Respiratory Flashcards
(113 cards)
1
Q
What is COPD?
A
Chronic Obstructive Pulmonary Disease - a disease characterised by airflow limitation that is not fully reversible
2
Q
Name 2 diseases which are included within COPD.
A
- Emphysema (pink puffers)
- Chronic bronchitis (blue bloaters)
3
Q
What happens in emphysema?
A
Alveolar destruction which leads to decreased elasticity of the lungs
4
Q
What happens in chronic bronchitis?
A
Airway narrowing due to hypertrophy and hyperplasia of mucus secreting goblet cells
5
Q
How is chronic bronchitis clinically defined?
A
A productive cough for at least 3 months a year, for at least 2 years
6
Q
What is the main risk factor for COPD?
A
Smoking
7
Q
What can increase the risk of early onset COPD?
A
Alpha-1 antitrypsin deficiency
8
Q
What are the risk factors for COPD (5)?
A
- Smoking
- Alpha-1 antitrypsin deficiency
- Increasing age
- History of lung infections
- Exposure to tobacco smoke, air pollution, dust, vapours, fumes, gas
9
Q
Describe the presentation of COPD (3).
A
- Productive cough
- Shortness of breath
- Barrel chest
10
Q
What causes a barrel chest as seen in COPD?
A
In COPD, less air is expelled so there is a build-up of air within the lungs which causes hyperinflation of the lungs
11
Q
Is clubbing seen in COPD?
A
No
12
Q
How will COPD sound on percussion?
A
Hyper-resonant
13
Q
How will COPD sound on auscultation (4)?
A
- Distant breath sounds
- Poor air movement
- Inspiratory crackles
- Expiratory wheeze
14
Q
How is COPD diagnosed?
A
Spirometry
15
Q
Which aspect of spirometry is used to monitor the progression of COPD?
A
FEV1
16
Q
What is meant by airway obstruction (2)?
A
Blockage of the airway which makes it difficult to expel all of the air in the lungs
- FEV1/FVC < 0.7
17
Q
Give examples of conditions which cause airway obstruction (5).
A
- COPD
- Asthma
- Cystic fibrosis
- Bronchiectasis
- Bronchiolitis
18
Q
What is meant by airway restriction (2)?
A
Decreased ability of the lungs to expand and fill with air
- FVC < 80% of predicted
- FEV1/FVC is normal
19
Q
Give examples of conditions which cause airway restriction (5).
A
- Pulmonary fibrosis
- Pneumonia
- Tuberculosis
- Sarcoidosis
- Asbestosis
20
Q
What other investigations can be used in the diagnosis of COPD (3)?
A
- Chest X-ray - exclude malignancies
- FBC - exclude anaemia
- ABG - for respiratory failure
21
Q
What would a COPD chest X-ray show (3)?
A
- Hyperinflation
- Flattened diaphragm
- Bullae - pockets of air
22
Q
Describe the stages of COPD.
A
- Mild - FEV1 above 80% of predicted
- Moderate - FEV1 50 - 80% of predicted
- Severe - FEV1 30 - 50% of predicted
- Very severe - FEV1 less than 30% of predicted
23
Q
What is the most useful management for COPD?
A
Smoking cessation
24
Q
Describe the management of COPD.
A
- 1st line - SABA/SAMA
- Asthma features present - SABA/SAMA as required + LABA + ICS
- Asthma features not present - SABA/SAMA as required + LABA + LAMA
25
How can an acute exacerbation of COPD be managed (6)?
- ABG to determine the level of intervention required
- Oxygen
- Bronchodilators
- Oral prednisolone
- CPAP before intubation and ventilation
- Antibiotics for infective causes
26
Name 2 organisms which can cause infective exacerbations of COPD. Which is most common?
- Haemophilus influenzae - most common
- Streptococcus pneumoniae
27
What prophylactic antibiotic can be used for COPD?
Azithromycin
28
How many cigarettes are in 1 pack?
20 cigarettes
29
Describe the MRC scale for shortness of breath.
- Grade 1 - SOB with strenuous exercise
- Grade 2 - SOB when hurrying or walking uphill
- Grade 3 - walks slower for people their age, stops for breath when walking on flat land
- Grade 4 - SOB after walking 100m on flat land
- Grade 5 - too SOB to leave the house, SOB doing day-to-day activities e,g changing clothes
30
How can COPD and asthma be differentiated?
- COPD - irreversible airway obstruction
- Asthma - reversible airway obstruction, symptoms improve with treatment e.g salbutamol
31
What type of reaction is asthma?
Type 1 hypersensitivity reaction
32
What can trigger asthma (7)?
- Air pollution
- Animals
- Infection
- Dust
- Damp/cold
- Exercise
- Strong emotions
33
Describe the presentation of asthma (6).
- Personal/family history of atopic triad
- Episodic symptoms
- Diurnal variation - symptoms worse early morning or at night
- Dry cough
- Shortness of breath
- Chest tightness
34
What makes up the atopic triad?
- Asthma
- Hay fever
- Eczema
35
How is asthma diagnosed?
Spirometry
36
How is asthma monitored?
Peak expiratory flow (PEF)
37
How can asthma be managed non-pharmacologically (5)?
- Avoid contact with triggers
- Yearly asthma review
- Yearly flu jab
- Advise exercise
- Avoid smoking
38
How can asthma be managed pharamcologically (4)? Give examples.
- SABA e.g salbutamol
- ICS e.g mometasone, budesonide
- Leukotrine receptor antagonists e.g montelukast
- LABA e.g salmeterol
39
In asthma management, what should be done before increasing the dose of a drug or adding a new drug?
Check inhaler technique and adherence
40
Describe the long-term management of asthma in adults.
1) SABA
2) SABA + ICS
3) SABA + ICS + LTRA
4) SABA + ICS + LABA (stop LTRA)
41
How can an acute asthma attack be managed?
OSHIT:
- Oxygen
- Salbutamol nebulised
- IV hydrocortisone or oral prednisolone
- Ipratropium bromide nebulised
- Theophylline
42
What is a life-threatening complication of severe asthma?
Cardiac arrest
43
What are 3 causes of narrowing in asthma?
- Increased mucus production
- Bronchoconstriction - smooth muscle contraction
- Inflammation of the mucosa
44
Name 2 side effects of salbutamol.
- Tachycardia
- Tremor
45
Name 2 side effects of ICS.
- Oral candida
- Stunted growth in children
46
What can be used to treat very severe asthma exacerbations?
Magnesium sulfate
47
What are the indicators of good asthma control (4)?
- No breathing difficulties, cough or wheeze on most days
- No night time symptoms
- Inhaler used no more than 3 times a week
- Able to exercise without symptoms
48
What are the signs of life-threatening asthma (6)?
- Silent chest
- Altered consciousness
- Exhaustion
- Cyanosis
- SpO2 < 92%
- PEFR < 33% predicted
49
What is TB?
An infectious disease caused by mycobacterium tuberculosis
50
How does mycobacterium tuberculosis need to be stained?
Zeihl-Neelsen staining:
- Turns bright red against a blue background
51
What type of bacteria is mycobacterium tuberculosis?
Acid-fast bacilli
52
Who is at greater risk of TB (5)?
- Known contact with someone who has TB
- Immigrants from areas with high rates of TB
- Immunosuppression
- Homeless people
- IVDU
53
Describe the presentation of TB (6).
- Recent travel
- Chronic, gradually worsening symptoms
- Cough - initially dry, later productive
- Fever
- Night sweats
- Weight loss
54
Where does a TB infection most commonly occur?
Lungs
55
Name a pathological hallmark of TB.
Caseating granulomas - immune cells encapsulate bacteria to try and contain it
56
What is active TB?
Active TB infection within the body
57
What is latent TB?
Immune system encapsulates sites of infection to stop the progression of the disease:
- Has TB bacteria
- No symptoms
- Not infectious
58
What is secondary TB?
Latent TB reactivates, usually after being immunocompromised
59
What is miliary TB?
Immune system is unable to control the infection resulting in severe disease
60
What can be seen on X-ray in miliary TB?
Millet seeds
61
Which vaccine can be given to those at increased risk of TB?
BCG vaccine - can only be given if Mantoux negative
62
What is used to look for latent TB (2)?
1st line - Mantoux test (tuberculin sensitivity test)
Confirmation - interferon gamma release assays (IGRA)
63
What type of reaction is involved in the Mantoux test?
Type 4 hypersensitivity reaction
64
What is the 1st line investigation for TB (3)?
Chest X-ray:
- Ghon complexes
- Hilar lymphadenopathy
- Patchy consolidation
65
What is the gold standard investigation for TB?
Nucleic acid amplification testing (NAAT)
66
Who should be notified in all cases of TB?
Public Health England - it is a notifiable disease
67
How is latent TB managed?
- Isoniazid and rifampicin - 3 months
- Isoniazid - 6 months
(Treatment needed due to risk of reactivation)
68
How is active TB managed?
RIPE:
- Rifampicin - 6 months
- Isoniazid - 6 months
- Pyrazinamide - 2 months
- Ethambutol - 2 months
69
Which of the TB drugs are hepatotoxic?
RIP
70
What should patients be prescribed alongside RIPE in the treatment of TB?
Pyridoxine (vitamin B6) - isoniazid can cause peripheral neuropathy
71
What is a side effect of rifampicin?
Red/orange discolouration of urine and tears
72
What is a side effect of isoniazid?
Peripheral neuropathy (I am so numb)
73
What is a side effect of pyrazinamide?
Gout
74
What is a side effect of ethambutol?
Eyes - colour blindness, reduced visual acuity
75
What is cystic fibrosis?
An autosomal recessive genetic condition which affects the mucus glands
76
What causes cystic fibrosis?
Genetic mutation in the CFTR gene on chromosome 7, this affects the chloride channels
77
What is the most common variation of the mutation that causes cystic fibrosis?
Delta-F508 (deletion)
78
How can cystic fibrosis affect the pancreas?
Thick pancreatic secretions can block the ducts, resulting in insufficient enzymes reaching the digestive tract
79
How can cystic fibrosis affect the airways?
Thick airway secretions can result in reduced airway clearance and increased susceptibility to bacterial infections
80
How can cystic fibrosis affect the reproductive system?
Congenital bilateral absence of the vas deferens meaning healthy sperm cannot be ejaculated, resulting in infertility
81
Describe the presentation of cystic fibrosis.
CF PANCREAS:
- Chronic cough
- Failure to thrive
- Pancreatic insufficiency - steatorrhea, varocious appetite due to malabsorption
- A
- Nasal polyps, neonatal intestinal obstruction e.g meconium ileus
- Clubbing of fingers
- Recurrent respiratory tract infections
- Electrolytes - salty skin when kissed
- Absence of vas deferens
- Sputum
82
How can cystic fibrosis be diagnosed shortly after birth?
Newborn blood spot test:
- Looks for pancreatic enzyme IRT which is released into blood in response to pancreatic damage
83
What is the gold standard investigation for cystic fibrosis?
Sweat test
84
Name 2 bacteria which can cause pneumonia in those with cystic fibrosis.
- Staphylococcus aureus
- Pseudomonas aeruginosa
85
How can cystic fibrosis be managed (6)?
- Chest physiotherapy - clear mucus to reduce the chance of infection
- Exercise
- High calorie diet - for malabsorption
- CREON tablets - help digest fats
- Dornase alpha - breaks down DNA to thin respiratory secretions
- Bronchodilators
86
What are the 2 different types of pneumonia?
- Community acquired pneumonia (CAP)
- Hospital acquired pneumonia (HAP)
87
What is community acquired pneumonia?
Pneumonia which develops outside of hospital or less than 48 hours after hospital admission
88
What is hospital acquired pneumonia?
Pneumonia which develops more than 48 hours after hospital admission
89
What are the 2 commonest causes of community acquired pneumonia?
- Streptococcus pneumoniae
- Haemophilius influenzae
90
What is the commonest cause of hospital acquired pneumonia?
E. coli
91
What can cause pneumonia in HIV/immunocompromised patients?
Pneumocystis jiroveci (fungus)
92
How is pneumocystis jiroveci treated?
Co-trimoxazole
93
Name 3 causes of atypical pneumonia.
- Legionella pneomophilia
- Mycoplasma pneumoniae
- Chlamydophilia pneumoniae
94
What is the 1st line treatment for atypical pneumonia?
Marcolides e.g azizthromycin, clarithromycin
95
What is the likely cause of pneumonia in alcohol-dependent patients?
Klebsiella pneumoniae
96
What is a key feature of klebsiella pneumoniae?
Red-current jelly sputum
97
What causes Legionnaires disease?
Legionella pneumophilia - unclean air-conditioning units in Spain
98
Which part of the lung is aspiration pneumonia most likely to affect? Why?
Right middle/lower lobe due to gravity
99
Describe the presentation of pneumonia (6).
- Fever
- Fatigue
- Shortness of breath
- Productive cough
- Haemoptysis
- Pleuritic chest pain - sharp chest pain worse on inspiration
100
How would pneumonia sound on percussion? Why?
Dull due to consolidation
101
What is the scoring system used for pneumonia?
CURB-65
102
Explain the components of CURB-65.
C - confusion
U - urea > 7
R - respiratory rate > 30
B - blood pressure < 90/60
65 - aged > 65
103
What investigations can be done to diagnose pneumonia?
- Oxygen sats
- CRP
- Chest X-ray
104
What is done for a CURB-65 score of 0-1?
5 days of oral amoxicillin (macrolide for penicillin allergy)
105
What is done for a CURB-65 score of 2?
7-10 days of oral/IV amoxicillin and clarithromycin
106
What is done for a CURB-65 score of 3+?
IV co-amoxiclav and clarithromycin
107
What is bronchiectasis?
Permanent dilation of the bronchi due to destruction of the elastic and muscular components of the bronchial wall, often due to recurrent/severe respiratory tract infections
108
What are risk factors for bronchiectasis?
PAC CHAIRS:
- Prior childhood respiratory infections
- Allergy to aspergillus fumigatus
- Ciliary dyskinesia
- Cystic fibrosis
- HIV
- Alpha-1 antitrypsin deficiency
- IBD
- Rheumatoid arthritis
- Sjogrens syndrome
109
Describe the presentation of bronchiectasis (6).
- Productive cough - large amounts of foul-smelling and khaki coloured sputum
- Haemoptysis
- Fever
- Chest pain
- Shortness of breath
- Finger clubbing
110
How is bronchiectasis diagnosed?
Chest CT - signet ring sign
111
How can the causative pathogen of bronchiectasis be identified?
Sputum culture
112
What are the most common causes of bronchiectasis (2)?
- Pseudomonas aeruginosa
- Haemophilus influenzae
113
What is a pleural effusion?
Build-up of fluid within the pleural cavity
