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63 Cards in this Set
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- Back
- 3rd side (hint)
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What is Kussmaul breathing?
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fast and deep:
metabolic acidosis, ex, anx |
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What is apneustic breathing?
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prolonged isp. phase
pontine lesions |
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Which drugs stimulate the respiratory centre?
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aspirin, progesterone, theophilline, catecholamines, psychotrophics
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What is the aA gradient?
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150-1.25(PaCO2)- PaO2
150 may be replaced by Fi)2 x 760 |
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What causes an increased Aa gradient with decreased DlCO?
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lung disease
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What are some causes of hypoxia that don't improve with 100% O2
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shunt
atelectasis intraalveolar filling intracardiac shunt vascular shunt in lungs |
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What causes occupational asthma?
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organic allergens
isocyanates animals |
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Natural progression of asthma?
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most children with asthma improve significantly in adolescence
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What are some factors indicating poor asthma control
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Prior non-fatal episodes: LOC during asthma attack, frequent ER visits, prior intubation, ICU admission
Ominous signs and sx: night time sx > 1 night a week, silent chest, FEV1<60%, limited ADL, use of SABA >3x/d |
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Diagnosis of asthma on PFT's?
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In asthmatics will have increase in FEV1 >12% with beta 2 agonist, or >20% with 10-14d of steroids or >20% spt variability
provocation testing: decrease in FEV1 >20% with provocation testing- done when bronchodilator responce not significant |
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Why is nasal examination done in asthmatics?
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asal examination should be included to check for the pale, swollen mucosa of associated allergic rhinitis, or nasal polyps that raise the possibility of aspirin-sensitivity
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Rapid sequence induction if asthma?
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ketamine + succinylcholine in life threatening cases
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Define chronic bronchitis?
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clinical definition: productive cough on most days for at least 3 consecutive months for 2 consecutive years
obstruction is due to narrowing of the airway lumen by mucosal thickening and excess mucus |
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What is the definition of emphysema?
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Pathological definition: dilataion and destruction of airspaces distal to the proximal bronchiole without obvious fibrosis.
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What are the 2 types of emphysema?
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centriacinar- resp. bronchioles- typical form seen in upper zones of smokers
panacinar- resp. bronchioles, alv ducts, alv cells: <1% of emphysema, primarily affects lower lobes |
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What is the prevalence of PE in patients presenting to hospital for COPD exacerbation of unknown origin?
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25%
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What is the best predictor of prognosis in COPD?
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FEV1:
<1L 50% 5 year survival <0.75 L: 33% 5 year survival |
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What is the BODE indec for risk of death in COPD?
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Predicts death/hospitalisation: 10 point index with 4 factors:
BMI <21 FEV1 (out of 3) dyspnoea (MMRC scale): walks slower than ppl same age on level surface, too breathless to leave house, when dressing/undressing Exercise capacity: 6 min walk test (250-350, 150-250, <149 |
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What is the function of the influenza vaccine in COPD?
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effective in reducing the number of influenza related illnesses
not in other acute respiratory illnesses |
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Define bronchiectasis
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an irreversible dilatation of airways due to inflammatory destruction of airway walls resulting from persistently infected mucus
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Gold standard for diagnosing bronichiectasis?
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HRCT
87-97% sensitivity, 93-100% specificity |
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Most common cause of lung abscesses?
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aspiration: thus oesophageal disorders, seizures and bulbar dysfunction increase risk
Anaerobic bacteria most common-but aerobic Most common: bacteria found in oral cavity: Peptostreptococcus, Prevotella, Bacteroides (usually not B. fragilis), and Fusobacterium spp |
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Appearance on imaging of different kinds of pulmonary abscesses
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Aspiration- more common to the RHS
Pneumonia/bronchiectaosis: multiple, basal, diffusely scattered septic: multiple and may affect any region of lungs |
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Define a pulmonary abscess
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Necrosis of the pulmonary parenchyma caused by a necrotising infection
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Most common cause of pulmonary abscesses in the immunocompromised host?
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Pseudomonas Aeruginosa and other aerobic gram-negative bacilli, Nocardia, and fungi
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Symptoms of pulmonary abscess?
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ndolent symptoms that evolve over a period of weeks or months. The characteristic features of anaerobic lung abscesses suggest pulmonary infection, including fever, cough, and sputum production. Evidence of chronic systemic disease is usually present, with night sweats, weight loss, and anemia.
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How is a lung abscess diagnosed on CXR?
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pulmonary infiltrate with a cavity, indicating tissue necrosis; an air-fluid level is frequently present
Better anatomical definition on CT: distinguish between a peripheral lung abscess and empyema/also do if there is not a timely clinical response to rx |
Do bronchoscopy if you think that they patient may have aspirated a foreign body- or may have an obstructing tumout
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How do you get a microbiological diagnosis for a lung abscess?
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difficult as anaerobic bacteria hard to culture and unlikely to be found in blood
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Management of lung abscess?
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IV antibiotics until afebrile and no longer systemically unwell
continue oral antibiotics when cavity no longer filled with fluid and no more purulent sputum rarely surgical intervention is required Choice of antibiotic depends on organism isolation Benpen + metro first line for management (anaerobes) Metro + 3rd gen ceph is aerobic gram -ve (klebsiella, alcoholics) |
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What is the prognosis of lung abscess?
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depends on underlying condition: classic anaerobic abscesses have 90-95% cure with therapy, immunocompromised may have up to 75% mortality
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What % of pulmonary emboli cause infarction?
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10%
Usually with existing deficits in circulation Infarct is usually haemorrhagic |
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Where do most PE's end up?
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Most pulmonary emboli are multiple, with the lower lobes being involved in the majority of cases
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Define massive PE
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auses hypotension, defined as a systolic blood pressure <90 mmHg or a drop in systolic blood pressure of ≥40 mmHg from baseline for >15 minutes. All acute PE not meeting the definition of massive PE are considered submassive PE
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Mortality of acute PE
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30 percent without treatment, primarily due to recurrent embolism. However, accurate diagnosis followed by effective anticoagulant therapy decreases the mortality rate to 2 to 8 percent
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Are people with ILD usually hypercapnic?
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no, hypoxaemia without hypercapnea due to V/Q mismatch
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Epidemiology of idiopathic pulmonary fibrosis?
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Commonly presents >age 50
Incidence rises with age M > F |
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Management and prognosisn of sarcoidosis
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85% of stage I resolve spontaneously
50% of stage II resolve spontaneously steroids for symptoms, declining lung function, hypercalcemia or involvement of eye, CNS, kidney, or heart (not for abnormal CXR alone) • methotrexate or other irnmunosuppressives occasionally used 10% mortality secondary to progressive fibrosis of lung parenchyma |
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Is hypersensitivity pneumonitis IgE mediated?
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NO
Acute = type III (immune complex reaction) Chronic = type IV- cell mediated, delayed hypersensitivity reaction |
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What % of people with PE have clinical sx of a DVT?
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<30%
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Contraindication to surgery in lung cancer?
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spread to contralateral LN or distant sites- patients with surgically resectable disease must undergo mediastinal node sampling as CT thorax not accurate in 20-40% of cases
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Perioperative mortality of lung cabcer surgery?
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6% if penumonectomy
3% lobectomy 1% segmentectomy |
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Where are large cell lung cancers usually found?
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peripherally, often anaplastic
15% of lung cancers |
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% of small cell lung cancers that have spread to extrathoracic sites at diagnosis
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70%
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Chemo for lung cancer
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cisplatin and etoposude
paxitaxel, vindorelbine, gemcytabine: newer NSCLC therapies New biologics: e.g. EGFR inhibitor (Gefitinib) |
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What is a bronchioalveolar carcinoma?
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grows on alveolar wall in periphery, may arise at sites of lung scarring
overall surv 25% |
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Define a solitary pulmonary nodule?
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approximately round
<3cm in diameter (if larger = mass, majority malig) |
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Management of SPN in >60 Y/O smokers?
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Serial CT <1cm, FNAB > 1cm
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What do you do with a SPN if CT suggests malignancy?
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If lesion peripheral →FNAB - identifies peripheral lesion as benign/ malignant in 95%
complications -bleeding/pneumothorax If lesion proximal →Bronchoscopy few complications Thoracoscopic biopsy If very high risk of malignancy → consider proceeding directly to lobectomy |
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False negatives and positives on PET?
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bronchoalveolar cell Ca, carcinoids, tumours< 1 cm
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When are inhaled corticosteroids added to the management of COPD?
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50% and who experience recurrent exacerbations. When inhaled corticosteroids are combined with a long-acting β2-agonist in such patients, the rate of decline in quality of life and health status is significantly reduced and the frequency of acute exacerbations is reduced by 25%;
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Incidence of OSA?
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affects 9% of men, 4% od women
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Define sleep apnea
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Apnea/hypopnea index >15 (number of apnoeic and hypopneic events per hour of sleep)
where apnea = no breathing for > 10s and hypopnea is >50% reduction in minute ventillateion for >10s |
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causes of Cheyne stokes breathing
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LV failure, brain stem lesions, encephalitis, encephalopathy, myxoedema, high altitude
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What is the doubling time for lung cancer?
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1 month to 1 year- most double in 50-100 days
a solid nodult that is stable on CXR/CT for 2 years is considered benign |
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Pleural effusions caused by malignancy
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lung cancer 35%
lymphoma 10% mets: breast 25%, ovarian, renal mesothelioma |
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What size of pleural effusion can you see on CXR?
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>200ml PA
>50ml leads to blunting of constophrenic angle on lateral |
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What are the indications for thoracocentesis
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Most people get thoracocentesis: only two scenarios where this is not done: when there is a small amount of pleural fluid and a secure clinical diagnosis (eg, viral pleurisy), or when there is clinically obvious heart failure (HF) without atypical features
risk of re-expansion pulmonary oedema if >1.5L of fluid taken |
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Factors that make thoracocentesis more dangerous?
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receiving anticoagulant therapy, have a bleeding diathesis, are receiving mechanical ventilation, have a small effusion, or have a skin infection
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Management of empyema
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antibiotic therapy 4-6 weeks
complete pleural drainage with chest tube if loculated- may require surgical drainage: CT scan should be obtained within 24 hours after chest tube placement. Failure of pleural drainage due to residual loculations of fluid should prompt thoracoscopy or thoracotomy to lyse adhesions, fully drain the pleural space, and optimize chest tube placement |
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Management of pneumothorax?
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Small + no resp/CV collapse resolve spontaneously: breathing 100% O2 acellerates resorption of air
small intercostal tube for small large/underlying lung disease: chest tube with underwater seal drain + suction repeated eps: pleurodesis with sclerotic agent or apical bullectomy with abrasion |
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How does PCP cause pneumothraces?
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necrosis of lung tissue adjecent to pleural surface
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What are the benign manifestations of asbestos exposure>
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1. benign asbestos pleural effusion: exudative, typically 10 years after exp, resolves
2. pleural plaques- calcified- marker of exposure, usually an asymptomatic radiologic finding |
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Management of mesothelioma
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resection (extrapleural pneumonectomy)- requires careful patient selection
rarely sucessful pt survival <1yr |
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