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3RD YEAR - Long Term Conditions/FOCP > Respiratory > Flashcards

Respiratory Flashcards

1
Q

How is COPD diagnosed?

A

Bedside: spirometry, ECG, BMI
Bloods: full blood count
Imaging: PA chest x-ray

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2
Q

What features would you expect to find during an COPD examination?

A

Inspection - tar-stained fingers, asterixis, hyper inflated barrel chest, tripod position, cyanosis, tremor
Palpation - reduced chest-expansion
Percussion - hyper-resonance
Auscultation - coarse crackles, wheeze, prolonged expiration, tachypnoea

(NB fine crackles = pulmonary fibrosis)

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3
Q

What scale should be used to measure the effect of COPD on daily activities?

A

MRC dyspnoea scale

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4
Q

What types of smoking cessation are there?

A

Nicotine replacement - patches/inhaled therapy
Bupropion
Varenidine

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5
Q

What measures should be taken emergency situation of low 02 sats?

A
  • Give 15L high flow oxygen
  • Give 2L after a bit (if C02 retainer)
  • Give nebulised salbutamol and ipatropium
  • Give prednisolone, doxycycline

Consider CPAP, BIPAP

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6
Q

How should COPD be managed initially?

A

Conservative: education, smoking cessation, pulmonary rehabilitation
Medical: short-acting b2 agonists (salbutamol), vaccinations

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7
Q

How should COPD be managed long-term?

A

Conservative: sputum suction, chest physiotherapy, 02 therapy, regular reviews
Medical: montelukast, muscarinic antagonists (tiotropium bromide), nebulisers, antibiotics, steroids, theophylline, mucolytics, give home rescue packs
Surgical: lung transplant

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8
Q

What is the criteria for LTOT?

A
  • p02 below 7.3
  • p02 below 8, PLUS cor pulmonale
  • stopped smoking, clinically stable
  • FEV1 < 30% preducted
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9
Q

What does pink, frothy sputum mean?

A

Pulmonary oedema

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10
Q

What is the definition of COPD?

A

A chronic disorder characterised by airway obstruction (FEV1/FVC = 70%) for over several months. It includes emphysema and chronic bronchitis

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11
Q

What is the pathophysiology behind COPD?

A
  1. Loss of elastic recoil in lungs
  2. Hyperinflated lungs and flattened diaphragm
  3. Loss of alveolar attachments to bronchi (emphysema)
  4. Loss of pleural pressure and airway collapse
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12
Q

How is a smoking pack year calculated?

A

(years smoked x cigs per day)/20

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13
Q

What is a pink puffer?

A

Increased alveolar ventilation and nearly normal O2/C02 levels, breathless but not cyanosed

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14
Q

What is a blue bloater?

A

Decreased alveolar ventilation, low O2 and high CO2, cyanosed but not breathless, rely on hypoxic drive to breathe

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15
Q

What are the signs of respiratory failure, secondary to COPD?

A
  • Decreased level of consciousness
  • Cyanosis
  • Flapping tremor (asterixis)
  • Oedema (cor pulmonale)
  • Tachypnoea/cardia
  • Fine inspiratory crackles
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16
Q

How should an acute exacerbation of COPD be managed?

A

Prednisolone 30mg for 5 days
Nebulised bronchodilators
Oxygen (24-28% via venturi)
+ antibiotics if sputum appears bacterial

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17
Q

When is pulmonary capillary wedge pressure measured?

A

Suspected respiratory distress - <19mmHg is diagnostic

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18
Q

How is ARDS managed?

A
  • Respiratory support - CPAP, mechanical ventilation
  • Circulatory support - inotropes, vasodilators, blood transfusion
  • Sepsis - antibiotics
  • Nutritional support - enteral
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19
Q

What is the definition of Type 1 respiratory failure?

A

Hypoxia (paO2<8) with adequate paC02

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20
Q

What causes type 1 RF?

A

Ventilation/perfusion mismatch:

  • Pneumonia
  • Pulmonary oedema
  • PE
  • Asthma
  • Emphysema
  • Pulmonary fibrosis
  • ARDS
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21
Q

What is the definition of Type 2 respiratory failure?

A

Hypoxia (pa02<8) with hypercapnia (paC02>6)

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22
Q

What causes type 2 RF?

A

Alveolar hypoventilation:

  • Pulmonary disease - COPD, pneumonia, asthma
  • Reduced respiratory drive - drugs, tumour, trauma
  • Neuromuscular disease - GBS, myasthenia gravid
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23
Q

What are the signs of hypercapnia?

A

Headache, peripheral vasodilatation, tachycardia, bounding pulse, tremor, confusion, drowsiness

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24
Q

What is the definition of asthma?

A

Recurrent episodes of dyspnoea, cough and wheeze caused by reversible airway obstruction

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25
What would spirometry results of asthma look like?
- FEV1/FVC/PEFR reduced | - FEV1 >15% increase after beta agonist
26
What is bronchiectasis?
Permanent abnormal dilatation of the bronchi and bronchioli, caused by recurrent infections
27
What are the main organisms causing bronchiectasis?
H. influenzae Strep. pneumoniae Staph. aureus Pseudomonas aeruginosa
28
What are the symptoms of bronchiectasis?
Cough, LOTS OF purulent sputum, intermittent haemopytsis
29
What are the signs of bronchiectasis?
Clubbing, coarse crackles, wheeze
30
What are some causes of bronchiectasis?
Congenital - CF, youngs syndrome, ciliary dyskinesia Infection - measles, pneumonia, TB Innate - allergic
31
How should bronchiectasis be managed?
Conservative - chest physio and mucus drainage Medical - antibiotics, bronchodilators, steroids Surgery - if severe haemoptysis
32
What are the symptoms of lung cancer?
Cough, dyspnea, chest pain, haemopytsis, weight loss, hoarseness, supraclavicular LN (pancoast), clubbing, recurrent chest infections
33
What is Horner's syndrome?
Ptosis, meiosis, unilateral anhydrosis and small pupil. --> these symptoms are associated with a pancoast tumour, found at the lung apex, and are caused by brachial plexus invasion
34
How is lung cancer classified?
``` Non-small cell -- squamous (35%), adenocarcinoma (27%) Small cell (20%) ```
35
Describe the characteristics of a squamous cell carcinoma
Located in proximal bronchi Central, cavitating lesion Slow-growing
36
Describe the characteristics of an adenocarcinoma in the lung
Located in peripheral lung Spreads to lymph nodes and distant organs Non-smokers Slow-growing
37
Describe the characteristics of small cell lung cancer
Found all over the lung Lymphadenopathy, highly metastatic Fast-growing (median survival is 1 year if treated) Usually presents as extensive (evident metastatic disease outside the ipsilateral hemithorax)
38
What is a mesothelioma?
A cancer affecting the lining of the organs (mesothelium), most commonly the lungs. It is associated with asbestos exposure and usually manifests as a unilateral pleural effusion.
39
How is non-small cell lung cancer managed?
Excision (if no spread), chemotherapy and radiotherapy (ceftuximab)
40
How is small cell lung cancer managed?
Attempt chemotherapy and radiotherapy but by presentation, care is usually palliative
41
What is a paraneoplastic syndrome?
A disorder triggered by an altered immune response to a neoplasm - these can sometimes present before the malignancy itself
42
Name some skeletal/cutaneous paraneoplastic syndromes, associated with lung cancer
Acanthosis nigricans (hyperpigmentation in body folds) Clubbing Dermatomyositis (inflammation of muscles and skin) Osteoarthropathy (disease of bones and joints)
43
Name some endocrine paraneoplastic syndromes, associated with lung cancer
Cushings (SCLC) Hypercalcemia (due to bone mets causing increased PTH) SIADH (excessive secretion of ADH, associated with SCLC) Tumour necrosis factor
44
Name some neurological paraneoplastic syndromes, associated with lung cancer
Lambort-Eaton syndrome (limb muscle weakness, associated with SCLC) Neuropathies Cerebellar degeneration Confusion and fits
45
How is lung cancer staged?
TNM T - primary tumour N - regional nodes M - distant metastasis
46
What could cause a pleural effusion with transudate?
Increased venous pressure (heart failure, fluid overload) Hypoproteinaemia Hypothyroidism Meigs syndrome
47
What is a transudate?
Low protein content | Caused by pressure disturbance
48
What is an exudate?
High protein content | Caused by inflammation
49
What could cause a pleural effusion with exudate?
Increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy (pneumonia, TB, SLE, carcinoma)
50
What is interstitial lung disease?
A number of conditions affecting the lung parenchyma in a diffuse way, causing chronic inflammation and fibrosis: - Asbestosis - Sarcoidosis - Silicosis - Drug related - Hypersensitivity related - Idiopathic - Caplan's syndrome - Coal workers pneumoconiosis
51
What are the symptoms of ILD?
Dyspnoea on exertion, non-productive cough, abnormal breath sounds
52
What is Caplans syndrome?
Association between rheumatoid arthritis, pneumoconiosis and nodules
53
What is cor pulmonale?
Right heart failure caused by chronic pulmonary arterial hypertension (usually from chronic lung disease), causing dyspnoea, hepatomegaly and oedema
54
RESPIRATORY EMERGENCIES - What are the symptoms of a life-threatening asthma attack?
Unable to complete sentences, tachypnoea, tachycardia, silent chest, cyanosis
55
RESPIRATORY EMERGENCIES - How is an acute asthma attack managed?
``` DO PEFR then... Oxygen Steroids (prednisolone) Nebulised salbumatol IV magnesium sulphate ```
56
RESPIRATORY EMERGENCIES - What are the symptoms and signs of a PE?
Dyspnoea, sudden onset pleuritic chest pain, cough, haemoptysis, haemodynamic collapse, tachycardia, hypoxia, gallop pulse
57
RESPIRATORY EMERGENCIES - How is PE diagnosed?
``` CTPA scan D-dimer Well's scoring system, give 1 each for: - Previous PE/DVT (+1.5) - Heart rate >100bpm (+1.5) - Recent surgery or immobilization (+1.5) - Clinical signs of DVT (+3) - Hemoptysis (+ 1) - Cancer (+1) - Alternative diagnosis less likely than PE (+3) ```
58
RESPIRATORY EMERGENCIES - What are the risk factors for PE?
- Recent surgery - Leg fracture - Prolonged bed rest - Pregnancy - Malignancy - Previous PE/DVT - Combined oral contraceptive pill
59
RESPIRATORY EMERGENCIES - How should a PE be managed?
- Thrombolysis (alteplase) | - When stable, LMWH administration until INR >2, then start warfarin for at least 3 months
60
RESPIRATORY EMERGENCIES - What are the causes of massive haemoptysis?
Bronchial tumour, bronchiectasis, active TB, pneumonia, warfarin
61
RESPIRATORY EMERGENCIES - How is massive haemoptysis diagnosed?
100-600ml of blood loss in 24 hours
62
RESPIRATORY EMERGENCIES - How is massive haemoptysis managed?
1. Airway protection and ventilation 2. IV fluid resuscitation, cross match (CVS support) 3. Nebulise adrenaline (stop bleeding) 4. Oral/IV tranexamic acid (antifibrinolytic that stops bleeding)
63
RESPIRATORY EMERGENCIES - What is a pneumothorax?
Air in the pleural cavity
64
RESPIRATORY EMERGENCIES - What are the symptoms and signs of a pneumothorax?
CAN BE ASYMPTOMATIC IF YOUNG | Sudden onset pleuritic chest pain, dyspnoea, reduced chest expansion, hyper-resonant percussion, tracheal deviation
65
RESPIRATORY EMERGENCIES - What causes a pneumothorax?
- Spontaneous in young men due to bulla rupture - Chronic lung disease - Infection - Trauma - Carcinoma - Connective tissue disorders (Marfans)
66
RESPIRATORY EMERGENCIES - What is a tension pneumothorax?
When air cannot escape the pleural cavity causing lung compression, inhibited venous return, hypotension and possible cardiac arrest (as heart has limited space)
67
RESPIRATORY EMERGENCIES - What are the signs of a tension pneumothorax?
- Raised JVP - Hypotension - Reduced air entry - Tracheal deviation on CXR - Cardiac arrest
68
RESPIRATORY EMERGNCIES - What is the difference in management of a pneumothorax and a tension pneumothorax?
Normal - chest drain, aspiration Tension - ABC, oxygen, large cannula into second intercostal space at midclavicular line, NO CXR until stable, chest drain
69
What are the indications for pleural tap (aspiration)?
- Pneumothorax - Pleural effusion - Traumatic haemopneumothorax - Post-op

3RD YEAR - Long Term Conditions/FOCP (39 decks)

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