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Year 3 Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is asthma

A

Chronic inflammation of airways secondary to T1 hypersensitivity
reversible bronchospasm - obstructs airway

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2
Q

Asthma risk factors

A 
Atopy 
maternal smoking, RSV infection 
low birth weight 
X breast fed
allergens exposure 
air pollution 
hygiene hypothesis
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3
Q

IgE mediated atopic conditions

A

Atopic dermatitis - eczema

Allergic rhinitis - hay fever

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4
Q

Asthma symptoms

A

cough (worse at night)
dyspnea
wheeze
chest tightness

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5
Q

Asthma signs

A

Expiratory wheeze
reduced PEFR
FEV1/FVC <70%

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6
Q

Asthma management

A
  1. SABA - salbutamol
  2. Inhaled corticosteroids
  3. Leukotriene receptor antagonists - montelukast
  4. LABA - salmeterol
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7
Q

Acute asthma?

A

worsening dyspnoea, wheeze, cough
not responding to SABA
can be triggered by infection

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8
Q

Moderate acute asthma

A

PEFR 50-75%
normal speech
RR <25
HR <110

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9
Q

Severe acute asthma

A

PEFR 33-50
can’t complete sentences
RR >25
HR >110

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10
Q

Life threatening acute asthma

A 
PEFR <33
O2 <92%
silent chest, cyanosis
bad resp effort
Bradycardia
dysrhythmia 
hypotension 
exhausted
confusion 
coma
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11
Q

near fatal acute asthma

A

PCO2 raised!

need mechanical ventilation

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12
Q

Acute asthma management

A
  • O2 - 15L, non rebreathe
  • 94-98% sats
  • salbutamol neb 5mg
  • ipratropium neb 0.5mg
  • hydrocortisone IV 100mg
    OR 40mg prednisolone oral
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13
Q

Acute severe/life threatening asthma management

A
  • magnesium sulfate IV 20mg
  • aminophylline, maybe IV salbutamol
  • invasive ventilation
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14
Q

COPD

A

chronic obstructive pulmonary disorder

chronic bronchitis, emphysema

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15
Q

COPD causes

A

smoking
alpha 1 antitrypsin deficiency
cadmium, coal, cotton, cement, grain

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16
Q

COPD symptoms

A

cough - productive
dyspnea
wheeze
RH failure - peripheral oedema

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17
Q

COPD CXR

A

hyperinflation
bullae (mimic pneumothorax)
flat hemidiaphragm
exclude lung cancer

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18
Q

COPD post-bronchodilator therapy

A 
FEV1/FVC ratio <0.7
and also FEV1
- mild >80%
- mod 50-70
- severe 30-49
- v severe <30
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19
Q

COPD management

A
  1. SABA/SAMA
  2. if they have asthmatic features - LABA/ICS
  3. If not LABA or LAMA
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20
Q

COPD triple therapy

A

if still exacerbations

LAMA, LABA, ICS

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21
Q

too many COPD exacerbations?

A

oral prophylactic AB therapy

azithromycin prophylaxis

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22
Q

requirements for starting oral prophylaxis antibiotic therapy

A

need to quit cigs
CT exclude atypical infection/TB
LFTs, ECG needed to exclude QT prolongation (azi can make it longer)

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23
Q

chronic productive cough w COPD?

A

mucolytics

Carbocysteine

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24
Q

long term O2 therapy

A 
15hrs a day 
if severe airflow abs
cyanosis
polycythameia
peripheral oedema 
raised JVP 
O2 <92%
measure w 2 ABGs
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25
Q

COPD exacerbation?

A

increased, dyspnea, cough, wheeze
increased sputum
hypoxic
acute confusion

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26
Q

COPD exacerbation organisms

A

H influenza
H rhinovirus
S pneumoniae
M catarrhalis

27
Q

COPD exacerbation management?

A

24% O2 Venturi mask 88-92%
Nebuliser salbutamol 5mg/4hr
Ipratropium 0.5mg/6hr
30mg prednisolone 5 days
And hydrocortisone???
oral ABS if sputum purulent/signs of pneumonia
- amoxicillin, clarithromycin, doxycycline

28
Q

what is pleural effusion, symptoms

A

excess fluid between pleura membrane

  • dyspnea
  • pleuritic chest pain
  • non-productive cough
29
Q

pleural effusion transudate

A 
<30g/L protein
Heart failure
Hypoalbuminaemia - liver disease, nephrotic metastases
hypothyroidism 
meigs ew?
30
Q

pleural effusion exudate

A 
>30g/L 
infection, pneumonia, TB, abcess
RA, SLE
lung cancer
PE
dressers
yellow nail
31
Q

pleural effusion signs

A

trachea AWAY
stony dull
less air entry, bronchial breathing
reduced expansion/resonance

32
Q

pleural effusion X-ray

A

Blunt costophrenic angles
Dense shadow –> meniscus
Mediastinal shift away
Coin lesion/cardiomegaly

33
Q

pleural effusion US

A

guides aspiration, detects fluid

34
Q

pleural effusion CT

A

underlying causes

35
Q

pleural effusion aspiration

A 
percuss border, 1/2 spaces below 
lignocaine
21g needle
send for inspection
allow to drain?
36
Q

pleural effusion fluid analysis raised amylase, low pH

A

pancreatitis, oesophageal perforation

37
Q

pleural effusion fluid analysis low glucose, low ph, high protein

A

RA, TB, SLE

38
Q

pleural effusion fluid analysis blood staining

A

mesothelioma, PE, TB

39
Q

pneumothorax, symptoms

A 
air in pleural space
collapse? 
- sudden
- dyspnea
- pleuritic chest pain
- sweating
- tachycardia, tachypnea
40
Q

tension pneumothorax, signs

A 
one-way valve - air can't escape 
respiratory distress
cardiac arrest
mediastinal compression
increased JVP
increased HR, low BP
41
Q

causes of primary pneumothorax

A

young, thin men

smokers

42
Q

causes of secondary pneumothorax

A 
COPD
asthma
CF
lung cancer
pneumonia
marfans, EDS, pulmonary fibrosis, sarcoidosis
43
Q

trauma pneumothorax

A

penetrating

blunt, rib fractures

44
Q

pneumothorax signs

A

reduced expansion, breath sounds, VR

resonant percussion

45
Q

tension pneumothorax management

A

resus
no CXR
large bore 2nd ICS mid clavicular
ICD

46
Q

primary pneumothorax management

A

<2cm/no SOB –> discharge?
larger –> aspirate, if fails chest drain
stop smoking!!!

47
Q

secondary pneumothorax management

A

> 50, >2cm, SOB
chest drain
if not attempt aspiration first

48
Q

sarcoidosis, who?

A

multisystem
non-caveating granulomas
young, African, females

49
Q

Acute sarcoidosis presentation

A 
erythema nodosum
bilateral lymphadenopathy 
fever - swinging 
polyarthralgia 
weight loss
fatigue
HSM
50
Q

sarcoidosis other features

A 
SOB, chest pain 
polyneuropathy 
renal stones
pit dysfunction 
uveitis
restrictive cardiomyopathy 
pericardial effusion 
cholestatic LFTS
lupus pernio
51
Q

sarcoidosis blood results

A

hypercalcaemia

increased ESR, Ig, LFTs, ACE

52
Q

sarcoidosis investigations

A

bloods
tuberculin neg in 2/3
spirometry - restrictive
biopsy - lung, LN, liver

53
Q

sarcoidosis management

A 
asymptomatic - nothing 
acute - bed rest, nsaids
chronic 
- 40mg red 4-6 wks
- immunosuppression - methotrexate, ciclosporin ...
54
Q

BHL differentials

A

sarcoidosis
TB, mycoplasma
lymphoma, carcinoma
interstitial disease

55
Q

type 1 resp failure

A 
hypoxaemic
PaO2 <8
PaCO2 <6
V/Q mismatch 
damage to lung tissue prevents oxygenation, diffusion failure
56
Q

type 2 resp failure

A 
hypercapnic 
PaO2 <8 
PaCO2 >6
may have V/Q mismatch
alveolar ventilation unable to excrete CO2
57
Q

type 1 resp failure causes

A

Pneumothorax, PE, pulmonary hypertension , atelectasis,
COPD, asthma, bronchiectasis
pulmonary fibrosis, oedema,

58
Q

type 2 resp failure causes

A 
chest wall, muscle weakness
CNS depression 
severe asthma
obesity 
hypothyroid
59
Q

hypoxia acute effects

A 
dyspnea, tachypnea
agitation 
confusion 
cyanosis 
tachyarrhythmias
60
Q

chronic hypoxia effects

A

polycythemia
pulmonary hypertension
cor pulmonale

61
Q

hypercapnia effects

A 
headache
flushing
peripheral vasodilation/warm
bounding pulse
flap 
confusion, coma
62
Q

asthma - spirometry

A

FEV1 reduced
FEV1/FVC <70%
obstructive pattern
increased 12% w beta agonist

63
Q

asthma investigations

A

spirometry
diurnal variation
atopy
FeNO (>40ppb positive)

64
Q

Pulmonary embolism?

A

Blood clot in lungs!
- pleuritic chest pain
- dyspnea
…

Year 3 Medicine (13 decks)

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