Respiratory Flashcards
1
Q
give some non-respiratory causes of chronic breathlessness
A
anaemia and heart disease
2
Q
what will the pH be in chronic acidosis or alkalosis?
A
normal, there has been compensation
3
Q
what will the HCo3 be in acute respiratory acidosis
A
normal
4
Q
what 3 things change in the lungs in asthma
A
bronchoconstriction
inflammation
airway remodelling: supepithelial fibrosis, increased muscle tone and gland enlargement.
This is mediated by cysteinyl leukotrines, histamine and cytokines
5
Q
how do glucocorticoids reduce inflammation?
A
inhibit phospholipase2, so phospholipid cannot become arachidonic acid which then forms prostaglandins (COX) and leukotrines (5-LO)
6
Q
what are montelukast and zafirlukiast
A
cysteinyl-1 receptor antagonists
7
Q
give some examples of long acting beta agonists
A
fomoterol
salmeterol
8
Q
what do ipratropium and tiotropium do?
A
muscarinic antagonists so they block the activation of smooth muscle
9
Q
what steroids are used for asthma
A
prednisolone
beclomethasone
budenoside
10
Q
what causes type I respiratory failure?
A
airflow obstruction so asthma, sleep apnoea, V/Q mismatch (this could be caused by pulmonary HTN, NO, RL shunt or dead space from PE or pulmonary oedema)
11
Q
what causes type II respiratory failure
A
co2 being trapped in the lungs causing an eqm (alveolar hypoventilation) so COPD, no respiratory drive (heroin OD), obesity, chest wall deformity, NMJ disorders, muscle weakness
12
Q
what would you use continuous positive airway pressure (CPAP) for?
A
pulmonary oedema or obstructive sleep apnoea
13
Q
what would you use bi-level positive airways pressure for?
A
type II respiratory failure because it improves alveolar ventilation, more so than CPAP
14
Q
what is ANCA associated vasculitis?
A
anti neutrophil cytoplasmic antibody associated vasculitis
15
Q
what is the respiratory burst?
A
where macrophages use NADPH oxidase to create superoxide 02- and H2O2. radicals to kill microorganisms
16
Q
what does PCP look like on CT and how is it treated?
A
diffuse peri-hilar ground glass
co-trimoxazole
17
Q
what causes the characteristic owl’s eye appearance on biopsy?
A
CMV
18
Q
what disease of the pleura will malignancy, infection, PE, inflammation, asbestos or trauma cause?
A
exudative pleural effusion (my ex ate a lot of meat)
19
Q
what distinguishes between exudate and transudate?
A
Light’s criteria after throracocentesis
20
Q
how are influenza A split up
A
into which haemagglutinin and neuradimase antigens they have
21
Q
what may influenza complicate into
A
bacterial pneumonia
22
Q
what is an asthma attack?
A
an exacerbation in which there is more bronchoconstriction, inflammation and mucus production
23
Q
how much improvement are you looking for with reversibility testing to diagnose asthma (b agonist 4-8 or ics 2w)
A
15%
24
Q
what does a respiratory rate of over 25 indicate
A
severe asthma attack
25
give some features of COPD
breathlessness, wheezing, weight loss, cyanosis, hyperexpansion, high output cardiac failure
26
what would the MRC dyspnoea scoring system give someone who had SOB on hills?
2
27
define COPD exacerbation
an acute worsening of symptoms that exceeds day to day variation and needs a change in medication. The more a patient has, the faster their lung function will decline.
28
which pathogen is likely cause pleuritic chest pain in pneumonia
Streptococcus pneumoniae
29
what should all pneumonia patients be tested for
hep B, hep C and HIV
30
what does CURB65 stand for?
```
Confusion
Urea>7mmol (but in the community, can't measure this)
Respiratory rate>30
Blood pressure<90/60
Over 65, get 1 point for each
```
31
at which CURB65 score should you definitely admit someone to hospital?
2 (moderate), 3+ is severe if they are above 4, consider admission to critical care
32
what atypical pneumonia would you suspect in a homeless person or for an HAI?
Klebsiella pneumoniae
33
what are some complications of pneumonia?
necrotising pneumonia, meningitis, bacteraemia, parapneumonic effusion, abscess
34
what may a PET scan show as cancer?
inflammation or infection since these areas will also metabolise more glucose
35
which cancers may lead to lung cancer?
```
breast
colorectal
prostate
kidney
thyroid
```
36
what are some paraneoplastic syndromes that occur in lung cancer?
```
PTH causing hypercalcaemia
finger clubbing
DIC
anorexia
SIADH (SCLC)
```
37
what respiratory diseases can asbestos cause?
```
mesothelioma
plaques
asbestosis (pulmonary fibrosis)
asbestos effusion
bronchial carcinoma
```
38
list some side effects of chemotherapy
```
alopecia
N&V
peripheral neuropathy
constipation
mucositis
rash
BM suppression (anaemia, thrombocytopenia, neutropenia)
fatigue
anaphylaxis
```
39
what can benign effusion complicate into?
diffuse pleural thickening
40
What do fine inspiratory creps, a restrictive disease and finger clubbing suggest?
Interstitial lung disease or (rarely) bronchiectasis
41
What do high lymphocytes from BAL suggest?
Sarcoidosis
42
Which idiopathic interstitial lung disease is not responsive to steroids?
Idiopathic pulmonary fibrosis, also called cryptogenic fibrosing alveolitis
43
give the pulmonary manifestations of cystic fibrosis
bronchiectasis, pneumothorax, inflammation, infection. Leads to obstruction on sprirometry.
44
what 2 things do you need to diagnose CF?
clinical signs and evidence of CFTR (CF transmemebrane conductance regulator) malfunction this is through sweat tests, nasal potential difference or small bowel ion studies
45
give some bacteria that affect patients with CF?
Pseudomonas aeruginosa, Staphylococcus aureus, mycobacteria
46
what is pulmonary hypertension defined as?
over 25mmHg pulmonary arterial pressure when right heart catheterisation is performed
47
what are some symptoms of pulmonary hypertension?
dyspnoea
ankle swelling
chest pain
48
list the stepwise treatments of asthma
```
Allergen avoidance
SABA
ICS
LABA
leukotrine receptor antagonist
steroid po
```
49
list the stepwise treatments of COPD
SABA
LABA/LAMA
ICS
all 4
50
consolidation which looks like pneumonia on CXR, what else could it be?
immune mediated lung disease
51
what would you add to broad spectrum antibiotics if an immunocompromised patient had pneumonia?
antifungals for aspergillus
52
what investigations can you carry out on the pleura?
Biopsy: Abrahams needle, CT guided biopsy (visible masses), VATS (video assisted throascopic surgery).
53
what is pleurodesis?
poudrage where steritalc is put between the layers of the pleura to stick them together for pneumothorax or pleural effusion
54
what is croup?
laryngotracheobroncitis, barking cough
55
define COPD
a disease characterised by airflow limitation which isn't fully reversible and is usually progressive and associated with abnormal inflammatory response of the lungs to noxious stimuli.
56
what is a complication of giving COPD patients inhaled corticosteroids?
increased risk of pneumonia
57
what is a COPD exacerbation
1) patient complains of it
| 2) requires a change in medication
58
what would suggest that a patient has developed a parapneumonic effusion (complicated or empyema)
fever doesn't settle after ABx
pain on deep inspiration
dull on percussion
reduced air entry
59
give some non-infectious causes of pneumonia
eosinophils, vasculitis, drugs
60
give some examples of occupational lung diseases
asthma, COPD, EAA, lung cancer, mesothilioma, fibrosis (asbestos, silica, coal); they happen due to someone's work alone. asthma and asbestosis are the most common
61
what kind of inhaled particles are there?
dusts (chiselling), fumes (welding) are solid
mists (metalwork) are liquid
vapours are gases. Some are respirable-small enough to get to the alveoli.
62
what is sarcoidosis
abnormal collections of inflammatory cells, responds to oral steroids but not ICS. It may be caused by bacteria, nanoparticles, firefighting, metalwork. It can lead to lung fibrosis, cardiac arrhythmia or nephrocalcinosis.
63
how is bronchiectasis treated?
mucus clearance with physio+mucolytics+hypertonic saline neb
antimicrobial therapy
bronchodilators
64
list the respiratory complications of CF
bronciectasisinfection, bronchitis, bronciectasis, fibrosis, inflammation, haemoptysis, sinusitis, pneumothroax
65
how can CF affect the liver?
biliary cirrhosis from obstruction of bile caliculi
66
what can cause pulmonary vasculitis?
Churg-Strauss syndrome, ANCA associated vasculitis, granulomatosis with polyangitis and microscopic polyangitis
67
what happens if TB spreads to the spine
Pott disease=TB spondylitis which may lead to kyphosis and spinal cord compression
68
what does the Bacille Calmette Guerin vaccine do?
It prevents TB becoming disseminated
69
what happens when mycobacterium tuberculosis enters the body 95% of the time?
macrophages starve it, no infection
70
what is the Ghon focus?
when tuberculosis and macrophages cause the formation of a granuloma, it progresses to complex where lymph nodes are involved
71
what will you find on auscultation in a patient with PE?
coarse crackles and pleural rub
72
what pulmonary vascular disorders can cause pulmonary hypertension
pulmonary thromboembolism, multiple pulmonary artery stenoses, pulmonary veno-oclusive disease or parasitic infection
73
what kind of cause of pulmonary hypertension is COPD
capillary, COPD causes vasoconstriction due to hypoxia>HTN
74
What are the symptoms of right heart failure and what do they indicate?
SOB, oedema, raised jugular venous pressure and ascites, they may have been caused by pulmonary hypertension
75
what signs suggest pneumothorax?
hyper-resonant, diminished breath sounds, reduced expansion
76
what should you do if you suspect tension pneumothorax?
very SOB, tachycardic and respiratory distress. Do not XR first but aspirate then XR then insert drain.
77
what can asbestos lead to?
```
asbestos bodies
pleural plaques (thickening and restriction)
pleural hickening
mesothilioma
astbestosis (pul fibrosis)
bronchial carcinoma
```
78
what is mesothelioma resistant to?
surgery
chemotherapy
radiotherapy
79
give symptoms of bronchial carcinoma
```
cough
chest pain]haemootysis
IVC obstruction
hoarse voice
hypercalcaemia
finger clubbing
```
80
what are some side effects of chemotherapy?
```
bone marrow suppression leading to anaemia, neutropenia or thrombocytopenia
alopecia
N&V
peripheral neuropathy
constipation
mucositis
rash
fatigue
anaphylaxis
```
81
what is alpha 1 antitrypsin?
protease inhibitor, it protects elastin so a deficiency leads to COPD
82
what infections are CF patients prone to?
H influenzae
| Strep pneumoniae-same as most common pneumonia causes.
83
what is the vital capacity?
tidal volume+inspiratory reserve volume+expiratory reserve volume, the most someone can breathe in and out
84
what is the functional residual volume?
the residual volume and the expiratory reserve
85
give some antibiotics used for hospital acquired pneumonias?
piperacillin
| tazobactam
86
what is a baltoma?
bronchus associaed tissue lymphoma, it is a B cell lymphoma-responds to chemo
87
define chronic bronchitis
excessive sputum production most days for 3 months of 2 successive years
88
what do theophylline and aminophylline do?
bronchodilate though not very effective
89
what causes exudate pleural effusion?
malignancy
infection
inflammation (local causes)
90
what is ARDS
acute respiratory distress syndrome which is acute lung injury with diffuse alveolar damage
91
give some causes of ARDS
```
direct trauma
burns
sepsis
pancreatitis
hypovolaemia shock
multiple blood transfusions
```
92
what conditions is spontaneous pneumothorax associated with?
Ehlers Danlos
| Marfans
93
give signs of a tension pneumothorax
distended neck veins
shock
hyperresonant percusssion
cyanosis
94
when would you used unfractioned heparin rather than LMWH for PE?
if the patient has renal failure, bleeding risk or is haemodynamically unstable
95
which cells are involved in the inflammation in COPD
CD8
macrophages
neutrophils
96
acute management of asthma
```
O SHIT ME
oxygen
salbutamol neb
hydrocortisone
ipratopium
theophylline
```
97
what type of disease will motor neurone disease cause?
restrictive
98
inhaled corticosteroid examples
beclamethasone
| budenoside
99
what may happen to the blood count in a pink puffer?
polycythaemia
100
how are asthmatic coughs different to COPD
COPD usually productive, asthma usually dry
101
what can cause bronchiectasis?
```
COPD
GORD
TB
pertussis
ciliary dysfunction
```
102
what may CF cause in the GI tract?
chronic pancreatitis
| malabsorption
103
most common cause of atypical pneumonia?
mycoplasma pneumoniae
104
what is Mycobacterium tuberculosis ingested by in the lungs
lymphocytes and Langerhan's cells, become epithelioid histiocytes
105
how is tuberculosis diagnosed?
3 sputum samples
106
what gives ELK symptoms?
ENT, lung, kidney-Granulomatous with polyangitis
107
what pulmonary diseases can methotrexate cause?
interstitial lung diseases
108
what kind of response does EAA cause
hypersenstivity type III
109
what lung carcinoma is not really linked to smoking
adenocarcinoma
110
what lung carcinoma is most common in smokers
squamous cell
111
most common lung carcinomas in order?
squamous cell
SCLC
adenocarcinoma
large cell
112
symptoms of pulmonary embolism?
sudden onset dyspnoea
unexplained cough
pleuritic chest pain
haemoptysis because blood is blocked so it's at high pressure elsewhere
113
what kind of chest pain may a patient with pneumonia experience?
pleuritic chest pain
114
pulmonary embolism treatment
heparin then warfarin
115
causes of transudate effusion?
cardiac failure
vena cava obstruction
decreased albumin
116
causes of exudate effusion?
malignancy
| bacterial infection
117
what must be checked in a patient with GB syndrome?
respiratory testing-peak flow or spirometry every 4 hours
