OTHERS Flashcards
What is ANCA associated vasculitis?
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
Whats the aetiology of eosinophilic granulomatosis with polyangiitis?
Genetics - HLA-DRB1 and HLA-DRB4
Medications e.g. montelukast, inhaled corticosteroids and omalizumab
What are the phases of eosinophilic granulomatosis with polyangiitis?
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.
What are the clinical features of eosinophilic granulomatosis?
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
What is granulomatosis with polyangiitis?
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.
What is Kartagener’s syndrome?
aka primary ciliary dyskinesia
Immobile cilia which causes bronchiectasis, recurrent sinusitis, subfertility and dextrocardia
What is a lung abscess?
A well circumscribed infection within the lung parenchyma
What causes lung abscesses?
Commonly - secondary to aspiration pneumonia
Others - haematogenous spread, direct extension from emphysema, bronchial obstruction
What are the feature of a lung abscess?
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
How should you investigate a lung abscess?
CXR - fluid-filed space seen within an area of consolidation
Sputum and blood cultures
How do you manage a lung abscess?
IV antibiotics
Percutaneous drainage if not resolving or even surgical resectin
What is found in the superior mediastinum?
Superior vena cava
Brachiocephalic veins
Arch of aorta
Thoracic duct
Trachea
Oesophagus
Thymus
Vagus nerve
Left recurrent laryngeal nerve
Phrenic nerve
What is found in the anterior mediastinum?
Thymus remnants
Lymph nodes
Fat
What is found in the middle mediastinum?
Pericardium
Heart
Aortic root
Arch of azygos vein
Main bronchi
What is found in the posterior mediastinum?
Oesophagus
Thoracic aorta
Azygos vein
Thoracic duct
Vagus nerve
Sympathetic nerve trunks
Splanchnic nerves
NICE guidance for managing respiratory tract infections:
Who should immediate antibiotic prescribing be considered for?
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
What are the Centor criteria?
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
How long should acute otitis media last?
4 days
How long should acute sore throat/acute pharyngitis/acute tonsillitis last?
1 week
How long should the common cold last?
Up to 10 days
How long should acute rhinosinusitis last?
Up to 2 and a half weeks
How long should acute bronchitis/cough last?
Up to 3 weeks
What is Atelectasis?
Lung collapse
What is Caplan syndrome?
Lung nodules in the context of rheumatoid arthritis
What is dextrocardia?
A rare congenital heart defect when the heart points to the right
What is situs inversus?
a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions
Whats the syndrome called which involves dextrocardia?
Kartagener syndrome
What are common causes of lobar collapse?
lung cancer (the most common cause in older adults)
asthma (due to mucous plugging)
foreign body
What are the signs of lobar collapse on the CXR?
Tracheal deviation and mediastinal shift towards the side of collapse
Elevation of the hemidiaphragm
How is the time course of a cough decided?
Acute - <3 weeks
Subacute - 3-8 weeks
Chronic - >8 weeks
What are some causes of clubbing?
Cyanotic heart disease/CF
Lung cancer/Lung abscess
UC
Bronchiectasis
Benign mesothelioma
Infective endocarditis/IPF
Neurogenic tumours
GI disease
If there is a white out of a hemithorax on x-ray how can you determine the cause?
Look at the position of the trachea
Whats the likely cause of a trachea pulled towards a white-out on CXR?
Pneumonectomy
Complete lung collapse
Pulmonary hypoplasia
Whats the likely cause of a central trachea and a white-out on CXR?ne
Consolidation
Pulmonary oedema
Mesothelioma
Whats the likely cause of a trachea pushed away from a white-out on CXR?
Pleural effusion
Diaphragmatic hernia
Large thoracic mass
What would you see on CXR in mesothelioma?
Thickened pleurae (more than the thickness of a pencil line is suggestive)
What can cause bilateral hilar lymphadenopathy?
TB
Sarcoidosis
Lymphoma/other maliganncy
Pneumoconiosis
Fungi e.g. histoplasmosis
Who are lung abscesses most common in?
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.
