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PACES Revision Cards > Respiratory Flashcards > Flashcards

Respiratory Flashcards

1
Q

Outline the MRC dyspnoea scale

A

1) Not troubled by SoB (except on strenous exercise)

2) SoB when hurrying or going up slight hill

3) Walks slower than contempories on flat/has to stop for breath

4) Stops for breath approx 100m or after a few minutes

5) Too SoB to leave house or SoB on dressing

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2
Q

Respiratory Causes of Clubbing

A

ABCDEF

A - Asbestosis & Abscess

B - Bronchiectasis & tB

C - CF

D - “Dirty” tumours e.g. mesothelioma

E - Empyema

F - Fibrosing Alveolitis (IPF)

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3
Q

Features of Life-Threatening Asthma

A

PEFR<33%
Silent chest
Poor respiratory effort
Bradycardia, hypotension
Arrhythmia
Exhaustion
Confusion/Coma

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4
Q

What is COPD?

A

Chronic obstructive airways disease
Limited reversibility
Combination of bronchitis and emphysema

Abnormal inflammatory response in airways leads to mucus hypersecretion and chronic tissue destruction –> remodelling –> fibrosis –> increased airway resistance

Commonest cause = cigarette smoking
Also consider alpha 1 antitrypsin deficiency and occupation (e.g. coal mining)

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5
Q

Clinical Features of COPD

A

Look around bedside for inhalers
?LTOT
Cachexic? Cushingoid appearance?

Pursed lip breathing
Use of accessory muscles
Bounding pulse
CO retention flap (asterixis)

Hyperinflated chest
Hyperresonance to percussion
Expiratory wheeze
?coarse crepitations

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6
Q

Can you name any severity indexes used for COPD?

A

MRC dyspnoea scale

Gold Staging for Airflow obstruction
- FEV1/FVC < 0.7, FEV1 <80%

BODE index
- FEV1
- 6 minute walk distance
- BMI
- MRC dyspnoea scale

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7
Q

How would you investigate someone in whom you suspect they have COPD?

A

Spirometry with reversibility testing
- FEV1/FVC < 0.7
- FEV1 < 0.8
- Minimal reversibility with bronchodilators
ECG

Bloods
- Routine including FBC (?polycythaemia), inflammatory markers, U&Es, LFTs (albumin may be low in chronic disease)
- ABG if ongoing oxygen requirement
- alpha1AT levels if young/FHx/minimal smoking history

CXR
- ?hyperinflation ?bullae ?flattened hemidiaphragm

HRCT
- Useful to grade and classify emphysema

Echocardiogram
- ?pulm HTN

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8
Q

Describe some key differences between COPD and Asthma

A

1) COPD more likely in smokers/ex-smokers

2) Asthma = diurnal pattern
- Serial peak flow measurements will show >20% diurnal variation

3) Asthma = history of triggers, history of atopy

4) Asthma = evidence of reversibility on spirometry with bronchodilators (>400mL improvement)

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9
Q

What are common causes of COPD exacerbations?

A

Infection (60%)
- Viruses e.g. influenza, parainfluenza, rhinovirus
- Bacteria e.g. haemophilus influenzae, streptococcus pneumoniae, pseudomonas

Environmental pollution

Unknown (30%)

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10
Q

Outline the management of COPD

A

O PARISIAN

Oxygen therapy
- To slow rate of progression to cor pulmonale

Pulmonary Rehab
= MDT programme of physio, nutrition team, education and behavioural intervention
- Indicated if MRC<3

Azithromycin
- Anti-inflammatory rather than long term antibiotic
- Reduce rate of exacerbations
- Indicated if >3 exacs requiring steroids or 1 exac requiring hospitalisation / year

Reduction of Lung volume (surgery)

Inhalers
- SABA/LABA +/- ICS +/- LAMA

Smoking Cessation
- Only treatment shown to alter disease progression

Immunisations
- Annual influenzae
- Pneumococcal if <65 or FEV1<40%

Anti-mucolytics e.g. Acetylcisteine
- Reduce risk of chest infections

Nutrition
- Poor nutritional state is linked to increased mortality and reduced immune function

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11
Q

When is Long Term Oxygen Therapy indicated in patients with COPD?

A

PaO2 < 7.3
or
PaO2 <8.0 if polycythaemic/nocturnal hypoxia/cor pulmonale or pulm HTN

Typically use >15 hours/day
Can also consider ambulatory or short burst O2 therapy

Home assessment before prescription
No smoking!

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12
Q

Indications for Lung Transplant in patients with COPD

A

BODE index >5
Post bronchodilator FEV1 <25%
Resting hypoxia and hypercapnia
Pulmonary HTN
Accelerated decline in FEV1

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13
Q

Can you outline medications we can offer to help with smoking cessation?

A

1) Nicotine Replacement Therapy
- Assess no. cigarettes/day to help with dosing
- When is their first cigarette? If on waking consider 24 hour patch as opposed to 16 hour
- Patches (long acting) +/- gum +/- inhalator
- Combination of long acting and short acting best

2) Buproprion
- Antidepressant and nicotinic antagonist
- Contraindicated in breastfeeding/pregnancy
- Risk of seizures

3) Varenicline
- Nicotine receptor agonist
- 12 week course
- Nausea/insomnia/abnormal dreams/neuropsychological effects

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14
Q

Indications for NIV

A

COPD Resp acidosis after 1 hour maximal therapy
= pH <7.35, pCO2 >6

Severe dyspnoea with resp muscle fatigue

T2RF secondary to chest wall deformity/neuromuscular disease/OSA

Cardiogenic pulmonary oedema unresponsive to CPAP

Weaning from tracheal intubation

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15
Q

Benefits of NIV

A

Bi-level positive airway pressure
- IPAP aids ventilation = removal of CO2
- EPAP recruits collapsed alveoli = improves gas exchange = improves oxygenation

Reduces needs for invasive intubation
(reduce risk of ventilator complications)
Reduce mortality
Reduce length of stay in hospital

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16
Q

Contraindications for NIV

A

Severe hypoxia (?consider if intubation and ventilation more appropriate)

Undrained pneumothorax

Facial injury

Burns

Fixed upper airway obstruction

Excessive secretions/vomiting

Reduced GCS/agitation

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17
Q

Indications for CPAP

A

Continuous positive airway pressure (PEEP, basically EPAP)

T1RF
Cardiogenic pulmonary oedema
Congestive cardiac failure
Pneumonia
Sleep apnoea

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18
Q

Outline common causes of Community Acquired Pneumonia

A

Strep pneumoniae (most common)
Haemophilus influenzae
Mycoplasma pneumoniae
Legionella
Staph Aureus (post influenza)

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19
Q

What is CURB scoring?

A

C - confusion
U - Urea>7
R - RR > 30
B - BP systolic <90
>65

<2 points, consider treating in community

CURB score of 5 has 57% 30 day mortality
CURB score of 3 has 17% 30 day mortality

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20
Q

What is Bronchiectasis?

A

Abnormal permanent dilatation and destruction of bronchi due to combination of
1) Chronic infection
2) Impaired mucus drainage
3) Airway obstruction
4) Defective host response

Occurs in distal bronchioles (no cartilage rings)

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21
Q

Causes of Bronchiectasis

A

CONGENITAL
- Cystic fibrosis (autosomal recessive)
- Kartagener’s (autosomal recessive)
- Young’s syndrome
- Yellow Nail syndrome

COPD

INFECTION
- Childhood infections e.g. measles, pertussis, TB
- Recurrent aspiration

OVERACTIVE IMMUNITY
- ABPA

UNDERACTIVE IMMUNITY
- HIV
- Leukaemia

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22
Q

Outline some complications of Bronchiectasis

A

Recurrent infections e.g. pseudomonas aeruginosa, haem influenzae

Empyema/abscess

Haemoptysis (can be MASSIVE!)

Cor Pulmonale

Cachexia

Anaemia of chronic disease

Metastatic infection e.g. CNS abscess

Secondary amyloidosis

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23
Q

Investigation Screen for Bronchiectasis

A

Sputum MC&S and AFB (multiple samples)
Spirometry - usually obstructive picture

Bloods
- Routine = FBC, U&Es, LFTs, inflam markers
- HIV
- Immunoglobulins
- Interferon gamma release assay if suspicious of TB
- Autoantibodies (vasculitis screen)
- Alpha 1 AT levels
- Aspergillus precipitans & IgE levels

CXR

HRCT is definitive test
- “Reid Classification” e.g. signet ring, tree-in-bud, tram-tracking

?Bronchoscopy

EXTRAS
- Sweat testing/genotyping if ?CF
- Nasal brushings if ?Kartagener’s

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24
Q

Outline the management of Bronchiectasis

A

Treat underlying pathology

CONSERVATIVE
- Stop smoking
- Optimise nutrition
- Vaccinations
- Sputum clearance/chest physio

MEDICAL Rx
- Antibiotics for infective exacerbations (10-14 days)
- Prophylactic azithromycin (antiinflam)
- Inhaled bronchodilators
- Inhaled steroids
- Mucolytics

SURGICAL Rx
- ?Lobectomy if localised
- Lung transplant in CF patients

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25
Q

Cystic Fibrosis

A

Autosomal recessive disease
Defect in CFTR gene on chromosome 7
- Most common defect = deltaF508
- Carrier rate = 1 in25

Defect in CFTR = chloride ions cannot leave cells = sodium and water reabsorption from mucus back into cells = thick viscous secretions

Multisystem disorder
- Nasal polyps
- Bronchiectasis and recurrent chest infections
- Diabetes (30% by age of 50)
- Malabsorption/FTT
- Biliary cirrhosis –> CLD (30%)
- Delayed puberty
- Infertility

Most diagnosed in neonatal period but 5% diagnosed after age of 18

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26
Q

Examples of common colonising organisms in CF

A

Haemophilus influenzae (early childhood)

Staph Aureus
Pseudomonas
Aspergillus

Burkholderia Cepacia = worst prognosis!
- Contraindication to lung transplant

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27
Q

Outline the management of CF

A

MDT Approach

CONSERVATIVE
- Daily chest physio and postural drainage
- Optimise nutrition
- Minimise contact with other CF pts (avoid cross infection)
- Vitamin supplements
- Pancreatic supplements

PHARMACOLOGICAL
- Treatment of pseudomonas colonisations with PO and nebulised antibiotics
- Lumacaftor / Ivacaftor
= indicated if homozygous delta F508 mutation. Increases number of CFTR proteins

SURGICAL
- Heart and lung transplant (5yr survival 60%)

Median survival 32 years but is improving

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28
Q

What is Young’s Syndrome?

A

Rare condition, unknown cause

Triad of
1) Azoospermia
2) Bronchiectasis
3) Rhinosinusitis

Often present in middle age with infertility

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29
Q

What is Yellow Nail Syndrome?

A

Rare condition, unknown cause

Usually affects >50s

2 of the 3:
1) Slow growing hard yellow finger and toe nails
2) Lymphoedema
3) Recurrent Pleural effusions + bronchiectasis

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30
Q

What is TB?

A

Infection caused by mycobacterium tuberculosis

Notifiable disease

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31
Q

Risk Factors for Active Pulmonary TB infection

A

Place of birth (Sub Sahara Africa & Asia)
Increasing age
HIV/AIDs
Homelessness/Overcrowded living spaces e.g prisons
Immunosuppression e.g. diabetes, chemo
Malignancy
Malnutrition

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32
Q

Outline some examples of extra pulmonary TB

A

TB meningitis
CNS tuberculoma

Scrofuloderma (cervical LNs)

Pericardial TB

Pott’s disease = spinal osteomyelitis
Spinal TB

Renal TB

Miliary TB = haematogenous spread to any organ

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33
Q

How would you investigate a patient in whom you suspect TB?

A

Sputum samples x 3 for Ziehl Neelsen staining
Early morning urine samples for AFB x 3

Tuberculin skin resting (Mantoux)
- Can be false negative if immunosuppressed

Interferon gamma Release Assay (Quantiferon)

HIV

CXR
CT Chest

?Bronchoscopy
?Biopsy of extrapulmonary site e.g. LNs

34
Q

Outline the management of TB

A

Notifiable disease! Inform public health - contract tracing
May need to have directly observed treatment if no fixed abode/non-compliant

RIPE medications
- Prior to starting, check LFTs and visual acuity/colour
- Typical course is 6 months of R & I, 2 months of P &E

RIFAMPICIN
- Enzyme inducer, red urine, GI disturbance

ISONIAZID
- Hepatitis, peripheral neuropathy

PYRAZINAMIDE
- Hepatoxicity, peripheral neuropathy, gout

ETHAMBUTOL
- Optic neuritis

35
Q

Potential Clinical Features of a patient with TB previously treated with surgical intervention e.g. plombage, phrenic nerve crush

A

Tracheal deviation towards side of previous TB
Phrenic nerve crush scar in supraclavicular fossa

Chest deformity/asymmetry
Thoracotomy/thoracoplasty (rib resection) scar
Reduced chest expansion on TB side
Dullness to percussion

36
Q

Possible respiratory complications of TB

A

Apical fibrosis

Aspergilloma in old TB cavity

Bronchiectasis secondary to LN obstruction

Pleural effusion/thickening

37
Q

Causes of Upper Zone Pulmonary Fibrosis

A

CHARTS

Coal Worker’s pneumoconioses

Histoplasmosis
Hypersensitivity pneumonitis
Histiocytosis X

Ankylosing spondylitis
ABPA

Radiation

TB

Sarcoidosis
Silicosis

38
Q

Causes of Lower Zone pulmonary fibrosis

A

RADIO

Rheumatoid arthritis

Asbestosis

Drugs e.g. amiodarone, nitrofurantoin

Idiopathic PF (IPF)

Other e.g. bronchiectasis, CTD e.g. SLE or systemic sclerosis, sjogren’s

39
Q

Iatrogenic/Drug causes of Pulmonary Fibrosis

A

“BBC is everyMANS Gold”

Bleomycin
Busulphan
Cyclophosphamide

Methotrexate
Amiodarone
Nitrofurantoin
Sulphasalazine

Gold

40
Q

Investigations for Pulmonary Fibrosis

A

LAB
- Routine bloods; ?eosinophilia on FBC (EAA)
- Immunoglobulins (ABPA)
- ACE (sarcoidosis)
- CK (myositis)
- Rheumatological screen e.g. ANA, RF, anti-DSNA, anti-Scl70, anti centromere

FUNCTIONAL
- Pulmonary function tests + DLCO
(Restrictive pattern with low DLCO)
- 6 minute walking test

RADIOLOGICAL
- CXR
- HRCT is key test
(Assess pattern, extent and distribution of fibrosis)

INVASIVE
- Bronchoscopy with Bronchoalveolar Lavage
- ?Lung biopsy

41
Q

Management of Pulmonary Fibrosis

A

Depends on underlying cause

CONSERVATIVE
- Pulmonary rehab

PHARMACOLOGICAL
- Corticosteroids - less likely to respond if male/late presentation/honeycombing on CT/BAL neutrophilia
- Immunosuppression e.g. AZA/MTX
- Supplemental Oxygen
- Antifibrotics e.g. pirfenidone
(Specialist MDT decision, FVC 50-80%)
- Symptom Management e.g. benzos, opiates

SURGICAL
- Lung transplant may be suitable in some cases

42
Q

What are the indications for lung transplant in UIP?

A

<65 years old

TLCO<40% predicted

Fall in FVC > 10% over 6 months

43
Q

Rheumatoid Lung Disease

A

1) Pleural effusions/pleurisy

2) Pulmonary nodules
- Can precede arthritis

3) Fibrotic Lung disease
- Lower zone

4) Caplan Syndrome = coal worker’s pneumoconioses & RA

5) Obliterative Bronchiolitis
- Small airways obstructions –> necrotising bronchiolitis
- Linked to Gold & penicillamine

44
Q

5 main types of pleural effusions

A

1) Transudates
- Raised hydrostatic or low oncotic pressures

2) Exudates
- Increased capillary permeability

3) Chylothorax
- Disruption of lymphatic ducts

4) Empyema
- Infection of pleural space

5) Haemothorax
- Bleeding into pleural space

45
Q

Transudative Pleural Effusions

A

Pleural protein < 20g/L

CHAM

C- CCF
H - Hypoalbuminaemia / Hypothyroidism
A - All failures (liver, renal)
M - Meig’s syndrome (= benign ovarian fibroma & right sided effusion)

46
Q

Exudative Pleural Effusions

A

Pleural protein >30g/L

PINTS

P -Pneumonia
I - Infarction (PE)
N - Neoplasia e.g. mesothelioma, metastases
T - TB/Trauma
S - Sarcoidosis/Scleroderma

47
Q

What is Light’s Criteria?

A

Used if pleural protein level equivocal e.g. 25g/L

Pleural effusion is an EXUDATE if …
1) Pleural Albumin/Serum Albumin > 0.5
2) Pleural LDH/Serum LDH > 0.6
3) Pleural LDH > 2/3 of ULN of serum LDH

HOWEVER - 25% of transudates mistakenly identified as exudates using light’s criteria

48
Q

Investigations for Pleural Effusions

A

Sputum MC&S +/- AFB

Bloods
- Routine
- ?Blood cultures
- Serum albumin and LDH

CXR
- >300mL to be seen on PA film
- >1000mL if mediastinal shift seen

USS

?CT thorax
?Bronchoscopy
?CT guided biopsy ?VATS

PLEURAL ASPIRATE TESTS
Pleural Fluid
- Cell Count
- Cytology
- Albumin & LDH (Light’s)
- Glucose
- pH (<7.2 = empyema!)
- Amylase (if suspicious of pancreatitis/oesophageal rupture)
- Lipids (if suspicious chylothorax)

49
Q

What might a pleural fluid glucose <2.0 indicate?

A

Malignancy

Empyema

Arthritis (RA)

TB

50
Q

What is the safety triangle for chest drain insertion?

A

Base of axilla
Lateral edge of pectoralis major
Lateral edge of latissimus dorsi
5th Intercostal Space

51
Q

Management of Acute Tension Pneumothorax

A

Emergency! A to E

14 - 16 gauge cannula into 2nd or 3rd intercostal space, midclavicular line

Chest drain (safety triangle)

52
Q

How would you manage a primary pneumothorax?

A

Primary pneumothorax = no history of underlying lung disease. Usually young, tall, thin men

A to E assessment

If <2cm and asymptomatic = supportive e.g. pain relief and oxygen therapy

If >2cm or symptomatic = aspirate with cannula in 2nd-3rd ICS
- If unsuccessful, chest drain

53
Q

How would you manage a secondary pneumothorax?

A

Secondary pneumothorax = due to underlying respiratory disease e.g. Asthma, COPD

If <50 & <2cm & asymptomatic = Supportive +/- aspirate

If > 50 & > 2cm +/- symptoms = chest drain

54
Q

Can you outline some advice we give to patients once they’ve had a pneumothorax?

A

Avoid smoking (increases risk of pneumoT)

No flying in 7 days after treatment

Avoid scuba diving for rest of life (unless undergo bilateral surgical pleurectomy)

55
Q

Indications for Surgical Intervention for Pneumothorax

A

Persistent air leak

Repeat pneumothorax
- 1st contralateral
- 2nd ipsilateral

Bilateral spontaneous pneumothoraces

56
Q

What is Obesity Hypoventilation Syndrome?

A

3 of
1) OSA
2) Hypercapnia
3) Restrictive PFTs

57
Q

Investigating OSA

A

Epworth Sleepiness Scale

Overnight Polysomnography
- Measures ECG, EMG, resp effort and oxygenation overnight
- Number of apnoeas overnight

FBC (polycythaemia)
TFTs (?hypothyroidism)

Morning ABG

58
Q

Management of OSA

A

CONSERVATIVE
- Advise weight loss if overweight (only 50% of OSA pts are obese)
- Stop smoking
- Reduce alcohol intake

MEDICAL
- CPAP = 1st line Rx but issues with compliance
- LTOT

Surgical intervention rare

59
Q

Complications of OSA

A

HTN
IHD & MIs
Arrhythmias

Stroke

Pulmonary HTN
OHS

60
Q

Outline the types of lung cancer

A

NON SMALL CELL LUNG CANCER
- Most common, 75-80%
- 3 main subtypes
= SCC > adenocarcinoa > large cell

SMALL CELL LUNG CANCER
- 20-25% of lung cancers
- Arise from APUD cells
- Rapidly growing with early metastases

61
Q

Common sites of lung cancer metastases

A

Brain
Liver
Adrenal Glands
Bone - osteolytic appearance, often in vertebral bodies

62
Q

Investigating for Lung Cancer

A

Lung Function Tests
- Suitability for surgical intervention

Sputum Cytology
- Positive in 20%

Bloods
- Routine (Na+ for SIADH, LFTs)

Imaging
CXR can be useful in first instance
CT CAP
- Evaluate tumour location & size, LNs & ?mets
- Identify site for biopsy
PET-CT scan
- More accurate at identifying mediastinal disease (?site for EBUS)

TISSUE SAMPLING
EBUS - nodal disease
CT guided biopsy - of mets or peripherally located cancer
Flexible bronchoscopy
Mediastinoscopy
VATS & pleural biopsy

63
Q

Paraneoplastic Features of NSCLC

A

Parathyroid-hormone Related Protein Secretions
- Raised PTHrP = hypercalcaemia
- SCC

Hypertrophic Pulmonary Osteoarthropathy
- Clubbing and pain at wrist and ankles due to new bone formation
- Adenocarcinoma & SCC

BCG Secreting Tumour
- Gynaecomastia
- Adenocarcinoma & large cell

64
Q

Management of NSCLC

A

Lung Cancer MDT

Consider if suitable for surgical resection
- Stage I or II TNM
- FEV1 >2L (if pneumonectomy); FEV1 > 1.5L (if lobectomy)

Radiotherapy
- Stage I - III if inoperable

Chemotherapy
- Post op or on its own
- Stage III-IV

Palliative Chemo/Radiotherapy if stage IV
Advanced Care Planning
Symptom control

65
Q

Contraindications for Surgical Intervention for NSCLC

A

Stage IIIb/IV (mets present)
FEV1<1.5L
Malignant pleural effusion
Tumour near hilum
Vocal cord paralysis
SVCO
Left recurrent laryngeal nerve palsy

66
Q

Paraneoplastic Features of SCLC

A

Ectopic ADH secretion
- = SIADH, with low sodium

Ectopic ACTH Secretion
- Cushing’s syndrome
= HTN, raised glucose, hypokalaemia, muscle weakness

Lambert-Eaton Myasthenic Syndrome (LEMS)
- Antibodies against VGCC
- Can precede diagnosis of lung cancer

67
Q

How is SCLC staged and mangaged?

A

Staged as either:
1) Limited = disease confined to ipsilateral hemithorax = 15-20 months median survival
2) Extensive = metastatic disease outside ipsilateral hemithorax = 8-13 months median survival

MDT Approach
Unlikely to be suitable for surgical intervention
Combination of radiotherapy and chemotherapy

68
Q

What is Pancoast’s Tumour?

A

Tumour in lung apex

Most commonly NSCLC (and usually SCC)

Invasive! - chest wall/ribs/brachial plexus/cervical sym nerves

PANCOAST’S SYNDROME =
Shoulder and arm pain along C8-T1 dermatomes
Horner’s Syndrome = miosis, ptosis, enophthalmos & anihydrosis
Hand muscle weakness & wasting

69
Q

What is SVCO?

A

Superior Vena Cava Obstruction

Oncological emergency!

Most common in lung cancer (SCLC>NSCLC) and lymphoma

FEATURES
- Cough, SoB
- Headache, worse on bending forwards
- Syncope
- Hoarse voice
- Facial & upper limb oedema
- Facial plethora
- Superficial vein distension of upper body
- Fixed elevated JVP
- Inspiratory stridor
- Pemberton’s sign = facial swelling on lifting of both arms

70
Q

How would you manage a patient with SVCO?

A

A to E assessment

Inform anaesthetic team and oncology team

Corticosteroids mainstay of treatment -
If evidence of respiratory compromise = IV dexamethasone

?Endovascular stenting
?Chemo/Radiotherapy (if unable to lie flat, unlikely to be able to tolerate radiotherapy)

71
Q

Indications for Pneumonectomy/Lobectomy

A

Resection of lung malignancy
- NSCLC mainly (25% suitable)

Localised bronchiectasis with uncontrolled symptoms

Old TB (prior to pharmacological Rx)

Fungal infections e.g. aspergilloma

Traumatic lung injury

Large emphysematous bullae

CF

72
Q

What FEV1 values do you need for a pneumonectomy?

A

FEV1 > 2L

73
Q

What FEV1 values do you need for a lobectomy?

A

FEV1 > 1.5L

74
Q

Indications for VATS

A

Lobectomy & pneumonectomy (less invasive)

Pleural biopsy

Lung parenchymal biopsy

Bullectomy & lung volume reduction for emphysema

Correction of spontaneous primary pnemothorax

Pleurodesis

Wedge resection

75
Q

Benefits of VATs as opposed to “traditional” thoracic surgery

A

Minimally invasive
- Reduce need for muscle division & rib spreading/fractures

Quicker recovery
Reduced length of stay in hospital
Earlier mobilisation
Lower doses opiates/analgesics required

All adds up to reduce risks associated with hospital admissions e.g. HAI, delirium

76
Q

Indications for Lung Transplant

A

ILD
Advanced COPD (usually single)
CF
Emphysema secondary to alpha1AT
Pulmonary HTN

Single = if >65 years old
Double = <60 years old

CRITERIA
- >50% chance of death within 2 years if no transplant
- >80% chance of survival >90 days
- >80% chance of 5yr survival

77
Q

Contraindications for Lung Transplant

A

Severe organ dysfunction e.g. cardiac failure

Acute Critical Illness

Severe malnutrition/obesity

Smoking in last 6 months

Malignancy in last 5 years

Poor exercise tolerance/unable to walk

78
Q

What is a Bullectomy?

A

= removal of giant bullae

Can help improve symptoms and lung function (restores mechanical linkage between chest wall and lungs)

Indications
1) Progressive SoB despite maximal Rx
AND
2) FEV1<50%
AND
3) Bullae>1/3 of hemithorax

79
Q

What is Cor Pulmonale?

A

= enlargement and failure of right side of heart due to increased vascular resistance secondary to respiratory disorder e.g. COPD

Fluid retention & pulmonary HTN –> increased strain on RV –> RV failure

Best treatment = prevention!

Will likely need LTOT & diuretics

80
Q

Signs of Bronchiectasis

A

Oxygen therapy
Sputum pots
Inhalers

Likely young if CF

Wet cough, ?cachexia

Clubbing, ?yellow nails

Midline/central line/portacath (?long term abx therapy)
?lymphadenopathy
Non deviated trachea

Coarse crackles
?Scars from previous lobectomy/wedge resection

81
Q

COPD Spirometry Diagnostic Values

A

FEV1/FVC < 0.7

Severity:
FEV1 0.8 - 1.0 = mild
FEV1 0.5 - 0.8 = moderate
FEV1 0.3 - 0.5 = severe
FEV1 <0.3 = very severe

PACES Revision Cards (9 decks)

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