Resp Flashcards
What is Allergic bronchopulmonary aspergillosis
Allergic bronchopulmonary aspergillosis results from an allergy to Aspergillus spores. In the exam questions often give a history of bronchiectasis and eosinophilia.
What are the features of allergic bronchopulmonary aspergillosis
bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma
bronchiectasis (proximal)
Investigation results in allergic bronchopulmonary aspergillosis
eosinophilia
flitting CXR changes
positive radioallergosorbent (RAST) test to Aspergillus
positive IgG precipitins (not as positive as in aspergilloma)
raised IgE
Management of allergic bronchopulmonary aspergillosis
oral glucocorticoids
itraconazole is sometimes introduced as a second-line agent
Where do you normally see Klebsiella pneumonia
Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics
Features of Klebsiella pneumonia
more common in alcoholic and diabetics
may occur following aspiration
‘red-currant jelly’ sputum
often affects upper lobes
Churg-Strauss Features
asthma
blood eosinophilia (e.g. > 10%)
paranasal sinusitis
mononeuritis multiplex
pANCA positive in 60%
Features of sarcoidosis
acute: erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia
insidious: dyspnoea, non-productive cough, malaise, weight loss
ocular: uveitis
skin: lupus pernio
hypercalcaemia
High risk characteristics for pneumothorax
haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax
Sarcoidosis stages by cxr signs
Stage 1 - bilateral hilar lymphadenopathy
Stage 2 - bhl & infiltrates
Stage 3 - infiltrates
Stage 4 - fibrosis
Fibrosis in lower zones causes
Idiopathic pulmonary fibrosis
Connective tissue disorders
Drugs - amiodarone, bleomycin & methotrexate
Asbestosis
Fibrosis in upper zones causes
Hypersensitivity pneumonitis
Coal workers pneumoconiosis
Silicosis
Sarcoidosis
Ankylosing spondylitis
TB
Radiation
Which drugs can precipitate Churg-Strauss
Montelukast
Bronchiectasis management
Physical training - inspiratory muscles
Postural drainage
Antibiotics for exacerbations - long term in severe cases
Bronchodilators for some
Immunisations
Surgery for some
Bronchiectasis most common organisms
Haemophilus influenza
Pseudomonas aeruginosa
Klebsiella
Strep pneumonia
Causes of raised transfer factor
Asthma
Pulmonary haemorrhage (goodpastures, granulomatosis with polyangitis)
Left to right shunts
Polycythaemia
Hyperkinetic states
Male
Exercise
Causes of lower transfer factor
Pulmonary fibrosis
Pneumonia
PE
Pulmonary oedema
Emphysema
Anaemia
Low cardiac output
What is transfer factor
The rate at which a gas will diffuse from alveoli to blood. Uses carbon monoxide to test.
What is Lofgren’s syndrome
An acute sarcoidosis - bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia
Young females
Excellent prognosis
Prevention of acute mountain sickness
Acetazolamide
Mechanism of high altitude pulmonary oedema (HAPE)
Hyperbaric hypoxia -> uneven hypoxic pulmonary vasoconstriction-> uneven blood flow in lungs -> areas of lung with more blood experience raise in cap pressure -> more fluid leakage
Classical pulmonary oedema features
Mechanism of high altitude cerebral oedema (HACE)
Hypoxia -> cerebral vasodilation -> elevated cerebral blood volume
Also - hypoxia = increase in permeability of blood brain barrier and capillaries in brain more leaky
SX - headache, ataxia & papilloedema
Management of HACE
Descent
Dex
Management of HAPE
descent
Nifedipine
Dex
Acetazolamide
O2
How does varenicline work?
Nicotinic receptor partial agonist
Start one week before target stop date
12 week course
Side effect - nausea, headache, insomnia
How does bupropion work?
Norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist
1-2 week before target stop date
Small risk of seizure (1 in 1000)
Not in epilepsy, pregnancy, eating disorders
Alpha 1 antitrypsin deficiency genetics
Chromosome 14
Autosomal recessive/co-dominant
Normal PiMM
Heterozygous PiMZ
Homo PiSS - 50% normal level
Homo PiZZ - 10% normal
What is catamenial pneumothorax?
3-6% of spontaneous pneumothorax in menstruating women - thought to be due to endometriosis in the thorax
What are the obstructive lung diseases
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
What pulmonary function test results do you get with the obstructive lung diseases
FEV1 - significantly reduced
FVC - reduced or Normal
FEV1% - reduced
What are the restrictive lung diseases?
Pulmonary fibrosis
Asbestosis
Sarcoidosis
ARDS
Kyphoscoliosis
Obseity
Neuromuscular disorders
Paraneoplastic features of small cell lung cancer
ADH- hyponatraemia
ACTH - Cushings - hypokalaemic alkalosis
Lambert-Eaton - myasthenic like syndrome
Paraneoplastic of squamous cell lung cancer
PTH related peptide secretion
Clubbing
HPOA
Lung carcinoid features
Age 40-50
Not smoking
Slow growing, long hx of symptoms.
Centrally located, not seen on cxr
Cherry red ball on bronch
Features of ARDS
Dyspnoea
Bilateral lung crackles
Low oxygen
Causes of bilateral hilar lymphadenopathy
Sarcoidosis
TB
Lymphoma
Pneumoconiosis - berylliosis
Fungi - histoplasmosis
Diagnostic test for OSA
Polysomnography
How long do you anticoagulate an unprovoked PE?
6 months
