Respiratory Flashcards
1
Q
What PaO2 is indicative of respiratory failure
A
<8
2
Q
What is type I respiratory failure
A
caused by V/Q mismatch, resulting in low PaO2 and normal/low PaCo2
3
Q
Describe what happens in type I respiratory failure
A
V/Q mismatch causes there to be not enough oxygen getting into the blood but the lungs’ capacity to excrete CO2 is preserved
4
Q
What may cause type I respiratory failure
A
- pneumonia
- asthma
- PE
- pulmonary oedema
5
Q
What is type II respiratory failure
A
hypoxia and hypercapnia, with or without V/Q mismatch
6
Q
What happens in type II respiratory failure
A
the lungs are not able to ventilate enough to get oxygen into the blood and also are not able to excrete CO2, resulting in acidosis
7
Q
What are causes of type II respiratory failure
A
pulmonary causes
- COPD
- pulmonary fibrosis
- asthma
reduced respiratory drive
- CNS trauma
- sedative drugs
neuromuscular
- myasthenic crisis
- paralysis
- obstructive sleep apneoa
8
Q
What is the most common cause of type II respiratory failure
A
COPD
9
Q
What are symptoms of hypoxia
A
- dyspnoea
- restnessness
- central cyanosis
- confusion
10
Q
What are symptoms of hypercapnia
A
- confusion/loss of conscioussness/coma
- peripheral venous dilatation
- CO2 retention flap
11
Q
What investigations should be done in suspected respiratory failure
A
- ABG
- Obs (particular sats)
- blood/sputum culture
- CXR
- bedside spirometry testing
12
Q
What is an extra consideration in the oxygen therapy of type II respiratory failure compared to type I
A
do not over oxygenate
13
Q
What is COPD
A
chronic bronchitis and emphysema causing progressive obstructive lung disease with little or no reversibility
14
Q
What pattern does COPD have on spirometry?
A
obstructive
15
Q
What spirometry result is distinctive of COPD
A
FEV1/FVC ratio reduced (<0.7)
16
Q
What are the clinical features of COPD
A
- dyspnoea
- chronic productive cough
- reduced exercise tolerance
17
Q
What are some differentials for COPD
A
- asthma
- bronchiectasis
- CHF
18
Q
What examination findings might be present in COPD
A
- central cyanosis
- barrel chest
- use of accessory muscles
- CO2 retention flap
- hyper-resonant lung fields
- wheeze
19
Q
What are the main complications of COPD
A
- exacerbations
- respiratory failure
- lung cancer
- cor pulmonale
20
Q
What investigations should be ordered in COPD
A
- spirometry
- CXR
- sputum culture
- alpha-1 antitrypsin if suspected
- echo (if cor pulmonale suspected)
21
Q
What is a possible genetic cause of COPD
A
alpha1 antitrypsin deficiency
22
Q
What are possible inhaled therapies for COPD
A
- SABA
- SAMA
- LABA
- LAMA
- inhaled corticosteroid
23
Q
Give a SABA name
A
salbutemol
24
Q
give a SAMA name
A
ipratropium
25
give a LABA name
salmeterol
26
give a LAMA name
triotropium
27
What is the common triple inhaler therapy for severe COPD
LABA + LAMA + inhaled corticosteroid
28
can you prescribe a SAMA with a LAMA
no they do not work in combination
29
Which inhaler must ICS be presribed with
LABA - and nevere alone
30
What drug might be presribed for chronic productive cough
carbocisteine - a mucolytic
31
What investigations should you do in a COPD exacerbation
* Obs
* sputum/blood culture
* ABG
* CXR
* ECG
32
What management can be given in COPD exacerbations
* Abx
* oral steroids
* nebulised SABA/SAMA
* oxygen therapy/NIV/invasive ventilation
33
What are the typical symptoms in asthma
* cough
* wheeze
* chest tightness
* breathlessness
34
What are the three main processes responsible for the majority of symptoms of asthma
* bronchospasm
* smooth muscle atrophy
* mucus plugging
35
What is characteristically heard on auscultation in asthma
polyphonic wheeze
36
An asthma attack is severe if ____
patient cannot complete sentences
37
an asthma attack is life-threatening if ___
the chest is silent
38
What is found on spirometry in asthma
an obstructive pattern with reversible bronchoconstriction
39
What is the spirometry test that shows reversibility called
the bronchodilatory reversibility test
40
What are the main types of pneumonia
* CAP
* HAP
* aspiration
41
What are the common causative agents of CAP
bacterial
* strep pneumonia
* haemophilus influenzae
* staph A
viral
* influenza A
42
What are common findings on exam in pneumonia
* reduced chest expansion
* dullness to percussion
* increased vocal fremitus
* crackles and bronchial breathing
all on affected side/lobe
43
What are common causative agents of HAP
* pseudomonas aeruginosa
| * staph aureus
44
What are symptoms of pneumonia
* dyspnoea
* chest pain
* SOB
* productive cough
* may be non-specific features in elderly or atopic pneumonia
45
What investigations should be ordered in suspected pneumonia
* CXR
* blood cultures
* sputum microscopy/culture/sensitivity
* ABG
* U&Es
* ECG (if chest pain)
46
What is the scoring for severity of pneumonia?
CURB65
```
confusion
urea up
respiratory rate up
blood pressure down
age >65
```
47
What is treatment for pneumonia
* Abx
* fluids
* oxygen
* analgesia
48
What are complications of pneumonia
* sepsis
* respiratory failure
* multiorgan failure
49
Where do pulmonary embolisms usually come from
deep vein thromboses in the leg (usually calf)
50
What are the factors that promote VTE
* blood stasis (immobility, bed rest)
| * hypercoagulability (surgery, malignancy)
51
What is the presentation of a pulmonary embolism
sudden onset
* dyspnoea
* chest pain
* haemoptysis
+/- haemodynamic instability
52
Which location of a pulmonary embolism causes sudden death
pulmonary saddle (in the middle of the pulmonary artery division)
53
What is the investigation of a PE
* CXR
* d-dimer
* CTPA
* ABG
* ECG
54
What might you find on ECG in pulmonary embolism
* sinus tachycardia
| * signs of right heart strain (t wave inversion in V1-V4)
55
Why might pulmonary embolism case right heart strain
arterial vasoconstriction around the area of the pulmonary embolism to try to divert blood to areas of the lung that are ventilated may cause pulmonary artery hypertension
56
What is treatment of PE
* LMW heparin (eg dalteparin)
* warfarin for at least 3 months
* oxygen therapy and analgesia
57
What treatment might be given if patient is haemodynamically unstable in PE
thromblysis (eg alteplase)
58
What might you do as prevention of VTE in hospitalised patients
* TED stockings
* early mobilisation
* anti-coagulation (eg enoxaparin)
59
What are the types of pneumothorax
* spontaneous
* traumatic
* iatrogenic
60
What is the typical patient with primary spontaneous pneumothorax
tall, thin, young men who smoke or have been playing sports
| possibly with a connective tissue disorder
61
What might cause secondary spontaneous pneumothorax
* COPD
* bullae
* other underlying lung conditions
62
How might spontaneous pneumothorax present
* dyspnoea
* pleuritic chest pain
* may be slow onset for primary and sudden onset for secondary
63
What might you find on exam of spontaneous pneumothorax
* reduced chest expansion
* hyperresonance
* diminished breath sounds
64
What investigations would you perform in spontaneous pneumothorax
* CXR
| * CT
65
Tracheal deviation would make you suspect ___?
tension pneumothorax
66
What are treatment options for spontaneous pneumothorax
* do nothing if young an the pneumothorax is small
* aspirate
* chest drain
* oxygen therapy
* pleurodesis is an option
67
How might tension pneumothorax present
* dyspnoea
* pleuritic chest pain
* haemodynamic instability
68
Should you order a CXR if tension pneumothorax
NO
69
What is the management of tension pneumothorax
insert a wide bore cannula into the 2nd intercostal space in the midclavicular line
then insert a chest drain
pleurodesis may be required
70
What are the types of lung cancer
SCLC
* small cell
NSCLC
* large cell
* adenoma
* squamous cell
71
Which type of lung cancer is the most aggressive
small cell
72
Which type of lung cancer might occur peripherally in the lung fields
* large cell
73
What are symptoms of lung cancer
* chest pain
* weight loss
* haemoptysis
* cough
* dyspnoea
74
Where are common locations for lung cancer metastases
* hilar lymph nodes
* bone
* brain
* liver
75
What investigations should be done in lung cancer
* CXR
* CT (for location and mets)
* bronchoscopy (and biopsy)
* PET scan
* LFTs
* bone profile
76
What is a pleural effusion
fluid in the pleural space
77
What are symptoms of pleural effusion
* may be asymptomatic
* dyspnoea/orthopnoea
* chest pain
* dry cough
* pleuritic chest pain
78
What signs might be found on examination of pleural effusion
* dullness to percussion
* bronchial breathing above effusion
* reduced chest expansion
* friction rub might be heard in inflammation
79
What tests should be ordered for pleural effusion
* ultrasound
* CXR
* CT chest
* aspiration
80
What is the difference between transudative and exudative pleural effusion
exudative has more protein and LDL
81
What does low glucose in the pleural fluid indicate?
infection or malignancy (something is using the glucose)
82
What is the name for blood in the pleural fluid
haemothorax
83
What is the name for lymph in the pleural fluid
chylothorax
84
What is the name for pus in the pleural fluid
empyema
85
What might cause transudative pleural effusion
* pulmonary hypertension
| * hypoproteinaemia
86
What might cause exudative pleural effusion
leaky vessels;
* sepsis
* malignancy
* infection
* inflammation
87
What are you measuring in the pleural fluid
* proteins
* LDLs
* white cells
* glucose
88
What is the management of pleural effusion
* treat underlying cause
* chest drain
* pleurodesis if required
89
What causes obstructive sleep apnoea
occlusion of the pharyngeal airway during sleep
90
What investigations are required for obstructive sleep apnoea
* sleep studies
| * CT if mechanical obstruction suspected
91
What ia treatment of obstructive sleep apnoea
* CPAP
| * surgery if necessary (eg tonsilectomy)
92
What is a possible complication of obstructive sleep apnoea
pulmonary hypertension
93
What causes interstitial lung disease
known cause
* occupational (asbestosis)
* drugs (eg nitrofurantoin)
* infection (eg fungi)
associated with systemic disease
* SLE, sarcoidosis, RA, ulcerative colitis
idiopathic
* idiopathic pulmonary fibrosis
94
What are symptoms of interstitial lung disease
* SOBOE
* non-productive cough
* abnormal breath sounds
95
What pattern does interstitial lung disease produce on spirometry
restrictive pattern
96
What is the treatment for interstitial lung disease
supportive care
97
What is bronchiectasis
long-term damage to bronchi caused by recurrent infection, resulting in permanent dilatation of these airways
98
What causes bronchiectasis
congenital causes
* CF, abnormal cilia
post-infection
* pertussis, HIV, TB
other
* bronchial obstruction eg with foreign body/tumour
99
What are the symptoms of bronchiectasis
* cough
* foul-smelling sputum
* haemoptysis
100
What pattern would be shown in spirometry of bronchiectasis
obstructive
101
What is the management of bronchiectasis
* antibiotics
| * physio
102
What causes cor pulmonale
pulmonary artery hypertension
103
What are causes of pulmonary hypertension
* RHF
* chronic pulmonary embolisms
* COPD
* pulmonary artery hypertension
104
What investigations can you order for pulmonary hypertension
* CXR (look for cardiomegaly and underlying respiratory pathology)
* spirometry
* CTPA (look for PE)
* Echo, ECG (look for RH strain/RHF)
* right heart catheterisation
105
What is required for diagnosis of pulmonary hypertension
right heart catheterisation
106
How might sarcoidosis manifest
* bilateral hilar lymphadenopathy
* arrhythmia
* uveitis
* erythema nodosum
107
How does acute sarcoidosis usually present
* erythema nodosum and painful joints
108
What blood results are characteristic of sarcoidosis
* elevated Ca2+
* elevated ACE
* lymphopenia
109
How is sarcoidosis diagnosed
tissue biopsy
110
What is the treatment for sarcoidosis
may resolve spontaneously, if not, prednisolone
111
What is the test for latent TB
Mantoux test
112
What is the difference between granulomas in TB and sarcoidosis
sarcoidosis granulomas are non-caseating (non necrotic tissue inside)
