1
Q
Is asthma a restrictive or obstructive disease?
A
Obstructive
2
Q
What is asthma?
A
Chronic inflammatory dx leading to airway obstruction
3
Q
Basic pathophysiology of asthma?
A
Smooth muscle in airways is hypersensitive > responds to stimuli > bronchoconstriction > airflow obstruction
4
Q
Which conditions is asthma associated with?
A
Atopic conditions:
Eczema
Hayfever
Food allergies
5
Q
Presentation of asthma?
A
SOB
Chest tightness
Dry cough
Wheeze
Symptoms worse at night
Symptoms improve with bronchodilators
6
Q
What type of wheeze is heard in a ‘well’ asthmatic patient?
A
Widespread polyphonic expiratory wheeze
7
Q
What are some triggers for asthma?
A
Infection
Nighttime or early morning
Exercise
Animals
Cold/damp/dusty air
Strong emotions
8
Q
Which drugs are generally contraindicated in asthma?
A
Beta-blockers
NSAIDs (ibuprofen/naproxen)
9
Q
What are the first-line investigations in asthma and when are they diagnostic without further investigation? (ADULTS)
A
Eosinophil count - above reference range
OR
Fractional exhaled nitric oxide (FeNO) - ≥ 50 ppb
10
Q
If first-line investigations are not diagnostic of asthma, which further investigations should be considered? (ADULTS)
A
Bronchodilator reversibility (BDR) with spirometry
OR
Peak expiratory flow (PEF) twice daily for 2 weeks (if BDR not available/delayed)
11
Q
When does BDR with spirometry diagnose asthma? (ADULTS)
A
FEV1 increase ≥ 12%
OR
FEV1 increase ≥ 10% of the predicted normal FEV1
12
Q
When does PEF monitoring diagnose asthma? (ADULTS)
A
PEF variability is ≥ 20%
13
Q
If asthma is not confirmed by eosinophil/FeNO/BDR or PEF
but is still suspected, which investigation should be considered? (ADULTS)
A
Bronchial challenge test
14
Q
What is a bronchial challenge test?
A
Inhaled histamine is used to stimulate bronchoconstriction
15
Q
What type of hypersensitvity occurs in asthma?
A
Type 1 IgE mediated
16
Q
What is the order of investigations for children with suspected asthma aged 5-16?
A
Fractional exhaled nitric oxide (FeNO)
BDR with spirometry
PEF variability (2 weeks)
Skin prick test or total IgE + blood
eosinophils
17
Q
What FeNO level is diagnostic of asthma in children 5-16?
A
> 35ppb
18
Q
What are the steps in asthma management in adults?
A
Low dose ICS+LABA when required
Low dose MART (ICS+LABA) regularly
Moderate dose MART (ICS+LABA) regularly
Check FeNO + blood eosinophils (if raised > asthma specialist)
Trial additional LTRA and/or LAMA
19
Q
Examples of LABAs?
A
Formoterol
Salmeterol
20
Q
Examples of LTRA?
A
Montelukast
21
Q
Examples of ICS?
A
Budesonide
Fluticasone
Mometasone
22
Q
What lifestyle factors are involved in asthma management?
A
Yearly flu jab
Yearly asthma review when stable
Regular exercise
Avoid smoking (including passive smoke)
Avoiding triggers where appropriate
Weight loss
23
Q
Examples of LAMA?
A
Tiotropium
Glycopyrronium
Ipratropium
24
Q
Features of an acute asthma attack?
A
Progressive SOB
Accessory muscle use
Tachypnoea
Wheeze
↑ Cough
Tight chest - reduced air entry (on ausc)
25
Features of a **moderate** asthma attack?
Peak flow **50 – 75%** best or predicted
26
Features of a **severe** asthma attack?
RR >25
HR >110
Peak flow **33-50%** best or predicted
Unable to complete sentences
27
Features of a **life-threatening** asthma attack?
PO2 <8
'Normal' PCO2
Peak flow **less than 33%**
Silent chest
↓HR and BP
Exhaustion/confusion
Cyanosis
28
Management of acute asthma attack? (ADULTS)
O2 via non-rebreathe mask
5mg salbutamol nebulised
0.5mg ipratropium nebulised
40-50mg PO prednisolone/IV hydrocortisone
+ MgSO4 IV (after senior review)
29
What are typical spirometry results in asthma?
FEV1/FVC <0.7
FVC often preserved
30
What should be prescribed following and acute asthma attack?
40-50mg prednisolone PO for minimum of 5 days in adults
31
If patients have had a previous near-fatal asthma attack, what should their management plan be, regardless of severity?
Patients should be **admitted to hospital** in the presence of a previous near-fatal attack
32
What are PaO2 and PaCO2 results in **type 1** respiratory failure?
↓ O2
Normal/low CO2
33
What are PaO2 and PaCO2 results in **type 2** respiratory failure?
↓ O2
↑ CO2
34
How does type 1 respiratory failure present?
Hypoxia:
Tachypnoea
Dyspnoea
Tachycardia
Confusion
Cyanosis
35
How does type 2 respiratory failure present - due to specific ABG finding (5)?
Hypercapnia:
Headache
Altered behaviour
Coma
Papilloedema
Warm extremities
36
What are some causes of **type 1** respiratory failure?
V/Q mismatch (failed oxygenation of blood)
Pulmonary oedema (poor vent)
Pneumonia (poor vent)
Asthma (poor vent)
Pulmonary embolism (poor perfusion)
37
What are some causes of **type 2** respiratory failure?
Insufficient alveolar ventilation
COPD (↑ airway resistance)
Chest deformities (↑ airway resistance)
Obesity (↑ airway resistance)
Neuromuscular (↓RR)
Sedatives (↓RR)
Exhaustion (↓RR)
38
Management of **type 1** respiratory failure?
High flow O2
If not effective consider:
CPAP (NIV)
Sedation and intubation
39
Management of **type 2** respiratory failure?
Controlled flow O2 (venturi) and treat underlying cause
If not effective consider:
BiPAP (NIV)
Sedation and intubation
40
Overdose of which drug can cause respiratory alkalosis?
Aspirin overdose - activates brains resp centres
41
What qualifies an asthma attack as 'near-fatal'?
Raised PaCO₂
+/- Requiring mechanical ventilation with raised inflation pressures
42
Examples of obstructive lung disease (4)?
Asthma
COPD
Emphysema
Bronchiectasis
43
Features of obstructive lung disease?
Normal lung capacity
↓ ability to inspire/expire
44
FEV1/FVC findings in obstructive lung disease?
FEV1 = decrease <80%
FVC = normal/slightly decreased
FEV1/FVC = <0.7
45
Examples of restrictive lung disease (6)?
Pulmonary fibrosis
Pulmonary oedema
Obesity/pregnancy
Lobectomy
Nueromuscular abnormalities
Skeletal abnormalities
46
Features of restrictive lung disease?
↓ Lung capacity
Normal ability to inspire/expire
47
FEV1/FVC findings in restrictive lung disease?
FEV1 = decreased <80%
FVC = decreased <80%
FEV1/FVC = >0.7
48
What is a pneumothorax?
Air in the pleural space causing lung collapse
49
What are possible causes of pneumothorax?
Spontaneous (primary or secondary to lung disease)
Iatrogenic - mechanical ventilation, bronchoscopy, CVC
Traumatic - blunt trauma, penetrating wound
50
Who is the classic presenting spontaneous pneumothorax patient?
Male, 20-30y/o, tall and slim
(Marfan's)
51
Which diseases may cause a secondary spontaneous pneumothorax?
TB
Pneumonia
COPD
Emphysema
CF
52
What is a tension pneumothorax?
Severe pneumothorax leading to:
Displacement of mediastinal structures
Haemodynamic compromise
53
Presentation of pneumothorax?
**May be asymptomatic**
Sudden onset breathlessness
Unilateral pleuritic pain
↓ breath sounds and expansion
Hyper-resonance
54
Which findings differentiate a tension pneumothorax?
Tracheal deviation
Severe resp. distress
Shock
55
When can a pneumothorax be managed conservatively and what is management?
If no/minimal symptoms
If <2cm
Primary spontaneous (PSP) = regular r/v as outpatient every 2-4 days
Secondary spontaneous (SSP) = review as inpatient
56
Investigations for pneumothorax?
CXR
ABG
CT
57
Treatment options for simple pneumothorax?
Ambulatory - one way vent device and r/v as outpatient every 2-3 days (remove when resolved)
Needle aspiration
Chest drain (if needed)
58
When is chest drain used for pneumothorax?
If needle aspiration unsuccessful in resolution
Tension pneumothorax
OR
High risk characteristics
59
Which high risk characteristics indicate a chest drain in pneumothoax (5)?
Haemodynamic compromise (tension pneumothorax)
Significant hypoxia
Bilateral pneumothorax
Haemopneumothorax
>50 years with significant smoking history
60
Where is cannula inserted for needle aspiration of pneumothorax?
2nd intercostal space, mid-clavicular line
61
Where is the insertion space for a chest drain and what are its borders?
Triangle of safety
5th intercostal space, midaxillary line
Borders = posterior edge of pec major, anterior edge of lat. dorsi
62
What to do if chest drain not sufficient in pneumothorax?
Suction
63
When is surgery indicated for pneumothorax?
Pleurectomy
If not resolving despite chest drain and suction OR
Recurrent pneumothorax
64
What must patients not do following pneumothorax?
No flying until 1 week post CXR
No scuba diving for life (unless surgery)
65
How can you tell a chest drain is working?
Swinging water level
Up = inspiration
Down = expiration
Bubbling = air leaving pleural cavity
66
When can a chest drain be remove in pneumothorax tx?
When no more bubbling
Including on coughing
67
Treatment of tension pneumothorax?
Immediate needle decompression
Followed by chest drain
(in triangle of safety)
68
In tension pneumothorax, which side does the mediastinum deviate to?
To the **opposite** side of the pneumothorax
69
What is acute bronchitis?
Inflammation of the trachea and major bronchi
70
Presentation of acute bronchitis?
Cough +/- productive
Sore throat
Wheeze
Examination - no focal chest signs other than polyphonic wheeze
71
Management of acute bronchitis?
Analgesia
Good fluid intake
Abx if indicated
72
Investigation to establish if acute bronchitis requires antibiotics?
CRP
73
What is first-line antibiotics for acute bronchitis?
Doxycycline
74
Risk factors for COPD?
Smoking
Occupational dust
Childhood infections
Alpha-1 antitrypsin deficiency
75
How does chronic bronchitis cause obstructive lung disease?
↑ Mucus + inflammation = scarred/thicken epithelium = ↑airway resistance
76
How does emphysema cause obstructive lung disease?
↑Protease destroys aleveoli = ↓ elasticity and recoil = enlarged air spaces
77
What may be seen on CXR in COPD?
Hyperinflation
Bullae
Flat hemidiaphragm
78
Which FEV1 (of predicted) correspond to severity of COPD (4)?
>80% - Stage 1 Mild
50-79% - Stage 2 Moderate
30-49% - Stage 3 Severe
<30% - Stage 4 Very severe
79
Presenting features of COPD?
Cough (if productive white/clear sputum)
Dyspnoea
Wheeze
Frequent LRTI
80
What signs may be found on examination of patient with COPD?
↑RR
Flapping tremor
Cyanosis
Barrel chest
Reduced chest expansion
Polyphonic expiratory wheeze
Hyperresonance
81
What is the criteria for diagnosing COPD (3)?
Gold criteria:
FEV1 <80%
FEV1:FVC <0.7
No improvement with bronchodilators
82
What can be prescribed to help with chronic cough in COPD?
Mucolytics - carbocisteine
83
What is non-medical management of COPD?
Smoking cessation
Flu + pneumococcal vaccine
Pulmonary rehab
Optimise weight
84
What is medical management of COPD?
1st line = SABA/SAMA (salbutamol/ipratropium)
2nd line = LABA + LAMA
IF asthmatic features - LABA + ICS
85
What features in COPD are suggestive of asthma as well?
Previous asthma/atopy
↑Eosinophils
FEV1 variation
86
Management of COPD acute exacerbation?
Nebulised SABA + SAMA
Oral corticosteroids (30mg pred 5/7)
Oxygen
Abx if indicated (doxycycline)
87
Signs of exacerbation in COPD?
↑Sputum or purulent
↑SOB
↑Wheeze
88
What can be used in COPD for those who cannot tolerate inhaled therapy?
Theophylline
89
What is the prophylactic antibiotic of choice in COPD patients who meet criteria?
Azithromycin
90
What are the most common infective causes of COPD exacerbation?
Haemophilus influenzae
Strp. pneumoniae
Moraxella catarrhalis
91
What is interstitial lung disease (ILD)?
Inflammation of lung parenchyma
92
What are presenting features of ILD (6)?
SOBOE
Dry cough
Fatigue
Fine end-inspiratory crackles
Finger clubbing
↓Chest expansion
93
How is ILD diagnosed?
CXR + HRCT scan
Ground glass appearance
Spirometry - restrictive pattern
94
Management of ILD (6)?
Remove/treat underlying cause
Stop smoking
O2 therapy if persistent hypoxia
Physio/rehab
Pneumococcal + flu vaccine
Lung transplant (65y cut off)
95
What are risk factors for ILD (5)?
Occupation - asbestos, silicone, coal dust
Drugs - nitrofurantoin, amiodarone, MTX
Hypersensitivity - extrinsic allergic alveolitis
Infx - TB, fungal, covid, viral
GORD
96
What can be prescribed in idiopathic pulmonary fibrosis?
Antifibrotics - slow disease progression
97
Which occupational exposures may lead to hypersensitivity pneumonitis (extrinsic allergic alveolitis)?
Farmers lung - aspergillus (fungal spores)
Bird-fanciers lung - avian protein (bird droppings)
98
What causes transudative pleural effusions?
Transudate - PRESSURE
CCF
Liver cirrhosis
Nephrotic syndrome
99
What causes exudative pleural effusions (4)?
Exudate - INFLAMMATION (+ increased capillary permeability)
Malignancy
Infection
Trauma
PE
100
What is the protein criteria for transudate/exudate?
Transudate = <30g/L
Exudate = >30g/L
101
What is the difference between CAP and HAP?
CAP - acquired in community
HAP - >48hrs after admission or within 10d discharge
102
Common HAP organisms (4)?
Gram -ve's:
Klebisella
E coli
Pseudomonas
MRSA
103
Common CAP organisms?
Strep. pneumoniae
H. influenzae
Viral causes (RSV/Covid/influenza)
104
Clinical presentation of pneumonia?
Fever/rigors/malaise
Productive cough
Dyspnoea
Pleuritic chest pain
105
Examination findings in pneumonia?
↑RR ↑HR ↑Temp
↓ O2 sats/cyanosis
Reduced breath sounds
Bronchial breathing
Coarse crackles
Dull percussion
Pleural rub
106
Investigations in suspected pneumonia?
CXR - diagnostic (consolidation)
FBC, U&E, CRP, LFT, glucose
ABG
Sputum +/- blood cultures
Throat swab
107
Risk factors for pneumonia (5)?
Immunocompromised
Hospitalisation
Chronic lung disease
Elderly/young
Alcoholic/smoker/IVDU
108
What is CURB-65 score and what is included?
Risk stratification for CAP
C = confusion
U = urea >7mmol/L
R = resp rate >30
B = SBP <90 or DBP <60
65 = >65yrs
109
What are the NICE recommendations for different CURB65 scores?
0-1 = home based care
2+ hospital treatment
3+ = consider ICU
110
Management of pneumonia - other than antibiotics?
Analgesia
O2
Antipyretics
IV fluids
Chest physio
111
What should be repeated following resolution of pneumonia?
CXR at 6 weeks
(Ensure resolution and no underlying pathology)
112
First-line antibiotics for CAP?
Mild: Amoxicillin or doxycycline (5d PO)
Mod: Amox/Dox + clarithromycin (7d PO)
Severe: Co-amox + clarithromycin (10d IV)
113
First-line antibiotics for HAP?
Mild: Doxycycine (5d PO)
Severe: Co-trimoxazole (5-7d IV)
114
Management of aspiration pneumonia?
Amoxicillin + metronidazole 5-7d IV
115
Which diseases commonly affect the upper lobes of the lung?
Tuberculosis
Silicosis
CF
Sarcoidosis
116
Which diseases commonly affect the lower lobes of the lung?
Asbestosis
Aspiration pneumonia
Pulmonary oedema
Idiopathic pulmonary fibrosis
117
What causes obstructive sleep apnoea (OSA)
Collapse of the pharyngeal airway
118
What are some risk factors for OSA (6)?
Obesity
Male
Alcohol
Large tonsils
Macroglossia
Marfan's syndrome
119
What are some presenting features of OSA?
Episodes of apnoea during sleep (via partner)
Snoring
Morning headache
Waking unrefreshed from sleep
Daytime sleepiness
120
What can OSA result in?
Respiratory acidosis (compensated)
Hypertension
121
How is OSA sleepiness assessed?
Epworth sleepiness scale
122
What are the diagnostic tests for OSA?
Sleep studies
123
Management of OSA?
Weight loss/↓Alcohol/Stop smoking
Intra-oral devices (mandibular advancement)
CPAP for moderate-severe
124
What are some presenting features of PE?
Chest pain
Dyspnoea
Haemoptysis
Tachypnoea
Tachycardia
May have signs of DVT
125
Risk factors for PE (8)?
Immobility
Recent travel
Long-haul flights
Pregnancy
Hormone therapy (oestrogen)
Malignancy
Polycythaemia
SLE
126
What is PERC in relation to PE?
Pulmonary embolism rule-out criteria
If all criteria absent - no further ix
127
Which score assesses the probability of PE?
Wells' score
128
What are some of the criteria included in wells score for PE (6)?
Clinical signs and sx of DVT
HR >100
Immobilisation for 3+ days or surgery in last 4 weeks
Prev DVT/PE
Haemoptysis
Malignancy
129
Wells' scoring correlating to probability of PE?
PE likely = >4
PE unlikely = 4 or less
130
Next investigations depending on Wells score for PE?
>4 = Immediate CTPA
4 or less = D-dimer test (if positive > CTPA)
131
Aside from DVT/PE, when else can D-dimer be raised (5)?
Pneumonia
Malignancy
Heart failure
Surgery
Pregnancy
132
When is VQ scan preferred over CTPA (2)?
Renal impairment
Contrast allergy
133
What ECG changes may be seen in PE?
**Sinus tachy** - most common
S1Q2T3
134
Management of PE?
Anticoagulation
O2
Analgesia
135
Anticoagulant choice in PE?
DOAC
Apixaban or rivaroxaban
136
What should be used 2nd line for PE and when is this indicated?
LMWH or warfarin
if eGFR <15mL/min
Antiphospholipid syndrome
137
How long should patients be on anticoagulants following PE?
Provoked = 3 months
Unprovoked = 6 months
Cancer treatment = 3-6 months
138
What is target INR when warfarin is used for PE?
2-3
139
How is PE with haemodynamic instability (massive PE) managed?
Thrombolysis
140
What is tuberculosis?
Infection causes by mycobacterium tuberculosis
141
How is TB cultured and what does it look like?
Acid-fast bacilli (rod shaped)
Using Ziehl-Neelsen
142
How is TB transmitted?
Airborne spread
143
What is a Ghon focus?
Lung lesion caused by TB
144
What is a Ghon complex?
Ghon focus + hilar lymphadenopathy
145
Risk factors for TB?
Living in South Asia, Latin America, Subsaharan African
Exposure
Immunocompromised
146
Presentation of TB?
Cough
Night sweat
Weight loss
Pyrexia
Haemoptysis
Lymphadenopathy
147
Investigations in suspected TB?
Cultures
CXR
NAAT
148
Management of active TB?
RIPE for 2 months
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Then rifampicin and isoniazid for 4 more months
149
What drug should be given alongside TB treatment?
Pyroxidine (vit B6)
150
Side effects of treatment for TB?
Rifampicin = red urine
Isoniazid = peripheral neuropathy (give pyroxidien)
Pyrazinamide = hyperuricaemia (gout)
Ethambutol = optic neuritis
RIP associated with hepatotoxicity
151
Risk factors for sarcoidosis (5)?
20-40 y/o
Women
Black ethnicity
Scandinavian ethnicity
Fhx
152
What are some presenting features of sarcoidosis?
Lymphadenopathy
Cough
Dyspnoea/Wheeze
Fever
Weight loss
Fatigue
Uveitis/conjunctivitis
Liver nodules
Heart block
Erythema nodosum
Lupus pernio
153
Investigations for suspcted sarcoidosis?
Bloods - raised Ca2+, leucopenia, deranged U&E/LFT
CXR - hilar lymphadenopathy
Skin biopsies
Pylmonary function tests
ECG
24hr calcium - hypercalciuria
154
Management of sarcoidosis?
Mild/asymptomatic = conservative
1st line = PO steroids 6-24 months
2nd line = Methotrexate
155
Prognosis of sarcoidosis?
Resolves spontaneously in 50% patients
156
What are some of the lung conditions related to asbestos?
Pleural plaques (benign)
Pleural thickening
Asbestosis (fibrosis)
Mesothelioma (malignant)
157
Symptoms of asbestosis (4)?
Symptoms of interstitial lung disease:
SOB
Dry cough
Clubbing
Fine insp. crackles
158
What is mesothelioma?
Malignancy of the pleura linked to asbestos exposure
159
Exposure to what can cause pneumoconiosis?
Silicia
Cotton
Coal
Asbestos
160
Common causes of occupational asthma?
Flour (bakeries)
Animal fur
Farms
Bleach (hair salons)
Wood dust
Car paint sprays
161
What are the two broad categories of lung cancer?
Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC) - adenocarcinoma, squamous, large cell
Mesothelioma (pleura)
162
What are some presenting features of lung cancer?
SOB
Cough
Haemoptysis
Weight loss
Lymphadenopathy
Recurrent pneumonias
Finger clubbing
163
What are features specifically of small cell lung cancer and what hormones may be involved?
Paraneoplastic syndromes due to release of:
ADH (SIADH)
ACTH (Cushing's)
164
Which type of lung cancer most commonly causes a hoarse voice and why?
Pancoast tumour
Due to recurrent laryngeal nerve being pressed on
165
Which type of lung cancer may cause parathyroid hormone-related protein (PTH-rp) secretion and what does it cause?
Squamous cell
Causes hypercalcaemia
166
Which lung cancer is most commonly seen in non-smokers?
Adenocarcinoma
167
Which cancer most commonly causes Horner's syndrome, why, and what are the symptoms?
Pancoast tumour pressing on sympathetic ganglion
Ptosis
Anhidrosis
Miosis
168
Who should be referred on the 2ww pathway for suspected lung cancer?
CXR findings suggesting cancer
40+ w/ unexplained haemoptysis
169
Who should be offered an urgent CXR (not 2ww) with suspected lung cancer?
Non-smokers: 40+ years with 2 unexplained symptoms
Smokers: 40+ years with 1 unexplained symptom
170
Investigations for suspected lung cancer?
CXR
CT w/ contrast
Bronchoscopy
PET
171
Main management options for different lung cancer types?
NSCLC = surgery +/- radiotherapy +/- chemo
SCLC = Chemo + radioherapy
172
What are some possible causes of pulmonary hypertension (5)?
Left heart failure
Chronic lung disease
Idiopathic
Pulmonary vascular dx e.g. PE
Sarcoidosis
173
What are some signs/symptoms of pulmonary hypertension (4)?
SOB
Raised JVP
Hepatomegaly
Peripheral oedema
174
ECG changes which may be seen in pulmonary HTN (3)?
Due to right-heart strain
P pulmonale (peaked P waves)
Right axis deviation
RBBB
175
Management of idiopathic pulmonary hypertension (4)?
Phosphodiesterase-5 inhibitors e.g. sildenafil
CCBs
IV prostaglandins
Endothelin receptor antagonists
176
What bedside test can detect coronavirus?
PCR
177
Management of COVID-19?
Supportive
If severe:
Dexamethasone 7-10d
Antivirals (Remdesivir) 5-10d
If ITU = ventilate prone position
178
What may be seen on blood tests in a legionella infection?
Hyponatraemia
Deranged LFTs
179
What does an arterial blood gas with raised bicarbonate and normal pH usually represent?
COPD - chronically retaining CO2 which is being compensated
180
Which bacteria is commonly associated with a preceding influenza infection?
Staph. aureus
181
What is goodpasture's syndrome AKA?
Anti-glomerular basement membrane (GBM) disease
182
Where does anti-GBM attack?
Glomerulus
Pulmonary basement membranes
183
Clinical features of goodpasture's?
Pulmonary haemorrhage
Rapidly progressive glomerulonephritis
184
Investigations in suspected goodpasture's anti GBM?
Renal biopsy = IgG deposits
185
Management of goodpasture's disease (3)?
Plasma exchange
Steroids
Cyclophosphamide
186
Symptoms of Goodpasture's disease (4)?
Coughing up blood
SOB
Fatigue
Sx of kidney failure
187
Which organs are primarily affected in alpha-1 antitrypsin deficiency?
Lungs and liver
(emphysema and liver cirrhosis)
188
How may alpha-1 antitrypsin deficiency present?
Early-onset COPD/lung disease
Signs of liver disease
189
Investigations in suspected alpha-1 antitrypsin deficiency (5)?
Serum alpha-1 antitrypsin
Genetic testing
CXR
HRCT
Spirometry
190
What protein does alpha-1 antitrypsin deficiency affect?
Elastase
191
Management of alpha-1 antitrypsin deficiency?
No smoking
Supportive - SABA, physio
IV alpha-1 antitrypsin protein
Organ transplant
192
What type of hypersensitivty reaction is in hypersensitivity pneumonitis?
Type III and IV
193
Specific examples of hypersensitivity pneumonitis?
Bird-fancier's lung
Farmer's lung
Mushroom workers lung
Malt worker's lung
194
Acute and chronic presentation of hypersensitivity pneumonitis?
Acute:
Dyspnoea
Dry cough
Fever
Chronic:
Lethargy
Productive cough
Anorexia and weight loss
Sx improve when away from allergen e.g. holidays
195
Investigations for hypersensitivity pneumonitis (4)?
Imaging
Bronchoalveolar lavage
Serology (IgG)
Bloods - NO eosinophilia
196
What finding on bronchoalveolar lavage would be suggestive of hypersensitivity pneumonitis?
Lymphocytosis
197
Management of hypersensitivity pneumonitis?
Avoid precipitating factors
PO steroids
198
In smokers, carboxyhaemoglobin levels of up to what is considered normal?
10%
199
What features support the initiation of corticosteroids in sarcoidosis?
Parenchymal lung disease
Uveitis
Hypercalcaemia
Neurological/Cardiac involvement
200
Which patients should be offered LTOT?
pO2 <7.3 kPa
pO2 7.3-8 with one of:
Pulmonary HTN
Peripheral oedema
Secondary polycythaemia
201
O2 sats threshold for life-threatening acute asthma?
<92%
202
What can low glucose in pleural effusion analysis?
Empyema
203
Indications for a chest drain insertion (5)?
Pleural effusion
Pneumothorax
Empyema
Haemothorax
Haemopneumothorax
204
Contraindications for chest drain insertion (4)?
INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions
Finals revision
flashcards
Decks in class (29)
# Cards
-
Endocrine284
-
Neurology264
-
Cardiology255
-
Emergency medicine106
-
Pharmacology29
-
Hepatobiliary95
-
Renal87
-
Respiratory204
-
Haematology172
-
Gastroenterology219
-
Urology106
-
Paediatrics328
-
Geriatrics45
-
Dermatology98
-
Obs + Gynae248
-
ENT91
-
GP + Misc72
-
Infections100
-
Orthopaedics150
-
Ophthalmology90
-
Vascular surgery48
-
Rheumatology120
-
Psychiatry154
-
Breast30
-
Anaesthetics42
-
Radiology11
-
Oncology35
-
Sexual health29
-
Public health133
