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
Bilateral hilar lymphadenopathy
Sarcoidosis
TB
Malignancy (lymphoma)
Pneumoconiosis
Fungi
Investigations for sarcoidosis
Clinical diagnosis, but tests to perform on anyone who is presenting with breathlessness;
Bedside- observations, cardiorespiratory examination, ECG, urine dipstick (kidney involvement), ophthalmoscopy (eye involvement)
Bloods- FBC UE LFT ESR CRP bone profile (hypercalcaemia in 10%)
Imaging- CXR, bronchoscopy with ultrasound guided biopsy of mediastinal lymph nodes (gold standard), USS of abdomen for other organ involvement, TTE (cardiac involvement)
Empyema CXR
lenticular crescentic opacity
Simple manoeuvres that can open airway
head tilt / chin lift
jaw thrust: preferred if concern about cervical spine injury
Oropharyngeal airway
Easy to insert and use
No paralysis required
Ideal for very short procedures
Most often used as bridge to more definitive airway
Laryngeal mask
Widely used
Very easy to insert
Device sits in pharynx and aligns to cover the airway
Poor control against reflux of gastric contents
Paralysis not usually required
Commonly used for wide range of anaesthetic uses, especially in day surgery
Not suitable for high pressure ventilation (small amount of PEEP often possible)
Tracheostomy
Reduces the work of breathing (and dead space)
May be useful in slow weaning
Percutaneous tracheostomy widely used in ITU
Dries secretions, humidified air usually required
Endotracheal tube
Provides optimal control of the airway once cuff inflated
May be used for long or short term ventilation
Errors in insertion may result in oesophageal intubation (therefore end tidal CO2 usually measured)
Paralysis often required
Higher ventilation pressures can be used
