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PA Conditions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is pneumonia?

Name pneumonia treatments.

A

LRTI, bacterial, inflammation with consolidation leading to infection of bronchi

Abx- oral/IV amox
Painkiller- NSAIDS
Vaccines- early pneumococcal
O2 therapy
Cough assistance
Ventilation support

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2
Q

Name pneumonia investigation?

A

Acute- ABCDE
Bloods- FBC, U&E, CRP, LFT, lactate
Obs
ECG
CXR
Sputum/ blood cultures
CURB-65

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3
Q

What is bronchiectasis?

Name bronchiectasis investigations?

A

Permanent dilation of airways leading to sputum accumulation -> inflammation -> infections
Caused by other diseases- CF, obstruction, immune, A-1AT def

Bloods- FBC, U&E, CRP, LFT,
Obs
CXR
HRCT
Spirometry
Cystic fibrosis test
Aspergillus antigen test
Sputum/ blood cultures

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4
Q

Name bronchiectasis management?

A

Antibiotics
Mucolytics
Inhaled corticosteroids
Bronchodilators
Chest physio/ airway clearance
O2 therapy
Lung transplant

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5
Q

Name respiratory failure investigations?

A

Acute= ABCDE
Bloods- FBC, U&E, CRP, LFT, TFT, CK
Obs
ABGs
Sputum cultures
ECG
Lung function- spirometry
CXR
HRCT

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6
Q

Name respiratory failure management?

A

Main goal to support oxygenation
Acute= ITU -> ABCDE
Assisted ventilation- intubation and mechanical ventilation-> invasive
Non-invasive ventilation- venturi/ non-rebreather

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7
Q

What is respiratory failure?

Name the causes of respiratory failure?

A

Failure of gas exchange/ ventilation leading to inability to maintain inadequate levels of O2= abnormal PaO2 + PaCO2

  1. V/Q mismatch-
    shunt- good perfusion but poor ventilation= blood not undergoing gas exchange= obstruction

Physiologic dead space- good ventilation but poor perfusion (shock, PE, COPD, asthma)

  1. Airway obstruction
    Fibrosis
    Oedema
    Foreign bodies
    Asthma/ COPD
    Compression- tumour/ lymph
  2. Impaired ventilation (hypoventilation)
    Neurological depression- drugs/ anaesthesia
    Nerve impairment- injury/ inflammation
    Chest wall injury
    Fatigue of respiratory muscle
  3. Impaired gas exchange
    O2/CO2 unable to cross alveoli/capillary membrane
    Toxic gas inhalation
    Pneumonia
    Sepsis
    ARDS
    Pneumothorax/ effusion/ oedema
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8
Q

What is cystic fibrosis?

Name cystic fibrosis management?

A

Genetic (autosomal recessive C7) delta-F508 mutation of the CFTR gene which controls Cl- and Na+ movement
Mutation= Cl- unable to pump out of epithelium -> water unable to move in -> thick mucus that clogs airways

Antibiotics
Chest physio/ clearance
Muclytics
Mental health support
Diabetes control
High calorie diet
Lung transplant
Cortiocosteroids
Lumacaftor/ Ivacaftor

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9
Q

Name cystic fibrosis investigation?

A

Sweat test- babies
Genetic testing
CXR
HRCT
Sputum cultures
Bloods

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10
Q

Name pulmonary embolism investigation?

What is a PE?

A

Bloods- D-dimer, FBC, U&E, CRP, LFT
CXR
HRCT
ABG

Thrombus formed in deep veins in lower limbs that has travelled to lungs and blocked artery

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11
Q

Name pulmonary embolism management?

A

Blood thinners- heparin/ warfarin

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12
Q

Name pulmonary hypertension investigations?

What is PH?

A

Bloods- D-dimer, FBC, U&E, CRP, LFT
CXR
ABG
ECG
ECHO
Spirometry
V/Q scan

Increased arterial pressure in lung vessels

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13
Q

Name pulmonary hypertension management?

A

Anticoagulant- warfarin
Diuretics
Digoxin
O2 therapy
Lung/ heart transplant
Balloon therapy angioplasty

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14
Q

Name lung cancer investigations?

A

2WW referral
Emergency admission
X-ray/ CT
Biopsy of lung
Lung function test
Determine pre-existing co-morbidities
MDT- patient reviewed by an MDT to ensure best outcome and correct diagnosis

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15
Q

Name lung cancer management?

A

Lobectomy- entire lung lobe removed

Wedge recession- tumour removal and a wedge of lung to ensure all cancer cells have been removed

Bi-lobectomy- 2 lobes of the right lung removed (Upper + Lower) or (Midder + Lower)

Pneumectomy- whole lung is removed (R or L)

Radiotherapy- stereotactic radiotherapy or stereotactic radiosurgery- high does to a specific region with minimal damage to surrounding tissue

Chemotherapy- cytotoxic drugs- severe side effects due to killing healthy cells

Tyrosine kinase inhibitors TKI’s- prevent cancer growth by blocking TK growth signals, only work on patients with certain genetic mutations and non-smokers

Immunotherapies- boost immune system, PDL-1 receptor blockers prevent cancers ability to hide from immune system

Pain medications

Holistic- yoga

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16
Q

Name asthma investigation?

What is asthma?

A

Bloods- FBC, U&E, LTF, CRP
Chest x-ray
ABGs- high O2 due to high RR and low CO2
Spirometry- FEV1:FVC <0.7
Challenge testing- administering histamine to induce symptoms and conform diagnosis
Skin-prick/ serum IgE

Obstructive lung condition
Chronic inflammation, swelling and constriction of bronchioles -> reversible with corticosteroids
* Excessive mucus production
* Airway obstruction
* Bronchoconstriction
Smooth muscles tighten -> airways swell -> mucus clogging airways -> difficulty moving air in/ out.

17
Q

Name asthma management?

A

1st-line: SAB2A- salbutamol (rapid action, airway dilation)
2nd-line: Inhaled Corticosteroids (ICS)- hydrocortisone, beclometasone (reduce inflammation)
3rd-line: LABA + ICS- Symbicort, formoterol
4th-line- Leukotriene receptor antagonists (LTRAs)- alternative to LABA + ICS

Poorly controlled- biologic therapy (mabs)

Other:
Periodic assessment- step-up or step-down
Asthma education for patient
Smoking cessation/ healthy diet
Good inhaler technique
Avoiding triggers

Acute a
sthma attack= ABCDE -> IV access for drugs -> ABG ->SaO2 >94% -> SABA neb -> LABA neb -> steroids
Follow-up following attack- GP -> specialist review -> customised asthma management plan

18
Q

Name COPD management?

A

First-line: mild= SABA and/or SAMA
Second-line if fails to improve= SAMA + LABA + ICS
Third-line: If LABA fails to improve then add LAMA -> (SABA + LABA +LAMA)

If patients don’t respond to this regime, a trial period of a SABA + LABA + LAMA + ICS can be offered for 3 months.

1st: SABA + SAMA
2nd: SABA + LABA + ICS
3rd: SABA +LABA + LAMA
4th: SABA +LABA + LAMA +ICS

MRC dyspnoea scale
Smoking cessation!!!
Pulmonary rehab- exercise/ breathing techniques
Personalised management plan
Weight management
Vaccinations
Rescue pack- antibiotics and steroids

Final step- lung transplant or bullectomy

19
Q

Name COPD investigation?

A

Bloods- FBC, CRP, U&E, LFT, lactate
Chest x-ray- hyperinflation, bullae, flat diaphragm,
ECG- tachycardia
PFT- obstructive pattern
ABGs- reduced PaO2 and hypercapnia- unable to breath out CO2
Spirometry- grade severity from stage 1-4
Genetic testing- A1AT deficiency
Grade SOB on MRC dyspnoea scale

20
Q

Name pleural effusion investigation?

Name types of effusion.

A

Inspection
Palpation
Percussion
Auscultation
Chest X-ray/ CT
Ultrasound

Pleural effusion- fluid in pleural space
Pneumothorax- air in pleural space
Mesothelioma- pleural malignancy
Haemothorax- blood in pleural space (trauma, cancer, embolism)
Chylothorax- lymphatic fluid in pleural space
Empyema- pus in pleural space (secondary infection)

21
Q

Name pleural effusion management?

A

Thoracentesis- fluid/ air removal from thoracic cavity.
Needle through 7-8th intercostal space below rib to avoid nerves.

Diagnostic/therapeutic- biopsy or fluid sample
Pleural fluid protein content analysis-
Transudate- low protein content = increased capillary hydrostatic P + decreased osmotic P = fluid leakage (heart failure, cirrhosis)
Exudate- high protein content = increased capillary permeability due to inflammation (pneumonia, TB, malignancy)

CT/ X-RAY- not pneumothorax

Treatment of Underlying Cause:
• Infection: Antibiotics are prescribed for bacterial infections.
• Heart Failure: Diuretics and medications to manage heart failure may be recommended.
• Malignancies: Treatment options may include surgery, chemotherapy, or radiation therapy.

22
Q

Name pneumothorax investigation?

A

Clinical examination
Inspection
Palpation
Percussion
Auscultation
Never CXR if tension

23
Q

Name pneumothorax management?

What is pneumothorax?

A

Tension pneumothorax- medical emergency and refer straight to intensive care and perform thoracostomy needle decompression to relieve air (2nd IC mid-clavicular) and not delay by X-ray/CT

Other pneumothorax
History
Examination
Chest X-ray
Distinguish between PSP or SSP

Abnormal amount of air in pleural space
Open- air enters the pleural cavity but some is able to escape, intrapleural pressure does not increase dramatically

Tension- life threatening condition caused by the continuous entrance and entrapment of air into the pleural space that is not able to escape = compressing of the lungs, heart, blood vessels- underlaying conditions or trauma (open chest wound, rib fracture)- results in cardiac arrest

24
Q

Likely causes bilateral hilar adenopathy?

A

Sarcoidosis
Infections- TB, fungal
Malignancy

A multisystem disorder characterised by the formation of non-caseating granulomas and typically presents with adenopathy in the hilar region of the lungs, hence it is usually an incidental finding on chest x-ray.

Causes- hypercalcemia, infection, immune response -> inflammation -> granuloma formation, genetic predisposition, dust/chemicals,

25
Q

How does alkolising spondylitis affect lung function?

A

Ankylosing spondylitis causes a restrictive defect on pulmonary function testing
FEV1 and FVC values are both reduced
Combination of apical lung fibrosis and thoracic kyphosis
Reduced chest wall expansion.

26
Q

How do pleural plaques present on x-rays?

A

Fibrous wall thickening of the pleura
Related to asbestos exposure

27
Q

Most common organism that causes cavitating lesion in pneumonia?

A

Klebsiella pneumoniae most commonly causes cavitating pneumonia lesions in the upper lobes, mainly in diabetics and alcoholics

28
Q

What are the FEV1/FVC classification readings for CODP?

A

MILD: FEV1 <80%
MODERATE: FVE1 between 50%-70%
SEVERE: FVE1 between 30%-49%
VERY SEVERE: FEV1 48%-<30%

29
Q

What could COPD symptoms in a young patient also possibly mean?

A

Alpha-1 antitrypsin deficiency
This is commonly misdiagnosed as asthma or COPD.

30
Q

Management of acute exacerbations of COPD?

A
  1. Prednisolone 30mg for 5 days
  2. Increase the frequency of bronchodilator use and consider giving via a nebulise
  3. Oral antibiotics first-line: amoxicillin or clarithromycin or doxycycline.
31
Q

What does a patient’s ABG with DKA who has diabetes show?

A

Metabolic acidosis with increased anion gap

32
Q

Name lung cancer types, location and associated conditions/ symptoms.

A

SCLC- central, Cushing’s syndrome

Adenocarcinoma- peripheral, women, non-smokers, asbestos, gynaecomastia
Squamous cell- central, columnar -> squamous, hypercalcemia
Large cell- peripheral
Pancoast tumours
Paraneoplastic syndrome- SC
Bronchial carcinoid- throughout
Mesothelioma- cancer of the pleura due to asbestos exposure

33
Q

What is CODP?

A

Inflammation of bronchial tubes leading to persistent cough with mucus

2 Causes:
Emphysema
Chronic bronchitis

Chronic bronchitis: Chronic, slowly progressive airflow limitation caused by an inflammatory response from poisonous substances.
Non-reversible

Chronic bronchitis= Irritation from substance -> inflammation bronchi -> increased mucus production -> mucus plugging-> productive cough

Emphysema characteristics:
Alveolar damage -> reduction in surface area for gas exchange
Loss of elasticity -> reduced expansion
Increased air trapping -> harder air to move in and out

Emphysema causes:
Acquired emphysema- alpha-1 antitrypsin inactivated due to smoking. Centriacinar and affects apical areas of lungs

Genetic emphysema- alpha-1 antitrypsin absent due to inherited genetic deficiency. Panacinar and affects lower areas of lungs

Smoking
Occupational- asbestos

34
Q

CODP causes?

A

Smoking
A1AT- deficiency
Occupational- asbestos
Repeated resp infections
Age- older

PA Conditions (13 decks)

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