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Phase 4 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the physiological causes of pulmonary oedema?

A

Increased capillary permeability
Increased capillary pressure
Decreased oncotic pressure
Lymphatic obstruction

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2
Q

Symptoms of pulmonary oedema?

A

SOB - orthopnoea, exercise dyspnoea, paroxysmal nocturnal dyspnoea
Tachypnoea
Cough - pink frothy sputum

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3
Q

Investigations for pulmonary oedema?

A

Bloods - FBC, U+Es, BNP, blood gas
CXR
ECG
Lung function tests - restrictive pattern

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4
Q

How can you divide up the causes of pulmonary oedema?

A

Cardiogenic

Non-cardiogenic

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5
Q

What non-cariogenic conditions can cause pulmonary oedema?

A

Non-cardiogenic

  • volume overload (increased cap pressure)
  • renal - AKI, CKD, renal artery stenosis (increased cap pressure)
  • ARDS (increased cap permeability)
  • lung transplant (may cause lymphatic insufficiency)
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6
Q

What cardiogenic conditions can cause pulmonary oedema?

A

All cause increased capillary pressure:

  • MI
  • Valve problem - aortic regurg/stenosis, mitral regurg
  • PE
  • Cardiomyopathy
  • Cardiac tamponade
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7
Q

Management of pulmonary oedema?

A

Varies with cause

1) Sit patient up + oxygen
2) Nitrates (vasodilators) if Syst BP >90
3) Furosemide
4) Opiates (not if heart failure) - decrease anxiety but may suppress respiratory drive
5) ?ACEi long term

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8
Q

RFs for a PE? (Name 5)

A 
Post-surgery
Long-haul flight
cOCP
Malignancy
Pregnancy
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9
Q

What is the pathophysiology of CF?

A

Defects if the CFTR protein, who’s gene is on the long arm of Chr 7
Most commonly ∆508
Causes high conc of Na and low conc Cl in secretions

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10
Q

How do babies with CF normally present? (if not picked up of Guthrie screening)

A

Meconium ileus
Respiratory infections
Failure to thrive

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11
Q

Respiratory presentations of CF?

A

Recurrent infections esp with Pseudomonas
If aspergilloma, may have haemoptysis
Bronchiectasis
Nasal polyps
Pulmonary HTN + fibrosis may cause cor pulmonale

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12
Q

GI manifestations of CF?

A 
Pancreatic insufficiency -> malabsorption, steatorrhoea, DM
Thickening of bile -> portal HTN
Liver cirrhosis/CLD -> gynaecomastia
Gallstones, cholecystitis
Acute pancreatitis
Intussusception
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13
Q

Other manifestations of CF?

A

Infertility for males (failure of vas deferens and epididymis to develop)
DM

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14
Q

Ix for CF

A

Immunoreactive trypsinogen in heel prick
Sweat test - >Na, >Cl
Nasal potential difference testing
Genetic testing

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15
Q

Management of pulmonary manifestations in CF?

A

Vigorous daily physiotherapy - with manual percussion, forced expiratory manoeuvres and vibration
May also be a role for postural drainage - lying in various positions
Prophylactic or responsive abx

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16
Q

Management of nutrition in CF?

A

Enteric coated pancreatic enzymes
KADE vitamin replacement
120% normal diet intake - high calorie, high fat

17
Q

Respiratory causes of clubbing?

A

Bronchus carcinoma, mesothelioma, bronchiectasis, abscess, empyema, fibrosing alveoli’s, CF
NOT COPD or asthma

18
Q

Which abx treats MRSA?

A

Vancomycin

19
Q

Which abx treats Legionella?

A

Clarithromycin

20
Q

Which organs does sarcoidosis affect?

A

Lungs, eyes, skin

Heart, kidney, CNS

21
Q

Investigations for sarcoidosis?

A

Bloods - Raised serum ACE, Ca, ESR and Ig
Urine - raised Ca
CXR/CT - hilar lymphadenopathy
Tissue biopsy - non-caseating granulomata with epithelioid cells

22
Q

Management of sarcoidosis?

A

Bilateral hilar lymphadenopathy alone - no Tx needed
Acute - bed rest + NSAIDs
Consider prednisolone 6-12 months

23
Q

What are the symptoms of idiopathic pulmonary fibrosis?

A

Dry cough, exertion dyspnoea, malaise, WL, arthralgia

24
Q

What are the signs of IPF?

A

SOB/cyanosis, clubbing, fine end-inspiratory creps

25
Q

Investigations for IPF?

A

Reduced transfer factor (TLCO)
ANA +ve in 30%
CXR - ground glass to honeycomb lung
CT - Ix of choice

26
Q

Management for IPF?

A

Best supportive care - O2, pulmonary rehab, opiates, palliative care

27
Q

How much does peak flow readings need to change by to diagnose asthma?

A

After bronchodilator reversibility test: improvement of FEV1 >12% and increase in volume of >200ml

28
Q

What is the side effect of salbutamol?

A

Tremor

29
Q

What is the side effect of ICS (beclometasone)?

A

stunted growth in
children
oral candida

30
Q

Asthma treatment?

A

SABA (salbutamol) - for symptomatic relief, relaxes SM of the airways

If asthma not controlled/new Dx + symptoms ≥3 times/wk or night-time waking:
ICS (beclometasone) - taken every day regardless of symptoms
Add a LTRA, continue if responsive
LTRA (Montelukast) - oral
LABA (salmeterol) - taken every day regardless of symptoms

MART (maintenance + reliever therapy) is now an option for patients with poorly controlled asthma – contains ICS + LABA in a single inhaler

31
Q

Main investigation for asthma after spirometry?

A

FeNO test

32
Q

Examples of T1 and T2 respiratory failure?

A

T1: Pneumonia, Pulmonary Oedema, PE, Asthma, Emphysema, Pulmonary fibrosis
T2:
- Pulmonary disease – asthma, COPD, pneumonia, end-stage pulmonary fibrosis etc
- Reduced respiratory drive – sedative drugs, CNS tumour or trauma
- Neuromuscular disease – cervical cord lesion, myasthenia gravis, GBS
- Thoracic wall disease – flail chest, kyphoscoliosis

33
Q

Symptoms of hypoxia?

A

SOB, agitation, central cyanosis, confusion

34
Q

Symptoms of hypercapnia?

A

headache, peripheral vasodilatation, tachycardia, tremor/flap, papilloedema

35
Q

Causes of pneumothorax?

A

Often spontaneous
Chronic disease - asthma, COPD, CF, Ca
Infectious - TB, pneumonia
Trauma

36
Q

When might you need surgical advice for a pneumothorax?

A 
If:
•bilateral pneumothoraxes
•Failure of IC drain insertion
•2+ previous pneumothoraxes on same side
•Hx of pneumothorax on the opposite side
37
Q

What causes transudates in pleural effusions?

A

D/t increased hydrostatic pressure
Too much fluid - CCF, fluid overload
Hypoproteinaemia - cirrhosis, malabsorption

38
Q

What causes exudates in pleural effusions?

A

The gap between the endothelial cells widen and fluids and proteins leak out, therefore there is a high protein content found in exudates e.g. caused by infection, Ca, PE, RA, SLE etc

Phase 4 (13 decks)

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