Respiratory Flashcards
(133 cards)
1
Q
What is the description of bronchiectasis?
A
Chronic infection of the bronchi and bronchioles leading to permanent dilatation of these airways.
2
Q
What are some symptoms of bronchiectasis?
A
Productive cough (yellow-green sputum, can become haemoptysis) Recurrent febrile episodes, malaise
3
Q
What are some signs of bronchiectasis?
A
Clubbing
Coarse inspiratory crepitations
Wheeze
4
Q
What are the causes of bronchiectasis?
A
Congenital
Cystic fibrosis
Bronchiole obstruction (tumour, foreign body)
5
Q
How do you diagnose bronchiectasis?
A
CXR - dilated + thickened bronchiole walls
CT - thickened bronchi which are wider than the adjacent blood vessel, cysts
Sputum culture - S. aureus, Pseudomonas, HiB
IgA deficiency
6
Q
What are some complications of bronchiectasis?
A
Pneumonia, pneumothorax
Empyema
Metastatic cerebral abscesses
Life-threatening haemoptysis
7
Q
What is the treatment of bronchiectasis?
A
- Postural drainage twice daily
- Physiotherapy
- Antibiotics (mild: cefaclor/ciprofloxacin,
flucloxacillin if S. aureus, persistent: ceftazidime) - Bronchodilators (e.g. nebulised salbutamol) + anti-inflammatory agents (e.g. corticosteroids such as prednisolone)
8
Q
What is the description of cystic fibrosis?
A
Autosomal recessive disorder in which there is a defect in the CFTR gene.
Failed opening of Cl channel -> increased cAMP -> increased viscosity of airway secretions.
9
Q
What are some symptoms of cystic fibrosis?
A
Recurrent infections, cough, wheeze Sinusitis, nasal polyps Breathlessness Haemoptysis Steatorrhoea Malabsorption Failure to thrive as a neonate
10
Q
What are some signs of cystic fibrosis?
A
Cyanosis
Finger clubbing
Bilateral coarse crackles
11
Q
How do you diagnose cystic fibrosis?
A
Sweat test Genetic testing (common CF mutations)
12
Q
What is the treatment of cystic fibrosis?
A
Lifestyle advice (smoking, vaccines) Antibiotics (as per bronchiectasis) SABAs, ICS for symptoms Physiotherapy to develop techniques for better breathing Gene therapy is not yet possible
13
Q
What is the description of allergic bronchopulmonary aspergillosis?
A
An allergic condition caused by type 1 and type 2 hypersensitivity reactions to Aspergillus fumigatus.
14
Q
What are some symptoms of allergic bronchopulmonary aspergillosis?
A
Wheeze Cough Sputum Dyspnoea Recurrent pneumonia
15
Q
How do you diagnose allergic bronchopulmonary aspergillosis?
A
CXR- transient segmantal collapse or bronchiectasis
Sputum culture - Aspergillus
16
Q
What is the treatment of allergic bronchopulmonary aspergillosis?
A
Prednisolone for acute attacks
Bronchodilators for asthma
17
Q
What is the description of aspergilloma?
A
A fungus ball within a pre-existing cavity (usually caused by TB or sarcoidosis)
18
Q
What are some symptoms of aspergilloma?
A
Cough
Haemoptysis
Lethargy +/- weight loss
19
Q
How do you diagnose aspergilloma?
A
CXR- round opacity within an apical cavity
Sputum culture
20
Q
What is the treatment for aspergilloma?
A
Only if symptomatic
Surgical excision
21
Q
What is the description of invasive aspergillosis?
A
Occurs when the immune system fails to prevent Aspergillus spores from entering the bloodstream via the lungs
22
Q
What are some risk factors for invasive aspergillosis?
A
Immunocompromised patients (HIV, leukaemia, burns) Broad-spectrum antibiotic therapy
23
Q
What are some symptoms of invasive aspergillosis?
A
Fever and chills
Haemoptysis
Shortness of breath
Chest and joint pain
24
Q
How do you diagnose invasive aspergillosis?
A
Lung biopsy
25
What is the treatment for invasive aspergillosis?
Voriconazole
26
What is the description of extrinsic allergic alveolitis?
Widespread diffuse inflammatory reaction in small airways and alveoli due to inhalation of foreign antigens, usually from animals.
Cigarette smokers actually have decreased risk.
Type III hypersensitivity
27
What are some symptoms of extrinsic allergic alveolitis?
```
Fever and malaise
Cough
Breathlessness
Wheeze
Coarse end inspiratory crackles
Weight loss
```
28
How do you diagnose extrinsic allergic alveolitis?
CXR - fluffy upper zone nodular shadows
CT - ground glass opacity
Restrictive lung pattern
Raised leucocytes + T cells
29
What is the treatment for extrinsic allergic alveolitis?
Oral prednisolone in early stages
| Prevent exposure to allergen
30
What is the description of lung cancer?
Carcinomas of the lung, bronchial carcinoma being the most common
31
What are some risk factors of lung cancer?
Cigarette smoking
Asbestos
Radiation
32
What is the histology of lung cancer?
Squamous cell carcinoma (35%)
Adenocarcinoma (27%)
Small cell carcinoma (20%)
Large cell carcinoma (10%)
33
What is the description of SCC of the lung?
Arise from epithelial cells
Local, slow metastasis.
Hypercalcaemia, PTH
34
What is the description of adenocarcinoma of the lung?
Common in non-smokers
Arises from mucus-secreting glandular cells
Metastasises widely
35
What is the description of small cell carcinoma of the lung?
Arise from APUD cells; secrete ACTH
Often centrally located
Rapid metastasis
36
What is the description of large cell carcinoma of the lung?
Poorly differentiated
| Metastasises early on
37
What are some symptoms of lung cancer?
```
Cough
Haemoptysis
Dyspnoea
Chest pain
Weight loss
```
38
What are some signs of lung cancer?
Cachexia
Anaemia
Clubbing
Hypertrophic pulmonary osteoarthropathy => wrist pain
Consolidation, collapse, pleural effusion
Metastasis - bone tenderness, hepatomegaly, confusion, fits
39
What are some complications of lung cancer?
```
Local - recurrent laryngeal nerve palsy
phrenic nerve palsy
Horner's syndrome (pan coast tumour)
pericarditis
Metastatic - Bone pain
Anaemia
Hypercalcemia
```
40
How do you diagnose lung cancer?
Cytology - sputum and pleural fluid
CXR - mass lesions, pleural effusion, hilar adenopathy, slow resolving consolidation, collapse, reticular shadowing
CT - stage the tumour
Bronchoscopy - to give histology and assess operability
41
What is the treatment of lung cancer?
Non-small cell tumours - Surgical excision or radical radiotherapy
Small cell tumours - chemotherapy
Surgery - can be curative. In stage III, treat with chemo to shrink tumour before surgery. Contraindicated if tumour is near hilum and/or evidence of metastasis.
Drugs - analgesia, steroids, anti-emetics, bronchodilators, anti-depressants
42
What is the description of asthma?
A lung disorder in which inflammation causes the bronchi to swell and narrow the airways.
43
What are some symptoms of asthma?
Chest tightness
Wheeze
Dry cough
Breathlessness
44
What are some signs of asthma?
Hyperinflated chest
Hyperesonant percussion note
Severe attack - inability to complete sentences, pulse more than 110bpm, respiratory rate >25bpm, PEF 33-50% predicted
Life-threatening attack - silent chest, confusion, exhaustion, cyanosis, SPO2 less than 92%, bradycardia, PEF less than 33% predicted
Near fatal attack - Highly increased PaCO2
45
How do you diagnose asthma?
Acute attack - PEF, sputum culture, FBC, U&E, CRP, ABG analysis (shows signs of hyperventilation)
Chronic - PEF monitoring, spirometry, FEV1/FVC ratio
46
What is the treatment of an acute attack of asthma?
O - Oxygen
S - Salbutamol (nebulised)
H - Hydrocortisone (IV)
I - Ipratropium (nebulised)
T - Theophylline (oral)
M - Magnesium sulfate (IV)
AN - Anaesthetist
47
What is the treatment of chronic asthma?
Step 1 - SABA for symptoms relief
Step 2 - Add inhaled corticosteroids (e.g. beclometasone)
Step 3 - Add LABA every 12 hours by inhaler
Step 4 - Increased dose of corticosteroid and add theophylline (oral), SABA (oral) or leukotriene receptor antagonist (oral)
Step 5 - Add daily oral prednisolone
48
What is the description of COPD?
Encompasses 2 main clinical syndromes: chronic bronchitis and emphysema.
Characterised by airflow obstruction that is mostly irreversible.
49
What are the two types of COPD patients?
Pink puffers - high alveolar ventilation, near normal PaO2 and low PaCO2. Breathless but not cyanosed. May progress to type 1 respiratory failure.
Blue bloaters - low alveolar ventilation, low PaO2 and a high PaCO2. They are cyanosed but not breathless. May go on to develop cor pulmonale. Supplemental oxygen should be given with care.
50
What are some symptoms of COPD?
Productive cough
Wheeze
Breathlessness
Infective exacerbations
51
What are some signs of COPD?
Tachypnoea
Use of accessory muscles of respiration
Hyperinflation
Cyanosis
52
What are some potential complications of COPD?
```
Hypertension
Osteoporosis
Weight loss
Cor pulmonale
Respiratory failure
```
53
How do you diagnose COPD?
FBC - increased PVC
CXR - hyperinflation, large pulmonary arteries, cor pulmonale
ABG - PaO2 decreased
Lung function - Obstructive (FEV1 low, FEV1/FVC ratio reduced)
54
What is the treatment of COPD?
Smoking cessation and lifestyle advice
Mild - SABA (salbutamol)
Moderate/severe - LABA (salmeterol)
SAMA (ipratropium) or LAMA (tiotropium)
Mild - Inh. corticosteroid (beclometasone)
Severe - PO corticosteroid if severe (prednisolone)
Also add:
Seretide (salmeterol + beclometasone)
Xanthine (theophylline)
Anti-mucolytic (carbocysteine)
55
What is the treatment for an acute exacerbation of COPD?
i - Ipratropium (nebulised)
S - Salbutamol (nebulised)
O - Oxygen
A - Antibiotics (e.g. amoxicillin, doxycycline)
P - Prednisolone (oral)
56
What is the description of acute respiratory distress syndrome?
Respiratory distress due to stiff lungs (reduced pulmonary compliance) and gas exchange impairment
57
What are some causes of acute respiratory distress syndrome?
Lung injury
Severe sepsis
Pneumonia
Haemorrhage
58
What are some symptoms of acute respiratory distress syndrome?
Breathlessness
Tachypnoea
Increasing hypoxaemia, central cyanosis
Fine bilateral crackles
59
What are some signs of acute respiratory distress syndrome
CXR shows bilateral pleural infiltrates
60
How do you diagnose acute respiratory distress syndrome?
4 main diagnosing features:
- Acute onset
- CXR => bilateral infiltrates
- Lack of congestive heart failure
- Refractory hypoxaemia
61
What is the treatment of acute respiratory distress syndrome?
Respiratory support - Continuous positive airway pressure with 40-60% oxygen
Circulatory support - fluid management with diuretics
Treat underlying condition - e.g. Sepsis
62
What is the description of type I respiratory failure?
Hypoxia (PaO2 < 8kPa) with a normal or low PaCO2.
63
What is type I respiratory failure caused by?
Mismatch in ventilation/perfusion e.g. pneumonia, PE, asthma, emphysema, ARDS, pulmonary oedema
64
What is the description of type II respiratory failure?
Hypoxia (PaO2 < 8 kPa) and hypercapnia (PaCO2 > 6 kPa)
65
What is type II respiratory failure caused by?
- Pulmonary disease (asthma, COPD, pneumonia, fibrosis, obstructive sleep apnoea)
- Reduced respiratory drive (sedation drugs, CNS tumour/trauma)
- Neuromuscular disease (cervical cord lesion, diaphragmatic paralysis, poliomyelitis, Guillain-Barre Syndrome)
- Thoracic wall disease (flail chest, kyphoscoliosis)
66
What are some signs and symptoms of respiratory failure?
Hypoxia - dyspnoea, restlessness, agitation, confusion, central cyanosis, pulmonary hypertension
Hypercapnia - headache, peripheral vasodilation, tremor/flap, tachycardia, bounding pulse
67
How do you diagnose respiratory failure?
Do investigations to figure out the underlying cause:
- Blood tests => FBC, U&E, CRP, ABG
- Radiology => CXR
- Microbiology => Sputum culture, blood culture
- Spirometry => COPD, Guillain-Barre syndrome
68
What is the treatment for type I respiratory failure?
Treat underlying cause
Oxygen (15L) non-rebreather (hypoxia)
Assisted ventilation if PaO2 < 8kPa despite 60% O2
69
What is the treatment for type II respiratory failure?
Oxygen (24%)
Recheck ABGs after 20min
- If PaCO2 is steady/lower, increase O2 concentration to 28%
- If PaCO2 rises > 1.5kPa and patient is still hypoxic, consider a respiratory stimulant (doxapram) or assisted ventilation (NIPPV)
70
What is the description of pulmonary embolism (PE)?
A blockage in one of the blood vessels in the lung.
71
What are some symptoms of pulmonary embolism (PE)?
```
Acute breathlessness
Pleuritic chest pain
Haemoptysis
Dizziness
Syncope
```
72
What are some signs of pulmonary embolism (PE)?
```
Pyrexia (fever)
Cyanosis
Tachypnoea
Tachycardia
Hypotension
Raised JVP
```
73
What are some causes of pulmonary embolism (PE)?
DVT
| Septic emboli
74
What are some risk factors for pulmonary embolism (PE)?
```
Recent surgery
Prolonged bed rest/reduced mobility
Pregnancy
Contraceptive pill
Previous PE
```
75
How do you diagnose pulmonary embolism (PE)?
- CXR usually normal, possible blunting of costophrenic angle
- ECG may be normal or show tachycardia
- D-dimer – if undetected, exclude diagnosis of PE
- V/Q scan shows underperfused areas
76
What is the treatment for pulmonary embolism (PE)?
- Oxygen - if hypoxic
- Morphine - IV and an anti-emetic
- If haemodynamically stable => vasopressors
- If haemodynamically unstable => thrombolysis
Then consider long-term anticoagulation
77
What is the description of pneumothorax?
Air in the pleural space leads to a collapsed lung.
| May be spontaneous (tall, thin males) or the result of trauma to the chest.
78
What are some symptoms of pneumothorax?
Sudden onset of dyspnoea and pleuritic chest pain
| Pale
79
What are some signs of pneumothorax?
Reduced expansion
Hyper-resonance to percussion
Diminished breath sounds on affected side
Trachea deviated away from affected side (tension pneumothorax)
80
How do you diagnose pneumothorax?
Presentation of symptoms
| CXR
81
What is the treatment of pneumothorax?
- Needle aspiration (2nd IC space, mid-clavicular line)
| - Chest drain if recurs using large bore cannula into 5th IC mid-axillary line
82
What is the description of pleural effusion?
Fluid in the pleural space
83
What are the types of pleural effusion?
```
Transudate - <25g/L
Exudate - >35g/ L
Blood - haemothorax
Pus - empyema
Chyle (lymph with fat) - chylothorax
```
84
What are some symptoms of pleural effusion?
Breathlessness
85
What are some signs of pleural effusion?
Stony dull percussion note
Decreased expansion
Diminished breath sounds on the affected side
Tracheal deviation away from the affected side
86
What is the cause of pleural effusion?
Presentation of symptoms
CXR - Small ones blunt the costophrenic edges, larger ones are seen as water-dense shadows
Ultrasound - identifies the fluid present and guides aspiration
Diagnostic aspiration
87
What is the treatment for pleural effusion?
Drainage - If symptomatic, can drain repeatedly
Pleurodesis - with talc, may be help recurrent pleural effusions
Surgery - May be necessary for large effusions
88
What is the description of empyema?
Pus in the pleural space
| Usually a complication of pneumonia
89
What are some symptoms of empyema?
Ongoing fever
| Pneumonia-like persistent symptoms
90
What is the treatment for empyema?
Surgical - drainage
91
What is the description of obstructive sleep apnoea?
Airway becomes closed during sleep.
| Partial occlusion results in snoring; complete occlusion results in apnoea.
92
What are some symptoms of obstructive sleep apnoea?
```
Loud snoring
Daytime somnolence
Poor sleep quality
Morning headache
Nocturia
```
93
What are some of the causes of obstructive sleep apnoea?
Obesity
Pre-existing COPD
Narrow pharyngeal opening
Respiratory depressants
94
What are some potential complications of obstructive sleep apnoea?
Pulmonary hypertension
| Type II respiratory failure
95
How do you diagnose obstructive sleep apnoea?
Overnight pulse oximetry (sometimes video recordings can be all that is required for diagnosis)
Polysomnography
EMG - chest and abdominal wall movements during sleep - can be diagnostic
96
What is the management of obstructive sleep apnoea?
Weight reduction
Avoidance of tobacco and alcohol
CPAP via a mask
Surgery is occasionally needed
97
What is the description of cor pulmonale?
Right heart failure due to chronic pulmonary hypertension
98
What are some symptoms of cor pulmonale?
Progressive breathlessness
Ankle oedema
Fatigue
99
What are some signs of cor pulmonale?
```
Cyanosis
Tachycardia
Parasternal heave, tricuspid regurgitation
Pulmonary hypertension
RV hypertrophy
Elevated JVP, ascites
```
100
How do you diagnose cor pulmonale?
FBC - Hb and haematocrit are high
ABG - hypoxia, with or without hypercapnia
CXR - enlarged right atrium, prominent pulmonary arteries
ECG - p-pulmonale, right axis deviation
101
What is the management of cor pulmonale?
Treat the underlying condition
Treat the respiratory failure - give oxygen
Treat cardiac failure - diuretics
102
What are some causes of cor pulmonale?
Lung disease - COPD, bronchiectasis, pulmonary fibrosis
Pulmonary vascular disease - emboli, vasculitis
Sleep apnoea
Scoliosis or kyphosis
103
What is the description of sarcoidosis?
Multi-system, non-caseating, granulomatous, type IV hypersensitivity disorder of unknown aetiology.
104
What are some symptoms of sarcoidosis?
```
Dry cough
Progressive dyspnoea
Reduced exercise tolerance
Chest pain
Weight loss
Fatigue
```
105
What are some signs of sarcoidosis?
```
Erythema nodosum
Lymphadenopathy
Uveitis
Hepatomegaly
Splenomegaly
```
106
How do you diagnose sarcoidosis?
- CXR multiple abnormalities, BHL
- Restrictive lung pattern
- Hypercalcaemia, raised ACE level
- Transbronchial biopsy
107
What is the treatment of sarcoidosis?
Most recover spontaneously
Acute sarcoidosis - bed rest and NSAIDs
Otherwise - corticosteroids
108
What is the description of interstitial lung disease?
Term used to describe a group of lung conditions which affect the lung parenchyma (part of the lung which is involved in gas exchange) in a diffuse manner.
109
What are some symptoms of interstitial lung disease?
Dyspnoea on exertion
Non-productive paroxysmal cough
Restrictive pulmonary spirometry
Abnormal breath sounds
110
What are the pathological features of interstitial lung disease?
Fibrosis and remodelling of the interstitium
Chronic inflammation
Hyperplasia of type II epithelial cells or type II pneumocytes
111
What is the classification of interstitial lung disease?
Those with known cause:
- Occupational/environmental e.g. asbestosis
- Drugs e.g. bleomycin
- Hypersensitivity reactions
- Infections e.g. TB
- Gastro-oesophageal reflux
Those associated with systemic disorders:
- Sarcoidosis
- Rheumatoid arthritis
- Ulcerative colitis
Idiopathic:
- Idiopathic pulmonary fibrosis
112
What is the description of idiopathic pulmonary fibrosis
Patchy scarring of lung with collagen deposition,
Most common type of interstitial lung disease.
Late onset.
Commoner in males.
113
What are some symptoms of idiopathic pulmonary fibrosis?
```
Dry cough
Exertional dyspnoea
Malaise
Weight loss
Arthralgia
```
114
What are some signs of idiopathic pulmonary fibrosis?
Cyanosis
Clubbing
Inspiratory crepitations
115
How do diagnose idiopathic pulmonary fibrosis?
ABG - decrease in PaO2, if severe then increase in PaCO2
Blood - increase in CRP, increase in immunoglobulins
CXR - initially ground-glass appearance, then honeycomb lung in advanced disease
CT - bilateral changes, essential for diagnosis
Spirometry - restrictive pattern
116
What is the treatment for idiopathic pulmonary fibrosis?
Supportive care - oxygen, pulmonary rehab, corticosteroids (oral prednisolone), anti-fibrotic (pirfenidone)
117
What is the description for coal worker's pneumoconiosis?
A dust disease that occurs from the inhalation of dust particles typically 2-5 micrometres in diameter which are retained in small airways and alveoli.
118
What are the two types of coal worker's pneumoconiosis?
Simple pneumoconiosis - simple, more common form of the disease. Refers to coal dust deposition in the lung. Symptoms COPD-like.
Progressive massive fibrosis - round fibrotic masses several cm in diameter develop on the upper lobes
119
What are the symptoms of coal worker's pneumoconiosis?
Considerable effort dyspnoea
Cough
Black sputum
120
What is the treatment for coal worker's pneumoconiosis/
Avoid exposure to dust
Treat bronchitis
Claim compensation
121
What is the description of silicosis?
A lung disease cause by the inhalation of silica particles which are very fibrogenic.
122
What are the symptoms of silicosis?
Progressive dyspnoea
Increase in incidence of TB
CXR - shows diffuse nodular pattern in upper and mid zones
123
What is the treatment of silicosis?
Avoid exposure to silica
| Claim compensation
124
What is the description of asbestosis?
Fibrosis caused by asbestos dust exposure.
125
What are the symptoms of asbestosis?
Progressive dyspnoea
Clubbing
Fine-end inspiratory crackles
Pleural plaques
126
What is the treatment of asbestosis?
Claim compensation
| Corticosteroids might help symptoms
127
What is the description of pneumonia?
A lower respiratory tract infection.
128
What are the different types of pneumonia?
Community acquired pneumonia
Hospital acquired pneumonia
Aspiration pneumonia
Immunocompromised acquired pneumonia
129
What are some symptoms of pneumonia?
- Fever and rigors
- Pleuritic chest pain
- Anorexia
- Breathlessness
- Cough – dry or productive
130
What are some signs of pneumonia?
Pyrexia
Cyanosis
Tachypnoea
Tachycardia
131
How do you diagnose pneumonia?
- CXR consolidation, effusions, collapse
- FBC + U&Es, CRP
- Sputum culture to detect organisms
- CURB65 score for CAP
132
What does the CURB65 score assess?
Confusion
Urea
Respiratory rate
BP
Age > 65
133
What is the treatment for pneumonia?
Community acquired pneumonia
- Mild/Moderate: (7 days) PO amoxycillin
If penicillin allergy PO doxycycline
if IV required IV clarithromycin
- Severe: (10 days) IV co-amoxiclav + IV clarithromycin/PO doxycycline
If penicillin allergy IV levofloxacin
Hospital acquired pneumonia
- Severe: (7-10days) amoxicillin + metronidazole + gentamicin
- Non-severe: (7 days) amoxicillin + metronidazole
Specific
- Staph. aureus flucloxacillin/vancomycin if MRSA
- Klebsiella cefotaxime
- Pseudomonas ceftazidime/ciprofloxacin + aminoglycide
- Mycoplasma clarithromycin/ciprofloxacin
- Legionella levofloxacin/moxifloxacin/consider rifampicin
- Chlamydophila doxycycline/clarithromycin
- Pneumocystis jiroveci co-trimoxazole
- Fungal amphoterecin
