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Respiratory System > 20) ILD and Pleural Diseases > Flashcards

20) ILD and Pleural Diseases Flashcards

1
Q

What is the interstitial space?

A

Potential space between alveolar cells and capillary basement membrane, only apparent in disease states

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2
Q

What can the interstitial space contain?

A

Fibrous tissue
Cells
Fluid

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3
Q

What is the function of the interstitium?

A

Supports lung
Allows collagen formation (repair and remodelling)
Releases cytokines

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4
Q

What structures can interstitial lung disease affect?

A

Alveoli, bronchioles, endothelium, mesenchymal and macrophage cells

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5
Q

How does fibrous tissue in interstitium affect lung function?

A

Less compliant lungs, decreased ventilation
Reduced diffusion - longer pathway
Reduced perfusion - capillary destruction

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6
Q

What does development of fibrous tissue in interstitium lead to?

A

Type 1 and then type 2 resp failure

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7
Q

What are some general symptoms of ILD?

A

Chronic shortness of breath, chronic cough, reduced exercise intolerance

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8
Q

What are some general signs of examination in ILD?

A 
Cyanosis
Tachycardia
Tachypnoea
RHF
Clubbing
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9
Q

Give some examples of occupational ILD:

A

Asbestosis, coal worker pneumoconiosis, silicosis

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10
Q

Give some examples treatments causing treatment related ILD:

A 
Radiation 
Methotrexate (Ra, sarcoid, chemo)
Nitrofuratoin (UTI)
Amiodarone (arrhythmias)
Bleomycin (lymphoma)
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11
Q

Give some examples of connective tissue disease causing ILD:

A

Rheumatoid arthritis
Lupus
Scleroderma

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12
Q

Give some examples of immunological ILD:

A

Sarcoidosis

Hypersensitivity pneumonitis

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13
Q

Give the main example of idiopathic ILD:

A

Idiopathic pulmonary fibrosis

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14
Q

What is idiopathic pulmonary fibrosis?

A

Progressive inflammatory condition of lungs with tissue destruction and fibrosis

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15
Q

When do those with IPF usually present and how are they diagnosed?

A

60-80 years

By CT

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16
Q

How does IPF present on CXR?

A

Small lungs with micronodular shadowing in lower lobes

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17
Q

What causes asbestosis and what does this lead to?

A

Inhalation of fibres

Leads to asbestos plaques and pleural thickening

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18
Q

How does asbestosis present on CXR?

A

Plaques, fibrosis, mesothelioma

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19
Q

How does sarcoidosis present? (include biopsy)

A

Cough, rash, non-caseating granuloma

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20
Q

How is sarcoidosis treated?

A

None, steroids, methotrexate

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21
Q

How does sarcoidosis present on CXR?

A

Miliary and nodular shadowing, diffuse fibrosis

22
Q

What is hypersensitivity pneumonitis?

A

Allergic reaction in walls of alveoli and bronchioles

23
Q

What is acute hypersensitivity pneumonitis called and how does is present on CXR?

A

Farmer’s lung

Micro-nodular infiltrate, dense at hila

24
Q

What is chronic hypersensitivity pneumonitis called and how does is present on CXR?

A

Bird fancier’s lung

Normal, progressing to fibrosis

25
Q

What are the functions of pleura?

A

Allows movement of lung and chest wall
Coupling of lung and chest wall
Pleural fluid circulation

26
Q

What is the parietal pleura’s innervation?

A

Intercostal and phrenic nerve

27
Q

Describe pleurisy:

A

Sever, sharp pain
Worse on inspiration or coughing
Pleural rub can be heard (creaking noise)

28
Q

What is the normal pleural fluid turnover?

A

15ml per day

29
Q

How is pleural fluid produced and absorbed?

A

Produced by capillary filtration at parietal pleura and absorbed by lymphatic drainage

30
Q

What can cause pleural fluid volume to rise?

A

Rise in intravascular pressure (heart failure)
Fall in plasma oncotic pressure
Increase in permeability of capillary
Obstruction to lymph flow

31
Q

What is fluid in pleural space called?

A

Pleural effusion

32
Q

What is blood in pleural space called?

What can cause this?

A

Haemothorax

Trauma

33
Q

What is pus in pleural space called?

What can cause this?

A

Empyema

Inflammation

34
Q

What is lymph (chyle) in pleural space called?

A

Chylothorax

35
Q

How can pleural fluid be obtained?

A

Thoracocentesis

36
Q

What is looked at in pleural fluid?

A

Appearance, cell count, protein, LDH, pH, glucose

37
Q

What causes a transudate?

A

Heart failure
Cirrhosis
Hypoalbuminaemia

38
Q

What causes an exudate?

A 
Infection (TB)
Malignancy 
Pulmonary embolism 
RA
Ascites
39
Q

What is pleural fibrosis?

A

Unabsorbed pleural effusion, reduces lung volume

40
Q

What pleural tumours are there?

A

Lung or breast metastases

Mesothelioma

41
Q

What can cause a primary pneumothorax?

A

Smoking
Tall
Iatrogenic - procedures e.g. central lines

42
Q

What causes a secondary pneumothorax?

A

Underlying disease e.g. COPD

43
Q

What are the symptoms of a pneumothorax?

A 
Chest pain (pleuritic)
Dyspnoea
44
Q

How is a pneumothorax treated?

A

None if small
Aspiration/chest drain
Chemical pleurodesis

45
Q

What is chemical pleurodesis?

A

Glue visceral and parietal peritoneum together using inflammation, so there is no space for fluid or air

46
Q

What are the symptoms of a tension pneumothorax?

A

Tachycardia, hypotension, hypoxemia, hyper-resonance

47
Q

What is the treatment for a tension pneumothorax?

A

Intercostal chest drain, 2nd ICS, MCL

48
Q

What congenital chest wall deformities are there?

A

Pectus excavatum (sternum) - timmy
Scoliosis
Kyphosis

49
Q

What acquired chest wall deformities are there?

A

Trauma - broken ribs, flail segment

50
Q

What muscle disease can cause restrictive respiratory failure?

A

Muscular dystrophy
Motor neurone disease
Polio

Respiratory System (4 decks)

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