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4MB Medicine (My version) > Respiratory > Flashcards

Respiratory Flashcards

1
Q

List some precipitants of asthma

A 
Cold
Exercise
Emotion, stress
Allergens (house dust, fur, occupational)
Infection
Smoking
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2
Q

Which class of blood pressure drug can exacerbate/worsen asthma?

A

B-blocker

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3
Q

List some symptoms and signs of asthma

A 
Dyspnoea
Dry cough, typically worse at night
Wheeze
Chest tightness
Hyperinflated/hyperresonant chest
Reduced air entry
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4
Q

What are the clinical features of an acute severe asthma attack?

A

Unable to complete sentences
Pulse over 100 bpm
Resp rate over 25 breaths/min
PEFR under 50% of predicted

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5
Q

What are the clinical features of an acute life-threatening asthma attack?

A

Silent chest
Bradycardia
Confusion
PEFR under 33$ of predicted

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6
Q

How is asthma diagnosed using PEFR?

A

PEFR monitoring shows diurnal variation of greater than 20% on 3 or more days of the week for 2 weeks

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7
Q

How is asthma diagnosed on spirometry?

A

Obstructive pattern of spirometry with more than 15% reversibility with a bronchodilator

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8
Q

What investigations would you arrange during an acute asthma attack?

A

PEFR
Sputum culture
FBC, U+E, CRP, ABG
CXR

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9
Q

What lifestyle advice could you give to an asthmatic?

A

Stop smoking
Avoid allergens/wear protection at work
Write a trigger diary

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10
Q

What is the 1st step in therapy for asthma?

A

Inhaled SABA (salbutamol) PRN

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11
Q

When do you move to step 2 therapy in asthma?

A

If using bronchodilator excessively or having night symptoms

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12
Q

What is the 2nd step in therapy for asthma?

A

SABA

Add regular inhaled steroid (beclometasone)

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13
Q

What is the 3rd step in therapy for asthma?

A

SABA
Inhaled steroid
Increase dose of inhaled steroid or add in LABA (salmeterol)

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14
Q

What is the 4th step in therapy for asthma?

A

SABA
Inhaled steroid
Stop LABA if no effect/improvement and add theophylline/montelukast

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15
Q

What is the 5th step in therapy for asthma?

A

SABA
Inhaled steroid
4th line drug
Oral prednisolone

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16
Q

Outline treatment for acute asthma

A 
Sit up
Give high flow O2
Nebulised salbutamol + ipratropium
IV hydrocortisone/oral prednisolone
Get an anaesthetist; oral theophylline/IV magnesium sulphate
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17
Q

What is the clinical definition of bronchitis?

A

Cough with sputum production on most days for 3 months in a 2 year period

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18
Q

List some symptoms and signs of COPD

A

Productive cough
Wheeze
Dyspnoea
Infective exacerbations

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19
Q

Describe a “pink puffer”

A

Breathless
Not cyanosed
Cachectic

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20
Q

What is meant by hypoxic drive in a patient with COPD?

A

Respiratory centres are insensitive to CO2 (because it has remained very high for a long period), so they rely on low O2 to maintain respiratory effort
Therefore giving them too much O2 would be detrimental to their breathing

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21
Q

How would you differentiate COPD from asthma on investigation?

A

Typically little/no bronchodilator reversibility in COPD

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22
Q

Which genetic condition predisposes to emphysema?

A

Alpha-1-antitrypsin deficiency

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23
Q

What is the 1st step in therapy for COPD?

A

Inhaled SABA (salbutamol)/inhaled SAMA (ipratropium) PRN

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24
Q

What is the 2nd step in therapy for COPD?

A

Regular inhaled ipratropium/tiotropium
OR
Regular inhaled salmeterol-beclometasone combo inhaler

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25
Q

What is the 3rd step in therapy for COPD?

A

Inhaled salmeterol
Inhaled beclometasone
Inhaled ipratropium/tiotropium
Refer to specialist

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26
Q

When would a COPD patient be put on long-term O2 therapy?

A

If PaO2 less than 7.4 kPa

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27
Q

Outline treatment of acute exacerbation of COPD

A 
24-28% O2
Nebulised salbutamol + ipratropium
IV hydrocortisone
Oral prednisolone
Antibiotic if infection
Consider theophylline and/or ventilation
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28
Q

What is pneumonia?

A

An acute lower respiratory tract infection that causes inflammation of the lungs

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29
Q

Which organisms typically cause community acquired pneumonia (CAP)?

A 
Strep pneumoniae
H influenzae
Mycoplasma
Staph aureus
Legionella
Moraxella, Chlamydia, Coxiella, gram -ve (atypical)
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30
Q

Which organisms typically cause hospital acquired pneumonia (HAP)?

A

Staph aureus
Enterobacter
Pseudomonas
Klebsiella

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31
Q

List some causes of aspiration pneumonia

A

Stroke
Myasthenia gravis
Bulba palsy
Oesophageal disease

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32
Q

Which organism can cause pneumonia in immunocompromised people?

A

Pneumocystis jirovecii

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33
Q

List some symptoms and signs of pneumonia

A 
Fever
Rigors
Malaise
Anorexia
Dyspnoea
Cough with purulent sputum
Pleuritic chest pain
Cyanosis
Confusion
Chest consolidation - reduced percussion, reduced expansion, crackles
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34
Q

What specific investigation is done for Legionella pneumonia?

A

Urinary antigen

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35
Q

Define the CURB65 score for CAP

A 
Confusion
Urea over 7
Resp rate over 30
BP under 90/60
Age 65 or over
Score of 3 = severe
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36
Q

What supportive treatment is advised for pneumonia?

A

IV fluids
O2
Analgesia

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37
Q

Which antibiotics are used for mild-moderate CAP?

A

Amoxicillin PO
Doxycycline PO if penicillin allergy
IV clarithromycin if NBM

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38
Q

Which antibiotics are used for severe CAP?

A

IV co-amoxiclav + PO doxycycline
IV levofloxacin if penicillin allergy
IV clarithromycin if NBM

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39
Q

Which antibiotic should be added if Legionella is suspected?

A

Rifampicin

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40
Q

Which antibiotic should be added if pneumocystis is suspected?

A

Co-trimoxazole

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41
Q

Which antibiotics are used for HAP?

A

Amoxicillin
Metronidazole
+/- gentamicin if severe

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42
Q

Which strain of H influenzae causes pandemics and which causes endemics?

A

A - pandemics

B - endemics

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43
Q

What investigations are done for influenza?

A

Nasopharyngeal swab PCR/culture

Serology

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44
Q

What is the treatment for influenza?

A

Bed rest, fluids, paracetamol

Oseltamivir (Tamiflu)

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45
Q

What is bronchiectasis?

A

Chronic dilation of airways due to longstanding infection or chronic disease

46
Q

Which conditions predispose/cause bronchiectasis?

A

Cystic fibrosis
Ciliary dyskinesia
Kartagener’s syndrome
Post-infection (measles, mumps, HIV, pneumonia, pertussis)

47
Q

Which organisms are associated with bronchiectasis?

A

H influenzae
Strep pneumoniae
Staph aureus
Pseudomonas

48
Q

List some symptoms and signs of bronchiectasis

A 
Persistent cough
Purulent sputum
Halitosis
Clubbing
Wheeze
Coarse inspiratory crepitations
49
Q

Outline treatment options for bronchiectasis

A

Postural drainage, chest physiotherapy
Antibiotics if infection
Bronchodilators, steroid
Surgery if localised

50
Q

What inheritance pattern does cystic fibrosis follow? What is the genetic defect?

A

Autosomal recessive

Mutation in CFTR gene on c7, leading to defective Cl- secretion and increased Na absorption in airways

51
Q

List some symptoms and signs of cystic fibrosis

A 
Failure to thrive, meconium ileus in infants
Cough
Wheeze
Recurrent infections
Bronchiectasis
GI upset (steatorrhoea)
Male infertility
Arthritis
Nasal polyps
Clubbing
52
Q

What investigations are done for cystic fibrosis?

A

Sweat test
Genetic screen
Faecal elastase

53
Q

Outline treatment options for cystic fibrosis

A

Symptom relief
Chest physiotherapy
Antibiotic if infection

54
Q

What happens in obstructive sleep apnoea?

A

Intermittent closure/collapse of pharyngeal airway during sleep

55
Q

List some causes of obstructive sleep apnoea

A

Obesity
Narrow anatomy
COPD
Resp depressants (opioids)

56
Q

List some symptoms and signs of obstructive sleep apnoea

A 
Loud snoring
Daytime somnolence
Poor sleep, unrefreshed feeling
Morning headache
Low libido
Decreased cognitive performance
Large neck and tongue, small mandible
57
Q

What investigations can be done for sleep apnoea?

A

Pulse oximetry
Video recording/sleep studies/polysomnography
Epworth sleepiness scale

58
Q

What is the clinical definition/diagnosis of obstructive sleep apnoea?

A

15 or more episodes of apnoea during 1 hour of sleep

59
Q

Outline treatment options for obstructive sleep apnoea

A 
Weight loss
Avoid tobacco and caffeine
CPAP via nasal mask during sleep
Modafinil
Surgery to relieve pharyngeal obstruction
60
Q

List some causes of acute respiratory distress syndrome

A 
Pneumonia
Aspiration
Vasculitis
Trauma
Sepsis
Haemorrhage
Obstetric events
Drugs (aspirin, heroin, paraquat)
61
Q

List some symptoms and signs of acute respiratory distress syndrome

A

Cyanosis
Dyspnoea
Fine inspiratory crackles
Peripherally warm

62
Q

What 4 features indicate severe ARDS?

A

Acute onset
CXR findings (infiltrates)
Pulmonary capillary wedge pressure under 19
Refractory hypoxaemia

63
Q

Outline treatment of ARDS

A

Treat cause
Resp support - CPAP, ventilate, inhaled NO
Diuretics
Aerolised surfactant

64
Q

Define type 1 respiratory failure

A

V/Q mismatch

Hypoxia (PaO2 under 8) with normal or low PaCO2

65
Q

List some causes of type 1 respiratory failure

A 
Pneumonia
Pulmonary oedema
PE
Asthma
Emphysema
ARDS
66
Q

List some symptoms and signs of type 1 respiratory failure

A

Signs of hypoxia: cyanosis, dyspnoea, confusion, agitation

67
Q

Outline treatment of type 1 respiratory failure

A

Treat cause
15L O2 non-rebreather
Assisted ventilation if required

68
Q

Define type 2 respiratory failure

A

Alveolar hypoventilation

Hypoxia with hypercapnia (PaCO2 over 6)

69
Q

List some causes of type 2 respiratory failure

A 
Asthma
COPD
Pulmonary fibrosis
Obstructive sleep apnoea
Reduced resp drive (opioids)
Chest wall abnormality
70
Q

What investigations are done in respiratory failure?

A

FBC, U+E, CRP, ABG
CXR
Microbiology if afebrile

71
Q

Outline treatment of type 2 respiratory failure

A

O2 24%
Keep reassessing ABG’s
Resp stimulant
NIPPV

72
Q

What is the maximum amount of O2 delivered by a nasal cannula?

A

1-4 L / min

O2 24-40%

73
Q

What is the maximum amount of O2 delivered by a Venturi mask

A 
Blue: 24%
White: 8%
Yellow: 5%
Red: 40%
Green: 60%
74
Q

What is the maximum amount of O2 delivered by a non-rebreather mask?

A

10-15 L / min

O2 60-90%

75
Q

What is Virchow’s triad with regards to thrombus formation?

A

Hypercoaguability of blood
Vessel damage
Abnormal flow of blood

76
Q

List some causes of pulmonary embolism

A 
Pregnancy
Immobility
Obesity
Post-surgery
Fracture
Malignancy
Contraception
77
Q

List some symptoms and signs of pulmonary embolism

A 
Sudden dyspnoea
Pleuritic pain
Haemoptysis
Pleural rub
Hypotension
Cyanosis
Raised JVP
78
Q

What investigations are done for suspected pulmonary embolism?

A

D-dimers (exclusive of PE but not specific)
CTPA is gold-standard; V/Q if unable
ECG

79
Q

Outline treatment of pulmonary embolism

A

LMW heparin
Oxygen
Commence warfarin
Thrombolyse if massive PE (alteplase)

80
Q

How does cor pulmonale arise?

A

Emphysema leads to hypoxia which causes vasoconstriction and right heart failure

81
Q

List some symptoms and signs of cor pulmonale

A 
Dyspnoea
Fatigue
Syncope
Cyanosis
Raised JVP
Tricuspid regurgitation
82
Q

Outline treatment of cor pulmonale

A

Encourage exercise and treat causes
Oxygen therapy
Diuretic (furosemide)
Vaccinate against pneumococcus and influenza

83
Q

What’s the difference between a transudative and exudative pleural effusion?

A

Transudate: protein content less than 25 g/L
Exudate: protein content more than 35 g/L

84
Q

List some causes of a transudate pleural effusion

A 
Heart failure
Cirrhosis
Nephrotic syndrome
Malabsorptive diseases
Hypothyroidism
Meig's syndrome
85
Q

List some causes of an exudate pleural effusion

A 
Infection
Inflammation
Cancer
Pancreatitis
MI
86
Q

List some symptoms and signs of pleural effusion

A 
Dyspnoea
Pleuritic pain
Reduced chest expansion
Stony dull percussion
Reduced breath sounds
Tracheal deviation
Clubbing
Lymphadenopathy
87
Q

How is pleural effusion investigated?

A

Palpate/CXR small effusions
USS guides diagnosis and therapeutic aspiration
Pleural aspirate cytochemistry

88
Q

Where is the landmark for pleural effuson drainage?

A

Thoracocentesis 5th intercostal space, mid-clavicular line

89
Q

List causes of pneumothorax

A 
Spontaneous (young, thin male)
Asthma
COPD
Trauma
Infection
CTD's (Marfan's, EDS)
Iatrogenic
90
Q

List some symptoms and signs of pneumothorax

A

Sudden pleuritic pain
Dyspnoea
Collapse
Reduced chest expansion and breath sounds
Hyperresonant percusion
Tracheal deviation (tension pneumothorax)

91
Q

Where are the landmarks for treating pneumothorax?

A

Needle aspirate 2nd intercostal space mid-clavicular line

Chest drain 5th intercostal space mid-axillary line

92
Q

What is the treatment for recurrent pneumothorax?

A

Pleurodesis

93
Q

What is sarcoidosis?

A

Multi-system non-caseating granulomatous type IV hypersensitivity
lol

94
Q

List some symptoms and signs of sarcoidosis

A 
Erythema nodosum
Polyarthralgia
Fatigue
Weight loss
Uveitis
Lymphadenopathy
Dyspnoea
95
Q

What is the classic appearance of sarcoidosis on CXR?

A

Bilateral hilar lymphadenopathy

96
Q

Describe some typical blood results in sarcoidosis

A

Raised serum ACE, ESR, Ca

Deranged LFT’s

97
Q

Outline treatment of sarcoidosis

A

Bed rest, NSAID
Steroid if symptomatic/organ involvement
IV steroid/immunosuppression if severe

98
Q

What is extrinsic allergic alveolitis?

A

Inhalation of foreign antigen causes widespread hypersensitivity reaction with alveolar infiltration and inflammation

99
Q

List symptoms and signs of extrinsic allergic alveolitis

A 
4-6h post-exposure
Fever
Rigors
Myalgia
Dry cough
Weight loss
Type 1 resp failure
Dyspnoea
Coarse end inspiratory crackles
100
Q

Describe CXR signs of extrinsic allergic alveolitis

A

Upper zone mottling, consolidation
Hilar lymphadenopathy
Honeycomb lung

101
Q

Outline treatment of extrinsic allergic alveolitis

A

Allergen avoidance
Oxygen therapy
Oral prednisolone

102
Q

What is the most common cause of interstitial lung disease?

A

Idiopathic pulmonary fibrosis

103
Q

List aetiology/risk factors for lung cancer

A

Smoking
Asbestos exposure
Radiation

104
Q

List clinical features of lung cancer

A 
Cough
Haemoptysis
Dyspnoea
Chest pain
Weight loss, anorexia
Cachexia
Anaemia
Clubbing
Wrist pain (HPOA)
Lymphadenopathy
105
Q

List some complications of lung cancer mets

A 
Bony tenderness
Hepatomegaly
Confusion, fits, focal CNS signs
Recurrent laryngeal nerve palsy (hoarseness)
Horner's syndrome (Pancoast tumour)
106
Q

What investigations would you do for lung cancer?

A 
CXR
CT
Bronchoscopy + biopsy
PET scan
Sputum + pleural fluid cytology
107
Q

Which classification of lung cancer is most common?

A

Non-small cell lung cancer

In this group, squamous cell carcinoma is the most common

108
Q

What endocrine hormones are secreted by small cell lung cancer?

A

ACTH

ADH

109
Q

What endocrine hormones are secreted by non-small cell lung cancer?

A

Squamous: secretes PTH, TSH

110
Q

Outline management of lung cancer

A

Chemotherapy or palliative radiotherapy for small cell
Surgery for small cell if T1-2 N0 M0
Surgery/curative radiotherapy for non-small-cell if stage I-II
Palliative radiotherapy +/- chemotherapy

111
Q

When would surgery for lung cancer be contraindicated?

A 
Tumour near hilum
FEV1 less than 1.5L
Metastasis
Stage III/IV disease
Vocal cord paralysis
SVC obstruction
112
Q

Which asbestos is more harmful - blue (crocidolite) or white (chrysotile)?

A

Blue asbestos is more fibrogenic and harmfuil

4MB Medicine (My version) (19 decks)

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