Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Comment on this CXR

A

Consolidation in the right middle lobe consistent with pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Comment on this CXR

A

Right lower lobe collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Comment on this CXR

A

A well defined thick walled cavitatory lesion is noted in the right para-hilar area in the midzone of right lung

aka Pulmonary TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define COPD

A

‘a chronic disease characterised by progressive airflow limitation that is not fully reversible and characterised by chronic bronchitis and emphysema’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define Obstructive Sleep Apnoea Syndrome

A

Recurrent episodes of partial or complete upper airway (pharyngeal) obstruction during sleep, intermittent hypoxia and sleep fragmentation manifesting as excessive daytime sleepiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe an approach to the analysis of blood gases in clinical practice

A

Always look at pO2 first to assess if the patient is in respiratory failure or requires additional oxygen

Next look at the pCO2 to determine Type 1 vs Type 2 Resp. Failure

Then look at the acid-base balance to determine if:

Acute Resp. Acidosis (Elevated pCO2, Normal Bicarb, Acidosis)

Comp. Resp. Acidosis (Elevated pCO2, Elevated Bicarb, Not Acidotic)

Acute on Chronic Resp. Acidosis (Elevated pCO2, Elevated Bicarb. Acidosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe clinical features of pulmonary embolism

A

Tachypnoea

Crackles

Tachycardia

Fever

Signs of Peripheral DVT

Pleuritic Chest Pain

Dyspnoea

Cough

Haemoptysis

Syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe investigations for pulmonary embolism

A

Modified Geneve Score (Risk Assessment)

D-Dimer (Raised, >230mg/L)

ABGs (Resp. Alkalosis with Reduced PaCO2)

Troponin

ECG

Echocardiogram

Radiology (CXR, CT-Pulmonary Angiogram, V/Q Scan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe pathological features in the lung which lead to pneumothorax

A

Sub-Pleural Blebs (blister-like air pockets) at the apex of the lung

Diffuse, microscopic emphysema below the surface of the visceral pleura

Spontaneous rupture can lead to a tear in the visceral pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the clinical diagnosis of Pulmonary Fibrosis

A

Clinical manifestation of UIP

Fibrotic lung disease, usually with no definitive cause

Progressive Breathlessness, Bibasilar Crackling, Hacking Dry Cough, Fatigue, Weakness, Finger Clubbing, Appetite and Weight Loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the clinical presentation of Sarcoidosis

A

May present with pulmonary, neurological, cardiac, dermatological or ocular findings

Systemic symptoms: Fever, Anorexia, Fatigue, Night Sweats, Weight Loss

Pulmonary symptoms: Cough, Haemoptysis, Dyspnoea on Exertion, Chest Pain

May be asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the clinical application of the Alveolar Air Equation

A

Arterial pO2 can be directly measured by ABG analysis, whereas Alveolar pO2 must be calculated

The difference between Alveolar pO2 and Arterial pO2 is known as the Alveolar-Arterial Oxygen Gradient

Normally, this should be less than 2-4kPa

Higher than this suggests a V/Q mismatch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the distant spread of lung cancer

A

Haematogenous - Liver, Bone, Brain, Adrenal

Lymphatic - Cervical Lymph Nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the effects of cigarette smoke on the airways and how this leads to pathology

A

Mucus Gland and Goblet Cell Hypertrophy –> Increased Mucus Production –> Cough and Sputum

Reduced Cilial Motility –> Decreased Mucus Clearance –> Increased Infection Risk

Anti-Protease Inhibition –> Increased Protease Activity –> Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the features of Usual Interstitial Pneumonia

A

Heterogenous appearance with areas of normal lung punctuated by marked fibrosis and honeycombing (mainly in subpleural areas) and fibroblastic foci (dense proliferations of fibroblasts and myofibroblasts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the immediate management of pulmonary embolism

A

Massive:

(PE associated with SBP <90mmHg or a drop in SBP of >40mmHg in <15 Minutes)

Give Unfractionated Heparin IV

Fluid Resuscitation

Thrombolysis with Alteplase if Fails to Improve

Sub-Massive:

Initially LMWH

Then Oral Anti-Coagulant for 3 Months (Factor Xa Inhibitors or Warfarin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the investigations used in the diagnosis of Obstructive Sleep Apnoea Syndrome

A

History (from Pt and Family)

Clinical Exam

Daytime Sleepiness Assessment (Epworth Score)

Limited Polysomnography (Home, 5 Channel; O2 Sats, HR, Flow, Thoracic and Abdominal Effort and Position)

Full Polysomnography (In-Hospital, Multi-Channel; EEG, Video, Audio, Thoracic/Abdominal Bands, Position, Flow, O2 Sats, Limb Leads, Snore)

Transcutaneous Oxygen Saturation and Carbon Dioxide Assessment

18
Q

Describe the mechanism of action of anti-fungal drugs

A
  • Azoles
    • e.g. Miconazole, Imidazole, Triazole, Thiazole
    • Inhibitors of 14-methylsterol alpha-demethylase which produces ergosterol
    • Ergosterol is an essential component of the fungal plasma membrane
    • Does not occur in animal or plants cells
  • Amphotericin B
    • Also exploits the ergosterol/cholesterol difference
    • It is not an enzyme inhibitor
    • Binds to ergosterol to form a pore in fungal membranes, leading to cell death
19
Q

Describe the methods of management of Obstructive Sleep Apnoea Syndrome

A

Weight Loss

Avoidance of Triggers (e.g. Alcohol)

Treatment of Underlying Factors

Continuous Positive Airway Pressure (Splints airway open to stop snoring and sleep fragmentation to reduce daytime sleepiness and improve quality of life)

Mandibular Advancement Device

Sleep Position Training

20
Q

State the pathological classification of Lung Cancer

A

Small Cell

Non-Small Cell (Large Cell, Adenocarcinoma or Squamous Cell)

21
Q

Describe the pathological consequences of local spread of lung cancer

A

Bronchial Obstruction

Lung Collapse or Consolidation (Retention Pneumonia)

Pleura - Haemorrhagic Effusion

Blood Vessels - Haemoptysis

Pericardium - Pericardial Effusion

Mediastinum - SVC Obstruction

Pancoast Tumour - Horner’s Syndrome, Brachial Plexus Compression

22
Q

Describe the pathology and presentation of Extrinsic Allergic Alveolitis

A

T-Cell mediated (immunological) inflammatory reaction in the alveoli and respiratory bronchioles

(N.B. EAA is NOT atopy)

May present with flu-like illness, cough, fever, chills, myalgia, malaise, dyspnoea

23
Q

Describe the pathology of Adenocarcinoma Non-Small Cell Lung Cancer

A

Common tumour in females

Also seen in non-smokers

Two-thirds arise in the periphery

Appearance: Glandular, Solid, Papillary or Lepidic with Mucin Production

24
Q

Describe the pathology of COPD

A

Increased number of mucus-secreting cells

CD8 lymphocyte driven inflammation of the airways, leading to scarring and thickening

Neutrophil infiltration

Loss of defined alveolar air spaces leading to loss of elasticity and air trapping

Causes airway collapse, and blockage of airways

25
Q

Describe the pathology of Large Cell (Non-Small Cell) Lung Cancer

A

Usually arises centrally

Undifferentiated malignant epithelial tumour that lacks the cytological features of SCLC and glandular or squamous differentiation

26
Q

Describe the pathology of Small Cell Lung Cancers

A

Most aggressive form, often metastasising early and widely

Often a good initial response to chemotherapy, but most patients relapse

Appearance: Oval to Spindle Shaped Cells, Inconspicuous Nucleoli, Scant Cytoplasm, Nuclear Moulding

27
Q

Describe the pathology of Squamous Non-Small Cell Lung Cancer

A

Tends to arise centrally from major bronchi

Slow growing and late to metastasise

Often within dysplastic epithelium following squamous metaplasia

Appearance: Malignant Epithelial Tumour showing Keratinisation and/or Intracellular Bridges

28
Q

Describe the serum biochemical adaptations to acute and chronic respiratory failure

A

In acute resp. failure, there is insufficient time for full renal compensation so the pH is low with a high/normal bicarbonate

In chronic resp. failure the kidneys are able to compensate with a raised bicarbonate and normal pH

29
Q

Describe the spirometric pattern that would be expected in obstructive versus restrictive respiratory disease

A

Obstructive (e.g. COPD/Asthma) - Reduced FEV1:FVC (<70%), Reversibility (>15% AND 400ml in Post-BD FEV1) in Asthma but NOT in COPD

Restrictive - Preserved FEV1:FVC (>70%) with Reduced % Predicted FVC

30
Q

Describe the typical features of a ‘Blue Bloater’

A

Usually in chronic bronchitis

Due to CO2 retention (becomes insensitive to it)

Low Resp. Drive and Type 2 Resp. Failure

(Low PaO2 and High PaCO2)

Cyanosis, Obesity, Crackles and Wheeze, Peripheral Oedema

Chronic Productive Cough, Purulent Sputum

31
Q

Describe the typical features of a ‘Pink Puffer’

A

Due to Emphysema

CO2 responsive with compensatory hyperventilation

Desaturates on Exercise, Pursed Lip Breathing, Use of Accessory Muscles, Wheeze, Indrawing of Intercostals, Tachypnoea, Cachectic Appearance

High Resp. Drive, Type 2 Resp. Failure

Low PaO2 and PaCO2

32
Q

Describe the pathological processes in Sarcoidosis

A

Chronic granulomatous disorder characterised by accumulation of lymphocytes and macrophages in organs (typically the lungs and intrathoracic lymph nodes)

Non-necrotising granulomas with multi-nucleated giant cells in the centre

33
Q

Outline the diagnostic features of spontaneous pneumothorax

A

Pleuritic Chest Pain

Dyspnoea

Respiratory Distress

Reduced Air Entry on Affected Side

Hyper-Resonance to Percussion

Reduced Vocal Resonance

Tracheal Deviation (If Tension)

34
Q

Outline the initial management of spontaneous pneumothorax

A

Observation if small or not very symptomatic

Aspiration (urgently if tension) with syringe in 2nd intercostal space, midclavicular line

Intercostal drain with underwater seal

35
Q

State cancers which most commonly metastasise to the lungs

A

Bowel, Breast, Prostate, Bladder, Kidney

36
Q

State indications for the use of non-invasive ventilation in COPD

A

Acute Exacerbations of COPD with Persistent Hypercapnic Respiratory Failure

(should be considered in the presence of respiratory acidosis with pH <7.35 or if acidosis persists despite maximal medical management)

37
Q

State pathological and clinical features that predispose to pulmonary embolism

A

Surgery <12 Weeks Previously

Immobilisation >3 Days in Previous 4 Weeks

Previous DVT/PTE

FHx of PTE/DVT

Lower Limb Fracture

Pregnancy or Post-Partum

Long Distance Travel

Oestrogen-Containing OCP Use

Antithrombin Deficiency

Protein S or C Deficiency

Factor V Leiden

38
Q

State potential drug interactions and pitfalls when using theophylline

A

Side effects include GI upset, palpitations, tachycardia/arrhythmias, headache, insomnia and hypokalaemia

Caution in liver disease and with concomitant use of enzyme inducers (rifampicin) and inhibitors (clarithromycin, ciprofloxacin)

Smoking increases theophylline clearance – dose may need to be adjusted following smoking cessation

39
Q

State risk factors which predispose to development of Obstructive Sleep Apnoea Syndrome

A

Obesity

Male Sex

Post-Menopause (Women)

Large Neck Circumference (>40cm)

Maxillomandibular Anomalies (Narrowing, Retrognathia)

Increased Tonsil/Adenoid/Tongue Size

FHx

40
Q

State some clinically differentiating features of Asthma and COPD

A

Episodic SOB in Asthma

Nocturnal Symptoms and Diurnal Variation in Asthma

Productive Cough in COPD

Asthma is Not Progressive, Has Exacerbations and Variable Symptoms

COPD is Progressive, Has Exacerbations and Persistent Symptoms

41
Q

State the Alveolar Air Equation

A

PaO2 = FiO2 - (1.25 x PaCO2)

PaO2 - Alveolar Oxygen Partial Pressure, kPa

FiO2 - Inspired Oxygen Concentration, kPa

42
Q

Using the Alveolar Air Equation comment on the following patient:

Man with COPD, on 28% Oxygen

pO2 - 7.6

pCO2 - 6.6

A

Alveolar pO2 = 28 - (1.25 x 6.6) = 19.75

Therefore, A-a = 19.75 - 7.6 = 12.15

Alveolar-Arterial Gradient is increased, suggesting V/Q mismatch

Phase 3 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions