Resp Flashcards
How do diarrhoea and vomiting affect acid base balance?
Diarrhoea –> lose HCO3 –> metabolic acidosis
Vomiting –> lose H –> metabolic alkalosis
Causes of resp acidosis and alkalosis
Resp acidosis: type 2 resp failure (COPD, severe asthma)
Resp alkalosis: type 1 resp failure (pneumonia, panic attacks)
Causes of metabolic acidosis and alkalosis
Metabolic acidosis: excess acid production e.g. diabetic ketoacidosis or exercise induced lactic acidosis, or diarrhoea so lose HCO3
Metabolic alkalosis: vom so lose H+, or diuretics
What is the treatment in acute severe asthma?
Oral prednisolone, nebulised salbutamol.
Then IV ipratropium bromide
THen IV magnesium
Call ICU
Define acute severe asthma
RR >25
HR>110
PEF 33-50%
Can’t complete sentences
Define life threatening asthma
SpO2 <92%
PEF <33%
Altered conscious level
Define near-fatal asthma
High CO2.
What is wheeze?
High pitched muscial whistling sound caused by narrowing of bronchial tubes
Why is wheeze more pronounced in expiration?
Because airways are narrower in expiration
Difference between specific and non-specific triggers of asthma?
Specific are allergens e.g. pollen, house dust mite
Non-specific are irritants e.g. cold weather, exercise
Most wheeze is ___piratory but wheeze in ____ is __piratory
Most wheeze expiratory, wheeze in stridor is inspiratory (because upper airway issue)
What can cause pink tinged frothy sputum?
LVF
What can cause clubbing?
Lung cancer, bronchiectasis, CF, pulmonary fibrosis
Why does pursed lip breathing help?
We don’t want to release too much air and make alveoli too small because then its harder to inflate them
What lung problems will cause mediastinal shift away from the problem?
Tension pneumothorax and pleural effusion
What lung problems will cause mediastinal shift towards the problem?
Lobar collapse, pulmonary fibrosis
What is hearing bronchial breath sounds in a vesicular location a sign of?
Pneumonia
Name continous and discontinuous lung sounds
Continuous: wheezes and stridors
Discontinuous: pleural friction rubs and crackles
What do fine and coarse crackles sound like?
Fine: high and soft
Coarse: loud and low
When do fine crackles, coarse cracles, and pleural friction rubs occur?
Fine: pneumonia
Coarse: COPD, bronchiectasis
Pleural friction rubs: pleurisy, PE
Do you know where to find the carina, aortic knuckle, hilar points, aorto-pulmonary window
good
Identify a CXR pleural effusion
Uniformly white area with concave surface (meniscus sign), costophrenic angles and heart border not visible
Identify a CXR tension pneumothorax
Air trapped between lung and chest wall, lung outline visible, air is hyperlucent, in tension there is mediastinal shift away
Name 4 TB drugs
Rifampicin, Isoniazide, Pyrazinamide, Ethambutol
Describe TB pathology
Caseating granuloma with Langhans giant cells, in pulmonary TB the granuloma calcifies to form a Ghon focus. Consolidation
Name a cause of CAP and HAP and treatments
CAP strep pneu treat with amoxicillin (+)
HAP staph aureus treat with co-amoxiclav (+ and -)
Describe a COPD CXR
Flattened hemidiaphragms, wider chest diameter, pulmonary arterial HTN, increased retrosternal space
How to differentiate latent and active TB?
Latent TB + for IFNy and TST but - for sputum culture
Where do TB lesions normally form
Apex of lungs because they’re aerobic
Difference between miliary and extrapulmonary TB
Miliary (disseminated) TB spreads via blood to anywhere
Extrapulmonary TB can occur in the LNs, GI, peritoneum, bones and joints
What should you treat pneumonia from atypical organism with?
Deoxycycline
What are the three types of breath sounds and where should you listen for them
Tracheal (neck midline), bronchial (manubrium), vesicular (peripheral lung)
What do the three types of breath sounds sound like
Tracheal - even inspiration and expiration, loud, harsh
Bronchial - short inspir and long expir, loud, less harsh
Vesicular - long inspir short expir, softer
A pleural effusion sounds…
Stony dull
Name causes of transudate and exudate in pleural effusion
Transudate: change in pressures e.g. HF, hypoalbuminemia.
Exudate: infections e.g. pneumonia, TB, bronchial carcinoma
Name causes of pneumothorax
Trauma (rib fracture or sharp), spontaneous primary from subpleural bulla (thin young males), secondary spontaneous from COPD, asthma, TB, bronchiectasis, lung cancer
What sign do you get from listening to consolidation
Bronchial breath sounds in vesicular location because consolidation solid transmits sounds better than normal air
What’s a bovine cough and how does it compare to normal
Normal cough involves big inspiration, closing glottis, increasing intrapulmonary pressure and sudden opening of glottis
In bovine cough its a non-explosive cough because you can’t close glottis
Name paraneoplastic syndromes due to lung cancer
SIADH, Cushing’s, finger clubbing, Eaton-Lambert syndrome (NMJ autoimmune), Horner’s syndrome
Which lung cancer is the most common in never smokers
Adenocarcinoma (type of non-small cell)
How does treatment differ in small cell and non-small cell lung cancer?
Non-small cell advances slower so if you catch in time surgery, chemo if late but only for symptom control. Small cell advances quicker so no surgery option, chemo or radio only
How does staging affect lung cancer treatment
Stages I/II given radical treatment, stage III is inoperable, stage IV is palliative. Beyond N1 is inoperable
