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Respiratory > Pleural effusion, sarcoidosis, sleep apnoea, CO poisoning > Flashcards

Pleural effusion, sarcoidosis, sleep apnoea, CO poisoning Flashcards

1
Q

Pathology of sarcoidosis

A

Inflammatory response causes nodules around body
Triggers: family hx, prior infection with TB or Borrelia burgdorferri
T cells + macrophages form granulomas around body – particularly at hilar lymph nodes
Granulomas are non-caseating
Can converge to form Langhans giant cell, contains Schaumann bodies with calcium + protein deposits
Also contain asteroid bodies

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2
Q

Typical presentation of sarcoidosis

A 
Affects young adults, typically african american women 
Cough, SOB, chest pain
Systemic upset  
Erythema nodosum 
Uveitis 
Arrhythmias
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3
Q

Radiological findings for sarcoidosis + blood results

A

Bilateral hilar lymphadenopathy
Beading of fissure on CT
Bloods: high calcium (excess vit D from macrophages) + increased ACE (from T cells)

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4
Q

What is Lofgren syndrome?

A

Acute systemic presentation of sarcoidosis:
Erythema nodosum
Arthralgia
Bilateral hilar lymphadenopathy

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5
Q

Assessment of ?sarcoidosis

A

CXR or CT
Biopsy + detection of noncaseating granulomas
EBUS

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6
Q

Management of sarcoidosis

A

If asymptomatic, no treatment equired
Oral glucocorticoids if symptomatic/ progressive
Inhaled steroids if cough is present

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7
Q

What is Obstructive sleep apnoea syndrome (OSAS) ?

A

Excessive daytime sleepiness + irregular breathing at night

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8
Q

S+S of OSAS

A 
Excessive daytime sleepiness
Snoring
Witnessed apnoeas 
Feeling unrefreshed on waking 
Mood swings, personality changes, depression 
Nocturia/ bedwetting 
Restlessness, sudden arousal from sleep
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9
Q

Diagnosis of OSAS

A

Refer to sleep centre for diagnosis + treatment

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10
Q

When should pts be urgently referred with OSAS?

A

Symptoms suggestive of head + neck cancer, symptoms of daytime sleepiness while driving/ heavy machinery, signs of resp or heart failure or COPD

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11
Q

Management of OSAS

A

Weight loss, exercise, smoking cessation
Advise sleeping on side
Assess risk for dm + cvd
Monitor BP

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12
Q

Pathology of CO poisoning

A

Exposure to CO causes tissue hypoxia

Binds to Hb 240x more than O2

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13
Q

When can CO poisoning occur

A

Faulty fuel burning appliances
Engine exhausts
Smoke from burning buildings
BBQs + camping stoves used inside

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14
Q

S+S of CO poisoning

A 
Dizziness, vertigo
Flushing
Headache 
Muscle pains 
N+V
Confusion 
LOC
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15
Q

Management of CO poisoning

A

Measure exhaled CO using breath test
Take heparinised venous blood sample
Give 100% O2 using tight fitting mask

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16
Q

Types of pleural effusion

A

Transudative
Exudative
Lymphatic effusion

17
Q

Describe the pathology of a transudative effusion

A

Due to high hydrostatic pressure (BP) -> caused by pulmonary HTN secondary to HF

Or low oncotic pressure (decreased oncotic pressure causes fluid to leak from low to high concentrations, leaking into pleural space) -> low protein is caused by cirrhosis or nephrotic syndrome

Usually bilateral

18
Q

Describe the pathology of an exudative effusion

A

Inflammation of pulmonary capillaries, causing them to be leaky + leak fluid + large molecules
Usually unilateral

19
Q

Describe the pathology of a lymphatic effusion

A

Chylothorax

Caused by damage to lymphatic duct by surgery or tumours

20
Q

S+S of effusion

A

SOB
Pleuritic CP (particularly exudative due to malignancy or infection)
Cough

21
Q

Diagnosis of pleural effusion

A

Aspirate under US guidance (above rib to avoid neurovascular bundle under rib)
Do a serum LDH

22
Q

Assessing exudative vs transudative criteria with results of pleural fluid

A

Protein >30 = exudative
<30 = transudative
If between 25-35, use Light Criteria

Light Criteria:
Fluid is considered exudative if:
Pleural protein: serum protein ratio >0.5
Pleural LDH: Serum LDH >0.6
Pleural LDH > 2/3 upper limit of serum LDH

23
Q

What are the differentials for bilateral hilar lymphadenopathy?

A

Lymphoma
TB
Sarcoidosis

24
Q

What are the CXR findings for coal workers pneumoconiosis?

A

Round nodular opacities in varying sizes

More granular than silicosis

25
Q

Causes of transudate

A 
LVF 
Liver failure 
Kidney failure 
PE 
Atelectasis 
Malignancy 
Hypothyroidism 
Meig's syndrome
26
Q

Causes of exudate

A 
Infection = TB, parapneumonic, empyema 
Malignancy (mesothelioma) 
Rheumatological 
Connective tissue disease 
PE 
Rare: post-MI, pancreatitis, drugs, RT, yellow-nail syndrome
27
Q

When can a pleural effusion be detected on clinical examination?

A

> 500ml

28
Q

What does a pleural effusion look like on CXR?

A

Meniscus with complete whiteout, uniform in colour

Remaining lung is increased in size, may push mediastinum + ribs away

29
Q

What is the cause of a pleural effusion with apical infiltrates?

A

TB

30
Q

What is a loculated effusion?

A

Effusion that is in pockets, doesn’t drop down with gravity + no meniscus sign
Caused by empyema

31
Q

What is the pleural fluid aspirate sent for?

A

Biochemistry: LDH, protein, glucose
Infection: culture, TB culture
pH
Cytology: test for malignancy

32
Q

What pH is pleural fluid + empyema?

A 
>7.2 = normal pleural fluid 
<7.2 = empyema
33
Q

What pleural fluid results will be present for an empyema?

A

pH <7.2
Glucose <3.3 (low)
Bacteria present
LDH >1000

34
Q

What are the causes of blood stained pleural fluid?

A

Malignancy (most likely)
TB
PE
Trauma

35
Q

What conditions cause a lymphocytic effusion?

A

TB (most likely) or rheumatoid condition

36
Q

What colours are lymphocytic, transudate + exudate?

A 
Transudative = clear 
Exudative = cloudy 
Lymphatic = milky
37
Q

What is the max therapeutic aspiration?

A

1.5L max

38
Q

What type of pleural effusion is the only one that warrants full drainage?

A

Empyema

Respiratory (8 decks)

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