Respiratory Flashcards
What condition would show up as a wedge-shape opacity on a CXR?
PE or Lung Infarction
From Vessel Occlusion
Who should be immediately admitted to the hospital if a PE is suspected?
Signs of haemodynamic instability - Pallor, tachycardia, hypotension, shock, and collapse).
Pregnant or has given birth within the past 6 weeks.
Major Risk Factors for PE?
DVT/ Prev DVT or PE.
Active cancer.
Recent surgery.
Lower limb trauma.
Significant immobility
Pregnancy / 6 weeks’ postpartum.
COCP
HRT
Increasing age >60
Obesity
Long-distance travel
What are the clinical features of PE?
SOB
Cough
Haemoptysis
Dizziness
Tachy, pyrexia, Increasing JVP, Hypoxemia,
Pleural rub
Murmurs - Widely split S2, Tricuspid regurg
Gallop rhythm
Hypotension
Where is a swallowed FB most likely to go in the lung?
Right Inferior Lobar Bronchus
Features of life-threatening asthma?
Peak flow <33 of best-predicted
Silent Chest
Cyanosis
Normal PaCO2 on ABG
Hypoxia on ABG <8 PaO2 or Acidosis
Clinical features of severe asthma?
Peak flow 33-50% of best-predicted
RR >25
HR >110bpm
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What areas of the body are responsible for breathing?
Pons respiratory centre
Medulla respiratory centre
Pre-botzinger complex
Explain steroid-responsiveness when talking about COPD?
A steroid responsiveness is characterised by an increase in the FEV1 by a certain level. This response means that continuing steroid treatments (inhalers, etc…) has a positive response.
What is the MRC Grading score used for in COPD +
Explain the different grades?
Describes the degree of breathlessness in a COPD patient.
1 - Not troubled by breathlessness except on vigorous exertion
2 - SOB when hurrying/walking up a hill (inclines)
3 - Walks slower than most people on the level, Stops for a breath when walking at their own pace (15mins)
4 - Stops for a breath after walking about 100m (stops after a few mins walking on the level)
5 -Too breathless to leave the house or breathless while undressing.
A. Name 7 Causes for Respiratory Alkolosis
B. What would you expect to see on an ABG?
A - CNS Infection, SAH, Panic Attack, PE, Asprin OD, Anaemia, any cause of hypoxia [Mainly process through hyperventilation]
B - pH (UP), pCO2 (Down), HCO3 (Down if partial comp. or chronic)
Obstructive Airway Disease causes?
4 Marks
Asthma
COPD
Bronchiectasis
Cystic Fibrosis
Restrictive Airway Disease Causes?
7 Marks
Resp: IPF, ARDS, Pneumoconiosis
Neuro: Myasthenia gravis, MND
Thoracic: Obesity, Kyphosis
What do you expect to see on spirometry for?
A - Obstructive disease
B - Restrictive disease
A - FEV1 Lower 0.7, Both FEV1 + FVC decreased proportionally (Both Reduced) - <80% Predicted normal values.
Respiratory Failures
A- Types + Pathophysiology
B - ABG Results
C- Primary causes
A - Type 1 - Hypoxia Only, V/Q mismatch leading to volume of air passing in and out of the lungs smaller than blood perfusing the lungs
ABG - PaO2 <8kpa, pCO2 = Normal
Asthma, CCF, PE, Pneumonia, Pneumothorax.
High V/Q areas / Low V/Q Areas
B-Type 2 - Hypercapnia + Hypoxia, Alveolar Hypoventilation leading to being unable to clear enough CO2 out of the lungs leading to build up.
ABG - PaO2 <8kpa + pCO2 >6kpa
Obstructive lung diseases - COPD
Restrictive lung diseases - IFP
Respiratory Depression - Opiate OD
Neuromuscular disease - GBS, MND
Thoracic wall disease/trauma - Rib Fracture
Define Pulmonary Hypertension?
Increase in mean pulmonary arterial pressure >15mmhg.
Causes of Pulmonary Hypertension?
Hint - 3 Main Domains
Parenchymal lung disease - COPD, Chronic Asthma, Interstitial lung disease, Bronchiectasis, CF
Pulmonary vascular disease - PE, Portal HTN, Idiopathic pulmonary hypertension, Pulmonary vasculitis
Hypoventilation - Sleep apneoa, Kyphosis/scoliosis, MG
Left Heart Disease - Mitral stenosis, regurg, LV HF
Main clinical features of Pulmonary HTN + ECG findings?
SOB, Fatigue, Syncope
Signs - ++JVP, Parasternal heave, Loud P2, S3 sound, Pansystolic murmur (tricuspid regurg), end-diastolic murmur (pulmonary regurg)
ECG - P pulmonale, RVH, RAD
Management of Pulmonary HTN?
Treat underlying condition
Pulmonary vascular resistance reduction- LTOT, CCB (Nifedipine), Sildenafil, Endothelin receptor antagonists, (Bosentan), Prostacyclin analogues
Manage Heart Failure
Heart-lung transplant in extreme cases
Define Bilateral Hilar Lymphadenopathy?
Causes?
Bilateral enlargement of lymph nodes of pulmonary hila
Causes- Sarcoidosis, TB, Bronchial Ca, Lymphoma, Interstitial lung disease (Silicosis), Heart Failure, Mycoplasma
What are Contraindications for thrombolysis?
Active bleeding
Head injury within the last 3Weeks
Previous Haemorrhagic stroke
CNS Malignancy
Define Obstructive Sleep Apnea (OSA)?
Intermittent closure and collapse of the upper airway leading to apnoeic episodes during sleep.
What are the risk factors for OSA?
Obesity
Male
Smoker
Alcohol
IPF
Structural airway pathology - Anatomy (Micrognathia)
Neuromuscular disease - MND, etc…
What are the main causes of OSA?
Abnormal anatomy and lack of neuromuscular compensatory mechanisms.
Clinical Features and Investigations for OSA?
CF - Snoring, choking, gasping, apnoeic episodes, Morning headache, sleepiness (Somnolence)
IX - Polysomnography, SpO2 Overnight
Management of OSA?
CPAP via nasal mask during sleep
Weight loss
Smoking Cessation
Alcohol avoidance
Surgery to relieve pharyngeal obstruction - Tonsillectomy, Uvulopalatopharyngoplasty (Removes excess tissue in the throat to make the airway wider. )
Where are the most common origin sites for emboli that cause PE?
DVTs - Proximal Leg Veins / Illac Veins
Differentials for Haemoptysis?
Category causes - Vascular, Infective, Immunological, Malignant
PE, Pneumonia, TB, Bronchiectasis, Goodpastures, GPA, Lung Ca, Aspergilloma, Mitral stenosis, LRTI, Pulmonary Oedema
Define ARDS?
Acute respiratory distress syndrome
Non-cardiogenic pulmonary oedema and diffuse lung inflammation causing pulmonary vascular permeability and leakage.
Histologically - Diffuse alveolar damage + Hyaline membrane formation
What Causes ARDS?
Pulmonary Causes - Chest sepsis, aspiration, inhalation injury, pulmonary contusion, tranfusion-related lung injury
Non-Pulmonary - Non-pulmonary sepsis, acute pancreatitits, DIC, drug od
Signs and Symptoms of ARDS?
Dyspnoea
Tachypnoea
Retractions
Bilateral crackles
Hypoxemia - Not responding to supportive O2
Investigations ARDS?
ABG
PaO2/FiO2 ratio <300mmhg / <100 (Severe)
Or <40kpa(200)
CXR - Bilateral opacities/infiltrates
Management of ARDS?
Mechanical ventilation - 6ml/kg + High PEEP to achieve adequate oxygenation.
DVT prophylaxis
Nutritional support - enteral/parenteral
Regular repositioning - pressure ulcer prophylaxis, proning
Mean art. pressure - >60mmhg
Abx - If infection present
