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Respiratory Flashcards

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1
Q

Functions of resp system

A

Gas exchange
pH regulation
Speech
Protection from infection

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2
Q

Average rate/minute

A

O2 - 250ml
CO2 - 200ml

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3
Q

Anatomy of resp system

A

Nose
Pharynx
Epiglottis
Larynx
Trachea
Bronchus
Lungs

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4
Q

How is patency of airways maintained

A

C shaped rings of cartilage

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5
Q

How can diameter of bronchiole be adjusted

A

Smooth muscle contraction

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6
Q

Conduction segment

A

Trachea
Primary bronchi
Smaller bronchi
Large bronchioles

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7
Q

Respiratory segment

A

Small bronchioles
Alveoli

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8
Q

Parts of lung

A

Right:
Superior lobe
Middle lobe
Inferior lobe

Left:
Superior lobe
Inferior lobe

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9
Q

Tidal volume

A

Volume in and out normally breathing

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10
Q

Expiratory reserve volume

A

Maximum volume that can be expelled from lungs without taking a big breath in first

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11
Q

Inspiratory reserve volume

A

Max volume that can be drawn into lungs

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12
Q

Residual volume

A

Air that always stays in lungs

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13
Q

Vital capacity

A

Inspiratory reserve volume + expiratory reserve volume + tidal volume

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14
Q

Functional residual capacity

A

Expiratory reserve volume + residual volume

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15
Q

Inspiratory capacity

A

Tidal volume + Inspiratory reserve volume

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16
Q

Average pulmonary volumes male and female

A

Male:
FVC - 4600ml
TLC - 5800ml

Female:
FVC - 3100ml
TLC - 4200ml

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17
Q

What allows expansion and contraction of alveoli

A

Elastin/elastic fibres

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18
Q

Parts of pleura

A

Visceral pleura
Intrapleural fluid
Parietal pleura

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19
Q

Function of pleural fluid

A

Allows pleural membranes to glide across eachother

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20
Q

How is lung held to thorax wall

A

Vacuum force within pleural membranes

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21
Q

What is sinus arrhythmia

A

Pulse increase during inspiration

Pulse decrease during expiration

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22
Q

Cause of sinus arrhythmia

A

Vagus nerve activation

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23
Q

What is shunt

A

Perfusion > ventilation

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24
Q

What is alveolar dead space

A

Ventilation > perfusion

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25
What is anatomical dead space
Air in conduction portion of airway
26
What is physiological dead space
Alveolar dead space + anatomical dead space
27
What is compliance of lungs
How easily lungs stretch upon inspiration
28
What cells produce surfactant
Type 2 pneumocyte
29
Surfactant function
Increase compliance
30
How does surfactant increase compliance
Reduce surface tension within alveoli
31
When does surfactant production begin
Week 25 gestation
32
When is surfactant production fully functional
Week 36
33
What is it called when premature babies struggle to breathe due to insufficient surfactant production
IRDS Infant respiratory distress syndrome
34
Muscles of inspiration
External intercostals Diaphragm Scalenes Sternocleidomastoid
35
Muscles of expiration
Passive while resting Internal intercostals Abdominal muscles
36
What is intrathoracic pressure (Pa)
Pressure within lungs Can be + or -
37
What is intrapleural pressure (Pip)
Pressure in pleural cavity Typically -ve in healthy lungs
38
What is trans pulmonary pressure (PT)
Difference between PA and Pip Almost always positive PT = Pa - Pip
39
How is gas transported in blood per litre
3ml O2 dissolved 197ml O2 on haemoglobin 77% CO2 dissolved 23% on deoxyhaemoglobin
40
What is cooperativity
When O2 binds to one subunit of haemoglobin it makes other units more likely to bind haemoglobin
41
What largely effects cooperativity of O2
Dissolved O2 in blood Known as Bohr effect
42
What increases O2 affinity for haemoglobin
Increase pH Decreased CO2 Decreased temperature Reduced DPG
43
What decreases O2 affinity for haemoglobin
Decreased pH Increased CO2 Increased temperature Increased DPG
44
What produces DPG
Metabolism of erythrocytes Often occurs in hypoxic areas
45
Why is CO so dangerous
Binds to Hb 250x easier than O2
46
Symptoms of CO poisoning
Hypoxia Anaemia Nausea Headache Resp rate normal CHERRY RED SKIN + MUCOUS MEMBRANES
47
Types of Hb
HbA - most Hb HbA2 HbF - foetal - higher affinity for O2 Glcosylated Hb - when Hb exposed to high levels of glucose Myoglobin - not actually a Hb, O2 carrier in muscle
48
Describe CO2 transport
7% remains dissolved 23% binds to form deoxyhaemoglobin 70% binds with water to form carbonic acid Reverse of this happens in pulmonary capillaries
49
Normal partial pressures of O2 and CO2 in blood
O2: 100mmHg 13kPa CO2: 40mmHg 5kPa
50
5 main types of hypoxia
Hypoxaemic hypoxia -decreased O2 from lungs Anaemic Hypoxia -reduced O2 carry capacity Stagnant hypoxia -insufficient heart pumping Histotoxic hypoxia -blocks cells using O2 I.E. CO poisoning Metabolic hypoxia -cell O2 demand too high
51
Pulmonary vs alveolar ventilation
Pulmonary: Total air entering lungs Alveolar: New air reaching alveoli
52
What is hyperventilation
Too much O2 Alveolar ventilation too fast
53
What is hypoventilation
Too little O2 Alveolar ventilation too slow
54
What is normal pulmonary blood pressure
25/10mmHg
55
What is the difference between A and a
A = alveolar a = arterial blood
56
Factors affecting rate of diffusion
Partial pressure gradient Gas solubility Available surface area Thickness of membrane
57
Types of spirometry
Static - volume exhaled Dynamic - time + volume exhaled
58
What is FEV1
Forced expiratory volume in 1 second
59
What is a normal FEV1/FVC I healthy people
80%
60
What does a high FEV1/FVC indicate
Restrictive lung disease
61
What does a low FEV1/FVC indicate
Obstructive lung disease
62
Symptoms of asthma
WHEEZE Chronic Dry/nocturnal/exertional cough Dyspnoea Reversible with Rx Multiple triggers
63
Why is NO test important
Tests for eosinophils in allergy/asthma
64
Important factors in history of suspected asthma
Family history of atopy Personal history of atopy Triggers
65
Types of asthma medication
SABA Inhaled corticosteroids LABA Leukotriene receptor antagonist Theophyllines Oral steroid
66
Side effects of ICS
Height suppression Oral thrush Suppression of natural hormones
67
What are the next steps if ICS is ineffective
LABA first Then consider LTRA/increasing ICS dose
68
LTRA drug name
Montelukast
69
Asthma delivery systems
MDI + spacer Dry powder device Nebuliser
70
Management of asthma exacerbation
Mild: -SABA + prednisolone Moderate: -SABA via neb + prednisolone + ipratropium albuterol Severe: -IV salbutamol, aminophylline, magnesium, hydrocortisone -intubate/ventilate
71
Non medical management of asthma
Remove triggers ie pets Avoid tobacco exposure
72
How do we measure asthma control
SANE Saba per week Absence from school/nursery Nocturnal symptoms per week Exertional symptoms per week
73
Is asthma obstructive or restrictive
Obstructive
74
Asthma risk factors
Genes -atopy Smoking -maternal during pregnancy -grandmother smoking Occupation Obesity Diet
75
Asthma severity assessment
Ability to speak HR RR PEF Sats ABG
76
Main test for asthma in adults
Spirometry
77
Other useful tests for asthma in adults
CXR Skin prick Total and specific IgE count FBC - eosinophilia
78
Specialist options for asthma in adults
Omalizumab (anti-IgE) Mepolizumab (anti-IL-5) Bronchial thermoplasty
79
Oral asthma therapies
LTRAs Theophylline Prednisolone
80
SABAs
Salbutamol Terbutaline
81
COPD causes
SMOKING pollution Occupational exposures Asthma Alpha-1 antitrypsin deficiency
82
COPD symptoms
Cough Dsypnoea Sputum Frequent chest infection Wheeze
83
Clinical signs of COPD
Cyanosis Cachexia Difficulty breathing Raised JVP Wheeze Hyperinflated/barrel chest Peripheral oedema
84
Types of respiratory failure
Type 1: decreased blood O2 Type 2: decreased blood O2 increased blood CO2
85
COPD spirometry
<0.7
86
Severe symptoms of COPD
Type 1 and 2 resp failure Cor pulmonale
87
Key features of COPD
>35 yrs Smokes Absence of asthma Obstructive spirometry CXR -hyperinflation of lungs -flat diaphragm -vascular hilum
88
Pulmonary function test of COPD
Increased volumes Low FEV1/FVC
89
What diseases combine to make COPD
Chronic bronchitis Emphysema
90
Non pharmacological management of COPD
SMOKING CESSATION Pulmonary rehab Vaccines -pneumococcus -influenza
91
Pharmacological management of COPD
SABA eg salbutamol SAMA eg ipratropium LAMA eg umeclidinium LABA eg salmeterol ICS + LABA - revlar (fluticasone/vilanterol) -fostair MDI
92
Signs of COPD exacerbation
Increased SOB Cough Sputum volume/colour Wheeze Chest tightness
93
COPD exacerbation management
Nebulised bronchodilator Corticosteroids Antibiotics Asses for resp failure
94
Management of acute resp failure
NIV Non invasive ventilation
95
Investigation of COPD exacerbation
FBC ABG ECG CXR Blood culture in febrile patients Sputum culture + sensitivities
96
Palliative care of COPD
Morphine Psychological support DNACPR? Discuss ceiling of treatment
97
Factors affecting Respiratory Infection
Microorganism pathogenicity Capacity to resist infection Population at risk
98
Acute Epiglotitis Cause
Haemophilus influenza type B Group A beta-haemolytic Strep
99
Types of LRTI
Bronchitis Bronchiolitis Pneumonia Bronchiectasis
100
Defence mechanisms of Respiratory tract
Macrophage-mucociliary escalatory system General immune system Resp tract secretions URT is a filter
101
Classifications of pneumonia
Anatomical Aetiological Microbiological
102
Causes of aspiration pneumonia
Vomiting Oesophageal lesion Obstetric anaesthesia Neuromuscular disorders Sedation
103
Vulnerable groups to TB
HIV/immunocompromised patients Elderly, neonates, diabetics
104
3 main groups of mycobateria
Tuberculosis Non-tuberculosis mycobacteria Leprosy
105
Bacteria causing TB
Mycobacterium Tuberculosis Mycobacterium Africanum Mycobacterium Bovis
106
Bacteria causing leprosy
Mycobacterium Leprae
107
Transmission of TB
Airborne - aerosol droplets EXCEPT M.Bovis spread through infected unpastuerized cow milk
108
TB clinical presentation
Cough Fever Night sweats Weight loss
109
CXR of TB findings
Fluffy/nodular apices Pleural effusion Miliary TB Pneumonic lesion with hilar lymphadenopathy
110
Investigation of TB
Sputum culture - 3 samples 8-24hrs gap Induced sputum Bronchoscopy Endobronchial US Lumbar puncture Urine Aspirate/biopsy from tissue
111
3 Outcomes of TB
Cleared/cured Contained latent Progressive disease
112
What is contained latent TB
Bacteria present doesn't cause disease Asymptomatic
113
Contained latent TB treatment
Rifampicin + isoniazid for 3 months
114
What is progressive TB
Tuberculosis bronchopneumonia Miliary TB
115
Rules of clinical management of TB
Multi antibiotic therapy Must last 6 months Done by specialists only Legally required to notify all cases Test for HIV, Hep B + C
116
Antibiotic Therapy of TB
First 2 months: Isoniazid + Pyrazinamide + Rifampicin + Ethambutol Last 4 months: Rifampicin + Isoniazid
117
Croup Treatment
Oral Dexamethasone
118
Epiglotitis Treatment
Intubation + antibiotics
119
Rhinitis Typical Duration
12 days
120
What does otitis media look like
Red Swelling Can rupture eardrum
121
Otitis media typical duration
3 days
122
Otitis media treatment
Analgesia If antibiotics, wait at least 24hrs
123
Tonsillitis/pharyngitis treatment
NOT amoxicillin Viral - no treatment Bacterial - penicillin 10 days
124
Tonsillitis/pharyngitis indications of bacterial infection
FeverPAIN score Scarlett fever indicates bacterial Swab
125
Croup symptoms
stridor hoarsness barking cough
126
Epiglottits symptoms
Stridor Drooling
127
Common bacteria causing LRTI in children
Strep Pneumoniae Haemophilis influenzae Moraxella Catarrhalis Mycoplasma Pneumoniae Chlamydia Pneumoniae
128
Common viruses causing LRTI in children
RSV Parainfluenza III Influenza A + B Adenovirus
129
General management of LRTI in children
O2 Hydration Nutrition
130
Tracheitis (croup which doesn't get better) treatment
Augmentin (Co-amoxiclav)
131
Bronchitis symptoms
Loose rattly cough Hx of URTI Post-tussive vomit No wheeze/crackle
132
Common pathogens causing bronchitis in children
Haemophilus Pneumococcus
133
Bronchitis treatment in children
None
134
Bronchiolitis symptoms
Nasal stuffiness Tachypnoea Poor feeding
135
Bronchiolitis findings
Crackles NO wheeze
136
Bronchiolitis typical duration
12 days worst at 5
137
Management of bronchiolitis
Maximal observation Minimal intervention Watch O2 sats
138
Pertussis symptoms
Whooping cough
139
Pneumonia symptoms
>48 hr fever SOB Grunting Reduced/bronchial breathing sounds
140
Pneumonia clinical findings
Crackles in 1 area (focal) Focal consolidation High fever
141
Management of pneumonia in children
Nothing if mild First line - amoxicillin 2nd line - macrolide IV antibiotics if child vomiting
142
Empyaema symptoms
Unwell Alot of pain
143
Empyaema treatment
Surgically drained IV antibiotics
144
Adult acute bronchitis duration
< 3 weeks
145
Commonest bronchiolitis cause
RSV
146
Acute bronchitis treatment
none/supportive
147
COPD exacerbation via infection symptoms
Sputum colour change Fever Increased SOB Wheeze Cough
148
Infectious causes of COPD exacerbation
Strep H.Influenzae Moraxella Catarrhalis Viral
149
Bronchiectasis causes
Idiopathic Childhood infection CF Ciliary Dyskinesia Hypogammaglobinaemia Allergic bronchopulmonary aspergillosis (ABPA)
150
Infective exacerbation of bronchiectasis
S.Aureus H.Influenzae Pseudomonas Aerigunosa
151
Signs + symptoms of bronchiectasis
Obstructive spirometry CXR - signet ring Chronic sputum production SOB Recurrent LRTI Haemoptysis Clubbing Coarse crackles Wheeze
152
Risk factors of pneumonia
Smoking + alcohol Age Viral illness Pre existing lung disease Immunocompromised IVDU Hospital environment
153
Types of pneumonia
Bronchopneumonia Lobar pneumonia Interstitial pneumonia
154
Pneumonia symptoms
Fever Rigors Myalgia Cough + sputum Pleuritic chest pain Dsypnoea Haemoptysis
155
Pneumonia signs
Tachy-pnoea/cardia Reduced chest expansion Dull patches in percussion Crepitations High vocal resonance
156
Pneumonia investigations
CXR In hospital: Bloods Swab Sputum culture Legionella urinary antigen
157
How is pneumonia severity scored
CURB65 score
158
What does CURB65 mean
Confusion Urea - blood urea > 7mmol/L Resp Rate >= 30 Blood Pressure < 90 S < 60 D 65 age >= 65
159
Treatment for CURB65 score 0-1
Amoxicillin Or for penicillin allergy Clarithromycin or doxycycline
160
Treatment for CURB65 score of 2
Amoxicillin + clarithromycin Or for penicillin allergy Levofloxacin
161
Treatment for CURB65 score 3-5
Co-amoxiclav + clarithromycin Or for penicillin allergy Levofloxacin or co-trimoxazole
162
Causes of recurrent pneumonia
Immunocompromised Underlying structural disease Aspiration?
163
Complications of pneumonia
Sepsis Acute kidney injury ARDS Empyaema Lung abscess
164
Signs of complicated pneumonia
Swinging fever Sweats High WCC + CRP Weight loss Failure to improve
165
Aetiology of lung cancer
SMOKING Asbestos Occupational exposure ^ Pulmonary fibrosis Vaping
166
4 main types of lung cancer
Squamous cell Adenocarcinoma Small cell carcinoma Large cell carcinoma
167
What is the worst type of lung cancer
Small cell carcinoma
168
Lung cancer investigations
CXR Bronchoscopy CT, MRI, PET scans FBC, LFT, renal and calcium test
169
Lung cancer symptoms
Haemoptysis Unexplained weight loss Fatigue Cough SOB Pleuritic pain
170
Symptoms of lung cancer pressing on nerves
Horner's syndrome Hoarse, bovine cough Pancoast T1 damage Diaphragmatic paralysis
171
Lung cancer treatment
Surgery Radiotherapy Chemotherapy Supportive/palliative treatment
172
Complications of obstructive sleep apnoea
Hypertension Stroke Heart disease Road accidents
173
Diagnosis of obstructive sleep apnoea
Hx + examination Epworth questionare Overnight sleep study
174
What is tested in overnight sleep study for obstructive sleep apnoea
Pulse oximetry Full polysomnography OSA severity
175
What is an apnoea vs a hypoapnoea
Apnoea - >10s microarousals Hypoapnoea - <10s microarousals
176
Causes of obstructive sleep apnoea
OBESITY Genetic - narrow pharynx Smoking + alcohol Drug use
177
Treatment of obstructive sleep apnoea
Weight reduction Alcohol avoidance diagnose + treat endocrine disorders PAP (positive airway pressure) Mandibular repositioning splint
178
Clinical features of narcolepsy
Cataplexy Daytime somnolence Hypnagogic/hypnopompic hallucinations Sleep paralysis
179
Narcolepsy treatment
Modafinil Dexamphetamine Venlofaxine - for cataplexy Sodium oxybate (xyrem)
180
Investigation of narcolepsy
PSG MSLT - multi sleep latency test - REM within 15 min falling asleep Low CSF orexin
181
Diseases that form COPD
Chronic bronchitis Emphysema
182
Chronic bronchitis causes
SMOKING Occupation - dust Pollution
183
Chronic bronchitis clinical definition
Sputum cough most days for 3 months at a time, for 2 or more consecutive years
184
Emphysema causes
SMOKING Occupation - dust Pollution A1-Antitrypsin deficiency Elastase/anti-elastase imbalance
185
Emphysema pathological definition
Dilatation or destruction of alveoli walls without obvious fibrosis
186
4 main types of emphysema
Centriacinar Panacinar Periacinar Scar ephysema
187
What is centriacinar emphysema
Large pockets of air at end of terminal bronchiole Seen in smokers Mainly at apices of lungs
188
What is panacinar emphysema
All alveoli dilated Seen in heavy smokers Seen in A1-Antitrypsin deficiency
189
What is periacinar emphysema
Spaces develop around blood vessels and pleura Can rupture and lead to pneumothorax
190
Why does COPD cause hypoxia
Airway obstruction Reduced respiratory drive Less alveolar surface area Shunt during exacerbation
191
Pulmonary vascular changes in hypoxia
Low O2 areas vasoconstrict Pulmonary bp raises Also due to 2ndary polycythaemia! Hypertrophy of RV Cor Pulmonale
192
Chronic ventilatory failure definition
pCO2 > 6kPA pO2 < 8kPA Normal blood pH Elevated bicarbonate
193
Chronic ventilatory failure symptoms
SOB Orthopnoea Peripheral oedema Morning headache Recurrent chest infection Disturbed sleep
194
Chronic ventilatory failure findings
Paradoxical abdominal wall movement Ankle oedema
195
Chronic ventilatory failure aetiology
Airway disease Chest wall abnormality Resp muscle weakness Central hypoventilation
196
Investigation of NMD in Chronic ventilatory failure
Lung function tests Assessment of hypoventilation Fluoroscopic screening of diaphragm
197
Treatment of Chronic ventilatory failure
Domicillary NIV O2 Tracheostomy ventilation
198
Restrictive lung disease definition
FVC <80% of normal FEV1/FVC often around 0.9
199
Restrictive lung disease lung causes
Interstitial lung disease Sarcoidosis Hypersensitivity pneumonitis
200
Restrictive lung disease skeletal causes
Kyphoscoliosis Ankylosing sponditis Thoracoplasty Rib Fracture
201
Restrictive lung disease sub-diaphragmatic causes
Obesity Pregnancy
202
Restrictive lung disease pleural causes
Pleural effusion Pneumothorax Pleural thickening
203
Restrictive lung disease muscular causes
Amyotrophic lateral sclerosis MND
204
What is interstitial lung disease
Disease causing thickening of space between alveoli and capillary
205
Examples of Interstitial lung diseases
Sarcoidosis Idiopathic pulmonary fibrosis Hypersensitivity Pneumonitis
206
Hypersensitivity pneumonitis examples
Bird fanciers lung Farmers lung Malt workers lung
207
Hypersensitivity pneumonitis causes
Exposure to a lot of foreign antigens ie -bird/animal proteins -Fungi -Chemicals Thermophilic actinomycetes
208
Acute hypersensitivity pneumonitis presentation
Fever, dry cough, myalgia Chills, 4-9 hrs after exposure Crackles, tachypnoea, wheeze Precipitating antibody
209
Chronic hypersensitivity pneumonitis presentation
Insidious Malaise, SOB, cough Low grade illness Crackles + wheeze
210
Hypersensitivity pneumonitis treatment
Prednisone
211
Idiopathic pulmonary fibrosis presentation
Chronic SOB + cough Typically older men Failed treatment for LVF or infection Clubbing + crackles
212
Idiopathic pulmonary fibrosis treatment
Refer to ILD clinic Oral anti-fibrotics Palliative care Transplant
213
Anti-fibrotic drugs
Perfenidone Nintedanib
214
Sarcoidosis presentation
Dry cough Non caseating granuloma Erythaema of skin Multi system
215
Who usually gets sarcoidosis
Adults < 40 Women > Men Worldwide
216
Sarcoidosis investigation
History + exam CXR Pulmonary function tests Bloods Urinalysis ECG TB skin test Eye exam Bronchoscopy EBUS
217
Sarcoidosis treatment
Mild disease - none Erythaema nodusum/arthralgia - NSAID Skin lesions/cough - Topical Csteroid Serious disease - Systemic corticosteroids
218
Sarcoidosis diagnosis
Clinical findings Imaging findings Serum calcium and ACE Biopsy
219
Screening for developmental lung disease
Antenatal scanning Newborn symptoms
220
Laryngomalacia presentation
Stridor -worse while upset and feeding
221
Tracheomalacia presentation
Barking cough Recurrent croup SOB on exertion Stridor/wheeze
222
Tracheomalacia management
Physio Antibiotics while unwell Resolves with time
223
Tracheo-oesophageal fistula presentation
Choking Colour change Cough with feeding Unable to pass NG tube
224
Tracheo-oesophageal fistula treatment
Surgery
225
What is CPAM
Congenital pulmonary airway malfunction Abnormal functioning lung tissue
226
Congenital diaphragmatic hernia treatment
Surgical repair
227
Examples of neonatal lung disease
IRDS Transient tachypnoea Chronic Lung disease
228
Transient tachypnoea cause
Infant doesnt clear lungs properly Associated with Caesarian section
229
IRDS names
Infant resp distress syndrome Hyaline membrane disease
230
IRDS cause
Lack of surfactant Associated with preterm birth
231
IRDS treatment
Antenatal steroids Surfactant replacement Appropriate ventilation + nutrition
232
Which gene is mutated in CF
CFTR
233
What pathological changes occur in CF
Abnormal Cl and Na transport lead to -Thick sticky mucus -reduced surfactant production
234
How many classes of CF mutation are there
6 I - III severe IV - VI are less severe
235
What is the most common CF mutation
Type II - F508 Deletion 75% of CF cases
236
Diagnosis of CF
Antenatally Neonatal screening -day 5 blood spot If neonatal screening positive refer for clinical assessment and sweat test
237
Which classes of CF are pancreatic insufficient
I-III
238
Symptoms of pancreatic insufficiency
Malabsorption Abnormal stools - pale, offensive, floats Failure to thrive
239
Symptoms of CF
Nail clubbing Salty skin Recurrent infection Poor growth Bulky/greasy stools
240
Imaging of CF
CXR CT scan
241
Features of CF on imaging
Tramlines Signet rings Consolidation Mucous plugging
242
Nutritional management of CF
Creon High fat Fat soluable vitamin + mineral supplements
243
Management of mucus in CF
Physiotherapy Mucolytics Bronchodilators
244
Management of inflammation in CF
Azithromycin
245
Management of fibrosis/scarring/bronchiectasis in CF
Supportive treatment Symptom management
246
Other conditions to consider with CF
Diabetes Osteoporosis Pneumothorax Haemoptysis
247
New drugs altering CFTR production
Ivacaftor Lumacaftor Tezacaftor
248
Indications for lung transplant in CF
Rapidly deteriorating lung function FEV1 <30% predicted Life threatening exacerbations Estimated survival < 2yrs Recurrent pneumothorax Recurrent severe haemoptysis
249
Contra-indications for lung transplant in CF
Other organ failure Malignancy within 5 yrs Significant peripheral vascular disease Drug/nicotine/alcohol dependancy Active systemic infection
250
Dangerous infections to consider with CF
Non-TB Mycobacteria Burkholderia Cepacia Pseudomonas Aeroginosa
251
DVT and PE risk factors
Trauma Surgery Cancer Pregnancy Inherited thrombophilia ie -Factor V Leiden -Protein C or S deficiency
252
DVT and PE investigations
FBC Troponin ABG D-Dimer CXR V/Q scan CTPA
253
PE treatment
O2 Low weight heparin ie dalteparin Warfarin DOACs Thrombolysis Pulmonary embolectomy
254
How is PE prognosis scored
PESI (PE severity index) score
255
PE symptoms
Pleuritic chest pain Cough Haemoptysis Acute dyspnoea
256
Severe PE symptoms
Syncope Cardiac arrest
257
PE signs
Pyrexia Pleural rub Dull percussion at base - effusion Tachy-pnoea/cardia Hypoxia Hypotension
258
Tests for probability of PE and DVT
Wells score Revised Geneva score
259
What is pulmonary hypertension
>20mmHg
260
Causes of pulmonary hypertension
Idiopathic Secondary to LHD Secondary to chronic resp disease Chronic thromboembolic pulmonary Hypertension (CTEPH) Miscellaneous ie sarcoid
261
Symptoms of pulmonary hypertension
Exertional dyspnoea Chest tightness Exertional syncope/presyncope Haemoptysis
262
Signs of pulmonary hypertension
Elevated JVP RV heave Loud 2nd pulmonary heart sound Hepatomegaly Ankle oedema
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Investigation of pulmonary hypertension
ECG Lung function test CXR Echocardiography V/Q scan CTPA
264
General treatment of pulmonary hypertension
Treat underlying condition O2 Anticoagulants (IPAH only) Diuretics
265
Specialist treatment of pulmonary hypertension
Endothelin receptor antagonists -Bosentan -Ambrisentan
266
Types of pleural Pathologies
Pleural effusion Pneumothorax Mesothelioma
267
What is a transudative pleural effusion
Occurs does to increased hydrostatic pressure or low plasma oncotic pressure
268
What is an exudative pleural effusion
Occurs due to increased capillary permeability - protein movement increases osmotic gradient
269
Transudate pleural effusion causes
LVF Liver cirrhosis
270
Exudative pleural effusion causes
Malignancy Parapneumonic effusion TB
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Types of pneumothorax
Spontaneous Traumatic Iatrogenic Tension
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Presentation of pneumothorax
Sudden onset Chest pain, SOB
273
Hx of pneumothorax
Tall thin young men Underlying lung disease Hx of biopsy, line or mechanical ventilation
274
Examination findings of pneumothorax
Tachypnoea Hypoxia Reduced chest wall movement Hyper-resonancy percussion May be normal
275
Diagnosis of pneumothorax
CXR CT thorax Ultrasound from experienced operator
276
Management of pneumothorax
Observation Aspiration if >2cm Chest drain Surgery if recurring problem
277
Diagnosis of pleural tumours
CXR CT thorax + biopsy

Medicine (13 decks)

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