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YR6 Images + Instruments > Resp Vivas > Flashcards

Resp Vivas Flashcards

1
Q

Respiratory indications for midline sternotomy

A

Anterior mediastinum tumour resection
Lower trachea + main stem bronchus surgery

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2
Q

What is CREST syndrome?

A

Subtype of limited systemic sclerosis a/w anti-centromere Abs
Calcinosis
Raynaud’s phenomenon
Oesophageal dysmotility
Sclerodactyly
Telangiectasia

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3
Q

Give a differential for CREST syndrome?

A

Diffuse cutaneous systemic sclerosis (anti-scl 70 abs)
(most common cause of death is ILD + pulmonary HTN)

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4
Q

Describe management of COPD

A
  1. SABA or SAMA
  2. Is there steroid responsiveness/ asthmatic features?
    Y: SAMA/ SABA + LABA + ICS
    N: SABA + LAMA + LABA
  3. SABA + LABA + LAMA + ICS
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5
Q

Name a SABA used in COPD

A

Salbutamol

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6
Q

Name a SAMA used in COPD

A

Ipratropium

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7
Q

Name a LAMA used in COPD

A

Tiotropium

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8
Q

Name a LABA used in COPD

A

Salmeterol

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9
Q

Name a ICS used in COPD

A

Budesonide
Beclometasone

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10
Q

Conservative Mx of COPD

A

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

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11
Q

Which 4 features suggest steroid responsiveness in COPD?

A

Previous dx of Asthma or Atopy
High blood eosinophil count
Substantial variation in FEV1 over time (>,400ml)
Substantial diurnal variation in PEF (>,20%)

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12
Q

When can oral theophylline be used in COPD?

A

After trials of short + long-acting bronchodilators or to people who can’t used inhaled therapy

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13
Q

When should mucolytics be considered in COPD?

A

In those with chronic productive cough
Continued if Sx improve

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14
Q

What can be used as prophylactic antibiotic therapy in COPD? When is this indicated?

A

Azithromycin
Continue to have exacerbations despite not smoking + having optimised standard Tx

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15
Q

What prerequisites are there for Azithromycin prophylaxis in COPD?

A

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)

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16
Q

What can be used to reduce risk of COPD exacerbations in those with severe COPD and frequent exacerbations?

A

PDE-4 inhibitors e.g. Roflumilast

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17
Q

What are the features of cor pulmonale seen in COPD?

A

Peripheral oedema
Raised JVP
Systolic parasternal heave
Loud P2

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18
Q

Describe management of cor pulmonale in COPD

A

LTOT
Loop diuretic for oedema e.g. Furosemide

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19
Q

Which factors may improve survival in patients with stable COPD?

A

Smoking cessation: single most important intervention
LTOT in those who fit criteria
Lung volume reduction surgery in selected patients

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20
Q

What are the types of lung volume reduction?

A

Lung volume reduction surgery
Endobronchial valves

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21
Q

What is lung volume reduction surgery?

A

Worst affected part of lung stapled off + removed. Remaining lung re-inflates + can work more effectively.
Laparoscopic

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22
Q

What are endobronchial valves?

A

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

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23
Q

What are the indications for LTOT?

A

pO2 of < 7.3 kPa OR pO2 of 7.3-8 kPa + one of the following:
secondary polycythaemia
peripheral oedema
pulmonary HTN

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24
Q

Most common cause of infective exacerbation of COPD

A

Haemophilus influenzae

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25
Q

Acute exacerbation of COPD Mx

A

Increase freq. bronchodilator use +/- give via nebuliser
Prednisolone 30mg OD for 5 days
If sputum purulent/ clinical signs of pneumonia: Amoxicillin/ Clarithromycin or doxycycline.

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26
Q

Criteria for admission in acute exacerbation of COPD

A

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)

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27
Q

Severe acute exacerbation of COPD Mx

A

28% Venturi mask, 4 L/min
Aim for sats of 88-92% for patients with RFs for hypercapnia + no prior hx of resp. acidosis
Target 94-98% if pCO2 is normal

Nebulised Salbutamol + Ipratropium

Steroids: Pred PO or IV Hydrocortisone

IV theophylline
If not responding to nebs

28
Q

Describe Mx of T2 respiratory failure in COPD

A

NIV if resp acidosis pH 7.25-7.35
- BiPaP

29
Q

Interstitial lung disease pathogenesis

A

Scarring (pulmonary fibrosis), inflammation or a mix

30
Q

What are the exposure related causes of ILD?

A

Hypersensitivity pneumonitis: farmers lung, bird fanciers lung

Pneumoconiosis: Asbestosis, Silicosis, Coal workers lung

Radiation pneumonitis

Drug induced: Amiodarone, Methotrexate, Nitrofurantoin, Bleomycin

31
Q

What are the causes of ILD secondary to connective tissue disease?

A

Systemic sclerosis
RhA
Polymyositis
SLE
Sjogrens
Mixed connective tissue disease

32
Q

Idiopathic causes of ILD

A

Idiopathic pulmonary fibrosis
Cryptogenic organising pneumonitits
Non specific interstitial pneumonitis
Acute interstitial pneumonitis

33
Q

5 other causes of ILD

A

Sarcoidosis
Vasculitis
UC
Renal tubular acidosis
AI thyroid disease
Infections e.g. TB

34
Q

Ix for ILD

A

Bedside: ABG (resp failure), ECG (right heart strain)

Lab: FBC (anaemia, polycythaemia), AI screen, serum ACE (sarcoidosis)

Imaging: CXR
HRCT: GS
Ground glass/ honeycombing
Volume loss
Bilateral reticulonodular interstitial infiltrates

35
Q

Describe lung function tests in ILD

A

Restrictive pattern with reduced transfer factor

36
Q

S/S of IPF

A

Progressive exertion dyspnoea
Bibasal fine end inspiratory crepitations
Dry cough
Clubbing

37
Q

Ix for IPF

A

Spirometry: restrictive
Impaired gas exchange: reduced TLCO
CXR: bilateral interstitial shadowing, ground glass, honeycombing
HRCT: required for dx

38
Q

Mx of IPF

A

Conservative: pulmonary rehab

Medical: little evidence. Some for Pirfenidone. O2 therapy

Surgical: lung transplant

39
Q

4 pulmonary manifestations of sarcoidosis

A

BHL
Dry cough
Progressive dyspnoea
Reduced exercise tolerance

40
Q

Indications for steroids in sarcoidosis

A

CXR stage 2/3 + symptomatic
(BHL + interstitial infiltrates)

41
Q

Ddx for coarse crackles

A

Bronchiectasis (may partially clear after coughing)
Chronic bronchitis

42
Q

ddx for fine crackles

A

Pulmonary fibrosis (interstitial process)

43
Q

Lateral thoracotomy scar ddx

A

Lobectomy (Lung malignancy, localised bronchiectasis, Aspergilloma, Large bullectomy (COPD))

Pneumonectomy (malignancy)

Single lung transplant

Lung volume reduction surgery

44
Q

Describe examination findings in pneumonectomy

A

Left/ right thoracotomy scar
Dull percussion note
Absent breath sounds
Trachea deviation towards pneumonectomy
Reduced expansion

45
Q

Describe examination findings in lobectomy

A

Left/ right thoracotomy scar
May be no other signs due to compensatory hyperexpansion of remaining lobes
May be some reduced expansion, dullness to percussion + reduced air entry

46
Q

Describe CXR of lobectomy/ pneumonectomy

A

FLUID fills cavity of removed lung (radio-OPAQUE)
Organs shift into cavity of removed lung (i.e. heart + trachea displaced)

47
Q

Define bronchiectasis

A

Permanent dilation of air wards secondary to chronic infection or inflammation

48
Q

5 causes of bronchiectasis

A

Post infective: TB, measles, pertussis, pneumonia

CF

Allergic bronchopulmonary aspergillosis

Immune deficiency: selective IgA

Ciliary dyskinetic function: Kartageners syndrome

49
Q

5 S/S of bronchiectasis

A

Persistent PRODUCTIVE cough
Dyspnoea
Haemoptysis
Coarse crackles + wheeze
Clubbing

50
Q

Ix for bronchiectasis

A

Sputum culture
Spirometry
FBC inc. WCC
CXR: r/o other pathology
HRCT: GS- signet ring sign, tram tracking, ring shadows, volume loss

51
Q

Mx of bronchiectasis

A

Physical training: inspiratory muscle training
Postural drainage
Abx for exacerbations
Bronchodilators in some
Immunisations
Surgery in localised disease

52
Q

Most common organism isolated from those with bronchiectasis

A

H influenzae

53
Q

Pathogenesis of CF

A

Increased viscosity of secretions due to defect in CF transmembrane conductance regular gene
Delta F508 on Chr7
Autosomal recessive

54
Q

How may CF present?

A

Neonatal: meconium ileus
Recurrent chest infections
Malabsorption: steatorrhoea, FTT
Liver disease

55
Q

6 features of CF

A

Short
DM
Delayed puberty
Rectal prolapse
Nasal polyps
Infertility/ subfertility

56
Q

Ix for CF

A

Heel prick test (newborn screening)
Sweat test: abnormally high sweat chloride
Genetic test: blood/ saliva

57
Q

Mx of CF

A

MDT approach
BD chest PT + postural drainage
High calorie diet inc. high fat
Minimise contact with other CF
Vitamin supplementation
Pancreatic enzyme supplementation
Lung transplant

58
Q

CI to lung transplant in CF

A

Burkholderia cepacia

59
Q

What drug may be used in CF?

A

Lumacaftor/ Ivacaftor (Orkambi)

60
Q

Causes of pulmonary oedema

A

Cardio: LVF (post MI/ IHD), valvular

ARDS: ?predisposing factors e.g. trauma, sepsis

Fluid overload

Neurogenic: head injury

61
Q

ddx for pulmonary oedema

A

Asthma/ COPD
Pneumonia
(may co-exist)

62
Q

3 Sx of pulmonary oedema

A

Dyspnoea
Orthopnoea
Pink frothy sputum

63
Q

Signs of pulmonary oedema

A

Distressed
Tachycardic
Tachypnoeic
Pulsus alternans
Raised JVP
Fine lung crackles
Wheeze

64
Q

Ix for pulmonary oedema

A

BNP: ?HF
U+Es
Troponin: ?MI
ECG: ?MI, dysrrhythmia
CXR: ABCDE
+/- echo

65
Q

LVF on CXR

A

Alveolar oedema “bats wing”
kerley B lines
Cardiomegaly
Dilated prominent upper lobe veins/ upper lobe diversion
E pleural Effusion

66
Q

How would you manage a patient with acute pulmonary oedema?

A
  1. Sit upright + high flow O2
  2. IV access + monitor ECG
  3. Diamorphine 5mg IV
  4. Furosemide 40-80mg IV
  5. GTN spray SL (not if SBP <90)

Consider further furosemide, nitrate infusion, CPAP

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