Respiratory Flashcards
Respiratory causes of clubbing
- Cancer: Bronchial, mesothelioma
- Cystic fibrosis and other Chronic supperative disease: lung abscess, bronchiectasis, empyema, TB
- Cryptogenic fibrosing alveolitis
Cardiac causes of clubbing
- Congenital cyanotic heart disease
- Infective endoCarditis
- Cancer: myxoma
GIT causes of clubbing
Cirrhosis
Crohns
Coeliac disease
Cancer: GI lymphoma
Other causes of clubbing
Congenital
T4
Local brachial AVM
Causes of cyanosis
Atmosphere: high altitude, nitrate contaminated water, cold
Respiratory: ventilation, diffusion, VQ mismatch
Cardiac: congenital, cardiac output, vascular
Red blood cells: hereditary, acquired, polycythaemia
Causes of obstructive airway disease
C.A.B.B.I.E
Small airways.
1.COPD
- Asthma
- Bronchiectasis
- Bronchiolitis
Large airways
5. Intrathoracic: fixed obstruction e.g. bronchial carcinoma, lymph-node, foreign body
- Extrathoracic: Inspiration Only E.G. Laryngeal Carcinoma, Epiglottiditis, Foreign Body and Throat, Goitre, Obstructive Sleep Apnoea
Causes of restrictive airway disease
Intraparenchymal
- Fibrosing alveolitis
- Pulmonary oedema
- Pulmonary hypertension
Extraparenchymal
- Neuromuscular: Guillain-Barre syndrome, MND, spinal cord injury
- Chest wall: ankylosing spondylitis
CXR – reticulonodular shadowing
F.I.N.E.shadows
Fibrosis:
a) upper zones: pneumoconioses, extrinsic alveolitis, TB, aspergillosis, seronegative arthropathies
b) middle zones: sarcoid
c) lower zones: SLE, cryptogenic fibrosing alveolitis, asbestosis, radiotherapy, drugs
Infection
a) atypical pneumonia
b) viral
Neoplasia
a) lymphangitis carcinomatosis
b) thyroid carcinoma
Edema
a) pulmonary oedema: Kerley B lines
b) long-standing pulmonary oedema/haemosiderosis
CXR - coin lesions and cavities
F.A.N.G.S
Fibrosis
Abscess: bacterial, Aspergillus, cyst
Neoplasia: primary or secondary
Granulomatous: rheumatoid arthritis, wegener’s
Structural: pulmonary infarction, traumatic haematoma
CXR – opacification
Consolidation: fluid, cells
Collapse: lobar, segmental atelectasis, pneumonectomy, thoracoplasty
Pleural disease: effusion, plaques
Mediastinal masses
Thyroid (retrosternal goitre).
Thyoma
Teratoma
TB or sarcoid lymph nodes
Terrible diagnoses e.g. lymphoma, aneurysm, dissection
Community-acquired pneumonia
Typical pathogens
- Lobar
a) Streptococcus pneumoniae (rapid onset, rusty sputum, rigors, plural, pericardial effusion, MR
b) gram-negative: haemophilus influenzae type b (rods) or Moraxella catarrhalis (cocci) - Cavities and empyema - patients are pretty SicK
a) Staphylococcus aureus (IVD users, cystic fibrosis, measles)
b) Klebsiella (short, plump, capsulated, gram-negative bacilli) - Alcoholics, diem, COPD, S.Africa. Bloody sputum
Community-acquired pneumonia atypical pathogens
Mycoplasma pneumoniae
Legionella pneumophila
Chlamydia pneumoniae
Coccinella burnetii
Hospital-acquired pneumonia
- Gram-positive (30%)
Staphylococcus aureus inc MRSA.
Streptococcus faecalis inc VRE.
Streptococcus pneumoniae
- Gram-negative (50%)
Pseudomonas aeruginosa
Acinetobacter.
Legionella.
Enterobacteria: Proteus, Enterobacter
- Anaerobes: Bacteroides
- Fungi
Causes of asthma
A.S.T.H.M.A
Atopy
Stress: exercise, emotion, viral URTI, cold, premenses, GO reflux
Toxins: smoking, allergens, drugs
Helminth
Malignancy: carcinoid
Autoimmune: Churg Strauss, Addison’s
Aspergillosis: allergic bronchopulmonary (ABPA)
Asthma management
T.A.M.E
Technique for inhaler
Avoidance: allergens etc
Monitor: peak flow
Educate: asthma nurse, plan
Asthma drugs
1.bronchospasm
A) beta-2 agonists
B) muscarinic antagonists
C) methylxanthines
- Inflammation
A) steroids
B) mast cell stabilisers
C) leukotriene receptor antagonists
Pathophysiology of chronic bronchitis
Smoke particles and repeated bacterial or viral infections–>
Squamous metaplasia, cillia inhibition, macrophage and lymphocyte infiltration–>
1) bronchospasm
2) mucus gland hyperplasia, goblet cell hyperplasia
3) inflammation: mucosal oedema, fibrosis, emphysema
4) hypersecretion–> bronchiole plugging –> obstruction + infection
Pathophysiology of emphysema
Cigarette tar/nicotine or alpha-1 antitrypsin deficiency –>
neutrophil chemotaxis recruitment and activation or decreased elastase–>
Alveolar wall proteolysis: a) centroacinar (smoke) or b) pancacinar (alpha1)
Sarcoidosis – PC
G.R.A.N.U.L.O.M.A.S
General: fever, weight loss, fatigue, lymphadenopathy (Lofgren syndrome = acute fever + arthralgia + cough+ erythema nodosum)
Respiratory: otitis, sinusitis, rhinitis, laryngitis, bihilar lymphadenopathy, parenchymal infiltration, fibrosis
Arthralgia
Neurological: bilateral seventh cranial nerve palsy, myopathy, seizures, dementia
Urine: polyuria, interstitial nephritis, renal stones
Liver: cholestatic LFTs
Ophthalmological: enlarged Lacrimal and salivary glands
Myocardial: pericardial effusion, restrictive cardiomyopathy secondary to myocardial granuloma’s and fibrosis leading to third-degree heart block or VT
Amenorrhoea etc. hypopituitarism
Skin: lupus pernio, Boeck’s sarcoid, scar infiltration, erythema nodosum
Causes a bronchiectasis
Chronic infection – inhalation e.g. bacteria, viral, aspergillosis, toxic gas
Bronchial obstruction – foreign body, lymph node, tumour, sarcoid
Host defences decreased – secretions e.g. cystic fibrosis, structural e.g. Marfan’s syndrome and Kartagener’s syndrome, immune e.g. HIV
Causes of lung abscess
Sputum tends to STI NK (due to anaerobes)
- Infection
Staphylococcus aureus TB Intestinal bacteria Nocardia Klebsiella
- Bronchial obstruction
- Host defences decreased
Causes a pneumothorax
STRIP
Spontaneous
Trauma
Ruptured oesophagus
Iatrogenic
Pulmonary disease
Causes of pleural effusion –transudate
C.H.E.S.T.
Cardiac failure
Hypoalbuminaemia – plasma oncotic pressure low e.g. cirrhosis nephrosis malnutrition malabsorption
Embolism, pulmonary
Superior venacaval obstruction
Subclavian or jugular vein catheter misplacement
Thyroid low: due to myxoedema
Causes of pleural effusion – exudate
I.N.S.U.L.A.T.I.O.N.
Infection e.g. strep pneumoniae, Mycoplasma, TB, viruses (EBV, Coxsackie), rheumatic fever
Neoplasia: bronchial carcinoma, pleural mesothelioma or fibroma, breast, ovarian, lymphoma
Surgery or trauma: CABG, mastectomy, radiotherapy
Uraemia
Liver, pancreatic, ovarian disease
Autoimmune: SLE, rheumatoid arthritis, scleroderma
Toxins: B.A.N.M.E – bromocriptine, amiodarone, nitrofurantoin, methysergide, environmental: asbestos
Infarction: pulmonary, myocardial (Dressler syndrome)
Suffered your rupture
Nail syndrome, yellow: due to lymphatic hyperplasia
Definition of adult respiratory distress syndrome
Common inflammatory response to various long insults resulting in:
T.O.X.I.C
Tachypnoea Oxygen decreased : progressive resp failure X-ray: bilateral pulmonary infiltrates Intersitial fluid increase Cardiac function is normal
Obstructive sleep apnoea – definition
O.S.A
Obstruction: obstruction of the upper airways occurs at night loss of muscle tone in sleep
Sleep: sleep disruption, snoring, sleepiness during day
Apnoea: apnoeic spells: decreased O2, patient wakes from sleep
Causes of OSA
OSA
Obesity, central
Structural features of upper airway e.g. nasal obstruction large tonsils macroglossia, jaw shape, cervical masses, laryngeal stenosis
Smoking
Sex: Male
Atony: neuromuscular, CNS, connective tissue laxity
Alcohol
Causes of pulmonary hypertension
1) pulmonary disease: cor pulmonale, recurrent PE, primary pulmonary hypertension
2) systemic: autoimmune e.g. SLE, infection e.g. HIV, drugs e.g. amphetamine
3) Mitral valve disease
4) left-to-right shunt (Eisenmenger syndrome)
Pathophysiology of asthma
Acute (30 mins):
Mast cell-antigen interaction –> histamine release
Bronchoconstriction, mucus plugs, mucosal swelling
Chronic (12h):
Th2 cells release IL 3, 4, 5 –> mast cell eosinophil and B cell recruitment
Airway remodelling
Life threatening asthma - PC
Any one:
PEFR <33%
SpO2 <92%, PCO2>4.6, PaO2<8kPa
CHEST- Cyanosis Hypotension Exhaustion/confusoin Silent chest, poor respiratory effort Tachy/brady/arrhythmia
Risk factors for PE
SPASMODICAL
Sex: F Pregnancy Age Surgery Maligancy Oral contraceptive DVT/PE previously Immobility Colossal size Antiphospholipid antibodies Lupus anti-coagulant
Causes of a non-resolving pneumonia
CHAOS
Complication - Empyema, lung abscess
Host – immunocompromised
Antibiotic – inadequate dose, poor oral absorption
Organism – resistant or unexpected organism not covered by empirical antibiotics
Second diagnosis – PE, cancer, organising pneumonia
Major side-effects of TB treatment
Rifampicin – hepatitis, brushes, febrile reaction, orange/red secretions, many drug interactions including warfarin and OCP
Isoniazid - hepatitis, rashes, peripheral neuropathy, psychosis
Pyrazinamide – hepatitis, rashes, vomiting, arthralgia
Ethambutol – retrobulbar neuritis
Therefore, MUST to a baseline visual acuity test and LFTs which must be monitored closely
CF definition
CF autosomal recessive disease leading to mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). This can lead to a multisystem disease (most commonly affect the respiratory and gastrointestinal systems) characterised by thick secretions.
Bronchiectasis Causes
P.I.G
Post infective – whooping cough, TB
Immune deficiency – Hypogammaglobulinaemia
Genetic / Mucociliary clearance defects – Cysticfibrosis, primary ciliary dyskinesia, Young’s
syndrome (triad of bronchiectasis, sinusitis, and
reduced fertility), Kartagener syndrome (triad of
bronchiectasis, sinusitits, and situs inversus)
