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Year 3 > Resp conditions > Flashcards

Resp conditions Flashcards

1
Q

What is acute bronchitis?

A

Infection of the bronchi

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2
Q

How is acute bronchitis different to pneumonia?

A

Infection is of the bronchi not the lung parenchyma

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3
Q

What symptoms will someone with acute bronchitis classically present with?

A

Cough that lasts <30 days
Cough may be productive (clear, white or discoloured sputum)
Cough worse at night and with exercise

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4
Q

Who cannot be diagnosed with acute bronchitis?

A

Those with an underlying respiratory condition eg asthmatics

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5
Q

Who is more likely to get acute bronchitis?

A

Smokers

Those who have been exposed to infectious agents

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6
Q

What is the first line investigation of acute bronchitis?

A

None, diagnosis is clinical

You might want to do a chest x ray to rule out pneumina

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7
Q

How is acute bronchitis managed?

A

Usually it doesn’t need to be treated and the cough will settle in 4 weeks
Anti pyretics eg paracetamol may be used
If there is a wheeze consider giving salbutamol

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8
Q

What are some complications of acute bronchitis?

A

Chronic cough

Pneumonia

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9
Q

What is asbestosis?

A

Diffuse interstitial fibrosis of the lungs due to exposure to asbestos

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10
Q

What symptoms will someone with asbestosis classically present with?

A

Exertional dyspnoea that is progressively getting worse
Cough (non productive/dry)
Crackles on auscultation

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11
Q

Who is more likely to get abestosis?

A

Those with exposure

Smokers

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12
Q

How long after exposure to asbestos will someone with asbestosis present?

A

20 years after

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13
Q

What is the first line investigation for asbestosis? What will you see?

A

Chest x ray- if after 20 years of exposure, you may see evidence of fibrosis and pleural thickening
Pulmonary function tests- usually will show restrictive disease but may also show features of obstructive disease

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14
Q

How is asbestosis managed?

A

First line lifestyle advice of importance of not smoking
May benefit from pulmonary rehabilitation
May need oxygen therapy- if sats are under 89% on room air
Give abx if there is any evidence of infection

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15
Q

What advice is it really important to give patients with asbestosis and why?

A

Don’t smoke- smoking when you have asbestosis increases the risk of lung cancer greatly

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16
Q

What are some complications of asbestosis?

A

Lung cancer

Cor pulmonalae

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17
Q

How long after exposure will you see radiographical changes in someone with asbestosis?

A

20 years

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18
Q

What is an LRTI?

A

An infection of the respiratory tract below the larynx

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19
Q

Where must an infection be for it to be an LRTI?

A

Below the larynx

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20
Q

What symptoms will someone with an LRTI classically present with?

A

Dry cough
Headache
Stuffy or runny nose
Low fever

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21
Q

Who is more likely to get LRTI?

A

Immunocompromised
Under 5 or over 65
Recent cold or flu
Recent surgery

22
Q

What type of organism most commonly causes an LRTI?

A

Virus

23
Q

What is the first line investigation for LRTI? What will it show

A

Dont need any, diagnosis can be clinical
Always do oxygen saturation
May do a chest x ray to rule out pneumonia

24
Q

How is LRTI managed?

A

Usually no medication is needed as its viral but may give abx if bacterial
Tell them to drink lots of water, salt gargle etc
Can take antipyretics and NSAIDs
If they are breathless an inhaler may be prescribed

25
Q

What are some complications of LRTI?

A

Progression to bronchitis or pneumonia

26
Q

What is fibrotic lung disease?

A

Fibrosis and scar tissue in the lung with no other obvious cause

27
Q

What symptoms will someone with fibrotic lung disease classically present with?

A

Exertional dyspnoea
Dry non productive cough
Crackles (especially in lung bases)
They may also have weight loss, malaise and clubbing

28
Q

Who is more likely to get fibrotic lung disease?

A

Increasing age
Smokers
Male sex
Family hx

29
Q

What are the first line investigations for fibrotic lung disease and what would you expect to see?

A

Chest x ray- abnormal and evidence of fibrosis
CT chest- evidence of fibrosis
Lung function tests- show restrictive disease (low forced vital capacity and total lung capacity
May do:
Anti nuclear antibodies- to rule out collagen vascular disease
Rheumatoid factor- to rule out RA as a cause

30
Q

How is fibrotic lung disease managed?

A

First line antifibrinotics eg pirfenidone or nintedanib
Pulmonary rehabilitation and oxygen therapy if needed
Prescribe PPI as an adjunct as it has been shown to increase survival rates

31
Q

What should you prescribe as an adjunct in fibrotic lung disease and why

A

PPI as it has been shown to increase survival and patients with fibrotic lung disease have a high risk of developing GORD

32
Q

What are some complications of fibrotic lung disease?

A

GORD

Pumonary hypertension

33
Q

What is obstructive sleep apnoea?

A

Episodes of apnoea due to complete or partial airway blockages at night

34
Q

What symptoms will someone with obstructive sleep apnoea classcially present with?

A 
Chronic snoring
Episodes of apnoea- waking up due to loud snore in attempt to open airway
Gasping
Unrefreshing sleep
Insomnia
Fatigue during the daytime
35
Q

Who is more likely to develop obstructive sleep apnoea?

A 
Male sex
Post menopausal females
Wide neck circumference
Structural abnormalities of the mandible
Down's syndrome 
Increased soft tissue in mouth and neck eg large tonsils, macroglossia
Obesity
Increasing age
Smokers 
PCOS
Family history
Hypothyroidisim
36
Q

What is the first line investigation of OSA? How does it work and what do you see?

A

Polysomnography- patient comes in for a night and apnoea: hypopnoea is measured, if over 15 and hour or over 5 an hour with symptoms and comorbities a diagnosis can be made

37
Q

What is polysomnography used for and what does it measure?

A

It is a test used to diagnose obstructive sleep apnoea and it measure apnoea: hypopnoea

38
Q

How is OSA managed?

A

First line CPAP- required titration to set
If not tolerated oral devices or implanted hypoglossal neurostimulation
If obese give lifestyle advice/ consider bariatric surgery

39
Q

What are some complications of OSA?

A 
Depression
Cardiovascular disease
Motor vehicle accident
Cognitive dysfunction
Impaired glucose metabolism
Mortality
40
Q

What is pulmonary hypertension?

A

Increased blood pressure in the pulmonary vessels

41
Q

What symptoms will someone with pulmonary hypertension classically present with?

A 
Chest pain
Dyspnoea- initially exertional but also on rest as disease progresses
Cyanosis
Fatigue
Dizziness or syncope
Oedema (as a result of heart failure)
42
Q

What are the 5 causes of pulmonary hypertension?

A 
PAH (pulmonary arterial hypertension)
Due to lung disease
Due to left sided heart disease (failure or valvular disease)
Vascular obstruction (clots etc) 
Other/ multifactorial disease
43
Q

What are the first line investigations for pulmonary hypertension? What would expect to see?

A

Echocardiogram- pressure in pulmonary arteries greater than 25 mmHg
Right heart catheterisation- catheter passed into right side of heart and then pulmonary vessels to confirm high pressure

May also do 
ECG- to rule our arrhythmia 
Bloods
Chest x ray
Cardiac MRI 
LFTs
Serology- HIV screen etc
44
Q

How is pulmonary hypertension managed?

A

Treat the underlying cause
If in heart failure give diuretics to offload them
Digoxin may be given to reduce heart rate and increase strength of contractions
Anticoagulate them if due to blood clots

Surgical interventions include pulmonary endartectomy (to remove old blood clots) to balloon angioplasty

45
Q

What are some complications of pulmonary hypertension?

A

Heart failure- cor pulmonalae when right sided
Blood clots
Arrhythmia
Increased risk in pregnancy

46
Q

What is ARDS?

A

Acute respiratory failure causing inflammation of the lungs without any evidence

47
Q

How is tension pneumothorax managed?

A

High flow oxygen with non rebreather mask
Analgesia
Insert a large bore needle (14 gauge IV catheter) into the 2nd ICS MCL
Aspirate air or fluid

48
Q

What is a primary pneumothorax and who is more likely to get one?

A

It is spontaneous and usually occurs in tall thin males

49
Q

How is primary pneumothorax managed?

A

Advise them to stop smoking
If <2cm and patient isn’t SOB discharge
If over 2cm and/or patient is SOB aspirate with a 16-18 g cannula
If this fails insert a chest drain

50
Q

How is a secondary pneumothorax managed?

A

<1cm then give oxygen and admit to monitor
If 1-2cm then aspirate
If >2cm or SOB then insert chest drain

51
Q

What is secondary pneumothorax?

A

Pneumothorax in someone with existing lung disease

Year 3 (104 decks)

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