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Conditions Flashcards

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1
Q

Asthma

A

= recurrent episodes of dyspnoea, cough and wheeze caused by reversible airway obstruction
Clinical: tachypnoea, audible wheeze, hyperinflated chest, diminished air entry
Ix: PEF, spirometry (normal bloods)

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2
Q

Signs of Severe Asthma Attack

A

Unable to complete sentances, RR > 25/min

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3
Q

Managment of Chronic Asthma

A
  1. SABA
  2. SABA and ICS
  3. SABA and ICS and LABA
  4. If LABA ineffective swap for leukotriene receptor/oral theophylline: if LABA helping, increase dose
  5. Oral Prednisalone
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4
Q

Management of Acute Asthma Attack

A 
Oxygen (100% non-rebreather mask)
Nebulised Salbutamol
IV Hydrocortisone OR PO Prednisalone
Ipratropium Bromide
Theophylline
Mag Sulphate (anaesthetist)
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5
Q

COPD

A

= combined effect of chronic bronchitis and emphysema > characterised by airway obstruction with little or no reversibility
Clinical: chronic dyspnoea, sputum production, wheeze
Ix: pulmonary function tests, show obstructive pattern
Complications: acute exacerbations, infection, respiratory failure, pneumothorax

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6
Q

Management of Chronic COPD

A
  1. SAMA
  2. LAMA
  3. LAMA and ICS
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7
Q

Management of Acute COPD

A
  1. 2-28% oxygen
  2. High dose salbutamol and ipratropium (nebulized)
  3. Oral Prednisalone
  4. Amoxicillin
  5. Doxapram
    May need intubation
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8
Q

Pathology of Bronchiectasis

A

= chronic infection of the bronchi and bronchioles which leads to localised reversible dilation of the bronchial tree
- The dilated, inflammed bronchi are easily collapsible

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9
Q

Bronchiectasis

A

Agents: H. influenzae, Strep. pneumoniae, Staph. aureus
Causes: CF, measles, pertussis, bronchiolitis, pneumonia, TB, bronchial obstruction
Clinical: persistent cough, purulent sputum, wheeze, crackles, haemoptysis
Ix: sputum culture, CXR, high resolution CT, spirometry (obstructive pattern)
Management: postural drainage, antibiotics
- Bronchodilators may be useful in COPD and asthma patients

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10
Q

Cystic Fibrosis

A

= autosomal recessive condition: mutations in the CFTR gene on chromosome
Clinical: failure to thrive
Resp (cough, wheeze, recurrent infections, bronchiectasis, haemoptysis, pneumothorax)
GI (pancreatic insufficiency, gallstones, cirrhosis)
Ix: genetic testing
Managment: regular physiotherapy, prophylactic antibiotics, enzyme replacement

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11
Q

Pulmonary Embolism

A

= usually as a result of venous thrombus, clots break off and pass through the veins, R side of heart and into pulmonary circulation
Rarer causes: air, fat or amniotic fluid embolism
RF: recent surgery, thrombophilia, fracture, malignancy, previous PE

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12
Q

Clinical Signs and Ix of PE

A

Clinical: acute breathlessness, pleuritic chest pain, haemoptysis, cyanosis, tachypnoea, pleural rub, hypotension
- Features depend on size/vessel blocked
Ix: Bloods, D-Dimer, ABG, V/Q scan, CT pulmonary angiogram?

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13
Q

Management of PE

A 
Hypoxic = give oxygen
Pain = morphine (may need anti-emetic)
Critical - immediate thrombolysis (tPa)
Not Critical - heparin
- LMW heparin 
- Unfractioned heparin
Low Systolic = rapid colloid infusion, dobutamine, (if not given) thrombolysis
Good Systolic = start warfarin regimen, confirm diagnosis
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14
Q

Type I Respiratory Failure

A

Hypoxia with a normal PaCO2 - usually the result of a V/Q mismatch
Causes: pneumonia, PE, asthma, emphysema
Clinical: dyspnoea, restlessness, confusion, central cyanosis
Ix: Bloods, ABG, CXR, blood cultures
Managment: treat underlying cause, high flow oxygen - may need assisted ventilation

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15
Q

Type II Respiratory Failure

A

Hypoxia with hypercapnia, caused by alveolar hyperventilation
Causes: COPD, asthma, pneumonia, reduced respiratory drive
Clincal: dyspnoea, confusion, headache, tachycardia, coma
Ix: Bloods, ABG, CXR, blood cultures
Management: treat underlying cause, give oxygen with care (e.g. COPD)

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16
Q

Acute Respiratory Distress Syndrome

A

= lung damage and release of inflammatory mediators causes increased capillary permeability and pulmonary oedema - often accompanied by multi-organ failure
Cause:
Pulmonary (pneumonia, inhalation, injury, aspiration)
Other (shock, sepsis, haemorrhage, ALF, trauma, eclampsia)
Clinical: cyanosis, tachypnoea, tachycardia, bilateral fine crackles
Ix: Bloods (inc FBC and amylase), cultures, ABG, CXR
Management: ICU, supportive therapy ( treat underlying cause)

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17
Q

Management of ARDS

A

Early: continuous positive pressure ventilator with 40-60% oxygen > most need mechanical ventilation
- Diuretics (-VE fluid balance)

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18
Q

Indication for Ventilation

A

PaO2 < 8.3 kPa AND/OR PaCO2 > 6kpa

This is DESPITE 60% oxygen

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19
Q

Sarcoidosis

A

= multisystem granulomatous disease - it is a Type IV hypersensitivity reaction which causes pulmonary fibrosis
- Involves lymph nodes, joints, liver, skin
Clinical: asymptomatic
ACUTE - erythema nodosum which resolves itself
Pulmonary - bilateral hilar lympahdenopathy, infiltrates, dry cough, dyspnoea, chest pain
Ix: CXR, spirometry (restrictive)
Can have raised calcium and LFTs
Management: bed rest, NSAIDs - use of corticosteroids in interstitial lung disease

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20
Q

Interstitial Lung Disease

A

= collective term for conditions which affect the lung interstitium/parachyma in a diffuse manner
- Characterised by chronic inflammation, progressive fibrosis
Clinical: SOB on exertion, non-productive paroxysmal cough, abnormal breath sounds, abnormal CXR, high resolution CT

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21
Q

Classification of ILD

A
  1. Those with known cause
  2. Those with associated systemic disorders
  3. Idiopathic
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22
Q

Extrinsic Allergic Alveolitis or Hypersensitivity Pneumonitis

A

= type III hypersensitivity reaction to inhalation of allergens
ACUTE - alveoli are infiltrated with acute inflammatory cells
CHRONIC - granulomas form > obliterative bronchiolitis
Clinical: cough, breathlessness, fever, crackles, wheeze
- Chronically may have weight loss, increasing dyspnoea
Ix: CXR (upper zone mottling/consolidation), bloods, restrictive changes
- Chronically would show honeycomb lung
Management: removal of antigen, oxygen > oral prednisalone

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23
Q

Causes of EAA/HP

A

Bird-Fanciers Lung
Pigeon-Fanciers Lung
Farmer’s/Mushroom Worker’s Lung
Malt/Sugar Worker’s Lung

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24
Q

Idiopathic Pulmonary Fibrosis

A

= a type of idiopathic interstitial pneumonia: it is an inflammatory cell infiltrate and pulmonary fibrosis disorder
Clinical: dry cough, exertional dyspnoea, malaise, weight loss, arthralgia, cyanosis, finger clubbing
Ix: Bloods (ABG), CXR (LOWER zone shadows of honeycomb lung) CT scan, restrictive pattern, lung biopsy
Management: mostly supportive, oxygen, opiates, palliative care

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25
Coal Workers Pneumoconiosis
= inhalation of coal dust particles which are ingested by macrophages - The death of the macrophages causes fibrosis CXR: may show round opacities, UPPER zones Usually asymptomatic
26
Silicosis
= inhalation of silica particles which are very fibrogenic Clincal: shows progressive dyspnoea, increased incidence of TB CXR: miliary or nodular pattern in UPPER zones - Spirometry shows restrictive defects
27
Asbestosis
= inhalation of asbestos fibres (blue most fibrogenic) Clinical: progressive dyspnoea, clubbing, fine crackles - Can cause pleural plaques, bronchial adenocarcinoma, mesothelioma
28
Caplan's Syndrome
Association between rheumatoid arthritis, pneumoconiosis and pulmonary rheumatoid nodules
29
Pulmonary Oedema
= collection of watery fluid in the lungs making it difficult to breath Causes: heart failure, high altitude exposure, ARDS, kidney failure, lung damage Clinical: coughing up blood (pink frothy sputum), PND, shortness of breath Ix: CXR, echocardiogram, ECG Managment: treatment of underlying causes, oxygen, loop diuretics, nitrates
30
Pleural Effusion
= fluid in the pleural space which can be transudate or exudate Clinical: usually asymptomatic/dyspnoea, pleuritic chest pain, stony dull to percuss, diminished breath sounds, bronchial breathing (if lung compressed) Ix: CXR - small effusions blunt angle Diagnostic aspiration - draw off 10-30ml pleural fluid Pleural biopsy, ultrasound Management: treat underlying cause, drainage or pleurodesis (if mesothelioma)
31
Blood in pleural space
Haemothorax
32
Pus in pleural space
Empyema
33
Both blood and air in pleural space
Haemopneumothorax
34
Transudate
``` <30g/l Increased venous pressure e.g. cardiac failure, constrictive pericarditis, fluid overload OR Hypoproteinaemia ```
35
Exudate
>30g/l | Increased leakiness of pleural capillaries secondary to infection, inflammation or malignancy
36
Foul smelling pleural effusion
Anaerobic Empyema
37
Food particles in pleural effusion
Oesophageal Rupture
38
Straw coloured pleural effusion
Cardiac Failure | Hypoalbuminaemia
39
Influenza
Influenza A = Pandemics Flu-like illness = parainfluenza viruses Clinical: fever (high, abrupt onset), malaise, headache, cough Ix: PCR, antibody detection, culture Treatment: self-limiting + paracetamol, antivirals can be used in serious cases e.g. oseltamivir Prevention: killed vaccine (HC workers, complex patients)
40
Bronchiolitis
``` = bronchi inflammation and occlusion Causes: RSV, metapneumovirus Clinical: 1st/2nd year of life, fever, corzya, cough, wheeze Ix: PCR on throat or nasal swabs Treatment: supportive treatment ```
41
Pertussis
= acute tracheobronchitis Clinical: cold-like symptoms, paroxysmal cough, vomiting is common Ix: serologoy of nasal swabs Management: Erithromycin
42
Lung Abscess
= cavitating area of localised supportive infection withing the lung Causes: inadequately treated pneumonia, aspiration, obstruction, infection, septic emboli Clinical: swinging fever, cough, foul smelling sputum, pleuritic chest pain, weight loss, malaise Ix: Bloods, CRP, cultures CXR - walled off cavity
43
Tuberculosis
= infectious disease of the respiratory tract > macrophages from a caseating granuloma: usually in the lungs Clinical: GRADUAL > cough, sputum, weight loss, malaise, night sweats, haemoptysis, breathlessness Ix: ZN stain, INF-gamma test, bronchosopy CXR - caseous necrosis, fibrosis, calcification in UPPER lobes
44
Management of Pulmonary TB
2 Months = rifampicin, isoniazid, ethambutol, pyrazinamide | 4 months = rifampicin, isoniazid
45
Pneumonia
= acute respiratory tract illness associated with fever, chest signs and abnormal x-ray Clinical: fever, rigors, malaise, anorexia, dyspnoea, cough, sputum, pleuritic pain, haemoptysis Ix: identify pathogen and assess severity, assess oxygenation, CXR
46
Causes of CAP
Strep pneumoniae H. influenzae Mycoplasma pneumoniae
47
Causes of HAP
Gram negative enterobacteria | Staph aureus
48
Causes of pneumonia in the immunocompromised patient
``` Strep pneumoniae H. influenzae Staph aureus Gram -VE bacilli Pneumocystis ```
49
Management of CURB CAP 0-2
Amoxicillin (Doxycycline if penicillin allergic)
50
Management of CURB CAP 3-5
Co-amoxiclav (Levofloxacin if allergic) | Doxycycline
51
Managment of ICU/HDU pneumonia
Co-amoxiclav (Levofloxacin if allergic) | Clarithromycin
52
Management of Acute Exacerbation of COPD
1. Amoxicillin | 2. Doxycycline
53
Chlamydia psittaci
- From birds (parrots) | CXR: patchy consolidation
54
Management of Chlamydia psittaci pneumonia
Doxycycline OR Clarithromycin
55
Chalmydia pneumoniae
- Illness of two phases (phrayngitis > pneumonia)
56
Management of Chalmydia pneumoniae
Doxycycline OR Clarithromycin
57
Legionella pneumonia
- Water tanks/air conditioning units - Flu-like, dry cough CXR: bi-basal consolidation
58
Management of Legionella pneumonia
Clarithromycin/erythromycin OR Levofloxacin
59
Staphylococcal Pneumonia (staph aureus)
- May be a complication of influenza - Young, elderly, IV drug users CXR: bilateral cavitating pneumonia
60
Management of Staphylococcal Pneumonia
Flucloxacillin - May add in rifampacin MRSA - Vancomycin
61
Klebsiella Pneumonia
Rare - usually elderly, diabetics, alcoholics | CXR: cavitating in UPPER lobe
62
Management of Klebsiella Pneumonia
Cefotaxime
63
Mycoplasma pneumoniae
Epidemics every 4 years - Dry cough Complications: erythema multiforme, G-B and S-J syndrome CXR: patchy shadowing of one lower lobe
64
Management of Mycoplasma pneumoniae
Clarithromycin/Doxycycline
65
PCP
- In the immunosuppressed e.g. HIV Clinical: dry cough, exertional dyspnoea, fever, bilateral crepitations CXR: interstitial shadowing - some cavitation
66
Management of PCP
Co-trimoxazole
67
Obstructive Sleep Apnoea Syndrome
= intermittent closure/collapse of the pharyngeal airway which causes episodes during sleep Clinical: Typical = obese middle aged man, presents because of snoring or day time somolence Poor sleep quality, morning headache RF: enlarged tonsils, adenoids, obesity, hypothyroidism, COPD, drugs Ix: pulse oximetry, sleep study Management: weight reduction, avoidance of tobacco/alcohol, nasal mask
68
Aspergillus Affects the Lung...
1. Asthma 2. Allergic Bronchopulmonary Aspergillosis 3. Aspergilloma 4. Invasive Aspergillosis
69
Asthma
Type I Hypersensitivity reaction
70
Allergic Bronchopulmonary Aspergillosis
= type I and III hypersensitivity reactions bronchoconstriction > continued inflammation = bronchiectasis Clinical: wheeze, cough, sputum, dyspnoea Ix: CXR, aspergillus in sputum, eosinophilia and raised IgE
71
Mycetoma (aspergilloma)
= fungus ball with a pre-existing cavity, usually asymptomatic Clinical: cough, lethargy, haemoptysis, weight loss Ix: CXR - apacity within a cavity Managment: Surgical excision of solitary lesions
72
Invasive aspergillosis
RF: immunocompromised, broad spectrum antibiotic therapy Ix: sputum culture, biopsy CXR - consolidation, abscess Treatment: voriconazole
73
Cor pulmonale
= right heart failure as a result of pulmonary hypertension Cause: pulmonary hypertension, lung disease Clinical: dyspnoea, fatigue, syncope, cyanosis, tachycardia, raised JVP, pansystolic murmur (tricuspid regurgitation), hepatomegaly Ix: FBC, ABG (hypoxia with/without hypercapnia) CXR - enlarged right side, prominent pulmonary arteries ECG - right axis deviation and hypertrophy
74
Primary Pulmonary Hypertension
Disease of the arteries within the lung themselves
75
Management of Cor Pulmonale
ACUTE - oxygen, monitor the ABG and gradually increase | Cardiac Failure treated using loop diuretics and U&E monitored
76
Pneumothorax
= can be primary or secondary (e.g. COPD) Causes: spontaneous, asthma, COPD, TB, pneumonia, connective tissue disorders Clinical: asymptomatic, sudden onset of dyspnoea, pleuritic chest pain, rapid deterioration = reduced exaspansion, hyper resonance, diminished breath sounds Ix: CXR - reduced lung markings
77
Tension Pneumothorax
- Similar signs, trachea may be deviated away from affected side - MEDICAL EMERGENCY Treatment: high flow oxygen and needle flow compression: 2nd intercostal space in mid clavicular line and chest drain
78
Non-small cell cancer
Large Cell Adenocarcinoma Squamous Cell Carcinoma (SCC)
79
Large Cell
Poorly differentiated | Metastasises early
80
Adenocarcinoma
- Usually peripheral Origin: mucus secreting glandular cells Most common type in non-smokers
81
Squamous Cell
Occurs centrally, often obstructing lesions of the bronchus | Origin: epithelial cells
82
Associations with squamous cell
Parathyroid hormone related protein (results in hypercalcaemia) Finger clubbing
83
Small Cell Carcinoma
Central and metastasises early | Origin: neuroendocrine cells
84
Associations with small cell carcinoma
Polypeptide hormones; ACH ACTH
85
Bronchial Carcinoma
- Can be divided into small cell and non-small cell RF: Cigarette smoking (asbestos) Clinical: cough, haemoptysis, dyspnoea, unexplained weight loss, chest pain, lethargy, anorexia, clubbing, pleural effusion Ix: FBC, CXR, CT scan, bronchoscopy and biopsy
86
Management (NON-SMALL CELL)
Excision if possible, curative radiotherapy
87
Management (SMALL CELL)
Usually disseminated, can respond to chemotherapy (usually a palliative option)
88
Complications of Bronchial Carcinoma
Recurrent laryngeal nerve palsy Dysphagia (compression) Metastatic complications
89
Pancoast Tumour
Apex of the lung, invades the brachial plexus > SVC obstruction
90
Mesothelioma
= tumour of the mesothelial cells which usually occurs in the pleura - Very strong association with previous asbestos exposure Clinical: chest pain, dyspnoea, weight loss, finger clubbing, recurrent pleural effusions Ix: CXR, CT scan, histology of pleural fluid Managment: chemotherapy can improve survival
91
Pseudomonas
- In those with bronchiectasis and CF | - Usually hospital acquired
92
Management of Pseudomonas Pneumonia
Ciprofloxacin | Gentamicin
93
Classic PE presentation
Swollen ankle/leg One sided chest pain Chest pain worse on inspiration

Respiratory (5 decks)

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