Respi Flashcards
(115 cards)
1
Q
Exam findings in ILD
A
- Peripheral cyanosis may be present
- Clubbing +
- Trachea - midline
- Chest wall mm – equal (maximum chest wall expansion reduced)
- Dull percussion
- VBS with fine end inspiratory crepitations (character doesn’t change after coughing)
(both lower zones or both upper zones depend on underlying causes) - Reduced VR
2
Q
Complications to look for in ILD
A
- Signs of pulmonary hypertension and corpulmonale
- Signs of respiratory failure
- Evidence of steroid use
3
Q
Causes to look for in ILD
A
Rheumatological disorder (RA, SS, AS),
Radiation mark,
Drug ho (amiodarone – check
pulse for AF),
Occupational hx
4
Q
Bedside tests in ILD
A
-SpO2, sputum pot (dry)
-Maximum chest wall expansion
5
Q
Signs of respiratory failure
A
Drowsiness
Confusion
Cyanosis
Type 2 RF - Bounding pulse, Warm hand & palmar erythema – d/t CO2 retention
Flapping tremor
6
Q
Signs of pulmonary hypertension
A
- Loud P2(2nd ht sound),
- Palpable P2,
- RVH – Left parasternal heave (+)
- Functional pulmonary regurgitation (EDM at pulmonary area) – Graham Steel murmur
- Functional tricuspid regurgitation (PSM at left lower sternal edge)
7
Q
Signs of Right Ventricular failure
A
Increased JVP,
Liver congestion
Ascites
Peripheral edema
8
Q
Causes of ILD (SIDHO)
A
- Systemic disorders - Rheumatoid arthritis, SLE, systemic sclerosis, MCTD, Sjögren’s
syndrome, Ankylosing spondylitis, Sarcoidosis - Idiopathic pulmonary fibrosis
- Drugs (nitrofurantoin, bleomycin, amiodarone, sulfasalazine, busulfan)
- Hypersensitivity reactions, eg hypersensitivity pneumonitis (EAA)
- Occupational/environmental, eg asbestosis, berylliosis, silicosis, cotton worker’s
lung (byssinosis) - Post Radiation therapy
9
Q
Causes of basal fibrosis (ICARD)
A
Idiopathic pulmonary fibrosis
Rheumatological disease (except ankylosing spondylitis and psoriasis)
Connective tissue disease
Drugs
Asbestosis
10
Q
Causes of apical fibrosis
(ABC LATERS)
A
Allergic bronchopulmonary aspergillosis
Berylliosis
Coal worker’s pneumoconiosis
Langerhans cell histiocytosis (Histiocytosis X)
Ankylosing spondylitis, Psoriasis
Tuberculosis
Extrinsic allergic alveolitis (hypersensitivity pneumonitis)
Radiation
Sarcoidosis, Silicosis
11
Q
Investigations for ILD
A
-CXR – reticulonodular infiltrates, honeycomb lung (if advanced)
- Bilat hilar LN (sarcoidosis)
HRCT – ground glass opacities, honeycomb lung, fibrosis
LFT – restrictive pattern with reduced Diffusing capacity of the Lungs for Carbon monoxide (DLCO)
ABG – usually Type 1 Resp failure
Bronchoscopy & lavage or lung biopsy
Blood tests – FBC, ESR, CRP
Autoimmune profile (ANA, ENA profile)
Rheumatoid factor, AntiCCP
Serum precipitins
Serum ACE
ECG – peak P wave, RVH (tall R in V1, V2) if pulmonary hypertension
12
Q
Treatment of ILD
A
General measures - Supportive care: oxygen, pulmonary rehabilitation, stop smoking
Vaccination (flu, Pneumococcal, Hib, Covid 19)
Treat the underlying cause eg stop drug, avoid exposure
-For IPF – high dose steroids, antifibrotics (Nintedanib and pirfenidone)
-For EAA – steroids
-For Sarcoid – steroid if indicated (Parenchymal lung disease, Uveitis, Hypercalcemia,
Neurological or cardiac involvement)
- Lung transplant in advanced disease
13
Q
Complications of COPD to look for during examination
A
- Signs of pulmonary hypertension and corpulmonale
- Signs of respiratory failure
- Evidence of steroid use
- Associated bronchiectasis or malignant change
14
Q
Causes to look for in COPD examination
A
- Evidence of smoking – tar stain on lip, fingers
- Features of liver insufficiency – alpha1 antitrypsin deficiency
15
Q
Examination findings in COPD
A
- Air trapping resulting in hyperinflation – Increased AP diameter, barrel shaped chest
- Reduced cricosternal notch distance
- Tracheal tug (downward mm dr inspiration)
- Decreased chest expansion
- Hyperresonance percussion note
- Downward displacement of liver dullness
- Obliteration of cardiac dullness
- Airway obstruction – Quiet VBS with prolonged expiration
Bilateral widespread expiratory wheezing
Force expiratory time (FET) > 6s - Increased respiratory effort – accessory ms working (alar nasi, sternomastoid,
intercostal m/s)
16
Q
Bedside tests in COPD
A
-SpO2, Sputum pot examination
-PEFR, FET
-Maximum chest wall expansion
17
Q
Ddx for wheezing (ABC)
A
-COPD
-Bronchiolitis obliterans
-Chronic Asthma, Asthma-COPD overlap symptoms
18
Q
Test for dx of COPD
A
Spirometry postbronchodilator FEV1/FVC <0.7
19
Q
Severity criteria for COPD
A
GOLD 1 - mild: FEV1 ≥80% predicted
GOLD 2 - moderate: 50% ≤ FEV1 <80% predicted
GOLD 3 - severe: 30% ≤ FEV1 <50% predicted
GOLD 4 - very severe: FEV1 <30% predicted
20
Q
Types of COPD
A
- Chronic bronchitis ( Blue bloater )
- Emphysema ( Pink puffer )
21
Q
Investigations for COPD
A
- CXR – Hyper-inflated lung fields with flattened diaphragms & Long narrow heart
shadow, Hyperlucency of lung fields, reduced peripheral vascular markings, Bullae - HRCT – more sensitive
- LFT – obstructive pattern with reduced DLCO
- ABG – Type 2 resp failure
- Blood tests – FBC (polycythemia, neutrophil leukocytosis), ESR, CRP
U&e creat, LFT - Alpha 1 antitrypsin level
- Sputum C&S
- ECG – peak P wave, RVH (tall R in V1, V2) if pulmonary hypertension
22
Q
Score for determining prognosis of COPD
A
BODE index
BMI
Obstruction by FEV1
Dyspnoea by MRC scale,
Exercise by 6 min walk test
23
Q
Common pathogens involved in AIE of COPD
A
Streptococcus pneumoniae
Haemophilius influenzae
Morexella catarrhalis
24
Q
General treatment measures for COPD
A
- Supportive care: oxygen, pulmonary rehabilitation, stop smoking,
vaccination (flu, Pneumococcal
25
Management of Acute exacerbation of COPD
- Controlled oxygen therapy Target SPO2 88-92%
- Nebulized bronchodilators
- Antibiotics if evidence of infection
- Steroids
- Non-invasive ventilation for severe hypercapnoeic respiratory failure
Invasive ventilation & ICU care
26
Management of chronic stable COPD
(Clinically stable non-smokers with 2 separate measurements of ABG 3 weeks apart
- PaO2 <7.3kPa despite maximal Tx
- PaO2 7.3–8.0 and pulmonary hypertension or polycythemia or peripheral oedema
or nocturnal hypoxia)
- Inhaler bronchodilator (LAMA +/- LABA +/- corticosteroids)
- Mucolytics
- Roflumilast to reduce exacerbation in chronic bronchitis
- Long term antibiotic therapy with azithromycin (250mg/day or 500mg 3 times/week
for 1 year) to reduce exacerbation
27
What is the role of surgery in COPD?
- Bullectomy
- Lung volume reduction surgery
- Bronchoscopic intervention of endobronchial valve/ lung coils
- Lung transplant
28
Examination findings in Bronchiectasis
- Clubbing +, fever, productive cough
- Trachea midline
- Chest wall mm normal
- Normal percussion note
- VBS with coarse crepitations (character change after coughing)
(Localize in one zone or may be bilateral)
- Wheezing may be present
- Normal VR
29
Complications to look for in bronchiectasis
- Signs of pulmonary hypertension and corpulmonale
- Signs of respiratory failure
30
Causes of bronchiectasis to look for during examination
- Cystic fibrosis – check RBS
- Kartagener’s syndrome – check apex beat for dextrocardia
- Evidence of RA
- HO childhood TB
31
Bedside tests to be done during examination for bronchiectasis
-SpO2
-Temperature
-Sputum pot examination
32
Ddx for crepitations and clubbing
- Interstitial lung disease
- Bronchiectasis
- CA lung
- Lung abscess
33
Respiratory causes of clubbing
Malignancy – Bronchogenic carcinoma, mesothelioma
Suppurative lung disease – empyema, lung abscess, bronchiectasis
Pulmonary fibrosis
34
What are the causes of bronchiectasis?
• Respiratory childhood infections - Pertussis, Measles, Tuberculosis
• Bronchial obstruction- Foreign body, Chronic aspiration, Endobronchial tumour,
Lymph nodes (tuberculosis, sarcoidosis, and malignancy)
• Muco-ciliary clearance defects - Cystic fibrosis, lmmotile cilia syndrome,
Kartagener's syndrome, Young syndrome
• Immunodeficiency - Congenital and acquired hypogammaglobulinaemia, Acquired
Immunodeficiency syndrome (AIDS)
• Allergic bronchopulmonary aspergillosis
• Autoimmune disease - Rheumatoid lung, Sjogren syndrome, IBD (UC > Crohn's)
• Idiopathic
35
Common pathogens in bronchiectasis
- Staphylococcus aureus
- Haemophilus influenzae
- Pseudomonas aeruginosa
- Streptococcus pneumoniae
- Klebsiella pneumoniae
- Aspergillus species
36
Investigations in bronchiectasis
- CXR – cystic shadows, thickened bronchial walls (tramline and ring shadows)
- HRCT – more sensitive
- LFT – usually obstructive pattern
- Sputum C&S
- Bronchoscopy
- Blood tests – FBC, ESR, CRP, U&e creat, LFT
- Serum immunoglobulins
- CF sweat test, RBS
- Aspergillus precipitins or skin-prick test RAST and total IgE
37
Treatment of bronchiectasis
*General measures - Supportive care: oxygen, pulmonary rehabilitation, stop
smoking, vaccination
*Airway clearance techniques - Chest physiotherapy & postural drainage
*Mucolytic (Nebulized DNase, hypertonic saline)
*Antibiotics should be prescribed according to bacterial sensitivities.
If ≥3 exacerbations per year, consider long-term nebulized antibiotics (Nebulized
tobramycin)
*Bronchodilators (eg nebulized salbutamol) may be useful in patients with asthma,
COPD, CF, ABPA
*Corticosteroids (eg prednisolone) and itraconazole for ABPA
*Surgery may be indicated in localized disease or to control severe hemoptysis
*Double lung transplant in advanced cases
38
Examination findings in pleural effusion
- Trachea/mediastinal – shift to opposite side
- Chest expansion – reduced
- Percussion note – stony dull
- Breath sound – reduced or absent VBS (rarely – BBS in area just above effusion)
- Vocal resonance – reduced
39
Complications of pleural effusion to look for during examination
Empyema – clubbing, fever
40
Causes of pleural effusion to look for during examination
- Generalized fluid overload features (bilat effusion) – cardiac, renal, liver, malnutrition
-LN, breast examination, Abd examination, testicular swelling
-Connective tissue disease features
41
Bedside tests to do during examination for pleural effusion
-SpO2
-Temperature
-Sputum pot examination
42
Ddx of pleural effusion
- Mass lesion
- Pleural thickening (dull percussion, normal VBS, VR N or reduced)
- Raised dome of diaphragm
43
Ddx of dullness at lung base
- Pleural effusion
- Pleural thickening
- Mass lesion
- Raised dome of diaphragm
- Collapse
- Lower lobe lobectomy if scar (+)
44
Transudative causes of pleural effusion
Congestive cardiac failure
Hypoalbuminemia
Nephrotic syndrome
Cirrhosis
45
Exudative causes of pleural effusion
Neoplasia
* Carcinoma of the lung, Mesothelioma, Lymphoma
* Secondary malignancy (breast, ovarian, pancreatic, and gastrointestinal)
CTD - Rheumatoid arthritis, SLE
lnfection - Pneumonia, Tuberculosis
Pulmonary infarction
46
Light's criteria for pleural effusion
Exudate if 1 or > criteria present
-Pleural fluid protein/serum protein >0.5
-Pleural fluid LDH/serum LDH >0.6
-Pleural fluid LDH >2/3 of upper limit of
normal serum LDH
47
Investigations done for pleural effusion
CXR – loss of costophrenic angle, homogenous opacity with upper meniscus border
USG chest
Pleural aspiration (for RE, cytology, Gram stain, C&S, AFB) +/- Pleural biopsy
Sputum C&S, AFB, cytology
CT chest, Bronchoscopy, CT abdomen
CTPA for PE
Blood tests – FBC, ESR, CRP
U&e creat, LFT
Autoimmune screen (ANA, ENA), RF, D-dimer
48
Treatment of pleural effusion
* Tx the underlying cause
* Therapeutic drainage (0.5–1.5L/24h)
* ICD drainage f/b Pleurodesis (with talc, doxycycline, bleomycin) for recurrent
malignant effusions
* ICD insertion esp for empyema +/- Intra-pleural alteplase and dornase alfa
49
Examination findings in consolidation
Trachea/mediastinal – midline (no shift)
Chest expansion – reduced
Percussion note – dull
Breath sound – BBS +/- coarse crepts +/- pleural rub
Vocal resonance – increased (whispering pectoriloquy)
50
Complications to look for in consolidation during examination
Signs of respiratory failure
Signs of sepsis
Tachycardia, low BP
51
Causes to look for in consolidation during examination
- Pneumonia (pyrexia, purulent sputum, hemoptysis)
- Malignancy (cachexia, clubbing, nicotine staining, LN, productive cough)
- Infarction (signs of pulmonary hypertension, DVT
52
Bedside to be done during examination for consolidation
-SpO2
-Temperature
-Sputum pot examination
53
Investigations for consolidation
CXR – homogenous or inhomogeneous opacity, air bronchogram
Sputum C&S, AFB, cytology
CT chest, Bronchoscopy
D-dimer, CTPA, ECG,
Echo for PE
Blood tests – FBC, ESR, CRP
U&e creat, LFT
ABG analysis – Type 1 Resp failure
Pleural aspiration if associated effusion
54
Typical organisms in CAP
Bacterial - Streptococcus pneumoniae (commonest),
Staphylococcus aureus, Haemophilus influenza / Viral infection
55
Atypical organisms in CAP
Mycoplasma pneumoniae, Legionella species, Chlamydia
56
Organisms in HAP
Gram-negative enterobacteria or Staph. Aureus, Pseudomonas,
Klebsiella, Bacteroides, and Clostridia
57
Severity score for consolidation
CURB-65
Confusion (Mental test score of 8 or less or new disorientation in person, place or time)
Urea > 7mmol/L
Respiratory rate > 30/min
BP (Sys <90mmHg Dias <60mmHg)
Age >65yrs
58
Treatment of pneumonia with CURB score 0-1
PO antibiotic/home treatment - PO amoxicillin or clarithromycin or doxycycline 5D
59
Treatment of pneumonia with CURB score 2
PO amoxicillin + clarithromycin or doxycycline 7D
If IV required: IV amoxicillin + clarithromycin
60
Treatment of pneumonia with CURB score ≥3
ITU care –
IV Co-amoxiclav or cephalosporin (eg cefuroxime) + clarithromycin 7-10D
Add flucloxacillin ± rifampicin if Staph suspected
Vancomycin, linezolid, clinda (or teicoplanin) if MRSA suspected 14-21 D
61
Treatment for pneumonia caused by atypical organisms
Legionella - Fluoroquinolone combined with clarithromycin, or rifampicin
Chlamydophila –Tetracycline
Mycoplasma – Clarithromycin or quinolone
Pneumocystis jirovecii - High-dose co-trimoxazole
62
Treatment for HAP
IV Aminoglycoside + antipseudomonal penicillin or 3rd-gen cephalosporin
63
Treatment for pulmonary infarction
Anticoagulation – SC LMW Heparin f/b warfarin
64
Examination findings in complete/total collapse
Affected area – flat on inspection, rib crowding may be seen
Trachea/mediastinal – pull towards side of lesion
Chest expansion – reduced
Percussion note – dull
Breath sound – reduced VBS
Vocal resonance – reduced
65
Examination findings in partial collapse
Affected area – flat on inspection
Trachea/mediastinal – pull towards side of lesion
Chest expansion – reduced
Percussion note – dull
Breath sound – BBS
Vocal resonance – increased
66
Complications to look for in collapse during examination
Respiratory failure
67
Causes to look for in collapse during examination
Malignancy (cachexia, dubbing, nicotine staining, lymphadenopathy)
- Tuberculosis (apical signs, lymphadenopathy)
- Hilar lymphadenopathy, i.e. sarcoidosis (erythema nodosum, maculopapular skin
lesions, lupus pernio, lymphadenopathy)
- Mucus plugs (features of asthma, COPD, or bronchiectasis)
68
Bedside tests to do during examination of collapse
-SpO2
-Temperature
-Sputum pot examination
69
Obstructive causes of collapse
Malignancy
Extrinsic compression by hilar lymphadenopathy (sarcoidosis, tuberculosis)
Tuberculosis
Mucus plugs (asthma, COPD, bronchiectasis)
Foreign body
70
Non-obstructive causes of collapse
Passive atelectasis – pl effusion, large bullae
Compression atelectasis – mass lesion
Adhesive atelectasis – ARDS
Cicatrization atelectasis – ILD, severe scarring
71
Investigations in collapse
CXR – lung opacity with mediastinal shift
towards the effected side
Sputum C&S, AFB, cytology
CT chest, Bronchoscopy for malignancy
Blood tests – FBC, ESR, CRP
U&e creat, LFT
ABG analysis – Type 1 Resp failure
72
Treatment of collapse
General measures - Supportive care: oxygen, pulmonary rehabilitation, stop smoking
Treat underlying cause
Eg. Tx of malignancy
Tx of TB
Mucolytics, Bronchoscopy and suction for mucus plug obstruction
Bronchoscopy and removal of foreign body
73
Types of lung Ca
Small cell
Non-small cell
adeno
squamous
anaplastic/large cell
bronchoalveolar CA
74
Presentation of Ca lung/ Superior Vena Cava Obstruction (SVCO)
Pl effusion
Consolidation
Collapse
Mass lesion (esp upper lobe-check Horner’s, C8-T1 radiculopathy, SVCO)
75
Examination findings of mass lesion
- Trachea/mediastinal – shift to opposite side
- Chest expansion – reduced
- Percussion note – dull
- Breath sound – reduced or absent VBS
- Vocal resonance – reduced
76
Signs of malignancy
- Cachexia, Cervical or supraclavicular LN, Evidence of smoking
- Finger clubbing, Hypertrophic pulmonary osteoarthropathy (HPOA)
77
Signs of pancoast tumor/upper lobe mass lesion
-Horner’s S (partial ptosis, miosis, enopthalmos, unilateral facial anhydrosis)
-C8-T1 radiculopathy (unilateral wasting of small m/s of hands, reduced sensation in
C8-T1 dermatomes)
-SVCO (facial plethora, dilated veins in upper chest & arms, non-pulsatile raised JVP)
78
Endocrine manifestations of paraneoplastic syndrome
SIADH (ectopic ADH hormone production)
Cushing syndrome (ectopic ACTH production)
Hypercalcemia (ectopic PTH-related peptide production)
Hyperthyroidism (ectopic thyroid stimulating hormone (TSH) production)
Hypoglycemia (ectopic insulin-like growth factor production)
79
Neurological manifestations of paraneoplastic syndrome
Lambert-Eaten myasthenic syndrome (pre-synapticV-gated Ca2 channel antibodies)
Subacute cerebellar degeneration (anti-Yo)
Sensory neuropathy (anti-Hu antibody)
Limbic encephalopathy (anti-Hu, anti-Yo antibodies)
80
Musculoskeletal manifestations of paraneoplastic syndrome
Polymyositis/Dermatomyositis (Anti Jo1 or Mi2, CK)
Clubbing
Hypertrophic pulmonary osteoarthropathy
81
Cutaneous manifestations of paraneoplastic syndrome
Acanthosis nigricans
Gynaecomastia (ectopic HCG production)
Thrombophlebitis
Thrombosis (Trousseau syndrome)
Ichthyosis
82
Investigations for lung CA
CXR
CT (chest)
Bronchoscopy and biopsy
Image (USG or CT) guided direct needle Bx
LN biopsy
Sputum cytology
USG chest, Pleural aspiration if associated effusion
CT abdomen, PET scan, Bone scan
Paraneoplastic hormone
Basic blood tests – FBC, ESR, U&E creatinine, LFT, Calcium
Lung function test preop assessment
83
Treatment of lung CA
D/p on staging,
Curative – surgical resection (pneumonectomy or lobectomy)
Chemotherapy
Radiotherapy
Combination therapy
Palliative care (pain control)
If SVCO – steroid, radiotherapy or chemotherapy, SVC stenting
anticoagulation if thrombosis present
84
Clinical presentation of Tuberculosis
Pleural effusion
Consolidation
Collapse
Fibrosis or fibro-cavitatory lesion
85
Examination findings of fibrosis with complete collapse + crepts in TB
Affected area – depressed
Trachea/mediastinal – pull to same side
Chest expansion – reduced
Percussion note – dull
Breath sound – reduced VBS with fine crepitations (character doesn’t change after
coughing)
Vocal resonance – reduced
86
Examination findings of fibrocavitatory lesion with partial collapse + crepts in TB
Affected area – depressed
Trachea/mediastinal – pull to same side
Chest expansion – reduced
Percussion note – dull
Breath sound – BBS with fine crepitations (character doesn’t change after coughing)
Vocal resonance – increased
87
Investigations in TB
CXR, CT chest
Sputum for AFB, gene X pert, AFB culture, Bronchoscopy and washing for AFB
Tuberculin test, IGRA (interferon gamma release assay) – latent TB
LN biopsy
Pleural fluid analysis +/- pleural biopsy if associated effusion
Blood tests - FBC, ESR, U&E creat, LFT, HIV test
88
Treatment of Tuberculosis
Anti TB (2 HRZE + 4 HR) 6 months if active infection
Chest physiotherapy / pulmonary rehabilitation for old TB lesion
89
Clinical presentation of rheumatoid lung
Basal fibrosis
Bronchiolitis obliterans
Bronchiectasis
Pleural thickening
Pulmonary nodules
Pleural effusion
90
Investigations for rheumatoid lung
CXR
HRCT
Lung function test (restrictive if fibrosis, obstructive if bronchiolitis)
Rheumatoid factor, Anti CCP
FBC, ESR, CRP
Pleural fluid analysis if effusion
Other baseline testsT
91
Treatment of rheumatoid lung
General measures – oxygen, smoking cessation, chest physio, inhaler bronchodilators
Specific measures dp on pattern of involvement
Treatment of RA
92
Examination findings in lobectomy and pneumonectomy
- Lateral thoracotomy scar (+)
- Abnormal lung signs present on the same side of scar
93
Complications to look for in examination of a patient with lobectomy and pneumonectomy
- respiratory failure
- compensatory emphysema
94
Causes to look for in examination of a patient with lobectomy and pneumonectomy
clubbing
old radiation marks
95
Bedside tests in examination of a patient with lobectomy and pneumonectomy
SpO2
Maximum chest wall expansion
PEFR
sputum pot
96
Indications for lobectomy
Malignancy (NSCLC)
Solitary pulmonary nodule
Lf pneumonectomy
LUL lobectomy
Bronchiectasis (uncontrolled symptoms, i.e. recurrent haemoptysis)
Cystic fibrosis
Tuberculosis
Lung abscess
97
Indications for pneumonectomy
Malignancy (CA lung, Mesothelioma, Metastasis)
Chronic lung infection or destroyed lung (Bronchiectasis, Tuberculosis, fungal inf)
Traumatic lung injury
98
CI for lobectomy
preop pulmonary function FEV1 < 1.5L
99
CI for pneumonectomy
preop pulmonary function FEV1 <2L or
predicted post op FEV1 <0.8L
100
Early post operative complications in lobectomy/pneumonectomy
bleeding,
wound infection
empyema
bronchopleural fistula
AF
DVT
PE
101
Long term complications of lobectomy/pneumonectomy
Compensatory emphysema
Post pneumonectomy syndrome (compression and stretching of
tracheobronchial tree and oesophagus d/t excessive mediastinal shift)
Inadequate lung function
102
Investigations in S/P lobectomy/pneumonectomy
CXR
CT chest
Monitoring of tumor recurrence if it is treated for CA
Reassessment of TB activity if it is treated for TB
Lung function test
Blood tests
103
Treatment of S/P lobectomy/pneumonectomy
Pulmonary rehabilitation
Tx of underlying condition
104
3 types of lung transplant
- Single lung transplant
- Bilateral (Double) lung transplant
- Combined heart-lung transplant
105
Examination findings in S/P lung transplant
- Scar (+)
SLT – unilateral lateral thoracotomy scar with normal respi examination on that side
and abnormal lung signs present on opposite site (pul fibrosis or emphysema)
DLT - transverse sternotomy or Clamshell scar with normal respi examination
- Transverse sternotomy or Clamshell scar
106
Complications to look for during examination of S/P lung transplant
Lung transplant functioning well or not - Respiratory failure features
- Chronic rejection (bronchiolitis obliterans) -SE of immunosuppressants
-Stigmata of infection, Benign and malignant skin lesions
-Complications relating to specific drugs:
Cyclosporin & Tacrolimus: gum hypertrophy, hirsutism, coarse tremor, hypertension,
diabetes mellitus, nephrotoxicity
Steroids: Cushingoid features (moon face, acne, striae, purpura), DM, hypertension
Azathioprine: Jaundice, anemia
MMF: anemia
107
Causes to look for in S/P lung transplant
-SLT – check other lung for pulmonary fibrosis or emphysema
-DLT – clubbing, previous central line scar for antibiotics and treating sepsis
108
Bedside tests to do in examination of S/P lung transplant
- SpO2, BP, Temperature, RBS
- Sputum pot examination
- Maximum chest wall expansion - Peak Expiratory Flow Rate (PEFR) if needed
109
Investigations for lung transplant
CXR (PA)
Lung function test
FBC, renal function, LFT
CVD risks – RBS, HbA1C, lipid profile
110
Indications for single lung transplant
Pulmonary fibrosis
Advanced emphysema
111
Indications for double lung transplant
Chronic bilateral pulmonary infection such as cystic fibrosis, bronchiectasis
112
Indications for combined heart-lung transplant
Advanced congenital heart disease complicated by Eisenmenger syndrome
Primary pulmonary hypertension unresponsive to medical therapy
Advanced lung ds with pulmonary hypertension with cor-pulmonale
113
CI to lung transplant
Current or recurring infection
Metastatic cancer
Severe heart problem or Serious health condition that cannot tolerate major surgery
114
Complications of lung transplant (Procedure related)
Bleeding, infection
Thrombosis of pulmonary artery
Stenosis of airways
115
Complications of lung transplant (Rejection)
Acute rejection
Chronic lung allograft dysfunction (CLAD)
Chronic rejection with obliterative bronchiolitis
