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Flashcards in General respiratory Deck (80):
1

What are 5 causes of dyspnoea?

1. cardiovascular cause2. respiratory cause3. metabolic4. mechanical (obesity)5. psychological (anxiety)

2

What is pleuritic chest pain?

Pain with inspiration. sharp focal pain. ask the patient to cough

3

what does stony dullness indicate for percussion note

pleural effusion

4

what is a wheeze?

musical note indicative of airway obstruction. often expiratory

5

what do we do if we suspect a tension pneumothorax?

urgent chest tube

6

what can clubbing indicate?

suppurative lung disease, interstitial lung disease (idiopathic, abestosis), cancer

7

why can someone with lung cancer may not have pain?

no pain fibres in the lung

8

what kind of colour is normal lung parenchyma in CT lung?

grey. Black holes will indicate COPD

9

what pathologies other than cancer can lead to an abnormal mass on the CXR?

infective causes like aspergillosis

10

what are the 4 types of lung cancer?

squamous cell carcinoma, adenocarcinoma, large cell and small cell

11

what is the number one cause of lung abscess?

aspiration

12

what is bronchiectasis?

dilation of bronchioles as a result of chronic inflammation and fibrosis.

13

where are lung abscesses usually located?

around the right main bronchus in the right lung bc it is more vertical and shorter than the left.

14

what are the criteria for diagnosis of squamous cell carcinoma?

• Criteria for diagnosis= intercellular bridges and keratinisation

15

where would we find adenocarcinoma in the lungs?

peripheral part of the lung

16

If there is non resolving consolidation pneumonia what do we think of?

adenocarcinoma in situ

17

what is adenocarcinoma often associated with?

pleuritic chest pain and pleural effusion

18

where might we see a Gohn's focus?

located in the lower portion of the right upper lobe or upper portion of the right lower lobe

19

what are 2 factors that reactivate primary TB? --> secondary TB?

Corticosteroids and HIV

20

what are some histopathological characteristics of TB?

granulomatous inflammation, central necrosis, epitheliod macrophages, lymphocytes, giant cells

21

what is the mutation that causes CF?

mutation in CF transmembrane conductance regulator on chromosome 7. This is a chloride channel--> defective chloride secretion

22

what organisms can cause a cavitating pneumonia?

Staphyloccocal pneumonia, klebsiella, Tb

23

what is the pathology of pulmonary fibrosis?

Fibrosis around secondary pulmonary lobules= pulmonary fibrosis --> leads to distortion of the airways + cystic dilation of airways

24

what are some causes of Pulmonary fibrosis

Amiodarone
Aspergillosis
Radiation
Idiopathic
methotrexate
ABPA
etc.

25

what are some causes of lung abscess?

aspergillosis, anaerobic bacteria

26

Gohn's focus?

lesion just above or below the interlober fissure--> necrotising granulomatous lesion

27

what is secondary TB?

reactivation of dormant primary infection

28

what stain do we use for mycobacterium tuberculosis?

Ziehl neelsen stain

29

what is a differential for TB histologically?

sarcoidosis, lymphoma

30

what are some causes of granulomatous inflammation in the lung?

mycobacterium, fungi, sarcoidosis, Wegner's granulomatosis, rheumatoid, aspiration pneumonia

31

what type of disease is sarcoidosis?

interstitial lung disease

32

what is a common presentation of sarcoidosis?

hilar lymphadenopathy with or without parenchymal infiltrates

33

is sarcoidosis necrotising or non necrotising granulomatous inflammation?

non necrotising granulomatous inflammation

34

why is it important to differentiate between sarcoidosis and TB?

Sarcoidosis is treated with steroids. If you treat TB with steroids, you will exacerbate the problem

35

what are 5 causes of bilateral lymphadenopathy?

sarcoidosis, lymphoma, TB, metastatic cancer and fungal/viral infection

36

whats the difference between emphysema and pulmonary fibrosis where you'd see enlarged spaces?

emphysema- lung size is larger, pulmonary fibrosis, lung size would be reduced

37

what does honeycomb lung mean in terms of prognosis?

poor prognosis; end stage manifestation of a large number of interstitial inflammatory and proliferative lung diseases

38

what are the two main categories of pleuritis?

infections and non infections

39

what are some non infectious causes of pleuritis?

infarction, PE, uraemia, tumour involvement, irradiation

40

what are the most frequent finding on initial examination for mesothelioma?

pleural effusion. Upon aspiration of the effusion, if it is highly viscous then you worry about mesothelioma

41

what is a lung abscess?

a necrotic cavity filled with pus

42

what are 3 causes of aspiration?

1. altered consciousness, 2. poor dental hygiene, 3. immunosuppression.

43

what do we mean by acute respiratory distress syndrome?

diffuse alveolar damage

44

what are some hallmark clinical and radiological features of ARDS?

respiratory failure and pulmonary oedema. Widespread consolidation is seen on CXR

45

what are some causes of end stage honeycomb lung?

Idiopathic interstitial pneumonia, diffuse alveolar damage, sarcoidosis, asbestosis, miliary TB, drugs, radiation

46

what are the major pathogens that can be derived from the sputum associated with bronchiectasis?

The major pathogens are Staph. aureus , Pseudomonas aeruginosa , H. influenzae and anaerobes. Other pathogens include Strep. pneumoniae and Klebsiella pneumoniae

47

what are 4 causes of interstitial fibrosis?

1. Drugs like methotrexate/ amiodarone
2. Radiation
3. idiopathic
4. Connective tissue disorders like RA, SLE, Sarcoidosis

48

where would you usually see a Gohn's focus for TB?

apex of the lower lobe or apex of the upper lobe

49

how would you describe the Tb histological pattern in the lung?

necrotising granulomatous inflammatory process

50

What are the major pathological features of a viral pneumonia?

necrosis of bronchial epithelium
inflammatory exudate
haemorrhage into surrounding alveoli
multinucleate giant cells formation
inclusion bodies

51

two categories of aspergillosis?

1. allergic bronchopulmonary aspergillosis + bronchopulmonary aspergillosis
2. Angio invasive aspergillosis

52

difference between ABPA and bronchopulmonary aspergillosis?

structure of the airways maintained in ABPA but granulomatous destruction in bronchopulmonary aspergillosis

53

can we make a diagnosis of legionella pneumonia after urinary antigen testing?

no. as the urinary antigen only covers one variant of legionella

54

what are the 2 main mechanisms of pleural effusions?

1. increased fluid entry (increased microvascular pressure/increased permeability)
2. decreased fluid exit via lymphatic system (obstruction by tumour)

55

what Ix do we order for a pleural effusion sample

1. Biochemistry- LDH (marker of activity), protein (for transudate vs exudate), pH (indicates anaerobic respiration), glucose
2. Cytology
3. micro and culture (inc. TB)

+ U/S, CXR, FBE, CRP, blood cultures, LFTs

56

reduced breath sounds, dull percussion note and reduced chest expansion- what are you thinking of?

Pleural effusions or raised hemidiaphragm

57

what are some causes of unilateral effusions?

infection, malignancy, post PE

58

what are some causes of bilateral effusions?

heart failure, liver failure, malignancy (mets)

59

why might oral antibiotics not work for empyema?

cannot penetrate the pleural space

60

how do we break down the loculations of an empyema?

tpA and DNAase

61

where do we see pleural plaques? what causes it?

usually on the diaphragm. Asbestos exposure, previous empyema

62

what sort of lung complications are there of asbestosis?

1. pleural plaques
2. pleural thickening
3. pleural effusions
4. mesothelioma
5. increased risk of lung cancer
6. pulmonary fibrosis- classic asbestosis

63

what is bronchiectasis?

chronic suppurative disorder leading to permanent dilatation of the bronchi

64

what are the congenital causes of bronchiectasis?

CF, Primary ciliary dyskinesia, alpha 1 antitrypsin deficiency
Primary hypogammaglobulinaemia

65

what are the acquired causes of bronchiectasis?

Post infectious (repeated RTI)
Hypogammaglobulinaemia
RA/Sjgrens/ABPA
Idiopathic

66

Complications of bronchiectasis?

Acute infection- pneumonia
Haemoptysis (massive >250mls of blood in less than 24 hrs
pneumothorax
Pseudomonas infection or aspergillosis

67

What is the short and long term management of bronchiectasis?

Non pharmacological: postural drainage, chest physio, pulmonary rehab, infection control

Pharmacological: treating the acute infection. Immunisation, treat pseudomonas colonisation

Optimise lung function with bronchodilators and steroids

Treat underlying cause

Surgery last resort

68

what are the 4 compartments of the lung where pathology can occur?

conducting airways, gas exchange, interstitium, vascular

69

what do we mean by 'diffuse lung disease'

dyspnoea, cough + diffuse involvement of the lungs as determined by CXR

70

what kind of processes cause an acute diffuse lung pattern?

water (oedema), inflammation, blood (vasculitis)

71

what is the most common cause of haemoptysis in the Australian community?

URTI
Acute bronchitis (viral cause)

72

how do we calculate minute ventilation?

TV x RR

73

what usually causes T1 resp failure, and what type of non invasive ventilation would we go for?

fluid and consolidation
CPAP

74

what type of non invasive ventilation do we go for in type 2 resp failure and why?

BiPAP
aids in inspiration and expiration phase of ventilation not just expiration as in CPAP

75

Ddx for cavitating lesions in the lung?

TB, fungal infection, bacterial abscess, wegner's granulomatous lesions and pulmonary infarcts

76

what ECG classical changes do you get in PE?

S1 Q3 T3

so Q waves in Lead 3, S waves in Lead 1, and inverted T wave in lead 3

also- sinus tachycardia

may also get Right axis deviation and RBBB

77

what does surfactant do?

increases lung compliance by reducing surface tension in the alveoli

78

what is kussmaul breathing?

fast and deep breathing

79

what sort of emphysema is associated with alpha 1 antitypsin deficiency?

panacinar emphysema

80

what do clinicians test for when ix for alpha 1 antitrypsin deficiency?

plasma AAT levels