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Year 4 > Medicine - Respiratory > Flashcards

Medicine - Respiratory Flashcards

1
Q

Describe the features and causes of T1RF

A 
Lung issue (issue with gas exchange and the ability of the lungs to add O2/remove CO2 from the lungs)
Low oxygen (<8kPa) but normal CO2

Causes:

  • pneumonia
  • pulmonary oedema
  • PE
  • shunt
  • pneumothorax…

VENTILATION PERFUSION MISMATCH

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2
Q

Describe the features and causes of T2RF

A 
Pump issue = lungs are working at removing CO2/adding O2, but there is an issue getting air into/out of the lungs in the first place!
Low O2 (<8kPa) and high CO2 (>6kPa)

Causes:

  • COPD
  • asthma
  • neuromuscular issue
  • analgesia
  • drugs
  • CNS trauma

ALVEOLAR HYPOVENTILATION

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3
Q

Signs/symptoms of hypoxia?

A

SCCAR

  • SOB
  • cyanosis
  • confusion
  • agitated
  • restless
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4
Q

Signs/symptoms of hypercapnia?

A 
headache
tachycardia
bounding pulse
tremor/flap
peripheral vasodilation
confusion
drowsy
papilloedema
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5
Q

Why must caution be taken when prescribing O2 to a patient with T2RF?

A

If they are a chronic CO2 retained then their respiratory centre relies on HYPOXIA for respiratory drive (rather than high CO2) therefore give O2 carefully as too much can depress respiratory drive

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6
Q

What is the most common cause of metabolic acidosis?

A

diarrhoea (loss of HCO3)

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7
Q

What is the most common cause of metabolic alkalosis?

A

Vomiting (loss of H+)

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8
Q

What is anion gap and why is it used?

A

Used to work out the cause of a metabolic acidosis
Calculated by cations (Na+ and K+) - anions (HCO3- and CL-)

  • raised AG = presence of XS acid!
  • normal AG = metabolic acidosis due to HCO3- loss!
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9
Q

Definition of COPD

A

FEV1/FVC <70%
% predicted FEV1 <80%
CB and E

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10
Q

Describe features of blue bloaters and pink puffers

A

BB = CB
- mild late SOB, copious sputum, cor pulmonale, T2RF, cyanosis, flapping tremor

PP = E
- severe early SOB, scanty sputum, no cor pulmonale, T1RF, wheeze and use of accessory muscles

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11
Q

What ECG features might you find in COPD?

A

R heart strain = S1 (large S waves in V1), Q3 (Q waves present in V3) and T3 (T wave inversion in V3)

Also seen in a PE!

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12
Q

What are the GOLD stages of COPD and why are they used

A 
Used to guide treatment, based on FEV1 % of predicted
stage 1 (mild) = >80%
stage 2 (moderate) = 50-79%
stage 3 (severe) = 30-49%
stage 4 (v severe) = <30%
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13
Q

Describe the investigations for COPD

A 
CXR
Bloods (high PCV, ?a1-antitryptase deficiency)
spirometry (diagnostic)
ABG
CT
ECG
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14
Q

Describe the treatment of COPD

A

1 - lifestyle

2 - pharmacological:

  • SABA/SAMA first
  • if FEV1 >50% add LABA/LAMA OR if <50% add LABA+ICS
  • then consider theophyllines/mucolytics

3 - pulmonary rehabilitation

4 - LTOT (use >15hrs/day for benefit)

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15
Q

What is the treatment for an acute COPD exacerbation?

A 
Increase bronchodilator use
Steroids
Abx
Oxygen
Ben salbutamol/ipratropium
Oral pred
?Diuretics
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16
Q

Describe the pharmacological treatment of asthma:

A

SABA + low dose ICS
Add LTRA
Add LABA
change ICS to high dose

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17
Q

Describe asthma and the features of airway remodelling you would find

A

thicker smooth muscle
thickened mucosa
increased goblet cell secretions
increased leukocyte recruitment and cell degranulation

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18
Q

How do you monitor an acute asthma attack?

A

Assess severity of attack
oxygen, salb nebs, IV hydrocortisone, oral pred
Monitor ECG (?arrhythmias)
Consider ipratropium/IV magnesium

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19
Q

How do you define a severe asthma attack?

A

PEF 33-50% predicted
unable to speak in complete sentences
RR >25
HR >110

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20
Q

How do you define a life threatening asthma attack?

A

PEF <33% predicted
confusion/silent chest
bradycardia
low O2 sats

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21
Q

What is the most likely causative agent/s of a CAP?

A
  • strep pneumoniae
  • haemophilus influenza
  • staph aureus (common after the flu)
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22
Q

What is the most likely causative agent/s of a HAP?

A
  • staph aureus (common after the flu)

- pseudomonas aeruginosa (ventilators!)

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23
Q

What is the likely causative infectious agent in a young pt presenting with few clinical findings but their CXR shows a much worse than expected pneumonia, and they have been feeling generally unwell and possibly have erythema multiforme rash?

A

mycoplasma pneumoniae

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24
Q

What is the most likely cause of pneumonia in a patient who has recently been travelling and may have drunk contaminated drinking water, with multi-system derangement (low Na, high CK, D&V, LFT derangement?)

A

legionella pneumoniae

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25
Which type of pneumonia is commonly associated with birds and present with fever, epistaxis and joint pain?
chlamydophila psittaci
26
Which type of pneumonia is commonly associated with farmers/sheep/goats and present with Q-fever (flu-like symptoms)
coxiella burnetti
27
Define acute and chronic Q fever
``` acute = 2-3 week incubation period, flu-like symptoms chronic = endocarditis, hepatitis and osteomyelitis ```
28
Which type of pneumonia is commonly associated with alcoholics/poor dental hygiene?
klebsiella pneumoniae
29
What two types of pneumonia-infections are common in patients who are immunocompromised?
PCP (pneumocystis jirovecci) | Aspergillosis
30
What is the CURB65 score used for and describe its components
``` Confusion Urea >7 RR >/=30 BP <90 syst / <60 dias 65yrs +++ ``` Used for CAP to guide treatment
31
What antibiotics are commonly used to treat CAP?
amox clarithromycin levofloxacin
32
What antibiotics are commonly used to treat HAP?
doxycycline co-amox gent
33
What antibiotics are commonly used to treat aspiration pneumonia?
metronidazole
34
What antibiotics are commonly used to treat mycoplasma legionella?
macrolide (arythromycin) or tetracycline
35
What medicine/s are commonly used to treat PCP?
co-trimoxazole
36
What are the risk factors for PE? - think of the PERC score
PERC = pulmonary embolism rule-out criteria (use this score if you have a LOW suspicion of PE, and if none of the components are present than the probability of a PE is <2%) ``` H - hormone therapy (HRT/COCP) A - age >50 D - prev DVT/PE C - coughing up blood (haemoptysis) L - leg swelling discrepancy O - O2 sats <94% T - tachycardia >100 S - surgery/trauma in last 4 weeks ```
37
What are the components of Virchow's triad?
1) vessel injury 2) venous stasis 3) activation of the clotting system
38
Describe 3 signs/symptoms of PE?
Signs: - pleural rub - AF - lung crackles Symptoms: - pleuritic chest pain - SOB - haemoptysis
39
What is the treatment for a PE?
Carry out the 2 level Well's score Score >4 = PE likely -> immediate CTPA with interim DOAC, if CTPA positive then PE diagnosed, if CTPA negative then consider USS for DVT Score = 4 = PE unlikely -> do D-dimer within 4hrs, positive D-dimer then do CTPA, negative D-dimer then consider alternative diagnosis Patient unstable -> thrombolyse with alteplase Patient stable -> - Provoked DVT = 3 months DOAC - Unprovoked DVT = 6 months DOAC
40
What are the 5 types/causes of a pneumothorax?
``` Spontaneous - primary/secondary Traumatic - iatrogenic/chest wall injury Closed Open Tension ```
41
What are the treatment options for a pneumothorax?
Primary pneumothorax: <2cm and pt not SOB = self-resolve >2cm or pt SOB = aspiration If still >2cm or pt SOB after aspiration = chest drain Secondary pneumothorax: <1cm = give O2 and admit for 24hrs 1-2cm = aspirate >2cm or failed aspiration = chest drain
42
What are the subtypes of lung cancer?
SCLC - from neuroendocrine cell line - chemosensitive - normally not fit for surgery as mets at presentation NSCLC - from epithelial cell line - squamous cell, large cells, adenocarcinoma, mesothelioma - less chemosensitive but better candidates for surgery
43
What are the investigations and treatment options for lung cancer?
``` CXR CT Sputum cytology Bloods Bone scan Bronchoscopy ``` Treatment - surgery - radiotherapy - chemotherapy (better for SCLC) - palliative
44
Define and describe the pathophysiology of a pleural effusion
accumulation of an abnormal volume of fluid in the pleural space rate of accumulation > removal hydrostatic pressure > osmotic
45
Describe the causes and features (in Light's criteria) of a exudate:
- occur when local factors are altered e.g. inflammation/inflammation, increased capillary permeability - > high protein (>30g/L), LDH >2/3rds ULN, protein ratio in pleural fluid to serum is >0.5 - > usually unilateral - > clear, cloudy, blood stained fluid causes: - pneumonia - malignancy - TB
46
Describe the causes and features (in Light's criteria) of a transudate:
- occur when systemic factors are altered e.g. high hydrostatic pressure, low protein - > low protein (>30g/L), LDH <2/3rds ULN, protein ratio in pleural fluid to serum is <0.5 - > usually bilateral - > usually clear fluid causes: - HF - cirrhosis - renal failure
47
What investigations would you do for a suspected pleural effusion?
Bloods, CXR, aspiration and send for: - cytology - immunology - bacteriology - microscopy and culture
48
Describe the pathophysiology of OSA: | What are the signs and symptoms of OSA?
- recurrent episodes of partial/complete airway obstruction during sleep - caused by narrowing of upper airway (anatomical, obesity, neuromuscular dysfunction) S/Sx: - snoring, witnessed apnoea - choking, sweating, dry mouth - autonomic sympathetic response: vasoconstriction (HTN) and cardiac arrhythmias - reduced libido - fatigue - nocturia - poor concentration/mood - morning headache
49
What investigations are carried out for OSA?
- good Hx - examination: Mallampati score, BP, BMI, tonsils, ?nasal polyps, sleep questionnaire - polysomnography - epworth sleepiness scale - TOSCA (transcutaneous O2/CO2 assessment)
50
What are the treatment options for OSA?
``` weight loss mandibular advancement device avoid smoking and alcohol sleep position trainers CPAP Inform DVLA! ```
51
Describe the three categories of interstitial lung disease:
1 - Those with a known cause: drugs, occupational, infections... 2 - Those associated with systemic disorders: sarcoidosis, RA, renal tubular acidosis... 3 - Idiopathic: IPF, non-specific interstitial pneumonitis
52
Define and describe the pathophysiology of IPF:
- the commonest cause of interstitial lung disease - a type of progressive fibrosing interstitial pneumonia - causes can be: occupational, drug induced, genetic, idiopathic, viral - scarring and fibrosis affects the blood/gas barrier limiting O2 perfusion into the blood
53
Describe bronchiectasis and its causes:
abnormal dilation of bronchi chronic inflammation -> permanent dilatation -> sputum production increases -> scarring Can be congenital, post-infectious or other causes CONGENITAL: - CF, ciliary dyskinesia POST-INF: - pneumonia, measles, pertussis, bronchiolitis, TB... OTHER: - caused by bronchial obstruction (by a tumour/foreign body) - allergic aspergillosus - RA - UC - idiopathic
54
What are the main causative organisms of bronchiectasis?
Pseudomonas aeruginosa H influenza Strep pneumoniae Staph aureus
55
Define cor-pulmonale
RV dysfunction secondary to chronic respiratory disease Leads to pulmonary HTN and RV failure/enlargement/hypertrophy
56
What are the causes of cor-pulmonale
Obstructive - COPD - asthma - bronchiectasis Vascular - primary pulmonary HTN - vasculitis - PE - ARDS Restrictive - IPF - drugs - anatomy - neuromuscular Central - OSA - obesity
57
What might you hear when you listen to the heart of a patient with cor-pulmonale?
1) pansystolic murmur (TR) 2) S2 splitting (AV valve closes slightly before PV due to increased pulmonary pressure) 3) Gallop rhythm = tachycardia + 3/4th HS - > 3 HS = physiological in children - > 4 HS = pathological
58
How is cor-pulmonale managed?
Oxygen (LTOT) Furosemide Use of vasodilators
59
Define pulmonary oedema and its causes
Fluid accumulation in lung tissues and alveoli Can be cardiogenic or non-cardiogenic cardiogenic = heart failure! failure to remove blood from pulmonary circulation leading to increased hydrostatic pressure in pulmonary capillaries which pushes fluid into the lungs non-cardiogenic = ARDS, chronic high altitude, AKI/CKD, PE
60
What are the presenting features of pulmonary oedema?
``` Hamoptysis: bloody, frothy sputum SOB, orthopnoea and PND Reduced exercise tolerance Leg and abdominal swelling Cyanosis JVP Bibasal creps Displaced apex beat RV heave tachycardia and 3/4th heart sounds ```
61
Describe sarcoidosis and how it may present
A multi-system disease Non-necrotising granulomatous inflammatory disease Mainly affects lungs and intra-thoracic LNs Presents with dry cough, SOB, chest pain, splenomegaly, hepatomegaly, erythema nodosum and BHL (bilateral hilar lymphadenopathy) Raised ACE and Ca
62
Name causes of a raised AG
``` MUDPILES methanol uric acid (uricaemia) DKA Paraldehyde Iron/isoniazide Lactic acid Ethanol s aSpirin/salycilates ```
63
Name causes of a normal AG
diarrhoea | renal tubular acidosis
64
What is the only cause of increased vocal resonance?!
consolidation (pneumonia)
65
What are the 5 MRC stages of dyspnoea?
``` 1 - breathless on strenuous exercise 2 - breathless when walking up a hill 3 - breathless walking on flat ground 4 - breathless when walking <100m 5 - too breathless for ADL ```
66
Name a complication of quickly treating pneumothorax
re expansion pulmonary oedema
67
Name some complications of lung cancer
- local mets - SVC obstruction - non-metaplastic paraneoplastic syndromes - > cushings (ACTH secreting) - > SIADH (ADH secreting) - > hypercalcaemia (PTH secreting)
68
What is Meig's syndrome?
R sided pleural effusion + ovarian fibroma
69
How is IPF investigated?
Bloods (all normal + autoimmune condition screen) Imaging (CXR and CT - honeycomb) PFTs (restrictive pattern) Bronchoscopy -> BAL/biopsy Video-assisted lung biopsy Others: urinary Ca excretion (?sarcoidosis)
70
Name causes of fibrosis predominantly in the upper lobes of the lungs
``` CHARTS coal workers (pneumoconiosis) hypersensitivity pneumonitis ankylosing spondylitis radiation TB sarcoidosis ```

Year 4 (28 decks)

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