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Respiratory

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happybee's version from 2017-05-07 10:22

Section 1

Question Answer
typical CAP organismsstrep pneumonia, Hib
severe CAP organismstaph, legionella
CURB 65confusion (amt<8), urea>7, rr >30, Bp <90/60
when to admit cap pxcurb 2
curb65 - 1 rx?home and doxycycline
curb65 - 2 rx?admit - doxy and penG
atypical CAP organisms (4)PJP, mycobacterium, chlamydia, legionella <lei M - Period- Leg yao si - Chlamsy>
2 groups more prone to atypical cap HIV and birds pet
one feature differentiate atypical from typicaldry cough
bibasal crackles, dry cough which CAP organismsPJP
unilateral on CXR- atypical or typicaltypical
rx for typical CAPdoxy
rx for atypical CAP macrolide
rx for legionella cap clarithromycin
birds --> which cap organismchlamydia
consolidation exam finding (4)bronchial breathing, dull percuss, increase vocal fremitus, reduce expansion
pneumonia is whihc type of resp failure 1
pneumococcus blood agar -- hemolysis?draughtsman - beta hemolytic
inv for pneumococcus that is not affected by abxurinary ag test
is PJP cultureable?no
legionella cap associated with which group of pplsmokers
outbreaks assoc with cooling towers, hotel showers which organism pneumonialegionella
memorize

Section 2

Question Answer
EGFR gene mutations associated with?adenocarcinoma
which body part is the most common site of metastatic tumorlung
most common type of lung canceradenocarcinoma
strongest assoc with smoking - which type lung casmall cell
most common ca in non smoker adenocarcinoma
no grade and no precursor - which typesmall cell
where is adenocarcinomaperipheral small airways
where is squamous cell calarge airways near hilum
where is small cell cacentral
central lesions (near hilum - squamous and small cell ca) - use what method of samplingbronchoscopy
adenocarcinoma (peripheral) use what to sample CT guided percutaneous biopsy / FNA
CT is good for TNM which one Tumor
PET for TNM which oneNodes and Mets
invasion of left recurrent laryngeal nerve --> which symptom of lung cahoarseness of voice
SVC obstruction due to tumor at whereright side lung tumor
symptoms of SVC obstruction head fullness, facial swelling, chest pain , dysphagia, hoarseness
emergency of SVC obstruction consequenceslaryngeal oedema, cerebral oedema, decrease CO
pancoast tumor @ where? involve which nerve?apex of lung involve cervical nerve and thoracic nerve
pancoast syndrome ?shoulder pain radiating the ulnar distribution
horner syndrome (4) miosis, anhidrosis, ptosis, endopthalmos
horner syndrome due to infiltration of wht nervesympathetic
lung ca metastasize to where?cns, bone, liver
ectopic ACTH manifestation increase cortisol , polyuria and thirst
typical paraneoplastic syndrome of small cell calambert eaton myasthenic syndrome
first indication of myasthenia graviseyelid droop
rx of small cell cano surgery use chemo
rx of non small cell casurgery
mesothelioma is a malignant tumor of where?the pleura
mesothelioma asso with what exposureasbestos
s&s with mesotheliomaSOB, chest pain
mesothelioma graded by?no grade too aggressive
prognosis of mesotheliomavery poor 18 months from dx
lung fibrosis = fibrosis of alveoli -- seen in what?asbestosis
asebestos causes what diseases?lung ca, mesothelioma,
presentation of asbestosisSOB gradually worsening
squamous cell ca path columnar --> smoke --> metaplasia->squamous -> dysplasia and Carcinoma in situ
muscle weaknees in px with lung ca why>lambert eaton myagravis syndrome
SIADH -> hypoNa presentationconfusion and irritable
memorize

Section 3

Question Answer
adr of Inhaled corticosteroid (2)oral candidiasis, hoarse voice
LABA can lead to electrolyte hypo-K
clinical feature to determine severity of acute asthma <CHEST> cyanosis, hypotension, exhaustion, silent chest, thirty 3 % of expected Peak flow
emergency rx of asthma <OSHIMT> oxygen >94, salbutamol, Hydrocortisone, iprotroprium, magnesium sulphate, theophylline , CPAP or BiPAP for type2
causes of copdalpha1 antitrypsin def, smoking
copd percussion note hyperresonant
copd breath soundsdecreased
criteria for LTOTpo2 <7.3 kpa
Hib culture methodCHOC
COPD FEV/FCV value , FEV<0.7 FEV:<80%
criteria for NIVpH<7.35
COPD exacerbation rxsalbutamol, ipratropium, doxy, co-amoxiclav
COPD organism Hib, moraxella, pneumococcus
cor pulmonale featuresperi oedema, raised JVP
wells >2 for DVT do whatleg vein USS within 4 hrs -> ove -> d- dimer
memorize

 

Question Answer
post - thrombotic syndrome --> (3) featuresvenous ulcer, hyperpigmentation, edema
post- thrombotic syndrome rxcompression , leg elevation
prophylaxis in hospital how?SC LMWH (dalteparin)
heparin works on which pathway?intrinsic
unfractioned heparin monitored byAPTT
LMWH monitored byfactor Xa assay
fondaparinux usually causes what ADRheparin induced thrombocytopenia
in renal failure which heparinuse unfractioned in renal failure
reverse heparinprotamine
drug for emobolic stroke prevetion in AFwarfarin
heart valve replacement embolic stroke prevetionwarfarin
arterial thrombosis (NOT EMBOLIC) prevention in e.g. MI, thrombotic strokeaspirin/ clopidogrel
warfarin monitoredINR
warfarin and cyp450 inducerrisk of clots
warfarin and cyp450 inhibitorbleeding
warfarin CINSAID, intracranial bleed, Hb
PE well's criteria <Can Not Treat If Pe Hates Me>clinical features of DVT 3, Not other likely 3, tachycardia >100 1.5, Immobility 1.5 Previous PE 1.5 haemoptysis 1, malignancy 1
PE wells <4 -->d-dimer
PE wells >4CTPA
if CTPA CI (e.g. renal failure, allergy) -->VQ scan
thrombus shows up dark/ white on CTPAdark
rx of PE (2)high flow o2, LMWH
connective cause of pleural effusionRA SLE
one GI exudate cause of pleural effusionpancreatitis
does PE --> pleural effusionyes exudate
transudate pleural effusion mechanism (which starling force)increase capillary pulmonary pressure
who gets secondary spontaneous pneumothoraxCOPD asthma, cf, TB, PJP, marfan
JVP in pneumothoraxincreases
chest expansion in pneumothoraxreduced
trachea deviated to which side in pneumothorraxpushed away
check out treatment path in pneumothorax
honeycomb lungs -> ?insterstitial lung fibrosis
drugs --> fibrosis (3)amiodarone, methotrexate, nitrofurantoin
NO CHEST PAIN non- productive paroxysmal cough DRY COUGH --> dxfibrosis
bilateral basal end- inspiratory crepitations - dxfibrosis/ pulmonary oedema, pneumonia, bronchitis
cor pulmonale from (2)COPD, fibrosis
multisystem causes of fibrosisSLE, RA, sarcoidosis
exacerbation of COPD vs pneumoniano consolidation on CXR as infection in COPD is in large airways
fibrosis invCT high resolution
memorize
wells <1 for DVT do what : d- dimer -> +ve -> USS