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pleural and pulmonary disorders Flashcards

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1
Q

What is a pleural effusion?

A

Abnormal collection of fluid in the pleural space

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2
Q

What are the features of transudates?

A

protein < 30g/l

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3
Q

What are some of the causes of transudates?

A
  • heart failure
  • liver cirrhosis
  • hypoalbuminaemia
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4
Q

what are the features of Exudates?

A

protein > 30g/l

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5
Q

What are some of the causes of exudates?

A
  • malignancy
  • infection inc TB
  • pulmonary infarct
  • asbestos
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6
Q

what does a pleural fluid pH of <7.3 suggest?

A
  • pleural inflammation
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7
Q

What is mesothelioma?

A
  • uncommon malignant tumour of the lining of the lung or (occasionally) abdominal cavity
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8
Q

what is a common cause of mesothelioma?

A
  • exposure to asbestos

- 30-40 years to develop

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9
Q

What are the treatment options for mesothelioma?

A
  • pleurodese effusions
  • radiotherapy
  • surgery
  • chemo
  • palliative care
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10
Q

what are the risk factors for spontaneous pneumothorax?

A
  • tall thin males
  • smoking
  • cannabis
  • underlying lung disease
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11
Q

What is pneumothorax

A
  • air in pleural space
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12
Q

What is the treatment for a tension pneumothorax?

A
  • needle decompression
  • with large bore venflon
  • 2nd intercostal space anteriorly in the mid clavicular line
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13
Q

what is a tension pneumothorax?

A
  • progressively increasing pressure in the pleural space

- pushes chest organs aside

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14
Q

What are the risk factors for pleural infection?

A
  • diabetes mellitus
  • immunosuppression
  • gastro - oesophageal reflex
  • alcohol misuse
  • IV drug abuse
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15
Q

Describe the management of a pleural infection?

A
  • Antibiotics
  • drain effusion as needed
  • discussion with surgeons
  • nutrition
  • VTE prophylaxis
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16
Q

What antibiotic should be used to treat pleural effusion?

A

Co amoxiclav

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17
Q

What is a pulmonary embolism?

A
  • blockage of a pulmonary artery by a blood clot, fat, tumour or air
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18
Q

When does pulmonary infarction occur?

A

if blood flow and oxygen to the lung tissues is compromised the lung tissue may die

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19
Q

When are DVTs most likely to embolism or lead to chronic venous insufficiency and venous leg ulcers?

A

When they are more proximal

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20
Q

Describe the clinical presentation of DVT?

A
  • whole leg or calf involved depending on the site
  • swollen
  • hot
  • red
  • tender
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21
Q

How are DVTs investigated?

A
  • ultrasound doppler leg scanner (1st line)

- CT scan

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22
Q

What are some of the risk factors associated with DVT and PE?

A
  • thrombophilia
  • contraceptive pill
  • pregnancy
  • pelvic obstructions
  • trauma
  • surgery
  • immobility
  • obesity
  • pulmonary hypertension
  • vasculitis
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23
Q

How can DVT be prevented?

A
  • early post op mobilisation
  • TED compression stockings
  • calf muscle exercises
  • subcutaneous low dose heparin
  • DOAC
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24
Q

How may a patient with PE present?

A
  • (acute) shortness of breath
  • (pleuritic) chest pain
  • haemoptysis
  • leg pain/swelling
  • collapse/sudden death
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25
What are the clinical features of PE?
- tachycardia - tachypnoea - cyanosis - fever - low BP - crackles - rub - pleural effusion - Type 1 respiratory failure - normal CXR
26
How might a PE be diagnosed?
- PESI score - ECG - acute right heart strain pattern - D dimers raised - isotope lung scan (V/Q) - CT pulmonary angiogram - leg and pelvic US - echocardiogram
27
When is an isotope lung scan useful?
- small peripheral emboli - perfusion defect before infarction - perfusion and ventilation mismatch detected after infarction
28
What may be an underlying cause of PE?
- cancer - autoantibodies - thrombophillia (if no obvious cause i.e. surgery)
29
How should a patient who is at high risk for PE be treated?
CT pulmonary angiogram
30
How should a patient in the ambulatory setting with low risk be investigated?
- CTPA or V/Q
31
How is DVT/PE treated?
- low molecular weight heparin and warfarin simultaneously - stop heparin after 3-5 days when INF>2 - OR - use solely use DOACs
32
What is pulmonary hypertension?
mean pulmonary arterial pressure > 25 mmHg - can be measured with right heart catheter - systolic PAP can be estimated with ECHO doppler
33
List some of the causes of pulmonary hypertension?
Pulmonary venous hypertension - left ventricular systolic function - mitral regurgitation - cardiomyopathy Pulmonary arterial hypertension - primary pulmonary hypertension - hypoxic - multiple PE
34
What is Cor pulmonale?
- right heart disease secondary to lung disease | - fluid retention due to hypoxia +/- right heart failure
35
Clinical signs of pulmonary hypertension and right heart failure?
- central cyanosis if hypoxic - dependent oedema - raised JVP with V waves - right ventricular heave at left parasternal edge - murmur or tricuspid regurgitation - load P2 - enlarged liver
36
How may pulmonary hypertension be investigated?
- ECG - CXR - SaO2 - pulmonary function with DLCO - echo - cardiac catheterisation - D - dimers - VQ scan - CT pulmonary angiogram - cardiac MRI
37
How is pulmonary hypertension treated?
- prophylactic anticoagulation (warfarin) - O2 if hypoxic - pulmonary vasodilators - lung transplant - Riociguat (pulmonary arterial vasodilator) - pulmonary endarterectomy (curative)
38
What is stridor?
- predominantly inspiratory wheeze due to large airways obstruction
39
What are some of the major cause of stridor in children?
- infections: croup, epiglottitis ect - foreign body - anaphylaxis/angioneurotic oedema
40
What are some of the common causes of stridor in adults?
- neoplasms - anaphylaxis - goitre - foreign body - trauma
41
How might stridor be investigated?
- laryngoscopy - bronchoscopy - flow volume loop - CXR - other imaging
42
How is a laryngeal obstruction treated?
- treat underlying cause e.g. foreign body removal - mask bag ventilation with high flow O2 - cricothyroidotomy - tracheostomy
43
- How may a malignant airway obstruction be treated?
- tumor removal: laser, photodynamic therapy, cryotherapy, diathermy, surgical resection - tumour compression - radiotherapy
44
Describe acute anaphylaxis?
- type 1 (immediate) hypersensitivity (IgE) - flushing, pruritus, urticaria - angioneurmtic oedema - abdominal pain/vomiting - hypotension - stridor, wheeze, respiratory failure
45
Describe the treatment of anaphylaxis?
- IM epinephrine (adrenaline) - IV antihistamine - IV corticosteroid - high flow O2 - nebulised bronchodilators - endotracheal intubation if necessary
46
What causes snoring?
- relaxation of pharyngeal dilator muscles during sleep | - upper airway narrowing, turbulent airflow and vibration of soft palate and tongue base
47
What is OSA?
- intermittent upper airway collapse in sleep | - recurrent arousals/sleep fragmentation
48
What are some of the risk factors for sleep apnoea?
- enlarged tonsils - obesity - retrognathia - acromegaly, hypothyroidism - oropharyngeal deformity - neurological - drugs
49
What are some of the consequences of sleep apnoea?
- excessive daytime sleepiness - personality change - cognitive/functional impairment - major impact on daytime function
50
How is OSA diagnosed?
- snoring and raised epworth score - overnight sleep study - domiciliary recording - full polysomnography
51
How is OSA treated?
- remove underlying cause - CPAP - Other: mandibular advancement device, surgery
52
What is pulmonary oedema ?
accumulation of fluid in the lung - interstitium - alveolar spaces causes a restrictive pattern of disease
53
What are some of the causes of pulmonary oedema?
- most important cause is cardiac failure 1. haemodynamic (inc hydrostatic pressure) 2. due to cellular injury
54
What is ARDS?
adult respiratory distress syndrome
55
Describe the pathogenesis or ARDS?
Injury - infiltration of inflammatory cells - cytokines - oxygen free radicals - injury to cell membranes
56
Describe the pathology or ARDS?
- fibrous exudate lining alveolar walls - cellular regeneration - inflammation
57
What are the possible outcomes of ARDS?
- death (50%) - resolution - Fibrosis
58
Describe neonatal RDS?
- occurs in premature infants - deficient in surfactant - inc effort in expanding lungs --> physical damage to cells
59
What is an embolus?
- a detached intravascular mass carried by the blood to a site in the body distant from its point of origin
60
What is Virchows triad?
1. factors in vessel wall 2. abnormal blood flow 3. Hypercoagulable blood
61
What does the effect of a PE depend on?
- size of embolus - cardiac function - respiratory function
62
Describe the morphology go pulmonary hypertension?
- medial hypertrophy of arteries - intimal thickening (fibrosis) - atheroma - Right ventricular hypertrophy - extreme cases: congenital heart disease)

The respiratory system (13 decks)

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