Resp Peer Teaching Flashcards
<p>what is pneumonia</p>
<p>it is inflammation and fluid collection in the lungs due to infection</p>
<p>three different types of pneumonia based on how it's acquired</p>
<ul> <li>community acquired pneumonia</li> <li>hospital acquired pneumonia</li> <li>Aspiration pneumonia <ul> <li>e.g. people who can't swallow properly</li> </ul> </li> </ul>
<p>what causes 90% of pneumonia</p>
<p>strep pneumoniae</p>
<p>name 4 bacterial causes of pneumonia</p>
<p>Strep pneumoniae</p>
<p>Staph aureus</p>
<p>Legionella's (if recently come back from spain with chest infection)</p>
<p>Jirovecci in HIV patients</p>
<p>name 8 types ofpeople at risk of Pneumonia</p>
<p>Infants and the elderly</p>
<p>COPD and other chronic lung conditions</p>
<p>the immunocompromised</p>
<p>nursing home residents</p>
<p>those with impaired swallowing</p>
<p>diabetics</p>
<p>heart failure</p>
<p>alcoholics and IVDUs</p>
<p></p>
<p>name 4 signs of pneumonia</p>
<p>drop in BP</p>
<p>fever</p>
<p>increased resp rate</p>
<p>increased sputum production</p>
<p>what might the colour of sputum indicate</p>
<p>green/rust coloured: bacteria</p>
<p>thin and white: viral</p>
<p>name 6symptoms of pneumonia</p>
<p>confusion (particularly in the elderly)</p>
<p>tired (not enough O2 in the blood)</p>
<p>pleuritic chest pain</p>
<p>SOB</p>
<p>headache</p>
<p>malaise</p>
<p>what is the gold standard Ix for pneumonia</p>
<p>CXR where you would see consolidation</p>
<p>what tests should you do for pneumonia</p>
<p>sputum sample</p>
<p>blood culture</p>
<p>Thoracentesis</p>
<p>FBC</p>
<p>ABG</p>
<p>what tool can you use to calculate the severity of commuity acquired pneumonia</p>
<p>CURB-65</p>
<p>what does CURB65 stand for</p>
<ul> <li>Confusion</li> <li>Urea >7mmol/L</li> <li>Resp rate</li> <li>Blood pressure</li> <li>Age over 65</li> </ul>
<p>one point for each</p>
<p>what do the scores mean in CURB65</p>
<ul>
<li>score 1: treat aas out patient</li>
<li>score 2: consider short stay in hospital/monitor closely as an outpatient</li>
<li>score 3+: hospitalisation and consideration for ITU</li>
</ul>
<p>describe the overall treatment of pneumonia</p>
<p>ABCDE approach (e.g. IV fluids and CPAP)</p>
<p>Analgesia for chest pain</p>
<p>Empirical Abx</p>
<p>then Abx guided by M,C and S</p>
<p></p>
<p>what should you do if a pneumonia patient is admitted for more than 12 hrs</p>
<p>thromboprophylaxis with LMWH</p>
<p>empirical Abx if it's aspiration pneumonia</p>
<p>anaerobic cover with metronidazole</p>
<p>what is the empirical abx for mild community acquired pneumonia</p>
<p>Amoxicillin</p>
<p>what is the empirical treatment for moderate community acquired pneumonia</p>
<p>amoxicillin and then clarithromycin</p>
<p>what is the empirical treatment for severe community acquired pneumonia</p>
<p>co-amoxiclav and clarithromycin</p>
<p>what is the causative organism of TB - describe it</p>
<p>mycobacterium tuberculosis</p>
<p>it is an aerobic, non-motile, slightly curved rod</p>
<p>how is TB spread</p>
<p>airborne droplets</p>
<p>name 8notifiable diseases</p>
<p>yellow fever</p>
<p>mumps</p>
<p>TB</p>
<p>rabies</p>
<p>diptheria</p>
<p>smallpox</p>
<p>anthrax</p>
<p>leprosy</p>
<p>plague</p>
<p></p>
<p>signs and symptoms of latent TB</p>
<p>none</p>
<p>where does TB normally infect</p>
<p>the apex of the lung</p>
<p>what are the signs and symptoms of active TB</p>
<p>signs: coughing up <strong>blood</strong> and looking unwell</p>
<p>symptoms: fever, night sweats, chills, chest pain</p>
<p>how is TB diagnosed</p>
<p>gold standard is doing 3x sputum tests</p>
<p>you can only diagnose if you find TB pathogen</p>
<p>what stain do you use for TB</p>
<p>Ziehl-Neelsen stain (this is used to identify acid fast organisms like mycobacteria)</p>
<p>other Ix for TB</p>
<p>Mantoux skin test</p>
<p>CXR</p>
<p>CT scan</p>
<p></p>
<p>Gohn complex may be visible on imaging</p>
<p>what is the treatment of TB</p>
<ul> <li>RIPE <ul> <li>Rifampicin</li> <li>Isoniazid</li> <li>Pyrazinamide</li> <li>Ethambutol</li> </ul> </li> <li>Rifampicin and Isoniazidfor six months</li> <li>Pyrazinamide and Ethambutol for the first two months of this</li> </ul>
<p>Rifampicin side effect</p>
<p>red body fluids: urine swear and tears</p>
<p>isoniazid side effect</p>
<p>peripheral neuropathy (tingling in hands and feet)</p>
<p>Pyrazinamide side effect</p>
<p>hepatitis</p>
<p>Ethambutol side effect</p>
<p>visual problems</p>
<p>what do all the TB drugs cause</p>
<p>hepatotoxicity</p>
<p>spirometry findings in lung obstruction</p>
<p>FEV1is <80% expected for their age</p>
<p>FEV1/FVC is <0.7</p>
<p>what is a SABA and give an example</p>
<p>short acting beta agonist</p>
<p>an example is salbutamol</p>
<p>what is a LABA</p>
<p>give an example</p>
<p>long acting beta agonist</p>
<p>an example is salmetarol</p>
<p></p>
<p>how do SABAs and LABAs work?</p>
<p>they bind to B2 adrenergic receptors and cause smooth muscle relaxation and bronchodilation</p>
<p>4 adverse effects of beta agonists</p>
<p>hypokalaemia</p>
<p>tremor</p>
<p>palpitations</p>
<p>muscle cramps</p>
<p>how do corticosteroids work</p>
<p>they suppress multiple inflammatory genes - in resp med they reduce inflammation in the airway and therefore lead to wider airways</p>
<p>name three corticosteroids</p>
<p>methylprednisolone</p>
<p>dexamethasone</p>
<p>prednisolone</p>
<p>what are two side effects of inhaled corticosteroids</p>
<p>increased risk of oral candida infection</p>
<p>hoarse voice</p>
<p></p>
<p>give 4 general side effects of corticosteroids</p>
<p>weight gain</p>
<p>osteoporosis</p>
<p>high blood pressure</p>
<p>susceptibility to infection</p>
<p>what is a side effect of ACE inhibitors</p>
<p>cough due to buildup of bradykinin</p>
<p>what is the definition of COPD</p>
<p>it is a collection of lung diseases that cause irreversible obstruction to ariflow out of the lungs</p>
<p>what are the three diseases included in COPD</p>
<p>emphysema</p>
<p>chronic bronchitis</p>
<p>chronic obstructive airway disease</p>
<p>what happens in emphysema</p>
<p>alveoli become large and lose their elasticity</p>
<p>cannor recoil to expel air</p>
<p>this leads to breakdown of alveolar membranes and can lead to giant bullae</p>
<p>when individual breathes in the air sacs become more full than they should causing a barrel chest</p>
<p>name two causes of COPD</p>
<p>smoking causes 90%</p>
<p>alpha-1 anti-trypin deficiency also causes it</p>
<p>how does smoking cause emphysema </p>
<p>it causes damage to the airway which releases inflammatory factors</p>
<p>thes break down the collagen and elastin in the airways</p>
<p>how does smoking cause chronic bronchitis?</p>
<p>airways become inflamed and narrowed</p>
<p>mucus production increases since smoking increases number of goblet cells</p>
<p>irritants damage cilia meaning mucus isn't effectively removed from the airway, this causes a chronic cough, mucus and phlegm production</p>
<p>how can you distinguish COPD caused by smoking and COPD caused by a-1 anti-trypsin deficiency?</p>
<p>in a-1 anti-trypsin deficiency the individual will be young and will have a family history of COPD as well as liver disease</p>
<p></p>
<p>also a-1 anti-trypin deficiency causes COPD in the lower acinae of the lungs whereas smoking causes it higher up</p>
<p>6 signs of COPD</p>
<p>barrel shaped chest</p>
<p>use of accessory muscles to breathe</p>
<p>ankle swelling (from heart failure)</p>
<p>chronic cough</p>
<p>sputum</p>
<p>wheeze</p>
<p>three symptoms of COPD</p>
<p>fatigue</p>
<p>low mood</p>
<p>SOB</p>
<p>Ix for COPD</p>
<ul> <li>spirometry <ul> <li>FEV<sub>1</sub>/FVC = <0.7</li> <li>FEV<sub>1</sub>= <80% expected for age</li> </ul> </li> <li>Chest X ray</li> <li>DLCO</li> <li>ABG</li> </ul>
<p></p>
<p>what is DLCO</p>
<p>Diffusing capacity of the lungs for carbon monoxide</p>
<p>patient inhales a fixed amount of CO2 and the amount of CO2 exhaled is measured after a certain time period. This shows how well CO2 is diffusing in and out of the blood</p>
<p>what is the aim of COPD treatment</p>
<p>COPD is irreversable so the aim of treatment is to improve symptoms and slow progression</p>
<p>treatment for COPD</p>
<ul> <li>Lifestyle <ul> <li>stop smoking</li> <li>exercise</li> <li>pulmonary rehabilitation</li> </ul> </li> <li>Pharmacological <ol> <li>SABA</li> <li>LABA</li> <li>LABA and Corticosteroid</li> <li>LAMA</li> </ol> </li> <li>Surgical <ul> <li>Lung transplant</li> </ul> </li> </ul>
<p>what is an example of a LAMA</p>
<p>tiotropium</p>
<p>what are the target oxygen sats for COPD patient</p>
<p>88-92%</p>
<p>what type of hypersensitivity reaction is asthma</p>
<p>type 1</p>
<p>what is the definition of asthma</p>
<p>it is a reversible chronic obstructive airway disease (air can't get out)</p>
<p>what are the two types of asthma</p>
<p>atopic and non-atopic</p>
<p>pathophys of atopic asthma</p>
<ul>
<li>allergen inhaled and engulfed by apc</li>
<li>apc presents to T cell</li>
<li>T cell releases cytokines that cause inflammation and clonal expansion of receptive B cells</li>
<li>next time antigen inhaled B cells recognise it and IgE is produced</li>
<li>IgE binds mast cells and when these enounter the antigen they degranulate releasing histamine</li>
<li>this causes bronchoconstriction and inflammation</li>
</ul>
<p>what are the causes of atopicasthma</p>
<p>genetics</p>
<p>environmental stimuli hygeine hypothesis</p>
<p></p>
<p>what are the causes of non-atopic asthma</p>
<p>stress</p>
<p>cold air</p>
<p>infection</p>
<p>name 9 things that can exacerbate asthma</p>
<p>infection</p>
<p>allergens</p>
<p>pollution</p>
<p>smoking</p>
<p>stress</p>
<p>ACE inhibitors</p>
<p>Beta blockers</p>
<p>cold weather</p>
<p>being overweight</p>
<p>signs and symptoms of asthma</p>
<p>signs: wheeze</p>
<p>symptoms: shortness of breath, dry cough worse in the morning</p>
<p>investigations for asthma</p>
<ul> <li>spirometry <ul> <li>FEV<sub>1</sub>/FVC <0.7</li> <li>reversibility testing <ul> <li>distinguishes from COPD</li> <li>before and 20 mins after bronchodilator</li> <li>FEV<sub>1</sub>will improve by more than 15% in pt with asthma</li> </ul> </li> </ul> </li> <li>peak flow <ul> <li>diurnal variation</li> </ul> </li> </ul>
<p>treatment for asthma</p>
<ul> <li>lifestyle <ul> <li>stop smoking</li> <li>avoid allergens and stress</li> </ul> </li> <li>drugs (BTS guidelines) <ol> <li>SABA</li> <li>corticosteroid</li> <li>corticosteroid and LABA</li> <li>Higher dose corticosteroid & biological therapy</li> <li>additional prednisolone</li> </ol> </li> </ul>
<p>what are the two parts of the pleura</p>
<p>1.Parietal: Chest Wall</p>
<p>2.Visceral: Lungs</p>
<p>what stops the lungs collapsing</p>
<p>the pleural space is much lower pressure than the airways and this causes them not to collapse</p>
<p>where is pleural fluid made and where does it drain</p>
<p>it is made by cells of the parietal layer</p>
<p>it is drained into the lymphatics</p>
<p>what is pleural effusion</p>
<p>it is a buildup of pleural fluid in the pleural space - it limits how much the lungs can expand and thereby impairs breathing</p>
<p>what things can cause transudate in the pleural space</p>
<p>heart failure</p>
<p>cirrhosis</p>
<p>nephrotic syndrome (not enough albumin to pull fluid back)</p>
<p>what things can cause exudate in the pleural space</p>
<p>PE</p>
<p>bacterial pneumonia</p>
<p>cancer</p>
<p>infection</p>
<p>what is the difference between transudate and exudate</p>
<p>transudate: <25g/L protein</p>
<p>exudate: >25g/L protein</p>
<p>signs of pleural effusion</p>
<p>decreased chest movement</p>
<p>reduced breath sounds</p>
<p>dull to percussion</p>
<p></p>
<p>ix for pleural effusion</p>
<ul> <li>CXR <ul> <li>very large effusion may cause tracheal deviation</li> </ul> </li> <li>percussion <ul> <li>dull</li> </ul> </li> <li>reduced breath sounds on auscultation</li> <li>thoracentesis to discover cause <ul> <li>gram stain</li> <li>cytology</li> </ul> </li> </ul>
<p>symptoms of pleural effusion</p>
<p>SOB</p>
<p>cough</p>
<p>chest pain</p>
<p>treatment for pleural effusion</p>
<p>aspirate/chest drain</p>
<p></p>
<p>what is a pneumothorax</p>
<p>it is a buildup of air in the pleural space</p>
<p></p>
<p>it causes the lung on the affected side to collapse (due to loss of pressure gradient) and inability for this lung to expand</p>
<p>how does pneumothorax present</p>
<p>sudden onset sharp one sided pleuritic chest pain and shortness of breath. pain worse when breathing in</p>
<p>what is the difference between a primary and secondary pneumothorax</p>
<p>primary: no underlying lung disease but risk factor</p>
<p>secondary: damage to the lungs caused by underlying pathology</p>
<p>which traumatic things can cause pneumothorax</p>
<p>rib fracture</p>
<p>gunshot</p>
<p>stabbing etc</p>
<p>what are the risk factors for primary pneumothorax</p>
<p>male</p>
<p>smoking</p>
<p>family history</p>
<p>connective tissue disease (marfans, ehlers danloss)</p>
<p>signs and symptoms of pneumothorax</p>
<ul> <li>signs <ul> <li>low blood pressure</li> <li>low oxygen levels</li> <li>diminished breath sounds on affected side</li> </ul> </li> <li>symptoms <ul> <li>SOB</li> <li>sharp one sided chest pain</li> </ul> </li> </ul>
<p>what is the gold standard investigation for a pneumothorax</p>
<p>CXR</p>
<p></p>
<p>can differentiate from pleural effusion because pneumothorax appears black whereas pleural effusion appears white</p>
<p>treatment for pneumothorax</p>
<ul> <li>small spontaneous ones can heal on their own (if they have caused no SOB)</li> <li>treat the underlying cause <ul> <li>close hole if there's an open wound</li> </ul> </li> <li>chest drain</li> <li>surgery</li> </ul>
<p>what is the difference between a pneumothorax and a tension pneumothorax</p>
<p>in a pneumothorax the hole allows air in and out</p>
<p>in tension pneumothorax the hole is more like a valve and onle lets air in and not out.</p>
<p>this causes the amount of air in the pleural space to increase rapidly</p>
<p></p>
<p>tension pneumothorax is a medical emergency</p>
<p>what would you see on a CXR of a tension pneumothorax</p>
<p>trachea would be deviated away from the affected lung</p>
<p>what is the treatment for tension pneumothorax</p>
<p>emergency --> immediately insert a chest drain</p>
<p>what is mesothelioma</p>
<p>this is a cancer of the pleura</p>
<p>what is the main cause of mesothelioma</p>
<p>asbestos</p>
<p>what are the symptoms of mesothelioma</p>
<p>fever</p>
<p>weight loss</p>
<p>fatigue</p>
<p>SOB</p>
<p>persistent cough</p>
<p>clubbed fingers</p>
<p>pain near affected side</p>
<p>Ix for mesothelioma</p>
<p>X-ray</p>
<p>CT scan</p>
<p>Biopsy</p>
<p>treatment for mesothelioma</p>
<ul> <li>if found early (which is rare) <ul> <li>radiotherapy and chemotherapy</li> </ul> </li> <li>if found late (which is more common) <ul> <li>palliative care</li> <li>pain relief</li> </ul> </li> </ul>
<p>what are the two broad types of lung cancer</p>
<p>small cell (10-15%)</p>
<p>non-small cell (80-85%)</p>
<p></p>
<p>what are the most common types of non-small cell lung cancer</p>
<p>squamous cell carcinomas and adenocarcinoma</p>
<p>name 4 causes of lung cancer</p>
<p>smoking</p>
<p>asbestos</p>
<p>chromium</p>
<p>arsenic</p>
<p></p>
<p>what are the symptoms of lung cancer</p>
<p>cough</p>
<p>haemoptysis</p>
<p>dyspnoea</p>
<p>chest pain</p>
<p>what are the signs of lung cancer</p>
<p>weight loss</p>
<p>anaemia</p>
<p>clubbing</p>
<p>enlarged supraclavicular or axillary nodes</p>
<p></p>
<p>haemoptysis is your major red flag here</p>
<p>investigations for lung cancer</p>
<p>CXR</p>
<p>CT Chest</p>
<p>Bronchoscopy</p>
<p>needle or surgical biopsy</p>
<p>what is the management of stage 1 and 2 lung cancer</p>
<p>surgical excision and radical deep x-ray therapy</p>
<p>what is the management of stage 3 and 4 lung cancer</p>
<p>palliative chemotherapy and radiotherapy</p>
<p>palliative care</p>
<p>what is the inheritance pattern of CF</p>
<p>autosomal recessive</p>
<p>what is the mutation in CF</p>
<p>CFTR channel on chromosome 7</p>
<p>what happens in CF</p>
<ul>
<li>Cl-can't be drawn out into the lumen due to faulty channel</li>
<li>water is therefore not drawn out into the channel due to osmosis</li>
<li>mucus is thick and sticky</li>
<li>this clogs the lumen</li>
<li>Na+ moves into cells due to electrochemical gradient since Cl- is -ve</li>
<li>this draws water into the cells with it (out of lumen) making mucus even thicker and stickier</li>
</ul>
<p>signs of CF</p>
<p>steatorrhea</p>
<p>children with a failure to thrive</p>
<p>finger clubbing</p>
<p>rectal prolapse</p>
<p></p>
<p>symptoms of CF</p>
<p>heavy mucus production</p>
<p>cough</p>
<p></p>
<p>complications from CF</p>
<p>infertility</p>
<p>pancreatitis</p>
<p>resp tract infections</p>
<p>bronchiectasis</p>
<p>Ix for cystic fibrosis</p>
<p>sweat test: high NaCl collected from skin indicates CF</p>
<p>genetic testing</p>
<p>faecal elastase in newborns is a marker of pancreatic damage caused by CF</p>
<p>what is the life expectancy in CF</p>
<p>about 50 years</p>
<p>non-pharma therapy for CF</p>
<p>physio - techniques for airway clearance</p>
<p>liaison psych</p>
<p>pharmacological treatment of CF</p>
<p>Abx to prevent infections</p>
<p>anti-mucinolytics</p>
<p>bronchodilators</p>
<p>insulin to replace that not made by a damaged pancreas</p>
<p>bisophosphonates and supplements due to malabsorption</p>
<p></p>
<p>NB they can have lung surgery if very bad</p>
<p>what is bronchiectasis</p>
<p>it is irreversible dilation of the bronchioles due to recurrent damage and inflammation. there's scarring, dilation and loss of cilia</p>
<p>bacteria stagnate in the bronchioles causing recurrent infections</p>
<p>what are the causes of bronchiectasis</p>
<p>it is the end point of chronic lung diseases such as cystic fibrosis, and COPD as well as bad infections</p>
<p>Ix for bronchiectasis</p>
<p>HRCT shows wide bronchi</p>
<p>Sputum culture: look for infectious agents in airway to treat with Abx</p>
<p>treatment of bronchiectasis</p>
<p>can't be cured so manage symptoms</p>
<p>stop smoking</p>
<p>vaccinate</p>
<p>give abx prophylactically</p>
<p>bronchodilators</p>
<p>steroids</p>
<p>name 5 lung conditions that can be work related</p>
<p>hypersensitivity pneumonitis</p>
<p>bronchitis (from irritants such as silicon)</p>
<p>fibrosis</p>
<p>carcinoma</p>
<p>asthma</p>
<p></p>
