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Phase 1 Exam > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Definition of PE

A
  • Consequence of the formation of thrombus within the deep veins due to Virchow’s triad
  • Common
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2
Q

Aetiology of PE

A
  • Due to Virchow’s triad within the veins - hypercoagubility, venous stasis and trauma.
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3
Q

Risk factors of PE

A
  • Malignancy, pregnancy, surgery, increasing age, previous history, family history, periods of immobility, recent air travel and HRT/OCP
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4
Q

Pathophysiology of PE

A
  • Massive PE obstructs the right ventricular outflow to leading to increase in pulmonary vascular resistance, causing acute right heart failure.
  • Lung tissue is ventilated but not perfused.
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5
Q

Presentation of PE

A
  • Small/medium PE’s present with breathlessness/pleuritic chest pain and haemoptysis
  • Massive PEs are medical emergencies - presenting with severe central chest pain, evidence of central cyanosis and increased jugular pressure.
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6
Q

Investigations of PE

A
  • Use Geneva scoring in order to workout likelyhood of PE
  • CXR, ECG and ABG can be used to identify other causes
  • D dimer
  • CT pulmonary angiography is diagnostic
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7
Q

Management of PE

A
  • LMWH, warfarin, DOACs
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8
Q

What is bronchiectasis?

A
  • Chronic inflammation which causes the bronchi and bronchioles to become damaged and dilated.
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9
Q

Aetiology of bronchiectasis

A
  • Primary ciliary dyskinesia
  • As the cilia can’t move correctly it allows for the build up of mucous within the airways, this allows bacteria to multiply leading to pneumonia. Eventually this leads to chronic inflammation with creates damaged
  • Cystic fibrosis is an example of a condition where this happens
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10
Q

Symptoms of bronchiectasis

A
  • Cough, wheeze, SOB, foul smelling mucous
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11
Q

Investigations of bronchiectasis

A
  • CT
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12
Q

Management of bronchiectasis

A
  • Antibiotics, surgery, drainage
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13
Q

Definition of bronchiolitis

A
  • Acute viral infection of the lower respiratory tract, usually caused by RSV and seen in children.
  • Usually before the age of 2 with peak incidence being in babies at 3m and 6m.
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14
Q

Risk factors of bronchiolitis

A
  • Older siblings, overcrowding, nursery, passive smoke, low birth weight or premature
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15
Q

Symptoms of bronchiolitis

A
  • Cold like symptoms for 2 - 3 days that follows with a persistent cough with tachypnoea/ chest recession and wheeze/crackles
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16
Q

Investigations of bronchiolitis

A
  • Viral swabs and pulse oximatory
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17
Q

Management of bronchiolitis

A
  • Usually self limiting, supportive measures and high flow nasal cannula
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18
Q

Definition of Asthma

A
  • Chronic inflammatory disorders of the large airways that is characterised by recurrent episodes of reversible airway obstruction.
  • Associated with widespread but variable airflow obstructions, which is increased in response to a stimuli.
  • Obstructions can either reverse spontaneously or with the use of pharmacological managements.
  • Can be either atopic or non atopic.
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19
Q

Aetiology of Asthma

A
  • Most cases are due to atopy.

- Consideration of dysregulation of the immune resposne could lead to the development of asthma in children.

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20
Q

Pathophysiology of Asthma

A
  • IgE immune mediated response leading to airway remodelling within the airways.
  • This leads to narrowing of the airway wall and hypersensitivity of the bronchial.
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21
Q

Presentation of Asthma

A
  • Intermittent breathlessness, wheezing and chest tightness.
  • Cough, particularly at night, is common
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22
Q

Investigations of Asthma

A
  • Spirometry - measures total volume of air a patient can exhale in one forced breath in one second. FVC - total amount of air that can forcefully expire and FEV1 - total amount of air expired in one second.
  • Peak exipatory flow - lower in asthmatics
  • Exhaled nitric oxide = gold standard
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23
Q

Management of Asthma

A
  • SABA (Terol) - reliever therapy = given to all patients
  • ICS (one) - preventor therapy, next step up, side effects include oral thrush, hoarsness and cough
  • Leukatrine receptor antagonists - tablets
  • LABA (Terol)
  • MART
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24
Q

What are the types of asthma?

A
  • Occupational
  • Seasonal
  • Exercise induced
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25
Q

Definition of TB

A
  • Pulmonary TB is caused by myobacterium tuberculosis - mostly dormant then progressives into active TB
  • It can affect other areas of the body but mainly hte lungs.
  • In the UK, the highest incidence is seen in immigrants, the homeless or HIV patients.
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26
Q

Aetiology of TB

A
  • Pink acid fast bacilli

- Latent TB = no clinical, bacteriological or radiographic evidence

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27
Q

Presentation of TB

A
  • Primary TB usually symptomless but possible eryhtem nodosum, small pleural effusion or pleural collapse.
  • Active TB can present with malaise, weight loss, fever, anorexia or cough.
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28
Q

Investigations of TB

A
  • Sputum - Ziehl Neelsen stain
  • CXR
  • Latent TB - Mantoux test or IGRA
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29
Q

Management of TB

A
  • 6 months RIPE reigmen
  • Rifamprici, isonitrix, pyraminamide and ethambutol for 2m then RI for 4 months
  • DOTS - direct observation therapy
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30
Q

Definition of flu

A
  • Acute respiratory tract infection caused by the seasonal influenza virus A, B or C.
  • Transmitted through inhalation of infected respiratory secretions that have been aerosolised through cough, sneezing or talking.
  • Cells made up of haemagglutinin and neurominidase which are antigen sites.
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31
Q

Aetiology of flu

A
  • Member of orthmyxovirus family

- Influenza A is responsible for larger outbreaks

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32
Q

Presentation of flu

A
  • Incubation is usually 1 to 3 days
  • Upper and/or lower respiratory tract symptoms
  • Usually fever, generalised aching in the limbs, severe headache, sore throat and dry cough.
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33
Q

Investigations of flu

A
  • Virology
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34
Q

Management of flu

A
  • Symptomatic treatment with paracetomol, bed rest and maintencance of fluid
  • Neurominidase inhibitors (Zanamivir) and tamiflu
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35
Q

Definition of pleural effusion

A
  • Excess fluid within the pleural space.

- Can be detected clinically at more than 500ml and on CXR at more than 300ml

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36
Q

Aetiology of pleural effusion

A
  • Transudate (heart failure and constrictive pericarditis - less than 30g of protein) and exudate (infection and malignancy, more than 30g of protein)
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37
Q

Presentation of pleural effusion

A
  • Dyspnoea

- Dull tone on chest percussion

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38
Q

Investigations of pleural effusion

A
  • Diagnostic aspiration
  • Contrast CT
  • Biopsy
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39
Q

Management of pleural effusion

A
  • Depends on underlying cause
  • Exudate usually drained
  • Transudate underlying cause
40
Q

Definition of hypersensitivity pneumonitis

A
  • Widespread diffuse inflammatory reaction within the alveoli and small airways of the lungs as a response to inhalation of organic dusts.
  • Most commonly seen in farmer’s lung
41
Q

Aetiology of hypersensitivity pneumonitis

A
  • Farmers, birds, humidifier, cheese washer, wine maker or mushroom
42
Q

Presentation of hypersensitivity pneumonitis

A
  • Fever, malaise, cough and SOB several hours after exposure to the antigen
  • Course end inspiratory crackles and squeaks.
43
Q

Investigations of hypersensitivity pneumonitis

A
  • CXR - would show fluffy nodular shadow

- CT

44
Q

Management of hypersensitivity pneumonitis

A
  • Steroids and identify cause to prevent
45
Q

Definition of pneumoconiosis

A
  • Group of intersistial lung diseases, mostly of occupational origin, caused by the inhalation of metals or mineral dusts.
  • 3 most common are silicosis (caused by the inhalation of silia), coal worker’s pneumoconiosis or chronic beryllium disease
46
Q

Presentation of pneumoconiosis

A
  • Dyspnoea on exertion, a cough, normal CXR or crackles on chest auscultation.
47
Q

Investigations of pneumoconiosis

A
  • CXR - calcification in upper zones, egg shell appearance in silicosis
  • CT
48
Q

Management of pneumoconiosis

A
  • No cure, about prevention

- Oxygen, bronchodilators, corticosteroids.

49
Q

What is asbestosis?

A
  • Associated with patients that have a clear history being exposed to the disease.
  • Long latency period of between 20 and 40 years.
  • Diagnosis is with XR, CT, lung function tests and biopsy.
  • Symptoms persistent cough, SOB, fatigue and wheezing.
  • No cure but can use oxygen therapy and pulmonary rehab.
50
Q

Definition of mesothelioma

A
  • Aggressive epithelial neoplasm of the lungs, pericardium, abdo and tunica vaginialis.
  • Most commonly caused by direct exposure to asbestosis.
  • Usually seen in patients that are male between 60 to 90, with incidence increasing since the 1960’s.
51
Q

Aetiology of mesothelioma

A
  • Asbestosis exposure - latency period

- Potentially exposure to radiation is a possible cause.

52
Q

Presentation of mesothelioma

A
  • SOB, diminished breaths sounds and dullness to percussion.
  • Fx and personal history of exposure to asbestosis.
  • Chest pain and cough.
53
Q

Investigations of mesothelioma

A
  • CXR/CT
54
Q

Management of mesothelioma

A
  • Surgery, chemo and radiotherapy
55
Q

Definition of idiopathic interstitial pneumonias

A
  • 40% of cases of diffuse parenchymal lung diseases with no known underlying cause
  • Idiopathic pulmonary fibrosis is the most common
56
Q

Definition of idiopathic pulmonary fibrosis

A
  • Rare chronic life threatening disease manifesting over several years and is characterised by the development in the formation of scar tissue
  • Usually develops in the late 60’s and more common in males.
57
Q

Presentation of idiopathic pulmonary fibrosis

A
  • Progressive breathlessness and non productive cough

- Eventually resp failure, pulmonary hypertension and cor pulmonale

58
Q

Investigations of idiopathic pulmonary fibrosis

A
  • CT, CXR, biopsy
59
Q

Management of idiopathic pulmonary fibrosis

A
  • Antifibrotic drugs

- Transplant

60
Q

Definition of sarcoidosis

A
  • A multisystem granulomateous disorder typically affecting young and middle aged adults
  • Usually female - northern europe and japan
  • Course is more severe in black patients
61
Q

Presentation of sarcoidosis

A
  • Cough, breathlessness
  • Bilateral hilar lyphadenopathy and/or pulmonary infiltrations as well as skin/eye lesions
  • Can be asymptomatic
62
Q

Investigations of sarcoidosis

A
  • Biospy, CT , CXR
63
Q

Management of sarcoidosis

A
  • Disease usually remits spontaneously within 2 years
  • Steroids
  • Steroid sparing agents
64
Q

Definition of anaphylaxis

A
  • Severe generalised or systemic hypersensitivity reaction, characterised by rapidly progressive life threatening airways and breathing issues as well as circulatory issues with associated skin and mucosal changes.
  • Incidence is higher in younger children
65
Q

Aetiology of anaphylaxis

A
  • Common allergens include food, drugs and insect bites.
66
Q

Presentation of anaphylaxis

A
  • Acute onset, airway swelling that leads to inspiratory stridor and hoarsevoice combined with SOB, wheeze, chest hyperinflatation and accessory muscle.
67
Q

Investigations of anaphylaxis

A
  • Mast cell tryptase

- ECG, U&E, ABG and CXR

68
Q

Management of anaphylaxis

A
  • 0.5mg adrenaline

- 1 in 1000

69
Q

Definition of pneumonia

A
  • Inflammation of the lung substance of the lungs and is usually caused by a bacteria.
  • Can be defined depending on it’s position so lobar or bronchopenumonia as well as being community or hospital acquired.
  • Usually hospitalisations for 6 to 9 days.
70
Q

Aetiology of pneumonia

A
  • Strep pneumonia - gram positive cocci - is the most common cause of community acquired pneumoniae.
71
Q

Presentation of pneumonia

A
  • Fever, sweats and rigor
  • Cough with sputum - characteristically rusty coloured sputum in patients with Strep pneumoniae
  • SOB and pleuritic chest pain
72
Q

Investigations of pneumonia

A
  • CURB 65
  • Increased HR and RR, low BP, fever and dehydration
  • Sputum culture
  • Check for HIV
73
Q

Management of pneumonia

A
  • Mild = amoxicillin 500mg

- Severe = IV antibiotics - co amoxiclav and clanthryomycin

74
Q

Definition of pneumothorax

A
  • Occurs when air gains access to the pleural space and accumulates.
  • Can lead to partial or complete collapse of the lung and be either spontaneous or due to secondary chest causes
  • More common in men and patients that smoke are at an increased risk
75
Q

Aetiology of pneumothorax

A
  • Spontaneous seen commonly in young males (Tall and thin) and underlying causes such as COPD or trauma
76
Q

Presentation of pneumothorax

A
  • Sudden onset pleuritic chest pain and breathlessness
77
Q

Investigations of pneumothorax

A
  • CXR
78
Q

Management of pneumothorax

A
  • Aspiration
  • Intercostal tube drain
  • Surgery - pleurectomy
79
Q

Definition of lung cancer

A
  • Most commonly bronchial tumours in 95% of primary lung tumours.
80
Q

Aetiology of lung cancer

A
  • Smoking
81
Q

Presentation of lung cancer

A
  • Haemotysis, cough for more than 3 weeks, chest pain and breathlessness, weight loss
82
Q

Investigations of lung cancer

A
  • CXR = shows fluffy/spiked apperance
  • Histology
  • CT
83
Q

Management of lung cancer

A
  • Surgery, chemo and radiotherapy
84
Q

Definition of respiratory failure

A
  • Occurs when pulmonary gas exchange is sufficiently impaired to cause hypoxaemia with or without hypercapnia
  • Inability of the lungs to adequately oxygenate the arterial blood supply or remove CO from the venous blood supply.
  • Resp failure occurs when PaO2 is more than 8 and PaCO2 is less than 7.
  • Type 1: Pa02 is low, PaCO2 is normal/low, it’s usually due to damage to the lungs - the hypoxaemia is due to ventilation - LUNG FAILURE
  • Type 2: Pa02 is low but PaCO2 is high, it’s caused by alveolar hypoventilation - PUMP FAILURE
85
Q

Aetiology of respiratory failure

A
  • Type 1: pulmonary oedema, pneumonia, acute severe asthma and COPD
  • Type 2: COPD and asthma
86
Q

Classification of respiratory failure

A
  • Acute respiratory failure: when there is an acute period of insufficient oxygenation of the blood or removal of CO2 from the blood.
  • Chronic resp failure: a period of time where there is a long term lack of oxygen supply leading to resp acidosis
87
Q

Presentation of respiratory failure

A
  • Could present with trauma and neck leading to resp failure.
  • Dyspnoea, confusion, tachypnoea, stridor, inability to speech, retraction of intercostal space and cyanosis.
88
Q

Investigations of respiratory failure

A
  • Pulse oximetry
  • FVC
  • ABG - Type 2 = resp acidosis and Type 1 = resp alkalosis
89
Q

Management of respiratory failure

A
  • Type 1 = oxygen (94 - 98%), treat cause and CPAP

- Type 2 = cautious oxygen (88 - 92%), medical treatment for 1 hour before intubation.

90
Q

Definition of COPD

A
  • Characterised by poorly reversible airflow limitations that is often progressive and associated with persistent inflammation.
  • COPD = Emphysema and chronic bronchitis
  • Over 65, smokers disease
91
Q

Aetiology of COPD

A
  • Smokers, exposure to pollutants and a1 antitripsin gene
92
Q

Pathophysiology of COPD

A
  • In chronic bronchitis, airflow narrowing leading to limited airflow due to hyperplasia and hypertrophy of mucosal gland secreting cells in the bronchial tree.
  • In emphysema, their is dilation and destruction of the lung tissue leading to reduced elastic recoil.
93
Q

Presentation of COPD

A
  • Cough with sputum, wheeze and breathlessness.
  • Blue bloaters = cyanosed
  • Tends to not have nocturnal symptoms and usually it happens to the same extent
94
Q

Investigations of COPD

A
  • LFT = FEV1/FVC ratio is less than 0.7
95
Q

Management of COPD

A
  • SABA or SAMA
  • LABA or LAMA
  • ICS and LABA
  • ICS, LABA and LAMA
  • Oxygen sats (88 - 92%)
  • Broncodilator neubliser
  • Smoking cessation and pulmonary rehab
  • Steroids and antibiotics

Phase 1 Exam (25 decks)

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