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Yr 3 ALS > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Obstructive vs respiratory disease

  • FEV1
  • FVC
  • FEV/FVC
A

OBSTRUCTIVE

  • FEV1 = ↓ ↓
  • FVC = ↓ or normal
  • FEV/FVC = ↓

RESTRICTIVE

  • FEV1 = ↓
  • FVC = ↓ ↓
  • FEV/FVC = ↑ or normal
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2
Q

Causes of obstructive disease

A
  • Asthma
  • COPD
  • Bronchiectasis
  • Emphysema
  • CF
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3
Q

Causes of restrictive disease

A
  • Fibrosis
  • Asbestosis
  • Sarcoidosis
  • ARDS
  • MSK disorders
  • Pregnancy
  • Lobectomy
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4
Q

Asthma

  • Cellular features
  • Ig responsible
  • Long term changes
A
  • Eosinophils
  • IgE = histamine, prostoglandins and leukotrienes
  • Smooth mucle hypertrophy + tickened basement membrane
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5
Q

Diagnostics asthma

A
  • Peak flow
  • Spiro
  • CHXR & FBC
  • Bronchial challenge (if spiro + peak flow dont show)
  • IgE
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6
Q

Treatment algorhythm asthma

A

(SABA)
IC + (LABA)
ML
Immunomodulator + (Tiotropium)

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7
Q
  • Moderate
  • Severe asthma
  • Life threatening
A
  • MOD = PEFR 50-70% + normal speech
  • SEVERE = PEFR 33-50%, no full sentances, accessory muscles and O2 sats 92+
  • LIFE THREATENING = PEFR >33%, altered GCS, arrythmias, ↓BP, cyanosis, O2 says >92
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8
Q

Treat Acute exacerbation asthma

A
  • Controlled 02 95-98% facemask
  • SABA + nebulised ipatropium bromide
  • IV hydrocortisone
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9
Q

Methods of low dose vs high dose O2 elivery

A

LOW (max up to 70%)

  • Nasal cannulae
  • Simple mask
  • Partial rebreather

HIGH (up to 100%)

  • Venturi = controlled
  • Resorvoir/Non rebreather
  • High flow nasal prongs
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10
Q

Targets for Oxygenation

A 
normal = 94-98%
hypercapnic = 88-92%
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11
Q

COPD

  • Definition
  • FEV/FVC definition
A

Umbrella term for emphysema and chronic bronchitis (cough and sputum for most days, at least 3mnths year)
-FEV/FVC = must be below 70% to be COPD

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12
Q

COPD Diagnostics

A
  • Spiro: ↑residual volume
  • CHXR: sometimes hyperfinflation
  • ECG
  • alpha-1-antitrypsan deficieny (auto dominant)
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13
Q

Drug treatment COPD

  • Asthmatic features
  • Non asthmatic features
A

ASTHMATIC features

  • SABA or SAMA
  • LABA + ICS
  • LABA + ICS + LAMA

NON ASTHMATIC features

  • SABA or SAMA
  • LABA or LAMA
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14
Q

When do we use theophylline or mucolytics

A
  • If cant tolerate inhaled therapy or if SABA/SAMA ineffective
  • With chronic productive cough
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15
Q

Lifestyle intervention COPD

A
  • Stop smoking
  • Annual influenza and one off pneumoccocal vaccine
  • Pulmonary rehab
  • Treat comorbidities
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16
Q

Histological change associated with chronic bronchitis

-cell involved

A

Squamus to columnar epithelial change

-Neutrophils

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17
Q

Bullae

A

Large closed off pocket of air that may require surgery

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18
Q

Type 1 respiratory failure

  • causes
  • subgroup
A

TYPE 1 = Hypoxia + normal CO2 = VQ mismatch

  • pneuomonia,PE,oedema,emphysema,alveolitis,asthma
  • PINK PUFFERS = eosinophilic emphysema patients
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19
Q

Type 2 respiratory failure

  • causes
  • subgroup
A

TYPE 2 = Hypoxia and Hypercapnia = NO VQ mismatch

  • COPD,asthma,CNS depression, apnoea, trauma
  • BLUE BLOATERS = cyanosed but not breathless - can develop cor pulmonale (bloat), neutrophilic COPD
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20
Q

Bronchiectasis

  • pathophys
  • causes
  • diagnostics
A
  • Destruction of alveolar walls, fibrosis and pooled mucos in lower lobes
  • TB (most common), CF, ciliray dysfunction, pertussis
  • CT (signet ring), CHXR
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21
Q

Mnominic for ABG

  • R.O.M.E
  • Mixed picture
A
  • Respiratory = Opposite , pH and C02/HCO3- = up/down
  • Metabolic = Equal , pH and HCO3-/C02 = up/up

-Mixed = only time when HCO3- and CO2 move in different directions

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22
Q

Base excess

A

A surrogate marker for HCO3- and metabolic dysfunctions

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23
Q

Anion gap

  • High
  • Low
A

Used to assess metabolic acidosis

  • High = more acid produces/ingested
  • Low = less acid produced or more excreted HCO3-
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24
Q

Causes Respiratory acidosis

A
  • Resp depression - opiates/benzos
  • Paralysis = low ventilation
  • Asthma/COPD
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25
Q

Causes Respiratory alkolosis

A
  • Hyperventilation
  • Hypoxia and hyperventilaroy compensation
  • PE
  • Pneumothorax
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26
Q

Causes Metabolic acidosis
↑Anion Gap
↓Anion Gap

A 
↑Anion gap
-DKA
-Lactic acidosis
-Aspirin overdose
↓Anion gap
-GI loss HCO3-
-Renal acidosis 
-Addisons disease
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27
Q

Causes Metabolic alkalosis

A
  • GI loss H+

- Renal loss H+

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28
Q

Squamus cell lung CA features

A
  • Occasionally cavitates - late metastasis
  • Associated with high PTH - HIgh Ca
  • Clubbing
  • 35% frequancy
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29
Q

Adenocarcinoma lung CA features

A
  • Arise from mucous cells
  • Occupational cancer, women, non-smokers, far east
  • Sommonly invades mediastium
  • Associated with pleural effusion
  • 35% frequancy
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30
Q

Large cell lung CA features

A
  • Well differentaited
  • Early metastasis
  • Poor prognosis
  • May secrete Beta-HCG
  • 10% Frequancy
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31
Q

Small cell lung CA features

A
  • Arise from Kulchitsky cells - tumor may secrete polypeptides
  • Often central/inoperable, poor chemo responce
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32
Q

Associated syndromes of small cell lung CA

A
  • Hypernatremia = ADH secretetion
  • Cushings = ACTH secretion
  • Lambert Eaton syndrome = paraneoplastic autoimmune disease Ab’s to Ca cells. Causes muscle weakness like m.gravis
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33
Q

Complications of Lung CA

A
  • SVC compression = SOB,oedema face, morning headaches and visual disturbance
  • Brachial plexus spread = pancoast tumor
  • Sympathetic ganglion spred = Horner (ptosis/myosis)
34
Q

Diagnostics for lung CA

A
  • CT = gold standard imaging
  • PET helpful for staging and establish eligibility non small cell surgery
  • CHXR - 70% cancers visable as mass
  • Bronchoscope and biopsy
35
Q

Treatment non small cell vs small cell

A

Non Small cell

  • Poor chemo response
  • Some eligible for surgery (no mets/svc obstruction, tumor near hylum)
  • Palliative/curative radio available for some

Small cell

  • Often early metastasis
  • Chemo and radio can help
  • 5yr survival = 10% with treatment
36
Q

Mesothelioma

  • 2 synergistic causes
  • First symptoms
  • Treatment and survival
A
  • Smoking and asbestos (even light exposure)
  • Pleural effusion, SOB, chest pain, ascites
  • No treatment surivaval = 2yrs
37
Q

NICE guidelines lung CA chemo choice
Non small cell
Small cell

A

Non-small cell

  • Cisplatin (carbo = second line) + premetrexed + radio
  • Surgery + Cisplatin

Small cell
-Chemo and radio (cisplatin/carboplatin + etoposide)

38
Q

What systemic ABG sign seen with massive PE

A

Metabolic acidosis (massive) or respiratory alkalosis

39
Q

Diagnostics PE

A
  • CTPA
  • V/Q scan
  • D-dimer = helps rule out PE
40
Q

CHXR signs for PE

A
  • Wedge shaped opacity
  • Hamptons hump
  • Oligaemia (decrased vessel size)
41
Q

What is diagnostic criteria taking into account clinical signs used in PE

A

Wells score (+4 = high risk)

42
Q

PE treatment protocol

A
  • Resp support
  • Fluids + (Na/Ad/Dobutamine vasoactive agents)
  • Anticoagulation
    1) Heparin + (warfarin)
    2) Riveroxaban or other NOAC
43
Q

What else can elevate D-dimer

A

Any inflammatory process

44
Q

Pleural effusion

  • Signs
  • Diagnostics
A
  • Costophrenic blunting on x ray (1st investigation)
  • Stony dull, decreased resonance, decreased sounds
  • Pleural USS - help locate
  • Diagnostic aspiration
45
Q

3 types of pleural fluid and causes

A
  • Transexudate = HF/Cirrhosis/Nephrotic syndrom
  • Exudate = Infection/neoplasm/PE/TB
  • Frank Pus = Empyma (pneumonia) acidic
46
Q

Where is the radiation point of diaphragm pain

A

Tip shoulder

47
Q

Most common pneumonia organisms (descending)

COMMUNITY (SHMCL) gram+

A
  • Strep P
  • Haem I
  • Mycoplasma
  • Chlamydia
  • Legionella
48
Q

Most common pneumonia organisms (descending)

HOSPITAL (SGM) gram-

A
  • Staph aureus
  • Gram - bacilli
  • Multidrug resistant
49
Q

Which pneumonia is most common in elderly

A

-Haemophilus Influenza

50
Q

Which penumonia often follows infection and what is an important clinical sign

A
  • Strep

- Rust sputum

51
Q

CURB-65 score

A
  • Confusion
  • Urea
  • Resp rate
  • BP
  • +65

Above 3 = hospital admission

52
Q

What Ab do you give for pneumonia before culture

A

Cephalosporin (then go by culture oral/iv)

53
Q

Important complication of pneumonia

A

Type 1 respiratory failure

54
Q

Features of mycoplasma pneumonia

A
  • Common in clusters - kids
  • Patchy opacities
  • Small pathogen with no cell wall
55
Q

Treat mycoplasma pneumonia

A 
1 = Macrolides
2 = Fluroquinones
56
Q

Important note about atypical pneuomonias

A

Can present without consolidation

57
Q

Primary site of bacteria engulfement in TB

A

Ghon focus

58
Q

5 Extra-pulmonary sites TB

A
  • Lupus vulgaris = painful nodular skin lesions
  • Arthritis
  • Renal
  • GIT
  • Contrictive pericarditis
59
Q

Diagnostics TB

  • Active
  • Latent
A
  • 3x + acid-fast sputum culture (1 must be early morning)

- Mantoux = LATENT

60
Q

Therapy TB

  • Normal
  • MD resistant
A

RIPE Therapy
Rifampicin/Isonazaid/Pyrazamide/Ethambutol

NORMAL
-All 4 RIPE for 2months then RIP ab therapy = 18wks

MD resistant
-RIPE for 18-24mnths

61
Q

Features of Interstitial Lung disease

A
  • Decreased compliance (restrictive)
  • Honeycombing “cystic” lung
  • Often involves lower lobes
62
Q

Complications Ideopathic puolmonary fibrosis

A
  • Hypertension
  • cor pulmonale
  • Type 1 respiratory failure
63
Q

CHXR features and signs of IPF

-Diagnositc test

A
  • Ground glass
  • Clubbing
  • Bibasal fine crackles
  • Decresed epansion

-High resolution CT

64
Q

IPF - epi and prognosis

A

Rare, affects 45+
No cure
Survival = 5yrs

65
Q

Pneumoconiosis

  • Precursor
  • CHXR
  • Treatment/Prognosis
  • Associated disease
A

Black lung/miners lung

  • Anthracosis (less severe)
  • small opacities to large fibrotic nodules
  • No treament poor prognosis
  • Caplans syndrome = association with RA
66
Q

Hypersensitivity/Allergic Alveolitis

  • Type of hypersensitivity
  • Subgroups
  • X-ray sign
A
  • Type 3
  • Farmers/Pigeon fanciers/cotton/sugar cane (bagosis)
  • Upper fibrosis - vessel sparing, honeycombine
67
Q

What test can be useful to test the severity of interstitial lung diseases

A

6-minute walk test

68
Q

Sarcoidosis

  • At risk groups
  • CHXR signs
  • Gold standard testing
A
  • Afrocaribbean and scandinavian
  • hilar lymph nodes, infiltrates, firbous granuloma honeycomb
  • confirm with biopsy and HCCT
69
Q

3 associates syndromes of sarcoidosis

A
  • Arthritis
  • Erythema nodosum
  • Hypercalcemia due to active vit D increase
70
Q

What other blood test result may indicate sarcoidosis

A

Extra serum ACH - produces by sacroidosis macrophages

71
Q

ARDS

  • Causes
  • Xray sign
  • Other test signs
A
  • Pancreatitis, shock, drugs, trauma, sepsis, malignancy
  • Bilateral diffuse infiltrates
  • Pulmonary capillary wedge pressure and ↑ESR
72
Q

Diagnostics sleep apnoea

  • gold standard
  • scale
A

-Polysonography = eeg measures REM
-Epworth sleep scale = looks are apnoeas per hour
1-14(mild) , 15-30(mod) , >30(sev)

73
Q

3 types of x rays

A

PA = patient stand erect
AP = patient sits erect (magnifies and widens)
Supine

74
Q

Causes tracheal deviation
AWAY
TOWARDS

A

TOWARDS

  • Pneumonectomy
  • Collapse
  • Hypoplasia

AWAY

  • Pneumothorax
  • Hernia
  • Large thoracic mass
  • Pleural effusion
75
Q

What 3 patholgies do no coexist with tracheal deviation

A
  • Mesothelioma
  • Pulmonary Oedema
  • Consolidation
76
Q

Signs of PE on x ray

A

Often normal x ray

77
Q

Signs Effusion on x ray

A

Batwing configuration

78
Q

Pickwickian syndrome

  • symptoms
  • diagnostics
  • treat
A

Obesity hypoventilation

  • daytime sleepyness, morning headaches, SOB
  • ABG + bicarb + Hct
  • nocturnal bipressure ventilation or CPAP
79
Q

Test for alveolar ventilation

A

Serum bicarbonate

80
Q

Another test of alveolar ventilation but is specific for nocturnal hypoxemia

A

Haematocrit (Hct)>45% diagnostic

Yr 3 ALS (10 decks)

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