Respiratory Flashcards
(154 cards)
1
Q
What is asthma?
A
Chronic inflammatory condition secondary to hypersensitvity which causes reversible airway obstruction
2
Q
What are symptoms of asthma?
A
Dyspnoea, cough, wheeze, diurnal variation
3
Q
What are signs of asthma?
A
Audible wheeze, hyperinflated chest, hyperresonance
4
Q
What are risk factors for developing asthma?
A
History of atopy, maternal smoking, low birthweight, bottle fed, exposure to high concentrations of allergens, air pollution, hygiene hypothesis
5
Q
What are some precipitants of asthma?
A
Cold air, exercise, emotions, smoking, pollution, NSAIDs, beta-blockers
6
Q
What is the FEV1 like in asthma?
A
Significantly reduced
7
Q
What is the FVC like in asthma?
A
Normal
8
Q
What is the FEV1/FVC ratio?
A
<70% (positive test for asthma)
9
Q
A 12%+ improvement of spirometry after administration of what drug is indicative of asthma?
A
Bronchodilators
10
Q
What other tests can be done for asthma?
A
Peak flow - (>20% variability)
Increased FeNO levels
Skin prick tests to check atopy
11
Q
What is the first line management of asthma?
A
SABA
12
Q
What is added to SABA inhaler first?
A
Low dose inhaled steroid
13
Q
What is the next treatment line after a SABA and an inhaler steroid?
A
LABA
14
Q
What is the next treatment line after SABA, inhaled steroid & LABA?
A
Increase steroid dose
Addition of theophylline/LTRA/LAMA
15
Q
What is the next treatment line after SABA, inhaled steroid, LABA, LTRA?
A
Addition of 4th agent - theophylline, LAMA, beta-agonist tablet
16
Q
What is the last line treatment for asthma?
A
Oral steroids
17
Q
Peak flow 50-75%, speech normal, RR <25, pulse <110 - severity of asthma attack?
A
Moderate
18
Q
Peak flow 33-50%, cant complete sentences, RR >25, pulse >110 - severity of asthma attack?
A
Severe
19
Q
Peak flow <33%, silent chest, cyanosis, bradycardia, hypotension, coma - severity of asthma attack?
A
Life threatening
20
Q
How is an acute asthma attack treated?
A
Oxygen
Salbutamol nebulised 5mg 6L/min
Ipratropium bromide nebulised
Steroids - 40-50mg predniolone orally or 100mg hydrocortisone IV
21
Q
What treatment should be given in acute asthma attack if it is life threatening?
A
IV Magnesium sulphate 2g over 20 minutes
22
Q
What is COPD?
A
Common progressive disorder characterised by airway obstruction consisting of chronic bronchitis and emphysema
23
Q
What are symptoms of COPD?
A
Cough, sputum, breathlessness
24
Q
What are signs of COPD?
A
Tachypnoea, use of accessory muscles, hyperinflation, wheeze, cyanosis, cor pulmonale
25
What are causes of COPD?
Smoking, alpha-1-antitrypsin deficiency
26
What is the FEV1 like in COPD?
Reduced
27
What is the FVC like in COPD?
Normal
28
What is the FEV1:FVC ratio like in COPD?
Reduced (<70%)
29
What may be seen on CXR in COPD?
Flattened hemidiaphragm
| Hyperinflation
30
What would an ABG show in COPD?
Compensated respiratory acidosis
31
What type of respiratory failure do you get in COPD?
Type 2 respiratory failure (Hypoxia with hypercapnia)
32
What conservative management would you recommend for COPD?
Stop smoking
| Increase exercise
33
What vaccines are important for people with diagnosed COPD?
Once off pneumococcal vaccination
| Annual flu vaccine
34
What is the first line treatment for COPD?
Either a SABA or a SAMA
35
What is the second line treatment for COPD dependent on?
FEV1
36
If FEV1 is over 50% of predicted, what is the second line treatment for COPD?
LABA or a LAMA
37
If the FEV1 is less than 50% of predicted, what is the second line treatment for COPD?
LABA + ICS or
| LAMA
38
What is the 3rd line treatment for COPD?
SABA + LABA + ICS + LAMA
39
Which two inhalers can you NOT give together?
SAMA and LAMA
40
What organism is the commonest cause of exacerbations of COPD?
Haemophilus influenzae
| also get strep pneumoniae and moraxella
41
When should antibiotics be given for an exacerbation of COPD?
Only if purulent sputum or signs of pneumonia
42
How should an infective exacerbation of COPD be managed?
Increase the frequency of bronchodilator or consider using nebulised
Prednisolone 30mg 7-14 days
43
If a patient has a severe exacerbation of COPD what can be done?
IV Aminophylline
| If pH <7.26 - intubate
44
What is pneumonia?
Acute lower respiratory tract infection
45
What are symptoms of pneumonia?
SOB, productive cough, chest pain, fevers, confusion, myalgia
46
What are signs of pneumonia?
Fever, cyanosis, confusion, tachycardia, hypotension, consolidation, dull percussion note
47
What is the commonest organism causing pneumonia?
Strep pneumoniae
48
What pneumonia is associated with water?
Legionella
49
What pneumonia is associated with alcoholics/diabetics?
Klebsiella - 'Red jelly sputum'
50
What pneumonia is associated with parrots?
Chlamydia pscittici
51
What pneumonia is associated with AIDS?
Pneumocystis jirovecii
52
How do you investigate pneumonia?
Blood CXR
53
How is legionella tested for?
Urinary antigen
54
How is pneumocystis jirovecii investigated?
Bronchoalveolar lavage
55
What are the components of CURB65 score?
```
Confusion
Urea >7
Respiratory rate >30
BP <90 systolic or <60 diastolic
65 years or older
```
1 point for each
56
What does a CURB65 score of 0-2 indicate?
Mild to moderate pneumonia
57
What does a CURB65 score of 3-5 indicate?
Severe pneumonia
58
How is community acquired mild/moderate pneumonia treated?
Amoxicillin 1g TDS (5 days)
59
How is severe community acquired pneumonia treated?
IV Co-amoxiclav + Doxycycline
| Step down to doxycycline 100mg BD
60
How is mild/moderate hospital acquired pneumonia treated?
PO Amoxicillin + Metronidazole (5 days)
61
How is severe hospital acquired pneumonia treated?
IV Amoxicillin + metronidazole + gentamicin. Step down to co-trimoxazole + metronidazole PO
62
How are atypical pneumonias normally treated?
Macrolides e.g. clarithromycin
63
How do you follow up patients with pneumonia who are at risk of lung cancer?
CXR in 6 weeks
64
What are complications of pneumonia?
Pleural effusion, empyema, abscess, respiratory failure, sepsis
65
What is tuberculosis?
An infectious disease of the respiratory tract
66
What causes TB and how does it spread?
Mycobacterium tuberculosis - airborne droplets
67
What does tuberculosis cause in the alveoli?
Caseating granulomas
68
What are risk factors for TB reactivation?
Diabetes, IVDU, HIV, immunosuppression,
69
What are symptoms of TB?
Malaise, fever, lymphadenopathy, night sweats, cough, haemoptysis, erythema nodosum, vertebral collapse, meningism
70
What does a CXR show in TB?
Consolidation, cavitating upper lobe lesions, bilateral hilar lymphadenopathy, fibrosis
71
What stain should you use on a sputum sample in TB and what does it show?
A Ziehl-Niehlson stain shows acid-fast bacilli
72
What antibiotics are used to treat TB?
2 months of rifampacin, isoniazid, pyramidizine and ethambutol
then 4 further months of rifampacin and isoniazid
73
What are side effects of rifampacin?
Enzyme inducer, orange body fluids?
74
What are side effects of isoniazid?
Neuropathy
75
What are side effects of pyramidizine?
Hepatitis, arthralgia
76
What are side effects of ethambutol?
Optic neuritis
77
What is an Assman focus?
A pulmonary lesion second to miliary TB that is disseminated in the blood
78
What are risk factors for lung cancer?
Cigarette smoking, asbestos exposure, chromium iron oxides, radiation, genetics, age
79
What are symptoms of lung cancer?
Cough, haemoptysis, dyspnoea, chest pain, anorexia, weight loss
80
What are signs of lung cancer?
Cachexia, anaemia, clubbing, lymphadenopathy, chest consolidation, collapse, pleural effusion
81
What investigations should be done for lung cancer?
```
Sputum cytology
CXR
Bronchoscopy/Percutaneous needle biopsy
CT Scan and PET for staging
Radionucleotide bone scan for mets
```
82
What does a CXR show in lung cancer?
Peripheral enlarged nodes, hilar enlargement, consolidation, collapse, pleural effusion
83
Which patients should get an urgent chest X-ray for suspicion of cancer?
Patients over 40 who have ever smoked with UNEXPLAINED SYMPTOMS of
2 from: cough, fatigue, SOB, chest pain, weight loss, appetite loss OR
1 from: clubbing, recurrent infection, lymphadenopathy, thrombocytosis
84
What cell does small cell lung cancer develop from?
Neuroendocrine cells
85
What paraneoplastic syndromes is SCLC associated with?
ADH and ACTH secretion
| Lambert-Eaton Myaesthenic Syndrome
86
What cell does adenocarcinoma of the lung develop from?
Mucus secreting cells
87
What is the commonest lung cancer in non-smokers?
Adenocarcinoma
88
What cell does squamous cell cancer of the lung develop from?
Epithelial cells
89
What paraneoplastic syndrome is squamous cell lung cancer associated with?
PTHrP secretion leading to hypercalcaemia
90
What may large cell lung cancer secrete?
beta HCG
91
What is a Pancoasts tumour?
A tumour at the lung apex commonly from NSCLCs
92
What may a Pancoasts tumour cause?
Horner's syndrome due to compression of sympathetic ganglion - miosis, ptosis, anhydrosis
93
How is small cell lung cancer treated?
Chemotherapy with some scope for radiotherapy. Mainly palliative
94
How is non-small cell lung cancer treated?
Surgery and radiotherapy. Poor response to chemotherapy.
95
Which lung cancers have better prognoses?
Non-small cell cancers
96
What is mesothelioma?
Tumour of the mesothelial cells of the lung pleura
97
What is mesothelioma associated with?
Asbestos exposure
98
What are features of mesothelioma?
Progressive SOB, chest pain, effusion, clubbing
99
What tests should be done for mesothelioma?
CXR/CT - shows pleural thickening
100
How is mesothelioma managed?
Palliative chemotherapy +/- radiotherapy
101
What are interstitial lung diseases characterised by?
Chronic inflammation and/or progressive interstitial fibrosis
102
What are symptoms of ILDs?
Breathlessness on exertion, non productive cough, abnormal breath sounds
103
What is the pathophysiology of ILD?
Fibrosis and remodelling of the interstitium and hyperplasia of epithelial cells and pneumocytes
104
What does spirometry show in ILD?
FEV1 - reduced
FVC - reduced
FEV1/FVC = normal
105
Does ILD show an obstructive or restrictive pattern on spirometry?
Restrictive
106
What is the commonest ILD?
Idiopathic pulmonary fibrosis
107
What are features of idiopathic pulmonary fibrosis?
Progressive exertional dyspnoea, bibasal crackles, dry cough, clubbing
108
What may imaging show in idiopathic pulmonary fibrosis?
CXR - ground glass appearance
| CT - honeycombing
109
How is IPF managed?
Pulmonary rehab
Pirfenidone
Oxygen
Lung transplant
110
Which occupation get silicosis?
Stonemasons/ceramics
111
'Egg shell hilar calcification'
Silicosis
112
Which occupation get byssinosis?
Cotton workers
113
Which occupation get beryllosis?
Aerospace workers
114
Which occupation get asbestosis?
Builders, plumbers, electricians etc
115
What drugs may cause pulmonary fibrosis?
Nitrofurantoin, amiodarone, bleomycin, sulphasalazine
116
What is the underlying cause of Extrinsic Allergic Alveolitis (EAA)?
Fungal spores/avian proteins producing a hypersensitivity reaction
117
What is EAA also known as?
Bird fanciers lung, farmers lung
118
How does EAA present acutely?
4-6 hours post exposure - rigors, fever, sob
119
How is EAA treated?
Avoid trigger
Oxygen
Oral prednisolone (acute)
Long term steroids if chronic
120
What other medical conditions may cause ILD?
Rheumatoid arthritis, SLE, sjogrens, UC
121
What is sarcoidosis?
Multisystem granulomatous disease of unknown cause
122
How does sarcoidosis affect the lungs?
Bilateral hilar lymphadenopathy, infiltrates, fibrosis, non-caseating granulomas, restrictive spirometry
123
What is pneumothorax?
Air in the pleural space
124
What are the causes of a pneumothorax?
Spontaneous, trauma, asthma, COPD, TB, pneumonia, abscess, cancer, CD, CPAP, Marfans, Ehlers-Danlos
125
What are clinical features of pneumothorax?
SOB, pleuritic chest pain, reduced chest expansion, hyper-resonance, diminished breath sounds
126
What are the investigations for pneumothorax?
CXR, ABG
127
How is an asymptomatic primary pneumothorax that is less than 2cm managed?
Discharge from hospital
128
How is a symptomatic primary pneumothorax managed?
Aspiration
129
How is a primary pneumothorax that is bigger than 2cm managed?
Aspiration
130
How is a secondary asymptomatic pneumothorax that is 0-1cm managed?
Oxygen + admit
131
How is a secondary asymptomatic pneumothorax that is 1-2cm managed?
Aspiration
132
How is a secondary symptomatic/>2cm pneumothorax managed?
Chest drain
133
What is a primary pneumothorax?
One that occurs without underlying lung pathology
134
What is a secondary pneumothorax?
One that occurs with underlying lung pathology
135
How is aspiration performed?
14G cannula in 2nd intercostal space midclavicular line
136
How is a chest drain inserted?
5th intercostal space, mid axillary line
137
What is a tension pneumothorax?
Potentially life threatening pneumothorax where the air is drawn into the pleural space but is not returned on expiration - 'one way valve'
138
What clinical features are seen with a tension pneumothorax?
Deviated trachea away from the side, tachycardia, hypotension, distended neck veins, raised JVP
139
What is the management of a tension pneumothorax?
Needle decompression & a chest drain
140
What is pleural effusion?
Fluid in the pleural space
141
What criteria can be used to classify pleural effusion?
Lights criteria
142
What is a transudate pleural effusion?
<30g/L protein content
143
What is an exudate pleural effusion?
>30g/L protein content
144
What is a haemothorax?
blood in the pleural space
145
What is pus in the pleural space called?
Empyema
146
What are the main causes of transudate pleural effusions?
Heart failure, pericarditis, fluid overload, cirrhosis, nephrotic syndrome, hypothyroidism, Meigs syndrome
147
What are the main causes of exudative pleural effusions?
Infection, inflammation, malignancy
148
What symptoms do pleural effusions cause?
Dyspnoea, non productive cough
149
What signs do pleural effusions cause?
Decreased expansion, stony dull percussion note, reduced breath sounds, tracheal deviation AWAY from effusion
150
What may be seen on a CXR in pleural effusion?
Blunting of costophrenic angles
| D sign in empyema
151
What investigations should you do for pleural effusion?
CXR
| Pleural aspirate
152
How is a pleural aspirate performed?
21G needle + 50ml syringe under USS
153
What should you check the fluid for in a pleural aspirate?
pH, protein, LDH, cytology, microbiology
154
How is pleural effusion managed?
Chest drain (<2L/24hrs)
