Respiratory Flashcards by Matthew Thompson

Indications for lung transplant
(FIVE)

Cystic fibrosis
Bronchiectasis
Pulmonary vascular disease
Pulmonary fibrosis
COPD

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Reasons for double lung transplant
(TWO)

Greater prognosis - better survival
CF and bronchiectasis

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Lung transplant medications
(THREE)

Tacrolimus
Mycophenolate
Steroids

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Complications of lung transplant
(FOUR)

Acute rejection
Opportunistic infections
Bronchiolitis obliterans
Increased malignancy - skin and lymphoproliferative

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Contraindications to lung transplant
(FOUR)

Recent malignancy
High or low BMI
Untreatable comorbidities heart/brain/kidneys
Active smoking/illicit drug use

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Indication for VATS
(FOUR)

Wedge resection
Lobectomy
Bullectomy
Treatment of recurrent pneumothoraces

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Benefits of VATS over open thoracotomy
(FOUR)

Reduced pain
Reduced wound complications
Reduced length of stay
Reduced healing time

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Indications for lobectomy
(FOUR)

Lung cancer
Aspergilloma
TB
Lung abscess

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Investigations for lung cancer
(SIX)

History
Exam
CXR
CT thorax (abdo, pelvis)
Tissue diagnosis - bronch/EBUC/CT guided
PET-CT

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Work up for lung surgery
(FOUR)

Lung function tests
Transfer factor
Echo
Cardiopulmonary exercise testing

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Histological subtypes of lung cancer

Small cell
Non small cell - adenoca (non-smoker), squamous cell ca (smoker)

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Small cell lung cancer treatment
(TWO)

Rapidly progressive, diagnosed late
Chemotherapy
Palliative measures

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Non-small cell lung cancer treatment
(THREE)

Surgery
Chemotherapy
Radiotherapy

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Signs in pneumonectomy vs lobectomy
(THREE)

Pneumonectomy always tracheal deviation, lobectomy sometimes
Pneumonectomy no breath sounds, lobectomy reduced or normal
Pneumonectomy dull percussion, lobectomy normal

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Respiratory causes of clubbing
(FOUR)

ILD
Bronchiectasis
CF
Lung cancer

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Differences between primary and secondary pneumothoraces

Primary - spontaneous in otherwise healthy
Secondary associated with underlying lung disease

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Investigations for asthma
(SEVEN)

Observations with sats
Bloods with FBC (eosinophilia), U+E, CRP
ABG in acute setting
RAST blood tests for allergens
CXR
Peak flow
Spirometry

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What would spirometry show in asthma vs COPD?

Reduced FEV1 both
Preserved FVC both
Reduced FEV1/FVC ratio both
Asthma would improve with bronchodilation

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Treatment of asthma
(FOUR)

SABA reliever
ICS
LABA/ICS
Montelukast

Causes of airflow obstruction
(FOUR)

Asthma
COPD
Bronchiestasis
Bronchiolitis obliterans

Causes of bibasal creps
(THREE)

ILD
CCF
Bronchiectasis

Investigations for ILD
(EIGHT)

Observations with sats
Bloods with FBC, U+E, LFT, CRP
Autoimmune screen
ABG
CXR
HR-CT
Echo
Spirometry

Autoimmune screen for ILD
(FOUR)

Rheumatoid factor
ANA
ANCA
Anti dsDNA

Lung function test findings in fibrosis

Reduced FEV1
Reduced FVC
Preserved FEV1/FVC
Reduced total lung volume
Reduced transfer factor

Treatment of ILD (FOUR)

MDT input - PT/OT input Treat underlying connective tissue disorder Consider steroids if groundglass CT Antifibrotic agent - pirfenidone

Causes of interstitial lung disease (EIGHT)

Idiopathic pulmonary fibrosis Asbestosis Silicosis SLE Rheumatoid arthritis Amiodarone Nitrofurantoin Methotrexate

Cause of cystic fibrosis

Autosomal recessive CFTR gene - chromosome 7 Increased salt excretion - leading to thicker mucus

Effects of cystic fibrosis (SEVEN)

Respiratory - bronchiectasis Pancreatic - exocrine insufficiency Liver - failure Kidney stones Gallstones Intestinal obstruction Reproductive involvement

Management of cystic fibrosis (SIX)

MDT specialist centre Chest physio - positional drainage Mucolytics and nebulisers Prophylactic abx nebulised/azithromycin Creon for pancreas Nutritional supplements (via PEG)

Microbiology in cystic fibrosis

Most common pseudomonas Burkholderia poor prognosis - contraindicates lung transplant

Cystic fibrosis exam findings (FIVE)

Productive cough Clubbing Coarse inspiratory crackles - upper lobes Possible supplemental feeding Portacath

Diagnosis of CF

Heelprick blood test in newborns Blood screening for mutation Sweat test

Features of yellow nail syndrome (FOUR)

Yellow dystrophic nails Lymphoedema Pleural effusions Bronchiectasis

Investigations for bronchiectasis (EIGHT)

Bloods with FBC, U+E, LFT, CRP HIV test Immunoglobulins Aspergillus serology Cystic fibrosis testing Sputum sample for MC+S Lung function tests CXR HR-CT

Treatment of bronchiectasis (FOUR)

MDT approach Chest physio with postural drainage Hypertonic saline nebs Consider long term azithromycin Prompt antibiotics for infection

Causes of bronchiectasis (SEVEN)

Idiopathic Yellow nail syndrome Immunodeficiency Rheumatoid arthritis and connective tissue diseases Pulmonary TB Cystic fibrosis Allergic bronchopulmonary aspergillosis

Causes of pleural effusion (EIGHT)

Exudate: Para-pneumonic Lung infarct from PE Malignancy Connective tissue diseases (sarcoid/rheumatoid) Transudate: Heart failure Liver failure CKD Hypoalbuminaemia

Differentiating between transudate and exudate

Light's criteria: Pleural protein, LDH vs serum protein, LDH

Investigations for pleural fluid (FIVE)

Protein LDH pH Culture Cytology and cell count

Management of pleural fluid in parapneumonic effusion

Guided by fluid pH negative/culture positive for drain Otherwise should spontaneously resolve

Management of effusion in lung cancer

Drainage Consider pleurodesis/indwelling pleural catheter

Indications for pneumonectomy (TWO)

Cancer - NSCLC - more central tumours Tuberculosis historically

Spirometry findings in COPD

Obstructive picture FEV1/FVC <0.7 FEV1 >80% mild FEV1 50-80% moderate FEV1 30-50% severe FEV1 <30% very severe

What is cor pulmonale

Right sided cardiac failure secondary to pulmonary disease Chronic hypoxia leads to pulmonary vasoconstriction This leads to pulmonary hypertension and right sided failure

Treatment for cor pulmonale (TWO)

Long term oxygen therapy - reduce hypoxia Diuretics

Inclusion criteria for LTOT

No smoking PaO2 <7.3 (<8.0 in cor pulmonale) PaCO2 not markedly increasing on O2

Spirometry findings in ILD

Reduced FEV1 Reduced FVC Preserved FEV1/FVC ratio Reduced transfer factor