Respiratory Medicine Flashcards
what are the two main types of intrinsic diseases that damage the lung parenchyma?
- interstital lung diseases
2. alveolar oedema or haemorrhage
what are the 4 main causes of interstitial lung disease?
- pneumoconiosis
- sarcoidosis
- idiopathic pneumonitis
- Hypersensitivity pneumonitis
what are the three categories, and some examples, of extrapulmonary/extrinsic causes of restrictive lung disease?
- Pleural disease
- chronic effusions
- adhesions
- PTX
- Thoracic deformaties or restrictions
- kyphoscoliosis
- obesity
- ankylosing spondylitis
- ascites
- pregnancy
- pectus excavatum
- Neuromuscular weakness
- ALS
- GBS
- myasthenia gravis
what are common symptoms of Restrictive lung disease across all aetiologies?
- cough
- dyspnoea
- tachypnoaea
- weight loss
- Bibasilar, inspiratory crackles or rales on auscultation -> HALLMARK
Advanced disease - digital clubbing
- cyanosis
- Loud inspiratory wheeze
- symptoms due to underlying cause
what are the findings on Spirometry for restrictive lung diseases?
- what are the findings on Spirometry for restrictive lung diseases?
- reduced TLC
- FEV1 and FVC are also often reduced
- FEV1/FVC are normal or increased
- appearance of spirometry trace in that of a narrowed normal flow volume loop.
What does interstital lung disease look like on CT?
ground glass appearance
what are the principles of treatment for restrictive lung diseases?
- smoking and other irritant inhalation cessation
- supportive care
- Management specific to cause → bronchodilators, corticosteroids or immune modulators
- management for IPF→ antifibrotic agents
- Lung transplantation only definitive treatment
What is the hallmark presentation for idiopathic pulmonary fibrosis?
1) cough
2) dyspnoae
3) FINE, ‘VELRCO’ BIBASILAR CREPS ON END INSPIRATION
What are the common causes of finger clubbing?
Cardiovascular:
1) Cyanotic congenital heart disease
2) Infective endocarditis
Respiratory:
1) Lung carcinoma
2) Chronic pulmonary suppuration
- Bronchiectasis
- lung abscess
- empyema
3) Idiopathic pulmonary fibrosis
What are uncommon causes of finger clubbing?
Respiratory:
1) CF
2) Asbestosis and mesothelioma
Gastro:
1) cirrhosis -> billiary mainly
2) IBD
3) Coeliac disease
What are the two main categories of TB?
- Primary tuberculosis
- initial infection of M.tuberculosis
- may cause primary progressive disease in immunocompromised people → but usually results in latent infection as immunity develops - Post primary tuberculosis
- results from either reactivation of a latent primary infection or from the repeat infection of a previously sensitised host
how is TB identifies in infected individuals?
Ziehl-Neelsen Stain
Describe the pathophysiology of primary TB infection
- inhaled infectious droplets reach terminal alveoli and are ingested by alveolar macrophages
- inhibition of phagolysosome fusion allows M.TB to survive within macrohage as an intracellular infection → replication, lysis and spread
- Cell-mediated immune response develops with activation of CD4+ T cells to the focus of infection to stimulate macrophages (via IFNy)
- granuloma formation to limit spread of infection → basically and immune focus of caseating necrosis containing macrophages and mycobacteria surrounded by lymphocytes
what are the 3 types of granulomas seen in TB?
- Ghon focus
- primary TB granuloma usually in middle or lower lung lobes
- Ghon complex
- Ghon focus + involvement of draining lymphatics and hilar node
- Ranke complex
- evolution of ghon complex resulting from fibrosis and calcification
what are the Pulmonary signs and symptoms of primary progressive or reactivation TB infection?
Signs
- pallor
- dullness to percussion of areas of consolidation
- Hyperresonance over areas of cavitation
- crepitations, bronchial breath sounds
Symptoms
- Constitutional symptoms
- purulent sputum with occasional haemoptysis
- pleuritic chest paun
- dysnpoea
