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respiratory_week_6_20190518190205 Flashcards

1
Q

what is a proximal (ileo-femoral) DVT

A

most likely to embolise, most likely to lead to chronic venous insufficiency and venous leg ulcers

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2
Q

what is a distal (polpiteal) DVT

A

least likely to embolise

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3
Q

what is clinical presentation of DVT

A

swollen, hot, red, tendor

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4
Q

how does a large PE present

A

cardiovascular shock, infarction, low BP, central cyanosis, sudden death

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5
Q

how does a medium PE present

A

pleuritic pain, haemoptysis and breathless

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6
Q

how does small, recurrent PE present

A

progressive dyspnoea, pulmonary hypertension and right heart failure (often clinically silent)

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7
Q

what is risk factors for both PE and DVT

A

endothelial hypoxia, venous stasis, hypercoaguable blood (cancer, post MI), thromophilia, the pill, pregnancy, pelvic obstruction, trauma, surgery, immobility, malignancy, pulmonary hypertension, obesity

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8
Q

what is clinical features of PE

A

tachycardia, tachypnoea, cyanosis, fever, low BP, crackles, rub, pleural effusiondecreased PaO2, decreased SaO2

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9
Q

what does PE look like on CXR

A

normal early on, maybe basal atelectasis, consolidation or some pleural effusion

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10
Q

what investigations are used in the diagnosis of PE

A

ECG (pulmonary artery pressure and right ventricular size - dilation is acute PE), D dimers raised, isotope lung scan (v/q), CT pulmonary angiogram, leg and pelvic ultrasound

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11
Q

what is the treatment for PE

A

thrombolysis (tenecteplase) for large PEIVC filter to prevent embolism from large ileofemoral/IVC clot (recurrent PEs)

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12
Q

what is the treatment for both PE and DVT

A

anticoagulation - heparin (stop when INR>2) sometimes with warfarin (3-6 months) or DOAC (dabigatran) or factor X inhibitor (rivaroxaban)

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13
Q

what is pulmonary hypertension

A

mPAP (mean pulmonary arterial pressure) > 25mmHg

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14
Q

how can systolic pulmonary arterial pressure be estimated

A

ECHO doppler

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15
Q

what are the causes of pulmonary venous hypertension (LeftHeartDisease)

A

LVSD (ischaemic), mitral regurgitation/stenosis, cardiomyopathy (alcohol, viral)

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16
Q

what are the causes of pulmonary arterial hypertension (PAH)

A

can be primary (young women) or secondary COPD, OSA, fibrosis (hypoxic), PE, emphysema, vasculitis, drugs (appetite suppressants), HIV, cardiac left to right shunt

17
Q

what are the clinical signs of pulmonary hypertension

A

central cyanosis, dependent oedema, raised JVP with V waves, right ventricular hypertrophy, murmur of tricuspid regurgitation, enlarged liver (pulsatile)

18
Q

how to distinguish between primary and secondary PAH

A

exclusion of other secondary causes diagnosis

19
Q

what is the treatment of primary pulmonary hypertension

A

warfarin and O2 if hypoxicpulmonary vasodilators (Ca2 channel blockers, endothelin antagonist, PDE5 inhibitor)

20
Q

what is the treatment of chronic thromboembolic pulmonary hypertension (CTEPH)

A

riociguant - pulmonary arterial vasodilator pulmonary endarterectomy (curative)

21
Q

what is pulmonary oedema

A

accumulation of fluid in the lung (interstitium and alveolar spaces) - restrictive pattern of disease

22
Q

what is the causes of pulmonary oedema

A

haemodynamic (heart failure) - increased hydrostatic pressurecellular injury (alveoli)localised PO - pneumonia generalised PO - ARDS

23
Q

what is ARDS (adult respiratory distress syndrome)

A

also shock lung or diffuse alveolar damage syndrome

24
Q

what is causes and the outcome of ARDS

A

cause - sepsis, diffuse infection (virus, mycoplasma) severe trauma or oxygen outcome - death, resolution or fibrosis (chronic restrictive lung disease)

25
Q

what is the pathogenesis of ARDS

A

injury (eg bacterial endotoxin), infiltration of inflammatory cells, cytokines, oxygen free radicals, injury to cell membranes

26
Q

what is the pathology of ARDS

A

fibrinous exudate lining alveolar walls (hyaline membranes), cellular regeneration and inflammation

27
Q

what is a pulmonary infarct

A

ischaemic necrosis, embolus necessary but not sufficient, bronchial artery supply compromised (cardiac failure)

28
Q

what is a primary neoplasia

A

benign (rare) or malignant mesothelioma

29
Q

what is a secondary neoplasia

A

common adenocarcinomas - lung, GIT, ovary)

30
Q

what is the characteristics of mesothelioma

A

asbestos related, mixed epithelial / mesenchymal differentiation, dismal prognosis

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