Respiratory Flashcards
Define COPD
- Progressive and irreversible
- Obstructive airway disease
- Combination of emphysema and chronic bronchitis
Clinical presentation of COPD
- Dyspnoea = breathlessness
- Tachypnoea = rapid breathing
- Cough + wheeze
- Recurrent sputum
- Barrel chest
Diagnosis of COPD
- FEV1/FVC < 0.70 + lack of reversibility of post-bronchodilator
- Chest X-ray
- FBC
Treatment of COPD
- Smoking cessation
- Pulmonary rehab
- Vaccines
- one-off pneumococcal
- annual influenza
- MedicatioN
- SABA = Short Acting Beta Agonist SALBUTAMOL
- SAMA = Short Acting Muscarinic Antagonoist IPRATROPIUM
- LABA = Long Acting Beta Agonist SALMETROL
- LAMA = Long Acting Muscarinic Antagonist TIOTROPIUM
- ICS = Inhaled CorticoSteroid BECLOMETASONE
Define asthma
Chronic airway inflammation and bronchospasm
Clinical presentation of asthma
- Diurnal variation - worse at night and early morning
- Known symptom trigger (help differentiate)
- Episodic shortness of breath
- Dry cough
- Aspirin sensitivity
Diagnosis of asthma
- Fractional exhaled nitric oxide (FeNO) >40ppb
- Spirometry - FEV1/FVC < 70%
- Bronchodilator reversibility (BDR) if spirometry +ve
Treatment of asthma
- SABA
- ICS
- LABA
Define Pneumonia
- Acute inflammation of terminal bronchioles
- Usually secondary to infection
State the microorganisms involved in Pneumonia
- Community Acquired Pneumonia
- Strep. pneumoniae
- Haemophilus influenzae
- Staph. aureus
- Hospital Acquired Pneumonia
- Pseudomonas (5 days after admission)
- E. coli
- Staph. aureus
- FUNGI
- Pneumocystis jiroveci
Clinical presentation of Pneumonia
- Productive cough
- Reduced breath sounds
- Pleuritic chest pain
- Fever
- Dyspnoea
Diagnosis of Pneumonia
1.CXR - consolidation
2. FBC - leukocytosis
3. U&E - deranged
4. CRP - infection marker
5. Sputum culture
Treatment of Pneumonia
- CAP
- Oral amoxicillin
- IF PENICILLIN ALLERGIC = DOXYCYCLINE/CLARITHROMYCIN
- IV if severe
- HAP
- LOW severity = oral co-amoxiclav
- HIGH severity = IV tazocin
- MRSA = ADD vancomycin
Describe the 4 types of TB
TB = RESTRICTIVE DISEASE
1. Primary infection
- Respiratory droplets from patients with active disease
2. Latent TB
- Immunocompetent patients harbour infection but asymptomatic
- Immunocompromised -> reactivation can occur
3. Secondary TB
- Reactivation and failure to contain bacteria
4. Miliary TB
- Systemic spread
Clinical presentation of TB
- Haemoptysis - coughing up blood
- Dyspnoea - trouble breathing
- Fever
- Weight loss
- Night sweats
- Finger clubbing if longstanding
Diagnosis of LATENT TB
Mantoux screening
- Intradermal injection of 0.1 mL
- 1:1000 purified protein derivative (PPD) tuberculin
- Inspect site 48-7h later
- Measure diameter of induration across forearm
- < 5mm = -ve
- > 5-15mm = +ve
- = previous BCG vaccine or TB infection if risk factors present
- > 15mm = STRONG +ve
- TB infection
Diagnosis of ACTIVE TB
- CXR
- Microbiology - sputum stain and mycobacterium culture
- Nucleic-Acid Amplification Test (NAAT0
- HIV and hepatitis status
Treatment of ACTIVE TB
- Initial phase (RIPE for 2months)
- Rifampicin - red secretions (S.E)
- Isoniazid - Feve, jaundice, nausea)
- Pyrazinamide - Hyperuricaemia
- Ethambutol - Optic neuritis
- Continuation phase (further 4 months)
- Rifampicin
- Isoniazid
- Multi-drug resistant TB
- Extended for 1-24 months with at least 6 drugs
- TB meningitis
- Longer continuation phase for 10 months
- Dexamethasone if required
Define CF
- Autosomal recessive
- Multi system
- CF transmembrane conductance regulator (CFTR) mutation
State the systems affected by CF
- Respiratory system
- GI
- Pancreas
- Liver
- Right heart failure (due to pulmonary hypertension)
State the clinical presentations and their diagnosis (->) of CF at different stages
- ANTENATAL
- Hyperechogenic bowel on ultrasound
-> chorionic villus sampling
- Hyperechogenic bowel on ultrasound
- NEONATAL
- Prolonged jaundice
- Meconium ileus
-> Guthrie heel-prick test
- CHILDHOOD
- Recurrent chest infections
- Failure to thrive
- Malabsorption
- Delayed puberty
-> Sweat test
- ADULTHOOD
- Same as childhood
- DM
- Male infertility
- Female sub-infertility
Treatment of CF
RESP. SYSTEM
1. Airway clearance
2. Broonchodilator
3. Mucoactive agents
- rhDNase
GI & hepatobiliary
1. High calorie + high fat diet
2. Fat soluble vit supplementation for pancreatic insufficiency
3. PPI
4. Pancreatic enzyme replacement
Define Bronchiectasis
- Debilitating lung disease
- Permanent dilation of bronchi
- Due to chronic bronchial inflammation
Clinical presentation of Bronchiectasis
- Shortness of breath
- Excess sputum
- Auscultation
- Coarse crackling on inspiration
- High pitch inspiratory squeak
- Clubbing
- Haemoptysis
Diagnosis of Bronchiectasis
- Chest X ray
- High res CT chest - signet ring sign
- Sputum culture
- FBC
Treatment of Bronchiectasis
- Chest physio
- Annual flu vaccine
- Mucoactive agent
- Bronchodilator
- Nebulised saline
Define and state the 2 types of pleural effusion
Abnormal excess of fluid in pleural space
1. Transudative effusion protein < 30g/L
2. Exudative effusion protein > 30g/L
Clinical presentation of pleural effusion
- Dyspnea
- Reduced chest expansion
- Cough
- Dullness to percussion
diagnosis of pleural effusion
- Chest x ray
- Pleural aspiration and analysis
- Colours suggestive of different conditions
Treatment of pleural effusion
- Treat underlying cause
- Thoracentesis = chest drainage
- Pleurodesis
Define and state types of pneumothorax
Abnormal accumulation of air within pleural space. Young, Male, Low BMI most likely
1. Primary spontaneous (no presence of underlying lung disease)
2. Secondary spontaneous (presence of lung disease)
3. Traumatic (any type of trauma)
4. Tension (previous 3 can turn into this; EMERGENCY)
Clinical presentation of pneumothorax
- sudden onset pleuritic chest pain
- Sudden onset dyspnoea
- Reduced breath sounds ipsilaterally
Diagnosis of pneumothorax
- CXR
- CT chest
Treatment of pneumothorax
- Aspiration and chest drain
- TENSION = significant cardiorespiratory compromise
- Needle decompression 2nd intercostal, midclavicular, line, same side
State the 3 main types of lung cancers
- Small-cell lung cancer (SCLC)
- Non-small cell lung cancer (NSCLC)
- Mesothelioma
Summarise SCLC
- LOCATION
- Central lesion
- SMOKING
- Strong link
- TREATMENT
- Chemoradiotherapy
State the 3 types of NSCLC and summarise
- Adenocarcinoma
- Peripheral lesion
- Low smoking link
- Surgery treatment
- Squamous-cell (MOST COMMON)
- Central lesion
- Strong smoking link
- Surgery treatment
- Large-cell
- Peripheral lesion
- Strong smoking link
- Surgery treatment
Diagnosis of lung cancer
- CXR
- CT chest with contrast
- Biopsy
Define mesothelioma
- Epithelial malignancy of mesothelial cells of pleura
- Primary cause = asbestos
Clinical presentation of mesothelioma
- Cough + shortness of breath
- Finger clubbing
- Reduced breath sounds
- Pleuritic chest pain
Diagnosis of mesothelioma
- CXR
- CT chest with contrast
Treatment of mesothelioma
- Surgery
- Chemotherapy
- Radiotherapy
Summarise pulmonary fibrosis
- Interstitial fibrosis of lung parenchyma
- Caused by many underlying conditions
Define sarcoidosis
- Inflammation
- Non-caseating granulomas
Clinical presentation of sarcoidosis
- Non productive cough
- Dyspnoea
- Lupus type rash
- Photophobia
Diagnosis of sarcoidosis
- Routine bloods for inflammatory markers
- Serum calcium: hypercalcaemia
- Raised ACE
- CXR
Treatment of sarcoidosis
- Steroids - methylprednisalone
- Immunosuppressant - Methotrexate
Describe the CURB-65 score for pneumonia
- Confusion
- Urea > 7
- Resp rate ≥ 30 mins
- SBP ≤ 90mmHg or DBP ≤ 60mmHg
- Age ≥ 65
1 POINT FOR EACH. 3-4 = URGENT HOSPITAL
State and describe the types of resp. failure
- TYPE 1
- Low O2
- Normal CO2
- Type 2
- Low O2
- High CO2
State the type of resp failure for all resp. conditions
- Asthma - Type 1
- PE - Type 1
- COVID - Type 1
- COPD - Type 2
- Pneumonia - Type 2
Pulomary hypertension is defined as pressure above what mmHg?
20 mmHg
