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FINALS REVISION > Resp > Flashcards

Resp Flashcards

1
Q

what is acute bronchitis

A

usually viral infection causing inflammation of trachea and major bronchi

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2
Q

how does acute bronchitis present

A 
cough - some sputum
sore throat
rhinorrhea
wheeze
low grade fever
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3
Q

how to differentiate between pneumonia and bronchitis

A

pneumonia - wheeze + other focal signs - crepitations, dull to percussion, bronchial breathing
pneumonia may also have some systemic symptoms such as fever malaise and myalgia

bronchitis - just wheeze

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4
Q

how is acute bronchitis managed

A

analgesia
fluids
if CRP 20-100 - offer delayed antibiotic prescription
if CRP >100 - immediate doxycycline
alternative for pregnancy/children - amoxicillin

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5
Q

what antibiotics in acute bronchitis

A

doxycycline

amoxicillin if preg/children

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6
Q

how would anaphylaxis present

A
  • angioedema of face, tongue, lips
  • hoarse voice
  • stridor (swelling of larynx)
  • wheeze
  • dyspnoea
  • hypotension
  • tachycardia
  • can also present with abdo pain
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7
Q

what skin changes in anaphylaxis

A

urticarial/erythematous rash

generalised itch

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8
Q

what dose of adrenaline for adult anaphylaxis

A

500mcg - 1 in 1000

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9
Q

how often can adrenaline IM injections be repeated and where is the best place to administer?

A

every 5 minutes

anterolateral aspect of middle third of thigh

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10
Q

what is refractory anaphylaxis

A

cardiorespiratory problems persist after 2 doses of IM adrenaline

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11
Q

how is refractory anaphylaxis treated

A

fluids if shocked

refer for ITU for IV adrenaline line

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12
Q

what treatment for anaphylaxis after patient has been stabilised?

A
  • non-sedating antihistamines such as CETIRIZINE for rash
  • serial tryptase measurements (tryptase can remain elevated for 12 hours, MEASURE WITHIN 6 HOURS)
  • all patients should be referred to specialist allergy clinic
  • provide patients with 2 adrenaline auto-injectors and training for how to use
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13
Q

what type of hypersensitivity is anaphylaxis

A

type 1

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14
Q

what is the pathophys of anaphylaxis

A

IgE stimulates mast cell degeneration causing release of histamine and other pro-inflammatory chemicals

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15
Q

what three treatments are given in anaphylaxis

A

IM adrenaline
Oral antihistamines
IV hydrocortisone

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16
Q

what conditions can be caused by asbestos exposure

A
  • pleural plaques
  • asbestosis
  • pleural thickening
  • mesothelioma
  • lung cancer
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17
Q

describe pleural plaques

A
  • benign, do not undergo malignant change, no follow up required
  • 20-40 year latency period
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18
Q

what can cause pleural thickening

A

empyema
haemothorax
asbestos exposure

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19
Q

describe asbestosis and its treatment

A

asbestosis causes lower lobe fibrosis, severity related to length of exposure

conservative treatment

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20
Q

what are the symptoms of asbestosis

A

progressive shortness of breath

reduced exercise tolerance

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21
Q

what is mesothelioma

A

cancer of the pleura, commonly caused by asbestos exposure, severity not related to length of exposure

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22
Q

what are the presenting features of mesothelioma

A

progressive sob
chest pain
pleural effusion

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23
Q

how is mesothelioma treated

A

palliative chemo

some radio/surgery

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24
Q

how does asbestos exposure relate to lung cancer

A

increases risk of lung ca

synergistic effect with smoking

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25
Q

what are the RFs for sleep apnoea

A

obesity
macroglossia (acromegaly, hypothyroidism, amyloidosis)
large tonsils
marfan’s

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26
Q

how does sleep apnoea present

A
  • excessive snoring
  • periods of apnoea during sleep
  • daytime somnolence, fatigue
  • HTN
  • compensated respiratory acidosis
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27
Q

what would ABG of sleep apnoea look like?

A

compensated respiratory acidosis

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28
Q

what scoring systems/assessments for sleep apnoea

A

epworth scale

multiple sleep latency tes - assess time taken to fall asleep in dark room

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29
Q

what investigations for sleep apnoea

A

sleep studies - polysomnography

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30
Q

what management for sleep apnoea

A
  • weight loss, stop drinking + smoking
  • CPAP
  • intra-oral devices such as mandibular advancement
  • inform DVLA if excessive daytime somnolence
31
Q

explain the pathophys of sleep apnoea

A

collapse of pharyngeal airway

32
Q

what are the complications of sleep apnoea

A

HTN
heart failure

can increase risk of MI and stroke

33
Q

what is the mgmt of PE with renal impairment (severe)

A

LMWH

34
Q

what is the mgmt of PE with anti phospholipid syndrome

A

LMWH

35
Q

what are the complications of PE

A 
sudden death
cardiac arrest
hypotension
syncope
pulmonary hypertension
36
Q

what is bronchiectasis

A

permanent dilation of airways secondary to chronic inflammation/infection

37
Q

what infections can lead to bronchiectasis

A

TB
measles
whooping cough
pneumonia

38
Q

what medical conditions can lead to bronchiectasis

A

CF
ciliary dyskinesia - kartagener, Young’s
bronchial obstructions - foreign body, lung cancer
yellow nail syndrome
IgA deficiency, hypogammaglobulinaemia

allergic bronchopulmonary aspergillosis

39
Q

how is bronchiectasis diagnosed

A

CXR

High resolution CT chest - tram-track and signet ring signs

40
Q

how does bronchiectasis present?

A 
cough, productive of large volumes of sputum
sob
chest pain
clubbing
recurrent chest infections
41
Q

how is bronchiectasis managed

A
  • physical training
  • postural drainage
  • antibiotics (long term rotating antibiotics if severe cases)
  • bronchodilators
  • immunisations
  • surgery if localised disease
42
Q

what are the most common organisms isolated in bronchiectasis

A
  • Haemophilus influenzae
  • Pseudomonas aeruginosa
  • Klebsiella spp.
  • Strep pneumoniae
43
Q

what is a serious complication of bronchiectasis

A

massive haemoptysis - needs bronchial artery embolisation

44
Q

what is bronchiolitis, who does it usually affect

A

infxn of bronchioles, usually with RSV, can be adenovirus,

babies <1year

45
Q

what RFs for severe bronchiolitis

A

congenital heart failure
superimposed bacterial infection
bronchopulmonary dysplasia (premature)
CF

46
Q

what symptoms of bronchiolitis

A 
dry cough
wheeze/fine inspiratory crackles
SoB
mild fever, coryzal symptoms
feeding difficulties associated with increasing dyspnoea
47
Q

when should babies be referred to A&E by ambulance in bronchiolitis

A
  • under 3 months
  • apnoea
  • child looks seriously unwell to a healthcare professional
  • severe resp distress:
    • grunting
    • marked chest recession
    • RR>70
    • use of accessory muscles
    • tracheal tug
    • cyanosis
    • O2 sats <92%

consider referral if dehydration or tachypnoea (>60) or if inadequate oral fluid intake (50-70% of usual)

48
Q

what management of bronchiolitis

A
  • humidified oxygen if low sats
  • ensure adequate food and fluid intake - NG tube if necessary
  • suctioning for secretions
49
Q

how is bronchiolitis diagnosed

A

clinical

immunofluorescence of nasal secretions may show RSB

50
Q

what are babies with bronchiolitis at inc risk of in childhood

A

viral induced wheeze

51
Q

explain pathophys of pneumothorax

A

air in the pleural space causing separation of lung from chest wall

52
Q

list some causes of pneumothorax

A

trauma
idiopathic
iatrogenic - central line insertion
lung pathologies - asthma, COPD, infection

53
Q

how is primary pneumothorax managed

A

if <2cm - discharge

if >2cm - aspiration
- failure of aspiration (still SOB, still >2cm) - chest drain

54
Q

how is secondary pneumothorax managed

A

> 2cm/sob/>50y = chest drain

1-2 cm - aspirate
<1cm - admit for obs and ox

55
Q

when can patients fly/diving after pneumothorax

A

fly after 1 week post xray check

no scuba diving unless bilateral pleurectomy

56
Q

what are the borders of the triangle of safety for chest drain insertion

A
  • mid-axillary line (lateral edge of latissimus dorsi)
  • anterior axillary line (lateral edge of pectoralis major)
  • 5th intercostal space (nipple line)

always insert chest drain ABOVE ribs to avoid neurovascular bundle

57
Q

how to confirm correct chest drain insertion

A

swinging (rise of water seal on inspiration, fall on expiration)
spontaneous bubbling of water as air leaves pleural space
re-inflation of lung

58
Q

what surgical options for pneumothorax

A
  • Video assisted thoracoscopic surgery
  • chemical pleurodesis (talc to irritate pleura)
  • abrasive pleurodesis (physical irritation of pleura)
  • pleurectomy
59
Q

what is a tension pneumothorax

A

trauma to chest cavity creating one-way valve that allows air into but not OUT of the pleural space

this is dangerous as air builds up with inspiration and increases the pressure in the thorax

this pushes on the mediastinum and its vessels and can lead to cardiorespiratory arrest

60
Q

what signs of tension pneumothorax

A
  • tracheal deviation AWAY from the side of the pneumothorax
  • reduced air entry
  • hyperresonant to percussion on affected side
  • TACHYCARDIA
  • HYPOTENSION
61
Q

what is the mgmt of tension pneumothorax

A

insert a large bore cannula into the second intercostal space, midclavicular line

once pressure is relieved with a cannula, chest drain can be inserted

if tension pneumothorax suspected, do not await investigations

62
Q

what is the difference between transudative and exudative pleural effusion

A

transudative - <30g/L protein

exudative - >30g/L protein

63
Q

what are the causes of transudative pleural effusions

A
  • heart failure
  • hypoalbuminaemia (liv disease, nephrotic syn, malabsorption)
  • hypothyroidism
  • meig’s syndrome (pleural effusion, ascites, ovarian Ca)
64
Q

what are causes of exudative effusion

A
  • pneumonia
  • lung ca, mesothelioma, mets
  • TB
  • connective tissue disease - RA/SLE
  • pancreatitis
  • PE
  • dressler’s syndrome
  • yellow nail syndrome
65
Q

what symptoms of pleural effusion

A

shortness of breath
non-productive cough
chest pain

66
Q

what signs of pleural effusion

A

tracheal deviation if massive
stony dullness to percussion
reduced breath sounds and chest expansion

67
Q

what imaging for pleural effusion

A
  • Posteroanterior CXR
  • USS chest
  • Contrast CT CAP to find underlying cause of exudative
68
Q

what other investigations aside from imaging for pleural effusion

A

pleural aspiration

send fluid for:

  • microbiology
  • cytology
  • pH, protein, LDH analysis
69
Q

if unsure if transudate/exudate, how do serum/fluid protein level differ in pleural effusion

A

pleural fluid protein / serum fluid protein > 0.5 = exudative

70
Q

what would CXR show in pleural effusion

A

blunting of costophrenic angles
fluid in lung fissures
larger effusion - meniscus
tracheal + mediastinal deviation if massive effusion

71
Q

how would oesophageal rupture affect pleural effusion fluid analysis

A

low pH
low glucose
raised amylase

72
Q

how would empyema fluid analysis look

A

turbid, cloudy
low pH <7.2
low glucose
high LDH

73
Q

how is recurrent pleural effusion managed

A
  • recurrent aspiration
  • pleurodesis
  • indwelling pleural catheter
  • drug management to alleviate symptoms - opiates for dyspnoea

FINALS REVISION (17 decks)

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