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4th Year Exam > Respiratory ILOs > Flashcards

Respiratory ILOs Flashcards

1
Q

Define type 1 and type 2 respiratory failure and give one cause of each

A

1: low O2, normal/low CO2 - COPD

2. low O2, high CO2 - severe asthma

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2
Q

Give 3 causes of hypoxaemia

A

Hypoventilation
Shunt
Ventilation/perfusion mismatch

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3
Q

Define COPD

A

Progressive airflow obstruction which is not fully reversible, associated with CD8+ cells, macrophages and neutrophils

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4
Q

Which deficiency is commonly seen in COPD patients?

A

Alpha-1-antitrypsin (can’t counterbalance destructive enzymes)

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5
Q

Outline the pathology of chronic bronchitis

A

Productive of sputum most days for at least 3 months in at least 2 years

  • narrow airways, interstitial support loss = mucus plugging
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6
Q

Outline the pathology of emphysema

A

Permanent enlargement of airspaces distal to terminal bronchioles

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7
Q

How does airflow obstruction occur in COPD?

A
  • Loss of elasticity
  • Air trapping + hyperinflation
  • Increased work of breathing
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8
Q

What may be seen on X-Ray and spirometry in COPD?

A

X-Ray: hyperinflation, black lungs, flat hemi-diaphragm, thin heart

S: <70% FEV1/FVC ratio

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9
Q

Give 5 management options for COPD

A
  • SA bronchodilator e.g. salbutamol
  • LA bronchodilator e.g. salmeterol
  • SAMA e.g. ipratropium
  • LAMA e.g. tiotropium
  • Pulmonary rehab
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10
Q

Define asthma and its cause

A

Chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

Immune mediated intolerance of external factor

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11
Q

Outline the pathology of asthma

A

Physiological: reversible/variable airflow obstruction

Pathological: airway inflammation/allergy

Clinical triggers: cold, exercise, cats…

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12
Q

Which 2 interleukins are implicated in asthma?

A

IL4 and IL33

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13
Q

What may be seen on spirometry in asthma?

A

FEV1/FVC ratio >70%

Reversibility of 15% and 400ml after salbutamol

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14
Q

Give 5 Tx steps in asthma management

A
  1. Inhaled SABA
  2. Add inhaled steroid
  3. Add inhaled LABA
  4. Consider more inhaled steroid or add leukotriene receptor e.g. Montelukast
  5. Daily steroid tablet
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15
Q

Outline the management steps in an acute asthma exacerbation

A 
Oxygen 
Salbutamol 
Hydrocortisone 
Ipratropium 
Theophylline 
Magnesium
Anaesthetics
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16
Q

Give 5 risks of a DVT/PE

A
  • Active malignancy
  • Recent major surgery
  • Recent hospitalisation
  • Recent trauma
  • Pregnancy
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17
Q

Give 2 investigations for DVT

A

D-dimer

Proximal duplex US

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18
Q

Which Wells score makes DVT likely

A

2 or more

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19
Q

Outline the steps of anticoagulation for DVT/PE

A
  • Apixaban/Rivaroxaban (if pt. has no other disease)
  • Apixaban/Rivaroxaban/LMWH (in renal impairment), CrCl<15 = LMWH
  • DOAC or LMWH in active cancer
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20
Q

What is Virchow’s triad in PE development?

A
  • Venous stasis
  • Vessel wall damage
  • Hypercoagulability
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21
Q

Which imaging technique is used in PE?

A

CTPA

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22
Q

Which Wells score makes PE likely?

A

Over 4

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23
Q

What anticoagulation can be used in confirmed PE?

A

Heparin

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24
Q

Define pneumothorax and give 4 types

A

Air within the pleural cavity leading to collapse of the elastic lung

  • Traumatic
  • Iatrogenic
  • Spontaneous
  • Tension
25
Outline the pathology of a tension pneumothorax
One-way valve = increased intrapleural pressure Impaired venous return and BP fall = arrest
26
Give 3 signs and symptoms of pneumothorax
- Pleuritic chest pain - Hyper-resonance on percussion - Tracheal deviation – late sign
27
What is defined as a small and large pneumothorax?
Small <2cm | Large >2cm
28
Give 4 management options for pneumothorax
- Intercostal drain + underwater seal - VATS - Talc pleurodesis - Pleural abrasion
29
How is a tension pneumothorax immediately managed?
Large bore cannula into 2nd ICS, mid clavicular line
30
Define pleural effusion
Fluid in pleural space >15ml
31
Outline Light's criteria and when it indicates an exudate
1. Fluid protein: serum protein ratio >0.5 2. Fluid LDH: serum LDH >0.6 3. Fluid LDH>2/3 maximum serum normal
32
Give 2 causes of a transudate and exudate PE
T: heart failure, renal failure E: malignancy, empyema
33
Describe small cell carcinoma
- Most aggressive - Oval/spindle cells with nuclear moulding - In and around hilus
34
Describe Squamous cell carcinoma
- In dysplastic epithelium - Central and slow growing - Keratinisation +/- intracellular bridges
35
Describe adenocarcinoma
- Periphery - more common in female - Produce mucin
36
Describe large cell carcinoma
- Not squamous or glandular | - Usually central
37
Give 3 targeted lung cancer therapies
- EGFR mutation = tyrosine kinase inhibitor - EML4-ALK gene fusions = ALK inhibitor - PDL1 = PDL1 inhibitors
38
What is mesothelioma?
Tumour of the pleura almost always due to asbestos exposure
39
Define obstructive sleep apnoea and give 2 symptoms
Recurrent episodes of partial/complete upper airway obstruction during sleep, intermittent hypoxia and sleep fragmentation Snoring Witnessed apnoea
40
Outline the pathology of OSA
Pharyngeal narrowing leads to arousal and one of: - Sleep disruption and risk of RTA - BP surge = heart attack and stroke
41
Give 2 investigations of OSA
- Limited sleep study (at home: O2, HR, flow, thoracic/abdo effort, position) - Full polysomnography (video, audio, thoracic + abdo bands, limb leads..)
42
Give 3 management options for OSA
-Weight loss -Avoid triggers e.g. alcohol -Continuous positive airways pressure (CPAP) o Splints airway open, fixed vs. autoset
43
Define sarcoidosis
Multisystem inflammatory disease of unknown cause mainly affecting the lungs and intrathoracic lymph nodes. Non-necrotising granulomatous inflammation
44
Give 4 features of sarcoidosis
- Systemic symptoms e.g. fever, anorexia, night sweats - Pulmonary dyspnoea on exertion - Chest pain - Cough
45
Define idiopathic pulmonary fibrosis
Characterised by progressive breathlessness, bibasilar crackles and subpleural honeycombing. More common in males and over 50s
46
Define Pulmonary fibrosis
Scarring in the lungs with a specific cause such as smoking and is different from idiopathic pulmonary fibrosis
47
Give 3 causes of PF
- Occupational and environmental e.g. asbestosis - Drug induced e.g. amiodarone, methotrexate - Connective tissue disease e.g. RA, lupus
48
How is pulmonary fibrosis diagnosed?
High resolution CT
49
Define bronchiectasis and give 2 causes
Permanent dilation of bronchi due to destruction of elastic and muscular component of bronchial wall - Post-infectious - Immunodeficiency
50
Give 3 symptoms of bronchiectasis
- Cough - Sputum - Crackles
51
Give 2 risks of bronchiectasis
Cystic Fibrosis | Host immunodeficiency
52
Give 2 investigations and 2 Tx for bronchiectasis
CXR + CT chest Airway clearance and inhaled bronchodilator
53
Define pulmonary hypertension and give 2 symptoms
High blood pressure in pulmonary arteries Dizziness Peripheral oedema
54
Define cor pulmonale
Enlargement and failure of right ventricle due to increased vascular resistance or high blood pressure in the lungs
55
Give 2 management options for cor pulmonale
Oxygen | Diuretics
56
Define Extrinsic Allergic Alveolitis and give 2 triggers
Allergy of lung parenchyma, beginning with trigger causing APCs to activate T-cells Bird dander Mushroom worker's lung
57
Outline what happens in the acute phase of illness of EAA
- 4-6 hours post exposure, can last days - Serum sickness illness - Wheeze, fever, cough, myalgia
58
Give 2 management options for EAA
Avoid triggers | Corticosteroids

4th Year Exam (20 decks)

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