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AMK > Lung Pathology > Flashcards

Lung Pathology Flashcards

1
Q

Pulmonary Embolism presentations

A
  • presents with chest pain and shortness of breath
  • causes tachycardia, hypoxia
  • right ventricular strain on the ECG
  • t wave inversion
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2
Q

What presents a massive pulmonary embolism

A

Systolic blood pressure of less than 90

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3
Q

Flu like illness, cough, target like lesions and shortness of breath and low hb?

A

Mycoplasmic pneumonia

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4
Q

why does PE cause tachycardia

A
  1. the blood clot in the lung vessels stops gas exchange
  2. lowers o2 levels
  3. hipothalamus detects this and sends signal to get more o2
  4. so heart starts to pump faster
  5. so blood pressure decreases
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5
Q

Process of asthma attack

A
  1. Bronchioles constrict
  2. Struggle to breathe
  3. RR increases to compensate for it
  4. O2 increases and CO2 decreases
  5. Then person tired
  6. RR decreased
  7. CO2 increases and O2 decreases and this is near fatal attack
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6
Q

Signs of moderate asthma attack

A

PEFR >50%
HR <110

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7
Q

Signs of severe asthma attack

A

PEFR 33-50%
HR 110
RR 25+
Cannot speak in full sentences

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8
Q

Signs of Life threatening asthma attack

A

Po2 <8
Pco2 (4.6-6.0) if it’s higher than normal = fatal attack
Hypotension
Silent chest
Cyanosis

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9
Q

Treatment for asthma

A
  1. Sit patient upright
  2. O2 via non breathable mask
  3. Nebulised salbutamol
  4. Hydrocortisone IV prednisone PO
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10
Q

What is Tension pneumothorax

A

A lot of air in the lungs

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11
Q

Where do you do a puncture for tension pneumothorax

A

2nd intercostal space, mid clavichord line

Do a puncture and take out the air

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12
Q

Patient has chronic cough and recurrent fevers
No sputum
Some chest pain when inhaling
Some shadowing on chest x ray and caseating granulomas

A

Pulmonary tuberculosis

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13
Q

Chronic cough
Enlarged lymph nodes
Fever
Addison’s disease
Hepatomegaly
Splenomegaly

A

Miliary TB
Calcifications in the lung
Due to erosion of alveoli

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14
Q

HIV and 6 weeks of cough
Yellow sputum

A

TB
very common in HIV

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15
Q

Dry cough
Weight loss
Fatigue
Wrist swelling

A

Adenocarcinoma of lung
Do CT pelvis and abdomen
Check for any metastasis

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16
Q

patient has erythematous oropharynx with white patches
she takes regular inhalers for asthma

what is the likely cause of her findings?

A

the beclomethasome inhaler

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17
Q

patient has erythematous oropharynx with white patches
she takes regular inhalers for asthma

what condition does the patient have?

A

oral candidiasis - thrush

it is very common in patients who take regular steroid inhalers

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18
Q

why are those taking regular inhalers for asthma more likely to get ill

A

steroids in the inhalers are immunosuppressive

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19
Q

what pathophysiological findings will be seen in COPD

A

excessive mucus secretion
hypoxia
cyanosis

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20
Q

what is COPD

A

enlargement of air spaces and destruction of the alveolar walls
it is irreversible
causes airway obstruction

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21
Q

patient has left sided pleuritic chest pain
visible pleura
absent lung markings

what is the likely diagnosis

A

pneumothorax

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22
Q

what findings are found with pneumothorax

A

hyper-resonant percussion note at the base

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23
Q

signs seen in pneumothorax

A

reduced chest expansion
reduced breath sounds
tachypnoea

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24
Q

increased vocal resonance heard at the lung base is seen when?

A

in consolidation

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25
Q

stoney dull percussion note at the base is seen when?

A

in pleural effusion

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26
Q

polyphonic wheeze is heard when?

A

exacerbation asthma

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27
Q

pulmonary sarcoidosis - what is it

A

inflammatory condition
small lumps of inflammatory cells in the lungs

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28
Q

features of sarcoidosis

A

fever
polyarthralgia
bilateral hilar lymphadenopathy

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29
Q

chronic sarcoidosis features

A

dry cough, reduced exercise tolerance
fatigue, weight loss
uveitis

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30
Q

management of sarcoidosis

A

steroids

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31
Q

patient has SOB, dry cough and fatigue
red painful eye and blurred vision

chest X-ray shows bilateral hilar lymphadenopathy

what is the diagnosis

A

patient has sarcoidosis

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32
Q

which immune components cause asthma

A

IgE antibodies

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33
Q

what type of reaction is asthma

A

type 1 hypersensitivity

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34
Q

type 1 hypersensitivity is mediated by which antibodies

A

IgE

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35
Q

IgG mediates which hypersensitivity reactions?

A

type 2, 3 and 5

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36
Q

when do you see respiratory alkalosis and normal o2 saturations?

A

in an anxiety/panic attack

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37
Q

when would thrombolysis be contraindicated in a patient with PE

A

if the patient has a past history of a haemorrhagic stroke
puts patient more at risk of having a stroke again

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38
Q

patient has very high levels of cortisol in blood - this is indicative of which condition

A

cushings syndrome

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39
Q

what is a cause of cushings syndrome

A

ectopic ACTH production - associated with small cell lung cancer

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40
Q

what happens in ectopic ACTH production?

A

excess cortisol
muscle weakness
central obesity
hypertension
hypokalaemia
diabetes

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41
Q

how to manage cushings syndrome

A

high dose dexamethasone

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42
Q

ectopic production of ADH would cause what features

A

causes fluid retention
hyponatraemia
headaches
nausea
muscle cramps
confusion

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43
Q

ectropion production of parathyroid hormone related protein - what does it cause

A

hypercalacaemia
bone pain
abdo pain
nausea
constipation

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44
Q

ectopic production of corticotrophin releasing hormone

A

similar symptoms to cushings syndrome but VERY HIGH serum CRH levels

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45
Q

ectopic production of growth hormone

A

enlargement of the feet and hands
hypertension

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46
Q

young man comes in with pneumothorax
chest x ray shows 3cm pneumothorax in the lung

what is the next best management

A

aspirate with 16-18G cannula

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47
Q

what is pneumothorax

A

air filled in the pleural space

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48
Q

what is a primary spontaneous pneumothorax

A

a pneumothorax that happens to someone without any underlying lung pathology

common in tall thin men

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49
Q

what is a secondary spontaneous pneumothorax

A

a pneumothorax that happens to someone who has an underlying lung pathology

eg. COPD, asthma, pneumonia, cystic fibrosis

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50
Q

what is compliance

A

measure of how the change in pressure can affect the change in volume - influenced by distensibility of the lungs and chest wall

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51
Q

formula for compliance

A

compliance = volume/pressure

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52
Q

what are 3 important pressures for lung ventilation

A
  1. intra-alveolar pressure
  2. intra-pleural pressure
  3. transpulmonary pressure - pressure difference between first 2 pressures
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53
Q

what is the mechanism of tension pneumothorax

A

air enters the air cavity but it can’t leave
air accumulates in the cavity

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54
Q

symptoms of pneumothorax

A

sudden-onset SOB and pleuritic chest pain

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55
Q

signs of pneumothorax

A

reduced chest expansion
hyper-resonant percussion note
absent breath sounds
vocal resonance is reduced on the affected side
tachycardia
hypotension

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56
Q

management of primary pneumothorax

A

patient is NOT SOB and the pneumothorax is <2cm - manage conservatively
patient IS SOB OR pneumothorax is >2cm - aspirate with cannula

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57
Q

patient has COPD and worsening SOB,
productive cough and swelling of feet

what is the diagnosis:?

A

cor pulmonale

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58
Q

patient has COPD and worsening SOB,
productive cough and swelling of feet

what signs would you expect to see?

A

split second heart sound with loud pulmonary component

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59
Q

what is cor pulmonale

A

right sided heart failure due to a long standing pulmonary disease

this then causes pulmonary hypertension

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60
Q

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

A

pleural effusion

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61
Q

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??

A

stony dull to percussion of the affected side of the chest

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62
Q

what is meigs syndrome

A

triad of:
ovarian benign tumour, ascites and pleural effusion

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63
Q

what is pleural effusion

A

build up of fluid in the pleural cavity

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64
Q

exudative causes of pleural effusion

A

caused by diseases
TB or pneumonia
bronchiol carcinoma

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65
Q

transudative causes of pleural effusion

A

conditions that increase capillary hydrostatic pressure eg congestive cardiac failure

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66
Q

signs of pleural effusion

A

trachea is deviated
reduced chest expansion affected side
percussion note is dull on the affected side

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67
Q

features of hospital acquired pneumonia

A

lower resp tract infection that happens after 48 hours of hospital admission

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68
Q

common causatives of hospital acquired pneumonia

A

pseudomonas aeruginosa
staphyl aureus
enterobacteria

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69
Q

features of aspiration pneumonia

A

in patients with unsafe swallow
on x ray - right bronchus is most likely affected as it is wider

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70
Q

features of staphylococcal pneumonia

A

due to staply aureua (gram positive)
found commonly in drug users
elderly patients
and influenza infection victims

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71
Q

features of klebsiella pneumonia

A

‘red current sputum’
gram negative bacteria cause
common in those with weakened immune system

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72
Q

features of mycoplasma pneumonia

A

flu like symptoms
dry cough and headache
younger patients

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73
Q

features of legionella pneumonia

A

fever cough and malaise
usually in those who are exposed to poor air conditioning
the antigen may present in the urine

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74
Q

features of chlamydophila psittaci pneumonia

A

comes from infected birds and parrots
lethargy
headache
hepatitis

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75
Q

features of pneumocystis pneumonia

A

immunosuppresed
extertional dyspnoea
dry cough
fever

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76
Q

scoring system for pneumonia severity

A

CURB 65

C- CONFUSION
U- UREA >7
R- RESP RATE >30
B- BP <90 AND <60
AGE >65

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77
Q

management of mild pneumonia

A

discharge home and give oral clarithromycin 500mg/12 hourly for 7 days

78
Q

what is the expected FEV1 in COPD

A

FEV1/FVC <0.7 and FEV1 of 70%

79
Q

why does FEV1 reduce in COPD

A

because it becomes harder for the lungs to expire the air quickly due to the airways being stiffened and obstructed

80
Q

what is FEV1 in mild COPD

A

> 80%

81
Q

what is FEV1 in moderate COPD

A

70-59%

82
Q

FEV1 in severe COPD

A

30-49%

83
Q

FEV1 in very severe COPD

A

<30%

84
Q

what is the physiology of COPD

A
  1. inflammation affects the small airways
  2. this then causes damage to the surrounding elastin
  3. this causes reduced tension in the airways
  4. mucus starts to plug in the lungs
  5. this causes the ‘obstructive’ symptoms
85
Q

what is emphysema

A

enlargement of the alveolar airspaces as elastin is destructed

86
Q

hyper resonance is found in which lung conditions

A

consolidation or tumour

87
Q

reduced resonance is found in which lung conditions

A

pleural effusion
pneumothorax

88
Q

what is empyema

A

collection of pus forms in the pleural space
causes fever
needs surgical draining

89
Q

what is exudative empyema

A

pus in the lungs that has a high protein count

90
Q

what is transudative empyema

A

pus in the lungs that has a low protein count

91
Q

what is used to detect if pleural effusion is transudative or exudative

A

lights criteria

92
Q

signs of right heart strain in PE

A

hypotension
cyanosis
raised jvp
parasternal heave

93
Q

what are the signs of PE

A

hypoxia
tachycardia
tachypnoea

94
Q

what is PE on ECG

A

S1Q3T3

95
Q

COPD is which two conditions together?

A

chronic bronchitis and empysema

96
Q

step 1 management of COPD

A

short acting b2 agonist
salbutamol

97
Q

step 2 management of COPD

A

long acting b2 agonist (formoterol) IF FEV1 >50%

long acting b2 agonist and corticosteroid IF FEV1 <50%

98
Q

step 3 management of COPD

A

long acting b2 agonist, corticosteroid and long acting muscarinic antagonist

99
Q

examination findings of COPD

A

tachypnoea
reduced chest expansion
hyperressonace
quiet breath sounds

100
Q

what is a common side effect of salbutamol

A

tachycardia and tremors

101
Q

investigation for pulmonary embolism

A

CT angiogram

102
Q

what are the ECG findings of someone who as COPD

A

right ventricular heave

103
Q

management of patient with PE who is heamodynamically stable

A

apixaban

104
Q

management of patient with PE who is heamodynamically unstable

A

thrombolysis

105
Q

asthma what is It

A

reversible airway obstruction
secondary to hypertension due to reactions to allergens

106
Q

features of asthma

A

breathlessness
wheeze
chest tightness
dry irritating cough
worse at night

107
Q

spirometry in asthma

A

FEV1/FVC ratio of less than 70%

108
Q

salbutamol - how does it work?

A

it is a short acting beta agonist - dilates the airways

109
Q

asthma management

A

SABA
SABA and low dose ICS - inhaled corticosteroid
SABA, low dose ICS and LABA

110
Q

ICS side effects

A

oral candidiasis - white spots in the mouth
voice alterations
brush your teeth and rinse your mouth

111
Q

SABA side effects

A

tremor
headaches
palpitations

112
Q

acute management of asthma

A

Nebuliser
o2 - only give if patient is hypoxic
predinisolone
ipratronium bromide

if needs be in serious cases - IV magnesium sulphate

113
Q

COPD - what is it

A

chronic bronchitis and emphysema
irreversible damage to the lungs
FEV1/FVC ratio of <70%

114
Q

findings of COPD

A

hyperinflation in the chest X ray
flat diaphragm

115
Q

ECG SIGNS FOR COPD

A

right ventricular strain and peaked p waves

116
Q

severity of COPD <0.7 ratio

A

stage 1 - mild

117
Q

stage 2 moderate COPD

A

50-79%

118
Q

stage 3 severe COPD

A

30-49%

119
Q

very severe COPD

A

<30%

120
Q

management of COPD

A

stopping smoking
give them flu vaccination and pneumococcal vaccination

121
Q

exacerbation of COPD

A

increased SOB and cough and wheeze

122
Q

management of exacerbation of COPD

A

sit the patient up
nebuliser
o2 - venturi mask
prednisolone
antibiotics if there is sputum

123
Q

features of pneumonia

A

SOB
chest crackles - coarse
low sats
fever
pain tacycardia

124
Q

cystic fibrosis - inheritance

A

autosomal recessive

125
Q

pneumocystis jiroveci pneumonia

A

HIV
dry cough and fever
chest xray shows - exercise induced desaturation

126
Q

treatment of pneumocystis jiroveci pneumonia

A

co-trimaxazole

127
Q

pathophysiology of cystic fibrosis

A

abnormal CFTR gene deletion
na/cl channel dysfunction
results in thick mucus production

128
Q

features of CF

A

meconium ileus - not passing the first stool (foetus)
childhood features: recurrent chest infections
steatorrhoea - fat in your stools
failure to thrive

129
Q

diagnosis of CF

A

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

130
Q

management of CF

A

high calorie diet
respiratory physio

131
Q

acute management for PE

A

A-E assessment
anticoagulation

132
Q

how long to give anticoagulants to PE patients

A

provoked PE - 3 months (eg happened due to surgery)
unprovoked - 6 months
ongoing

133
Q

management of massive PE

A

thrombolysis with an IV bolus of alteplase

134
Q

what is a massive PE

A

PE with features of heamodynamical instbility

135
Q

what are the complications of thrombolysis

A

previous intracranial haemorrhage
or recent stroke

136
Q

pneumothorax - what is It

A

air in the plural space

137
Q

risk factors of pneumothorax

A

tall thin young males or smokers

138
Q

features of pneumothorx

A

SOB
pleuritic chest pain
reduced chest expansion on the effected side
hyper resonance percussion
absent breath sounds
tachycarida and tracheal deviation

139
Q

primary pneumothorax management

A

SOB and >2cm - aspirate with cannula

140
Q

primary pneumothorax management

A

not SOB and <2cm - discharge

141
Q

secondary pneumothorax management

A

no SOB and <1cm - observe for 24 hours
no SOB and 1-2cm - aspirate and observe for 24 hours
SOB or >2cm - chest drain

142
Q

borders for triangle of safety

A

mid- axillary line 5th clavicular space
pec major
lat dorsie

143
Q

tension pneumothorax management

A

A-E assessment
high flow oxygen via non breathe mask
immediate needle decompression with cannula

144
Q

squamous cell carcinoma - what is it

A

highly associated with smoking
slow growing
metastasises late

145
Q

adenocarcinoma - what is it

A

common in non-smokers
metastasises early

146
Q

small cell carcinoma

A

highly associated with smoking
metastisizes early

147
Q

X-ray findings of plural effusions

A

blunting of the lung that is effected
fluid in lung fissures
meniscus on the effected lung

148
Q

what is tactile remits

A

hold patients back and ask them to say 99
you will feel vibrations
- if so then it means it is plural effusion

149
Q

features of respiratory acidosis

A

low ph
raised CO2
Hco3 is high
co2 retention

150
Q

respiratory alkalosis features

A

high ph
low PCO2
normal or high HCO3
hyperventilation
PE

151
Q

metabolic acidosis features

A

low Ph
normal or low CO2
low HCO3
raised lactate
raised ketones
ketoacidosis
increased h ions

152
Q

metabolic alkalosis features

A

high ph
normal or high CO2
high HCO3
loss of h ions
vomitng
increased aldosterone activity

153
Q

pneumonia has what resonance?

A

increased resonance
but dull percussion

154
Q

pleural effusion has what resonance

A

decreased resonance
stony dull percussion

155
Q

first line treatment for MILD community acquired pneumonia

A

amoxicillin for first line

clarithroymycin or doxycline (if allergic or above is not working)

156
Q

treatment for SEVERE community acquired pneumonia

A

co-amoxiclav with clarithromycin

157
Q

what is the core triad of acute chest crisis

A
  • seen in patients with sickle cell anaemia
  • tachypnoea, wheeze and cough with hypoxia
158
Q

management of acute chest crisis

A

high flow oxygen
antibiotics
exchange transfusion

159
Q

what is the Pemberton sign

A

when the patient goes pale and finds it difficult to breath when their arms are raised above their head
- indicates IVC obstruction

160
Q

what is lymphadenitis

A

inflammation of the lymph nodes

161
Q

what is lymphangitis

A

inflammation of the lymph vessels

162
Q

what is lymph

A

responsible for tissue drainage
absorption of fats
produces lymphocytes

163
Q

how does the lymphatic drainage work

A

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

164
Q

infected lymph nodes symptoms

A

swollen
red
painful
moveable

165
Q

cancerous lymph node signs

A

hard
painless
cannot move
sits into the surrounding tissues

166
Q

how to describe lymph nodes?

A

SCAM
s - size/site
c - colour
a - associated symptoms
m - movement

167
Q

what X-ray findings call for a 2ww for lung cancer

A

hisar enlargement
peripheral opacity
pleural effusion
collapse

168
Q

what type of lymph swelling does lung cancer cause

A

supraclavicular

169
Q

complications of small cell carcinoma

A

SIADH
Cushings syndrome

170
Q

complications of squamous cell carcinoma

A

hyoercalacaemia
LEMS

171
Q

common signs of lung cancer

A

pembertons sign
SVC obstruction
Horners syndrome - partial ptosis, eye closes, half of face sweats and other half doesnt
anhidryosis and miosis

172
Q

what is sarcoidosis

A

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

173
Q

symptoms of sarcoidosis

A

swollen lymph nodes
weight loss
SOB and dry cough
painful rash on the shins of the legs
eye pain

174
Q

management of tension pneumothorax

A

16G cannula, in the 2nd intercostal space, mid-clavicular line

175
Q

management of primary pneumothorax

A

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

176
Q

management of secondary pneumothorax

A

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

177
Q

primary spontaneous pneumothorax - what is it

A

a collapsed lung in someone without any respiratory illnesses

178
Q

secondary spontaneous pneumothorax - what is it

A

a collapsed lung due to a respiratory illness

179
Q

what is theophylline?

A

it is a medication used in the long term management of asthma
- it blocks adenosine receptors and thus causes bronchodilation

180
Q

why can lung cancer cause arthritis issues

A

hypertrophic pulmonary oesteoarthropathy - happens due to lung malignancy

do CT scan

181
Q

what is total lung capacity

A

the total volume of air in the lungs after a maximal inspiration

182
Q

what is tidal volume

A

the volume of air inhaled and exhaled in a quiet breath

183
Q

what is vital capacity

A

the volume of air that can be forcefully exhaled on maximal inhalation

184
Q

what is inspiratory capacity

A

volume of air what can be forcefully inhaled after quiet exhalation

185
Q

what is residual volume

A

the volume of air that is always left in the lungs

186
Q

empyema

A

filling of pus in the pleural cavity

CAUSES SWINGING FEVERS

187
Q

pathology of ventilation in COPD patients

A

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.

188
Q

management of COPD in severe cases - when patient is severely hypoxic

A

For the management of COPD, you give BiPAP

this allows the pressure to increase when breathing in and to decrease when breathing out

189
Q

What is one medication used for hypertension that can cause pulmonary fibrosis

A

Amiodarone

190
Q

What are the causes of exudative plural fusion?

A

Lung cancer, TB, pneumonia

191
Q

Why do opioids cause of respiratory depression?

A

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

192
Q

what lung infection is a cause of Addisons disease

A

TB

AMK (27 decks)

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