respiratory to work on COPY Flashcards
1
Q
Name 3 pathogens that can cause hospital acquired pneumonia (HAP)
A
mainly gram negative
- Pseudomonas aeruginosa
- E.coli
- Klebsiella penumoniae
- Staphylococcus aureus
2
Q
What signs might you see in someone with pneumonia?
A
- increased resp rate and HR
- hypotension
- decreased O2 saturation
- dull to percuss
- increased tactile fremitus
3
Q
What is the treatment for someone with Legionella pneumoniae?
A
Fluoroquinolone + clarithromycin
4
Q
What is the treatment for someone with Pseudomonas aeruginosa pneumonia?
A
IV ceftazidime + gentamicin
5
Q
Give 3 potential complications of pneumonia
A
- Respiratory failure
- Hypotension
- Empyema
- Lung abscess
6
Q
What can cause bronchiectasis?
A
- Congenital = Cystic fibrosis
- Idiopathic (50%)
- Post infection - (most common)
- pneumonia,
- TB,
- whopping cough
- Bronchial obstruction
- RA
- Hypogammaglobulinaemia
7
Q
Which bacteria might cause bronchiectasis?
A
- Haemophilus influenza (children)
- Pseudomonas aeruginosa (adults)
- Staphylococcus aureus (neonates often)
8
Q
Give 3 signs of bronchiectasis
A
- Finger clubbing
- Coarse inspiratory crepitate (crackles)
- Wheeze
9
Q
What investigations might you do on someone to determine whether they have bronchiectasis?
A
CXR = kerley B lines, dilated bronchi with thickened walls, multiple cysts containing fluid
High resolution CT = bronchial wall dilation
Spirometry = obstructive lung disease
Sputum culture - h.influenzae is most common
10
Q
Describe the treatment for bronchiectasis
A
- Antibiotics
- Anti-inflammatories (azithromycin)
- Bronchodilators (nebulised salbutamol)
- Chest physio - physical training
- Surgery = lung resection or transplant
11
Q
What are 3 possible respiratory complications of CF?
A
- Pneumothorax
- Respiratory failure
- Cor pulmonale
- Bronchiectasis
12
Q
Name 3 associated conditions with CF
A
- Osteoporosis
- Arthritis
- Vasculitis
13
Q
what are the risk factors of lung cancer
A
- Smoking = main cause
- Asbestos
- Radon exposure
- Coal products
- pulmonary fibrosis
- HIV
- genetic factors
14
Q
Name 3 differential diagnosis’s of lung cancer
A
- Oesophageal varices
- COPD
- Asthma
- Pneumonia
- Bronchiectasis
15
Q
Give 4 possible complications of lung cancer
A
- SVC obstruction
- ADH secretion –> SIADH
- ACTH secretion –> Cushing’s
- Serotonin secretion –> carcinoid
- Peripheral neuropathy
- Pathological fractures
- Hepatic failure
16
Q
What are the 3 characteristic features of asthma?
A
- Airflow limitation - usually reversible spontaneously or with treatment
- Airway hyper-responsiveness
- Bronchial inflammation with T lymphocytes, mast cells, eosinophils with associated plasma exudation
17
Q
Describe neurogenic infalmmation
A
Sensory nerve activation initiates impulses which stimulates CGRP (pro-inflammatory)
this activates mast cells and innervates goblet cells
18
Q
Describe the process of airway remodelling in asthma
A
- Hypertrophy and hyperplasia of smooth muscle cells narrow the airway lumen
- Deposition of collagen below the BM thickens the airway wall
- metaplasia occurs with an increase in number of mucus-secreting goblet cells
19
Q
What are the signs of asthma?
A
- Tachypnoea - rapid breathing
- Audible wheeze
- Widespread polyphonic wheeze
- Cough
20
Q
What are the signs of a life threatening asthma attack?
A
- Hypoxia = PaO2 <8 kPa, SaO2 <92%
- Silent chest
- Bradycardia
- Confusion
- PEFR < 33% predicted
- Cyanosis
21
Q
Give 3 differential diagnosis’s of asthma
A
- COPD
- Bronchial obstruction
- Pulmonary oedema
- Pulmonary embolism
- Bronchiectasis
22
Q
What is the long-term guideline mediation regime for asthma?
A
- SABA
- SABA + ICS
- SABA + ICS + LTRA
- SABA + ICS + LTRA/LABA + MART
23
Q
Give 3 possible complications of asthma
A
- Exacerbation
- Pneumothorax
- Pneumonia
24
Q
Describe the pathophysiology of chronic bronchitis
A
Airway inflammation –> fibrosis and luminal plugs –> decreased alveolar ventilation
25
Describe the pathophysiology of emphysema
Dilation and destruction of the lung tissue distal to the terminal bronchioles
Enlarged alveoli + loss of elastic recoil = increased alveolar ventilation
26
What can cause COPD?
1. Genetic = alpha 1 antitrypsin deficiency
2. Smoking = major cause
3. Air pollution
4. Occupational factors = dust, chemicals
27
Name 4 symptoms of COPD
1. Dyspnoea
2. Cough +/- sputum
3. Expiratory wheeze
4. Weight loss
5. SOB
28
Give 4 signs of COPD
1. Tachypnoea
2. Barrel shaped chest
3. Hyperinflantion
4. Cyanosis
5. Pulmonary hypertension
6. Cor pulmonale
29
Give 3 differential diagnosis's for COPD
1. Asthma
2. HF
3. Pulmonary embolism
4. Bronchiectasis
5. Lung cancer
30
Give 3 factors that can be used to establish a diagnosis of COPD
1. Progressive airflow obstruction
2. FEV1/FVC ratio < 0.7
3. Lack of reversibility
31
What are the treatments for COPD?
general:
- stop smoking (refer to cessation services)
- pneumococcal vaccine
- annual flu vaccine
step 1:
- SABA (salbutamol or terbutaline) or SAMA (ipratropium bromide)
step 2:
- If no asthmatic / steroid response:
- LABA (salmeterol)
- LAMA (tiotropium)
- If asthmatic / steroid response:
- LABA (i.e. salmeterol)
- ICS (i.e. budesonide)
step 3:
- long term oxygen therapy
32
Give 3 advantages and 1 disadvantage of using ICS in the treatment of COPD?
Advantages
1. Improve QOL
2. Improve lung function
3. Reduce the likelihood of exacerbations
Disadvantages:
1. There is an increased risk of pneumonia
33
Give 3 possible complications of COPD
1. Exacerbations
2. Infection
3. Respiratory failure
4. Cor pulmonale
5. Pneumothorax
34
Give 2 potential consequences of exacerbations of COPD/asthma
1. Worsened symptoms
2. Decreased lung function
3. Negative impact of QOL
4. Increased mortality
5. Huge economic cost
35
What is the treatment for an exacerbation of COPD?
Steroids (hydrocortisone / prednisolone)
+
nebulised bronchodilators (salbutamol / ipratropium bromide)
+
antibiotics
Physiotherapy → sputum clearance
If severe:
IV aminophylline (bronchodilator),
NIV (CPAP / BIPAP)
36
What does the pleural fluid contain?
Protein - albumin, globulin, fibrinogen
| Mesothelial cells, monocytes and lymphocytes
37
what are the causes of a transudate pleural effusion?
fluid movement (systemic causes)
1. Heart failure
2. fluid overload
3. Peritoneal dialysis
4. Constrictive pericarditis
5. hypoproteinaemia
- cirrhosis
- hypoaluminaemia
- nephrotic syndrome
38
Name 3 causes of a exudate pleural effusion
inflammatory (local causes)
1. Pneumonia
2. Malignancy
3. TB
4. pulmonary infarction
5. lymphoma
6. mesothelioma
7. asbestos exposure
8. MI
39
How does a pleural effusion present?
- SOB especially on exertion
- Dyspnoea
- Pleuritic chest pain
- cough
- Loss of weight (malignancy)
- Chest expansion reduced on side of effusion
- In large effusion the trachea may be deviated away from effusion
- Stony dull percussion note on affected side
- Diminished breath sounds on affected side
- Decreased tactile vocal fremitus (vibration of chest wall when speaking)
- Loss of vocal resonance
40
How might you diagnose a pleural effusion?
1st line: CXR =
blunt costophrenic angles, fluid in lung fissures, meniscus, tracheal and mediastinal deviation
USS - identify pleural fluid
aspiration (thoracentesis/pleural tap)
- purulent = empyema (pus)
- turbid (cloudy) = infected
- milky = chylothorax
41
How would you treat a pleural effusion?
Dependent on cause
Fluid overload or congestive HF - diuretic
Infective - antibiotics
Large effusions often need aspiration or drainage
42
How can pneumothorax be classified?
```
Spontaneous pneumothorax
Traumatic pneumothorax
Iatrogenic pneumothorax
Lung Pathology
Tension pneumothorax
```
43
How does a pneumothorax present?
- Sudden onset dyspnoea and pleuritic chest pain
- as the pneumothorax enlarges the patient becomes more breathless and may develop pallor and tachycardia
- Reduced expansion
- Hyper-resonant percussion
- Diminished breath sounds
44
What investigation might you do in someone you suspect to have a pneumothorax?
CXR = translucency and collapse
ABG = in dyspnoeic patients check for hypoxia
45
Name a possible complication of a pneumothorax
Tension pneumothorax
46
What are 5 major categories of interstitial lung disease
1. Associated with systemic disease - rheumatological
2. Environmental aetiology - fungal, dusts
3. Granulomatous disease - sarcoidosis
4. Idiopathic - idiopathic pulmonary fibrosis
5. Other
47
What are the 4 major features of interstitial lung disease?
1. Cough
2. Dyspnoea
3. Restirictve spirometry
4. Abnormal CXR/CT
48
Give 3 pulmonary symptoms of sarcoidosis
1. Dry cough
2. Progressive SOB
3. Wheeze
4. Chest pain
49
What investigations might you do in someone who you suspect to have sarcoidosis?
CXR = hilar and/or paratracheal adenopathy with upper lobe predominant, bilateral infiltrates; pleural effusions
Bloods = increase ESR, lymphopenia, increase CAE, raised LFTs
Bronchoalveolar lavage = increased lymphocytes
Lung tissue biopsy = diagnostic = non-caseating granulomata (increased lymphocytes in active disease and increased neutrophils in pulmonary fibrosis)
CXR = staging
50
How can you stage sarcoidosis?
Using CXR
Stage 1 = bilateral hilar lymphadenopathy (BHL)
Stage 2 = pulmonary infiltrates with BHL
Stage 3 = pulmonary infiltrates without BHL
Stage 4 = progressive pulmonary fibrosis, bulla formation and bronchiectasis
51
How do you treat acute sarcoidosis?
NSAIDs and bed rest
52
How do you treat sarcoidosis?
do not treat symptomatic stage 1, and asymptomatic stage 2 or 3
patients with BHL do not need treatment - most recover spontaneously
acute = bed rest and NSAIDs
prednisolone orally
if severe = IV methylprednisolone
if steroid resistant = methotrexate (requires close monitoring)
lung transplant in severe cases
53
Give 2 possible differential diagnosis's for sarcoidosis
1. Lymphoma
| 2. Pulmonary TB
54
Describe the pathophysiology of idiopathic pulmonary fibrosis
repetitive injury to the alveoli epithelium causes wound healing mechanisms to become uncontrolled
this leads to fibroblast over-production and increased fibrosis
this leads to a loss of elasticity and ability to perform gas exchange is impaired -> restrictive lung disease and progressive respiratory failure
55
what are the risk factors of idiopathic pulmonary fibrosis?
- cigarette smoking
- infectious agents - CMV, Hep C, EBV
- occupational dust exposure
- drugs - methotrexate, imipramine
- GORD
- genetic predisposition
56
what are the clinical features of idiopathic pulmonary fibrosis
1. Dry cough
2. SOB on exertion
3. Systemic = malaise, weight loss, arthralgia
4. Cyanosis
5. Finger clubbing
6. bibasal crackles (Inspiratory crackles/crepitus)
7. dyspnoea
57
What investigations might you do in someone you suspect to have idiopathic pulmonary fibrosis?
ABG = type 1 respiratory failure
Bloods = raised CRP, immunoglobulins and check autoantibodies
CXR/CT = degreased lung volume + honeycomb lung
High resolution CT = ground glass appearance
Spirometry = restrictive
Lung biopsy = confirmation
58
What is the treatment for idiopathic pulmonary fibrosis?
Pharmacological: Pirfenidone, nintedanib - antifibrotic
Non pharmacological: Smoking cessation, physiotherapy, vaccines up to date
Lung transplantation last resort
59
what are the possible complications of idiopathic pulmonary fibrosis
1. Respiratory failure
| 2. Cor pulmonale
60
Define pulmonary hypertension
A disease of the small pulmonary arteries characterised by vascular proliferation and remodelling. It results in a progressive increase in pulmonary vascular resistance (PVR)
Increase in mean pulmonary arterial pressure >25 mmHg and secondary right ventricular failure
61
What can cause an increase in mPAP?
Increase resistance to flow
| Increased flow rate
62
what are the causes of pulmonary hypertension
- pre-capillary
- multiple small PE's
- left-to-right shunts
- primary
- capillary
- emphysema
- COPD
- Post-capillary
- backlog of blood causes secondary hypertension
- LV failure
- chronic hypoxaemia
- living at high altitude
- COPD
63
what is the clinical presenation of pulmonary hypertension
initial features - due to an inability to increase cardiac output
- exertional dyspnoea
- lethargy and fatigue
- ankle swelling
- Accentuated pulmonic component to the 2nd heart sound
- Tricuspid regurgitation murmur
- peripheral oedema, cyanosis
- cor pulmonale
64
What investigations might you do in someone to determine whether they have pulmonary hypertension?
Initial tests:
- CXR - Enlarged main pulmonary artery, enlarged hilar vessels and pruning.
- ECG - right ventricular hypertrophy, right axis deviation, right atrial enlargement. (A normal ECG does not rule out the presence of significant pulmonary hypertension)
- TTE - (trans-thoracic echocardiogram)
Diagnostic test: Right heart catheterisation
65
Describe the treatment of pulmonary hypertension
```
General supportive therapy:
Treat underlying cause
- Oral anticoagulants - WARFARIN
- diuretics for oedema
- oxygen
- oral CCBs
- Supervised exercise training
Avoiding pregnancy
```
In treatment-resistant patients:
Balloon atrial septostomy - produces right-to-left shunting that decompresses the right atrium and right ventricle, increases systemic cardiac output, and decreases systemic arterial oxygen saturation
Lung transplantation
66
Describe pulmonary infection of TB
Bacilli settle in lung apex
| Macrophages and lymphocytes mount an effective immune response that encapsulate and contains the organism forever
67
Describe the pathogenesis of pulmonary TB disease
TB spread via respiratory droplets as it is an airborne infection
1. Alveolar macrophages ingest bacteria and the rods proliferate inside.
2. Drain into hilar lymph nodes 🡪 present antigen to T lymphocytes 🡪 cellular immune response.
3. Delayed hypersensitivity reaction 🡪 tissue necrosis and granuloma formation: caseating.
- Primary Ghon Focus
- Ghon Complex – Ghon focus + lymph nodes
68
Give 3 risk factors for TB
1. Living in a high prevalence area
2. IVDU
3. Homeless
4. Alcohol
5. HIV +ve
69
What systemic symptoms might you see as a result of TB?
1. Weight loss
2. Night sweats
3. Anorexia
4. Malaise
5. low grade fever
70
What pulmonary symptoms might you see as a result of TB?
```
Productive cough
Haemoptysis
Cough >3 weeks (dry or productive)
Breathlessness
Sometimes chest pain
```
71
Name 3 places where TB might spread to?
1. Bone and joint = pain and swelling
2. Lymph nodes = pain and discharge
3. CNS = TB meningitis
4. Biliary TB = disseminated
5. Abdominal TB = ascites, malabsorption
6. GU TB = sterile pyuria, WBC in GU tract
72
What investigations might you do to determine whether someone has TB?
Inflammatory markers = raised CRP, hyperalbuminaemia, thromobocytosis, high B cell count
CXR = consolidation, collapse, pleural effusion
Microbiology - sputum/biopsy = Ziehl-Neelson stain and culture
73
Give 2 potential side effects of Rifampicin
1. Red urine
2. Hepatitis
3. Drug interaction - it's an enzyme inducer
74
Give 2 potential side effects of Isoniazid
1. Hepatitis
| 2. Neuropathy
75
Give 2 potential side effects of Pyrazinamide
1. Hepatitis
2. Gout
3. Neuropathy
76
Give a potential side effect of Ethambutol
Optic neuritis
77
Give 2 factors that can increase the risk of drug resistance in TB
1. If the patient has had previous treatment
2. If they live in a high risk area
3. If they have contact with resistant TB
4. If they have a poor response to therapy
78
Describe the disease course of whooping cough
7-10 day incubation --> 1-2 week catarrhal stage --> 1-6 week paroxysmal stage
79
What is the treatment of whooping cough?
Clarithromycin - in catarrhal or early paroxysmal stages
- have little effect on disease course in paroxysmal stage
80
Give 2 possible complications of whooping cough
1. Pneumonia
2. Encephalopathy
3. Sub-conjunctival haemorrhage
81
what is the clinical presentation of the alimentary effects of cystic fibrosis?
• Thick secretions
• Reduced pancreatic enzymes (due to mucus blocking pancreatic duct)
• Pancreatic insufficiency (diabetes mellitus & steatorrhoea (fatty stools
since enzymes not released to digest fat)
• Distal intestinal obstruction syndrome - bowel obstruction (equivalent of
meconium ileus) resulting in reduced GI motility
• Reduced bicarbonate (HCO3-)
• Maldigestion & malabsorption thus poor nutrition (associated with
pulmonary sepsis)
• Cholesterol Gallstones (in increased frequency) & cirrhosis
• Increased incidence of peptic ulcers & malignancy
82
what are the risk factors for pleural effusion?
- Previous lung damage
| - Asbestos exposure
83
what are the risk factors for pneumothorax?
```
Smoking
Family history
Male
Tall and slender build
Young age
Presence of underlying lung disease
```
84
what is the pathophysiology of pneumothorax?
Normally intrapleural pressure is negative
When there is a bridge between alveoli and pleural space or atmosphere and pleural space
Flow of air in until communication closed or gradient closed.
85
what is the clinical presentation of a tension pneumothorax?
```
Cardiopulmonary deterioration:
Hypotension – imminent cardiac arrest
Respiratory distress
Low sats
Tachycardia
Shock
Severe chest Pain
```
86
what are the clinical features of a tension pneumothorax?
Tracheal deviation to contralateral side
Ipsilateral reduced breath sounds
Hyperresonance on percussion
Hypoxia
87
what are the causes of pneumothorax?
- In patients over 40 years of age the usual cause is underlying COPD
- Other/rarer causes include:
• Bronchial asthma
• Carcinoma
• Breakdown of a lung abscess leading to bronchopleural fistula
• Severe pulmonary fibrosis with cyst formation
• TB
• Pneumonia
• Cystic fibrosis
• Trauma (penetrating or rib fracture)
• Iatrogenic e.g. pacemakers or central lines
88
what is the catarrhal phase of whooping cough?
* Patient highly infectious
* Cultures from respiratory cultures are positive in 90% of cases
* Malaise
* Anorexia
* Rhinorhoea (nasal cavity congested with significant amount of mucus)
* Conjunctivitis
89
what are the investigations for whooping cough?
- Chronic cough and one clinical feature indicated pertussis
- Chronic cough and history of contact or microbiological diagnosis is used to confirm pertussis
- Suggested clinically by the characteristic whoop and history of contact with an infected individual
- PCR test
- But culture of a nasopharyngeal swab = definitive diagnosis
90
what are the signs of TB?
```
Signs of bronchial breathing
Dullness to percuss
Decreased breathing
fever
crackles
```
91
what is the treatment for pneumonia?
Maintaining O2 Sats between 94-98%
In COPD patients: maintain O2 sats between 88-92%
Analgesia: paracetamol or NSAIDs
IV fluids
92
what are the common organisms that cause atypical pneumonia?
Mycoplasma pneumoniae,
Chlamydophila pneumoniae,
Legionella pneumophila
coxiella burnetii
93
what is the mechanism of action for rifampicin for TB?
bactericidal - blocks protein synthesis
94
what is the mechanism of action of isoniazid for TB?
bactericidal - blocks cell wall synthesis
95
what is the mechanism of action for pyrazinamide for TB?
bactericidal initially, less effective later
96
what is the mechanism of action for ethambutol
bacteriostatic - blocks cell wall synthesis
97
what antibiotics are used for bronchiectasis?
- pseudomonas aeruginosa = oral ciprofloxacin
- h.influenzae = oral amoxycillin, co-amoxyclav or doxycycline
- staph aureus = flucloxacillin
98
what is the characteristic presentation of COPD?
```
productive cough
white or clear sputum
wheeze
SOB
following many years of smoking
```
99
what are the systemic effects of COPD?
```
hypertension
osteoporosis
depression
weight loss
reduced muscle mass with general weakness
```
100
what is the pathophysiology of pulmonary hypertension?
The main vascular changes are:
Vasoconstriction
Smooth-muscle cell and endothelial cell proliferation
Thrombosis
101
what are the signs of emphysema?
```
Dyspnoea / Tachypnoea
Minimal cough
Pink skin, pursed-lip breathing
Accessory muscle use
Cachexia
Hyperinflation (barrel chest)
Weight loss (due to increased work of breathing and cachexia)
```
102
what are the investigations for IE COPD?
ABG
- CO2 retention → acidosis
- Raised pCO2 + low pO2 = T2RF
Chest X-Ray, sputum culture + sensitivities for antibiotic therapy, FBC + U&E
103
what is intrinsic allergic asthma?
- Often starts in middle-aged and attacks are usually triggered by respiratory infections
104
what are the genetic factors for asthma?
* Genes controlling the production of cytokines IL-3,-4,-5,-9 & -13
* ADAM33 is associated with airway hyper-responsiveness and tissue remodelling
105
what are the risk factors for developing asthma
- Personal history of atopy
- Family history of asthma or atopy
- Obesity
- Inner-city environment
- Premature birth (low birth weight, not breast-fed)
- Socio-economic deprivation
- exposure to allergens
106
which drugs can trigger asthma attacks?
NSAIDs and aspirin
| beta blockers - results in bronchoconstriction which results in airflow limitation and potential attack
107
what is the acute management of asthma?
1. oxygen
2. salbutamol nebuliser
3. ipratropium bromide nebuliser
4. hydrocortisone IV or oral prednisolone
5. IV magnesium sulfate
6. aminophylline / IV salbutamol
108
give 2 examples of LABAs
- salmeterol
| - formoterol (full agonist)
109
give an example of a SAMA
ipratropium
110
give an example of a LAMA
tiotropium
111
what is the mechanism of action for ICS?
- They reduce the number of inflammatory cells in the airways
- Suppress production of chemotactic mediators
- Reduce adhesion molecular expression
- Inhibit inflammatory cell survival in the airway
- Suppress inflammatory gene expression in airway epithelial cells
112
what are the side effects of ICS?
Loss of bone density
Adrenal suppression
Cataracts
Glaucoma
113
what are the advantages of inhaled drugs?
- lungs are robust -> can handle repeated exposure
- very rapid absorption
- large SA
- fewer drug metabolising enzymes
- non-invasive port of entry
- fewer systemic side effects
114
what are the risk factors for developing pneumonia?
- under 16 or over 65
- HIV infection
- DM
- CF
- COPD
- smoking
- excess alcohol
- IVDU
- immunosuppressant therapy
115
what are the extra-pulmonary manifestations of lung cancer?
Recurrent laryngeal nerve palsy - hoarse voice
Superior vena cava obstruction - facial swelling, distended veins in neck and upper chest, Pemberton’s sign
Horner’s syndrome - ptosis, miosis, anhidrosis
116
what is the management for PE?
- if investigations are delayed start anticoagulation
1st line = apixaban/rivaroxaban
LMWH for 5 days followed by dabigatran
3 months for provoked
>3 months for unprovoked
IVC filter
117
what is the management for haemodynamic instability caused by a PE?
- IV thrombolysis - alteplase
- catheter directed thrombolysis
- embolectomy
118
what are the most common causes of pharyngitis?
group A strep = most common
| EBV
119
what are the clincial features of pharyngitis that suggest a viral cause?
runny nose, blocked nose, sneezing, cough
120
what are the clinical features of pharyngitis that suggest a bacterial cause?
fever, pharyngeal exudate, cervical lymphadenopathy, absence of cough + runny nose
121
what is the management for pharnygitis?
group A strep = phenoxymethylpenicillin (clarithromycin if allergic to penicillin)
viral = self resolving, supportive care
122
what are the most common causes of sinusitis?
Common infectious agents:
Streptococcus pneumoniae
Haemophilus influenzae
Rhinoviruses
123
what are the risk factors for sinusitis?
nasal pathology e.g. septal deviation or nasal polyps
recent local infection e.g. rhinitis or dental extraction
swimming/diving
smoking
124
what is the clinical presentation of sinusitis caused by bacteria?
```
symptoms > 10 days
purulent nasal discharge
nasal obstruction
dental/facial pain
headache
```
125
what is the management for sinusitis?
Symptom management with analgesia and intranasal decongestants
intranasal corticosteroids considered if symptoms have been present for >10 days
Antibiotic therapy not normally required but may be given for severe presentations (phenoxymethylpenicillin first-line)
126
what is the clinical diagnosis of chronic bronchitis?
cough/sputum for more than 3 months in 2 consecutive years
127
what are the signs of COPD on CXR?
hyperinflation
bullae
flat hemidiaphragm
128
what are the signs that long term oxygen therapy is required in COPD?
- FEV1 < 30% predicted value
- cyanosis
- polycythaemia
- peripheral oedema
- raised JVP
- O2 less than or equal to 92% on room air
129
what is the treatment for latent TB?
rifampicin
isoniazid
RI for 6 months
I for 3 months
130
what is the name of the lung disorder that reflects inhaled dust/toxins?
pneumoconiosis
131
what happens to FEV1, FVC and FEV1/FVC ratio in obstructive disease?
FVC < 80%
FVC = normal
FEV1/FVC < 0.7
132
what happens to FEV1, FVC and FEV1/FVC ratio in restrictive disease?
FVC reduced
| FEV1/FVC normal
133
define inspiratory reserve volume (IRV)
additional volume of air that can be forcibly inhaled after tidal volume inhalation
134
define expiratory reserve volume (ERV)
additional air that can be forcibly exhaled after tidal volume expiration
135
what is forced vital capacity (FVC)
maximum air that can be forcibly exhaled after maximal inhalation
136
defiine total lung capacity
vital capacity plus residual volume
maximum amount the lungs can hold
137
define residual volume (RV)
volume remaining in the lungs after maximal exhalation
138
define functional residual capacity
volume of air remaining in lungs after tidal volume exhalation
139
define tidal volume
volume of air moved in and out of lungs during normal breath
140
define FEV1
volume of air forcibly exhaled during 1 second
141
give 2 equations to work out TLC
```
TLC = VC + RV
TLC = TV + FRC + IRV
```
142
what is normal tidal volume?
500ml
143
givee the equation for FRC
FRC = ERV + RV
144
define peak expiratory flow (PEF)
greatest rate of airflow tjat can be obtained during forced expiration
145
what is the transfer co-efficient?
ability of O2 to diffuse across alveolar membrane
146
how can you find transfer coefficient?
low dose CO is inspired, patient asked to hold breath for 10s at TLC
amount of gas transferred is measured
147
what is bronchiolitis?
airway obstruction caused by inflammation of broncholes
| caused by RSV
148
what is bronchiolitis caused by?
RSV
149
what is the difference between bronchitis and bronchiolitis?
```
bronchiolitis = inflammation of bronchioles - due to RSV
bronchitis = inflammation of bronchi - due to irritants and chemicals
```
150
what is Centor criteria used for?
determines likelihood a sore throat is bacterial
151
what causes croup?
parainfluenza virus
152
give 5 side effects of radiotherapy
```
fatigue
anorexia
cough
oesophagitis
systemic sypmtoms
```
153
give 4 side effects of chemotherapy
alopecia
nausea/vomiting
peripherral neuropathy
constipation or diarrhoea
154
what is type 1 respitatory failure
hypoxia
155
what is type 2 respiratory failure?
hypoxia and hypercapnia
156
give 3 signs of hypercapnia
bounding pulse
flapping tremor
confusion
157
what can cause type 1 respiratory failure
airway obstruction - COPD, asthma
failure of diffusion - emphysema, ILD
V/Q mismatch - dead space, shunt, HF
alveolar hypoventilation - opiates, emphysema
158
what can cause type 2 respiratory failure
alveolar hypoventilation
159
which diseases can result in type 1 respiratory failure?
COPD
sleep apnoea
asthma
160
is TLC increased or decreased in restrictive lung disease?
decreased
161
is TLC increased or decreased in obstructive lung disease?
increased
162
name 6 places TB can spread to?
```
bones and joints = swelling and pain
lymph nodes = swelling and discharge
CNS = TB meningitis
abdominal TB = ascites, malabsorption
GU = sterile pyuria, WBC in GU tract
```
163
what might you see on CXR of someone with TB?
consolidation
collapse
pleural effusion
164
what treatments are given for V/Q mismatch?
ventilation support - CPAP, BIPAP
165
what are the signs of asthma?
decreased air entry
hyper-inflated chest
hyper-resonant percussion
tachypnoea
166
what are the atypical causes of pneumonia?
- Mycoplasma pneumoniae
| - Chlamydophila pneumoniae
