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Theme 4 > Enhanced Respiratory Disorders > Flashcards

Enhanced Respiratory Disorders Flashcards

1
Q

Example of thromboembolic disease

A

Embolism

DVT

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2
Q

Embolism definition

A

Any intravascular material that migrates from original location to occlude distal vessel

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3
Q

PE symptoms

A
  • Dyspnea
    • Cough
    • Hypoxoeamia
    • Pleuritic chest pain
    • Pleural rub
    • Haemoptysis
    • Syncope
    • Tachycardia
    • Calf pain, swelling
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4
Q

PE risk factors - blood

A
  • Genetic: positive family history
    • Pregnancy
    • Oral contraceptive use
    • Malignancy
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5
Q

PE risk factors - vascular damage

A
  • Smoking
    • Surgery
    • Hypertension
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6
Q

PE risk factors - flow

A
  • Immobility (surgery, long travel)

* Pregnancy

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7
Q

Diagnosis of PE

A
  • D-dimer - screening blood test
    • Duplex ultrasound (legs > arms)
    • CT pulmonary angiography
    • Ventilation perfusion scan (V/Q scan)
    • CXR: supportive findings but not-diagnostic
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8
Q

Treatment and management of PE

A 
•	Anti-coagulation
	◦	Heparin
	◦	Warfarin (coumarin)
	◦	Direct thrombin inhibitors 
	◦	factor Xa inhibitors
	•	(removable) Inferior vena cava filter
	•	Screen for pro-coagulable condition
	•	Screen for cancer in selected patients
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9
Q

Anti-coagulation for PE

A

◦ Heparin
◦ Warfarin (coumarin)
◦ Direct thrombin inhibitors
◦ factor Xa inhibitors

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10
Q

Sarcoidosis

A

Sterile inflammation - activate CD4+ cells and macrophage

Inhale unidentified antigen into lungs
T cell receptors bind to antigen - dendritic
Antigen presenting cells present and release cytokines (IFN-g, IL-2, IL-12)

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11
Q

Pulmonary sarcoidosis imaging

A
  • Lymphadenopathy: hilar > mediastinal
    • Lung nodules: innumerable tiny to larger conglomerate nodules
    • Fibrosis – largely affects the airways
    • Upper lobe predominant disease
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12
Q

Pulmonary sarcoidosis symptoms

A
  • In some cases: no symptoms
    • Cough and dyspnea, especially with exertion
    • Systemic symptoms: fatigue, sweats, weight loss, fevers, achyness
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13
Q

Clinical management of pulmonary sarcoidosis

A
  • Medications treatment as needed: corticosteroids (eg. prednisolone), +/- other immunosuppressant medications
    • Screen for multi-organ disease: eye exam, EKG, blood tests for blood cell counts/liver function/kidney function/calcium
    • Establish baseline PFT data
    • Calcium levels can cause kidney stones
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14
Q

Cystic Fibrosis

A

Autosomal recessive
Mucoid obstruction of exocrine gland

CFTR protein = 1480 AA
Deletion or alteration
ΔF508 (loss of phenylalanine) = most common

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15
Q

CF = multisystem disease

A
  • Lung disease
    • Pancreatic insufficiency
    • Malnourishment
    • Meconium ileus
    • Male infertility
    • Osteoporosis
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16
Q

CF findings - examination

A
  • Wheezing
    • Haemoptysis
    • Rhonchi
17
Q

CF findings - imaging

A 
•	Bronchiectasis
	◦	Signet ring sign
	◦	Tram tracking
	•	Densities from mucous plugging
	•	Hyperinflation
	•	Shrunken, fibrotic lungs
18
Q

Pulmonary complications

A

Acute Infections
Chronic infections
Haemoptysis
Respiratory failure

19
Q

Pulmonary complications - Acute Infections

A
  • Pseudomonas aeruginosa and MRSA are common, typical microbes in CF
    • Flora changes with age: gram positive à (resistant) gram negatives
20
Q

Pulmonary complications -Chronic infections

A
  • Pseudomonas and B cepacia

* Allergic bronchopulmonary aspergillosis (ABPA)

21
Q

Pulmonary complications - Haemoptysis -

A

inflamed blood vessels in bronchiectasis

22
Q

Pulmonary complications - respiratory failure

A

Infectious insults + progressive loss of lung function from fibrosis

23
Q

CF treatments

A
  • Bronchodilators
    • Airway clearance techniques
    • Mucous thinners
    ◦ Hypertonic nebulizer treatments
24
Q

Airway clearance technique

A

◦ Postural drainage

◦ Chest physical therapy

25
Q

Other CF treatments

A 
◦	Corticosteroids, inhaled > systemic
	◦	Antibiotics, sometimes long term
	◦	CFTR potentiators: Ivacaftor
	◦	Lung transplant
	◦	Pancreatic enzyme replacement: lipase, protease, and amylase
26
Q

Duplex ultrasound

A

legs > arms

Non-invasive evaluation of blood flow in arteries/veins

27
Q

NICE - Well’s criteria

A
  • 4+: admit for definitive testing
    • < 4: screening d-dimer
    • Other countries: 2 points = moderate risk
28
Q

Heparin

A

Anticoagulant - blood thinner
Injected in veins
Side effects: bleeding, pain, low blood platelets and heparin induced thrombocytopenia

29
Q

Warfarin - coumarin

A

Anticoagulant - blood thinner

Theme 4 (16 decks)

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