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Respiratory Flashcards

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1
Q

CAP: Pathophysiology (3)

A
  1. Infection causes inflammation of the lung
  2. Fluid and blood cells leak into alveoli
  3. Infection spreads leading to consolidation
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2
Q

CAP: Mortality rate

A

12%

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3
Q

CAP: Three most causative common organisms (3)

A
  1. Streptococcus pneumonia
  2. Haemophilus Influenza
  3. Mycoplasma pneumonia
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4
Q

CAP: Pulmonary Symptoms (5)

A
  1. Cough
  2. SOB
  3. Purulent Sputum
  4. Pleuritic Chest pain
  5. Haemoptysis
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5
Q

CAP: Systemic Symptoms (3)

A
  1. Fever
  2. Malaise
  3. Rigors
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6
Q

CAP: Extrapulmonary Symptoms (3)

A
  1. Confusion
  2. Abdominal pain
  3. GI upset
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7
Q

CAP: Pulmonary Signs (5)

A
  1. Dull percussion
  2. Increased vocal resonance/fremitus
  3. Coarse inspiratory crackles
  4. Reduced Expansion
  5. Bronchial breathing
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8
Q

CAP: Systemic features (4)

A
  1. Tachypnoea
  2. Tachycardia
  3. Hypotension
  4. Cyanosis
  5. Pyrexia
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9
Q

Hospital-acquired pneumonia: Definition (2)

A

LTRI, 48 Hours after hospital admission

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10
Q

Hospital-acquired pneumonia: Causative organisms (3)

A
  1. Pseudomonas aerguinosa
  2. Staphylococcal aureus
  3. Enterobacteria
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11
Q

Aspiration pneumonia: Definition (2)

A
  1. Patients with unsafe swallow
  2. Right lung typically affected as right bronchus is wider
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12
Q

Staphylococcal pneumonia: Key features (2)

A
  1. Bilateral, cavitating bronchopneumonia
  2. Occurs in compromised immune systems - elderly, IV users, Influenza infections
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13
Q

Klebsiella pneumonia: Key features (4)

A
  1. Upper lobes affected
  2. Cavitating
  3. ‘Red-current sputum’
  4. Compromised immune systems
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14
Q

Mycoplasma pneumonia: Key features (3)

A
  1. Flu-like symptoms
  2. Younger patients
  3. Auto-immune features (auto-immune anaemia)
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15
Q

Legionella pneumonia: Key features (3)

A
  1. Flu-like symptoms, SOB, dry cough
  2. Associated with legionnaire’s disease
  3. Hyponatraemia and abnormal LFTs
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16
Q

Chlamydophila psittaci pneumonia: Key Features (3)

A
  1. Psittacosis
  2. Acquired from infected birds
  3. Also infects liver, spleen, kidneys and heart
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17
Q

Penumocystis pneumonia: Key features (2)

A
  1. Occurs in immunosuppressed or HIV positive
  2. Caused by jiroveci (fungus)
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18
Q

CAP: CXR findings (4)

A
  1. Consolidation
  2. Signs of pleural effusion
  3. Cavitation
  4. Loss of heart border
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19
Q

CAP: Investigations (4)

A
  1. Blood cultures
  2. Suptum culture
  3. Urine antigen test (pneumococcal, legionella)
  4. PCR (mycoplasma)
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20
Q

CAP: CURB-65 classification score

A

C - confusion
U - Urea (>7)
R - Respiratory Rate (>30)
B - Blood pressure (<90/<60)
65 - Age > 65 years

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21
Q

CAP: Interpretation of CURB-65 score (4)

A

0-5 score indicating mortality
0-1 Home treatment
2 Consider hospital treatment
3-5 ITU

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22
Q

CAP: Useful biomarkers

A

CRP - if drops by day 3 prognosis is good

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23
Q

CAP: Mild antibiotics (1)

A

Oral/IV amoxicilin

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24
Q

CAP: Moderate antibiotics (2)

A

Oral/IV Amoxicillin and clarithromycin

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25
CAP: Severe antibiotics (2)
IV Co-amoxiclav and IV Clarithromycin
26
CAP: Non-pharmacological management (4)
1. O2 2. Fluid resuscitation 3. Analgesia 4. Chest drain (Empyema)
27
CAP: Prevention (1)
Pneumococcal vaccine (>65, AIDS, chronic conditions)
28
CAP: Complications (2)
1. Parapneumonic pleural effusion 2. Empyema (pus in pleural cavity)
29
CAP: Management of empyema
1. Antibiotics according to culture sensitivity 2. Chest drain 3. Supportive care (O2)
30
Pneumothorax: Definition
Air within pleural space
31
Pneumothorax: Primary Pneumothorax definition
No clear cause or underlying lung pathology
32
Pneumothorax: Secondary Pneumothorax Definition
Occurs dye to lung pathology such as COPD, asthma, TB, CF etc.
33
Pneumothorax: Tension Pneumothorax Definiton (2)
Breach in lung surface - pressure buildup around lung - one-wave valve wherein air cannot leave during expiration. Can be fatal by leading to obstructive shock (ipsilateral lung collapses, mediastinal shift and SVCO)
34
Pneumothorax: Traumatic Pneumothorax Definition
Iatrogenic or non-iatrogenic trauma to the lungs causes pneumothorax
35
Spontaneous pneumothorax: Aetiology
1. Primary (no lung pathology, tall, thin man) 2. Secondary (lung pathology - connective tissue, obstruction, infection, malignancy)
36
Traumatic pneumothorax: Aetiology
1. Iatrogenic - central line, CPAP, pacemaker, CT guided biopsy 2. Non-iatrogenic - penetrating or blunt trauma
37
Pneumothorax: Epidemiology (2)
- Typically young, tall, thin men - Smoking increases risk for men by causing apical blebs to form
38
Pneumothorax: Pathophysiology (2)
1. Sub-pleural bleb rupture - intra pleural pressure becomes equal to atmospheric 2. One-way valve created - air enters, but can't leave - intrapleural pressure is greater than atmospheric
39
Pneumothorax: Symptoms (3)
1. Sudden onset SOB 2. Pleuritic chest pain 3. Might have cough
40
Pneumothorax: Signs (5)
1. Tachypnoea 2. Reduced lung expansion 3. Hyper-resonant percussion 4. Reduced or absent breath sounds 5. Reduced vocal resonance
41
Tension pneumothorax: Specific signs (3)
1. Haemodynamic compromise 2. Tracheal deviation contra-laterally 3. Mediastinal shift
42
Pneumothorax: CXR findings
1. Lung edge is visible 2. Loss of lung markings
43
Pneumothorax: Emergency management
1. ABCDE 2. Decompression with 16-gauge cannula at second intercostal space, mid-clavicular line
44
Primary Pneumothorax: Management (2)
1. No SOB, <2cm, conservative management 2. SOB or >2cm, Aspiration with 12-18G cannula under local anaesthetic (CD if fails)
45
Secondary Pneumothorax: Management
1. No SOB, <1cm, admit and observe 2. No SOB, 1-2cm, CXR aspiration 3. SOB, >2cm intercostal chest drain
46
Pneumothorax: Working drain
Swinging and bubbling
47
Pneumothorax: Management where chest drain unsuccessful
Video-assisted thoracoscopic surgery (VATS)
48
Pneumothorax: After-care
1. No scuba-diving 2. No flying 3. No heavy lifting
49
Pneumothorax: Complications
Surgical emphysema (air leaks out of chest drain and accumulates under skin)
50
Pleural Effusion: Definition
Fluid in pleural space
51
Pleural Effusion: Haemothorax definition
Blood in pleural space
52
Pleural Effusion: Empyema definition
Pus in pleural space
53
Pleural Effusion: Haemopneumothorax
Blood and air in pleural space
54
Pleural Effusion: Transudate vs Exudate biochemistry
Transudate protein is <25 g/L, exudate chemistry is >35gL of protein
55
Pleural Effusion: Causes of transudate (3)
Non-infective causes of increase fluid volume: - Increased venous pressure (Cardiac failure, fluid overload) - Hypoproteinaemia (Cirrhosis, nephrotic syndrome) - Hypothyroidism
56
Pleural Effusion: Causes of exudate
Increased leakiness of pleural capillaries due to: - Infection (pneumonia) - Inflammation (Rheumatoid Arthritis) - Malignancy (carcinoma, metastasis)`
57
Pleural Effusion: Symptoms (3)
Asymptomatic OR Pleuritic chest pain SOB
58
Pleural Effusion: 3 key signs
1. Decreased expansion 2. Stony dull percussion note 3. Diminished breath sounds *Also look for signs of aspiration or other cause*
59
Pleural Effusion: Sign found above the effusion
Bronchial breathing
60
Pleural Effusion: Sign found in case of a big effusion
Tracheal deviation to the other side
61
Pleural Effusion: CXR finding (small and large)
1. Small: blunts costophrenic angle 2. Large: water-dense shadow with concave (meniscus upper borders)
62
Pleural Effusion: What does a flat upper border on CXR mean?
There is a pneumothorax
63
Pleural Effusion: 4 key tests
1. CXR 2. Ultrasound 3. Diagnostic aspiration 4. Biopsy
64
Pleural Effusion: Use of an ultrasound
Identifies fluid and can guide aspiration
65
Pleural Effusion: What to send aspirate to the lab for? (4)
Cytology Clinical chemistry (protein, glucose etc.) Bacteriology Immunology (if indicated)
66
Pleural Effusion: 3 steps of management
1. Drainage if symptomatic or empyema 2. Pleurodesis for symptomatic or malignant effusions 3. Surgery for persistent collections and increasing pleural thickness
67
Pleural Effusion: Clear, straw-coloured (2)
Transudate, Exudate
68
Pleural Effusion: Turbid, yellow (2)
Empyema, parapneumonic effusion
69
Pleural Effusion: Haemorrhagic (3)
Trauma, malignancy, pulmonary infarction
70
Pleural Effusion: (3) Glucose (<3.3) pH (<7.2) LDH (pleural:serum plasma (>0.6)
1. Empyema 2. Malignancy 3. TB
71
COPD: Definition
COPD is a common progressive disorder characterised by airway obstruction
72
COPD: FEV1 and FVC diagnostic values (3)
FEV1 <80%, FEV1/FVC <0.7 with little or no reversibility
73
COPD: 4 things distinguishing COPD from asthma
1. Age of onset, COPD >35 2. Smoking or pollution related 3. Sputum production 4. Minimal diurnal or day to day FEV1 variation
74
COPD: Chronic bronchitis clinical definiton
Sputum production on most days for 3 months of 2 successive years
75
COPD: Emphysema histological definition
Enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls
76
COPD: Prevalence
10-20% of adults over 40
77
COPD: Symptomatic presentation of chronic bronchitis (4)
Blue bloaters: 1. Patients may be obese 2. Frequent cough and sputum production 3. Accessory muscle use, not breathless 4. Rhonchi and wheeze
78
COPD: Clinical signs of chronic bronchitis (4)
Blue bloaters 1. Decreased alveolar ventilation - low O2, High CO2 2. Cyanosis 3. May develop Cor pulmonate 4. Respiratory centres insensitive to CO2
79
COPD : Symptoms of emphysema (Pink puffer) (3)
Pink Puffers 1. Very thin with a barrel chest 2. Little or no cough 3. Breathing assisted by pursed lips, accessory muscles, tripod sitting position
80
COPD: Pink Puffer/ Emphysema signs on examination (2)
1. Hyperresonant chest 2. Wheeze
81
COPD: Emphysema clinical signs (3)
Pink Puffer 1. Breathless but not cyanosed 2. Increased alveolar ventilation, near normal O2, and normal or low CO2 3. May progress to type 1 respiratory failure
82
COPD: 4 key general symptoms
1. Wheeze 2. Dyspnoea 3. Cough 4. Sputum production
83
COPD: Signs on examination (5)
1. Hyperinflation 2. Decreased cricosternal distance 3. Decreased expansion 4. Resonant or hyper-resonant percussion note 5. Quiet breath sounds
84
COPD: MRC dyspnoea scale (5)
Grade 1 – Breathless on strenuous exercise Grade 2 – Breathless on walking up hill Grade 3 – Breathless that slows walking on the flat Grade 4 – Stop to catch their breath after walking 100 meters on the flat Grade 5 – Unable to leave the house due to breathlessness
85
COPD: GOLD 4 stages of COPD
Stage 1: FEV1 >80% of predicted Stage 2: FEV1 50-79% of predicted Stage 3: FEV1 30-49% of predicted Stage 4: FEV1 <30% of predicted
86
COPD: 4 key complications of COPD
1. Acute exacerbations 2. Polycythaemia 3. Cor pulmonale 4. Respiratory failure
87
COPD: What does FBC show?
Raised PCV is response to chronic hypoxia
88
COPD: 5 Key tests
1. FBC 2. CT 3. ECG 4. ABG 5. Spirometry
89
COPD: CXR findings (4)
1. Hyperinflation 2. Flat hemidiaphragms 3. Large central pulmonary arteries 4. Decreased peripheral markings
90
COPD: CT findings
1. Bronchial wall thickening 2. Scarring 3. Air space enlargement
91
COPD: ABG findings
Decreased CO2, Hypercapnia
92
COPD: Spirometry findings
Obstructive and air trapping (FEV1 <80%, FEV1:FVC ratio <70%, Increased TLC, Decreased DLCO)
93
COPD: Chronic COPD management if FEV1 >50% (3)
1. SABA + SAMA 2. LABA + LAMA or LABA + ICS (if asthmatic features) 3. LAMA + LABA + ICS
94
COPD: Acute COPD exacerbation treatment (4)
1. SABA + LABA (Salbutamol + Ipratropium) 2. Give oxygen 3. Steroids (IV hydrocortisone, prednisolone) 4. Antibiotics
95
COPD: Acute COPD exacerbation - stages of treatment if no response (4)
1. IV aminophylline 2. NIPPV if RR >30 or PCO2 rising despite treatment 3. Doxapram 4. Intubation and ventilation
96
Acute COPD exacerbation: Presentation
Increasing cough Breathlessness Wheeze Decreased exercise capacity
97
Acute COPD exacerbation: Investigations
1. ABG 2. CXR (Pneumothorax and infection) 3. FBC 4. ECG 5. Sputum culture
98
COPD: Treatment by GOLD category
A: Bronchodilator B: LAMA + LABA C: LAMA then LAMA+LABA or LABA + ICS (if asthma) D: LAMA + (LABA + ICS)
99
Pulmonary Embolism: Pathophysiology
Venous thrombus forms in pelvis and/or legs - clots break off and pass through veins and right side of the heart - these lodge in the pulmonary circulation - this blocks flow to lungs, and strain right side of hear
100
Pulmonary Embolism : What are DVTs and YEs collectively known as?
Venous thromboembolism (VTE)
101
Pulmonary Embolism: Rare causes (3)
1. Septic emboli 2. RV embolus after MI 3. Fat, air or amniotic fluid embolism
102
Pulmonary Embolism: Strongly associated Risk factors (7)
1. Recent surgery 2. Thrombophilia 3. Leg fracture 4. Prolonged bed rest/immobility 5. Malignancy 6. Pregnancy/combined contraceptive pill 7. Previous PE
103
Pulmonary Embolism: 2 Key surgeries associated with VTE
1. Abdominal/hip surgery 2. Hip/knee replacement
104
Pulmonary Embolism: Weak risk factor
Long haul flights
105
Pulmonary Embolism: DVT prophylaxis
1. LMWH (enoxaparin) 2. Anti-embolic compression stockings
106
Pulmonary Embolism: Contraindication for LMWH (2)
Active bleeding, or existing anticoagulation (i.e. warfarin)
107
Pulmonary Embolism: Contraindication for compression stockings
Peripheral arterial disease
108
Pulmonary Embolism: Clinical features of small vs large
Small can be asymptomatic, large are fatal
109
Pulmonary Embolism: 5 key signs
1. Dizziness 2. Syncope 3. Haemoptysis 4. Pleuritic chest pain 5. Sudden onset dyspnoea
110
Pulmonary Embolism: Key questions for history (3)
1. Risk factors 2. Previous DVT/PE 3. Family history
111
Pulmonary Embolism: Signs of DVT (2)
1. Unilateral leg swelling 2. Tenderness
112
Pulmonary Embolism: Key systemic signs on examination (4)
1. Pyrexia 2. Cyanosis 3. Tachycardia 4. Hypotension
113
Pulmonary Embolism: Key respiratory signs (4)
1. Pleural Rub 2. Pleural effusion 3. Tachypnoea 4. Raised JVP
114
Pulmonary Embolism: Criteria used for diagnosis
Wells Score
115
Pulmonary Embolism: Some things taken into account by Wells (2)
1. Risk factors (surgery, bed ridden, previous DVT) 2. Signs (Haemoptysis, Tachycardia, DVT signs)
116
Pulmonary Embolism: How to interpret Wells score (2)
1. >4 Immediate CTPA or treat empirically 2. <4 do a d-dimer - Immediate CTPA or treatment if +ve
117
Pulmonary Embolism: Key Tests (3)
1. Bloods (Clotting, D-dimer) 2. CTPA 3. V/Q scan
118
Pulmonary Embolism: Test to assess for alternative cause
1. CXR
119
Pulmonary Embolism: How CTPA works
CT chest scan with contrast which highlights arteries to show clots
120
Pulmonary Embolism: How V/Q scan works
Radioactive isotopes (inhaled and injected) and gamma camera compares ventilation and perfusion in the lungs
121
Pulmonary Embolism: Signs on ABG
1. Respiratory alkalosis (High RR leads to CO2 expulsion) Low O2, Low CO2
122
Pulmonary Embolism: Signs on CXR
Normal or 1. Oligaemia of affected segment 2. Wedge shaped opacity 3. Dilated arteries 4. Vessel effusion 5. Linear atelectasis
123
Pulmonary Embolism: ECG findings
1. Sinus tachycardia 2. RBBB 3. RV strain (Inversion of T in V1-4) 4. S1Q3T3 (This pattern in rare)
124
Pulmonary Embolism: Acute management of large PE (5)
(Oxygen, Pain and blood pressure) 1. O2 2. Morphine + anti-emetic 3. IV and LMWH/Fondaparinux 4. Fluid if hypotension 5. Thrombolysis if haemodynamically unstable
125
Pulmonary Embolism: Treatment in case of massive, harm-dynamically unstable PE
Thrombolysis (Ateplase injection via cannula or central catheter) Then long term anti-coagulation
126
Pulmonary Embolism: Haemodynamically stable treatment
1. LMWH or unfractionated heparin (renal impairment) (5 days) 2. Start DOAC or Warfarin
127
Pulmonary Embolism: When to start heparin while using warfarin?
When INR is 2-3 due to inital prothrombotic effect of warfarin
128
Pulmonary Embolism: Treatment if anti-coagulation is contraindicated
Surgical placement of vena caval filter
129
Pulmonary Embolism: Length of treatment for provoked PE
3 months and then reassess risk
130
Pulmonary Embolism: Length of treatment for unprovoked
>3 months
131
Pulmonary Embolism: Length of treatment for malignancy
Continue treatment for 6 months with LMWH
132
Pulmonary Embolism: Pregnancy
LMWH is continued until the end of pregnancy

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