Respiratory Flashcards
What are the indications for VATS?
- Lobectomy
- Wedge resection
- Decortication
- Bullectomy
- Pleurectomy
What are the causes of obstructive airway disease?
- Asthma
- COPD
- Bronchiectasis
- Obstructive bronchiolitis
What are the causes of bibasal crepitations
- Interstitial lung disease
- Bronchiectasis
- Bilateral pneumonia
- Pulmonary oedema
What are the poor prognostic factors in idiopathic pulmonary fibrosis?
- Older age
- Dyspnoea
- Low/declining pulmonary function
- Pulmonary artery hypertension
- Co-existing emphysema
- Extensive radiological involvement
- Low exercise tolerance
- Exertional desaturation
- UIP pattern on histology
Colonisation with which types of bacteria are contraindications to lung transplantation in cystic fibrosis?
- Burkholderia cenocepacia
- Bycobacterium abscessus
What are the criteria for lung transplantation?
Patients with end-stage lung disease that meet following criteria:
1. >50% risk of death from lung disease within 2yrs
2. >80% likelihood of surviving at least 90 days post-transplantation
2. >80% likelihood of 5yrs post-transplant survival from general medical perspective
What are the most common conditions for which lung transplantation is indicated?
- Interstitial lung disease
- Cystic fibrosis
- COPD
- Pulmonary vascular diseases
What are the indications for single vs double lung transplant?
- Single lung transplantation is generally performed in patients with COPD or ILD
- Double lung transplantations are generally reserved for suppurative lung diseases such as CF and bronchiectasis or pulmonary vascular diseases
- Double lung transplants can be considered for COPD or ILD if benefits are thought to outweigh the risks such as in younger patients or if diseases complicated by pulmonary hypertension
What are some absulute contraindications for lung transplantation?
- A history of malignancy in the past five years, or previous two years if the
malignancy has low risk of recurrence; for example, a basal cell skin carcinoma. - Untreatable significant heart, liver, kidney or brain dysfunction
(unless combined organ transplantation can be performed). - Uncorrected atherosclerotic disease with suspected or confirmed end organ
ischaemia or dysfunction and/or coronary arterydisease not amenable to
revascularisation. - Acute illness such as sepsis, myocardial infarction, and hepatic failure would be
contraindications. - Chronic infection with highly virulent or resistant organisms that are poorly
controlled pre-transplant. - Mycobacterium abscessus particularly seen in patients with cystic fibrosis is
deemed a contra indication. - Significant chest wall or spinal deformity.
- Obese patients with a BMI >35 kg/m2
- Current non-adherence to therapies would be a worrying sign suggesting
someone should not be transplanted. - As mentioned by the candidate here, psychiatric or psychological conditions with
inability to cooperate with treatments and healthcare team. - No social support system.
- Severely impaired functional status with very poor rehabpotential.
- Substance abuse including smoking or dependence.
Whar are some relative contraindications for lung transplantation?
- Age > 65 (usual limit for single lung, age 60 might be considered max age for double lung).
- BMI > 30 kg/m2
- Severe malnutrition (local center BMI < 17/kg/m2)
- Severe osteoporosis.
- Resistant organisms colonising the patient, such as burkholderia cenocepacia.
What is the most common indication for lung transplantation worldwide?
COPD
What is Yellow Nail syndrome?
Yellow Nail Syndrome (YNS) is a rare disorder characterized by three main symptoms: yellow, thickened nails that grow slowly or detach; respiratory issues such as chronic cough, bronchiectasis, and pleural effusion; and swelling in the lower limbs due to lymphedema. The exact cause of YNS remains unknown, but it is often associated with autoimmune diseases, lymphatic disorders, or cancers.
The condition primarily affects adults over 50, though it has been reported in children as well. Some researchers suggest that YNS may be linked to improper circulation, lymphatic drainage issues, or fluid buildup around the lungs. Treatment focuses on managing symptoms rather than curing the syndrome. For nail changes, topical vitamin E and oral antifungal medications like itraconazole may help improve nail growth. Respiratory symptoms are treated with appropriate medical interventions, while swelling can be managed with compression therapy.
Despite its rarity, YNS can significantly impact quality of life. Early recognition and symptom management are crucial for improving patient outcomes. If you suspect YNS, consulting a healthcare provider for proper diagnosis and treatment is recommended.
How can an exudative pleural effusion be distinguished from transudative?
- Fluid protein content <25g/L = Transudative
- Fluid protein content >25g/L = Exudative
- Fluid content 25 - 35g/L (use Light’s criteria):
1. Fluid/serum protein ratio >0.5
2. Fluid/serum LDH ratio >0.6
3. Fluid LDH level >2/3 normal serum LDH levels
What are the causes of exudative pleural effusion?
- Infective (parapneuomic, TB)
- Inflammatory (connective tissue disorders, vasculitides, drugs)
- Malignancy (lung cancer, mesothelioma, lymphoma)
What are the causes of transudative pleural effusion?
Increased hydrostatic pressure:
- Heart failure
- Constrictive pericarditis
Hypoalbuminaemia:
- Chronic liver disease
- Nephrotic syndrome
What investigations should pleural aspirates be sent for?
- pH
- LDH concentration
- Protein concentratiion
- Cell count
- Cytology
- Gram stain/MCS
- AFB
What are the indications for lobectomy/pneumonectomy?
- Non-small cell lung cancer (central tumours = pneumoonectomy, peripheral tumours = lobectomy)
- Lung abscesses (lobectomy/wedge resection)
- Localised bronchiectasis (lobectomy/wedge resection)
- TB
- Lung trauma
What are the contraindications for lobectomy/pneumonectomy surgery for lung cancer?
- Metastatsis present (stage IIIb or beyond)
- FEV <1.5 (lobectomy) or <2 (pneumonectomy)
- Malignant pleural effusion
- Tumour near hilum
- Vocal cord paralysis
- SVC obstruction
What are the methods for obtaining tissue diagnosis for suspected lung cancer?
- Percutaneous radiologically-guided biopsy
- Bronchoscopy/EBUS
- Percutaneous lymph node biopsy
- Cytology of malignant pleural effusions
What are the causes of apical lung fibrosis?
CHARTS:
- Coal-miners pneumoconiosis
- Histiocytosis
- Ankylosing spondylitis
- Radiation
- TB
- Sarcoidosis/silicosis
What are the causes of basal lung fibrosis?
SCARAB:
- Systemic sclerosis
- Cryptogenic fibrosing alveolitis (i.e. idiopathic pulmonary fibrosis)
- Amiodarone (+ other drugs):
1. Bleomycin
2. Nitrofurantoin
- Rheumatoid Arthritis
- Bronchiectasis
What are the types of lung diseases associated with rheumatoid arthritis?
- Pulmonary fibrosis
- Bronchiectasis
- Diaphragmic paralysis
- Bronchiolitis obliterans
What histoloical pattern of injury is usually associated with RA-associated pulmonary fibrosis in contrast to other connective tissue disorders?
RA is usually associated with UIP while other connective tissue disorders are usually associated with NSIP
