Yr 6 PACES knowledge > Resp > Flashcards

Resp Flashcards

(37 cards)

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1
Q

Evidence of specific cause of Pulmonary fibrosis

A
  • RA: Boutonnières, swan neck, nodules
  • Systemic sclerosis: sclerodactyly, telangiectasia, microstomia
  • SLE: malar rash, discoid rash
  • Sarcoidosis: erythema nodosum
  • Radiation: tattoos on chest
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2
Q

Causes of pulmonary fibrosis

A
  • Idiopathic
  • Rheumatology - RA, SLE, SS, Sjrogren’s
  • Sarcoidosis
  • EAA: moulds, avian proteins
  • Occupational exposure: coal, asbestos, silica
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3
Q

3 drugs which cause pulmonary fibrosis

A

Methotrexate
Amiodarone
Bleomycin

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4
Q

3 bedside tests for suspected pulmonary fibrosis

A

PEFR
Spirometry
ECG (RV hypertrophy)

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5
Q

Bloods for suspected pulmonary fibrosis

A 
FBC 
ABG
ESR, CRP
ANA (in IPF)
RhF and antiCCP (in RA)
ACE and Ca (in sarcoid)
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6
Q

Mx of pulmonary fibrosis

A

Conservative: smoking cessation, pulmonary rehabilitation

Medical: steroids for EAA, sarcoid, CTDs

Surgical: lung transplant

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7
Q

Signs of pneumonectomy/lobectomy

A

Tracheal shift towards abnormal side

  • Reduced expansion
  • Dull percussion
  • No BS
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8
Q

Differentials for an oblique scar on lateral/posterior chest wall

A
  • Lobectomy
  • Pneumonectomy
  • Thoracotomy: biopsy, empyema, abscess
  • Transplant
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9
Q

Indications for lobectomy/pneumonectomy

A

90% bronchogenic carcinoma

  • Bronchiectasis
  • COPD: lung reduction surgery
  • TB: historic, upper lobe
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10
Q

Pathology classification of lung cancer

A

NSCLC and SCLC

SQCC: bronchogenic, smoking, PTHrP + hypercalcemia

ADENOCARCINOMA: peripheral, late presentation (mets), non-smokers + women

SCLC: poor prognosis, late presentation, smokers

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11
Q

Complications of lung cancer

A

Local:

  • Brachial plexus –> Horner’s syndrome
  • SVCO
  • Recurrent laryng nerve
  • Phrenic nerve

Paraneoplastic:

  • PTHrP –> Ca
  • SIADH –> hyponatremia
  • ACTH –> Cushings

Derm: acanthuses nigricans

Mets:

  • Bone pain
  • Liver failure
  • Confusion, fits, focal neurology
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12
Q

Ix in lung cancer

A

Bloods: FBC, U+Es (Na), LFTs (mets), bone profile (PTH, Ca)

Imaging:
CXR
Volumetric CT
PET scan - mets

Histology: percutaneous FNA or transbronchial biopsy

Thoracoscopy + LN sampling

Pulmonary function tests (assess fitness for surgery)

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13
Q

Mx of lung cancer

A

Conservative:
Smoking cessation
Pulmonary rehabilitation
PTOT

Medical:
Chemotherapy + radiotherapy

Surgical:
If no metastatic spread!

Palliative care:

  • Analgesia
  • Radiotherapy - for haemoptysis, bone or CNS mets
  • If persistent effusions - pleurodesis
  • SVCO: radiotherapy + IV dexamethasone
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14
Q

Old management of TB

A
  • Thoracoplasty (rib removal)
  • Plombage (polystyrene balls in thoracic cavity)
  • Phrenic nerve crush (diaphragm weakness)
  • Apical lobectom
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15
Q

Current Mx of TB - what MUST be done before starting treatment

A

RIPE for 2 months
then RI for a further 4 months
- coadminster pyridoxine w isoniazid

  • LFTs + visual acuity + colour vision testing
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16
Q

Side effects of TB treatment

Study These Flashcards
A

Rifampicin: orange urine, cyp450 induction
Isoniazid: Peripheral neuropathy
Pyrazinamide: hepatitis
Ethambutol: optic neuritis!! (loss of colour)

17
Q

Features of latent TB

Study These Flashcards
A

Pt is infected but no clinical Sx or CXR features

- Non infectious!

18
Q

Pathophysiology of primary TB infection

Study These Flashcards
A

TB grows in pleura = Ghon focus
TB spreads to LNs:
Lung lesion + LNs = Ghon complex

Most people’s immune system controls the infection: fibrosis of Ghon focus –> calcified nodule

19
Q

Diagnosis of latent vs active TB

Study These Flashcards
A

Latent: tuberculin skin test, if +ve do IGRA

Active: CXR + 3 sputum samples.

  • Culture in Lowenstein Jensen media = GOLD STANDARD
  • Microscopy w Ziehl-Neelsen stain
20
Q

What is the initial screening test for latent TB? what are the cons of this?

Study These Flashcards
A

Tuberculin skin test: inject purified protein + observe induration @ 48-72hours

tests +ve if BCG, other mycobacteria :(
also tests -ve if HIV, sarcoid, lymphoma :(

21
Q

Causes of a cavitating lung lesion

Study These Flashcards
A

Infection: TB, Staph, Klebsiella
Rheumatoid nodules
Malignancy: SqCC

22
Q

pulmonary fibrosis - upper lobe causes?

Lower lobe causes?

Study These Flashcards
A 
Upper:
Aspergillus
Coal, silica
EAA - bird fanciers lung
TB

Lower:
Sarcoidosis
Toxins (methotrexate, bleomycin, amiodarone)
Asbestosis
Idiopathic
Rheum: SLE, SS, RA
Silicosis
23
Q

Drugs which cause pulmonary fibrosis

Study These Flashcards
A

Bleomycin
Amiodarone
Nitrofurantoin
Methotrexate

24
Q

Findings O/E of bronchiectasis

DDx

Study These Flashcards
A

Clubbing
Dull percussion note
Bilateral coarse crackles - may CHANGE W COUGH

Ddx: CHF, Bilateral pleural effusion

25
Define bronchiectasis
Permanent dilated bronchi secondary to damage of elastic + muscular layers of bronchial wall
26
Causes of bronchiectasis
- Congenital: CF, Kartageners - Infectious: TB, pertussis - Associated: RA, UC, ABPA - OBSTRUCTION = cancer #1 cause = severe childhood LRTI (due to immunodeficiency)
27
Ix in ?bronchiectasis
Sputum MC+S + cytology Bloods: FBC, CRP, autoantibdoes, aspergillus CXR: tram track opacifications, ring lesions CT chest: signet ring (thickens bronchus = adjacent vascular bundle) SPIROMETRY = OBSTRUCTIVE
28
Mx of bronchiectasis
Conservative: Smoking cessation Pulmonary rehab Chest physio Medical: ?prophylactic abx against pseudomonas Vaccine = pneumococcal, flu Salbutamol inhaler Surgical: transplant
29
Stoma + bilateral coarse crackles
probs UC w bronchiectasis
30
COPD - findings O/E
``` Hands: salbutamol tremor CO2 flap Chest: Barrel chest Accessory muscle breathing Cachectic Hyper resonant PN Reduced expansion Auscultation...? ```
31
Ix for ?COPD
``` PEFR Spirometry Basic Obs Sputum MC+S Bloods: FBC, ABG, CRP CXR ECG ```
32
Medical Mx of COPD
Depends on severity - SABA PRN - LAMA or LABA - LABA + LAMA - LABA + ICS + LAMA - theophylline home O2
33
Mx of COPD exacerbation
``` Airway: patent? Breathing: oxygen via venturi mask ABG CXR Circulation: bloods (FBC, CRP, U+Es, LFTs, glucose, BCs if pyrexial), give maintenance fluids ```
34
Mx of COPD exacerbation
``` Airway: patent? Breathing: oxygen via venturi mask ABG CXR Circulation: bloods (FBC, CRP, U+Es, LFTs, glucose, BCs if pyrexial), give maintenance fluids ``` Salbutamol + ipatropium nebs Oral pred +/- IV hydrocortisone If no response --> NIV
35
Useful drug for smoking cessation
Varenicicline
36
Pneumothorax mx (no underlying lung disease)
>2cm/SOB --> aspiration | no SOB and <2cm --> 10L O2 and observe
37
pneumothorax mx in >50yo or underlying lung disease
SOB>2cm --> chest drain 1-2cm --> aspirate <1cm --> 10L O2 + admit 24 hours
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