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Respiratory Flashcards

1
Q

Describe the Epidemiology of Asthma (2)

A
  • Commonly presents in childhood/adolescence

- More common in developed countries

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2
Q

What are the two types of Asthma

A
  • Allergic/Eosinophillic

- Non-Allergic/Non Eosinophillic

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3
Q

What are the 3 main characteristics of Asthma

A
  • Airway hyper-responsiveness
  • Airway obstruction
  • Bronchial inflammation/fibrosis with smooth muscle hypertrophy, increased mucosal secretion and epithelial damage
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4
Q

What are the risk factors for Asthma (5)

A
  • Atopy
  • Family History
  • Premature birth
  • Obesity
  • Poor socioeconomic status
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5
Q

What are the main precipitating factors for Asthma (6)

A
  • Cold air
  • Smoke (tobacco)
  • Exercise
  • Allergens
  • Stress
  • NSAIDs and Beta blockers
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6
Q

How might someone with Asthma present (6)

A
  • Intermittent dyspnoea
  • Wheeze
  • Frequent exacerbation due to an identifiable factor
  • Cough
  • Symptoms worse at night
  • Often a younger patient
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7
Q

What tests might you do in Asthma (4)

A
  • RCP3
  • Spirometry
    - Obstructive pattern (FEV1/FVC <0.7)
  • PEFR diary with introduction of Salbutamol
  • Skin prick test (for allergies)
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8
Q

What medication might you prescribe in Asthma (3)

A
  • Beta agonists
    - SABA (salbutamol)
    - LABA (Salmeterol)
  • Muscarinic Antagonists
    - SAMA (Ipratropium)
    - LAMA (Tiotropium)
  • Inhaled Corticosteroids
    - Prednisolone
    - May be given systemically if ineffective
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9
Q

What is the medication Guideline regime in Asthma (4)

A
  • SABA
  • SABA and ICS
  • SABA and LABA and ICS
  • SABA and LABA and ICS plus 4th?
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10
Q

How would a patient having an acute Asthma attack present (3)

A
  • Tachycardia
  • Resp. Rate > 24
  • Unable to finish sentences due to severe
    breathlessness
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11
Q

How would you treat an acute Asthma attack (3)

A
  • Oxygen (keep above 92%)
  • Nebulised Salbutamol
  • Prednisolone
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12
Q

What is COPD

A
  • A disease state with progressive airway obstruction that is not fully reversible
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13
Q

What are the risk factors for COPD (3)

A
  • Smoking
  • Alpha 1 Antitrypsin defficiency
  • Occupational factors (Coal dust, chemicals, etc.)
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14
Q

What are the two diseases in COPD

A
  • Chronic Bronchitis

- Emphysema

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15
Q

Describe the pathophysiology of Chronic Bronchitis

A
  • Airway narrowing and increased mucosal secretions in response to inhaled irritants
  • Hypertrophy and Hyperplasia of mucus scereting glands of Bronchi
  • Inflammation and fibrosis of Bronchial walls leading to airway narrowing
  • Blue Bloaters
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16
Q

Describe the pathophysiology of Emphysema

A
  • Dilatation and destruction of lung tissue distal to bronchioles in reponse to inhaled irritants
  • inflammation leads to decreased elastic recoil and dilatation of alveoli
  • This leads to alveolar collapse and decreased compliance/ decreased gas exchange
  • pink puffers
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17
Q

How might someone with COPD present (6)

A
  • Chronic productive (clear) cough
  • Breathlessness
  • Wheeze
  • Frequent infections
  • Symptoms worsened by cold/damp
  • Usually older Smokers
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18
Q

What is the treatment for COPD (4)

A
  • Smoking cessation (most effective)
  • B2 Agonists
    - LABA (salmeterol)
    - SABA (salbutamol)
  • Corticosteroids
    - 2 week prednisolone trial
    - beclametasone ICS if improves symptoms
  • Oxygen therapy
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19
Q

What type of disease is Hypersensitivity Pneumonitis

A
  • Autoimmune Interstitial Lung Disease (restrictive)
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20
Q

What is the epidemiology of Hypersensitivity Pneumonitis (2)

A
  • Usually in Adults

- Acute, Sub-Acute and Chronic Forms

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21
Q

What are the causes/risk factors for hypersensitivity pneumonitis

A
  • Farmers Lung (Mouldy Hay)
  • Cheese Workers Lung (Mouldy Cheese)
  • Pigeon Fanciers Lung (Proteins in droppings)
  • Malt Worker (Mouldy Malt)
  • Existing Lung Disease
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22
Q

Describe the Pathophysiology of Hypersensitivity Pneumonitis

A
  • Type 3 hypersensitivity reaction
  • Cellular immune response and immune complex deposition in response to inhaled allergen
  • This leads to granulatomous inflammation and hence progressive fibrosis of the lung parenchyma
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23
Q

How might someone with acute Hypersensitivity Pneumonitis present (6)

A
  • Fever, sweats, rigor
  • Dyspnoea
  • Dry cough
  • Myalgia
  • Crackling
  • Tight chest
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24
Q

How might someone with sub-acute Hypersensitivity Pneumonitis present (8)

A
  • Similar to acute but less pronounced and slower onset
  • May have a history of acute attacks
  • Fever, sweats, rigor
  • Dyspnoea
  • Dry cough
  • Myalgia
  • Crackling
  • Tight chest
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25
Q

How might someone with Chronic Hypersensitivity Pneumonitis present (5)

A
  • Unlikely to have history of acute attack
  • Progressive dyspnoea
  • Weight loss
  • Cyanosis
  • Finger clubbing
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26
Q

What tests might you do on someone with Hypersensitivity Pneumonitis (3)

A
  • Bloods
    • Raised ESR/CRP
    • Raised WCC
  • Chest X-Ray
    • Diffuse Nodular Shadowing
    • Fibrotic Shadowing in upper zone
  • Spirometry
    • Reversible Restriction
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27
Q

How would you treat someone with Acute/ Subacute Hypersensitivity Pneumonitis (3)

A
  • Remove Allergen
  • Oxygen
  • Prednisolone
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28
Q

How would you treat someone with Chronic Hypersensitivity Pneumonitis (2)

A
  • Avoid exposure to allergen

- Prednisolone

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29
Q

Describe the Epidemiology of Brochiectasis (3)

A
  • More common in Females
  • Often caused by infection
  • Incidence increases with age
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30
Q

What are the causes of Bronchiectasis (3)

A
  • Infection
    • Pneumonia/TB
  • Congenital
    • Cystic Fibrosis/Primary Ciliary Dyskinesia
  • Mechanical bronchial obstruction
    • Tumour
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31
Q

Describe the Pathophysiology of Bronchiectasis

A
  • Decreased Mucociliary clearance and impaired immune function lead to recurrent lung infections
  • This results in constant bronchial wall inflammation and fibrosis
  • In response to this the airways permanently dilate
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32
Q

How might someone with Bronchiectasis present (6)

A
  • Chronic productive cough with green smelly sputum
  • Dyspnoea
  • Chest pain
  • Recurrent infection
  • Wheeze
  • Finger clubbing
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33
Q

What tests might you run for Bronchiectasis (5)

A
  • Chest X-Ray
    - Dilated Airways
  • Sputum Culture
    - Look for bacterial colonisation
  • Spirometry
    - Restrictive pattern
  • Test for Cystic Fibrosis
  • Bronchoscopy
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34
Q

What is the treatment for Bronchiectasis (3)

A
  • Mucus Drainage
  • Antibiotics to treat infections
  • Bronchodilator
  • ICS
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35
Q

Describe the Epidemiology of Cystic Fibrosis (3)

A
  • More common in Caucasians
  • Multi-System mostly affects lungs and pancreas
  • Autosomal recessive
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36
Q

Describe the pathophysiology of Cystic Fibrosis

A
  • Mutation of Cystic Fibrosis gene on chromosome 7
  • Codes for Cystic Fibrosis Transmembrane regulator
  • CFTR tranports Cl which is followed by Na then water into mucus
  • in CF this means that less water moves into mucus resulting in thicker secretions
  • Leads to Obstruction/ Bronchiectasis and Pancreatic insufficiency
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37
Q

How might someone with Cystic Fibrosis present (9)

A
  • Thicc mucus
  • Cough
  • Shortness of breath
  • Anorexia/ Weight loss
  • Bowel obstruction
  • Wheeze
  • Recurrent infection
  • Diabetes
  • Weight loss
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38
Q

What tests might you run for Cystic Fibrosis (3)

A
  • Genetic screening
  • Sweat test (Salt >60mmol/L)
  • Clinical/Family History
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39
Q

What is the treatment for Cystic Fibrosis (7)

A
  • Education
  • Vaccination/Antibiotics
  • Pancreatic replacement therapy
  • ADEK vitmain suplements
  • B2 agonists and ICS to relive symptoms
  • Stop Smoking
  • Amiloride (reduces Na transport)
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40
Q

Describe the Epidemiology of Sarcoidosis (4)

A
  • Type of Interstitial lung disease
  • Commonly affects adults 20-40
  • More common in women
  • Multi-system granulatomous disease mostly affects lungs and Lymph nodes
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41
Q

How might someone with Sacrcoidosis present (6)

A
  • Fever, Fatigue, Weight loss
  • Erythema Nodosum (red lumps on skin)
  • Cough
  • Progressive dyspnoea
  • Lymphadenopathy
  • Chest pain
  • plus so many others i cba fucking learning
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42
Q

What tests might you run for Sarcoidosis (3)

A
  • Chest X-Ray
    - Bilateral Hilar Lymphadenopathy
    - Lung infiltrates/fibrosis
  • Biopsy
    • Non Caseating Granulomas (DIAGNOSTIC)
  • Bronchoscopy
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43
Q

How would you treat Sarcoidosis (2)

A
  • Acute attack
    - Bed rest and NSAIDs
  • Steroids
    - Prednisolone (IV Methylprednisolone if severe)
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44
Q

Describe the epidemiology of Idiopathic pulmonary fibrosis (IPF) (3)

A
  • More common in Males, Inc. with age
  • Most common cause of interstitial lung disease
  • Progressive lung fibrosis of unknown cause
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45
Q

Describe the pathophysiology of IPF

A
  • Progressive fibrosis of lung parenchyma

- Leads to decreased lung compliance and impaired gas exchange due to thicker alveolar membrane

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46
Q

What are the risk factors for IPF (5)

A
  • Smoking
  • Infectious agents
  • GORD
  • Occupational exposure
  • Drugs
47
Q

How might someone with IPF present (6)

A
  • Dry cough
  • Progressive dyspnoea
  • Crackle
  • Malaise/Arthralgia
  • Weight loss
  • Cyanosis/Finger clubbing
48
Q

What tests might you run for IPF (4)

A
  • Chest X-Ray
  • High Resolution CT
  • Spirometry
    - Restriction
  • Biopsy
49
Q

How do you treat IPF (4)

A
  • Oxygen
  • Opiates
  • Treat cough/GORD
  • Anti fibrotic
    - Perfenidone (if eligible)
50
Q

Define Pulmonary Hypertension

A
  • Mean pulmonary arterial pressure >25 mmHg with secondary right heart failure
51
Q

Describe the epidemiology of Pulmonary Hypertension

A
  • May be caused by any disease that causes increased resistance to pulmonary flow or increased blood flow from RV
52
Q

Describe the Pathophysiology of Pulmonary Hypertension

A
  • Raised MAP leads to arterial wall damage causing release of vasoconstrictors
  • Vasoconstriction caused increased afterload leading to RV hypertrophy, dilatation and faliure
53
Q

How might someone with Pulmonary Hypertension present (5)

A
  • Exertertional dyspnoea
  • Chest pain
  • Fatigue/lethargy
  • Oedema
  • Syncope
54
Q

What tests would you run for Pulmonary Hypertension (3)

A
  • Chest X-Ray
    - PA dilated proximally then taper distally
    - RV hypertrophy
  • ECG
    - RV hypertrophy
  • Right heart catherterisation
    - Mean Pulmonary arterial pressure >25
55
Q

How do you treat Pulmonary Hypertension (4)

A
  • Treat underlying cause
  • CCB
    - Verapamil (pulmonary vasodilators)
  • Warfarin
  • Diuretics for Oedema
56
Q

Define Pleural Effusion

A
  • An excess accumulation of fluid in the pleural cavity
57
Q

Describe the epidemiology of pleural effusion (2)

A
  • Transudates and Exudates

- More common in adults

58
Q

Describe the pathophysiology of pleural effusion

A
  • Transudates Protein <20
    - Leakage of fluid into pleural cavity due to
    decreased blood oncotic pressure
  • Exudates Protein >20
    - Leakage of fluid into pleural cavity due to
    increased capillary/pleural permeability due to
    infection/inflammation/malignancy
59
Q

How might someone with pleural effusion present (5)

A
  • Dyspnoea
  • Cough
  • Pleuritic chest pain
  • Decreased chest expansion on side of effusion
  • Dull percussion/diminished breath sounds
60
Q

What tests would you do for pleural effusion (2)

A
  • CXR
    - Water shadowing
  • Pleural tap
    - Needle aspiration
    - Sample sent to lab
61
Q

How might you treat pleural effusion

A
  • Transudates treat underlying cause

- Exudates drainge

62
Q

Describe the epidemiology of pneumothorax (2)

A
  • Spontaeous or secondary to trauma

- More common in males

63
Q

What are the risk factors for pneumothorax (4)

A
  • Smoking
  • Male
  • Tall and thin
  • Mechanical Ventilation
64
Q

Describe the pathophysiology of pneumothorax

A
  • Normally pressure in pleural cavity is negative but when a tear in pleura occurs it becomes the same as the lung
  • This causes partial collapse of the lung due to its elastic recoil
65
Q

How might someone with a pneumothorax present (4)

A
  • Sudden onset dyspnoea and pleuritic chest pain
  • Hyper-resonant to percussion and diminished breath sounds
  • Reduced chest expansion
  • Pallor and tachycardia as it progresses
66
Q

What tests might you run for pneumothorax (1)

A
  • CXR
    - Areas devoid of lung markings
    - Blurred lines (i know you want it)
67
Q

What is the treatment for pneumothorax (3)

A
  • Needle aspiration then chest drain
  • Oxygen
  • Surgery if reccurent
68
Q

Describe the epidemiology of Bronchial Carcinoma (4)

A
  • Most common metastatic tumour
  • Secondary more common than primary
  • 3rd biggest killer in UK
  • More common in men
69
Q

What are the risk Factors for Bronchial carcinoma (4)

A
  • Smoking
  • Occupational exposure eg. Asbestos/coal
  • Radiation
  • Previous/current lung disorder
70
Q

What are the two categories of Bronchial carcinoma

A
  • Small cell carcinoma

- Non small cell carcinoma

71
Q

Describe small cell carcinoma (4)

A
  • Associated with smoking
  • Early metastases
  • Arises from endocrine cells
  • Poor prognosis
72
Q

Describe Non small cell carcinoma

A
  • Squamous cell carcinoma
    - most strongly associated with smoking
  • Adenocarcinoma
    - Most common overall
    - Fairly metastatic
73
Q

Where might Bronchial Carcinoma spread (5)

A
  • Bones
  • Lymph nodes
  • Brain
  • Adrenal glands
  • Liver
74
Q

Where can secondary bronchial carcinoma arise from (4)

A
  • Bladder
  • Kidney
  • Breast
  • Bowel
75
Q

How might someone with bronchial carcinoma present (6)

A
  • Weight loss/ malaise
  • Cough/ Wheeze
  • Haemoptysis
  • Chest pain
  • Reccurent infection
  • Shortness of breath
76
Q

What tests might you do for bronchial carcinoma (3)

A
  • CXR
    • Round shadowing
  • CT for staging- TNM
  • Bronchoscopy and biopsy
77
Q

How might you treat bronchial cell carcinoma (3)

A
  • Surgical excision
  • Chemo/Radiotherapy
  • Palliative
    • Bronchodilators
    • Analgesia
    • Steroids
    • Anti Emetics
78
Q

Describe the Epidemiology of Mesothelioma (3)

A
  • More common in males
  • 40-70
  • Strong association with asbestos exposure
79
Q

Describe the pathophysiology of mesothelioma

A
  • High grade malignancy that starts as nodular and spreads to encompass the entire pleural surface
80
Q

How might someone with Mesothelioma present (4)

A
  • Weight loss/malaise
  • Shortness of breath
  • Chest pain
  • Recurrent pleural effusion
81
Q

What tests might you run for mesothelioma (2)

A
  • CXR
    • Pleural effusion and thickening
  • Biopsy
82
Q

Describe the treatment for mesothelioma

A
  • ‘youre fucked mate’
  • Generally resistant to surgery, Chemo and Radiotherapy
  • Diagnosis- Death = 8 months
83
Q

How might someone with Pharyngitis/Tonsilitis present (5)

A
  • Inflamed tonsils
  • Sore throat
  • Tender neck glands
  • Tender cervical lymph nodes
  • High temperature
84
Q

How do you treat Pharyngitis/Tonsilitis

A
  • No treatment required
  • If persistent Penoxylmethylpenicillin (swear big pharma just try to piss of med students because they couldn’t get into med school)
85
Q

How might someone with sinusitis present (4)

A
  • Frontal headache
  • Tender face pain
  • Rhinorrhea
  • Fever
86
Q

How do you treat Sinusitis (2)

A
  • Nasal decongestants

- Co-amoxiclav

87
Q

How might someone with acute epiglottitis present (4)

A
  • High fever
  • Airflow obstruction
  • Sore throat and pain on swallowing
  • Sits up straight and inspiratory wheeze
88
Q

How do you treat acute epiglottitis (2)

A
  • Urgent endotracheal intubation

- IV ceftazidime

89
Q

How might someone with whooping cough present (4)

A
  • Chronic cough
  • Vomiting during/ after attacks
  • Fever
  • Inspiratory whoop
90
Q

How do you treat whooping cough (2)

A
  • Clarithromycin

- Vaccination

91
Q

Describe the epidemiology of Pneumonia (4)

A
  • Hospital aquired Pneumonia
  • Community aquired Pneumonia
  • Aspiration Pneumonia
  • Immunocompromised
92
Q

What are the risk factors for Pneumonia (5)

A
  • <16
  • > 65
  • Immunocompromised
  • Smoking
  • IV drug use
93
Q

Describe the pathophysiology of Pneumonia

A
  • Spread by respiratory droplets
  • Bacteria invade normally sterile distal airways
  • Alveolar macrophages overwhelmed do recruit neutrophils
  • Neutrophils produce inflammatory exudate (pus)
  • In non-severe this is then cleared by apoptosis
  • In severe there is
    - Non resolution
    - Excess inflammation
    - Lung injury
94
Q

How might someone with Pneumonia present (5)

A
  • Fever, sweats, rigors
  • Productive cough
  • Pleuritic chest pain
  • Dull to percussion/decreased breath sounds
  • Breathlessness
95
Q

What tests might you run for Pneumonia (3)

A
  • CXR
    • Shadowing (diffuse)
  • Sputum culture
  • Bloods
    • Raised ESR, CRP, WCC
96
Q

What are the common bacterial causes of pneumonia (5)

A
  • Haemophilus Influenzae (CAP)
  • Streptococcus Pneumoniae (CAP)
  • Kelbsiela Pneumoniae (CAP and HAP)
  • E. Coli (CAP and HAP)
  • Staphylococcus Areus (HAP)
97
Q

How do you Assess the severity of pneumonia

A 
- CURB65 1 point for each 
Confusion?
Urea (6mmol/L)
Resp. rate >30
Blood pressure <90/60
65 >65
- 0/1= mild 1/2= moderate (Hospital) 3/4= severe (Hospital) 5= ITU admission
98
Q

How do you treat Pneumonia (4)

A
  • Oxygen
  • Analgesia
  • Mild - clarithromycin
  • Severe - iv Co-amoxiclav and clarithromycin
99
Q

What are potential complications of pneumonia (3)

A
  • Resp. failure
  • Parapneumonic effusion
  • Hypotension
100
Q

Describe the epidemiology of Tuberculosis (3)

A
  • 1/3 of population infected
  • 9 million cases 2 million deaths each year
  • Main cause of death in HIV
101
Q

What are the four main causes of TB (bacteria)

A
  • Mycobacterium tuberculosis
  • Mycobacterium bovis
  • Mycobacterium africanum
  • Mycobacterium microti
102
Q

What are the risk factors for TB (6)

A
  • HIV/immunosupression
  • Homeless/prison
  • Malnutrition
  • Diabetes
  • IV drug use
  • Inc. age
103
Q

How might someone with TB present (5)

A
  • Weight loss/anorexia
  • Productive cough
  • Chest pain
  • Shortness of breath
  • Fever/malaise/sweats
104
Q

What tests might you do in TB (3)

A
  • CXR
    • Nodular shadowing
    • Diffuse consolidation
  • Sputum sample
  • Bronchoscopy (if cannot get sputum)
105
Q

How do you treat TB (2)

A
  • Notify public health england (and their mum)
  • RIPE
    Rifampicin (6 months)
    Isoniazid (6 months)
    Pyrazinamide (2 months)
    Ethambutol (2 months)
106
Q

What are the risk factors for pulmonary embolism (2)

A
  • DVT (surgery, fracture, plane)

- Polycythaemia

107
Q

How might PE present (5)

A
  • Sudden onset dyspnoea (most common)
  • Pleuritic chest pain
  • Haemoptysis
  • Raised resp. rate
  • Hypotension/tachycardia
108
Q

How do you diagnose PE (3)

A
  • Plasma D-dimer
  • CT pulmonary angiography
  • CXR- small effusion
109
Q

How do you treat PE (5)

A
  • Oxygen
  • Morphine
  • LMW heparin (enoxaparin)
  • Thrombolysis
  • Surgery
110
Q

What is the epidemiology of occupational asthma (4)

A
  • 15% of all adult onset asthma
  • 90% due to allergen exposure at work
  • 10% due to lung injury with exposure to irritant
  • 1500-3000 cases per year
111
Q

What are the features of occupational asthma (5)

A
  • Latent period
  • Deterioration
  • Gradual improvement
  • Often causes depression
  • Associated with flour, wood, metal and paint spray
112
Q

What happens to patients post occupational asthma diagnosis (4)

A
  • Unemployment
  • Compensation
  • Chronic resp. disorder
  • Depression
113
Q

How can you prevent occupational asthma (5)

A
  • Risk assessment
  • Elimination
  • Substitution
  • Masks/ventilators
  • Ventilation

Finals (11 decks)

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