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Yr 5 - Respiratory > Revision - Asthma, COPD, Lung Cancer & Pleural Effusion > Flashcards

Revision - Asthma, COPD, Lung Cancer & Pleural Effusion Flashcards

1
Q

What bronchodilator reversibility test result indicates asthma?

A

Improvement in FEV1 >12% after bronchodilator therapy

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2
Q

Stepwise mx of asthma in adults?

A

1) SABA

2) SABA + low dose ICS

3) SABA + ICS + LTRA

4) SABA + ICS + LABA +/- LTRA

5) SABA +/- LTRA, switch ICS/LABA for a MART (that includes a low dose ICS)
- or SABA +/- LTRA + LABA + med dose ICS

6) SABA +/- LTRA and one of the following:
- increase ICS to high-dose (only as part of a fixed-dose regime, not as a MART)
- trial of an additional drug e.g. theophylline

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3
Q

What is a MART?

A

A form of combined ICS and fast acting LABA.

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4
Q

Can dose of ICS be increased in a MART to medium?

A

No - switch to fixed-dose regime

Medium dose ICS + LABA

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5
Q

What type of hypersensitivity reaction is an asthma attack?

A

IgE type 1

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6
Q

What medications can exacerbate asthma? (3)

A
  • beta blockers
  • acetylcholinesterase inhibitors e.g. donepezil, neostigmine
  • NSAIDs
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7
Q

Why can AChEIs exacerbate asthma?

A

Due to increased bronchial secretions

(think OPPOSITE of anticholinergics)

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8
Q

Give some features of a severe asthma attack

A
  • PEFR 33-50%
  • RR >25
  • inability to speak in full sentences
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9
Q

Give features of a life-threatening asthma attack

A
  • PEFR <33%
  • silent chest
  • bradycardia
  • hypotension
  • O2 sats <92%
  • cyanosis
  • exhaustion
  • ‘normal’ PaCO2
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10
Q

Stepwise pharmacological mx of acute asthma?

A

1) ABCDE

2) O2 15L NRBM

3) Back to back nebulised salbutamol

4) Corticosteroids: 40-50mg oral pred or IV hydrocortisone

5) Nebulised ipratropium bromide

6) IV mag sulphate or IV aminophylline (specialist input)

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11
Q

Dose of pred giben in acute asthma?

A

40-50mg daily for 5 days

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12
Q

IV steroid option in acute asthma?

A

IV hydrocortisone

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13
Q

What is ipratropium bromide?

A

SAMA

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14
Q

Which inherited disorder can predispose to COPD?

A

A1AT deficiency

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15
Q

How is alpha 1 antitrypsin deficiency inherited?

A

Autosomal dominant

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16
Q

COPD is usually a combination of what 2 disease?

A

Bronchitis & emphysema

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17
Q

Why are those with COPD prone to headaches?

A

CO2 retention

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18
Q

How can COPD affect the heart?

A

Low O2 levels –> additional strain on heart.

This can lead to right ventricle hypertrophy and potentially cor pulmonale.

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19
Q

What 2 cardiac conditions can COPD lead to?

A

1) RV hypertrophy

2) Cor pulmonale

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20
Q

What is cor pulonale?

A

Cor pulmonale is a condition that causes the RIGHT side of the heart to fail.

Long-term high blood pressure in the arteries of the lung and right ventricle of the heart can lead to cor pulmonale

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21
Q

Cause of polycythaemia in COPD?

A

compensatory physiologic response to hypoxia.

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22
Q

Pharmacological mx of acute exacerbation of COPD?

A

1) O2

2) nebulised salbutamol

3) nebulised ipratropium bromide

4) steroids

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23
Q

Stepwise mx of chronic COPD?

A

1) SAMA or SABA as required

2) Are there asthmatic featues:

2a) yes –> SABA/SAMA as required, ICS + LABA regularly

2b) no –> SABA as required, LABA + LAMA regularly

3) SABA as required, ICS + LABA + LAMA regularly

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24
Q

What are some asthmatic features or features suggestive of steroid responsiveness in COPD?

A

1) previous diagnosis of asthma or atopy

2) raised eosinophil count

3) substantial variation in FEV1 over time

4) substantail diurnal variation in peak PEFR (at least 20%)

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25
Q

What are the 2 types of NSCLC?

A

1) Adenocarcinoma

2) Squamous cell carcinoma

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26
Q

Which lymph nodes tend to be found first on examination in lung cancer?

A

Supraclavicular

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27
Q

What antibodies is limbic encephalitis associated with?

A

Anti-Hu abs

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28
Q

Target of antibodies in Lambert-Eaton myasthenic syndrome?

A

Its 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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29
Q

What muscles does Lambert-Eaton myasthenic syndrome affect?

A

Weakness in proximal muscles

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30
Q

Weakness in Lambert-Eaton vs myasthenia gravis?

A

Lambert-Eaton –> improves with repetitive movement

Myasthenia Gravis –> worsens with repetitive movement

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31
Q

What is referral criteria for suspected cancer (2 week referral for CXR)?

A

Patients over 40 with:

  • Clubbing
  • Lymphadenopathy (supraclavicular or persistent abnormal cervical nodes)
  • Recurrent or persistent chest infections
  • Raised platelet count (thrombocytosis)
  • Chest signs of lung cancer
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32
Q

What investigation is then used to assess the stage, lymph node involvement and presence of metastases in lung cancer?

A

Staging CT w/ contrast of chest, abdomen & pelvis

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33
Q

Which type of lung cancer is most likely to cause a pleural effusion?

A

Adenocarcinomas (& mesotheliomas)

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34
Q

Which type of lung cancer is most commonly related to hypercalcaemia?

A

Squamous cell carcinoma

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35
Q

What cells do small cell lung cancers arise from?

A

From endocrine cells (Kulchitsky cells) – these are APUD cells

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36
Q

1st line management in NSCLC in patients with disease isolated to a single area?

A

Surgery –> intention is to remove the entire tumour and cure the cancer

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37
Q

Management options in SCLC?

A

Usually with chemotherapy or radiotherapy

The prognosis is generally worse than NSCLC.

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38
Q

What PEFR is needed for discharge following an asthma attack?

A

> 75%

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39
Q

Prior to discharge, following an acute asthma attack, how long must patients be stable for on their discharge medication (i.e. no nebulisers or oxygen)?

A

12-24h

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40
Q

Stepwise diagnostic testing in asthma (age 5-16 y/o)?

A

1) all children should have spirometry with a bronchodilator reversibility (BDR) test

2) a FeNO test should be requested if there is NORMAL spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test

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41
Q

Stepwise diagnostic testing in asthma (age ≥17 y/o)?

A

1) patients should be asked if their symptoms are better on days away from work/during holidays. If so, patients should be referred to a specialist as possible occupational asthma

2) ALL patients should have spirometry with a bronchodilator reversibility (BDR) test

3) ALL patients should have a FeNO test

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42
Q

Does a negative result on spirometry exclude asthma as a diagnosis?

A

no - refer for FeNO testing

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43
Q

Vaccinations in COPD?

A
  • annual influenza
  • one off pneumonoccal
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44
Q

In acute asthma, when is an ABG indicated?

A

If patient has O2 sats <92%

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45
Q

What anaesthetic agents are patients with myasthenia gravis very sensitive to?

A

Non-depolarising agents, such as rocuronium

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46
Q

Next step in asthma mx in children aged 5-16 years with asthma not controlled by a SABA + paediatric low-dose ICS?

A

Add trial of LTRA

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47
Q

Can A1AT deficiency be diagnosed prenatally?

A

Yes - via CVS or amniocentesis

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48
Q

Why should you be cautious of using EllaOne (Ulipristal acetate) in severe asthma?

A

Due to the anti-glucocorticoid effect of ulipristal acetate

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49
Q

What is coal worker’s pneumoconiosis?

A

An occupational lung disease caused by long term exposure to coal dust particles.

It is most commonly experienced by those who have been involved in the coal mining industry and severity is linked to the extent of exposure.

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50
Q

What is seen on CXR in coal worker’s pneumoconiosis?

A

Upper zone fibrosis

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51
Q

Spirometry results in coal worker’s pneumoconiosis?

A

Restrictive lung function tests - a normal or slightly reduced FEV1 and a reduced FVC

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52
Q

Mx of asthma in children aged 5-16 y/o not controlled by a SABA + paediatric low-dose ICS + LTRA?

A

Add LABA and stop LTRA

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53
Q

Asthma mx during pregnancy?

A

Inhaled drugs, theophylline and prednisolone can be taken as normal during pregnancy and breast-feeding

54
Q

Describe Light’s criteria for establishing an exudative effusion

A

1) Fluid protein/serum protein >0.5

2) Fluid LDH/serum LDH >0.6

3) Pleural fluid LDH >2/3 of normal upper limit of serum LDH

55
Q

What are the most common causes of transudative pleural effusions?

(6)

A

1) Congestive cardiac failure

2) Liver failure

3) Hypoalbuminaemia

4) Hypothyroidism

5) Meig’s syndrome

6) Nephrotic syndrome

56
Q

How does hypoalbuminemia cause transudative pleural effusion?

A

Hypoalbuminemia can cause a decrease in oncotic pressure causing extravasation of fluid into the interstitial space

57
Q

Why would a urine dip be indicated in pleural effusion?

A

Assess for proteinuria - may indicate nephrotic syndrome

58
Q

What imaging is indicated in idiopathic pulmonary fibrosis?

A

High resolution CT –> ‘ground glass’ appearance

59
Q

Spirometry result in pulmonary fibrosis?

A

Restrictive picture:

1) FEV1 and FVC are equally reduced
2) FEV1/FVC ratio greater than 70%

60
Q

What 2 medications are licensed that can slow the progression of pulmonary fibrosis

A

1) Pirfenidone
2) Nintedanib

61
Q

Give 3 causes of drug induced pulmonary fibrosis

A

1) Amiodarone

2) Nitrofurantoin

3) Methotrexate

62
Q

What conditions can pulmonary fibrosis occur 2ary to? (4)

A

1) A1AT deficiency

2) RA

3) Sarcoidosis

4) SLE

63
Q

What triad is seen in yellow nail syndrome?

A

1) yellow fingernails

2) bronchiectasis

3) lymphoedema

64
Q

What is an important area of the history to cover in bronchiectasis?

A

Childhood LRTIs

65
Q

What are the 2 most common infective organisms in bronchiectasis?

A

1) H. influenzae

2) Pseudomonas aeruginosa

66
Q

What is the test of choice for establishing a bronchiectasis diagnosis?

A

High resolution CT

67
Q

What do lung function tests typically show in bronchiectasis?

A

Typically obstructive pattern

68
Q

What should be done before prescribing Abx in bronchiectasis?

A

Sputum culture

69
Q

What is the he Abx of choice for bronchiectasis exacerbations caused by Pseudomonas aeruginos?

A

Ciprofloxacin

70
Q

Abx length in bronchiectasis exacerbations?

A

Extended: 7-14 days

71
Q

RR in moderate vs severe acute asthma?

A

Moderate: <25

Severe: >25

72
Q

PEFR in moderate, severe and life-threatening acute asthma?

A

Moderate: 50-75%

Severe: 33-50%

Life-threatening:<33%

73
Q

Murmur in mitral stenosis?

A

Mid diastolic murmur

74
Q

features of mitral stenosis?

A
  • haemoptysis
  • AF
  • SOB
  • malar flush
  • mid diastolic murmur
75
Q

What is there often a history of in aspergilloma?

A

TB

76
Q

What may CXR show in aspergilloma?

A

Rounded opacity

77
Q

What are pleural plaques?

A

Fibrous thickenings on the pleura

78
Q

What are pleural plaques often associated with?

A

Asbestos exposure (e.g. boiler engineer)

79
Q

Are pleural plaques malignant?

A

No - don’t undergo malignant chance so NO follow up needed

80
Q

What is the most common form of asbestos-related lung disease?

A

Pleural plaques

81
Q

When is Abx prophylaxis required in COPD patients?

A

COPD patients who have had more than 3 exacerbations requiring steroid therapy and at least 1 exacerbation requiring hospital admission in the previous year.

82
Q

What class of Abx is used for prophylaxis in COPD patients?

A

Macrolides e.g. azithromycin

83
Q

What pO2 level is indicator for long term oxugen therapy (LTOT)?

A

pO2 <7.3 kPa

or pO2 7.3-8 kPa and one of the following:
1) 2ary polycythaemia
2) peripheral oedema
3) pulmonary HTN

84
Q

Pleural fluid findings of low glucose may indicate what?

A

1) Rheumatoid arthritis (exudate)
2) TB (exudate)

85
Q

Pleural fluid findings of raised amylase may indicate what?

A

1) pancreatitis

2) oesophageal perforation

86
Q

What is the most common cause of occupational asthma?

A

Isocyanates e.g. factories producing spray painting, foam moulding using adhesives

87
Q

What pCO2 indicates near-fatal asthma?

A

Raised >6.0 kPa

88
Q

What electrolyte abnormality is seen in sarcoidosis?

A

Hypercalcaemia

89
Q

What skin manifestation is seen in sarcoidosis?

A

Erythema nodosum

90
Q

Mainstay of treatment in small cell lung cancer?

A

Chemotherapy

91
Q

Where in the lungs does asbestosis cause fibrosis?

A

Lower zone fibrosis

92
Q

What does lung abscess most commonly form 2ary to?

A

Aspiration pneumonia

93
Q

Common causes of respiratory alkalosis?

A

Anxiety leading to hyperventilation
Altitude
PE
Salicylate poisoning
CNS disorders e.g. stroke, subarachnoid haemorrhage, encephalitis
Pregnancy

94
Q

What type of metabolic disurbance does salicylate poisoning cause?

A

Salicylate overdose leads to a MIXED respiratory alkalosis and metabolic acidosis.

95
Q

Which type of pneumonia is associated with herpes labialis?

A

Strep. pneumoniae

96
Q

Does a PE cause respiratory acidosis or alkalosis?

A

Respiratory alkalosis

97
Q

3 most common causes of meningitis in >60 y/o?

A

1) Strep pneumoniae

2) Neisseria meningitidis

3) Listeria monocytogenes

98
Q

An elderly patient presents with watery diarrhoea after being treated for pneumonia. Blood tests show a new, marked neutrophilia.

What is most likely organism?

A

C. diff

99
Q

What is silicosis a risk factor for?

A

Developing TB

100
Q

Features of silicosis?

A

Persistent cough
Exertional SOB
upper zone fibrosing lung disease
‘egg-shell’ calcification of the hilar lymph nodes

101
Q

How does Cushing’s affect muscles?

A

Proximal muscle weakness

102
Q

What respiratory condition can lead to Cushing’s?

A

Small cell lung cancer

103
Q

What triad is seen in Kartagener syndrome?

A

1) situs inversus totalis (including dextrocardia)
2) chronic sinusitis
3) bronchiectasis

104
Q

Gold standard investigation to diagnose mesothelioma?

A

Thoracoscopic biopsy & histology

105
Q

FEV1 (of predicted) indicates the severity of COPD.

Describe FEV1 for COPD stage 1, 2, 3 and 4

A

Stage 1: >80%

Stage 2: 50-79%

Stage 3: 30-49%

Stage 4: <30%

106
Q

Does COPD cause clubbing?

A

No

107
Q

Where is emphysema in A1AT most prominent?

What about in COPD?

A

COPD - upper lobes

A1AT - lower lobes

108
Q

What is the commonest cause of stridor in children?

A

Laryngomalacia

109
Q

1st line Abx in infective exacerbation of COPD?

A

Amoxicillin or doxycycline or clarithromycin

110
Q

Presentation of Klebsiella pneumonia on CXR?

A

Cavitating pneumonia in upper lobes

111
Q

How often should you consider ‘stepping down’ asthma treatment?

A

Every 3 months or so

112
Q

What should you aim for in the step down treatment of asthma?

A

Aim for a reduction of 25-50% in the dose of inhaled corticosteroids

113
Q

What is the most common organism found on ascitic fluid culture in SBP?

A

E. coli

114
Q

Is post-exposure prophylaxis for HIV recommended following human bites?

A

No (even if the individual has known HIV/AIDS) due to low risk of transmission

115
Q

Mx of PCP pneumonia?

A

Co-trimoxazole

116
Q

What is the most common cause of infective endocarditis?

A

Staph. aureus

117
Q

What are two most notable types of Streptococcus viridans?

A

1) Strep. mitis

2) Strep. sanguinis

118
Q

Who is prone to developing endocarditis secondary to Viridans streptococci e.g. Streptococcus sanguinis?

A

Patients with poor dental hygiene

119
Q

Post-exposure prophylaxis for HIV routine?

A

4 weeks of antiretroviral therapy, arrange HIV testing at 12 weeks

120
Q

What is the timeframe for post-exposure prophylaxis for HIV being started?

A

4 weeks

121
Q

What are the causes of UPPER zone lung fibrosis?

Mneumonic: CHARTS

A

C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - TB
S - Silicosis/sarcoidosis

122
Q

How may lower lobe pneumonia present?

A

With upper quadrant abdo pain

123
Q

What is the reason that Mycoplasma pneumoniae causes haemolytic anaemia?

A

IgM antibodies against Mycoplasma pneumoniae react against human red blood cells at cold temperatures causing them to agglutinate.

This can be seen in a peripheral blood smear.

124
Q

What test should be offered to all patients with TB?

A

HIV

125
Q

What is the most common cause of neutropenic sepsis?

A

Staph epidermis - associated with central line infections.

126
Q

Is smoking a risk factor for Grave’s?

A

Yes

127
Q

Mx of all patients with a CD4 count lower than 200/mm3?

A

All patients with a CD4 count lower than 200/mm3 should receive prophylaxis against PCP pneumonia w/ oral co-trimoxazole

128
Q

What is the most common cause of death in measles?

A

Pneumonia

129
Q

How can the risk of oral candidiasis be reduced in inhaled steroid use?

A

Take ICS using large volume spacer (less local drug deposition in mouth)

130
Q

Why are dry powder asthma inhalers better for the environment than metered dose inhalers?

A

Metered dose inhalers use hydrofluorocarbon propellant (a greenhouse gas).

Dry powder inhalers do not
use propellants.

131
Q
A

Yr 5 - Respiratory (4 decks)

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