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Conditions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

CAP: Pathophysiology (3)

A
  1. Infection causes inflammation of the lung
  2. Fluid and blood cells leak into alveoli
  3. Infection spreads leading to consolidation
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2
Q

CAP: Mortality rate

A

12%

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3
Q

CAP: Three most causative common organisms (3)

A
  1. Streptococcus pneumonia
  2. Haemophilus Influenza
  3. Mycoplasma pneumonia
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4
Q

CAP: Pulmonary Symptoms (5)

A
  1. Cough
  2. SOB
  3. Purulent Sputum
  4. Pleuritic Chest pain
  5. Haemoptysis
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5
Q

CAP: Systemic Symptoms (3)

A
  1. Fever
  2. Malaise
  3. Rigors
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6
Q

CAP: Extrapulmonary Symptoms (3)

A
  1. Confusion
  2. Abdominal pain
  3. GI upset
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7
Q

CAP: Pulmonary Signs (5)

A
  1. Dull percussion
  2. Increased vocal resonance/fremitus
  3. Coarse inspiratory crackles
  4. Reduced Expansion
  5. Bronchial breathing
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8
Q

CAP: Systemic features (4)

A
  1. Tachypnoea
  2. Tachycardia
  3. Hypotension
  4. Cyanosis
  5. Pyrexia
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9
Q

Hospital-acquired pneumonia: Definition (2)

A

LTRI, 48 Hours after hospital admission

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10
Q

Hospital-acquired pneumonia: Causative organisms (3)

A
  1. Pseudomonas aerguinosa
  2. Staphylococcal aureus
  3. Enterobacteria
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11
Q

Aspiration pneumonia: Definition (2)

A
  1. Patients with unsafe swallow
  2. Right lung typically affected as right bronchus is wider
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12
Q

Staphylococcal pneumonia: Key features (2)

A
  1. Bilateral, cavitating bronchopneumonia
  2. Occurs in compromised immune systems - elderly, IV users, Influenza infections
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13
Q

Klebsiella pneumonia: Key features (4)

A
  1. Upper lobes affected
  2. Cavitating
  3. ‘Red-current sputum’
  4. Compromised immune systems
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14
Q

Mycoplasma pneumonia: Key features (3)

A
  1. Flu-like symptoms
  2. Younger patients
  3. Auto-immune features (auto-immune anaemia)
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15
Q

Legionella pneumonia: Key features (3)

A
  1. Flu-like symptoms, SOB, dry cough
  2. Associated with legionnaire’s disease
  3. Hyponatraemia and abnormal LFTs
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16
Q

Chlamydophila psittaci pneumonia: Key Features (3)

A
  1. Psittacosis
  2. Acquired from infected birds
  3. Also infects liver, spleen, kidneys and heart
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17
Q

Penumocystis pneumonia: Key features (2)

A
  1. Occurs in immunosuppressed or HIV positive
  2. Caused by jiroveci (fungus)
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18
Q

CAP: CXR findings (4)

A
  1. Consolidation
  2. Signs of pleural effusion
  3. Cavitation
  4. Loss of heart border
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19
Q

CAP: Investigations (4)

A
  1. Blood cultures
  2. Suptum culture
  3. Urine antigen test (pneumococcal, legionella)
  4. PCR (mycoplasma)
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20
Q

CAP: CURB-65 classification score

A

C - confusion
U - Urea (>7)
R - Respiratory Rate (>30)
B - Blood pressure (<90/<60)
65 - Age > 65 years

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21
Q

CAP: Interpretation of CURB-65 score (4)

A

0-5 score indicating mortality
0-1 Home treatment
2 Consider hospital treatment
3-5 ITU

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22
Q

CAP: Useful biomarkers

A

CRP - if drops by day 3 prognosis is good

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23
Q

CAP: Mild antibiotics (1)

A

Oral/IV amoxicilin

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24
Q

CAP: Moderate antibiotics (2)

A

Oral/IV Amoxicillin and clarithromycin

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25
Q

CAP: Severe antibiotics (2)

A

IV Co-amoxiclav and IV Clarithromycin

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26
Q

CAP: Non-pharmacological management (4)

A
  1. O2
  2. Fluid resuscitation
  3. Analgesia
  4. Chest drain (Empyema)
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27
Q

CAP: Prevention (1)

A

Pneumococcal vaccine (>65, AIDS, chronic conditions)

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28
Q

CAP: Complications (2)

A
  1. Parapneumonic pleural effusion
  2. Empyema (pus in pleural cavity)
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29
Q

CAP: Management of empyema

A
  1. Antibiotics according to culture sensitivity
  2. Chest drain
  3. Supportive care (O2)
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30
Q

Pneumothorax: Definition

A

Air within pleural space

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31
Q

Pneumothorax: Primary Pneumothorax definition

A

No clear cause or underlying lung pathology

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32
Q

Pneumothorax: Secondary Pneumothorax Definition

A

Occurs dye to lung pathology such as COPD, asthma, TB, CF etc.

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33
Q

Pneumothorax: Tension Pneumothorax Definiton (2)

A

Breach in lung surface - pressure buildup around lung - one-wave valve wherein air cannot leave during expiration.
Can be fatal by leading to obstructive shock (ipsilateral lung collapses, mediastinal shift and SVCO)

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34
Q

Pneumothorax: Traumatic Pneumothorax Definition

A

Iatrogenic or non-iatrogenic trauma to the lungs causes pneumothorax

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35
Q

Spontaneous pneumothorax: Aetiology

A
  1. Primary (no lung pathology, tall, thin man)
  2. Secondary (lung pathology - connective tissue, obstruction, infection, malignancy)
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36
Q

Traumatic pneumothorax: Aetiology

A
  1. Iatrogenic - central line, CPAP, pacemaker, CT guided biopsy
  2. Non-iatrogenic - penetrating or blunt trauma
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37
Q

Pneumothorax: Epidemiology (2)

A
  • Typically young, tall, thin men
  • Smoking increases risk for men by causing apical blebs to form
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38
Q

Pneumothorax: Pathophysiology (2)

A
  1. Sub-pleural bleb rupture - intra pleural pressure becomes equal to atmospheric
  2. One-way valve created - air enters, but can’t leave - intrapleural pressure is greater than atmospheric
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39
Q

Pneumothorax: Symptoms (3)

A
  1. Sudden onset SOB
  2. Pleuritic chest pain
  3. Might have cough
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40
Q

Pneumothorax: Signs (5)

A
  1. Tachypnoea
  2. Reduced lung expansion
  3. Hyper-resonant percussion
  4. Reduced or absent breath sounds
  5. Reduced vocal resonance
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41
Q

Tension pneumothorax: Specific signs (3)

A
  1. Haemodynamic compromise
  2. Tracheal deviation contra-laterally
  3. Mediastinal shift
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42
Q

Pneumothorax: CXR findings

A
  1. Lung edge is visible
  2. Loss of lung markings
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43
Q

Pneumothorax: Emergency management

A
  1. ABCDE
  2. Decompression with 16-gauge cannula at second intercostal space, mid-clavicular line
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44
Q

Primary Pneumothorax: Management (2)

A
  1. No SOB, <2cm, conservative management
  2. SOB or >2cm, Aspiration with 12-18G cannula under local anaesthetic (CD if fails)
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45
Q

Secondary Pneumothorax: Management

A
  1. No SOB, <1cm, admit and observe
  2. No SOB, 1-2cm, CXR aspiration
  3. SOB, >2cm intercostal chest drain
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46
Q

Pneumothorax: Working drain

A

Swinging and bubbling

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47
Q

Pneumothorax: Management where chest drain unsuccessful

A

Video-assisted thoracoscopic surgery (VATS)

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48
Q

Pneumothorax: After-care

A
  1. No scuba-diving
  2. No flying
  3. No heavy lifting
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49
Q

Pneumothorax: Complications

A

Surgical emphysema (air leaks out of chest drain and accumulates under skin)

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50
Q

Pleural Effusion: Definition

A

Fluid in pleural space

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51
Q

Pleural Effusion: Haemothorax definition

A

Blood in pleural space

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52
Q

Pleural Effusion: Empyema definition

A

Pus in pleural space

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53
Q

Pleural Effusion: Haemopneumothorax

A

Blood and air in pleural space

54
Q

Pleural Effusion: Transudate vs Exudate biochemistry

A

Transudate protein is <25 g/L, exudate chemistry is >35gL of protein

55
Q

Pleural Effusion: Causes of transudate (3)

A

Non-infective causes of increase fluid volume:
- Increased venous pressure (Cardiac failure, fluid overload)
- Hypoproteinaemia (Cirrhosis, nephrotic syndrome)
- Hypothyroidism

56
Q

Pleural Effusion: Causes of exudate

A

Increased leakiness of pleural capillaries due to:
- Infection (pneumonia)
- Inflammation (Rheumatoid Arthritis)
- Malignancy (carcinoma, metastasis)`

57
Q

Pleural Effusion: Symptoms (3)

A

Asymptomatic
OR
Pleuritic chest pain
SOB

58
Q

Pleural Effusion: 3 key signs

A
  1. Decreased expansion
  2. Stony dull percussion note
  3. Diminished breath sounds
    Also look for signs of aspiration or other cause
59
Q

Pleural Effusion: Sign found above the effusion

A

Bronchial breathing

60
Q

Pleural Effusion: Sign found in case of a big effusion

A

Tracheal deviation to the other side

61
Q

Pleural Effusion: CXR finding (small and large)

A
  1. Small: blunts costophrenic angle
  2. Large: water-dense shadow with concave (meniscus upper borders)
62
Q

Pleural Effusion: What does a flat upper border on CXR mean?

A

There is a pneumothorax

63
Q

Pleural Effusion: 4 key tests

A
  1. CXR
  2. Ultrasound
  3. Diagnostic aspiration
  4. Biopsy
64
Q

Pleural Effusion: Use of an ultrasound

A

Identifies fluid and can guide aspiration

65
Q

Pleural Effusion: What to send aspirate to the lab for? (4)

A

Cytology
Clinical chemistry (protein, glucose etc.)
Bacteriology
Immunology (if indicated)

66
Q

Pleural Effusion: 3 steps of management

A
  1. Drainage if symptomatic or empyema
  2. Pleurodesis for symptomatic or malignant effusions
  3. Surgery for persistent collections and increasing pleural thickness
67
Q

Pleural Effusion: Clear, straw-coloured (2)

A

Transudate, Exudate

68
Q

Pleural Effusion: Turbid, yellow (2)

A

Empyema, parapneumonic effusion

69
Q

Pleural Effusion: Haemorrhagic (3)

A

Trauma, malignancy, pulmonary infarction

70
Q

Pleural Effusion: (3)
Glucose (<3.3)
pH (<7.2)
LDH (pleural:serum plasma (>0.6)

A
  1. Empyema
  2. Malignancy
  3. TB
71
Q

COPD: Definition

A

COPD is a common progressive disorder characterised by airway obstruction

72
Q

COPD: FEV1 and FVC diagnostic values (3)

A

FEV1 <80%, FEV1/FVC <0.7 with little or no reversibility

73
Q

COPD: 4 things distinguishing COPD from asthma

A
  1. Age of onset, COPD >35
  2. Smoking or pollution related
  3. Sputum production
  4. Minimal diurnal or day to day FEV1 variation
74
Q

COPD: Chronic bronchitis clinical definiton

A

Sputum production on most days for 3 months of 2 successive years

75
Q

COPD: Emphysema histological definition

A

Enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

76
Q

COPD: Prevalence

A

10-20% of adults over 40

77
Q

COPD: Symptomatic presentation of chronic bronchitis (4)

A

Blue bloaters:
1. Patients may be obese
2. Frequent cough and sputum production
3. Accessory muscle use, not breathless
4. Rhonchi and wheeze

78
Q

COPD: Clinical signs of chronic bronchitis (4)

A

Blue bloaters
1. Decreased alveolar ventilation - low O2, High CO2
2. Cyanosis
3. May develop Cor pulmonate
4. Respiratory centres insensitive to CO2

79
Q

COPD : Symptoms of emphysema (Pink puffer) (3)

A

Pink Puffers
1. Very thin with a barrel chest
2. Little or no cough
3. Breathing assisted by pursed lips, accessory muscles, tripod sitting position

80
Q

COPD: Pink Puffer/ Emphysema signs on examination (2)

A
  1. Hyperresonant chest
  2. Wheeze
81
Q

COPD: Emphysema clinical signs (3)

A

Pink Puffer
1. Breathless but not cyanosed
2. Increased alveolar ventilation, near normal O2, and normal or low CO2
3. May progress to type 1 respiratory failure

82
Q

COPD: 4 key general symptoms

A
  1. Wheeze
  2. Dyspnoea
  3. Cough
  4. Sputum production
83
Q

COPD: Signs on examination (5)

A
  1. Hyperinflation
  2. Decreased cricosternal distance
  3. Decreased expansion
  4. Resonant or hyper-resonant percussion note
  5. Quiet breath sounds
84
Q

COPD: MRC dyspnoea scale (5)

A

Grade 1 – Breathless on strenuous exercise
Grade 2 – Breathless on walking up hill
Grade 3 – Breathless that slows walking on the flat
Grade 4 – Stop to catch their breath after walking 100 meters on the flat
Grade 5 – Unable to leave the house due to breathlessness

85
Q

COPD: GOLD 4 stages of COPD

A

Stage 1: FEV1 >80% of predicted
Stage 2: FEV1 50-79% of predicted
Stage 3: FEV1 30-49% of predicted
Stage 4: FEV1 <30% of predicted

86
Q

COPD: 4 key complications of COPD

A
  1. Acute exacerbations
  2. Polycythaemia
  3. Cor pulmonale
  4. Respiratory failure
87
Q

COPD: What does FBC show?

A

Raised PCV is response to chronic hypoxia

88
Q

COPD: 5 Key tests

A
  1. FBC
  2. CT
  3. ECG
  4. ABG
  5. Spirometry
89
Q

COPD: CXR findings (4)

A
  1. Hyperinflation
  2. Flat hemidiaphragms
  3. Large central pulmonary arteries
  4. Decreased peripheral markings
90
Q

COPD: CT findings

A
  1. Bronchial wall thickening
  2. Scarring
  3. Air space enlargement
91
Q

COPD: ABG findings

A

Decreased CO2, Hypercapnia

92
Q

COPD: Spirometry findings

A

Obstructive and air trapping
(FEV1 <80%, FEV1:FVC ratio <70%, Increased TLC, Decreased DLCO)

93
Q

COPD: Chronic COPD management if FEV1 >50% (3)

A
  1. SABA + SAMA
  2. LABA + LAMA or LABA + ICS (if asthmatic features)
  3. LAMA + LABA + ICS
94
Q

COPD: Acute COPD exacerbation treatment (4)

A
  1. SABA + LABA (Salbutamol + Ipratropium)
  2. Give oxygen
  3. Steroids (IV hydrocortisone, prednisolone)
  4. Antibiotics
95
Q

COPD: Acute COPD exacerbation - stages of treatment if no response (4)

A
  1. IV aminophylline
  2. NIPPV if RR >30 or PCO2 rising despite treatment
  3. Doxapram
  4. Intubation and ventilation
96
Q

Acute COPD exacerbation: Presentation

A

Increasing cough
Breathlessness
Wheeze
Decreased exercise capacity

97
Q

Acute COPD exacerbation: Investigations

A
  1. ABG
  2. CXR (Pneumothorax and infection)
  3. FBC
  4. ECG
  5. Sputum culture
98
Q

COPD: Treatment by GOLD category

A

A: Bronchodilator
B: LAMA + LABA
C: LAMA then LAMA+LABA or LABA + ICS (if asthma)
D: LAMA + (LABA + ICS)

99
Q

Pulmonary Embolism: Pathophysiology

A

Venous thrombus forms in pelvis and/or legs - clots break off and pass through veins and right side of the heart - these lodge in the pulmonary circulation - this blocks flow to lungs, and strain right side of hear

100
Q

Pulmonary Embolism : What are DVTs and YEs collectively known as?

A

Venous thromboembolism (VTE)

101
Q

Pulmonary Embolism: Rare causes (3)

A
  1. Septic emboli
  2. RV embolus after MI
  3. Fat, air or amniotic fluid embolism
102
Q

Pulmonary Embolism: Strongly associated Risk factors (7)

A
  1. Recent surgery
  2. Thrombophilia
  3. Leg fracture
  4. Prolonged bed rest/immobility
  5. Malignancy
  6. Pregnancy/combined contraceptive pill
  7. Previous PE
103
Q

Pulmonary Embolism: 2 Key surgeries associated with VTE

A
  1. Abdominal/hip surgery
  2. Hip/knee replacement
104
Q

Pulmonary Embolism: Weak risk factor

A

Long haul flights

105
Q

Pulmonary Embolism: DVT prophylaxis

A
  1. LMWH (enoxaparin)
  2. Anti-embolic compression stockings
106
Q

Pulmonary Embolism: Contraindication for LMWH (2)

A

Active bleeding, or existing anticoagulation (i.e. warfarin)

107
Q

Pulmonary Embolism: Contraindication for compression stockings

A

Peripheral arterial disease

108
Q

Pulmonary Embolism: Clinical features of small vs large

A

Small can be asymptomatic, large are fatal

109
Q

Pulmonary Embolism: 5 key signs

A
  1. Dizziness
  2. Syncope
  3. Haemoptysis
  4. Pleuritic chest pain
  5. Sudden onset dyspnoea
110
Q

Pulmonary Embolism: Key questions for history (3)

A
  1. Risk factors
  2. Previous DVT/PE
  3. Family history
111
Q

Pulmonary Embolism: Signs of DVT (2)

A
  1. Unilateral leg swelling
  2. Tenderness
112
Q

Pulmonary Embolism: Key systemic signs on examination (4)

A
  1. Pyrexia
  2. Cyanosis
  3. Tachycardia
  4. Hypotension
113
Q

Pulmonary Embolism: Key respiratory signs (4)

A
  1. Pleural Rub
  2. Pleural effusion
  3. Tachypnoea
  4. Raised JVP
114
Q

Pulmonary Embolism: Criteria used for diagnosis

A

Wells Score

115
Q

Pulmonary Embolism: Some things taken into account by Wells (2)

A
  1. Risk factors (surgery, bed ridden, previous DVT)
  2. Signs (Haemoptysis, Tachycardia, DVT signs)
116
Q

Pulmonary Embolism: How to interpret Wells score (2)

A
  1. > 4 Immediate CTPA or treat empirically
  2. <4 do a d-dimer - Immediate CTPA or treatment if +ve
117
Q

Pulmonary Embolism: Key Tests (3)

A
  1. Bloods (Clotting, D-dimer)
  2. CTPA
  3. V/Q scan
118
Q

Pulmonary Embolism: Test to assess for alternative cause

A
  1. CXR
119
Q

Pulmonary Embolism: How CTPA works

A

CT chest scan with contrast which highlights arteries to show clots

120
Q

Pulmonary Embolism: How V/Q scan works

A

Radioactive isotopes (inhaled and injected) and gamma camera compares ventilation and perfusion in the lungs

121
Q

Pulmonary Embolism: Signs on ABG

A
  1. Respiratory alkalosis (High RR leads to CO2 expulsion)
    Low O2, Low CO2
122
Q

Pulmonary Embolism: Signs on CXR

A

Normal or
1. Oligaemia of affected segment
2. Wedge shaped opacity
3. Dilated arteries
4. Vessel effusion
5. Linear atelectasis

123
Q

Pulmonary Embolism: ECG findings

A
  1. Sinus tachycardia
  2. RBBB
  3. RV strain (Inversion of T in V1-4)
  4. S1Q3T3 (This pattern in rare)
124
Q

Pulmonary Embolism: Acute management of large PE (5)

A

(Oxygen, Pain and blood pressure)
1. O2
2. Morphine + anti-emetic
3. IV and LMWH/Fondaparinux
4. Fluid if hypotension
5. Thrombolysis if haemodynamically unstable

125
Q

Pulmonary Embolism: Treatment in case of massive, harm-dynamically unstable PE

A

Thrombolysis (Ateplase injection via cannula or central catheter)
Then long term anti-coagulation

126
Q

Pulmonary Embolism: Haemodynamically stable treatment

A
  1. LMWH or unfractionated heparin (renal impairment) (5 days)
  2. Start DOAC or Warfarin
127
Q

Pulmonary Embolism: When to start heparin while using warfarin?

A

When INR is 2-3 due to inital prothrombotic effect of warfarin

128
Q

Pulmonary Embolism: Treatment if anti-coagulation is contraindicated

A

Surgical placement of vena caval filter

129
Q

Pulmonary Embolism: Length of treatment for provoked PE

A

3 months and then reassess risk

130
Q

Pulmonary Embolism: Length of treatment for unprovoked

A

> 3 months

131
Q

Pulmonary Embolism: Length of treatment for malignancy

A

Continue treatment for 6 months with LMWH

132
Q

Pulmonary Embolism: Pregnancy

A

LMWH is continued until the end of pregnancy

Conditions (4 decks)

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