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Other Flashcards

1
Q

ARDS recommendation

A

strongly in favour:
tidal volume <6ml/kg IBW
plateau pressure <30cmH2O
prone position for moderate/severe ARDS >12 hours

Weakly in favour:
higer PEEP, neuromuscular blockers, ECMO

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2
Q

ARDS grading

A

PaO2/FiO2 <300mmHg (40kPa) despite PEEP >5cmH2O
Mild: >200mmHg (27kPa)
Moderate: >100 (13 kPa)
Severe: <100 (13kPa)

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3
Q

ECMO for ARDS

A

Severe ARDS
High lung injury score
hypercapnic pH <7.2
No CI to anticoagulation

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4
Q

Guillain Barre syndrome - risk of respiratory failure

A

Bulbar dysfunction
facial weakness
Max Inspiratory Pressure <30
Max expiratory pressure <40
FVC drop >30% from baseline
FVC <15ml/kg

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5
Q

Flow volume loops:
Causes of fixed upper airways obstruction

A

Tracheal stenosis
fixed central airway tumour
fibrotic structure
Goitre

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6
Q

Flow volume loops:
causes of variable intrathoracic obstruction

A

Tracheomalacia
Bronchogenic cysts
lower tracheal lesions e.g. tumour
polychondritis

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7
Q

Flow volume loops:
Causes of variable extrathoracic obstruction

A

Vocal cord paralysis
subglottic stenosis
extrathoracic tracheomalacia
polychondritis
mobile upper tracheal tumours
goitre

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8
Q

Flow volume loops:
Causes of saw tooth palter

A

neuromuscular disease
parkinsons disease
OSA

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9
Q

causes of high TLCO

A

Lying flat
Exercise
Asthma
Pulmonary haemorrhage
Polycythaemia
L-> R shunt
AV malformations
hyperthyroidism

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10
Q

Causes of low TLCO

A

Emphysema
Fibrosis
Anaemia
R -> L shunt
PE
CO poisoning

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11
Q

Causes of normal KCO and Low TLCO

A

Chest wall disease
NMD
Kyphoscoliosis
obesity
lung resection
pleural thickening

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12
Q

Causes of isolated low TLCO

A

Pulm hypertension

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13
Q

CPET

A

Normal - VO2 max >80%
Cardiac - High HR, Ventilatory reserve
Resp - VE >80%, HR reserve, low Vt

VO2 max <15ml/kg/min (40%) - severe
Anaerobic threshold <40% VO2 - abnormal

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14
Q

CPET contraindications absolute

A

acute MI, angina
Arrhythmia
Haemodynamic instability
syncope
infective endocarditis
Acute myocarditis/pericarditis
uncontrolled CCF
AAA leaking or dissection
uncontrolled asthma
desat <85% RA

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15
Q

CPET contraindication relative

A

uncontrolled hypertension
severe AS
Pulm hypertension
HOCM
VTE <2 weeks
pregnancy
Tachy/brady

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16
Q

end expiratory pleural pressure

A

4kPa

17
Q

Aa gradient

A

pAO2 - paO2

pAO2 = piO2 - (paCO2 /0.8)

> 4 = v/Q mismatch

18
Q

Lobectomy mortality

A

~2-3%
FEV1 >1.5L

19
Q

Pneumonectomy mortality

A

~6-8%
FEV1 >2L

20
Q

Post-op FEV1

A

Pre-op FEV1 x seg after resection /19

<40% increases risk

21
Q

Surgical lung biopsy ILD 90 day mortality

A

4%

22
Q

Transplant criteria for COPD

A

BODE >7
Hospitalisations with exacerbations
pulm hypertension
cor pulmonale
FEV1 <25%
TLCO <20%
Homogenous distribution of emphysema
smoking cessation >6 months
completed pulm rehab
Resp failure - high CO2, low O2

23
Q

Transplant criteria for CF

A

FEV1 <30%
Rapid progression
increase frequency of exacerbations
ITU admission
resp failure, LTOT
pulm hypertension
severe recurrent haemoptysis
recurrent or refractory pneumothorax
6MWT <400m

Relative CI - burkholderia and abscesses

24
Q

Transplant criteria for ILD

A

TLCO <40% or drop by >15%
FVC drop by >10% over 6 months
6MWT desat to <88% or <250m or decline in 50m over 6 months
pulm htn
exacerbations
age <65

25
Q

Transplant criteria for pulm hypertension

A

NYHA >3
Rapidly progressive disease
6MWT <350m
MAP 15mmHg
cardiac index <2L/min/m2
IV inotropic support
haemoptysis
pericardial effusion

26
Q

Criteria for lung volume reduction surgery - COPD

A

FEV1 >20%
TLC >100%
RV >150%
pCO2 <7.3
pO2 >6
6MWT >140
<3 ex in 12 months
heterozygous emphysema - upper lobe
intact fissures

27
Q

CI for lung volume reduction surgery

A

diffuse emphysema
ILD
giant bulla
pulm hypertension

28
Q

Complications for LVRS

A

persistent air leak
pneumonia
T2RF
post-op mortality 2-15%

29
Q

LVRS criteria

A

upper lobe heterogenous emphysema
RV:TLC >60
TLCO >20
BMI >18

Not suitable in: severe comorbidities, chronic resp disease, malignancy, pulm hypertension

30
Q

Referral criteria for LVRS

A

nonsmoker >4months
pulm rehab
MRC >3
6MWT >140
FEV1 <50%
TLCO >20%
RV >150%
RV:TLC >55%
CO2 <7
BMI > 18

31
Q

Criteria for endobronchial valves

A

upper or lower lobe
heterogeneous
collateral ventilation negative
RV >180%
TLCO>20
BMI >18

32
Q

Birt Hogg Dube syndrome

A

AD condition. benign skin hamartomas, most commonly located on the head and neck; pulmonary cysts and spontaneous pneumothorax; and an increased risk of renal cancer.

33
Q

Obesity lung function test

A

Restrictive. low FRC. TLC/RV ratio presevered

34
Q

Normal RV/TLC ratio

A

<35%

35
Q

Empey index

A

FEV1/PEFR ratio
normal <10; if >10 - upper airway obstruction

36
Q

Diaphragm paralysis - test

A

MIP and Sniff nasal insp pressure low
MEP normal

37
Q

A-a gradient

A

normal 1-3 depending on age
raised A-a gradient = inappropriately low PaO2 -> PE, R to L cardiac shunt

Resp SCE (9 decks)

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