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Phase 4 > Resp > Flashcards

Resp Flashcards

1
Q

what are 6 environmental triggers of asthma?

A 
viral/bacterial infection
allergen exposure
food additives
chemicals 
irritants
aspirin
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2
Q

what are 3 risk factors for asthma?

A

FHx
Atopic Hx
nasal polyposis

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3
Q

what are 5 presentations of asthma?

A 
episodic SOB
dry cough
expiratory wheeze and chest tightness
nasal polyposis
diurnal PEFR variation
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4
Q

what are 4 investigations of Asthma?

A

FEV1/FVC ratio - <70% predicted and bronchodilator reversibility

factional exhaled NO - >40 ppb

Peak expiratory flow rate - less than expected in gender and height matched person

skin prick allergy testing

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5
Q

what are 3 differentials for asthma?

A

cystic fibrosis
pulmonary oedema
COPD

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6
Q

what are the 2 different types of asthma?

A

Eosinophilic - most common (70%)

non-eosinophilic

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7
Q

what is atopy?

A

when an individual readily develops IgE against common environmental antigens

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8
Q

what is non-eosinophilic asthma triggered by?

A

exercise, cold air, stress, smoking, obesity, menstrual cycle

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9
Q

what is eosinophilic asthma triggered by?

A

allergens

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10
Q

what drug class should you never give to asthmatics?

A

BETA BLOCKERS

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11
Q

what 4 immune cells are present in asthma?

A

mast cells
eosinophils
dendritic cells
lymphocytes

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12
Q

what are 4 features of an asthma attack?

A

reduced chest expansion
prolonged expiratory tume
bilateral expiratory polyphonic wheeze
tachypnoea

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13
Q

what are 4 features of uncontrolled asthma?

A

PEFR less than 50%
RR < 25
pulse <110
normal speech

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14
Q

what are 3 features of a severe asthma attack?

A

inability to complete sentences
pulse >110
RR >25
PEFR 33-50%

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15
Q

what are 5 features of a life threatening asthma attack?

A 
silent chest
confusion and exhaustion
cyanosis 
bradycardia
PEFR <33%
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16
Q

what is the management for an asthma attack?

A

O2 therapy
salbutamol
nebulised ipratropium bromide
prednisolone/hydrocortisone IV

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17
Q

when in the day is asthma worst?

A

worse at night and early morning

DIURNAL

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18
Q

how is asthma diagnosed with peak flow?

A

a greater than 15% increase in FEV1 or PEFR following bronchodilator inhalation

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19
Q

how do B2 agonists work?

A

binds to B2 receptor coupled with Gs protein
=> adenyl cyclase converts ATP to cyclic AMP =>
increases in cyclic AMP leads to bronchodilation

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20
Q

what are the 4 main treatments of asthma?

A

SABAs - salbutamol and terbutaline

LABAs - salmeterol, formoterol
muscarinic antagonists - ipratropium (short), tiotropium (long)

inhaled corticosteroids - prednisolone, beclomatasone, budesonide

leukotriene receptor antagonists (LTRA) - bronchodilator, montelukast

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21
Q

how do muscarinic antagonists work?

A

act on M3 receptors

prevent Ach from binding => no smooth muscle contraction

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22
Q

what are 6 side effects of corticosteroids?

A 
susceptibility to infection
osteoporosis and muscle wasting 
cataracts
diabetes
skin thinning and bruising
growth retardation
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23
Q

what are 2 steroid sparing agents that can be used in asthma?

A

methotrexate

ciclosporin

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24
Q

what is the medication regime for asthma mild to severe?

A

SABA
SABA + ICS
SABA + ICS + lLTRA
SABA + ICS + ILTRA/LABA + MART

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25
Q

what are 3 complications of asthma?

A

severe exacerbation
airway remodelling
candida due to inhaled corticosteroids

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26
Q

what is the most common causative agent for CA pneumonia?

A

streptococcus pneumonia

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27
Q

what are 5 manifestations of pneumonia?

A 
cough +/- sputum 
SOB 
pleuritic chest pain
rigors/night sweats and fever
abnormal auscultatory findings
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28
Q

what are 4 investigations of pneumonia?

A

CXR - new shadowing - gold
CRP - raised
FBC - raised WBCs
sputum culture

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29
Q

what assessment tool is used to assess pneumonia severity?

A

CURB65

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30
Q

what is the CURB65 score?

A 
Confusion
Urea ≥7mmol/L
Respiratory rate≥ 30/min 
Blood pressure; low systolic < 90mm/Hg or diastolic ≤60mm/Hg
Age ≥ 65
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31
Q

what are 3 risk factors for CA pneumonia?

A

> 65 years
resident in healthcare setting
COPD

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32
Q

what are 3 complications of pneumonia?

A

septic shock
ARDS
antibiotic associated C. Diff

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33
Q

what is COPD?

A

a progressive disease state characterised by airflow limitation that is not fully reversible. Contains both emphysema and chronic bronchitis

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34
Q

what are 4 causes of COPD?

A

smoking - 40-70%
air pollution
occupational exposure
alpha-1 Antitrypsin deficiency

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35
Q

what are 3 risk factors for COPD?

A

smoking
older age
genetics - alpha-1 antitrypsin

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36
Q

why is there increased mucous secretion in COPD?

A

increased goblet cell size and number

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37
Q

what are 5 manifestations of COPD?

A

productive cough and SOB
pursed lips - increased resprate and barrel chest
cyanosis
expiratory wheeze

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38
Q

what FEV1/FVC ratio is needed for an obstructive lung disease?

A

<0.7

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39
Q

what FEV1/FVC ratio is needed for a restrictive lung disease?

A

> 0.7

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40
Q

what are 3 investigations for COPD?

A

spirometry - <0.7 => non reversible

CXR - rule out pathology, hyper inflated lungs and flat diaphragm

FBC

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41
Q

what is needed for a COPD diagnosis (bronchitis)?

A

daily productive cough lasting at least 3 months of the year for at least 2 years in a row

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42
Q

what are 3 differentials for COPD?

A

Asthma
congestive HF
TB

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43
Q

what is alpha-1 Antitrypsin Deficiency?

A

rare genetic condition causing lung and liver problems
early onset COPD/cirrhosis even without smoking/drinking Hx
autosomal co-dominant

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44
Q

what is the pharmacological treatment for COPD?

A 
bronchodilators 
- SABA => Salbutamol
- SAMA => ipratropium
- LABA => Salmeterol 
- LAMA => tiotropium
Inhaled corticosteroids

order => SABA/SAMA, LABA + LAMA, ICS

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45
Q

What are the 4 stages of COPD?

A

1 - FEV1 >80% predicted
2 - FEV1 50-79%
3 - FEV1 30-49%
4 - FEV <30%

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46
Q

what are 3 complications of COPD?

A

Cor pulmonale
resp failure
pneumothorax

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47
Q

What is cystic fibrosis?

A

a severely life-shortening genetic disease resulting from abnormalities in the cystic fibrosis transmembrane conductance regulator (CFTR), a chloride channel found in cells lining the lungs, intestines, pancreatic ducts, sweat glands, and reproductive organs.

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48
Q

what is the prevalence of CF?

A

1 in 2500 live births

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49
Q

what is the inheritance pattern for CF?

A

Autosomal recessive on chromosome 7

there are mutations in the CF transmembrane conductance regulator

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50
Q

what are 3 risk factors for CF?

A

FHx
known carrier parents
Caucasian ethnicity

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51
Q

how does CF affect the pancreas?

A

blockage of exocrine ducts, early activation of pancreatic enzymes, autodestruction of exocrine pancreas

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52
Q

how does CF affect the intestine?

A

bulky stools and intestine blockages

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53
Q

how does CF affect the lungs?

A

mucus retention. Chronic infection, inflammation and lung destruction (fibrosis)

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54
Q

what are 5 manifestations of CF?

A 
failure to pass meconium/steatorrhoea
failure to thrive despite a voracious appetite
wet sounding cough 
recurrent chest infections
chronic sinusitis
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55
Q

what is a GU abnormality that is common in those with CF?

A

males lacking a vas deference

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56
Q

what are 3 investigations of CF?

A

sweat test - GOLD - >60mmol/L
genetic testing
Guthrie heel prick test - immunoreactive trypsinogen test

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57
Q

what are 3 differentials for CF?

A

asthma
primary immunodeficiency
coeliac disease

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58
Q

what is the treatment for CF?

A 
prophylactic antibiotics - flucloxacillin 
education 
chest physio
flu vaccine 
B2 agonists and ICS - symptom relief  
mucolytics - Dornase alfa
pancreatic enzyme replacement
immunomodulators - azathioprine
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59
Q

what are 3 complications of CF?

A

pneumothorax
chronic respiratory acidosis
acute respiratory failure

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60
Q

what is the average age of survival of a CF patient?

A

40

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61
Q

what is HA pneumonia?

A

an acute lower respiratory tract infection that is by definition acquired after at least 48 hours of admission to hospital

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62
Q

what is the most common early onset HA pneumonia?

A

pseudomonas aeruginosa

< 5 days after admission

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63
Q

what is the most common late onset HA pneumonia?

A

S. Aureus

> 5 days after admission

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64
Q

what are 3 risk factors for HA pneumonia?

A

poor infection control/hand hygiene
intubation and mechanical ventilation
decreased consciousness

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65
Q

what extra tests do you have to do in HA pneumonia?

A

sputum culture
nasopharyngeal swap
tracheal aspirate samples

BEFORE antibiotics

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66
Q

what are 3 complications of CA pneumonia?

A

empyema
lung abcess
sepsis

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67
Q

what is the most deadly cancer in the UK?

A

Lung cancer

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68
Q

what are 3 risk factors for lung cancer?

A

smoking
radon gas
occupational exposure

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69
Q

what are the 3 different types of primary lung cancer?

A

small cell
non-small cell
carcinoid tumour

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70
Q

what are some features of small cell lung cancer?

A 
more aggressive 
neuroendocrine tumour
high grade
associated with smoking 
CHEMO
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71
Q

what are some features of non-small cell lung cancer?

A

85% of primary lung carcinomas
squamous cell, adenocarcinoma, large cell
resection + chemo

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72
Q

what are some features of carcinoid tumours?

A

neuroendocrine tumour
malignant potential
surgery

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73
Q

what are 5 manifestations of local lung cancer?

A 
SOB 
persistent cough/new change
haemoptysis 
hoarse voice
pleuritic chest pain
recurrent chest infections
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74
Q

what are 4 systemic manifestations of lung cancer?

A

weight loss
fatigue
bone pain
finger clubbing

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75
Q

what are 4 paraneoplastic syndromes?

A

SIADH
secretion of ACTH, PTH and other hormones
Hypertrophic pulmonary osteoarthropathy
myasthenic syndrome

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76
Q

what are 3 manifestations of hypertrophic pulmonary oseteoarthropathy?

A

digital clubbing
periostitis
painful arthropathy

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77
Q

what are 3 investigations of lung cancer?

A

CXR
CT chest, liver, adrenals
sputum cytology

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78
Q

what is the prognosis for lung cancer?

A

10% at 10 years

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79
Q

how are lung cancers classified?

A

TNM classification

80
Q

what are 2 pleural neoplasms?

A

pleural fibroma - benign

mesothelioma - malignant, usually caused by asbestos

81
Q

what is pertussis?

A

an upper respiratory tract infection (URTI) caused by bordetella pertussis characterised by a severe cough.

82
Q

what is the causative agent for pertussis?

A

bordetella pertussis

83
Q

what are 3 risk factors for pertussis?

A

<6 months
baby born to infected mother
incomplete immunisation

84
Q

how is pertussis transmitted?

A

dropplets

85
Q

what are 5 manifestations of pertussis?

A 
cough 
inspiratory wheeze (stridor)
rhiorrhoea
post-tussive vomiting 
low grade fever
86
Q

what are 3 investigation of pertussis?

A

culture of nasopharyngeal aspirate/ swab from posterior nasopharynx - PCR
serology
FBC

87
Q

what are 3 differentials to pertussis?

A

upper resp tract infection

CA pneumonia

88
Q

what is the management for pertussis?

A

azithromycin/clarithromycin

erythromycin if pregnant

89
Q

what are 3 complications of pertussis?

A

pneumonia
seizure
rib fracture

90
Q

what is pleural effusion?

A

fluid collection between the parietal and visceral pleural surfaces of the thorax

91
Q

what is the most common cause of pleural effusion?

A

heart failure

92
Q

what are 3 risk factors for pleural effusion?

A

pneumonia
malignancy
PE

93
Q

what are 5 manifestations of pleural effusion?

A 
SOB 
dullness to percussion
pleuritic chest pain and rub
cough 
quieter breath sounds
94
Q

what are 3 investigations of pleural effusion?

A

posterior-anterior and lateral CXR - blunt costophrenic angle
pleural ultrasound
microscopy and culture of pleural fluid

95
Q

what are 3 differentials for pleural effusion?

A

pleural thinking
pulmonary collapse
elevated hemidiaphragm

96
Q

what is the treatment for pleural effusion?

A 
loop diuretics - frusemide 
therapeutic throacentesis 
antibiotics if infective
pleurodesis (talc) 
physio
oxygen
97
Q

what is the normal amount of pleural fluid?

A

5-10ml

98
Q

what criteria determines whether something is a transudate or exudate?

A

lights criteria

99
Q

what are 3 complications of pleural effusion?

A

pneumothorax
empyema
trapped lung

100
Q

what are transudates? what causes?

A

pleural fluid protein < 1/2 serum protein

caused by HF, liver failure, kidney failure

101
Q

what are exudates? what causes?

A

pleural fluid protein > 1/2 serum protein

caused by pneumonia, cancer, TB, drugs

102
Q

what is empyema?

A

a bacterial pussy infection of the pleural fluid

103
Q

what is pneumothorax?

A

abnormal accumulation of air in the pleural space

104
Q

what are 4 risk factors for pneumothorax?

A

smoker
FHx
previous pneumothorax

105
Q

what are 5 manifestations of pneumothorax?

A 
chest pain
SOB 
ipsilateral reduced breath sounds
hypoxia 
cardiopulmonary deterioration
106
Q

what are 2 X -ray signs of pneumothorax?

A

tracheal shift

visible rim around lung margin

107
Q

what are 3 differentials for pneumothorax?

A

acute exacerbation of asthma
COPD exacerbation
PE

108
Q

what is the management for pneumothorax?

A

pleural aspiration
high flow O2 and obs
chest drain
may need surgery to find and fix hole - thoracotomy

109
Q

what is the management for a tension pneumothorax?

A

insert large bore cannula into 2nd intercostal space midclavicular line immediately

110
Q

what are 5 signs of a tension pneumothorax?

A 
deviated trachea - away
surgical emphysema 
distended neck veins
hypotension
hyper expansion ipsilaterally 
mediastinal displacement
111
Q

what is the causative agent for TB?

A

mycobacterium tuberculosis

112
Q

what percentage of latent TB progresses to active?

A

10%

113
Q

what are 5 risk factors for TB?

A 
birth in endemic country 
exposure to infection
immunosuppression
Homelessness
IVDU
114
Q

what is the pathophysiology of TB?

A

Inhalation of droplet nuclei => engulfed by alveolar macrophages => Multiplies within alveolar macrophage and burst out causing a response from the immune system => either clearance, latent infection or progression to primary disease

115
Q

what kind of granuloma is formed in TB?

A

caseating

116
Q

what are 7 manifestations of TB?

A 
cough
fever
anorexia/weight loss
malaise
night sweats
pleuritic chest pain 
haemoptosys
117
Q

what are 3 investigations for TB?

A

CXR
3X sputum acid fast bacilli smear
sputum cultures

118
Q

what is the gold standard test for TB?

A

nucleic acid amplification test

119
Q

how can you test for latent TB?

A 
Mantoux test (TB skin test) - also positive with BCG
interferon gamma release assay - more specific
120
Q

what are 3 differentials for TB?

A

COVID-19
CA Pneumonia
lung cancer

121
Q

what is the treatment for TB?

A 
RIPE 
rifampicin
Isoniazid
Pyrazinamide
Ethambutol
122
Q

what are 3 complications of TB?

A

transmission
ARDS
pneumothorax

123
Q

what do you have to do when someone is diagnosed with TB?

A

INFORM PUBLIC HEALTH ENGLAND

ISOLATE PATIENT

124
Q

what are the 5 atypical pneumonia pathogens?

A

Legionella pneumophila - air conditioning, water sources, hyponatraemia, deranged LFTs

Mycoplasma pneumoniae - young adults, autoimmune haemolytic anaemia

Chlamydophila pneumoniae

Chlamydophila psittaci - birds

Coxiella burnetti

125
Q

what antibiotic can be used on S. Pneumonae pneumonia?

A 
beta-lactams - Amoxicillin, cefuroxime (if allergic to penicillins)
or 
Macrolides - Clarithromycin
or 
Fluoroquinolones - Ciprofloxacin
126
Q

what antibiotics are used to treat H. influenza pneumonia?

A

beta-lactams + - Co-Amoxiclav
or
Tetracyclines - doxycycline

127
Q

when is S. Aureus normally a causative agent of pneumonia?

A

HAP
after recent influenza
after being on a ventilator

128
Q

what antibiotics do atypical pneumonia bacterias need?

A 
macrolides - erythromycin/clarithromycin
or 
tetracyclines - doxycycline 
or 
fluroquinalones - ciprofloxacin
129
Q

what antibiotics should be started in the treatment of HA pneumonias?

A 
Piperacillin-tazobactam (or Co-amoxiclav in early onset)
or 
Cefurioxime
possibly 
Vancomycin for MRSA
130
Q

what are the signs of ephasema?

A

pink puffers - breathing with pursed lips
barrel chest
flattened diaphragm

131
Q

what are the signs of chronic bronchitis?

A

wheeze
crackles or rales
cyanosis - blue bloaters

132
Q

what kind of chemo is used in lung cancer?

A

platinum based - cisplatin

133
Q

what is is the name of a focal caseating granuloma in TB shown on X-ray?

A

Ghon complex

134
Q

what kind of hypersensitivity reaction in TB?

A

type 4

135
Q

what are 4 side effects of rifampicin?

A

hepatitis
orange bodily fluids
flu like symptoms
impaired contraceptive pill

136
Q

what are 3 side effects of isoniazid?

A

hepatitis
peripheral neuropathy - pyridoxine prophylaxis
agranulocytosis

137
Q

what are 3 side effects of pyrazinamide?

A

hepatitis
gout
arthralgia and myalgia

138
Q

what are 2 side effects of ethambutol?

A

optic neutritis

renal impairment

139
Q

what is the management for low severity CA pneumonia?

A

amoxicillin
OR
Doxycycline/clarithomycin (atypical suspected)

140
Q

what is the management for moderate severity CA pneumonia?

A

Amoxicillin + clarithomycin

141
Q

what is the management for severe CA pneumonia?

A

IV Co-Amociclav and clarithomycin

142
Q

what is the management for high severity HA pneumonia?

A

broad spectrum antibiotics - ceftriaxone

143
Q

what is the management for low severity HA pneumonia?

A

oral co-amoxiclav

144
Q

what bacteria is associated with pneumonia in CCOPD?

A

Haemophilus influenzae

145
Q

what bacteria is associated with pneumonia as a secondary cause or with access or empyema?

A

s. aureus

146
Q

what fungus can cause pneumonia in those with HIV?

A

pneumocytitis jiroveci

147
Q

what is the most common opportunistic infection in people with HIV?

A

penumocytitis jiroveci

148
Q

what staining identified pneumocytitis jiroveci?

A

silver staining - fungi

149
Q

what is the first line management of pneumocytitis jiroveci?

A

trimethoprim/sulfamethoxazole (co-trimoxazole)

prednisolone
IV pentamidine - in contraindications

150
Q

what is the most common cause of interstitial lung disease?

A

idiopathic pulmonary fibrosis

151
Q

what disease caused X-ray honeycombing of lung tissue?

A

excess collagen in pulmonary fibrosis

152
Q

what anti-fibrotic agents can be used in interstitial lung disease?

A

pirenidone or nintedanib

153
Q

what kind of disease is sarcoidosis?

A

granulomatous (non-caeseating)

154
Q

what are 8 manifestations of sarcoidosis?

A 
cough
SOB
erythema nodosum (lumps on shins)
polyarthralgia
uveitis
constitutional symptoms
cervical and submandibular lymphadenoathy
lupus pernio
155
Q

what electrolyte imbalance does sarcoidosis cause?

A

hypercalcaemia

156
Q

what is the gold standard investigation for sarcoidosis?

A

tissue biopsy

157
Q

what enzyme is elevated in sarcoidosis?

A

ACE - all granulomatous disease

158
Q

what are 3 differentials for sarcoidosis?

A

TB
Lymphoma
HIV

159
Q

what is the 1st line treatment for sarcoidosis?

A

corticosteroids - inhaled budesonide or oral prescidolone

2 - immunosuppressants

160
Q

what proportion of the caucasian population is a carrier for CF?

A

1 in 25

161
Q

what is normal pulmonary artery pressure?

A

25 mmHg

162
Q

what are 6 manifestations of pulmonary hypertension?

A 
SOB and oedema
fatigue
chest pain 
syncope
tachycardia
raised JVP
163
Q

what ECG changes does R heart strain cause?

A

R ventricular hypertrophy - R waves on chest leads V1-3 and S waves on V4-6

right axis deviation
RBBB

164
Q

what is the treatment for primary pulmonary hypertension?

A

IV prostanoids
endothelia receptor antagonist
posphodiesterase-5 inhibiter - sildenafil

165
Q

what type of sensitivity reaction is hypersensitivity pneumonitis?

A

type III/IV

166
Q

what’s goodpasture syndrome?

A

an anti-basement membrane autoimmune disease causing a type II hypersensitivity reaction that affects the lungs and kidneys

167
Q

what are 3 risk factors of good pastures?

A

HLA-DR15
Infection
smoking

168
Q

what are 3 differentials for good pastures?

A

wegener’s granulomatosis
SLE
microscopic polyangitis

169
Q

what is the management of good pastures?

A

immunosuppressants - corticosteroids, cyclophosphamide
plasmapheresis
dialysis
ventilation

170
Q

what is c-ANCA a marker for?

A

Wegener’s granulomatosis

171
Q

what is Wegener’s granulomatosis?

A

A multi-system disorder of unknown causes characterised by necrotising granulomatous inflammation and vasculitis of small vessels.
affects resp tract and kidneys and is treated with steroids and immunosuppression

172
Q

what is otitis media?

A

the presence of inflammation in the middle ear, associated with an effusion and accompanied by the rapid onset of symptoms and signs of an ear infection

173
Q

what are 5 manifestations of sinusitis?

A 
rhinorrhoea
facial pain
headache
fever
voice  change
174
Q

what is the 1st line antibiotic for bacterial sinusitis?

A

penicillin V

175
Q

what is epiglottis classically caused by?

A

HiB infection

176
Q

what kind of bacteria is HiB?

A

gram-negative coccobacillus

177
Q

what are 7 manifestations of epiglottitis?

A 
stridor - high pitched exhale wheeze
muffled voice 
fever
sore throat 
dysphagia 
tripod position
178
Q

what antibiotics are generally given in epiglottitis?

A

ceftriaxone

179
Q

what is the most common cause of croup?

A

parainfluenza virus

180
Q

what is the croup cough described as?

A

barking

181
Q

what does pulmonary hypertension look like on CXR?

A

Enlargement of the pulmonary arteries
Lucent lung fields
Enlarged right atrium
Elevated cardiac apex due to right ventricular hypertrophy

182
Q

what is the most common non-small cell lung cancer?

A

adenocarcinoma

183
Q

what are 4 features of bronchiectasis?

A

persistent cough
dyspnoea
recurrent pulmonary infections
clubbing

184
Q

what kind of lung tumour can cause Horners syndrome?

A

pancoast tumour

185
Q

what does a pancoast tumour press on to cause Horner’s syndrome?

A

the sympathetic chain

186
Q

name an ICS?

A

budesonide

187
Q

what is the most common lung cancer in smokers?

A

squamous cell carcinoma

188
Q

what causes bronchiectasis?

A

FREQUENT INFECTIONS!!

189
Q

what are 4 complications of bronchiectasis?

A

pneumothorax
empyema
lung abscess
life threatening haemoptysis

190
Q

what is the treatment for HiB pneumonia?

A

Co-amoxiclav +

doxycycline

191
Q

what is the most common demographic for sarcoidosis?

A

black females

192
Q

what is the treatment for a CURB65 score 1 or less?

A

oral amoxicillin

non-admission

193
Q

what is the treatment for CURB65 score of 2?

A

oral co-amoxiclav + clarithromycin

possible hospital

194
Q

what is the treatment for CURB65 score of 3+?

A

IV co-amoxiclav + clarithromycin

3 - hospital mebs ICU
4+ - ICU

195
Q

what is the name of a leukotriene receptor antagonist?

A

Montelukast

196
Q

what are 6 features of well controlled asthma?

A 
no night time symptoms
inhaler used < 3X a week
no breathing difficulties most days
exercise without symptoms 
normal lung function test

Phase 4 (19 decks)

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