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Respiratory Flashcards

1
Q

what are restrictive lung diseases characterised by?

A

a reduction in lung volume, causing difficulty inhaling

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2
Q

give some examples of restrictive lung diseases…

A

interstitial lung disease
sarcoidosis
neuromuscular disease

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3
Q

what are obstructive lung diseases characterised by?

A

a reduction in airflow, causing difficulty exhaling

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4
Q

what symptoms accompany obstructive lung diseases?

A

cough and shortness of breath

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5
Q

give some examples of obstructive lung diseases…

A

COPD
asthma
cystic fibrosis

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6
Q

what are the 2 types of restrictive lung disease?

A

intrinsic (interstitial) or extrinsic (extra-pulmonary)

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7
Q

raised serum ACE levels, indicated which intrinsic restrictive lung condition?

A

sarcoidosis

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8
Q

the triad of dry cough, crackles and finger clubbing, are commonly seen in which intrinsic restrictive lung condition?

A

idiopathic pulmonary fibrosis

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9
Q

what happens to…
total lung capacity, FVC, FEV1 and the REV1:FVC ratio
…in intrinsic restrictive lung disease?

A

reduced total lung capacity
reduced FVC
reduced FEV1
normal (>0.8) ratio

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10
Q

what happens to…
total lung capacity, FVC, FEV1 and the REV1:FVC ratio
…in obstructive lung disease?

A

slightly reduced FVC
reduced FEV1
reduced ratio (<0.7)

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11
Q

what are the 2 main conditions of the pleura

A

pleural effusion

pneumothorax

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12
Q

what is a pleural effusion?

A

build-up of fluid in the pleural space

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13
Q

what is the effect of a pleural effusion on ventilation?

A

causes limited lung expansion and therefore ventilation

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14
Q

name some different types of pleural effusion…

A

hydrothorax
hemothorax
urinothorax
pleural empyema

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15
Q

what are the symptoms of a pleural effusion?

A

chest pain
dyspnoea
dry cough (fluid outside lung)

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16
Q

what are the 2 types of fluid in a pleural effusion? + explain

A

transudate - low protein, caused by systemic problem e.g. congestive HF

exudate - high protein, caused by an inflammatory problem e.g. infection or malignancy

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17
Q

what testing is done to confirm diagnosis of a pleural effusion?

A

chest x-ray
thoracic ultrasound
thoracentesis to extract fluid for analysis

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18
Q

treatment of pleural effusion?

A

intercostal drain in 5th intercostal space mid-axillary line

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19
Q

what is a pneumothorax?

A

air in the pleural space

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20
Q

describe a typical patient presenting with a primary spontaneous pneumothorax…

A

tall, thin, young male presenting with symptoms at rest

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21
Q

symptoms of a pneumothorax?

A

sharp one-sided chest pain
dyspnoea
hyper-resonance on percussion
absent breath sounds on auscultation

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22
Q

tests to diagnose pneumothorax?

A

chest x-ray

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23
Q

how to tell the difference between a pneumothorax or tension pneumothorax?

A

x-ray: in a tension pneumothorax there will be mediastinal shift and/or tracheal deviation

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24
Q

treatment of tension pneumothorax?

A

needle chest decompression - 5th intercostal space mid-axillary line

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25
give examples of a type I hypersensitivity reaction...
allergic rhinitis anaphylaxis food allergies
26
give examples of a type II hypersensitivity reaction...
Grave's disease | autoimmune haemolytic anaemia
27
give examples of a type III hypersensitivity reaction...
SLE | rheumatoid arthritis
28
give examples of a type IV hypersensitivity reaction...
diabetes mellitus I Hashimoto's thyroiditis MS GCA
29
what are the characteristics of asthma?
increased eosinophils chronic airway inflammation reversible airflow limitation
30
what are the symptoms of asthma?
``` coughing tight chest wheeze difficulty breathing whistle during expiration ```
31
what medication is given for mild intermittent asthma?
inhaled short-acting beta 2 agonist e.g. salbutamol | bronchodilator
32
what is the first add regular preventative medication for asthma?
low dose inhaled corticosteroid | anti-inflammatory
33
acute treatment of asthma attack?
- salbutamol via neb - +/- ipratropium bromide - oxygen for 93-95% sats - oral / IV corticosteroids (prednisolone or hydrocortisone) - IV magnesium
34
what is the mnemonic for signs of life-threatening asthma?
33 92 CHEST - PEF <33% - oxygen <92% - cyanosis - hypotension - exhaustion - silent chest - tachycardia
35
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
36
what is respiratory failure?
the blood has not enough oxygen or too much carbon dioxide
37
what is type 1 respiratory failure? what typical values will be produced?
hypoxia - lung failure - low oxygen <8kPa - normal or low CO2
38
what is type 2 respiratory failure? what typical values will be produced?
hypercapnia - respiratory muscle pump failure - high CO2 >6kPa - low oxygen <8kPa
39
treatment of hypoxia?
oxygen
40
treatment of hypercapnia?
ventilation (non-invasive or invasive)
41
when is ECMO used?
to treat severe hypoxia or hypercapnia
42
what are the symptoms of COPD?
- dyspnoea - cough - wheeze - sputum - reduced exercise tolerance - barrel chest - cyanosis - asterixes
43
what 2 processes cause COPD?
- chronic bronchitis | - emphysema
44
what are the management steps of COPD?
1. stop smoking 2. SABA or SAMA 3. FEV>50% - LABA or LAMA 4. FEV<50% - LABA + ICS 5. LABA + LAMA + ICS
45
what can cause an acute exacerbation of COPD?
infections
46
treatment of acute COPD exacerbations?
- controlled oxygen (88-92% sats) - nebuliser - IV hydrocortisone and oral prednisolone for 7-14 days - antibiotics if infection
47
what is pneumonia?
infection of the air sacs
48
what is the most common causative organism of typical pneumonia?
streptococcus pneumoniae
49
what is the most common causative organism of typical pneumonia in COPD patients?
haemophiliac influenza
50
what is the most common causative organism of pneumonia in HIV patients?
pneumocystis jivoreci
51
how does pneumocystis jivoreci often present?
HIV patient | dry cough and exercise induced desaturation
52
what are the 2 most common causative organism of atypical pneumonia?
mycoplasma pneumoniae | legionella (infected air conditioning units)
53
symptoms of typical pneumonia?
high fever productive cough chest pain myalgia
54
signs of typical pneumonia?
crackles tachypnoea, tachycardia shadows on x-ray lobar consolidation on CT
55
signs and symptoms of atypical pneumonia?
``` moderate fever dry cough myalgia abdo pain headache may have clear examination and x-ray ```
56
what score is used to asses pneumonia?
CURB-65
57
what does CURB-65 stand for?
``` confusion AMTS<8 serum urea >7 RR >30 BP <90 systolic or <60 diastolic age >65 ```
58
management of pneumonia?
antibiotics (amoxicillin, co-amoxiclav) - oxygen to maintain 94-98% - IV fluids if dehydrated
59
what disease is caused by respiratory syncytial virus?
bronchiolitis
60
who is normally affected by bronchiolitis?
babies and children <2 y/o
61
symptoms of bronchiolitis?
runny nose fever dry cough wheezing
62
management of bronchiolitis?
supplemental oxygen
63
what is the cause of cystic fibrosis?
abnormal CFTR protein - reduced Cl pumped into secretions - less water follows - thick mucus
64
symptoms of cystic fibrosis?
new borns: meconium ileus early childhood: pancreatic insufficiency children: infections in lungs
65
what is croup and what is it caused by?
viral infection in infants | parainfluenza virus
66
barking cough, stridor, fever in infant | diagnosis?
croup
67
treatment of croup?
oral dexamethasone to reduce tracheal swelling
68
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
69
what is infant respiratory distress syndrome caused by?
insufficiency of surfactant production by type II pneumocytes at birth
70
treatment of infant respiratory distress syndrome?
oxygen | severe: endotracheal tube

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