Resp Conditions Flashcards
What is the pathology of asthma?
Reversible airway narrowing:
Bronchial muscle contraction
Mucosal swelling
Increased mucous production
What are the symptoms of asthma?
Dyspnoea Wheeze Cough Diurnal variation – typically worse at night Episodic
What investigations would be done if asthma was suspected?
Spirometry
Peak flow
How is asthma treated?
SABA (short acting beta agonist) – salbutamol ICS low dose Add LTRA (leukotriene receptor antagonist) – Montelukast Add LABA
What are the two types of COPD?
Emphysema
Chronic bronchitis
What is the pathology of COPD?
Emphysema - pink puffers, increased alveolar ventilation, breathless but not cyanosed
Bronchitis - blue bloaters, decreased alveolar ventilation, cyanosed, not breathless
What causes COPD?
Smoking
What are the symptoms of COPD?
Cough Sputum Dyspnoea Wheeze Chest – wheeze, reduced expansion and air entry
What investigations would be done if COPD was suspected?
Spirometry – FEV1/FVC ratio <0.7 CXR – lung hyperinflation Sputum culture ABG – high CO2 ECG
How is COPD managed?
Stop smoking 1 – SABA/SAMA 2 – LABA + LAMA if no asthmatic / steroid response, if they are responsive then LABA + ICS 3 – LABA + LAMA + ICS 4 – nebulisers, oral theophylline
What are the complications of COPD?
Acute exacerbations of condition
Respiratory failure
Lung cancer
What is the pathology of pneumonia?
Inflammation of lung parenchyma caused by LRTI
What are the different types of pneumonia?
Community acquired
Hospital acquired – develops >48hrs after hospital admission
Aspiration
What are the causes of pneumonia?
Community – strep pneumoniae, haemophilus influenzae, morexalla catarrhalis
Hospital – staph aureus
What are the symptoms of pneumonia?
Fever SOB Cough Sputum Haemoptysis Pleuritic pain Chest – reduced expansion, consolidation, dull percussion
What investigations would be done if pneumonia was suspected?
Sputum culture
CXR – consolidation
Bloods – FBC, U&Es, LFT, CRP
How is pneumonia treated?
Antibiotics
Oxygenation
Hydration
What are the complications of pneumonia?
Pleural effusion Empyema Lung abscess Respiratory failure Septicaemia
How is the severity of pneumonia assessed?
CURB 65 - 1 point for each Confusion Urea >7mmol/l Respiratory rate >30/min BP <90/60 mmHg Age > 65
Type 1 respiratory failure
Low PO2, normal PCO2
Type 2 respiratory failure
Low PO2, raised PCO2
What are the histological subtypes of lung cancer?
Small cell – 25% Non-small cell: Squamous – 35% Adenocarcinoma – 25% Large cell – 10%
What are the symptoms of lung cancer?
Cough Haemoptysis Dyspnoea Chest pain Lethargy Weight loss Clubbing Hoarse voice
What investigations would be done if lung cancer was suspected?
CXR – hilar enlargement, peripheral opacity, pleural effusion (unilateral), collapse
Contrast enhanced CT
Biopsy
PET
How is lung cancer treated?
Non-small cell – surgery (typically lobectomy), radiotherapy if early enough, chemotherapy if later
Small cell – combination radiotherapy and chemotherapy
What are the complications of lung cancer?
Recurrent laryngeal nerve palsy Phrenic nerve palsy SVC obstruction Horner’s syndrome (Pancoast tumour) Syndrome of inappropriate ADH
How is lung cancer staged?
TNM staging
Where does lung cancer commonly metastasise to?
Bone
Brain
Liver
Adrenal glands
What is the pathology of pulmonary embolism?
Thrombus in the pulmonary arteries
What typically causes a pulmonary embolism?
Deep vein thrombosis Risk factors: Pregnancy Recent flight Immobility Recent surgery Thrombophilia
What are the symptoms of pulmonary embolism?
Sudden onset: Breathlessness Pleuritic chest pain Haemoptysis Dizziness Syncope
What investigations would be done if a pulmonary embolism was suspected?
CT pulmonary angiogram
V/Q scan
D-dimer
How is a pulmonary embolism treated?
LMWH – dalteparin
Long-term anticoagulation – warfarin, NOAC (apixaban)
Massive PE – thrombolysis
What score is used to assess someones risk of a pulmonary embolism?
Wells score
What is the pathology of a pneumothorax?
Air in the pleural space separating the lung from the chest wall
What are the causes of a pneumothorax?
Spontaneous Chronic lung disease Infection Traumatic Carcinoma Connective tissue disorders
What are the symptoms of a pneumothorax?
Sudden onset:
Breathlessness
Pleuritic chest pain
Chest – hyper-resonant percussion, reduced expansion
How is a pneumothorax investigated?
CXR - not if a tension pneumothorax is suspected
How is a pneumothorax treated?
If no SOB and <2cm rim air then will resolve spontaneously
If SOB and/or >2cm rim air then aspirate
If aspiration fails twice – chest drain
Tension – insert large bore hole cannula into 2nd intercostal space, mid-clavic line then chest drain
What is a common finding of a tension pneumothorax?
Tracheal deviation
What is the pathology of a pleural effusion?
Fluid in the pleural space
Transudates <25g/L
Exudates >25g/L
What causes a pleural effusion?
Transudate (fluid moving across into pleural space) – congestive heart failure, hypothyroidism, hypo-albuminaemia
Exudate (inflammation, protein leaks into space from tissue) – lung cancer, pneumonia, RA, TB
What are the symptoms of a pleural effusion?
SOB
Pleuritic chest pain
Chest – reduced air entry, dull percussion, diminished breath sounds
Tracheal deviation if massive
What investigations would be done if a pleural effusion was suspected?
CXR – blunting of costophrenic angle
Ultrasound
Diagnostic aspiration
Pleural biopsy
How is a pleural effusion treated?
Conservative if small effusion
Drainage – aspiration, drain
Pleurodesis – recurrent effusions
Haemothorax
Blood in the pleural space
Empyema
Pus in the pleural space
What are the risk factors for contracting tuberculosis?
Known contact with active TB
Immigrants from areas of high TB prevalence
Immuno-suppressed
What is the causative agent of tuberculosis and how is it stained?
Mycobacterium tuberculosis (rod shaped) – Zeihl-Neelsen stain, turns bacteria red on blue background
What are the symptoms of tuberculosis?
Asymptomatic Fever Weight loss Night sweats Clubbing Cough Pleurisy Haemoptysis
How is tuberculosis investigated?
Mantoux test – intradermal injection Interferon-gamma release assays CXR Sputum culture Nucleic acid amplification test (NAAT) Biopsy
How is tuberculosis treated?
(RIPE) 4 for 2 months: Rifampicin Isoniazid Pyrazinamide Ethambutol 2 for 4 months: Rifampicin Isoniazid
What are the complications of tuberculosis?
R – irn bru urine, tears, hepatitis, oral contraceptive pill ineffective
I – hepatitis, peripheral neuropathy
P – gout
E – optic neuropathy
How is cystic fibrosis inherited?
Autosomal recessive
What is the pathology of cystic fibrosis?
Mutation in CF transmembrane conductance regulator (CFTR) gene on chromosome 7 leading to defective Cl secretion and increased Na absorption across the epithelium
What are the symptoms of cystic fibrosis?
Neonate – failure to thrive, meconium ileus, rectal prolapse
Children – cough, wheeze, thick sputum production, recurrent infections, pancreatic insufficiency, male infertility, clubbing
How is cystic fibrosis investigated?
Screened at birth – newborn blood spot test
Sweat test – sweat Na and Cl >60mmol/L
Genetic testing during pregnancy – amniocentesis
Faecal elastase – pancreatic enzyme deficiency
How is cystic fibrosis treated?
Chest physiotherapy Treat infections where they arise Prophylactic flucloxacillin Bronchodilators CREON tablets if pancreatic insufficiency
What are common colonisers of cystic fibrosis?
Staph aureus
Pseudomonas aeruginosa
