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PACES ellen > Past stations > Flashcards

Past stations Flashcards

1
Q

COPD is

A

A progressive disease characterised by airflow obstruction and airway inflammation , which has little or no reversibility.
Usually related to smoking

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2
Q

COPD is staged using

A

The GOLD criteria- which stages the disease based on airway obstruction using the FEV1

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3
Q

The GOLD stages are…

A

GOLD 1 (mild) - FEV1 >80% of predicted but symptomatic
GOLD 2 (moderate)- FEV1 50-79%
GOLD 3 (severe) - FEV1 30-49%
GOLD 4 (very severe) - FEV1 <30%

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4
Q

GOLD stands for

A

Global Initiative for Obstructive Lung disease

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5
Q

Symptoms of COPD

A

Breathlessness on exertion (can use MRC)
Wheeze
Frequent infections
Fatigue
Chronic cough

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6
Q

Signs on examination

A

At bedside:
Sputum pot
Inhalers
Steroids

Hands:
Tar staining
Tremor/ CO2 flap
Bounding pulse

Neck:
Raised JVP if cor pulmonale

Face:
Cushingoid
Cachectic
Pursed lip breathing
Cyanosis
Oral thrush

Chest inspection:
Scars from bullectomy/ lung volume reduction
barrel shaped chest

Palpation:
reduced expansion
hyperresonant
increased vocal fremitus
RV heave

Auscultation
Polyphonic wheeze
Crepitations if infection
Reduced breath sounds over bullae/ bullectomy
prolonged expiratory phase

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7
Q

If signs of COPD in a young patient …

A

Could be alpha -1 - antitrypsin deficiency
May also be jaundiced (liver involvement)

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8
Q

Presenting the case of COPD

A

I believe this patient has COPD due to peripheral signs of…
and central signs of…

There were/nt signs of complications such as P HTN/ RVF
infections
or respiratory compromise eg needing O2
or CUSHINGOID ??- steroid use

Differentials for COPD
A1AD
Asthma
Cardiac wheeze
Bronchiectasis

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9
Q

Investigations in COPD

A

Bedside;
Obs
ABG
Sputum
ECG

Bloods
FBC UE LFTs CRP Bone/ Mg, A1AT
CXR
HRCT

PFTs with transfer factor + test reversibility
echo

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10
Q

Lung function findings in copd

A

FEV1/FVC <70%
FEV1<80% predicted
Reduced diffusion capacity
Incr TLC/ residual volume
Minimal reversibility

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11
Q

XR findings COPD

A

hyper expanded lung fields
flattened hemidiaphragm
bullae

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12
Q

HRCT findings in COPD

A

Emphysema- can grade it
Can grade and localise bullae

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13
Q

Management of COPD

A

MDT approach

General:
Smoking cessation/ NRT
Optimise nutrition
Pulmonary rehabilitation
Vaccines
Home O2 (PaO2 <7.3 or polycythaemia)

Medical:
SABA/ SAMA
SABA/ LABA
or LAMA/LABA
If asthmatic features- ICS
combination therapy if still bad
Theophylline
Carbocisteine

Exacerbations :
Nebulisers
NIV
Steroids

Surgery in some cases;
Bullectomy
lung reduction
lung transplant

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14
Q

Signs of a failing kidney

A

-Pain over the graft site
-abdo pain
-Generally unwell/ malaise associated with worsening renal function + increasing urea/ toxic metabolites
-fluid overload
-poor urine output

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15
Q

renal screen

A

Bedside:
Urine dip/ ACR and MCS
ECG

Bloods
FBC UE LFT Bone profile, vit D

Immunology
ANA ENA anti DS DNA , RF, ANti GBM, p and c anca
immunoglobulins, complement C3 and C4
Serum electrophoresis

Imaging
Renal USS
MRI kidney

Tissue biopsy for histology

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16
Q
A
17
Q

What options are available for smoking cessation.

A

Behavioural treatments
-include motivational interviewing/ counselling

NRT
Drug options including varenicline

18
Q

SPK ? what bedside tests should you ask for?

A

URINE DIP FOR GLUCOSE
FUNDOSCOPY FOR RETINOPATHY

19
Q

How is the pancreas drained in SPK?

A

drained into the bowel
prep drained into the bladder but this often resulted in UTIs

20
Q

Complications of post transplant immunosuppression

A

-infections
-malignancy (PTLD/solid/Skin)
-warts
-skin changes: cushingoid/hirsutism)
-chronic transplant injury (cyclosporin & tac are nephrotoxic)
-metabolic diseaeses , eg DM/anaemia/ hyperlipidaemia, htn
-CVD

21
Q

Benefits of SPK

A

-Aims to cure diabetes and nephropathy
-aims to prevent further nephropathy
-improves QOL -> no need for BM monitoring/ insulin injections/ dialysis
-metabolic health improved including lipids and CV risk

22
Q

complications of SPK

A

-rejection
-technical graft failure: graft thrombosis
-graft pancreatitis
-infeciton

23
Q

alternatives to pancreas transplant?

A

islet cell transplantation
- may not require immunosuppression as may have an infusion of their own islets
-evidence is lacking on which one is better

24
Q

issues in transplanting organs

A

consent
compatibility
technical considerations (anatomy)- eg do they need a nephrectomy
fitness for surgery
immunosuppression
rejection
risk of recurrent disease (high in amyloid/IgA)

25
Q

who makes the decision for a transplant

A

the patient
an MDT

26
Q

causes of chronic renal failure

A

-Diabetic nephropathy
-Glomerulonephritis
-PKD
-Reflux nephropathy
-HTN
-Chronic pyelonephritis

27
Q

causes of glomerulonephritis

A

-IgA nephropathy
-Vasculitis associated glomerulonephritis eg panca/ canca
-Nephritis linked to systemic disease eg Lupus nephritis
-infections such as HIV
-Goodpastures syndrome

28
Q

contra-indications to transplant?

A

active malignancy
active infection
IV drug abuse or ETOH abuse
Psychiatric disease
Unable to engage in clinics/ immunosuppression / monitoring

29
Q

types of rejection of transplants:

A

-Hyperacute rejection (Antibodies against transplant), transplant must be removed
-Acute rejection (may be difficult to distinguish from other issues eg PTLD) - treat with high dose steroids
-Chronic rejection-> gradual graft dysfunction. vascular usually
-Antibody mediated rejection, requires histology to diagnose

30
Q

donor + recipient work up includes

A

ABO/ HLA cross matching
screening for transmittable disease and latent viruses
MRA/ isotope scanning to check which is the better kidney

check their renal function + their risk factors

psychology / support

Cardiovascular risk assessment

31
Q

why is the kidney placed in the pelvis?

A

-good blood supply
-enough space for it anatomically
-easy location to biopsy if needed

32
Q

prognostic factors in renal transplantation

A

-primary renal disease aetiology and risk of recurrence
-live vs deceased donor
-ischaemic time of kidney
-compliance with immunosuppression and monitoring
-episodes of rejection
-cross matching

33
Q

indications for LTOT in COPD ?

A

pa O2 <7.3
or paO2< 8 with polycythaemia / or PHTN or nocturnal hypoxamia

34
Q
A

PACES ellen (2 decks)

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