema = Diuretics)
2.Treat underlying cause
3.Long term O2 therapy

164
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
165
Q

Describe the management for Cor Pulmonale.

A

1.Treating symptoms
(e.g Oedema = Diuretics)
2.Treat underlying cause
3.Long term O2 therapy

166
Q

What is the prognosis for Cor Pulmonale?

A

Poor:(
-Unless the underlying cause is reversible

167
Q

A patient has a severe exacerbation of their COPD. What is the typical management for this?

A

-IV aminophylline
-Non-invasive ventilation (NIV)
-Intubation and ventilation with admission to intensive care

168
Q

What are the contraindications for Non-Invasive Ventilation?

A

-Cardiac or Resp. Arrest
-Organ failure
-Severe GI bleeding
-Facial trauma
-Upper airway obstruction

169
Q

What are the contraindications for Intubation?

A

-Severe Airway trauma
-Airway obstruction

170
Q

A patient with a severe exacerbation of their COPD and airway obstruction is in hospital. What is contraindicated and is done instead?

A

Cannot: Intubation (due to obstruction)

Can: Doxapram (respiratory stimulant)

171
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
172
Q

What is the pathophysiology of Interstitial lung disease?

A

Inflammation and fibrosis of the lung parenchyma (lung tissue). Fibrosis involves the replacement of elastic and functional lung tissue with non-functional scar tissue.

173
Q

What is the pathophysiology of Idiopathic Pulmonary Fibrosis?

A

Progressive pulmonary fibrosis with no apparent cause.

174
Q

Describe a general presentation of a patient with Idiopathic Pulmonary Fibrosis.

A

-Over 50yrs old
-Insidious onset of shortness of breath
-Dry cough for over more than 3mnths

175
Q

What is the prognosis for a patient with Idiopathic Pulmonary Fibrosis?

A

Poor:(
-2-5 years life expectancy from diagnosis

176
Q

What are the two medications prescribed to slow the progression of Idiopathic Pulmonary Fibrosis?

A
  1. Pirfenidone
    2.Nintedanib
177
Q

What does Nintedanib do?

A

Reduces fibrosis and inflammation by inhibiting tyrosine kinases

178
Q

List the drugs that can cause Secondary Pulmonary Fibrosis?
(Name 4)

A

1.Amiodarone (also causes grey/blue skin)
2.Cyclophosphamide
3.Methotrexate
4.Nitrofurantoin

179
Q

List the conditions that can cause Secondary Pulmonary Fibrosis.
(Name 5)

A

1.Alpha-1 antitrypsin deficiency
2.Rheumatoid arthritis
3.Systemic lupus erythematosus (SLE)
4.Systemic sclerosis
5.Sarcoidosis

180
Q

What is Hypersensitivity Pneumonitis?

A

-Also called extrinsic allergic alveolitis, involves type III and type IV hypersensitivity reaction to an environmental allergen.
-Inhalation of allergens in patients sensitised to that allergen causes an immune response, leading to inflammation and damage to the lung tissue.

180
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
181
Q

What is a Bronchoalveolar lavage?

A

Airways are washed with sterile saline to gather cells, after which the fluid is collected and analysed, performed during a Bronchoscopy.

182
Q

What findings would you expect from a Bronchoalveolar Lavage for a patient with Hypersensitivity Pneumonitis?

A

Raised Lymphocytes (Lymphocytosis)

183
Q

Describe the management for a patient with Asthma that is having Hypersensitivity Pneumonitis.

A

-Remove the allergen
-Oxygen (where necessary)
-Steroids

184
Q

List the specific causes of a Hypersensitivity Pneumonitis reaction.
(Name 4)

A

-Bird-fancier’s lung is a reaction to bird droppings
-Farmer’s lung is a reaction to mouldy spores in hay
-Mushroom worker’s lung is a reaction to specific mushroom antigens
-Malt worker’s lung is a reaction to mould on barley

185
Q

What is the pathophysiology of Cryptogenic Organising Pneumonia?

A

Focal area of inflammation of the lung tissue. It can be idiopathic or triggered by infection, inflammatory disorders, medications, radiation, environmental toxins, or allergens.

186
Q

Describe a typical presentation of a patient with Cryptogenic Organising Pneumonia.

A

-Shortness of breath
-Cough
-Fever
-Lethergy

=Similar symptoms to Infectious Pneumonia .

187
Q

Upon auscultation, what would you expect to hear from a patient with Cryptogenic Organising Pneumonia?

A

Inspiratory crackles

188
Q

A patient has come in presenting with shortness of breath, fever and lethargy with Inspiratory crackles on auscultation. Chest Xray shows focal consolidation. What are the two differential diagnoses and what feature of presentation differentiates the two differentials?

A

i)Cryptogenic Organising Pneumonia and Infective Pneumonia

ii)Focal consolidation on Chest Xray confirms that it is Cryptogenic Organising Pneumonia.

189
Q

What is the definitive investigation for confirming Cryptogenic Organising Pneumonia?

A

Lung Biopsy

190
Q

What is the treatment for Cryptogenic Organising Pneumonia?

A

Systemic Corticosteroids

191
Q

What is the pathophysiology of Asbestosis?

A

Lung fibrosis related to asbestos exposure. Asbestos is fibrogenic, meaning it causes lung fibrosis. It is also oncogenic, meaning it causes cancer. The effects of asbestos usually take several decades to develop.

192
Q

What are the physiological issues caused by Asbestos?
(Name 4)

A

1.Lung Fibrosis
2.Pleural thickening and pleural plaques
3.Addenocarcinoma
4.Mesothelioma

193
Q

What is the treatment to reverse the effects of Asbestosis?

A

TRICK QUESTION
=No treatment to reverse the effects

194
Q

What is the management for Asbestosis?

A

1.Pulmonary rehabilitation – a programme of exercises and education to help manage your symptoms.

2.Oxygen therapy – breathing in oxygen-rich air from a machine or tank to help improve breathlessness if your blood oxygen levels are low.

3.Inhaler to ease breathing (if your symptoms are mild)

195
Q

How would you categorise Pleural Effusion?

A

-Exudative – a high protein content (more than 30g/L)

-Transudative – a lower protein content (less than 30g/L)

196
Q

Name 3 top causes for Exudative Pleural Effusion.

A

1.Cancer (e.g., lung cancer or mesothelioma)

2.Infection (e.g., pneumonia or tuberculosis)

3.Rheumatoid arthritis

197
Q

What does ‘Exudative causes’ of Pleural effusion mean?

A

Inflammation causes protein to leak out of tissues into the pleural space.

198
Q

What does ‘Transudative causes’ of Pleural effusion mean?

A

Fluid moves across and shifts into the pleural space.

199
Q

What are the main causes of Transudative Pleural Effusion?
(Name 4)

A

1.Congestive Cardiac Failure
2.Hypoalbuminaemia
3.Hypothyroidism
4.Meigs Syndrome

200
Q

A patient present with a Benign Ovarian Tumour, Pleural effusion and Ascites. What is the cause and how would you resolve the Pleural effusion and Ascites?

A

i) Meigs Syndrome
ii)Remove the tumour

201
Q

What is the main typical presenting symptom of Pleural Effusion?

A

Shortness of Breath

202
Q

What are the examination findings you would expect from a patient with Pleural Effusion?
(Name 3)

A

1.Dullness to percussion over the effusion
2.Reduced breath sounds
3.Tracheal deviation away from the effusion in very large effusions

203
Q

What are the Chest Xray findings you would expect from a patient with Pleural Effusion?
(Name 4)

A

1.Blunting of the costophrenic angle
2.Fluid in the lung fissures
3.Larger effusions will have a meniscus (a curving upwards where it meets the chest wall and mediastinum)
4.Tracheal and mediastinal deviation away from the effusion in very large effusions

204
Q

What two investigations would you do after a Chest Xray to understand the underlying causes of Pleural Effusion in a patient?

A

-Ultrasound and CT
-Pleural fluid analysis

205
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
206
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
207
Q

What are the management options for Pleural Effusion.

A

1.Treat the underlying cause (most cases)
2.Pleural aspiration (to offer temporary relief as it will reoccur again if underlying causes aren’t resolved)
3.Chest Drain (drain and prevents reoccurrence)

208
Q

A patient has been hospitalised with Pneumonia and is improving despite their ongoing fever. What is most likely the cause of the fever and what is the first investigation step now?

A

i) Empyema
ii)Pleural aspiration

209
Q

What is Empyema?

A

Infected Pleural Effusion

210
Q

What findings would expect from a Pleural Aspiration from a patient with Empyema?

A

-Pus
-Low pH
-Low glucose
-High LDH

211
Q

How would you treat a patient with Empyema?

A

Chest drain and antibiotics

212
Q

What antibiotics are most suitable for treating Empyema?

A

1.B-lactam with B-Lactamase inhibitors
-Amoxicillin-clavulanate
-Piperacillin-tazobactam

2.Carbapenems
-Imipenem
-Meropenem

213
Q

Name 2 examples of β-lactam with β-lactamase inhibitors.

A

-Amoxicillin-clavulanate
-Piperacillin-tazobactam

214
Q

Name 2 examples of Carbapenems?

A

-Imipenem
-Meropenem

215
Q

A tall, thin young man has come in after playing football presenting with sudden breathlessness and pleuritic chest pain. What is the first red flag cause you would think of?

A

Pneumothorax

216
Q

What are the investigations to be done for patients with suspect Pneumothorax?

A

-Erect Chest Xray
-CT thorax (for small pneumothorax)

217
Q

What is the management for a patient with a confirmed Pneumothorax of less than 2cm of air and normal breathing?

A

-No treatment is required as it will spontaneously resolve

-Follow-up in 2 – 4 weeks is recommended

218
Q

What is the management for a patient with confirmed Pneumothorax 3cm and shortness of breath?

A

Air is more than 2cm so:

-Aspiration followed by reassessment

-When aspiration fails twice, a chest drain is required

219
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
220
Q

List 3 scenarios of Pneumothorax patients who require an immediate chest drain.

A

-Unstable patients
-Bilateral or Secondary Pneumothoraces,

221
Q

Where would you insert a chest drain?

A

‘Triangle of safety’:
-5th intercostal space
-Midaxillary line / Lateral edge of the Latissimus Dorsi
-Anterior Axillary Line

222
Q

When inserting a chest drain, is it inserted below or above the rib?

A

=Above
(to avoid Neurovascular Bundle)

223
Q

What are the 2 main complications of a chest drain?

A

1.Air leaks around the drain site (indicated by persistent bubbling of fluid, particularly on coughing)
2.Surgical emphysema (also known as subcutaneous emphysema) is when air collects in the subcutaneous tissue

224
Q

What will be done to treat a Pneumothorax after a Chest Drain fails?

A

Video-assisted thoracoscopic surgery (VATS):

1.Abrasive pleurodesis (using direct physical irritation of the pleura to seal pleural space)

2.Chemical pleurodesis (using chemicals, such as talc powder, to irritate the pleura to seal pleural space)

3.Pleurectomy (removal of the pleura)

225
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
226
Q

When will Surgery be considered in Pneumothorax?

A
227
Q

When will Surgery be considered in Pneumothorax?

A

-A chest drain fails to correct the pneumothorax
-There is a persistent air leak in the drain
-The pneumothorax reoccurs (recurrent pneumothorax)

228
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
228
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
229
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
230
Q

What is the pathophysiology of Tension Pneumothorax?

A

Trauma to the chest wall that creates a one-way valve that lets air in but not out of the pleural space.
Therefore, air is drawn into the pleural space during inspiration, and trapped during expiration. This creates pressure inside the thorax to push the mediastinum across, kink the big vessels in the mediastinum and cause cardiorespiratory arrest.

231
Q

What medical emergency does Tension Pneumothorax cause?

A

Cardiorespiratory Arrest

232
Q

Name 5 signs of Tension Pneumothorax.

A

1.Tracheal deviation away from the side of the pneumothorax
2.Reduced air entry on the affected side
3.Increased resonance to percussion on the affected side
4.Tachycardia
5.Hypotension

233
Q

A tension pneumothorax is suspected in a patient. What do you do immediately?

A

!NO investigations!

1.Cannula in the fourth or fifth intercostal space, anterior to the midaxillary line

2.Chest drain
(once the pressure is relieved by the cannula)

234
Q

What are the causes of Pneumothorax?
(Name 4)

A

1.Spontaneous
2.Trauma
3.Iatrogenic, for example, due to lung biopsy, mechanical ventilation or central line insertion
4.Lung pathologies such as infection, asthma or COPD

235
Q

What would you expect from a Chest Xray from a patient with Pneumothorax?

A

-No lung markings
-Line demarcating the edge of the lung where the lung markings end and the Pneumothorax begins

236
Q

What is the pathophysiology of Pneumothorax?

A

Air enters the pleural space, separating the lung from the chest wall.

237
Q

What does Venous Thromboembolism (VTE) refer to?

A

Deep Vein Thrombosis and Pulmonary Embolism.

238
Q

List the possible reasons for patients to be put on Prophylactic treatment to reduce the risk of Venous Thromboembolism (VTE).
(Name 9)

A

1.Immobility
2.Recent surgery
3.Long-haul travel
4.Pregnancy
5.Hormone therapy with oestrogen (e.g., combined oral contraceptive pill or hormone replacement therapy)
6.Malignancy
7.Polycythaemia (raised haemoglobin)
8.Systemic lupus erythematosus
9.Thrombophilia (blood forms clots too easily)
10.Surgery

239
Q

All patients are assessed for their risk of Venous Thromboembolism when admitted to hospital. What form of prophylaxis will high risk patients need to take?

A

Low Molecular Weight Heparin
=Enoxaparin

240
Q

A patient admitted to hospital and is of high risk of VTE and is on Warafin. What prophylaxsis will they be put on.

A

NOT Heparin as it is contraindicated

=Compression stockings

241
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
242
Q

What are the contraindications of Enoxaparin?

A

-Active bleedings
-Existing Anticoagulation with Warafin
-Haemophilia

243
Q

When are Anti-embolic compression stockings contraindicated?

A

Peripheral Arterial Disease

244
Q

What is the most common cause of Pulmonary Embolism?

A

Deep Vein Thrombosis

245
Q

As Pulmonary Embolism is usually asymptomatic and life-threatening, there is a low threshold for suspecting PE. What are the presenting features?

A

-Haemoptysis (coughing up blood)
-Shortness of breath
-Cough
-Pleuritic chest pain (sharp pain on inspiration)
-Hypoxia
-Tachycardia
-Raised respiratory rate
-Low-grade fever
-Haemodynamic instability causing hypotension

246
Q

What are the main signs of Deep Vein Thrombosis?

A

Unilateral leg swelling and tenderness

247
Q

What would you expect from a Chest Xray from a patient with Pulmonary Embolism?

A

Normal

248
Q

What are the investigations necessary for a patient with suspected Pulmonary Embolism?

A

-Chest Xray (to rule out other pathology)
-CT Pulmonary Angiogram (CTPA)
-D-Dimer (blood test)

249
Q

A patient has a ‘Likely’ Well’s score suggestive of Pulmonary Embolism. What investigation will be done?

A

CT Pulmonary Angiogram

250
Q

A patient has a ‘Unlikely’ Well’s score suggestive of Pulmonary Embolism. What investigation will be done?

A

D-Dimer Blood test

-If positive, perform a CT Pulmonary Angiogram

251
Q

Classify a D-Dimer blood test.
Are they Sensitive or Not-Sensitive?
Are they specific or non-specific?

A

Sensitive and Non-specific

252
Q

What else could a raised D-Dimer blood test indicate?

A

1.Pneumonia
2.Malignancy
3.Heart failure
4.Surgery
5.Pregnancy

253
Q

A patient has been diagnosed with Pulmonary Embolism. What is the first line medication?

A

Apixaban or Rivaroxaban
(Anticoagulants)

254
Q

What is second line in Pulmonary Embolism treatment?

A

Low Molecular Weight Heparin

255
Q

What does Haemodynamic Instability or Compromise mean?

A

Abnormal or Unstable blood pressure which can cause inadequate blood flow

255
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
256
Q

What does Haemodynamic Instability or Compromise mean?

A

Abnormal or Unstable blood pressure which can cause inadequate blood flow

257
Q

A patient has had a massive Pulmonary Embolism with Haemodynamic compromise. How is this treated?

A

-Continuous Infusion of Unfractionated Heparin

+Thrombolysis with Streptokinase and Alteplase and Tenecteplase

258
Q

Describe the Long-term Anticoagulation medications for a patient with Pulmonary Embolism.

A

-DOACs : Apixaban, Rivaroxaban, Edoxaban and Dabigatran

259
Q

A patient has had a Pulmonary Embolism and is being considered for the appropriate Long-term management. He has renal impairement.
What is their best option? (i.e what can they have and not have)

A

Cannot: DOACs due to renal impairment

Can: Warafin

260
Q

A patient has had a Pulmonary Embolism and is being considered for the appropriate Long-term management. He has renal Anti-phospholipid Syndrome .
What is their best option? (i.e what can they have and not have)

A

Cannot: DOACs

Can: Warafin

261
Q

A patient has had a Pulmonary Embolism and is being considered for the appropriate Long-term management. She is pregnant
What is their best option? (i.e what can they have and not have)

A

Cannot: DOACs and Warafin

Can: Low Molecular Weight Heparin (LMHW) e.g Enoxaparin

262
Q

What is the most common example of Low Molecular Weight Heparin?

A

Enoxaparin

263
Q

What are the regulations for how long anticoagulants should be taken?

A

-3 months with a reversible cause (then review)

-Beyond 3 months with unprovoked PE, recurrent VTE or an irreversible underlying cause (e.g., thrombophilia)

-3-6 months in active cancer (then review)

264
Q

How is Pulmonary Hypertension defined?

A

Mean pulmonary arterial pressure of more than 20  mmHg.

265
Q

What is the pathophysiology of Pulmonary Hypertension?

A

Increased resistance and pressure in the pulmonary arteries causing strain on the right side of the heart as it tries to pump blood through the lungs. There is back pressure through the right side of the heart and into the systemic venous system

266
Q

What are the 5 grouped causes of Pulmonary Hypertension?

A

-Group 1 – Idiopathic pulmonary hypertension or connective tissue disease (e.g., systemic lupus erythematous)

-Group 2 – Left heart failure, usually due to MI or systemic hypertension

-Group 3 – Chronic lung disease (e.g., COPD or pulmonary fibrosis)

-Group 4 – Pulmonary vascular disease (e.g., pulmonary embolism)

-Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders

267
Q

What are the signs and symptoms of a patient with Pulmonary Hypertension?
(Start with the main presenting symptom)

A

1.Shortness of breath

2.Syncope (loss of consciousness)
3.Tachycardia
4.Raised jugular venous pressure (JVP)
5.Hepatomegaly
6.Peripheral oedema

268
Q

What ECG changes would you expect from a patient with Pulmonary Hypertension?

A

-P Pulmonale (Peaked P waves)
-Tall R waves in V1 and V2 leads

269
Q

What Chest-Xray changes would you expect in a patient with Pulmonary Hypertension?

A

1.Dilated pulmonary arteries
2.Right ventricular hypertrophy

270
Q

What does a Raised NT-proBNP indicate?

A

Right Ventricular Failure

271
Q

What is the prognosis for a patient with Pulmonary Hypertension?

A

Poor:(
2-3 yr survial after diagnosis

272
Q

How would treat Idiopathic Pulmonary Hypertension?

A

-Calcium channel blockers
-Intravenous prostaglandins (e.g., epoprostenol)
-Endothelin receptor antagonists (e.g., macitentan)
-Phosphodiesterase-5 inhibitors (e.g., sildenafil)

273
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
274
Q

How would you treat Secondary Pulmonary Hypertension?

A

Treat/Manage underlying cause

275
Q

What is the pathophysiology of Sarcoidosis?

A

It is a chronic granulomatous disorder. Granulomas are inflammatory nodules full of macrophages. The cause of these granulomas is unknown.

276
Q

A 32yr old Black African female patient presents with a dry cough and shortness of breath as well as nodules on her shins. What is this most likely to be?

A

Sarcoidosis

277
Q

Which patients are more likely to experience Sarcoidosis?

A

-Aged 20-39 or around 60
-Women
-Black ethnic origin

278
Q

How common is it for patients with Sarcoidosis to have Erythema Nodusum?

A

Less than half of patients with sarcoidosis have skin involvement.

279
Q

What are some common skin problems for patients with Sarcoidosis to have?

A

-Erythema Nodosum
-Panniculitis (Inflammation of fat)
-Lupus Pernio (specific to Sarcoidosis with raised purple skin lesion often on cheeks and nose)

280
Q

A patient presents with raised purple skin lesions on the cheeks and nose. What is most likely the cause.

A

Lupus Pernio caused by Sarcoidosis.

281
Q

Sarcoidosis affects most organs in the body. What organ does it mainly affect?

A

Lungs

282
Q

What are the 3 most common effects on the Lungs by Sarcoidosis?

A

1.Mediastinal lymphadenopathy
2.Pulmonary fibrosis
3.Pulmonary nodules

283
Q

What blood tests would you do to screen for Sarcoidosis?

A

-ACE (raised indicates Sarcoidosis)
-Calcium (Hypercalcaemia indicates Sarcoidosis)

284
Q

A patient had mild symptoms of Sarcoidosis. What is the management?

A

Nothing (Conservative)

285
Q

A patient has been struggling with their Sarcoidosis symptoms. What is their management?

A

Oral Steroids
+Bisphosphonates (to protect against Osteoporosis when on long term steroids)

286
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
287
Q

A patient has been struggling with their Sarcoidosis symptoms. What is their management?

A

Oral Steroids
+Bisphosphonates (to protect against Osteoporosis when on long term steroids)

288
Q

What is the second line treatment for Sarcoidosis?

A

Methotrexate

288
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
289
Q

Some patients have progression of their Sarcoidosis causing 2 issues. What are they?

A

1.Pulmonary Fibrosis
2.Pulmonary Hypertension

290
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
291
Q

Some patients have progression of their Sarcoidosis causing 2 issues. What are they?

A

1.Pulmonary Fibrosis
2.Pulmonary Hypertension

292
Q

A patient comes in coughing up sputum that is tested. Results show Acid-fast Bacilli that stain red with Zeihl-Neelsen staining. What is the bacteria and the most likely diagnosis?

A

Mycobacterium Tuberculosis
=Tuberculosis (TB)

293
Q

What type of bacteria causes TB, what shape is it and how does it stain?

A

=Mycobacterium
-Acid-Fast Bacili
-Bright Red Zeihl-Neelsen stain against a blue background

294
Q

Which patients are most likely to have TB?

A

-Non-UK born patients (e.g South Asia)
-HIV patients
-On Immunosuppressant medications
-Those in close contact to TB

295
Q

A patient has Latent TB. What is their management?

A

Nothing

296
Q

A patient has Latent TB that is at risk of being reactivated. What is their management?

A

-Isoniazid and rifampicin for 3 months
-Isoniazid for 6 months

297
Q

What is the management for a patient with Active TB?
(Remember mneumonic)

A

RIPE
R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months

298
Q

What is the main side effect of Isoniazid and what must be prescribed with it to prophylactically help prevent it?

A

Peripheral Neuropathy
+Prescribe Pyridoxine (Vit.B6)

299
Q

A patient has been prescribed Rifampicin, Isoniazid, Pyrazinamide and Ethambutol. What else should they be prescribed?

A

Pyridoxine
(Prophylactically protects against side effect of Isoniazid which is Peripheral Neuropathy).

300
Q

What should be done for a TB patient when waiting to be put on their medications?

A

Be put in a Negative Pressure Room in Hospital to prevent spread of the airborne disease

301
Q

A patient is being put on Rifampicin. What potential drug interaction should they be warned about?

A

Contraceptive Pill
-Decrease efficacy

302
Q

What potential complication can Pyrazinamide cause?

A

Gout

303
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
303
Q

A patient has recently started treatment for TB. They noticed numbness / unusual sensations in their fingertips and feet. Which medication is most likely to be implicated?

A

Isoniazide

304
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
305
Q

What are the side effects of Ethambutol?

A

Colour blindness and reduced visual acuity

306
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
307
Q

What TB medications are associated with Heptatoxicity?

A

RIP
Rifampicin, isoniazid and pyrazinamide

308
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
309
Q

What TB medications are associated with Heptatoxicity?

A

RIP
Rifampicin, isoniazid and pyrazinamide

310
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
311
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol
312
Q

List the drugs used for Asthma management in order according to the NICE asthma management ladder.

A
  1. SABA: Salbutamol
    2.Corticosteroids : Glucacorticosteroids, Prednisone, Methylpredisolone
    3.LTRA:Montelukast
    4.LABA: Salmeterol /Formoterol

Progress Test Y2 Med (5 decks)

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