Deck 3 Flashcards
Q. Name two signs of idiopathic pulmonary fibrosis, how can diagnosis occur?
A. Cough, shortness of breath
B. Constitutional symptoms
C. Clubbing, crackles (fine end inspiratory crepitations), skin/eyes/joints
D. Pulmonary function tests – restrictive patterns, reduced gas transfer, low/normal paO2
E. Blood tests – eosinophils, total IgE
F. High res CT – different distributions depending on diagnosis
Q. What are the 5 major categories of interstitial lung diseases?
Diseases affecting the interstitium i.e. tissue and space around air sacs: concerns alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues.
A. Systemic – rheumatological, vasculitis
B. Environmental – dust, fungal, dust
C. Granulomatous – sarcoid, wegener’s
D. Idiopathic - Idiopathic pulmonary Fibrosis
E. Other - lymphangiolyomyomatosis, eosinophilic pneumonia
Q. Name two rare lung diseases
A. Lymphangiolyomyomatosis – benign proliferation of lymphatic smooth muscle cells – often presents in pregnancy
B. Langerhans cell histiocytosis –proliferation of histiocytes (tissue macrophages) affecting multi-systems
C. Pulmonary alveolar proteinosis – stimulation of alveolar macrophages, abnormal accumulation of pulmonary surfactant
Q. What is sarcoidosis? Which systems does it affect?
A. A multi-system disease of unknown aeitiology
B. Affecting any organ system, but predominantly the lymph nodes and lung
C. Typical granulomatous histology
Q. What are the three main disorders of pulmonary vasculature?
A. Pulmonary embolism
B. Pulmonary hypertension
C. Pulmonary vasculitis
Q. Name three predisposing factors for acute myocardial infarction
A. Fracture, knee surgery, bed rest, increasing age, obesity
Q. Name three investigations appropriate for MI diagnosis?
A. Chest X-ray B. ECG C. D-dimer (coag cascade) D. Scoring system E. CTPA (CT pulmonary angiogram) or ventilation-perfusion scan (V/Q)
Q. Name two treatment options for pulmonary embolism
A. Heparin
B. Novel oral anticoag (NOAC)
C. Reperfusion – thrombolysis, interventional radiology, embolectomy
Q. Name three features of pulmonary hypertension presentation, which investigation is appropriate?
A. Dyspnoea B. Ankle swelling C. Chest pain D. Syncope E. ECHO F. (Many different forms of PH, associated with various conditions)
Q. Describe the pathophysiology of pulmonary vasculitis
A. Destruction of blood vessels
B. Number of different disorders defined by size, type and location
C. Diagnosis hard due to overlapping of signs and symptoms – all rare
Q. Describe the pathophysiology of asthma
A. Bronchial hyper-responsiveness
B. Inflammation = lumen becomes narrower
C. Excessive contraction of smooth muscle
D. Hypertrophy and proliferation of smooth muscle = further narrowing
E. Airway odema = airway remodelling
Q. What are the two main types of asthma? Which cell types are associated with each type?
A. Eosinophilic – associated with allergy, (also non allergic) –fungal, common aeroallergens, occupation (lab workers, vet staff, animal breeders, bakers, paint sprayers), pets, exposures. (25% are atopic – IgE mediated)
B. Non-eosinophilic - non-smoking/smoking/obesity related
Associated with monocytes, macrophages, neutrophils
Q. Name three factors that may affect the severity of asthma
A. Smoking, exercise, weight, dysfunctional breathing,
B. Inhaler technique, adherence to medication, additional diagnoses
C. How to grade the level – ask about number of inhalers/medication, A&E attendances/admissions, ventilation, antibiotics and steroid usage, nocturnal waking, prev pneumonias?
Q. What signs and symptoms are suggestive of asthma?
A. Episodic wheeze
B. Cough
C. SOB
D. Diurnal variation (worse in the morning)
E. Brittle disease (type 1, chronic severe; type 2 sudden dips)
F. Provoking factors – allergens, infections, menstrual cycle, exercise, occupation, birth
G. Age of conset
H. FHx (hay fever, asthma, eczema)
Q. What differences can be seen between COPD and asthma
A. COPD – associated with smokers, more relentless progressive SOB, less variation
B. Asthma – variable, early onset, often FHx of asthma/hay fever/eczema
C. Overlap does occur
