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Respiratory system > Pathology > Flashcards

Pathology Flashcards

1
Q

Asthma

A

Chronic inflammatory condition due to episodic exacerbations of bronchoconstriction by triggers

Sx - episodic, worse at night, dry cough, wheeze and shortness of breath,

Ix - ECG, peak flow, Blood gasses

Mx - SABA first line when exacerbated sx
- ICS each day to prevent sx
*If failing to resound to treatment in life threatening - BiPAP

Acute attack - oxygen given
- Salbutamol and ipratropium bromide by nebuliser
- Hydrocortisone IV

IV Aminophilline if sever attack

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2
Q

Acute asthma diagnosis

A
  • Rapid deterioration in symptoms
  • Moderate - PEFR 50-75% predicted
  • Severe “ 33-50% predicted, resp rate >25, HR>110, unable to complete sentences
  • Life-threatening - PEFR<33%, sats <92%, becoming tired, no wheeze (airways so tight), haemodynamically unstable
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3
Q

Emphysema

A

Lots of air in the lungs caused by a loss of elastic fibres of alveoli

Cx - Smoking and A1 anti trypsin defect

Sx - SOB

Ix - CT, bloods, lung function tests

Mx - bronchodilators, ICS, antibiotics

  • When elastic fibres are removed, leads to increased lung compliance, greater airway space and so greater resistance leading to increased work of breathing, decreasing transfer factor
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4
Q

Pulmonary fibrosis

A

Replacement of elastic fibres with collagen fibres in alveoli walls leading to stiff walls and reduced lung compliance

Cx - Infections, allergy, toxins, irritants, CT diseases

Sx - shortness of breath, exercise intolerance, dry cough, loss of appetite and weight loss

Ix - breathing and blood test
CT

Mx - Lifestyle changes
- pirfenidone to slow progression sand reduce collagen growth

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5
Q

Bronchiectasis

A
  • Very large airways, become blocked, inflammation across whole bronchi tube, poor clearance of secretions, (obstructive defect)
  • Haemophlious influenza most common

Cx - Infections, cystic fibrosis, cilia not functioning, gamma globulin deficiency

Sx - cough with a lot of sputum, occasional haemoptysis, coarse crepitations, clubbing in fingers

Ix - HRCT 1st choice showing bronchial wall dilation and lack of bronchial wall tapering
- coarse crepitations at base

  • Feature of Kartagenrs syndrome
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6
Q

Gamma globulins

A

IgG - most common, in blood and fluid helping to protect from bacterial and viral infections

IgE - Small amount in blood, increase due to parasites and allergy (Type 1 sensitivity reactions)

IgM - In blood and lymph, first made after infection (Type 2 hypersensitivity reaction)

IgA - Lining respiratory tract, saliva,

IgD - Not fully understood

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7
Q

Pulmonary chondroma

A
  • Benign tumour of cartilage
  • More likely to be females
  • More likely to be peripheral
  • Associated with Carnery’s triad
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8
Q

Pulmonary hamartoma

A
  • Disordered proliferation of mature cartilage, fat and smooth muscle
  • More likely males than females
  • More likely to be central
  • Solitary
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9
Q

TNM grading system

A

T - Tumour size (1-4)
N - Nodes spread (0-2)
M - Metastases (0-2) - No lungs or liver, just lungs, both

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10
Q

Adenocarcinoma

A
  • Develop more peripherally in the lung
  • Associated with areas of fibrous scarring
  • Glandular epithelium malignancy
  • Most common tumour
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11
Q

Lung cancers

A
  • 3rd most common cancer behind breast and prostate
    *80% of cases are smokers

> Non small-cell (80%)
Adenocarcinoma - 40% - non smokers (cavity lesions)
squamous cell carcinoma - 20% - smokers (cavity lesions)
large cell carcinoma - 10%
Mesothelioma - around the lining of an organ

> Small cell (20%)
* cells contain neurosecretory granules that can release neuroendocrine hormones - responsible for multiple paraneoplastic syndromes

Sx - SOB, cough, haemoptysis, finger clubbing, recurrent Pneumonia, weight loss, lymphadenopathy (supraclavicular are often first)

Ix - Chest x-ray, CT
- biopsy of lung tissue
**Raised platelets

Mx - surgery
- radio, chemo or immunotherpy

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12
Q

Mesothelioma

A
  • Tumour of tissue surrounding an organ
  • Almost always due to asbestosis exposure
  • development of the mesothelioma is usually 20 or more years from the time of exposure

Sx - Chest pain, SOB, weight loss, persistent cough, tiredness
* spread into lung, pleural cavity, hilar lymph nodes usually

Ix - Chest X ray - pleural plaques present (benign)
- thoracoscopy and histology

Mx - surgery
- chemo, radio and immunotherapy

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13
Q

Extra-pulmonary manifestations of lung cancer

A

> Invasion of local structures
- SVC blocked due to tumour co impression leading to raised JVP
- Recurrent laryngeal nerve compression leading to hoarseness
- Phrenic nerve compression leading to elevation of the hemi diaphragm
- Cushing’s syndrome by ectopic ACTH secretion
- Pancoast tumour at apex of the lung causing Horner’s syndrome

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14
Q

Pancoast tumour

A
  • Growing tumour usually in the apex of the lung that can cause suppression on SVC leading to raised JVP
  • Can compress sympathetic plexus resulting in Horner’s syndrome
  • Can compress recurrent laryngeal nerve causing a coarse voice
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15
Q

Hypertrophic osteoarthropathy

A
  • Prominent with squamous cell lung cancers
  • Clubbing and inflammation of the membrane (periostitis) of joint, especially DIJ

Sx - Swelling of ankles, knees wrists and elbows MC joints and finger clubbing

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16
Q

Transfer/perfusion defect

A

Transfer/perfusion - Flow of blood to alveolar capillaries (need PaCO2)

Defect - Determines alveolar capillary gas transfer (reduced PaCO2)

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17
Q

Cystic fibrosis

A

Mutation in Phe508del causing mutation in CFTR gene,C7, leading to a chloride channel defect, affecting mucus secreting cells

Sx - Thick sticky mucus, plugging airways and pancreas, persistent cough, repeated lung infections, wheezing, inflamed nasal passage, failure to thrive, loose greasy stools
*can cause delayed puberty

Ix - newborn blood spot test

Mx - bronchodilators, steroids
- prophylactic antibiotics

18
Q

Restrictive defect

A
  • Due to stiff alveolar walls, reducing lung compliance (alveolar walls aren’t able to expand)

FEV1 <80% predicted

FVC <80% predicted

FEV1/FVC ratio >70% normal

19
Q

Obstructive defect

A
  • Airways become narrowed due to inflammation from secretions

FEV1 <80% predicted

FVC = normal or low

FEV1/FVC ratio <70% predicted

20
Q

Ventilation defect

A

Ventilation - Flow of air into alveoli

Defect - Reduced flow of air into alveoli due to increase PaCO2 (respiratory acidosis)

21
Q

Surfactant deficiency

A
  • Type II pneumocytes that secrete surfactant have not yet differentiated to secrete surfactant
  • Leads to increased surface tension, reduced lung volume and increased work of breathing
22
Q

Pneumothorax

A
  • Collapsed lung due to air in pleural cavity pushing on the lung causing it to collapse

Sx - Sudden chest pain and shortness of breath, reduced breath sounds on affected side, hyper resonant on percussion

Cx - injury such as car accident or assault, lung disease such as COPD,

Tension pneumothorax - Air held in pleural cavity under positive pressure causing a mediastinal shift to the opposite side

1st spontaneous - No underlying trauma or conditions (tall people with Marfan’s syndrome for example)

2nd spontaneous - Underlying disease present but no trauma (those with cystic fibrosis)

Iatrogenic - lung biopsy, mechanical ventilation, central line insertion

Ix - CXR - if symptoms obvious no need for scan

Mx - needle aspiration 2nd ICS
- chest drain into triangle of safety

**If secondary pneumothorax and is >2cm and/or SOB, patients should be treated with a chest drain 1st line

23
Q

Pleural effusions

A

Blood, lymph or chly in the pleural cavity

Cx - Penetrating injury to lung, heart and great vessels, cancer, infection, heart failure

Sx - reduced expansion, dull percussion, diminished breath sounds at the affected side, sudden shortness of breath, sudden chest pain, tracheal shift to opposite site

Ix - CXR then CT chest

Mx - Insert chest drain into safe triangle in axilla region - can affect long thoracic nerve and cause winged scapula

‘safe triangle’: Lateral border of pec major, lateral border of latissimus dorsi and horizontal line from the nipple going laterally

24
Q

Transudative and exudative causes of pleural effusions

A

Exudative - inflammation, high protein
- lung cancer, pneumonia, rheumatoid arthritis, tuberculosis

Transudative - Fluid shifting, low protein
- congestive cardiac failure, hypoalbuminaemia, hypothyroidism

25
Q

02 dissociation curve

A

Acidosis = shift right
- Reduced oxygen affinity but increased delivery of oxygen to tissues
Cx - Low pH or high temperature

Alkalosis = shift left (lots of air)
- Increased oxygen affinity but reduced delivery of oxygen to tissues
Cx - high pH or low temperature

26
Q

Investigations into neuromuscular disorder

A

FEV1 and FVC restrictive pattern but FEV1/FVC ratio can also be increase….>100%

E.g. Myasthenia gravis (restrictive pattern of lung disease)

27
Q

Kartagener’s syndrome

A

Autosomal recessive cilia disorder (microtubules)

Comprising: Bronchiectasis, situs inversus and chronic sinusitis

Sx - Recurrent chest infections, infertility, defective movement of cilia, ear/nose/throat symptoms

28
Q

COPD

A
  • Umbrella term - Non reversible, long term deterioration in air flow through lungs caused by damage to lung tissues
  • Usually always a smoker
  • Chronic bronchitis - productive cough for 3 months in the last 2 years

Sx - Productive cough, shortness of breath, infective exacerbations, coarse crepitations and wheeze

Ix - Bloods - Deficient in A1 anti trypsin protein
- Lung function tests
- CXR showing hyper inflated lungs

Mx - SABA or SAMA 1st line - if not working give LABA and LAMA
- exacerbation - with purulent sputum or pneumonia - give amoxicillin or clarithromycin
2nd line - doxycycline
* Acute exacerbation - 5 days oral prednisone
- if max treatment not working - BiPAP

29
Q

type I respiratory failure

A

hypoxia (PaO2<8Kpa) with normal or low PaCO2

Cx - Ventilation perfusion missmatch

30
Q

Type II respiratory failure

A

Hypoxia (PaO <8kPa) with hypercapnia (PaCO2 >6kPa)

Cx - alveolar hypoventilation with or without V/Q mismatch

31
Q

Pneumonia

A
  • An acute lower respiratory tract infection causing consolidation of alveoli due to build up of secretions in sacs

Sx - Fever, rigors, malaise, anorexia, shortness of breath, coughing purulent sputum, haemoptysis, pleuritic chest pain

Ix - Chest x ray or CT
- Blood for organism causing
- Reduced/bronchial/harsh breath sounds, dull percussion, coarse crackles in the lungs

Mx - amoxicillin or clarithromycin 5 days 1st line if mild
- Amoxicillin and clarithromycin 7-10 days if severe
repeat CXR in 6 weeks

  • usually streptococcus pneumonia or haemophilus influenza
32
Q

Lung tumour associations

A

Small cell - SIADH ,^ ACTH causing hypertension, hyperglycaemia, hypokalaemia, Lambert eaton syndrome

Squamous cell - PTHrp causing hypercalcaemia, HPOA, clubbing, hyperthyroidism

Adenocarcinoma - Gynaecomastia and HPOA

33
Q

Pulmonary embolism

A

Clot (usually from DVT) travels to the pulmonary arteries. Leads to reduced blood flow to the lung tissues and create strain on the right side of the heart

Risk factors - immobility, long flights, pregnancy, malignancy…

Sx - SOB, cough with or without blood, pleuritic chest pain, hypoxia, tachycardia, raised resp rate, haemodynamically unstable

Ix - Initial - D dimer, CXR (wedge shaped)
- CTPA for diagnosis
- If CT negative, check lower limb proximal US

Mx - Heparin first line
2nd - Apixiban or enoxoparin
* Massive PE thrombi-lysis first line - altaplaze

34
Q

Pulmonary hypertension

A

Increase pressure in the pulmonary arteries, causing strain on right side of the heart - leads to back pressure on systemic circulation

Cx - connective tissue disease, left sided HF, COPD, PE, sarcoidosis

Sx - SOB, syncope, tachycardia, raised JVP, hepatomegaly, peripheral oedema

Ix - right ventricular hypertrophy and increased BNP

35
Q

Sarcoidosis

A
  • Small nodules of granuloma tissue (macrophages) forming around your Body - lungs, eyes, joints, skin and lymph nodes
  • 2 spikes (early adulthood and around 60)
    *black females affected most

Cx - immune system overdrive, attacking its tissues and organs

Sx - tender bumps on the skin (erythema nodusum), SOB, persistent dry cough, lymphadenopathy , fever, fatigue, weigh loss, night sweats

Ix - Bloods - raised ACE, hypercalcaemia, raised Ig, raised CRP, LFT, urine test for kidneys, reduced ejection fraction
- ECG or EKG
- lung function tests
- eye exam
- Chest x ray - bilateral hilar lymohadenopahty
- biopsy nodules

Mx - Conservative
- steroids if: - stage2/3, high ca, heart, eye or neuro involvement…

36
Q

Tuberculosis

A

*Infection spread through inhaling tiny droplets from coughs or sneezes from an infected person
Cx - mycobacterium tuberculosis

Sx - persistent cough with mucous and possibly blood, weight loss, night sweats, high temperature, loss of appetite and swelling in the neck

Ix - CXR - paint sprinkled
- CT and ultrasound for other areas of the body
- Unilateral hilar lymphadenopathy
- granulomas with caseous necrosis

Mx - Long course of antibiotics - rifampicin
- vaccination

*If giving biologics (infliximab), TB status must be checked first

  • most common in Africa and Asia
37
Q

Atelectasis

A
  • Common post op condition where basal alveolar collapse can lead to resp difficulties

Cx - when airways become clogged with bronchial secretions

Sx - dyspnoea and hypoxia around 72hrs post surgery

Mx - upright position
- chest physio - breathing exercises

38
Q

TCLO measurement

A

Measurement of gas transfer from alveoli to blood

high - asthma, haem, l-r shunts, polycythaemia

low - everything else

39
Q

Acute respiratory distress syndrome (ARDS)

A
  • Increased permeability of alveolar capillaries leading to fluid accumulation
    *Mortality of 40%

Cx - infection, trauma, transfusion, cardio pulmonary bypass, pancreatitis

Sx - dyspnoea, bilateral lung crackles, low sats

Ix - CXR, ABG

Mx - oxygenation/ventilation prone position, antibiotics

40
Q

Obstructive sleep apnoea

A
  • Episodes where the person stops breathing during sleep

Sx - snoring, day time sleeping, tiredness,

Ix - sleep studies (Polysomnography)

Mx - CPAP
- lifestyle factors - weight, alcohol and smoking

*DVLA informed if causing excessive daytime sleepiness

Respiratory system (3 decks)

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