Revision Flashcards
what can cause an acute wet cough (2)
LRTI, pneumonia
what can cause an chronic wet cough (2)
chronic bronchitis, bronchiectasis
what are the three types of onset of wet cough
acute, sub acute
(in-between), chronic
how long does a viral infection last
few days- self limiting
how long does a bacterial infection last
10+ days, longer if not treated
how long do mycobacterial infections last
months- TB and others can last for years
how long does pertussis last
‘100 day cough’
what are the associated features of a wet cough
fever, weight loss, pain, haemoptysis, breathlessness
what are the two onsets of fever
chronic, intermittent
what types of pain are commonly associated with wet cough
pleuritic, chronic
what conditions could be associated with the associated features of a wet cough
TB, associated PE, BXT, lung cancer
what does SPUR stand for
severe, persistent, unresponsive to treatment, resistant
when does cancer cause a cough
if it is big or close to the carina
who mostly gets a dry cough
post menopausal woman
what can trigger a dry cough
external factors
what are the differentials for a dry cough
drug reaction, ‘serious pathology’ (cancer, ILD), perennial rhinitis, cough variant asthma, reflux
what is the primary abnormality in a chronic dry cough
heightened cough reflex
what is a cough reflex heightened due to
lower threshold ot increased stimulation in resp tract
what are the red flags for cancer
weight loss, haemoptysis, pain, night sweats
what is the prognosis for a chronic dry cough
resolution unlikely especially when over a year
what can pulmonary fibrosis cause in terms of coughing
persistent cough
what is the definition of a chronic dry cough
non productive cough or 8 weeks or more
how is a chronic dry cough treated
smoking cessation, stop ACE inhibitors (drug reaction), lansoprazole, qvar, nasal steroid
what are the signs of ILD
cough and crackles in the chest
what does a chronic dry cough mostly start as
LRTI
what is cough variant asthma also known as
eosinophilic bronchitis
why are secondary treatments not regularly used to treat chronic dry cough
as toxic and very poorly tolerated
what can cause breathlessness
heart failure, asthma and lung diseases, PE, angina equivalent +more
what is the functional categorisation of breathlessness
oxygen transport,
mechanical disadvantage (restriction/weakness),
respiratory drive (signals from brain),
perception of breathing (hyperventilation)
what is the fick equation and what does it show
oxygen uptake
VO2= CO x (CaO2 - CvO2)
does breathlessness mean lack of oxygen
no
what should be asked in a history of breathlessness
onset and duration, severity, exacerbating or relieving factors, associated symptoms, FH, SH
what could cause instant onset breathlessness
pneumothorax, PE
what could cause acute onset breathlessness
asthma, pneumonia, acute MI, cardiac tapmonade
what could cause sub-acute onset breathlessness (days)
PE, pulmonary vasculitis, SVCO (superior vena cava obstruction)
what could cause chronic breathlessness
COPD, ILD, pulmonary hypertension, anaemia
what tests can be used to assess breathlessness
spirometry, peak flow meter, body box, CXR
what are the three sizes of haemoptysis
massive (250ml- enough to cause airway obstruction), submassive (100ml), minimal (streaks, clots)
how is haemoptysis managed
maintain airway, ensure adequate oxygenation, fluid/blood resuscitation, stabilise the patient, look for cause
what can cause haemoptysis
lung cancer, bronchiectasis, PE, tuberculosis, (rarities; trauma, goodpastures, AVMS)
how can lung cancer cause haemoptysis
neovascularisation, eorsion through bronchial vessels, fragile vessels
how can bronchiectasis cause haemoptysis
erosions of vessels due to infection, aspergilloma, abscess formation
how can a PE cause haemoptysis
obstruction of pulmonary vessels (build up of blood pressure), infarction of lung (bleeds when it dies), alveolar haemorrhage (bronchial and pulmonary bleeding)
how can TB cause haemoptysis
cavitation, erosion through bronchial blood vessels
what is cavitation
gas filled areas
how is lung cancer treated
diathermy, cryotherapy, radiotherapy, surgery
how is bronchiectasis treated
antibiotics/fungals, embolism of bronchial artery- lung devoid pf blood from this vessel forever
how is a PE treated
anticoagulants, lung resection
how is TB treated
quadruple therapy, bronchial embolisation
what can cause minor haemoptysis
‘big 4’ (LC, BXT, PE, TB), acute infection trauma
IMPORTANT
what are the severity markers for a severe asthma exacerbation
- if they can finish a sentence in a single breath
- peak flow less than 60%
- resp rate of more than 30
- tachycardia
IMPORTANT
what are the severity markers for a life threatening asthma attack
- lower level of consciousness
- bradycardia
- silent chest
- peak flow less than 30%
IMPORTANT
what is the most common pneumonia and how is it treated
streptococcus- amoxicillin
what is the likely type of cancer in a proximal tumour in a woman
adeno-
what is the likely type of cancer in a proximal tumour in a man
squamous
small mass cancer =?
small cell
IMPORTANT
what does ROME mean
respiratory opposite
metabolic equal
Respiratory= Opposite:
- pH is high, PCO2 is down (Alkalosis).
- pH is low, PCO2 is up (Acidosis).
Metabolic= Equal:
- pH is high, HCO3 is high (Alkalosis).
- pH is low, HCO3 is low (Acidosis).
in blood gases what two should you compare
FiO2 to pO2
IMPORTANT
what is type 1 resp failure
hypoxemic- failure of oxygen exchange
IMPORTANT
what is type 2 resp failure
hypercapnic- failure to exchange or remove carbon dioxide
what are the resp causes of pleuritic chest pain
pneumonia or PE
what causes stony dullness
fluid outside of the lungs, pleural effusion
what is pulmonary oedema and what are the symptoms
fluid within the lungs; basal crackles, orthopnoea, pink frothy sputum,
59 year old smoker, male, presents with weight loss, haemoptysis, cough, SOB. He has finger clubbing, is anaemic and apyrexial
lung caner
65 y/o female with SOB and right sided pleuritic chest pain. has a pleural rub
pulmonary embolus, pleural rub due to inflammation
62 y/o female presents with one day history of fever, rigors, SOB and right sided pleuritic chest pain. on exam decreased expansion, dullness to percussion, bronchial breathing on the right side
pneumonia
25 y/o male presents after falling from 6ft. has SOB, right sided chest pain, worse on inspiration, localised tenderness on right side of chest, equal air entry
fractured rib
65 year old man, life time smoker, dyspnoea, decreased chest expansion, stony dullness, decreased air entry into left base
pleural effusion
85 y/o female, SOB, bilateral pitting ankle oedema to mid shin, bilateral basal crackles, CXR: kerly B lines, prominent upper lobe vessels, cardiomegaly
pulmonary oedema
what do kerly B lines show
fluid tracking
58 year old man presents with 18 months history of increasing SOB, is tachypnoeic, has finger clubbing, fine end inspiratory crackles
cryptogenic fibrosing alveolitis (idiopathic interstitial lung disease)
what type of disease is goodpastures syndrome
autoimmune
35 y/o female, fever, night sweats, weight loss, productive cough with haemoptysis. ziehl-neelson stain is pos for acid fast bacilli
tuberculosis
female 76, presents with SOB, productive cough with pink frothy sputum, is peripherally cyanosed, tachycardic, tachypnoeic, bilateral inspiratory crackles
pulmonary oedema
female 65, cough and haemoptysis, hoarsening of the voice, supraclavicular lymphadenopathy
bronchial carcinoma
man 34, short history of haemoptysis, cough for a fortnight, ankles swelling 5 days ago, high creatinine, antibody screen in pos for p-ANCAand anti-glomerular basement membrane antibodies
goodpastures syndrome (damaged kidneys, coughing up blood)
female 45, has ovarian carcinoma, 12 hr history of haemoptysis, dyspnoea and pleuritic chest pain, is apyrexial, right sided pleural rub, CXR shows wedge shaped infarct peripherally on the right
Pulmonary embolis- predisposed from cancer
man 60, dry cough, confusion, diarrhoea, been on business trip to spain
pneumonia- legionella pneumophilla
women, 35, 10 year history of HIV, poorly compliant to medication, progressive SOB and dry cough
pneumonia - pneumocystis carni (more common in HIV)
male 42, fever, arthralgia and mucoid sputum. neg blood cultures, CXR had patchy consolidation in right lung, recently bought a parrot
pneumonia - chlamydia psittici
female 31, sore throat, cough, malaise, throat erythematous, chest sounds vesicular
pneumonia - rhinovirus (sore throat, URTI)
female 24, cystic fibrosis, chest infection resistant to large amount of antibiotics
pneumonia - pseudomonas aeroginosa (resistant to many antibiotics, common in CF)
how do you treat: boy 4, mild intermittent attacks of wheeze and cough early in the morning, on no other medications
asthma- SABA (salbutamol)
how do you treat: girl 8, 5 year history of asthma poorly controlled, taking low dose inhaled beclometasone and salbutamol PRN
beclometasone= becotide= steroid
review inhaler technique, if that doesn’t increase steroid or give LABA
how do you treat: girl 12, asthma attack, RR 30, cant complete sentences, no relief from blue inhaler
high flow oxygen and nebulised salbutamol
what is the acute treatment for asthma
OhSHITMan O-oxygen S-salbutamol H-hydrocortisone I- Ipratropium bromide T - Theophylline M- magnesium sulphate
‘how do you treat: girl 12, asthma attack, RR 30, cant complete sentences, no relief from blue inhaler’ now drowsy, feeble resp effort, peak flow not recordable, has been given salbutamol and prednisolone
prednisolone= oral steroid, anti inflammatory
get senior help, intubate the patient
how do you treat: girl 15, getting asthma review, well controlled on inhaled beclometasone and salbutamol, wakes once a week with cough and wheeze
increases steroid or give LABA (salmeterol)
what is the first line management: woman 58, 4 month history of weight loss, malaise, night sweats, back pain, 3 week history of SOB, dry cough. Radiography demonstrates loss of intervertebral disc space between T12 and L1, with partial wedge of collapse of L1 and large right pleural effusion
pleural biopsy, and aspirate then bronchoscopyand bronchial aspirate
what is the first line management: women 87, wheelchair dependant, SOB at rest, pleuritic chest pain, D-Dimer elevated
CXR, CT pulmonary angiogram for PE, ventillation perfusion scan
(d-dimer goes up with inflammation)
what is the first line management: boy 15, nocturnal and post exercise cough, chest exam clear, peak expiratory flow rate just below median
peak expiratory flow rate diary, spirometry
what is the first line management: man 74, COPD, started on new inhaler, measure of response needed
peak expiratory flow rate diary, spirometry
what is the first line management: unkempt male, pinpoint pupils, RR of 6
ABG: check if resp failure, check O2 sats, show severity
what is the first line of treatment for asthma
SABA, add on steroids if worsens
how do you asses the severity of an asthma attack
peak flow %, RR, HR, ability to complete sentences
what are the side effects of rifampicin
orange wee
what are the side effects of isoniazid
peripheral neuropathy
what are the side effects of pyrazinamide
nausea
what are the side effects of ethanbutol
colour blindness
what is bronchitis
thickening of bronchi due to inflammation
what can cause rusty coloured sputum
pneumococcal pneumonia, cancer
what condition is likely if you cant see the diaphragm in a CXR
lower lobe pneumonia
describe lower lobe collapse
loss of volume shown by mediastinal shift, hilum pulled down from normal position to supply remaining lower lobe
what lobe of the lung is affected if there is loss of outline of the right heart border
middle lobe
what lobe of the lung is affected if there is loss of outline of the left heart border
lingula
does stridor happen on in or expiration
inspiration
is wheeze on inspiration or expiration
expiration
what is cachexia
underweight
what is consolidation
when anything denser than air fills the air spaces in the lung
