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Respiratory > Overview of conditions > Flashcards

Overview of conditions Flashcards

COPD, asthma, pneumothorax, pleural effusion, empyema, resp failure, mesothelioma, pneumonia, pulmonary oedema

1
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease

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2
Q

What is COPD?

A

A (potentially partially reversible) condition where airflow progressively reduces over time, especially in expiration (there is greater resistance).

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3
Q

Who gets COPD?

A

Smokers, people in industrialised countries (air pollution)

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4
Q

How do patients with COPD present?

A

Breathlessness - that has developed over time
Productive cough
(Wheeze)

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5
Q

How do patients with COPD and chronic bronchitis present?

A

Productive cough
Infections with purulent sputum
Increasing breathlessness
Wheeze

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6
Q

What is the treatment for mild COPD?

A

SAMA = ipratropium

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7
Q

What is the treatment for moderate COPD?

A

LABA/LAMA combo

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8
Q

What are the complications/types of COPD?

A

Emphysema

Chronic bronchitis

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9
Q

What is the prognosis of COPD?

A

It is SOMETIMES partially reversible but is mainly palliative

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10
Q

How do you diagnose COPD?

A 
CXR
Arterial blood gas
Spirometry
Pulmonary function test
CT scan
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11
Q

What is a pleural effusion?

A

an abnormal collection of fluid in the pleural space

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12
Q

How do you diagnose pleural effusion?

A

Examination - dull percussion
CXR, CT scan
Pleural aspirate/biopsy - allowing biochem and cytology and culture

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13
Q

How do you treat a pleural effusion that isn’t malignant?

A

Drainage, if infectious then antibiotics and may need surgery

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14
Q

What is mesothelioma?

A

an uncommon, malignant tumour of the lining of the lung, causing pleural thickening causing the lung to shrink

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15
Q

Who gets it mesothelioma?

A

People who have been exposed to asbestos

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16
Q

How do patients with mesothelioma present?

A 
Breathlessness
Chest pain
Weight loss
Fever
Sweating
Cough
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17
Q

How do you diagnose mesothelioma?

A

Imaging
Pleural fluid aspiration
Biopsy

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18
Q

What is the treatment for mesothelioma?

A 
Palliative:
- radiotherapy
- chemotherapy
- pleurodese effusions
Can do surgery but only in clinical trials.
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19
Q

What is the prognosis for mesothelioma?

A

Palliative

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20
Q

What is the treatment for malignant mesothelioma?

A 
Drain, pleurodesis, long term pleural catheter
(Palliate symptoms
Repeated pleural taps
Talc slurry
Pleurodesis
Long term pleural catheters
Surgical options: abrasion, pleurectomy)
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21
Q

What is a pneumothorax?

A

Air in the pleural space

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22
Q

Who gets pneumothorax/more common in?

A

Tall thin men, smokers, cannabis users, underlying lung disease patients

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23
Q

How do patients with pneumothorax present?

A

Acute onset of pleuritic chest pain
SOB
Hypoxia

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24
Q

What are the signs that a patient has a pneumothorax?

A 
Tachycardia
Hyper-resonant percussion (extra hollow)
Reduced expansion
Quiet breath sounds on auscultation
Hamman's sign (click)
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25
Q

How do you diagnose someone with pneumothorax?

A

CXR

sometimes CT as well

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26
Q

What is the treatment for a pneumothorax?

A 
NO treatment if no symptoms (asymptomatic) and small
OTHERWISE
Oxygen
Aspiration in the 2nd intercostal space
if not enough time then...chest drain
MAY NEED
suction or surgical intervention
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27
Q

What is a tension pneumothorax?

A

When a pneumothorax is so large that it causes the lung to collapse and shift to the other side, displacing the trachea and heart

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28
Q

How do you diagnose a tension pneumothorax?

A 
No breath sounds
Tracheal deviation
Hypotension (low BP)
Raised JVP (jugular venous pressure)
Reduced air entry on the affected side
29
Q

What is the treatment for a tension pneumothorax?

A

Needle decompressions (2nd intercostal space (for emergency) vs the safety triangle)

30
Q

What is empyema?

A

A pleural effusion but pus instead of liquid

31
Q

What is the treatment for empyema?

A

Antibiotics (6 wks, co-amoxiclav)
Drain as needed
If doesn’t go away then surgeons remove it all and wash out the lung.

32
Q

What is asthma?

A

A recurrent and reversible (in the short term) obstruction to the airways in response to a substance that isn’t necessarily noxious and doesn’t normally affect non-asthmatic subjects.

33
Q

What is the asthma triad?

A

Reversible airflow obstruction
Airway hyperresponsiveness
Airway hyperinflammation

34
Q

Where does asthma affect?

A

BOTH the large and small airways

35
Q

What are the steps of the dynamic evolution of asthma?

A

Bronchoconstriction
Chronic airway inflammation
Airway remodelling
Inflammatory cascade

36
Q

What is the initial response in asthma?

A

Constriction of the bronchioles = bronchospasm

37
Q

What is the secondary response to asthma?

A

The immune response

38
Q

What permanent changes can asthma cause as a result of long standing inflammation?

A

Thickening of smooth muscle in bronchioles
Increased secretion of mucus
Accumulation of interstitial fluid
Epithelial damage, exposing sensory nerve endings
Sub-epithelial fibrosis

39
Q

Who gets asthma?

A

5-10% of the Population in industrialised countries.
Can be genetically predisposed
Non-smokers
Could be genetically predisposed

40
Q

How do asthmatics present?

A 
Wheezing (on expiration)
Struggling to breathe
Tight chest
Cough
Diurnal variability (bad at night and worse in the mornings)
41
Q

How is asthma diagnosed?

A

Challenge tests
Spirometry
Peak flow (how much can blow out)
Exercise testing

42
Q

What is the first line treatment for asthma?

A

SABA (salbutamol - blue inhaler) with an inhaled steroid (glucocorticoid - brown inhaler)

43
Q

If a SABA and an ICS doesn’t work for asthma what do you add in?

A

A LABA (salmeterol)

44
Q

If SABA, ICS and LABA doesn’t work for asthma what do you do?

A 
Increase the dose of the ICS
ADD: CysLT1 (LTRA) (Montelukast)
LAMA triple therapy (tiotropium)
xanthines (theophylline)
cromones (cromoglycate)
Anti-IgE (omalizumab)
Anti-IL-5 (mepolizumab)
Anti-IL4a (duplimab)
45
Q

What is the difference between restrictive and obstructive lung disease, give examples?

A

Obstructive have problems with expiration (COPD, asthma)

Restrictive have problems with inspiration (pulmonary fibrosis)

46
Q

what is the treatment for chronic asthma?

A

Avoid triggers
ICS
+/- non-steroidal anti-inflammatory (eg: theophylline, anti-leukotriene)
+/- LABA/LAMA to stabilise smooth muscle

47
Q

what is the treatment for acute asthma?

A 
Oral prednisolone
Nebulised high dose salbutamol 
\+/- neb ipratropium, IV aminophylline
At least 60% O2
Assisted ventilation if failing PaO2 and rising PaCO2
48
Q

what is the treatment for COPD as it progresses?

A 
LABA/LAMA combo
ICS/LABA/LAMA combo
PDE4 inhibitor (roflumilast
Mucolytic (carbocisteine)
Antibiotics (azithromycin)
49
Q

treatment of acute COPD?

A

Nebulised high dose salbutamol + ipratropium
Oral prednisolone
Antibiotic if infectious exacerbation (amoxycillin/doxycycline)
24-28% O2
Non invasive ventilation

50
Q

how do you distinguish between type 1 and 2 respiratory failure?

A

Type 1 is hypoxic with normal or low CO2

Type 2 is hypoxic and hypercapnic (high CO2)

51
Q

what is pneumonia?

A

inflammation of the lung, normally due to infection, resulting in consolidation on a CXR

52
Q

what are the types of pneumonia?

A 
community acquired
hospital acquired
aspiration pneumonia
legionella
atypical/walking pneumonia
53
Q

stages of lobar pneumonia?

A

congestion
red hepatization
grey hepatization
resolution

54
Q

what are the common causes of pneumonia? (3)

A

strep pneumonia
haem influenzae
staph aureus

55
Q

what are common community acquired pneumoniae?

A

mycoplasma pneumoniae
coxiella burnetiid
chlamydia psittaci
legionella pneumophilia

56
Q

what type of pneumonia is more common in alcoholics?

A

klebsiella

57
Q

what would you find when examining someone with pneumonia?

A

late inspiratory crackles

dull percussion

58
Q

what investigations would you do for pneumonia?

A 
CXR
blood culture
serology
PCR
ABGs
Bloods
Sputum
59
Q

what does the CURB65 mean and what is it used for?

A

used to assess severity of community acquired pneumonia.

Confusion
Urea (>7)
Resp rate (>30)
Bp (systolic <90, dia <61)
65 - age
60
Q

what is pneumothorax?

A

air in the pleural cavity

61
Q

what is pleural effusion?

A

fluid in the pleural cavities

62
Q

what is pulmonary oedema?

A

fluid in the alveolar spaces

63
Q

what is the general treatment for pneumonia?

A

amoxicillin or doxycycline if allergic
oxygen
fluids
bed rest

64
Q

why can’t you use penicillin for mycoplasma pneumonia?

A

it has no cell wall so is resistant

65
Q

what is the treatment for community acquired pneumonia?

A

tetracycline and macrolides

66
Q

what is the treatment for hospital acquired pneumonia?

A

amoxicillin and gentamicin

67
Q

what is the treatment for aspiration pneumonia and why>

A

amoxicillin and metronidazole (as need anaerobic cover as came from stomach)

68
Q

what is the treatment for legionella pneumoniae?

A

levofloxacin

Respiratory (8 decks)

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