Resp Flashcards
1
Q
What are the anatomical classifications of Pneumonia?
A
Bronchopneumonia (patchy consolidation of different lobes) Lobar Pneumonia (Congestion, Red Hepatisation, Grey Hepatisation, Resolution)
2
Q
What are the four aetiological classifications of Pneumonia?
A
Community Acquired, Hospital Acquired, Immunocopromised, Aspiration
3
Q
Name three causative organisms of Community Acquired Pneumonia
A
Streptococcus Pneumoniae, Haemophilus Influenza, Moraxella Catarrhalis
4
Q
Name three causative organisms of Hospital Acquired Pneumonia
A
Staphylococcus Aureus (inc MRSA), Klebsiella Pneumoniae, Pseudomonas Auerginosa
5
Q
Name two causative organisms of Immunocompromised Pneumonia
A
Pneumocystis Jiroveccii (fungi) and TB
6
Q
What type of organisms are responsible for aspiration pneumonia?
A
Anaerobes
7
Q
What lung is more likely to be affected by aspiration pneumonia
A
Right
8
Q
Name four symptoms of Pneumonia
A
Dyspnoea, Cough (Purulent), Fever, Pleuritic Chest Pain
9
Q
Name four signs of Pneumonia
A
Tachycardia, Tachypnoea, Cyanosis, Confusion
10
Q
What would you find OE of Pneumonia?
A
Decreased expansion, Dull percussion, Bronchial Breathing, Increased vocal resonance, Crackles
11
Q
What are you looking for on a CXR of Pneumonia?
A
Infiltrates, Cavities, Effusion
12
Q
When would you do an ABG in a pneumonia patient?
A
if pO2<92%
13
Q
Apart from a CXR and ABG, name three investigations you could do for pneumonia, and what would you expect them to show?
A
Urine - Pneumococcal/Legionella antigens
Bloods - raised WCC, raised CRP, raised urea
Sputum - Microscopy, culture and staining
14
Q
How is the severity of pneumonia scored?
A
CURB 65 - actually calculates the mortality but from this the severity can be inferred
Confusion, Urea>7mmol/l, Resp Rate>30, BP Systolic<90, Age>65
15
Q
What is the management of mild CAP?
A
500mg Amoxicillin for 5 days
16
Q
What is the management of moderate CAP?
A
500mg Amoxicillin AND 200mg Doxycycline for 5 days
17
Q
What is the management of severe CAP?
A
IV Co-Amoxiclav and ORAL Clarithromycin
18
Q
What is the management of HAP?
A
Mild/Moderate - Oral Co-Amoxiclav Severe - IV Co-Amoxiclav Fluids Analgesia Follow up CXR at 6/52
19
Q
What is Pneumovax?
A
Vaccination against pneumococcal pneumonia
GIven to over 65s, immunosupressed, diabetics
Lasts for 6yrs
20
Q
Name 5 complications of Pneumonia
A
Respiratory Failure, Hypotension, AF, Pleural Effusion, Empyema
21
Q
What is Interstitial Lung Disease?
A
Umbrella term for disorders causing fibrosis of the lungs
22
Q
What are the 5 classifications of ILD?
A
Idiopathic, Granulomatous, Occupational, Rheumatic, Iatrogenic
23
Q
What are the causes of Idiopathic ILD?
A
Usual Interstitial Pneumonia, Acute Interstitial Pneumonia, Non Specific Interstitial Pneumonia
24
Q
Name a granulomatous cause of ILD
A
Sarcoidosis - systemic inflammation characterised by non caseating granulomas
25
Name three drugs causing ILD
Bleomycin, Nitrofurantoin, Amioderone
26
What is Extrinsic Allergic Alveolitis?
Hypersensitivity reaction
| Can be acute (more reversible) or chronic (less reversible)
27
Name three symptoms of ILD
Dry cough, Exertional Dyspnoea, Malaise
28
Name three signs of ILD (hint:3Cs)
Cyanosis, Clubbing, Crepitations (fine)
29
Name three investigations carried out for ILD, and what they would show
Bloods - ABG and looking for underlying cause
CXR- reduced lung volume, lower zone shadowing
Spirometry - Restrictive Pattern
30
What would a biopsy of UIP type ILD show?
Patchy and honeycombing
31
Name four managements of ILD
1) Remove offending cause
2) Stop smoking
3) Medication
4) Oxygen
32
Name the two possible pharmacological interventions for ILD
N - Acetyl Cystiene (anti-oxidant properties)
| Pirfenidone (downregulates growth factors and reduces fibrosis, FVC between 50 and 80%)
33
Define Asthma
Chronic inflammatory disease of the airways causing intermittent and reversible airway obstruction
34
Name four pathological changes in asthma
Basement membrane thickening
TH2 mediated mast cell degranulation (Prostaglandins, Leukotrienes, Histamines)
Mucus Hypersecretion
Smooth Muscle hypertrophy and hyperplasia
35
Name three symptoms of Asthma
Dyspnoea, Intermittent cough, Wheeze
36
Name three signs of Asthma
Tachypnoea, Decreased air entry, Audible wheeze
37
Name the features of mild Asthma
No features of severe asthma
| PEFR>75%
38
Name the features of moderate Asthma
No features of severe asthma
| PEFR 50-75%
39
Name the features of severe Asthma
PEFR 33-50%
Incomplete sentences
RR>25
HR>110
40
Name the features of life threatening Asthma
PEFR<33%
pO2<92%
Cyanosis
Poor resp effort/silent chest
41
Name the features of near fatal Asthma
raised pCO2
42
What is the management of acute asthma?
Aim for 94-98% O2
5mg Nebulised salbutamol (every 15 mins)
40mg Oral Prednisolone
43
What is the management of severe asthma?
500mcg Nebulised Ipratropium Bromide (Antimuscarinic)
| Back to Back Salbutamol
44
What is the management of life threatening asthma?
ITU
CXR
IV Aminophylline (Adenosine Antagonist)
IV salbutamol
45
Name the 5 features of an asthma discharge plan
```
PEFR>75%
5 days oral prednisolone
GP follow up in 2 working days
Resp Clinic follow up in 4 weeks
Asthma Nurse referral
```
46
What is the definition of COPD?
Progressive airway obstruction with little or no reversibility.
Umbrella term for Chronic Bronchitis and Emphysema
47
Name 3 causes of COPD
Smoking
Alpha 1 Anti-Trypsin
Industrial Exposure (soot)
48
Name 3 pathological features of COPD
Mucous gland hyperplasia
Mucous gland hypersecretion
Ciliary Dysfunction
49
Name 5 signs of COPD
Tachypnoea, Hyperinflation, Decreased expansion, Hyper resonance, quiet breath sounds
50
What are 4 complications of COPD?
Exacerbations, Polycythaemia, Resp Failure, Cor Pulmonale
51
What would a CXR of COPD show?
Hyperinflation and flattened diaphragm
52
What would a CT of COPD show?
Bronchial wall thickening and air space enlargement
53
What would Spirometry of COPD show?
Obstructive pattern with poor reversibility
54
State the 5 features of the COPD care bundle
```
Smoking cessation
Pulmonary Rehab
COPD Information Booklet (breathe easy and british lung foundation)
Inhaler technique
Outpatient follow up
```
55
What are the requirements for giving LTOT to COPD patients?
Have to use it atleast 16/24 every day
Must be a non smoker
Must not retain CO2
If pO2 is constently less than 7.2kPa (or 8kPa with Cor Pulmonale)
56
What is the definition of Bronchiectasis?
Chronic dilation of one or more bronchi due to chronic inflammation leading to poor mucociliary clearance
57
Name the four main categories of Bronchiectasis causes
Post infective, Immune deficiency, Genetic Deficiency, Obstruction
58
Name two post infective causes of Bronchiectasis
Whooping Cough
| TB
59
Name an immune deficiency causing Bronchiectasis
Hypogammaglobulinaemia
60
Name four genetic defects causing Bronchiectasis
Cystic Fibrosis, Primary Ciliary Dyskinesia, Youngs Syndrome (Bronchiectasis, SInusitis, Reduced Fertility), Kartageners Syndrome (Bronchiectasis, Sinusitis, Situs Inversus)
61
Name the four main infective organisms in Bronchiectasis
Haemophilus Influenza
Streptococcus Pneumoniae
Staphylococcus Aureus
Pseudomonas Auerginosa
62
State 3 symptoms of Bronchiectasis
Persistent cough, copious sputum production, intermittent haemoptysis
63
State 3 signs of Bronchiectasis
Clubbing, Coarse crepitations, Wheeze
64
What is the gold standard investigation for Bronchiectasis, and what does it show?
HRCT
| Dilation of the bronchi to larger than the adjacent blood vessel (sygnet ring sign)
65
State 5 management options in Bronchiectasis
```
Airway Clearance (flutter valve,mucolytics,physio)
Antibiotics
Flu Vaccine
Steroids
Pulmonary Rehab
```
66
Name 2 mucolytics
Acetyl Cysteine
| Bromhexine
67
Define Cystic Fibrosis
Autosomal recessive mutation on chromosome 7, leading to abnormalities of CFTR gene (reducing chlorine secreiton and hence mucous dilution)
68
How is Cystic Fibrosis diagnosed?
History of CF in Sibling/Positive Newborn Test
AND
Sweat Test/Genotyping/Nasal Potential Difference
69
Describe 3 ways CF can present
Meconium Ileus
Intestinal Absorption (reduced pancreatic enzymes)
Recurrent Chest Infections
70
Name 4 complications of CF
Respiratory Infections
Low Body Weight
Distal Intestinal Obstruction Syndrome (usually ileocaeca region, palpable RIF mass)
CF related diabetes
71
What lifestyle advice would you give CF patients?
```
No smoking
Avoid other CF patients
Avoid Jacuzzis
NaCl tablets in hot weather
Flu Vaccine
```
72
Give 5 risk factors for PE
```
COCP/HRT
Recent surgery
Reduced mobility
Malignancy
Leg Fracture
```
73
PE may be asymptomatic, however give 4 ways in which they can present
Acute Dyspnoea
Pleuritic chest pain
Haemoptysis
Syncope
74
Give 4 signs of a PE
Pyrexia
Tachycardia
Tachypnoea
Raised JVP
75
What is a massive PE
A PE causing haemodynamic compromise, causing hypotension
76
What investigations would you do for a PE
ABG
D Dimers (only if WELLS score<4)
ECG (S1Q3T3)
CTPA
77
How would you manage a PE?
LMWH or Fondaparinux
| Long term anticoagulation or IVC filter
78
How would you manage a massive PE?
Thrombolysis with alteplase
79
What are the contraindications to thrombolysis?
Stroke less than 6 months ago
GI bleed less than 1 month ago
Bleeding disorder
80
Name four classifications of Pneumothorax
Spontaneous (Primary or Secondary)
Traumatic
Tension
Iatrogenic (post central line/pace maker)
81
Give 5 risk factors for a Pneumothorax
```
Pre-existing lung disease
Tall&thin
Smoking
Diving
Marfans
```
82
How would a pneumothorax present?
Asymptomatic
OR
Sudden onset dyspnoea, pleuritic chest pain, reduced expansion, diminished breath sounds
83
When do you NOT do a CXR in pneumothoraces?
If a tension pneumothorax is suspected
84
How do you manage a tension pneumothorax?
Large bore needle into 2nd intercostal space mid clavicular line
85
How do you manage a primary pneumothorax?
If lung markings are more than 2cm from chest wall then give O2 and insert a large bore needle into 4th intercostal space mid axillary line
If this is unsuccessful then try a chest drain
86
What are the two types of pleural effusion?
Transudative (pleural protein<30g/l)
| Exudative (pleural protein>30g/l)
87
Give 3 causes of a transudative pleural effusion
Heart Failure, Cirrhosis, Hypoalbuminaemia
88
Give 3 causes of an exudative pleural effusion
Malignancy, Infection (eg parapneumonic effusion), Inflammatory (RA)
89
How would you diagnose a pleural effusion?
CXR
| Ultrasound guided pleural aspiration (biochemistry,cytology,microbiology)
90
How might a patient with Pleural Effusion present? What would you find OE?
May be asymptomatic OR dyspnoea/pleuritic chest pain
| OE: stony dull percussion,reduced expansion, diminished breath sounds
91
Name three different types of management for a pleural effusion
Drain (URGENT if empyema/pH<7.2)
Pleurodesis
Surgery (if increasing collections/pleural thickening)
92
What should you consider before draining a pleural effusion?
If you have reached the correct diagnosis
93
Define Obstructive Sleep Apnoea
Upper airway narrowing, provoked by sleep causing excessive daytime sleepiness
94
Give two broad causes of Obstuctive Sleep Apnoea
```
Small Pharyngeal Size (neck fat, large tonsils, craniofacial abnormalities)
Excess narrowing (Obesity, Neuromuscular Disease, Muscle relaxants)
```
95
Give 3 presentations of OSA
Snoring, Excessive daytime sleepiness, Nocturia
96
Give 3 diagnostic methods for OSA
Epworth Sleepiness Scale, Overnight Oximetry, Sleep Study EEG
97
Give a conservative and a surgical management for OSA
Conservative - Lose weight
| Surgical - Pharyngeal surgery
98
Describe the two possible ventilation methods used in OSA
CPAP - upper airways splinted open with 10mmHg positive pressure, no ventilatory support
NIV - non invasive ventilation, bilevel postive pressure so does provide ventilatory support
99
Give 3 non respiratory presentations of lung cancer
SVC Obstruction (raised JVP, upper limb swelling)
Horner's Syndrome (Miosis, Anhidrosis and Partial Ptosis)
Paraneoplastic (Cushings, Hypercalcaemia)
100
Describe the WHO Performance Status
0 - Fully active without restriction
1 - Restricted in strenuous activity but able to carry out light work
2 - Capable of self care but unable to carry out work activities, up and about more than 50% working day
3 - Limited self care, confined to bed/chair more than 50% waking hours
4 - Completely disabled
5 - Dead
101
Give four histological sub types of non small cell carcinoma
35% Squamous Cell
27% Adenocarcinoma
10% Large Cell
<1% Adenocarcinoma in situ
102
Why do small cell carcinomas often give rise to paraneoplastic syndromes?
They arise from Kulchitskey cells, which are endocrine cells
103
What is Lambert Eaton Syndrome?
Syndrome assoicated with Small Cell Carcinoma
Autoimmune attack against VGCCs causing impaired ACh release
Weak Muscles, Difficulty swallowing, Difficulty breathing
104
What is a Hamartoma?
Usually a benign cancer
| Appears as a lobulated mass with flecks of calcification
105
What is a malignant mesothelioma? What is it strongly related to?
A cancer of the mesothelial cells occurring in the pleura of the lungs
Strong association with asbestos exposure
Poor prognosis
106
Define Acute Respiratory Distress Syndrome
A type of respiratory failure characterised by wide spread inflammation of the lungs
107
Give 5 causes of ARDS
Pneumonia, Vasculitis, Sepsis, Pancreatitis, Malaria
108
How would a patient in ARDS present?
Cyanotic, Tachypnoeic, Tachycardic, Peripheral vasodilation, Bilateral fine crackles
109
What is the diagnostic criteria for ARDS?
```
One of:
Acute Onset
Bilateral Infiltrates
Pulmonary Capillary Wedge Pressure <19mmHg
Refractory Hypoxaemia
```
110
Describe the management for ARDS
ITU admission
Resp Support - CPAP or mechanical ventilation (low tidal volume though to prevent pneumothorax)
Circulatory Support - Arterial line for haemodynamic monitoring, Inotropes, Vasodilators, Blood transfusions
111
Give 3 risk factors for Sarcoidosis
Age (20-40)
Afro-caribbean
HLA DRB1
112
What is Lofgren Syndrome
Acute form of Sarcoidosis
| Characterised by Fever, Erythema Nodosum, Polyarthralgia, Bilateral Hilar Lymphadenopathy
113
How does Sarcoidosis Pulmonary Disease present?
Dry Cough, Progressive Dyspnoea, Chest Pain
114
Describe the stages of Pulmonary Sarcoidosis on a CXR
Stage 0 - Normal
Stage 1 - Bilateral Hilar Lymphadenopathy
Stage 2 - Bilateral Hilar Lymphadenopathy and Peripheral Pulmonary Infiltrates
Stage 3 - Peripheral Pulmonary Infltrates alone
Stage 4 - Progressive pulmonary fibrosis, Honeycombing, Bullae
115
How would you manage pulmonary sarcoidosis?
Mild/Moderate - 40mg Prednisolone OD then taper
| Severe - IV methylpred, Anti TNF, Lung Transplant
116
What is Coal Workers Pneumoconiosis?
Workers inhale coal dust, which are ingested by macrophages which then die, release their enzymes and cause fibrosis
Can progress to Pulmonary Fibrosis
117
What would a CXR of Coal Workers Pneumoconiosis show?
Many round opacities (especially in upper zone)
118
What is Caplans Syndrome?
Pulmonary Fibrosis in coal workers who have rheumatoid arthritis
119
How would a patient with Caplans present?
Cough, SOB, Painful joints and morning stiffness
120
What three investigations would be indicated in Caplans and what would they show?
CXR - Well defined nodules (potentially cavitating like TB)
Spirometry - Mixed restrictive and obstructive
Bloods - RF, ANA
121
What is Silicosis?
Inhalation of silica particles which are fibrogenic. Associated with metal mining/stone quarrying/ceramic manufacture
122
How does Silicosis present?
Progressive Dyspnoea
| Increased incidence of TB
123
What two investigations would be indicated in Silicosis?
CXR - Miliary Pattern in upper/mid zones
| Spirometry - Restrictive
124
What is characteristic of Bronchiectasis on CXR?
Tram Tracks
125
How would you treat a COPD exacerbation?
No purulent sputum - supportive, likely viral
| Purulent Sputum - Amoxicillin TDS 5d (or Doxycycline if Pen allergic)
126
What antibiotics would you use for Aspirational Pneumonia?
Co-Amoxiclav
127
What antibiotics would you use for Pneumonia caused by an atypical pathogen?
Co-Amoxiclav + Doxycycline/Clarithromycin
128
What antibiotics would you use for Ventilator Assisted Pneumonia?
IV Piperacillin and Tazobactam
