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2A > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what is COPD?

A
  • chronic respiratory symptoms eg cough, SOB
  • airflow obstruction
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2
Q

what is FEV1

A

forced expiratory volume in one second

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3
Q

what is FVC

A

forced vital capacity

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4
Q

what FEV1/FVC ratio show airflow obstruction

A

<0.7

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5
Q

what is bronchitis characterised by?

A

chronic cough
sputum production
(for at least 3 months in 2 consecutive years)

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6
Q

what are GOLD grades in COPD?

A

1 - mild - FEV1 >80%
2 - moderate - FEV1 50-80%
3 - severe - FEV1 30-50%
4 - very severe - FEV1 <30%

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7
Q

COPD risk factors

A

Smoking
Biomass fumes
Occupational exposures
Air pollution
Genetic factors
Aging population

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8
Q

symptoms of COPD

A
  • SOB
  • cough
  • wheeze
  • sputum
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9
Q

signs of COPD

A
  • tachypnoea
  • accessory muscle use
  • hyperextended chest
  • cyanosis
  • cor pulmonal
  • weight loss
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10
Q

differential diagnosis of COPD

A

Heart failure
Pulmonary embolus
Pneumonia
Lung cancer
Asthma
Bronchiectasis

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11
Q

what does xray show in COPD

A

hyperinflated lungs

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12
Q

what is MRC dyspnoea scale

A

1 SOB on vigorous exercise
2 SOB going up hills
3 Able to walk on flat at own pace
4 Exercise tolerance 100-200 meters on flat
5 Housebound/SOB on minor tasks or dressing

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13
Q

what is CAT assessment

A

asseses COPD severity
Qs like sleep, tight chest? etc..

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14
Q

prevention of COPD

A
  • stopping smoking
  • PPE
  • air quality measures
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15
Q

management of COPD non pharmaceutical

A
  • pulmonary rehab programme - exercise program
  • smoking cessation/nicotine replacement therapy - most important factor
  • vaccinations eg flu
  • lung vol reduction surgery
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16
Q

medications for COPD

A

-Beta 2 agonists (SABA/LABA) (SABA - salbutamol)
- anticholinergics
- inhaled corticosteroids

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17
Q

what are inhaled corticosteroids not recommended?

A
  • repeated pneumonia events
  • blood eosiophils <100
  • history of myobacterial infection
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18
Q

what is procalcitonin

A

inflammation marker
- more specific to bacterial infection that CRP

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19
Q

what is acute exacerbation of COPD

A

worening of symptoms beyond normal variation
- breathlessness, fever, sputum change

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20
Q

resp failure type 1 vs 2

A

1 - low paO2 normal/low Paco2
2 low paO2, HIGH paCo2

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21
Q

what causes a raised alveolar-arterial gradient

A

V/Q mismatch
diffusion limitation
Shunt

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22
Q

restrictive vs obstructive airflow

A

restrictive - low FVC, ratio normal - parenchyma/chest wall conditions
obstructive - FEV1 low, ratio <0.7 - airway conditions

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23
Q

causes of low/high TLCO

A

low - reduced lung vol
high - increased capillary blood flow - large lung vol - obesity/severe asthma - pulmonary haemorrhage

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24
Q

what is pneumothorax

A

collapse of the lung - air in pleural space - injury or hole in lung/pleura

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25
Q

common presentation of pneumothorax

A

tall, thin young man
sudden breathlessness and pleuritic chest pain

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26
Q

cause of pneumothorax

A
  • spontaneous
  • trauma
  • iatrogenic - eg from biopsy
  • infection
  • asthma/copd
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27
Q

investigations for pheumothorax

A

erect chest xray - shows no lung markings
- measure by BTS guidelines
- ct thorax if too small to be seen on xray

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28
Q

management of high risk pneumothorax

A

chest drain

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29
Q

management options for lower risk pneumothorax

A
  • conservative
  • pleural vent ambulatory device
  • needle aspiration, chest drain
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30
Q

where is a chest drain inserted

A

triangle of safety
- 5th intercostal space
- midaxillary line
- anterior axillary line
just above rib - avoids neurovascular bundle

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31
Q

complication of chest drain

A

air leaks around drain site
surgical emphysema (subacutaneous)

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32
Q

surgical options for pheumothorax

A

(if recurrent or chest drain fails)
- by Video-assisted thoracoscopic surgery (VATS)
abrasive or chemical pleurodesis
pleurectomy

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33
Q

what can tension pneumothorax lead to

A

cardiorespiratory arrest

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34
Q

signs of tension pneumothorax

A

Tracheal deviation away from the side of the pneumothorax
Reduced air entry on the affected side
Increased resonance to percussion on the affected side
Tachycardia
Hypotension

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35
Q

management of tension pneumothorax

A

Insert a large bore cannula into the second intercostal space in the midclavicular line - to relieve pressure
- follow with chest drain

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36
Q

what is ruptured in primary spontaneous pneumothorax

A

apical pleural bleb

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37
Q

symptoms of pneumothorax

A

breathlessness
pleuretic chest pain
cough

38
Q

signs of pneumothorax

A

Tachyopnoea
— Hypoxia
— Unilateral chest wall expansion
— Reduced breath sounds
— Hyper-resonant percussion note

39
Q

tension pneumothorax

A

valve-like mechanism
- +ve pleural pressure
- displaces mediastinum and cardiac compromise

40
Q

what is pleural effusion

A

collection of fluid in pleural space

41
Q

causes of transudate pleural effusion

A
  • HF
  • cirrhotic liver diease
  • renal failure
  • hypoalbuminemia
  • myxoedema
  • meig syndrome
42
Q

causes of exudate pleural effusion

A
  • pneumonia
  • cancer
  • TB
  • autoimmune
  • PE
  • DRugs
43
Q

exudate vs transudate

A

trans - pleural fluid protein <1/2 serum protein
ex - >1/2 serum protein

44
Q

symptoms of pleural effusion

A
  • asymptomatic
  • breathlessness
  • cough
  • pain
  • fever
45
Q

signs of pleural effusion

A

Reduced chest wall
expansion
— Quiet breath sounds
— “Stony” Dull Percussion
— Reduced tactile/ vocal
fremitus
— Meditational shift away from affected side

46
Q

chest xray pleural effusion

A

blunting of diaphragm
fluid in lung fissures
meniscus - larger effusion
tracheal/mediastinal deviation

47
Q

lights criteria for exudative effusion

A

pleural fluid protein / serum protein greater than 0.5
Pleural fluid LDH / serum LDH greater than 0.6
Pleural fluid LDH greater than 2/3 of the normal upper limit of the serum LDH

48
Q

triad for meigs syndrome

A

pleural effusion
benign ovarian tumour
ascites

49
Q

pleural fluid analysis

A

protein count
LDH
pH
Glucose
microbiology

50
Q

what is empyema

A

infected pleural effusion
- pus, low pH, low glucose, high LDH
- treated with chest drain and antibiotics

51
Q

treatment of pleural effusion

A

conservative - small effusions resolve when treating underlying cause
- pleural aspiration - may recur
- chest drain

52
Q

microbiology for TB

A

zeihl nelson stain - turn bright red against blue background
(resistant to acid staining) - acid-fast bacilli

53
Q

disease course of TB

A

immediate clearance
primary activation
latent TB
secondary TB

54
Q

extrapulmonary TB

A

areas other than lungs
eg lymph nodes, pleura, CNS, pericardium etc

55
Q

abscess type in TB

A

COLD abscess in neck
- not red and painfull

56
Q

BCG vaccine

A
  • protects against M.tuberculosis - severe form and complicated but less against pulmonary TB
  • Mantoux test prior
57
Q

presenatation of TB

A

cough (haemoptysis)
lethargy
fever/night sweats
weight loss
lymphadenopathy
erythema nodosum (on shins)
spinal pain - potts disease

58
Q

tests for immune response for TB

A

mantoux test (tuberculin intradermally shows bleb over 5mm)
interferon-gamma release assay

59
Q

primary Tb on xray

A

patchy consolidation,
pleural effusions
hilar lymphadenopathy.

60
Q

reactivated TB on xray

A

patchy or nodular consolidation with cavitation

61
Q

disseminated miliary (uncontrolled) TB on xray

A

millet seeds

62
Q

cultures for TB

A
  • sputum - induction with nebulised hypertonic saline or bronchoscopy and bronchoalveolar lavage if not enough
  • mycobacterium blood culture
  • lymph node aspiration or biospy
    then NAAT
63
Q

treatment of latent TB

A

isoniazid (6months) or 3months with rifampicin

64
Q

treatment for active TB

A

R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months

65
Q

what is given to prevent peripheral neuropathy by isoniazid

A

pyridoxine
or vit B6

66
Q

side effects of TB drugs

A

Numbness or unusual sensations in their feet implicates isoniazide (“I’m-so-numb-azid”). Difficulty recognising colours implicates ethambutol (“eye-thambutol”). Urine or tears that are orange or red implicates rifampicin (“red-I’m-pissin’”).

67
Q

what are interstitial lung diseases

A

broad spectrum of conditions affecting lung interstitium - space between alveolus and capilaries

68
Q

most common type of ILD

A

idiopathic pulmonary fibrosis

69
Q

pathology of ILD

A
  • inflammation and fibrosis
  • extracellular matrix secreted
  • interstitium becomes thicker
  • increased diffusion distance - gas exchange compramised
70
Q

primary causes of ILD

A
  • Idiopathic pulmonary fibrosis
  • Acute interstitial pneumonia
  • desquamative interstitial pneumonia
71
Q

secondary causes of ILD

A
  • RA, SLE
  • Drugs - amiodarone
  • infective - mycoplasma pneumonia
  • environmental - asbestosis
72
Q

risk factors for ILD

A
  • male
  • smoking
  • occupational - dust exposure etc
73
Q

symptoms of ILD

A
  • Progressive exertional dyspnoea
  • dry cough
  • connective tissue symptoms eg arthralgia, dysphagia, dry eyes
  • malaise fatigue
    (signs of connective tissue diseases eg Raynaud’s)
74
Q

ILD lung function tests

A

restrictive - FVC reduced, FEV1 reduced
- may be normal

75
Q

ILD xray

A

reticular opacities (thickening of interstitium)- lower/upper zone

76
Q

investigations for ILD

A
  • HRCT
  • chest xray
  • cpr/esr
  • FBC - may show anaemia
  • antibodies for autoimmune conditions
  • bronchalveolar lavage or lung biopsy may be needed
77
Q

causes of upper zone fibrosis ILD

A

Coal-worker pneumoconiosis

Histiocytosis-X

Ankylosing spondylitis

Radiation (e.g. for breast cancer)

Tuberculosis

Sarcoidosis and silicosis

78
Q

causes of lower zone fibrosis ILD

A

Rheumatoid arthritis

Asbestosis

SLE, scleroderma and Sjogren’s syndrome

Idiopathic pulmonary fibrosis

Others (including drugs)

79
Q

management of ILD

A
  • smoking cessation
  • vaccines - flue & pneumococcal
  • antifibrotics for idiopathic pulmonary fibrosis - pirfenidone/nintedanib
  • corticosteroids for RA etc
80
Q

complications of ILD

A
  • resp failure
  • pulmonary hypertension
  • anxiety/depression
  • cushings syndrome from corticosteroids
81
Q

lung carcinoma risk factors

A
  • smoking
  • occupation eg asbestos
  • air pollution
  • ionising radiation
  • genetics
  • chronic lung diseases
82
Q

progression of lung cancer

A
  • atypical adenomatous hyperplasia
  • carcinoma in-situ
  • invasive carcinoma
83
Q

presentation of lung cancer

A
  • persistant cough
  • haeoptysis
  • SOB
  • weight loss, fatigue
  • complications eg pleural effusion, pneumothorax
  • asymptomatic
84
Q

2 broad types of lung carcinoma

A

small cell
non-small cell

85
Q

subtypes of lung cancer

A

adenocarcinoma
squamous cell carcinoma - (non)keratinising
small cell carcinoma - neuroendo

86
Q

diagnosis of lung cancer

A
  • CT/CT-PET
  • biopsy
87
Q

what tumour receptor means better response for immune modulator therapy

A

PD-L1 - non-small cell

88
Q

pleural malignancy

A
  • risk factor = asbestos
  • pleural thickening, persistent pleural effusion
  • proliferation of mesothelial cells
89
Q

FISH diagnosis of mesothelioma

A

p16 homozygous deletion - support diagnosis but doesn’t exclude

90
Q

histology of ipf

A

usual interstitial pneumonia

91
Q
A

2A (9 decks)

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