Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

finals > Respiratory > Flashcards

Respiratory Flashcards

1
Q

asthma - definition?

A
  • chronic reversible obstructive airway disease -> inflammation / bronchospasm
  • non/eosinophilic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

name some asthma risk factors?

A
  • atopy
  • maternal smoking, low birth weight, formula fed
  • air pollution
  • allergens, eg dust mites

Triggers
- infection, nighttime, exercise, animals, cold/damp air, strong emotions

Occupational
- workplace triggers - eg flour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

asthma Px?

A
  • episodic sx
  • diurnal variation - worse at night
  • SOB
  • chest tightness
  • dry cough
  • wheeze - widespread, polyphonic
  • reduced PEFR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

asthma Ix?

A
  • bloods, CXR maybe
  • spirometry - reduced FEV1, FEV1/FVC <70%
  • bronchodilator reversibility test
  • FeNO
  • peak flow diary
  • direct bronchial challenge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

asthma Dx ?

A

Initial Ix
- FeNO
- spirometry with bronchodilator reversibility

If dx uncertain
- peak flow diary

If still uncertain
- direct bronchial challenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

BTS asthma management?

A
  • SABA - salbutamol
  • Add ICS - low dose beclometasone
  • Add LABA - salmeterol / maintenance and reliever therapy (MART)
  • Increase ICS dose / add leukotriene receptor antagonist (LTRA) - montelukast
  • Specialist mx - eg oral prednisolone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NICE asthma management?

A
  • SABA - salbutamol
  • Add ICS - low dose beclometasone
  • Add LTRA - montelukast
  • Add LABA - salmeterol
  • Consider changing to MART
  • Increase ICS dose
  • Consider high dose ICS or additional drugs - LAMA / theophylline
  • Specialist mx - eg oral prednisolone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

extra things involved in asthma Mx?

A
  • ?occupational - refer to resp
  • yearly flu jab
  • yearly asthma review
  • consider stepping down tx every 3mo or so
  • reducing ICS dose - only by 25-30% at a time
  • regular exercise, avoid smoking, avoid triggers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

describe some common drugs used in asthma Mx?

A

SABA - salbutamol
LABA - salmeterol, formoterol
SAMA - ipratropium
LAMA - tiotropium
ICS - beclometasone / budesonide
MART - Fostair - beclometasone + formoterol
Trimbow - beclometasone + formoterol + glycopyrronium
LTRA - montelukast
Theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is an acute exacerbation of asthma?

A
  • rapid deterioration in sx in asthma
  • triggers as chronic, may be infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how might acute asthma present?

A
  • SOB
  • Cough
  • Accessory muscle use
  • Tachypnoea
  • Global wheeze
  • Reduced air entry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

acute asthma grading criteria: moderate versus severe?

A

Moderate
- PEF 50-75%

Acute severe
- PEF 33-50% best
- RR>25
- HR>110
- Unable to complete sentences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

acute asthma severity: life threatening

A
  • PEF <33%
  • Sats <92%
  • Silent chest, cyanosis
  • Bradycardia, low BP
  • Exhaustion, confusion, coma

near fatal = raised pCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

acute asthma Ix?

A
  • ABG - resp alkalosis -> hypoxic -> normal pCO2
  • bloods, CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when to admit with acute asthma?

A
  • Life-threatening grade
  • Acute severe grade + unresponsive to tx
  • Previous near-fatal attack
  • Pregnancy
  • Occurring despite oral corticosteroid
  • Px at night
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

acute asthma Mx?

A
  • abx
  • O2
  • salbutamol - inhaler / nebs
  • PO prednisolone 40-50mg / IV hydrocortisone 5d (3d in paeds)
  • ipratropium - nebs
  • IV Mg
  • IV salbutamol
  • IV aminophylline
  • Intubation/ventilation, ECMO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

criteria for acute asthma discharge?

A
  • Stable on discharge medication (no nebs / O2) for 12-24hrs
  • Inhaler technique checked + recorded
  • PEF >75%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is COPD?

A
  • Chronic irreversible progressive condition involving airway obstruction, emphysema, chronic bronchitis

Causes
- smoking, A1AT deficiency, coal, cotton, cement..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

discuss pathophysiology of COPD?

A
  • bronchitis - airway inflammation, fibrosis, mucus production
  • emphysema - parenchymal destruction, loss of elastic recoil, reduced SA for gas exchange
  • V/Q mismatch, lack of oxygenation, CO2 retention
  • increased pulmonary artery pressure -> PAH, RHF
  • some pts are CO2 retainers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how might COPD present?

A
  • SOB, cough, sputum, wheeze
  • recurrent infections
  • minimal diurnal variation
  • accessory muscles
  • hyperinflation
  • decreased cricosternal distance
  • decreased expansion, hyperresonant
  • pursed lips
  • cyanosis, cachexia
  • cor pulmonale - peripheral oedema, raised JVP, SOBOE, syncope, chest pain
  • PP/BB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MRC SOB scale

A
  1. SOB on marked exertion
  2. SOB on hills
  3. Slow or stop on flat
  4. Exercise tolerance 100-200 yards on flat
  5. Housebound / SOB on minor tasks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

COPD versus asthma?

A
  • Younger onset in asthma
  • Smoking - in most with COPD
  • Asthma - sx vary, less so in COPD
  • Nocturnal sx in asthma
  • Persistent productive cough - COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

COPD Ix?

A
  • spirometry - FEV1/FVC<70%
  • CXR - hyperinflation, flat hemidiaphragms, bullae
  • FBC - anaemia/polycythaemia
  • ECG / ECHO
  • CT thorax
  • transfer factor for CO (TLCO)
  • ?A1AT levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

COPD severity - 4 stage scale

A

Stage 1 / mild - FEV1>80%
Stage 2 / moderate - FEV1 50-79%
Stage 3 / severe - FEV1 30-49%
Stage 4 - very severe - FEV1 <30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

brief overview of COPD Mx?

A
  • stop smoking, pneumococcal/flu jabs
  • pulm rehab
  • inhalers
  • oral theophylline
  • prophylactic abx - azithromycin
  • mucolytics
  • PDE-4 inhibitors - roflumilast
  • furosemide for cor pulmonale
  • LTOT - long-term O2 therapy
  • surgery - lung volume reduction surgery, bullectomy, lung transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

COPD inhaler based Mx?

A

1st step
- SABA / SAMA

2nd step
Asthma/steroid-responsive features
- previous dx asthma/atopy
- variation FEV1 >400mls
- diurnal variation PEF >20%
- raised eosinophils
- if no features -> LABA + LAMA (anoro ellipta)
- if features - LABA + ICS (fostair)

3rd step
- LABA + LAMA + ICS (trimbow)

NB do not prescribe LAMA with SAMA (change to SABA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are indications for long term O2 therapy?

A

Assess by measuring 2 ABGs >3wks apart in stable COPD pts on optimum mx, carry out if
- FEV1<30%, cyanosis, polycythaemia, peripheral oedema, raised JVP, sats <92%

Indication
Offer LTOT if pO2 <7.3, or pO2 7.3-8 and any of:
- secondary polycythaemia
- peripheral oedema
- PAH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

COPD complications?

A
  • acute exacerbation, resp failure
  • secondary polycythaemia
  • PAH, cor pulmonale
  • PTX
  • lung ca
  • exercise limitation - reduced QoL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is an infective exacerbation of COPD?

A
  • acute deterioration in sx in COPD pt
    Causes
  • bacterial - H influenzae, strep pneumoniae, M catarrhalis
  • Viral - human rhinovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

IE-COPD Px?

A
  • SOB, cough, wheeze
  • increased sputum
  • hypoxia, acute confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

IE-COPD Ix?

A
  • Bloods - FBC, U/E, CRP, cultures
  • ABG - resp acidosis (raise bicarb indicates chronic retainer)
  • CXR
  • ECG
  • sputum culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

when might you admit someone with IE-COPD?

A
  • Severe SOB
  • Acute confusion, impaired consciousness
  • Cyanosis
  • Low sats
  • Social reasons - eg unable to cope at home
  • Significant comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

IE-COPD Mx?

A
  • O2
  • salbutamol / ipratropium
  • 30mg prednisolone for 5d / IV hydrocortisone
  • abx - amoxicillin / clarithromycin / doxycycline
  • chest physio

if severe:
- IV aminophylline
- NIV - biPAP
- intubation / ventilation
- doxapram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

pneumonia - definition

A
  • infection of lung tissue - inflammation in alveolar space
  • inflammation + pus - impairs gas exchange
  • neutrophils - cytokines - inflammatory response + fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

types of pneumonia?

A

CAP - community
HAP - >48hrs in hospital
VAP - intubated
Aspiration - form aspiration of foods/fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

typical bacterial causes of pneumonia?

A
  • Strep pneumoniae (most common), H influenzae (COPD)
  • Moraxella catarrhalis – COPD / immunocompromised
  • Pseudomonas aeruginosa – CF / bronchiectasis
  • S aureus – CF
  • MRSA – HAP
  • Klebsiella – alcoholics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

atypical causes of pneumonia?

A

Atypical - cannot be cultured in normal way
- Legionella – air conditioning units, causes SIADH (hyponatraemia) – urine antigen test to screen
- Mycoplasma pneumoniae – mild pneumonia, erythema multiforme rash – target lesions, neuro sx in young pts
- Chlamydophila pneumoniae – mild chronic pneumonia + wheeze in school children
- Coxiella burnetiid / Q fever – bodily fluids of animals – eg farmer
- Chlamydia psittaci – contact with infected birds – eg parrot owner

Other
- Pneumocystis jirovecii pneumonia (PCP) – immunocompromised, eg HIV with low CD4 – dry cough, SOBOE, night sweats, co-trimoxazole to tx
- COVID-19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

pneumonia Px?

A
  • cough, sputum +/- blood, SOB, fever, malaise, myalgia, pleuritic chest pain
  • delirium
  • dull to percussion
  • bronchial breath sounds
  • coarse focal crackles, reduced AE
  • raised RR, tachycardia, hypoxia, hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

CURB-65 scoring system?

A

C – confusion
U – urea >7mmol/L
R – resp rate >30
B – BP<90 systolic / 60 diastolic
65 – age >65yo

  • Score 0-1 – mild, consider home tx
  • Score 2– moderate, hospital admission
  • Score 3-5 – severe, admit, monitor, consider ITU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

pneumonia Ix?

A
  • bloods - FBC, U/E, CRP, cultures, ABG
  • CXR - focal consolidation
  • sputum culture
  • pneumococcal / legionella urinary antigen tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

pneumonia Mx?

A
  • Abx - amoxicillin / doxy / clari / co-amox / IV / tazocin
  • O2
  • IV fluids
  • intubation / ventilation
  • rpt CXR in 6wks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

acute bronchitis - Px, Ix and Mx?

A
  • infection / inflammation of trachea/bronchi - viral often

Px
- cough +/- sputum
- sore throat
- rhinorrhoea
- wheeze
- fever
DDx from pneumonia
- may have no sputum/wheeze/SOB
- no focal chest signs

Ix
- clinical dx
- bloods, CXR etc

Mx
- doxy / amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

aspiration pneumonia: definiton, RFs and Mx?

A
  • inhalation of stomach contents/secretions, leading to URTI
  • chemical pneumonitis, obstruction of resp tract, bacterial infection
  • usually R lower/middle lobes

RFs
- impaired GCS, swallowing disorder, poor mobility, older age, NBM, COPD

Mx
- bronchoscopy - remove, send to MC+S
- tracheal suction
- intubation/ventilation
- abx - amoxicillin/doxy/clari/erythro / co-amox/ levofloxacin
- chest physio, bronchodilators, fluids
- SALT referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

lung cancer: definition + most common typer?

A
  • cancer of lungs
  • 95% of primary are bronchial carcinomas
  • mets more common than primary - kidney, prostate, bone, GI tract, cervix, ovary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

lung cancer RFs?

A
  • smoking, occupational (asbestos, coal, tar etc), radiation, pulm fibrosis, COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

types of lung cancer?

A

Small cell lung cancer (SCLC) - 20%
- NE hormones released -> paraneoplastic

Non-small cell lung cancer (NSCLC) - 80%
- adenocarcinoma - 40% - often seen in non-smokers
- squamous cell - 20% - cavitating lesions
- large cell - 10%
- other - 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

lung cancer Px?

A
  • SOB, cough, chest pain, haemoptysis
  • monophonic wheeze
  • finger clubbing
  • recurrent pneumonia
  • wt loss, lethargy
  • lymphadenopathy (supraclavicular)
  • mets - bone pain, headache, seizures, hepatic/abdo pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

possible extrapulmonary manifestations of lung cancer - really long flashcard!

A
  • Recurrent laryngeal nerve palsy - hoarse voice
  • Phrenic nerve palsy - SOB (diaphragm weakness)
  • SVC obstruction - facial swelling, difficulty breathing…
  • Horner’s syndrome - Pancoast tumour
  • SIADH - ectopic ADH from SCLC - hyponatraemia
  • Cushing’s syndrome - ectopic ACTH from SCLC - HTN, hyperglycaemia, hypokalaemia, alkalosis
  • Hypercalcaemia - ectopic PTH from SCC
  • Limbic encephalitis - SCLC causes immune system to produce ABs against limbic system - short-term memory impairment, hallucination, confusion, seizures
  • Lambert-Eaton myasthenic syndrome - ABs against SCLC also target Ca channels in presynaptic motor neurons
  • Gynaecomastia - AC
  • Hypertrophic pulmonary osteoarthropathy (HPOA) - AC / SCC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

lung cancer referral criteria

A

2ww for ?lung ca if
- CXR suggesting lung ca
- >40yo + unexplained haemoptysis

Offer urgent 2wk CXR in >40yo non-smoker and 2 of the following, or smoker and 1 of:
- Cough, fatigue, SOB, chest pain, weight loss, appetite loss

Consider urgent CXR if >40yo with
- Persistent / recurrent chest infection
- Finger clubbing
- Lymphadenopathy
- Chest signs of cancer
- Thrombocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

lung cancer Ix?

A
  • bloods
  • CXR - hilar enlargement, peripheral opacity, pleural effusion, collapse
  • CT TAP + contrast
  • bronchoscopy
  • PET scan - TNM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

lung cancer Mx?

A

SCLC
- chemo / radio
- stents / debulking surgery
- poor prognosis

NSCLC
- surgery - segmentectomy/wedge resection, lobectomy, pneumonectomy
- radiotherapy
- chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

mesothelioma - definition?

A
  • Tumour of mesothelial cells - 80-90% in pleura - other sites are peritoneum, pericardium, testes
  • asbestos - 45yr latent period
  • high-grade, may invade intercostal nerves, severe pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

mesothelioma Px?

A
  • chest pain
  • SOB
  • wt loss
  • finger clubbing
  • recurrent pleural effusions
  • mets - lymphadenopathy, hepatomegaly, bone pain/tenderness, abdo pain/obstruction
54
Q

mesothelioma Ix?

A
  • CXR/CT - unilateral pleural thickening/effusion
  • pleural aspiration - bloody
  • pleural biopsy
55
Q

mesothelioma Mx?

A
  • resistant to surgery/chemo/radio
  • palliative chemo
56
Q

PE - definition and patho?

A

thrombus (blood clot) in pulmonary arteries
- venous thrombus, usually from DVT
- obstructs RV outflow - sudden increase in pulmonary vascular resistance - acute RHF
- lung tissue ventilated, not perfused - V/Q mismatch

57
Q

PE risk factors?

A
  • Immobility
  • Recent surgery
  • Long-haul flight
  • Pregnancy
  • Oestrogen therapy - cOCP, HRT
  • Malignancy
  • Polycythaemia
  • SLE
  • Thrombophilia
58
Q

VTE prophylaxis options

A
  • Assess for VTE risk
  • LMWH (enoxaparin) if higher risk - CI - active bleeding, warfarin/DOAC
  • Anti-embolic compression stockings - CI - PAD
59
Q

PE Px?

A
  • SOB
  • Cough
  • Haemoptysis
  • Pleuritic chest pain
  • Hypoxia
  • Tachycardia
  • Raised RR
  • Low-grade fever
  • Hypotension
  • May have DVT sx
60
Q

PE Ix?

A
  • PERC rule
  • PE Wells score

If PE likely (>4)
CTPA
- positive - dx
- negative - consider leg USS
Delay to CTPA - interim DOAC/LMWH

PE unlikely (<4)
D dimer
- positive - CTPA
- negative - stop anticoagulation, alt dx
V/Q scanning - maybe if renal impairment

Other Ix
- CXR - ?wedge-shaped opacification
- ECG - S1Q3T3, RBBB, right axis deviation, sinus tachy
- ABG - low O2/CO2

61
Q

PE Mx/

A

Tx as outpatient if
- stable, no comorbidities, support at home
- Pulmonary Embolism Severity Index (PESI) score to stratify risk
- O2, analgesia

Anticoagulation
- DOAC - apixaban/rivaroxaban (1st line / active cancer)
- LMWH, then dabigatran / edoxaban
- LMWH, then warfarin
- renal impairment - LMWH / heparin / LMWH then warfarin
- APL - LMWH then warfarin

Unstable
- thrombolysis - alteplase
- surgical thrombectomy
- IVC filter

62
Q

anticoagulation Tx length after PE?

A

Anticoagulation length
- all pts - 3mo
- provoked - stop after 3mo (3-6mo if active cancer)
- unprovoked - 6mo total
- ORBIT score - assess bleeding risk

63
Q

pleural effusion?

A
  • fluid in pleural space
  • empyema - pus
  • chylothorax - lymphatic fluid - trauma / carcinoma infiltration
64
Q

transudative pleural effusion?

A

Transudative (<30g/L protein) – tend to be issue with flow
- Heart failure (most common)
- Hypoalbuminaemia - liver disease, nephrotic syndrome, malabsorption
- Hypothyroidism
- Meigs’ syndrome – benign ovarian tumour, pleural effusion, ascites

65
Q

exudative pleural effusion?

A

Exudative (>30g/L protein) – tend to be inflammation
- Infection – pneumonia, TB, subphrenic abscess
- RA, SLE
- Neoplasia – lung ca, mesothelioma, mets
- Pancreatitis
- PE
- Dressler’s syndrome

66
Q

pleural effusion Px?

A
  • SOB
  • Non-productive cough
  • Chest pain
  • Dull to percussion
  • Reduced breath sounds
  • Reduced chest expansion
  • Large effusion - tracheal deviation away from effusion
67
Q

pleural effusion Ix?

A
  • CXR - blunting of costophrenic angles, fluid in lung fissures, meniscus, tracheal deviation
  • USS
  • contrast CT
  • pleural aspiration - send for pH, protein, LDH, cytology, micro
68
Q

interpreting pleural aspiration

A
  • Low glucose - RA, TB
  • Raised amylase - pancreatitis, oesophageal perf
  • Blood - mesothelioma, PE, TB
  • Empyema - pus, low pH, low glucose, high LDH
69
Q

what is Lights criteria?

A

Differentiate between transudate / exudate where protein 25-35. Exudate likely if at least one of the following is met:
- Pleural fluid protein / serum protein >0.5
- Pleural fluid LDH / serum LDH >0.6
- Pleural fluid LDH >2/3 upper limit normal of normal serum LDH

70
Q

pleural effusion Mx?

A
  • tx cause
  • pleural aspiration
  • chest drain

Empyema
- chest drain
- Abx

Recurrent
- recurrent aspiration
- pleurodesis
- indwelling pleural catheter
- opioids for SOB

71
Q

PTX definition?

A
  • air in pleural cavity, can collapse lung
72
Q

types of PTX?

A

Primary spont PTX (PSP) - no underlying disease

Secondary spont PTX (SSP) - COPD, asthma, CF, cancer, PCP, Marfan’s

Traumatic - blunt / penetrating

Iatrogenic - eg thoracentesis, CVC, ventilation

Tension PTX - BP drops

73
Q

PTX Px?

A
  • sudden onset SOB
  • pleuritic CP
  • hyper-resonant
  • reduced AE
  • reduced chest expansion
  • tachypnoea, tachycardia
  • surgical emphysema
  • tension - resp distress, tracheal deviation, hypotension
74
Q

PTX Ix?

A
  • CXR
  • CT chest
75
Q

PTX Mx?

A

If no sx
- conservative mx

If sx - assess for high risk characteristics
- haemodynamic compromise
- significant hypoxia
- bl PTX
- underlying lung disease
- >50yo, smoker
- haemothorax

If high risk characteristics + safe to intervene (>2cm) -> seldinger chest drain

If no high risk - choice of intervention
- conservative - IP/OP with clinic follow up
- ambulatory device - Rocket Pleural vent
- needle aspiration - if unsuccessful, then chest drain

76
Q

management of recurrent / persistent PTX?

A
  • video-assisted thoracoscopic surgery (VATS) for mechanical / chemical (talc) pleurodesis +/- bullectomy / pleurectomy
77
Q

key info to give on discharge after PTX?

A
  • avoid smoking
  • if ptx persists - cannot fly
  • avoid scuba diving - unless undergone bl surgical pleurectomy, normal PFTs/chest CT post-op
78
Q

management of tension PTX?

A
  • needle decompression - 2nd ICS MCL, or 4/5th ICS just anterior to mid-axillary
  • then chest drain
79
Q

bronchiectasis - definition, patho + main causative organisms

A
  • permanent dilatation + thickening of bronchi after chronic inflammation
  • impaired mucociliary transport - chronic cough, excessive sputum, recurrent infections
  • main orgs - H influenzae, strep pneumoniae, S aureus, pseudomonas
80
Q

bronchiectasis causes?

A
  • post-infective - TB, measles, pertussis, pneumonia
  • CF
  • cancer/TB
  • immune deficiency
  • allergic bronchopulmonary aspergillosis
  • ciliary dyskinetic syndromes
  • yellow nail syndrome
81
Q

bronchiectasis Px?

A
  • persistent cough
  • sputum, purulent
  • SOB
  • intermittent haemoptysis
  • recurrent chest infections
  • coarse crackles / wheeze on auscultation
  • finger clubbing
  • wt loss
82
Q

bronchiectasis Ix?

A
  • sputum culture
  • CXR - tram-track opacities, ring shadows
  • HRCT - dilated/thickened bronchi, signet ring sign
  • spirometry - obstructive
  • bronchoscopy
83
Q

bronchiectasis Mx?

A
  • vaccines
  • chest physio, postural drainage
  • extended abx course for exacerbations (7-14d)
  • pseudomonas - cipro
  • H influenzae - amoxicillin, co-amox, doxy
  • S aureus - fluclox
  • long-term abx - azithromycin - if 3+ exacerbations/yr
  • bronchodilators
  • surgical resection
  • lung transplant
84
Q

obstructive sleep apnoea?

A
  • collapse of pharyngeal airways whilst asleep leading to apnoeas
85
Q

OSA RFs?

A
  • middle aged, male
  • obesity
  • alcohol
  • smoking
  • macroglossia
  • large tonsils
  • Marfan’s
86
Q

OSA Px?

A
  • Partner may report excessive snoring, periods of apnoeas
  • Morning headache
  • Waking up unrefreshed from sleep
  • Daytime sleepiness
  • Concentration problems
  • Reduced O2 sats during sleep
  • Severe - HTN, HF, increased risk of MI / stroke
87
Q

OSA Ix?

A
  • Epworth sleepiness scale
  • Multiple Sleep Latency Test (MSLT)
  • sleep studies
88
Q

OSC Mx?

A
  • reduce alcohol, stop smoking, lose weight
  • CPAP
  • intra-oral devices - eg mandibular advancement
  • surgery - uvulopalatopharyngoplasty (UPPP)
  • inform DVLA if daytime sleepiness
89
Q

name some occupational lung disorders?

A

Inhaling something at work, leads to:
- acute bronchitis, oedema
- Pulmonary fibrosis
- Occupational asthma
- Hypersensitivity pneumonitis
- Bronchial carcinoma

90
Q

what is occupational asthma?

A
  • asthma sx worse at work
  • peak flow diary to compare work/home
91
Q

what is pneumoconiosis? who is affected?

A
  • inhalation of coal dust, fibrosis occurs
  • coal mine workers -> coal-workers pneumoconiosis (CWP)
  • particles ingested by alveolar macrophages - die, release enzymes, cause fibrosis
  • simple pneumoconiosis / progressive massive fibrosis (PMF)
92
Q

what is silicosis?

A
  • inhalation of silica particles - fibrogenic
  • upper zone fibrosis, egg-shell calcification of hilar lymph nodes
  • eg stonemasons, sandblasters, pottery
  • massive airways restriction
93
Q

discuss asbestos and impact on lungs?

A

Pleural plaques
- benign
- discrete fibrous / partially calcified thickened area

Pleural thickening
- extensive thickening of pleura - fibrosis
- can lead to restrictive lung disease

Asbestosis
- lung fibrosis from asbestos exposure - an ILD
- Px - SOB, clubbing, bl end-insp crackles, restrictive

Mesothelioma

Lung cancer
- most common form of cancer from asbestos exposure

94
Q

Byssinosis

A
  • inhalation of textile fibre dust
  • chest tightness, cough, SOB
  • Sx worse first day back at work after break
95
Q

Berylliosis

A
  • inhalation of copper alloy
  • aerospace, electrical devices
  • progressive SOB, pulm fibrosis
96
Q

Pulmonary siderosis

A
  • inhalation of metallic particles - metal grinding, welding
  • little effect on lung function
97
Q

what is pulmonary fibrosis?

A
  • diseases that cause lung fibrosis - scarring of lungs, loss of elasticity
  • an interstitial lung disease (ILD)
98
Q

what is ILD?

A

Disease which causes inflammation + fibrosis of lung parenchyma

  • Idiopathic pulmonary fibrosis
  • secondary pulmonary fibrosis
  • EAA
  • cryptogenic organising pneumonia
  • asbestosis
99
Q

pathophysiology of pulmonary fibrosis?

A
  • fibrosis may be secondary to lung damage, focal in response to irritants, or diffuse parenchymal disease

Idiopathic pulm fib (IPF)
- progressive PF, no apparent cause

Secondary pulm fib
- drugs - amiodarone, methotrexate, nitrofurantoin
- conditions - A1AT, RA, SLE, SSc, sarcoidosis

100
Q

pulmonary fibrosis Px?

A
  • SOBOE
  • Dry cough
  • fatigue
  • IPF - bibasal find end insp crackles, finger clubbing
101
Q

pulmonary fibrosis Ix?

A
  • bloods - eg CRP, ANA, RF
  • spirometry - restrictive - FEV1 + FVC reduced, FEV1:FVC >70%
  • HRCT - ground-glass appearance
  • TLCO test - reduced transfer factor
  • lung biopsy
  • bronchoalveolar lavage
102
Q

Mx of pulmonary fibrosis?

A
  • stop smoking, physio, pulm rehab, vaccines
  • home O2 if hypoxic
  • lung transplant

IPF
- pirfenidone
- nintedanib

103
Q

Extrinsic allergic alveolitis (EAA)?

A
  • hypersensitivity pneumonitis
  • diffuse granulomatous inflammation of lung parenchyma due to inhalation of organic antigens
  • an ILD
  • T3 and T4 hypersensitivity

Bird-fancier’s lung – reaction to bird droppings
Farmer’s lung – reaction to mouldy spores in hay
Mushroom worker’s lung – reaction to specific mushroom antigens
Malt workers lung – reaction to mould on barley

104
Q

EAA Px

A

Acute (4-8hrs post-exposure)
- SOB, dry cough, fever, rigors, chest tightness
- crackles on ausc
- resolves after Ag removed

Chronic (wks/months)
- lethargy
- SOB
- productive cough
- anorexia, wt loss

105
Q

EAA Ix?

A
  • CXR / CT - upper/mid zone fibrosis
  • Bloods - assay for specific IgG
  • Spirometry - restrictive
  • bronchoscopy + bronchoalveolar lavage
  • biopsy
106
Q

EAA Mx?

A
  • remove allergen
  • O2
  • steroids - oral prednisolone
107
Q

Pulmonary arterial hypertension (PAH)

A
  • increased pulmonary artery pressure + resistance, >20mmHg
108
Q

PAH pathophysiology?

A
  • hypoxic vasoconstriction, inflammation, endothelium damage - vasoconstrictor release, increased pressure
  • right heart strain, back pressure into venous system
  • RV pumps harder -> RVH, RHF
  • thrombosis tendency
109
Q

what causes PAH?

A
  • Idiopathic
  • Connective tissue disease, eg SLE
  • LHF - usually due to MI / HTN
  • COPD, pulmonary fibrosis
  • PE
  • Sarcoidosis, glycogen storage disease, haem disorders
110
Q

how might PAH Px?

A
  • SOB
  • Syncope
  • Cough
  • Tachycardia
  • Raised JVP
  • Hepatomegaly
  • Peripheral oedema
  • Hypotension
111
Q

PAH Ix?

A
  • ECG - RH strain, RAD, RBBB, RVH, p pulmonale
  • CXR - RVH, dilated pulmonary arteries
  • pulm function tests
  • ECHO
  • HRCT / cardiac MRI
  • 6min walking distance
  • BNP raised
  • right heart catheterisation
112
Q

PAH Mx options?

A
  • diuretics, anticoagulants, LTOT if hypoxic, tx anaemia
  • tx cause
  • CCB - nifedipine, diltiazem, amlodipine - cause vasodilation
  • endothelin receptor antagonist - bosentan - prevent vasoconstriction
  • phospohdiesterase type 5 inhibitor - sildenafil - reduce pulm BP
  • prostacyclin / prostaglandin analogues - iloprost - vasodilate
  • balloon atrial septostomy
  • lung transplant
113
Q

what is sarcoidosis?

A
  • Chronic multisystem granulomatous disorder (nodule full of macrophages) of unknown cause
  • F, 20-39yo/60yo, black ethnic origin
  • can affect any organ - tends to be lungs/thora
114
Q

sarcoidosis Px?

A

Acute sarcoidosis
- fever, erythema nodosum, polyarthralgia, BHL

Pulm disease
- dry cough, SOB, decreased exercise tolerance, chest pain

Other sx
- lupus pernio
- hepatomegaly, deranged LFTs, cholestasis, cirrhosis
- lymphadenopathy, wt loss, splenomegaly, fatigue
- salivary gland, eye, face, CNs, pituitary, renal, cardiac sx

Lofgren’s syndrome
- erythema nodosum + BHL + polyarthralgia

115
Q

Ix of sarcoidosis?

A
  • raised Ca, ACE
  • CXR, HRCT, MRI, PET
  • biopsy - non-caseating granulomas with epithelioid cells
  • other Ix for organ involvement - U/E, LFTs, ophthalmoscopy, ECG, ECHO, US liver/kidney
116
Q

sarcoidosis Mx?

A
  • mild sx - conservative
  • oral steroids - prednisolone + bisphosphonates
  • methotrexate, anti-TNF
  • lung transplant
117
Q

lung abscesses?

A
  • well-circumscribed infection within lung parenchyma, contains pus
  • after aspiration pneumonia, IE, lung tumour…
  • S aureus, Klebsiella, Pseudomonas, but typically polymicrobial
118
Q

Px of lung abscess?

A
  • pneumonia sx, but more subacute
  • fever, night sweats, wt loss
  • productive cough - foul sputum
  • haemoptysis
  • chest pain, SOB
  • dull to percussion, bronchial breathing
  • clubbing
119
Q

Ix of lung abscess?

A
  • CXR - fluid-filled space, air-fluid level
  • sputum + blood cultures
  • sepsis workup
120
Q

lung abscess Mx?

A
  • IV abx
  • percutaneous drainage
  • surgical resection
121
Q

what is TB?

A
  • infection caused by Mycobacterium tuberculosis
  • acid-fast bacilli - see with ZN stain - bright red cells on blue background
122
Q

TB pathophysiology - including naming types of TB?

A
  • spread by saliva droplets, then several possible outcomes:

Immediate clearance
- most cases

Primary active TB
- Ghon focus (lung lesion) develops - granuloma forms (collection of epithelioid histiocytes) - heals by fibrosis - T4 hypersensitivity

Latent TB
- immune system encapsulates bacteria, stops disease progression

Secondary TB
- reactivation of latent TB to active infection
- cavity erodes into airways

Miliary TB
- disseminated + severe disease

Extrapulmonary TB
- disease in other areas

Drug-resistant TB
- resistant to tx

123
Q

RFs of TB?

A
  • close contact - household member
  • immigrants relatives from high prevalence areas
  • immunocompromised
  • malnutrition, homelessness, drug users, smokers, alcoholics
124
Q

what is the BCG vaccine?

A
  • intradermal, live attenuated M bovis
  • generates immune response
  • test with Mantoux test first - only give if negative
125
Q

TB Px (systemic, pulmonary and extrapulmonary symptoms)

A

Systemic sx
- fever, lethargy, night sweats, wt loss, lymphadenopathy

Pulm sx
- cough, haemoptysis, chest pain, consolidation, pleural effusion

Extrapulmonary sx
- Bone – bone pain, Pott’s
- Abdo – ascites, lymph nodes, ileal malabsorption
- GU – epididymitis, LUTS, pyuria
- CNS – meningitis, sx of raised ICP
- Cardiac – pericarditis, pericardial effusion
- Skin – lupus vulgaris (red/brown lesions), erythema nodosum

126
Q

TB Ix - for immune response and active disease

A

For immune response - previous infection, latent TB, active TB
- mantoux test
- IGRA

For active disease
- CXR - patchy consolidation, hilar lymphadenopathy, pleural effusions, upper lobe cavitation, millet seed appearance
- cultures - sputum (3x), blood, lymph node aspiration/biopsy - caseating granuloma on histology
- NAAT

127
Q

TB Mx?

A
  • MDT, notify PHE, isolate, test for other IDs

Active TB
- Rifampicin - 6mo
- Isoniazid (with pyridoxine vit B6) - 6mo
- Pyrazinamide - 2mo
- Ethambutol - 2mo

Latent TB
- 3mo isoniazid (and vit B6) + rifampicin
- OR 6mo isoniazid (and vit B6)

Meningeal TB
- Tx for >12mo
- add steroids
- may need direct observed therapy

128
Q

influenza?

A
  • acute resp illness from infection with influenza virus
  • A/B/C serotypes, H/N Ags
  • un/complicated
  • droplet infection/contact
  • vaccinate - >65yo, pregnant, young children, healthcare workers
129
Q

influenze Px?

A
  • 1-4d incubation period
  • Fever
  • Lethargy
  • Anorexia
  • Myalgia, joint pain
  • Headache
  • Dry cough
  • Sore throat
  • Coryzal sx
130
Q

influenza Ix?

A
  • clinical dx
  • POCT / viral PCR to monitor outbreaks
131
Q

influenza Mx?

A
  • self-care
  • antivirals - tamiflu (oseltamivir), inhaled zanamivir - start <48hrs for it to be effective
132
Q

ARDS - causes, Px, Ix, Mx

A
  • severe inflammatory reaction in lungs
  • alveolar collapse, pulm oedema, inflammatory exudate, decreased lung compliance, fibrosis of lung tissue

Causes
- sepsis, pneumonia, trauma, massive blood transfusion, smoke inhalation, pancreatitis

Px
- resp distress, SOB, elevated RR
- bl lung crackles
- hypoxia

Ix
- CXR - bilateral infiltrates
- ABG - hypoxia, resp failure

Mx
- resp support
- prone positioning
- ITU
- PEEP

finals (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions