Pleural effusion, sarcoidosis, sleep apnoea, CO poisoning Flashcards
Pathology of sarcoidosis
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
Typical presentation of sarcoidosis
Affects young adults, typically african american women Cough, SOB, chest pain Systemic upset Erythema nodosum Uveitis Arrhythmias
Radiological findings for sarcoidosis + blood results
Bilateral hilar lymphadenopathy
Beading of fissure on CT
Bloods: high calcium (excess vit D from macrophages) + increased ACE (from T cells)
What is Lofgren syndrome?
Acute systemic presentation of sarcoidosis:
Erythema nodosum
Arthralgia
Bilateral hilar lymphadenopathy
Assessment of ?sarcoidosis
CXR or CT
Biopsy + detection of noncaseating granulomas
EBUS
Management of sarcoidosis
If asymptomatic, no treatment equired
Oral glucocorticoids if symptomatic/ progressive
Inhaled steroids if cough is present
What is Obstructive sleep apnoea syndrome (OSAS) ?
Excessive daytime sleepiness + irregular breathing at night
S+S of OSAS
Excessive daytime sleepiness Snoring Witnessed apnoeas Feeling unrefreshed on waking Mood swings, personality changes, depression Nocturia/ bedwetting Restlessness, sudden arousal from sleep
Diagnosis of OSAS
Refer to sleep centre for diagnosis + treatment
When should pts be urgently referred with OSAS?
Symptoms suggestive of head + neck cancer, symptoms of daytime sleepiness while driving/ heavy machinery, signs of resp or heart failure or COPD
Management of OSAS
Weight loss, exercise, smoking cessation
Advise sleeping on side
Assess risk for dm + cvd
Monitor BP
Pathology of CO poisoning
Exposure to CO causes tissue hypoxia
Binds to Hb 240x more than O2
When can CO poisoning occur
Faulty fuel burning appliances
Engine exhausts
Smoke from burning buildings
BBQs + camping stoves used inside
S+S of CO poisoning
Dizziness, vertigo Flushing Headache Muscle pains N+V Confusion LOC
Management of CO poisoning
Measure exhaled CO using breath test
Take heparinised venous blood sample
Give 100% O2 using tight fitting mask
Types of pleural effusion
Transudative
Exudative
Lymphatic effusion
Describe the pathology of a transudative effusion
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
Describe the pathology of an exudative effusion
Inflammation of pulmonary capillaries, causing them to be leaky + leak fluid + large molecules
Usually unilateral
Describe the pathology of a lymphatic effusion
Chylothorax
Caused by damage to lymphatic duct by surgery or tumours
S+S of effusion
SOB
Pleuritic CP (particularly exudative due to malignancy or infection)
Cough
Diagnosis of pleural effusion
Aspirate under US guidance (above rib to avoid neurovascular bundle under rib)
Do a serum LDH
Assessing exudative vs transudative criteria with results of pleural fluid
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
What are the differentials for bilateral hilar lymphadenopathy?
Lymphoma
TB
Sarcoidosis
What are the CXR findings for coal workers pneumoconiosis?
Round nodular opacities in varying sizes
More granular than silicosis
