Lung Pathology Flashcards
Pulmonary Embolism presentations
- presents with chest pain and shortness of breath
- causes tachycardia, hypoxia
- right ventricular strain on the ECG
- t wave inversion
What presents a massive pulmonary embolism
Systolic blood pressure of less than 90
Flu like illness, cough, target like lesions and shortness of breath and low hb?
Mycoplasmic pneumonia
why does PE cause tachycardia
- the blood clot in the lung vessels stops gas exchange
- lowers o2 levels
- hipothalamus detects this and sends signal to get more o2
- so heart starts to pump faster
- so blood pressure decreases
Process of asthma attack
- Bronchioles constrict
- Struggle to breathe
- RR increases to compensate for it
- O2 increases and CO2 decreases
- Then person tired
- RR decreased
- CO2 increases and O2 decreases and this is near fatal attack
Signs of moderate asthma attack
PEFR >50%
HR <110
Signs of severe asthma attack
PEFR 33-50%
HR 110
RR 25+
Cannot speak in full sentences
Signs of Life threatening asthma attack
Po2 <8
Pco2 (4.6-6.0) if it’s higher than normal = fatal attack
Hypotension
Silent chest
Cyanosis
Treatment for asthma
- Sit patient upright
- O2 via non breathable mask
- Nebulised salbutamol
- Hydrocortisone IV prednisone PO
What is Tension pneumothorax
A lot of air in the lungs
Where do you do a puncture for tension pneumothorax
2nd intercostal space, mid clavichord line
Do a puncture and take out the air
Patient has chronic cough and recurrent fevers
No sputum
Some chest pain when inhaling
Some shadowing on chest x ray and caseating granulomas
Pulmonary tuberculosis
Chronic cough
Enlarged lymph nodes
Fever
Addison’s disease
Hepatomegaly
Splenomegaly
Miliary TB
Calcifications in the lung
Due to erosion of alveoli
HIV and 6 weeks of cough
Yellow sputum
TB
very common in HIV
Dry cough
Weight loss
Fatigue
Wrist swelling
Adenocarcinoma of lung
Do CT pelvis and abdomen
Check for any metastasis
patient has erythematous oropharynx with white patches
she takes regular inhalers for asthma
what is the likely cause of her findings?
the beclomethasome inhaler
patient has erythematous oropharynx with white patches
she takes regular inhalers for asthma
what condition does the patient have?
oral candidiasis - thrush
it is very common in patients who take regular steroid inhalers
why are those taking regular inhalers for asthma more likely to get ill
steroids in the inhalers are immunosuppressive
what pathophysiological findings will be seen in COPD
excessive mucus secretion
hypoxia
cyanosis
what is COPD
enlargement of air spaces and destruction of the alveolar walls
it is irreversible
causes airway obstruction
patient has left sided pleuritic chest pain
visible pleura
absent lung markings
what is the likely diagnosis
pneumothorax
what findings are found with pneumothorax
hyper-resonant percussion note at the base
signs seen in pneumothorax
reduced chest expansion
reduced breath sounds
tachypnoea
increased vocal resonance heard at the lung base is seen when?
in consolidation
stoney dull percussion note at the base is seen when?
in pleural effusion
polyphonic wheeze is heard when?
exacerbation asthma
pulmonary sarcoidosis - what is it
inflammatory condition
small lumps of inflammatory cells in the lungs
features of sarcoidosis
fever
polyarthralgia
bilateral hilar lymphadenopathy
chronic sarcoidosis features
dry cough, reduced exercise tolerance
fatigue, weight loss
uveitis
management of sarcoidosis
steroids
patient has SOB, dry cough and fatigue
red painful eye and blurred vision
chest X-ray shows bilateral hilar lymphadenopathy
what is the diagnosis
patient has sarcoidosis
which immune components cause asthma
IgE antibodies
what type of reaction is asthma
type 1 hypersensitivity
type 1 hypersensitivity is mediated by which antibodies
IgE
IgG mediates which hypersensitivity reactions?
type 2, 3 and 5
when do you see respiratory alkalosis and normal o2 saturations?
in an anxiety/panic attack
when would thrombolysis be contraindicated in a patient with PE
if the patient has a past history of a haemorrhagic stroke
puts patient more at risk of having a stroke again
patient has very high levels of cortisol in blood - this is indicative of which condition
cushings syndrome
what is a cause of cushings syndrome
ectopic ACTH production - associated with small cell lung cancer
what happens in ectopic ACTH production?
excess cortisol
muscle weakness
central obesity
hypertension
hypokalaemia
diabetes
how to manage cushings syndrome
high dose dexamethasone
ectopic production of ADH would cause what features
causes fluid retention
hyponatraemia
headaches
nausea
muscle cramps
confusion
ectropion production of parathyroid hormone related protein - what does it cause
hypercalacaemia
bone pain
abdo pain
nausea
constipation
ectopic production of corticotrophin releasing hormone
similar symptoms to cushings syndrome but VERY HIGH serum CRH levels
ectopic production of growth hormone
enlargement of the feet and hands
hypertension
young man comes in with pneumothorax
chest x ray shows 3cm pneumothorax in the lung
what is the next best management
aspirate with 16-18G cannula
what is pneumothorax
air filled in the pleural space
what is a primary spontaneous pneumothorax
a pneumothorax that happens to someone without any underlying lung pathology
common in tall thin men
what is a secondary spontaneous pneumothorax
a pneumothorax that happens to someone who has an underlying lung pathology
eg. COPD, asthma, pneumonia, cystic fibrosis
what is compliance
measure of how the change in pressure can affect the change in volume - influenced by distensibility of the lungs and chest wall
formula for compliance
compliance = volume/pressure
what are 3 important pressures for lung ventilation
- intra-alveolar pressure
- intra-pleural pressure
- transpulmonary pressure - pressure difference between first 2 pressures
what is the mechanism of tension pneumothorax
air enters the air cavity but it can’t leave
air accumulates in the cavity
symptoms of pneumothorax
sudden-onset SOB and pleuritic chest pain
signs of pneumothorax
reduced chest expansion
hyper-resonant percussion note
absent breath sounds
vocal resonance is reduced on the affected side
tachycardia
hypotension
management of primary pneumothorax
patient is NOT SOB and the pneumothorax is <2cm - manage conservatively
patient IS SOB OR pneumothorax is >2cm - aspirate with cannula
patient has COPD and worsening SOB,
productive cough and swelling of feet
what is the diagnosis:?
cor pulmonale
patient has COPD and worsening SOB,
productive cough and swelling of feet
what signs would you expect to see?
split second heart sound with loud pulmonary component
what is cor pulmonale
right sided heart failure due to a long standing pulmonary disease
this then causes pulmonary hypertension
patient has abdo swelling and SOB
there is a mass in her abdo consistent with ovarian fibroma
shifting dullness
what is the most likely diagnosis
pleural effusion
patient has abdo swelling and SOB and ascites
there is a mass in her abdo consistent with ovarian fibroma
shifting dullness
what signs would be seen??
stony dull to percussion of the affected side of the chest
what is meigs syndrome
triad of:
ovarian benign tumour, ascites and pleural effusion
what is pleural effusion
build up of fluid in the pleural cavity
exudative causes of pleural effusion
caused by diseases
TB or pneumonia
bronchiol carcinoma
transudative causes of pleural effusion
conditions that increase capillary hydrostatic pressure eg congestive cardiac failure
signs of pleural effusion
trachea is deviated
reduced chest expansion affected side
percussion note is dull on the affected side
features of hospital acquired pneumonia
lower resp tract infection that happens after 48 hours of hospital admission
common causatives of hospital acquired pneumonia
pseudomonas aeruginosa
staphyl aureus
enterobacteria
features of aspiration pneumonia
in patients with unsafe swallow
on x ray - right bronchus is most likely affected as it is wider
features of staphylococcal pneumonia
due to staply aureua (gram positive)
found commonly in drug users
elderly patients
and influenza infection victims
features of klebsiella pneumonia
‘red current sputum’
gram negative bacteria cause
common in those with weakened immune system
features of mycoplasma pneumonia
flu like symptoms
dry cough and headache
younger patients
features of legionella pneumonia
fever cough and malaise
usually in those who are exposed to poor air conditioning
the antigen may present in the urine
features of chlamydophila psittaci pneumonia
comes from infected birds and parrots
lethargy
headache
hepatitis
features of pneumocystis pneumonia
immunosuppresed
extertional dyspnoea
dry cough
fever
scoring system for pneumonia severity
CURB 65
C- CONFUSION
U- UREA >7
R- RESP RATE >30
B- BP <90 AND <60
AGE >65
management of mild pneumonia
discharge home and give oral clarithromycin 500mg/12 hourly for 7 days
what is the expected FEV1 in COPD
FEV1/FVC <0.7 and FEV1 of 70%
why does FEV1 reduce in COPD
because it becomes harder for the lungs to expire the air quickly due to the airways being stiffened and obstructed
what is FEV1 in mild COPD
> 80%
what is FEV1 in moderate COPD
70-59%
FEV1 in severe COPD
30-49%
FEV1 in very severe COPD
<30%
what is the physiology of COPD
- inflammation affects the small airways
- this then causes damage to the surrounding elastin
- this causes reduced tension in the airways
- mucus starts to plug in the lungs
- this causes the ‘obstructive’ symptoms
what is emphysema
enlargement of the alveolar airspaces as elastin is destructed
hyper resonance is found in which lung conditions
consolidation or tumour
reduced resonance is found in which lung conditions
pleural effusion
pneumothorax
what is empyema
collection of pus forms in the pleural space
causes fever
needs surgical draining
what is exudative empyema
pus in the lungs that has a high protein count
what is transudative empyema
pus in the lungs that has a low protein count
what is used to detect if pleural effusion is transudative or exudative
lights criteria
signs of right heart strain in PE
hypotension
cyanosis
raised jvp
parasternal heave
what are the signs of PE
hypoxia
tachycardia
tachypnoea
what is PE on ECG
S1Q3T3
COPD is which two conditions together?
chronic bronchitis and empysema
step 1 management of COPD
short acting b2 agonist
salbutamol
step 2 management of COPD
long acting b2 agonist (formoterol) IF FEV1 >50%
long acting b2 agonist and corticosteroid IF FEV1 <50%
step 3 management of COPD
long acting b2 agonist, corticosteroid and long acting muscarinic antagonist
examination findings of COPD
tachypnoea
reduced chest expansion
hyperressonace
quiet breath sounds
what is a common side effect of salbutamol
tachycardia and tremors
investigation for pulmonary embolism
CT angiogram
what are the ECG findings of someone who as COPD
right ventricular heave
management of patient with PE who is heamodynamically stable
apixaban
management of patient with PE who is heamodynamically unstable
thrombolysis
asthma what is It
reversible airway obstruction
secondary to hypertension due to reactions to allergens
features of asthma
breathlessness
wheeze
chest tightness
dry irritating cough
worse at night
spirometry in asthma
FEV1/FVC ratio of less than 70%
salbutamol - how does it work?
it is a short acting beta agonist - dilates the airways
asthma management
SABA
SABA and low dose ICS - inhaled corticosteroid
SABA, low dose ICS and LABA
ICS side effects
oral candidiasis - white spots in the mouth
voice alterations
brush your teeth and rinse your mouth
SABA side effects
tremor
headaches
palpitations
acute management of asthma
Nebuliser
o2 - only give if patient is hypoxic
predinisolone
ipratronium bromide
if needs be in serious cases - IV magnesium sulphate
COPD - what is it
chronic bronchitis and emphysema
irreversible damage to the lungs
FEV1/FVC ratio of <70%
findings of COPD
hyperinflation in the chest X ray
flat diaphragm
ECG SIGNS FOR COPD
right ventricular strain and peaked p waves
severity of COPD <0.7 ratio
stage 1 - mild
stage 2 moderate COPD
50-79%
stage 3 severe COPD
30-49%
very severe COPD
<30%
management of COPD
stopping smoking
give them flu vaccination and pneumococcal vaccination
exacerbation of COPD
increased SOB and cough and wheeze
management of exacerbation of COPD
sit the patient up
nebuliser
o2 - venturi mask
prednisolone
antibiotics if there is sputum
features of pneumonia
SOB
chest crackles - coarse
low sats
fever
pain tacycardia
cystic fibrosis - inheritance
autosomal recessive
pneumocystis jiroveci pneumonia
HIV
dry cough and fever
chest xray shows - exercise induced desaturation
treatment of pneumocystis jiroveci pneumonia
co-trimaxazole
pathophysiology of cystic fibrosis
abnormal CFTR gene deletion
na/cl channel dysfunction
results in thick mucus production
features of CF
meconium ileus - not passing the first stool (foetus)
childhood features: recurrent chest infections
steatorrhoea - fat in your stools
failure to thrive
diagnosis of CF
sweat test - >60mmol - put two electrode patches on the skin and make patient sweat and test it - for chloride ions
chest x ray
genetic testing - heel prick test
management of CF
high calorie diet
respiratory physio
acute management for PE
A-E assessment
anticoagulation
how long to give anticoagulants to PE patients
provoked PE - 3 months (eg happened due to surgery)
unprovoked - 6 months
ongoing
management of massive PE
thrombolysis with an IV bolus of alteplase
what is a massive PE
PE with features of heamodynamical instbility
what are the complications of thrombolysis
previous intracranial haemorrhage
or recent stroke
pneumothorax - what is It
air in the plural space
risk factors of pneumothorax
tall thin young males or smokers
features of pneumothorx
SOB
pleuritic chest pain
reduced chest expansion on the effected side
hyper resonance percussion
absent breath sounds
tachycarida and tracheal deviation
primary pneumothorax management
SOB and >2cm - aspirate with cannula
primary pneumothorax management
not SOB and <2cm - discharge
secondary pneumothorax management
no SOB and <1cm - observe for 24 hours
no SOB and 1-2cm - aspirate and observe for 24 hours
SOB or >2cm - chest drain
borders for triangle of safety
mid- axillary line 5th clavicular space
pec major
lat dorsie
tension pneumothorax management
A-E assessment
high flow oxygen via non breathe mask
immediate needle decompression with cannula
squamous cell carcinoma - what is it
highly associated with smoking
slow growing
metastasises late
adenocarcinoma - what is it
common in non-smokers
metastasises early
small cell carcinoma
highly associated with smoking
metastisizes early
X-ray findings of plural effusions
blunting of the lung that is effected
fluid in lung fissures
meniscus on the effected lung
what is tactile remits
hold patients back and ask them to say 99
you will feel vibrations
- if so then it means it is plural effusion
features of respiratory acidosis
low ph
raised CO2
Hco3 is high
co2 retention
respiratory alkalosis features
high ph
low PCO2
normal or high HCO3
hyperventilation
PE
metabolic acidosis features
low Ph
normal or low CO2
low HCO3
raised lactate
raised ketones
ketoacidosis
increased h ions
metabolic alkalosis features
high ph
normal or high CO2
high HCO3
loss of h ions
vomitng
increased aldosterone activity
pneumonia has what resonance?
increased resonance
but dull percussion
pleural effusion has what resonance
decreased resonance
stony dull percussion
first line treatment for MILD community acquired pneumonia
amoxicillin for first line
clarithroymycin or doxycline (if allergic or above is not working)
treatment for SEVERE community acquired pneumonia
co-amoxiclav with clarithromycin
what is the core triad of acute chest crisis
- seen in patients with sickle cell anaemia
- tachypnoea, wheeze and cough with hypoxia
management of acute chest crisis
high flow oxygen
antibiotics
exchange transfusion
what is the Pemberton sign
when the patient goes pale and finds it difficult to breath when their arms are raised above their head
- indicates IVC obstruction
what is lymphadenitis
inflammation of the lymph nodes
what is lymphangitis
inflammation of the lymph vessels
what is lymph
responsible for tissue drainage
absorption of fats
produces lymphocytes
how does the lymphatic drainage work
there is the arterial and Venous end
- there is high pressure at the arterial end
- interstitial fluid leaks out of the capillaries due to the high pressure
- then this drains into the lymphatic system
- returns back in the venous end
infected lymph nodes symptoms
swollen
red
painful
moveable
cancerous lymph node signs
hard
painless
cannot move
sits into the surrounding tissues
how to describe lymph nodes?
SCAM
s - size/site
c - colour
a - associated symptoms
m - movement
what X-ray findings call for a 2ww for lung cancer
hisar enlargement
peripheral opacity
pleural effusion
collapse
what type of lymph swelling does lung cancer cause
supraclavicular
complications of small cell carcinoma
SIADH
Cushings syndrome
complications of squamous cell carcinoma
hyoercalacaemia
LEMS
common signs of lung cancer
pembertons sign
SVC obstruction
Horners syndrome - partial ptosis, eye closes, half of face sweats and other half doesnt
anhidryosis and miosis
what is sarcoidosis
an inflammatory condition - inflammatory cells build up in different parts of the body
affects the lungs, eyes, skin
hilar enlargement
painful rash on the legs and swelling of the nose
symptoms of sarcoidosis
swollen lymph nodes
weight loss
SOB and dry cough
painful rash on the shins of the legs
eye pain
management of tension pneumothorax
16G cannula, in the 2nd intercostal space, mid-clavicular line
management of primary pneumothorax
IF no SOB and the pneumothorax is <2cm then the patient can be discharged and sent home to review in 2-4 weeks time
IF SOB/ pneumothorax is >2cm then use 16-18G cannula
management of secondary pneumothorax
If NO SOB and <1cm then give oxygen and admit for 24 hours
if no SOB and 1-2cm then admit for 24 hours
IF SOB or >2cm then CHEST DRAIN
primary spontaneous pneumothorax - what is it
a collapsed lung in someone without any respiratory illnesses
secondary spontaneous pneumothorax - what is it
a collapsed lung due to a respiratory illness
what is theophylline?
it is a medication used in the long term management of asthma
- it blocks adenosine receptors and thus causes bronchodilation
why can lung cancer cause arthritis issues
hypertrophic pulmonary oesteoarthropathy - happens due to lung malignancy
do CT scan
what is total lung capacity
the total volume of air in the lungs after a maximal inspiration
what is tidal volume
the volume of air inhaled and exhaled in a quiet breath
what is vital capacity
the volume of air that can be forcefully exhaled on maximal inhalation
what is inspiratory capacity
volume of air what can be forcefully inhaled after quiet exhalation
what is residual volume
the volume of air that is always left in the lungs
empyema
filling of pus in the pleural cavity
CAUSES SWINGING FEVERS
pathology of ventilation in COPD patients
In normal people when CO2 increases brain signals to the brain to get rid of it and this causes breathing.
However, in COPD patients CO2 is always high.
For prolonged periods of time because the CO2 is high, the brain stops, sensing it and starts sensing when oxygen levels are low.
So ventilation is derived by hypoxia.
This is why COPD patients generally have a low oxygen level, so giving them too much Oxygen can mean that the brain will stop breathing as it will feel that there is enough oxygen.
management of COPD in severe cases - when patient is severely hypoxic
For the management of COPD, you give BiPAP
this allows the pressure to increase when breathing in and to decrease when breathing out
What is one medication used for hypertension that can cause pulmonary fibrosis
Amiodarone
What are the causes of exudative plural fusion?
Lung cancer, TB, pneumonia
Why do opioids cause of respiratory depression?
Opiate like morphine or excreted by the kidneys if the kidneys are not working properly due to acute kidney injury, then the updates are excreted more slowly, and if these levels are not monitored, they can build up in court for a treat depression which can lead to low oxygen levels and lower respiratory rate
what lung infection is a cause of Addisons disease
TB
