Resp Flashcards
(19 cards)
What group of conditions does COPD cover? How are they classified?
Chronic, Obstructive Airway Disease (FEV1 <80% + FEV1/FVC<0.7)
Chronic Bronchitis, Chronic Asthma + Emphysema
Persistent and productive cough, hyper-inflated chest, expiratory wheeze, tachypnea, smoker, CO2 flap (acidosis), Peripheral Oedema
Treat: Long term oxygen therapy +corticosteroids eg./ beclometasone + LAB2A eg./ Salmetrol
A pt presents with SOB, chest tightening pain. They report substantial haemoptysis. On investigation you hear a pleuritic rub and a dull lung base. You diagnose a PE. How is this managed? What else would you look for signs of in this patient?
Investigate- FBC, D-Dimers, ABG (drop O2 + CO2), CT Pulmonary Angiogram/ V/Q Scan, CxR, ECG
Treat:
Oxygen
Anticoagulants - LMW Heparin till INR >2 + 3 months of warfarin.
+ Thrombolysis if massive PE
Prophylaxis
Heparin eg./ delta-rain to immobile pts + compression stockings
A pt presents to their GP with SOB, chest tightness and a dry cough with intermittent wheezing. What is your working diagnosis? What questions would you want to ask to confirm this? What is the management of this pt?
Asthma- T1Hypersensitivity of bronchi and airways (IgE + ADAM33 gene, grandmother effect) Ask about VARIATION in symptoms \+ Spirometry FEV1/FVC <70% Lung Volume RV/TLC >30% \+ FEV1 with steroid trial \+ skin prick with allergen, total IgE Sputum Culture/CxR to exclude infection Treat: 1. SAB2A eg./ Salbutamol 2. + Inhaled corticosteroid eg./ beclometasone (if 1 used more 1+ daily/ nocturnal symptoms) 3. + LAB2A- eg./ Salmetrol
A pt from Sierra Leon, now living in Aberdeen presents with what was originally thought to be a chest infection. The pt now has haemoptysis and cervical lymphadenopathy. He also complains of weight loss and night sweats. What infectious disease must you disclude? How would you do this? Hw is this disease treated? Where else can it occur?
Mycobacterium Tuberculosis- Bacterial infection spread by droplets Primary Infection- Pulmonary/ Gentiurinary/ Bone/ Skin/ Menigitis Latent Phase Test: Mantoux Test (latent), CxR (cavitation and calcification), Sputum (AFB ZN Stain), Histology (caveating granulomas) 4 drugs, 2 months Rifampicin Ethambutol Isoniazid Pyrazinamide \+ 2 drugs, 4 months Rifampicin Isonizid \+ notify government
Describe the pathophysiology of Cystic Fibrosis, what tests are available to confirm it and what are the common infections a CF pt is exposed to?
Defect in C7q gene- Cl channel- change in composition of airway surface (inc Na in Dec Cl out) changes epithelial surface predisposing it to infection and bronchiectasis.
Neonatal Screening- Guthrie Test (immunoreactive Tripsinogen)/ Sweat Test (Cl>Na)
Complications- Respiratory, GI (DM, Sterattorhea, gallstones, liver cirrhosis), male infertility, osteoporosis, arthritis
An CF pt presents to clinic with fever, dysnopea, cough, sputum, haemoptysis and pleuritic pain. On examination they have signs of consolidation. What is the most likely diagnosis? How would you investigate and treat this? What are the clinical signs of consolidation?
Pneumonia- inflammation of airways spaces in lungs due to infection +/- fluid filled.
Signs of consolidation- diminished expansion, dull percussion, inc vocal tactile fremitis, bronchial breathing.
Test: Oxygen Sats, BP, FBC, Blood Culture, U+E, LFTs, CxR, Sputum (microscopy + culture), Pleural Aspirate
Management- CURB65
Describe the CURB 65 score used in management of pneumonia
Confusion Urea >7 Resp Rate >30 BP- Systolic (<90), Diastolic (<60) 65+
0-1- Low Risk,Out Pt- Amoxycillin/ Clarithromycin
2-3- Med Risk, Hosp- + levofloxacin
3-5- High Risk, ITU- Coamoxiclav + clarithromycin
A pt who was in a motor cycle accident arrives at A+E with breathlessness and dizziness. On examination he has tracheal deviation, decreased expansion and is hyper resonant. What is your working diagnosis and what investigations would you want to carry out to confirm this? What complications can occur from spontaneous healing? How would you treat the pt to stop this from happening?
Primary, Traumatic,Non-iatrogenic Penumothorax
Investigations- CxR, Blood Gas
Complications- Spontaneous Haemopheumothorax- healing with adhesions between 2 layers which breaks apart in recurrent episodes.
Treat:
Chest Drain- if large (>2cm air, in <2cm air watch and wait)
Tension ( 1 way valve, air into pleural space)- tac pleurodesis, pleuroectomy,
What are the risk factors and main types of lung cancer.
How do they present and are investigated?
How is it managed?
- Smoking, Asbestos, Radiation, Pollution, Genes
- SquamousSC (FGFR1, DPR2), Adenocarcinoma (HER2, BRAF), SmallCC (most aggressive, smoking), LCC, Alveolar CC
SSC vs NSCC most important division - Cough, haemoptysis, wheeze, tough, SOB, chest + bone pain if mets- bone tenderness/ confusion/ fits/ hepatomegaly
- Cytology (sputum, pleural fluid), CxR, FNA (peripheral nodes), CT (staging), Bronchoscopy (histology), PET-CT (staging), Radionucleotide Scan (bone mets), LungFTs (asses ability for lobectomy)
- If NSCC- excision (based of LFT, no mets) or curative radiotherapy OR Chemo+ Radio (late stage)
If SCC- usually caught when disseminated. Chemo/ Pallitive Radiotherapy, Pleural Drainage, Analgesia, Bronchiodilators etc
You see a small mass on a CXR. What are the potential diagnoses?
- Malignancy (1° or 2°)
- Cyst
- Infection
- Granuloma
- Carcinoid Tumour
- Encased Effusion
- Skin Tumour
- Pulmonary Hamartoma
A patient presents with a pyrexia of unknown origin. Upon careful watching you see their NEWS Chart records a swinging temperature. What disease process must you rule out? Simply, how would you do it?
Swinging temperature- vascualitis
Blood test for ANCA (+ve)
What are the potential risks of a bronchoscopy?
Cough
Bleeding
Pnuemothorax
Temperature
You prescribe a patient with pneumonia Tanozin. What must you check with the patient beforehand?
Allergy to penicillinsified
What is the definition of Respiratory Failure? How is each type classified?
Inadequate gas exchange (PaO2<8kPa) resulting in hypoxia.
T1 and T2 differentiated by levels of PaCO2
You see an x-ray of a patient in clinic with bilateral, upper scaring of both lungs. What 2 diagnosis’ must you rule out and how would you do this?
Tb-Mantoux skin test
Sarcoidosis- multi systematic
What characteristic sign is seen on CXR with an empyema?
D sign
What sign would you expect to see in a pleural drain inserted correctly?
Swinging sign
Moves with change in size of pleural space with regards to breathing
You see a chest drain in a patient in the ward. When would you expect to see bubbles in the drain and when would you not?
See bubbles- pneumothorax
No bubbles- pleural effusion, clamp as fluid/ pus has run
When would you expect to see a polyphonic wheeze vs a monophonic wheeze?
Polyphonic- numerous dilated airways eg./ asthma, COPD
Monophonic- single, large airway eg./ stridor
