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SJ Phase 2a > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define COPD

A
  1. Progressive and irreversible
  2. Obstructive airway disease
  3. Combination of emphysema and chronic bronchitis
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2
Q

Clinical presentation of COPD

A
  1. Dyspnoea = breathlessness
  2. Tachypnoea = rapid breathing
  3. Cough + wheeze
  4. Recurrent sputum
  5. Barrel chest
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3
Q

Diagnosis of COPD

A
  1. FEV1/FVC < 0.70 + lack of reversibility of post-bronchodilator
  2. Chest X-ray
  3. FBC
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4
Q

Treatment of COPD

A
  1. Smoking cessation
  2. Pulmonary rehab
  3. Vaccines
    • one-off pneumococcal
    • annual influenza
  4. 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
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5
Q

Define asthma

A

Chronic airway inflammation and bronchospasm

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6
Q

Clinical presentation of asthma

A
  1. Diurnal variation - worse at night and early morning
  2. Known symptom trigger (help differentiate)
  3. Episodic shortness of breath
  4. Dry cough
  5. Aspirin sensitivity
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7
Q

Diagnosis of asthma

A
  1. Fractional exhaled nitric oxide (FeNO) >40ppb
  2. Spirometry - FEV1/FVC < 70%
    • Bronchodilator reversibility (BDR) if spirometry +ve
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8
Q

Treatment of asthma

A
  1. SABA
  2. ICS
  3. LABA
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9
Q

Define Pneumonia

A
  1. Acute inflammation of terminal bronchioles
  2. Usually secondary to infection
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10
Q

State the microorganisms involved in Pneumonia

A
  1. Community Acquired Pneumonia
    • Strep. pneumoniae
    • Haemophilus influenzae
    • Staph. aureus
  2. Hospital Acquired Pneumonia
    • Pseudomonas (5 days after admission)
    • E. coli
    • Staph. aureus
  3. FUNGI
    • Pneumocystis jiroveci
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11
Q

Clinical presentation of Pneumonia

A
  1. Productive cough
  2. Reduced breath sounds
  3. Pleuritic chest pain
  4. Fever
  5. Dyspnoea
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12
Q

Diagnosis of Pneumonia

A

1.CXR - consolidation
2. FBC - leukocytosis
3. U&E - deranged
4. CRP - infection marker
5. Sputum culture

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13
Q

Treatment of Pneumonia

A
  1. CAP
    • Oral amoxicillin
    • IF PENICILLIN ALLERGIC = DOXYCYCLINE/CLARITHROMYCIN
    • IV if severe
  2. HAP
    • LOW severity = oral co-amoxiclav
    • HIGH severity = IV tazocin
    • MRSA = ADD vancomycin
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14
Q

Describe the 4 types of TB

A

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

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15
Q

Clinical presentation of TB

A
  1. Haemoptysis - coughing up blood
  2. Dyspnoea - trouble breathing
  3. Fever
  4. Weight loss
  5. Night sweats
  6. Finger clubbing if longstanding
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16
Q

Diagnosis of LATENT TB

A

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

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17
Q

Diagnosis of ACTIVE TB

A
  1. CXR
  2. Microbiology - sputum stain and mycobacterium culture
  3. Nucleic-Acid Amplification Test (NAAT0
  4. HIV and hepatitis status
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18
Q

Treatment of ACTIVE TB

A
  1. Initial phase (RIPE for 2months)
    • Rifampicin - red secretions (S.E)
    • Isoniazid - Feve, jaundice, nausea)
    • Pyrazinamide - Hyperuricaemia
    • Ethambutol - Optic neuritis
  2. Continuation phase (further 4 months)
    • Rifampicin
    • Isoniazid
  3. Multi-drug resistant TB
    • Extended for 1-24 months with at least 6 drugs
  4. TB meningitis
    • Longer continuation phase for 10 months
    • Dexamethasone if required
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19
Q

Define CF

A
  1. Autosomal recessive
  2. Multi system
  3. CF transmembrane conductance regulator (CFTR) mutation
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20
Q

State the systems affected by CF

A
  1. Respiratory system
  2. GI
  3. Pancreas
  4. Liver
  5. Right heart failure (due to pulmonary hypertension)
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21
Q

State the clinical presentations and their diagnosis (->) of CF at different stages

A
  1. ANTENATAL
    • Hyperechogenic bowel on ultrasound
      -> chorionic villus sampling
  2. NEONATAL
    • Prolonged jaundice
    • Meconium ileus
      -> Guthrie heel-prick test
  3. CHILDHOOD
    • Recurrent chest infections
    • Failure to thrive
    • Malabsorption
    • Delayed puberty
      -> Sweat test
  4. ADULTHOOD
    • Same as childhood
    • DM
    • Male infertility
    • Female sub-infertility
22
Q

Treatment of CF

A

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

23
Q

Define Bronchiectasis

A
  1. Debilitating lung disease
  2. Permanent dilation of bronchi
  3. Due to chronic bronchial inflammation
24
Q

Clinical presentation of Bronchiectasis

A
  1. Shortness of breath
  2. Excess sputum
  3. Auscultation
    • Coarse crackling on inspiration
    • High pitch inspiratory squeak
  4. Clubbing
  5. Haemoptysis
25
Q

Diagnosis of Bronchiectasis

A
  1. Chest X ray
  2. High res CT chest - signet ring sign
  3. Sputum culture
  4. FBC
26
Q

Treatment of Bronchiectasis

A
  1. Chest physio
  2. Annual flu vaccine
  3. Mucoactive agent
  4. Bronchodilator
  5. Nebulised saline
27
Q

Define and state the 2 types of pleural effusion

A

Abnormal excess of fluid in pleural space
1. Transudative effusion protein < 30g/L
2. Exudative effusion protein > 30g/L

28
Q

Clinical presentation of pleural effusion

A
  1. Dyspnea
  2. Reduced chest expansion
  3. Cough
  4. Dullness to percussion
29
Q

diagnosis of pleural effusion

A
  1. Chest x ray
  2. Pleural aspiration and analysis
    • Colours suggestive of different conditions
30
Q

Treatment of pleural effusion

A
  1. Treat underlying cause
  2. Thoracentesis = chest drainage
  3. Pleurodesis
31
Q

Define and state types of pneumothorax

A

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)

32
Q

Clinical presentation of pneumothorax

A
  1. sudden onset pleuritic chest pain
  2. Sudden onset dyspnoea
  3. Reduced breath sounds ipsilaterally
33
Q

Diagnosis of pneumothorax

A
  1. CXR
  2. CT chest
34
Q

Treatment of pneumothorax

A
  1. Aspiration and chest drain
  2. TENSION = significant cardiorespiratory compromise
    • Needle decompression 2nd intercostal, midclavicular, line, same side
35
Q

State the 3 main types of lung cancers

A
  1. Small-cell lung cancer (SCLC)
  2. Non-small cell lung cancer (NSCLC)
  3. Mesothelioma
36
Q

Summarise SCLC

A
  1. LOCATION
    • Central lesion
  2. SMOKING
    • Strong link
  3. TREATMENT
    • Chemoradiotherapy
37
Q

State the 3 types of NSCLC and summarise

A
  1. Adenocarcinoma
    • Peripheral lesion
    • Low smoking link
    • Surgery treatment
  2. Squamous-cell (MOST COMMON)
    • Central lesion
    • Strong smoking link
    • Surgery treatment
  3. Large-cell
    • Peripheral lesion
    • Strong smoking link
    • Surgery treatment
38
Q

Diagnosis of lung cancer

A
  1. CXR
  2. CT chest with contrast
  3. Biopsy
39
Q

Define mesothelioma

A
  1. Epithelial malignancy of mesothelial cells of pleura
  2. Primary cause = asbestos
40
Q

Clinical presentation of mesothelioma

A
  1. Cough + shortness of breath
  2. Finger clubbing
  3. Reduced breath sounds
  4. Pleuritic chest pain
41
Q

Diagnosis of mesothelioma

A
  1. CXR
  2. CT chest with contrast
42
Q

Treatment of mesothelioma

A
  1. Surgery
  2. Chemotherapy
  3. Radiotherapy
43
Q

Summarise pulmonary fibrosis

A
  1. Interstitial fibrosis of lung parenchyma
  2. Caused by many underlying conditions
44
Q

Define sarcoidosis

A
  1. Inflammation
  2. Non-caseating granulomas
45
Q

Clinical presentation of sarcoidosis

A
  1. Non productive cough
  2. Dyspnoea
  3. Lupus type rash
  4. Photophobia
46
Q

Diagnosis of sarcoidosis

A
  1. Routine bloods for inflammatory markers
  2. Serum calcium: hypercalcaemia
  3. Raised ACE
  4. CXR
47
Q

Treatment of sarcoidosis

A
  1. Steroids - methylprednisalone
  2. Immunosuppressant - Methotrexate
48
Q

Describe the CURB-65 score for pneumonia

A
  1. Confusion
  2. Urea > 7
  3. Resp rate ≥ 30 mins
  4. SBP ≤ 90mmHg or DBP ≤ 60mmHg
  5. Age ≥ 65
    1 POINT FOR EACH. 3-4 = URGENT HOSPITAL
49
Q

State and describe the types of resp. failure

A
  1. TYPE 1
    • Low O2
    • Normal CO2
  2. Type 2
    • Low O2
    • High CO2
50
Q

State the type of resp failure for all resp. conditions

A
  1. Asthma - Type 1
  2. PE - Type 1
  3. COVID - Type 1
  4. COPD - Type 2
  5. Pneumonia - Type 2
51
Q

Pulomary hypertension is defined as pressure above what mmHg?

A

20 mmHg

SJ Phase 2a (13 decks)

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