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Med Finals - Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define pneumonia

A

Infection of the lung tissue, causes inflammation of the lung and sputum filling airways and alveoli

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2
Q

Common types of pneumonia

A

Hospital acquired
Community acquired
Aspiration

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3
Q

History of pneumonia

A

Shortness of breath
Cough productive of sputum
Fever
Haemoptysis
Pleuritic chest pain
Delirium
Sepsis

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4
Q

Clinical signs of pneumonia

A

Tachypnoea
Tachycardia
Hypoxia
Hypotension
Fever
Confusion
Bronchial breath sounds - harsh sounds
Focal coarse crackles
Dullness to percussion

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5
Q

Severity assessment in pneumonia

A

CURB65
Confusion
Urea > 7
Resp rate >30
Blood pressure <90 systolic
Age >65
0/1 - treat at home
>2 admit
>3 intensive care

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6
Q

Common causative organisms

A

Streptococcus pneumoniae
Haemophilus influenza

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7
Q

Define atypical pneumonia

A

Pneumonia caused by an organism that cannot be culture in the normal way or detected using gram stain - legionella

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8
Q

Where are you likely to get legionella pneumophila from

A

Infected water or air conditioning units - can cause SIADH

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9
Q

Signs of mycoplasma pneumoniae

A

Erythema multiforme - target lesions
May also see neurological signs

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10
Q

Investigations in pneumonia

A

CXR
FBC
UE
CRP
Sputum
Blood cultures - atypical screening

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11
Q

Define FEV1

A

Forced expiratory volume in 1 second - amount of air that can be forcibly exhaled in 1 second

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12
Q

Define FVC

A

Forced vital capacity - the total amount of air that can be forcibly exhaled

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13
Q

FEV1 and FVC in obstructive disease

A

FEV1 is less than 75% of FVC - ratio <75

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14
Q

FEV1 and FVC in restrictive disease

A

FEV1 and FVC both reduced - ratio >75

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15
Q

Examples of obstructive disease

A

Asthma - reversible
COPD

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16
Q

Examples of restrictive disease

A

Interstitial lung disease
Neurological - MND
Scoliosis or chest deformity
Obesity

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17
Q

Define peak flow rate

A

The fasted expiratory flow of air possible - useful measure of control in obstructive lung disease

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18
Q

Define asthma

A

Chronic inflammatory condition of the airways that causes episodic exacerbations of bronchoconstriction.

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19
Q

History of asthma

A

Episodic symptoms
Diurnal variability - worse at night
Dry cough
Wheeze
Shortness of breath
Atopic conditions
FH

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20
Q

Clinical signs of asthma

A

Bilateral widespread polyphonic wheeze
Reversibility with brochodilators

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21
Q

Investigations of asthma

A

Spirometry with reversibility testing
Peak flow

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22
Q

Management of asthma

A

SABA - salbutamol
ICS -
LABA - salmeterol
LAMA - tiotropium
Leukotriene receptor antagonists - montelukast

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23
Q

Define acute asthma exacerbation

A

Characterised by rapid deterioration in symptoms trigged by any of the typical triggers

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24
Q

Grading of asthma severity as moderate

A

PEFR - 50-75%

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25
Q

Grading of asthma severity as severe

A

PEFR - 33 - 50%
RR > 25
HR >110
Unable to complete sentences

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26
Q

Grading of acute asthma as life-threatening

A

PEFR <33
O2 <92
Becoming tired
No wheeze - silent chest, so tight no air entry
Hamodynamic instability

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27
Q

Management of moderate acute asthma exacerbation

A

Nebulised salbutamol
Nebulised ipratropium
Steroids - oral pred continued for 5 days
Abx if infection

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28
Q

Management of severe acute asthma exacerbation

A

Moderate management +
Oxygen
Aminophylline infusion
Consider IV salbutamol

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29
Q

Management of life threatening acute asthma exacerbation

A

Severe management +
IV magnesium sulphate
ICU admission
Intubation

30
Q

Typical ABG in asthma

A

Respiratory alkalosis - tachypnoea drops CO2
Normal CO2 or hypoxia is concerning 0 indicates tiring
High CO2 is very bad - not breathing at all

31
Q

Define COPD

A

Chronic obstructive pulmonary disease is a non-reversible long term deterioration in air flow through the lungs caused by damage to the lung tissues - often by smoking - resulting in obstructive respiratory disease

32
Q

History of COPD

A

Long term smoker
Chronic shortness of breath
Cough
Sputum production
Wheeze
Recurrent respiratory infections
Wheeze
Haemoptysis and chest pain also possible.

33
Q

Investigations of COPD

A

Spirometry - obstructive with no reversibility
CXR
FBC
BMI
Sputum culture
ECG and echo - heart failure
CT thoraz
Alpha 1 antitrypsin
Transfer factor for carbon monoxide

34
Q

Management of COPD

A

Smoking cessation
SABA
LABA
LAMA
ICS
LTOT

35
Q

Define type 1 respiratory failure

A

Low O2 with normal CO2

36
Q

Define type 1 respiratory failure

A

Low O2 with normal CO2 (only one is effected)

37
Q

Define type 2 respiratory failure

A

Low O2 with raised CO2

38
Q

Management of COPD exacerbation

A

Home - pred, inhalers and abx
Hospital - Nebs, steroids, abx, physio
Severe - consider IVs

39
Q

Define interstitial lung disease

A

An umbrella term used to describe conditions that affect the lung parenchyma causing inflammation and fibrosis.

40
Q

Define idiopathic pulmonary fibrosis

A

Progressive pulmonary fibrosis with no clear causes

41
Q

Clinical signs of pulmonary fibrosis

A

Bibasal fine inspiratory crackles
Clubbing

42
Q

Drugs that can cause pulmonary fibrosis

A

Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin

43
Q

Conditions that can cause pulmonary fibrosis

A

Alpha 1 antitrisin
Rheumatoid
SLE
Systemic sclerosis

44
Q

Define hypersensitivity pneumonitis

A

Type III hypersensitivity reaction to an environmental allergen that causes parenchymal inflammation and destruction

45
Q

Examples of hypersensitivity pneumonitits

A

Bird fanciers lung
Farmers lung
Mushroom workers lung
Malt workers lung

46
Q

Define asbestosis

A

Lung fibrosis related to the inhalation of asbestos

47
Q

Define pleural effusion

A

Collection of fluid within the pleural cavity

48
Q

Types of pleural effusion

A

Exudative - protein >3g/dL
Transudative - protein <3

49
Q

Examples of exudative effusion

A

Related to inflammation - causes protein to leak
Lung cancer
Pneumonia
Rheumatoid
TB

50
Q

Examples of transudative effusions

A

Relate to fluid moving across membrane
Congestive heart failure
Hypoalbuminaemia
Hypothyroidism
Meig’s syndrome - right sided effusion with ovarian malignancy

51
Q

History of pleural effusion

A

Shortness of breath
Dullness to percussion over effusion
Reduced breath sounds
Tracheal deviation - sever effusion

52
Q

Signs of effusion on CXR

A

Blunting of costophrenic angles
Fluid in fissures
Large effusiongs will have meniscus
Trachael deviation

53
Q

Management of pleural effusion

A

Treat cause
Aspirate and drain

54
Q

Define empyema

A

Infected pleural effusion - pus and acidic aspiration low glucose

55
Q

Define pneumothorax

A

Air within the pleural space seperating the lung from the chest wall.

56
Q

Common causes of pneumothorax

A

Spontaneous - tall sports people
Trauma
Iatrogenic
Pathology - Infection, asthma, COPD

57
Q

Management of pneumothorax

A

<2 cm - conservative and follow up
>2 cm - aspiration/chest drain

58
Q

Define tension pneumothorax

A

Pneumothorax at high pressure such that the mediastinum is pushed across the thorax.
Normally caused by trauma creating a one-way valve.

59
Q

Clinical signs of a tension pneumothorax

A

Tracheal deviation
Reduced air entry
Increased resonance to percussion
Tachycardia
Hypotension
Unequal chest expansion

60
Q

Management of tension pneumothorax

A

Insertion of large bore cannula into the second intercostal space in the midclavicular line of the affected side

61
Q

Define pulmonary embolism

A

Condition where a blood clot forms - usually a DVT in the legs - travels throught the venous system, right side of the heart and then the lungs where it occludes an artery.

62
Q

Risk factors for PE

A

Immobility
Recent surgery
Long haul flight
Pregnancy
HRT
Malignancy
Polycythaemia
SLE
Thrombophilia

63
Q

History of PE

A

Shortness of breath
Cough - may be haemoptysis
Pleuritic chest pain
Hypoxia
Tachycardia
Raised RR
Low grade fever
Haemodynamic instability - hypotension
Signs of DVT

64
Q

Investigations of PE

A

CT pulmonary angiogram
ABG - alkalosis, blowing off co2

65
Q

Management of PE

A

O2
Analgesia
LMWH - DOAC
Thrombolysis?

66
Q

Duration of anticoagulation following PE

A

Obvious reversible cause, provoked - 3 months
Not provoked - 6 months

67
Q

Clinical signs of pulmonary hypertension

A

ECG - ventricular hypertrophy, right axis deviation, RBBB
CXR - dilated pulmonary vessels, right ventricular hypertrophy
Raised proBNP
Echo

68
Q

Define sarcoidosis

A

A granulomatous inflammatory condition. Granulomas are nodule of inflammation full of macrophages -

69
Q

Common organs affected in sarcoidosis

A

Lungs - 90%
Liver - 20%
Eyes - 20%
Skin - 15%
Heart - 5%
Kidneys - 5%
CNS - 5%
PNS - 5%
Bones - 2%

70
Q

Investigations in sarcoidosis

A

Gold standard diagnostic - Histology
CXR - hilar lymphadenopathy

71
Q

Management of sarcoidosis

A

Conservative
Steroids
Methotrexate
Transplant

Med Finals - Medicine (10 decks)

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