2.02 - Lungs Flashcards
Define haemoptysis
coughing up blood originating from respiratory tract below the level of the larynx
what two symptoms may be mistaken for haemoptysis
haematemesis - bloody vomit
pseudo-haemoptysis - cough reflex stimulated by blood not originating in the lungs or bronchi
what can cause haemoptysis
carcinomas
bronchitis
bronchiectasis
airway trauma
foreign body
pneumonia
tuberculosis
aortic aneurysm
PE
what symptoms are present in bronchitis alongside haemoptysis
abrupt onset cough
fever
what symptoms of bronchiectasis are present alongside haemoptysis
chronic productive cough
what symptoms alongside haemoptysis are present in TB / Pneumonia
fever
night sweats
weight loss
what symptoms alongside haemoptysis are present in bronchiogenic carcinoma
anorexia
what symptoms alongside haemoptysis may be seen in congestive heart failure
dyspnoea
fatigue
orthopnoea
frothy pink sputum
what signs may be found on observations of a patient with haemoptysis
fever
tachypnoea
weight loss
hypoxia
what signs may be found on general inspection of a patient with haemoptysis
cyanosis
pallor
muscle wasting (cachexia)
small red marks on skin due to dilation of small vessels (telangectasia)
what signs may be found in respiratory examination of a patient with haemoptysis
signs of LVF
diastolic murmur
tachypnoea
tachycardia
pleural rub
clubbing
define dyspnoea
uncomfortable, rapid, or difficult breathing
feeling of chest tightness
pain when breathing
body needs more oxygen than it is getting
what does each number of the breathlessness score mean (1-6)
- no breathlessness
- breathless on vigorous exertion
- breathless when walking up slopes
- breathless walking on flat ground, needing occasional breaks
- needing frequent breaks walking on flat
- unable to leave the house
what symptom accompanies dyspnoea in asthma or viral infection
wheeze
what symptoms may accompany dyspnoea in pneumonia
fever
green sputum
haemoptysis
what symptoms may accompany dyspnoea in COPD
chronic cough
dyspnoea is also chronic
what would be a likely diagnosis of a patient presenting with dyspnoea and ankle swelling
heart failure
what would be the likely diagnosis of a patient presenting with dyspnoea with a history of unilateral leg swelling
pulmonary embolism
what other symptom is likely to present with dyspnoea in anaemia
fatigue
list the commonly used lung function tests
sputum examination
peak flow
pulse oximetry
arterial / venous blood gas
spirometry
list positive results of sputum examination and what they are signs of
clear and colourless = bronchitis
yellow/green/brown = pulmonary infection
red = haemoptysis
black = smoke / coal dust
frothy white = pulmonary oedema
what is peak flow
measures FEV1 using a peak flow metre
estimates airway calibre in suspected asthma
effort dependent
what is the normal pulse oximetry range for healthy patients
94-98%
what is the normal pulse oximetry range in patients with COPD
88-92%
what is measured in ABG
pH, pO2, pCO2, HCO3
what is measured in spirometry
FVC and FEV1
FVC:FEV1 ratio gives an estimate of airflow obstruction severity
what spirometry result shows obstructive lung defect
reduced FEV1
what is the appearance of the spirometry graph in obstructive lung disease in comparison to normal
flatter
what spirometry result is expected in restrictive lung disease
FEV1:FVC ratio normal / high
both are significantly reduced
what is the appearance of the spirometry graph in restrictive disease compared to normal
same shape but shorter
what is the difference between obstructive and restrictive lung diseases
obstructive - difficult getting air in and out of lungs due to obstruction
restrictive - difficulty fully expanding lungs
define COPD
chronic obstructive pulmonary disease
progressive airway obstruction
irreversible
results in chronic bronchitis and emphysema
what is chronic bronchitis
chronic productive cough for at least 3 months over 2 consecutive years
what is emphysema
abnormal enlargement of alveoli resulting in loss of surface area for gas exchange
what are the causes of COPD
90% - smoking
10% - alpha 1 antitrypsin deficiency (genetic)
pts with alpha1 antirtrypsin def. have significantly increased risk if they smoke
what is the pathophysiology of chronic bronchitis in COPD
chronic inflammation of airways leads to CD8 T cell and macrophage infiltration
leads to narrowing of airways and hyper secretion of mucus
what is the pathophysiology of emphysema in COPD
chronic inflammation leads to increased elastase production
elastase destroys elastin, causing dilation of alveoli
reduces surface area for gas exchange
what is the pathophysiology of cor pulmonale
right ventricular impairment secondary to pulmonary disease
most commonly caused by COPD
chronic hypoxia -> vasoconstriction of pulmonary arteries -> pulmonary HTN -> right heart failure
what are the symptoms of COPD
chronic productive cough
SOB
winter bronchitis
wheeze
what signs are seen in COPD
SOB, pursed lip breathing, tripodding, accessory muscle use
wheeze
crackles
downward displacement of liver
what are the red flag symptoms in lung disease (cancer)
weight loss
haemoptysis
anorexia
chest pain
lymphadenopathy
finger clubbing
fatigue
what are the levels of severity for COPD (4)
1 - Mild: FEV1 >80% of predicted
2 - Moderate: FEV1 50-79% of predicted
3 - Severe: FEV1 30-49% of predicted
4 - Life-Threatening: <30% of predicted
what is the conservative treatment of COPD
stop smoking - prevent it from worsening
pneumococcal vax
annual flu vax
pulmonary rehab
what is the first line medical management for COPD
SABA / SAMA inhaler
if inhaled treatment needed to relieve breathlessness
inhaler education necessary
what is the second line medical management of COPD for a patient with a history of steroid responsiveness or asthma
LABA + ICA
what is the second line medical management of COPD for a patient with NO history of steroid responsiveness or asthma
LABA + LAMA
what is the third line medical management of COPD
LABA + LAMA + ICS combined inhaler (trimbow)
What is the management of acute COPD exacerbation
Oxygen (keep sats 88-92%)
Bronchodilator nebuliser (salbutamol)
Corticosteroids (30mg oral prednisolone)
Antibiotics
what are the complications of COPD
respiratory failure
pneumonia
pneumothorax
polycythaemia
anaemia
depression :(
define asthma
common chronic inflammatory disorder or the airways, leading to variable airway obstruction
usually presents in childhood
what other conditions are asthmatic patients likely to have
atopic conditions - eczema, hay fever, food allergies
also fhx of these
what is atopy
genetic predisposition to IgE mediated allergen sensitivity
atopic asthma
atopic dermatitis (eczema)
atopic rhinitis (hay fever)
what is the hygiene hypothesis
increased autoimmune / allergic disease in developed countries
reduced exposure to infectious pathogens at young age may predispose to autoimmune disease
what a are the 4 main causes of asthma
atopy
occupational
exercise
aspirin
what are the symptoms of asthma
cough, worse at night
dyspnoea
chest tightness
poor sleep
what are the signs of asthma
expiratory wheeze
prolonged expiration
tachypnoea
harrison’s sulcus
what is harrison’s sulcus
groove on inferior border of rib cage seen in children with severe asthma
what are the signs of acute asthma attack
worsening of normal symptoms
reduced peak flow
signs of respiratory failure
what symptoms are present in moderate, severe, and life threatening asthma attacks
moderate: increase of normal symptoms
severe: cant complete sentences
life threatening: silent chest, cyanosis, confusion
what vital signs indicate severe asthma attack
HR > 110
RR > 25
what vital sign indicates life threatening asthma attack
<92% oxygen saturation
what % of expected PEF is seen in each level of asthma attack
moderate: 50-70%
severe: 33-50%
life threatening: <33%
what tests are done to diagnose asthma
spirometry
bronchodilator reversibility testing
FENO
peak flow variability - diary
direct bronchial challenge testing
what is the first line management for asthma
salbutamol inhaler PRN
when should treatment step up be considered for asthma
using salbutamol inhaler >3 times per week
what is the second line medical management for asthma
SABA + ICS
what is the third line medical management for asthma
SABA + LAMA + ICS
what is done if an asthmatic patient is taking SABA + LABA + ICS and their symptoms are not improving
increase ICS dose
refer for specialist review
what is the first line treatment for acute asthma attack
salbutamol + ipratropium nebuliser
oxygen
oral steroids
what is the second line treatment for acute asthma attack
IV magnesium sulphate
