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Flashcards in Resp Deck (177)
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1

What can cause upper zone lung fibrosis

TB
extrinsic allergic alveolitis
sarcoidosis
silicosis
ank spond

2

What can cause lower zone lung fibrosis

IPF
drugs
asbestosis

3

What drugs can cause lower zone lung fibrosis

amiodarone
methotrexate
bleomycin
nitrofurantoin

4

What is idiopathic pulmonary fibrosis

progressive fibrosis of the interstitial alveolar tissue
excessive collagen deposition
no known cause

5

Who is IPF most common in

men aged 50-70
smokers

6

What are the symptoms of IPF

dry cough
SOB

7

What are the signs of IPF

fine end-inspiratory bibasal crackles
clubbing

8

How should a patient with suspected IPF be investigated?

Bedside
Bloods: ABG, ANA, CRP
Micro:
Imaging: CXR, HRCT,
Special tests: spirometry, TLCO

9

What are the common findings on CXR in IPF

reticular shadowing
small, irregular, peripheral opacities - ground-glass
decreased lung volume
honeycombing

10

What are the common findings on HRCT in IPF

reticular opacities
honeycombing

essential for diagnosis!

11

What are the common findings on spirometry in IPF

reduced FVC
reduced FEV1
FEV1/FVC normal/increased

12

What What are the common findings on TLCO in spirometry

reduced transfer factor
impaired gas exchange

13

What is the management of IPF

pulmonary rehabilitation
oxygen

clinical trial
lung transplant

14

What is the prognosis in IPF

50% 5 year survival rate

15

What investigations should be carried out in suspected COPD

Bedside: BMI, ECG
Bloods: FBC,
Micro
Imaging: CXR
Special tests: post bronchodilator spirometry

16

State the MRC Dyspnoea Scale grades

1 = not breathless
2 = breathless on walking up hill
3 = walks slowly
4 = breathless after 100 metres/ few mins
5 = unable to leave house

17

How are the stages of COPD defines

perventage predicted of FEV1

18

State the stages of COPD defined by the FEV1

>80% = mild
50-79% = moderate
30-49% = severe
<30% = very severe

19

What are the signs of COPD on CXR

increased lung volume
flattened diaphragm
bullae

20

Describe the steps in the pharmacological management of stable COPD

1. LABA/LAMA
2. if FEV1 >50% = LABA/LAMA
if FEV1 <50% = LABA+ICS/LAMA
3. if LABA -> LABA+ICS
if LAMA -> LABA+ICS + LAMA

21

What general measures are involved in the management of COPD

pulmonary rehabilitation
stop smoking
influenza vaccine
pneumococcal vaccine

22

What bacteria are most commonly present in acute exacerbation of COPD

Haemophilus influenzae
Streptococcus pneumoniae
Moraxella catarrhalis

23

Descrebe the steps in management of an acute exacerbation of COPD

admit
nebulised salbutamol and ipatropium
oxygen - if known hypercapnic, 28% venturi(white) at 4l
IV hydrocortisone and oral presnisolone
Abx if sputum purulent - doxycycline

24

What is the rationale behind LTOT in COPD

maintaining PaO2 >8kPa for >15hours per day increases the 3yr survival rate by 50%

25

What are the criteria for LTOT in COPD

PaO2 <7.3 on two separate occasions greater then 3 weeks apart

PaO2 7.3-8 + evidence of pulmonary hypertension, polycythaemia, peripheral oedema, nocturnal hypoxia on two separate occasions greater then 3 weeks apart

26

Which patients with COPD should be assessed for LTOT

very severe airflow obstruction (FEV1 < 30% predicted), 'considered' for patients with severe airflow obstruction (FEV1 30-49% predicted)
cyanosis
polycythaemia
peripheral oedema
raised JVP
oxygen saturations less than or equal to 92% on room air

27

What are the diagnostic criteria should be used when assessing a patient with suspected COPD?

FEV1/FVC <70%

symptoms!

28

What is the difference between a primary and secondary pneumothrax?

primary = no underlying disease
secondary = occurs in presence of underlying disease`

29

What is the difference between a pneumothorax and a tension pneumothorax?

tension = trachea deviated away from affected side.

Air cannot leave pleural cavity during expirations due to valve like flap in parietal pleura.

30

What tests should be done in suspected pneumothorax?

ABG
CXR