Respiratory Flashcards
what 3 features characterise asthma
reversible airflow limitation
airway hyper-responsiveness
inflammation of the bronchi
how is asthma investigated?
peak flow, spirometry, greater than 15% improvement following bronchodilator use
skin prick to determine allergic cause
how is asthma managed
beta2 agonist - use as needed up to 4x a day
inhaled steroid 2x daily
if still uncontrolled, long acting beta2 agonist, leukotriene agonists
oral steroids
how is COPD defined
progressive airway obstruction with little reversibility
FEV1/FVC <0.7
chronic bronchitis + emphysema
differentiate between pink puffers and blue bloaters
PP = emphysema. thin, underweight, severe dyspnoea, hypoxic, normal/low PCO2, may progress to type I resp failure
BB = chronic bronchitis. peripheral oedema, wheezy, cyanosed, not breathless, low PO2, high PCO2, may progress to type II resp failure. rely on hypoxic drive. May develop cor pulmonale
management of COPD
Smoking cessation + other lifestyle changes pulmonary rehabilitation salbutamol short acting anti-muscarinic - ipratropium long acting beta agonist - salmeterol long acting anti-muscarinic - tiotropium corticosteroids oxygen therapy
what are the different types of bronchial carcinoma
Small cell Non Small Cell: 1) Adenocarcinoma 2) Squamous cell (most common) 3) Large cell 4) Large cell neuroendocrine
How might lung cancer be linked to Horner’s syndrome
Pancoast’s tumour
compression of sympathetic chain
which have a better prognosis, small cell or non-small cell cancers?
Small cell - usually metastasised by presentation, may respond to chemo, survival 12 months
Non-small cell - 50% 2yr survival
presentation of pneumothorax?
may be asymptomatic
sudden onset dyspnoea, chest pain, reduced chest expansion, unilateral diminished breath sounds.
hyper-resonance
deviated trachea in tension pneumothorax
why is a tension pneumothorax a medical emergency?
air drawn in through one way valve, cannot escape
increasing pressure can compress great veins»_space; cardiorespiratory arrest
What is transudate, and name some causes of a transudate pleural effusion
transudate = low protein fluid <25g/L
^ venous pressure, due to heart failure, fluid overload
Hypoproteinaemia, due to malabsorption, liver disease, nephrotic syndrome
what is exudate, and name some causes of exudate pleural effusion
Exudate = protein rich, >35g/L
infection, malignancy, RA, pulmonary infarct
increased leakiness of capillaries
is unilateral pleural effusion more likely to be transudate or exudate?
Exudate,
e.g. a tumour, empyema, ruptured thoracic duct etc
how much fluid is required to cause X-ray changes
50ml = costophrenic blunting from a lateral view
200ml to be visible PA
500ml for clinical diagnosis
