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ΩΩ 2a Bateman - Systems Based > Lung Pathology > Flashcards

Lung Pathology Flashcards

1
Q

WHAT IS COPD?

A

Collection of lung diseases that cause IRREVERSIBLE obstruction to airflow out of the lungs.

Umbrella term for two diseases chronic bronchitis and emphysema

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2
Q

What are the causes of COPD?

A

Smoking

A1AT

IV drug use

Industrial exposure to chemicals

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3
Q

WHAT IS CHRONIC BRONCHITIS?

https://www.youtube.com/watch?v=Y29bTzKK_P8

A

Bronchial tubes inflammation

IRREVERSIBLE

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4
Q

What is chronic bronchitis defined as?

A

Cough, sputum production on most days for 3 months of 2 successive yrs

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5
Q

What does smoking cause?

What does this cause?

In chronic bronchitis

A

Hypertrophy and hyperplasia of the mucinus glands (bornchi)
Hypertrophy and hyperplasia of goblet cells (bronchioles)
Increase in mucus

Cilia also become short and less motile
Harder to move mucus

Air trapping

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6
Q

How can pulmonary hypertension happen in chronic bronchitis?

A

Decreased gas exchange causign vasocontriction

Large proportion

Increases pulminary vascular resistance

Develops pulmonary hypertension

Right side of heart enlarges

Cor pulmonale

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7
Q

How can a person become cyanosed in chronic bronchitis?

A

CO2 trapped in alveoli takes up more space

O2 unable to fill alveoli

Less goes into the blood

More CO2 in alveoli means less CO2 can come out the blood

More CO2 in blood less O2

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8
Q

What is the reid index?

A

Size of the mucinus glands relative to the rest of the layers

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9
Q

Who does chronic bronchitis affect?

A

Affects middle aged heavy smokers

Some following pollution chronically

Recurrent low grade bronchial infections

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10
Q

What are the symptoms of chronic bronchitis?

A

Dyspnea

Wheeze

Crackles

Cough

Production of mucus (sputum)

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11
Q

What are the signs of chronic bronchitis?

A

Hypoxemia
Hypercapnia
These cause cyanosis

Pulmonary hypertension
Result of low O2
Causing cor pulmonale

Tachypnoea

Use of accessory muscles

Hyperinflation

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12
Q

What are the differential diagnosis for chonic bronchitis?

A

Alpha1-Antitrypsin Deficiency

Asthma

Bronchiectasis

Chronic Obstructive Pulmonary Disease (COPD)

Chronic Sinusitis

Gastroesophageal Reflux Disease

Influenza

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13
Q

What are the investigations for chronic bronchitis?

A

Spirometry

Chest X-ray
Rule out other lung conditions, such as pneumonia.

ECG
Right venticle and atria enlargment (cor pulmonale)

Sputum (bacteria).

ABG: PaO2 decrease ± hypercapnia

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14
Q

What are the non-pharmocological management options for chronic bronchitis?

A

Stop smoking

Physical activity

Vaccinations
Flu
Pneumococcal
Pertussis

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15
Q

What is the pharmocological management options for chronic bronchitis?

A
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16
Q

What is mMRC and CAT in COPD?

A

The modified Medical Research Council (mMRC) Questionnaire is widely used for assessing the severity of breathlessness in patients with COPD.

The COPD Assessment Test (CAT) is a questionnaire for people with Chronic Obstructive Pulmonary Disease (COPD).

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17
Q

WHAT IS EMPHYSEMA?

https://www.youtube.com/watch?v=TEuSV_7gWA8

A

Enlargement of alveolar airspaces with destruction of elastin in walls.

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18
Q

What are the causes of emphysema?

A
  1. Cigarette smoking. (MAINLY)
  2. Alpha-1-antitrypsin deficiency
  3. Coal dust exposure
  4. Cadmium toxicity
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19
Q

What happens when the alveoli becomes irritated by smoke?

What does this do?

What happens when exhaling?

A

Triggers an inflammatory response, immune cells come in

Releasing inflammatory mediators
(Proteases, Collangenases)
Breaks down the collagen and elastin in the alveoli wall

Bernoulli principle

Exhalation of air has a lower pressure and pulls the airway inwards, ormal airways can withstand this
Emphysema airways have less elastin and collagen therefore collapse

Leads to air trapping

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20
Q

What happens when air comes into emphysema lungs?

A

Lungs are more compliant

Lungs overinflate

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21
Q

What happens in alpha-1 antitrypsin deficiency?

A
  1. Macrophages produce proteases
    • Helps clear debris
    • Can damage tissue
  2. Alpha-1 antitrypsin is a protease inhibitor
  3. Protects against damage
  4. Deficiency means proteases can damage lungs
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22
Q

What are the oxygen and carbon dioxide levels in emphysema?

A

‘pure’ emphysema appears with reduced PaCO2 and normal PaO2 at rest due to overventillation (‘pink puffers’)

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23
Q

What are the symptoms of emphysema?

A

Dyspnea - shortness of breath

Exhaling through pursed lips to keep lungs inflated

Cough - sputum

Weight loss due to metabolic demands

1/3 of lung capacity is destroyed before symptoms

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24
Q

What are the signs of emphysema?

A

Barrel chest - overinflated chest on x-ray

Flattened diaphragm

Pulmonary hypertension

Right heart failure

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25
Q

What are the differential diagnosis of emphysema?

A

Bronchiectasis

Bronchitis

Lymphangioleiomyomatosis

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26
Q

What are the investigations for emphysema?

A

Pulmonary/Lung Function tests
Spirometry is the best test to detect airflow limitation and obstruction.

Blood tests
Hb level increase secondary polycythaemia.

Chest x-ray
This helps to show hyperexpansion of the lungs.

ECG or Echocardiogram
Right heart failure (a complication of emphysema and COPD).

Blood gases
Normal, later stages of disease, low oxygen and high carbon dioxide levels.

High resolution CT
Best test for detecting emphysema and bullae (big dilated air spaces).

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27
Q

What are the non-pharmocological management options for emphysema?

A

Stop smoking

Physical activity

Vaccinations
Flu
Pneumococcal
Pertussis

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28
Q

What is the pharmocological management options for emphysema?

A
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29
Q

What are the complications of COPD?

A

Pneumothorax

Cor pulmoale

Acute exaccerbations

Infection

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30
Q

WHAT IS AN EXACERBATION OF COPD DEFINED AS?

A

An exacerbation can be defined as a sustained worsening of the patient’s symptoms from his or her usual stable state that is beyond normal day-to-day variations, is acute in onset and requires additional therapy

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31
Q

What are the most likely causative organism in an exacerbation of COPD?

A

S. pneumoniae, H. influenzae and Moraxella cartarrhalis

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32
Q

What are the clinical features of an exacerbation of COPD?

A

worsening of previous stable condition

increased wheeze

increased dyspnoea

increased sputum volume

increased sputum purulence

chest tightness

fluid retention

reduced exercise tolerance

increased fatigue

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33
Q

What are the investigations for an exacerbation of COPD?

A

Chest X-ray

Arterial Blood Gas

Sputum Sample

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34
Q

What is the treatment for an exacerbation of COPD?

A

Increase bronchodilator use - consider nebs

Antibitoics
Amoxicillin

Steroids
Prednisolone

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35
Q

What is given for prophylaxis against exaccerbations in COPD?

A

Azithromycin 250mg 3 times a week

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36
Q

WHAT IS BRONCHIECTASIS?

https://www.youtube.com/watch?v=rTcVPHszU5E

A

Irreversible dilation of the bronchioles

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37
Q

What are the causes of bronchiectasis?

A 
**_Congenital_** 
Cystic fibrosis (CF);

Post-infection
TB
HIV

**_Other_**
Bronchial obstruction (tumour, foreign body)
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38
Q

What is the pathology of bronchiectasis?

A

Infection and imparied drainage

Activates neutrophilic proteases and cytokines causing inflammation

Increaed mucus and increased stagnent bacteria

Cycle starts again

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39
Q

What are the signs and symptoms of bronchiectasis?

A

Chronic cough - foul smelling sputum

Flecked with blood sometimes.

Finger clubbing

Coarse inspiratory crepitations.

Wheeze

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40
Q

What are the differential diagnosis for bronchectasis?

A

Alpha1-Antitrypsin Deficiency

Aspiration Pneumonitis and Pneumonia

Asthma

Bronchitis

Chronic Obstructive Pulmonary Disease (COPD)

Cystic Fibrosis

Emphysema

Gastroesophageal Reflux Disease

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41
Q

What are the tests for bronchiectasis?

A

Sputum culture

Chest X-Ray
Cystic shadows, thickened bronchial walls

HRCT chest
To assess extent and distribution of disease.

Spirometry
Obstructive.

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42
Q

What is the management for bronchiectasis?

A

Stop smoking

Airway clearance exercises

Bronchodilators

Corticosteroids

Antibiotics - if infective cause
Amoxicillin

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43
Q

What are the complications with bronchiectasis?

A

Pneumonia

Emphysema

Septicaemia

Amyloid formation.

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44
Q

WHAT IS ALPHA-1 ANTITRYPSIN DEFICIENCY?

A

A deficiency in alpha-1 antitrypsin

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45
Q

What does alpha-1 antitryspin do?

What is the gene that codes for it?

What chromosome is it on?

A

Inactivates elastase (a protease)

SERPINA1

Long arm of chromosome 14

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46
Q

When would you favour alpha 1-antitryspin deficiency as a dignosis?

A

Never smoked

Young

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47
Q

What are the symptoms of alpha-1 antitrypsin deficiency?

A

Shortness of breath

Wheezing

Mucus production

Chronic cough

Cirrhosis
Inability to make coagulation factors
Build up of toxins

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48
Q

What investigations are done for alpha-1 antitrypsin deficiency?

A

Assaying protease inhibitor activity

Typing proteins with isoelectric focusing

Bloods
A1AT low

Biopsy
Liver - Periodic-acid shiff stain

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49
Q

What is the treatment of alpha-1 antitrypsin deficiency?

A

Augmentation therapy
IV infusion of normal protein
Slow of halts progression

Inhlaers

Oxygen

Liver transplant

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50
Q

WHAT ARE INTERSTITIAL LUNG DISEASES?

A

Disease of the alveoli primarily

Scarring

Fibrosis

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51
Q

What are some causes of interstitial lung disease?

A

Congenital
Neurofibromatosis
Tuberous sclerosis

Chemical or dust inhalation
Organic dusts e.g. moulds, avian proteins
Mineral dusts e.g. silica, coal dust, asbestos

Unknown causes:
Idiopathic haemosiderosis
Sarcoidosis

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52
Q

What are the symptoms of interstitial lung diseases?

A

Dry cough

Digital clubing

Diffuse inspiratory crackles

Dysponea

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53
Q

What can acute interstitial lung diseases cause?

A

Acute respiratory distress syndrome

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54
Q

WHAT ARE SOME CAUSES OF ACUTE RESPIRATORY DISTRESS?

A

Shock

Trauma

Infections

Gas inhalation

Narcotic abuse

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55
Q

What are the symptoms of acute respiratory distress syndrome?

A

Tachypnoea

Dyspnoea

Pulmonary oedema

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56
Q

WHAT IS PNEUMOCONIOSIS?

A

Lung disease caused by inhaled dust Organic or inorganic dust (mineral)

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57
Q

What happens in coal workers’ pneumoconiosis?

A

Coal is ingested by alveolar macrophages (dust cells)

They aggregate around bronchioles

The consequences vary from trivial to lethal.

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58
Q

WHAT IS RHEUMATOID ARTHRITIS INTERSTITIAL LUNG DISEASE?

A

Rheumatoid arthritis interstitial lung disease (RA-ILD) is increasingly recognised and is clinically significant in up to 5% of patients with RA

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59
Q

What are the investigations for rheumaotid arthritis interstitial lung disease?

A
  1. Pulmonary function testing
  2. High resolution CT
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60
Q

What is the treatment for rheumatoid arthritis interstitial lung disease?

A

High-dose corticosteroids
Prednisolone

Immunosuppresants
Azathioprine

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61
Q

What is Caplan’s syndrome?

A

The association between rheumatoid arthritis, pneumoconiosis, and pulmonary rheumatoid nodules.

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62
Q

How do you treat coal workers pneumoconiosis?

A

Avoid exposure to coal dust

Treat co-existing chronic bronchitis

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63
Q

WHAT IS ASBESTOSIS?

A

Pneumoconiosis caused by inhalation of asbestos fibres, classically causing a chronic, diffuse, interstitial fibrosis of the lun

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64
Q

What is asbestosis caused by?

A

Inhaltion of asbestos.

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65
Q

What are the features of asbestosis?

A

Similar to other fibrotic lung diseases with progressive dyspnoea, clubbing, and fine end-inspiratory crackles.

Also causes pleural plaques, increased risk of bronchial adenocarcinoma and mesothelioma.

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66
Q

What are the investigations for asbestosis?

A

Chest X-ray
Diffuse bilateral shadowing, honeycomb lung. There may be pleural plaques which are an indicator of previous exposure to asbestos

Lung function tests
Restrictive

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67
Q

What is the management of asbestosis?

A

Symptomatic.

Patients are often eligible for compensation through the UK Industrial Injuries Act.

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68
Q

WHAT IS EXTRINSIC ALLERGIC ALVEOLITIS?

https://www.youtube.com/watch?v=PIuj6XiMlps

A

Inflammation of the alveoli due to an extrinsic allergen of known type

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69
Q

What are two types of extrinsic allergic alveolitis?

A

Bird fancier’s lung
Avian proteins in droppings
Antigens

Farmer’s lung
Caused by fungus (poorly stored / mouldy hay)

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70
Q

What is the pathology of EAA?

What type of sensitivity is it?

A

Allergens comes in

Irritates alveoli and activates neutrophils

Releases inflammatory cytokines

Cascade leads to B cell antibody prodction

Complexes form

TYPE 3

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71
Q

What are the two types of EEA?

A

Acute (few hours after only inflammation)

Chronic (fibrosis)

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72
Q

What is seen in chronic that is not seen in acute EAA?

A

Granulomas

Non-caseating

Macrophages fuse with eachother making granulomas

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73
Q

What are the symptoms of extrinsic allergic alveolitis?

A

Acute
Fever
Rigors
Myalgia
Dyspnoea
Crackles (no wheeze).

Chronic
Increasing dyspnoea
Weight decrease
Exertional dyspnoea
Type I respiratory failure
Cor pulmonale.

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74
Q

What are the tests for extrinsic allergic alveolitis?

A

CXR
Upper-zone mottling/consolidation

Honeycombing sometimes

Blood
FBC (neutrophilia); ESR increase; ABGS; positive serum precipitins (indicate exposure only).

Lung function tests
Restrictive defect; reduced gas transfer during acute attacks.

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75
Q

What are the management options for extrinsic alergic alveolitis?

A

Remove allergen

O2

Oral prednisolone

76
Q

What is the difference between asthma and EAA?

A

Asthma
Obstructive
Larger airways
Type 1 allergic

EAA
Restrictive
Smaller airways
Type 3 and 4 allergic

77
Q

WHAT IS SARCOIDOSIS?

https://www.youtube.com/watch?v=D-ahTqbqnqE

A

Granulomatous disease affecting mainly the lungs, but also lymph nodes in a greater frequency.

78
Q

What type of granuloma is sarcoidosis?

A

Non-ceasiating granulomatous disease

79
Q

What is the epidemology of sarcoidosis?

A

African-americans

Women more than men

Under 40 years of age

Non smokers

80
Q

What is the cause of sarcoidsis?

What cells are disregulated?

A

Unknown

Disregulation of CD4 cells

81
Q

What are the pulmonary symptoms of sarcoidosis?

A

4 D’s!

Dry cough

Digital clubbing

Dyspnoea

Diffuse inspiatory crackles

82
Q

What are the non-pulmonary symptoms of sarcoidosis?

A
  1. Skin – erythema nodosum
  2. Arthritis - esp. of feet, hands
  3. Cardiac– heart block, VT, heart failure
  4. Ocular– anterior uveitis, can lead to blindness
  5. Intracranial (brain) – chronic meningitis, seizures, neuropathy
  6. Derangement of liver and renal function – hepatic granuloma (70% patients), hypercalcaemia(
83
Q

What are the tests for sarcoidosis?

A

Tissue biopsy
Diagnostic non-caseating granulomatas

X-ray
Enlarged lymph nodes

24h urine
Ca2+ increase.

Blood
Increased ESR, lymphopenia, LFT incerease,
Serum ACE increase
Increased Ca2+

84
Q

What is the management of sarcoidosis?

A

Nothing usually

Corticosteroids
Prednisolone PO

85
Q

What is an acute version of sarcoidosis called?

A

Lofgren sydrome

86
Q

WHAT IS IDIOPATHIC PULMONARY FIBROSIS?

A

Uknown excess amount of collagen in the lungs connective tissue and interstitial tissue after damage

87
Q

What is the cause of IPF?

88
Q

What are the risk factors for IPF?

A
  1. Old age
  2. Smoking
  3. Male
89
Q

What happens with fluid in IPF?

A

Loss of alveoli and start pooling fluid

Seen as honeycombing

90
Q

What are the symptoms of IPF?

A

4 D’s!

Dry cough

Digital clubbing

Dyspnoea

Diffuse inspiatory crackles

91
Q

What are the tests for IPF?

A

CXR
Thickening of alveoli walls
Honeycomb lung

_Spirometry
​_Restrictive; decrease transfer factor.

Blood
ABG decrease in oxygen, increase in CO2
CRP increase; immunoglobulins increase;
ANA (30% +ve), rheumatoid factor (10% +ve).

BAL (Bronchoalveolar lavage)

92
Q

What are the management options for idiopathic pulmonary fibrosis?

A

Supportive care
Oxygen, pulmonary rehabilitation, opiates, palliative care input

Antifibrotic medications
Pirfenidone and nintedanib

Lung transplant

93
Q

WHAT ARE THE TWO TYPES OF LUNG TUMOUR?

A

Bronchial.

Pleural.

94
Q

What are the different types of bronchial cancers?

A

Malignant (95%) = lung cancer

  1. Non small cell cancer
  2. Small cell cancer

Benign

  1. Hamartoma
  2. Carcinoid
  3. Lipoma
95
Q

What are the causes of lung cancer?

A

Smoking

Asbestos

Chromium

Arsenic

96
Q

What are the cell types of lung cancer?

A

Small cell lung cancer 15%

Non small cell lung cancer 85%
Squamous
Adenocarcinoma (adenocarcinoma-in situe)
Large cell 5%
NOS

97
Q

What are the symptoms of local lung cancer?

A

Cough (40%)

Chest pain (20%)

Haemoptysis (7%)

98
Q

What are the signs of lung cancer?

A

Weight loss

Anaemia

Clubbing

Supraclavicular or axillary nodes

99
Q

What are the investigations for lung cancer?

A
  1. CXR
  2. Constrast chest CT
  3. Bronchoscopy
  4. Needle or surgical biopsy
100
Q

What are the sites of metastatic disease from lung cancer?

BBALL

A

Bone

Brain

Adrenal glands

Lymph glands

Liver

101
Q

What is the treatment of lung cancers?

A

Stage I/II
surgical excision and radical deep x-ray therapy

Stage III/IV
Palliative chemotherapy, chemotherapy and radiotherapy, palliative care

102
Q

WHAT IS MESOTHELIOMA?

https://www.youtube.com/watch?v=MMmjTbywMSI

A

Tumour of mesothelial cells in the pleura

103
Q

What is the pathology of mesothelioma?

A

Epithelioid (Activated macrophages resembling epithelial cells)

Sarcomatoid (Sarcomatous, spindled or diffuse malignant fibrous mesothelioma)

Inflammation

DNA damage

104
Q

What are the symptoms of mesothelioma?

A
  1. FEVER
  2. WEIGHT LOSS
  3. FATIGUE
  4. SOB
  5. Persistent cough
  6. Clubbed fingers
105
Q

What are the tests for mesotheiomas?

A

CXR
Pleural thickening/effusion. Bloody pleural fluid

CT scan

Pleural aspiration

Biopsy

106
Q

What is the treatment for mesotheliomas?

A

Symptom control

Palliative chemotherapy (Pemetrexed + cisplatin)

Radical surgery/debulking surgery

Palliative radiotherapy

107
Q

What is type 1 respiratory failure? What is the cause?

A

Type 1: Low PaO2, normal (or low) paCO2, normal or high A-a gradient.

Limited of ventilation, perfusion or diffusion.

108
Q

What is type 2 respiratory failure? What is the cause?

A

Type 2: low paO2, high CO2, usually normal A-a gradient (acute or chronic).

Alveolar hypoventilation.
CO2 enters alveoli, but not removed.

109
Q

WHAT IS PNEUMONIA?

A

An infection in the lungs by microbes

Brings water into lung making it harder to breath

110
Q

Who are the people at risk of pneumonia?

A

Infants and the elderly.

COPD and certain other chronic lung diseases.

Immunocompromised.

Nursing home residents.

Diabetes.

Alcoholics and intravenous drug users.

111
Q

How can pneumonia be classified?

A

Bronchopneumonia
Throughout lung

Atypical
Interstatium

Lobar

112
Q

What are the common microbes that cause pneumonia?

A

Viruses
Influenza

Bacteria
Strep pneumoniae

Staph aureus

Legionella’s (hot country, air conditioning)

Jirovecci (HIV patients)

113
Q

What are the symptoms of pneumonia?

A

Fever

Rigors

Fatigue

Pleuritic chest pain

SOB

Headache

Cough with sputum (rusty green)

114
Q

What are the signs of pneumonia?

A

Pyrexia

Cyanosis

Tachypnoea

Drop in BP

SPUTUM

Confusion(esp. elderly)

115
Q

How can you investigate if somebody has suspected pneumonia?

A

Listen to the chest

Gold standard
CXR
Consolidation.

Determine the causative organism

Sputum sample and blood culture

Urinary antigen test –Legionellas

Thoracentesis

116
Q

How do you manage pneumonia?

A

Antibiotics for CAP:

Mild: oral amoxicillin

Moderate: oral amxoicillin and clarithromycin

Severe: IV co-amoxiclav and clarithromycin

Antibiotics for Legionellas:

Fluoroquinolone (ciprofloxacin) + clarithromycin

117
Q

What is CURB-65?

A

Confused

Urea >7

Resp rate >30

Blood pressure 90/60

Over 65

118
Q

WHAT IS ASTHMA?

A

REVERSIBLE chronic obstructive airway disease

119
Q

What are the two main types of asthma?

A

Eosinophilic.
Associated with allergy.
Also non-allergic variant.

Non-eosinophilic.

120
Q

What is asthma if not eosinophilic?

A

Overlaps with smoking and obesity.

121
Q

What are the two different triggers of asthma and what are some examples?

A

Allergic
Genetics, environmental stimuli, hygiene hypothesis

Non-allergic
Intrinsic e.g. stress, cold air, infection

122
Q

What is atopy?

A

Asthma

Hayever

Eczema

123
Q

What type of hypersensitivity is asthma?

A

Type 1 as it involves IgE

124
Q

What are the symptoms of asthma?

A

Chest tightness

Coughing

Wheezing

Dyspnea

Sputum

125
Q

What are the tests for asthma?

A

Spirometry
FEV1/FVC<70% + Reversibility testing

Peak flow
(keep a diary –diurnal variation)

Bronchodilator reversability

126
Q

What are the differential diagnosis for asthma?

A

Bronchiectasis

CF

PE

Bronchial obstruction - foreign body, tumour, etc

Aspiration

COPD

127
Q

What are the steps of treatment for chronic asthma?

A

Step 1
SABA (salbutamol)
Step 2
SABA + Beclametasone (ICS)
Step 3
SABA + ICS + LTRA (montoleukast)
Step 4
SABA + low-dose ICS + long-acting beta agonist (LABA) + LRTA
Step 5
SABA + LTRA + Low dose MART
Step 6
SABA + LTRA + medium dose MART
Step 7
SABA + LTRA + High dose ICS + Muscarnic receptor agonist

128
Q

What is the treatment for an acute asthmatic?

A

Oxygen 15L O2 sats 94-98%

Salbutamol 5mg nebs

Hhydrocortisone 100mg IV

Ipatropium bromide 0.5mg nebs

Theophyilline IV

Magnesium sulphate 2mg IV

Escalate care

129
Q

WHAT IS TUBERCULOSIS CAUSED BY?

What is this bacteria?

A

Mycobacterium Tuberculosis

Which is an AEROBIC, NON-MOTILE SLIGHTLY CURVED ROD

130
Q

What are the risk factors for TB?

A

Born in high prevalence area

IVDU Homeless

Alcoholic

Prisons

HIV+.

131
Q

How is TB spread?

A

AIRBORNE DROPLETS

132
Q

What are the different types of TB?

A

Healthy
Person has never been infected with TB

Active TB
This is when the bacterium are multiplying in the lungs and people have symptoms

Latent
The TB bacteria are NOT dividing in the lungs. Individual asymptomatic.

133
Q

What are the symptoms of TB?

A

Fever

Night sweats

Chills

Chest pain

Cough

Sputum

Haemoptysis

Breathlessness

134
Q

What are the signs of TB?

A

Coughing up BLOOD

Individual will look unwell

135
Q

How can you diagnose TB?

A

Sputum test (3x) - Ziehl–Neelsen stain
Used to detect acid fast organisms

Mantoux skin test
Latent TB

CXR
Enlarged lymph nodes
GOHN COMPLEX

CT scan

136
Q

What is the treatment for active TB?

A

Rifampicin. 6 months

Isoniazid. 6 months

Pyrazinamide 2 months

Ethambutol. 2 months

137
Q

What are some side effects of RIPE?

A

Rifampicin
Red urine, hepatitis, drug interactions.

Isoniazid
Hepatitis, neuropathy

Pyranzidimide
Hepatitis, arthralgia / gout, rash.

Ethanbutol
Optic neuritis

138
Q

WHAT IS PNEUMOTHORAX?

A

Build up of AIR in the pleural space

139
Q

What are the causes of a pneumothorax?

A

Primary
No underlying lung disease, but risk factors include

  1. Male
  2. Smoking
  3. Connective tissue disease (Marfans, Ehlers Danlos).

Secondary
Underlying lung pathology that has caused it.

  1. Trauma
  2. Fractured ribs
  3. Stab wound
  4. Gunshot
  5. Catheter
  6. Biopsy
140
Q

What are the clinical features of a pneumothorax?

A

Symptoms

  1. SOB
  2. Sharp
  3. ONE SIDED chest pain
  4. Altered consciousness

Signs

  1. Tachycardia
  2. Tachypneoa
141
Q

What are the tests for a pneumothorax?

142
Q

What are the management options for a pneumothorax?

A

Primary pneumothorax

  1. If the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
  2. Otherwise, aspiration should be attempted
  3. If this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

Secondary pneumothorax

  1. If the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
  2. Otherwise aspiration should be attempted if the rim of air is between 1-2cm. If fails then chest drain. All patients should be admitted for at least 24 hours
  3. If the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
143
Q

What is the emergency pneumothroax?

A

Tension pneumothorax

Thrachea deviation

144
Q

How do you treat a tension pneumothorax?

A

Needle decompresion and chest drain 2nd intercostal space

145
Q

WHAT IS A PLEURAL EFFUSION?

What type of fluid can be there?

A

Fluid in the pleural space

Chyle, blood, serous, pus.

146
Q

How can pleural effusions be divided?

A

Transudates
Excessive production of pleural fluid or resorption is reduced. E.g. heart failure, cirrhosis, nephrotic syndrome

Exudates
Result from damaged pleura. E.g. PE, bacterial pneumonia, cancer, viral infection, pancreatitis

147
Q

What are the different names for blood in pleural splace etc?

A

Blood in the pleural space is a haemothorax, pus in the pleural space is an empyema, and chyle (lymph with fat) is a chylothorax.

Both blood and air in the pleural space is called a haemopneumothorax.

148
Q

What are the symptoms of a pleural effusion?

A

SOB

Cough

Chest pain

149
Q

What are the signs of a pleural effusion?

A

Decreased chest movement

Reduced breath sounds

Dull to percussion

150
Q

What are the tests for a pleural effusion?

A

CXR
white (fluid),

Listen to the chest
Dull to percussion
Reduced breath sounds

Thoracocentesis

151
Q

What are the management options for a pleural effusion?

A

Aspirate / chest drain

Pleurodesis

152
Q

WHAT IS A PULMONARY EMBOLISM?

Where is it most commonly from?

A

Clot inside a pulmonary vessel

a DVT

153
Q

What are the risk factors for a pulmonary embolism?

A

Immobility - >3 days, surgery within last 4 weeks

Previous DVT/ PE

Pregnancy

Thrombophilic syndromes

Malignancy

Hormone Therapy

154
Q

What are the symptoms of a pulmonary embolism?

A

Sudden onset dyspnoea

Chest pain

Red, swollen leg ?

Haemoptysis

Pre-syncope, syncope

Tachycardia

155
Q

What are the signs of a pulmonary embolism?

A

Pyrecia

Cyanosis

Tachycardia

Tachypnoea

Hypertension

Raised jvp

156
Q

What is Well’s score?

What do the results show?

A
  1. Active cancer, or cancer that’s been treated within last six months- 1
  2. Paralyzed leg - 1
  3. Recently bedridden for more than three days or had major surgery within last four weeks - 1
  4. Tenderness near a deep vein - 1
  5. Swollen leg - 1
  6. Swollen calf with diameter that’s more than 3 centimeters larger than the other calf’s - 1
  7. Pitting edema in one leg - 1
  8. Large veins in your legs that aren’t varicose veins - 1
  9. Previously diagnosed with DVT - 1
  10. Other diagnosis more likely -2

>3 High Risk of DVT
1 or 2 Moderate risk
0 or less Low risk of DVT

157
Q

What are the tests for a PE?

A

D-dimer – negative excludes PE but positive doe not prove it

If positive, need to do CTPA

158
Q

What is the management of a PE?

A

Oxygen

Analgesia

Anticoagulation – LMWH, Fondoparinux

Start Warfarin – long term anticoagulation (Rivaroxaban is a suitable alternative)

Embelecetomy if large PE

159
Q

WHAT IS GOODPASTURE’S SYNDROME?

A

Vasculitis

Triad of:

  1. Glomerulonephritis
  2. Pulmonary haemorrhage
  3. Autoantibodies to GBM and alvelor basement membrane
160
Q

What is goodpasture’s syndrome caused by?

A

Antibodies form against type IV collagen

161
Q

What type of sensitivty reaction is goodpastures syndrome?

162
Q

What are the environmental risk factors for goodpatures syndrome?

A

Smoking

Infection

Oxidative stress

163
Q

What are the symptoms for goodpasture’s syndrome?

A

Haemoptysis
SOB, chest pain, cough,

Haematuria
Proteinuria, oedema, uraemia, high bp

164
Q

What are the tests for goodpasture’s syndrome?

A

CXR
Infiltrates due to pulmonary haemorrhage, often in lower zones.

Kidney biopsy
Crescentic glomerulonephritis.

165
Q

What are the treatment options for goodpasture’s syndrome?

A

Immunosuppressive
Cyclophosphamide, prednisolone, rituximab

Plasmapheresis

166
Q

WHAT IS GRANULOMATOSIS WITH POLYANGITIS (formerly termed Wegener’s granulomatosis)?

https://www.youtube.com/watch?v=Ax98k35h_jk

A

Small vessel vasculitis with caseating granulomas

167
Q

What type of sensitivity is wegners?

168
Q

What parts of the body are affected in wegners?

A
  1. Nasal passage
  2. Respiratory tract
  3. Kidneys
169
Q

What are the features of wegener’s granulomatosis?

A
  1. Kidneys
    RPGN with crescent cells, haematuria
  2. Lung
    Migrating cavitatingcoin nodules, haemoptysis, pulmonary infiltrates
  3. URT
    Saddle nose deformity, epistaxis
  4. Eyes
    Iritis, scleritis, episcleritis
  5. Arthritis
  6. Elbow nodules
170
Q

What antibodies are involved in wegners?

171
Q

What are the tests for Wegener’s granulomatosis?

A

cANCA
Positive

Urinalysis
Proteinuria or haematuria

Biopsy of kidneys
Granulomas

CXR
Nodules ± fluffy infiltrates of pulmonary haemorrhage

Increased ESR/CRP

172
Q

What is the treatment for wegener’s granulomatosis?

A

Corticosteroids

Cyclophosphamide
Inhibit immune system

173
Q

WHAT IS PULMONARY HYPERTENSION?

https://www.youtube.com/watch?v=Dx4QgdN_hI4

A

Mean arterial blood pressure greater than 25 mmhg

174
Q

What are the causes of pulmonary hypertension?

A

Pre-capillary
Multiple small PEs cause obliteration of vascular bed
Left-to-right shunts cause increased pulmonary blood flow and pressure

Capillary
Disease of pulmonary vascular bed
Eg emphysema, COPD

Post-capillary
Backlog of blood causes secondary pulmonary hypertension
LV failure

Chronic hypoxaemia
Living at high altitude
COPD

175
Q

What are the symptoms of pulmonary hypertension?

A

Fatigue, pre-syncope

Tachycardia

Raised JVP

Altered heart sounds (louder S2)

Peripheral oedema – sacral, ankle

176
Q

What is the diagnosis of pulmonary hypertension?

A

Chest radiology
May show right atrial dilatation and right ventricular enlargement

ECG
Increase pressure in pulmonary articles and right venticle, right axis deviation, R wave in V1, inverted T waves in right precordial lead

Echocardiography
Demonstrates a dilated right ventricle with impaired function and often provides the first evidence of pulmonary hypertension

Spirometry
Chronic lung disease sometimes

177
Q

What is the treatment for pulmonary hypertension?

A
  1. Oxygen
  2. Diuretics
    Furosemide
  3. Anticoagulation
    DOAC
  4. Prostacyclin analogue
    Apoprostenol
178
Q

WHAT IS CYSTIC FIBROSIS?

https://www.youtube.com/watch?v=BhFpFiZumS0

A

Excessive mucus build up in lungs and pancreas

179
Q

What causes cystic fibrosis?

A

Autosomal recessive

CF transmembrane conductance regulator (CFTR) gene

Chromosome 7

DeltaF508

180
Q

What is the pathophysiology of cystic fibrosis?

A

Defect in chlorine channel

Chlorine can therefore not be transported into the lumen.

Water does not move out by osmosis, making the mucus thick and sticky, clogging up the lumen.

Na+ also moves into the cells via an electrochemical gradient (Cl- is negative, Na+ is positive), which also draws water in with it and makes the mucus even more thick and sticky.

181
Q

What can happen in newborns for cystic fibrosis?

A

Meconium - first stool

Can get stuck in intestine

Meconium ileus

182
Q

How is pancreatic insufficiency caused in cystic fibrosis?

A

Thick secretions block the duct

No enzymes into intestine

Protein and fat not absorbed

Failure to thrive

Steatorrhoea

Pancreas damaged due to backup of enzymes

Localised inflammation - pancreastitis

183
Q

What are the symptoms for cystic fibrosis?

A
  1. Neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
  2. Recurrent chest infections (40%)
  3. Malabsorption (30%): steatorrhoea, failure to thrive
  4. Other features (10%): liver disease
184
Q

What are the signs for cystic fibrosis?

A

Steatorrhea

Children with a failure to thrive

Finger clubbing

Rectal prolapse

185
Q

What tests are done for cystic fibrosis?

A

90% diagnosed before the age of 8.

FAECAL ELASTASE

Sweat (NaCl) test
Parents taste salt when kissing baby

Genetics testing
DeltaF508

186
Q

What are the management options for cystic fibrosis?

A

NO CURE, therefore symptom management

Non-pharmalogical
Physio for airway clearance

Pharmalogical
Antibiotics, anti-mucinolytics, bronchodilators, enzymes, insulin, bisphosphonates

Surgery
Lung transplant

187
Q

What are the complications of CF?

A

INFERTILITY

Pancreatitis

RESP TRACT INFECTIONS

Bronchiectasis

ΩΩ 2a Bateman - Systems Based (11 decks)

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