Respiratory conditions Flashcards
(116 cards)
1
Q
What is the prevalence of asthma?
A
5-8% of the population
2
Q
What are the characteristics of asthma?
A
Recurrent episodes of dyspnoea, cough and wheeze caused by reversible airways obstruction.
3
Q
What three factors contribute to airway narrowing in asthma?
A
Bronchial muscle contraction
Mucosal swelling/inflammation
Increased mucus production
4
Q
What are the symptoms of asthma?
A
Intermittent dyspnoea
Wheeze
Cough (often nocturnal)
Sputum
5
Q
What is it important to ask about in an asthma history?
A
Precipitants Diurnal variation Exercise Disturbed sleep Acid reflux Other atopic disease The home Job Days per week off work/school
6
Q
How many people with asthma have acid reflux?
A
40-60%
7
Q
What conditions are in the ectopic triad?
A
asthma
eczema
hayfever
8
Q
What precipitants are there for asthma?
A
Cold air Exercise Emotion Allergens Infection Smoking Pollution NSAIDS Beta blockers
9
Q
What are the signs of asthma?
A
Tachypnoea Audible wheeze Hyperinflated chest Hyperresonant percussion Reduced air entry
10
Q
What are the signs of a severe asthma attack?
A
inability to complete sentences
Pulse >110bpm
Respiratory rate >25/min
PEF 33-50% predicted rate
11
Q
What are the signs of a Life threatening asthma attack?
A
Silent chest Confusion Exhaustion Cyanosis Bradycardia PEF
12
Q
What tests should be done in an acute asthma attack?
A
PEF Sputum culture FBC, U&E, CRP Blood cultures ABG CXR
13
Q
What should be done if PaCO2 is normal or raised?
A
Transfer to high dependency unit or ITU for ventilation as this signified failing respiratory effort
14
Q
What are the differentials of a severe asthma attack?
A
Acute infective exacerbation of COPD Pulmonary oedema Upper respiratory tract obstruction Pulmonary embolus Anaphylaxis
15
Q
What is the treatment of life threatening or severe asthma?
A
Assess severity of attack
Salbutamol 5mg nebuliser
Hydrocortisone/Prednisolone
O2 therapy
16
Q
If life threatening features of asthma are still present after initial treatment what actions should be taken?
A
Inform ICU and seniors
Salbutalmol nebulizers every 15mins
Add ipratropium 0.5mg to nebulizers
Give single dose of magnesium sulfate
17
Q
What sort of drug is salbutamol?
A
beta2 agonist
18
Q
What is the standard dose inhaled steroid added to an asthmatics treatment course if they need to use their Beta2 agonist inhaler more than once daily?
A
Beclametasone
19
Q
Why should patients rinse their mouth adter corticosteroid inhalation?
A
To avoid oral candiasis
20
Q
How is COPD characterized?
A
By airflow obstruction that is not fully reversible
21
Q
What is FEV1 and FVC?
A
FEV1: forced expiratory volume in 1 second
FVC: forced vital capacity
22
Q
How can we define airflow obstruction?
A
FEV1/FVC:
23
Q
How is chronic bronchitis defined?
A
Clinically as cough, sputum production on most days for 3 months of 2 successive years. Symptoms improve if they stop smoking
24
Q
How is emphysema defined?
A
Histologically as enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls
25
Signs of pink puffers?
increased alveolar ventilation
normal Pa02 and normal/low PaC02
Breathless but not cyanosed
May progress to type 2 respiratory failure
26
Signs of blue bloaters?
reduced alveolar ventilation
low PaC02 and high PaC02
Cyanosed but not breathless
May develop cor pulmonale
27
Why should supplementary oxygen be given with care to blue bloaters?
Their respiratory centres are relatively insensitive to C02 and they rely on hypoxic drive to maintain respiratory effort
28
Symptoms of COPD?
Cough
Sputum
Dyspnoea
Wheeze
29
Signs of COPD?
```
Tachypnoea
use of accessory muscles
hyperinflation
Decreased cricosternal Distance
Decreased expansion
Hyperresonant percussion
Quiet breath sounds
Wheeze
Cyanosis
Cor pulmonale
```
30
How can we distinguish COPD form asthma
Asthma is reversible, COPD is not
31
What are the complications of COPD?
```
Acute exacerbations with/without infection
Polycythaemia
Respiratory failure
Cor pulmonale
Pneumothorax
Lung carcinoma
```
32
What are bullae?
Fluid filled sacs or lesions (latin for bubble)
33
What investigations are there for COPD?
```
FBC (increased PVC)
CXR
ECG
ABG
Lung function (spirometry)
```
34
What is FEV1 is shown in very severe COPD
FEV1
35
Non pharmaceutical treatment for COPD?
Smoking cessation
Diet advice (supplements may help)
Encourage exercise
36
Pharmaceutical treatment for mild/moderate COPD
Inhaled long acting antimuscarinic/ Beta agonist
37
Pharmaceutical treatment for severe COPD?
Combination of long acting beta2 agonists and corticosteroids or tiotropium (anticholinergic bronchodilator)
38
What is LOTT
Long term O2 therapy
39
What is hypercapnia?
Abnormally elevated C02
40
What is the management of acute COPD?
Nebulized bronchodilators (salbutamol and ipratropium)
Controlled 02 therapy
Steroids (IV hydrocortisone and oral prednisolone)
Antibiotics (if evidence of infection amoxicillin 500mg)
41
What is a pneumothorax?
A collection of air in the pleural cavity resulting in collapse of the lung on the affected side
42
Causes of pneumothorax?
```
Spontaneous (especially in young tall thin men) due to rupture of a subpleural bulla
Chronic lung diseases
Infection
Traumatic (including iatrogenic)
Carcinoma
Connective tissue disorders
```
43
Symptoms of pneumothorax
Can be asymptomatic (in fit young people with small pneumothorax)
Sudden onset dyspnoea
Pleuritic chest pain
Sudden deterioration of asthma or COPD
44
Signs of pneumothorax
Reduced expansion
Hyper resonance
Diminished breath sounds on the affected side
Tachycardia
With a tension pneumothorax the trachea will be deviated away and the patient will be very unwell
45
When should a CXR not be performed?
A CXR should not be performed if a tension pneumothorax is suspected as it will delay immediate necessary treatment
46
Investigations for pneumothorax
CXR
| Ultrasound (supine trauma patients)
47
What occurs in a tension pneumothorax?
Air drawn into the pleural space with each inspiration has no route of escape during expiration. The mediastinum is pushed over into the contralateral hemithorax, kinking and compressing the great veins
48
Signs of tension pneumothorax
```
Respiratory distress
Tachycardia
Hypotension
Distended neck veins
Deviated trachea
Reduced air entry/sounds on affected side
```
49
Treatment of tension pneumothorax?
Insertion of large bore needle with syringe into second intercostal space midclavicular line
Following this insert chest drain
50
In a primary pneumothorax when should aspiration be attempted?
SOB and/or rim of air >2cm on chest Xray
51
What is the management criteria for chest drain or aspiration in a secondary pneumothorax?
If SOB and age >50 and rim of air >2cm on CXR chest drain. If not aspiration should still occur
52
What is pneumonia?
An acute lower respiratory tract illness associated with fever, symptoms and signs in the chest and abnormalities on the CXR
53
What are the three most common classifications of pneumonia?
Community acquired
Hospital acquired
Aspiration
54
What are the most common microbes to cause CAP?
Streptococcus pneumonia
Mycoplasma pneumonia
Haemophilus influenzae
55
How often do mixed pathogens occur in CAP?
25% of the time
56
How can we define a hospital acquired pneumonia?
Pneumonia occurring >48 hours after hospital admission
57
What are the risk factors for aspiration pneumonia?
```
Stroke
Myasthenia
bulbar palsies
Reduced consciousness
Oesophageal disease
Poor dental hygeine
```
58
Symptoms of pneumonia?
```
Fever
Rigor
Malaise
Anorexia
Dyspnoea
Cough
Purulent sputum
Haemoptysis
Pleuritic pain
```
59
What are the sings of pneumonia?
```
Pyrexia
Cyanosis
Confusion
Tachypnoea
Tachycardia
Hypotension
Signs of consolidation
Pleural rub
```
60
What are the signs of consolidation?
Diminished expansion
Dull percussion note
Increased tactile vocal fremitus/resonance
Bronchial breathing
61
For what three reasons do we test pneumonia?
To establish a diagnosis
To assess severity
To identify responsible pathogens
62
How do we assess pneumonia severity?
CURB 65
63
What does CURB 65 stand for?
Confusion (amts 7mmol/L)
Respiratory rate (>30/min)
BP (65)
64
Management for Pneumonia?
```
Antibiotics
Oxygen
IV fluids
Analgesia
Follow up
```
65
What are the possible complications of pneumonia?
```
Pleural effusion
Empyema
Lung abscess
Respiratory failure
Septicaemia
Brain abscess
Pericarditis
Myocarditis
Cholestatic jaundice
```
66
Which form of pneumonia tends to occur in epidemics every 4 years?
Mycoplasma pneumonia
67
Which form of pneumonia colonises water tanks?
Legionella pneumophilia
68
What are the ABG signs in type 1 respiratory failure?
Pa02
69
What are the ABG signs in type 2 respiratory failure?
Pa02 6.5kPa
70
What is empyema?
Pus in the pleural space
71
What are the environmental risk factors for carcinoma of the bronchus?
```
Smoking
Asbestos
Chromium
arsenic
iron oxides
radioation
```
72
What are the two classifications of primary bronchial cancers?
15% SCLCs (small cell lung cancer)
85% NSCLC (non-small cell carcinoma)
73
What are the symptoms of lung cancer?
```
Cough
Haemoptysis
Dyspnoea
Chest pain
Recurrent/slowly resolving pneumonia
Lethargy
Anorexia
Weight loss
```
74
What are the signs of lung cancer?
```
Cachexia
Anaemia
Clubbing
HPOA
Supraclavicular/axillary nodes
Chest signs
Metasrases
```
75
What are the chest signs in lung cancer?
Sometimes none
Consoldation
Collapse
Pleural effusion
76
Signs of metastases?
```
Bone tenderness
Hepatomegaly
Confusion
Fits
Focal CNS signs
Proximal myopathy
Peripheral neuropathy
```
77
Non-environmental risk factors for lung cancer?
Increased age
COPD
History of cancer
78
Local complications of lung cancer?
```
Recurrent laryngeal palsy
Phrenic nerve palsy
Horners syndrome
Pancoasts syndrome
SVC obstruction
Pericarditis
AF
Rib erosion
```
79
What is pancoasts syndrome?
Classically caused by an apical malignant neoplasm of the lung resulting in Horners syndrome, ipsilateral reflex sympathetic dystrophy and shoulder and arm pain that leads to wasting of the hand muslces and paraesthesiae in the medial side of the arm
80
What is HPOA?
hypertrophic pulmonary oseoarthropathy
81
Tests for lung cancer?
```
Cytology
CXR
Fine needle aspiration/biopsy
CT
Bronchoscopy
```
82
Treatment for non-small cell tumours?
Depending on severity:
Excision
Curative radiotherapy
Chemotherapy with/without radiotherapy
83
Treatment for small cell tumours?
These are nearly always disseminated at presentation, they may respond to chemotherapy but invariably relapse
84
What types of medication are used for palliation in lung cancer?
```
Analgesia
Steroids
Antiemetics
Cough linctus (codeine)
Bronchodilators
Antidepressants
```
85
What is the prognosis of non small cell lung carcinoma?
50% 2yr survival without spread 10% with spread
86
What is the prognosis of small cell lung carcinoma?
Median survival is 3 months if untreated
| 1-1.5 years if treated.
87
What is pleural effusion?
Fluid in the pleural space
88
How are pleural effusions caregorised?
By their protein concentration into transudates (35g/L)
89
What is blood in the plurals pace called?
haemothorax
90
What is pus in the pleural space called?
empyema
91
What is chylothorax?
chyle (lymoh with fat) in the pleural space
92
What are the common medical causes of pleural transudates?
```
Heart failure
Cirrhosis
Hypoalbuminaemia
Peritoneal dialysis
Hypothyroidism
```
93
What are transudates caused by?
Disturbances of hydrostatic or colloid osmotic pressure
94
What are the common medical causes of pleural exudates?
```
Pneumonia
Malignancy
Pulmonary infarction
TB
SLE
```
95
What are the symptoms of pleural effusion?
Normally asymptommatic
Dyspnoea
Pleuritic chest pain
96
Signs of pleural effusion?
```
On the side of expansion:
Decreased expansion
Stony dull percussion note
Diminished breath sounds
Tracheal deviation (with large effusions)
```
97
Tests for pleural effusion?
CXR
Ultrasound
Diagnostic aspiration
Pleural biopsy
98
Management for pleural effusion?
Management of the underlying cause
Drainage
Pleurodesis
Surgery (for persistent collections and increasing pleural thickness)
99
What is pleurodesis?
This is injection of a sclerosant to cause adhesion of the visceral and parietal pleura. (tetracycline, sterile talc, bleomycin)
100
If pleural fluid is clear what does that indicate?
Transudate
101
What are the causes of bloody pleural fluid?
malignancy
PE with infarction
Trauma
Post cardiac injury syndrome
102
When should aspiration of a pleural be avoided?
If a transudate is confirmed aspiration should be avoided
103
What does turbid yellow appearing e indicate?
Empyema, parapnuemonic effusion
104
What does a high pleural fluid Lymphocyte count indicate?
```
Malignancy
TB
RA
SLE
Sarcoidosis
```
105
Risk factors for PE?
```
Recent surgery
Thrombophilia
Leg fracture
Prolonged bed rest/reduced mobility
Malignancy
Pregnancy
Previous PE
```
106
Symptoms of PE?
```
Vary depending on number, size and distribution of emboli:
acute breathlessness
pleuritic chest pain
haemoptysis
Dizziness
syncope
```
107
Signs of PE?
```
Pyrexia
Cyanosis
Tachypnoea
Tachycardia
Hypotension
Raised JVP
PLeural rub
Pleural effusion
```
108
Tests for PE?
```
FBC, U&E, D-dimers
CXR (mainly exclusive)
ECG
ABG
Echocardiography
CTPA (CT pulmonary angiography)
```
109
Why should D-dimers only be performed in people without a high probability of a PE?
A negative test is used to exclude a PE. However a positive test does not prove a diagnosis of a PE
110
What is the recommended first line imaging for a PE?
CTPA (CT pulmonary angiography)
111
When should we always suspect a PE?
In a patient with sudden collapse 1-2 weeks after surgery
112
What are the casues for a D-dimer increase?
```
Thrombosis
inflammation
post op
infection
malignancy
```
113
What is acute the management of a large PE?
```
Oxygen
Morphine (if in pain/distressed)
Immediate thrombolysis (if critically ill) 50mg alteplase
IV heparin
Maintain BP (fluids)
Warfarin regimen
```
114
What are the goals of pneumonia testing?
To establish a diagnosis
Identify pathogens
Assess severity
115
How is pneumonia severity assessed?
CURB 65
116
What does CURB 65 stand for?
Confusion (7mmol/L)
Respiratory rate (>30mins)
Bp (
