Pulmonary causes Flashcards
1
Q
Causes of apical lung fibrosis
A
- Tuberculosis (TB)
- Extrinsic allergic alveolitis
- Ankylosing spondylitis
- Allergic bronchopulmonary aspergillosis
- Radiation
- Sarcoidosis
- Histiocytosis X
2
Q
Causes of lower lung fibrosis
A
- Cryptogenic fibrosing alveolitis
- Asbestosis
- Aspiration pneumonia
- Rheumatoid arthritis
- Drug-related pulmonary fibrosis
- Systemic sclerosis
- Sarcoidosis
3
Q
Tracheal deviation - Pulled toward pathology (inside lung)
A
- Atelectasis
- Pneumonectomy
- Diaphragmatic paralysis
4
Q
Tracheal deviation - Pulled away from pathology (outside lung)
A
- Massive pleural effusion
- Tension Pneumothorax
- Neck or thyroid mass
- Large mediastinal mass
5
Q
Raised TLCO
A
- Asthma
- Pulmonary haemorrhage (Wegener’s, Goodpasture’s)
- Left-to-right cardiac shunts
- Polycythaemia
- Hyperkinetic states
- Male gender, exercise
6
Q
Lower TLCO
A
- COPD (much trapped air)
- Emphysema
- Pneumonia
- Pulmonary oedema
- Pulmonary fibrosis
- Pulmonary emboli
- Anaemia
- Low cardiac output
7
Q
Bronchiectasis
A
- Post-infective: tuberculosis, measles, pertussis, pneumonia
- Allergic bronchopulmonary aspergillosis (ABPA)
- Immune deficiency: selective IgA, hypogammaglobulinaemia
- Bronchial obstruction e.g. lung cancer/foreign body
- Cystic fibrosis
- Ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
- Yellow nail syndrome (lymphoedema, pleural effusion & yellow nail)
8
Q
Most common organisms isolated from patients with bronchiectasis
A
- Haemophilus influenzae (most common)
- Pseudomonas aeruginosa
- Klebsiella spp.
- Streptococcus pneumoniae
9
Q
Causes of false positive sweat test
A
- Malnutrition
- Glycogen storage diseases
- G6PD
- Adrenal insufficiency
- Nephrogenic diabetes insipidus
- Hypothyroidism, hypoparathyroidism
10
Q
Pulmonary eosinophilia
A
- Churg-Strauss syndrome
- Allergic bronchopulmonary aspergillosis (ABPA)
- Loffler’s syndrome
- Eosinophilic pneumonia
- Hypereosinophilic syndrome
- Tropical pulmonary eosinophilia
- Nitrofurantoin, sulphonamides, daptomycin
11
Q
Causes of mismatch in V/Q
A
- PE
- Old pulmonary embolisms
- AV malformations
- Vasculitis
- Previous radiotherapy
Note: COPD gives matched defects
12
Q
Oxidant drugs (can cause methemoglobinemia)
A
- Metoclopramide
- Dapsone
- Sulfonamides
- Local anesthetics (lidocaine)
- Nitrates
13
Q
Pleural glucose < 3.3 MMOL
A
- Tuberculous effusion (typically around 80’s)
- Malignant effusion (typically around 60’s)
- Parapneumonic effusion/Empyema
- Rheumatoid effusion (VERY low, typically < 30’s)
14
Q
Causes of elevated pleural fluid amylase
A
- Malignancy
- Esophageal rupture
- Pancreatic disease
15
Q
Causes of low pH < 7.2 in pleural fluid
A
In exudates:
* Complicated parapneumonic effusion/ empyema
* Malignancy
* RA
* TB.
In transudates:
* Urinothorax
16
Q
Most common causes of malignant effusion
A
- Lung cancer 30 %
- Breast cancer 25 %
- Lymphoma 20 %
17
Q
Eosinophilic pleural effusion
A
- Air or blood in the pleural space (e.g., pneumothorax, hemothorax)
- Infectious processes (particularly parasitic)
- Malignancy (especially Hodgkin lymphoma)
- Pulmonary embolism
- Benign asbestos
Pearl: Presence of eos and > 5% mesothelial cells makes TB unlikely
18
Q
> 50% lymphocytes in pleural effusion
A
- TB
- Fungal
- Malignancy
19
Q
PMN predominance in pleural effusion
A
- Parapneumonic
- Pancreatitis
- PE
- Peritonitis
20
Q
Differential of turbid, pale or whitish pleural fluid
A
- Chylothorax
- Pseudochylothorax
- Complicated parapneumonic effusions (empyema)
21
Q
Chemicals associated with occupation-related asthma
A
- Diisocyanates
- Persulfates
- Aldehydes
- Amines
22
Q
Differential diagnosis of bilateral hilar adenopathy
A
- Sarcoidosis
- Lymphoma
- Tuberculosis
- Pneumoconiosis
- Berylliosis
- Fungal diseases like histoplasmosis.
Note: no amyloidosis
23
Q
Bacterial causes of postinfluenza pneumonia
A
- Streptococcus pneumoniae
- Staphylococcus aureus
24
Q
Disorders associated with increase D-dimer
A
- Arterial thromboembolic disease
- Venous thromboembolic disease
- DIC / severe sepsis
- Preeclampsia and eclampsia
- Vaso-occlusive episode of sickle cell disease
- Systemic inflammatory response syndrome
- Severe liver disease /Renal disease
- Malignancy
- Normal pregnancy
25
Causes of central sleep apnea
* Heart failure
* Left heart disease
* CNS
* Medications (opioids)
* Hypercapnia
* High altitude
26
Causes of increased vocal resonance
* Consolidation
* Bronchiectasis
* Cavitation
* Mass
27
Causes of decreased vocal resonance
* Pleural effusion
* Pneumothorax
* Lung fibrosis
* Lobectomy
* Pneumonectomy
28
Drugs that can cause pneumonitis and/or pulmonary fibrosis
* Amiodarone
* Nitrofurantoin
* Methotrexate
* Cyclophosphamide
* Bleomycin
29
Cavitating lung lesion in x-ray
* Staphylococcus aureus
* Klebsiella pneumoniae
* Squamous Cell Lung Cancer
* Tuberculosis (TB)
* Granulomatosis with Polyangiitis (formerly known as Wegener's Granulomatosis)
* Aspergillosis
* Histoplasmosis
* Coccidioidomycosis
30
Bilateral interstitial infiltrates
* Pneumocystis jirovecii (formerly known as Pneumocystis pneumonia or PCP)
* Mycoplasma pneumoniae
* Chlamydophila pneumoniae (formerly known as Chlamydia pneumoniae)
* Various Viral infections
31
Lobar pneumonia
* Streptococcus pneumoniae (Pneumococcus)
* Haemophilus influenzae
* Klebsiella pneumoniae
32
Interventions in COPD with survival benefit
* Smoking cessation: The most effective intervention. Reduces the rate of decline in lung function and improves survival rates significantly.
* Long-term oxygen therapy (LTOT): Improves survival in severe COPD with chronic hypoxemia.
* Pulmonary rehabilitation: Improves quality of life and exercise tolerance, and can decrease hospitalizations, but direct impact on survival is less clear in the literature.
* Lung Volume Reduction Surgery (LVRS): Has shown survival benefit in selected groups of patients, particularly those with upper lobe predominant emphysema and low exercise capacity.
* Lung transplantation: Provides survival benefit in selected patients, usually those with advanced disease not responding to other treatments.
