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Finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What causes COPD?

A

smoking, occupation, environmental exposure

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2
Q

What is chronic bronchitis and emphysema?

A

Chronic bronchitis = inflammation in the bronchi –> cough and sputum
Emphysema = dilatation of the alveolar sacs and alveoli –> reduced SA for gas exchange

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3
Q

What is the difference between COPD and asthma?

A

COPD is minimally reversible with bronchodilators (both obstructive)

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4
Q

What would you see on spirometry with COPD?

A

FEV1:FVC ratio of <0.7 = obstructive
Little to no response to reversibility testing

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5
Q

How do you assess the severity of COPD?

A

Mild = FEV1 >80%
Moderate = FEV1 50-79%
Severe = FEV1 30-49%
Very severe = FEV1 <30%

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6
Q

What does a CXR show for those with COPD?

A

Hyperinflation, flattening of diaphragm and hyperlucent lung fields

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7
Q

Why do COPD patients have polycythaemia?

A

Chronic hypoxia –> raised Hb

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8
Q

When should we test for alpha-1 antitrypsin deficiency?

A

Young patient (<40) with COPD symptoms, unresponsive to treatments given

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9
Q

what is the iniital steps in medical management of COPD?

A

SABA or SAMA

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10
Q

If there are no asthmatic or steroid responsive features what is the 2nd step in treating COPD? (after SABA and SAMA)

A

LABA and LAMA

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11
Q

If there are asthmatic or steroid responsive features what is the 2nd step in treating COPD? (after SABA and SAMA)

A

LABA and ICS

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12
Q

What is the third stage of managing COPD?

A

LABA, LAMA and ICS

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13
Q

What is cor pulmonale?

A

Right sided heart failure caused by respiratory disease - pulmonary HTN limits RV pumping blood into pulmonary vessels –> back pressure

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14
Q

What are the symptoms of cor pulmonale?

A

SOB, oedema, breathlessness on exertion, syncope, chest pain

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15
Q

What is the most common bacterial cause of infective COPD exacerbation?

A

Haemophilus Influenzae

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16
Q

What is the management for acute COPD?

A
  1. regular nebulisers - salbutamol and ipratropium
  2. steroids - prednisolone 30mg OD for 5 days
  3. antibiotics if signs of infection
  4. oxygen - guided by ABG numbers
  5. may require escalating to ICU or NIV
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17
Q

Which type of NIV is used for what type of respiratory failure?

A

Type 1 = CPAP
Type 2 = BiPAP

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18
Q

What is the pathophysiology of asthma?

A

Chronic inflammation in airways due to smooth muscle hypersensitivity –> bronchoconstriction that is reversible with bronchodilators

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19
Q

When are symptoms worse with asthma?

A

Diurnal variation - typically worse early in mornings and at night

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20
Q

What would you see on spirometry in asthma?

A

FEV1:FVC ratio of <0.7 (obstructive)
Reversibility of this with bronchodilators (should increase by at least 12%)

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21
Q

What other tests can be done to diagnose asthma in those with normal spirometry?

A

Fractional exhaled nitric oxide, peak flow variability, direct bronchial challenge testing

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22
Q

What is the step wise approach for asthma management?

A
  1. SABA PRN
  2. ICS low dose
  3. LRTA (discontinue if no effect)
  4. LABA
  5. Consider MART
  6. Increase ICS to moderate dose
  7. Consider high dose ICS/LAMA/theophylline
  8. Refer
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23
Q

During acute exacerbation of COPD what occurs on the ABG?

A

Initially have respiratory alkalosis due to raised respiratory rate –> respiratory acidosis as it progresses (bad sign as shows they are getting tired)

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24
Q

What are the features of moderate asthma? (1)

A

50-75% peak flow

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25
Q

What are the features of severe asthma? (4)

A

Peak flow 33-50%
Resp rate >25
HR >110
Unable to complete full sentences

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26
Q

What are the features of life-threatening asthma?

A

Peak flow <33%
Sats <92%
PaO2 <8kPa
Becoming tired
Confusion or agitation
Silent chest
Haemodynamic instability

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27
Q

What is the stepwise approach for managing acute asthma?

A
  1. Oxygen
  2. Salbutamol nebulisers
  3. Ipratropium nebulisers
  4. IV Hydrocortisone/ PO prednisolone
  5. IV magnesium sulphate
  6. Aminophylline/IV salbutamol
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28
Q

What needs to be done following an acute asthma attack?

A

Optimise long term management, rescue pack of oral steroids, before discharge need to be stable on discharge meds for at least 12 hours

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29
Q

Which type of lung cancers causes paraneoplastic syndromeS?

A

SCLC

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30
Q

What is the most common sub type of lung cancer?

A

Adenocarcinoma

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31
Q

What symptoms occur in lung cancer?

A

SOB, cough, haemoptysis, clubbing, weight loss, lymphadenopathy (supraclavicular)

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32
Q

What can occur due to a pancoast tumour?

A

Horner’s syndrome due to tumour in apex pressing on the sympathetic ganglion - ptosis, anhidrosis and miosis

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33
Q

What paraneoplastic syndromes are associated with SCLC?

A

SIADH, Cushing’s, hypercalcaemia, Lambert-eaton, limbic encephalitis

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34
Q

Lung cancers can put pressure on surrounding structures which can lead to ..?

A

Recurrent laryngeal nerve palsy, phrenic nerve palsy, SVC obstruction

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35
Q

What does a CXR show in someone with lung cancer?

A

Hilar enlargement, peripheral opacity, unilateral pleural effusion, lobe collapse

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36
Q

What investigations are done in lung cancer?

A

CXR = 1st line (done in 2ww clinic), staging CT, PET scan, bronchoscopy with endobronchial USS biopsy

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37
Q

What is the treatment for someone with SCLC?

A

Chemotherapy + adjuvant radiotherapy

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38
Q

What is the treatment for someone with early non-small cell lung cancer?

A

Surgery or radiotherapy can both be curative in early disease

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39
Q

What two things increase survival rates in those with COPD?

A

Smoking cessation and LTOT

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40
Q

What is the criteria for 2ww referral for lung cancer?

A

Over 40 and: clubbing, lymphadenopathy, recurrent/persistent chest infection, raised platelet count or CXR findings

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41
Q

Where is aspiration pneumonia likely to be in the lungs?

A

Right middle or lower lobe - due to right main bronchus being more vertical

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42
Q

What symptoms would you see in pneumonia?

A

Cough, sputum production, SOB, fever, pleuritic chest pain

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43
Q

What do you score a point for on the CURB-65?

A

C- confusion
U- urea>7mmol/l
R- RR>30
B- BP<90 systolic
65 - age >65

44
Q

What are the most common causes of bacterial pneumonia?

A

Strep pneumoniae and haemophilus influenzae

45
Q

What investigations would you do in pneumonia?

A

Sputum cultures, blood cultures, antigen tests for atypical

46
Q

What are the standard antibiotics for pneumonia?

A

Amoxicillin + clarithromycin/doxycycline for atypical

47
Q

How is TB spread?

A

Inhaling saliva droplets from infected individuals

48
Q

What are the risk factors for TB?

A

Close contacts with active TB, immigrants, immunocompromised, neglect, IVDU

49
Q

What are the presenting symptoms in TB?

A

Chronic symptoms: cough, haemoptysis, tiredness, weight loss, lymphadenopathy

50
Q

What investigations would you do to diagnose TB?

A

3 sputum cultures, CXR (patchy consolidation, pleural effusions and hilar lymphadenopathy)

51
Q

What tests can be used to check for previous TB infection?

A

Mantoux test and interferon-gamma release assay

52
Q

What are the 4 treatments used for TB and their common side effects?

A

Rifampicin 6 months - red secretions, P450 inducer
Isoniazid 6 months - peripheral neuropathy
Pyrazinamide 2 months - gout and kidney stones
Ethambutol 2 months - colour blindness

53
Q

What are the risk factors for PE?

A

Immobility, recent surgery, long haul travel, oral oestrogen, malignancy, polycythaemia

54
Q

What is the classic presentation of PE?

A

Hypoxic patient, clear chest, tachycardia
May also have pleuritic chest pain and haemoptysis

55
Q

What is the initial and gold standard investigation for PE?

A

D-dimer initial test done if wells score says PE is unlikely
CTPA/VQ scan - gold standard done in those where Wells score says PE is likely

56
Q

What are the first and second line treatment options for PE?

A

1st line = apixiaban/rivaroxaban
2nd line = LMWH

57
Q

What treatments are used to prevent PE?

A

Stockings and LMWH (prophylactic dose)

58
Q

What is the treatment for a massive PE with haemodynamic compromise?

A

Continuous unfractionated heparin infusion

59
Q

What is bronchiectasis?

A

Permanent dilatation of the bronchi

60
Q

What are the symptoms associated with bronchietasis?

A

SOB, chronic productive cough, recurrent chest infections, weight loss

61
Q

What is the gold standard for diagnosing bronchiectasis?

A

High resolution CT

62
Q

How do you treat bronchiectasis?

A

LTOT, LABA, chest physio, prophylactic abx

63
Q

How is CF inherited and on what chromosome is the mutation?

A

Autosomal recessive
Chromosome 7

64
Q

What symptoms are common in CF?

A

chronic cough, thick sputum, recurrent LRTI, steatorrhoea, failure to thrive

65
Q

How is CF diagnosed?

A

Newborn blood spot test, sweat test = gold standard, genetic testing during pregnancy

66
Q

How do they treat pseudomonas colonisation in CF?

A

Nebulised tobramycin and oral ciprofloxacin

67
Q

What are exudative causes of pleural effusion? (high protein)

A

Cancer, infection, rheumatoid arthritis, pulmonary embolism

68
Q

What are the transudative causes of pleural effusion? (low protein)

A

Heart failure, hypoalbuminaemia, hypothyroidism, meig’s syndrome

69
Q

What examination findings are present in pleural effusions?

A

Dullness to percussion, reduced breath sound, tracheal deviation away from effusion (if big)

70
Q

What CXR findings are present in pleural effusions?

A

Blunting of the costophrenic angle, fluid in lung fissures, may have meniscus

71
Q

Who are the typical patients in primary sponatenous pneumothoraces?

A

Tall, thin, young male who smoke and play sport

72
Q

What is the management of primary pneumothroax <2cm and no SOB?

A

No treatment required - follow up in 2-4 weeks

73
Q

What is the management of primary pnuemothorax >2cm or SOB?

A

Aspiration with 16G cannula, if reamins >2cm or the patient remains SOB following this a chest drain should be inserted

74
Q

Which pneumothorax patients require a chest drain insertion instead of aspiration?

A

Unstable patients, bilateral and secondary pneumothroaces >2cm

75
Q

What are the signs of tension pneumothorax on examination?

A

Tracheal deviation away from pneumothorax, reduced air entry, increased resonance to percussion on affected side

76
Q

What is the management for tension pneumothorax?

A

Insert large bore cannula into 2nd IC space midclavicular line - needle decompression

Followed by chest drain = definitive management

77
Q

What is pulmonary hypertension?

A

Increased pressure in the pulmonary arteries >20mmHg

78
Q

What ECG would you expect in right sided heart strain caused by pulmonary disease?

A

Tall R waves in V1 and V2, deep S waves in V5 and V6, right axis deviation and RBBB

79
Q

What treatments are used for pulmonary hypertension

A

sildenafil, epoprostenol, iloprost

80
Q

What is the typical patient for sarcoidosis?

A

Black, woman aged 20-39 with erythema nodosum

81
Q

What results of spirometry would you expect in interstitial lung disease?

A

Restrictive =
FEV1 reduced-normal
FVC reduced
FEV1:FVC >0.7

82
Q

What blood test results are associated with sarcoidosis?

A

Raised ACE, raised calcium

83
Q

What does a CXR show in sarcoidosis?

A

Bilateral hilar lymphadenopathy

84
Q

What treatments are available for sarcoidosis?

A

Steroids and methotrexate

85
Q

What are the key features of interstitial lung disease?

Symptoms and exam findings

A

SOBOE, dry cough, fatigue, bi-basal inspiratory crackles, finger clubbing

86
Q

What treatments are available for idiopathic pulmonary fibrosis?

A

Pirfenidone, nintedanib

87
Q

What are the typical features of someone with anti-GBM/good pastures syndrome?

A

Acute kidney failure and coughing up blood

88
Q

What management is required for secondary pneumothoraxes with rim of air 1-2cm?

A

Aspiration with 16G cannula, if this fails chest drain

89
Q

What is the management of someone with secondary pneumothorax <1cm?

A

Oxygen and admit for observation for 24 hours

90
Q

What organism commonly causes pneumonia in alcoholics and diabetics?

A

Klebsiella pneumoniae - causes cavitating lesions in upper lobes and currant jelly-like sputum

91
Q

Which type of pneumonia commonly causes erythema multiforme?

A

Mycoplasma pneumoniae

92
Q

What organisms are associated with hospital acquired pneumonia?

A

E.coli, staph, Klebsiella

93
Q

How is legionnaire’s diseases treated?

A

Clarithromycin

94
Q

What is the treatment of hospital acquired pneumonia?

A

Within 5 days of admission = co-amoxiclav or cefuroxime

More than 5 days after admission = tazocin

95
Q

What is atelectasis?

A

Post op complication that results in basal alveolar collapse

96
Q

What are the features of a lung abscess?

A

Subacute presentation (weeks to months)
Persistent cough with foul smelling sputum, fever, dullness to percussion, SOB

97
Q

What are the causes of lung abscess?

A

Most commonly aspiration pneumonia, but can also spread from blood, or come from bronchial obstruction e.g. lung cancer

98
Q

Which kind of lung cancer are cavitating lesions most commonly found?

A

Squamous cell carcinoma

99
Q

Which subtype of lung cancer is most commonly found in non-smokers?

A

Adenocarcinoma

100
Q

When are steroids indicated to treat sarcoidosis?

A

Symptomatic, hypercalcaemia or have heart/eye/neuro involvement

101
Q

Give an example of the common types of inhalers - SABA, SAMA, LAMA, LABA

A

SABA - salbutamol
SAMA - ipratropium
LABA - salmeterol
LAMA - tiotropium

102
Q

What is the criteria for LTOT in COPD patients?

A

pO2 <7.3 or between 7.3 and 8 + one of the following:
secondary polycythaemia, peripheral oedema, pulmonary hypertension

103
Q

Following a case if pneumonia what follow up should a patient have?

A

Repeat CXR in 6 weeks

104
Q

What are the findings that someone is tiring in severe asthma attacks?

A

CO2 retention and therefore low pH

105
Q

How does legionnaire’s disease present and how is it diagnosed?

A

Severe pneumonia, hyponatraemia and deranged LFTs
Can be diagnosed on urinary antigen

106
Q

Which lung cancer is associated with gynaecomastia?

A

Adenocarcinoma

107
Q
A

Finals (21 decks)

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