resp Flashcards
1
Q
Investigations for asthma
A
TLCO- normal spirometry and PEF- >15% reversibility Fev1 and FEV1/FVC reduced FBC and Sputum- Eosinophils Skin prick tests CXR- excludes pneumothorax
2
Q
conservative management for chronic asthma
A
Make a personalised action plan
avoid allergens
train to use inhaler
stop smoking
3
Q
pharmacological reliever of asthma
A
SABA salbutamol PRN
4
Q
Pharmacoloical prevention in uncontrolled asthma 1st line
A
ICS Beclometasone
5
Q
Pharmacoloical prevention in uncontrolled asthma 2nd line
A
ICS + LTRA
6
Q
Pharmacoloical prevention in uncontrolled asthma 3rd line
A
ICS + LABA- salmetreol
7
Q
Pharmacoloical prevention in uncontrolled asthma 4th line
A
ICS + LAMA- theophyline
8
Q
Asthma biologic agents
A
uncontrolled after everything else- Omalizumab
9
Q
Acute Asthma: uncontrolled or moderate classification
A
PEFR > 50
RR<25
pulse<110
able to make sentences
10
Q
Acute Asthma: severe classification
A
PEFR 33-50
RR>25
pulse>110
unable to make sentences
11
Q
Acute Asthma: life threatening classification
A
PEFR <33
PaO2 low
Paco2 normal
12
Q
Acute Asthma: near fatal classification
A
PACO2 high
13
Q
Treatment of acute asthma
A
predniselone oral or IM O2 SABA or SAMA - Ipatropium Bromide CXR exclude pneumothorax ABGs PEFR Review within 48 hours
14
Q
3 Pathophysiology of asthma
A
Inflamation of the Bronchi
Bronchial smooth muscle spasm
Mucus production
15
Q
symptoms of Asthma
A
Diurnal varation and episodic Cough wheeze SOB/ Dyspnoea Sputum
16
Q
Signs of Asthma
A
Tachypnoea
Hyperinflated chest
PEFR low
17
Q
what are the conditions under the term COPD
A
chronic bronchitis
chronic asthma
emphysema
18
Q
what is meant by Blue bloaters and what is the pathophysiology and symptoms
A
chronic bronchitis and excess mucus production,
productive cough, SOB
reduced O2 to enter and less CO2 to leave, Hypoxia and hypercapnia. this causes Cyanosis and type 2 resp failure (VQ mismatch) as well as vasoconstriction. progressing to COR pulmonar- pulmonary hypertension, RV hypertrophy and right Heart failure.
this leads to oedema, ascites and raised JVP
hypoxemia causes polycythemia and hypercapnia causes Acidosis
19
Q
what is meant by pink puffers and what is the pathophysiology and symptoms
A
emphysema, also caused by smoking, inflamation causes destruction of alveolar wall and capillaries.
causes air trapping due to lack of recoil.
causes barrel chest. and pursing of lips of intercostals to allow breathing, heavy use of accessory muscles.
can eventually lead to cor pulmonar too
Matched VQ deficit due to hypoxia and reduced perfusion
TLC increased TLCO/DLCO decreased due reduced SA
hyperinflation
20
Q
what is the pathophysiology behind emphysema
A
smoking causes increased work by alveolar macrophages and release of cytokine.
neutrophil recruitment and formation of neutrophil granulomas which secrete elastin
elastin destroys alveoli and inflammation destroys capillaries
21
Q
what is the pathophysiology behind chronic bronchitis
A
smoking causes goblet cell hypertrophy= increased mucus
inflammation causes ulcers and fibrosis causing scarring that leads to narrowing
22
Q
what are the cardinal features of COPD
A
Chronic cough, productive cough
dyspnoea
other: wheeze tightness
23
Q
signs of COPD
A
raised JVP ascites oedema
barrel chest cynosis cor pulmonary tachypnoea weight loss hyperinflation intercostal drawing and pursed lip respiration
24
Q
Investigations for COPD
A
Spirometery ABG=O2 low and CO2 high FBC= Polycythemia CT or CXR- barrelcesting and hyperinflation ECG= RV hypertrophy Echo=pulmonary valve incompetency
25
other than smoking what is a cause for emphysema
Alpha antitrypsin Deficiency- inhered disease lacking anti elastin proteins so causes destruction of alveoli.
suspect if family history of emphysema or young non smoker
26
what is the spirometery and LFTs of COPD show
```
FEV1<0.8
FVC/FEV1<70%
TLCO reduced
TLC increased
RV increased
```
27
what is used to asses severity of COPD
GOLD classification
| Global obstructive lung disease classification
28
GOLD Classification mild
FEV1>0.8 FVC/FEV1<0.7 no or mild breathlessness
29
GOLD Classification moderate
FVC/FEV1<0.7 FEV1= 0.5-0.8 SOB on exertion
30
GOLD Classification severe
FVC/FEV1<0.7 FEV1=0.3-0.5 SOB on minimal exertion like getting dressed
31
GOLD Classification very severe
FVC/FEV1<0.7 FEV1<0.3 SOB at rest
32
questionnaire used in COPD management
CAT questionnaire
33
Conservative management of COPD
stop smoking, exercise, improve diet, stay up to date on vaccinations- influenza and pneumococcal
34
relief of COPD symptoms
SAMA- ipatropium bromide or SABA - salbutamol
35
Management of COPD if uncontrolled after SAMA or SABA/ Mild to moderate COPD
add LAMA titropium or thyophiline or add LABA salmeterol. if adding LAMA avoid SAMA. SABA can still be continued
36
Management of sever COPD/ after LAMA LABA
ICS + LABAorLAMA
37
management if absolutely nothing else works
LTOT- long term oxygen therapy
38
what are the requirements for prescribing LTOT
palliative
medication isnt working (PaO2<7.2 after treatment)and they are have quite smoking
they have developed signs of cor Pulmonary( fluid overoad, RV hypertention, pulmonary hypertension )
39
other treatmnet options in COPD
mucolytics
antidepressants
Diuretics if cor Pulmonary
antibiotics if exacerbation
40
what is the difference between COPD and Athma
COPD the symptoms are not variable diurnally and are always present + there is less than 15% reversibility in COPD
main inflammatory cell is CD8+ in COPD
athma = CD4+
41
risk factors for COPD
```
Smoking,
polutants
working with harmful chemicals
genetics-susceptibility or Alpha antitrypin deficiency
infection
```
42
treating COPD exacerbation
antibiotics + steriods
| if deveoped resp failure then give oxygen via venturi mask
43
what is bronchiactasis
abnormally dilated bronchi, occurred due to reoccurring infections and inflammation. is irreversible
44
causes of bronchiactasis
```
mostly idiopathic.
cystic fibrosis
congenital abnormality
post infection, TB penumonia
immune suppressed- HIV chemo
autoimmune
```
45
what is the pathogens associated with infection in bronchiactasis
H influenza, Stap aures, strep pneumonia
46
symptoms of bronchiactasis
main: Persistent cough that brings up a large amount of sputum can be clear but also green if infection
SOB
haemoptysis
pleuritic chest pain
fever
halitosis
Hint to remember- there is chronic infection so symptom is trying to clear that by cough and sputum
47
signs of bronchiactaisis
```
finger clubbing (uncommon)
crackles
inspiratory crepitus
Wheeze
pyrexia
```
48
investigations of bronchoiactasis
| golf standard
High resolution CT scan shows dilation and bronchial wall thickining
49
other investigations of bronchiactatsis
```
CXR- shows broncial dilation
sputum sample
spirometry- obstructive disease
TLCO unaffected
broncoscopy
```
50
Treatment of Bronchiactasis
| conservative
Postural drainage, to remove mucus
| stop smoking exercise diet and vaccinations
51
Treatment of Bronchiactasis
| pharmacological
Bronchodilators - SABA for a flare up
ICS- reduce inflammation
Antibiotics - amoxicillin or clarithromycin
52
Treatment of Bronchiactasis
| surgical
Treat localised Haemoptysis or option for transplant
53
Prevalence of cytic fibrosis
type of inheritance
prevalence
pathophysiology and location of mutation
commonest life treatening autosomal ressecive disease
1 in 2000 births
mutation in chromosome 7 causing dysfucntional CFTR Cystic fibrosis trasmembrane concirdance regulator causing Cl to be retained Na to be retained and causing secretions like mucus to be more viscous
54
clinical features of CF
```
SOB
productive cough, very thick mucus
reoccuring infections
CF developes into bronchiactasis
or resp failure and cor pulmonary due to obstruction
```
sterratohorrea
can develop DM
weightloss
meconium Ileus + failure to thrive
no development of vas deferns or empdysimus infertility
55
investigations and diagnostics in CF
Sweat Test= increased CL and NA in sweat
family history
genetic test
radiology check for bronchiectasis by HRCT
56
Managment of CF
```
postural drainage
stop smoking+ diet+ vaccines
Replacement pancreatic enzyme
ADEK vitamins
Bronchodilators - ICS+ SABA
mucolytics + antibiotics
```
57
checking for complications of CF
```
Glucose-DM
FBC, U&E Clotting
CXR- Bronchiactasis
Spirometery- Obstructive
DEXA Scan?
```
58
What is a mesothelioma and its causes
Cancer of the mesothelium, cells lining organs like Pericardium, pleura or peritoneum
commonest cause is asbestos exposure
commonest type is pleural mesothelioma
59
Presentation for pleural mesothelioma
```
Fatigue unexplained weight loss Pyrexia
SOB chest pain,
persistent cough
clubbing
reduced expansion
dull percussion
```
60
diagnoses of mesthelioma and its treatment
CXR+CT + Biopsy = diagnostic
treat by chemo+radiotherapy
if small enough use surgery
61
Prognosis of mesothelioma
50% mortality in 1 year
62
what is the commonest lung tumour and its main attributed cause
Bronchial carcinoma of non small cells, squamous
| Smoking
63
Symptoms of Bronchial carcinoma
```
Cough
chest pain
Haemoptyis
SOB
+ Weightloss and fatigue
```
64
Signs of Bronchial carcinoma
Anaemia, Clubbing
supraclavicular lymph node enlargement
slowly resolving infection or pneumonia
65
2 types of carcinoma
small cell carcinoma- usually of small cell endocrine cell- worst prognosis
non small cell- squamous cell or adenocarcinoma better prognosis
66
What is direct spread of Bronchial carcinoma
```
Presses on Phrenic-hemidiaphram paralysis
recurrent laryngeal- horsness of voice
or bracial plexus-parasthesia
SVC - early morning headache
Oesophagus- Dysphagia
```
67
common metastatic spread of Bronchial Carcinoma
Bone, Brain
68
Investigations and diagnosis of bronchial carcinoma
CXR- diagnostic, can show nodules, pleural effusion or lung collapse
CT and CT guided biopsy and PET= Staging of tumour
69
Treatment of Bronchial carcinoma
If stage 1 or 2 then surgically remove
| if 3 or 4 then requires Chemo plus radiotherapy + palliative care
70
what is the infective agent in TB
Mycobacterium Tuberculosis
71
what tests can be done to detect Mycobacterium Tuberculosis in a lab
M TB is fast acid bacilli which means it doesn't respond to gram test. would respond to ziehl neelson test +ve
72
how is TB transmitted
Transmitted via aersol dropplets
73
what are the signs of latent TB and how does it become active TB
CXR clear or may show rankes complex calcification
non infective
test +ve for Montoux test or Interferon gamma release assay
becomes activated when the immune system becomes suppressed
74
what are the signs of primary TB
many asymptomatic but can have symptoms of flu, lethargy malaise pyrexia
CXR is clear or may show small pleural effusion
75
what are the outcomes and complications of active TB
```
Locally- bronchial pneumonia, pleural effusion, bronchiactasis
spread vascular becomes milliary TB:
Renal Injury
Potts Spine
TB meningitis
Hepatitis
lymph adenoma
```
76
Presentation of active TB
cough starts dry then becomes productive
persisting cough
drenching night sweats
SOB
pleuritic chest pain
haemoptysis
infection: pyrexia, malaise, fatigue, weightloss
77
Investigations of TB
CXR shows cavitation + Pleural effusion
Sputum sample or bronchoalveolar lavage - Shows Mycobacterum TB - use Nucleic acid amplification test
```
Skin tests:
TB test (mantoux test, tuberculin skin test) test +VE for primary active latent or Bovine (vaccination) TB
Interferon Gamma Release Assay- more specific- doesnt pick up BCG
```
78
Treatment of Active TB
4 antibiotics for 6 months+ containment (-VE pressure room) until no longer infectious + Direct observation therapy to encourage taking medication
Isoniazid - Also prescribe this in Drug resistant TB 20 months
Rifampican
Pyrazinamide
Ethambutol
79
Treatment of latent TB
Isonizide + Vit B
80
Prevention of TB
BCG- Mycobacterium bovis
| works 70% of the time and prevents milliary TB
81
What are the causes of plural effusion
Transudate causes (Increased venous pressure): fluid overload. Heart failure. Cor Pulmonary. pericarditis Hypoprotienemia
Exudate causes (increased leakyness and inflamation): Pneumonia, carcinoma, TB, rheumatoid and SLE
82
What are the types of fluid present in pleural effusion
Transudates= low serum protein<30 g/l
Exudates = high serum protein > 30g/l
Emphyma- pus containing fluid- often due to pneumonia
83
symptoms of Pleural effusion
Asymptomatic, SOB, Pleuritic chest pain
84
Signs of pleural effusion
Friction pleural rub
dull percussion sounds
reduced chest inflation
tracheal deviation if effusion is severe
85
Investigation and diagnosis of Pleural effusion
Diagnostic- pleural effusion aspirate - analysis cause and type of fluid
other:
CXR - shows effusion
broncoscopy guided biopsy
86
managment of pleural effusion
only drain if emphyma, malignant effusion or if there is excess and severity
treat underlying condition
87
What is pneumothorax
air in the pleural space
88
causes of pneumothorax
mostly idiopathic, can be iatrogenic
| if over 40, possibly not idiopathic- COPD Asthma TB pneumonia (anything that can cause pleural effusion)
89
risk factors for pneumothorax
male
tall
skinny
smoker
90
symptoms of pneumothorax
sudden onset of unilateral Pleuritic chest pain, SOB
91
signs of pneumothorax
tachypnoea tachycardia
no movement in chest wall on affected side
hyper resonance
pallor
tracheal deviation- sign of tension pneumothorax
92
what causes spontaneous pneumothorax
Bursting of pleural bullae- small collection of air between lung and visceral pleura- usually on upper lobes
93
Diagnosis and investigation of pneumothorax
CXR is diagnostic
94
management of peunmothorax
if small do nothing avoid exercise
if medium large or tension- insert chest drain + aspirate air
if reoccurring pneumothorax consider pleurictomy
95
Risk factors for pneumonia
immune deficiency , HIV, chemo, elderly and children
usually occurs post viral infection that lowers immune system
Altered lung physiology- Interstitial lung disease CF Asthma COPD
dysphagia
96
causing pathogen of Community acquired pneumonia
Strep. pneumoni - main agent
staph aures, including MRSA
H. Influenza
97
symptoms of pneumonia
```
Cough, productive
SOB
pleuritic chest pain
haemoptysis
symptoms of infection: malaise fatigue, rigor sweating
```
98
signs of pneumonia
```
confusion- may be only sign in elderly
tachypnoea
tachycardia
pyrexia
dull percussion
reduced chest expansion
pleural rub
low BP
```
99
Investigation and diagnosis of pneumonia
```
CXR- shows effusion, air bronchiogram or normal
sputum sample- Strep pneumonia
blood sample exclude sepsis
Other
LFT U&E GFR- asses severity
FBC= Increased WCC CRP ESR
```
100
management of pneumonia
start oral antibiotic or if severe , cannot wait for results start immediate IV antibiotics
IV Co-amoxiclav ( amoxicillan + Clavalic acid)
then continue on oral co- amoxiclav and clarythromycin
if hypoxia- O2
Hypotensive/shock - IV saline
pleuritic pain- analgesia + anti emetic
101
Complications of pneumonia
```
Pleural effusion- emphyma
Sepsis
lung absess
Resp failure- Type 1
pericarditis
```
102
Assessing severity of of pneumonia
```
CURB65
confusion
Urea>7mmole/L
Resp rate>30
BP<90/60
Over 65 YO
0-1 mild outpatient
2 moderate - possible hospital
3-5 severe admit to hospital and consider ITU
```
103
prevention of pneumonia and who gets it
Pneumococcal vaccine
over 65, any lung disease that can be exacerbated
CF COPD Bronchiactasis asthma
renal or heart failure
104
Sepsis pathophysiology
increased pro inflammatory cytokines= vasodilation
Hypotension and impaired cardiac contractility
reduced perfusion to organs
tissue hypoxemia causes increased resp rate due to increased demand for O2 and renal impairment which increases urea>7mmol/L
105
Causative agent in Hosputal aquired pneumonia
Enterobacteria - E.Coli
| S aures MRSA
106
Causative agents of pneumonia in immunocompromised
Step pneumonia
Staph aures
H.Influenza same as CAP
107
Causative agents in atypical pneumonia and presentation
legionella pneumophilia- found in colonised water tanks presnets with infection symptoms plus dry cough and SOB
