resp Flashcards
asbestos-related lung disease
asbestosis- not mesothelioma
occurs 10+ years after initial exposure.
diffuse interstitial fibrosis of the lung, pleural plaques, thickening, effusions and rounded atelectasis.
S+S: progressive SOB, or incidentally picked up.
Ix: Cxr - PA and lateral.
pulmonary function tests.
Rx: importance of not smoking.
pulmonary rehab/ supplimentary 02
if real real bad- lung transplant.
complications: cor pulmonale
lung cancer
asthma/ COPD overlap
an obstructive lung condition with clinical and inflammatory characteristics of asthma and COPD.
OR
COPD with bronchodilator response + elevated peripheral eosinophils.
the presence of airflow obstruction in individuals with a history of asthma and older than 40
Rf: ciggies, pollution.
S+S: cough, sputum, sob, wheeze. – 4-5x higher exacerbation rates compared to asthma or copd alone.
Ix: spirometry- FEV1 represents disease severity.
postbronchodilator therapy fev1/fev less than 0.7
partial bronchodilator response (10%- normally 15% in asthma)
criteria: over 40
prev described bronchodilator response
10 pack years
history of asthma.
documented atopy
3 is usually good.
Rx: stop smoking, vaccinate.
Saba
SAMA
ICS+LABA (never laba alone)
connective tissue disease/ inflammatory disease respiratory manifestations
generally either cause interstitial lung disease or pulmonary hypertensions
6 that mainly cause
Systemic sclerosis (SSc) or scleroderma.
Rheumatoid arthritis (RA).
Systemic lupus erythematosus (SLE).
Sjogren syndrome (SS).
Mixed connective tissue disease (MCTD).
Polymyositis/dermatomyositis (PM/DM).
Rx of pulm HTN- epoprostenol- prostaglandin- dilates pulm vasc.—- IV
these area available in inhaled form (iloprost) bosentan (oral)
can also give sildenafil
otherwise generally treat the inflammatory/ connective tissue disorder- antiinflams or DMARDS or biologics.
idiopathic pulmonary fibrosis
IPF is a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown aetiology.
S+S: bi-basilar inspiratory crackles, older age (e.g., >60 years), and unexplained symptomatic or asymptomatic bilateral pulmonary fibrosis on a CXR or high-resolution CT
finger clubbing is a significant one.
Rf: male, age, FH, ciggies, genetic mutations.
Ix: CXR, PFT, high res CT.
Rx: exacerbation- high dose steds + supportive care
long term- antifibrotic therapy-
pirfenidone
or
nintedanib.
2’ - lung transplantation
or pal care.
metastatic lung disease which bits do they spread to, and where does it come from
lung parenchyma: breast, lung, colorectal cancer, uterine leiomyosarcoma, and head/neck squamous cell carcinomas
endobronchial tree of the lungs: colorectal, renal, lung cancer, and lymphomas
2nd most frequent site of mets
signs symptoms, investigations, treatment of lung metastases
S+S: SBO, cough, haemoptysis, wt loss, fatigue, electrolyte disturbances.
Ix: biopsy- histopathological staining to determine tissue of origin.
CT chest
Rx: case by case, chaemo, radio, immunotherapy and surgery are all viable options.
occupational lung disease
Three of the major diseases in this category: silicosis, coal workers’ pneumoconiosis (black lung disease), and chronic beryllium disease (berylliosis).
all pneumoconiosisis
they cause fibrosis of the lungs- nodules or interstitial fibrosis.
S+S: quite acute onset and severe SOB with prev history of exposure 20 years aho.
Ix: CXR (nodules in upper zone, fibrosis in upper zone)
spiro- restrictive pattern
beryllium lymphocyte proliferation test- +ve if sensitised to beryllium.
Rx: symptomatic
oral steroids in beryllium disease.
transplant if real bad.
pleural effusion, investigation, diagnostic criteria, signs and symptoms and treatment.
difference in causes of tranudate vs exudate is another card
caused by many conditions- e.g heart faliure, malignancy, infection, lupus etc.
either a transudate or an exudate
An exudative effusion is diagnosed if one or more of the following criteria are met:
Pleural fluid protein/serum protein ratio of more than 0.5
Pleural fluid LDH/serum LDH ratio of more than 0.6
Pleural fluid LDH is more than two-thirds of the upper limit of the normal serum LDH value.
If none of these criteria are met, the fluid is considered transudative.
S+S: amount of fluid correlates poorly with symptoms- SOB is common, cough, fever.
dullness on percussion, dec BS.
Rx: drainage for symptomatic patients
resolve cause of symptoms.
causes of exudative vs transudative pleural effusion
exudative pleural effusion causes:
pulmonary infections, such as pneumonia or tuberculosis; malignancy; inflammatory disorders, such as pancreatitis, lupus, and rheumatoid arthritis; postcardiac injury syndrome; chylothorax; hemothorax; post-coronary artery bypass grafting (post-CABG); and benign asbestos pleural effusion.
transudative- things that alter oncotic/ hydrostatic pressure.
left heart failure, nephrotic syndrome, liver cirrhosis, hypoalbuminemia, or peritoneal dialysis
sarcoidosis
a chronic granulomatous disease of unknown aetiology.
accumulation of lymphocytes and macrophages in organs- causing non-caseating granulomas.
lymph and lungs involved 90% of time, but can be in any organ.
S+S: dependant on the organ involved, pulm usual. fatigue, cough, arthralgia, lymphadenopathy, uveitis.
RF: 20-50 years, FH, Scandinavian.
Ix: a diagnosis of exclusion
CXR- bilateral hilar adenopathy, bilateral upper lobe infiltrates.
FBC- anaemia, leukopenia.
screen any other organ you think may be involved.
histological examination
Rx: quite high chance of remission in stage 1 and 2. 20% in stage 3.- no chance in stage 4.
oral steds for stage 2-4. - topical if its possible in skin manifestations.
2’ - methotrexate.
if acute give IV.
Idiopathic pulmonary arterial hypertension
a disease of small pulmonary arteries- proliferation + remodelling.
leads to right vent failure and then—— death.
defined by a mean pulmonary arterial pressure >20 mmHg at rest
S+S: non-specific and include dyspnoea on exertion, fatigue, and a loud pulmonary component of the second heart sound.
if bad can get periph oedema.
Rf: FH, female, genetic mutations, appetite suppressants. 20-50y/o.
Ix: CXR- enlarged pulm artery.
ecg- RVH, RAxis deviation,
right heart catheterisation- the definitive test- 20mmhg or more in pulm art.
Rx: if +ve response to vasoreactivity test– CCB– nifedipine.
if no vasoreactivity- endothelin receptor agonist + phosphodiesterase 5 inhib. amristentan + tadalafil.
lung transplant if real bad.
stages of sarcoidosis
Stage 0 (no pulmonary sarcoidosis): no sign of granulomas in the lungs or lymph nodes
Stage 1 (lymphadenopathy): granulomas present in the lymph nodes only
Stage 2 (lymphadenopathy and pulmonary infiltrates): granulomas present in both the lymph nodes and the lungs
Stage 3 (pulmonary infiltrates): granulomas present in the lungs only
Stage 4 (pulmonary fibrosis): scarring of the lung tissue and permanent damage.
