Respiratory Flashcards
what two pathologies make up COPD?
emphysema
bronchitis
what is emphysema?
loss of elastic recoil in the alveoli
what is chronic bronchitis in COPD?
mucus
fibrosis/thickening of airways = impaired flow of air
is COPD restrictive or obstructive?
obstructive
lung volume is fine but nt able to blow air in/out
in chronic COPD what provides the inspiratory drive?
hypoxia
CO2 is permanently high as not able to blow it off, so body becomes desensitised
5 signs/symptoms that indicate COPD?
dyspnoea cough wheeze odema secondary to heart failure tachypnoea chest 'tightness' weight loss recurrent infections exacerbations and better periods barrel chest pursed lip breathing, bent over
3 symptoms of chronic disease that are generally NOT seen in COPD?
clubbing
haemoptysis
chest pain
in COPD what does spirometry show?
FVC fairly normal
FEV1 is low, less than 80% of expected
FEV1/FVC ratio less than 0.7
poor response to bronchodilators eg salbutamol
what might a chest x ray show in COPD?
only see severe disease
enlarged lungs
bullae (air pockets)
flattened diaphragm
excludes cancer and infection
what part of the lung is most affected in alpha 1 antitrypsin deficiency?
the bottom
panacinar
use a CT or CXR to see this
what is TCLO and what does it tell you?
transfer factor for carbon monoxide
low in COPD
high in asthma
what is first line for COPD?
smoking cessation
short acting b2 agonist eg salbutamol
or short acting anti muscarinic eg ipratropium bromide
vaccinations
what is second line for COPD?
long acting b2 agonist + long acting antimuscarinic
eg oladaterol/tiotropium combo
what is third line for COPD, or 2nd line for COPD with asthmatic features?
inhaled corticosteroid (eg beclomethasone) + LABA (eg salmeterol)
when is ipratropium bromide contraindicated?
closed angle glaucoma
urinary retention eg BPH
side effects of ipratropium bromide / antimuscarinics?
arrythmia dizziness blurred vision glaucoma G| upset
side effects of salbutamol?
tachycardia, arrythmia
hypokalaemia esp in diabetes
an example of a long acting beta 2 agonist?
salmeterol
oladaterol
what drugs interact syngerstically with steroids?
beta agonists
steroids = increased expr of beta2receptor
beta agonist = increased expression of steroid receptor
as well as relax smooth muscle, what else do beta 2 agonists do?
reduce histamine release
what is pirfenidone?
antifibrotic
for advanced resp conditions
what is theophylline?
phosphodiesterase inhibitor
bronchodilation
reduces reactivity to histamine
what is carbocysteine?
mucolytic
type 1 vs type 2 resp failure?
type 1 = low O2
type 2 = low O2 high CO2, resp acidosis
how can you tell if a respiratory acidosis is chronic?
the bicarbonate will be raised, kidneys trying to compensate, but this can’t happen immediately so you only see it in chronic
5 triggers for asthma?
infection exercise cold air dust damp pollen emotion tobacco beta blockers aspirin
what kind of hypersensitivity reaction is asthma?
type 3 / type 1
what cells/molecules are involved in asthma?
cytokines = IgE and mast cells
mast cells release histamine, prostaglandins, leukotrienes
and attract eosinophils
what happens in the late response of asthma?
immune mediators damage the epithelium
why is airflow reduced in asthma?
bronchoconstriction & mucus
is asthma reversible?
initially, yes
over time inflammatory reactions mean the basement membrane becomes thicker and fibrosed, = permanently reduced diameter, then it is not reversible
what does an asthma attack look like?
trigger worsening SOB tachynoea using accessory muscles tachycardia
what is the wheeze like in asthma?
polyphonic
bilateral
widespread
episodic
what does spirometry show in asthma?
FVC fairly normal
FEV1 is low, less than 80% of expected
FEV1/FVC ratio less than 0.7
improves with bronchodilators eg salbutamol
- 12% increase in FEV1, 200ml increase in vol
worsens with histamine/metacholine challenge, which causes hyperreactivity
what is FENO, how is it used?
fractional exhaled nitrogen oxide
more than 40 is pos
can be used in investigation of asthma
what is first line for asthma?
SABA eg salbutamol
what is second line for asthma?
inhaled corticosteroid eg beclamethosone
what are some third line options for asthma?
- montelukast
- laba eg salmeterol (need to be taking saba too)
theophylline
lama
more steroid
what is montelukast?
a leukotriene antagonist
what is a problem with theophylline?
it has a very narrow TI
NICE treatment for severe asthma attack in hospital?
salbutamol (nebulised)
ipratropium bromide nebulised
oral predisolone or IV hydrocortisone
in asthma exacerbation what is the ABG like?
initially low pCO2, as trying to get enough oxygen in - alkalosis
normal co2 means pt is getting tired of compensatory breathing, this is a bad sign
what are the two most common kinds of non small cell lung cancer?
squamous cell (central) adenocarcinoma (peripheral) - from mucus secreting cells
what cells is small cell lung cancer from?
kulchitsky cells (neuroendocrine)
which is generally worse, small cell or non small cell lung cancer?
small cell, as it tends to cause paraneoplastic syndromes
5 clinical presentations of lung cancer?
SOB cough haemoptysis clubbing recurrent infection lymphadenopathy - supraclavicular fever, weight loss, night sweats, lethargy pleuritic chest pain wheeze
what is the wheeze like in lung cancer?
fixed monophonic
a recurrent laryngeal nerve palsy could be caused by a ______ tumour and would result in __________
lung
hoarse voice
a phrenic nerve palsy caused by a lung tumour would cause ______ weakness and this would manifest as _______
diagphragm
SOB
what is pembertons sign?
bilateral arm elevation = facial oedema
shows the vena cava is being occluded by a lump in the neck, eg enlarged thyroid or lung cancer
what is Horners syndrome?
unilateral ptosis, anhydrosis, myosis
caused by pancoast tumour in the apex of the lung pressing on the sympathetic ganglion
what is lambert-eaton myasthenic syndrome?
the body produces antibodies against small cell cancer
the antibodies also attack voltage gated calcium channels
proximal weakness, diplopia, ptosis, dysphagia
what hormone does squamous cell lung cancer commonly release and what is the effect of this?
PTH
hypercalcaemia
osteomalacia
two molecules that small cell lung cancer commonly releases that cause paraneoplastic syndromes?
ADH = SIADH = hyponatraemia AcTH = cushings
what is an important cause of limbic encephalitis?
small cell lung cancer releases antibodies to the limbic system
= memory loss, hallucinations and seizures
anti Hu antibodies
3 features of lung cancer seen on a chest x ray?
hilar enlargement
circular peripheral opacity
unilateral pleural effusion
lung collapse
how might you obtain a biopsy in lung cancer?
percutaneous
or with an ultrasound guide bronchoscopy
how can you scan the body to look for cancer?
PET-CT
higher uptake of glucose tracer where there is more cancer
treatment for non small cell lung cancer?
surgery can often be curative
adjuvant or palliative chemo/radio
treatment for small cell lung cancer?
generally not curative
platinum based chemo + radiotherapy
5 risk factors for pulmonary embolism?
immobility eg flight recent surgery pregnancy oestrogens malignancy polycythaemia thrombophilia eg antiphospholipid syndrome inflam conditions eg SLE
5 clinical manifestations of pulmonary embolism?
hypoxia -- cyanosis SOB haemoptysis tachycardiaa tachypnoea pleuritic chest pain hypotension pyrexial right parasternal heave syncope
investigations in ?PE?
CXR to exclude pneumothorax, pneumonia
well’s score - is PE likely?
- yes – do a CTPA
- no – do a d dimer – if d dimer raised – do a CTPA
if you want to do a CTPA for PE but it is contraindicated what can you do instead?
when would CTPA be contraindicated?
ventilation-perfusion scan - shows good ventilation poor perfusion
CTPA contraind if allergy to contrast or severe kidney failure
what would ABG show in PE?
low oxygen - as blood cannot get to the alveoli to pick up the oxygen
resp alkalosis - as co2 is being blown off
management of PE? - 5
supportive - admission, analgaesia, oxygen enoxaparin alteplase - if PE is large surgical embelectomy vena cava filter
in pregnant patients at a high risk of PE, what is the best prophylaxis?/
heparin
where does lung cancer commonly metastasise to?
brain bone liver adrenals lymph
where does secondary lung cancer usually come from?
breast prostate colon bladder neuroblastoma
who is TB most common in?
people moving from outside of UK esp s asia, subsaharan africa
immunocomp
alcoholic
homeless, ivdu
what is TB’s waxy capsule made of?
mycolic acid
how does latent TB arise?
the immune system forms a granuloma around the bacteria
but the granuloma does not succeed in killing it and instead actually seals off the bacteria and protects it
what is it called when latent TB reactivates?
secondary TB
what is milliary TB?
Disseminated infection
what is a ‘cold abscess’?
TB forms a colony in the lymph this is often what allows it to spread painless lump in lymph usually in the neck no surrounding inflammation
how does TB usually spread between people?
through inhaled drops oof infected saliva
5 presentations of pulmonary TB?
fatigue, night sweats, weight loss, fever cold abscess cough/haemoptysis dyspnoea clubbing crackles
how does the mantoux test work?
inject tuberculin
if there is more than 5mm induration of skin after 72 hours it is pos
the person has had TB and the imune system has generated a response against the ag
what alternative to mantoux test checks for immune response to TB?
IGRA - interferon gamma release assay
looks to interferon alpha in response to tb antigen
(quantiferon is an igra test)
tb on a chest x ray:
- 3 features of primary TB?
- 2 features of reactivated TB?
GHON COMPLEX Primary: pleural effusion patchy consolidation lymphadenopathy dense homogenous opacity
secondary: nodular consolidations
cavitations at the top of the lung
what are TB on culture?
acid fast bacilli
red on ziehl-neilson stain
what is the usual management of TB and what are some side effects?
R - rifampicin - red tears/urine, cyp induction - 6 months
I - isoniazid - lupus, peripheral neuropathy - 6 months
P - pyrazinamide - gout, hepatitis - 2 months
E - ethambutol - eye probs eg colour blind - 2 months
steroids
is TB a notifiable disease?
yes
what is the most common cause of community acquired pneumonia?
strep pneumoniae
what is the second most common cause of community acquired pneumonia?
haemophilus influenzae
pseudomonas causes pneumonia in who?
cystic fibrosis
bronchiectasis
what syndrome can legionella pneumophilia cause, alongside pneumonia?
SIADH
what extra-respiratory syndromes does mycoplasma pneumoniae present with?
erythema multiformae (target rash) neuro symptoms
in exams a bird owner with a cough and infection is usually infected with
chlamydia psittaci
what is ‘lung consolidation’?
lung is full o stuff (water, mucus) not air
what is aspiration pneumonia caused by?
foreign material in the lungs
‘q fever’ is most often seen in farmers, what is it caused by?
coxiella burnetti
5 symptoms of pneumonia?
SOB productive cough haemoptysis pleuritic chest pain delirium sepsis - fever tachycardia tachypnoea hypotension etc
5 signs of pneumonia?
fever, tachycardia, tachypnoea hypotension bronchial/harsh breath sounds equally loud on inspiration/expiration dullness to percuss crackles
what system is used to consider how risky a patients pneumonia will be? what does it consider? what score warrants admission?
CURB-65 C - confusion U - uraemia R - resp rate high B - bp less than 90/ or /60 over 65
consider admit if score of 2 or more
3 or more – intensive care
3 antibiotics commonly used in pneumonia?
co amoxiclav
amoxicillin
doxycycline
clarithromycin - -mycin = macrolide. usually co amoxiclav + -mycin for hosp treatment
ceftriaxone
what antibiotic works against MRSA?
Vancomycin
what is an empyma?
infected pulmonary effusion
3 complications of pneumonia?
ARDS sepsis lung abscess pleural effusion empyma death
where is the division between the upper and lower respiratory tract?
vocal chords
5 parts of the upper resp tract (that might get infected!)
nasal passages sinuses pharynx larynx, above vocal cords tonsils eustachian tube
is tonsilitis usually caused by a bacteria or virus?
virus
3 features that suggest a tonsilitis is bacterial, not viral?
fever
tonsillar exudate
no cough
tender anterior cervical lymph nodes
some microbiology of strep pyogenes?
lancefield group a
beta haemolytic
catalase neg
presentation of tonsilitis?
usually associated with pharyngitis red inflamed sore tonsils sore throat pain on swallowing fever malaise headache
first line drug for bacterial tonsilitis?
penicillin V
what is otitis media?
inflammation of the ‘middle ear’
commonly infection of the eustachian tube following urt inf
4 bacteria that cause most upper resp tract infections?
strep pneumoniae
h influenzae
moraxella catarrhalis
staph aureus
5 presenting signs/symptoms of otitis media?
ear pain hearing loss loss of balance inflamed/perforated tympanic membrane middle ear effusion otorrhea (discharge)
1st and 2nd line treatments for otitis media and sinusitis?
1 - amoxicillin
2 - co amoxiclav
what could you use instead of penicillin/amoxicillin if pt is allergic to penicillin?
clarithromycin
is sinusitis usually bacterial or viral?
viral
eg rhinovirus
presentation of sinusitis? 4
purulent rhinorrhoea face pain headache fever voice changes change in smell/taste cough
differences between copd and asthma?
copd: non reversible, interval symptoms
emphysema vs bronchitis presentation?
emphysema = pink puffer - pursed lips, bent over, skinny,
blue bloater = reactive pulmonary vasoconstriction, overweight, productive cough, hypertension
what is the most common interstitial lung disease?
idiopathic pulmonary fibrosis
what kind of spirometry does silicosis and aspestosis have?
restrictive
presentation of silicosis and asbestosis?
dry cough
dyspnoea
generally quiet, not crackly chest
what systems are affected by granulomatosis with polyangiitis?
ELK ENT - conjunctivitis, ear infections (ent involvement separates it from goodpastures) Lung - cough/dyspnoea/wheeze Kidney - haematuria general malaise, fever etc
what investigation for staging lung cancer?
CT chest, liver, adrenals
on CXR what is the difference between the consolidation inn tb and pneumonia?
TB - in the middle
pneumonia - at the bottom
what are the most common causes of hosp acquired pneumonia?
aerobic gram neg bacilli eg
pseudomonas
klebsiella
e coli
first line imaging for ?lung cancer or ?TB?
chest x ray
in a non smoker what lung cancer is most common??
adenocarcinoma
What is the most common form of pulmonary fibrosis?
idiopathic
5 aetiologies of pulmonary fibrosis?
idiopathic ra/sle/annkylosing spondylitis/other connective tissue diseases vasculitis eg goodpastures aspergillus/TB infection drugs eg amiodarone, methotrexate aspiration sarcoidosis
presentation of pulmonary fibrosis?
dry cough
SOB
fine bilateral crackles when you listen to chest
wheeze haemoptysis chest pain clubbing cor pulmonale
what kind of spirometry is seen in pulmonary fibrosis?
restrictive - so reduced fvc
because fibrosis prevents the lung from expanding
what investigation for pulmonary fibrosis?
chest CT is best but can do x ray if not available
ground glass appearance - irregular peripheral opacities
how is DCLO affected in pulmonary fibrosis?
reduced
as gas exchange is impaired
2 drugs for pulmonary fibrosis?
pirfenidone/nintendinab - anti fibrotic
what is the epidemiology of sarcoidosis?
female
black and scandinavian
young adults/60+
what is the pathophysiology of sarcoidosis?
& what type of hypersensitivity?
type 4 hypersensitivity
unknown antigen
granuloma
pulmonary fibrosis and nodules
what cells make up the granulomas in sarcoidosis?
macrophage in the center
t cells on the edges
what is the most common location for the granulomas in sarcoidosis?
the hilar lymph node, where the bronchi meets the lung
symptoms of pulmonary sarcoidosis?
cough
gradual onset progressive dyspnoea
mediastinal lymphadenopathy
5 extrapulmonary effects of sarcoidosis?
systemic - fever, weight loss, fatigue skin - erythema nodosum, lupus pernio joints - polyarthralgia eye - uveitis, conjunctivitis heart - bundle branch block hypercalcaema liver - nodules, cirrhosis, cholestasis nervous system - diabetes insipidus, bells palsy
treatment for sarcoidosis?
generally resolves spontaneously
1st line = prednisolone
2nd line = methotrexate/azathiopurine
blood tests in sarcoidosis? - 3
raised serum ACE
raised serum calcium
raised serum soluble il2 receptor
what is gold standard investigation for sarcoidosis and what will you see?
ultrasound guided biopsy of mediastinal lymph nodes
non caseating granuloma with epitheloid cells
on a chest x ray in sarcoidosis what would you see?
hilar lymphadenopathy
bilateral lung exudate
what is lofgrens syndrome and what condition is it most commonly associated with?
sarcoidosis
triad of bilateral hilar lymphadenopathy, polyarthritis and erythema nodosum
what is bronchiectasis?
widening of the bronchioles and build up of mucus
5 aetiologies of bronchiectasis?
young syndrome cf infection eg tb, pneumonia, hiv, pertussis bronchial obstruction eg tumour rheumatoid arthritis/uc alpha 1 antitrypsin deficiency copd
why is there increased risk of infection in bronchiectasis?
because the cilia are damaged so cannot clear the mucus+infection as easily
is bronchiectasis an obstructive or restrictive disease?
obstructive, the main problem is that mucus obstructs the airways
why is there pulmonary hypertension in bronchiectasis?
in response to hypoxia the pulmonary vessels constrict in an attempt to divert flow to somewhere with better airflow
5 clinical presentations of bronchiectasis?
persistent productive cough purulous sputum which is foul smelling and dark green (usually has been sat around in the lung for a long time before it can be coughed up) intermittent haemoptysis SOB clubbing wheeze coarse inspiratory crepitations prone to respiratory infections
what does the chest x ray show in bronchiectasis?
cystic shadows
dilated and thickened bronchi and bronchioles
how to manage the mucus in bronchiectasis?
mucolytic eg carbocysteine
flutter valve for mucus drainage
what population is at greatest risk of cystic fibrosis?
caucasian
what is the mutation in cf and what is the effect of it?
mutation in CFTR protein
= lack of cl- into mucus secretions
= thick and sticky mucus
5 clinical presentations of CF?
Failure to thrive cough - haemoptysis/thick sputum wheeze recurrent resp inf bronchiectasis pancreatic insufficiency = steatorrhoea and diabetes gall stones, cholestasis male infertility nasal polyps cyanosis clubbing bilateral coarse crackles
what is the test for CF in newborns? how does it work?
Guthrie
detects raised trypsinogen
trypsinogen raised in response to pancreatic damage
what is the gold standard CF test?
sweat test
inject pilocarpine to stimulate sweat production
salty sweat = cf, sweat glands are opposite so cl- cannot be absorbed from the sweat
two methods of genetic testing for CF during pregnancy?
amniocentesis
chorionic villus sampling
management for CF?
chest physio
antibiotics - acute or prophylactic
mucolytics eg dornase alpha
bronchodilators eg salbutamol
fat soluble vitamin supplement
ursodeoxycholic acid to improve bile flow
ivacaftor or lunacaftor depending on mutation
what is a pleural effusion?
fluid in the pleural cavity
exudative vs transudative effusion?
transudative = low protein, less than 3 exudative = high protein, more than 3
3 aetiology of transudative pleural effusion?
transudative is caused by movement of fluid eg
congestive heart failure
low albumin
hypothyroid
peritoneal dialysis
3 aetiologies of exudative pleural effusion?
exudative caused by inflammation, which means both fluid and proteins can move
lung cancer pneumonia tb RA SLE and other autoimmune pulmonary embolism
clinical presentation of pleural effusion?
SOB cough pleuritic chest pain stony dull to percussion reduced chest expansion superior raspy breathing tracheal and mediastinal deviation, if severe
investigation for pleural effusion?
chest drain/pleural effusion, test the fluid for culture, protein/LDH, appearance, cell count
chest xray
what does the chest x ray in pleural effusion show?
blunting of the costophrenic angle
fluid in the lung fissures
meniscus at the bottom
tracheal and mediastinal deviation
management of pulmonary effusion?
antibiotics
diuretics
pleural aspiration or chest drain
small may spontaneously resolve
2 complications of pulmonary effusion?
empyema
trapped lung
in exams what is a common epidemiology/type of patient for pneumothorax?
a tall young male with sudden onset shortness of breath while playing sport
what conditions is spontaneous pneumothorax more likely in?
marfans
rheumatoid arthritis
etc
some causes of iatrogenic pneumothorax?
central line insertion
mechanical ventillation
lung biopsy
presentation of pneumothorax?
sudden onset SOB / pain / cough cyanosis tachycardia tachypnoea reduced breath sounds hyper resonance pleuritic chest pain
first line investigation for pneumothorax?
erect chest x ray - see a visible rim with no lung markings
gold standard investigation for pneumothorax?
ct thorax
allows you to see smaller pneumothorax and measure them more effectively than a cxr
when would a pneumothorax not need management?
less than 2cm with no SOB
management of pneumothorax? 3
high flow oxygen
insert a chest drain at 5th intercostal space on the mid axillary line
aspiration
what can you do for recurrent pneumothorax?
surgery to remove the pleura or stick the visceral and parietal layers together
where is the air in pneumothorax?
in the pleural space (between visceral and parietal pleura)
what is a tension pneumothorax caused by?
trauma
one way valve
clinical presentation of tension pneumothorax?
decreased air entry unequal lung expansion tachycardia hypotension trachial deviation hyperresonance
management of tension pneumothorax?
large bore canula
2nd intercostal space
mid clavicular line
at what pressure is pulmonary hypertension diagnosed?
25mmHg
what are the 5 groups of aetiology of pulmonary hypertension?
- primary - eg SLE
- left sided heart failure - eg MI, systemic hypertension
- chronic lung disease - eg COPD - reactive vasoconstriction
- pulmonary vascular disease eg PE
- miscellaneous eg sarcoidosis, vasculitis
what is the effect on the lungs of hypertension?
thickening of alveolar and capillary membranes
= reduced gas exchange
what is cor pulmonale?
increased pressure in the lung vessels backs up into right ventricle = rv hypertrophy = backpressure into veins = systemic oedema
clinical presentation of pulmonary hypertension?
SOB worse when flat / on excercise - orthopnoea syncope tachycardia raised jvp hepatomegaly peripheral oedema chest pain heart murmur
what does an ECG show in pulmonary hypertension?
large R waves on the right V1-V3
large S waves on left V4-V6
right axis deviation
right bundle branch block
a blood test that would show heart pathology in pulmonary hypertension?
NT - pro - BNP
3 drugs for primary pulmonary hypertension?
IV prostanoid eg epoprostenol
endothelin receptor antagonist eg macitenan
pde-5 inhibitor eg sildenafil
3 complications of pulmonary hypertension?
resp failure
heart failure
arrythmia
how many points do you need on the well’s score for pe to be likely?
if wells is more than 4 PE could be likely
gold standard test for pulmonary hypertension?
right heart catheterisation
this is a way of measuring the pulmonary BP
Bird fanciers lung, farmers lung and malt workers lung are all examples of
hypersensitivity pneumonitis
what type of hypersensitivity reaction is hypersensitivity pneumonitis?
type 3
over time – type 4
what happens to the lung in hypersensitivity pneumonitis?
fibrosis – impaired gas exchange, loss of elasticity
non caseating granulomas
what part of the lung is most affected in hypersensitivity pneumonitis?
top
presentation of acute hypersensitivity pneumonitis?
fever, rigors
cough
dyspnoea
headache
presentation of chronic hypersensitivity pneumonitis?
progressive cough progressive dyspnoea fatigue cyanosis resp failure weight loss clubbing
what do you see on biopsy with hypersensitivity pneumonitis?
non caseating granuloma
management of hypersensitivity pneumonitis?
steroids
remove trigger
what do you see on imaging in hypersensitivity pneumonitis?
diffuse infiltrate
ground glass (fibrosis)
bronchiectasis
what are the antibodies to in goodpastures?
type 4 collagen
which is in glomerular basement membranes
presentation of goodpastures? - 5
cough SOB haemoptysis haematuria proteinuria oliguria
hypertension anorexia myalgia/arthralgia lethargy fever
best investigation for goodpastures, what do you see?
kidney biopsy
immunoflorescence - iGg associated with glomerulus
crescents
inflammation
what is DCLO in goodpastures?
high
management of goodpastures?
plasmaphoresis
steroids
cyclophosphamide
what is the most common ANCA vasculitis?
granulomatosis with polyangiitis
which ANCA antibody is usually associated with granulomatosis with polyangiitis?
cANCA
what do you see on chest imaging of granulomatosis with polyangiitis?
nodules
fluffy alveolar haemorrhage
cavitating lesions
consolidation
mesothelioma is associated with
asbestos!
what is mesothelium?
epithelium that forms lining ie pleura, peritoneum, pericardium etc
what molecule does mesothelioma express?
calretinin
presentation of mesothelioma?
history to suggest clubbing sob pleuritic chest pain harmoptysis fever, weight loss etc
which part of the lung is fibrosed in mesothelioma?
lower
polo mint sign on CT is associated with what condition?
PE
bronchus sign on CT indicates what lung pathology?
bronchogenic cancer
tree in bud sign on CT indicates what lung pathology?
pneumonitis, bronchiolitis
split pleura sign on CT indicates what lung pathology?
exudative, malignant or infected pleural effusion
signet ring sign on CT indicates what lung pathology?
bronchiectasis
what is the most common type of lung cancer?
squamous
what is the most common lung cancer in non smokers?
adenocarcinoma
complications of bronchiectasis?
empyema
respirator failure
repeated inf = worsening lung function
pneumothorax from repeated coughing
what is the microbiology of h influenzae?
small
gram neg
cocco-bacillus
risk factors for pneumothorax?
smoking
trauma
previous pneumothorax
mechanical ventilation
how long after admission is it called hospital acquired pneumonia?
48hrs
what type of hypersensitivity is goodpastures?
type 2
what is gold standard for TB diagnosis?
sputum culture
what is the most common cause of pneumonia in bronchiectasis?
h influenzae
which sinus is most prone to infection and what are the symptoms of that?
maxillary, because it drains from the top
forehead and cheek tenderness
worse when leaning forward
is cystic fibrosis restrictive or obstructive?
obstructive
3 Indicators of good asthma control?
no night time symptoms inhaler used no more than 3x per week no breathing difficulties, cough or wheeze on most days able to exercise without symptoms normal lung function test
