Respiratory Flashcards
What condition is Horner’s syndrome associated with?
Pancoast tumour
What are the features of Horner’s syndrome?
Miosis (small pupil)
Ptosis
Enopthalmos (sunken eye)
Anhidrosis (loss of sweating on one side)
What drastically increases the risk of pneumothorax in young otherwise healthy men?
Stopping smoking
Reduces risk from 10% to 0.1%
What test should be offered to all patients with TB?
HIV testing - latent TB is often pushed into active disease by immunosuppression
What lesions are often seen in TB?
Ghon focus
What is extrinsic allergic alveolitis?
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
What is the presentation in acute EAA?
4-8 hours after exposure
SOB
Dry cough
Fever
Inspiratory crackles/squeaks
What is the presentation in chronic EAA?
Progressive exertional breathlessness as a result of pulm. fibrosis
There may be a history of acute episodes
Inspiratory crackles consistent with pulm. fibrosis
What would you see on chest x-ray in EAA?
Diffuse ground glass changes with small nodules (acute)
Pulmonary fibrosis in upper/mid zones (chronic)
What do you see on bloods in EAA?
Neutrophil leukocytosis
No eosinophilia
What do you see on pulmonary function testing in EAA?
A restrictive pattern
How do we manage EAA?
Allergen avoidance
Oral prednisolone may help recovery, but not prognosis
What is sarcoidosis?
A multisystem disorder of unknown aetiology characterised by non-caseating granulomas
What demographic are most likely to get sarcoidosis?
Young adults and people of African descent
HLA B8 gene associated
What are the features of sarcoidosis?
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%)
What would you see on chest x-ray in sarcoidosis?
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
What would you see on tissue biopsy and spirometry in sarcoidosis?
Tissue biopsy: non-caseating granulomas
Spirometry: may show a restrictive defect
How do we treat sarcoidosis?
If just erythema nordosum, arthralgia etc, no treatment, just NSAIDs for pain
If pulm. features/radiological features >6 months, oral steroids
What is bronchiectasis?
A permanent dilation of the airways (bronchial wall) secondary to chronic infection/inflammation
What are the causes of bronchiectasis?
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)
What are the symptoms of bronchiectasis?
Chronic cough Sputum production (copious, mucopurulent) 50% have haemoptysis Anaemia Raised JVP Clubbing Cyanosis Cor pulmonale
Kartagener’s syndrome
Mutation in the gene coding for dynein
Causes ciliary dysmotility
Sinusitis
Infertility in men
Young’s syndrome
Triad of bronchiectasis, rhinosinusitis and decreased fertility due to viscous mucus
Investigations in bronchiectasis?
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)
Management of bronchiectasis?
Physiotherapy - twice daily postural drainage
Bronchodilators - if reversibility has been demonstrated with formal testing
Long-term rotating abx
IImmunisations
Common organisms isolated in bronchiectasis?
H. influenzae (most common)
Pseudomonas aeruginosa
Klebsiella
Strep. pneum
What is allergic bronchopulmonary aspergillosis?
This is the result of an allergy to aspergillus spores
It is most commonly seen in people with asthma or CF
What are the features of bronchopulmonary aspergillosis?
Bronchoconstriction (wheeze, cough, dyspnoea)
Bronchiectasis
What investigation findings would there be in ABPA?
Positive test for aspergillus spp. on skin biopsy
Blood test - raised IgE
Chest x-ray - transient x-ray changes
How do we manage ABPA?
Steroids
Itraconazole sometimes as 2nd line agent
What is an aspergilloma?
A mycetoma (mass-like fungus ball) which often colonises an existing lung cavity (e.g. secondary to TB, lung cancer or CF)
What are the features of aspergilloma?
Asymptomatic
Cough
Haemoptysis (75%)
Weight loss, fever, malaise
What are the investigation findings in aspergilloma?
Dense opacity, crescent/halo sign may be present
How do we treat aspergilloma?
Surgical resection
Klebsiella pneumoniae
Most commonly causes a cavitating pneumonia in the upper lobes, particularly in diabetics + alcoholics
Wegener’s granulomatosis (granulomatosis with polyangiitis)
URTIs Rapidly progressive glomerulonephritis Saddle-shape nose deformity Vasculitis rash Proptosis
Treat with:
Steroids
Cyclophosphosphamide
