Clinical respiratory Flashcards
Clubbing grading
None visible
- Fluctuation and softening of nail beds only
Mild
- Loss of the normal angle between nailbed and fold (<165°)
- Schamroth’s window obliterated
Moderate
- Increased convexity of the nailfold
- Clubbing visible at a glance
Gross
- Thickening of entire distal end of finger (drumstick)
Hypertrophic osteomyopathy
- DIP and MCP joints swollen and painful
Silicosis
Risk factors:
- Exposure to brick and stone dust
Features:
- Lung fibrosis - upper lobe
- Pulmonary nodules -
Asbestosis
The range of lung disease caused by exposure to asbestos
Latent period of 20-30 years
Death is typically due to cor pulmonale or asbestos-associated cancers
Features:
- Pleural plaques
- Pulmonary fibrosis - lower lobe
- Mesothelioma or carcinoma
Investigations:
- Imaging e.g. CXR, CT
- PFTs - decreased VC, TLC, KLCO
- Biopsy to isolate asbestos fibres
Bronchial carcinoid tumours
Rare neuroendocrine tumours which can secrete active substances
- May not present with carcinoid syndrome
- Typically recurrent haemoptysis + segmental
collapse
Epidemiology:
- 1-2% of all lung cancers
- 15% metastasise
- M = F
- Presents c. 45 years
Features:
- Mostly endobronchial
- Wheezing
- Haemoptysis
- Chronic cough
- Segmental lung collapse
Investigation
- Imaging incl. CXR and CT
- Blood chromogranin A levels
- Urinary 5-hydroxyindoleacetic acid levels
- Bronchoscopy + biopsy
Chronic pulmonary aspergillosis
A long-term infection of the lungs by Aspergillus fumigatus
- Immunocompetent
- Can have coexisting aspergilloma
- Underlying respiratory disease
Features:
- Chronic exposure
- SOB
- Cough incl haemoptysis
- Fatigue
Investigations:
- Bloods
- High Aspergillus precipitins
- Sputum
- PCR, microscopy
- Can proceed to BAL
- Imaging
- CXR, CT thorax
Management:
- Monitoring
- Resection of aspergilloma, particularly if having significant haemoptysis
- Oral itraconazole
Allergic bronchopulmonary aspergillosis
Combined type I and type III hypersentivity reaction to Aspergillus colonisation
- Underlying asthma or CF
- Colonisation
Features:
- Cough
- Wheeze
- Sputum plugging
- Worsening asthma control
Investigations:
- Bloods
- Eosinophilia
- Raised Aspergillus precipitins
+ IgE
- Imaging
- CXR - fleeting infiltrates
- HRCT
Management:
- Oral steroids
Cough-variant asthma
Asthma characterised by airway inflammation but minimal bronchoconstriction (therefore no wheeze)
Features:
- Chronic cough which is worse in the cold, morning, after exercise
Investigations:
- PFTs normal
- No diurnal variation in peak flow
Management:
- Trial of 2/12 ICS or short course of oral steroids
- Usually no response to bronchodilators
Pulmonary hypertension
Mean pulmonary artery pressure >25mmHg at rest, measured via right heart catheterisation
Aetiology:
- Group 1 = idiopathic, CTD
- Group 2 = left heart disease
- Group 3 = lung disease
- Group 4 = CTEPH
- Group 5 = all others
Features:
- SOBOE
- Chest pain
- Syncope
- Peripheral cyanosis
- Small volume pulse
- Raised JVP with prominant A wave
- Parasternal (RV) heave
Investigations:
- CXR - prominent arteries
- ECG - RVH, RAD
- Echo - estimate PAP via TR, RV dilatation and impairment
- RH catheterisation - diagnostic
Management:
- In all cases, diuretics + anticoagulation
- Bilateral lung/heart transplantation in a subset of severe disease
- Group 1
- Endothelin antagonists e.g.
bosentan
- Prostanoids e.g. iloprost
- PDE inhibitors e.g. sildenafil
- Group 4
- Pulmonary endarterectomy
Silicosis
Occupational lung disease resulting from exposure to crystalline silica
- Stonemasons, slate miners, ceramics workers
- Silica is 10x more fibrosing than coal dust
Features:
- Progressive SOB, dry cough, etc.
- Upper lobe-predominant fibrosis
- Pulmonary nodules
- Increased risk of pulmonary TB
Management:
- Progressive disease despite cessation of exposure
Upper lobe fibrosis
Ankylosing spondylitis
Tuberculosis
Sarcoidosis
Extrinsic allergic alveolitis
Silicosis
Allergic bronchopulmonary aspergillosis
Post-radiotherapy
Yellow nails syndrome
A syndrome of abnormal lymphatic drainage
Features:
- Grossly thickened yellow nails
- Lymphoedema
- Bronchiectasis
- Small bilateral pleural effusions
