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Long Case > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Definition of asthma

A

Recurrent episodes of dyspnea, cough and wheeze caused by reversible airway obstruction

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2
Q

Possible precipitants/causes of asthma

A 
Cold
Exercise
Emotion
LBW/not breast fed
Quantity of exercise tolerance
Sleep quality
Acid reflux
Atopic disease
Dust/pets
Aspirin
Days off work/school
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3
Q

Asthma examination findings

A

Hyperinflated chest
Hyper resonant percussion
Diminished air entry
Widespread wheeze

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4
Q

Asthma differentials

A 
Pulmonary oedema
COPD
SVC obstruction
Pneumothorax/PE
Bronchiectasis
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5
Q

investigations asthma

A 
Bloods including ABG ( only if hypoxic)
Peak flow
Sputum culture
CXR
Spirometry
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6
Q

Non-pharmacological management of asthma

A 
Smoking cessation
Avoidance of precipitants
Twice daily PEF
Emergency action plan
?Home O2
Pulmonary rehabilitation
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7
Q

Pharmacological management of chronic asthma

A

Inhaled corticosteroid (fluticosone or beclometasone) and SABA PRN
ICS regularly and SABA PRN
LABA salmeterol and ICS low dose and SABA PRN
LABA and ICS high dose and SABA PRN
Leukotrine receptor antagonist (monteleukast)
Oral prednisone

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8
Q

Pharmacological management of acute asthma

A

Nebulised salbutamol
Oxygen
Hydrocortisone or prednisolone
Add ipratropium nebs and magnesium sulphate

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9
Q

Definition bronchiectasis

A

Permanent dilation of the walls of bronchi with associated destructive/inflammatory changes leading to chronic airway infection

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10
Q

List some causes of bronchiectasis

A 
Cystic fibrosis
Primary cilia dyskinesia
Infections in childhood
Rheumatoid arthritis
COPD
ILD
Idiopathic (50%)
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11
Q

Complications of bronchiectasis

A 
Pneumonia
Pleurisy
Empyema
Lung abcess
Cor pulmonale
Amyloidosis
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12
Q

Differentials for bronchiectasis

A

Bronchitis
COPD
TB

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13
Q

investigations for bronchiectasis

A 
CXR
Sputum culture
Test for cystic fibrosis
Spirometry (for severity)
High resolution CT
\+- bronchoscopy
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14
Q

Non-pharmacological mangement bronchiectasis

A 
twice daily postural drainage
physiotherapy
influenza/pneumococcal vaccines
smoking cessation
Home O2 with severe disease
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15
Q

Pharmacological management bronchiectasis

A

Antibiotics (based on culture)
bronchodilators
Surgery if localised disease/severe haemoptysis

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16
Q

Presentation of COPD

A

dyspnoea
chronic cough
chronic sputum production
history of risk factors (smoking, pollution, occupation chemicals and dust)

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17
Q

Most common genetic marker in COPD

A

alpha1-antitrypsin deficiency

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18
Q

Investigations for COPD

A

Spirometry (diagnosis)
CXR
ECG (RVH from cor pulmonale)
ABG

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19
Q

how do pathophysiologies of emphysema and chronic bronchitis differ

A

Emphysema:alveolar inflammation and decreased elastic tissue means hyperinflation. Hyperinflation leads to breathing at higher volumes. Lungs have less compliance at higher volumes, so in order to maintain positive airway pressure patient must purse lips (pink puffer)
Bronchitis: increasing mucus and airway narrowing leads to increased airway resistance. Expiration no longer passive, airways collapse on expiration. CO2 retention and relies on hypoxic drive (blue bloater)

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20
Q

Differentials for COPD

A

Asthma
Congestive Heart failure
Bronchiectasis
TB

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21
Q

Definition of “chronic bronchitis”

A

Cough and sputum production for at least three months in each of the last two consecutive years

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22
Q

Non pharmacological treatment of COPD

A

Smoking cessation
Oxygen therapy
Influenza vaccination
Ventilatory support

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23
Q

What is the difference between Bipap and Cpap

A

Bipap delivers different air pressures varying with inspiration or expiration. It is used in type 2 respiratory failure.

Cpap only delivers one strength of air pressure, it is not ventilation but splints the airway open. It is used in type 1 respiratory failure.

24
Q

Pharmacological treatment of COPD

A

Mild: SABA or SA anticholinergic
Moderate: LABA (salmeterol) or LA anticholinergic (tiotropium) incruse ellipta
Severe: ICS and LABA (Symbicort) or LA anticholinergic or LAMA and LABA (anora ellipta)
Very severe: ICS (Flixotide) and LABA and LA anticholinergic

25
Q

Treatment of acute exacerbation of COPD

A 
Oxygen
SABA nebulisers +/- short-acting anticholinergics
Systemic corticosteroids
Antibiotics if evidence of infection
Aminophylline if not responding
Magnesium sulphate
26
Q

Known causes of interstitial lung disease

A 
Asbestosis, silicosis, bird poo, coal
Methotrexate, amiodarone
Hypersensitivity (extrinsic allergic alveolitis)
TB, fungal
Also associated with systemic disorders
27
Q

Investigations for interstitial lung disease

A 
CXR
CT
Spirometry
Bloods
Bronchoalveolar lavage
Biopsy
28
Q

Treatment interstitial lung disease

A

Cannot reverse established fibrosis
Steroids
Transplantation

29
Q

Types of lung cancer

A 
Non-small cell (85%):
adenocarcinoma (most common)
squamous cell cancer
large cell
alveolar cell
Small cell (15%) - smokers
Mesothelioma
30
Q

Complications of lung cancer

A 
Recurrent laryngeal palsy
Horner's syndrome
SVC obstruction
SIADH ACTH by small cell tumours
Lambert Eaton myasthenic syndrome (small cell)
Dermatomyositis
31
Q

Differential diagnosis of lung nodule on xray

A 
Malignancy
Abcesses
Granuloma
Carcinoid tumour-flushing/diarhoea due to serotonin
Pulmonary hamartoma
AV malformation
Cyst
Foreign body
Skin tumour
32
Q

Investigations for lung cancer

A 
Cytology
CXR
Bronchoscopy
Bloods
CT/PET
Lung function tests
33
Q

Management of lung cancer

A

Non small cell: Exision if localised and no mets
radiotherapy
Chemo and radiotherapy if severe
Small cell: chemotherapy with platinum based drugs
Prophylactic cranial irradiation in patients with complete responses
Palliation (1-1.5 year survival)

34
Q

Conditions which increase risk of obstructive sleep apnoea

A 
pregnancy
heart disease
renal disease
lung disease
PCOS
35
Q

Investigations for OSA

A

Pulse oximetry and video recordings at home
Sleep study/polysomnography
TFTs (hypothyroidism)
ECG
Definitive diagnosis is >5 apnoeic episodes per hour over several hours lasting >10 seconds each

36
Q

Treatment OSA

A

Weight loss
Avoid sedatives
Reverse underlying cause
CPAP if moderate to severe

37
Q

What are some signs of sarcoidosis?

A 
Bilateral hilar lymphadenopathy
Pulomary infiltrates
Erythema nodosum
Lupus pernio
Polyarthralgia
Cardiomyopathy
Uveitis
38
Q

Investigations sarcoidosis

A 
Bloods (raised ESR, raised serum ACE)
Urine (raised Ca)
CXR
Pulmonary Function tests
Biopsy (non-caseating granulomata)
39
Q

Treatment sarcoidosis

A

Mild: bed rest NSAIDS
Otherwise steroids (prednisone)
60% resolves after 2 years

40
Q

What is the difference between pulmonary and miliary TB?

A

Pulmonary: cough, sputum, malaise, pleural effusion
Milliary: Haematogenous spread, non specific signs, no effusion but clinically unwell

41
Q

What is the difference between diagnosing active and latent TB?

A

Latent TB use Mantoux or quantiferon gold

Active use CXR and PCR

42
Q

Treatment TB

A 
Start therapy without clinical results
Rifampicin 600mg
Isoniazid 300mg
Pyrazinamide 2g
Ethambutol 15mg/kg
For 8 weeks then 16 weeks on just rifampicin and isoniazid
43
Q

How does cystic fibrosis present in neonates vs children?

A

Neonates: failure to thrive, meconium ileus
Children: cough, wheeze, recurrent illness, bronchiectasis, pancreatic insufficiency

44
Q

Diagnosis of cystic fibrosis

A

Sweat test
genetic testing
faecal elastase (pancreatic insufficiency)

45
Q

Treatment cystic fibrosis

A

Pulmonary: physiotherapy, antibiotics, mucolytics
Gastro: pancreatic enzyme replacement, vitamin supplements
Treat diabetes

46
Q

Most common causes of community acquired pneumonia

A

Step pneumonia

Haemophilus influenzae

47
Q

Investigations for pneumonia

A 
CXR
Bloods
Sputum culture
\+-ABG
Urine (pneumococcal/legionella antigen)
\+- Pleural fluid for culture
48
Q

Describe the CURB score

A 
Confusion
Urea >7mmol/L
Respiratory rate >30
BP <90 systolic
Age >65
49
Q

Treatment pneumonia

A 
Antibiotics-preferably oral
Oxygen prn
IV fluids
Analgesia
Repeat CXR
50
Q

MRC dyspnoea scale

A 
1 Breathless with hard exertion
2 Breathless when walking up slight hill
3 Slow walker on level ground
4 Stop for breath after walking 100 metres
5 Breathless getting dressed
51
Q

Indications for home oxygen with COPD

A

PaO2< 55mmHg

SaO2 <88%

52
Q

Therapy for an acute coronary syndrome

A 
Antiplatelets
ACE inhibitors
Atorvastatin
Beta blocker
Bedside monitoring (telemetry)
Bloods (both on admission and for monitoring)
Clexane
Cath lab
Cardiac rehab
53
Q

How is severity of COPD determined?

A

GOLD criteria based of FEV1
Mild FEV1 >80
Moderate 50

54
Q

Contraindications for spirometry

A 
Vomiting/haemoptysis
pneumothorax
recent thoracic surgery
MI
Thoracic aneurysms
55
Q

How do we determine if a pleural fluid is exudate or transudate?

A

Light’s criteria
Pleural fluid protein/serum protein ratio = >0.5
Pleural fluid/serum LDH >0.6
Pleural fluid LDH> 2/3 upper limit for serum

Long Case (11 decks)

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