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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

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
What causes the aiway limitation in asthma patients
* 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
What is the pathology of late onset (intrinsic asthma)
* Not related to atopic conditions * No evidence of IgE mediation * No seasonal variation * Pathophysiology relatively unknown
27
What are the symptoms of asthma
Cough Wheeze Chest tightness Shortness of breath Variable expiratory airflow limitation Vary over time and in intensity
28
What can trigger asthma
* Exercise * Allergen or irritant exposure * Changes in weather * Viral respiratory infections * NSAIDs (5% asthmatics) * Beta -blockers
29
What measures are taken to diagnose asthma
* History * Peak Flow * Trial SABA * Blood Tests
30
What is classed as complete control of asthma
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
What asthma controllers (meds) do people take long term
systemic corticosteroids methotrexate leukotriene antagonists LABA inhaled corticosteroids
32
What are some relievers for asthma
SABA short acting theophylline inhaled anticholinergics
33
What is cystic fibrosis
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
What is the test for cystic fibrosis
Sweat test -sweat chloride >60 mmol/L is suggestive of cystic fibrosis. Gene test
35
How is cystic fibrosis managed
* 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
What percentage of lung cancers are preventable
89%
37
What are the survival rates of people diagnosed with lung cancer
~ 40%1-year survival ~ 15% 5-year survival ~ 10% 10-year survival
38
What are the two main branches of lung cancer
Small cell carcinoma Non-small cell carcinoma
39
What are the types of non-small cell carcinoma lung cancers
Adenocarcinoma (smaller airways) (non smokers) Squamous cell carcinoma (bronchi) Large cell carcinoma (centrally/large)
40
What lung cancer is common in older smokers
Small cell carcinoma
41
What are signs of lung cancer
* cachexia (loss of muscle) * finger clubbing * cervical lymphadenopathy (enlargement of lymph nodes) * wheeze
42
What clinical investigations are carried out to test for cancer
* Chest X-ray (first-line) * CT chest-abdomen-pelvis * Bronchoscopy and biopsy * PET CT for staging.
43
How is small cell lung cancer treated
*chemotherapy *radiotherapy
44
How is non-small cell lung cancer treated
*surgery *targeted therapy * immunotherapy *chemotherapy *palliative care
45
What bacteria usually causes pneumonia
Streptococcus pneumoniae (pneumococcus)
46
What are the signs and symptoms of pneumonia
* cough * Breathlessness * Pleuritic pain * pyrexia * tachypnoea * Tachycardia
47
What are the signs and symptoms of TB
Asymptomatic Malaise Weight loss Fever Night sweats Productive cough Shortness of breath Chest pain Extrapulmonary disease
48
How does TB progress
* 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
What are the tests for a TB diagnosis
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
What is a Pulmonary Embolus
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
What are the risk factors for a pulmonary embolus
* Age * Obesity * Previous VTE * Malignancy * HRT/COCP * Pregnancy * Immobility * Hospitalisation * Cancer * Atrial Fibrillation * Factor V Leiden Deficiency
52
How is an acute Pulmonary Embolus treated
* Thrombolysis * Percutaneous catheter removal of clot Anticoagulation must be taken for 6 months min
53
What drugs are common with asthmatic patients
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 (9 decks)

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