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Respiratory Flashcards

1
Q

Bronchiectasis

What is it, and cause?
Main symptoms?
What are 3 syndromes it is most commonly associated with?

A

What - Chronic inflammation of the bronchi/oles that leads to permanent dilation and thinning of the airways
Main symptoms - Chronic cough, lots of sputum (yellow, green), intermittent hemoptysis
Causes - Basically get an inflammatory process after an inflammation alongside another contributing process such as airway obstruction, decreased lung defense mechanisms or impaired drainage. Get an chronic infection and result in irreversible damage and dilation of the bronchi

Associated diseases - CF,

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2
Q

Asthma - Symptoms and signs

A

Symptoms
-Cough, wheeze, dyspnea, chest tightness
Signs - wheezing,prolonged expiratory phase, hyper inflated or hyper resonant chest
-severe - signs of severe dyspnea - accessory muscle use and absence of lung sounds

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3
Q

How to initially diagnose someone?

A

Hospital - skip diagnosis and treat

Outpaint

  1. PFTs = FEV1/FVC reduced (FVC same and FEV1 reduced)
  2. If PFTs normal –> methyl choline (to induce bronchospasm) - if negative then no astham, if positive - asthma
  3. If PFTs decreased –> give albetelol - if positive - then asthma is reversible, if negative then not asthma
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4
Q

How to assess severity of disease and how to treat

A

Table

-learn !!!

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5
Q

Acute exacerbation

A

Diagram learn

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6
Q

Types of SABA, LABA, ICS, oral steroids used for asthma

A

SABA - salbutamol, terbutaline
ICS - Beclometasone diproprionate, Budesonide, fluticasone proprionate
LTA - oral montelukast (age 2-4)
LABA - formoterol, salmeterol, eformoterol
PO - oral prednisone
SAMA - Ipratropium

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7
Q

Differential diagnosis ASthma

A

Pulmonary oedema

  • COPD
  • Large airway obstruction (foreign body/ tumour)
  • Pneumothroax
  • Bronchiectasis
Acute attack 
COPD exhaserbation
-pulmonary oedema
-URI
-pulmonary embolus
-anaphylaxis
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8
Q

DVT - main symptoms , how are they diagnosed

A

-Odema in leg,
-typically in popliteal or femoral veins (no valves in deep veins - can travel)
-Difference >2cm between legs, and below 2cm of tuberosity
Diagnosed - Ultrasound
Treatment - anticoagulation

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9
Q

Physiology behind PE

A
  • DVT occurs in leg travel to lung
  • wedges in lung –> causes ischaemia, necrosis (haemoptysis, pleuritic chest pain)
  • Get increased pressures - pulmonary hypertension –> can lead to right heart strain (S1,Q3,T3)
  • Get platelet mediated vasodilation, fluid leaks into avleolar space -makes oxygen diffusion decreased (harder to flow through)
  • Then to increase DL02 = hbg x sp02 x CO (hr x sv)
  • will increased CO - get tachycardia and tachypnoea
  • this will also cause a hypocapnia (co2 is perfusion limited and have increased perfusion so get more blown off)
  • get a hypoxaemic respiratory alkalosis
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10
Q

Presentation PE

A

shortness of breath, tachypnea, tachycardia, a pleuritic chest pain, and a Clear Chest X-ray.

  • can get right sided heart strain - ECG - S1Q3T3
  • can also get haemoptysis
  • look for one leg larger than the other

signs - pyrexia, cyanosis, tachypnoea, tachycardia, hypotension, raised JVP, plerual rub, plueral effsuion, DVT

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11
Q

Diagnosis PE

A

First complete a wells score

  • if Low - D Dimer - rule out
  • if more than 4 and kidneys are normal - CTA
  • If more than 4 and abnormal kidneys - do a V/Q scan - MUST HAVE A NORMAL XRAY

-if leg is swollen do a leg US first - least invasive

pulmonary angiogram - is gold standard, however normally is not the answer because it is invasive (only in setting of massive PE producing hypotension) –> for tpa admission
-or if pre-test probability is extremly high and ct does not show PE

-chest xray, ecg - to rule out other things
xray - can show ateletaxis

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12
Q

Treatment PE

A

-heparin - 5 days
or LMWH - enoxaparin,
-bridge to warfarin
-or NOAC - dabigatran, rivaroxaban or apixiban

-tpa - only if massive PE - hypotension, heart signs, trop, bnp, strain on echo/ecg (Streptokinase, alteplase)

  • DONT DO A IVC filter
  • Thrombectomy - ONLY IF chronic MASSIVE PE AND pul hypertension
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13
Q

What does warfarin inhibit

What to do if INR gets large

A

factors 2,7,9,10 protein C
measure INR - 2-3

INR <5 - Hold a dose
INR 5-9 - hold dose, vit K
INR > 9 - hold dose, Vit K, lower dose
Bleeding - Fresh frozen plasma, vit k

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14
Q

oncotic vs hydrostatic pressure

A

Hydrostatic - capillary pressure - pushes things out

Oncotic - solutes outside capilaries - can draw fluid out of vessels

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15
Q

Defining pleural effusions

transudate vs exudate

A

Transudate - (fluid from vessels)

  • CHF (hydrostatic)
  • Cirrhosis, gastrosis, nephrosis (oncotic pressure)

Exudate - (fluid + other stuff from inflammation)

  • Malignancy
  • Pneumonia
  • TB
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16
Q

Signs/ Symptoms pleural effusion

A
  • SOB, orthpnoea
  • Pleurtic chest pain
  • Dullness to percussion
17
Q

Diagnosis

A

Chest Xray

  • blunted costophrenic angle
  • When it gets bigger - then get both above and horizontal meniscus (fluid in chest)
  • dont know if haemothroax, chyothorax or plueral effusion (blood, chyme, fluid) —-> Throencitesis to figure out what it is
18
Q

How to diagnose

A

Look at diagram

Image - lateral decubus xray, US, CT (pick xray)

  • Is it loculated or not (simple or need surgeon)
  • less than 1cm - to small, watch and wait
  • if get sepitations lobes - pockets of fluid, then it is loculated –> throacostomy (chest tube +/- tpa)
  • if this fails –> need to do a throcotomy
  • if it is not loculated - DO not tap
  • if they have CHF - most likely to be this, so just diurese - if this does not work, then can do thorosentesis
  • then want to determine if it is exudate or transudate
19
Q

How to determine if exudate or transudate

A

Do not tap if too small, loculated or CHF - on xray.

Thorsentesis 
Lights criteria 
-LDH >2/3 
-LDH/Serum ULN >0.6
-TPfluid/TPserum LDH >0.5
(lactate dehydrogenase)

(fluid comes first) - if you have lots of stuff in the pleural space, then get ratios closer to 1 (exudate) (transudate - will be low ratios)

need all criteria negative for transudate
-Need one criteria to be exudate

Test these tubes
-Tube 1 - Cell count w Diff
Pneumonia - leukocytosis w polys) 
TB/Malignancy - white cells with - lymphocytes 
Haemothroax/cancer - rbcs

-Tube 2 - cytology = cancer - then is stage 4 (metastatic disease)

-Tube 3 - glucose, pH
adenosine deaminase - tb, Triglycerides - chylothroax
Tube 4 - Blood culture –> gram stain and culture - look for bacteria, fungi and tb -

20
Q

What is COPD

-how to make diagnosis

A

Emphysema (pink puffer)
-pursed lips (proloned exhalation), barell chest, increased co2 retention, no change in 02

Bronchitis (blue blower)

  • Decrease o2 - cyanosis (due to inflammatory damage)
  • vasoconstriction - pulmonary hypertension –> right sided heart failure , oedema

Diagnosis - PFTs
-FEV1/FVC - (both are decreased and ratio is also decreased)
(can do chest xray, abg, ecg to rule out other things)

21
Q

Treatment - stable

A 
SABA
LAMA
LABA
ICS
PDe4 (phosphdiesteraid 4 inhibitors) 
Steroids

COPDER
C - corticosteroids (ICS, PO, IV - depending on severity)
O - oxygen SP02 <88% (want it between 88-92% because dont want to lose hypoxic drive) or give if Pa02 <55
P - Prevention - vaccines, flu and streptococcal, and stop smoking
D - Dilators - SABA, LAMA, LABA
R - rehab - exercise tolerance

22
Q

COPD exacerbation - signs and symptoms

A
  • cough, wheeze, sputum production

- do a chest xray, ecg, abg to cancel other differentials

23
Q

Management COPD exacerbation

and how do we tell how bad?

A

Antibiotics - Amoxyicillin or doxycyclin
Bronchodilators - salbutamol, ipratropium
Steroids - Prednisone PO or IV methyprednisolone

Look at their response to therapy

  1. get better –> go home (PO steroids, mederdose inhalors)
  2. okay –> need more time –> wards (PO and nebulised - bronchodilators)
  3. Get worse - confusion, absent wheeze or lung sounds, co2 increase –> ICU - IV steroids, ipap or pt tube
24
Q

Groups of COPD classification

A 
FEV1/FVC <70%, and FEV1 post bronchodilator 
Group A - FEV1 60-80% MILD 
Group B - FEV1 40-60% MOD
Group C - FEV1 <40% Severe 
Group D - acute exacerbation

Group A + B - saba, lama, laba
Group C - ICS
Group D - exhaserbation, consider home oxygen if <90% on more than 1 occasion

25
Q

Types of SABA, LAMA, LABA

ICS

A

SABA - salbutamol, terbutaline SAMA - ipratrpoum
LAMA - umeclidinium, tiotroium, glycopyrronium
LABA - salmeterol, formeterol, indacaterol
ICS -

Random Progress Test (10 decks)

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