Clinical Lectures Flashcards

Question

Managing COPD

Answer 1

Maximise bronchodilation- improves symptoms ensures mucous clearance reduce inflammation and bacterial colonisation Short acting b agonist SABA- salbutamol Long acting muscarinic antagonist LAMA eg tiotropium Combination long acting bronchodilators Add an inhaled steroid in selected patients

Answer 2

Respiratory tract infections Peaks of air pollution Interruption of maintenance therapy Idiopathic Mimics/aggravators: pneumonia, pulmonary embolism, pleural effusion, arrhythmia/ congestive cardiac failure, pneumothorax Management: -steroids- prednisolone , nebulised bronchodilators salbutamol and ipratropium, oxygen, theophyllines, antibiotics, noninvasive ventilation Increased breathlessness, increased sputum, green sputum

Answer 3

Sleep related breathing disorder characterised by recurrent episodes of complete or partial obstruction of upper airway during sleep these can cause apnoea (complete airflow obstruction with temporary absence or cessation of breathing) or hypopnoea decreased airflow) Classically middle aged obese man with loud snoring and excessive sleepiness in day Who: increasing age, man, obesity, family history, enlarged tonsils, NMD How do we find it: sleep studies (polysomnography) to confirm diagnosis refer to sleep clinic Treat: continuous positive airway pressure CPAP, lifestyle changes such as weight loss and smoking cessation, inform DVLA

Answer 4

Abnormal accumulation of air within the pleural space Sudden chest pain, sudden SOB, sweating, reduced breath sounds Who: trauma, tall slender young people, underlying lung disease Diagnosis; CXR unless very unstable then treat immediately Treatment: aspirate at 2nd intercostal space at midclavicular line using 14G needle Complications: cardiac arrest pressure on heart so it cant function effectively

Answer 5

Obstruction of pulmonary vasculature secondary to an embolus these emboli typically originate in lower extremities most commonly secondary to deep vein thrombosis Pleuritic chest pain, SOB dsypnoea, haemoptysis, DVT Signs: often none, may be pleural rub Who: post surgery, flights, immobility, cancer, OCP, pregnancy, smoking, factor V leiden, protein S or C deficiency (FH). Diagnosis: look at symptoms, D-dimer blood test, CT pulmonary angiogram, VQ scan - mismatch multiple PE CXR: grossly normal, basal atelectasis +/- effusion, pleural based wedge shape of increased opacity= hamptons hump, oligaemia/hypovolaemia= westermarks signs, rarely infarction with cavitation Treatment: thrombolysis, normally just need anticoagulation- LMWH then NOAC or warfarin requires INR monitoring ,

Answer 6

Pulmonary artery pressure >25mmhg SOB, fatigue, syncope/dizziness, R heart failure, peripheral oedema, ascites, loud 2nd heart sound, tricuspid regurgitation- pansystolic murmur Who: rare, most common cause is COPD, more women, idiopathic, Diagnosis: ECG, echocardiogram more accurate by right heart catheter, CT chest Treatment: highly specialist management, drugs can target pulmonary vascular function PDE type 5 inhibitor Managing r heart failure and pulmonary hypertension associated with lung disease is mostly about correcting hypoxia

Answer 7

Typical vs atypical Typical: pre existing disease, abrupt onset, purulent sputum, pleuritic pain, marked systemic upset, localised signs, responds to beta lactams Atypical: previously well, insidious onset, dry cough, SOB, wheeze, mild systemic upset, no response to beta lactams Organisms (strep pneumoniae/ haem influenzae) Severity CURB65 Complications: respiratory failure, lung abscess, parapneumonic effusion, empyema Consolidation on X-rays

Answer 8

Caused by mycoplasma tuberculosis Night sweats, fever, weight loss, productive cough, haemoptysis, may be latent or active, reactivation Diagnosis by testing sputum for acid fast bacilli AFB, if lymph nodes involved aspirate, bronchoscopy if no sputum, test for HIV Treatment: RIPE therapy 4 antibiotics: rifampicin, isoniazid, pyrizinamide, ethambutol. Resistance, hepatitis Blood borne spread TB: meninges, musculoskeletal, genitourinary, gastrointestinal, pericardial Controlling TB: housing/overcrowding, nutrition/child health, immunisation, chemoprophylaxis

Answer 9

Acute: previously well, usually viral, not always sputum production, cough, may be complicated by secondary bacterial infection Recurrent: cough with sputum, more likely bacterial, no features of chronic bronchitis, look for underlying sinus infection, post nasal drip and bronchiectasis

Answer 10

A cycle of chronic bronchial widening, poor mucous clearance, and recurrent infections Crackles in chest sometimes clubbing, cough, thick mucous production Who: post infections, immune deficiency, poor mucociliary clearance Cystic fibrosis Diagnosis: CXR, sputum culture, consider cause/risk factor Treatments: physiotherapy (postural drainage), bronchodilators, long term antibiotics nebulised or inhaled colomycin, tobramycin, oral macrolides- azithromycin Complications: widespread use antibiotics, resistance

Answer 11

Defined as PaO2 <8.0kpa while breathing air or PaCo2>6.5kpa Type 1: low oxygen hypoxaemia Type 2: low oxygen and high CO2 hypoxaemia and hypercapnia Need to find underlying cause: sepsis, pneumonia, pulmonary embolism, IECOPD, pulmonary oedema. Investigate with ABG, blood tests, CXR, ECG Management: hypoxaemia kills first so give oxygen first and fix co2 and pH later

Answer 12

Nasal cannula Simple mask low flow rate means you can rebreathe CO2 Venturi: different sized adaptors most ore is oxygen concentrations good for chronic lung disease Non-rebreathe one way valve highest possible oxygen therapy

Answer 13

Respiratory arrest Respiratory fatigue Airway compromise due to decreased consciousness Bilevel positive airway pressure ventilation BiPap: non invasive form of mechanical ventilation provided by means of nasal prongs or a full face mask Invasive mechanical ventilation: replaces the respiratory muscle pump Goal for assisted ventilation: improve ventilation by optimising gas exchange, rest respiratory muscles, assistance for neural or muscle dysfunction

Answer 14

Non-severe cases: oral amoxycillin and macrolide or levofloxacin or moxifloxacin Severe cases: Iv co-amoxiclav and macrolide, cefuroxime and macrolide, benzylpencillin and levofloxacin Severity: CURB65: confusion, urea, respiratory rate, Bp, over 65

Answer 15

Antibiotics: penicillins, anaerobic Drainage Surgery: break adhesions, decortication (remove fibrous tissue), open drainage

Answer 16

Abnormal membrane chloride channel Impaired mucous clearance, obstruction pancreatic duct, in utero obstruction of male reproductive tract, focal biliary cirrhosis Bronchiectasis, pancreatic insufficiency, infertility Investigations: sweat test, genetic testing Aggressive management of bronchiectasis Pancreatic enzyme supplements Insulin Nutrition Lung transplantation

Answer 17

During exercise metabolism is increased which results in a build up of carbon dioxide and a reduction in the supply of oxygen These changes are detected by chemoreceptors and impulses are sent to the respiratory control centre in the brainstem Signals are sent to the diaphragm and intercostal muscles to increase the rate of ventilation (this process is involuntary) As the ventilation rate increases CO2 levels in the blood will drop restoring blood pH (also O2 levels will rise)

Answer 18

More likely to affect respiratory function if it affects breathing centres in brainstem Chemoreceptors on ventral side of medulla oblongata effectively detect CO2

Answer 19

Affect our most basic functions -unconscious patient -look for cranial never signs to locate it Difficult to see on CT scans better on MRI Brainstem may be affected by larger lesions above it pushing downwards leading to respiratory failure

Answer 20

Decrease respiratory drive so decrease ventilation Post surgery Overdoses Morphine and other opiates Benzodiazepines

Answer 21

MND Duchenne muscular dystrophy Usually causes chronic deterioration Tests include: -spirometry—> low FVC -transcutaneous CO2 monitoring overnight -arterial blood gas- type 2 respiratory failure

Answer 22

Degeneration of the ventral horns in spinal cord where UMN meets LMN, mix of LMN and UMN pathology Usually starts with limbs or bulbar muscles Can result in diaphragmatic weakness-> respiratory failure Poor swallowing -> recurrent aspiration Progressive- usually fatal 2-5 years from diagnosis Managing respiratory failure: non-invasive ventilation, reduces CO2, extends life and probably improves QOL

Answer 23

Cycle between NREM and REM sleep REM: decrease muscle tone, increase sympathetic nervous system activity Measure apnoea Hypopnea index AHI- measures number combine average of apnoeas and hypopneas per hour of sleep >30 is severe OSA

Answer 24

Associated with obesity and Craniofacial abnormalities Usually snoring Daytime sleepiness Choking overnight Morning headaches Can occur in down syndrome and acromegaly Micrognathia (Lower jaw undersized) in Treacher-Collins syndrome surgical correction

Answer 25

Continuous positive airway pressure CPAP at night Use >4 hours/ night Provides a continuous airflow to ensure airways are open helps to counteract some metabolic risk factors