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Respiratory Flashcards

1
Q

List some precipitants of asthma

A 
Cold
Exercise
Emotion, stress
Allergens (house dust, fur, occupational)
Infection
Smoking
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2
Q

Which class of blood pressure drug can exacerbate/worsen asthma?

A

B-blocker

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3
Q

List some symptoms and signs of asthma

A 
Dyspnoea
Dry cough, typically worse at night
Wheeze
Chest tightness
Hyperinflated/hyperresonant chest
Reduced air entry
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4
Q

What are the clinical features of an acute severe asthma attack?

A

Unable to complete sentences
Pulse over 100 bpm
Resp rate over 25 breaths/min
PEFR under 50% of predicted

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5
Q

What are the clinical features of an acute life-threatening asthma attack?

A

Silent chest
Bradycardia
Confusion
PEFR under 33$ of predicted

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6
Q

How is asthma diagnosed using PEFR?

A

PEFR monitoring shows diurnal variation of greater than 20% on 3 or more days of the week for 2 weeks

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7
Q

How is asthma diagnosed on spirometry?

A

Obstructive pattern of spirometry with more than 15% reversibility with a bronchodilator

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8
Q

What investigations would you arrange during an acute asthma attack?

A

PEFR
Sputum culture
FBC, U+E, CRP, ABG
CXR

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9
Q

What lifestyle advice could you give to an asthmatic?

A

Stop smoking
Avoid allergens/wear protection at work
Write a trigger diary

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10
Q

What is the 1st step in therapy for asthma?

A

Inhaled SABA (salbutamol) PRN

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11
Q

When do you move to step 2 therapy in asthma?

A

If using bronchodilator excessively or having night symptoms

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12
Q

What is the 2nd step in therapy for asthma?

A

SABA

Add regular inhaled steroid (beclometasone)

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13
Q

What is the 3rd step in therapy for asthma?

A

SABA
Inhaled steroid
Increase dose of inhaled steroid or add in LABA (salmeterol)

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14
Q

What is the 4th step in therapy for asthma?

A

SABA
Inhaled steroid
Stop LABA if no effect/improvement and add theophylline/montelukast

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15
Q

What is the 5th step in therapy for asthma?

A

SABA
Inhaled steroid
4th line drug
Oral prednisolone

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16
Q

Outline treatment for acute asthma

A 
Sit up
Give high flow O2
Nebulised salbutamol + ipratropium
IV hydrocortisone/oral prednisolone
Get an anaesthetist; oral theophylline/IV magnesium sulphate
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17
Q

What is the clinical definition of bronchitis?

A

Cough with sputum production on most days for 3 months in a 2 year period

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18
Q

List some symptoms and signs of COPD

A

Productive cough
Wheeze
Dyspnoea
Infective exacerbations

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19
Q

Describe a “pink puffer”

A

Breathless
Not cyanosed
Cachectic

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20
Q

What is meant by hypoxic drive in a patient with COPD?

A

Respiratory centres are insensitive to CO2 (because it has remained very high for a long period), so they rely on low O2 to maintain respiratory effort
Therefore giving them too much O2 would be detrimental to their breathing

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21
Q

How would you differentiate COPD from asthma on investigation?

A

Typically little/no bronchodilator reversibility in COPD

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22
Q

Which genetic condition predisposes to emphysema?

A

Alpha-1-antitrypsin deficiency

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23
Q

What is the 1st step in therapy for COPD?

A

Inhaled SABA (salbutamol)/inhaled SAMA (ipratropium) PRN

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24
Q

What is the 2nd step in therapy for COPD?

A

Regular inhaled ipratropium/tiotropium
OR
Regular inhaled salmeterol-beclometasone combo inhaler

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25
What is the 3rd step in therapy for COPD?
Inhaled salmeterol Inhaled beclometasone Inhaled ipratropium/tiotropium Refer to specialist
26
When would a COPD patient be put on long-term O2 therapy?
If PaO2 less than 7.4 kPa
27
Outline treatment of acute exacerbation of COPD
``` 24-28% O2 Nebulised salbutamol + ipratropium IV hydrocortisone Oral prednisolone Antibiotic if infection Consider theophylline and/or ventilation ```
28
What is pneumonia?
An acute lower respiratory tract infection that causes inflammation of the lungs
29
Which organisms typically cause community acquired pneumonia (CAP)?
``` Strep pneumoniae H influenzae Mycoplasma Staph aureus Legionella Moraxella, Chlamydia, Coxiella, gram -ve (atypical) ```
30
Which organisms typically cause hospital acquired pneumonia (HAP)?
Staph aureus Enterobacter Pseudomonas Klebsiella
31
List some causes of aspiration pneumonia
Stroke Myasthenia gravis Bulba palsy Oesophageal disease
32
Which organism can cause pneumonia in immunocompromised people?
Pneumocystis jirovecii
33
List some symptoms and signs of pneumonia
``` Fever Rigors Malaise Anorexia Dyspnoea Cough with purulent sputum Pleuritic chest pain Cyanosis Confusion Chest consolidation - reduced percussion, reduced expansion, crackles ```
34
What specific investigation is done for Legionella pneumonia?
Urinary antigen
35
Define the CURB65 score for CAP
``` Confusion Urea over 7 Resp rate over 30 BP under 90/60 Age 65 or over Score of 3 = severe ```
36
What supportive treatment is advised for pneumonia?
IV fluids O2 Analgesia
37
Which antibiotics are used for mild-moderate CAP?
Amoxicillin PO Doxycycline PO if penicillin allergy IV clarithromycin if NBM
38
Which antibiotics are used for severe CAP?
IV co-amoxiclav + PO doxycycline IV levofloxacin if penicillin allergy IV clarithromycin if NBM
39
Which antibiotic should be added if Legionella is suspected?
Rifampicin
40
Which antibiotic should be added if pneumocystis is suspected?
Co-trimoxazole
41
Which antibiotics are used for HAP?
Amoxicillin Metronidazole +/- gentamicin if severe
42
Which strain of H influenzae causes pandemics and which causes endemics?
A - pandemics | B - endemics
43
What investigations are done for influenza?
Nasopharyngeal swab PCR/culture | Serology
44
What is the treatment for influenza?
Bed rest, fluids, paracetamol | Oseltamivir (Tamiflu)
45
What is bronchiectasis?
Chronic dilation of airways due to longstanding infection or chronic disease
46
Which conditions predispose/cause bronchiectasis?
Cystic fibrosis Ciliary dyskinesia Kartagener's syndrome Post-infection (measles, mumps, HIV, pneumonia, pertussis)
47
Which organisms are associated with bronchiectasis?
H influenzae Strep pneumoniae Staph aureus Pseudomonas
48
List some symptoms and signs of bronchiectasis
``` Persistent cough Purulent sputum Halitosis Clubbing Wheeze Coarse inspiratory crepitations ```
49
Outline treatment options for bronchiectasis
Postural drainage, chest physiotherapy Antibiotics if infection Bronchodilators, steroid Surgery if localised
50
What inheritance pattern does cystic fibrosis follow? What is the genetic defect?
Autosomal recessive | Mutation in CFTR gene on c7, leading to defective Cl- secretion and increased Na absorption in airways
51
List some symptoms and signs of cystic fibrosis
``` Failure to thrive, meconium ileus in infants Cough Wheeze Recurrent infections Bronchiectasis GI upset (steatorrhoea) Male infertility Arthritis Nasal polyps Clubbing ```
52
What investigations are done for cystic fibrosis?
Sweat test Genetic screen Faecal elastase
53
Outline treatment options for cystic fibrosis
Symptom relief Chest physiotherapy Antibiotic if infection
54
What happens in obstructive sleep apnoea?
Intermittent closure/collapse of pharyngeal airway during sleep
55
List some causes of obstructive sleep apnoea
Obesity Narrow anatomy COPD Resp depressants (opioids)
56
List some symptoms and signs of obstructive sleep apnoea
``` Loud snoring Daytime somnolence Poor sleep, unrefreshed feeling Morning headache Low libido Decreased cognitive performance Large neck and tongue, small mandible ```
57
What investigations can be done for sleep apnoea?
Pulse oximetry Video recording/sleep studies/polysomnography Epworth sleepiness scale
58
What is the clinical definition/diagnosis of obstructive sleep apnoea?
15 or more episodes of apnoea during 1 hour of sleep
59
Outline treatment options for obstructive sleep apnoea
``` Weight loss Avoid tobacco and caffeine CPAP via nasal mask during sleep Modafinil Surgery to relieve pharyngeal obstruction ```
60
List some causes of acute respiratory distress syndrome
``` Pneumonia Aspiration Vasculitis Trauma Sepsis Haemorrhage Obstetric events Drugs (aspirin, heroin, paraquat) ```
61
List some symptoms and signs of acute respiratory distress syndrome
Cyanosis Dyspnoea Fine inspiratory crackles Peripherally warm
62
What 4 features indicate severe ARDS?
Acute onset CXR findings (infiltrates) Pulmonary capillary wedge pressure under 19 Refractory hypoxaemia
63
Outline treatment of ARDS
Treat cause Resp support - CPAP, ventilate, inhaled NO Diuretics Aerolised surfactant
64
Define type 1 respiratory failure
V/Q mismatch | Hypoxia (PaO2 under 8) with normal or low PaCO2
65
List some causes of type 1 respiratory failure
``` Pneumonia Pulmonary oedema PE Asthma Emphysema ARDS ```
66
List some symptoms and signs of type 1 respiratory failure
Signs of hypoxia: cyanosis, dyspnoea, confusion, agitation
67
Outline treatment of type 1 respiratory failure
Treat cause 15L O2 non-rebreather Assisted ventilation if required
68
Define type 2 respiratory failure
Alveolar hypoventilation | Hypoxia with hypercapnia (PaCO2 over 6)
69
List some causes of type 2 respiratory failure
``` Asthma COPD Pulmonary fibrosis Obstructive sleep apnoea Reduced resp drive (opioids) Chest wall abnormality ```
70
What investigations are done in respiratory failure?
FBC, U+E, CRP, ABG CXR Microbiology if afebrile
71
Outline treatment of type 2 respiratory failure
O2 24% Keep reassessing ABG's Resp stimulant NIPPV
72
What is the maximum amount of O2 delivered by a nasal cannula?
1-4 L / min | O2 24-40%
73
What is the maximum amount of O2 delivered by a Venturi mask
``` Blue: 24% White: 8% Yellow: 5% Red: 40% Green: 60% ```
74
What is the maximum amount of O2 delivered by a non-rebreather mask?
10-15 L / min | O2 60-90%
75
What is Virchow's triad with regards to thrombus formation?
Hypercoaguability of blood Vessel damage Abnormal flow of blood
76
List some causes of pulmonary embolism
``` Pregnancy Immobility Obesity Post-surgery Fracture Malignancy Contraception ```
77
List some symptoms and signs of pulmonary embolism
``` Sudden dyspnoea Pleuritic pain Haemoptysis Pleural rub Hypotension Cyanosis Raised JVP ```
78
What investigations are done for suspected pulmonary embolism?
D-dimers (exclusive of PE but not specific) CTPA is gold-standard; V/Q if unable ECG
79
Outline treatment of pulmonary embolism
LMW heparin Oxygen Commence warfarin Thrombolyse if massive PE (alteplase)
80
How does cor pulmonale arise?
Emphysema leads to hypoxia which causes vasoconstriction and right heart failure
81
List some symptoms and signs of cor pulmonale
``` Dyspnoea Fatigue Syncope Cyanosis Raised JVP Tricuspid regurgitation ```
82
Outline treatment of cor pulmonale
Encourage exercise and treat causes Oxygen therapy Diuretic (furosemide) Vaccinate against pneumococcus and influenza
83
What's the difference between a transudative and exudative pleural effusion?
Transudate: protein content less than 25 g/L Exudate: protein content more than 35 g/L
84
List some causes of a transudate pleural effusion
``` Heart failure Cirrhosis Nephrotic syndrome Malabsorptive diseases Hypothyroidism Meig's syndrome ```
85
List some causes of an exudate pleural effusion
``` Infection Inflammation Cancer Pancreatitis MI ```
86
List some symptoms and signs of pleural effusion
``` Dyspnoea Pleuritic pain Reduced chest expansion Stony dull percussion Reduced breath sounds Tracheal deviation Clubbing Lymphadenopathy ```
87
How is pleural effusion investigated?
Palpate/CXR small effusions USS guides diagnosis and therapeutic aspiration Pleural aspirate cytochemistry
88
Where is the landmark for pleural effuson drainage?
Thoracocentesis 5th intercostal space, mid-clavicular line
89
List causes of pneumothorax
``` Spontaneous (young, thin male) Asthma COPD Trauma Infection CTD's (Marfan's, EDS) Iatrogenic ```
90
List some symptoms and signs of pneumothorax
Sudden pleuritic pain Dyspnoea Collapse Reduced chest expansion and breath sounds Hyperresonant percusion Tracheal deviation (tension pneumothorax)
91
Where are the landmarks for treating pneumothorax?
Needle aspirate 2nd intercostal space mid-clavicular line | Chest drain 5th intercostal space mid-axillary line
92
What is the treatment for recurrent pneumothorax?
Pleurodesis
93
What is sarcoidosis?
Multi-system non-caseating granulomatous type IV hypersensitivity lol
94
List some symptoms and signs of sarcoidosis
``` Erythema nodosum Polyarthralgia Fatigue Weight loss Uveitis Lymphadenopathy Dyspnoea ```
95
What is the classic appearance of sarcoidosis on CXR?
Bilateral hilar lymphadenopathy
96
Describe some typical blood results in sarcoidosis
Raised serum ACE, ESR, Ca | Deranged LFT's
97
Outline treatment of sarcoidosis
Bed rest, NSAID Steroid if symptomatic/organ involvement IV steroid/immunosuppression if severe
98
What is extrinsic allergic alveolitis?
Inhalation of foreign antigen causes widespread hypersensitivity reaction with alveolar infiltration and inflammation
99
List symptoms and signs of extrinsic allergic alveolitis
``` 4-6h post-exposure Fever Rigors Myalgia Dry cough Weight loss Type 1 resp failure Dyspnoea Coarse end inspiratory crackles ```
100
Describe CXR signs of extrinsic allergic alveolitis
Upper zone mottling, consolidation Hilar lymphadenopathy Honeycomb lung
101
Outline treatment of extrinsic allergic alveolitis
Allergen avoidance Oxygen therapy Oral prednisolone
102
What is the most common cause of interstitial lung disease?
Idiopathic pulmonary fibrosis
103
List aetiology/risk factors for lung cancer
Smoking Asbestos exposure Radiation
104
List clinical features of lung cancer
``` Cough Haemoptysis Dyspnoea Chest pain Weight loss, anorexia Cachexia Anaemia Clubbing Wrist pain (HPOA) Lymphadenopathy ```
105
List some complications of lung cancer mets
``` Bony tenderness Hepatomegaly Confusion, fits, focal CNS signs Recurrent laryngeal nerve palsy (hoarseness) Horner's syndrome (Pancoast tumour) ```
106
What investigations would you do for lung cancer?
``` CXR CT Bronchoscopy + biopsy PET scan Sputum + pleural fluid cytology ```
107
Which classification of lung cancer is most common?
Non-small cell lung cancer | In this group, squamous cell carcinoma is the most common
108
What endocrine hormones are secreted by small cell lung cancer?
ACTH | ADH
109
What endocrine hormones are secreted by non-small cell lung cancer?
Squamous: secretes PTH, TSH
110
Outline management of lung cancer
Chemotherapy or palliative radiotherapy for small cell Surgery for small cell if T1-2 N0 M0 Surgery/curative radiotherapy for non-small-cell if stage I-II Palliative radiotherapy +/- chemotherapy
111
When would surgery for lung cancer be contraindicated?
``` Tumour near hilum FEV1 less than 1.5L Metastasis Stage III/IV disease Vocal cord paralysis SVC obstruction ```
112
Which asbestos is more harmful - blue (crocidolite) or white (chrysotile)?
Blue asbestos is more fibrogenic and harmfuil

4MB Medicine (My version) (19 decks)

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