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PACES > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Contraindications for lung transplant in CF

A

Burkholderia cepacia colonised in sputum
Mycobacterium

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2
Q

Light’s criteria

A
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3
Q

Indications for VATS

A
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4
Q

Mutations in CF

A

Mutations in CFTR excretion - more salt excretion in mucus
Most common deltaF508

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5
Q

Specific treatment for deltaF508

A

Ivacaftor and Orkambi

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6
Q

Surgical treatment in COPD

A

Lung reduction surgery
Lung transplant

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7
Q

Indications for LTOT in COPD

A

Pa02 <8kpa with evidence of pulmonary hypertension, polycythaemia or peripheral neuropathy

Pa02 <7.3kPa

No smoking in household

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8
Q

Long term treatment in COPD

A

Smoking Cessation
Pulmonary rehab
Vaccinations - flu/COVID/pneumococcal
Inhaler therapy - LABA/LAMA or adding ICS if eosinophilia or repeated infections
LTOT

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9
Q

Indications to NIV

A

Capacitous refusal
Facial fractures
Oesophageal burns
Vomiting
Pneumothorax
Airway obstruction
Pneumothorax
Hypotension
Recent upper GI surgery

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10
Q

Spirometry values in COPD

A

Diagnosis - FEV1/FVC <70%

Mild - FEV1 50 - 80%
Moderate - FEV1 30-50%
Severe - <30%

Increased residual volume

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11
Q

Investigations in new COPD

A

FBC - anaemia, polycythaemia and eosinophilia
IGE to aspergillus and dog/cat dander
A1AT deficiency if young
ABG

CXR
CT - emphysema and bulls lung disease

Spirometry with reversibility testing

ECHO if concerns re PHTN

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12
Q

Differential diagnoses for COPD

A

Asthma
EGPA
A1AT

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13
Q

Signs of portal hypertension

A

Raised JVP
Pulsatile liver
Lud second heart sound
Pedal oedema
Tricuspid regurgitation

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14
Q

Clinical findings in COPD on inspection

A

Barrel Chested
Tar staining
Pursed lips
Tremor
Central cyanosis
Raised JVP in cor pulmonate

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15
Q

Signs in bronchiectasis

A

Wet cough
Clubbing
Long lines and central access
Cachexia
Scars from previous lines or lung surgery
Clamshell scar under the ribcage
Deviated apex beat and loud P2
Wet coarse crackles at bases - change with coughing

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16
Q

Presentation in bronchiectasis

A

Signs of right sided heart failure - raised JVP, pedal oedema, loud P2
Signs of treatment - neb or iv antibiotics
Scars from lung transplant
Possible etiology

17
Q

Causes of bronchiectasis

A

Congenital
- Kartageners - dextracardia
- CF

Yellow nail syndrome

Post infectious eg tb, childhood pneumonias (pertussis)

Autoimmune
- RA
- lupus
- sjogrens
- IBD

Immunodeficiencies:
- Hypogamma globulinaemia
- CVID
- HIV

ABPA

18
Q

Ix in bronchiectasis

A

HRCT - signet rings, tram lines, tree in bud appearance, inner lumen bigger than adjacent blood vessel

Bloods
- HIV test
- Autoimmune screen
- Immunoglobulin
- IgE aspergillus
- eosinophilia

Sputum samples

Sweat test and ciliary biopsy in CF

Lung function tests
- Reduced FEV1 - obstructive due to inflamed or scarred airways

Echo if concerns re pulmonary hypertension

19
Q

Mx in bronchiectasis

A

MDT
Patient education
Identify cause
Chest physio - postural chest drainage
Hypertonic saline nebs
Targeted antibiotic therapy
Carbocisteine
Opep device - flutters and breaks up mucus
Immunization
Dietician
Prophylaxis antibiotics
- if having more than two chest infections which have been fully treated
- dependent on sensitivities
- may be oral or nebulised (eg PO azithromycin or Neb tobramycin)

20
Q

Ix in ILD

A

Bedside test inc SpO2

Bloods including Rhf, anti-CCP, ANA, ANCA, dsDNA

ABG

CXR

HRCT
- Honeycombing - fibrosis
- Ground glass shadowing - alveoli’s

ECHO - signs of pulmonary hypertension

Spirometry

Potential biopsy - unclear diagnosis - via bronchoscopy or trans lung

21
Q

Spirometry findings in ILD

A

Restrictive pattern
Decrease in FEV1 and FVC with preserved ratio
Reduced TLC
Decrease in transfer factor

22
Q

MX of ILD

A

MDT
Resp nurses
PT and OT
Treatment of underlying CTD
Steroids
Idiopathic ILD - anti-fibrotic agents
- Pirfenedone or ninetenib - its with a FVC 50-80% to slow disease progression
Lung transplant

23
Q

Causes of ILD

A

Idiopathic
RA
SLE
Asbestosis
Drugs - bleomycin, amiodarone, MTX, nitrofurantoin
AS
Radiation
Coal workers pneumoconiosis
Silicosis
EAA
Sarcoidosis
TB

24
Q

Features in CF

A

Increased and thickened respiratory secretions
Pancreatic insufficiency
Decrease in fertility
Liver disease - portal HTN
Osteopenia
Nasal polyps
Distal intestinal obstruction syndrome
Gallstones and kidney stones

25
Q

Management in CF

A

MDT in specialist centre
Chest physio
Nebulised therapy
Mucolytics
Nebulised prophylactic antibiotics
Creon
Dietician
Nutritional supplementation
Treatment of infection with 2 week course of antibiotics
Fat soluble vitamin supplementation

26
Q

Diagnosis of CF

A

Screening with Guthrie test
Episode of meconium ileus
Sweat test
Genetic testing

27
Q

Commonest indicator conditions for lung transplantation

A

CF
Bronchiectasis
ILD
Pulmonary vascular disease
COPD

28
Q

Double vs single lung transplant

A

Prognosis better with double lung transplant - 7.5 vs 4 years

29
Q

Medications used in lung transplantation

A

Combination of tacrolimus, MMF and steroids

30
Q

Complications of lung transplant

A

Hyperacute/acute rejection
Opportunistic infections
Brochiolitis obliterates - chronic rejection - 50% at 5 years
Increased risk of malignancy including post transplant lymphoproliferative disease and skin malignancies

31
Q

Contraindications to lung transplantation

A

Malignancies within last 5 years

Untreatable heart, brain or liver dysfunction that won’t be treated with transplant

Untreated atherosclerotic disease or CAD not amenable to revascularisation

High or low BMIs

Using illicit drugs or smoking

Mental health issues which would stop them taking regular meds or turning up to clinic appts

Virilent lung pathogens including Burkholderia cepacia or mycobacterium

32
Q

Indications for single lung transplant

A

COPD
ILD

33
Q

Indications for lung transplant

A

> 50% risk of death from lung condition within 2 years without transplant
80% chance of survival 90 days post transplant
80% chance of 5 year survival from general medical viewpoint

34
Q

Indications in CF for lung transplant

A

FEV1 <30%
Significant pHTN
Poor exercise tolerance
High exacerbation frequency
Frequent PTXs
Haemoptysis despite pulmonary artery embolisation
NIV

35
Q

Indications in ILD of lung transplant

A

Due to poor prognosis - fibrotic NSIP with no contraindications should be considered

FVC <80%

Transfer factor <40%

Any oxygen requirement or symptomatic dyspnoea

36
Q
A

PACES (6 decks)

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