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FINALS (not specialities) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the definition of chronic obstructive pulmonary disorder?

A

A progressive respiratory disorder characterised by an obstructive pattern:


FEV1 = <80% predicted

FEV1/FVC <0.7

Little to no reversibility

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2
Q

What is COPD an umbrella term for?

A

Chronic Bronchitis - cough, sputum production on most days for 3 months of 2 successive years

Emphysema - histologically as enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls

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3
Q

What are the risk factors for developing COPD?

A

Non-modifiable = genetics (alpha 1 antitrypsin deficiency)

Modifiable = SMOKING, environmental exposure e.g. coal, pollution

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4
Q

What are the 3 main symptoms of COPD?

A

Wheeze
Dyspnoea
Cough + frothy white sputum production

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5
Q

What are the signs of an exacerbation of COPD?

A

Resp - tachypnoea, hand flap (CO2 retention), quiet breath sounds, hyperressonance

Use of accessory muscles, tripodding

Cyanosis

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6
Q

What is a pink puffer?

A

Breathless but not cyanosed

↑ alveolar ventilation but O2 cannot cross alveolar wall as efficiently due to thickening/fibrosis

T1RF

(emphysematous)

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7
Q

What is a blue bloater?

A

Cyanosed but not breathless

↓ alveolar ventilation due to inflammation and ↑ mucous

T2RF + have a hypoxic drive to breath due to chronic CO2 retention

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8
Q

What is the management of an acute exacerbation of COPD?

A

Neb salbutamol and ipratropium bromide

Titrated o2 - aim for 88-92%

Steroids

IV aminophylline if no response

Consider abx if infective symptoms

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9
Q

When would NIV be considered in a patient with an acute exacerbation of COPD?

A

Resp rate >30

pH <7.35 and worsening despite treatment

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10
Q

What is the long term pharmacological management of COPD?

A

1) SABA

2) FEV >50 = LABA or LAMA
FEV <50 = LAMA/LABA + ICS

3) all of it together

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11
Q

What is the non-pharmacological long term management of COPD?

A

Smoking Cessation!!! Diet advice!!

Influenza + Pneumococcal Vaccine!!!

Pulmonary Rehabilitation

Long Term Oxygen Therapy

Ceiling of care
?Surgery

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12
Q

When would long term oxygen therapy be considered for a patient with COPD?

A

if pO2 = <7.3 on >2 occassions >3 weeks apart

OR

7.3-8 + other conditions/symptoms e.g. cor pulmonale

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13
Q

What are the 3 most common causative organisms for CAP?

A

Strep Pneumoniae
H. Influenzae
Moraxella Catarrhalis

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14
Q

What are 3 atypical organisms for CAP?

A

Staph Aureus
Chlamydia
Mycoplasma Pneumoniae

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15
Q

What is the CURB 65 score?

A

Confusion
Urea = >7
Respiratory rate = >30
Blood pressure = <90 mmHg
> 65

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16
Q

How should the CURB 65 Score be interpreted?

A 
0-1 = PO abx 
2 = Hospital 
3 = very bad
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17
Q

When can a hospital acquired pneumonia be diagnosed? What are the 3 most common causative organisms?

A

within 48hr of admission

Gram-negative enterobacteria
Staph. aureus
Klebsiella
Pseudomonas

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18
Q

Give 2 examples of causative organisms of pneumonia in an immunocompromised host

A

The normal CAP organisms

Pneumocystis Jiroveci

Aspergillus SPP

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19
Q

How does pneumonia present?

A

Productive cough (greenish sputum) +/- blood

Shortness of breath

Feeling generally unwell - fever, rigors, anorexia

Pleuritic chest pain

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20
Q

What signs could be elicited on a patient with pneumonia?

A

Consolidation - Coarse crackles, dull percussion, reduced chest expansion, bronchial breathing

Tachypnoea, tachycardia
cyanosis

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21
Q

What is the management of CAP?

A

CURB 65

Moderate = PO amoxicillin/doxycyline/clarithromycin

severe = admit for IV abx

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22
Q

What is the management of HAP?

A

Moderate = PO Co-Amox/ Doxycylcine/ Cefalexin

Severe = IV Piperacillin + Tazobactam, Meropenem, Ceftriaxone, Cefuroxime

23
Q

How can immunocompromised be protected against their specific pneumonias?

A

pneumococcal vaccine

give to:
>65
Chronic heart, liver, renal, lung conditions
Diabetes on meds
Immunocompromised
24
Q

What is the definition of interstitial lung disease?

A

Fibrosis or chronic inflammation within the parenchyma

leading to a restrictive pattern of breathing on spirometry

25
Q

What are the causes of upper lobe ILD?

A

APENT

Aspergillosis (malt worker)
Pneumoconiosis (silica, coal)
Extrinsic Allergic Alveolitis (pigeon)
Seronegative (PAIR)
TB
26
Q

What are the causes of lower lobe ILD?

A

STAIR

Sarcoidosis
Toxins
Asbestosis
Idiopathic pulmonary fibrosis
Rheumatological conditions (RA, SLE, Scleroderma)
27
Q

Give 6 toxins that may cause lower lobe ILD

A 
Methotrexate
Bleomycin
Sulfalazine
Azathoprine
Amiodarone
Nitrofurantoin
28
Q

what are the signs and symptoms of ILD?

A

Dyspnoea on exertion
Non-productive, paroxysmal cough

Clubbing, cyanosis, fine end-inspiratory crackles, ? weight loss

29
Q

Define extrinsic allergic alveolitis

A

Repeated inhalation of an allergen

leads to a type III hypersensitivity reaction in the acute phase.

prolonged and more chronic = type IV hypersensitivity reaction occurs leading to the formation of granulomas.

30
Q

Define idiopathic pulmonary fibrosis

A

Infiltration of inflammatory cells and fibrosis of the parenchyma.

Unknown cause but common.

For supportive and palliative care.

31
Q

What is the gold standard imaging to diagnose ILD?

A

High resolution computed tomography (HRCT chest)

32
Q

What is the FEV1/FVC seen in obstructive disease?

A

<70% or <0.7

33
Q

What is the FEV1/FVC seen in restrictive disease?

A

Normal to increased

so >70%

34
Q

What is a pneumothorax and what is the difference between a primary and a secondary pneumothorax?

A

Air within the pleural cavity

Primary = no underlying lung condition
Secondary = the patient has a pre-existing lung disease
35
Q

What are the risk factors for pneumothorax?

A

Non-modifiable:

  • Tall and slim
  • Underlying lung disease e.g. Asthma or COPD

Modifiable:

  • Trauma
  • Invasive ventilation/ NIV
  • Smoking
36
Q

Give 4 symptoms of pneumothorax

A

Shortness of breath
Pleuritic chest pain
Reduced lung expansion
Tracheal deviation if tension

37
Q

Give 3 signs of pneumothorax

A

Severe tachypnoea
Mediasteinal shift
hypotension

38
Q

How can a large pneumothorax be differentiated from a small on CXR?

A

large = >2cm visible rim between lung margin and chest wall at the level of the hilum

39
Q

How would a primary pneumothorax be managed in a patient <50?

A

Asymptomatic + small = o2, monitor and follow up CXR

Symptomatic or large = Aspirate. IF this fails then insert a chest drain

40
Q

How would a secondary pneumothorax and/or a patient >50 be managed?

A

Small/asymptomatic = monitor + o2

Large/symptomatic = aspirate then chest drain if fails

41
Q

What is the location of the chest drain to manage a pneumothorax?

A

Mid-clavicular line

2nd/3rd intercostal space

42
Q

What is the management of a tension pneumothorax?

A

Emergency needle decompression!

Get a cardiothoracic surgeons opinion

43
Q

Give a complication of pneumothorax

A

Surgical emphysema

occurs when air/gas is located in the subcutaneous tissues (the layer under the skin).

44
Q

Which lung cancer is most associated with smoking and hypercalcaemia?

A

Squamous cell

45
Q

What are the 4 medications used in TB treatment? Give one side effect for them

A

RIPE

Rifampicin - red/orange wee + hepatotoxic
Isonazid - peripheral neuropathy
Pyrazinamide - hyperuricaemia (gout)
Ethambutol - blurred vision/reduced visual acuity

46
Q

Define bronchiectasis

A

Permanent dilation of the bronchi and bronchioles due to chronic infection

47
Q

What are the 5 main causes of bronchiectasis?

A

Post-Infection: Tuberculosis; HIV; Measles; Pertussis; Pneumonia

Bronchial Pathology: Obstruction by foreign body or tumour

Allergic Bronchopulmonary aspergillosis (ABPA)

Congenital: Cystic fibrosis; Kartagener’s syndrome; Primary ciliary dyskinesia; Young syndrome

Hypogammaglobulinaemia

48
Q

What are the features of an acute moderate asthma attack?

A

Increasing symptoms but no signs of a severe attack

PEFR 50-75%

49
Q

What are the features of an acute severe asthma attack?

A

PEFR 33-50%
RR >25
HR >110
Can’t speak in full sentences

50
Q

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

A 
PEFR <33%
PaO2 <8
NORMAL PACO2
poor respiratory effort
cyanosis
exhaustion/unable to speak/change in conscious levels
arrhythmia
51
Q

What are the features of an acute near fatal asthma attack?

A

The same as life threatening but they begin to retain CO2 so PaCO2 increases

52
Q

Describe the features of a safe asthma discharge bundle

A

Meds - Been on discharge medication for 12-24 hours, check inhaler technique, on PO and I corticosteroids

  • PEF >75% of best or predicted
  • Own PEF meter and written asthma action plan
  • Follow up in 2 days with GP, and in 4 weeks at respiratory clinic
53
Q

define COPD

A

progressive obstructive disorder of the airway

Get an obstructive pattern of breathing = (fev1 <80% predicted; fev1/fvc <0.7

little or no reversibility

It includes chronic bronchitis and emphysema.

54
Q

What does the COPD care bundle comprise of? (5)

A

1) assess inhaler technique
2) Rescue pack and mx plan
3) Smoking cessation advice and referral
4) Pulmonary rehab referral
5) Follow up within 72 hours

FINALS (not specialities) (7 decks)

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