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Respiratory
| Question | Answer |
|---|---|
| Causes of pulmonary eosinophilia | Churg-Strauss syndrome allergic bronchopulmonary aspergillosis (ABPA) Loffler's syndrome eosinophilic pneumonia hypereosinophilic syndrome tropical pulmonary eosinophilia drugs: nitrofurantoin, sulphonamides less common: Wegener's granulomatosis |
| Loffler's syndrome | transient CXR shadowing and blood eosinophilia thought to be due to parasites such as Ascaris lumbricoides causing an alveolar reaction presents with a fever, cough and night sweats which often last for less than 2 weeks. generally a self-limiting diseas |
| Causes of ARDS | Causes infection: sepsis, pneumonia massive blood transfusion trauma smoke inhalation acute pancreatitis cardio-pulmonary bypass |
| Investigations ABPA | eosinophilia flitting CXR changes positive radioallergosorbent (RAST) test to Aspergillus positive IgG precipitins (not as positive as in aspergilloma) raised IgE |
| Managemen of ABPA | steroids itraconazole is sometimes introduced as a second-line agen |
| Risk factors for the development of aspiration pneumonia include: | Poor dental hygiene Swallowing difficulties Prolonged hospitalization or surgical procedures Impaired consciousness Impaired mucociliary clearance |
| The bacteria often implicated in aspiration pneumonia are aerobic, and often include: | Streptococcus pneumoniae Staphylococcus aureus Haemophilus influenzae Pseudomonas aeruginosa |
| chemicals associated with occupational asthma: | isocyanates - the most common cause. Example occupations include spray painting and foam moulding using adhesives platinum salts soldering flux resin glutaraldehyde flour epoxy resins proteolytic enzymes |
| Most common organisms isolated from patients with bronchiectasis: | Haemophilus influenzae (most common) Pseudomonas aeruginosa Klebsiella spp. Streptococcus pneumoniae |
| Bronchiolitis pathogen | Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases. other causes: mycoplasma, adenoviruses |
| abscess (Staph aureus, Klebsiella and Pseudomonas) squamous cell lung cancer tuberculosis Wegener's granulomatosis pulmonary embolism rheumatoid arthritis aspergillosis, histoplasmosis, coccidioidomycosis | |
| Differential of cavitatory lung lesion on x ray | |
| Common causes of lobar collapse include: | lung cancer (the most common cause in older adults) asthma (due to mucous plugging) foreign body |
| Lung metastases are seen with a wide variety of cancers including: | breast cancer colorectal cancer renal cell cancer bladder cancer prostate cancer |
| Features of pulmonary oedema on a chest x-ray may include: | interstitial oedema bat's wing appearance upper lobe diversion (increased blood flow to the superior parts of the lung) Kerley B lines pleural effusion cardiomegaly may be seen if there is cardiogenic cause |
| COPD: causes | Smoking! Alpha-1 antitrypsin deficiency Other causes cadmium (used in smelting) coal cotton cement grain |
| Lofgren's syndrome | is an acute form sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. |
| Exudate pleural effusion | (> 30g/L protein) infection: pneumonia (most common exudate cause), TB, subphrenic abscess connective tissue disease: RA, SLE neoplasia: lung cancer, mesothelioma, metastases pancreatitis pulmonary embolism Dressler's syndrome yellow nail syndrome |
| Transudate pleural effusion | (< 30g/L protein) heart failure (most common transudate cause) hypoalbuminaemia (liver disease, nephrotic syndrome, malabsorption) hypothyroidism Meigs' syndrome |
| Classification of PAH | Group 1: Pulmonary arterial hypertension (PAH) - idiopathic* - familial - associated conditions: Group 2: Pulmonary hypertension with left heart disease Group 3: Pulmonary hypertension secondary to lung disease/hypoxia Group 4: Pulmonary hypertension du |
| Respiratory acidosis may be caused by a number of conditions: | COPD decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema neuromuscular disease obesity hypoventilation syndrome sedative drugs: benzodiazepines, opiate overdose |
| Respiratory alkalosis Common causes | anxiety leading to hyperventilation pulmonary embolism salicylate poisoning* CNS disorders: stroke, subarachnoid haemorrhage, encephalitis altitude pregnancy |
| A variety of respiratory problems may be seen in patients with rheumatoid arthritis: | pulmonary fibrosis pleural effusion pulmonary nodules bronchiolitis obliterans complications of drug therapy e.g. methotrexate pneumonitis pleurisy Caplan's syndrome - massive fibrotic nodules with occupational coal dust exposure infection (possibly aty |
| Lofgren's syndrome | is an acute form of sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis |
| Mikulicz syndrome | * there is enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma |
| Heerfordt's syndrome | (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis |
| Sarcoidosis stages in CXR | stage 0 = normal stage 1 = bilateral hilar lymphadenopathy (BHL) stage 2 = BHL + interstitial infiltrates stage 3 = diffuse interstitial infiltrates only stage 4 = diffuse fibrosis |
| Indications for steroids in sarcoidosis | patients with chest x-ray stage 2 or 3 disease who are symptomatic. Patients with asymptomatic and stable stage 2 or 3 disease who have only mildly abnormal lung function do not require treatment hypercalcaemia eye, heart or neuro involvement |
| Discharge criteria and advice post-discharge for pneumonia | NICE recommend that patients are not routinely discharged if in the past 24 hours they have had 2 or more of the following findings: temperature higher than 37.5°C respiratory rate 24 breaths per minute or more heart rate over 100 beats per minute systo |
| Theophylline poisoning | Features acidosis, hypokalaemia vomiting tachycardia, arrhythmias seizures Management consider gastric lavage if <1 hour prior to ingestion activated charcoal whole-bowel irrigation can be performed if theophylline is sustained release form charcoal hae |
| Management of small cell lung ca | usually metastatic disease by time of diagnosis patients with very early stage disease (T1-2a, N0, M0) are now considered for surgery. NICE support this approach in their 2011 guidelines however, most patients with limited disease receive a combination |
| Criteria (American-European Consensus Conference) ARDS | acute onset (within 1 week of a known risk factor) pulmonary oedema: bilateral infiltrates on chest x-ray ('not fully explained by effusions, lobar/lung collapse or nodules) non-cardiogenic (pulmonary artery wedge pressure needed if doubt) pO2/FiO2 < 40k |
| Lung cancer: small cell Paraneoplastic | associated with ectopic ADH, ACTH secretion ADH → hyponatraemia ACTH → Cushing's syndrome ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis Lambert-Eaton syndrome: antibodies to voltage |
| Non-invasive ventilation - key indications | COPD with respiratory acidosis pH 7.25-7.35* type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea cardiogenic pulmonary oedema unresponsive to CPAP weaning from tracheal intubation |
Created by:
Dr.Selma
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