Respiratory Flashcards
(141 cards)
1
Q
Causes of clubbing?
A
Malignant causes = Squamous cell carcinoma
Fibrosis = Pulmonary, Cystic, TB
Suppuration = Bronchiectasis, empyema, lung abscess
2
Q
Pneumonia anatomical classification?
A
Bronchopneumonia = Patchy consolidation of different lobes
Lobar = Fibrosupparative consolidation of a single lobe
3
Q
Pneumonia etiological classification?
A
CAP = S. Pneumonia, S. Aureus, mycoplasma
HAP = Pseudomonas, E. coli, S. Aureus
Aspiration = during anaesthesia, stroke, bulbar palsy
4
Q
Strep pneumonia features?
A
80% of cases
High fever, rapid onset, herpes labialis
5
Q
Which pneumonia in COPD patients?
A
H. Influenza
6
Q
Which pneumonia follows influenza infection?
A
Staph Aureus
7
Q
Features of mycoplasma pneumonia?
A
Younger, prodromal flu then a dry cough
Erythema multiforme
Serology is diagnostic
8
Q
Legionella features?
A
Hyponatraemia, deranged LFT’s and lympopaenia
Also see diarrhoea and confusion
30% have pleural effusions
Diagnosis by urinary antigen
9
Q
Klebsiella features?
A
Alcoholics and diabetics
Cavitating upper lobe pneumonia
Redcurrant jelly sputum
10
Q
PCP features?
A
Immunocompromised
Dry cough and exercise induced saturations
Pneumothorax common
Often need BAL to diagnose
11
Q
What is the CURB65 score and when do you treat?
A
Confusion Urea > 7 RR > 30 BP <90/60 Age>65
Score > 2 = hospital, >3 consider ITU
12
Q
Management of community acquired pneumonia?
A
low severity = 5 days amoxicillin 1g TDS
Moderate = 10 days of amoxicillin and clarithromycin
Severe = 10 days of co-amoxiclav and clarithromycin
13
Q
Management of hospital acquired pneumonia?
A
Mild (<5 days) = co-amoxiclav 625mg TDS
Severe (>5 days) = Tazobactam / piperacillin 4g IV QDS
14
Q
How do you manage legionella and mycoplasma pneumonias?
A
Macrolide
15
Q
How should you follow up pneumonias?
A
Chest x-ray at 6 weeks
16
Q
3 complications of pneumonias?
A
Pleural effusion
Empyema
Abscess
17
Q
What is an empyema and features?
A
Pus in the pleural cavity
Pyrexia rigors and dullness to percussion
18
Q
Investigations and management of empyema?
A
Thoracentesis = fluid will be purulent, putrid and pH <7.2.
Total protein > 30
Culture +ve
Management:
CAE = Amoxicillin and metronidazole
HAE = Vancomycin and tazocin
19
Q
What is a lung abscess and its features?
A
Collection of pus in the lungs that leads to cavity formation
Fever + cough and putrid expectorations
Pleuritic pain
20
Q
Investigations and management of lung abscess?
A
FBC, CXR = cavitation with clear fluid level, sputum culture and stain.
Management:
chest physio and postural drainage
Clindamycin and ceftriaxone IV
Surgical drainage via video assisted thoracoscopy
21
Q
What is SIRS?
A
2 of;
Temperature >38 or <36
HR>90
RR>20 or PaCO2 <32mmHg
WBC >12000 or <4000
22
Q
What is sepsis, severe sepsis and septic shock?
A
sepsis = SIRS with a source of infection
Severe sepsis = Sepsis with end organ dysfunction
Septic shock = Severe sepsis with hypotension despite adequate fluid resuscitation
23
Q
What is high risk criteria for sepsis?
A
New altered mental state Systolic <90 Oliguric for 18 hours or <0.5ml/kg for 1 hour Cyanosed, mottled Non-blanching rash HR >130 RR>25
24
Q
Management of sepsis?
A
Culture
Lactate
Urine output
IV antibiotics
Fluids
Oxygen
Immediate senior review if high risk, and regular half hourly observations
25
What is bronchiectasis?
Permanent dilation of the bronchi due to destruction of elastic and muscular components of the bronchial wall
Causes due to recurrent severe infections secondary to an underlying disorder
26
Causes of bronchiectasis?
50% idiopathic
Post infective e.g. TB, pneumonia (most common is H. Influenza)
Genetic e.g. cystic fibrosis
Ciliary dyskinetic disorders e.g. Kartageners syndrome
27
Features of bronchiectasis?
Persistent cough with purulent sputum / haemoptysis
Clubbing
Coarse crackles and monophonic wheeze
28
Investigations for bronchiectasis?
CXR = non-specific dilated thickened airways
Volume-CT = signet ring sign where bronchi are larger than adjacent pulmonary arteries, dilated thickened airways and tram lines. = GOLD STANDARD
Test for other causes e.g. chloride sweat test (>60mmol/L)
29
Management of bronchiectasis?
Conservative = Exercise and improved nutrition. Pulmonary physio and clearance. STOP SMOKING
Medical = Salbutamol 200ug 2 puffs BD
Antibiotics for exacerbations
30
Whats is Kartageners syndrome and its features?
Primary ciliary dyskinesia. Dynein arm defect resulting in immotile cilia
```
Clinical features:
Dextrocardia or complete situs inversus
Right testicle hangs lower than the left
Recurrent sinusitis
Subfertility
```
31
What is cystic fibrosis?
Severely life shortening genetic disease, due to abnormalities in the cystic fibrosis transmembrane conductor.
autosomal recessive
causes reduced lumina secretion of chloride and increased Na absorption = viscous secretions
32
Clinical features of CF?
Newborn = failure to pass meconium, FTT, rectal prolapse
Adults = Nasal polyps / sinusitis
Infections and bronchiectasis
GI = Pancreatic insufficiency - DM, steatorrhoea
Clubbing
33
Investigations and management of CF?
Guthrie heel prick test
Sweat test >60mmol/L is likely
MDT approach
Resp = chest physio
Inhaled bronchodilators = salbutamol 100-200ug prior to clearance
Inhaled mucloytic = Dornase alfa 2.5mg nebulised + hypertonic saline
Antibiotics for acute infetions
GI = high calorie diet, high fat intake
Creon - give with ranitidine to create an alkali environment = better absorption
Fat soluble vitamins ADEK
34
What is pulmonary aspergillus infection?
Fungal infection predominantly affecting immunocompromised
35
What conditions come under the term aspergillosis?
```
Allergic bronchopulmoary aspergillosis
Extrinsic allergic alveolitis
Invasive pulmonary aspergillosis
Chronic aspergillosis
Aspergilloma
```
36
What is allergic bronchopulmonary aspergillosis, features investigations and management?
Hypersensitivity reaction, often in long standing asthma / CF
SOB, cough and wheeze
Ix = CXR = bronchiectasis, sputum stain = black on silver stain
Eosinophilia
Mx = long term steroids and itraconazole + high dose steroids for acute attack
37
What is extrinsic allergic alveoli's and clinical features?
Hypersensitivity induced lung damage. Malt workers lung = aspergillus clavatus
4-8 hours post exposure, SOB, dry cough and fever
Upper - mid zone fibrosis
no eosinophilia
38
What is invasive pulmonary aspergillosis, PC, investigations and management?
Inhalation of spores resulting in sinus and pulmonary involvement.
Pleuritic chest pain and pleural rub.
Nasal ulcers, rash, headache
NO COUGH
Aspergillus stain black on silver
CXR = consolidation
Mx = Voriconazole
39
What causes chronic aspergillosis, PC, investigations and management?
Caused by aspergillus fumigatus, seen in patients with chronic lung disease
>3 months of fatigue, cough and weight loss. HAemoptysis and SOB
CXR = caveatting / scarring fibrosis
Voriconazole
40
What is aspergilloma, PC, investigations and management?
Occurs in pre-existing lung cavities, commonly secondary to TB
Usually occurs due to chronic aspergillosis secondary to A. Fumigatus
Cough, haemoptysis, Hx of TB
CXR = Round apical opacity
High titre of aspergillus precipitans
Mx = surgical removal
41
How can we classify lung cancer?
Non-small cell = 80%
- Squamous cell
- Adenocarcinoma
- Large cell carcinoma
Small cell = 20%
Others are rare e.g. mesothelioma
42
Where is SCC located vs adenocarcinoma + large cell?
SCC = central
| Adeno + large cell = peripheral
43
What hormones may each non-small cell cancer secrete?
SCC = PTHrP = hypercalcaemia
- can also get hyperthyroid due to ectopic TSH
Large cell = B-HCG
44
Which non-small cell cancer is associated with smoking?
SCC is strongly associated in smoking
| Adenocarcinoma is the most common in non-smokers, however the majority are still smokers
45
Which non-small cell is strongly associated with finger clubbing?
SCC
46
Which non-small cell commonly has extra-thoracic metastases?
Adenocarcinoma
47
Where is small cell carcinoma located?
Centrally
48
What ectopic hormones are produced in small cell?
ADH = hyponatraemia
ACTH = Cushings syndrome and bilateral adrenal hyperplasia.
- High cortisol levels can also cause hypokalaemic acidosis
49
Which lung cancer causes LEMS and what is it
Small cell
Lambert-eaton myasthenia syndrome
Antibodies to voltage gated calcium channels = myasthenia like
Difficulty walking and muscle tenderness
50
What is the 2 week referral for lung cancer criteria?
CXR suggests cancer or if over 40 with unexplained haemoptysis
51
Differential for coin lesion on CXR?
NIB
Neoplasia
Infection = TB, klebsiella
Benign = Wegeners
52
Investigations for lung cancer?
Bloods
CXR
Contrast enhanced volume CT of lower neck/thorax/upper abdo if known / suspected malignancy
Biopsy for staging
53
Lung cancer staging - tumour?
```
Tx = can't be assessed
T0 = no signs
T1 = <3cm, within lung
```
T2 = 3-5cm and involves main bronchus but 2cm from carina, pleural involvement, lung collapse
T3 = 5-7cm
T4 >7cm
54
Lung cancer staging nodes?
```
Nx = can't be assessed
N0 = don't contain cancer cells
N1 = Cancer in LN's within lung and hilum
```
N2 = in mediastinum on same side as the tumour
N3 = in mediastinum opposite side of tumour
55
Small cell lung cancer management?
Usually present very late
Combo of radiotherapy and chemotherapy
Rarely resection
Extensive = palliative
56
Management of NSCLC?
Generally poor response to chemo
Stage 1/2 = surgical.
If sufficient pulmonary reserve = lobectomy, if not = wedge resection
± adjuvant chemotherapy
If can't have surgery = radiotherapy
Later stages = radiotherapy with platinum based chemotherapy regime
57
What is ARDS and its criteria?
Increased permeability of alveolar capillaries leading to fluid accumulation in alveoli = non-cariogenic pulmonary oedema
Must have:
Onset within one week, on background of RF ew.g. pneumonia
Bilateral opacities on CXR
PaO2: FiO2 <200 on PEEP, or CPAP >5cm
58
Clinical features of ARDS?
Dyspnoea, RR raised, bilateral lung crackles, low sats
59
Causes of ARDS?
Infection e.g. sepsis or pneumonia
Aspiration
DIC
Trauma / burns / inhalation injury
60
Management of ARDS?
ITU
AIRWAY:
Ventilation = PEEP 5-10cm H2O, low tidal volume ventilation at 6ml/kg
GOAL = inspiratory plateau <30cm water
CIRCULATION:
Maintain CO and oxygen with inotropes e.g. Noradrenaline / dobutamine
treat underlying cause
61
What is respiratory failure and the two types?
Acute impairment of gas exchange between the lungs and blood causing hypoxia ± hypercapnia
Type 1 = oxygen <8Kpa. Due to V/Q mismatch and diffusion failure
Type 2 = Oxygen <8Kpa, and PaCo2 >6Kpa
Due to Alveolar hypoventilation
62
Causes of type 1 respiratory failure?
V/Q mismatch and diffusion failure
Fluid - pulmonary oedema
Pus - pneumonia
Blood - pulmonary haemorrhage
Vascular e.g. PE, P-HTN
63
Causes of type 2 respiratory failure?
Alveolar hypoventilation
Obstruction e.g. Asthma/COPD, bronchiectasis
Restrictive e.g. Sedation, GBS, flail chest
64
Spirometry restrictive vs obstructive?
Obstructive = very low FEV1, FVC reduced / normal
FEV1:FVC is reduced
Restrictive = FEV1 reduced, but FVC significantly reduced
FEV1:FVC is normal / raised
65
Management of respiratory failure?
Type 1 = Oxygen to keep sats at 94-98
Assisted ventilation if PaO2 <8 despite 60% oxygen
Type 2 = controlled oxygen therapy at 24% aiming for saturations 88-92 and PaO2 >8
ABG after 20 minutes
66
What does each Venturi colour deliver?
```
Yellow = 5
White = 8
Blue = 24
Red = 40
Green = 60
```
67
What is asthma?
Chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity
68
Causes of asthma?
Atopy = T1 hypersensitivity to and allergen, pollen etc
Stresses = cold air, exercise and emotion
Toxins = Smoking, pollution, BB's and NSAIDs
69
Clinical features of asthma?
Cough ± sputum, often worse at night
Wheeze and chest tightness
Diurnal variation, worse AM
Expiratory wheeze, and reduced air entry
70
Asthma investigations?
Spirometry:
FEV1:FVC obstructive pattern = decreased = <70%
With bronchodilator reversibility. +ve if FEV1 improves by 12% or volume increase >200ml
Exhaled nitric oxide: In adults >40 parts/billion = positive
71
Management of chronic asthma - conservative?
TAME
Technique for inhaler use
Avoid allergens
Monitor peak flow with diary
Educate = Specialist nurse, need for compliance and written action plan in case of emergency
72
Management of chronic asthma - medical?
1st line = SABA salbutamol 200ug 2 puffs BD as a reliever
2nd line = low dose ICS + SABA if not controlled by SABA alone or at presentation waking at night / symptoms >3 times a week
3rd line = Add in leukotriene receptor antagonist = monteleukast 10mg PO OD
4th line:
SABA + low dose ICS + LABA = Salmeterol 50ug 1 puff BD.
Continue LTRA if it worked
5th line = continue SABA ± LRTA.
Also use low dose ICS with a MART (maintenance and reliever therapy) e.g. symbicort = Budesonide and formoterol
6th line = Continue SABA ± LRTA
Increase ICS to moderate dose
Continue MART or switch to LABA
7th line: one of.....
Increase ICS to high dose
Trial additional drug e.g. theophylline
Specialist advice
73
What are the steroid doses for asthma?
Budesonide or equivalent:
Low = <400ug
Moderate = 400-800
High > 800
74
Signs of life threatening severe asthma?
```
PEFR <33%
Sats <92%
CHEST:
Cyanosis
Hypotension
Exhaustion and confusion
Silent chest
Tachycardia / arrhythmias
```
75
Admission criteria for acute asthma attack?
Any feature of life threatening
Moderate severity but had previously near fatal attack
If have any severe feature, refractory to treatment
76
Management of acute asthma attack
ABC, oxygen
5mg Salbutamol driven via oxygen. Every 20 minutes for 3 doses.
Followed by every 1-4 hours when required
Ipratropium bromide 0.5mg neb
Steroids 100mg IV hydrocortisone
40mg prednisolone (continue for 5 days)
Refractory = discuss with senior clinician
Ipratropium neb with each salbutamol dose
If refractory still = Magnesium sulphate 1-2g IV over 20 minutes
Next IV salbutamol 5ug/minute IV
Life threatening = ITU, Aminophylline 100mg slow infusion
77
Monitoring in acute asthma attack?
PEFR before treatment and before and after each salbutamol
Monitor bloods after 1 hour
Discharge when PEF >75% expected
Discharge on steroids for 5 days, and book appointment with respiratory clinic in 4 weeks. GP in 2 days time.
TAME
78
What is COPD?
Progressive disease characterised by airflow limitation, that is not fully reversible
79
What is emphysema?
Enlarged air spaces distal to the terminal bronchioles = destruction of the alveolar walls
Prominent in upper lobes In COPD
Lower lobes in A1AT deficiency
80
What is chronic bronchitis?
Cough and sputum production on most days for 3 months of two successive years
81
Pathophysiology of COPD?
Chronic inflammation = airway narrowing and remodelling
Increased goblet cells
Enlargement of mucin secreting glands
82
Signs of hyper inflated chest?
Barrel chest
Reduced cricosternal distance (normal 3 fingers)
Loss of cardiac dullness
Displaced liver edge
83
Clinical features of COPD?
RF's e.g. smoking
cough, frequently in the morning
wheezing and crackles on auscultation
Prolonged expiratory phase + pursed lips
84
What are pink puffers bs blue bloaters?
Pink puffers = emphysema
Increased alveolar ventilation = breathless but not cyanosed
nearly normal oxygen and CO2
Progresses to type 1 respiratory failure
Blue bloaters in chronic bronchitis = cyanosed but not breathless
Low oxygen and high CO2 = progress to type 2 failure
85
Complications of COPD?
Cor pulmonale if long standing = peripheral oedema, raised JVP
Recurrent pneumonia (H. Influenza)
Pneumothorax
Respiratory failure
86
Investigations for COPD?
Spirometry = fixed obstructive = FEV1:FVC = low
CXR = hyperinflated
87
GOLD criteria for post-bronchodilator FEV1 in COPD?
GOLD 1 = mild = >80%
2 = moderate = 50-79%
3 = severe = 30-49%
4 = very severe = <30%
88
COPD conservative management?
Stop smoking
Pulmonary rehab
Dietary advice
Influenza annual vaccine and pneumococcal one off
89
medical management of cOPD
SABA salbutamol 200ug 2 puffs BD
OR
SAMA Ipratropium
Remains breathless next step based on FEV1
>50% = LABA e.g. salmeterol and LAMA e.g. tiotropium
<50% = LABA + ICS, or LAMA
IF START LAMA STOP SAMA
Persistent:
If taking LABA alone add in ICS
Otherwise give LAMA+LABA+ICS
Still refractory = theophylline
90
When should you give long term oxygen therapy in COPD?
Do ABG on two occasions three weeks apart.
```
Offer it if PO2 < 7.3kPa or PO2 7.3-8 and one of following:
Secondary polycythaemia
Nocturnal hypoxaemia
Peripheral oedema
Pulmonary HTN
```
If on it need at least 15 hours a day
91
Acute exacerbation of COPD causes and management?
```
Viral URTI (30%) = human rhinovirus
Bacterial = H. Influenza
```
Controlled oxygen therapy via a blue 24% Venturi mask. aim for 88-92 sats
Aim for oxygen >8, PCO2 less than 1.5
Bronchodilators = nebulised salbutamol 5mg/4 hours and ipratropium 0.5mg neb / 6 hours
Steroids = IV hydrocortisone 200mg and prednisolone 30mg PO
Ongoing = increase bronchodilator dose and continue prednisone for 1 weeks
92
What are the Wells criteria for a PE?
3 points for:
Clinical signs of DVT
PE #1 diagnosis
1.5 points:
HR>100
Immobile <3 days ago, surgery <4 weeks ago
Previous
1 point for:
Haemoptysis
Malignancy w/treatment in last 6 months
93
Investigations for PE?
ECG
CXR = peripheral wedge, enlarged pulmonary artery
PE likely = Wells score > 4 = immediate CTPA
PE unlikely = Wells score <4 = D-Dimer, if +ve = CTPA
If have renal impairment do a V/Q scan to avoid contrast
94
Management of PE?
Acute = Oxygen, analgesia
Alteplase 50mg bolus stat
LMWH enoxaparin 1mg/kg/dose SC BD
If systolic >90 start warfarin 5mg PO OD until INR 2-3
Ongoing = TEDs, long term graduated compression stockings
Continue warfarin for 3 months if provoked
If unprovoked = > 3 months
95
What is a pneumothorax?
When air gains access to and accumulates in the pleural space
96
How can we classify pneumothoracies?
Closed = intact chest wall, air leaking from lung
Open = defect in chest wall, communication between pleural cavity and exterior
Tension = Air enters pleural cavity via one way valve, cannot escape
97
Causes of pneumothorax?
Spontaneous primary = smokers, young thin men
Spontaneous secodnary:
Marfans
COPD
Pulmonary fibrosis
Trauma
Iatrogenic
98
Management of tension pneumothorax?
ABC
Oxygen
Large bore cannula into the 2nd ICS midclavicular line
Chest tube following decompression to prevent immediate recurrence
99
Management of primary pneumothorax?
Rim >2cm and not SOB = consider discharge or percutaneous aspiration
If rim> 2cm, SOB or aspiration failed = chest drain.
STOP SMOKING
100
Management of secondary pneumothorax?
All should be admitted
> 50 + rim >2cm / SOB = chest drain
If rim 1-2cm = aspiration. If it fails = chest drain
<1cm = oxygen for 24 hours
101
What is a pleural effusion?
Fluid collection between the parietal and visceral surfaces of the thorax
thin layer of fluid is always there but normal flow / production is disrupted
102
Classification of pleural effusion?
Transudate < 25
Exudate >35
Lights criteria 25-35:
103
What is lights criteria?
Pleural protein : serum protein > 0.5
Pleural LDH : Serum LDH >0.6
Pleural LDH > 2.3rds the upper limit of normal
104
Causes of exudates?
Increased capillary permeability;
Infection = Pneumonia / TB
Neoplasm
Inflammation e.g. SLE
105
What causes transudate?
Increased capillary hydrostatic pressure or reduced oncotic pressure:
CCF
Renal failure
Reduced albumin e.g. Nephrosis, liver failure and malabsorption
MEIGS
106
Investigations for pleural effusion
CXR
Pleural USS
LDH, protein levels in pleural fluid and serum
107
Management of pleural effusion?
Symptomatic = Thoracocentesis
Suspect infection =Antibiotics
If malignant = Thoracocentesis and pleurodesis e.g. Talc, bleomycin. These cause inflammation and fusion of viscera
108
Indications for chest drain in pleural effusion?
Fluid is cloudy / purulent
pH < 7.2
Organism identified
109
What is sarcoidosis?
Multisystem disorder, of unknown aetiology characterised by non-caveating granulomas
Lungs and LNs involved in 90%
110
Clinical features of sarcoidosis?
GRANULOMAS
General = Swinging fever, anorexia, fatigue, LN's
Resp = Otitis and sinusitis. Dry cough and SOB
Arthralgia
Neuro = Peripheral / cranial neuropathy, SOL
Urine = raised calcium and macrophages in granulomas can convert vitamin D to active form = RENAL STONES
Low hormones = pituitary dysfunction
Opthalmological = uveitis
Myocardial = restrictive cardiomyopathy, pericardial effusion
Abdo = hepatosplenomegaly
Skin = erythema nodosum
111
Investigations for sarcoidosis?
Bloods = raised calcium
LFT's raised
CXR = lymphadenopathy
Stage 1 = bilateral hilar LN
2= + pulmonary Infiltrates
3 = infiltrates, no BHL
4 = extensive fibrosis
112
Management of sarcoidosis?
```
Acutely = steroids
Ongoing = prednisone 40mg PO OD for 3 months then taper
```
If cannot tolerate steroids. = methotrexate
113
Indications for steroid use in sarcoidosis?
```
Stage 2-4 on CXR
Parenchymal lung disease
Uveitis
Hypercalcaemia
Neuro / cardio involvement
```
114
What is interstitial lung disease?
Large group of disorders affecting the interstitium, which is the lace like network of tissue that extends throughout both lungs supporting the alveoli
Diseases cause thickening and scarring of interstitium
115
What is extrinsic allergic alveolitis?
Non-IgE mediated alveolitis due to repeated inhalation of non human protein
116
Types of extrinsic allergic alveolitis?
Avian proteins = bird fanciers lung
Saccharopolyspora = Farmers lung
Aspergillus cravats = malt workers lung
Thermophillic actinomyces = mushroom workers lung
117
Clinical features of extrinsic allergic alveolitis?
Acute = 4-6 hours post-exposure
Fevers, rigors and malaise
Dry cough and dyspnoea
Crackles
Chronic = worsening dyspnoea
clubbing
weight loss
T1 resp failure
118
Investigations of EAA?
NO EOSINOPHILIA
CXR = patchy nodular Infiltrates and fibrosis
119
Management of EAA?
Avoid antigen
Prednisolone 40mg PO OD
Long term low dose
120
Types of industrial lung disease?
Coal workers pneumoconiosis
Silcosis
Asbestosis
121
What is coal workers pneumoconiosis, PC and CXR findings?
Progressive massive fibrosis
PC = dyspnoea and chronic bronchitis
CXR = upper one fibrotic mass
122
what is silicosis caused by and CXR findings?
Quarrying and sand blasting
Upper zone reticular shadowing and egg shell calcification of hilar nodes
123
What causes asbestosis, PC and CXR findings?
Demolition and ship building
Chest pain, weight loss, clubbing and effusions
CXR = Pleural plaques, pleural effusions. LOWER LOBE fibrosis
124
What is idiopathic pulmonary fibrosis?
Chronic lung condition characterised by progressive fibrosis of interstitum
Typically seen in males, 50-70
125
Clinical features of idiopathic pulmonary fibrosis?
Progressive SOB and cough
Clubbing
Bibasal crackles
126
Investigations of idiopathic pulmonary fibrosis?
CXR = bilateral interstitial ground glass shadowing
Spirometry = restrictive = FEV1;FVC high as FVC low
Reduced transfer factor
127
Management of idiopathic pulmonary fibrosis?
Supportive = stop smoking, pulmonary rehab and oxygen.
Palliative
Lung transplant is the only cure
128
What is the definition of pulmonary hypertension?
Mean pulmonary artery pressure > 25mmHg at rest, >30mmHg with exercise
129
Causes of pulmonary HTN?
Left heart disease = MR / MS, LVF and L to R shunt
Lung disease = COPD, severe chronic asthma and interstitial lung disease
Vascular e.g. PE, sickle cell
Hypoventilation e.g. Obesity and kyphoscoliosis
130
Clinical features of pulmonary HTN?
SOB, fatigue, chest pain
Cyanoiss and peripheral oedema
Hepartomegaly
40% have tricuspid regurgitation
131
Investigations for pulmonary HTN?
ABG
CXR = enlarged right heart
ECG = P pulmonale and RVH
132
Management of pulmonary HTN?
Treat underlying cause
| Long term oxygen therapy
133
What is cor pulmonale?
RHF due to pulmonary HTN
134
what is obstructive sleep apnoea?
Episodes of complete or partial upper airway obstruction
135
RF's for obstructive sleep apnoea?
obese
Male
Smoker, alcohol
idiopathic pulmonary fibrosis
136
Clinical features of obstructive sleep apnoea?
Excessive daytime sleepiness = Epworth sleepiness scale
Chronic snoring
Episodes of apnoea / gasping
Insomnia
137
Investigations of obstructive sleep apnoea?
Sleep studies and oxygen saturations
138
Management of obstructive sleep apnoea?
Weight loss, stop smoking and drinking
CPAP first line if moderate to severe
Surgery = tonsillectomy etc
139
Smoking cessation 3 methods?
NRT = pregnancy
Varenicline
Buproprion
140
How does varenicline work?
Nicotinic receptor partial agonist
Start 1 week before target to stop date, course is 12 weeks
Caution if depression
141
How doers bupropion work?
Norepinephrine and dopamine reuptake inhibitor
Start 1-2 weeks prior to stop date
Small risk of seizures = not in epilepsy
