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3rd year > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define Asthma

A

Chronic inflammation disease of the lung airways characterised by reversible airflow obstruction and bronchospasm?

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2
Q

What are the 3 defining features of asthma?

A

Reversible airflow limitation
Airway hyper-responsiveness
Bronchial inflammation

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3
Q

Who gets/has asthma?

A

2 peaks

  1. 5-15 (more males than females)
  2. 55-64 (more females than males)
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4
Q

Difference between atopic asthma and non atopic?

A

Non atopic - causative organism found - often starts middle age but often Hx resp illness
Atopic - no causative organism found. Frequent in allergic individuals

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5
Q

What is the allergic triad?

A

Asthma
Eczema
Rhinitis (hayfever)

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6
Q

What are the biological causes of asthma? (3)

A

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

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7
Q

What are the triggers of asthma? (7)

A 
Cold air
Exercise 
Emotion
Drugs - NSAIDs, Asthma
Allergens
Irritants
Viruses - HSV,RSV, Parainfluenza
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8
Q

What is the pathophysiology process of asthma?

1. IgE hypersensitivity reaction casusing…

A
  1. Bronchoconstriction
  2. Inflammation - caused my mast cells, eoisinphils, dendritic cells, lymphocytes
  3. Increased mucous production
  4. Airway remodelling
    - loss cilliated columnar cells due to epithelial damage
    - thickened basement membrane due to deposition repair collagens
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9
Q

Symptoms of asthma?

A 
Wheeze
Nocturnal dysnoea
COugh (normally noctunal)
Chest tightness
SOB
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10
Q

Signs of asthma?

A

Hyperinfaltion, hyper resonance
Wheeze
decrease ae
Tacypnoeic

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11
Q

What are features of severe acute asthma?

A

HR >110, RR >25, PEFR 33-55%, Cant speak full sentences

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12
Q

What are the features of life threatening asthma?

A

PEFR <33%, o2 sats <92%

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13
Q

What are the features of near fatal asthma?

A

paCO2 >6kpa

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14
Q

DDX of asthma include?

A 
Pulmonary Oedema
COPD
Pneumothorax
Bronchiectasis
SVC obstruction
Large airway obstruction
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15
Q

IX asthma?

A

Peak flow - monitor and management
Spirometry - if FEV1 increases after bronchodilator = asthma
X ray - rule out other problems
(exercise testing, prednisiloen trial)

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16
Q

Treatment of asthma?

A 
Salbutamol
Budesonide
Salmeterol
(adding up each time)
Severe uncontrolled symtoms = high does corticosteroids, long term b2 agonist, +LRTA/theophyline
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17
Q

Define COPD

A

Progressive disease that includes chronic bronchitis and emphysema

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18
Q

What is chronic Bronchitis?

A

Chronic bronchitis is a cough with sputum production on most days for 3 months for 2 years

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19
Q

What is Emphysema?

A

Enlarged air spaces distal to terminal bronchioles due to destruction of alveoli walls

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20
Q

Centri - acinar emphysema?

A

Most common

damage around bronchioles but bronchioles not actually involved

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21
Q

Pan acinar emphysema?

A

whole acinus destruction

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22
Q

Irregular emphysema?

A

patchy

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23
Q

What does emphysema result in? (2)

A

Air trapping and increase TLC due to loss of elastic recoil

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24
Q

3 mechanisms to COPD limiation of airflow

A
  1. Loss elastic recoil
    Reduced recoid causes airways to collapse during expiration.
    LEss alveoli means less gas exchange can occur
  2. increase mucous - increase goblet cells in bronchial mucosa
  3. inflammation
    epithelial cells get damaged and ulcerated - cuboidal cells get replaced with squamous cells
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25
Q

Risk factors of COPD? (4)

A

Smoking 90%
A1 trypsin deficiency
Age
air pollution/occupational dusst

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26
Q

What are the symptoms of copd? (5)

A 
SOB
Chronic Cough
Chest pain
Wheeze
Recurrent chest infections
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27
Q

What are the signs of COPD?

A 
Hyperinflation, hyperresonant
tachypnoeic
accessory muscles 
pursed lip breathing
Co2 flap/ cyanosis if severe
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28
Q

Some of the ddx COPD?

A 
Asthma
Pneumonia
Lung cancer
Bronchiectasis
TV 
CHF
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29
Q

IX of COPD?

A 
CXR - flattened hemidiaphragms and hyperinflation
Spirometry
ABG
FBC - polycythaemia
ECG - cor pulmonale
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30
Q

Treatment of COPD?

A

Salbutamol, Ipatropium Bromide
Salmeterol, Tiotropium bromide (longer acting)
Inhaled steroids
Oral steroids

Mucolytics for chronic cough eg carbocysteine

Doxycycline for acute exacerbatins (infections)

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31
Q

What is a pneumothorax?

A

Air in pleura resulting in lung collapse on the affected side?

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32
Q

What are the 3 different types of pneumothorax?

A

primary sponty
secondary sponty
tension

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33
Q

What is cause of primary sponty?

A

Sponty rupture of a sub plural bullae

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34
Q

Causes of secondary sponty?

A

These are caused by underlying lung conditiosn including: Asthma, COPD, TB, CF

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35
Q

Causes of tension pneumothorax?

A

Trauma and creation of the one way valve. MEDICAL EMERGENCY

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36
Q

Risk factors for spontaneous pneumothorax?

A 
White, blonde, skinny, tall
Lung disease
Marfans
Smoking 
Fam hx
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37
Q

Symptoms of pneumothorax?

A

Acute pluritic chest pain
SOB
Dyspnoea

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38
Q

Signs of pneumothorax?

A 
small can = asymptomatic
Hyperesonant unilateral
Decrease voacal resonance 
Decrease ae
tenstion - Tracheal deviation away, HR up
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39
Q

Ix of pneumothorax?

A

Chest x ray but dont wait if think tension.

40
Q

Treatement of tension pneumothorax?

A

2nd intercostal space wide bore cannula mid clavicular line

41
Q

Treatment of sponty pneumothorax?

A

Insertion of chest drain in safe triangle (cba to learn borders)

42
Q

Prognosis of pneumothorax?

A

Good but recurrence high 54 %

43
Q

What are the two main categories of bronchial carcinoma?

A

Small-cell

Non-small cell

44
Q

What are the features of small-cell carcinoma?

A

Also called out cell carcinoma
Highly malignant and often inoperable the presentation
Originate from kulchitsky cells

45
Q

What percentage do non-small cell lung carcinoma is account for?

A

85%

46
Q

What are the features of squamous cell lung carcinoma?

A

Arise from epithelium cells
Cause obstructive lesions of the bronchus
Local spread common metastasises late

47
Q

What are the features of lung adenocarcinoma?

A

Increased risk smokers
Arise from mucus cells in Bronchus epithelium
Often metastasised to brain and bone

48
Q

What are the features of large cell lung carcinoma?

A

Just less differentiated types of large cell and squamous cell

49
Q

What are carcinoid lung tumours?

A

Slow growing neuroendocrine tumour

Arise from kulchitsky cells

50
Q

What are the risk factors of lung cancer?

A

Smoking asbestos radiation age history of cancer

51
Q

What are the symptoms of lung cancer?

A 
Cough, haemoptysis 
Weight loss
Chest pain
Dyspnoea
Lethargy
52
Q

All the signs of lung cancer?

A

Cache is
Anaemia
Supraclavicular or axillary lymph adenopathy
Bone/liver problems

53
Q

What are the investigations of lung cancer?

A

Triple screen
Chest x-ray for cancer causing symptoms
Pet scan looking for mets
CT looking for lymphadenopathy/spread

(Bronchoscope, bloods - anemia, lft

54
Q

What is the management of large cell lung carcinoma?

A

Can try chemotherapy but often palliative radio therapy and chemotherapy with analgesia

55
Q

What is the treatment for non-small cell lung carcinoma is?

A

Surgical reception
Radiotherapy/chemotherapy
Gefitinib if EGFR TK mutation

56
Q

What type of long tumour can cause Horners syndrome?

A

Pancoast tumour

57
Q

Where does lung cancer and norms metastasise?

A

Brain bone liver

58
Q

Define pneumonia?

A

Severe chest infection with x-ray changes and associated fever and chest symptoms

59
Q

What are the two different types of pneumonia?

A

Lobar

Diffuse

60
Q

What are the common causes of community acquired pneumonia?

A

Streptococcus pneumonia
Haemophilia influenza
Moxarella catarrhalis

61
Q

What are the common causes of hospital acquired pneumonia?

A

Gram negative organisms
Staphylococcus aureus
Viruses

62
Q

What is the definition of hospital-acquired Pneumonia ?

A

Pneumonia 48 hours after hospital admission

63
Q

What type of pneumonia does klebsiella course?

A

Cavitating pneumonia

64
Q

What are the risk factors of pneumonia (lots)?

A 
Age
Viral infection is
Smoking
Immunocompromised
Hospitalised
Alcohol
IVD staphylococcus aureus
65
Q

Symptoms of pneumonia?

A 
Cough
Fever/ anorexia/ rigor
Shortness of breath
Dyspnoea
Pleuritic pain
66
Q

What does curb 65 stand for?

A 
Confusion
Urea above seven
Respect for you rate above 30
Blood pressure below 90
Age > 65
67
Q

What are the signs on examination of pneumonia?

A 
Pyrexial
Cyanosis
Confusion
Consolidation - dull, increase vocal resonance
Tachycardia tachypnoeic
Fine crackles if pleural effusion
Hypotension
68
Q

What are the differences of pneumonia?

A

Plural effusion
Simple day
Asthma
Bronchiectasis

69
Q

What are the investigations for pneumonia??

A

Chest x-ray - consolidation +- effusion
Bloods - wcc up, crp esr cultures if think sepsis
Sputum MC and s

70
Q

What to do with the results of curb?

A

0-1 treat at home
2 - treat at hospital
More than 3 treat in ICU
( it’s outta 5)

71
Q

What is the treatment for pneumonia?

A

Amoxicillin clarithromycin doxycycline co a,oxiclavTazocin

72
Q

What makes up Tazocin?

A

Pipperocillin and tazobactam

73
Q

What is bronchiectasis?

A

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.

74
Q

What is the definition of a plural effusion?

A

Fluid in the plural space more than 500 mils to be symptomatic

75
Q

What are the two different types of pleural effusion?

A

Transudate and exudate

76
Q

What is transudate pleural effusion?

A

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

77
Q

What is exudate pleural effusion?

A

More than 25 g/L of protein
Normally due to leaky capillaries in information
Can because by pneumonia TB, pe

78
Q

What are the symptoms of plural effusion?

A

Often asymptomatic
Dyspnoe
Pleuritic chest pain

79
Q

Signs on examination of pleural effusion?

A 
Fine crackles the lung bases
Stony Delph to pick us
Decreased vocal resonance 
D crease Chest expansion
If v big - tracheal deviation, mediastinal shift
80
Q

Investigations for plural affusion?

A

X Ray- meniscus, costophrenic angles lost
Water dense shadow
Diagnostic aspiration
Go two intercostal space above the border of effusion and suck some out

81
Q

What is the characteristics needed for empyema?

A

Effusion has pH less than 7.2

82
Q

What is the treatment for pleural effusion?

A

Treat underlying cause obviously
Drain if symptomatic
If it keeps happening do pleurodesis which is basically where are you a obliterate the pleural space

83
Q

What is a PE?

A

Obstruction of a vessel within the pulmonary tree usually caused by a DVT

84
Q

What is the biological cause?

A 
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
85
Q

What is verchows triad?

A

Blood constituent
Blood vessels
Blood flow

86
Q

What is the pathophysiological effect of a PE?

A

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

87
Q

What are the symptoms of a PE?

A

Pleuritic chest pain
Coughing up blood
Syncope
Dyspnoea

88
Q

Are the signs of PE?

A 
Tachypnoea
Tachycardia
Hypotension
Right ventricular heave
Raised JVP
Hypoxia
Gallop pulse
89
Q

Investigations for PE?

A

Pulmonary coronary angiogram
D dimer
Ultrasound to look for clots
ABGECG

90
Q

Treatment for PE?

A 
Low molecular weight heparin e.g. tinzaparin
Consider thrombolysis (streptokinase/alteplase)
91
Q

What is the rapid treatment for PE?

A

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

92
Q

What is pulmonary fibrosis?

A

Fibrosis and loss of elasticities of the lungs due to lung damage

93
Q

Only fibrosis restrictive or obstructive lung disease?

A

Restrictive

94
Q

What are the four types?

A

Replacement due to long damage
Extrinsic alveolitis due to hypersensitivity
Granulomatous disease e.g. sarcoidosis
Radio active exposure

95
Q

Discuss blue bloater?

A 
Cyanosed not breathless
Alveoli the hypoperfused
Low oxygen high CO2
Rely on hypoxia drive to breathe and keep going
May develop cor pulmonary
96
Q

Discuss pink puffer?

A

Alveoli hyperperfused
Not cyanosed but breathless
May progress to type 1 reps failure

3rd year (10 decks)

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