Lungs: Restrictive Intrinsic Conditions - Pulmonary Fibrosis, Sarcoidosis, Asbestosis, Pneumonia Flashcards
IPF
-presentation
45+ Persistent SOB on exertion, dry cough Bilateral inspiratory crackles Clubbing Restrictive spirometry
IPF
-triggers and exposures
Idiopathic
Drug induced
- chemo
- methotrexate
- amiodarone
- nitrofurantoin
Environmental
- asbestos, orgnaic dust
- hay, straw, grain
- bird poo
AI
-RA, SLE, Sjogrens, scleroderma, dermatomyositis, polymyositis
IPF
-investigations
Clinical diagnosis with the support of lung function tests and imaging
LFTs - spirometry, gas transfer => restrictive intrinsic lung problem
Scans
-CXR => interstitial lung markings
-CT => reticular honeycombing, traction bronchiectasis
Procedures done if still unsure - broncheolar lavage, lung biopsy
IPF management
- conservative
- medical
- surgical
MAINLY SUPPORTIVE
- Pulmonary rehabilitation
- Oxygen therapy
- Smoking cessation
Nintedanib
Pirfenidone
Lung transplantation/palliative care
Upper lung fibrosis causes
Lower lung fibrosis causes
Upper
- Coal worker
- Histiocytosis/hypersensitivity pneumonitis
- AS
- Radiation
- TB
- Silicosis (rocks, soil)/sarcoidosis
Lower
- IPF
- Most connective tissue AI cond MINUS AS
- Drugs - amiodarone, bleomycin (chemo), methotrexate
- Asbestosis
What is sarcoidosis
- epidemiology
- etiology
- pathophysiology
Women
Young adults
Mix of genetic and environmental
AI => non caseating granulomas on lungs and skin
Can be acute or chronic
Sarcoidosis
-acute presentation
Loefgren syndrome - acute, mild, self limiting
Bilateral hilar lymphadenopathy
Erythema nodosum
Arthritis
SOB, persistent dry cough
Tender swollen LN
Sarcoidosis
-investigations, diagnosis
Clinical diagnosis of exclusion
- Restrictive spirometry
- High Ca, ACE, CRP
- CXR - bilar hilar lymphadenopathy
- Lung biopsy - non caseating granulomas
Sarcoidosis
-management
Acute episodes can be self limiting
NSAIDs/CS depending on severity
-may also use methotrexate, azathiopurine, HCQ = LFTs needed to assess impacts
If end stage lung disease - lung transplants considered
What 4 lung problems can asbestos exposure cause
- presentation
- management
Pleural plaques - benign (20-40 years latent)
Asbestosis - severity linked to length of exposure
- lower lung fibrosis => SOB, low exerecise tolerance
- conservatively managed
Mesothelioma - limited exposure can cause disease
- SOB, chest pain, pleural effusions
- v aggressive => palliative chemo
Lung cancer
Pneumonia
-epidemiology and etiology
Young children/elderly
IC
Droplet inhalation
Haematogenous
Pneumonia
-presentation
Dyspnoea
Purulent/clear sputum
Cough
Fever
High RR,
Hypotension, pyrexia (systemic inflammation)
Crackles, increased VR (exudate and consolidation)
Central cyanosis/confusion (hypoxemia)
Pneumonia
-investigations, diagnosis
DEFINITIVE - CXR IDENTIFY ORGANISM -Blood, sputum culture -Viral PCR -Atypical serology -Urine AG (legionella, pneumococcal)
ABG - PO2
FBC
U&E, LFT, CRP
CURB65
-interpretation of results
Confusion AMTS<8 Urea >7 RR >30 BP systolic<90 diastolic<60 65
0-1 home
2 admission considered
3-5 urgent admission, maybe ITU
Pneumonia
-management
Empirical broad spec ABx in 4hrs
0-amox
1-2-amox+clarithromycin
3-5-coamox+clarythromycin
Most common causative organism for pneumonia
- presentation
- management
S pneumonia - amox
- acute, high fever
- pleuritic pain, cold sores
2nd most common causative organism for pneumonia
-management
Causative organism of pneumonia post influenza
-management
Causative organism of pneumonia in alcoholics
-presentation
Viral - management depends on virus
S aureus - fluclox
Klebsiella pneumonia - red currant sputum
What are some causes of atypical pneumonias
How are they different from other pneumonias
Slow onset, flulike
Dry cough, fatigue, substernal chest pain
Often no physical exam findings => CXR looks worse than patient
Extrapulmonary features
Mycoplasma pneumonia - culture, serology
- younger people
- neuro and systemic symptoms (rashes)
Chlamydophila pneumonia - culture and serology
-Mild symptoms
Legionella - urine AG
-Severe pneumonia with a high mortality
CAN ALL BE MANAGED WITH ERYTHROMYCIN
Common causes of aspiration pneumonia
- location
- bacteria involved
Foreign materials entering bronchial tree
- poor dentition
- dysphagia
- prolonged hospitalisation, surgery
- unconscious
S pneumonia, aureus, H influenza, P aeruginosa, sterile (pneumonitis)
Fungal causes of pnuemonia
- epidemiology
- presentation
- causative organism, management
HIV, IC
- SOB
- dry cough
- fever
- v few chest signs
Aspergillus - amphotericin
PCP (HIV) - cotrimoxazole + CS
Complications of pneumonia
Sepsis ARDS Parapneumonic effusion, empyema Cavitations MI
Follow up 6wks after pneumonia
Prevention of pneumonia
CXR if
- smoker
- 50+
- symptomatic to check for lung cancer
Pneumonia, flu vaccine
