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3rd yr clinical > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are the two main types of lung cancer and their subdivisions

A

Non small cell lung cancer
-Adenocarcinoma (40%)
-Squamous cell carcinoma (20%)
-Large cell carcinoma

Small cell lung cancer (neuroendocrine)

Mesothelioma is cancer of the pleura

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2
Q

What would be present in a superior vena cava obstruction in someone with lung cancer

A

Facial swelling, hard to breath, distended chest and neck veins, putting hands above head causes congestion - will have more of an acute onset than heart failure symptoms- is na emergency

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3
Q

What is Horner’s syndrome

A

Pancoast tumour pressing the sympathetic ganglion- triad of ptosis, anhidrosis and miosis (pupil constriction)

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4
Q

What is lambert-eaton myasthenia syndrome

A

Antibodies against small cell lung cancer damage calcium channels in motor neurones- proximal muscle weakness etc

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5
Q

What is the first line investigation for lung cancer

A

CXR
looking for hilar enlargement
Peripheral opacity
Pleural effusion
Collapse

CT CAP is used for staging

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6
Q

What signs would be present in pneumonia

A

Bronchial breath sounds (harsh inspiratory and expiratory)
Focal coarse crackles
Dullness to percussion

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7
Q

What scoring system is used for Pneumonia

A

CURB-65 in hosp and CRB-65 in community
C-Confusion
U-Urea
R-Resp rate >30
B-BP<90 systolic or <60 diastolic
65> 65 YRS

Score over 3 is high risk

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8
Q

What are the main organisms that cause pneumonia

A

-Steptococcus pneumonia
-Haemophilus influenza

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9
Q

What are the main causes of atypical pneumonia

A

Legionella- infected water inhalation, can cause SIADH- urine antigen screening test

Mycoplasma pneumonia - mild with target lesion rash

Chlamydophila pneumonia - children

Coxiella burnettic/ Q fever- body fluids to animals- flu like illness

Chlamydia psittaci - infected birds

Need macrolides (clarithromycin) to tetracycylines (doxy)

Pneumocytis jirovecii - fungal - immunocomp patients- give co-trimoxazole

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10
Q

What antibiotics are used in mild pneumonia

A

Oral amoxicillin, doxycycline/ clarithromycin for 5 days

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11
Q

What antibiotics are used in moderate/severe pneumonia

A

IV abx stepped down to oral

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12
Q

What are the features and causes of respiratory acidosis

A

Rentention of CO2 means more CO2 in the blood making it acidic

On an ABG if the bicarb is high then bicarb is trying to compensate for high CO2- this indicates CO2 retention is chronic

COPD patients

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13
Q

What are the features and causes of respiratory alkalosis

A

When a patient blows off too much CO2- anxiety / PE

If patient has anxiety they will have low PaC02 and high 02 - they are just hyperventilating

If patient has PE they will have low CO2 and low O2

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14
Q

What are the causes of metabolic alkalosis

A

Loss of hydrogen ions (acid)
-From GI tract- diarrhoea/vomiting
-From kidneys -increased aldosterone activity- Conn’s syndrome, liver cirrhosis, loop diuretics, thiazide diuretics

Will have raised Ph and raised Bicarb - no issues with CO2

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15
Q

What are the causes and features of metabolic acidosis

A

-Low pH and low Bicarb, no issues with CO2/O2

Can be caused by DKA- raised ketones
Raised lactate
Increased hydrogen ions in renal failure/ rhabdomyolysis, reduced bicarb in diarrhoea, renal failure

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16
Q

What respiratory support is given in acute respiratory distress syndrome

A

-ARDS causes collapse of alveoli (atelectasis) so low volumes and pressures are used to avoid overinflating the parts of the lungs that are still working

Positive end expiratory pressure is used to stop lungs collapsing further

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17
Q

What type of airway pressure is used in obstructive sleep apnoea

A

Continuous positive airway pressure - continuous pressure during each breath

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18
Q

What is bipap and when is it used

A

Bilevel positive airway pressure
Different air pressures for inhalation (IPAP) and exhalation (EPAP)

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19
Q

What would be seen on spirometry for an obstructive lung disease

A

FEV1/FVC <70% as FVC will have good volume but due to obstruction FEV1 is reduced- asthma and COPD

20
Q

What would be seen for spirometry in a restrictive disease

A

Normal FEV1/FVC >70% as both FEV1 and FVC are equally reduced
-Sarcoidosis, interstitial lung disease, pulmonary fibrosis, obesity, motor neurone disease, scoliosis

21
Q

What findings are relevant on a reversibility test for asthma

A

Greater than 12% increases in FEV1 will support an asthma diagnosis

22
Q

What tests are done for asthma

A
  1. Fractional exhaled nitric oxide
  2. Spirometry with bronchodilator reversibility

Less important but keep a peak flow diary

23
Q

What is the long term stepwise management of asthma

A
  1. Short acting Beta-2 agonist - salbutamol
  2. Inhaled corticosteroid low dose
  3. Leukotriene receptor antagonist- montelukast
  4. Long acting beta 2 agonist- salmeterol or combination of short and long acting inhaler
  5. High dose corticosteroid inhaler
24
Q

How is an asthma exacerbation graded

A

Peak flow 50-75% of normal - moderate

Peak flow 33-49% of normal- severe

Peak flow<33%- life threatening

25
Q

What is the management of a mild and moderate acute asthma exacerbation

A

Mild
Inhaled beta 2 agonists- via spacer
Quadrupled dose of inhaled corticosteroids for 2 weeks
Oral steroids
Abx

Moderate
Hosp admission
Nebulised beta-2 agonists
IV steroids

26
Q

What is the management of a severe asthma exacerbation

A
  1. Hosp admission
  2. Oxygen sats>94-98%
  3. Nebulised ipatropium bromide
  4. IV magnesium sulfate
  5. IV salbutamol
  6. IV aminophylline
27
Q

What is the staging of COPD

A

Stage 1- FEV1>80
Stage 2 - FEV1 50-79
Stage 3- FEV1 30-49
Stage 4- FEV1< 30

28
Q

What is the stepwise medical management of COPD

A
  1. Short acting beta 2 agonist - salbutamol
  2. Short acting muscarinic antagonists (ipatropium bromide)
29
Q

What is the treatment for asthma stepwise if there are asthma and steroid responsive features

A

Combination of long acting beta agonists and inhaled corticosteroids- symbicort

30
Q

What is the treatment for asthma when there are no asthma or steroid responsive features

A

Long acting beat agonist combined with a long acting muscarinic antagonist

31
Q

How is an acute exacerbation of COPD managed?

A

-Target oxygen sats -88-92% due to CO2 retention

  1. Regular inhalers/ nebulisers
  2. Steroids - red 30mg, once daily for 5 days
    3.Antibiotics

If severe
-IV aminophylline
-non-invasive ventilation
-intubation and ventilation

32
Q

What investigations are done for suspected bronchiectasis

A

-Sputum culture- haemophilus influenza/ pseudomonas aeruginosa

CXR will show tram track opacities

Diagnosis done with a high res CT

33
Q

What are the main features of bronchiectasis

A

Recurrent infection , finger clubbing, pseudomonas auerginosa, if exacerbation- need 7-14 days on abx,
If caused by pseudomonas aeruginosa give ciprofloxacin

34
Q

What is the treatment for idiopathic pulmonary fibrosis

A

-Progressive with no cause
-Medications to slow disease progression - pirfenidone and nintedanib

35
Q

What are the causes of secondary pulmonary fibrosis

A

Drugs- amiodarone, cyclophosphamide, methotrexate, nitrofuratonin

Alpha-1-antitrypsin deficiency
RA
SLE
Systemic sclerosis
Sarcoidosis
Asbestos
Cyrptogenic organising pneumonia

36
Q

What are the features of hypersensitivity pneumonitis in pulmonary fibrosis

A

Type 3 and 4 hypersensitivity reactions
Raised lymphocytes in bronchoalveloar lavage

bird fanciers lung, farmers lung etc

Treatment- remove allergen, oxygen, steroids

37
Q

What are the risk factors for a PE

A

Immobility
Surgery
Long haul travel
Pregnancy
Hormone therapy with oestrogen
Malignancy
Polycythaemia
SLE
Thrombophilia

38
Q

What is the main VTE prophylaxis

A

LMWH- Enoxaparin and anti embolic stockings

39
Q

What score is used for risk of PE

A

Well’s score

40
Q

How is a PE diagnosed

A
  1. Calculate Well’s score
  2. If PE likely- Do CTPA
  3. If PE unlikely do a d-dimer and if that is positive do a CTPA

Can also do a VQ scan

41
Q

What are the treatment options for a PE

A

1st line anticoagulant with apixaban/rivaroxaban started as soon as suspected even if there is a delay in scan

If haemodynamically unstable- give continuous infusion of unfractionated heparin and IV thrombolysis with streptokinase

42
Q

What is the long term treatment for a PE

A

DOACs first line unless antiphospholipid syndrome or pregnancy then give warfarin

If cause was reversible- anticoagulant for 3 months

If PE was unprovoked, recurrent or active cancer- anticoagulant for 6 months

43
Q

What are the main causes of pulmonary hypertension

A

Group 1- Idiopathic/ CT disease (SLE)
Group 2- Left sided HF due to MI or systemic HTN
Group 3- Chronic lung disease (COPD, Pul fibrosis)
Group 4- Pulmonary Vascular disease (PE)
Group 5 - Miscellaneous (sarcoid etc)

44
Q

What are the main features of sarcoidosis

A

Granulomas, erythema nodosum, lymphadenopathy, lupus perno (skin lesions on face)

Lungs -Mediastinal lymphadenopathy, pulmonary fibrosis, pulmonary nodules

Systemic- fever, fatigue, weight loss

Liver- cirrhosis, cholestasis

Eyes- uveitis, conjunctivitis

CNS involvement, Kidney involvement, PNS involvement (facial nerve plasy), bones

Lofgren’s syndrome- erythema nodosum, bilateral hilar lymphadenopathy, polyarthraglia

45
Q

What investigations are done in sarcoidosis

A

Blood tests- screening- Raised ACE
-Raised calcium

CXR- Bilateral hilar lymphadenopathy
Bronchoscopy- non caseating granulomas

46
Q

What is the management of sarcoidosis

A

Oral steroids 6-24 months
Bisphosphates to protect against osteoporosis while on steroids

Methotrexate second line

47
Q
A

3rd yr clinical (22 decks)

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