respiratory Flashcards
(120 cards)
1
Q
3 factors characterizing asthma
A
reversible airway inflammation
airway hyper responsiveness
inflammation of bronchi
2
Q
causes of asthma
A
atrophy hygiene hypothesis aspirin induced occupational exercise induced
3
Q
describe atrophy and related conditions
A
genetic predisposition to IgE mediated allergen sensitivity
allergic asthma, atopic dermatitis, allergic rhinitis
4
Q
what are the 3 phases of asthma
A
early phase
late phase
chronicity
5
Q
describe early phase of asthma
A
type 1 hypersensitivity->IgE release activating mast cells
mast cells degranulate w/ histamine
6
Q
what role does histamine play in early phase of asthma
A
smooth muscle contraction + bronchoconstriction
7
Q
describe late phase of asthma
A
recurrence of inflammatory cells such as polymorphonuclear/ T cells
beta agonist cannot accomplish complete reversal
8
Q
describe chronic phase of asthma
A
airway remodelling (non reversible) persistent inflammation w/ airways filled with fibrous tissue
9
Q
diagnostic of asthma
A
spirometry: obstructive pattern
FeNO: eospinopilic airway inflammation is raised
peak flow tests daily recorded
10
Q
obstructive vs restrictive pattern spirometry
A
obstructive:
FVC: normal/ reduced, FEV1: reduced
FEV1/FVC: <70%
restrictive:
both decreased, ratio is normal %
11
Q
treatment of asthma
A
SABA
SABA+ low dose ICS
low dose ICS+ LABA
higher ICS+ LABA
(move to second stage when there is uncontrolled symptoms)
12
Q
acute attacks of asthma
A
salbutamol (SABA)
oxygen (94-98%)
steroids (prednisolone/ IV hydrocortisone)
ipratropium bromide
13
Q
mode of action: ipratropium bromide
A
SAMA: muscarinic antagonist
14
Q
mode of action: adrenaline
A
alpha agonist
15
Q
define COPD
A
non reversible long term blockage in air flow to lung tissue damage: smoking, alpha 1 antitrypsin deficiency
16
Q
COPD vs ASTHMA
A
COPD not reversible w/ bronchodilators, symptoms will exacerbate during lung infections
17
Q
describe COPD: chronic bronchitis
A
- chronic inflammation of bronchi with neutrophilic, CD8+ t lymphocytes and macorphages infiltration
- chronic productive cough for 3 months over 2 consecutive years
18
Q
pathological changes in chronic bronchitis
A
goblet cell hyperplasia
mucus hypersecretion
narrowing of small airways
19
Q
describe COPD: emphysema
A
abnormal air sac enlargement distal to terminal bronchioles causing reduced area for gas exchange->chronic hypoxia
20
Q
what causes alveoli destruction in emphysema
A
^proteases due to neutrophils and macrophages-> protease elastase cause decrease elastin-> collapse/ dilation and bullae formation
21
Q
COPD symptoms
A
productive cough, SOB, wheeze, recurrent respiratory infections
22
Q
diagnosis of COPD
A
spirometry
CXR, FBC, BMI
23
Q
COPD: long term management
A
smoking cessation+ flu vaccines
- SABA/ SAMA
- LABA/LAMA
- LABA + ICS
24
Q
when is long term oxygen therapy used in COPD
A
PaO2< 7.3 kPa
or
PaO2< 8 kPa with:
pulmonary hypertension, peripheral oedema
25
symptoms of COPD exacerbation
pyrexia, SOB, sputum
CO2 retention-> flapping tremor/ confusion
cracked wheeze on auscultation
26
define type 1 respiratory failure
normal pCO2 and low pO2
27
define type 2 respiratory failure
raised pCO2 and low pO2
| ie, COPD
28
effect of CO2 and HCO in lungs
^CO2= acidic (low pH)
| ^ HCO= basic (high pH)
29
2 rules for oxygen saturations in COPD
1. if retaining CO2: aim for O2 at 88-92% with Venturi mask
| 2. not retaining CO2 + bicarbonate is normal: aim for oxygen sat 94% +
30
at home COPD exacerbation treatment
prednisolone
inhalers or nebulizers
antibiotics for infections
31
in hospital non severe COPD exacerbation treatment
nebulised bronchodilators
steroids
antibiotics for infection
physiotherapy for sputum
32
in hospital severe COPD exacerbation cases treatment
IV aminophylline
non-invasive ventilation, intubation
Doxapram
33
define pneumonia
inflammation of the lung parenchyma where normal air-filled lungs is filled with infective liquid known as consolidation
34
what are the three route for bacteria to reach the lungs
inhalation
aspiration
hematogenous
35
name the organisms involved in CAP: typical pneumonia
streptococcus pneumonia
| haemophilus influenza
36
name the organisms involved in CAP: atypical pneumonia
```
mycoplasma pneumoniae
coxiella burnetti (Q fever)
```
37
presentation of streptococcus pneumoniae
cough, pleuritic pain, pyrexia
| leukocytosis and raised CRP
38
describe mycoplasma pneumoniae (type, patient type, symptoms, diagnostic)
rod shaped bacterium, no cell wall
young ppl
arthralgia, haemolytic anaemia
serology
39
define hospital acquired pneumonia
pneumonia contracted> 48 hours after hospital admission
40
organisms in hospital acquired pneumonia
gram negative bacteria:
pseudomonas aeruginosa
staphylococcus aureus
legionella pneumophila
41
describe pseudomonas aeruginosa (type, risk factor, sputum)
gram negative bacillus
immunosuppressed patients (ie, bronchiectasis due to cystic fibrosis)
green sputum
42
pseudomonas aeruginosa treatment
cephalosporin, amino glycoside
43
define aspiration pneumonia
inhalation of oropharyngeal or gastric contents
44
what type of patient may get aspiration pneumonia
neuro/muscular problems
oesophageal conditions
mechanical interventions like endotracheal tubes
45
complications of pneumonia
pulmonary effusion, pneumothorax
| sepsis, AF
46
what does CURB-65 measure for
mortality risk of pneumonia
47
what does CURB-65 stand for
```
C: confusion
U: urea>7
R: respiratory rate> 30
B: blood pressure < 90/60
65 years of age or older
```
48
what does CURB-65 score mean
0-1=low risk/ mild
2= intermediate risk / moderate
3-5= high risk / severe
49
CAP treatment
mild: amoxicillin (use clarithromycin/ doxycycline instead for allergy)
moderate: amoxicillin + clarithromycin
severe: IV co-amoxiclav and clarithromycin
50
2 types of lung cancer
small cell
non small cell (adenocarcinoma, squamous cell, large cell)
(also mesothelioma: asbestos)
51
adenocarcinoma vs squamous cell
Adeno: non-smoker, lung peripheries
squamous: smoker, PTHcentral part of lungs (bronchus)
52
unique features of small cell lung cancer
poor prognosis, fast doubling time
cancer of APUD (neuroendocrine) cell find in lungs
smokers
53
symptoms that may present with small cell carcinoma
ectopic ADH/ACTH production (Cushing's syndrome=^ cortisole)
| weight gain, easy bruising and hyperpigmentation
54
lung cancer: signs of pleural effusion
exudative
dull/ stony percussion
reduced vocal resoncance/ breath sound
55
when should CXR be ordered for lung cancer
patient over 40 + concerning symptoms:
| weightloss, hemoptysis
56
diagnosis of lung cancer
CXR: focal lesion, pleural effusion , widen mediastinum
| CT for suggestive CXR, include neck and upper abdomen for staging
57
T in TNM staging
T0 - tumour not visible but found in sputum culture / bronchial fluids
T1 - 3cm or less
T2 - 3 < x
58
N in TNM staging
N0 - no lymph node metastases
N1 - ipsilateral hilar lymph node
N2 - ipsilateral mediastinal or subcarinal lymph nodes
N3 - contralateral mediastinal or hilar lymph nodes
59
M in TNM staging
M0 - no distant metastases
| M1 - distant metastases
60
cause and spread of TB
caused by mycobacterium spread via aerosolized droplets
61
characteristics of mycobacterium
aerobes
facultative intracellular
acid fast bacilli
62
primary vs progressive primary vs latent TB
prim: initial infection, suppressed in majority of individuals
1a. latent: non infectious state after primary infection
1b. progress: primary infection not suppressed, prolonged infection
63
what is the ghon complex
lesion seen in children w/ TB
| ghon focus+ ipsilateral mediastinal lymph node
64
symptoms of TB
fever, weightless, malaise
65
diagnosis of TB
Active: CXR, Ziehl-Neelson stain(AFB, langhans type giant cells)
Latent: Tuberculin skin test
66
CXR findings in TB
Ghon focus
Bilateral hilar lymphadenopathy
Miliary shadowing
67
active TB treatment
- Rifampicin, Isoniazid, Pyrazinamide and Ethambutol for 4 months
- Rifampicin and Isoniazid for a further 2 month
68
latent TB treatment
Rifampicin and Isoniazid for 3 months
OR
Isoniazid for 6 months
69
side effects of TB drugs
Rifampicin: hepatitis, orange urine/sweat
Isoniazid: peripheral neuropathy
Pyrazinamide: ^ uric acid, gout
Ethambutol: optic neuritis
70
define pneumothorax
air in intrapleural cavity (between visceral pleura and parietal pleura)
71
what are the 2 types of pneumothorax
spontaneous (no trauma)
| traumatic (yes trauma)
72
2 types of spontaneous pneumothorax and their risk groups
primary: no pathophysiological lungs (tall/thin male)
secondary: pathological lungs (50+ and COPD/ asthmatic patients)
73
symptoms of spontaneous pneumothorax
sudden onset dyspnoea and chest pain
hyper resonance on percussions
decrease air entry
74
what is tension pneumothorax
spontaneous pneumothorax patients who are hemodynamically (abnormal bp, arrhythmias) unstable
75
tension pneumothorax treatment
urgent needle decompression inserted through 2nd intercostal space midclavicular line
76
procedure for haem stable patients w/ spontaneous pneumothorax
send for CXR
77
treatment for primary pneumothorax patients
large (>2cm) or breathless: needle aspiration (14-16G)
| small (<2cm) and asymptomatic: outpatient followup
78
treatment for secondary pneumothorax
(>2cm) or breathless: chest drain
(1-2) : needle aspiration (14-16G)
< 1cm: observe for at least 24h
79
symptoms of traumatic pneumothorax
hypotension + tachycardia
| chest pain + hypoxaemia
80
treatment of traumatic pneumothorax
immediate needle decompression
81
define bronchiectasis
irreversible + abndomal dilatation of airways
| commonly secondary to cystic fibrosis
82
what is the predominant inherited cause of bronchiectasis
primary ciliary dyskinesia
83
symptoms of bronchiectasis
persistent sputum production and cough over years
| may have immune disorders/ COPD
84
diagnostic of bronchiectasis
high resolution CT scan
85
what is bronchiectasis exacerbation
infections cause worsening symptoms
| H. influenzae, S. aureus, P. aeruginosa, and S. pneumoniae.
86
define cystic fibrosis
autosomal recessive mutations to the CFTR gene on the long-arm of chromosome 7
87
when and what test is used to screen CF
day 5 after birth
| newborn heel prick test (measure Immuno-reactive trypsin)
88
what are some confirmatory testings for CF
Sweat test: sweat chloride > 60mmol/L = +++
| Genetic testing: screen for common mutations or entire CFTR gene
89
define pleural effusion
abnormal collection of fluid in pleural cavity (between visceral pleura and parietal pleura)
90
what are the 3 serous membranes that line the lung
Visceral pleura: inner layer. Covers the lungs, blood vessels and bronchi
Pleural space: Contains ~10 mL of fluid
Parietal pleura: outer layer. Attaches to the chest wall
91
function of pleural cavity fluid
Lubricates: easier for the layers to slide over one another during respiration
Generates surface tension: pulls the two layers (parietal and visceral) adjacent to one another
92
where does the pleural cavity get the liquid from?
vessels at the parietal and visceral pleura
93
define hydrostatic pressure and the role it has on pleural cavity fluid
Hydrostatic: pressure exerted by a fluid against a membrane, Increases lead to fluid leaking from blood vessels
94
define oncotic pressure and the role it has on pleural cavity fluid
Oncotic pressure: osmotic pressure produced by large macromolecules (e.g. proteins). Exerts a ‘pulling power’ on fluid
95
define lymphatic drainage and the role it has on pleural cavity fluid
Lymphatic drainage: drains body fluid and returns it to the systemic circulation. Can alter the hydrostatic pressure
96
3 reasons that increase fluid entry to pleural cavity
Increased vasculature permeability
Increased microvascular pressure
Decreased plasma oncotic pressure
97
what causes Increased vasculature permeability
infection, malignancy: loss of fluid and macromolecules from 'leaky' vessels
98
what causes increase microvascular pressure
heart failure: increased venous pressure affects hydrostatic pressure forcing fluid out
99
what causes decreased plasma oncotic pressure
cirrhosis: leading fluid accumulation
100
transudative vs exudative pleural effusion
Transudate: no protein/ cellular content, due to change in hydrostatic and oncotic pressure (HF, cirrhosis)
Exudate: high protein/ cellular content, from inflammatory conditions that affect vessel permeability /lymphatic drainage. (infection/ malignancy)
101
symptoms of pleural effusion
reduced vocal resonance/ breath sounds
stony dull percussion
SOB + non productive cough
102
diagnostic of pleural effusion
CXR
103
symptoms of pulmonary embolism
SOB, pleuritic chest pain, pleural rub,
| sinus tachycardia, DVT symptoms
104
diagnostic of PE
well's score 4+: CTPA, not available-> anticoagulation if safe.
well's score ≤ 4: d-dimer . positive= send for CTPA
105
what is d-dimer
fibrin-degradation product, produced when blood clots are broken down by fibrinolytic system
106
management for PE/ DVT initial and long term
initial: apixaban or rivaroxaban-> LMWH-> thrombolysis
| long term: warfarin, a DOAC or LMWH
107
key features of sarcoidosis
mostly black
CXR: Bilateral hilar lymphadenopathy
red lesions/ erythema nodusum
108
key features of pulmonary fibrosis/ interstitial lung disease
chronic exertion dyspnea
honeycombing (clusters of cystic air spaces)
reticular opacities
109
TLC formula
VC+ RV
| vital capacity + residual volume
110
describe type 1 pneumocytes
thin squamous cell covering 97% of alveolar surface
111
describe type 2 pneumocytes
cuboidal cells, secret surfactant
| may not produce enough until 35 weeks causing premature babies being prone to respiratory distress
112
law of Laplace+ example
tension/ pressure exerted on spherical wall, is inversely proportional to sphere's thickness (thin wall=more pressure/tension)
ie, alveoli are prone to collapse due to alveolar surface tension and surfactant increase alveolar thickness reducing surface tension
113
describe coup symptoms and treatment
inspiratory stridor, cough, and hoarseness
| dexamethasone and supportive care
114
What does wells score PE look for
```
Clinical signs of DVT
PE is likely
Tachycardia > 100
Surgery in the past Monet
Prior DVT/PE
Haemoptysis
Malignancy
```
115
Treatment for HAP
Amoxicillin and metronidazole
| If sevré give in IV form
116
Acute exacerbation of asthma treatment
```
oxygen (94-98%)
salbutamol (neb)
Hydrocortisone (IV) OR oral prednisolone
Ipratropium (neb)
Theophylline (oral)
Magnesium sulphate (IV)
An anesthetist (to intubate)
```
117
Acute exacerbation of COPD treatment
```
Ipratropium
Salbutamol
oxygen (target 88-92%)
Amoxicillin (/doxycycline)
Prednisolone
```
118
Define tidal vs vital volume
Tidal: normal passive air intake and out
Vital: force inspiration and expiration
119
Sevré asthma symptoms
120
Life threatening asthma symptoms
