Respiratory 2

Question 1

List some key findings in restrictive lung diseases:

Answer 1

Decreased TLC

Reduced FEV1

Reduced FVC

Decreased DLCO (Diffusion Lung Capacity of Carbon Dioxide)

Question 2

What are some key histological findings in IPF?

Answer 2

Usual Interstitial Pneumonia
- this refers to the typical appearance of scarring of the lung with abnormalities which are consistent with IPF.

these include:

• Temporal Heterogeneity
• different parts affected at different times - in other words, it doesn’t all look the same
• Fibroblastic foci
• found around the edges of scarred tissue, suggesting new scar tissue is about to be laid down
• Honeycombing
• late stage, cystic formation

Question 3

How is a biopsy taken in IPF?

Answer 3

Video Assisted thoracic surgery

Question 4

What gene has been associated with IPF?

Answer 4

MUC5B

Question 5

List some treatments for obstructive sleep apnea:

Answer 5

Weight loss

CPAP
- needs least 4 hours use, 70% of the time

Mandible thrust

Question 6

When draining a pleural effusion, what is the treatment and what needs to be remembered?

Answer 6

Small bore chest drain placed in the safe triangle of the chest

*done under ultrasound guidance

Question 7

In a chest drain when do you remove it following a pneumothorax?

Answer 7

24 hours after the bubbling has stopped

Question 8

What are the two types of spontaneous pneumothorax?

Answer 8

Primary
- no underlying lung disease

Secondary
- underlying lung disease - COPD

Question 9

List some common causes of pleural effusion:

Answer 9

Increased hydrostatic pressure

Decreased osmotic pressure
- hypoalbuminemia

Increased vascular permeability
- pneumonia

Decreased lymphatic drainage

Increased intrapleural negative pressure

Question 10

What are the most crucial determinants for exudate vs transudate?

Answer 10

Protein >30g

Lactate Dehydrogenase: >2/3 for normal serum LDH

Pleural protein/ serum protein ratio: >0.5%

Pleural LDH/ Serum LDH >0.6%

Question 11

What is an indication for using Medical thoracoscopy?

Answer 11

Undiagnosed cytology of negative pleural effusions

Question 12

What is the management of pleural empyema:

Answer 12

Establish if person is septic, then:

Small bore drain

Saline wash - multiple

IV Antibiotics

DVT prophylaxis

Fibrinolytics

Question 13

When should empyema be suspected?

Answer 13

When there is evidence of sepsis with a pleural effusion

When someone has pneumonia and isn’t getting better

Question 14

What is the management for secondary pneumothorax?

Answer 14

All patients admitted +/- drainage

+ oxygen

Question 15

Outwith the guidelines, if someone has a large (>2cm) pneumothorax but is asymptomatic, what is the treatment recommended?

Answer 15

Conservative management, without drain.

Question 16

What is the criteria for obstructive sleep apnea?

Answer 16

Apneonitic events which are: Cessation or near cessation or airflow with >4% drop in sats for >10 seconds.
Leading to awakening

*>15 episodes of apnea an hour
or
>5 + severe related symptoms

Question 17

Pulmonary Embolism:

Answer 17

Presence of risk factors
Chest pain
Dyspnea (>20bpm)
tachycardia

Differentials: 
Unstable Angina 
M.I 
Acute asthma 
Pneumonia 

Risk Factors:

• Hypercoagulability
• Blood Stasis
• vessel injury

Diagnosis:
- Well score
- D - Dimer
(positive D dimer or >2 on wells or both then treat as DVT)

• CTPA
• V/Q scan

Treatment:
Oxygen
Heparin
Fluids

if hemodynamically unstable then thrombolysis