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CARES > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

What is coughing up blood called?

A

Haemoptysis

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2
Q

What are some presenting symptoms of respiratory disease?

A
  • Cough
  • Sputum
  • Haemoptysis
  • Breathlessness
  • Wheeze
  • Chest pain - SOCRATES
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3
Q

Questions to be asked about a cough?

A
  • When? (Time of day)
  • Type? (chesty vs dry)
  • Triggers? (e.g. animal hair)
  • Positional?
  • Associated features (sputum/haemoptysis, wheeze)
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4
Q

What must be asked to patients presenting with respiratory disease?

A

If they have an active lung disease (COPD, asthma, lung cancer etc)

Have the symptoms changed?

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5
Q

What are the common symptoms for chronic respiratory disease?

A

Exercise intolerance
Cough
Sputum

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6
Q

What is pleurisy?

A

Inflammation of the tissue between the lungs and ribcage (pleura)

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7
Q

What are the common symptoms of pleurisy?

A
  • A sharp chest pain when you breathe (sometimes felt in shoulder)
  • The pain may be worse when you cough, sneeze or move around or on inspiration
  • It may be relieved by taking shallow breaths.
  • Other symptoms include shortness of breath and a dry cough.
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8
Q

What type of respiratory diseases does a fever typically present?

A

Infective cases e.g. pneumonia, TB or empyema

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9
Q

What symptoms may indicate a malignancy or chronic infection instead of acute?

A
  • Cough over 3 weeks
  • Malaise/fatigue
  • Weight loss
  • Fevers
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10
Q

When patient presents with bleeding of any type (e.g. coughing, vomiting, urine), what must be asked?

A

Are you on:

  • Anticoagulants or antiplatelets?
  • Aspirin?

Action may need to be taken to reverse the effect of these

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11
Q

What type of medication is Salbutamol?

A

B2 adrenoceptor agonist

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12
Q

Is salbutamol long or short acting?

A

Short

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13
Q

What are short-acting bronchodilators typically used for?

A

relief of bronchoconstriction

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14
Q

What are long-acting bronchodilators typically used for?

A

Predominantly used for prevention

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15
Q

How do B2 agonists work?

A

Bind to B2 receptors in the lungs and mimic catecholamines, stimulating cAMP –> causes smooth muscle relaxation and systemic vasodilation

BRONCHODILATOR - opens airways

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16
Q

What is Salbutamol / B2 agonists used to treat?

A

Used to relieve symptoms of asthma and chronic obstructive pulmonary disease (COPD)

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17
Q

What are the potential side effects of Salbutamol?

A
  • Arrhythmias
  • Tremor
  • Palpitations
  • Hypokalaemia (so may be used to treat hyperkalaemia)
  • Dizziness
  • Headache
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18
Q

What causes side effects of Salbutamol on the heart?

A

Works on B1 receptors on heart which typically bind noradrenaline (released from sympathetic adrenergic nerves) and adrenaline.

B-agonists mimic this, stimulating formation of cAMP but this enhances myocyte contraction

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19
Q

What is a pack year defined as?

A

A pack year is defined as 20 cigarettes smoked each day for 1 year.

The pack year history is calculated by the number of packs (of 20 cigarettes) a patient has smoked each day multiplied by the number of years they have smoked this for.

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20
Q

What are potential childhood causes of bronchiectasis?

A

Lung infections such as pneumonia, whooping cough or TB that damages the bronchi

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21
Q

What are the commonest genetic causes of bronchiectasis?

A

Cystic fibrosis and primary ciliary dyskinesia (formerly Kartagener’s syndrome)

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22
Q

During infective episodes during bronchiectasis, how does the sputum change?

A

The sputum usually increases in volume and often changes colour e.g from clear to green or brown

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23
Q

When can finger clubbing present?

A

Lung cancer or chronic infections (TB, bronchiectasis, endocarditis)

24
Q

What are the stages of finger clubbing?

A

1 - increased sponginess of nailbed

2 - loss of hyponychial angle

3 - increased curvature of nail

4 - drumstick appearance of nail

25
Q

What common antibiotic should the junior doctor prescribe for his community acquired pneumonia while waiting for the blood and pleural fluid cultures?

A

Co-Amoxiclav

26
Q

What is Co-Amoxiclav? What is it used to treat?

A

A mixed antibiotic of Amoxicillin and Clavulanic acid.

It is commonly used for treating Respiratory infections and used in combination with Clarithromycin for Community Acquired Pneumonia requiring hospital admission

27
Q

What is Flucloxacillin used to treat?

A

Skin infections

28
Q

What is Metronidazole used to treat?

A

Anaerobic bacteria so often for gastrointestinal or mouth infections.

29
Q

What is Trimethoprim used to treat?

A

Urinary tract infections

30
Q

What is Grade 1 on the MRC dyspnoea scale?

A

Not troubled by breathlessness except on strenuous exercise

31
Q

What is Grade 2 on the MRC dyspnoea scale?

A

Short of. breath when hurrying or walking up a slight hill

32
Q

What is Grade 3 on the MRC dyspnoea scale?

A

Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace

33
Q

What is Grade 4 on the MRC dyspnoea scale?

A

Stops for breath after walking about 100 metres or after a few minutes on level ground

34
Q

What is Grade 5 on the MRC dyspnoea scale?

A

Too breathless to leave the house, or breathless when dressing or undressing

35
Q

What are the common CVS symptoms associated with breathlessness?

A
  • Chest pain
  • Lie flat, pillow use (orthopnoea)
  • Breathless at night (may be PND)
  • Palpitations
  • Ankle swelling (peripheral oedema)
  • Cold/blue hands/feet
  • Pain in calves on walking (claudication)
36
Q

What are the common respiratory symptoms associated with breathlessness?

A
  • Cough (time period crucial)
  • Sputum, colour, volume
  • Any blood in sputum? (haemoptysis)
  • Shortness of breath
  • Wheeze
  • Fever, night sweats
  • Recent CXR
37
Q

What is an exacerbation of COPD?

A

A sustained worsening of the person’s symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset.

38
Q

What are commonly reported symptoms of an exacerbation of COPD?

A

Worsening breathlessness, cough, increased sputum production and change in sputum colour

39
Q

Difference in COPD and asthma:

  1. Smoker?
  2. Symptoms under age of 35?
  3. Chronic productive cough?
  4. Breathlessness?
  5. Night time waking with breathlessness and/or wheeze?
  6. Significant diurnal or day-to-day variability of symptoms
A

COPD:

  1. Nearly all smokers
  2. Rare
  3. Common
  4. Persistent and progressive
  5. Uncommon
  6. Uncommon

Asthma:

  1. Possibly smokers
  2. Common
  3. Uncommon
  4. Variable
  5. Common
  6. Common
40
Q

What is asterixis?

A

A neurological disorder that causes loss of motor control of certain areas of the body

Asterixis is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. This motor disorder is characterised by an inability to maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist.

41
Q

You find a flapping tremor (asterixis) when you examine his hands. What is this likely to be a sign of in this gentleman?

A

Hypercapnoea

42
Q

What is flapping tremor a sign of?

A

Hypercapnoea and hepatic encephalitis

43
Q

What are typical percussion sounds in pneumonia?

A

Dull percussion - indicate that there is fluid in a lung or collapse of part of a lung

Crackles - made by movement of fluid in the tiny air sacs of the lung

Bronchial breath sounds - tubular, hollow sounds which are heard when auscultating over the large airways

44
Q

If a patient has presented with breathlessness, what should you be actively looking for when looking at their hands?

A

Tar staining, clubbing, koilonychia, flapping tremor

Pulse

45
Q

If a patient has presented with breathlessness, what should you be actively looking for when looking at their face?

A

Anaemia, cyanosis, oral candidiasis (steroid inhalers)

46
Q

If a patient has presented with breathlessness, what should you be actively looking for when looking at their neck?

A

Nodes, JVP (heart failure), tracheal position (is it deviated?)

47
Q

If a patient has presented with breathlessness, what should you be actively looking for when looking at their chest?

A

Respiratory rate, scars, deformity

Palpate, expansion, percuss, auscultate

48
Q

If a patient has presented with breathlessness, what should you be actively looking for when looking at their legs?

A

Oedema, signs of DVT

49
Q

Expected findings of percussion in:

  1. Pneumonia
  2. Exacerbation of COPD
  3. Pleural effusion
A
  1. Dull
  2. Resonant
  3. Stony dull
50
Q

Expected findings of auscultation in:

  1. Pneumonia
  2. Exacerbation of COPD
  3. Pleural effusion
A
  1. Bronchial breath sounds, crackles
  2. Vesicular BS, added wheeze
  3. Reduced breath sounds
51
Q

Expected findings of tactile vocal fremitus in:

  1. Pneumonia
  2. Exacerbation of COPD
  3. Pleural effusion
A
  1. Increased
  2. Normal
  3. Reduced
52
Q

Expected findings of vocal resonance in:

  1. Pneumonia
  2. Exacerbation of COPD
  3. Pleural effusion
A
  1. Increased
  2. Normal
  3. Reduced
53
Q

What causes a wheeze?

A

Airway obstruction:

  • Infection; viral, bacteria
  • Cardiac wheeze
  • Bronchiectasis; mucus plugging
  • Anaphylaxis
54
Q

What is acute management for breathlessness and wheeze?

A

Inhaled B2 agonist + steroid:

  • Salbutamol
  • Prednisolone
55
Q

What is acute management for cough and sputum?

A

Antibiotics (possible infection) according to guidelines

  • Doxycycline
  • Amoxicillin
56
Q

What is acute management for ankle swelling?

A

Diuretics:

- Loop - Furosemide, Bumetanide

57
Q

Longer term management for breathlessness/COPD?

A
  • Breathing exercises
  • Relaxation
  • Opiates
  • Oxygen
  • Advanced care planning (preferred place of care/death, levels of care, hospital admissions)

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