Respiratory Flashcards
1
Q
Lung malignancy associated with asbestos
A
Mesothelioma
2
Q
Presentation of lung cancer
A
SOB
Cough
Haemoptysis
Finger clubbing
Lymphadenopathy
Weight loss
Recurrent pneumonia
3
Q
Clubbing causes
A
Respiratory
- Pulmonary fibrosis
- Lung Cancer
- Bronchiectasis
- Tb
not COPD?
Cardio
- Heart failure
- Endocarditis
Gastro
-IBD
4
Q
SIADH presentation
A
Syndrome of inappropriate ADH
Ectopic ADH secreted by small-cell lung cancer - presents with hyponatremia
5
Q
Cushing’s syndrome small cell lung cancer
A
Ectopic ACTH secretion
6
Q
Hypercalcaemia lung cancer
A
Ectopic parathyroid hormone secreted by squamous cell carcinoma
7
Q
Lung cancer bloods don’t forget
A
Electrolytes
- Ca - PTH secretion
- Na - ADH secretion
8
Q
Thrombocytosis causes - raised platelet count
A
Blood loss, cancer, infections, bone marrow damage, recent surgery, splenectomy
9
Q
Thrombocytopenia causes
A
Bleeding, infections, immune thrombocytopenia, blood cancers.
10
Q
Lung cancer syspected - investigation first?
A
CXR
11
Q
CXR findings suggestive of cancer
A
Hilar enlargement, peripheral opacity, pleural effusion (unilateral), collapse
12
Q
CXR suggests lung cancer - then what
A
Staging CT chest abdo & pelvis, PET CT
Bronchoscopy with endobronchial ultrasound
Biopsy - percutaneous or via bronchospy
13
Q
Treatment lung cancer
A
Surgery, radiation, chemo.
Stents if obstruct
14
Q
Pneumonia is
A
Infection of the lung tissue, causing inflammation of the alveolar space
15
Q
Acute bronchitis is
A
Infection and inflammation in the bronchi & bronchioles
16
Q
LRTI includes
A
Pneumonia & Acute bronchitis
17
Q
LRTI vs URTI causative organism
A
The lower down in the respiratory tract the more likely to be bacterial
18
Q
Pneumonia classifications
A
Community acquired
Hospital acquired
Ventilator acquired
Aspiration pneumonia
19
Q
Aspiration pneumonia is associated with which bacteria
A
Anaerobic
20
Q
Pneumonia symptoms
A
Cough
Sputum production
SOB
Fever
Malaise
Haemoptysis
Pleuritic chest pain
Delirium - acute confusion
21
Q
Chest examination of pneumonia
A
Bronchial Breath sounds
Focal coase crackles
Dullness to percussion
22
Q
CURB-65 predicts
A
Mortality with pneumonia - use to determine treatment at home, hospital, ICU
23
Q
CURB-65 stands for
A
Confusion
Urea >7
Resp rate >30
Blood pressure <90 systolic, <60 diastolic
age 65
24
Q
Top causes of typical bacterial pneumonia (2)
A
Streptococcus pneumoniae
Haemophilus influenzae
25
Cystic fibrosis or bronchiectasis pneumonia causative organism
Pseudomonas aeruginosa
26
Hospital acquired pneumonia organism
MRSA
27
Immunocompromised patients, chronic pulmonary disease - pneumonia causative organism
Moraxella catarrhalis
28
Atypical pneumonia caused by
organisms that cannot be culture in the nomal way, or detected using a gram stain.
29
Atypical pneumonia treatment with penicillin is
Ineffective - use macrolides - clarithromycin, tetracycline - doxycline
30
Causes atypical pneumonia
Legionella, Mycoplasma pneumoniae.
Pneumocystis jirovecii - fungal
31
Legionella
The typical exam patient has recently had a cheap hotel holiday and presents with pneumonia symptoms and hyponatraemia. A urine antigen test can be used as an initial screening test.
32
Patients with low CD4 in HIV are prescribed prophylacted co-trimoxazole to protect against
Pneumocytis jiovecii pneumonia - PCP - a fungal pneumonia
33
Pneumonia investigations
CRP
CBC
Renal profile - urea level for CURB-65 score, and AKI
CXR
For moderate or severe infection
-Sputum cultures
-Blood cultures
34
Pneumonia management
Typical - ABx amoxicillin, doxycycline
Moderate may need IV ABx first.
Respirator support - Oxygen, intubation and ventilation
35
Complications pneumonia
Sepsis, acute respiratory distress syndrome, pleural effusion, empyema, lung abscess, death
36
Empyema
Collection of pus in a cavity in the body
Infected pleural effusion
37
ABG normal value for pH
7.35-7.45
38
ABG normal value for HCO3
22-26
39
Type 1 respiratory failure
low o2, normal co2
40
Type 2 respiratory failure
low o2, high co2
41
Causes of respiratory alkalosis
hyperventilation - anxiety, PE
42
Causes of metabolic acidosis
DKA, diarrhoea, renal failure, hypoxia raised lactate
43
Metabolic alkalosis causes
Vomiting
44
Acute respiratory distress syndrome is
Severe inflammatory reaction of the lungs often secondary to pneumonia or trauma
45
Acute respiratory distress syndrome clnical findings
Atalectasis, pulmonary oedema, decreased lung compliance, fibrosis of lung tissue
46
Acute respiratory distress syndrome symptoms
Respiratory distress, hypoxia
47
PEEP
Positive end-expiratory pressure - keeps airway from collapsing
48
CPAP
Provides Peep
49
Obstructive disease diagnosis
FEV1/FVC < 70%
50
Obstructive lung disease examples
Asthma, COPD
51
Restrictive lung disease diagnosis
FEV1 and FVC equally reduced
FEV1 and FVC ratio greater than 70%
52
Restrictive lung disease examples
Interstitial lung disease
Sarcoidosis
Obesity
53
Peak flow reduced in
Obstructive lung disease, especially asthma
54
Asthma - other atopic conditions
Eczema, hay fever, allergies
55
Asthma presentation
Dyspnoea, chest tightness, dry cough, wheeze
Symptoms should improve with bronchodilators
56
Asthma examination
Normal when patient is well
Polyphonic expiratory wheeze
57
localised wheeze differentials
Inhaled foreign body, tumour, thick sticky mucus plug obstructing airway
CXR next step
58
Typical triggers of asthma
Infection, night time or early morning, exercise, animals, cold damp air, strong emotions.
59
Asthma investigations
Spirometry, reversibility testing (give bronchodilator & expect 12 % increase in FEV1)
60
SMART therapy
Formoterol + ?
61
Asthma management additional
Yearly flu jab, regular exercise, avoid smoking, avoid triggers, careful when sick change dose
62
Acute exacerbation of asthma grading
Proportion of peak flow compared to predicted or best
63
COPD is
Long-term, progressive condition involving airway obstruction, chronic bronchitis and emphysema.
64
Chronic bronchitis is the
long-term symptoms of a cough
65
Emphysema is
damage and dilation of the alveolar sacs and alveoli, decreasing the surface area for gas exchange.
66
COPD salbutamol
Minimally reversible
67
COPD
Shortness of breath, cough, sputum, wheeze, recurrent respiratory infections especially in winterr
68
COPD investigations
CXR especially to exclude other pathology.
FBC
Sputum culture
ECG, Echo
Serum alpha-1-antitrypsin deficiency
69
SAMA example
Ipratropium
70
COPD long term management
Annual flu vaccine
SMOKING Cessation
71
Cor pulmonale is
Right sided heart failure caused by respiratory disease (pulmonary hypertension).
COPD, PE, interstitial lung disease, cystic fibrosis.
72
Cor pulmonale signs on examination
Hypoxia, Raised JVP, Peripheral oedema
parasternal heave
Murmurs
Hepatomegaly
73
Acute exacerbation of COPD typically causes respiratory acidosis or alkalosis
Acidosis - CO2 retaining
74
IE COPD investigations
CXR, ECG, FBC, Us&Es to check electrolytes, Sputum culture, blood culture
75
O2 therapy in COPD
Tend to retain CO2 when treated with oxygen - target o2 sats of 88-92%
76
COPD management of acute exacerbation
Inhalers or nebulisers
steroids
antibiotics
Respiratory physiotherapy
Monitor - ABGs
77
Bronchiectasis is
Involves permanent dilation of the bronchi
78
Causes of bronchiectasis
Damage to airways
- idiopathic
- pneumonia
- whooping cough
- Tb
- Cystic fibrosis
- RA
79
Symptoms bronchiectasis
SOB
Chronic productive cough
Recurrent chest infections
Weight loss
80
Bronchiectasis clinical signs
Clubbing, Cor pulmonale, Scattered crackles that clear with coughing, scattered wheezes and squeaks.
81
Common infective organisms bronchiectasis
Haemophilus influenza, pseudomonas aeruginosa
82
Test of choice for bronchiectasis
high resolution CT
83
Management bronchiectasis
Vaccines
Respiratory physiotherapy
Long term antibiotics for frequent exacerbations
Long acting bronchodilators for breathlessness
Long term oxygen therapy
Lung transplant end stage
nfective exacerbations require:
Sputum culture (before antibiotics)
Extended courses of antibiotics, usually 7–14 days
Ciprofloxacin is the usual choice for exacerbations caused by Pseudomonas aeruginosa
84
Interstitial lung disease is
Inflammation and fibrosis of the lung parenchyma - fibrosis involves the replacement of elastic and functional lung tissue with non-functional scar tissue.
85
Symptoms of interstitial lung disease
Shortness of breath on exertion, dry cough, fatigue
86
Idiopathic pulmonary fibrosis findings on examination
Bibasal inspiratory crackles, finger clubbing, reduced chest expansion
87
Diagnosis of intersitial lung disease involves
Clinical features, high resolution CT, spirometry showing restrictive pattern
88
Management interstitial lung disease
Poor prognosis & limited options
- remove or treat underlying cause
- home oxygen
- stop smoking
- flu vaccine
- advanced care planning
89
Respiratory ask about
Asbestos
Home damp
90
Idiopathic pulmonary fibrosis
No apparent cause
2-5 year life expectancy from diagnosis
Pirfenidone reduces fibrosis and inflammation through various mechanisms
Nintedanib reduces fibrosis and inflammation by inhibiting tyrosine kinase
91
Secondary Pulmonary Fibrosis
Several drugs can cause pulmonary fibrosis:
Amiodarone (also causes grey/blue skin)
Cyclophosphamide
Methotrexate
Nitrofurantoin
Pulmonary fibrosis can occur secondary to other conditions:
Alpha-1 antitrypsin deficiency
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Systemic sclerosis
Sarcoidosis
92
Hypersensitivity Pneumonitis
Allergic alveolitis - hypersensitivity to environmental allergen.
Raised lymphocytes
93
Two types of pleural effusion
Exudative (high protein)
Transudative (low protein)
94
Exudative causes of pleural effusion (3)
Related to inflammation
- lung cancer
- infection - pneumonia or TB
- RA
95
Transudative causes of pleural effusion (3)
Heart failure, hypoalbuminaemia, hypothyroid
96
Pleural effusion symptoms
Shortness of breath
97
Examination findings pleural effusion
-Dullness to percussion over the effusion
-Reduced breath sounds
- tracheal deviation away from the effusion in very large effusions
98
Pleural effusions investigations
CXR - blunting of costophrenic angle
- fluid in the lung fissures
- larger effusions will a meniscus - a curving upwards where it meets the chest wall and mediastinum
- tracheal deviation away from effusion
99
Pleural effusion small
Ultrasound and CT
100
Treatment pleural effusion
-Conservative management
- Pleural aspiration - drain
- Chest drain - drain and prevent recur
101
Pneumothorax is
Air enters the pleural space - separating the lung from the chest wall
102
Pneumothorax causes
Spontaneous, trauma, iatrogenic e.g. lung biopsy
Lung pathologies such as infection, asthma or COPD
103
Pneumothorax investigation
CXR
104
Pneumothorax management
No SOB - spontaneously resolve
SOB - Aspiration, or chest drain
105
Chest drain insertion point
Triangle of Safety
- 5th ICS
- Mid-axillary line
- Anterior axillary line (pec major edge)
106
Chest drain complications
Subcutaneous emphysema
107
Tension pneumothorax
Trauma - creates one way valve air in but not out of pleural space - pressure on mediastinum cardiorespiratory arrest
108
Management of tension pneumothorax
pressure relieved with cannula
then chest drain
109
Signs of tension pneumothorax
Tracheal deviation away, reduced air entry, increased resonance to percussion, tachycardia, hypotension
110
PE risks
Immobility, recent surgery, pregnancy, hormone therapy with oestrogen, malignancy, thrombophilia, long haul flights.
111
VTE prophylaxis
Enoxaparin
TEDS (unless PAD)
112
Presentation PE
SOB
Cough
Haemoptysis
Pleuritis chest pain
Hypoxia
Tachycardia
Raised resp rate
Low grade fever
+ may be signs DVT
113
PE tools online
PERC - pulmonary embolism rule out criteria
Wells score - predicts probability of patient having a PE
114
Diagnosis PE
CXR - usually normal, rule out other pathology
Wells score
D-dimer
CTPA
114
Conditions raised D-dimer
Pneumonia, malignancy, HF, surgery, pregnancy
115
PE management
Hospital admission, oxygen, analgesia, monitoring for deterioration
Anticoagulation
Thrombolysis (risk of bleeding)
116
PE long term anticoagulation
3 months if a reversible cause otherwise longer
117
Pulmonary hypertension refers to
Increased resistance and pressure in pulmonary arteries - causes strain on the right side of the heart
118
Causes of pulmonary hypertension
Left heart failure
Chronic lung disease - COPD or pulmonary fibrosis
PE
119
Signs and symptoms Pulmonary hypertension
SOB mainly
Also raised JVP, peripheral oedema
120
Investigations pulmonary htn
ECG - right axis deviation, R bundle branch block
CXR - R ventricular hypertrophy
proBNP
Echo
121
Pulmonary HTN management
CCB
Treat underlying cause
Supportive treatments - oxygen and diuretics
122
Sarcoidosis
Chronic granulomatous disorder
123
Sarcoidosis skin features
Erythema nodosum - appear kind of like bruises
124
Sarcoidosis imaging & bloods
Raised ACE - screening test, hypercalcaemia
- CXR - hilar lymphadenopathy
- CT
+ histology
125
Sarcoidosis management
Conservative if mild, oral steroids
Sarcoidosis spontaneously resolves 1/2 time, otherwise progress to pulmonary fibrosis
126
OSA risk factors
Middle age, male, obesity, alcohol, smoking
127
Presentation OSA
Snoring, morning headache, waking up unrefreshed, daytime sleepiness and concentration problems
Severe can cause HTN & HF
128
OSA investigations
STOP BANG
Epworth sleepiness scale
Then sleep study
129
Management
CPAP machine, reduce risk factors
130
Signs and symptoms of pleural effusion
Signs - reduced chest expansion, reduced breath sounds, reduced vocal resonance, tracheal deviation away, stony dull to percussion
Symptoms - dry cough, dyspnoea, orthopnoea, chest pain
131
HFrEF which of will not reduce mortality
Aldosterone agonist, ACEi, loop diuretic or B blocker
Loop diuretic
132
Large QRS complexes
LV hypertrophy
133
