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* year 2 Clinical Pathology > respiratory > Flashcards

respiratory Flashcards

1
Q

what does ABPA stand for?

what is it?

A

allergic bronchopulmonary aspergillosis

asthma triggered by exposure to aspergillus fungus

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2
Q

what are the 4 types of hypersensitivity reactions?

incl. time before clinical signs, molecular characteristics + examples

A

type 1 - Anaphylaxis/Allergy/Atopy

  • <30mins
  • IgE, degranulation of mast cells
  • hay fever/asthma/allergy/etc

type 2 - antiBodies

  • 5-12hrs
  • antigen -> formation of IgM + IgG antiBodies which destroy target cells which have antigen
  • transfusion reactions/Rh incompatability

type 3 - immune Complex

  • 3-8hrs
  • antibodies + antigens form complexes that cause damaging inflammation
  • SLE/RA/serum sickness

type 4 - Delayed cell-mediated reaction

  • 24-48hrs
  • antigens activate T cells (all others are B cell related)
  • transplant rejection/contact dermatitis (eg poison ivy)
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3
Q

what are 3 changes seen in chronic asthma?

A
  • bronchiolar wall smooth muscle hypertrophy
  • mucus gland hyperplasia
  • resp bronchiolitis -> centrilobular emphysema
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4
Q

bronchiectasis:

  • what is it?
  • causes? 5
  • signs/symptoms? 3
A

PERMANENT dilation of bronchi + bronchioles dt destruction of the muscle + elastic tissue

  • infections (TB, fungal, without Abx)
  • CF
  • kartagener syndrome (aka primary ciliary dyskinesia)
  • bronchial obstruction (tumour, foreign body)
  • autoimmune conditions (lupus, RA, IBD, GVHD)
  • long-standing cough
  • intermittent fever
  • copious amounts of foul-smelling sputum
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5
Q

what is the technical definition of chronic bronchitis?

A

cough + sputum for 3 months in each of 2 consecutive years

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6
Q

what is the pathology of chronic bronchitis?

A
  • mucus gland hyperplasia + hypersecretion
  • secondary infection by low virulence bacteria
  • chronic inflammation

chronic inflammation of small airways -> wall weakness + destruction -> centrilobular emphysema

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7
Q

what are the types of emphysema seen in:

  • smokers?
  • people with a1-antitrypsin deficiency?
A

smokers:
- centrilobular (aka centiacinar)

a1-antitrypsin deficiency
- panlobular (aka panacinar)

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8
Q

what are the differences between COPD which is predominantely bronchitis and that which is predominant emphysema:

  • age?
  • dyspnoea?
  • cough?
  • infections?
  • CXR findings?
  • stereotype?
A

predominantely bronchitis:

  • age 40-45
  • dyspnoea: mild
  • cough: lots, copius sputum
  • infections: common
  • CXR findings: prominent vessels, large heart
  • stereotype: ‘blue bloater’

predominant emphysema

  • age 50-75
  • dyspnoea: severe
  • cough: not as much, scanty sputum
  • infections: rare
  • CXR findings: small heart, hyperinflated lungs
  • stereotype: ‘pink puffer’
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9
Q

chronic bronchitis + emphysema in coal miners

  • what is it? (legally)
  • how many years of work qualify?
  • what does degree of compensation depend on? 2
A

UK prescribed occupational disease in coal miners
- chronic bronchitis +/or emphysema

> 20 years underground work

  • degree of disability
  • smoking history

nb no CXR or history of dust exposure needed

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10
Q

what features are common to all interstitial lung diseases? 3

A
  • increased tissue in alveolar-capillary wall (-> increased gas diffusion distance)
  • inflammation -> fibrosis
  • decreased lung compliance
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11
Q

acute interstitial pneumonia/pneumonitis:

  • what is it?
  • cause?
  • treatment?
  • similar to?
A

acute diffuse damage to interstitium of lungs
- short period between beginning of symptoms to resp failure

idiopathic

mechanical ventilation + corticosteroids
- but prognosis poor, only cure is transplant

acute/adult respiratory distress syndrome (ARDS) - aka ‘shock lung’

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12
Q

chronic interstitial lung diseases:

  • symptoms? 2
  • signs? 2
  • end-stage sign?
  • examples? 3
A

symptoms:

  • increasing dyspnoea (for years)
  • dry cough

signs:

  • clubbing
  • fine crackles

end-stage sign = ‘honeycomb lung’

examples:

  • idiopathic pulmonary fibrosis
  • many pneumoconioses
  • sarcoidosis
  • collagen vascular diseases-associated lung diseases
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13
Q

idiopathic pulmonary fibrosis:

  • which lobes first + worst affected?
  • histology?
  • histology same as? 2
A

lower lobes affected first + most severely

interstitial chronicinflammation + variably mature fibrous tissue
- adjacent normal alveolar walls

  • collagen vascular disease-associated interstitial lungdisease
  • asbestosis
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14
Q

sarcoidosis in lungs:

  • pathology?
  • other organs that can be affected?
  • what else affected?
  • often mistaken for?
  • blood test results? 2
  • normally seen in?
A

non-caseating pulmonary granulomas

  • skin
  • heart
  • brain
  • liver
  • hilar lymph nodes

mistaken for TB
- granulomas are necrotic in TB, not in sarcoidosis

  • hypercalcaemia
  • high serum ACE

young adult women

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15
Q

definition of pneumoconioses?

A

non-neoplastic lung diseases due to inhalation of mineraldusts, organic dusts, fumes + vapours
- often occupational

aka ‘the dust diseases’

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16
Q

what is cor pulmonale?

A

the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance (such as from pulmonic stenosis) or high blood pressure in the lungs

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17
Q

silicosis:

  • cause?
  • people affected? 2
  • pathology?
  • increased risk of?
A

exposure to silica - sand + stone dust

  • stone masons
  • building site workers

fibrosis + very discrete fibrous silicotic nodules (also found in adjacent lymph nodes)

  • lung cancer
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18
Q

hypersensitivity pneumonitis:

  • aka?
  • type of hypersensitivity reaction?
  • two examples of types?
  • pathology?
  • can lead to?
A

extrinsic allergic alveolitis

type 3 (immune Complex)

  • ‘farmer’s lung’ - antigens in hay
  • ‘pigeon fancier’s lung’ - bird antigens

inflammation around bronchioles, with poorly formed non-caseating granulomas extends alveolar walls

repeated episodes -> interstitial fibrosis

nb reversible in early stages

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19
Q

4 major types of primary malignant lung tumours?

A
  • small cell carcinoma

non-small cell:

  • adenocarcinoma
  • squamous cell carcinoma
  • large cell undifferentiated carcinoma
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20
Q

what is the difference between a sarcoma and a carcinoma?

A

carcinoma: epithelial tissue tumour

sarcoma connective/non-epithelial tissue tumour

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21
Q

causes of lung cancer? 5

A
  • tobacco smoking
  • occupationa/industrial hazards (eg asbestos, uranium, nickel)
  • radiation (eg radon mining, post atom bomb)
  • lung fibrosis
  • genetic mutations
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22
Q

lung cancer:

  • symptoms? 7
  • signs? 3
A

symptoms:

  • haemoptysis
  • cough
  • breathlessness
  • fatigue
  • weight loss
  • hoarse voice (if recurrent laryngeal nerve)
  • horner’s syndrome (symp chain)

signs:

  • clubbing
  • pleural effusion (if spreads to pleura)
  • raised ACTH, ADH + PTH
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23
Q

where does lung cancer commonly metastasise to? 6

how might these present?

A
  • lymph nodes (swollen in neck)
  • pleura (pleural effusion)
  • liver
  • bone (fractures)
  • adrenal
  • brain (seizures)
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24
Q

what electrolyte disturbances are seen in small cell carcinomas? 3

A
  • hyponatraemia
  • hypokalemia
  • hypercalcaemia
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25
Q

what is lymphangitis carcinomatosa?

A

lymphatics within lung are diffusely involved by tumour

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26
Q

what % of lung cancer patients are elligable for surgery?

A

about 10%

  • either cancer not resectable of physically not fit enough (as it’s major surgery), often both as present late
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27
Q

what is the normal lung pleura made up of?

A

single layer of mesothelial cells (with connective tissue on non-pleural-cavity side)
- on both layers of pleura

secrete hyaluronic acid rich mucinous pleural fluid

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28
Q

what are 7 causes of pleural inflammation?

A

primary inflammatory diseases
- eg SLE, RA

infections

  • norm secondary to pneumonias or TB
  • primary coxackie B infection

pulmonary infarction
- secondary to pulm arterial thromboembolism

emphysema
- secondary to ruptured bullae

cancer

therapeutic
- pleurodesis, usually with talc, to treat recurrent pleural effusions or recurrent pneumothoraxes

iatrogenic

  • radiotherapy to thorax
  • immune reactions to drugs
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29
Q

pleural inflammation:

  • names? 2
  • symptom?
  • sign?
  • associated condition?
  • can develop into?
A

pleurisy or pleuritis

pleuritic chest pain
- sharp localised pain exacerbated by breathing

auscultation of a PLEURAL RUB during breathing

often associated pleural effusion

  • weak breath sounds on auscultation
  • dull on percussion

pleural fibrosis

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30
Q

what are the 2 types of asbestos associated pleural fibrosis?

  • level of asbestos exposure?
  • symptoms?
  • is it elligable for industrial injuries disablement benefit?
A

parietal pleural fibrous plaques

  • low-level exposure
  • asymptomatic
  • not elligIble

diffuse pleural fibrosis

  • high-level exposure
  • breathlessness
  • elligible
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31
Q

what are the effects of pleural fibrosis?

what procedure can be done to reduce these?

A
  • prevent normal expansion + commpression of lung -> breathessness

pleural decortication
- removal of the fibrous tissue

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32
Q

what is is called when these fluid are in the pleural cavity:

  • serous fluid?
  • pus?
  • blood?
  • lymph?
  • air?
A

serous fluid = pleural effusion

pus = empyema/pyothorax (norm secondary to pneumonia)

blood = haemothorax (norm traumatic or secondary to ruptured thoracic aortic aneurysm)

Lymph = chylothorax (norm trauma to thoracic duct)

air = pneumothorax

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33
Q

2 types of pleural effusions = transudates + exudates, what is the difference between them:

  • pathology?
  • protein content?
  • lactate dehydrogenase content?
  • causes? (trans = 4, exu = 2)
A

transudates:

  • low capillary osmotic pressure +/or high capillary hydrostatic pressure
  • low protein
  • low lactate dehydrogenase
    • high vascular hydrostatic pressure (LV failure, renal failure)
    • low capillary osmotic pressure (hypoalbuminaemia - hepatic cirrhosis, nephrotic syndrome)

exudates:

  • pathological capillaries loose semi-permeability
  • high protein
  • high lactate dehydrogenase
    • inflammation (with or without infection)
    • cancer

“stuff to do with osmosis forms a transudate, it is just TRAvelling through, so doesn’t leave lots of proteins etc, EXudate can develop into Empyema, everything EXits the capillaries”

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34
Q

treatments for pleural effusions? 4

A
  • aspiration of fluid with needle + syringe (ultrasound guided)
  • treat underlying cause (if possible)
  • pleural drain (for recurrent effusions)
  • pleurodesis (for recurrent effusions)
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35
Q

what are the 2 different types of pneumothorax?

pathologies?

what can both cause?

A

open pneumothorax:

  • chest wall perforation
  • normally traumatic
  • connects body surface to pleural cavity
  • external air -> pleural cavity during inspiration, reducing potential lung expansion

closed pneumothorax

  • lung perforation
  • usually not traumatic
  • connects lung air spaces to the pleural cavity
  • lung air -> pleural cavity during inspiration, reducing potential lung expansion

both can cause: tension pneumothorax
- air in during inspiration but not out during expiration

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36
Q

causes of closed pneumothoraxes? 4

A

ruptured emphysematous bullae

common inflammatory lung diseases

  • asthma
  • pneumonia
  • TB
  • CF

traumatic
- lung tears from fractured ribs

iatrogenic

  • mechanical ventilation at high pressures
  • lung + pleural biopsies
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37
Q

pneumothorax:

  • symptoms? 2
  • signs? 5
A

symptoms: (small ones may be asymptomatic)
- breathlessness
- pleuritic chest pain

signs:

  • cyanosis
  • tachycardia
  • tracheal deviation (in tension pneumothorax)
  • hyperressonant percussion
  • reduced breath sounds on auscultation
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38
Q

what is the most common type of primary pleural neoplasm?

what 2 cancers often metastasise to the pleura?

A

malignant mesothelioma

  • breast
  • lung
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39
Q

malignant mesothelioma:

  • cause?
  • cells/tissues it affects?
  • metastasise?
A

if pleural, 80-90% caused by asbestos
(- thoracic radiation)
(- BRAC1 gene)

mesothelial cells that line serous cavities:

  • pleura (92%)
  • peritoneum (8%)
  • pericardium
  • tunica vaginalis

tend not to metastasise widely
- but if they do then go to other lung pleuraor peritoneum etc

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40
Q

how do you diagnose a malignant mesothelioma?

A
  • can use imaging but difficult to identify and thus target biopsies at

if the is an accompanying pleural effusion, malignant cells may be shed into this
- therefore effusion cytology may allow an early tissue diagnosis to be made

nb a small tumour can produce a large pleural effusion

then use dyes to work out cell type tumour has grown from to differentiate between mesothelioma + lung tumours

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41
Q

what does desmoplasia mean?

A

the growth of fibrous or connective tissue

so if something is desmoplastic (eg a tumour) then it has low cellular component and is largely connective tissue

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42
Q

what is asbestosis?

is it elligible for industrial injuries disablement benefit?

A

a usual pneumonia-like proggressive pulmonary interstitial fibrosis caused by high level exposure to asbestos dust
- fibrosis of the alveolar walls impairs both gas exchange + lung expansion + contraction during breathing

yes

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43
Q

what skin lesions can people exposed to asbestos present with?

A

asbestos corns

- benign hyperkeratotic wart-like skin lesions

44
Q

what would lymphoma look like on a chest x-ray

A

a mass above the mediastinum

- enlargement of mediastinal lymph nodes

45
Q

what are you likely to hear when auscultating a patient with:

  • pneumonia
  • interstitial lung disease
A

pneumonia/infection:

  • coarse crackles
  • more likely to be localised

interstitial lung disease

  • fine crackles
  • more likely to be all over lungs
46
Q

name 8 causes of haemoptysis

A
  • TB
  • pneumonia
  • bronchitis
  • aspergilloma
  • brochiectasis
  • lung cancer
  • PE
  • aspiration of foreign body
47
Q

in which type of lung cancer can ‘keratin pearls’ be seen histologically?

A

squamous carcinomas

48
Q

what metaplastic change is seen in smoker’s lungs?

A

ciliated columnar epithelium -> stratified squamous epithelium

49
Q

what is it called when the lymphatics in the lung are diffusely involved by tumour?

A

Lymphangitis carcinomatosa

50
Q

what is the most oncogenic type of asbestos?

A

crocidolite - ‘blue asbestos’

“crocodiles are dangerous”

51
Q

what are the differential diagnoses for hilar lymphadenopathy? 4

A

ie swollen hilar lymph nodes on x-ray

sarcoidosis

infection

  • TB
  • fungal

neoplastic

  • lymphoma
  • cancer

inorganic dust disease
- silicosis

52
Q

name of diagnostic skin test used to determine if someone has been exposed to TB?

A

heaf test

53
Q

condition seen in infants that results in inflammation + oedema of bronchioles + commonly caused by RSV (respiratory syncytial virus)?

A

bronchiolitis

54
Q

What are the 3 main symptoms of infectious mononucleosis (EBV/glandular fever)?

A
  • fever
  • tonsillar pharyngitis
  • cervical lymphadenopathy (enlarged cervical lymph nodes)
55
Q

what is a complication of infectious mononucleosis (EBV/glandular fever)?

A

Splenic rupture

56
Q

What drug should you avoid giving in patients who could have infectious mononucleosis (EBV/glandular fever)? Why?

A

Ampicillin

- interaction results in a non-allergic rash = mac-pap rash

57
Q

What would be 3 clinical signs that would suggest a sore throat was caused by Epstein barr virus?

A
  • symmetrically inflamed tonsils
  • soft palate inflammation
  • posterior cervical lymphadenopathy (ie enlarged cervical lymph nodes)
58
Q

what is the most common bacterial cause of a sore throat?

A

Group A beta-haemolytic streptococcus (GABHS)

- ‘strep throat’

59
Q

name 5 viruses which commonly cause pharyngitis (+ tonsillar pharyngitis)

A
  • rhinovirus
  • coronavirus
  • parainfluenza
  • influenza (A+B)
  • adenovirus
60
Q

what is the name of the criteria that’s used to establish whether a sore throat is caused by a bacterial infection? What 4 factors does it use?

A

Centor criteria

  • tonsillar exudate
  • tender anterior cervical lymphadenopathy
  • fever over 38 degrees
  • absence of cough

if 3 or 4 of above are met, the positive predictive value is 40-60%
- if none or 1 criteria is met the negative predictive value is 80%

61
Q

what tests would be performed in suspected infectious mononucleosis (EBV)? 2

A
  • Blood sample for monospot
    OR
  • EBV serology
62
Q

When should you give antibiotics for sore throats?

A
  • non-severe acute tonsillar pharyngitis, if symptoms >a week + getting worse
  • severe acute tonsillar pharyngitis
  • quinsy
  • epiglottitis
63
Q

What are the 3 main symptoms of infectious mononucleosis (EBV/glandular fever)?

A
  • fever
  • tonsillar pharyngitis
  • cervical lymphadenopathy (enlarged cervical lymph nodes)
64
Q

what is a complication of infectious mononucleosis (EBV/glandular fever)?

A

Splenic rupture

65
Q

What drug should you avoid giving in patients who could have infectious mononucleosis (EBV/glandular fever)? Why?

A

Ampicillin/amoxicillin

- interaction results in a non-allergic rash = mac-pap rash

66
Q

What would be 3 clinical signs that would suggest a sore throat was caused by Epstein barr virus?

A
  • symmetrically inflamed tonsils
  • soft palate inflammation
  • posterior cervical lymphadenopathy (ie enlarged cervical lymph nodes)
67
Q

what is the most common bacterial cause of a sore throat?

A

Group A beta-haemolytic streptococcus (GABHS)

- ‘strep throat’

68
Q

name 5 viruses which commonly cause pharyngitis (+ tonsillar pharyngitis)

A
  • rhinovirus
  • coronavirus
  • parainfluenza
  • influenza (A+B)
  • adenovirus
69
Q

what is the name of the criteria that’s used to establish whether a sore throat is caused by a bacterial infection? What 4 factors does it use?

A

Centor criteria

  • tonsillar exudate
  • tender anterior cervical lymphadenopathy
  • fever over 38 degrees
  • absence of cough

if 3 or 4 of above are met, the positive predictive value is 40-60%
- if none or 1 criteria is met the negative predictive value is 80%

70
Q

When should you give antibiotics for sore throats?

A
  • non-severe acute tonsillar pharyngitis, if symptoms >a week + getting worse
  • severe acute tonsillar pharyngitis
  • quinsy
  • epiglottitis
71
Q

Epiglottitis:

  • normally viral or bacterial?
  • What used to be most common cause?
  • Other causative organisms? 2
  • Management?
A

Almost always bacterial

Haemophilus influenza type b (Hib) was commonest cause
- now vaccinated against (but adults + unvaccinated kids still at risk)

  • streptococcus pneumoniae
  • group A strep

securing airway + oxygenation is priority!!
Then:
- blood cultures + epiglottic swabs (have anaesthetist on standby when inspecting throat!)
- IV antibiotics
- Analgesia

If Hib epiglottitis, inform public health

72
Q

What are the risk factors for otitis externa? 5

A
  • swimming (or other water exposure) (aka ‘swimmer’s ear’)
  • trauma (eg ear scratching, cotton swabs)
  • occlusive ear devices (eg hearing aids, ear phones)
  • allergic contact dermatitis (eg due to shampoos, cosmrtics)
  • dermatological conditions (eg psoriasis)
73
Q

Otitis externa:

  • symptoms? 3
  • Definition of acute vs chronic?
  • Typically unilateral or bilateral?
A
  • otalgia (ear pain)
  • pruritis (itchy)
  • non-mucoid ear discharge
acute = symptoms <3/52
chronic = symptoms >3/52
acute = norm unilateral
chronic = norm bilateral
74
Q

Acute otitis externa:

  • normal cause?
  • complication?
  • Investigations?
  • management?
A

90% bacterial

necrotising (malignant) otitis externa

  • ear swab or pus sample for culture
    for necrotising OE: CT temporal bone + bone biopsy (blood cultures if systemically unwell)
  • remove/modify precipitating factors
  • remove pus/debris from ear = ‘toileting’ the ear
  • analgesia
  • topical antibiotics for mild- moderate (ie ear drops)
  • systemic Abx for severe
75
Q

Malignant (necrotising) external otitis:

  • what is it?
  • Most commonly occurs in? 2
  • Symptoms/signs? 4
  • Treatment?
A

When EO spreads to skull base (can be life threatening)

  • elderly diabetic
  • immunocompromised
  • severe pain
  • otorrhoea (ear discharge)
  • granulation tissue in canal floor
  • cranial nerve palsys are possible

min 6 weeks Abx

76
Q

chronic otitis externa:

  • symptoms? 2
  • what ear canal looks like?
  • Normal causes? 2
  • Treatment?
A
  • pruritis (itching)
  • mild discomfort

erythematous external canal that’s normally devoid of wax (often bilateral)
- white keratin debris may fill ear canal + over time, canal wall skin -> thickened, narrowing the canal

  • allergic contact dermatitis (eg chemicals in shampoos/cosmetics)
  • generalised skin conditions (eg atopic dermatitis, psoriasis)

treat underlying cause

77
Q

Otitis media (OM):

  • what is it?
  • Normal cause?
  • Features of uncomplicated acute OM? 5
  • Features of complicated acute OM? 4
  • Severe complication?
A

Middle ear inflammation (fluid present in middle ear, behind ear drum)

Viruses!

Uncomplicated:

  • mild pain
  • <72 hrs duration
  • absence of severe systemic symptoms
  • temp <39 deg
  • no ear discharge

complicated:

  • severe pain
  • perforated ear drum (+/or discharge)
  • purulent discharge (+/or perforation)
  • bilateral infection

mastoiditis

78
Q

what is the pinna?

another name for it?

A

externally projecting part of the ear

auricle

79
Q

mastoiditis:

  • what is it?
  • what influences likelihood of getting it? 2
  • clinical features? 5
  • Investigation?
  • Treatment?
A

Infection of the mastoid bone + air cells

  • more likely if a child
  • more likely if didn’t get Abx for otitis media

features:

  • fever
  • posterior ear pain
  • local erythema over the mastoid bone
  • oedema of the pinna
  • posteriorly + downward displaced auricle

CT always required (need to know extent of infection)

  • analgesia
  • IV antibiotics +/- mastoidectomy
80
Q

Pinna cellulitis

  • what is it?
  • Cause?
  • Treatment?
A

Cellulitis of the ear

Associated with trauma (normally ear piercing)

Bacterial infection

Antibiotics

81
Q

Pneumonia:

  • what is it?
  • Clinical definition?
  • 2 anatomical patterns?
A

Infection affecting the most distal airways + alveoli – formation of an inflammatory exudate

Lower respiratory tract infection with consolidation on x-ray

Bronchopneumonia
- patchy distribution centred on inflamed bronchioles + bronchi then spread to surrounding alveoli

lobarpneumonia
- affects a large part, or the entirety, of a lobe

82
Q

what are 90% of lobarpneumonia caused by?

A

s. pneumonia

83
Q

what are the 4 different types of pneumonia? (defined by where infection occurred)
- definitions?

A

Community acquired pneumonia (CAP)

Hospital acquired pneumonia (HAP)
- pneumonia developing >48hrs after hosp admission

Ventilator acquired pneumonia (VAP)

  • subgroup of HAP
  • pneumonia developing >48hrs after ET intubation + ventilation

aspiration pneumonia

  • resulting from abnormal entry of fluids (eg food, drink, stomach contents) into LRT
  • patient norm has impaired swallow (eg stroke or parkinsons)
84
Q

what sort of organisms cause:

  • ‘typical’ CAP? (+5 examples)
  • ‘atypical’ CAP (+5 examples)
A

‘typical’ = have cell wall

  • strep pneumonia
  • haemophilus influenza
  • Moraxella catarrhalis
  • Staph aureus
  • Klebsiella pneumonia

‘atypical’ = no/atypical cell wall

  • mycoplasma pneumonia
  • legionella pneumophilia
  • chlamydophila pneumoniae
  • chlamydophila psittaci
  • coxiella burnetii

your leg and your cock get chlamydia

85
Q

‘typical’ pneumonia

  • symptoms? 5
  • signs? 4
A

symptoms:

  • fever/chills
  • productive cough
  • mucopurulent sputum
  • pleuritic chest pain
  • general malaise (fatigue, anorexia)

signs:

  • tachypnoea
  • tachycardia
  • hypotension
  • exam findings: dull to percuss, reduced air entry, bronchial breathing

nb usually rapid onset (though not as acute as PE/cardiac)

86
Q

mycoplasma pneumoniae (causes an ‘atypical’ pneumonia)

  • commonly affects?
  • Main symptom?
  • Diagnosis?
  • Rare complications? 4
A

Children + young adults (autumn epidemics every 4-8 years)

Cough

Serology (difficult to culture)

  • pericarditis
  • arthritis
  • guillain-barre*
  • peripheral neuropathy
87
Q

legionella pneumophilia (causes an ‘atypical’ pneumonia)

  • where norm get infection from?
  • Signs/symptoms? 7
  • Abnormal blood results? 2
A

Colonises water piping systems
- outbreaks associated w showers, air con units, humidifiers

  • high fevers
  • rigors
  • cough: dry initially, becoming productive
  • dyspnoea
  • vomiting
  • diarrhoea
  • confusion
  • deranged LFTs
  • hyponatraemia
88
Q

chlamydophila psittaci (causes an ‘atypical’ pneumonia)

  • infection associated with?
  • Associated symptoms/conditions?
A

Exposure to birds

  • rash
  • hepatitis
  • haemolytic anaemia
  • reactive arthritis

consider in those w pneumonia, splenomegaly + hx of bird exposure

89
Q

what acronym is used to assess disease severity in pneumonia?
What does each bit stand for?

A

CURB-65

C – confusion
U – urea (>7mmol/L in blood)
R – resp rate >30
B – blood pressure (systolic <90 or diastolic <60)
65 – age >65 years

score of 1 given to each feature

score of 0-1 = home management
score of 2 = hosp management
score of 3-5 = hosp (assess for ITU admission)

90
Q

what is the management of any type of pneumonia?

A
  • ABC
  • Then prompt Abx therapy

As part of circulation:
- gain IV access + give IV fluids if haemodynamically unstable + urinary catheter to monitor urine output

91
Q

what are the possible complications of pneumonia? 3

A
  • pleural effusion
  • empyema
  • lung abscess
92
Q

what are the most common viral causes of pneumonia in:

  • adults? 3
  • children? 2
  • immunocomprimised? 4 (+ above causes)
A 
adults:
-	influenza A + B
-	adenovirus
-	varicella zoster virus (VZV)
children:
-	RSV
-	Parainfluenza
Immunocompromised:
-	measles
-	herpes simplex (HSV)
-	cytomegalovirus (CMV)
-	HHV-6
93
Q

What are the symptoms of normal (uncomplicated) influenza? 5

- how long do these normally take to resolve?

A
  • fever
  • headache
  • myalgia
  • DRY cough
  • sore throat

2-3 weeks

94
Q

what is a complication of varicella zoster virus infection in adults?

  • who is this most likely to affect? 4
  • symptoms? 3
A

VZV pneumonia

  • immunocomprimised
  • adults w chronic lung disease
  • smokers
  • preganant women (not more likely to affect but, if infected, worse prognosis)

insidious onset 1-6 days after rash appears, progressive symptoms:

  • tachypnoea
  • dyspnoea
  • dry cough
95
Q

who is pneumonia caused by cytomegalo virus likely to affect? 2

A
  • transplant recipients (esp lung)

- HIV patients

96
Q

Bronchiectasis:

  • symptoms? 4
  • management in infective exacerbations? 4
A
  • breathlessness
  • chronic cough
  • mucopurulent sputum production
  • recurrent infections
  • antibiotics
  • effective clearance of resp secretions (eg physiotherapy, postural drainage)
  • nutritional support
  • annual influenza vaccine
97
Q

who is given the:

  • pneumococcal vaccination? 3
  • Annual flu jab? 3
A

Pneumococcal:

  • patients w chronic heart, lung + kidney disease
  • patients with splenectomy
  • infant vaccination schedule

annual flu:

  • 2-17 yr olds
  • over 65s
  • chronic disease, multiple comorbidities
98
Q

allergic bronchopulmonary aspergillosis (ABPA):

  • who it affects? 3
  • clinical presentation?
  • Diagnosis? 3
  • View on CT scan?
  • Treatment? 2
A
  • atopy
  • asthma
  • CF

worsening asthma + lung function

  • high total IgE
  • specific IgE to aspergillus
  • positive seum IgG to aspergillus

may demonstrate central bronchiectasis

  • corticosteroids
  • antifungal therapy
99
Q

pulmonary aspergilloma:

  • who affects?
  • Symptoms/signs? 5
  • Diagnosis? 2
  • Complication?
  • Treatment? 2
A

People with old cavities (eg caused by TB, sarcoidosis)

  • cough
  • haemoptysis
  • weight loss
  • wheeze
  • clubbing
    nb some are asymptomatic
  • CXR/CT thorax
  • positive test for aspergillus IgG antibody

massive haemoptysis

  • surgical resection
  • antifungals (injected into cavity or orally)
    nb 10% resolve spontaneously
100
Q

pneumocystis jiroveci pneumonia

  • what causes it?
  • Who gets it?
  • Symptoms? 4
  • Diagnosis?
  • Treatment? 3
A

Fungus
- but lacks ergosterol in its cell wall so is not susceptible to a number of antifungals

insidious onset of:

  • fever
  • dyspnoea
  • non-productive cough
  • reduced exercise tolerance (get very SOB on exertion)

PCR to detect P. jiroveci DNA from induced sputum (hard to find in expectorated sputum)

  • supportive care
  • antimicrobials
  • steroids
101
Q

pulmonary nocardiasis

  • causative organism?
  • Who affects? 2
  • Clinical presentation?
  • Treatment? 2
A

Inhalation of nocardia asteroides

  • immunosuppressed
  • pre-existing lung condition

presentation/clinical findings are variable, making diagnosis hard

  • supportive care (ABC etc)
  • antibiotics (several months)

nb this is rare, even in affected groups

102
Q

respiratory TB

  • natural history of disease?
  • % of primary infections which are symptomatic?
A

Organisms are inhaled, depending on host’s immune system infection will either become quiescent or progress and/or disseminate
- reactivation of disease may occur later in life, particularly in immunocompromised

90% asymptomatic

103
Q

what is disseminated TB called?

A

Miliary TB

104
Q

respiratory TB

  • symptoms? 5
  • diagnosis?
  • Treatment?
  • Prevention?
A
  • chronic productive cough
  • haemoptysis
  • weight loss
  • fever
  • night sweats

interferon gamma release assays (IGRA) +/- tuberculin skin test
- mantoux can be used (doesn’t differentiate active from latent disease)

combined antibiotics for 6 months

give BCG to infants/kids in high prevalence areas

nb TB is a notifiable disease (to public health) + contract tracing occurs

105
Q

what criteria is used to define an exudate in a pleural effusion?

what are the detils of this?

A

lights criteria

  • Effusion protein/serum protein ratio greater than 0.5
  • Effusion lactate dehydrogenase (LDH)/serum LDH ratio greater than 0.6
  • Effusion LDH level greater than two-thirds the upper limit of the laboratory’s reference range of serum LDH

effusion is likely to be exudative if any one of these criteria is filled

106
Q

which type of lung cancer most commonly causes paraneoplastic syndromes?

A

small cell carcinomas

nb these still rarely cause them though

eg:

  • syndrome of inappropriate antidiuretic hormone secretion (SIADH)
  • cushings syndrome etc
107
Q

which lobe of the lung is TB most likely to affect?

A

upper lobe

aka apical shadow

* year 2 Clinical Pathology (11 decks)

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