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Clinical cases- respiratory > COPD, pneumothorax and pulmonary fibrosis > Flashcards

COPD, pneumothorax and pulmonary fibrosis Flashcards

1
Q

Symptoms of COPD?

A

Breathlessness, green sputum, ankle swelling

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2
Q

Symptoms for exacerbation?

A

Increased breathlessness (dyspnoea, increased sputum production and increased cough/ green sputum

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3
Q

How to work out pack years

A

Number of cigarettes by day/ number in pack (20) x how long they have smoked

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4
Q

What is long term therapy for oxygen?

A

On oxygen continuously

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5
Q

What is ambulatory oxygen therapy?

A

On oxygen only on exertion or when mobile

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6
Q

What is short burst oxygen therapy?

A

When need after exercising

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7
Q

When is LTOT needed?

A
  • Low oxygen saturation
  • Ankle swelling

• Patients with COPD who have a PaO2 <7.3 kPa
• PaO2 > 7.3 and <8 kPa when stable +1 or more
- secondary polycythaemia
- nocturnal hypoxaemia
- peripheral oedema
- pulmonary hypertension

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8
Q

When reading blood gases what should you do?

A

Blood gas PaO2= 20 kPa, PaCO2 =10kPa, pH= 7.1 – Type 2 R failure- always look at pH first- normally 7.35 to 7.45- this is acidic then need to see why acidosis then look at CO2- if in normal range unlikely CO2 causing acidosis but CO2 high here so most likely causes the acidosis. This is R acidosis so is R failure. If CO2 would check bicarbonate to see if it was a metabolic acidodsis.

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9
Q

What is the treatment to COPD?

A
  • Beta-agonist – short and long
  • Anticholinergic agents
  • Inhaled /oral Steroids
  • Antibiotics
  • Mucolytics
  • Flu vaccination
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10
Q

What are therapies for COPD?

A

Initial treatment- Non-invasive treatment
Other therapies in COPD
• LTOT- long term oxygen therapy
• Pulmonary rehabilitation- course where they are taught breathing exercise
• Surgery- bullous disease (lung V reduction)

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11
Q

What happens when you have bronchoscope lung volume reduction and how is it treated?

A

Bronchoscopic lung volume reduction / Intrabronchial valves an emerging therapies
• The valve obstructs airflow into targeted segments
• Allows passage of distal air and mucus
• Redirect ventilation away from more diseased lung tissue

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12
Q

What is a tension pneumothorax?

A

What is a tension pneumothorax?- tissue forms a one way valve allowing air to enter the pleural space and preventing its escape- leak between the visceral and parietal pleura- no air to come out

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13
Q

What are the symptoms of a tension pneumothorax?

A

Symptoms- Bruised, pain in L chest, tender to touch and became short of breath

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14
Q

What is the mechanism of a tension pneumothorax? Why is there a low BP?

A
  • Progressive build-up of air within the pleural space
  • Air can escape into the pleural space but not return
  • Progressive build-up of pressure in the pleural space pushes the mediastinum to the opposite side
  • This results in obstruction to venous return to the heart
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15
Q

What are the signs of a tension pneumothorax?

A
  • Tachypnoea
  • Bruising
  • Tenderness over ribs
  • Trachea deviated away from pneumothorax →  Surgical emphysema – crunching
  • Expansion ↓
  • Increased percussion note ↑
  • Breath sounds ↓
  • Raised central venous pressure ↑
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16
Q

What is a spontaneous pneumothorax?

A

A spontaneous pneumothorax is the sudden onset of a collapsed lung without any apparent cause, such as a traumatic injury to the chest or a known lung disease.

17
Q

What is a primary spontaneous pnuemothorax?

A

Primary spontaneous pneumothorax is likely due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space.

18
Q

What is a secondary spontaneous pnuemothorax?

A

Secondary spontaneous pneumothorax (SSP) occurs in people with a wide variety of parenchymal lung diseases. These individuals have underlying pulmonary pathology that alters normal lung structure. Air enters the pleural space via distended, damaged, or compromised alveoli.

19
Q

Is it safe to fly after having a pneumothorax?

A
  • Non Traumatic: CXR must confirm resolution before flight / 7 days and can fly
  • Traumatic: the time period following full radiographic resolution should be at least two weeks
  • The risk of recurrence is higher in those with co-existing lung disease. This risk does not decline significantly for at least a year
  • A definitive surgical intervention undertaken via thoracotomy is likely to be entirely successful and patients should be allowed to fly once they have recovered from the effects of their surgery
20
Q

Can a pneumothorax occur in absence of trauma?

A
  • Primary spontaneous pneumothorax- smoking and family history
  • Secondary spontaneous pneumothorax- many disease such as COPD/ CF etc.
21
Q

How common is it for a pneumothorax to reoccur?

A
  • After the first spontaneous pneumothorax there is a 10% chance of recurrence
  • After a second pneumothorax this increases to 40%
22
Q

Diagnosis of pulmonary fibrosis

A
  • Methotrexate and steroids
  • Progressive breathlessness
  • Persistent non-productive cough
  • Fine inspiratory crackles
23
Q

What is ILD (interstitial lung disease)?

A

Interstitial lung disease

  • Often symptomatic late in disease course when fibrosis is present
  • Can present with acute interstitial pneumonitis (Hamman-Rich syndrome)
  • Median age 50 to 60 years, (M:F = 2 to 3:1)
  • Association with seropositive and erosive joint disease
24
Q

What structures are affected by the joints?

A

Rheumatoid arthirtis

25
Q

How does pulmonary fibrosis affect the FEV1/ FVC ratio?

A

FEV1/ FVC ratio- restriction FVC would be reduced and FEV1 would be normal – ratio be high- pulmonary fibrosis is a restrictive disease

26
Q

What are side effects of steroid therapy?

A
  • Thrush
  • Bruising
  • Increased weight
  • Cushingoid
  • Increased risk of infection
  • Osteoporosis
27
Q

What is type 1 R failure?

A

Hypoxia- PaCO2 may be normal or low ventilation/ perfusion (V/Q) mismat

28
Q

What is type 2 R failure?

A

Hypoxia and hypercapnoea- Inadequate alveolar ventilation- PaCO2 high

Clinical cases- respiratory (3 decks)

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