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BRS High Yield errors > Respiratory > Flashcards

Respiratory Flashcards

1
Q

A syndrome commonly associated with Small Cell Lung Cancer?

A

Paraneoplastic Syndrome → Can cause Cushing’s Syndrome.

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2
Q

Lambert Eaton in Small Cell Lung Cancer? Why?

A

Autoantibodies against Ca2+ channels at the neuromuscular junction secreted in the setting of small cell carcinoma of the lung can cause Lambert-Eaton syndrome as a paraneoplastic syndrome.

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3
Q

Paraneoplastic Syndromes (NSCL/SC)

A

[placement]

Small cell

  • ADH
  • ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
  • Lambert-Eaton syndrome

Squamous cell

  • parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
  • clubbing
  • hypertrophic pulmonary osteoarthropathy (HPOA)
  • hyperthyroidism due to ectopic TSH

Adenocarcinoma

  • gynaecomastia
  • hypertrophic pulmonary osteoarthropathy (HPOA)
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4
Q

Biggest risk factor for men and women in chronic respiratory failure?

A

Men: smoking

Women: household pollution

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5
Q

What measurement scale is used to determine whether someone has acute respiratory failure?

A

Berlin score

  • What are the components of the respiratory failure scales?

Timing (1 week)

Chest imaging (not explained by cardiac origins)

Chest oedema (bilateral infiltrates on chest x-ray)

Oxygenation: pO2/FiO2 < 40kPa (200 mmHg)

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6
Q

Cut off for Type 1 Respiratory Failure?

A

PaO2 < 60

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7
Q

Cut off for Type 2 Respiratory Failure?

A

PaCO2 > 45

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8
Q

What’s Type 3 Respiratory Failure?

A

Low functional residual capacity (atelectasis) → Hypercapnia/Hypoxemia

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9
Q

What’s Type 4 Respiratory Failure?

A

Patients on ventilation

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10
Q

Pulmonary causes of ARDS?

A

INFECTION

Aspiration
Trauma
Burns: Inhalation
Surgery
Drug Toxicity

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11
Q

Extra-Pulmonary cause

A

INFECTION

Trauma
Pancreatitis
Burns
Transfusion
Surgery
BM transplant
Drug Toxicity

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12
Q

Brief explanation of lung injury mechanism?

A
  1. Infection → Alveolar macrophage secrete TNF α + IL 8.
  2. Cause a protein rich oedema + degradation of surfactant → Lung cannot expand like normally.
  3. Leukocytes move from blood vessels to the alveoli causing gap between blood vessel and alveoli to increase → LESS EFFECTIVE GAS EXCHANGE OCCURRING
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13
Q

What are some molecules that are released during lung injury that can worsen prognosis?

A

Damage Associated Molecular Patterns

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14
Q

Increased shunt fraction is a feature of type 1 or 2 resp failure?

A

T1

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15
Q

2 types of (pro inflammatory) ARDS?

A

Hypo + Hyper

  • Which type above seems worse?

Hyper

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16
Q

What are the upper and lower inflection points in PV loops of ARDS?

A

Essentially, LIP is point where alveolar can fill, and UIP is point where pragmatically any more pressure recruits minimal alveoli

17
Q

Explain Ventilator induced lung injury (what term is used to describe the phenomenon?).

A

Occurs if we drive the pressure too high. Causes too much air to stay in the lung because patients cannot exhale all of it out, building it up and building up the pressure especially in patients with underlying lung disease. Called ‘breath stacking’.

18
Q

What scoring system is used to determine escalation of therapy of respiratory failure?

A

Murray Score

19
Q

What are the components of the Murray score?

A

PaO2-FiO2 ratio, CXR, PEEP + Compliance (PCPC) - 0 to 4

20
Q

What score means the patient needs ECMO treatment?

A

3

21
Q

Inclusion criteria for ECMO

A
  • Severe resp failure (non cardiac, murray >3)
  • Positive pressure ventilation is not enough
22
Q

Exclusion criteria for ECMO

A
  • Contraindication to continuation of active treatment
  • Significance co-morbidity
  • Significant life limiting co-morbidities.
23
Q

Which vein is used in ECMO?

A

Femoral Vein (either to femoral of jugular)

24
Q

Types of ventilation

A

Volume controlled
Pressure controlled
Assisted breathing modes
Advanced ventilatory modes

25
Q

Cardiopulmonary exercise test uses which tools?

A

Treadmill which incrementally increasing levels to measure peak VO2 (also ECG, CO2, Ventilation)

26
Q

CP exam: primary outcome?

A

Peak VO2

27
Q

Advantages of CP exam

A

Precise, reproducible, quantifies to metabolism and safety

28
Q

How are CP exams displayed?

A

9 panel chart

29
Q

Cycling or Treadmill on CP exam? (2 reasons)

A

Cycle

Cycle ergometry gives a more controlled understanding of the relationship between oxygen consumption and work rate

  • Walking, running and everything in-between has a greater variation in biomechanical efficiency – not to mention differences in gait between patients.
  • Dorris won’t go rocketing off a bike if she decides to stop without warning.
30
Q

Incremental shuttle walk test: primary outcome

A

Total distance walked before volitional end

31
Q

6 minute walk test: primary outcome?

A

Distance walked in 6 min

32
Q

6 minute walk test AND incremental shuttle test: secondary outcomes?

A

‘percieved exertion’, heart rate and pulse oximetry

33
Q

Advantage of 6 minute walk

A

Patient driven pace

34
Q

Name of scale we use in the 6 minute walk test?

A

Borg Scale

35
Q

All the systems that affect exercise capacity?

A

Neuro, MSK, Resp, CVR

36
Q

What’s RER and what’s the significance of it being over 1 and under 1?

A
  • VCO2/VO2
  • Under 1: More O2 than CO2 → Aerobic Respiration
  • Over 1: More CO2 than O2 → Anaerobic Respiration
37
Q

What happens to anaerobic threshold if it is earlier in a CP exam?

A

Underlying pulmonary disease/deconditioning: COPD/Poor CO or arterial disease as anaerobic respiration is occuring earlier

38
Q

The graph is indicative of what?

A

  • Answers

Right-Left shunt, atrial defect

BRS High Yield errors (4 decks)

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