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4 - Med > Respiratory > Flashcards

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

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2
Q

name the 3 categories of pneumonia ?

A
  • community acquired
  • hospital acquired (>48 hrs from hospital admission)
  • aspiration
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3
Q

pneumonia px ? (7)

A

sob, cough, sputum, fever, haemoptysis, pleuritic chest pain, sepsis

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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
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5
Q

pneumonia RF (5)

A
  • > 65
  • care home
  • COPD
  • cigarettes
  • poor oral hygiene
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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

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7
Q

what is CURB 65 for ? (3)

A
  • predicts mortality
  • whether PO/IV
  • hospital admission)
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8
Q

what is atypical pneumonia ?

A

pneumonia caused by organs that cannot be detected with gam stains (doesn’t react to penicillin)

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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)
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10
Q

who should receive the pneumococcal vaccine ?

A

at risk groups
>65
- chronic heart/liver/kidney/lung dsease
- DM
- immunosuppression

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11
Q

what is bronchiectasis ? what anatomy affected ?

A

chronic inflammation of bronchi + bronchioles => permanent dilatation + thinning of these airways

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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)

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13
Q

bronchiectasis aetiology ? (5)

A

caused by anything that causes chronic inflam
- recurrent and/or severe infection
- immunodeficiency (HIV)
- genetic
- COPD
- idiopathic

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14
Q

name some genetic conditions associated with brnochietctasis ?

A
  • CF
  • Kartageners
  • PCD
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15
Q

bronchiectasis px ? (5)

A
  • chronic cough
  • sputum production
  • dyspnoea
  • fatigue
  • haemoptsys
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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
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17
Q

Bronchiectasis Mx ? if continued deterioration ?

A
  • daily airway clearance
  • Abx (amoxicillin)
  • muculystics (N-acetyl cysteine)

if continued deterioration: surgical therapy (lung transplant)

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18
Q

what pathogen often causes aspiration pneumonia ? how might this present

A

klebsiella pneumonia
- red currant jelly sputum

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19
Q

what are the 3 most common cancers in UK ?

A
  • Breast
  • Prostate
  • Lung
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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%)
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21
Q

what does non-small cell lung cancer include ? (3) which most common ?

A
  • adenocarcinoma
  • SCC (most common)
  • large cell carcinoma
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22
Q

asbestos exposure leads to what sort of cancer ?

A

malignant mesothelioma (poor prognosis)

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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)

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24
Q

signs and symptoms of lung cancer ? (7)

A
  • sob
  • cough
  • haemoptysis
  • finger clubbing
  • pneumonias
  • weight loss
  • lymphadenopathy
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25
Q

what investigations done for suspected lung cancer ? what is diagnostic test ?

A
  • CXR
  • staging CT scan (chest, abdo, pelvis)
  • histological diagnosis (bronchoscopy or percutaneously)
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26
Q

differential diagnosis of nodule in the lung on a CXR ? (6)

A
  • malignancy (primary or secondary)
  • abscesses
  • granuloma
  • artery-venous malformation
  • insisted effusion
  • foreign body
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27
Q

what could be seen on CXR in lung cancer presentation ? (3)

A
  • hilar enlargement
  • lung collapse
  • pleural effusion
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28
Q

complications of lung cancer ? local ? (1) metastatic ? (2) non-metastatic ? (3)

A
  • 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)
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29
Q

what is asthma ? triad of sx ?

A

recurrent eps of dyspnoea, cough, wheeze caused by reversible airway obstruction

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30
Q

explain the 3 pathophysiological processes in asthma ?

A
  • bronchial muscle contraction (triggered by variety of stimuli)
  • mucosal swelling/inflma (mast cell/basophil degranulation => inflam mediator release)
    0 increased mucus production
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31
Q

what are the target oxy sats in asthma ?

A

94 - 98%

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32
Q

what is atopy ?

A

tendency to develop IgE mediated reactions to common aero-allergens

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33
Q

asthma presentaiton ?

A
  • dyspnea, wheeze, cough
  • come + go (episodic, triggers + exacerbations)
  • diurnal variation (worse at night)
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34
Q

what white cell is important in atopic conditions ?

A

eosinophils

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35
Q

what investigations for asthma and describe the results ?

A
  • 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
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36
Q

what lifestyle advice for asthma ?

A
  • quit smoking
  • avoid precipitants
  • weight losses
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37
Q

desreib stepwise approach to chronic asthma mx ? (5) give example of name of each drug type

A
  • SABA (salbutamol)
  • Add ICS (beclametasone)
  • Add LABA (salmetarol)
  • Add leukotriene receptor antagonist (montelukast)
  • step 5: add regular oral prednisolone
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38
Q

what is COPD ? reversible or non ?

A

non-reversible, long term deterioration in airflow through lungs caused by damage to lung tissues (usually result of smoking)

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39
Q

what are the 2 categories to COPD ? describe a bit

A
  • Chronic bronchitis: long term inflammation of bronchi
  • Emphysema: Alveolar damage, elastin breakdown => reduced elastic recoil
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40
Q

COPD lung pathophysiology overview. what kind of airway pathology ?

A
  • 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
Q

what is theist common organism for infective exacerbations in COPD ?

A

haemophilus influenza

42
Q

COPD px ?

A

long term smoker with
- sob
- cough (sputum)
- wheeze
- recurrent resp infections

43
Q

chronic dry cough differential ? (8)

A
  • Asthma
  • COPD
  • GORD
  • malignancy
  • ACEI
  • OSA
  • Interstitial lung disease
44
Q

differentila for pleuritic chest pain ? (5)

A
  • ACS
  • aortic dissection
  • pneumothorax
  • pericardial effusion/tamponade
  • PE
45
Q

COPD spirometry results ?

A

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
Q

descbre the results you might find in COPD:
- CXR
- FBC
- Pulse oximetry
- ABG
- ECG

A
  • 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
Q

what jabs for COPD patients ? (2)

A
  • annual flu jab
  • pneumococcal (1 dose when 65)
48
Q

describe stepwise COPD Mx ?

A
  • 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
Q

If severe COPD what would you consider ?

A
  • Long term oxy therapy (LTOT)
  • long term prophylactic Ab
50
Q

what do you need to be careful about with oxygen therapy in a patient with COPD ?

A

too much oxy in someone prone to retaining C)2 can press resp drive => reduce breathing rate and reduce resp effort => CO2 retention

51
Q

Describe ABG in COPD exacerbation ?

A

resp acidosis
- low pH because raised CO2 (not able to get rid of)

52
Q

what does high bicarb in a COPD patient indicate ?

A

high bicarb indicates chronically retaining CO2 (kidneys produce more bicarb to compensate)

53
Q

Mx of exacerbation of COPD ? in hospital ?

A
  • prednisolone + regular inhalers/nebulisers
  • Abx (if infective exacerbation)
  • in hospital: nebulised bronchodilators, steroids (prednisolone), Abx, physiotherapy
54
Q

What is pulmonary embolism ?

A

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
Q

PE presentation ? signs ?

A
  • sob
  • cough +/- blood
  • pleuritic chest pain

signs: hypoxia, tachycardia, tachypnoea, low grade fever, dysnpoea

56
Q

PE investigations ? what scoring tool used ?

A
  • If wells score likely: CT pulmonary angiogram (IV contrast highlights pulmonary arteries)
  • Wells score unlikely: D-dimer test => if positive then CTPA
57
Q

PE Mx ? haemodynmically unstable ?

A
  • 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
Q

What is pneumothorax ? where ?

A

when air gets into pleural space that separates lung form chest wall

59
Q

pneumothorax aetiology ? (4)

A
  • spontaneously
  • secondary to trauma
  • medical interventions (mechanical ventilation)
  • lung pathology (infection, asthma, COPD)
60
Q

pneumothorax typical presentaiton ?

A

tall tin young man with sudden breathlessness + pleuritic chest pain while playing sport
- ipsilateral hyperinflation, hypoxia

61
Q

pneumothorax Ix ?

A

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
Q

pneumothorax Mx ? depends on what

A

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
Q

where is a chest drain inserted into ?

A

triangle of safety

64
Q

what is tension pneumothorax ? pathophys ? what could it cause ?

A

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
Q

tension pneumothorax signs ? (4)

A
  • tracheal deviation
  • reduced air entry to affected side
  • tachycardia
  • hypotension
66
Q

tension pneumothorax Mx ?

A
  • insert large bore cannula into 2nd intercostal space in MCL (on side of affected hemithorax)
67
Q

What is pleural effusion ? where is it ?

A

collection of fluid in the pleural cavity (between lung + chest wall)

68
Q

what are the two types of pleural effusion aetiology ? difference between them

A
  • exudative (high protein)
  • transudative
69
Q

describe exudative pleural effusions ? give examples of causes ? (4)

A

inflammation => protein leaks out of trees into pleural space
- lung cancer (malignancy associated with exudate)
- TB
- pneumonia
- pericarditis

70
Q

describe translative pleural effusions ? give examples ?

A

fluid moves across
- Congestive heart failure (most common)
- hypoalbuminaemia

71
Q

how does pleural effusion present ? (3) big effusion ? (3)

A

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
Q

Risk factors for pleural effusions ?

A
  • congestive heart failure (transudative cause)
  • pneumonia
  • malignancy
73
Q

what investigation for suspected pleural effusion ? what would you see ? (3)

A

CXR
- blunting of costophrenic angle
- fluid in lung fissues
- tracheal deviation

74
Q

Pleural effusion managment ?

A

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
Q

what is empeyema ? suspect in which patients

A

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
Q

empeyema presentaiton ?

A

constitution sx, recent pneumonia
signs of sepsis

77
Q

empeyema mx ?

A

pleural aspiration (shows pus, acidotic suggests infection)
- chest drain + antibiotics (empirical - amoxicillin) + supportive care

78
Q

what are the borders of the triangle of safety ? (4)

A
  • base of axilla
  • lateral edge pec major
  • 5th ICS
  • anterior border latissimus dorsi
79
Q

what is cor pulmonale ?

A

right sided HF caused by chronic pulmonary arterial hypertension

80
Q

right sided HF pathophysiology ?

A

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
Q

causes of cor pulmonale ? (5)

A
  • COPD
  • PE
  • Interstitial lung disease
  • CF
  • primary pulmonary HTN
82
Q

cor pulmonale presentaiton ? (5) signs ? (6)

A
  • often asymptomattic
  • sob
  • peripheral oedema
  • syncope
  • chest pain
    signs: hypoxia, cyanosis, raised JVP, peripheral oedema, 3rd hears sound, murmurs
83
Q

cor pulmoale Mx ? (3)

A
  • loop dietetics
  • oxy (if hypoxic)
  • treat underlying cause
84
Q

What is sarcoidosis ?

A

it is granulomatous inflammatory condition (unknown aetiology) - multi system
- granulomas are nodules of inflammation full of macrophages

85
Q

typical sarcoidosis Px ?

A
  • dry cough, sob, dyspnoea, chest pain
    (usually chest symptoms but can have extra pulmonary manifestations)
    (symptoms can vary dramatically: asymptomatic (50%) - life threatening)
86
Q

sarcoidosis is multi system disease. describe some of the manifestations in these areas:
- Lungs
- systemic
- Liver
- Eyes
- Skin
- Heart

A
  • 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
Q

what do 90% of sarcoidosis patients have on CXR ?

A

(BHL)
- bilateral hilar lymphadenopathy

88
Q

differential for bilateral hilarity lymphadenopathy ?

A
  • Sarcoidosis
  • TB
  • Malignancy
89
Q

what is the diagnostic test for sarcoidosis ? who’s what ?

A

histology (gold standard): biopsy of area affected: shows non-caveating granulomas with epithelioid cells

90
Q

sarcoidosis Mx ?

A
  • Mild or no sx: no treament
  • oral steroids + bisphosphonates
  • methotrexate
91
Q

sarcoidosis prognosis ?

A

will spontaneously resolve in 6 months in 60 % of patients

92
Q

what is interstitial sun disease ?

A

umbrella term to describe conditions that affect lung parenchyma => inflam => fibrosis
- fibrosis is replacement of normal elastic lung tissue with stiff scar tissue

93
Q

what unique finding is found in examination of patient with idiopathic pulmonary fibrosis ?

A

fine end inspiratory crepitations

94
Q

what investigations for interstitial lung disease ? finding ?

A

high resolution thorax CT (ground glass appearance)
- lung biopsy: if CT unclear

95
Q

ILD managment ? (6)

A

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
Q

what is the commonest cause of ILD ? describe a bit

A

idiopathic pulmonary fibrosis (idiopathic interstitial pneumonia)
- progressive fibrosis of lung tissue without clear cause

97
Q

idiopathic pulmonary fibrosis presentaiton ?

A

insidious onset sob
dry cough > 3 months
finger clubbing

98
Q

idiopathic pulmonary fibrosis mx ?

A

pirfenidone (anti fibrotic)
mimtedanib (may)

99
Q

what can cause secondary pulmonary fibrosis ? (4)

A
  • alpha 1 anti trypsin deficiency
  • RA
  • SLE
  • systemic sclerosis

4 - Med (12 decks)

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