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Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Pneumonia symptoms (4 things) and signs (4 things)

A

Symptoms-

  • Dyspnoea
  • Fever
  • Cough with purulent sputum
  • PLEURITIC pain

Signs-

  • Dull percussion
  • Crackles and BRONCHIAL breathing on auscultation
  • Rigors (septicaemia)
  • Cyanosis and Tachypnoea (RESPIRATORY FAILURE)
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2
Q

Pneumonia investigations (4 things)

A

CXR- infiltrates

SPUTUM ANALYSIS to identify causative organisms

PNEUMOCOCCAL or LEGIONELLA antigens in urine

BLOODS- Raised WCC and raised CRP/ESR

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3
Q

Pneumonia assessment

A

CURB 65

Confusion
Urea >7
Resp rate >30/min
BP <90/60
>65 years old

Each is worth 1 point-
1= outpatient care
2= admission
3 or more= ICU admission

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4
Q

Pneumonia Treatment

A

BAPP

Breathing- maintain O2 levels
Antibiotics- treat underlying cause
Pain- analgesics
Pneumococcal vaccines (prioritised in D-I-65 (Diabetics, Immunosuppressant patients, patients over 65)

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5
Q

Pneumonia causative organisms (5 things)

A

Pneumococcal pneumoniae

Staph Pneu

Kleb Pneu

PSEUDONOMAS (like in BE/CF)

PNEUMOCYSTIS (seem more commonly in immunosuppressant patients)

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6
Q

Complications of pneumonia

A

Septic shock (if organism enters blood stream and releases cytokines)

Pleural effusion

Empyema

HYPOTENSION (due to sepsis or dehydration)

Respiratory failure

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7
Q

Bronchiectasis pathophysiology

A

infection of distal airways results in inflammation and release of inflammatory markers

impairs ciliary action- allows bacteria to proliferate

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8
Q

Bronchiectasis causative organisms (4 things)

A

Pseudonomas aeriginosa (common in patients with cystic fibrosis)

Strep pneumoniae

HAEMOPHILUS influenza

Staph aureus

Aspergillus

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9
Q

Causes of Bronchiectasis

A

TRICKY

Acquired-

  • Tumor
  • Rheumatoid arthritis
  • INFLAMMATORY BOWEL DISEASE

Congenital-

  • Cystic fibrosis
  • Kartagener’s Syndrome (causes cilia to be immobile, removing the defensive mechanism of the respiratory tract)
  • Young’s Syndrome (associated with AZOOSPERMIA)
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10
Q

Bronchiectasis symptoms (3 things) and signs (3 things)

A

Symptoms-

  • PURULENT sputum
  • persistent COUGH
  • fever

Signs-

  • Clubbing
  • Crackles
  • Inspiratory crepitations
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11
Q

Bronchiectasis investigations

A

CXR- tram track opacities
Sputum culture
Bloods- WCC/ CRP/ ESR/ TFTs/ LFTs

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12
Q

Bronchiectasis treatment

A 
Antibiotics (ciprofloxacin for pseudonomas)
Bronchodilators
Corticosteroids (prednisolone)
Postural Drainage
Surgery
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13
Q

Cause of Cystic Fibrosis

A

CFTR gene mutation

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14
Q

Cystic Fibrosis pathophysiology

A

Defect in Cl- secretion and increased Na+ absorption

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15
Q

Cystic Fibrosis investigations

A

Sweat Test
Guthrie’s Test in neonatal period

CXR- hyperinflation/ bronchiectasis

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16
Q

Signs of Cystic Fibrosis

A

Cyanosis
Clubbing
Crackles (bilateral)

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17
Q

Cystic Fibrosis treatment (3 things)

A

Physiotherapy
Ciprofloxacin
Bronchodilators

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18
Q

Cystic Fibrosis associations (3 things)

A

Pancreatic insufficiency
Diabetes
Male infertility

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19
Q

Asthma Signs and Symptoms

A

Wheezing
Shortness of Breath
Coughing

Ask about history of ATOPY (tendency to develop allergies)

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20
Q

Asthma pathophysiology

A

Allergen affects Th2 cells

Th2 cells release IL 4

IL 4 stimulates B lymphocytes

B lymphocytes produce IgE

IgE cause mast cell degranulation

Mast cell degranulation releases histamine

Histamine causes bronchoconstriction

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21
Q

Asthma Investigations

A

Peak expiratory flow rate (note diurnal variation)

Blood test- INCREASED IgE

CHECK FOR ONEUMOTHORAX and CONSOLIDATIONS in CXR

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22
Q

Treatment of ACUTE ASTHMA

A 
Oxygen
Salbutamol
HYDROCORTISONE
Ipratropium
Theophylline
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23
Q

Side effects of SALBUTAMOL

A

Increased HR
Decreased potassium
Tremor
Anxiety

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24
Q

Side effects of THEOPHYLLINE

A

GI upsets
Fits
Arrhythmias

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25
Q

GENERAL treatment of Asthma

A

Salbutamol

Salbutamol + BECLOMETASONE

Salbutamol + salmeterol +
more BECLOMETASONE

Salbutamol + salmeterol + even more BECLOMETASONE

Consider Theophylline or Montelukast (leukotriene receptor antagonist)

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26
Q

COPD PATHOPHYSIOLOGY

A

CHRONIC BRONCHITIS-

  • cough with sputum production for at least 3 months in 2 consecutive years
  • Mucus gland HYPERPLASIA and smooth muscle HYPERTROPHY

EMPHYSEMA-

  • permanent dilated airways distal to terminal bronchioles with alveolar destruction and bullae formation
  • associated with ALPHA-1 ANTITRYPSIN DEFICIENCY and INCREASED ELASTASE ACTIVITY
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27
Q

Causes of COPD

A

GASES

Genetic
Air pollutiion
Smoking
Exposure through occupation (COAL MINING)
Second hand smoking
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28
Q

INVESTIGATIONS of COPD (5 things)

A

Spirometry- FEV1<80% of predicted value OR FEV1/FVC <0.7

BLOODS- Alpha-1 antitrypsin levels/ WCC/ ESR/ CRP

CXR- hyperinflation/ emphysema/ DIAPHRAGMATIC flattening

ECG- COR PULMONALE

SPUTUM CULTURE

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29
Q

Treatment of COPD

A

FEV1<50%-

  • SABA/ SAMA
  • LABA
  • LABA + ICS
  • LAMA + LABA/ICS

FEV1>50%-

  • SABA/ SAMA
  • LABA+ ICS
  • LAMA + LABA/ICS

OR for both-

SABA/ SAMA
LAMA
LAMA + LABA/ICS

SABA- salbutamol
LAMA- salmeterol
SABA- iptratropium
LABA- tiotropium

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30
Q

Complications of COPD

A

CLIPPeR

Cor pulmonale (right sided heart failure due to pulmonary hypertension)

Lung cancer

Infections (MACROLIDE usually helps)

Pneumothorax

Polycythaemia

Respiratory Failure

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31
Q

Type 1 (Normal CO2) Respiratory Failure Causes

A 
Pneumonia
Pulmonary Embolism
Pulmonary Oedema
Emphysema
Asthma
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32
Q

Type 2 (High CO2) Respiratory Failure Causes

A 
COPD/ Asthma
Cerebrovascular disease
Opiate overdose
Myasthenia gravis
Motor neuron disease
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33
Q

Respiratory Failure symptoms

A

Agitation
Breathlessness
Confusion
Drowsiness/ Fatigue

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34
Q

Signs of Type 2 (High CO2) Respiratory Failure

A

A flapping tremor
Bounding pulse
Cyanosis

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35
Q

Pink Puffer

A

Type 1 Respiratory Failure

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36
Q

Blue Bloater

A

Type 2 Respiratory Failure

37
Q

Complications of Respiratory Failure

A

Heart failure
Arrhythmia
Pericarditis

38
Q

When to consider ABG (6 conditions)

A

Acute exacerbation of Chronic chest condition
Validate measurements from pulse oximetry
CO2 retention signs (bounding pulse/ flaps)
IMPAIRED CONSCIOUSNESS
Signs of LOW O2- CONFUSION/ CYANOSIS/ HALLUCINATIONS
Unexpected deterioration

39
Q

Coal Worker Pneumoconiosis

A

Inhalation of coal dust particles

Dust particles accumulate in parenchyma and are engulfed by macrophages

They die releasing enzymes that result in TISSUE FIBROSIS

40
Q

Asbestosis (5 things)

A

Inhalation of asbestos fibres

Fusiform rods are found in macrophages

Associated with MALIGNANT MESOTHELIOMA

PLEURAL PLAQUES in CXR

White asbestos- lowest fibrogenicity
Blue asbestos- highest fibrogenicity

41
Q

Silicosis (7 things)

A

AKA Potter’s ROT

Inhalation of silica particles (they can’t be removed by respiratory defences)

Macrophages engulf these and release TNF and cytokines

TNF and cytokines induce fibroblasts- results in fibrosis and collagen deposition

EGGSHELL CALCIFICATION of HILAR LYMPH NODES i CXR
NODULAR lesions in UPPER LOBES

Associated with increased TB infection

42
Q

Beryliosis

A

Caused by inhaling beryllium

Causes GRANULOMA formation made up of:

  • Giant cells
  • Macrophages
  • Epithelioid cells
43
Q

GRANULOMATOUS CONDITIONS (resp) (5 things)

A 
Beryliosis
TB
Leprosy
Sarcoidosis
Cat-scratch disease
44
Q

Siderosis

A

Inhaling IRON

Benign with NO APPARENT SYMPTOMS or ALTERED LUNG FUNCTIONS

45
Q

If RESPIRATORY ACIDOSIS

A

Type 2 Respiratory Failure

46
Q

If RESPIRATROY ALKALOSIS

A

Hyperventilation

47
Q

If METABOLIC ACIDOSIS

A

Check ANION GAP-

High= increase in internally produced acids
Normal= high ingested acids, or high excreted HCO3-
48
Q

Lung cancer CENTRAL LOCATION (3 things about each)

A

SQUAMOUS CELL CARCINOMA-

  • Associated with SMOKING
  • Paraneoplastic PARATHYROID-like actions
  • KERATIN PEARLS seen histologically

SMALL CELL CARCINOMA-

  • Associated with LAMBERT-EATON SYNDROME
  • ACTH and ADH are generated ectopically
  • KULCHITSKY CELLS seen histologically
49
Q

Lung cancer PERIPHERAL LOCATION (4 things about each)

A

ADENOCARCINOMA-

  • Associated with HYPERTROPHIC OSTEOARTHROPATHY
  • NOT associated with smoking
  • More common in women
  • MUCIN-POSITIVE STAINING seen histologically

LARGE CELL CARCINOMA-

  • Larger anaplastic cells
  • High cytoplasm to nucleus ratio
  • Lack light microscopic features of other tumors
  • Treated by SURGICAL EXCISION
50
Q

Lung cancer located in APEX

A

PANCOAST’s TUMOR-

  • Results in Homer’s Syndrome-
    1) MIOSIS (pupil’s constricted heavily)
    2) PTOSIS (drooping eyelid)
    3) ANHIDROSIS (inability)
51
Q

Lunch Cancer located in PLEURA

A

MESOTHELIOMA-

  • Associated with ASBESTOSIS
  • PSAMMOMA BODIES are seen histologically
52
Q

Deep Vein Thrombosis PATHOPHYSIOLOGY

A

VIRCHOW’s TRIAD

HYPERCOAGULABILITY-

  • Malignancy
  • Clotting abnormalities
  • Oral contraceptive pill
  • Surgery
  • Trauma

VENOUS STASIS-

  • Heart failure
  • Immobility (e.g. surgery)
  • Pregnancy

TRAUMA-

  • Inflammation
  • Previous thrombosis
53
Q

Signs and Symptoms of Deep Vein Thrombosis

A

AE POET

Asymptomatic
Engorgement of surface veins

Pain
Oedema
Erythema/ discoloration
Temperature increased in symptomatic leg

54
Q

Differential diagnosis of DVT

A

A musculoskeletal injury
Baker’s cyst rupture
Cellulitis

55
Q

Investigations in DVT

A

D- DIMER test

B-mode venous compression ultrasonography (for DVT above knee)

Investigations to uncover cause of DVT

56
Q

TREATMENT for DVT

A

Anticoagulation therapy with unfractionated HEPARIN or LMWH (DALTEPARIN)
Secondary management with WARFARIN

57
Q

Signs and Symptoms of PULMONARY EMBOLISM

A 
Pleuritic chest pain
Breathlessness
Tachycardia/ Tachypnoea
Cyanosis
HAEMOPTYSIS
58
Q

Pulmonary Embolism PATHOPHYSIOLOGY

A

THREE pathways-

1) Platelet factor release- SEROTONIN and THROMBOXAN A2 cause vasoconstriction
2) Decreased alveolar perfusion (underperfused lung leads to diminished gas exchange)
3) Decreased surfactant- leads to ventilation/ perfusion mismatch, hypoxaemia, dyspnoea

59
Q

Causes of Pulmonary Embolism

A

DVT
Fat/ air emboli
AMNIOTIC FLUID EMBOLI
Foreign material introduced via IV drug use

60
Q

Investigations of Pulmonary Embolism (6 things)

A

D Dimer

Thrombophilia screening if recurrent PE and under 50yo

CXR USUALLY NORMAL!

ECG- Sinus tachycardia

ABG- Hypoxaemia

WELL’s Score

61
Q

Treatment for Pulmonary Embolism

A

MASSIVE PE or HAEMODYNAMICALLY UNSTABLE= ALTEPLASE

HAEMODYNAMICALLY STABLE= LMWH or HEPARIN (if renal impairment)

Then give DOAC or WARFARIN

62
Q

Pneumothorax Signs and Symptoms

A

CHAD TIPS

Cyanosis
Hypoxia
Auscultation (decreased on affected side)
Dyspnoea

Tachypnoea
Ipsilateral chest pain
Percussion- HYPER RESONANT or NORMAL
Shoulder tip pain

63
Q

Pneumothorax Pathophysiology

A

Primary- idiopathic/ rupture of pleural bleb- TALL, YOUNG, SLIM MEN

Secondary- in patients with prior lung condition

Tension- Due to trauma- MEDIASTINAL SHIFT and lung collapse

64
Q

Causes of Pneumothorax

A

RALTS CRIT

Rheumatoid arthritis
Ankylosing Spondylitis
Lung cancer
Trauma (stab wound)
Sarcoidosis

COPD
Ruptured pleural bleb
Idiopathic pulmonary fibrosis
TUBERCULOSIS

65
Q

Investigations on Pneumothorax

A

CXR- follow the PLEURAL LINE, may show tracheal deviation away from lesion

CT scan

ABG- hypoxia

66
Q

Pneumothorax Treatment

A

If <2cm- no treatment- advice against diving and flying

If >2cm- aspirate with or without intercostal drain

Tension pneumothorax- immediate decompression with a bore needle inserted into 2nd intercostal space mid-clavicular line

67
Q

Complications of Pneumothorax (3 things)

A

Cardiac arrest
Risk of future pneumothorax
Cardiac arrest

68
Q

Causes of TRANSUDATE Pleural Effusion (3 things)

A

Increased Venous Pressure-

  • Cardiac Failure
  • Constrictive Pericarditis
  • Fluid Overload

Decreased Protein-

  • CIRRHOSIS
  • Nephrotic Syndrome
  • Malabsorption

Decreased Thyroid

69
Q

Causes of EXUDATE Pleural Effusion (3 things)

A

(Increased leakiness of pleural capillaries)

  • Infection (pneumonia/ TB)
  • Inflammation (SLE/ RA)
  • Malignancy
70
Q

Investigations of Pleural Effusion

A

CXR- Costophrenic angle blunted

- If there is a FLAT HORIZONTAL UPPER BORDER- there is also a pneumothorax

71
Q

Pleural Fluid- High Neutrophils (2 things)/ High Lymphocytes (5 things)

A

HIGH NEUTROPHILS-

  • Parapneumonic effusion
  • Pulmonary Embolism

HIGH LYMPHOCYTES-

  • Malignancy
  • TB-
  • RA
  • SLE
  • SARCOIDOSIS
72
Q

Pleural Fluid- Low Glucose/ Low pH/ High LDH (5 things)

A
  • Malignancy
  • SLE
  • RA
  • TB
  • EMPYEMA
73
Q

Pleural Fluid- High Amylase (4 things)

A

PANCREATITIS
OESOPHAGEAL RUPTURE
Bacterial pneumonia
Carcinoma

74
Q

Causes of Sarcoidosis

A

Fever
Polyarthralgia
Erythema Nodosum
Bilateral Hilar Lymphadenopathy

75
Q

Causes of Bilateral Hilar Lymphadenopathy

A

OH SHIM-

Organic Dust Disease
Hypersensitivity Pneumonitis

Sarcoidosis
Histocytosis X
Infection- TB/ Mycoplasma
Malignancy

76
Q

Non Pulmonary Signs of Sarcoidosis (7 things)

A

OG ABC
(Organs, glands, arrhythmia, bell’s palsy, calcium)

  • Large Liver and Spleen
  • Large Parotid and Lacrimal glands
  • Arrhythmia/ BBB
  • BELL’s PALSY
  • HIGH CALCIUM
  • HIGH ESR
  • HIGH ACE
77
Q

Sarcoidosis Treatment and Indications for corticosteroids in Sarcoidosis (4 things)

A

BHL alone doesn’t need treatment

Acute Sarcoidosis- Bed rest and NSAIDs

In severe- IV methylprednisolone or immunosuppressants may be needed

INDICATIONS for CORTICOSTEROIDS-

  • Parenchymal Lung Disease
  • Hypercalcaemia
  • Uveitis
  • Neurological or Cardiac involvement
78
Q

Causes of Upper (5), Mid (2) and Lower (2) Fibrotic Shadowing on CXR

A

Upper-

  • TB
  • Hypersensitivity Pneumonitis
  • Ankylosing Spindylitis
  • RADIOTHERAPY
  • PROGRESSIVE MASSIVE FIBROSIS

Mid-

  • Sarcoidosis
  • Histoplasmosis

Lower-

  • Idiopathic pulmonary fibrosis
  • ASBESTOSIS
79
Q

Symptoms (5) and Signs (3) of Idiopathic Pulmonary Fibrosis

A

Symptoms-

  • Dry cough
  • Dyspnoea
  • Malaise
  • Weigh LOSS
  • Arthralgia

Signs-

  • Clubbing
  • Cyanosis
  • Crackles
80
Q

Investigations for Idiopathic Pulmonary Fibrosis

3 for bloods
4 for CXR

A

Bloods-

  • low PaO2
  • high CRP
  • high Immunoglobulins

CXR-

  • Low lung volume
  • Bilateral lower zone
  • Reticonodular shadows
  • Honeycomb lungs

HIGH LYMPHOCYTES- good prognosis
HIGH NEUTROPHILS- bad prognosis

81
Q

Management of Idiopathic Pulmonary Fibrosis

A
  • O2
  • Pulmonary rehabilitation
  • Opiates
  • NINTEDANIB and PIRFENIDONE are shown to help
  • Don’t use high-dose steroids unless diagnosis of IPF is in doubt
82
Q

Complications of Idiopathic Pulmonary Fibrosis (2 things)

A

Respiratory Failure

Increased risk of Lung Cancer

83
Q

Phrenic Nerve innervates these three things

A

PERICARDIUM

CENTRAL DIAPHRAGM

MEDIASTINAL part of PARIETAL PLEURA

84
Q

6 Respiratory Manifestations of Rheumatoid Arthritis

A
  • Pulmonary Fibrosis
  • Pleural Effusion
  • Pleurisy
  • Infection
  • Pulmonary Nodules
  • CAPLAN’s SYNDROME- massive fibrotic nodules with occupational coal dust exposure
85
Q

What separates the thoracic and abdominal cavities and forms the central tendon of the diaphragm?

A

SEPTUM TRANSVERSUM

86
Q

The two diaphragm hernias

A

Morgnani (anterior)

  • minimal effect on lung development
  • overall good

Bochdalek (posterior)

  • pulmonary hyperplasia
  • overall bad
87
Q

Optimal PaO2 in ventilation

A

Needs to be 10kPa lower than % of O2 given (so 20kPa for someone on 30% O2)

88
Q

Chemoceptor locations

A

Central- located in medulla-

  • respond to DECREASED pH in brain interstitial fluid
  • does NOT respond to low O2

Peripheral- located in BIFURCATION of carotid arteries and ARCH of AORTA-
- respond to low O2, low pH and increased CO2 in arterial blood

89
Q

3 Respiratory Centres and 3 points for each of them

A

MEDULLARY RESPIRATORY CENTRE-

1) Inspiratory and Expiratory neurones
2) Has ventral group which controls FORCED EXPIRATION and has dorsal group which controls INSPIRATION
3) DEPRESSED BY OPIATES

APNEUSTIC CENTRE-

1) LOWER PONS
2) Stimulates INSPIRATION
3) Overridden by Pneumotaxic control to end inspiration

PNEUMOTAXIC CENTRE-

1) UPPER PONS
2) Inhibits INSPIRATION
3) FINE-TUNES RESP RATE

Medicine (15 decks)

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