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Year 4 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What PaO2 is indicative of respiratory failure

A

<8

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2
Q

What is type I respiratory failure

A

caused by V/Q mismatch, resulting in low PaO2 and normal/low PaCo2

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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

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4
Q

What may cause type I respiratory failure

A
  • pneumonia
  • asthma
  • PE
  • pulmonary oedema
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5
Q

What is type II respiratory failure

A

hypoxia and hypercapnia, with or without V/Q mismatch

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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

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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
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8
Q

What is the most common cause of type II respiratory failure

A

COPD

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9
Q

What are symptoms of hypoxia

A
  • dyspnoea
  • restnessness
  • central cyanosis
  • confusion
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10
Q

What are symptoms of hypercapnia

A
  • confusion/loss of conscioussness/coma
  • peripheral venous dilatation
  • CO2 retention flap
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11
Q

What investigations should be done in suspected respiratory failure

A
  • ABG
  • Obs (particular sats)
  • blood/sputum culture
  • CXR
  • bedside spirometry testing
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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

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13
Q

What is COPD

A

chronic bronchitis and emphysema causing progressive obstructive lung disease with little or no reversibility

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14
Q

What pattern does COPD have on spirometry?

A

obstructive

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15
Q

What spirometry result is distinctive of COPD

A

FEV1/FVC ratio reduced (<0.7)

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16
Q

What are the clinical features of COPD

A
  • dyspnoea
  • chronic productive cough
  • reduced exercise tolerance
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17
Q

What are some differentials for COPD

A
  • asthma
  • bronchiectasis
  • CHF
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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
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19
Q

What are the main complications of COPD

A
  • exacerbations
  • respiratory failure
  • lung cancer
  • cor pulmonale
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20
Q

What investigations should be ordered in COPD

A
  • spirometry
  • CXR
  • sputum culture
  • alpha-1 antitrypsin if suspected
  • echo (if cor pulmonale suspected)
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21
Q

What is a possible genetic cause of COPD

A

alpha1 antitrypsin deficiency

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22
Q

What are possible inhaled therapies for COPD

A
  • SABA
  • SAMA
  • LABA
  • LAMA
  • inhaled corticosteroid
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23
Q

Give a SABA name

A

salbutemol

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24
Q

give a SAMA name

A

ipratropium

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25
Q

give a LABA name

A

salmeterol

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26
Q

give a LAMA name

A

triotropium

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27
Q

What is the common triple inhaler therapy for severe COPD

A

LABA + LAMA + inhaled corticosteroid

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28
Q

can you prescribe a SAMA with a LAMA

A

no they do not work in combination

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29
Q

Which inhaler must ICS be presribed with

A

LABA - and nevere alone

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30
Q

What drug might be presribed for chronic productive cough

A

carbocisteine - a mucolytic

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31
Q

What investigations should you do in a COPD exacerbation

A
  • Obs
  • sputum/blood culture
  • ABG
  • CXR
  • ECG
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32
Q

What management can be given in COPD exacerbations

A
  • Abx
  • oral steroids
  • nebulised SABA/SAMA
  • oxygen therapy/NIV/invasive ventilation
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33
Q

What are the typical symptoms in asthma

A
  • cough
  • wheeze
  • chest tightness
  • breathlessness
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34
Q

What are the three main processes responsible for the majority of symptoms of asthma

A
  • bronchospasm
  • smooth muscle atrophy
  • mucus plugging
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35
Q

What is characteristically heard on auscultation in asthma

A

polyphonic wheeze

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36
Q

An asthma attack is severe if ____

A

patient cannot complete sentences

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37
Q

an asthma attack is life-threatening if ___

A

the chest is silent

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38
Q

What is found on spirometry in asthma

A

an obstructive pattern with reversible bronchoconstriction

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39
Q

What is the spirometry test that shows reversibility called

A

the bronchodilatory reversibility test

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40
Q

What are the main types of pneumonia

A
  • CAP
  • HAP
  • aspiration
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41
Q

What are the common causative agents of CAP

A

bacterial

  • strep pneumonia
  • haemophilus influenzae
  • staph A

viral
* influenza A

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42
Q

What are common findings on exam in pneumonia

A
  • reduced chest expansion
  • dullness to percussion
  • increased vocal fremitus
  • crackles and bronchial breathing

all on affected side/lobe

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43
Q

What are common causative agents of HAP

A
  • pseudomonas aeruginosa

* staph aureus

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44
Q

What are symptoms of pneumonia

A
  • dyspnoea
  • chest pain
  • SOB
  • productive cough
  • may be non-specific features in elderly or atopic pneumonia
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45
Q

What investigations should be ordered in suspected pneumonia

A
  • CXR
  • blood cultures
  • sputum microscopy/culture/sensitivity
  • ABG
  • U&Es
  • ECG (if chest pain)
46
Q

What is the scoring for severity of pneumonia?

A

CURB65

confusion
urea up
respiratory rate up
blood pressure down
age >65
47
Q

What is treatment for pneumonia

A
  • Abx
  • fluids
  • oxygen
  • analgesia
48
Q

What are complications of pneumonia

A
  • sepsis
  • respiratory failure
  • multiorgan failure
49
Q

Where do pulmonary embolisms usually come from

A

deep vein thromboses in the leg (usually calf)

50
Q

What are the factors that promote VTE

A
  • blood stasis (immobility, bed rest)

* hypercoagulability (surgery, malignancy)

51
Q

What is the presentation of a pulmonary embolism

A

sudden onset

  • dyspnoea
  • chest pain
  • haemoptysis

+/- haemodynamic instability

52
Q

Which location of a pulmonary embolism causes sudden death

A

pulmonary saddle (in the middle of the pulmonary artery division)

53
Q

What is the investigation of a PE

A
  • CXR
  • d-dimer
  • CTPA
  • ABG
  • ECG
54
Q

What might you find on ECG in pulmonary embolism

A
  • sinus tachycardia

* signs of right heart strain (t wave inversion in V1-V4)

55
Q

Why might pulmonary embolism case right heart strain

A

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
Q

What is treatment of PE

A
  • LMW heparin (eg dalteparin)
  • warfarin for at least 3 months
  • oxygen therapy and analgesia
57
Q

What treatment might be given if patient is haemodynamically unstable in PE

A

thromblysis (eg alteplase)

58
Q

What might you do as prevention of VTE in hospitalised patients

A
  • TED stockings
  • early mobilisation
  • anti-coagulation (eg enoxaparin)
59
Q

What are the types of pneumothorax

A
  • spontaneous
  • traumatic
  • iatrogenic
60
Q

What is the typical patient with primary spontaneous pneumothorax

A

tall, thin, young men who smoke or have been playing sports

possibly with a connective tissue disorder

61
Q

What might cause secondary spontaneous pneumothorax

A
  • COPD
  • bullae
  • other underlying lung conditions
62
Q

How might spontaneous pneumothorax present

A
  • dyspnoea
  • pleuritic chest pain
  • may be slow onset for primary and sudden onset for secondary
63
Q

What might you find on exam of spontaneous pneumothorax

A
  • reduced chest expansion
  • hyperresonance
  • diminished breath sounds
64
Q

What investigations would you perform in spontaneous pneumothorax

65
Q

Tracheal deviation would make you suspect ___?

A

tension pneumothorax

66
Q

What are treatment options for spontaneous pneumothorax

A
  • do nothing if young an the pneumothorax is small
  • aspirate
  • chest drain
  • oxygen therapy
  • pleurodesis is an option
67
Q

How might tension pneumothorax present

A
  • dyspnoea
  • pleuritic chest pain
  • haemodynamic instability
68
Q

Should you order a CXR if tension pneumothorax

69
Q

What is the management of tension pneumothorax

A

insert a wide bore cannula into the 2nd intercostal space in the midclavicular line
then insert a chest drain
pleurodesis may be required

70
Q

What are the types of lung cancer

A

SCLC
* small cell

NSCLC

  • large cell
  • adenoma
  • squamous cell
71
Q

Which type of lung cancer is the most aggressive

A

small cell

72
Q

Which type of lung cancer might occur peripherally in the lung fields

A
  • large cell
73
Q

What are symptoms of lung cancer

A
  • chest pain
  • weight loss
  • haemoptysis
  • cough
  • dyspnoea
74
Q

Where are common locations for lung cancer metastases

A
  • hilar lymph nodes
  • bone
  • brain
  • liver
75
Q

What investigations should be done in lung cancer

A
  • CXR
  • CT (for location and mets)
  • bronchoscopy (and biopsy)
  • PET scan
  • LFTs
  • bone profile
76
Q

What is a pleural effusion

A

fluid in the pleural space

77
Q

What are symptoms of pleural effusion

A
  • may be asymptomatic
  • dyspnoea/orthopnoea
  • chest pain
  • dry cough
  • pleuritic chest pain
78
Q

What signs might be found on examination of pleural effusion

A
  • dullness to percussion
  • bronchial breathing above effusion
  • reduced chest expansion
  • friction rub might be heard in inflammation
79
Q

What tests should be ordered for pleural effusion

A
  • ultrasound
  • CXR
  • CT chest
  • aspiration
80
Q

What is the difference between transudative and exudative pleural effusion

A

exudative has more protein and LDL

81
Q

What does low glucose in the pleural fluid indicate?

A

infection or malignancy (something is using the glucose)

82
Q

What is the name for blood in the pleural fluid

A

haemothorax

83
Q

What is the name for lymph in the pleural fluid

A

chylothorax

84
Q

What is the name for pus in the pleural fluid

85
Q

What might cause transudative pleural effusion

A
  • pulmonary hypertension

* hypoproteinaemia

86
Q

What might cause exudative pleural effusion

A

leaky vessels;

  • sepsis
  • malignancy
  • infection
  • inflammation
87
Q

What are you measuring in the pleural fluid

A
  • proteins
  • LDLs
  • white cells
  • glucose
88
Q

What is the management of pleural effusion

A
  • treat underlying cause
  • chest drain
  • pleurodesis if required
89
Q

What causes obstructive sleep apnoea

A

occlusion of the pharyngeal airway during sleep

90
Q

What investigations are required for obstructive sleep apnoea

A
  • sleep studies

* CT if mechanical obstruction suspected

91
Q

What ia treatment of obstructive sleep apnoea

A
  • CPAP

* surgery if necessary (eg tonsilectomy)

92
Q

What is a possible complication of obstructive sleep apnoea

A

pulmonary hypertension

93
Q

What causes interstitial lung disease

A

known cause

  • occupational (asbestosis)
  • drugs (eg nitrofurantoin)
  • infection (eg fungi)

associated with systemic disease
* SLE, sarcoidosis, RA, ulcerative colitis

idiopathic
* idiopathic pulmonary fibrosis

94
Q

What are symptoms of interstitial lung disease

A
  • SOBOE
  • non-productive cough
  • abnormal breath sounds
95
Q

What pattern does interstitial lung disease produce on spirometry

A

restrictive pattern

96
Q

What is the treatment for interstitial lung disease

A

supportive care

97
Q

What is bronchiectasis

A

long-term damage to bronchi caused by recurrent infection, resulting in permanent dilatation of these airways

98
Q

What causes bronchiectasis

A

congenital causes
* CF, abnormal cilia

post-infection
* pertussis, HIV, TB

other
* bronchial obstruction eg with foreign body/tumour

99
Q

What are the symptoms of bronchiectasis

A
  • cough
  • foul-smelling sputum
  • haemoptysis
100
Q

What pattern would be shown in spirometry of bronchiectasis

A

obstructive

101
Q

What is the management of bronchiectasis

A
  • antibiotics

* physio

102
Q

What causes cor pulmonale

A

pulmonary artery hypertension

103
Q

What are causes of pulmonary hypertension

A
  • RHF
  • chronic pulmonary embolisms
  • COPD
  • pulmonary artery hypertension
104
Q

What investigations can you order for pulmonary hypertension

A
  • CXR (look for cardiomegaly and underlying respiratory pathology)
  • spirometry
  • CTPA (look for PE)
  • Echo, ECG (look for RH strain/RHF)
  • right heart catheterisation
105
Q

What is required for diagnosis of pulmonary hypertension

A

right heart catheterisation

106
Q

How might sarcoidosis manifest

A
  • bilateral hilar lymphadenopathy
  • arrhythmia
  • uveitis
  • erythema nodosum
107
Q

How does acute sarcoidosis usually present

A
  • erythema nodosum and painful joints
108
Q

What blood results are characteristic of sarcoidosis

A
  • elevated Ca2+
  • elevated ACE
  • lymphopenia
109
Q

How is sarcoidosis diagnosed

A

tissue biopsy

110
Q

What is the treatment for sarcoidosis

A

may resolve spontaneously, if not, prednisolone

111
Q

What is the test for latent TB

A

Mantoux test

112
Q

What is the difference between granulomas in TB and sarcoidosis

A

sarcoidosis granulomas are non-caseating (non necrotic tissue inside)

Year 4 (13 decks)

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