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Semester 3 > Resp-TB, RF... > Flashcards

Resp-TB, RF... Flashcards

1
Q

What is latent TB?

A

Infected with the TB bacteria but do not have the signs and symptoms of the active disease. Only 1 in 10 infections result in disease

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2
Q

What is the primary complex of TB?

A

Lesion (Ghon focus) and draining gland
Usually asymptomatic
Skin text conversion

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3
Q

What are the symptoms of respiratory TB?

A 
Primary infection usually asymptomatic
May be non-specific
Often constitutional only 
Tirednedd and malasia
Weight loss and anorexia
Fever (low grade or hectic)
Cough most common
Breathlessness indicative of pleural effusion
Haemoptysis occasionally
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4
Q

What are the signs of resp TB?

A

Nonspecific
Pallor
Fever
Evidence of weightless
Clubbing in extensive or longstanding disease only
Often no signs in the chest despite marked radiological abnormality
Localized wheezing if bronchial narrowing
Cervical nodes palpable

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5
Q

Who is at risk of developing active disease after latent infection of TB?

A 
IV drug abusers
HIV cases
Solid transplant recipients
Haematological malignancy
Chronic renal failure/haemodialysis
Anti TNF alpha treatment 
Silicosis
Underweight
Vitamin D deficiency? Iron deficiency?
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6
Q

What is erythema nodosum?

A

Red nodules beneath the skin, commonly on the shins. Often no trigger but TB can

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7
Q

What are the mechanisms of post-primary TB?

A

Direct progresion
Reactivation
Haematogenous spread
Exogenous reinfection

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8
Q

What is haemoptysis?

A

Coughing of blood from the respiratory tract below the level of the larynx

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9
Q

When might haemoptysis occur in TB?

A 
May occur in active cavitating disease
More common in post-TB bronchiectasis
Rausmussen's aneurysm in old TB cavity
Mycetoma in old TB cavity
Broncholithiasis
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10
Q

What is a Rasmussen’s aneurysm?

A

Pulmonary artery aneurysm adjacent or within a TB cavity

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11
Q

Is pleural TB more common in males or females?

A

Males

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12
Q

What are the mechanisms for pleural involvement in TB?

A
  1. Hypersensitivity response in primary infection may cause acute pleuritic price with fever
  2. TB empyema with ruptured cavity - has tendency to burrow through chest wall
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13
Q

Who is lymph node TB most common in?

A

Females

Asians

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14
Q

How does Lymph TB present/

A

Often painles
Most commonly in neck
Discrete swelling to marked inflammation of the rupture
Intra-thoracic node may collapse bronchi

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15
Q

What can osteo-articular TB cause?

A 
Peripheral arthritis
Osteomyelitis
Dactylitis
Tenosynovitis
Poncet's disease - aseptic polyarthritis of knees, ankles and elbows. Cultures negative and X-rays normal
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16
Q

What is TB spondylitis?

A

Most common form of osteo-articuar TB
Starts generally in sub-chondral bone and spreads to vertebral bodies and joint space
Follows longitudinal ligaments
Mainly lower thoracic and upper lumbar spine

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17
Q

What causes miliary TB?

A

Bacilli spreading through the blood stream, either during primary infection or as reactivation (elderly in low prevalence countries)

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18
Q

What organs are involved in miliary TB?

A

Lungs always involved, other organ involvement variable.

Headaches sugget meningeal involvement

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19
Q

How doe miliary TB present?

A 
Headache (suggests meningeal involvement)
Few resp symptoms
Pericardial, pleural effusions small
Ascites may be present
Retinal involvement (children)
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20
Q

Discuss chronic “cryptic” miliary TB.

A 
Usually in over 60s 
High mortality
Insidious onset
Weightloss, lethargy and interittent fever
High index of suspicion required
Not infrequently found at post-mortem
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21
Q

WHat is the ABC of chest imaging?

A 
Airway - trachea
Breathing - lungs
Circulation - heart 
Disability - bones
Everything else
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22
Q

WHy might there be no air in the lung?

A

Removed
Collapsed
Consolidated
Fluid filled

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23
Q

What is the interstitium and what does it do?

A

Between the alveoli and capillaries. Trafficking of cells between them, inflammatory cells in response

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24
Q

What other structures does interstitial disease effect?

A 
Acini
Alveoli lumen 
Bronchiolar lumen
Bronchioles
Epithelial, endothelial, mesenchymal, macrophages and recruited inflammatory cells affected
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25
What are the symptoms of interstitial lung disease?
Shortness of breath - gradual | Cough - dry
26
On examination of someone with suspected interstitial lung disease, what would the signs be on examination?
``` Clubbing Cyanosis Tachycardia Signs of right heart failure (only if severe) Tachypnoea Decreased chest movement Couse crackles ```
27
What are the different types of interstitial lung disease?
``` Occupational Treatment related Connective tissue disease Immunological Idiopathic - most common ```
28
What diseases can asbestos cause?
Asbestos plaques - thickening of the pleura. Not problem Diffuse pleural thickening Benign asbestos pleural effusion Asbestosis - interstitial lung firbrosis due to asbestos Mesothelioma Bronchogenic lung cancer Rounded atelectasis
29
What is needed to diagnose asbestosis?
Exposure history Interstitial fibrosis - CXR/CT Restrictions Fibrosis
30
What drugs can cause ILD?
``` Mehotrexate Bleomycin Amiodarone Nitrofurantoin Drugs often given to treat lung diseases... ```
31
What connective tissue diseases can cause ILD?
``` Dermatomyositis/Polymyositis Sjogren's syndrome Systemic Lupus erythematosis Schleroderma Rheumatoid arthritis - may predate arthritic symptoms Disease or treatment may be cause ```
32
What is the cause and symptoms of sarcoidosis?
``` Genetic predisposition Often asymptomatic Cough and breathlessness normal chest examination May get better, remain static, worse - unpredictable ```
33
What does a biopsy of sarcoidosis look like?
Non-caseasting granulomatous (same as TB except non-caseating
34
What are the sections of the pleura?
Parietal pleura Visceral pleura Pleural space
35
What is the function of the pleural space?
Allow movement of lung and chest wall Coupling of chest wall and lung - inward lung recoil, outward chest wall recoil Pleural fluid circulation
36
What is the blood supply to the parietal and visceral pleura?
Parietal: - Costal pleura - intercostals and IMA - Mediastinal - Bronchial, upper diaphragmatic and IMA - Pleural dome - subclavian artery - Venous drainage - peribronchial anad venae cavae Visceral: - Bronchial arteries and pulmonary circulation - Venous drainage - Pulmonary venous circulation
37
What is the innervation of the parietal and visceral pleura?
Parietal: Somatic, sympathetic and parasympathetic. Phrenic and intercostal nerves Visceral pleura - devoid of somatic innervation
38
Where does pleural fluid turnover occur?
Production - Capillary filtration (starling forces. Parietal only) Absorption - Lymphatic drainage, parietal pleural lymphatics - via stomata on parietal pleural surface (mainly mediastinal, diaphragmatic regions)
39
Why might there be increased pleural fluid production?
Lung interstitial fluid increase Hydrostatic pressure increase Permeability increase Oncotic pressure decrease
40
Why might there be decreased absorption of pleural fluid?
Lymphatic blockage | Elevated systemic venous pressures
41
What treatment is done for pleural effusion?
Thoracocentesis
42
What might be a cause of pleural effusion?
Empyema - commonly associated with pneumonia Haemothorax Chylothorax
43
What might cause pleural malignancy?
Metastatic | Mesothelioma - primary. Asbestos exposure, pain, breathlessness, effusion, mediastinal pleural enhancement
44
What are the common congenital chest wall diseases?
Pectus deformities Scoliosis Kyphosis Muscular dystrophy
45
What are common acquired chest wall disease?
Trauma Iatrogenic ANkylosing spondylitis Motor neurone disease
46
What problems are associated with chest wall disease?
``` Ventilation Sleep disordered breathing Poor clearance secretions Atelectasis Pneumonia ```
47
What does the respiratory system do?
Ensures oxygen enters the blood at the same rate as metabolism utilises it Carbon dioxide leaves the blood at the same rate as metabolism produces it
48
What is the oxygen transport chain?
Air -> airway -> alveolar gas -> alveolar membrane -> arterial blood -> regional arteries -> capillary blood -> tissues
49
What is respiratory failure?
Not enough oxygen enters the blood or Not enough CO2 leaves it Do not necessarily occur together
50
What is type 1 resp failure?
``` Not enough oxygen enters CO2 loss not compromised pO2 of arterial blood low pCO2 normal or low (Most commonly perfusion problem) Problem with alveolar membrane, either some or all ```
51
What is type 2 resp failure?
``` Not enough oxygen enters the blood Not enough CO2 leaves it pO2 low pCO2 high aka pump failure ventilation problem ```
52
WHat are the symptoms of type 1 resp failure?
Breathlessness Exercise intolerance Cyanosis - deoxygenated blood so patient appears blue
53
What can cause type 1 resp failure?
``` Ventilation perfusion mismatch Pulmonary embolism Pneumonia Consolidation Pulmonary oedema Fibrosis - fibrosing alveolitis, extrinsic allergic alveolitis, pneumoconiosis ```
54
What is acute hypoxia?
pO2 < 8.0 kPa Detected by peripheral cheomreceptors -> increase ventilation Effects on pCO2 (decrease - reason for pCO2 drop in resp 1 failure), detected by central chemoreceptors
55
What is chronic hypoxia?
Renal correction of acid base balance | Increased ventilation, increased oxygen transport capacity, Hb increased by erythropoietin
56
What are the causes of type 2 resp failure?
Ineffective resp effort: Poor resp effort - resp depression (narcotics), muscle weakness (upper/lower neurone) Chest wall problems - scoliosis/kyphosis, trauma, pneumothorax Hard to ventilate lungs - high airway resistance, COPD, asthma
57
What is emphysema?
``` Destruction of ling tissue Changes in compliance Ventilation perfusion mismatch Affects oxygen supply Type 1 failure initially ```
58
What are the acute effects of resp failure?
pCO2 rises, pO2 falls Central chemoreceptors Breathlessness - some compensation
59
What are the results of CO2 retention in chronic resp failure?
``` CSF acidity corrected by choroid plexus Initial acidosis Initial acidosis corrected by kidney Reduction of resp drive Persisting hypoxia ```
60
What are the effects of chronic resp failure on the pulmonary circulation?
Effects of hypoxia on pulmonary arterioles Pulmonary hypertension Right heart failure (Cor pulmonare)
61
What is the management of resp failure?
Oxygen therapy - be careful not too much - can cause further decrease in ventilation, increased CO2 etc Removal of secretions Assisted ventilation Treat acute exacerbation

Semester 3 (19 decks)

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