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Pass Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What condition is Horner’s syndrome associated with?

A

Pancoast tumour

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2
Q

What are the features of Horner’s syndrome?

A

Miosis (small pupil)
Ptosis
Enopthalmos (sunken eye)
Anhidrosis (loss of sweating on one side)

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3
Q

What drastically increases the risk of pneumothorax in young otherwise healthy men?

A

Stopping smoking

Reduces risk from 10% to 0.1%

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4
Q

What test should be offered to all patients with TB?

A

HIV testing - latent TB is often pushed into active disease by immunosuppression

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5
Q

What lesions are often seen in TB?

A

Ghon focus

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6
Q

What is extrinsic allergic alveolitis?

A

A hypersensitivity to a variety of inhaled organic particles. It is thought to be caused by largely immune-mediated tissue damage (type III hypersensitivity), though there is some type IV hypersensitivity in the chronic stage

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7
Q

What is the presentation in acute EAA?

A

4-8 hours after exposure
SOB
Dry cough
Fever

Inspiratory crackles/squeaks

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8
Q

What is the presentation in chronic EAA?

A

Progressive exertional breathlessness as a result of pulm. fibrosis
There may be a history of acute episodes

Inspiratory crackles consistent with pulm. fibrosis

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9
Q

What would you see on chest x-ray in EAA?

A

Diffuse ground glass changes with small nodules (acute)

Pulmonary fibrosis in upper/mid zones (chronic)

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10
Q

What do you see on bloods in EAA?

A

Neutrophil leukocytosis

No eosinophilia

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11
Q

What do you see on pulmonary function testing in EAA?

A

A restrictive pattern

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12
Q

How do we manage EAA?

A

Allergen avoidance

Oral prednisolone may help recovery, but not prognosis

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13
Q

What is sarcoidosis?

A

A multisystem disorder of unknown aetiology characterised by non-caseating granulomas

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14
Q

What demographic are most likely to get sarcoidosis?

A

Young adults and people of African descent

HLA B8 gene associated

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15
Q

What are the features of sarcoidosis?

A

Acute:
Erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia

Insidious:
Dyspnoea, non-productive cough (due to pulm. fibrosis), malaise, weight loss

Hypercalcaemia
Lupus pernio
Anterior uveitis
Kidneys have granulomas (70%)

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16
Q

What would you see on chest x-ray in sarcoidosis?

A

A chest x-ray may show the following changes:
stage 0 = normal
stage 1 = bilateral hilar lymphadenopathy (BHL)
stage 2 = BHL + interstitial infiltrates
stage 3 = diffuse interstitial infiltrates only
stage 4 = diffuse fibrosis

17
Q

What would you see on tissue biopsy and spirometry in sarcoidosis?

A

Tissue biopsy: non-caseating granulomas

Spirometry: may show a restrictive defect

18
Q

How do we treat sarcoidosis?

A

If just erythema nordosum, arthralgia etc, no treatment, just NSAIDs for pain

If pulm. features/radiological features >6 months, oral steroids

19
Q

What is bronchiectasis?

A

A permanent dilation of the airways (bronchial wall) secondary to chronic infection/inflammation

20
Q

What are the causes of bronchiectasis?

A

Post-infective (localised bronchiectasis): TB/measles/pertussis/pneumonia

Generalised bronchiectasis:
CF
Ciliary dyskinetic syndromes (Young’s/Kartagener’s)
Immune deficiency (selective IgA)
RA
Bronchial obstruction (e.g. lung cancer/foreign body)

21
Q

What are the symptoms of bronchiectasis?

A 
Chronic cough
Sputum production (copious, mucopurulent)
50% have haemoptysis
Anaemia
Raised JVP
Clubbing
Cyanosis
Cor pulmonale
22
Q

Kartagener’s syndrome

A

Mutation in the gene coding for dynein
Causes ciliary dysmotility
Sinusitis
Infertility in men

23
Q

Young’s syndrome

A

Triad of bronchiectasis, rhinosinusitis and decreased fertility due to viscous mucus

24
Q

Investigations in bronchiectasis?

A 
Chest x-ray:
Tram lines (thickened bronchial walls)

High resolution CT:
‘Signet ring’ sign - thickened bronchial wall larger than adjacent blood vessel (looks like circles with white blob attached on a CT)

25
Q

Management of bronchiectasis?

A

Physiotherapy - twice daily postural drainage
Bronchodilators - if reversibility has been demonstrated with formal testing
Long-term rotating abx
IImmunisations

26
Q

Common organisms isolated in bronchiectasis?

A

H. influenzae (most common)
Pseudomonas aeruginosa
Klebsiella
Strep. pneum

27
Q

What is allergic bronchopulmonary aspergillosis?

A

This is the result of an allergy to aspergillus spores

It is most commonly seen in people with asthma or CF

28
Q

What are the features of bronchopulmonary aspergillosis?

A

Bronchoconstriction (wheeze, cough, dyspnoea)

Bronchiectasis

29
Q

What investigation findings would there be in ABPA?

A

Positive test for aspergillus spp. on skin biopsy
Blood test - raised IgE
Chest x-ray - transient x-ray changes

30
Q

How do we manage ABPA?

A

Steroids

Itraconazole sometimes as 2nd line agent

31
Q

What is an aspergilloma?

A

A mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to TB, lung cancer or CF)

32
Q

What are the features of aspergilloma?

A

Asymptomatic
Cough
Haemoptysis (75%)
Weight loss, fever, malaise

33
Q

What are the investigation findings in aspergilloma?

A

Dense opacity, crescent/halo sign may be present

34
Q

How do we treat aspergilloma?

A

Surgical resection

35
Q

Klebsiella pneumoniae

A

Most commonly causes a cavitating pneumonia in the upper lobes, particularly in diabetics + alcoholics

36
Q

Wegener’s granulomatosis (granulomatosis with polyangiitis)

A 
URTIs
Rapidly progressive glomerulonephritis
Saddle-shape nose deformity
Vasculitis rash
Proptosis

Treat with:
Steroids
Cyclophosphosphamide

Pass Medicine (24 decks)

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