COPD is a risk factor for…..?
- COPD is a risk factor for pneumothorax
What type of drug is symbicort and what is it used to treat?
- Steroid and LABA (long acting Beta-agonist)
- COPD
What type of drug is tiotropium and what is it used to treat?
- Anti-muscarinic
- COPD
In a patient with shortness of breath and a raised JVP, assuming these are linked and not due to separate pathologies, give a ddx - 3 causes of the raised JVP and SOB
- Right HF
- COPD → chronic hypoxia → pulmonary HTN - ‘cor pulmonale?’ → Right HF → raised JVP
- PE → right heart strain → pulmonary HTN? ‘Cor pulmonale? → raised JVP
What are some risk factors for the development of PE?
- DVT
- Previous DVT / PE
- Immobility
- Surgery
- Malignancy
What are the characteristic features of pneumothorax on a CXR?
- No lung markings on the side of the pneumothorax - clear, pure black lung
- Tracheal deviation away from the side of the pneumothorax
What are the 2 types of classifications of pneumothorax - each have 2 divisions?
- Simple vs tension
- Primary (spontaneous) vs secondary (secondary to chronic lung disease e.g. COPD)
Outline the management plan for primary and secondary pneumothorax
Primary pneumothorax:
- If < 2cm
- Discharge, repeat CXR
- If > 2cm / SOB
- FIRST: Pleural aspiration - insertion of a large bore cannula to remove air from the pleural space
- IF UNSUCCESSFUL: Chest drain - inserted at 4th ICS MCL
Secondary pneumothorax:
- If < 2cm
- Pleural aspiration
- If > 2cm
- Chest drain
What breath sound do you hear in PE?
- Vesicular
1) PE can lead to a CVS phenomenon that causes a constellation of CVS signs, what is this and what are the signs?
2) What is a much more common ECG finding than the one mentioned in part 1 (one of the signs)?
1)
- PE → Right Heart Strain
- Signs:
- ↑ JVP
- RAD (Right Axis Deviation)
- RBBB (Right Bundle Branch Block) - V2 ‘M’, V6 ‘W’ (WilliaM MarroW)
- S1Q3T3 on ECG - i.e Deep S-wave on lead I, Deep Q-wave on lead 3 and T-wave inversion on lead 3
2)
- Sinus tachycardia
Outline the management plan for PE in order. For haemodynamicall and not haemodynamically stable patients
If haemodynamically stable:
- LMWH
- CTPA → if confirmed PE, continue LMWH
- LMWH + Warfarin
- Then just take warfarin when INR is optimal
If haemodynamically unstable:
- Thrombolysis
What will the FEV1 : FVC ratios show in…
1) Restrictive lung disorders?
2) Obstructive lung disorders?
1)
RESTRICTIVE PATTERN e.g. in fibrosis
- FEV1/FVC ratio > 70%
OBSTRUCTIVE PATTERN e.g. in asthma, COPD
- FEV1/FVC ratio < 70% Obstructivelung disease (Asthma, COPD)
Give some respiratory causes of clubbing
- Bronchial carcinoma
- Bronchiectasis
- Empyema
- Fibrosing alveolitis
- Mesothelioma
- Lung abscess
Give some causes of restrictive lung diseases (pulmonary fibrosis)
- Idiopathic fibrosing alviolitis
- Connective tissue disorders
- SLE
- RA
- Scleroderma
- Drugs
- Methotrexate
- Amiodarone
- Nitrofurantoin
- Asbestosis - important to check occupation
True or false - COPD has clubbing
- False
What are the radiological (CXR) signs of COPD?
- Hyperinflated lungs > 7 ribs
- Flattened diaphragm
Identify the different types of opacities on the CXR and what they suggest
- Homogenous shadow → fluid, effusion or collapase
- Reticulo-nodular (lines and dots) → fibrosis
- Fluffy alveolar (interstitial) shadowing → fluid (pulmonary oedema) , pus (pneumonia) or blood
- Masses / cavitations
