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)
2
Q
List symptoms of pneumonia
A
- Fever
- Rigors
- Malaise
- Anorexia
- Dyspnea
- Cough
- Purulent sputum
- Haemoptysis
- Pleuritic pain
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
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
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)
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
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
8
Q
List symptoms of idiopathic pulmonary fibrosis
A
- Dyspnoea
- Cough (dry)
- Malaise
- Arthralgia
- Weight loss
9
Q
List signs of idiopathic pulmonary fibrosis
A
- Crackles (fine end-inspiratory creps, bi-basal)
- Clubbing
- Cyanosis
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)
11
Q
Define extrinsic allergic alveolitis
A
Repetitive inhalation of allergens provoking a hypersensitivity response causing granuloma formation and obliterative bronchiolitis
12
Q
Describe epidemiology of extrinsic allergic alveolitis
A
- 6-21% pigeon breeders
- 2-8% amongst farmers
- 7% of patient with ILD have EAA
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
14
Q
List symptoms of extrinsic allergic alveolitis
A
4-6h after exposure
- Fever
- Rigors
- Dyspnoea
- Cough
- Myalgia
Chronic
- SOBOE
- Dry cough
15
Q
List signs of extrinsic allergic alveolitis
A
- Clubbing
- Mild pyrexia
- Bi-basal, fine, inspiratory crepitations
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
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
Describe management of bronchiectasis
- 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
List complications of bronchiectasis
- Recurrent infections
- Cor pulmonale
- Respiratory failure
- Massive haemoptysis
27
Describe prognosis of bronchiectasis
- Irreversible
| - Faster decline where more frequent severe exacerbations occur
28
Describe epidemiology of mesothelioma
- 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
Describe aetiology/risks of mesothelioma
- 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
List signs of mesothelioma
- SOB
- Clubbing
- Dullness to percussion
- Reduced breath sounds
- Pleural friction rub on auscultation
31
Define asbestosis
Asbestosis is diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos fibres.
32
Describe epidemiology of asbestosis
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
Describe aetiology/risks of asbestosis
- Asbestos exposure
- Shipyard, construction and maintenance workers
- Smoking, as it reduces ability to clear asbestos fibres
34
List symptoms of asbestosis
- Progressive dyspnoea
| - Dry cough
35
List signs of asbestosis
- Clubbing
| - Fine end-expiratory crackles
36
Describe investigations for asbestosis
- 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
Describe ABG appearance in respiratory alkalosis
- Low CO2
- High pH
- HCO3- may be low if compensating
38
List causes of respiratory alkalosis
- Panic attack/ hyperventillation
- Pain
- Hypoxia
- Pulmonary embolism
- Pneumothorax
- Iatrogenic (excessive mechanical ventillation)
39
Describe ABG appearance in respiratory acidosis
- High CO2
- Low pH
- HCO3- may be high if compensating
40
List causes of respiratory acidosis
- Type 2 resp failure
- COPD
- Respiratory depression (opiods)
- Asthma
- Guillian barre
- Iatrogenic
