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Phase 2a - conditions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is COPD?

A

Chronic obstructive pulmonary disease - a group of lung disorders that cause airflow obstruction, not fully reversible.

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2
Q

What is the pathophysiology of COPD?

A

Emphysema

Chronic bronchitis

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3
Q

What is emphysema?

A

Abnormal, permanent enlargement of alveoli. Air cannot be effectively expelled out.

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4
Q

What is chronic bronchitis?

A

Inflammation of the airways leading to mucous production, lymphocyte invasion, scarring and fibrosis.

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5
Q

What type of respiratory failure does COPD result in?

A

Type 2

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6
Q

What are some of the causes of COPD?

A

Smoking
Occupational dust/chemical exposures
Pollution
Cystic fibrosis

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7
Q

What are the pathophysiological obstructive mechanisms in COPD?

A

Loss of elasticity
Inflammation and scarring
Mucous secretion

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8
Q

What are the symptoms of COPD?

A

Cough with sputum
Wheeze
Dyspnoea
Tired and lack of energy

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9
Q

What are the signs of COPD?

A

Raised BP
Use of accessory muscles
Hyperinflation - barrel chest
Frequent infections

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10
Q

What is the mechanism of the ‘pink puffer’ in COPD?

A

Increased alveolar ventilation, normal oxygen, normal/low CO2, not cyanosed, breathless –> due to emphysema

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11
Q

What is the mechanism of the ‘blue bloater’ in COPD?

A

Decreased alveolar ventilation, low oxygen, high CO2, cyanosed –> due to chronic bronchitis

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12
Q

What is the FEV/FVC ratio post bronchodilator to diagnose COPD?

A

<0.7

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13
Q

What investigations should be carried out in COPD?

A

Spirometry
Chest X-Ray
DLCO

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14
Q

What does a chest X-Ray show in COPD?

A

Hyperinflation, depressed diaphragm.

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15
Q

What does a DLCO test show?

A

The extent to which CO2 is diffusing in and out of alveoli.

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16
Q

What are the differential diagnoses for COPD?

A

Heart failure
Pulmonary embolism
Pneumonia
Asthma

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17
Q

What is the general lifestyle advice for COPD?

A

Smoking cessation
Physical activity
Flu vaccine - to avoid exacerbations
Pulmonary rehabilitation

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18
Q

What pharmacological therapies are available in COPD?

A

2 - Long acting muscarinic antagonists or long acting beta agonists.
3 - Long acting beta agonist and inhaled corticosteroid
4 - long acting beta agonist and ICS and short acting muscarinic antagonist.

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19
Q

What is an example of a short acting muscarinic antagonist?

A

Ipratropium

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20
Q

What is an example of a long acting muscarinic antagonist?

A

Tiotropium

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21
Q

What is an example of a short acting beta agonist?

A

Salbutamol

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22
Q

What is an example of a long acting beta agonist?

A

Salmeterol

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23
Q

What are the target oxygen sats for a patient

A

88-92%

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24
Q

What is the difference between asthma and COPD?

A

COPD is not as variable
COPD has a later age of onset typically
COPD has a more relentless progression
COPD is not fully reversible unlike asthma

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25
Q

What is asthma?

A

A reversible cause of obstructive airways disease due to bronchial hypersensitivity.

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26
Q

What respiratory failure does asthma cause?

A

Type 1

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27
Q

What is the pathophysiological basis of allergic asthma?

A

Type 1 hypersensitivity reaction resulting in an IgE inflammatory response - leading to bronchoconstriction and smooth muscle contraction.

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28
Q

What are the two types of asthma?

A

Allergic (eosinophilic)

Non-allergic

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29
Q

What are conditions associated with asthma? Why?

A

Hayfever, aczema. These are other atopic conditions, which often occur together.

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30
Q

What are the exacerbating features of asthma?

A

Cold
Exercise
Allergens
Infection

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31
Q

What are the symptoms of asthma?

A

Intermittent dyspnoea
Wheeze
Cough (often nocturnal)
Often worse in the morning (diurnal variation)

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32
Q

What are the signs of asthma?

A 
Other atopic disease 
Raised RR
Audible wheeze 
Decreased air entry 
Precipitated by triggers
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33
Q

How do you investigate chronic asthma?

A 
Spirometry 
Peak flow monitoring 
Chest X-Ray 
Skin prick tests 
Exhaled nitric oxide test
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34
Q

What does spirometry show in asthma?

A

FEV/FVC <0.7

>15% increase in FEV post bronchodilator

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35
Q

What do peak flow tests show in asthma?

A

Diurnal variation >20%

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36
Q

What does an exhaled nitric oxide test show in asthma?

A

Increased amount of exhaled nitric oxide due to the inflammation of the airways.

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37
Q

What investigations should be carried out in chronic asthma?

A

Peak flow
Cultures
ABG

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38
Q

What is a sign that respiratory failure is occurring in an acute asthma attack?

A

Normal or raised CO2 - hyperventilation would usually produce a low CO2 level.

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39
Q

What are the differential diagnoses of asthma?

A

Pulmonary oedema
COPD
Large airways obstruction

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40
Q

What general advice should be given to an asthmatic patient?

A

Smoking cessation

Avoid allergens and triggers

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41
Q

What is the pharmacological ladder of treatment for asthma?

A 
1 - SABA 
2 - SABA + ICS (+/- leukotriene)
3 - SABA + ICS + LABA 
4 - Increase dose of steroid 
5 - Consider biologics
6 -  Oral steroid 
Move onto next stage of 3/4 time a week.
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42
Q

What is the action of beta agonists? What are their side effects?

A

Relax bronchial smooth muscle.

Tachycardia, tremor, anxiety, hypokalaemia

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43
Q

What is an example of an inhaled corticosteroid? What is its action?

A

Beclometasone.

Reduce bronchial inflammation.

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44
Q

What are the side effects of long term steroid use?

A

Osteoporosis, adrenal suppression, cataracts

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45
Q

What are the requirements for an acute asthma attack?

A

Peak flow 33-50%
RR > 25
HR > 110
Can’t complete sensible

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46
Q

What are the requirements for a life threatening asthma attack?

A

Peak flow < 33%
O2 < 92%
Altered consciousness

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47
Q

What is the treatment for an acute asthma attack?

A

Salbutamol
Prednisolone
Oxygen - according to sats
MONITOR closely

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48
Q

What is hypersensitivity pnuemonitis?

A

Inflammation of small airways and alveoli caused by an allergic reaction to an inhaled allergen.

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49
Q

What is the pathogenesis of hypesensitivity pneumonitis?

A

Chronic inflammation
Interstitial granulomas
Interstitial fibrosis

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50
Q

Give 3 examples of hypersensitivity pneumonitis?

A

Farmer’s lung - from mouldy hay
Bird fancier’s lung - handling pigeons
Maltworker’s lung

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51
Q

What are the symptoms of hypersensitivity pneumonitis?

A

Malaise
Dyspnoea
Cough
Weight loss

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52
Q

What are the signs of hypersensitivity pneumonitis?

A

Inspiratory squeaks

Bilateral fine crackles

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53
Q

What investigations can be carried out in suspected hypersensitivity pneumonitis?

A

Chets X-Ray
Lung function tests
Serum antibodies

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54
Q

What type of airways disease foe hypersensitivity pneumonitis cause?

A

Restrictive

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55
Q

What are the differential diagnoses of hypersensitivity pneumonitis?

A

Asthma

Interstitial lung disease

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56
Q

What is the management of hypersensitivity pneumonitis?

A

Avoid exposure

Steroids

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57
Q

What are the lung conditions that can be included in occupational lung disorders?

A 
Bronchitis 
Fibrosis 
Occupational asthma 
Hypersensitivity pneumonitis 
Carcinoma
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58
Q

What type of materials can cause occupational lung diseases?

A

Dusts
Vapours
Fumes

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59
Q

Give an example of materials that can cause occupational lung disease?

A

Silicon

Asbestos

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60
Q

What is bronchiectasis?

A

Irreversible dilatation of bronchioles due to recurrent damage.

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61
Q

What are possible causes of bronchiectasis?

A

Tuberculosis
Obstructions
Complication from other conditions - cystic fibrosis, COPD

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62
Q

What is the pathophysiology of bronchiectasis?

A

Damage to the airways causes scarring and inflammation. Result in airways widening, excess mucous production.

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63
Q

What are the symptoms of bronchiectasis?

A

Persistent cough
Large sputum production
Dyspnoea
Haemoptysis - due to infection.

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64
Q

What are the possible signs of bronchiectasis?

A

Course crackles on auscultation

Clubbing of fingers

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65
Q

What is a complication of bronchiectasis?

A

Recurrent infections - due to less clearance of the airways.

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66
Q

What investigations can be carried out in bronchiectasis?

A

CT

Chest X-Ray

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67
Q

What is the general lifestyle advice in bronchiectasis?

A

Smoking cessation
Vaccinations - to minimise future infection risk
Chest physiotherapy

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68
Q

What are the pharmacological management options in bronchiectasis?

A

Antibiotics

Steroids

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69
Q

What are the possible complications of bronchiectasis?

A

Pneumonia
Pleaural effusion
Pneumothorax
Haemoptysis

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70
Q

What is the inheritance of cystic fibrosis?

A

Autosomal recessive

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71
Q

What is the genetic mutation in cystic fibrosis?

A

CF transmembrane protein of chromosome 7 mutation

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72
Q

What is the pathophysiology of cystic fibrosis?

A

CFTR protein is a chloride channel, a mutation results in low chloride secretion and increased sodium absorption. This causes thick mucous to clog ducts.

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73
Q

What areas of the body does cystic fibrosis primarily affect?

A

Respiratory

Gastrointestinal

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74
Q

What are the respiratory symptoms of cystic fibrosis?

A

Wheeze
Cough
Recurrent infections
Bronchiectasis

75
Q

What are the gastrointestinal symptoms of cystic fibrosis?

A

Pancreatic insufficiency
Gallstones
Steathorrea

76
Q

What are the investigations for cystic fibrosis?

A

Sweat test - sodium and chloride >60mmol/l
Genetic screening
Feacal elastase - a marker of pancreatic dysfunction

77
Q

What is the management of cystic fibrosis?

A 
Physiotherapy to aid airways clearance 
Antibiotics for exacerbations 
Mucinlytics to air clearance 
Bronchodilators. 
Pancreatic enzyme replacement
78
Q

What is a pleural effusion?

A

Accumulation of fluid in the pleural space

79
Q

What are the two type of fluids that can accumulate in a pleural effusion?

A

Transudate

Exudate

80
Q

What is a transudate fluid?

A

Low protein <25g/l

81
Q

What is an exudate fluid?

A

High protein >35g/l

82
Q

What are the causes of a transudate fluid build up in pleural effusion?

A

Increased venous pressure - cardiac failure, constrictive pericarditis.
Hypoprotienaemia - cirrhosis, nephrotic syndrome

83
Q

What are the causes of an exudate fluid build up in pleural effusion?

A

Damage to the pleura -
Pneumonia
TB
Cancer

84
Q

What are the symptoms of pleural effusion?

A

Dyspnoea

Pleuritic chest pain

85
Q

What are the signs of a pleural effusion?

A

Decreased expansion on the affected side
Stony, dull percussion
Diminished breath sounds.

86
Q

What investigations can diagnose a pleural effusion?

A

Chest X-Ray - white shows fluid (if dense so absorbs)

Diagnostic aspiration to examine the pleural fluid.

87
Q

What is the management of a pleural effusion?

A

Drainage.

If very recurrent - pleurodesis can glue layers together and stop collection.

88
Q

What other types of fluid can be found in a pleural effusion?

A

Blood - haemothorax
Pus - empyema
Chyle - chylothorax

89
Q

What is a pneumothorax?

A

An accumulation of air in the pleural space

90
Q

Why does a pneumothorax cause the lung to deflate?

A

Pressure in the pleural space is usually negative to keep the lung inflated. If air enters then it is no longer negative and the elastic recoil of the lung causes it to deflate.

91
Q

What are the causes of a pneumothorax?

A

Trauma
Spontaneous rupture of a ab-pleural bulla
Secondary lung damage - COPD, asthma, TB

92
Q

What are the symptoms of a pneumothorax?

A 
Sudden onset
Dyspnoea 
Pleuritic chest pain 
Worse breathing in 
Onse sided.
93
Q

What are the signs of a pneumothorax?

A

Reduced expansion on the affected side
Hyper-resonance on percussion of affected side
Diminished breath sounds of affected side.

94
Q

What investigation can diagnose a pneumothorax and what does it show?

A

Chest X-Ray - black areas show air presence (low density so rays pass through)

95
Q

What is the management of a pneumothorax?

A

If small and spontaneous - can often self heal
Aspiration
Chets drain

96
Q

What is a tension pneumothorax?

A

A pneumothorax in which air can only move from the lung to pleural space (ie. the hole acts as a one way valve).

97
Q

What is the pathophysiology of a tension pneumothorax?

A

Air accumulated rapidly in the pleural space, trachea begins to deviate towards collapsed lung. There is a risk of vein compression.

98
Q

What is the management for tension pneumothorax?

A

Chest drain ASAP.

99
Q

How are lung cancers divided?

A

Small cell

Non-small cell

100
Q

Are lung small cell or non-small cell cancers more common?

A

Non-small cell

101
Q

What is a characteristic feature of small cell lung cancer presentation?

A

Usually present with a very high grade - mestastatic

102
Q

What are the types of non-small cell lung cancers?

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma

103
Q

What is the most common location for a lung cancer?

A

Bronchus

104
Q

What are the causes of lung tumours?

A

Cigarette smoke
Asbestos
Radon
Nickel

105
Q

What are the symptoms of a bronchial carcinoma?

A 
Cough 
Haemoptysis 
Dyspnoea 
Chest pain 
Recurrent infections
106
Q

What are the signs of bronchial carcinoma?

A

Weight loss
Anaemia
Finger clubbing
Supraclavicular/axillary node enlargement.

107
Q

What are the investigations for lung cancer?

A

Chest X-Ray
Cytology of sputum
Bronchoscopy
Biopsy

108
Q

What determines the treatment of lung cancer?

A

Tumour type and grade?

109
Q

What are the treatment options for non-small cell tumours?

A

Low grade - excision or curative radiotherapy

High grade - chemotherpy

110
Q

What are the treatment options for small cell tumours?

A

Nearly always metastatic at presentation so usually palliative management.

111
Q

What are the differential diagnoses for a lung nodule on chest X-Ray?

A 
Malignancy 
Abscess
Granuloma 
Cyst 
Foreign body
112
Q

What are the common primary site for lung metastases to originate from?

A

Kidney
Prostate
Breast
Bone

113
Q

What is a mesothelioma?

A

Cancer of the pleura

114
Q

What is the most common cause of a mesothelioma?

A

Asbestos

115
Q

What is the management of a mesothelioma?

A

Often present at a very late stage - so mostly palliative.

116
Q

What in pneumonia?

A

Inflammation of the lungs due to infection?

117
Q

What are the four different classifications of pneumonia|?

A

Community-acquired
Hospital-acquired
Aspiration
Immunocomprimised patients

118
Q

What is the commonest causative organism of pneumonia?

A

Streptococcus pneumonia

119
Q

What is the appearance of strep. pneumonia on gram stain?

A

Gram positive diplococci

120
Q

What are the most common causes of hospital acquired pneumonia?

A

Gram negative enterobacteria - E.coli, salmonella, shigella, klebsiella, proteus.
Staph aureua.

121
Q

What is a more unusual cause of pneumonia?

A

Legionellas

122
Q

What are the symptoms of pneumonia?

A 
Fever 
Rigors 
Malaise 
Dyspnoea 
Cough 
Haemoptysis 
Pleuritic pain
123
Q

What are the signs of pneumonia?

A 
High temperature (pyrexia)
Tachycardia 
High respiratory rate 
Confusion 
Hypotension 
Diminished expansion 
Pleural rub.
124
Q

What investigations should be carried out in pneumonia?

A

Chest X-Ray

Sputum culture and microscopy to find organism.

125
Q

What is the system used to grade the severity of pneumonia?

A 
Confusion 
Urea >7
Respiratory rate >30
BP <90/<60
Age >65
CURB65
126
Q

What does the CURB65 score mean to a patients treatment?

A

Higher score = higher mortality
Score 1 - outpatient
Score 2 - hospital inpatient
Score 3 - hospital and consider ITU

127
Q

What is the supportive treatment required in pneumonia?

A

IV fluids
Oxygen
Analgesia

128
Q

What are the standard antibiotic therapies for community acquired pneumonia?

A

Mild - oral amoxicillin
Moderate - oral amoxicillin and clarithromycin
Severe - IV co-amoxiclav and clarithromycin

129
Q

What is the antibiotic treatment for Legionellas?

A

fluoroquinolone and clarithromycin

130
Q

What is the antibiotic treatment for S. aureus?

A

Flucloxacillin

131
Q

Who should be offered the pneumococcal vaccine?

A

Vulnerable groups - >65, chronic conditions, diabetes.

132
Q

What are the possible complications of pneumonia?

A 
Pleural effusion 
Lung abscess
Respiratory failure 
Septicaemia 
Hypotension
133
Q

What is the causative organism of tuberculosis?

A

Mycobacterium tuberculosis

134
Q

How is TB detected?

A

Ziehl-Neelson stain - shows as an acid fast bacilli

135
Q

How is TB spread?

A

Aerosol from an effected individual - cough/spit etc.

Bovine TB from cows milk

136
Q

When first infected with TB what are the possible outcomes?

A

Primary TB develops in 5%

The TB lies latent

137
Q

What occurs in primary TB?

A

Granulomas develop - mostly in the lung apex = primary focus.
Mediastinal lymph nodes enlarge

138
Q

What is the primary (Ghon) complex?

A

Primary focus and mediastinal lymph node enlargement.

139
Q

What are the general symptoms of active tuberculosis?

A

Weight loss
Night sweats
Fever
Fatigue

140
Q

What are the respiratory symptoms of active tuberculosis?

A

Persistent cough
Chest pain
Haemoptysis

141
Q

What are the extra-pulmonary symptoms of active tuberculosis?

A

Lymph node swelling
Bone pain and swelling
Meningitis

142
Q

What is miliary TB?

A

Granulomata everywhere!

143
Q

How may a Chest X-Ray suggest TB?

A

Cavitation
Fibrosis
Calcification

144
Q

How do you diagnose active TB?

A 
Sputum samples (>3) microscopy and culture
If extra pulmonary try pleura, urine, ascites, peritoneum etc.
145
Q

What does a blood test show in active tuberculosis?

A

Anaemia, raised platelets, raised ESR and CRP, decreased albumin.

146
Q

How do you diagnose latent TB?

A

Mantoux test - skin response test to Tb antigen, shows a memory to TB (ie, a previous infection has been experienced.

147
Q

What are the downfalls of the Mantoux test?

A

Will be positive if had the BCG vaccine.

Will be positive even if the infection is completely eradicated - could lead to unnecessary treatment.

148
Q

What is the standard treatment for active TB?

A 
Rifampicin 
Isoniazid
Pyrazinamide
Ethambutol 
2 months of all 4 and 4 more months of RI only.
149
Q

What is a side effect of Rifampicin?

A

Red urine

150
Q

What is a side effect of Isoniazid?

A

Peripheral neuropathy

151
Q

What is a side effect of Pyrazinamide?

A

Hepatitis

152
Q

What is a side effect of Ethambutol?

A

Optic neuritis

153
Q

Why is adherence critical in treatment of TB?

A

If not then resistant TB may develop and this is much harder to treat.

154
Q

What is the treatment regime for latent TB?

A

6mo isoniazid or 3mo isoniazid and rifampicin.

155
Q

What must also occur on a diagnosis of tuberculosis?

A

Notification of public health england.

156
Q

What can be done to reduce TB?

A

BCG vaccine to newborns

Contact tracing of TB contacts.

157
Q

What organism causes whooping cough?

A

Bordatella pertussis

158
Q

How is influenza transmitted?

A

Aerosol - coughs and sneezes.

159
Q

What causes seasonal epidemics of influenza?

A

Antigenic drift

160
Q

What causes pandemics of influenza?

A

Antigenic shift

161
Q

What is the definition of respiratory failure?

A

Inability of the lungs to adequately oxygenate arterial blood and/or eliminate CO2 from venous circulation.

162
Q

What is type 1 respiratory failure?

A

PaO2 < 8kPa

Normal/low CO2

163
Q

What is type 2 respiratory failure?

A

PaO2 <8kPa

PaCO2 >6kPa

164
Q

What are the causes of respiratory failure?

A 
Decreased FiO2 
V/Q mismatch - asthma, pneumonia, PE etc. 
Increased shunt
Diffusion impairment 
Alveolar hypoperfusion
165
Q

What is the primary cause of type 2 respiratory failure?

A

Alveolar hypoperfusion - ie. obstruction, COPD, sleep apnoea.

166
Q

What are the signs of type 1 respiratory failure?

A 
Cyanosis 
Tachypnoea
Use of accessory muscles 
Tachycardia 
Confusion
167
Q

What are the signs of type 2 respiratory failure?

A 
Think hypercapnia 
Bounding pulse 
Flapping tremor 
Confusion 
Drowsiness
Reduced consciousness
168
Q

What is the treatment of type 1 respiratory failure?

A

Target O2 94-98%
Treat cause
If this does not work - CPAP

169
Q

What is the treatment of type 2 respiratory failure?

A

O2 target 88-92%
Medication for 1 hour - bronchodilators, steroids
Not worked - ventilate

170
Q

Why are O2 target sats lower in type 2 respiratory failure?

A

Drive to breathe has changed from carbon dioxide to oxygen, so may reduce the hypoxic drive if it rises too high.

171
Q

What is the cause of a pulmonary embolism?

A 
Deep vein thrombus 
RV thrombus 
Tumour 
Fat 
Foreign material - IVDU
172
Q

What are the risk factors for pulmonary embolism?

A

Recent surgery
Leg fracture
Immobility
Malignancy

173
Q

What is dead space?

A

When alveoli are perfused but not ventilated - the V/Q ratio is large/infinite.

174
Q

What are the symptoms of a pulmonary embolism?

A

Sudden onset dyspnoea
Pleuritic chest pain
Haemoptysis

175
Q

What are the signs of pulmonary embolism?

A

Pyrexia
Cyanosis
Tachypnoea
Tachycardia

176
Q

What are the investigations for a pulmonary embolism?

A

Blood tests
Chest X-Ray
ABG
serum D-dimer - NOT specific (rises in inflammation and infection)

177
Q

What is the management of a pulmonary embolism?

A

Oxygen if hypoxic
Analgesia
LMWH and warfarin
Continue warfarin for 6 months if a spontaneous cause.

178
Q

What action can be taken to prevent pulmonary embolism?

A

Compression stockings
LMWH for prophylaxis in the high risk
Anticoagulation post incident.

179
Q

What is the pathophysiology of acute respiratory distress syndrome?

A

Damage to the lungs causes release of inflammatory mediators, increase in vascular permeability and pulmonary oedema – fibrosis.

180
Q

What is the cause or ARDS?

A

Pneumonia, injury, shock, haemorrhage.

181
Q

What are the signs of ARDS?

A

Cyanosis
Tachypnoea
Tachycardia
Peripheral vasodilation

182
Q

What is the management of ARDS?

A

Supportive and treat cause

183
Q

What is cor pulmonale?

A

Right heart failure caused by pulmonary arterial hypertension.

184
Q

What are the causes of cor pulmonale?

A

COPD
Bronchiectasis
Emboli

Phase 2a - conditions (11 decks)

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