Respiratory

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Author:
mewinstanley@googlemail.com
ID:
261012
Filename:
Respiratory
Updated:
2014-02-09 12:34:50
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respiratory
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Description:
Lungs for finals
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  1. Define COPD
    • Airflow obstruction that is not fully revesible
    • includes Chronic bronchitis + Emphysema
  2. Give 3 symptoms + 2 signs of COPD?
    • SoB
    • Wheeze
    • Cough
    • Fatigue

    O/E

    • cyanotic
    • cachectic
    • barrel chested
    • use of accessory muscles
  3. What would suggest a severe exacerbation of COPD?
    • dehydration
    • RR>25
    • Pulse >110
    • Inability to talk in sentences
  4. Life threatening COPD?
    • Confused
    • Drowsy
    • ^^^^^[H+]
  5. Which nebs would you use for COPD and how do they work?
    Salbutamol -> Short acting B2 agonist

    Ipratropium -> antimuscarinic, decreases airway tone A/E; dry mouth, Acute angle closure glaucoma

    Theophylline -> Inhibit PDE4; bronchodilate, ^^mucocilliary clearance A/E; low therapeutic index
  6. Define asthma?
    Reversible airway narrowing [FEV change of >15%] with diurnal variation

    Age <5yo = viral wheeze
  7. What are the features of a severe asthma attack?
    • PEFR <50%
    • RR>25
    • Pulse >110
    • Inability to speak in sentences
  8. What are the features of life threatening asthma?
    • PEFR <33%
    • PO2 <8
    • PCO2 N/^^
  9. What is the aim of asthma Mx?
    Control of symptoms;

    • no daytime symptoms
    • no nighttime awakening
    • no need for rescue medication
    • no exacerbations
    • no limitations on activity
    • minimal side effects
  10. Outline the stepwise Mx of Asthma in adults
    1 - SABA [Salbutamol]

    2 - SABA + steroid

    3 - SABA + STEROID +LABA

    4 - increase steroid or trial leukotriene receptor antagonist

    5 -Daily PO steroid
  11. What are the different types of Pneumonia?
    Lobar -> spread via inflammatory oedema red hepatisation -> grey hepatisation -> resolution

    Bronchopneumonia -> lower lobes, centered on bronchioles -> patchy consolidation
  12. Name 3 typical causative organisms for Pneumonia?
    • Strep Pneumoniae
    • H. Influenzae
    • Pseudomonas Aeruginosa in CF
  13. Atypical orgs?
    • Chlamydia Psitacci
    • Chalmydia Pneumoniae
    • Coxiella burnetti
    • Mycoplasma Pneumonia
    • Legionella Pneumophila
  14. Assess severity of Pneumonia?
    CURB65

    • Confusion
    • Urea >7
    • RR >30
    • BP -> Sys <90, dia <60
    • >65yo
  15. Define bronchiectasis + give 2 causes;
    Permanent dilation of the bronchi + bronchioles usually assoc with chronic infection

    Congenital; CF, youngs syndrome

    Acquired; Infection [measles, pertussis, pneumonia, MTB] Tumour, RA
  16. What are the 4 types of Lung malignancy?
    Adenocarcinoma -> most common, peripheral incidetaloma

    Squamous CC -> localised central mass, cavitating lesions [retention pneumonia + collapse] -> Smokers

    Small cell carcinoma -> most aggressive -> late Pc, early mets -> smokers

    Large Cell -> Dx of exclusion -> central poorly differentiated tumour
  17. What are the CF indicating LungCa?
    • Cough
    • Haemoptysis
    • Chest pain
    • Effects of Mets [SIADH, patho #]
    • retention Pneumonia
    • Clubbing
    • weight loss
    • anorexia
  18. Give 5 causes of clubbing?
    Lungs

    • Lung Ca
    • Suppurative lung disease [abscess, empyema, CF]
    • TB
    • Mesothelioma

    Heart

    • Hypoxic congenital conditions
    • cyanotic heart disease
    • subacute infective endocarditis
    • atrial myxoma
  19. Give 2 causes for pneumothorax?
    • Traumatic
    • Tall thin males
    • Iatrogenic
    • Marfans
    • Emphysema
  20. What are the symptoms + 3 signs of PTx?
    Symp

    • Acute onset pleuritic CP
    • SoB

    Signs

    • Tachpnoea, tachycardia
    • ipsilateral decreased chest expansion
    • decreased breath sounds
    • hyper-resonant to percussion
  21. Mx?
    • <20% -> resolve spontaneously
    • Chest drain 5th intercostal mid axillary line, above rib approach
    • Tension -> venflon, 2nd intercostal
  22. Features of Tension PTx?
    • Respiratory distress
    • ^^JVP
    • Tracheal deviation
  23. Give 4 CF of PTE?
    • SoB
    • Tachypnoea
    • Pleuritic CP
    • Tachycardic
    • cough
    • haemoptysis
    • leg pain
  24. RF for PTE?
    • Age >65
    • Surgery/# within 1 month
    • PMH - DVT/PTE
    • Malignancy
    • Haemoptysis
  25. Mx of PTE?
    ABCDE

    Anticoagulate -> LMWH [Dalteparin] then warfarinise [until therapeutic INR]

    Thrombolysis if peri-arrest/PEA/RVOT obstruction
  26. Define transudative pleural effusion and give 2 causes?
    alteration of systemic factors the produce pleural fluid. Protein <25g/dL

    • CHF
    • Cirrhosis
    • Nephrotic Syndrome
    • PTE
  27. Define Exudative Pleural effusion and give 2 causes?
    Increase in permeability of pulmonary capillaries/Poor lymphatic drainage

    • Infection -> parapneumonic, empyema
    • Malignancy -> Lung Ca, Lymphoma, Met
    • Inflammatory -> RA/SLE
    • Trauma -> Chylothorax/Haemothorax
  28. What are the CXR features of pleural effusion?
    Only if >200ml [PA]

    • dense opacification
    • loss of costophrenic angle
    • loss of costomediastinal margin
  29. How would you Ix a PE?
    Microscopy, C+S, Grams stain

    Cytology -> Malignancy

    Analysis; Protein + LDH
  30. For Sarcoidosis give;
    - 2CF
    - 2 Ix
    Idiopathic multi-system non-caseating granulomas

    CF - arythmia, ant uveitis, erythema nodosum [on shins] arthralgia

    Ix - CXR [bulky hilum], serum ACE, Biopsy
  31. Outline the genetic features of CF?
    • most common ingerited of caucasian
    • AR inherit of Mt CFTR gene - faulty chloride ion channel
  32. What are the CF of Cystic fibrosis?
    Paeds - late maecomnuim, frequent chest infections, failure to thrive

    clubbing

    Bronchiectasis - S. Aureus, Pseudomonas aureginosa

    males = infertile
  33. Define Idiopathic pulmonary fibrosis?
    Pregressive scarring of lung parenchyma that is ultimateley fatal

    HR-CT shows preated episodes of focal damage to alveolar epithel consistant w autoimmune process
  34. CF of pulmonary fibrosis?
    • >50
    • insiduous progressive dyspnoea
    • non-productive cough
    • SoB
    • Clubing
    • Bi-basal fine insp crackles

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