Acute Resp

Question 1

What is T1RF

Answer 1

Hypoxia

Question 2

What is T2RF

Answer 2

Hypoxia

Hypercapnic

Question 3

What is the fundamental problem with T1RF?

Answer 3

V/Q mismatch

Question 4

Why is CO2 not raised in T1RF

Answer 4

Because we hyperventilate to compensate

Question 5

What is the fundamental problem in T2RF

Answer 5

Alveolar hypoventilation

Question 6

Acute causes of T1RF (7)

Answer 6

Acute asthma
Atalectasis
Pulmonary Oedema
Pneumonia
Pneumothorax
PE
ARDS

Question 7

Acute causes of T2RF (6)

Answer 7

Acute severe asthma
COPD
Upper airway obstruction
Neuropathies (GBS, MND)
Drugs (opiates)

Question 8

Traumatic vs spontaneous pneumathoraces - which pleura is involved

Answer 8

Traumatic - at least the parietal

Spontaneous - at least the visceral

Question 9

Mx of a tension pneumothorax

Answer 9

Immediate needle decompression with a large bore cannula in the MCL in the 2nd ICS

Question 10

Mx of a spontaneous pneumothorax (primary and secondary)

Answer 10

PRIMARY
If no SoB or <2cm: discharge
>2cm/SoB: needle aspiration + O2
Otherwise: chest drain

SECONDARY
If no SoB or <1cm: Observe + O2
1-2cm: needle aspiration
>2cm/SoB: chest drain

Question 11

What scoring is used to investigate a PE

Answer 11

Well’s

Question 12

How is Well’s score used

Answer 12

> 4 CTPA

=<4 D-dimer

Question 13

What sign on a CXR shows a PE

Answer 13

Westermark

Question 14

What is occluded in chronic PE and what is the symptom

Answer 14

Pulmonary microvasculature

Exertional dyspnoea

Question 15

What do we use to prevent VTE in hospital

Answer 15

TEDs and Tinz

Thrombo-embolic deterrent stockings and Tinzaparin (a popular LMWH)

Question 16

What does the name of thrombolytic drugs end in?

Answer 16

-ase

Question 17

3 thrombolytics commonly used

Answer 17

Alteplase
Streptokinase
rt-PA

Question 18

Mx of a PE

Answer 18

Are they haemodynamically stable?
Yes - subacute/chronic
Respiratory support
Anticoagulation
e.g.
Fondaparinux/Heparin for 5 days
Warfarin for 3 months

No - massive PE
Respiratory support
1st line: Thrombolysis
2nd line: Embolectomy
e.g.
Alteplase
Streptokinase
rt-PA

Question 19

Causes of ARDS (7)

Answer 19

Drugs
Barotrauma
Nearly drowning
Severe burns
Sepsis
Pneumonia
Transfusion reactions

Question 20

In which population is ARDS particularly common in and why(2)

Answer 20

critically ill/ITU patients

because many of the causes of ARDS such as burns need intensive management – but also because mechanical over-ventilation can trigger ARDS

Question 21

What type of respiratory failure is caused by ARDS

Answer 21

T1

Question 22

Pathophysiology of ARDS

Answer 22

Complicated inflammatory response which leads to diffuse alveolar damage. As inflammatory markers are recruited they increase the vascular permeability in order to promote further recruitment. This leads to fluid entering the lungs in a similar way to pulmonary oedema. This then causes your alveoli to collapse collapse which decreases the surface area for gas exchange and also increases the distance between the capillary and the alveoli (diffusion distance). This decreases the rate at which oxygen can be loaded into the capillary – decreasing oxygenation (type 1 resp failure)

Question 23

X ray findings for pulmonary oedema

Answer 23

A - alveolaroedema(bat wing opacities)
B - Kerley B lines.
C - cardiomegaly.
D - dilated upper lobe vessels.
E - pleural effusion.

Question 24

X ray findings for ARDS

Answer 24

A - alveolaroedema(bat wing opacities)
B - Kerley B lines.
C - cardiomegaly.
D - dilated upper lobe vessels.
E - pleural effusion.