Respiratory Flashcards
What are the causes of pulmonary hypertension?
Group 1. Primary pulmonary HTN or SLE Group 2. LHF due to MI or system HTN Group 3. Chronic lung disease e.g. COPD Group 4. PE Group 5. Sarcoidosis, haematological disorders
What are the signs and symptoms of Pulmonary HTN?
SOB is main
Other: Syncope Loud S2 Tachycardia Raised A waves on JVP Hepatomegaly Peripheral odema
What are the investigations for pulmonary HTN?
ECG:
- R ventricular hypertrophy
- R axis deviation
- RBBB
CXR:
- dilated pulmonary arteries
- R ventricular hypertrophy
What is the management of pulmonary HTN?
Primary pulmonary HTN:
- IV prostanodids e.g. epoprostenol
- Endothelin receptor antagonist e.g. macitentan
- Phosphodiesterase-5 inhibitors e.g. sidenafil
What is the presentation of asthma?
Episodic symptoms Diurnal variation - worse at night Dry cough with wheeze and SOB Hx of other atopic conditions FHx Bilateral widespread polyphonic wheeze
Acute: respiratory alkalosis
What are the investigations for asthma?
First line:
- fractional exhaled NO
- spirometry with bronchodilator reversibility
Second line:
- peak flow variability
- direct bronchial challenge test
What is the management of asthma? (NICE)
- Salbutamol
- Add inhaled corticosteroid
- Add oral LTRA e.g montelukast
- Add LABA e.g. salmeterol
- Consider changing to MART regime
- Increase inhaled corticosteroid dose to moderate
- Increase inhaled corticosteroid to high dose or oral theophyline or tiotropium
- Refer to specialist
How is an asthma exacerbation graded?
Moderate:
- PEFR 50-75% predicted
Severe:
- PEFR 33-50% predicted
- RR > 25
- HR > 110
- Unable to complete full sentences
Life threatening:
- PEFR <33%
- Sats <92%
- Becoming tired
- Silent chest
- Haemodynamically unstable
What is the treatment for an asthma exacerbation?
Moderate: Neb salbutamol Neb ipratropium bromide Steroids Abs
Severe:
O2
Aminophyline infusion
Consider IV salbutamol
Life threatening:
IV magnesium sulfate infusion
Admission to ITU
Intubate
Give the presentation of COPD
Chronic SOB Cough Sputum production Wheeze Recurrent resp infections esp in winter
Describe the MRC Dyspnoea Scale
Grade 1. Breathless on strenuous exercise Grade 2. On walking up hill Grade 3. SOB that slows walking on flat Grade 4. Stop to catch breath after 100m Grade 5. Unable to leave house
What is the diagnosis of COPD?
Based on clinical presentation plus spirometry
FEV1/FVC <0.7
FEV1 <80% of predicted
What is the long term management of COPD?
Stop smoking
Pneumococcal and annual flu vaccine
- Salbutamol or Ipratropium bromide
- Combined LABA+LAMA (if no asthmatic or steroid responsive features)
- If steroid responsive/asthma features = Combined LABA+ICS
How do you distinguish the different types of respiratory failure?
Low PO2 indicates hypoxia and respiratory failure
Normal PCO2 with low PO2 = type 1
Raised PCO2 with low PO@ = type 2
Oxygen therapy in COPD
If retaining CO2 aim for 88-92% titrated by venturi mask
If not retaining CO2 and bicarb normal, then give oxygen aim >94%
Give the histology of lung cancers
Non-small cell lung cancer (80%)
- Adenocarcinoma (40%)
- Squamous cell carcinoma (20%) (cavitating)
- Large cell carcinoma (10%)
Small cell lung cancer (20%)
What are the signs and symptoms of lung cancer?
SOB Cough Haemoptysis Finger clubbing Recurrent pneumonia Weight loss Lymphadenopathy
What are the investigations for lung cancer?
CXR: first line
- hilar enlargement
- peripheral opacity
- pleural effusion
- collapse
Staging CT
PET CT
Bronchoscopy
Histological diagnosis
What are the treatment options for lung cancer?
Surgery = first line in non-small cell lung cancers
Radiotherapy - curative in NSCLC
Chemo
Tx for SCLC = radio and chemo
What are the extrapulmonary manifestations of lung cancers?
Recurrent laryngeal nerve palsy Phrenic nerve palsy Superior vena cava obstruction Horners syndrome SIADH - SCLC Cushing's syndrome - SCLC Hypercalcaemia - Squamous cell carcinoma Lambert eatorn myasthenic syndrome
What is the lambert-eaton myasthenic syndrome?
A result of antibodies produced by the immune system against SCLC cells.
antibodies damage the voltage gated calcium channels on the presynaptic terminal in motor neurones leading to proximal muscle weakness, diplopia, ptosis.
Patients have reduced tendon reflexes
What is a mesothelioma?
Lung malignancy affecting mesothelial cells fo the pleura. Strongly linked to asbestos inhalation.
May have lag of up to 45 years between exposure and diagnosis
Difference between exudative and transudative pleural effusion
Exudative means high protein count >3g/dl
Transudative means low protein count <3g/dl
What are the exudative causes of pleural effusion?
Related to inflammation. Inflammation results in protein leaking out of tissues.
Lung cancer
Pneumonia
Rheumatoid arthritis
Tb