Flashcards in General respiratory Deck (80):
What are 5 causes of dyspnoea?
1. cardiovascular cause2. respiratory cause3. metabolic4. mechanical (obesity)5. psychological (anxiety)
What is pleuritic chest pain?
Pain with inspiration. sharp focal pain. ask the patient to cough
what does stony dullness indicate for percussion note
what is a wheeze?
musical note indicative of airway obstruction. often expiratory
what do we do if we suspect a tension pneumothorax?
urgent chest tube
what can clubbing indicate?
suppurative lung disease, interstitial lung disease (idiopathic, abestosis), cancer
why can someone with lung cancer may not have pain?
no pain fibres in the lung
what kind of colour is normal lung parenchyma in CT lung?
grey. Black holes will indicate COPD
what pathologies other than cancer can lead to an abnormal mass on the CXR?
infective causes like aspergillosis
what are the 4 types of lung cancer?
squamous cell carcinoma, adenocarcinoma, large cell and small cell
what is the number one cause of lung abscess?
what is bronchiectasis?
dilation of bronchioles as a result of chronic inflammation and fibrosis.
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.
what are the criteria for diagnosis of squamous cell carcinoma?
• Criteria for diagnosis= intercellular bridges and keratinisation
where would we find adenocarcinoma in the lungs?
peripheral part of the lung
If there is non resolving consolidation pneumonia what do we think of?
adenocarcinoma in situ
what is adenocarcinoma often associated with?
pleuritic chest pain and pleural effusion
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
what are 2 factors that reactivate primary TB? --> secondary TB?
Corticosteroids and HIV
what are some histopathological characteristics of TB?
granulomatous inflammation, central necrosis, epitheliod macrophages, lymphocytes, giant cells
what is the mutation that causes CF?
mutation in CF transmembrane conductance regulator on chromosome 7. This is a chloride channel--> defective chloride secretion
what organisms can cause a cavitating pneumonia?
Staphyloccocal pneumonia, klebsiella, Tb
what is the pathology of pulmonary fibrosis?
Fibrosis around secondary pulmonary lobules= pulmonary fibrosis --> leads to distortion of the airways + cystic dilation of airways
what are some causes of Pulmonary fibrosis
what are some causes of lung abscess?
aspergillosis, anaerobic bacteria
lesion just above or below the interlober fissure--> necrotising granulomatous lesion
what is secondary TB?
reactivation of dormant primary infection
what stain do we use for mycobacterium tuberculosis?
Ziehl neelsen stain
what is a differential for TB histologically?
what are some causes of granulomatous inflammation in the lung?
mycobacterium, fungi, sarcoidosis, Wegner's granulomatosis, rheumatoid, aspiration pneumonia
what type of disease is sarcoidosis?
interstitial lung disease
what is a common presentation of sarcoidosis?
hilar lymphadenopathy with or without parenchymal infiltrates
is sarcoidosis necrotising or non necrotising granulomatous inflammation?
non necrotising granulomatous inflammation
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
what are 5 causes of bilateral lymphadenopathy?
sarcoidosis, lymphoma, TB, metastatic cancer and fungal/viral infection
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
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
what are the two main categories of pleuritis?
infections and non infections
what are some non infectious causes of pleuritis?
infarction, PE, uraemia, tumour involvement, irradiation
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
what is a lung abscess?
a necrotic cavity filled with pus
what are 3 causes of aspiration?
1. altered consciousness, 2. poor dental hygiene, 3. immunosuppression.
what do we mean by acute respiratory distress syndrome?
diffuse alveolar damage
what are some hallmark clinical and radiological features of ARDS?
respiratory failure and pulmonary oedema. Widespread consolidation is seen on CXR
what are some causes of end stage honeycomb lung?
Idiopathic interstitial pneumonia, diffuse alveolar damage, sarcoidosis, asbestosis, miliary TB, drugs, radiation
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
what are 4 causes of interstitial fibrosis?
1. Drugs like methotrexate/ amiodarone
4. Connective tissue disorders like RA, SLE, Sarcoidosis
where would you usually see a Gohn's focus for TB?
apex of the lower lobe or apex of the upper lobe
how would you describe the Tb histological pattern in the lung?
necrotising granulomatous inflammatory process
What are the major pathological features of a viral pneumonia?
necrosis of bronchial epithelium
haemorrhage into surrounding alveoli
multinucleate giant cells formation
two categories of aspergillosis?
1. allergic bronchopulmonary aspergillosis + bronchopulmonary aspergillosis
2. Angio invasive aspergillosis
difference between ABPA and bronchopulmonary aspergillosis?
structure of the airways maintained in ABPA but granulomatous destruction in bronchopulmonary aspergillosis
can we make a diagnosis of legionella pneumonia after urinary antigen testing?
no. as the urinary antigen only covers one variant of legionella
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)
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
3. micro and culture (inc. TB)
+ U/S, CXR, FBE, CRP, blood cultures, LFTs
reduced breath sounds, dull percussion note and reduced chest expansion- what are you thinking of?
Pleural effusions or raised hemidiaphragm
what are some causes of unilateral effusions?
infection, malignancy, post PE
what are some causes of bilateral effusions?
heart failure, liver failure, malignancy (mets)
why might oral antibiotics not work for empyema?
cannot penetrate the pleural space
how do we break down the loculations of an empyema?
tpA and DNAase
where do we see pleural plaques? what causes it?
usually on the diaphragm. Asbestos exposure, previous empyema
what sort of lung complications are there of asbestosis?
1. pleural plaques
2. pleural thickening
3. pleural effusions
5. increased risk of lung cancer
6. pulmonary fibrosis- classic asbestosis
what is bronchiectasis?
chronic suppurative disorder leading to permanent dilatation of the bronchi
what are the congenital causes of bronchiectasis?
CF, Primary ciliary dyskinesia, alpha 1 antitrypsin deficiency
what are the acquired causes of bronchiectasis?
Post infectious (repeated RTI)
Complications of bronchiectasis?
Acute infection- pneumonia
Haemoptysis (massive >250mls of blood in less than 24 hrs
Pseudomonas infection or aspergillosis
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
what are the 4 compartments of the lung where pathology can occur?
conducting airways, gas exchange, interstitium, vascular
what do we mean by 'diffuse lung disease'
dyspnoea, cough + diffuse involvement of the lungs as determined by CXR
what kind of processes cause an acute diffuse lung pattern?
water (oedema), inflammation, blood (vasculitis)
what is the most common cause of haemoptysis in the Australian community?
Acute bronchitis (viral cause)
how do we calculate minute ventilation?
TV x RR
what usually causes T1 resp failure, and what type of non invasive ventilation would we go for?
fluid and consolidation
what type of non invasive ventilation do we go for in type 2 resp failure and why?
aids in inspiration and expiration phase of ventilation not just expiration as in CPAP
Ddx for cavitating lesions in the lung?
TB, fungal infection, bacterial abscess, wegner's granulomatous lesions and pulmonary infarcts
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
what does surfactant do?
increases lung compliance by reducing surface tension in the alveoli
what is kussmaul breathing?
fast and deep breathing
what sort of emphysema is associated with alpha 1 antitypsin deficiency?