Respiratory Pathology Flashcards
What is COPD made up of?
chronic bronchitis
emphysema
COPD spirometry
obstructive
Long term complications of COPD
cor pulmonale
from pulmonary hypertension
CURB-65 score
confusion urea >7 RR >30 BP <90/60 Age >65
HAP
occurs 2 days or more after admission
gram negative bacteria: klebsiella, e.coli, pseudomonas
s.aureus, s.pneumonia
CAP
strep pneumoniae most common cause
influenza and other viruses also
aspiration pneumonia
high risk in intoxicated patients, acute stroke patients, those with impaired swallowing and septic patients with reduced consciousness
Diffuse parenchymal lung diseases
large group of conditions characterised by inflammation centres on the interstitial of alveolar walls
Causes of diffuse parenchymal lung diseases
unknown cause pneumoconioses extrinsic allergic alveoli's side effects of treatment multisystem diseases
long term complications of DPLDs
cor pulmonale
from pulmonary hypertension
Lung cancer peak age group
50-60
lung cancer risk factors
cigarette smoking
industrial hazards
environmental exposure
genetic factors
what is the most common type of lung cancer
adenocarcinoma
other common types of lung cancer
ADENOCARCINOMA
SCC
Small cell carcinoma
large cell carcinoma
SCC in lung cancer
strong association with smoking
tends to be in the larger airways near the hilum
graded as well/moderately/poorly differentiated
Adenocarcinoma in lung cancer
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
Small cell carcinoma
strongest association with smoking
usually central location
highly aggressive tumour
not graded
Large cell carcinoma
undifferentiated carcinomas that can’t be otherwise categorised microscopically
how is tissue sampling and diagnosis of lung cancer done
central lesions - bronchoscopy
peripheral lesion - CT guided sampling
staging of lung cancer
TNM system
CT or PET/PET-CT imaging
symptoms and signs of lung cancer
cough haemoptysis stridor/wheeze hoarse voice breathlessness chest wall pain no-resolving pneumonia
SVC obstruction - facial swelling
B symptoms
Pancoast tumours
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
Horner’s syndrome
enophthalmos
ptosis
mitosis
anhidrosis
Paraneoplastic syndromes
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.
Management of lung cancers
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
Mesothelioma
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
Asbestosis
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
Signs and Symptoms of COPD
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
Causes of COPD
SMOKING alpha-1 antitrypsin environmental/occupational hazards IVDU immunodeficiency
COPD investigations
Spirometry
FBC (polycythaemia)
alpha-1 antitrypsin
ABG (T2RF)
CXR (hyperinflation, prominent pulmonary arteries, flattened hemidiaphragms)
ECG - P pulmonale, RVH, right axis deviation
Acute management of an infective exacerbation of COPD
BOSA bronchodilators (salbutamol, ipratropium) Oxygen Steroids Antibiotics
Long term management of COPD
conservative - smoking cessation
medical - steroids, salbutamol, theophylline, sodium chromoglycate (mucolytic), LTOT
surgical - removal of bullae
Signs of asthma
tachypnoea widespread polyphonic wheeze reduced air entry signs of atopy e.g. eczema intermittent SOB cough (often nocturnal) sputum
Triggers of asthma
airborne substances respiratory infections exercise induced cold air air pollutants and irritants e.g. smoke medications emotion and stress
investigations of asthma
serial peak flow
peak flow diary in the morning and evening and will see the diurnal variation
management of asthma attack
OSHIT
oxygen salbutamol hydrocortisone ipratropium theophylline/magnesium sulphate
Asthma BTS management guidelines
- Inhaled SABA as required
- add ICS 200-800microg/day
- add LABA
- increase ICS dose up to 2000microg/day
- daily steroid tablet
- refer patient for specialist care
Presentation of PE
dyspnoea - sudden onset haemoptysis tachycardia elevated JVP pleuritic chest pain tachycardia/palpitations
Causes of PE
DVT (70% from proximal thighs)
usually thrombus from veins of thigh or pelvis, embolisms via right heart into pulmonary arteries
Risk factors for PE
SPASMODICAL
sex: female pregnancy age increasing surgery malignancy oestrogen DVT/PE history immobility colossal size antiphospholipid antibodies lupus anticoagulant
investigations of PE
bedside - obs (sats, BP)
bloods - ABG (resp failure)
imaging - CTPA, CXR
WELLS SCORE to determine use of D-Dimer or not
treatment of PE
oxygen
heparin
thrombolysis
warfarin/NOAC
presentation of pulmonary effusion
tachypnoea possible coughing hand signs increased JVP stony dullness on percussion unilateral reduced expansion SOB pleuritic chest pain tracheal deviation away from the effusion
causes of transudate pleural effusion
heart failure
kidney failure
liver failure
fluid overload in general
causes of exudate pleural effusion
malignancy
infection
inflammation
rheumatoid arthritis
what is lights criteria for pleural effusion?
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
risk factors of primary pneumothorax
young athletes tall people marina's syndrome smokers age >55
causes of secondary pneumothorax
COPD bullae rupture
ILD
presentation of pneumothorax
tachycardia reduced expansion hyperresonance decreased TVF:VR decreased breath sounds tracheal deviation SOB pleuritic chest pain sudden onset
HAP organisms
gram negative
klebsiella
e.coli
pseudomonas
staph
haem
CAP abx
amoxicillin
doxycycline
HAP abx
gentamycin
aspiration pneumonia abx
metronidazole
symptoms of TB
productive cough haemoptysis fever weight loss night sweats
What needs to be asked about when considering a diagnosis of TB?
living conditions
recent contact
previous illness (latent TB)
causes of reactivation of TB
corticosteroids HIV malnutrition age end stage CKD chemotherapy
TB treatment
(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)
difference between T1 and T2 respiratory failure
T1: hypoxia with normal or low CO2
T2: hypoxia and hypercapnia
symptoms of hypoxia
dyspnoea restlessness agitation confusion central cyanosis polycythaemia pulmonary hypertension cor pulmonale
symptoms of hypercapnia
headache peripheral vasodilation tachycardia bounding pulse tremor/flap papilloedema confusion coma drowsiness
causes of T1RF
VQ mismatch
hypoventilation
abnormal diffusion
R to L cardiac shunts
causes of T2RF
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
examples of VQ mismatch
pneumonia PE emphysema ARDS pulmonary oedema asthma pulmonary fibrosis
what is bronchiectasis
chronic inflammation of the bronchi and bronchioles leading to permanent dilatation and thinning of the airways
symptoms of bronchiectasis
gradual onset
productive cough
SOB
chest pain
causes of bronchiectasis
congenital: CF, young, primary ciliary dyskinesia
post infection: measles, pertussis, bronchiolitis, TB, pneumonia, HIV
other: obstruction, allergic, RA, UC, idiopathic, hypogammaglobulinaemia
treatment of bronchiectasis
airway clearance techniques and mucolytics
antibiotics
bronchodilators
corticosteroids
surgery may be indicated in localised disease or to control severe haemoptysis
what is cystic fibrosis?
an autosomal recessive disorder
defective airway surface liquid secretion, disposing the lung to pulmonary infections and bronchiectasis
what are the signs and symptoms of cystic fibrosis
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)
signs and symptoms of interstitial lung disease
abnormal breath sounds abnormal CXR or HRCT restrictive pulmonary spirometry with decreased DCLO dyspnoea on exertion non productive paroxysmal cough abnormal breath sounds
causes of ILD
inhaled substances drug induced CI and AI disorders infection malignancy
