Respiratory Flashcards

1
Q

Vital capacity

A

Maximum volume of air that can be expired after maximal inspiration

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2
Q

Pneumothorax algorithm

A

Even

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3
Q

Indications for corticosteroids treatment for sarcoidosis

A

Parenchymal lung disease
Uveitis
Hypercalceamia
Neurological or cardiac involvement

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4
Q

HAPE treatment

A

Nipedefine
Acetozolamide
Phosphordiestarase 4 inhibitors

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5
Q

ABPA

A

Non responsive asthma
Blood test - eosinophilia
CXR - proximal bronchiactasis
Treatment - oral/ weaning course of prednisolone

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6
Q

Cavitating lung elisions

A

Staph aureus,klebsiella,pseudomonas,squamous cell cancer,tb,wegeners,or,ra,aspergillosis,histoplasmosis,coccidiomycosis

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7
Q

EGPA Cannot give drug

A

Monte lucas

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8
Q

Severe obesity in transfer factor

A

FEV1 reduces
FVC Reduces
FEV1/FVC normal
KCO normal

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9
Q
A
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10
Q

COPD Staging

A

Mild stage 1 ~ 80
Stage 2 ~50-80
Stage 3~ 30-50
Stage 4 ~ 30

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11
Q

Asothioprin
1. low TPMT
2. intract
3. pregnancy

A
  1. Low TPMT(inhibit purin synthesis) - pansytophenia
  2. Alo
  3. safe
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12
Q

ARDS

A
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13
Q
A

The symptoms described are consistent with chronic aspiration occurring in the elderly. The CT findings are radiological bronchiectasis, a sequela of recurrent episodes of aspiration pneumonia. This does not, however, equate to a clinical diagnosis of bronchiectasis. The absence of honeycombing and ground-glass opacities counts against the diagnosis of radiation pneumonitis and idiopathic pulmonary fibrosis.

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14
Q

Chronic Pulmonary Aspergillosis (CPA)

A

Causes and Risk Factors:
Underlying Lung Conditions:
CPA is more common in individuals with pre-existing lung problems, such as: Tuberculosis, COPD, Sarcoidosis , Bronchiectasis Cystic fibrosis, previous lung disease or surgery

Symptoms:
Chronic Cough: A persistent cough, may hemoptysis
Shortness of Breath: Difficulty breathing, especially with exertion -significant symptom.
Weight Loss, Fatigue, Wheezing, chest pain, and fever

Diagnosis - CT - cavities, fungal balls (aspergillomas), and nodules., sputum, bronchoalveolar lavage
Treatment - oral agents like itraconazole or voriconazole, Aspergillus-specific IgG antibody test

primarily caused by Aspergillus fumigatus, that affects the lungs and often occurs in individuals with pre-existing lung conditions. The pathophysiology involves fungal growth and inflammation within the lungs, leading to lung damage and potentially forming cavities or a fungal ball

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15
Q

aspergilloma

A

a fungus ball formed by the fungus Aspergillus within a pre-existing lung cavity. It’s a non-invasive form of chronic pulmonary aspergillosis. Aspergillomas often develop in areas of the lung previously damaged by conditions like tuberculosis.

spergillomas may be asymptomatic, others can cause symptoms like hemoptysis (coughing up blood), wheezing, shortness of breath, and fatigue.

Diagnosis:
Chest X-rays or CT scans can reveal the characteristic appearance of an aspergilloma, often described as a mobile mass within a cavity.

aspergilloma is a manifestation of CPA, specifically a fungal ball within a lung cavity. CPA is a broader term encompassing various forms of Aspergillus infection, some of which can lead to aspergilloma formation.

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16
Q

invasive aspergillosis

A

a serious, potentially life-threatening fungal infection that typically affects individuals with weakened immune systems

Invasive aspergillosis is a serious, potentially life-threatening infection that occurs in immunocompromised individuals, while aspergilloma is a fungal ball that typically develops in pre-existing lung cavities and is usually less severe.

fever, cough, chest pain, and hemoptysis (coughing up blood).

It involves the fungus invading tissues and blood vessels, causing inflammation, tissue damage, and the spread of infection to other organs.
Immunocompromised individuals, including those undergoing cancer treatment, bone marrow transplantation, or with certain immune system diseases, are at high risk.

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17
Q

Type I hypersensitivity to Aspergillus fumigatus

A

an immediate, IgE-mediated allergic reaction to the fungus. It’s a key component of Allergic Bronchopulmonary Aspergillosis (ABPA), a condition primarily affecting individuals with asthma or cystic fibrosis, and is typically diagnosed through skin testing or elevated IgE levels.

IgE-mediated reaction:
Type I hypersensitivity involves IgE antibodies binding to allergens like A. fumigatus antigens

leading to symptoms like asthma exacerbations, mucus production, and even bronchiectasis. symptoms similar to asthma, including wheezing, cough, shortness of breath, and potentially coughing up blood or brown flecks.

Diagnosis:
Aspergillus skin tests (AST) and measuring A. fumigatus-specific IgE levels in the blood are commonly used to diagnose ABPA and confirm the presence of type I hypersensitivity to A. fumigatus.

18
Q

Allergic Bronchopulmonary Aspergillosis (ABPA)

A

Type I Hypersensitivity:
The most common type of hypersensitivity in ABPA is the IgE-mediated reaction (Type I). When individuals are exposed to A. fumigatus spores, their immune systems produce IgE antibodies that bind to specific antigens on the fungal spores.

Type III Hypersensitivity:
Type III reactions involve the formation of IgG-mediated immune complexes. These complexes can deposit in the airways and cause inflammation and tissue damage.

Type IV Hypersensitivity:
Type IV reactions are mediated by T cells and can contribute to chronic inflammation and tissue damage in ABPA.

Hypersensitivity Pneumonitis:
Inhalation of A. fumigatus can also trigger hypersensitivity pneumonitis, a type IV reaction characterized by inflammation of the lung tissue.

Severe Asthma with Fungal Sensitization (SAFS):
Fungal sensitization, including A. fumigatus, has been linked to exacerbations of allergic asthma.

19
Q

Q fever

A

a disease caused by the bacteria Coxiella burnetii

Acute Q fever often presents with flu-like symptoms like fever, headache, and fatigue, and may include atypical pneumonia or hepatitis. Chronic Q fever, if it develops, is more likely to manifest as endocarditis or other long-term complications.

linical Manifestations:
Acute Q Fever:
Flu-like illness: High fever, headache, fatigue, myalgias (muscle aches) are common.
Atypical pneumonia: May be mild or more severe, with symptoms like cough, chest pain, and shortness of breath.
Hepatitis: Liver inflammation can lead to elevated liver enzymes and, in some cases, jaundice.
Other manifestations: Less common complications include rash, gastrointestinal symptoms, and neurological involvement.
Chronic Q Fever:
Endocarditis: The most common and severe complication, affecting the heart valves.
Other complications: May include myocarditis, pericarditis, and less frequently, other systemic complications like encephalitis or meningitis.
Diagnosis:
Serological Testing:
Blood tests to detect antibodies against C. burnetii are the primary method for diagnosis.
Other tests:
Culture or PCR testing can be used to isolate the bacteria, especially in severe cases or when serological testing is inconclusive.
Treatment:
Acute Q Fever: Doxycycline is the primary antibiotic used for acute Q fever.
Chronic Q Fever: Doxycycline, often in combination with hydroxychloroquine, is used for long-term treatment of chronic Q fever.

20
Q

Cystic fibrosis (CF)

A

affecting the lungs and digestive system due to a defect in the CFTR protein, which regulates chloride and water movement across cell membranes. This defect leads to thick, sticky mucus buildup, obstructing airways and digestive tracts. The most commonly affected organs include the sinuses, lungs, pancreas, biliary and hepatic systems, intestines, and sweat glands.
espiratory issues (wheezing, cough, thick mucus), digestive problems (foul-smelling stools, poor weight gain), and other indicators like malabsorption, rectal prolapse, or pancreatitis.

mutations in the CFTR gene

Consequences of Mucus Buildup:
Respiratory: Chronic infections (like Pseudomonas aeruginosa), chronic lung disease, and respiratory failure.
Digestive: Malnutrition, poor growth, and digestive problems.
Other: Skin rashes, sweat-related problems, and potential fertility issues in males.

Diagnosis - A sweat chloride level of 60 mmol/L or greater is strongly indicative of CF. A chloride level of 60 mmol/L or greater strongly suggests CF.
Levels between 30-59 mmol/L require further investigation.

21
Q

Bronchiectasis

A

characterized by permanent, abnormal dilation of the bronchi due to inflammation and infection, leading to impaired mucus clearance and recurrent infections. Below is a comprehensive overview of bronchiectasis, including its assessment tools, severity scoring systems, and clinical implications

Pathophysiology: Damage to the bronchial walls causes mucus accumulation, bacterial colonization, and recurrent infections, creating a vicious cycle of inflammation and structural damage

Symptoms: Chronic cough, excessive sputum production, dyspnea, hemoptysis, and recurrent respiratory infections

Etiologies: Post-infectious (most common), cystic fibrosis (CF), immune deficiencies, autoimmune diseases, and idiopathic causes

Diagnostic Tools
Imaging
High-Resolution CT (HRCT): Gold standard for diagnosis, showing bronchial dilation, wall thickening, and mucus plugging

BRICS Score: A radiological scoring system for idiopathic/post-infectious bronchiectasis, assessing bronchial dilatation and emphysema extent.

Microbiological Tests
Sputum cultures to identify pathogens (e.g., Pseudomonas aeruginosa), which worsen prognosis

Pulmonary Function Tests (PFTs)
Reduced FEV1 (forced expiratory volume in 1 second) correlates with disease severity

  1. Severity Assessment Scores
    FACED Score
    Components:
    FEV1 (<50% = 2 points),
    Age (≥70 years = 2 points),
    Chronic colonization (Pseudomonas = 1 point),
    Extension (>2 lobes = 1 point),
    Dyspnea (mMRC 3–4 = 1 point) 1.

Interpretation:
0–2: Mild (5-year mortality <5%).
3–4: Moderate (5-year mortality ~10%).
5–7: Severe (5-year mortality ~30%) 15.

Bronchiectasis Severity Index (BSI)
Components: Age, BMI, FEV1%, exacerbations, hospitalizations, dyspnea, microbial colonization, and radiological involvement

Interpretation:
0–4: Mild (1-year mortality <3%).
5–8: Moderate (1-year mortality ~5%).
≥9: Severe (1-year mortality ~10%) 810.
Comparison of FACED vs. BSI
FACED: Better for predicting mortality (AUC 0.87 vs. 0.75 for BSI) 5.

BSI: More comprehensive, incorporating exacerbations and hospitalizations, and better for predicting hospitalization risk

  1. Clinical Management
    Antibiotics: Chronic macrolides (e.g., azithromycin) for Pseudomonas colonization or frequent exacerbations
    Airway Clearance: Physiotherapy (e.g., postural drainage, percussion devices)
    Surgery/Lung Transplant: For localized severe disease or respiratory failure
  2. Prognosis
    Severe bronchiectasis (FACED ≥5 or BSI ≥9) has high mortality (up to 30% at 5 years) and hospitalization rates (>50%) 18.
22
Q

COPD

A

Spirometry: Diagnosis requires a post-bronchodilator FEV1/FVC ratio <0.7 to confirm airflow obstruction. Pre-bronchodilator spirometry may suffice if no obstruction is detected, unless clinical suspicion is high
Clinical Suspicion: Suspect COPD in patients >35 years with risk factors (e.g., smoking, biomass exposure) and symptoms like dyspnea, chronic cough, or sputum production
Exclusions: Differentiate from asthma, bronchiectasis, and heart failure using history, imaging, and additional tests (e.g., CT for structural abnormalities)

Pharmacological Management
First-line: Start with short-acting bronchodilators (SABA or SAMA) for symptom relief.

Maintenance Therapy:
Dual bronchodilators (LABA + LAMA) are preferred over monotherapy for symptomatic patients, regardless of FEV1.
Inhaled corticosteroids (ICS) are added only for patients with asthmatic features (e.g., eosinophilia, prior asthma diagnosis) or frequent exacerbations despite dual therapy.
Avoid ICS in non-asthmatic COPD due to pneumonia risk.
Newer Agents: Consider ensifentrine (PDE3/4 inhibitor) or dupilumab (for eosinophilic COPD) in refractory cases

  1. Non-Pharmacological Interventions
    Smoking cessation: Mandatory, with behavioral support and pharmacotherapy (e.g., varenicline).
    Pulmonary rehabilitation: Recommended for symptomatic patients (FEV1 <50%) to improve exercise tolerance and quality of life.
    Vaccinations: Annual influenza and pneumococcal vaccines to prevent exacerbations.
    Oxygen therapy: For severe hypoxemia (PaO2 ≤55 mmHg or SpO2 ≤88%).
  2. Exacerbation Management
    Acute exacerbations: Use oral corticosteroids (e.g., prednisolone) and antibiotics if purulent sputum is present
    Prevention: Prophylactic azithromycin (unlicensed) may reduce exacerbations in non-smokers with frequent events, but requires monitoring 9.

Triple therapy (LABA/LAMA/ICS): Reserved for patients with persistent symptoms/exacerbations despite dual therapy and after optimizing non-drug measures.

Pulmonary hypertension: New emphasis on echocardiography for assessment and referral to specialist centers

23
Q

psittacosis

A

primarily spread from birds to humans

flu, including fever, headache, muscle aches, and cough. However, in some cases, psittacosis can develop into pneumonia, with symptoms such as shortness of breath and chest pain.
can lead to complications like myocarditis, endocarditis, or even encephalitis

diagnosis - next-generation sequencing (mNGS) are used to identify the bacteria in samples like blood or bronchoalveolar lavage fluid.

24
Q

Non-small cell lung cancer (NSCLC)

A

develops in the epithelial cells of the lung, ranging from the central bronchi to the terminal alveoli.

Squamous cell carcinoma: Typically starts near a central bronchus. - 25–30%): Central airways; strongly associated with smoking
Adenocarcinoma: Usually originates in the peripheral lung tissue, often in the mucus-producing cells lining the bronchioles. - (40% of NSCLC): Often found in peripheral lung tissue; linked to both smokers and non-smokers.
Large cell carcinoma: Can occur in various locations within the lung. - (10–15%): Aggressive, can occur anywhere in the lungs

Tobacco smoking is the primary risk factor, with a 90% association - obacco smoke causes DNA damage and mutations
Epigenetic alterations, like DNA methylation, can silence DNA repair genes
Oncogene Activation and Tumor Suppressor Gene Inactivation

Other risks:
Secondhand smoke, radon, asbestos, air pollution.
Genetic mutations (e.g., EGFR, ALK, KRAS) in non-smokers
Family history, HIV infection, and prior radiation therapy

NSCLC progression involves several steps, including hyperplasia, metaplasia, dysplasia, and carcinoma in situ, before becoming invasive cancer.
Persistent cough, hemoptysis, chest pain, dyspnea, weight loss, fatigue, and recurrent infections 36.
Advanced stages may present with hoarseness (vocal nerve involvement) or neurological symptoms (brain metastases)

Treatment by Stage
Stage I–II: Surgery (lobectomy or wedge resection) ± adjuvant therapy (chemotherapy/targeted drugs for high-risk cases).
Stage III: Multimodal approach—chemoradiation ± immunotherapy (e.g., durvalumab) or surgery if resectable.
Stage IV:
Targeted therapy: For driver mutations (e.g., osimertinib for EGFR, alectinib for ALK)
Immunotherapy: PD-1/PD-L1 inhibitors (pembrolizumab, nivolumab) for tumors with high PD-L1 expression
Chemotherapy: Used if no actionable mutations or immunotherapy fails.

25
Radiation pneumonitis
an inflammation of the lungs that can occur after radiation therapy to the chest area. It's an acute side effect that typically appears within a few months of treatment, although it can sometimes develop later. The main symptoms are shortness of breath and a dry cough. Treatment - corticosteroids to reduce inflammation Inflammatory Markers: CRP, ESR): high Procalcitonin:normal Serum ferritin and D-dimer: elevated Pulmonary Function Tests: Reduced lung volumes, compliance, and diffusing Biochemical and Genetic Markers: KL-6 and SP-A and -D: involved in the integrity of the blood-air barrier and may be elevated due to type II pneumocyte damage. Surfactant proteins: Proinflammatory cytokines (TGFβ, TNFα, interleukins): elevated Imaging: Chest CT: preferred imaging technique for detecting radiation pneumonitis, with ground-glass opacities and patchy consolidations being characteristic findings. Chest X-ray: In early ground-glass opacities may not be visible on X-ray, but CT can detect them. Imaging features: Thickened pulmonary interstitium and crazy paving patterns are common in severe radiation pneumonitis and COVID-19. Late-stage fibrosis: Linear scarring and volume loss are typical findings in later stages of radiation pneumonitis.
26
Common Types of Adenocarcinoma:
Lung Adenocarcinoma – The most common type of non-small cell lung cancer (NSCLC), often found in non-smokers. Prostate Adenocarcinoma – The most common form of prostate cancer. Colorectal Adenocarcinoma – Affects the colon or rectum and is a leading cause of cancer-related deaths. Pancreatic Adenocarcinoma – Aggressive and often diagnosed at a late stage. Breast Invasive Ductal Carcinoma (IDC, a type of adenocarcinoma) – The most common breast cancer type. Gastric (Stomach) Adenocarcinoma – Linked to H. pylori infection and dietary factors. Esophageal Adenocarcinoma – Often associated with Barrett’s esophagus and chronic acid reflux. Causes & Risk Factors: Genetic mutations (e.g., KRAS, EGFR, TP53 mutations) Chronic inflammation (e.g., GERD, H. pylori infection) Environmental factors (e.g., smoking, asbestos exposure) Hormonal influences (e.g., estrogen in breast cancer) Obesity and diet (linked to colorectal and pancreatic cancers) Family history of cancer Symptoms (Vary by Location): Lung: Persistent cough, shortness of breath, chest pain Colorectal: Blood in stool, changes in bowel habits Pancreatic: Jaundice, abdominal pain, weight loss Prostate: Urinary difficulties, pelvic pain Breast: Lump, nipple discharge, skin changes Diagnosis: Imaging: CT, MRI, PET scans Biopsy: Microscopic examination of tissue Blood Tests: Tumor markers (e.g., PSA for prostate, CA-19-9 for pancreatic) Endoscopy: For gastrointestinal cancers Treatment Options: Surgery (tumor removal) Chemotherapy (drugs to kill cancer cells) Radiation Therapy (targeted radiation) Immunotherapy (boosts immune response) Targeted Therapy (drugs targeting specific mutations, e.g., EGFR inhibitors) Hormone Therapy (for breast/prostate cancer)
27
Pulmonary TB
Symptoms include: Persistent cough (often with phlegm or blood) Fever, night sweats, and weight loss Fatigue and chest pain Diagnosis Molecular tests (e.g., Xpert MTB/RIF Ultra) for rapid detection, especially in extrapulmonary TB Culture-based methods: Time-to-detection (TTD) in liquid cultures correlates with transmission risk. Shorter TTD (≤9 days) indicates higher bacillary load and infectivity Sputum smear microscopy and chest X-rays for active case-finding in high-risk groups (e.g., homeless populations, migrants) Treatment Standard therapy: A 6-month course of antibiotics (e.g., rifampicin, isoniazid). Drug-resistant TB may require up to 2 years of treatment Directly observed therapy (DOT): Recommended for adherence challenges, with thrice-weekly dosing under supervision Latent TB: Treat all patients under 65 years (previously 35) to prevent reactivation
28
Asthma pathophysiology
involves airway inflammation, leading to airflow obstruction and hyperresponsiveness. This inflammation is characterized by the infiltration and activation of immune cells, including eosinophils, T-helper cells, and mast cells. The resulting bronchospasm, mucus hypersecretion, and airway remodeling contribute to the characteristic symptoms of asthma Airflow Obstruction: The narrowing of the airways, known as airflow obstruction, factors: Bronchospasm: Airway Edema: Mucus Plugging: Airway Remodeling: Airway Hyperresponsiveness: Cellular and Molecular Mechanisms: IgE Antibodies: Th2 Immune Response: The T-helper 2 (Th2) subset of lymphocytes plays a crucial role in the development of asthma, contributing to the production of IgE antibodies and the release of inflammatory cytokines. Inflammatory Mediators: leukotrienes, histamine, and prostaglandins, contribute to bronchospasm, increased mucus production
29
Mantoux test
A positive Mantoux test (a raised, hard area of a certain size or larger) means the person has been exposed to TB bacteria and has developed an immune response. The Mantoux test primarily indicates exposure to TB, used to determine if someone is eligible for the BCG vaccine, which is a vaccine against TB BCG vaccine is generally recommended for newborns, children up to 15, and adults up to 35 who are at increased risk of TB exposure, such as healthcare workers
30
Familial primary pulmonary hypertension (PPH)
a genetic form of pulmonary arterial hypertension (PAH) that can be inherited in an autosomal dominant pattern with reduced penetrance (BMPR2 gene mutation) clinical and pathological features with the sporadic form of PPH, including high blood pressure in the pulmonary arteries, right ventricular failure, and potentially death.
31
Multi drug resistant tb treatment
MDR-TB is caused by Mycobacterium tuberculosis resistant to isoniazid and rifampicin, the two most effective first-line TB drugs. Rifampicin-resistant TB (RR-TB) is also grouped with MDR-TB in treatment protocols Diagnostic Testing for MDR-TB Molecular tests: Xpert MTB/RIF Ultra: Rapid detection of TB and rifampicin resistance (results in 2 hours) Line Probe Assays (LPAs): Detect resistance to isoniazid, rifampicin, fluoroquinolones, and injectable drugs (e.g., GenoType MTBDRplus/MTBDRsl) Phenotypic DST: Liquid culture (e.g., MGIT) confirms resistance but takes weeks Preferred Short-Course Regimens (6–9 Months) BPaLM/BPaL (6 months, all-oral) BPaLM: Bedaquiline (B), pretomanid (P), linezolid (L), moxifloxacin (M) – for RR/MDR-TB without fluoroquinolone resistance BPaL: Omits moxifloxacin for fluoroquinolone-resistant cases Success rate: ~89% in trials, fewer side effects than older regimens 9-Month All-Oral Regimen For RR/MDR-TB without fluoroquinolone resistance: Intensive phase (4–6 months): Bedaquiline, levofloxacin/moxifloxacin, clofazimine, ethambutol, pyrazinamide, high-dose isoniazid. Continuation phase (5 months): Levofloxacin/moxifloxacin, clofazimine, ethambutol, pyrazinamide Individualized Regimens (18–24 Months) For complex resistance (e.g., XDR-TB) or intolerance to short-course drugs. Combines Group A drugs (bedaquiline, linezolid) with Group B/C drugs (clofazimine, cycloserine) based on DST 4. Key Treatment Principles All-oral regimens: Injectable agents (e.g., amikacin) are no longer first-line due to toxicity 69. Directly Observed Therapy (DOT): Mandatory to ensure adherence Monitoring: Monthly sputum tests, ECG (for bedaquiline-induced QT prolongation), and liver/kidney function tests 68. Early discharge: Possible if non-infectious and adherent, with outpatient monitoring 1.
32
obstructive sleep apnea (OSA)
1. Definition and Epidemiology OSA is characterized by repeated episodes of upper airway collapse during sleep, leading to apnoea (complete breathing pause) or hypopnoea (reduced airflow) Prevalence: Affects ~4% of middle-aged men and 2% of women in Western countries, with rising incidence linked to obesity 2. Symptoms and Risk Factors Symptoms Nocturnal: Loud snoring, witnessed apnoeas, choking/gasping, nocturia, unrefreshing sleep Daytime: Excessive sleepiness, fatigue, cognitive impairment, morning headaches Risk Factors Obesity (strongest predictor), male gender, age >50, large neck circumference (>16–17 inches) Comorbidities: Hypertension, type 2 diabetes, atrial fibrillation, stroke, and heart failure 3. Diagnosis Initial Assessment: Suspect OSA if ≥2 symptoms (e.g., snoring + witnessed apnoeas). Use: Epworth Sleepiness Scale (ESS) and STOP-Bang Questionnaire (but ESS alone is insufficient for referral). Diagnostic Tests: Home respiratory polygraphy (first-line). Polysomnography (PSG) if polygraphy is inconclusive. Severity Grading: Mild: Apnoea-Hypopnoea Index (AHI) 5–14/hour. Moderate: AHI 15–29/hour. Severe: AHI ≥30/hour . 4. Treatment Options Lifestyle Modifications Weight loss, smoking cessation, alcohol reduction, and sleep hygiene (e.g., avoiding supine sleep). Continuous Positive Airway Pressure (CPAP) First-line for moderate/severe OSA: Fixed-level CPAP with telemonitoring for 12 months. Auto-CPAP: Alternative for intolerance or variable pressure needs Side Effects: Nasal dryness (managed with heated humidification) Alternative Therapies Mandibular Advancement Splints (MAS): For mild OSA or CPAP-intolerant patients with good dental health Positional Modifiers: For positional OSA (e.g., devices to prevent supine sleep) Surgery: Tonsillectomy (for large tonsils) or upper airway stimulation (e.g., Inspire therapy) for refractory cases
33
Silicosis
Symptoms: Early stages: May be asymptomatic or mild, with a cough, sputum, and progressive shortness of breath. Later stages: Persistent cough, shortness of breath, fatigue, weakness, and chest pain. Advanced stages: Difficulty breathing even at rest, leading to possible house or bed confinement. Chest X-ray or CT scan: lung scarring and nodules. Complications: Tuberculosis, Lung cancer Progressive massive fibrosis, Chronic obstructive pulmonary disease (COPD) types Chronic Silicosis (Most Common) Develops after 10+ years of moderate exposure. Symptoms: Gradual shortness of breath, cough, fatigue. Accelerated Silicosis Develops within 5–10 years of high exposure. Faster progression than chronic silicosis. Acute Silicosis (Rare but Severe) Develops weeks to months after extreme silica exposure. Symptoms: Severe cough, fever, rapid breathing, weight loss.
34
Cryptogenic organizing pneumonia (COP
a rare lung condition and is a type of interstitial lung disease lung tissue becomes inflamed and scarred, obstructing airflow and leading to respiratory difficulties. While the exact cause is often unknown, the condition is characterized by the formation of organized granulation tissue within the lungs, which can be effectively treated with corticosteroids in most cases. Key Features of COP: Cryptogenic (Unknown Cause) – The exact cause is unidentified, though it may follow infections, drug reactions, or connective tissue diseases. Organizing Pneumonia Pattern – Histopathology shows granulation tissue plugs (Masson bodies) in alveoli and bronchioles. Subacute Presentation – Symptoms develop over weeks to months. Symptoms: Persistent dry cough Shortness of breath (dyspnea) Fatigue Fever (low-grade) Weight loss Crackles on lung auscultation Diagnosis: Imaging (CT Chest) – Shows patchy consolidations (often migratory), ground-glass opacities, and a reversed halo sign (atoll sign) in some cases. Lung Biopsy (Surgical or Transbronchial) – Confirms organizing pneumonia. Bronchoalveolar Lavage (BAL) – May show lymphocytosis. Exclusion of Other Causes (e.g., infections, vasculitis, drug toxicity). Treatment: Corticosteroids (e.g., prednisone 0.5–1 mg/kg/day) – Rapid response is typical, but relapses may occur if tapered too quickly. Immunosuppressants (e.g., azathioprine, mycophenolate) – For steroid-refractory cases. Supportive Care (oxygen if hypoxemic).
35
Severe and Life-Threatening Asthma (Status Asthmaticus)
Key Features of Life-Threatening Asthma Severe Airflow Obstruction – PEF < 33% predicted or FEV₁ < 25%. Hypoxemia – PaO₂ < 60 mmHg (or SpO₂ < 90% on room air). Hypercapnia – PaCO₂ > 45 mmHg (indicates impending respiratory failure). Silent Chest – Due to minimal air movement (ominous sign). Altered Mental Status – Confusion, drowsiness (suggests CO₂ retention). Hemodynamic Instability – Bradycardia, hypotension (pre-arrest sign). Immediate Management (ABC Approach) 1. Oxygen High-flow oxygen (15 L/min via non-rebreather mask) to maintain SpO₂ ≥ 92%. Caution in COPD overlap (target SpO₂ 88–92% to avoid CO₂ retention). 2. Bronchodilators Nebulized short-acting β₂-agonists (SABA) – Salbutamol (albuterol) 5–10 mg + ipratropium bromide 0.5 mg (back-to-back nebulizers). Continuous nebulization if severe (e.g., 10–15 mg/hr salbutamol). IV β₂-agonists (e.g., salbutamol IV) if poor response. 3. Corticosteroids Oral/IV methylprednisolone (40–125 mg) or hydrocortisone (100 mg IV 6-hourly). Prednisolone 40–50 mg PO if mild-moderate. 4. Magnesium Sulfate 1.2–2 g IV over 20 min (reduces bronchospasm). 5. Second-Line Therapies (if no improvement) IV aminophylline (loading dose 5 mg/kg, then infusion). Heliox (helium-oxygen mix) to reduce turbulent airflow. Ketamine (bronchodilator properties, used in intubated patients). 6. Ventilatory Support Non-invasive ventilation (BiPAP) – If hypercapnic but conscious. Intubation & Mechanical Ventilation – Indications: Respiratory arrest Coma or severe confusion Severe hypoxia/hypercapnia despite treatment Exhaustion or hemodynamic instability ⚠️ Caution: Permissive hypercapnia (allow PaCO₂ to rise to avoid barotrauma). Low tidal volume (6–8 mL/kg) to prevent dynamic hyperinflation. Risk Factors for Fatal Asthma Previous ICU admissions/intubations Poor adherence to inhalers Overuse of SABA (> 1 canister/month) Comorbidities (COPD, obesity, GERD) Psychosocial factors (depression, substance abuse) Prevention & Long-Term Management Optimize controller therapy: High-dose ICS + LABA (e.g., fluticasone/salmeterol). Biologics (if severe eosinophilic asthma): Omalizumab, mepolizumab, benralizumab. Trigger avoidance: Smoking cessation, allergen control. Asthma action plan: Early recognition of worsening symptoms.
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coal workers pneumoconiosis
an occupational lung disease caused by long-term exposure to coal dust. It's characterized by inflammation and scarring of lung tissue, making it difficult to breathe early, often asymptomatic stages (simple CWP) to more severe forms, including progressive massive fibrosis (PMF) Coal dust deposition in alveoli → engulfed by macrophages → inflammatory response. Fibrosis due to cytokine release (TNF-α, TGF-β). PMF develops when fibrosis progresses to form large masses. Clinical Features Symptoms Early stages: Often asymptomatic or mild chronic cough (black sputum possible). Advanced disease: Progressive dyspnea (worsens with exertion). Wheezing (if coexisting COPD). Hemoptysis (if PMF cavitates or infects). Cor pulmonale (peripheral edema, JVD) in late stages. Signs Coarse crackles (if fibrosis present). Clubbing (rare, suggests complicating lung cancer or TB). Cyanosis (if severe hypoxemia). Diagnosis 1. Imaging Chest X-ray (CXR) Simple CWP: Small, rounded opacities (upper lobes). PMF: Large, irregular masses (often bilateral, may cavitate). High-Resolution CT (HRCT) – More sensitive for early detection. 2. Pulmonary Function Tests (PFTs) Restrictive pattern (↓ TLC, ↓ FVC, normal/↑ FEV1/FVC ratio). Obstructive pattern (if coexisting COPD or emphysema). ↓ DLCO (if fibrosis or emphysema present). 3. Occupational History ≥10 years of coal mining exposure (but can occur earlier with heavy exposure). 4. Biopsy (Rarely Needed) Shows coal macules (dust-laden macrophages) and fibrotic nodules.
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Pleural tuberculosis (TB)
form of extrapulmonary TB where the infection affects the pleura, the membranes lining the lungs and chest cavity. It's the second most common extrapulmonary form of TB after lymph node TB. Causes and Mechanisms: Primary or Reactivation TB: Spread from Lung: Spread from Lymph Nodes: Hypersensitivity: Symptoms: Pleuritic chest pain Cough Fever and Night Sweats Weight Loss and Anorexia Dyspnea Diagnosis: Clinical Suspicion: A high index of suspicion is needed, especially in TB-endemic areas. Pleural Fluid Analysis: Exudate: Pleural fluid is typically an exudate, which is fluid with a high protein concentration. Lymphocyte-rich: The fluid usually contains a high number of lymphocytes (a type of white blood cell). ADA Levels: Adenosine deaminase (ADA) levels in pleural fluid are often elevated, according to a 2018 review. Mycobacterial Culture: Culture of pleural fluid or biopsy specimens is crucial to identify Mycobacterium tuberculosis. Biopsies: Pleural biopsies can help confirm the diagnosis and may be necessary in cases where pleural fluid cultures are negative. Imaging: Chest X-ray or CT scan can help identify pleural effusions and assess the extent of the disease.
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Moraxella catarrhalis
antibiotics, especially those that overcome the bacteria's resistance to beta-lactam antibiotics like penicillin. Common treatments include amoxicillin-clavulanate (Augmentin), trimethoprim-sulfamethoxazole (Bactrim), and extended-spectrum cephalosporins like cefixime. In some cases, macrolides like azithromycin or tetracyclines might be used, particularly in adults, alongside fluoroquinolones. Beta-lactamase Production: Most strains of M. catarrhalis produce beta-lactamase, an enzyme that inactivates penicillin-type antibiotics. This is why combinations like amoxicillin-clavulanate are often preferred. Antibiotic Resistance: It's crucial to ensure that the chosen antibiotic is effective against the specific strain of M. catarrhalis, as resistance can develop. Full Course: Patients should complete the full course of antibiotics, even if they start feeling better, to prevent the infection from returning or becoming resistant. Other Treatments: In some cases, a "watchful waiting" approach may be considered, especially for mild infections. Underlying Conditions: Infections in individuals with underlying health conditions or weakened immune systems may require more aggressive treatment and longer courses of antibiotics.
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interstitial pneumonitis
Common Symptoms: Shortness of breath Dry cough: A persistent, non-productive cough is a frequent symptom. Fatigue: Extreme tiredness and weakness are commonly reported. Chest discomfort: Pain or tightness in the chest may occur. Weight loss: Unexplained weight loss is sometimes associated with ILD. Clubbing: Abnormal enlargement and curving of the base of the fingernails can be a sign of ILD, especially with advanced disease.
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small cell lung cancer
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