Respiratory Flashcards
what are restrictive lung diseases characterised by?
a reduction in lung volume, causing difficulty inhaling
give some examples of restrictive lung diseases…
interstitial lung disease
sarcoidosis
neuromuscular disease
what are obstructive lung diseases characterised by?
a reduction in airflow, causing difficulty exhaling
what symptoms accompany obstructive lung diseases?
cough and shortness of breath
give some examples of obstructive lung diseases…
COPD
asthma
cystic fibrosis
what are the 2 types of restrictive lung disease?
intrinsic (interstitial) or extrinsic (extra-pulmonary)
raised serum ACE levels, indicated which intrinsic restrictive lung condition?
sarcoidosis
the triad of dry cough, crackles and finger clubbing, are commonly seen in which intrinsic restrictive lung condition?
idiopathic pulmonary fibrosis
what happens to…
total lung capacity, FVC, FEV1 and the REV1:FVC ratio
…in intrinsic restrictive lung disease?
reduced total lung capacity
reduced FVC
reduced FEV1
normal (>0.8) ratio
what happens to…
total lung capacity, FVC, FEV1 and the REV1:FVC ratio
…in obstructive lung disease?
slightly reduced FVC
reduced FEV1
reduced ratio (<0.7)
what are the 2 main conditions of the pleura
pleural effusion
pneumothorax
what is a pleural effusion?
build-up of fluid in the pleural space
what is the effect of a pleural effusion on ventilation?
causes limited lung expansion and therefore ventilation
name some different types of pleural effusion…
hydrothorax
hemothorax
urinothorax
pleural empyema
what are the symptoms of a pleural effusion?
chest pain
dyspnoea
dry cough (fluid outside lung)
what are the 2 types of fluid in a pleural effusion? + explain
transudate - low protein, caused by systemic problem e.g. congestive HF
exudate - high protein, caused by an inflammatory problem e.g. infection or malignancy
what testing is done to confirm diagnosis of a pleural effusion?
chest x-ray
thoracic ultrasound
thoracentesis to extract fluid for analysis
treatment of pleural effusion?
intercostal drain in 5th intercostal space mid-axillary line
what is a pneumothorax?
air in the pleural space
describe a typical patient presenting with a primary spontaneous pneumothorax…
tall, thin, young male presenting with symptoms at rest
symptoms of a pneumothorax?
sharp one-sided chest pain
dyspnoea
hyper-resonance on percussion
absent breath sounds on auscultation
tests to diagnose pneumothorax?
chest x-ray
how to tell the difference between a pneumothorax or tension pneumothorax?
x-ray: in a tension pneumothorax there will be mediastinal shift and/or tracheal deviation
treatment of tension pneumothorax?
needle chest decompression - 5th intercostal space mid-axillary line
give examples of a type I hypersensitivity reaction…
allergic rhinitis
anaphylaxis
food allergies
give examples of a type II hypersensitivity reaction…
Grave’s disease
autoimmune haemolytic anaemia
give examples of a type III hypersensitivity reaction…
SLE
rheumatoid arthritis
give examples of a type IV hypersensitivity reaction…
diabetes mellitus I
Hashimoto’s thyroiditis
MS
GCA
what are the characteristics of asthma?
increased eosinophils
chronic airway inflammation
reversible airflow limitation
what are the symptoms of asthma?
coughing tight chest wheeze difficulty breathing whistle during expiration
what medication is given for mild intermittent asthma?
inhaled short-acting beta 2 agonist e.g. salbutamol
bronchodilator
what is the first add regular preventative medication for asthma?
low dose inhaled corticosteroid
anti-inflammatory
acute treatment of asthma attack?
- salbutamol via neb
- +/- ipratropium bromide
- oxygen for 93-95% sats
- oral / IV corticosteroids (prednisolone or hydrocortisone)
- IV magnesium
what is the mnemonic for signs of life-threatening asthma?
33 92 CHEST
- PEF <33%
- oxygen <92%
- cyanosis
- hypotension
- exhaustion
- silent chest
- tachycardia
what are the 4 possible signs of acute severe asthma?
PEF 33-50%
respiratory rate >25/min
heart rate >110/min
inability to complete sentences in one breath
what is respiratory failure?
the blood has not enough oxygen or too much carbon dioxide
what is type 1 respiratory failure? what typical values will be produced?
hypoxia
- lung failure
- low oxygen <8kPa
- normal or low CO2
what is type 2 respiratory failure? what typical values will be produced?
hypercapnia
- respiratory muscle pump failure
- high CO2 >6kPa
- low oxygen <8kPa
treatment of hypoxia?
oxygen
treatment of hypercapnia?
ventilation (non-invasive or invasive)
when is ECMO used?
to treat severe hypoxia or hypercapnia
what are the symptoms of COPD?
- dyspnoea
- cough
- wheeze
- sputum
- reduced exercise tolerance
- barrel chest
- cyanosis
- asterixes
what 2 processes cause COPD?
- chronic bronchitis
- emphysema
what are the management steps of COPD?
- stop smoking
- SABA or SAMA
- FEV>50% - LABA or LAMA
- FEV<50% - LABA + ICS
- LABA + LAMA + ICS
what can cause an acute exacerbation of COPD?
infections
treatment of acute COPD exacerbations?
- controlled oxygen (88-92% sats)
- nebuliser
- IV hydrocortisone and oral prednisolone for 7-14 days
- antibiotics if infection
what is pneumonia?
infection of the air sacs
what is the most common causative organism of typical pneumonia?
streptococcus pneumoniae
what is the most common causative organism of typical pneumonia in COPD patients?
haemophiliac influenza
what is the most common causative organism of pneumonia in HIV patients?
pneumocystis jivoreci
how does pneumocystis jivoreci often present?
HIV patient
dry cough and exercise induced desaturation
what are the 2 most common causative organism of atypical pneumonia?
mycoplasma pneumoniae
legionella (infected air conditioning units)
symptoms of typical pneumonia?
high fever
productive cough
chest pain
myalgia
signs of typical pneumonia?
crackles
tachypnoea, tachycardia
shadows on x-ray
lobar consolidation on CT
signs and symptoms of atypical pneumonia?
moderate fever dry cough myalgia abdo pain headache may have clear examination and x-ray
what score is used to asses pneumonia?
CURB-65
what does CURB-65 stand for?
confusion AMTS<8 serum urea >7 RR >30 BP <90 systolic or <60 diastolic age >65
management of pneumonia?
antibiotics (amoxicillin, co-amoxiclav)
- oxygen to maintain 94-98%
- IV fluids if dehydrated
what disease is caused by respiratory syncytial virus?
bronchiolitis
who is normally affected by bronchiolitis?
babies and children <2 y/o
symptoms of bronchiolitis?
runny nose
fever
dry cough
wheezing
management of bronchiolitis?
supplemental oxygen
what is the cause of cystic fibrosis?
abnormal CFTR protein - reduced Cl pumped into secretions - less water follows - thick mucus
symptoms of cystic fibrosis?
new borns: meconium ileus
early childhood: pancreatic insufficiency
children: infections in lungs
what is croup and what is it caused by?
viral infection in infants
parainfluenza virus
barking cough, stridor, fever in infant
diagnosis?
croup
treatment of croup?
oral dexamethasone to reduce tracheal swelling
following birth a baby develops fast breathing, fast HR, chest wall retractions, expiratory grunting, nasal flaring and a blue skin discolouration
what is going on?
infant respiratory distress syndrome
what is infant respiratory distress syndrome caused by?
insufficiency of surfactant production by type II pneumocytes at birth
treatment of infant respiratory distress syndrome?
oxygen
severe: endotracheal tube
