32. Further Issues of CF Flashcards Preview

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Flashcards in 32. Further Issues of CF Deck (21):

Name members of the multidisciplinary team which may be involved in care for a CF patient. (~7 and more!)

1. consultants (~3)
2. dietician
3. physiotherapist (~2)
4. psychologists
5. pharmacists
6. microbiologists
7. ward staff
...GI team, community nurses, genetic staff, nutrition nurses, GPs, x ray staff, GYN and OBs


What is the main issue for CF patients especially if they are young?

fertility issues


When does puberty generally occur in CF patients?

much later than normal


Does CF have any effect on sexual function in men or women?

no effect


Does CF have any effect on fertility in men?

> 95% males infertile due to blocked/absence of vas deferens


Does CF have any effect on fertility in women?

females remain fertile although poor nutritional state may affect chances of conception


What are the available options for males with fertility issues due to CF?

1. adoption (usually unlikely)
2. artificial insemination with donor sperm (AID; 60-70% success rate)
3. intra- cytoplasmic sperm injection (ICSI); 25-30% success rate


Describe the procedure for intracytoplasmic sperm injection technique.

Sperm injection technique where a sperm is injected into the egg


What is the difference between IVF and ICSI

- in IVF, the egg and sperm are mixed together in a dish and sperm fertilises the egg "naturally"
- ICSI involves directly picking up a single sperm if healthy sperm availability is limited and inserting it straight into the egg


What is needed before deciding on a fertility plan for females? (4)

- screening of partner
- counselling (re-long term impact of condition on family)
- good communication with CF team
- optimum health (lung function and weight)


According to studies, females with CF have bigger fertility issues under what circumstances?

those with advanced or poorly controlled lung disease prior to conception


Why is lung transplantation not always an option?

it's a last resort treatment (not a miracle cure)


Where in UK are double lung transplants performed?

Freeman hospital in Newcastle


What criteria do patients have to meet to be considered for a lung transplant? (6)

1. FEV1<30% predicted
2. big weight loss
3. hypoxia at rest (de-saturation on exercise)
4. hypercapnia
5. recurrent worsening sepsis
6. worsening quality of life


What are the criteria for the inpatient assessment prior to transplant in Newcastle? (4)

1. 3 or 4 day admission
2. patient must bring a carer
3. seen by multi-disciplinary team
4. large clinical investigations prior (2 way information sharing process)


What are the possible outcomes following an inpatient assessment? (6)

1. active list
2. passive list
3. too well
4. decision not to go on list (by patient)
5. decision not to go on list (by team)
6. too ill


What are the 3 questions which need to be asked prior to lung transplant?

1. is the condition bad enough?
2. is the rest of the body good enough?
3. does the patient want this?


What are ABSOLUTE contra-indications to transplant? (6)

- other organ failure
- malignancy within 5 years
- significant peripheral vascular disease
- drug, nicotine, alcohol dependency
- active systemic infection
- microbiological issues (e.g. M.abscessus)


What are RELATIVE contra-indications to transplant? (7)

- other organ dysfunction
- non-compliance
- steroids >20mg daily
- absence of recognised social support (vital for post-op)
- osteoporosis
- low BMI
- surgical risks (previous thoracic surgery)


What are common psychological issues faced by CF patients prior to lung transplant surgery?

1. hope
2. fear
3. guilt/conflict
4. stress


What do lung transplant survival rate statistics range from?

range from ~30-60%