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Medicine Y3 TCD 13-24 > ZTF Respiratory not covered > Flashcards

ZTF Respiratory not covered Flashcards

1
Q

What is FEV1 and what is it a measure of

A
  • Forced expiratory volume in 1 second.
  • This is the amount of air a person can exhale as fast as they can in 1 second.
  • This is a measure of the ability of air to freely flow out of the lungs.
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2
Q

in what kind of respiratory conditions is the FEV1 reduced

A

obstruction to the air flow

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3
Q

what is FVC and what is it a measure of

A
  • Forced vital capacity
  • total amount of air a person can exhale after a full inhalation
  • measure of the total volume of air that the person can take in to their lungs.
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4
Q

In what kind of respiratory conditions is the FVC reduced

A

if there is any restriction on the capacity of the lungs

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5
Q

Obstructive lung disease can be diagnosed when then FEV1:FVC ratio is less than

A

75%

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6
Q

name the common obstructive respiratory diseases

A

asthma

COPD

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7
Q

restrictive lung disease can be diagnosed when the FEV1:FVC ratio is

A

above 75% as both FEV1 and FVC are reduced equally

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8
Q

give some causes of restrictive lung disease

A

Interstitial lung disease
Neurological (i.e. motor neurone disease)
Scoliosis or chest deformity
Obesity

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9
Q

give examples of non-invasive ventilation (NIV)

A

BiPAP or CPAP

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10
Q

what does BiPAP involve

A

cycle of high and low pressure to correspond to the patients inspiration and expiration

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11
Q

when is BiPAP used and what is the criteria

A

when there is type 2 respiratory failure typically due to COPD

respiratory acidosis despite adequate medical treatment

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12
Q

what are the indications for CPAP

A

Obstructive sleep apnoea
Congestive cardiac failure
Acute pulmonary oedema

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13
Q

What is interstitial lung disease

A

an umbrella term to describe conditions that affect the lung tissue (lung parenchyma)

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14
Q

how is ILD diagnosed

A

high resolution CT

shows ground glass appearance

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15
Q

what is the general management of ILD

A

Remove or treat the underlying cause
Home oxygen where they are hypoxic at rest
Stop smoking
Physiotherapy and pulmonary rehabilitation
Pneumococcal and flu vaccine
Advanced care planning and palliative care where appropriate
Lung transplant is an option but the risks and benefits need careful consideration

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16
Q

what are the examination findings in idiopathic pulmonary fibrosis

A

bibasal fine inspiratory crackles and finger clubbing

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17
Q

what 2 medications are licensed for idiopathic pulmonary fibrosis to slow the progression of the disease

A

Pirfenidone is an antifibrotic and anti-inflammatory

Nintedanib is a monoclonal antibody targeting tyrosine kinase

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18
Q

name some medications that can cause pulmonary fibrosis

A

Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin

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19
Q

name some conditions of which pulmonary fibrosis can occur secondary to

A

Alpha-1 antitripsin deficiency
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Systemic sclerosis

20
Q

what is hypersensitivity pneumonitis also known as

A

Extrinsic Allergic Alveolitis

21
Q

what does bronchoalveolar lavage show in Extrinsic Allergic Alveolitis

A

raised lymphocytes and mast cells

22
Q

management of pneumothorax

if there is no SOB and less than 2cm rim of air on CXR then what is the management

A

no treatment

follow up in 204 weeks

23
Q

management of pneumothorax

if SOB or there is a greater than 2cm rim of air on CXR then what is the management

A

aspiration and reassessment

24
Q

management of pneumothorax

if aspiration fails twice then what is required

A

chest drain

25
Q

management of pneumothorax

what do unstable patients or bilateral or secondary pneumothorax require

A

chest drain

26
Q

what is the management of a tension pneumothorax

A

insert a large bore cannula into the second intercostal space in the midclavicular line

27
Q

chest drains are inserted into the ‘triangle of safety’

name the boarders

A

The 5th intercostal space (or the inferior nipple line)
The mid axillary line (or the lateral edge of the latissimus dorsi)
The anterior axillary line (or the lateral edge of the pectoris major)

28
Q

why is the needle inserted just above the rib

A

to avoid the neuromuscular bundle

29
Q

what are the main causes of pulmonary hypertension

A

Group 1 – Primary pulmonary hypertension or connective tissue disease such as systemic lupus erythematous (SLE)
Group 2 – Left heart failure usually due to myocardial infarction or systemic hypertension
Group 3 – Chronic lung disease such as COPD
Group 4 – Pulmonary vascular disease such as pulmonary embolism
Group 5 – Miscellaneous causes such as sarcoidosis, glycogen storage disease and haematological disorders

30
Q

what is pulmonary hypertension

A

increased resistance and pressure of blood in the pulmonary arteries.

Increasing the pressure and resistance in the pulmonary arteries causes strain on the right side of the heart trying to pump blood through the lungs.

This also causes a back pressure of blood into the systemic venous system.

31
Q

what ECG changes are seen in pulmonary hypertension

A

right ventricular hypertrophy
right axis deviation
right bundle branch block

32
Q

what CXR changes are seen in pulmonary hypertension

A

dilated pulmonary arteries

right ventricular hypertrophy

33
Q

what is the treatment off primary pulmonary hypertension

A 
IV prostanoids (e.g. epoprostenol)
Endothelin receptor antagonists (e.g. macitentan)
Phosphodiesterase-5 inhibitors (e.g. sildenafil)
34
Q

What is sarcoidosis

A

granulomatous inflammatory condition. Granulomas are nodules of inflammation full of macrophages.

35
Q

in sarcoidosis what are the two spikes in incidence and who does it affect more

A

young adulthood and around 60

black and women are most affected

36
Q

sarcoidosis mainly affects the lungs but name some extra pulmonary symptoms

A

systemic: fever, fatigue, weight loss
Liver: cirrhosis, cholestasis
eyes: uveitis, conjunctivitis, optic neuritis
skin: erythema nodosum (tender red nodules on shins), Lupus pernio (raised, purple lesions commonly on cheeks and nose)

37
Q

Lofgrens syndrome is a specific presentation of sarcoidosis and is characterised by the triad of

A

Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia (joint pain in multiple joints)

38
Q

name differentials to sarcoidosis

A 
Tuberculosis
Lymphoma
Hypersensitivity pneumonitis
HIV
Toxoplasmosis
Histoplasmosis
39
Q

what would be raised in blood tests for sarcoidosis

A

Raised serum ACE. This is often used as a screening test.
Hypercalcaemia (rasied calcium) is a key finding.
Raised serum soluble interleukin-2 receptor
Raised CRP
Raised immunoglobulins

40
Q

what is the gold standard for confirming the diagnosis of sarcoidosis and what does this show

A

histology from a biopsy

non-caveating granulomas with epitheoid cells

41
Q

what is the treatment of sarcoidosis

A

No treatment is considered as first line in patients with no or mild symptoms as the condition often resolves spontaneously.
Oral steroids are usually first line where treatment is required and are given for between 6 and 24 months. Patients should be given bisphosphonates to protect against osteoporosis whilst on such long term steroids.
Second line options are methotrexate or azathioprine
Lung transplant is rarely required in severe pulmonary disease

42
Q

what is the prognosis of sarcoidosis

A

Sarcoidosis spontaneously resolves within 6 months in around 60% of patients.

In a small number of patients it progresses with pulmonary fibrosis and pulmonary hypertension, potentially requiring a lung transplant.

Death in sarcoidosis is usually when it affects the heart (causing arrhythmias) or the central nervous system.

43
Q

what is obstructive sleep apnoea

A

collapse of the pharyngeal airway during sleep
Apnoea episodes are where the person will stop breathing for up to few minutes
reported by the patients partner as the patient is unaware of these. episodes

44
Q

what are the risk factors for obstructive sleep apnoea

A 
Middle age
Male
Obesity
Alcohol
Smoking
45
Q

name the features of obstructive sleep apnoea

A 
Apnoea episodes during sleep (reported by partner)
Snoring
Morning headache
Waking up unrefreshed from sleep
Daytime sleepiness
Concentration problems
Reduced oxygen saturation during sleep
46
Q

what scale is used to assess symptoms associatedwith obstructive sleep apnoea

A

Epworth sleepiness scale

47
Q

what is the treatment for obstructive sleep apnoea

A

CPAP

Medicine Y3 TCD 13-24 (32 decks)

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