RESP2 Flashcards

Question

What is Asbestos?

Answer 1

A group of naturally occuring fibres composed of **hydrated magnesium silicates** Once _inhaled_ they can block small airways and then proceed to _chronic inflammation and fibrosis_. (due to the bodys immune response)

Answer 2

Anyone who worked in the following industries **_in the past_** mining and milling of fiber cement textiles insulation ship building yard power stations

Answer 3

The spectrum of disorders includes: 1. **Asbestosis** 2. **Pleural disease** (benign asbestos effusion, pleural plaques) 3. **Malignancies** (non small cell and small cell carcinoma of the lung as well as malignant mesothelioma) Primary lung Ca is 5 to 7 times higher in those with asbestosis and 1.5 times higher in those with pleural plaques

Answer 4

Pulmonary fibrosis caused by inhalation of asbestos fibres. Slow indolent course. Progressive Diffuse fibrosis. +/- pleural disease. Mostly people who were exposed in past years.

Answer 5

**Uncoated or coated asbestos fibres (asbestos bodies)** in association with **Interstitial Pulmonary fibrosis** Similar to UIP (usual interstitial pneumonitis) Except - asbestos doesn't tend to have fibroblast foci and does have mild fibrosis of visceral pleura

Answer 6

Most will be **asymptomatic for 20-30** years after exposure **Chronic, progressive exertional dyspnoea** (often cough, wheeze and sputum are absent - unless smoker) o/e **fine bibasal end inspiratory crackles** **FInger clubbing 40%** cor pulmonale with **elevated JVP and peripheral oedema**

Answer 7

1, **pulmonary function tests** - restrictive defect with reduced DLCO reduced pulmonary compliance, Reduced lung volumes 2. **HRCT** - parenchymal fibrosis, coarse _honeycombing_ in advanced disease - **pleural plaques** (these are differenitators from other types of fibrosis) 3**. Broncoalveolar lavage** - helps to differentiate from malignancy, infection, pneumonitis if other tests have not been sufficiently diagnostic

Answer 8

1. History of asbestos exposure 2. Evidence of lung fibrosis 3. Absence of other causes of diffuse parenchymal lung disease

Answer 9

Idiopathic pulmonary fibrosis Drug induced pneumonitis interstitial pneumonitis associated with rheumatoid arthritis or rheumatic disease Chronic hypersensitivity pneumonitis chronic pulmonary fibrosis and emphysema pleuropulmonary fibroelastosis

Answer 10

NO cure 1. Smoking cessation 2. Vaccinations for influenza and pneumococcal disease. 3. Prompt treatment of respiratory infections 4. Supplemental oxygen if patient becomes hypoxaemic 5. Early detection of physiologic and radiologic abnormalities

Answer 11

1. Pleural disease - eg pleural plaques or effusions 2. Malignancy - eg malignant mesothelioma or lung cancer 3. Respiratory failure in the context of progressive fibrosis

Answer 12

1. Pleural involvement is a hallmark of asbestos related disease 2. Pleural effusions - benign asbestos related effusions 3. Pleural plaques and diffuse pleural thickening - benign but can cause pain and discomfort

Answer 13

It is a rare neoplasm arising from the **mesothelial surface** of pleura, peritoneal cavity, tunica vaginalis, or pericardium **Malignant pleural mesothelioma is the most common type.** **Asbestos is the ONLY known risk factor** for malignant mesothelioma

Answer 14

It appears that relative risk of lung cancer in smoking and asbestos exposure is mulitplicative - smoking and asbestos indepently increase risk of malignancy. Together they increase risk 59 fold

Answer 15

- bilateral pleural calcifications and subdiaphragmatic calcifications - Pleural plaques alone are not a diagnosis of asbestosis (just asbestos exposure). Dx of asbestosis requires fibrosis and absence of other diffuse parenchymal lung disease Mesothelioma - often presents with an effusion on xr

Answer 16

Could be asymptomatic Could have persistent wheeze, cough, dyspnoea Could present with **recurrent pneumonia** might have asymetric chest wall movements and/or tracheal deviation on examination ( or could be normal) Ix - CXRay - inspiratory and expiratory films may give better visualisation

Answer 17

1. Open airway and under direct vision (pref with laryngoscope) look in mouth for a foreign body - if present remove with magills forceps 2. Place child prone with head down 3. Administer 5 intrascapular back blows 4. Turn child over and apply five chest thrusts 5. Check in the mouth if foreign body has appeared 6. continue alternating back blows and chest thrusts 7. Call ambulance for urgent transfer

Answer 18

Sit child upright in position they feel most comfortable arrange for urgent transfer to hospital for removal of foreign body in operating theatre

Answer 19

No child less that 15 months should be offered pop corn, raw apples, hard lollies or raw carrot. Children under 4 should not be offered peanuts Avoid toys with small parts until age of 3 Children should be offered one piece of food at a time and encouraged to sit quietly while eating

Answer 20

1. Stridor 2. Barking cough 3. Hoarseness 4. Respiratory distress - increased effort and reduced efficacy

Answer 21

1. At rest or only with activity? (Rest - severe) 2. Respiratory effort - Work of breathing 3. Respiratory efficacy - cyanosis and Sp02 Not how 'loud' the stridor is

Answer 22

Turbulent flow in the upper airway

Answer 23

Croup Laryngomalacia Epiglottitis Bacterial Tracheiits Foreign body inhalation Angioedema Trauma to throat Tonsillitis with peritonsilar abcess

Answer 24

Avoid overhandling/examination of the throat Keep calm - child, parent and staff, sit upright, dont separate child from parents arms Assess severity and monitor progression Ascertain and treat cause nebulised adrenaline if in doubt early referral to ED if indicated

Answer 25

Its caused by laxity of the supraglottic structures 99% mild or moderate - Commences 4-6 weeks after birth and lasts for up to two years Inspiratory stridor worse when supine, during URTI, when feeding Improves when prone Otherwise healthy Severe - FTT, feeding issues, apnoea, cor pulmonale - needs referral to otolaryngology for endoscopic evaluation Management - medical - acid suppression, high calorie diet , posture repositioning Surgical review for severe cases

Answer 26

BT and EPI - toxic, high fever BT - exp and insp stridor EPI - drooling, sitting up in tripod position, no Hib croup - responds to pred, and adrenaline Croup - insp

Answer 27

1. Educate patient on the self limiting nature of illness - explain that cough lasts 2-3 weeks and 90% have cough resolution by 4 weeks. 2. Prescribe paracetamol for fever (sympto mx) 3. Prescribe NSAID for pain (sympto mx) 4. SAFETY NETTING Review if new-onset fever, difficulty breathing, symptoms last greater than 3 to 4 weeks, or bloody sputum 5. If cough persists for more than 8 weeks, need to investigate for causes of chronic cough

Answer 28

SELF LIMITING lower respiratory tract infection involving the large airways, WITHOUT EVIDENCE OF PNEUMONIA, that occurs in the ABSENCE OF COPD

Answer 29

Subset of COPD Cough lasts for more than 3 months in 2 consecutive years

Answer 30

Pneumonia - would have **SIGNS OF SEVERE INFECTION** tachycardia, tachypnoea, rigors, hypoxia, audible crackles + bronhcial breath sounds, percussive dullness etc Acute bronchitis **can't happen in a person with COPD** So this will be a well, fit person with minimal past history and no signs of severity except for a productive cough with sputum **_cough with coloured or purulent sputum does not BY ITSELF need a chest xray or antibiotics_** **_Education, symptomatic mx and safety netting_**

Answer 31

90% is viral Influenza A and B Parainfluenza Respiratory Syncitial virus Corona virus types 1 to 3 Rhinovirus Bacteria are uncommon - bordetella pertussis, mycoplasma pneumoniae

RESP2 Flashcards

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