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T Year > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

What is COPD made up of?

A

chronic bronchitis

emphysema

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2
Q

COPD spirometry

A

obstructive

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3
Q

Long term complications of COPD

A

cor pulmonale

from pulmonary hypertension

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4
Q

CURB-65 score

A 
confusion
urea >7
RR >30
BP <90/60
Age >65
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5
Q

HAP

A

occurs 2 days or more after admission

gram negative bacteria: klebsiella, e.coli, pseudomonas

s.aureus, s.pneumonia

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6
Q

CAP

A

strep pneumoniae most common cause

influenza and other viruses also

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7
Q

aspiration pneumonia

A

high risk in intoxicated patients, acute stroke patients, those with impaired swallowing and septic patients with reduced consciousness

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8
Q

Diffuse parenchymal lung diseases

A

large group of conditions characterised by inflammation centres on the interstitial of alveolar walls

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9
Q

Causes of diffuse parenchymal lung diseases

A 
unknown cause
pneumoconioses
extrinsic allergic alveoli's
side effects of treatment
multisystem diseases
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10
Q

long term complications of DPLDs

A

cor pulmonale

from pulmonary hypertension

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11
Q

Lung cancer peak age group

A

50-60

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12
Q

lung cancer risk factors

A

cigarette smoking
industrial hazards
environmental exposure
genetic factors

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13
Q

what is the most common type of lung cancer

A

adenocarcinoma

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14
Q

other common types of lung cancer

A

ADENOCARCINOMA
SCC
Small cell carcinoma
large cell carcinoma

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15
Q

SCC in lung cancer

A

strong association with smoking
tends to be in the larger airways near the hilum
graded as well/moderately/poorly differentiated

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16
Q

Adenocarcinoma in lung cancer

A

increasing incidence
most common type of cancer in non smokers (EGFR mutations??)
tends to arise in smaller peripheral airways
graded as well/moderately/poorly differentiated

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17
Q

Small cell carcinoma

A

strongest association with smoking
usually central location
highly aggressive tumour
not graded

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18
Q

Large cell carcinoma

A

undifferentiated carcinomas that can’t be otherwise categorised microscopically

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19
Q

how is tissue sampling and diagnosis of lung cancer done

A

central lesions - bronchoscopy

peripheral lesion - CT guided sampling

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20
Q

staging of lung cancer

A

TNM system

CT or PET/PET-CT imaging

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21
Q

symptoms and signs of lung cancer

A 
cough
haemoptysis
stridor/wheeze
hoarse voice
breathlessness
chest wall pain
no-resolving pneumonia

SVC obstruction - facial swelling

B symptoms

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22
Q

Pancoast tumours

A

cancer in the apex of the lung which involves the 8th cervical and 1st and 2nd thoracic nerves

may manifest as pan coasts syndrome - shoulder pain radiating in an under distribution down the arm or as Horner’s syndrome

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23
Q

Horner’s syndrome

A

enophthalmos
ptosis
mitosis
anhidrosis

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24
Q

Paraneoplastic syndromes

A

HYPERCALCAEMIA - production of a PTH related peptide which causes the release of calcium form the bones

SIADH - leads to inappropriate water reabsorption, cerebral oedema, drowsiness, confusion

ACTH secretion - cushing’s syndrome

Lambert Eaton myasthenia syndrome (LEMS) - typically associated with small cell carcinomas. autoantibodies block VGCC in he presynaptic membrane blocking ACh release.

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25
Q

Management of lung cancers

A

SCLC - highly aggressive, surgery has little role, chemotherapy, soon become chemoresistant

NSCLC - surgery is a possibility if disease stage is low and chemotherapy is also used

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26
Q

Mesothelioma

A

malignant tumour of the pleura associated with asbestos exposure

long latency period

most patients are men over 60 with breathlessness and chest pain, often with a pleural effusion

occupational history is important

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27
Q

Asbestosis

A

a type of DPLD
diffuse fibrosis of the lung parenchyma due to asbestos
need very high levels of asbestos exposure so this is rare
usually present with gradually worsening breathlessness which terminates in chronic respiratory failure

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28
Q

Signs and Symptoms of COPD

A 
Barrel chest
Tripod position, accessory muscle use
Red face (polycythaemia)
Hyper resonance
Tachypnoea
Reduced expansion
Wheeze
Signs of RHF/cor pulmonate
Chronic productive cough
Breathless at rest
Recurrent Infections
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29
Q

Causes of COPD

A 
SMOKING
alpha-1 antitrypsin
environmental/occupational hazards
IVDU
immunodeficiency
30
Q

COPD investigations

A

Spirometry
FBC (polycythaemia)
alpha-1 antitrypsin
ABG (T2RF)
CXR (hyperinflation, prominent pulmonary arteries, flattened hemidiaphragms)
ECG - P pulmonale, RVH, right axis deviation

31
Q

Acute management of an infective exacerbation of COPD

A 
BOSA
bronchodilators (salbutamol, ipratropium)
Oxygen
Steroids
Antibiotics
32
Q

Long term management of COPD

A

conservative - smoking cessation

medical - steroids, salbutamol, theophylline, sodium chromoglycate (mucolytic), LTOT

surgical - removal of bullae

33
Q

Signs of asthma

A 
tachypnoea
widespread polyphonic wheeze
reduced air entry
signs of atopy e.g. eczema
intermittent SOB
cough (often nocturnal)
sputum
34
Q

Triggers of asthma

A 
airborne substances
respiratory infections
exercise induced
cold air
air pollutants and irritants e.g. smoke
medications
emotion and stress
35
Q

investigations of asthma

A

serial peak flow

peak flow diary in the morning and evening and will see the diurnal variation

36
Q

management of asthma attack

A

OSHIT

oxygen
salbutamol
hydrocortisone
ipratropium
theophylline/magnesium sulphate
37
Q

Asthma BTS management guidelines

A
  1. Inhaled SABA as required
  2. add ICS 200-800microg/day
  3. add LABA
  4. increase ICS dose up to 2000microg/day
  5. daily steroid tablet
  6. refer patient for specialist care
38
Q

Presentation of PE

A 
dyspnoea - sudden onset
haemoptysis
tachycardia
elevated JVP
pleuritic chest pain
tachycardia/palpitations
39
Q

Causes of PE

A

DVT (70% from proximal thighs)

usually thrombus from veins of thigh or pelvis, embolisms via right heart into pulmonary arteries

40
Q

Risk factors for PE

A

SPASMODICAL

sex: female
pregnancy
age increasing
surgery
malignancy
oestrogen
DVT/PE history
immobility
colossal size
antiphospholipid antibodies
lupus anticoagulant
41
Q

investigations of PE

A

bedside - obs (sats, BP)
bloods - ABG (resp failure)
imaging - CTPA, CXR

WELLS SCORE to determine use of D-Dimer or not

42
Q

treatment of PE

A

oxygen
heparin
thrombolysis
warfarin/NOAC

43
Q

presentation of pulmonary effusion

A 
tachypnoea
possible coughing
hand signs
increased JVP
stony dullness on percussion
unilateral reduced expansion
SOB
pleuritic chest pain
tracheal deviation away from the effusion
44
Q

causes of transudate pleural effusion

A

heart failure
kidney failure
liver failure
fluid overload in general

45
Q

causes of exudate pleural effusion

A

malignancy
infection
inflammation
rheumatoid arthritis

46
Q

what is lights criteria for pleural effusion?

A

it is in exudate IF one or more of the following…

pleural fluid protein: serumfluid protein >0.5

pleural fluid LDH:serum LDH >0.6

pleural fluid LDH >2/3 the upper limit of normal serum

47
Q

risk factors of primary pneumothorax

A 
young athletes
tall people
marina's syndrome
smokers
age >55
48
Q

causes of secondary pneumothorax

A

COPD bullae rupture

ILD

49
Q

presentation of pneumothorax

A 
tachycardia
reduced expansion
hyperresonance
decreased TVF:VR
decreased breath sounds
tracheal deviation
SOB
pleuritic chest pain
sudden onset
50
Q

HAP organisms

A

gram negative

klebsiella
e.coli
pseudomonas

staph
haem

51
Q

CAP abx

A

amoxicillin

doxycycline

52
Q

HAP abx

A

gentamycin

53
Q

aspiration pneumonia abx

A

metronidazole

54
Q

symptoms of TB

A 
productive cough
haemoptysis
fever
weight loss
night sweats
55
Q

What needs to be asked about when considering a diagnosis of TB?

A

living conditions
recent contact
previous illness (latent TB)

56
Q

causes of reactivation of TB

A 
corticosteroids
HIV
malnutrition
age
end stage CKD
chemotherapy
57
Q

TB treatment

A

(6 months of therapy)
RIPE for 2
RI for 4

Rifampicin (hepatitis, stains body fluids pink)
Isoniazid (polyneuropathy at high doses0
Pyrazinamide (hepatitis)
Ethambutol (optic neuritis)

58
Q

difference between T1 and T2 respiratory failure

A

T1: hypoxia with normal or low CO2
T2: hypoxia and hypercapnia

59
Q

symptoms of hypoxia

A 
dyspnoea
restlessness
agitation
confusion
central cyanosis
polycythaemia
pulmonary hypertension
cor pulmonale
60
Q

symptoms of hypercapnia

A 
headache
peripheral vasodilation
tachycardia
bounding pulse
tremor/flap
papilloedema
confusion
coma
drowsiness
61
Q

causes of T1RF

A

VQ mismatch
hypoventilation
abnormal diffusion
R to L cardiac shunts

62
Q

causes of T2RF

A

pulmonary disease: asthma, COPD, pneumonia
reduced respiratory drive: sedatives, CNS tumour or trauma
neuromuscular disease: cervical cord lesion, poliomyelitis, GBS, diaphragm paralysis
thoracic wall disease: flail chest, kyphoscoliosis

63
Q

examples of VQ mismatch

A 
pneumonia
PE
emphysema
ARDS
pulmonary oedema
asthma
pulmonary fibrosis
64
Q

what is bronchiectasis

A

chronic inflammation of the bronchi and bronchioles leading to permanent dilatation and thinning of the airways

65
Q

symptoms of bronchiectasis

A

gradual onset
productive cough
SOB
chest pain

66
Q

causes of bronchiectasis

A

congenital: CF, young, primary ciliary dyskinesia

post infection: measles, pertussis, bronchiolitis, TB, pneumonia, HIV

other: obstruction, allergic, RA, UC, idiopathic, hypogammaglobulinaemia

67
Q

treatment of bronchiectasis

A

airway clearance techniques and mucolytics
antibiotics
bronchodilators
corticosteroids
surgery may be indicated in localised disease or to control severe haemoptysis

68
Q

what is cystic fibrosis?

A

an autosomal recessive disorder

defective airway surface liquid secretion, disposing the lung to pulmonary infections and bronchiectasis

69
Q

what are the signs and symptoms of cystic fibrosis

A

signs: cyanosis, finger clubbing, bilateral coarse crackles
neonate: failure to thrive, meconium ileum, rectal prolapse

children/YA: rest (wheeze, cough, infections, haemoptysis, pneumothorax, etc), GI (pancreatic insufficiency, gallstones, obstruction, cirrhosis), other (male infertility, osteoporosis, vasculitis, nasal polyps, sinusitis)

70
Q

signs and symptoms of interstitial lung disease

A 
abnormal breath sounds
abnormal CXR or HRCT
restrictive pulmonary spirometry with decreased DCLO
dyspnoea on exertion
non productive paroxysmal cough
abnormal breath sounds
71
Q

causes of ILD

A 
inhaled substances
drug induced
CI and AI disorders
infection
malignancy

T Year (18 decks)

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