Resp exam Flashcards
What are the causes of upper zone fibrosis? 7
Coal worker’s pneumoconiosis, histiocytosis, hypersensitivity pneumonitis, ankylosing spondylitis, radiation, TB, silicosis, sarcoidosis
These conditions lead to fibrosis primarily in the upper lung zones.
What are the causes of lower zone fibrosis? 3 then 9 drugs
CTDs, asbestosis, IPF, drugs: Amiodarone, bleomycin, methotrexate, nitrofurantoin, procainamide, isoniazid, cyclophosphamide, gold, sulfasalazine
CTDs refers to connective tissue diseases.
What are the signs of pulmonary hypertension? 5
Loud palpable P2, PSM of TR, RV heave, displaced apex, raised JVP
P2 refers to the second heart sound, TR is tricuspid regurgitation, RV is right ventricle, and JVP is jugular venous pressure.
List the features of yellow nail syndrome. 5
Yellow nails, bronchiectasis, pleural effusions, chronic sinusitis, symmetrical lower limb lymphoedema
Yellow nail syndrome is characterized by these specific clinical features.
What are the causes of bronchiectasis? (1 other, 2 congenital, 3 infections, 5 immune overactivity, 3 immune underactivity, 4 obstructive)
Idiopathic, congenital (CF, Kartagener’s), childhood infections (measles, TB, pertussis), immune overactivity (ABPA, IBD-associated, RA, SLE, SS), immune underactivity (hypogammaglobulinaemia, CVID, AIDS), obstructive (IL, lung tumor, obstructive airways disease, mediastinal LN)
ABPA refers to allergic bronchopulmonary aspergillosis, IBD is inflammatory bowel disease, RA is rheumatoid arthritis, SLE is systemic lupus erythematosus, SS is Sjögren’s syndrome, CVID is common variable immunodeficiency.
What are the complications of bronchiectasis? 7
Cor pulmonale, secondary amyloidosis, massive haemoptysis, pneumothorax, pneumonia, abscess, metastatic brain abscess
Cor pulmonale refers to right heart failure due to lung disease.
What are the side effects of Rifampicin? 4
Enzyme inducer, hepatitis, rash, orange secretions
Rifampicin can cause discoloration of bodily fluids.
What are the side effects of Isoniazid? 2
Peripheral neuropathy, hepatitis
Isoniazid is an antibiotic used to treat tuberculosis.
What are the side effects of pyrazinamide? 3
Hepatitis, arthralgia, interstitial nephritis
What are the side effects of Ethambutol? 4
Retrobulbar neuritis, hepatitis, rash, eosinophilia
Ethambutol is also used in the treatment of tuberculosis.
What are the indications for lobectomy or pneumonectomy? 8
Localised bronchiectasis, uncontrolled haemoptysis after failed BAE, early NSCLC, suspicious nodule, lung volume reduction for COPD, lung abscess, trauma, CF, old TB treatment
NSCLC refers to non-small cell lung cancer, BAE is bronchial artery embolization.
What are the criteria for suitability for lobectomy / pneumonectomy? 3
Lobectomy: FEV1 >1.5L; Pneumonectomy: FEV1 >2L; Desaturation >4% or cannot walk 250m = high risk; CI if VO2 <15ml/kg/min
FEV1 is forced expiratory volume in one second, VO2 is oxygen consumption.
What are the indications for VATS? 6
Lobectomy, pleural biopsy, wedge resection, decortication, bullectomy, pleurectomy
VATS stands for video-assisted thoracoscopic surgery.
What are the indications for lung transplant? 5 - double vs single
also general criteria
CF (double), bronchiectasis (double), fibrosis (single), pulmonary hypertension (?double), COPD (A1ATD, ex-smokers - single)
Criteria are: medical therapy is ineffective, ADLs are significantly limited, life expectancy is limited, cardiac function is adeqaute (if lung-only transplantation)
A1ATD refers to alpha-1 antitrypsin deficiency.
What are the absolute contraindications for lung transplant? 7
BMI >35, untreatable other-organ failure, unstable condition, significant chest wall/spinal deformity, uncontrolled extra-pulmonary symptoms of systemic illness, substance addiction/abuse within 6 months, history of poor adherence to medical treatment
BMI refers to body mass index.
What are the relative contraindications for lung transplant? 5
> 60yo, severely limited functional status, chronic infection with resistant bacteria, BMI >30, BMI <17
These factors may increase the risk of transplant failure.
What are the complications of lung transplant? 6
Bleeding from anastomotic joints, bronchial stenosis at the site of anastomosis, early graft dysfunction from ischaemic reperfusion injury, acute or chronic rejection, infections (bacterial, fungal, viral), 20% mortality at 1 year, 50% mortality at 5 years
Anastomotic joints refer to the connections made during surgery.
Classification of COPD severity
Mild: FEV1 >80% + symptomatic; Moderate: FEV1 50-80%; Severe: FEV1 30-50%; Very Severe: FEV1 <30%
FVC is forced vital capacity.
What are the causes of COPD? 3
Smoking (apical), industrial dust exposure (apical), A1AT deficiency (basal)
COPD stands for chronic obstructive pulmonary disease.
What are the surgical options for COPD? 4
Bullectomy, endobronchial valve replacement, lung reduction surgery, single lung transplant
These options aim to improve lung function and quality of life.
What are the indications for lung volume reduction surgery in COPD? 6
Predominantly emphysematous disease, predominantly UL, FEV1 >20% predicted, DLCO >20% predicted, no/mild pulmonary HTN (PASP <45mmHg), no disabling disease
DLCO is diffusing capacity of the lungs for carbon monoxide.
What are the indications for bullectomy? 2
Bullae >1L, bullae compress surrounding lung
Bullae are air-filled spaces in the lungs that can cause complications.
What are the assessment criteria for long-term oxygen therapy (LTOT)? 6
FEV1 <30% (consider if 30-49%), cyanosis, polycythaemia, peripheral oedema, raised JVP, SpO2 <92% OA
OA refers to oxygen ambient.
What are the inclusion criteria for LTOT? 4
Non-smoker, PaO2 <7.3kPa on air on 2x occasions 3/52 apart, no significant PaCO2 rise with oxygen, PaO2 <8kPa if cor pulmonale, secondary polycythaemia, or peripheral oedema
PaO2 is partial pressure of oxygen.
