Respiratory Flashcards
(144 cards)
1
Q
Give two examples of type 1 respiratory failure
A
- PE
- Pneumonia
2
Q
Give two examples of type 2 respiratory failure
A
- COPD
- Asthma
- Emphysema
- Neuromuscular disease
3
Q
Define COPD
A
Progressively worsening, irreversible airflow obstruction
4
Q
What are the subsets of COPD?
A
- Bronchitis
- Emphysema
- A1AT deficiency
5
Q
What is chronic bronchitis?
A
- Hypertrophy + hyperplasia of mucous glands → mucus hypersecretion + ciliary dysfunction → productive cough
- Inflammation → airway narrowing (bronchoconstriction) → limited airflow
Cough for 3+ months, over 2+ years
6
Q
What is emphysema?
A
- Exposure to irritants → degrades elastin in alveoli + airways → air-trapping → poor gas exchange
- ** Loss of elastin → lose elasticity →lungs more compliant (lungs expand + hold air) → exhaling difficulty**
- Dilation + destruction of the lung tissue (distal to terminal bronchioles)
7
Q
A1AT deficiency inheritence pattern
A
Autosomal recessive
8
Q
A1AT Pathology
A
- Alpha-1 antitrypsin = degrades NE (neutrophil elastase) - protects excess damage to elastin layer (esp in lungs)
- A1AT deficiency → Increased NE → (paracinar) emphysema + liver issues
9
Q
Who should you suspect A1AT deficiency in?
A
Younger/middle age men with COPD Sx - but NO SMOKING HISTORY!
10
Q
Rx for COPD
A
- SMOKING
- Air pollution
- Genetic factors (A1AT deficiency)
- Occupational exposure (chemical, vapors, fumes)
- Advanced age
11
Q
Differentiating factor between COPD and asthma
A
COPD = not significantly reversible with bronchodilators (e.g. salbutamol)
COPD obstructive picture = does NOT show a dramatic response to reversibilty testing with beta-2 agonist (e.g. salbutamol) during spirometry testing
12
Q
A 65 y/o who is a long-term smoker presents with:
* Chronic SOB
* Cough
* Sputum production
* Wheeze
* Recurrent respiratory infections (particularly in winter)
Possible diagnosis?
A
COPD
13
Q
What are the signs of COPD?
A
- Barrel chest
- Coarse crackles
- Wheezing on ausculation
- Tachypnoea
- Weight loss
- Hyper-resonance on percussion
- Cor pulmonale
14
Q
Symptoms of COPD
A
- Cough
- Freq. morning
- Usually productive (sputum)
- SOB
15
Q
What are the 2 main pathogens that cause acute exacerbations in COPD?
A
- S. Pneumo
- H. influenzae
16
Q
What does an ‘obstructive’ picture indicate on spirometry?
A
Overall lung capacity is not as bad as their ability to quickly blow air out of their lungs
FEV1/FVC ratio <0.7
17
Q
What is the severity of ariflow obstruction graded by?
A
FEV1
- Stage 1: FEV1 >80% of predicted
- Stage 2: FEV1 50-79% of predicted
- Stage 3: FEV1 30-49% of predicted
- Stage 4: FEV1 <30% of predicted
18
Q
Ix for COPD
A
- Pulse oximetry (low oxygen saturation)
- Spirometry: FEV1/FVC < 0.7 (obstructive picture)
- Diffusing capacity of carbon monoxide (DLCO): Decreased
- CXR: Signs of hyperinflation (flattened diaphragm, hyperexpansion)
- ABG: May should type 2 respiratory failure
- FBC: Anaemia, polycythaemia (rasied Hb) - in response to chronic hypoxia
- Genetic testing: A1AT deficiency
19
Q
What are the grades in the Modified Medical Research Council Dyspnoea Sacle (mMRCD Scale)?
A
- Grade 5 – Unable to leave the house due to breathlessness
- Grade 4 – Stop to catch their breath after walking 100 meters on the flat
- Grade 3 – Breathless that slows walking on the flat
- Grade 2 – Breathless on walking up hill
- Grade 1 – Breathless on strenuous exercise
20
Q
COPD does not cause which extra-pulmonary manifestation?
A
Clubbing!
21
Q
What WBCs underpin the pathology of asthma and COPD?
A
- Asthma = characterised by eosinophillic inflammation
- COPD = characterised by neutrophilic inflammation
22
Q
What is the treatment plan for COPD?
A
In order:
* Smoking cessarion + vaccines (pneumococcal + influenza)
* Step 1: Beta-2 agonists (salbutamol)
* Step 2: SABA (salbutamol) + LABA (salmeterol) + LAMA (tiotropium)
* Long term oxygen therapy at home (must be non-smoker) or the nebulisers (salbutamol and/or ipratropium)
23
Q
What is the O2 target for someone having an COPD exacerbation?
A
88-92%
24
Q
Name 2 complicatiosn of COPD
A
- Cor pulmonale
- Recurrent pneumonia
- Depression
- Polycythaemia
- Respiratory failure
25
What does an ABG look like in an COPD exacerbation?
* Respiratory acidosis + raised bicarbonate (HCO3-)
26
Ix to run if you suspect a COPD exacerbation
* CXR (rule out pneumonia)
* ECG (check for HF)
* CRP (infection)
* Sputum culture
* FBC (rasied WBC count)
* Bloood cultures (if septic)
27
Management of an acute eacerbation in COPD
Home:
* **Prednisolone**
* **Regular inhalers/nebulisers (SABA)**
* **Antibiotics (if infection)**
Hospital:
* **Nebulsied bronchodilators (salbutamol)**
* **Steroids (IV hydrocortisone OR oral prenisolone)**
* Antibiotics (if infection)
* Physiotherapy
More:
* **NIV**
| Antibiotics (amoxicillin)
28
What is asthma?
* Chronic inflammatory reversible airway disease - characterised by REVERSIBLE AIRWAY OBSTRUCTION
* AIRWAY HYPERRESPNSIVENESS & INFLAMED BRONCHIOLES + mucus secretion
29
Triggers
* Infection
* Alergen
* Cold weather
* Exercise
* Drugs (beta-blockers, aspirin)
| Bronchoconstriction = caused by hypersensitivity of the airways
30
What conditions are in the atopic triad?
* Eczema
* Asthma
* Hayfever (atopic rhinitis)
31
Presentation of asthma
* Episodic
* Diurnal variability (worse at night)
* **Dry cough w/ wheeze + SOB**
* **Bilateral widespread 'polyphonic' wheeze **
32
Name soem clinical manifestations that there is another diagnosis, that is not asthma
- Wheeze related to coughs and colds more suggestive of ***viral induced wheeze***
- **Isolated or productive cough**
- Normal investigations
- **No response to treatment**
- **Unilateral wheeze →** this suggests a focal lesion or infection.
33
First line testing for asthma
* Fractional exhaled nitric oxide
* Spirometry with bronchodilator reversibility
- FEV1/FVC <0.7
- Shows good response to bronchodilator (>12% FEV1 increase)
34
Asthma: Name a SABA, ICS, LABA, LTRA, LAMA
* SABA: Salbutamol
* ICS: Beclomethasone
* LABA: Salmeterol
* LTRA: Monkelukast
* LAMA: Tiotropium bromide
35
What is used in the long-term management of asthma?
* SABA
* SABA + ICS
* SABA + ICS + LTRA
36
Mangement for an asthma exacerbation (mnemonic)
OSHITME
* O - Oxygen
* S - Salbutamol (nebulised)
* I - ICS (hydrocortisone)
* T - Theophylline
* M - Magnesium sulfate
* E - Esculate
37
Additional management for asthma
* Annual flu jab
* Annual asthma review
* Advise exercise + avoid smoking
38
Clincial manifestations of an acute exacerbation of asthma
- **Progressively worsening SOB**
- **Use of accessory muscles**
- **Tachypnoea** (fast respiratory rate)
- **Symmetrical expiratory wheeze** on auscultation
- The chest can sound ‘tight’ on auscultation - with reduced air entry
39
What is used to grade acute asthma exacerbations and what are the groupings?
**Peak expiratory flow rate (PEFR)**
* Moderate: 50-75% predicted
* Severe: 33-50% predicted
* Life-threatening: Less than 33% (silent chest - no air entry)
40
What bacterium is tuberculosis caused by?
Mycobacterium tuberculosis
41
What is the staining required for TB?
Zeihl-Neelsen stain
(bacteria turns bright red against blue background)
42
Transmssion of TB
Aerosol transmission
43
How does latent TB present?
* No clincial disease
* Detectable CMI to TB on tuberculin skin test (Mantoux test)
44
What is the primary (Ghon) focus?
**Bacilli** + **macrophages** = coalesce to form a **granuloma**
45
What is a Ghon complex?
Pimary focus + medastinal lymph nodes (enlarged)
46
What are the stages of TB?
- **Active TB** = active TB in various areas within the body
- Majority of cases → immune system = able to kill + clear the infection
- **Latent TB** = The immune system = encapsulates sites of infection → stopping the progression of the disease
- **Secondary TB** = when latent TB reactivated
- **Miliary TB** = When the immune system = unable to control the disease → causes a **disseminated severe disease**
47
How and where may you get extrapulmonary TB?
* Haematogenous dissemination
* TB meningitis
* Pleural TB
* Genito-urinary TB
* Bacilli in lymph nodes
* **Miliary TB**
48
Presentation of TB
* **WEIGHT LOSS + NIGHT SWEATS**
* Cough +/- haemoptysis
* Low grade fever, malaise
Extrapulmonary TB: Lymph node TB (swelling +/- discharge)
49
Ix for TB
First line:
* **Mantoux skin (tuberculin) test**
- Tests for immune response to TB (by previous, latent or active TB)
* **Sputum culture** (**Ziehl-Neelson test** - red is positive)
Other:
* CXR
* Biopsy
50
What vaccine is used for TB?
Neonatal BCG vaccine (live attenuated)
51
What are the drugs used in TB? ANd how long are they given for?
RIPE:
* R - Rifampicin (6 months)
* I - Isoniazid (6 months)
* P - Pyrazinamide (2 months)
* E - Ethambutol (2 months)
52
Give side effects of the TB RIPE drugs
* Rifampicin → **red urine**, hepatitis
* Isonazid → **peripheral neuropathy**, hepatitis
* Pyrazinamide → **rash**, arthralgia, hepatitis
* Ethambutol → **optic neuritis**
rifampicin (“red-an-orange-pissin’”)
isoniazide (“I’m-so-numb-azid”)
ethambutol (“eye-thambutol”)
53
What type of granuloma forms in TB
Caseating granuloma
54
Give a complciation of TB
* Pleural effusion
* Pericardial effusion
* Consolidation
* Pneumothorax
55
If a patients presents with chronic illness, fever and weight loss, what should you suspect?
TB
56
Define pneumonia
* Infection of lung parenchyma
* Causes inflammation of lung tissue + sputum filling the airways + alveoli
* Can be seen as consolidation on an CXR
57
What are the main causative organisms for pneumonia?
* Streptococcus pneumoniae (50%)
* Haemophilus influenzae (20%)
* Pseudomonas aeruginosa in patients with CF or bronchiectasis
58
What is a viral caused pneumonia - that is also an AIDS defining illness?
Pneumocystis pneumonia (PCP)
59
What antiobotic do you not use for atypical pneumonia, and what do you use instead?
* Don't use penicillins
* Use a macrolide (clarithromycin)
* Tetracycline (doxycycline)
60
Give an example of an atypical pneumonia
Legionella pneumophilia (Legionnaire's disease)
| Can cause hyponatraemia
61
How does PCP present?
* Dry cough (with sputum)
* SOB on exertion
* Nigh sweats
62
What is the treatmemt for PCP?
Co-trimoxazole
63
Difference in presentation between typical and atypical pneumonia?
* Typical pneumonia: Productive cough w/ rusty coloured sputum (purulent)
* Atypical pneumonia: Dry cough, low grade fever
64
A patient presents with:
* Productive cough w/ rusty coloured sputum
* Pleuritic chest pain
* Tachypoea
* Dullness to percussion
Possible diagnosis?
Typical pneumonia
* Productive cough w/ rusty coloured sputum (suggests streptococcus pneumoniae)
65
Ix for pneumonia
* 'Point of care' test in primary care
* Pulse oximetry
* CXR (**CONSOLIDATION**)
* Sputum culture + sensitivities
* Urinary antigen
- Legionella spp
- S. pneumoniae
66
What does the CURB65 stand for?
In hospital (CURB65); Out of hospital (CRB65) - no urea
- **C** – **C**onfusion (new disorientation in person, place or time)
- **U** – **U**rea > 7 mmol/L
- **R** – **R**espiratory rate ≥ 30/min
- **B** – **B**lood pressure < 90 systolic or ≤ 60 diastolic.
- **65** – Age ≥ **65**
67
What is the CURB65 core used for?
* Severity assessment of pneumonia
* Predicts mortality
- Score 0/1: Consider treatment at home
- Score ≥ 2: Consider hospital admission
- Score ≥ 3: Consider intensive care assessment
68
What inheritence pattern is CF?
Autosomal recessive
69
What gene (on which chromosome) is affected in CF?
* **Cystic fibrosis transmembrane conductance regulatory (CFTR) gene**
* **Chromosome 7**
70
What ion channel is affected in CF?
Chloride channel
71
How many people are CF carriers?
1 in 25
72
Both parents are healthy, one sibling has cystic fibrosis and a second child does not have the disease, what is the likelihood of the second child being a carrier?
2 in 3
73
What are 3 major complications in CF?
- **Thick pancreatic + biliary secretions → blockage of ducts → lack of digestive enzymes**
- E.g. pancreatic lipase in the digestive tract
- **Low volume thick airway secretions → reduce airway clearance → bacterial colonisation → airway infection susceptibility**
- **Congenital bilateral absence of the vas deferens**
- Patients = generally have healthy sperm → but no way of getting from the testes to the ejaculate → male infertility
74
Sign of CF in neonates
**Meconium ileus**
**Low weight or height on growth charts**
- Recurrent lower respiratory tract infections
- Failure to thrive
- Pancreatitis
75
Signs of CF
* **Low weight or height on growth charts **
* Finger clubbing
* Crackles + wheexe on ausculation
* Abdominal distension
* Genital abnormalities in males
76
Symptoms of CF
* **Chronic cough (wet sounding cough)
* Thick sputum production
* Recurrent respiratory tract infections
* Steatorrhoea**
* Abdominal pain + bloating
77
A yound child presents with recurrent lower respiratory tract infections, pancreatitis and failure to thrive. Possible diagnosis?
Cystic fibrosis
78
What are the investigations for CF?
* Newborn bloodspot test (screening)
* **Sweat test (Na+ + Cl- >60mmol/L) = diagnostic**
* Genetic testing for GFTR (amniocenteses)
79
What are the 2 most common colonising bacteria in CF patients?
* **Staphylococcus aureus** → prophylactic **flucloxacillin**
* **Pseudomonas aeruginosa** → difficiult to treat + **worsens prognosis**
80
Which antibiotic do you use for pseudomonas aeruginosa in CF?
Oral ciprofloxacin
81
First line treatments for CF
* Chest physiotherapy
* High calorie diet (malabsorption + increased respiratory effort)
Medication:
* Prophylactic flucloxacillin
* Bronchodilators (salbutamol)
* Vaccinations (Pneumococcal, Influenza, Varicella)
* Treat chest infections when they occur
82
Complications of CF
* **Failure to thrive + delayed puberty**
* **Depression + anxiety**
* **Chronic respiratory failure**
* Cor Pulmonale
* **Diabetes mellitus**
* Acute/retention pancreatitis (**pancreatic insufficiency**)
* **Liver disease**
83
Complication of mediastinal shift in a pneumothorax or pleural effusion
Impaired cardiovascular function
84
Define pleural effusion and the different types
Pleural effusion = abnormal collection of fluid in the pleural cavity
* Exudative → high protein count (>3g/dL) (**cloudy**)
* Transudative → lower protein count (<3g/dL) (**transparent**)
* Transudative or exudative = helps determine the cause
85
Name an exudative cause of pleural effusion
- Exudative causes = related to **inflammation**
- Inflammation → results in protein leaking out of the tissues into the pleural space
- **Ex- → moving out of lung tissue**
- Exudative causes → think causes of inflammation:
- **Lung cancer**
- **Pneumonia**
- Rheumatoid arthritis
- **Tuberculosis**
86
Name a transudative cause of pleural effusion
- Transudative causes = relate to **fluid moving across into the pleural space**
- Trans- → moving across
- Transudative causes = think about causes of **fluid shifting**
- **Congestive heart failure**
- **Hypoalbuminaemia**
- Hypothyroidism
87
Pathology of pleural effusion
* Excess fluid accumulates in pleural space
* Lung expansion limited → **impaired ventilation**
88
A patient presents with SOB, O/E, has reduced breath sounds and dullness to percussion over the effusion. Possible diagnosis?
Pleural effusion
89
What are the signs of a pleural effusion?
* Reduced breath sounds
* Dullness to percussion over the effussion
* Decreased or absent tactile fremitus
* If massive: Tracheal deviated away from the effusion + mediastinal shift
90
What are the symptoms of a pleural effusion?
* SOB
* Pleuritic chest pain
* Cough
91
What is empyema?
Infected pleural effusion
(Suspect in a patient with pneumonia with new or ongoing fever)
(Treated with chest drain + antibiotics)
92
Ix for pleural effusion
* 1st + GS: Postero-anterior and lateral CXR
* Other: Thoracentesis → sample of pleural fluid (from aspiration + chest drain)
93
What CXR results are seen in a pleural effusion?
* **Blunting** of the **costophrenic angle**
* **Fluid** in lung **fissures**
* Larger effusion → **meniscus**
* Massive effusion → **tracheal + mediatstinal deviation**
94
What do you look for thoracentesis in a pleural effusion?
* Protein count (exudate or transudate)
* Cell count
* pH
* Microbiology testing
95
Treatment for a pleural effusion
- **Small effusions → Conservative management + treatment of underlying cause**
- E.g. Heart failure → diuretic
- **Larger effusions → aspiration or chest drain**
96
What is a pneumothorax?
**Air in the pleural space/cavity**
* Separating the lung from the chest wall
* Can be primary (spontaneous) or secondary (trauma/pathology)
97
What is a tension pneumothorax?
* ** One-way valve** formed by damaged tissue air enters + can’t escape → intrathoracic pressure build up → **impaired cardiac + respiratory function**
98
Who is the typical patient that presents with pneumothorax?
* **Young, tall, thin, young man**
* Present with **sudden breathlessness + pleuritic chest pain** (possibly playing sports)
99
Rx for a pneumothorax
- **Smoking**
- **Tall and slender body build**
- **Age less than 40 years**
- **Male**
- **Recent invasive medical procedure**
- **Chest trauma**
- **Acute severe asthma**
- COPD
- Tuberculosis
- Cystic fibrosis
- **Changes in atmospheric pressure**
100
Pathology of a pneumothorax
- Air enters through damage to chest wall/lung/gas-producing microorganisms
- **Positive pressure** in the **pleural space** if air enters → **lung partial/complete collapse**
101
Symptoms of pneumothorax
* **Sharp chest pain (one-sided)**
* Dyspnoea
* Hypercapnia → confusion, coma
102
What are the signs of a pneumothorax?
- **Reduced/absence of breath sounds (affected side/ipsilateral)**
- **Hyperresonance to percussion**
- Tachycardia
- Cyanosis
103
Ix for a pneumothorax
* 1st: **Postero-anterior CXR**
- Excess fluid = appears black
- Absence of lung markings between the lung margin + chest wall
* Gold standard: **CT Chest**
- Can detect small pneumothorax (that CXR wont pick up on)
- Detects underlying pathology
104
What is the most common ABG findining in a penumothorax?
Respiratory alkalosis
105
Differentials for a penumothorax
- **Asthma, acute exacerbation**
- **COPD, acute exacerbation**
- **Pulmonary embolism**
- **Pleural effusion**
106
Treatment for a pneumothorax
* No SOB + less than 2cm air on CXR → **no treatment required** (maybe supplememtal oxygen)
* **SOB** and/or **more than 2cm air** on CXR → percutaneous **aspiration**
* If aspiration fails twice or unstable, bilateral, or secondary → **chest drain **
107
Where is a chest drain inserted?
In the 'triangle of safety'
* The 5th intercostal space
108
What is the management sentence for chest drain for a tension pneumothorax?
“Insert a large bore cannula into the second intercostal space in the midclavicular line.”
109
What is a tension pneumothorax?
* Tension pneumothorax = caused by trauma to the chest wall → creates a one-way valve (lets air in + not out of the pleural space)
* **Tension pneumothorax** = dangerous as it creates pressure inside of the thorax → **pushes the mediastinum across** → **kink** the **big vessels** in the **mediastinum** → **cardiorespiratory arrest**
110
Difference in presentation between a pneumothorax and a tension pneumothorax
* Pneumothorax: Dyspnoea + chest pain
* Tension pneumothorax: Patients are distressed with rapid laboured respirations + cyanosis + profuse diaphoresis + tachycarida
111
What is an interstitial lung disease?
* Umbrella term used to describe conditions that affect the lung parenchyma (the lung tissue) → causing **inflammation + fibrosis**
* Between **inflammatory + fibrosing (scarring)** → ILDs are within a spectrum
112
Pathology of interstitial lung disease
* Interstitial lung disease → **thin membrane = thickens** → **little carbon monoxide** goes into the capillary → **stays in the lung** → goes into expiratory breath → transfer factor of the lung for carbon monoxide **(TLCO) = reduced**
* Oxygen (+ other gas) uptake = reduced in ILD
113
What is a diagnosis of interstitial lung disease a combination of?
Clinical features + High resolution CT thorax
(Unclear disease → take lung biopsy → confirm diagnosis on histology)
114
Describe the appearance of an intersitial lung disease on a high resolution chest CT
'**Ground glass**' appearance
115
Ix for interstitial lung disease
* Incremental shuttle walk test
* Six-minute walk test
* High resolution chest CT
116
What is idiopathic pulmonary fibrosis?
Idiopathic pulmonary fibrosis = causes **scarring of the lung tissue later in life**
117
Pathology of idopathic pulomonary fibrosis
* **Myofibroblasts** deposit **collagen** in the extracellular matrix → **thickened lung tissue** → cannot inflate properly → lung volume decreases over time
* The **thickened tissue** leads to **lower gas exchange efficiency** in the lungs
118
What are the two drugs for idiopathic pulmonary fibrosis?
* Pirfenidone
* Nintedanib
119
What is key in the treatment of intersitial lung disease?
* Removal of antigen in hypersensitivity pneumonitis
* Removal of drug in drug-induced pulmonary fibrosis
120
Who is idiopathic pulmonary fibrosis most commonly seen in?
Oler men (60) who smoke
121
What type of respiratory failure is idiopathic pulmonary fibrosis?
Type 1 respiratory failure
122
Sx of idiopathic pulmonary fibrosis
* Exertional dyspnoea
* Dry unproductive cough
123
What are the investigations for idiopathic pulmonary fibrosis?
* First line: **Spirometry → restrictive**
- FEV1:FVC >0.7 BUT FVC is decreased (<0.8 normal)
* Gold-standard: **High resolution chest CT**
- **Ground glass lungs** + traction bronchiectasis
124
Treatment of idiopathic pulmonary fibrosis
* Smoking cessation + vaccines
* Pirfenidone, ninetedanib
* Surgery (lung transplant)
125
Treatment of idiopathic pulmonary fibrosis
* Smoking cessation + vaccines
* Pirfenidone, ninetedanib
* Surgery (lung transplant)
126
What underlying disease should you treat in interstitial lung disease?
Connective tissue disease
127
What drugs cause drug-induced pulmonary fibrosis?
* Methotrexate
* Amiodarone
* Nitrofurantoin
* Cyclophosphamide
128
What is hypersensitivity pneumonitis and what type of hypersensitivity reaction is it?
* Hypersensitivity pneumonitis = type III hypersensitivity reaction - to a environmental allergen
* Causes parenchymal inflammation + destruction in people that are sensitive to that allergen
129
What is key to investigate hypersensitivity pneumonitis?
Clinical history = key
* Pets
* Mould
* Occupation
130
Ix for hypersensivity pneumonitis
* Bronchoalveolar lavage (BAL) - raised lymphocytes
* CT chest (ground-glass shadowing)
* Serum IgG (positive)
* Pulmonary function test (restrictive; mixed restrictive/obstructive)
* TLCO (decreased)
131
Types of hypersensitivity pneumonitis
- ***Bird-fanciers lung*** is a reaction to bird droppings
- ***Farmers lung*** is a reaction to mouldy spores in hay
- ***Mushroom workers’ lung*** is a reaction to specific mushroom antigens
- ***Malt workers lung*** is a reaction to mould on barley
132
Mx of hypersensitivity pneumonitis
* Identification + removal of antigen
* Prednisolone (orally)
* Smoking cessation, pulmonary rehabilitation, supplemental oxygen
133
Name a disease that causes secondary pulmonary fibrosis
* Alpha-1 antitripsin deficiency
* Rheumatoid arthritis
* Systemic lupus erythematosus (SLE)
* Systemic sclerosis
134
What is sarcoidosis?
A granulomatoid inflammatory condition
(Granulomas = nodules of inflammation full of macrophages)
135
Typical patient that presents with sarcoidosis
20-40 black woman with a dry cough and shortness of breath. She has nodules on her shins - suggesting erythema nodosum.
| May also have uritis
136
What does sarcoidosis do to the lungs?
* Mediastinal **lymphadenopathy**
* Pulmonary **fibrosis**
* Pulmonary nodules/**granulomas** (contain macrophages)
137
First line and gold-standard Ix for sarcoidosis
* First line: CXR (hilar lymphadenopathy)
* Gold standard: Biopsy (non-caseating granuloma)
138
Management of sarcoidosis
* Oral steroids (prednisolone)
* Immunosupressants (methotrexate or azathioprine)
139
What is pulmonary hypertension?
* Increased pressure + resistance of blood in the pulmonary arteries
* mPAP > 25mmHg
140
What are some causes of pulmonary hypertension?
- Pulmonary vascular disorders → PE
- Disease of lung and parenchyma → COPD
- Cardiovascular → Mitral stenosis, LV HF, congenital heart disease
141
What happens due to pulmonary hypertension?
Increased pressure + resistance in the pulmonary arteries causes:
* Strain on the right side of the heart → trying to pump through the lungs
* Also, causes a back pressure of blood into the systemic venous system
142
What is the presentation of pulmonary hypertension?
* Exertional dyspnoea + fatigue + syncope
* Right-sided heart failure signs
- Raised JVP
- Peripheral oedema
- Louder S2 than normal
143
Ix for pulmonary hypertension
ECG:
* Right ventricular hypertrophy
* Right bundle branch block
* Right axis deviation
CXR:
* Dilated pulmonary arteries
* Right ventricular hypertrophy (elevated cardiac apex)
Echo = can be used to estimate pulmonary artery pressure
144
Treatment for pulmonary hypertension
* **Sildenfil** (phosphodiesterase-5 inhibitors)
* CCB (**amlodipine**)
* Treat underlying cause (PE or SLE)
* Diuretics for oedema
