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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
Q

What would spirometry results of asthma look like?

A
  • FEV1/FVC/PEFR reduced

- FEV1 >15% increase after beta agonist

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26
Q

What is bronchiectasis?

A

Permanent abnormal dilatation of the bronchi and bronchioli, caused by recurrent infections

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27
Q

What are the main organisms causing bronchiectasis?

A

H. influenzae
Strep. pneumoniae
Staph. aureus
Pseudomonas aeruginosa

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28
Q

What are the symptoms of bronchiectasis?

A

Cough, LOTS OF purulent sputum, intermittent haemopytsis

29
Q

What are the signs of bronchiectasis?

A

Clubbing, coarse crackles, wheeze

30
Q

What are some causes of bronchiectasis?

A

Congenital - CF, youngs syndrome, ciliary dyskinesia
Infection - measles, pneumonia, TB
Innate - allergic

31
Q

How should bronchiectasis be managed?

A

Conservative - chest physio and mucus drainage
Medical - antibiotics, bronchodilators, steroids
Surgery - if severe haemoptysis

32
Q

What are the symptoms of lung cancer?

A

Cough, dyspnea, chest pain, haemopytsis, weight loss, hoarseness, supraclavicular LN (pancoast), clubbing, recurrent chest infections

33
Q

What is Horner’s syndrome?

A

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
Q

How is lung cancer classified?

A 
Non-small cell -- squamous (35%), adenocarcinoma (27%)
Small cell (20%)
35
Q

Describe the characteristics of a squamous cell carcinoma

A

Located in proximal bronchi
Central, cavitating lesion
Slow-growing

36
Q

Describe the characteristics of an adenocarcinoma in the lung

A

Located in peripheral lung
Spreads to lymph nodes and distant organs
Non-smokers
Slow-growing

37
Q

Describe the characteristics of small cell lung cancer

A

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
Q

What is a mesothelioma?

A

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
Q

How is non-small cell lung cancer managed?

A

Excision (if no spread), chemotherapy and radiotherapy (ceftuximab)

40
Q

How is small cell lung cancer managed?

A

Attempt chemotherapy and radiotherapy but by presentation, care is usually palliative

41
Q

What is a paraneoplastic syndrome?

A

A disorder triggered by an altered immune response to a neoplasm - these can sometimes present before the malignancy itself

42
Q

Name some skeletal/cutaneous paraneoplastic syndromes, associated with lung cancer

A

Acanthosis nigricans (hyperpigmentation in body folds)
Clubbing
Dermatomyositis (inflammation of muscles and skin)
Osteoarthropathy (disease of bones and joints)

43
Q

Name some endocrine paraneoplastic syndromes, associated with lung cancer

A

Cushings (SCLC)
Hypercalcemia (due to bone mets causing increased PTH)
SIADH (excessive secretion of ADH, associated with SCLC)
Tumour necrosis factor

44
Q

Name some neurological paraneoplastic syndromes, associated with lung cancer

A

Lambort-Eaton syndrome (limb muscle weakness, associated with SCLC)
Neuropathies
Cerebellar degeneration
Confusion and fits

45
Q

How is lung cancer staged?

A

TNM
T - primary tumour
N - regional nodes
M - distant metastasis

46
Q

What could cause a pleural effusion with transudate?

A

Increased venous pressure (heart failure, fluid overload)
Hypoproteinaemia
Hypothyroidism
Meigs syndrome

47
Q

What is a transudate?

A

Low protein content

Caused by pressure disturbance

48
Q

What is an exudate?

A

High protein content

Caused by inflammation

49
Q

What could cause a pleural effusion with exudate?

A

Increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy (pneumonia, TB, SLE, carcinoma)

50
Q

What is interstitial lung disease?

A

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
Q

What are the symptoms of ILD?

A

Dyspnoea on exertion, non-productive cough, abnormal breath sounds

52
Q

What is Caplans syndrome?

A

Association between rheumatoid arthritis, pneumoconiosis and nodules

53
Q

What is cor pulmonale?

A

Right heart failure caused by chronic pulmonary arterial hypertension (usually from chronic lung disease), causing dyspnoea, hepatomegaly and oedema

54
Q

RESPIRATORY EMERGENCIES - What are the symptoms of a life-threatening asthma attack?

A

Unable to complete sentences, tachypnoea, tachycardia, silent chest, cyanosis

55
Q

RESPIRATORY EMERGENCIES - How is an acute asthma attack managed?

A 
DO PEFR then...
Oxygen
Steroids (prednisolone)
Nebulised salbumatol
IV magnesium sulphate
56
Q

RESPIRATORY EMERGENCIES - What are the symptoms and signs of a PE?

A

Dyspnoea, sudden onset pleuritic chest pain, cough, haemoptysis, haemodynamic collapse, tachycardia, hypoxia, gallop pulse

57
Q

RESPIRATORY EMERGENCIES - How is PE diagnosed?

A 
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
Q

RESPIRATORY EMERGENCIES - What are the risk factors for PE?

A
  • Recent surgery
  • Leg fracture
  • Prolonged bed rest
  • Pregnancy
  • Malignancy
  • Previous PE/DVT
  • Combined oral contraceptive pill
59
Q

RESPIRATORY EMERGENCIES - How should a PE be managed?

A
  • Thrombolysis (alteplase)

- When stable, LMWH administration until INR >2, then start warfarin for at least 3 months

60
Q

RESPIRATORY EMERGENCIES - What are the causes of massive haemoptysis?

A

Bronchial tumour, bronchiectasis, active TB, pneumonia, warfarin

61
Q

RESPIRATORY EMERGENCIES - How is massive haemoptysis diagnosed?

A

100-600ml of blood loss in 24 hours

62
Q

RESPIRATORY EMERGENCIES - How is massive haemoptysis managed?

A
  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
Q

RESPIRATORY EMERGENCIES - What is a pneumothorax?

A

Air in the pleural cavity

64
Q

RESPIRATORY EMERGENCIES - What are the symptoms and signs of a pneumothorax?

A

CAN BE ASYMPTOMATIC IF YOUNG

Sudden onset pleuritic chest pain, dyspnoea, reduced chest expansion, hyper-resonant percussion, tracheal deviation

65
Q

RESPIRATORY EMERGENCIES - What causes a pneumothorax?

A
  • Spontaneous in young men due to bulla rupture
  • Chronic lung disease
  • Infection
  • Trauma
  • Carcinoma
  • Connective tissue disorders (Marfans)
66
Q

RESPIRATORY EMERGENCIES - What is a tension pneumothorax?

A

When air cannot escape the pleural cavity causing lung compression, inhibited venous return, hypotension and possible cardiac arrest (as heart has limited space)

67
Q

RESPIRATORY EMERGENCIES - What are the signs of a tension pneumothorax?

A
  • Raised JVP
  • Hypotension
  • Reduced air entry
  • Tracheal deviation on CXR
  • Cardiac arrest
68
Q

RESPIRATORY EMERGNCIES - What is the difference in management of a pneumothorax and a tension pneumothorax?

A

Normal - chest drain, aspiration
Tension - ABC, oxygen, large cannula into second intercostal space at midclavicular line, NO CXR until stable, chest drain

69
Q

What are the indications for pleural tap (aspiration)?

A
  • Pneumothorax
  • Pleural effusion
  • Traumatic haemopneumothorax
  • Post-op

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

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