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Phase 2 Cardiorespiratory > 3. Obstructive Lung Disease, PE, TB and Interstitial Lung Disease > Flashcards

3. Obstructive Lung Disease, PE, TB and Interstitial Lung Disease Flashcards

1
Q

name three mechanisms of airways obstruction

A
  • excess mucous
  • bronchial smooth muscle hypertrophy
  • alveolar destruction - loss of traction which keeps the bronchial walls open
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2
Q

Define the following:

  1. FVC
  2. FEV1
  3. Name 5 factors that influence expected spirometry values
A
  1. the amount of air that can be forcibly exhaled from the lungs after taking the deepest breath possible
  2. maximal amount of air that you can forcibly exhale in one second
  3. age, gender, height, weight, ethnicity
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3
Q

What is the normal reference ranges of the following:

  1. FEV1
  2. FVC
  3. FEV1/FVC ratio
A
  1. > 80% expected
  2. > 80% expected
  3. > 0.7
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4
Q
  1. What are the spirometry results in airway obstruction?

2. what is reversibility?

A
  1. FEV1 <80% expected/best
    FEV1/FVC <0.7
  2. improvement of >15% following use of bronchodilator
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5
Q

What are the three characteristics of asthma?

A
  • reversible airflow limitation
  • airway hyper-responsiveness
  • bronchial inflammation
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6
Q

name 4 precipitating factors of asthma

A
  1. occupational sensitisers - spray paints, flour/organic dusts
  2. cold air and exercise
  3. atmospheric pollution
  4. drugs - NSAIDs and beta blockers
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7
Q

describe the Th2 driven inflammatory process driving asthma

A
  1. dendritic cells present allergen to T cell
  2. T cell differentiates into Th2 cell
  3. Th2 produces Il-4 - this promotes IgE production by B cells
  4. IgE binds to mast cells in the airway
  5. mast cells degranulate when antigen binds. release of inflammatory mediators
  6. cytokines activate T and B cells; IL-5 attracts eosinophils
  7. Eosinophils produce leukotrienes
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8
Q

Name the 4 classic signs and symptoms of asthma

A
  1. dyspnoea
  2. expiratory wheeze
  3. cough
  4. chest tightness
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9
Q

Name 3 factors in a history that could indicate asthma

A
  1. symptoms often worse at night
  2. exacerbated by particular triggers
  3. exercise/cold may make symptoms worse
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10
Q

Name 4 investigations for ?asthma

A
  1. spirometry
  2. PEFR
  3. FBC (raised eosinophils)
  4. FeNO (exhaled nitric oxide) - raised
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11
Q

Describe the 5 steps of asthma management

A
  1. SABA
  2. add ICS
  3. Add LABA
  4. increase steroid and add 4th drug (leukotriene antagonist or theophyline)
  5. Add steroid tablet, and refer
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12
Q
  1. Name 4 signs/symptoms of status epilepticus

2. name 4 signs that this could be life threatening

A
  1. inability to complete sentences in one breath
    tachypnoea
    tachycardia
    PEFR <50%
  2. silent chest; feeble respiratory effort
    exhaustion, confusion
    bradycardia or hypotension
    PEFR <30%
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13
Q

define chronic bronchitis

A

productive cough that lasts for more than 3 months, with recurring bouts occurring for at least 2 consecutive years

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14
Q

What does the lymphocytic infiltrate in chronic bronchitis consist of?

A

CD8 cells and neutrophils

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15
Q

How does emphysema cause airflow obstruction?

A

loss of radial traction - therefore pleural pressure>radial traction, leading to reduced alveolar pressure, leading to collapse of airways prematurely.

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16
Q

Name 4 symptoms of COPD

A
  1. cough - usually productive
  2. progressive dyspnoea
  3. wheeze
  4. frequent infective exaverbations
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17
Q

What might a patient with COPD demonstrate on general examination?

A 
intercostal indraping
pursed lip breathing
use of accessory muscles
hyperinflation of chest
flapping tremor due to hypercapnia
clubbing
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18
Q
  1. What will a patient with COPD have on percussion?

2. What will a patient with COPD have on auscultation?

A
  1. hyperresonance

2. wheeze and/or coarse crackles

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19
Q

Name 5 investigations for ?COPD

A
  1. spirometry
  2. pulse oximetry
  3. ABG
  4. CXR - reveals hyperinflation (flattened diaphragm, increased intercostal spaces, hyperlucent lungs)
  5. sputum culture
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20
Q

What is the FEV1% predicted in the following COPD stages?

  1. mild
  2. moderate
  3. severe
  4. very severe
A
  1. ≥ 80%
  2. <80%
  3. <50%
  4. <30%
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21
Q

Describe the 3 step management of COPD

A
  1. SABA or SAMA
  2. add LABA or LAMA
  3. Add ICS if severe, had frequent exacerbations and significant symptoms
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22
Q

what is carbocystine used for?

A

mucolytic

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23
Q
  1. What is the aim of long term oxygen therapy?

2. When is it indicated?

A
  1. to minimise pulmonary hypotension

2. sats <88% confirmed twice over a 3 week period, or if there is evidence of pulmonary hypotension

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24
Q

How are acute exacerbations of COPD managed? (4)

A
  1. antibiotics if cause is infective
  2. bronchodilators
  3. oxygen therapy
  4. oral corticosteroids
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25
Q

Name 3 clinical markers of COPD severity

A
  1. FEV1
  2. hyperaemia
  3. MRC dyspnoea scale
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26
Q

Name the only 2 methods which can improve prognosis of COPD

A
  1. LTOT

2. smoking cessation

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27
Q

What is a pneumothorax?

A

an accumulation of air in the pleural space

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28
Q

Describe the following causes of pneumothorax

  1. primary spontaneous pneumothorax
  2. secondary spontaneous pneumothorax
  3. Traumatic Pneumothorax
A
  1. occurs without precipitating event in a person without clinically apparent pleural disease
  2. occurs as a complication of underlying pulmonary disease, typically COPD
  3. Results from a penetrating injury to the chest
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29
Q

What is a tension pneumothorax?

A

a pneumothorax whereby the air is trapped within the pleural cavity under positive pressure. Air accumulates in the plural space on inspiration but can’t escape.

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30
Q

Name 3 symptoms of pneumothorax

A
  • ipsilateral chest pain
  • shoulder tip pain
  • dyspnoea
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31
Q

Describe examination findings for pneumothorax (5)

A
  • tachypnoea
  • cyanosis
  • hyperresonant over affected side
  • decreased breath sounds over affected side
  • tracheal deviation away
32
Q

Name 3 investigations for ?pneumothorax

A

CXR - visible pleural edge and no lung marrkings peripheral to this
Chest CT - useful in . differentiating pneumothorax from bullous emphysema
ABG

33
Q

How is a pneumothorax managed?

A

Chest drain

34
Q

What is pleural effusion?

A

excess fluid that accumulates in the pleural cavity

35
Q
  1. What is an exudative effusion?

2. Name causes of exudative effusion

A
  1. inflammatory process drives leakage of protein and fluid

2. infection, inflammation, tumours

36
Q
  1. What is a transudative effusion?

2. What causes a transudative effusion?

A
  1. mediated by increased hydrostatic pressure or decreased oncotic pressure
  2. heart failure, cirrhosis, constrictive pericarditis
37
Q
  1. Name 3 symptoms of pleural effusion

2. Name 3 examination findings of pleural effusion

A
  1. pleuritic chest pain, cough, dyspnoea

2. dullness to percussion, decreased tactile vocal fremitus

38
Q

What investigations would be performed for ? pleural effusion? (2)

A
  • CXR - reduced costophrenic angles or dense shadowing

- pleural aspiration

39
Q

describe the pathophysiology of pneumonia

A

Invasion and overgrowth of pathogenic micro-organisms in lung parenchyma, which overwhelms host defences
inflammatory response results in intra-alveolar exudates and infiltration of neutrophils and macrophages
Exudates fill the alveoli, resulting in consolidation. This hinders oxygenation

40
Q

name 5 risk factors for community acquire pneumonia

A
  1. age (<16 or >65)
  2. co-morbidities
  3. other respiratory conditions
  4. lifestyle - alcohol, smoking, IV drug use
  5. Iatrogenic - immunosuppression; prolonged corticosteroids
41
Q
  1. What type of organisms commonly cause community acquired pneumonia?
  2. Name 4 examples of the common causative pathogens
A
  1. gram positive organisms
  2. strep pneumoniae
    H. influenzae
    group A strep
    staph aureus
42
Q

Name three atypical organisms that can cause pneumonia

A
  1. mycoplasma pneumoniae
  2. legionella
  3. chlamydia
43
Q
  1. Name 4 presentations of Pneumonia
  2. Name some extrapulmonary features of pneumona
  3. How may CAP present in the elderly?
A
  1. cough - often productive with coloured sputum
    breathlessness
    fever
    chest pain - pleuritic
2. myalgia, arthralgia, malaise
headache
GI symptoms
skin rashes
hepatitis (feature of legionella pneumonia)
  1. confusion or recurrent falls (NON SPECIFIC SYMPTOMS)
44
Q

Name 4 examination findings for pneumonia

A
  1. decreased chest expansion
  2. dullness to percussion
  3. bronchial breath sounds
  4. increased vocal resonance
45
Q
  1. What does CURB-65 examine?
  2. What is it an assessment of?
  3. What do the following scores mean?:
    a) 1
    b) 2
    c) 3+
A
  1. confusion, plasma urea, resp rate, systolic BP and age
  2. severity of pneumonia

3a) treat as outpatient
3b) admit to hospital
3c) emergency admission; consider ITU

46
Q

Name 6 investigations for ?pneumonia

A
  1. CXR - new shadowing provides definitive diagnosis
  2. FBC
  3. ABG
  4. blood culture
  5. sputum culture
  6. urinary antigen testing (legionella and pneumococcus)
47
Q
  1. What type of organisms cause hospital acquired pneumonia?

2. Name 4 examples

A
  1. gram negative aerobes

2. pseudomonas aeruginosa, e. coli, klebsillea pneumoniae. Staph aureus (not gram neg)

48
Q

What is hospital acquired pneumonia?

A

acute lower respiratory tract infection which is acquired after at least 48 hours of admission to hospital and is not in incubation at the time of admission

49
Q

Name 4 factors that are associated with increased mortality from hospital acquired pneumonia

A
  • time from admission to pneumonia
  • age
  • use of mechanical ventilation
  • cancer
50
Q

Name 5 complications of pneumonia

A
  • respiratory failure
  • sepsis
  • pleural effusion
  • empyema
  • lung abscess
51
Q
  1. What do PE’s normally arise from?

2. Name the three components of Virchow’s triad.

A
  1. VTE in the legs

2. venous stasis, vessel trauma, hypercoagulability

52
Q

Name risk factors for PE (7)

A
  1. recent surgery
  2. thrombophillia
  3. prolonged bed rest/reduced motility
  4. malignancy
  5. pregnancy
  6. previous use of contraceptive pill/HRT
  7. previous PE
53
Q

How may a PE present?

A
  • acute BREATHLESSNESS
  • PLEURITIC chest pain
  • haemoptysis
  • dizziness/syncope
  • hypotension
  • tachypnoea
  • tachycardia
  • unilateral calf swelling
54
Q

Name 7 factors that are assessed in the Well’s score for PE

A
  1. clinically suspected DVT
  2. alternative diagnosis is less likely than PE
  3. Tachycardia
  4. Immobilisation/surgery in past 4 weeks
  5. Hx of DVT/PE
  6. Haemoptysis
  7. Malignancy
55
Q
  1. What does a well’s score >2 warrant?
  2. What does a well’s score >4 warrant?
  3. What does a well’s score > 6 warrant?
A
  1. CT scan only if D Dimer is positive
  2. give treatment before performing CT scan. Still needs a D dimer
  3. Perform CT scan without D dimer
56
Q
  1. How is a PE prevented? (2)
  2. What is the management for patients with PE
  3. What is the duration of treatment for patients with:
    a) confirmed PE
    b) unconfirmed PE
A
  1. unfractionated heparin, LMWH, or fondaparinux
    compression stockings
  2. LMWH heparin pending diagnosis; DOACs following diagnosis

3a) 3 months
b) 6 months

57
Q
  1. What is bronchiectasis?
  2. What is the underlying pathological mechanism?
  3. Name 3 diseases which can cause bronchiectasis
A
  1. abnormal and permanent dilatation of the airways
  2. cycle of neutrophillic inflammation, recurrent infection and damage to the airway. loss of cillia, excess mucous and wall destruction, which further impedes mucocilliary clearance
  3. TB, COPD and CF
58
Q

Describe 7 clinical features of bronchiectasis

A
  1. persistent cough
  2. copious purulent sputum production
  3. breathlessness
  4. haemoptysis (usually a sign of infection)
  5. recurrent infection
  6. pleuritic chest pain
  7. coarse crackles on auscultation
59
Q

Name the 3 investigative tests of bronchiectasis

A
  1. HRCT - engagement ring appearence
  2. CXR
  3. sputum culture
60
Q
  1. What is the birth prevalence of CF?

2. What is the carrier rate of CF?

A
  1. 1 in 2500

2. 1 in 25

61
Q
  1. What is the normal function of CFTR?
  2. What is the effect of mutated CFTR?
    a) pancreas
    b) Intestine
    c) respiratory system
A
  1. transport of cl out of the cell; changes membrane potential which prevents the reabsorption of sodium. water follows by osmosis
  2. Cl transport is impaired. Water secretion is impaired. Mucous is sticky
    a) blockage of exocrine ducts. Early activation of pancreatic enzymes which can lead to endocrine and exocrine insufficiency
    b) bulky stools can lead to obstruction
    c) mucus stasis, airway inflammation and infection. Leads to progressive bronchiectasis
62
Q

Describe clinical features of CF relating to the respiratory system

A
  1. recurrent infection
  2. chronic cough and sputum production
  3. breathlessness
  4. nasal polyps
  5. recurrent sinusitis
  6. resp failure and cor pulmonale
63
Q
  1. Describe clinical features of CF relating to the GI tract

2. Describe clinical features of CF relating to the endocrine system

A
    • exocrine pancreatic insufficiency - FTT/low BMI
      - meconium ileus in infancy
      - distal intestinal obstruction
      - steatorrhoea
      - increased risk of GI malignancy
      -
  2. pancreatic damage results in CF related diabetes (Type1/Type2 picture)
64
Q
  1. How regularly should CF patients be reviewed?

2. What tests should be performed at every review?

A
  1. every 3 months

2. FEV1 and BMI

65
Q
  1. How does apnoea occur during sleep?

2. How does apnoea lead to waking?

A
  1. activity of respiratory muscles is reduced. Reflexes which normally keep the upper airway open during wakefullness (genioglossus, palate) become hypotonic during sleep. Consequently, upper airway collapses
  2. apnoea → hypoxia → central hypoxic stimulation and increasingly strenuous respiratory efforts → waking
66
Q

Name 5 contributory factors which can narrow the airway further in sleep apnoea

A
  1. obesity
  2. large tonsils
  3. macroglossia
  4. maxillomandibular anomalies
  5. respiratory depressants - alcohol, sedatives, strong analgesia
67
Q
  1. What collateral hx is important for a diagnosis of Obstructive sleep apnoea?
  2. What patient reported questionnaire is also used in the diagnosis of obstructive sleep apnoea?
  3. What does this scale try to elicit (in general)
A
  1. snore-silence-snore cycle
  2. Epworth Sleepiness scale
  3. excessive daytime somnolence
68
Q
  1. What is obesity hypoventilation syndrome otherwise known as?
  2. What is the pathophysiology of the condition?
A
  1. Pickwickian Syndrome
  2. Severely obese people fail to breathe rapidly enough or deeply enough during the day, resulting in hypoxia and hypercapnia.

adipose tissue restricts the normal movement of the chest muscles, making them less compliant, thus respiratory muscles are fatigued more easily
airflow in and out of the lung is also restricted by excessive tissue in the neck
patients expend more energy to breathe effectively

Inadequate removal of CO2 → acidosis. Ventillatory response to acidosis is blunted.

69
Q

What 3 factors are required for a diagnosis of Obesity Hypoventilation Syndrome?

A
  1. BMI >30
  2. arterial CO2 >45mmHg
  3. no alternative explanation for hypoventilation
70
Q
  1. What are the 2 main types of restrictive lung disease?

2. What is the pattern of spirometry in restrictive lung disease?

A
  1. Interstitial and extrapulmonary

2. decreased TLC; decreased FVC; decreased FEV1; normal/increased FEV1/FVC ratio

71
Q
  1. How do patients with interstitial lung disease typically present?
  2. Common examination findings
A
  1. progressive dyspnoea ± cough
    weight loss/anorexia; malaise
  2. bibasal crackes; expiratory crackles; clubbing
72
Q
  1. What is the common finding on
    a) CXR
    b) HRT
    For a patient with idiopathic pulmonary fibrosis
A

1a) ground glass appearance

1b) honeycombing

73
Q
  1. What is hypersensitivity pneumonitis?

2. Name 3 examples of this condition

A
  1. non-IgE mediated allergic reaction affecting the small airways and alveoli
  2. Farmer’s Lung - response to mouldy hay
    Bird Fancier’s Lung - response to aviann proteins
    Mushroom picker’s lung
74
Q
  1. What is pneumoconiosis?
  2. How do patients usually present?
  3. Which tests are of beneficial diagnostic value
A
  1. class of diseases caused by exposure to mineral/metal dusts (mostly occupational)
  2. exertional dyspnoea; cough; crackles, dullness, wheeze; clubbing.
    Strong hx of occupational exposures
  3. CXR
    spirometry
    HRCT
75
Q
  1. What is sarcoidosis?

2. Describe the epidemiology of sarcoidosis

A
  1. a multisystem granulomatous disorder of unknown aetiology, characterised by non-caseating granulomas
  2. affects females more than males
    age at presentation 25-40
76
Q
  1. Describe the clinical features typical of pulmonary sarcoidosis
  2. Name and describe the 2 Eponymous syndromes associated with Sarcoidosis
A
  1. dry cough; dyspnoea; chest pain
  2. LOFGREN’S
    • fever
    • arthralgia
    • bihilar lymphadenopathy
    • erythema nodosum (painful bruise like nodules appearing over the shins/legs)
    HEERFORDT’S
    • fever
    • parotid swelling
    • uveitis
    • facial palsy
77
Q
  1. What are the 4 principles of sarcoidosis management?

2. What is the prognosis of sarcoidosis?

A
  1. monitoring and watchful waiting
    steroids
    immunosuppression
    transplantation
  2. 25% show spontaneous clinical regression
    25% develop progressive lung disease

Phase 2 Cardiorespiratory (7 decks)

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