Respiratory Flashcards
What is pneumoconiosis?
Pulomonary Fibrotic Disease secondary to Particular inhalation.
What is acute interstitial pneumonia?
Inflammatory disease within the alveolar walls, not in the alveolar space.
Normally Viral
Can occur with chicken pox
What is lymphangitis Carcinomatosa?
When Lung Ca has spread into the lymph. The lymph and veins around teh bronchioles are “stuffed” with cancer cells.
You get the impression of Pulmonary Fibrosis, therefore an important differential.
Important Questions to ask in a Hx of someone you expect to have Pulmonary Fibrosis?
Dysponea, dry cough? B symptoms Symptoms of reflux Dysphagia (sclerosis) Joint Pain (RA) Neurological (sarcoid) occular (sarcoid) medical Hx occupational Hx smoking Hx.
What is the difference between Emphysema and Honey Comb Lung?
Both are the dilation of airspaces w/ destruction of alveoli.
But Emphysema is w/out pulmonary fibrosis
What is Asbestos and how does it lead to Pulmonary Fibrosis?
A silicate
Have 2 different types of fibres:
1) serpentine (curved) fibres, relatively safe
2) Amphibole (straight fibres), highly dangerous
Fibres are too long for phagocytosis, therefore they are surrounded by macrophages, which constantly leak inflammatory markers. Therefore you get a constant low grade inflammatory process which leads to PF.
What are pleural plaques?
Benign condition related to asbestos exposure
They are patches of pleura (normally parietal) that thicken and calcify over time.
Small and in the mid-section
On chest X-ray= Holly Like
What is Benign Asbestos Pleural Effusion?
Exudate pleural effusion , maybe blood stained
uncommon diagnosis >25yrs since exposure
What is diffuse pleural thickening?
Usually effects the visceral pleura
oftens follows benign asbestos pleural effusion.
if it involves the costophrenic angles= restrictive lung disease.
CT shows smooth uniform pleural thickening
Highly likely to get biopsy for mesothelioma.
What is asbestosis?
Interstitial fibrosis caused by asbestos dust.
Chronic and Heavy exposure
rarely occurs <20years post exposure
On autopsy you would expect to find asbestos particles within the lung parenchyma= typically beaded and amber in colour, coated in Iron.
What are mesotheliomas?
Malignant Neoplasms arising from serosal surfaces.
Universally fatal
Related to asbestos exposure
No safe level of exposure
PC: SOB, chest pain and constitutional symptoms
Important differential for UNILATERAL pleural effusion.
What is sarcoidosis?
Systemic Disease characterised by noncaseating granulomas
Has an unknown cause
Often a diagnosis of exclusion
21% present with respiratory illness though 40-50% is an incidental finding on CXR. Without treatment will progress to pulmonary fibrosis
16% present with Erythema Nodosum.
What is Extrinsic Allergic Alveolitis/Hypersensitivity Pneumonitis?
It is a pneumonitis caused by an antibody and cellular response to an antigen
Mononuclear infiltration and non-caseatint granulomas and Giant Cells are seen in Histology.
Sub divided into Acute, sub-acute and Chronic/
What is acute extrinsic allergic alveolitis?
Develop Fever, Malaise and SOB 4-8hrs post a large antigen exposure.
Resolves in 48hrs
eg. Farmer exposed to mouldy hay.
What is chronic extrinsic allergic alveolitis?
Insidious w/ dyspnoea and fibrosis
more common w/ long term low grade exposure
eg. budgie pet owner
What is sub-acute extrinsic allergic alveolitis?
progressive dysponia and alveolar symptoms
eg. pigeon fanciers lung.
What is bronchiolitis?
Viral infection of the respiratory epithelial cells of the small airways leading to necrosis, inflammation, oedema and mucus secretion
What is the most common causative organism of bronchiolitis?
Respiratory Syncytial Virus
Who does bronchiolitis effect?
Infants under <2
Peak incidence 3-6months
What are the symptoms of bronchiolitis?
Cough, tachypnoea, wheezing, increased WOB, low grade fever, coryzal prodromal phase, uncommon= apnoea
Day 4-5 are the worst
What is syndrome of inappropriate ADH secretion?
Rare complication of bronchiolitis
Become fluid overloaded and hyponatremic
Therefore fit as get cerebral oedema.,
How do you assess respiratory effort in Children?
Effort= RR, Recession, Noise (Wheeze, Stridour, Grunting( Efficacy= O2 sats (94%), Auscultation Effect= HR, Cap Refill, BP, colour, AVPU
Signs of Moderate Acute Asthma attack?
ADULT
Increase in Symptoms
Peak Flow >50-75% of best or predicted
Signs of Severe Acute Asthma Attack?
ADULT
1 of the following: Peak Flow 33-55% best or predicted Respiratory Rate =/>25min HR =/>110 min Inability to complete full sentences in one breath
Signs of a life-threatening acute asthma attack?
ADULT
Severe asthma attack+ 1 of the following
Peak Flow <33% SpO2 <92% PaO2 <8kPa PaCO2 4.6-60 kPa Silent Chest cyanosis poor respiratory effort arrhythmias exhaustion altered concious level Hypotension
What is Epiglottitis?
An acute infection of the larynx
the epiglottis swells and secretions pool compromising the airway
Causes stridor
Medical emergency- EUA w/intubation
HiB most common cause ( decreasing since vaccine, though group A Beta haemolytic strep is increasing)
on X-ray get thumb-print sign
What is croup?
Stridor
75% viral- parainfluenza
bacterial- diptheria
What is a pancoast tumour?
Typically a NSCC, commonly squamous cell tumour found in the lung apices
PC= often pain in scapula, brachial plexus injury and Horner’s syndrome
What is horners syndrome?
Ipsilateral flushing and anhydrosis, constricted pupil and dropping eyelid
What is a small cell carcinoma?
15% of all Lung Ca
malignant epithelial tumour arsing from cells in the LRT
small, densly packed, scant cytoplasm and finely granular nucleur chromatin.
Highly associated with smoking
tends to be central lung and mediastinal involvement.
aggressive
often 2/3 distant mets at diagnosis
What does spirometry look like in pure restrictive disease?
All volumes and capacities are reduced.
What does a vitalograph look like in pure restrictive disease?
FVC and FEV1 are reduced
therefore FEV1/FVC are equal or increased.
what does a spirometery graph look like in obstructive disease?
volumes and capacity are unchanged but flow rate to achieve this is reduced.
what does a vitalograph look like in obstructive disease?
FVC remains the same
FEV1 is reduced
