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Year 3 > MedED chronic SOB > Flashcards

MedED chronic SOB Flashcards

1
Q

What are the 3 categories of lung disease anatomically?

A

Airways
Alveolar
Parenchymal

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2
Q

What are symptoms of resp conditions that you should ask about? What specifically might you ask about?

A 
Cough- wet/dry?
SOB- exertional?
Haemoptysis
Fatigue
Chest pain- pleuritic?
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3
Q

What cells mediate inflammation in asthma?

A

Mast cells
IgE
Eosinophil

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4
Q

What happens to the airway and parenchyma in asthma?

A 
Airway= obstructed (reversibly)
Parenchyma= in tact
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5
Q

What type of obstruction is present in asthma?

A

Reversible/ variable obstruction

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6
Q

How will someone with asthma classically present?

A 
SOB
Dry cough
Chest tightness
Waking up at night coughing
Triggered when cold
Wheeze
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7
Q

What triad of atopy might someone with asthma have?

A

Food allergy
Hayfever
Eczema

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8
Q

What are risk factors for asthma?

A

Family history
Allergies eg food, hayfever, pets, dust mites
GORD (it can make asthma worse)

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9
Q

What condition can make asthma worse?

A

GORD

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10
Q

What is used to assess the severity of someones asthma? How does it work

A

ACT= asthma control test

It works by:
Score over 20= controlled
Score under 19= uncontrolled

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11
Q

What does BDR stand for?

A

Bronchodilator reversible

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12
Q

What will FEV1/FVC be in obstructive disease?

A

<0.7

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13
Q

What will FEV1/FVC be in restrictive disease?

A

> 0.7

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14
Q

What is the first line investigation for asthma?

A

Spirometry

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15
Q

What happens to FEV1 in asthma?

A

Reduced

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16
Q

What happens to FVC in asthma?

A

It stays the same

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17
Q

What investigations might you do for asthma?

A

Spirometry

Fractional exhaled nitric oxide

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18
Q

What is fractional exhaled nitric oxide in asthma?

A

Over 40 ppm

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19
Q

What treatment addresses inflammation in asthma?

A

Inhaled corticosteroids

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20
Q

What dose of ICS is most effective in asthma?

A

Low dose

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21
Q

What are the asthma reliever medications? Why are they relievers?

A

They make the symptoms go away but do not address the inflammation

1) SABA- not effective in infections or exacerbations
2) LTRA
3) LABA
4) LAMA

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22
Q

What medications should you start for an adult with asthma?

A 
First= start low dose ICS (inhalers)
Second= start LTRA
Third= add LABA (if doing this stop LTRA) 
Fourth= LABA as MART

Also give SABA alongside all of this
Review every 4-8 weeks and they have to be adherent

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23
Q

What is MART?

A

Combination inhaler of ICS with a LABA (LABA has long and short acting components)

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24
Q

What is important when reviewing medications in a patient with asthma? How might you do this

A

Adherence- they have to be adherent or it wont work
Ask them:
How many times a week would you forget you medications
Can you show me how you take your inhaler
Do you know what your medications do?

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25
Q

What is occupational asthma and what do you need to know about it?

A

Asthma due to inhaled particles at work
Symptoms resolve during the holidays/ time away from work and get worse when at work
To manage they should try to avoid their triggers eg use PPE, then also manage like normal asthma

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26
Q

What type of obstruction do you get in COPD?

A

Irreversible airway obstruction

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27
Q

What are the features of COPD?

A

Small airway obstruction
Emphysema
Excess mucus production

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28
Q

What is the main anti inflammatory molecule in the lung?

A

Alpha 1 antitrypsin

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29
Q

Deficiency of what causes inflammation of the lungs?

A

Alpha 1 antitrypsin

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30
Q

What are the biggest risk factors for COPD?

A

Increasing age

Smoking

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31
Q

How will someone with COPD classically present?

A

Dyspnoea- exertional, persistent
Cough- this may be productive (30% of patients have a cough)
Wheeze

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32
Q

What will you ask in a COPD hx?

A

Smoking?
Family hx of COPD/ alpha 1 antitrypsin
Have you had any exacerbations
Ask all malignancy symptoms- increased risk of cancer
RHF- ankle swelling
Associated symptoms- pink frothy sputum/heamoptysis/ hoarse voice etc

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33
Q

What heart problem is associated with COPD and why?

A

RHF- the heart is pumping through an obstructed lung system

34
Q

What are some signs of COPD?

A 
Barrel chest/ hyperexpansion
Wheeze
Cyanosis 
CO2 flap
Tachypnoea
Cor pulmonale= ankle swelling, raised JVP, RV heave
Tar staining
Flared nostrils
Use of accessory muscles to breathe 
Look for clubbing because of increased risk of malignancy
35
Q

How do you identify hyperexpansion?

A

Reduced cricosternal distance

36
Q

What is the first line investigation for COPD?

A

Spirometry

37
Q

What will you see on spirometry in COPD?

A

Obstruction with no bronchodilator reversibility

FEV1/FVC <0.7

38
Q

What should you use to assess severity of COPD? What does it measure

A

MRC- it measures dyspnoea

39
Q

What is the first line pharmacological treatment for COPD?

A

SABA or SAMA
If this doesnt help and there are asthma features (eosinophils, FEV1 variability, peak flow variability)= ICS and LABA, then ICS and LABA and LAMA
If no asthma features= LABA and LAMA, them LABA and LAMA and ICS

40
Q

Why is ICS not given to COPD patients unless they have asthma features?

A

It reduces immunity and increases risks of flares which they are more likely to die of

41
Q

How will someone with idiopathic pulmonary fibrosis present?

A 
Chronic SOB
Progressive exertional dyspnoea
Dry cough 
Clubbing
Bibasal inspiratory creps
Weight loss, fatigue, malaise
42
Q

What crackles do you get with fibrosis?

A

Bi basal fine end inspiratory crackles

43
Q

What are risk factors for pulmonary fibrosis?

A

Increasing age

Smoking

44
Q

What is the gold standard investigation for IPF? What will the results be?

A

Spirometry and gas transfer- Spirometry= FEV1/FVC >0.7, reduced gas transfer

45
Q

What is DLCO and what does it tell you?

A

Diffusing capacity for carbon monoxide- it tells you how quick carbon monoxide is moving across the alveoli and will therefore tell you if there is an alveolar pathology

46
Q

What are causes of pulmonary fibrosis?

A

Exposure to toxins

Rheumatoid arthritis- check rheumatoid factor, anti ccp, ana panel etc

47
Q

How is IPF managed?

A

Specialist care:
Pulmonary rehab
Ambulatory or long term o2
Antifibrotics (pirfenidone or nintedanib if FVC is between 50-80% predicted)

48
Q

What is the prognosis of IPF?

A

2/3 years
It will stay until you die
Decline might be slow or extremely fast

49
Q

What are extrapulmonary symptoms of sarcoidosis?

A

Joint pain
Lupus pernio or erythema nodosum
Eye problems- photophobia, red painful eye, blurry vision

50
Q

What is sarcoidosis?

A

Non caseating granulomas deposited around the body causing disease
Can affect all organs but most commonly lungs

51
Q

What are risk factors for sarcoidosis?

A

Infection with TB
Women aged 20-40
Family hx
Afro caribbean

52
Q

How will someone with sarcoidosis classically present?

A

Chronic dry cough
Fatigue
Progressive SOB (exertional)
Skin lesions- erythema nodosum or lupus pernio
Eye problems - photophobia, painful red eye, blurry vision due to posterior and anterior uveitis
Facial nerve palsy
Cardiomyopathy

53
Q

What is a non caseating granuloma?

A

A collection of macrophages around a core

54
Q

Is there necrosis in sarcoidosis?

A

No

55
Q

What are some signs of sarcoidosis when you examine someone?

A

Wheeze
Ronchi
Erythema nodosum

56
Q

What are pulmonary manifestations of sarcoidosis?

A

Bilateral hilar lymphadenopathy

57
Q

What electrolyte is high in sarcoidosis?

A

Calcium

58
Q

What is there a lack of in stage 4 sarcoidosis?

A

Hilar lymphadenopathy

59
Q

What investigations are done for sarcoidosis?

A 
Investigate all organs
Lungs: CXR
High resolution CT
ECG
UEs
LFTs
60
Q

What is high in sarcoidosis?

A

Calcium

Serum ACE

61
Q

How is sarcoidosis managed?

A

Mainly corticosteroids

Immunosupressants if this doesnt work eg azothioprine, methotrexate

62
Q

What is OSA?

A

Complete or partial collapse of the upper airway causing obstructive apnoea or hypopnoea

63
Q

What are risk factors for OSA?

A

Obesity
Cushings
Acromegaly
Menopause

64
Q

How will OSA present?

A

Loud snoring, then silence then snoring again
Daytime sleepiness
Restless sleep

65
Q

What will someone with sleep apnoea tell you when they present?

A

They will tell you they are tired and have bad sleep

They may not be aware they are waking at night because they can wake up hundreds of times without knowing it

66
Q

What scoring system is used for OSA? What does it stand for? What score is needed

A

STOP BANG: snoring, tired, observed apnoea, pressure (BP), BMI over 35, age over 35, neck cirum over 40 and male gender
Score over 3= refer to polysomnography

67
Q

What is the gold standard investigation for OSA? What does it calculate

A

Night time in lab polysomnography

It calculates apnoea hypopnoea index which is average no of obstrucitve events per hour

68
Q

What is treatment for OSA when someone is asymptomatic vs symptomatic

A 
Everyone= weight loss, smoking and alcohol stop, sleep on side if poss
Asymp= intra oral mandibular advancement device
Symp= CPAP
69
Q

What occupational lung disease is caused by coal?

A

Simple pnuemocosis

Progressive massive fibrosis

70
Q

What is simple pneumoconosis?

A

Coal in the lungs

71
Q

What are symptoms of simple pneunomocosis?

A

None, usually asymptomatic

72
Q

How will someone with progressive massive fibrosis present?

A

History of working in a coal mine
Exertional dyspnoea
Cough with or without black sputum
Fibrotic masses on CXR

73
Q

What is important to remember in occupational lung disease?

A

The patients may be entitled to compensation if they apply within 3 years of being diagnosed

74
Q

What professions increase risk of silicosis?

A

Arty stuff like stonemasonry, pottery, ceramics

75
Q

How will someone with silicosis present?

A

Cough and SOB

Upper lobe fibrotic masses

76
Q

What 3 main particles cause interstitial lung disease?

A

Coal
Asbestos
Silica

77
Q

What professions increase risk of asbestosis?

A

Working with asbestos: shipyard workers, mining, aerospace
Working near asbestos: electricians, painters and masons
Background workers

78
Q

How will someone with asbestosis present?

A

Chronic progressive exertional dyspnoea
Dry cough
May have malignancy symptoms- FLAWS and haemoptysis

79
Q

What are signs of asbestosis?

A 
Clubbing
Reduced expansion
Asbestos warts
Bibasal crackles
RHF
80
Q

What type of CT is done for ILD?

A

High resolution

Year 3 (104 decks)

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