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Y3 Core Conditions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Asthma

A

Chronic inflammatory condition characterised by reversible airflow obstruction, airway hyper-responsiveness, involvement of T cells, mast cells, eosinophils and smooth muscle hypertrophy.

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2
Q

Most common chronic condition in children

A

Asthma

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3
Q

Causes of Asthma

A

Atopy: triad with hayfever, eczema and asthma
Genetic
Environment: viral, bacterial infections, allergen exposure, occupational exposure, food additives and chemicals

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4
Q

Pathophysiology of Asthma

A

Type 1 IgE mediated hypersensitivity reaction causing:

  • bronchoconstriction
  • Inflammation caused by mast cells, eosinophils, dendritic cells and lymphocytes (Th2 response)
  • Increased mucous production
  • Airway remodelling
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5
Q

What happens in airway remodelling

A

Loss of ciliated cells
Increase in goblet cells and mucus
Smooth muscle hyperplasia due to contraction
Nerves contribute to irritability of airways

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6
Q

Symptoms of Asthma

A

Wheezing, coughing, sputum, SOB, chest tightness, triggered by cold air, exercise, pollution, allergens, nocturnal dyspnoea

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7
Q

Signs on examination of Asthma

A

Tachypnoea, wheeze, hyper inflated chest, hyper-resonant to percuss, decreased air entry,

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8
Q

Investigations for asthma

A

FEV1/ FVC ration, FEV1, PEFR, CXR, FBC, immunoassay for allergen specific IgE

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9
Q

Expected FEV1/FVC ratio for Asthma and COPD

A

<0.7

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10
Q

Airflow obstruction

A

A reduced FEV1 and a reduced FEV1/FVC ratio, such that FEV1 is less than 80% of that predicted, and FEV1/FVC is less than 0.7.

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11
Q

Differentials for asthma

A

CF, chronic rhino sinusitis, tracheomalacia, vascular ring, foreign body aspiration, vocal cord dysfunction, alpha-1 antitrypsin deficiency, COPD, bronchiectasis, PE, congestive heart failure

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12
Q

Vascular ring

A

Congenital lesion where normal vessels are in an abnormal location and may cause compressionof oesophagus or airway

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13
Q

Treatment for Asthma

A
  1. Short-acting beta agonist e.g salbutamol
  2. Inhaled corticosteroids e.g fluticacsone, budesonise, beclometasone.
    Leukotrine-receptor antagonist e.g. montelukast and theophylline
  3. Inhaled corticosteroids AND long-acting inhaled B2 agonist (LABA) e.g. salmetrol
  4. High dose inhaled corticosteroid and regular bronchodilators: add LABA and LRTA
  5. Regular oral corticosteroids: add prednisolone 40mg daily

Don’t give LABA without ICS to patients

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14
Q

Complications of Asthma

A

Treatment from inhaled corticosteroids can lead to: oral candidiasis, dysphonia, oesophageal candidiasis

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15
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

Progressive disease characterised by airway obstruction with little or no reversibility and FEV1/FVC ratio <0.7.
Includes chronic bronchitis (blue bloaters) and emphysema (pink puffers)

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16
Q

Chronic bronchitis

A

Cough, sputum production on most days for 3 months of 2 consecutive years

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17
Q

Emphysema

A

Enlarged airspaces distal to terminal bronchioles with destruction of alveolar walls. Classified according to site of damaged: centri-acinar, pan-acinar, irregular.

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18
Q

How common is COPD

A

3rd most common cause of death
>40 yo, mostly men
90% of COPD patients are smokers

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19
Q

Causes of COPD

A
  • Loss of elasticity and alveolar attachments
  • Inflammation and scarring causing narrowing of airways
  • Mucus secretion blocking airways
    leading to hyperinflation of lungs and breathlessness
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20
Q

Risk factors for COPD

A

Smoking
Age
Alpha-1-antitrypsin deficiency
Air pollution, occupational dusts, fumes etc

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21
Q

Symptoms of COPD

A

chronic cough, sputum, SOB, recurrent chest infections, weight loss, barrel chest

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22
Q

Signs of COPD

A

Tachypnoea, accessory muscles used, pursed lip, cyanosis, CO2 flap, wheeze, decreased vesicular breath sounds, peripheral oedema

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23
Q

Pink Puffers (Emphysema)

A

Breathless but not cyanosed. Increased alveolar ventilation. Accessory muscle used, cachexia, barrel chest. May progress to type 1 respiratory failure

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24
Q

Blue Bloaters (Bronchitis)

A

Cyanosed but not breathless. Decreased alveolar ventilation. May progress to type 2 respiratory failure. Can develop cor pulmonale.

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25
Q

Difference between Asthma and COPD

A

Asthma presents earlier, has no sputum and is a reversible airway obstruction

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26
Q

Investigations for COPD

A

Chest Xray, spirometry can differentiate between obstructive and restrictive, FBC, ABG, ECG, sputum culture

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27
Q

Managing COPD

A

Smoking cessation, pulmonary rehabilitation, exercise, Diet advice and supplementation, vaccination and antiviral therapy, depression advice and treatment

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28
Q

Treating COPD

A
  1. Inhaled therapy
  2. Oral therapy
  3. Oxygen therapy
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29
Q

Inhaled therapy for COPD

A
  • Short-acting beta agonist e.g. salbutamol, turbutaline
  • Short-acting muscarinic antagonist e.g. ipratropoum
  • Long-acting muscarinic antagonist e.g. tiotropium
  • Inhaled corticosteroids
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30
Q

Oral therapy for COPD

A

Oral corticosteroids
Theophylline
Mucolytics e.g. carbocisteine
Antibiotics

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31
Q

Complications for COPD

A 
Cor pulmonale
Recurrent pneumonia
Pneumothorax
Depression
Respiratory failure
Anaemia 
Secondary Polycythaemia
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32
Q

Pulmonary fibrosis

A

A restrictive condition when interstitial lungs become damaged and scarred losing its elasticity

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33
Q

3 types of pulmonary fibrosis

A

Replacement fibrosis- secondary to lung damage
Focal fibrosis - in response to irritants
Diffuse lung parenchyma

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34
Q

5 main causes of Pulmonary fibrosis

A

Drug induced, radiation induced, environmental , autoimmune and occupational

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35
Q

Investigating Pulmonary fibrosis

A

CT

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36
Q

Bronchial Cancer

A

malignant neoplasm of the lung arising from the epithelium of the bronchus. 2 types: SCLC and NSCLC

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37
Q

Small Cell Lung Carcinoma

A

15% of cases, highly malignant, arise from Kulchitsky cells

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38
Q

Non Small Cell Lung Carcinoma

A

85% of cases

39
Q

Different types of NSCLC

A

Adenocarcinoma, squamous cell carcinoma, large cell carcinoma carcinoid tumours and bronchoalveolar cell

40
Q

How common are Bronchial Cancers

A

Most common malignant tumour world-wide

41
Q

Risk factors for Bronchial Carcinoma

A

Smoking, asbestos, radiation, iron oxides, coal, arsenic, petrol, Male, EGFR-TK mutation

42
Q

Symptoms of Bronchial carcinoma

A

cough, dyspnoea, haemopytsis, chest pain, weight loss, fatigue, wheeze

43
Q

Investigations for Bronchial Carcinoma

A

CXR, CT, sputum cytology, bronchoscopy, PET, thoracentesis, bloods

44
Q

Differentials of Bronchial Carcinoma

A

Pneumonia, carcinoid tumour, infectious granuloma, sarcoidosis, RA, TB, lymphoma

45
Q

Treatment for bronchial carcinoma

A

chemotherapy, radiotherapy, prophylactic cranial irradiation, surgery

46
Q

Erlotibin (Tarceva)

A

Cancer treatment drug for Non-small Cell Lung Cancer that has spread. Used alongside Gemcitabine

47
Q

Gefitinib

A

Gefitinib is tyrosine kinase inhibitor that stops growth of cancer cells with Epidermal growth factor receptors

48
Q

Complication of Bronchial Carcinoma

A

Recurrent laryngeal nerve palsy, Phrenic nerve palsy, SVC obstruction, Horner’s syndrome, pericarditis, AF

49
Q

Pneumothorax

A

Collection of air in the pleural cavity causing collapse of the lung on the affected side

50
Q

Who is normally affected by a pneumothorax

A

Males more than females
Primary Spontaneous pneumothoraces more so in 20s
Secondary Spontaneous pneumothoraces common 60+

51
Q

Pathophysiology of a pneumothorax

A

Normally alveolar pressure is higher than intrapleural pressure and intrapleural pressure is less than atmospheric pressure. If communication develops, gases will flow down pressure gradient and into pleural space.

Eventually, intrapleural pressure exceeds atmospheric pressure causing hypoxia.

52
Q

Beck’s triad

A

Signs associated with acute cardiac tamponade or pneumothorax.

Hypotension, distended neck veins, and distant heart sounds

53
Q

Primary Spontaneous Pneumothorax

A

Without preceding trauma.

Mainly due to smoking

54
Q

Secondary Spontaneous Pneumothorax

A

Complication of an underlying pulmonary disease

55
Q

Risk factors for Pneumothorax

A

Male, tall, smoking, recent invasive procedure, Marfan’s, homocystinuria, lung cancer

56
Q

Signs of pneumothorax

A

Distressed, sweating, dyspnoea, cyanosis, tachycardia, hypotension, raised JVP, tracheal deviation, hyper-resonant to percussion, decreased breath sounds

57
Q

Differentials for pneumothorax

A

Pleural effusion, pulmonary embolus, asthma exacerbation, MI

58
Q

Treating a Tension pneumothorax

A

Immediate needle compression with 14-gauge cannula at 2nd intercostal space, mid-clavicular line

59
Q

Treating a PSP or SSP

A

Oxygen and percutaneous aspiration, chest drain insertion into safe triangle, talc pleurodesis

60
Q

Borders of safe triangle for chest drain insertion

A

Lateral border of pectoralis major, anterior border latissimus, base of axillaa dn 5th IC space

61
Q

Complications of pneumothorax

A

Pulmonary oedema, high rate of reccurence, Talc pleurodesis causing ARDS

62
Q

Unilateral Pleural Effusion

A

Excess fluid between the parietal and visceral pleura.

63
Q

Light’s Criteria

A

Differentiates between exudate and transudate. Pleural fluid is exudate if one criteria is met:

  • PF protein/ serum protein >0.5
  • LDH/LDH >0.6
  • PF LDH >2/3 the upper limits of serum LDH
64
Q

Difference between Transudate and Exudate

A

Transudate is fluid pushed through the capillary due to high pressure within the capillary.

Exudate is fluid that leaks around the cells of the capillaries caused by inflammation

65
Q

Protein concentration of transudates and exudates

A

Transudates: <25g/L
Exudates: > 35g/L

66
Q

Signs and symptoms of Pleural Effusion

A

Dyspnoea, Pleuritic chest pain, decreased chest expansion, reduced breath sounds, tactile vocal fremitus and vocal resonance decreased, mediastinum shift

67
Q

Differentials for a pleural effusion

A

Pneumothorax- but presents black on CXR and hyperresonant to percussion

68
Q

Investigations for a pleural effusion

A

CXR: blunting of costophrenic angles, pleural biopsy

69
Q

Treatment for pleural effusion

A

Diuretics, pleural drainage, pleurodesis if recurrent

70
Q

Pneumonia

A

Lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid.

71
Q

Main causes of CAP

A
  1. Streptococcus Pneumoniae
  2. H. Influenza
  3. Mycoplasma pneumonia
72
Q

HAP

A

Acquired >48 hours after hospital admission. Commonly due to gram negative bacteria or Staph A

73
Q

Risk factors for Pneumonia

A

Age, viral infection with influenza, hospitalized ill patients, smoking, alcohol, bronchiestasis, CF, bronchial obstruction, immunosuppression

74
Q

Symptoms of Pneumonia

A

Cough, purulent sputum, fever, rigors, malaise, anorexia, dyspnoea, haemoptysis, pleuritic pain

75
Q

Signs of Pneumonia

A

pyrexia, cyanosis, confusion, tachypnoea, tachycardia, hypotension, reduced expansion, dull to percuss, increased tactile fremitus, vocal rub,

76
Q

Differentials for pneumonia

A

Bronchieactasis, COPD, Asthma, Pleural effusion

77
Q

Investigations for pneumonia

A

CXR: consolidation, FBC, Sputum, bronchoscopy

78
Q

CURB65

A 
Predicts mortality in CAP. 
Confusion (AMTS<=8)
Urea >7mmol/L
Respiratory Rate >30/in
BP <90 systolic 
>65yo
79
Q

Treating Pneumoniae

A

Oral ABX: amoxcillin, clarithromycin, doxycycline
IV ABX: co-amoxiclav, cephalosporin + clarithromycin
oxygen, Pneumoccocal vaccine

80
Q

Complications for Pneumonia

A

Respiratory failure, hypotension, AF, pleural effusion, lung abscess, septicaemia, Pericarditis, Cholestatic jaundice

81
Q

Pulmonary Embolism

A

Obstruction of vessel withing the pulmonary tree by an embolus usually from a DVT

82
Q

Aetiology of a PE

A

Fat: following bone fracture
Air: from neck vein cannulation
Thrombosis: from DVT, septic embolus

83
Q

Virchow’s Triad

A

Altered blood flow, Altered vessel, Hypercoagulability

84
Q

Risk factors for PE

A

Increasing age, BMI >30kg/m2, varicose veins, continuous travel >3hrs, Bedrest for >4days, pregancy, Oestrogen therapy, plasminogen deficiency

85
Q

Risk factors for PE: Blood diseases

A 
Thrombophilia
Antithrombin deficiency
Protein C or S deficiency 
Factor V Leiden
Prothrombin gene variant 
Antiphospholipid antibody
86
Q

Risk factors for PE: Diseases or surgical procedures

A

Trauma, malignancy, Cardicac/ respiratory failure, Recenr MI or stroke, acute medical illness, IBD, Nephrotic syndrome, Myeloproliferative disorders, Sickle cell anaemia,, central venous catheter, paraproteinaemia, proxysmal nocturnal haemoglobinuria prostatectomy

87
Q

Symptoms of PE

A

Dyspnoea, pleuritic chest pain, cough, haemoptysis, dizziness, syncope

88
Q

Signs of PE

A

Tachypnoea, tachycardia, hypoxia, cyanosis, hypotension, raised JVP, Pyrexia

89
Q

Differentials of PE

A

Pneumothorax, Acute coronary syndrome, Aortic dissection, Pneumonia, Cardiac tamponade, septicaemia

90
Q

Investigations for PE

A

-Two Level Well’s Score
-Computed tomographic pulmonary angiography
-D dimer testing
ABG: may show type 1 respiratory failure
CXR
ECG

91
Q

Two Level Well’s Score

A

A DVT and PE probability scoring for diagnosing. Points of more than 4 suggest PE likely. Clinical feature:

  • Signs and symptoms of DVT
  • An alternative diagnosis is less likely than PE
  • > 100bpm HR
  • Immobilisation
  • Previous DVT/PE
  • Haemoptysis
  • Malignancy
92
Q

Treating PE

A
  • Anticoagulation with LMWH e.d. tinzaparin or fondaparinux
  • Unfractionated heparin for those with renal impairment, increased risk of bleeding
  • Stop heparin when INR >2
93
Q

Complications of a PE

A

Chronic thromboembolic pulmonary hypertension

Y3 Core Conditions (13 decks)

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