respiratory_week_6_20190518190205 Flashcards
what is a proximal (ileo-femoral) DVT
most likely to embolise, most likely to lead to chronic venous insufficiency and venous leg ulcers
what is a distal (polpiteal) DVT
least likely to embolise
what is clinical presentation of DVT
swollen, hot, red, tendor
how does a large PE present
cardiovascular shock, infarction, low BP, central cyanosis, sudden death
how does a medium PE present
pleuritic pain, haemoptysis and breathless
how does small, recurrent PE present
progressive dyspnoea, pulmonary hypertension and right heart failure (often clinically silent)
what is risk factors for both PE and DVT
endothelial hypoxia, venous stasis, hypercoaguable blood (cancer, post MI), thromophilia, the pill, pregnancy, pelvic obstruction, trauma, surgery, immobility, malignancy, pulmonary hypertension, obesity
what is clinical features of PE
tachycardia, tachypnoea, cyanosis, fever, low BP, crackles, rub, pleural effusiondecreased PaO2, decreased SaO2
what does PE look like on CXR
normal early on, maybe basal atelectasis, consolidation or some pleural effusion
what investigations are used in the diagnosis of PE
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
what is the treatment for PE
thrombolysis (tenecteplase) for large PEIVC filter to prevent embolism from large ileofemoral/IVC clot (recurrent PEs)
what is the treatment for both PE and DVT
anticoagulation - heparin (stop when INR>2) sometimes with warfarin (3-6 months) or DOAC (dabigatran) or factor X inhibitor (rivaroxaban)
what is pulmonary hypertension
mPAP (mean pulmonary arterial pressure) > 25mmHg
how can systolic pulmonary arterial pressure be estimated
ECHO doppler
what are the causes of pulmonary venous hypertension (LeftHeartDisease)
LVSD (ischaemic), mitral regurgitation/stenosis, cardiomyopathy (alcohol, viral)
what are the causes of pulmonary arterial hypertension (PAH)
can be primary (young women) or secondary COPD, OSA, fibrosis (hypoxic), PE, emphysema, vasculitis, drugs (appetite suppressants), HIV, cardiac left to right shunt
what are the clinical signs of pulmonary hypertension
central cyanosis, dependent oedema, raised JVP with V waves, right ventricular hypertrophy, murmur of tricuspid regurgitation, enlarged liver (pulsatile)
how to distinguish between primary and secondary PAH
exclusion of other secondary causes diagnosis
what is the treatment of primary pulmonary hypertension
warfarin and O2 if hypoxicpulmonary vasodilators (Ca2 channel blockers, endothelin antagonist, PDE5 inhibitor)
what is the treatment of chronic thromboembolic pulmonary hypertension (CTEPH)
riociguant - pulmonary arterial vasodilator pulmonary endarterectomy (curative)
what is pulmonary oedema
accumulation of fluid in the lung (interstitium and alveolar spaces) - restrictive pattern of disease
what is the causes of pulmonary oedema
haemodynamic (heart failure) - increased hydrostatic pressurecellular injury (alveoli)localised PO - pneumonia generalised PO - ARDS
what is ARDS (adult respiratory distress syndrome)
also shock lung or diffuse alveolar damage syndrome
what is causes and the outcome of ARDS
cause - sepsis, diffuse infection (virus, mycoplasma) severe trauma or oxygen outcome - death, resolution or fibrosis (chronic restrictive lung disease)
what is the pathogenesis of ARDS
injury (eg bacterial endotoxin), infiltration of inflammatory cells, cytokines, oxygen free radicals, injury to cell membranes
what is the pathology of ARDS
fibrinous exudate lining alveolar walls (hyaline membranes), cellular regeneration and inflammation
what is a pulmonary infarct
ischaemic necrosis, embolus necessary but not sufficient, bronchial artery supply compromised (cardiac failure)
what is a primary neoplasia
benign (rare) or malignant mesothelioma
what is a secondary neoplasia
common adenocarcinomas - lung, GIT, ovary)
what is the characteristics of mesothelioma
asbestos related, mixed epithelial / mesenchymal differentiation, dismal prognosis
