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Phase 2a Annabel > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Define FEV1

A

Forces expiratory volume in one second

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2
Q

Define FVC

A

Forced vital capacity
- Total amount of air forcibly expired after taking a deep breath

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3
Q

What indicates an abnormal FEV1?

A

> 80% than normal

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4
Q

What does a low FVC indicate?

A

Restriction

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5
Q

What does a FEV1:FVC ratio of <0.7 indicate?

A

Airway obstruction

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6
Q

What does a high FEV1/FVC ratio with low FVC indicate?

A

Airway restriction

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7
Q

What indicates type 1 respiratory failure?

A

pO2 is low
pCO2 is low or normal
HCO3 is normal

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8
Q

What are 2 causes of type 1 respiratory failure?

A

RESTRICTIVE

Pneumonia
Pulmonary embolism

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9
Q

What levels indicate type 2 respiratory failure?

A

pO2 is low
pCO2 is high
HCO3 is normal if acute, increased if chronic

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10
Q

What are 2 causes of type 2 respiratory failure?

A

OBSTRUCTIVE

Hypoventilation
Emphysema
COPD

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11
Q

Define COPD

A

Non-reversible, progressively worsening airflow obstruction in the lungs

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12
Q

What are 3 types of COPD?

A

Chronic bronchitis
Emphysema
Alpha 1 antitrypsin deficiency

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13
Q

What are the risk factors of COPD?

A

Smoking
Air pollution
Genetic factors
Increased age

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14
Q

What gene is linked to COPD?

A

Alpha-1 anti trypsin deficiency
- Autorecessive

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15
Q

What does A1AT deficiency cause?

A

Deficiency in A1AT which inhibits neutrophil elastase

Early onset COPD
Cirrhosis

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16
Q

Define chronic bronchitis?

A

Chronic productive cough with sputum for 3+ months for 2+ years

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17
Q

Define emphysema

A

Enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

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18
Q

Outline the pathophysiology of chronic bronchitis?

A

Chronic exposure to pollutants -> hypersecretion of mucus in bronchi -> airway inflammation -> fibrotic changes -> narrowing of airways

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19
Q

What are the features of COPD?

A

Dysponea
Wheeze
Productive cough
Sputum production

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20
Q

What are the features of bronchitis?

A

BLUE BLOATERS

Pus sputum production
Cyanosis
Hypoxia
Obesity
Clubbing

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21
Q

How do cigarettes cause chronic bronchitis?

A

Interferes with cilia action
Dampens leukocyte response

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22
Q

Outline the pathophysiology of emphysema

A

Destruction of elastin layer -> loss of elastic recoil -> reduced alveolar surface area -> airway collapse in expiration

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23
Q

What are the 4 types of emphysema?

A

Centriacinar
Panacinar
Distal acinar
Irregular emphysema

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24
Q

What part of the lungs are affected by centriacinar emphysema?

A

Respiratory bronchioles

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25
Q

What is the MC cause of centri-acinar emphysema?

A

Cigarettes

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26
Q

What part of the lungs are affected by pan-acinar emphysema?

A

Whole acini
- respiratory bronchioles, alveoli, alveolar sacs

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27
Q

What part of the lungs are affected by distal acinar emphysema?

A

Distal airway structure

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28
Q

What is the MC cause of panacinar emphysema?

A

Alpha-1 antitrypsin deficiency

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29
Q

What are the features of emphysema?

A

PINK PUFFER

Pursed lip breathing
Hyperresonant chest on percussion
BARREL CHEST (too much air)
Cachexia (muscle wasting)

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30
Q

How does COPD affect V/Q?

A

Increases CO to compensate for decreased ventilation

DECREASES V/Q

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31
Q

What is V/Q?

A

Ventilation/perfusion ratio

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32
Q

Define ventilation rate(as in V/Q)

A

Volume of gas inhaled and exhaled from the lungs in a given time period

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33
Q

Define perfusion (as in V/Q)

A

Total volume of blood reaching the pulmonary capillaries in a given time period

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34
Q

Define bullae

A

Air filled space of >1cm in diameter in the lung that develops due to destruction of the lung parenchyma

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35
Q

What is a complication of emphysema?

A

Bullae rupture -> pneumothorax

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36
Q

How is COPD diagnosed?

A

FEV <0.8
FEV1/FVC <0.7
History of smoking ect
DLCO: diffusing capacity of CO across lung

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37
Q

How is Dysponea graded?

A

MRC 1-5

1- on strenuous exercise
2- walking up hill
3- can walk slow on flat
4- can catch breath after 100m on flat
5- housebound, cant do daily activity

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38
Q

What is stage 1 COPD?

A

FEV1 >80%

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39
Q

What is stage 2 COPD?

A

FEV1 50-79%

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40
Q

What is stage 3 COPD?

A

FEV1 30-49%

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41
Q

What is stage 4 FEV1 COPD?

A

<30%

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42
Q

How is emphysema diagnosed?

A

CXR:

Hyper inflated chest
Bullae
Decreased peripheral vascular marking
Flattened hemidaphragms

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43
Q

What marker differentiates COPD from asthma?

A

DLCO diffusing capacity of oxygen through lungs

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44
Q

What may ABG show in COPD?

A

T2 respiratory failure
Compensated acidosis

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45
Q

What is an exacerbation of COPD?

A

Acute worsening of symptoms
- Cough, SOB, sputum production and wheeze

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46
Q

What are the causes of COPD exacerbation?

A

Haemophilius influenzae (MC)
S. Pneumoniae

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47
Q

Outline the pathophysiology of COPD exacerbation

A

Excess O2 -> dead space -> V/Q mismatch -> CO2 retention -> respiratory acidosis

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48
Q

How does COPD exacerbation appear on ABG?

A

Low pH (acidosis)
Raised pCO2
Raised bicarbonate (not enough to reduce acid)

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49
Q

What is the target saturation in COPD exacerbation?

A

88-92

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50
Q

How is COPD exacerbation treated?

A

Abx: clarithromycin, amoxicillin, doxycycline
oxygen
steroids and nebuliser

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51
Q

What is the baseline treatment of COPD?

A

Smoking cessation + flu and pneumoniae vaccine

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52
Q

What is the first line treatment of COPD?

A

Short acting beta-2 agonist/SABA (salbutamol)
OR
Short acting muscarinic antagonist/SAMA (ipratropium bromide)

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53
Q

What is a short acting muscarinic antagonist?

A

Ipratropium bromide

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54
Q

What is the second line treatment of COPD?

A

No asthma features = LABA+ SABA + LAMA

Asthma features (eosinophils) = LABA + SABA + ICS

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55
Q

What is a long acting beta agonist?

A

Salmeterol
Formoterol

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56
Q

What is a short acting beta-2 agonist?

A

Salbutamol
Terbutaline

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57
Q

What is an example of of a LAMA?

A

Tiotropium

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58
Q

What is a type of ICS used in COPD?

A

Fostair
Seretide
Prednisolone

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59
Q

What is used in the 3rd line treatment for COPD?

A

LABA + LAMA + SABA + ICS

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60
Q

What is used in severe COPD?

A

Long term oxygen therapy

MUST STOP SMOKING

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61
Q

When is oxygen given in COPD?

A

PaO2 <7.2
Or
PaO2 7.3-8 with oedema, pulmonary HTN, noctutural hypoxaemia

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62
Q

When is oxygen therapy avoided in COPD patients?

A

Smokers- but they can have it after they quit

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63
Q

When is surgery indicated in COPD?

A

Upper lobe predominant emphysema -> lung reduction surgery

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64
Q

What are the complications of COPD?

A

Cor pulmonale
Infection (IECOPD)

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65
Q

When is alpha 1 antitrypsin deficiency suspected?

A

Young onset COPD and/or no history of smoking

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66
Q

Define asthma

A

Chronic inflammatory condition causing:
episodic airflow limitation
airway hyperresponsiveness
inflamed bronchioles

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67
Q

What are 3 triggers of asthma?

A

Infection
Exercise
Animals
Cold/damp
Dust
Beta blockers

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68
Q

What are the 2 types of asthma?

A

Allergic (IgE mediated)
Non-allergic (non-IgE mediated)

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69
Q

What is the MC type of asthma?

A

Allergic

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70
Q

Describe allergic asthma

A

IgE mediated, extrinsic T1 hypersensitivity reaction

ATOPIC

Caused by environmental triggers
Early presentation
May link to hygiene hypothesis

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71
Q

What are the features of non-allergic asthma?

A

Non-IgE mediated, intrinsic

Presents later
Associated with smoking and obesity
Exacerbated by exercise and cold weather

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72
Q

Define atopy

A

Tendency to readily develop IgE against common environmental agents, leading to elevated serum IgE and airway hyperresponsiveness

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73
Q

What are the risk factors of asthma?

A

History of atopy
Obesity
Inner city environment
Premature birth
Socioeconomic deprivation

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74
Q

Outline the pathophysiology of asthma

A
  1. Overexpressed TH2 cells in airways exposed to trigger
  2. TH2 cytokine release IL3,4,5,13 and IgE production + eosinophils
  3. IgE mast cells -> histamines and eosinophils release MBP
  4. Bronchial constriction and muscus hypersecretion
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75
Q

What is the atopy triad?

A

Allergic rhinitis (hay fever)
Asthma
Eczema

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76
Q

What is Samter’s triad/ aspirin exacerbated respiratory disease?

A

Aspirin sensitivity
Nasal polyps
Asthma

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77
Q

What are the symptoms of asthma?

A

Wheeze
Cough
Chest tightness
SOB
Episodic with triggers

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78
Q

What are the 4 classifications of asthma attacks?

A

Moderate (PEF 50-75)
Acute Severe (PEF 33-50) can’t finish sentence
Life threatening (PEF <33 and decreased consciousness, silent chest)
Near Fatal (raised PaCO2)

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79
Q

What is PEF?

A

Peak expiratory flow

Volume of air forcibly expired from lungs in one exhalation after a deep breath in

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80
Q

How is asthma diagnosed?

A
  1. Fractional exhaled nitrous oxide (FeNO) increased
    - due to eosinophils
  2. Spirometry shows obstruction (FEV1/FVC <0.7)
  3. Bronchodilator reversible test positive (>12% FEV1)
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81
Q

How is asthma differentiated from COPD?

A

Bronchodilator reversible test positive in asthma
COPD usually occurs later
COPD more progressive

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82
Q

How is asthma treated?

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LAMA if 5 or older
    SABA + ICS + LTRA if <5
  4. SABA + ICS + LABA +/- LTRA
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83
Q

What is an example of a LTRA?

A

Montelukast

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84
Q

How are asthma exacerbations treated?

A

O SHIT ME

O2
Nebulised SABA
Hydrocortisone (ICS)
Ipratropium
Theophylline
MgSO4
Escalate care

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85
Q

What are 2 respiratory tract infections?

A

Pneumonia
Tuberculosis

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86
Q

Define TB

A

Granulomatous ceasating disease caused by mycobacteria

type 4 hypersensitivity reaction

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87
Q

What are the 4 causes of TB?

A

Mycobacterium tuberculosis (MC)
Mycobacterium Bovis (unpasteurised milk)
Mycobacterium africanum
Mycobacterium microti

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88
Q

Where is TB most common?

A

South Asia
Sub Saharan Africa

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89
Q

How does TB stain?

A

Acid fast bacilli- go red/pink with Ziehl-Neelson stain

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90
Q

What are the microbiological features of TB?

A

Aerobic
Non motile
Non sporing
Slightly curved rods/ bacilli
Thick waxy capsule
Slow growing

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91
Q

What are the risk factors of TB?

A

Origination from high incidence country
HIV
Immunosupression
Poverty and malnutrition
Overcrowding
IVDU
Smoking and alcohol

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92
Q

How is TB spread?

A

Airborne via respiratory droplets

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93
Q

How many people with TB have latent infection?

A

95%

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94
Q

What are the 3 stages of TB?

A

Primary infection (can instantly progress)
Latent
Reactivation

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95
Q

What is it called when TB spreads systemically?

A

Military TB

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96
Q

What occurs in the primary phase of TB infection?

A

Initial contact with alveolar macrophages -> some bacilli taken into hilar lymph nodes -> granulomas form in lung apex (mainly) -> macrophages and lymphocytes kill most but some still remain

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97
Q

What occurs in the latent phase of TB?

A

TH1 response -> ceasating Granuloma formation -> ceasating necrosis in Granuloma (Gohn focus)-> 95% don’t have disease but can reactivate

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98
Q

What occurs in the reactivation phase of TB?

A

Bacilli + macrophages form granulomas -> Granuloma grows -> Granuloma and enlarged lymph grow as Ghon complex -> develops into cavity -> expelled when coughing

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99
Q

What is a Ghon focus?

A

Seen in TB, caseous necrotic tissue forms when the tissue inside a granuloma dies

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100
Q

What is a Ghon complex?

A

Ghon focus and affected hilar lymph nodes

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101
Q

What are 2 differential diagnoses of TB?

A

Cor pulmonale
Portal HTN
Heart failure

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102
Q

What are the symptoms of TB?

A

Night sweats
Weight loss and anorexia
Fever
Dysponea
Productive cough
Haemoptysis

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103
Q

How is latent TB diagnosed?

A

Tuberculin skin test/ mantoux skin test
-Inject tuberculin under skin, wait 3 days, >5mm is positive
Interferon gamma release assay

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104
Q

How is TB diagnosed?

A

GS: culture sputum 3x (takes 5 weeks)
- Ziehl-Neelsen stain
X-ray:
Hilar lymphadenopathy
Ghon complexes
Pleural effusion
Reactivation = UPPER LOBES

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105
Q

How is latent TB treated?

A

Isoniazid for 6 months
Isoniazid + rifampicin for 3 months

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106
Q

How is active TB treated?

A

RIPE

Rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 2 months
Ethambutol - 2 months

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107
Q

What are the complications of TB?

A

Haemopytisis
Pneumothorax
Fistula
Military TB

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108
Q

What are the side effects of Rifampicin?

A

Orange discolouration urine

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109
Q

What are the side effects of isoniazid?

A

PerIpheral neuropathy
- give pyroxidine

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110
Q

What are the side effects of pyrazinamide?

A

Hyperuricaemia -> gout
HepatItIs

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5
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111
Q

What are the side effects of ethambutol?

A

EYEthambutol

Optic neuritis
Colour blindness
Reduced visual acuity

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112
Q

Define pneumonia

A

inflammation of the lung and fluid exudate into alveoli Secondary to infection

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113
Q

What are some causes of pneumonia?

A

Strep pneumoniae (rusty sputum)
Haemophilius influenzae
Klebseilla (alcoholic and red sputum)

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114
Q

What are the 2 types of pneumonia?

A

Community acquired pneumonia (CAP)
Hospital acquired pneumonia (HAP)

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115
Q

When is CAP commonly seen?

A

Usually no immunosupression or malignancy
Can occur in all age but common in age extremes

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116
Q

What are the MC causes of CAP?

A

MC: strep. Pneumoniae
H. Influenzae
Mycoplasma pneumoniae - atypical pneumonia

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117
Q

What cause of pneumonia is common in people coming back from Spain and places with air conditioning?

A

Legionella

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118
Q

Define HAP

A

New onset of cough with purulent sputum and an X-ray consolidation, in patients who have spent >48 hours in hospital

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119
Q

Who is HAP commonly seen in?

A

Elderly
Ventilator associated
Post operative

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120
Q

What are the MC causes of HAP?

A

Aerobic gram negative bacilli

Pseudomonas aeruginosa
E. Coli
Klebsiella pneumoniae

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121
Q

What is aspiration pneumonia?

A

Pneumonia due to aspiration of food into the lungs (usually right lung)

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122
Q

What are the risk factors of pneumonia?

A

Age extremes
HIV
DM
COPD
IVDU
Smoking

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123
Q

Outline the pathophysiology of typical pneumonia

A

Bacteria invades -> exudate forms inside alveoli -> sputum production

124
Q

Outline the pathophysiology of atypical pneumonia

A

Bacteria invades -> exudate forms in interstitium of alveoli -> dry cough

125
Q

What are the symptoms of pneumonia?

A

Productive cough with rusty coloured sputum
Pyrexia
Pleuritic chest pain
Dysponea and breathlessness
Tachycardia, Tachypnoea, hypoxia
Confusion in older people

126
Q

What breath sounds are seen in pneumonia?

A

Bronchial breath sounds equally as loud on inspiration and expiration
Focal coarse crackles (air through sputum)
Dullness to percussion

127
Q

What are the symptoms of atypical pneumonia?

A

Dry cough
Low grade fever

128
Q

How is pneumonia diagnosed?

A

CXR shows consolidation
CXR shows air bronchogram
Sputum culture to find cause
ESR and CRP raised

129
Q

What is consolidation?

A

Air filled bronchi made visible by fluid filled surrounding alveoli

130
Q

What are mulitlobar pneumonic lesions on CXR indicative of?

A

S. Pneumoniae
S. Aureus
Legionella

131
Q

What are multiple pneumonic abscesses on CXR indicative of?

A

S. Aureus

132
Q

What are upper lobe pneumonic lesions on CXR indicative of?

A

Klebsiella bur exclude TB first

133
Q

How is pneumonia severity assessed?

A

CURB65

134
Q

How is CURB65 scored?

A

C= confusion
U= urea >7
R= respiratory rate >30
B= blood pressure <90 systolic or <60 diastolic
65 or over

135
Q

What should be done if CURB65 score is 0-1?

A

Stay at home

136
Q

What should be done if CURB65 score is 2?

A

Consider hospital

137
Q

What should be done if CURB65 score is 3+?

A

ITU

138
Q

What are the mortality rates of CURB65 score?

A

0 = 0.7
3= 17
5 = 57

139
Q

What is the first line treatment of pneumonia?

A

1 = amoxicilllin 5-7 days
2= amoxicillin + clarithromycin 7-10 days
3<= IV co-amoxiclav + clarithromycin

140
Q

How is staph aureus treated?

A

Flucloxacillin

141
Q

How is strep pneumoniae treated?

A

Amoxicillin

142
Q

How is H. Influenzae treated?

A

Amoxicillin
Doxycycline

143
Q

How is Klebsiella treated?

A

Co-amoxiclav or cephalosporins

144
Q

How is legionella treated?

A

Clarithromycin

145
Q

What 2 organisms can cause pneumonia in immunocompromised people?

A

Pseudomonas aeurgionosa
Pneumocystis pneumonae (HIV!)

146
Q

How is pneumonia in immunocompromised people treated?

A

Folic acid Abx
- Co-trimoxazole

147
Q

How is immunocompromised pneumonia diagnosed?

A

Silver stain

148
Q

What are the complications of pneumonia?

A

Parapneumonic effusion
Empyema
Lung abscess

149
Q

Define cystic fibrosis

A

Autorecessive mutation of CFTR (cystic fibrosis transmembrane conductance regulatory gene) gene on chromosome 7

150
Q

What is the MC mutation in CF?

A

Delta-F508

151
Q

How many people are CF carriers?

A

1/25

152
Q

What is the normal function of the CFTR gene?

A

Secretes Cl- actively and Na+ and H2O passively into ducal secretions making them thin and watery

153
Q

What occurs when the CFTR gene is mutated in CF?

A

Less Cl- is excreted so more H2O and Na+ is reabsorbed, causing the mucus to thicken

154
Q

Outline the pathophysiology of CF in the lungs

A

Mutated CFTR + impaired mucociliary clearance as mucus is too thick -> stagnation -> increased infection risk + difficultly breathing -> increased risk of bronchiectasis

155
Q

What are the symptoms of CF at birth?

A

20% have meconium ileus

Thick black sticky stool that can obstruct the bowel

156
Q

What are the respiratory symptoms of CF?

A

Thick sticky sputum
Crackles on austication
Chronic cough
Recurrent lower respiratory tract infection.

157
Q

What are the GI symptoms of CF?

A

Pancreatitis and pancreas insufficiency
Thick secretions
Steatorrhoea + deficiency of fat soluble vitamins

158
Q

What are the GU symptoms of CF?

A

Frequent UTI
Males infertile due to absence of vas deferents and epididymis
Females may lose periods later on due to thick cervical mucus

159
Q

What are some other symptoms of CF?

A

Salty sweat
Clubbing
Osteoporosis

160
Q

What are the risk factors of CF?

A

Caucasian
FHx

161
Q

How is CF diagnosed?

A

GS: sweat gland test- Na and Cl- will be >60mmol/L
Genetic testing
Newborn spot blood test

162
Q

How is CF treated/managed?

A

Prophylactic Abx
Nebulised mucolytics
Pancreatic stuff: give insulin and vit DAKE
Chest physio and no smoking
Lung transplant

163
Q

Define bronchiectasis

A

Permanent dilation of bronchi and bronchioles from chronic infections

164
Q

What are 4 common infections in bronchiectasis?

A

Haemophilius influenzae
Strep pneumoniae
Staph aureus
Pseudomonas aeruginosa

165
Q

What are the symptoms of bronchiectasis?

A

Chronic purulent cough with foul smelling mucus and intermittent haemoptysis
Dysponea
Coarse inspiratory crackles
Clubbing

166
Q

What part of the lungs are commonly affected by bronchiectasis?

A

Lower lobes

167
Q

What are the risk factors of bronchiectasis?

A

Previous infection
CF
HIV

168
Q

Outline the pathophysiology of bronchiectasis

A

Bronchitis -> bronchiectasis -> fibrosis

169
Q

What are 2 differential diagnoses of bronchiectasis?

A

COPD
Asthma
TB
Chronic sinusitis

170
Q

How is bronchiectasis diagnosed?

A

CXR shows dilated bronchi ad thickened walls (tramline and ring shadows)
GS: high resolution CT shows SIGNET RING SIGN
Spirometry shows obstruction
Sputum culture

171
Q

How is bronchiectasis treated?

A

Physio and postural draining
Abx
Bronchodilator
Mucolytic

172
Q

What is an example of a mucolytic?

A

Carbocistiene

173
Q

Define pleural effusion

A

Excessive accumulation of fluid in the pleural space (between visceral and parietal pleura)

174
Q

What are the 2 types of pleural effusion?

A

Exudative (protein >30g/L)
Transudative (protein <30g/L)

175
Q

What are some other effusions in pleural effusion?

A

Blood- haemothorax
Pus- empyema
Lymph- chylothorax

176
Q

What are the causes of transudative pleural effusion?

A

Heart failure
Fluid overload
Cirrhosis
NephrOtic syndrome

177
Q

What are the causes of exudative pleural effusion?

A

Cancer
Pneumonia
TB

178
Q

What are the signs of pleural effusion?

A

Can be asymptomatic
Dull percussion on affected side
Diminished breath sounds on affected side
Chest expansion reduced on affected side
Tracheal deviation AWAY from effusion

179
Q

When is Lights criteria used?

A

Pleural effusion

When protein content borderline exudative (25-35)

180
Q

How is pleural effusion diagnosed?

A

CXR when 300ml< present seen as water dense shadows (WHITE)
Small effusions reduce costophrenic angles
USS thoracentesis/pleural tap
- sent for testing

181
Q

How is pleural effusion treated?

A

Small can be conservative- loop diuretics
Chest drainage
If recurrent = pleurodesis
Can use PIC (Indwelling catheter) if recurrent too

182
Q

What is pleurodesis?

A

Injection adhering the visceral and parietal pleura to prevent re accumulation of pleural effusion

183
Q

What are the risk factors of pleural effusion?

A

Asbestos exposure
Previous lung damage
Infection

184
Q

Define empyema

A

Infected pleural effusion (pus)

185
Q

What are the symptoms of pleural effusion?

A

SOB
Dyspnoea
Pleuritic pain
Failure of fever to settle on Abx

186
Q

How is Empyema diagnosed?

A

Pus in pleuritic aspiration
Acidic pH
Low glucose

187
Q

How is empyema treated?

A

Chest drain
Thoracoscopy
Indwelling pleural catheter (PIC) if recurrent

188
Q

Define pneumothorax

A

Air in the pleural space leading to partial or complete collapse of the lungs

189
Q

What are the risk factors of pneumothorax?

A

Male
Smoking
Connective tissue disorder
Mechanical ventilation

190
Q

What are the 2 types of pneumothorax?

A

Primary: spontaneous, no underlying cause
Secondary: known cause, trauma or infection ect

191
Q

What are the causes of pneumothorax?

A

Bronchial asthma
COPD
TB
Pneumonia
CF
Trauma

192
Q

Outline the pathophysiology of pneumothorax

A

Normally pressure is negative (vacuum) -> breach in pleura -> abnormal connection (fistula) between pleural space and airways

193
Q

What are the symptoms of pneumothorax?

A

Usually tall, thin male with connective tissue disorder/trauma

Sudden onset of dysponea and/or pleuritic test pain
Enlargement = increased Dysponea, pallor, tachycardia
Reduced Breath sounds

194
Q

What breath sounds are present in pneumothorax?

A

Hyper resonance to percussion
Reduced expansion
Diminished breath sounds

195
Q

How is pneumothorax diagnosed?

A

CXR= air appears black, tracheal deviation to other side (tension) and line demarcating edge
CT for smaller pneumothorax

196
Q

Define tension pneumothorax

A

Trauma to the chest causing a one way valve letting air in but not out of the pleural space

Causes massive increase of pressure with every breath, can compress heart

197
Q

What are the complications of tension pneumothorax?

A

Cardio respiratory arrest

198
Q

What are the symptoms of tension pneumothorax?

A

Tracheal deviation away from pneumothorax
Reduced air entry to affected side
Increased resonant percussion
Severe chest pain

199
Q

How is pneumothorax treated?

A

Insert large bore cannula into second intercostal space in midclavicular line

200
Q

What type of pneumonia commonly affects HIV patients?

A

Pneumocystis jiroveci

201
Q

What is the MC interstitial lung disease (ILD)?

A

Idiopathic fulmonary fibrosis

202
Q

What is a granulomatous ILD?

A

Sarcoidosis

203
Q

What is an inhalation ILD?

A

Hypersensitivity pneumonitis
Pneumoconiosis

204
Q

What causes pneumoconiosis?

A

Asbestosis
Silicosis

205
Q

What are 2 idiopathic pneomonias?

A

Pulmonary fibrosis
Non-pulmonary fibrosis

206
Q

What is a connective tissue ILD?

A

Sleroderma
RA

207
Q

What are 2 drugs that can induce ILD?

A

Amiodarone
Biemycin

208
Q

Define interstitial lung disease (ILD)

A

Umbrella term for lung pathology that causes scarring/fibrosis of the lungs

209
Q

Define idiopathic pulmonary fibrosis (IPF)

A

Formation of fibrosis in the lungs with no known cause

210
Q

Who does IPF affect?

A

60+ male smokers

211
Q

What are the risk factors of IPF?

A

Cigarettes
Infectious agents (CMV, Hep C)
Occupationa dust exposure
Drugs
GORD

212
Q

What are the symptoms of IPF?

A

Dry cough
Excertional Dysponea
Bibasal crackles
Joint pain
Cyanosis

213
Q

How is IPF diagnosed?

A

Spirometry: restriction (FEV1/FVC >70% but low FVC)
HR-CT: shows GROUND GLASS APPEARANCE

214
Q

How is IPF treated?

A

Pirfenidone + nintedanib

Lung transplant
Short survival so can go to palliative

215
Q

Define sarcoidosis

A

Multisystem granulomatous disorder of an unknown cause

216
Q

Who does sarcoidosis commonly affect?

A

20-40
Women
Afro Caribbean’s

217
Q

What are the symptoms of sarcoidosis?

A

Dry cough
Progressive Dysponea
Anterior uveitis
Lupus pernio- bluish purple nodules and plaques on nose, cheek, and ears

218
Q

How is sarcoidosis diagnosed?

A

CXR for staging: shows bilateral hilar lymphadenopathy and pulmonary infiltrates
GS: tissue biopsy shows NON CAESATING GRANULOMATA
raised calcium and ACE

219
Q

How is sarcoidosis treated?

A

Low stage = recovery is spontaneous
Acute: bed rest and NSAIDs
Corticosteroids: Prednisolone if symptomatic

220
Q

When is sarcoidosis not treated?

A

Symptomatic at stage 1
Asymptomatic at stage 2+3

221
Q

Define pulmonary hypertension

A

MPAP above 25mmHg when measured with right heart catheterisation

222
Q

What is mPAP?

A

Mean pulmonary artery pressure

223
Q

What can pulmonary hypertension cause?

A

Cor pulmonale

224
Q

What is a pre capillary cause of pulmonary hypertension?

A

Pulmonary embolism

225
Q

What is a capillary/lung cause of pulmonary HTN?

A

COPD
Asthma

226
Q

What is a post capillary cause of pulmonary HTN?

A

Left ventricle failure

227
Q

Outline the pathophysiology of pulmonary hypertension

A

Pulmonary vasoconstriction-> higher resistance -> pulmonary HTN -> endothelial damage -> RVH -> RH failure

228
Q

What are the symptoms of pulmonary hypertension?

A

Excertional dysponea
Fatigue
RHF sights: hepatomegaly, ascites, pleural effusion, peripheral oedema

229
Q

How is pulmonary hypertension diagnosed?

A

GS: RH catheter
CXR: cardiomegaly and RVH
ECHO and ECG

230
Q

How is pulmonary hypertension treated?

A

Sildenafil (phosphodiesterase-5 inhibitors)
Prostaglandin analogues
Diuretics for oedema
CCB

231
Q

Define mesothelioma

A

Tumour of the mesothelial cells of the pleura

232
Q

What is the MC cause of mesothelioma?

A

Asbestos exposure

233
Q

Who is commonly affected by mesothelioma?

A

40-70 year old men with asbestos exposure a long time ago

234
Q

What are the symptoms of mesothelioma?

A

Chest pain
Constant cough with haemopytis
Clubbing
Night sweats
Weight loss
Recurrent pleural effusion

235
Q

How is mesothelioma diagnosed?

A
  1. Imaging CXR-> contrast CT showing pleural effusion and pleural thickening
    GS: pleural biopsy
    Bloody/straw pleural fluid
236
Q

How is mesothelioma treated?

A

Death in 8 months usually- palliative

237
Q

What are 5 sites that lung cancers commonly metastasise to?

A

Bone
Liver
Adrenals
Brain
Lymph nodes

238
Q

Are primary or secondary lung cancers more common?

A

Secondary

239
Q

Why are secondary lung cancers more common?

A

Lungs oxygenate all blood so higher risk of metastasis

240
Q

Define bronchial carcinoma

A

Cancer originating in the lung parenchyma

241
Q

What are the 2 types of bronchial carcinoma?

A

Small cell lung carcinoma (SCLC)
Non-small cell carcinoma

242
Q

Who is affected by SCLC?

A

ONLY affects smokers

243
Q

Define SCLC

A

Affects bronchi and appears as small cells with minimal cytoplasm

244
Q

What are the symptoms of SCLC?

A

Cough with haemoptysis
Constitutional cancer symptoms
Compression symptoms
PARANEOPLASTIC SYNDROMES

245
Q

How is lung cancer diagnosed?

A

1: imaging (CXR -> contrast CT)
GS: bronchoscopy an biopsy

246
Q

What are the risk factors of lung cancer?

A

Smoking
Asbestos
Coal
Lung disease
HIV

247
Q

How is SCLC treated?

A

Palliative usually- very aggressive and fast spreading

248
Q

What are paraneoplastic syndromes associated with?

A

Small cell lung cancer

249
Q

What are 3 paraneoplastic syndromes?

A

Ectopic ACTH- Cushings
Ectopic ADH- SIADH
Lambert Eaton syndrome

250
Q

What is the MC lung cancer?

A

Adenocarcinoma

251
Q

Define squamous cell carcinoma

A

Bronchial carcinoma arising from lung epithelium that resembles squamous epithelium

252
Q

Who does squamous cell carcinoma commonly affect?

A

Smokers

253
Q

Where does squamous cell carcinoma commonly affect and what are its features?

A

Central lung
Lesions with central necrosis

254
Q

What paraneoplastic syndrome is associated with squamous cell carcinoma?

A

PTHrP-> hypercalcaemia

(PTH related peptide)

255
Q

What is the prognosis of squamous cell carcinoma?

A

Metastasises late and spreads locally so ok prognosis

256
Q

How is squamous cell carcinoma treated?

A

Surgical excision
Metastasis = chemo+ radio

257
Q

What lung cancer is most commonly associated with non-smokers?

A

Adenocarcinoma

258
Q

Where does lung adenocarcinoma arise from?

A

Mucus secreting glandular epithelium

259
Q

What is the main risk factor of lung adenocarcinoma?

A

Asbestos exposure

260
Q

What is lung adenomas closely related to?

A

Hypertrophic pulmonary osteoarthropathy

261
Q

What is the triad of hypertrophic pulmonary osteoartropathy?

A

Clubbing
Arthritis
Long bone swelling

262
Q

Does lung adenocarcinoma metastasise often?

A

Yes

263
Q

How is lung adenocarcinoma treated?

A

Surgical excision
Metastasis likely so chemo, radiotherapy

264
Q

What are 4 sites that most commonly metastasise to the lungs?

A

Breast
Bowel
Kidney (MC)
Bladder

265
Q

What are the common symptoms of lung cancer?

A

Cough
Breathlessness
haemoptysis
Chest pain
Clubbing

266
Q

How is lung cancer generally diagnosed?

A

Contrast CT
Bronchoscopy and Biopsy

267
Q

What are 3 signs of lung cancer metastasis?

A

Pancost tumour -> horners syndrome
Pembertons sign
Hoarse voice

268
Q

What is Pemberton’s sign?

A

Raising arms causes facial flushing

269
Q

What causes pembertons sign?

A

SVC obstruction due to compression

270
Q

What does a hoarse voice indicate in lung cancer?

A

Compression of recurrent laryngeal nerve

271
Q

Define Pancoast tumour

A

Tumour in lung apex metastases to neck sympathetic plexus

272
Q

What does a pancoast tumour cause?

A

Horners syndrome

273
Q

What are the 3 signs of Horners syndrome?

A

IPSILATERAL

Ptosis (droopy eyelid)
Myosis (pupil constricted)
Anhydrosis (lack of sweat)

274
Q

Define hypersensitivity pneumonitis

A

Type 3 hypersensitivity reaction causing alveolar and bronchial inflammation after exposure to an inhaled antigen

275
Q

What are the risk factors of hypersensitivity pneumonitis?

A

Farmers lung- mouldy hay
Bird fanciers lung- keeping birds
Cheese workers- mouldy cheese
Malt workers- mouldy malt
Humidifier fever - contaminated air conditioning

276
Q

What are the symptoms of hypersensitivity pneumonitis?

A

Dysponea
Dry cough
Fever
T1 RF

277
Q

How is hypersensitivity pneumonitis diagnosed?

A

CXR: patchy nodular infiltrates
History mainly

278
Q

How is hypersensitivity pneumonitis treated?

A

Remove allergen
Corticosteroids

279
Q

Define Goodpastures disease

A

T2 hypersensitivity reaction causing pulmonary and renal pathology

280
Q

What are the risk factors of Goodpastures?

A

HLA DR15
Cigarettes
Asbestosis

281
Q

Outline the pathophysiology of Goodpastures

A

Anti-GBM antibodies attack BM of alveoli and glomeruli -> alveolar haemmorage + glomerulonephrisis

282
Q

What are the symptoms of Goodpastures?

A

Haemoptysis + haematuria

Cp, cough, HTN, oedema

283
Q

How is Goodpastures diagnosed?

A

ANTI-GBM ANTIBODIES positive
Lung + kidney biopsy
Ig deposition

284
Q

How is Goodpastures treated?

A

Corticosteroids + plasma exchange

285
Q

Define pharyngitis

A

Inflammation of the pharynx

286
Q

What causes pharyngitis?

A

Viral (MC) - EBV
Bacteria - S. pyrogenes

287
Q

What are the symptoms of pharyngitis?

A

Sore throat and fever
Viral = cough and congestion
Bacterial = exudate

288
Q

Define sinusitis

A

Inflammed mucosa of the nasal cavity and nasal sinuses

289
Q

What causes sinusitis?

A

Mostly viral
Bacterial - MC s.pneumonia

290
Q

What are the symptoms of sinusitis?

A

Frontal headache
Nasal cavity filled with loads of mucus
Facial pain and tenderness

291
Q

Define otitis media

A

Inflammed middle ear

292
Q

How is otitis media diagnosed?

A

Otoscopy shows Inflammed TM

293
Q

Define epiglottis

A

Inflammation of the epiglottis, causing airway obstruction

294
Q

What are the symptoms of epiglottis?

A

Tripoding- leant fowards with mouth open and tongue out

295
Q

How is epiglottis diagnosed?

A

Laryngoscopy
Lateral radiograph: THUMB PRINT SIGN

296
Q

What causes whooping cough?

A

Bordatella pertussis

297
Q

Define croup/ acute laryngobrochitis

A

Occasional complication of upper respiratory tract infection (esp. parainfluenza)

298
Q

What are the symptoms of croup?

A

Hoarse voice
Barking cough
Strider

299
Q

How is croup treated?

A

Single dose dexamethasone

300
Q

what is the blood marker for sarcoidosis?

A

increased ACE and calcium

301
Q

what is the first line treatment for asthma?

A

SABA eg salbutamol

302
Q

what is the second line treatment for asthma?

A

SABA + ICS
sabutamol + prednisolone

303
Q

what is the 3rd line treatment for asthma?

A

SABA + ICS + LTRA if <5
SABA + ICS + LABA if 5 or older

304
Q

what is the 4th line treatment for asthma?

A

SABA + ICS + LABA +/- LTRA
salbutamol + prednisolone + salmeterol + montelukast

305
Q

what hypersensitivity reaction is TB?

A

type 4

306
Q

define granuloma

A

aggregate of epitheliod histocytes

307
Q

Describe diurnal variation in asthma

A

Peak expiratory flow rate (PEFR) and shortness of breath is worse at night and early morning

Phase 2a Annabel (12 decks)

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