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Conditions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is COPD?

A

Chronic Obstructive Pulmonary Disease - a disease characterised by airflow limitation that is not fully reversible

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2
Q

Name 2 diseases which are included within COPD.

A
  • Emphysema (pink puffers)
  • Chronic bronchitis (blue bloaters)
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3
Q

What happens in emphysema?

A

Alveolar destruction which leads to decreased elasticity of the lungs

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4
Q

What happens in chronic bronchitis?

A

Airway narrowing due to hypertrophy and hyperplasia of mucus secreting goblet cells

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5
Q

How is chronic bronchitis clinically defined?

A

A productive cough for at least 3 months a year, for at least 2 years

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6
Q

What is the main risk factor for COPD?

A

Smoking

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7
Q

What can increase the risk of early onset COPD?

A

Alpha-1 antitrypsin deficiency

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8
Q

What are the risk factors for COPD (5)?

A
  • Smoking
  • Alpha-1 antitrypsin deficiency
  • Increasing age
  • History of lung infections
  • Exposure to tobacco smoke, air pollution, dust, vapours, fumes, gas
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9
Q

Describe the presentation of COPD (3).

A
  • Productive cough
  • Shortness of breath
  • Barrel chest
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10
Q

What causes a barrel chest as seen in COPD?

A

In COPD, less air is expelled so there is a build-up of air within the lungs which causes hyperinflation of the lungs

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11
Q

Is clubbing seen in COPD?

A

No

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12
Q

How will COPD sound on percussion?

A

Hyper-resonant

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13
Q

How will COPD sound on auscultation (4)?

A
  • Distant breath sounds
  • Poor air movement
  • Inspiratory crackles
  • Expiratory wheeze
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14
Q

How is COPD diagnosed?

A

Spirometry

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15
Q

Which aspect of spirometry is used to monitor the progression of COPD?

A

FEV1

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16
Q

What is meant by airway obstruction (2)?

A

Blockage of the airway which makes it difficult to expel all of the air in the lungs
- FEV1/FVC < 0.7

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17
Q

Give examples of conditions which cause airway obstruction (5).

A
  • COPD
  • Asthma
  • Cystic fibrosis
  • Bronchiectasis
  • Bronchiolitis
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18
Q

What is meant by airway restriction (2)?

A

Decreased ability of the lungs to expand and fill with air
- FVC < 80% of predicted
- FEV1/FVC is normal

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19
Q

Give examples of conditions which cause airway restriction (5).

A
  • Pulmonary fibrosis
  • Pneumonia
  • Tuberculosis
  • Sarcoidosis
  • Asbestosis
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20
Q

What other investigations can be used in the diagnosis of COPD (3)?

A
  • Chest X-ray - exclude malignancies
  • FBC - exclude anaemia
  • ABG - for respiratory failure
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21
Q

What would a COPD chest X-ray show (3)?

A
  • Hyperinflation
  • Flattened diaphragm
  • Bullae - pockets of air
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22
Q

Describe the stages of COPD.

A
  • Mild - FEV1 above 80% of predicted
  • Moderate - FEV1 50 - 80% of predicted
  • Severe - FEV1 30 - 50% of predicted
  • Very severe - FEV1 less than 30% of predicted
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23
Q

What is the most useful management for COPD?

A

Smoking cessation

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24
Q

Describe the management of COPD.

A
  • 1st line - SABA/SAMA
  • Asthma features present - SABA/SAMA as required + LABA + ICS
  • Asthma features not present - SABA/SAMA as required + LABA + LAMA
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25
Q

How can an acute exacerbation of COPD be managed (6)?

A
  • ABG to determine the level of intervention required
  • Oxygen
  • Bronchodilators
  • Oral prednisolone
  • CPAP before intubation and ventilation
  • Antibiotics for infective causes
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26
Q

Name 2 organisms which can cause infective exacerbations of COPD. Which is most common?

A
  • Haemophilus influenzae - most common
  • Streptococcus pneumoniae
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27
Q

What prophylactic antibiotic can be used for COPD?

A

Azithromycin

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28
Q

How many cigarettes are in 1 pack?

A

20 cigarettes

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29
Q

Describe the MRC scale for shortness of breath.

A
  • Grade 1 - SOB with strenuous exercise
  • Grade 2 - SOB when hurrying or walking uphill
  • Grade 3 - walks slower for people their age, stops for breath when walking on flat land
  • Grade 4 - SOB after walking 100m on flat land
  • Grade 5 - too SOB to leave the house, SOB doing day-to-day activities e,g changing clothes
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30
Q

How can COPD and asthma be differentiated?

A
  • COPD - irreversible airway obstruction
  • Asthma - reversible airway obstruction, symptoms improve with treatment e.g salbutamol
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31
Q

What type of reaction is asthma?

A

Type 1 hypersensitivity reaction

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32
Q

What can trigger asthma (7)?

A
  • Air pollution
  • Animals
  • Infection
  • Dust
  • Damp/cold
  • Exercise
  • Strong emotions
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33
Q

Describe the presentation of asthma (6).

A
  • Personal/family history of atopic triad
  • Episodic symptoms
  • Diurnal variation - symptoms worse early morning or at night
  • Dry cough
  • Shortness of breath
  • Chest tightness
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34
Q

What makes up the atopic triad?

A
  • Asthma
  • Hay fever
  • Eczema
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35
Q

How is asthma diagnosed?

A

Spirometry

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36
Q

How is asthma monitored?

A

Peak expiratory flow (PEF)

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37
Q

How can asthma be managed non-pharmacologically (5)?

A
  • Avoid contact with triggers
  • Yearly asthma review
  • Yearly flu jab
  • Advise exercise
  • Avoid smoking
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38
Q

How can asthma be managed pharamcologically (4)? Give examples.

A
  • SABA e.g salbutamol
  • ICS e.g mometasone, budesonide
  • Leukotrine receptor antagonists e.g montelukast
  • LABA e.g salmeterol
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39
Q

In asthma management, what should be done before increasing the dose of a drug or adding a new drug?

A

Check inhaler technique and adherence

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40
Q

Describe the long-term management of asthma in adults.

A

1) SABA
2) SABA + ICS
3) SABA + ICS + LTRA
4) SABA + ICS + LABA (stop LTRA)

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41
Q

How can an acute asthma attack be managed?

A

OSHIT:
- Oxygen
- Salbutamol nebulised
- IV hydrocortisone or oral prednisolone
- Ipratropium bromide nebulised
- Theophylline

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42
Q

What is a life-threatening complication of severe asthma?

A

Cardiac arrest

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43
Q

What are 3 causes of narrowing in asthma?

A
  • Increased mucus production
  • Bronchoconstriction - smooth muscle contraction
  • Inflammation of the mucosa
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44
Q

Name 2 side effects of salbutamol.

A
  • Tachycardia
  • Tremor
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45
Q

Name 2 side effects of ICS.

A
  • Oral candida
  • Stunted growth in children
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46
Q

What can be used to treat very severe asthma exacerbations?

A

Magnesium sulfate

47
Q

What are the indicators of good asthma control (4)?

A
  • No breathing difficulties, cough or wheeze on most days
  • No night time symptoms
  • Inhaler used no more than 3 times a week
  • Able to exercise without symptoms
48
Q

What are the signs of life-threatening asthma (6)?

A
  • Silent chest
  • Altered consciousness
  • Exhaustion
  • Cyanosis
  • SpO2 < 92%
  • PEFR < 33% predicted
49
Q

What is TB?

A

An infectious disease caused by mycobacterium tuberculosis

50
Q

How does mycobacterium tuberculosis need to be stained?

A

Zeihl-Neelsen staining:
- Turns bright red against a blue background

51
Q

What type of bacteria is mycobacterium tuberculosis?

A

Acid-fast bacilli

52
Q

Who is at greater risk of TB (5)?

A
  • Known contact with someone who has TB
  • Immigrants from areas with high rates of TB
  • Immunosuppression
  • Homeless people
  • IVDU
53
Q

Describe the presentation of TB (6).

A
  • Recent travel
  • Chronic, gradually worsening symptoms
  • Cough - initially dry, later productive
  • Fever
  • Night sweats
  • Weight loss
54
Q

Where does a TB infection most commonly occur?

A

Lungs

55
Q

Name a pathological hallmark of TB.

A

Caseating granulomas - immune cells encapsulate bacteria to try and contain it

56
Q

What is active TB?

A

Active TB infection within the body

57
Q

What is latent TB?

A

Immune system encapsulates sites of infection to stop the progression of the disease:
- Has TB bacteria
- No symptoms
- Not infectious

58
Q

What is secondary TB?

A

Latent TB reactivates, usually after being immunocompromised

59
Q

What is miliary TB?

A

Immune system is unable to control the infection resulting in severe disease

60
Q

What can be seen on X-ray in miliary TB?

A

Millet seeds

61
Q

Which vaccine can be given to those at increased risk of TB?

A

BCG vaccine - can only be given if Mantoux negative

62
Q

What is used to look for latent TB (2)?

A

1st line - Mantoux test (tuberculin sensitivity test)
Confirmation - interferon gamma release assays (IGRA)

63
Q

What type of reaction is involved in the Mantoux test?

A

Type 4 hypersensitivity reaction

64
Q

What is the 1st line investigation for TB (3)?

A

Chest X-ray:
- Ghon complexes
- Hilar lymphadenopathy
- Patchy consolidation

65
Q

What is the gold standard investigation for TB?

A

Nucleic acid amplification testing (NAAT)

66
Q

Who should be notified in all cases of TB?

A

Public Health England - it is a notifiable disease

67
Q

How is latent TB managed?

A
  • Isoniazid and rifampicin - 3 months
  • Isoniazid - 6 months
    (Treatment needed due to risk of reactivation)
68
Q

How is active TB managed?

A

RIPE:
- Rifampicin - 6 months
- Isoniazid - 6 months
- Pyrazinamide - 2 months
- Ethambutol - 2 months

69
Q

Which of the TB drugs are hepatotoxic?

A

RIP

70
Q

What should patients be prescribed alongside RIPE in the treatment of TB?

A

Pyridoxine (vitamin B6) - isoniazid can cause peripheral neuropathy

71
Q

What is a side effect of rifampicin?

A

Red/orange discolouration of urine and tears

72
Q

What is a side effect of isoniazid?

A

Peripheral neuropathy (I am so numb)

73
Q

What is a side effect of pyrazinamide?

A

Gout

74
Q

What is a side effect of ethambutol?

A

Eyes - colour blindness, reduced visual acuity

75
Q

What is cystic fibrosis?

A

An autosomal recessive genetic condition which affects the mucus glands

76
Q

What causes cystic fibrosis?

A

Genetic mutation in the CFTR gene on chromosome 7, this affects the chloride channels

77
Q

What is the most common variation of the mutation that causes cystic fibrosis?

A

Delta-F508 (deletion)

78
Q

How can cystic fibrosis affect the pancreas?

A

Thick pancreatic secretions can block the ducts, resulting in insufficient enzymes reaching the digestive tract

79
Q

How can cystic fibrosis affect the airways?

A

Thick airway secretions can result in reduced airway clearance and increased susceptibility to bacterial infections

80
Q

How can cystic fibrosis affect the reproductive system?

A

Congenital bilateral absence of the vas deferens meaning healthy sperm cannot be ejaculated, resulting in infertility

81
Q

Describe the presentation of cystic fibrosis.

A

CF PANCREAS:
- Chronic cough
- Failure to thrive
- Pancreatic insufficiency - steatorrhea, varocious appetite due to malabsorption
- A
- Nasal polyps, neonatal intestinal obstruction e.g meconium ileus
- Clubbing of fingers
- Recurrent respiratory tract infections
- Electrolytes - salty skin when kissed
- Absence of vas deferens
- Sputum

82
Q

How can cystic fibrosis be diagnosed shortly after birth?

A

Newborn blood spot test:
- Looks for pancreatic enzyme IRT which is released into blood in response to pancreatic damage

83
Q

What is the gold standard investigation for cystic fibrosis?

A

Sweat test

84
Q

Name 2 bacteria which can cause pneumonia in those with cystic fibrosis.

A
  • Staphylococcus aureus
  • Pseudomonas aeruginosa
85
Q

How can cystic fibrosis be managed (6)?

A
  • Chest physiotherapy - clear mucus to reduce the chance of infection
  • Exercise
  • High calorie diet - for malabsorption
  • CREON tablets - help digest fats
  • Dornase alpha - breaks down DNA to thin respiratory secretions
  • Bronchodilators
86
Q

What are the 2 different types of pneumonia?

A
  • Community acquired pneumonia (CAP)
  • Hospital acquired pneumonia (HAP)
87
Q

What is community acquired pneumonia?

A

Pneumonia which develops outside of hospital or less than 48 hours after hospital admission

88
Q

What is hospital acquired pneumonia?

A

Pneumonia which develops more than 48 hours after hospital admission

89
Q

What are the 2 commonest causes of community acquired pneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilius influenzae
90
Q

What is the commonest cause of hospital acquired pneumonia?

A

E. coli

91
Q

What can cause pneumonia in HIV/immunocompromised patients?

A

Pneumocystis jiroveci (fungus)

92
Q

How is pneumocystis jiroveci treated?

A

Co-trimoxazole

93
Q

Name 3 causes of atypical pneumonia.

A
  • Legionella pneomophilia
  • Mycoplasma pneumoniae
  • Chlamydophilia pneumoniae
94
Q

What is the 1st line treatment for atypical pneumonia?

A

Marcolides e.g azizthromycin, clarithromycin

95
Q

What is the likely cause of pneumonia in alcohol-dependent patients?

A

Klebsiella pneumoniae

96
Q

What is a key feature of klebsiella pneumoniae?

A

Red-current jelly sputum

97
Q

What causes Legionnaires disease?

A

Legionella pneumophilia - unclean air-conditioning units in Spain

98
Q

Which part of the lung is aspiration pneumonia most likely to affect? Why?

A

Right middle/lower lobe due to gravity

99
Q

Describe the presentation of pneumonia (6).

A
  • Fever
  • Fatigue
  • Shortness of breath
  • Productive cough
  • Haemoptysis
  • Pleuritic chest pain - sharp chest pain worse on inspiration
100
Q

How would pneumonia sound on percussion? Why?

A

Dull due to consolidation

101
Q

What is the scoring system used for pneumonia?

A

CURB-65

102
Q

Explain the components of CURB-65.

A

C - confusion
U - urea > 7
R - respiratory rate > 30
B - blood pressure < 90/60
65 - aged > 65

103
Q

What investigations can be done to diagnose pneumonia?

A
  • Oxygen sats
  • CRP
  • Chest X-ray
104
Q

What is done for a CURB-65 score of 0-1?

A

5 days of oral amoxicillin (macrolide for penicillin allergy)

105
Q

What is done for a CURB-65 score of 2?

A

7-10 days of oral/IV amoxicillin and clarithromycin

106
Q

What is done for a CURB-65 score of 3+?

A

IV co-amoxiclav and clarithromycin

107
Q

What is bronchiectasis?

A

Permanent dilation of the bronchi due to destruction of the elastic and muscular components of the bronchial wall, often due to recurrent/severe respiratory tract infections

108
Q

What are risk factors for bronchiectasis?

A

PAC CHAIRS:
- Prior childhood respiratory infections
- Allergy to aspergillus fumigatus
- Ciliary dyskinesia
- Cystic fibrosis
- HIV
- Alpha-1 antitrypsin deficiency
- IBD
- Rheumatoid arthritis
- Sjogrens syndrome

109
Q

Describe the presentation of bronchiectasis (6).

A
  • Productive cough - large amounts of foul-smelling and khaki coloured sputum
  • Haemoptysis
  • Fever
  • Chest pain
  • Shortness of breath
  • Finger clubbing
110
Q

How is bronchiectasis diagnosed?

A

Chest CT - signet ring sign

111
Q

How can the causative pathogen of bronchiectasis be identified?

A

Sputum culture

112
Q

What are the most common causes of bronchiectasis (2)?

A
  • Pseudomonas aeruginosa
  • Haemophilus influenzae
113
Q

What is a pleural effusion?

A

Build-up of fluid within the pleural cavity

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