Respiratory Flashcards
1
Q
what is pneumonia ?
A
Acute LRTI associated with fever and symptoms of chest
- infection of lung tissues => inflam of lung tissue + sputum fill airways + alveoli
2
Q
name the 3 categories of pneumonia ?
A
- community acquired
- hospital acquired (>48 hrs from hospital admission)
- aspiration
3
Q
pneumonia px ? (7)
A
sob, cough, sputum, fever, haemoptysis, pleuritic chest pain, sepsis
4
Q
pneumonia signs ? and chest sounds ? (3)
A
- signs: tachypnoea, tachycardia, hypoxia, hypotension, fever, confusion
- chest sounds: bronchial breath sounds, focal course crackles, dullness to percussion
5
Q
pneumonia RF (5)
A
- > 65
- care home
- COPD
- cigarettes
- poor oral hygiene
6
Q
what can be used to assess severity of pneumonia ? describe with values ?
A
CURB 65
- confusion
- urea (>7)
- RR (>30)
- BP (<90/60)
- >/=65
7
Q
what is CURB 65 for ? (3)
A
- predicts mortality
- whether PO/IV
- hospital admission)
8
Q
what is atypical pneumonia ?
A
pneumonia caused by organs that cannot be detected with gam stains (doesn’t react to penicillin)
9
Q
CAP pneumonia Mx ? mild ? moderate ?
A
- mild CAP: 5 day course of oral Box (amoxicillin)
- moderate-severe CAP: 7 day course oral Box (amoxicillin + macrolide)
- give oxy if hypoxic (<94% or <88% if patient at risk of CO2 retention)
10
Q
who should receive the pneumococcal vaccine ?
A
at risk groups
>65
- chronic heart/liver/kidney/lung dsease
- DM
- immunosuppression
11
Q
what is bronchiectasis ? what anatomy affected ?
A
chronic inflammation of bronchi + bronchioles => permanent dilatation + thinning of these airways
12
Q
bronchiectasis pathophys ? obstructive of restrictive ?
A
obstructive lung disease
chronic inflam => bronchial wall oedema + increased mucus production => bronchioles damaged + dilated => further inflammation (=> airway obstruction)
13
Q
bronchiectasis aetiology ? (5)
A
caused by anything that causes chronic inflam
- recurrent and/or severe infection
- immunodeficiency (HIV)
- genetic
- COPD
- idiopathic
14
Q
name some genetic conditions associated with brnochietctasis ?
A
- CF
- Kartageners
- PCD
15
Q
bronchiectasis px ? (5)
A
- chronic cough
- sputum production
- dyspnoea
- fatigue
- haemoptsys
16
Q
bronchiectasis Ix ? think aetiology (4)
A
- sputum cultures (bacteria)
- rheumatoid factor (more common in RA pop)
- sweat chloride test (CF)
- serum HIV antibody
17
Q
Bronchiectasis Mx ? (3) if continued deterioration ?
A
- daily airway clearance
- Abx (amoxicillin)
- muculystics (N-acetyl cysteine)
if continued deterioration: surgical therapy (lung transplant)
18
Q
what pathogen often causes aspiration pneumonia ? how might this present
A
klebsiella pneumonia
- red currant jelly sputum
19
Q
what are the 3 most common cancers in UK ?
A
- Breast
- Prostate
- Lung
20
Q
describe the histology of lung cancer - what 2 groups can they be split into ?
A
- non small cell lung cancer (80%)
- small cell lung cancer (20%)
21
Q
what does non-small cell lung cancer include ? (3) which most common ?
A
- adenocarcinoma (most common)
- SCC
- large cell carcinoma
22
Q
asbestos exposure leads to what sort of cancer ?
A
malignant mesothelioma (poor prognosis)
23
Q
What is small cell lung cancer ? describe the quirky thing about them
A
malignant epithelial tumour form cells of lower resp tract
- contain neuro-secretory granules that can release near endocrine hormones (so can be responsible for para-neoplastic syndromes)
24
Q
signs and symptoms of lung cancer ? (7)
A
- sob
- cough
- haemoptysis
- finger clubbing
- pneumonias
- weight loss
- lymphadenopathy
25
what investigations done for suspected lung cancer ? what is diagnostic test ?
- CXR
- staging CT scan (chest, abdo, pelvis)
- histological diagnosis (bronchoscopy or percutaneously)
26
differential diagnosis of nodule in the lung on a CXR ? (5)
- malignancy (primary or secondary)
- abscesses
- granuloma
- insisted effusion
- foreign body
27
what could be seen on CXR in lung cancer presentation ? (3)
- hilar enlargement
- lung collapse
- pleural effusion
28
complications of lung cancer ? local ? (1) metastatic ? (2) non-metastatic ? (3)
- local: recurrent laryngeal nerve palsy. phrenic nerve palsy
- metastatic: brain, bone
- non-metastatic: endo (ectopic secretion e.g. ACTH => cushings), near (cerebellar degeneration, myopathy), vascular (thrombophlebitis, anaemia)
29
what is asthma ? triad of sx ?
recurrent eps of dyspnoea, cough, wheeze caused by reversible airway obstruction
30
explain the 3 pathophysiological processes in asthma ?
- bronchial muscle contraction (triggered by variety of stimuli)
- mucosal swelling/inflma (mast cell/basophil degranulation => inflam mediator release)
- increased mucus production
31
what are the target oxy sats in asthma ?
94 - 98%
32
what is atopy ?
tendency to develop IgE mediated reactions to common aero-allergens
33
asthma presentaiton ?
- dyspnea, wheeze, cough
- come + go (episodic, triggers + exacerbations)
- diurnal variation (worse at night)
34
what white cell is important in atopic conditions ?
eosinophils
35
what investigations for asthma and describe the results ?
- spirometry: FEV1:FVC < 0.7 (suggests obstruction)
- reversibility spirometry testing (greater than 12% increase in FEV1 after bronchodilator use)
- Peak flow: variability throughout the day
36
what lifestyle advice for asthma ?
- quit smoking
- avoid precipitants
- weight losses
37
desreib stepwise approach to chronic asthma mx ? (5) give example of name of each drug type
- SABA (salbutamol)
- Add ICS (beclametasone)
- Add LABA (salmetarol)
- Add leukotriene receptor antagonist (montelukast)
- step 5: add regular oral prednisolone
38
what is COPD ? reversible or non ?
non-reversible, long term deterioration in airflow through lungs caused by damage to lung tissues (usually result of smoking)
39
what are the 2 categories to COPD ? describe a bit
- Chronic bronchitis: long term inflammation of bronchi
- Emphysema: Alveolar damage, elastin breakdown => reduced elastic recoil
40
COPD lung pathophysiology overview. what kind of airway pathology ?
- smoking => narrowing + remodelling of airways: increase number of goblet cells and enlargement of mucus secreting glands, alveolar loss, vascular changes (pulmonary hypertension) ...
- lung tissue damage => obstruction => reduced ventilation + prone to infections
41
what is theist common organism for infective exacerbations in COPD ?
haemophilus influenza
42
COPD px ?
long term smoker with
- sob
- cough (sputum)
- wheeze
- recurrent resp infections
43
chronic dry cough differential ? (8)
- Asthma
- COPD
- GORD
- malignancy
- ACEI
- OSA
- Interstitial lung disease
44
differentila for pleuritic chest pain ? (5)
- ACS
- aortic dissection
- pneumothorax
- pericardial effusion/tamponade
- PE
45
COPD spirometry results ?
diagnosis: clinical presentation + spirometry (obstruction)
- spirometry: FEV1/FVC: <0.7
- FEV1 < 80% predicated value
- no large response to salbutamol
(severity of airflow obstruction is graded using FEV1)
46
descbre the results you might find in COPD:
- CXR
- FBC
- Pulse oximetry
- ABG
- ECG
- CXR: hyperinflation
- FBC: high WBC, exclude anaemia
- Pulse oximetry: low oxy sats
- ABG: High CO2, low oxy (CO2 retention)
- ECG: cor pulmonate may develop)
47
what jabs for COPD patients ? (2)
- annual flu jab
- pneumococcal (1 dose when 65)
48
describe stepwise COPD Mx ?
- SABA or SAMA first line (salbutamol, ipratroprium bromide)
- if no asthmatic or steroid responsive features: LAMA + LAMA (combo inhaler)
- If Do asthmatic or steroid response features: LAMA + ICS
49
If severe COPD what would you consider ?
- Long term oxy therapy (LTOT)
- long term prophylactic Ab
50
what do you need to be careful about with oxygen therapy in a patient with COPD ?
too much oxy in someone prone to retaining C)2 can press resp drive => reduce breathing rate and reduce resp effort => CO2 retention
51
Describe ABG in COPD exacerbation ?
resp acidosis
- low pH because raised CO2 (not able to get rid of)
52
what does high bicarb in a COPD patient indicate ?
high bicarb indicates chronically retaining CO2 (kidneys produce more bicarb to compensate)
53
Mx of exacerbation of COPD ? in hospital ?
- prednisolone + regular inhalers/nebulisers
- Abx (if infective exacerbation)
- in hospital: nebulised bronchodilators, steroids (prednisolone), Abx, physiotherapy
54
What is pulmonary embolism ?
blood clot (thrombus) forms in pulmonary arteries (usually result of DVT)
- PE => block blood flow to lungs and create strain on right side of heart
55
PE presentation ? signs ?
- sob
- cough +/- blood
- pleuritic chest pain
signs: hypoxia, tachycardia, tachypnoea, low grade fever, dysnpoea
56
PE investigations ? what scoring tool used ?
- If wells score likely: CT pulmonary angiogram (IV contrast highlights pulmonary arteries)
- Wells score unlikely: D-dimer test => if positive then CTPA
57
PE Mx ? haemodynmically unstable ?
- oxygen (if hypoxic)
- analgesia
- DOAC (apixiban)
haemodynamically unstable (if massive PE): thrombolysis (streptokinase, alteplase)
- only used in severe PE as dangerous due to sig risk of bleeding
58
What is pneumothorax ? where ?
when air gets into pleural space that separates lung form chest wall
59
pneumothorax aetiology ? (4)
- spontaneously
- secondary to trauma
- medical interventions (mechanical ventilation)
- lung pathology (infection, asthma, COPD)
60
pneumothorax typical presentaiton ?
tall tin young man with sudden breathlessness + pleuritic chest pain while playing sport
- ipsilateral hyperinflation, hypoxia
61
pneumothorax Ix ?
erect CXR (will show area between lung tissue + chest wall)
- CT of throw can assess size of smaller pneumothorax
- tore Ix to rule out cardiac causes (ACS)
62
pneumothorax Mx ? depends on what
depends on size and sx
- if no SOB + <2cm: no treatment + with outpatient follow up in 2-4 days (will resolve spontaneously)
- If SOB or >2cm: aspiration + reassessment (if aspiration files twice, then chest drain)
63
where is a chest drain inserted into ?
triangle of safety
64
what is tension pneumothorax ? pathophys ? what could it cause ?
Emergency !
- trauma creates one way valve (only lets air in to pleural space) => air drain in in inspiration and trapped in expiration => pneumothorax gets later => increase pressure => mediastinum moves across => major vessels kink => cardiorespiratory arrest
65
tension pneumothorax signs ? (4)
- tracheal deviation
- reduced air entry to affected side
- tachycardia
- hypotension
66
tension pneumothorax Mx ?
- insert large bore cannula into 2nd intercostal space in MCL (on side of affected hemithorax)
67
What is pleural effusion ? where is it ?
collection of fluid in the pleural cavity (between lung + chest wall)
68
what are the two types of pleural effusion aetiology ? difference between them
- exudative (high protein)
- transudative
69
describe exudative pleural effusions ? give examples of causes ? (4)
inflammation => protein leaks out of trees into pleural space
- lung cancer (malignancy associated with exudate)
- TB
- pneumonia
- pericarditis
70
describe translative pleural effusions ? give examples ?
fluid moves across
- Congestive heart failure (most common)
- hypoalbuminaemia
71
how does pleural effusion present ? (3) big effusion ? (3)
takes up space so lungs can't fill with air => sob, dullness when percussed, reduced breath sounds
big effusion: tracheal deviation, cough, pruritic chest pain
72
Risk factors for pleural effusions ?
- congestive heart failure (transudative cause)
- pneumonia
- malignancy
73
what investigation for suspected pleural effusion ? what would you see ? (3)
CXR
- blunting of costophrenic angle
- fluid in lung fissues
- tracheal deviation
74
Pleural effusion managment ?
need to think about what the cause is
- aspirate pleural fluid to analyse (protein count, cell count, pH, glucose, microbiology testing)
- treat underlying cause (HF, Infection)
- larger effusions: pleural aspiration, chest drain
75
what is empeyema ? suspect in which patients
infected pleural effusion (presence of pus in the pleural space)
- suspect in patient with improving pneumonia but new or ongoing fever (mortality 15-20%)
76
empeyema presentaiton ?
constitution sx, recent pneumonia
signs of sepsis
77
empeyema mx ?
pleural aspiration (shows pus, acidotic suggests infection)
- chest drain + antibiotics (empirical - amoxicillin) + supportive care
78
what are the borders of the triangle of safety ? (4)
- base of axilla
- lateral edge pec major
- 5th ICS
- anterior border latissimus dorsi
79
what is cor pulmonale ?
right sided HF caused by chronic pulmonary arterial hypertension
80
right sided HF pathophysiology ?
increased pressure + resistance in pulmonary arteries (pulmonary hypertension) => RV unable to effectively pump blood out of ventricle into pulmonary artery => back pressure in RA => vena cava => systemic venous system
81
causes of cor pulmonale ? (5)
- COPD
- PE
- Interstitial lung disease
- CF
- primary pulmonary HTN
82
cor pulmonale presentaiton ? (5) signs ? (6)
- often asymptomattic
- sob
- peripheral oedema
- syncope
- chest pain
signs: hypoxia, cyanosis, raised JVP, peripheral oedema, 3rd hears sound, murmurs
83
cor pulmoale Mx ? (3)
- loop dietetics
- oxy (if hypoxic)
- treat underlying cause
84
What is sarcoidosis ?
it is granulomatous inflammatory condition (unknown aetiology) - multi system
- granulomas are nodules of inflammation full of macrophages
85
typical sarcoidosis Px ?
- dry cough, sob, dyspnoea, chest pain
(usually chest symptoms but can have extra pulmonary manifestations)
(symptoms can vary dramatically: asymptomatic (50%) - life threatening)
86
sarcoidosis is multi system disease. describe some of the manifestations in these areas:
- Lungs
- systemic
- Liver
- Eyes
- Skin
- Heart
- Lungs: mediastinal lymphadenopathy, pulmonary fibrosis, nodules
- systemic: fever, fatigue, weight loss
- Liver: nodules, cirrhosis, cholestatsis
- Eyes: uveitis, conjunctivitis, optic neuritis
- Skin: erythema nodosum, lupus pernio (raised purple skin lesions)
- Heart: BBB, heart block, myocardial muscle involvement
87
what do 90% of sarcoidosis patients have on CXR ?
(BHL)
- bilateral hilar lymphadenopathy
88
differential for bilateral hilarity lymphadenopathy ?
- Sarcoidosis
- TB
- Malignancy
89
what is the diagnostic test for sarcoidosis ? who's what ?
histology (gold standard): biopsy of area affected: shows non-caveating granulomas with epithelioid cells
90
sarcoidosis Mx ?
- Mild or no sx: no treament
- oral steroids + bisphosphonates
- methotrexate
91
sarcoidosis prognosis ?
will spontaneously resolve in 6 months in 60 % of patients
92
what is interstitial sun disease ?
umbrella term to describe conditions that affect lung parenchyma => inflam => fibrosis
- fibrosis is replacement of normal elastic lung tissue with stiff scar tissue
93
what unique finding is found in examination of patient with idiopathic pulmonary fibrosis ?
fine end inspiratory crepitations
94
what investigations for interstitial lung disease ? finding ?
high resolution thorax CT (ground glass appearance)
- lung biopsy: if CT unclear
95
ILD managment ? (6)
prognosis generally poor as damage is irreversible
- remove of treat underlying cause
- oxy if hypoxic at rest
- stop smoking
- physiotherapy _ pulmonary rehab
- pneumococcal and flu vaccine
- lung transplant
96
what is the commonest cause of ILD ? describe a bit
idiopathic pulmonary fibrosis (idiopathic interstitial pneumonia)
- progressive fibrosis of lung tissue without clear cause
97
idiopathic pulmonary fibrosis presentaiton ?
insidious onset sob
dry cough > 3 months
finger clubbing
98
idiopathic pulmonary fibrosis mx ?
pirfenidone (anti fibrotic)
nintedanib (mab)
99
what can cause secondary pulmonary fibrosis ? (4)
- alpha 1 anti trypsin deficiency
- RA
- SLE
- systemic sclerosis
