Respiratory Short Flashcards
Causes of upper lobe pulmonary fibrosis?
Silicosis, sarcoidosis Miner's (coal) lung Ankylosing spondylitis/APBA Radiation Tuberculosis
Causes of lower lobe pulmonary fibrosis?
Cryptogenic fibrosis alveolitis Asbestosis RA Drugs Scleroderma
Signs of severity of ILD?
dyspnoea CO2 elevation on ABG 6MWT < 88% gas transfer coefficient < 35% predicted presence of pulmonary hypertension
Signs of bronchiectasis on HRCT?
signet-ring sign (airway > 1.5 diameter of vessel) lack of bronchial tapering bronchial wall thickening tree in bud cysts from bronchial wall
Signs of ILD on HRCT?
reticulation traction bronchiectasis honeycombing architectural distortion volume loss
Lights criteria for exudate?
protein > 0.5
LDH >2/3 ULN
pleural:serum LDH > 0.6
Causes of transudate pleural effusion?
heart failure (most common cause of transudate) cirrhosis (hepatic hydrothorax) nephrotic syndrome peritoneal dialysis hypoalbuminaemia urinothorax constrictive pericarditis trapped lung SVCO duro-pleural fistula
Causes of exudate pleural effusion?
malignant infectious (most common cause of exudative effusion) connective tissue disease drug induced pancreatitis PE ARDS chylothorax uraemic pleurites
Causes of congenital bronchiectasis?
cystic fibrosis
primary ciliary dyskinesia
congenital hypogammaglobulinaemia
yellow nail syndrome
Causes of acquired bronchiectasis?
childhood infections localised disease ABPA RA sjogren's COPD recurrent aspiration ILD idiopathic
Severity of COPD based on FEV1?
FEV1 > 80% - mild
FEV1 50-80% - moderate
FEV1 < 50% severe
FEV1 < 30% very severe
Three top causes of bronchiectasis?
postinfective
COPD
cystic fibrosis
What is bronchiectasis?
abnormal and permanently dilated airways with bronchial wall thickening
What is the differential diagnosis of bilateral lower zone crackles?
bronchiectasis
lung fibrosis
pulmonary oedema
bilateral pneumonia
What is cor pulmonale?
right sided cardiac dysfunction secondary to pulmonary hypertension from respiratory cause
What bronchodilators should be used for COPD?
first line LABA or LAMA
if exacerbations add LABA/LAMA (on PBS need to have failed monotherapy for combination therapy)
then add ICS - IMPACT study showed reduces exacerbations - add earlier if history of asthma or eosinophilia
What tests are used to diagnose cystic fibrosis?
heel prick test
sweat test
genetic testing
What are the extrapulmonary manifestations of CF?
diabetes pancreatic insufficiency CF related liver disease - gallstones, cirrhosis, portal hypertension osteoporosis malnutrition infertility sinusitis
What is the prevalence and carrier incidence of CF?
1:2500, 1:25
What organisms are commonly found in the sputum of patients with CF?
haemophillus influenzae staph aureus moraxella strep pneumoniae aspergillus fumigatus burkholderia cepacia (poor prognosis) pseudomonas aeuriginosa (poor prognosis) mycobacterium abscessus (poor prognosis)
What are the respiratory complications of CF?
infective exacerbations pneumothorax haemoptysis aspergillus repiratory failure
What paraneoplastic syndromes are associated with small cell lung cancer?
cushing’s syndrome
SIADH
lambert-eaton syndrome
What are the clinical signs and symptoms of SVC obstruction?
oedema of face, neck, upper body prominent neck and chest wall vessels facial plethora stridor headache dizziness
What are the side effects of TB treatment?
drug induced hepatitis optic neuritis (ethambutol) peripheral neuropathy (isoniazid)
Which drugs may cause pleural effusion?
amiodarone phenytoin methotrexate nitrofurantoin beta blockers
How do you differentiate between a lobectomy and pneumonectomy?
pneumonectomy:
- trachea deviates towards the side of surgery
- decreased breath sounds over the whole lung field
- reduced chest expansion
lobectomy
- trachea deviates away from side of surgery
- reduced breath sounds only over area of lobectomy
What criteria do patients need to be eligible for surgery in lung cancer?
FEV1 > 1.5L
TLCO > 50%
no severe pulmonary hypertension
no metastatic disease
What is the differential diagnosis of dullness to percussion of the lung?
pleural effusion pleural thickening collapse consolidation raised hemidiaphragm lobectomy
What are the complications of bronchiectasis?
pneumonia pneumothorax empyema collapse pulmonary hypertension amyloidosis
What are the most common respiratory pathogens in bronchiectasis?
staph aureus haemophilus influenzae strep pneumoniae pseudomonas aeruginosa klebsillea pneumoniae
What are the indications for lobectomy?
bronchiectasis malignancy cystic fibrosis tuberculosis lung abscess
What are the causes of a cavitating lung lesion?
TB staph aureus klebsillea pneumoniae pseudomonas aeruginosa aspergilloma
