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Resp Flashcards

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1
Q

pres of asthma

A

wheezing, sob, chest tightness, cough (nocturnal)

diurnal variation
wheeze (polyphonic, expiratory)

FHx atopy/nasaly polyposis

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2
Q

triggers of asthma?
allergic?
non-allergic?

A

house dust mite, pet fur, grass pollen -> IgE

exercise, cold air, stress, emotion, viral infection, smoking

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3
Q

drugs CI in asthma?

A

Beta blockers -> B2 = airway obstruction

NSAIDs/aspiring -> block COX-1 -> decrease PGs + overprod of inflam leukotrienes

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4
Q

what happens in acute airway inflammation?

A

constriction
oedema
mucus hypersecretion

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5
Q

features of chronic airway inflammation?

A

airway remodelling

airway hyperresponsiveness

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6
Q

pathology of early phase asthma?

A

allergen -> mast cells release IgE

histamines, leukotrienes and TNFa -> increased vascular permeability and hypersecretion of mucus

AIRWAY OEDEMA

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7
Q

key cell in later phase asthma? what happens?

A

eosinophil mediated

increase goblet cells -> hyperresponsive

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8
Q

effect of acute vs chronic inflam?

A

acute inflam -> bronchoconstriction

chronic -> airway hyperresponsiveness

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9
Q

Qs to assess asthma control?

A

in the last 4 weeks how often have you:

i) been SoB?
ii) woken from sleep?
iii) used reliever?
iv) been stopped from doing normal activities?
v) how would you rate asthma control?

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10
Q

what should you always check in asthma?

A

inhaler technique

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11
Q

ix in asthma?

A 
PEFR
Reversibility testing [FEV1 improves by 15% on SABA]
spirometry 
CXR
FBC
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12
Q

mx of asthma?

A
  1. saba
    • ics
    • ltra
    • ltra + laba
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13
Q

ix in acute exacerbation of asthma

A

PEF
SpO2
ABG

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14
Q

mx of acute asthma exacerbation?

if exhausted?

A 
OSHIT
O2 (94-98)
Salbutamol (neb)
Hydrocortisone/pred
Ipratropium (neb)
Theophyline (IV)
MgSO4 (IV)

if exhausted -> intubate

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15
Q

features of life threatening asthma attack?

A 
33,92,CHEST
33>PEFR
92>O2 sats
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachypniea
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16
Q

what is COPD

A

chronic obstruction, irreversible -> air trapping and hyperinflation

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17
Q

pathology of COPD

A

chronic inflam -> increased goblet cells, narrow airways + vascular changes -> pulm HTN

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18
Q

o/e of COPD

A

barrel chest
CO2 flap
hyperresonant

In actue exacerbation -> coarse crackles + wheeze

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19
Q

comps of COPD

A 
cor pulmonale
pneumonia
depression
polycythaemia
resp failure
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20
Q

signs of cor pulmonale

A

raised JVP
distended neck veins
hepatomegaly

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21
Q

mx of cor pulmonale

A

LT O2

Loop diuretic

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22
Q

T1 vs T2 resp failure

A

T1 = V/Q mismatch [pink puffer]

T2 = alveolar hypoventilation [blue bloater]

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23
Q

spiro finding in COPD

A

obstructive: FEV1/FVC<0.7

non reversible

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24
Q

ix in COPD

A 
Spirometry 
ABG
CXR
FBC
sputum culture
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25
CXR signs of COPD
flat diaphragm increased intercostal spaces hyperlucent lungs increased AP diameter
26
severity of COPD - FEV1
mild > 80% mod 50-80% severe 30-50% v severe <30%
27
non pharma mx of COPD
education vaccinations smoking cessation obesity mx
28
pharma mx of COPD
SABA/SAMA if FEV1>50% [LABA, LABA+ICS] if FEV1<50% [LABA+ICS] then: LABA+LAMA+ICS
29
common causes of COPD exacerbation
H. influenza S. pneumoniae M. catarrhalis
30
mx of acute exacerbation of COPD
``` SHONA Steroids Heparin O2 (88-92%) Neb bronchodilators Abx ```
31
Abx in COPD exacerbation? | CAP vs HAP?
CAP = amoxicillin / doxycycline HAP = vancomycin / tazocin
32
when is pneumonia classified as HAP?
if LRTI >2d post admission
33
pneumonia risk score? + where to treat?
CURB 65 ``` 0-1 = low risk, o/p 2 = mod risk -> admit 3-5 = high risk -> ITU ```
34
cause of CAP in younger adults? | pres?
Mycoplasma pneumoniae dry cough + atypical CXR + AI haemolytic anaemia + erythema multiforme
35
possible cause of HAP in immunocomp patient?
fungus; pneumocystis jirovecii = PCP
36
how does PCP pres?
CD4 < 200 cough sats drop on exertion
37
mx of PCP?
co-trimoxazole
38
pres of CAP?
cough with sputum + expectoration fever (high in pneumococcal) dyspnoea pleuritic pain
39
o/e of pneumonia
crackles reduced air entry (u/l) pleural rub vocal fremitus
40
ix for pneumonia
``` FBC, CRP ABG sputum - MC+S CXR blood cultures +/- urinary antigen -> for legionella and pneumococcus ```
41
CXR of pneumonia?
air bronchograms consolidation atelectasis
42
CURB 65 score = which abx?
0-1 -> amoxicillin/clarithromycin 5d PO 2 -> amoxicililn + clarithromycin 7-10d PO 3 -> co-amoxiclav + clarithromycin (IV) 7-10d
43
if high risk pneumonia and penicillin allergic; what abx?
cefotaxime
44
mx of HAP?
IV cefotaxime + gentamicin
45
mx of legionella
clarithromycin + fluoroquinolone
46
mx of chalmydia pneumonia
doxycycline
47
comps of pneumonia
septic shock ARDS pleural effusion + empyema
48
RFs for TB
``` birth endemic immunocomp poor nutrition over crowding IVDU ```
49
screen for TB
tuberculin skin test
50
what type of infection is active TB
granulomatous
51
ix in TB
CXR 3x sputum acid fast bascilli smear sputum culture FBC NAAT ?HIV
52
stain for TB
Ziehl-Neelsen turns pink
53
seen on CXR of TB: primary? healed primary? post primary?
- consolidation + ipsilat hilar lymphadenopathy - Ghon focus = large round calcified lesion near hilum - upper zone opacities with cavitation + calcification + consolidation of hilum
54
Mx of TB | what to check before?
``` RIPE DOTS Rifampicin (6m) Isoniazid (6m) Pyrazinamide (2m) Ethambutol (2m) ``` directly observed therapy 3x/week
55
TB drugs + SEs?
Rifampicin -> liver toxicity, orange wee Isoniazid -> liver tox, peripheral neuropathy Pryazinamid -> liver tox, hepatitis Ethambutol -> visual disturbance, optic neuritis
56
pres of extra-pulmonary TB
``` pleural effusions LN - scrofula GU - frequency, dysuria, haematuria Bone - osteomyelitis; Pott's disease Brain - meningitis Abdo - ascites ```
57
CT of disseminated TB
millet seed appearance | liver/spleen/lung
58
RFs for DVT
cancer, trauma, major surgery, hospitalisation, immobilisation, COCP, obesity genetics -> factor V leiden, antiphospholipid
59
Virchow's triad in DVT
venous stasis vessel injury activation of clotting system
60
DVT score
Wells >2
61
Ix in wells 0-1?
D-dimer
62
ix in wells >=2
PVUSS
63
comps of PE
RHF -> cardiac arrest
64
types of emboli in PE
``` thrombus amniotic fluid embolus fat embolus air embolus tumour ```
65
o/e PE
``` pleural rub tachyc, tachyp elevated JVP hypoxia shock ```
66
ddx of PE
ACS aortic dissection pneumothorax
67
ix in PE
``` Wells CXR ECG CXR ABG D-dimer ``` CTPA (if Wells>4 or D-dimer +ve)
68
mx of PE? stable? unstable?
100% O2, IV fluids, morphine Stable -> LMWH Unstable -> heparin +/- thrombolysis
69
long term mx of PE
warfarin for 3m
70
mx symptomatic DVT
dalteparin
71
Prevention of VTE
early mobilisation stockings avoid COCP
72
spiro of pulm fibrosis
restrictive FVC reduced FEV1/FVC normal
73
pres of Pulm fibrosis
``` 4Ds Dry cough Dyspnoea Diffuse inspiratory crackles Digital clubbing ```
74
causes of pulm fibrosis
connective tissue disease occupational iatrogenic [amiodarone, bleomycin, MTX] irritants [hypersensitiviy, pneumonitis] radiation
75
RFs for idiopathic pulm fibrosis
smoking dust exposure chronic aspiration
76
Q in IPF?
occupation
77
main comp of IPF
pulm HTN -> cor pulmonale
78
ix in IPF
``` CXR CT spiro -> restrictive ANA (?SLE) Biospy ```
79
XR findings in IPF
reticular shadowing shaggy heart border
80
high res CT of IPF?
ground glass honeycomb reticular
81
general mx of IPF
``` O2 physio exercise / wt loss vaccine smoking cessation ```
82
pharma mx of IPF
anti-fibrotic pirfenidone (inhibits collagen synthesis)
83
DDx for upper lung fibrosis
``` Upper - ESCHART (granulomatous) Extrinsic allergic alveolitis Sarcoid/silicosis Coal worker's pneumoconiosis Histiocytosis X Ank spond Radiotherapy TB ```
84
DDx for lower lung fibrosis
``` Lower - RASCO (systemic) RA Asbestosis Systemic sclerosis/SLE Cryptogenic fibrosing alveolitis Other (drugs) ```
85
upper vs lower lung fibrosis?
upper = granulomatous lower = systemic
86
Caplans syndrome?
pulm fibrosis in coal workers with RA
87
EAA - RFs
hx of exposure to organic dust / birds / agricultural / mould
88
Pathophys of EAA
Non-IgE mediated inflam of alveoli and distal bronchioles
89
ix in EAA
WCC, CRP CXR -> diffuse interstitial shadowing (upper zone) CT -> reticulo-nodular shadowing, ground glass Spiro -> restrictive Bronchoalveolar lavage = CD8
90
Mx of EAA?
allergen avoidance O2 + pred
91
Pneumoconioses? Cause? Latent period? curable?
chronic lung disease from exposure to mineral dust or metal coal, silicosis, asbestosis coal - 10y asbestos - 15-60y incurable NOTIFIABLE ? compensation
92
Coal worker with RA = ?
caplans syndrome
93
conditions causing black sputum?
coal workers pneumoconiosis silicosis
94
ix in asbestosis
CXR -> ground glass
95
asbestosis can cause what cancer?
pleural mesothelioma
96
sx of pleural mesothelioma
dry cough, dyspnoea, clubbing, pleuritic chest pain +/- pleural effusion +/- wt loss, fatigue, fever, night sweats
97
ix in pleural mesothelioma
CXR -> irreg thickening CT thoracentesis -> exudate pleural biopsy
98
mx of pleural mesothelioma
operable at stage 1 + chemo if > 1 -> chemoradio + COMPENSATION
99
pleural effusion?
fluid in potential space between visceral and parietal pleura
100
types of effusion? causes? how to tell the difference?
Transudate (protein<30g/L) -> HF, cirrhosis, hypoalbuminaemia, nephrotic Exudate (protein>30g/L) -> pneumonia, malignancy, TB, AI disease
101
o/e pleural effusion
u/l reduced chest expansion stony dull to percussion decreased breath sounds
102
CXR in small pleural effusion
blunted costophrenic angle
103
bilateral effusion, transudate or exudate?
likely to be transudate
104
mx pleural effusion? transudate? exudate?
trans - do not tap!! ex - symptomatic -> pleural tap
105
mx of malignant cause of effusion
pleurodesis to prevent recurrence
106
causes of bilat hilar lymphadenopathy
``` TIMES TB Inorganic dust [silicosis] Malignancy [lymphoma, carcinoma, mediastinal] EAA Sarcoidosis ```
107
pneumothorax?
air in the pleural space
108
RFs for pneumothorax
primary spontaneous -> tall thin males, smoking, marfans, FH secondary spontaneous -> lung disease; COPD, CF, TB, PCP Trauma
109
tension pneumothorax?
intrapleural pressure > atmospheric pressure valve mechanism lets air in but not out -> lung deflates and mediastinum shits contralaterally compressing great veins and reducing venous return to heart
110
pres of pneumothorax
pain on breathing in
111
o/e of pneumothorax
hyperresonant reduced expansion decreased breath sounds
112
pres + o/e tension pneumothorax
resp distress distended neck veins tracheal deviation away hyperexpanded hemithorax
113
CXR of pneumothorax
visceral pleural line | no lung markings
114
mx pneumothorax? if initially unsuccessful?
high flow O2 aspirate 16-18G cannula in 2nd IC space, mid-clav line if this doesnt work -> chest drain + admit
115
where to put chest drain?
mid-axillary line | IC 4-6
116
DDx of pleuritic chest pain?
``` ACS aortic dissection pneumothorax PE pneumonia malignancy ```
117
bronchiectasis?
permanent dilatation and thickening of airways due to recurrent infection and inflammation
118
causes of bronchiectasis?
post-infection immunocomp genetic [CF, ciliary dyskinesia, A1AD] Connective tissue diseas IBD
119
Bugs often seen in bronchiectasis
aspergillus fumigatus S.aureus, H. influenza, S.pneumonia, Pseudomonas aeruginosa
120
pres on infective bronchiectasis
cough + sputum (+/- blood) dyspnoea + wheeze wt loss + fatigue
121
o/e bronchiectasis
inspiratory coarse crackles (shift on cough) | inspiratory squeaks
122
ix in bronchiectasis
CXR - dilate bronchi with thick walls TRAM-TRACK SIGN CT is gold standard sputum -MC+S
123
Bronchiectasis bugs: gram +ve? gram -ve?
+ve = S.aureus, S.pneumonia -ve = pseudomonas aeruginosa (high risk in CF)
124
mx bronchiectasis
exercise, nutrition, airway clearance (postural drainage) + mucolytics +inhaled bronchodilator +inhaled hypertonic saline
125
mx recurrent pseudomosas
neb gentamicin
126
mx severe exacerbation of bronchiectasis?
IV ciprofloxacin
127
Gene in CF?
CFTR | Cl- channel
128
organs affected by CF
``` lungs bowel pancreas sweat reproductive organs ``` --> thick sticky secretions
129
screening for CF?
immunoreactive trypsinogen on heel prick (Guthrie test)
130
pres of CF
neonates -> failure to pass meconium, FTT, cough resp -> recurrent infections, cough, wheeze, mucus GI -> gallstones, decreased motility Panc _> DM, steatorrhoea Reprod -> male infertility +/- clubbing
131
ix for CF
serum immunoreactive trypsiogen sweat test genetic test faecal elastase (pancreatic assessment)
132
mx for CF
chest physio inhaled bronchodilator inhaled mucolytic (dornoase alfa + hypertonic saline) vaccinations prophylactic abx [fluclox] pancreatic enzymes (DEAK)
133
pressure for pulm HTN
>25mmHg at rest
134
mx pulm HTN
CCB / sildenafil anticoag furosemide +/- O2
135
types of lung Ca?
NSCLC (85%) - adenocarcinoma, squamous cell carcinoma large cell carcinoma SCLC (25%)
136
2ww for lung ca?
``` >40 + 2 of: cough fatigue sob chest pain wt loss anorexia smoker ```
137
paraneoplastic features of SCLC
LEMS [anti-VGCaC] SIADH ACTH [HTN, hyperglycaemia, hypoK, alkalosis]
138
paraneoplastic features of squamous cell Ca
PTH-rP -> hypercalcaemia + bone pain | TSH -> hyperthyroidism
139
paraneoplastic feature of adenocarcinoma
gynaecomastia
140
where are lung adenocarcinomas
peripheral lung
141
where are lung squamous cell carcinomas? | usual pres?
central airway -> obstruction
142
pancoast tumour invades? (3)
brachial plexus -> weakness, paraesthesia, pain sympathetic chain -> horners recurrent laryngeal nerve -> hoarse
143
where is pancoast tumour found?
superior sulcus
144
signs of lung Ca
monophonic wheeze pleural effusion SVCO clubbing
145
ix for lung ca
``` CXR CT/MRI brain spirometry FBC LFT bone scan biopsy ```
146
common mets of lung Ca
liver, bones, brain, adrenals
147
mx SCLC
not surgery! chemo + radio + prophylactic cranial irradiation
148
palliative care sx+mx in lung Ca
``` SoB -> opiate Obstruction -> radio Pleural effusion -> aspiration Cough -> opiate Hoarse ->ENT SVCO -> chemo+radio Bone pain -> radio SCC -> dexamethasone ```
149
Good pastures?
anti-GBM | collagen type IV
150
pres of goodpastures
kidney -> oedema, reduced UO, haematuria | lung -> haemoptysis, cough, SoB
151
ix in goodpastures
urinalysis U+Es Renal biopsy -> crescentic glomerulonephritis CXR Anti-GBM ANA (normal, r/o lupus nephrtitis) Anti-steptolysin O -> r/o post strep glomerulonephritis
152
mx goodpastures
oral corticosteroid +plasmapheresis +cyclophosphamide O2+ blood products for severe pulmonary haemorrhage
153
ABG in resp failure? Type 1? Type 2?
T1; O2<8kPa T2; O2<8kPA + CO2>6kPa
154
mx resp failure
admit + resus aim for sats>90%
155
what is ARDS?
non-cardiogenic pulm oedema and diffuse lung inflammation
156
causes of ARDS?
sepsis | pancreatitis
157
ix ARDS
``` low tidal volume ventilation CXR ABG blood cultures sputum culture urine culture ```
158
mx ARDS
supportive care - resus | Abx + treat cause

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