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Resp Flashcards

1
Q

What happens in the airway in asthma?

A

Release of inflammatory mediators (Th2 reaction), influx of basophils, mast cells, eosinophils:

  • bronchial smooth muscle contraction
  • increased mucus production
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2
Q

What time of day are asthma symptoms generally worse?

A
  • Morning (PEFR will be reduced)
  • Nocturnal cough
  • After interaction with trigger/exercise.
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3
Q

What type of wheeze can be heard in asthmatics?

A

Audible, widespread, polyphonic wheeze

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4
Q

When is percussion of the chest hyper resonant?

A

Pneumothorax
Emphysema
Asthma
COPD

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5
Q

When is percussion of the chest dull?

A

Consolidation
Fluid
Collapse
Tumour

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6
Q

When is percussion of the chest stony dull?

A

Pleural effusion

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7
Q

What is being unable to speak in full sentences
pulse of greater than 110
RR greater than 25 defined as in asthma?

A

Severe asthma

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8
Q

What are signs of a life threatening asthma attack

A 
Silent chest
Confusion 
Exhaustion 
Cyanosis 
Bradycardia 
PEF<33% expected
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9
Q

What is the progression of asthma medication?

A
  1. Occasional salbutamol (short acting beta 2 agonist)
    • inhaled steroid: beclometasone
    • long acting beta 2 agonist: salmeterol
  4. Trial: increasing beclometasone, theophylline, leukotriene receptor agonist
  5. Once daily dose of oral prednisolone
    REFER
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10
Q

What is the definition of chronic bronchitis?

A

Chronic cough & sputum production on most days for 3 months for two consecutive years.

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11
Q

What is the definition of emphysema?

A

Enlarged airspace with alveolar wall destruction

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12
Q

What is the spirometry definition of COPD?

A

FEV1<80% predicted
FEV1/FVC <0.7
Little/no reversibility

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13
Q

What will the oxygen and co2 look like on an ABG in

a) type 1 resp failure
b) type 2 resp failure?

A

1) O2 low, CO2 normal

2) O2 low, CO2 high

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14
Q

What will lung function tests show in COPD?

A

Obstructive & air trapping

  • increased total lung capacity
  • increased residual volume
  • decreased DLCO
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15
Q

How can bronchial carcinoma present?

A 
Cough (+/- blood)
SOB 
Chest pain 
Recurrent infections 
Lethargy, weight loss 
Anaemia
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16
Q

What can be present on a CXR when there is a bronchial carcinoma?

A
  • Consolidation
  • Collapse
  • Effusion
  • Enlarged hilar
  • Bone mets
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17
Q

Where do mets from bronchial carcinoma tend to spread?

A
  1. Brain
  2. Bone
  3. Liver
  4. Adrenal
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18
Q

What lung cancer secretes ACTH?

A

Small cell

19
Q

What lung cancer secretes PTH?

A

Squamous

20
Q

What is the CURB65 score?

A 
Confusion - <8 on AMTS
Urea - >7mmol/L
Respiratory Rate - >30
BP <90, <60
over 65
0-1 = home 
2 = hospital
3+ = ?ITU
21
Q

What is classed as a hospital acquired pneumonia?

A

If it presents 48 hours after admission

22
Q

What condition presents with decreased chest expansion, dull percussion, increased tactile vocal resonance & bronchial breathing?

A

Pneumonia

23
Q

Generally what is the management of pneumonia?

A

IV clarithromycin and co-amoxiclave

24
Q

What treatment is given for aspiration pneumonia?

A

Cephalosporin and metronidazole

25
Q

Which has more protein, transudate or exudate?

A

Exudate

26
Q

What type of pleural effusion is caused by infection, inflammation, cancer, pneumonia, TB, RA & PE as a result of leaky capillaries?

A

Exudative

27
Q

What type of pleural effusion is caused by an increase in venous pressure (heart failure), hypoproteinaemia (cirrhosis) & hypothyroidism?

A

Transudative

28
Q

What happens to the tactile vocal fremitus in pleural effusion?

A

Decreases (fluid harder for sound to travel through)

29
Q

Differential diagnosis of:
Reduced chest expansion and breath sounds on right side. Stony dull to percuss, with decreased tactile vocal fremitus. Some bronchial breathing heard.

A

Pleural effusion on RHS.

30
Q

What are features of a pleural effusion chest x ray?

A

Small blunt costophrenic angles.

Water dense shadow with meniscus.

31
Q

Where can a diagnostic aspirate be taken from in a pleural effusion?

A

Percuss upper border

go 1 - 2 intercostal spaces below where stony dull starts.

32
Q

Management of pleural effusion?

A

Drain: needle in 5th intercostal space, anterior to mid axillary line

33
Q

What is a subpleural bulla rupture?

A

A pneumothorax, commonly occurring in young, thin males

34
Q

Differential diagnosis of reduced chest expansion and breath sounds on the right, hyperresonant percussion, decreased tactile vocal fremitus.

A

Pneumothorax

35
Q

Definition of a tension pneumothorax.

A

Air is drawn into the pleural space on inspiration and cannot leave on expiration.

36
Q

What is the serious complication of a tension pneumothorax?

A

Compression of the great veins resulting in cardiac arrest

37
Q

What direction will the trachea move in

a) pneumothorax
b) pleural effusion
c) collapse
d) consolidation

A

a) away
b) away
c) towards
d) towards

38
Q

When would you hear fine end inspiratory crepitations?

A

Pulmonary fibrosis

39
Q

What are the symptoms and signs of pulmonary fibrosis?

A
  • symptoms: dry cough
  • SOB on exertion
  • Malaise
  • Weight loss
  • Cyanosis
  • Clubbing
40
Q

What drug is it important to avoid in pulmonary fibrosis?

A

Steroids

41
Q

What will spirometry show in pulmonary fibrosis?

A 
Low FVC (<80% predicted)
Low FEV1 (<80% predicted)
Normal FEV1/FVC
42
Q

What is FEV1?

A

The volume of air the patient is able to exhale in the first second of a forced expiration.

43
Q

What is FVC?

A

The total volume of air the patient can forcibly exhale in one breath.

CCs (12 decks)

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