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Respiratory Flashcards

1
Q

What are the antigens on the influenza virus?

A

Haemagglutinin and Neuraminidase antigen - they attach to the respiratory epithelium. This is what we develop immunity against.

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2
Q

Features of influenza

A

fever, limb ache, headache, sore throat, dry cough

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3
Q

Influenza Mx?

A

paracetamol, bed rest, maintain fluids

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4
Q

What is COPD?

A

poorly reversible airflow limitation, it is progressive and associated with persistant inflammation in the lungs.

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5
Q

Causes of COPD

A

smoking, pollution, A1 antitrypsin deficiency

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6
Q

How does smoking cause COPD?

A

Mucous gland hypertrophy in large airways causes increased neutrophils/macrophages/lymphocytes which release inflammatory mediators that break down connective tissue.

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7
Q

Discuss the 2 pathophysiologies of COPD?

A

1) CHRONIC BRONCHITIS - airway narrowing with hypertrophy and hyperplasia of mucous secreting glands and oedema. Columnar epithelium –> Squamous.
2) EMPHYSEMATOUS - loss of elastic recoil meaning alveoli close on expiration - airflow limitation and trapping.

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8
Q

What are pink puffers?

A

Predominant emphysema - breathless, not cyanosed

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9
Q

What are blue bloaters?

A

Predominant bronchitis - hypoventilate, cyanosed, oedematous, CO2 retention (bounding pulse.)

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10
Q

COPD features?

A

cough, sputum, wheeze, breathless, years of smokers cough, worse with infections.

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11
Q

COPD signs on examination?

A

Breathless, increased expiration time, poor chest expansion, lungs hyperinflated, barrel shaped chest, use of accessory muscles.

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12
Q

What cells are involved in COPD inflammation?

A

Macrophages, neutrophils, CD8 cells.

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13
Q

COPD complications?

A

cor pulmonale, respiratory failure.

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14
Q

Investigations for COPD?

A

Lung function test - progressive airflow limitation
CXR - lungs hyperinflated, flat diaphragm
CT - emphysematous bullae
Bloods - polycythaemia?
ABG - hypoxia, hypercapnia
ECG/ECHO

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15
Q

Stages of COPD?

A
  1. MILD - Chronic cough. FEV1/FVC <70%, FEV1 > 80%
  2. MOD - Breathless on exertion, FEV1/FVC <70%, 50%
  3. Severe - breathless on minimal exertion
  4. v severe - breathless at rest
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16
Q

What is FEV1 and FVC?

A 
FEV1 = forced volume expired in 1 second
FVC = total volume expired
FEV1/FVC = ratio to measure airflow limitation - <75% = airflow limitation, >75% = restrictive lung disease
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17
Q

General measures for COPD patients?

A

STOP SMOKING! influenza and pneumococcal vaccine.

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18
Q

Medical therapy for COPD?

A
  1. SABA + SAMA (salbutamol + tiotropium bromide)
  2. Prednisolone
  3. O2 therapy - guided by blood gas measurements
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19
Q

Features of a COPD exacerbation?

A

worsened cough and breathlessness, sputum, wheeze, hypoxia and confusion.

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20
Q

Common cause of a COPD exacerbation?

A

H.Influenzae

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21
Q

Treatment of an exacerbation of COPD?

A
  1. Give O2 (aim for SpO2 of 88-92%)
  2. Bronchodilators (Salbutamol and ipratropium bromide)
  3. Prednisolone 40mg
  4. Co-Amoxiclav

Other: LMWH to avoid DVT, escalate with Aminophylline, ventilate with BiPAP.

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22
Q

What is OSA?

A

repeated cessation of breathing for >10 seconds due to obstructed upper airway during sleep.

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23
Q

RF for OSA?

A

obesity, alcohol, hypothyroid

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24
Q

OSA features?

A

loud snoring, daytime sleepiness

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25
Q

OSA Ix?

A

measure O2 sats whilst sleeping

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26
Q

OSA Mx?

A

lose weight, remove tonsils, CPAP whilst sleeping

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27
Q

What is bronchiectasis?

A

Abnormal and permanent dilation of central and medium sized airways. Results in impaired clearance of bronchial secretions –> poolings which cause secondary bacterial infections and inflammation.

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28
Q

Causes of bronchiectasis?

A

post infective, CF, AIDS

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29
Q

Features of bronchiectasis?

A

chronic productive cough, recurrent infections, thick foul sputum, breathless, wheeze

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30
Q

What do you hear on auscultation of a patient with bronchiectasis?

A

coarse crackles

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31
Q

Ix for bronchiectasis? what would these show?

A

CXR - dilated bronchi and thickened walls, cysts?
CT - airway dilation, walls thickened, cysts
sputum culture

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32
Q

Mx of bronchiectasis?

A

stop smoking, physio for sputum clearance

influenza and pneumococcal vaccine

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33
Q

how to manage an exacerbation of bronchiectasis?

A

resp physio (mucus clearance)
ABx - flucloxacillin
bronchodilators
steroids

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34
Q

What causes CF?

A

autosomal recessive condition with mutation in CFTR transmembrane protein which is resposible for transporting CL-. Mutation causes increased salt content of the mucus = increased viscosity.
Commonest mutation = deltaF508

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35
Q

Features of CF?

A

frequent infections, bronchiectasis, airflow limitation, respiratory failure, finger clubbing, sinusitis

36
Q

Non resp features of CF?

A

short stature, pancreas insufficiency, delayed puberty, male infertility.

37
Q

Ix for CF?

A
  • Sodium sweat test - >60 is diagnostic.
  • Blood DNA analysis
  • Radiological features.
38
Q

Mx of CF?

A
  • resp physio
  • pancreatic enzymes to help with digestion
  • inhaled recombinant therapy
  • treat P.Aeruginosa infection (Increases mortality) - nebulsed Abx therapy.
39
Q

What is Asthma? 3 main features?

A

chronic inflammatory condition affecting the lungs and causing reversible airway obstruction.

Features: Airflow limitation, hyperresponsive airways, inflamed bronchi

40
Q

what is atopy?

A

IgE forms against commen environmental antigens e.g. dust mites, pollution.

41
Q

Pathogenesis of asthma?

A

INFLAMMATION - involving mast cells/eosinophils/CD4 cells in the bronchial wall. Involved in initial uptake of triggers and present to Th2 lymphocytes.
REMODELLING - airway smooth muscle hypertrophy and hyperplasia.

42
Q

Features of Asthma?

A

Asthma attacks, wheezing, SoB, tight chest, cough.

  • features are intermittant
  • diurnal variation (worse at night)
  • symptoms provoked by triggers.
43
Q

What do you find on examination during an asthma attack?

A
  • reduced chest expansion
  • prolonged expiratory time
  • bilateral expiratory polyphonic wheeze
44
Q

Asthma Ix?

A

FEV1, PERF, - show diurnal variation, improve with bronchodilator
histamine challenge
skin prick test
CXR during asthma attack

45
Q

Management of Asthma (day to day)?

A

Avoid triggers and precipitating factors, don’t smoke, avoid B Blockers

  1. Inhaled SABA (salbutamol, B2 receptor agonist. Relaxes bronchial smooth muscles.)
  2. Inhaled steroids (beclometasone, SE = oral candidiasis.)
  3. Add LTRA (e.g. monteleukast)
  4. Add LABA (salmeterol - relaxes bronchial smooth muscles.)
  5. Increase inhaled steroids
  6. Prednisolone
  7. Hospital admission
46
Q

Features of Acute severe asthma?

A

Severe progression of asthma symptoms over hours/days - MEDICAL EMERGENCY.
can’t speak sentences, high RR, high HR, PERF = 35-50% predicted, silent chest, cyanosis, exhaustion, reduced GCS,

47
Q

What is PERF?

A

Maximum flow generated during forced expiration

48
Q

management of acute severe asthma?

A
  1. Sit up and give high flow O2
  2. nebulised Salbutamol + ipratropium bromide and O2
  3. IV hydrocortisone

If not improving

  • MgSO4
  • IV aminophylline
  • IV salbutamol + ITU admission
49
Q

When is it safe to discharge an asthma attack pt?

A

No Sob, no wheeze, stable obs

CHECK - inhaler technique, reason for exacerbation and create an asthma plan.

50
Q

Common causes of pneumonia?

A

strep.pneumonia (community)
S.Aureus (IVDU)
P.Aeruginosa (CF)

51
Q

Pneumonia features?

A

fever, cough, sputum, pleurisy, dyspnoea.

52
Q

How do you assess the severity of a pneumonia? what does it look at?

A

CURB65. confused? urea>7? RR>30? BP<90/60? Age>65

53
Q

Ix for pneumonia?

A

CXR, sputum culture, ABG
Bloods - WCC, LFT, culture
Urine - legionella/pneumococcal antigens

54
Q

DD of pneumonia?

A

PE, pulmonary oedema, bronchial carcinoma, hypersensitivity pneumonitis

55
Q

Mx of pneumonia?

A

CAP - amoxicillin (macrolide if allergic - e.g. erythromycin)
S.Aureus - Flucloxacillin

56
Q

Pathophysiology of TB?

A

primary infection = subpleural lesions called Ghon’s focus form. Neutrophils invade and are replaced by macrophages (Langhan’s giant cells.)
The infection becomes latent –> and reactivates to cause post-primary TB.

57
Q

Features of TB?

A

fever, weight loss, malaise, anorexia, cough, blood stained sputum, small pleural effusion

58
Q

Ix for TB? special stains and tests….

A
  • CXR - patchy nodules in the upper apex
  • Sputum - Ziehl-Neelson stain and culture
  • Bronchoschopy
  • Extra pulm - LN/bone biopsy and urine testing
  • Skin - mantoux test
  • HIV testing
59
Q

Which Abx are used for TB?

A

Rifampicin, Isoniazid (6 months)

pyrazinamide, ethambutol (2 months)

60
Q

methods to prevent TB?

A

screen close contacts - XR and mantoux test

BCG vaccine

61
Q

What is sarcoidosis?

A

multisystem granulomatous disorder which presents with bilateral hilar lymphadenopathy.

62
Q

Features of sarcoidosis in each organ?

A 
CHEST - cough, breathless, wheeze
SKIN - granuloma in scars
EYE - uveitis, lacrimal gland enlargement
BONE - arthralgia
NEURO - masses
63
Q

Ix for sarcoidosis?

A

biopsy, CXR, lung function tests

SERUM ACE - increased in most patients.

64
Q

Mx of sarcoidosis?

A

prednisolone

65
Q

What is Idiopathic pulm fibrosis (IPF)?

A

patchy fibrosis of the interstitium with absence of inflammation. Fibroblastic proliferation

66
Q

Features of IPF?

A

breathlessness, non productive cough, resp failure, pulm HTN, clubbing

67
Q

Ix of IPF and signs?

A

CXR - ground glass appearance (honeycombed)
CT - bilateral opacities
Lung function - restrictive defect
ABG - hypoxaemia

68
Q

Mx of IPF?

A

prednisolone, lung transplant.

69
Q

What is hypersensitivity pneumonitis?

A

widespread inflammation in alveoli due to reaction to organic particles?

70
Q

Features of hypersensitivity pneumonitis and findings on examination?

A

features: cough, fever, malaise, SoB

O/E: increased RR, coarse crackles, wheeze

71
Q

causes of hypersensitivity pneumonitis?

A

farmers lung, bird fanciers lung, malt workers.

72
Q

Ix of hypersensitivity pneumonitis? and findings

A

CXR - fluffy nodular shaddowing in upper zones
FBC - increased WCC
Lung function - restrictive defect
Bronchoalevolar lavage - T lymphocytes and granulocytes

73
Q

RF for lung cancer

A

smoking, asbestos, arsenic, pollution

74
Q

Local and metastatic features of lung cancer?

A

Local: cough, chest pain, haemoptysis, breathless
Met: local - bone pain, fractures, hoarse voice. Distant - brain

75
Q

Ix of lung cancer?

A

CXR, sputum culture, fine needle aspiration, bronchoscopy, PET scan, lung function tests

76
Q

What does SCLC develop from?

A

Endocrine cells (Kulchitsky cells) - they secrete hormones and metastasize early.

77
Q

Effects of asbestos on the lung? name 3

A 
Asbestos bodies - shows exposure
Plaques - fibrotic
Effusion - pain and dyspnoea
Mesothelioma - cancer (pain and PE)
Asbestosis - breathless, clubbint, inspiratory crackes, restrictive defect
78
Q

What is the definition of a pleural effusion?

A

excess fluid in the pleural space (>500mL)

79
Q

Signs of a pleural effusion?

A

reduced chest wall movement, dull to percuss, absent breath sounds, reduced vocal resonance, mediastinal shifting.

80
Q

name different causes of pleural effusion and how to differentiate between them?

A

TRANSUDATE (pleural protein <30) - HF, low albumin, hypothyroid, nephrotic synd, cirrhosis
EXUDATE (pleural protein>30) - infection, empyema, TB, malignancy.

81
Q

Ix of a pleural effusion?

A

pleural fluid aspiration, CT, CXR, sputum culture, bloods, ECG, pleural biopsy

82
Q

What is a pneumothorax?

A

Air in the pleural space causing lung collapse

83
Q

What is a tension pneumothorax and how does it occur?

A

occurs with patients on ventilation. Pleural tear acts as a valve which allows air in on inspiration but it can’t be expired. Unilateral increase in intrapleural pressure which causes respiratory distress and shock.

84
Q

Symptoms of a pneumothorax? signs on examination?

A

sudden onset, pleuritic chest pain, breathless

hyperresonnat percussion and reduced breath sounds

85
Q

Ix of a pneumothorax ?

86
Q

Mx of pneumothorax?

A

thoracentesis - aspirate the air and reinflate the lung

87
Q

what is antigenic shift and drift?

A

Shift - major changes in H and N antigens which is associated with pandemic infections
Drift - annual minor changes in the strains which causes less severe epidemics.

Finals (21 decks)

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