Respiratory Flashcards

Question

What is asthma

Answer 1

A reversible chronic respiratory condition associated with airway inflammation and hyper-responsiveness

Answer 2

exposure to irritants -> inflammatory response -> effect on airways

Answer 3

Genetic environmental stress medication Prenatal smoking occupation Diet and nutrition

Answer 4

wheeze cough sob chest tighness

Answer 5

Fatigue Interrupted sentences us of accessory muscles cyanosis

Answer 6

tachycardia

Answer 7

tachypnoea

Answer 8

wheeze rubbing reduced breath sounds

Answer 9

hypoxaemia

Answer 10

upper resp viral symptoms polyphonic wheeze on auscultation nasal flaring intercostal recession tripoding

Answer 11

Presence of more than one symptoms FEV1/FVC ration of less than 70% BRD test - shows improvement of FEV1 of 12% and increase in volume of at least 200ml FeNO result of 40ppb or higher PEF helps diagnose

Answer 12

increasing symptoms PEF> 50-75 best or predicted No features of acute severe asthma

Answer 13

pef 33-50% best or predicted RR- >25/min HR->110/min inability to complete sentences in one breath

Answer 14

PEF <33% best or predicted Sp02 < 92% Pa02< 8kPa altered conscious level exhaustion arrythmia hypotension cyanosis silent chest poor respiratory effort

Answer 15

raised PaCO2 and or requiring mechanical ventilation with raised inflation pressures

Answer 16

Spo2<92% PEF 33-50% best or predicted can't complete sentences in one breath or too breathless to talk or feed

Answer 17

Spo2 <92% PEF< 33% best or predicted

Answer 18

FeNO->spirometry ->BDR -> peak flow monitoring ->refer for other tests

Answer 19

Spirometry-> BDR-> FeNO-> Peak flow monitoring

Answer 20

Regular preventer (Low dose ICS) Initial add on therapy (add inhaled LABA to low -dose ICS. Additional controller therapies (consider increasing ICS dose or adding LTRA) Refer to specialist therapies

Answer 21

Regular preventer (Very low dose of ICS or LTRA for <5 yrs) Initial add-on therapy (very low dose ICS + Child>5 -> add inhaled LABA or LTRA and for children <5 add LTRA Additional controller therapies consider increasing ICS to low dose or children >5 add LTRA or LABA Refer to specialist therapies

Answer 22

Nicotine patch Varenicline Bupropion

Answer 23

Vaping Community support Counselling Hypnotherapy Acupuncture

Answer 24

primary lung cancer They can be classified into small cell and non-small cell lung cancers Non small more common than small cell

Answer 25

Smoking History of cancer exposure to harmful chemicals Lung disease

Answer 26

Cough - may be bloody SOB chest pain Hoarseness Fever Noisy breathing Weight loss Slowly resolving chest infection

Answer 27

Anamia Thrombocytopenia Raised leukocytes ESR/CRP may be raised

Answer 28

CXR CT-CAP

Answer 29

Bronchoscopy Biopsy

Answer 30

Smoking cessation Radiotherapy Chemotherapy Surgery

Answer 31

Laryngeal nerve palsy Metastatic Superior vena cava obstruction

Answer 32

Chronic inflammation of the bronchi and bronchioles leading to permanent dilation of these airways

Answer 33

Half is idiopathic but others: Post- infection (TB, pertussis) Congenital Immune deficiency Connective tissue disease Cystic fibrosis Fibrosis

Answer 34

Cystic fibrosis Host immunodeficiency Previous infection congenital disorders of bronchial airways

Answer 35

Persistent cough copious purulent sputum intermittent haemoptysis fever finger clubbing coarse inspiratory crepitation wheeze large airway Ronchi

Answer 36

CXR CT- show dilation of bronchi with or without airway thickening Sputum culture FBC

Answer 37

they are neuro-endocrine tumours commonly originate from cells in the stomach, lungs, duodenum, thymus and liver. The bioactive substances result in diarrhoea, bronchoconstriction, skin flushing, right heart problems

Answer 38

Carcinoid tumour cells secrete bioactive substances like serotonin, bradykinin. These bioactive substances with physical symptoms of flushing, abdominal pain and etc is called carcinoid syndrome

Answer 39

Family history

Answer 40

- Palpable mass - Pain - Weight loss. - Skin changes (pellagra) - Diarrhoea

Answer 41

Group of progressive obstructive lung diseases including chronic bronchitis and emphysema

Answer 42

Damage to endothelium impairing the mucociliary response to clear mucus & bacteria results in airway deformation and narrowing of the lumen limiting airflow

Answer 43

Enlargement of airspaces (alveoli), leading to declining in alveolar surface area limiting gas exchange loss of elastic recoil equals airflow limitation; loss of alveolar supporting structure leads to airway narrowing

Answer 44

- Age - Genetics (alpha-1-antitrypsin deficiency) - Tobacco smoke exposure (smoking & second-hand smoking) - Smoking asthmatics - Exposure to fumes - Exposure to workplace irritants

Answer 45

Blue bloaters Mild dyspnoea Cyanotic Obese Crackles/Wheeze possible Peripheral oedema

Answer 46

Chronic productive cough: cough and sputum production for at least 3 months in each of 2 consecutive years.

Answer 47

PINK PUFFERS Minimal cough Pink skin, pursed lips Cachexic Accessory muscle use Barrell chested Hyperinflation Decreased breath sound

Answer 48

Diagnosed by spirometry - FEV1/FVC less than 0.7 FBCs U&Es CRP CXR Sputum Culture

Answer 49

Smoking cessation offer pneumococcal and influenza vaccine self-management plan

Answer 50

Offer SABA or SAMA then... if not asthmatic ->LABA or LAMA then... if worsening symptom effecting QUALY then consider 3-month trial of LABA+LAMA+ICS or if person has severe or moderate exacerbation within a year then consider LABA+LAMA+ICS

Answer 51

Offer SABA or SAMA then... if asthmatic->LABA+ICS then LABA+LAMA+ICS

Answer 52

- Respiratory infections - Lung cancer - Heart disease - Pulmonary hypertension

Answer 53

Right ventricle failure through pulmonary artery hypertension due to a lung disorder

Answer 54

- Most commonly as a result of high blood pressure in the pulmonary arteries (Pulmonary hypertension) - As a result, increased afterload causes structural problems - Most notably hypertrophy of the right ventricle (mainly chronic) - Because the right ventricle is a good volume pump and not a pressure pump this causes issues - Decreased right ventricle output results in decreased left ventricle filling and therefore reduced cardiac output - Acute cor pulmonale can be caused by pulmonary embolism (PE) or acute respiratory distress syndrome (ARDS)

Answer 55

- Most commonly as a result of high blood pressure in the pulmonary arteries (Pulmonary hypertension) - As a result, increased afterload causes structural problems - Most notably hypertrophy of the right ventricle (mainly chronic) - Because the right ventricle is a good volume pump and not a pressure pump this causes issues - Decreased right ventricle output results in decreased left ventricle filling and therefore reduced cardiac output - Acute cor pulmonale can be caused by pulmonary embolism (PE) or acute respiratory distress syndrome (ARDS)

Answer 56

secondary to lung disease Acute:ARDS, PE Chronic: COPD

Answer 57

Distended neck vein cyanosis raised JVP SOB Tiredness Chest pain

Answer 58

Bloods - FBC, ABG, Coag studies Imaging - CXR, Echocardiogram, CTPA Special Tests - alpha-1-antitrypsin - Broncoscopy - Lung Biopsy

Answer 59

Medical (Usually initiated by secondary care) - Treat underlying disease - Oxygen - Diuretics such as furosemide or Butenamide - Vasodilate the pulmonary arteries - Phlebotomy for severe hypoxia Surgical - Heart or lung transplant as last resort

Answer 60

- Exertional syncope - Hypoxia - Limited exercise tolerance - Peripheral oedema - Tricuspid regurgitation - Death

Answer 61

Cystic Fibrosis is an autosomal recessive disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, on chromosome 7

Answer 62

Failure to thrive, meconium ileus, rectal prolapse

Answer 63

cough, wheeze, recurrent infections, bronchiectasis, pneumothorax, haemoptysis, respiratory failure, cor pulmonale

Answer 64

pancreatic insufficiency, distal intestinal obstruction syndrome, gall stones, cirrhosis

Answer 65

male infertility, osteoporosis, arthritis, vasculitis, nasal polyps, sinusitis, hypertrophic pulmonary osteoarthropathy

Answer 66

Blood spot on newborn sweat test genetic screening Faecal elastase

Answer 67

MDT approach

Answer 68

aka acute laryngotracheitis common childhood illness caused by inflammation of the upper resp tract as a results of a viral infection

Answer 69

parainfluenza RSV

Answer 70

- Viral URTI causes nasopharyngeal inflammation that may spread to the larynx and trachea, causing subglottal inflammation, oedema and compromise of the airway at its narrowest portion - Movement of vocal cords is impaired leading to the characteristic cough

Answer 71

mostly effects 6mnth to 6 yrs old genetics

Answer 72

barking cough stridor hoarse cry coryzal

Answer 73

Modified Westley scoring system clinical diagnosis but o2 stats less than 95 indicated resp impairment

Answer 74

well hydrated, manage fever dexamethasone Nebulised budesonide Nebulised adrenaline

Answer 75

pneumonia pneumothorax pulmonary oedema dehydration

Answer 76

collection or presence of frank pus within pleural space

Answer 77

often due to infections post pneumonia Begins as free flowing pleural fluid that becomes infected Bacteria colonises the free fluid during the exudate stage when there is an increase of fluid production

Answer 78

Anaerobic, staph and gram neg infections are most common causes

Answer 79

Pneumonia endoscopy lung abscess alcoholism Diabetes COPD

Answer 80

SOB Fever and sweating Dry cough Chest pain upon breathing Weight loss Tachypnoea Rales Ronchi Dullness to percussion

Answer 81

**Bloods** - FBCs, U&Es, CRP **Orifice Test** - Throacentesis **X-ray/Imaging** - CXR, CT Chest **Special Tests** - blood cultures

Answer 82

**Medical** - Thoracentesis/ Chest drain - Antibiotics based on causative agent Surgical - removal of affected area

Answer 83

Fibrosis Empyema necessitatis

Answer 84

It is an acute respiratory illness due to infection with the influenza virus

Answer 85

- Influenza A - more frequent and the cause of major influenza outbreaks - Influenza B - tends to circulate with A in yearly outbreaks and causes less severe illness - Influenza C - tends to cause a mild or asymptomatic illness akin to the common cold Influenza A and B viruses cause most clinical disease

Answer 86

- Closed environments - e.g schools, prisons, and residential homes - Very Young - Elderly - Immunocompromised - Pre-existing cardiac or respiratory illness

Answer 87

- Malaise - Anorexia - Headache - Fever - Myalgia - Non-productive cough - Sore throat

Answer 88

- Diagnosis is usually a clinical one. Available tests include: - Direct viral culture of nasopharyngeal swabs/aspirates - PCR

Answer 89

self-limiting

Answer 90

acute bronchitis influenza related pneumonia exacerbation of other conditions

Answer 91

It is a cancerous tumour arising from the mesothelium including that of the pleura

Answer 92

Can be caused by asbestos exposure

Answer 93

Long latency period

Answer 94

12-month life expectancy after diagnosis

Answer 95

Metastatic lung cancers are cancers that have spread to the lungs from a primary source

Answer 96

brain bone abdomen prostate adrenal kidneys

Answer 97

Family history exposure to industrial chemical agents primary cancer genetics

Answer 98

Chest pain SOB Haemoptysis Weight loss Recurrent infection Night sweats Cough

Answer 99

FBC, ESR, CRP, LFT, RFT CXR PET scan ECG

Answer 100

based on individual case

Answer 101

Pleural effusion Superior vena cava

Answer 102

Pneumonia is a common lower respiratory tract infection, characterised by inflammation of the lung tissue. It is almost always an acute infection, and almost always caused by bacteria

Answer 103

Cough and at least one other lower respiratory tract symptom AND New focal chest signs on examination AND EITHER sweating, fevers, shivers, aches and pains OR fever >38 AND No other explanation for symptoms.

Answer 104

- Smoking - Age: infants and the elderly - Alcohol excess - Preceding viral infections: for example: influenza - Bronchial obstruction: COPD - Bronchiectasis - Immunosuppression: AIDS, chemotherapy - Hospitalisation - Underlying predisposing disease: Diabetes, CVD

Answer 105

strep pneumonia

Answer 106

staph aureus mycoplasma pneumonia haemophilus influenza

Answer 107

Klebsiella pneumonia strep pyogenes pseudomonas aeruginosa Coxiella burnetti chlamydia psittaci actinomyces israeli

Answer 108

Mucor spp/Aspergillus spp (mold), Candida spp/cryptococcus spp (Yeast), histoplasma spp/blastomyces spp/coccidioides spp (All dimorphic fungus)

Answer 109

Acute illness characterised by cough, purulent sputum, fever. Other common symptoms aches and pains, vomiting, anorexia, pleuritic chest pain, dyspnoea.

Answer 110

LFT FBC Blood and sputum culture U&E CRP (high) Throat and nasal swab CXR

Answer 111

- Hydration - Resting - Use CURB-65 if in primary care to determine if the patient needs hospital care - Oxygen - Antibiotic

Answer 112

Confusion Urea RR->30 per minute BP- sytolic of 90 or less or diatolic of 60 or lkess 65 years of age or older 0 - low risk 1-2 intermediate if 2 consider hospitalisation 3-5- high -> urgent admission

Answer 113

pleural effusion lung abscess empyema sepsis

Answer 114

less common causative pathogen, not detectable on gram stain

Answer 115

Mycoplasma. pneumoniae, Chlamydophila. pneumoniae and Legionella pneumophila

Answer 116

macrolide or doxycycline

Answer 117

barracks and institutions children and young adults

Answer 118

dry cough sore throat flu like symptoms

Answer 119

myocarditis, meningo-encephalitis, maculopapular rash, haemolytic anaemia

Answer 120

erythromycin/ clarithromycin tetracycline

Answer 121

Previously healthy patient Contaminated air condition Cough, chills, temp, myalgia

Answer 122

confusion hepatitis renal impairment Hyponatraemia lung abscess empyema hypotension

Answer 123

CXR blood culture legionella serolgy

Answer 124

Erythromycin 14 -21 days of antibiotics, O2, IV abx/fluids Rifampicin BD by mouth or IV in combination to all severely ill patients in whom diagnosis confirmed or thought to be likely

Answer 125

droplet spread like coughing or sneezing

Answer 126

Pharyngitis hoarseness otitis media

Answer 127

first line- azithromycin Tetracycline macrolides fluoroquinolones

Answer 128

Pseudomonas aeruginosa, Staphylococcal aureus and Enterobacteriaceae (especially Klebsiella, E. coli and Enterobacter spp.)

Answer 129

acquired 48 hours after admission to hospital

Answer 130

Flucloxacillin erythromycin

Answer 131

High fever rigors pleuritic chest pain purulent and gelatinous blood stained sputumn

Answer 132

alcoholism diabetes, copd elderly

Answer 133

cefuroxime

Answer 134

common pathogen in bronchiectasis

Answer 135

sputum culture

Answer 136

antipseudomonal penicillin (e.g.,ticarcillin, piperacillin), ceftazadime, meropenem, ciprofloxacin

Answer 137

Pneumocystis Jirovecii (carnii) pneumonia (PCP)

Answer 138

dry cough, exertional dyspnoea &desaturation, fever, bilateral crepitations.

Answer 139

co-trimoxazole, pentamidine

Answer 140

A group of lung diseases, also referred to as occupational lung diseases, including asbestosis, silicosis, coal workers pneumoconiosis and Berylliosis

Answer 141

- Smoking - Occupation related: working in environments that expose one to the mineral dusts - Occupations include: - Mining, construction or foundry work - Underground coal mining - High temperature ceramics

Answer 142

- Shortness of breath - Cough - Chest tightness - Wheezing - Haemoptysis - History of industrial work - - Widespread wheeze and crackles on auscultation - Dullness on percussion - Clubbing - Cyanosis - Barrel chest

Answer 143

Highly contagious disease also known as “Whooping Cough”

Answer 144

Vaccine: for 16-31 weeks pregnant and in childhood schedule vaccinations.

Answer 145

- Transmitted by sneeze or cough or through touching of contaminated surface - Caused by Bordetella Pertussis (BP) - BP then releases toxins to help anchor itself to the epithelium - Toxins also paralyse the cilia, causing an excess of mucus build up - Mucus build up triggers violent cough reflex - Causes violent coughing spells called “paroxysms” - Swollen airways cause whooping noise - Significant cause of morbidity and mortality in infants younger than 2 years old

Answer 146

- Vaccine wears off by teenage years so an outbreak can cause pertussis in teenage or adult years - Infants less than a year old who unvaccinated or haven’t received all recommended vaccines have a high risk of complications and death

Answer 147

- Runny nose - Nasal congestion - Cough - Low grade fever

Answer 148

FBC CXR Nasopharyngeal swab

Answer 149

Hospital admission for infants under 6 months of age and for any older child who has had apnoeic or cyanotic spells Macrolides can reduce infective period -clarithromycin/azithromycin Oxygen should be given if there is cyanosis.

Answer 150

Progressive increase in pulmonary vascular resistance (PVR) and, ultimately, right ventricular failure and death. Increase in mean pulmonary arterial pressure ≥25 mm Hg at rest as assessed by right heart catheterisation.

Answer 151

- Family History of PAH - Obesity - Obstructive Sleep Apnea - Female Gender - Pregnancy

Answer 152

chest pain, exertional dyspnoea, fatigue, syncope.

Answer 153

small volume pulse, peripheral cyanosis, a raised jugular venous pulse (JVP), a parasternal - right ventricular – heave, peripheral oedema

Answer 154

Right heart catheterisation is needed to confirm the diagnosis ECG - right ventricular hypertrophy Echocardiography - demonstrates a dilated right ventricle with impaired function

Answer 155

Lung nodules are circular/rounded structures that appears on CXR/CT thorax and are traditionally defined as <3cm.

Answer 156

- Infection - Previous lung malignancy - Immunocompromised - Smoking

Answer 157

- Usually asymptomatic - If symptomatic, symptoms would be consistent with underlying pathology such as weight loss/haemoptysis/SOB if malignant, fever/joint pain/SOB/haematuria if infectious/inflammatory cause.

Answer 158

Pleural plaques are benign areas of thickened tissue that form in the pleura, or lung lining

Answer 159

asbestos exposure Pleural plaques develop 10 to 30 years after initial asbestos exposure and usually do not require treatment.

Answer 160

Inflammation of the pleura which compromises lubrication and results in pain

Answer 161

- Pneumonia - Trauma - Cancers such as mesothelioma or lung Ca - Rheumatoid arthritis - Trauma - Pulmonary embolism - Viral respiratory illnesses - Allergic reactions to drugs - HIV - Respiratory conditions such as Asbestos etc

Answer 162

- The lungs, rib cage and chest wall are lined with epithelium known as the Visceral pleura and the Parietal Pleura - The Visceral pleura is known as the inner layer which lines the surface of the lungs - The Parietal Pleura is known as the outer layer and lines the chest wall, rib cage and mediastinum - Both layers are supplied by different nerves resulting in different pain sensations - Parietal pleura is supplied by the Phrenic nerve resulting in sharp localised pain - Visceral Pleura is supplied by the Autonomic nerve resulting in dull achy pain - Between both layers there is fluid which acts as a lubricate allowing for inspiration and expiration - When the pleura is inflamed (which can be caused by many illnesses); the pleural lining rubs together causing pain

Answer 163

- Viral illness - Malignancy - Pneumothorax

Answer 164

Finding can vary depending on cause chest pain exacerbated by deep inspiration cough SOB

Answer 165

These must be done to rule out other causes of Chest pain **Bloods** - Routine including Troponin and ABG (D-Dimer may be done if appropriate) **X-ray/Imaging** - to exclude cardiac cause **Special Tests** - CXR: These will rule out common differentials such as Pneumothorax, pleural effusions, etc - A diagnosis of pleurisy/pleuritis can be done once other differentials have been confidently excluded

Answer 166

- This again is dependent on cause and patients PMH - First line (if patient is otherwise stable) : NSAIDS - Second line: Indomethacin - REMEMBER TO TREAT UNDERLYING CAUSE IF APPROPRIATE (e.g. Abx if cause is a bacterial infection)

Answer 167

- Adhesions of the pleura which can leave patients suffering with Chronic chest pain and SOB - Pleural effusion

Answer 168

Abnormal collection of air in the pleural space The pleural cavity pressure is more than the atmospheric pressure

Answer 169

- Tension pneumothorax occurs when a large amount of air is present within the lung causing the lung to deflate - The pressure outside the lung is greater and can cause the trachea to deviate, eventually kinking the inferior vena cava which is what usually leads to death - Often called a collapsed lung

Answer 170

- Male - Age - Smoking - Mechanical ventilation - Previous pneumothorax

Answer 171

- Sudden chest pain - Shortness of breath - In severe cases – struggling to breathe - PMH of Pneumothorax, Marfan’s Syndrome - Cyanosis - Tachycardia - Absent breath sounds - Hyperresonance on percussion - Tracheal deviation in tension pneumothorax

Answer 172

- BOXES (bloods, orifices, x ray/imaging, ECG, special tests) X-ray/Imaging - CXR: if not life threatening - CT Scan: if not life threatening

Answer 173

Conservative - If less than 2cm and asymptomatic **Medical** - Oxygen if SOB **Surgical** - Wide bore cannula, 2nd intercostal space, midclavicular line to decompress in tension pneumothorax - Chest drain insertion - Pleurodesis: for recurrent pneumothorax

Answer 174

- Can occur repeatedly again - May require surgery to prevent this

Answer 175

Abnormal collection of air within the pleural space The pleural cavity pressure is = the atmospheric pressure

Answer 176

- Traumatic pneumothorax occurs as a result of trauma - Most commonly as a result of a stab wound with a knife - Can also occur with blunt trauma

Answer 177

- Male - Age - Smoking - Mechanical ventilation - Previous pneumothorax

Answer 178

- Sudden chest pain - Shortness of breath - In severe cases – struggling to breathe - PMH of Pneumothorax, Marfan’s Syndrome - Cyanosis - Tachycardia - Absent breath sounds - Hyperresonance on percussion - Tracheal deviation in tension pneumothorax

Answer 179

- CXR: if not life threatening - CT Scan: if not life threatening

Answer 180

Conservative - If less than 2cm and asymptomatic Medical - Oxygen if SOB Surgical - Needle aspiration: Wide bore cannula, 2nd intercostal space, midclavicular line to decompress in tension pneumothorax - Chest drain insertion - Pleurodesis: for recurrent pneumothorax

Answer 181

- Can occur repeatedly again - May require surgery to prevent this

Answer 182

Abnormal collection of air within the pleural space The pleural cavity pressure is less than atmospheric pressure

Answer 183

Primary pneumothorax occurs without cause usually occurs in the absence of significant lung disease

Answer 184

- Male - Age - Smoking - Mechanical ventilation - Previous pneumothorax

Answer 185

- Sudden chest pain - Shortness of breath - In severe cases – struggling to breathe - PMH of Pneumothorax, Marfan’s Syndrome - Cyanosis - Tachycardia - Absent breath sounds - Hyperresonance on percussion - Tracheal deviation in tension pneumothorax

Answer 186

BOXES (bloods, orifices, x ray/imaging, ECG, special tests) **X-ray/Imaging** - CXR: if not life threatening - CT Scan: if not life threatening

Answer 187

Conservative - If less than 2cm and asymptomatic Medical - Oxygen if SOB Surgical - Needle aspiration: Wide bore cannula, 2nd intercostal space, midclavicular line to decompress in tension pneumothorax - Chest drain insertion - Pleurodesis: for recurrent pneumothorax

Answer 188

- Can occur repeatedly again - May require surgery to prevent this

Answer 189

Collection of abnormally present fluid in the pleural space

Answer 190

- Occurs as a result of inflammation of the lungs or pleura - This causes exudative effusion - Systemic infections, heart failure, cirrhosis or malignancy can also cause an effusion - This causes transudative effusion

Answer 191

Infection cancer autoimmune drugs pulmonary embolism

Answer 192

CHF Liver disease ESRD Nephrotic syndrome Pulmonary embolism

Answer 193

Meigs' syndrome Endometriosis

Answer 194

Pancreatic oesophageal rupture

Answer 195

- Congestive heart failure - Pneumonia - Malignancy - Recent CABG surgery

Answer 196

- Shortness of breath - Cough - Pleuritic chest pain - PMH of cardiothoracic surgery, liver cirrhosis, malignancy, renal failure - Decreased/absent breath sounds - Dullness to percussion - Decreased/absent tactile fremitus

Answer 197

**Bloods** - WBC, U&E, CRP, Tumour markers **X-ray/Imaging** - CXR, CT Chest **Special Tests** - Blood cultures, Pleural fluid analysis (Light’s criteria)

Answer 198

Medical - Therapeutic pleural drainage Surgical - Pleurodesis

Answer 199

Pneumothorax

Answer 200

Restrictive disease Pulmonary fibrosis is a condition in which there is diffuse fibrosis of lung parenchyma with a resultant impairment of gas transfer and ventilation-perfusion mismatching.

Answer 201

Family history cigarette smoking advanced age male sex

Answer 202

Dyspnoea Cyanosis Clubbing Slightly reduced chest expansion Bronchial breathing On auscultation there may be late-inspiratory and pan-inspiratory crackles heard over the affected lung

Answer 203

A combination of aforementioned clinical features and imaging/biopsy can suggest the diagnosis of pulmonary fibrosis. - CXR – shows typical scarring pattern in the lungs, suggestive of the disease. Typical basilar, peripheral, bilateral, asymmetrical, reticular opacities - CT scan of the lungs and/or a lung biopsy are usually needed to confirm diagnosis. - CRP and ESR mildly elevated

Answer 204

Pulmonary rehabilitation Corticosteroid therapy Other immunosuppressive therapy - drugs such as cyclophosphamide and azathioprine have been used as a steroid sparing agent Lung transplantation Antifibrotic agents - pirfenidone is an immunosuppressant that is thought to have anti-inflammatory and antifibrotic effects. Oxygen - to palliate symptoms of breathlessness

Answer 205

Clot in the pulmonary artery/arteries impairs perfusion of the lungs and can lead to lung infarction and death A pulmonary embolus is a fragment of thrombus (or clot) that breaks off and travels in the blood until it lodges in the pulmonary vasculature in the lungs.

Answer 206

Endothelial damage, venous stasis and hypercoagulability lead to clot formation

Answer 207

Right ventricular thrombus septic emboli Fat, air or amniotic fluid embolism Neoplastic cells Parasites

Answer 208

Any causes of immobility or hypercoagulability: recent surgery recent stroke or MI disseminated malignancy thrombophilia/antiphospholipid syndrome prolonged bed rest pregnancy, postpartum, COCP/HRT

Answer 209

Small emboli may be asymptomatic large can be fatal SOB Chest pain Haemoptysis Syncope fever Cyanosis Tachcardia Raised jvp Hypotension

Answer 210

WELLS score PERC score D-dimer CXR ECG ABG CT V/Q scan CTPA

Answer 211

HAD CLOTS Hormone Age >50 Dvt/pe history Coughing blood Leg swelling O2 less than 95% Tachycardia- 100+ Surgery/ Trauma

Answer 212

D-dimer is a breakdown product of cross-linked fibrin by the fibrinolytic system. D-dimer levels become elevated when there is lysis of cross-linked fibrin within the thrombus. Used to rule out PE

Answer 213

Recent surgery or trauma Patient has other auto-immune or inflammatory process going on in the body Liver / Renal / Heart Failure Pregnancy Sepsis Sickle cell disease Acute MI or Stroke

Answer 214

The greatest utility of the CXR in diagnosis of PE is exclusion of alternate disorders

Answer 215

Manage airway Anticoagulation DOACS: dabigatran, Rivaroxaban, Apixaban Lowe molecular weight heparin Warfarin orally

Answer 216

Cardiac arrest Pleural effusion Pulmonary infarction Death

Answer 217

Respiratory syncytial virus Contagious viral infection of the respiratory tract, most often the cause of Bronchiolitis

Answer 218

RSV is spread from person to person via respiratory droplet 2-8 days The virus spreads to the respiratory tract targeting the apical ciliated epithelial cells

Answer 219

Chronic lung disease Immune compromised In utero exposure to Tabacco smoke low socioeconomic disease Premature birth

Answer 220

Cold-like symptoms: - Low-grade fever - Cough - Wheezing - Rales - Cyanosis - PMH of premature birth, weakened immune system, heart or lung defects/disease

Answer 221

- FBCs - U&Es Special Tests - Rapid RSV antigen testing

Answer 222

**Conservative** - Observations - Hydration **Medical** - Bronchodilators - Alpha agonists

Answer 223

Bronchiolitis Pneumonia

Answer 224

The interruption of sleep as a result of a narrowing of the throat This leads to irregular breathing at night and excessive daytime sleepiness

Answer 225

Male sex Obesity Smoking Hypothyroidism

Answer 226

Excessive daytime sleepiness Impaired concentration Snoring Unrefreshing sleep Choking episodes during sleep Witnessed apnoeas - a ten-second pause in breathing Restless sleep

Answer 227

Polysomnography - is the gold standard investigation. Epworth Sleepiness scale.

Answer 228

Lifestyle advice/Behavioural interventions – weight loss, smoking cessation, reduction in alcohol consumption. CPAP – it is the gold standard treatment. Pharmacotherapy but its role is limited. Surgery

Answer 229

It is a multisystem chronic inflammatory condition characterised by non-caseating epithelioid granulomata. Affects lungs, skin, lymph nodes and eyes most commonly. Accumulation of lymphocytes and macrophages and the formation of non-caseating granulomas

Answer 230

**Constitutional symptoms** – fever, night sweats, weight loss **Lung** – dry cough, dyspnoea **Skin** – erythema nodosum (tender, painful, bilateral) **Eye** – anterior uveitis

Answer 231

CXR – bilateral hilar lymphadenopathy CT Blood tests

Answer 232

Tuberculosis (TB) is an infection caused by Mycobacterium Tuberculosis and mainly affects the lungs The bacteria is spread by inhaling respiratory droplets

Answer 233

- The disease is airborne - infection occurs through the inhalation of droplets that may be present in the air if someone with TB has been coughing or sneezing - TB is split into two categories: Latent and Active - Latent TB - you have the TB bacteria present within your body, however it is in an inactive state and therefore asymptomatic and isn’t contagious. It can become active at a later stage, usually when the immune system is weaker e.g. neutropenia through chemotherapy, HIV etc - Active TB - can occur either weeks after contracting the bacteria or several years later, now infective to others - The lungs are the most common site for TB infection - Extrapulmonary TB can manifest in other organs mainly the brain and spinal cord

Answer 234

Close contact of TB patient Homeless patients, those with alcohol dependency and other drug misusers HIV-positive and other immunocompromised patients Elderly patients

Answer 235

cough, sputum, haemoptysis, breathlessness, lobar collapse, bronchopneumonia, hoarseness

Answer 236

breathlessness, pain, effusion

Answer 237

pain, arrhythmias, cardiac failure, pericarditis

Answer 238

malabsorption, diarrhoea, obstruction

Answer 239

haematuria, renal failure, epididymitis, salpingitis, infertility

Answer 240

erythema nodosum, lupus vulgaris

Answer 241

iritis, choroiditis, keratoconjunctivitis

Answer 242

arthritis, osteomyelitis

Answer 243

lymphadenopathy, cold abscesses, sinuses

Answer 244

tuberculoma, meningitis

Answer 245

- If Active pulmonary TB is suspected: -Chest X-Ray -Sputum culture sample: for acid-fast bacilli smear, mycobacterial cultures and nucleic acid amplification testing (NAAT)

Answer 246

- If Active extrapulmonary TB is suspected: -Chest X-ray and sputum sample should be requested -Also, additional investigations depending on the likely site of infection

Answer 247

Tuberculin skin test (Mantoux test) - Injecting 0.1mL of liquid containing tuberculin purified protein derivative (PPD) into top layers of forearm skin - Check 48-72 hours after injection - Positive if ≥5 mm skin induration Offer Mantoux test to: - Close contacts of person with active TB - Immunocompromised adults - Healthcare workers - Immigrants from high incidence countries

Answer 248

For people with active TB without central nervous system involvement, offer: - Isoniazid (with pyridoxine), rifampicin, pyrazinamide and ethambutol for 2months - Then isoniazid (with pyridoxine) and rifampicin for a further 4 months. - Modify the treatment regimen according to drug susceptibility testing

Answer 249

- Isoniazid (with pyridoxine) and rifampicin x3 months OR - Isoniazid (with pyridoxine) x6 months

Answer 250

Pleural effusion Empyema Pneumothorax Laryngitis Enteritis Mycetoma with Aspergillus fumigatus in a healed cavity Cor pulmonale secondary to extensive fibrosis Death

Answer 251

Extrinsic allergic alveolitis is a lung disorder resulting from repeated inhalation of organic dust , usually in a specific occupational setting. In the acute form, respiratory symptoms and fever begin several hours after exposure to the dust.

Answer 252

A lung disease that develops due to inhalation of asbestos fibre,which is a fibrous hydrated magnesium silicate. Asbestos fibres are used for building roofs, insulation etc. Long time exposure to asbestos leads to shortness of breath by causing fibrosis of the lung.

Respiratory Flashcards

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