Respiratory Flashcards
1
Q
Define FEV1
A
Forces expiratory volume in one second
2
Q
Define FVC
A
Forced vital capacity
- Total amount of air forcibly expired after taking a deep breath
3
Q
What indicates an abnormal FEV1?
A
> 80% than normal
4
Q
What does a low FVC indicate?
A
Restriction
5
Q
What does a FEV1:FVC ratio of <0.7 indicate?
A
Airway obstruction
6
Q
What does a high FEV1/FVC ratio with low FVC indicate?
A
Airway restriction
7
Q
What indicates type 1 respiratory failure?
A
pO2 is low
pCO2 is low or normal
HCO3 is normal
8
Q
What are 2 causes of type 1 respiratory failure?
A
RESTRICTIVE
Pneumonia
Pulmonary embolism
9
Q
What levels indicate type 2 respiratory failure?
A
pO2 is low
pCO2 is high
HCO3 is normal if acute, increased if chronic
10
Q
What are 2 causes of type 2 respiratory failure?
A
OBSTRUCTIVE
Hypoventilation
Emphysema
COPD
11
Q
Define COPD
A
Non-reversible, progressively worsening airflow obstruction in the lungs
12
Q
What are 3 types of COPD?
A
Chronic bronchitis
Emphysema
Alpha 1 antitrypsin deficiency
13
Q
What are the risk factors of COPD?
A
Smoking
Air pollution
Genetic factors
Increased age
14
Q
What gene is linked to COPD?
A
Alpha-1 anti trypsin deficiency
- Autorecessive
15
Q
What does A1AT deficiency cause?
A
Deficiency in A1AT which inhibits neutrophil elastase
Early onset COPD
Cirrhosis
16
Q
Define chronic bronchitis?
A
Chronic productive cough with sputum for 3+ months for 2+ years
17
Q
Define emphysema
A
Enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls
18
Q
Outline the pathophysiology of chronic bronchitis?
A
Chronic exposure to pollutants -> hypersecretion of mucus in bronchi -> airway inflammation -> fibrotic changes -> narrowing of airways
19
Q
What are the features of COPD?
A
Dysponea
Wheeze
Productive cough
Sputum production
20
Q
What are the features of bronchitis?
A
BLUE BLOATERS
Pus sputum production
Cyanosis
Hypoxia
Obesity
Clubbing
21
Q
How do cigarettes cause chronic bronchitis?
A
Interferes with cilia action
Dampens leukocyte response
22
Q
Outline the pathophysiology of emphysema
A
Destruction of elastin layer -> loss of elastic recoil -> reduced alveolar surface area -> airway collapse in expiration
23
Q
What are the 4 types of emphysema?
A
Centriacinar
Panacinar
Distal acinar
Irregular emphysema
24
Q
What part of the lungs are affected by centriacinar emphysema?
A
Respiratory bronchioles
25
What is the MC cause of centri-acinar emphysema?
Cigarettes
26
What part of the lungs are affected by pan-acinar emphysema?
Whole acini
- respiratory bronchioles, alveoli, alveolar sacs
27
What part of the lungs are affected by distal acinar emphysema?
Distal airway structure
28
What is the MC cause of panacinar emphysema?
Alpha-1 antitrypsin deficiency
29
What are the features of emphysema?
PINK PUFFER
Pursed lip breathing
Hyperresonant chest on percussion
BARREL CHEST (too much air)
Cachexia (muscle wasting)
30
How does COPD affect V/Q?
Increases CO to compensate for decreased ventilation
DECREASES V/Q
31
What is V/Q?
Ventilation/perfusion ratio
32
Define ventilation rate(as in V/Q)
Volume of gas inhaled and exhaled from the lungs in a given time period
33
Define perfusion (as in V/Q)
Total volume of blood reaching the pulmonary capillaries in a given time period
34
Define bullae
Air filled space of >1cm in diameter in the lung that develops due to destruction of the lung parenchyma
35
What is a complication of emphysema?
Bullae rupture -> pneumothorax
36
How is COPD diagnosed?
FEV <0.8
FEV1/FVC <0.7
History of smoking ect
DLCO: diffusing capacity of CO across lung
37
How is Dysponea graded?
MRC 1-5
1- on strenuous exercise
2- walking up hill
3- can walk slow on flat
4- can catch breath after 100m on flat
5- housebound, cant do daily activity
38
What is stage 1 COPD?
FEV1 >80%
39
What is stage 2 COPD?
FEV1 50-79%
40
What is stage 3 COPD?
FEV1 30-49%
41
What is stage 4 FEV1 COPD?
<30%
42
How is emphysema diagnosed?
CXR:
Hyper inflated chest
Bullae
Decreased peripheral vascular marking
Flattened hemidaphragms
43
What marker differentiates COPD from asthma?
DLCO diffusing capacity of oxygen through lungs
44
What may ABG show in COPD?
T2 respiratory failure
Compensated acidosis
45
What is an exacerbation of COPD?
Acute worsening of symptoms
- Cough, SOB, sputum production and wheeze
46
What are the causes of COPD exacerbation?
Haemophilius influenzae (MC)
S. Pneumoniae
47
Outline the pathophysiology of COPD exacerbation
Excess O2 -> dead space -> V/Q mismatch -> CO2 retention -> respiratory acidosis
48
How does COPD exacerbation appear on ABG?
Low pH (acidosis)
Raised pCO2
Raised bicarbonate (not enough to reduce acid)
49
What is the target saturation in COPD exacerbation?
88-92
50
How is COPD exacerbation treated?
Abx: clarithromycin, amoxicillin, doxycycline
oxygen
steroids and nebuliser
51
What is the baseline treatment of COPD?
Smoking cessation + flu and pneumoniae vaccine
52
What is the first line treatment of COPD?
Short acting beta-2 agonist/SABA (salbutamol)
OR
Short acting muscarinic antagonist/SAMA (ipratropium bromide)
53
What is a short acting muscarinic antagonist?
Ipratropium bromide
54
What is the second line treatment of COPD?
No asthma features = LABA+ SABA + LAMA
Asthma features (eosinophils) = LABA + SABA + ICS
55
What is a long acting beta agonist?
Salmeterol
Formoterol
56
What is a short acting beta-2 agonist?
Salbutamol
Terbutaline
57
What is an example of of a LAMA?
Tiotropium
58
What is a type of ICS used in COPD?
Fostair
Seretide
Prednisolone
59
What is used in the 3rd line treatment for COPD?
LABA + LAMA + SABA + ICS
60
What is used in severe COPD?
Long term oxygen therapy
MUST STOP SMOKING
61
When is oxygen given in COPD?
PaO2 <7.2
Or
PaO2 7.3-8 with oedema, pulmonary HTN, noctutural hypoxaemia
62
When is oxygen therapy avoided in COPD patients?
Smokers- but they can have it after they quit
63
When is surgery indicated in COPD?
Upper lobe predominant emphysema -> lung reduction surgery
64
What are the complications of COPD?
Cor pulmonale
Infection (IECOPD)
65
When is alpha 1 antitrypsin deficiency suspected?
Young onset COPD and/or no history of smoking
66
Define asthma
Chronic inflammatory condition causing:
episodic airflow limitation
airway hyperresponsiveness
inflamed bronchioles
67
What are 3 triggers of asthma?
Infection
Exercise
Animals
Cold/damp
Dust
Beta blockers
68
What are the 2 types of asthma?
Allergic (IgE mediated)
Non-allergic (non-IgE mediated)
69
What is the MC type of asthma?
Allergic
70
Describe allergic asthma
IgE mediated, extrinsic T1 hypersensitivity reaction
ATOPIC
Caused by environmental triggers
Early presentation
May link to hygiene hypothesis
71
What are the features of non-allergic asthma?
Non-IgE mediated, intrinsic
Presents later
Associated with smoking and obesity
Exacerbated by exercise and cold weather
72
Define atopy
Tendency to readily develop IgE against common environmental agents, leading to elevated serum IgE and airway hyperresponsiveness
73
What are the risk factors of asthma?
History of atopy
Obesity
Inner city environment
Premature birth
Socioeconomic deprivation
74
Outline the pathophysiology of asthma
1. Overexpressed TH2 cells in airways exposed to trigger
2. TH2 cytokine release IL3,4,5,13 and IgE production + eosinophils
3. IgE mast cells -> histamines and eosinophils release MBP
4. Bronchial constriction and muscus hypersecretion
75
What is the atopy triad?
Allergic rhinitis (hay fever)
Asthma
Eczema
76
What is Samter’s triad/ aspirin exacerbated respiratory disease?
Aspirin sensitivity
Nasal polyps
Asthma
77
What are the symptoms of asthma?
Wheeze
Cough
Chest tightness
SOB
Episodic with triggers
78
What are the 4 classifications of asthma attacks?
Moderate (PEF 50-75)
Acute Severe (PEF 33-50) can’t finish sentence
Life threatening (PEF <33 and decreased consciousness, silent chest)
Near Fatal (raised PaCO2)
79
What is PEF?
Peak expiratory flow
Volume of air forcibly expired from lungs in one exhalation after a deep breath in
80
How is asthma diagnosed?
1. Fractional exhaled nitrous oxide (FeNO) increased
- due to eosinophils
2. Spirometry shows obstruction (FEV1/FVC <0.7)
3. Bronchodilator reversible test positive (>12% FEV1)
81
How is asthma differentiated from COPD?
Bronchodilator reversible test positive in asthma
COPD usually occurs later
COPD more progressive
82
How is asthma treated?
1. SABA
2. SABA + ICS
3. SABA + ICS + LAMA if 5 or older
SABA + ICS + LTRA if <5
4. SABA + ICS + LABA +/- LTRA
83
What is an example of a LTRA?
Montelukast
84
How are asthma exacerbations treated?
O SHIT ME
O2
Nebulised SABA
Hydrocortisone (ICS)
Ipratropium
Theophylline
MgSO4
Escalate care
85
What are 2 respiratory tract infections?
Pneumonia
Tuberculosis
86
Define TB
Granulomatous ceasating disease caused by mycobacteria
type 4 hypersensitivity reaction
87
What are the 4 causes of TB?
Mycobacterium tuberculosis (MC)
Mycobacterium Bovis (unpasteurised milk)
Mycobacterium africanum
Mycobacterium microti
88
Where is TB most common?
South Asia
Sub Saharan Africa
89
How does TB stain?
Acid fast bacilli- go red/pink with Ziehl-Neelson stain
90
What are the microbiological features of TB?
Aerobic
Non motile
Non sporing
Slightly curved rods/ bacilli
Thick waxy capsule
Slow growing
91
What are the risk factors of TB?
Origination from high incidence country
HIV
Immunosupression
Poverty and malnutrition
Overcrowding
IVDU
Smoking and alcohol
92
How is TB spread?
Airborne via respiratory droplets
93
How many people with TB have latent infection?
95%
94
What are the 3 stages of TB?
Primary infection (can instantly progress)
Latent
Reactivation
95
What is it called when TB spreads systemically?
Military TB
96
What occurs in the primary phase of TB infection?
Initial contact with alveolar macrophages -> some bacilli taken into hilar lymph nodes -> granulomas form in lung apex (mainly) -> macrophages and lymphocytes kill most but some still remain
97
What occurs in the latent phase of TB?
TH1 response -> ceasating Granuloma formation -> ceasating necrosis in Granuloma (Gohn focus)-> 95% don’t have disease but can reactivate
98
What occurs in the reactivation phase of TB?
Bacilli + macrophages form granulomas -> Granuloma grows -> Granuloma and enlarged lymph grow as Ghon complex -> develops into cavity -> expelled when coughing
99
What is a Ghon focus?
Seen in TB, caseous necrotic tissue forms when the tissue inside a granuloma dies
100
What is a Ghon complex?
Ghon focus and affected hilar lymph nodes
101
What are 2 differential diagnoses of TB?
Cor pulmonale
Portal HTN
Heart failure
102
What are the symptoms of TB?
Night sweats
Weight loss and anorexia
Fever
Dysponea
Productive cough
Haemoptysis
103
How is latent TB diagnosed?
Tuberculin skin test/ mantoux skin test
-Inject tuberculin under skin, wait 3 days, >5mm is positive
Interferon gamma release assay
104
How is TB diagnosed?
GS: culture sputum 3x (takes 5 weeks)
- Ziehl-Neelsen stain
X-ray:
Hilar lymphadenopathy
Ghon complexes
Pleural effusion
Reactivation = UPPER LOBES
105
How is latent TB treated?
Isoniazid for 6 months
Isoniazid + rifampicin for 3 months
106
How is active TB treated?
RIPE
Rifampicin - 6 months
Isoniazid - 6 months
Pyrazinamide - 2 months
Ethambutol - 2 months
107
What are the complications of TB?
Haemopytisis
Pneumothorax
Fistula
Military TB
108
What are the side effects of Rifampicin?
Orange discolouration urine
109
What are the side effects of isoniazid?
PerIpheral neuropathy
- give pyroxidine
110
What are the side effects of pyrazinamide?
Hyperuricaemia -> gout
HepatItIs
111
What are the side effects of ethambutol?
EYEthambutol
Optic neuritis
Colour blindness
Reduced visual acuity
112
Define pneumonia
inflammation of the lung and fluid exudate into alveoli Secondary to infection
113
What are some causes of pneumonia?
Strep pneumoniae (rusty sputum)
Haemophilius influenzae
Klebseilla (alcoholic and red sputum)
114
What are the 2 types of pneumonia?
Community acquired pneumonia (CAP)
Hospital acquired pneumonia (HAP)
115
When is CAP commonly seen?
Usually no immunosupression or malignancy
Can occur in all age but common in age extremes
116
What are the MC causes of CAP?
MC: strep. Pneumoniae
H. Influenzae
Mycoplasma pneumoniae - atypical pneumonia
117
What cause of pneumonia is common in people coming back from Spain and places with air conditioning?
Legionella
118
Define HAP
New onset of cough with purulent sputum and an X-ray consolidation, in patients who have spent >48 hours in hospital
119
Who is HAP commonly seen in?
Elderly
Ventilator associated
Post operative
120
What are the MC causes of HAP?
Aerobic gram negative bacilli
Pseudomonas aeruginosa
E. Coli
Klebsiella pneumoniae
121
What is aspiration pneumonia?
Pneumonia due to aspiration of food into the lungs (usually right lung)
122
What are the risk factors of pneumonia?
Age extremes
HIV
DM
COPD
IVDU
Smoking
123
Outline the pathophysiology of typical pneumonia
Bacteria invades -> exudate forms inside alveoli -> sputum production
124
Outline the pathophysiology of atypical pneumonia
Bacteria invades -> exudate forms in interstitium of alveoli -> dry cough
125
What are the symptoms of pneumonia?
Productive cough with rusty coloured sputum
Pyrexia
Pleuritic chest pain
Dysponea and breathlessness
Tachycardia, Tachypnoea, hypoxia
Confusion in older people
126
What breath sounds are seen in pneumonia?
Bronchial breath sounds equally as loud on inspiration and expiration
Focal coarse crackles (air through sputum)
Dullness to percussion
127
What are the symptoms of atypical pneumonia?
Dry cough
Low grade fever
128
How is pneumonia diagnosed?
CXR shows consolidation
CXR shows air bronchogram
Sputum culture to find cause
ESR and CRP raised
129
What is consolidation?
Air filled bronchi made visible by fluid filled surrounding alveoli
130
What are mulitlobar pneumonic lesions on CXR indicative of?
S. Pneumoniae
S. Aureus
Legionella
131
What are multiple pneumonic abscesses on CXR indicative of?
S. Aureus
132
What are upper lobe pneumonic lesions on CXR indicative of?
Klebsiella bur exclude TB first
133
How is pneumonia severity assessed?
CURB65
134
How is CURB65 scored?
C= confusion
U= urea >7
R= respiratory rate >30
B= blood pressure <90 systolic or <60 diastolic
65 or over
135
What should be done if CURB65 score is 0-1?
Stay at home
136
What should be done if CURB65 score is 2?
Consider hospital
137
What should be done if CURB65 score is 3+?
ITU
138
What are the mortality rates of CURB65 score?
0 = 0.7
3= 17
5 = 57
139
What is the first line treatment of pneumonia?
1 = amoxicilllin 5-7 days
2= amoxicillin + clarithromycin 7-10 days
3<= IV co-amoxiclav + clarithromycin
140
How is staph aureus treated?
Flucloxacillin
141
How is strep pneumoniae treated?
Amoxicillin
142
How is H. Influenzae treated?
Amoxicillin
Doxycycline
143
How is Klebsiella treated?
Co-amoxiclav or cephalosporins
144
How is legionella treated?
Clarithromycin
145
What 2 organisms can cause pneumonia in immunocompromised people?
Pseudomonas aeurgionosa
Pneumocystis pneumonae (HIV!)
146
How is pneumonia in immunocompromised people treated?
Folic acid Abx
- Co-trimoxazole
147
How is immunocompromised pneumonia diagnosed?
Silver stain
148
What are the complications of pneumonia?
Parapneumonic effusion
Empyema
Lung abscess
149
Define cystic fibrosis
Autorecessive mutation of CFTR (cystic fibrosis transmembrane conductance regulatory gene) gene on chromosome 7
150
What is the MC mutation in CF?
Delta-F508
151
How many people are CF carriers?
1/25
152
What is the normal function of the CFTR gene?
Secretes Cl- actively and Na+ and H2O passively into ducal secretions making them thin and watery
153
What occurs when the CFTR gene is mutated in CF?
Less Cl- is excreted so more H2O and Na+ is reabsorbed, causing the mucus to thicken
154
Outline the pathophysiology of CF in the lungs
Mutated CFTR + impaired mucociliary clearance as mucus is too thick -> stagnation -> increased infection risk + difficultly breathing -> increased risk of bronchiectasis
155
What are the symptoms of CF at birth?
20% have meconium ileus
Thick black sticky stool that can obstruct the bowel
156
What are the respiratory symptoms of CF?
Thick sticky sputum
Crackles on austication
Chronic cough
Recurrent lower respiratory tract infection.
157
What are the GI symptoms of CF?
Pancreatitis and pancreas insufficiency
Thick secretions
Steatorrhoea + deficiency of fat soluble vitamins
158
What are the GU symptoms of CF?
Frequent UTI
Males infertile due to absence of vas deferents and epididymis
Females may lose periods later on due to thick cervical mucus
159
What are some other symptoms of CF?
Salty sweat
Clubbing
Osteoporosis
160
What are the risk factors of CF?
Caucasian
FHx
161
How is CF diagnosed?
GS: sweat gland test- Na and Cl- will be >60mmol/L
Genetic testing
Newborn spot blood test
162
How is CF treated/managed?
Prophylactic Abx
Nebulised mucolytics
Pancreatic stuff: give insulin and vit DAKE
Chest physio and no smoking
Lung transplant
163
Define bronchiectasis
Permanent dilation of bronchi and bronchioles from chronic infections
164
What are 4 common infections in bronchiectasis?
Haemophilius influenzae
Strep pneumoniae
Staph aureus
Pseudomonas aeruginosa
165
What are the symptoms of bronchiectasis?
Chronic purulent cough with foul smelling mucus and intermittent haemoptysis
Dysponea
Coarse inspiratory crackles
Clubbing
166
What part of the lungs are commonly affected by bronchiectasis?
Lower lobes
167
What are the risk factors of bronchiectasis?
Previous infection
CF
HIV
168
Outline the pathophysiology of bronchiectasis
Bronchitis -> bronchiectasis -> fibrosis
169
What are 2 differential diagnoses of bronchiectasis?
COPD
Asthma
TB
Chronic sinusitis
170
How is bronchiectasis diagnosed?
CXR shows dilated bronchi ad thickened walls (tramline and ring shadows)
GS: high resolution CT shows SIGNET RING SIGN
Spirometry shows obstruction
Sputum culture
171
How is bronchiectasis treated?
Physio and postural draining
Abx
Bronchodilator
Mucolytic
172
What is an example of a mucolytic?
Carbocistiene
173
Define pleural effusion
Excessive accumulation of fluid in the pleural space (between visceral and parietal pleura)
174
What are the 2 types of pleural effusion?
Exudative (protein >30g/L)
Transudative (protein <30g/L)
175
What are some other effusions in pleural effusion?
Blood- haemothorax
Pus- empyema
Lymph- chylothorax
176
What are the causes of transudative pleural effusion?
Heart failure
Fluid overload
Cirrhosis
NephrOtic syndrome
177
What are the causes of exudative pleural effusion?
Cancer
Pneumonia
TB
178
What are the signs of pleural effusion?
Can be asymptomatic
Dull percussion on affected side
Diminished breath sounds on affected side
Chest expansion reduced on affected side
Tracheal deviation AWAY from effusion
179
When is Lights criteria used?
Pleural effusion
When protein content borderline exudative (25-35)
180
How is pleural effusion diagnosed?
CXR when 300ml< present seen as water dense shadows (WHITE)
Small effusions reduce costophrenic angles
USS thoracentesis/pleural tap
- sent for testing
181
How is pleural effusion treated?
Small can be conservative- loop diuretics
Chest drainage
If recurrent = pleurodesis
Can use PIC (Indwelling catheter) if recurrent too
182
What is pleurodesis?
Injection adhering the visceral and parietal pleura to prevent re accumulation of pleural effusion
183
What are the risk factors of pleural effusion?
Asbestos exposure
Previous lung damage
Infection
184
Define empyema
Infected pleural effusion (pus)
185
What are the symptoms of pleural effusion?
SOB
Dyspnoea
Pleuritic pain
Failure of fever to settle on Abx
186
How is Empyema diagnosed?
Pus in pleuritic aspiration
Acidic pH
Low glucose
187
How is empyema treated?
Chest drain
Thoracoscopy
Indwelling pleural catheter (PIC) if recurrent
188
Define pneumothorax
Air in the pleural space leading to partial or complete collapse of the lungs
189
What are the risk factors of pneumothorax?
Male
Smoking
Connective tissue disorder
Mechanical ventilation
190
What are the 2 types of pneumothorax?
Primary: spontaneous, no underlying cause
Secondary: known cause, trauma or infection ect
191
What are the causes of pneumothorax?
Bronchial asthma
COPD
TB
Pneumonia
CF
Trauma
192
Outline the pathophysiology of pneumothorax
Normally pressure is negative (vacuum) -> breach in pleura -> abnormal connection (fistula) between pleural space and airways
193
What are the symptoms of pneumothorax?
Usually tall, thin male with connective tissue disorder/trauma
Sudden onset of dysponea and/or pleuritic test pain
Enlargement = increased Dysponea, pallor, tachycardia
Reduced Breath sounds
194
What breath sounds are present in pneumothorax?
Hyper resonance to percussion
Reduced expansion
Diminished breath sounds
195
How is pneumothorax diagnosed?
CXR= air appears black, tracheal deviation to other side (tension) and line demarcating edge
CT for smaller pneumothorax
196
Define tension pneumothorax
Trauma to the chest causing a one way valve letting air in but not out of the pleural space
Causes massive increase of pressure with every breath, can compress heart
197
What are the complications of tension pneumothorax?
Cardio respiratory arrest
198
What are the symptoms of tension pneumothorax?
Tracheal deviation away from pneumothorax
Reduced air entry to affected side
Increased resonant percussion
Severe chest pain
199
How is pneumothorax treated?
Insert large bore cannula into second intercostal space in midclavicular line
200
What type of pneumonia commonly affects HIV patients?
Pneumocystis jiroveci
201
What is the MC interstitial lung disease (ILD)?
Idiopathic fulmonary fibrosis
202
What is a granulomatous ILD?
Sarcoidosis
203
What is an inhalation ILD?
Hypersensitivity pneumonitis
Pneumoconiosis
204
What causes pneumoconiosis?
Asbestosis
Silicosis
205
What are 2 idiopathic pneomonias?
Pulmonary fibrosis
Non-pulmonary fibrosis
206
What is a connective tissue ILD?
Sleroderma
RA
207
What are 2 drugs that can induce ILD?
Amiodarone
Biemycin
208
Define interstitial lung disease (ILD)
Umbrella term for lung pathology that causes scarring/fibrosis of the lungs
209
Define idiopathic pulmonary fibrosis (IPF)
Formation of fibrosis in the lungs with no known cause
210
Who does IPF affect?
60+ male smokers
211
What are the risk factors of IPF?
Cigarettes
Infectious agents (CMV, Hep C)
Occupationa dust exposure
Drugs
GORD
212
What are the symptoms of IPF?
Dry cough
Excertional Dysponea
Bibasal crackles
Joint pain
Cyanosis
213
How is IPF diagnosed?
Spirometry: restriction (FEV1/FVC >70% but low FVC)
HR-CT: shows GROUND GLASS APPEARANCE
214
How is IPF treated?
Pirfenidone + nintedanib
Lung transplant
Short survival so can go to palliative
215
Define sarcoidosis
Multisystem granulomatous disorder of an unknown cause
216
Who does sarcoidosis commonly affect?
20-40
Women
Afro Caribbean’s
217
What are the symptoms of sarcoidosis?
Dry cough
Progressive Dysponea
Anterior uveitis
Lupus pernio- bluish purple nodules and plaques on nose, cheek, and ears
218
How is sarcoidosis diagnosed?
CXR for staging: shows bilateral hilar lymphadenopathy and pulmonary infiltrates
GS: tissue biopsy shows NON CAESATING GRANULOMATA
raised calcium and ACE
219
How is sarcoidosis treated?
Low stage = recovery is spontaneous
Acute: bed rest and NSAIDs
Corticosteroids: Prednisolone if symptomatic
220
When is sarcoidosis not treated?
Symptomatic at stage 1
Asymptomatic at stage 2+3
221
Define pulmonary hypertension
MPAP above 25mmHg when measured with right heart catheterisation
222
What is mPAP?
Mean pulmonary artery pressure
223
What can pulmonary hypertension cause?
Cor pulmonale
224
What is a pre capillary cause of pulmonary hypertension?
Pulmonary embolism
225
What is a capillary/lung cause of pulmonary HTN?
COPD
Asthma
226
What is a post capillary cause of pulmonary HTN?
Left ventricle failure
227
Outline the pathophysiology of pulmonary hypertension
Pulmonary vasoconstriction-> higher resistance -> pulmonary HTN -> endothelial damage -> RVH -> RH failure
228
What are the symptoms of pulmonary hypertension?
Excertional dysponea
Fatigue
RHF sights: hepatomegaly, ascites, pleural effusion, peripheral oedema
229
How is pulmonary hypertension diagnosed?
GS: RH catheter
CXR: cardiomegaly and RVH
ECHO and ECG
230
How is pulmonary hypertension treated?
Sildenafil (phosphodiesterase-5 inhibitors)
Prostaglandin analogues
Diuretics for oedema
CCB
231
Define mesothelioma
Tumour of the mesothelial cells of the pleura
232
What is the MC cause of mesothelioma?
Asbestos exposure
233
Who is commonly affected by mesothelioma?
40-70 year old men with asbestos exposure a long time ago
234
What are the symptoms of mesothelioma?
Chest pain
Constant cough with haemopytis
Clubbing
Night sweats
Weight loss
Recurrent pleural effusion
235
How is mesothelioma diagnosed?
1. Imaging CXR-> contrast CT showing pleural effusion and pleural thickening
GS: pleural biopsy
Bloody/straw pleural fluid
236
How is mesothelioma treated?
Death in 8 months usually- palliative
237
What are 5 sites that lung cancers commonly metastasise to?
Bone
Liver
Adrenals
Brain
Lymph nodes
238
Are primary or secondary lung cancers more common?
Secondary
239
Why are secondary lung cancers more common?
Lungs oxygenate all blood so higher risk of metastasis
240
Define bronchial carcinoma
Cancer originating in the lung parenchyma
241
What are the 2 types of bronchial carcinoma?
Small cell lung carcinoma (SCLC)
Non-small cell carcinoma
242
Who is affected by SCLC?
ONLY affects smokers
243
Define SCLC
Affects bronchi and appears as small cells with minimal cytoplasm
244
What are the symptoms of SCLC?
Cough with haemoptysis
Constitutional cancer symptoms
Compression symptoms
PARANEOPLASTIC SYNDROMES
245
How is lung cancer diagnosed?
1: imaging (CXR -> contrast CT)
GS: bronchoscopy an biopsy
246
What are the risk factors of lung cancer?
Smoking
Asbestos
Coal
Lung disease
HIV
247
How is SCLC treated?
Palliative usually- very aggressive and fast spreading
248
What are paraneoplastic syndromes associated with?
Small cell lung cancer
249
What are 3 paraneoplastic syndromes?
Ectopic ACTH- Cushings
Ectopic ADH- SIADH
Lambert Eaton syndrome
250
What is the MC lung cancer?
Adenocarcinoma
251
Define squamous cell carcinoma
Bronchial carcinoma arising from lung epithelium that resembles squamous epithelium
252
Who does squamous cell carcinoma commonly affect?
Smokers
253
Where does squamous cell carcinoma commonly affect and what are its features?
Central lung
Lesions with central necrosis
254
What paraneoplastic syndrome is associated with squamous cell carcinoma?
PTHrP-> hypercalcaemia
(PTH related peptide)
255
What is the prognosis of squamous cell carcinoma?
Metastasises late and spreads locally so ok prognosis
256
How is squamous cell carcinoma treated?
Surgical excision
Metastasis = chemo+ radio
257
What lung cancer is most commonly associated with non-smokers?
Adenocarcinoma
258
Where does lung adenocarcinoma arise from?
Mucus secreting glandular epithelium
259
What is the main risk factor of lung adenocarcinoma?
Asbestos exposure
260
What is lung adenomas closely related to?
Hypertrophic pulmonary osteoarthropathy
261
What is the triad of hypertrophic pulmonary osteoartropathy?
Clubbing
Arthritis
Long bone swelling
262
Does lung adenocarcinoma metastasise often?
Yes
263
How is lung adenocarcinoma treated?
Surgical excision
Metastasis likely so chemo, radiotherapy
264
What are 4 sites that most commonly metastasise to the lungs?
Breast
Bowel
Kidney (MC)
Bladder
265
What are the common symptoms of lung cancer?
Cough
Breathlessness
haemoptysis
Chest pain
Clubbing
266
How is lung cancer generally diagnosed?
Contrast CT
Bronchoscopy and Biopsy
267
What are 3 signs of lung cancer metastasis?
Pancost tumour -> horners syndrome
Pembertons sign
Hoarse voice
268
What is Pemberton’s sign?
Raising arms causes facial flushing
269
What causes pembertons sign?
SVC obstruction due to compression
270
What does a hoarse voice indicate in lung cancer?
Compression of recurrent laryngeal nerve
271
Define Pancoast tumour
Tumour in lung apex metastases to neck sympathetic plexus
272
What does a pancoast tumour cause?
Horners syndrome
273
What are the 3 signs of Horners syndrome?
IPSILATERAL
Ptosis (droopy eyelid)
Myosis (pupil constricted)
Anhydrosis (lack of sweat)
274
Define hypersensitivity pneumonitis
Type 3 hypersensitivity reaction causing alveolar and bronchial inflammation after exposure to an inhaled antigen
275
What are the risk factors of hypersensitivity pneumonitis?
Farmers lung- mouldy hay
Bird fanciers lung- keeping birds
Cheese workers- mouldy cheese
Malt workers- mouldy malt
Humidifier fever - contaminated air conditioning
276
What are the symptoms of hypersensitivity pneumonitis?
Dysponea
Dry cough
Fever
T1 RF
277
How is hypersensitivity pneumonitis diagnosed?
CXR: patchy nodular infiltrates
History mainly
278
How is hypersensitivity pneumonitis treated?
Remove allergen
Corticosteroids
279
Define Goodpastures disease
T2 hypersensitivity reaction causing pulmonary and renal pathology
280
What are the risk factors of Goodpastures?
HLA DR15
Cigarettes
Asbestosis
281
Outline the pathophysiology of Goodpastures
Anti-GBM antibodies attack BM of alveoli and glomeruli -> alveolar haemmorage + glomerulonephrisis
282
What are the symptoms of Goodpastures?
Haemoptysis + haematuria
Cp, cough, HTN, oedema
283
How is Goodpastures diagnosed?
ANTI-GBM ANTIBODIES positive
Lung + kidney biopsy
Ig deposition
284
How is Goodpastures treated?
Corticosteroids + plasma exchange
285
Define pharyngitis
Inflammation of the pharynx
286
What causes pharyngitis?
Viral (MC) - EBV
Bacteria - S. pyrogenes
287
What are the symptoms of pharyngitis?
Sore throat and fever
Viral = cough and congestion
Bacterial = exudate
288
Define sinusitis
Inflammed mucosa of the nasal cavity and nasal sinuses
289
What causes sinusitis?
Mostly viral
Bacterial - MC s.pneumonia
290
What are the symptoms of sinusitis?
Frontal headache
Nasal cavity filled with loads of mucus
Facial pain and tenderness
291
Define otitis media
Inflammed middle ear
292
How is otitis media diagnosed?
Otoscopy shows Inflammed TM
293
Define epiglottis
Inflammation of the epiglottis, causing airway obstruction
294
What are the symptoms of epiglottis?
Tripoding- leant fowards with mouth open and tongue out
295
How is epiglottis diagnosed?
Laryngoscopy
Lateral radiograph: THUMB PRINT SIGN
296
What causes whooping cough?
Bordatella pertussis
297
Define croup/ acute laryngobrochitis
Occasional complication of upper respiratory tract infection (esp. parainfluenza)
298
What are the symptoms of croup?
Hoarse voice
Barking cough
Strider
299
How is croup treated?
Single dose dexamethasone
300
what is the blood marker for sarcoidosis?
increased ACE and calcium
301
what is the first line treatment for asthma?
SABA eg salbutamol
302
what is the second line treatment for asthma?
SABA + ICS
sabutamol + prednisolone
303
what is the 3rd line treatment for asthma?
SABA + ICS + LTRA if <5
SABA + ICS + LABA if 5 or older
304
what is the 4th line treatment for asthma?
SABA + ICS + LABA +/- LTRA
salbutamol + prednisolone + salmeterol + montelukast
305
what hypersensitivity reaction is TB?
type 4
306
define granuloma
aggregate of epitheliod histocytes
307
Describe diurnal variation in asthma
Peak expiratory flow rate (PEFR) and shortness of breath is worse at night and early morning
