Resp Flashcards
1
Q
CPAP and BIPAP which is used to treat Type 1 vs 2 resp failure
A
CPAP T1, BIPAP T2
2
Q
Name 3 types of COPD
A
Chronic bronchitis, emphysema, Alpha-1 Antitrypsin (A1AT) deficiency
3
Q
What are risk factors for COPD
A
Cigarettes
Air pollution
Genetics (A1AT deficiency)
4
Q
What inheritance pattern is A1AT deficiency
A
Autosomal co-dominant
5
Q
What is the pathology of chronic bronchitis
A
Hypertrophy+ hyperplasia of mucous glands (as protective against RF)
Chronic inflammation cells infiltrate bronchi- luminal narrowing
Mucus hypersecretion, ciliary dysfunction, narrowed lumen
6
Q
How long does someone have a cough for nd cough sputum for to be classed as chronic bronchitis
A
2 periods of Cough with sputum 3+ months over 2 years
7
Q
What is the pathology of emphysema
A
Destruction of the elastin layer in alveolar ducts/ air sacs and resp bronchioles.
Elastin keeps these walls open during expiration so decreased elastin traps air distal to the blockage
8
Q
What are different types of emphysema
A
Centriacinar:- resp bronchioles
Panacinar:- r.b, alv, alv sacs
Distal acinar
Irregular
9
Q
What emphysema are smokers most at risk from
A
Centriacinar
10
Q
What is the pathology of A1AT deficiency
A
A1AT degrades neutrophil elastase which protects the lungs from excess damage to the elastin layer. A deficiency in liver production of A1AT leads to panacinar emphysema and liver issues.
11
Q
Where is A1AT produced
A
Liver
12
Q
Who do you suspect A1AT deficiency in
A
Young/ middle aged men with emphysema with COPD Sx but no history of smoking
13
Q
What are Sx of COPD
A
Typically older, chronic cough w/ (often purulent) sputum
Extensive smoking Hx and constant dyspnoea
14
Q
Blue bloater (COPD) Sx
A
Chronic purulent cough
Dyspnoea
Cyanosis
Obesity
15
Q
Pink puffer (emphysema) Sx
A
Minimal cough
Pursed lip breathing
Cachectic (muscle loss)
Barrel chest+ hyper resonant percussion
16
Q
What is a complication of emphysema
A
Bullae rupture (Bullae is a large air sac)
17
Q
What finding do you get on spirometry of obstructive disease
A
FEV1:FEV <0.7
18
Q
What is difference in change of FEV1 in bronchodilator reversible and irreversible obstruction
A
<12% irreversible (COPD)
>12% reversible (Asthma)
19
Q
What is a complication of COPD
A
Cor pulmonale
RHS heart failure due to increased pulmonary HTN
20
Q
What is DlCO
A
Diffsuion capacity of CO across lung
21
Q
How does DlCO differ in asthma from COPD
A
Low in COPD
Normal in asthma
22
Q
Other than spirometry and DLCO, what other investigation might you perform in someone with suspected COPD
A
Genetic testing for A1AT
ABG show T2RF
ECG
CXR
23
Q
What can CXR show in a patient with COPD
A
Flattened diaphragm + bullae formation
24
Q
What is long term management for COPD
A
Influenze+ pneumococal vaccines
1- SABUTEROL
2- SALBUTEROL+ SALMETEROL+ TIOTROPIUM
3-(2+) Inhaled corticosteroids
25
What is O2 sat target for patients in hospital with acute COPD attack
88-92 because excess O2 is dead space leading to V/Q mismatch and increased CO2 retention (resp acidosis)
26
What are the 2 types of asthma
Allergic 70%
Non-allergic 30%
27
Differences between allergic and non-allergic asthma
Allergic:- IgE mediated, Extrinsic, T1 Hypersensitivity, due to environmental trigger, often early presentation
Non-allergic:- non IgE mediated, intrinsic, may prevent later, harder to treat, associated with smoking
28
Triggers for asthma
Infection, allergies, cold weather, exercise, drugs (beta-blockers, aspirin)
29
What is the atopic triad
Atopic rhinitis, asthma, eczma
30
What is samters triad
Nasal polyps, asthma, aspirin sensitivity
31
How can aspirin exacerbate Asthma
Aspirin inhibits COX-1/2 so shunts more arachidonic acid
32
Pathology of asthma
Overexpressed TH2 cells in airway exposed to trigger. TH2 cytokine release leads to IgE production and eosinophil recruitment. Both lead to bronchial constriction.
33
What cytokines are released by TH2 in asthma
IL-3,4,5,13
34
How does IgE production lead to bronchial constriction
Mast cell degranulation
Histamines
Leukotrienes
Tryptase
35
How do eosinophils lead to bronchial constriction in asthma
Release toxic proteins
36
What happens over time in asthma
Chronic remodelling
37
What is treatment for chronic Asthma
1:- Salbutamol
2:- SAB2A+ Inhaled corticosteroid
(Asses inhaler technique)
3:- SAB2A+ ICS + Leukotriene receptor antagonist
4:- SAB2A + ICS+ Salmeterol +/- LTRA
5:- Increase ICS dose
38
What is an example of a leukotriene receptor antagonist
Montelukast
39
What is treatment for exacerbations of asthma
OSHITME
O2
nebulised Salbutamol
Hydrocortisone (ICS)
IV MgSO4
IV Theophylline
BIPAP
+/- Abx if infection present
40
What is lung cancer of the plura called (primary)
Mesothelioma
41
If primary lung cancer is in the lung parenchyma what is name
Bronchial
42
How can you divide Bronchial lung cancers
Small cell 20%
Non-small cell 80%
43
What are the non-small cell lung cancers
Squamous cell carcinoma 20%
Adenocarcinoma 40%
Carcinoid
Large Cell 10%
44
What are the main metastisis sites of lung cancer
Bone, Liver, Adrenals, Brain, Lymph nodes
45
What is the main cause of mesothelioma
Asbestos (typically don't present until decades after exposure)
46
Who is the common presentation for mesothelioma
Male 40-70
47
What are standard cancer symptoms
Weight loss, night pain, TATT
48
What are Sx of lung cancer
SOB, persistent cough, pleuritic chest pain
Hoarse voice from tumour pressing on recurrent laryngeal nerve
49
What is 1st line investigation in lung cancer
CXR
50
What do you see on XR/ CT in mesothelioma
Pleural thickening +/- effusion
51
What is the diagnostic investigation for mesothelioma
Biopsy
52
What antigen is non-specifically raised in mesothelioma
Cancer antigen 125
(Raised in many tumour)
53
What is management for mesothelioma
Usually palliative even though unlikely to distantly metastise
If found early can try surgery + chemo/ radio but generally resistant
54
What is a BALT lymphoma
A non-Hodgkin lymphoma originating in bronchi
Bronchus associated lymphoid tissue
55
Who exclusively suffers from small cell carcinomas
Smokers
56
What are Small cell lung cancers
Neurosecretory granules release neuroendocrine hormones. Responsible for many paraneoplastic syndromes such as Cushings and SIADH
57
What are complications of SCLC
Ectopic ACTH:- Cushings
Ectopic: ADH:- SIADH
Lambert Eaton syndrome:- autoimmune vs NMJ
Fast-growing and early metastasis
58
What is Lambert Eaton Syndrome
The result of antibodies produced by the immune system against SCLC also targets voltage-gated calcium channels sited on presynaptic terminals on motor neurons.
59
What are Sx of Lambert Eaton Syndrome
Weakness in proximal muscles
Diplopia (double vision)
ptosis
slurred speech/ dysphagia
Autonomic dysfunction (dry mouth/ dizziness)
60
Which part of the lung does squamous cell carcinoma affect
Central lung
61
What hormone may lung squamous cell carcinoma secrete
PTHrP can lead to hypercalcemia
62
From where does squamous cancer in the lung arise from
Lung epithelium
63
What is metastasis/ spread of lung squamous cancer
Late Mets
Local spread mostly
64
Most common cause of squamous lung cancer
Smokers
65
Most common cause of lung adenocarcinoma
Asbestos
66
What part of the lung does an adenocarcinoma effect
Peripheral lung
67
From where do lung adenocarcinoma arise
Mucus secreting glandular epithelium
68
What is common mets location for lung adenocarcinoma
Bone, brain, adrenals, lymph nodes, liver
69
What genetics is are lung carcinoid tumours associated with
MEN1 mutation
Neurofibromatosis 1
70
What hormone does a lung carcinoid tumour secrete
Serotonin
71
What scale is used to assess the level of dyspnoea
MRC breathlessness scale
72
When do Sx present with a carcinoid tumour
When liver mets present
73
What is 1st line investigation in suspected lung cancer
CXR, CT
74
What is the diagnostic investigation for lung cancer
Bronchoscopy+ biopsy
75
What test is used to give staging to lung cancer
MRI
76
What is treatment for non small cell cancer
Surgical excision is early
Met:- Chemo/ radio MAB therapy
77
Are primary or secondary lung tumours more likely
Secondary as all blood comes through lungs
78
Which cancers met to lungs often
Breast, kidney, bowel, bladder
79
What is a Pancoast tumour
Tumour in lung apex that metastasises to neck's sympathetic plexus causing Horners Syndrome:- Ptosis, myosis, anhidrosis
80
Risk factors for PE
Anything affecting Virchow's triad
81
What are Sx of PE
Sudden onset SOB+ chest pain(pleuritic), painful swollen calf
Haemophysis
Raised JVP
Tachycardia+ dyspnoea
82
What score is used to assess the probability of PE
Wells score
<4 PE unlikely
>4 PE likely
83
What if wells score <4 what investigation
D-dimer:- sensitive but not specific
84
What is gold standard investigation for PE
CT pulmonary angiogram
85
What are the ECG characteristics of a PE
S1Q3T3
S waves deep in lead 1
Q waves deep in lead 3
T waves inverted in lead 3
RBBB IN V1-V3
Right axis deviation
Sinus tachycardia
86
What type of Ultrasound scan may you use to investigate DVT
Doppler
87
Why do you do a CXR in suspected PE even though it does show
Rule of DDx, Plueral effusion/ pneomthorax
88
Treatment for PE if the patient is haemodynamically stable
Anticoagulants
1- DOAC (Rivaroxaban)
if DOAC CI 1- LMWH
2- Warfarin
89
Treatment for PE if the patient is haemodynamically unstable
Thrombolysis
If fails catheter embolectomy
90
What are prophylaxis options for PE
Compression stockings, regular walking, SC LMWH
91
What is the most common interstitial lung disease
Pulmonary Fibrosis
92
What are risk factors for pulmonary fibrosis
Smoking, occupational, drugs (methotrexate), viruses
93
What resp failure does PF lead to
T1
94
Sx of PF
Exertional dyspnoea, dry unproductive cough,
95
Is PF restrictive or obstructive?
Restrictive
96
What is GS imaging for PF
High res CT chest
97
What does Chest CT show in PF
Ground Glass lungs + traction bronchiectasis
98
What are non-pharmological treatment options for PF
Smoking cessation + vaccines
Surgery- lung transplant
99
Pharmacological treatment options for PF
Pirfenidone
Nintedanib
100
What is sarcoidosis
A granulomatous disease in which there is an abnormal collection of inflammatory cells that forms clumps on the lungs, skin or lymph nodes
101
Who is the classic presentation of sarcoidosis
Women 20-40, Afro-Caribbean
102
What are Sx of sarcoidosis
Fever, fatigue, dry cough, dyspnoea, eye lesions (uveitis), lupus pernio (blue red nodules on nose/ cheeks)
103
What does a CXR show in sarcoidosis
Bilateral hilar adenopathy+ pulmonary infiltrates
104
What is the diagnostic investigation for sarcoidosis and what does it show
Biopsy shows non-caseating granuloma
105
What blood levels are raised in sarcoidosis
Serum Ca
Serum Ace (granulomas)
106
Name 4 granulomatous diseases
TB (Casting)
Crohn's
Sarcoidosis
Leprosy
107
Treatment for symptomatic sarcoidosis
Corticosteroids
108
What traid do you see in Lofgrens syndrome
Bilateral hilar lymph node infiltration
Erthyema nodosum
Acute polyarthritis (mc ankles)
Is an acute form of sarcoidosis
109
What type of hypersensitivity is hypersensitivity pneumonitis
Type 3 (immune Ab-Ag complex deposition @ lung tissues causes hyperresponsive)
110
Risk factor for hypersensitivity pneumonitis
Farming/ bird-keeping
111
What is most common hypersensitivity pneumonitis
Farmers lung
112
What type of hypersensitivity is good pastures syndrome
Type 2
113
What antibody is present in good pastures
Anti-GBM (attacks lung + kidneys)
114
What lung + kidney damage do you see on biopsy in good pastures
Lung fibrosis
Glomerular nephritis
115
What is pneumonia
Infection of the lung causing fluid exudation into alveoli due to inflammation. Typically from inhaled pathogens
116
What are the 2 types of pneumonia
Community-acquired pneumonia
Hospital-acquired pneumonia
117
How long after admission to be classed as hospital-acquired pneumonia
>48 hours
118
What bacteria cause CAP with MC
S. pneumaniae MC
H. Influenzae
Mycoplasma pneumonia
119
What pneumonia-causing bacteria is associated with air conditioning/ coming back from Spain
Legionella
120
What type of bacteria mostly cause HAP
Gram -ve aerobic bacilli
P. aeruginosa
E. coli
Klebsiella
121
Which pneumonia is more severe and why
HAP:- organisms are more drug resitant
122
RF for pneumonia
Immunocompromised (HIV), IVdu, pre-existing resp disease, v young/ old
123
Pathology of typical pneumonia
Bacteria invades and exudate forms inside alveoli lumen + sputum
124
Pathology of atypical pneumonia
Bacteria invade and exudate forms in interstitium of alveoli + dry cough
125
What are Sx of typical pneumonia
Productive cough with nasty-coloured sputum
Pyrexic
Pleuritic chest pain
tachypnoea
Confusion in elderly
126
What is 1st line + diagnostic test for pneumonia and what does it show
CXR shows consolidation
air bronchogram:- fluid-filled surrounding alveoli make air-filled bronchi visible
127
What can you do to Identify organisms in pneumonia
Sputum sample + culture
128
What is the scoring system to assess the severity of CAP
CURB65
Confusion
Urea nitrogen
RR> 30
BP <90/60 (either)
65 y/o +
129
Treatment for pneumonia
O2 (94-98), broad spec Abx, NSAIDS,
130
What is antibiotic treatment based on curb score for CAP (what is exception)
0 to 2:- Amoxicillin
3-5:- Co-Amoxiclac+ clarithromycin
exception:- legionella needs clarithromycin 1st line
131
What is aspiration pneumonia
Seen in Px w/ stroke, bulbar palsy:- aspiration of gastric acid contents into lungs
132
Which pathogens cause atypical pneumonia
Mycoplasm pneumoniae
Chlamydia pneumoniae
133
What type of bacteria cause TB
Mycobacterium tuberculosis complex
134
What are the mycobacterium tuberculosis complex pathogens
M. tuberculosis (MC)
M. africanum
M. microtis
M. bavis (unpasteurised milk)
135
Describe the microbiology of M. Tuberculosis
Has waxy coating makes gram stain ineffective.
Are acid-fast bacilli
Use Zeihl-Neelsen stain
Turn bright red
136
Where is TB common
China, India, Pakistan
Subsaharan Africa
137
How does TB spread
Airborne
138
What are RF for TB
Country + travel associated
Immunocompromised
Homeless/ crowded housing
IVDU
Smoking + alcohol
Higher age
139
What is the pathology of TB
TB phagocytosed but resists killing then forms caseous granulomatous. T cells recruited + central region of granuloma undergoes caseating necrosis. Primary Gohn Focus in upper parts of the lung. Ghon focus spreads to nearby lymph nodes (ghon complex). In most patients infection contained within granulomas (latent TB) if spreads systemically (miliary TB)
140
Pulmonary Sx of TB
Night sweat and weight loss
Pyrexia, chest pain and Px looks unwell
141
What are extrapulmonary Sx of TB
Meningitis, skin change, TB pericarditis, joint pain
142
What investigations can be performed in suspected TB
Mantoux skin test
Sputum culture X3
CXR biopsy
143
What is the treatment for TB
RI(6)PE(2)
Rifampicin:- 6 months
Isoniazid:- 6 months
Pyrazinamide:- 2 months
Ethambutol:- 2 months
144
What is a SE of rifampicin
Bloody urine
145
SE of Isoniaziol
perIpheral neuropathy
(Tingling hands+ feet)
146
SE of Pyramidine
hePatitis
147
SE of ethambutamol
Eye problems
148
What is Granulomatosis with polyangiitis
Granulomatous Vasculitis affecting small+ medium vessels typically causes ENT, lung + kidney Sx
149
What antibodies is Granulomatosis with polyangiitis associated with
c-ANCA
150
What are the Sx of Granulomatosis with polyangiitis
Saddle-shaped nose, ear infection
Diffuse alveolar haemorrage
Glomerular nephritis
151
What inheritance pattern of cystic fibrosis
Autosomal reccesive
152
What chromosome is mutated in cystic fibrosis
Chromosome 7
153
What are the risk factors for cystic fibrosis
fHx, caucasian
154
What is the pathophysiology of cystic fibrosis?
Defective CFTR gene usually secrets Cl- actively and Na+ passively into ductal secretions making them thin and watery. Now secretions are thicker with increased Na+ and Cl- retention.
155
What are resp Sx of cystic fibrosis?
Thick+ sticky sputum, recurrent upper resp tract infections
Bronchiectasis
156
What do you see in neonates with cystic fibrosis
Meconium ileus:- first stool to thick/ sticky to pass through bowel- leads to bowel obstruction
Failure to thrive
Finger clubbing
Abdominal distention
157
GIT Sx of cystic fibrosis
Thick secretions
Pancreatic insufficiency
Bowel obstruction
158
Other Sx of CF thats not resp/ GIT
Atrophy of vas deferens+ epididymis (infertility)
Very salty sweat
159
What is the common mutation that causes CF
Delta-f508 on chromosome 7:- codes for CFTR protein
160
What is GS investigation for CF (with levels)
Sweat test:- Na+ and CL->60mmol/L in children
161
Other investigations to carry out other than sweat test in CF
Faecal elastase reduced due to pancreas blockage
Genetic testing
Blood spot test (picks up mosts cases)
162
Non-pharmological Management for CF
Non-curative
Chest physio, no-smoking, exercise
High-calorie diet
163
Pharmacological management of CF
Bronchodilator
Prophylactic flucloxacillin
Nebulised dornase alfa
Vaccines (varicells, influenzae, pneumocaccal)
Enzyme replacements
164
How many children have cystic fibrosis
1 in 2,500
165
How many people are carriers of CF
1/25
166
Causes of finger clubbing in Children
Hereditary clubbing
Cyanotic heart disease
Infective endocarditis
CF
TB
IBD
Liver cirrhosis
167
What is pleural effusion?
Excess fluid accumulation between the viseral+ parietal plural layer
168
In plural effusion, what are the 2 types of fluid?
Transudative (protein <25g/L) (TRANSparent)
Exudative (protein >35g/L) (Cloudy)
169
What causes transudative pleural effusion
Increase in hydrostatic pressure or decrease in oncotic pressure
CHF
Liver cirrhosis
Nephrotic syndrome
170
What causes exudative plural effusion
Inflammation causing increase in vascular permeability
Cancer
TB
Pnuemonia
171
Sx of Plural effusion
Dyspnoea, pleuritic chest pain, cough, decrease in breathing sounds
Dull percussion on ipsilateral side
172
What is GS and 1st investigation in suspected pleural effusion
CXR
173
What does CXR show in pleural effusion
Blunting of costophrenic angles
Excess fluid appears white
Large effusions have meniscus
Massive effusions have tracheal and mediastinal deviation
174
Other than CXR, what investigation do you perform in pleural effusion
Thoracentesis (aspiration of pleural fluid)
pH, lactate, WCC, Microscopy
175
What is the treatment for pleural effusion
Chest drain
If recurrent- pleurodesis:- surgical fusing of layers to prevent fluid build-up
176
What is a pneumothorax?
Excess air accumulation in pleural space causes collapse
177
What is the typical presentation of pneumothorax
Tall thin males with a connective tissue disorder (Marfan's) +/- smoker, some kind of trauma
178
What is primary vs secondary pneumothorax
Primary:- spontaneous
Secondary:- trauma/ pathology
179
Sx of plueral effusion
SOB, one-sided sharp pleuritic chest pain, decreases in breathing sounds
Hyporesonant percussion ipsilateral
180
What is GS+ 1st investigation for pneumothorax
CXR
181
What do you see on CXR in a pneumothorax?
Excess fluid appears black
Tracheal deviation to otherside
182
What is the most sensitive imaging for small pneumothorax
CT
183
What are 2 types of pneumothorax
Simple
Tension
184
Simple vs tension pneumothorax
Simple:- Non-medical emergency, little tracheal diversion, air can flow in+ out of valve, unlikely to worsen
Tension:- Medical emergency with tracheal diversion, one-way vale growths with every breath
185
Treatment for a simple pneumothorax
Small:- Self healing
Larger:- Needle decompression
-chest drain (longer term)
186
Treatment for tension pneumothorax
If obvious go straight to Tx don't bother with CXR
Large bore cannula into 2nd intercostal space @ midclavicular line
Needle decompress then chest drain
187
What is resting mPAP that shows Pulmonary Htn
>25mmHg
188
How is pulmonary pressure measured
Right heart catheterisation
189
Pre capillary causes of pulmonary Htn
Pulmonary Emboli
Primary hypertension
190
Capillary + lung causes of Pul Htn
COPD
Asthma
191
Post capillary cause of pul Htn
Left heart failure
192
What can cause chronic hypoxia
COPD, altitude
193
What Signs/ symtptoms of Pul Htn
Exertional dyspnoea + fatigue
Tachycardia, Hepatomegaly
RHF signs:- Raised JVP
Peripheral oedema
Louder S2
194
What are initial investigation to carry out in suspected Pul Htn
CXR, ECG, ECHO
195
What do you see on CXR and echo in Pul Htn
Echo:- RVH
CXR:- RVH, enlarged proximal pulmonary artery
196
What ECG changes do you see in Pul Ht
Large R waves or right sided leads (v1-v3)
Large S waves on left side leads (v4-v6)
Right axis deviation
RBBB
197
What is the diagnostic/ GS investigation for Pul Htn
Right heart catheter
198
Treatment for Pul Htn
Phosphodiesterase-5 inhibitor:- sildenafil (VIAGRA)
CCB (amlodipine)
Endothelin 1 antagonist/ prostaglandin analogues
Diruretics for oedema
199
What is the treatment for Granulomatosis with polyangiitis
Corticosteroids
