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yr6 paces - icsm final year Alistair Scott - Medicine COPY (shannon mckay) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Features and stages of clubbing

A

1) Bogginess / fluctuance of nail bed
2) Loss of concave nail fold angle
3) ↑ longitudinal and transverse curvature
4) Soft tissue expansion at distal phalanx (drumstick)

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2
Q

Respiratory causes of clubbing

A

Carcinoma

  • Bronchial
  • Mesothelioma

Chronic lung suppuration

  • Empyema, abcess
  • Bronchiectasis, CF

Fibrosis

  • Idiopathic pulmonary fibrosis / CFA
  • TB
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3
Q

Cardiac causes of clubbing

A
  • Infective endocarditis
  • Congenital cyanotic heart disease
  • Atrial myxoma
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4
Q

GI causes of clubbing

A
  • Cirrhosis
  • Crohn’s, UC
  • Coeliac
  • Cancer - GI lymphoma
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5
Q

Definition of cyanosis

A
  • Blue discolouration of mucosal membranes or skin

- Deoxygenated Hb >5g/dl

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6
Q

Respiratory causes of cyanosis

A
  • Hypoventilation - COPD, musc
  • ↓ diffusion: pulm oedema, fibrosing alveolitis
  • V/Q mismatch: PE, AVM (e.g. HHT)
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7
Q

Cardiac causes of cyanosis

A

Congenital - Fallot’s, TGA

↓ CO: MS, systolic LVF

Vascular: Raynaud’s, DVT

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8
Q

CURB 65 score

A

Assessing severity of asthma

Confusion - AMT<8
Urea - >7
Resp rate - >30
BP - <90/60
65 yo or older

Score
0-1 -> home treatment
2 -> hospital treatment
3 -> ?ITU

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9
Q

Empirical abx treatment for mild/mod/severe CAP

A

Mild - amox 500mg TDS for 5 days or clari 500mg BD for 7 days

Moderate - both as above for 7 days unless pen allergy, consider IV

Severe - co-amoxiclav 1.2g TDS IV / cefuroxime 1.5g TDS IV
AND clari 500MG BD IV for 7-10 days. Add fluclox if staph suspected.

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10
Q

Empirical therapy for atypical CAPs

A

Chlamydia - tetracycline

PCP - Co-trimoxazole

Legionella - clari and rifampacin

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11
Q

Empirical abx therapy for HAP

A

Mild / <5 days - co-amox 625mg PO TDS for 7 days

Severe / >5 days - Tazocin +/- Vanc +/- Gent for 7 days

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12
Q

Definition of type 1 and type 2 respiratory failure

A

Both - PaO2 <8

Type 1 - PaCO2 <6
Type 2 - PaCO2 >6

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13
Q

Causes of lung abscess

A
  • Aspiration
  • Bronchial obstruction: tumour, foreign body
  • Septic emboli: sepsis, IVDU, RH endocarditis
  • Pulmonary infarction
  • Subphrenic / hepatic abscess
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14
Q

Features of lung abscess

A
  • Swinging fever
  • Cough, foul purulent sputum, haemoptysis
  • Malaise, wt. loss
  • Pleuritic pain
  • Clubbing
  • Empyema (pus in the plural cavity)
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15
Q

Systemic Inflammatory Response Syndrome

A

Inflammatory response to a variety of insults manifested by 2 or more of:

  • Temp >38 or <36
  • HR >90
  • RR > 20 or PaCO2 <4.6
  • WCC >12 or <4 or >10% bands
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16
Q

Pathophysiology of bronchiectasis

A

Chronic infection of bronchi/bronchioles -> permenent dilatation

Retained inflammatory secretions and microbes -> airway damage and recurrent infection

17
Q

Common organisms of infection in bronchiectasis

A

H. influenza
Pneumococcus
S. aureus
Pseudomonas

18
Q

Congenital causes of bronchiectasis

A

CF (mainly upper lobe inflitration)

Kartagener’s / Primary Ciliary Dyskinesia

Young’s syndrome (azoospermia + bronchiectasis)

19
Q

Causes of post-infectious bronchiectasis

A 
Measles
Pertussis
Pneumonia
TB
Bronchiolitis
20
Q

Immunodeficiency causes of bronchiectasis

A

Bruton’s X-linked agammaglobinaemia

Common Variable Immunodeficiency

IgG subclass deficiency
IgA deficiency
21
Q

signs and symptoms of bronchiectasis

A
  • Persistent cough with purulent sputum
  • Haemoptysis
  • Fever and weight loss
  • Clubbing
  • Coarse inspiratory creps
22
Q

Complications of bronchiesctasis

A 
Pneumonia
Pleural effusion
Pneumothorax
Pulmonary HTN
Massive haemoptysis
Cerebral abcess
Amyloidosis
23
Q

Pathogenesis of CF

A

Mutation in CFTR gene on Chromosome 7 (commonly ∆F508)

↓ luminal Cl secretion and ↑ Na reabsorption → viscous secretions.

In sweat glands, ↓ Cl and Na reabsorption → salty sweat

24
Q

Clinical features of CF in neonates

A

Failure to thrive
Meconium ileus
Rectal prolapse

25
Q

Clinical features of CF in children and young adults

A

Nose: nasal polyps, sinusitis

Resp: cough, wheeze, infections, bronchiectasis, haemoptysis, pneumothorax, cor pulmonale

GI: Pancreatic insufficiency (DM and steatorrhoea), Distal Intestinal Obstruction Syndrome, Gallstones, Cirrhosis

Male infertility, osteoporosis, vasculitis

26
Q

Types of lung cancer

A

Small-cell and non-small-cell (squamous cell carcinoma, adenocarcinoma, large-cell)

27
Q

Lung squamous cell carcinoma

A

35% of lung cancer
M>F
Smokers
Radon gas

Centrally located
Keratinisation

Locally invasive
Metastasise late via LN
PTH releasing -> ↑Ca

28
Q

Lung adenocarcinoma

A

25% of lung cancer
Females
Non-smokers
Far East

Peripherally located
Glandualar differentiation

Extrathoracic mets common and early -> 80% present with mets

29
Q

Large cell lung cancer

A

10% of lung cancer

Peripheral or central
Large, poorly differentiated cells

Poor prognosis

30
Q

Small-cell lung carcinoma

A

20% of lung cancer
Smokers

Central location, near bronchi
Small, poorly differentiated cells

80% present with advanced disease
v. chemo sensitive but poor prognosis
Ectopic hormone secretion

31
Q

Clinical features of ARDS

A

Tachypnoea
Cyanosis
Bilateral fine creps
SIRS

32
Q

Pulmonary causes of ARDS

A

Pneumonia
Aspiration
Inhalation injury
Contusion

33
Q

Systemic causes of ARDS

A 
Shock
Sepsis
Trauma
Haemhorrage and multiple transfusions
Pancreatitis
Acute liver failure
DIC
34
Q

Definintion of chronic asthma

A

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli.

35
Q

Definition of COPD

A
  • Airway obstruction: FEV1 <80%, FEV1:FVC <0.70
  • Chronic bronchitis: cough and sputum production on most days for 3mo of 2 successive years.
  • Emphysema: histological diagnosis of enlarged air spaces distal to terminal bronchioles c¯ destruction of
    alveolar walls.

yr6 paces - icsm final year Alistair Scott - Medicine COPY (shannon mckay) (4 decks)

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