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Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Functions of resp system

A

Gas exchange
pH regulation
Speech
Protection from infection

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2
Q

Average rate/minute

A

O2 - 250ml
CO2 - 200ml

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3
Q

Anatomy of resp system

A

Nose
Pharynx
Epiglottis
Larynx
Trachea
Bronchus
Lungs

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4
Q

How is patency of airways maintained

A

C shaped rings of cartilage

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5
Q

How can diameter of bronchiole be adjusted

A

Smooth muscle contraction

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6
Q

Conduction segment

A

Trachea
Primary bronchi
Smaller bronchi
Large bronchioles

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7
Q

Respiratory segment

A

Small bronchioles
Alveoli

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8
Q

Parts of lung

A

Right:
Superior lobe
Middle lobe
Inferior lobe

Left:
Superior lobe
Inferior lobe

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9
Q

Tidal volume

A

Volume in and out normally breathing

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10
Q

Expiratory reserve volume

A

Maximum volume that can be expelled from lungs without taking a big breath in first

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11
Q

Inspiratory reserve volume

A

Max volume that can be drawn into lungs

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12
Q

Residual volume

A

Air that always stays in lungs

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13
Q

Vital capacity

A

Inspiratory reserve volume + expiratory reserve volume + tidal volume

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14
Q

Functional residual capacity

A

Expiratory reserve volume + residual volume

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15
Q

Inspiratory capacity

A

Tidal volume + Inspiratory reserve volume

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16
Q

Average pulmonary volumes male and female

A

Male:
FVC - 4600ml
TLC - 5800ml

Female:
FVC - 3100ml
TLC - 4200ml

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17
Q

What allows expansion and contraction of alveoli

A

Elastin/elastic fibres

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18
Q

Parts of pleura

A

Visceral pleura
Intrapleural fluid
Parietal pleura

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19
Q

Function of pleural fluid

A

Allows pleural membranes to glide across eachother

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20
Q

How is lung held to thorax wall

A

Vacuum force within pleural membranes

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21
Q

What is sinus arrhythmia

A

Pulse increase during inspiration

Pulse decrease during expiration

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22
Q

Cause of sinus arrhythmia

A

Vagus nerve activation

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23
Q

What is shunt

A

Perfusion > ventilation

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24
Q

What is alveolar dead space

A

Ventilation > perfusion

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25
Q

What is anatomical dead space

A

Air in conduction portion of airway

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26
Q

What is physiological dead space

A

Alveolar dead space + anatomical dead space

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27
Q

What is compliance of lungs

A

How easily lungs stretch upon inspiration

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28
Q

What cells produce surfactant

A

Type 2 pneumocyte

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29
Q

Surfactant function

A

Increase compliance

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30
Q

How does surfactant increase compliance

A

Reduce surface tension within alveoli

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31
Q

When does surfactant production begin

A

Week 25 gestation

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32
Q

When is surfactant production fully functional

A

Week 36

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33
Q

What is it called when premature babies struggle to breathe due to insufficient surfactant production

A

IRDS
Infant respiratory distress syndrome

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34
Q

Muscles of inspiration

A

External intercostals
Diaphragm
Scalenes
Sternocleidomastoid

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35
Q

Muscles of expiration

A

Passive while resting
Internal intercostals
Abdominal muscles

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36
Q

What is intrathoracic pressure (Pa)

A

Pressure within lungs
Can be + or -

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37
Q

What is intrapleural pressure (Pip)

A

Pressure in pleural cavity
Typically -ve in healthy lungs

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38
Q

What is trans pulmonary pressure (PT)

A

Difference between PA and Pip
Almost always positive
PT = Pa - Pip

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39
Q

How is gas transported in blood per litre

A

3ml O2 dissolved
197ml O2 on haemoglobin

77% CO2 dissolved
23% on deoxyhaemoglobin

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40
Q

What is cooperativity

A

When O2 binds to one subunit of haemoglobin it makes other units more likely to bind haemoglobin

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41
Q

What largely effects cooperativity of O2

A

Dissolved O2 in blood
Known as Bohr effect

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42
Q

What increases O2 affinity for haemoglobin

A

Increase pH
Decreased CO2
Decreased temperature
Reduced DPG

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43
Q

What decreases O2 affinity for haemoglobin

A

Decreased pH
Increased CO2
Increased temperature
Increased DPG

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44
Q

What produces DPG

A

Metabolism of erythrocytes

Often occurs in hypoxic areas

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45
Q

Why is CO so dangerous

A

Binds to Hb 250x easier than O2

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46
Q

Symptoms of CO poisoning

A

Hypoxia
Anaemia
Nausea
Headache
Resp rate normal

CHERRY RED SKIN + MUCOUS MEMBRANES

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47
Q

Types of Hb

A

HbA - most Hb
HbA2
HbF - foetal - higher affinity for O2
Glcosylated Hb - when Hb exposed to high levels of glucose
Myoglobin - not actually a Hb, O2 carrier in muscle

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48
Q

Describe CO2 transport

A

7% remains dissolved
23% binds to form deoxyhaemoglobin
70% binds with water to form carbonic acid

Reverse of this happens in pulmonary capillaries

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49
Q

Normal partial pressures of O2 and CO2 in blood

A

O2:
100mmHg
13kPa

CO2:
40mmHg
5kPa

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50
Q

5 main types of hypoxia

A

Hypoxaemic hypoxia
-decreased O2 from lungs

Anaemic Hypoxia
-reduced O2 carry capacity

Stagnant hypoxia
-insufficient heart pumping

Histotoxic hypoxia
-blocks cells using O2 I.E. CO poisoning

Metabolic hypoxia
-cell O2 demand too high

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51
Q

Pulmonary vs alveolar ventilation

A

Pulmonary:
Total air entering lungs

Alveolar:
New air reaching alveoli

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52
Q

What is hyperventilation

A

Too much O2
Alveolar ventilation too fast

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53
Q

What is hypoventilation

A

Too little O2
Alveolar ventilation too slow

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54
Q

What is normal pulmonary blood pressure

A

25/10mmHg

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55
Q

What is the difference between A and a

A

A = alveolar
a = arterial blood

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56
Q

Factors affecting rate of diffusion

A

Partial pressure gradient
Gas solubility
Available surface area
Thickness of membrane

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57
Q

Types of spirometry

A

Static - volume exhaled
Dynamic - time + volume exhaled

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58
Q

What is FEV1

A

Forced expiratory volume in 1 second

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59
Q

What is a normal FEV1/FVC I healthy people

A

80%

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60
Q

What does a high FEV1/FVC indicate

A

Restrictive lung disease

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61
Q

What does a low FEV1/FVC indicate

A

Obstructive lung disease

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62
Q

Symptoms of asthma

A

WHEEZE
Chronic
Dry/nocturnal/exertional cough
Dyspnoea
Reversible with Rx
Multiple triggers

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63
Q

Why is NO test important

A

Tests for eosinophils in allergy/asthma

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64
Q

Important factors in history of suspected asthma

A

Family history of atopy
Personal history of atopy
Triggers

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65
Q

Types of asthma medication

A

SABA
Inhaled corticosteroids
LABA
Leukotriene receptor antagonist
Theophyllines
Oral steroid

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66
Q

Side effects of ICS

A

Height suppression
Oral thrush
Suppression of natural hormones

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67
Q

What are the next steps if ICS is ineffective

A

LABA first
Then consider LTRA/increasing ICS dose

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68
Q

LTRA drug name

A

Montelukast

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69
Q

Asthma delivery systems

A

MDI + spacer
Dry powder device
Nebuliser

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70
Q

Management of asthma exacerbation

A

Mild:
-SABA + prednisolone
Moderate:
-SABA via neb + prednisolone + ipratropium albuterol
Severe:
-IV salbutamol, aminophylline, magnesium, hydrocortisone
-intubate/ventilate

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71
Q

Non medical management of asthma

A

Remove triggers ie pets
Avoid tobacco exposure

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72
Q

How do we measure asthma control

A

SANE
Saba per week
Absence from school/nursery
Nocturnal symptoms per week
Exertional symptoms per week

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73
Q

Is asthma obstructive or restrictive

A

Obstructive

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74
Q

Asthma risk factors

A

Genes
-atopy
Smoking
-maternal during pregnancy
-grandmother smoking
Occupation
Obesity
Diet

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75
Q

Asthma severity assessment

A

Ability to speak
HR
RR
PEF
Sats
ABG

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76
Q

Main test for asthma in adults

A

Spirometry

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77
Q

Other useful tests for asthma in adults

A

CXR
Skin prick
Total and specific IgE count
FBC
- eosinophilia

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78
Q

Specialist options for asthma in adults

A

Omalizumab (anti-IgE)
Mepolizumab (anti-IL-5)
Bronchial thermoplasty

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79
Q

Oral asthma therapies

A

LTRAs
Theophylline
Prednisolone

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80
Q

SABAs

A

Salbutamol
Terbutaline

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81
Q

COPD causes

A

SMOKING
pollution
Occupational exposures
Asthma
Alpha-1 antitrypsin deficiency

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82
Q

COPD symptoms

A

Cough
Dsypnoea
Sputum
Frequent chest infection
Wheeze

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83
Q

Clinical signs of COPD

A

Cyanosis
Cachexia
Difficulty breathing
Raised JVP
Wheeze
Hyperinflated/barrel chest
Peripheral oedema

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84
Q

Types of respiratory failure

A

Type 1: decreased blood O2
Type 2: decreased blood O2 increased blood CO2

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85
Q

COPD spirometry

A

<0.7

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86
Q

Severe symptoms of COPD

A

Type 1 and 2 resp failure
Cor pulmonale

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87
Q

Key features of COPD

A

> 35 yrs
Smokes
Absence of asthma
Obstructive spirometry
CXR
-hyperinflation of lungs
-flat diaphragm
-vascular hilum

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88
Q

Pulmonary function test of COPD

A

Increased volumes
Low FEV1/FVC

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89
Q

What diseases combine to make COPD

A

Chronic bronchitis
Emphysema

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90
Q

Non pharmacological management of COPD

A

SMOKING CESSATION
Pulmonary rehab
Vaccines
-pneumococcus
-influenza

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91
Q

Pharmacological management of COPD

A

SABA eg salbutamol
SAMA eg ipratropium
LAMA eg umeclidinium
LABA eg salmeterol
ICS + LABA
- revlar (fluticasone/vilanterol)
-fostair MDI

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92
Q

Signs of COPD exacerbation

A

Increased SOB
Cough
Sputum volume/colour
Wheeze
Chest tightness

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93
Q

COPD exacerbation management

A

Nebulised bronchodilator
Corticosteroids
Antibiotics
Asses for resp failure

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94
Q

Management of acute resp failure

A

NIV
Non invasive ventilation

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95
Q

Investigation of COPD exacerbation

A

FBC
ABG
ECG
CXR
Blood culture in febrile patients
Sputum culture + sensitivities

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96
Q

Palliative care of COPD

A

Morphine
Psychological support
DNACPR?
Discuss ceiling of treatment

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97
Q

Factors affecting Respiratory Infection

A

Microorganism pathogenicity
Capacity to resist infection
Population at risk

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98
Q

Acute Epiglotitis Cause

A

Haemophilus influenza type B
Group A beta-haemolytic Strep

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99
Q

Types of LRTI

A

Bronchitis
Bronchiolitis
Pneumonia
Bronchiectasis

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100
Q

Defence mechanisms of Respiratory tract

A

Macrophage-mucociliary escalatory system
General immune system
Resp tract secretions
URT is a filter

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101
Q

Classifications of pneumonia

A

Anatomical
Aetiological
Microbiological

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102
Q

Causes of aspiration pneumonia

A

Vomiting
Oesophageal lesion
Obstetric anaesthesia
Neuromuscular disorders
Sedation

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103
Q

Vulnerable groups to TB

A

HIV/immunocompromised patients
Elderly, neonates, diabetics

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104
Q

3 main groups of mycobateria

A

Tuberculosis
Non-tuberculosis mycobacteria
Leprosy

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105
Q

Bacteria causing TB

A

Mycobacterium Tuberculosis
Mycobacterium Africanum
Mycobacterium Bovis

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106
Q

Bacteria causing leprosy

A

Mycobacterium Leprae

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107
Q

Transmission of TB

A

Airborne - aerosol droplets

EXCEPT M.Bovis spread through infected unpastuerized cow milk

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108
Q

TB clinical presentation

A

Cough
Fever
Night sweats
Weight loss

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109
Q

CXR of TB findings

A

Fluffy/nodular apices
Pleural effusion
Miliary TB
Pneumonic lesion with hilar lymphadenopathy

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110
Q

Investigation of TB

A

Sputum culture - 3 samples 8-24hrs gap
Induced sputum
Bronchoscopy
Endobronchial US
Lumbar puncture
Urine
Aspirate/biopsy from tissue

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111
Q

3 Outcomes of TB

A

Cleared/cured
Contained latent
Progressive disease

112
Q

What is contained latent TB

A

Bacteria present doesn’t cause disease
Asymptomatic

113
Q

Contained latent TB treatment

A

Rifampicin + isoniazid for 3 months

114
Q

What is progressive TB

A

Tuberculosis bronchopneumonia
Miliary TB

115
Q

Rules of clinical management of TB

A

Multi antibiotic therapy
Must last 6 months
Done by specialists only
Legally required to notify all cases
Test for HIV, Hep B + C

116
Q

Antibiotic Therapy of TB

A

First 2 months:
Isoniazid + Pyrazinamide + Rifampicin + Ethambutol

Last 4 months:
Rifampicin + Isoniazid

117
Q

Croup Treatment

A

Oral Dexamethasone

118
Q

Epiglotitis Treatment

A

Intubation + antibiotics

119
Q

Rhinitis Typical Duration

A

12 days

120
Q

What does otitis media look like

A

Red
Swelling
Can rupture eardrum

121
Q

Otitis media typical duration

A

3 days

122
Q

Otitis media treatment

A

Analgesia
If antibiotics, wait at least 24hrs

123
Q

Tonsillitis/pharyngitis treatment

A

NOT amoxicillin
Viral - no treatment
Bacterial - penicillin 10 days

124
Q

Tonsillitis/pharyngitis indications of bacterial infection

A

FeverPAIN score
Scarlett fever indicates bacterial
Swab

125
Q

Croup symptoms

A

stridor
hoarsness
barking cough

126
Q

Epiglottits symptoms

A

Stridor
Drooling

127
Q

Common bacteria causing LRTI in children

A

Strep Pneumoniae
Haemophilis influenzae
Moraxella Catarrhalis
Mycoplasma Pneumoniae
Chlamydia Pneumoniae

128
Q

Common viruses causing LRTI in children

A

RSV
Parainfluenza III
Influenza A + B
Adenovirus

129
Q

General management of LRTI in children

A

O2
Hydration
Nutrition

130
Q

Tracheitis (croup which doesn’t get better) treatment

A

Augmentin (Co-amoxiclav)

131
Q

Bronchitis symptoms

A

Loose rattly cough
Hx of URTI
Post-tussive vomit
No wheeze/crackle

132
Q

Common pathogens causing bronchitis in children

A

Haemophilus
Pneumococcus

133
Q

Bronchitis treatment in children

A

None

134
Q

Bronchiolitis symptoms

A

Nasal stuffiness
Tachypnoea
Poor feeding

135
Q

Bronchiolitis findings

A

Crackles
NO wheeze

136
Q

Bronchiolitis typical duration

A

12 days
worst at 5

137
Q

Management of bronchiolitis

A

Maximal observation
Minimal intervention
Watch O2 sats

138
Q

Pertussis symptoms

A

Whooping cough

139
Q

Pneumonia symptoms

A

> 48 hr fever
SOB
Grunting
Reduced/bronchial breathing sounds

140
Q

Pneumonia clinical findings

A

Crackles in 1 area (focal)
Focal consolidation
High fever

141
Q

Management of pneumonia in children

A

Nothing if mild
First line - amoxicillin
2nd line - macrolide
IV antibiotics if child vomiting

142
Q

Empyaema symptoms

A

Unwell
Alot of pain

143
Q

Empyaema treatment

A

Surgically drained
IV antibiotics

144
Q

Adult acute bronchitis duration

A

< 3 weeks

145
Q

Commonest bronchiolitis cause

A

RSV

146
Q

Acute bronchitis treatment

A

none/supportive

147
Q

COPD exacerbation via infection symptoms

A

Sputum colour change
Fever
Increased SOB
Wheeze
Cough

148
Q

Infectious causes of COPD exacerbation

A

Strep
H.Influenzae
Moraxella Catarrhalis
Viral

149
Q

Bronchiectasis causes

A

Idiopathic
Childhood infection
CF
Ciliary Dyskinesia
Hypogammaglobinaemia
Allergic bronchopulmonary aspergillosis (ABPA)

150
Q

Infective exacerbation of bronchiectasis

A

S.Aureus
H.Influenzae
Pseudomonas Aerigunosa

151
Q

Signs + symptoms of bronchiectasis

A

Obstructive spirometry
CXR - signet ring
Chronic sputum production
SOB
Recurrent LRTI
Haemoptysis
Clubbing
Coarse crackles
Wheeze

152
Q

Risk factors of pneumonia

A

Smoking + alcohol
Age
Viral illness
Pre existing lung disease
Immunocompromised
IVDU
Hospital environment

153
Q

Types of pneumonia

A

Bronchopneumonia
Lobar pneumonia
Interstitial pneumonia

154
Q

Pneumonia symptoms

A

Fever
Rigors
Myalgia
Cough + sputum
Pleuritic chest pain
Dsypnoea
Haemoptysis

155
Q

Pneumonia signs

A

Tachy-pnoea/cardia
Reduced chest expansion
Dull patches in percussion
Crepitations
High vocal resonance

156
Q

Pneumonia investigations

A

CXR
In hospital:
Bloods
Swab
Sputum culture
Legionella urinary antigen

157
Q

How is pneumonia severity scored

A

CURB65 score

158
Q

What does CURB65 mean

A

Confusion
Urea - blood urea > 7mmol/L
Resp Rate >= 30
Blood Pressure < 90 S < 60 D
65 age >= 65

159
Q

Treatment for CURB65 score 0-1

A

Amoxicillin
Or for penicillin allergy
Clarithromycin or doxycycline

160
Q

Treatment for CURB65 score of 2

A

Amoxicillin + clarithromycin
Or for penicillin allergy
Levofloxacin

161
Q

Treatment for CURB65 score 3-5

A

Co-amoxiclav + clarithromycin
Or for penicillin allergy
Levofloxacin or co-trimoxazole

162
Q

Causes of recurrent pneumonia

A

Immunocompromised
Underlying structural disease
Aspiration?

163
Q

Complications of pneumonia

A

Sepsis
Acute kidney injury
ARDS
Empyaema
Lung abscess

164
Q

Signs of complicated pneumonia

A

Swinging fever
Sweats
High WCC + CRP
Weight loss
Failure to improve

165
Q

Aetiology of lung cancer

A

SMOKING
Asbestos
Occupational exposure ^
Pulmonary fibrosis
Vaping

166
Q

4 main types of lung cancer

A

Squamous cell
Adenocarcinoma
Small cell carcinoma
Large cell carcinoma

167
Q

What is the worst type of lung cancer

A

Small cell carcinoma

168
Q

Lung cancer investigations

A

CXR
Bronchoscopy
CT, MRI, PET scans
FBC, LFT, renal and calcium test

169
Q

Lung cancer symptoms

A

Haemoptysis
Unexplained weight loss
Fatigue
Cough
SOB
Pleuritic pain

170
Q

Symptoms of lung cancer pressing on nerves

A

Horner’s syndrome
Hoarse, bovine cough
Pancoast T1 damage
Diaphragmatic paralysis

171
Q

Lung cancer treatment

A

Surgery
Radiotherapy
Chemotherapy
Supportive/palliative treatment

172
Q

Complications of obstructive sleep apnoea

A

Hypertension
Stroke
Heart disease
Road accidents

173
Q

Diagnosis of obstructive sleep apnoea

A

Hx + examination
Epworth questionare
Overnight sleep study

174
Q

What is tested in overnight sleep study for obstructive sleep apnoea

A

Pulse oximetry
Full polysomnography
OSA severity

175
Q

What is an apnoea vs a hypoapnoea

A

Apnoea - >10s microarousals
Hypoapnoea - <10s microarousals

176
Q

Causes of obstructive sleep apnoea

A

OBESITY
Genetic - narrow pharynx
Smoking + alcohol
Drug use

177
Q

Treatment of obstructive sleep apnoea

A

Weight reduction
Alcohol avoidance
diagnose + treat endocrine disorders
PAP (positive airway pressure)
Mandibular repositioning splint

178
Q

Clinical features of narcolepsy

A

Cataplexy
Daytime somnolence
Hypnagogic/hypnopompic hallucinations
Sleep paralysis

179
Q

Narcolepsy treatment

A

Modafinil
Dexamphetamine
Venlofaxine - for cataplexy
Sodium oxybate (xyrem)

180
Q

Investigation of narcolepsy

A

PSG
MSLT - multi sleep latency test
- REM within 15 min falling asleep
Low CSF orexin

181
Q

Diseases that form COPD

A

Chronic bronchitis
Emphysema

182
Q

Chronic bronchitis causes

A

SMOKING
Occupation - dust
Pollution

183
Q

Chronic bronchitis clinical definition

A

Sputum cough most days for 3 months at a time, for 2 or more consecutive years

184
Q

Emphysema causes

A

SMOKING
Occupation - dust
Pollution
A1-Antitrypsin deficiency
Elastase/anti-elastase imbalance

185
Q

Emphysema pathological definition

A

Dilatation or destruction of alveoli walls without obvious fibrosis

186
Q

4 main types of emphysema

A

Centriacinar
Panacinar
Periacinar
Scar ephysema

187
Q

What is centriacinar emphysema

A

Large pockets of air at end of terminal bronchiole
Seen in smokers
Mainly at apices of lungs

188
Q

What is panacinar emphysema

A

All alveoli dilated
Seen in heavy smokers
Seen in A1-Antitrypsin deficiency

189
Q

What is periacinar emphysema

A

Spaces develop around blood vessels and pleura
Can rupture and lead to pneumothorax

190
Q

Why does COPD cause hypoxia

A

Airway obstruction
Reduced respiratory drive
Less alveolar surface area
Shunt during exacerbation

191
Q

Pulmonary vascular changes in hypoxia

A

Low O2 areas vasoconstrict
Pulmonary bp raises
Also due to 2ndary polycythaemia!
Hypertrophy of RV
Cor Pulmonale

192
Q

Chronic ventilatory failure definition

A

pCO2 > 6kPA
pO2 < 8kPA
Normal blood pH
Elevated bicarbonate

193
Q

Chronic ventilatory failure symptoms

A

SOB
Orthopnoea
Peripheral oedema
Morning headache
Recurrent chest infection
Disturbed sleep

194
Q

Chronic ventilatory failure findings

A

Paradoxical abdominal wall movement
Ankle oedema

195
Q

Chronic ventilatory failure aetiology

A

Airway disease
Chest wall abnormality
Resp muscle weakness
Central hypoventilation

196
Q

Investigation of NMD in Chronic ventilatory failure

A

Lung function tests
Assessment of hypoventilation
Fluoroscopic screening of diaphragm

197
Q

Treatment of Chronic ventilatory failure

A

Domicillary NIV
O2
Tracheostomy ventilation

198
Q

Restrictive lung disease definition

A

FVC <80% of normal
FEV1/FVC often around 0.9

199
Q

Restrictive lung disease lung causes

A

Interstitial lung disease
Sarcoidosis
Hypersensitivity pneumonitis

200
Q

Restrictive lung disease skeletal causes

A

Kyphoscoliosis
Ankylosing sponditis
Thoracoplasty
Rib Fracture

201
Q

Restrictive lung disease sub-diaphragmatic causes

A

Obesity
Pregnancy

202
Q

Restrictive lung disease pleural causes

A

Pleural effusion
Pneumothorax
Pleural thickening

203
Q

Restrictive lung disease muscular causes

A

Amyotrophic lateral sclerosis
MND

204
Q

What is interstitial lung disease

A

Disease causing thickening of space between alveoli and capillary

205
Q

Examples of Interstitial lung diseases

A

Sarcoidosis
Idiopathic pulmonary fibrosis
Hypersensitivity Pneumonitis

206
Q

Hypersensitivity pneumonitis examples

A

Bird fanciers lung
Farmers lung
Malt workers lung

207
Q

Hypersensitivity pneumonitis causes

A

Exposure to a lot of foreign antigens ie
-bird/animal proteins
-Fungi
-Chemicals
Thermophilic actinomycetes

208
Q

Acute hypersensitivity pneumonitis presentation

A

Fever, dry cough, myalgia
Chills, 4-9 hrs after exposure
Crackles, tachypnoea, wheeze
Precipitating antibody

209
Q

Chronic hypersensitivity pneumonitis presentation

A

Insidious
Malaise, SOB, cough
Low grade illness
Crackles + wheeze

210
Q

Hypersensitivity pneumonitis treatment

A

Prednisone

211
Q

Idiopathic pulmonary fibrosis presentation

A

Chronic SOB + cough
Typically older men
Failed treatment for LVF or infection
Clubbing + crackles

212
Q

Idiopathic pulmonary fibrosis treatment

A

Refer to ILD clinic
Oral anti-fibrotics
Palliative care
Transplant

213
Q

Anti-fibrotic drugs

A

Perfenidone
Nintedanib

214
Q

Sarcoidosis presentation

A

Dry cough
Non caseating granuloma
Erythaema of skin
Multi system

215
Q

Who usually gets sarcoidosis

A

Adults < 40
Women > Men
Worldwide

216
Q

Sarcoidosis investigation

A

History + exam
CXR
Pulmonary function tests
Bloods
Urinalysis
ECG
TB skin test
Eye exam
Bronchoscopy
EBUS

217
Q

Sarcoidosis treatment

A

Mild disease - none
Erythaema nodusum/arthralgia - NSAID
Skin lesions/cough - Topical Csteroid
Serious disease - Systemic corticosteroids

218
Q

Sarcoidosis diagnosis

A

Clinical findings
Imaging findings
Serum calcium and ACE
Biopsy

219
Q

Screening for developmental lung disease

A

Antenatal scanning
Newborn symptoms

220
Q

Laryngomalacia presentation

A

Stridor
-worse while upset and feeding

221
Q

Tracheomalacia presentation

A

Barking cough
Recurrent croup
SOB on exertion
Stridor/wheeze

222
Q

Tracheomalacia management

A

Physio
Antibiotics while unwell
Resolves with time

223
Q

Tracheo-oesophageal fistula presentation

A

Choking
Colour change
Cough with feeding
Unable to pass NG tube

224
Q

Tracheo-oesophageal fistula treatment

A

Surgery

225
Q

What is CPAM

A

Congenital pulmonary airway malfunction

Abnormal functioning lung tissue

226
Q

Congenital diaphragmatic hernia treatment

A

Surgical repair

227
Q

Examples of neonatal lung disease

A

IRDS
Transient tachypnoea
Chronic Lung disease

228
Q

Transient tachypnoea cause

A

Infant doesnt clear lungs properly
Associated with Caesarian section

229
Q

IRDS names

A

Infant resp distress syndrome
Hyaline membrane disease

230
Q

IRDS cause

A

Lack of surfactant
Associated with preterm birth

231
Q

IRDS treatment

A

Antenatal steroids
Surfactant replacement
Appropriate ventilation + nutrition

232
Q

Which gene is mutated in CF

A

CFTR

233
Q

What pathological changes occur in CF

A

Abnormal Cl and Na transport lead to
-Thick sticky mucus
-reduced surfactant production

234
Q

How many classes of CF mutation are there

A

6
I - III severe
IV - VI are less severe

235
Q

What is the most common CF mutation

A

Type II - F508 Deletion
75% of CF cases

236
Q

Diagnosis of CF

A

Antenatally
Neonatal screening
-day 5 blood spot
If neonatal screening positive refer for clinical assessment and sweat test

237
Q

Which classes of CF are pancreatic insufficient

A

I-III

238
Q

Symptoms of pancreatic insufficiency

A

Malabsorption
Abnormal stools
- pale, offensive, floats
Failure to thrive

239
Q

Symptoms of CF

A

Nail clubbing
Salty skin
Recurrent infection
Poor growth
Bulky/greasy stools

240
Q

Imaging of CF

A

CXR
CT scan

241
Q

Features of CF on imaging

A

Tramlines
Signet rings
Consolidation
Mucous plugging

242
Q

Nutritional management of CF

A

Creon
High fat
Fat soluable vitamin +
mineral supplements

243
Q

Management of mucus in CF

A

Physiotherapy
Mucolytics
Bronchodilators

244
Q

Management of inflammation in CF

A

Azithromycin

245
Q

Management of fibrosis/scarring/bronchiectasis in CF

A

Supportive treatment
Symptom management

246
Q

Other conditions to consider with CF

A

Diabetes
Osteoporosis
Pneumothorax
Haemoptysis

247
Q

New drugs altering CFTR production

A

Ivacaftor
Lumacaftor
Tezacaftor

248
Q

Indications for lung transplant in CF

A

Rapidly deteriorating lung function
FEV1 <30% predicted
Life threatening exacerbations
Estimated survival < 2yrs
Recurrent pneumothorax
Recurrent severe haemoptysis

249
Q

Contra-indications for lung transplant in CF

A

Other organ failure
Malignancy within 5 yrs
Significant peripheral vascular disease
Drug/nicotine/alcohol dependancy
Active systemic infection

250
Q

Dangerous infections to consider with CF

A

Non-TB Mycobacteria
Burkholderia Cepacia
Pseudomonas Aeroginosa

251
Q

DVT and PE risk factors

A

Trauma
Surgery
Cancer
Pregnancy
Inherited thrombophilia ie
-Factor V Leiden
-Protein C or S deficiency

252
Q

DVT and PE investigations

A

FBC
Troponin
ABG
D-Dimer
CXR
V/Q scan
CTPA

253
Q

PE treatment

A

O2
Low weight heparin ie dalteparin
Warfarin
DOACs
Thrombolysis
Pulmonary embolectomy

254
Q

How is PE prognosis scored

A

PESI (PE severity index) score

255
Q

PE symptoms

A

Pleuritic chest pain
Cough
Haemoptysis
Acute dyspnoea

256
Q

Severe PE symptoms

A

Syncope
Cardiac arrest

257
Q

PE signs

A

Pyrexia
Pleural rub
Dull percussion at base - effusion
Tachy-pnoea/cardia
Hypoxia
Hypotension

258
Q

Tests for probability of PE and DVT

A

Wells score
Revised Geneva score

259
Q

What is pulmonary hypertension

A

> 20mmHg

260
Q

Causes of pulmonary hypertension

A

Idiopathic
Secondary to LHD
Secondary to chronic resp disease
Chronic thromboembolic pulmonary Hypertension (CTEPH)
Miscellaneous ie sarcoid

261
Q

Symptoms of pulmonary hypertension

A

Exertional dyspnoea
Chest tightness
Exertional syncope/presyncope
Haemoptysis

262
Q

Signs of pulmonary hypertension

A

Elevated JVP
RV heave
Loud 2nd pulmonary heart sound
Hepatomegaly
Ankle oedema

263
Q

Investigation of pulmonary hypertension

A

ECG
Lung function test
CXR
Echocardiography
V/Q scan
CTPA

264
Q

General treatment of pulmonary hypertension

A

Treat underlying condition
O2
Anticoagulants (IPAH only)
Diuretics

265
Q

Specialist treatment of pulmonary hypertension

A

Endothelin receptor antagonists
-Bosentan
-Ambrisentan

266
Q

Types of pleural Pathologies

A

Pleural effusion
Pneumothorax
Mesothelioma

267
Q

What is a transudative pleural effusion

A

Occurs does to increased hydrostatic pressure or low plasma oncotic pressure

268
Q

What is an exudative pleural effusion

A

Occurs due to increased capillary permeability - protein movement increases osmotic gradient

269
Q

Transudate pleural effusion causes

A

LVF
Liver cirrhosis

270
Q

Exudative pleural effusion causes

A

Malignancy
Parapneumonic effusion
TB

271
Q

Types of pneumothorax

A

Spontaneous
Traumatic
Iatrogenic
Tension

272
Q

Presentation of pneumothorax

A

Sudden onset
Chest pain, SOB

273
Q

Hx of pneumothorax

A

Tall thin young men
Underlying lung disease
Hx of biopsy, line or mechanical ventilation

274
Q

Examination findings of pneumothorax

A

Tachypnoea
Hypoxia
Reduced chest wall movement
Hyper-resonancy percussion
May be normal

275
Q

Diagnosis of pneumothorax

A

CXR
CT thorax
Ultrasound from experienced operator

276
Q

Management of pneumothorax

A

Observation
Aspiration if >2cm
Chest drain
Surgery if recurring problem

277
Q

Diagnosis of pleural tumours

A

CXR
CT thorax + biopsy

Medicine (13 decks)

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