Respiratory Flashcards
1
Q
what is COPD?
A
- chronic respiratory symptoms eg cough, SOB
- airflow obstruction
2
Q
what is FEV1
A
forced expiratory volume in one second
3
Q
what is FVC
A
forced vital capacity
4
Q
what FEV1/FVC ratio show airflow obstruction
A
<0.7
5
Q
what is bronchitis characterised by?
A
chronic cough
sputum production
(for at least 3 months in 2 consecutive years)
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%
7
Q
COPD risk factors
A
Smoking
Biomass fumes
Occupational exposures
Air pollution
Genetic factors
Aging population
8
Q
symptoms of COPD
A
- SOB
- cough
- wheeze
- sputum
9
Q
signs of COPD
A
- tachypnoea
- accessory muscle use
- hyperextended chest
- cyanosis
- cor pulmonal
- weight loss
10
Q
differential diagnosis of COPD
A
Heart failure
Pulmonary embolus
Pneumonia
Lung cancer
Asthma
Bronchiectasis
11
Q
what does xray show in COPD
A
hyperinflated lungs
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
13
Q
what is CAT assessment
A
asseses COPD severity
Qs like sleep, tight chest? etc..
14
Q
prevention of COPD
A
- stopping smoking
- PPE
- air quality measures
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
16
Q
medications for COPD
A
-Beta 2 agonists (SABA/LABA) (SABA - salbutamol)
- anticholinergics
- inhaled corticosteroids
17
Q
what are inhaled corticosteroids not recommended?
A
- repeated pneumonia events
- blood eosiophils <100
- history of myobacterial infection
18
Q
what is procalcitonin
A
inflammation marker
- more specific to bacterial infection that CRP
19
Q
what is acute exacerbation of COPD
A
worening of symptoms beyond normal variation
- breathlessness, fever, sputum change
20
Q
resp failure type 1 vs 2
A
1 - low paO2 normal/low Paco2
2 low paO2, HIGH paCo2
21
Q
what causes a raised alveolar-arterial gradient
A
V/Q mismatch
diffusion limitation
Shunt
22
Q
restrictive vs obstructive airflow
A
restrictive - low FVC, ratio normal - parenchyma/chest wall conditions
obstructive - FEV1 low, ratio <0.7 - airway conditions
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
24
Q
what is pneumothorax
A
collapse of the lung - air in pleural space - injury or hole in lung/pleura
25
common presentation of pneumothorax
tall, thin young man
sudden breathlessness and pleuritic chest pain
26
cause of pneumothorax
- spontaneous
- trauma
- iatrogenic - eg from biopsy
- infection
- asthma/copd
27
investigations for pheumothorax
erect chest xray - shows no lung markings
- measure by BTS guidelines
- ct thorax if too small to be seen on xray
28
management of high risk pneumothorax
chest drain
29
management options for lower risk pneumothorax
- conservative
- pleural vent ambulatory device
- needle aspiration, chest drain
30
where is a chest drain inserted
triangle of safety
- 5th intercostal space
- midaxillary line
- anterior axillary line
just above rib - avoids neurovascular bundle
31
complication of chest drain
air leaks around drain site
surgical emphysema (subacutaneous)
32
surgical options for pheumothorax
(if recurrent or chest drain fails)
- by Video-assisted thoracoscopic surgery (VATS)
abrasive or chemical pleurodesis
pleurectomy
33
what can tension pneumothorax lead to
cardiorespiratory arrest
34
signs of tension pneumothorax
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
35
management of tension pneumothorax
Insert a large bore cannula into the second intercostal space in the midclavicular line - to relieve pressure
- follow with chest drain
36
what is ruptured in primary spontaneous pneumothorax
apical pleural bleb
37
symptoms of pneumothorax
breathlessness
pleuretic chest pain
cough
38
signs of pneumothorax
Tachyopnoea
Hypoxia
Unilateral chest wall expansion
Reduced breath sounds
Hyper-resonant percussion note
39
tension pneumothorax
valve-like mechanism
- +ve pleural pressure
- displaces mediastinum and cardiac compromise
40
what is pleural effusion
collection of fluid in pleural space
41
causes of transudate pleural effusion
- HF
- cirrhotic liver diease
- renal failure
- hypoalbuminemia
- myxoedema
- meig syndrome
42
causes of exudate pleural effusion
- pneumonia
- cancer
- TB
- autoimmune
- PE
- DRugs
43
exudate vs transudate
trans - pleural fluid protein <1/2 serum protein
ex - >1/2 serum protein
44
symptoms of pleural effusion
- asymptomatic
- breathlessness
- cough
- pain
- fever
45
signs of pleural effusion
Reduced chest wall
expansion
Quiet breath sounds
“Stony” Dull Percussion
Reduced tactile/ vocal
fremitus
Meditational shift away from affected side
46
chest xray pleural effusion
blunting of diaphragm
fluid in lung fissures
meniscus - larger effusion
tracheal/mediastinal deviation
47
lights criteria for exudative effusion
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
triad for meigs syndrome
pleural effusion
benign ovarian tumour
ascites
49
pleural fluid analysis
protein count
LDH
pH
Glucose
microbiology
50
what is empyema
infected pleural effusion
- pus, low pH, low glucose, high LDH
- treated with chest drain and antibiotics
51
treatment of pleural effusion
conservative - small effusions resolve when treating underlying cause
- pleural aspiration - may recur
- chest drain
52
microbiology for TB
zeihl nelson stain - turn bright red against blue background
(resistant to acid staining) - acid-fast bacilli
53
disease course of TB
immediate clearance
primary activation
latent TB
secondary TB
54
extrapulmonary TB
areas other than lungs
eg lymph nodes, pleura, CNS, pericardium etc
55
abscess type in TB
COLD abscess in neck
- not red and painfull
56
BCG vaccine
- protects against M.tuberculosis - severe form and complicated but less against pulmonary TB
- Mantoux test prior
57
presenatation of TB
cough (haemoptysis)
lethargy
fever/night sweats
weight loss
lymphadenopathy
erythema nodosum (on shins)
spinal pain - potts disease
58
tests for immune response for TB
mantoux test (tuberculin intradermally shows bleb over 5mm)
interferon-gamma release assay
59
primary Tb on xray
patchy consolidation,
pleural effusions
hilar lymphadenopathy.
60
reactivated TB on xray
patchy or nodular consolidation with cavitation
61
disseminated miliary (uncontrolled) TB on xray
millet seeds
62
cultures for TB
- 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
treatment of latent TB
isoniazid (6months) or 3months with rifampicin
64
treatment for active TB
R – Rifampicin for 6 months
I – Isoniazid for 6 months
P – Pyrazinamide for 2 months
E – Ethambutol for 2 months
65
what is given to prevent peripheral neuropathy by isoniazid
pyridoxine
or vit B6
66
side effects of TB drugs
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
what are interstitial lung diseases
broad spectrum of conditions affecting lung interstitium - space between alveolus and capilaries
68
most common type of ILD
idiopathic pulmonary fibrosis
69
pathology of ILD
- inflammation and fibrosis
- extracellular matrix secreted
- interstitium becomes thicker
- increased diffusion distance - gas exchange compramised
70
primary causes of ILD
- Idiopathic pulmonary fibrosis
- Acute interstitial pneumonia
- desquamative interstitial pneumonia
71
secondary causes of ILD
- RA, SLE
- Drugs - amiodarone
- infective - mycoplasma pneumonia
- environmental - asbestosis
72
risk factors for ILD
- male
- smoking
- occupational - dust exposure etc
73
symptoms of ILD
- Progressive exertional dyspnoea
- dry cough
- connective tissue symptoms eg arthralgia, dysphagia, dry eyes
- malaise fatigue
(signs of connective tissue diseases eg Raynaud's)
74
ILD lung function tests
restrictive - FVC reduced, FEV1 reduced
- may be normal
75
ILD xray
reticular opacities (thickening of interstitium)- lower/upper zone
76
investigations for ILD
- HRCT
- chest xray
- cpr/esr
- FBC - may show anaemia
- antibodies for autoimmune conditions
- bronchalveolar lavage or lung biopsy may be needed
77
causes of upper zone fibrosis ILD
Coal-worker pneumoconiosis
Histiocytosis-X
Ankylosing spondylitis
Radiation (e.g. for breast cancer)
Tuberculosis
Sarcoidosis and silicosis
78
causes of lower zone fibrosis ILD
Rheumatoid arthritis
Asbestosis
SLE, scleroderma and Sjogren’s syndrome
Idiopathic pulmonary fibrosis
Others (including drugs)
79
management of ILD
- smoking cessation
- vaccines - flue & pneumococcal
- antifibrotics for idiopathic pulmonary fibrosis - pirfenidone/nintedanib
- corticosteroids for RA etc
80
complications of ILD
- resp failure
- pulmonary hypertension
- anxiety/depression
- cushings syndrome from corticosteroids
81
lung carcinoma risk factors
- smoking
- occupation eg asbestos
- air pollution
- ionising radiation
- genetics
- chronic lung diseases
82
progression of lung cancer
- atypical adenomatous hyperplasia
- carcinoma in-situ
- invasive carcinoma
83
presentation of lung cancer
- persistant cough
- haeoptysis
- SOB
- weight loss, fatigue
- complications eg pleural effusion, pneumothorax
- asymptomatic
84
2 broad types of lung carcinoma
small cell
non-small cell
85
subtypes of lung cancer
adenocarcinoma
squamous cell carcinoma - (non)keratinising
small cell carcinoma - neuroendo
86
diagnosis of lung cancer
- CT/CT-PET
- biopsy
87
what tumour receptor means better response for immune modulator therapy
PD-L1 - non-small cell
88
pleural malignancy
- risk factor = asbestos
- pleural thickening, persistent pleural effusion
- proliferation of mesothelial cells
89
FISH diagnosis of mesothelioma
p16 homozygous deletion - support diagnosis but doesn't exclude
90
histology of ipf
usual interstitial pneumonia
91
