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Respiratory AM > Obstructive lung diseases > Flashcards

Obstructive lung diseases Flashcards

1
Q

What are the airflow limitations in obstructive lung disease?

A

Peak flow reduced
FEV1 reduced
FVC may or may not be reduced
FEV1/FVC reduced

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2
Q

What are the causes of chronic bronchitis?

A 
Smoking
Atmospheric pollution
Occupation
Dust
Alpha1 antitrypsin deficiency
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3
Q

What is chronic bronchitis?

A

Cough productive of sputum most days in at least 3 consecutive months for 2 or more years

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4
Q

What are the morphological changes to large airways in chronic bronchitis?

A

Mucous gland hyperplasia
Goblet cell hyperplasia
Minor inflammation and fibrosis

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5
Q

What are the morphological changes t small airways in chronic bronchitis?

A

Goblet cells appear

Inflammation and fibrosis in longstanding disease

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6
Q

What are the causes of emphysema?

A 
Smoking
Atmospheric pollution
Occupation
Dust
Alpha1 antitrypsin deficiency
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7
Q

What is emphysema?

A

Increase beyond normal in the size of airspaces distal to terminal bronchiole arising from either dilation or destruction of their walls

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8
Q

What are the forms of emphysema?

A

Centriacinar
Panacinar
Periacinar
Scar

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9
Q

What is centriacinar emphysema?

A

Begins with bronchiolar dilation then alveolar tissue is lost

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10
Q

What is panacinar emphysema?

A

Permanent destruction of entire acinus distal to respiratory bronchioles

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11
Q

What are emphysemic spaces called?

A

Blebs and bullae

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12
Q

What are the mechanisms of airway obstruction in COPD?

A

Large airways- little contribution by glands and mucous
Small airways- smooth muscle tone, inflammation, fibrosis
partial collapse of airway wall on expiration
Loss of alveolar attachments

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13
Q

What is COPD?

A

Chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months

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14
Q

What is the prevalence of COPD?

A

1 million in UK diagnosed, but only about 50% of cases diagnosed
6th most common cause of death in UK

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15
Q

What are the causes of COPD?

A 
SMOKING
Chronic asthma
Passive smoking
Maternal smoking
Air pollution
Occupation
Alpha 1 antitrypsin deficiency
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16
Q

What si the typical COPD patient?

A

Over 40
Smoker/ex-smoker
Dyspnoea on exertion
Cough

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17
Q

What are the symptoms of COPD?

A 
Dyspnoea
Cough
Wheeze
Weight loss
Peripheral oedema
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18
Q

What is th differential diagnosis for COPD?

A 
COPD
Asthma
Lung cancer
LV failure
Fibrosing alveoli's
Bronchiectasis
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19
Q

What PMH may a COPD patient have?

A

Asthma as a child
Respiratory diseases
Ischaemic heart disease

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20
Q

What are the signs of COPD?

A 
Dyspnoea
Pursed lip breathing
Breathing using accessory muscles
Cyanosis
CO2 flap/tremor
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21
Q

What are the non respiratory symptoms of COPD?

A

Loss of muscle mass
Weight loss
Cardiac disease
Depression/anxiety

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22
Q

How is the severity of COPD assessed?

A 
FEV1 real vs predicted
>80% mild
50-79% moderate
30-49% severe
<30% very severe
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23
Q

What are the baseline tests for COPD?

A 
Spirometry
CXR- hyperinflation, tumours, heart problems 
FBC
BMI- lower BMI=more problems
alpha1 antitrysin if patient under 50
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24
Q

What are the methods of prevention of progression of COPD?

A

Smoking cessation

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25
Q

What are the relieving treatments for COPD?

A

Inhalers
Short acting bronchiole dilators- SABA and SAMA
Long acting bronchodilators- LABA and LAMA
High dose inhaled corticosteroids- reviler and fostair

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26
Q

What are the methods of prevention of COPD exacerbation?

A

Flu and pneumococcal vaccines

Pulmonary rehab- programme of exercise, education and support

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27
Q

What are the non-pharmacological managements of COPD?

A 
Smoking cessation
Vaccinations
Pulmonary rehab
Nutritional assessment 
Psychological support
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28
Q

What is the management of exacerbated COPD?

A

Short acting bronchodilators
Steroids- 40mg prednisone for 5-7 days
Antibiotics
Hospital admission- tachypnoea, low O2, hypotension

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29
Q

What is the treatment of COPD requiring hospital admission?

A

Nebulised bronchodilators
Corticosteroids
Antibiotics
Non invasive ventilation

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30
Q

What is a pulmonary embolism?

A

Am embolus that lodges in the lungs and normally originates in the deep veins of the legs

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31
Q

What are the risk factors for pulmonary embolism?

A 
Recent major trauma or surgery 
Cancer
Cardiopulmonary disease
Pregnancy
Inherited thrombophilia
Oral contraceptive
32
Q

What are the signs and symptoms of a small isolated peripheral pulmonary embolus?

A 
Pleuritic chest pain
Cough
Haemoptysis
Pyrexia
Pleural rub
Stony dullness to perfusion at base
33
Q

What are the signs and symptoms of a large PE blocking perfusion?

A

Breathlessness
Tachycardia
Tachypnoea
Hypoxia

34
Q

What are the signs of a massive central PE?

A 
Syncope
Reduced cardiac output
Acute loss of blood flow to brain
Cardiac arrest
Tachycardia
Tachypnoea
Hypoxia
Hypertension
35
Q

How is PE diagnosed?

A 
Small= CT pulmonary angiogram
Large= radiography
36
Q

What investigations are done fro PE?

A 
FBC, biochemistry, blood gases
CXR
ECG
D dimer
CT pulmonary angio
V/Q scan
Echo
37
Q

What is the prognosis of PE?

A

Small with anticoagulant treatment- good prognosis
Mortality 0-25% at 1 month
PESI score predicts mortality

38
Q

What is the treatment for PE?

A

Oxygen if hypoxic
Low molecular weight heparin while awaiting tests
Warfarin once diagnosis confirmed
Direct oral anticoagulants
Thrombolysis
Pulmonary embolectomy
Treated for 3 months but lifelong treatment recommended if high risk of recurring

39
Q

What is pulmonary hypertension?

A

Elevated blood pressure in pulmonary arterial tree >25 mmHg

40
Q

What are the causes of pulmonary hypertension?

A

Idiopathic
Secondary to chronic respiratory disease or left heart disease
Chronic thromboembolic PH
Micellanious- collagen vascular disease, portal hypertension, congenital heart disease, HIV

41
Q

What are the symptoms of pulmonary hypertension?

A

Exertional dyspnoea
Chest tightness
Exertional syncope/presyncope

42
Q

What are the signs of pulmonary hypertension?

A 
High JVP
RV heave
Loud pulmonary second heart sound
Hepatomegaly
Ankle oedema
43
Q

What investigations should be carried out for pulmonary hypertension?

A 
ECG
Lung function tests
CXR
Echo
V/Q scan
Right heart catheterisation
44
Q

What does right heart catheterisation allow for in pulmonary hypertension?

A

Allows direct measurement of pulmonary artery pressure

Measurement of wedge pressure and cardiac output

45
Q

What are the general treatment measures of pulmonary hypertension?

A

Treat underlying condition
Oxygen
Anticpagulation
Diuretics

46
Q

What are the specific treatment measures for pulmonary hypertension?

A 
Calcium channel antagonist
Prostacyclin
Endothelium receptor antagonists
Phosphodiesterase inhibitors
Thromboendarectomy
Lung/heart transplant
47
Q

What is the gene and disease prevalence for cystic fibrosis?

A

1 in 25

1 in 2500

48
Q

What are the clinical features of cystic fibrosis in infants and young children?

A

Recurrent chest infections

Failure to thrive

49
Q

What are the clinical features of cystic fibrosis in older children and adults?

A

Recurrent chest infections
Nasal polyps and sinusitis
Male infertility

50
Q

How is cystic fibrosis diagnosed?

A

Immunoreactive trypsinogen screening at 5 days
If positive, mutation analysis performed
Sweat test to check chloride levels- >60 indicative of CF

51
Q

What are the cardinal features of cystic fibrosis?

A 
Lungs= recurrent bronchopulmonary infection- pneumonia, bronchiectasis, scarring, abscesses 
Pancreatic= abnormal stools- pale/orange, greasy, oily, very offensive-, failure to thrive-  may do well on great milk, deficiencies of fat soluble vitamins, ADEK.
52
Q

How are infections prevented in cystic fibrosis patients?

A 
Segregation
Airway clearance and adjuncts
Mucolytics
Prophylactic antibiotics
Annual influenza vaccine
53
Q

What are the most common pathogens that infect those with cystic fibrosis?

A

In early life- staph aureus, H. influenzae

Later- pseudomonas aeruginosa

54
Q

How is chronic infection dealt with in patients with cystic fibrosis?

A

Suppress bacterial load
Treat infective exacerbations
Reduce inflammation- ibuprofen, azythromycin, prednisilone

55
Q

What are non respiratory manifestations of cystic fibrosis?

A 
GI= dysmotility- gusto-oesophageal reflux, distal intestinal obstruction, constipation/rectal prolapse
GI= coexistent disease- Crohn's, coeliac
Hepatomegaly
Upper airway polyps and sinusitis
Diabetes
Bones= osteopenia, arthropathy
Heat exhaustion
Bilateral absence of vas deferens
Vaginal candidiasis 
Stress incontinence
56
Q

What are the respiratory symptoms of cystic fibrosis?

A 
Reduced mucociliary clearance
Increased bacterial adherence 
Reduced endocytosis of bacteria
Aggressive progressive bronchiectasis 
Recurrent LRTI
Progressive airflow obstruction
Respiratory failure
Haemoptysis 
Pneumothorax
57
Q

What respiratory tract infections are treated with oral antibiotics in CF?

A

Staph
Haemophilus
Pneumococcus

58
Q

What respiratory tract infections are treated with IV antibiotics in CF?

A

Pseudomonas
Stenotrophomonas
Burkholderia

59
Q

What are some treatments of CF?

A

Treatment of infections
Ivacaftor
Lung transplant

60
Q

What is ivacaftor?

A

Drug that binds to CFTR and improves transport of chloride ions in CF
Only for patients with G551D gene- 5-10%

61
Q

What are indications for lung transplant in a CF patient?

A 
Rapidly deteriorating lung function
FEV1 <30% predicted
Life threatening exacerbations
Estimated survival
Increasing weight loss
Hypoxia at rest
Hypercapnia
Recurrent worsening sepsis
62
Q

What are the contraindications for lung transplant in CF?

A

Absolute- other organ failure, malignancy, significant peripheral vascular disease, drugs, nicotine, alcohol, active systemic infection, microbiological issues (Mycobacterium abscessus)
Relative- Other organ dysfunction, non compliance, steroids >20mg daily, abcense of social support, osteoporosis, low BMI, surgical risks (previous thoracic surgery)

63
Q

How is an acute asthma attack managed?

A 
Oxygen
Salbutamol (nebuliser)
Prednisilone 40mg/hydrocortisone 100mg
Ipratripium (nebuliser)
IV magnesium sulphate
64
Q

What are the cons of metered dose inhalers?

A

Needs coordinations
50-60% remains in mouth and pharynx
Elderly, young and v unwell can’t use

65
Q

What are the pros of using a metered dose inhaler with a spacer?

A

Low ora-pharyngeal deposition
Reduced speed or aerosol
Reduced risk of oral candidiasis and dysphagia with steroids

66
Q

What are the pros and cons of dry powder inhalers?

A

Less coordination required

Lot of ora-pharyngeal deposition

67
Q

What are the aims of asthma treatment?

A 
No daytime symptoms 
No night awakening due to asthma
No need for rescue medication
No asthma attacks
No limitation on activity
Minimal side effects from medication
68
Q

What is the 1st step of asthma treatment?

A

Short acting B2 agonists- salbutamol, terbutaline

69
Q

What is the 2nd step of asthma treatment and when is this given?

A

Inhaled corticosteroids- beclomethasone

When using reliever 3x a week, waking 1 night a week, symptomatic 3x a week

70
Q

What is the 3rd step of asthma treatment?

A

Long acting B2 agonist and ICS- fostair

71
Q

What is the 4th step of asthma treatment?

A

Inhaled long acting anti muscarinic- triputaline, relaxes bronchial smooth muscle, causes dry mouth, GI upset, headaches
Leukotrine receptor antagonists

72
Q

What is the 5th step of asthma treatment?

A

Long term oral steroids- 40mg prednisolone

73
Q

What are some steroid sparing drugs used in treatment of asthma?

A

Immunisuppressives

Methotrexate, ciclosporin, oral gold

74
Q

What are some non-pharmacological management options of asthma?

A 
Inhaler technique
Smoking cessation
Flu/pneumococcal vaccines
Co-morbidities
Allergen avoidance
75
Q

What are the signs of moderate acute asthma?

A

Increasing symptoms

PEF 50-75% predicted

76
Q

What are the signs of severe acute asthma?

A

PEF 33-50%
Resp rate >25
Pulse >110
Inability to complete sentences in one breath

77
Q

What are the signs of life threatening acute asthma?

A 
Altered convoys level
Exhaustion
Arrythmia
Hypotension
Cyanosis
Silent chest
Poor resp effort
PEF <33% predicted
SpO2 <92%
PaO2 <8kPa

Respiratory AM (10 decks)

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