Resp Flashcards
Type 1 respiratory failure?
Hypoxia associated with hyperventilation and low CO2
Type 2 respiratory failure?
Hypoxia associated with hypoventilation, thus reduced clearance of CO2.
Acute states- respiratory acidosis
Bronchiectasis Definition?
permanent irreversible dilatation of bronchi and bronchioles
Aetiology of bronchiectasis?
Obstruction with severe infection or severe infection alone e.g. whooping cough
Genetics (CF, Kartagener’s syndrome)
Immunodeficiency (hypogammaglobulinemia)
Clinical features of bronchiectasis?
Chronic cough
Purulent sputum, sometimes blood
Finger clubbing
What part of the lung is most affected by bronchiectasis?
Lower lobes
Manifestation of Cystic Fibrosis?
meconium ileus recurrent and frequent infections w/ pseudomonas Bronchiectasis chronic pancreatitis malabsorption
Diagnosis of Cystic Fibrosis?
Prenatal screening
Measure chloride conc. in sweat
Obstructive Airways on PFTs?
Dec. FEV1
Normal or Dec. FVC
Dec. FEV1/FVC ratio
In what percentage of COPD is smoking implicated?
90%
What do ‘blue bloater’ and ‘pink puffer’ indicate?
Chronic Bronchitis
Emphysema
Chronic Bronchitis Definition?
persistent productive cough on most days for a minimum of 3 months of the year for no less than 2 consecutive years, which can’t be contriubted to any other cardiac or respiratory cause
Emphysema Definition?
abnormal, permanent enlargement of the airspaces distal to the terminal bronchiole, due to destruction of their walls and with minimal fibrosis
Chronic Bronchitis Pathology?
Irritants (most commonly cigarette smoking) cause:
Hypersecretion of mucous
Inflammation and fibrosis -> obstruction
Squamous metaplasia/dysplasia/SCC can occur
The most common form of emphysema?
Centri-acinar
The most common form of emphysema?
Centri-acinar
Where does centri-acinar emphysema occur?
Upper lobes
What is centri-acinar emphysema associated with?
Smoking, coal dust
What is pan-acinar emphysema associated with?
Alpha 1 Antitrypsin deficiency
Where does pan-acinar emphysema usually affect?
Lower lobes
Types of bronchial asthma?
Atopic (most common)
Non-atopic
Drug-induced asthma (aspirin)
Occupational asthma
What causes atopic asthma?
Type 1 IgE mediated Hypersensitivity reaction
What causes non-atopic asthma?
No evidence of allergens
Viral causes/inhaled air pollutants
What drug can induce asthma?
Aspirin
What is allergic bronchopulmonary aspergillosis?
proximal bronchiectasis seen in patients with asthma
inhalation of aspergillus spores
What is obliterative bronchiolitis?
rare
lumen of small bronchioles become obliterated by fibrous tissues
What causes obliterative bronchiolitis?
CT disease, IBD, Transplant (Graft vs. Host Disease, Chronic lung allograft rejection)
Causes of Pulmonary Embolism?
Thromboembolism!!!!!
Tissue embolism, tumour embolism, foreign body embolism, fat embolism, amniotic fluid, air/gas (Caisson’s disease-bends)
Virchow’s Triad?
Stasis, Hypercoagulability, Injury
Risk for PEs?
heart disease, increased age, bed rest & immobility, OCP, tissue injury, late pregnancy, previous PE
Symptoms of Pulmonary Embolism?
dyspnoea, fever, haemoptysis, cough, signs of pleuritis, rales, tachycardia
often can be silent
Pulmonary Oedema definition?
accumulation of fluid within the interstitium and alveolar airspaces
Pulmonary Oedema presentation?
Dyspnoea, orthopnoea, cough, fine crackles on auscultation
Pulmonary Hypertension Definition?
elevated pulmonary arterial pressure
Causes of pulmonary HTN?
primary/idiopathic- minority
secondary- decrease in cross-sectional area of pulmonary vascular bed (emphysema
secondary- increased vascular blood flow (mitral stenosis, LVF)
Pulmonary HTN clinical features?
intense fatigue, dyspnoea, cor pulmonale/ RHF, pulmonary artery atheroma
What is a hamartoma?
mass of tissue formed of components normally present in adult lung
What is the peak age for lung carcinomas?
65-75 years
Symptoms of lung cancers?
asymptomatic
cough, weight loss, dyspnoea, chest pain, haemoptysis, antibiotic resistant pneumonia, bronchiectasis, lung abscess
paraneoplastic syndrome
Spread of lung cancer?
Local invasion- hoarseness, dysphagia, obstruction of SVC, Horner’s syndrome
Lymphatic- SVC obstruction
Distant spread- everywhere, bone, brain and liver most common
Histology of Lung Carcinomas?
Small Cell Lung Carcinoma
Non-small cell Lung Carcinoma (SCC, adenocarcinoma, Large Cell Carcinoma)
Which lung carcinoma has the worst prognosis?
Small Cell Lung Carcinoma
What part of the lungs does SCLC occur in?
central lobes and peri-bronchial
Defining features of SCC?
production of keratin
destruction of intercellular bridges
What are carcinoid tumours?
group of neuroendocrine neoplasms
What gene mutations are involved with lung cancers?
EGFR, KRAS, ALK
Which mutation commonly occurs in smokers?
KRAS mutation
What is a drug used to treat lung carcinomas?
Pembrolizumab
What are pleural effusions like to percuss?
Dull
What are pneumothoraxes like to percuss?
Hyper-resonant
When is pleurisy pain worse?
On breathing
What is malignant mesothelioma strongly associated with?
Asbestos exposure
What neoplasm is strongly associated with asbestos exposure?
Malignant mesothelioma
What is the prognosis for malignant mesothelioma?
Very poor, usually dead within 2 years
What is Adult Respiratory Distress Syndrome (ARDS)?
clinical term for presence of diffuse alveolar damage with hyaline membranes
fatal in 40% of cases
How does ARDS present?
acute respiratory distress, tachypnoea, dyspnoea, arterial hypoxaemia
What are pneumoconiosis?
a group of lung diseases caused by inhalation of dusts
Examples of extrinsic allergic alveolitis?
farmer’s lung, pigeon breeder’s lung, air conditioner lung
What is sarcoidosis distinguished by?
non-caseating granulomas
Where does a SCC usually occur?
arising at the centre of the lung
What is pneumonia?
an inflammatory condition affecting the lung parenchyma which is usually caused by an infective agent
Classifications of pneumonia?
Bronchopneumonia, lobar pneumonia, non-infective special pneumonia
Most common bacterial cause of pneumonia?
Strep. pneumoniae
Treatment for community-acquired pneumonia? (strep. pneumoniae)
Amoxicillin
If v severe- +erythromycin or clarithromycin
Treatment for pneumonia (Mycoplasma, Coxiella, chlamydia, legionella)?
erythromycin/ tetracycline
Treatment for pneumonia (staph aureus)?
Flucloxallin
If MRSA- vancomycin
Treatment for pneumonia (staph aureus)?
Flucloxallin
If MRSA- vancomycin
Treatment for pneumonia (pseudomonas aeruginosa)?
aminoglycoside + beta lactam
What is Legionnaire’s Disease?
acute pneumatic illness
fever, chills, cough, confusion, chest pain, arthralgia, malaise, nausea, vomiting
What causes Legionnaire’s Disease?
Legionella Pneumophilia
What percentage of Legionnaire’s disease is fatal?
5-20%
What common fungus infects the lungs of patients with AIDS?
Pneumocystis Jiroveci
What distinguishing feature appears in cytomegalovirus?
Owl-eyes
What is the leading cause of death in AIDS patients?
TB
What is seen in TB?
Caseating granulomatous tissue
When does primary TB usually occur?
In childhood
usually asymptomatic
What part of the lungs does primary TB affect?
Ghon complex in the midzone
What part of the lungs does secondary TB affect?
upper lobes, upper part of lower lobes
What can aspiration of gastric contents cause?
Lung abscess
What can distal acinar emphysema cause?
Spontaneous Pneumothorax
