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Respiratory Disease Flashcards

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1
Q

What does spirometry test?

A

Forced expiratory volume in 1 second (FEV1)
Forced vital capacity
FEV1/FVC

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2
Q

How can you diagnose obstructive lung disease with spirometry?

A

FEV1/FVC < 0.7

as FEV1 is reduced and FVC is less reduced

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3
Q

How can you diagnose restrictive lung disease with spirometry?

A

FEV1/FVC > 0.7

FEV1 and FVC are both reduced equally

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4
Q

What mnemonic is used to analyse a chest X-ray?

A

DR ABCDE

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5
Q

What are the symptoms of COPD?

A

Cough (with white phlegm), worse in the morning SoB

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6
Q

What are the signs of COPD?

A

Barrel chest, hyper-resonance on percussion, quiet breath sounds over bullae, wheeze, coarse crackles

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7
Q

What are risks factors for COPD?

A

Smoking, advanced age, genetics

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8
Q

What spirometry would you expect in a COPD patient?

A

FEV1/FVC < 0.7

Predicted FEV1 lowers are COPD gets worse

Also ABG, sputum, CT

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9
Q

What is the pharmacological management of COPD?

A

Step 1: SABA or SAMA
Step 2: LABA + LAMA or LABA + ICS
Step 3: LABA + LAMA + ICS
Step 4. inhaled corticosteroids

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10
Q

What is a common SABA?

A

Salbutamol

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11
Q

What is a common SAMA?

A

Ipratropium bromide

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12
Q

What are two common LABA?

A

Salmeterol

Formoterol

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13
Q

What is a common LAMA?

A

Tiotropium

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14
Q

What is a common ICS?

A

Beclomethasone

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15
Q

What are the most common side effects of COPD medication?

A

Fine tremor, anxiety, headache, dry mouth

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16
Q

What O2 do you use for hypoxic patients?

A

High flow O2

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17
Q

What saturation do you aim for for COPD patients?

A

88-92%

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18
Q

What are most common causes of acute COPD exacerbations?

A

Bacterial: haemophilus influenzae, streptococcus pneumoniae

Viral (30%)

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19
Q

How does a patient with an acute COPD exacerbation present?

A

SoB, cough, wheeze, decreased exercise tolerance

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20
Q

How do you treat an acute COPD exacerbation?

A
  1. Salbutamol + ipratropium
  2. Steroids - IV hydrocortisone and prednisolone
  3. Abx
  4. CHest physio to help mucous clearance
  5. Consider IV aminophylline if patient isn’t responding
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21
Q

What are symptoms of asthma?

A

Cough, dyspnoea, wheeze, chest tightness

Key to know: symptoms frequency, recognisable triggers, how many days of work/school are missed; compliance

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22
Q

What are signs of asthma?

A

Expiratory wheeze on auscultation of the chest, reduced PEFR

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23
Q

How is asthma diagnosed?

A

FEV1/FVC < 0.7

Reversible during spirometry

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24
Q

What is the pharmacological management ladder for asthma?

A
  1. SABA prn
  2. SABA prn + low dose ICS
  3. SABA prn + low dose ICS + LABA
  4. SABA prn + medium dose ICS + LABA
  5. SABA prn + high dose ICS + LABA
  6. SABA prn + high dose ICS + LABA + corticosteroid
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25
How would you quantify the severity of an acute exacerbation of asthma?
Moderate: PEFR 50-70%, normal speech, RR<25, HR<110 Severe: PEFR 30-50%, can't complete sentences, RR>25, HR>110 Life-threatening: PEFR < 33%, silent chest, cyanosis, feeble respiratory effort, dysrhythmia, bradycardia, hypotension
26
How would you treat an acute exacerbation of asthma?
Think OH SHIT ME Oxygen, salbutamol, Hydrocortisone IV, Ipratropium bromide, theophylline, magnesium sulfate, escalate Monitor saturations, ABG, watch potassium
27
How may a patient with a resp infection present?
Cough, sputum, dyspnoea, So, fever or chills, pleuritic pain, general chest pain, confusion
28
What is CURB65 used for?
Assessing severity of resp infection
29
What does CURB65 stand for?
``` Confusion Urea > 7 mmol/L RR > 30/min BP; systolic < 90, diastolic <60 65 years old or older ``` 0 - 1 home-based care 2 - admit 3 - ICU
30
Common cause of pneumonia?
Haemophilus influenza
31
What are risk factors for hospital-acquired infections?
``` Poor hygiene Head of bed positioned at 30 degrees Mechanical ventilation Neurological deficit Unsafe swallowing ```
32
What antibiotics would you give for pneumonia?
Typical - amoxicillin Atypical - clarithromycin IECOPD - amox/doxy or clarith
33
What is the typical TB infection presentation?
Chronic cough, pyrexia, anorexia, night sweats, pleuritic chest pain, general malaise
34
What are risk factors for TB infections?
Exposure, birth in endemic country, immunosuppression, overcrowding
35
How would you treat TB infection?
RIPE Rifampin Isoniazid Pyrazinamide Ethambutol
36
What are the symptoms for respiratory malignancy?
Cough, haemoptysis, dyspnoea, chest pain, anorexia, fatigue
37
When would you consider malignancy?
Patient with a history of smoking and chest signs (SVC obstruction, change in voice, Horner's syndrome)
38
What is Horner's syndrome?
Ptosis, miosis, anhidrosis
39
What are initial investigations for malignancy?
``` Bloods CXR Cytology CT Bronchoscopy PET ```
40
What are key facts for small cell lung cancer?
Usually central, almost always smokers, metastasises early, the worst prognosis 20% of all lung cancers
41
What is small cell lung cancer often associated with?
Ectopic hormone secretion ADH --> hyponatraemia ACTH --> Cushing's
42
What are key facts for squamous cell lung cancer?
Typically central Associated with PTH secretion and hypercalcemia Strongly associated with clubbing
43
What are key facts for adenocarcinoma?
Typically peripheral Most common in noon-smokers Most common in women
44
What are key facts for large cell lung cancer?
Peripheral and very large Anaplastic, poorly differentiated tumours with poor prognosis May secrete beta-hCG
45
What is mesothelioma caused by?
Exposure to asbestos
46
What is the prognosis of mesothelioma?
50% 1 year survival | 5% 5 year survival
47
What is most common after asbestos exposure?
Pleural plaques
48
How do you manage lung cancer?
Chemotherapy and/or radiotherapy
49
What is the prognosis for non-small cell lung cancer?
50% 2 year survival without spread | 10% with spread
50
What is the prognosis for small cell lung cancer?
Median survival 3 months if untreated | 1-1.5 years if treated
51
What is type 1 respiratory failure?
Hypoxaemia without hypercapnia: PaO2 < 8kPA
52
What is type 2 respiratory failure?
Hypoxaemia with hypercapnia: PaCO2 > 6.5kPa and PaO2 < 8kPA
53
What are the main causes of type 1 respiratory failure?
Pneumonia Pulmonary oedema PE ARDS
54
What are the main causes of type 2 respiratory failure?
CNS trauma Pulmonary fibrosis NMD
55
What often causes pulmonary embolisms?
Often from venous thromboembolism from leg or pelvis
56
What are risk factors for pulmonary embolism?
Recent surgery, thrombophilia, immobility, malignancy, pregnancy
57
What are symptoms of pulmonary embolism?
Pleuritic chest pain, haemoptysis, dyspnoea
58
What are signs for pulmonary embolism?
Tachcardia, tachypnoea, hypotension, pyrexia, raised JVP
59
What is the scoring system for diagnosing pulmonary embolism?
Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins): 3 points An alternative diagnosis is less likely than PE: 3 points HR > 100bpm: 1.5 points Immobilisation for more than 3 days or surgery in previous 4 weeks: 1.5 points Haemoptysis: 1 point Malignancy: 1 point PE likey with more than 4 points
60
How would you treat a pulmonary embolism?
Anticoagulants and warfarin | Heparin
61
How could you prevent pulmonary embolisms?
Give heparin to immobile patients Stop HRT/the pill pre-operatively If FHx of VTE/PE, consider thrombophilia screening
62
How does a patient with pulmonary oedema present?
Dysnpoea, orthopnoea, pink frothy sputum | Distressed, pale, sweaty, tachycardic, tachypnoea, pulsus aternans, raised JVP, fine crackles, gallop rhythm
63
How would you manage pulmonary oedema?
Daily weights (aim for 0.5kg/day loss) Repeat CXR Furosemide Optimise HF and cardiac medication
64
How would you manage a patient with acute pulmonary oedema?
1. Sit patient upright and place onto high flow oxygen through a NRB 2. IV access and monitoring: ECG (treat arrhythmias), CXR, bloods, ABG and ? Echo 3. Diamorphine 1.25-5mg IV slowly (caution in liver failure and COPD) 4. Furosemide IV 40-80mg slowly (larger dose in renal failure) 5. GTN 2 puffs SL or 2x0.3mg SL tablets if systolic >90 6. Nitrate infusion if systolic >100 (if systolic <100 treat as cardiogenic shock and call ITU) 7. Consider CPAP – get help before initiating (CCO or ITU)
65
How would a patient with a pneumothorax present?
Sudden onset pleuritic pain and shortness of breath
66
What are the signs of pneumothorax?
Reduced expansion, hyper resonance, reduced breath sounds
67
What investigations would you do for a pneumothorax?
CXR | ABG
68
What can be causes of a pneumothorax?
``` Spontaneous - young, tall men Chronic lung disease Infection Trauma Carcinoma Connective tissue disorders ```
69
How would you manage an acute pneumothorax?
Chest drain in safe triangle: | Mid axillary line + 5th intercostal space
70
How would you manage a primary pneumothorax?
If <2cm rim and patient not SoB, then consider discharge If rim>2cm or chest drain, then chest drain Patient advice: no smoking, permanently avoid diving
71
How would you manage a secondary pneumothorax?
If patient >50yo, rim>2cm, then chest drain Otherwise, attempt aspiration Admit patients for a minimum of 24 hours
72
What are the symptoms of pleural effusion?
SoB, non-productive cough, chest pain
73
What are the signs of a pleural effusion?
Dullness to percussion, reduced breath sounds, reduced expansion
74
What are the two classifications of pleural effusions?
Transudate Exudate
75
What are the characteristics of a transudate?
Low protein, caused by systemic problems Liver cirrhosis and heart failure
76
What are the characteristics of a exudate?
High protein, caused by local problems Infection, malignancy, TB
77
What are Lights criteria for determining exudate vs transudate?
Protein Exudate is more likely if: 1. Pleural fluid protein/serum protein > 0.5 2. Pleural fluid LDH/serum LDH >0.6

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