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High Yield > Respiratory Disease > Flashcards

Respiratory Disease Flashcards

1
Q

What does spirometry test?

A

Forced expiratory volume in 1 second (FEV1)
Forced vital capacity
FEV1/FVC

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2
Q

How can you diagnose obstructive lung disease with spirometry?

A

FEV1/FVC < 0.7

as FEV1 is reduced and FVC is less reduced

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3
Q

How can you diagnose restrictive lung disease with spirometry?

A

FEV1/FVC > 0.7

FEV1 and FVC are both reduced equally

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4
Q

What mnemonic is used to analyse a chest X-ray?

A

DR ABCDE

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5
Q

What are the symptoms of COPD?

A

Cough (with white phlegm), worse in the morning SoB

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6
Q

What are the signs of COPD?

A

Barrel chest, hyper-resonance on percussion, quiet breath sounds over bullae, wheeze, coarse crackles

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7
Q

What are risks factors for COPD?

A

Smoking, advanced age, genetics

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8
Q

What spirometry would you expect in a COPD patient?

A

FEV1/FVC < 0.7

Predicted FEV1 lowers are COPD gets worse

Also ABG, sputum, CT

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9
Q

What is the pharmacological management of COPD?

A

Step 1: SABA or SAMA
Step 2: LABA + LAMA or LABA + ICS
Step 3: LABA + LAMA + ICS
Step 4. inhaled corticosteroids

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10
Q

What is a common SABA?

A

Salbutamol

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11
Q

What is a common SAMA?

A

Ipratropium bromide

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12
Q

What are two common LABA?

A

Salmeterol

Formoterol

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13
Q

What is a common LAMA?

A

Tiotropium

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14
Q

What is a common ICS?

A

Beclomethasone

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15
Q

What are the most common side effects of COPD medication?

A

Fine tremor, anxiety, headache, dry mouth

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16
Q

What O2 do you use for hypoxic patients?

A

High flow O2

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17
Q

What saturation do you aim for for COPD patients?

A

88-92%

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18
Q

What are most common causes of acute COPD exacerbations?

A

Bacterial: haemophilus influenzae, streptococcus pneumoniae

Viral (30%)

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19
Q

How does a patient with an acute COPD exacerbation present?

A

SoB, cough, wheeze, decreased exercise tolerance

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20
Q

How do you treat an acute COPD exacerbation?

A
  1. Salbutamol + ipratropium
  2. Steroids - IV hydrocortisone and prednisolone
  3. Abx
  4. CHest physio to help mucous clearance
  5. Consider IV aminophylline if patient isn’t responding
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21
Q

What are symptoms of asthma?

A

Cough, dyspnoea, wheeze, chest tightness

Key to know: symptoms frequency, recognisable triggers, how many days of work/school are missed; compliance

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22
Q

What are signs of asthma?

A

Expiratory wheeze on auscultation of the chest, reduced PEFR

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23
Q

How is asthma diagnosed?

A

FEV1/FVC < 0.7

Reversible during spirometry

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24
Q

What is the pharmacological management ladder for asthma?

A
  1. SABA prn
  2. SABA prn + low dose ICS
  3. SABA prn + low dose ICS + LABA
  4. SABA prn + medium dose ICS + LABA
  5. SABA prn + high dose ICS + LABA
  6. SABA prn + high dose ICS + LABA + corticosteroid
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25
Q

How would you quantify the severity of an acute exacerbation of asthma?

A

Moderate: PEFR 50-70%, normal speech, RR<25, HR<110

Severe: PEFR 30-50%, can’t complete sentences, RR>25, HR>110

Life-threatening: PEFR < 33%, silent chest, cyanosis, feeble respiratory effort, dysrhythmia, bradycardia, hypotension

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26
Q

How would you treat an acute exacerbation of asthma?

A

Think OH SHIT ME

Oxygen, salbutamol, Hydrocortisone IV, Ipratropium bromide, theophylline, magnesium sulfate, escalate

Monitor saturations, ABG, watch potassium

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27
Q

How may a patient with a resp infection present?

A

Cough, sputum, dyspnoea, So, fever or chills, pleuritic pain, general chest pain, confusion

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28
Q

What is CURB65 used for?

A

Assessing severity of resp infection

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29
Q

What does CURB65 stand for?

A 
Confusion
Urea > 7 mmol/L
RR > 30/min
BP; systolic < 90, diastolic <60
65 years old or older

0 - 1 home-based care
2 - admit
3 - ICU

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30
Q

Common cause of pneumonia?

A

Haemophilus influenza

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31
Q

What are risk factors for hospital-acquired infections?

A 
Poor hygiene
Head of bed positioned at 30 degrees
Mechanical ventilation
Neurological deficit
Unsafe swallowing
32
Q

What antibiotics would you give for pneumonia?

A

Typical - amoxicillin
Atypical - clarithromycin
IECOPD - amox/doxy or clarith

33
Q

What is the typical TB infection presentation?

A

Chronic cough, pyrexia, anorexia, night sweats, pleuritic chest pain, general malaise

34
Q

What are risk factors for TB infections?

A

Exposure, birth in endemic country, immunosuppression, overcrowding

35
Q

How would you treat TB infection?

A

RIPE

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

36
Q

What are the symptoms for respiratory malignancy?

A

Cough, haemoptysis, dyspnoea, chest pain, anorexia, fatigue

37
Q

When would you consider malignancy?

A

Patient with a history of smoking and chest signs (SVC obstruction, change in voice, Horner’s syndrome)

38
Q

What is Horner’s syndrome?

A

Ptosis, miosis, anhidrosis

39
Q

What are initial investigations for malignancy?

A 
Bloods
CXR
Cytology
CT
Bronchoscopy
PET
40
Q

What are key facts for small cell lung cancer?

A

Usually central, almost always smokers, metastasises early, the worst prognosis

20% of all lung cancers

41
Q

What is small cell lung cancer often associated with?

A

Ectopic hormone secretion

ADH –> hyponatraemia
ACTH –> Cushing’s

42
Q

What are key facts for squamous cell lung cancer?

A

Typically central
Associated with PTH secretion and hypercalcemia
Strongly associated with clubbing

43
Q

What are key facts for adenocarcinoma?

A

Typically peripheral
Most common in noon-smokers
Most common in women

44
Q

What are key facts for large cell lung cancer?

A

Peripheral and very large
Anaplastic, poorly differentiated tumours with poor prognosis
May secrete beta-hCG

45
Q

What is mesothelioma caused by?

A

Exposure to asbestos

46
Q

What is the prognosis of mesothelioma?

A

50% 1 year survival

5% 5 year survival

47
Q

What is most common after asbestos exposure?

A

Pleural plaques

48
Q

How do you manage lung cancer?

A

Chemotherapy and/or radiotherapy

49
Q

What is the prognosis for non-small cell lung cancer?

A

50% 2 year survival without spread

10% with spread

50
Q

What is the prognosis for small cell lung cancer?

A

Median survival 3 months if untreated

1-1.5 years if treated

51
Q

What is type 1 respiratory failure?

A

Hypoxaemia without hypercapnia: PaO2 < 8kPA

52
Q

What is type 2 respiratory failure?

A

Hypoxaemia with hypercapnia: PaCO2 > 6.5kPa and PaO2 < 8kPA

53
Q

What are the main causes of type 1 respiratory failure?

A

Pneumonia
Pulmonary oedema
PE
ARDS

54
Q

What are the main causes of type 2 respiratory failure?

A

CNS trauma
Pulmonary fibrosis
NMD

55
Q

What often causes pulmonary embolisms?

A

Often from venous thromboembolism from leg or pelvis

56
Q

What are risk factors for pulmonary embolism?

A

Recent surgery, thrombophilia, immobility, malignancy, pregnancy

57
Q

What are symptoms of pulmonary embolism?

A

Pleuritic chest pain, haemoptysis, dyspnoea

58
Q

What are signs for pulmonary embolism?

A

Tachcardia, tachypnoea, hypotension, pyrexia, raised JVP

59
Q

What is the scoring system for diagnosing pulmonary embolism?

A

Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins): 3 points

An alternative diagnosis is less likely than PE: 3 points

HR > 100bpm: 1.5 points
Immobilisation for more than 3 days or surgery in previous 4 weeks: 1.5 points
Haemoptysis: 1 point
Malignancy: 1 point

PE likey with more than 4 points

60
Q

How would you treat a pulmonary embolism?

A

Anticoagulants and warfarin

Heparin

61
Q

How could you prevent pulmonary embolisms?

A

Give heparin to immobile patients
Stop HRT/the pill pre-operatively
If FHx of VTE/PE, consider thrombophilia screening

62
Q

How does a patient with pulmonary oedema present?

A

Dysnpoea, orthopnoea, pink frothy sputum

Distressed, pale, sweaty, tachycardic, tachypnoea, pulsus aternans, raised JVP, fine crackles, gallop rhythm

63
Q

How would you manage pulmonary oedema?

A

Daily weights (aim for 0.5kg/day loss)
Repeat CXR
Furosemide
Optimise HF and cardiac medication

64
Q

How would you manage a patient with acute pulmonary oedema?

A
  1. Sit patient upright and place onto high flow oxygen through a NRB
  2. IV access and monitoring: ECG (treat arrhythmias), CXR, bloods, ABG and ? Echo
  3. Diamorphine 1.25-5mg IV slowly (caution in liver failure and COPD)
  4. Furosemide IV 40-80mg slowly (larger dose in renal failure)
  5. GTN 2 puffs SL or 2x0.3mg SL tablets if systolic >90
  6. Nitrate infusion if systolic >100 (if systolic <100 treat as cardiogenic shock and call ITU)
  7. Consider CPAP – get help before initiating (CCO or ITU)
65
Q

How would a patient with a pneumothorax present?

A

Sudden onset pleuritic pain and shortness of breath

66
Q

What are the signs of pneumothorax?

A

Reduced expansion, hyper resonance, reduced breath sounds

67
Q

What investigations would you do for a pneumothorax?

A

CXR

ABG

68
Q

What can be causes of a pneumothorax?

A 
Spontaneous - young, tall men
Chronic lung disease
Infection
Trauma
Carcinoma
Connective tissue disorders
69
Q

How would you manage an acute pneumothorax?

A

Chest drain in safe triangle:

Mid axillary line + 5th intercostal space

70
Q

How would you manage a primary pneumothorax?

A

If <2cm rim and patient not SoB, then consider discharge

If rim>2cm or chest drain, then chest drain

Patient advice: no smoking, permanently avoid diving

71
Q

How would you manage a secondary pneumothorax?

A

If patient >50yo, rim>2cm, then chest drain

Otherwise, attempt aspiration

Admit patients for a minimum of 24 hours

72
Q

What are the symptoms of pleural effusion?

A

SoB, non-productive cough, chest pain

73
Q

What are the signs of a pleural effusion?

A

Dullness to percussion, reduced breath sounds, reduced expansion

74
Q

What are the two classifications of pleural effusions?

A

Transudate

Exudate

75
Q

What are the characteristics of a transudate?

A

Low protein, caused by systemic problems

Liver cirrhosis and heart failure

76
Q

What are the characteristics of a exudate?

A

High protein, caused by local problems

Infection, malignancy, TB

77
Q

What are Lights criteria for determining exudate vs transudate?

A

Protein
Exudate is more likely if:
1. Pleural fluid protein/serum protein > 0.5
2. Pleural fluid LDH/serum LDH >0.6

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