Interstitial Lung Disease, The Pleura And Chest Wall Flashcards

1
Q

What is the interstitium of the lungs?

A

Space in between alveoli and bloodstream

Needed to function

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2
Q

What is the role of the lung interstitium?

A

Release cytokines
Conduit for things to leave circulation and vice versa
Collagen formation

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3
Q

Interstitial diseases can affect many different parts of anatomy/physiology, name a few

A
Acini
Bronchioles 
Mesenchyme 
Alveoli lumen 
Epithelia 
Macrophages 
Bronchiolar lumen 
Inflammatory cells 
Ventilation
Diffusion 
Perfusion
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4
Q

Interstitial lung disease is what type of defect

A

Restrictive

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5
Q

What would the FEV1/FVC ratio for ILDs look like

A

FEV1 reduced
FVC reduced
Therefore ratio about normal

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6
Q

What is a common CXR finding for ILD?

A

Haziness

Looks like lace over the lungs

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7
Q

What do we call the rounded cystic areas in ILD?

A

Honeycombing

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8
Q

What are the 2 main symptoms of any ILD?

A

Chronic shortness of breath

Chronic cough

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9
Q

Give some signs on examination that would chest ILD

A
Clubbing 
Cyanosis 
Tachycardia 
Tachypnoea 
Signs of RH failure 
Decreased chest movement 
Coarse crackles
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10
Q

What are the classifications of ILDs?

A
Occupational 
Treatment related 
Connective tissue disease
Immunological 
Idiopathic
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11
Q

What is the largest group of ILDs?

A

Idiopathic

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12
Q

Name some causes of occupational ILD

A

Asbestos
Silicone
Coal dust (coal workers pneumoconiosis)

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13
Q

Name some treatments that can cause ILD

A
Radiation 
Methotrexate 
Nitrofurantoin (given for UTI) 
Amiodarone 
Chemotherapy
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14
Q

Name some connective tissue diseases that can lead to ILD

A
Rheumatoid arthritis 
SLE (lupus)
Polymyositis 
Scleroderma 
Sjogren's
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15
Q

Name some immunological problems that can cause ILD

A

Sarcoidosis (granulomas)

Hypersensitivity pneumonitis

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16
Q

Describe idiopathic pulmonary fibrosis (IPF)

A
Commonest ILD
60-80 years 
Median survival = 3 years 
Often diagnosed via CT 
There are new therapies to treat: antifibrotics and vegF inhibitors
17
Q

Define asbestosis

A

Interstitial lung disease caused by asbestos

18
Q

Other than asbestosis, what other problems can asbestos exposure lead to?

A
Asbestos plaques
Diffuse pleural thickening 
Benign asbestos pleural effusions
Mesothelioma 
Bronchogenic lung cancer
Rounded atelectasis
19
Q

Describe sarcoidosis

A
Often asymptomatic 
Sometimes a cough and rash 
Lung function tests can be normal or abnormal 
Non-caseating granulomas 
Differential: lymphoma and TB
20
Q

What is the treatment for sarcoidosis?

A

Sometimes no treatment
Steroids
Methotrexate

21
Q

Which pleura has somatic innervation?

A

Only the parietal

22
Q

Describe pleuritic pain

A

Sharp
Severe
Worse with inspiration

23
Q

What is the rate of pleural fluid turnover?

A

15 ml/day

24
Q

How can liver cirrhosis affect the pleura?

A

Lack of production of albumin
Decreased oncotic pressure
Increased production of pleural fluid

25
Q

What changes would cause increased production of pleural fluid?

A

Increased hydrostatic pressure capillaries
Increased permeability
Decreased oncotic pressure capillaries

26
Q

What would cause decreased absorption of the pleural fluid?

A

Lymphatic blockage

Elevated systemic venous pressure

27
Q

To be called an exudate, pleural protein divided by serum protein must be …

A

> 0.5

And LDH > 0.6

28
Q

What might we analyse pleura fluid for?

A
Appearance
Cell count 
Protein 
PDH 
pH 
Glucose
Cytology
29
Q

What is pleural empyema?

A

Pockets of fluid

Not evenly affecting the lung

30
Q

What are the most common cancers to send mets to the lungs?

A

Breast
Renal
Colon

31
Q

What are the different types of pneumothorax?

A

Primary - in otherwise healthy people
Secondary - underlying lung disease
Iatrogenic - eg. Central lines

32
Q

What are the main symptoms of pneumothorax?

A

Pleuritic chest pain

Dyspnoea

33
Q

How is a pneumothorax treated?

A

Look at CXR
Observation
High flow oxygen
Possibly a chest pain needed

34
Q

What are the signs of a tension pneumothorax?

A

CVS compromise - tachycardia, hypotension
Decreased chest expansion
Hyperresonance and absent breath sounds on side of pneumothorax
Shift of mediastinum to opposite side
Hypoxaemia

35
Q

Name some congenital chest wall abnormalities

A

Pectus deformities
Scoliosis
Kyphosis
Muscular dystrophy

36
Q

Name some acquired causes of chest wall disease

A

Trauma
Iatrogenic
Ankylosing spondylitis
Motor neurone disease

37
Q

Name some consequences of a chest wall disease

A
Ventilation failure 
Poor clearance of secretions
Pneumonia 
Sleep disordered breathing 
Atelectasis