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Year 4 General Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

clear and colourless sputum?

A

chronic bronchitis

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2
Q

yellow green sputum?

A

pneumonia

COPD exacerbation

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3
Q

frothy white/pink sputum?

A

pulmonary oedema

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4
Q

tidal volume

A

volume of air breathed in and out in a normal quiet breath

~500ml

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5
Q

inspiratory reserve volume

A

extra volume that can be inspired over and above the tidal volume

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6
Q

expiratory reserve volume

A

extra volume that can be expired over and below the tidal volume

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7
Q

residual volume

A

volume of air remaining in lungs after a maximal expiration

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8
Q

(forced) vital capacity

A

volume of air that can be exhaled after a maximal inspiration
TV + IRV + ERV

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9
Q

inspiratory capacity

A

TV + IRV

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10
Q

functional residual capacity

A

volume remaining in lungs after a quiet expiration

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11
Q

total lung capacity

A

total volume of air the lungs can hold

ie sum of all volumes

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12
Q

https://teachmephysiology.com/respiratory-system/ventilation/lung-volumes/

A

lung volumes

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13
Q

what is a normal FEV1/FVC ratio

A

~80%

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14
Q

what happens to the FEV1/FVC ratio in obstructive disease

A

FEV1 is reduced but FVC is normal so the ratio is <70%

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15
Q

what happens to the FEV1/FVC ratio in restrictive disease

A

FEV1 and FVC are both reduced but the ratio is >70%

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16
Q

what is the normal O2 sat target range for most people

A

94-98%

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17
Q

what is the normal O2 sat target for people with COPD

A

88-92%

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18
Q

describe type 1 resp failure

A

hypoxia

normal CO2

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19
Q

describe type 2 resp failure

A

hypoxia

hypercapnia

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20
Q

TLC and RV are increased/decreased in obstructive lung disease

A

increased in obstructive lung disease

decreased in restrictive lung disease

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21
Q

indications for bronchoalveolar lavage (BAL)

A

malignancy
pneumonia in immunosuppressed
TB
ILD

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22
Q

OSA can cause hyper/hypotension

A

hypertension

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23
Q

what is pneumonia

A

acute lower respiratory tract infection

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24
Q

what is community acquired pneumonia CAP and what are common causes

A

acquired in the community
most common cause - strep pneumoniae
HiB
mycoplasma

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25
what are less common causes of CAP
``` staph legionella moraxella chlamydia coxiella anaerobes viral ```
26
what is hospital acquired penumonia HAP
pneumonia >48hr after hospital admission
27
what bugs cause HAP
``` gram negative enterobacteria staph pseudomonas klebsiella bacteroides clostridium ```
28
what is aspiration pneumonia
aspiration of gastric contents which enters the resp tract causing infection
29
RF for aspiration pneumonia
``` stroke myasthenia gravis bulbar palsies low GCS oesophageal disease ```
30
what bugs can cause pneumonia in immunocompromised people
PJP fungi viral
31
what bug is most likely to be the cause of pneumonia in a HIV patient and what is the treatment
PJP | co-trimoxazole
32
what bug is most likely to be the cause of pneumonia in PWID and what is the treatment
Staph A flucloxacillin (causes a bilateral cavitating bronchopneumonia)
33
what bug is most likely to be the cause of pneumonia in homeless/alcoholic/returned traveller/from asia and what is the treatment
TB | 2 RIPE 4 RI antibiotics
34
what bug is most likely to be the cause of pneumonia in homeless/alcoholic/DM and what is the treatment
Klebsiella cefotaxime / imipenem causes a cavitating pneumonia
35
what bug is most likely to be the cause of pneumonia in bronchiectasis/CF/frequently hospitalised and what is the treatment
``` pseudomonas ticarcillin ciprofloxacin + gentamicin ceftazidine meropenem ```
36
what bug is most likely to be the cause of pneumonia in returned travellers (from spain) and what is the treatment
legionella levofloxacin clarithromycin
37
what bug is most likely to be the cause of pneumonia in someone with pet bird/parrot and what is the treatment
chlamydophila psittaci | tetracyclines
38
what bug is most likely to be the cause of pneumonia in children and young adults and what is the treatment
mycoplasma pneumoniae macrolides / tetracyclines / fluoroquinolone 'walking wounded'
39
what bug is most likely to be the cause of pneumonia in farmers
coxiella burnetti
40
symptoms and signs of pneumonia
``` fever cough malaise SOB purulent sputum pleuritic chest pain haemoptysis cyanosis confusion (delirium) tachycardia bronchial breathing signs of consolidation ```
41
potential investigations for pneumonia
``` ABCDE O2 if hypoxic IV access for FBC, U+E, LFT, CRP, blood cultures, amylase, troponins ECG erect CXR sputum culture CURB 65 ```
42
tests for legionella pneumonia
sputum culture | urinary antigen / culture
43
what is the CURB 65 score | list its components
``` used to assess severity of pneumonia, one point for each of the following: Confusion Urea >7 RR >30 BP S <90 or D <60 65yr or older ```
44
approach to pneumonia depending on CURB 65 score
0-1: at home 2: hospital >=3: severe, hospital admission and IV treatment
45
management of pneumonia in hospital
``` PO/IV antibiotics IV fluids antiemetics analgesia oxygen if hypoxic CXR (and follow up at 6 weeks) ```
46
complications of pneumonia
``` sepsis pleural effusion empyema lung abscess resp failure - type 1 hypotension AF ```
47
who is eligible for the pneumococcal vaccine
``` elderly immunocompromised - chemo, HIV, steroids chronic heart/liver/renal/lung disease COPD asthma hyposplenism DM ```
48
what antibiotics should those with a CURB65 score of 0-2 for CAP receive
amoxicillin PO 5 days | allergic: doxycycline or clarithromycin
49
what antibiotics should those with a CURB65 score of 3-5 for CAP receive
IV co-amoxiclav + doxycycline | allergic: levofloxacin
50
what antibiotics should those with non-severe HAP receive
PO amoxicillin 5 days | allergic: doxycycline
51
what antibiotics should those with severe HAP receive
IV amoxicillin and gentamicin | allergic: IV co-trimoxazole + gentamicin
52
what antibiotics should those with non-severe aspiration pneumonia receive
PO amoxicillin + metronidazole | allergic: doxycycline + metronidazole
53
what antibiotics should those with severe aspiration pneumonia receive
IV amoxicillin + metronidazole + gentamicin | allergic: replace amox with doxycycline/clarithromycin
54
when do you give antibiotics for COPD exacerbations
increased purulent sputum and symptomatic
55
antibiotics for COPD exacerbation
amoxicillin | allergic: doxycycline
56
what is the most common type of pneumonia
pneumococcal pneumonia (strep pneumoniae)
57
diagnosis of mycoplasma pneumoniae
PCR sputum or serology
58
complications of mycoplasma pneumoniae
erythema multiforme SJS meningoencephalitis GBS
59
features of legionnaire's disease
``` dry cough SOB water tank coloniser flu like symptoms bi basal consolidation deranged LFTs abdominal pain hyponatraemia ```
60
commonest viral cause of pneumonia
influenza
61
features of PJP pneumonia
SOB dry cough insidious onset exertional dyspnoea
62
features of COVID-19 virus
``` SOB cough ansomia loss of taste fatigue ```
63
what is SARS
severe acute respiratory syndrome | caused by SARS-CoV virus
64
features of empyema on aspiration
bright yellow pH <7.2 low glucose and high LDH
65
flucloxacillin and co-amoxiclav can cause jaundice, true or false
true
66
what is bronchiectasis
persistent abnormal dilatation of the airways
67
features of bronchiectasis
``` recurrent infections with: HiB, strep pneumoniae, staph a, pseudomonas copious purulent sputum haemoptysis finger clubbing wheeze ```
68
causes of bronchiectasis
``` idiopathic CF Primary ciliary dyskinesia post infection ABPA RA UC ```
69
in bronchiectasis, spirometry shows an obstructive/restrictive pattern
obstructive
70
what is cystic fibrosis
AR condition causing a mutation in the CFTR gene on chromosome 7 leading to defective chloride secretion and increased Na absorption across airway epithelium changes in airway surface liquid predispose to recurrent chronic infections and bronchietasis
71
features of CF
``` meconium ileus failure to thrive cough wheeze nasal polyps recurrent infections resp failure haemoptysis pancreatic insufficiency - DM, failure to absorb fat gallstones male infertility osteoporosis sinusitis finger clubbing ```
72
how can aspergillus affect the lungs
1. asthma - type 1 hypersensitivity to fungal spores 2. allergic bronchpulmonary aspergillosis - type 1 + 3 hypersensitivity 3. aspergilloma 4. invasive aspergillosis 5. extrinsic allergic alveolitis
73
RF for lung cancer
smoking age asbestos radiation
74
what are the different types of lung cancer
``` Small cell (SCLC) Non-small cell (NSCLC) - squamous - adenocarcinoma - large cell ```
75
symptoms of lung cancer
``` chronic cough >3months SOB chest pain haemoptysis lethargy, malaise, fatigue weight loss hoarse voice (RLN palsy) ```
76
signs of lung cancer
``` cachectic anaemia finger clubbing paraneoplastic syndromes lymphadenopathy ```
77
small cell lung cancer is a neuroendocrine type tumour?
yes
78
paraneoplastic syndromes associated with SCLC
SIADH: hyponatraemia ^ACTH secretion: Cushing's syndrome LEMS: antiCa channel Ab
79
paraneoplastic syndromes associated with squamous cell lung cancer
PTHrp
80
paraneoplastic syndromes associated with adenocarcinoma
HPOA | hypertrophic pulmonary osteoarthropathy
81
pathophysiology behind squamous cell lung cancer
smoking results in metaplasia of columnar glandular lung tissue to stratified squamous cells (protective) which then becomes cancerous
82
complications of lung cancer
``` recurrent laryngeal nerve palsy - from compression of nerve hooking around hilum/aorta phrenic nerve palsy SVC obstruction Horner's syndrome rib erosion AF metastases: brain, bone, liver, lungs ```
83
what is a Pancoast tumour and what is a potential complication
apical lung cancer | Horner's syndrome from compression of the sympathetic nerves
84
what is Horner's syndrome
ptosis - partial miosis - pupil constriction anhydrosis - ipsilateral
85
adenocarcinomas are more likely to be found centrally/peripherally
peripherally
86
management of the following lung cancers: SCLC NSCLC
SCLC - chemotherapy | NSCLC - excision for peripheral tumours, radiotherapy, chemotherapy
87
small cell lung cancer is more likely to metastasise fast/slow
fast | more likely to have disseminated disease early on
88
what lung diseases can asbestos cause
pleural plaques | mesothelioma
89
D.Dx of a lung nodule in a CXR
``` malignancy abscess granuloma carcinoid tumour cyst hamartoma ```
90
symptoms of asthma
``` SOB dry cough nocturnal/early morning symptoms wheeze atopy tight chest triggers: cold weather, exercise, NSAIDs, allergens ```
91
stepwise approach to asthma therapy
1. inhaled SABA - salbutamol 2. ICS 3. inhaled LABA 4. increase dose of ICS 5. consider leukotriene antagonist
92
management for exercise induced asthma
leukotriene receptor antagonist LABA sodium cromoglicate theophyllines
93
when would you consider stepping up treatment wise in asthma
if using SABA >3 times a week
94
asthma shows a restrictive/obstructive pattern on spirometry
obstructive
95
management of acute asthma
``` ABCDE PEFR to determine severity O2 if hypoxic nebulised SABA steroid: PO pred / IV hydrocortisone nebulised ipratropium bromide IV magnesium sulphate IV aminophylline ```
96
symptoms of COPD
exertional dyspnoea chronic cough (productive) wheeze exacerbations
97
what red flags must you ask about in COPD
``` unintentional weight loss chest pain peripheral oedema fatigue occupational hazards haemoptysis ```
98
investigations for COPD
spirometry CXR FBC BMI
99
what comprises COPD
emphysema and chronic bronchitis
100
management of COPD
``` lifestyle modifications: smoking cessation, exercise, pulmonary rehab, vaccination SABA/SAMA ICS LAMA/LABA - non-asthmatic features ICS/LABA - asthmatic features ICS/LABA/LAMA PO steroids PO theophylline ```
101
antibiotic of choice for prophylaxis in COPD
azithromycin
102
indications for long term O2 therapy in COPD
``` FEV1<30% cyanosis polycythaemia peripheral oedema raised JVP SaO2 <92% MUST NOT BE A SMOKER ```
103
what is a cardiac complication of COPD
cor pulmonale | right heart failure secondary to lung disease
104
what is acute respiratory distress syndrome ARDS
acute lung injury which may be caused by direct lung injury or secondary to systemic disease lung damage and release of inflammatory mediators results in a non-cardiogenic pulmonary oedema often accompanied by multi-organ failure
105
causes of ARDS
``` pneumonia vasculitis contusion shock sepsis DIC pancreatitis acute liver failure eclampsia drugs ```
106
what is respiratory failure
inadequate gas exchange results in hypoxia
107
what is type 1 resp failure
hypoxia only
108
what is type 2 resp failure
hypoxia and hypercapnia
109
T1RF is mainly caused by?
``` VQ mismatch e.g. pneumonia pulmonary oedema PE asthma emphysema pulmonary fibrosis ARDS ```
110
T2RF is mainly caused by?
alveolar hypoventilation e.g. pulmonary disease: asthma, COPD, OSA, pneumonia reduced resp drive: opiates, CNS tumour, trauma neuromuscular disease thoracic wall disease
111
clinical features of hypoxia
``` SOB restlessness agitation confusion cyanosis ```
112
clinical features of hypercapnia
``` headache peripheral vasodilatation tachycardia bounding pulse tremor / flap papilloedema confusion ```
113
what is a pulmonary embolus (PE) and list its causes
``` clot that has broken off and lodged in the pulmonary circulation can arise from: DVT - most common right ventricular thrombus septic emboli fat air amniotic fluid tumour ```
114
RF for PE/DVT
``` immobility recent surgery pregnancy contraception long haul flight cancer thrombophilia previous PE ```
115
clinical features of PE
``` swollen hot leg SOB chest pain haemoptysis dizziness tachycardia tachypnoea hypotension hypoxia ```
116
investigations for PE
``` FBC, U+E, LFT, CRP, d dimer, coagulation screen ABG ECG CXR leg USS CTPA / VQ scan ECHO ```
117
d dimer is a good test for DVT/PE?
no | it is sensitive but not specific ie if it is raised it does not confirm PE but if it is low it can exclude
118
What is the Wells score
scoring system to estimate the probability of a PE
119
a Wells score of ? is likely to be a PE | what is the management
>4 | arrange hospital admission for CTPA
120
a Wells score of ? is not likely to be a PE | what is the management
<=4 | arrange a d dimer with results available within 4 hours
121
ECG patterns in PE
tachycardia S1Q3T3 RBBB
122
treatment of PE in hospital
1. DOAC | 2. thrombolysis (alteplase) for a massive PE and patient is haemodynamically unstable
123
what is a pneumothorax
air in the pleural space
124
RF for pneumothorax
``` tall thin men CTD - Marfan's, Ehler-Danlos smokers asthma COPD trauma iatrogenic - chest drain ```
125
clinical features of pneumothorax
acute SOB pleuritic chest pain reduced breath sounds hyperresonant percussion
126
what makes a tension pneumothorax different from a pneumothorax
tracheal deviation | mediastinal shift
127
with a tension pneumothorax, the trachea will be deviated away/towards the affected side
AWAY!!!
128
management of a spontaneous pneumothorax >2cm
chest aspiration with cannula | if not improving or is a secondary pthx, insert a chest drain and admit
129
small vs large pneumothorax?
small <2cm | large >2cm
130
management of a tension pneumothorax
immediate call for help needle decompression in 2nd ICS mid clavicular line on affected side then a chest drain
131
what is a pleural effusion
fluid in the pleural space
132
pleural effusions can be transudate or exudate, what does this mean
transudate: <30g protein organ failure, fluid overload, hypoproteinaemia, hypothyroidism, Meig's syndrome exudate: >30g protein infection, cancer, inflammation
133
what is a: haemothorax empyema chylothorax
blood in the pleural space pus in the pleural space chyle in the pleural space
134
clinical features of pleural effusion
asymptomatic pleuritic chest pain stony dull to percuss reduced breath sounds
135
large effusions can cause the trachea to deviate away/towards the affected side on CXR
away from affected side
136
CXR feature of pleural effusion
blunting of costophrenic angle
137
management of pleural effusion
chest drain / aspiration
138
what is sarcoidosis
a multisystem non-caseating granulomatous disorder of unknown origin
139
clinical features of sarcoidosis
``` asymptomatic SOB cough erythema nodosum arthralgia bihilar lymphadenopathy hepatomegaly hypercalcaemia high serum ACE ```
140
management of sarcoidosis
BHL alone - nothing acute - bed rest, NSAIDs Steroids: symptomatic, eye disease, ^Ca, neuro/cardiac involvement
141
D.Dx for bihilar lymphadenopathy BHL
Cancer sarcoidosis infection - TB, mycoplasma EAA
142
what is ILD
interstitial lung disease is a generic term to describe diffuse lung disease / fibrosis / inflammation
143
clinical features of ILD
SOB cough non productive abnormal breath sounds
144
ILD is restrictive/obstructive
restrictive
145
classification of ILD
known cause associated with systemic disease idiopathic
146
known causes of ILD
``` occupational e.g. asbestosis, silicosis drugs e.g. nitrofurantoin, bleomycin, amiodarone, sulfasalazine hypersenstivity e.g. EAA infection GORD ```
147
systemic diseases causing ILD
``` RA sarcoidosis SLE SS MCTD Sjogrens UC ```
148
idiopathic causes of ILD
idiopathic pulmonary fibrosis
149
What is Caplan's syndrome
associated with RA, pneumoconiosis, and pulmonary rheumatoid nodules
150
what is OSA
obstructive sleep apnoea is characterised by intermittent closure of pharyngeal airway causing episodes of apnoea during sleep
151
RF for OSA
Male obesity macroglossia Downs syndrome
152
clinical features of OSA
``` daytime somnolence loud snoring poor sleep quality morning headache decreased cognitive performance HTN change in personality ```
153
complications of OSA
pulmonary HTN type 2 resp failure HTN
154
Scoring system for OSA
Epworth sleepiness scale
155
management of OSA
weight loss avoid smoking and alcohol CPAP at night
156
what is cor pulmonale
right heart failure caused by chronic arterial pulmonary hypertension
157
ABCDE of heart failure on CXR
``` A - Alveolar oedema (Batwing opacities) B - kerley B lines (interstitial oedema) C - Cardiomegaly D - Dilated prominent upper lobe vessels E - pleural Effusions ```
158
what is the TLCO test
Transfer factor for CO | assesses gas transfer of oxygen from lungs into blood
159
idiopathic pulmonary fibrosis will have a low/high FEV1/FVC ratio and a low/high TLCO
high ratio | low TLCO
160
what does a reduced TLCO mean?
reduced ability of the lungs to perform gas exchange
161
what test is widely used for latent TB
Mantoux / tuberculin skin test
162
if you have had the BCG vaccine, can you have a reaction to the Mantoux test?
yes, you may have a mild reaction | this does not necessarily mean you have TB
163
what is IGRA
blood test for TB used following a positive Mantoux test
164
causes of haemoptysis
``` lung cancer / metastases lung abscess PE bronchiectasis / CF vasculitides: GPA, EGPA, Goodpasture's trauma AVM post surgery ```
165
pulmonary causes of breathlessness
airway obstruction - tumour, infection, foreign body, asthma, COPD, bronchiectasis, cancer parenchyma - fibrosis, sarcoid, TB, tumour, pneumonia circulation - PE, vasculitis, pul HTN pleural - effusion, pneumothorax chest wall - scoliosis, kyphosis neuromuscular - MG, GBS, MND
166
non-pulmonary causes of breathlessness
``` anaemia obesity pregnancy metabolic acidosis (DKA) left HF psychogenic ```

Year 4 General Medicine (16 decks)

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