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5th Year > Respiratory Stuff > Flashcards

Respiratory Stuff Flashcards

1
Q

What are the 5 causes of a widened mediastinum on CXR?

A 
Lymphoma
Retrosternal goitre
Thoracic aortic aneurysm
Teratoma
Thymus tumour
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2
Q

What should you do if you see a widened mediastinum on CXR?

A

Get a CT

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3
Q

What spirometry will idiopathic pulmonary fibrosis show?

A

Restrictive lung disease

Reduced Transfer Factor Coefficient

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4
Q

What is the management of sleep apnoea?

A

Weight loss

CPAP

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5
Q

How is CURB-65 calculated?

A 
Confusion - AMTS<8
Urea >7
RR >30
BP <90/60
Age >65yrs
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6
Q

Which antibiotics correspond with which CURB-65 scores?

A 
0-1 = amoxicillin
2+ = amoxicillin + clarithromycin
3+ = hospital
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7
Q

What is the treatment sequence for asthma?

A 
SABA
ICS
LTRA
LABA
MART
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8
Q

What is the management of a secondary pneumothorax?

A 
>50yrs/>2cm = chest drain
1-2cm = aspirate
<1cm = admit with oxygen
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9
Q

Which cells are involved in SCLC?

A

APUD cells

Generally central

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10
Q

What are the 3 paraneoplastic syndromes of SCLC?

A

SIADH -> Hyponatraema
ACTH -> Cushing’s +/- hypokalaemia acidosis
LEMS -> muscle weakness

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11
Q

What are the features of Churg-Strauss syndrome?

APE MP

A 
Asthma
Polyps/paranasal sinusitis
Eosinophilia
Mononeuritis multiplex
pANCA +ve (60%)
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12
Q

Which asthma drugs may precipitate Churg-Strauss syndrome?

A

LTRAs

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13
Q

What is the new name for Churg-Strauss syndrome?

A

Eosinophilic granulomatosis with polyangiitis

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14
Q

Which organism is associated with red-currant jelly sputum?

A

Klebsiella

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15
Q

Who gets klebsiella pneumonia?

A

Alcoholics
Those at risk of aspiration
Immunocompromised

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16
Q

What structural lung features is klebsiella associated with?

A

Cavitation
Empyema
Pleural adhesions

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17
Q

What is the death rate of kelbsiella pneumonia?

A

50% with Abx

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18
Q

What two investigations should an adult with suspects asthma receive?

A

FeNO test

Spirometry with reversibility

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19
Q

What are the centor criteria?

A 
Tonsilar exudate
Anterior LNs
Fever
Absence of a cough
3+ = Abx
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20
Q

What is a pancoast tumour?

A

Lung tumour in the left apex

May compress recurrent laryngeal N -> hoarse voice

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21
Q

What is the most likely diagnosis if someone has calcified granulomas on CXR and a travel history?

A

TB

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22
Q

If you suspect lung cancer on a CXR, what imaging should you order?

A

Contrast-enhanced CT chest, liver and adrenals

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23
Q

What are the hallmarks of alpha-1-antitrypsin deficiency?

A

Basal lobe emphysema in young age
Early lung dysfunction and bronchitis
Also causes liver cirrhosis

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24
Q

What is the management of alpha-1-antitrypsin deficiency?

A

Alpha-1-antitrypsin concentrates

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25
Q

What is the next step in management for COPD after SABA?

A

LABA and LAMA

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26
Q

Someone is ventilated, acutely unwell and apyrexial: what is the diagnosis?

A

Aspiration

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27
Q

What CXR features are seen with aspiration?

A

Patchy consolidation of Right base

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28
Q

What are the FEV1 cut-offs for COPD severity?

A 
>0.8 = mild
0.5-0.8 = moderate
0.3-0.5 = severe
<0.3 = very severe
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29
Q

What 2 things must be required for COPD diagnosis?

A
  1. Spirometry showing FEV1/FVC <0.7

2. COPD symptoms

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30
Q

What are the causes of upper zone fibrosis?

CHARTS

A 
Coal
Histiocytosis
Ankylosing spondylitis/aspergillosis
Radiation
TB
Silicosis/sarcodiosis
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31
Q

What are the borders of the chest drain triangle?

A

Latissimus dorsi
Pec. major
Line superior to nipple

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32
Q

What are the contraindications for lung cancer surgery? (6)

A 
SVC obstruction
FEV1 <1.5 (<2.0 for pneumonectomy)
Malignant pleural effusion
Vocal cord paralysis
Hilar tumour
Mets
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33
Q

What the causes of a ‘white out’ with the trachea TOWARDS the affected side?

A

Pneumonectomy
Endobronchial intubation
Pulmonary hypoplasia

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34
Q

What the causes of a ‘white out’ with the trachea CENTRAL?

A

Consolidation
Pulmonary oedema
Mesothelioma

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35
Q

What the causes of a ‘white out’ with the trachea AWAY FROM the affected side?

A

Pleural effusion
Diaphragmatic hernia
Large thoracic mass

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36
Q

What are the features of idiopathic pulmonary fibrosis?

A

50-70yr old male
Exertional dyspnoea
Clubbing
Restrictive spirometry

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37
Q

What does idiopathic pulmonary fibrosis appear as on CXR?

A

Ground-glass appearance with irregular peripheral opacities
Progresses to honey-combing\
Requires CT for diagnosis

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38
Q

What is the average life expectancy of someone diagnosed with idiopathic pulmonary fibrosis?

A

3-4yrs

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39
Q

What is the management of idiopathic pulmonary fibrosis?

A

Pulmonary rehab
Oxygen
Lung transplant

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40
Q

What are the transudate criteria, according to Light’s criteria?

A

Fluid/serum protein <0.5

Fluid/serum LDH <0.6

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41
Q

What are the features of an exudate?

A 
Cloudy
Protein >3g/100ml
pH <7.2
Glucose >40
LDH >200
Cells >1000/mm3
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42
Q

What are the causes of an exudate? (6)

A 
Infection/penumonia
Malignancy
PE
Pancreatitis
Dressler's syndrome
Yellow nail syndrome
43
Q

What are the causes of a transudate? (4)

A

Heart failure
Hypoalbuminaemia eg. liver disease/nephrotic syndrome
Hypothyroidism
Meig’s syndrome

44
Q

What are the criteria for receiving LTOT?

A
  1. pO2 <7.3 on 2 ABGs
  2. pO2 7.3-8.0 on 1 ABG with one of:
    - Secondary polycythaemia
    - Nocturnal hyperaemia
    - Peripheral oedema
    - Pulmonary hypertension
45
Q

What is PCD/Kartagener’s?

A

Defective dynein arm -> immotile cilia

46
Q

What are the 4 features of PCD? DR BS

A

Dextrocardia
Recurrent sinusitis
Bronchiectasis
Subfertility

47
Q

How do you distinguish between exudate and transudate?

A

Exudate = >30g/L protein
Transudate = <30g/L protein
If 25-35g/L protein, use Light’s criteria

48
Q

What is lupus pernio?

A

Raised purple indurated plaques on nose
Not itchy or painful
Indicative of sarcoidosis

49
Q

When do you give steroids following an asthma exacerbation?

A

ALL asthma exacerbations

40-50mg 5-7 days

50
Q

What are the 3 sarcoid syndromes?

A

Lofgren’s syndrome
Mikulicz syndrome (outdated)
Heerfardt’s syndrome (uveoparotid syndrome)

51
Q

What are the features of Lofgren’s syndrome? (4)

A 
Bilateral hilar lymphadenopathy
Erythema nodosum
Fever
Polyarthralgia
Good prognosis
52
Q

What is Mikulicz syndrome?

A

Large parotid and lacrimal glands

Due to sarcoid, TB or lymphoma

53
Q

What are the features of Heerfardt’s syndrome? (3)

A

Parotid enlargement
Fever
Uveitis

54
Q

What is varenicline?

A

Partial nicotinic receptor agonist
Causes dopamine release
Used in smoking cessation but never in combo with other smoking cessation drugs
Only effective for 3-4wks

55
Q

How is varenicline used?

A

Start 1 week before stop target
Continue for 12 week course
More effective than bupropion

56
Q

What is bupropion?

A

Noradrenaline and dopamine reuptake inhibitor and nicotinic antagonist

57
Q

What is the FeNO cut-off for asthma?

A

> 40ppb

58
Q

What is the post-bronchodilator improvement cut-off for asthma?

A

> 12%

>200ml

59
Q

What is the PEFR variability cut-off for asthma?

A

> 20%

60
Q

What is the most common organism in COPD exacerbations?

A

H. influenzae

61
Q

What are the features of empyema on aspiration?

A

pH <7.2
Low glucose
Increased LDH

62
Q

Which enzyme may be raised in sarcoidosis?

A

ACE

Angiotensin Converting Enzyme

63
Q

What is the long-term management of sarcoidosis?

A

Stage 0-1 = no treatment
Stage 2-4 = 12-24m steroids (20-40mg pred)
Chronic = steroid sparing agents eg. MXT

64
Q

What is the management of refractory sarcoidosis?

A

Infliximab 3-5mg/kg

At 0, 1 and 2 weeks, then at 1m, then monthly forever

65
Q

What investigation is diagnostic of sleep apnoea?

A

Polysomnography

66
Q

What is Wernicke’s triad?

A

Ophthalmoplegia
Ataxia
Confusion

67
Q

What may be heard on auscultation of someone with idiopathic pulmonary fibrosis?

A

Fine end-inspiratory crepitations

At bases

68
Q

What kind of fibrosis is amiodarone associated with?

A

Lower zone fibrosis

69
Q

What is the most common lung cancer in non-smokers?

A

Adenocarcinoma

70
Q

What non-pulmonary features are lung adenocarcinomas associated with?

A

Gynaecomastia

Hypertophic pulmonary osteoarthritis

71
Q

What is the management of a primary pneumothorax?

A

<2cm and NOT breathless = discharge

>2cm or breathless = aspirate (CD if fail)

72
Q

What is the management of a secondary pneumothorax?

A

> 50yrs, >2cm or breathless = chest drain
1-2cm = aspirate
<1cm = admit for 24hrs

73
Q

Which protein accumulates in hepatocytes alpha-1-antitrypsin deficiency?

A

Mutant protein Z

74
Q

What is the name for a calcified granuloma containing TB?

A

Ghon complex

75
Q

What are some features of emphysematous bullae?

A

Can mimic a pneumothorax for chest drain provides no relief

76
Q

What are pneumatoceles?

A

Similar to emphysematous bullae but with thin wall

Generally due to ventilator-associated injury

77
Q

What is ARDS?

A

Acute onset of breathlessness with bilateral pulmonary oedema and low sats despite high O2
NOT cariogenic in origin

78
Q

What increases the total gas transfer (TLCO)?

A

Asthma and L->R shunts
These don’t affect alveoli so lungs compensate for hypoxia by increasing gas transfer
Also pulmonary haemorrhage, polycythaemia and exercise

79
Q

What is the most common causative organism of pneumonia?

A

Strep pneumoniae

80
Q

What is the most common causative organism of IECOPD?

A

H. influenzae

Doesn’t show CXR consolidation

81
Q

What is the management of H. influenzae IECOPD?

A

Amoxicillin + Tetracycline + Pred

82
Q

What organism is associated with bird owners?

A

C. psittaci

83
Q

How should someone administer a puff of salbutamol?

A

Hold each for puff for 10 seconds

Wait minimum 30 seconds between puffs

84
Q

What are the 3 indications for steroids in sarcoidosis?

A

Stage 2/3 with symptoms
Hypercalcaemia
Eye/heart/neuro involvement

85
Q

Who is at risk of klebsiella pneumonia?

A

Alcoholics
Diabetics
Anyone at risk of aspiration

86
Q

Where in the lungs does klebsiella pneumonia usually occur?

A

Upper lobes

87
Q

What are the 3 common causes of post-operative SoB?

A

Atelectasis - resonant to percuss
Pneumonia
PE

88
Q

What is the management of post-op atelectasis?

A

Deep breathing and chest physio

89
Q

What causes reduced TLCO?

A

Restrictive conditions and COPD

90
Q

What is Kartagener’s syndrome?

A

Primary Ciliary Dyskinesia

91
Q

What are the features of PCD?

A 
Dextrocardia
Recurrent sinusitis
Bronchiectasis
Subfertility
(R testicle hangs lower than L)
92
Q

Name a contraindication for bupropion

A

Epilepsy

93
Q

When should you consider stepping down Tx for asthma?

A

If patient not used salbutamol at all in last 12m

Half ICS dose and review in 6m

94
Q

What is the gold standard investigation for mesothelioma?

A

Thoracoscopy and histology

95
Q

What vaccinations should COPD patients receive?

A

Annual influenza

One-off pneumococcal

96
Q

What are pleural plaques?

A

Benign plaques with no malignant potential
Generally due to asbestos exposure
Often have 20-40yr lag period

97
Q

What surgical procedure may be used in the management of alpha-1-antitrypsin deficiency?

A

Lung volum reduction surgery

Removes worst areas of lung to direct air to areas with better exchange

98
Q

What is the management of HACE?

High-altitude cerebral oedema

A 
Tx = Dexamethasone
Prevention = Acetazolamide
99
Q

What does the loss of L heart border on CXR indicate?

A

Lingula consolidation

No L middle lobe

100
Q

What is an indication for surgery in bronchiectasis?

A

Confined to single lobe on CT

101
Q

What scoring system is used to identify sleep apnoea?

A

Epworth sleepiness scale

102
Q

How do you know a chest drain is correctly placed?

A

Water seal rises with inspiration and falls with expiration

103
Q

How does an aspergilloma appear on CXR?

A

Rounded opacity surrounded by air rim

Often have TB PMHx

104
Q

When aspirating pleural fluid, what is the main criteria for placing a chest drain?

A

pH <7.2 indicates bacterial infection -> chest drain inserted

5th Year (8 decks)

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