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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
Q

What are causes of exudate pleural effusion?

A 
Infection
Malignancy
Rheumatoid arthritis
PE
Asbestos related
Pancreatitis
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26
Q

What can cause haemothorax?

A

Trauma

Iatrogenic e.g. central line

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27
Q

What can cause chylothorax?

A

Lymphatic interruption
Lymphoma
Iatrogenic

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28
Q

How does chylothorax appear?

A

Milky

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29
Q

What indicates empyema?

A

Decreased pH, decreased glucose and infection

CT and US show septations

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30
Q

What are risk factors for empyema?

A

Alcoholism

Immunocompromise

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31
Q

What is the Tx of empyema?

A

Abx +/- drainage

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32
Q

What is the intersticium?

A

Potential space between alveolar membrane and capillary across which gas can move

33
Q

What pts develop primary pneumothorax?

A

Otherwise healthy people, tend to be taller males

34
Q

Which pts can develop secondary pneumothroax?

A

Those with underlying lung disease e.g. Cancer or COPD

35
Q

What are the S/S of pneumothorax?

A

Pleuritic chest pain

Dyspnoea if large

36
Q

What is iatrogenic pneumothorax?

A

Caused by procedures e.g. Central lines

37
Q

How are small and large pneumothoracies differentiated on CXR?

A

Small 2cm

38
Q

What are the treatment options for pneumothorax?

A

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
Q

What treatment option is available for pneumothorax pts who do not want surgery?

A

Chemical pleurodesis via surgical talk into drain to cause irritation of visceral and parietal pleura –> inflammation –> adhesion

40
Q

How should a tension pneumothorax be diagnosed?

A

Clinically

41
Q

What are S/S of tension pneumothorax?

A

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
Q

What is the Tx for tension pneumothorax?

A

Immediate cannula into affected side
Oxygen
Intercostal chest drain
Resp/thoracic surgical referral to prevent repeat

43
Q

What congenital chest wall diseases can lead to hypoxia and hypercapnia?

A

Pectus deformities
Scoliosis
Kyphosis
Muscular dystrophy

44
Q

What acquired chest wall diseases can lead to hypoxia and hypercapnia?

A

Trauma
Iatrogenic
Ankylosing spondylitis
Motor neurone disease

45
Q

What is a radiograph?

A

Electromagnetic wave of high energy and short wavelength passed through body –> different tissues absorb different amounts –> levels of contrast on grey scale

46
Q

Why is CXR appropriate for almost all pts?

A

Low dose of radiation

47
Q

What two different projections can be used for CXR?

A 
PA projection (conventional, back to front)
AP projection
48
Q

When are AP CXR used?

A

For pts who are too unwell to stand

49
Q

What are the potential problems with using AP CXR?

A

Heart magnified
Lungs under inflated due to sitting position
Scapula over lung fields

50
Q

What is checked for when assessing inclusion on a CXR?

A

1st rib
Lateral margin of ribs
Costophrenic angle

51
Q

How is rotation assessed on CXR?

A

Spinous processes should be directly in the middle of medial ends of clavicles

52
Q

Taken during inspiratory phase

At point of intersection of diaphragm and MCL should see 5-7 anterior ribs

A

How is lung volume assessed on CXR?

53
Q

What on CXR indicates incomplete inspiration?

A

Big heart –> increased lung markings

54
Q

What indicates exaggerated expansion caused by obstructive airway disease on CXR?

A

Flattened diaphragm

55
Q

What effects lung volume filling on CXR?

A

Pt and radiographer factors e.g. explanation, inspiratory effort

56
Q

How is penetration assessed on CXR?

A

Vertebrae should be just visible through heart and complete left hemidiaphragm should be visible

57
Q

What can manipulate penetration on CXR if it is inadequate?

A

Digital manipulation

58
Q

What is an artefact on CXR?

A

External/iatrogenic material that obstructs view e.g. Clothes, buttons, hair, surgical or vascular lines, pacemaker

59
Q

Give 10 areas of thoracic anatomy which should be examined when assessing a CXR.

A 
Trachea
Hila - L should be higher than R
Lungs
Diaphragm
Heart
Aortic knuckle
Ribs
Scapulae
Breasts
Bowel gas
60
Q

When might the nipples not show equally on CXR?

A

Penetration is not equal

61
Q

Give a systematic approach to assessing a CXR.

A 
Pt demographics
Projection
Adequacy: RIP
Airway
Breathing
Circulation
Diaphragm and dem bones
62
Q

List review areas in CXR where pathology is commonly missed.

A 
Apices
Thoracic inlet
Paratracheal stripe
AP window
Hila
Behind heart
Below diaphragm
Bones 
Edge of films
63
Q

What is the silhouette sign?

A

Adjacent structures of differing density give crisp silhouette and loss of this contour indicates pathology esp. consolidation

64
Q

What causes mediastinal shift on CXR?

A 
Push= increase in volume or pressure e.g. pleural effusion or tension pneumothroax
Pull= decreased volume or pressure e.g. lung collapse
65
Q

What signs of pneumothorax are visible on CXR?

A

Visible pleural edge with no visible lung markings

66
Q

What is visible on CXR in pleural effusion?

A

Uniform white area visible
Loss of costophrenic angle
Hemidiaphragm obscured
Meniscus of fluid at upper border

67
Q

What can cause lobar lung collapse?

A 
Aspirated foreign material
Mucus plugging
Iatrogenic
Bronchogenic carcinoma
Compression by adjacent mass
68
Q

How does lobar lung collapse appear on CXR?

A 
Raised epsilateral hemidiaphragm
Crowding of ipsilateral ribs
Shift of mediastinum due to atelectasis
Crowding of pulmonary vessels
Luftsichel sign in left upper lobe
69
Q

How does consolidation appear on CXR?

A

Dense opacification +/- air bronchogram

70
Q

What can cause consolidation in lung cancer?

A

Cells

71
Q

What differentiates a nodule from a mass when assessing a SoL on CXR?

A

Nodule 3cm

72
Q

What causes SoLs?

A

Malignancy - primary will be single SoL, metastases often have multiple
Benign mass lesion
Inflammation
Congenital

73
Q

What can a SoL mimic on CXR?

A

Bone lesion
Cutaneous lesion
Nipple shadow

74
Q

What additional sign may be visible on CXR in SoL if phrenic diaphragm is implicated?

A

Raised hemidiaphragm

75
Q

What should the cardiac index be on PA image?

A
76
Q

What is indicated if the heart is the wrong way round on CXR with the apex on R?

A

Dextrocardia

77
Q

What is indicated if heart is the wrong way round and liver and gastric bubble are on the opposite side to normal?

A

Situs inversus

78
Q

What are CT scans which give much more information than CXR not suitable for all pts?

A

Deliver much higher doses of radiation, esp if a contrast is used

79
Q

Why might CT not be appropriate for lactating women?

A

Sensitivity of breasts to radiation

Semester 3 (50 decks)

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