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Phase 2A conditions > Respiratory Conditions > Flashcards

Respiratory Conditions Flashcards

1
Q

What is Bronchogenic cancer?

A

Small Mediastinal tumour filled with fluid. Presents with bronchus sign: airway leading directly to a peripheral mass

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2
Q

What are the stages of Lung cancer?

A

I: one lung and less than 4cm
II: more than 4cm, may spread to near lymph node
III: contralateral node or close structure invasion
IV: outside chest

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3
Q

What is the difference between hypoxia and hypoxaemia?

A

Hypoxia: tissues
hypoxaemia: blood

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4
Q

What is type 1 respiratory failure and what can cause it?

A

low O2 and normal or low CO2

COPD, pneumonia, asthma, pneumothorax , PE

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5
Q

what is type 2 respiratory failure and what can cause it?

A

low O2 and high CO2

COPD, severe asthma,

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6
Q

What defines obstructive lung diseases and what are examples?

A

airflow is impaired: less than 80% of FEV1 and FEV1/FVC ratio below 0.7

Asthma, COPD, bronchiectasis

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7
Q

What defines restrictive lung diseases and what are examples?

A

lungs don’t function effectively: less than 80% of FVC, normal ratio

pulmonary fibrosis, obesity, sarcoidosis

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8
Q

What is COPD?

A

Progressive airflow limitation that is not fully reversible: emphysema (alveoli destruction), chronic bronchitis and small airway fibrosis

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9
Q

What is the aetiology of COPD?

A 
smoking, 
respiratory infections and alpha-1 antitrypsin deficiency: 
autosomal dominant (SERPINA 1), increase of alveolar destruction, can accumulate in liver and causes cirrhosis
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10
Q

what are RF for COPD?

A

smoking, advanced age, exposure to pollution

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11
Q

How does COPD present?

A

wheeze, breathlessness, productive cough with white sputum and can have systemic symptoms (depression, HTN, osteoporosis)

severe: breathless at rest, hyperinflation, can develop pulmonary HTN and HF

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12
Q

What are two types of symptom presentation in COPD?

A

Blue bloaters: chronic bronchitis, overweight, cyanosis, oedema due to R HF
Pink Puffers: emphysema, pursed lip breathing, pink skin, barrel chest

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13
Q

What tests do you order for COP and what results do you expect?

A

Order spirometry, oximetry, ABG’s, cxr

- FEV1/FVC below 0.7, less than 80% of FEV1
- hypoxia in advanced cases and flattened diaphragm, on xr
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14
Q

What are differentials of COPD?

A

asthma, congestive HF, bronchiectasis

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15
Q

What complications are associated with COPD?

A

cor pulmonale, recurrent pneumonia, depression, respiratory failure

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16
Q

How do you treat COPD?

A

Treat conservatively with smoking cessation, rehab

- antimuscarinic inhaler (tiotropium bromide) and salbutamol
- LABA if needed
- corticosteroids
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17
Q

What is asthma and what is its pathology?

A

Chronic Inflammatory airway disease:

narrowing of airways due to smooth muscle contraction, thickening of wall and secretions within lumen

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18
Q

What are the two types of asthma?

A

eosinophil and non-eosinophilic asthma

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19
Q

What are precipitating factors for asthma attacks or development?

A

allergens, cold air, exercise, diet, pollution, anxiety, drugs or occupational exposure

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20
Q

what is the timeline of an asthma attack?

A

bronchoconstriction after 30 min, constriction decreases and inflammation starts after 3 hours, eosinophils and full inflammation after 6 hours

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21
Q

What are RF for asthma?

A

history of atopy, family history, obesity, polluted environment, premature birth, socio-economic deprivation

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22
Q

How does asthma present?

A

episodic wheezing and breathlessness, cough, sputum and symptoms can be worse at night
During an attack: chest expansion is reduced, prolonged expiration, wheezing

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23
Q

what tests do you order for asthma?

A

peak flow expiratory rate, FEV1/FVC ratio, cxr, FBC, exercise test, spirometry, exhaled nitric oxide (measures eosinophil inflammation)

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24
Q

How is asthma classified based on PFER?

A
  • mild: 50-75% and increase in symptoms
  • severe: 33-50%, RR above 25, HR above 110, can’t complete sentence 1 breath
  • life threatening: below 33%, hypotension, change in consciousness, silent chest
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25
Q

What are differentials of asthma?

A

COPD, large airway obstruction, pulmonary oedema

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26
Q

What distinguishes COPD from asthma?

A

later onset and smokers, less variation, sputum production

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27
Q

How do you manage asthma?

A

Stepwise approach:

  • SABA (salbutamol) when needed: short effect, airway relaxation, also used in acute attacks
  • low corticosteroid inhaler (beclometasone): daily, reduce inflammation
  • Leukotriene receptor antagonists (montelukast)
  • LABA (salmeterol)
  • MART regime i.e. combined therapy
  • increase steroids
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28
Q

What is small cell lung cancer and what are its features?

A

Cancer of neuroendocrine cells and arises from central bronchus

  • secretes polypeptide hormones
  • fast growth and rapid spread
  • limited or extensive
  • strongly associated with smoking
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29
Q

How does small cell cancer present?

A

cough, haemoptysis, wheezing, clubbing, recurrent infections, breathlessness

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30
Q

What tests do you order for small cell lung cancer?

A

cxr and CT, bronchoscopy, FBC

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31
Q

How do you treat small cell carcinoma?

A

Surgery usually not curative and usually relapses

- limited: chemo and radiation
- extensive: chemo, pleural drainage, endobronchial therapy to treat narrowing
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32
Q

What types of cancer fall under non-small cell and what are the features?

A
  • Squamous cell: of epithelial cells and can produce keratin, central airways, smoking associated
  • Adenocarcinoma: most common, mucus secreting glandular cells, central or peripheral and usually single lesion, no smoking association
  • Large cell: poorly differentiated and throughout lungs, if its not one of the others
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33
Q

How does non small cell present?

A

cough, haemoptysis, hoarseness, chest pain, weight loss and neurological symptoms

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34
Q

What tests do you order for non small cell?

A

fine needle aspiration , cxr and CT

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35
Q

How do you treat non small cell?

A
  • Surgery if no metastases but can still reoccur

- chemo and radio

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36
Q

What is mesothelioma and what are the features?

A

Tumour of mesothelial cells of the pleura from asbestos exposure

- chronic inflammation and oxidative stress lead to high grade malignancy
- starts as nodules and extends as a sheet: spreads around pleural surfaces and can invade chest wall, nerves and lymphatics
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37
Q

what is the aetiology of mesothelioma?

A

asbestos exposure (latent period), radiotherapy and genetics

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38
Q

what are Fr for mesothelioma?

A

male, 40-70, asbestos, radiation

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39
Q

How does mesothelioma present?

A

chest pain, dyspnoea, weight loss, clubbing, recurrent pleural effusions

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40
Q

What tests would you order for mesothelioma and what do you expect?

A

cxr (unilateral effusions, pleural thickening), MRI, thoracentesis and pleural biopsy (straw coloured and bloody pleural fluid)

41
Q

How do you treat mesothelioma?

A

Not very treatable, treat depending on if it is operable:

- operable: extra-pleural pneumonectomy (remove parietal and visceral)
- inoperable: chemo or radiotherapy
- all death to coroner
42
Q

What is a PE?

A

Dislodged thrombi occluding the pulmonary vasculature

43
Q

What is the aetiology of a PE?

A

clot breaking off, RV thrombus (MI), septic emboli (endocarditis), fat or air embolism, parasites, neoplastic cells, foreign materials

44
Q

what are RF for a PE?

A

Virchow’s triad, age, previous DVT

45
Q

How does a PE present?

A

Presentation depends on size of emboli: SoB, pleuritic chest pain, cough, haemoptysis, syncope

- hypotension, cyanosis, pleural rub
- polo mint sign: partial filling defect in vessel on CTPA
46
Q

How do you calculate a wells score for a PE?

A
  • DVT, leg swelling, pain: 3pts
  • HR above 100: 1.5
  • immobilization or surgery in last 4 weeks: 1.5
  • previous DVT or PE: 1.5
  • Haemoptysis: 1
  • Cancer: 1
  • alternative diagnosis less likely: 3

likely=4

47
Q

What do yo do if a well’s score is likely?

A
  • CTPA immediately or anticoagulation (apixaban)

- Echo 2nd line

48
Q

What do you do if well’s score is unlikely?

A
  • D-dimer within 4 hours or anticoagulants (apixaban)

- positive: CTPA

49
Q

What are differentials of a PE?

A

asthma, COPD, MI, HF

50
Q

What are complications of a PE?

A

death, pulmonary infarction

51
Q

How do you treat a PE?

A

ABCDE approach to assess severity

- O2 if needed and anticoagulant (apixaban or LMWH followed by dabigatran)
- thrombolysis if massive
- LT: warfarin, INR target 2-3
52
Q

What is TB?

A

Airborne infection with mycobacterium tuberculosis

53
Q

What is the physiopathology of TB?

A
  • Primary TB infection: TB enters lungs and infiltrate macrophages to stop them from killing it, causing localised infection. Macrophages fuse producing giant Langerhans cells. Granulomas form in infected areas with caseous necrosis leading to Ghon focus (primary granuloma, normally upper lobe of lung). Secondary lesions in lymph nodes=Ghon complex
  • Bacteria is walled off within granuloma and lies dormant
  • Reactive TB: compromised immune system and reactivation - not all primary infected develop disease
54
Q

What are RF for TB?

A

HIV/immunosuppression, diabetes mellites, aging, poverty, smoking and alcohol

55
Q

How does TB present?

A
  • Primary is usually asymptomatic or mild flu, reactive: cough, crepitations, weight loss, night swats, fever, chest pain
    • can have extra pulmonary manifestations i.e. lymph node swelling, joint pain, ascites
56
Q

What tests do you order for TB and what results do you expect?

A

Order cxr (consolidation and shadows in upper zones, cavities are a sign of active TB), sputum test (definitive diagnosis), tuberculin skin test (cannot distinguish between active and latent)

57
Q

How do you treat TB?

A
  • All cases must be notified to PH england and start treatment before complete diagnosis
    • RIPE: Rifampicin (6mon), Isoniazid (6mon), Pyrazinamide (2), Ethambutol (2)
    • 12 moth treatment if CNS involvement
58
Q

What is pneumonia and what’s the pathology?

A

Lower respiratory tract infection:

  • Overwhelmed host defence and neutrophils produce puss (exudate)
  • Normally resolves but if there is excessive inflammation or lung injury it can become severe
59
Q

What is CAP and what are common causes?

A

community acquired (not compromised, common in extreme ages): strep. pneumoniae, H. influenza, Mycoplasma peumoniae

60
Q

What is HAP and what are common causes?

A

hospital acquired (48 hrs after admission or HC setting within 3 months): aerobic gram -ve bacilli or rods i.e. E.coli, Klebsiella pneumoniae, pseudomonas aeruginosa

61
Q

What are RF for pneumonia?

A

HIV, extreme ages, diabetes, cystic fibrosis, COPD, bronchiectasis, smoking, excess alcohol

62
Q

How does pneumonia present?

A

fever, rigors, malaise, anorexia, breathlessness, cough, purulent sputum (if rusty its strep), pleuritic chest pain, coarse crackles, bronchial sounds

63
Q

What tests do you order for pneumonia and what do you expect?

A
  • CXR: lag, look for air bronchogram i.e. dark, position tells organism
    • multilobar: strep. pneumoniae
    • abscess: s. aureus
    • upper lobe: klebsiella
64
Q

How do you score CURB 65?

A

CURB 65 assesses severity of CAP: confusion, urea (7+), RR (30+), BP (90/60), 65+

65
Q

What are complications of pneumonia?

A

respiratory failure, hypotension, empyema (infected fluid), abscess

66
Q

How do you treat pneumonia?

A
  • Maintain sats over 94 (in COPD over 88)
  • CURB65 0 or 1: amoxicillin
  • CURB65 2: amoxicillin and clarythromycin
  • CURB65 3-6: co amoxiclav and clarythromycin
  • doxycycline if penicillin allergy
67
Q

What is pulmonary fibrosis?

A

Abnormal pulmonary healing process: progressive scarring and loss of compliance and function

  • affects interstitium: tissue between alveoli
  • irreversible and ultimately fatal
68
Q

What is the aetiology of pulmonary fibrosis?

A

over proliferation of type 2 pneumocytes leading to excess collagen production

69
Q

What are RF for pulmonary fibrosis?

A

50-70, smoking, male, occupational dust, GORD

70
Q

How does Pulmonary fibrosis present?

A

coughing (dry and non productive), cyanosis, clubbing, dry inspirational crackles, respiratory failure

71
Q

How do you diagnose pulmonary fibrosis?

A

exclude other causes of interstitial lung disease

72
Q

How do you investigate pulmonary fibrosis?

A

CT, biopsy from 3 areas, spirometry

73
Q

How do you treat pulmonary fibrosis?

A

anti fibrotic medication and lung transplant

74
Q

what are interstitial lung diseases?

A

Group of disorders causing scarring of lung tissue

75
Q

What is sjogren’s syndrome?

A

Autoimmune condition resulting in dry eyes and dry mouth

76
Q

How do you treat Sjogren’s?

A

Artificial tears and saliva. DMARD’s

77
Q

What is sarcoidosis?

A

Formulation of noncaseating granulomata (can affect any organ)

78
Q

What are RF for sarcoidosis?

A

genetic, females, previous sarcoidosis, 20-50

79
Q

How does sarcoidosis present?

A

Can be asymptomatic but generally presents with lymphadenopathy, weight loss, dry eyes

  • lower respiratory: wheezing, chest pain, crackles, cough
  • upper: dysphagia, cough, hoarseness, nasal obstruction
80
Q

How do you treat sarcoidosis?

A

treat with NSAIDs, corticosteroids, antimetabolites or immunosupressants

81
Q

What is bronchiectasis?

A

Chronic inflammation and destruction of airways leading to permanent dilation

82
Q

What is the aetiology of bronchiectasis?

A

Aetiology includes airway obstruction, infections, chronic inflammation (Cystic fibrosis)

83
Q

How does bronchiectasis present?

A

wheezing, productive cough, foul smelling mucus, heamoptysis, clubbing and LT hypoxia

84
Q

How do you investigate brinchiectasis and what do you expect?

A

CT (dilated bronchi), sputum culture, spirometry (decreased FEV1 and decreased ratio) and sweat test

85
Q

How do you treat bronchiectasis?

A

SABA inhalers, ICS and antibiotics

86
Q

What is CF?

A

autosomal recessive multi system disorder: lungs GI, reproductive and sweat glands

87
Q

What is the pathology of CF?

A
  • CFTR gene defect (chromosome 7) causes CFTR (transmembrane regulator) mutations
  • impaired sodium and chloride transport leading to thick secretions: plugging up airway and leading to inflammation and thickening of airway wall
88
Q

What are complications of CF?

A

chronic infections of respiratory tract, bronchiectasis, pneumothorax, cirrhosis, infertility

89
Q

How does CF present?

A

Highly variable presentation: chronic and productive cough, dyspnoea, clubbing, basilar crackle, expiratory wheeze, hyper resonance
Triad: increased sweat chloride levels, chronic sinopulmonary disease and pancreas insufficiency

90
Q

How do you investigate CF and what do you expect?

A

cxr (hyperinflation, flattened diaphragm, bronchial thickening), Genetic testing, sweat test (administer pilocarpine to stimulate sweat and find increased chloride content)

91
Q

How do you treat CF?

A

CFTR regulators, bronchodilators, steroids and antibiotics if there are infections

92
Q

What is a pneumothorax?

A

Abnormal collection of air in pleural cavity: air enters and the positive pressure in the pleural space causes partial or complete lung collapse

93
Q

What are different types of pneumothorax?

A
  • Primary: no clear cause, healthy young males
  • Secondary: with existing lung disease
  • Tension: one way valve
  • traumatic: penetrating injury
94
Q

What are RF of pneumothorax?

A

smoking, COPD, asthma, TB, male

95
Q

How does a pneumothorax present?

A

sharp one-sided chest pain, tachycardia, dyspnoea, cyanosis, hypercapnia, absence breath sounds of affected side, trachea displaces away from affected side

96
Q

How do you investigate a pneumothorax and what do you expect?

A

cxr (tracheal deviation, dark lung fields, mediastinal shift), ultrasound

97
Q

How do you treat a pneumothorax?

A
  • Pleurodesis
  • Needle thoracotomy for tension pneumothorax
  • oxygen if needed
98
Q

How do you act based of CURB 65 scores:

A

0 or 1: mild, outpatient
2: moderate, inpatient
3-6: severe, ICU

Phase 2A conditions (7 decks)

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