Respiratory

Question 1

Allergic Bronchopulmonary Aspergillosis

(Clinical S&S, Pathophysio, Ix, Management)

Answer 1

• Bronchiectasis + Eosinophilia
• Type 1 Hypersensitivity to Aspergillus fumigatus
• Aspergillus skin-prick test (most specific investigation)
• +ve IgG precipitins
• Sputum culture for aspergillus +ve
• 45-degree branches
• 1st line: Steroids
  2nd line: Add itraconazole

Question 2

Pneumothorax

(Primary vs Secondary, Tension vs no tension, Estimated size of pneumothorax, Management for primary vs secondary, Recurrent pneumothorax)

Answer 2

Primary pneumothorax: No underlying lung disease
Secondary pneumothorax: Has underlying lung disease (eg COPD)

Tension pneumothorax - immediate needle thoracocentesis. Don’t wait for CXR
No tension pneumothorax - CXR first.

Size of pneumothorax - Increases by 15% every 1cm interpleural distance

Management:
- Primary
- <2cm asymptomatic - Home
- >2cm or symptomatic - needle aspiration
- No improvement post aspiration - chest drain
- If discharged, will need 2-4 week follow up
- Secondary
- <1cm - oxygen and admit for observation
- 1-2cm and asymptomatic - needle aspiration
- >2cm or symptomatic - chest drain
- All patients must be observed for at least 24 hours

Recurrent pneumothorax
- CT Scan
- +/- video assisted thoracoscopy