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Anatomy (make or break marks) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the most common cause of P.E. ?

A

often due to venous thromboemboli from leg/pelvis.

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2
Q

What are the symptoms of P.E.?

A

Sudden, acute breathlessness.
Pleuritic chest pain
Tachypnoea, Tachycardia
Haemoptysis, pink frothy sputum

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3
Q

What investigations are relevant to P.E.?

A

CT pulmonary angiography (gold standard, diagnostic)

D-dimer (a low D-dimer [negative result] effectively rules out P.E. but a postive result is not diagnostic)

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4
Q

How do you treat P.E.?

A

anticoagulation for all! (LMW heparin + oral warfarin)

If P.E. deemed “massive”/ haemodynamicaly unstable, thrombolysis with alteplase.

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5
Q

What is a pneumothorax?

A

Collection of air in the pleural cavity due to rupture of the subpleural bulla.

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6
Q

What are the symptoms/ signs of a pneumothorax?

A

Sudden onset breathlessness.
Pleuritic chest pain.

Ipsilateral reduced chest expansion.
Hyperresonance
Reduced breath sounds

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7
Q

What is the difference between a simple pneumothorax and a tension pneumothorax?

A

Simple pneumothorax - volume of air in pleural cavity does not increase
Tension - volume of air in pleural cavity increases due to the formation of a one way valve. There is also tracheal deviation in tension pneumothorax (away from side of pneumothorax)

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8
Q

How do you treat a simple pneumothorax?

A

If patient breathless and rim of air > 2cm in CXR—> aspirate: 2nd intercostal space, midclavicular line

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9
Q

How do you treat a tension pneumothorax?

A

Aspirate: 2nd intercostal space, midclavicular line
(followed by)
chest drain: 5th intercostal space, midaxillary line

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10
Q

How is the trachea deviated in: pleural effusion, tension pneumothorax and complete collapse of lung?

A

pleural effusion: trachea deviated away
tension: trachea deviated away
collapse of lung: trachea pulled towards

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11
Q

What is pleural effusion?

A

Accumulation of fluid in the pleural cavity.

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12
Q

What are the signs of pleural effusion?

A

Stony dull to percuss
reduced chest expansion on affected side
reduced or absent breath sounds
mediastinal displacement away from affected side.

(there may also be breathlessness and pleuritic chest pain

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13
Q

What is bronchiectasis?

A

Abnormal widening of airways (obstructive).

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14
Q

What are the signs/symptoms of bronchiectasis?

A

chronic productive cough, producing large amounts of smelly sputum. May contain blood. Recurrent chest infections. Clubbing.
Florid (widespread) crepitations - coarse crackles

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15
Q

How do you diagnose bronchiectasis?

A

CT scan: “signit ring appearance”

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16
Q

What are the causes of bronchiectasis and how do you treat?

A

TB. Cystic fibrosis. Whooping cough.

Treat by postural drainage.

17
Q

What are the signs/ symptoms of pulmonary fibrosis?

A

(3 C’s) Cough (dry. Clubbing. Cyanosis.

fine bibasal crackles

18
Q

What investigation is done for pulmonary fibrosis and what would you see?

A

CXR: “ground glass appearance” - bilateral interstitial shadowing.

19
Q

What is Sarcoidosis and who does it commonly affect?

A

Type 4 autoimmune disease. more common in young, black females.

20
Q

What are the signs/symptoms of sarcoidosis?

A

erythema nodosum. non-caseating granulomas.
Fatigue. Weight loss. Uveitis.
bilateral hilar lymphadenopathy.

21
Q

What investigations are relevant to sarcoidosis?

A

CXR - look for bilateral hilar lymphadenopathy.

increase in serum ACE and Calcium levels.

22
Q

What is an Abdominal Aortic Aneurysm and what are the signs/ symptoms?

A

AAA = swelling of the abdominal aorta.

(often asymptomatic) May be a pulsaltile mass present. Lower back pain possible.

23
Q

What are the symptoms of a ruptured AAA?

A

severe abdominal pain. starting in epigastrium, radiating to back. Tachycardia, hypotension (due to blood loss)

24
Q

What investigations are done relevant to AAA?

A

US is a good 1st line investigation if asymptomatic but pulsaltile mass present.
CT is gold standard and used if AAA approaching 5cm or before surgery.
(regular US surveillance, every 6 months, for those with AAA)

25
Q

When is surgery given in AAA?

A

if AAA is larger than 5cm - elective surgery

if ruptured AAA - urgent surgery

26
Q

Define type 1 respiratory failure.

A

hypoxia (Pa O2

27
Q

Define type II respiratory failure.

A

Hypoxia (Pa O2 6)

28
Q

how do you treat type I and type II respiratory failure?

A

Type I: give oxygen

Type II: give controlled oxygen therapy (venturi, start at 24%) and monitor CO2 levels.

29
Q

What investigation is done in respiratory failure?

A

ABG

30
Q

What are signs of type I and type II respiratory failure?

A

type I: breathlessness, cyanosis, confusion.

type II: headache, drowsiness, tremor/flap

31
Q

Describe the pathophysiology of asthma.

A

Eosinophil mediated inflammation of airways (IgE). reversible, diurnal variation.

32
Q

What is the investigation of choice for asthma?

A

Peak expiratory flow (PEF)

33
Q

Give the step by step treatment of asthma.

A

1) salbutamol 2) if SABA used more than once a day, add beclometasone (ICS) 3) add Salmetarol (LABA) 4) if LABA has an affect, continue and increase dose of ICS
5) other meds to try: montelukast (leukotriene rec antagonist), oral theophyline
6) steroid trial - prednisolone (PO)

34
Q

What is the treatment of acute asthma?

A 
(OSHITMAN)
Oxygen 100% non-rebreather mask (15L/min)
Salbutamol (5mg) nebulised (6 L/min)
Hydrocortison IV or Prednisolone (PO)
Ipratropium nebulised hourly 
Theophyline IV
Magnesium sulphate IV
call anesthetist
35
Q

What is COPD?

A

chronic bronchitis and emphysema (destruction of alveoli)

neutrophil mediated

36
Q

What investigations are useful in COPD?

A

Spirometry, gold standard. (FEV1 > 50% = mild) (FEV1

Anatomy (make or break marks) (9 decks)

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