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The respiratory system > pleural and pulmonary disorders > Flashcards

pleural and pulmonary disorders Flashcards

1
Q

What is a pleural effusion?

A

Abnormal collection of fluid in the pleural space

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2
Q

What are the features of transudates?

A

protein < 30g/l

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3
Q

What are some of the causes of transudates?

A
  • heart failure
  • liver cirrhosis
  • hypoalbuminaemia
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4
Q

what are the features of Exudates?

A

protein > 30g/l

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5
Q

What are some of the causes of exudates?

A
  • malignancy
  • infection inc TB
  • pulmonary infarct
  • asbestos
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6
Q

what does a pleural fluid pH of <7.3 suggest?

A
  • pleural inflammation
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7
Q

What is mesothelioma?

A
  • uncommon malignant tumour of the lining of the lung or (occasionally) abdominal cavity
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8
Q

what is a common cause of mesothelioma?

A
  • exposure to asbestos

- 30-40 years to develop

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9
Q

What are the treatment options for mesothelioma?

A
  • pleurodese effusions
  • radiotherapy
  • surgery
  • chemo
  • palliative care
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10
Q

what are the risk factors for spontaneous pneumothorax?

A
  • tall thin males
  • smoking
  • cannabis
  • underlying lung disease
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11
Q

What is pneumothorax

A
  • air in pleural space
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12
Q

What is the treatment for a tension pneumothorax?

A
  • needle decompression
  • with large bore venflon
  • 2nd intercostal space anteriorly in the mid clavicular line
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13
Q

what is a tension pneumothorax?

A
  • progressively increasing pressure in the pleural space

- pushes chest organs aside

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14
Q

What are the risk factors for pleural infection?

A
  • diabetes mellitus
  • immunosuppression
  • gastro - oesophageal reflex
  • alcohol misuse
  • IV drug abuse
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15
Q

Describe the management of a pleural infection?

A
  • Antibiotics
  • drain effusion as needed
  • discussion with surgeons
  • nutrition
  • VTE prophylaxis
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16
Q

What antibiotic should be used to treat pleural effusion?

A

Co amoxiclav

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17
Q

What is a pulmonary embolism?

A
  • blockage of a pulmonary artery by a blood clot, fat, tumour or air
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18
Q

When does pulmonary infarction occur?

A

if blood flow and oxygen to the lung tissues is compromised the lung tissue may die

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19
Q

When are DVTs most likely to embolism or lead to chronic venous insufficiency and venous leg ulcers?

A

When they are more proximal

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20
Q

Describe the clinical presentation of DVT?

A
  • whole leg or calf involved depending on the site
  • swollen
  • hot
  • red
  • tender
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21
Q

How are DVTs investigated?

A
  • ultrasound doppler leg scanner (1st line)

- CT scan

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22
Q

What are some of the risk factors associated with DVT and PE?

A
  • thrombophilia
  • contraceptive pill
  • pregnancy
  • pelvic obstructions
  • trauma
  • surgery
  • immobility
  • obesity
  • pulmonary hypertension
  • vasculitis
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23
Q

How can DVT be prevented?

A
  • early post op mobilisation
  • TED compression stockings
  • calf muscle exercises
  • subcutaneous low dose heparin
  • DOAC
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24
Q

How may a patient with PE present?

A
  • (acute) shortness of breath
  • (pleuritic) chest pain
  • haemoptysis
  • leg pain/swelling
  • collapse/sudden death
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25
Q

What are the clinical features of PE?

A
  • tachycardia
  • tachypnoea
  • cyanosis
  • fever
  • low BP
  • crackles
  • rub
  • pleural effusion
  • Type 1 respiratory failure
  • normal CXR
26
Q

How might a PE be diagnosed?

A
  • PESI score
  • ECG - acute right heart strain pattern
  • D dimers raised
  • isotope lung scan (V/Q)
  • CT pulmonary angiogram
  • leg and pelvic US
  • echocardiogram
27
Q

When is an isotope lung scan useful?

A
  • small peripheral emboli
  • perfusion defect before infarction
  • perfusion and ventilation mismatch detected after infarction
28
Q

What may be an underlying cause of PE?

A
  • cancer
  • autoantibodies
  • thrombophillia
    (if no obvious cause i.e. surgery)
29
Q

How should a patient who is at high risk for PE be treated?

A

CT pulmonary angiogram

30
Q

How should a patient in the ambulatory setting with low risk be investigated?

A
  • CTPA or V/Q
31
Q

How is DVT/PE treated?

A
  • low molecular weight heparin and warfarin simultaneously
  • stop heparin after 3-5 days when INF>2
  • OR
  • use solely use DOACs
32
Q

What is pulmonary hypertension?

A

mean pulmonary arterial pressure > 25 mmHg

  • can be measured with right heart catheter
  • systolic PAP can be estimated with ECHO doppler
33
Q

List some of the causes of pulmonary hypertension?

A

Pulmonary venous hypertension

  • left ventricular systolic function
  • mitral regurgitation
  • cardiomyopathy

Pulmonary arterial hypertension

  • primary pulmonary hypertension
  • hypoxic
  • multiple PE
34
Q

What is Cor pulmonale?

A
  • right heart disease secondary to lung disease

- fluid retention due to hypoxia +/- right heart failure

35
Q

Clinical signs of pulmonary hypertension and right heart failure?

A
  • central cyanosis if hypoxic
  • dependent oedema
  • raised JVP with V waves
  • right ventricular heave at left parasternal edge
  • murmur or tricuspid regurgitation
  • load P2
  • enlarged liver
36
Q

How may pulmonary hypertension be investigated?

A
  • ECG
  • CXR
  • SaO2
  • pulmonary function with DLCO
  • echo
  • cardiac catheterisation
  • D - dimers
  • VQ scan
  • CT pulmonary angiogram
  • cardiac MRI
37
Q

How is pulmonary hypertension treated?

A
  • prophylactic anticoagulation (warfarin)
  • O2 if hypoxic
  • pulmonary vasodilators
  • lung transplant
  • Riociguat (pulmonary arterial vasodilator)
  • pulmonary endarterectomy (curative)
38
Q

What is stridor?

A
  • predominantly inspiratory wheeze due to large airways obstruction
39
Q

What are some of the major cause of stridor in children?

A
  • infections: croup, epiglottitis ect
  • foreign body
  • anaphylaxis/angioneurotic oedema
40
Q

What are some of the common causes of stridor in adults?

A
  • neoplasms
  • anaphylaxis
  • goitre
  • foreign body
  • trauma
41
Q

How might stridor be investigated?

A
  • laryngoscopy
  • bronchoscopy
  • flow volume loop
  • CXR
  • other imaging
42
Q

How is a laryngeal obstruction treated?

A
  • treat underlying cause e.g. foreign body removal
  • mask bag ventilation with high flow O2
  • cricothyroidotomy
  • tracheostomy
43
Q
  • How may a malignant airway obstruction be treated?
A
  • tumor removal: laser, photodynamic therapy, cryotherapy, diathermy, surgical resection
  • tumour compression
  • radiotherapy
44
Q

Describe acute anaphylaxis?

A
  • type 1 (immediate) hypersensitivity (IgE)
  • flushing, pruritus, urticaria
  • angioneurmtic oedema
  • abdominal pain/vomiting
  • hypotension
  • stridor, wheeze, respiratory failure
45
Q

Describe the treatment of anaphylaxis?

A
  • IM epinephrine (adrenaline)
  • IV antihistamine
  • IV corticosteroid
  • high flow O2
  • nebulised bronchodilators
  • endotracheal intubation if necessary
46
Q

What causes snoring?

A
  • relaxation of pharyngeal dilator muscles during sleep

- upper airway narrowing, turbulent airflow and vibration of soft palate and tongue base

47
Q

What is OSA?

A
  • intermittent upper airway collapse in sleep

- recurrent arousals/sleep fragmentation

48
Q

What are some of the risk factors for sleep apnoea?

A
  • enlarged tonsils
  • obesity
  • retrognathia
  • acromegaly, hypothyroidism
  • oropharyngeal deformity
  • neurological
  • drugs
49
Q

What are some of the consequences of sleep apnoea?

A
  • excessive daytime sleepiness
  • personality change
  • cognitive/functional impairment
  • major impact on daytime function
50
Q

How is OSA diagnosed?

A
  • snoring and raised epworth score
  • overnight sleep study
  • domiciliary recording
  • full polysomnography
51
Q

How is OSA treated?

A
  • remove underlying cause
  • CPAP
  • Other: mandibular advancement device, surgery
52
Q

What is pulmonary oedema ?

A

accumulation of fluid in the lung
- interstitium
- alveolar spaces
causes a restrictive pattern of disease

53
Q

What are some of the causes of pulmonary oedema?

A
  • most important cause is cardiac failure
    1. haemodynamic (inc hydrostatic pressure)
    2. due to cellular injury
54
Q

What is ARDS?

A

adult respiratory distress syndrome

55
Q

Describe the pathogenesis or ARDS?

A

Injury

  • infiltration of inflammatory cells
  • cytokines
  • oxygen free radicals
  • injury to cell membranes
56
Q

Describe the pathology or ARDS?

A
  • fibrous exudate lining alveolar walls
  • cellular regeneration
  • inflammation
57
Q

What are the possible outcomes of ARDS?

A
  • death (50%)
  • resolution
  • Fibrosis
58
Q

Describe neonatal RDS?

A
  • occurs in premature infants
  • deficient in surfactant
  • inc effort in expanding lungs –> physical damage to cells
59
Q

What is an embolus?

A
  • a detached intravascular mass carried by the blood to a site in the body distant from its point of origin
60
Q

What is Virchows triad?

A
  1. factors in vessel wall
  2. abnormal blood flow
  3. Hypercoagulable blood
61
Q

What does the effect of a PE depend on?

A
  • size of embolus
  • cardiac function
  • respiratory function
62
Q

Describe the morphology go pulmonary hypertension?

A
  • medial hypertrophy of arteries
  • intimal thickening (fibrosis)
  • atheroma
  • Right ventricular hypertrophy
  • extreme cases: congenital heart disease)

The respiratory system (13 decks)

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