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Respiratory Flashcards

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1
Q

Outline some key clinical differences between asthma and COPD:

A

COPD:

  • smokers
  • rare <35 years
  • Chronic cough is common
  • Persistent shortness of breath
  • Night symptoms are uncommon
  • variability in symptoms is minimal

Asthma is the opposite to all these.

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2
Q

In FBC of COPD what would you expect too see?

A

polycaethemia

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3
Q

What two infections commonly cause exacerbation of COPD?

A

H. Influenza

S. Pneumonia

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4
Q

What are some common sites that mesotheliomas have metastasised from?

A

Ovary

breast

Lymphomas

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5
Q

Define Allergy:

A

An immune intolerance mediated by the immune system to a particular trigger.
there must be recognition and a response

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6
Q

What is a stridor indicative of?

A

Inspiration difficulty

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7
Q

Define asthma:

A

Chronic inflammatory condition of the airways that causes recurrent episodes of wheezing, breathlessness and chest tightening.
- partially reversibly

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8
Q

List come clinical features of asthma:

A 
Wheeze 
cough 
sputum is clear 
breathlessness
exercise intolerance
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9
Q

How is asthma diagnosed?

A

Diary of peak flow

Histamine bronchial Provocation Test
- 20% drop in FEV1

Spirometry

Scratch test

Sputum
- Eosinophil infiltrate

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10
Q

List asthma management:

A

Stage I: SABA

Stage II: ICS + SABA

Stage III: ICS + LABA + SABA 
or 
LRA 
or
theoyphyline 
or 
B2 agonist tablet (not <12 years old)

Stage IV: high dose ICS + dialators
+
Antimuscarinic (ipatropium)

Stage V: Oral steroids

+

omalizumab
Mepolizumab
Infliximab

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11
Q

Definition of life threatening asthma attack?

A

PEF: <33%
SpO2 <92%

Reduced breath sounds

<

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12
Q

Definition of severe asthma attack:

A

Inability to complete full sentences

PEF: 33-50%
REspiratory rate> 25

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13
Q

Management of severe asthma attack:

A

Oxygen: 40-60%

Nebulised: salbutamol 5mg
or
Terbutaline 10mg

Prednisolone 40-50mg
or
IV hydrocortisone 100mg

failure in 15-30mins:

  • senior help
  • contact ICU

IV magnesium 1.2g over 20mins

IV salbutamol

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14
Q

what is the subsequent management of severe asthma attack?

A

Sats: 94-98%

steroids - 6 hourly

Nebulised B2 4-6 hourly

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15
Q

When can a person be discharged after a severe asthma attack?

A

24 hour use of medicine with no reductionin PEF.

PEF >75%

Oral and inhaled steroids to be given

Arrangement with GP in 2 days

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16
Q

What is hypersensitivity pneumonitis

A

Restrictive lung disease characterised by widespread inflammation affecting small airways and alveoli

caused by known allergen.

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17
Q

Outline pathophysiology of Hypersensitivity pneumoitis

A

first exposure:
Type IV hypersensitivity reaction:
IL12
IFN gama

activation of TH1 cell

Second exposure:

Type III hypersensitivity reaction
reactivation of antibodies.

fibrosis scarring.
complement activation.

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18
Q

Symptoms of hypersensitivity pneumonitis:

A

Fever
malaise
cough
- after the exposure a few hours later

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19
Q

What is the criteria for obstructive sleep apnea?

A

The cessation or near cessation of airflow.

> 4% oxygen desaturation lasting >10secs

> 15 episodes of Apnea per hour. (AHI>15)
or
5-15 episodes with compatible symptoms

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20
Q

Symptoms of sleep apnea?

A

Snorer

Disruptive sleep

Daytim Somnolence

Fatigue

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21
Q

What score can be used in sleep apnea to assess the the distance of the tongue from roof of mouth?

A

Mallampati score

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22
Q

Investigations into sleep apnea:

A

Epsworth sleeping score

Limited Polysomnography

Full Polysomnography

Transcutaneous Oxygen Sats

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23
Q

What are the two main differentials for sleep apnea?

A

Hyponoea:
- reduced oxygen flow but doesn’t meed criteria for sleep apnea

Respiratory effort related arousals

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24
Q

Define interstitial lung disease:

A

Umbrella term used to describe a group of disorders that lead to scarring lung and restrictive lungs

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25
What are some key medications that can cause intersitial lung disease?
- nitrofurantoin - DMARDS - Amiodarone - ACE inhibitors - Chemotherapy - Heroin/ methadone - Radiation treatment
26
When assessing for ILD what test should be done?
Chest x-ray CRP - inflammatory marker FBC Immunology - rheumatoid factor - Serum ACE (for sarcoid) ABGs ECG
27
What is IPF?
Pulmonary disorder of unknown aetiology that is patchy progress bilateral interstitial fibrosis
28
Outline pathogenesis of IPF?
Damage to epithelial cells. Macrophages and neutrophil infiltration - promote collagen formation - TGF- Beta Alveolar epithelium become myoepithlelial cells - laying down more collagen and leading to restriction Type II pneumocyte activation, replacement of type I. promotes further inflammation
29
Clinical findings of IPF?
Velcro-like crackles durign inspiration CT: Subpleural reticular abnormalities - honeycombing - ground glass appearance
30
What is the histological appearance of IPF? and how is it done?
Done by Video- assisted thoracic surgery - histology: interstitial pneumonia pattern - dense fibrosis material in subpleura - destruction of normal lung - inflammatory infiltrate with temporal heterogeneity Fibroblastic Foci - myofibroblastic proliferation
31
What is treatment options for IPF?
It is fatal. Lung transplant needed. Pirfenidone - reduced fibrosis formation Nintedanib - tryosine kinase inhibitor N- Acetyl cysteine - mucus Oxygen therapy Antibiotics for infection
32
When would you not aspirate a pleural effusion?
if bilateral. | - likely to be transudate
33
What is Light's criteria for pleural effusion?
Fluid >30g protein Fluid Lactate dehydrogenase is 2/3rd upper limit of normal plasma PLeural serum protein ratio >0.5 unilaterally varying colour
34
How can malignant pleural effusions be managed?
indwelling pleural catheter
35
Whats the most common type of hypersensitivty pneumonitis, and what is the pathogen?
Farmer's lung micropolyspora faeni
36
What investigations are done for COPD?
Spirometry with reversibility Chest x-ray - hyperinfaltion - heart looks small High resolution CT - bullae ABGs - assess for respiratory failure FBC - polycaethemia Alpha -1 antitrypsin BMI < low associated with worse prognosis Sputum - for infections ECG and Echo - heart function
37
Define emphysema:
Abnormal permenant enlargement of the airspaces distal to the terminal bronchioles
38
What are the dyspnoea scale?
used to assess the level of breathlessness in COPD: Grade 1: Dyspnoea on strenous activity Grade 2: Dyspnoea when hurrying or walking up hill Grade 3: walks slower than others on ground level cause of breathlessness grade 4: stops for breathes every 100m at ground level Grade 5: too breathless to leave house. Dressing makes breathless.
39
What's an important cytokine in the pathogenesis of IPF?
TGF - Beta
40
What is the stain used to identified TB? and what is it staining?
Ziehl Neelsen staining Acid fast bacteria, in TB specifically: Mycolic acid
41
In TB, what is called when the granuloma forms, and then what is it called when this affects the lymph node aswell?
Ghon focus Ghon complex
42
If a patient presents with pneumonia, what microbiology tests should you carry out?
Respiratory samples: - sputum - viral PCR from gargle Urine: - Legionella - PCR Blood cultures MRSA screen
43
In severe CAP, what is the recommended antibiotics?
IV Amoxicillin or IV co-amoxiclav + Clarithromycin or Levofloxacin if penicillin allergy
44
Outwith air conditioners, where else can legionella come about?
compost (soil)
45
Name another two types of Legionella infections:
Pontiac fever - acute, self limiting febrile infection Extra-pulmonary Legionella - seen in immunocompromised - myocarditis etc.
46
Who is most likely to get Mycoplasma Pneumonia?
Young school children
47
How is Chlamydia Psittaci spread?
Parrots
48
What type of pneumonia often causes pleural effusions?
S. pneumonia
49
What are the normal alleles for anti - trypsin and what are the pathological ones, and how do they relate too COPD?
MM - are normal ZM - heterozygous - will get the disease if smoker ZZ - homozygous - will get panoemphysema
50
What investigations are done to assess COPD?
Spirometry - with reversibility - raised TLC - Reduced FEV/FVC >.70 Chest X-ray Sputum analysis ABGs - hypoxic FBC - polycythemia
51
When is it considered to be respiratory failure?
<8kPa of oxygen >6.7kPa of CO2
52
Is an allergy dose dependent?
No it is not dose dependant - there is either a reaction or not a reaction. unlike reactivity to stimulus, which is dose dependent
53
What are extra- thoracic bronchial disease affected up?
In air problems because they have cartilage which maintains them open - allowing expiration
54
When diagnosing asthma, using the histamine provocation test, what is the drop in the FEV1 we are looking for?
>20%
55
What is considered a small pneumothorax and what is the management of such a small pneumothorax?
<2cm. in healthy people will self heal | - monitor over 7 days
56
If a pneumothorax is large, what is the size? and what is the management?
>2cm | Aspiration of air
57
In the setting of tension pneumothorax, what is the immediate management?
Don't have time for imaging. Large IV cannula - insert at 2nd intercostal space at midclavicular line followed by Chest drain
58
What are the treatment regimes for COPD?
``` >50% SABA + a)LABA b)LAMA c) LABA + LAMA d) LABA+ LAMA + ICS ``` ``` <50% SABA+ a) LABA + ICS b) LAMA c) LABA + ICS + LAMA ```
59
Define Obstructive sleep apnea and obstructive sleep apnea syndrome:
Obstructive sleep apnea = recurrent episodes of partial or complete upper airway obstruction with intermittent hypoxia Syndrome = manifests as the daytime sleepiness thus if a person has daytime somnolence then they have syndrome time.
60
What are the main issues associated with OSA?
Heart attack and Strokes
61
Whats the symptoms of OSA?
Snorer Witnessed of apnoeas Disruptive sleep Daytime somnolence Low mood
62
What clinical examination do you do of someone with OSA?
Weight BMI BP Neck circumference Epworth Sleepiness Score Home Limited polysomnography FUll Polysomnography Transcutaneous Oxygen Saturation and Carbon Dioxide Assessment
63
Whats the advantages of the Full polysomnography?
Correct patient Accurate assessment of sleep EEG Parasomniac activity - sleep talking, REM
64
What is severe Sleep apnea?
AHI >30
65
Who do you treat in sleep apnea?
Obstructive sleep apnea syndrome. i.e. you treat those who have symptoms. with aim to improve day somnolence and improve quality of life.
66
What is the treatment of sleep Apnea?
Weight loss Avoiding triggers - alcohol Continual positive airway pressure - forces airway opens
67
What can be used if a patient can't tolerate CPAP?
Mandibular mouth guard - pulls the jaw forward only useful in mild to moderate disease
68
In hypersensitivity pneumonitis, where is the inflammation?
within the alveolar
69
List some key findings histological findings of IPF:
Interstitial Pneumonia fibroblastic focuses Heterogeneous in nature - varying areas affected.
70
In asthma outline the main cytokines and described what they do:
Il-4 = activation of Th2 IL 5 = Eosinophils Il 13 = activates mucus secretion LT4 = stimulus to the neutrophil and smooth muscle

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