Y3 CARDIORESPIRATORY Flashcards
Causes of a left parasternal heave?
Right ventricular hypertrophy
(Very rarely caused by severe left atrial enlargement which can push the right ventricle towards)
What is pulmonary artery hypertension?
An elevated pulmonary arterial pressure >=25mmHg at rest, measured by right heart catheterisation
How does pulmonary arterial hypertension present?
SOB on exertion
Chest pain
Fatigue
Syncope
What is pickwickian syndrome?
This is obesity hypoventilation syndrome
Blood gas findings in a PE
Hypoxaemia
Hypocapnia
Respiratory alkalosis
Whats the MOA of ipratropium and tiotropium? Whats the main difference between them?
It blocks muscarinic acetylcholine receptors
Tiotropium is longer acting
Examples of SABAs?
Salbutamol
Terbutaline
Examples of LABAs?
Salmeterol
Formoterol
Examples of SAMAs?
Ipraotropium
Examples of LAMAs?
Tiotropium
What is bronchoscopy?
This involves passing a long, thin, flexible telescope with a bright light on the end into the lungs through the nose
Photos and samples can be taken
What is monitored during bronchoscopy?
Pulse oximetry and ECG
Is a bronchoscopy performed under any anaesthesia?
Yes under GA
Investigations for lung cancer?
Bloods
CXR first
CT chest
Bronchoscopy to allow biopsy
PET scanning in non-small cell lung ca
How does mesothelioma present?
Dyspnoea first symptom from pleural effusions
Weight loss, chest wall pain, clubbing
Which lung is more commonly affected by mesothelioma?
The right
Where does mesothelioma metastasise to?
Contralateral lung
Peritoneum
Whats the latent period for mesothelioma after asbestos exposure?
30-40 years
Which lung cancers are typically central?
SCC and small cell lung cancer
Lung cancer risk factors?
Smoking
Radon
Occupation exposure and pollution - arsenic, asbestos, beryllium, nickel, silica, coal fumes, cadmium
What is the moa of bupropion?
A norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
Reduces the reinforcing efefcts of nicotine and helps alleviate nicotine withdrawal symptoms
Whats the moa of varenicline?
Nicotinic receptor partial agonist
Which valvular heart disease causes the most severe pulmonary hypertension?
Mitral stenosis
Of all the rate controlling AF drugs, which acts the fastest?
Metoprolol
What cases S3?
Diastolic filling of the ventricle
Normal if <30
Causes: LV failure, constrictive pericarditis and mitral regurgitation
What causes S4?
Caused by atrial contraction against a stiff ventricle
Causes: AS, HOCM, hypertension
What are some causes of hypertension and hypokalaemia?
Primary hyperaldosteronism e.g. conns
Liddles syndrome
Cushing syndrome
Renal aretry stenosis
Congenital adrenal hyperplasia
Renin-producing tumours
How can excess licorice affect bp?
Too much glycyrrhizinic acid can inhibit 11 beta-hydroxylase
What is interstitial pneumonitis? What can cause it?
Aka idiopathic interstitial pneumonia/fibrosis
Non-infective inflammation of the interstitium in the lungs that can be caused by RA/SLE/scleroderma, amiodarone therapy, chemotherapy drugs, environmental exposures, radiation, hypersensitivity reaction to mold etc
Risk factors for asthma?
PHx or FHx of atopic disease
Male sex pre-pubertal and female sex in adulthood
Respiratory infections in infancy
Exposure to tobacco smoke
Premature birth and LBW
Obesity
Social deprivation
Exposure to inhaled particulates
What are some workplace exposure risks for asthma?
Isocyanates from spray paints or foam moulding - most common
Flour dust at bakeries
Platinum salts
Soldering flux resin
Glutaraledehyde
Epoxy resins
Proteolytic enzymes
Whats the max dose of amlodipine?
10mg OD
What is the pathophysiology of asthma?
Inflamed airways react to environmental triggers -> airways narrow -> excessive mucus production = bronchial mucus plugging
Protein level in transudate and exudate causes?
Transudate <30g/L
Exudate >30g/L
What are causes of transudate pleural effusions?
This usually indicates a problem with pressure/balance of fluid within the body’s capillaries. Usually B/L
HF - most common
Hypoalbuminaemia e.g. liver disease, nephrotic syndrome, malabsorption
Hypothyroidism
Meig’s syndrome
What are causes of exudate pleural effusions?
This usually indicates inflammation, infection or damage to the pleural membranes. Usually U/L
Infections - pneumonia (MC), TB
Connective tissue diseases e.g. RA, SLE
Neoplasia
Pancreatitis
PE
Dressler’s syndrome
Yellow nail syndrome
What is the pleural friction rub?
A raspy breathe sound that is like a squeak or grating sound
From the movement of inflamaed pleural surfaces against each other during the movement of the chest wall
What can cause a pleural friction rub?
PE
Pneumonia
Rarely - pleural malignancy or spontaneous pneumothorax
Which genetic paediatric syndrome can cause aortic stenosis?
Williams syndrome - can cause supravalvular aortic stenosis
