ZTF Respiratory not covered Flashcards
What is FEV1 and what is it a measure of
- 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.
in what kind of respiratory conditions is the FEV1 reduced
obstruction to the air flow
what is FVC and what is it a measure of
- 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.
In what kind of respiratory conditions is the FVC reduced
if there is any restriction on the capacity of the lungs
Obstructive lung disease can be diagnosed when then FEV1:FVC ratio is less than
75%
name the common obstructive respiratory diseases
asthma
COPD
restrictive lung disease can be diagnosed when the FEV1:FVC ratio is
above 75% as both FEV1 and FVC are reduced equally
give some causes of restrictive lung disease
Interstitial lung disease
Neurological (i.e. motor neurone disease)
Scoliosis or chest deformity
Obesity
give examples of non-invasive ventilation (NIV)
BiPAP or CPAP
what does BiPAP involve
cycle of high and low pressure to correspond to the patients inspiration and expiration
when is BiPAP used and what is the criteria
when there is type 2 respiratory failure typically due to COPD
respiratory acidosis despite adequate medical treatment
what are the indications for CPAP
Obstructive sleep apnoea
Congestive cardiac failure
Acute pulmonary oedema
What is interstitial lung disease
an umbrella term to describe conditions that affect the lung tissue (lung parenchyma)
how is ILD diagnosed
high resolution CT
shows ground glass appearance
what is the general management of ILD
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
what are the examination findings in idiopathic pulmonary fibrosis
bibasal fine inspiratory crackles and finger clubbing
what 2 medications are licensed for idiopathic pulmonary fibrosis to slow the progression of the disease
Pirfenidone is an antifibrotic and anti-inflammatory
Nintedanib is a monoclonal antibody targeting tyrosine kinase
name some medications that can cause pulmonary fibrosis
Amiodarone
Cyclophosphamide
Methotrexate
Nitrofurantoin
name some conditions of which pulmonary fibrosis can occur secondary to
Alpha-1 antitripsin deficiency
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Systemic sclerosis
what is hypersensitivity pneumonitis also known as
Extrinsic Allergic Alveolitis
what does bronchoalveolar lavage show in Extrinsic Allergic Alveolitis
raised lymphocytes and mast cells
management of pneumothorax
if there is no SOB and less than 2cm rim of air on CXR then what is the management
no treatment
follow up in 204 weeks
management of pneumothorax
if SOB or there is a greater than 2cm rim of air on CXR then what is the management
aspiration and reassessment
management of pneumothorax
if aspiration fails twice then what is required
chest drain
management of pneumothorax
what do unstable patients or bilateral or secondary pneumothorax require
chest drain
what is the management of a tension pneumothorax
insert a large bore cannula into the second intercostal space in the midclavicular line
chest drains are inserted into the ‘triangle of safety’
name the boarders
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)
why is the needle inserted just above the rib
to avoid the neuromuscular bundle
what are the main causes of pulmonary hypertension
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
what is pulmonary hypertension
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.
what ECG changes are seen in pulmonary hypertension
right ventricular hypertrophy
right axis deviation
right bundle branch block
what CXR changes are seen in pulmonary hypertension
dilated pulmonary arteries
right ventricular hypertrophy
what is the treatment off primary pulmonary hypertension
IV prostanoids (e.g. epoprostenol) Endothelin receptor antagonists (e.g. macitentan) Phosphodiesterase-5 inhibitors (e.g. sildenafil)
What is sarcoidosis
granulomatous inflammatory condition. Granulomas are nodules of inflammation full of macrophages.
in sarcoidosis what are the two spikes in incidence and who does it affect more
young adulthood and around 60
black and women are most affected
sarcoidosis mainly affects the lungs but name some extra pulmonary symptoms
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)
Lofgrens syndrome is a specific presentation of sarcoidosis and is characterised by the triad of
Erythema nodosum
Bilateral hilar lymphadenopathy
Polyarthralgia (joint pain in multiple joints)
name differentials to sarcoidosis
Tuberculosis Lymphoma Hypersensitivity pneumonitis HIV Toxoplasmosis Histoplasmosis
what would be raised in blood tests for sarcoidosis
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
what is the gold standard for confirming the diagnosis of sarcoidosis and what does this show
histology from a biopsy
non-caveating granulomas with epitheoid cells
what is the treatment of sarcoidosis
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
what is the prognosis of sarcoidosis
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.
what is obstructive sleep apnoea
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
what are the risk factors for obstructive sleep apnoea
Middle age Male Obesity Alcohol Smoking
name the features of obstructive sleep apnoea
Apnoea episodes during sleep (reported by partner) Snoring Morning headache Waking up unrefreshed from sleep Daytime sleepiness Concentration problems Reduced oxygen saturation during sleep
what scale is used to assess symptoms associatedwith obstructive sleep apnoea
Epworth sleepiness scale
what is the treatment for obstructive sleep apnoea
CPAP
