Obstructive lung diseases NN Flashcards
3 types of Obstructive lung disease
COPD
ASTHMA
BRONCHIECTASIS (CYSTIC FIRBOSIS RELATED)
Chronic bronchitis definition
COPD with productive cough for >3 months for 2+ years
Definition of emphysema
COPD with increase neutrophil and nuclease/elastase release. This destroys elasticity of alveoli - bronchioles collapse and alveoli have decreased surface are
Cause of COPD
smoking
pollutants
alpha 1 anti trypsin deficiency (only emphysema )
Alveolar macrophages phagocytose smoke particles and release which cytokines
IL8, which call immune cells (neutrophils) into the lungs which release ROS, free radicals, proteases.
This destroys bronchial wall, trigger smooth muscle to contract (bronchospasm)
What happens in bronchioles when a person smokes repeatedly and activates the immune response at the bronchial level?
The bronchial cells pre-emptively release TGF-beta which activates fibroblasts. Consequence increase in fibrosis.
If centrilobular emphysema, the cause is probably
smoking
If large acini in the lower lobes of the lungs (panacinar emphysema), the cause is probably
alpha 1 anti-trypsin deficiency
What is the job of alpha 1 antitrypsin?
Inhibit the elastases released by neutrophils in the lungs to avoid destruction of the alveolar walls
Alpha 1 anti trypsin deficiency leads to panacinar emphysema and what?
Liver damage
Atopic triad includes?
Atopic dermatitia, allergic rhinitis, allergic asthma
Can viral URTI cause asthma exacerbation
yes
Can BB exacerbate asthma?
Yes. Bronchioles have B2 adrenergic receptors which have to bronchodilate.
So BB will block the ability of bronchodilation
What is Samters triad?
Patients with nasal polyps, asthma, ASA usage - can develop a massive asthma exacerbation
What happens during an asthma attack?
Bronchospasm
bronchial edema
bronchial hyper response spasm
increase mucus and increase bronchial edema
Regarding asthma, a dendritic cell picks up the irritant, shows it to a helpter T cell which releases IL4/5, which activates plasma cells to?
Release antibodies IgE, which activate Mast cells to release Leukotriens, PGI, histamines
IL 5 can trigger bone marrow to increase production of?
eosinophils. They release major basic protein and cationic peptides.
An 86-year-old female presents with intermittent claudication.
Which investigation will be most helpful in determining whether she is a suitable candidate for bypass surgery?
Digital subtraction arteriography.
a form of angiography that compares images before and after intravenous injection of an iodine-based dye.
Which vessel lies closest to the posterior aspect of the manubrium of the sternum at the midline and so is vulnerable when this bone is divided?
Left brachiocephalic trunk
The uterus reaches the umbilicus at week 20. The symphysial-fundal height (SFH) is usually equal (± 2 cm) to the number of weeks of gestation. This is measured by first palpating the fundus of the uterus. The tape measure is placed at this point and then rolled over the longitudinal axis of the uterus until it reaches the pubic symphysis. The length in centimetres is then recorded.
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batwing pattern of diffuse infiltrates on CXR
pneumocystitis jirovecii
Pneumocystis is an opportunistic fungus that predominantly affects the lung. In the lung, it typically resides in the alveoli, tightly adhering to type I cells. The immune reaction against the organism by the alveolar macrophages results in extensive exudation and the formation of a hyaline membrane. Lung biopsy shows foamy vacuolated exudates. Extra-pulmonary sites include the thyroid, lymph nodes, liver and bone marrow.
Diffuse alveolar haemorrhage (DAH) is a rare and potentially fatal complication of SLE. It presents with sudden dyspnea, decreased hematocrit, and possibly hemoptysis. BAL fluid shows haemorrhage and chest X-ray reveals diffuse infiltrates. Infections must be ruled out before treatment. Normal CRP levels suggest no severe infection, while low complement indicates an SLE flare. Urine testing for renal involvement is important. Prompt and aggressive treatment, including plasmapheresis, improves prognosis. DLCO may be high due to alveolar blood’s ability to absorb carbon monoxide. Clinical diagnosis, imaging, and bronchoscopy guide therapy initiation as a medical emergency. Lung biopsy shows pulmonary capillaritis with neutrophilic infiltration resembling ARDS-like damage in SLE-associated DAH.
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Bronchoalveolar lavage (BAL) positive for CD4 cells
SARCOIDOSIS
aspirin overdose symptoms
Mild aspirin (salicylate) overdose presents as tinnitus (salicylates are ototoxic), nausea and vomiting, while more severe overdoses can present with confusion, hallucinations, seizures and pulmonary oedema. Salicylates stimulate the respiratory centre, leading to an initial respiratory alkalosis, as shown in this case. Metabolic acidosis can follow.
Monitoring of aneurysms can be done using ultrasound or CT scanning. For aneurysms measuring 3-4.4 cm, annual scans are recommended. Aneurysms measuring 4.5-5.4 cm require scans every three months. Once an aneurysm reaches 5.5 cm, referral to a vascular surgeon is necessary. Abdominal ultrasound scans are used for the initial screening of AAAs, typically performed on men during their 65th birthday year. Routine screening for females is not recommended, as AAAs are predominantly found in males.
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Hydatidiform mole is part of gestational trophoblastic disease, resulting from abnormal fertilisation of an ovum, leading to complete or partial mole (46 XX, XY or 69 XXX, XXY). Both subtypes result in non-viable pregnancies, with complete mole being more common. These moles typically present at the extremes of reproductive age. This woman’s symptoms of vaginal bleeding, excessive vomiting, large-for-dates uterus, and high hCG level align with hydatidiform mole. Pelvic ultrasound may reveal a ‘snowstorm’ appearance. Treatment options depend on fertility desires, with dilation and evacuation for fertility preservation and hysterectomy for those not wanting to conceive. Antiemetics are prescribed for nausea and vomiting.
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