Respiratory Flashcards
Define Asthma
Chronic inflammation disease of the lung airways characterised by reversible airflow obstruction and bronchospasm?
What are the 3 defining features of asthma?
Reversible airflow limitation
Airway hyper-responsiveness
Bronchial inflammation
Who gets/has asthma?
2 peaks
- 5-15 (more males than females)
- 55-64 (more females than males)
Difference between atopic asthma and non atopic?
Non atopic - causative organism found - often starts middle age but often Hx resp illness
Atopic - no causative organism found. Frequent in allergic individuals
What is the allergic triad?
Asthma
Eczema
Rhinitis (hayfever)
What are the biological causes of asthma? (3)
Atopic - circulating allergen specific IgE
Genetic- no specific gene but several seem to play a part in development avec environment
Environment - allergen exposure, maternal smoking, viruses, hygeine
What are the triggers of asthma? (7)
Cold air Exercise Emotion Drugs - NSAIDs, Asthma Allergens Irritants Viruses - HSV,RSV, Parainfluenza
What is the pathophysiology process of asthma?
1. IgE hypersensitivity reaction casusing…
- Bronchoconstriction
- Inflammation - caused my mast cells, eoisinphils, dendritic cells, lymphocytes
- Increased mucous production
- Airway remodelling
- loss cilliated columnar cells due to epithelial damage
- thickened basement membrane due to deposition repair collagens
Symptoms of asthma?
Wheeze Nocturnal dysnoea COugh (normally noctunal) Chest tightness SOB
Signs of asthma?
Hyperinfaltion, hyper resonance
Wheeze
decrease ae
Tacypnoeic
What are features of severe acute asthma?
HR >110, RR >25, PEFR 33-55%, Cant speak full sentences
What are the features of life threatening asthma?
PEFR <33%, o2 sats <92%
What are the features of near fatal asthma?
paCO2 >6kpa
DDX of asthma include?
Pulmonary Oedema COPD Pneumothorax Bronchiectasis SVC obstruction Large airway obstruction
IX asthma?
Peak flow - monitor and management
Spirometry - if FEV1 increases after bronchodilator = asthma
X ray - rule out other problems
(exercise testing, prednisiloen trial)
Treatment of asthma?
Salbutamol Budesonide Salmeterol (adding up each time) Severe uncontrolled symtoms = high does corticosteroids, long term b2 agonist, +LRTA/theophyline
Define COPD
Progressive disease that includes chronic bronchitis and emphysema
What is chronic Bronchitis?
Chronic bronchitis is a cough with sputum production on most days for 3 months for 2 years
What is Emphysema?
Enlarged air spaces distal to terminal bronchioles due to destruction of alveoli walls
Centri - acinar emphysema?
Most common
damage around bronchioles but bronchioles not actually involved
Pan acinar emphysema?
whole acinus destruction
Irregular emphysema?
patchy
What does emphysema result in? (2)
Air trapping and increase TLC due to loss of elastic recoil
3 mechanisms to COPD limiation of airflow
- Loss elastic recoil
Reduced recoid causes airways to collapse during expiration.
LEss alveoli means less gas exchange can occur - increase mucous - increase goblet cells in bronchial mucosa
- inflammation
epithelial cells get damaged and ulcerated - cuboidal cells get replaced with squamous cells
Risk factors of COPD? (4)
Smoking 90%
A1 trypsin deficiency
Age
air pollution/occupational dusst
What are the symptoms of copd? (5)
SOB Chronic Cough Chest pain Wheeze Recurrent chest infections
What are the signs of COPD?
Hyperinflation, hyperresonant tachypnoeic accessory muscles pursed lip breathing Co2 flap/ cyanosis if severe
Some of the ddx COPD?
Asthma Pneumonia Lung cancer Bronchiectasis TV CHF
IX of COPD?
CXR - flattened hemidiaphragms and hyperinflation Spirometry ABG FBC - polycythaemia ECG - cor pulmonale
Treatment of COPD?
Salbutamol, Ipatropium Bromide
Salmeterol, Tiotropium bromide (longer acting)
Inhaled steroids
Oral steroids
Mucolytics for chronic cough eg carbocysteine
Doxycycline for acute exacerbatins (infections)
What is a pneumothorax?
Air in pleura resulting in lung collapse on the affected side?
What are the 3 different types of pneumothorax?
primary sponty
secondary sponty
tension
What is cause of primary sponty?
Sponty rupture of a sub plural bullae
Causes of secondary sponty?
These are caused by underlying lung conditiosn including: Asthma, COPD, TB, CF
Causes of tension pneumothorax?
Trauma and creation of the one way valve. MEDICAL EMERGENCY
Risk factors for spontaneous pneumothorax?
White, blonde, skinny, tall Lung disease Marfans Smoking Fam hx
Symptoms of pneumothorax?
Acute pluritic chest pain
SOB
Dyspnoea
Signs of pneumothorax?
small can = asymptomatic Hyperesonant unilateral Decrease voacal resonance Decrease ae tenstion - Tracheal deviation away, HR up
Ix of pneumothorax?
Chest x ray but dont wait if think tension.
Treatement of tension pneumothorax?
2nd intercostal space wide bore cannula mid clavicular line
Treatment of sponty pneumothorax?
Insertion of chest drain in safe triangle (cba to learn borders)
Prognosis of pneumothorax?
Good but recurrence high 54 %
What are the two main categories of bronchial carcinoma?
Small-cell
Non-small cell
What are the features of small-cell carcinoma?
Also called out cell carcinoma
Highly malignant and often inoperable the presentation
Originate from kulchitsky cells
What percentage do non-small cell lung carcinoma is account for?
85%
What are the features of squamous cell lung carcinoma?
Arise from epithelium cells
Cause obstructive lesions of the bronchus
Local spread common metastasises late
What are the features of lung adenocarcinoma?
Increased risk smokers
Arise from mucus cells in Bronchus epithelium
Often metastasised to brain and bone
What are the features of large cell lung carcinoma?
Just less differentiated types of large cell and squamous cell
What are carcinoid lung tumours?
Slow growing neuroendocrine tumour
Arise from kulchitsky cells
What are the risk factors of lung cancer?
Smoking asbestos radiation age history of cancer
What are the symptoms of lung cancer?
Cough, haemoptysis Weight loss Chest pain Dyspnoea Lethargy
All the signs of lung cancer?
Cache is
Anaemia
Supraclavicular or axillary lymph adenopathy
Bone/liver problems
What are the investigations of lung cancer?
Triple screen
Chest x-ray for cancer causing symptoms
Pet scan looking for mets
CT looking for lymphadenopathy/spread
(Bronchoscope, bloods - anemia, lft
What is the management of large cell lung carcinoma?
Can try chemotherapy but often palliative radio therapy and chemotherapy with analgesia
What is the treatment for non-small cell lung carcinoma is?
Surgical reception
Radiotherapy/chemotherapy
Gefitinib if EGFR TK mutation
What type of long tumour can cause Horners syndrome?
Pancoast tumour
Where does lung cancer and norms metastasise?
Brain bone liver
Define pneumonia?
Severe chest infection with x-ray changes and associated fever and chest symptoms
What are the two different types of pneumonia?
Lobar
Diffuse
What are the common causes of community acquired pneumonia?
Streptococcus pneumonia
Haemophilia influenza
Moxarella catarrhalis
What are the common causes of hospital acquired pneumonia?
Gram negative organisms
Staphylococcus aureus
Viruses
What is the definition of hospital-acquired Pneumonia ?
Pneumonia 48 hours after hospital admission
What type of pneumonia does klebsiella course?
Cavitating pneumonia
What are the risk factors of pneumonia (lots)?
Age Viral infection is Smoking Immunocompromised Hospitalised Alcohol IVD staphylococcus aureus
Symptoms of pneumonia?
Cough Fever/ anorexia/ rigor Shortness of breath Dyspnoea Pleuritic pain
What does curb 65 stand for?
Confusion Urea above seven Respect for you rate above 30 Blood pressure below 90 Age > 65
What are the signs on examination of pneumonia?
Pyrexial Cyanosis Confusion Consolidation - dull, increase vocal resonance Tachycardia tachypnoeic Fine crackles if pleural effusion Hypotension
What are the differences of pneumonia?
Plural effusion
Simple day
Asthma
Bronchiectasis
What are the investigations for pneumonia??
Chest x-ray - consolidation +- effusion
Bloods - wcc up, crp esr cultures if think sepsis
Sputum MC and s
What to do with the results of curb?
0-1 treat at home
2 - treat at hospital
More than 3 treat in ICU
( it’s outta 5)
What is the treatment for pneumonia?
Amoxicillin clarithromycin doxycycline co a,oxiclavTazocin
What makes up Tazocin?
Pipperocillin and tazobactam
What is bronchiectasis?
Long-term condition were weight of the long become widened and leads to build up an excess mucus and therefore increased risk of infection. Often an endpoint of various condition because airway inflammation.
What is the definition of a plural effusion?
Fluid in the plural space more than 500 mils to be symptomatic
What are the two different types of pleural effusion?
Transudate and exudate
What is transudate pleural effusion?
Less than 25 g/L of protein
Normally due to Venus leakage
Due to stuff like heart failure, pericarditis, fluid overload
Can be due to hypoproteinaemia from liver problems
What is exudate pleural effusion?
More than 25 g/L of protein
Normally due to leaky capillaries in information
Can because by pneumonia TB, pe
What are the symptoms of plural effusion?
Often asymptomatic
Dyspnoe
Pleuritic chest pain
Signs on examination of pleural effusion?
Fine crackles the lung bases Stony Delph to pick us Decreased vocal resonance D crease Chest expansion If v big - tracheal deviation, mediastinal shift
Investigations for plural affusion?
X Ray- meniscus, costophrenic angles lost
Water dense shadow
Diagnostic aspiration
Go two intercostal space above the border of effusion and suck some out
What is the characteristics needed for empyema?
Effusion has pH less than 7.2
What is the treatment for pleural effusion?
Treat underlying cause obviously
Drain if symptomatic
If it keeps happening do pleurodesis which is basically where are you a obliterate the pleural space
What is a PE?
Obstruction of a vessel within the pulmonary tree usually caused by a DVT
What is the biological cause?
Usually caused by DVT Can be caused by a different type of embolism Amniotic fluid From central line Fat from surgery Embolism from endocarditis vegetation
What is verchows triad?
Blood constituent
Blood vessels
Blood flow
What is the pathophysiological effect of a PE?
Causes a VQ miss match and there is ventilation but no perfusion therefore increase of dead space and Decrease gas exchange
After a few hours lung stops producing lung surfactant and collapse ensues
Pulmonary htn causes cardiovascular difficulty
What are the symptoms of a PE?
Pleuritic chest pain
Coughing up blood
Syncope
Dyspnoea
Are the signs of PE?
Tachypnoea Tachycardia Hypotension Right ventricular heave Raised JVP Hypoxia Gallop pulse
Investigations for PE?
Pulmonary coronary angiogram
D dimer
Ultrasound to look for clots
ABGECG
Treatment for PE?
Low molecular weight heparin e.g. tinzaparin Consider thrombolysis (streptokinase/alteplase)
What is the rapid treatment for PE?
ABCDE assessment
02 15L non rebreathe
Invasive/non invasive ventilation if required
Morphine 5mg plus anti-emetic 10mg metoclopramide
IV access to Widebore cannulas
Low molecular weight heparin
What is pulmonary fibrosis?
Fibrosis and loss of elasticities of the lungs due to lung damage
Only fibrosis restrictive or obstructive lung disease?
Restrictive
What are the four types?
Replacement due to long damage
Extrinsic alveolitis due to hypersensitivity
Granulomatous disease e.g. sarcoidosis
Radio active exposure
Discuss blue bloater?
Cyanosed not breathless Alveoli the hypoperfused Low oxygen high CO2 Rely on hypoxia drive to breathe and keep going May develop cor pulmonary
Discuss pink puffer?
Alveoli hyperperfused
Not cyanosed but breathless
May progress to type 1 reps failure
