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PACES > Resp > Flashcards

Resp Flashcards

1
Q

Signs of COPD in the hands

A

CO2 retention flap
Tar staining
Bounding pulse

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2
Q

Signs of hyper expansion seen in a patient with COPD

A

 ↓ cricosternal distance
 Loss of cardiac dullness on percussion
 Palpable liver edge

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3
Q

What are signs of cor pulmonale?

A 
 ↑JVP
 Left parasternal heave: RV hypertrophy
 LoudP2±S3
 MDM of pulmonary regurg
 Ascites and pulsatile hepatomegaly
 Peripheral oedema
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4
Q

Definition of COPD

A

Is used to define two conditions:

Chronic bronchitis: Cough productive of sputum on most days for ≥3mo on ≥2 consecutive years

Emphysema: Histological description of alveolar wall destruction with air collapse and air trapping

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5
Q

4 features you would see on spirometry of a patient with COPD?

A

 ↑ TLC and residual volume (RV)
 FEV1 <80%
 FEV1:FVC <0.7
 ↓ transfer factor

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6
Q

How can you determine the prognosis of a patient with COPD?

A

Bode index

Looks at:
 BMI
 Obstruction: FEV1
 Dyspnoea: MRC score
 Exercise capacity: 6 min walk
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7
Q

Gold Classification COPD

A

Global Initiative for Obstructive Lung Disease) - allows you to tailor therapy to the patient

Looks at:

 mMRC dyspnoea score (modified medical research council)
 Airflow limitation
 No. of exacerbations per year

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8
Q

Conservative management of COPD (4)

A

MDT
 GP, dietician, physio, resp physician, specialist nurses
 Regular review 1-2x / yr

Smoking Cessation: single most important intervention
 Specialist nurse and support programme
 Nicotine replacement therapy
 Varenicline: partial nicotinic agonist

Pulmonary Rehabilitation Therapy
 Tailored exercise programme
 Disease education
 Psychosocial support

Co-morbidities
 Nutritional assessment and dietary support
 CV risk Mx
 Vaccination: pneumococcal and seasonal influenza

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9
Q

Medical Management of COPD

A

Principal Therapies
 Anti-muscarinics: short- or long-acting
 β-agonists: short- or long-acting
 Inhaled corticosteroids: in combination ̄c β-B

Other Therapies
 Theophylline or Roflumilast: PDIs 
 Carbocisteine: mucolytic
 Home emergency pack for acute exacerbations 
 LTOT
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10
Q

Surgical Management of COPD

A

 Used for recurrent pneumathoraces or large bullae

 Bullectomy
 Lung reduction surgery (removing damaged parts of the lungs)

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11
Q

Definition of asthma

A

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli.

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12
Q

Conservative management of Asthma

A

M TAME

General
 MDT: GP, specialist nurses, respiratory physician
 Technique for inhaler use
 Avoidance: allergens, smoke (ing), dust
 Monitor: Peak flow diary (2-4x/d)
 Educate
        Liaise  ̄c specialist nurse 
        Need for Rx compliance 
        Emergency action plan
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13
Q

Management of acute asthma exacerbations

A

Immediate

  1. Sit-up
  2. 100% O2 via non-rebreathe mask (aim for 94-98%)
  3. Nebulised salbutamol (5mg) and ipratropium (0.5mg) 4. Hydrocortisone 100mg IV or pred 50mg PO (or both) 5. Write “no sedation” on drug chart

Life threatening
 Inform ITU
 MgSO4 2g IVI over 20min
 Nebulised salbutamol every 15min (monitor ECG)

IV Rx if No Improvement in 15-30min:
 Nebulised salbutamol every 15min (monitor ECG)
 Continue ipratropium 0.5mg 4-6hrly
 MgSO4 2g IVI over 20min
 Salbutamol IVI 3-20ug/min
 Consider aminophylline
          Load: 5mg/kg IVI over 20min
          Monitor Levels
ITU for intubation
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14
Q

What are some of the causes of PF?

A 
Upper (PENTA):
 Pneumoconiosis: Coal, Silica
 Extrinsic allergic alveolitis
 Negative, sero-arthropathy (ank spond)
 TB
 Aspergillosis : ABPA
Lower (STAIR):
 Sarcoidosis (mid zone)
 Toxins: BANS ME
 Asbestosis
 Idiopathic pulmonary fibrosis
 Rheum: RA, SLE, SS, Sjogren’s, PM/DM
TOXINS (BANS ME):
 Bleomycin, Busulfan
 Amiodarone
 Nitrofurantoin
 Sulfasalazine
 MEthotrexate
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15
Q

Spirometry results for PF?

A

 ↓TLC ̧ ↓RV, ↓FEV and ↓FVC
 FEV1:FVC >0.8
 ↓ transfer factor

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16
Q

Management of PF

A

MDT: GP, pulmonologist, physio, psych, palliative care,
specialist nurses, pts. family

Anti fibrotic: e.g. perfenidone

Rx specific cause:
 EAA: steroids
 Sarcoidosis: steroids
 Connective tissue disease: steroids

Supportive care:
Stop smoking: single most beneficial strategy Pulmonary rehabilitation
LTOT
Symptomatic: anti tussive such as codeine phosphate

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17
Q

Ddx for bronchiectasis

A

COPD
Asthma
Pneumonia

18
Q

Causes of bronchiectasis

A 
Congenital
 CF
 PCD / Kartagener’s
 Young’s: azoospermia + bronchiectasis
 Hypogammaglobulinaemia: XLA, CVID, SAD
Acquired
 Idiopathic
 Post-infectious: pertussis, TB, measles
 Obstruction: tumour, foreign body
 Associated: RA, IBD (esp. UC), ABPA
19
Q

Ix for bronchiectasis

A

Sputum

Blood
 FBC: ACD
 Serum Ig: may do provocative testing
 Aspergillus: RAST, precipitins, ↑IgE, eosinophilia  RA: anti-CCP, RF, ANA

Spirometry
 Obstructive

HRCT
 Signet ring sign: thickened dilated bronchi + smaller adjacent vascular bundle
 Pools of mucus in saccular dilatations

CXR
 tramlines and ring shadows (bunch of grapes)

20
Q

Management of bronchiectasis

A

Conservative
 MDT: GP, pulmonologist, physio, dietician, immunologist
 Physio: postural drainage, active cycle breathing, pulmonary rehabilitation

Medical
 Abx
 Exacerbations: e.g. cipro for 7-10d
 May use prophylactic azithromycin
 Bronchodilators: nebulised β agonists
 Treat underlying cause
 CF: DNAase, pancreatin (Creon), ADEK vitamins
 ABPA: Steroids
 Immune deficiency: IVIg
 Vaccination: flu, pneumococcus

Surgical
 May be indicated in severe localised disease or obstruction

21
Q

Organs affected by CF

A 
 Bronchioles → bronchiectasis
 Pancreatic ducts → DM, malabsorption
 GIT → Distal Intestinal Obstruction Syndrome
 Liver → gallstones, cirrhosis
 Fallopian tubes → ↓ female fertility
 Seminal vesicles → male infertility
22
Q

Causes of pleural effusion

A

Transudate

  • CCF
  • Renal failure
  • ↓ albumin
  • Hypothyroidism
  • Meig’s syn.

Exudate

  • Infection: pneumonia, TB -Ca:1O or2O
  • Inflammation: RA, SLE
  • Infarction: PE
  • Trauma
23
Q

What are the types of lung malignancy?

A 
Non-Small Cell Lung Cancer
SCC: 35%
 Highly related to smoking 
 Centrally located
 PTHrP → ↑ Ca2+

Adenocarcinoma: 25%
 RF: female non-smokers
 Peripherally located
 80% present ̄c extrathoracic mets

Large-cell: 10%

Small Cell Lung Cancer: 20%
       Highly related to smoking
       Central location
       80% present  ̄c advanced disease
       Ectopic hormone secretion
24
Q

Outline the CURB 65 score and how would you interpret the result

A

Severity: CURB-65 (only if x-ray changes)

 Confusion (AMT ≤8) 
 Urea >7mM
 Resp. rate >30/min 
 BP <90/60
 ≥65

Score
0-1 → home Rx
2 → hospital Rx
≥ 3 → consider ITU

25
Q

How do you treat TB and what are some of the side effects of the drugs?

A

 RMP: hepatitis, orange urine, enzyme induction
 INH: peripheral sensory neuropathy, ↓PMN
 PZA: hepatitis, arthralgia (CI: gout, porphyria)
 EMB: optic neuritis → loss of colour vision first

26
Q

Causes of obstructive lung disease

A 
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
Alpha 1 Antitrypsin deficiency
27
Q

Causes of restrictive lung disease

A

Pulmonary fibrosis
Asbestosis
Sarcoidosis

Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity
28
Q

Causes of apical lung fibrosis

A 
C- Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
29
Q

Causes of lower lobe lung fibrosis

A 
Sarcoid 
Toxins 
Asbestosis
Idiopathic PF
Rheumatological

Most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
Drug-induced: amiodarone, bleomycin, methotrexate

30
Q

Ddx for coarse crackles

A

Pneumonia
Bronchiectasis (can be mixed)
Pulmonary oedema

Discontinuous, brief, popping sounds. They have also been described as a bubbling sound. More common during inspiration.

31
Q

Ddx for fine end-inspiratory crackles

A

Fine end-inspiratory crackles are associated with pulmonary fibrosis

Brief, discontinuous, popping sounds that are high-pitched. Similar to wood burning in a fireplace. More commonly heard during inspiration.

32
Q

How can you tell the difference between fine and coarse crackles?

A

Fine are usually smaller airways and normally on inspiration

Coarse usually on inspiration and expiration and may change if you ask the patient to cough

33
Q

Features O/E of lung collapse?

A

Trachea deviation towards affected side
Reduced breath sounds
Dull to percussion

34
Q

4 causes of pulmonary hypertension?

A 
Chronic thromboembolic disease/recurrent PEs
Chronic lung disease
Congenital heart disease
Left sided heart disease
HTN
35
Q

Causes of trachea pulled toward the white-out on xray?

A

Pneumonectomy
Complete lung collapse e.g. endobronchial intubation
Pulmonary hypoplasia

36
Q

Causes of Trachea pushed away from the white-out on xray?

A

Pleural effusion
Diaphragmatic hernia
Large thoracic mass

37
Q

Causes of trachea central on white-out CXR?

A

Consolidation
Pulmonary oedema (usually bilateral)
Mesothelioma

38
Q

Causes of exudative pleural effusion?

A

The Boys In the NYPD Choir were singing Exudate:

TB
Infection (pneumonia, abscess)
Neoplasm
Yellow nail syndrome
PE, Pancreatitis
Dressler's syndrome
Connective tissue: RA & SLE
39
Q

Findings on lung function test of restrictive conditions?

A

Reduced FEV1
Significantly reduced FVC
Normal/increased FEV1/FVC ratio

40
Q

Findings on lung function test of obstructive conditions?

A

FEV1 - significantly reduced
FVC - reduced or normal
FEV1% (FEV1/FVC) - reduced

PACES (13 decks)

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