Flashcards in Respiratory Deck (75):
What is sameters triad?
Asthma, nasal polyps, NSAID sensitivity
Management of allergic rhinitis?
Consider leukotryne receptor antagonists
Where do over 90% of epistaxis originate?
Kiesselbach plexus in Little's area on anterior inferior septum
What are the two key receptors on bronchial smooth muscle and their effects when stimulated?
B2 stimulated by sympathetic nervous system causing bronchodilation
M3 stimulated by parasympathetic nervous system causing bronchoconstriction
Where is aspiration pneumonia most common and why?
Right lung due to the wider and more vertical right bronchus
What is the name for the ridge of cartilage where the trachea splits?
What kind of pneumocytes secrete surfactant?
Where do the bronchioles get there blood supply from?
Where are the three sites where bronchial breath sounds can be heard normally and why?
Right sternoclavicular joint
Right posterior interscapular space
The tracheobronchial tree is close to the chest wall with no overlaying lung tissue
Whats the difference between bronchial and vesicular breath sounds?
Vesicular: Soft and low. I:E 3:1. No pause between inspiration and expiration.
Bronchial: Higher pitched and louder. I:E usually equal. Pause between inspiration and expiration.
What does bronchial breath sounds over lung peripheries indicate?
No ventilation in the alveoli so the sound heard is travelling from the bronchi
Consolidation, cavitation, atelectasis with patent bronchi, masses
Most common organism in acute epiglottitis?
Management of acute epiglottitis?
Secure airway and oxygen
Do not examine oral cavity
2g IV Ceftriaxone
What does thumbprint sign on lateral neck xray suggest?
Most common organism in croup?
Management of croup?
Dexamethasone 0.6mg/kg orally
1:1000 adrenaline 5ml nebulised
What keeps the lungs inflated?
Pressure in the airways is greater than the pressure in the pleural space forcing out the lining of the lung
What is the key difference in definitions of atelectasis and pneumothorax which are both forms of collapsed lung?
Atelectasis is deflated alveoli
Pneumothorax is air in the pleural cavity
What is the most common cause of atelectasis?
Blockage of the bronchioles or bronchus due to mucous, foreign bodies or tumours.
What is a bulla?
Large air containing lesion
What is parenchyma?
Functional tissue of an organ
What are the 3 classic CXR patterns of pneumonia?
Lobar pneumonia: consolidation in entire lobe
Bronchopneumonia: patchy distribution along small airways
Interstitial pneumonia: inflammation within the interstitium with generalised increased lung markings
What are common signs of pneumonia on CXR?
Consolidation, pleural effusion, infiltrates
Most common organism in lobar pneumonia?
Who classically gets Klebsiella pneumonia and what is a distinguishing feature?
Diabetics, alcoholics, aspiration
Red current jelly sputum
Most common organism in pneumonia for COPD patients?
What is the most common organism causing secondary pneumonia?
CURB 65 scoring and rankings
BP <90 or <60
Treatment for mild CAP?
Amoxicillin 1g TDS for 5 days (doxycyline if pen allergic)
Treatment for severe CAP?
IV Co-amox + PO Doxy
Treatment for HAP?
Non-severe PO Amox
Severe IV Amox + Gent
Treatment for aspiration pneumonia?
IV Amox, Met, Gent
What are the classical symptoms in atypical pneumonias?
Dry cough, low grade fever
How do you determine legionella?
Urine antigen test
How do you diagnose Mycoplasma?
How do you diagnosis PCP?
What kind of granuloma is seen in TB?
Caseating (T cells and macrophages form a granuloma with a necrotic centre)
What is a ghon focus and where is it classically found?
Granuloma caused by TB (only detectable on Xray if it calcifies - ranke complex)
Usually sub pleural in lower lung lobes
What staining is used to identify TB?
ZN - identifies acid fast bacilli (turns red)
SABA (salbutamol) or SAMA (ipratropium)
FEV1 >50%: LABA (salmeterol) or LAMA (tiotropium)
FEV1<50%: LABA + ICS combo inhaler (folmeterol + beclamethasone) or LAMA (tiotropium)
LABA (salmeterol) + ICS (beclamethasone) + LAMA (tiotropium)
What is the purpose of steroids in COPD treatment?
They reduce the frequency of exacerbations
Investigations for asthma?
Spirometry (FEV1:FVC ratio <70%)
Bronchodilator reversibility test (FEV1 or FVC improvement)
Functional exhaled nitric oxide test (Increased NO as it correlates with inflammation)
What is step up asthma treatment in adults?
SABA + ICS
SABA + ICS (beclamethasone) + LTRA (montelukast)
SABA + ICS + LABA (salmeterol) +/- LTRA
SABA + MART (maintenance and reliever therapy ICS + LABA in one inhaler)
What are the first two steps of asthma treatment in children?
1- LTRA (montelukast)
2- ICS + LTRA
2- ICS + LABA
What is in a fostair inhaler?
Beclamethasone and formoterol
What is in a seretide inhaler?
Fluticasone and formoterol
What is in a clinil inhaler?
Why does respiratory acidosis occur in acute asthma?
Airway obstruction with reduced air in and out of the lungs thus reduce O2 in and CO2 out. Oxygen levels drop in the blood (T1RF) and CO2 levels begin to rise increasing formation of carbonic acid and subsequent dissociation in to H+. Body can blow of CO2 initially by increasing RR. As body tires CO2 rises (T2RF).
Main side effects of steroids?
Growth restriction, diabetes, cushing's syndrome
What drugs should you be cautious to use in asthma?
NSAIDs (disruption of arachidonic acid cascade with a decrease in thromboxane and prostaglandins leads to an increase in pro inflammatory leukotreines)
BBlockers (B2 receptors cause relaxation of bronchial smooth muscle and when blocked can cause constriction)
Main side effects of beta agonists?
Fine tremor (contraction of skeletal muscle)
Tachycardia (contraction of cardiac muscle)
Hypotension (relaxation of arterial smooth muscle)
What is Churg Strauss syndrome?
Astham, Oesinophilia, Vasculitis
What is interstitial lung disease?
Fibrosis of the lung interstitium (tissue and space around the air sacs, thickening the barrier for gas exchange, decreased gas exchange, decreased lung filling ability)
What are the two main causes of restrictive lung disease?
Interstitial lung disease
Chest wall abnormalities
What are some drug causes of pulmonary fibrosis?
bleomycin, amioderone, radiation
What are the 4 main types of interstitial lung disease?
What are the 4 key pneumoconosies?
Asbestosis (insulation material - construction workers, plumbers, shipyard workers)
Berylliosis (miners, aerospace workers)
Silicosis (sand blasters)
What is sarcoidosis?
systemic disease with formation of non-caseating granulomas in multiple organs
What happens in extrinsic allergic alveolitis and what are the common types?
Chronic exposure to an allergen causes formation of granulomas within the lung and fibrosis
Farmers, bird handlers
Management of primary pneuomthorax <2cm and asymptomatic?
Management of primary pneumothorax >2cm or symptomatic?
Admit, aspirate (2ICS mid clavic)
Drain if fails (5ICS mid aux)
Management of secondary pneumothorax?
0-1cm: admit for 24hrs
1-2cm: aspirat, insert chest drain if fails
>2cm or symptomatic: chest drain
What is ARDS?
Diffuse lung inflammation with non cardiogenic pulmonary odema
Wells score: >2 Leg USS within 4hrs if not D.dimer and LMWH
<1 d.dimer (if positive USS)
Management of DVT?
LMWH (dalteparin sub cut according to weight)
Start on an anticoagulant (warfarin or NOAC)
How long should patients be continued on anticoagulants post PE/DVT?
Active Ca: LMWH 6months
How to manage pleural effusion?
USS guided aspiration with 21G needle and 50ml syringe
What are the protein levels in pleural effusion?
What are the 3 key features of small cell lung cancer?
Paraneoplastic Syndromes (ACTH - cushings, ADH - hyponatremia, Lambart Eaton - ABs to neurons)
Why is it key to distinguish between small cell and non small cell lung cancer?
Small cell is highly responsive to chemo
Non small cell is considered for surgery and radiotherapy but not responsive to chemo
What are the main types of non-small cell lung cancer and the key features of each?
Squamous (PTH secretion causing hypercalcemia, TSH secretion), Adenocarcinoma (non smokers, peripheral)
Size of tumour