Resp Vivas Flashcards
Respiratory indications for midline sternotomy
Anterior mediastinum tumour resection
Lower trachea + main stem bronchus surgery
What is CREST syndrome?
Subtype of limited systemic sclerosis a/w anti-centromere Abs
Calcinosis
Raynaud’s phenomenon
Oesophageal dysmotility
Sclerodactyly
Telangiectasia
Give a differential for CREST syndrome?
Diffuse cutaneous systemic sclerosis (anti-scl 70 abs)
(most common cause of death is ILD + pulmonary HTN)
Describe management of COPD
- SABA or SAMA
- Is there steroid responsiveness/ asthmatic features?
Y: SAMA/ SABA + LABA + ICS
N: SABA + LAMA + LABA - SABA + LABA + LAMA + ICS
Name a SABA used in COPD
Salbutamol
Name a SAMA used in COPD
Ipratropium
Name a LAMA used in COPD
Tiotropium
Name a LABA used in COPD
Salmeterol
Name a ICS used in COPD
Budesonide
Beclometasone
Conservative Mx of COPD
SMOKING cessation advice: inc. offering NRT: varenicline or bupropion
Annual influenza vaccination
One-off pneumococcal vaccination
Pulmonary rehab to all who view themselves as functionally disabled by COPD
Which 4 features suggest steroid responsiveness in COPD?
Previous dx of Asthma or Atopy
High blood eosinophil count
Substantial variation in FEV1 over time (>,400ml)
Substantial diurnal variation in PEF (>,20%)
When can oral theophylline be used in COPD?
After trials of short + long-acting bronchodilators or to people who can’t used inhaled therapy
When should mucolytics be considered in COPD?
In those with chronic productive cough
Continued if Sx improve
What can be used as prophylactic antibiotic therapy in COPD? When is this indicated?
Azithromycin
Continue to have exacerbations despite not smoking + having optimised standard Tx
What prerequisites are there for Azithromycin prophylaxis in COPD?
CT thorax (to r/o bronchiectasis)
Sputum culture (to r/o atypical infections + TB)
LFTs + ECG to r/o QT prolongation (as azithromycin can prolong QT)
What can be used to reduce risk of COPD exacerbations in those with severe COPD and frequent exacerbations?
PDE-4 inhibitors e.g. Roflumilast
What are the features of cor pulmonale seen in COPD?
Peripheral oedema
Raised JVP
Systolic parasternal heave
Loud P2
Describe management of cor pulmonale in COPD
LTOT
Loop diuretic for oedema e.g. Furosemide
Which factors may improve survival in patients with stable COPD?
Smoking cessation: single most important intervention
LTOT in those who fit criteria
Lung volume reduction surgery in selected patients
What are the types of lung volume reduction?
Lung volume reduction surgery
Endobronchial valves
What is lung volume reduction surgery?
Worst affected part of lung stapled off + removed. Remaining lung re-inflates + can work more effectively.
Laparoscopic
What are endobronchial valves?
Bronchoscopic lung volume reduction (BLVR)
One-way valves stop air from getting into diseased parts of lungs when breathing in but allow air + mucus out when breathing out.
Causes target area of lung to shrink
What are the indications for LTOT?
pO2 of < 7.3 kPa OR pO2 of 7.3-8 kPa + one of the following:
secondary polycythaemia
peripheral oedema
pulmonary HTN
Most common cause of infective exacerbation of COPD
Haemophilus influenzae
Acute exacerbation of COPD Mx
Increase freq. bronchodilator use +/- give via nebuliser
Prednisolone 30mg OD for 5 days
If sputum purulent/ clinical signs of pneumonia: Amoxicillin/ Clarithromycin or doxycycline.
Criteria for admission in acute exacerbation of COPD
Severe breathlessness
Acute confusion/ impaired consciousness
Cyanosis
O2 sats <90% on pulse ox
Inability to cope at home/ living alone
Significant comorbidity (cardiac disease or insulin-dependent diabetes)