Respiratory Flashcards
Restrictive spirometry picture
FEV 1 normal or decreased
FVC decreased
FEV1/FVC normal or increased
Obstructive spirometry picture
FEV1 decreased
FVC decreased or normal
FEV1/ FVC decreased
When to use BIPAP?
Type 2 respiratory failure - COPD
Think BI = 2
When to use CPAP?
Type 1 respiratory failure
Pulmonary oedema
What vaccines should COPD patients get?
Annual influenza and one off pneumococcal
Which conditions show an obstructive spirometry picture?
COPD and Asthma
Bronchiectasis
Bronchiolitis obliterans
Which conditions show a restrictive spirometry picture?
Fibrosis
Asbestosis
Sarcoidosis
Ank spon
ARDS
Severe obesity
Small cell lung cancer
Features:
ADH - hyponatraemia
ACTH - cushings
Lambert Eaton syndrome
*Chemotherapy and radiotherpay, rarely surgical management if very early disease
Klebsiella pnuemonia
Diabetics/ Alcoholics
Cavitating pneumonia of the upper lobes
Legionella pneumonia
Contaminated water supplies
Bilateral chest symptoms
Mycoplasma pneumonia
Extra-pulmonary features such as: haemolytic anaemia and erythema multiforme
Staph aureus pneumonia
Most likely cause of pneumonia following influenza
Strep pneumonia
Most common cause of pneumonia
who can’t take bupropion?
Epileptics - lowers seizure threshold
What are the criteria for chest drain insertion in patients with a pleural effusion?
if the fluid is purulent or turbid/cloudy
if the fluid is clear but the pH is less than 7.2
What type of surgery can be used to manage alpha-1 antitrypsin deficiency?
Long volume reduction surgery
What is the mechanism of action of varenicline used in smoking cessation?
nicotine receptor partial agonist
What is bronchiectasis?
Permanent dilatation of the airways secondary to chronic infection or inflammation.
What is the most common organism associated with bronchiectasis?
H.influenza
What are the treatment options for bronchiectasis?
physical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
postural drainage
antibiotics for exacerbations + long-term rotating antibiotics in severe cases
bronchodilators in selected cases
immunisations
surgery in selected cases (e.g. Localised disease)
How does ABPA present?
Wheeze/ cough/ SOB
Eosinophilia
Raised IgE
Positive RAST test to aspergillus
Signs of proximal bronchiectasis on CXR, bronchocoeles on CT
What is Goodpasture’s syndrome?
Autoimmune disease - antibodies attack the basement membrane in the lungs and kidneys
Smoking is a risk factor
+VE for pANCA and Anti GBM antibodies
Ix with biopsy
Tx with plasmapheresis and steroids
Whooping cough - what bug?
Bordetella pertussis
Tx - clari/ azithro
Bronchiolitis - what bug?
RSV or metapneumovirus
Investigations for CF?
Faecal elastase
HRCT
Which type of lung cancer is the most common overall?
Which has the strongest association with smoking?
Adenocarcinoma - most common
Small cell carcinoma - mostly in smokers
Which type of lung cancer is most likely to arise in the bronchi?
Squamous
Name the SABAs and the SAMAs
SABAs - salbutamol, albuterol, terbutaline
SAMAs - ipratropium, oxitropium
Name the LABAs and the LAMAs
LABAs - salmeterol, formoterol
LAMAs - tiotropium, glycopyronium
Which drugs are the xanthines?
Theophylline, aminophylline
What is the Boher effect?
Increasing the partial pressure of C02 / decreasing pH results in Hb having a lower affinity for 02
What is the Haldane effect?
Removing 02 from Hb increases its affinity for C02
What happens with the 02/ C02 in type 2 respiratory failure?
In a chronically hyperaemic patient they have a low 02 Hb saturation. C02 occupies the empty binding sites instead. When 02 is given to the patient, the C02 is pushed off the Hb and into the blood stream.
Which vaccines are inactivated?
Polio
Hep A
Which vaccines are the live attenuated?
MMR
BCG
Typhoid
What are the type 1 hypersensitivity reactions?
IgE Mediated
Asthma, eczema, anaphylaxis
What are the type 2 hypersensitivity reactions?
Antibodies
Auto-immune
Grave’s
Myaesthenia gravis
Pemphigus
Not auto-immune
Transfusion reactions
Haemolytic disease of the newborn
What are the type 3 hypersensitivity reactions?
Immune complex mediated
Antibodies bind to antigens which form immune complexes which get trapped in small blood vessels and joints
SLE, farmer’s lung etc
What are the type 4 hypersensitivity reactions?
T cell mediated
eg sarcoidosis, TB
How does adrenaline work on the lungs. Eg in anaphylaxis?
Acts on B2 receptors
Constricts arterial smooth muscle
Dilates bronchial smooth muscle - decrease airflow obstruction
Increases BP - limits vascular leakage
What is plasmapheresis?
A method of removing blood plasma from the body by withdrawing blood, separating it into plasma and cells, and transfusing the cells back into the bloodstream. It is performed especially to remove antibodies in treating autoimmune conditions.
How does bronchial challenge testing work?
Breathe in metacholine or histamine
- promotes bronchoconstriction
Then check spirometry
Asthmatics will react to lower doses
What is aspergilloma?
Fungus ball forms in existing lung cavities (eg secondary to TB/ cancer/ fibrosis)
Cough + haemoptysis
Rounded opacity on CXR
What is the ‘asthma triad’ ?
Obstruction, Inflammation, Hyperresponsiveness
Which types of disease affect the upper lung zones?
TB
Ank spon
Sarciodosis
Silicosis
Pneumoconiosis (coal worker’s lung)
EAA
Which types of disease affect the lower lung zones?
Asbestosis
Connective tissue disease
Idiopathic pulmonary fibrosis
Drugs
What are the TB drug side effects?
Rifampicin - orange urine
Isoniazid - Peripheral neuropathy
Pyrazinamide - hyperuricaemia
Ethambutol - optic neuritis, arthralgia
What are the new asthma guidelines for management?
Low dose MART (ICS +formoterol - LABA) - use PRN
Low dose MART as maintenance + also can use PRN
Moderate dose MART
If no other features - no raised eosinophils and no raised FeNo can try adding LTRA or LAMA, otherwise refer on to a specialist
SABA can still be used PRN also
What are the COPD guidelines for management ?
SABA or SAMA PRN
If asthmatic features - add LABA + ICS
If no asthmatic features - add LABA + LAMA
LABA + LAMA + ICS
What are the criteria for an asthma attack being severe in 2-5 yr olds versus >5yrs, versus adults ? (HR and RR thresholds)
2-5 yrs HR >140 and RR 40
>5yrs HR 125 and RR >30
Adults HR >110 and RR >25
