Respiratory COPY Flashcards
What is bronchiectasis
permanent dilation of airways
Causes of bronchiectasis
- post-infection
- CF
- lung cancer
Signs and symptoms of bronchiectasis
- dyspnoea
- cough
- haemoptysis
- recurrent chest infections
Investigations for bronchiectasis
- chest xray → kerly B lines
- sputum → H.influenzae most common
Management of bronchiectasis
- physical training
- postural drainage
- prophylactic Abs
- surgery if disease localised
What is pleural effusion?
collection of fluid in the pleural cavity → space between parietal ad visceral pleura
Types of pleural effusion
exudative → high protein count
- transudative → lower protein count
Causes of exudative pleural effusion
related to inflammation
- proteins leak out of tissue into pleural space
- lung cancer
- pneumonia
- RA
- TB
Causes of transudative pleural effusion
related to fluid moving across pleural space
- congestive cardiac failure
- hypoalbuminaemia
- hypothyroidism
- Meig’s syndrome
What is Meig’s syndrome?
right sided pleural effusion with ovarian malignancy
Presentation of pleural effusion
- SOB
- cough
- stony dull percussion over effusion
- reduced breath sounds
- tracheal deviation away from effusion if large
Investigations for pleural effusion
- chest xray
- pleural US
- thoracocentesis → diagnoses underlying cause
What would you seen on a chest xray with pleural effusion
- blunting of costophrenic angle
- fluid in lung fissures
- meniscus
- tracheal and medial deviation
Treatment of pleural effusion
dependent on cause
- congestive HF → loop diuretics
- infective → Abs
- malignant → therapeutic thoracocentesis
- large effusions often need aspiration or drainage
What is interstitial lung disease?
- umbrella term for conditions that affect lung parenchyma
- cause inflammation and fibrosis
Diagnosis of interstitial lung disease
- clinical features
- high resolution CT thorax → ground glass appearance
- lung biopsy if unsure
Treatment of interstitial lung disease
supportive, prevent progression
- remove/treat underlying cause
- home O2 if hypoxic at rest
- stop smoking
- physiotherapy
- pneumococcal/flu vaccine
- lung transplant
What are the three types of interstitial lung disease?
- idiopathic pulmonary fibrosis
- occupational lung disorders
- systemic disease → Wegner’s, Goodpasture’s
What is idiopathic pulmonary fibrosis?
formation of scar tissue in lungs with no known cause
Presentation of IPF
- dyspnoea
- dry cough
- bibasal crackles
Treatment of IPF
- prifenidone
- nintedanib
- treatments for ILD
What is sarcoidosis?
- granulomatous inflammatory condition
- varied severity
Presentation of sarcoidosis
affects any organ in body
most common = lung
- mediastinal lymphadenopathy
- pulmonary fibrosis
- pulmonary nodules
Investigations for sarcoidosis
GOLD STANDARD = histology from biopsy
- non-caseating granulomas with epithelioid cells
Treatment for sarcoidosis
- if mild, resolves spontaneously
- oral steroids, bisphophonates
- methotrexate/azathrioprine
- lung transplant if severe
What is pulmonary HTN?
- disease of small pulmonary arteries
- vascular proliferation and remodelling
- progressive increased in PVR
What are the main vascular changes in pulmonary HTN?
- vasoconstriction
- smooth muscle cell and endothelial cell proliferation
- thrombosis
Symptoms of pulmonary HTN
- exertional dyspnoea
- lethargy, fatigue
- ankle swelling
Signs of pulmonary HTN
- accentuated component to 2nd heart sound
- tricsupid regurgitation murmur
- fatigue, peripheral oedema, cyanosis
Diagnosis of pulmonary HTN
initial tests
- chest xray → enlarged main pulmonary artery/hilar vessels
- ECG
- trans-thoracic echo
GOLD STANDARD = right heart catheterisation
Treatment of pulmonary HTN
supportive
- treat underlying cause
- oral anticoagulants
- if fluid retention, diuretics
- supplemental O2
- supervised exercise training
- avoid pregnancy
treatment-resistant patients
- balloon atrial septostomy
- lung transplantation
What are the two types of bronchial carcinoma?
- small cell lung carcinoma → worse prognosis
- non-small cell carcinoma → more common
Why is it useful to identify different types of lung cancer?
- different types differ in histology and behaviour
- helpful for providing prognosis and determining treatment
- presentations are similar
Risk factors of lung cancer
- smoking
- asbestos
- coal and products of coal combustion
- radon exposure
- pulmonary fibrosis
- HIV
- genetic factors
Symptoms of local disease in lung cancer
- persistent cough
- SOB
- haemoptysis
- weight loss
- chest pain
- wheeze
- infections
Symptoms of metastatic disease in lung cancer
- bone pain
- headache
- seizures
- neurological deficit
Paraneoplastic changes in lung cancer
increased
- PTH → hyperparathyroidism
- ADH → SIADH
- ACTH → Cushings
finger clubbing
Investigations for lung cancer
- chest xray → central mass, hilar lymphadenopathy, pleural effusion
- CT chest/liver/adrenal glands → staging
- sputum cytology → malignant cells in sputum
GOLD STANDARD = percutaneous/bronchoscopic biopsy and histology
Treatment of lung cancer
- depends on cell type
- surgery → lobectony, segmentectomy, wedge resection
- radiotherapy
- chemo
- palliative care
Small cell lung cancer
- strong association with smoking
- arises from endocrine cells in central bronchus
- secretes polypeptide hormones
- treatment = chemo
Squamous cell carcinoma
- most strongly associated with smoking
- arises from epithelial cell in central bronchus
- associated with production of keratin
Adeoncarcinoma
- most common primary lung cancer
- most common type in non-smokers
- originate from mucus-secreting glandular cells
- metastasises to pleura, lymph nodes, brain, bone, adrenals
Secondary lung cancer
- more common than primary
can spread from
- breast
- bowel
- bladder
- prostate
- kidney
Common sites of metastasis of lung cancer
- liver
- bone
- adrenal glands
- brain
