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Respiratory System Flashcards

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1
Q

What is coughing up blood called?

A

Haemoptysis

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2
Q

What are some presenting symptoms of respiratory disease?

A
  • Cough
  • Sputum
  • Haemoptysis
  • Breathlessness
  • Wheeze
  • Chest pain - SOCRATES
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3
Q

Questions to be asked about a cough?

A
  • When? (Time of day)
  • Type? (chesty vs dry)
  • Triggers? (e.g. animal hair)
  • Positional?
  • Associated features (sputum/haemoptysis, wheeze)
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4
Q

What must be asked to patients presenting with respiratory disease?

A

If they have an active lung disease (COPD, asthma, lung cancer etc)

Have the symptoms changed?

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5
Q

What are the common symptoms for chronic respiratory disease?

A

Exercise intolerance
Cough
Sputum

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6
Q

What is pleurisy?

A

Inflammation of the tissue between the lungs and ribcage (pleura)

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7
Q

What are the common symptoms of pleurisy?

A
  • A sharp chest pain when you breathe (sometimes felt in shoulder)
  • The pain may be worse when you cough, sneeze or move around or on inspiration
  • It may be relieved by taking shallow breaths.
  • Other symptoms include shortness of breath and a dry cough.
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8
Q

What type of respiratory diseases does a fever typically present?

A

Infective cases e.g. pneumonia, TB or empyema

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9
Q

What symptoms may indicate a malignancy or chronic infection instead of acute?

A
  • Cough over 3 weeks
  • Malaise/fatigue
  • Weight loss
  • Fevers
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10
Q

When patient presents with bleeding of any type (e.g. coughing, vomiting, urine), what must be asked?

A

Are you on:

  • Anticoagulants or antiplatelets?
  • Aspirin?

Action may need to be taken to reverse the effect of these

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11
Q

What type of medication is Salbutamol?

A

B2 adrenoceptor agonist

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12
Q

Is salbutamol long or short acting?

A

Short

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13
Q

What are short-acting bronchodilators typically used for?

A

relief of bronchoconstriction

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14
Q

What are long-acting bronchodilators typically used for?

A

Predominantly used for prevention

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15
Q

How do B2 agonists work?

A

Bind to B2 receptors in the lungs and mimic catecholamines, stimulating cAMP –> causes smooth muscle relaxation and systemic vasodilation

BRONCHODILATOR - opens airways

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16
Q

What is Salbutamol / B2 agonists used to treat?

A

Used to relieve symptoms of asthma and chronic obstructive pulmonary disease (COPD)

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17
Q

What are the potential side effects of Salbutamol?

A
  • Arrhythmias
  • Tremor
  • Palpitations
  • Hypokalaemia (so may be used to treat hyperkalaemia)
  • Dizziness
  • Headache
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18
Q

What causes side effects of Salbutamol on the heart?

A

Works on B1 receptors on heart which typically bind noradrenaline (released from sympathetic adrenergic nerves) and adrenaline.

B-agonists mimic this, stimulating formation of cAMP but this enhances myocyte contraction

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19
Q

What is a pack year defined as?

A

A pack year is defined as 20 cigarettes smoked each day for 1 year.

The pack year history is calculated by the number of packs (of 20 cigarettes) a patient has smoked each day multiplied by the number of years they have smoked this for.

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20
Q

What are potential childhood causes of bronchiectasis?

A

Lung infections such as pneumonia, whooping cough or TB that damages the bronchi

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21
Q

What are the commonest genetic causes of bronchiectasis?

A

Cystic fibrosis and primary ciliary dyskinesia (formerly Kartagener’s syndrome)

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22
Q

During infective episodes during bronchiectasis, how does the sputum change?

A

The sputum usually increases in volume and often changes colour e.g from clear to green or brown

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23
Q

When can finger clubbing present?

Study These Flashcards
A

Lung cancer or chronic infections (TB, bronchiectasis, endocarditis)

24
Q

What are the stages of finger clubbing?

Study These Flashcards
A

1 - increased sponginess of nailbed

2 - loss of hyponychial angle

3 - increased curvature of nail

4 - drumstick appearance of nail

25
What common antibiotic should the junior doctor prescribe for his community acquired pneumonia while waiting for the blood and pleural fluid cultures?
Co-Amoxiclav
26
What is Co-Amoxiclav? What is it used to treat?
A mixed antibiotic of Amoxicillin and Clavulanic acid. It is commonly used for treating Respiratory infections and used in combination with Clarithromycin for Community Acquired Pneumonia requiring hospital admission
27
What is Flucloxacillin used to treat?
Skin infections
28
What is Metronidazole used to treat?
Anaerobic bacteria so often for gastrointestinal or mouth infections.
29
What is Trimethoprim used to treat?
Urinary tract infections
30
What is Grade 1 on the MRC dyspnoea scale?
Not troubled by breathlessness except on strenuous exercise
31
What is Grade 2 on the MRC dyspnoea scale?
Short of. breath when hurrying or walking up a slight hill
32
What is Grade 3 on the MRC dyspnoea scale?
Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace
33
What is Grade 4 on the MRC dyspnoea scale?
Stops for breath after walking about 100 metres or after a few minutes on level ground
34
What is Grade 5 on the MRC dyspnoea scale?
Too breathless to leave the house, or breathless when dressing or undressing
35
What are the common CVS symptoms associated with breathlessness?
- Chest pain - Lie flat, pillow use (orthopnoea) - Breathless at night (may be PND) - Palpitations - Ankle swelling (peripheral oedema) - Cold/blue hands/feet - Pain in calves on walking (claudication)
36
What are the common respiratory symptoms associated with breathlessness?
- Cough (time period crucial) - Sputum, colour, volume - Any blood in sputum? (haemoptysis) - Shortness of breath - Wheeze - Fever, night sweats - Recent CXR
37
What is an exacerbation of COPD?
A sustained worsening of the person's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset.
38
What are commonly reported symptoms of an exacerbation of COPD?
Worsening breathlessness, cough, increased sputum production and change in sputum colour
39
Difference in COPD and asthma: 1. Smoker? 2. Symptoms under age of 35? 3. Chronic productive cough? 4. Breathlessness? 5. Night time waking with breathlessness and/or wheeze? 6. Significant diurnal or day-to-day variability of symptoms
COPD: 1. Nearly all smokers 2. Rare 3. Common 4. Persistent and progressive 5. Uncommon 6. Uncommon Asthma: 1. Possibly smokers 2. Common 3. Uncommon 4. Variable 5. Common 6. Common
40
What is asterixis?
A neurological disorder that causes loss of motor control of certain areas of the body Asterixis is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. This motor disorder is characterised by an inability to maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist.
41
You find a flapping tremor (asterixis) when you examine his hands. What is this likely to be a sign of in this gentleman?
Hypercapnoea
42
What is flapping tremor a sign of?
Hypercapnoea and hepatic encephalitis
43
What are typical percussion sounds in pneumonia?
Dull percussion - indicate that there is fluid in a lung or collapse of part of a lung Crackles - made by movement of fluid in the tiny air sacs of the lung Bronchial breath sounds - tubular, hollow sounds which are heard when auscultating over the large airways
44
If a patient has presented with breathlessness, what should you be actively looking for when looking at their hands?
Tar staining, clubbing, koilonychia, flapping tremor Pulse
45
If a patient has presented with breathlessness, what should you be actively looking for when looking at their face?
Anaemia, cyanosis, oral candidiasis (steroid inhalers)
46
If a patient has presented with breathlessness, what should you be actively looking for when looking at their neck?
Nodes, JVP (heart failure), tracheal position (is it deviated?)
47
If a patient has presented with breathlessness, what should you be actively looking for when looking at their chest?
Respiratory rate, scars, deformity Palpate, expansion, percuss, auscultate
48
If a patient has presented with breathlessness, what should you be actively looking for when looking at their legs?
Oedema, signs of DVT
49
Expected findings of percussion in: 1. Pneumonia 2. Exacerbation of COPD 3. Pleural effusion
1. Dull 2. Resonant 3. Stony dull
50
Expected findings of auscultation in: 1. Pneumonia 2. Exacerbation of COPD 3. Pleural effusion
1. Bronchial breath sounds, crackles 2. Vesicular BS, added wheeze 3. Reduced breath sounds
51
Expected findings of tactile vocal fremitus in: 1. Pneumonia 2. Exacerbation of COPD 3. Pleural effusion
1. Increased 2. Normal 3. Reduced
52
Expected findings of vocal resonance in: 1. Pneumonia 2. Exacerbation of COPD 3. Pleural effusion
1. Increased 2. Normal 3. Reduced
53
What causes a wheeze?
Airway obstruction: - Infection; viral, bacteria - Cardiac wheeze - Bronchiectasis; mucus plugging - Anaphylaxis
54
What is acute management for breathlessness and wheeze?
Inhaled B2 agonist + steroid: - Salbutamol - Prednisolone
55
What is acute management for cough and sputum?
Antibiotics (possible infection) according to guidelines - Doxycycline - Amoxicillin
56
What is acute management for ankle swelling?
Diuretics: | - Loop - Furosemide, Bumetanide
57
Longer term management for breathlessness/COPD?
- Breathing exercises - Relaxation - Opiates - Oxygen - Advanced care planning (preferred place of care/death, levels of care, hospital admissions)

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