Respiratory pathology 3 '1' Flashcards
What is rhinitis ?
A common upper respiratory tract infection
What is the progression of rhinitis ?
Self limiting but dose occasionally develop into pneumonia, bronchiolitis, meningitis or septicaemia
What causes rhinitis ?
Usually a pathogen but can also be allergenic. Atopic genes causes increased likelihood to have rhinitis.
What is another name for allergenic rhinitis ?
Hay fever
What is otitis media ?
A commonviral infection of the ear.
What are the symptoms of otitis media ?
Bulging ear drum and erythema (rash) Sore ear Leaking ear Hearing difficulties Sleeping difficulties
What is the progression of otitis media like ?
Can have a secondary pneumococcus infection which will cause rupture of the ear drum
Usually self limiting
What is the treatment for otitis media ?
Analgesics (Pain killers)
Antibiotics (occasionally and if bacterial infection has been confirmed)
What are tonsillitis / pharyngitis ?
Very common upper respiratory tract infections
What are the signs and symptoms of tonsillitis ?
Red Swollen tonsils with white or yellow stuff on them A sore throat fever difficulties swallowing bad breath
What are the signs and symptoms of pharyngitis ?
Sneezing Running nose Headache Cough fatigue fever chills
What are may pharyngitis’s called ?
The common cold
What is tonsillitis/pharyngitis caused by ?
viral or bacterial infection
How is tonsillitis/pharyngitis diagnosed ?
Throat swab (Usually takes to long) Observations. Fever, low energy, feeling sick for ages, pallor around the mouth, scarlet fever all suggest bacterial infection.
Treatment for tonsillitis/pharyngitis
Viral - Nothing
Bacterial - 10 day course of penicillin
What is pertussis also known as ?
Whooping cough
Treatment for pertussis ?
Vaccination which reduces chance and severity
Signs and symptoms of pertussis
Coughing fits
Vomiting
Colour change
What is pertussis sometimes diagnosed as ?
Asthma
What is mesothelioma ?
malignancy of the pleura which is rare and aggressive
What is the prognosis for mesothelioma ?
poor outcome
Causes of mesothelioma
It is caused by asbestos fibres which reach the partial pleura and cause inflammation which provokes tumour formation. Because of this is most commonly found in men who are plumbers, electricians, shipbuilders, power plant workers and people who have worked with boilers and engines. The period between asbestos contact and tumour formation can be between 20 and 40 years and patient often tell you about friend and colleagues who have already dies from asbestos contact in the history.
What are the signs and symptoms of mesothelioma ?
chest pain, SOB and weight loss, clubbed nails and signs of pleural effusion
What investigations are used to help diagnose mesothelioma ?
CXR is useful in identifying a effusion, CT gives good imaging of the pleura. However tissue is required for diagnosis. This can be done using a blind pleural biopsy using a Abrams pleural needle or using a CT thorax and biopsy or pleural biopsy via thoracoscopy
Treatment for mesothelioma ?
Treat the effusion
Chemotherapy for some patients but its not very effective
Trial drugs
Palliative surgery
What should you encourage mesothelioma patients to investigate ?
Work related compensation
What is a Hydropneumothorax ?
Collection of both fluid and air.
What is a Haemothorax ?
Collection of blood in the pleural cavity
What is diffuse alveolar damage an example of ?
a restrictive interstitial lung disease which is acute
Risk factors for diffuse alveolar damage
Major trauma, Chemical injury / toxic inhalation, Circulatory shock, Drugs, Infection including viruses, Auto(immune) disease, Radiation, and others are idiopathic
What is hypersensitivity pneumonitis ?
Hypersensitivity pneumonitis is an example of a restrictive interstitial lung disease. It is a granulomatous response to a chronic interstitial lung disease (Same as sarcoidosis)
What is hypersensitivity pneumonitis characterised by ?
hypersensitivity to organic molecules.
Which occupations are you more likely to find hypersensitivity pneumonitis in ?
in farming where farmers may inhale different organic antigens causing this disease.
How does hypersensitivity pneumonitis present ?
malaise SOB Cough low grade illness crackles Wheeze
What is UIP ?
Usual interstitial pneumonitis is one of the outcomes of a chronic response to interstitial injury. Most commonly this presents as pulmonary fibrosis.
Describe pulmonary fibrosis
Pulmonary fibrosis is mainly seen in the elderly. . It presents suddenly and is a progressive disease (kills in 5 years). It often progresses to basal and posterior fibrosis with honeycombing. However if a lung is honeycombed it does not necessary mean that the patient has UIP.
Signs and symptoms of pulmonary fibrosis
Basel crackles (that sounds like Velcro), and also SOB and cough, clubbing, cyanosis.
Treatment of pulmonary fibrosis
Steroids (not great form of treatment) Surgical options (transplant,) Pirfenidone Nintedanib palliative care
What is one complication of pulmonary fibrosis ?
Secondary pneumothorax
What is CPAM ?
Congenial pulmonary airway malformation (CPAM) is a condition which babies are born with where there is abnormal non-functioning lung tissue. It is mostly detected antenatally and occur sporadically. They normally resolve themselves but surgical intervention may be required.
What is Congenital diaphragmatic hernia ?
Congenital diaphragmatic hernia is a condition a babies may be born with. The diaphragm normally develops around week 7 and closes at week 18 however if it doesn’t close then this condition arises. It is mostly detected antenatally and will require surgical repair. Prognosis depends on degree of lung hypoplasia (underdevelopment).
What is Transient tachypnoea ?
Transient tachypnoea is a condition associated with caesarean section where fluid doesn’t move as effectively around the lungs as it should but it will improve by itself in 1-2 days.
What is Chronic lung disease ?
Chronic lung disease is associated with premature birth where ongoing oxygen support is required at term. It has multifactorial causes and is associated with increases childhood respiratory morbidity.
What are the main things which smoking causes ?
COPD Lung Cancer Heart disease Other cancers Type II diabetes Osteopetrosis
What can second hand smoking cause ?
Respiratory infections Bronchitis Bronchiolitis Pneumonia Cot death Middle ear infections
What does smoking in pregnancy increase the risk off ?
Low weight birth stillbirth miscarriage preterm birth heart defects sudden infant death
What does a cigarette contain ?
A cigarette are highly engineered product of which contain tobacco, of which there are many types. Cigarettes also contain more than 4,000 chemicals including 60 known carcinogens (cancer causers). Examples include nicotine (the addictive part), arsenic, tar, cadmium, carbon monoxide, acetone and hydrogen cyanide.
What are the two main families of carcinogens ?
The two main families of carcinogens are polycyclic aromatic hydrocarbons (lots in old cigarettes and cause cancer in bronchi) and N-nitrosamines (lots in newer cigarettes and cause adenocarcinomas, it does this more so in females than in males).
How many people die from a smoking related cause each year ?
10,000
What is the largest preventable cause of death ?
Smoking
How many years does a smoker lose?
7.5
What are the two main brands of cigarettes ?
There are two brands that control around 80% of the UK smoking market. Imperial brands and Japan tobacco international
What % of the population smokes ?
5%
Describe some strategies used to help stop smoking
There have been a number of strategies to help stop smoking. Protecting children. It is now illegal to sell tobacco to under 18s and smoke in private vehicle with kids, vending machines and proxy purchase is also not allowed. Smoking in public places is now almost universally banned. UK government take a large tax on cigarettes to help drive the price up. Smuggling however does happen. European law (which has now changes) but they insist on picture warning on the surface of packets to deter people from smoking. They also ban distinguishable flavours from being added to cigarettes i.e. menthol. Packs are limited to a minimum of 20 (more expensive and so require more thought to buy), they also limit tar, nicotine and carbon monoxide content. They also band terms such as ‘mild’ which might make people think that they are safer. Global health also have a series of standards. Smoking cessation.
What are the names of the some of the things which cause issues with gas exchange ?
ventilation/perfusion mismatch Diffusion impairment Alveolar hypoventilation Pneumonia COPD
What is ventilation perfusion mismatch ?
When the ventilation or perfusion is greater than the other and so there is a reduction in efficient gas exchange
What is diffusion impairment ?
Increased thickness means there is an increase in time taken for gas to diffuse across a membrane.
What is alveolar hypoventilation ?
Volume of air moved in and out of the lungs is reduced
What is an example of a condition which causes diffusion impairment ?
Pneumonia
What is an example of a condition which causes a V/Q mis match ?
COPD
Name some reasons other than lung cancer why thoracic surgery may be performed ?
Lung Abscess Thymic Tumours Tracheal surgery Pneumothorax Bullous lung disease Bronchogenic cysts A lung transplant
Describe lung abscesses and why surgery is required sometimes
Surgery is performed to remove the abscess and prevent it from bursting into the pleura and causing empyema.
Describe thymic tumours and why surgery is required sometimes
two rare types of cancer which forms in the cells on the outside of the thymus
Describe benign tumours and why surgery is required sometimes
Non cancerous tumours. They can get quite big and there is a chance that they might no be benign and so some people want them removed
What are the two types of pneumothorax ?
Primary - Happens without a known cause or underlying conditions
Secondary - Happens due to an underlying cause
Describe the surgery which is carried out for pneumothorax
Key hole surgery, using talc or sandpaper etc to help the pleura stick better
What is the name of the surgery perfumed on the pneumothorax ?
pleurodesis
Describe bullous lung disease and why surgery is required sometimes
Abnormal pocket of air in the lungs can develop into a pneumothorax.
Describe bronchogenic cysts and why surgery is required sometimes
present at birth and can cause breathing complications
What conditions may be considered for a lung transplant ?
Cystic fibrosis
Pulmonary hypertension
Pulmonary fibrosis
Emphysema
Conditions for a lung transplant
Good support < 65 not obese no renal failure no diabetes no mental health
