Respiratory exam Flashcards
What are the indications for a VATs procedure
Decortication, segmentectocmy, bullectomy, lobectomy, treatment for recurrent pneumothoraces
benefits of VATs vs. thoracotomy
Reduced pain , wound complicaitons, healing time , reduced length of stay
Indications for a lobectomy
Main : Lung Ca
others: TB , Lung Abscess, Aspergilloma
What are the diagnostic investigations for a suspected lung cancer
Diagnosis: Chest radiograph , Staging CT, Tissue Diagnosis ( EBUS , Bronchoscopy with direct sampling)
What is the work up for lung cancer
1) Full lung function tests including transfer factor assessment.
2) Cardiopulmonary exercise testing
What FEV1 for a lobectomy and pneumonectomy
Lobectomy >1.5 or >2.0
What is the VO2 Max for good operative outcome for a pneumonectomy
VO2 max of at least 15ml/kg/min.
What are the different histological cell types of cancer
Lung cancer be classified into small cell and non-small cell lung cancer.
Non Small cancer is adenocarcinomas, large cell and squamous cell
What is good respiratory conservative management plan
Up to date with vaccines
Smoking cessation
Lung rehab
What are the treatment options for NSCLC and SCLC
SCLC tends to be aggressive and present late , typical treatment is palliative chemotherapy
How would you manage a pneumothroax
Manage with A-E Approach
if primary then aspirate up to 2.5L < if no residual volume and symptom free then consider discharge. If ongoing symptoms or residual volume is large then consider chest drain
When would you consider surgical management of a pneumothorax
If ongoing air leak, not resolving with chest drain insertion or if recurrent pneumothoraces then surgical management may be considered.
What is the investigations of asthma
if unstable - A- E Approach
PEFR
Eosinophils (FBC) or WCC raised
IgE levels
CXR
reversible airflow obstruction , PEFR / FEV1 in response to a beta agonist - 200ml in FEV1 or 15% change compared to baseline.
causes of airway obstruction
typically it is either asthma or chronic obstructive pulmonary disease, rarer causes include Bronchiectasis or obliterative bronchiolitits.`
Causes of ILD
1) idiopathic, Sarcoidosis,
2) occupational disorder - asbestosis or silicosis , extrinsic allergic alveolitis (psiticosis),
3) CTD - SLE , Rheumatoid Arthirtis, ANK spond.
4)Medications : Nitrofurantoin , methotrexate , Amiodarone.
A patient with IPF , if FVC < 80%
Consider pifernidone or nintenanib
Tertiary management of ILD includes
MDT , HRCT review of underlying aetiology of the ILD. MDT approach of the condition
Common connective tissue disease that cause ILD
SLE , Systemic sclerosis , Rheumatoid arthritis , ANK spond
Ix for ILD
confirmation : Lung Function tests
Cause: HRCT , Avian precipitans, EBUS, Lung Biopsy (last resort) , CTD screen
Poor prognostic factors in ILD
IPF has the worse prognosis, median survival is 2-3 years from diagnosis. Poor prognostic factors include older age, dyspnoea, coexisting emphysema , extensive radiographic involvement , exertional desaturation
MX for IPF
Lung rehab , Nintenanib, pirfenidone , lung transplant.
Mx for Non specific interstitial pneumonia
oral or IV Steroid and steroid sparing agent - Azathioprine or mycophenolate mofetil.
Causes of CF
Autosomal recessive condition of the CFTr gene that causes dysfunction in Cl- transport and increased salt excretion , manifests as secretions having increased viscosity affecting the GI tract, respiratory system and the reproductive system
Complications of CF
Pancreatic insufficiency and therefore hyperglycaemia
Bronchiectasis
Liver failure
Gallstones / Kidney stones
Osteoporosis
Male infertility
at risk of aspergilloma and pneumothorax
Microbiology of cystic fibrosis
Different profile of bacteria, commonly pseudomonas, poor prognosis is conferred by Burkholderria and is a contraindication to lung transplant
Management of CF
MDT approach
Physiotherapy
Mucolytics
Prophylactic and targetted long duration abx
Creon tablets
Multivitamin therapy
Nutritional supplementation
