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Respiratory Flashcards

1
Q

What is asthma

A

Chronic airway inflammation that causes episodic exacerbations of bronchoconstriction

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2
Q

What is asthma charecterised by

A
  • Reversible airflow limitations
  • Airway Hyper-responsiveness
  • Brobchial inflammation
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3
Q

What are the 2 groups os asthma

A
  • Eosinophillic

- Non eosinophillic

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4
Q

What are the 2 types of eosinophillic asthma

A

Atopic

  • Fungal allergy
  • Common aeroallergens
  • Occupational
  • Pets

Non - atopic

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5
Q

What are the 3 types on non-eosionophillic asthma

A
  • Non smoking non eosinophillic
  • Smoking assosciated
  • Obesity related
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6
Q

What are triggers for asthma

A
  • Infection
  • Cold air
  • Animals
  • Excercise
  • Cold/damp
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7
Q

Asthma presentation - Sx

A
  • Dry cough
  • Wheeze
  • S.O.B
  • Chest tightness
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8
Q

Asthma presentation - signs

A
  • Bilateral polyphonic wheeze
  • Prolonged expiratory time
  • Hyperinflated chest
  • Diurinal variability -worse at night
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9
Q

Asthma investigations

A

1st -
Spirometry -with reversibility

Peak air flow - 2x per day

CXR - hyperinflation in acute attack

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10
Q

Asthma conservative management

A
  • Avoid smoking and allergens
  • Loose weight
  • Avoid triggers (NSAIDs)
  • Yearly asthma review
  • Yearly influenza vaccination
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11
Q

Asthma Medical management

A

1 - SABA (Salbutamol)

2 - SABA + ICS
(Budoneside)

3 - SABA + ICS + LABA
(Salmeterol)

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12
Q

Function of beta agonists

A
  • Bind to B2 receptor on lungs
  • Increase CAMP
  • Relaxation
  • Bronchodilation

Similar to adrenaline and noradrenaline

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13
Q

What is bronchiectasis

A

Permanent dilatation of bronchi and bronchioles due to destruction of elastic and muscualr comonenets of bronchial wall

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14
Q

What are the causes of bronchiectasis

A

Recurrent infections secondary to underlying conditions

Bronchial damage

  • Pneumonia
  • WHooping cough

Cystic fibrosis

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15
Q

Bronchiectasis presnetation - Sx

A

Cough

  • Green purulent sputum
  • Intermitent haemoptysis

Breathlesness
Wheeze
Fatigue

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16
Q

Bronchiectasis presentation - signs

A
  • Clubbing
  • Bilateral coarse crackles
  • High pitch inspiratory wheeze
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17
Q

Bronchiectasis investigations - Gold standard

A

HRCT

  • Airway dialtation
  • Bronchial wall thickening
  • Bronchial wall cysts
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18
Q

Bronchiectasis investigations

A

CXR

  • Cystic shadows
  • Thickened bronchial walls

Sputum culture

Spirometry
- Obstructive pattern

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19
Q

Bronchiectasis management

A

Mucolytics - Dornase aplha

Respiratory physio

Antibiotics

Pneumococcal and Flu vaccination

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20
Q

What is COPD

A

Non reversible long term deterioration in airflow through the lungs caused by damage to lung tissue

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21
Q

What is COPD charecterised by?

A

Airway obstruction

Airway limitation

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22
Q

COPD causes

A
  • Smoking ( > 20 pack years)
  • Chrnoic exposure to pollutants
  • Alpha 1 antitrypsin deficiency
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23
Q

What is chronic bronchitis

A

Cough with sputum for 3 months for 2 consecutive years

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24
Q

Pathophysiology of chronic bronchitis

A
  • underlying inflammation
  • Mucous hypersecretion
  • Inflammatory oedema
  • Scarring and thickening
  • Airway narrows
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25
Q

What is emphyesema

A

Dilatation and destruction of lung tissue distal to terminal bronchioles

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26
Q

Pathophysiology of emphysema

A
  • Elastin breakdown due to inflammation
  • Loss of elastic recoil
  • Air trapped in lungs
  • exhalation through pursed lips
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27
Q

Histological presentation of emphysema

A

Enlarged air spaces distal to terminal bronchioles with alveolar destruction

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28
Q

When should you suspect COPD Dx

A
  • Long term smoker
  • Chrnoic SOB
  • Cough
  • Sputum
  • Wheeze
  • Recurrent infections - winter
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29
Q

Chrnoic bronchitis presentation

A
  • productive cough >3m for 2 years

BLUE BLOATER

  • Central cyanosis
  • reduced excercise tolerance
  • Abnormal auscultation
  • Dyspnoea at rest
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30
Q

Emphysema presentation

A

PINK PUFFER

  • CO2 retention
  • Barrel chest
  • Pursed lips
  • Non productive cough
  • Use of accessory muscles of inspiration
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31
Q

COPD management - conservative

A
  • smoking cessation

- Pneumoccocal and influenza vaccine

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32
Q

COPD management - medical

A
  • SABA

No asthmatic/ No steroid responsive features
- LABA + LAMA

Asthmatic / steroid responsive features
- LABA + LAMA + ICS

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33
Q

O2 targets for COPD patients

A

88-92%

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34
Q

COPD exacerbation

  • Community
  • Hospital
A

Community

  • Strep pneumoniae
  • Influenza

Hospital
- Pseudomonas aeruginosa

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35
Q

Small cell lung cancer

- association

A

Stong assosciation with smoking

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36
Q

what can a Small cell lung cancer lead to

A

Paraneoplastic syndromes due to release of neurosecretory granules

ACTH –> Cushings
ADH –> SIADH
Tumour Auto-Ab –> Lambert-eaton myasthenic syndrome (NMJ attacked)

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37
Q

Non small cell lung cancer subtypes

A
  • Squamous cell
  • Large cell
  • Adenocarcinoma
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38
Q

Squamous cell carcinoma

  • assosciation
  • name 2 things produced by the tumour
A
  • Strongly assosciated with smoking
  • Keratin production
  • PTH secretion –> Hypercalcaemia
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39
Q

Adenocarcinoma

- assosciation

A
  • STRONG assosciation with Asbestos

- more common in non smokers

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40
Q

What is a Pancoast tumour

and what is the presentation

A

Tumour of lung apex

compression of B.V and nerves

  • Thoracic duct –> Upper arm swelling
  • Brachial plexus –> Weakness in hand muscles
  • SNS –> Horners syndrome
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41
Q

What is horners syndrome

A
  • anhyrosis
  • partial ptosis
  • miosis
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42
Q

Lung cancer presentation

A
  • cough ( > 3wks –> CXR)
  • SOB
  • Haemoptysis
  • Clubbing
  • Chest pain
  • WL / fever / night sweats
  • Recurrent infections
  • Pleural effusions
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43
Q

Sx of mets

A
  • Bone pain
  • Seizures
  • Hepatic pain
  • Abdo pain
  • Headache
  • Neurological defecit
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44
Q

1st line Lung cnacer investigations

A

CXR

  • Hilar enlargement
  • Peripheral opacity
  • Pleural effusion
  • Collapse

Sputum cytology
Contrast enhanced CT CAP - staging

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45
Q

2nd line Lung cancer investigations

A

PET-CT - increases metabolic activity

Bronchocscopy with biopsy

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46
Q

Presentation of RLN palsy in Pancoast tumour

A
  • Hoarse voice

- Bovine cough

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47
Q

SVC obstruction in Pancoast tumpur presentation

A
  • Facial swelling
  • Difficulty breathing
  • Distended neck veins
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48
Q

What is pemberton’s sign

A
  • Raise hands above head
  • Facial congestion and cyanosis
  • Obstruction of SVC by pancoast tumour
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49
Q

Pleural effusion

  • Transudative
  • protein content
  • causes
A
  • LESS protein
    Increased hydrostatic pressure or decreased oncotic pressure

Pleural protein <3g/dL

Causes:

  • CCF
  • Hypoalbuminaemia
  • Hypothyroidism
  • Meig’s syndrome
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50
Q

PLeural effusion

  • Exudative
  • protein content
  • causes
A
  • MORE protein
    Increased leakiness of pleural capillaries due to infection or inflammation

Pleural protein >3g/dL

Causes:

  • Lung cancer
  • Pneumonia
  • TB
  • Rhematoid arthiritis
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51
Q

Pleural effusion Sx

A
  • SOB
  • Dyspnoea
  • Pleurisy
  • Dry non productive cough
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52
Q

Pleural effusion signs

  • exmaination
  • ausculation
  • percussion
A
  • tracheal deviation
  • decreased chest expansion
  • Diminished breath sounds
  • Decreased tactile fremitus
  • Dullness to percussion
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53
Q

Pleural effusion investigations

A

CXR

  • Meniscus - large
  • Blunting of costaphrenic angles - small

Thoracocentesis

  • Lights criteria
  • Red cell count
  • LDH count
  • Protein count
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54
Q

Where do you insert a chest drian

A

triangle os safety

  • Lateral boarder of pec major
  • Anterior boarder of Lat dorsi
  • Lateral level of the nipple
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55
Q

When to suspect empeyema

A

Infected pleural effusion

- Pt with improving pneumonia but new/on going fever

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56
Q

Name 3 causes of CAP

A
  • Strep pneumonia
  • Hameophillius influnzae
  • Mycoplasma pneumonia
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57
Q

Name 3 causes of HAP

A
  • S.Aureus
  • Psedomonas aeruginosa
  • Klebsiella pneumonia
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58
Q

Fungal Pneumonia

  • causes
  • presentation
  • Tx
A

Pneumocytisis jiroveci
- Immunocompromised Pts

Dry non productive cough
SOB on exertion
Night sweats

Co-trimoxazole

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59
Q

Pneumonia presentation

A
  • SOB
  • Productive cough
  • Haemoptysis
  • Fever
  • Pleuritic chest pain
  • Delerium
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60
Q

Sign of Strep penumonia infection - CAP

A

Rusty coloures sputum

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61
Q

Pneumonia signs

  • examiantion
  • percussion
  • auscultation
A

Tachypnoea
Tachycardia
Hypoxia

Dull percussion note
Increased vocal fremitus

Bronchial breath sounds - consolidation
Focal coarse crackles

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62
Q

Pneumonia severity assessment

A

CURB - 65

Confusion

Urea - > 7

Resp rate - >30

BP -

  • < 90 Systolic
  • < 60 diastolic

Age - > 65

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63
Q

Pneumonia CURB score results

A

0-1 –> PO Abx + Home tx

2 - consider admission

3 - severe –> ICU

64
Q

Pneumonia investigations

A

CXR
- Consolidation

Sputum

  • gram stain
  • culture
  • sensitivity

Bloods

65
Q

Abx -

CURB (0-1)

A

Oral therapy
- Amoxixillin

Penecillin allergy
Doxycycline / clarithromycin

66
Q

Abx

CURB (2)

A

Oral therapy

- Amoxicillin + Clarithromycin

67
Q

Abx

CURB (3)

A

IV therapy

Co-amoxiclav + Clarithromycin

68
Q

What is a pneumothorax

A

Air in pleural space leading to partial or complete lung collapse

69
Q

Name 3 causes of a spontaneous pneumothorax

A

Primary - Young pts with no known resp illnesses
- Marfans

Secondary - Pts with pre-exisitng resp illnesses

  • COPD
  • CF
  • Sarcoidosis
70
Q

Name 3 causes of tramuatic pneumothorax

A
  • tension - stab wound
  • pleural aspiration
  • pleural biopsy
  • infection
71
Q

Non tension penumothorax presentation

A

Sx

  • dyspnoea
  • pleuritic chest pain
  • breathlessness
72
Q

Non tension pneumothorax signs

A

percussion
- Hyper resonant

Aucultation
- decreased breath sound s

Examiantion
- decreased chest expansion

73
Q

tension pneumothorax signs

A 
Distended neck veins 
tracheal deviation 
reduced air entry 
hypotension 
tachycardia
74
Q

Tx of tension penumothorax

A

Insert large bore needle with syringe filled with 0.9% sailine into 2nd intercostal space mid clavicualr line

75
Q

Pulmonary embolism

what does a large and a small emboli cause

A

Large - HF and cardiac arrest

Small - intrapulmonary dead space and V/Q mismatch

76
Q

Causes of hypercoagulability

- virchows triad

A 
dehydration 
polycythaemia 
contraceptive pill - oestrogen 
nephrotic syndrome 
maignancy
77
Q

What is virchows triad

A

hypercoagulability
stasis of blood flow
endothelial injury

78
Q

Pulmoary embolism presentation

A
  • SOB
  • Pleuritic chest pain
  • Haemoptysis
  • Fever
  • Hypoxia
  • Tachycardia
  • DVT
79
Q

What does tachypnoea lead to in a PE

A

respiratory alkalosis

80
Q

Pulmonary embolism investigations

A

1st line

  • CTPA (IV contrast)
  • V/Q perfusion scan
  • D-dimer
  • ABG
  • ECG
81
Q

Explain the Wells score

A

Risk of pt presenting with sx having a DVT/PE

Likely (>4) –> CTPA

Unlikely –> D-dimer –> Positive –> CTPA

82
Q

Small PE management

A
  1. O2 + analgesia
  2. Enoxaparin
  3. Long term anti-coag
    - Warfarin
    - DOAC
    - LMWH - pregnancy/malignancy
83
Q

Large PE management

A

Haemodyanmic compromise (BP < 90mmHg)

Thrombolysis - STREPTOKINASE / ALTEPLASE

84
Q

What is pulmonary fibrosis

A

chronic inflammation with scar tissue formation

85
Q

Pulmonary fibrosis RF

A

Smoking
Infection - CMV / Hep C / EBV
Family Hx

86
Q

What drugs are a RF for pulmonary fibrosis

A

amiodarone
Methotrexate
Ant-depressants
Nitrofurantoin

87
Q

Pulmonary fibrosis presnetation

A
  • dyspnoea
  • cough - non productive and paroxysmal
  • breathlesness
  • resp failure
88
Q

Pulmonary fibrosis signs

A
  • clubbing
  • Auscultation
    Crackles - fine inspiratory basal
89
Q

Pulmonary fibrosis investigations

A

High resolution CT
- ground glass apperance

CXR

Spirometry - restrictive

Bloods - Type 1 resp failure

Lung biopsy - exclude sarcoidosiss

90
Q

Pulmonary fibrosis mangement

A

Medications - target fibroblastic proliferation and tissue remodelling

Prifenidone - antifibtoric and anti-inflamm (slows FVC decline)

Nintedanib - MAB targeting tyrosine kinase

91
Q

Causes of secodnary pulmonary fibrosis

A
  • alpha 1 anti-tryspin
  • SLE
  • R.A
  • Systemic sclerosis
92
Q

What is sarcoidosis

- Epidemiology

A

Multi-system inflammatory granulomatous disorder

- More common in Africans
- More common in females
- 2 peaks of incidence
20 + 60

93
Q

Sarcoidosis presentation

A
  • progressive dyspnoea
  • dry cough
  • haemoptysis
  • chest pain
  • arthralgia
  • fever
  • weight loss
  • fatigue
94
Q

Sarcoidosis investigations

A

CXR

  • BHL
  • Reticular opacities

High resolution CT

  • lymphadenopathy
  • diffuse nodularity

FBC

  • Increased ACE
  • Hypercalcaemia

Bronchoscopy + biopsy

95
Q

Gold standard for sarcoidosis

A

Bronchoscopy with biopsy and histology

- Non caesiating granuloma with epitheliod cells

96
Q

When is tx required for sarcoidosis

A

eye involvement
hypercalcaemia
extra - pulmonary sx

97
Q

Sarcoidosis Tx

A

Oral steroids - Prednisolone
- bisphosphonates prophylacitcally prescirbes

Mehtotrexate / Azathioprine

Lung transplant

98
Q 
Sarcoidosis organ involvement 
lungs
liver
eyes
skin 
kidneys 
bones 
CNS
A

BHL
pulmonary fibrosis / nodules

liver nodules
cirrhosis
cholestasis

uveitis
conjunctivitis
optic neuritis

erythema nodosum
lupus pernio - raised purp;e skin lesions

kidney stones - hyeprcalcaemia
nephroclacinosis

Arthralgia
arthiritis

Encephalopathy
Diabetes insipidus

99
Q

What causes TB infection

- describe the organism

A

Mycobacterium tuberculosis
Aerobic bacilli
ACID FAST - Red with Zehil neelsen stain

100
Q

Signs of systmeic milliary TB

A

Kidney - sterile pyuria
Menigitis
Adrenals - Addisons

101
Q

What is the vaccine for TB

A

BCG Vaccine

  • following -ve Mantoux test + immunosuppresion checking
  • given to high risk pts
102
Q

TB presentation

A 
Pulmonary TB 
- cough > 3 weeks 
- Haemoptysis 
- chest pain 
- breathlesness
Fever
Weight loss
Night sweats 
Erythema nodosum 
Lethargy
103
Q

TB investigations

A

CXR

Sputum (x3)

  • stain and microscopy
  • culture

FBC

104
Q

TB appearnce on CXR

A

primary

  • patchy consolidation
  • pleural effusion

reactivated
- nodualr consolidation with cavitation (upper lobes)

dissmeinated
- millet seeds

105
Q

what is the interferon gamma test

A

used in pts with no features of active TB but +ve mantoux test

106
Q

TB management

A 
RIPE 
Rifampicin - 6m
Isoniazid - 6m
Pyrazinamide - 2m 
Ethambutol - 2m

Pyridoxine

107
Q

MOA + S/E Rifampicin

A

Inhibits RNA polymerase
blocks protein synthesis

Red/orange - tears / urine

CYP450 inducer - contraceptive pill reduced effect

108
Q

MOA + S/E Isoniazid

A

Blocks mycolic acid synthesis

Peripheral neuropathy

109
Q

S/E Pyrazinamide

A

Hyperuricaemia –> GOUT

110
Q

S/E Ethambutol

A

Colour blindness

Reduced visual acuity

111
Q

Salbutamol inhaler S/E

A
  • FIne tremor
  • Tachycardia
  • hypokalaemia
112
Q

ICS S/E

A

Oral candida

Stunted child growth

113
Q

what do small cell lung cancers release

A

PT-hrp –> Hypercalcaemia

114
Q

Percussion examples of:

  • dullness
  • stony dullness
  • hyper resonant
A

tumout
infection
consolidation
collapsed lobe

pleural effusion

pneumothorax

115
Q

TVF Examples of:

  • increased volume
  • decreased volume
A

Consolidation
Tumour
Lobar collapse
Pneumonia

Pleural effusion
Pneumothorax

116
Q

What would reduced breath sounds indicate

A

reduced air entry into that region of the lung

  • pneumothorax
  • pleural effuision
117
Q

What would fine insipiratiry end crackles indicate

A

pulmonary fibrosis

118
Q

What would a wheeze indiate

A

asthma
copd
bronchiectasis

119
Q

What would coarse crackles indicate

A

pneumonia
bronchiectasis
pulmonary oedema

120
Q

Obstructive lung disorders

A 
COPD 
Asthma 
Emphysema 
Bronchiectasis 
CF
121
Q

Restricitve lung disorders

A

Fibrotic lung disease

  • pulmonary fibrosis
  • pulmonary oedema
  • obesity
  • preganancy
  • MND / Guillian barre
122
Q

Obstructive pattern

A

FEV1 < 80 predicted

Ratio < 70%

123
Q

Restrictive pattern

A

FEV1 < 80%
FVC < 80%

Ratio > 70%

124
Q

What is Type 1 resp failure

A

Hypoxaemaia - Low PaO2

Normocapnia - Normal CO2 ( or can be low)

125
Q

Causes ot Type 1 respiratory failure

A

V/Q mismatch

  • pulmonary oedema
  • pulmonary embolism
  • pulmonary HTN
  • Pneumonia
126
Q

What is type 2 resp failure

A

Hypoxaemia - Low PaO2

Hypercapnia - High PaCO2

127
Q

Causes of type 2 respiratory failure

A

Alveolar hypoventilation

  • COPD
  • Asthma
  • Obesity
  • Rib fractures
  • Guillian barre syndrome
  • MND
  • Opiates
128
Q

Causes of respiratory alkalosis

A
  • Anxiety
  • Pain
  • PE
  • Pneumothorax
129
Q

Hypercapnia sx

A
  • Bounding pulse
  • Asterixis
  • Decreased consciousness
  • Confusion
130
Q

Acute pulmonary oedema tx

A

Furosemide
GTN
Oxygen
Diamorphine

131
Q

Causes of clubbing

  • lung
  • cardiac
  • GI
A 
cystic fibrosis 
lung cancer 
bronchiectasis 
infective endocarditis 
IPF
Mesothelioma

Cirrhosis
Chrons
UC
Coeliac

132
Q

ACEi adverse effects

A

Hypotension
dry cough
hyperkalaemia
renal failure

133
Q

ARBs adverse effects

A

hypotension
hyperkalaeia
renal failure

134
Q

ARBs examples

A

Candesartan
Losartan
Irbesartan

135
Q

Causes of a bounding pulse

A

CO2 retention

Aortic regurgitation

136
Q

Causes of raised JVP

  • lung
  • cardiac
A

Venous HTN - Right sided HF

  • COPD
  • Interstitial lung disease

Cor pulmonale

Tricuspid regurgitation

Constrictive pericarditis

CCF

137
Q

Causes of pulsus paradoxus

A

Cardiac tamponade
Severe acute asthma
Severe exacerbation of COPD

138
Q

Tracheal deviation - away from side of pathologu

A

Tension pneumothorax

Large pleural effusions

139
Q

Tracheal deviation - towards side of pathology

A

Lobar collapse

Fibrosis

140
Q

Causes of decreased cricosternal distance

A

Hyperinflation

  • Asthma
  • COPD
141
Q

Causes of dullness to percuss

A

Consolidaion
tumour
lobar collapse

142
Q

Causes of stony dullness

A

Pleural effusions

143
Q

Causes of hyper-resonance

A

Decreased tissue density -

Pneumothorax

144
Q

Increased vibration on tactile vocal resonance

A

Consolidation
Tumour
Lobar collapse

145
Q

Decreased vibration on tactile vocal resonace

A

Pleural effusion

Pneumothorax

146
Q

Causes of bronchial breath sounds

A

Consolidation

147
Q

Respiratory causes of lymphadenopathy

A

Lung cancer
TB
Sarcoidosis

148
Q

Respiratory cause of erythema nodosum

A

Sarcoidosis

149
Q

Causes of coarse crackles on auscultation

A

Chronic bronchitis

Pneumonia

150
Q

Causes of a wheeze

A

Asthma
Bronchiectasis
COPD

151
Q

Causes of a plethoric complexion

A

CO2 retenion

Polycythaemia - COPD

152
Q

Causes of symmetrical reduced chest expansion

A

Pulmonary fibrosis

153
Q

Causes of coarse crackles on auscultation

A

pneumonia
bronchiectasis
pulmonary oedema

154
Q

Causes of serous sputum

  • frothy
  • pink
  • clear
A

Pulmonary oedema

Cancer

155
Q

Causes of mucoid sputum

  • clear
  • grey
  • white
A

Chronic bronchitis
COPD
Asthma

Disease summaries (9 decks)

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