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Respiratory Flashcards

1
Q

What is asthma?

A

Chronic inflammatory condition secondary to hypersensitvity which causes reversible airway obstruction

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2
Q

What are symptoms of asthma?

A

Dyspnoea, cough, wheeze, diurnal variation

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3
Q

What are signs of asthma?

A

Audible wheeze, hyperinflated chest, hyperresonance

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4
Q

What are risk factors for developing asthma?

A

History of atopy, maternal smoking, low birthweight, bottle fed, exposure to high concentrations of allergens, air pollution, hygiene hypothesis

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5
Q

What are some precipitants of asthma?

A

Cold air, exercise, emotions, smoking, pollution, NSAIDs, beta-blockers

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6
Q

What is the FEV1 like in asthma?

A

Significantly reduced

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7
Q

What is the FVC like in asthma?

A

Normal

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8
Q

What is the FEV1/FVC ratio?

A

<70% (positive test for asthma)

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9
Q

A 12%+ improvement of spirometry after administration of what drug is indicative of asthma?

A

Bronchodilators

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10
Q

What other tests can be done for asthma?

A

Peak flow - (>20% variability)
Increased FeNO levels
Skin prick tests to check atopy

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11
Q

What is the first line management of asthma?

A

SABA

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12
Q

What is added to SABA inhaler first?

A

Low dose inhaled steroid

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13
Q

What is the next treatment line after a SABA and an inhaler steroid?

A

LABA

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14
Q

What is the next treatment line after SABA, inhaled steroid & LABA?

A

Increase steroid dose

Addition of theophylline/LTRA/LAMA

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15
Q

What is the next treatment line after SABA, inhaled steroid, LABA, LTRA?

A

Addition of 4th agent - theophylline, LAMA, beta-agonist tablet

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16
Q

What is the last line treatment for asthma?

A

Oral steroids

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17
Q

Peak flow 50-75%, speech normal, RR <25, pulse <110 - severity of asthma attack?

A

Moderate

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18
Q

Peak flow 33-50%, cant complete sentences, RR >25, pulse >110 - severity of asthma attack?

A

Severe

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19
Q

Peak flow <33%, silent chest, cyanosis, bradycardia, hypotension, coma - severity of asthma attack?

A

Life threatening

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20
Q

How is an acute asthma attack treated?

A

Oxygen
Salbutamol nebulised 5mg 6L/min
Ipratropium bromide nebulised
Steroids - 40-50mg predniolone orally or 100mg hydrocortisone IV

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21
Q

What treatment should be given in acute asthma attack if it is life threatening?

A

IV Magnesium sulphate 2g over 20 minutes

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22
Q

What is COPD?

A

Common progressive disorder characterised by airway obstruction consisting of chronic bronchitis and emphysema

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23
Q

What are symptoms of COPD?

A

Cough, sputum, breathlessness

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24
Q

What are signs of COPD?

A

Tachypnoea, use of accessory muscles, hyperinflation, wheeze, cyanosis, cor pulmonale

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25
Q

What are causes of COPD?

A

Smoking, alpha-1-antitrypsin deficiency

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26
Q

What is the FEV1 like in COPD?

A

Reduced

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27
Q

What is the FVC like in COPD?

A

Normal

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28
Q

What is the FEV1:FVC ratio like in COPD?

A

Reduced (<70%)

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29
Q

What may be seen on CXR in COPD?

A

Flattened hemidiaphragm

Hyperinflation

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30
Q

What would an ABG show in COPD?

A

Compensated respiratory acidosis

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31
Q

What type of respiratory failure do you get in COPD?

A

Type 2 respiratory failure (Hypoxia with hypercapnia)

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32
Q

What conservative management would you recommend for COPD?

A

Stop smoking

Increase exercise

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33
Q

What vaccines are important for people with diagnosed COPD?

A

Once off pneumococcal vaccination

Annual flu vaccine

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34
Q

What is the first line treatment for COPD?

A

Either a SABA or a SAMA

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35
Q

What is the second line treatment for COPD dependent on?

A

FEV1

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36
Q

If FEV1 is over 50% of predicted, what is the second line treatment for COPD?

A

LABA or a LAMA

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37
Q

If the FEV1 is less than 50% of predicted, what is the second line treatment for COPD?

A

LABA + ICS or

LAMA

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38
Q

What is the 3rd line treatment for COPD?

A

SABA + LABA + ICS + LAMA

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39
Q

Which two inhalers can you NOT give together?

A

SAMA and LAMA

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40
Q

What organism is the commonest cause of exacerbations of COPD?

A

Haemophilus influenzae

also get strep pneumoniae and moraxella

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41
Q

When should antibiotics be given for an exacerbation of COPD?

A

Only if purulent sputum or signs of pneumonia

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42
Q

How should an infective exacerbation of COPD be managed?

A

Increase the frequency of bronchodilator or consider using nebulised
Prednisolone 30mg 7-14 days

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43
Q

If a patient has a severe exacerbation of COPD what can be done?

A

IV Aminophylline

If pH <7.26 - intubate

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44
Q

What is pneumonia?

A

Acute lower respiratory tract infection

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45
Q

What are symptoms of pneumonia?

A

SOB, productive cough, chest pain, fevers, confusion, myalgia

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46
Q

What are signs of pneumonia?

A

Fever, cyanosis, confusion, tachycardia, hypotension, consolidation, dull percussion note

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47
Q

What is the commonest organism causing pneumonia?

A

Strep pneumoniae

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48
Q

What pneumonia is associated with water?

A

Legionella

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49
Q

What pneumonia is associated with alcoholics/diabetics?

A

Klebsiella - ‘Red jelly sputum’

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50
Q

What pneumonia is associated with parrots?

A

Chlamydia pscittici

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51
Q

What pneumonia is associated with AIDS?

A

Pneumocystis jirovecii

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52
Q

How do you investigate pneumonia?

A

Blood CXR

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53
Q

How is legionella tested for?

A

Urinary antigen

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54
Q

How is pneumocystis jirovecii investigated?

A

Bronchoalveolar lavage

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55
Q

What are the components of CURB65 score?

A 
Confusion
Urea >7
Respiratory rate >30
BP <90 systolic or <60 diastolic
65 years or older

1 point for each

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56
Q

What does a CURB65 score of 0-2 indicate?

A

Mild to moderate pneumonia

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57
Q

What does a CURB65 score of 3-5 indicate?

A

Severe pneumonia

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58
Q

How is community acquired mild/moderate pneumonia treated?

A

Amoxicillin 1g TDS (5 days)

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59
Q

How is severe community acquired pneumonia treated?

A

IV Co-amoxiclav + Doxycycline

Step down to doxycycline 100mg BD

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60
Q

How is mild/moderate hospital acquired pneumonia treated?

A

PO Amoxicillin + Metronidazole (5 days)

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61
Q

How is severe hospital acquired pneumonia treated?

A

IV Amoxicillin + metronidazole + gentamicin. Step down to co-trimoxazole + metronidazole PO

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62
Q

How are atypical pneumonias normally treated?

A

Macrolides e.g. clarithromycin

63
Q

How do you follow up patients with pneumonia who are at risk of lung cancer?

A

CXR in 6 weeks

64
Q

What are complications of pneumonia?

A

Pleural effusion, empyema, abscess, respiratory failure, sepsis

65
Q

What is tuberculosis?

A

An infectious disease of the respiratory tract

66
Q

What causes TB and how does it spread?

A

Mycobacterium tuberculosis - airborne droplets

67
Q

What does tuberculosis cause in the alveoli?

A

Caseating granulomas

68
Q

What are risk factors for TB reactivation?

A

Diabetes, IVDU, HIV, immunosuppression,

69
Q

What are symptoms of TB?

A

Malaise, fever, lymphadenopathy, night sweats, cough, haemoptysis, erythema nodosum, vertebral collapse, meningism

70
Q

What does a CXR show in TB?

A

Consolidation, cavitating upper lobe lesions, bilateral hilar lymphadenopathy, fibrosis

71
Q

What stain should you use on a sputum sample in TB and what does it show?

A

A Ziehl-Niehlson stain shows acid-fast bacilli

72
Q

What antibiotics are used to treat TB?

A

2 months of rifampacin, isoniazid, pyramidizine and ethambutol
then 4 further months of rifampacin and isoniazid

73
Q

What are side effects of rifampacin?

A

Enzyme inducer, orange body fluids?

74
Q

What are side effects of isoniazid?

A

Neuropathy

75
Q

What are side effects of pyramidizine?

A

Hepatitis, arthralgia

76
Q

What are side effects of ethambutol?

A

Optic neuritis

77
Q

What is an Assman focus?

A

A pulmonary lesion second to miliary TB that is disseminated in the blood

78
Q

What are risk factors for lung cancer?

A

Cigarette smoking, asbestos exposure, chromium iron oxides, radiation, genetics, age

79
Q

What are symptoms of lung cancer?

A

Cough, haemoptysis, dyspnoea, chest pain, anorexia, weight loss

80
Q

What are signs of lung cancer?

A

Cachexia, anaemia, clubbing, lymphadenopathy, chest consolidation, collapse, pleural effusion

81
Q

What investigations should be done for lung cancer?

A 
Sputum cytology
CXR
Bronchoscopy/Percutaneous needle biopsy
CT Scan and PET for staging
Radionucleotide bone scan for mets
82
Q

What does a CXR show in lung cancer?

A

Peripheral enlarged nodes, hilar enlargement, consolidation, collapse, pleural effusion

83
Q

Which patients should get an urgent chest X-ray for suspicion of cancer?

A

Patients over 40 who have ever smoked with UNEXPLAINED SYMPTOMS of
2 from: cough, fatigue, SOB, chest pain, weight loss, appetite loss OR
1 from: clubbing, recurrent infection, lymphadenopathy, thrombocytosis

84
Q

What cell does small cell lung cancer develop from?

A

Neuroendocrine cells

85
Q

What paraneoplastic syndromes is SCLC associated with?

A

ADH and ACTH secretion

Lambert-Eaton Myaesthenic Syndrome

86
Q

What cell does adenocarcinoma of the lung develop from?

A

Mucus secreting cells

87
Q

What is the commonest lung cancer in non-smokers?

A

Adenocarcinoma

88
Q

What cell does squamous cell cancer of the lung develop from?

A

Epithelial cells

89
Q

What paraneoplastic syndrome is squamous cell lung cancer associated with?

A

PTHrP secretion leading to hypercalcaemia

90
Q

What may large cell lung cancer secrete?

91
Q

What is a Pancoasts tumour?

A

A tumour at the lung apex commonly from NSCLCs

92
Q

What may a Pancoasts tumour cause?

A

Horner’s syndrome due to compression of sympathetic ganglion - miosis, ptosis, anhydrosis

93
Q

How is small cell lung cancer treated?

A

Chemotherapy with some scope for radiotherapy. Mainly palliative

94
Q

How is non-small cell lung cancer treated?

A

Surgery and radiotherapy. Poor response to chemotherapy.

95
Q

Which lung cancers have better prognoses?

A

Non-small cell cancers

96
Q

What is mesothelioma?

A

Tumour of the mesothelial cells of the lung pleura

97
Q

What is mesothelioma associated with?

A

Asbestos exposure

98
Q

What are features of mesothelioma?

A

Progressive SOB, chest pain, effusion, clubbing

99
Q

What tests should be done for mesothelioma?

A

CXR/CT - shows pleural thickening

100
Q

How is mesothelioma managed?

A

Palliative chemotherapy +/- radiotherapy

101
Q

What are interstitial lung diseases characterised by?

A

Chronic inflammation and/or progressive interstitial fibrosis

102
Q

What are symptoms of ILDs?

A

Breathlessness on exertion, non productive cough, abnormal breath sounds

103
Q

What is the pathophysiology of ILD?

A

Fibrosis and remodelling of the interstitium and hyperplasia of epithelial cells and pneumocytes

104
Q

What does spirometry show in ILD?

A

FEV1 - reduced
FVC - reduced
FEV1/FVC = normal

105
Q

Does ILD show an obstructive or restrictive pattern on spirometry?

A

Restrictive

106
Q

What is the commonest ILD?

A

Idiopathic pulmonary fibrosis

107
Q

What are features of idiopathic pulmonary fibrosis?

A

Progressive exertional dyspnoea, bibasal crackles, dry cough, clubbing

108
Q

What may imaging show in idiopathic pulmonary fibrosis?

A

CXR - ground glass appearance

CT - honeycombing

109
Q

How is IPF managed?

A

Pulmonary rehab
Pirfenidone
Oxygen
Lung transplant

110
Q

Which occupation get silicosis?

A

Stonemasons/ceramics

111
Q

‘Egg shell hilar calcification’

112
Q

Which occupation get byssinosis?

A

Cotton workers

113
Q

Which occupation get beryllosis?

A

Aerospace workers

114
Q

Which occupation get asbestosis?

A

Builders, plumbers, electricians etc

115
Q

What drugs may cause pulmonary fibrosis?

A

Nitrofurantoin, amiodarone, bleomycin, sulphasalazine

116
Q

What is the underlying cause of Extrinsic Allergic Alveolitis (EAA)?

A

Fungal spores/avian proteins producing a hypersensitivity reaction

117
Q

What is EAA also known as?

A

Bird fanciers lung, farmers lung

118
Q

How does EAA present acutely?

A

4-6 hours post exposure - rigors, fever, sob

119
Q

How is EAA treated?

A

Avoid trigger
Oxygen
Oral prednisolone (acute)
Long term steroids if chronic

120
Q

What other medical conditions may cause ILD?

A

Rheumatoid arthritis, SLE, sjogrens, UC

121
Q

What is sarcoidosis?

A

Multisystem granulomatous disease of unknown cause

122
Q

How does sarcoidosis affect the lungs?

A

Bilateral hilar lymphadenopathy, infiltrates, fibrosis, non-caseating granulomas, restrictive spirometry

123
Q

What is pneumothorax?

A

Air in the pleural space

124
Q

What are the causes of a pneumothorax?

A

Spontaneous, trauma, asthma, COPD, TB, pneumonia, abscess, cancer, CD, CPAP, Marfans, Ehlers-Danlos

125
Q

What are clinical features of pneumothorax?

A

SOB, pleuritic chest pain, reduced chest expansion, hyper-resonance, diminished breath sounds

126
Q

What are the investigations for pneumothorax?

127
Q

How is an asymptomatic primary pneumothorax that is less than 2cm managed?

A

Discharge from hospital

128
Q

How is a symptomatic primary pneumothorax managed?

A

Aspiration

129
Q

How is a primary pneumothorax that is bigger than 2cm managed?

A

Aspiration

130
Q

How is a secondary asymptomatic pneumothorax that is 0-1cm managed?

A

Oxygen + admit

131
Q

How is a secondary asymptomatic pneumothorax that is 1-2cm managed?

A

Aspiration

132
Q

How is a secondary symptomatic/>2cm pneumothorax managed?

A

Chest drain

133
Q

What is a primary pneumothorax?

A

One that occurs without underlying lung pathology

134
Q

What is a secondary pneumothorax?

A

One that occurs with underlying lung pathology

135
Q

How is aspiration performed?

A

14G cannula in 2nd intercostal space midclavicular line

136
Q

How is a chest drain inserted?

A

5th intercostal space, mid axillary line

137
Q

What is a tension pneumothorax?

A

Potentially life threatening pneumothorax where the air is drawn into the pleural space but is not returned on expiration - ‘one way valve’

138
Q

What clinical features are seen with a tension pneumothorax?

A

Deviated trachea away from the side, tachycardia, hypotension, distended neck veins, raised JVP

139
Q

What is the management of a tension pneumothorax?

A

Needle decompression & a chest drain

140
Q

What is pleural effusion?

A

Fluid in the pleural space

141
Q

What criteria can be used to classify pleural effusion?

A

Lights criteria

142
Q

What is a transudate pleural effusion?

A

<30g/L protein content

143
Q

What is an exudate pleural effusion?

A

> 30g/L protein content

144
Q

What is a haemothorax?

A

blood in the pleural space

145
Q

What is pus in the pleural space called?

146
Q

What are the main causes of transudate pleural effusions?

A

Heart failure, pericarditis, fluid overload, cirrhosis, nephrotic syndrome, hypothyroidism, Meigs syndrome

147
Q

What are the main causes of exudative pleural effusions?

A

Infection, inflammation, malignancy

148
Q

What symptoms do pleural effusions cause?

A

Dyspnoea, non productive cough

149
Q

What signs do pleural effusions cause?

A

Decreased expansion, stony dull percussion note, reduced breath sounds, tracheal deviation AWAY from effusion

150
Q

What may be seen on a CXR in pleural effusion?

A

Blunting of costophrenic angles

D sign in empyema

151
Q

What investigations should you do for pleural effusion?

A

CXR

Pleural aspirate

152
Q

How is a pleural aspirate performed?

A

21G needle + 50ml syringe under USS

153
Q

What should you check the fluid for in a pleural aspirate?

A

pH, protein, LDH, cytology, microbiology

154
Q

How is pleural effusion managed?

A

Chest drain (<2L/24hrs)

Finals Revision (22 decks)

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