resp Flashcards by Niamh Hearty

tram rack opacities or ring shadows on x-ray

bronchiectasis

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whats the gold standard test for bronchiectasis

High resolution CT

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What lung cancer secretes ATCH

small cell carcinoma- causing cushings

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What lung cancer secretes PTH

squamous cell carcinoma

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WHICH LUNG CANCER IS COMMON IN NON SMOKERS?

adenocarcinoma

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What lung cancer is associated with hypercalcemia and why?

squamous cell carcinoma due to the parathyroid secretion. can cause weakness dehydration and altered mental status

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histologicallly what type of lung cancer is assciated with desmosomes or keratin pearls?

squamous cell carcinoma

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most comon type of lung cancer?

adenocarcinoma

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which lung cancer is more likely to be peripheral

adenocarcinoma

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what lung cancer may produce mucin and has glands son histology?

adenocarcinoma

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clubbing, long bone swelling and arthritis

adenocarcinoma

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lung cancer associated with paraneoplastic syndromes

small cell lung cancer

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which lung cancer is the fastest growing?

small cell carcinoma- but also responsive to chemo

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what cells do small cell lung cancer arise from

APUD* cells
- A - Amine - High Amine Content
- PU - Precursor Uptake - High uptake of Amine Precursors
- D - Decarboxylase - High Content of Decarboxylase Enzymes

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conditions predominantly causing fibrosis of the upper lobes?

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

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Causes of Fibrosis predominately affecting the lower zones?

AIDS-
Asbestosis

Idiopathic pulmonary fibrosis

Drug-induced: amiodarone, bleomycin, methotrexate

Scleroderma- most connective tissue disorders (except ankylosing spondylitis) e.g. SLE

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what are the high risk characteristics for Pneumothorax that determine the need for a chest drain

HIS B.U.S.H.
H – Haemodynamic compromise (think tension PTX)
I – Insignificant oxygen? → Significant hypoxia
S – Smoker ≥ 50 years (age + smoking history)
B – Bilateral pneumothorax
U – Underlying lung disease
S – Smoker (reinforces the ≥50 & smoking risk)
H – Haemothorax

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what is the 4 criteria for acute respiratory syndrome?

acute onset
chest x ray or ct showing oedema in lungs
PF ratio of less than 300
resp distress not due to cardiac causes- like HF

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pneumonia in alcoholic organism?

Klebsiella

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pneumonia after influenza infection

Staphylococcus aureus

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exudative plural effusion causes

inflammation
lung cancer
pneumonia
Rheumatoid arthritis
SLE
TB
Pancreatitis
(protien >30)

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Transudative pleural effusion causes

heart failure
Hypoalbuminamia
hypothyroidism
Meigs syndrome (r. sided plural effusion, ovarian cancer, ascites)
(protein <30)

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what lung cancer is most common in non smokers?

adenocarcinoma

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Ground-glass appearance on X-ray

Pulmonary fibrosis and Respiratory Distress Syndrome of the newborn
Hypersensitivity Pneumonitis

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Chest infection with a parrot/pigeon as pet

chlamydophila psittaci

signet ring sign on CT

Bronchiole wider than neighbouring arteriole Bronchiectasis

Child with barking cough

Croup

pneumonia in HIV patients organism?

Pneumocystis pneumonia

treatment of pneumonia in patients with HIV

Co-tramoxazole [± prednisolone if severe]

Asthma + Nasal Polyps + Salicylate sensitivity

Samter’s Triad

Red Jelly sputum

Klebsiella Pneumoniae

Mucoid sputum

Chlamydia psittaci

ACTH secreting lung tumour

Small cell carcinoma of the lung

PTH secreting lung tumour

Squamous cell ca. of lung

Eggshell calcification at hilar region

Silicosis

Assmann Focus

Apical lesion of secondary tuberculous infection

Management of infective exacerbation of COPD

iSOAP i - ipratropium S - Salbutamol O - Oxygen A - amoxicillin P - prednisolone

what lung cancers are central

Squamous + Small-cell

what lung cancers are peripheral

adenocarcinomas

lung cancer in asbestos exposure?

adenocarcinoma

Farmer’s lung; major antigen

Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni) Hypersensitivity Pneumonitis

Hypersensitivity Pneumonitis-malt workers' lung organism?

Aspergillus clavatus

Hypersensitivity Pneumonitis-mushroom workers' lung organism?

thermophilic actinomycetes

what type of hypersensitivity happens in Extrinsic allergic alveolitis

type III hypersensitivity

what lung cancer can cause gyneocomastia.

adenocarcinoma- adeno where these boobs come from doc large cell- large boobies

Rifampin – side effect (TB Drug)

red-orange discoloration of urine and tears, rashes and hepatotoxicity.

Isoniazid side effect (TB Drug)

tingling, parasthesiae of the extremities

Pyrazinamide side effects (TB Drug)

joint pain, rash, allergic reaction, yellow skin or eyes, worsening gout

Ethambutol side effect (TB Drug)

change in vision, optic neuritis and red-green colour blindness.

farmer with sheep presents with fever, malaise, raised ALT or AST, atypical pneumonia endocarditis (culture-negative)

Q- Fever

questions referring to sewage workers, farmers, vets or people who work in an abattoir who has jaundice renal failure lung haemorrhage

Leptospirosis causing weils disease

what virus cause croup?

Parainfluenza

what organism causes Whooping cough

Bordetella pertussis

what causes Bronchiolitis

respiratory syncytial virus

type of atypical pneumonia that often affects younger patients and is asociated with erythema multiforme and cold autoimmune haemolytic anaemia

Mycoplasma pneumoniae

how is Mycoplasma pneumoniae diagnosed

cold agglutination- blood clumps in cold

treatment of Mycoplasma pneumoniae

organism doesn't have cell wall so- tetracylines or macrolides

The triangle of safety for chest drain insertion

base of the axilla, lateral edge pectoralis major, 5th intercostal space and the anterior border of latissimus dorsi

what antibiotic should be used for prophylaxis in COPD

Azithromycin

FEV1 really reduced- restrictive or obstructive?

obstructive

FCV reduced more than FEV1 obstructive or restrictive?

restrictive

normal FVC;FEV1 ratio?

restrictive

Reduced FVC;FEV1

Obstructive

lung + liver issues in young patient

Alpha-1 antitrypsin deficiency

Alpha-1 antitrypsin deficiency inheritance pattern?

autosomal co-dominant

what antibiotics should be used in acute exacerbation of COPD

amoxicillin or clarithromycin or doxycycline

name the SAMA

Ipratropium

what is Tiotropium

LAMA

Salmeterol, and Formoterol are what?

LABAs

what qualifies as a severe acute asthma attack

PEFR 33 - 50% Can't complete sentences RR > 25/min Pulse > 110 bpm

what qualifies as a life threatening acute asthma attack

PEFR < 33% best or predicted Oxygen sats < 92% 'Normal' pCO2 (4.6-6.0 kPa) Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma

what qualifies as a modetate acute asthma attack

PEFR 50-75% best or predicted Speech normal RR < 25 / min Pulse < 110 bpm

PEFR 50-75% best or predicted- what classification of acute exacerbation of asthma?

moderate

'Normal' pCO2 (4.6-6.0 kPa)- what classification of acute exacerbation of asthma?

life threatening

RR < 25 / min- what classification of acute exacerbation of asthma?

moderate

PEFR < 33% best or predicted-what classification of acute exacerbation of asthma?

life threatening

PEFR 33 - 50% - what classification of acute exacerbation of asthma?

severe

RR > 25/min- what classification of acute exacerbation of asthma?

severe

cant complete sentences-what classification of acute exacerbation of asthma?

severe

what is naer fatal acute asthma attack

raised PaCo2 >6

what dose of pregdisolone PO should be given in actute asthma attack

40-50mg for at least 5 days

how do you know if a copd patient is a chronic co2 retainer?

look at the HCO3 if its more than 28 they are

componenets of CURB-65 score?

Confusion Urea- >7 Respiratory rate > 30 Blood pressure systolic <= 90 mmHg and/or diastolic <= 60 mmHg Age- >65

CRB-65 of 1-2 what do you do?

consider hospital if hypoxic- if not can manage at home

CURB-65 3 or more

ICU

CURB-65 of 2

admit to ward

Management in primary pneumothorax without shortness of breath, and <2cm in size

conservative management

managemnt of pneumothorax >2cm + symptomatic + high-risk features

chest drain

what are the drug management options in idiopathic pulmonary fibrosis

Pirfenidone and nintedanib

what does Pirfenidone do?

its for isopathic pulmonary fibrosis. it works by reducing fibroblast proliferation and collagen synthesis- inhibiting transforming growth factor-beta (TGF-β),

what does nintedanib do?

It is a tyrosine kinase inhibitor used in idiopathic pulmonary fibrosis.

What type of pneumocytes secrete surfactant?

type 2

what is the tidal volume?

volume inspired or expired with each breath at rest 500ml in males, 350ml in females

what is the Inspiratory reserve volume (IRV)

maximum volume of air that can be inspired at the end of a normal tidal inspiration inspiratory capacity = TV + IRV

what is TV + IRV

inspiratory capacity

what is Expiratory reserve volume (ERV)

maximum volume of air that can be expired at the end of a normal tidal expiration

what lung volum is significantly reduced in obesity

Expiratory reserve volume (ERV) (increased abdominal fat mass pushes up against the diaphragm, reducing the volume of air that can be expelled)

what is Residual volume?

volume of air remaining after maximal expiration usually 1.2L and increases with age

what is Functional residual capacity (FRC)

the volume in the lungs at the end-expiratory position FRC = ERV + RV

what is the normal Vital capacity (VC) for males and females

4,500ml in males, 3,500 mls in females

inspiratory capacity + ERV= what?

Vital capacity

Bronchiectasis common organisms?

haemophilus unfluenza pseudomonas aeruginosa

Hypersensitivity Pneumonitis- Humidifier/air-con/ hot tub lung organism?

Mycobacterium avium complex (MAC)

Hypersensitivity Pneumonitis- Bird fanciers lung organism?

avian proteins from bird droppings

what antigens are involved in Hypersensitivity Pneumonitis?

IgA and IgG (type III hypersensitivity)

long standing cough + really foul smelling sputum?

Bronchiectasis

what eletrolyte abnormality can sarcoidosis cause?

hypercalcaemia- granulomas produce vitamin D

What are the boundaries of the 'safe triangle' for chest drain insertion?

Bounded by latissimus dorsi, pectoralis major, line superior to the nipple and apex at the axilla.

what bloods do you look at if you suspect sarcoidosis

Serum ACE levels Calcium both usually raised

Ventilated patients' pneumonia organism?

Pseudomonas aeruginosa

what must the FeNO be more than to diagnose asthma in children and adults?

Children: ≥ 35 ppb Adults: ≥ 50 ppb

cannonball metastases in the lung are a result of what?

Renal cell carcinoma can metastasise to the lungs, causing 'cannonball metastases'

which of the lung cancers are accoicated with Cavitating lesions

Cavitating lesions are more common with squamous cell than other types of lung cancer

What additional test may be conducted for Non-Small Cell Lung Cancer to determine eligibility for curative treatment?

PET Scanning with 18-Flurodeoxygenase

What paraneoplastic features can present with squamous cell carcinoma

1.Parathyroid Hormone-Related Protein Secretion → Hypercalcaemia 2. Hypertrophic Pulmonary Osteoarthropathy - proliferative periostitis of the bone 3. Ectopic TSH secretion → Hyperthyroidism

What may Large Cell Carcinomas secrete

Beta hCG

Which lung is more commonly impacted by Mesothelioma?

right

bronchiectasis and eosinophilia in exam question

Allergic bronchopulmonary aspergillosis

Contraindications to lung cancer surgery

SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, vocal cord paralysis

Low pO2, no CO2 retention

Type 1 respiratory failure

Low pO2, high pCO2

Type 2 respiratory failure

Tiotropium is a selective blocker of what muscarinic receptors?

In respiratory smooth muscle, what types of muscarinic AChRs mediate contraction.

M1 and M3

“Steeple” sign on X ray

laryngotracheobronchitis/croup

Asthma + Nasal Polyps + Salicylate sensitivity

Samter’s Triad Aspirin-Exacerbated Respiratory Disease/AERD)

Mucoid sputum

Chlamydia psittaci

Rusty sputum

Pneumococcal pneumonia

What is the mechanism of action of montelukast?

Leukotriene receptor antagonist

bronchiectasis + recurrent sinusitis + heart moved towards the right side

Kartagener's syndrome (also known as primary ciliary dyskinesia)

resp Flashcards

(129 cards)