Tachycardia Tachypnoea Cyanosis Fever Low BP Crackles Rub Pleural effusion CXR Normal prior to infarction Basal atelectasis and consolidation follow

Week 6 Flashcards by Joe Farrimond

What are some pre-disposing risk factors to DVT and PE?

Contraceptive pill and hormone replacement therapy

Pregnancy

Pelvic obstruction

Trauma, trauma, immobility

Malignancy

Pulmonary hypertension

Obesity

How well did you know this?

Not at all

Perfectly

PE - signs

Tachycardia

Tachypnoea

Cyanosis

Fever

Low BP

Crackles

Rub

Pleural effusion

CXR

Normal prior to infarction
Basal atelectasis and consolidation follow

How well did you know this?

Not at all

Perfectly

Shock Lung is a type of ARDS, what causes it?

Sepsis

Diffuse infection

Severe trauma

Oxygen

How well did you know this?

Not at all

Perfectly

Pulmonary oedema causes an obstructive/restrictive pattern of disease

Restrictive

How well did you know this?

Not at all

Perfectly

What are the three components of Virchow’s Triad?

Factors in the vessel wall i.e. endothelial injury
Abnormal blood flow (venous stasis)
Hypercoaguability (cancer patients, post-MI patients)

How well did you know this?

Not at all

Perfectly

Name one thrombolytic drug

Tenecteplase - activates tissue plasminogen (tPA)

Only for large life-threatening PEs

How well did you know this?

Not at all

Perfectly

What is sleep apnoea? What are the risk factors?

Intermittent upper airway collapse in sleep

1-4% of the adult ppn suffer

Risk factors

enlarged tonsils
obesity
hypothyroidism, acromegaly
oropharyngeal deformities
neurological - stroke, MS etc.
Drugs - opiates, alcohol etc.

How well did you know this?

Not at all

Perfectly

Depending on their size, pulmonary emboli may present in different ways. Examples of small, medium and large presentations

Small

often clinically “silent”, subacute
progressive breathlessnes
pulmonary hypertension
right heart failure

Medium

pleuritic pain
breathlessness
haemoptysis

Large

cardiovascular shock
low BP
central cyanosis
sudden death

How well did you know this?

Not at all

Perfectly

Pulmonary emboli are often subclinical - true or false

What is the source of most pulmonary emboli?

True

DVT of lower limbs is most commonly the source.

95% of PEs are thromboembolisms

How well did you know this?

Not at all

Perfectly

What is stridor?

A predominantly inspiratory wheeze due to obstruction in the large airways

How well did you know this?

Not at all

Perfectly

Sleep apnoea - treatment

Continuous Positive Airway Pressure (CPAP)

How well did you know this?

Not at all

Perfectly

What cellular pathology is seen in ARDS?

Fibrinous exudate lining the alveolar walls - hyaline membranes

Cellular regeneration

Inflammation

How well did you know this?

Not at all

Perfectly

DVT - clinical presentation and differential

Presentation

Depending on the site, the whole leg could be affected, or just the calf
Leg appears swollen, hot, red and tender

Differential

Popliteal synovial rupture (Baker’s Cyst)
Superficial thrombophlebitis
Calf cellulitis

How well did you know this?

Not at all

Perfectly

Warfarin and LMW Heparin are anti-coagulants with long half-lives, so may need to be reversed. How is this done?

What is the downside of the NOACs?

Reverse warfarin with vitamin K1

Reverse heparine with protamine

The NOACs have no reversal agent

How well did you know this?

Not at all

Perfectly

Name 2 pharmacological methods of DVT prevention

Subcutaneous low dose low molecular weight heparin (Fragmin) given as a once daily injection - also start Warfarin at the same time as heparin, and continue Warfarin treatment for 3-6 months

Novel Oral Anticoagulant therapy (NOACs)

Dabigatran - directly inhibits thrombin
Rivaroxaban - directly inhibts factor Xa

How well did you know this?

Not at all

Perfectly

What is pulmonary infarction?

Study These Flashcards

Blockage resulting in ischaemic necrosis

Pulmonary emboli are necessary but not sufficient alone

What is the difference between a proximal and distal DVT?

Study These Flashcards

Proximal

Ileo-femoral
most likely to embolise
most likely to lead to chronic venous insufficiency and leg ulcers

Distal

Popliteal
least likely to embolise

Anaphylaxis - treatment

Study These Flashcards

IV Adrenaline

IV antihistamine

IV corticosteroid

High flow O₂

Nebulised bronchodilators

Suspect DVT? Investigate! What do you do?

Study These Flashcards

Doppler Ultrasound (1st line)

Non-invasive, easy
Excludes popliteal cysts and pelvic masses

CT scan

Visualise the ileo-femoral veins, IVC and pelvis

Causes of transudate pleural effusion (low protein)

Study These Flashcards

Cardiac failure

hypoproteinaemia

Causes of exudate pleural effusion (high protein)

Study These Flashcards

Pneumonia

Connective tissue disease

malignancy

What conditions could be affecting the supraglottis/larynx that would result in stridor?

Study These Flashcards

Laryngomalacia

“soft larynx”, most common cause of stridor in children
immature cartilage of the larynx collapses inwards during inhalation, causing obstruction

Supraglottic mass

Glottic lesions

Vocal cord paralysis

Think stridor? Investigate! What do you do?

Study These Flashcards

Laryngoscopy

Bronchoscopy

CXR

Other imaging - CT, thyroid scan

How is cor pulmonale caused?

Study These Flashcards

Feature of right sided heart disease secondary to lung disease

Specific Causes

ARDS
COPD
Primary pulmonary hypertension
Pulmonary emboli
ILD
CF
Sarcoidosis

What severe complication is sleep apnoea associated with?

RTAs - equivalent to being twice the legal limit in alcohol

Signs of acute anaphylaxis

Flushing, pruritus (itch), urticaria (hives) Angioedema (lips, tongue, face, larynx, bronchi) Abdominal pain, vomiting Hypotension (due to vasodilation and plasma exudation) Stridor, wheeze and respiratory failure

What are some causes of stridor in adults?

Neoplasms in the larynx, trachea or bronchi Anaphylaxis Goitre Trauma e.g. strangulation

Cor pulmonale - clinical presentation

SOB Wheezing Raised JVP Ascites Cyanosis Cardiomegaly Jaundice Hepatomegaly 3rd heart sound Intercostal recession

Pulmonary hypertension - clinical signs and symptoms

Clinical signs * Central cyanosis if hypoxic * Dependent oedema * Raised JVP * Right ventricular heave at left sternal edge * Murmur of tricuspid regurgitation * Loud P2 sound Symptoms * SOB * Fatigue * Chest pain * Palpitations * Lightheadedness * Fainting * Peripheral oedema

Pulmonary hypertension - causes

1. Hypoxia - constricted blood vessels 2. Increased flow through pulmonary circulation - due to congenital defects 3. Blockages (PE), or loss (emphysema) of pulmonary vascular bed 4. Back pressure from left sided heart failure **Right ventricular hypertrophy** is a sign

Give an example of a primary and secondary pleural neoplasia

Primary - malignant mesothelioma Secondary - adenocarcinoma

PE - clinical presentation

Sudden breathlessness Pleuritic chest pain Haemoptysis Leg pain/swelling Collapse/sudden death

What are the most common causes of stridor in children?

Laryngomalacia Infections * Croup * Epiglottitis * Diptheria * Infectious mononucleosis Foreign body inhalation Anaphylaxis/angioedema

Cor pulmonale is associated with left/right sided heart failure. What is seen in acute and chronic cor pulmonale?

Right sided heart failure. Includes right ventricular hypertrophy (chronic), right ventricular dilatation (acute) and swollen legs, congested liver etc

Suspect PE? Investigate! What do you do?

Diagnosis is based on a combination of investigations and test results Tests * ECG * Examine D-dimers - will usually be raised * V/Q scan - sensitive for small peripheral emboli (see pic) * CT pulmonary angiogram (CTPA) - picks up larger clots in the proximal vessels

Week 6 Flashcards

(35 cards)