resp clinical Flashcards
(98 cards)
1
Q
asthma AEx
A
extrinsic -
atopic, genetic
intrinsic -
no trigger identified, late onset
2
Q
asthma Sx
A
episodic symptoms
diurnal variability
dry cough + wheeze
SOB
decreased exercise tolerance
3
Q
asthma SGx
A
history of other atopic conditions (eczema, hayfever, food allergies)
family history
4
Q
asthma Ix
A
CLINICAL DX
high prob -> try treatment
mid prob -> spirometry
- obstructive pattern
- bronchodilator reversibility
low prob -> consider referral / other causes
5
Q
asthma Tx
A
- SABA + ICS
- add LABA / LAMA
- add montelukast / theophylline
- add oral steroid / omalizumab/mepolizumab/dupilumab
6
Q
ACUTE asthma Tx
A
60% O2
salbutamol + ipratropium NEB
hydrocortisone IV OR oral prednisolone
Mg sulphate / aminophylline IV
intubation if failing
7
Q
COPD AEx
A
smoking
age
genetic predisposition
8
Q
COPD Sx
A
chronic symptoms
progressive SOB
chronic cough
non-atopic exacerbations
9
Q
COPD SGx
A
wheezing (CB)
reduced breath sounds (EM)
10
Q
COPD Ix
A
clin presentation + spirometry
- obstructive pattern
DLCO decreased in EM
11
Q
COPD Tx
A
smoking, pulm rehab, vaccines
TL - LAMA, Dx ?
TR - LAMA/LABA, LAMA/LABA/ICS (EoS)
BL - bronchodilator
BR - LABA or LAMA
12
Q
ACUTE COPD Tx
A
oral prednisolone
increase SAMA / SABA
antibiotics (infection)
hospital = O2 + NEB/NIV
13
Q
CF AEx
A
autosomal recessive
caucasians
14
Q
CF Sx
A
recurrent resp infections
chronic daily cough + sputum
SOB
nasal polyps
haemoptysis
15
Q
CF SGx
A
salty sweat
infertility (males)
CF related diabetes
cyanosis
clubbing
chest hyperinflation
bilateral course crackles
GI symptoms also
16
Q
CF Ix
A
sweat test - diagnostic
genetic testing for CFTR mutations
17
Q
CF Tx
A
chest physiotherapy
CFTR modulators = kaftrio
lung transplant at FEV1 <40%
18
Q
CF Tx (exacerbation)
A
more physio, antibiotics 2 weeks
19
Q
CF Tx (systemic)
A
pancreas - CREON (exocrine failure), diabetes monitoring
liver - TIPSS (portal hypertension)
bowels - DIOS, laxatives, fluids + hydration
20
Q
pneumonia AEx
A
step. pneumoniae
H. influenza (nurseries)
staph. aureus (PWID)
legionella (water/abroad)
mycoplasma (young)
coxiella (farming)
21
Q
pneumonia Sx
A
SOB
pleuritic chest pain
productive cough
fever
elderly -
confusion
diarrhoea
reduced mobility
22
Q
pneumonia SGx
A
rigors
crackles and rub
tachypnoea
herpes labialis (reactivation of HSV)
cyanosis
23
Q
pneumonia Ix
A
CAP generally not Ix
FBC, CRP, U+E
CXR = consolidation
sputum culture, blood culture (generally for suspected res / atypical)
24
Q
pneumonia Tx (CAP)
A
CURB 0-2: amoxicillin PO/IV (AL: doxycycline)
CURB 3-5: co-amoxiclav IV + doxy PO (AL: levofloxin)
ICU: co-amoxiclav + clarithromycin IV (AL: levofloxin)
25
pneumonia Tx (HAP/aspiration)
non-severe: PO amoxicillin (AL: doxycycline)
severe: amoxicillin + gentamycin IV (AL: doxycycline + gent)
aspiration + metronidazole to each (anaerobic cover)
26
pneumonia Tx (atypicals)
doxycycline
legionella: clarithromycin / erythromycin OR levofloxin
27
pleural effusion AEx
transudative -
HF, liver cirrhosis
(protein <30)
exudative - malignancy, infection (protein >30)
28
pleural effusion Sx
chest pain
dry cough
SOB
difficulty taking deep breaths
29
pleural effusion SGx
reduced chest expansion (one side)
stony dull percussion
30
pleural effusion Ix
CXR
aspiration - colour, cytology, microbiology, pH, glucose
pleural biopsy
31
pleural effusion Tx
treat underlying disorder
(infection) simple effusion = antibiotics
complicated = antibiotics + chest drain
32
empyema AEx
complication of pneumonia
primary = iatrogenic / idiopathic
RF: immuno def / suppression
33
empyema Sx
slow to resolve pneumonia
may get better + spike
34
empyema Ix
CXR - fluid level (meniscus)
USS - preferred method
CT - empyema / abscess distinction
35
empyema Tx
broad spec Iv antibiotics (amoxi + metronidazole)
oral antibiotics after cultures (usually co-amoxiclav)
chest tube drainage (5th ICS, midaxillary)
36
intrapulmonary abscess AEx
complication of pneumonia
can be due to septic emboli (PWID)
37
intrapulmonary abscess Sx
pneumonia that worsens despite treatment
weight loss
cough +/- sputum
lethargy, tiredness, weakness
38
intrapulmonary abscess Ix
CXR - walled cavity
CT - differentiate abscess / empyema
39
intrapulmonary abscess Tx
broad spec antibiotics
(occasionally) surgical drainage / resection
40
bronchiectasis AEx
CF (most common)
bronchial obstruction
lung infection
immunodeficiency
idiopathic
41
bronchiectasis Sx
chronic productive cough
fever + malaise
haemoptysis (flecks)
42
bronchiectasis SGx
clubbing
recurrent infections
coarse crackles
reduced / absent breath sounds
43
bronchiectasis Ix
CT - thickened + dilated airways, 'signet rings'
44
bronchiectasis Tx
underlying cause
physio - airway clearing techniques
antibiotics for acute exacerbations
45
lung cancer AEx
smoking
asbestos
pollution
46
lung cancer Sx
cough 3+ weeks
SOB
haemoptysis
chest / shoulder pain
weight loss
tiredness / lack of energy
hoarse voice (recurrent laryngeal nerve)
47
lung cancer SGx
stridor
clubbing
enlarged liver
swollen lymph nodes
tracheal deviation
pleural rub / stony dull percussion
recurrent pneumonia
48
lung cancer Ix
FBC, coagulation screen, decreased Na+, increased Ca2+
CXR - peripheral not visible
biopsy - bronchoscopy (central), Ct guided (peripheral), lymph node /pleural fluid aspiration
CT thorax (staging), PET scan (mets), USS (pleural effusion)
49
lung cancer Tx
SCLC - chemo / radiotherapy
NSCLC - peripheral excised,
chemo / radiotherapy
palliative - chemo / radiotherapy, stenting, analgesia, antiemetics
50
mesothelioma AEx
asbestos (20-40 years later)
51
mesothelioma Sx
SOB
chest pain
weight loss
52
mesothelioma SGx
present w/ pleural effusion
stony dull percussion
53
mesothelioma Ix
CXR - plural effusion, 'pleural mass w/ lobulated margin', pleural thickening
CT - pleural mass (staging)
biopsy - thoracoscopy
aspiration - lymphocytes + decreased glucose
54
mesothelioma Tx
palliative - chemo / radiotherapy
TALC (sclerosing agent)
long term pleural catheter
54
pneumothorax AEx
primary spontaneous -
no underlying lung disease
(usually) ruptured bulla
RF = tall thin men, smokers
secondary spontaneous -
underlying lung disease (COPD), iatrogenic, trauma
55
pneumothorax Sx
PSP can be asymptomatic
acute pleuritic chest pain
SOB
56
pneumothorax SGx
hypoxia
tachycardia
reduced breath sounds / expansion (one side)
hyper-resonant percussion
57
tension pneumothorax SGx
hypotension
tachycardic
raised resp rate
tracheal deviation
elevated JVP
58
pneumothorax Ix
CXR
59
pneumothorax Tx
none if asymptomatic
PSP = needle asp (5th ICS, midaxillary), chest drain if fails
60
tension pneumothorax Tx
needle decompression (large gauge canula, 2nd/3rd ICS, midclavicular)
61
restrictive lung disease AEx
intrinsic + extrinsic
62
restrictive lung disease Sx
progressive SOB
+/- dry cough
CO2 retention = headache, confusion, lethargy
63
restrictive lung disease SGx
finger clubbing
obese / kyphosis / scoliosis
fibrotic crepitations
pleural effusion / ascites
cyanosis
CO2 retention = flushed skin, bounding pulse, rapid resp rate, premature heartbeats, muscle twitches, flapping tremor
64
restrictive lung disease Ix
PFT - restrictive pattern
ABGs - type 1/2 resp failure, decreased PaCO2
CXR, chest CT, USS (pleural + abdominal)
bloods - connective tissue screen, vasculitis screen, eosinophilia, secondary polycythaemia (chronic hypoxia)
65
restrictive lung disease Tx
treat underlying cause
supportive = O2, CPAP, NIV
66
pulmonary hypertension AEx
LV systolic dys
mitral regurg / stenosis
cardiomyopathy
hypoxia, PE, congenital HD
67
pulmonary hypertension Sx
fatigue
SOB
chest pain
68
pulmonary hypertension SGx
dependant oedema
elevated JVP
right ventricular heave
tricuspid murmur
loud P2
hepatomegaly (pulsatile)
central cyanosis
69
pulmonary hypertension Ix
echo doppler - estimates systolic pressure
right heart catherization (confirms)
ECG - right axis deviation, RBBB
CXR - cardiomegaly
70
pulmonary hypertension Tx
primary = vasodilators + lung transplant
secondary = treat cause
71
idiopathic pulmonary fibrosis AEx
unknown
(repeated injury to alveolar epithelium - NOT inflamm)
more common in smokers
72
idiopathic pulmonary fibrosis Sx
progressive SOB
dry cough
weight loss
fatigue
malaise
73
idiopathic pulmonary fibrosis SGx
clubbing
cyanosis
bilateral fine inspiratory crackles
74
idiopathic pulmonary fibrosis Ix
PFT - restrictive
CXR - bilateral infiltrates
CT - reticulonodular fibrotic shadowing, traction bronchiectasis, honeycombing (late stage)
biopsy - only if CT isnt diagnostic, usual interstitial pneumonia pattern
75
idiopathic pulmonary fibrosis Tx
antifibrotic drugs
(nintedanib / pirfenidone)
O2 if hypoxic
lung transplant (young)
76
pneumoconiosis AEx
inhaled mineral dust (asbestos / coal)
caplan's syndrome = occ dust + RA
silicosis = silica
77
pneumoconiosis Sx
dry cough
progressive SOB
NO PAIN - malignancy
78
pneumoconiosis SGx
clubbing
inspiratory crackles
79
pneumoconiosis Ix
simple = incidental CXR finding (asymptomatic)
complicated =
spirometry - restrictive
CXR - progressive massive fibrosis
80
sarcoidosis AEx
unknown
type 4 hypersensitivity
81
sarcoidosis Sx
fever
weight loss
fatigue
cough
wheeze
SOB
chest pain
82
sarcoidosis SGx
lung crackles
hepatomegaly
splenomegaly
uveitis
erythema nodosum
skin infiltration
83
sarcoidosis Ix
CXR - bilateral hilar lymphadenopathy
CT - peripheral nodular infiltrates
biopsy - non-caseating granulomas
PFT - restrictive pattern
bloods - increased serum ACE, increase CRP, hypercalcaemia
84
sarcoidosis Tx
acute = self-limiting, steroids in affected vital organ
chronic = PO steroids, immunosuppression
85
hypersensitivity pneumonitis AEx
type 3 hypersensitivity to inhaled pathogen
(thermophilic bacteria (farmers), avian proteins, fungi)
86
ACUTE hypersensitivity pneumonitis Sx / SGx
malaise
dry cough
pyrexia
SOB
crackles
NO wheeze
87
CHRONIC hypersensitivity pneumonitis Sx / SGx
progressive cough + SOB
malaise
crackles
clubbing (unusual)
88
hypersensitivity pneumonitis Ix
acute = CXR - widespread pulmonary infiltrates
chronic = CXR - pulmonary fibrosis
PFT - restrictive pattern
bloods - serum antibodies
lung biopsy if in doubt - non-caseating granulomas
89
hypersensitivity pneumonitis Tx
acute = O2 + steroids, avoid antigen
chronic = antigen avoidance, PO steroids, anti-fibrotic therapy
90
TB AEx
mycobacterium tuberculosis
(also mcyo bovis (from cows))
RF = immigrants, recent contacts, social deprivation, immunosuppression)
91
TB Sx
90% pulmonary only
cough +/- haemoptysis
SOB
10% extra
fever + chills
night sweats
fatigue
loss of appetite
weight loss
erythema nodosum
range of organ specific Sx
92
TB Ix
active = CXR - shadows, lesions, consolidation, ghon focus (granuloma), bilateral hilar lymphadenopathy
ziehil-neelson stains
histology - granuloma w/ caseous necrosis
latent = tuberculin skin test
93
TB Tx
acute = rifampicin + isoniazid (6m), pyrazinamide + ethambutol (4m)
latent = rifampicin + isoniazid (3m) OR isoniazid (6m)
94
sleep apnoea AEx
overweight, middle aged men
enlarged tonsils / adenoids, retrognathia, acromegaly, hyperthyroidism, oropharyngeal deformity, neurological, drugs, anaesthesia
95
sleep apnoea Sx
excessive daytime sleepiness (epworth sleepiness scale)
loud snoring
unrefreshed, restless sleep
96
sleep apnoea Ix
overnight sleep study = oximetry, domiciliary reading, full polysomnography
97
sleep apnoea Tx
treat underlying cause
CPAP
mandibular advancement drive (mild cases)
surgery (mandibular deformities etc)
