Respiratory extra Flashcards
What would be the cause of chronic dyspnoea, normal spirometry and lung volumes but a low TCLO?
P.E
Anaemia
Pulmonary artery hypertension
What are some causes for a low TCLO?
Intestinal lung disease
Emphysema
Cardiac failure
P.E
Anaemia
TCLO is determined by two factors:
- alveolar surface volume
- blood flow to the lung
Anything that affects these will lead to a reduction.
*note that asthma can be normal or lead to higher TCLO due to neovascularisation
if there is a complete flat top to a pleural effusion - what does that suggest?
Suggest there is air in the pleural space as well
What is the management of a pleural effusion?
Investigations:
- Chest x-ray
- US guided sample
Lights criteria
Immunology testing (autoimmune)
Cytology (malignancy)
Cultures and gram staining
Treatment:
- treat underlying cause
- Drainage if symptomatic - Drain no more than 1.5L and do not drain to empty
Pleurodesis with talc
or
Surgical fixation of pleura
Malignant management:
- Medical pleurodesis
- indwelling catheter
What is the management of pleural empyema?
Diagnostic when:
pH <7.2
LDH high
Low glucose
management:
- chest drain
- IV antibiotics
- DVT prophylaxis
When must a ABG be done over a VBG?
For accurate reading of paO2 and accurate readings of paCO2
What are the complications of obstructive sleep apnoea?
HTN Increased risk of stroke Type II respiratory failure Car accidents Cor pulmonale
What are the types of pneumothoraxes that occur?
Spontaneous
- primary
- secondary
Trauma
- iatrogenic
- traumatic
When can the canula used for the immediate management of a tension pneumothorax be removed? and when is the chest drain removed?
Once the chest drain is inserted and bubbling
Chest drain removed once it stops bubbling - demonstrating all the air has been removed from the pleural space.
List some potential findings seen in the blood work up and skin and CNS of atypical pneumonia:
FBC:
- haemolytic anaemia - mycoplasma
U&Es
- hyponatremia - legionella (SIADH)
Skin:
- erythema multiforma - mycoplasma
CNS:
- hyponatremia
What are the clinical features of sarcoidosis and how is investigated?
Skin:
- erythema nodosa
- lupus perinio
Eyes:
- keratoconjunctivitis sicca
- Anterior uveitis
Neurological:
- peripheral neuropathy
Cardio:
- cor- pulmonale
- conduction
Investigations: Bloods: - FBC (anamia) - U&Es (kidney involvement) - Ca2+ levels
Orifices:
- Bronchoscopy with biopsy
x-rays:
- CXR
- CT scan
- Echocardiogram
ECG
- for heart
Special test:
- ACE levels
What bloods do you want in a patient presenting with an acute exacerbation of COPD and what are some differentials and how are you going to manage them?
Investigations: - FBC - U&Es - CRP - ABG \+/- Theophylline levels
- Sputum cultures
- CXR
Differentials:
- pneumonia
- pneumothorax
- P.E
- Left ventricular failure
Management:
- Oxygen - venturi mask 28% until ABG back
- Steroids
- Nebs - salbutamol/ ipratropium
- Antibiotics
- Chest physio
- DVT prophylaxis
+/- carbocysteine
List some causes, features and investigations into hypersensitivity pneumonitis:
Causes:
- Farmer’s lung - Micropolyspora faeni
- Maltworker’s lung - aspergillus
- Pigeon fanciers lung
- Chemical worker’s lung
Investigations:
- CXR (fluffy nodular shadowing)
- Anti-bodies towards to allergen
- High resolution CT scan (Ground class and honeycombing)
- Spirometry
What are the main types of work related lung injuries and what is the no.1 presenting symptom of mesothelioma?
Coal workers Pneumoconiosis
Silicosis
Asbestosis
Mesothelioma
*mesothelioma presents with unilateral painful pleural effusion
List some risk factors for IPF:
Smoking Chronic aspirations EBV Coeliac disease IBD
What are the clinical features of IPF and how is diagnosed and list some features that would be seen if a biopsy was done:
Features:
- progressive dyspnoea
- weight loss
- Non-productive cough
- clubbing
- velcro-like crackles on inspiration
Investigations:
- FBC (neutrophils/ eosinophils?)
- Autoimmune serology? - RA? SLE?
- ABG
X-rays:
- High resolution CT (ground class and honey combing)
- Echocardiogram (cor-pulmonale)
ECG:
- cor- pulmonale
Special tests:
- spirometery
Biopsy:
- temporal heterogenicity
- fibroblastic foci
What are the functional levels of COPD?
all have FEV1/FVC <0.7
FEV1:
- > 80%
- 50-80%
- 30-50%
- <30%
Following an acerbation of COPD what things need to be liased with the GP?
Smoking cessation
Vaccinations
Assessment for oxygen therapy?
List some key investgiatiosn warrented in a P.E:
FBC - polycaethemia, underlying infection?
Coagulation studies
ABG
ECG
CXR - patients still get a CXR
CTPA
What advice can be given to prevent a P.E on a flight?
Hydration
75mg aspirin if appropriate
Move when possible
Avoid alcohol
What blood tests do you want into lung cancer?
FBC - anaemia?
LFTs - metastasis?
Bone profile - Mets, Ca2+
U&Es - paraneoplastic
What conditions are associated with IPF?
RA
SLE
IBD
