more respiratory diseases Flashcards
Non-infectious respiratory diseases excluding malignancies, COPD, and asthma.
risk factors for pulmonary embolism
thrombosis
malignancy
surgery
immobility
definition of embolism
a mass of material in the vascular system lodged in a vessel blocking its lumen
most common cause of pulmonary embolism
DVT
signs of first class pulmonary embolism
idiopathic pulmonary hypertension
small level pulmonary deficiency
signs of second class pulmonary embolism
acute respiratory and cardiac problems
chest pain
shortness of breath
right heart strain
ECG signs of second class pulmonary embolism
deep S waves in lead I
presence of Q waves and inverted T waves in lead 3
sign of third class pulmonary embolism
sudden death
treatment of pulmonary embolism
anticoagulants (heparin and warfarin)
thrombolysis
risk factors for sarcoidosis
age 20-29
women >40
coeliac disease
Black people (increased genetic tendency)
pathology of sarcoidosis
non-caseating granulomas
signs of sarcoidosis
wheezing
coughing
chest pain
diagnostic tests for sarcoidosis
CT PET biopsy test tissues to rule out other causes bloods - increased ESR
treatment of sarcoidosis
anti-inflammatories
give corticosteroids if patient has parenchymal lung disease, uveitis, hypercalcaemia, or neurological or cardiac involvement
pathology of idiopathic pulmonary fibrosis
active lung epithelium produces mediators –> differentiation in myofibroblasts –> produce excess extracellular matrix –> remodelling of lung architecture and deposition of collagen
signs of idiopathic pulmonary fibrosis
dry cough malaise weight loss cyanosis finger clubbing
complications of idiopathic pulmonary fibrosis
respiratory failure
increased risk of lung cancer
diagnostic tests for idiopathic pulmonary fibrosis
ABG - decreased Pao2 and increased PaCO2
CXR/CT - decreased lung volume and honeycomb lung (essential for diagnosis)
spirometry - restrictive
biopsy
treatment for idiopathic pulmonary fibrosis
corticosteroids
antifibrinitic drugs (pirfenidone)
tyrosine kinase inhibitors (nintedanib)
transplant
how do tyrosine kinase inhibitors work against idiopathic pulmonary fibrosis?
reduce fibroblast proliferation
reduce production of collagen and fibrogenic mediators
inhibit other growth factor receptors
risk factors for pleural effusion
heart failure
TB
cirrhosis
pathology of pleural effusion
damage to pleura leads to secretion of fluid which is in greater volume than can be absorbed by the lymphatic system
signs of pleural effusion
bronchial breathing
decreased expansion
decreased percussion (stony dull)
decreased vocal resonance
complications of pleural effusion
constricts breathing
constricts cardiac contractions
diagnosis of pleural effusion
CXR
fluid biopsy
treatment of pleural effusion
treat underlying cause
pleural tap if large effusion
pleuroperitoneal shunt if chronic
treatment of pneumothorax
treat primary condition
chest drain
signs of tension pneumothorax
respiratory distress
hypotension
tachycardia
tracheal deviation from side with pneumothorax
what is a pneumothorax?
gas in the cavity between the lung and the chest wall, causing the lung to collapse
pathology of pulmonary hypertension
high pulmonary artery blood pressure due to arterial swelling
risk factors for pulmonary hypertension
family history prior clots in the lungs HIV mitral valve disease sickle cell LV dysfunction
signs of pulmonary hypertension
syncope
tachycardia
symptoms of pulmonary hypertension
shortness of breath feeling faint or dizzy chest pain palpitations oedema
diagnosis of pulmonary hypertension
echocardiogram
ECG
pulmonary function tests
exclude other causes
treatment of pulmonary hypertension
oxygen therapy
diuretics
prostaglandins
clotting inhibitors
risk factors for hypersensitivity pneumonitis
exposure to an inhaled allergen
e.g. Farmer’s lung, Pigeon fancier’s lung
pathology of hypersensitivity pneumonitis
either type 3 or type 4 hypersensitivity
treatment of hypersensitivity pneumonitis
depends on causes - e.g. antibiotics or corticosteroids
blood test results for hypersensitivity pneumonitis
raised neutrophilia lymphocytosis eosinophilia raised ESR and CRP blood gases - hyperaemia serum antibodies
signs on CT scan of hypersensitivity pneumonitis
patchy ground glass attenuation
small, poorly defined centrilobular nodules
patchy areas of air trapping
evidence of pulmonary fibrosis and honeycombing if advanced
what percentage of adult asthma is occupational?
15%
what is pneumoconiosis caused by?
inhalation of mineral dust - e.g. asbestos, silicates, coal dust
how many people with occupational asthma end up unemployed?
1/3
what does asbestos exposure cause?
pleural plaques
diffuse pleural thickening
asbestosis
mesothelioma
diagnosis of occupational asthma
OASYS peak flow diary - measure every few hours - a positive work effect index is suggestive of occupational asthma
causes of Goodpasture’s syndrome
viral respiratory infection
breathing in hydrocarbon solvents
how much more likely are men to develop Goodpasture’s syndrome than women?
8x
pathology of Goodpasture’s syndrome
anti-glomerular basement membrane antibodies attack collagen
signs of Goodpasture’s syndrome
coughing up blood dry cough shortness of breath bloody urine burning sensation when urinating nausea and vomiting pale skin oedema
treatment of Goodpasture’s syndrome
plasmapheresis
corticosteroids
bp correcting medication
kidney transplant
risk factors for Wegener’s granulomatosis (granulomatosis with polyangiitis)
genetic
which blood vessels are inflamed in Wegener’s granulomatosis
sinuses
lungs
kidneys
pathology of Wegener’s granulomatosis
a form of vasculitis
widespread anti-neutrophil cytoplasmic antibodies
first sign of Wegener’s granulomatosis
rhinitis
then goes on to cause many other problems
diagnosis of Wegener’s granulomatosis
test for cytoplasmic c-ANCA autoantibodies (90% cases)
treatment of Wegener’s granulomatosis
corticosteroids
cyclophosphamide
rituximab
