Resp Flashcards
Serious complications of sinusitis
Infection of meninges
Orbital cellulitis
Kartagener’s sx triad and pathophysiology
Bronchiectasis
Sinusitis
Situs inversus
Abnormal ciliary function: failure to clear mucus + bacteria
Most common association with nasopharyngeal carcinoma
EBV
Rare outside E/SE Asia - usually undetected until metastasises to lymph nodes
Decent prognosis with radiation therapy
Causes of acute laryngitis
Pathogens
Irritants (esp cigarette smoke)
Mechanical factors, eg endotracheal intubation
Overuse of voice
Sequelae of acute laryngitis
- Resolution
- Spread of infection: bronchitis, bronchopneumonia, lung abscess
3 Airway obstruction: laryngeal oedema (esp epiglottitis in children)
Causes of atelectasis
Obstruction: foreign object, mucus plugging
Compression: pneumothorax, oedema
Scarring:
Surfactant loss
Causes of bronchiectasis
Irreversible dilatation of bronchi
Congenital: CF, Kartagener’s etc.
Acquired: infection (esp measles + pertussis), obstruction (foreign object or tumour)
Signs of idiopathic pulmonary fibrosis
Dyspnoea
Cough
Finger clubbing
3 most common pneumoconioses
Coal worker’s
Silicosis (slate minining, quarrying, stone masonry)
Asbestosis
What are farmer’s lung/ pigeon-fanciers’ lung examples of?
Extrinsic allergic alveolitis
type III and type IV
Predisposing factors for pneumonia
INSPIRATION Immunosuppression Neurological impairment of the cough reflex Secretion retention Pulm oedema Impaired mucociliary clearance Resp tract infection Abx and cytotoxics Tracheal intubation Impaired alveolar macraphages Other Neoplasia
Pathogens causing CAP
Generally Gram +ve
Strep pneumoniae
Haemophilus influenzae
Pathogens causing HAP
Generally Gram -ve Klebsiella Pseudomonas MRSA E.coli
Who gets viral pneumonia?
Children, eg measles, varicella
Immunocompromised, eg CMV - esp common after bone marrow transplant
Pathogens causing fungal pneumonia
Candida and aspergillus
Can cause widespread areas of necrosis - mortality is high
PCP (Pneumocystis carinii pneumonia) - small fungal yeasts
How can TB spread from the Ghon complex?
If no resolution, e.g. in immunocompomise:
Bronchus: from lymph nodes erodes into bronchus > other bronchus > neighbouring lung
Blood vessel: causing miliary TB
Direct lymphatic spread: pleura, pericardium
What is secondary TB?
Reactivation of latent infection - occurs in ~5-10%
Apical Assmann focus
Primary TB has small granulomatous focus but large lymph node response
Secondary TB has large granulomatous disease but minimal lymph node involvement
Types of lung ca
Squamous (slow-growing, metastasises late)
AC (slow-growing, including from peripheries, metastasises early)
Large-cell anaplastic
Small-cell (neuroendocrine) - mets normally present at diagnosis
Common primary sites for lung mets
Breast Kidney Uterus Ovaries Testes Thyroid
usually via blood, ie bilateral deposits
Meds that can cause chronic pulmonary fibrosis
Some anticancer agents
CCBs
amiodarone
Causes of haemothorax
Trauma, esp rib #
Surgery
Pulmonary infarcts
Spontaneous rupture of diseased arteries, eg atheroma, dissecting aortic aneurysm
Causes of chylothorax
Leakage from thoracic duct, typically malignant infiltration, surgery, trauma
Where is the anatomical dead space?
Conducting part of tract ~150 mL
Where does aspirated material tend to go?
R bronchus
How many lung lobes?
2 on L: superior + inferior
3 on R: superior + middle + inferior
What is the normal V/Q
0.8
1 is ideal
Which conditions are obstructive? How would this be reflected by FEV1/FVC?
Asthma, COPD, bronchiectasis
<0.7
Asthma steps
- Inhaled SABA
- Add inhaled CS (400 mcg/day usual starting dose - up to 800)
- Add LABA (discontinue if poor response)
- Increase inhaled CS up to 2000 mcg/day, or add leukotriene receptor antagonist
- Oral steroids in addition to inhaled steroids
Possible cause of emphysema in younger patients
alpha-1-antitrypsin deficiency
Most common pathogen implicated in acute exacerbations of COPD
Haemophilus influenzae
MRC dyspnoea scale
Grade 1: only on exertion
Grade 2: SOB on walking up hill
Grade 3: slower than contemporaries
Grade 4: has to stop after few mins/ 100 m
Grade 5: too breathless to leave house/ on dressing
What is the BODE index
For prognosis in COPD BMI Obstruction Dysnoea (MRC scale) Exercise tolerance
COPD steps
- SABA or SAMA
- LABA or LAMA (+ICS if FEV <50%)
- Theophylline, mucolytics - oral CS not recommended
- LTOT
What may be seen on bronchiectasis CXR?
Tram-tracks/ fluid lines
HRCT is gold-standard
What are the GI/ endo features of CF?
DM, pancreatic insufficiency, liver disease, gallstones, osteoporosis, infertility in males (absent ductus deferens bilaterally), subfertility in females
First-line investigation in CF
Sweat test
What is the acute presentation of sarcoid?
Lofgren syndrome
Good prognosis: bedrest and NSAIDs
fever, erythema nodosum, bilat hilar lymphadenopathy, polyarthralgia
What is Caplan syndrome?
Coal workers’ pneumoconiosis associated with RA
What pathogen commonly causes pnemonia after influenza?
Staph aureus
Pathogen most likely to cause pneumonia in alcoholics?
Klebsiella
also most common in diabetics
What are the features seen on blood tests in Legionella pneumonia?
Deranged LFTs
Hyponatraemia
Erythema multiforme is associated with which pneumonia
Mycoplasma infections
CURB-65
Confusion (AMTS <8) Urea >7 RR >30 BP <90 or diastolic <60 65 years
0/1: treat at home
2: inpatient treatment
3: consider ITU
Causes of lung abscess
Primary: existing pneumonia or lung disease
Secondary: aspiration, septic emboli from R sided infective endocarditis
Clinical features of lung abscess
Swinging fevers, night sweats, productive cough (purulent sputum)
Extra-pulmonary manifestations of TB
arthritis, meningitis, Pott spine, erythema nodosum, clubbing
Why request LFTs in TB?
Meds tend to be hepatotoxic
Medications for TB
2 months RIPE
4 months RI
TB drug side-effects
Rifampicin (RED-fampicin): reddish/orange secretions, hepatitis
Isoniazid (Iso-NEURO-zid): peripheral neuropathy (supplement with vit B6 prophylaxis), agranulocytosis, hepatitis
Pyrazinamide (Pyr-OUCH-zinamide): hyperuricaemia causing gout, myalgia, hepatitis
Ethambutol (EYE-thambuto): optic neuritis, renal impairment
What is Meig syndrome?
Triad of ovarian cancer, ascites and R-sided pleural effusion
Causes transudate