Respiratory Flashcards
(129 cards)
1
Q
What is ARDS?
A
Acute respiratory distress syndrome (ARDS) is a non-cardiogenic pulmonary oedema and diffuse lung inflammation syndrome that often complicates critical illness.
2
Q
What is the criteria for diagnosing ARDS?
A
Acute onset (within 1 week)
Bilateral opacities on chest x-ray
PaO₂/FiO₂ (arterial to inspired oxygen) ratio of ≤300 on positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) ≥5 cm H₂O
3
Q
What are the Risk Factors of ARDS?
A
> Sepsis > Aspiration > Pneumonia > Severe Trauma and Blood Transfusions > Lung Transplantations > Pancreatitis > HX of alcohol > Burns and Smoke Inhalation > Drowning
4
Q
What is the epidemiology of ARDS?
A
Overall, 10% to 15% of patients admitted to the intensive care unit meet the criteria for ARDS, with an increased incidence among mechanically ventilated patients.
5
Q
What are the signs and symptoms of ARDS?
A
Low oxygen sats Acute respiratory failure dyspnoea Increased Resp Rate Pulmonary Crepitations Low lung Compliance Fever, cough and pleuritic chest pain
6
Q
What investigations do you do for ARDS?
A
> CXR- bilateral infiltrates
ABG- Type 1 respiratory failure
Sputum/ Blood/ Urine Culture for infection
Amylase and lipase- 3 times upper limit of normal in acute pancreatitis
7
Q
What is an Arterial Blood Gas?
A
An arterial blood gas (ABG) is a blood test carried out by taking blood from an artery, rather than a vein. It measures the level of gases and pH in the blood.
8
Q
What are the indications of an arterial blood gas?
A
Respiratory failure - in acute and chronic states.Any severe illness which may lead to a metabolic acidosis - for example: Cardiac failure. Liver failure. Renal failure. …Ventilated patients.Sleep studies.Severely unwell patients from any cause - affects prognosis.
9
Q
What are the contraindications of an ABG?
A
poor collateral circulation peripheral vascular disease in the limb cellulitis surrounding the site arteriovenous fistula. impaired coagulation (e.g. anticoagulation therapy, liver disease, low platelets <50)
10
Q
What are some Asbestos related lung diseases?
A
AsbestosisLung cancer.MesotheliomaPleural effusionPleural plaquesThickening of the tissues around the lungs.
11
Q
What is asbestosis?
A
Asbestosis is diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos fibres.
12
Q
What are the risk factors of asbestosis?
A
> Inhaled asbestos
> Cigarette smoking
13
Q
What are the signs and symptoms of asbestosis?
A
> Dyspnoea on exertion> cough> Crackles> Chest pain > (clubbing)
14
Q
What is the epidemiology of asbestosis?
A
In 2016 in the UK, 1050 new cases of asbestosis were assessed under the Industrial Injuries and Disablement Benefit scheme; around 1-2% of these cases were female
15
Q
What investigations would you do for asbestosis?
A
> CXR PA and lateral (lower zone linear interstitial fibrosis; progressively involves the entire lung; pleural thickening)> Pulmonary function tests (Restrictive changes, may have obstructive picture)> High res CT> Lung biopsy> Bronchial Lavage
16
Q
What is mesothelioma?
A
Malignant mesothelioma is an aggressive epithelial neoplasm arising from the lining of the lung, abdomen, pericardium, or tunica vaginalis
17
Q
What are the risk factors of mesothelioma?
A
> Asbestos> Age 60-85> Radiation> Genetics, male, simian virus 40
18
Q
What are the signs and symptoms of mesothelioma?
A
> SOB> Diminished breath sounds> Dullness to percussion> Chest pain> cough> Constitutional symptoms
19
Q
What is the epidemiology of mesothelioma?
A
The disease is more common in men and white people, and typically occurs in older adults (sixth to ninth decade of life).In the UK, the incidence has been increasing rapidly since the 1960s, when the mesothelioma register was established to record cases. Currently it is projected that the annual number of deaths in the UK will peak some time between the years 2011 and 2015, with 1950 to 2450 deaths.
20
Q
What investigations would you do for mesothelioma?
A
> CXRUnilateral pleural effusion, irregular pleural thickening, reduced lung volumes, and/or parenchymal changes related to asbestos exposure (e.g., lower zone linear interstitial fibrosis)> CT Chest and Upper abdo with IV contrastPleural thickening and/or discrete pleural plaques, pleural and/or pericardial effusions; enlarged hilar and/or mediastinal lymph nodes; chest wall invasion and/or spread along needle tracts can occur
21
Q
What is a pleural effusion?
A
A pleural effusion results when fluid collects between the parietal and visceral pleural surfaces of the thorax.
22
Q
What are the signs and symptoms of a pleural effusion?
A
> SOB> Dullness to percussion> Pleuritic chest pain> Cough> Quieter breath sounds> Decreased or absent tactile fremitus
23
Q
What are the risk factors of a pleural effusion?
A
> CHF> Pneumonia> Malignancy> Recent CABG
24
Q
What is the epidemiology of pleural effusions?
A
About 1.5 million people develop a pleural effusion in the US each year.
25
What investigations would you do for pleural effusions?
For InfectionCXRBloods- FBC, CRPPleural fluid- cytology, culture, pH, glucose and cholesterol, WBC, RBCSputum Gram stain and cultureFor Cardiac CausesCXRN-terminal pro-brain natriuretic peptide (NT-pro-BNP) in pleural fluidLDH and protein in pleural fluid and serumFor MalignancyBloodsPleural fluid- pH, glucose and cholesterol, WBC, RBC
26
What is Aspergillosis?
Filamentous fungi of the Aspergillus species are ubiquitously found as soil inhabitants. Inhalation of the aerosolised conidia (spores) causes the infection.
27
What are the risk factors of Aspergillosis?
> allogeneic stem cell transplantation> prolonged severe neutropenia (>10 days)> immunosuppressive therapy> chronic granulomatous disease (CGD)> solid organ transplantation (SOT)> acute leukaemia> aplastic anaemia> pre-existing cavity (aspergilloma)
28
What are the signs and symptoms of Aspergillosis?
> Pleuritic chest pain> Pleural rub> Nasal ulcer> Skin rash> Cough> Headache> Fever> Congestion or sinus tenderness> Haemoptysis/ dyspnoea/ facial pain/ seizure/ malaise/ weight loss
29
What is the epidemiology of Aspergillosis?
Usually in immunocompromised hosts such as cancer and transplant patients
30
What investigations would you do for aspergillosis?
> CXR- nodules, infiltrates, cavities, lesions> High resolution CT of chest, sinuses and brain- nodules, masses, bone erosions, local lesions> MRI brain and sinuses- sinus opacity, bone erosion, space occupying lesion> Sputum smear and culture- shows hyphae and aspergillus species> Serum Aspergillus galactomannan antigen by EIA- positive
31
What is Asthma?
A chronic inflammatory airway disease characterised by intermittent airway obstruction and bronchial hyper-reactivity. May include cells like mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial cells.
32
What are the risk factors of asthma?
Family historyAllergensAtopic history (bronchoconstriction and airway oedema)Cold air/ smoking/ exercise/ infection/ NSAIDsNasal polyposisObesityGastro oesophageal reflux Inflammatory cells, goblet cells, smooth muscle constriction
33
What are the signs and symptoms of asthma?
Intermittent dyspnoeaWheeze (exploratory polyphonic)Chest tightnessCoughSputumDiurnal variation/ disturbed sleepTachypnoea; audible wheeze; hyperinflated chest; hyperresonant percussion note; air entry decreased ; widespread, polyphonic wheeze.
34
What is the epidemiology of asthma?
Affects 5-8% of the population. 10-15% in UKCan have ‘childhood asthma’50% 0f asthma deaths in >65 yrs340 million people globally
35
What investigations do you do for asthma?
PEFR- <33 (life threatening), 33-50 (severe), chronic is variableSputum culture- for bugs or eosinophilsBloodsFBC- eosinophilia or neutrophiliaU&ECRPCultureIgE total and specific ABGPaCO2 normal or raised, transfer to ITUSpirometry Obstructive defect (reduced ratio, under 0.7)CXR (excludes pneumothorax or infection)FeNO fractional exhaled nitric oxide Measures eosinophilic inflammationMeasures responsiveness to steroid Positive = 40 ppb (smoking lowers)Bronchodilator reversibility testlooking for improvement > 12%Also volume improvement of 200mlBronchial challenge nebuliser histamine PC20 < 8mg/ml is positive (20% fall in FEV1)
36
What is the management of acute asthma?
AcuteNebulised salbutamol O2 IV hydrocortisone and PO prednisoloneBudesonide (INH)Salmeterol (LABA)aminophylline
37
What is the prognosis of asthma?
Relatively normalHigher risk of airway related issuesICS can pose risks
38
What is the difference between a severe and life threatening asthma attack?
Severe attack: inability to complete sentences; pulse >110bpm; respiratory rate >25/min; PEF 33–50% predicted.Life-threatening attack: silent chest; confusion; exhaustion; cyanosis (PaO2 <8 kPabut PaCO2 4.6–6.0, SpO2 <92%); bradycardia; PEF <33% predicted. Near fatal: increased PaCO2.
39
What are the complications of asthma?
Exacerbations- oxygen, nebulisers, hydrationAirway remodelling- Candidiasis (INH steroids)- anti fungals like fluconazoleDysphonia (INH steroids)- change inhalers
40
What is the management of chronic asthma?
ChronicSABA (salbutamol)INH corticosteroid (budesonide/ beclomethasone)LABA (salmeterol)Leukotriene receptor antagonist (montelukast)/ theophylline/ nedocromil or cromoglicate
41
What is bronchiectasis?
Bronchiectasis is the permanent dilation of bronchi due to the destruction of the elastic and muscular components of the bronchial wall.
42
What are the risk factors of bronchiectasis?
CFImmunodeficiencyPrevious infectionCongenitalPrimary ciliary dyskinesiaMeasles, tb, whooping coughAlpha 1 antitrypsin deficiency, connective tissue disease, IBD, aspiration or inhalation injury, focal bronchial obstruction, (tall, thin, white females over 60), thyroiditis
43
What are the signs and symptoms of bronchiectasis?
CoughSOBSputum (lots of foul smelling)FatigueHaemoptysisRhinosinusitisWeight lossWheezingPleuritic chest painCrackles (mid or early DyspnoeaFeverClubbing
44
What is the epidemiology of bronchiectasis?
Prevalence may be increasing worldwideMore common in older peopleIncidence = 1-2 per 100,000
45
What are the investigations for bronchiectasis?
CXRNormal or obscured hemidiaphragm Thin walled ring shadows with ot without fluid levels, tram lines, tubular or ovoid opacitiesSignet ringHigh-resolution chest CTThickened dilated airways with ot without air fluid levels, varicose constrictions along airwaysFBCHigh eosinophil countBronchopulmonary aspergillosisNeutrophiliasputum culture and sensitivityG+ve/G-ve/non TB Mycobacteria/ fungiserum alpha-1 antitrypsin phenotype and levelMay be abnormalserum immunoglobulinsDecreased IgG, IgM or IgAsweat chloride testHigh or lowrheumatoid factorMay be positiveAspergillus fumigatus skin prick testserum HIV antibodynasal nitric oxide (NNO)pulmonary function tests
46
What are the complications of bronchiectasis?
Massive haemoptysis> Breathing and circulation support> Interventional radiologistRespiratory failure> Airway protection Cor pulmonale> May require transplantationBrain abscessAmyloidosis Pneumonia, sinusitis
47
What is the management of bronchiectasis?
Exercise and improved nutritionAirway clearance therapyInhaled bronchodilatorInhaled hyperosmolar agentLong term oral macrolideInhaled antibioticShort term oral antibioticIV antibioticsSurgeryNon invasive ventilationSupplemental oxygen
48
What is the prognosis of bronchiectasis?
IrreversibleSymptom control and exacerbationsSeverity indexQuality of life may be affected19% after 14 yrs
49
What is COPD?
A progressive disorder characterised by airway obstruction (FEV1/FVC < 0.7) that is irreversible (i.e. salbutamol won’t help). It encompasses emphysema and chronic bronchitis.
50
What are the risk factors of COPD?
Age of onset >35SmokingPollutionGeneticsBeing white/ male/ poorAbnormal lung development
51
What is the epidemiology of COPD?
Prevalence = 10-20% of the over- 40s2.5 x 10^6 deaths per year worldwide
52
What are the signs and symptoms of COPD?
CoughSOBSputum WheezeBarrel chestFatigueHeadacheTachypnoea, use of accessory musclesHyper resonant chestDistant breath sounds, poor air movement, wheezing and coarse cracklesCyanosisAsterixisDistended neck veins, hepatojugular reflexSwelling (lower extremities)ClubbingHepatosplenomegaly
53
What investigations can you do for COPD?
Pulse oximeterLow oxygen satsFBCIncreased PVCCXRHyperinflationFlat hemidiaphragmsLarge central pulmonary arteriesReduced peripheral vascular markingsbullaeECGRight atrial and ventricular hypertrophy (cor pulmonale)ABGLow PaO2 plus hypercapniaSpirometryFEV1 < 80%FEV1/FVC <70%Increased TLC/RVDLCO reduced
54
What are the complications of COPD?
Cor Pulmonale- oxygen therapyRecurrent pneumonia- Antibiotics, pneumococcal vaccinationDepression- lifestyle, therapy, antidepressantsPneumothorax- conservative management or chest drainRespiratory failure- non invasive positive pressure ventilation/ mechanical ventilationAnaemiaPolycythaemia
55
What is the management of COPD?
Lifestyle- smoking cessation and diet adviceMucolyticsFlu treatmentsLong term oxygen therapy
56
What is the prognosis of COPD?
Depends on severity of disease based on FEV1 Use BODE indexResp failure has poor prognosis
57
What is EAA?
Hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis, is the result of non-IgE mediated immunological inflammation. HP is caused by repeated inhalation of non-human protein, which can be of natural plant or animal origin or can be the result of a chemical conjugated to a human airway protein, such as albumin.
58
What are the risk factors to EAA?
SmokingViral infectionExposure to avian protein, mould, bacterial and acid anhydride antigenExposure to diisocyanates, metal-working fluidNitrofurantoin, methotrexate, roxithromycin, rituximabHerbal supplements with ayurvedic medicine
59
What is the epidemiology of EAA?
The prevalence of HP is not precisely known. It most probably varies with the antigen, the exposure concentration, and as yet unidentified host factors.
60
What are the signs and symptoms of EAA?
Exposure in historyDyspnoeaNon productive coughProductive coughMalaiseFeverWeight lossBibasilar or diffuse ralesClubbing
61
What investigations are needed for EAA?
Immunological response to causative agentBloodsFBCLeukocytosisNormochromic, normocytic anaemiaESRElevatedAlbuminLowCXRInfiltrates, nodular or patchyFibrosisCT chestGround glass shadowingPoorly defined micronodulesMosaic attenuationCentrilobular nodulesRelative basal sparingPulmonary function testRestrictiveMixed restrictive/ obstructiveDiffusing lung capacity of Carbon monoxideDecreasedBronchoalveolar lavagePositive antibody and lymphocytosisLung biopsyBronchocentric infiltrates incl. Lymphocytes, plasma cells, neutrophils, foamy macrophages and non-caseating granulomasInterstitial fibrosis
62
What is Idiopathic Pulmonary Fibrosis (IPF)?
Idiopathic pulmonary fibrosis (IPF) is a rare, chronic, life-threatening disease that manifests over several years and is characterised by the formation of scar tissue within the lungs and progressive dyspnoea.IT IS AN INTERSTITIAL LUNG DISEASE.
63
What are the risk factors of IPF?
AgeMaleFHxSmokers (due to oxidative injury)GORD/ Dust/ infection/ diabetes
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What is the epidemiology of IPF?
The precise incidence and prevalence of IPF are not known. The prevalence in the US has been estimated to be between 14.0 and 42.7 cases per 100,000 people. Similar results have been reported in Finland and in the UK.
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What are the signs and symptoms of IPF?
DyspnoeaCoughWeight loss, fatigue, malaiseCracklesClubbing
66
What investigations are important for IPF?
CXRBasilar, peripheral, bilateral, asymmetrical, reticular opacitiesHigh resolution CTBasilar and subpleural predominat areas of increased reticultion (honeycombing)Traction bronchiectasisAnti-nuclear antibodies Normal or elevatedRheumatoid factorNormal or elevatedAnti cyclic citrullinated peptideNormalMyositis panelNormal
67
What is Non Small Cell Lung Cancer? (NSCLC)
Lung cancer comprises a group of malignant epithelial tumours arising from cells lining the lower respiratory tract.
68
What are the risk factors of NSCLC?
> Cigarette smoking> Environmental tobacco exposure> COPD> FHx> Radon Gas exposure> Older age
69
What are the signs and symptoms of NSCLC?
> Cough > Dyspnoea> Haemoptysis> Chest and shoulder pain> Weight loss> Fatigue> Pulmonary abnormalities
70
What is the epidemiology of NSCLC?
Worldwide, lung cancer is the most common non-cutaneous cancer and is increasing at a rate of 0.5% per year.
71
What are the investigations you might do for NSCLC?
> CXR- nodules, masses, pleural effusions, collapse> Contrast enhanced CT of lower neck, thorac and upper abdomen- Size, location and extent of primary tumour
72
What is Small cell lung cancer?
Small cell lung cancer (SCLC), previously referred to as oat cell carcinoma, is a malignant epithelial tumour arising from cells lining the lower respiratory tract.
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What are the RFs for Small Cell lung cancer?
> Cigarette smoking> Environmental tobacco exposure> Radon gas exposure> Asbestos exposure
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What are the signs and symptoms of Small Cell lung cancer?
> Cough > Dyspnoea> Haemoptysis> Chest and shoulder pain> Weight loss> Fatigue> Pulmonary abnormalities
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What is the epidemiology of small cell lung cancer?
More than 39,000 deaths are attributed to lung cancer in England and Wales each year.
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What are the investigations for small cell lung cancer?
CXR- central mass, hilar lymphadenopathy, pleural effusionCT chest, liver and adrenal glands- Lymphadenopathy and direct mediastinal invasionSputum cytology- Malignant cells in sputum
77
What is obstructive sleep apnoea?
Obstructive sleep apnoea (OSA) is characterised by episodes of complete or partial upper airway obstruction during sleep
78
What are the risk factors for obstructive sleep apnoea?
> Obesity> Male> Post menopause> Large neck circumference> Maxillomandibular anomalies> Increased volume of soft tissues> FHx> PCOS> Chronic snoring> Hypothyroidism> Down's syndrome> Mucopolysaccharides> Older Age> Black, hispanic or asian> Tobacco smoking
79
What are the signs and symptoms of obstructive sleep apnoea?
> Excessive daytime sleepiness> Episodes of apnoea> Episodic gasping> Restless sleep> Insomnia> Macroglossia> Chronic snoring> Mood disorders> Nocturia> Erectile dysfunction> Morning headaches> Dry mouth
80
What is the epidemiology of obstructive sleep apnoea?
OSA is estimated to affect 4% of men and 2% of women in the US, based on the definition of OSA as an Apnoea-Hypopnoea Index (AHI) of ≥5 episodes/hour with excessive daytime sleepiness
81
What investigations do you need to do for obstructive sleep apnoea?
> Polysomnography> Portable multichannel sleep tests> Awake fibreoptic endoscopy
82
What is pneumoconiosis?
The pneumoconioses are a group of interstitial lung diseases, mostly of occupational origin, caused by the inhalation of mineral or metal dusts
83
What are the risk factors of pneumoconiosis?
Occupational exposures:> Silica> Coal> Beryllium> Cigarette smoking
84
What are the signs and symptoms of pneumoconiosis?
> Dyspnoea> Cough> Crackles on auscultation> Tightness or wheezing> Cyanosis> Barrel chest> Haemoptysis> Clubbing
85
What is the epidemiology of pneumoconiosis?
The incidence of silicosis appears to be decreasing in Great Britain.Although the number of deaths has been decreasing, the prevalence of coal workers’ pneumoconiosis, advanced coal workers’ pneumoconiosis, and lung transplants for coal workers’ pneumoconiosis has been increasing in the US since the 1990s.
86
What investigations are important for pneumoconiosis?
> CXRprogressive upper zone non-calcified, small, rounded opacities> SpirometryRestrictive (may be obstructive or mixed pattern> Beryllium lymphocyte proliferation testIf sensitised to beryllium: positive response
87
What is pneumonia?
An acute LRTI associated with fever and chest symptoms/signs and CXR abnormalities.CAP- acquired outside HC setting (likely strep pneumoniae)HAP- acquired inside HC setting after 48 hrs.
88
What are the types of pneumonia?
AspirationAtypical- Cannot be cultured by normal methods (legionella, mycobacterium, chlamydia)Chlamydophila- C pneumoniae, major cause of pneumoniaCAP/ HAP(more G-ve)Pneumocystis jiroveci (PCP)- causes disease in immunocompromised patients with CD4<200 cells per microlit etc.SARS (SARS coronavirus) TRAVEL HISTORY
89
What are the risk factors of pneumonia?
Very young or very oldOvercrowdingHealthcare settingCOPD/ smoking
90
What is the epidemiology of pneumonia?
Incidence = 5-11 per 1000Mortality about 21% in hospital
91
What are the signs and symptoms of pneumonia?
FeverCoughDyspnoeaChest painRigorsAnorexiaPurulent sputum HaemoptysisPleuritic painPyrexiaCyanosisConfusionTachypnoeaTachycardiaHypotension ConsolidationPleural rub
92
What investigations would you do for pneumonia?
ABGLow oxygen satsBloodsLeukocytosisNormal U/ESlightly elevated Blood glucoseCRP may be elevatedSputumUrineAntigen for legionella and pneumococcusCXRNew infiltratesPCRAntigensBronchoscopy/ bronchoalveolar lavage
93
What does CURB-65 stand for?
CURB-65ConfusionUrea (<7 mmol/L)Resp rate (>30 /min)BP <90 systolic/ 60 diastolic65 yrs or older>3 severe pneumonia, consider ITU
94
What is the management of pneumonia?
Pneumococcal vaccineAntibiotics (Amoxicillin/ clarithromycin/ doxicillin/ co amoxiclav/ flucox/ rifampicin etc.) levofloxacinOxygenIV fluidsAnalgesia (if pleurisy)6 week follow up- CXR
95
What is the complications of pneumonia?
Pleural (parapneumonic) effusion (drain)Empyema (drain with radiological guidance)Lung abscess (antibiotics and drainage)Resp. failure (oxygen)Septicaemia (IV AB)AF (beta blocker or digoxin)PericarditisMyocarditisCholestatic jaundice (due to AB)Repeat CRP and CXR if not progressing
96
What is the prognosis of pneumonia?
Determined by age, general health and setting in which AB was given.Mortality rate varies by disease but lower in outpatients than inpatientsReadmission rate is 7-12%There are prognostic biomarkers like ANP, CRP, cortisol etc.
97
What is the definition of a pneumothorax?
Air leak between in the pleural space
98
What are the types of pneumothorax?
PrimarySecondaryTraumatic Tension
99
Describe the types of pneumothorax?
Primary spontaneous no underlying disease Secondary spontaneous underlying lung disease Greater morbidity and mortality Greater symptom presence Not usually with exertion Traumatic result of trauma Iatrogenic (biopsies, aspiration)TensionIntrapleural space >>> atmospheric pressure Ball valve mechanism- pressure doesn’t escape
100
What is the incidence of pneumothorax?
1-18/ 10000
101
What are the RFs for pneumothorax?
Male > FemalesBMI- tall skinny Smoking tobacco or cannabisOlder, over 55 FHxRecent medical procedures Resp. Conditions:asthma COPDTBILDs- cystic lung diseasesCF
102
What are the signs and symptoms of pneumothorax?
Chest pain, sudden onset DyspnoeaHyperexpanded, hyperresonant, ipsilateral hemithoraxIpsilateral diminished breath soundsSHx- pilot or diver, smoking, drugs FHxReview- wheezy, fevers, green sputum for infection
103
What investigations fo you do for pneumothorax?
Bloods (should all be normal)CXR (pneumothorax)CT (for complex cases- bullous disease)US chest but why
104
What is the management and advice for a pneumothorax?
Large = =>2cm (50%) of lung margin and chest wall at level of hillsTreat underlying cause-Antibiotics/ injury management etc.Nothing - watch and wait Aspirate BEFORE DRAINChest drain (<14Fr) (14-16G if tension pneumothorax)Oxygen Surgery No flying 1-6 weeks after No diving ever Smoking cessation Come back in if symptoms
105
How do you relieve the different sizes of pneumothorax?
Primary:Large (>2cm)- Aspirate with cannulaSmall (<2cm)- discharge and reviewSecondary:Large (>2cm)- Chest drain (try aspiratiob first)Small (<2 cm)- Aspirate with 16-18G cannulaV small (<1cm) watch and wait on admission (24hrs)
106
What are the complications of a pneumothorax?
> Re-expansion pulmonary oedema> Tal pleurodesis related ARDS
107
What is the prognosis of a pneumothorax?
High rate of recurrence
108
What is a pulmonary embolism?
Pulmonary embolism (PE) is a life-threatening condition resulting from dislodged thrombi occluding the pulmonary vasculature
109
What is Virchow's triad?
> Hypercoagulability> Stasis> Vessel wall injury
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What are the types of embolus?
FatAirThrombusBacteria Amniotic fluid Trauma
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What are the signs and symptoms of PE?
Nonspecific signsSOB Pleuritic chest pain Haemoptysis
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What differentials might you have with a PE?
MIPNEUMOTHORAXAORTIC DISSECTION PNEUMONIA BOERHAAVE'S PERFORATION OF THE OESOPHAGUS
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What Investigations would you do for PE?
CXRBloodsFBCUETropninBlood gasECGsinus tachycardia Right heart strain Wells score for PED DIMER if PE is unlikely (not raised rules this out)Scan lungs if PE likely CTPA (ct pulmonary angiogram) [HIGH RADIATION]V/Q scan looks at ventilation perfusion mismatch US of legs for DVT
114
What is the management of a PE?
AssessmentStabilise high flow oxygen IV fluid Inotropic agents if needed Anticoagulate short term- LMWHLong term- warfarin or DOACCancer/ pregnancy- LMWH or DOAC IVC filter if needed
115
What are the symptoms of a massive PE?
hypotension Syncope Cyanosis Cardiac arrest
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What is the management of a massive PE?
ABCDEICU careEmergency echo Alteplase 100mg over 2 hrs (if haemodynamically unstable)
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What are the complications of a PE?
RecurrenceSudden cardiac death Pneumonia on lung tissue that was infarcted
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What is the prognosis of a PE?
Not good if not treated early
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What are the risk factors of a PE?
> Age> DVT> Surgery> Immobility> Previos VTE/ FHx> Cancer> Pregnancy> Hypercoagulability (e.g. FV Leiden, deficiencies, antiphospholipid antibody syndrome)
120
What is Sarcoidosis?
Sarcoidosis is a chronic granulomatous disorder of unknown aetiology, commonly affecting the lungs, skin, and eyes. It is characterised by accumulation of lymphocytes and macrophages and the formation of non-caseating granulomas in the lungs and other organs.Non caseating- no necrotic core
121
What are the risk factors of sarcoidosis?
Aged 20-40FHx sarcoidosisScandinavian origin(Female, non smoker, black ancestry, puerto rican, european)Immune dysregulation to allergen
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What is the epidemiology of sarcoidosis?
Incidence is about 6 cases per 100,000 person-years.
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What are the signs and symptoms of sarcoidosis?
CoughDyspnoeaChronic fatigueArthralgiaWheezingRhonchiLymphadenopathyPhotophobiaRed painful eyeBlurred visionErythema nodosumFacial palsyHypercalcaemia symptoms Lupus pernio
124
What investigations are used for sarcoidosis?
CXRHilar/ paratracheal adenopathyUpper lobe predominant bilateral infiltratesPleural effusionsEgg shell calcificationsBloodsFBC (Anaemia and leukopenia)ESR (raised)Urea and Creatinine (May be elevated)Liver enzymes (elevated)Serum calcium (Elevated)Pulmonary Function TestsRestrictive/ obstructive/ mixedECGConduction defectsPurified Protein derivative of tuberculinNegativeBronchoalveolar lavagehigh CD4/CD8 ratio >3.5
125
What is tuberculosis?
An infection caused by Mycobacterium tuberculosis. It can affect any organ system. It is a rod shaped gram positive bacillus. Slow growing- can be dormant then active. Extra pulmonary tB is not infectious.
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What are the risk factors of TB?
> Exposure> Endemic country> HIV and immunosuppression> Silicosis> Malignancy> IVDU> Alcoholism> Homelessness> Age> Smoking> Dialysis
127
What is the epidemiology of Tb?
Higher in immigration centres from high risk countries (Asia)
128
What are the signs and symptoms of TB?
CoughFeverAnorexiaWeight lossMalaise LymphadenopathyHaemoptysis, pleuritic chest pain, dyspnoea, clubbing (chronic), erythema nodosum, night sweats Uveitis, conjunctivitis Lupus vulgaris
129
What investigations do you do for TB?
Chest x ray> Pulmonary symptoms Mediastinal lymphadenopathyPleural effusions Lobar consolidationMiliary > Reactivation Classically in apices and mid zone Upper zone fluffy diseaseCavitating pneumonia Tuberculin skin test (may be positive if BCG has been given)takes a few monthsInterferon gamma release assays ELISpot (cell specific)ELISA (total IFN)3 Sputum culture/ smears to rule out infective TBFBCCSF microscopy (TB meningitis)Lymphocytic High proteinHigh glucose
