Respiratory Flashcards
(106 cards)
1
Q
If the FEV1/FVC ratio is <0.7 is this obstructive or restrictive?
A
Obstructive
Because low FEV1 and normal FVC
2
Q
If the FEV1/FVC ratio is >0.7 is this obstructive or restrictive?
A
Restrictive
Normal ratio because both FEV1 and FVC are low
3
Q
What is the transfer co-efficient?
A
Measure of the ability of oxygen to diffuse across the alveolar membrane
4
Q
How do you measure the transfer co-efficient?
A
Inspire low dose CO, 10 second breath hold at TLC
5
Q
What are the causes of respiratory failure (LAVISH)?
A
Low inspired O2 Alevolar hyperventilation V/Q Mismatch Impaired diffusion Shunt Hypoventilation
6
Q
What are the target oxygen sats in Type 1 Respiratory failure?
A
94-98%
7
Q
What are the target oxygen sats in Type 2 Respiratory failure?
A
88-92%
8
Q
Other than oxygen, what is another treatment method used in type 1 respiratory failure?
A
CPAP- Continuous positive airways pressure - increases ventilation and V/Q ratios
9
Q
Other than oxygen, what is another treatment method used in type 2 respiratory failure?
A
NIV - Non-invasive ventilation - bi-phasic positive airway pressure to increase ventilation
10
Q
What is the main cause of type 1 respiratory failure?
A
Pulmonary embolism
Pulmonary oedema and pneumonia
11
Q
Name 4 symptoms of hypercapnia?
A
Bounding pulse Flapping tremor Drowsiness and confusion Loss of consciousness Warm peripheries
12
Q
What is the definition of bronchitis?
A
Cough and sputum production for 3 months for 2 or more years
13
Q
Name 4 signs of cor-pulmonale?
A
- Raised JVP
- Loud second heart sound
- Peripheral oedema
- Systolic parasternal leave
- Widening of pulmonary artery on chest X-ray
14
Q
What are the two 1st line medications in COPD?
A
SABA- Salbutamol
LAMA- Tiotropium
15
Q
What is the 2nd line COPD treatment if FEV1 >50%?
A
LABA or LAMA
16
Q
What is the 3rd Line COPD treatment?
A
LAMA - tiotropium
LABA- Formeterol
Inhaled corticosteroid
17
Q
What does the CURB-65 score stand for?
A
Confusion Urea <7mmol/l Respiratory Rate >30/min Blood Pressure <90mmHg (systolic) <60mmHg 65-Age
18
Q
What is 1st line treatment for mild pneumonia (CURB-65- 0-1)?
A
Amoxicillin
Clarithromycin in penicillin allergy
Treat as outpatient
19
Q
What is 1st line treatment for moderate pneumonia (CURB-65- 2)?
A
Amoxicillin and clarithromycin PO
Hospital admission
20
Q
What is 1st line treatment for severe pneumonia (CURB-65- 3-5)?
A
Co-amoxiclav and clarithromycin IV
Urgent admission and consider ITU
Alternatives cefuroxime and clarithromycin
21
Q
Which antibiotics would you used in atypical bacterial causes?
A
Macrolides (erythromycin) or fluroquinolones (ciprofloxacin)
22
Q
Patient with pneumonia, chest X-ray taken - multiple abscesses seen - what is likely cause?
A
Staph Aureus
23
Q
Patient with pneumonia, chest X-ray taken - upper lobe cavity seen - what is likely cause?
A
Klebseilla pneumoniae (but must exclude TB)
24
Q
Which two organisms most commonly cause HAP?
A
Staph aureus
Klebsiella
25
What are the extra pulmonary features associated with pneumonia caused by mycoplasma pneumoniae?
Raynauds
Haemolytic anaemia
Bullous myringitis (blisters on tympanic membrane)
Encephalitis
26
What are the extra pulmonary features associated with pneumonia caused by legionella spp?
Diarrhoea
Abnormal liver tests
Interstitial nephritis
27
What is empyema?
Failure of fevers or markers of inflammation to settle on antibiotics
28
What markers on thoracocentesis suggest a para-pneumonic effusion that needs drainage?
pH <7.2, glucose low, pus or thick fluid and positive gram stain
29
How do you treat para-pneumonic effusion?
Co-amoxiclav
30
What would the peak expiratory flow have to be, to be diagnosed with asthma?
> 20% of predicted on >3 days a weeks for 2-4 days with diurnal variation
31
What is first line management of Asthma?
SABA- Salbutamol
32
What is second line management of Asthma?
SABA + Inhaled corticosteroid
33
What is third line management of Asthma?
SABA + Inhaled corticosteroid + LABA (salmeterol)
34
How do you measure eosinophilic inflammation in asthma?
Exhaled nitric oxide
35
Name 3 side effects of steroid use?
Osteoporosis , diabetes, oral candida, hoarse voice, weight gain, high blood pressure and suppress immune system
36
Name 3 topical complications of long term steroid use?
Hoarse voice, oral candida, easy bruising
37
What are the signs of an asthma attack?
```
33,92, CHEST
33 PEFR <33%
92 <92% O2 sats
Cyanosis
Hypotension
Exhaustion
Silet chest
Tacycarhia
```
38
What is the management for an acute asthma attack?
```
OSHITME
Oxygen 40-60%
Salbutamol nebuliser
Hydrocortisone
Ipatropium bromide
Theophylline
Magnesium sulphate
Escalate care
```
39
Name 3 complications of bronchiectasis?
Pneumonia
Fungal colonisation
Metastatic abscesses
40
Which disease leads to honeycomb lung?
Fibrosing alveolitis/interstitial lung diseases
41
What is pneumoconiosis?
Lung disease caused by inhaled dust
42
What type of hypersensitivity reaction is seen in the mantoux test?
Type 4 hypersensitivity
43
How do you treat pneumothorax?
Needle in the second intercostal space
44
Name 5 transudate causes of pleural effusion?
1. Heart failure
2. Liver cirrhosis
3. Nephrotic syndrome
4. Hypothyroidism
5. Peritoneal dialysis
45
Name 3 exudate causes of pleural effusion?
1. Infection eg TB
2. Inflammation - pneumonia
3. Malignancy
46
What would you see on an X-ray of pleural effusion?
Blunting of the costaphrenic angles
47
What do mesothelial plaques express?
Calretinin
48
Which type of lung cancer is most strongly associated with smoking?
Non-small cell squamous
49
What are the sites of metastatic spread from lung cancer?
Liver, bone, adrenal glands, brain
50
What does para-neoplastic mean?
Non metastatic manifestations of malignant disease
51
Give 3 examples of para-neoplastic syndromes caused by lung cancer?
1. Hypercalcaemia (PTH secretions)
2. Hyponatreamia
3. Finger clubbing
4. Non-infective endocarditis
52
What is the mean pulmonary pressure in pulmonary hypertension?
>25mmHg
53
Which pneumonia causing organism is stained using Lowenstein- Jenson Medium?
Mycobacterium tuberculosis
54
Which two glycoproteins in HIV molecular allow it to attach and bind to CD4 via CCR5?
gp120 and gp40
55
Once HIV viral caspid has entered the cell, how does it integrate into the host cell?
Reverse transcript changes viral RNA to DNA within the cell
Girl DNA integrates into the host cell DNA
When the host then translates the DNA, the virus DNA is also produced
56
Name 6 preventative methods of HIV?
1. Circumcision
2. Post Exposure Prophlaxis and Pre Prophlyaxis
3. STI control
4. Microbicides
5. Behavioural therapy
6. HAART - treament as prevention
57
What symptoms/ signs would you see in a patient in the clinically latent period of HIV?
1. Persistant generalised lymphadenopathy
2. Recurrent shingles
3. Oral candidiasis
4. Raised protein levels (immunoglobulins)
58
What are the three respiratory presentations of HIV?
1. Pneumocytitis jirovecci pneumonia
2. Strep Pneumonia
3. TB
59
Name 3 of the CNS disease presentations in HIV?
1. Cerebral toxoplasmosis
2. Meningitis
3. Ophthalmic lesions eg CMV
60
What are the 2 HIV related neoplasms?
1. Kaposi Sarcoma
| 2. Lymphoma
61
Which three drugs are commonly used in HAART?
2 nucleoside reverse transcriptase inhibitors
AND
1 non-nucleoside reverse transcriptase inhibitors OR
Protease inhibitor
62
What are the 3 hallmarks of asthma pathophsiology?
1. Airway inflammation
2. Airway obstruction - smooth muscle hypertrophy, bronchoconstrictions
3. Bronchial hyper-responsiveness
63
Give 3 precipitants of asthma?
Cold air, emotion, allergens, smoking, occupational allergens
64
What are the signs of asthma?
Reduced air entry, expiratory polyphonic wheeze, tachypnoea, cyanosis, increased use of accessory muscles, hyper-resonant on percussion
65
Suggest 3 non-medical asthma treatment?
Stop smoking, lose weight, breathing exercise programmes
66
What is the definition pf chronic bronchitis?
Productive cough for at least 3 months a year
67
Why do you purse lips in emphysema?
To increase pressure in alveoli
68
What are the 5 symptoms of COPD?
```
Chronic Cough
Wheeze
Regular sputum production
Frequent infection
SOB
```
69
Give 4 signs of COPD?
```
Pursed lip breathing
Barrel chest
Cyanosis
Reduced breath sounds
Use of accessory muscles
```
70
Which inflammatory cells are present in Asthma?
Mast cells and eosinophils
71
Which inflammatory cells are present in COPD?
Neutrophils
72
What is GOLD standard diagnosis in COPD?
Spirometry
73
What scale is used for prognosis of COPD?
BODE Index
| BMI, obstruction, dysnpnoea, exercise
74
What are 4 of the non-pharmacoligical managements of COPD?
Pulmonary rehabilitation
Smoking cessation
Physio- for sputum clearance
Influenza and pneumococcal vaccinations
75
What is the 2nd line COPD treatment if FEV1 <50%?
LABA + ICS or LAMA
76
What are signs of pneumothorax?
Deviated trachea, mediastinal shift
77
What sign is present on X-ray with bronchiectasis?
Tram-track sign on CXR
78
What is GOLD standard diagnosis for bronchiectasis?
CT
79
Where is mutation in CF?
Transmembrane conducts regulate (CFTR) on chromosome 7
80
What are the extra-intestinal features of CF?
Biliiary cirrhosis, hepatitis
| GU - amenorrhoea
81
What is the acute cause of ILD?
ARDS
82
What do you see on an X-ray in ARDS?
Bilateral infiltrates
83
Give 5 chronic causes of ILD?
Vasculitis, rheumatoid arthritis, asbesto, EAA, amiodarone
84
What would you see in CXR of sarcoid?
Bilateral hilar lympaphadenopathy
85
What is seen in the blood which is raised in sarcoid?
ACE
86
How do you treat sarcoid?
Steroids
87
What are the acute symptoms of EAA?
Fever, cough, chest ache, fatigue
88
What type of hypersensitivity reaction is good pastures?
Type 2
89
How do you diagnose good pastures?
Anti-GBM in blood
90
What score do you use to assess the risk in PE?
Wells score - History of PE, malignancy, recent trauma, immobilisation >3 days, combined oral contraceptive pill
91
What are the 3 atypical pneumonia causes?
Mycoplasma, legionella (Spain), chlamydophillia pneumonia, chlamydiophilia psitattaci
92
What are the signs of pneumonia?
tachycardia, low sats, fevers, reduced breath sounds
93
What is seen in blood count of pneumonia?
Raised WCC, neutrophils and CRP
94
What are risk factors for TB?
```
Poverty, increased droplet spread
Poor hygiene
Immunosuppression (HIV)
Smokers
Foreign travel
```
95
Which culture do you use to grow mycobacterium tuberculosis?
Lowenstein-jensen culture (secondary to ziegler-neelson stain)
96
What is the side effect of pyrazinamide?
P= Purines = Gout and joint problems
97
What is the side effect of isoniazid?
I= Isolated nerve problems - Peripheral neuropathy
98
What lung cancer is a neuro-endocrine tumour?
Small Cell
| Secretes ADH
99
Which antibiotic treats pneumococcal pneumonia?
Amoxiccilin
100
What like organism causes pneumonia in CF patients?
Pseudomonas auerginosa
101
What is the pathophsiological difference between allergic asthma and extrinsic allergic alveolitis?
Asthma – Type 1
IgE mediated, mast cells release histamine
Macrophage activation
Bronchoconstriction, goblet cell secretions, hypertrophy
EAA – type 3
Immune complex forms with allergen
Complexes saturate clearance system
Build up in lungs causing inflammation and INTERSTITIAL DAMAGE(not bronchial)
102
In TB what is the primary lesion called?
A ghon focus, a ghon complex is the initial focus plus the hilar lymphadenopathy
103
What is the difference between pink puffers and blue bloaters?
Pink puffer - increased alveolar ventilation, low PaO2, breathless not cyanosed and can progress to type 1 failure
Blue bloaters have recused alveolar ventilation, decrease PaO2, increased PaCO2 - cyanosed but not breathless and can cause cor pulmonale
104
Give 4 causes of pulmonary hypertension?
PE, left to right shunt eg ASD/VSD, emphysema, LV failure, COPD
105
Name 4 signs of pulmonary hypertension?
Fatigue, tacycardia, raised JVP, flounder S2, peripheral oedema
106
Why does asthma not cause a reduction in transfer factor?
Normal structure of alveolus and lung stricture just can't move oxygen into lung
