Respiratory Flashcards
(87 cards)
1
Q
What are the antigens on the influenza virus?
A
Haemagglutinin and Neuraminidase antigen - they attach to the respiratory epithelium. This is what we develop immunity against.
2
Q
Features of influenza
A
fever, limb ache, headache, sore throat, dry cough
3
Q
Influenza Mx?
A
paracetamol, bed rest, maintain fluids
4
Q
What is COPD?
A
poorly reversible airflow limitation, it is progressive and associated with persistant inflammation in the lungs.
5
Q
Causes of COPD
A
smoking, pollution, A1 antitrypsin deficiency
6
Q
How does smoking cause COPD?
A
Mucous gland hypertrophy in large airways causes increased neutrophils/macrophages/lymphocytes which release inflammatory mediators that break down connective tissue.
7
Q
Discuss the 2 pathophysiologies of COPD?
A
1) CHRONIC BRONCHITIS - airway narrowing with hypertrophy and hyperplasia of mucous secreting glands and oedema. Columnar epithelium –> Squamous.
2) EMPHYSEMATOUS - loss of elastic recoil meaning alveoli close on expiration - airflow limitation and trapping.
8
Q
What are pink puffers?
A
Predominant emphysema - breathless, not cyanosed
9
Q
What are blue bloaters?
A
Predominant bronchitis - hypoventilate, cyanosed, oedematous, CO2 retention (bounding pulse.)
10
Q
COPD features?
A
cough, sputum, wheeze, breathless, years of smokers cough, worse with infections.
11
Q
COPD signs on examination?
A
Breathless, increased expiration time, poor chest expansion, lungs hyperinflated, barrel shaped chest, use of accessory muscles.
12
Q
What cells are involved in COPD inflammation?
A
Macrophages, neutrophils, CD8 cells.
13
Q
COPD complications?
A
cor pulmonale, respiratory failure.
14
Q
Investigations for COPD?
A
Lung function test - progressive airflow limitation
CXR - lungs hyperinflated, flat diaphragm
CT - emphysematous bullae
Bloods - polycythaemia?
ABG - hypoxia, hypercapnia
ECG/ECHO
15
Q
Stages of COPD?
A
- MILD - Chronic cough. FEV1/FVC <70%, FEV1 > 80%
- MOD - Breathless on exertion, FEV1/FVC <70%, 50%
- Severe - breathless on minimal exertion
- v severe - breathless at rest
16
Q
What is FEV1 and FVC?
A
FEV1 = forced volume expired in 1 second FVC = total volume expired FEV1/FVC = ratio to measure airflow limitation - <75% = airflow limitation, >75% = restrictive lung disease
17
Q
General measures for COPD patients?
A
STOP SMOKING! influenza and pneumococcal vaccine.
18
Q
Medical therapy for COPD?
A
- SABA + SAMA (salbutamol + tiotropium bromide)
- Prednisolone
- O2 therapy - guided by blood gas measurements
19
Q
Features of a COPD exacerbation?
A
worsened cough and breathlessness, sputum, wheeze, hypoxia and confusion.
20
Q
Common cause of a COPD exacerbation?
A
H.Influenzae
21
Q
Treatment of an exacerbation of COPD?
A
- Give O2 (aim for SpO2 of 88-92%)
- Bronchodilators (Salbutamol and ipratropium bromide)
- Prednisolone 40mg
- Co-Amoxiclav
Other: LMWH to avoid DVT, escalate with Aminophylline, ventilate with BiPAP.
22
Q
What is OSA?
A
repeated cessation of breathing for >10 seconds due to obstructed upper airway during sleep.
23
Q
RF for OSA?
A
obesity, alcohol, hypothyroid
24
Q
OSA features?
A
loud snoring, daytime sleepiness
25
OSA Ix?
measure O2 sats whilst sleeping
26
OSA Mx?
lose weight, remove tonsils, CPAP whilst sleeping
27
What is bronchiectasis?
Abnormal and permanent dilation of central and medium sized airways. Results in impaired clearance of bronchial secretions --> poolings which cause secondary bacterial infections and inflammation.
28
Causes of bronchiectasis?
post infective, CF, AIDS
29
Features of bronchiectasis?
chronic productive cough, recurrent infections, thick foul sputum, breathless, wheeze
30
What do you hear on auscultation of a patient with bronchiectasis?
coarse crackles
31
Ix for bronchiectasis? what would these show?
CXR - dilated bronchi and thickened walls, cysts?
CT - airway dilation, walls thickened, cysts
sputum culture
32
Mx of bronchiectasis?
stop smoking, physio for sputum clearance
| influenza and pneumococcal vaccine
33
how to manage an exacerbation of bronchiectasis?
resp physio (mucus clearance)
ABx - flucloxacillin
bronchodilators
steroids
34
What causes CF?
autosomal recessive condition with mutation in CFTR transmembrane protein which is resposible for transporting CL-. Mutation causes increased salt content of the mucus = increased viscosity.
Commonest mutation = deltaF508
35
Features of CF?
frequent infections, bronchiectasis, airflow limitation, respiratory failure, finger clubbing, sinusitis
36
Non resp features of CF?
short stature, pancreas insufficiency, delayed puberty, male infertility.
37
Ix for CF?
- Sodium sweat test - >60 is diagnostic.
- Blood DNA analysis
- Radiological features.
38
Mx of CF?
- resp physio
- pancreatic enzymes to help with digestion
- inhaled recombinant therapy
- treat P.Aeruginosa infection (Increases mortality) - nebulsed Abx therapy.
39
What is Asthma? 3 main features?
chronic inflammatory condition affecting the lungs and causing reversible airway obstruction.
Features: Airflow limitation, hyperresponsive airways, inflamed bronchi
40
what is atopy?
IgE forms against commen environmental antigens e.g. dust mites, pollution.
41
Pathogenesis of asthma?
INFLAMMATION - involving mast cells/eosinophils/CD4 cells in the bronchial wall. Involved in initial uptake of triggers and present to Th2 lymphocytes.
REMODELLING - airway smooth muscle hypertrophy and hyperplasia.
42
Features of Asthma?
Asthma attacks, wheezing, SoB, tight chest, cough.
- features are intermittant
- diurnal variation (worse at night)
- symptoms provoked by triggers.
43
What do you find on examination during an asthma attack?
- reduced chest expansion
- prolonged expiratory time
- bilateral expiratory polyphonic wheeze
44
Asthma Ix?
FEV1, PERF, - show diurnal variation, improve with bronchodilator
histamine challenge
skin prick test
CXR during asthma attack
45
Management of Asthma (day to day)?
Avoid triggers and precipitating factors, don't smoke, avoid B Blockers
1. Inhaled SABA (salbutamol, B2 receptor agonist. Relaxes bronchial smooth muscles.)
2. Inhaled steroids (beclometasone, SE = oral candidiasis.)
3. Add LTRA (e.g. monteleukast)
4. Add LABA (salmeterol - relaxes bronchial smooth muscles.)
4. Increase inhaled steroids
5. Prednisolone
6. Hospital admission
46
Features of Acute severe asthma?
Severe progression of asthma symptoms over hours/days - MEDICAL EMERGENCY.
can't speak sentences, high RR, high HR, PERF = 35-50% predicted, silent chest, cyanosis, exhaustion, reduced GCS,
47
What is PERF?
Maximum flow generated during forced expiration
48
management of acute severe asthma?
1. Sit up and give high flow O2
2. nebulised Salbutamol + ipratropium bromide and O2
3. IV hydrocortisone
If not improving
- MgSO4
- IV aminophylline
- IV salbutamol + ITU admission
49
When is it safe to discharge an asthma attack pt?
No Sob, no wheeze, stable obs
| CHECK - inhaler technique, reason for exacerbation and create an asthma plan.
50
Common causes of pneumonia?
strep.pneumonia (community)
S.Aureus (IVDU)
P.Aeruginosa (CF)
51
Pneumonia features?
fever, cough, sputum, pleurisy, dyspnoea.
52
How do you assess the severity of a pneumonia? what does it look at?
CURB65. confused? urea>7? RR>30? BP<90/60? Age>65
53
Ix for pneumonia?
CXR, sputum culture, ABG
Bloods - WCC, LFT, culture
Urine - legionella/pneumococcal antigens
54
DD of pneumonia?
PE, pulmonary oedema, bronchial carcinoma, hypersensitivity pneumonitis
55
Mx of pneumonia?
CAP - amoxicillin (macrolide if allergic - e.g. erythromycin)
S.Aureus - Flucloxacillin
56
Pathophysiology of TB?
primary infection = subpleural lesions called Ghon's focus form. Neutrophils invade and are replaced by macrophages (Langhan's giant cells.)
The infection becomes latent --> and reactivates to cause post-primary TB.
57
Features of TB?
fever, weight loss, malaise, anorexia, cough, blood stained sputum, small pleural effusion
58
Ix for TB? special stains and tests....
- CXR - patchy nodules in the upper apex
- Sputum - Ziehl-Neelson stain and culture
- Bronchoschopy
- Extra pulm - LN/bone biopsy and urine testing
- Skin - mantoux test
- HIV testing
59
Which Abx are used for TB?
Rifampicin, Isoniazid (6 months)
| pyrazinamide, ethambutol (2 months)
60
methods to prevent TB?
screen close contacts - XR and mantoux test
| BCG vaccine
61
What is sarcoidosis?
multisystem granulomatous disorder which presents with bilateral hilar lymphadenopathy.
62
Features of sarcoidosis in each organ?
```
CHEST - cough, breathless, wheeze
SKIN - granuloma in scars
EYE - uveitis, lacrimal gland enlargement
BONE - arthralgia
NEURO - masses
```
63
Ix for sarcoidosis?
biopsy, CXR, lung function tests
| SERUM ACE - increased in most patients.
64
Mx of sarcoidosis?
prednisolone
65
What is Idiopathic pulm fibrosis (IPF)?
patchy fibrosis of the interstitium with absence of inflammation. Fibroblastic proliferation
66
Features of IPF?
breathlessness, non productive cough, resp failure, pulm HTN, clubbing
67
Ix of IPF and signs?
CXR - ground glass appearance (honeycombed)
CT - bilateral opacities
Lung function - restrictive defect
ABG - hypoxaemia
68
Mx of IPF?
prednisolone, lung transplant.
69
What is hypersensitivity pneumonitis?
widespread inflammation in alveoli due to reaction to organic particles?
70
Features of hypersensitivity pneumonitis and findings on examination?
features: cough, fever, malaise, SoB
| O/E: increased RR, coarse crackles, wheeze
71
causes of hypersensitivity pneumonitis?
farmers lung, bird fanciers lung, malt workers.
72
Ix of hypersensitivity pneumonitis? and findings
CXR - fluffy nodular shaddowing in upper zones
FBC - increased WCC
Lung function - restrictive defect
Bronchoalevolar lavage - T lymphocytes and granulocytes
73
RF for lung cancer
smoking, asbestos, arsenic, pollution
74
Local and metastatic features of lung cancer?
Local: cough, chest pain, haemoptysis, breathless
Met: local - bone pain, fractures, hoarse voice. Distant - brain
75
Ix of lung cancer?
CXR, sputum culture, fine needle aspiration, bronchoscopy, PET scan, lung function tests
76
What does SCLC develop from?
Endocrine cells (Kulchitsky cells) - they secrete hormones and metastasize early.
77
Effects of asbestos on the lung? name 3
```
Asbestos bodies - shows exposure
Plaques - fibrotic
Effusion - pain and dyspnoea
Mesothelioma - cancer (pain and PE)
Asbestosis - breathless, clubbint, inspiratory crackes, restrictive defect
```
78
What is the definition of a pleural effusion?
excess fluid in the pleural space (>500mL)
79
Signs of a pleural effusion?
reduced chest wall movement, dull to percuss, absent breath sounds, reduced vocal resonance, mediastinal shifting.
80
name different causes of pleural effusion and how to differentiate between them?
TRANSUDATE (pleural protein <30) - HF, low albumin, hypothyroid, nephrotic synd, cirrhosis
EXUDATE (pleural protein>30) - infection, empyema, TB, malignancy.
81
Ix of a pleural effusion?
pleural fluid aspiration, CT, CXR, sputum culture, bloods, ECG, pleural biopsy
82
What is a pneumothorax?
Air in the pleural space causing lung collapse
83
What is a tension pneumothorax and how does it occur?
occurs with patients on ventilation. Pleural tear acts as a valve which allows air in on inspiration but it can't be expired. Unilateral increase in intrapleural pressure which causes respiratory distress and shock.
84
Symptoms of a pneumothorax? signs on examination?
sudden onset, pleuritic chest pain, breathless
| hyperresonnat percussion and reduced breath sounds
85
Ix of a pneumothorax ?
CXR, CT
86
Mx of pneumothorax?
thoracentesis - aspirate the air and reinflate the lung
87
what is antigenic shift and drift?
Shift - major changes in H and N antigens which is associated with pandemic infections
Drift - annual minor changes in the strains which causes less severe epidemics.
