Respiratory Flashcards
How many lobes are there in the right lung?
3
Main bronchus wider and more vertical
What is the pattern of lung function tests in normal lungs?
FEV1 >80% predicted
FVC >80%
FEV1:FVC 75-80%
What is the pattern of lung function tests in restrictive lung disease?
FEV1 <80%
FVC <80%
FEV1:FVC >70%
What is the pattern of lung function tests in obstructive lung disease?
FEV1 <80%
FVC normal or low
FEV1:FVC <70%
What are some causes of restrictive lung disease?
Fibrosis, sarcoidosis, pneumonia, CTF, effusion, kyphoscoliosis
What are some causes of obstructive lung disease?
Asthma, COPD, bronchiectasis, cystic fibrosis
What are the commonest organisms in CAP?
Streptococcus pneumoniae
Haemophilius influenzae
What are some causes of aspiration pneumonia?
Stroke, myasthenia, bulbar palsies, reduced consciousness, oesophageal disease
What are some examination findings in pneumonia?
Reduced expansion Dull percussion Increased vocal fremitus Bronchial breathing Pleural rub
What investigations should be done in pneumonia?
FBC, U&E, LFT, CRP, ABG
CXR
Sputum culture
Urine - legionella and pneumococcal antigens
What is in the CURB score?
Confusion Urea >7mmol/L Resp rate >30 BP <90 systolic or <60 diastolic 65 years
What are some clinical features of legionella pneumonia and how is it treated?
Flu like symptoms then dry cough & dyspnoea
Anorexia, D&V, hepatitis, renal failure, confusion
Fluoroquinolone
What are some clinical features of chlamoydophila pneumonia?
Biphasic illness
- Pharyngitis, otitis, hoarseness
- Pneumonia
What are some complications of pneumonia?
Type 1 respiratory failure Hypotension Atrial fibrillation Pleural effusion Empyema Lung abscess Myocarditis and pericarditis
What is the triad of Kartagener syndrome?
Primary ciliary dyskinesia
Situs inverts
Frontal sinus abnormalities
What are the symptoms and signs of bronchiectasis?
Persistent cough, copious purulent sputum, intermittent haemoptysis
Finger clubbing, coarse inspiratory crepitations
What investigations should be done for bronchiectasis?
Sputum culutre
CXR - cystic shadows, thickened bronchial walls, tramline &ring shadows
HRCT
Spirometry
What are some features of small cell lung tumours?
Neuroendocrine cells
Central location - smokers
Grow fast
Cause paraneoplastic syndromes
What are some different types of non-small cell lung tumours?
Adenocarcinoma - peripheral
SCC - central, smoking, PTH release
Carcinoid
Large cell
What does ACTH release from small cell tumours cause?
Increased cortisol
Cushing’s and immunosuppression
What does autoantibodies release from lung tumours cause?
Lambert-Eaton myasthenic syndrome
Type 2 hypersensitivity
Gait difficulty, autonomic involvement, hyporeflexia
What does PTH-related protein release from lung tumours cause?
Ca released from bones
Weak bones and hypercalcaemia
What does ADH release from lung tumours cause?
Water retention
Bloating, oedema, hypertension
Increased urinary sodium
What different things can aspergillus cause?
Asthma Allergic bronchopulmonary aspergillosis Aspergilloma Invasive aspergillosis Extrinsic allergic alveolitis
What is the pathophysiology of asthma?
- Bronchial muscle contraction
- Mucosal swelling/inflammation
- Increased mucus production
What are some features of severe asthma?
Inability to complete sentences
RR >25
PEF 33-50%
What are some features of life-threatening asthma?
Silent chest, confusion, exhaustion, cyanosis
SpO2 <92%
Increased CO2
PEF <33%
What are some complications of COPD?
Acute exacerbations Polycythaemia Respiratory failure Cor pulmonale Pneumothorax Lung carcinoma
What are the criteria for long term O2 therapy?
Stable non-smokers PaO2 <7.3
PaO2 7.3-8 + pulmonary HTN/oedema/polycythaemia
Terminally ill patients
What is acute respiratory distress syndrome?
Lung damage and inflammatory mediators caused by direct lung injury or secondary to severe systemic illness
What are some causes of ARDS?
Pneumonia, aspiration, vasculitis
Sepsis, DIC, pancreatitis, ALF
What are some diagnostic criteria for ARDS?
Acute onset
CXR - bilateral infiltrates
PCWP <19mmHg or no heart failure
Refractory hypoxaemia
What are some causes of type 1 respiratory failure?
Pneumonia, PE, asthma, emphysema, fibrosis, ARDS
What are some causes of type 2 respiratory failure?
COPD, obstructive sleep apnoea, CNS tumour/trauma, myasthenia, GBS
What are symptoms and signs of a PE?
Acute breathlessness, pleuritic pain, haemoptysis
Tachypnoea, tachycardia, hypotension, raised JVP
What is the emergency management of PE?
O2 if needed Morphine and anti-emetic IV access and LMWH Fluid bolus if needed Long term anticoagulation
What are some causes of a pneumothorax?
Spontaneous, asthma, COPD, TB, carcinoma, Marfan’s, Ehler’s Danlos
What is a transudate and what causes it?
Low protein effusion due to increased venous pressure or hypoproteinaemia
heart failure, cirrhosis, nephrotic syndrome
What is an exudate and what causes it?
Effusion due to leaky pleural capillaries
Infection
Inflammation - RA, SLE
Malignancy
What are the lab values for an exudate?
Protein >35g/L
Effusion: serum protein >0.5
Effusion: serum LDH >0.6
What is sarcoidosis?
A multisystem granulomatous disorder
What are the acute signs and symptoms of sarcoidosis?
Fever, erythema nodosum, polyarthalgia, bilateral lymphadenopathy
What are the pulmonary manifestations of sarcoidosis?
Dry cough, dyspnoea, reduced exercise tolerance
BHL +/- fibrosis/infiltrates
What are the non-pulmonary manifestations of sarcoidosis?
Lymphadenopathy, hepato-splenomegaly
Uveitis, conjunctivitis, glaucoma
Bell’s palsy, neuropathy, SOL
Cardiomyopathy, arrhythmias
What is the treatment of sarcoidosis?
Acute - bed rest and NSAIDs
May need steroids to induce remission
What are some causes of interstitial lung disease?
Asbestosis
Amiodarone, sulfasalazine, nitrofurantoin
Sarcoidosis, RA, SLE, CTD, Sjogren’s
Idiopathic
What are the symptoms and signs of idiopathic pulmonary fibrosis?
Dry cough, exertion dyspnoea, malaise, cyanosis, finger clubbing, end inspiratory crepitations
