Respiratory Flashcards
State 4 risk factors of pneumonia in any patient?
Elderly
Smoking
Underlying respiratory disease
Immunosuppression
Name 4 conditions often associated with asthma?
Eczema
Allergic rhinitis
Peanut/food allergies
Hay fever
Give 4 strategies you can use to prevent relapse of an asthmatic attack?
Education on inhaler technique
Avoidance of triggers
Check medication compliance
Encourage exercise to increase lung capacity
What is atopy?
Group of disorders that often runs in families caused by an IgE related hypersensitivity reaction.
What are the pathological changes seen in bronchitis? 4 things
Narrowed airways
Reduced airflow
Hypertrophy
Mucous gland hyperplasia
Name 2 accessory muscles of respiration?
Sternocleidomastoid
Abdominal muscles
Scalene muscles
Name 3 typical organisms that cause community acquired pneumonia?
Streptococcus pneumonia
Haemophilus influenza
Mycoplasma pneumonia
Give 5 symptoms of pneumonia?
Fever Rigors Malaise Anorexia Dyspnoea Cough Haemoptysis Pleuritic pain
Suggest 5 signs seen in pneumonia?
Fever Cyanosis Tachypnoea Tachycardia Hypotension Consolidation (dull percussion, low expansion, bronchial breathing) Pleural rub
What is the CURB65 score, what is the criteria and how do you respond to the score?
Assessment of severity of pneumonia
Confusion
Urea >7mmol/L
Respiratory rate >30
BP 65
0-1 = Home treatment 1-2 = Hospital treatment >3 = Severe pneumonia
What medication would you prescribe in community acquired pneumonia?
Amoxicillin and Clarithromycin
What are the possible complications of pneumonia? 4 things
Pleural effusion Empyema Lung abscess Respiratory failure Pericarditis Brain abscess Death
Give 4 key questions you would ask about in an asthmatic?
Precipitants Exercise tolerance Disturbed sleep Home environment Occupation Days off
Give 3 signs of an asthma attack?
Tachypnoea Audible wheeze Hyper inflated chest Hyper resonant percussion Low air entry Polyphonic wheeze
What clinical features will make you think of acute severe asthma? 4 things
Peak flow 33-50%
Respiratory >25
Heart >110
Unable to complete sentences in one breath
What clinical features would point towards life threatening asthma? 5 things
Disturbed consciousness Exhaustion Low BP Cyanosis Silent chest
Peak flow <8kPa
What clinical features would make you think near fatal asthma attack?
High PaCO2 or requiring mechanical ventilation
What is the management in an acute severe attack of asthma?
15L O2 via non rebreathe mask
Salbutamol + ipratropium bromide nebulized
Hydrocortisone IV/Prednisalone PO
CXR rule out pneumothorax
Add IV magnesium sulphate if deteriorating
Senior review/Contact ITU
What are the steps in the BTS guidelines for managing chronic asthma?
- SABA
- Add inhaled steroid (beclometasone)
- Add LABA (salmeterol)
- Add theophylline or leukotriene receptor antagonist (monteleukast)
- Add prednisalone PO
What are the possible complications of COPD? 4 things
Acute exacerbation +/- infection Polycythaemia Respiratory failure Cor pulmonale Pneumothorax Lung carcinoma
Name 2 signs and 2 symptoms of COPD?
Tachypnoea Use of accessory muscles Hyperinflation Decreased expansion Wheeze Cyanosis
Cough
Sputum production
Dyspnoea
Wheeze
What are the X-ray changes seen in COPD? 5 things
Hyperinflation Flat hemidiaphragms Large central pulmonary arteries Decreased peripheral markings Bullae
What are the acute changes seen in asthma? 4 things
Airway (smooth muscle) constriction
Micro vascular leakage/oedema
Vasodilation
Mucus hyper secretion
What are the chronic changes seen in asthma? 4 things
- Subepithelial fibrosis
- Smooth muscle hyperplasia/hypertrophy
- Goblet cell hyperplasia
- New vessel formation
Give 4 conservative managements of COPD?
Smoking cessation Exercise Treat poor nutrition Lose weight Vaccinations (influenzae, pneumococcal) Pulmonary rehabilitation/palliative care
What are the steps in treating stable COPD? 3 steps
- Life style changes/ conservative management
- Antimuscarinic (ipratropium) or B2 agonist PRN
- Regular anticholinergic or LABA + inhaled corticosteroids
- LABA + inhaled steroid + anticholinergic
What is the acute management of COPD?
- Controlled O2 therapy 24-28%
- Nebulized salbutamol and ipratropium
- Steroids hydrocortisone and prednisalone
- Antibiotics if evidence of infection
Give 5 risk factors for a PE?
Recent surgery Leg fracture Prolonged bed rest Malignancy Pregnancy Previous PE
What is the acute management of a PE?
O2 100% Morphine + antiemetic Thrombolyse or surgery (massive emboli with haemodynamic compromise) LMWH Warfarin
What are the management options for a pneumothorax? 5 things
Primary:
2cm air rim or symptoms = Aspiration
No response to aspiration = Chest drain
Secondary
Anytime = Aspiration
SOB, >50y/o, rim of air >2cm, unsuccessful aspiration = Chest drain
Bilateral pneumothoracies, Failure of drain, Hx of prev. pneumotharcies = Surgery
What are the respiratory causes of clubbing?
Abscess Bronchiectasis Cancer Decreased O2 Empyema Fibrosing alveolitis
Give 5 causes of bronchiectasis?
CF Kartageners syndrome Bronchiolitis Pneumonia TB Obstruction Rheumatoid arthritis
Give 3 signs and 3 symptoms of bronchiectasis?
Symptoms:
Persistent cough
Loads of purulent sputum
Haemoptysis
Signs:
Finger clubbing
Inspiratory crepitations
Wheeze
Give 3 complications of bronchiectasis?
Pneumonia
Pleural effusion
Pneumothorax
Cerebral abscess
What 3 investigations can you do in Bronchiectasis?
Sputum culture CXR HRCT chest Spirometry Bronchoscopy
Give 5 symptoms of Tuberculosis?
Cough Haemoptysis Malaise Lethargy Weight loss Night sweats Anorexia
What are CXR signs seen in tuberculosis? 4 things
Consolidation Cavitation Fibrosis Calcification Pleural effusion
What 4 investigations would you request for tuberculosis?
CXR Ziehl-Nielsen sputum stain for AFB Sputum culture Bronchoscopy Mantoux test Biopsy/histology CT scan
Give the 4 drugs used for tuberculosis and regime
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
4 drugs for 2 months
R & I for 4 months
Give 3 public health measures put in place for tuberculosis?
BCG for any person who is high risk
Screening of immigrants
Isolation of confirmed cases
Notification of the HPA
Give 2 different types of pleural effusion and their causes?
Transudate-cardiac failure, hypothyroid, nephrotic syndrome, renal failure
Exudate-pneumonia, lung carcinoma, PE, TB
What do you test for in pleural fluid?
Protein count Bacterial culture and sensitivity Cytology Cell count Glucose
What is the location for aspiration in a pneumothorax?
2nd intercostal space
Mid clavicular line
Give 3 CXR changes in a pneumothorax?
Tracheal shift
Decreased lung markings
Raised hemidiaphragm
Unequal chest expansion
Give the definition of asthma?
Hyper-responsiveness of the bronchi to various ‘broncho-constricting’ agents that results in reversible airway obstruction which is ether spontaneous or following treatment and airway inflammation
Give 3 possible complications of COPD?
Respiratory failure
Cor pulmonale
Lung carcinoma
Pneumothorax
What 4 signs can you see on CXR of a COPD patient?
Hyperinflation (>6 anterior ribs) Flat hemidiaphragms Large central pulmonary arteries Fewer peripheral vascular markings Bullae
Name 3 atypical organisms that cause community acquired pneumonia?
Staph Aureus
Legionella spp
Moraxella catarrhalis
Chlamydia
Give 3 organisms that can cause hospital acquired pneumonia?
Gram negative enterobacteria
Staph.aureus
Pseudomonas
Klebsiella
Name 3 patient groups at risk of aspiration pneumonia?
Stroke patients
Myasthenia gravis
Unconscious
Poor dental hygiene
Name 4 signs seen in consolidation?
Reduced chest expansion Dull percussion note Increased tactile fremitus Increased vocal resonance Bronchial breathing
Give 4 management steps for pneumonia?
IV fluids (dehydrated => shock)
O2 therapy (>92%/>8kPa O2)
Analgesia (pleuritic chest pain)
Abx (empirical)
State 4 possible complications of pneumonia?
Respiratory failure Pleural effusion Lung abscess Septicaemia CVS complications (AF, hypotension)
In the tuberculin skin test, give a reason why a result might be false negative?
Immunocompromised patients (AIDS, steroids, Splenectomy, Malignancy)
Before treatment of tuberculosis occurs, what assessments must be made? 2 things
Renal/Liver function tests
Visual/Colour acuitity
Give one side effect each for the drugs used in the treatment of tuberculosis?
Rifampicin - tears/urine orange
Isoniazide - peripheral neuropathy
Pyrazinamide - arthralgia
Ethambutol - optic neuritis
How do you manage Obstructive sleep apnoea? 3 things
Simple measures: weight reduction, increase exercise, improving diet. Avoidance of alcohol and tobacco.
Assisted non-invasive ventilation (CPAP via nasal mask)
Surgery: tonsillectomy, tracheostomy
What are the 2 complications associated with Idiopathic pulmonary fibrosis?
Type 1 respiratory failure
Increased risk of lung cancer
How would you manage an acute exacerbation of COPD? 3 things
Oxygen therapy - controlled starting with 24%
Triple therapy - nebs bronchodilators, steroids, Abx (evidence of infection)
?Physio for expulsion of sputum
How do you manage acute pulmonary oedema?
OMFG Oxygen Morphine Furosemide GTN
What is the scoring system used in PE and give 4 components of it?
Well’s score
Localized tenderness along venous system Entire leg swollen Pitting oedema > assymptomatic leg Collateral superfical veins Major surgery in last month
