Miscellaneous Respiratory Flashcards
What is hypersensitivity pneumonitis/extrinsic allergic alevolitis?
Hypersensitivity induced lung damage due to inhaled organic particles (bird fanciers lung, farmers lung, mushroom workers lung)
NB- not coal miners lung (that’s different)
Features of hypersensitivity pneumonitis
Lethargy, dyspnoea, productive cough, anorexia and weight loss
NB- weeks-months after exposure (may have dyspnoea, fever, dry cough a few hours after the exposure)
Investigations for hypersensitivity pneumonitis
Imaging- fibrosis
Lavage- lymphocytosis
Blood- no eosinophilia
Specific IgG antibodies
Management of hypersensitivity pneumonitis
Avoid precipitating factor
Oral glucocorticoids
Kartageners syndrome (primary ciliary dyskinesia)
Dectrocardia or complete situs invertus (quiet heart sounds or small volume complexes in lateral leads), inverted p wave lead I
Bronchiectasis
Recurrent sinusitis
Subfertility (male and female)
Causes of upper zone fibrosis
CHARTS
Coal workers pneumoconiosis
Histiocytosis/hypersensitivity pneumonitis
AS (think that there is an AS in charts, and AS affects spine which is an “upper” problem)
Radiation
TB
Silicosis/sarcoidosis
Causes of lower zone fibrosis
MAID
Most connective tissues diseases (eg. SLE, alpha 1 antitrypsin, except ankylosing spondylitis)
Asbestosis
IPF
Drug induced eg. Amiodarone, bleomycin, methotrexate
Obstructive sleep apnoea predisposing features
Obesity
Macroglossia- acromegaly, hypothyroidism, amyloidosis
Large tonsils
Marfan’s syndrome
Consequences of obstructive sleep apnoea
Daytime somnolence
Compensated respiratory alkalosis
Hypertension
Assessment of OSA
Epworth sleepiness scale
Sleep studies (polysomnography)
Management of OSA
Weight loss
CPAP
Intraoral device
Tell DVLA if causing daytime sleepiness
Surgery last resort
Respiratory manifestations of RA
Pulmonary fibrosis
Pleural effusion
Pulmonary nodules
Bronchiolitis obliterans
Drug SE’s- methotrexate pneumonitis
Caplans syndrome- fibrotic nodules with coal dust exposure
Infection secondary to immunosuppression
Pleurisy
Features of sarcoidosis
Acute- erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
Insidious- dyspnoea, non productive cough, malaise, weight loss, night sweats
Skin- lupus pernio
Hypercalcaemia
Lofgrens syndrome
Acute disease. Bilateral hilar lymphadenopathy, erythema nodosum, fever and poly arthralgia secondary to sarcoidosis
Heerfortds syndrome
Parotid enlargement, fever, uveitis secondary to sarcoidosis
Staging sarcoidosis
0- normal
1- BHL
2- BHL + interstitial infiltrates
3- diffuse interstitial infiltrates
4- diffuse fibrosis
Management of sarcoidosis
Conservative- lifestyle measures
Medical- Steroid indications;
-CXR stage 2/3 with symptoms
-hypercalcaemia
-eye heart or neuro involvement
If steroids unsuccessful, try methotrexate or azathioprine
Surgical- transplant for end-stage fibrosis
Features of silicosis
Fibrosis lung disease
Egg shell calcification of hilar lymph nodes
Lupus pernio
Raised purple plaque that appears on face is associated with sarcoidosis
Kartageners syndrome
Dextrocardia or complete situs invertus (quiet heart sounds, small volume complexes in lateral leads)
Bronchiectasis
Recurrent sinusitis
Subfertility
Causes of white shadows in CXR
consolidation
pleural effusion
collapse
pneumonectomy
specific lesions e.g. tumours
fluid e.g. pulmonary oedema
Causes of a white out with a central trachea
Consolidation
Pulmonary oedema (usually bilateral)
Mesothelioma
Relative contraindications of a chest drain
INR >1.3
Platelet count <75
Pulmonary bullae
Pleural adhesions
Yellow nail syndrome
Nail discolouration and dystrophy
Lymphoedema
Chronic respiratory disorder
