Other Flashcards
What is Wegeners granulomatosis
Granulomatous with polyangia (autoimmune inflammatory condition affecting endothelial cells)
Pathophysiology of Wegeners granulomatosis
Unknown.
Vasculitis.
Thought to be an attack on endothelial cells
Classification of Wegeners granulomatosis
ELK classification depending on if it affects ENT, Lungs and/or Kidneys
Clinical presentation of Wegeners granulomatosis
Multisystem: range of signs and symptoms.
Fatigue, fever, pleural pain, rhinorrhea, haemoptysis, haematuria.
Epidemiology of Wegeners granulomatosis
6/1,000,000
Diagnosis of Wegeners granulomatosis
FBC
U and E
ESR
C-ANCA an p-ANCA (very suggestive)
Treatment of Wegeners granulomatosis
Prednisolone
Cyclophosphamide (immunosuppressant) with Rituximab (monoclonal antibody)
Complications of Wegeners granulomatosis
Acute Kidney Injury
Resp failure
What is Pulmonary Thromboembolus and infarct
Where thromboembolus blocks right ventricular outflow, pulmonary arteries and branches
DVT embolism
Types of Pulmonary Thromboembolus and infarct
Small-medium (can be clinically silent)
Massive (medical emergency)
Risk factor for DVT embolism
Long periods of immobility (usually sat down) such as a long flight or surgery
Clinical presentation of small-medium pulmonary thromboembolus and infarct
Breathlessness Pleuritic chest pain Haemoptysis if infarction Tachypnoea Pleural rub Exudative pleural effusion
Clinical presentation of massive pulmonary thromboembolus and infarct
Severe central chest pain Shock Pale Sweaty Tachypnoea Tachycardia Cyanosis Increased JVP 2nd heart sound and gallop
Diagnosis of pulmonary thromboembolus and infarct
Revised Geneva score to predict probability of PE.
CXR (decreased vascular markings, raised hemi diaphragm) ECG may exclude differentials eg MI.
D-dimers, spiral CT.
ECHO diagnostic and can be performed at bedside, good for massive.
Treatment of pulmonary thromboembolus and infarct
Initial therapy: Oxygen.
Thrombolysis, LMWH, warfarin.
High risk of recurrence: Vena cava filter
Complications of massive pulmonary thromboembolus and infarct
Acute right heart failure
Syncope
Death
What is a pulmonary embolism
Occlusion of the pulmonary vasculature by a clot
Often it occurs from a deep vein thrombosis (DVT) that has become dislodged and forms an embolus that lodges in the pulmonary arterial vasculature, blocking the vessels
Signs and symptoms of Pulmonary Embolism
Breathlessness (may be of sudden onset or progressive) Tachypnoea Pleuritic chest pain Cyanosis Haemoptysis
(Symptom correlation depends on where the pulmonary circulation is occluded)
Causes of pulmonary embolism
DVT Air embolus Fat embolus Amniotic fluid embolus Foreign material introduced via IV drug
3 pathways involved in pathophysiology of pulmonary embolism
- Platelet factor release: serotonin and thromboxane A2 cause vasoconstriction
- Decreased alveolar perfusion: lung is underperfused and this leads to diminished gas exchange
- Decreased surfactant: this leads to ventilation/perfusion mismatch, hypoxaemia and dyspnoea
Complications of pulmonary embolism
SAPPPP Sudden death Arrhythmia Pulmonary infarction Pleural effusion Paradoxical embolism Pulmonary hypertension
Investigations of pulmonary embolism
D-dimer (sensitive, but not specific - negative result used to rule out PE) Thrombophilia screening CXR (usually normal) ECG ABG CT, Pulmonary Angiography V/Q scan
How could you calculate risk of pulmonary embolism
Wells score
D-dimer test for pulmonary embolism is SENSITIVE but not specific - what is meant by this
Sensitivity is the ability of a test to correctly identify those with the disease (true positive rate)
Specificity is the ability of the test to correctly identify those without the disease (true negative rate)
What test is used to rule out pulmonary embolism
D-dimer
Negative test result rules out PE
When is Thrombophilia screening used
In patients <50 years with recurrent PE
PE - what would you see on an ABG
Hypoxaemia
PE - what is seen on an ECG
Sinus tachycardia
S1Q3T3 pattern is classical but rare (excludes MI)
Treatment of Acute PE
Oxygen
IV fluids
Thrombolysis therapy if indicated e.g. alteplase if massive PE or haemodynamically unstable
LMWH
Long-term management of PE
Anticoagulation
Inferior vena cava filter
Side effects of anticoagulants
passing blood in your urine passing blood when you poo or having black poo severe bruising prolonged nosebleeds bleeding gums vomiting blood or coughing up blood heavy periods in women
Examples of anticoagulants
Warfarin
Rivaroxaban
Heparin
Other examples (except PE) of when anticoagulants are used
strokes or transient ischaemic attacks
heart attacks
deep vein thrombosis (DVT)
