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Respiratory Flashcards

1
Q

What is bronchiectasis?

A

Chronic inflammation of bronchi and bronchioles leading to permanent bronchial dilation.

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2
Q

Which infections cause bronchiectasis?

A
  • Measles
  • Pertussis
  • Bronchiolitis
  • Pneumonia
  • TB
  • HIV
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3
Q

What are the non infectious causes of bronchiectasis?

A
  • Cystic fibrosis
  • Tumour
  • RA
  • UC
  • Allergic bronchopulmonary aspergillosis
  • COPD
  • Asthma
  • Idiopathic
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4
Q

What are the symptoms of bronchiectasis?

A
  • Persistent cough
  • Copious purulent sputum
  • Haemoptysis
  • Dyspnoea
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5
Q

What are the signs of bronchiectasis?

A
  • Finger clubbing
  • Coarse inspiratory crepitations
  • Wheeze
  • Rhonchi
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6
Q

What are the complications of bronchiectasis?

A
  • Pneumonia
  • Pleural effusion
  • Pneumothorax
  • Haemoptysis
  • Cerebral abscess
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7
Q

What Ixs would you do if you suspect bronchiectasis?

A
  • Sputum culture
  • CXR
  • CT - gold standard, shows bronchial dilation
  • Bronchoscopy
  • Spirometry
  • Serum IgE if suspecting ABPA
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8
Q

How would bronchiectasis present on CXR?

A

Ring shadows

Thickened bronchial walls

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9
Q

How would bronchiectasis present in spirometry?

A

Obstructive pattern FEV1/FVC <70%

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10
Q

How would you treat bronchiectasis?

A
  • Physiotherapy
  • Mucolytics
  • Antibiotics
  • Salbutamol
  • Corticosteroids
  • Smoking cessation
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11
Q

What are the risk factors for bronchiectasis?

A
  • Age >70
  • Female
  • Smoking history
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12
Q

What are the differentials of bronchiectasis?

A
  • COPD
  • Asthma
  • Pneumonia
  • Chronic sinusitis
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13
Q

Which virus most commonly causes coryza (common cold)?

A

Rhinovirus

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14
Q

What are the symptoms of coryza?

A
  • Malaise
  • Pyrexia
  • Sore throat
  • Watery nasal discharge
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15
Q

Which pathogens cause sinusitis?

A

Strep. pneumoniae and H.influenzae

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16
Q

What are the symptoms of sinusitis?

A
  • Frontal headache
  • Facial pain
  • Nasal discharge
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17
Q

What is the treatment of sinusitis?

A
  • Broad spectrum abx e.g. co-amoxiclav

- Topical corticosteroids

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18
Q

What are the symptoms of rhinitis?

A
  • Nasal discharge
  • Sneezing
  • Itchy eyes
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19
Q

What is the treatment of rhinitis?

A
  • Avoid allergens
  • Antihistamine
  • Steroid nasal spray
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20
Q

Which virus causes pharyngitis?

A

Adenovirus

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21
Q

What are the symptoms of pharyngitis?

A
  • Sore throat

- Fever

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22
Q

Severe pharyngitis implies bacterial infection. Which bacteria causes pharyngitis?

A

Haemolytic strep

Staph aureus

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23
Q

What is another term for acute laryngo-tracheobronchitis?

A

Croup

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24
Q

Which viruses cause croup?

A

Parainfluenza or RSV

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25
Croup is characterised by a barking cough and stridor due to inflammatory oedema in the larynx. How can you treat this?
- Oxygen - Oral/IM corticosteroids - Nebulized adrenaline
26
What are the signs of croup?
- Intercostal and sternal recession - Agitation - Lethargy
27
Which antibodies are produced in asthma?
IgE
28
What are the three broad mechanisms of asthma?
1. Inflammation 2. Remodelling - smooth muscle hypertrophy 3. Airway thickening + narrowing
29
What are the symptoms of asthma?
- Diurnal variation (worse early morning + night) - Wheeze - Cough - Sputum - Dyspnoea
30
Which factors precipitate asthma?
- Pollution - Infections - Cold air - Exercise - Stress - Allergens - Infection - Smoking - Beta blockers - NSAIDs
31
What are the signs of asthma?
- Hyperinflated chest - Tachypnoea - Hyper-resonant percussion - Cyanosis - Confusion
32
What pattern would you expect to see on spirometry for someone with asthma?
Obstructive - FEV1/FVC <70%
33
Apart from spirometry, what other investigations can you do for asthma?
- Peak flow - ABG - CXR - Skin prick test - Histamine challenge
34
Which lifestyle changes can you recommend to someone with asthma?
- Smoking cessation - Avoid precipitants - Lose weight - Correct inhaler technique - Up to date vaccinations
35
Name the medications used to treat asthma.
- SABA - salbutamol - Inhaled steroid - beclomethasone - LABA - salmeterol - Leukotriene receptor agonist - montelukast - Aminophylline - Oral prednisolone
36
What are the side effects of beta agonists?
- Tachycardia - Low potassium - Tremor - Anxiety
37
Why are patients advised to rinse their mouth out after inhaling steroids?
To prevent oral candidiasis
38
What are the risk factors for developing asthma?
- FH - Male sex - Prematurity and LBW - Exposure to tobacco smoke - Obesity - Social deprivation - Childhood infections
39
What are the complications of asthma?
- Pneumonia - Pneumothorax - Respiratory failure - Status asthmaticus
40
What are the two pathophysiological factors which make up COPD?
1. Chronic bronchitis - cough + sputum on most days for 3 months 2. Emphysema - enlarged distance between alveoli and capillaries due to destruction of alveolar wall
41
Which factors suggest COPD over asthma?
- Age of onset >35 - Smoking - Chronic dyspnoea - Sputum - Minimum diurnal variation
42
What are the risk factors for developing COPD?
- Smoking - Chronic exposure to pollutants - Alpha-1 antitrypsin deficiency (leads to alveolar destruction)
43
What are the symptoms of COPD?
- Cough - Sputum - Wheeze - Dyspnoea - Recurrent lower resp infections - Fatigue - Headache due to CO2 retention
44
What are the signs of COPD?
- Tachypnoea - Hyperinflation - Decreased expansion - Resonant percussion - Wheeze on auscultation - Cyanosis - Pursed lip breathing - Use of accessory muscles of respiration
45
What term is given to severe emphysema?
Pink puffer
46
What term is given to severe chronic bronchitis?
Blue bloater
47
How can you differentiate between pink puffers and blue bloaters?
Pink puffer: - Normal PaO2 and PaCO2 - Breathless but not cyanosed Blue bloater: - Low PaO2 and high PaCO2 - Cyanosed but not breathless
48
What are the complications of COPD?
- Infection - Polycythaemia - Respiratory failure - Cor pulmonale - Pneumothorax - Lung cancer - Bronchiectasis - Osteoporosis (chronic steroid use)
49
Which investigations would you do in COPD?
- FBC - raised PCV - CXR - hyperinflation, flattened diaphragm - ABG - Sputum culture - Spirometry - obstructive - CT - ECG - cor pulmonale
50
What lifestyle advice would you give someone with COPD?
- Smoking cessation | - Annual flu vaccine
51
How would you manage an acute exacerbation of COPD?
- Oxygen to maintain sats 88-92% without increasing CO2 - Salbutamol + ipratropium bromide - Oral steroids - Antibiotics
52
Outline the stepwise approach for treating COPD.
1. SABA or SAMA (ipratropium bromide) 2. If no asthmatic features, give LABA and LAMA 3. If there are asthmatic features, give LABA and ICS 4. If still worsening, combine LABA, LAMA and ICS
53
What are the indications for long term oxygen therapy for someone with COPD?
1. SpO2 <88% | 2. PaO2 <7.3kPa
54
Which organism causes TB?
Mycobacterium tuberculosis
55
How is TB transmitted?
Aerosol droplets
56
What are the risk factors for re-activating latent TB?
- New TB infection - HIV - Organ transplant - Immunosuppression - Malnutrition - Haemodialysis
57
What are the symptoms of TB?
- Fever - Weight loss - Night sweats - Malaise - Clubbing - Enlarged and tender lymph nodes
58
Which organs can extrapulmonary TB present in?
- Heart - pericarditis - Brain - meningitis - GI - peritonitis
59
What are the signs of TB?
- Purulent sputum - Haemoptysis - Enlarged and tender lymph nodes - Bronchial breathing - Dullness to percussion
60
What are the differential diagnoses of TB?
- Bacterial pneumonia - Viral respiratory tract infection - Interstitial lung disease - Malignancy - Sarcoidosis
61
What investigations can you do for active TB?
- Sputum culture and microscopy - CXR - Urine dip - sterile pyuria - ECG - HIV test
62
Mycobacterium are acid fast bacilli. Which stain is used to detect this?
Ziehl-Neelson stain
63
Which culture media is used for mycobacterium?
Lowenstein-Jensen
64
How would a CXR appear in someone with TB?
- Lobar consolidation - Nodular opacities - Miliary TB nodules - Caseating granuloma - Pleural effusion
65
What test is given to detect latent TB?
Mantoux test
66
What is the drug regime to treat active TB?
First 2 months: Isoniazid, rifampicin, pyrazinamide and ethambutol Followed by: Isoniazid and rifampicin for a further 4 months
67
What is the drug regime to treat latent TB?
Three months of isoniazid + rifampicin OR six months of isoniazid only
68
What is the drug regime to treat TB with CNS involvement?
First 2 months: Isoniazid, rifampicin, pyrazinamide and ethambutol Followed by: Isoniazid and rifampicin for a further 10 months
69
What are the side effects of rifampicin?
Orange discolouration of urine Low platelets Raised LFT
70
What are the side effects of isoniazid?
Neuropathy - always give vitamin B6 (pyridoxine) to prevent this Low WCC
71
What is the side effect of ethambutol?
Optic neuritis
72
What are the side effects of pyrazinmide?
Hepatitis | Arthralgia
73
What are the complications of TB?
- Pleural effusion - Pneumothorax - Bronchiectasis - Respiratory failure
74
What is pulmonary hypertension?
Elevated pulmonary artery pressure >25mmHg and secondary RV failure
75
What is the normal mean pulmonary artery pressure?
10-14 mmHg
76
What is the normal mean systemic arterial pressure?
90 mmHg
77
Pulmonary hypertension occurs due to an increase in pulmonary vascular resistance or an increase in pulmonary blood flow. What are the primary causes?
- Hereditary - Chronic haemolytic anaemia - SLE - RA - SSRIs - HIV - Schistosomiasis
78
What are the secondary causes of pulmonary hypertension?
- COPD - Sarcoidosis - Chronic PE - Left heart disease
79
What are the risk factors for pulmonary hypertension?
- Obesity and sleep apnoea | - Prolonged exposure to high altitude
80
What are the symptoms of pulmonary hypertension?
- Breathlessness - Fatigue - Chest pain - Syncope
81
What are the signs of pulmonary hypertension?
- Peripheral oedema - Elevated JVP - Hepatomegaly - Pulsatile liver - Ascites
82
What is the gold standard Ix for pulmonary hypertension?
Echo - can calculate pulmonary pressure | Right heart catheterisation
83
What conservative management is advised for those with pulmonary hypertension?
- Flu vaccine | - Contraceptive advice (pregnancy is associated with mortality)
84
Which medications are given for pulmonary hypertension?
- Diuretics - Oxygen - Digoxin - Anticoagulation - CCBs - Sildenafil
85
What are the risk factors for lung cancer?
- Smoking - Asbestos - Iron oxides - Chromium - Radon gas - FH
86
Lung cancer is split into small cell and non-small cell carcinoma. What are the types of non-small cell carcinoma?
1. Adenocarcinoma 2. Squamous cell 3. Large cell carcinoma
87
What do small cell carcinomas secrete?
ACTH - Cushings | ADH - SIADH
88
What are the symptoms of lung cancer?
- Cough - Haemoptysis - Weight loss - New onset breathlessness - Chest pain - Bone pain - Fatigue
89
What is 1 pack year?
Smoking one pack (20 cigs) a day, for a year
90
What are the signs of lung cancer?
- Cachexia - Clubbing - Hepatomegaly - Cervical lymphadenopathy - Wheeze on auscultation
91
What are the differentials of lung cancer?
- TB - Sarcoidosis - Wegener's disease - Non-Hodgkin lymphoma
92
Which blood tests would you do for lung cancer?
- FBC: anaemia of chronic disease - LFTs: raised ALP + GGT = hepatic mets, raised ALP = bone mets - U&Es - Serum calcium
93
What are the signs of lung cancer on a CXR?
- Opacities - Pleural effusion - Collapsed lung
94
What is the gold standard Ix to identify lung cancer?
Bronchoscopy with biopsy
95
How would you manage stage I-III non-small cell lung cancer?
- Lobectomy - Chemo - Radiotherapy if unsuitable for surgery
96
How would you manage stage IV non-small cell lung cancer?
- Targeted drug therapy - Immunotherapy - Chemo - Palliative radiotherapy
97
How would you manage small cell lung cancer?
- Chemo - Radiotherapy Surgery is rare as most patients present with advanced disease
98
Horner's syndrome is a complication of lung cancer due to a Pancoast tumour. What are the features of this?
Ptosis Miosis Anhidrosis Enophthalmos
99
What are the complications of lung cancer?
- SVC obstruction | - SIADH
100
What causes byssnosis?
Endotoxins in bacteria in raw cotton
101
What causes berylliosis?
Beryllium copper
102
In interstitial lung disease, the diffusion distance in the interstitium becomes greater, impairing gas exchange. Is this reversible or irreversible?
Irreversible
103
What is the primary cause of interstitial lung disease?
Idiopathic pulmonary fibrosis
104
What are the secondary causes of interstitial lung disease?
- RA - SLE - Asbestosis - Methotrexate
105
What are the symptoms of interstitial lung disease?
- Progressive exertional dyspnoea - Dry cough - Malaise - Fatigue
106
What are the signs of interstitial lung disease?
- End-inspiratory crepitations - Dullness to percussion - Clubbing - Raynaud's
107
What is the spirometry pattern in interstitial lung disease?
Restrictive - normal FEV1/FVC ratio. Reduced FEV1 + FVC
108
What is the CXR pattern in interstitial lung disease?
-Fine opacities
109
What is the CT pattern in interstitial lung disease?
-Honeycombing
110
What is the medical management for interstitial lung disease?
- Prednisolone | - Oxygen
111
What are the complications of interstitial lung disease?
- Respiratory failure | - Pulmonary hypertension
112
What are the most 3 common causes of community acquired pneumonia?
1. Strep. pneumoniae 2. H.influenzae 3. Mycoplasma
113
Some patients acquire pneumonia via aspiration. Which patients are at risk of this?
- Stroke - Myasthenia - Bulbar palsies - Poor dental hygiene
114
What are the symptoms of pneumonia?
- Chest pain - Purulent sputum - Fever - Weight loss - Breathlessness - Cough - Haemoptysis
115
What are the signs of pneumonia?
- Cyanosis - Tachypnoea - Tachycardia - Hypotension - Crackles
116
What are the signs of consolidation (no air movement)?
- Diminished expansion - Dull percussion - Bronchial breathing - Pleural rub - Increased vocal resonance
117
How would pneumonia present on a CXR?
- Lobar infiltrates | - Pleural effusion
118
Which investigations are needed to diagnose pneumonia?
- Sputum culture - WBC - Blood cultures - Pulse oximetry - Urine dip - Pleural aspiration
119
CURB65 is used to assess severity of pneumonia. What are the components of this score?
``` Confusion Urea >7 mmol/L Resp rate >30/min BP <90 mmHg systolic Age >65 ```
120
What does a CURB65 score of 2 indicate?
Admission
121
What does a CURB65 score of 3+ indicate?
ITU | Mortality
122
How would you treat mild community acquired pneumonia?
Oral amoxicillin or erythromycin
123
How would you treat severe community acquired pneumonia?
Oxygen | IV clarithromycin and IV cefuroxime
124
What are the complications of pneumonia?
``` Pericarditis Pleural effusion Lung abscess Sepsis Myocarditis ```
125
Which groups are offered the pneumonia vaccination?
- Age >65 years - Diabetics - Immunosuppressed - Chronic renal, heart, lung or liver disease

3a (13 decks)

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