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Semester 3 > Resp Session 8 > Flashcards

Resp Session 8 Flashcards

1
Q

What is the pathogenesis of interstitial lung disease (diffuse parenchymal lung disease)?

A

Start in intersticium –> surrounding structures involved –> acini, alveoli lumen, bronchioles lumen, bronchioles involved –> hypoxia and hypercapnia

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2
Q

How are ventilation, diffusion and perfusion affected in interstitial lung disease?

A

Ventilation decreased due to decreased compliance
Diffusion decreased due to barrier to gas exchange
Perfusion decreased due to damage/destruction of alveolar capillaries

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3
Q

What pattern on lung function tests is seen in interstitial lung disease?

A

Restrictive

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4
Q

What cells are involved in interstitial lung disease?

A 
Epithelial
Endothelial
Mesenchymal
Macrophages
Recruited inflammatory cells
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5
Q

What is seen on CXR in interstitial lung disease?

A

Loss of silhouette sign

Increased reticular and nodular shadowing

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6
Q

What is seen on CT scan in interstitial lung disease?

A

Fibrosis visible as patchy white/grey areas

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7
Q

What is the classic Hx in interstitial lung disease?

A

Insidious onset with gradual decline SoB

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8
Q

What are the S/S of interstitial lung disease?

A 
Progressive SoB on exertion +/- non-productive cough
Clubbing
Peripheral/central cyanosis
Tachycardia
Tachypnoea
Decreased chest movement
Course crackles
Signs of cor pulmonale
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9
Q

What are the 5 types of interstitial lung disease?

A 
Occupational
Tx related
CT disease
Immunological
Idiopathic
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10
Q

What can cause CT disease leading to interstitial lung disease?

A 
Rheumatoid arthritis
SLE
Polymyositis
Schleroderma
Sjorgen's
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11
Q

At what age do immunological interstitial lung disease pts typically present?

A

20 or 60-70 y.o.

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12
Q

At what age does idiopathic pulmonary fibrosis typically present?

A

60-80 y.o.

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13
Q

What is the problem with new therapies for idiopathic pulmonary fibrosis?

A

Slow mortality and decline in FVC but have significant drug toxicity

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14
Q

What effects can asbestos exposure have in the lungs?

A 
Asbestos plaques
Diffuse pleural thickening
Benign asbestos pleural effusions
Mesothelioma
Bronchogenic lung cancer
Rounded atelectasis
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15
Q

What is asbestosis?

A

Interstitial lung disease and asbestos exposure

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16
Q

How is sarcoidosis usually identified?

A

Incidentally as vast majority indolent

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17
Q

What is found on biopsy in sarcoidosis?

A

Non-caseating granulomas

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18
Q

What are differentials for sarcoidosis following biopsy?

A

Lymphoma

TB

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19
Q

What are the Tx options for sarcoidosis?

A

None
Steroids
Methotrexate (2nd line for steroid sparing)

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20
Q

How is pleural fluid in the reabsorbed in the pleural cavity?

A

Via stomata on parietal pleural surface –> lymphatic drainage

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21
Q

What can cause increased production of pleural fluid?

A 
Increase in lung interstitial fluid
Hydrostatic pressure increases
Permeability increases
Oncotic pressure decreases
Peritoneal fluid seeps through diaphragm
Thoracic duct disruption so no drainage
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22
Q

What can cause decreased absorption of pleural fluid?

A

Lymphatic blockage

Increased systemic venous pressures

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23
Q

What does Light’s criteria state?

A

Pleural fluid is exudate if:
Pleural fluid protein/serum protein > 0.5
Pleural fluid or serum LDH > 0.6
Pleural fluid LDH > 2/3 upper normal lab limits

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24
Q

What are causes of transudate pleural effusion?

A 
Heart failure
Cirrhosis
Hypoalbuminaemia
Atelectasis
Nephrotic syndrome
Constrictive pericarditis
Meigs syndrome
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25
What are causes of exudate pleural effusion?
``` Infection Malignancy Rheumatoid arthritis PE Asbestos related Pancreatitis ```
26
What can cause haemothorax?
Trauma | Iatrogenic e.g. central line
27
What can cause chylothorax?
Lymphatic interruption Lymphoma Iatrogenic
28
How does chylothorax appear?
Milky
29
What indicates empyema?
Decreased pH, decreased glucose and infection | CT and US show septations
30
What are risk factors for empyema?
Alcoholism | Immunocompromise
31
What is the Tx of empyema?
Abx +/- drainage
32
What is the intersticium?
Potential space between alveolar membrane and capillary across which gas can move
33
What pts develop primary pneumothorax?
Otherwise healthy people, tend to be taller males
34
Which pts can develop secondary pneumothroax?
Those with underlying lung disease e.g. Cancer or COPD
35
What are the S/S of pneumothorax?
Pleuritic chest pain | Dyspnoea if large
36
What is iatrogenic pneumothorax?
Caused by procedures e.g. Central lines
37
How are small and large pneumothoracies differentiated on CXR?
Small 2cm
38
What are the treatment options for pneumothorax?
Small, closed w/o significant SoB: observation, discharge and early review If admittance for obs needed: high flow O2 Pts with SoB: simple aspiration Recurrent cases: open thoracotomy and pleurectomy
39
What treatment option is available for pneumothorax pts who do not want surgery?
Chemical pleurodesis via surgical talk into drain to cause irritation of visceral and parietal pleura --> inflammation --> adhesion
40
How should a tension pneumothorax be diagnosed?
Clinically
41
What are S/S of tension pneumothorax?
Tachycardia Hypotension Decreased chest expansion with hyper resonance and absent breath sounds on one side Mediastinal shift --> tracheal displacement and shift of apex beat Hypoxaemia
42
What is the Tx for tension pneumothorax?
Immediate cannula into affected side Oxygen Intercostal chest drain Resp/thoracic surgical referral to prevent repeat
43
What congenital chest wall diseases can lead to hypoxia and hypercapnia?
Pectus deformities Scoliosis Kyphosis Muscular dystrophy
44
What acquired chest wall diseases can lead to hypoxia and hypercapnia?
Trauma Iatrogenic Ankylosing spondylitis Motor neurone disease
45
What is a radiograph?
Electromagnetic wave of high energy and short wavelength passed through body --> different tissues absorb different amounts --> levels of contrast on grey scale
46
Why is CXR appropriate for almost all pts?
Low dose of radiation
47
What two different projections can be used for CXR?
``` PA projection (conventional, back to front) AP projection ```
48
When are AP CXR used?
For pts who are too unwell to stand
49
What are the potential problems with using AP CXR?
Heart magnified Lungs under inflated due to sitting position Scapula over lung fields
50
What is checked for when assessing inclusion on a CXR?
1st rib Lateral margin of ribs Costophrenic angle
51
How is rotation assessed on CXR?
Spinous processes should be directly in the middle of medial ends of clavicles
52
Taken during inspiratory phase | At point of intersection of diaphragm and MCL should see 5-7 anterior ribs
How is lung volume assessed on CXR?
53
What on CXR indicates incomplete inspiration?
Big heart --> increased lung markings
54
What indicates exaggerated expansion caused by obstructive airway disease on CXR?
Flattened diaphragm
55
What effects lung volume filling on CXR?
Pt and radiographer factors e.g. explanation, inspiratory effort
56
How is penetration assessed on CXR?
Vertebrae should be just visible through heart and complete left hemidiaphragm should be visible
57
What can manipulate penetration on CXR if it is inadequate?
Digital manipulation
58
What is an artefact on CXR?
External/iatrogenic material that obstructs view e.g. Clothes, buttons, hair, surgical or vascular lines, pacemaker
59
Give 10 areas of thoracic anatomy which should be examined when assessing a CXR.
``` Trachea Hila - L should be higher than R Lungs Diaphragm Heart Aortic knuckle Ribs Scapulae Breasts Bowel gas ```
60
When might the nipples not show equally on CXR?
Penetration is not equal
61
Give a systematic approach to assessing a CXR.
``` Pt demographics Projection Adequacy: RIP Airway Breathing Circulation Diaphragm and dem bones ```
62
List review areas in CXR where pathology is commonly missed.
``` Apices Thoracic inlet Paratracheal stripe AP window Hila Behind heart Below diaphragm Bones Edge of films ```
63
What is the silhouette sign?
Adjacent structures of differing density give crisp silhouette and loss of this contour indicates pathology esp. consolidation
64
What causes mediastinal shift on CXR?
``` Push= increase in volume or pressure e.g. pleural effusion or tension pneumothroax Pull= decreased volume or pressure e.g. lung collapse ```
65
What signs of pneumothorax are visible on CXR?
Visible pleural edge with no visible lung markings
66
What is visible on CXR in pleural effusion?
Uniform white area visible Loss of costophrenic angle Hemidiaphragm obscured Meniscus of fluid at upper border
67
What can cause lobar lung collapse?
``` Aspirated foreign material Mucus plugging Iatrogenic Bronchogenic carcinoma Compression by adjacent mass ```
68
How does lobar lung collapse appear on CXR?
``` Raised epsilateral hemidiaphragm Crowding of ipsilateral ribs Shift of mediastinum due to atelectasis Crowding of pulmonary vessels Luftsichel sign in left upper lobe ```
69
How does consolidation appear on CXR?
Dense opacification +/- air bronchogram
70
What can cause consolidation in lung cancer?
Cells
71
What differentiates a nodule from a mass when assessing a SoL on CXR?
Nodule 3cm
72
What causes SoLs?
Malignancy - primary will be single SoL, metastases often have multiple Benign mass lesion Inflammation Congenital
73
What can a SoL mimic on CXR?
Bone lesion Cutaneous lesion Nipple shadow
74
What additional sign may be visible on CXR in SoL if phrenic diaphragm is implicated?
Raised hemidiaphragm
75
What should the cardiac index be on PA image?
76
What is indicated if the heart is the wrong way round on CXR with the apex on R?
Dextrocardia
77
What is indicated if heart is the wrong way round and liver and gastric bubble are on the opposite side to normal?
Situs inversus
78
What are CT scans which give much more information than CXR not suitable for all pts?
Deliver much higher doses of radiation, esp if a contrast is used
79
Why might CT not be appropriate for lactating women?
Sensitivity of breasts to radiation

Semester 3 (50 decks)

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