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Respiratory > Rep I > Flashcards

Rep I Flashcards

1
Q

Define asthma

A

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli

  • Hyper- responsiveness
  • Air flow obstruction
  • Inflammation
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2
Q

Outline the pathophysiology associated with asthma

A

ACUTE

  • Mast cell Ag interaction
  • Histamine release
  • Bronchoconstriction, mucus plugs and mucosal swelling

CHRONIC

  • Th2 cells release IL 3,4,5
  • Mast cell, eosinophil and B cell recruitment
  • Airway modelling
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3
Q

List the causes of asthma

A
  1. Atopy
    - T1 hypersensitivity
    - Dust mites, pollen, food, animals and fungus
  2. Stress
    - Cold air
    - Viral UTI
    - Exercise
    - Emotion
  3. Toxins
    - Smoking
    - Pollution
    - Drugs ( NSAIDs, B-blockers)
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4
Q

Signs of asthma

A 
Increased RR
Increased HR 
Widespread polyphonic wheeze 
Hyper inflated chest 
Decreased air entry 
Signs of steroid use
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5
Q

Key features in an asthmatic hx

A 
Precipitants 
Diurnal variation 
Exercise tolerance 
Life effect (sleep, work) 
Home and job environment
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6
Q

Outline the findings that would be seen on lung function tests

A

Spirometry

  • Obstructive pattern c FEV1:FVC = <0/75
  • > 15% improvement in FEV1 with B agonist
  • PEFR monitoring diurnal variation and morning dipping
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7
Q

Management of asthma

A
  1. SABA as required
  2. low dose ICS
  3. Add LABA to ICS asa combined treatment
  4. Consider increasing the dose of ICS
  5. Add on therapies
    - LTRA (Montelukast)
    - Theophylline
    - LAMA
  6. Oral steriods at the lowest dose possible
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8
Q

Signs of life threatening asthma

A
  • PEFR <33%
  • SpO2 <92%, PaO2 <8kpa
  • Cyanosis
  • Hypotension
  • Exhaustion, confusion
  • Silent chest with poor resp effort
  • Tachy/Brady/ arrhythmias
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9
Q

Define COPd

A 
Chronic bronchitis (cough and sputum production on most days) 
Emphysema 
Airway obstruction FEV1<80%, FEV1:FVC<0.72
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10
Q

Signs of COPD

A
  • Increase RR
  • Hyperinflation
  • Wheeze
  • Cor pulmonale ( increase JVP, loud p2 )

PINK PUFFERs
Normal Po2, normal or low PaCO2
Type I resp failure

BLUE BLOATERs
Retainers, high Co2
Type II resp failure

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11
Q

Investigations for COPD

A

CXR

  • Hyperinflation
  • Prominent pulmonary arteries
  • Peripheral oligaemia

ECG
- R atrial hypertrophy, p pulmonale

Spirometry

  • FEV1 < 80%
  • FEV:FVC 0.70
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12
Q

Management of COPD

A
  1. Stop smoking
  2. Offer pneumococcal and influenza vaccines
  3. Offer pulmonary rehabilitation if indicated

PHARMA

  • Offer either a SABA ( salbutamol) or a SAMA ( ipratorpium)
  • Offer either a LABA (salmeterol) or a LAMA (tiotorpium)
  • Combine LABA and LAMA and ICS
  • If the patients has asthma symptoms that respond to steroid add a ICS prior to adding in a LAMA
  • If the steroid has no improvement revert to LAMA and LABA
  • Also consider mucolyitics like carbocisteine
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13
Q

Guidelines with regards to LTOT in people with COPD

A
  • Serious outflow obstruction FEV1 <30%
  • Cyanosis
  • Polycythemia
  • Peripheral oedema
  • Increased JVP
  • O2 sats <92%
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14
Q

Classify pneumonia

A
  1. Community acquired pneumonia
    - S.aureus, Moraxella, Chlamydia
  2. Hospital Acquired pneumonia
    - >48hrs post admission
    - S aureus
    - grm -ve enterobacteria
  3. Aspiration
    - Anaerobes
  4. Immunocompromised
    - PCP
    - TB
    - CMV/HSV
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15
Q

Sings of pneumonia on CXR

A 
Consolidation 
Decreased expansion 
Dull percussion 
Bronchial breathing 
Decreased air entry 
Crackles 
Pleural rub
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16
Q

Name and discuss the scoring system for pneumonia

A

CURB-65

  • Confusion
  • Urea > 7mM
  • Resp rate >30
  • BP <90/60
  • > 65 yres
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17
Q

Abx management of pneumonia

A

CAP

  1. Mild: Amoxicillin 500mg TDS 5 days
  2. Severe: Co-amoxiclav 1.2g TDS

HAP
1. Tazocin (+/- vanco +/- gent)

Aspiration
1. Co-amoxiclav 625mg PO TDS

PCP: Co-trimoxale
Legionella: Clarithromycin + rifampacin

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18
Q

List the complications of pneumonia

A 
Respiratory failure 
Hypotension 
AF 
Pleural effusion 
Empyema 
Lung abscess (get swinging fevers with a lung abscess)
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19
Q

Describe the pathophysiology of bronchiectasis

A 
Chronic infection of the bronchi or bronchioles leads to permanent dilatation 
Airway damage and recurrent infection 
- H influenza 
- Pneumococcus 
- S aureus 
- Pseudomonas
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20
Q

Causes of bronchiectasis

A 
Congenital 
Post infections (measles, TB)
Immunodeficiency (hypogammaglobulinaemia)
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21
Q

Signs of bronchiectasis

A

Clubbing
Coarse inspiratory crackles
Wheeze
Purulent sputum (pneumococcus) (pseudomonas)

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22
Q

Investigations for bronchiectasis

A 
Sputum MCS 
Blood 
- Se Ig, Aspergillus, RF 
CXR
- Thickened bronchial walls (tramlines and rings) 
Spirometery 
- Obstructive pattern
HRCT 
- Dilated thickened airways
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23
Q

Management of bronchiectasis

A

Chest physio
Abx for exacerbations (ciprofloxacin 7-10days)
Bronchodilators

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24
Q

Outline the pathophysiology associated with CF

A 
Autosommal recessive condition 
Mutation in the CFTR gene on Chr7 
Defective CFTR protein is unresponsive to cAMP 
Transported of chloride ions is impaired
Decrease in luminal Cl- secretion 
Increase in NA reabsortion 
Results in viscous secretions 
Salty sweat
25
Q

CF is a multi system disease. Outline which systems are involved and how they are affected

A

Nasal: polyps
Resp: wheeze, cough, infections, pneumothorax
GI: Pancreatic insufficiency, gallstones, cirrohosis
Infertility
Low BMI

26
Q

Key organisms that affect CF patients

A

Early disease

  • s.aureus
  • h.influenza

Late

  • P.aeruginosa
  • b.cepacia
27
Q

Diagnosis of CF

A
  1. Sweat test NA and Cl > 600mM
  2. Genetic screening
  3. Faecal elastase
  4. Immunoreactive trypsinogen
28
Q

Management of CF patients

A

CHEST

  • physio
  • abx for infections
  • mucolytics (dnase)

GI

  • Creon
  • ADEK supplements
  • Insulin
  • Ursodeoxycholic acid, stimulate biles secretion

Gene therapy

29
Q

List the types of lung cancers

A
  1. SCC
  2. Adeno
  3. Large cells
  4. Small cell
30
Q

Discuss the pathology and behaviour of the following lunch cancers

  1. SCC
  2. Adeno
  3. Large cells
  4. Small cell
A

SSC

  • Centrally located
  • Keratinisation
  • Locally invasive
  • Metastasise late
  • Secrete PTHrP

Adeno

  • Peripherally located
  • Glandular differentiation
  • Mucin production
  • More common in females
  • Present with mets

Large cell

  • Large poorly differentiated cells
  • Poor prognosis

Small cell

  • Central located
  • Near bronchi
  • V chemosensitive but v poor prognosis
  • ectopic hormone secretion
31
Q

Test in the investigations of lung cancer

A 
Bloods (BC UEs Ca LFTs0
CXR 
- Coin lesion
- Hilar enlargement 
- Consolidation 
- Effusion  
Contrast enhanced Volumetric CT 
PET CT 
Radio nucleotide bone scan 
Biopsy
32
Q

CXR coin lesion differentials

A 
Foreign body
Abscess
Neoplasia 
Granuloma 
Structural (AVM)
33
Q

Management of lung ca

A 
MDT 
NSCLA
- Surgical resection
- Curative radiotherapy 
- Chemo

SCLA

  • Palliative radio
  • Rx obstruction
  • Analgesia
34
Q

Complications associated with lung cancer

A
  1. Local
    - recurrent laryngeal N.palsy
    - SVC obstruction
    - Horner’s syndrome
  2. Paraneoplastic
    - Endo
    SIADH
    Cushings
    Carcinoid
    PTHrP
  • Rheum
    Polymyositis

-Neuro
Peripheral neuropathy

  • Derm
    Acanthosis nigricans
  • Metastatic
    Path #
    Hepatic failure
    Addisons
35
Q

Classify pleural effusion and name the classy the criteria used to differentiate between the groups

A
  1. Transudates: effusion protein <25g/L
  2. Exudate: effusion protein > 35g/L

Between apply Lights

Exudate must have one of

  • serum protein ratio > 0.5
  • serum LDH ration > 0/6
  • LDH os 0.6 x ULN
36
Q

List the causes of exudates pleural effusion

A 
Increased capillary permeability 
Infection; pneumonia, Tb
Neoplasm: bronchial, lymphoma
Inflammation: RA, SLE
Infarction
37
Q

List the causes of transudates

A 
Increase capillary hydrostatic or decrease oncotic pressure 
CCF
Renal failure 
Decrease albumin 
Hypothyroidism 
Meig's syndrome 
- Right pleural effusion 
- Ascites 
- Ovarian fibroma
38
Q

Presentation of pleural effusion

A 
Can be asymptomatic or can present with dyspnoea and pleuritic pain 
Tracheal deviation 
Decreased expansion 
Stony dullness
Decrease air entry 
Beaware of associated disease 
CA
Liver disease 
RA
SLE
Hypothyroidism
39
Q

Define pulmonary hypertension

A

PA pressure > 25mmHg

40
Q

List the causes of pHTN

A
  1. Left heart disease
    - mitral stenosis
    - mitral regurgitation
    - l - r shunt
  2. Lung parenchymal disease
    - COPD
    - Asthma
    - Interstitial lung disease
    - CF
  3. Pulmonary Vascular disease
    - Scleroderma
    - SLE
    - Wegners
    - Sickle cell
    - Portal hypertension
41
Q

Investigations of pHTN

A

ECG

  • P Pulmonale
  • RVH
  • RAD

Echo
- Tricuspid regurgitation

Right heart catheterisation
- Gold standard

42
Q

Define Cor pulmonale

A

RHF due to pHTN

43
Q

List the signs of cor pulmonate on examination

A 
Increased JVP with a wave 
Left parasternal heave
Loud P2
Murmur 
Pulsatile hepatomegaly
44
Q

List the management of pHTN

A

Decrease pulmonary resistance

  • LTOT
  • CCB (nifedipine)
  • Sildenafil (PDE-5 inhibitors)

Cardiac failure

  • ACEi
  • Diuretics
45
Q

Classify the different types of pneumothorax

A
  1. Closed
    Intact chest wall, air leak from the lung to the pleural cavity
  2. Open
    Defect in the chest wall allows communication between the PTX and the exterior
  3. Tension
    Air enters pleural cavity through a one way valve and can’t escape
46
Q

List the causes of a pneumothorax

A

Spontaneous

  • No underlying disease, seen in young men and smokes
  • Underlying lung disease such as COPD, marinas, EDS,

Trauma

Iatrogenic

  • Central line insertion
  • PP ventilation
  • Biopsy
47
Q

Cause of mesothioloma

A

Asbestos exposure

Note prognosis is very poor, presents in a similar way to lung cancer.
It is important to notify patients of the compensation scheme that is available to them.

48
Q

Define Goodpastures disease

A

Acute glomerulonephritis and alveolar haemorrhage
Type II antigen-antibody reaction
Presence of antiglomerular basement membrane antibodies (Anti-GBM abs)
Bind to the kidney basement membrane and the alveolar membrane.
Complement cascade is activated
Attackes type IV collagen of basement membranes

49
Q

Key investigations for Goodpastures

A

Bloods

  • ESR
  • ANCA-ve
  • Anti- GBM antibodies (ELISA)

CXR

  • infiltrates pulmonary haemorrhage
  • patchy consolidation

Kidney biopsy
- crescentric glomerulonephritis

50
Q

Treatment for Goodpastures

A
  1. Remove circulating abs via plasmapheresis
  2. Place on high dose corticosteroids
  3. IV methylprednisolone + cyclophosphamide
51
Q

List the potential causes of hypersensitivity pneumonitis

A
  1. Bird’s fanciers lung
  2. Farmer’s and mushroom workers lung
  3. Malt workers lung
  4. Sugar workers lung
52
Q

Outline the CXR findings in hypersensitivity pneumonitis

A

Upper zone mottling
Hilar lymphadenopathy
Honey comb lung in acute cases

53
Q

Classify the different types of lung disease

A
  1. Associated with systemic disease
  2. Enviromental triggers
  3. Granulomatous disease
  4. Idiopathic
  5. Other
54
Q

Define sarcoidosis

A

Multi system granulomatous disorder of unknown cause
Mass of macrophages forming giant cells
Non caesating

55
Q

Outline the systems affect by sarcoidosis

A

Pulmonary

  • Bilateral hilar lymphadenopathy
  • Cough
  • Dyspnoea

Non pulmonary

  • Hepatomegaly
  • Splenomegaly
  • Conjunctivitis
  • Cardiomyopathy
  • Nephrocalcinosis
  • Enlargement of the paratoid glands
  • Bell’s palsy
56
Q

Outline the radiological staging of sarcoidosis

A 
Stage 0: Normal 
Stage 1: BHL 
Stage 2: BHL + pulmonary inflitrates 
Stage 3: as above
Stage 4: Progressive pulmonary fibrosis

Biopsy will reveal non casting granulomatous

57
Q

Treatment for patients with sarcoidosis

A

Acute

  1. Bed rest
  2. NSAIDs

Chronic
1. Steroids (prednisalone)

58
Q

Clinical features of pulmonary fibrosis

A 
Dry cough 
Excertional dyspnoea 
Weight loss
Cyanosis 
Finger Clubbing 
Fine end inspiratory crackles
59
Q

How does rheumatoid arthritis affect the lungs

A

Pleural adhesions
Fibrosing alveolitis
Rheumatoid nodules
Obliterative disease of the small bronchioles

Respiratory (2 decks)

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