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Year 2 Med > 2.02 - Lungs > Flashcards

2.02 - Lungs Flashcards

(70 cards)

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1
Q

Define haemoptysis

A

coughing up blood originating from respiratory tract below the level of the larynx

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2
Q

what two symptoms may be mistaken for haemoptysis

A

haematemesis - bloody vomit
pseudo-haemoptysis - cough reflex stimulated by blood not originating in the lungs or bronchi

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3
Q

what can cause haemoptysis

A

carcinomas
bronchitis
bronchiectasis
airway trauma
foreign body
pneumonia
tuberculosis
aortic aneurysm
PE

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4
Q

what symptoms are present in bronchitis alongside haemoptysis

A

abrupt onset cough
fever

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5
Q

what symptoms of bronchiectasis are present alongside haemoptysis

A

chronic productive cough

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6
Q

what symptoms alongside haemoptysis are present in TB / Pneumonia

A

fever
night sweats
weight loss

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7
Q

what symptoms alongside haemoptysis are present in bronchiogenic carcinoma

A

anorexia

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8
Q

what symptoms alongside haemoptysis may be seen in congestive heart failure

A

dyspnoea
fatigue
orthopnoea
frothy pink sputum

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9
Q

what signs may be found on observations of a patient with haemoptysis

A

fever
tachypnoea
weight loss
hypoxia

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10
Q

what signs may be found on general inspection of a patient with haemoptysis

A

cyanosis
pallor
muscle wasting (cachexia)
small red marks on skin due to dilation of small vessels (telangectasia)

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11
Q

what signs may be found in respiratory examination of a patient with haemoptysis

A

signs of LVF
diastolic murmur
tachypnoea
tachycardia
pleural rub
clubbing

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12
Q

define dyspnoea

A

uncomfortable, rapid, or difficult breathing
feeling of chest tightness
pain when breathing
body needs more oxygen than it is getting

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13
Q

what does each number of the breathlessness score mean (1-6)

A
  1. no breathlessness
  2. breathless on vigorous exertion
  3. breathless when walking up slopes
  4. breathless walking on flat ground, needing occasional breaks
  5. needing frequent breaks walking on flat
  6. unable to leave the house
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14
Q

what symptom accompanies dyspnoea in asthma or viral infection

A

wheeze

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15
Q

what symptoms may accompany dyspnoea in pneumonia

A

fever
green sputum
haemoptysis

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16
Q

what symptoms may accompany dyspnoea in COPD

A

chronic cough
dyspnoea is also chronic

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17
Q

what would be a likely diagnosis of a patient presenting with dyspnoea and ankle swelling

A

heart failure

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18
Q

what would be the likely diagnosis of a patient presenting with dyspnoea with a history of unilateral leg swelling

A

pulmonary embolism

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19
Q

what other symptom is likely to present with dyspnoea in anaemia

A

fatigue

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20
Q

list the commonly used lung function tests

A

sputum examination
peak flow
pulse oximetry
arterial / venous blood gas
spirometry

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21
Q

list positive results of sputum examination and what they are signs of

A

clear and colourless = bronchitis
yellow/green/brown = pulmonary infection
red = haemoptysis
black = smoke / coal dust
frothy white = pulmonary oedema

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22
Q

what is peak flow

A

measures FEV1 using a peak flow metre
estimates airway calibre in suspected asthma
effort dependent

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23
Q

what is the normal pulse oximetry range for healthy patients

A

94-98%

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24
Q

what is the normal pulse oximetry range in patients with COPD

A

88-92%

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25
what is measured in ABG
pH, pO2, pCO2, HCO3
26
what is measured in spirometry
FVC and FEV1 FVC:FEV1 ratio gives an estimate of airflow obstruction severity
27
what spirometry result shows obstructive lung defect
reduced FEV1
28
what is the appearance of the spirometry graph in obstructive lung disease in comparison to normal
flatter
29
what spirometry result is expected in restrictive lung disease
FEV1:FVC ratio normal / high both are significantly reduced
30
what is the appearance of the spirometry graph in restrictive disease compared to normal
same shape but shorter
31
what is the difference between obstructive and restrictive lung diseases
obstructive - difficult getting air in and out of lungs due to obstruction restrictive - difficulty fully expanding lungs
32
define COPD
chronic obstructive pulmonary disease progressive airway obstruction irreversible results in chronic bronchitis and emphysema
33
what is chronic bronchitis
chronic productive cough for at least 3 months over 2 consecutive years
34
what is emphysema
abnormal enlargement of alveoli resulting in loss of surface area for gas exchange
35
what are the causes of COPD
90% - smoking 10% - alpha 1 antitrypsin deficiency (genetic) pts with alpha1 antirtrypsin def. have significantly increased risk if they smoke
36
what is the pathophysiology of chronic bronchitis in COPD
chronic inflammation of airways leads to CD8 T cell and macrophage infiltration leads to narrowing of airways and hyper secretion of mucus
37
what is the pathophysiology of emphysema in COPD
chronic inflammation leads to increased elastase production elastase destroys elastin, causing dilation of alveoli reduces surface area for gas exchange
38
what is the pathophysiology of cor pulmonale
right ventricular impairment secondary to pulmonary disease most commonly caused by COPD chronic hypoxia -> vasoconstriction of pulmonary arteries -> pulmonary HTN -> right heart failure
39
what are the symptoms of COPD
chronic productive cough SOB winter bronchitis wheeze
40
what signs are seen in COPD
SOB, pursed lip breathing, tripodding, accessory muscle use wheeze crackles downward displacement of liver
41
what are the red flag symptoms in lung disease (cancer)
weight loss haemoptysis anorexia chest pain lymphadenopathy finger clubbing fatigue
42
what are the levels of severity for COPD (4)
1 - Mild: FEV1 >80% of predicted 2 - Moderate: FEV1 50-79% of predicted 3 - Severe: FEV1 30-49% of predicted 4 - Life-Threatening: <30% of predicted
43
what is the conservative treatment of COPD
stop smoking - prevent it from worsening pneumococcal vax annual flu vax pulmonary rehab
44
what is the first line medical management for COPD
SABA / SAMA inhaler if inhaled treatment needed to relieve breathlessness inhaler education necessary
45
what is the second line medical management of COPD for a patient with a history of steroid responsiveness or asthma
LABA + ICA
46
what is the second line medical management of COPD for a patient with NO history of steroid responsiveness or asthma
LABA + LAMA
47
what is the third line medical management of COPD
LABA + LAMA + ICS combined inhaler (trimbow)
48
What is the management of acute COPD exacerbation
Oxygen (keep sats 88-92%) Bronchodilator nebuliser (salbutamol) Corticosteroids (30mg oral prednisolone) Antibiotics
49
what are the complications of COPD
respiratory failure pneumonia pneumothorax polycythaemia anaemia depression :(
50
define asthma
common chronic inflammatory disorder or the airways, leading to variable airway obstruction usually presents in childhood
51
what other conditions are asthmatic patients likely to have
atopic conditions - eczema, hay fever, food allergies also fhx of these
52
what is atopy
genetic predisposition to IgE mediated allergen sensitivity atopic asthma atopic dermatitis (eczema) atopic rhinitis (hay fever)
53
what is the hygiene hypothesis
increased autoimmune / allergic disease in developed countries reduced exposure to infectious pathogens at young age may predispose to autoimmune disease
54
what a are the 4 main causes of asthma
atopy occupational exercise aspirin
55
what are the symptoms of asthma
cough, worse at night dyspnoea chest tightness poor sleep
56
what are the signs of asthma
expiratory wheeze prolonged expiration tachypnoea harrison's sulcus
57
what is harrison's sulcus
groove on inferior border of rib cage seen in children with severe asthma
58
what are the signs of acute asthma attack
worsening of normal symptoms reduced peak flow signs of respiratory failure
59
what symptoms are present in moderate, severe, and life threatening asthma attacks
moderate: increase of normal symptoms severe: cant complete sentences life threatening: silent chest, cyanosis, confusion
60
what vital signs indicate severe asthma attack
HR > 110 RR > 25
61
what vital sign indicates life threatening asthma attack
<92% oxygen saturation
62
what % of expected PEF is seen in each level of asthma attack
moderate: 50-70% severe: 33-50% life threatening: <33%
63
what tests are done to diagnose asthma
spirometry bronchodilator reversibility testing FENO peak flow variability - diary direct bronchial challenge testing
64
what is the first line management for asthma
salbutamol inhaler PRN
65
when should treatment step up be considered for asthma
using salbutamol inhaler >3 times per week
66
what is the second line medical management for asthma
SABA + ICS
67
what is the third line medical management for asthma
SABA + LAMA + ICS
68
what is done if an asthmatic patient is taking SABA + LABA + ICS and their symptoms are not improving
increase ICS dose refer for specialist review
69
what is the first line treatment for acute asthma attack
salbutamol + ipratropium nebuliser oxygen oral steroids
70
what is the second line treatment for acute asthma attack
IV magnesium sulphate

Year 2 Med (10 decks)

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