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Y3 Core Conditions > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

Asthma

A

Chronic inflammatory condition characterised by reversible airflow obstruction, airway hyper-responsiveness, involvement of T cells, mast cells, eosinophils and smooth muscle hypertrophy.

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2
Q

Most common chronic condition in children

A

Asthma

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3
Q

Causes of Asthma

A

Atopy: triad with hayfever, eczema and asthma
Genetic
Environment: viral, bacterial infections, allergen exposure, occupational exposure, food additives and chemicals

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4
Q

Pathophysiology of Asthma

A

Type 1 IgE mediated hypersensitivity reaction causing:

  • bronchoconstriction
  • Inflammation caused by mast cells, eosinophils, dendritic cells and lymphocytes (Th2 response)
  • Increased mucous production
  • Airway remodelling
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5
Q

What happens in airway remodelling

A

Loss of ciliated cells
Increase in goblet cells and mucus
Smooth muscle hyperplasia due to contraction
Nerves contribute to irritability of airways

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6
Q

Symptoms of Asthma

A

Wheezing, coughing, sputum, SOB, chest tightness, triggered by cold air, exercise, pollution, allergens, nocturnal dyspnoea

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7
Q

Signs on examination of Asthma

A

Tachypnoea, wheeze, hyper inflated chest, hyper-resonant to percuss, decreased air entry,

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8
Q

Investigations for asthma

A

FEV1/ FVC ration, FEV1, PEFR, CXR, FBC, immunoassay for allergen specific IgE

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9
Q

Expected FEV1/FVC ratio for Asthma and COPD

A

<0.7

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10
Q

Airflow obstruction

A

A reduced FEV1 and a reduced FEV1/FVC ratio, such that FEV1 is less than 80% of that predicted, and FEV1/FVC is less than 0.7.

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11
Q

Differentials for asthma

A

CF, chronic rhino sinusitis, tracheomalacia, vascular ring, foreign body aspiration, vocal cord dysfunction, alpha-1 antitrypsin deficiency, COPD, bronchiectasis, PE, congestive heart failure

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12
Q

Vascular ring

A

Congenital lesion where normal vessels are in an abnormal location and may cause compressionof oesophagus or airway

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13
Q

Treatment for Asthma

A
  1. Short-acting beta agonist e.g salbutamol
  2. Inhaled corticosteroids e.g fluticacsone, budesonise, beclometasone.
    Leukotrine-receptor antagonist e.g. montelukast and theophylline
  3. Inhaled corticosteroids AND long-acting inhaled B2 agonist (LABA) e.g. salmetrol
  4. High dose inhaled corticosteroid and regular bronchodilators: add LABA and LRTA
  5. Regular oral corticosteroids: add prednisolone 40mg daily

Don’t give LABA without ICS to patients

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14
Q

Complications of Asthma

A

Treatment from inhaled corticosteroids can lead to: oral candidiasis, dysphonia, oesophageal candidiasis

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15
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

Progressive disease characterised by airway obstruction with little or no reversibility and FEV1/FVC ratio <0.7.
Includes chronic bronchitis (blue bloaters) and emphysema (pink puffers)

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16
Q

Chronic bronchitis

A

Cough, sputum production on most days for 3 months of 2 consecutive years

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17
Q

Emphysema

A

Enlarged airspaces distal to terminal bronchioles with destruction of alveolar walls. Classified according to site of damaged: centri-acinar, pan-acinar, irregular.

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18
Q

How common is COPD

A

3rd most common cause of death
>40 yo, mostly men
90% of COPD patients are smokers

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19
Q

Causes of COPD

A
  • Loss of elasticity and alveolar attachments
  • Inflammation and scarring causing narrowing of airways
  • Mucus secretion blocking airways
    leading to hyperinflation of lungs and breathlessness
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20
Q

Risk factors for COPD

A

Smoking
Age
Alpha-1-antitrypsin deficiency
Air pollution, occupational dusts, fumes etc

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21
Q

Symptoms of COPD

A

chronic cough, sputum, SOB, recurrent chest infections, weight loss, barrel chest

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22
Q

Signs of COPD

A

Tachypnoea, accessory muscles used, pursed lip, cyanosis, CO2 flap, wheeze, decreased vesicular breath sounds, peripheral oedema

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23
Q

Pink Puffers (Emphysema)

A

Breathless but not cyanosed. Increased alveolar ventilation. Accessory muscle used, cachexia, barrel chest. May progress to type 1 respiratory failure

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24
Q

Blue Bloaters (Bronchitis)

A

Cyanosed but not breathless. Decreased alveolar ventilation. May progress to type 2 respiratory failure. Can develop cor pulmonale.

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25
Difference between Asthma and COPD
Asthma presents earlier, has no sputum and is a reversible airway obstruction
26
Investigations for COPD
Chest Xray, spirometry can differentiate between obstructive and restrictive, FBC, ABG, ECG, sputum culture
27
Managing COPD
Smoking cessation, pulmonary rehabilitation, exercise, Diet advice and supplementation, vaccination and antiviral therapy, depression advice and treatment
28
Treating COPD
1. Inhaled therapy 2. Oral therapy 3. Oxygen therapy
29
Inhaled therapy for COPD
- Short-acting beta agonist e.g. salbutamol, turbutaline - Short-acting muscarinic antagonist e.g. ipratropoum - Long-acting muscarinic antagonist e.g. tiotropium - Inhaled corticosteroids
30
Oral therapy for COPD
Oral corticosteroids Theophylline Mucolytics e.g. carbocisteine Antibiotics
31
Complications for COPD
``` Cor pulmonale Recurrent pneumonia Pneumothorax Depression Respiratory failure Anaemia Secondary Polycythaemia ```
32
Pulmonary fibrosis
A restrictive condition when interstitial lungs become damaged and scarred losing its elasticity
33
3 types of pulmonary fibrosis
Replacement fibrosis- secondary to lung damage Focal fibrosis - in response to irritants Diffuse lung parenchyma
34
5 main causes of Pulmonary fibrosis
Drug induced, radiation induced, environmental , autoimmune and occupational
35
Investigating Pulmonary fibrosis
CT
36
Bronchial Cancer
malignant neoplasm of the lung arising from the epithelium of the bronchus. 2 types: SCLC and NSCLC
37
Small Cell Lung Carcinoma
15% of cases, highly malignant, arise from Kulchitsky cells
38
Non Small Cell Lung Carcinoma
85% of cases
39
Different types of NSCLC
Adenocarcinoma, squamous cell carcinoma, large cell carcinoma carcinoid tumours and bronchoalveolar cell
40
How common are Bronchial Cancers
Most common malignant tumour world-wide
41
Risk factors for Bronchial Carcinoma
Smoking, asbestos, radiation, iron oxides, coal, arsenic, petrol, Male, EGFR-TK mutation
42
Symptoms of Bronchial carcinoma
cough, dyspnoea, haemopytsis, chest pain, weight loss, fatigue, wheeze
43
Investigations for Bronchial Carcinoma
CXR, CT, sputum cytology, bronchoscopy, PET, thoracentesis, bloods
44
Differentials of Bronchial Carcinoma
Pneumonia, carcinoid tumour, infectious granuloma, sarcoidosis, RA, TB, lymphoma
45
Treatment for bronchial carcinoma
chemotherapy, radiotherapy, prophylactic cranial irradiation, surgery
46
Erlotibin (Tarceva)
Cancer treatment drug for Non-small Cell Lung Cancer that has spread. Used alongside Gemcitabine
47
Gefitinib
Gefitinib is tyrosine kinase inhibitor that stops growth of cancer cells with Epidermal growth factor receptors
48
Complication of Bronchial Carcinoma
Recurrent laryngeal nerve palsy, Phrenic nerve palsy, SVC obstruction, Horner's syndrome, pericarditis, AF
49
Pneumothorax
Collection of air in the pleural cavity causing collapse of the lung on the affected side
50
Who is normally affected by a pneumothorax
Males more than females Primary Spontaneous pneumothoraces more so in 20s Secondary Spontaneous pneumothoraces common 60+
51
Pathophysiology of a pneumothorax
Normally alveolar pressure is higher than intrapleural pressure and intrapleural pressure is less than atmospheric pressure. If communication develops, gases will flow down pressure gradient and into pleural space. Eventually, intrapleural pressure exceeds atmospheric pressure causing hypoxia.
52
Beck's triad
Signs associated with acute cardiac tamponade or pneumothorax. Hypotension, distended neck veins, and distant heart sounds
53
Primary Spontaneous Pneumothorax
Without preceding trauma. | Mainly due to smoking
54
Secondary Spontaneous Pneumothorax
Complication of an underlying pulmonary disease
55
Risk factors for Pneumothorax
Male, tall, smoking, recent invasive procedure, Marfan's, homocystinuria, lung cancer
56
Signs of pneumothorax
Distressed, sweating, dyspnoea, cyanosis, tachycardia, hypotension, raised JVP, tracheal deviation, hyper-resonant to percussion, decreased breath sounds
57
Differentials for pneumothorax
Pleural effusion, pulmonary embolus, asthma exacerbation, MI
58
Treating a Tension pneumothorax
Immediate needle compression with 14-gauge cannula at 2nd intercostal space, mid-clavicular line
59
Treating a PSP or SSP
Oxygen and percutaneous aspiration, chest drain insertion into safe triangle, talc pleurodesis
60
Borders of safe triangle for chest drain insertion
Lateral border of pectoralis major, anterior border latissimus, base of axillaa dn 5th IC space
61
Complications of pneumothorax
Pulmonary oedema, high rate of reccurence, Talc pleurodesis causing ARDS
62
Unilateral Pleural Effusion
Excess fluid between the parietal and visceral pleura.
63
Light's Criteria
Differentiates between exudate and transudate. Pleural fluid is exudate if one criteria is met: - PF protein/ serum protein >0.5 - LDH/LDH >0.6 - PF LDH >2/3 the upper limits of serum LDH
64
Difference between Transudate and Exudate
Transudate is fluid pushed through the capillary due to high pressure within the capillary. Exudate is fluid that leaks around the cells of the capillaries caused by inflammation
65
Protein concentration of transudates and exudates
Transudates: <25g/L Exudates: > 35g/L
66
Signs and symptoms of Pleural Effusion
Dyspnoea, Pleuritic chest pain, decreased chest expansion, reduced breath sounds, tactile vocal fremitus and vocal resonance decreased, mediastinum shift
67
Differentials for a pleural effusion
Pneumothorax- but presents black on CXR and hyperresonant to percussion
68
Investigations for a pleural effusion
CXR: blunting of costophrenic angles, pleural biopsy
69
Treatment for pleural effusion
Diuretics, pleural drainage, pleurodesis if recurrent
70
Pneumonia
Lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid.
71
Main causes of CAP
1. Streptococcus Pneumoniae 2. H. Influenza 3. Mycoplasma pneumonia
72
HAP
Acquired >48 hours after hospital admission. Commonly due to gram negative bacteria or Staph A
73
Risk factors for Pneumonia
Age, viral infection with influenza, hospitalized ill patients, smoking, alcohol, bronchiestasis, CF, bronchial obstruction, immunosuppression
74
Symptoms of Pneumonia
Cough, purulent sputum, fever, rigors, malaise, anorexia, dyspnoea, haemoptysis, pleuritic pain
75
Signs of Pneumonia
pyrexia, cyanosis, confusion, tachypnoea, tachycardia, hypotension, reduced expansion, dull to percuss, increased tactile fremitus, vocal rub,
76
Differentials for pneumonia
Bronchieactasis, COPD, Asthma, Pleural effusion
77
Investigations for pneumonia
CXR: consolidation, FBC, Sputum, bronchoscopy
78
CURB65
``` Predicts mortality in CAP. Confusion (AMTS<=8) Urea >7mmol/L Respiratory Rate >30/in BP <90 systolic >65yo ```
79
Treating Pneumoniae
Oral ABX: amoxcillin, clarithromycin, doxycycline IV ABX: co-amoxiclav, cephalosporin + clarithromycin oxygen, Pneumoccocal vaccine
80
Complications for Pneumonia
Respiratory failure, hypotension, AF, pleural effusion, lung abscess, septicaemia, Pericarditis, Cholestatic jaundice
81
Pulmonary Embolism
Obstruction of vessel withing the pulmonary tree by an embolus usually from a DVT
82
Aetiology of a PE
Fat: following bone fracture Air: from neck vein cannulation Thrombosis: from DVT, septic embolus
83
Virchow's Triad
Altered blood flow, Altered vessel, Hypercoagulability
84
Risk factors for PE
Increasing age, BMI >30kg/m2, varicose veins, continuous travel >3hrs, Bedrest for >4days, pregancy, Oestrogen therapy, plasminogen deficiency
85
Risk factors for PE: Blood diseases
``` Thrombophilia Antithrombin deficiency Protein C or S deficiency Factor V Leiden Prothrombin gene variant Antiphospholipid antibody ```
86
Risk factors for PE: Diseases or surgical procedures
Trauma, malignancy, Cardicac/ respiratory failure, Recenr MI or stroke, acute medical illness, IBD, Nephrotic syndrome, Myeloproliferative disorders, Sickle cell anaemia,, central venous catheter, paraproteinaemia, proxysmal nocturnal haemoglobinuria prostatectomy
87
Symptoms of PE
Dyspnoea, pleuritic chest pain, cough, haemoptysis, dizziness, syncope
88
Signs of PE
Tachypnoea, tachycardia, hypoxia, cyanosis, hypotension, raised JVP, Pyrexia
89
Differentials of PE
Pneumothorax, Acute coronary syndrome, Aortic dissection, Pneumonia, Cardiac tamponade, septicaemia
90
Investigations for PE
-Two Level Well's Score -Computed tomographic pulmonary angiography -D dimer testing ABG: may show type 1 respiratory failure CXR ECG
91
Two Level Well's Score
A DVT and PE probability scoring for diagnosing. Points of more than 4 suggest PE likely. Clinical feature: - Signs and symptoms of DVT - An alternative diagnosis is less likely than PE - >100bpm HR - Immobilisation - Previous DVT/PE - Haemoptysis - Malignancy
92
Treating PE
- Anticoagulation with LMWH e.d. tinzaparin or fondaparinux - Unfractionated heparin for those with renal impairment, increased risk of bleeding - Stop heparin when INR >2
93
Complications of a PE
Chronic thromboembolic pulmonary hypertension

Y3 Core Conditions (13 decks)

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