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Respiratory

QuestionAnswer
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
ABPA demonstrating a mass overlying the left hilum. In the right upper parahilar region a few ring shadow / tram track opacities are also noted, suggestive of bronchiectasis
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