Childhood and Worker's Diseases Flashcards
what is a pleural effusion
abnormal collection of fluid in the pleural space
what are the two most useful tests for diagnosing pleural effusion
ultrasound and x-ray
what is the appearance of a pleural effusion on an x-ray and what does it suggest
flat line suggest pneumothorax or hydro-pneumothorax
round substances in between lobes suggest fluid
meniscus suggest fluid
what is the name for pleural effusions with protein content less than 30mg
Transudate
what is the name for pleural effusions with protein content more than 30mg
Exudate
what does a straw coloured pleural aspirate suggest
cardiac failure, hypoalbuminaema
what does a blood pleural aspirate suggest
trauma, malignancy, infection, infarction
what are the causes of transudate effusions
heart failure, meigs syndrome, liver cirrhosis
what are the causes of exudate effusions
pneumonia, TB, carcinoma,
what is meigs syndrome
a triad of benign ovarian tumour, pleural effusion and ascites
what is the normal pleural pH
7.6
what does a pleural pH of less than 7.3 suggest
pleural inflammation, empyema, malignancy
what is the treatment plan for pleural effusions
depends on underlying cause
but can drain the effusion
what is pleurodesis and what is it used as a treatment for
artificial procedure to prevent the lung from collapsing again
pleural effusions
what are the related conditions of asbestos
benign pleural plaques
diffuse pleural thickening
pleural effusion
what stage of asbestos exposure is asymptomatic
benign pleural plaques
what are the symptoms often caused by acute asbestos pleuritis
fever, pain, bloody pleural effusions
what do pleural effusions and diffuse pleural thickening cause in patients
restrictive impairment
what is malignant mesothelioma
incurable pleural cancer
presents with chest pain and pleural effusion
what are the typical features of pulmonary fibrosis related to asbestosis
restrictive defect
asbestos bodies in sputum
asbestos fibre in biopsy
what are the two cancers that patients with asbestosis exposure have increased risk to
bronchial adenocarcinoma and mesothelioma
what are the clinical features of asbestosis
progressive dyspnoea
clubbing
find, end-inspiratory crackles
pleural plaques
what is sarcoidosis
a granulomatous (type 4 hypersensitive) disease
symptoms of chronic sarcoidosis
lung infiltrates (alveolitis)
skin infiltrates
hypercalcaemia
peripheral lymphadenopathy
signs of sarcoidosis seen on an x-ray
bilateral hilar lymphadenopathy
symptoms of acute sarcoidosis
erthyema nodosum (red nodules on the legs) painful joints and eyes inflammation of the glands bilateral hilar lymphadenopathy fever dry cough progressive dyspnoea chest pain decreased exercise tolerance
differential for bilateral hilar lymphadenopathy on an x-ray
sarcoidosis
TB
signs of sarcoidosis seen on a CT-scan
peripheral nodular infiltrate
signs of sarcoidosis seen on a tissue biopsy
non-caseating granuloma
signs of sarcoidosis in blood tests
raised ACE serum levels
raised calcium levels
raised inflammatory markers
Treatment of acute and chronic sarcoidosis
Acute - self limiting, NSAIDs, steroids (if vital organ damage)
Chronic - oral steroids, immunosuppresion
buzzwords for sarcoidosis
- African-Carribean woman
- Raised Ca2+ and ACE levels
- Bilateral hilar lymphadenopathy, erythema nodosum, granulomas, fatigue, uveitis and weight loss
buzzwords for pleural effusion
stony dull to percuss
what is EAA
hypersensitive pneumonitis
type III hypersensitive (immune complex deposition)
what are some causes of EAA
Bird-fanciers and Pigeon-fanciers lung
Farmer’s and mushroom workers lung
Malt worker’s lung
acute presentation of EAA
dry cough, breathlessness, fever, myalgia, no wheeze, crackles, hypoxia
chronic presentation of EAA
increasing dyspnoea, weight loss, clubbing, crackles, dry cough
what is common of EAA on x-rays
upper zone mottling/consolidation
what is the results of pulmonary function test in EAA (what type of defect)
restrictive defect
low FEV1 and FEV
high or normal ratio
low gas transfer
how to diagnosis EAA
history of exposure
presence of IgG antibodies to guilty antigen
treatment for EAA
remove antigen
steroids if needed
4 C’s of idiopathic pulmonary fibrosis (IPF)
(dry) cough, clubbing, crepitations, cyanosis
secondary causes of IPF
RA, systemic sclerosis, asbestos, drugs
presentation of IPF
progressive breathlessness, dry cough, malaise, weight loss, joint pain (arthralgia)
PFT of patient with IPF
restrictive defect decreased FEV1 and FVC normal or raised ratio reduced lung volumes low gas transfer
X-ray of patient with IPF
- honeycomb lung
- bilateral lower zone reticulonodular shadowing
CT scan of IPF
- ground glass appearance
treatment of IPF
oxygen, opiates, pallative care
recommended high dose steroids not used
buzzwords for IPF
Ground-glass appearance on X-ray
Honeycomb lung
what are the two types of coal worker pneumoconiosis
Simple
Complicated
what is simple pneumoconiosis
chest x-ray abnormality only
no impaired lung function
associated with COPD
treatment of simple and complicated pneumoconiosis
avoid coal dust
treat co-exisiting chronic bronchitis
claim compensation
what is complicated pneumoconiosis
progressive massive fibrosis leading to restrictive pattern with breathlessness
associated with emphysema
what does complicated pneumoconiosis eventually go on to cause
Cor pulmonale
what is Caplan’s syndrome
association between rheumatoid arthritis, pneumoconiosis and pulmonary rheumatoid nodules
what is silicosis
simple pneumoconiosis - chest XR abnormality only
what is seen in a chest x-ray of silicosis
egg-shell calcification of hilar nodes
diffuse miliary or nodular pattern in the upper zone
clinical features of silicosis
progressive dyspnoea, increased incidence of TB, restrictive tendency
buzzwords for silicosis
- Snow storm appearance on x ray
- egg-shell calcification of hilar nodes on x ray
what is the pathology of neonatal respiratory distress syndrome
not enough surfactant in the lungs to keep them inflated
what is in surfactant and what is its production stimulated by
phospholipids, apoproteins
steroids
what is the complications of neonatal distress syndrome
no breath sounds on 1 side
sudden deterioration
what is the x-ray appearance of neonatal distress syndrome
distinctive cloudy appearance
what is the treatment of neonatal distress syndrome
ventilation, artificial surfactant
buzzwords for neonatal distress syndrome
ground glass appearance on x-ray
what is a pneumothorax
air in the pleural space
what can causes a pneumothorax in infants
intermittent postive - pressure ventilation
what is the classification of chronic lung disease in infants
O2 requirements beyond 36 weeks corrected gestation plus evidence of ILD
what is indicative of cystic fibrosis
infant with raised immune-reactive trypsin levels on neonatal screening
what is CF
autosomal recessive
mutations in the CF transmembrane conductance regulator (CFTR) gene on chromosome 7
what does the defect in CF cause
error in Cl- channel leads to defective Cl secretion and increase sodium absorption across airway epithelium
what does CF predispose the lungs to
chronic pulmonary infections
bronchiectasis
clinical features of CF in neonatal
failure to thrive
rectal prolapse
loose stool due to meconium ileus (bowel is sticky causes it to block)
clinical features of CF in young adult
cough, wheeze, recurrent infections cor pulmonale male infertility nasal polyps gallstones
how is CF diagnoses
sweat test - sodium and chloride levels > 60mmol/L
genetics - screen for mutatiosn
tests for CF
bacteriology - cough swab, sputum culture
spirometry - obstructive defect
management of CF
physiotherapy, bronchodilators
what is Kartagener’s syndrome
autosomal recessive disease
defect in the structure and function of sensory and motile cilia
presentation of Kartagener’s syndrome
- possible neonatal RDS
- chronic rhinorrhoea, rhinitis, otitis
- COPD, recurrent pneumonia, bronchiectasis
- male infertility, decreased female fertility
features of Kartagener’s syndrome
dextrocardia
what is croup
viral laryngotracheobronchitis
i.e. infection of the larynx and trachea
signs of croup
stridor
barking cough
treatment for croup
oral steroids
what is pertussis
“whooping cough”
baby from developing country, irritable, no fever, neck rigidity
mycobacterium TB
what is common causes of bronchiolitis in the young
Respiratory Syncytial Virus (RSV)
hMPV
adenovirus
symptoms of bronchiolitis in the young
tachypnoea, poor feeding, irritating cough,
apnoea in small babies
symtoms and features of pneumonia in small children
cough, sputum, fever
dullness on percussion, increased vocal fremitus and resonance, bronchial breathing
microorganisms causing pneumonia in neonates
E.coli, Klebsiella, Staph aureus
microorganisms causing pneumonia in infants
strep pneumonia, chlamydia,
microorganisms causing pneumonia at school age
strep pneumonia, Staph aureus, legionella, mycoplasma
what type of chest pain is worse on inspiration
pleuritic
