Respiratory 2

Question 1

Sarcoidosis typical pt?

Answer 1

female, black
SOB
Dry cough
erythema nodosum

Question 2

Blood Test. for sarcoidosis?
Imaging?

Answer 2

ACE - raised
Calcium - raised

CXR - HILAR LYMPHADENOPATHY

HRCT - pulmonary nodules

Question 3

what establishes dx in sarcoidosis?

Answer 3

ACE / calcium bloods
CXR -
Bronchoscopy w USS guided biopsy of MEDIASTINAL LYMPH NODES

Question 4

histology of sarcoidosis?

Answer 4

non- caseating granulomas with epitheliod cells

Question 5

Other tests for sarcoid?

Answer 5

U&Es
ACR - proteinuria
LFTs
opthal
ECG / echo
USS abdo

Question 6

mx of sarcoid?

Answer 6

oral steroids ;
> bisphosphonate

2) Methotrexate
3) Lung transplant

Question 7

prognosis of sarcoidosis?

Answer 7

resolves in 50%
<2 years

> Pulmonary fibrosis / pulmonary HTN
<10% overall mortality

Question 8

Mx of pulmonary HTN?

Answer 8

manage cause / if idiopathic CCB

supportive : oxygen and diuretics

Question 9

Ix pulmonary HTN?

Answer 9

bloods: NT-proBNP

Image:
CXR :
Dilated pulmonary arteries
Right ventricular hypertrophy

ECG: right sided heart failure

Question 10

ECG changes in right sided HF - pulmonary HTN

Answer 10

p pulmonale - peaked p waves
R waves are tall in v1/v2 and DEEP S waves in V5/V6

Right bundle branch block

Question 11

cause of Pulmonary HTN

Answer 11

1) idiopathic / connective

2) Congestive heart failure from an MI / HTN

3) COPD / pulmonary fibrosis so lung term lung disease

4) vascular - PE

5) Misc: sarcoidosis

Question 12

when are ABGs useful?

Answer 12

type 2 respiratory failure - COPD

Question 13

what is FiO2?

Answer 13

fraction of inhaled oxygen
room has fio2 od 21%

> venturi are good to control this

Question 14

T2RF?

Answer 14

low oxygen and raised carbon dioxide

Question 15

T1RF?

Answer 15

normal co2 and low o2

Question 16

raised bicarb is a sign of ?

Answer 16

chronic Co2 retention

Question 17

Respiratory alkalosis mainly occurs from?

Answer 17

breathing too fast

getting rid of too much co2

raised RR

1) hyperventilating
2) pulmonary embolism

Question 18

benefits of prone positioning in ARDS?

Answer 18

reducing compression of the lungs by other organs
improves blood flow to the lungs
improve clearance of secretions
improve overall oxygenation

Question 19

venturi mask colour that gives most Fi02?

least?

Answer 19

green
blue

Question 20

what is PEEP?

Answer 20

end expiratory pressure
> remains in airways at end of exhalation
>

if you give additional pressure then airways remain inflated

++ atelectasis
improves ventilation
opens more areas for gas exchange

Question 21

Positive end-expiratory pressure is added by:

Answer 21

high flow nasal cannula
NIV
mechanical

Question 22

NIV?

Answer 22

essentially BiPAP

bilateral + airway pressure

cycle of high and low pressure to correspond wiht inspiration and expiration

Question 23

NIV involves?

Answer 23

full face mask
hood
/ tigh fitting nasal mask

blows air into lungs and ventilates them

Question 24

What does mechanical ventilation involve?

Answer 24

Fi02
respiratory rate

tidal volume
Ins:exp ratio

peak flow rate
peak inspiratory pressure
positive end expiratory pressure

Question 25

what is ECMO

Answer 25

extracorporeal membrane

blood removed

passed through a machine where oxygen is added

CO2 is removed then pumped back