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
Management of bronchiectasis?
Physiotherapy - twice daily postural drainage Bronchodilators - if reversibility has been demonstrated with formal testing Long-term rotating abx IImmunisations
26
Common organisms isolated in bronchiectasis?
H. influenzae (most common) Pseudomonas aeruginosa Klebsiella Strep. pneum
27
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
28
What are the features of bronchopulmonary aspergillosis?
Bronchoconstriction (wheeze, cough, dyspnoea) | Bronchiectasis
29
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
30
How do we manage ABPA?
Steroids | Itraconazole sometimes as 2nd line agent
31
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)
32
What are the features of aspergilloma?
Asymptomatic Cough Haemoptysis (75%) Weight loss, fever, malaise
33
What are the investigation findings in aspergilloma?
Dense opacity, crescent/halo sign may be present
34
How do we treat aspergilloma?
Surgical resection
35
Klebsiella pneumoniae
Most commonly causes a cavitating pneumonia in the upper lobes, particularly in diabetics + alcoholics
36
Wegener's granulomatosis (granulomatosis with polyangiitis)
``` URTIs Rapidly progressive glomerulonephritis Saddle-shape nose deformity Vasculitis rash Proptosis ``` Treat with: Steroids Cyclophosphosphamide