Respiratory Flashcards
(80 cards)
1
Q
Obstructive vs respiratory disease
- FEV1
- FVC
- FEV/FVC
A
OBSTRUCTIVE
- FEV1 = ↓ ↓
- FVC = ↓ or normal
- FEV/FVC = ↓
RESTRICTIVE
- FEV1 = ↓
- FVC = ↓ ↓
- FEV/FVC = ↑ or normal
2
Q
Causes of obstructive disease
A
- Asthma
- COPD
- Bronchiectasis
- Emphysema
- CF
3
Q
Causes of restrictive disease
A
- Fibrosis
- Asbestosis
- Sarcoidosis
- ARDS
- MSK disorders
- Pregnancy
- Lobectomy
4
Q
Asthma
- Cellular features
- Ig responsible
- Long term changes
A
- Eosinophils
- IgE = histamine, prostoglandins and leukotrienes
- Smooth mucle hypertrophy + tickened basement membrane
5
Q
Diagnostics asthma
A
- Peak flow
- Spiro
- CHXR & FBC
- Bronchial challenge (if spiro + peak flow dont show)
- IgE
6
Q
Treatment algorhythm asthma
A
(SABA)
IC + (LABA)
ML
Immunomodulator + (Tiotropium)
7
Q
- Moderate
- Severe asthma
- Life threatening
A
- MOD = PEFR 50-70% + normal speech
- SEVERE = PEFR 33-50%, no full sentances, accessory muscles and O2 sats 92+
- LIFE THREATENING = PEFR >33%, altered GCS, arrythmias, ↓BP, cyanosis, O2 says >92
8
Q
Treat Acute exacerbation asthma
A
- Controlled 02 95-98% facemask
- SABA + nebulised ipatropium bromide
- IV hydrocortisone
9
Q
Methods of low dose vs high dose O2 elivery
A
LOW (max up to 70%)
- Nasal cannulae
- Simple mask
- Partial rebreather
HIGH (up to 100%)
- Venturi = controlled
- Resorvoir/Non rebreather
- High flow nasal prongs
10
Q
Targets for Oxygenation
A
normal = 94-98% hypercapnic = 88-92%
11
Q
COPD
- Definition
- FEV/FVC definition
A
Umbrella term for emphysema and chronic bronchitis (cough and sputum for most days, at least 3mnths year)
-FEV/FVC = must be below 70% to be COPD
12
Q
COPD Diagnostics
A
- Spiro: ↑residual volume
- CHXR: sometimes hyperfinflation
- ECG
- alpha-1-antitrypsan deficieny (auto dominant)
13
Q
Drug treatment COPD
- Asthmatic features
- Non asthmatic features
A
ASTHMATIC features
- SABA or SAMA
- LABA + ICS
- LABA + ICS + LAMA
NON ASTHMATIC features
- SABA or SAMA
- LABA or LAMA
14
Q
When do we use theophylline or mucolytics
A
- If cant tolerate inhaled therapy or if SABA/SAMA ineffective
- With chronic productive cough
15
Q
Lifestyle intervention COPD
A
- Stop smoking
- Annual influenza and one off pneumoccocal vaccine
- Pulmonary rehab
- Treat comorbidities
16
Q
Histological change associated with chronic bronchitis
-cell involved
A
Squamus to columnar epithelial change
-Neutrophils
17
Q
Bullae
A
Large closed off pocket of air that may require surgery
18
Q
Type 1 respiratory failure
- causes
- subgroup
A
TYPE 1 = Hypoxia + normal CO2 = VQ mismatch
- pneuomonia,PE,oedema,emphysema,alveolitis,asthma
- PINK PUFFERS = eosinophilic emphysema patients
19
Q
Type 2 respiratory failure
- causes
- subgroup
A
TYPE 2 = Hypoxia and Hypercapnia = NO VQ mismatch
- COPD,asthma,CNS depression, apnoea, trauma
- BLUE BLOATERS = cyanosed but not breathless - can develop cor pulmonale (bloat), neutrophilic COPD
20
Q
Bronchiectasis
- pathophys
- causes
- diagnostics
A
- Destruction of alveolar walls, fibrosis and pooled mucos in lower lobes
- TB (most common), CF, ciliray dysfunction, pertussis
- CT (signet ring), CHXR
21
Q
Mnominic for ABG
- R.O.M.E
- Mixed picture
A
- Respiratory = Opposite , pH and C02/HCO3- = up/down
- Metabolic = Equal , pH and HCO3-/C02 = up/up
-Mixed = only time when HCO3- and CO2 move in different directions
22
Q
Base excess
A
A surrogate marker for HCO3- and metabolic dysfunctions
23
Q
Anion gap
- High
- Low
A
Used to assess metabolic acidosis
- High = more acid produces/ingested
- Low = less acid produced or more excreted HCO3-
24
Q
Causes Respiratory acidosis
A
- Resp depression - opiates/benzos
- Paralysis = low ventilation
- Asthma/COPD
25
Causes Respiratory alkolosis
- Hyperventilation
- Hypoxia and hyperventilaroy compensation
- PE
- Pneumothorax
26
Causes Metabolic acidosis
↑Anion Gap
↓Anion Gap
```
↑Anion gap
-DKA
-Lactic acidosis
-Aspirin overdose
↓Anion gap
-GI loss HCO3-
-Renal acidosis
-Addisons disease
```
27
Causes Metabolic alkalosis
- GI loss H+
| - Renal loss H+
28
Squamus cell lung CA features
- Occasionally cavitates - late metastasis
- Associated with high PTH - HIgh Ca
- Clubbing
- 35% frequancy
29
Adenocarcinoma lung CA features
- Arise from mucous cells
- Occupational cancer, women, non-smokers, far east
- Sommonly invades mediastium
- Associated with pleural effusion
- 35% frequancy
30
Large cell lung CA features
- Well differentaited
- Early metastasis
- Poor prognosis
- May secrete Beta-HCG
- 10% Frequancy
31
Small cell lung CA features
- Arise from Kulchitsky cells - tumor may secrete polypeptides
- Often central/inoperable, poor chemo responce
32
Associated syndromes of small cell lung CA
- Hypernatremia = ADH secretetion
- Cushings = ACTH secretion
- Lambert Eaton syndrome = paraneoplastic autoimmune disease Ab's to Ca cells. Causes muscle weakness like m.gravis
33
Complications of Lung CA
- SVC compression = SOB,oedema face, morning headaches and visual disturbance
- Brachial plexus spread = pancoast tumor
- Sympathetic ganglion spred = Horner (ptosis/myosis)
34
Diagnostics for lung CA
- CT = gold standard imaging
- PET helpful for staging and establish eligibility non small cell surgery
- CHXR - 70% cancers visable as mass
- Bronchoscope and biopsy
35
Treatment non small cell vs small cell
Non Small cell
- Poor chemo response
- Some eligible for surgery (no mets/svc obstruction, tumor near hylum)
- Palliative/curative radio available for some
Small cell
- Often early metastasis
- Chemo and radio can help
- 5yr survival = 10% with treatment
36
Mesothelioma
- 2 synergistic causes
- First symptoms
- Treatment and survival
- Smoking and asbestos (even light exposure)
- Pleural effusion, SOB, chest pain, ascites
- No treatment surivaval = 2yrs
37
NICE guidelines lung CA chemo choice
Non small cell
Small cell
Non-small cell
- Cisplatin (carbo = second line) + premetrexed + radio
- Surgery + Cisplatin
Small cell
-Chemo and radio (cisplatin/carboplatin + etoposide)
38
What systemic ABG sign seen with massive PE
Metabolic acidosis (massive) or respiratory alkalosis
39
Diagnostics PE
- CTPA
- V/Q scan
- D-dimer = helps rule out PE
40
CHXR signs for PE
- Wedge shaped opacity
- Hamptons hump
- Oligaemia (decrased vessel size)
41
What is diagnostic criteria taking into account clinical signs used in PE
Wells score (+4 = high risk)
42
PE treatment protocol
- Resp support
- Fluids + (Na/Ad/Dobutamine vasoactive agents)
- Anticoagulation
1) Heparin + (warfarin)
2) Riveroxaban or other NOAC
43
What else can elevate D-dimer
Any inflammatory process
44
Pleural effusion
- Signs
- Diagnostics
- Costophrenic blunting on x ray (1st investigation)
- Stony dull, decreased resonance, decreased sounds
- Pleural USS - help locate
- Diagnostic aspiration
45
3 types of pleural fluid and causes
- Transexudate = HF/Cirrhosis/Nephrotic syndrom
- Exudate = Infection/neoplasm/PE/TB
- Frank Pus = Empyma (pneumonia) acidic
46
Where is the radiation point of diaphragm pain
Tip shoulder
47
Most common pneumonia organisms (descending)
| COMMUNITY (SHMCL) gram+
- Strep P
- Haem I
- Mycoplasma
- Chlamydia
- Legionella
48
Most common pneumonia organisms (descending)
| HOSPITAL (SGM) gram-
- Staph aureus
- Gram - bacilli
- Multidrug resistant
49
Which pneumonia is most common in elderly
-Haemophilus Influenza
50
Which penumonia often follows infection and what is an important clinical sign
- Strep
| - Rust sputum
51
CURB-65 score
- Confusion
- Urea
- Resp rate
- BP
- +65
Above 3 = hospital admission
52
What Ab do you give for pneumonia before culture
Cephalosporin (then go by culture oral/iv)
53
Important complication of pneumonia
Type 1 respiratory failure
54
Features of mycoplasma pneumonia
- Common in clusters - kids
- Patchy opacities
- Small pathogen with no cell wall
55
Treat mycoplasma pneumonia
```
1 = Macrolides
2 = Fluroquinones
```
56
Important note about atypical pneuomonias
Can present without consolidation
57
Primary site of bacteria engulfement in TB
Ghon focus
58
5 Extra-pulmonary sites TB
- Lupus vulgaris = painful nodular skin lesions
- Arthritis
- Renal
- GIT
- Contrictive pericarditis
59
Diagnostics TB
- Active
- Latent
- 3x + acid-fast sputum culture (1 must be early morning)
| - Mantoux = LATENT
60
Therapy TB
- Normal
- MD resistant
RIPE Therapy
Rifampicin/Isonazaid/Pyrazamide/Ethambutol
NORMAL
-All 4 RIPE for 2months then RIP ab therapy = 18wks
MD resistant
-RIPE for 18-24mnths
61
Features of Interstitial Lung disease
- Decreased compliance (restrictive)
- Honeycombing "cystic" lung
- Often involves lower lobes
62
Complications Ideopathic puolmonary fibrosis
- Hypertension
- cor pulmonale
- Type 1 respiratory failure
63
CHXR features and signs of IPF
| -Diagnositc test
- Ground glass
- Clubbing
- Bibasal fine crackles
- Decresed epansion
-High resolution CT
64
IPF - epi and prognosis
Rare, affects 45+
No cure
Survival = 5yrs
65
Pneumoconiosis
- Precursor
- CHXR
- Treatment/Prognosis
- Associated disease
Black lung/miners lung
- Anthracosis (less severe)
- small opacities to large fibrotic nodules
- No treament poor prognosis
- Caplans syndrome = association with RA
66
Hypersensitivity/Allergic Alveolitis
- Type of hypersensitivity
- Subgroups
- X-ray sign
- Type 3
- Farmers/Pigeon fanciers/cotton/sugar cane (bagosis)
- Upper fibrosis - vessel sparing, honeycombine
67
What test can be useful to test the severity of interstitial lung diseases
6-minute walk test
68
Sarcoidosis
- At risk groups
- CHXR signs
- Gold standard testing
- Afrocaribbean and scandinavian
- hilar lymph nodes, infiltrates, firbous granuloma honeycomb
- confirm with biopsy and HCCT
69
3 associates syndromes of sarcoidosis
- Arthritis
- Erythema nodosum
- Hypercalcemia due to active vit D increase
70
What other blood test result may indicate sarcoidosis
Extra serum ACH - produces by sacroidosis macrophages
71
ARDS
- Causes
- Xray sign
- Other test signs
- Pancreatitis, shock, drugs, trauma, sepsis, malignancy
- Bilateral diffuse infiltrates
- Pulmonary capillary wedge pressure and ↑ESR
72
Diagnostics sleep apnoea
- gold standard
- scale
-Polysonography = eeg measures REM
-Epworth sleep scale = looks are apnoeas per hour
1-14(mild) , 15-30(mod) , >30(sev)
73
3 types of x rays
PA = patient stand erect
AP = patient sits erect (magnifies and widens)
Supine
74
Causes tracheal deviation
AWAY
TOWARDS
TOWARDS
- Pneumonectomy
- Collapse
- Hypoplasia
AWAY
- Pneumothorax
- Hernia
- Large thoracic mass
- Pleural effusion
75
What 3 patholgies do no coexist with tracheal deviation
- Mesothelioma
- Pulmonary Oedema
- Consolidation
76
Signs of PE on x ray
Often normal x ray
77
Signs Effusion on x ray
Batwing configuration
78
Pickwickian syndrome
- symptoms
- diagnostics
- treat
Obesity hypoventilation
- daytime sleepyness, morning headaches, SOB
- ABG + bicarb + Hct
- nocturnal bipressure ventilation or CPAP
79
Test for alveolar ventilation
Serum bicarbonate
80
Another test of alveolar ventilation but is specific for nocturnal hypoxemia
Haematocrit (Hct)>45% diagnostic
