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Year 2 > Resp Lecture 2 > Flashcards

Resp Lecture 2 Flashcards

1
Q

Definition of asthma

A

Condition characterized by reversible airway obstruction caused dueto airway inflammation, bronchial hyper-responsiveness, which mayor may not be triggered by allergens

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2
Q

What are the different types of asthma?

A

allergic asthma

non allergic asthma

late onset asthma

occupational asthma

asthma with obesity

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3
Q

Pathophysiology of allergic asthm

A

Th2 mediated asthma

  • Step 1: Allergen enters the body
  • Step 2: dendritic cells identify the allergen (throughDAMPS and PAMPS)
  • Step 3: allergen uptake by dendritic cells
  • Step 4: activation of the helper T cells-Th2activation
  • Step 5: B cell activation + mast cell + eosinophil cellrecruitment
  • Step 6: B cellIgEantibodiesThe patient is now said to be sensitized to the allergen
  • Step 7: on subsequent exposure,IgEantibodiesbind onto mast cells
  • Step 8: degranulation of the mast cells (containprestored inflammatory mediators like histamine+leukotriene)
  • Step 9: allergic reaction:
  • Histamine causes arteriolar dilatation and venularendothelial contraction
  • Leukotrienes: primarily cause vasoconstriction andincreased vascular permeability
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4
Q

Pathophysiology of non-allergic asthma

A

Th17 mediated

  • Step 1: Neutrophil activation
  • Step 2: extended neutrophil lifespan
  • Step 3: release of granular enzymes +ROS
  • Step 4: ROS + enzymes causebronchoconstriction

Thus, non allergic asthma tends to bepresent with non-resolving mucosalinflammation-Tends to be triggered by viruses-Do not respond to antihistamines

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5
Q

Classic signs and symptoms of asthma

A

Wheeze

Cough

Breathlessness/SOB

Variation insymptoms-worsein the morningand at night

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6
Q

Diagnosis of asthma in adults

A
  • Spirometry→(FEV1/FVC<0.7)=obstructive disease
  • BDR-increase in FEV1-12% + 200ml inresponse to ICS/ B2 agonists
  • FeNO→40ppm
  • Fractional exhaled Nitric oxide
  • During inflammation higher amount of NOproduced by the epithelial cells and hencehigh levels of NO is indicative of airway inflammation
  • PEF (peak expiratory flow)variation by12% (best of 3)
  • BHR→Drop in FEV1-20%•Patients with asthma will respond to muchlower doses of pharmacological agents likehistamine or methacholineas compared toa normal perso
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7
Q

Diagnosis ofasthma in children

A
  • Spirometry→(FEV1/FVC<0.7)= obstructivedisease
  • BDR-increase in FEV1-12% inresponse to ICS/ B2 agonists
  • FeNO→35ppm
  • Greater than 20% variability inPEF monitored over 2-4 weeksis diagnostic of asthma
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8
Q

How do you differentiate between COPD and Asthma?

A

Asthma

  • Variation in symptom presentation (worse in the morning and at night)
  • Chronic productive cough is uncommon- Sputum production only in acute exacerbations
  • May not having a smoking history
  • A trigger or allergen may be associated with the symptoms
  • Reversible lung function
  • Variable SOB

COPD

Symptoms are always present

Chronic productive cough with production of sputum (chronic bronchitis)

Almost always have a smoking history!

Less likely to find an allergen

Progressively worsening lung function

Progressively worsening SOB

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9
Q

Differentiating asthma from cardiacconditions

A

•Asthma

  • Chest pain/tightness
  • SOB-not on exertio

•Other cardiac conditions

  • Chest pain/tightnessradiating to thejaws/shoulder/left arm
  • EXERTIONAL SOB withother cardiac symptoms such as peripheral oedem
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10
Q

Treatment for asthma

A
  • Bronchodilators
  • First choice: SABA-salbutamol inhalers–reliever inhalers
  • LABA-third line
  • Second line: Steroids (ICS)
  • Beclomethasone
  • Prednisolone
  • Third line: LRTA-leukotriene receptor antagonists)
  • LAMA
  • Theophylline
  • Oxygen-as needed
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11
Q

Give examples of Upper respiratory tract ifections?

A

Epiglottitis

Tonsilitis

Croup

Viral illness

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12
Q

Give examples of Lower respiratory tract infections?

A

Bronchiolitis

Influenza

Viral induced wheeze

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13
Q

Tonsilitis

Symptoms:

Signs

Bugs

Ix:

Tx:

A
  • Symptoms: sore throat, earache, pyrexia > 38C
  • -Signs: enlarged, inflamed tonsils +/- lymphadenopathy
  • -Bugs: Group A Strep
    • Investigations: Throat swab
  • -Tx: Ab if bacterial, analgesia ( difflam spray, ibuprofen)
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14
Q

What is croup?

A

inflammation of the larynx and trachea in children, associated with infection and causing breathing difficulties

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15
Q

Croup

symtons

signs

bugs

Tx

A
  • -Symptoms : viral illlness-> barking cough and stridor middle of night
  • -Sign: inspiratory stridor, intercostal/subcostal recession
  • -Bugs: Parainfluenza> RSV
  • -Tx: dexamethasone
  • -Mnemonic: CrouP: C: corticosteroids->dexamethasone

P: parainfluenza

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16
Q

What is epiglottitis?

A

Epiglottitis is inflammation and swelling of the epiglottis. It’s often caused by an infection, but can also sometimes happen as a result of a throat injury. The epiglottis is a flap of tissue that sits beneath the tongue at the back of the throat.

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17
Q

Epiglottitis

Symtoms

signs

bugs

A
    • Young children, HIB unimmunized
  • -Symptoms: very unwell, pyrexia, soft stridor, little cough ,drooling (can’t swallow secretions)
  • -Signs: drooling, tripod position, dysphagia
  • -Bugs: Haemophilus influenza type B >> Strep Pyogenes, pneumoniae

4 D’s: Dysphagia, Dysphonia, Drooling, Distress

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18
Q

Viral Illness

Symptoms

Signs

Bugs

Ix

A
  • Common cold
  • Symptoms: nasal discharge, sneezing, painful, throat/ears, pyrexia, headache, malaise
  • Signs: red pharynx, pus, bilateral red tympanic membranes, yellow/green discharge
  • Bugs: Rhinovirus> Enterovirus> Coronavirus> RSV> Parvovirus > Adenovirus
  • Investigations: NONE
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19
Q

Bronchiolitis

symotoms

signs

bugs

RF

Ix

Tx

A
  • Symptoms: coryzal symptoms, cough, progressive increased WOB, poor feeding
  • Signs: tug, nasal flare, head bobbing, recession, crackles, wheeze, cyanosed
  • Bugs: RSV, adenovirus, metapneumovirus, influenza
  • RF: premature, immunocompromised, congenital heart/lung disease
  • Investigations: Cough swab
  • Tx: supportive, Palivizumab- prophylactic injection for RSV
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20
Q

Influenza

Defintion

Subtypes

symptoms

signs

Ix

Tx

A
  • Highly contagious disease occurring in winter months.
  • Influenza virus A,B,C ( rarely C).
  • Subtypes: based on surface antigens H ( haemagglutinin), N ( neuraminidase)
  • Symptoms: pyrexia, myalgia, headache, cough, chills
  • Signs: red throat, hypotension, bradycardia
  • Investigations: blood test, rapid antigen test
  • Tx: supportive: antipyretics, analgesia, oseltamivir
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21
Q

What is pneumonia?

A

•Inflammation of lungs due to a causative organism, produces consolidation/ interstitial lung infiltrates

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22
Q

Pneumonia

symptoms

Signs

Ix

A
  • Symptoms: productive cough, SOB, chest pain, haemoptysis, fever
  • Signs: SoB, tachypnea, cyanosis, hypotensive, reduced chest expansion. Dull percussion, coarse crackles on auscultation
  • Investigations: CURB- 65/CRB-65, CXR, sputum culture, bloods
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23
Q

What are the bacterial viral and fungal pathogens associated with pneumonia?

A

•Bacterial:

  • Typical: Strep Pneumoniae (CAP), Haemophilus influenzae , Pseudomonas Aeruginosa (HAP/VAP)
  • Atypical: Legionella, Chlamydia spp.

•Viral:

  • Influenza
  • RSV
  • SARS-COV2

•Fungal:

  • TB aspergillosis
  • Pneumocystis jirovecci
24
Q

What is pleural empyema

A

•Collection of pus in the pleural cavity

25
Q

Pleural empyema

Symptoms

signs

RF

bugs

Ix

A
  • Symptoms: fever, cough, breathlessness, lethargy, reduced exercise tolerance
  • Signs: reduced chest expansion, reduced breath sounds, stony dull percussion
  • RF: pneumonia, iatrogenic intervention, DM, underlying carcinoma/TB
  • Bugs: Strep pneumoniae, Staph A
  • Investigations: blood culture, CXR, thoracentesis
26
Q

What is a lung abscess?

stages

rf

symptoms

A
  • Cavity filled with pus in lung parenchyma, suppurative inflammation of lung tissue
    • As a result of aspiration, malignancy, pathogens
  • -Right>> Left lung : wider, straighter mainstem bronchus
  • -Stages: pneumonitis-> necrosis-> cavitation-> abscess formation
  • -RF: Chronic aspiration, chronic lung infection, immunocompromised
  • -Symptoms: fever, cough, weight loss, night sweats
27
Q

What is Interstitial Lung Disease?

A
  • Restrictive Lung Disease
  • Umbrella term that describes a collection of lung disorders that affect the interstitium
28
Q

ILDs can be classed into two groups what are they?

A

Known cause

Idiopathic

29
Q

Examples of idiopathic ILD

A

Idiopathic pulmonary fibrosis

NSIP- Nonspecific interstitial pneumonia

30
Q

Known cause ILDs can be further split into what?

A

Connective tissue disease

Occupational Exposure

Granulomatous disease

Treatment induced

31
Q

Examples for connective tissue disease ILD s

A

Systemic Lupus Erythematosus

Rheumatoid Arthritis

Systemic Sclerosis

32
Q

Examples of occupation exposure ILDs

A

Asbestosis

Silicosis

33
Q

Examples of Granulomatous diseases ILDs?

A

sarcoidosis

Hypersensitivity Pneumonitis

34
Q

What is idiopathic pulmonary fibrosis?

trigger?

RF?

A

-Ongoing repair process → excess collagen and scar tissue in the interstitial tissue of the lung

-The trigger is unknown

-It is a chronic progressive fibrotic lung disease and ultimately fatal

-Risk factors

  • Male
  • 50-70 years
  • Tobacco smoking
35
Q

Pathophysiology of IPF

A

Loss of structural integrity, loss of elasticity and restricted gas exchange leading to progressive respiratory failure

36
Q

Characterisitics of IPF

A

Characteristics of IPF

  • Irreversibly enlarged damaged bronchioles and alveoli
  • Fibroblastic foci
  • Honeycombing (cystic airspaces with fibrous walls)
37
Q

What is the management for IPF

A
  • Median survival time for patients with IPF is 2-5 years
  • Anti-fibrotic therapy (Pirifenidone, nintedanib)
  • Lung transplant

Best supportive care (palliative care, pulmonary rehabilitation, oxygen therapy

38
Q

How do you know if it is non specific interstitial pneumonitis?

A

CT: Ground-glass opacities

39
Q

What is Hypersensitivity Pneumonitis

A

Hypersensitivity pneumonitis (HP) or extrinsic allergic alveolitis (EAA) is a rare immune system disorder that affects the lungs. It is an inflammation of the airspaces (alveoli) and small airways (bronchioles) within the lung, caused by hypersensitivity to inhaled organic dusts and molds.

40
Q

What causes Hypersensitivity Pneumonitis?

A
  • Caused by an immunologic reaction to an inhaled known organic agent causing an inflammatory response in the alveoli and small airways
  • There are >3000 known causes of hypersensitivity pneumonitis
  • Aspergillus species
  • Mycobacterium species
  • Animals, plants, chemicals
41
Q

Types of hypersensitivity pneumonitis related to occupation ?

A
42
Q

Patho of hypersensitivity pneumonitis

A
43
Q

Clinical features of hypersensitivity pneumonitis

A
44
Q

Diagnosis of Hypersensitivity Pneumonitis?

A
  • History of antigen exposure (IgG-specific antibodies)
  • Clinical symptoms
  • radiological : HRCT
  • Ground glass airway opacities
  • Honeycombing
  • Dilated airways
  • PFT: restrictive or obstructive pattern
  • Bronchoscopy: lymphocytosis (>20%)
  • Lung biopsy: poorly defined, non-caseating granulomas
45
Q

Management of hyoersensitivity pneumonitis

A
  • Antigen avoidance
  • Corticosteroids
  • Immunosuppressive therapy
46
Q

What is sarcoidosis?

Epidemiology?

A
  • Chronic, immune-related, multi-system granulomatous disease characterised by the presence of non-infectious, noncaseating granulomas and chronic interstitial pulmonary fibrosis
  • More common in female
  • African descent
  • Peak presentation is 20-50 years
47
Q

Patho of sarcoidosis?

A
48
Q

CF of sarcoidosis?

A

Lung (90%)

  • interstitial lung disease
  • Bilateral hilar lymphadenopathy

Brain

  • Cranial nerve palsies
  • Meningitis

Eye

  • Uveitis
  • Glaucoma

Heart

  • Myocarditis, pericarditis
  • Restrictive cardiomyopathy
  • Arrhythmia, AV blocks

MSK

  • Phalangeal bone cysts
  • Arthritis

Splenomegaly, Granulomatous hepatitis

Skin (10-30%)

  • Erythema nodosum
  • Subcutaneous nodules
  • Lupus pernio
49
Q

Diganosis for sarcoidosis?

A
  • CXR
  • Blood tests
  • -Elevated Serum ACE
  • -Hypercalcaemia, hypercalciuria
  • Bronchoscopy+biopsy
  • -Noncaseating granuloma
  • Bronchioalveolar lavage
  • -Raised CD4:CD8 ratio
50
Q

What is abestosis?

A

-Diffuse pulmonary fibrosis caused by inhalation of asbestos fibres, mostly affecting the lower lobes of the lung

51
Q

What are related diseases to abestos?

A

Latency period is 20-30 years after initial exposure

  • Pleural plaques (most common) → increases risk of pleural effusion
  • Diffuse interstitial pulmonary fibrosis (asbestosis)
  • -Small linear opacities in lower lung fields
  • Primary Bronchogenic Carcinoma (cigarette smoking)
  • Malignant Mesothelioma
  • -Haemorrhagic pleural effusion and pleural thickening
52
Q

CF and History for abestosis?

A

Clinical features

  • Dyspnoea
  • Finger clubbing
  • O/E shows bi-basal end-inspiratory crackles
  • Systemic features

History

  • Connective tissue disease?
  • History of occupational exposure?
  • Idiopathic?
53
Q

Ix for abestosis

A
  • Lung function tests
  • Bloods (systemic diseases, connective tissue diseases)
  • Radiology: Chest X-ray, HRCT
  • Bronchoscopy + biopsy
54
Q
A
55
Q
A
56
Q
A
57
Q
A

Year 2 (33 decks)

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