1
Q
What is pleural effusion?
A
- collection of fluid in the pleural cavity
- can be exudative (high protein) or transudative (low protein)
- causes lung compression
2
Q
What are exudative causes of pleural effusion?
A
- inflammatory: protein leaks out of tissue into pleural space
- lung cancer
- pneumonia
- autoimmune: RA, SLE
- TB
3
Q
What are transudative causes of pleural effusion?
A
- caused by fluid shift into pleural space
- heart, liver or renal failure
- hypoalbuminaemia
- myxoedema
- ascites
4
Q
What are the symptoms of pleural effusion?
A
- breathlessness
- cough
- pain and fever
5
Q
What are the signs of pleural effusion?
A
- reduced chest wall expansion
- quiet breath sounds
- dull percussion
- mediastinal shift away from affected side
6
Q
What investigations are done for pleural effusions and what does it show?
A
- CXR
- blunting of costophrenic angle
- fluid in lung fissures
- meniscus and tracheal/mediastinal deviation
- ultrasound
7
Q
What is the treatment of pleural effusion?
A
- conservative management of cause
- pleural aspiration
- chest drain
8
Q
What are the criteria for pleural infection?
A
- pH <7.2
- glucose < 3.3 mmol/L
- PF LDH > 1000IU/L
- bacterial growth
- macroscopic appearance of pus
9
Q
What is empyema?
A
- infected pleural effusion
- improving pneumonia but new/ongoing fever
10
Q
How is empyema investigated and treated?
A
- aspiration: pus, acidic pH, low glucose, high LDH
- chest drain to remove pus and antibiotics
11
Q
What are the causes of empyema?
A
- community: S. milleri, S. pneumoniae, S. aureus
- Hospital: MRSA, enterococcus
12
Q
What investigations are done for pneumothorax and what do these show?
A
- erect chest X-ray
- area between lung tissue and chest wall with no lung markings
- line demarcating where pneumothorax begins
- CT can detect smaller pneumothorax
13
Q
How is pneumothorax managed?
A
- <2cm rim and no SOB: no treatment, follow up 2-4 weeks
- > 2cm rim/SOB: aspiration and reassessment
14
Q
What are risk factors for pneumothorax?
A
- COPD, asthma, CF, lung cancer
- Marfan’s, RA
- ventilation
- smoking
15
Q
What is pulmonary hypertension?
A
- inc resistance and pressure in pulmonary arteries
- causes strain on RHS of heart
- back pressure in systemic venous system
16
Q
What are the 5 groups of causes of pulmonary hypertension?
A
- primary/connective tissue disease: SLE
- left HF: due to MI, htn
- chronic lung disease: COPD
- pulmonary vascular disease: PE
- misc: e.g. sarcoidosis
17
Q
What is the presentation of pulmonary hypertension?
A
- shortness of breath
- syncope
- tachycardia
- raised JVP
- hepatomegaly
- peripheral oedema
18
Q
What investigations are done for pulmonary hypertension?
A
- ECG change: RV hypertrophy, R axis deviation, RBBB
- CXR: dilated pulmonary arteries, RV hypertrophy
- Echo
19
Q
What is the management of pulmonary hypertension?
A
- IV prostanoids e.g. epoprostenol
- endothelin receptor antagonist e.g. macitentan
- phosphodiesterase-5 inhibitor e.g. sildenafil
20
Q
What is sarcoidosis?
A
- granulomatous inflammatory condition
- nodules of inflammation full of macrophages
21
Q
What is the epidemiology of sarcoidosis?
A
- young adulthood or around age 60
- more frequent in black patients
22
Q
What are the pulmonary manifestations of sarcoidosis?
A
- bilateral hilar lymphadenopathy with pulmonary infiltrates and fibrosis
- dry cough, progressive dyspnoea, chest pain
23
Q
What are the extra pulmonary presentations of sarcoidosis?
A
- uveitis, conjunctivitis
- cirrhosis
- erythema nodosum
- fever, fatigue, weight loss
24
Q
What investigations are done in sarcoidosis?
A
- CXR and high res CT
- raised serum ACE and IL-2 receptor
- hypercalcaemia
25
What is the gold standard diagnosis of sarcoidosis?
- histology from biopsy
- bronchoscopy w USS guided biopsy of mediastinal lymph nodes
- non-caseating granulomas with epithelioid cells
26
What are the differential diagnoses for sarcoidosis?
- TB
- lymphoma
- hypersensitivity pneumonitis
- HIV
27
What is the treatment of sarcoidosis?
- no treatment if mild
- oral steroids and bisphosphonates
- 2nd line: methotrexate/azathioprine
28
What is the visceral and parietal pleura?
- visceral: covers the lungs
- parietal: forms the inner lining of the chest wall
- pleural space is a potential space filled with a small amount of fluid for lubrication
29
What is the purpose of the pleura?
- to allow optimal expansion and contraction of the lungs
- pleural fluid allows gliding without friction of pleura
30
What is pneumothorax?
- collapse of the lung leading to presence of air in the pleural space
31
What is the pathophysiology of pneumothorax?
- air entering due to hole in lung/pleura or chest wall injury
- intrapleural pressure is negative leading to air being sucked in and lung collapse
32
What are the types of pneumothorax?
- primary spontaneous
- secondary spontaneous
- traumatic
- iatrogenic
33
What is primary spontaneous pneumothorax?
- no underlying lung disease
- rupture of apical pleural bleb: air escaping into weakness in pleura
34
What are the risk factors for primary spontaneous pneumothorax?
- tall, thin, males
- smokers
- age 20-40
35
What are the causes of secondary spontaneous pneumothorax
- known lung disease, 60% due to COPD
- infection
- genetic predisposition
- catamenial pneumothorax
36
What are the symptoms of pneumothorax?
- acute/sudden
- breathlessness
- pleuritic chest pain
- cough
37
What are the clinical signs of tension pneumothorax?
- tachypnoea
- hypoxia
- unilateral chest wall expansion
- reduced breath sounds
38
What is tension pneumothorax?
- ONE WAY valve like mechanism causes air to be drawn into chest cavity during inspiration and trapping air in expiration
- displaces mediastinium causing dec CO and can lead to cardioresp arrest
39
What are the examination signs of tension pneumothorax?
- Tracheal deviation away from side of pneumothorax
- Reduced air entry
- Increased resonance to percussion
- Tachycardia
- Hypotension
40
What is the management of tension pneumothorax?
- insert large bore cannula into 2nd intercostal space in mid clavicular line
41
What is haemothorax and how is it managed?
- blood in the pleural cavity with a haemtocrit ratio of > 50%
- management: drainage
42
What is hydropneumothorax and what are the causes?
- air and fluid in the pleural space
- cause: iatrogenic, gas forming organisms, thoracic trauma
43
What is PaO2?
the pressure exerted by oxygen molecules when dissolved in blood plasma
44
What is type 1 respiratory failure?
- Low PaO2 - less than 8.0
- normal or low PaCO2
- normal HCO3
- V/Q mismatch e.g. pneumonia, PE
45
What is type 2 respiratory failure?
- Low PaO2
- High PaCO2
- normal HCO3 (acute) or high if chronic
- airway obstruction (COPD) or alveolar hypoventilation
46
What are the causes of a raised alveolar-arterial gradient?
1. V/Q mismatch
2. defects in diffusion
3. shunt (R to L)
47
What is arterial/alveolar gradient?
- measure of the efficiency of gas transfer
- normal range: 1-2kPa or 1-3kPa in elderly
48
What are the responses to hypoxia?
- systemic vasodilation
- pulmonary vasoconstriction
49
What are the functions of the lungs?
- Gas exchange
- Acid-base balance
- Defence
- Hormones
- Heat exchange
50
What is the FEV1/FVC ratio for an obstructive vs restrictive lung disease?
- obstructive: FEV1/FVC <0.7
- restrictive: normal ratio but lowered FVC
51
What is DLCO?
diffusion factor of the lung for carbon monoxide
52
What causes a lowered DLCO?
- thickening of alveolar-capillary membrane
- reduced lung volumes
53
What causes a raised DLCO?
- increased capillary blood vol
- pulmonary haemorrhage
- L to R shunt
54
What is COPD?
- Irreversible, long term deterioration in air flow caused by lung damage
- persistent resp symptoms caused by inflammation
- exacerbations occur triggered by infection
55
What is the aetiology of COPD?
- caused by smoking
- chronic inflammation from exposure to noxious particles or gases
- Alpha 1 antitrypsin deficiency
56
What is bronchitis?
- chronic cough with sputum production
- occurring for at least 3 months in the past 2 consecutive years
57
What is the pathophysiology of bronchitis?
- inc goblet cells
- inc production of mucus causing plugs
- thickening of resp epithelia
- all leading to narrowing of airways
58
What is emphysema?
- causes holes in the lung
- loss of elastic tissue
- destruction of lung parenchyma
59
What are the risk factors for COPD?
- smoking
- air pollution
- occupational exposure (metal/coal dust)
- genetic factors
- biomass fumes (unvented fires)
60
How does COPD present?
- chronic breathlessness
- cough
- sputum
- wheeze
- recurrent resp infections
61
How does COPD affect vasculature?
- hypoxia and vascular injury
- pulmonary artery intima proliferation and thickening
- reduction in transfer of oxygen into the body
- contributes to V/Q mismatch
62
What are the differential diagnoses for COPD?
- heart failure
- PE
- pneumonia
- lung cancer
- asthma
- bronchiectasis
63
How is COPD investigated?
- spirometry (FEV1/FVC <0.7)
- CXR or CT thorax
64
What are the 5 grades on the MRC dyspnoea scale?
1. breathless on strenuous exercise
2. breathless on walking uphill
3. breathless slowing walking on flat
4. stop to catch breath after 100m on flat
5. unable to leave house
65
What is the immediate COPD management?
- smoking cessation
- pneumococcal and flu vaccines
- SABA (salbutamol) PRN
66
What is the 1st step in the long term management of COPD?
1. SABA (salbutamol) or SAMA (e.g. ipratropium bromide)
67
What is the 2nd step in long term COPD management?
2. if non-asthmatic: LABA + LAMA
if asthmatic: LABA + inhaled corticosteroid
68
What investigations are done for a COPD exacerbation?
- ABG: low pH and raised CO2: resp acidosis
- raised HCO3 to balance acidic CO2
- type 1 or 2 resp failure?
- CXR and sputum
69
Which drugs can be used to treat a COPD exacerbation?
- salbutamol (SABA)
- ipratropium (SAMA)
- prednisolone
- mechanical (non-invasive) ventilation aiming for 88-92% O2 sats
70
What is cystic fibrosis?
- autosomal recessive condition affecting mucus glands
- caused by genetic mutation of CFTR gene on chromosome 7 coding for chloride channels
71
What are the symptoms of cystic fibrosis?
- chronic cough
- thick sputum
- recurrent resp tract infections
- steatorrhoea
- child tastes salty due to conc sweat
- failure to thrive
72
What are signs of cystic fibrosis?
- low weight or height
- nasal polyps
- clubbing
- crackles and wheeze on auscultation
- abdo distention
73
How is cystic fibrosis diagnosed?
- newborn blood spot testing
- sweat test (GOLD)
- genetic testing for CTFR by amniocentesis or chorionic villous sampling
- faecal elastase
74
What is the sweat test for cystic fibrosis?
- pilocarpine applied to patch of skin
- electrodes placed either side
- current passed causing sweating and sample sent to lab for chloride conc testing
- >60mmol/L is diagnostic
75
Which bacteria commonly affect children with cystic fibrosis and how is it prevented?
- S. aureus
- Pseudomonas aeruginosa
- prophylactic flucloxacillin taken
76
What is the first sign of cystic fibrosis?
- meconium ileus
- thick and sticky black stool - obstructs bowel
- not passing within 24 hrs of birth > abdo distention and vomiting
77
What is the pathophysiology behind cystic fibrosis?
- thick pancreatic and biliary secretions: block ducts > lack of digestive enzymes
- low volume, thick airway secretions > reduce clearance leading to bacterial colonisation and infection
- congenital bilateral absence of vas deferens
78
What is the pathology of cystic fibrosis?
- issues with Cl- channel on apical membrane of epithelial cells
- dec Cl- secretion and inc Na+ absorption leads to reduced water secretion and thickened mucus
79
What is the management of cystic fibrosis?
- chest physio: clear mucus
- exercise: improve resp function
- high calorie diet: malabsorption
- bronchodilators: salbutamol
80
What bacteria causes TB and what type is it?
- mycobacterium tuberculosis
- acid fast bacillus
- bright red against blue background in Ziehl-Neelsen
81
Describe the spread and pathology of TB
- inhaling saliva droplets from infected people
- active or latent when encapsulated by immune system
- reactivated = secondary TB
- affects lungs, lymph nodes and skin
82
What are risk factors for TB?
- Known contact with active TB
- Immigrants from areas of high TB prevalence
- Immunosuppression
- Homeless people, drug users or alcoholics
83
What is the presentation of TB?
- Lethargy
- Fever, night sweats
- Weight loss
- erythema nodosum
- Cough ± haemoptysis
84
What investigations are done for TB?
- Mantoux (tuberculin) test (previous immune response): injecting tuberculin
- interferon gamma release assay (IGRA) +ve
85
What is seen on CXR of TB?
- Primary: patchy consolidation, pleural effusion, hilar lymphadenopathy
- Reactivated: patchy or nodular consolidation with cavitation in upper zones
- Disseminated: “millet seeds” uniformly distributed throughout the lung fields
86
What is the management of latent TB?
- Isoniazid and rifampicin for 3 months
- Isoniazid for 6 months
87
What is the management of active TB?
- Rifampacin - 6 mo
- Isoniazid - 6 mo
- Pyrazinamide - 2 mo
- Ethambutol - 2 mo
88
What is the public health management of TB?
- test contacts
- notify public health
- negative pressure rooms for infected patients to prevent airborne spread
89
What route and form are respiratory drugs delivered in?
- inhaled: dry powders - deep penetration and correct dose
- nebulisers: aerosol form
90
What are the advantages of inhaled medicines?
- large s.a. and rapid absorption
- medicine acts directly on lung or enters systemic circulation
- fewer metabolising enzymes than in blood and liver
- oral route allows administration of small particles
91
What are the 2 categories of bronchodilators?
- adrenergic (SNS): cause bronchodilation and inhibit histamine release
- anti-cholinergic (PSNS): block bronchoconstriction
92
How do β 2 adrenoreceptor agonists cause bronchodilation?
- activation of adenyl cyclase > inc in cAMP
- cAMP activates kinase A which inhibits phosphorylation of myosin and lowers intracellular calcium > relaxation
93
How do anti-cholinergic drugs cause bronchodilation?
- block muscarinic receptors (M1-5) on airway smooth muscle preventing contraction, gland secretion and enhancing neurotransmission
- ipratropium bromide
94
How are muscarinic receptors activated?
- Ach released from airway neurons and non-neuronal cells
- binds to M1, M2 and M3 receptors
- found on airway epithelial, smooth muscle cells and submucosal glands
95
How do glucocorticoids reduce inflammation?
- suppress chemotactic mediators
- reduced adhesion molecule expression
- suppress inflammatory gene expression in airway epithelial cells
- can become resistant (esp neutrophilic asthma)
96
What are the different delivery systems for inhaled drugs?
- pressurised metered-dose inhaler
- spacer: slow down particles and allow more time for evaporation > more inhaled
- dry powder inhalers
- nebulisers
97
What is bronchiectasis?
- obstructive lung disease
- abnormal dilation of bronchi
- caused by excessive, persistent inflammation
- influx of inflammatory cells into airway wall
98
What is the presentation of bronchiectasis?
- chronic cough
- excess sputum
- dyspnoea
- chest pain
- haemoptysis
99
What are the investigations and management of bronchiectasis?
- sputum sample
- obstructive spirometry: FEV1:FVC <0.7
- high res CT: signet ring sign dilated bronchi, cysts
- mucolytics, β2 agonists
100
What is idiopathic pulmonary fibrosis?
- stiffening due to chronic inflammation
- excess fibrous connective tissue > permanent scarring, airway thickening
- unclear cause
101
What is the pathophysiology behind idiopathic pulmonary fibrosis?
- fibroblasts repair damaged tissue
- migrate to the lungs and become myofibroblasts and deposit collagen in ECM
- thickens and stiffens lungs so can't contract/inflate
- inc interstitial barrier between alveoli and capillary membrane
- fibroblasts are resistant to apoptosis
102
How does idiopathic pulmonary fibrosis present and what are the complications?
- cough, breathlessness
- bibasal fine inspiratory crackles
- clubbing
- leads to T1 resp failure
103
How is pulmonary fibrosis diagnosed and treated?
- spirometry
- GOLD: high res CT
- pirfenidone or nintedanib
104
How does pirfenidone work?
- inhibits TGF β
- reduces proliferation of fibroblasts and therefore thickening of ECM
105
How does nintedanib work?
- inhibits tyrosine kinase receptors
- reduces growth and differentiation of fibroblasts
- platelet derived growth factor, vascular endothelial growth factor
106
What is the epidemiology of lung cancer?
- 3rd most common cancer
- 2:1 male: female
107
What are the causes of lung cancer?
- cigarette smoking (75%)
- occupational: asbestos, nickel, arsenic (10%)
- lung fibrosis
- passive smoking
108
What are the local symptoms of lung cancer?
- continuous cough for 3+ weeks
- shortness of breath
- recurrent chest infections
- haemoptysis
109
What systemic symptoms can occur from lung cancer?
- weight loss
- malaise (anaemia)
- paraneoplastic syndrome
110
What are some types of lung tumours?
- carcinoma
- benign
- salivary gland type (bronchus)
- soft tissue tumours (sarcoma)
- lymphoma
111
What are the types of non-small cell lung carcinoma?
- adenocarcinoma
- squamous cell carcinoma
- large cell carcinoma
- treatment: resection ± chemoradiotherapy
112
What is small cell lung carcinoma?
- neuroendocrine tumour
- high grade neoplasm: presents rapidly, worse prognosis
- associated with cigarette smoking
- primary treatment is chemotherapy
113
How is lung cancer diagnosed?
- bloods
- CXR and CT, MRI for staging
- endobronchial biopsy of tumour/metastatic lymph nodes
114
What are signs of cancer on CXR?
- hilar enlargement
- peripheral opacity
- pleural effusion (unilateral)
- collapse
115
What is mesothelioma and what is the cause?
- affects mesothelial cells of pleura
- linked to asbestos inhalation
- latent period of up to 45 years
- palliative surgery
116
Describe the presentation of asbestosis
- pleural plaques
- pleural effusion
- fibrotic lung
- end-inspiratory crackles
- clubbing
117
What is pneumonia?
- infection of lung tissue and inflammation
- causes inflammation and sputum in airways and alveoli
- community, hospital acquired or aspiration
118
What are the atypical causes of pneumonia and how are they treated?
- Legionella pneumophila
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Chlamydophila psittaci
- Coxiella burnetti
- macrolides
119
What is the pathophysiology behind pneumonia?
- alveolar macrophages phagocytose bacteria
- become overwhelmed and produce proinflammatory response to attract neutrophils
- results in dead bacteria, neutrophils, tissue fluid & inflammatory proteins = inflammatory exudate or ‘pus’ in the airspaces
- known as consolidation
120
What are the symptoms of pneumonia?
- fever, rigors
- cough and shortness of breath
- pleuritic chest pain
121
What type of sputum indicates what type of bacteria?
- rusty: S. pneumoniae
- none: Mycoplasma, Chlamydophilia, Legionella
122
What are the signs of pneumonia?
- raised HR and resp rate
- low BP
- fever
- dehydration
123
What chest signs present with pneumonia (of consolidation)?
- bronchial breath sounds: harsh
- focal coarse crackles + wheeze: air passing through sputum
- dullness to percussion
124
What investigations are done for pneumonia?
- CXR: showing consolidation
- FBC, U&Es
- CRP
- sputum and blood cultures
- legionella and pneumococcal urinary antigens
125
What is CURB 65?
- Confusion
- Urea > 7mmol/L (if in hospital)
- Resp rate ≥ 30/min
- Blood pressure <90 systolic or ≤60 diastolic
- age ≥65
126
How is CURB 65 actioned?
- 0/1 treat at home
- 2 hospital admission
- ≥ 3 ICU assessment
127
What is the treatment of pneumonia?
- Score 0-1: oral amoxicillin 500mg or if penicillin allergic then clarithromycin/ doxycycline
- Score 2: oral amoxicillin + clarithromycin
- Score 3-5: IV co-amoxiclav + clarithromycin
128
How is pneumonia prevented?
- pneumococcal vaccine: adults 65+, immunocompromised, chronic conditions
- influenza vaccine
- smoking cessation
129
What are some signs of complications of pneumonia?
- Delerium
- Renal impairment: Urea rise
- Respiratory rate high: inc O2 demand due to lactic acid from anaerobic respiration
- BP drop
130
What is hypersensitivity pneumonitis?
- type III reaction to environmental allergen
- causes parenchymal inflammation and destruction
131
Describe type III hypersensitivity pneumonitis
- prior sensitisation
- IgG antibodies retain immune memory
- antigen-antibody complexes formed on secondary exposure and aren't cleared
132
How is hypersensitivity pneumonitis tested for?
- bronchoalveolar lavage: collecting cells from airways during bronchoscopy by washing with fluid
- collecting + testing fluid
- raised lymphocytes and mast cells
133
How is hypersensitivity pneumonitis managed?
- remove allergen
- give oxygen
- steroids
134
What are some specific examples of types of hypersensitivity pneumonitis?
- Bird-fanciers lung: bird droppings
- Farmers lung: mouldy spores in hay
- Mushroom workers’ lung: mushroom antigens
- Malt workers lung: mould on barley
135
Which drugs can commonly cause ILD?
- nitrofurantoin
- methotrexate
- amiodarone
- bleomycin
136
What are the chemical controls of blood?
- chemoreceptors respond to rising CO2 and lowered O2
- medulla oblongata, carotid and aortic bodies
137
What are the causes of respiratory failure?
- low oxygen delivery: altitude
- airway obstruction
- gas exchange/diffusion limitation: lung fibrosis
- V/Q mismatch: pneumonia, PE
- alveolar hypoventilation: emphysema
138
What is occupational lung disease?
- inhaling harmful substances in the workplace
- may develop in the workplace or aggravate symptoms of a pre-existing condition
139
What are some examples of substances causing occupational lung disease?
- dust: chiselling stone, cutting wood
- fumes: welding
- mists: metalworking
- vapours: paint spraying
140
Describe occupational asthma
- variable latent period
- deteriorating symptoms throughout the week with an improvement over the weekend
141
What are the causes of occupational asthma?
- wood
- flour
- metal
- working fluids
- isocyanate paint
142
What is asthma?
- chronic inflammatory condition causing bronchospasm
- narrowed airways > obstruction of airflow to lungs
- varies over time
143
What is the presentation of asthma?
- episodic
- diurnal variability and worse at night
- dry cough, wheeze, shortness of breath
- atopic triad: hayfever, eczema, asthma
- family history
144
What are the causes of asthma?
- environmental: pollen, smoke, dust, mould
- genetics
- hygiene hypothesis
145
What is the cause of wheeze?
- narrowing of airways causes laminar flow to become turbulent
146
What is the physiology behind asthma?
- smooth muscle contracts on irritation
- chronic inflammation leads to scarring and airway remodelling
147
What is the pathophysiology behind asthma?
- dendritic cells present allergens to Th2 cells
- Th2 cells activated and cytokines released which activates humoral immunity
- inc in mast cells, eosinophils and IgE production
- IgE leads to mast cell degranulation
- release of histamines, leukotrienes and tryptase
148
What is the investigation for asthma?
- spirometry: FEV1/FEV <0.7
- reversibility: give salbutamol and see if ratio normal (0.8)
- fractional exhaled nitric oxide: over 50ppb (adults)
149
Which types of drugs are used to relax airway smooth muscle?
- β-2 agonists
- anti-muscarinics
- theophyllines
150
Which types of drugs are used to dampen inflammation?
- corticosteroids
- leukotriene receptor antagonists
- biologics
- macrolides
151
What is the management of asthma?
- SABA PRN
- SABA + ICS
- SABA + ICS + LABA
- plus LTRA e.g. monteleukast
152
What is an example of:
1. SABA
2. LABA
3. SAMA
4. LAMA?
1. salbutamol
2. salmeterol
3. ipratropium bromide
4. tiotropium bromide
153
How do leukotriene receptor antagonists work?
- Leukotrienes produced by immune system
- cause inflammation, bronchoconstriction, mucus secretion
- antagonists block effects
154
What breaks a breath hold?
raised CO2 detected in CSF
155
Where does gas exchange begin?
- in the respiratory bronchioles
- terminal bronchioles > resp bronchioles > alveolar ducts > sacs
156
What is the name for an area of collapsed lung?
- atelectasis
157
What is the name for an accumulation of air around the heart?
- pneumomediastinum
158
How is the severity of stable COPD assessed?
- FEV1 (% predicted)
Stage 1: >80% of predicted
Stage 2: 50-79% of predicted
Stage 3: 30-49% of predicted
Stage 4: <30% of predicted
159
What are paraneoplastic symptoms of lung cancer?
- ectopic ACTH > Cushing's
- ectopic ADH > SIADH
160
What are blood gas results for metabolic alkalosis (pH, PaCO2, HCO3-)?
- pH: high
- PaCO2: normal/high
- HCO3-: high
161
What are blood gas results for respiratory alkalosis (pH, PaCO2, HCO3-)?
- pH: high
- PaCO2: low
- HCO3-: normal/low
162
What are blood gas results for respiratory acidosis (pH, PaCO2, HCO3-)?
- pH: low
- pCO2: high
- HCO3-: normal
163
What are blood gas results for metabolic acidosis (pH, PaCO2, HCO3-)?
- pH: low
- pCO2: normal/low
- HCO3-: low
164
What are blood gas results for respiratory acidosis with metabolic compensation (pH, PaCO2, HCO3-)?
- pH: low/normal
- pCO2: high
- HCO3-: high
165
What are blood gas results for respiratory alkalosis with metabolic compensation (pH, PaCO2, HCO3-)?
- pH: high/normal
- pCO2: low
- HCO3-: low
166
What is the aetiology of pulmonary vasculitis?
- autoimmune: arthritis, lupus
- infection: TB, legionnaires
- drugs
- COPD, asthma
- genetic
167
What are the causes of lung abcesses?
- Viridans Strep, anaerobes, Klebsiella pneumoniae (and other gram -ve bacteria)
- aspiration of gastric contents, alcoholic, poor dental hygiene
168
What is the criteria for diagnosis with hospital acquired pneumonia and who does it affect?
- acquired at least 48hrs after admission
- elderly
- ventilator
- post op
169
What is the presentation of hospital acquired pneumonia?
- new fever
- purulent secretions
- new radiological infiltrates
- new WCC or CRP inc
- inc O2 requirement
170
Which bacteria cause hospital acquired pneumonia?
- Staph. aureus incl MRSA
- Pseudomonas aeruginosa
- Acinetobacter baumanii
- Klebsiella pneumoniae
171
What is the treatment of hospital acquired pneumonia?
- early onset (≤5 days): metronidazole/co-amoxiclav
- late onset: anti-pseudomonal: piperacillin-tazobactam
172
What is the presentation of whooping cough?
- catarrhal phase (resp infection symptoms) followed by paroxysmal (whooping cough)
- coughing spasms with whoop when trying to inspire between bouts
- mainly in children
173
What viruses commonly cause upper resp tract illnesses?
- rhinoviruses
- influenza A viruses
- coronaviruses
- adenoviruses
- parainfluenza viruses
- resp syncytial viruses (children)
174
What are the causes of pharyngitis?
- rhinovirus, adenovirus
- bacterial: Strep pyogenes: lancefield group A β haemolytic
175
How are respiratory viruses diagnosed?
- multiplex PCR
- green viral throat swab
176
What is pulmonary vasculitis?
- Wegner's granulomatosis
- vasculitis affecting small and medium vessels
- granulomatosis with polyangitis
177
What are the symptoms of Wegner's granulomatosis?
- saddle shaped nose
- ear infection
- diffuse alveolar haemorrhage > haemoptysis
- glomerulonephritis > haematuria
178
How is Wegner's granulomatosis diagnosed and treated?
- cANCA +ve
- corticosteroids e.g. rituximab
179
What is silicosis?
- SiO2 inhalation
- cough and exertional SOB
- calcification of hilar lymph nodes
180
What is tidal volume?
- volume that enters and leaves with each breath
181
What is inspiratory and expiratory reserve volume?
- extra volume that can be inspired/expired above tidal volume
182
What is residual volume?
volume remaining after max expiration which can't be measured by spirometry
183
What lung diseases present with an obstructive FEV1/FVC ratio?
- asthma
- COPD
- bronchiectasis
184
What lung diseases present with an restrictive FEV1/FVC ratio?
- Pulmonary fibrosis
- Asbestosis
- Sarcoidosis
- ankylosing spondylitis
- Neuromuscular disorders
Osha 2a
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