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Yr3 Revision: Condensed Notes > Resp IV > Flashcards

Resp IV Flashcards

1
Q
A
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2
Q

Which inherited diseases can cause bronchiectasis? [4]

A
  • (Alpha-1-antitrypsin deficiency)
  • Connective tissue disorders (e.g., rheumatoid arthritis)
  • Cystic fibrosis
  • Yellow nail syndrome
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3
Q

Describe the classic triad of yellow nail syndrome [3]

A
  • Yellow fingernails
  • Bronchiectasis
  • Lymphoedema

TOM TIP: Yellow nail syndrome is characterised by yellow fingernails, bronchiectasis and lymphoedema. Patients are stable and have good clinical signs, making it a good choice for OSCEs. As it is rare, examiners will score high marks if you can combine these features and name the diagnosis.

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4
Q

Describe the classical signs of bronchiectasis [5]

A
  • Scattered crackles throughout the chest that change or clear with coughing
  • Scattered wheezes and squeaks
  • Sputum pot by the bedside
  • Oxygen therapy (if needed)
  • Weight loss (cachexia)
  • Finger clubbing
  • Signs of cor pulmonale (e.g., raised JVP and peripheral oedema)
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5
Q

When taking a history and examining the patient, it is also important to consider other systems of the body too, as these may reveal co-morbid conditions associated with the development of bronchiectasis
.
Which do these include? [4]

A

Joints:
- RA

GI:
- IBD
- Cystic fibrosis
- GORD

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6
Q

Sputum culture is used to identify colonising and infective organisms. The most common infective organisms are? [2]

A

Haemophilus influenza

Pseudomonas aeruginosa

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7
Q

Asides from imaging investigations, describe what else you would investigate for bronchiestasis [7]

A

Sputum culture
- Most commonly Haemophilus influenzae and Pseudomonas aeruginosa

FBC:
- may reveal high eosinophil count in bronchopulmonary aspergillosis

specific IgE or skin prick test to Aspergillus fumigatus

serum alpha-1 antitrypsin phenotype and level

serum immunoglobulins
- to identify individual immunoglobulin deficiencies as underlying aetiology

Rheumatoid factor

Serum HIV antibody

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8
Q

TOM TIP: The key features to remember with bronchiectasis are [4]

A

TOM TIP: The key features to remember with bronchiectasis are finger clubbing, diagnosis by HRCT, Pseudomonas colonisation and extended courses of 7-14 days of antibiotics for exacerbations.

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9
Q

Describe the treament algorithm for bronchiestasis for the initial presentation? [5]

A

initial presentation
1ST LINE: exercise and improved nutrition.
- Including vitamin D supplementation
- Higher BMI has beneficial outcomes
- Excercise is considered form of airway clearance

PLUS –
airway clearance therapy (ACT):
- maintenance of oral hydration; percussion, breathing, or coughing strategies
- positioning and postural drainage; positive expiratory pressure devices; and oscillatory devices
- recommended for 15 to 30 minutes, 2 or 3 times daily

PLUS –
self-management plan

CONSIDER –
inhaled bronchodilator:
- salbutamol inhaled

CONSIDER –
mucoactive agent
- hypertonic saline

BMJ BP

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10
Q

acute exacerbation: mild to moderate underlying disease if is first or new presentation of Pseudomonas aeruginsoa

A

1ST LINE –
short-term oral antibiotic:
- For adults, prescribe amoxicillin 500 mg three times a day for 7–14 days

PLUS –
increased airway clearance

PLUS –
continued maintenance therapy:
- Healthy diet & exercise
- Higher BMI
- Nebulised bronchodilators
- Nebulised hyperosmolar agents, such as hypertonic saline,

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11
Q

Describe how treatment for bronchiectasis would be escalated in a stepwise manner if they were suffering ≥ 3 exacerbations in one year despite following the initial management?

A

3 or more exacerbations per year despite maintenance therapy
1ST LINE –
reassess physiotherapy ± mucoactive treatment

PLUS –
continued maintenance therapy
- Azithromycin 500 mg three times a week, or
- Azithromycin 250 mg daily, or
- Offer a minimum of 6 months treatment, but up to 1 year may be required.

CONSIDER –
long-term antibiotic

CONSIDER –
surgery:
- Surgical resection is considered in patients with localised disease whose symptoms are not controlled by optimal medical treatment
- Complete resection of the bronchiectatic area is associated with the best results

CONSIDER –
treatment of respiratory failure

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12
Q

A patient is diagnosed with bronchiestasis. Subsequent sputum sampling diagnoses them the infective agent as Streptococcus pneumoniae. What is the approriate first line treatment

  • Co-amoxiclav 625 mg three times daily
  • Amoxicillin 500 mg three times daily
  • Flucloxacillin 500 mg four times daily
  • Doxycycline 100 mg twice daily PLUS rifampicin (for adults)
  • Ciprofloxacin 500 or 750 mg twice daily
A

Amoxicillin 500 mg three times daily

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13
Q

When giving long term antibiotic therapy to those with bronchiestasis, if people have concurrent Pseudomonas aeruginosa infection, first-line therapy is []

A

inhaled colistin.

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14
Q

A patient is diagnosed with bronchiestasis. Subsequent sputum sampling diagnoses them the infective agent as Haemophilus influenzaebeta lactam negative. What is the approriate first line treatment

  • Co-amoxiclav 625 mg three times daily
  • Amoxicillin 500 mg three times daily
  • Flucloxacillin 500 mg four times daily
  • Doxycycline 100 mg twice daily PLUS rifampicin (for adults)
  • Ciprofloxacin 500 or 750 mg twice daily
A

A patient is diagnosed with bronchiestasis. Subsequent sputum sampling diagnoses them the infective agent as Haemophilus influenzae. What is the approriate first line treatment

  • Co-amoxiclav 625 mg three times daily

Amoxicillin 500 mg three times daily

  • Flucloxacillin 500 mg four times daily
  • Doxycycline 100 mg twice daily PLUS rifampicin (for adults)
  • Ciprofloxacin 500 or 750 mg twice daily
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15
Q

A patient is diagnosed with bronchiestasis. Subsequent sputum sampling diagnoses them the infective agent as Haemophilus influenzae (beta-lactamase positive). What is the approriate first line treatment

  • Co-amoxiclav 625 mg three times daily
  • Amoxicillin 500 mg three times daily
  • Flucloxacillin 500 mg four times daily
  • Doxycycline 100 mg twice daily PLUS rifampicin (for adults)
  • Ciprofloxacin 500 or 750 mg twice daily
A

Co-amoxiclav 625 mg three times daily

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16
Q

A patient is diagnosed with bronchiestasis. Subsequent sputum sampling diagnoses them the infective agent as Pseudomonas aeruginosa. What is the approriate first line treatment

  • Co-amoxiclav 625 mg three times daily
  • Amoxicillin 500 mg three times daily
  • Flucloxacillin 500 mg four times daily
  • Doxycycline 100 mg twice daily PLUS rifampicin (for adults)
  • Ciprofloxacin 500 or 750 mg twice daily
A

A patient is diagnosed with bronchiestasis. Subsequent sputum sampling diagnoses them the infective agent as Pseudomonas aeruginosa. What is the approriate first line treatment

  • Co-amoxiclav 625 mg three times daily
  • Amoxicillin 500 mg three times daily
  • Flucloxacillin 500 mg four times daily
  • Doxycycline 100 mg twice daily PLUS rifampicin (for adults)
  • Ciprofloxacin 500 or 750 mg twice daily
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17
Q

A patient is diagnosed with bronchiestasis. Subsequent sputum sampling diagnoses them the infective agent as Klebsiella. What is the approriate first line treatment

  • Co-amoxiclav 625 mg three times daily
  • Amoxicillin 500 mg three times daily
  • Flucloxacillin 500 mg four times daily
  • Doxycycline 100 mg twice daily PLUS rifampicin (for adults)
  • Ciprofloxacin 500 or 750 mg twice daily
A

A patient is diagnosed with bronchiestasis. Subsequent sputum sampling diagnoses them the infective agent as Klebsiella. What is the approriate first line treatment

  • Co-amoxiclav 625 mg three times daily
  • Amoxicillin 500 mg three times daily
  • Flucloxacillin 500 mg four times daily
  • Doxycycline 100 mg twice daily PLUS rifampicin (for adults)
  • Ciprofloxacin 500 or 750 mg twice daily
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18
Q

Which vaccines are recommonded for bronchiestasis? [2]

A

Vaccines (e.g., pneumococcal and influenza)

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19
Q

[] is the usual choice for infective exacerbations caused by Pseudomonas aeruginosa

A

Ciprofloxacin is the usual choice for exacerbations caused by Pseudomonas aeruginosa

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20
Q

How long are the extended course of Abx for infective exacerbations? [1]

A

Extended courses of antibiotics, usually 7–14 days

21
Q
A

Cardiac tamponade

22
Q

This CXR causes hypoxia due to which underlying mechanism

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

This CXR causes hypoxia due to which underlying mechanism

V/Q mismatch

23
Q

This CXR causes hypoxia due to which underlying mechanism

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Pneumothorax causing V/Q mismatch

24
Q

Describe what is meant by low and high V/Q mismatch in hypoxia [2]

State what could cause each [2]

A

Hypoxaemia usually caused by:

Low V/Q:
- alveoli with poor ventilation compared to perfusion
- Caused by: airway disease or interstitial lung disease where ventilation is reduced
- Therefore, hypxoxia induced v/c occurs and redirects blood to better ventilated areas

High V/Q:
- Poor perfusion c.f ventilation
- Caused by: PE

25
Q

State 4 conditions that cause pulmonary shunts [4]

A

pneumonia
ARDS
pulmonary oedema
alveolar collapse

26
Q

What is meant by diffusion limitation (causing hypoxia?)

Describe two pathophysiological causes of diffusion limitation [2]

A

Diffusion limitation refers to the impairment of gaseous exchange across the alveolocapillary membrane.

Causes:
Reduced surface area:
- reduced surface area of alveoli due to pathological destruction limits the amount of lung tissue available for gaseous exchange.

Alveolocapillary membrane changes:
- inflammation and fibrosis of the alveolocapillary membrane impairs diffusion across it.

27
Q

Describe what is meant by increased dead space causing hypoxaemia [1]

A

Areas of the lung that are ventilated but not perfused and therefore do not contribute to gaseous exchange.

(It can be thought of as an extreme V/Q mismatch and the opposite of a shunt)

28
Q

Name two pathologies that cause increased dead space [2]

A

emphysema (COPD) and interstitial lung disease destroying pulmonary capillaries

29
Q

What is the most common cause of T1RF? [1]

A

V/Q mismatch

30
Q

State 5 common causes of T1RF [6] (and the cause of hypoxia)

A

Diffusion abnormality:
- Pulmonary fibrosis
- Emphysema in COPD

V/Q mismatch: reduced V
- Pneumonia
- Pulmonary oedema
- Pneumothorax

V/Q mismatch: reduced Q
- Pulmonary embolism

Low inspired oxygen

Hypxoxia = increased V
More CO2 exhaled
Hypoxia but not hypercapnic

31
Q

T2RF is seen in conditions that cause what changes to alveoli? [1]

A

T2RF is seen in conditions that result in alveolar hypoventilation.

32
Q

What are common causes of acute T2FR? [5]

A

Exacerbations of obstructive lung disease:
* COPD (most common)
* Severe asthma
* Cystic fibrosis
* Bronchiectasis

Respiratory depressants (e.g. opiate overdose)

Acute T2RF: failure of ventilation

33
Q

What are common causes of chronic T2FR? [5]

A

Obstruction to airways:
* COPD
* Severe asthma

Hyperexpanded lungs:
- COPD

Thoracic cage problems:
- Kyphoscoliois
- Obesity

Weakness of resp. muscles
* Chronic neurological disorders (e.g. motor neuron disease)
* Chronic neuromuscular disorders (e.g. myopathies)

34
Q

What type of hypoxia does scoliosis cause? [1]

A

Hypoventilation (get smaller diaphragm working)

35
Q

Which of the following would this CXR cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Lobar pneumonia causing V/Q mismatch

36
Q

Out of which of the following would this CXR cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Diffusion abnormality: patient has sarcoidosis

37
Q

Out of which of the following would this CXR cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Hypoventilation: patient has TB

38
Q

Out of which of the following would this CXR cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Hypoventilation: lobar collapse

39
Q

Out of which of the following would this CXR cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Diffusion limitation:
Pulmonary fibrosis

40
Q

Out of which of the following would this CXR cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Hypoventilation: COPD

Can be T1 or T2RF

41
Q

Out of which of the following would this cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Hypoventilition: motor neuron disease - can’t use muscles / diaphragm to breathe

42
Q

Out of which of the following would this CXR cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

VQ mismatch: pneumothroax

43
Q

Out of which of the following would this cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Morbid obesity: hypoventilation

44
Q

Out of which of the following would this CXR cause hypoxaemia?

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Shunt: eisenmenger syndrome

45
Q

Hypoventilaton:

State pathologies that cause

Obstruction to airways [2]
Hyper-expanded lungs [1]
Thoracic cage problems [2]
Weakness of respiratory muscles [2]

A

Obstruction to airways
- COPD
- Asthma

Hyper-expanded lungs:
- COPD

Thoracic cage problems
- Kyphoscoliosis
- Thoracoplasty
- Obesity

Weakness of respiratory muscles
- MND
- MD

46
Q

V/Q mismatch:

State causes for:

  • Area of lung perfused but not ventilating (airspaces filled with fluid [2]; lung collapsed [2] )
  • Area of lung ventilated, but not perfused (2)
A

Area of lung perfused but not ventilating:

  • airspaces filled with fluid: pneumonia; pulmonary oedema
  • lung collapsed: pneumothorax; lung collaspe

Area of lung ventilated, but not perfused: PE; shock

47
Q

Explain why diffusion abnormalities cause hypoxia but not hypercapnia [2]

A

In diffusiin abnormalities: ventilation is normal, but a barrier to the transer of oxygen from alveoli to blood stream

  • Hypoxia leads to increased ventilation
  • More CO2 is exhaled
  • Creates hypoxia but not hypercapnia
48
Q

Which of the following causes hypercapnia

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

A

Which of the following causes hypercapnia

V/Q mismatch
Shunt
Diffusion limitation
Hypoventilation
Increased dead space

49
Q

How do you manage acute T2RF? [4]

A

Controlled oxygen:
- 0.5 - 2l/min via nasal cannulae
- 24 to 28% masks using venturi valves

Regular ABG to monitor CO2 levels

Consider non-invasive ventilation (BIPAP) if pH and CO2 dont improve

Go over BIPAP - is this correct?

Yr3 Revision: Condensed Notes (51 decks)

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