Respiratory Flashcards
1
Q
What does bloody sputum indicate?
A
Haemoptosis
2
Q
What does yellow green sputum indicate?
A
Pulmonary infection
3
Q
What does black sputum indicate?
A
Coal mining
4
Q
What does pink frothy sputum indicate?
A
Pulmonary oedema
5
Q
What is peak expiratory flow?
A
An estimate of airway calibre
6
Q
What is a normal spO2 in a healthy young adult?
A
99-98%
7
Q
Where is atrial blood gas taken from usually?
A
Femoral or radial artery
8
Q
What is the definition of type 1 resp failure?
A
defined as PaO2 <8
9
Q
What is the definition of type 2 resp failure?
A
defined as PaO2 <8 and paCO2 >6.0kPa.
10
Q
What is spirometery?
A
It measures functional lung volumes
11
Q
What it FEV1?
A
Forced expiratory volume in 1 sec
12
Q
What is FVC
A
Forced vital capacity?
13
Q
Which is affected more in obstructive lung disease, FEV1 or FVC
A
FEV1
14
Q
Which is affected more in restrictive lung disease, FEV1 or FVC
A
FVC
15
Q
What are some causes of obstructive lung disease?
A
Asthma, COPD
16
Q
What are some causes of restrictive lung disease?
A
Lung fibrosis, sarcoidosis; pneumoconiosis, interstitial pneumonias; connective tissue diseases; pleural effusion; obesity; kyphoscoliosis; neuromuscular problems.
17
Q
What’s the commonest cause for community acquired pneumonia
A
Strep pneumonia
18
Q
What’s the commonest cause for hospital acquired pneumonia
A
Staph A
19
Q
What are the common causes of aspiration pneumonia?
A
stroke, myasthenia, bulbar palsies, consciousness (eg post- ictal or drunk), oesophageal disease (achalasia, reflux), or with poor dental hygiene risk aspirating oropharyngeal anaerobes.
20
Q
What’s the commonest cause for immune compromised pneumonia
A
Strep pneumonia
21
Q
What are the clinical symptoms of pneumonia?
A
Shivers, fever, rigors, malaise, dyspnoea, anorexia, purulent sputum, haemoptysis and pleuritic pain
22
Q
What are the signs of pneumonia?
A
Pyrexia, cyanosis, confusion (can be the only sign in the elderly—may also be hypothermic), tachypnoea, tachy- cardia, hypotension, signs of consolidation (diminished expansion, dull percussion note, tactile vocal fremitus/vocal resonance, bronchial breathing), and a pleural rub.
23
Q
How is severity of pneumonia measured?
A
CURB65 of: Confusion (abbreviated mental test ≤8); Urea >7mmol/L; Respiratory rate ≥30/min; BP
24
Q
What is the management of pneumonia?
A
Antibiotics
Keep sp02 over 94%
IV fluids for anorexia and shock,
Pain killers
25
What are the possible complications of pneumonia?
Pleural effusion, empyema, lung abscess, respiratory failure, septicaemia, brain abscess, pericarditis, myocarditis, cholestatic jaundice.
26
What is an empyema?
Pus in the plural space
27
What is clear sputum a sign of?
Chronic bronchitis
28
What are the common presenting symptoms of respiratory illness?
Cough with sputum, dyspnoea, haemoptysis, hoarseness, wheeze, chest pain, stridor
29
What is a stridor and what can cause it?
An inspirational sound due to the partial blockage of upper airways. Can be in the lumen (tumour, bilateral cord palsy, foreign body) or within the wall (anaphylactic oedema, laryngospasm, tumour, amyloidosis, acute epiglottitis, croup) or extrinsic (goitre, post op, lymphadenopathy)
30
What is a hollow bovine cough associated with?
Recurrent laryngeal nerve palsy
31
Loud brassy cough suggests
Pressure on trachea, eg tumour
32
Barking cough suggests
A croup
33
Chronic cough can be caused by
Pertussis, tb, asthma
34
Dry chronic cough can be
Side effect of ace inhibitors,
| Caused by acid irritation due to oesophageal reflux
35
What are the causes of haemoptysis?
Infective (tb, bronchiectisis, lung abscess)
Neoplastic
Vascular (lung infarction, vasculitis)
Parenchymal (interstitial fibrosis, sarcoidosis, cystic fibrosis)
Foreign bodies
Pulmonary hypertension
Coagulopathies (thrombocytopenia, warfarin overuse)
Pseudo haemoptysis
36
What can cause wasting of intrinsic muscles?
T1 lesions
37
What can cause tender wrists?
Cancer, hypertrophic pulmonary osteoarpathy
38
What can cause a tracheal displacement?
It can collapse away from large pleural effusion or tension pneumothorax
39
What can cause an impalpable apex beat?
COPD, pleural effusion, dextrocardia
40
What are bronchial breath sounds and what are some causes?
Harsh with a gap between inhalation and exhalation
Occurs when lung tissue has become firm
Eg consolidation, localized fibrosis, pleural effusion
41
What can diminished breath sounds be caused by?
Pleural effusions, pleural thickening, pneumothorax, bronchial obstruction, COPD, asthma
42
What can cause a monophonic wheeze?
Single obstruction of airways, eg tumour
43
What can cause a polyphonic wheeze?
Wide spread narrowing of airways, COPD and asthma
44
What can cause end inspiration crackles?
Distal opening of airways, pulmonary oedema, alveoli fibrosis
45
What can cause mid inspiration crackles?
More proximal airways, bronchiectisis
46
What can cause early inspiration crackles?
Small airway disease, eg COPD
47
What is bronchiectisis? What are the common causes?
Chronic infection of bronchi and bronchioles leading to permanent dilation of the airways
H influenzae, strep pneumonia, staph A, pseudomonas
48
What are the common causes of bronchiectisis?
CF, young's syndrome; primary ciliary dyskinesia; Kartagener’s syndrome
Aft: Measles, TB, HIV, bronchiolitis, pneumonia
49
What are the signs and symptoms and complications of bronchiectisis?
Symptoms: cough, copious purulent sputum, intermittent haemoptysis
Signs: finger clubbing, wheeze, inspiratory creptitations
Complications: pneumonia, pneumothorax, cerebral abscess amyloidosis
50
What are the clinical features of CF?
Respiratory: cough; wheeze; recurrent infections; bron- chiectasis; pneumothorax; haemoptysis; respiratory failure; cor pulmonale. Gastro- intestinal: pancreatic insufficiency (diabetes mellitus, steatorrhoea); distal intestinal obstruction syndrome (meconium ileus equivalent); gallstones; cirrhosis. Other: male infertility; osteoporosis; arthritis; vasculitis nasal polyps; sinusitis; and hypertrophic pulmonary osteoarthropathy (HPOA). Signs: cyanosis; finger clubbing; bilateral coarse crackles.
51
What are the five ways aspergillus cam affect the lung?
Asthma, type 1 hypersensitivity
Allergic bronchopulmonary aspergillosis:wheeze cough, purulent sputum, dyspnoea, recurrent pneumonia
Aspergilloma: cough, haemoptysis
Invasive aspergillosis: in immunocompromised
Extrinsic allergic alveolitis: hypersensitivity
52
What are the major risk factors for lung tumours?
Smoking, coal mining, asbestos, chromium, arsenic, iron oxides, radiation
53
What are the signs and symptoms of lung cancer?
Haemoptysis, cough, weight loss, lethargy, chest pain, anorexia, recurrent pneumonia
Cachexia, anaemia, clubbing, wrist tenderness, auxiliary nodes
Consolidation, lung collapse, pleural effusion
Hepatomegaly, bone tenderness,
54
Complications of lung tumours?
Recurrent laryngeal nerve palsy, phrenic nerve palsy, SVC obstruction, rib erosion, horner's syndrome
Metastasis to brain and bone
confusion, fits
55
What are the three factors that cause airway narrowing in asthma
Bronchial muscle constriction
Mucosal swelling- caused by mast cell degranulation
Increased mucus production
56
What are the symptoms of asthma?
```
Intermittent dyspnoea on exercising, relieved by bronchodilators
Audible Wheeze
Nocturnal cough
Sputum
Often there is a presence of other ectopic diseases (hay fever, eczema)
Hyper inflated chest
Tachypnoea
Hyperressonant chest
```
57
What are the differentials for asthma?
Pulmonary oedema, bronchiectasis, COPD, airway obstruction, PE, pneumothorax
58
What are the medications used for asthma?
Beta agonists- bronchodilators
Corticosteroids- minimize systemic effects
Aminophylline-reduce bronchoconstriction
Anticholinergics-reduce muscle spasm
Leukotrine inhibitors-
Anti IgE antibody
59
What is the definition of COPD?
Progressive obstructive lung disorder (FEV1/FVC
60
What is the presentation of pink puffers?
Breathless but not cyanosed, no bloating, can progress to type 1 resp failure
Increased alveolar ventilation, I almost normal paO2
61
What is the presentation of blue bloaters?
Not breathless, but cyanosed and bloated. Low paO2 and high paCO2. May develop cor pulmonale
62
What are the signs and symptoms of COPD
Recurrent infections, breathlessness, cough, sputum, hyperinflation of chest, tachypnoea
63
What it acute respiratory stress syndrome?
Acute lung injury, caused by injury or aft infection
| Causes release of inflammatory cytokines which causes non cardiogenic pulmonary oedema and multi organ failure
64
What can cause acute respiratory distress syndrome?
Sepsis, hypovolemia, anaphylaxis, pneumonia, aspiration, malaria
65
What are the clinical features of ARDs
tachypnoea, tachycardia, fine inspiratory bilateral crackles, cyanosis,vasodilation
66
What is the treatment if ARDS?
Ventilation, CPAP (continuous positive airway pressure)
67
What is type 1 resp failure usually caused by?
Pneumonia, asthma, fibrosis, pleural effusion, PE, emphysema,
68
How do you treat type 1 resp failure
O2 with monitoring
69
What can cause a type 2 resp failure?
Pulmonary disease: asthma, COPD, fibrosis, pneumonia, sleep apnoea
Depressed resp rate: drugs
Neuromuscular causes: diaphragm paralysis, mysanthia gravis, guillan barré
70
How do you treat type 2 resp failure?
With controlled O2, start at 24% because hypercapnic drive may drive resp rate
71
What is a pulmonary embolism and how is it usually caused?
Emboli forms in lungs,
Usually from a thromboemboli from a DVT
Can come from a thromboemboli from right heart and other random things (gas, fat, amniotic fluid)
72
What are the risk factors for a thromboembolism?
```
Reduced motility,
Post op
Thrombophilia,
Malignancy
Post partum
```
73
What are the clinical features of a PE?
Symptoms: Acute Breathlessness, syncope, dizziness, haemoptysis, pleuritic chest pain
Signs: pyrexia, tachycardia, tachypnoea, cyanosis, hypotension, raised JVP, pleural rub
74
What are the risk factors of a PE
Thrombophilia, previous post partum, post op, bed rest, malignancy
75
What are the causes of a pneumothorax?
Usual presentation is spontaneous in young, healthy males
| Can also be COPD, asthma, TB, pneumonia, lung abscess, carcinoma, CF, sarcoidosis, silicosis, etc
76
What are the clinical features of a pneumothorax?
Pleuritic chest pain, acute, sudden onset breathlessness
| Hyper resonance, deviation of trachea, diminished breath sounds
77
What is the management of a pneumothorax?
Chest drain, go between 1st and 2nd IC space mid clavicular
78
What is a pleural effusion and what are the types?
Fluid in plural space
Classified based on protein conc.
Transudates have low protein,
Exudates have high protein
79
What are the causes of Transudate pleural effusions?
Increased venous pressure, like HF, and constrictive pericarditis
80
What can cause an exudate pleural effusion?
Increased leakiness of pleural cavities
| Pneumonia, TB, pulmonary infarction
81
What signs could you see with a pleural effusion?
Stony dull on percussion, reduced breath sounds, bronchial breathing
82
What is sarcoidosis?
It's a multi system granulomatous disease of unknown origin
83
What are the signs of sarcoidosis?
Chest pain, progressive dyspnoea, reduced exercise tolerance, Hepatomegaly, splenomegaly, conjunctivitis, uveitis,
84
What is interstitial lung disease?
A disease which affects lung parenchyma in a diffused manner
| Characterised by lung inflammation and chronic inflammation
85
What are the signs and symptoms of interstitial lung disease?
Dyspnoea, non productive cough, abnormal breath sounds abnormal chest X-ray, ct scan, restrictive pulmonary disease on ct scan
86
What is extrinsic allergic alveolitis and what are the notable causes?
Hypersensitivity reaction; alveoli is infiltrated by inflammatory cells, then granuloma's start to form
Birds
Farmers lung, mushroom farmer's lung
87
What are the clinical features of allergic alveolitis?
Dyspnoea, crackles, no wheeze, dry cough, fever, rigors, myalgia
Weight loss, Exertional dyspnoea,
88
What are the clinical signs of idiopathic pulmonary fibrosis?
Dyspnoea, arthralgia, clubbing, fine end inspiratory crackles, malaise, weight loss, dry cough
89
What is cor pulmonale?
RHF caused by chronic lung failure
90
What are the clinical features of cor pulmonale?
Dyspnoea, heave, oedema, Hepatomegaly, fatigue, syncope, raised JVP
91
What are the causes of cor pulmonale
Fibrosis, asthma,COPD, bronchiectasis
Mysanthia gravis,
Vasculitis, emboli
92
In an X-ray, what does a completely obscured R. Heart border indicate?
Focal consolidation
93
In an X-ray, what do tramlines and ring shadows indicate?
Bronchiectasis
94
Any acute admission to the hospital due to asthma should
Be seen as an opportunity to review self management skills
95
What is the first line treatment for acute asthma?
High dose inhaled beta-2 agonists
96
An acute severe asthma episode can be discharged if
PEFR returns to 75% of predicted within 1 hour of initial treatment
97
What must happen before a patient is discharged from an Asthma attack?
The patient must be stable on their own medication regime
98
What do enlarged supra clavicular lymphnodes and bronchial breathing suggest?
Lung carcinoma
99
What do clubbing and coarse inspiratory crepitations suggest?
Cystic fibrosis
100
What do mouth ulcers and unilateral chest dullness suggest?
SLE
101
What does a unilateral calf oedema and a pleural run suggest?
PE
102
What does unilateral Ptosis and unilateral reduction in air entry suggest?
Pancoast tumour
103
What causes hyponatremia in a patient with lung cancer?
Inappropriate ADH secretion
104
What does inappropriate ADH secretion in lung cancer suggest?
Small cell cancer
105
What does audible gurgling imply and what is the treatment for it?q
Presence of liquid in the upper airway
| Treated with suction
106
If a patient has respiratory depression and has contracted pupils what treatment should be used?
Naloxone
107
PE causes what kind of chest pain?
Pleuritic, sharp and inspiratory chest pain
108
What does abdominal pain and postural hypotension suggest?
Adrenal insufficiency
109
What does abdominal pain, lung cancer and postural hypotension suggest?
Metastasis to adrenal glands causing Addison's disease
