Integration and Review of Respiratory Medicine Flashcards
Be able to reproduce this chart.
Reproduce chart
Reversibility of asthma is demonstrated by a 12-15% or 200ml increase in FEV1 from the baseline, 15 min after treatment with what?
inhaled short acting Beta 2 agonist
How will a persons FEV1 be affected if they have asthma and are given a methacholine challenge test?
FEV1 is reduced
Be able to go through the stepwise approach towards the treatment of chronic asthma.
What is bronchiecstasis?
Permanent dilatation of bronchi and bronchioles (diff. from emphysema)
A person with bronchiecstasis can have it due to what conditions?
destruction of cartilage, muscle and elastic tissue.
Bronchiectstasis can happen because of what?
Chronic necrotizing infections (of the bronchi and bronchioles).
Is bronchiecstasis a primary disease?
no it occurs secondary to persisting infection or obstruction.
How do you treat bronchiecstasis?
clearing aiways, chest physiotherapy, appropriate antibiotics
Describe etiology of bronchiecstasis.
chronic infection
tuberculosis,H. influenzae,andS. aureus
atypical mycobacteria
bronchial obstruction
CF
ciliary function
immunodeficiency
allergic bronchopulmonary aspergillosis (ABPA
autoimmune conditions like RA and Sjögren’s syndrome
a1- antitrypsin deficiency
What are the main clinical features of bronchiecstasis?
Cough with copius sputum
Wheezing/rhonchi
Hemoptysis
Dyspnea
clubbing
What are the common radiographic features of bronchiecstasis?
tram track sign -chest X-ray
dilated airways, signet ring sign, tree in bud sign - CT
What is Hoover’s sign?
paradoxical inward movement of the rib cage with inspiration
Hoover’s sign can be seen in what lung pathology?
bronchitis and emphysema
How is diaphragmatic excursion assessed?
by percussion
Is clubbing of the digits a sign of COPD?
no
A chest skiagram may show what hallmark signs in an individual with COPD?
increased peribronchial markings
hyperinflation
What may a blood test in an individual with COPD present with?
Arterial Blood Gas - Hypoxemia, respiratory acidosis (↑PCO2 and ↓pH) due to ventilatory failure.
Blood tests may reveal mild polycythemia secondary to the chronic hypoxia.
Emphysema
Abnormal permanent enlargement of the air spaces distal to the terminal bronchioles and destruction of their walls without any obvious fibrosis with progressive dyspnea.
Where is centriacinar type emphysema most commonly located?
upper lobes
Most common cause of centriacinar emphysema?
exposure to smoke
Explain the pathology behind panacinar emphysema.
most common presentation ofAAT deficiency
also due to a functional AAT deficiency as a result of smoking
oxidants and inflammatory reaction of smoke can destroy AAT
smoking exacerbateseffects of genetic AAT deficiency
Where is panacinar type of emphysema usually found? (why)
in the lower lobes
result of lower lobes recieving ↑ perfusion allowing more immune cells to traffic into the alveoli
Who is paraseptal emphysema most commonly found in?
most commonly involves young, otherwise healthy males
What are some complications associated with paraseptal emphysema?
associated with bullae
found near the pleura
increased risk for spontaneous pneumothorax
Know some general characteristics that would allow you to make a differential diagnosis between emphysema and bronchitis?
Do restricive lung disease cause reduced or increased lung compliance?
reduced lung compliance
Do restrictive lung diseases cause increased or decreased elastic recoil?
increased elastic recoil
Are there increased or decreased expiratory flow rates in restrictive lung diseases? (explain why)
increased expiratory flow rates due to increased radial traction (result of increased elastic recoil) on airway walls
What are some clinical features of ILD’s?
Progressive exertion dyspnea and persistent dry cough
What are common findings about chest X-ray of person with ILD?
Bibasilar Reticular pattern or Nodular opacities
Honeycomb like features
Hilar/mediastinal lymphadenopathy
What are the signs you may see in the heart that could lead you to suspect there is some type of ILD?
Signs of cor-pulmonale, Loud P2
Upon arterial blood gas analysis what may you find in a person with ILD?
Hypoxemia (exertional to resting)
Normal or reduced PaCO2
Respiratory alkalosis.
On HRCT (high-res computed tomography)
Honeycombing, ground glass opacities
better assessment of the extent and distribution of disease
Coexisting disease is often best recognized e.g., mediastinal adenopathy, carcinoma, or emphysema
What is pneumoconiosis?
ILD due to inhalation of small dust particles(coni = latin for dust)
Pathophysiology of pneumoconiosis?
varied and based on the type of dust
In terms of fibrogenicity of dust particles list from least to most of the particles we discussed.
coal (least), asbestos, silica, and beryllium (max)
Small particles less than 2 microns affect what structures and how are they cleared?
affect alveoli (< 2 microns) phagocytosed by macrophages
Intermediate particles that affect respiratory bronchioles ( > 2 microns but < 10 microns) are cleared by what?
muck-ciliary transport
Be able to reproduce chart listing the types of pneumoconioses depending on the disease and exposure.
roofing and plumbing can also be listed as exposures that can cause asbestosis.
What parts of the lungs does asbestosis affect?
lower lobes including the entire respiratory unit
Describe how asbestos bodies appear and what cells they appear in
(Ferruginous body) golden-brown fusiform rods (due to iron and protein deposition) resemble dumbbells → made of iron! located inside macrophages
What may be found in the diaphragm and posterolateral mid lung of someone with asbestosis?
calcified pleural plaques
What part of the lungs are affected by silicosis?
upper lobes
Pathology of silicosis.
macrophages activated by silica (quartz) release fibrogenic cytokines
Characteristic feature upon biopsy of someone with silicosis.
silica particles surrounded by collagen “eggshell” calcification of hilar lymph nodes
What are sequelae associated with silicosis?
may impair macrophage function , ↑ susceptibility to TB (3 fold increased risk), ↑ incidence of lung cancer
Pathology of berylliosis. (What other condition does it resemble)
Non-caseating granulomas, nodular infiltrates, and enlarged
lymph nodes (resembles sarcoidosis)
Be able to compare and contrast bronchitis obliterans with bronchiolitis obliterans organizing pneumonia.
What is sarcoidosis?
multisystem granulomatous disease of unknown etiology that predominantly affects the lungs causing restrictive lung disease
What are hallmarks of sarcoidosis?
non caseating granulomatous inflammation of multiple organs,
lupus perinea (bluish-red or violaceous nodules and plaques over the nose, cheeks and ears).
Erthyma nodosum (painful shiny nodules most commonly on shins) less specific but more common
Eye lesions: uveitis
Is there a single diagnostic test for sarcoidosis?
no which makes diagnosis challenging
Best way to go about diagnosing sarcoidosis?
Diagnosis is clinical and often one of exclusion
Upon chest radiograph what are some characteristic features of saroidosis?
bilateral hilar lymphadenopathy, lungs involved in 90% of the cases
Explain what are some characteristic lab features for one with sarcoidosis.
↑ serum ACE , hypercalcemia , ↑ 1-α-hydroxylase → hypervitaminosis D, ↑CD4:CD8 in BAL.
What are the best ways to treat sarcoidosis pharmacologically?
First-line: Systemic corticosteroids - prednisone
Second line: Methotrexate
