Respiratory Flashcards
which conditions cause a predomnant apical distribution of fibrosis
S CHART P S: sarcoidosis, silicoiss C: coal worker's pneumonconiosis H: hypersensitivity penumonitis A: Aspergillosis, ankylosing spondylitis R: radiation T: Tuberculosis P: psoriasis
which conditions causes a predominant basal fibrosis
IDC AR , D: HAM
Idiopathic pulmonary fibrosis
Drugs:amioderon, hydralazine, methotrxate
Connective tissue disease
Asbestosis
Rheumatological disease (except ankylosing spondylitis and psoriasis)
causes of clubbing
Respiratory: 1. lung carcinoma( usually not small cell carcinoma) 2. chronic pulmonary suppuration(bronchiectaiss, lung abscess, empyema) 3. pulmonary fibrosis, asbestosi 4. cystic fibrosis 5. pleural fibroma or mesothelioma 6. mediastinal disease (lymphoma, carcinoma) Cardiovascular: 1. infective endocarditis 2. cyanotic congenital heart disease other: inflammatory bowel disease cirrhoissi coeliac disease thyrotoxicosis brachial arteriovenous aneurysm
causes of transudate pleural effusion (pleural:serum protein <0.6)
cardiac failure, nephrotic syndrome, liver failure, hypothyroidism
causes of exudate pleural effusion (pleural:serum protein >0.5, or pleural LDH>2/3 upper limit of normal or pleural :serum >0.6
pneumonia, neoplasm, TB, sarcoidosis, pulmonary infarction, subphrenic abscess, pancreatitis, connective tissue disease-RA, SLE, drugs,radiation
Durgs approved for the treatment of PAH
- endothelin receptor antagonist: bosentan,and ambrisentan
- the phosphodiesterase inhibitors, sldenafil and tadalafil
- the prostanoids, intravenous epoprostanol and inheled iloprost
What are the radiologic signs of ILD
Chest X ray IPF
volume loss, reticulation with a lower lobe and peripheral preference.
HRCT findings in Interstitial Fibrosis
• Honeycombing , multilayered thick-walled cysts.
• Architectural distortion with traction bronchiectasis due to fibrosis.
• Predominance in basal and subpleural region.
• Mild mediastinal lymphadenopathy
What are the radiologic signs of PAH
Pulmonary HT
Pulmonary arterial hypertension is defined as a mean pulmonary arterial pressure exceeding 25 mmHg at rest 11 or >30 mmHg with exercise and pulmonary capillary wedge pressure ≤15 mmHg measured by cardiac catheterisation
X ray
• enlarged pulmonary arteries
• pruning of peripheral pulmonary vessels
what are the radiologic sings of bronchiectasis
bronchus visualised within 1 cm of pleural surface
lack of tapering
increased bronchoarterial ratio (diameter of a bronchus >artery>1.5 indicate bronchiectasis)
ancillary findings:
bronchial wall thickening (normally wall of bronchus
treatment of interstitial lung disease
1 prednisolone, 1mg/kg/day, half this after 4-12 weeks
- immunosuppressive, azathioprine with low does steroids, may benefit
- antifibrotic agents are under trial: pirfenidone reduces lung decline
- colchicine 0.6mg inhibits macrophage production of fibroblast growth factor, efficacy is controversial
- N-acetylcystine in combination iwth immunosuppression reduces deterioration o flund funtion
- treat underlying GORD
what is the differential diagnosis of dullness and dull percussion note at a lung base?
pleural effusion pleural thickening collapse consolidation raised hemidiaphragm lower lobe lobectomy(in the presence of thoracotomy scar)
what are the cause of a haemorrhagic pleural effusion
malignancy
pulmonary embolus
Tuberculosis
chest trauma
if the pleural fluid LDH>1000IU/L, what would be that suggest
Empyema
malignant effusion
rheumatoid effusion
what are the causes of low glucose concentration in pleural fluid?
malignancy empyema Tuberculosis oesophageal rupture rheumatoid arthritis SLE (same as the PH
what are the causes of a chylothorax
lymphatic obstruciton
lymphatic damage
Nephrotic syndrome
cirrosis
what are the differenctial diagnosis of productive cough, coarse crackles and clubbing
bronchiectasis
carcinoma of the lung
lung abcess
pulmonary fibrosis
where the bronchial breath sound present? (brachial breath sound has prolonged expiratory phase and has a blowing quality)
nomral: over the trachea and right, left main bronchi
causes:
lobar pneumonia
localised fibrosis or collapse
above a pleural effsuion
large lung cavity
what are the causes of bronchiectasis?
respiratory childhood infections - pertussis - measles - tuberculosis bronchial obstrucitons -foreighn body - chronic aspiration - endobronchial tumour - lymph nodes - granulomata fibrosis - long standing pulmonary fibrosis fibrosis complicating TB and sarcoidosis - fibroiss complicating unresolved or suppurative pneumonia Muco-cilliary clearanc defects - cystic fibrosis -immotile cilia syndorme immunodeficiency - hypogammaglobulinaemia - acquired immunodeficiency syndrome allergic bronchopulmonary aspergillosis autoimmune disease - rheumatoid arthritis -sjogren syndrome -inflammatory bowel diseaes congenital anatomical defects idiopathic
what are the possible indications for a lobectomy
bronchiectasis malignancy solitary pulmonary nodule cystic fibrosis tuberculosis lung abscess
what are the possible indicaitons for pneumonectomy?
bronchiectasis
malignancy
tuberculosis
waht are the causes of a cavitating lung lesion?
infectious cuases: - staphlococcus aureus - klebsiella pneumonia - TB - aspergilloma - pseudomonas aeruginosa - Anaerobic infections Non-infectious causees: - Malignancy - Granulomatosis with polyangiitis - pulmonary rheumatoid nodule
what are the extrapulmonary manifestation of mycoplasma pneumonia?
Neuological - aseptic menigitis - encephalitis -transverse myelitis -Guillain- barre sydnrome - cranial and peripheral neuropathy cardiac - myocaiditis - pericarditis rheumatological - arthralgia -myalgia -myositis haematological -thrombocytopenia -cold autoimmune haemolytic anaemia - DIC gastrointestinal - diarrhoea - vomiting - hepatitis - pancreatitis dermatological - eyrthema nodosum - erythema mulfiform - steven-johnson syndrome endocrine - SIADH renal - glomerulonephritis -interstitial nephritis
what are the eCG features of PE
sinus tachycardia tall R in V1 right ventricular strain right bundle branch block T wave inversion in V1-V3 S1Q3T3 inferior ST elevation
what are possible cause of collapse?
malginancy(cachexia, clubbing, nicotine staining, lymphadenopathy
tuberculosis (apical signs,lymphadenopathy)
Hilar lymphadenopathy (sarcoidosis, erythema nodosum,
Mucus plugs ( features of asthma, COPD, or bronchiectasis)
Hyper inflated lung
Reduced chest expansion Distance reduced Hyper Resonance on percussion Intercostal recession Distant heart Barrel shape chest Chest x Ray: Flattered diaphragm Increased intercostal space More than 6 anterior ribs
