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Pulmonology and Thoracic surgery > Bronchial obstruction, Pneumonia, Hemoptysis, Pulmonary Fibrosis > Flashcards

Bronchial obstruction, Pneumonia, Hemoptysis, Pulmonary Fibrosis Flashcards

1
Q

Bronchial obstruction vs. Bronchial obturation

A

Bronchial obstruction - airway and/or bronchiolar lumen narrowing
Bronchial obturation - complete blockage of the bronchi

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2
Q
  • Components of Bronchial obstruction

- systemic effects of Bronchial obstruction (4)

A

Reversible - bronchospasms, edema
Irreversible - remodeling

-hypoxemia, pulmonary hypertension, cor pulmonale chronicum, secondary erythema

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3
Q

Bronchial obstruction

  • symptoms
  • diagnosis
A

-cough, dyspnea, wheezing, rales, prolonged exhalation

  • FEV1/FVC and FEV1/VC are below the lower limit of the norm
  • spirometry with salbutamol –> FEV1 and (or FVC) >12% and 200ml –> positive response
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4
Q

Bronchial obstruction

-most common causes

A
  • Generalized: asthma, COPD, bronchiectasis, acute bronchitis, exacerbated chronic bronchitis, GERD, mental disorders (hypervent.), permanent inhalation of infectious agents.
  • Local: tumors, foreign bodies, bronchial tuberculosis, stenosis, scar after intubation, diphtheria
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5
Q

Pneumonia

-definition

A

acute inflammation of the lung tissues, due to microbial exposure, edema, proteins, inflammatory cells accumulation in the alveoli

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6
Q

Pneumonia

-classification

A

CAP - disorder started outside of hospital/nursing home
HAP - disorder started >48 hours after hospital admission
VAP - disorder started >48 hours after mechanical vent started
pneumonia of immunosuppressed person
aspiration pneumonia

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7
Q

Community-acquired Pneumonia (CAP)

  • etiology
  • risk factors (6)
  • symptoms
A
  • most common - S.pneumoniae and H. influenzae (most common in smokers, COPD, chronic bronchitis)
  • respiratory viruses, immunodeficiency, GERD, >65 y.o, hypoventilation, >20mg prednisolone/day
  • acute resp. infection symptoms –> cough, sputum, chest pain, shortness of breath + fever
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8
Q

Community-acquired Pneumonia (CAP)

  • investigation
  • indication for hospitalization
A
  • chest x-ray (anterior and lateral) + blood test (clinical + CRP)
  • radiological signs of lung infiltration
  • chest x-ray may be negative or non-specific in the first 48hours.

-severe pneumonia, older patients (>65), severe comorbidity, no effect of outpatient treatment for 3d., social problems

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9
Q

Community-acquired Pneumonia (CAP)

-treatment

A
  • antibiotic - non-severe (Amoxicillin), severe (Aminopenicillin)
  • oxygen therapy or mechanical vent.
  • fluid infusion and non-steroid analgesic (if necessary)
  • low molecular weight heparin if the patient is immobile

Recovery time: >1 month, usually 2w.

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10
Q

Hospital-acquired pneumonia (HAP)

  • risk factors
  • etiology
A

-impaired consciousness, intubation, flustered swallowing, cough reflex, lying position, enteral nutrition, catheters, antacids, surgery

  • early onset (up to 5d.) –> S. pneumonia, H.influenzae, Enterobacteril, Methicilin-susecptible S.aureus
  • late onset (after 5d. or >) –> Pseudomonas, Acinetobacter, Methicllin-resistant S.aureu
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11
Q

Hospital-acquired pneumonia (HAP)

  • what to do?
  • differential diagnosis (4)
A
  • x-ray, CT in unclear cases, blood culture, CRP, arterial blood gases
  • chest US - if fluid in the pleural cavity
  • bronchoscopy - in case of mechanical ventilation and suspected aspiration
  • it usually manifests as opacities in both lungs

-congested lungs, partial or total lung atelectasis, diffuse alveolar hemorrhage, respiratory distress syndrome

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12
Q

Hospital-acquired pneumonia (HAP)

-diagnostic criteria

A
  1. disease onset >48h after hospitalization
  2. radiological signs - new opacities or consolidation
    +
    at least 2 symptoms: fever, leukocytosis, leukopenia, purulent lower resp. secretions, pathogen isolated from the lower resp. tract, worsening blood gases
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13
Q

Hospital-acquired pneumonia (HAP)

-treatment

A

-most cases: 1st choice is beta-lactam

  • high probability for MRSA: vancomycin, linezolid
  • late-onset or high risk for drug resistance: anti-pseudomonal penicillin
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14
Q

Hospital-acquired pneumonia (HAP)

  • a risk factor for:
    1. Pseudomonas (3)
    2. MRSA (6)
A
  1. long time in ICU, corticosteroids, chronic lung disorders with structural changes
  2. head injury, coma, diabetes, renal failure, long time in ICU, recently used antibiotics
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15
Q

Hospital-acquired pneumonia (HAP)

-prevention (5)

A
  • mouth hygiene
  • non-invasive ventilation
  • extracorporeal membrane oxygenation (ECMO)
  • early tracheostomy
  • monitor the pressure of the endotracheal and tracheostomy cuff
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16
Q

Hemoptysis

-most common causes:

A
  • bleeding from the airways below the larynx
    1. Non-massive: chronic bronchitis, pneumonia, bronchiectasis, lung cancer, lung stasis, anti-coagulant overdose
    2. Massive: >100-600ml of blood/day –> tuberculosis, lung abscess, bronchiectasis
    3. Diffuse alveolar hemorrhage: granulomatosis with polyangiitis, microscopic polyangiitis, anti-GBM disease
17
Q

Hemoptysis

  • seasonality
  • examination
A
  • more common in winter
  • if in summer –> investigate –> lung cancer
  • x-ray, blood tests (platelets, hemoglobin), urea, creatinine, coagulogram
  • ANA, ANCA, anti-GBM, bronchoscopy, CT
18
Q

Hemoptysis - massive hemoptysis

  • prognosis depends on:
  • first aid
A
  • the amount of blood loss, bleeding intensity, co-morbidities
  • ICU –> control hypotension (nitroglycerin under the tongue), mechanical vent. –> treatment –> bronchoscopic methods, bronchial artery angiography and embolization, etiological treatment
19
Q

Idiopathic pulmonary fibrosis (IPF)

  • definition
  • pathogenesis
A
  • chronic and progressive disorder of unknown cause characterized by deposition of extracellular matrix leading to extensive lung remodeling
  • normal alveolus –> alveolar injury –> abnormal alveolar repair –> fibrosis
20
Q

Idiopathic pulmonary fibrosis (IPF)

-symptoms

A
  • chronic cough and shortness of breath during exercise
  • progressive dyspnea, clubbing, watch glass nails
  • auscultation: Velckro crackles
  • spirometry: FVC decrease
21
Q

Idiopathic pulmonary fibrosis (IPF)

  • chest x-ray
  • CT
A

-“honeycomb changes”, decrease lung volumes

  • non-homogenous changes (most damaged: peripheral and lower part)
  • honeycombing, traction bronchiectasis decrease
  • few or no ground glass areas
  • reticular changes
22
Q

Idiopathic pulmonary fibrosis (IPF)

-differential diagnosis

A
  • pulmonary fibrosis associated with CT disease
  • interstitial pneumonia
  • chronic hypertensive pneumonia
23
Q

Idiopathic pulmonary fibrosis (IPF)

  • treatment
  • treatment of exacerbation
A
  • Pirfenidone or Nintedanib
  • O2 therapy in chronic resp. failure
  • prognosis is bad!
  • glucocorticoids
  • x-ray will have more areas of ground-glass opacities

Pulmonology and Thoracic surgery (8 decks)

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