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Phase 2A :!: > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

what are 6 environmental triggers of asthma?

A 
viral/bacterial infection
allergen exposure
food additives
chemicals 
irritants
aspirin
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2
Q

what are 3 risk factors for asthma?

A

FHx
Atopic Hx
nasal polyposis

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3
Q

what are 5 presentations of asthma?

A 
episodic SOB
dry cough
expiratory wheeze and chest tightness
nasal polyposis
diurnal PEFR variation
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4
Q

what are 4 investigations of Asthma?

A

FEV1/FVC ratio - <70% predicted and bronchodilator reversibility

factional exhaled NO - >40 ppb

Peak expiratory flow rate - less than expected in gender and height matched person

skin prick allergy testing

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5
Q

what are 3 differentials for asthma?

A

cystic fibrosis
pulmonary oedema
COPD

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6
Q

what are the 2 different types of asthma?

A

Eosinophilic - most common (70%)

non-eosinophilic

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7
Q

what is atopy?

A

when an individual readily develops IgE against common environmental antigens

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8
Q

what is non-eosinophilic asthma triggered by?

A

exercise, cold air, stress, smoking, obesity, menstrual cycle

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9
Q

what is eosinophilic asthma triggered by?

A

allergens

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10
Q

what drug class should you never give to asthmatics?

A

BETA BLOCKERS

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11
Q

what 4 immune cells are present in asthma?

A

mast cells
eosinophils
dendritic cells
lymphocytes

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12
Q

what are 4 features of an asthma attack?

A

reduced chest expansion
prolonged expiratory tume
bilateral expiratory polyphonic wheeze
tachypnoea

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13
Q

what are 4 features of uncontrolled asthma?

A

PEFR less than 50%
RR < 25
pulse <110
normal speech

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14
Q

what are 3 features of a severe asthma attack?

A

inability to complete sentences
pulse >110
RR >25
PEFR 33-50%

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15
Q

what are 5 features of a life threatening asthma attack?

A 
silent chest
confusion and exhaustion
cyanosis 
bradycardia
PEFR <33%
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16
Q

what is the management for an asthma attack?

A

O2 therapy
salbutamol
nebulised ipratropium bromide
prednisolone/hydrocortisone IV

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17
Q

when in the day is asthma worst?

A

worse at night and early morning

DIURNAL

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18
Q

how is asthma diagnosed with peak flow?

A

a greater than 15% increase in FEV1 or PEFR following bronchodilator inhalation

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19
Q

how do B2 agonists work?

A

binds to B2 receptor coupled with Gs protein
=> adenyl cyclase converts ATP to cyclic AMP =>
increases in cyclic AMP leads to bronchodilation

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20
Q

what are the 4 main treatments of asthma?

A

SABAs - salbutamol and terbutaline

LABAs - salmeterol, formoterol
muscarinic antagonists - ipratropium (short), tiotropium (long)

inhaled corticosteroids - prednisolone, beclomatasone, budesonide

leukotriene receptor antagonists (LTRA) - bronchodilator, montelukast

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21
Q

how do muscarinic antagonists work?

A

act on M3 receptors

prevent Ach from binding => no smooth muscle contraction

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22
Q

what are 6 side effects of corticosteroids?

A 
susceptibility to infection
osteoporosis and muscle wasting 
cataracts
diabetes
skin thinning and bruising
growth retardation
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23
Q

what are 2 steroid sparing agents that can be used in asthma?

A

methotrexate

ciclosporin

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24
Q

what is the medication regime for asthma mild to severe?

A

SABA
SABA + ICS
SABA + ICS + lLTRA
SABA + ICS + ILTRA/LABA + MART

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25
what are 3 complications of asthma?
severe exacerbation airway remodelling candida due to inhaled corticosteroids
26
what is the most common causative agent for CA pneumonia?
streptococcus pneumonia
27
what are 5 manifestations of pneumonia?
``` cough +/- sputum SOB pleuritic chest pain rigors/night sweats and fever abnormal auscultatory findings ```
28
what are 4 investigations of pneumonia?
CXR - new shadowing - gold CRP - raised FBC - raised WBCs sputum culture
29
what assessment tool is used to assess pneumonia severity?
CURB65
30
what is the CURB65 score?
``` Confusion Urea ≥7mmol/L Respiratory rate≥ 30/min Blood pressure; low systolic < 90mm/Hg or diastolic ≤60mm/Hg Age ≥ 65 ```
31
what are 3 risk factors for CA pneumonia?
>65 years resident in healthcare setting COPD
32
what are 3 complications of pneumonia?
septic shock ARDS antibiotic associated C. Diff
33
what is COPD?
a progressive disease state characterised by airflow limitation that is not fully reversible. Contains both emphysema and chronic bronchitis
34
what are 4 causes of COPD?
smoking - 40-70% air pollution occupational exposure alpha-1 Antitrypsin deficiency
35
what are 3 risk factors for COPD?
smoking older age genetics - alpha-1 antitrypsin
36
why is there increased mucous secretion in COPD?
increased goblet cell size and number
37
what are 5 manifestations of COPD?
productive cough and SOB pursed lips - increased resprate and barrel chest cyanosis expiratory wheeze
38
what FEV1/FVC ratio is needed for an obstructive lung disease?
<0.7
39
what FEV1/FVC ratio is needed for a restrictive lung disease?
>0.7
40
what are 3 investigations for COPD?
spirometry - <0.7 => non reversible CXR - rule out pathology, hyper inflated lungs and flat diaphragm FBC
41
what is needed for a COPD diagnosis (bronchitis)?
daily productive cough lasting at least 3 months of the year for at least 2 years in a row
42
what are 3 differentials for COPD?
Asthma congestive HF TB
43
what is alpha-1 Antitrypsin Deficiency?
rare genetic condition causing lung and liver problems early onset COPD/cirrhosis even without smoking/drinking Hx autosomal co-dominant
44
what is the pharmacological treatment for COPD?
``` bronchodilators - SABA => Salbutamol - SAMA => ipratropium - LABA => Salmeterol - LAMA => tiotropium Inhaled corticosteroids ``` order => SABA/SAMA, LABA + LAMA, ICS
45
What are the 4 stages of COPD?
1 - FEV1 >80% predicted 2 - FEV1 50-79% 3 - FEV1 30-49% 4 - FEV <30%
46
what are 3 complications of COPD?
Cor pulmonale resp failure pneumothorax
47
What is cystic fibrosis?
a severely life-shortening genetic disease resulting from abnormalities in the cystic fibrosis transmembrane conductance regulator (CFTR), a chloride channel found in cells lining the lungs, intestines, pancreatic ducts, sweat glands, and reproductive organs.
48
what is the prevalence of CF?
1 in 2500 live births
49
what is the inheritance pattern for CF?
Autosomal recessive on chromosome 7 there are mutations in the CF transmembrane conductance regulator
50
what are 3 risk factors for CF?
FHx known carrier parents Caucasian ethnicity
51
how does CF affect the pancreas?
blockage of exocrine ducts, early activation of pancreatic enzymes, autodestruction of exocrine pancreas
52
how does CF affect the intestine?
bulky stools and intestine blockages
53
how does CF affect the lungs?
mucus retention. Chronic infection, inflammation and lung destruction (fibrosis)
54
what are 5 manifestations of CF?
``` failure to pass meconium/steatorrhoea failure to thrive despite a voracious appetite wet sounding cough recurrent chest infections chronic sinusitis ```
55
what is a GU abnormality that is common in those with CF?
males lacking a vas deference
56
what are 3 investigations of CF?
sweat test - GOLD - >60mmol/L genetic testing Guthrie heel prick test - immunoreactive trypsinogen test
57
what are 3 differentials for CF?
asthma primary immunodeficiency coeliac disease
58
what is the treatment for CF?
``` prophylactic antibiotics - flucloxacillin education chest physio flu vaccine B2 agonists and ICS - symptom relief mucolytics - Dornase alfa pancreatic enzyme replacement immunomodulators - azathioprine ```
59
what are 3 complications of CF?
pneumothorax chronic respiratory acidosis acute respiratory failure
60
what is the average age of survival of a CF patient?
40
61
what is HA pneumonia?
an acute lower respiratory tract infection that is by definition acquired after at least 48 hours of admission to hospital
62
what is the most common early onset HA pneumonia?
pseudomonas aeruginosa < 5 days after admission
63
what is the most common late onset HA pneumonia?
S. Aureus > 5 days after admission
64
what are 3 risk factors for HA pneumonia?
poor infection control/hand hygiene intubation and mechanical ventilation decreased consciousness
65
what extra tests do you have to do in HA pneumonia?
sputum culture nasopharyngeal swap tracheal aspirate samples BEFORE antibiotics
66
what are 3 complications of CA pneumonia?
empyema lung abcess sepsis
67
what is the most deadly cancer in the UK?
Lung cancer
68
what are 3 risk factors for lung cancer?
smoking radon gas occupational exposure
69
what are the 3 different types of primary lung cancer?
small cell non-small cell carcinoid tumour
70
what are some features of small cell lung cancer?
``` more aggressive neuroendocrine tumour high grade associated with smoking CHEMO ```
71
what are some features of non-small cell lung cancer?
85% of primary lung carcinomas squamous cell, adenocarcinoma, large cell resection + chemo
72
what are some features of carcinoid tumours?
neuroendocrine tumour malignant potential surgery
73
what are 5 manifestations of local lung cancer?
``` SOB persistent cough/new change haemoptysis hoarse voice pleuritic chest pain recurrent chest infections ```
74
what are 4 systemic manifestations of lung cancer?
weight loss fatigue bone pain finger clubbing
75
what are 4 paraneoplastic syndromes?
SIADH secretion of ACTH, PTH and other hormones Hypertrophic pulmonary osteoarthropathy myasthenic syndrome
76
what are 3 manifestations of hypertrophic pulmonary oseteoarthropathy?
digital clubbing periostitis painful arthropathy
77
what are 3 investigations of lung cancer?
CXR CT chest, liver, adrenals sputum cytology
78
what is the prognosis for lung cancer?
10% at 10 years
79
how are lung cancers classified?
TNM classification
80
what are 2 pleural neoplasms?
pleural fibroma - benign | mesothelioma - malignant, usually caused by asbestos
81
what is pertussis?
an upper respiratory tract infection (URTI) caused by bordetella pertussis characterised by a severe cough.
82
what is the causative agent for pertussis?
bordetella pertussis
83
what are 3 risk factors for pertussis?
<6 months baby born to infected mother incomplete immunisation
84
how is pertussis transmitted?
dropplets
85
what are 5 manifestations of pertussis?
``` cough inspiratory wheeze (stridor) rhiorrhoea post-tussive vomiting low grade fever ```
86
what are 3 investigation of pertussis?
culture of nasopharyngeal aspirate/ swab from posterior nasopharynx - PCR serology FBC
87
what are 3 differentials to pertussis?
upper resp tract infection | CA pneumonia
88
what is the management for pertussis?
azithromycin/clarithromycin erythromycin if pregnant
89
what are 3 complications of pertussis?
pneumonia seizure rib fracture
90
what is pleural effusion?
fluid collection between the parietal and visceral pleural surfaces of the thorax
91
what is the most common cause of pleural effusion?
heart failure
92
what are 3 risk factors for pleural effusion?
pneumonia malignancy PE
93
what are 5 manifestations of pleural effusion?
``` SOB dullness to percussion pleuritic chest pain and rub cough quieter breath sounds ```
94
what are 3 investigations of pleural effusion?
posterior-anterior and lateral CXR - blunt costophrenic angle pleural ultrasound microscopy and culture of pleural fluid
95
what are 3 differentials for pleural effusion?
pleural thinking pulmonary collapse elevated hemidiaphragm
96
what is the treatment for pleural effusion?
``` loop diuretics - frusemide therapeutic throacentesis antibiotics if infective pleurodesis (talc) physio oxygen ```
97
what is the normal amount of pleural fluid?
5-10ml
98
what criteria determines whether something is a transudate or exudate?
lights criteria
99
what are 3 complications of pleural effusion?
pneumothorax empyema trapped lung
100
what are transudates? what causes?
pleural fluid protein < 1/2 serum protein caused by HF, liver failure, kidney failure
101
what are exudates? what causes?
pleural fluid protein > 1/2 serum protein caused by pneumonia, cancer, TB, drugs
102
what is empyema?
a bacterial pussy infection of the pleural fluid
103
what is pneumothorax?
abnormal accumulation of air in the pleural space
104
what are 4 risk factors for pneumothorax?
smoker FHx previous pneumothorax
105
what are 5 manifestations of pneumothorax?
``` chest pain SOB ipsilateral reduced breath sounds hypoxia cardiopulmonary deterioration ```
106
what are 2 X -ray signs of pneumothorax?
tracheal shift | visible rim around lung margin
107
what are 3 differentials for pneumothorax?
acute exacerbation of asthma COPD exacerbation PE
108
what is the management for pneumothorax?
pleural aspiration high flow O2 and obs chest drain may need surgery to find and fix hole - thoracotomy
109
what is the management for a tension pneumothorax?
insert large bore cannula into 2nd intercostal space midclavicular line immediately
110
what are 5 signs of a tension pneumothorax?
``` deviated trachea - away surgical emphysema distended neck veins hypotension hyper expansion ipsilaterally mediastinal displacement ```
111
what is the causative agent for TB?
mycobacterium tuberculosis
112
what percentage of latent TB progresses to active?
10%
113
what are 5 risk factors for TB?
``` birth in endemic country exposure to infection immunosuppression Homelessness IVDU ```
114
what is the pathophysiology of TB?
Inhalation of droplet nuclei => engulfed by alveolar macrophages => Multiplies within alveolar macrophage and burst out causing a response from the immune system => either clearance, latent infection or progression to primary disease
115
what kind of granuloma is formed in TB?
caseating
116
what are 7 manifestations of TB?
``` cough fever anorexia/weight loss malaise night sweats pleuritic chest pain haemoptosys ```
117
what are 3 investigations for TB?
CXR 3X sputum acid fast bacilli smear sputum cultures
118
what is the gold standard test for TB?
nucleic acid amplification test
119
how can you test for latent TB?
``` Mantoux test (TB skin test) - also positive with BCG interferon gamma release assay - more specific ```
120
what are 3 differentials for TB?
COVID-19 CA Pneumonia lung cancer
121
what is the treatment for TB?
``` RIPE rifampicin Isoniazid Pyrazinamide Ethambutol ```
122
what are 3 complications of TB?
transmission ARDS pneumothorax
123
what do you have to do when someone is diagnosed with TB?
INFORM PUBLIC HEALTH ENGLAND | ISOLATE PATIENT
124
what are the 5 atypical pneumonia pathogens?
Legionella pneumophila - air conditioning, water sources, hyponatraemia, deranged LFTs Mycoplasma pneumoniae - young adults, autoimmune haemolytic anaemia Chlamydophila pneumoniae Chlamydophila psittaci - birds Coxiella burnetti
125
what antibiotic can be used on S. Pneumonae pneumonia?
``` beta-lactams - Amoxicillin, cefuroxime (if allergic to penicillins) or Macrolides - Clarithromycin or Fluoroquinolones - Ciprofloxacin ```
126
what antibiotics are used to treat H. influenza pneumonia?
beta-lactams + - Co-Amoxiclav or Tetracyclines - doxycycline
127
when is S. Aureus normally a causative agent of pneumonia?
HAP after recent influenza after being on a ventilator
128
what antibiotics do atypical pneumonia bacterias need?
``` macrolides - erythromycin/clarithromycin or tetracyclines - doxycycline or fluroquinalones - ciprofloxacin ```
129
what antibiotics should be started in the treatment of HA pneumonias?
``` Piperacillin-tazobactam (or Co-amoxiclav in early onset) or Cefurioxime possibly Vancomycin for MRSA ```
130
what are the signs of ephasema?
pink puffers - breathing with pursed lips barrel chest flattened diaphragm
131
what are the signs of chronic bronchitis?
wheeze crackles or rales cyanosis - blue bloaters
132
what kind of chemo is used in lung cancer?
platinum based - cisplatin
133
what is is the name of a focal caseating granuloma in TB shown on X-ray?
Ghon complex
134
what kind of hypersensitivity reaction in TB?
type 4
135
what are 4 side effects of rifampicin?
hepatitis orange bodily fluids flu like symptoms impaired contraceptive pill
136
what are 3 side effects of isoniazid?
hepatitis peripheral neuropathy - pyridoxine prophylaxis agranulocytosis
137
what are 3 side effects of pyrazinamide?
hepatitis gout arthralgia and myalgia
138
what are 2 side effects of ethambutol?
optic neutritis | renal impairment
139
what is the management for low severity CA pneumonia?
amoxicillin OR Doxycycline/clarithomycin (atypical suspected)
140
what is the management for moderate severity CA pneumonia?
Amoxicillin + clarithomycin
141
what is the management for severe CA pneumonia?
IV Co-Amociclav and clarithomycin
142
what is the management for high severity HA pneumonia?
broad spectrum antibiotics - ceftriaxone
143
what is the management for low severity HA pneumonia?
oral co-amoxiclav
144
what bacteria is associated with pneumonia in CCOPD?
Haemophilus influenzae
145
what bacteria is associated with pneumonia as a secondary cause or with access or empyema?
s. aureus
146
what fungus can cause pneumonia in those with HIV?
pneumocytitis jiroveci
147
what is the most common opportunistic infection in people with HIV?
penumocytitis jiroveci
148
what staining identified pneumocytitis jiroveci?
silver staining - fungi
149
what is the first line management of pneumocytitis jiroveci?
trimethoprim/sulfamethoxazole (co-trimoxazole) prednisolone IV pentamidine - in contraindications
150
what is the most common cause of interstitial lung disease?
idiopathic pulmonary fibrosis
151
what disease caused X-ray honeycombing of lung tissue?
excess collagen in pulmonary fibrosis
152
what anti-fibrotic agents can be used in interstitial lung disease?
pirenidone or nintedanib
153
what kind of disease is sarcoidosis?
granulomatous (non-caeseating)
154
what are 8 manifestations of sarcoidosis?
``` cough SOB erythema nodosum (lumps on shins) polyarthralgia uveitis constitutional symptoms cervical and submandibular lymphadenoathy lupus pernio ```
155
what electrolyte imbalance does sarcoidosis cause?
hypercalcaemia
156
what is the gold standard investigation for sarcoidosis?
tissue biopsy
157
what enzyme is elevated in sarcoidosis?
ACE - all granulomatous disease
158
what are 3 differentials for sarcoidosis?
TB Lymphoma HIV
159
what is the 1st line treatment for sarcoidosis?
corticosteroids - inhaled budesonide or oral prescidolone 2 - immunosuppressants
160
what proportion of the caucasian population is a carrier for CF?
1 in 25
161
what is normal pulmonary artery pressure?
25 mmHg
162
what are 6 manifestations of pulmonary hypertension?
``` SOB and oedema fatigue chest pain syncope tachycardia raised JVP ```
163
what ECG changes does R heart strain cause?
R ventricular hypertrophy - R waves on chest leads V1-3 and S waves on V4-6 right axis deviation RBBB
164
what is the treatment for primary pulmonary hypertension?
IV prostanoids endothelia receptor antagonist posphodiesterase-5 inhibiter - sildenafil
165
what type of sensitivity reaction is hypersensitivity pneumonitis?
type III/IV
166
what's goodpasture syndrome?
an anti-basement membrane autoimmune disease causing a type II hypersensitivity reaction that affects the lungs and kidneys
167
what are 3 risk factors of good pastures?
HLA-DR15 Infection smoking
168
what are 3 differentials for good pastures?
wegener's granulomatosis SLE microscopic polyangitis
169
what is the management of good pastures?
immunosuppressants - corticosteroids, cyclophosphamide plasmapheresis dialysis ventilation
170
what is c-ANCA a marker for?
Wegener's granulomatosis
171
what is Wegener's granulomatosis?
A multi-system disorder of unknown causes characterised by necrotising granulomatous inflammation and vasculitis of small vessels. affects resp tract and kidneys and is treated with steroids and immunosuppression
172
what is otitis media?
the presence of inflammation in the middle ear, associated with an effusion and accompanied by the rapid onset of symptoms and signs of an ear infection
173
what are 5 manifestations of sinusitis?
``` rhinorrhoea facial pain headache fever voice change ```
174
what is the 1st line antibiotic for bacterial sinusitis?
penicillin V
175
what is epiglottis classically caused by?
HiB infection
176
what kind of bacteria is HiB?
gram-negative coccobacillus
177
what are 7 manifestations of epiglottitis?
``` stridor - high pitched exhale wheeze muffled voice fever sore throat dysphagia tripod position ```
178
what antibiotics are generally given in epiglottitis?
ceftriaxone
179
what is the most common cause of croup?
parainfluenza virus
180
what is the croup cough described as?
barking
181
what does pulmonary hypertension look like on CXR?
Enlargement of the pulmonary arteries Lucent lung fields Enlarged right atrium Elevated cardiac apex due to right ventricular hypertrophy
182
what is the most common non-small cell lung cancer?
adenocarcinoma
183
what are 4 features of bronchiectasis?
persistent cough dyspnoea recurrent pulmonary infections clubbing
184
what kind of lung tumour can cause Horners syndrome?
pancoast tumour
185
what does a pancoast tumour press on to cause Horner's syndrome?
the sympathetic chain
186
name an ICS?
budesonide
187
what is the most common lung cancer in smokers?
squamous cell carcinoma
188
what causes bronchiectasis?
FREQUENT INFECTIONS!!
189
what are 4 complications of bronchiectasis?
pneumothorax empyema lung abscess life threatening haemoptysis
190
what is the treatment for HiB pneumonia?
Co-amoxiclav + | doxycycline
191
what is the most common demographic for sarcoidosis?
black females
192
what is the treatment for a CURB65 score 1 or less?
oral amoxicillin | non-admission
193
what is the treatment for CURB65 score of 2?
oral co-amoxiclav + clarithromycin possible hospital
194
what is the treatment for CURB65 score of 3+?
IV co-amoxiclav + clarithromycin 3 - hospital mebs ICU 4+ - ICU
195
what is the name of a leukotriene receptor antagonist?
Montelukast
196
what are 6 features of well controlled asthma?
``` no night time symptoms inhaler used < 3X a week no breathing difficulties most days exercise without symptoms normal lung function test ```

Phase 2A :!: (14 decks)

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