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mrcp paces > Respiratory > Flashcards

Respiratory Flashcards

1
Q 
VATS lobectomy 
Indications 
Benefits
Signs on examination 
FEV1
Vmax
A

Indications
Lung malignancy
Infection - TB, Aspergilloma, Lung abscess
Bronchiectasis with recurrent sx and haemoptysis

Benefits of VATS
Minimally invasive
Reduced rates of wound complication
Quicker healing time and length of stay

Signs on examination
Triangulation scars with one largest (3-4cm)
Recent - reduced signs over lobe
Historic - normal lung exam

FEV1 - >1.5L
Vmax - 15ml/kg/min

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2
Q

Causes of consolidation

A

Pneumonia
Malignancy
Pulmonary infarct

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3
Q

Causes of obstructive spirometry

A

COPD
Asthma
Bronciectasis
Obliterative bronchiolitis

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4
Q

Causes of ILD

A 
Idiopathic pulmonary fibrosis
Connective tissue disease
RA
Sarcoidosis
TB
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5
Q

Causes of basal lung fibrosis

A 
Drugs
Asbestosis 
RA
Sclerosis / CTD
Idiopathic pulmonary fibrosis
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7
Q

Causes of pul htn

A

Primary pul htn

Secondary:
Pulmonary vascular disease - Recurrent PEs, schistosomiasis, autoimmune (ILD)

Acquired heart disease - valvular, cardiomyopathy, CCF
Congenital heart disease - ASD, VSD, PDA

Structural lung disease: COPD, CF

Non-pulmonary causes of alveolar hypoventilation - kyphoscoliosis, Pickwickian, neuromuscular weakness.

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7
Q

Mx of bronchiectasis

A

Conservative - stop smoking, vaccination, postural drainage and breathing exercises, chest physiotherapy

Medical - bronchodilators, saline nets, mucolytics, inhaled abx. 2/52 abx for any infection, long term abx (azithromycin). LTOT

Surgical - lobectomy, pneumonectomy, double lung transplant, bronchial artery embolisation for haemoptysis

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8
Q

VATS scar

Indications

A 
Lobectomy
Pneumonectomy 
Wedge resection 
Decortication 
Bullectomy 
Persistent air leak of pneumothroax
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9
Q

Causes of collapse / atelectasis

A

Acute - mucous plugging, chest wall / rib injury, foreign body

Sub acute - obstructing neoplasm, post op

Chronic - fibrotic change, bronchiectasis, diaphragmatic palsy

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10
Q

Lung manifestations of RA

A

ILD - fibrosing alveolitis
RA-associated pleural effusion
Obliterative bronchiolitis
Pulmonary nodules

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11
Q

Treatment of cystic fibrosis

A

MDT
Cause and complications

GI:
Creon and nutritional support
Laxatives

Resp:
Abx
Mucolytics 
Chest physiotherapy for mucous clearance 
Inhaled therapies

Endocrine
Insulin

Cause:
Lumacaftor / ivacaftor to promote CFTR presence and function

Surgical - double lung transplant

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13
Q

Causes of a SVC obstruction

A

Malignancy - Lung carcinoma, Lymphoma
CV - Aortic aneurysm
Mediastinal fibrosis
Thyroid - Goitre

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14
Q

What are the features of EAA

A

Acute pulmonary and systemic sx occurring post allergen exposure
Pulmonary: Cough, wheeze, chest tightness
Systemic: fever, fatigue, myalgia
Sx occur within 4-12hrs of exposure and settle when not exposed
Type III antigen/antibody response but can progress to granulomatous inflammation

Chronic exposure can cause an organising pneumonia and obliterative bronchiolitis and fibrotic change

Common triggers - hay, mould, bird antigens

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15
Q

What would you expect to see on spirometry of someone with COPD?
How is it classified

A

FEV1/FCC <70%
Total lung capacity and residual volume increased
Decreased transfer factor

FEV1 >80% predicted - mild
FEV1 50-80% predicted - moderate
FEV1 30-50% predicted - severe
FEV1 <30% predicted - very severe

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15
Q

Ddx of pleural effusion (dull lung base)

A

Raised hemidiapharagm
Basal collapse
Pleural thickening - TB, mesothelioma

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16
Q

Pattern of spirometry in ILD

A

Restrictive
Reduced FEV1 and FVC with preserved ratio (>0.7)
Reduced total lung capacity and transfer factor

17
Q

Pul art pressure to dx pul htn

Causes

Mx

A

> 25mmHg at rest or >30 on exertion
PCWP <15 indicates primary pul htn, not due to CCF

Causes:
Primary
Chronic hypoxia (causes vasoconstriction)
Chronic PEs
CCF
ARDS
ILD
Eisenmengers post shunt
Hypoventilation

Mx:
Vasodilator challenge - prostacyclin infusion/inhalation
If +ve response - CCB (nifedipine, diltiazem)
If -ve response - prostacyclin analogues (iloprost), endothelia antagonist (bosentan), PDEi (sildenafil)

Diuresis
Anticoagulation

18
Q

CXR signs of pneumonectomy

A

White out on one side with trachea devoted toward the white out (vs effusion - pushed)

19
Q

Investigation of a pt with suspected lung ca

A 
Hx and examination 
CXR
CT CAP +/- PET CT (functional imaging)
Lung function testing
Tissue diagnosis - throacoscopy, bronchoscopy +/- EBUS, CT-guided biopsy
Preparation for surgery - echo
20
Q

Indications for lung transplant

A

Criteria:
Severe / end stage disease - >50% risk of death from lung disease within 2yrs without transplant
Good functional baseline / co-morbidities - >80% chance surviving 90 days post transplant
>80% chance of 5yr survival from general medical conditions

1 - lung vascular disease - pul htn (primary or due to systemic disease), Eisenmenger’s syndrome,e

2 - interstitial lung disease - idiopathic fibrosis, fibrosis due to connective tissue disease, sarcoidosis, chronic allergic alveolitis

3 - obstructive lung disease - COPD

4 - Supporative lung disease - bronchiectasis and CF

22
Q

Investigations of ILD

A

Manage the disease and investigate for an underlying cause

Peripheral saturation and ABG to assess for LTOT
Bloods incl RF, ANCA and dsDNA to exclude a connective tissue diagnosis
CXR and HRCT
Spirometry to restrictive pattern
Echo for R heart function
Bronchoscopy +/- biopsy

22
Q

Contraindication for lung transplant

A

Current sepsis / infection / AIDS
Disseminated malignancy or within past 5yrs
Significant pyschiatic hx causing inability to comply with immunosuppressive regime
Very high (>35) or low (<17) BMI
Current smoking / drug use
Co-morbidities - Untreatable other organ failure - heart, liver, kidney or atherosclerotic disease not amenable to revascularisation

23
Q

3 causes of bronchiectasis

A

Primary / idiopathic
Associated with smoking-related COPD

Post infection (pertussis, measles, TB)
Congenital - yellow nail, Kartageners
Cystic fibrosis
Immunodeficiency - hypogammaglobulinaemia
ABPA
24
Q

Causes of apical lung fibrosis

A 
Beryllium 
Radiation 
Extrinsic allergic alveolitis (EAA)
ABPA and ank spond
Sarcoidosis
TB
25
Q

Complications of lung transplant

A

1 - surgical complications - recurrence, failure, pain, scarring, bleeding, infection (typical and atypical, viral, bacterial and fungal)

2 - complications related to immunosuppression - infection and malignancy (skin, lymphoproliferative)

3 - rejection - hyper-acute, acute and chronic (bronchiolitis obliterans is usual mode - leading cause of death after first year)

4 - recurrence of disease

5 - SE of drugs - tacrolimus (tremor and raised BM), ciclosporin (renal impairment and gum hypertrophy), mycophenylate (BM suppression), steroids (Cushingoid)

26
Q

Clinical manifestations of cystic fibrosis

A

Failure to thrive and meconium ileus

GI:
Chronic malnutrition 
Pancreatic insufficiency 
Bowel obstruction 
DM and gallstones

Resp:
Bronchiectasis and abscess formation

Infertility (absence of vas deferens)

Renal stones

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