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Respiratory Flashcards

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1
Q

Pneumonia symptoms (4 things) and signs (4 things)

A

Symptoms-

  • Dyspnoea
  • Fever
  • Cough with purulent sputum
  • PLEURITIC pain

Signs-

  • Dull percussion
  • Crackles and BRONCHIAL breathing on auscultation
  • Rigors (septicaemia)
  • Cyanosis and Tachypnoea (RESPIRATORY FAILURE)
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2
Q

Pneumonia investigations (4 things)

A

CXR- infiltrates

SPUTUM ANALYSIS to identify causative organisms

PNEUMOCOCCAL or LEGIONELLA antigens in urine

BLOODS- Raised WCC and raised CRP/ESR

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3
Q

Pneumonia assessment

A

CURB 65

Confusion
Urea >7
Resp rate >30/min
BP <90/60
>65 years old

Each is worth 1 point-
1= outpatient care
2= admission
3 or more= ICU admission

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4
Q

Pneumonia Treatment

A

BAPP

Breathing- maintain O2 levels
Antibiotics- treat underlying cause
Pain- analgesics
Pneumococcal vaccines (prioritised in D-I-65 (Diabetics, Immunosuppressant patients, patients over 65)

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5
Q

Pneumonia causative organisms (5 things)

A

Pneumococcal pneumoniae

Staph Pneu

Kleb Pneu

PSEUDONOMAS (like in BE/CF)

PNEUMOCYSTIS (seem more commonly in immunosuppressant patients)

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6
Q

Complications of pneumonia

A

Septic shock (if organism enters blood stream and releases cytokines)

Pleural effusion

Empyema

HYPOTENSION (due to sepsis or dehydration)

Respiratory failure

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7
Q

Bronchiectasis pathophysiology

A

infection of distal airways results in inflammation and release of inflammatory markers

impairs ciliary action- allows bacteria to proliferate

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8
Q

Bronchiectasis causative organisms (4 things)

A

Pseudonomas aeriginosa (common in patients with cystic fibrosis)

Strep pneumoniae

HAEMOPHILUS influenza

Staph aureus

Aspergillus

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9
Q

Causes of Bronchiectasis

A

TRICKY

Acquired-

  • Tumor
  • Rheumatoid arthritis
  • INFLAMMATORY BOWEL DISEASE

Congenital-

  • Cystic fibrosis
  • Kartagener’s Syndrome (causes cilia to be immobile, removing the defensive mechanism of the respiratory tract)
  • Young’s Syndrome (associated with AZOOSPERMIA)
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10
Q

Bronchiectasis symptoms (3 things) and signs (3 things)

A

Symptoms-

  • PURULENT sputum
  • persistent COUGH
  • fever

Signs-

  • Clubbing
  • Crackles
  • Inspiratory crepitations
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11
Q

Bronchiectasis investigations

A

CXR- tram track opacities
Sputum culture
Bloods- WCC/ CRP/ ESR/ TFTs/ LFTs

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12
Q

Bronchiectasis treatment

A 
Antibiotics (ciprofloxacin for pseudonomas)
Bronchodilators
Corticosteroids (prednisolone)
Postural Drainage
Surgery
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13
Q

Cause of Cystic Fibrosis

A

CFTR gene mutation

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14
Q

Cystic Fibrosis pathophysiology

A

Defect in Cl- secretion and increased Na+ absorption

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15
Q

Cystic Fibrosis investigations

A

Sweat Test
Guthrie’s Test in neonatal period

CXR- hyperinflation/ bronchiectasis

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16
Q

Signs of Cystic Fibrosis

A

Cyanosis
Clubbing
Crackles (bilateral)

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17
Q

Cystic Fibrosis treatment (3 things)

A

Physiotherapy
Ciprofloxacin
Bronchodilators

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18
Q

Cystic Fibrosis associations (3 things)

A

Pancreatic insufficiency
Diabetes
Male infertility

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19
Q

Asthma Signs and Symptoms

A

Wheezing
Shortness of Breath
Coughing

Ask about history of ATOPY (tendency to develop allergies)

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20
Q

Asthma pathophysiology

A

Allergen affects Th2 cells

Th2 cells release IL 4

IL 4 stimulates B lymphocytes

B lymphocytes produce IgE

IgE cause mast cell degranulation

Mast cell degranulation releases histamine

Histamine causes bronchoconstriction

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21
Q

Asthma Investigations

A

Peak expiratory flow rate (note diurnal variation)

Blood test- INCREASED IgE

CHECK FOR ONEUMOTHORAX and CONSOLIDATIONS in CXR

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22
Q

Treatment of ACUTE ASTHMA

A 
Oxygen
Salbutamol
HYDROCORTISONE
Ipratropium
Theophylline
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23
Q

Side effects of SALBUTAMOL

A

Increased HR
Decreased potassium
Tremor
Anxiety

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24
Q

Side effects of THEOPHYLLINE

A

GI upsets
Fits
Arrhythmias

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25
GENERAL treatment of Asthma
Salbutamol Salbutamol + BECLOMETASONE Salbutamol + salmeterol + more BECLOMETASONE Salbutamol + salmeterol + even more BECLOMETASONE Consider Theophylline or Montelukast (leukotriene receptor antagonist)
26
COPD PATHOPHYSIOLOGY
CHRONIC BRONCHITIS- - cough with sputum production for at least 3 months in 2 consecutive years - Mucus gland HYPERPLASIA and smooth muscle HYPERTROPHY EMPHYSEMA- - permanent dilated airways distal to terminal bronchioles with alveolar destruction and bullae formation - associated with ALPHA-1 ANTITRYPSIN DEFICIENCY and INCREASED ELASTASE ACTIVITY
27
Causes of COPD
GASES ``` Genetic Air pollutiion Smoking Exposure through occupation (COAL MINING) Second hand smoking ```
28
INVESTIGATIONS of COPD (5 things)
Spirometry- FEV1<80% of predicted value OR FEV1/FVC <0.7 BLOODS- Alpha-1 antitrypsin levels/ WCC/ ESR/ CRP CXR- hyperinflation/ emphysema/ DIAPHRAGMATIC flattening ECG- COR PULMONALE SPUTUM CULTURE
29
Treatment of COPD
FEV1<50%- - SABA/ SAMA - LABA - LABA + ICS - LAMA + LABA/ICS FEV1>50%- - SABA/ SAMA - LABA+ ICS - LAMA + LABA/ICS OR for both- SABA/ SAMA LAMA LAMA + LABA/ICS SABA- salbutamol LAMA- salmeterol SABA- iptratropium LABA- tiotropium
30
Complications of COPD
CLIPPeR Cor pulmonale (right sided heart failure due to pulmonary hypertension) Lung cancer Infections (MACROLIDE usually helps) Pneumothorax Polycythaemia Respiratory Failure
31
Type 1 (Normal CO2) Respiratory Failure Causes
``` Pneumonia Pulmonary Embolism Pulmonary Oedema Emphysema Asthma ```
32
Type 2 (High CO2) Respiratory Failure Causes
``` COPD/ Asthma Cerebrovascular disease Opiate overdose Myasthenia gravis Motor neuron disease ```
33
Respiratory Failure symptoms
Agitation Breathlessness Confusion Drowsiness/ Fatigue
34
Signs of Type 2 (High CO2) Respiratory Failure
A flapping tremor Bounding pulse Cyanosis
35
Pink Puffer
Type 1 Respiratory Failure
36
Blue Bloater
Type 2 Respiratory Failure
37
Complications of Respiratory Failure
Heart failure Arrhythmia Pericarditis
38
When to consider ABG (6 conditions)
Acute exacerbation of Chronic chest condition Validate measurements from pulse oximetry CO2 retention signs (bounding pulse/ flaps) IMPAIRED CONSCIOUSNESS Signs of LOW O2- CONFUSION/ CYANOSIS/ HALLUCINATIONS Unexpected deterioration
39
Coal Worker Pneumoconiosis
Inhalation of coal dust particles Dust particles accumulate in parenchyma and are engulfed by macrophages They die releasing enzymes that result in TISSUE FIBROSIS
40
Asbestosis (5 things)
Inhalation of asbestos fibres Fusiform rods are found in macrophages Associated with MALIGNANT MESOTHELIOMA PLEURAL PLAQUES in CXR White asbestos- lowest fibrogenicity Blue asbestos- highest fibrogenicity
41
Silicosis (7 things)
AKA Potter's ROT Inhalation of silica particles (they can't be removed by respiratory defences) Macrophages engulf these and release TNF and cytokines TNF and cytokines induce fibroblasts- results in fibrosis and collagen deposition EGGSHELL CALCIFICATION of HILAR LYMPH NODES i CXR NODULAR lesions in UPPER LOBES Associated with increased TB infection
42
Beryliosis
Caused by inhaling beryllium Causes GRANULOMA formation made up of: - Giant cells - Macrophages - Epithelioid cells
43
GRANULOMATOUS CONDITIONS (resp) (5 things)
``` Beryliosis TB Leprosy Sarcoidosis Cat-scratch disease ```
44
Siderosis
Inhaling IRON | Benign with NO APPARENT SYMPTOMS or ALTERED LUNG FUNCTIONS
45
If RESPIRATORY ACIDOSIS
Type 2 Respiratory Failure
46
If RESPIRATROY ALKALOSIS
Hyperventilation
47
If METABOLIC ACIDOSIS
Check ANION GAP- ``` High= increase in internally produced acids Normal= high ingested acids, or high excreted HCO3- ```
48
Lung cancer CENTRAL LOCATION (3 things about each)
SQUAMOUS CELL CARCINOMA- - Associated with SMOKING - Paraneoplastic PARATHYROID-like actions - KERATIN PEARLS seen histologically SMALL CELL CARCINOMA- - Associated with LAMBERT-EATON SYNDROME - ACTH and ADH are generated ectopically - KULCHITSKY CELLS seen histologically
49
Lung cancer PERIPHERAL LOCATION (4 things about each)
ADENOCARCINOMA- - Associated with HYPERTROPHIC OSTEOARTHROPATHY - NOT associated with smoking - More common in women - MUCIN-POSITIVE STAINING seen histologically LARGE CELL CARCINOMA- - Larger anaplastic cells - High cytoplasm to nucleus ratio - Lack light microscopic features of other tumors - Treated by SURGICAL EXCISION
50
Lung cancer located in APEX
PANCOAST's TUMOR- - Results in Homer's Syndrome- 1) MIOSIS (pupil's constricted heavily) 2) PTOSIS (drooping eyelid) 3) ANHIDROSIS (inability)
51
Lunch Cancer located in PLEURA
MESOTHELIOMA- - Associated with ASBESTOSIS - PSAMMOMA BODIES are seen histologically
52
Deep Vein Thrombosis PATHOPHYSIOLOGY
VIRCHOW's TRIAD HYPERCOAGULABILITY- - Malignancy - Clotting abnormalities - Oral contraceptive pill - Surgery - Trauma VENOUS STASIS- - Heart failure - Immobility (e.g. surgery) - Pregnancy TRAUMA- - Inflammation - Previous thrombosis
53
Signs and Symptoms of Deep Vein Thrombosis
AE POET Asymptomatic Engorgement of surface veins Pain Oedema Erythema/ discoloration Temperature increased in symptomatic leg
54
Differential diagnosis of DVT
A musculoskeletal injury Baker's cyst rupture Cellulitis
55
Investigations in DVT
D- DIMER test B-mode venous compression ultrasonography (for DVT above knee) Investigations to uncover cause of DVT
56
TREATMENT for DVT
Anticoagulation therapy with unfractionated HEPARIN or LMWH (DALTEPARIN) Secondary management with WARFARIN
57
Signs and Symptoms of PULMONARY EMBOLISM
``` Pleuritic chest pain Breathlessness Tachycardia/ Tachypnoea Cyanosis HAEMOPTYSIS ```
58
Pulmonary Embolism PATHOPHYSIOLOGY
THREE pathways- 1) Platelet factor release- SEROTONIN and THROMBOXAN A2 cause vasoconstriction 2) Decreased alveolar perfusion (underperfused lung leads to diminished gas exchange) 3) Decreased surfactant- leads to ventilation/ perfusion mismatch, hypoxaemia, dyspnoea
59
Causes of Pulmonary Embolism
DVT Fat/ air emboli AMNIOTIC FLUID EMBOLI Foreign material introduced via IV drug use
60
Investigations of Pulmonary Embolism (6 things)
D Dimer Thrombophilia screening if recurrent PE and under 50yo CXR USUALLY NORMAL! ECG- Sinus tachycardia ABG- Hypoxaemia WELL's Score
61
Treatment for Pulmonary Embolism
MASSIVE PE or HAEMODYNAMICALLY UNSTABLE= ALTEPLASE HAEMODYNAMICALLY STABLE= LMWH or HEPARIN (if renal impairment) Then give DOAC or WARFARIN
62
Pneumothorax Signs and Symptoms
CHAD TIPS Cyanosis Hypoxia Auscultation (decreased on affected side) Dyspnoea Tachypnoea Ipsilateral chest pain Percussion- HYPER RESONANT or NORMAL Shoulder tip pain
63
Pneumothorax Pathophysiology
Primary- idiopathic/ rupture of pleural bleb- TALL, YOUNG, SLIM MEN Secondary- in patients with prior lung condition Tension- Due to trauma- MEDIASTINAL SHIFT and lung collapse
64
Causes of Pneumothorax
RALTS CRIT ``` Rheumatoid arthritis Ankylosing Spondylitis Lung cancer Trauma (stab wound) Sarcoidosis ``` COPD Ruptured pleural bleb Idiopathic pulmonary fibrosis TUBERCULOSIS
65
Investigations on Pneumothorax
CXR- follow the PLEURAL LINE, may show tracheal deviation away from lesion CT scan ABG- hypoxia
66
Pneumothorax Treatment
If <2cm- no treatment- advice against diving and flying If >2cm- aspirate with or without intercostal drain Tension pneumothorax- immediate decompression with a bore needle inserted into 2nd intercostal space mid-clavicular line
67
Complications of Pneumothorax (3 things)
Cardiac arrest Risk of future pneumothorax Cardiac arrest
68
Causes of TRANSUDATE Pleural Effusion (3 things)
Increased Venous Pressure- - Cardiac Failure - Constrictive Pericarditis - Fluid Overload Decreased Protein- - CIRRHOSIS - Nephrotic Syndrome - Malabsorption Decreased Thyroid
69
Causes of EXUDATE Pleural Effusion (3 things)
(Increased leakiness of pleural capillaries) - Infection (pneumonia/ TB) - Inflammation (SLE/ RA) - Malignancy
70
Investigations of Pleural Effusion
CXR- Costophrenic angle blunted | - If there is a FLAT HORIZONTAL UPPER BORDER- there is also a pneumothorax
71
Pleural Fluid- High Neutrophils (2 things)/ High Lymphocytes (5 things)
HIGH NEUTROPHILS- - Parapneumonic effusion - Pulmonary Embolism HIGH LYMPHOCYTES- - Malignancy - TB- - RA - SLE - SARCOIDOSIS
72
Pleural Fluid- Low Glucose/ Low pH/ High LDH (5 things)
- Malignancy - SLE - RA - TB - EMPYEMA
73
Pleural Fluid- High Amylase (4 things)
PANCREATITIS OESOPHAGEAL RUPTURE Bacterial pneumonia Carcinoma
74
Causes of Sarcoidosis
Fever Polyarthralgia Erythema Nodosum Bilateral Hilar Lymphadenopathy
75
Causes of Bilateral Hilar Lymphadenopathy
OH SHIM- Organic Dust Disease Hypersensitivity Pneumonitis Sarcoidosis Histocytosis X Infection- TB/ Mycoplasma Malignancy
76
Non Pulmonary Signs of Sarcoidosis (7 things)
OG ABC (Organs, glands, arrhythmia, bell's palsy, calcium) - Large Liver and Spleen - Large Parotid and Lacrimal glands - Arrhythmia/ BBB - BELL's PALSY - HIGH CALCIUM - HIGH ESR - HIGH ACE
77
Sarcoidosis Treatment and Indications for corticosteroids in Sarcoidosis (4 things)
BHL alone doesn't need treatment Acute Sarcoidosis- Bed rest and NSAIDs In severe- IV methylprednisolone or immunosuppressants may be needed INDICATIONS for CORTICOSTEROIDS- - Parenchymal Lung Disease - Hypercalcaemia - Uveitis - Neurological or Cardiac involvement
78
Causes of Upper (5), Mid (2) and Lower (2) Fibrotic Shadowing on CXR
Upper- - TB - Hypersensitivity Pneumonitis - Ankylosing Spindylitis - RADIOTHERAPY - PROGRESSIVE MASSIVE FIBROSIS Mid- - Sarcoidosis - Histoplasmosis Lower- - Idiopathic pulmonary fibrosis - ASBESTOSIS
79
Symptoms (5) and Signs (3) of Idiopathic Pulmonary Fibrosis
Symptoms- - Dry cough - Dyspnoea - Malaise - Weigh LOSS - Arthralgia Signs- - Clubbing - Cyanosis - Crackles
80
Investigations for Idiopathic Pulmonary Fibrosis 3 for bloods 4 for CXR
Bloods- - low PaO2 - high CRP - high Immunoglobulins CXR- - Low lung volume - Bilateral lower zone - Reticonodular shadows - Honeycomb lungs HIGH LYMPHOCYTES- good prognosis HIGH NEUTROPHILS- bad prognosis
81
Management of Idiopathic Pulmonary Fibrosis
- O2 - Pulmonary rehabilitation - Opiates - NINTEDANIB and PIRFENIDONE are shown to help - Don't use high-dose steroids unless diagnosis of IPF is in doubt
82
Complications of Idiopathic Pulmonary Fibrosis (2 things)
Respiratory Failure | Increased risk of Lung Cancer
83
Phrenic Nerve innervates these three things
PERICARDIUM CENTRAL DIAPHRAGM MEDIASTINAL part of PARIETAL PLEURA
84
6 Respiratory Manifestations of Rheumatoid Arthritis
- Pulmonary Fibrosis - Pleural Effusion - Pleurisy - Infection - Pulmonary Nodules - CAPLAN's SYNDROME- massive fibrotic nodules with occupational coal dust exposure
85
What separates the thoracic and abdominal cavities and forms the central tendon of the diaphragm?
SEPTUM TRANSVERSUM
86
The two diaphragm hernias
Morgnani (anterior) - minimal effect on lung development - overall good Bochdalek (posterior) - pulmonary hyperplasia - overall bad
87
Optimal PaO2 in ventilation
Needs to be 10kPa lower than % of O2 given (so 20kPa for someone on 30% O2)
88
Chemoceptor locations
Central- located in medulla- - respond to DECREASED pH in brain interstitial fluid - does NOT respond to low O2 Peripheral- located in BIFURCATION of carotid arteries and ARCH of AORTA- - respond to low O2, low pH and increased CO2 in arterial blood
89
3 Respiratory Centres and 3 points for each of them
MEDULLARY RESPIRATORY CENTRE- 1) Inspiratory and Expiratory neurones 2) Has ventral group which controls FORCED EXPIRATION and has dorsal group which controls INSPIRATION 3) DEPRESSED BY OPIATES APNEUSTIC CENTRE- 1) LOWER PONS 2) Stimulates INSPIRATION 3) Overridden by Pneumotaxic control to end inspiration PNEUMOTAXIC CENTRE- 1) UPPER PONS 2) Inhibits INSPIRATION 3) FINE-TUNES RESP RATE

Medicine (15 decks)

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