Resp Paces Flashcards

Question

Management of IPF

Answer 1

Pulmonary rehab Antifibrotic drugs eg. Pirfenidone LTOT Lung transplant

Answer 2

UIP Asbestosis Connective tissue diseases Aspiration

Answer 3

Clubbing Wet cough Hyperinflated lungs reduced chest expansion Coarse inspiratory crackles and wheeze Portacath PEG

Answer 4

Incidence of 1/2500 live births Autosomal recessive chromosome 7q Gene encodes CFTR (Cl- channel)

Answer 5

Secretions are thickens and block the lumens of various structures causing: - bronchiectasis - diabetes and loss of pancreatic exocrine function - distal intestinal obstruction syndrome - absence of vas deferens in males causing infertility - subfertility in women due to affect of fallopian tubes

Answer 6

Screening with heel prick test (low immunoreative trypsin) Sweat test (Na > 60mmol) Genetic testing CXR CT

Answer 7

Physiotherapy Antibiotics - both prophylactic and treatment Monitor for diabetes Pancrease and fat- soluble vitamins Mucolytics Immunisations Lung transplant Gene therapy is an ongoing area of research Poor prognosis if becomes infected with Burkholderia cepacia

Answer 8

Staph aureus in young children Then H.influenza Then pseudomonas aeruginosa in teenage years

Answer 9

Burkholderia infection Sepsis Multi- organ dysfunction History of non-adherence to treatment Morbid obesity Refractory GORD

Answer 10

Scar - clamshell incision, central line, traceostomay Clubbing which may indicate CF, bronchiectasis, pulmonary hypertension

Answer 11

Chronic end stage lung disease and meet 3 criteria: 1. > 50% risk of death within 2 years 2. >80% chance of survival 90 days post transplant 3. >80% chance of survival 5 years post transplant

Answer 12

Primary graft dysfunction (acute rejection) - very common Chronic rejection usually secondary to bronchiolitis obliterans syndrome (BOS) Infections Malignancy - post transplant lymphoproliferative disease - skin cancer Complications of immunosuppressants

Answer 13

Malignancy in the last 5 years or 2 years of low risk of recurrence Heart/liver/ kidney failure Atheroscleorotic disease with end organ damage Chronic infection with resistant organisms Mycobacterium abscess Chest wall or spinal deformity Obesity or low BMI Non- adherence to therapy Psychiatric disease

Answer 14

Cachexia Clubbing Inspiratory coarse crackles Wheeze Sputum Cor pulmonale Yellow nail syndrome (yellow nails and lymphoedema

Answer 15

Sputum culture and cytology CXR: tramlines and ring shadows CT: signet ring sign Tests for specific causes

Answer 16

Immunoglobulins HIV Aspergillus RAST or skin prick testing Rheumatoid serology Saccharine ciliary motility test Genetic screening for cystic fibrosis Testing for IBD

Answer 17

Congenital: kartageners and CF Childhood infection: measles and TB Immune over activity: allergic bronchopulmonary aspergillosis (ABPA) IBD Immune under activity: hypogammaglobinaemia, CVID Aspiration

Answer 18

Physiotherapy Antibiotics for acute infection Low dose azithromycin for prophylaxis Mucolytics

Answer 19

Cor pulmonale Secondary amyloidosis Massive haemoptysis

Answer 20

Pleural effusions Bronchiectasis Chronic sinusitis Chronic bronchitis Recurrent pneumonia

Answer 21

Topical vitamin E

Answer 22

Cachexia Clubbing and tar staining Lymphadenopathy Tracheal deviation - towards collapse or away from effusion Reduced expansion Dull percussion note Increased vocal resonance in collapse or consolidation Reduced tactile vocal fremitus in effusion Evidence of mets Evidence of treatment (lobectomy scar or radiotherapy tattoo Evidence of complications - SVCO - recurrent laryngeal nerve palsy - horners and wasted small muscles of the hand - neurological - dermatomyositis, Gottrons papules or acanthosis nigricans

Answer 23

Small cell Non small cell - squamous - typically central, most associated with smoking - adenocarcinoma - large cell - alveolar

Answer 24

CXR CT Sputum cytology Bronchoscopy/percutanous needle CT guided/ pleural tap Staging CT Lung function tests to aide treatment decisions

Answer 25

Non small cell lung ca: increased PTHrP causing hypercalcaemia (typically squamous cell) SCLC: increased ACTH (cushings) and SIADH

Answer 26

NSCLC: lobectomy or pneumonectomy, radiotherapy, chemotherapy Surgery considered for stage 1 or 2 disease or potentially stage 3 if no mediastinal lymphadenopathy SCLC: chemotherapy New targeted treatments

Answer 27

> 2L for pneumectomy > 1.5L for lobectomy

Answer 28

Large centrally located tumours or those that impinge the proximal bronchial tree

Answer 29

Thoracotomy scar Reduced expansion on affected side Tracheal deviation towards pneumonectomy Dull percussion note Absent tactile fremitus Bronchial breathing in the upper zone with reduced breath sounds throughout the rest of the hemi thorax

Answer 30

The pneumonectomy space fills with fluid over 3 months and you will see an air fluid level which will then be completely opaque after around 3 months

Answer 31

Bronchopleural fistula: Bronchial stump breaks down and the pneumonectomy space becomes infected with resp organisms Pneumonectomy empyema: complication of bronchopleural fistula and required drainage

Answer 32

Asymmetrically reduced expansion Trachea pushed away from side of effusion Stony dull percussion note Absent tactile vocal fremitus Reduced breath sounds Bronchial breathing above

Answer 33

Cancer: clubbing, lymphadenopathy, mastectomy CCF: raised JVP, peripheral oedema Chronic liver disease Chronic renal failure (evidence of RRT) Connective tissue disease (rheumatoid hands, butterfly rash of SLE)

Answer 34

Consolidation Collapse Previously lobectomy Pleural thickening (normal tactile fremitus) Raised hemidiaphragm

Answer 35

Transudate (protein <30) - CCF, liver or renal failure Exudate (protein >30) - cancer - infection - infarction - RA/SLE

Answer 36

If 25-35g/L of protein, use Lights criteria An exudate is indicated by: Effusion protein : plasma protein > 0.5 Effusion LDH : plasma LDH >0.6 Effusion LDH > 2/3 of upper limit of normal serum LDH Empyema: low glucose and pH <7.2

Answer 37

Collection of pus in the pleural space Most frequent organisms are anaerobes, staph, gram -ve Associated with bronchial obstruction, recurrent aspiration, poor dentition, alcohol dependency

Answer 38

LDH and protein Glucose and pH MC&S Cytology If suspicious of Chylothorax send triglycerides A glucose level <1.6 are seen in effusions due to RA

Answer 39

Nebs, inhalers, sputum pot, dyspnoea, central cyanosis, pursed lips Co2 retention flap, bounding pulse Tar- stained fingers Hyper- expanded Percussion note resonant with loss of cardiac dullness Expiratory polyphonic wheeze Cor pulmonale signs (raised JVP, ankle oedema, RV heave, loud P2, tricuspid regurgitation)

Answer 40

Smoking Air pollution Low birthweight and low socioeconomic status Dust exposure Alpha- 1 - antitrpsin deficiency

Answer 41

Diagnosis: FEV1:FVC <0.7 Severity (FEV1) Mild >80% Moderate 50-79% Severe 30-49% Very severe <30% Patient also have large TLC and reduced diffusion capacity (DLCO)

Answer 42

CXR- hyperexpanded, R/O pneumothorax ABG Spirometry Alpha- 1 - antitrypsin if younger, minimal smoking hx or FHx ECG: p-pulmonale, right axis deviation, RBBB Sputum culture - most commonly H.influenza, streptococcus

Answer 43

Smoking cessation Beta agonist LABA+LAMA LABA + ICS if evidence of steroid responsivity Triple therapy (LABA, LAMA, ICS) Vaccination Nutrition and exercise LTOT Pulmonary rehab

Answer 44

Bullectomy (if bullae greater than 1L and compressing surrounding lung) Transplantation if: FEV1 and DLCO <20% History of hospitalisation with an exacerbation with T2RF Pulmonary hypertension/ cor pulmonale

Answer 45

Non smoker PaO2 <7.3 on air PaO2 < 8 on air if cor pulmonale PaCO2 that does not significantly rise on O2 O2 for at least 16hours a day Improved average life expectancy by 9 months

Answer 46

Dyspnoea - too breathless to leave house (1) - too breathless to wash/dress (2) Eosinophils <0.05 Consolidation on CXR (1) Acidaemia (1) A Fibrillation (1) Score 3 or me = indicated increased risk of inpatient mortality

Answer 47

Chest deformity and absent ribs, thoracotomy scar Tracheal deviation towards side of fibrosis Reduced expansion Dull percussion but present tactile vocal fremitus Crackles and bronchial breathing

Answer 48

Isoniazid: peripheral neuropathy (co prescribe pyridoxine) and hepatitis Rifampicin: hepatitis, increased COCP metabolism, orange urine Ethambutol: retro-bulbar neuritis and hepatitis Pyrazinamide: hepatitis

Answer 49

Plombage: insertion of polystyrene balls into the thoracic cavity Phrenic nerve crush Thoracoplasty (rib removal)

Answer 50

If yellow sclera- urgent review If red colour less bright - urgent review Watch out for peripheral neuropathy Orange/red secretions will dye contact lenses Don’t rely on COCP

Answer 51

FBC CRP LFTs HIV and hepatitis screen Sputum Urine AFB Quantiferon test CXR CT (upper lobe fibrosis, traction bronchiectasis) Bronchoscopy Biopsy extra pleural site for culture

Answer 52

TB Radiation Ankylosing spondylitis/ABPA Sarcoidosis, silicosis Histoplasmosis Extrinsic allergic alveolitis

Answer 53

RA Asbestosis Scleroderma, SLE, sjogrens IPF Drugs

Answer 54

UIP on diagnosis of no CI ILD with FVC < 80% or transfer factor <40% or O2 requirement May be listed if FVC drop >10% in 6 months In CF if FEV1 <30%, poor exercise tolerance, pulmonary arterial hypertension, high exacerbation frequency, recurrent pneumothoracices, haemoptysis COPD: bode index score >7 (fev1, 6 min walk distance, dyspnoea scale, BMI)