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Year 3 - Diseases > Resp 2 > Flashcards

Resp 2 Flashcards

1
Q

List the types of pneumonia

A
  • Community acquired - primary or secondary to underlying disease. Typical s. pnuemoniae, haemophilius influenzae. moraxella. Atypical Mycoplasma, s. aureus, legionella, chlamydia
  • Hospital acquired (>48h after hospital admission, most common cause enterobacter or staph aureus)
  • Aspiration (stroke, myasthena, bulbar palsies, reduced consciousness, oesophageal disease, poor dental hygiene all risks most commonly right middle zone)
  • Immunocompromised (strep pneumoniae, h.influenzae, s. aureus)
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2
Q

List symptoms of pneumonia

A
  • Fever
  • Rigors
  • Malaise
  • Anorexia
  • Dyspnea
  • Cough
  • Purulent sputum
  • Haemoptysis
  • Pleuritic pain
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3
Q

List signs of pneumonia

A
  • Pyrexia
  • Cyanosis
  • Confusion
  • Tachypnoea
  • Tachycardia
  • Consolidation (dullness to percussion, reduced expansion, increased vocal resonance, bronchial breathing, basal creps)
  • Pleural rub
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4
Q

Define idiopathic pulmonary fibrosis

A
  • Chronic lung disease which is characterised with scarring of the lungs and progressive dyspnoea
  • The most common interstitial lung disease
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5
Q

Describe aetiology of idiopathic pulmonary fibrosis

A
  • Predisposed host (surfactant protein mutatuions). Recurrent alveolar damage results in cytokine release, activating fibroblasts differentiating into myofibroblasts and increased collagen synthesis
  • Drugs can produce similar illness (bleomycin, methotrexate and amiodarone)
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6
Q

List risk factors of idiopathic pulmonary fibrosis

A
  • Smoking
  • Occupational exposure to metal or wood
  • Chronic micro-aspiration
  • Animal or vegetable dusts
  • GERD
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7
Q

Describe epidemiology of idiopathic pulmonary fibrosis

A
  • 14-40 per 100000 people in US (prevalence)
  • Increases with advancing age
  • 2/3 over 60 by the time of presentation, mean age of diagnosis 60-70 years
  • More common in men
  • Survival 2-5 years from diagnosis
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8
Q

List symptoms of idiopathic pulmonary fibrosis

A
  • Dyspnoea
  • Cough (dry)
  • Malaise
  • Arthralgia
  • Weight loss
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9
Q

List signs of idiopathic pulmonary fibrosis

A
  • Crackles (fine end-inspiratory creps, bi-basal)
  • Clubbing
  • Cyanosis
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10
Q

List investigations for idiopathic pulmonary fibrosis

A
  • CRP raised, immunoglobulins, ANA
  • Spirometry restrictive pattern (FEV1/FVC > 0.8)
  • CXR late changes - ground class, cor pulmonale, honeycombing
  • HR-CT (early changes - ground glass)
  • Biopsy (gold standard)
  • Bloods and ABG
  • BAL (raised lymphocytes or neutrophils and eosinophils)
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11
Q

Define extrinsic allergic alveolitis

A

Repetitive inhalation of allergens provoking a hypersensitivity response causing granuloma formation and obliterative bronchiolitis

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12
Q

Describe epidemiology of extrinsic allergic alveolitis

A
  • 6-21% pigeon breeders
  • 2-8% amongst farmers
  • 7% of patient with ILD have EAA
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13
Q

Describe aetiology/types of extrinsic allergic alveolitis

A
  • Bird fanciers and pigeon fanciers lung
  • Farmers and mushroom workers lung
  • Malt workers lung
  • Bagassosis or sugar workers lung
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14
Q

List symptoms of extrinsic allergic alveolitis

A

4-6h after exposure

  • Fever
  • Rigors
  • Dyspnoea
  • Cough
  • Myalgia

Chronic

  • SOBOE
  • Dry cough
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15
Q

List signs of extrinsic allergic alveolitis

A
  • Clubbing
  • Mild pyrexia
  • Bi-basal, fine, inspiratory crepitations
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16
Q

List investigations for extrinsic allergic alveolitis

A
  • Restrictive pattern on spirometry
  • Normal CXR, can have upper zone mottling, hilar lymphadenopathy
  • HR-CT ground glass
  • BAL increased cellularity (lymphocytes and mast cells)
  • Bloods, ABG
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17
Q

Describe epidemiology of pneumoconiosis

A
  • 100 per year deaths from silcosis in the US
  • Decreasing incidence
  • Latency of 20 years from first exposure
18
Q

Describe aetiology of pneumoconiosis

A
  • Scilia
  • Coal
  • Beryllium
  • Inhalation of coal dust, silica or asbestosis
  • Asbestosis is a type of pneumoconiosis, as is silicosis
19
Q

List signs and symptoms of pneumoconiosis

A

May be NORMAL

  • SOB, dry cough.
  • Clubbing
  • Bi-basal inspiratory creps
  • Decreased breath sounds
  • Signs of RHF
20
Q

Describe investigations for pneumoconiosis

A
  • Spirometry restrictive pattern
  • CXR showing micronodular mottling
  • HR-CT - bilateral lower zone reticoulonodular shadowing and pleural plaques
  • BeLPT for beryllium
21
Q

List risk factors for pneumonia

A
  • Smoking
  • Travel
  • Immunocompromised
  • Legionella air con
  • Chlamydia psittaci pet birds
  • Klebsilla more common in alcoholics
22
Q

List specific qualities on pneumonia investigation that point to a particular pathogen

A
  • Legionella hyponatraemia and abnormal LFTs
  • Mycoplasma transverse myelitis
  • Staph cavitating lesion with air fluid level
  • Klebsiella also has cavitating legion
23
Q

Describe presentation of atypical pneumonia

A
  • Dry cough
  • Headache
  • Diarrhoea
  • Myalgia
  • Hepatitis
24
Q

Describe investigation results in atypical pneumonia

A
  • Urine tested for legionella
  • Mycoplasma cold agglutins on blood film
  • LFTs for legionella
25
Q

Describe management of bronchiectasis

A
  • Exercise, good diet, vaccinations
  • Airway clearance (chest physiotherapy, high frequency oscillation device, nebulised hypertonic saline)
  • IV antibiotics for infection, oral prophylactic antibiotics to prevent infection (azithromycin)
  • Surgical resection
26
Q

List complications of bronchiectasis

A
  • Recurrent infections
  • Cor pulmonale
  • Respiratory failure
  • Massive haemoptysis
27
Q

Describe prognosis of bronchiectasis

A
  • Irreversible

- Faster decline where more frequent severe exacerbations occur

28
Q

Describe epidemiology of mesothelioma

A
  • 90% of patients report previous asbestos exposure
  • Only 20% of patients have signs of asbestosis on CXR
  • More common in men, and older white patients.
  • Incidence increasing in UK
29
Q

Describe aetiology/risks of mesothelioma

A
  • Exposure to asbestos, with latency period of 20-40 years
  • Prior exposure to radiotherapy (a known carcinogen)
  • Genetic predisposition e.g., mutation of the BAP1 gene; and the simian virus 40 (SV-40)
  • Male, age 60-85
30
Q

List signs of mesothelioma

A
  • SOB
  • Clubbing
  • Dullness to percussion
  • Reduced breath sounds
  • Pleural friction rub on auscultation
31
Q

Define asbestosis

A

Asbestosis is diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos fibres.

32
Q

Describe epidemiology of asbestosis

A

In 2018 in the UK, 950 new cases of asbestosis were assessed under the Industrial Injuries and Disablement Benefit scheme; around 1% to 2% of these cases were female

33
Q

Describe aetiology/risks of asbestosis

A
  • Asbestos exposure
  • Shipyard, construction and maintenance workers
  • Smoking, as it reduces ability to clear asbestos fibres
34
Q

List symptoms of asbestosis

A
  • Progressive dyspnoea

- Dry cough

35
Q

List signs of asbestosis

A
  • Clubbing

- Fine end-expiratory crackles

36
Q

Describe investigations for asbestosis

A
  • CXR (PA and lateral - interstitial fibrosis and bilateral pleural thickening, pleural plaques)
  • Pulmonary function tests (restrictive changes, though may have obstructive changes in COPD)
  • Lung biopsy where absence of known asbestos exposure or uncertainty. (Interstitial fibrosis, asbestos bodies)
  • Bronchial lavage
37
Q

Describe ABG appearance in respiratory alkalosis

A
  • Low CO2
  • High pH
  • HCO3- may be low if compensating
38
Q

List causes of respiratory alkalosis

A
  • Panic attack/ hyperventillation
  • Pain
  • Hypoxia
  • Pulmonary embolism
  • Pneumothorax
  • Iatrogenic (excessive mechanical ventillation)
39
Q

Describe ABG appearance in respiratory acidosis

A
  • High CO2
  • Low pH
  • HCO3- may be high if compensating
40
Q

List causes of respiratory acidosis

A
  • Type 2 resp failure
  • COPD
  • Respiratory depression (opiods)
  • Asthma
  • Guillian barre
  • Iatrogenic

Year 3 - Diseases (27 decks)

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