Respiratory Flashcards
Causes of interstital lung disease?
Idiopathic pulmonary fibrosis
CTD (RA/Sclerosis/AS/DM, SLE, sjogrens, MCTD)
Drug induced (nitro, amiodarone, bleomycin, MTX, cyclophosphamide)
Radiation
Pneumoconioses (coal, sillicosis, berylliosis, asbestosis)
Allergic pneumonitis
Vasculitis (GPA, EGPA, anti-GBM)
Granulomatous -Sarcoidosis -TB Lymphangitis carcinomatosis HLH (haemophagocytic lymphohistiocytosis) Lymphangioleiomyomatosis
What pathological patterns are there for interstitial lung disease?
NSIP - Nonspecific interstitial pneumonia
-better prognosis
UIP - Usual interstitial pneumonia
- -IPF
- -asbestosis, hypersensitivity, drug
AIP - Acute interstitial pneumonitis
DIP - Desquamative IP
–Smoking
Organising pneumonia
What investigations can be performed for ILD?
Bloods (FBC, U&E, ANA, ANCA, CK, ACE, Ig, compelement)
CXR
ABG
Echo (R heart function)
Spirometry & Lung function
-Reduced diffusing capacity
-6 minute walk test (need for portable oxygen)
HRCT
-Reticular pattern, traction bronchiectasis
-Honeycombing if severe
-Different patterns depending on cause e.g. UIP, AIP
Lung biopsy if indeterminate
Bronchoscopy
-inflammatory
What is the management of ILD?
Treat underlying cause
Non pharmacological
- MDT approach - respiratory physios, CNS, consultant, OT
- Pulmonary rehabilitation
Pharmacological
- Some are steroid responsive
- Nintedanib
- Pirenidone (limited evidence
Oxygen therapy
-pO2 <7.3 (or <8 with PAH)
Lung transplant
What are the respiratory manifestations of rheumatoid arthritis?
- Pleurisy/Pleural effusions
- Rheumatoid nodules
- Obliterative bronchiolitis
- Fibrosis
- Caplan syndrome (coal & RA)
What are the causes of bronchiectasis?
Hereditary
- Primary ciliary dyskinesia
- Kartagener’s
- Cystic fibrosis
- Immunodeficiency
- Yellow nail syndrome
- Young’s syndrome
Acquired
- Infection - pertussis, measles, pneumonia TB
- Acquired immunodeficiency (HIV, malignancy)
- ABPA
- Recurrent aspiration
Obstructive causes
- Tumour
- Foreign object
Traction bronchiectasis
-ILD
COPD
Causes of upper lobe fibrosis?
CHARTS Coal workers lung Histoplasmosis Hypersensitivity pneumonitis Histiocytosis X Ankylosing spondylitis ABPA Radiation TB Sarcoid
Causes of lower zone fibrosis
RATIO:
RA Asbestosis CTD IPF Other: Drug induced, pneumoconiosis
Respiratory causes of clubbing?
Bronchiectasis & CF IPF Bronchial cancer Mesothelioma Suppuative lung disease (empyema) Lung abscess
How do you investigate bronchiectasis?
Bloods (FBC, U&E, LFT, Ig, IgG/IgE to aspergillus, ANA) CXR Pulmonary function tests -Obstructive pattern Bronchoscopy for washings Sputum cultures inc. TB HRCT
Aetiology:
Sweat test
Genetic testing (hereditary)
Nasal brushings/electron microscopy
What is the management of bronchiectasis?
MDT approach -Physiotherapy (postural drainage, percussion, flutter valve) Education Smoking cessation Vaccinations
Meds
Carbocisteine
Saline nebs
Bronchodilators
Antibiotics
- Broad spec and prlonged for exacerbations
-Prophylactic: colistin nebulisers, azithromycin
Surgical
- Lobectomy - localised disease
- Lung transplant
What systems are affected in CF?
Respiratory:
-Bronchiectasis
Gastrointestinal
- Pancreatic insufficiency
- Biliary cirrhosis
- Gallstones
ENT:
-Sinus disease
Osteoporosis
Diabetes
Infertility
What is the pathogenesis of CF?
CFTR mutation
- CF transmembrane conductance regulator protein
- Delta F508
- Exocrine tissues
Presnts chloride moving out of cells, Na hyabsorbed to excess, pulls water into cells
Dehydrates extracellular surfaces - thick secretions
Common organisms in Bronchiectasis
H. influenzae Pneumococcus Staph Psudomonas Burkholderia Cepacia (complex disease - rapid decline in lung function)
What are the complications of Bronchiectasis?
Cor Pulmonale
Infections
Haemoptysis
Empyema/abscess
Nonpulmonary:
- Anaemia
- Metastatic infection
- Secondary amyloid
