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T Year > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

(71 cards)

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1
Q

What is COPD made up of?

A

chronic bronchitis

emphysema

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2
Q

COPD spirometry

A

obstructive

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3
Q

Long term complications of COPD

A

cor pulmonale

from pulmonary hypertension

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4
Q

CURB-65 score

A 
confusion
urea >7
RR >30
BP <90/60
Age >65
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5
Q

HAP

A

occurs 2 days or more after admission

gram negative bacteria: klebsiella, e.coli, pseudomonas

s.aureus, s.pneumonia

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6
Q

CAP

A

strep pneumoniae most common cause

influenza and other viruses also

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7
Q

aspiration pneumonia

A

high risk in intoxicated patients, acute stroke patients, those with impaired swallowing and septic patients with reduced consciousness

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8
Q

Diffuse parenchymal lung diseases

A

large group of conditions characterised by inflammation centres on the interstitial of alveolar walls

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9
Q

Causes of diffuse parenchymal lung diseases

A 
unknown cause
pneumoconioses
extrinsic allergic alveoli's
side effects of treatment
multisystem diseases
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10
Q

long term complications of DPLDs

A

cor pulmonale

from pulmonary hypertension

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11
Q

Lung cancer peak age group

A

50-60

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12
Q

lung cancer risk factors

A

cigarette smoking
industrial hazards
environmental exposure
genetic factors

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13
Q

what is the most common type of lung cancer

A

adenocarcinoma

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14
Q

other common types of lung cancer

A

ADENOCARCINOMA
SCC
Small cell carcinoma
large cell carcinoma

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15
Q

SCC in lung cancer

A

strong association with smoking
tends to be in the larger airways near the hilum
graded as well/moderately/poorly differentiated

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16
Q

Adenocarcinoma in lung cancer

A

increasing incidence
most common type of cancer in non smokers (EGFR mutations??)
tends to arise in smaller peripheral airways
graded as well/moderately/poorly differentiated

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17
Q

Small cell carcinoma

A

strongest association with smoking
usually central location
highly aggressive tumour
not graded

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18
Q

Large cell carcinoma

A

undifferentiated carcinomas that can’t be otherwise categorised microscopically

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19
Q

how is tissue sampling and diagnosis of lung cancer done

A

central lesions - bronchoscopy

peripheral lesion - CT guided sampling

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20
Q

staging of lung cancer

A

TNM system

CT or PET/PET-CT imaging

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21
Q

symptoms and signs of lung cancer

A 
cough
haemoptysis
stridor/wheeze
hoarse voice
breathlessness
chest wall pain
no-resolving pneumonia

SVC obstruction - facial swelling

B symptoms

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22
Q

Pancoast tumours

A

cancer in the apex of the lung which involves the 8th cervical and 1st and 2nd thoracic nerves

may manifest as pan coasts syndrome - shoulder pain radiating in an under distribution down the arm or as Horner’s syndrome

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23
Q

Horner’s syndrome

A

enophthalmos
ptosis
mitosis
anhidrosis

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24
Q

Paraneoplastic syndromes

A

HYPERCALCAEMIA - production of a PTH related peptide which causes the release of calcium form the bones

SIADH - leads to inappropriate water reabsorption, cerebral oedema, drowsiness, confusion

ACTH secretion - cushing’s syndrome

Lambert Eaton myasthenia syndrome (LEMS) - typically associated with small cell carcinomas. autoantibodies block VGCC in he presynaptic membrane blocking ACh release.

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25
Management of lung cancers
SCLC - highly aggressive, surgery has little role, chemotherapy, soon become chemoresistant NSCLC - surgery is a possibility if disease stage is low and chemotherapy is also used
26
Mesothelioma
malignant tumour of the pleura associated with asbestos exposure long latency period most patients are men over 60 with breathlessness and chest pain, often with a pleural effusion occupational history is important
27
Asbestosis
a type of DPLD diffuse fibrosis of the lung parenchyma due to asbestos need very high levels of asbestos exposure so this is rare usually present with gradually worsening breathlessness which terminates in chronic respiratory failure
28
Signs and Symptoms of COPD
``` Barrel chest Tripod position, accessory muscle use Red face (polycythaemia) Hyper resonance Tachypnoea Reduced expansion Wheeze Signs of RHF/cor pulmonate Chronic productive cough Breathless at rest Recurrent Infections ```
29
Causes of COPD
``` SMOKING alpha-1 antitrypsin environmental/occupational hazards IVDU immunodeficiency ```
30
COPD investigations
Spirometry FBC (polycythaemia) alpha-1 antitrypsin ABG (T2RF) CXR (hyperinflation, prominent pulmonary arteries, flattened hemidiaphragms) ECG - P pulmonale, RVH, right axis deviation
31
Acute management of an infective exacerbation of COPD
``` BOSA bronchodilators (salbutamol, ipratropium) Oxygen Steroids Antibiotics ```
32
Long term management of COPD
conservative - smoking cessation medical - steroids, salbutamol, theophylline, sodium chromoglycate (mucolytic), LTOT surgical - removal of bullae
33
Signs of asthma
``` tachypnoea widespread polyphonic wheeze reduced air entry signs of atopy e.g. eczema intermittent SOB cough (often nocturnal) sputum ```
34
Triggers of asthma
``` airborne substances respiratory infections exercise induced cold air air pollutants and irritants e.g. smoke medications emotion and stress ```
35
investigations of asthma
serial peak flow peak flow diary in the morning and evening and will see the diurnal variation
36
management of asthma attack
OSHIT ``` oxygen salbutamol hydrocortisone ipratropium theophylline/magnesium sulphate ```
37
Asthma BTS management guidelines
1. Inhaled SABA as required 2. add ICS 200-800microg/day 3. add LABA 4. increase ICS dose up to 2000microg/day 5. daily steroid tablet 6. refer patient for specialist care
38
Presentation of PE
``` dyspnoea - sudden onset haemoptysis tachycardia elevated JVP pleuritic chest pain tachycardia/palpitations ```
39
Causes of PE
DVT (70% from proximal thighs) usually thrombus from veins of thigh or pelvis, embolisms via right heart into pulmonary arteries
40
Risk factors for PE
SPASMODICAL ``` sex: female pregnancy age increasing surgery malignancy oestrogen DVT/PE history immobility colossal size antiphospholipid antibodies lupus anticoagulant ```
41
investigations of PE
bedside - obs (sats, BP) bloods - ABG (resp failure) imaging - CTPA, CXR WELLS SCORE to determine use of D-Dimer or not
42
treatment of PE
oxygen heparin thrombolysis warfarin/NOAC
43
presentation of pulmonary effusion
``` tachypnoea possible coughing hand signs increased JVP stony dullness on percussion unilateral reduced expansion SOB pleuritic chest pain tracheal deviation away from the effusion ```
44
causes of transudate pleural effusion
heart failure kidney failure liver failure fluid overload in general
45
causes of exudate pleural effusion
malignancy infection inflammation rheumatoid arthritis
46
what is lights criteria for pleural effusion?
it is in exudate IF one or more of the following... pleural fluid protein: serumfluid protein >0.5 pleural fluid LDH:serum LDH >0.6 pleural fluid LDH >2/3 the upper limit of normal serum
47
risk factors of primary pneumothorax
``` young athletes tall people marina's syndrome smokers age >55 ```
48
causes of secondary pneumothorax
COPD bullae rupture | ILD
49
presentation of pneumothorax
``` tachycardia reduced expansion hyperresonance decreased TVF:VR decreased breath sounds tracheal deviation SOB pleuritic chest pain sudden onset ```
50
HAP organisms
gram negative klebsiella e.coli pseudomonas staph haem
51
CAP abx
amoxicillin | doxycycline
52
HAP abx
gentamycin
53
aspiration pneumonia abx
metronidazole
54
symptoms of TB
``` productive cough haemoptysis fever weight loss night sweats ```
55
What needs to be asked about when considering a diagnosis of TB?
living conditions recent contact previous illness (latent TB)
56
causes of reactivation of TB
``` corticosteroids HIV malnutrition age end stage CKD chemotherapy ```
57
TB treatment
(6 months of therapy) RIPE for 2 RI for 4 Rifampicin (hepatitis, stains body fluids pink) Isoniazid (polyneuropathy at high doses0 Pyrazinamide (hepatitis) Ethambutol (optic neuritis)
58
difference between T1 and T2 respiratory failure
T1: hypoxia with normal or low CO2 T2: hypoxia and hypercapnia
59
symptoms of hypoxia
``` dyspnoea restlessness agitation confusion central cyanosis polycythaemia pulmonary hypertension cor pulmonale ```
60
symptoms of hypercapnia
``` headache peripheral vasodilation tachycardia bounding pulse tremor/flap papilloedema confusion coma drowsiness ```
61
causes of T1RF
VQ mismatch hypoventilation abnormal diffusion R to L cardiac shunts
62
causes of T2RF
pulmonary disease: asthma, COPD, pneumonia reduced respiratory drive: sedatives, CNS tumour or trauma neuromuscular disease: cervical cord lesion, poliomyelitis, GBS, diaphragm paralysis thoracic wall disease: flail chest, kyphoscoliosis
63
examples of VQ mismatch
``` pneumonia PE emphysema ARDS pulmonary oedema asthma pulmonary fibrosis ```
64
what is bronchiectasis
chronic inflammation of the bronchi and bronchioles leading to permanent dilatation and thinning of the airways
65
symptoms of bronchiectasis
gradual onset productive cough SOB chest pain
66
causes of bronchiectasis
congenital: CF, young, primary ciliary dyskinesia post infection: measles, pertussis, bronchiolitis, TB, pneumonia, HIV other: obstruction, allergic, RA, UC, idiopathic, hypogammaglobulinaemia
67
treatment of bronchiectasis
airway clearance techniques and mucolytics antibiotics bronchodilators corticosteroids surgery may be indicated in localised disease or to control severe haemoptysis
68
what is cystic fibrosis?
an autosomal recessive disorder defective airway surface liquid secretion, disposing the lung to pulmonary infections and bronchiectasis
69
what are the signs and symptoms of cystic fibrosis
signs: cyanosis, finger clubbing, bilateral coarse crackles neonate: failure to thrive, meconium ileum, rectal prolapse children/YA: rest (wheeze, cough, infections, haemoptysis, pneumothorax, etc), GI (pancreatic insufficiency, gallstones, obstruction, cirrhosis), other (male infertility, osteoporosis, vasculitis, nasal polyps, sinusitis)
70
signs and symptoms of interstitial lung disease
``` abnormal breath sounds abnormal CXR or HRCT restrictive pulmonary spirometry with decreased DCLO dyspnoea on exertion non productive paroxysmal cough abnormal breath sounds ```
71
causes of ILD
``` inhaled substances drug induced CI and AI disorders infection malignancy ```

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