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Phase 3 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Outline some key clinical differences between asthma and COPD:

A

COPD:

  • smokers
  • rare <35 years
  • Chronic cough is common
  • Persistent shortness of breath
  • Night symptoms are uncommon
  • variability in symptoms is minimal

Asthma is the opposite to all these.

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2
Q

In FBC of COPD what would you expect too see?

A

polycaethemia

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3
Q

What two infections commonly cause exacerbation of COPD?

A

H. Influenza

S. Pneumonia

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4
Q

What are some common sites that mesotheliomas have metastasised from?

A

Ovary

breast

Lymphomas

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5
Q

Define Allergy:

A

An immune intolerance mediated by the immune system to a particular trigger.
there must be recognition and a response

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6
Q

What is a stridor indicative of?

A

Inspiration difficulty

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7
Q

Define asthma:

A

Chronic inflammatory condition of the airways that causes recurrent episodes of wheezing, breathlessness and chest tightening.
- partially reversibly

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8
Q

List come clinical features of asthma:

A 
Wheeze 
cough 
sputum is clear 
breathlessness
exercise intolerance
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9
Q

How is asthma diagnosed?

A

Diary of peak flow

Histamine bronchial Provocation Test
- 20% drop in FEV1

Spirometry

Scratch test

Sputum
- Eosinophil infiltrate

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10
Q

List asthma management:

A

Stage I: SABA

Stage II: ICS + SABA

Stage III: ICS + LABA + SABA 
or 
LRA 
or
theoyphyline 
or 
B2 agonist tablet (not <12 years old)

Stage IV: high dose ICS + dialators
+
Antimuscarinic (ipatropium)

Stage V: Oral steroids

+

omalizumab
Mepolizumab
Infliximab

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11
Q

Definition of life threatening asthma attack?

A

PEF: <33%
SpO2 <92%

Reduced breath sounds

<

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12
Q

Definition of severe asthma attack:

A

Inability to complete full sentences

PEF: 33-50%
REspiratory rate> 25

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13
Q

Management of severe asthma attack:

A

Oxygen: 40-60%

Nebulised: salbutamol 5mg
or
Terbutaline 10mg

Prednisolone 40-50mg
or
IV hydrocortisone 100mg

failure in 15-30mins:

  • senior help
  • contact ICU

IV magnesium 1.2g over 20mins

IV salbutamol

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14
Q

what is the subsequent management of severe asthma attack?

A

Sats: 94-98%

steroids - 6 hourly

Nebulised B2 4-6 hourly

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15
Q

When can a person be discharged after a severe asthma attack?

A

24 hour use of medicine with no reductionin PEF.

PEF >75%

Oral and inhaled steroids to be given

Arrangement with GP in 2 days

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16
Q

What is hypersensitivity pneumonitis

A

Restrictive lung disease characterised by widespread inflammation affecting small airways and alveoli

caused by known allergen.

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17
Q

Outline pathophysiology of Hypersensitivity pneumoitis

A

first exposure:
Type IV hypersensitivity reaction:
IL12
IFN gama

activation of TH1 cell

Second exposure:

Type III hypersensitivity reaction
reactivation of antibodies.

fibrosis scarring.
complement activation.

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18
Q

Symptoms of hypersensitivity pneumonitis:

A

Fever
malaise
cough
- after the exposure a few hours later

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19
Q

What is the criteria for obstructive sleep apnea?

A

The cessation or near cessation of airflow.

> 4% oxygen desaturation lasting >10secs

> 15 episodes of Apnea per hour. (AHI>15)
or
5-15 episodes with compatible symptoms

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20
Q

Symptoms of sleep apnea?

A

Snorer

Disruptive sleep

Daytim Somnolence

Fatigue

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21
Q

What score can be used in sleep apnea to assess the the distance of the tongue from roof of mouth?

A

Mallampati score

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22
Q

Investigations into sleep apnea:

A

Epsworth sleeping score

Limited Polysomnography

Full Polysomnography

Transcutaneous Oxygen Sats

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23
Q

What are the two main differentials for sleep apnea?

A

Hyponoea:
- reduced oxygen flow but doesn’t meed criteria for sleep apnea

Respiratory effort related arousals

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24
Q

Define interstitial lung disease:

A

Umbrella term used to describe a group of disorders that lead to scarring lung and restrictive lungs

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25
Q

What are some key medications that can cause intersitial lung disease?

A
  • nitrofurantoin
  • DMARDS
  • Amiodarone
  • ACE inhibitors
  • Chemotherapy
  • Heroin/ methadone
  • Radiation treatment
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26
Q

When assessing for ILD what test should be done?

A

Chest x-ray

CRP - inflammatory marker

FBC

Immunology

  • rheumatoid factor
  • Serum ACE (for sarcoid)

ABGs

ECG

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27
Q

What is IPF?

A

Pulmonary disorder of unknown aetiology that is patchy progress bilateral interstitial fibrosis

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28
Q

Outline pathogenesis of IPF?

A

Damage to epithelial cells.

Macrophages and neutrophil infiltration

  • promote collagen formation
  • TGF- Beta

Alveolar epithelium become myoepithlelial cells
- laying down more collagen and leading to restriction

Type II pneumocyte activation, replacement of type I. promotes further inflammation

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29
Q

Clinical findings of IPF?

A

Velcro-like crackles durign inspiration

CT: Subpleural reticular abnormalities

  • honeycombing
  • ground glass appearance
30
Q

What is the histological appearance of IPF? and how is it done?

A

Done by Video- assisted thoracic surgery

  • histology: interstitial pneumonia pattern
  • dense fibrosis material in subpleura
  • destruction of normal lung
  • inflammatory infiltrate

with temporal heterogeneity

Fibroblastic Foci - myofibroblastic proliferation

31
Q

What is treatment options for IPF?

A

It is fatal.

Lung transplant needed.

Pirfenidone
- reduced fibrosis formation

Nintedanib
- tryosine kinase inhibitor

N- Acetyl cysteine
- mucus

Oxygen therapy

Antibiotics for infection

32
Q

When would you not aspirate a pleural effusion?

A

if bilateral.

- likely to be transudate

33
Q

What is Light’s criteria for pleural effusion?

A

Fluid >30g protein

Fluid Lactate dehydrogenase is 2/3rd upper limit of normal plasma

PLeural serum protein ratio >0.5

unilaterally

varying colour

34
Q

How can malignant pleural effusions be managed?

A

indwelling pleural catheter

35
Q

Whats the most common type of hypersensitivty pneumonitis, and what is the pathogen?

A

Farmer’s lung

micropolyspora faeni

36
Q

What investigations are done for COPD?

A

Spirometry with reversibility

Chest x-ray

  • hyperinfaltion
  • heart looks small

High resolution CT
- bullae

ABGs
- assess for respiratory failure

FBC
- polycaethemia

Alpha -1 antitrypsin

BMI < low associated with worse prognosis

Sputum
- for infections

ECG and Echo
- heart function

37
Q

Define emphysema:

A

Abnormal permenant enlargement of the airspaces distal to the terminal bronchioles

38
Q

What are the dyspnoea scale?

A

used to assess the level of breathlessness in COPD:

Grade 1: Dyspnoea on strenous activity

Grade 2: Dyspnoea when hurrying or walking up hill

Grade 3: walks slower than others on ground level cause of breathlessness

grade 4: stops for breathes every 100m at ground level

Grade 5: too breathless to leave house. Dressing makes breathless.

39
Q

What’s an important cytokine in the pathogenesis of IPF?

A

TGF - Beta

40
Q

What is the stain used to identified TB? and what is it staining?

A

Ziehl Neelsen staining

Acid fast bacteria, in TB specifically: Mycolic acid

41
Q

In TB, what is called when the granuloma forms, and then what is it called when this affects the lymph node aswell?

A

Ghon focus

Ghon complex

42
Q

If a patient presents with pneumonia, what microbiology tests should you carry out?

A

Respiratory samples:

  • sputum
  • viral PCR from gargle

Urine:
- Legionella - PCR

Blood cultures

MRSA screen

43
Q

In severe CAP, what is the recommended antibiotics?

A

IV Amoxicillin or IV co-amoxiclav
+
Clarithromycin

or

Levofloxacin if penicillin allergy

44
Q

Outwith air conditioners, where else can legionella come about?

A

compost (soil)

45
Q

Name another two types of Legionella infections:

A

Pontiac fever
- acute, self limiting febrile infection

Extra-pulmonary Legionella

  • seen in immunocompromised
  • myocarditis etc.
46
Q

Who is most likely to get Mycoplasma Pneumonia?

A

Young school children

47
Q

How is Chlamydia Psittaci spread?

A

Parrots

48
Q

What type of pneumonia often causes pleural effusions?

A

S. pneumonia

49
Q

What are the normal alleles for anti - trypsin and what are the pathological ones, and how do they relate too COPD?

A

MM - are normal

ZM - heterozygous - will get the disease if smoker

ZZ - homozygous - will get panoemphysema

50
Q

What investigations are done to assess COPD?

A

Spirometry - with reversibility

  • raised TLC
  • Reduced FEV/FVC >.70

Chest X-ray

Sputum analysis

ABGs
- hypoxic

FBC
- polycythemia

51
Q

When is it considered to be respiratory failure?

A

<8kPa of oxygen

> 6.7kPa of CO2

52
Q

Is an allergy dose dependent?

A

No it is not dose dependant - there is either a reaction or not a reaction.

unlike reactivity to stimulus, which is dose dependent

53
Q

What are extra- thoracic bronchial disease affected up?

A

In air problems because they have cartilage which maintains them open - allowing expiration

54
Q

When diagnosing asthma, using the histamine provocation test, what is the drop in the FEV1 we are looking for?

A

> 20%

55
Q

What is considered a small pneumothorax and what is the management of such a small pneumothorax?

A

<2cm. in healthy people will self heal

- monitor over 7 days

56
Q

If a pneumothorax is large, what is the size? and what is the management?

A

> 2cm

Aspiration of air

57
Q

In the setting of tension pneumothorax, what is the immediate management?

A

Don’t have time for imaging.

Large IV cannula - insert at 2nd intercostal space at midclavicular line

followed by Chest drain

58
Q

What are the treatment regimes for COPD?

A 
>50%
SABA +
a)LABA
b)LAMA 
c) LABA + LAMA 
d) LABA+ LAMA + ICS
<50% 
SABA+
a) LABA + ICS 
b) LAMA 
c) LABA + ICS + LAMA
59
Q

Define Obstructive sleep apnea and obstructive sleep apnea syndrome:

A

Obstructive sleep apnea = recurrent episodes of partial or complete upper airway obstruction with intermittent hypoxia

Syndrome = manifests as the daytime sleepiness
thus if a person has daytime somnolence then they have syndrome time.

60
Q

What are the main issues associated with OSA?

A

Heart attack and Strokes

61
Q

Whats the symptoms of OSA?

A

Snorer

Witnessed of apnoeas

Disruptive sleep

Daytime somnolence

Low mood

62
Q

What clinical examination do you do of someone with OSA?

A

Weight
BMI
BP
Neck circumference

Epworth Sleepiness Score

Home Limited polysomnography

FUll Polysomnography

Transcutaneous Oxygen Saturation and Carbon Dioxide Assessment

63
Q

Whats the advantages of the Full polysomnography?

A

Correct patient

Accurate assessment of sleep

EEG

Parasomniac activity - sleep talking, REM

64
Q

What is severe Sleep apnea?

A

AHI >30

65
Q

Who do you treat in sleep apnea?

A

Obstructive sleep apnea syndrome. i.e. you treat those who have symptoms.
with aim to improve day somnolence and improve quality of life.

66
Q

What is the treatment of sleep Apnea?

A

Weight loss

Avoiding triggers - alcohol

Continual positive airway pressure - forces airway opens

67
Q

What can be used if a patient can’t tolerate CPAP?

A

Mandibular mouth guard
- pulls the jaw forward

only useful in mild to moderate disease

68
Q

In hypersensitivity pneumonitis, where is the inflammation?

A

within the alveolar

69
Q

List some key findings histological findings of IPF:

A

Interstitial Pneumonia

fibroblastic focuses

Heterogeneous in nature - varying areas affected.

70
Q

In asthma outline the main cytokines and described what they do:

A

Il-4 = activation of Th2

IL 5 = Eosinophils

Il 13 = activates mucus secretion

LT4 = stimulus to the neutrophil and smooth muscle

Phase 3 (50 decks)

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