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Resp Flashcards

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1
Q

what is acute bronchitis

A

usually viral infection causing inflammation of trachea and major bronchi

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2
Q

how does acute bronchitis present

A 
cough - some sputum
sore throat
rhinorrhea
wheeze
low grade fever
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3
Q

how to differentiate between pneumonia and bronchitis

A

pneumonia - wheeze + other focal signs - crepitations, dull to percussion, bronchial breathing
pneumonia may also have some systemic symptoms such as fever malaise and myalgia

bronchitis - just wheeze

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4
Q

how is acute bronchitis managed

A

analgesia
fluids
if CRP 20-100 - offer delayed antibiotic prescription
if CRP >100 - immediate doxycycline
alternative for pregnancy/children - amoxicillin

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5
Q

what antibiotics in acute bronchitis

A

doxycycline

amoxicillin if preg/children

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6
Q

how would anaphylaxis present

A
  • angioedema of face, tongue, lips
  • hoarse voice
  • stridor (swelling of larynx)
  • wheeze
  • dyspnoea
  • hypotension
  • tachycardia
  • can also present with abdo pain
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7
Q

what skin changes in anaphylaxis

A

urticarial/erythematous rash

generalised itch

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8
Q

what dose of adrenaline for adult anaphylaxis

A

500mcg - 1 in 1000

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9
Q

how often can adrenaline IM injections be repeated and where is the best place to administer?

A

every 5 minutes

anterolateral aspect of middle third of thigh

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10
Q

what is refractory anaphylaxis

A

cardiorespiratory problems persist after 2 doses of IM adrenaline

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11
Q

how is refractory anaphylaxis treated

A

fluids if shocked

refer for ITU for IV adrenaline line

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12
Q

what treatment for anaphylaxis after patient has been stabilised?

A
  • non-sedating antihistamines such as CETIRIZINE for rash
  • serial tryptase measurements (tryptase can remain elevated for 12 hours, MEASURE WITHIN 6 HOURS)
  • all patients should be referred to specialist allergy clinic
  • provide patients with 2 adrenaline auto-injectors and training for how to use
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13
Q

what type of hypersensitivity is anaphylaxis

A

type 1

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14
Q

what is the pathophys of anaphylaxis

A

IgE stimulates mast cell degeneration causing release of histamine and other pro-inflammatory chemicals

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15
Q

what three treatments are given in anaphylaxis

A

IM adrenaline
Oral antihistamines
IV hydrocortisone

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16
Q

what conditions can be caused by asbestos exposure

A
  • pleural plaques
  • asbestosis
  • pleural thickening
  • mesothelioma
  • lung cancer
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17
Q

describe pleural plaques

A
  • benign, do not undergo malignant change, no follow up required
  • 20-40 year latency period
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18
Q

what can cause pleural thickening

A

empyema
haemothorax
asbestos exposure

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19
Q

describe asbestosis and its treatment

A

asbestosis causes lower lobe fibrosis, severity related to length of exposure

conservative treatment

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20
Q

what are the symptoms of asbestosis

A

progressive shortness of breath

reduced exercise tolerance

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21
Q

what is mesothelioma

A

cancer of the pleura, commonly caused by asbestos exposure, severity not related to length of exposure

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22
Q

what are the presenting features of mesothelioma

A

progressive sob
chest pain
pleural effusion

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23
Q

how is mesothelioma treated

A

palliative chemo

some radio/surgery

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24
Q

how does asbestos exposure relate to lung cancer

A

increases risk of lung ca

synergistic effect with smoking

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25
what are the RFs for sleep apnoea
obesity macroglossia (acromegaly, hypothyroidism, amyloidosis) large tonsils marfan's
26
how does sleep apnoea present
- excessive snoring - periods of apnoea during sleep - daytime somnolence, fatigue - HTN - compensated respiratory acidosis
27
what would ABG of sleep apnoea look like?
compensated respiratory acidosis
28
what scoring systems/assessments for sleep apnoea
epworth scale | multiple sleep latency tes - assess time taken to fall asleep in dark room
29
what investigations for sleep apnoea
sleep studies - polysomnography
30
what management for sleep apnoea
- weight loss, stop drinking + smoking - CPAP - intra-oral devices such as mandibular advancement - inform DVLA if excessive daytime somnolence
31
explain the pathophys of sleep apnoea
collapse of pharyngeal airway
32
what are the complications of sleep apnoea
HTN heart failure can increase risk of MI and stroke
33
what is the mgmt of PE with renal impairment (severe)
LMWH
34
what is the mgmt of PE with anti phospholipid syndrome
LMWH
35
what are the complications of PE
``` sudden death cardiac arrest hypotension syncope pulmonary hypertension ```
36
what is bronchiectasis
permanent dilation of airways secondary to chronic inflammation/infection
37
what infections can lead to bronchiectasis
TB measles whooping cough pneumonia
38
what medical conditions can lead to bronchiectasis
CF ciliary dyskinesia - kartagener, Young's bronchial obstructions - foreign body, lung cancer yellow nail syndrome IgA deficiency, hypogammaglobulinaemia allergic bronchopulmonary aspergillosis
39
how is bronchiectasis diagnosed
CXR | High resolution CT chest - tram-track and signet ring signs
40
how does bronchiectasis present?
``` cough, productive of large volumes of sputum sob chest pain clubbing recurrent chest infections ```
41
how is bronchiectasis managed
- physical training - postural drainage - antibiotics (long term rotating antibiotics if severe cases) - bronchodilators - immunisations - surgery if localised disease
42
what are the most common organisms isolated in bronchiectasis
- Haemophilus influenzae - Pseudomonas aeruginosa - Klebsiella spp. - Strep pneumoniae
43
what is a serious complication of bronchiectasis
massive haemoptysis - needs bronchial artery embolisation
44
what is bronchiolitis, who does it usually affect
infxn of bronchioles, usually with RSV, can be adenovirus, babies <1year
45
what RFs for severe bronchiolitis
congenital heart failure superimposed bacterial infection bronchopulmonary dysplasia (premature) CF
46
what symptoms of bronchiolitis
``` dry cough wheeze/fine inspiratory crackles SoB mild fever, coryzal symptoms feeding difficulties associated with increasing dyspnoea ```
47
when should babies be referred to A&E by ambulance in bronchiolitis
- under 3 months - apnoea - child looks seriously unwell to a healthcare professional - severe resp distress: - grunting - marked chest recession - RR>70 - use of accessory muscles - tracheal tug - cyanosis - O2 sats <92% consider referral if dehydration or tachypnoea (>60) or if inadequate oral fluid intake (50-70% of usual)
48
what management of bronchiolitis
- humidified oxygen if low sats - ensure adequate food and fluid intake - NG tube if necessary - suctioning for secretions
49
how is bronchiolitis diagnosed
clinical | immunofluorescence of nasal secretions may show RSB
50
what are babies with bronchiolitis at inc risk of in childhood
viral induced wheeze
51
explain pathophys of pneumothorax
air in the pleural space causing separation of lung from chest wall
52
list some causes of pneumothorax
trauma idiopathic iatrogenic - central line insertion lung pathologies - asthma, COPD, infection
53
how is primary pneumothorax managed
if <2cm - discharge if >2cm - aspiration - failure of aspiration (still SOB, still >2cm) - chest drain
54
how is secondary pneumothorax managed
>2cm/sob/>50y = chest drain 1-2 cm - aspirate <1cm - admit for obs and ox
55
when can patients fly/diving after pneumothorax
fly after 1 week post xray check | no scuba diving unless bilateral pleurectomy
56
what are the borders of the triangle of safety for chest drain insertion
- mid-axillary line (lateral edge of latissimus dorsi) - anterior axillary line (lateral edge of pectoralis major) - 5th intercostal space (nipple line) always insert chest drain ABOVE ribs to avoid neurovascular bundle
57
how to confirm correct chest drain insertion
swinging (rise of water seal on inspiration, fall on expiration) spontaneous bubbling of water as air leaves pleural space re-inflation of lung
58
what surgical options for pneumothorax
- Video assisted thoracoscopic surgery - chemical pleurodesis (talc to irritate pleura) - abrasive pleurodesis (physical irritation of pleura) - pleurectomy
59
what is a tension pneumothorax
trauma to chest cavity creating one-way valve that allows air into but not OUT of the pleural space this is dangerous as air builds up with inspiration and increases the pressure in the thorax this pushes on the mediastinum and its vessels and can lead to cardiorespiratory arrest
60
what signs of tension pneumothorax
- tracheal deviation AWAY from the side of the pneumothorax - reduced air entry - hyperresonant to percussion on affected side - TACHYCARDIA - HYPOTENSION
61
what is the mgmt of tension pneumothorax
insert a large bore cannula into the second intercostal space, midclavicular line once pressure is relieved with a cannula, chest drain can be inserted if tension pneumothorax suspected, do not await investigations
62
what is the difference between transudative and exudative pleural effusion
transudative - <30g/L protein | exudative - >30g/L protein
63
what are the causes of transudative pleural effusions
- heart failure - hypoalbuminaemia (liv disease, nephrotic syn, malabsorption) - hypothyroidism - meig's syndrome (pleural effusion, ascites, ovarian Ca)
64
what are causes of exudative effusion
- pneumonia - lung ca, mesothelioma, mets - TB - connective tissue disease - RA/SLE - pancreatitis - PE - dressler's syndrome - yellow nail syndrome
65
what symptoms of pleural effusion
shortness of breath non-productive cough chest pain
66
what signs of pleural effusion
tracheal deviation if massive stony dullness to percussion reduced breath sounds and chest expansion
67
what imaging for pleural effusion
- Posteroanterior CXR - USS chest - Contrast CT CAP to find underlying cause of exudative
68
what other investigations aside from imaging for pleural effusion
pleural aspiration send fluid for: - microbiology - cytology - pH, protein, LDH analysis
69
if unsure if transudate/exudate, how do serum/fluid protein level differ in pleural effusion
pleural fluid protein / serum fluid protein > 0.5 = exudative
70
what would CXR show in pleural effusion
blunting of costophrenic angles fluid in lung fissures larger effusion - meniscus tracheal + mediastinal deviation if massive effusion
71
how would oesophageal rupture affect pleural effusion fluid analysis
low pH low glucose raised amylase
72
how would empyema fluid analysis look
turbid, cloudy low pH <7.2 low glucose high LDH
73
how is recurrent pleural effusion managed
- recurrent aspiration - pleurodesis - indwelling pleural catheter - drug management to alleviate symptoms - opiates for dyspnoea

FINALS REVISION (17 decks)

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