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RESP > PE pneumothorax pleural effusion ILD > Flashcards

PE pneumothorax pleural effusion ILD Flashcards

1
Q

what are the causes of PE?

A

usually arise from DVTs in proximal leg or iliac veins

rarely:
R ventricle post MI
septic emboli in R-sided endocarditis

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2
Q

what are the risk factors for PE?

A 
SPASMODICAL 
sex- female
pregnancy
age- high
surgery- 10d post-op straining at stool 
malignancy
oestrogen- OCP/HRT
DVT/PE previous hx 
immobility
colossal size 
antiphospholipid antibodies
lupus anti-coagulant
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3
Q

what are the symptoms of PE?

A

depends on size, number + distrubtion of emboli

dyspnoea
pleuritic pain
haemoptysis
syncope

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4
Q

what are the signs of PE?

A 
fever
cyanosis
tachycardia tachypnoea
RHF- hypotension, raised JVP, loud P2
evice of cause- DVT
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5
Q

what invx for PE?

A 
bloods- FBC UE clotting d-dimer
ABG
CXR
ECG
doppler US- thigh + pelvis
CTPA + venous phase of legs + pelvis

V/Q scan no longer used

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6
Q

what can be seen on ABG in PE?

A

normal or lowered paO2 + paCO2 + raised pH

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7
Q

what can be seen on CXR in PE?

A

normal or
oligaemia
linear atelectasis

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8
Q

what can be seen on ECG in PE?

A

sinus tachycardia
RBBB
RV strain (inverted T in V1-V4)

S1 Q3 T3 rare

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9
Q

how do you diagnose PE?

A

1) assess probability using Wells’ score
2) low-probability- D-dimer
- negative- excludes PE
- positive- CTPA
3) high probability- CTPA

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10
Q

what preventative treatment can be done for PEs?

A

risk assessment for all patients
TEDS
prophylactic LMWH
avoid OCP/HRT if at risk

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11
Q

what is the acute management of PE?

A

1) oxygen NRB 100%
2) analgesia - morphine +/- metoclopramide
3) if critically ill with massive PE consider thrombolysis- alteplase 50mg bolus stat (surgical or interventional embolectomy)

4) LMWH heparin eg enoxaparin 1.5mg/24h SC
5) further treatment depends on SBP

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12
Q

if SBP <90 in PE what would you do?

A

give 500ml colloid

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13
Q

if SBP<90 still low after 500ml colloid in PE what would you do?

A

give inotropes

dobutamine- aim for SBP>90
consider addition of NORAD
consider thrombolysis- med or surg

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14
Q

if SBP>90 in PE what would you do?

A

start warfarin

confirm dx

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15
Q

what is the ongoing management of PE after acutely treating?

A

1) TEDS stocking in hospital
2) graduated compression stockings for 2yrs if DVT- prevents post-phlebitic syndrome

3)continue LMWH until INR>2 at least 5 days 
target INR= 2-3
duration:
- remedial cause- 3m
- no known cause- 6m
- on going cause- indefinite

4)VC filter if repeat DVT/PE despite anticoagulation

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16
Q

what is a pneumothorax?

A

accumulation of air in pleural space with 2* lung collapse

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17
Q

how is a pneumothorax classified?

A

closed
open
tension

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18
Q

what is a closed pneumothorax?

A

intact chest wall

air leaks from lung into pleural cavity

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19
Q

what is an open pneumothorax?

A

defect in chest wall allows communication between PTX + exterior- may be sucking

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20
Q

what is a tension pneumothorax?

A

air enters pleural cavity through one-way valve + cannot escape -> mediastinal compression

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21
Q

what are the categories of causes of pneumothorax?

A

spontaneous- 1* + 2*
trauma
iatrogenic

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22
Q

what are the 1* spontaneous causes of pneumothorax?

A

1*- no underlying lung disease
young thin men- ruptured subpleural bulla
smokers

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23
Q

what are the 2* spontaneous causes of pneumothorax?

A 
2* -underlying lung disease
COPD
marfans, EDS
pulmonary fibrosis
sarcoidosis
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24
Q

what are the trauma causes of pneumothorax?

A

penetrating

blunt +/- rib fractures

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25
Q

what are the iatrogenic causes of pneumothorax?

A

subclavian CVP line insertion
positive pressure ventilation
transbronchial biopsy
liver biopsy

26
Q

what are the symptoms of pneumothorax?

A

sudden onset
dypsnoea
pleuriti chest pain

tension- respiratory distress, cardiac arrest

27
Q

what are the signs of pneumothorax?

A

chest

  • reduced expansion
  • resonant percussion
  • reduced breath sounds
  • reduced VR

tension- raised JVP, mediastinal shift, tachy, low bp

crepitus- surgical emphysema

28
Q

what invx would you do for pneumothorax?

A

ABG
US
CXR- expiratory film helpful

29
Q

what can you see on CXR in pneumothorax?

A

translucency + collapse (2cm rim=50% vol loss)
mediastinal shift away from PTX
surgical emphysema

cause- rib fractures, pulmonary disease eg bullae

30
Q

what is the acute management of tension pneumothorax?

A

resuscitate patient
no CXR
large bore venflon into 1nd ICS mid clav line
insert ICD

31
Q

what is the acute management of traumatic pneumothorax?

A

resuscitate patient
analgesia- morphine
3-sided wet dressing if sucking
insert ICD

32
Q

what is the acute management of 1* pneumothorax?

A

if not SOB +/or rim>/2cm then consider discharge

if SOB +/or rim>2cm- aspirate- if successful consider discharge
if unsuccessful insert ICD

33
Q

what is the acute management of 2* pneumothorax?

A

if SOB + >50yo + rim>/2cm- insert ICD

if not then aspirate- if successful admit for 24h
if unsuccessful insert ICD

34
Q

what is light’s criteria for an exudate pleural effusion?

A

serum protein ratio>0.5
serum LDH ratio>0.6
LDh is 0.6xULN
effusion protein>35g/L

35
Q

what is the light’s criteria for transudate pleural effusion?1

A

effusion protein <25g/L

36
Q

what are the causes of exudate pleural effusion?

A

exudates- increase cap permeability

infection- pneumonia, TB
neoplasm- bronchial, lymphoma, mesothelioma
inflammation- RA, SLE
infarction

37
Q

what are the causes of transudate pleural effusion?

A

transudate- raised cap hydrostatic or decreased oncotic pressure

CCF
renal failure
hypothyroidism
decreased albumin- nephrosis, liver failure, enteropathy

meig’s syndrome- R pleural effusion, ascites, ovarian fibroma

38
Q

what are the symptoms of pleural effusion?

A

asymptomatic
dyspnoea
pleuritic chest pain

39
Q

what are the signs of pleural effusion? in CHEST

A 
tracheal deviation AWAY from effusion 
reduced expansion
stony dull percussion 
reduced air entry
bronchial breathing just above effusion
decreased VR
40
Q

what are the SIGNS of associated diseases with pleural effusion?

A

cancer- cachexia, clubbing, HPOA, LNs, radiation burn, radiation tattoo

chronic liver disease
cardiac failure
RA, SLE
hypothyroidism

41
Q

what investigations would you do for pleural effusion?

A 
bloods- FBC UE LFT TFT Ca ESR
CXR
US- helps tapping
volumetric CT
Diagnostic tap
42
Q

what can you see on CXR for pleural effusion?

A

blunt costophrenic angles
dense shadow with meniscus
mediastinal shift AWAY
cause- coin lesion, cardiomegaly

43
Q

what do you send the diagnostic tap for in pleural effusion?

A

chemistry- protein, LDH, ph, glucose, amylase

bacteriology- MCS, auramine stain, TB culture

cytology
immunology- SF, ANA, complement

44
Q

in a diagnostic tap what would you see in empyema, cancer, TB, RA + SLE?

A

raised protein
decreased glucose <3.3mM
decreased ph<7.2
raised LDH>0.6 xserum/ULN

45
Q

in a diagnostic tap what would you see in an oesophageal rupture?

A 
decreased ph<7.2
raised amylase (also in pancreatitis)
46
Q

when would you do a pleural biopsy?

A

if pleural fluid is inconclusive

ct guided with Abrams needle

47
Q

what is the management pleural effusion?

A

treat underlying cause
drainage if symptomatic 2L/24h- repeated aspiration or ICD

if recurrent malignant effusion: chemical pleurodesis
persistent effusions: surgery

48
Q

what are the principle features of ILD?

A

dyspnoea
dry cough
abnormal CXR/CT
restrictive spirometry

49
Q

what are the causes of ILD?

A 
environmental- asbestosis, silicosis 
hypersensitivity- EAA
infection- TB, viral, fungi
idiopathic- CFA/idiopathic pulmonary fibrosis 
drugs 
associated with systemic disease
50
Q

what are the drug causes of ILD?

A 
BANS ME
bleomycin, busulfan
amiodarone 
nitrofurantoin
sulfasalazine
methotrexate, methysergide
51
Q

what are the associated systemic diseases with ILD?

A

sarcoidosis
RA
SLE, systemic sclerosis, sjogren’s, MCTD
UC, ankylosing spondylitis

52
Q

what are the upper zone causes (location) of ILD?

A 
A PENT
aspergillosis- ABPA
pneumoconiosis- coal, silica
extrinsic allergic alveolitis
negative sero-arthropathy
TB
53
Q

what are the lower zone causes (location) of ILD?

A 
STAIR
sarcoidosis (mid zone) 
toxins- BANS ME
asbestosis
idiopathic pulmonary fibrosis
rheum- RA, SLE, scleroderma, sjogrens, PM/DM
54
Q

what is obstructive sleep apnoea?

A

intermittent closure/collapse of pharyngeal airway leading to apnoeic episodes during sleep

55
Q

what are the risk factors of obstructive sleep apnoea?

A 
obesity 
male
smoker
alcohol
idopathic pulmonary fibrosis
structural airway pathology eg micrognathia
NM disease eg MND
56
Q

what investigations would you do for obstructive sleep apnoea?

A

SPO2

polysomnography is DIAGNOSTIC

57
Q

what is the treatment of obstructive sleep apnoea?

A

weight loss
avoid smoking + alcohol
CPAP during sleep via nasal mask

surgery to relieve pharyngeal obstruction- tonsillectomy or uvulopalatpharyngoplasty

58
Q

what are the clinical features of obstructive sleep apnoea?

A

1) nocturnal
snoring, choking, gasping, apnoeic, episodes

2) daytime
morning headache, somnolence, less memory + attention, irritability, depression

59
Q

what are the complications of obstructive sleep apnoea?

A

pulmonary HTN
type 2 resp failure
cor pulmonale

60
Q

what brief advice can you give for smoking cessation?

A

ASK, ADVISE, ACT

ask- enquire smoking status
advise- best way to sotp is with support + medication
act- provide details of where to get help eg NHS stop smoking helpline

61
Q

how do you facilitate quitting smoking?

A

1) refer to specialist stop smoking service
2) nicotine replacement- gum, patches
3) varenicline- selective partial nicotine receptor agonist- 23% abstinence at 1 yr, start while still smoking
4) bupropion another option

RESP (4 decks)

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