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Flashcards in Respiratory Deck (141)
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1

Causes of clubbing?

Malignant causes = Squamous cell carcinoma

Fibrosis = Pulmonary, Cystic, TB

Suppuration = Bronchiectasis, empyema, lung abscess

2

Pneumonia anatomical classification?

Bronchopneumonia = Patchy consolidation of different lobes

Lobar = Fibrosupparative consolidation of a single lobe

3

Pneumonia etiological classification?

CAP = S. Pneumonia, S. Aureus, mycoplasma

HAP = Pseudomonas, E. coli, S. Aureus

Aspiration = during anaesthesia, stroke, bulbar palsy

4

Strep pneumonia features?

80% of cases
High fever, rapid onset, herpes labialis

5

Which pneumonia in COPD patients?

H. Influenza

6

Which pneumonia follows influenza infection?

Staph Aureus

7

Features of mycoplasma pneumonia?

Younger, prodromal flu then a dry cough
Erythema multiforme
Serology is diagnostic

8

Legionella features?

Hyponatraemia, deranged LFT's and lympopaenia

Also see diarrhoea and confusion

30% have pleural effusions

Diagnosis by urinary antigen

9

Klebsiella features?

Alcoholics and diabetics
Cavitating upper lobe pneumonia
Redcurrant jelly sputum

10

PCP features?

Immunocompromised
Dry cough and exercise induced saturations
Pneumothorax common

Often need BAL to diagnose

11

What is the CURB65 score and when do you treat?

Confusion
Urea > 7
RR > 30
BP <90/60
Age>65

Score > 2 = hospital, >3 consider ITU

12

Management of community acquired pneumonia?

low severity = 5 days amoxicillin 1g TDS

Moderate = 10 days of amoxicillin and clarithromycin

Severe = 10 days of co-amoxiclav and clarithromycin

13

Management of hospital acquired pneumonia?

Mild (<5 days) = co-amoxiclav 625mg TDS

Severe (>5 days) = Tazobactam / piperacillin 4g IV QDS

14

How do you manage legionella and mycoplasma pneumonias?

Macrolide

15

How should you follow up pneumonias?

Chest x-ray at 6 weeks

16

3 complications of pneumonias?

Pleural effusion
Empyema
Abscess

17

What is an empyema and features?

Pus in the pleural cavity

Pyrexia rigors and dullness to percussion

18

Investigations and management of empyema?

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

What is a lung abscess and its features?

Collection of pus in the lungs that leads to cavity formation

Fever + cough and putrid expectorations
Pleuritic pain

20

Investigations and management of lung abscess?

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

What is SIRS?

2 of;
Temperature >38 or <36
HR>90
RR>20 or PaCO2 <32mmHg

WBC >12000 or <4000

22

What is sepsis, severe sepsis and septic shock?

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

What is high risk criteria for sepsis?

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

Management of sepsis?

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