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Diseases of human systems > respiratory medicine > Flashcards

respiratory medicine Flashcards

1
Q

What is the normal resp rate of adults

A

12-10 breaths per min

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2
Q

What are the normal FEV values in adults

A
  • Healthy adult male >3.5L
  • Healthy adult female >2.5L
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3
Q

What are 4 Rheumatological Conditions

A
  • Rheumatoid Arthritis
  • Systemic Sclerosis
  • Systemic Lupus Erythematosis
  • Myositis
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4
Q

What is the most common breathing disorder while sleeping

A

OSA (obstructed sleep apnoea)

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5
Q

What are symptoms of OSA

A

Snoring, apnoea periods, dry mouth, daytime
fatigue, daytime somnolence, poor concentration, headaches, depression

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6
Q

What causes OSA

A

Upper airway obstruction, but movement of the chest wall (rib cage and abdomen) persists

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7
Q

What risk factors are associated with breathing diseases

A

Male
Obesity
Type 2 diabetes
Smoking
Alcohol
Down’s syndrome
Craniofacial abnormalities
Hypothyroidism
Acromegaly

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8
Q

What does STOP BANG stand for and what is it used to diagnose

A

Used to diagnose OSA
S- do you Snore (loudly?)
T- are you often Tired during the day
O- has anyone Observed you choking/gasping in sleep
P- high blood Pressure

B- BMI >35
A-Age >50
N- Neck circumference >16” or 17”
G- Gender are you male

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9
Q

How is OSA treated

A
  • Lifestyle changes
  • Continuous Positive Airway Pressure (CPAP)
  • Mandibular Advancement Devices
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10
Q

What do these symptoms indicate and what action should be taken:
* Unwell, scared pt
* Muffled voice
* if the child coughs it may sound like a “quack”
* increasing dysphagia
* drooling
* stridor

A

Indicative of Epiglottitis and urgent admission to hospital is required

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11
Q

What is epiglottitis

A
  • Localized swelling of epiglottis caused by infection
  • Obstructs the laryngeal inlet.
  • Haemophilus influenzae.
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12
Q

How is tonsillitis managed/treated

A
  • Analgesia
  • Soft diet
  • If difficulty swallowing or unilateral; swelling refer to ENT urgently
  • Recurrent symptoms refer to ENT routinely
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13
Q

What is COPD (chronic obstructive pulmonary disease)

A

Airflow obstruction due to chronic inflammation
Chronic Bronchitis
* Inflammation
* Excess mucus
* Chronic productive cough >3 months in 2 consecutive years
Emphysema
* Alevolar membrane degradation
* Recurrent inflammation, scarring and loss of parenchymal lung texture

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14
Q

What is the second largest cause of emergency admissions in uk

A

COPD

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15
Q

How many people in the uk does COPD affect

A

1.2 million

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16
Q

What is the pathology of COPD

A

Mucous hypersecretion
* increasing goblet cells and size of bronchial submucosal glands

Ciliary dysfunction
* Squamous metaplasia of epithelium (bronchitis)
* Dysfunction of the mucociliary escalator
* Difficulty expectorating

Airflow obstruction and hyperinflation/air trapping
* Small airways inflammation & narrowing
* Loss of lung elastic recoil (emphysema)
* Progressive air trapping during expiration
* Hyperinflation of the lungs

Gas exchange abnormalities
* Hypoxaemia with or without hypercapnia
* Abnormal distribution of
ventilation/perfusion ratios

Pulmonary hypertension
* late COPD
* loss of pulmonary capillary bed
* endothelial dysfunction
* remodelling of the pulmonary arteries

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17
Q

What are the symptoms of COPD

A

Chronic Cough
Fatigue
Dyspnoea
Excess mucus
Shortness of breath
Chest discomfort

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18
Q

What factors cause COPD

A
  • Smoking
  • Pollution
  • Occupational Exposure
  • Genetics (alpha 1- antitrypsin deficiency)
  • Lung development
  • Asthma
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19
Q

How COPD diagnosed

A

Spirometry
-measure post-bronchodilator spirometry to
confirm the diagnosis of COPD

Chest radiograph
-exclude other pathologies

Full blood count
-identify anaemia or polycythaemia

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20
Q

What treatment can be given to those with COPD

A
  • Aim to prevent these sequelae
  • Minimise progression of disease
  • Minimise exacerbations
  • Lifestyle measures
  • Smoking cessation
  • Exercise
  • End stage – oxygen therapy
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21
Q

What Sp O2 result would patients with COPD have

A

around 86-92 O2

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22
Q

What other illnesses can arise from COPD

A
  • Reduced QoL
    -5th cause of disability worldwide
  • Cor Pulmonale
  • Frequent LRTI
  • Secondary polycythaemia
  • Pneumothorax
  • Respiratory failure
  • Lung cancer
  • Muscle wasting & cachexia
23
Q

What antibodies does asthma stimulate production of

A

IgE

24
Q

What is asthma

A
  • Chronic respiratory condition associated with airway inflammation and
    hyper-responsiveness.
  • Asthma is one of the most common long-term conditions worldwide.
25
Q

What causes the aiway limitation in asthma patients

A
  • mucosal oedema
    Atopy and airway hyperactivity lead to airway limitation due to:
  • bronchoconstriction - contraction of bronchial smooth muscle
  • an increased secretion of tenacious mucous
26
Q

What is the pathology of late onset (intrinsic asthma)

A
  • Not related to atopic conditions
  • No evidence of IgE mediation
  • No seasonal variation
  • Pathophysiology relatively unknown
27
Q

What are the symptoms of asthma

A

Cough
Wheeze
Chest tightness
Shortness of breath
Variable expiratory airflow limitation
Vary over time and in intensity

28
Q

What can trigger asthma

A
  • Exercise
  • Allergen or irritant exposure
  • Changes in weather
  • Viral respiratory infections
  • NSAIDs (5% asthmatics)
  • Beta -blockers
29
Q

What measures are taken to diagnose asthma

A
  • History
  • Peak Flow
  • Trial SABA
  • Blood Tests
30
Q

What is classed as complete control of asthma

A

no daytime symptoms
no night-time awakening due to asthma
no need for rescue medication
no exacerbations
no limitations on activity including exercise
normal lung function
minimal side effects from medication

31
Q

What asthma controllers (meds) do people take long term

A

systemic corticosteroids
methotrexate
leukotriene antagonists
LABA
inhaled corticosteroids

32
Q

What are some relievers for asthma

A

SABA
short acting theophylline
inhaled anticholinergics

33
Q

What is cystic fibrosis

A

Multisystem disorder, affecting the lungs, pancreas, liver, and intestine
Impairs the normal clearance of mucus from the lungs, which facilitates the
colonization and infection of the lungs by bacteria

34
Q

What is the test for cystic fibrosis

A

Sweat test
-sweat chloride >60 mmol/L is suggestive of cystic fibrosis.

Gene test

35
Q

How is cystic fibrosis managed

A
  • Antibiotics
  • Airway clearance techniques such as active cycle of breathing techniques (ACBT) or
    use of airway clearance devices.
  • Regular exercise improves both lung function and overall fitness.
  • Heart-lung transplant
36
Q

What percentage of lung cancers are preventable

A

89%

37
Q

What are the survival rates of people diagnosed with lung cancer

A

~ 40%1-year survival
~ 15% 5-year survival
~ 10% 10-year survival

38
Q

What are the two main branches of lung cancer

A

Small cell carcinoma
Non-small cell carcinoma

39
Q

What are the types of non-small cell carcinoma lung cancers

A

Adenocarcinoma (smaller airways) (non smokers)
Squamous cell carcinoma (bronchi)
Large cell carcinoma (centrally/large)

40
Q

What lung cancer is common in older smokers

A

Small cell carcinoma

41
Q

What are signs of lung cancer

A
  • cachexia (loss of muscle)
  • finger clubbing
  • cervical lymphadenopathy (enlargement of lymph nodes)
  • wheeze
42
Q

What clinical investigations are carried out to test for cancer

A
  • Chest X-ray (first-line)
  • CT chest-abdomen-pelvis
  • Bronchoscopy and biopsy
  • PET CT for staging.
43
Q

How is small cell lung cancer treated

A

*chemotherapy
*radiotherapy

44
Q

How is non-small cell lung cancer treated

A

*surgery
*targeted therapy
* immunotherapy
*chemotherapy
*palliative care

45
Q

What bacteria usually causes pneumonia

A

Streptococcus pneumoniae (pneumococcus)

46
Q

What are the signs and symptoms of pneumonia

A
  • cough
  • Breathlessness
  • Pleuritic pain
  • pyrexia
  • tachypnoea
  • Tachycardia
47
Q

What are the signs and symptoms of TB

A

Asymptomatic
Malaise
Weight loss
Fever
Night sweats
Productive cough
Shortness of breath
Chest pain
Extrapulmonary disease

48
Q

How does TB progress

A
  • Mycobacterium tuberculosis
  • Gram stain ineffective

Reactivation of infection when the immune
system is impaired
* destructive cavitating upper zone pneumonia
* multiplication of organisms within the cavities
* airway communication with cavities leading to:
* endobronchial spread within the lungs
* airborne spread to others

Miliary Tuberculosis
* disseminated disease spreads through the blood
* tuberculomas in brain, kidney, bone, etc
* tuberculous meningitis
* may follow primary or post-primary infection
* poor prognosis

49
Q

What are the tests for a TB diagnosis

A

Chest X-ray

HIV serology

Brain MRI (miliary TB)

Sputum sample
*Ziehl-Neelsen stain for acid-fast bacilli
*culture for confirmation of diagnosis and sensitivity testing

Blood tests
*interferon gamma release assay (IGRA)
*GeneXpert nucleic acid amplification test and antibiotic sensitivity

Lumbar puncture
*investigation for TB meningitis

50
Q

What is a Pulmonary Embolus

A

Clot from a vein, originating in the venous sinuses of the calf or the
femoral vein or the pelvis, detaches and becomes lodged in the
pulmonary arterial tree

51
Q

What are the risk factors for a pulmonary embolus

A
  • Age
  • Obesity
  • Previous VTE
  • Malignancy
  • HRT/COCP
  • Pregnancy
  • Immobility
  • Hospitalisation
  • Cancer
  • Atrial Fibrillation
  • Factor V Leiden Deficiency
52
Q

How is an acute Pulmonary
Embolus treated

A
  • Thrombolysis
  • Percutaneous catheter removal of clot

Anticoagulation must be taken for 6 months min

53
Q

What drugs are common with asthmatic patients

A

Corticosteroids
-Inhaled (controllers) Pressurised metered dose inhalers with spacer (E.g. becotide)
-Oral (severe disease)
-Intravenous (emergency use)

Beta-2 agonists
-Inhaled SABA e.g. salbutamol or terbutaline (rapid onset)
-Inhaled LABA e.g. salmeterol or formoterol
-Oral
-Intravenous

Leukotriene Receptor Antagonists
-Oral e.g. Montelukast

Muscarinic Antagonists
-Inhaled e.g. ipratropium

Theophylline
-Oral

Diseases of human systems (8 decks)

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