Resp 2 Flashcards
List the types of pneumonia
- Community acquired - primary or secondary to underlying disease. Typical s. pnuemoniae, haemophilius influenzae. moraxella. Atypical Mycoplasma, s. aureus, legionella, chlamydia
- Hospital acquired (>48h after hospital admission, most common cause enterobacter or staph aureus)
- Aspiration (stroke, myasthena, bulbar palsies, reduced consciousness, oesophageal disease, poor dental hygiene all risks most commonly right middle zone)
- Immunocompromised (strep pneumoniae, h.influenzae, s. aureus)
List symptoms of pneumonia
- Fever
- Rigors
- Malaise
- Anorexia
- Dyspnea
- Cough
- Purulent sputum
- Haemoptysis
- Pleuritic pain
List signs of pneumonia
- Pyrexia
- Cyanosis
- Confusion
- Tachypnoea
- Tachycardia
- Consolidation (dullness to percussion, reduced expansion, increased vocal resonance, bronchial breathing, basal creps)
- Pleural rub
Define idiopathic pulmonary fibrosis
- Chronic lung disease which is characterised with scarring of the lungs and progressive dyspnoea
- The most common interstitial lung disease
Describe aetiology of idiopathic pulmonary fibrosis
- Predisposed host (surfactant protein mutatuions). Recurrent alveolar damage results in cytokine release, activating fibroblasts differentiating into myofibroblasts and increased collagen synthesis
- Drugs can produce similar illness (bleomycin, methotrexate and amiodarone)
List risk factors of idiopathic pulmonary fibrosis
- Smoking
- Occupational exposure to metal or wood
- Chronic micro-aspiration
- Animal or vegetable dusts
- GERD
Describe epidemiology of idiopathic pulmonary fibrosis
- 14-40 per 100000 people in US (prevalence)
- Increases with advancing age
- 2/3 over 60 by the time of presentation, mean age of diagnosis 60-70 years
- More common in men
- Survival 2-5 years from diagnosis
List symptoms of idiopathic pulmonary fibrosis
- Dyspnoea
- Cough (dry)
- Malaise
- Arthralgia
- Weight loss
List signs of idiopathic pulmonary fibrosis
- Crackles (fine end-inspiratory creps, bi-basal)
- Clubbing
- Cyanosis
List investigations for idiopathic pulmonary fibrosis
- CRP raised, immunoglobulins, ANA
- Spirometry restrictive pattern (FEV1/FVC > 0.8)
- CXR late changes - ground class, cor pulmonale, honeycombing
- HR-CT (early changes - ground glass)
- Biopsy (gold standard)
- Bloods and ABG
- BAL (raised lymphocytes or neutrophils and eosinophils)
Define extrinsic allergic alveolitis
Repetitive inhalation of allergens provoking a hypersensitivity response causing granuloma formation and obliterative bronchiolitis
Describe epidemiology of extrinsic allergic alveolitis
- 6-21% pigeon breeders
- 2-8% amongst farmers
- 7% of patient with ILD have EAA
Describe aetiology/types of extrinsic allergic alveolitis
- Bird fanciers and pigeon fanciers lung
- Farmers and mushroom workers lung
- Malt workers lung
- Bagassosis or sugar workers lung
List symptoms of extrinsic allergic alveolitis
4-6h after exposure
- Fever
- Rigors
- Dyspnoea
- Cough
- Myalgia
Chronic
- SOBOE
- Dry cough
List signs of extrinsic allergic alveolitis
- Clubbing
- Mild pyrexia
- Bi-basal, fine, inspiratory crepitations
List investigations for extrinsic allergic alveolitis
- Restrictive pattern on spirometry
- Normal CXR, can have upper zone mottling, hilar lymphadenopathy
- HR-CT ground glass
- BAL increased cellularity (lymphocytes and mast cells)
- Bloods, ABG
Describe epidemiology of pneumoconiosis
- 100 per year deaths from silcosis in the US
- Decreasing incidence
- Latency of 20 years from first exposure
Describe aetiology of pneumoconiosis
- Scilia
- Coal
- Beryllium
- Inhalation of coal dust, silica or asbestosis
- Asbestosis is a type of pneumoconiosis, as is silicosis
List signs and symptoms of pneumoconiosis
May be NORMAL
- SOB, dry cough.
- Clubbing
- Bi-basal inspiratory creps
- Decreased breath sounds
- Signs of RHF
Describe investigations for pneumoconiosis
- Spirometry restrictive pattern
- CXR showing micronodular mottling
- HR-CT - bilateral lower zone reticoulonodular shadowing and pleural plaques
- BeLPT for beryllium
List risk factors for pneumonia
- Smoking
- Travel
- Immunocompromised
- Legionella air con
- Chlamydia psittaci pet birds
- Klebsilla more common in alcoholics
List specific qualities on pneumonia investigation that point to a particular pathogen
- Legionella hyponatraemia and abnormal LFTs
- Mycoplasma transverse myelitis
- Staph cavitating lesion with air fluid level
- Klebsiella also has cavitating legion
Describe presentation of atypical pneumonia
- Dry cough
- Headache
- Diarrhoea
- Myalgia
- Hepatitis
Describe investigation results in atypical pneumonia
- Urine tested for legionella
- Mycoplasma cold agglutins on blood film
- LFTs for legionella
Describe management of bronchiectasis
- Exercise, good diet, vaccinations
- Airway clearance (chest physiotherapy, high frequency oscillation device, nebulised hypertonic saline)
- IV antibiotics for infection, oral prophylactic antibiotics to prevent infection (azithromycin)
- Surgical resection
List complications of bronchiectasis
- Recurrent infections
- Cor pulmonale
- Respiratory failure
- Massive haemoptysis
Describe prognosis of bronchiectasis
- Irreversible
- Faster decline where more frequent severe exacerbations occur
Describe epidemiology of mesothelioma
- 90% of patients report previous asbestos exposure
- Only 20% of patients have signs of asbestosis on CXR
- More common in men, and older white patients.
- Incidence increasing in UK
Describe aetiology/risks of mesothelioma
- Exposure to asbestos, with latency period of 20-40 years
- Prior exposure to radiotherapy (a known carcinogen)
- Genetic predisposition e.g., mutation of the BAP1 gene; and the simian virus 40 (SV-40)
- Male, age 60-85
List signs of mesothelioma
- SOB
- Clubbing
- Dullness to percussion
- Reduced breath sounds
- Pleural friction rub on auscultation
Define asbestosis
Asbestosis is diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos fibres.
Describe epidemiology of asbestosis
In 2018 in the UK, 950 new cases of asbestosis were assessed under the Industrial Injuries and Disablement Benefit scheme; around 1% to 2% of these cases were female
Describe aetiology/risks of asbestosis
- Asbestos exposure
- Shipyard, construction and maintenance workers
- Smoking, as it reduces ability to clear asbestos fibres
List symptoms of asbestosis
- Progressive dyspnoea
- Dry cough
List signs of asbestosis
- Clubbing
- Fine end-expiratory crackles
Describe investigations for asbestosis
- CXR (PA and lateral - interstitial fibrosis and bilateral pleural thickening, pleural plaques)
- Pulmonary function tests (restrictive changes, though may have obstructive changes in COPD)
- Lung biopsy where absence of known asbestos exposure or uncertainty. (Interstitial fibrosis, asbestos bodies)
- Bronchial lavage
Describe ABG appearance in respiratory alkalosis
- Low CO2
- High pH
- HCO3- may be low if compensating
List causes of respiratory alkalosis
- Panic attack/ hyperventillation
- Pain
- Hypoxia
- Pulmonary embolism
- Pneumothorax
- Iatrogenic (excessive mechanical ventillation)
Describe ABG appearance in respiratory acidosis
- High CO2
- Low pH
- HCO3- may be high if compensating
List causes of respiratory acidosis
- Type 2 resp failure
- COPD
- Respiratory depression (opiods)
- Asthma
- Guillian barre
- Iatrogenic
