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Phase 2a > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is COPD?

A

A disease state characterised by airflow limitation which is not fully reversible.

Emphysema and chronic bronchitis.

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2
Q

What is the pathophysiology of COPD?

A

Chronic inflammation affecting central and peripheral airways, lung parenchyma and alveoli, and pulmonary vasculature.

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3
Q

What causes COPD?

A
  • Tobacco smoking
  • Air pollution
  • Indoor burning of biomass fuel
  • Occupational exposure to dusts, chemical agents and fumes
  • Alpha-1-antitrypsin deficiency
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4
Q

What are the risk factors for COPD?

A
  • Cigarette smoking
  • Advanced age
  • Genetics
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5
Q

What are the signs and symptoms of COPD?

A
  • Cough
  • SOB
  • Sputum production
  • Barrel chest
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6
Q

What can be found on examination of COPD?

A
  • Hyper-resonance on percussion
  • Poor air movement and wheezing on auscultation
  • Coarse crackles
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7
Q

How is COPD diagnosed?

A

Spirometry - FEV1/FVC ratio <0.7

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8
Q

What are the differentials for COPD?

A
  • Asthma
  • Congestive heart failure
  • Bronchiectasis
  • TB
  • Upper airway dysfunction
  • ACEi induced cough
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9
Q

What is the management for an acute exacerbation of COPD?

A
  • O2 therapy
  • Salbutamol
  • Steroids
  • Treat cause
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10
Q

What is the management of COPD?

A
  • Smoking cessation
  • Pulmonary rehab
  • Medication
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11
Q

What is the medical treatment for COPD?

A
  1. Short-acting beta agonist (SABA) or short-acting muscarinic agonist (SAMA)
  2. Add LABA or LAMA (moderate disease)
  3. Add inhaled corticosteroid - beclamethasone (severe disease)
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12
Q

Give an example of a SABA.

A

Salbutamol

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13
Q

Give an example of a SAMA.

A

Ipratropium

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14
Q

Give an example of a LABA.

A

Salmetrol

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15
Q

Give an example of a LAMA.

A

Tiotrium

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16
Q

What are the possible complications of COPD?

A
  • Cor pulmonale
  • Lung cancer
  • Recurrent pneumonia
  • Depression
  • Pneumothorax
  • Respiratory failure
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17
Q

What is bronchitis?

A

Inflammation of bronchi leading to narrowing of airways due to tissue swelling and excess mucus production.

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18
Q

What is chronic bronchitis?

A

Bronchitis lasting more than 3 months a year for more than 2 years.

Associated with COPD.

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19
Q

What is the pathophysiology of chronic bronchitis?

A

Inflammation → fibrosis → thickening of wall → reduced lumen size → decreased FEV1

  • Main cell involved - neutrophils
  • Main leukocyte - CD8
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20
Q

What are the causes of bronchitis?

A
  • Can be infections (usually viral)
  • Forms a component of COPD
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21
Q

What are the features of acute bronchitis?

A
  • Chesty cough (often productive and lasting up to 2 weeks)
  • Fever
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22
Q

How is acute bronchitis managed?

A

Self-limiting

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23
Q

What is the pathophysiology of emphysema?

A
  • Loss of elasticity of alveoli
  • Inflammation and scarring (reduces size of lumen)
  • Mucus hypersecretion (increased diffusion distance)
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24
Q

What is the pathophysiology of TB?

A
  • Infection through droplet inhalation
  • Deposition in alveoli → engulfed by macrophages → evades lysis and multiplies in macrophages
  • Proliferation of bacilli in macrophage kills macrophage and release of mycobacteria
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25
Q

What are the risk factors for TB infection?

A
  • Exposure to TB
  • Birth in endemic country
  • HIV infection
  • Immunosuppressant medication
  • Silicosis
  • Apical fibrosis
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26
Q

What is the clinical presentation of TB?

A
  • Cough
  • Fever
  • Anorexia
  • Weight loss
  • Malaise
  • Night sweats
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27
Q

How is TB diagnosed?

A
  • Sputum acid-fast bacilli smear (positive)
  • Sputum culture
  • Nucleic acid amplification test (positive for M. tuberculosis)
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28
Q

What are the differentials for TB?

A
  • Covid-19
  • Community-acquired pneumonia
  • Lung cancer
  • Non-tuberculosis mycobacterium
  • Fungal infection
  • Sarcoidosis
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29
Q

What is the management for TB?

A
  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
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30
Q

What is the clinical presentation of cystic fibrosis?

A
  • Positive newborn screen
  • Failure to pass meconium
  • Failure to thrive
  • Wet-sounding cough
  • Recurrent infection
  • Chronic sinusitis
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31
Q

How is CF diagnosed?

A
  • Sweat test
  • Immunoreactive trypsinogen test (newborn screening)
  • Genetic testing
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32
Q

What are the differentials for CF?

A
  • Primary ciliary dyskinesia
  • Primary immunodeficiency
  • Asthma
  • GORD
  • Chronic aspiration
  • Coeliac disease
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33
Q

How is CF managed?

A
  • SABAs for asthma-like symptoms
  • Mucolytics and hydrators
  • Antibiotics
  • Inhaled corticosteroids
  • Anti-inflammatory agents
  • CFTR modulator
  • Lung transplant
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34
Q

What is pneumonia?

A
  • Lower respiratory tract infection
  • Inflammation of lung tissue
  • Normally acute and caused by bacteria
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35
Q

How can pneumonia be classified?

A
  • Anatomical location (one lobe = localised, multiple locations = diffused)
  • Aetiology (pneumococcal or atypical)
  • Community vs hospital acquired
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36
Q

How is hospital acquired pneumonia defined?

A

Pneumonia that develops at least 48 hours after admission

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37
Q

What is the pathophysiology of pneumonia?

A

Infection occurs through one of 4 pathways:
- Inhalation
- Aspiration of oropharyngeal secretions into trachea
- Haematogenous spread
- Direct extension from adjacent infected loci

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38
Q

What is the most common cause of community acquired pneumonia?

A

Strep pneumoniae

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39
Q

What is the most common cause of hospital acquired pneumonia?

A
  • Gram negative bacilli
  • Staph aureus
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40
Q

What are the risk factors for pneumonia?

A
  • Strep pneumoniae infection
  • Hospitalisation
  • Cigarette smoking
  • Alcohol excess
  • Bronchiectasis
  • Immunosuppression
  • IVDU
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41
Q

What is the clinical presentation of pneumonia?

A
  • SOB and tachypnoea
  • Cough
  • Fever
  • Rigours
  • Vomiting
  • Headache
  • Anorexia
  • Pleuritic chest pain
  • Tachycardia
42
Q

How is pneumonia diagnosed?

A

CXR
- Consolidation

43
Q

What are the differentials for pneumonia?

A
  • PE
  • Pulmonary/pleural TB
  • Pulmonary oedema
44
Q

How is pneumonia managed?

A
  • Hospital acquired - Piperacillin / Tazobactam
  • Community acquired - Amoxicillin
45
Q

What are the possible complications of pneumonia?

A
  • Respiratory failure
  • Hypotension
  • Pleural effusion
  • Lobar collapse
  • Thromboembolism
  • Pneumothorax
  • Sepsis
  • ARDS
46
Q

What is asthma?

A

A chronic lung condition where there is chronic inflammation of the airways and hypersensitivity of the airways.

47
Q

What is the pathophysiology of asthma?

A

Initial trigger → release of inflammatory mediators → activation and migration of other inflammatory cells

48
Q

What are the risk factors for asthma?

A
  • FHx
  • Allergens
  • Atopic history
49
Q

What is the clinical presentation of asthma?

A
  • Upper respiratory tract infection
  • Dyspnoea
  • Cough
  • Expiratory wheeze
  • Nasal polyposis
  • Diurnal variation of symptoms
50
Q

How is asthma diagnosed?

A

FEV1/FEC < 80% predicted

51
Q

What are the differentials for asthma?

A
  • CF
  • Chronic rhinosinusitis
  • Foreign body aspiration
  • Alpha-1-antitrypsin deficiency
  • COPD
  • Bronchiectasis
52
Q

What is the management for asthma?

A
  1. SABA eg. salbutamol PRN
  2. Low dose ICS daily if uncontrolled
  3. Add a leukotriene agonist
  4. Add LABA eg. salmeterol if still uncontrolled
53
Q

What are the possible complications for asthma?

A

Airway remodelling

54
Q

What is a pneumothorax?

A

When air gets into and accumulated in the pleural space.

55
Q

What is the pathophysiology of a pneumothorax?

A

Because the thoracic cavity is normally below its resting volume, and the lung is above its resting volume, the thoracic cavity enlarges and the lung becomes smaller when a pneumothorax develops

56
Q

What are the causes of a pneumothorax?

A
  • Chest injury
  • Lung disease
  • Ruptured air blisters
  • Mechanical ventilation
57
Q

What are the risk factors for pneumothorax?

A
  • Smoking
  • Genetics
  • Lung disease
  • Mechanical ventilation
  • Previous pneumothorax
58
Q

What is the clinical presentation of a pneumothorax?

A
  • Chest pain
  • Dyspnoea
  • Ipsilateral reduced breath sounds
  • Hypoxia
  • Cough
59
Q

How is pneumothorax diagnosed?

A

CXR

60
Q

What are the differentials for pneumothorax?

A
  • Asthma
  • COPD
  • PE
  • Myocardial ischaemia
  • Pleural effusion
  • Bronchopleural fistula
61
Q

What is the management for pneumothorax?

A
  • Aspiration
  • Oxygen therapy
  • Surgery
62
Q

What are the possible complications of pneumothorax?

A

Re-expansion pulmonary oedema

63
Q

What is bronchiectasis?

A

Permanent dilation of bronchi due to destruction of elastic and muscular components of the bronchial wall.

Normally a consequence of recurrent and/or severe infections secondary to an underlying condition

64
Q

What are the causes of bronchiectasis?

A
  • Post-infection
  • Immunodeficiency
  • Genetic
  • Aspiration/inhalation injury
  • Connective tissue disorder
  • Inflammatory bowel disease
  • COPD and asthma
  • Idiopathic
65
Q

What is the clinical presentation of bronchiectasis?

A
  • Cough
  • Sputum production
  • Crackles and high-pitched inspiration
  • Dyspnoea
  • Fever
  • Fatigue
  • Haemoptysis
  • Weight loss
  • Wheezing
66
Q

How is bronchiectasis diagnosed?

A
  • CXR
  • High-resolution chest CT
67
Q

What are the differentials for bronchiectasis?

A
  • COPD
  • Asthma
  • Pneumonia
  • Chronic sinusitis
68
Q

What is the management for bronchiectasis?

A
  • Exercise and improved nutrition
  • Airway clearance therapy
  • Antibiotics to clear acute exacerbations
  • Some patients may benefit from bronchodilators
69
Q

What are the possible complications of bronchiectasis?

A
  • Massive haemoptysis
  • Respiratory failure
  • Cor pulmonale
  • Ischaemic stroke
70
Q

What is pleural effusion?

A

Fluid collection between parietal and visceral pleural surfaces of the thorax.

If the normal flow of fluid is disrupted, fluid accumulates, resulting in a pleural effusion.

71
Q

What are the risk factors for pleural effusion?

A
  • Congestive heart failure
  • Pneumonia
  • Malignancy
72
Q

What is the clinical presentation of pleural effusion?

A
  • Dyspnoea
  • Dullness on percussion
  • Pleuritic chest pain
  • Cough
  • Quieter breath sounds
  • Decreased or absent tactile fremitus
73
Q

How is pleural effusion diagnosed?

A
  • Posterior-anterior and lateral CXR
  • Pleural US (fluid present)
74
Q

What are the differentials for pleural effusion?

A
  • Pleural thickening
  • Pulmonary collapse and consolidation
  • Elevated hemidiaphragm
  • Pleural tumours
  • Covid-19
75
Q

How is pleural effusion managed?

A
  • Diuretic (furosemide)
  • Antibiotics if infective
76
Q

What are the complications of pleural effusion?

A
  • Atelectasis/lobar collapse
  • Re-expansion PE
  • Pleural fibrosis
  • Pseudochylothorax
  • Trapped lung
77
Q

What causes whooping cough?

A

Bordatella pertussis

78
Q

What is the clinical presentation of whooping cough?

A

Catarrhal phase (1-2 weeks)
- Rhinorrhoea, low-grade fever etc

Paroxysmal phase (1-6 weeks)
- Coughing spasms
- Inspiratory ‘whoop’
- Post-ptussive vomiting

79
Q

What are the complications of whooping cough?

A
  • Pneumonia
  • Encephalopathy
  • Subconjunctival haemorrhage
80
Q

What is the management for whooping cough?

A
  • Clarithromycin
  • Vaccination dTaP (diphtheria, tetanus and acellular pertussis)
81
Q

What is idiopathic pulmonary fibrosis?

A

Formation of scar tissue within the lungs and progressive dyspnoea

82
Q

What are the risk factors for idiopathic pulmonary fibrosis?

A
  • Family history
  • Cigarette smoking
  • Older age
  • Male sex
83
Q

What is the clinical presentation of idiopathic pulmonary fibrosis?

A
  • Dyspnoea
  • Cough
  • Crackles
  • Weight loss
  • Fatigue
  • Malaise
  • Clubbing
84
Q

How is idiopathic pulmonary fibrosis diagnosed?

A
  • CXR
  • High-resolution CT
85
Q

How is an acute exacerbation of idiopathic pulmonary fibrosis managed?

A

High-dose corticosteroid eg. prednisolone

86
Q

What is the ongoing management for pulmonary fibrosis?

A
  • Antifibrotic therapy (prednisolone)
  • 2nd line - Lung transplant
87
Q

What are the possible complications of pulmonary fibrosis?

A
  • Pulmonary hypertension
  • Lung cancer
  • GORD
  • Pulmonary
  • Pneumothorax
  • PE
  • DVT
  • ACS
88
Q

What is sarcoidosis?

A

A chronic granulomatous disease of unknown aetiology, commonly affecting the lungs, skin and eyes.

Accumulation of lymphocytes and macrophages and the formation of non-casketing granulomas in the lungs and other organs

89
Q

What are the risk factors for sarcoidosis?

A
  • Age 20-40
  • Family history
  • Scandinavian origin
90
Q

What is the clinical presentation of sarcoidosis?

A
  • Cough/wheezing
  • Dyspnoea
  • Chronic fatigue
  • Arthralgia
  • Photophobia
  • Red, painful eye
  • Blurred vision
  • Lymphadenopathy
91
Q

How is sarcoidosis diagnosed?

A

CXR

92
Q

What are the differentials for sarcoidosis?

A
  • TB
  • Histoplasmosis
  • Non-small cell lung cancer
  • Lymphoma
  • Brylliosis
  • Hypersensitivity pneumonitis
93
Q

How is sarcoidosis managed?

A

Prednisolone

94
Q

What is pulmonary hypertension?

A

Defined as a mean pulmonary arterial pressure of higher than 25mmHg

95
Q

What are the causes of pulmonary hypertension?

A
  • Group 1 - Primary pulmonary hypertension or connective tissue disease (eg. SLE)
  • Group 2 - Left heart failure (eg. due to MI)
  • Group 3 - Chronic lung disease (eg. COPD)
  • Group 4 - Pulmonary vascular disease (eg. PE)
  • Group 5 - Miscellaneous causes
96
Q

What is the clinical presentation of pulmonary hypertension?

A
  • SOB
  • Fatigue
  • Chest pain
  • Syncope
  • Tachycardia
  • Raised JVP
  • Hepatomegaly
  • Peripheral oedema
97
Q

How is pulmonary hypertension diagnosed?

A
  • ECHO (estimate pulmonary BP)
  • Right heart catheterisation (accurate measurement)
98
Q

How is pulmonary hypertension managed?

A
  • Supportive therapy
  • IV prostaglandins (epoprostenol)
  • Endothelin receptor antagonists (macitentan)
  • Phosphodiesterase-5 inhibitors (sildenafil)
  • If secondary, treat underlying cause
99
Q

What are the possible complications of pulmonary hypertension?

A
  • Respiratory failure
  • Heart failure
  • Arrhythmias
100
Q

What is lung cancer?

A

Generally a carcinoma of the bronchus, sometimes alveolar tumours or benign tumours.

Vast majority are primary, some can be metastases.

101
Q

What is the pathophysiology of small cell carcinoma of the lung?

A

Arise from endocrine cells (Kulchitsky cells).

These secrete polypeptides, some cause further cell growth by auto feedback.

Phase 2a (11 decks)

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