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Phase 2a Summaries > Respiratory > Flashcards

Respiratory Flashcards

1
Q

If the FEV1/FVC ratio is <0.7 is this obstructive or restrictive?

A

Obstructive

Because low FEV1 and normal FVC

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2
Q

If the FEV1/FVC ratio is >0.7 is this obstructive or restrictive?

A

Restrictive

Normal ratio because both FEV1 and FVC are low

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3
Q

What is the transfer co-efficient?

A

Measure of the ability of oxygen to diffuse across the alveolar membrane

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4
Q

How do you measure the transfer co-efficient?

A

Inspire low dose CO, 10 second breath hold at TLC

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5
Q

What are the causes of respiratory failure (LAVISH)?

A 
Low inspired O2 
Alevolar hyperventilation 
V/Q Mismatch 
Impaired diffusion 
Shunt 
Hypoventilation
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6
Q

What are the target oxygen sats in Type 1 Respiratory failure?

A

94-98%

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7
Q

What are the target oxygen sats in Type 2 Respiratory failure?

A

88-92%

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8
Q

Other than oxygen, what is another treatment method used in type 1 respiratory failure?

A

CPAP- Continuous positive airways pressure - increases ventilation and V/Q ratios

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9
Q

Other than oxygen, what is another treatment method used in type 2 respiratory failure?

A

NIV - Non-invasive ventilation - bi-phasic positive airway pressure to increase ventilation

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10
Q

What is the main cause of type 1 respiratory failure?

A

Pulmonary embolism

Pulmonary oedema and pneumonia

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11
Q

Name 4 symptoms of hypercapnia?

A 
Bounding pulse 
Flapping tremor 
Drowsiness and confusion 
Loss of consciousness 
Warm peripheries
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12
Q

What is the definition of bronchitis?

A

Cough and sputum production for 3 months for 2 or more years

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13
Q

Name 4 signs of cor-pulmonale?

A
  1. Raised JVP
  2. Loud second heart sound
  3. Peripheral oedema
  4. Systolic parasternal leave
  5. Widening of pulmonary artery on chest X-ray
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14
Q

What are the two 1st line medications in COPD?

A

SABA- Salbutamol

LAMA- Tiotropium

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15
Q

What is the 2nd line COPD treatment if FEV1 >50%?

A

LABA or LAMA

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16
Q

What is the 3rd Line COPD treatment?

A

LAMA - tiotropium
LABA- Formeterol
Inhaled corticosteroid

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17
Q

What does the CURB-65 score stand for?

A 
Confusion 
Urea <7mmol/l
Respiratory Rate >30/min
Blood Pressure <90mmHg (systolic) <60mmHg
65-Age
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18
Q

What is 1st line treatment for mild pneumonia (CURB-65- 0-1)?

A

Amoxicillin
Clarithromycin in penicillin allergy
Treat as outpatient

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19
Q

What is 1st line treatment for moderate pneumonia (CURB-65- 2)?

A

Amoxicillin and clarithromycin PO

Hospital admission

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20
Q

What is 1st line treatment for severe pneumonia (CURB-65- 3-5)?

A

Co-amoxiclav and clarithromycin IV
Urgent admission and consider ITU
Alternatives cefuroxime and clarithromycin

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21
Q

Which antibiotics would you used in atypical bacterial causes?

A

Macrolides (erythromycin) or fluroquinolones (ciprofloxacin)

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22
Q

Patient with pneumonia, chest X-ray taken - multiple abscesses seen - what is likely cause?

A

Staph Aureus

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23
Q

Patient with pneumonia, chest X-ray taken - upper lobe cavity seen - what is likely cause?

A

Klebseilla pneumoniae (but must exclude TB)

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24
Q

Which two organisms most commonly cause HAP?

A

Staph aureus

Klebsiella

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25
Q

What are the extra pulmonary features associated with pneumonia caused by mycoplasma pneumoniae?

A

Raynauds
Haemolytic anaemia
Bullous myringitis (blisters on tympanic membrane)
Encephalitis

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26
Q

What are the extra pulmonary features associated with pneumonia caused by legionella spp?

A

Diarrhoea
Abnormal liver tests
Interstitial nephritis

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27
Q

What is empyema?

A

Failure of fevers or markers of inflammation to settle on antibiotics

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28
Q

What markers on thoracocentesis suggest a para-pneumonic effusion that needs drainage?

A

pH <7.2, glucose low, pus or thick fluid and positive gram stain

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29
Q

How do you treat para-pneumonic effusion?

A

Co-amoxiclav

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30
Q

What would the peak expiratory flow have to be, to be diagnosed with asthma?

A

> 20% of predicted on >3 days a weeks for 2-4 days with diurnal variation

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31
Q

What is first line management of Asthma?

A

SABA- Salbutamol

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32
Q

What is second line management of Asthma?

A

SABA + Inhaled corticosteroid

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33
Q

What is third line management of Asthma?

A

SABA + Inhaled corticosteroid + LABA (salmeterol)

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34
Q

How do you measure eosinophilic inflammation in asthma?

A

Exhaled nitric oxide

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35
Q

Name 3 side effects of steroid use?

A

Osteoporosis , diabetes, oral candida, hoarse voice, weight gain, high blood pressure and suppress immune system

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36
Q

Name 3 topical complications of long term steroid use?

A

Hoarse voice, oral candida, easy bruising

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37
Q

What are the signs of an asthma attack?

A 
33,92, CHEST 
33 PEFR <33% 
92 <92% O2 sats 
Cyanosis 
Hypotension 
Exhaustion 
Silet chest 
Tacycarhia
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38
Q

What is the management for an acute asthma attack?

A 
OSHITME 
Oxygen 40-60% 
Salbutamol nebuliser 
Hydrocortisone 
Ipatropium bromide 
Theophylline 
Magnesium sulphate 
Escalate care
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39
Q

Name 3 complications of bronchiectasis?

A

Pneumonia
Fungal colonisation
Metastatic abscesses

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40
Q

Which disease leads to honeycomb lung?

A

Fibrosing alveolitis/interstitial lung diseases

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41
Q

What is pneumoconiosis?

A

Lung disease caused by inhaled dust

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42
Q

What type of hypersensitivity reaction is seen in the mantoux test?

A

Type 4 hypersensitivity

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43
Q

How do you treat pneumothorax?

A

Needle in the second intercostal space

44
Q

Name 5 transudate causes of pleural effusion?

A
  1. Heart failure
  2. Liver cirrhosis
  3. Nephrotic syndrome
  4. Hypothyroidism
  5. Peritoneal dialysis
45
Q

Name 3 exudate causes of pleural effusion?

A
  1. Infection eg TB
  2. Inflammation - pneumonia
  3. Malignancy
46
Q

What would you see on an X-ray of pleural effusion?

A

Blunting of the costaphrenic angles

47
Q

What do mesothelial plaques express?

A

Calretinin

48
Q

Which type of lung cancer is most strongly associated with smoking?

A

Non-small cell squamous

49
Q

What are the sites of metastatic spread from lung cancer?

A

Liver, bone, adrenal glands, brain

50
Q

What does para-neoplastic mean?

A

Non metastatic manifestations of malignant disease

51
Q

Give 3 examples of para-neoplastic syndromes caused by lung cancer?

A
  1. Hypercalcaemia (PTH secretions)
  2. Hyponatreamia
  3. Finger clubbing
  4. Non-infective endocarditis
52
Q

What is the mean pulmonary pressure in pulmonary hypertension?

A

> 25mmHg

53
Q

Which pneumonia causing organism is stained using Lowenstein- Jenson Medium?

A

Mycobacterium tuberculosis

54
Q

Which two glycoproteins in HIV molecular allow it to attach and bind to CD4 via CCR5?

A

gp120 and gp40

55
Q

Once HIV viral caspid has entered the cell, how does it integrate into the host cell?

A

Reverse transcript changes viral RNA to DNA within the cell
Girl DNA integrates into the host cell DNA
When the host then translates the DNA, the virus DNA is also produced

56
Q

Name 6 preventative methods of HIV?

A
  1. Circumcision
  2. Post Exposure Prophlaxis and Pre Prophlyaxis
  3. STI control
  4. Microbicides
  5. Behavioural therapy
  6. HAART - treament as prevention
57
Q

What symptoms/ signs would you see in a patient in the clinically latent period of HIV?

A
  1. Persistant generalised lymphadenopathy
  2. Recurrent shingles
  3. Oral candidiasis
  4. Raised protein levels (immunoglobulins)
58
Q

What are the three respiratory presentations of HIV?

A
  1. Pneumocytitis jirovecci pneumonia
  2. Strep Pneumonia
  3. TB
59
Q

Name 3 of the CNS disease presentations in HIV?

A
  1. Cerebral toxoplasmosis
  2. Meningitis
  3. Ophthalmic lesions eg CMV
60
Q

What are the 2 HIV related neoplasms?

A
  1. Kaposi Sarcoma

2. Lymphoma

61
Q

Which three drugs are commonly used in HAART?

A

2 nucleoside reverse transcriptase inhibitors
AND
1 non-nucleoside reverse transcriptase inhibitors OR
Protease inhibitor

62
Q

What are the 3 hallmarks of asthma pathophsiology?

A
  1. Airway inflammation
  2. Airway obstruction - smooth muscle hypertrophy, bronchoconstrictions
  3. Bronchial hyper-responsiveness
63
Q

Give 3 precipitants of asthma?

A

Cold air, emotion, allergens, smoking, occupational allergens

64
Q

What are the signs of asthma?

A

Reduced air entry, expiratory polyphonic wheeze, tachypnoea, cyanosis, increased use of accessory muscles, hyper-resonant on percussion

65
Q

Suggest 3 non-medical asthma treatment?

A

Stop smoking, lose weight, breathing exercise programmes

66
Q

What is the definition pf chronic bronchitis?

A

Productive cough for at least 3 months a year

67
Q

Why do you purse lips in emphysema?

A

To increase pressure in alveoli

68
Q

What are the 5 symptoms of COPD?

A 
Chronic Cough 
Wheeze 
Regular sputum production 
Frequent infection 
SOB
69
Q

Give 4 signs of COPD?

A 
Pursed lip breathing 
Barrel chest 
Cyanosis 
Reduced breath sounds 
Use of accessory muscles
70
Q

Which inflammatory cells are present in Asthma?

A

Mast cells and eosinophils

71
Q

Which inflammatory cells are present in COPD?

A

Neutrophils

72
Q

What is GOLD standard diagnosis in COPD?

A

Spirometry

73
Q

What scale is used for prognosis of COPD?

A

BODE Index

BMI, obstruction, dysnpnoea, exercise

74
Q

What are 4 of the non-pharmacoligical managements of COPD?

A

Pulmonary rehabilitation
Smoking cessation
Physio- for sputum clearance
Influenza and pneumococcal vaccinations

75
Q

What is the 2nd line COPD treatment if FEV1 <50%?

A

LABA + ICS or LAMA

76
Q

What are signs of pneumothorax?

A

Deviated trachea, mediastinal shift

77
Q

What sign is present on X-ray with bronchiectasis?

A

Tram-track sign on CXR

78
Q

What is GOLD standard diagnosis for bronchiectasis?

A

CT

79
Q

Where is mutation in CF?

A

Transmembrane conducts regulate (CFTR) on chromosome 7

80
Q

What are the extra-intestinal features of CF?

A

Biliiary cirrhosis, hepatitis

GU - amenorrhoea

81
Q

What is the acute cause of ILD?

A

ARDS

82
Q

What do you see on an X-ray in ARDS?

A

Bilateral infiltrates

83
Q

Give 5 chronic causes of ILD?

A

Vasculitis, rheumatoid arthritis, asbesto, EAA, amiodarone

84
Q

What would you see in CXR of sarcoid?

A

Bilateral hilar lympaphadenopathy

85
Q

What is seen in the blood which is raised in sarcoid?

A

ACE

86
Q

How do you treat sarcoid?

A

Steroids

87
Q

What are the acute symptoms of EAA?

A

Fever, cough, chest ache, fatigue

88
Q

What type of hypersensitivity reaction is good pastures?

A

Type 2

89
Q

How do you diagnose good pastures?

A

Anti-GBM in blood

90
Q

What score do you use to assess the risk in PE?

A

Wells score - History of PE, malignancy, recent trauma, immobilisation >3 days, combined oral contraceptive pill

91
Q

What are the 3 atypical pneumonia causes?

A

Mycoplasma, legionella (Spain), chlamydophillia pneumonia, chlamydiophilia psitattaci

92
Q

What are the signs of pneumonia?

A

tachycardia, low sats, fevers, reduced breath sounds

93
Q

What is seen in blood count of pneumonia?

A

Raised WCC, neutrophils and CRP

94
Q

What are risk factors for TB?

A 
Poverty, increased droplet spread 
Poor hygiene 
Immunosuppression (HIV) 
Smokers 
Foreign travel
95
Q

Which culture do you use to grow mycobacterium tuberculosis?

A

Lowenstein-jensen culture (secondary to ziegler-neelson stain)

96
Q

What is the side effect of pyrazinamide?

A

P= Purines = Gout and joint problems

97
Q

What is the side effect of isoniazid?

A

I= Isolated nerve problems - Peripheral neuropathy

98
Q

What lung cancer is a neuro-endocrine tumour?

A

Small Cell

Secretes ADH

99
Q

Which antibiotic treats pneumococcal pneumonia?

A

Amoxiccilin

100
Q

What like organism causes pneumonia in CF patients?

A

Pseudomonas auerginosa

101
Q

What is the pathophsiological difference between allergic asthma and extrinsic allergic alveolitis?

A

Asthma – Type 1
IgE mediated, mast cells release histamine
Macrophage activation
Bronchoconstriction, goblet cell secretions, hypertrophy

EAA – type 3
Immune complex forms with allergen
Complexes saturate clearance system
Build up in lungs causing inflammation and INTERSTITIAL DAMAGE(not bronchial)

102
Q

In TB what is the primary lesion called?

A

A ghon focus, a ghon complex is the initial focus plus the hilar lymphadenopathy

103
Q

What is the difference between pink puffers and blue bloaters?

A

Pink puffer - increased alveolar ventilation, low PaO2, breathless not cyanosed and can progress to type 1 failure
Blue bloaters have recused alveolar ventilation, decrease PaO2, increased PaCO2 - cyanosed but not breathless and can cause cor pulmonale

104
Q

Give 4 causes of pulmonary hypertension?

A

PE, left to right shunt eg ASD/VSD, emphysema, LV failure, COPD

105
Q

Name 4 signs of pulmonary hypertension?

A

Fatigue, tacycardia, raised JVP, flounder S2, peripheral oedema

106
Q

Why does asthma not cause a reduction in transfer factor?

A

Normal structure of alveolus and lung stricture just can’t move oxygen into lung

Phase 2a Summaries (12 decks)

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