Respiratory Flashcards
What is COPD?
Non-reversible, long-term deterioration in air flow through the lungs caused by damage to lung tissue.
Explain the pathophysiology of COPD.
Damage to lung tissue causes air flow obstruction, making it difficult to ventilate the airways and making them more prone to developing infections.
What are the types of COPD?
Chronic bronchitis and emphysema.
-Also A1AT deficiency.
Explain the dyspnoea scale.
1 - Breathless of strenuous exercise.
2 - Breathless walking up hill.
3 - Breathless on flat land.
4 - Stop to catch breath after walking 100m on flat land.
5 - Unable to leave house due to breathlessness.
What are two risk factors for COPD?
Smoking and air pollution.
Describe the pathophysiology of chronic bronchitis.
Hypertrophy and hyperplasia of mucous glands, chronic inflammation cells infiltrate bronchi.
Describe the pathophysiology of emphysema.
Destruction of elastin layers in ducts, alveoli and respiratory bronchioles.
-Air is trapped distal to blockage, causing bullae.
Describe the pathophysiology of A1AT deficiency.
Autosomal dominant inheritance - no smoking history.
-A1AT usually degrades NE which protects elastin, no A1AT means no NE is active and elastin is damaged.
How does COPD present?
Older patient with chronic productive cough (sputum) and SOB.
-Wheezing and recurrent respiratory infections.
Which investigations are used for COPD? What are the results?
Spirometry - Obstructive (FEV1/FVC < 0.7).
Test for reversibility with b2 agonists:
-Large response - Asthma.
-Small/no response - COPD.
CXR and TLCO.
What is the long term management of COPD? (3 lines).
Smoking cessation and flu/pneumonia vaccines.
1st line - SAB2A (salbutamol) or SAMA (ipratropium bromide).
2nd line - SAB2A, LAB2A and LAM3A.
3rd line - SAB2A, LAB2A, LAM3A, ICS.
How is severe COPD managed?
Long term oxygen therapy.
What usually causes exacerbation of COPD?
Viral or bacterial infections.
How is COPD exacerbation managed at home?
Prednisolone, inhalers/nebulisers and antibiotics if evidence of infection.
How is COPD exacerbation managed in hospital?
Nebulised bronchodilators, steroids, antibiotics and ventilation.
What is asthma?
Chronic inflammatory condition of the airways that causes episodic exacerbations of bronchoconstriction.
Explain the pathophysiology of asthma.
Reversible airway obstruction that typically responds to bronchodilators (salbutamol).
-Bronchoconstriction causes an obstruction of airflow in the lungs.
What is the atopic triad?
Atopic rhinitis, asthma and eczema.
What are four risk factors for asthma?
History of atopy, low birth weight, not breastfed and exposure to allergens.
What are the types of asthma?
Allergic and non-allergic.
-Allergic - IgE mediated T1 hypersensitivity due to environmental trigger.
-Non-allergic - Non IgE mediated, usually due to smoking.
What are eight triggers for asthma?
Infections, early night/late night, exercise, animals, cold, dust, strong emotions and drugs (beta-blockers).
How does asthma typically present?
Episodic symptoms of dry cough, wheeze (bilateral widespread polyphonic) and SOB that is usually worse at night.
-Young patient with history and family history of atopy.
What are the investigations for asthma?
FeNO - Increased conc, in breath means inflammation.
Spirometry with bronchodilator reversibility.
Reduced FEV1, normal FVC. FEV1/FVC < 0.7.
What is the acute management of asthma?
Oxygen. salbutamol, ipratropium bromide, IV hydrocortisone, IV MgSO4.
Describe the long term management of asthma. (5 lines).
1st line - SAB2A.
2nd line - SAB2A and ICS.
3rd line - SAB2A, ICS and LTRA.
4th line - SAB2A, ICS, LTRA and LAB2A.
5th line - Increase ICS dose.
Explain the drugs used in asthma.
-SAB2A - Short acting beta-2 agonists (salbutamol): Used as a reliever - cause bronchodilation.
-ICS - Inhaled corticosteroids (beclomethasone): Reduce inflammation in airways - preventer.
-LTRA - Leukotriene receptor antagonists (montelukast): Block leukotrienes which cause inflammation and bronchoconstriction.
-LAB2A - Long acting beta-2 agonists (salmeterol): Same as SAB2As but longer action.
-LAMA -long acting antimuscarinics (tiotropium): Block Ach receptors - bronchodilation.
What is pneumonia?
Infection of the lung tissue which causes inflammation and sputum which fill the airways and alveoli.
How does pneumonia appear on XRAY?
Consolidation.
How is pneumonia classified?
Community (CAP) - Outside of hospital.
Hospital (HAP) - 48h after hospital admission.
Aspiration - As a result of aspirating foreign material like food.
What are five risk factors for developing pneumonia?
Immunocompromised, IVDU, pre-existing respiratory disease, very young/old.
What is the cause of pneumonia?
Typically can bacterial but can also be viral and fungal.
-Flu virus.
-PCP - P, jirovecci (aids defining illness).
What are the organisms that cause CAP? What is the most common? Which are atypical?
S. pnuemoniae (mc), H. influenzae.
-Mycoplasma pnuemoniae and legionella - atypical pneumonia.
What are the organisms that cause HAP?
Pseudomonas, E.coli, klebsiella and MRSA.
What is atypical pnuemonia?
Pneumonia caused by an organism that cannot be cultured in the normal way or detected using a gram stain.
-Don’t respond to penicillin so treated with macrolides (e.g. clarithromycin), fluoroquinolones (e.g. levofloxacin) or tetracyclines (e.g. doxycycline).
How does pneumonia present?
Productive cough (sputum) with SOB and fever.
-Pleuritic chest pain and haemoptysis.
-Sepsis.
How does atypical pneumonia present?
Dry cough and low grade fever.
What are six signs of pneumonia?
Tachypnoea, tachycardia, hypoxia, hypotension, fever, confusion.
What is the first line investigation of pneumonia?
CXR with consolidation.
What are other investigations for pneumonia?
Bloods - FBC which shows raised WCC. Raised CRP.
What are investigations for severe pneumonia?
Sputum sample and blood culutres.
How is pneumonia severity assessed?
CURB65:
-Confusion.
-Urea > 7.
RR > 30.
BP <90/60 mmHg.
65+ years old.
Why is pneumonia severity assesssed?
Predictor of mortality and guides treatment - home, hospital or ICU.
What is the management for pneumonia?
Analgesia for pain.
Broad spectrum antibiotics - dependent on bacteria and severity.
How is CAP treated?
CURB 0-2 - Amoxicillin.
CURB 3-5 - Co-amoxiclav and clarythromycin.
How is HAP treated?
IV co-amoxiclav and gentamicin.
What are five complications of pneumonia?
Sepsis, pleural effusion, empyema, lung abscesses and death.
What is tuberculosis?
Infectious granulomatous creating disease caused by the mycobacterium tuberculosis bacteria.
How is TB spread?
Airborne.
Is TB common in the UK?
No, more prevalent in non-UK born patients who are immunocompromised.
Where is TB common in the world?
South Asia and Sub-Saharan Africa.
What are four risk factors for TB?
Country/travel, immunocompromised, homeless/crowded housing, IVDU.
What is the difference between active and latent TB?
Active - Active infection in various areas of the body.
Latent - Infection is confined to granulomas but is still alive.
What is secondary TB?
When latent TB reactivates into active infection.
How is TB stained?
Stained via Zeihl-Neelsen stain to bright red due to acid-fastness (resistant to acids in staining procedure).
What is the presentation of latent TB?
Asymptomatic.
What is miliary TB?
When the immune system is unable to control the disease.
What is extrapulmonary TB?
When the TB spreads to other areas.
How does TB usually present?
Fever and night sweats, lethargy, weight loss, cough, haemoptysis.
What are the investigations for TB?
3 sputum cultures with positive Zeihl-Neelsen stains.
-Mantoux test = looks for previous immune response to TB.
CXR.
Describe the Mantoux test.
Tests for previous immune response to TB.
-Tuberculin injected into skin, the bleb is measured and if it is bigger than 5mm it is positive.
-Then test for active disease.
What is the management of latent TB?
Isoniazid and rifampicin for 3 months. OR:
Isoniazid for 6 months.
What is the management of active TB?
RIPE:
-Rifampicin for 6 months.
-Isoniazid for 6 months.
-Pyrazinamide for 2 months.
-Ethambutol for 2 months.
What are the side effects of active TB treatment?
Rifampicin - Red/orange urine and tears.
Isoniazid - Peripheral neuropathy.
Pyrazinamide - Hepatitis and gout (hyperuricaemia).
Ethambutol - Colour blindness and reduce visual acuity.
-All cause hepatotoxicity.
What is cystic fibrosis?
An autosomal recessive condition affecting the mucous glands.
Describe the genetics of cystic fibrosis.
Mutation on chromosome 7 in the CFTR gene.
-Autosomal recessive inheritance.
Describe the epidemiology of cystic fibrosis.
1 in 25 are carriers, 1 in 2500 children have it.
What is the prognosis for cystic fibrosis?
Median life expectancy is 47y.
90% develop pancreatic insufficiency.
50% develop diabetes.
30% develop liver disease.
What are two risk factors for cystic fibrosis?
Family history and white.