Other notes Flashcards
What is pulmonary fibrosis?
Thickening and scarring of lung tissue, with gas exchange being affected
What type of lung disease is pulmonary fibrosis?
Restrictive
What are the causes of upper zone pulmonary fibrosis? (A TEA SHOP)
- ABPA (allergic broncho-pulmonary aspergillosis)
- TB
- Extrinsic allergic alveolitis
- Ankylosing Spondylitis
- Sarcoidosis
- Histiocytosis
- Occupational (silicosis, berylliosis)
- Pneumoconiosis (coal-worker’s)
- Can also be idiopathic
What drugs can cause pulmonary fibrosis?
- Nitrofurantoin (for UTIs)
- Methotrexate
- Amiodarone (for arrhythmias)
What are the symptoms of pulmonary fibrosis?
- Exertional dyspnoea
- Persistent non-productive cough
- Fatigue
What investigations are done for pulmonary fibrosis?
- Auscultation – bibasilar, fine end-inspiratory crackles or rales
- Pulmonary function tests – high/normal FEV1/FVC ratio (restrictive lung disease)
- HR CT is best form of imaging. - CXR may show reticular shadowing
How to treat pulmonary fibrosis?
- Antibiotics (bacterial interstitial pneumonia)
- Corticosteroids
What are the risk factors for a pneumothorax?
- Family history
- Slim, tall
- Smoker
- Male
- Marfan’s syndrome
What are the symptoms of a pneumothorax?
- Sudden, severe, and/or stabbing, ipsilateral pleuritic chest pain
- Dyspnoea
- Reduced, or absent breath sounds
- Hyper resonant percussion,
- Decreased fremitus on the ipsilateral side
Which way does the trachea deviate in tension pneumothorax and pleural effusion?
- PUSHES away from affected lung
Which way does the trachea deviate in collapse?
- PULLED towards affected lung §
What is seen on CXR for pneumothorax?
- Reduced/absent lung markings
- Changes in radiolucency – collection of air will appear darker
- Deep sulcus signs – dark and deep costophrenic angle on affected side
- Tracheal deviation in tension
What are respiratory causes of clubbing?
- Fibrotic lung disease e.g. idiopathic pulmonary fibrosis
- Chronic suppurative (pus producing) lung disease (bronchiectasis, chronic abscesses)
- Lung cancer (all except small cell)
What are the cardiac causes of clubbing?
- Infective endocarditis
- Atrial myxoma
- Congenital cyanotic heart disease
What are the gastro causes of clubbing?
- IBD (not IBS!)
- Coeliac disease
- Cirrhosis
What are other causes of clubbing?
- Thyroid acropachy
- Idiopathic/familial
What should be given in allergic reaction?
IM adrenaline
What medication should not be given in PAD?
Beta blockers
What are the classic features of venous ulcers?
- Red
- Oozing
- Irregular margins
- Shallow
What are the classic features of arterial ulcers?
- Pale
- Painful
- Punched out
- Well defined borders
What are the classic features of neuropathic ulcers?
- Over pressure areas (painless ulcers)
- Associated with sensory neuropathy
- Burning, tingling in legs
- Warm with good pulses
What are the symptoms of appendicitis?
- Progressive fever
- Anorexia (hamburger sign)
- Nausea, vomiting, diarrhoea, and/or constipation
- Initially, dull migratory periumbilical pain, after 4–24 hours, sharp RLQ pain with rebound tenderness
What are the signs of appendicitis?
- McBurney point tenderness: an area one-third of the distance from the right anterior superior iliac spine to the umbilicus (in the RLQ)
- Rovsing’s sign: deep palpation of the LLQ causes RLQ referred pain
What are the investigations for appendicitis?
- FBC: Raised CRP, Mild leucocytosis
- Urine analysis: useful to exclude pregnancy in women, renal colic and urinary tract infection.
- Abdominal and pelvic CT:
- Abnormal appendix (diameter >6 mm) identified or calcified appendicolith
- Wall thickening, wall enhancement, and inflammatory changes in the surrounding tissues.
What is the treatment for appendicitis?
- Appendicectomy
- Prophylactic intravenous antibiotics reduces wound infection rate
- What is sarcoidosis?
- Who is more likely to get sarcoidosis?
- Granulomatous inflammatory condition. Granulomas are nodules of inflammation full of macrophages.
- Women more likely, African people more likely
What are the symptoms of acute sarcoidosis?
- General: fever, malaise, lack of appetite, weight loss
- Pulmonary: dyspnea, cough, chest pain
- Extrapulmonary: arthritis, anterior uveitis, erythema nodosum
What are the pulmonary symptoms of chronic sarcoidosis?
- Dry cough, exertional dyspnoea
- Mild rales on pulmonary auscultation.
What are the extrapulmonary symptoms of chronic sarcoidosis?
- Peripheral lymph nodes
- Eyes: granulomatous uveitis, blurred vision
- Skin: Lupus pernio, Scar sarcoidosis
- Musculoskeletal; bone lesions
- Nervous system (neurosarcoidosis): cranial nerve palsy (7th cranial nerve palsy is the most common), diabetes insipidus, meningitis, hypopituitarism
What is Lupus pernio?
Pathognomonic, extensive, purple skin lesions on the nose, cheeks, chin, and/or ears
What is scar sarcoidosis?
Inflamed, purple skin infiltration and elevation of old scars or tattoos
What 2 syndromes are associated with sarcoidosis?
- Lofgren’s syndrome
- Heerfordt’s syndrome
- What are the symptoms of Lofgren’s syndrome?
- Which condition does it affect?
- Bilateral hilar lymphadenopathy (BHL)
- Erythema nodosum: primarily affects the extensor surface of the lower legs
- Polyarthralgia: symmetrical arthritis that primarily affects the ankles
- Fever
- Sarcoidosis
- What are the symptoms of Heerfordt’s syndrome?
- Which condition does it affect?
- Fever
- Parotitis
- Uveitis
- Facial palsy
What are the FBC findings for sarcoidosis?
- Raised serum ACE:screening test
- Hypercalcaemia
- Raised serum soluble interleukin 2 receptor
- Raised CRP and ESR
- Raised immunoglobulins
What are imaging findings for sarcoidosis?
- Chest X-ray shows hilar lymphadenopathy
- High resolution CT thorax shows hilar lymphadenopathy and pulmonary nodules
- MRI can show CNS involvement
- PET scan can show active inflammation in affected areas
- Tissue biopsy (gold standard): non caseating granulomas
- Spirometry: may show restrictive defect
What is the treatment for sarcoidosis?
- Asymptomatic: no treatment
- 1st line: Glucocorticoids (6-24 months)
- 2nd line: Methotrexate or azathioprine
- What is methotrexate given for?
- How often can methotrexate be given?
- What should be given with methotrexate?
- Chemotherapy and immunosuppressive agent
- Once a week
- Folic acidly the days methotrexate isn’t given on as it can lower folic acid levels.
- What is Wernicke’s encephalopathy?
- What are the features of this?
- What can it lead to?
- Result from thiamine deficiency due to alcohol excess
- Confusion
- Opthalmaplegia (disturbances of eye movements)
- Ataxia (difficulties with coordinated movements)
- Korsakoff’s syndrome
What are the features of korsakoff’s syndrome?
- Anterograde amnesia: unable to make new memories
- Retrograde amnesia: unable to recall past memories
- Confabulation: made-up stories fill in any gaps in memory.
- What is fat embolism?
- What are the causes of this?
- Entry of fat cells into the circulation
- Long bone fractures
- Orthopedic surgery
- Bone marrow transplant
- Sickle cell crises
What is the presentation of a fat embolus?
- Multiple fractures followed by early onset (within 24 hours) of hypoxia, dyspnea, and tachypnea
- Neurologic manifestations: acute confusional state and altered level of consciousness to seizures and focal deficits
- A petechial rash: only appears in about a third of cases.
- What Henoch-Schonlein Purpura?
- Who does it present in?
- What is it triggered by?
- IgA vasculitis that presents with a purpuric rash affecting the lower limbs and buttocks in children.
- Most common in children under the age of 10.
- Upper airway infection or gastroenteritis.
- What are the symptoms of Henoch-Schonlein Purpura?
- What is the onset of these symptoms?
The 4 classic features are:
- Purpura (100%): palpable, non-blanching rash.
- Common sites: lower extremeities, buttocks, areas of pressure (from socks or clothing)
- Joint pain (75%): common in ankles and knees
- Abdominal pain (50%) : colicky abdominal pain, bloddy stools, N+V
- Renal involvement (50%) : signs and symptoms of nephritic syndrome
- 1-3 weeks after an infection
What is the treatment for Henoch-Schonlein Purpura?
Most cases of HSP are self-limiting and only require supportive care (pain management with NSAIDs), rest and adequate hydration.
Which type of infection leads to neutrophils to be raised?
Bacterial
Which type of infection leads to eosinophils to be raised?
Allergy and parasitic infection
Which type of infection leads to lymphocytes to be raised?
Chronic inflammation and acute viral infections
What leads to IgE to be raised?
Allergic asthma, malaria and type 1 hypersensitivity reactions
Which antibody is used to diagnose rheumatoid arthritis?
Anti-CCP antibody
Which antibody is used to diagnose SLE?
Anti nuclear antibodies (ANA) in particular antibodies to dsDNA
How to treat primary pneumothorax?
- If no SOB and there is a < 2cm rim of air then no treatment required.
- If SOB and/or there is a > 2cm rim of air, then aspirate.
- If aspiration fails twice, then chest drain.
How to treat secondary pneumothorax?
- If the patient is > 50 years old and the rim of air is > 2cm and/or the patient is SOB then so chest drain
- Otherwise aspiration should be attempted if the rim of air is between 1-2cm.
- If less than 1cm then the give oxygen and admit for 24 hours.
How to treat tension pneumothorax?
- Aspirate prior to CXR
2. Chest drain
- Where is chest aspirated?
- Where is chest drain placed?
- 2nd ICS mid clavicular line (also known as needle thoracostomy)
- 5th ICS mid axillary line
- What happens in ARDS?
- Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli.
What are the causes of ARDS?
- Traume
- Pneumonia
- Sepsis
- Shock
- Massive blood transfusion
What are the signs and symptoms of ARDS?
Dyspnoea, tachypnoea, bilateral basal crepitations, low oxygen saturations
How to diagnose ARDS?
- Acute onset (within 1 week of known risk factor)
- PCWP – pulmonary capillary wedge pressure <19 mmHg
- CXR – bilateral diffuse infiltrates
How to treat ARDS?
- Oxygenation/ventilation to treat the hypoxaemia
- General organ support e.g. vasopressors as needed.
- Treat underlying cause
What is atelectasis?
Common postoperative complication in which basal alveolar collapse can lead to respiratory difficulty
- What are the features of atelectasis?
- What is the menagement?
- Dyspnoea and hypoxaemia around 72 hours postoperatively
- Chest physiotherapy
