1
Q
What does a sputum sample film show in acute bronchitis?
A
Neutrophil granulocytes (inflammatory WBCs)
2
Q
What pathogen causes influenza?
A
RNA virus - orthomyxoviridae
3
Q
How is influenza diagnosed?
A
Clinical diagnosis
- viral culture - PCR
4
Q
What are the symptoms of influenza?
A
- Coryzal symptoms
- Fever
- Headache
- Non-productive cough
- Sore throat
5
Q
What is croup?
A
- Inflammation of the upper respiratory tract
- acute laryngotracheitis
- due to viral infection
6
Q
What organism is most responsible for croup?
A
- Parainfluenza
- RSV
7
Q
What are the symptoms of croup?
A
Seal-like barking cough
- runny nose
- fever
- stridor
- voice hoarseness
8
Q
How do you diagnosis croup?
A
Clinical diagnosis
- Significant resp impairment ( O2 <95%)
9
Q
Is RSV contagious?
A
Yes
10
Q
What is the most common complication RSV?
A
Bronchiolitis
11
Q
How is RSV spread?
A
air droplet
12
Q
What are the RSV symptoms?
A
Cold-like symptoms:
- low grade fever
- wheezing
- chest congestion / rhinorrhea
- SOB
- Cough
13
Q
What is bacterial pneumonia?
A
- bacterial mediated inflammation
- infection of the lung tissue in which the alveoli become filled with MO, fluid & inflamm cells
14
Q
What are the most common microorganism causing bacterial pneumonia?
A
- streptococcus pneumonia
- H.influenza
- staphylococus aureus
15
Q
What are the key symptoms for bacterial pneumonia?
A
- Green Productive Cough*
- SOB
- Fever
- Chest pain
16
Q
What are the key signs for bacterial pneumonia?
A
- Increased tactile & vocal fremitus
- Dullness to percuss
- Bronchial breath sounds
- Late inspiratory crackles
17
Q
Investigations for pneumonia?
A
- CXR : to identify location and extent
- CRP : inflammation
18
Q
What score is used to admit pt to hospital with pneumonia?
A
CRB-65
> 3 = urgent admission
> 2 = hospital management
0 = conservative management at home
19
Q
What are the key symptoms for viral pneumonia?
A
Non-productive cough
Systemic symptoms:
- fever
- runny nose
- myalgia
- fatigue
20
Q
What are the investigation findings for viral pneumonia?
A
- Viral PCR
- CXR : more likely bilateral consolidation
21
Q
What is acute bronchiolitis?
A
- Acute viral infection of the LRT
- Characterised by epithelial destruction, cellular oedema & airwary obstruction by inflamm debris & mucus
22
Q
Most common cause of bronchiolitis
A
RSV
23
Q
what are the symptoms of acute bronchiolitis?
A
- Fever
- Cough
- Poor feeding
- Apnoea
24
Q
What are the signs of acute bronchiolitis?
A
Clinical diagnosis: < 2 presenting with 1-3 days hx of coryzal symptoms
- persistent cough
- tachypnoea or chest recession (both)
- wheeze or crackles OA (both)
25
Investigation for acute bronchiolitis
CLINICAL DIAGNOSIS
- check 02 sats
- CXR not recommended unless evidence of deterioration
26
What is acute epiglottitis?
Cellulitis of the supra-glottis - may cause airway compromise.
- Airway emergency in children
27
What is the most common cause for acute epiglottitis?
H.Influenza
28
What are the symptoms of acute epiglottitis?
- Sore throat
- Stridor
- Tripod position : lean forward + extending neck.
- Dysphagia
- Fever
- Drooling
29
What are the signs for acute epiglottitis?
High - pitched inspiratory wheeze
| * DO NOT EXAMINE THROAT*
30
What are the investigation finding for acute epiglottitis?
Lateral neck radiograph - THUMB SIGN
31
What are the complications of acute epiglottitis?
- Abscess formation
- Sepsis
- Pneumothorax
- Meningitis
32
What is pertussis?
- Whooping cough
33
What organism causes pertussis?
- Bordetella Pertussis
34
How is pertussis transmitted?
- Sneeze or cough (airborne)
35
What are the 3 phases of symptoms called in Pertussis?
1st phase = catarrhal
- runny nose
- malaise
- sore throat
- low-grade fever
- dry cough
2nd phase = paroxysmal (1-6 weeks)
- short expiratory burst followed by inspiratory gasp (whoop)
- thick mucus secretions
3rd phase = convalescent (3 months)
- gradual improvements in cough frequency + severity
36
What are the key symptoms should you suspect for pertussis?
Acute cough > 14 days w/ no apparent cause w/:
- paroxysmal cough
- inspiratory whoop
- Post-tussive vomiting
- undiagnosed apnoeic attack
37
How to diagnose pertussis?
Nasopharyngeal swab
38
What is empyema?
Defined as the presence of frank pus in the pleural space.
39
What are the common infection causing empyema?
- Due to post pneumonia
- Anaerobic, staph & gram-negative infections
- Klebsiella: alcoholism, currant jelly-like sputum.
40
What are the symptoms of empyema?
- SOB
- Fever
- Pleuritic chest pain
41
What are the signs of empyema?
- Tachypnoea
- Reduced breath sounds
- Dullness to percuss
42
What are the investigation findings of empyema?
CXR: blunting of the costophrenic angle or effusion on affected side
CRP & WCC- raised in infection
43
What investigation is diagnostic for empyema?
Thoracentesis: aspiration of the frank pus
44
What is chronic bronchitis?
Long-term inflammation of the lining of the bronchial tubes
45
What are the symptoms of chronic bronchitis?
- Cough
- Sputum
- Fatigue
- SOB
- Chest discomfort
46
What is emphysema?
Condition causes SOB due to damaged alveoli in the lungs
47
What are the signs and symptoms of emphysema?
- SOB (progressive & at rest)
- Fatigue
- Central & peripheral cyanosis
- Persistent wheeze
- Productive cough
48
What are the signs of emphysema?
- " Pink puffers"
- Accessory muscle use
- Barrel chest
- Hyper-resonance on percussion
- Absent or quiet breath sounds on auscultation
49
What are the investigation for emphysema?
- Bloods: Serum Alpha 1-antitrypsin
- CXR
- Sputum culture
- Lung function test
50
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
51
What is COPD?
- Airflow limitation
| Group of progressive lung disease including chronic bronchitis & emphysema (treatable but not curable)
52
What is the pathophysiology of COPD?
CB: damage to endothelium impairing the mucociliary response to clear mucus & bacteria – airway deformation & narrowed lumen
EMP: enlargement of alveoli, leading to decline in gas exchange
53
What deficiency causes COPD?
Alpha 1-trypsin
54
What are the symptoms for COPD?
- SOBOE (progressive)
- Chronic cough
- Regular sputum production
- Wheeze
- Weight loss
- Fatigue
- PND
- Ankle swelling (cor pulmonale)
- Chest pain
- Haemoptysis
55
What are the signs for COPD?
- Frequent LRTI
- Cyanosis
- Raised JVP
- Cachexia
- Barrel chest
- Accessory muscle use
- Purse lip breathing
- Crackles OA
56
How is COPD diagnosed?
Clinical features + spirometry
57
What investigations are carried when suspecting COPD?
- Spirometry
- CXR
- ABG
- Sputum culture
- Serum alpha 1-trypsin
58
What spirometry findings confirms persistent airflow obstruction?
A post-bronchodilator FEV1/FVC < 0.7
59
How is the severity of COPD classified?
Post-bronchodilator FEV1/FVC < 0.7
FEV1 (of predicted)
> 80% : Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients
50-79% : Stage 2 - Moderate
30-49% : Stage 3 - Severe
< 30% : Stage 4 - Very severe
60
What are CXR findings in COPD?
- Hyperinflation
- Bullae
- Flat haemodiaphragm
(exclude cancer)
61
What are the asthmatic features when treating COPD?
1) any previous, secure diagnosis of asthma or of atopy
2) a higher blood eosinophil count
3) substantial variation in FEV1 over time (at least 400 ml)
4) substantial diurnal variation in peak expiratory flow (at least 20%)
62
What are the complications of COPD?
- Secondary polycythaemia : Increased haematocrit due to long-term hypoxia
- Respiratory acidosis: indicates BiPAP
- Recurrent chest infections
- Cor pulmonale
63
What can a large bullae in CXR in COPD mimic?
Pneumothorax
64
What type of bacteria is Haemophilus influenza?
- Gram negative rod
65
What is asthma?
Chronic respiratory condition associated with airway inflammation and hyper-responsiveness.
66
What is asthma associated with?
Eczema + Hay fever
67
What features is required for the classification of moderate asthma?
1) PEFR 50-75% best or predicted
2) Speech normal
3) RR < 25 / min
4) Pulse < 110 bpm
68
What features is required for the classification of severe asthma?
1) PEFR 33 - 50% best or predicted
2) Can't complete sentences
3) RR > 25/min
4) Pulse > 110 bpm
69
What features is required for the classification of life-threatening asthma?
1) PEFR < 33% best or predicted
2) Oxygen sats < 92%
3) 'Normal' pC02 (4.6-6.0 kPa)
4) Silent chest, cyanosis or feeble respiratory effort
5) Bradycardia, dysrhythmia or hypotension
6) Exhaustion, confusion or coma
70
What are the features of klebsiella pneumonia?
- RF: alcohol and diabetes
- 'red-currant jelly' sputum
- Upper lobe
71
What are the common symptoms associated with asthma?
- Wheeze
- Chest tightness
- SOB
- Cough
72
What are the clinical signs associated with asthma?
- OBS : HR > 110, RR > 25
- Tracheal deviation
- Widespread wheeze OA
- Chest deformity/ hyperinflated chest ( chronic asthma)
73
When do symptoms of asthma commonly present (timing)?
- Worse at night
- Early in the morning
- In response to exercise
- Allergen exposure
- Cold air
- After taking aspirin or BB
74
What does normal PaCO2 in acute asthma indicate?
- Exhaustion
This is classified as life-threatening
75
When is chest X-RAY indicated in acute asthma?
Not routinely done"
- life-threatening asthma
- suspected pneumothorax
- failure to respond to treatment
76
What investigations are considered in asthma?
1) Spirometry : < 70 % in FEV1/FVC suggests airflow limitation
- -> normal spirometry does not r/o asthma
- -> BDR: confirms diagnosis, > 12% improvement, with an increase in volume of > 200ml is positive result
2) Peak flow : > 20% variability is positive result
- ->support diagnosis
3) FENO testing : esonophilic airway limitation support diagnosis (> 40 ppb)
4) Allergy testing
77
What is sleep apnoea?
the interruption of sleep as a result of a narrowing of the throat
78
What symptoms can indicate sleep apnoea?
- Loud snoring
- Day time sleepiness
- impaired concentration
- Unrefreshed on waking
- Witnessed apnoea: choking noises while sleeping
79
What should you examine for in sleep apnoea?
- Enlarged tonsils
- small jaw
- nasal blockage
80
What questionnaire is helpful in diagnosing OSAS?
Epsworth sleepiness questionnaire
81
What investigations can be carried out in sleep apnoea?
- Polysomnography : sleep study to measure apnoea /hypoapnoea episodes
- Lung function
- Endoscopy
82
What is Pulmonary Embolism?
One or more emboli from a thrombus in the vein, lodged in and obstructing the pulmary arterial system causing resp dysfunction
83
What are the risk factors for PE?
1) Immobilisation
2) Surgery in the last 4 weeks
3) Previous DVT/PE
4) Malignancy
5) Increased coagulability
84
What is the triad of symptoms for PE?
1) SOB
2) Chest pain
3) Haemoptysis
- cyanosis
- unilateral leg swelling
- syncope
85
Signs of PE
- Tachycardia
- RR > 20
- Raised JVP
- Pleural rub
- Hypotension
86
What score is used for PE?
Wells score :
1) DVT
2) PE is #1 diagnosis OR equally likely
3) Heart rate > 100
4) Immobilization at least 3 days OR surgery in the previous 4 weeks
5) Previous, objectively diagnosed PE or DVT
6) Haemoptysis
7) Malignancy w/ treatment within 6 months or palliative
87
What is the 1st line investigation for PE?
CTPA
| > 4 points on Well's
88
When is CTPA contraindicated?
| What is 1st line in this case?
Renal impairment - due to contrast
Pregnancy
1st line in above = V/Q scan
89
When do you offer D-dimer test?
< 4 points on Well's
90
If CTPA is negative, what is the next step if DVT is suspected?
Proximal Leg USS
91
What ECG changes is associated with PE?
1) Large S wave in lead I
2) Q wave in lead III
3) Inverted T-wave in lead III
* S1Q3T3*
4) RBBB
5) RAD
92
What might you see on an ABG in PE?
Respiratory alkalosis
93
If a pt has PE + hypotension, what would you do?
Thrombolyse (alteplase)
94
What is 1st line medication in PE without hypotension?
DOAC - apixaban or rivaroxaban
95
What is another criteria used in PE?
pulmonary embolism rule-out criteria (the PERC rule)
- -> all the criteria must be absent to have negative PERC result, i.e. rule-out PE
- -> this should be done when you think there is a low pre-test probability of PE, but want more reassurance that it isn't the diagnosis
- -> a negative PERC reduces the probability of PE to < 2%
- -> if your suspicion of PE is greater than this then you should move straight to the 2-level PE Wells score, without doing a PERC
96
What is the PERC?
Criteria:
1) Age > 50
2) HR > 100
3) O2 < 94%
4) Previous DVT or PE
5) Recent surgery or trauma in the past 4 weeks
6) Haemoptysis
7) Unilateral leg swelling
8) Oestrogen use
97
If Well's score is > 4 points, what does it mean and what is the algorithm?
PE likely:
1) CTPA
2) Delay in CTPA, interim anticoag until scan
98
If Well's score is < 4 points, what does it mean and what are the next steps?
PE unlikely:
1) D-dimer test
- -> If + , CTPA
- -> if - , stop anticoag and consider alternative diagnosis
99
What is the possible CXR finding in PE?
- Typically normal
| - Possible wedge-shaped opacification
100
Which score is used when starting and continuing anticoagulation in PE?
HAS-BLED
101
What is Cor Pulmonale?
Right ventricle failure through pulmonary artery htn due to lung disorder
102
What can cause Cor Pulmonale?
- PE
- Acute respiratory distress syndrome
- Chronic : COPD
103
What are the symptoms of COR Pulmonale?
- SOB
- Chest pain
- Fatigue
- DIzziness
- SOBOE
- Ankle swelling
104
What are signs associated with Cor Pulmonale?
* Left parasternal heave* (sign of right ventricular hypertrophy)
- S3, S4 + pansystolic murmur
- Intercostal recession
- Systolic bruits
- Raised JVP
- Increased HR
- Crackles
105
What are the ECG findings associated with Cor Pulmonale?
- Increased P wave amplitude
- PR depression
- RAD
106
What investigation can be carried out for Cor Pulmonale?
CXR = rught artial size + pulmonary artery enlargement
CTPA/MRI of the chest
V/Q scan = PE or RHF
107
Painful rash + cough = diagnosis?
sarcoidosis
108
What pathogen is the most common cause for fungal pneumonia?
Pneumocystis Jiroveci
| Typically seen in patients with HIV
109
What are the symptoms and signs associated with Pneumocystis Jiroveci?
- dry cough
- SOB
- Fever
- exercise induced desaturations
- absence of chest signs
110
What is pneumocystis pneumonia?
- fungal infection in one or both lungs
| - common in people with weakened immune system (AIDs)
111
What is pneumocystis jiroveci also known as?
Pnuemocystis carinii pneumonia (PCP)
| - most common opportunistic infection in AIDs
112
What is a common complication of PCP?
pneumothorax
113
What investigations are carried our for PCP?
1. CXR: bilateral interstitial pulmonary infiltrates but can present with other x-ray findings e.g. lobar consolidation.
2. Sputum often fails to show PCP
3. Special test: bronchoalveolar lavage (BAL) - often needed to demonstrate PCP (silver stain shows characteristic cysts)
114
When is PCP prophylaxis indicated?
all patients with a CD4 count < 200/mm³
115
What is Tuberculosis?
- Infection caused by Mycobacterium tuberculosis that most commonly affects the lungs
116
What are the symptoms of TB?
1. Coughing > 3 weeks
2. Haemoptysis
3. Night sweats
4. Unintended weight loss
117
What are the investigations carried out for TB?
1) Chest x-ray
- upper lobe cavitation is the classical finding of reactivated TB
- bilateral hilar lymphadenopathy
2) Sputum smear
- 3 specimens are needed
- rapid and inexpensive test
- stained for the presence of acid-fast bacilli (Ziehl-Neelsen stain)
- -> all mycobacteria will stain positive
3) Sputum culture
- the gold standard investigation
- more sensitive than a sputum smear and nucleic acid amplification tests
- can assess drug sensitivities
- can take 1-3 weeks
4) Nucleic acid amplification tests (NAAT)
- allows rapid diagnosis (within 24-48 hours)
- more sensitive than smear but less sensitive than culture
118
What is the gold standard investigation for TB?
Sputum culture
119
What are the side effects of the drugs used in TB?
Rifampicin = hepatoxicity , orange tears & urine
Isoniazid = hepatoxicity, peripheral neuropathy
Pyrazinamide = gout
Ethambutol = optic neuritis
120
What should all patients with TB be tested for?
HIV
121
What is Bronchiectasis?
Permanent dilatation of the airways secondary to chronic infection or inflammation.
122
What are the symptoms of Bronchiectasis?
1. Persistent production of mucous
2. Cough >8 weeks
3. SOB
123
What are the signs for Bronchiectasis?
1. Coarse crackles
2. Wheeze
3. Stridor
4. large airway rhonchi (snore-like)
124
What are the investigations for Bronchiectasis?
1. CXR (1st line)
- Tramlines
- honey-combing
2. High-resolution computered tomography (gold-standard)
- bronchial wall dilation
3. Spirometry
4. Assess for cystic fibrosis
125
What are the most common organisms causing Bronchiectasis?
- Haemophilus influenzae (most common)
- Pseudomonas aeruginosa
- Klebsiella spp.
- Streptococcus pneumoniae
126
What is Cystic Fibrosis?
- An autosomal recessive disorder causing increased viscosity of secretions (e.g. lungs and pancreas)
127
What are the presenting features of Cystic Fibrosis?
- neonatal period : meconium ileus, less commonly prolonged jaundice
- recurrent chest infections
- malabsorption: steatorrhoea, failure to thrive
- other features (10%): liver disease
128
What are some other features associated with Cystic Fibrosis?
- short stature
- diabetes mellitus
- delayed puberty
- rectal prolapse (due to bulky stools)
- nasal polyps
- male infertility, female subfertility
129
What test is used for diagnosis of Cystic Fibrosis?
* *Sweat test**
- patient's with CF have abnormally high sweat chloride
- normal value < 40 mEq/l, CF indicated by > 60 mEq/l
130
What is Pulmonary Hypertension?
- Mean pulmonary arterial pressure > 25 mmHg at rest
131
What are the symptoms of Pulmonary Hypertension?
- Chest pain
- Exertional SOB
- Fatigue
- Syncope
132
What are the signs of Pulmonary Hypertension?
- Large A wave in JVP
- Peripheral cyanosis
- Parasternal - right ventricular heave
- Peripheral oedema
133
What are the special tests carried out in Pulmonary Hypertension?
- Echo : dilated R ventricle with impaired function
- Cardiac catheterisation : essential for diagnosis
- CT or MRI : enlargement of pulmonary arteries
134
What are the ECG findings in Pulmonary Hypertension?
- RAD
- R wave in V1
- Inverted T wave in right pericardial leads
- RBB
- Tall peaked p waves in lead II
135
What does SSRI in 3rd trimester cause?
- Pulmonary HTN in newborn
136
What is Pleural Effusion?
Fluid collect between the parietal and visceral pleural surfaces of the thorax
137
What is the aetiology of Pleural Effusion?
- if the normal flow of fluid is disrupted with either too much fluid production or not enough being removed.
138
What are the symptoms of Pleural Effusion?
- SOB
- Non productive cough
- Pleuritic chest pain
139
What are the signs of Pleural Effusion?
- Quieter breath sounds
- Decreased or absent tactile fremitus
- Dull to percuss
- Reduced chest expansion
140
How can Pleural Effusion be classified?
According to the protein conc:
1. Transudate (< 30 g/L)
2. Exudate (> 30g/L)
141
What investigation are carried out for Pleural Effusion?
Imaging:
- Posterioranterior (PA) chest x-ray
- USS: for pleural aspiration
- Contrast CT : investigate underlying cause
Pleural aspiration :
- fluid sent for pH, protein, LDH, cytology and microbiology
142
What is light's criteria?
Used to distinguish between transudate and exudate
143
What are the pleural findings indication in pleural effusion
1. low glucose: rheumatoid arthritis, tuberculosis
2. raised amylase: pancreatitis, oesophageal perforation
3. heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis
144
When is pleural fluid sampling diagnostic?
- Pleural infection : all pt with pleural effusion associated with sepsis or pneumonia
1. Fluid = purulent or cloudy --> chest tube for drainage
2. Fluid = clear but pH < 7.2 --> chest tube placed
145
What are the pleural findings in empyema?
Turbid effusion with :
1. pH < 7.2
2. low glucose
3. high LDH
146
What is Pneumothorax?
- when air gain access to & accumulates in the pleural space
147
What are the types of pneumothorax?
1. Primary - occurs without a cause
2. Traumatic - results of trauma. commonly - stab wound
3. Tension - large amount of air present within the lung causing the lung to deflate
148
What are the symptoms of pneumothorax?
Symptoms onset sudden:
- SOB
- Pleuritic chest pain
- sweating
- tachypnoea
- tachycardia
149
What are the signs for pneumothorax?
- Absent breath sounds
- Trachial deviation
- Hyperressonance on percussion
150
What are the investigations for pneumothorax
- CXR
- CT : differentitate between emphysema + pneumothorax
- Bronchoscopy
151
What is the management of secondary pneumothorax if < 1 cm?
- Admit + give oxygen for 24 hours + review
152
What is the management of Primary Pneumothorax?
1. < 2 cm + no SOB = discharge
2. Otherwise, aspirate
3. > 2 cm or SOB = chest drain inserted
153
What scoring system is used for suspected obstructive sleep apnoea?
Epworth scale
154
What would the finding of TB be on a chest radiograph?
Upper zone fibrosis
155
What is pleurisy?
Inflammation of the pleura which compromises lubrication and results in pain
156
What are the signs of pleurisy?
- Reduced breath sounds
- Pleuritic rub
- Rapid/shallow breathing
157
What are the symptoms of pleurisy?
- Chest pain
- sharp stabbing pain
- worse on inspiration
Dependent on cause:
- cough (productive)
- systemic symp: fever, rigors
- SOB /altered breathing
158
When is a diagnosis of pleurisy made?
- When other differentials have been confidently excluded
159
How to investigate pleurisy?
Tests done to r/o other causes:
- bloods : trop, ABG, D-dimer
- X-Ray: pneumothorax, pleural effusion
- CT: show the condition of the pleura
160
What are the 2 types of lungs cancer based on histology?
1. Small Cell Lung cancer (SCLC)
| 2. Non- Small Cell Lung Cancer (NSCLC)
161
What are the different types of NSCLC?
1. Adenocarcinoma
2. Squamous
3. Large cell
4. alveolar cell carcinoma
5. bronchial adenoma
162
What are the features of lung cancer?
1. Persistent cough
2. haemoptysis
3. dyspnoea
4. chest pain
5. Weight loss
6. hoarseness
163
What the examination findings of lung cancer?
1. Fixed monophonic wheeze
2. supraclavicular lympadenopathy or persistent cervical lympadenopathy
3. Clubbing
164
What is the investigation used for definitive diagnosis for lung cancer?
Biopsy guided by CT or bronchoscopy
165
What is the first line investigation when suspecting lung cancer?
CXR
| - can give false negative
166
What is the referral criteria for 2WW pathway for lung cancer?
1. CXR suggest lung cancer
| 2. > 40 y/o + unexplained haemoptysis
167
What is the criteria to offer urgent CXR to assess lung cancer?
> 40 y/o + 2 or more of:
- cough
- fatigue
- SOB
- Chest pain
- weight loss
- appetite loss
- smoker
168
What are the electrolyte disturbances caused by small cell lung cancer?
1. ADH --> Hyponatraemia
| 2. Secretes ACTH --> Cushing's
169
What are the features of squamous?
- PTH --> hypercalcaemia
| - clubbing
170
Which type of lung cancer may secrete beta-hCG?
Large cell carcinoma
171
What are the common site for metastases from lung cancer?
- Brain
- Bone
- Abdo (Liver)
- Prostate
- Adrenal
- Kidneys
172
What investigation is carried out metastatic tumours?
PET Scan
173
What is carcinoid tumour?
Slow-growing tumour that originate in cells of the diffuse neuroendocrine system
174
What is carcinoid syndrome?
- Usually occurs when metastases are present in the liver + release serotonin into circulation
175
What symptoms does carcinoid tumour cause?
Entire body involvement:
- Flushin
- diarhhoea
- bronchospasm
- hypotension
- valvular stenosis (right)
176
What are lung nodules?
Circular/round structures on CXR/CT <3cm
177
What can cause lung nodules?
- Benign tumours
- lung infection
- scars from previous infection
- cancer
- Autoimmune disorder
178
What is
| Idiopathic pulmonary fibrosis?
Chronic lung condition characterised by progressive fibrosis of the interstitium of the lungs.
179
What are the features of Idiopathic pulmonary fibrosis?
1. progressive exertional dyspnoea
2. bibasal fine end-inspiratory crepitations on auscultation
3. dry cough
4. clubbing
180
What investigation is used for diagnosis of Idiopathic pulmonary fibrosis?
High - resolution CT scan
181
What is the CXR finding for Idiopathic pulmonary fibrosis?
bilateral interstitial shadowing - typically small, irregular, peripheral opacities -
- 'ground-glass'
- later progressing to 'honeycombing'
182
What is Pneumoconiosis?
Accumulation of dust in the lungs
- and response of the bodily tissue to its presence
AKA - Black lung disease
183
What is the CXR finding for pneumoconiosis?
- Upper zone fibrosis
184
What are the symptoms of pneumoconiosis?
- SOBOE
| - Cough (black sputum)
185
What are the examination findings for pneumoconiosis?
- Normal chest exam
| - crackles OA
186
What is Sarcoidosis?
Multisystem disorder of unknown aetiology characterised by non-caseating granulomas
--> Small patches of red and swollen tissues
187
What are the features of Sarcoidosis?
- SOB
- Dry cough
Acute:
- eythema nodosum
- bilateral hilar lymphadenopathy
- swinging fever
- polyarthralgia
- Hypercalcaemia
188
How is Sarcoidosis diagnosed?
- No diagnostic test, largely clinical
189
Obstructive picture of spirometry?
Reduced FEV1 (<80% of predicted normal)
Reduced FVC (less than the FEV1 drop)
FEV1/FVC ratio <0.7
190
Restrictive picture of Spirometry?
Reduced FEV1 (<80%)
Reduced FVC (<80%)
Normal FEV1/FVC (>70%)
ICM Matrix
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