Respiratory Flashcards
(34 cards)
Interstitial Lung Disease
What are the causes of interstitial lung disease?
- Idiopathic (IPF/Cryptogenic fibrosing alveolitis)
- Inhaled agents (Hypersenitivity pneumonitis/EAA, Astestosis, Berylliosis, Silicosis)
- Rheumatological (RA, SLE, SS sclerosis, DM, PM, MCTD, Ankylosing spondylitis)
- Vasculitic (PAN, GPA, EGPA)
- Granulomatous (Sarcoidosis)
- Infectious (TB, ABPA)
- Drugs (Amiodarone, Nitrofurantoin, Busulphan, Bleomycin, Methotrexate)
- Radiation
- Genetic (NF, Tuberous sclerosis)
Interstitial Lung Disease
What are the causes of apical fibrosis?
SCHART
- Silicosis, Sarcoidosis
- Coal Worker’s Pneumoconiosis
- Histiocytosis
- Ankylosing Spondylitis, ABPA
- Radiation
- Tuberculosis
Interstitial Lung Disease
What are the causes of basal fibrosis?
RASIO
- Rheumatoid Arthritis
- Asbestosis
- Systemi Sclerosis
- Idiopathic pulmonary fibrosis and Hamman-Rich syndrome
- Other (Drugs: busulphan, bleomycin, nitrofurantoin, hydralazine, MTX, amiodarone)
Pleural Effusion
What are Light’s Criteria?
Light’s criteria for an exudate:
1)Pleural protein: Serum protein >0.5
2)Pleural LDH: Serum LDH >0.6
3)Pleural LDH >2/3 upper limit of normal serum value
Require 1 criteria to diagnose as exudate
Pleural Effusion
What are the causes of an exudative pleural effusion?
- Infection: Pneumonia, Tuberculosis.
- Inflammation: :RA, SLE, Sarcoidosis.
- Ischaemia/Infarction: PE
- Malignancy: Lung carcinoma, Mesothelioma, Secondary malignancy, Lymphoma, Meig’s syndrome (ovarian fibroma).
- Drugs: Methysergide, Methotrexate, Bromocriptine, Nitrofurantoin
Pleural effusion
What are the causes of a transudative pleural effusion?
- Cardiac: CCF, Constrictive pericarditis
- Liver: Cirrhosis, Hypoalbuminaemia
- Renal: Nephrotic syndrome, Uraemia.
- Hypothyroidism
Pleural Effusion
What are the criteria for a complicated parapneumonic pleural effusion?
A complicated parapneumonic effusion requires chest drainage:
- > 50% Hemithorax
- Loculated
- Turbid
- pH < 7.2
- LDH >1000
- Glucose <3.4
Pleural Effusion
What are the criteria for an empyema?
An empyema requires chest drainage:
- Positive culture
- Frank pus on pleural tap
- > 50% Hemithorax
- pH <7.2
- LDH >1000
- Glucose <3.4
Bronchiectasis
What are the causes of bronchiectasis?
- Respiratory Childhood Infections: Measles, Pneumonia, TB, ABPA
- Bronchial Obstruction: Foreign body, Endobronchial tumour
- Immunodeficiency: Congenital & Acquired Hypogammaglobulinaemia, AIDS
- Autoimmune Diseases, RA, SS, IBD
- Mucociliary Clearance Defects: CF, Immotile cilia syndrome, Kartagener’s syndrome, Young syndrome, Yellow Nail Syndrome
SVC Obstruction
What are the causes of SVC obstruction?
- Malignancy: Lymphoma (NHL>HL), Bronchial carcinoma (SCLC)
- Mediastinal Masses: Goitre, Thymoma, Mediastinal fibrosis, Thoracic aortic aneurysm
- Central Venous Thrombosis: Complication of central venous catheters, Thrombophilic disorders
Lung Consolidation
What are the causes of a cavitating lung lesion?
Infection, Malignancy, Vasculitis
- Infection/lung abscess: TB, Aspergilloma, Histoplasmosis, Coccidiomycosis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Anaerobic infections
- Non-Infectious: Malignancy, GPA, Pulmonary rheumatoid nodule, Caplan’s syndrome
What are the clinical features of sarcoidosis?
Systemic: fever, wt loss
Pulmonary: cough, sob, nasal congestion
CXR: hilar lymphadenopathy, pulmonary fibrosis
Eye: uveitis
Skin/arthralgia: erythema nodosum; lupus pernio nose
Nerve: neuropathy/palsied; facial nerve palsy
Cardiac: arrhythmia
Investigations for sarcoidosis?
- FBC: lymphocytopenia, eosinophilia
- ESR
- ACE level
- CXR, CT chest
- PFT, ABG
- bronchoscopy and biopsy
- LN biopsy
Treatment for sarcoidosis?
- indications: - increasing symptoms, worsening lung function, Neuro/renal/cardiac/eye complications
- prednisone 1mg/kg 1 yr taper
- if long term Rx needed: MTX, AZA
- hydroxychloroquine for skin disease
- infliximab: 3rd line
What are causes of clubbing?
- resp: lung ca, bronchiectasis, CF, Idiopathic pulmonary fibrosis
- cardiac: cyanotic congenital heart disease, IE
- GI: cirrhosis, IBD, Coeliac
- thyrotoxicosis
What us the differential for bilateral crackles?
- pulmonary edema/cardiac failure
- bronchiectasis
- atelectasis
- bilateral pneumonia
- pulmonary fibrosis (fine crackles)
What is the differential for a lung mass on imaging?
- carcinoma - primary or metastatic
- lung abscess
- TB
- pulmonary infarct
- granuloma: I.e. Fungal
What are the signs of asthma severity?
- symptoms throughout day
- nightly symptoms >7x/week
- SABA use several times a day
- extreme interference with normal activity
- FEV1
How to investigate asthma?
- spirometry: obstructive, reversible 12%
- bronchial challenge testing if normal spiro
- PEF for monitoring
- allergen skin testing
How would you manage asthma? (Maintenance Rx)
Non pharm: - allergen avoidance, smoking cessation - asthma action plan Pharm: - vaccinations - SABA - ICS alone - ICS/LABA combination - prednisone - treat GORD, if present
How to diagnose sleep apnea?
- sleep study: apnea-hypopnea index (severe >60)
- ABG
What is the PAP for dx of pulmonary HTN?
> 25 at rest
Or
30 with exercise
What investigations for pulmonary HTN?
- CXR
- PFT
- ECG
- ABG
- CTPA or VQ
- HRCT
- TTE
- R heart cath
- 6min walk test
What are the types/classes of pulm HTN?
- Pulmonary arterial HTN
- From L heart disease
- Due to lung disease
- Due to chronic PE
- Unclear multifactorial mechanisms
