Term
| Examples of triggers for asthma |
|
Definition
- Seasonal
- Cold weather
- Resp. infections
- Medications (NSAIDs, aspirin, beta blockers)
- Exercise
- Emotional stress
- Foods (nuts, MSG, seafood)
- Reflux
- Menstrual cycle
- Dusts or gases |
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|
Term
| Definition of mild asthma |
|
Definition
- Coughing
- Soft wheeze
- Minor difficulty breathing
- No difficulty in speaking sentences
- PEF >60% predicted
- Oxygen saturation >94% |
|
|
Term
| Definition of moderate asthma |
|
Definition
- Persistent cough
- Loud wheeze
- Obvious difficulty breathing
- Use of accessory mm.
- Able to speak phrases
- PEF 40-60% predicted
- Oxygen saturation 91-93% |
|
|
Term
|
Definition
Airway inflam. leads to:
1) Hypersecretion of mucus
2) Airway m. constriction
3) Swelling of bronchial membranes |
|
|
Term
| Clinical signs that suggest severe asthma |
|
Definition
- Anxious, laboured respiration, sitting upright gasping for air
- Unable to speak more than a few words
- Exhausted & drowsy
- Pale or cyanosed
- Tachypnoea, tachycardia
- Intercostal recession, marked use of accessory resp. mm., raised clavicles, barrel chest
- Hyper-resonant on percussion
- Prolonged expiration
- High pitched wheeze on insp/exp +/- silent chest
- PEF <40% predicted value
- O2 sats <90% |
|
|
Term
|
Definition
- Hypoxia
- Cardiac arrest
- Pneumothorax
- Collapse
- Infection
- Emphysema (progressive hyperinflation)
- Cor pulmonale |
|
|
Term
| Common causes of exacerbations of COPD |
|
Definition
- Infective/pneumonia
- Cardiac failure
- Asthma
- Medication change
- Sedative drugs
- PE
- Pleural effusion
- Arrhythmia
- MI |
|
|
Term
| What may be seen on spirometry that would suggest COPD as the cause? |
|
Definition
- Low FEV1
- Red. FVC
- Red. vital capacity (VC)
- Inc. residual volume (RV)
- Inc. total lung capacity (TLC)
- Low PEF w/out steroid improvement
- Low diffusion capacity |
|
|
Term
|
Definition
- Cor pulmonale ("blue bloater")
- Recurrent chest infections (esp. H. influenza, Strep pneumoniae)
- Hypoxia
- Hypercapnia/CO2 retention
- Polycythaemia |
|
|
Term
| How is COPD differentiated from asthma? |
|
Definition
COPD:
- Chronic process
- Assoc. w/ smoking
- Constant dyspnoea (no diurnal variation)
- Highly productive sputum & progressively worsens
- Not sig. changed w/ oral steroid trial |
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|
Term
| Risk factors for interstitial lung disease |
|
Definition
- Exposure to dusts, fumes, asbestos (coal, silicosis)
- Sarcoidosis
- Ankylosing spondylitis
- Radiation exposure
- Tuberculosis
- Rheumatoid arthritis
- Hay, birds, lab rat exposure (extrinsic fibrosing alveolitis)
- Scleroderma
- Drugs (e.g. methotrexate, amiodarone, oxygen ventilation) |
|
|
Term
| What spirometry findings would suggest interstitial lung disease? |
|
Definition
Restrictive picture
- Low FEV1
- Red. FVC
- Raised FEV1/FVC ratio
- Red. vital capacity
- Low PEF w/out steroid improvement
- V. low diffusion capacity |
|
|
Term
| Pathophys of interstitial lung disease |
|
Definition
- Thickening of alveoli walls
- Stiffness of lungs
- Impaired gas transfer |
|
|
Term
| Possible causes of pneumothorax |
|
Definition
- Trauma (penetrating wound, rib fracture)
- Mechanical ventilation
- Spontaneous (subpleural bullae)
- Weakened lung wall (asthma, emphysema, TB, CF) |
|
|
Term
| Types of obstructive respiratory disorders |
|
Definition
- COPD
- Asthma
- Bronchiectasis |
|
|
Term
| Clinical features of hypoxaemia |
|
Definition
- Central cyanosis
- Tachycardia
- Restlessness
- Confusion |
|
|
Term
| Clinical features of hypercapnoea |
|
Definition
- Respiratory flap
- Tachypnoea
- Palmar erythema
- Full bounding pulse
- Papilloedema |
|
|
Term
| Ways to confirm diagnosis of sleep apnoea |
|
Definition
- Sig. fall in arterial O2 sats overnight in a cyclical manner
- EEG |
|
|
Term
| Advice to pts w/ sleep apnoea |
|
Definition
- Red. weight
- Red. alcohol intake
- Red. stimulant intake |
|
|
Term
| Types of pleural effusion |
|
Definition
Transudative
- <30g protein/L
- low LDH
- low WCC
- Clear fluid
Exudative
- >30g protein/L
- high LDH
- high WCC
- low glucose
- murky/bloody fluid |
|
|
Term
| Examples of each type of pleural effusion |
|
Definition
Transudative
(FAILURES)
- Cardiac failure (LVF, PE)
- Hypoalbuminaemia (liver disease, nephrotic syndrome)
Exudative
- Pneumonia
- TB
- Irradiation
- Haemothorax/trauma
- Carcinoma
- PE/infarction
- Connective tissue disease (Rh arthritis) |
|
|
Term
| Causes of pleural effusion |
|
Definition
- Inc. hydrostatic pressure (CHF)
- Dec. oncotic pressure (hypoalbuminaemia)
- Inc. vascular permeability (pneumonia)
- Inc. intrapleural neg. pressure (atelectasis)
- Dec. lymphatic drainage (mediastinal carcinoma) |
|
|
Term
|
Definition
- DVT
- Recent surgery
- Recent ortho problems
- Long travel
- Clotting disorders
- Active malignancy
- Smoking
- HRT or OCP
- Pregnancy
- Obesity |
|
|
Term
|
Definition
- Death
- Infarction of lung
- Reduced CO (syncope)
- Cardiogenic shock (RHF/LHF)
- Pulmonary hypertension |
|
|
Term
| Difference b/w type 1 & type 2 respiratory failure |
|
Definition
Type 1
- Pt is able to ventilate, but circulation is poor (hypoxaemia)
- PaO2 <60 mmHg, PaCO2 <50 mmHg
e.g. asthma, PE, pneumonia, pulmonary fibrosis, ARDS
Type 2
- Pt is unable to breathe mechanically
- PaO2 <60 mmHg, PaO2 >50 mmHg (hypercapnic)
e.g. sedation/heroin overdose, COPD, neuromuscular drugs, chest wall problems (flail chest, obesity), CNS disorders (myaethenia gravis, brainstem injury) |
|
|
Term
| Examination findings of respiratory distress |
|
Definition
- Cyanosis
- Pursed-lip breathing
- Accessory muscle use
- Diaphragmatic breathing (paradoxical movement of diaphragm outwards during inspiration)
- Intercostal indrawing
- Inc. JVP
- Dec. O2 sats
- Tachypnoea
- Tachycardia |
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