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Resp Flashcards

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1
Q

What are the 2 most common causes of acute cough

A

Upper respiratory tract infections (URI) and acute bronchitis are the most common causes of acute cough.

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2
Q

What are the 2 most common causes of sub-acute cough

A

Subacute cough is often a sequela of a URI (postinfectious cough) but can also be due to

1) chronic bronchitis
2) pneumonia.

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3
Q

What are the 2 most common causes of chronic cough

A

Chronic cough is often caused by rhinitis/sinusitis (upper airway cough syndrome), asthma, GERD, and ACE inhibitors.

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4
Q

Red flag symptoms of cough

A

SOB
Blood
Weight-loss
Fever

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5
Q

Which conditions can you see a nocturnal cough

A

Asthma and GERD

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6
Q

DDX for productive cough

A 
pneumonia
bronchitis
bronchiectasis
pulmonary edema
tuberculosis
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7
Q

DDX for non-productive cough

A 
asthma
interstitial lung disease
viral pneumonia (e.g., adenovirus. RSV, influenza virus)
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8
Q

What is the 3rd most common cause of cough

A

GERD

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9
Q

State some clinical features of PE

A

Acute onset of symptoms, often triggered by a specific event (e.g., on rising in the morning, sudden physical strain/exercise)

Dyspnea and tachypnea (> 50% of cases)

Sudden chest pain (∼ 50% of cases), worse with inspiration

Cough and hemoptysis

Possibly decreased breath sounds, dullness on percussion, split-second heart sound audible in some cases

Tachycardia (∼ 25% of cases), hypotension

Jugular venous distension

Low-grade fever

Syncope and shock with circulatory collapse in massive PE (e.g., due to a saddle thrombus)

Symptoms of DVT: unilaterally painful leg swelling

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10
Q

State 4 causes of pulmonary hypertension

A

1) COPD
2) Valvular heart disease-Mitral valve disease
3) chronic sleep apnea
4) idiopathic

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11
Q

What is the difference between cor pulmonale and pulmonary HTN

A

Pulmonary hypertension: chronically elevated mean pulmonary arterial pressure (mPAP) at rest ≥ 25 mm Hg (normal: 10–14 mm Hg) due to chronic pulmonary and/or cardiac disease or unknown reasons (idiopathic form)

Cor pulmonale: altered structure (hypertrophy, dilation) or impaired function of the right ventricle caused by pulmonary hypertension resulting from a primary disorder of the respiratory or pulmonary artery system

basically when Chronic lung disease CAUSES right-sided heart failure(it is called) cor pulmonale

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12
Q

State some signs you will see on physical examination for someone with pulmonary hypertension

A 
Loud and palpable second heart sound (often split)
Parasternal heave 
Nail clubbing
Jugular vein distention 
Symptoms of right heart failure
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13
Q

What is the treatment for pulmonary hypertension

A

Treatment of the underlying cause
E.g., bronchodilators and inhalation corticosteroids for patients with COPD, CPAP for patients with obstructive sleep apnea

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14
Q

State some causes of heart failure-systolic or diastolic

A

Coronary artery disease, myocardial infarction
Arterial hypertension
Valvular heart disease
Diabetes mellitus (diabetic cardiomyopathy)
Renal disease
Infiltrative diseases (e.g., hemochromatosis, amyloidosis)

Cardiac arrhythmias
Dilated cardiomyopathy (e.g., Chagas disease, chronic alcohol use, idiopathic)
Myocarditis
Constrictive pericarditis
Restrictive or hypertrophic cardiomyopathy
Pericardial tamponade

Obesity
Smoking
COPD
Heavy drug (recreational and prescription) and alcohol abuse

The three major causes of heart failure are coronary artery disease, hypertension, and diabetes mellitus. Patients typically have multiple risk factors that contribute to the development of CHF.

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15
Q

Outline the management of PE patient

  • go through stable patient
  • unstable patient
A

Follow flow char on AMBOSS

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16
Q

PE ECG signs are:

A

Sinus tachycardia most commonly seen
Signs of right ventricular pressure overload
SIQIIITIII -pattern
New right bundle branch block
Bradycardia < 50 or tachycardia > 100 bpm
Right or extreme right axis deviation (30% of cases)
T negativity in leads V2and V3 (∼ 30%)

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17
Q

1st line treatment for PE-acute treatment

A

first line for haemodynamically stable PE/DVT Treatment- Apixaban (Direct Xa inhibitor) - remember do not use NOAC in renal impairment

eTG-Oral factor Xa inhibitors (eg apixaban, rivaroxaban) are preferred to dabigatran or warfarin to treat proximal DVT and PE because they do not require parenteral anticoagulation for initiation. Apixaban and rivaroxaban do not require routine anticoagulation monitoring; however, using the correct dose is vital because underdosing may not provide adequate anticoagulation.

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18
Q

What is the long term prophylaxis for PE

A

Long term anti-coagulation

  • First-line- Apixaban
  • DVT or PE provoking factor that is no longer present- anticoagulant therapy for 3 months
  • Otherwise, assess risks and benefit.
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19
Q

Pregnancy VTE is

A

LMWH

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20
Q

Bronchial breath sounds in the lung parenchyma

A

Pneumonia

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21
Q

Bronchodilator reversibility/post-bronchodilator test
What findings need to be there in the test that allows differentiating between reversible obstruction from irreversible destruction

A

An increase in FEV1 by 200ml or 15% of the initial value indicates reversible airway obstruction(bronchial asthma)

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22
Q

3A’s of Klebsiella

Study These Flashcards
A

Aspiration pneumonia
Alcoholics and diabetics
Abscess in lungs

23
Q

Risk factors for melioidosis induced pneumonia

  • what is the organism
  • state risk factors
Study These Flashcards
A

Risk factors

1) T2DM
2) Alcohol
3) Hazardous alcohol consumption
4) CKD
5) Chronic lung disease
6) Immunosuppressive therapy

24
Q

What is the eTG management for pneumonia

Study These Flashcards
A

Management- First is to assess Pneumonia severity, using CURB 65, SMART COP and clinical judgement. Essentially assess the degree of the derangement of vitals + lactate, confusion, multilobar involvement.

Empirical therapy

Low-severity- Out-patient (SMART-COP 0-2)

Mono- Amoxicillin (only if review possible within 48 hours),OR Combination- Amoxicillin, Doxycycline

Moderate severity - Hospital (SMART-COP 3-4)

Benzylpenicillin+ Doxycycline

High severity - ICU (SMART-COP >5)

Ceftriaxone + azithromycin

25
What is the eTG management for pneumonia in the wet climate
eTG- A repeat chest X-ray is recommended for adults 6 to 8 weeks after the episode of pneumonia to confirm resolution. If in tropical region- Low severity- Same as above Moderate Severity- three drug regime Ceftriaxone + Gentamicin + Doxycycline( the last one is a consideration) High Severity Wet- Meropenem or PipTaz + Azithromycin Dry Season- Azithomycin + Ceftriaxone All high severity cases we have to add Azithromycin(marcolide)
26
Complications of pneumonia-SLAP HER
- Respiratory failure - Hypotension - Atrial fibrillation( common in elderly) - Pleural effusion( inflammation of the pleura by adjacent pneumonia may casue fluid exudation into the pleural space) - Empyema( pus in the pleural space) - Lung abscess - Septicaemia - Pericarditis and myocaridits - Jaundice
27
Which location and what characteristics do small cell lung cancer(SCLC) posses
Location- central Strong correlation with cigarette smoking Pulmonary neuroendocrine tumour; associated with several paraneoplastic syndromes Very aggressive; early metastases Associated mutations: l-myc
28
What are the two main types of non-small cell lung cancer, which one is more common
Adenocarcinoma- More common | SCC
29
What are the characteristics of an adenocarcinoma-NSLC
Most common type of lung cancer overall and in women Most common lung cancer in non-smokers Associated mutations: EGFR , ALK , and KRAS Distant metastases are common Noninvasive subtype: bronchioloalveolar carcinoma
30
SCC in NSLC- state some characteristics
Strong association with smoking! Cavitary lesions are common Direct spread to hilar lymph nodes ↑ Parathyroid hormone-related protein (PTHrP) leads to hypercalcemia (See Hypercalcemia of malignancy)
31
↑ Parathyroid hormone-related protein (PTHrP) leads to hypercalcemia (See Hypercalcemia of malignancy)
Squamous cell carcinoma in NSLC
32
What are some extrapulmonary symptoms of lung cancer
1) Constitutional symptoms (weight loss, fever, weakness) 2) Clubbing of the fingers and toes 3) Signs or symptoms of tumour infiltration or compression of neighbouring structures 4) Paralysis of the recurrent laryngeal nerve: hoarseness 5) Paralysis of the phrenic nerve: results in diaphragmatic elevation and dyspnea 6) Malignant pleural effusion: dullness on percussion, reduced breath sounds on the affected side
33
Which lung cancer types give paraneoplastic sydrome and what are they
- Clinical syndrome due to chemical product by tumour (not tumour itself) - 3-10% of lung cancers have this and it’s common in small cell carcinomas - Small Cell Carcinoma o Ectopic adrenocorticotropic hormone (ACTH) syndrome: usually results only in weight loss and weakness, but thin skin, wasting of the extremities, central obesity, hirsutism, menstrual irregularities, hypogonadism, bruising, and acne may rarely occur o SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion): excess ADH secretion, hypovolaemia and hyponatraemia - Squamous Cell Carcinoma o Hypercalcaemia – PTHrP secretion (or may indicate malignant bone metastases) - Adenocarcinoma o Hypertrophic Pulmonary Osteoarthropathy (HPOA)/Finger Clubbing
34
What is the cut off for solitary pulmonary nodule to not be worried about
Less than 4mm if there is no clinical symptoms | If there are follow up in 12 months
35
What are signs of CXR that point to malignancy
Solitary nodule Indirect signs: atelectasis, post-obstructive pneumonia, pleural effusion (particularly unilateral), mediastinal widening, cavitary lesions
36
Definition for pleural effusion
Pleural effusion is an accumulation of fluid in the pleural cavity between the lining of the lungs and the thoracic cavity (i.e., the visceral and parietal pleurae).
37
2 types of pleural effusion are
1) Transductive | 2) Exudative
38
Pathophysiology for transductive pleural effusion | -state 3 causes
Increase in hydrostatic pressure Decrease in oncotic pressure Causes- Congestive heart failure Hepatic cirrhosis Nephrotic syndrome
39
Pathophysiology for exudative pleural effusion
Increase in capillary permeability Causes- 1) Infection 2) Malignancy 3) PE 4) Autoimmune
40
What is the criteria for pleural effusion
Light's criteria
41
Pleural fluid with blood indicated
Malignancy
42
What is the treatment for pleural effusion
Treat underlying condition (e.g., loop diuretics for acute congestive heart failure, antibiotics for pneumonia). Therapeutic thoracentesis to remove fluid A chest x-ray should be performed after each of these procedures in order to rule out iatrogenic pneumothorax!
43
What is the life-threatening variant of pneumothorax
Tension pneumothorax
44
P-THORAX
``` Pleuritic pain Tracheal deviation Hyperresonance Onset sudden Reduced breath sounds (and dyspnea) Absent fremitus X-rays show collapse. ```
45
Tension pneumothorax the trachea shifts to the vs spontaneous pneumothorax the trachea shifts to the
In spontaneous pneumothorax, a shift may occur toward the ipsilateral side. TP-Tracheal deviation towards the contralateral side
46
COPD - what does treatment depend on - what is the mainstay treatmtn
Treatment depends on the GOLD stage but is mainly comprised of -short and long-acting bronchodilators (beta-agonists and parasympatholytics) and glucocorticoids.
47
3 main complications of COPD
1) Pulmonary hypertension 2) Exacerbation of COPD 3) Respiratory failure Alveolar hypoventilation → hypoxic pulmonary vasoconstriction → pulmonary hypertension → cor pulmonale
48
Chronic bronchitis vs Emphysema
Chronic bronchitis: productive cough (cough with expectoration) for at least 3 months each year for 2 consecutive years Emphysema: permanent dilatation of pulmonary air spaces distal to the terminal bronchioles. The condition is caused by the destruction of the alveolar walls and of the pulmonary capillaries required for gas exchange.
49
O2 therapy for COPD patients should be given with care why?
Their respiratory centres are relatively insensitive to CO2 and they rely on hypoxic drive to maintain respiratory effort —supplemental oxygen should be given with care.
50
FEV1/FVC has to be less than how much in COPD
70%
51
Post-bronchodilator test--> asthma vs COPD
FEV1 does not increase significantly (ΔFEV1 ≤ 12%)→ Irreversible bronchoconstriction → COPD more likely FEV1 increases significantly → Reversible bronchoconstriction → Asthma more likely
52
What supplementation is needed for COPD
Vitamin D3 and calcium in cases of deficiency
53
Aspirin-induced asthma: mechanisms
Aspirin-induced asthma: NSAID inhibition of COX-1 → ↓ PGE2 → ↑ leukotrienes and inflammation → submucosal edema → airway obstruction

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