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Medicine block > Resp medicine block > Flashcards

Resp medicine block Flashcards

1
Q

What are some common presenting complaints for a resp hx?

A
  • Dyspnoea
  • Chest pain
  • Wheeze
  • Cough
  • Sputum
  • Haemopytsis
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2
Q

What are some specific qs for dyspnoea and chest pain?

A

Dyspnoea - MRC score, exercise tolerance, T+R, PND, dinural variation

Chest pain - site, severity, radiation, T+R, associated sx

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3
Q

What are some specific qs for wheeze and cough?

A

Wheeze - T+R, dinural variation, cough

Cough - dry or productive, T+R, dinural variation, w eating or dyspepsia, positional, nasal secretion, fever

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4
Q

What are some specific qs for sputum and haemopytsis?

A

Sputum - amount in 24 hours, colour, consistency

Haemopytsis - amount, freq, fever, night sweats, weight loss

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5
Q

What is some relevant PMH?

A
  • Surgery
  • Cancer
  • Childhood/previous lung infection
  • Asthma
  • COPD
  • Nasal polyps
  • DVT/PE
  • CVS disease
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6
Q

What do you ask in a drug hx?

A
  • What drug?
  • Route, dose, freq, adherance
  • OTC or herbal remedies
  • Allergies
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7
Q

What relevant FH is there?

A
  • Resp disease
  • CVS disease
  • Thrombophilia
  • CF
  • Cancer
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8
Q

What qs do you ask in a SH?

A
  • Performance status
  • Smoking - how long for/when stopped, pack years
  • Alcohol
  • ADL, accom, carers?
  • Occupational exposure, esp asbestos
  • Recent foreign travel/immobility
  • Pets
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9
Q

What is the MRC dyspnoea score? 1-5

A
  1. SOB only on strenuous exercise
  2. SOB when in a rush or walking up a small hill
  3. SOB on flat ground/need to stop for breath
  4. SOB when walking 100m
  5. Too breathlessness to leave the house, when dressing
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10
Q

What is the WHO performance score? 0-5

A
  1. No restriction to activity
  2. Restricted in physically strenuous activity but able to do light work
  3. Ambulatory and self care but can’t do work activities
  4. In bed >50% of day
  5. In bed/chair all of day, can’t do self care
  6. Dead
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11
Q

Give the definition for:

  • Ambulatory
  • Dinural variation
  • PND
  • Orthopnoea
A

Ambulatory - adapted for walking
Dinural variation - variation in symptoms (in this case pulm func) depending on the time of day
PND - paraoxysmal nocturnal dyspnoea
Orthopnoea - SOB lying down

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12
Q

How do you report a CXR?

A
  • Name and age of pt, date of XR
  • What type of XR - AP, PA, erect or mobile
  • Quality of XR - rotation, penetration, adequate inspiration
  • ABC - airwarys+lungs, bones, cardio + diagphragm, apices etc
  • Say what you can obviously see
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13
Q

What are the different regions of the lung on CXR?

A

Upper
Middle
Lower zones

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14
Q

What is the cardio thoracic ratio?

A

Diameter of the heart should be half the diameter of the thorax. If the diameter of the heart is increased = cardiomegaly.

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15
Q

What is spirometry? What does the FEV1:FVC ratio indicate?

A

Way to measure different lung volumes, can create flow time graphs and flow vol loops from these.
FEV1:FVC >80% = restrictive lung disease and <70% = obstructive lung disease.

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16
Q

What are some examples of obstructive and restrictive lung diseases?

A

Obstructive - COPD and asthma

Restrictive - pulm fibrosis, interstitial lung disease, asbestosis, neuromuscular disease

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17
Q

What are FEV1 and FVC?

A

FEV1 - forced expiratory vol in first second

FVC - forced vital capacity over 6 seconds after max inspiration

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18
Q

Draw the different flow time graphs, label what they show

A

Answers on iPad

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19
Q

Draw the different flow vol loops and label what they show, there are 6

A

Answers on iPad

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20
Q

What can you see on ABG?

A
  • Hypoxia
  • Acid base balance
  • A-a gradient
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21
Q

What are the 4 causes of hypoxia?

A
  • Hypoventilation
  • V/Q mismatch
  • Shunt
  • Diffusion impairment
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22
Q

What are the causes of resp acidosis?

A

Hypoventilation eg. neuromuscular disease

Alveolar hypoventilation - COPD.

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23
Q

What is the A-a gradient?

A

A = alveolar O2
a = arterial O2
In a healthy young person it should be <2 kPa and in elderly people <4 kPa. >4 kPA = lung pathology

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24
Q

How do you work out the A-a gradient?

A

PAO2 = PIO2(room air) - PCO2/o.8.

Then PAO2 - PaO2 to calculate the gradient.

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25
Q

What is anaphylaxis?

A

Serious allergic reaction. IgE - antigen - mast cells and basophils increase - histamine increase - body response

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26
Q

What is the body’s response to anaphylaxis?

A
  • Pruritis, uticaria
  • Angioedema
  • Stridor, bronchial obstruction, hoarseness, wheeze, tight chest
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27
Q

How is anaphylaxis managed?

A
  • Remove trigger, manage airway and 100% O2
  • 5mg IM adrenaline, repeat every 5 mins
  • IV hydrocortisone 200 mg
  • IV chlorpheniramine 5 mg
  • If hypotensive = lie flat and resus
  • Bronchospasm = NEB salbutamol
  • Laryngeal oedema = NEB adrenaline
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28
Q

What are the parameters to define mild, moderate and severe asthma attacks?

A

Mild - PEFR >75%
Mod - PEFR 50-75%
Severe - PEFR 33-50%, can’t complete sentences, RR >25/min, pulse >110 bpm

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29
Q

What defines a life threatening and then a near fatal asthma attack?

A

Life threatening - <33% PEFR, confused, exhausted, poor resp effort, silent chest, cyanosis, hypotension, arrhythmias, sats <92%, ABG pO2 <8 kPa
Near fatal - raised pCO2

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30
Q

What is acute asthma management?

A
  • AtoE, 100% O2 - aim for 94-98%, if <92% do ABG
  • 5mg NEB salbutamol, can repeat after 15mins
  • 40mg oral prednisolone STAT
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31
Q

What do you add on to acute asthma management in a severe attack?

A
  • NEB ipratropium bromide 500mcg

- Consider back to back salbutamol

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32
Q

What do you add on to acute asthma management if life threatening attack?

A
  • Consider IV salbutamol
  • ITU/anaesthetic assessment
  • Urgent portable CXR
  • IV aminophylline
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33
Q

What is aminophylline?

A

Theophylline (adenosine receptor antagonists, reduces bronchoconstriction) + ethylenediamine, relaxes smooth muscle and relieves bronchial spasm

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34
Q

What are the causes of COPD exacerbations? How can you distinguish between the two?

A

Infective - fever, change in sputum vol and colour, increased WCC or CRP
Non infective causes eg. PE or pollution

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35
Q

How do you manage COPD exacerbations?

A

Always AtoE approach.

  • Give O2 - aim 94-98% but if have acute/previous type 2 resp failure 88-92%
  • NEB salbutamol and ipratopium
  • Prednisolone 30mg STAT and OD for 7 days
  • If purulent sputum and raised WCC = Abx
  • CXR
  • Consider IV aminophylline and NIV if type 2 resp fail, pH 7.25-7.35
  • Consider ITU referral if pH <7.25
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36
Q

Define these terms:

  • NIV

- Type 2 resp failure

A

NIV - non invasive ventilation

Type 2 resp failure - raised PaCO2

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37
Q

What is the criteria to diagnose pneumonia?

A

Consolidation on CXR with fever. +/- purulent sputum, raised WCC and CRP.

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38
Q

What is the management of pneumonia?

A

Always AtoE approach.

  • If signs of sepsis start immediately w IV Abx and fluids
  • Otherwise Abx as per the CURB65 score, local guidelines and pt allergies
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39
Q

What is the CURB65 score?

A 
C - confusion
U - urea >7
R - RR >30/min
B - <90mmHg systolic <60mmmHg diastolic
65 - older than this
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40
Q

What defines massive haemopytsis?

A

240ml over 24 hours or 100ml/day over consecutive days.

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41
Q

How is massive haemopytsis managed?

A

AtoE approach!

  • Lie pt on side of lesion
  • Stop NSAIDs, aspirin, anticoag
  • Oral tranexamic acid for 5 days or can be IV
  • Consider Vit K
  • CT aortogram, may be able to do bronchial artery embolism
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42
Q

What is tranexamic acid?

A

Anti fibrinolytic by binding to plasminogen, inhibiting plasmin formation.

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43
Q

What are the signs and sx of tension pneumothorax?

A

Signs - tracheal and mediastinal shift away from pneumothorax, reduced lung sounds, reduced chest movement, hyperresonance, cyanosis, tachy, hypotension

Sx - pleuritic chest pain, SOB

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44
Q

How is tension pneumothorax managed?

A

Large IV cannula in 2nd ICS mid clav line. Chest drain in affected side.

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45
Q

What are the sx of PE?

A
  • Pleuritic chest pain
  • SOB
  • Haemopytsis
  • Signs of low cardiac output
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46
Q

What are some signs of low cardiac output?

A
  • Fatigue, confusion, reduced consciousness
  • Cold peripheries, delayed cap refill
  • Hypotension and tachy
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47
Q

What are some RF of PE?

A
  • Obstetrics
  • Surgery
  • Malignancy
  • Period of immobility
  • Previous VTE
  • Lower limb fracture/varicose vein
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48
Q

What is the initial management of PE?

A
  • AtoE, oxygen if SOB, analgesia if in pain

- Subcut LMWH whilst waiting for CTPA

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49
Q

How is PE diagnosed and what is the treatment once diagnosis is confirmed?

A

CTPA - CT pulm angiogram. Then full anticoag.

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50
Q

What are the options of anticoag to treat PE?

A

Dalteparin
Enoxaparin
Tinzaparin
Fondaparinux

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51
Q

What are the signs of massive PE and how is it treated?

A

Treat = IV alteplase

Signs - R sided heart strain, hypotension, almost at cardiac arrest

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52
Q

What are some contraindications of thrombolysis?

A
  • Aortic dissection
  • CNS malignancy
  • Thrombolytic/ischaemic stroke
  • GI bleed
  • Bleeding disorder
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53
Q

What are the characteristics of asthma?

A
  • Chronic airway inflam and obstruction
  • Reversible w treatment or spontaneously
  • Airway more responsive to stimuli than normal = increased narrowing
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54
Q

What are the sx of asthma?

A
  • SOB
  • Tight chest
  • Cough that is worse at night
  • Wheeze
  • Increased RR
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55
Q

What are some differentials of wheeze?

A
  • Bronchitis
  • Allergies
  • Acute asthma exacerbation
  • Pulm oedema
  • GORD
  • Foreign body
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56
Q

What is the pathophysiology of asthma?

A
  • Airway and epithelial damage causes fibrosis and BM thickening
  • Eosinophils, T lymphocytes and mast cells release histamine, leukotrienes, prostaglandins and cytokines
  • Increased mucus (mucus plugging can be fatal in severe asthma), SM hyperplasia and hypertrophy
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57
Q

What is eosinophilia?

A

Some pt w asthma have eosinophilic inflam which normally responds to steroids. There are other causes eg. COPD, hayfever, lymphoma, SLE, aspergillosis

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58
Q

What is the criteria for discharge after asthma exacerbation?

A
  • PEFR >75%
  • Stop NEB 24 hours before discharge
  • Asthma nurse reassess inhaler technique and adherance
  • Go home w 5 days prednisolone
  • GP follow up w/i 2 days and clinic w/i 4 weeks
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59
Q

What are some asthma trigger factors?

A
  • Smoking, pollution, occupational irritants
  • URTI
  • Allergies, exercise, cold air
  • Stress
  • Drugs - aspirin, b blockers
  • Food and drink eg. dairy
60
Q

What is COPD and what are the causes of it?

A

Progressive airway obstruction, not fully reversible and primarily caused by smoking. Emphysema + chronic bronchitis.
Causes - smoking, a1 antitrypsin def, industrial exposure, childhood infection eg. pertussis

61
Q

What is the effect of COPD on the lungs ?

A
  • Mucus gland hyperplasia
  • Loss of cilial func
  • Chronic inflam and fibrosis or small airways
  • Emphysema = alveolar wall destruction = enlargement of air spaces distal to terminal bronchioles
62
Q

What is the COPD care bundle?

A

Outpatient treatment of COPD:

  • Stop smoking
  • Pulm rehab
  • Bronchodilators
  • Antimuscarinics
  • Mucolytics
  • Steroids
  • Diet
  • LTOT if needed
63
Q

What is pulm rehab?

A

MDT team 6-12 weeks supervised exercise, unsupervised home exercise, nutritional advise and disease education.

64
Q

What is LTOT?

A

Long term oxygen therapy: = long term hypoxia causes renal and cardiac damage. Give up to 16 hours a day. If pO2 <7.3 kPa consistently or 8kPa w cor pulmonale. Pt mustn’t smoke or retain CO2.

65
Q

What are the different types of pneumonia and their causative organisms?

A

CAP - S.pneumoniae. H.influenzae, Moraxella catarrhalis
HAP - MRSA, E.coli, pseudomonas
Atypical - Legionella pneumophilia, Chlamydia pneumoniae
Other types eg. aspiration

66
Q

How is pneumonia diagnosed?

A

Consolidation on a CXR

67
Q

What are the differentials for consolidation on a CXR?

A
  • Pneumonia
  • Haemorrhage
  • Lobar collapse - bronchial blockage
  • Lung cancer
  • TB (upper lobe)
68
Q

What is the treatment of pneumonia?

A

Need to calculate a CURB65 score and then use this as well as local guidelines and pt allergies to diagnose Abx. +/- paracetemol.
Even if low CURB65 score respond to signs of sepsis - refer to ITU.

69
Q

What Ix are needed into pneumonia?

A
  • CXR
  • Routine bloods
  • Sputum cultures
  • If febrile - blood cultures
  • If high CURB65 do an atypical pneumonia screen = serology and Legionella urine test
  • Low sats = ABG
70
Q

What is involved in a pneumonia follow up?

A

Resp clinic 6 weeks post:

  • HIV test
  • CXR to confirm resolution
  • Immunoglobulin
  • IgG - pneumococcal and H.influenzae
71
Q

What are the causes of non resolving pneumonia?

A 
CHAOS
Complication - empyema, abscess
Host - immunosuppressed
Abx - wrong dose or poor oral absorption
Organism - resistant or unexpected
Secondary diagnoses - PE, cancer
72
Q

What are corona viruses?

A

Group of viruses causing illness ranging from the common cold to much more severe resp distress eg. SARS-CoV

73
Q

What are the clinical features of a pt requiring hospital admission w corona virus?

A
  • Hypoxia
  • Lymphopenia - reduced lymphocyte level
  • Bilateral lower zone changes on CXR
74
Q

What is the management of COVID 19 ?

A
  • O2 supplementation, may need CPAP or invasive ventilation
  • Dexamethasone
  • Abx if suspect superadded bacterial infection
75
Q

Define these terms:

  • CPAP

- SARS

A

CPAP - continuous positive airways pressure

SARS - severe acute resp syndrome

76
Q

What are the clinical features of TB?

A
  • Weight loss, night sweats, fever, malaise
  • Resp - cough +/- sputum, haemopytsis, pleural effusion
  • Non resp - skin, bone, abdo, CNS features
77
Q

What are the differentials for haemopytsis?

A
  • Infection - pneumonia, TB, CF, bronchiectasis
  • Haemorrhage - vasculitis, coagulopathy, bronchial artery emobolism
  • Malignancy - lung cancer, mets
  • PE
78
Q

What are the RF of TB?

A
  • Past hx of TB or TB contact
  • Recent foreign travel to country w high TB incidence
  • Immunosuppressed = DM, IVDU, dialysis/renal fail, transplant pt, HIV, alcoholic, low BMI
79
Q

What is the immediate management of TB?

A
  • AtoE approach
  • Start infection control measures - side room, PPE<
  • Culture ASAP
  • If can’t tell between pneumonia or TB start Abx for pneumonia
80
Q

What are the Ix into TB?

A
  • If productive cough = x3 sputum samples for AFB and TB culture
  • If not productive bronchoscopy
  • Maybe CT if suspect but CXR shows nothing
  • Routine bloods +LFTs +HIV +Vit D
81
Q

What are the drugs of anti TB therapy?

A
  • x2 months x4 Abx = rifampicin, ethambutol, isoniazid, pyrazinamide
  • Then x4 months x2 Abx = rifampicin + isoniazid
82
Q

What is important when doing anti TB therapy?

A
  • Need compliance - may even need DOT
  • Need visual acuity test before ethambutol as it can cause retrobulbar neuritis
  • Need to give pyridoxine w isoniazid to prevent peripheral neuropathy
83
Q

What are the SE of anti TB therapy drugs?

A

All = hepatitis and rashes, need to measure LFTs often

  • Pyrazinamide - arthralgia, vomiting
  • Isoniazid - peripheral neuropathy, psychosis
  • Ethambutol - retrobulbar neuritis
  • Rifampicin - orange/red secretions, febrile reaction
84
Q

What is bronchiectasis?

A
  • Chronic dilation of one or more bronchi

- Poor mucus clearance = predisposition to recurrent bacterial infection

85
Q

What are the causes of bronchiectasis?

A
  • Immune def eg. HIV, malignancy
  • Post infective - whooping cough or TB
  • Genetic mucociliary clearance defects eg. CF, primary ciliary dyskinesia
  • Obstruction eg. tumour, foreign body, lymph node
  • Toxic insult eg. gastric aspiration
  • RA
86
Q

What are the IX to confirm bronchiectasis diagnosis? What are the signs?

A

Gold standard - high resolution CT chest, can see signet ring sign
CXR - tram tracks

87
Q

What are the bloods to decide the cause of bronchiectasis?

A
  • HIV test
  • Immunoglobulin levels
  • CF genotype
  • Rheumatoid factor
  • Auto Ab
  • Alpha 1 antitrypsin
88
Q

What are the common infective organisms in bronchiectasis?

A
  • H.influenzae
  • Moraxella catarrhalis
  • Pseudomonas aeurginosa
  • Aspergillosis or candida
89
Q

What is the management of bronchiectasis?

A
  • Physio for mucus clearance
  • Treat the underlying cause
  • 10-14 days Abx depending on culture in exacerbation
  • Supportive - vaccines and inhalers
  • Pulm rehab if MRC >3
90
Q

What is the management of bronchiectasis exacerbations?

A

H.influenzae = amoxicillin/doxycyline. Pseudomonas - ciprofloxacin
IV if severe.
Long term prophylactic Abx if recurrent infective exacerbations.

91
Q

How do you define a bronchiectasis exacerbation?

A

Worsening of 3 or more key symptoms over 48 hours:

  • Cough
  • Sputum vol, consistency or purulence
  • Haemopytsis
  • SOB
  • Fatigue
92
Q

What is ABPA?

A

Allergic bronchopulm aspergillosis - caused by aspergillus fumigatus exposure = combination type 1 and 3 hypersensitivity reaction.
Seen more in pt w asthma, CF and bronchiectasis.

93
Q

What can ABPA lead to?

A

Bronchiectasis, often in the upper lobe

94
Q

How is a diagnosis of ABPA made?

A
  • Symptoms = dry cough and wheeze

- Blood test = raised total IgE and raised aspergillus IgE

95
Q

What is the treatment of ABPA?

A

Steroids, needed if ongoing symptoms and raised total IgE

96
Q

What is CF?

A

Cystic fibrosis - autosomal recessive disease which causes mutation of CFTR = thickened secretions, most commonly affects resp and GI but can affect anywhere.

97
Q

How is CF diagnosis made?

A
  • Hx of CF in sibling or positive newborn screen
  • Sweat test = increased NaCl
  • x2 CF mutations identified
98
Q

What are the clinical features of CF?

A
  • Chronic sinusitis, nasal polyps, bronchiectasis, recurrent LRTI
  • Liver disease, portal hypertension, gallstones
  • Pancreatic insufficiency
  • Intestinal obstruction
  • Clubbing and osteoporosis
  • Male infertility
99
Q

What are the presentations of CF?

A
  • Meconium ileus = newborn not passing ileus, bilious vom and abdo distension
  • Malabsorption due to pancreatic insuff
  • Recurrent chest infections
  • Positive new born screen
100
Q

What are the complications of CF?

A
  • Resp infection - aggressive Abx and physio
  • Reduced body weight - high cal, nutritional supplement, NG or PEG
  • DIOS
  • CF related diabetes - insulin
101
Q

What is DIOS? How is it treated?

A

Distal intestinal obstruction syndrome - hard dehydrated faeces causing obstruction - palpable mass in RIF. Can see on AXR.
Treat - PO gastrograffin enema = draws water into bowel and rehydrates faeces in hopes it will pass

102
Q

What is CF management?

A
  • Physio for airway clearance
  • Pancreatic enzyme replacement therapy
  • Long term prophylactic Abx
  • Novel CFTR modulators eg. Kaftrio
  • Monitoring new problems or things like weight and liver disease
103
Q

What is the lifestyle advice for pt w CF?

A
  • No smoking !!!
  • Avoid other CF pt, people w colds, jacuzzis and stables
  • NaCl tablets in hot weather or strenuous exercise
  • Annual flu jab
  • Keep Nebulisers dry and clean
104
Q

What is the pleural cavity?

A

Potential space between the outer pleura (parietal) and inner pleura (visceral) containing pleural fluid.

105
Q

What are the types of pleural disease?

A
  • Pneumothorax
  • Pleural effusion
  • Empyema
  • Pleural tumour
  • Pleural plaques
  • Pleural thickening
106
Q

What are the different types of pneumothorax?

A
  • Spontaneous, primary or secondary (have lung disease)
  • Traumatic
  • Tension
  • Iatrogenic
107
Q

What are the RF of pneumothorax?

A
  • Lung disease
  • Height
  • Smoker
  • Trauma
  • Diver
  • Marfan’s
108
Q

What is the management of tension pneumothorax?

A
  • Primary = O2 and aspirate then reaspirate or drain if didn’t work
  • Secondary = ICD sooner
  • Tension = needle decompression in 2nd ICS MCL
109
Q

What are the Ix into pleural effusion?

A
  • CXR
  • ECG and echo
  • Bloods - FBC, CRP, LFT, U&E, LDH, bone profile, clotting
  • Staging CT contrast if suspect exudative cause
  • US guided needle aspiration = protein, LDH, pH, cytology, microbiology
110
Q

Transudate vs exudate effusion

A 
Transudate = <30 g/L protein
Exudate = >30g/L protein
111
Q

What are the causes of transudate effusion?

A
  • Heart failure
  • Cirrhosis
  • Hypoalbuminaemia
    Often can just treat the underlying cause.
112
Q

What are the causes of exudate effusion?

A
  • Infection
  • Lung malignancy
  • Inflam
113
Q

What is Light’s criteria?

A

If there is increased protein and LDH in serum/pleural fluid then effusion is more likely to be exudative.

114
Q

What is interstitial lung disease?

A

Umbrella term for conditions affecting the lung parenchyma. Need to take a comprehensive occupational and environmental Hx.
Restrictive on PFTs.

115
Q

What is UIP and what are the classical findings?

A

Usual interstitial pneumonia - most common ILD, mainly iatrogenic.
Findings - clubbing, reduced chest expansion, fine inspiratory crackles (velcro) best heard in basal and axillary areas, may have features of pulm HTN

116
Q

What is extrinsic allergic alveolitis and what is the clinical presentation?

A

Hypersensitivity pneumonitis, inhalation of an antigen individual is sensitised to.
Can be acute (reversible) or chronic (less reversible).

117
Q

What are the common drugs that cause fibrosis of lung?

A
  • Amiodarone
  • Bleomycin
  • Methotrexate
  • Nitrofurantoin
  • Penicillamine
118
Q

What is sarcoidosis?

A

Multisystem inflam condition, idiopathic. Non caseating granuloma usually affecting resp but can affect any organ.
50% spontaneously resolve and the rest lead to progressive disease.

119
Q

What are the Ix into sarcoidosis?

A
  • CXR and PFT
  • Bloods - U&Es, ACE, Ca2+
  • ECG, echo, cardiac MRI
  • CT/MRI head if headaches
120
Q

What are the treatment principles of ILD?

A
  • Remove environmental, occupational and drug triggers
  • Stop smoking
  • Treat infective exacerbations
  • O2 if resp failure
  • Palliative
  • Transplant
121
Q

What are the clinical features of lung cancer?

A
  • Asymptomatic, found incidentally
  • Horner’s syndrome
  • Mets and paraneoplastic disease
  • Worsening of any resp symptom
  • SVC obstruction
  • Increased risk TE disease
122
Q

What are Horner’s syndrome and paraneoplastic disease?

A

Horner’s - mitosis, anhydrosis and partial ptosis due to compression of sympathetic nerve in neck by pancoast tumour.
Paraneoplastic syndromes - Cushing’s, clubbing, anaemia, hypercalcaemia, SIADH

123
Q

What are the RF of lung cancer?

A
  • High pack years
  • FH of lung cancer
  • Carcinogen exposure eg. asbestos
  • Airflow obstruction
  • Increasing age
124
Q

What are the histological classes of lung cancer? What are their prognoses?

A

Small cell lung cancer - more aggressive so worse prognosis, 1.5 year survival.
Non small cell lung cancer - 80% 5 year Hx in stage 1 and decreases a bit as increase stage.

125
Q

What are the Ix into lung cancer?

A
  • Bloods - FBC, U&E, Ca2+, LFTs, INR
  • CXR and staging CT for TNM
  • FNA of lymph node, CT biopsy and bronchoscopy
  • PET scan for mets
126
Q

What is the treatment of lung cancer?

A
  • Surgery = curative in stage 1 and 2
  • Surgery and adjuvant chemo in stage 3
  • RT curative if not suitable for surgery or used in palliative care
  • Just chemo stage 3-4
127
Q

What is OSA?

A

Obstructive sleep apnoea: upper airway obstruction during sleep = sleep fragmentation. Usually affecting obese males. Either small pharynx w normal narrowing (narrowing normal in sleep as pharyngeal dilators relax) or normal pharynx w excessive narrowing,

128
Q

What are the causes of a small pharynx?

A
  • Large tonsils
  • Craniofacio abnormalities
  • Extra submucosal tissue eg. myoxedema
  • Increased neck fat
129
Q

What are the causes of excessive narrowing causing OSA?

A
  • Obesity
  • Neuromusc disease eg. MS, stroke
  • Muscle relaxants eg. alcohol and sedatives
  • Increasing age
130
Q

What are the clinical features of OSA?

A
  • Repetitive upper airwards collapse = arousal = fragmented sleep and excessive day time sleepiness
  • Arousals increase BP
  • Nocturia
  • Nocturnal sweating, GORD and reduced libido
131
Q

What is the Epworth sleepiness score?

A

Chance of dozing when doing activites eg. driving, passenger in car, watching TV or reading book

132
Q

What is a CPAP?

A

Cont positive airway pressure = prevents airway collapse so prevents sleep fragmentation and daytime sleepiness. Given via a nasal mask.

133
Q

Sympathomimetics:

  • Example
  • Indication and MOA
  • SE
A

eg. salbutamol (short) and formeterol (long). Used for bronchospasm. B2 selective adrenergic agonists, increase cAMP in SM = bronchodilation.
SE - tremor, headache, GI upset, palpitations, tachy

134
Q

Antimuscarinics:

  • Example
  • Indication and MOA
  • SE
A

eg. Ipratropium (short) and tiotropium (long). Used for bronchospasm normally in COPD, muscarinic antagoinst. Decreases cGMP = reduces intracell Ca2+ = decreased SM contractility.
SE - dry mouth, cough, constipation, headache

135
Q

Xanthines:

  • Examples
  • Indication and action
  • SE
A

eg. Aminophylline, theophylline
Used for asthma and COPD by blocking phosphodiesterases = decreased cAMP breakdown = bronchodilation.
SE - headache, GI upset, reflux, palpitations, dizziness.

136
Q

Inhaled steroids:

  • Examples
  • Indication and MOA
  • SE
A

Eg. budesonide, beclomethasone, fluticasone. Used for asthma and COPD. Decreased bronchial inflam.
SE - cough, oral thrush, hoarse. voice

137
Q

Corticosteroids:

  • Examples
  • Indication and MOA
  • SE
A

eg. Prednisolone, hydrocortisone, dexamethasone. Used to suppress inflam, allergy and immune responses by altering gene transcription of inflam mediators.
SE - adrenal suppression, hyperglycaemia, psychosis, indigestion, mood swings.

138
Q

What is DLCO?

A

Diffusing capacity of the lungs for CO:

  • Reduced = empysema, pulm fibrosis, alveolar inflam
  • Normal = problem w chest wall, neuromusc disease
139
Q

What is Batwing’s distribution?

A

Apical and basal sparing in pulmonary oedema as fluid leaks from central hilar vessels.

140
Q

What is part of the Wells’ score?

A
  • Clinical sx of DVT
  • PE is no1 diagnosis
  • HR >100
  • Immobilisation for 3 days or surgery w/i 4 weeks
  • Previously diagnosed PE/DVT
  • Haemopytsis
  • Malignancy w/i last 6 months
141
Q

What is ARDS?

A

Acute respiratory distress syndrome = non cardiogenic pulmonary oedema and diffuse lung inflam:

  • Acute onset (w/i 1 week)
  • Bilat opacities on CXR
  • PaO2/FiO2 ratio <300 on positive end expiratory pressure
142
Q

What are the CF of ARDS?

A
  • Dyspnoea and hypoxaemia
  • Critically ill pt
  • Increased RR
  • Pulm crackles
143
Q

What are the RF and causes of ARDS?

A

RF - sepsis, aspiration, pneumonia, severe trauma

144
Q

What are the complications of ARDS?

A
  • Pneumothorax
  • Ventilator associated pneumonia
  • Multiple organ failure
  • Pulm fibrosis w prolonged resp failure
145
Q

How do you treat ARDS?

A

Mechanical ventilation, shown to reduce mortality

146
Q

What does an elevated A-a gradient idicate?

A

pO2 higher in alveoli than in arterial blood = V/Q mismatch:

  • Dead space ventilation - pneumonia, asthma, COPD, PE
  • L to R shunt - pulm oedema, ARDS, pneumonia
  • Alveolar hypoventilation - pulm fibrosis, ILD

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