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