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Phase 2a medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is FEV1?

A

Forced expiratory volume in 1 second

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2
Q

What is FVC?

A

Forced vital capacity, the total amount of air forcibly expired.

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3
Q

What are the values for FVC in airways restriction?

A

Lower than 80% with a normal FEV1:FVC ratio

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4
Q

What are the values for Airway obstruction?

A

FEV1:FVC ratio is below 0.7

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5
Q

What are the 2 types of COPD?

A

Chronic bronchitis and emphysema

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6
Q

What is chronic bronchitis?

A

Increased mucus production due to irritants.

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7
Q

Pathophysiology of chronic bronchitis?

A

Mucus narrows airways, hypertrophy and hyperplasia in the mucus glands due to increased irritants.
Not as much O2 can come in and CO2 can’t get out due to the mucus.

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8
Q

What do patients with chronic bronchitis present with?

A

Hypercapnia and hypoxemia as the mucus plugs prevent O2 from entering the lungs and CO2 from leaving.

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9
Q

What is emphysema?

A

Increased breakdown of elastin in the lungs leading to reduced recoil of the lungs.

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10
Q

Pathophysiology of emphysema?

A

Macrophages phagocytose pollutants/particles, release cytokines, attracting neutrophils to the area.
Elastase is released which breaks down elastin.
Alveoli collapse due to lack of elastin.

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11
Q

What is alpha-1 antitrypsin?

A

An inhibitor of the enzyme elastase

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12
Q

What does this mean for patients with alpha-1 antitrypsin deficiency?

A

There is more elastase and therefore leads to the development of emphysema.

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13
Q

What are the risk factors for COPD?

A

Smoking, exposure to particles and pollutants.

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14
Q

Which patients are described as blue bloaters?

A

Patients with chronic bronchitis, commonly have a high BMI and cyanosis due to hypercapnia.

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15
Q

Which patients are described as the pink puffers?

A

Chronic emphysema, exhale through pursed lips to prevent alveolar collapse.

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16
Q

Presentations of chronic bronchitis?

A

Chronic productive cough, sputum, wheezing on expiration, inspiratory crackles, dyspnoea on exertion, hyper resonance to percussion.

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17
Q

Presentations of emphysema?

A

Weight loss, wheezing on expiration, hyper-resonance to percussion.

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18
Q

What are the gold standard tests for COPD?

A

Pulmonary function tests and spirometry. Do tests with and without bronchodilators if theres less than a 12% increase in FEV1 its likely to be COPD.

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19
Q

When should you start COPD on supplemental O2?

A

if O2 is less than 88%, if they have other conditions then start at 90%

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20
Q

What will you see on ABG in COPD?

A

Elevated CO2 low pH and low O2

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21
Q

What might a CXR show in COPD?

A

Can show a flat diaphragm, hyperinflation, air trapping and bullae (an air pocket due to emphysema)

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22
Q

Differential diagnoses for COPD?

A

Asthma, congestive heart failure, bronchiectasis.

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23
Q

Management of COPD generally?

A

Smoking cessation, influenza and pneumococcal vaccine.

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24
Q

Mild or intermittent COPD?

A

SAMA or SABA with a spacer

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25
Q

Moderate or severe COPD?

A

LAMA or LABA with corticosteroids.

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26
Q

Acute exacerbation of COPD?

A

IV methylprednisolone

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27
Q

Name a SAMA?

A

Ipratropium

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28
Q

Name a LAMA?

A

Tiotropium

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29
Q

Name a SABA?

A

Albutcol

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30
Q

Nama a LABA?

A

Salmeterol

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31
Q

How does a muscarinic receptor work?

A

ACH increases the amount of Ca2+ in the cell leading to bronchoconstriction.

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32
Q

How does a SAMA and a LAMA work?

A

Block ACH from being able to bind and causing less bronchoconstriction.

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33
Q

How do B2 receptors work?

A

When adrenaline or noradrenaline binds, increases the amount of cAMP leading to relaxation of smooth muscle.

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34
Q

How do SABA’s and LABAs work?

A

They are B2 receptor agonists, increasing the level of cAMP and therefore bronchodilation.

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35
Q

What is asthma?

A

A chronic inflammatory condition causing narrowing of the airways leading to difficulty breathing.

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36
Q

What is the age of onset for asthma?

A

3-5years

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37
Q

What are the risk factors for asthma?

A

Genetic predisposition, atopic triad, obesity, inner city environment, premature birth, socioeconomic deprivation.

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38
Q

What are asthma attacks commonly triggered by?

A

Air pollution, dust, dander, aspirin, beta blockers.

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39
Q

What happens during an asthma attack?

A

When a trigger enters the lungs eosinophils release their granules, this causes damage to cells lining the bronchioles leading to smooth muscle spasms and increased mucus production.

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40
Q

Symptoms of asthma?

A

Chest tightness, dyspnea, wheezing, coughing, mucus plugs in sputum. nocturnal coughing.

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41
Q

Signs of asthma?

A

Tachypnoea, audible wheeze, hyperinflated chest, decreased air entry and hyperresonant percussion note

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42
Q

What is the gold standard investigation for asthma?

A

Peak expiratory flow rate measured before and after a bronchodilator.

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43
Q

What questions should you ask to diagnose asthma?

A

Recent nocturnal waking, usual asthma symptoms in a day, interference with activities of daily living.

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44
Q

How to manage asthma?

A 
Avoid contact with triggers, 
Immediate: 
O2 therapy, 
Nebulised salbutamol 
Prednisolone 
Daily:
1. Salbutamol when required
2. SABA plus inhaled corticosteroid 
3. Add a LABA if not controlled.
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45
Q

What is a PE?

A

When an embolus becomes lodged in the pulmonary artery blocking blood flow to the lung.

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46
Q

What is the most common cause of a PE?

A

DVT - 95%

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47
Q

What are the risk factors for PE?

A

Major surgery, pregnancy, COPD, congestive heart failure, varicose veins, immobility, increasing age, malignant disease.

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48
Q

What are the common sources of a PE?

A

External iliac, femoral, deep femoral, popliteal

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49
Q

What are the CV affects of the PE?

A

An embolism lodged in a pulmonary artery causes an increase in pulmonary vascular pressure.
Increased right ventricular pressure leads to right sided HF.

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50
Q

What are the lung affects of PE?

A

V/Q mismatch due to obstruction of pulmonary artery.
Inflammation causes cytokine release and bronchoconstriction.
Hyperventilation, hypercapnia and respiratory acidosis.

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51
Q

What are the key presentations of a PE?

A

Dyspnoea, pleuritic chest pain, swollen leg and pain in the legs

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52
Q

What are the signs of a PE?

A

Tachycardia and hypotension

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53
Q

1st line investigations for a PE?

A

CXR to exclude pneumonia and pneumothorax

ECG to exclude MI and pericarditis.

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54
Q

Whats the gold standard investigation for a PE?

A

CT pulmonary angiogram

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55
Q

What would you do in a PE if the D-dimer was positive?

A

It could be a PE so CT pulmonary angiogram.

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56
Q

How to manage PE?

A

Oxygen, fluids, opiates for pain.

Anticoagulants used for a minimum of 3 months, Use heparin and Warfarin

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57
Q

Which is faster acting heparin or warfarin?

A

Heparin works immediately, warfarin takes 5 days to work.

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58
Q

What criteria is used to decide how likely it is a patient will have a PE?

A

Well’s criteria

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59
Q

What Wells score value indicates that a PE is likely?

A

Greater than 4

60
Q

What is IPF?

A

The formation of scar tissue in the lungs with no known cause.

61
Q

Epidemiolgy of IPF?

A

2/3 >60 M>F

62
Q

What is the presentation of IPF?

A

Dyspnoea, dry cough, bibasal crackles

63
Q

What investigations would you do in IPF?

A

High resolution CT, would show a ground glass appearance.

64
Q

What is the pharmalogical treatment for IPF?

A

Pirfenidone and nintedanib

65
Q

What is the non-pharmological treatment for IPF?

A

Smoking cessation, physiotherapy, vaccines up to date.

66
Q

What is asbestosis?

A

The inhalation of asbestos

67
Q

What are the presentations of asbestosis?

A

Dyspnoea on exertion, dry cough, normal chest on auscultation

68
Q

How many years after exposure does asbestosis occur>

A

10 years after initial exposure

69
Q

What investigations would you do for asbestosis?

A

CXR, Spirometry (showing restriction), High res CT

70
Q

Treatment for asbestosis?

A

Remove exposure, smoking cessation, symptom treatment.

71
Q

What are the complications of asbestosis?

A

Mesothelioma, pleural thickening

72
Q

What is Goodpasture’s syndrome?

A

Autoimmune anti-glomerular basement membrane disease where antibodies attakc the basement membrane in the lungs and kidneys.

73
Q

What is the presentation of goodpastures?

A

Haemoptysis, haematuria, dyspnoea, glomerulonephritis, chest pain, fever, fatigue.

74
Q

What are the investigations for good pastures?

A

Lung and kidney biopsy for anti-GBM antibodies.

75
Q

What is the treatment for goodpastures?

A

Prednisalone, immunosuppresents (cyclophosphamide), plasmapheresis.

76
Q

What is hypersensitivity pneumonitis?

A

A type 3 hypersensitivity reaction causing alveolar and bronchial inflammation

77
Q

What is the presentation of hypersensitivity pneumonitis?

A

Dyspnoea, cough, fever, malaise, weight loss

78
Q

What investigations for hypersensitivity pneumonitis?

A

Bronchoalveolar lavage: raised lymphocytes and mast cells.

79
Q

What is bronchoalveolar lavage?

A

Where water is washed into the lungs then collected again and sent for analysis.

80
Q

What is the treatment for hypersensitivity pneumonitis?

A

Remove allergens and steroids.

81
Q

What is granulomatosis with polyangiitis?

A

Systemic vasculitis involving small and medium vessels.
Classically ENT, lung and kidney involvement.
Associated with ANCA.

82
Q

What is the general presentation of granulomatosis with polyangiitis?

A

Malaise, fatigue, fever, night sweats, arthralgias.

83
Q

ENT symptoms of granulomatosis with polyangiitis?

A

Rhinorrhoea, chronic ear infections, conjunctivitis, scleritis, hoarseness.

84
Q

Lung symptoms of granulomatosis with polyangiitis?

A

Cough, dyspnoea, wheeze

85
Q

Kidney symptoms of granulomatosis with polyangiitis?

A

Haematuria

86
Q

What investigations would you do for granulomatosis with polyangiitis?

A

ANCA, urinalysis and CT chest.

87
Q

What treatment would you do for granulomatosis with polyangiitis?

A

Prednisalone, immunosuppression (rituximab, methotrexate) prophylactic antibiotics.

88
Q

What is a pneumothorax?

A

Air in the pleural space

89
Q

What are the most common causes of a pneumothorax?

A

Spontaneously, secondary to trauma, medical intervention, pathology e.g. asthma, COPD, infection.

90
Q

What is the typical patient with a pneumothorax?

A

Young, tall and thin

91
Q

What is a tension pneumothorax?

A

A one way valve into the pleura, the air can get in but can’t get out.
Progressively squashing the lung upon breathing

92
Q

What would you see on CXR in a tension pneumothorax?

A

Tracheal deviation

93
Q

1st line treatment of a tension pneumothorax?

A

Large bore cannula into the second intercostal space midclavicular line as a way for air to get out.

94
Q

What are the key presentations of a pneumothorax?

A

Sudden shortness of breath, pleuritis chest pain, comes on when playing sports.

95
Q

What’s the first line investigation for a pneumothorax?

A

Erect chest x-ray. Patient standing upright with their lungs fully expanded.

96
Q

What is the gold standard investigation for pneumothorax?

A

CT thorax as it can detect smaller pneumothorax’s

97
Q

Treatment of a pneumothorax less than 2cm in size?

A

Usuallt resolves spontaneously, just do a follow up CXR.

98
Q

Pneumothorax greater than 2cm?

A

Aspiration?

99
Q

When should you use a chest drain to treat a pneumothorax?

A

If aspiration fails twice or if its secondary to other conditions.

100
Q

Whereabouts is a chest drain inserted?

A 
The triangle of safety:
5th intercostal space 
mid axillary line, 
anterior axillary line 
Above the rib to above the neurovascular bundle.
101
Q

What is a pleural effusion?

A

Fluid in the pleural space

102
Q

What is an exudative pleural effusion?

A

Inflammation causing protein leaking into the pleural space

e.g. lung cancer, pneumonia, RA, TB

103
Q

What is a transudative pleural effusion?

A

Caused by congestive heart failure, hypoalbulminaemia and hypothyroidism.
Low protein in fluid

104
Q

What are the key presentations of pleural effusion?

A

Shortness of breath

Dullness to percuss, reduced breath sounds

105
Q

What’s the 1st line investigation for pleural effusion?

A

CXR showing: blunting of costophrenic angle, fluid in the lung fissures, large effusions meniscus.

106
Q

Gold standard for pleural effusions?

A

Sample of the pleural fluid by aspiration or chest drain.

107
Q

Management of a larger effusion?

A

Aspiration or chest drain

108
Q

What is sarcoidosis?

A

Granulomatous inflammatory condition.

109
Q

What is the cause of sarcoidosis?

A

Unknown

110
Q

Who is affected by sarcoidosis?

A

young adults and around age 60. women and black people more common.

111
Q

What are granulomas?

A

Nodules of inflammation that are full of macrophages

112
Q

What is erythrma nodosum?

A

Tender, red nodules on the shins.

113
Q

Typical presentation of patient with sarcoidosis?

A

Young, black, female patient with dry cough and SOB, nodules on the shins

114
Q

1st line investigation for sarcoidosis?

A

Serum ACE is raised anf serum calcium.

115
Q

Gold standard investigation for sarcoidosis?

A

Histology, biopsy of the affected area showing non-caeseating granulomas with epithelioid cells.

116
Q

What would sarcoidosis show on CXR?

A

Hilar lymphadenopathy

117
Q

How to treat sarcoidosis?

A

condition usually resolves spontaneously but steroids can be given.

118
Q

What causes TB?

A

Mycobacterium tuberculosis

119
Q

How does TB work inside a macrophage?

A

Instead of being broken down by lysosomes, it is able to resist lysosomal degradation and multiply.

120
Q

How to granulomas form in TB?

A

Immune cells surround the bacteria and wall it off forming a granuloma. The middle of the granuloma dies and this is caseous necrosis.

121
Q

What happens when someone with latent TB becomes immunocompromised?

A

The bacteria can spread again, this time spreading to the upper lobes and potentially spreading systemically.

122
Q

Key presentations of TB?

A

Fever, night sweats, weight loss, coughing up blood

123
Q

1st line investigation of TB?

A

CXR to look for granuloma and signs of active TB

124
Q

How to manage latent TB?

A

Isoniazid for 9months

125
Q

How to manage an active TB infection?

A

Combination of antibiotics

126
Q

What can you use to test for TB?

A

The PDD intradermal skin test.

127
Q

What are the 2 types of lung cancer/

A

Small cell lung cancer and non small cell carcinoma

128
Q

What are the risk factors for lung cancer?

A

Cigaretter smoking, asbestos, coal and products of coal combustion, radon exposure, PF, HIV, genetic factors.

129
Q

Lung cancer symptoms of local disease?

A

Persistent cough, SOB, Haemoptysis, chest pain

130
Q

What is a paraneoplastic change?

A

Where a tumour secretes a specific hormone

131
Q

Can lung cancers undergo paraneoplastic changes?

A

yes

132
Q

First line investigations for Lung cancer?

A

CXR, CT chest, liver and adrenals, sputum cytology .

133
Q

What might you see on a CXR in lung cancer?

A

Central mass, hilar lymphadenopathy, pleural effusion.

134
Q

What tests are diagnostic for lung cancer?

A

Biopsy and histology

135
Q

Which lung cancer arises from endocrine cells?

A

Small cell lung cancer

136
Q

What kinds of hormones does small cell lung cancer secrete?

A

Polypeptide hormones

137
Q

Which lung cancer is most strongly associated with cigarette smoking?

A

Squamous cell carcinoma

138
Q

Which cells does squamous cell carcinoma arise from?

A

Epithelial cells in the central bronchus

139
Q

Which is the most common lung cancer in non-smokers?

A

adenocarcinoma

140
Q

What types of cell do adenocarcinomas originate from/

A

Mucus-secreting glandular cells.

141
Q

Whereabouts do lung cancers commonly metastise?

A

Liver, bone, adrenal glands, brain

142
Q

What is pulmonary hypertension?

A

A disease of the small pulmonary arteries characterised by vascular proliferation and remodelling.
Progressive increase in pulmonary vascular resistance.

143
Q

What are the causes of pulmonary hypertension?

A

Anything that increases PVR or increases pulmonary blood flow.

COPD, emphysema, LV failure etc

144
Q

WHat are the clinical features of pulmonary hypertension/

A

Exertional dyspnoea, lethargy and fatigue, ankle swelling.

145
Q

What are the signs of pulmonary hypertension?

A

Tricuspid regurgitation murmur

146
Q

What is the diagnostic test for pulmonary HTN?

A

Right heart catheterisation

147
Q

Treatment for pulmonary HTN?

A

Oral anticoags, dieuretics, supplemental oxygen, supervised exercise training, avoid pregnancy.

Phase 2a medicine (14 decks)

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