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2A > Resp > Flashcards

Resp Flashcards

1
Q

What are the two types of asthma?

A 
Eosinophillic = associated with allergy, T cells recruit eosinophills which damge the epitherlium leading to inflammation and mucus production
Non-eosinophillic = influenced by smoking an dobesity, involves neutrophils instead of eosinophills
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2
Q

What is the atopic triad?

A

Eczema, Hayfever and Asthma

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3
Q

S&S of asthma?

A

Episodic polyphonic expiratory wheeze with cough and dysponea. There will be diurnal variation (worst between 3-5am) and may be hyperinflation of the chest.
Symptoms worsened by Bera-blockers and aspirin

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4
Q

Tests for asthma?

A

FEV1:FVC < 70% as FEV1 <80% but FVC is normal
Eosinophillic = increased eosinophils, do FENO test.
Atopy tests, no crackles or sputum in the lungs

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5
Q

Treatment for asthma?

A

Avoid allergens and quit smoking/lose weight
Bronchodilators (Beta-2 agoinsts e.g. SA - Salbutamol and LA - salmeterol) or anticholinergics (tiotropium).
Severe cases = inhaled steroids.
Omalizumab/mepolizumab in severe eosinophilic disease.
Bronchial thermoplasty

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6
Q

What is the diagnostic criteria for severe asthma?

A

1 of = continuous steroid treatment needed or high dose inhaled steroids neededd
2 of = additional reliever medication needed, FEV1 < 20%, > 1 A&E visit per year, >3 steroid courses per year, rapid deterioration with 25% steroid reduction or any near fatal event

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7
Q

What is brittle asthma?

A

A rare form of severe asthma which is unpredictable and difficult to control. It can be life threatening

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8
Q

When should you admit an asthma attack to hospital, what are the criteria?

A

Severe (1 of) = PEFR 33-50%, RR >25, HR >110, inability to complete scentences
Life-theatening (1 of) = PEFR <33%, PaO2 <8kPa, PaCO2 >4.6kPa, exhaustion/confusion/coma, arrythmia/hypotension, silent chest/cyanosis

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9
Q

Treatment of asthma attack?

A

Salbutamol nebulised with oxygen, prednisolone (IV/PO), add ipratropium if no improvement.
Concider ICU admission.
Measure PEFR 20 mins after nebulising and take ABG (repete every 2 hours)

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10
Q

What criteria must be met to discharge a patient after an acute astma attack?

A

Achieve PEFR >75% with <25% diurnal variation
Been stable on discharge medication for >24 hours
Had inhaler technique checked
Have their own PEF meter and management plant
Steroids and bronchodilator therapy to take home
GP appointment <48hrs booked
Resp clinic appointment <4 weeks booked

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11
Q

What is COPD?

A

Progressive disease of irreversible airway obstruction.
Is a combination of chronic bronchitits (airway inflammation and mucus = increased airway resistance) and emphysema (loss of alveolar attachments and decreased elastic recoil)

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12
Q

What are the 2 main causes of COPD?

A

Smoking, Alpha-1 antitrypsin deficiency

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13
Q

S&S of COPD?

A

Dysponea, wheeze and productive cough with minimal diurnal variation. There will be tachyponea, hyperressonant percussion and hyperinflation/barrel chest due to use of accessory muscles to breath

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14
Q

What is the scoring system used to grade COPD dysponea?

A 
MRC dysponea score (mMRC = US, same but 0-4)
1 = SOB on marked exertion
2 = SOB on hills
3 = has to slow or stop on flat
4 = tolerates 100-200 yards on flat
5 = housebound/ SOB at minor tasks
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15
Q

Treatment for COPD?

A

Bronchodilators = Beta-agonists (SA - salbutamol, LA - salmeterol) or anti-cholinergics (e.g. tiotropium), inhaled corticosteroids, oxygen therapy with/without NIV, mucolytics, lung transplant/volume reduction surgery

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16
Q

How is COPD classified?

A

Stage 1 = FEV1 >80%, chronic cough and no-mild SOB
Stage 2 = FEV1 50-79%, SOB on exertion
Stage 3 = FEV1 30-49%, SOB on low exertion
Stage 4 = FEV1 <30%, SOB at rest

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17
Q

Pink Puffers vs Blue Bloaters?

A 
PP = increased alveolar ventilation normal O2/CO2, emphysematous and weight loss - breathless but NOT cyanosed
BB = decreased alveolar ventilation, low PaO2/high PaCO2, cyanosed but not breathless - may relt on hypoxic drive to breath
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18
Q

What is bronchiectasis?

A

Chronic inflammation of the bronchi/bronchioles leading to permanent dilation and thickening of the airway. Patients struggle to clear the airways and suffer frequent infections

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19
Q

Causes of bronchiectasis?

A

Pneumonia, granulamotous disease e.g. TB, measlesm whooping cough, CF, HIV, foreign body, allergy or tumour

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20
Q

S&S of bronchiectasis?

A

Nail clubbing, wheeze, foul-smelling purluent sputum, chest pain, dysponea and intermitent haemoptyisis

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21
Q

Treatment of bronchiectasis?

A

Chest physio, postural drainage, mucolytics, anti-imflammatories e.g. long-term azithromycin, surgery if local disease and bronchodilators

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22
Q

What is idiopathic pulmonary fibrosis?

A

A type of ILD characterised by progressive chronic pulmonary fibrosis with minimal/abscent inflammation and collagen deposition leading to loss of elasticity and loss of gas exchange ability. Restrictive lung disease.

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23
Q

S&S of idiopathic pulmonary fibrosis?

A

dry cough with or without sputum, exertional dysponea, cyanosis, weight loss, finger clubbing and fine bi-basal crackling

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24
Q

Treatment for idiopathic pulmonary fibrosis?

A

Ambulatory oxygen, pulmonary rehab, pirfenidone to reduce FVC decline, lung transplant and opioids in palliative care.
DO NOT give high dose steroids

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25
Q

Risk factors for idiopathic pulmonary fibrosis?

A

Being male, smoking, infection e.g. CMV/EBV, drugs e.g. methotrexate, GORD and occupational dust exposure

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26
Q

What causes cystic fibrosis?

A

An autosomal recessive mutation on chromosome 7 meaning a defective CFTR protein is made so less chloride ions are secreted and more sodium ions are absorbed = thicker mucus

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27
Q

S&S of CF

A 
Neonate = failure to thrive, meconium ileus and rectal prolapse
Resp. = cough, wheeze, dysponea, thick mucous production, reccurent infections and bronchiestasis
GI = thick secretions, pancreatic insufficiency, increased cholesterol gall stones, intestinal obstruction and poor nutrition
Other = male infertility, salty sweat, clubbing and osteoporosis
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28
Q

What is a diagnostic test for CF?

A 
One or more of:
Sweat test (salty)
Absent vas deferens and epididymis
GI and nutritional disorders
Genetic screening in known genotypes
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29
Q

Treatment for CF?

A

Stop smoking, chest physio, prophylactic antibiotics/vaccines, Beta-2 agonists and inhaled corticosteroids, mucolytics, pancreatic enzyme replacement, bisphosphonates and lung transplant

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30
Q

What is sarcoidosis?

A

ILD. It is a granulomatous disorder of unknown cause affecting any organ system but mainly the lymp nodes and the lungs

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31
Q

S&S of sarcoidosis?

A

Fever, weight loss, fatigue, dry cough, progressive dysponea, decreased exercise tolerance, chest pain, lymphadenopathy, hepatosplenomegaly, conjunctivitis, Bell’s palsy, cardiomyopathy, arrhythmias, erythma nodosum and renal stones

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32
Q

Treatment of sarcoidosis?

A

Acute = bed rest and NSAIDs
Prednisolone or if severe IV methyprednisolone/immunosuppresants e.g. methotrexate. Lung transplant
If BHL alone there is no need for treatment.

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33
Q

What is a definitive test for sarcoidosis?

A

Tissue biopsy showing non-caseating granulomatas

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34
Q

What is Wegener’s granulomatous?

A

Granulomatous disease characterised by necrotising granulomatous inflammation and vasculitis of the small/medium vessels - ANCA positive

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35
Q

S&S of Wegener’s granulomatous?

A

Severe rhinorrhoea and nasal mucosal ulceration, glomerulonephritis, proteinuria/haematuria, skin purpura, cough, peripheral neuropathy and arthritis

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36
Q

Treatment of Wegener’s granulomatous?

A

Predisolone and cyclophosphamide/rituximab

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37
Q

What is Hypersensitivity pneumonitits?

A

ILD. Caused by allergic response (type 3 hypersensitivity) to an inhaled antigen or ingested drug which leads to granulomatous inflammation of the lung parnchyma.
Acute/subacute = reccurrent pneumonitits
Chronic = fibrosos/emphysema/permanent lung damage

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38
Q

S&S of hypersenitivity pneumonitis?

A 
Acute = fever, rigours, myalgia, dry cough, dysponea, crackles (no wheeze) and chest-tightness
Subacute = history of acute attacks. Same as above but more severe and more gradual onset
Chronic = cyanosis, weight loss, clubbing, increased dyspone and type 1 respiratory failure
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39
Q

When do the different types of hypersensitivity pneumonitis onset/begin to heal?

A 
Acute = onset 4-6 hours post exposure, resolves 24-48 hours post removal of causative antigen
Sub-acute = onset due to intermittent low level exposure, resolves in weeks-months after causative antigen is removed
Chronic = no history of preceeding acute symptoms and only partial recovery on removal of causative antigen
40
Q

Treatment of hypersensitivity pneumonitis?

A

Remove/avoid allergen, give oxygen and prednisolone (long term in chronic)

41
Q

What is is Goodpasture’s syndrome?

A

A type II hypersensitivity reaction and autoimmune disease against the basement membrane of the kindeys and lungs leading to alveolar haemorrhage and acute glomerulonephritis

42
Q

S&S of Goodpasture’s syndrome?

A

anaemia, acute glomerulonephritis, cough, intermittent haemoptysis and tiredness. Starts with symptoms of URT infection e.g. sneezing/fever

43
Q

What is the diagnostic test for goodpasture’s syndrome?

A

anti-GBM antibodies in the blood

44
Q

Treatment for goodpasture’s syndrome?

A

Treat shock, prednisolone and plasmapheresis.

Some patients improve spontaneously others progress to renal failure

45
Q

Risk factors for PE?

A

DVT, recent surgery, throbophillia, imobilisation, malignancy, pregnancy, combined oestrogen pill/HRT and previous PE

46
Q

S&S of PE?

A

Tachycardia, tachyponea, cyanosis, hypotension, pleural rub, pleural effusion, dysponea, heamoptysis, dizziness, syncope and tender hard calf

47
Q

Tests for PE?

A

V/Q mismatch, D-dimer is positive - then do CT pulmonary angiography (will also be positive), increased troponin (due to RH failure)

48
Q

Treatment of PE?

A

Oxygen, morphine plus anti-emetic, LMW heparin, IV fluids, thrombolysis, long term = LMW heparin and warfarin/DOAC

49
Q

What is pulmonary hypertension?

A

Mean pulmonary arterial pressure >25mmHg and secondary right heart failure.
Occurs due to increase in pulmonary vascular resisitance or increase in pilmonary blood flow.

50
Q

What are the different types of pulmonary hypertension?

A

Group 1 = pulmonary arterial hypertension - connective tissue diseases, HIV or cirrhosis
Group 2 = L heart disease - mitral/aortic valve disease and LVHF
Group 3 = lung disease - COPD, pulmonary fibrosis and obstructive sleep apnoea
Group 4 = chronic blood clots - PE or clotting disorders
Group 5 = other causes e.g. inflamatory/metabolic disorders, tumours and kidney disease

51
Q

S&S of pulmonary hypertension?

A

Exertional dysponea, lethargy, fever, ankle oedema, chest pain, syncope and cor pulmonale

52
Q

Treatment of pulmonary hypertension?

A

Treat underlying cause, oxygen, warfarin, diuretics, CCBs, phosphodiesterase-5-inhibitors and heart-lung transplant

53
Q

What are the two types of pleural effusion?

A

Transudate = <25g/l of protein with transparent fluid. The blood vessels remain intact
Exudate = >35g/l of protein with cloudy fluid.
The pleural cappilaries are leaky to protein

54
Q

Causes of pleural effusion?

A 
Transudate = increased venous pressure (e.g. due to HF or fluid overload), hypoproteinemia (e.g. due to cirrhosis, malabsorption or nephrotic syndrome) and peritoneal dialysis
Exudate = pneumonia, malignancy, TB and pulmonary/myocardial infarction
55
Q

S&S of pleural effusion?

A

Pleuritic chest pain, decreased chest expansion on the effected side, tracheal deviation away from effected side, stony dull percussion, decreased vocal resonance, breathlessness and cough

56
Q

How do you diagnose pleural effusion?

A

Aspiration with pleural tap.
Purulent = pus effusion, turbid = infection effusion and milky = lymph fluid effusion
300-600ml seen on CXR

57
Q

Treatment of pleural effusion?

A

Treat the underlying cause, drain if symptomatic, pleurodesis with talc (with doxycycline injections) to prevent ruccurence and surgery

58
Q

What are the types of pmeumothorax?

A 
Simple = 2 way valve in the lung, can be open (caused by penetrating thoracic injury which allows air to enter teh chest - pleural cavity pressure = thoracic pressure) or closed (caused by air originating from the respiratory sytem - pleural cavity pressure < atmospheric pressure)
Tension = one way valve, pleural cavity pressure > atmospheric pressure
59
Q

S&S of pneumothorax?

A

Reduced chest expansion on the affected side, hyper-resonant percussion on teh affected side, absent breath sounds on the affected side, tachycardia, tachyponea, dysponea and pleuritic chest pain.
IF TENSION = tracheal deviation away from affected side

60
Q

Treatment for pneumothorax?

A

Stop smoking, oxygen mask, needle thoacostomy aspiration (2nd intercostal space in mid-clavicular line), intercostal chest drain in triangle of saftey if traumatic/haemothorax/mechanically ventilated

61
Q

What is the main complication of tension pneumothorax?

A

Cardiorespiratory arrest

62
Q

Common causes of pharygitis/tonsillitis?

A

Adenovirus, rhinovirus, EBV, HIV and lancefield group A beta-haemolytic streptococcus e.g. strep pyogenes

63
Q

S&S of pharygitis/tonsillitis?

A

Sore throat, fever, tender and enlarged neck lympnodes/glands, large tonsils with exudate in tonsillitis

64
Q

Common causes of sinusitis?

A

streptococcus pneumoniae

haemophillus influenzae

65
Q

S&S of sinusitis?

A

fever, purulent nasal discharge, facial/ear/teeth pain

66
Q

Common causes of acute epiglottitis?

A

Haemophilus influenzae, steptoccocus pneumoniae, fungal infections (if immunocompromised), herpes simplex virus and VZV

67
Q

S&S of acute epiglottits?

A

Fever, sore throat, odonophagia, weight loss, inspiratory stridor, oral thrush, severe airflow obstuction and diarrhoea

68
Q

Treatment for acute epiglottits?

A

Urgent endotracheal intubation and IV ceftazidime

69
Q

Causes of whooping cough?

A

Bordetella pertussis - most common, B.parapertussis and B. bronchiseptica

70
Q

S&S of whooping cough?

A

chronic cough, fever, subconjunctival haemorrhage, rhinorrhoea, malaise, anorexia and coughing spasms ending in vomiting

71
Q

Treatment for whooping cough?

A

Clarithromycin early on and vaccination

72
Q

What is coup/acute laryngotracheobronchitis?

A

A complication of URT infections leading to inflammatory oedema extending to the vocal cords and epiglottis. Causes narrowing of teh neck and abdomen during inspiration

73
Q

S&S of coup?

A

Fever, cyanosis, prominent barking cough, increased resp. rate, prominent intercostal recessions and inspiratory stridor

74
Q

Common causes of TB?

A

Mycobacterium tuberculosis - most common, mycobacterium bovis, mycobacterium africanum and mycobacterium microti

75
Q

S&S of TB infection?

A

weight loss, fever, anorexia, night sweats, malaise
Pulmonary = productive cough >3weeks, occasional haemoptysis, chest pain, hoarse voice and dysponea
Extrapulmonary = lymphadenopathy, bone pain, frequency, dysuria, haematuria, meningeal inflammation with thick exudatem raised ICP

76
Q

Treatment of TB?

A

Antibiotic treatment: rifampficin and isoniazib for 6 months, pyrazinamide and ethambutol for 2 months. THE FIRST 2 MONTHS OF ALL 4 IS INTENSIVE.
Offer patient DOTS to enusre compliance, contact tracing and notify PHE

77
Q

How do you diagnose TB?

A

Ziehl-neelsen stain of sputum collected on 3 seperate occassions and tuberculin stain test for latent disease checks

78
Q

What are the types of pneumonia?

A 
CAP = no underlying malignancy or immunosuppresion can be localised or diffuse
HAP = new onset in patients who have been hospitalized >48hours or who have been in the health care setting for >3months, often seen in ventilated patients
Immunocompromised = as it sounds
Aspiration = acute aspiration of gastric contents into the lungs
79
Q

Causes of pneumonia?

A

CAP: Strep. pneumonia = most common, H. influenzae, staph.aureau, Klebsiella pneumoia, Mycoplasma pneumonia and E.coli
HAP: MRSA, E.coli, Klebsiella pneumonia, pseudomonas aeruginosa

80
Q

S&S of pneumonia?

A

Fever, night sweats, anorexia, pleuritic chest pain, tachyponea, tachycardia, dysponea, chest is dull to percuss, dry/productive cough, cyanosis, purulent sputum, decreased blood pressure and condusion

81
Q

What is CURB 65?

A

An assesment criteria for CAP severity. 1 point for each:
Confusion, Urea >7mmol/l, RR>30, BP <90mmHg systolic and/or <60mmHg diastolic, older than 65.
0-1 = mild, no admission necessary,
2 = moderate, admit
3-5 = severe, admit and closely monitor

82
Q

Treatment for pneumonia?

A

Oxygen and analgesics,
Stage 0-2 = amoxicillin for 5-7 days
Stage 3+ = co-amoxiclav/clarithromycin for 7-10days
Long term = stop smoking and vaccinate

83
Q

What is empyema?

A

A collection of pus in the plural cavity often associated with pneumonia

84
Q

S&S of empyema?

A

Ongoing fever, pain on deep inspiration, dull stony percussion, decreased air entry to the lungs and failure of symptoms to improve on antibiotics

85
Q

Treatment of empyema?

A

Immediate chest drain, co-amoxiclav, piperacillin-tazobatam AND meropenem

86
Q

What is a lung abscess?

A

Severe localised cavity and pus fromation within the lungs. Caused by strep. milleri and klebsiella pneumoniae

87
Q

Treatment of a lung abscess?

A

6 weeks of antibiotics and surgical drainage

88
Q

What is small cell lung cancer?

A

A very aggressive lung cancer which metasisises early. It arises from epithelial cells in the central bronchus and has a strong association with smoking. They secrete polypetptide hormoes and have a poor prognosis

89
Q

What is non-small cell lung cancer?

A

Can be divided into squamous cell carcinoma (arises from central epithelial cells - strong association with smoking and causes necorsis), adenocarcinoma (arises from mucous-secreting cells - associtaed with asbestos) and carcinoid tumours (are neuroendocrine secreting cells).
It has some association with smoking and metastises less aggressivley

90
Q

Where do secondary lung tumours commonly come from?

A

Breast, bowel, kidney and bladder cancers

91
Q

S&S of lung cancer?

A

Cough, dysponea, haemoptysis, chest pain, anorexia, weight loss, anaemia, clubbing, pleural effusions and reccurent infection

92
Q

What staging is udsed for lung cancer?

A

TNM staging system

93
Q

Treatment of lung cancer?

A

NSCLC (more common) - surgical excision, chemotherapy and/or radiotherapy
SCLC - combined chemotherapy and radiotherapy. Palliative care with dexamethosone, tracheal stenting, pleural drainage, steroids, analgesics and antiemetics

94
Q

What is a mesothelioma?

A

A high grade malignancy of the pleura which is strongly associated with asbestos. Also affects the mesthelial cells of the peritoneum, pericardium and testes

95
Q

S&S of mesothelioma?

A

Chest pain, dysponea, reccurent pleural effusions, finger clubbing, weight loss, anorexia and anemia

96
Q

Treatment of mesothelioma?

A

Prognosis is very poor, death <8months.

Refer all cases to HM coroner

2A (12 decks)

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