Resp Flashcards
Sx of PE?
Acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, syncope, cyanosis, tachypnoea, tachycardia, hypotension, raised JVP and pleural rub
Which score can be used to calculate the risk of PE?
Well’ score
Dx and Tx of PE?
CT Pulmonary Angiography
Oxygen, morphine and anti-emetic, IV LMW heparin, thrombolysis with alteplase if haemodynamically unstable
Long term anticogaulation with DOAC e.g. rivaroxiban or warfarin
Sx of TB?
Fever, weight loss, night sweats, clubbing, chronic productive cough, chest pain, haemoptysis
Dx of TB?
Test for latent TB with the mantoux skin test
Test for active TB with CXR = nodular/patchy shadows in the upper zone, fibrosis and cavitiation. Take a sputum sample and perform a Ziehl-neelsen stain to look for acid-fast bacilli (all mycobacteria are this).
Tx of TB? Give SEs of the drugs?
NOTIFY PHE
6 months antibiotic treatment with Rifampicin (makes body secretions orange-red), Isoniazid (causes peripheral neuropathies), Pyrazinamide (causes hepatotoxicity) and Ethambutol (causes colour blindness)
What organisms casue TB?
Mycobacteria. Most common = Mycobacterium tuberculosis
Sx of pneumonia?
Fever, malaise, dyspnoea, cyanosis, cough with purulent sputum, haemoptysis, pleuritic pain, tachycardia, tachypnoea and hypotension.
What will you find on examination in pneumonia?
Consolidation = Reduced chest expansion, dull percussion, increased vocal resonance and bronchial breathing
Pleual rub
CXR = lobar infiltrates, cavitation and pleural effusion
How do you calculate pneumonia severity? What does the score mean?
CURB-65 Confusion (1) Urea >7mmol/L (1) Resp rate >= 30/min (1) BP <90 systolic and/or <60 diastolic (1) 65 or over (1) A score of 2 or more suggests patient should be admitted to hospital
What are the most common causative organisms of pneumonia?
CAP = Strep pneumoniae (commonest), haemophilus influenzae HAP = Pseudomonas aeruginosa, MRSA
What is the name of the lung tumour commonly caused by asbestos exposure? How does it present?
Mesothelioma
Chest pain, dyspnoea, weight loss, finger clubbing, reccurrent pleural effusions.
What are the main types of bronchial carcinoma?
Small Cell LC = strongly associated with smoking, often metastasized by presentation
Non-Small Cell LC = Squamous or adenocarcinoma are the main ones. Adenocarcinoma = MOST COMMON
Sx of lung cancer?
Cough, haemoptysis, dyspnoea, chest pain, clubbing, weight loss and frequent pneumonias.
Can cause consolidation, pleural effusion and lung collapse
Sx of pneumothorax?
Sudden onset dyspnoea and pleuritic chest pain. Unilateral decreased chest expansion, hyperresonant percussion, reduced vocal resonance and diminished breath sounds.
Tension pneumothorax = tracheal deviation away from the affected side
How can you distinguish transudates and exudates in pleural effusion? What casues each?
Transudates = <25g/L of protien. Caused by HF, fluid overload, cirrhosis, nephrotic syndrome and malabsorption Exudates = >35g/L of protein. Caused by pneumonia, TB, RA, SLE, malignancy etc.
How does pleural effusion appear on examination?
Unilateral reduced chest expansion, stony dull percussion, reduced breath sounds, decreased vocal resonance and broncial breathing above the effusion (if the lung is compressed).
Tracheal deviation away from the affected side.
Sx of pleural effusion?
Dyspnoea, pleuritic chest pain, dry cough and orthopnoea
Sx of CF? What do you find OE?
Neonate = failure to thrive and rectal prolapse Older = cough, wheeze, recurrent chest infections, bronchiectasis, haemoptysis, pancreatic insufficiency, male infertitility OE = cyanosis, finger clubbing and bilateral coarse crackles
Dx and Tx of CF?
Sweat test (measures the amount of sodium and chloride in the sweat - will be high in CF) Genetic screening (look for mutation in CFTR gene on chromosome 7) Chest physio, mucolytics, bronchodilators etc.
Sx of bronchiectasis? What is seen OE?
Persistent cough, lots of purulent sputum, intermittent haemoptysis, wheeze
Clubbing, coarse biphasic crackles
Causes of bronchiectasis?
CF
H.influnezae, Strep. pneumoniae, Staph. aureus, Pseudomonas aeruginosa
Tx of bronchiectasis?
Chest physio and mucolytics, antibiotics, bronchodilators e.g. salbutamol and corticosteroids e.g. prednisolone
What is Empyema?
A build up of pus in the pleural space. It often occurs as a complication of pneumonia and should be suspected in any patient whith resolved pneumonia who develops a recurrent fever
Sx of lung abscess?
Swinging fever, cough, purulent foul-smelling sputum, pleuritic chest pain, haemoptysis, weight loss, clubbing
Causes of lung abscess?
Poorly treated pneumonia, aspiration (often seen in alcoholics) and broncial obstruction e.g. malinancy
Sx of Idiopathic Pulmonary Fibrosis? What is seen OE?
Dry cough, exertional dyspnoea, weight loss, cyanosis, arthralgia
Finger clubbing, fine end-inspiratory crackles
Dx and Tx of IPF?
CXR = decreased lung volume and honeycombing of the lung Spiromitery = restirctive lung disease (FEV1 <80%, FEV1:FVC >70%) Tx = oxygen, pulmonary rehabilitation, opiates, palliative care
What Sx are seen in all Intersitial Lung Diseases (ILD)
Dyspnoea on exertion, non-productive paroxysmal cough, abnormal breath sounds and restrictive spirometry.
Sx of sarcoidosis?
Granulomas develop throughout the body!
Fever, dry cough, progressive dyspnoea, decreased exercise tolerance, chest pain, hepatosplenomegaly, uveitis/conjunctivitis, erythema nodosum, cardiomyopathy, arrhythmias and renal stones
What is BHL? How does it appear on X-ray and what may it indicate?
Bilateral Hilar Lymphadenopathy.
Enlargement of the mediastinal lymphnodes (in the hila)
Indicates sarcoidosis, infection e.g. TB, malignancy or hypersensitivity pneumonitits
What is hypersensitivity pneumonitis?
A type III hypersensitivity reaction leading to inflammation of the lungs. Common casues = farmers lung and pigeon fanciers lung
Sx of acute and chronic hypersensitivity pneumonitis?
Acute = fever, dry cough, dyspnoea, chest-tightness and pulmonary crackles Chronic = cough, increasing dyspnoea, cyanosis, weight loss, clubbing and type 1 respiratory failure
Tx of hypersensitivity pneumonitis?
Acute = remove allergen, give oxygen and oral prednisolone Chronic = avoid allergen exposure, long term prednisolone
Sx of GPA (Wegener’s granulomatosis)?
Saddle nose deformity, epistaxis, nasal obstruction
Renal involvement = proteinuria and haematuria
Lung involvement = cough and haemoptysis
Dx and Tx of GPA (Wegener’s granulomatosis)?
ANCA positive - it is a form of vasculitis
Tx = corticosteroids and cyclophosphamide
Sx of Goodpastures syndrome?
This is a type II hypersensitivity reaction caused by anti-GBM antibodies
Oliguria, haematuria, dyspnoea and haemoptysis. It also causes anaemia = fatigue and pale skin
Sx of asthma?
Episodic polyphonic expiratory wheeze, cough, dyspnoea, diurnal variation, chest hyperinflation
Dx of asthma?
FeNO test. Reduced peak expiratory flow
Obstructive disese = PEF1 <80%, PEF1:FVC <70%
Tx of asthma?
SABA (e.g. salbutamol) or SAMA (e.g. tiotropium) ADD inhaled corticosteroids ADD LABA/LAMA.
In severe eosinophilic disease consider monoclonal antibodies e.g. omalizumab
How do you treat an asthma attack?
40-60% oxygen, salbutamol (nebulised with oxygen), IV hydrocortisone, IV magnesuim sulfate if severe attack
Sx of COPD?
Chronic cough, progressive dyspnoea (worse on exertion), sputum production, wheeze, cyanosis, chest hyperinflation, use of acessory muscles, frequent LRT infections
Dx of COPD? How is this used to stage COPD?
FEV1 <80%, FEV1:FVC <70%
Stage 1 = FEV1 >80%, chronic cough and no-mild breathlessness
Stage 2 = FEV1 50-79%, breathlessness on exertion
Stage 3 = FEV1 30-49%, breathlessness on low exertion
Stage 4 = FEV1 <30%, breathless at rest
Tx of COPD?
Smoking cessation, SABA/SAMAs (e.g. salbutamol or ipatropium) ADD LABA/LAMA, ADD inhaled corticosteroids. Oxygen in acute exacerbations (consider NIV)
These patients are at risk of developing type 2 respiratory failure!
Define the two types of respiratory failure?
Type 1 = hypoxia with normal/low carbon dioxide levels
Type 2 = hypoxia with hypercapnia
Causes of Type 1 respiratory failure?
Ventilation/perfusion mismatch = pneumonia, pulmonary oedema, PE, asthma, ephysema and pulmonary fibrosis.
Also due to hypoventilation, abnormal diffusion, R to L cardiac shunts and ARDS e.g. due to opiate OD
Causes of Type 2 respiratory failure?
Alveolar hypoventialtion with or without V/Q mismatch.
Pulmonary disease = asthma, COPD, obstructive sleep apnoea, pnumonia
Reduced respiratory drive = opiates and CNS injury
Neuromuscular disease = myasthenia gravis, Guillain-Barre syndrome and C spine injury
Thoracic wall diseas = flail chest
Sx of hypoxia?
dyspnoea, restlessness, agitation, confusion, central cyanosis.
If chronic = polycythaemia, pulmonary hypertension and cor pulmonale
Sx of hypercapnia?
Headache, peripheral vasodilation, tachycardia, bounding pulse, tremour/asterixis, papilloedema, confusion, drowsiness and coma
Sx of pharyngitis/tonsillitis?
Sore throat, tender cervical lymph nodes/glands in the neck, fever, enlarged tonsils with exudate in tonsilitis
Sx of sinusitis?
Fever, facial pain, pain in the ears/teeth, purulent nasal discharge, cold-like symptoms
Sx of acute epiglottitis?
Fever, sore throat, severe airway obstruction, odonphagia, fatigue, weight loss, diarrhoea, oral thrush, inspiratory stridor
Sx of whooping cough?
Chronic cough with coughing spasms that end in vomiting, clear lungs, subconjunctival haemorrhage, fever.
VACCINATE CHILDREN
Tx of acute epiglottitis?
Urgent endotracheal intubation, IV ceftazidime
What is coup?
A complication of URT infection causing oedema of teh vocal cords and epiglottis = a barking cough (like a seal), inspiratory stidor and cyanosis
Sx of glandular fever (infective mononucleosis)
Fever, lymphadenopathy, severe sore throat, tonsilar enlargement, anorexia, fatigue, hepatosplenomegaly which can lead to jaundice
Tx of coup?
Nebulised adrenaline, oxygen, fluids, oral/IM dexamethasone
