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Medicine - Year 3 > Medicine - Respiratory > Flashcards

Medicine - Respiratory Flashcards

1
Q 
Lung Cancer
Types:
Symptoms:
Paraneoplastic Syndromes (6):
Risk factors:
Investigations:
Management:
Met locations:
A

Types:

  • Non-small cell, eg. squamous cell, adenocarcinoma
  • Small cell - very aggressive, surgical options not available, paraneoplastic syndromes

Symptoms: SOB, Cough, Haemoptysis, Weight loss, Supraclavicular lymphadenopathy

Paraneoplastic Syndromes: Phrenic nerve impingement (SOB), Recurrent Laryngeal Nerve palsy (Hoarse Voice), SVC obstruction (Facial swelling/distended veins), Horner’s syndrome in a Pancoast tumour, SIADH, Cushing’s syndrome, Hypercalcaemia (PTHrP OR lytic bone lesions), Lambert-Eason myaesthenic syndrome

Risk factors: Smoking, Increasing Age, FH, Asbestos

Investigations: CXR, Staging CT, US-Guided FNA for biopsy, Endobronchial ultrasound, PET-CT for mets

Management: Non-small cell = Lobectomy
Radiotherapy is first line after this - can be radical or palliative
Combination chemo-radiotherapy can work in small cell, but rarely
Palliative = Airway stents, Radiotherapy, Anxiolytics

Met locations: Cervical lymph nodes, Liver, Bones, Adrenal Glands

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2
Q 
COPD
Pathophysiology:
Chronic changes:
Causes:
Symptoms:
Signs:
Risk factors:
Investigations:
Management:
Complications:
A

Pathophysiology: Airflow obstruction that is progressive and not fully reversible. Encompasses emphysema and chronic bronchitis.

Chronic changes: Mucous gland hyperplasia and loss of cilia function, emphysematous change, fibrosis and remodelling of the airways

Causes: Smoking, A-1 antitrypsin, occupational exposure

Symptoms: Cough with sputum production

Signs: CO2 retention tremor, pursed lip breathing, hyperresonance, barrel chest, expiratory wheeze, ankle oedema due to pulmonary hypertension

Investigations: Spirometry (FEV1/FVC ratio <70%), ABG for respiratory failure, CXR for hyperinflation, a-antitrypsin

Management:
Outpatient: Smoking cessation, Pulmonary rehabilitation (6-12 week programme), Bronchodilators, Steroids, Mucolytics, Influenza vaccine/Pneumococcal, LTOT

Complications: Acute exacerbation of COPD

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3
Q

How do you calculate pack years? (eg. 30 a day for 35 years)

A

20/day for 1 year = 1 pack year

1.5*35

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4
Q

What are the stages of the MRC Dyspnoea scale?

A
  1. Breathless only with strenuous exercise
  2. Breathless when hurrying on a level ground or walking up a hill
  3. Walks slower than normal people or needs to stop for breath at own pace on level ground
  4. Stops for breath after 100m
  5. Too breathless to go outside or get dressed
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5
Q

Acute Exacerbation of COPD
Presentation:
Management:

A

Presentation: Severe SOB, Fever, Chest Pain, Raised WCC

Management:

  • Aim for 88-92% O2, controlled oxygen
  • Nebulised salbutamol and ipratropium
  • Oral prednisolone (then OD for 7 days)
  • Antibiotics
  • ABG
  • NIV if Type 2 Respiratory Failure
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6
Q 
Asthma: Chronic
Pathophysiology:
Presentation:
Common triggers:
Investigations:
Management:
A

Pathophysiology: - Hypersensitivity reaction leading to eosinophil release, mast cell degranulation, histamine and leukotriene release, leading to smooth muscle contraction
- Leads to: Goblet cell hyperplasia -> more mucous production/mucous plug, smooth muscle hyperplasia and hypertrophy, mucosal swelling, airway remodelling in long-term asthma
- Expiratory outflow obstruction
Reversible

Presentation: Dry cough, wheeze, breathlessness, chest tightness

Common triggers: Smoking, Allergens, dust mites, cold, exercise, aerosols

Investigations: Peak flow <70% (Obstructive)

Management:
Step 1: SABA (Salbutamol)
Step 2: SABA + ICS (Beclomethosone)
Step 3: SABA + ICS + Leukotriene receptor antagonist (Montelukast)
Step 4: SABA + LTRA + LABA/ICS combined (Salmeterol)

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7
Q

Acute Asthma
BTS Asthma Severity Guidelines:
Treatment of acute asthma attack:

A

Asthma severity:

  • Mild - >75% PEFR
  • Moderate - 50-75% PEFR
  • Severe - 33-50% PEFR, Cannot complete sentences in one breath, RR>25, HR >110
  • Life threatening - <33%, <92% sats, Cyanosis/Poor respiratory effort, exhaustion, confusion, hypotension, normal pCO2
  • Near Fatal - Raised pCO2/Need a ventilator

Asthma treatment:

  • Oxygen, aiming for 94-98% titrated via ABG
  • Salbutamol nebuliser
  • Oral Prednisolone/IV Hydrocortisone
  • Ipratropium Bromide nebulisers
  • ITU
  • Magnesium Sulphate
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8
Q 
Pneumothorax
Pathophysiology:
Causes:
Symptoms:
Signs:
Risk factors:
Investigations:
Management:
A

Pathophysiology: Communication between pleural space and the atmosphere, air flows from the atmosphere, into the pleural cavity - loss of elastic recoil of the lung (due to loss of pleural seal)

Causes: Primary: Commonly in young, tall men who smoke - bulla bursts
Secondary: COPD, Asthma, Bronchiectasis, Lung cancer, Trauma, Pneumonia

Symptoms: SOB, Chest Pain, Cough (dry)

Signs: Tracheal deviation (tension-only), dyspnoea, hyper-resonant, tachycardia, reduced lung expansion, absent breath sound

Risk factors: Male, Smoking, Lung disease, Being tall, Marfan’s disease, Mechanical Ventilation

Investigations: X-ray

Management: Oxygen, Aspirate, Chest Drain in 5th intercostal space, mid-axillary line

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9
Q

Tension Pneumothorax
Pathophysiology:
Symptoms:
Management:

A

Pathophysiology: When air can enter the pleural cavity, but cannot escape because of a flap, causing pressure to increase

Symptoms: SOB, hypotension, tachycardia, silent breath sounds, tracheal deviation, pleuritic chest pain

Management: Venflon into the second intercostal space, mid-clavicular line and chest drain

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10
Q 
Interstitial Lung Disease
Name 5 types of ILD:
Pathophysiology:
Symptoms:
What drugs cause ILD (2):
A

Types: Idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, sarcoidosis, asbestosis, non-specific pneumonitis

Pathophysiology: Restrictive pattern on spirometry, reduced compliance but increased elastic recoil, leading to reduced lung volume

Symptoms: Exertional SOB, dry cough, clubbing, weight loss, dry inspiratory wheeze, fine crackles

ILD drugs: Methotrexate, Amiodarone, Ciprofloxacin, Nitrofurantoin

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11
Q 
Sarcoidosis
Pathophysiology:
Symptoms:
Investigations:
Management:
A

Pathophysiology: Multisystem inflammatory condition with non-caseating granulomas, causes lung fibrosis when granulomas heal

Symptoms: Erythema nodosum, SOB, cough, clubbing, fine crackles

Investigations: Peak flow, CXR (BILATERAL HILAR LYMPHADENOPATHY), Renal Function, Calcium (hypercalcaemia occurs), ECG

Management: 80% go into remission spontaneously, only treat if signs of skin disease, uveitis, persistent hypercalcaemia - then give corticosteroids

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12
Q

Name 3 causes of Bilateral Hilar Lymphadenopathy on an X-ray

A
  1. Sarcoidosis
  2. Tuberculosis
  3. Lymphoma
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13
Q 
Pulmonary Embolism
Causes:
Symptoms:
Signs:
Risk factors:
Investigations:
Wells Score:
Management:
Complications:
A

Symptoms: Tachycardia, SOB, DVT. low BP, Sats drop, Haemoptysis

Signs: Raised JVP, hypotension, DVT

Risk factors: Surgery, Immobilisation, Pregnancy, Malignancy, Varicose Veins, Obesity, COCP

Investigations: CTPA, CXR, ABG, ECG, D-dimer, Wells Score

Management: Oxygen, Fluid resuscitation, enoxaparin, thrombolysis if massive PE, continued DOAC for 3 months if identified cause, or lifelong if not

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14
Q

Wells Score - define:

A 
Wells Score: Can Not Treat If Surgical PE, Help ME
Clinical suspicion of PE - 3 
No other likely differential - 3
Tachycardia - 1.5
Immobilisation or Surgery - 1.5
PE/DVT in the past - 1.5
Haemoptysis - 1
Malignancy - 1

> 4 PE likely

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15
Q

Name the 5 signs of PE on an ECG:

A
  • Sinus tachy
  • S1Q3T3
  • RBBB
  • RV Strain
  • Right Axis Deviation
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16
Q

Thrombolysis
Contraindications:
Complications:

A

Contraindications: Haemorrhagic stroke within 6 months, CNS neoplasia, recent surgery, recent GI bleed, aortic dissection

Complications: Haemorrhage, Hypotension, Systemic embolisation of thrombi, Allergy

17
Q 
Pleural Effusion
Pathophysiology:
Causes (Exudate and Transudate):
Symptoms:
Signs:
Investigations:
A

Pathophysiology: Dysfunction of either production or absorption

Causes (Exudate and Transudate):
Exudate (>30g/L of protein): Pneumonia/TB, RA/SLE, Malignancy, Pancreatitis, Pericarditis

Transudate: Heart Failure, Hypoalbuminaemia (cirrhosis/nephrotic syndrome), PE, Meig’s syndrome (fibroma)

Symptoms: Breathlessness, chest pain, cough, gradual onset

Signs: Tracheal deviation, dyspnoea, reduced lung expansion, stony dull percussion, reduced vocal resonance

Investigations: CXR, Echo, ECG, Thoracentesis (USS-guided chest drain)

18
Q 
Pneumonia
Pathophysiology:
CAP Organisms:
HAP Organisms:
Atypical Oraganisms:
Symptoms:
Signs:
Investigations:
Management:
Complications:
A

Pathophysiology: Inflammation of the lung parenchyma due to infection

CAP: Strep pneumoniae, H influenzae, Moraxella Catarrhalis
HAP: Staph aureus
Atypical: Legionella, Mycoplasma, Chlamydia

Symptoms: Fever, cough/sputum production, pleuritic chest pain, SOB, vomiting/malaise

Signs: Crackles, pyrexia, tachycardia, tachypnoea, cyanosis, bronchial breathing

Investigations: CURB-65 score, ABG, CXR, FBC, U&Es, CRP

Management: Amoxicillin or Co-Amoxiclav if >3 CURB-65, Flu/Pneumococcal vaccine

Complications: Sepsis, Lung Abscess, Pleural Effusion, Empyema, Resp Failure, Pneumothorax

19
Q

CURB-65 - define:

A
  • Confusion
  • Urea >7mmol/L
  • Respiratory rate > 30
  • BP <90 or <60
  • Over 65
    > 3 = IV Co-amoxiclav
20
Q 
Tuberculosis
Pathophysiology:
Causes of reactivation:
Symptoms:
Signs:
Investigations:
Latent TB detection:
Management:
A

Pathophysiology: Mycobacterium tuberculosis - must write pulmonary TB in the exam. Macrophages engulf mycobacterium and form primary focus. TB can drain out of this and into lymph nodes to cause systemic TB. Mostly develops into latent TB. 10% reactivate, 5% within 2 years.

Causes of reactivation: HIV, IVDU, Organ transplants, Diabetes

Symptoms: Fever, Night sweats, weight loss and anorexia, cough, pleural effusion

Signs: Erythema Nodosum, Meningitis, Pericardial effusion

Investigations: CXR, Acid fast bacilli, HIV test

Latent TB: Tuberculin (Mantoux) (measures cell response to tuberculin from mycobacterium cell wall) via hypersensitivity reaction if previously exposed. False positive with BCG, False negative in immunosuppressed.
QuantiFERON/IGRA: Detects interferon and T-cell response. Cannot tell the difference between latent and active TB, but not affected by BCG.

Management: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol - All for 2 months, then Rifampicin and Isoniazid for 4 months, compliance must be monitored eg. directly observed therapy, Notify authorities as notifiable disease

21
Q

Name 5 systemic signs of TB

A
  • Miliary TB - wide dissemination of TB nodules via the lymph nodes
  • Tuberculous meningitis
  • Pericardial effusion
  • Swollen lymph nodes/Scrofula
  • Potts Disease
    12 months treatment + steroids for CNS TB meningitis, 6 months + steroids for pericardial effusion
22
Q 
Bronchiectasis
Pathophysiology:
Causes:
Organisms:
Symptoms:
Investigations:
Management:
Complications:
A

Pathophysiology: Chronic dilation of the bronchi, exhibiting poor mucous clearance and increased disposition

Causes: TB/Pertussis, Hypogammaglobulinaemia, CF, Young’s syndrome (bronchiectasis, sinusitis, reduced fertility), Primary ciliary dyskinesia, Kartagener’s (bronchiectasis, sinusitis, situs inversus), RA

Organsisms: Pseudomonas aeruginosa, Haemophilus influenzae

Symptoms: Recurrent infections, daily productive cough, breathlessness, intermittent haemoptysis

Investigations: High resolution CT thorax - signet ring sign

Management: Physiotherapy to help with mucous clearance, sputum sampling and prophylactic antibiotics, hypertonic saline nebuliser, flu vaccine, pulmonary rehabilitation if MRC Dyspnoea > 3

23
Q

What type of X-ray is used to look at the lungs?

A

PA

24
Q

What two conditions cause mediastinal push away?
What is the definition of a “large” pneumothorax?
What sound will be heard on percussion of a pleural effusion?

A

1: Pleural effusion, tension pneumothorax
2: >2cm away from the lung walls
3: Dull sound/Stony dull

25
Q

Respiratory Failure
Types and definitions:
Causes of Type 1:
Causes of Type 2:

A

Types:
Type 1 = O2 <8kPa and normal or low pCO2 - Hyperventilation
Type 2 = O2 <8kPa) and high CO2 - Hypoventilation

Type 1 causes: Hyperventilation, Asthma, ARDS, Pneumonia, PE, Fibrotic lung disease

Type 2 causes: Hypoventilation eg. opiate OD, head injury, severe COPD, scoliosis

26
Q

What is the management of acute anaphylaxis?

A

Oxygen
IM adrenaline 0.5mg 1:1000 every 5 minutes
IV hydrocortisone
IV chlorphenamine
Nebulised salbutamol for bronchospasm
Nebulised adrenaline for laryngeal oedema

27
Q 
Obstructive Sleep Apnoea
Pathophysiology:
Causes:
Symptoms:
Investigations:
Management:
Complications:
A

Pathophysiology: Upper airway narrowing during sleep, causing sleep fragmentation

Causes: Obesity causing reduced pharyngeal size, neuromuscular disease, alcohol, increasing age

Symptoms: Highly fragmented sleep, excessive daytime sleepiness (epworth sleepiness scale), hypertension

Investigations: Overnight oximetry/sleep studies

Management: Weight loss, extra pillows, reduce alcohol, mandibular advancement device, CPAP

Complications: DVLA must be informed

28
Q 
Cystic Fibrosis
Pathophysiology:
Symptoms:
Investigations:
Management:
Complications:
A

Pathophysiology: CFTR gene mutation, leading to ineffective chloride ion transport and thickened mucous

Symptoms: Meconium ileus, intestinal malabsorption, chest infections, distal intestinal obstruction syndrome

Investigations: Genetic test/ newborn screening/sweat chloride concentration test

Management: No smoking, avoid other CF sufferers, avoid ill people, annual influenza immunisation

Complications: Respiratory infections, low body weight, distal intestinal obstruction syndrome, CF-related diabetes

29
Q

What is the treatment for COPD long-term?

A

Low level: SABA + LAMA (Salbutamol and Tiotropium)
Mid level: SABA + LAMA + LABA (Salmeterol)
High level: SABA + LAMA + LABA + ICS

Medicine - Year 3 (6 decks)

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