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Hayders Phase 2A > resp > Flashcards

resp Flashcards

1
Q

Investigations for asthma

A 
TLCO- normal 
spirometry and PEF- >15% reversibility Fev1 and FEV1/FVC reduced 
FBC and Sputum- Eosinophils
Skin prick tests 
CXR- excludes pneumothorax
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2
Q

conservative management for chronic asthma

A

Make a personalised action plan
avoid allergens
train to use inhaler
stop smoking

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3
Q

pharmacological reliever of asthma

A

SABA salbutamol PRN

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4
Q

Pharmacoloical prevention in uncontrolled asthma 1st line

A

ICS Beclometasone

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5
Q

Pharmacoloical prevention in uncontrolled asthma 2nd line

A

ICS + LTRA

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6
Q

Pharmacoloical prevention in uncontrolled asthma 3rd line

A

ICS + LABA- salmetreol

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7
Q

Pharmacoloical prevention in uncontrolled asthma 4th line

A

ICS + LAMA- theophyline

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8
Q

Asthma biologic agents

A

uncontrolled after everything else- Omalizumab

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9
Q

Acute Asthma: uncontrolled or moderate classification

A

PEFR > 50
RR<25
pulse<110
able to make sentences

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10
Q

Acute Asthma: severe classification

A

PEFR 33-50
RR>25
pulse>110
unable to make sentences

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11
Q

Acute Asthma: life threatening classification

A

PEFR <33
PaO2 low
Paco2 normal

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12
Q

Acute Asthma: near fatal classification

A

PACO2 high

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13
Q

Treatment of acute asthma

A 
predniselone oral or IM 
O2 
SABA or SAMA - Ipatropium Bromide 
CXR exclude pneumothorax 
ABGs 
PEFR 
Review within 48 hours
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14
Q

3 Pathophysiology of asthma

A

Inflamation of the Bronchi
Bronchial smooth muscle spasm
Mucus production

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15
Q

symptoms of Asthma

A 
Diurnal varation and episodic 
Cough 
wheeze 
SOB/ Dyspnoea 
Sputum
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16
Q

Signs of Asthma

A

Tachypnoea
Hyperinflated chest
PEFR low

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17
Q

what are the conditions under the term COPD

A

chronic bronchitis
chronic asthma
emphysema

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18
Q

what is meant by Blue bloaters and what is the pathophysiology and symptoms

A

chronic bronchitis and excess mucus production,
productive cough, SOB
reduced O2 to enter and less CO2 to leave, Hypoxia and hypercapnia. this causes Cyanosis and type 2 resp failure (VQ mismatch) as well as vasoconstriction. progressing to COR pulmonar- pulmonary hypertension, RV hypertrophy and right Heart failure.
this leads to oedema, ascites and raised JVP
hypoxemia causes polycythemia and hypercapnia causes Acidosis

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19
Q

what is meant by pink puffers and what is the pathophysiology and symptoms

A

emphysema, also caused by smoking, inflamation causes destruction of alveolar wall and capillaries.
causes air trapping due to lack of recoil.
causes barrel chest. and pursing of lips of intercostals to allow breathing, heavy use of accessory muscles.
can eventually lead to cor pulmonar too
Matched VQ deficit due to hypoxia and reduced perfusion
TLC increased TLCO/DLCO decreased due reduced SA
hyperinflation

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20
Q

what is the pathophysiology behind emphysema

A

smoking causes increased work by alveolar macrophages and release of cytokine.
neutrophil recruitment and formation of neutrophil granulomas which secrete elastin
elastin destroys alveoli and inflammation destroys capillaries

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21
Q

what is the pathophysiology behind chronic bronchitis

A

smoking causes goblet cell hypertrophy= increased mucus

inflammation causes ulcers and fibrosis causing scarring that leads to narrowing

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22
Q

what are the cardinal features of COPD

A

Chronic cough, productive cough
dyspnoea
other: wheeze tightness

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23
Q

signs of COPD

A

raised JVP ascites oedema

barrel chest cynosis cor pulmonary tachypnoea weight loss hyperinflation intercostal drawing and pursed lip respiration

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24
Q

Investigations for COPD

A 
Spirometery 
ABG=O2 low and CO2 high 
FBC= Polycythemia 
CT or CXR- barrelcesting and hyperinflation 
ECG= RV hypertrophy 
Echo=pulmonary valve incompetency
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25
Q

other than smoking what is a cause for emphysema

A

Alpha antitrypsin Deficiency- inhered disease lacking anti elastin proteins so causes destruction of alveoli.
suspect if family history of emphysema or young non smoker

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26
Q

what is the spirometery and LFTs of COPD show

A 
FEV1<0.8
FVC/FEV1<70%
TLCO reduced 
TLC increased 
RV increased
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27
Q

what is used to asses severity of COPD

A

GOLD classification

Global obstructive lung disease classification

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28
Q

GOLD Classification mild

A

FEV1>0.8 FVC/FEV1<0.7 no or mild breathlessness

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29
Q

GOLD Classification moderate

A

FVC/FEV1<0.7 FEV1= 0.5-0.8 SOB on exertion

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30
Q

GOLD Classification severe

A

FVC/FEV1<0.7 FEV1=0.3-0.5 SOB on minimal exertion like getting dressed

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31
Q

GOLD Classification very severe

A

FVC/FEV1<0.7 FEV1<0.3 SOB at rest

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32
Q

questionnaire used in COPD management

A

CAT questionnaire

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33
Q

Conservative management of COPD

A

stop smoking, exercise, improve diet, stay up to date on vaccinations- influenza and pneumococcal

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34
Q

relief of COPD symptoms

A

SAMA- ipatropium bromide or SABA - salbutamol

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35
Q

Management of COPD if uncontrolled after SAMA or SABA/ Mild to moderate COPD

A

add LAMA titropium or thyophiline or add LABA salmeterol. if adding LAMA avoid SAMA. SABA can still be continued

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36
Q

Management of sever COPD/ after LAMA LABA

A

ICS + LABAorLAMA

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37
Q

management if absolutely nothing else works

A

LTOT- long term oxygen therapy

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38
Q

what are the requirements for prescribing LTOT

A

palliative
medication isnt working (PaO2<7.2 after treatment)and they are have quite smoking
they have developed signs of cor Pulmonary( fluid overoad, RV hypertention, pulmonary hypertension )

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39
Q

other treatmnet options in COPD

A

mucolytics
antidepressants
Diuretics if cor Pulmonary
antibiotics if exacerbation

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40
Q

what is the difference between COPD and Athma

A

COPD the symptoms are not variable diurnally and are always present + there is less than 15% reversibility in COPD
main inflammatory cell is CD8+ in COPD
athma = CD4+

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41
Q

risk factors for COPD

A 
Smoking, 
polutants
working with harmful chemicals 
genetics-susceptibility or Alpha antitrypin deficiency
infection
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42
Q

treating COPD exacerbation

A

antibiotics + steriods

if deveoped resp failure then give oxygen via venturi mask

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43
Q

what is bronchiactasis

A

abnormally dilated bronchi, occurred due to reoccurring infections and inflammation. is irreversible

44
Q

causes of bronchiactasis

A 
mostly idiopathic. 
cystic fibrosis 
congenital abnormality 
post infection, TB penumonia
immune suppressed- HIV chemo 
autoimmune
45
Q

what is the pathogens associated with infection in bronchiactasis

A

H influenza, Stap aures, strep pneumonia

46
Q

symptoms of bronchiactasis

A

main: Persistent cough that brings up a large amount of sputum can be clear but also green if infection
SOB
haemoptysis
pleuritic chest pain
fever
halitosis
Hint to remember- there is chronic infection so symptom is trying to clear that by cough and sputum

47
Q

signs of bronchiactaisis

A 
finger clubbing (uncommon)
crackles 
inspiratory crepitus
Wheeze
pyrexia
48
Q

investigations of bronchoiactasis

golf standard

A

High resolution CT scan shows dilation and bronchial wall thickining

49
Q

other investigations of bronchiactatsis

A 
CXR- shows broncial dilation
sputum sample
spirometry- obstructive disease 
TLCO unaffected 
broncoscopy
50
Q

Treatment of Bronchiactasis

conservative

A

Postural drainage, to remove mucus

stop smoking exercise diet and vaccinations

51
Q

Treatment of Bronchiactasis

pharmacological

A

Bronchodilators - SABA for a flare up
ICS- reduce inflammation
Antibiotics - amoxicillin or clarithromycin

52
Q

Treatment of Bronchiactasis

surgical

A

Treat localised Haemoptysis or option for transplant

53
Q

Prevalence of cytic fibrosis
type of inheritance
prevalence
pathophysiology and location of mutation

A

commonest life treatening autosomal ressecive disease
1 in 2000 births
mutation in chromosome 7 causing dysfucntional CFTR Cystic fibrosis trasmembrane concirdance regulator causing Cl to be retained Na to be retained and causing secretions like mucus to be more viscous

54
Q

clinical features of CF

A 
SOB 
productive cough, very thick mucus 
reoccuring infections 
CF developes into bronchiactasis 
or resp failure and cor pulmonary due to obstruction

sterratohorrea
can develop DM
weightloss

meconium Ileus + failure to thrive
no development of vas deferns or empdysimus infertility

55
Q

investigations and diagnostics in CF

A

Sweat Test= increased CL and NA in sweat
family history
genetic test
radiology check for bronchiectasis by HRCT

56
Q

Managment of CF

A 
postural drainage 
stop smoking+ diet+ vaccines 
Replacement pancreatic enzyme 
ADEK vitamins 
Bronchodilators - ICS+ SABA 
mucolytics + antibiotics
57
Q

checking for complications of CF

A 
Glucose-DM
FBC, U&amp;E Clotting 
CXR- Bronchiactasis 
Spirometery- Obstructive 
DEXA Scan?
58
Q

What is a mesothelioma and its causes

A

Cancer of the mesothelium, cells lining organs like Pericardium, pleura or peritoneum
commonest cause is asbestos exposure
commonest type is pleural mesothelioma

59
Q

Presentation for pleural mesothelioma

A 
Fatigue unexplained weight loss Pyrexia 
SOB chest pain, 
persistent cough 
clubbing 
reduced expansion
dull percussion
60
Q

diagnoses of mesthelioma and its treatment

A

CXR+CT + Biopsy = diagnostic
treat by chemo+radiotherapy
if small enough use surgery

61
Q

Prognosis of mesothelioma

A

50% mortality in 1 year

62
Q

what is the commonest lung tumour and its main attributed cause

A

Bronchial carcinoma of non small cells, squamous

Smoking

63
Q

Symptoms of Bronchial carcinoma

A 
Cough 
chest pain 
Haemoptyis
SOB
\+ Weightloss and fatigue
64
Q

Signs of Bronchial carcinoma

A

Anaemia, Clubbing
supraclavicular lymph node enlargement
slowly resolving infection or pneumonia

65
Q

2 types of carcinoma

A

small cell carcinoma- usually of small cell endocrine cell- worst prognosis
non small cell- squamous cell or adenocarcinoma better prognosis

66
Q

What is direct spread of Bronchial carcinoma

A 
Presses on Phrenic-hemidiaphram paralysis 
recurrent laryngeal- horsness of voice
or bracial plexus-parasthesia 
SVC - early morning headache
Oesophagus- Dysphagia
67
Q

common metastatic spread of Bronchial Carcinoma

A

Bone, Brain

68
Q

Investigations and diagnosis of bronchial carcinoma

A

CXR- diagnostic, can show nodules, pleural effusion or lung collapse
CT and CT guided biopsy and PET= Staging of tumour

69
Q

Treatment of Bronchial carcinoma

A

If stage 1 or 2 then surgically remove

if 3 or 4 then requires Chemo plus radiotherapy + palliative care

70
Q

what is the infective agent in TB

A

Mycobacterium Tuberculosis

71
Q

what tests can be done to detect Mycobacterium Tuberculosis in a lab

A

M TB is fast acid bacilli which means it doesn’t respond to gram test. would respond to ziehl neelson test +ve

72
Q

how is TB transmitted

A

Transmitted via aersol dropplets

73
Q

what are the signs of latent TB and how does it become active TB

A

CXR clear or may show rankes complex calcification
non infective
test +ve for Montoux test or Interferon gamma release assay
becomes activated when the immune system becomes suppressed

74
Q

what are the signs of primary TB

A

many asymptomatic but can have symptoms of flu, lethargy malaise pyrexia
CXR is clear or may show small pleural effusion

75
Q

what are the outcomes and complications of active TB

A 
Locally- bronchial pneumonia, pleural effusion, bronchiactasis 
spread vascular becomes milliary TB:
Renal Injury 
Potts Spine
TB meningitis 
Hepatitis
lymph adenoma
76
Q

Presentation of active TB

A

cough starts dry then becomes productive
persisting cough
drenching night sweats
SOB
pleuritic chest pain
haemoptysis
infection: pyrexia, malaise, fatigue, weightloss

77
Q

Investigations of TB

A

CXR shows cavitation + Pleural effusion
Sputum sample or bronchoalveolar lavage - Shows Mycobacterum TB - use Nucleic acid amplification test

Skin tests:
TB test (mantoux test, tuberculin skin test) test +VE for primary active latent or Bovine (vaccination) TB 
Interferon Gamma Release Assay- more specific- doesnt pick up BCG
78
Q

Treatment of Active TB

A

4 antibiotics for 6 months+ containment (-VE pressure room) until no longer infectious + Direct observation therapy to encourage taking medication
Isoniazid - Also prescribe this in Drug resistant TB 20 months
Rifampican
Pyrazinamide
Ethambutol

79
Q

Treatment of latent TB

A

Isonizide + Vit B

80
Q

Prevention of TB

A

BCG- Mycobacterium bovis

works 70% of the time and prevents milliary TB

81
Q

What are the causes of plural effusion

A

Transudate causes (Increased venous pressure): fluid overload. Heart failure. Cor Pulmonary. pericarditis Hypoprotienemia

Exudate causes (increased leakyness and inflamation): Pneumonia, carcinoma, TB, rheumatoid and SLE

82
Q

What are the types of fluid present in pleural effusion

A

Transudates= low serum protein<30 g/l
Exudates = high serum protein > 30g/l
Emphyma- pus containing fluid- often due to pneumonia

83
Q

symptoms of Pleural effusion

A

Asymptomatic, SOB, Pleuritic chest pain

84
Q

Signs of pleural effusion

A

Friction pleural rub
dull percussion sounds
reduced chest inflation
tracheal deviation if effusion is severe

85
Q

Investigation and diagnosis of Pleural effusion

A

Diagnostic- pleural effusion aspirate - analysis cause and type of fluid
other:
CXR - shows effusion
broncoscopy guided biopsy

86
Q

managment of pleural effusion

A

only drain if emphyma, malignant effusion or if there is excess and severity
treat underlying condition

87
Q

What is pneumothorax

A

air in the pleural space

88
Q

causes of pneumothorax

A

mostly idiopathic, can be iatrogenic

if over 40, possibly not idiopathic- COPD Asthma TB pneumonia (anything that can cause pleural effusion)

89
Q

risk factors for pneumothorax

A

male
tall
skinny
smoker

90
Q

symptoms of pneumothorax

A

sudden onset of unilateral Pleuritic chest pain, SOB

91
Q

signs of pneumothorax

A

tachypnoea tachycardia
no movement in chest wall on affected side
hyper resonance
pallor
tracheal deviation- sign of tension pneumothorax

92
Q

what causes spontaneous pneumothorax

A

Bursting of pleural bullae- small collection of air between lung and visceral pleura- usually on upper lobes

93
Q

Diagnosis and investigation of pneumothorax

A

CXR is diagnostic

94
Q

management of peunmothorax

A

if small do nothing avoid exercise
if medium large or tension- insert chest drain + aspirate air
if reoccurring pneumothorax consider pleurictomy

95
Q

Risk factors for pneumonia

A

immune deficiency , HIV, chemo, elderly and children
usually occurs post viral infection that lowers immune system
Altered lung physiology- Interstitial lung disease CF Asthma COPD
dysphagia

96
Q

causing pathogen of Community acquired pneumonia

A

Strep. pneumoni - main agent
staph aures, including MRSA
H. Influenza

97
Q

symptoms of pneumonia

A 
Cough, productive
SOB
pleuritic chest pain 
haemoptysis 
symptoms of infection: malaise fatigue, rigor sweating
98
Q

signs of pneumonia

A 
confusion- may be only sign in elderly 
tachypnoea 
tachycardia 
pyrexia
dull percussion 
reduced chest expansion 
pleural rub 
low BP
99
Q

Investigation and diagnosis of pneumonia

A 
CXR- shows effusion, air bronchiogram or normal
sputum sample- Strep pneumonia 
blood sample exclude sepsis 
Other 
LFT U&amp;E GFR- asses severity
FBC= Increased WCC CRP ESR
100
Q

management of pneumonia

A

start oral antibiotic or if severe , cannot wait for results start immediate IV antibiotics
IV Co-amoxiclav ( amoxicillan + Clavalic acid)
then continue on oral co- amoxiclav and clarythromycin
if hypoxia- O2
Hypotensive/shock - IV saline
pleuritic pain- analgesia + anti emetic

101
Q

Complications of pneumonia

A 
Pleural effusion- emphyma 
Sepsis 
lung absess
Resp failure- Type 1 
pericarditis
102
Q

Assessing severity of of pneumonia

A 
CURB65
confusion 
Urea>7mmole/L
Resp rate>30
BP<90/60
Over 65 YO
0-1 mild outpatient 
2 moderate - possible hospital 
3-5 severe admit to hospital and consider ITU
103
Q

prevention of pneumonia and who gets it

A

Pneumococcal vaccine
over 65, any lung disease that can be exacerbated
CF COPD Bronchiactasis asthma
renal or heart failure

104
Q

Sepsis pathophysiology

A

increased pro inflammatory cytokines= vasodilation
Hypotension and impaired cardiac contractility
reduced perfusion to organs
tissue hypoxemia causes increased resp rate due to increased demand for O2 and renal impairment which increases urea>7mmol/L

105
Q

Causative agent in Hosputal aquired pneumonia

A

Enterobacteria - E.Coli

S aures MRSA

106
Q

Causative agents of pneumonia in immunocompromised

A

Step pneumonia
Staph aures
H.Influenza same as CAP

107
Q

Causative agents in atypical pneumonia and presentation

A

legionella pneumophilia- found in colonised water tanks presnets with infection symptoms plus dry cough and SOB

Hayders Phase 2A (10 decks)

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