Resp 2 Flashcards
Eosinophilic granulomatosis with polyangiitis AKA Churg-Strauss
- What clinical features are seen?
- What medication can cause it?
- What is seen on investigation?
- asthma
- mononeuritis multiplex -> neuropathy to at least 2 separate nerve areas
- paranasal sinusitis
- LTRAs
3,
- eosinophilia
- pANCA positive
Extrinsic allergic alveolitis
- What is the main type of hypersensitivity seen?
- What clinical features are seen in the
a) acute
b) chronic phase - What is seen on investigation?
- How is it managed?
- type III
- a) 4-8hrs
- dyspnoea
- dry cough
- fever
b) weeks-months
- dyspnoea
- productive cough
- lethargy
- anorexia and weight loss
- NO eosinophilia
- IgG specific antibodies
- upper / mid zone fibrosis + “ground glass” appearance of pneumonitis
- bronchoalveolar lavage: lymphocytosis
4.
- avoidance of allergen
- glucocorticoids
Granulomatosis with polyangiitis AKA Wegener’s granulomatosis
- What clinical features are seen?
- What is seen on investigation?
- How is it managed?
- resp: dyspnoea, haemoptysis, epistaxis, nasal crusting
- rapidly-progressing glomerulonephritis
- vasculitic rash
- eye involvement (e.g. proptosis)
- Cranial nerve lesions
- cANCA (90%) pANCA (25%)
- renal biopsy: epithelial crescents in Bowman’s capsule
- steroids
- cyclophosphamide
Idiopathic Pulmonary Fibrosis
- Who is it commonly seen in?
- What clinical features are seen?
- What is seen on investigation?
NOTE: poor prognosis - ave. life expectancy 3-4 years
- 50-70 twice as common in males
- progressive exertional dyspnoea
- dry cough
exam: - clubbing
- fine crackles at the end of inspiration
- spirometry: restrictive picture
- TCLO: reduced (reflecting impaired gas exchange)
- CXR: ground glass appearance progressing to honeycombing
- CT required for diagnosis
Kartagener’s Syndrome
- What is its pathogenesis?
- What clinical features are seen?
- dynein arm defect results in immotile cilia
- dextrocardia
- bronchiectasis
- recurrent sinusitis
- sub fertility (diminished sperm motility / immotile cilia in fallopian tube)
- right testicle lower than left (AKA situs inversus - can also be seen in CF)
Klebsiella
- When is it more common?
- What clinical features are seen?
- alcoholics
- diabetics
- aspiration
- red currant jelly sputum
- affects upper lobes
- abscess formation / empyema
Lung abscess
- T/F often more than one microbial cause.
- What clinical features point towards lung abscess over a pneumonia?
- What is seen on investigation?
- true
- subacute I.e. developing over weeks/months
- foul-smelling sputum
exam: - dull percussion + bronchial breathing
- clubbing
- CXR: fluid filled space +/- air-fluid level
Lung fibrosis
State the causes for lung fibrosis in the
- upper zones
- lower zones
- coal worker’s pneumoconiosis
- hypersensitivity alveolitis (AKA extrinsic allergic alveolitis)
- ank. spond.
- TB
- sarcoidosis + silicosis
mnemonic: people with upper lobe fibrosis often require difficult CHATS
- idiopathic
- connective tissue disorders
- asbestosis
- drug induced: amiodarone, bleomycin, methotrexate
Inhaler Technique
- Describe the technique
- How long should you wait before attempting a second dose?
- remove cap and shake
breathe out gently
put mouthpiece in mouth and as you begin to breathe in (slow and deeply) press cannister down and continue slow + deep breath
hold breath for 10 seconds (or as long as is comfortable)
- 30 seconds
Acute bronchitis
- When do you consider antibiotic therapy?
- What antibiotics can be used?
- systemically very unwell
- co-morbidities
- CRP:
- > 20 offer played prescription
- > 100 offer immediate prescription
- amoxicillin or doxycycline
(but remember this cannot be used in children or pregnant women)
Mesothelioma
- What clinical features are seen?
- What investigations are carried out?
- dyspnoea
- weight loss
- chest wall pain
- clubbing
- 30% present as pleural effusion
- pleural CT
- effusion analysis (only helpful 20-30% of the time)
- local anaesthetic thorascopy (95% effective)
Microscopic polyangiitis
- What clinical features are seen?
- What is seen on investigation?
1.
- resp: dyspnoea, cough, haemoptysis
- renal impairment: raised creatinine, haematuria, proteinuria
- palpable purpuric rash
- mononeuritis multiplex
- systemic/general: fever, weight loss, myalgia, lethargy
- pANCA (50-75%)
cANCA (40%)
Non-invasive ventilation
- What are the key indications?
- Bilevel pressure support
a) What pressure is given on
i) inspiration
ii) expiration
b) What is the machines back up rate of breathing
- COPD with resp. acidosis pH 7.25-7.35 (<7.25 requires HDU care or higher)
- type II resp. failure with chest wall deformity, neuromuscular disease or obstructive sleep apnoea
- cardiogenic pulmonary oedema unresponsive to CPAP
2
a)
i) 10-15cm H2O
ii) 4-5cm H2O
b) 15 breaths per minute at ratio of 1:3 inspiration:expiration
Obstructive Sleep Apnoea
- What can be predisposing factors?
- What investigations are done?
- How is it managed?
- macroglossia: acromegaly, hypothyroidism, amyloidosis
- large tonsils
- obesity
- Marfan’s
- epworth sleepiness scale
- multiple sleep latency test (how long it takes to sleep in dark room)
- sleep studies: polysomnography
- weight loss
- CPAP
- intra-oral devices (if mild or CPAP not tolerated)
- if daytime sleepiness inform DVLA
Oxygen Dissociation Curve
- What will effect the oxygen dissociation curve?
NOTE:
if they are Low, the curve shifts Left and oxygen delivery is Lower
if they are Raised, the curve shifts to the Right, and oxygen delivery is RAISED
- CO2
- H+ (Acid)
- 2,3-DPG
- exercise
- temperature
CADET, face right
(If raised curve goes to right)
