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CSIM2 Mechanisms & Investigation of disease > Chest Medicine > Flashcards

Chest Medicine Flashcards

1
Q

Airway diseases (3)

A

COPD, Asthma, Bronchiectasis

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2
Q

Respiratory Diseases of the PARENCHYMA/ INTERSTITIUM (4)

A

Fibrosis, Hypersensitivity Pneumonitis,

Emphysema, pneumonia

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3
Q

Respiratory Diseases of the Pluera

A

Pleural Effusion, Pleural thickening, Mesothelioma/Pleural malignancy

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4
Q

Vascular problems

A

PE, Pulmonary hypertension

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5
Q

Ventilation problems

A

Sleep disordered breathing, obesity hypoventilation, neuromuscular problems, thoracic cage abnormality

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6
Q

Imaging for lung diseases

A

CXR, HRCT,

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7
Q

Pulmonary function tests

A

Spirometry – FEV1/ VC/ FVC/ FEV1/VC ratio

Lung volumes – TLC/ RV

Transfer factor – TLCO/ KCO

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8
Q

Restrictive lung diseases

A

Normal FEV1/VC

Obesity, Thoracic cage abnormalities, fibrosis, neuromuscular abnormalities

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9
Q

Obstructive lung diseases

A

FEV1/VC <70%
Asthma
COPD
Bronchiectasis

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10
Q

Flow Volume loops

A

Can show if airflow is appropriate for a particular lung volume. Can give an indication of where major problem is.

Large airway obstruction- flattened exp and inspir loop,

Diffuse small airway obstruction- early peaked exp loop and normal inspir loop

Intrathoracic obstruction (mediastinal tumour) have a more pronounced affect on the expiratory than inspiratory limb

Extrathorcic obstruction (goiter) has a more pronounced affect on the inspiratory than expiratory limb

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11
Q

Lung volumes TLC & RV- Obstructive

A

TLC increases with hyperinflation, RV increases due to gas trapping

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12
Q

Lung volumes TLC & RV- Restrictive

A

TLC- reduced

RV- normal/low

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13
Q

Test of functionality of the alveolar-capillary membrane

A

Transfer factor

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14
Q

Factors affecting TLCO (5)

A
  1. Ventilation Perfusion Mismatch - common in many lung diseases
  2. Reduction in the area of alveolar-capillary membrane - e.g. emphysema
  3. Increased thickness of alveolar-capillary membrane - e.g. pulmonary fibrosis
  4. Pulmonary Blood flow - e.g. pulmonary hypertension
  5. Haemoglobin concentration - e.g. anaemia leads to a decrease in TLCO
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15
Q

KCO

A

Transfer coefficient=functionality ‘per unit volume’ of lung.

Can increase to compensate for low TLCO if extra pulmonary causes of reduced lung volume obesity, thoracic cage abnormalities etc.

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16
Q

HRCT

A

1mm slice every 10 mm, good for suspected diffuse lung conditions

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17
Q

Spiral or Helical CT

A

Less resolution but done in continuum therefore dont miss small nodules etc

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18
Q

Pneumoconiosis

A

Lung disease caused by mineral dust
Fibrogenic=coal, silica, asbestos
Non fibrogenic= Siderosis (Iron) Welders
Baritosis (Ba miners)

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19
Q

Silicosis

A
  1. Early : diffuse nodules on CXR
    Differentiate from sarcoidosis, TB, diffuse malignancy
  2. Late : solid mass / upper zone
    Differentiate from lung cancer, TB
  3. Restrictive lung function abnormality
    4.Characteristic findings on biopsy
    Dense fibrosis with birefringent particles
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20
Q

Coal workers pneumoconiosis

A

Early : diffuse nodules on CXR
Differentiate from sarcoidosis, TB, diffuse malignancy
Late : solid mass / upper zone
Differentiate from lung cancer, TB
Restrictive lung function abnormality
Characteristic findings on biopsy
Dust accumulation around terminal bronchioles with fibrosis

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21
Q

Asbestos related disease

A

Heavy exposure= Lung cancer, asbestosis

Light exposure= mesothelioma, plueral plaques (no impact on lung function), plueral fibrosis

22
Q

Transudate

A

Effusion fluid caused by changes in mechanical or oncotic pressure.

LOW protein <30g/L, LDH <200

Cardiac, renal failure, cirrhosis, ascites

23
Q

Exudate

A

Effusion fluid caused by Increased permeabiliity of cap by pleural disease

Protein>30g/L, LDH>200

Malignancy, infection, inflammation,

24
Q

Occupational asthma

A

Asthma which is caused by exposures to some agent at work (or is substantially worsened)

50% still have astham even after leaving work

Can be sensitiser (90%) Latency period between 1st exposure to a “sensitiser” and immunologically-driven symptoms

or irritant induced

25
Q

Work related asthma

A

Asthma symptoms which are increased because of exposures at work (eg exercise, dust, cold)

26
Q

Investigation of occupation asthma

A 
History
Skin prick tests
Peak flow readings at work and home
Airway responsiveness measurements 
Inhalational challenge test

Tx- as per standard BTS

27
Q

Chronic Bronchitis

A

Chronic or recurrent excessive mucus secretion in the bronchial tree

28
Q

Emphysema

A

An increase beyond the normal in the size of the air spaces distal to the terminal bronchiole(alveoli) accompanied by destruction of their walls and without obvious fibrosis.”

29
Q

Cor Pulmonale

A

V/Q matching process constricts blood flow around areas of hypoxia, in emphysema hypoxia is everywhere=> pulomnary hypertension,

30
Q

Type 1 Respiratory Failure

A

PaO2 < 8kPa

Causes
V/Q mismatch & shunt

31
Q

Type 2 Respiratory Failure

A

PaO2 < 8 kPa on air & PaCo2 > 6 kPa

Causes
Hypoventilation
Increase in deadspace ventilation
V/Q mismatch

32
Q

Symptoms suggestive of respiratory insufficiency

A 
Breathless on exertion (dyspnoea)
Breathless when lying down (orthopnoea)
Poor concentration
Extreme fatigue
Decreased appetite
Anxiety
Nocturnal hypoventilation symptoms
Disturbed sleep, frequent awakenings, morning headaches
33
Q

Investigation of respiratory insufficiency

A
  1. FVC / SNIP / MIP / MEP - to measure and assess inspiratory and expiratory function
  2. Overnight oximetry or transcutaneous CO2 monitoring – to assess presence of nocturnal hypoventilation
  3. Arterial Blood Gas analysis – to determine urgency of treatment assessment
  4. Venous bicarbonate – to measure total CO2
  5. Sleep studies
34
Q

Hypoventilation

A

COPD
OSA
DMD

35
Q

OSA

A

Ix
Epworth sleepiness score
Limited somnography
Oximetry only

Tx
Weight loss
CPAP- effective at controlling Sx

36
Q

DMD & COPD

A

NIV

37
Q

Interstitial Lung disease

A

An imprecise term for a range of diseases which affect the lung parenchyma with cellular infiltration of the alveoli, interstitium and distal airways, and which may progress to fibrosis

38
Q

Types of ILD

A
  1. Idiopathic Pulmonary Fibrosis
  2. Sarcoidosis
  3. Hypersensitivity Pneumonitis (EAA)
  4. Pneumoconiosis
  5. Connective tissue disease
  6. Drug related interstitial disease
39
Q

IPF Tx

A
  1. Nothing
  2. Best Supportive Care ie:oxygen/rehab
  3. Pirfenidone/Nintedanib (expensive & rare)
  4. Recruit to Clinical Trials
  5. Transplant
40
Q

IPF features Hx

A
  • Progressive breathlessness
  • Dry cough
  • Failure to respond to treatments for other conditions
41
Q

IPF Ex findings

A
  • cyanosis
  • clubbing
  • fine crackles
  • reduced chest expansion
42
Q

Multisystem granulomatous disease of unknown cause primarily affecting the lung

A

Sarcoid

No Tx or steroids if required

43
Q

ILD Ix

A

CXR=> HRCT
Lung Function
ABG
Auto antibodies and serum ACE

44
Q

Bilateral Hilar/Mediastinal Lymphadenopathy

A

Sarcoid
TB
Lymphoma
Carcinoma

45
Q

EBUS

A

Used to take biopsy mediastinal lymph nodes

46
Q

EAA (hypersensitivity Pneumonisitis

A

Presents with cough, breathlessness and sometimes systemic symptoms of fever, weight loss

Occupation/Hobbies!

47
Q

EAA Ex

A

Crackles & Also wheeze and squeaks

48
Q

EAA Diagnosis

A

Usually suffice to have appropriate exposure, positive antibody response and clinical/radiological picture

49
Q

EAA Ix

A

Mosaicism on HRCT (air trapping) hallmark

50
Q

EAA Tx

A

Avoid antigen

Steroids

51
Q

IPF

A

All lung function parameters reduced

Type 1 Respiratory Failure picture

CSIM2 Mechanisms & Investigation of disease (8 decks)

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