Respiratory pathology 3 Flashcards
Names the different types of emphysema
Centriacinar emphysema
Panacinar
Periacinar
Scar
Describe centriacinar emphysema
Starts with bronhcial dilation and then causes loss of surface area in the proximal acini. Occurs at the top of the lungs. Caused by smoking.
Describe panacinar emphysema
Occurs in large sections of the lung. Occurs at the bottom of the lungs. Caused by genetics.
Describe periacrinar emphysema
Occurs in the distal part of the acini and may burst into the pleura causing empyema.
Describe scar emphysema
Develops around a scar. Clinically insignificant.
mMRC breathlessness scale
0 = Only breathless on strenuous exercise 1 = Breathless when hurrying on the flat or when walking up a slight incline 2 = Breathless when walking at own pace and will have to stop or walks slower than others there age 3 = Can't walk further than 10 yds before stopping for breath 4 = Doesn't leave the house, is breathless doing basic tasks
What is the GOLD scale used for ?
Determining the severity of COPD
What does the GOLD scale say ?
1 = FEV1/FVC > 80% of predicted
2 = FEV1/FVC 50-79% of predicated
3 = FEV1/FVC 30-49% of predicted
4 FEV1/FVC < 30%
What are some of the difference between Asthma and COPD ?
Smoking Age Breathlessness Productive cough Night disturbances Variation of symptoms
What is the inhaler treatment given to a patient with COPD and breathlessness ?
SABA (Using SABA daily) SABA + LAMA (using SABA > 3 times a week) SABA + LAMA/LABA (Using SABA > 3 times a week) No help from further treatment
What inhaler treatment is given to a COPD patient with exacerbations ?
SABA + LAMA (Continues exacerbations) SABA + LAMA/LABA (Continued exacerbations) SABA + LAMA/LABA /ICS (Continues exacerbations) No further treatment
Criteria for giving LTOT
PaO2 < 7.3 kPa
or
PaO2 < 8 and complications of chronic hypoxia such as pulmonary hypertension or peripheral oedema
Examination findings for COPD
Hyper-resonance (Hyperinflation) Crackles and wheeze Raised JVP Fine tremor Flapping tremor pursed lip breathing peripheral oedema Cachexia Cyanosis
What is mild Asthma attack?
Use inhalers, oral steroids, have an early follow up
What is moderate asthma attack?
HR < 100
RR < 25
Can speak and complete sentences
Increased symptoms
What is a severe asthma attack ?
HR > 100
RR > 25
Can speak but cant complete sentences
What is a life threatening asthma attack ?
Confused Grunting Cant speak Normal PCO2 PaO2 < 8kPa SaO2 < 92%
What is a near fatal asthma attack ?
Increased CO2
Need to mechanical ventilation
What is the treatment pathways for asthma in children ?
Very low dose ICS (LTRA in < 5s) + SABA Use of SABA > 2 times a week Very low dose ICS (LTRA in < 5s) + LABA (LTRA in < 5s) Use of SABA > 2 times a week Very low dose ICS (LTRA in < 5s) + LTRA + LABA or Low dose ICS (LTRA in < 5s) + LABA or Low dose ICS
What is the treatment pathways for asthma in adults ?
SABA + Low dose ICS Use of SABA > 2 times a week SABA + Low does ICS + LABA Use of SABA > 2 times a week SABA + Medium dose ICS + LABA or SABA + Low dose ICS + LABA + LTRA
Types of bronchiectasis
Veracious
Cylindrical
Cystic
Describe CURB 65
Confusion Urea > 7 mmHg RR > 30 SBP > 90 DBP > 60 Age > 65
Score of 1 = Manage at home
Score of 2 = Maybe bring into hospital
Score of 3-5 = bring into hospital and treat as severe
What is CURB 65 used for ?
Determining the severity of pneumonia
Treatment for Pneumonia
CURB 0-1. Amoxicillin (or clarithromycin or doxycycline if penicillin allergy) for 5 days
CURB 2. Amoxicillin + clarithromycin (Levofloxacin if penicillin allergy) for 5-7 days
CURB 3 -5. Co-Amoxiclav + clarithromycin (Levofloxacin or co-trimoxazole if penicillin allergy) for 7-10 days
What are three bacteria which cause TB ?
M.Tuberculosis
M.Africanum
M.Bovis
Describe the treatment for TB
Isoniazid (H) = 6 months= Causes peripheral neuropathy, Hepatitis and rash
Pyrazinamide (Z) = 2 months = Gout, Hepatitis and rash
Ramipril (R)= 2 months = Causes orange urine etc, rash, Hepatitis, makes oral contraception inactive
Ethambutol (E)= 6 months = Optic neuropathy, rash
Where in the body should a chest drain be inserted ?
2ns intercostal space
Midclavicular line
What is the name of the protein mutated in CF ?
CFTR
What is the most common CF causing mutation ?
Delta F508
Results from sweat tests
> 60 Likely to have CF
< 30 Not likely to have CF
30-60 may have CF
What is the sweat test used for ?
Identifying people with CF
Name of enzyme’s given to CF patients
CREON
Treatment for CF
Replacement enzymes Chest physiotherpy Bronchodilators Mucolytics Antibiotics Azithromycin High calorie, high fat diet Lung transplant
What would mean someone with CF was suitable for a lung transplant?
Estimated survival < 2 years
FEV1<30%
life threatening condition
TNM staging system
Tx = Tumour size was not able to be determined T0 = Tumour doesn't exist T1 = < 3cm T2 = 3-5 cm or Bronchial or pleural involvement T3 = 5-7 cm or Pericardial or chest wall involvement T4 = > 7cm or involvement of other thoracic structures or metastasis
N0 = No nodal involvement N1 = 1 node N2 = 2 nodes N3 = 3 nodes
M0 = No metastasis M1a = Metastasis to other parts of the lung M1b = 1 extrathoracic metastasis M1c = 2 extrathorastic metastasis
What is used to determine T N and M ?
T = CT, PET/CT or bronchoscopy N = CT, PET/CT, mediastinoscopy, EBUS M = CT, PET/CT, bone scan
FEV1 required for different surgeries
FEV1 > 1 for a lobectomy
FEV1 > 2 for a pneumonectomy
Typical radiotherapy and SABR cycles
Radiotherapy 55Gy in 20 fractions
SABR 54Gy in 3 fractions
