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RESPIRATORY > OTHERS > Flashcards

OTHERS Flashcards

1
Q

What is ANCA associated vasculitis?

A

An umbrella term for:
Microscopic polyangiitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis

These are small vessel vasculitis Ed’s that can affect arterioles, capillaries and venues
EGPA can also affect medium sized vessels

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2
Q

Whats the aetiology of eosinophilic granulomatosis with polyangiitis?

A

Genetics - HLA-DRB1 and HLA-DRB4
Medications e.g. montelukast, inhaled corticosteroids and omalizumab

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3
Q

What are the phases of eosinophilic granulomatosis with polyangiitis?

A

Prodromal phase: characterised by asthma and allergic rhinitis. Asthma occurs in 97% of patients. Usually precedes vasculitic phase by 3 years but may be delayed up to 10 years.
Eosinophilic phase: eosinophils infiltrate a variety of tissue without overt vasculitis. May see marked eosinophilia on full blood count.
Vasculitic phase: multi-system involvement with granulomatous inflammation. Can be life-threatening.

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4
Q

What are the clinical features of eosinophilic granulomatosis?

A

Adult-inset asthma is predominant

Lethargy
Flu-like illness
Weight loss
Fever
ENT involvement e.g. sinusitis, otitis media, nasal polyps, rhinitis
Lung symptoms - cough, dynspnoe, wheeze
Cardiac, cutaneous, neurological, kidney, GI and MSK involvement

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5
Q

What is granulomatosis with polyangiitis?

A

aka wegeners granulomatoiss

It is an autoimmune condition associated with a necrotizing granulomatous vasculitis, affecting both the upper and lower respiratory tract as well as the kidneys.

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6
Q

What is Kartagener’s syndrome?

A

aka primary ciliary dyskinesia
Immobile cilia which causes bronchiectasis, recurrent sinusitis, subfertility and dextrocardia

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7
Q

What is a lung abscess?

A

A well circumscribed infection within the lung parenchyma

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8
Q

What causes lung abscesses?

A

Commonly - secondary to aspiration pneumonia
Others - haematogenous spread, direct extension from emphysema, bronchial obstruction

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9
Q

What are the feature of a lung abscess?

A

Similar to pneumonia but more subacute and may have night sweats and weight loss
Fever, productive cough with foul-smelling sputum, chest pain, dyspnoea, clubbing

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10
Q

How should you investigate a lung abscess?

A

CXR - fluid-filed space seen within an area of consolidation
Sputum and blood cultures

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11
Q

How do you manage a lung abscess?

A

IV antibiotics
Percutaneous drainage if not resolving or even surgical resectin

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12
Q

What is found in the superior mediastinum?

A

Superior vena cava
Brachiocephalic veins
Arch of aorta
Thoracic duct
Trachea
Oesophagus
Thymus
Vagus nerve
Left recurrent laryngeal nerve
Phrenic nerve

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13
Q

What is found in the anterior mediastinum?

A

Thymus remnants
Lymph nodes
Fat

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14
Q

What is found in the middle mediastinum?

A

Pericardium
Heart
Aortic root
Arch of azygos vein
Main bronchi

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15
Q

What is found in the posterior mediastinum?

A

Oesophagus
Thoracic aorta
Azygos vein
Thoracic duct
Vagus nerve
Sympathetic nerve trunks
Splanchnic nerves

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16
Q

NICE guidance for managing respiratory tract infections:

Who should immediate antibiotic prescribing be considered for?

A

Children <2 with bilateral acute otitis media
Children with otorrhoea who have acute otitis media
Pt with acute sore throat, acute pharyngitis or acute tonsillitis when 3 or more Centor criteria are present
Pt deemed at risk of developing complications e.g. >65, pre-existing comorbidities, serious symptoms, systemically unwell

17
Q

What are the Centor criteria?

A

Criteria that, when 3 or more are present, there is a 40-60% chance its caused by group A beta-haemolytic streptococcus

  • presence of tonsillar exudate
  • tender anterior cervical
  • lymphadenopathy or lymphadenitis
  • history of fever
  • absence of cough
18
Q

How long should acute otitis media last?

A

4 days

19
Q

How long should acute sore throat/acute pharyngitis/acute tonsillitis last?

A

1 week

20
Q

How long should the common cold last?

A

Up to 10 days

21
Q

How long should acute rhinosinusitis last?

A

Up to 2 and a half weeks

22
Q

How long should acute bronchitis/cough last?

A

Up to 3 weeks

23
Q

What is Atelectasis?

A

Lung collapse

24
Q

What is Caplan syndrome?

A

Lung nodules in the context of rheumatoid arthritis

25
Q

What is dextrocardia?

A

A rare congenital heart defect when the heart points to the right

26
Q

What is situs inversus?

A

a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions

27
Q

Whats the syndrome called which involves dextrocardia?

A

Kartagener syndrome

28
Q

What are common causes of lobar collapse?

A

lung cancer (the most common cause in older adults)
asthma (due to mucous plugging)
foreign body

29
Q

What are the signs of lobar collapse on the CXR?

A

Tracheal deviation and mediastinal shift towards the side of collapse
Elevation of the hemidiaphragm

30
Q

How is the time course of a cough decided?

A

Acute - <3 weeks
Subacute - 3-8 weeks
Chronic - >8 weeks

31
Q

What are some causes of clubbing?

A

Cyanotic heart disease/CF
Lung cancer/Lung abscess
UC
Bronchiectasis
Benign mesothelioma
Infective endocarditis/IPF
Neurogenic tumours
GI disease

32
Q

If there is a white out of a hemithorax on x-ray how can you determine the cause?

A

Look at the position of the trachea

33
Q

Whats the likely cause of a trachea pulled towards a white-out on CXR?

A

Pneumonectomy
Complete lung collapse
Pulmonary hypoplasia

34
Q

Whats the likely cause of a central trachea and a white-out on CXR?ne

A

Consolidation
Pulmonary oedema
Mesothelioma

35
Q

Whats the likely cause of a trachea pushed away from a white-out on CXR?

A

Pleural effusion
Diaphragmatic hernia
Large thoracic mass

36
Q

What would you see on CXR in mesothelioma?

A

Thickened pleurae (more than the thickness of a pencil line is suggestive)

37
Q

What can cause bilateral hilar lymphadenopathy?

A

TB
Sarcoidosis
Lymphoma/other maliganncy
Pneumoconiosis
Fungi e.g. histoplasmosis

38
Q

Who are lung abscesses most common in?

A

IVDU
Immunocompromised hosts (HIV-AIDS, post-transplantation, or those receiving prolonged immune suppressive therapy)
Patients with high risk for aspiration: seizures, bulbar dysfunction, alcohol intoxication, and cognitive impairment.

RESPIRATORY (22 decks)

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