Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr3 - General Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

AAFB

A

Acid and Alcohol Fast Bacili

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ABPA

A

Allergic Bronchopulmonary Aspergilosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

BIPAP

A

Bilevel Positive Airway Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CPAP

A

Continuous Positive Airways Pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

EAA

A

Extrinsic Allergic Alveolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ICD

A

Intercostal Chest Drain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ILD

A

Interstitial Lung Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

INH

A

Inhaled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LTOT

A

Long Term Oxygen Therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MCL

A

Mid-Clavicular Line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

NIV

A

Non-Invasive Ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PEFR

A

Peak Expiratory Flow Rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PFT’s

A

Pulmonary Function Tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PND

A

Paroxysmal Nocturnal Dyspnoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SVCO

A

Superior Vena Cava Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

UIP

A

Usual Interstitial Pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define vital capacity

A

Volume of air expired from the lungs from a maximal inspiration using a slow/relaxed manoeuvre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define forced vital capacity

A

Volume of air than can be forcibly expelled from the lungs from a position of maximal inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define forced expiratory volume

A

Volume of air forcibly expelled from the lungs in the first second - following maximal inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define FEV1/FVC

A

Volume of air forcibly expired in the first second as a percentage of the total volume exhaled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Obstructive vs Restrictive spirometry

A

Obstructive - smooth curve reaching close to normal volume over a longer period of time
Restrictive - plateaus at a lower than normal volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Early small airways obstruction on volume flow chart

A

Slight depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chronic obstructive diseases on volume flow chart

A

Large depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Fixed large airway obstruction of volume flow chart

A

Circular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Restrictive disease on volume flow chart

A

Normal height but very narrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Causes of low paO2

A

Hypoventilation
Diffusion impairment
Shunt
V/Q mismatch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Causes of respiratory acidosis

A

Hypoventilation
- neuromuscular diseases
Alveolar hypoventilation
- COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Define A-a gradient

A

A=alveolar
a= arterial
Difference between oxygen concentration in the alveoli and arterial system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How to calculate A-a gradient

A

PAO2 = PIO2 - PaCO2/0.8

PIO2 = room air (20kPa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Normal A-a gradient

A

Young healthy people - less than 2kPa
Older people - less than 4kPa
> 4 = lung pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Define anaphylaxis/angioedema

A 
Serious allergic reaction 
Occurs when sensitised individual exposed to specific antigen
- insects bites/stings
- food
- medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Pathophysiology of anaphylaxis

A

Immunological response

IgE -> Antigen -> mast cell and basophils -> histamine increases -> body response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Clinical features of anaphylaxis

A

Occurs in minutes
- pruritus, urticaria, angioedema, hoarseness
Progresses to
- stridor and bronchial obstruction, wheeze and chest tightness from bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Treatment for anaphylaxis

A

Remove trigger, maintain airway - 100% O2
IM adrenaline 0.5 mg
IV hydrocortisone 200 mg
IV chlorpheniramine 10mg
If hypotensive - lie flat and fluid resuscitate
Bronchospasm - NEB salbutamol
Laryngeal oedema - NEB adrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Features of mild asthma attack

A

No features of severe asthma

PEFR > 75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Features of moderate asthma attack

A

No features of severe asthma

PEFR 50-75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Features of severe asthma attack

A

PEFR 33-50% of best or predicted
Cannot complete sentences in 1 breath
RR > 25/min
HR > 110/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Features of life-threatening asthma attack

A

PEFR < 33% of best or predicted
Sats < 92% or ABG pCO2 < 8kPa
Cyanosis, poor respiratory effort, near or fully silent chest
Exhaustion, confusion, hypotension or arrhythmias
Normal pCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Features of near fatal asthma attack

A

Raised pCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Acute asthma management

A

ABCDE
Aim for SpO2 94-98% with oxygen as needed - ABG if sats < 92%
5mg nebulised salbutamol - repeat after 15 mins
40mg oral Prednisolone STAT - IV hydrocortisone if PO not possible
If severe
- nebulised Ipratropium Bromide 500mg
- back to back salbutamol
If life threatening or near fatal
- urgent ITU or anaesthetist assessment
- urgent portable CXR
- IV aminophyline
- IV salbutamol if nebulised route ineffective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Features of COPD exacerbations

A 
Infective
- change in sputum volume / colour
- fever
- raised WCC +/- CRP
Non-infective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Management of COPD exacerbations

A

ABCDE approach
Oxygen
- via fixed performance face mask due to risk of CO2 retention
- aim for SaO2 88-92% - guided by ABGs
NEBs - salbutamol and Ipratropium
Steroids - Prednisolone 30mg STAT and OD for 7 days
Antibiotics if raised CRP / WCC or purulent sputum
CXR
IV aminophylline
NIV if type 2 respiratory failure and pH 7.25-7.35
If pHh <7.25 consider ITU referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Features of pneumonia

A

Consolidation on CXR with fever +/- purulent sputum +/- raised WCC and/or CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Management of pneumonia

A

ABCDE
If features of sepsis - immediately treat using sepsis pathway
Treat with antibiotics as per CURB-65 score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How to calculate CURB-65 score

A 
1 point for
Confusion 
Urea - > 7.0mmol/L
RR > 30
BP < 90 mmHg
Aged over 65
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Definition of massive haemoptysis

A

> 240mls in 24 hrs

> 100mls/day over consecutive days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Management of massive haemoptysis

A

ABCDE
Lie patient on side of suspected lesion
Oral tranexamic acid for 5 days - or IV
Stop NSAIDs / aspirin / anticoagulants
Antibiotics if evidence of respiratory tract infection
Consider vitamin K
CT aortogram - bronchial artery embolisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Features of tension pneumothorax

A

Hypotension
Tachycardia
Deviation of trachea away from side of pneumothorax - x-ray
Mediastinal shift away from pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Management of tension pneumothorax

A

Large bore IV cannula into 2nd ICS MCL

Chest drain into affected side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Symptoms of PE

A

Chest pain - pleuritic
SOB
Haemoptysis
Low cardiac output followed by collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Risk factors for PE

A 
Surgery
- abdo/pelvic
- knee/hip replacement
- post-op ITU
Lower limb
- fracture
- varicose veins
Malignancy
- abdo/pelvis/advanced/metastatic
Reduced mobility
Previous proven VTE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Management of PE

A 
ABCDE
Oxygen if hypoxia
Fluid resuscitation - if hypotensive
Thrombolysis considered if massive PE confirmed on echo or CT
- check for contraindications
Fully anticoagulated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Features of a massive PE

A

Hypotension/imminent cardiac arrest
Signs of right heart strain on CT/echo
Consider thrombolysis with IV alteplase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Thrombolysis contraindications

A 
Absolute 
- haemorrhagic stroke or ischaemic stroke < 6 months
- CNS neoplasia
- recent trauma or surgery
- GI bleed < 1 month
- bleeding disorder
- aortic dissection
Relative
- warfarin
- pregnancy
- advanced liver disease
- infective endocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Thrombolysis complications

A 
Bleeding
Hypotension
Intracranial haemorrhage/stroke
Reperfusion arrhythmias
Systemic embolisation of thrombus
Allergic reaction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Characteristics of asthma

A

Chronic inflammatory disease of the airways
Airway obstruction that is reversible - spontaneously or with treatment
Increased airway responsiveness to a variety of stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Wheeze differentials

A

Acute asthma exacerbation
Bronchitis - viral or bacterial
Pulmonary oedema
PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Asthma pathophysiology

A

Airway epithelial damage - shedding and sub epithelial fibrosis, basement membrane thickening
Cytokines amplify inflammatory response
Increased numbers of mucus secreting goblet cells and smooth muscle hyperplasia and hyper trophy
Mucus plugging - fatal and severe asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Inflammatory cells involved in asthma reactions

A

Eosinophils
Th2 lymphocytes
Mast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Inflammatory mediators released in asthma

A

Histamine
Leukotrienes
Prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Criteria for safe asthma discharge after exacerbation

A

PEFR > 75%
Stop regular nebulisers for 24 prior to discharge
Inpatient asthma nurse review to reassess inhaler technique and adherence
Provide PEFR meter and written asthma action plan
At least 5 days oral Prednisolone
GP follow up within 2 working days
Respiratory clinic follow up within 4 weeks
Consider psychosocial factors for severe or worse

62
Q

Differentials for eosinophilia

A 
Airway inflammation - asthma or COPD
Hay fever / allergies
Allergic Bronchopulmonary Aspergilosis 
Drugs
Vasculitis
Eosinophilia pneumonia 
Parasites
Lymphoma
SLE
Hypereosinophilic syndrome
63
Q

Triggering factors for asthma

A 
Smoking
Upper respiratory tract infections - mainly viral
Allergens
- pollen
- house dust mite
- pets
Exercise
Occupational irritants
Pollution
Drugs
- aspirin
- beta blockers
Food and drinks
- dairy produce
- alcohol
- orange juice
Stress
For severe asthma consider
- inhaled heroin
- pre-menstrual
- psychosocial aspects
64
Q

Steps for a chronic asthma appointment

A

Use BTS stepwise management guidelines
Assess and teach the inhaler technique
Use self management plans
Avoid trigger factors

65
Q

COPD definition

A

Characterised by airflow obstruction

  • progressive
  • not fully reversible
  • does not change markedly over several months
66
Q

Pathophysiology of COPD

A

Umbrella term which encompasses emphysema and chronic bronchitis
Mucous gland hyperplasia
Loss of cilial function
Emphysema - alveolar wall destruction causing irreversible enlargement of air spaces distal to the terminal bronchioles
Chronic inflammation - macrophages and neutrophils
Fibrosis of small airways

67
Q

Causes of COPD

A

Smoking
Inherited α-1-antitrypsin deficiency
Industrial exposure

68
Q

Outpatient COPD management

A 
COPD care bundle
Smoking cessation
Pulmonary rehabilitation
Bronchodilators
Antimuscarinics
Steroids
Mucolytics
Diet
LTOT and lung volume reduction if appropriate
69
Q

Criteria for long term oxygen therapy

A

pO2 consistently below 7.3 kPa or below 8 kPa with cor pulmonale
Non-smokers
Not rents in high levels of CO2

70
Q

Features of LTOT

A

Continuous oxygen therapy for most of the day - at least 16hrs for survival benefit
Extended periods of hypoxia cause renal and cardiac damage - prevented by LTOT
O2 needs balanced with loss of independence and reduced activity which may occur

71
Q

Features of pulmonary rehabilitation

A

Many COPD patients avoid exercise and physical activity because of breathlessness
Leads to a vicious cycle of increasing social isolation and inactivity leading to worsening of symptoms
Pulmonary rehabilitation aims to break this cycle - MDT 6-12 week programme of supervised exercise, unsupervised home exercise, nutritional advice and disease education

72
Q

CXR consolidation differentials

A 
Pneumonia
TB - usually upper lobe
Lung cancer
Lobar collapse - blockage of bronchi
Haemorrhage
73
Q

Management of community acquired pneumonia

A

Prompt assessment and CXR on admission - consolidation
FBC, U&Es, CRP and sputum culture
CURB-65 score to guide management
No delay in initiating antibiotics +/- paracetamol
ITU referral if high CURB-65 score

74
Q

Pneumonia follow up involves

A 
HIV test
Immunoglobulins
Pneumococcal IgG serotypes
Haemophilia us influenzae b IgG
Follow up clinic in 6 weeks with repeat CXR to ensure resolution
75
Q

Causes of non-resolving pneumonia

A

C - complication - empyema, lung abscess
H - host - immune compromised
A - antibiotic - inadequate dose, poor oral absorption
O - organism - resistant or unexpected organism not covered by empirical antibiotic
S - second diagnosis - PE, cancer, organising pneumonia

76
Q

Clinical features of TB

A

Fever and nocturnal sweats - drenching
Weight loss - weeks-months
Malaise
Respiratory TB - cough, purulent sputum/haemoptysis, pleural effusion
Non-respiratory TB - Erythema nodosum, lymphadenopathy, bone/joint, abdo, meningitis, genitourinary, military, pericardial effusion

77
Q

TB risk factors

A 
Past history of TB
Known history of TB contact
Born in country with high TB incidence
Evidence of immunosuppression
- IVDU
- HIV
- solid organ transplant recipients
- renal failure/dialysis
- malnutrition/low BMI
- DM
- alcoholism
78
Q

Management of respiratory TB

A

ABCDE approach and aim to culture
Admit to side room and start infection control
Routine bloods and HIV test and vitamin D levels
CT chest if clinical features/CXR not typical
MRI brain/spine if miliary
If pt critically unwell and high likelihood of TB starts anti-TB therapy after sputum samples sent
Notify TB nurse specialists - support, public health issues and initiate contact tracing
TB culture can take 6-8 weeks - treatment depends on clinical suspicion

79
Q

Basics of anti-TB therapy

A

Rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 4 months
Ethambutol - 4 months
Check LFTs
Dose is weight dependent
Directly observed therapy (DOT) sometimes used as compliance is crucial
Pt awareness of common and serious side effects
Pyridoxine given as prophylaxis against peripheral neuropathy

80
Q

Major side effects of TB treatment

A

Rifampicin
- hepatitis, rashes, febrile reaction, orange/red secretions, many drug interactions including warfarin and OCP
Isoniazid
- hepatitis, rashes, peripheral neuropathy, psychosis
Pyrazinamide
- hepatitis, rashes, vomiting, arthralgia
Ethambutol
- retrobulbar neuritis

81
Q

Features of bronchiectasis

A

Chronic dilation of one or more bronchi
- bronchi exhibit poor mucus clearance
- predisposition to recurrent or chronic bacterial infection
Gold standard diagnostic test = high resolution CT

82
Q

Causes of bronchiectasis

A

Post-infective - whooping cough, TB
Immune deficiency - hypogammaglobulinaemia
Genetic/much ciliary clearance defects - cystic fibrosis, Young’s syndrome, Kartagener syndrome
Obstruction - foreign body, tumour, extrinsic lymph node
Toxic insult - gastric aspiration, inhalation of toxic chemicals
Allergic Bronchopulmonary Aspergilosis
Secondary immune deficiency - HIV, malignancy
Rheumatoid arthritis
Associations - IBD, yellow nail syndrome

83
Q

Bronchiectasis common organisms

A 
Haemophilus influenzae
Pseudomonas aeruginosa
Moraxella catarrhalis
Stenotrophomonas maltophilia
Fungi - aspergillus, candidia
Non-tuberculous mycobacteria
84
Q

Bronchiectasis management

A

Treat underlying cause
Physiotherapy - mucus clearance
Antibiotics according to sputum culture/sensitivities for acute exacerbations and chronic suppressive therapy
Supportive - flu vaccine, bronchodilators
Pulmonary rehab

85
Q

Cystic fibrosis definition

A

Autosomal recessive disease leading to mutations in cystic fibrosis transmembrane conductance regulator (CFTR)
Multi system disease characterised by thickened secretions

86
Q

Criteria for CF diagnosis

A

One or more characteristic phenotypic features
- or history of CF in sibling
- or positive newborn screening test result
And
- increased sweat chloride concentration - > 60 mol/L Sweat Test
- or identification of two CF mutations - genotyping
- or demonstration of abnormal nasal epithelial ion transport

87
Q

CF presentations

A

Meconium ileus
- newborn bowel blocked by sticky secretions
- signs of intestinal obstruction soon after birth with bilious vomiting, abdominal distention and delay in passing meconium
Intestinal malsorption
- mostly evident in infancy
- severe deficiency of pancreatic enzymes
Recurrent chest infections
Newborn screening

88
Q

Common complications of CF

A

Respiratory infections
- needs aggressive therapy with physio and antibiotics
- often receive prophylactic antibiotics
Low body weight
- careful monitoring
- pancreatic enzyme replacement therapy
- high calorie intake and extra supplements
- NG or PEG feeding
Distal intestinal obstruction syndrome (DIOS)
- faecal obstruction in ileocaecum
- often due to insufficient prescription of pancreatic enzymes or non-compliance, salt deficiency or hot weather
- presents with palpable right iliac fossa mass
CF related diabetes

89
Q

CF lifestyle advice

A

No smoking
Avoid other CF patients
Avoid friends/relatives with colds/infections
Avoid jacuzzis (pseudomonas)
Clean and dry nebulisers thoroughly
Avoid stables, compost or rotting vegetation - risk of aspergillus fumigatus inhalation
Annual influenza immunisation
Sodium chloride tablets in hot weather/vigorous exercise

90
Q

Define pneumothorax

A

Air in pleural cavity

91
Q

Define pleural effusion

A

Fluid in pleural cavity

92
Q

Define empyema

A

Infected fluid in pleural cavity

93
Q

Define pleural plaques

A

Discrete fibrous areas

94
Q

Define pleural thickening

A

Scarring/calcification causing thickening

95
Q

Types of pneumothorax

A 
Spontaneous
Primary - no lung disease
Secondary - lung disease
Traumatic
Tension
Iatrogenic
96
Q

Pneumothorax risk factors

A 
Pre-existing lung disease
Height
Smoking/cannabis
Diving
Trauma/chest procedure
Association with other conditions - Marfan's syndrome
97
Q

Pneumothorax management

A

Primary
- if symptomatic of >2cm of air on CXR - give O2 and aspirate
Secondary
- lower threshold for ICD
If persistent air leak > 5 days refer to thoracic surgeons
Discharge advice - no flying or diving until resolved

98
Q

Pleural effusion approach

A

Hx + Ex
CXR
ECG
Bloods - FBC, U+Es, LFTs, CRP, bone profile, LDH, clotting
Echo - suspected heart failure
Staging CT with contrast - if suspected exudate with cause

99
Q

Pleural effusion diagnosis

A 
USS guided pleural aspiration 
- biochemistry - protein, pH, LDH
- cytology 
- microbiology - AAFB
Consider thoracoscopy or CT pleural biopsy for new effusion
100
Q

Causes of transudate effusions

A 
Heart failure
Cirrhosis
Hypoalbuminaemia - nephrotic syndrome or peritoneal dialysis
Hypothyroidism
Mitral stenosis
PE
SVCO
101
Q

Management of transudate effusions

A

Often no diagnostic tap required
Treat underlying cause
- stop or reduce treatment if effusion resolves
- if effusion persisted then therapeutic aspiration/drainage required

102
Q

Criteria for exudate effusion

A

Pleural protein > 30 g/L

103
Q

Causes of exudate effusions

A 
Malignancy
Infection
- parapneumonic, TB, HIV
Inflammatory 
- RA, pancreatitis, benign asbestos effusion, PE
104
Q

Define Light’s criteria

A

If pleural fluid protein level between 25 and 35 g/L exudate if one or more of the following

  • pleural fluid protein/serum protein > 0.5
  • pleural fluid LDH/serum LDH > 0.6
  • pleural fluid LDH > 2/3 upper limit of normal
105
Q

Define interstitial lung disease (ILD)

A

Umbrella term describing a number of conditions that affect the lung parenchyma in a diffuse manner

  • usual interstitial pneumonia (UIP)
  • non-specific interstitial pneumonia (NSIP)
  • extrinsic allergic alveolitis
  • sarcoidosis
106
Q

Clinical features of UIP

A

Clubbing
Reduced chest expansion
Fine inspiratory crepitations - best heard basal/axillary areas
Features of pulmonary hypertension

107
Q

Cause of UIP

A

Idiopathic

108
Q

Pathophysiology of extrinsic allergic alveolitis

A

Inhalation of organic antigen to which the individual has been sensitised

109
Q

Clinical presentation of extrinsic allergic alveolitis

A 
Acute
- short period from exposure - 4-8hrs
- reversible
- spontaneously settles 1-3 days
- can recur
Chronic
- chronic exposure
- less reversible
110
Q

Define sarcoidosis

A

Multi system inflammatory condition of unknown cause
Non-caseating granulomas
Immunological response
50% get spontaneous remission, others get progressive disease

111
Q

Investigations for sarcoidsos

A 
PFTs - fibrosis
CXR - 4 stages
Bloods - renal function, ACE, calcium
Urinary calcium
Cardiac involvement - ECG, 24 tape, ECHO, cardiac MRI
CT/MRI head - headaches - neuro sarcoid
112
Q

ILD treatment principles

A 
Depends on underlying pathology
Occupational exposure - remove
Drug associated - avoid
Stop smoking
Transplantation
Treatment of infections
Oxygen 
MDT
Palliative care
113
Q

Clinical features of lung cancer

A

Asymptomatic - incidental finding
Any respiratory symptom/systemic deterioration
SVCO
Horner’s syndrome
Metastatic disease - liver, adrenals (Addison’s), bone, pleural, CNS
Paraneoplastic - clubbing, hypercalcaemia, anaemia, SIADH, Cushing’s syndrome, thrombo-embolic disease

114
Q

Risk factors for lung cancer

A 
Large number of smoking pack years
Airflow obstruction
Increasing age
Family history
Exposure to other carcinogens - asbestos
115
Q

Diagnostic tests for lung cancer

A

Bloods - FBC, U&Es, calcium, LFT’s, INR
CXR
Staging CT - spiral CT thorax and upper abdo
Histology
- US guided neck node FNA for cytology
- bronchoscopy
- CT biopsy
- thoracoscopy
PET scan - helps detect small metastasis not seen on staging CT

116
Q

Histological classification of lung cancer

A 
Small cell lung cancer
Non-small cell lung cancer
- squamous cells
- adenocarcinoma
- large cell carcinoma
- bronchoalveolar cancer
117
Q

Principles of lung cancer treatment

A

Curative surgery for stages I and II
Surgery and adjuvant chemotherapy clinical trial for stage IIIa
Chemotherapy - stage III/IV and PS 0-2
Radiotherapy - curative for those not fit for surgery
Palliative care
Watch and wait

118
Q

SCLC treatment

A

Rapid growth rate and extensive spread at time of diagnosis for surgery
Chemotherapy mainstay
Palliative radiotherapy

119
Q

Define obstructive sleep apnoea (OSA)

A

Upper airway narrowing provoked by slept causing sufficient slept fragmentation to result in significant daytime symptoms - excessive sleepiness
Due to small pharyngeal size or excessive narrowing occurring with relaxation

120
Q

Causes of small pharyngeal size

A

Fatty infiltration of pharyngeal tissues and external pressure from increased neck fat and/or muscle bulk
Large tonsils
Craniofacial abnormalities
Extra sub mucosal tissue - myxoedema

121
Q

Causes of excessive narrowing of airway during sleep

A

Obesity enhance residual muscle dilator action
Neuromuscular disease with pharyngeal involvement may lead to greater loss of dilator muscle tone - stroke, MND, myotonic dystrophy
Muscle relaxants - sedatives, alcohol
Increasing age

122
Q

Clinical effects of OSA

A

Excessive daytime sleepiness
Rise in daytime BP
Nocturia
Snoring and apnoea attacks witnessed by partner

123
Q

Features of epworth sleepiness scale

A

Points for following - 0=never would dose, 1=slight chance, 2=moderate chance, 3=high chance

  • sitting and reading
  • watching TV
  • sitting in public place
  • passenger in car for an hour
  • lying down to rest in the afternoon
  • sitting and talking
  • sitting quietly after lunch without alcohol
  • in car whilst stopped in traffic
124
Q

Diagnosis of OSA

A

Overnight oximetry alone

125
Q

Management of OSA

A

Treatment given based on symptoms/QoL
Weight loss, sleep decubitus rather than supine, avoid/reduce evening alcohol intake
Snores and mild OSA - Mandible advancement devices, consider pharyngeal surgery
Significant OSA - nasal CPAP, gastroplasty/bypass
Severe OSA and CO2 retention - NIV prior to CPAP if acidotic

126
Q

Features of CPAP

A

Usually given via nasal mask
Upper airways splinted open with 10cm H2O pressure - prevents airway collapse, sleep fragmentation and daytime somnolence
Opens collapsed alveoli and improves V/Q matching

127
Q

Examples of sympathomimetics

A 
Short acting
- Salbutamol
- Terbutaline
Long acting
- Formeterol
- Salmeterol
128
Q

Indications of sympathomimetics

A

Bronchospasm

129
Q

Action of sympathomimetics

A

β2-selective adrenergic agonists

- increase cAMP in SMCs resulting in relaxation thus bronchodilation

130
Q

Metabolism of sympathomimetics

A

Metabolised - liver

Excreted - urine

131
Q

Side effects of sympathomimetics

A 
Tremor
Headache
GI upset
Palpitations
Tachycardia 
Hypokalaemia
132
Q

Examples of antimuscarinics

A

Short acting
- Iptropium
Long acting
- Tiotropium

133
Q

Indications for antimuscarinics

A

Bronchospasm - typically COPD

134
Q

Action of antimuscarinics

A

Muscarinic antagonist

- decreases cGMP which affects the intra cellular calcium -> decreased SMC contractility

135
Q

Metabolism for antimuscarinics

A

Metabolised - partially in the liver

Excreted - urine

136
Q

Common side effects of antimuscarinics

A

Dry mouth
Constipation
Cough
Headache

137
Q

Examples of xanthines

A

Aminophylline

Theophylline

138
Q

Main indications for xanthines

A

Asthma

COPD

139
Q

Action of xanthines

A

Block phosophodiesterases -> decreased cAMP breakdown -> bronchodilation

140
Q

Metabolism of xanthines

A

Metabolised - liver

Excreted - urine

141
Q

Common side effects of xanthines

A 
Headache
GI upset
Reflux
Palpitations
Dizziness
142
Q

Other effects of xanthines

A

Positive chronotropic and inotropic effects

Diuretic action

143
Q

Therapeutic window of xanthines

A 
Plasma level 10-20 mg/L
Toxic effects are serious
- arrhythmias
- seizures
- N+V
- hypotension
144
Q

Examples of inhaled glucocorticoids

A

Beclomethasone
Budesonide
Fluticasone

145
Q

Indications for inhaled steroids

A

Asthma

COPD

146
Q

Actions of inhaled steriods

A

Increases airway calibrate by decreasing bronchial inflammation +/- modifying allergic reactions
Weak mineralcorticoid activity

147
Q

Metabolism of glucocorticoids

A

Metabolised - liver

Excreted - urine

148
Q

Side effects of inhaled glucocorticoids

A

Cough
Oral thrush
Unpleasant taste
Hoarseness

149
Q

Examples of glucocorticoids

A

Prednisolone - PO
Hydrocortisone - IV/IM
Dexamthasone - PO/IV
Triamcinolone - IM

150
Q

Actions of glucocorticoids

A

Alters gene transcription
Anti-inflammatory, immunosuppressive, increased gluconeogenesis, decreased glucose utilisation, increased protein catabolism

151
Q

Common side effects of non-inhaled glucocorticoids

A 
Adrenal suppression - courses > 3 weeks
Hyperglycaemia
Psychosis
Insomnia
Indigestion
Mood swings
Diabetes
Cataracts
Glaucoma
Peptic ulceration
Susceptibility to infections
Osteoporosis 
Muscle wasting 
Skin thinning
Cushingoid appearance
152
Q

Considerations for long term steroid use

A

PPI - reduce GORD
Bisphosphonates - bone protection
Steroid card
Should not be withdrawn abruptly

Yr3 - General Medicine (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions