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Year 3 core conditions > repsiratory > Flashcards

repsiratory Flashcards

1
Q

what is asthma?

A

chronic inflammatory disorder characterised by recurrent episodes of typical symptoms: wheee, chest tightness, breathlessness, cough + airflow obstruction, hyper responsiveness and airway inflammation

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2
Q

2 types of asthma

A

extrinsic/atopic childhood asthma: triggered by inhalational of allergens

intrinsic/ non-atopic adult onset: progressive and less responsive to therapy

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3
Q

what is an asthma attack?

A

worsened symptoms over a period of hours to days not responsive to patients normal asthma medications

requires either an increase in normal treatments or new more complex treatment

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4
Q

who gets asthma?

A

1 in 12 children
1 in 10 adults
males more than females in childhood then opposite in adults

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5
Q

causes of asthma

A

atopy
genetic
environment: allergen exposure, occupational factors, viral infections, drugs, maternal smoking, hygiene hypothesis

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6
Q

risk factors of asthma

A 
personal or family history of atopy
air pollution
obesity
prematurity and low birth weight 
viral infections in early childhood
maternal smoking
smoking
early exposure to broad spec Abc
beta blockers
anti inflammatory drugs
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7
Q

pathophysiology of asthma

A

allergen induced airway inflammation = smooth muscle constriction, thickening of airway wall, basement membrane thickening and mucus and exudate in airway lumen

airway remodelling -

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8
Q

presentation of asthma

A

typical episodic symptoms: breathlessness, chest tightness, cough, wheeze

diurnal variation
reduction on holiday or at home (occupational)
sputum
triggered by cld air, URTI, exercise, pollution, allergen, occupation

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9
Q

signs on examination of asthma

A 
tahcypnoea
wheeze - polyphonic
hyperinflated chest
hyper reosnant to percussion
decreased air entry
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10
Q

acute asthma signs

A

severe attack = inability to complete sentences, pulse>110, RR > 25, PEFR 33-55%

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11
Q

investigations for asthma

A

peak flow - diurnal variation
spirometry - does FEV1 improve with bronchodilator?
exercise tests
prednisolone trial
CXR to rule out other causes
skin prick, blood tests and allergen provocation tests to find triggers

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12
Q

treatment of asthma

A

step wise approach

salbutamol
\+ low dose ICS
\+ low dose ICS + LABA
\+ medium dose ICS +LABA
\+high dose ICS + LABA + omalizumab
\+ high dose ICS + LABA + oral corticosteroid + omalizumab
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13
Q

acute asthma treatment

A

O SHIT ME

Oxygen 15L non rebreathe mask
Salbutamol 5mg nebulizer every 15-30min
Hydrocortisone 200mg IV or prednisolone 40mg oral
Ipratropium bromide IV 0.5mg 4-6hts
Theophylline
Magnesium sulphate 2g IV
Extra help
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14
Q

what is COPD

A

progressive lung disease characterised by airflow obstruction with little or no reversibility

chronic bronchitis + emphysema

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15
Q

who gets COPD

A

> 50 yo
insidious onset
more in men
smokers

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16
Q

risk factors for COPD

A

tobacco smoking
occupation exposure - dust, chemicals, noxious gas, particles
air pollution
genetics - homoxygous antitrypsin deficiency?

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17
Q

pathophysiology of COPD

A

damage to lung by 3 mechanisms

  • inflammatory cell activation by cigarrete smoke
  • oxidative stress
  • impaired mucociliary clearance
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18
Q

presentation of COPD

A

progressive SOB
reduced exercise tolerance
persistent cough
chronic sputum production
wt loss, peripheral muscle weakness or wasting
frequent infective exacerbations occur giving purulent sputum

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19
Q

signs on examination of COPD

A

pink puffers - breathlessness is predominant problem, they’re not cyanosed

blue bloaters - hypoventilation, cyanosed, oedematous, CO2 retention

red flag = clubbing - lung cancer until proven otherwise

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20
Q

investigations for COPD

A

gold standard = spirometry
FEV1/FVC ratio <0.7 = presence of persistent airflow limitation

severity classified in terms of effect on lung function

pulse oximetry, CXR, FBC, sputum culture, A antitrypsin, ECG/ECHO

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21
Q

management of COPD

A

smoking cessation
bronchodilators - step wise approach, inhaled tiotropium bormide, short acting beta antagonist, long acting B2 agonist added

corticosteoids

prevention of infectiosn - vaccines

oxygen

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22
Q

complications of COPD

A

exacerbations
respiratory failure
cor pulmonale
lung cancer

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23
Q

what is bronchial carcinoma

A

95% of primary lung tumours
most common malignant tumour in western world
more in men 3:1

24
Q

types of bronchial carcinoma

A

small cell 20-30% - in endocrine cells, repsonds to chemo, mets common, poor prognosis

non-small cell (squamous, large cell, adenocarcinoma) -

25
Q

risk factors for bronchial carcinoma

A

smoking
urban areas
passive smoking
exposure to asbestos and possibly also contact with arsenic, chromium, ron oxides and products of coal combustion

26
Q

presentation of bronchial carcinoma

A

local effects of tumour - cough, chest pain, haemoptysis, breathlessness

spread within chest - pain and bone fractures, pancoasts tumour - horners syndrome, spread to LRL nerve - coarseness and bovine cough,

metastatic disease - bone, brain are common

non metastatic manifestations, - finger clubbing, malaise, lethargy, weightloss, lymphadenopathy

27
Q

investigations of bronchial carcinoma

A

confirm diagnosis y CXR
determine histology by biopsy via bronchoscopy or tranthoracic FNA

assess spread of tumour by PET CT

28
Q

treatment of bronchial carcinoma

A

non-small cell lung cancer - surgeyr, neoadjuvant chemo, radiotherapy

small cell - chemo and radiotherpay for limited disease, just chemo for extensive disease, very poor prognosis

29
Q

causes of pneumothorax

A

tension penumothorax - pleural tear acts as one way valve for air. unilateral increase in intrapleural pressure

spontaneous - tall, young and thin men, rwuslt of rupture of a pleural bleb (congenital defect in connective tissue of alveolar wall)

secondary - pneumothorax associated with underlying lung disease (COPD)

30
Q

presentation of Pnuemothorax

A

sudden onset of pleuritic chest pain and breathlessness

31
Q

signs on examination of pneumothorax

A

reduced breath sounds

hyperessonant percussion

32
Q

investigations of pneumothorax

A

standard PA chest XR to confirm diagnosis

CT differentiates emphysematous bullae from pneumothoracies and prevent potentially dangerous aspiration

CT detects small pneumothoracies

33
Q

treatment of pneumothorax

A

if breathless

aspirate air

if failure to re-expand lung

intercostal tube drainage

if still no re expansion after 48hrs , then surgery pleurectomy or pleurodesis

34
Q

causes of pleural effusion - unilateral

A

transudate - protein <30g/L

  • caused by imbalance of hydrostatic forces
  • heart failure, hypoalbuminaemia, constrictive pericarditis, hypothyroidism, ovarian fibroma

exudate >30mg protein
- infection, malignancy, PE with infarction, connective tissue disease,

35
Q

presentation of pleural effusion

A

may be asymptomatic if small but breathless if large

reduced chest wall movements
stony dull to percussion
absent breath sounds
reduced vocal resonance`

36
Q

investigations of pleural effusion

A

CXR - mensicus visible on erect
diagnostic pleural fluid aspiration - appearance noted and sent to cytology

contrast enahnced CT if diagnosis remains unclear

pleural biopsy - for tissue diagnosis

37
Q

treatment of pleural effusion

A

exudates - drain

transudates - treat underlying causes

malignant effusions - treat by aspiration followed by installation of sclerosing agent into pleural space - talc, tetracycline, bleomycin

38
Q

cuases of lobar pneumonia

A

inflammation of lungs caused by bacteria

classified anatomically - lobar, bronchopneumonia

TB also is cause

can be caused by aspiration of vomit and radiotherapy

39
Q

risk factors of lobar pneumonia

A 
underlying lung disease
smoking
alcohol abuse
immunosuppression
other chronic illness
40
Q

presentation of lobar pneumonia

A

pyrexia, respiratory symptoms (cough, sputum, pleurisy, dyspnoea), signs of consolidation and pleural rub,

41
Q

important history questions for pneumonia

A 
contact with bird (psittacosis)
farm animals
recent stays in large hotels 
chronic alcohol abuse
IV drug abuse
contact with other patients with pneumonia
42
Q

signs on examination of pneumonia

A

CURB 65

Confusion
Urea >7mmol/L
Respiratory rate >30/min
Blood pressure <90/<60

43
Q

investigations for pneumonia

A 
CXR - only this if outpatient
sputum 
blood tests
serology
ABG
urine
44
Q

treatment of pneumonia

A

pleuritic pain = analgesia
hypoxaemia = oxygen
fluids
physiotherapy
HAP: coamoxiclav 3x daily or more severe cases use second generatio cephalosporin
metronidazole dded in those at risk of anaerobic infection

antibiotic treatment adjusted after MC+S results

45
Q

causes of PE

A

most common = DVT in lower limb

other sources - tumours, fat, amniotic fluid, sepsis, foreign bodies, air

46
Q

risk factors of PE

A 
DVT
prev DVT or PE
active cancer
recent surgery hospitalisation
lower limb trauma
immobilisation
pregnancy
47
Q

presentation of PE

A

dyspnoea
tachypnoea
pleuritic chest pain
features of DVT

48
Q

signs on examination of PE

A 
tahcycardia
haemoptysis
syncope
hypotension
crepitations
cough or fever
49
Q

investigations for PE

A

wells score

CXR, ABG, ECG
ddimer for exclusion

spiral CT with IV contrast
radionuclide lung scan (demonstrates areas of ventilated lung with perfusion defects)

50
Q

treatment of PE

A

high flow oxygen if hypoxemic

thrombolysis for massive embolism

surgical embolectomy occasionally if thrombolysis contraindicated or ineffective

analgesia

prevention of further: LMWH, oral warfarin

51
Q

who gets pulmonary fibrosis

A

late 60s

more common in males

52
Q

what is pulmonary fibrosis

A

restrictive lung disease
patchy fibrosis of the interstitium and minimal or absent inflammation, acute fibroblastic proliferation and collagen deposition

53
Q

risk factors of pulmonary fibrosis

A

cigarette smoking
viral infections
exposure to environmental pollutants, inc silica and hard metal dusts
bacteria and animal proteins and gases and fumes
use of certain meds
genetics
GORD

54
Q

presentation of pulmonary fibrosis

A

progressive breathlessness and non-productive cough

eventually, resp failure, pul hypertension and cor pulmonale

finger clubbing in 2/3 and fine inspiratory basal crackles heard on auscultation

acute form = hamman-rich syndrome

55
Q

investigations of pulmonary fibrosis

A

CXR appearances are initially of a ground glass appearance progressing to fibrosis and a honeycomb lung

changes mostly in lower lung zones

high res CT most sensitive imaging

blood tests: hypoxaemia with normal PacO2 autoantibodies such as antinuclear factor and rheumatoid factor in 1/3

histological confirmation is required in some patients

56
Q

treatment of pulmonary fibrosis

A

large doses of prednisolone daily
azathioprine and cyclophosphamide can be tried

single lung transplantation now an established treatment in some patients

Year 3 core conditions (15 decks)

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