Respiratory 2

oelomar's version from 2016-04-12 16:01


Question Answer
What is sarcoidosis?A common idiopathic multisystem granulomatous disorder with lung involvement 90% of the time. It is characterised pathologically by non-caseating (non-necrotising) granulomas.
What are the clinical features of sarcoidosis?Sarcoidosis can affect many different organs of the body. It may be asymptomatic. The most common presentation is with respiratory symptoms or abnormalities found on chest x-ray (50%). Less common presentations include fatigue or weight loss (5%), peripheral lymphadenopathy (5%), and fever (4%). Neurological presentations are rare but well recognised and can mimic a variety of conditions. Chest x-ray may be normal in up to 20% of non-respiratory cases, though pulmonary lesions may be detected later.
There are four stages of pulmonary involvement based on radiological stage of sarcoidosis, which is helpful in prognosis. What are these four stages?Stage 1: Bilateral hilar lymphadenopathy (BHL) alone. Stage 2: BHL with pulmonary infiltrates. Stage 3: Pulmonary infiltrates without BHL. Stage 4: Fibrosis.
What is bilateral hilar lymphadenopathy?Bilateral enlargement of the lymph nodes of the pulmonary hila. It is a radiographic term that describes the enlargement of mediastinal lymph nodes. This is a characteristic feature of sarcoidosis which is usually symptomless and only detected on chest x-ray.
Name some of the extrapulmonary manifestations of sarcoidosis.Skin and ocular sarcoidosis are the most common extrapulmonary presentations. Skin lesions occur in 10% of cases. Sarcoidosis is the most common cause of erythema nodosum. Anterior uveitis is common and presents with misting vision, pain, and a red eye, but posterior uveitis may present simply as progressive loss of vision. Other less common extrapulmonary manifestations include keratoconjunctivitis sicca, CNS involvement, arthralgia, hepatosplenomegaly, and cardiac manifestations.
How is sarcoidosis managed?Most persons (>75%) only requires symptomatic treatment with NSAIDs. Severe symptoms are generally treated with corticosteroids, although steroid-sparing agents such as azathioprine and methotrexate are often used as alternatives.
Sarcoidosis is more common in black males. True or false?False. It is more common in black females.
Give a typical presentation for someone with sarcoidosis.A black female with bilateral hilar lymphadenopathy, erythema nodosum, anterior uveitis and hypercalcemia.


Question Answer
What is hypersensitivity pneumonitis?Inflammation of the alveoli within the lung caused by hypersensitivity (non-IgE mediated) to inhaled organic dusts.
What is Farmer’s lung?A hypersensitivity pneumonitis induced by inhalation of biologic dusts coming from hay dust or mould spores or other agricultural products, resulting in a type III hypersensitivity inflammatory response. It is the most common hypersensitivity pneumonitis.
What are the signs and symptoms of acute hypersensitivity pneumonitis (4-6 hours after exposure)?Type III hypersensitivity reaction. Dyspnoea, cough, fever, chills, malaise (lasting 18-24 hrs). CXR shows diffuse infiltrates.
What are the signs and symptoms of chronic hypersensitivity pneumonitis?Type IV hypersensitivity reaction. It is of insidious onset. Dyspnoea, cough, malaise, anorexia, weight loss. CXR shows a predominantly upper lobe reticulonodular pattern.
How is hypersensitivity pneumonitis treated?Systemic corticosteroids can relieve symptoms and speed resolution.
What is pneumoconiosis?A disease of the lungs due to inhalation of dust, characterised by inflammation, coughing, and fibrosis.
How is pneumoconiosis treated?There is no effective treatment. Therefore, the key is exposure prevention through the use of protective equipment.
What are the clinical features of coal-worker’s pneumoconiosis?Simple coal-worker’s pneumonitis has no signs and symptoms, although a chest x-ray will show multiple nodular opacities, mostly in the upper lobe. However, simple coal-worker’s pneumonitis can progress to complicated pneumonitis, of which the signs and symptoms include dyspnoea and Caplan’s syndrome.
What is Caplan’s syndrome?A combination of rheumatoid arthritis and pneumoconiosis. It presents with cough and shortness of breath in conjunction with features of rheumatoid arthritis.


Question Answer
What is silicosis?Lung fibrosis caused by the inhalation of dust containing silica (i.e. it’s a type of pneumoconiosis).
What are the signs and symptoms of silicosis?Dyspnoea, cough, and wheezing.
What will a chest x-ray show in someone with silicosis?The upper lobes are affected more than the lower lobes. Early silicosis will show nodular disease (i.e. simple pneumoconiosis). In late silicosis, the nodules come together to form masses.
What is the link between silicosis and tuberculosis?Patients with silicosis are more susceptible to tuberculosis infection (reasons not well understood).
What is meant by the “eggshell calcification” that can be seen in silicosis?Eggshell calcification refers to fine calcification seen at the periphery of a mass, and usually relates to lymph node calcification. This can happen in silicosis when there is hilar lymph node enlargement.
What is asbestosis?A lung disease resulting from the inhalation of asbestos particles, marked by severe fibrosis and a high risk of mesothelioma (cancer of the pleura), i.e. it’s a type of pneumoconiosis.
What are the signs and symptoms of asbestosis?It is of insidious onset. Shortness of breath on exertion is usually the first symptom with increased dyspnoea as the disease progresses. Patients also present with a non-productive cough.
What will a chest x-ray show in someone with asbestosis?The lower lobes are affected more than the upper lobes. Early asbestosis shows fibrosis with linear streaking. Late asbestosis shows cysts and honeycombing. Asbestosis can also cause pleural and diaphragmatic plaques (diaphragmatic plaques are highly suggestive of asbestosis, especially if bilateral).
What are ferruginous bodies and what is their presence suggestive of?Histopathological findings in interstitial lung disease suggestive of significant asbestosis. They are yellow-brown rod-shaped structures which represent asbestos fibres coated in macrophages.


Question Answer
What is byssinosis?A rare type of pneumoconiosis associated with working in cotton mills.
What are the clinical features of byssinosis?The symptoms start on the first day back at work after a break (Monday sickness) with improvement as the week progresses.
What is berylliosis?A chronic allergic-type lung response and chronic lung disease caused by exposure to beryllium and its compounds.
What is the link between berylliosis and sarcoidosis?There isn’t one, apart from that they have similar clinical pictures, meaning that they can occasionally be hard to distinguish from one another.
Name some drug-induced causes of interstitial lung disease?Antineoplastic agents: bleomycin, mitomycin, busulfan, cyclophosphamide, methotrexate, chlorambucil. Antibiotics: nitrofurantoin, penicillin, sulphonamide. Cardiovascular drugs: amiodarone, tocainide. Anti-inflammatory agents: methotrexate, penicillamine. Gold salts. Illicit drugs (heroin, methadone).


Question Answer
What are most common causative agents of community-acquired pneumonia?Streptococcus pneumoniae (most common) followed by haemophilus influenzae and mycoplasma pneumoniae.
What are the most common causative agents of hospital-acquired pneumonia?Most commonly staphylococcus aureus or gram negative enterobacteria.
What are the clinical features of pneumonia?Cough (with or without sputum), fever, pleuritic chest pain, dyspnoea, Tachypnoea, tachycardia. Elderly often present atypically; altered level of consciousness is sometimes the only sign. Signs of consolidation (diminished expansion, dull percussion note, increased tactile vocal fremitus/vocal resonance, bronchial breathing), and pleural rub (velcro noise on expiration).
What is “CURB-65” and what does it stand for?It is a clinical predication rule for predicting the mortality in community-acquired pneumonia. C=Confusion of new onset. U=blood Urea nitrogen >7mmol/L. R=Respiratory rate >30/minute. B=Blood pressure <90/60mmHg. Age 65 or more.
How is the CURB-65 scoring system interpreted?0-1=Treat as an outpatient. 2=Consider a short stay in hospital or watch very closely as an outpatient. 3-5=Requires hospitalisation with consideration as to whether they need to be in ICU.
If a patient’s CURB-65 score is 1, how are they treated?Amoxicillin, or clarithromycin if allergic to penicillin (Add clarithromycin if atypical pneumonia is suspected.
If a patient’s CURB-65 score is 2-3, how are they treated?Benzylpenicillin & doxycycline.
If a patient’s CURB-65 score is 4-5, how are they treated?Co-amoxiclav & clarithromycin (If penicillin allergic then Vancomycin & ciprofloxacin).
How is hospital-acquired pneumonia treated?Mild is treated with doxycycline. Moderate/severe is treated with tazocin.
Name some of the complications of pneumonia.Pleural effusion, empyema, lung abscess, respiratory failure, sepsis.


Question Answer
What is a lung abscess?A type of liquefactive necrosis (a type of necrosis which results in a transformation of the tissue into a liquid viscous mass) of the lung tissue and formation of cavities (more than 2cm) containing necrotic debris or fluid caused by microbial infection.
What are the clinical features of a lung abscess?Fever, cough, purulent, foul smelling sputum, pleuritic chest pain, haemoptysis, malaise, weight loss, clubbing, anaemia.
How is a lung abscess treated?Pulmonary physiotherapy and postural drainage, as well as broad-spectrum antibiotics.
Streptococcus pneumoniae is the commonest cause of bacterial pneumonia. Name some other conditions for which it is also the most common cause.Meningitis, otitis media (in children), sinusitis.
Mycoplasma pneumoniae is the second most common cause of pneumonia. Name some other conditions that can be caused by mycoplasma pneumoniae.Erythema multiforme, Guillain-Barre syndrome.
What is walking pneumonia?Walking pneumonia is an informal term for pneumonia that isn't severe enough to require bed rest or hospitalisation. Patients may feel like they have a cold. The symptoms are generally so mild that patients don't feel the need to stay home from work or school, and are therefore walking around.
What is cavitary pneumonia, name a common causative agent?A disease in which the alveoli (which are normally an average of 0.1mm in size) become enlarged due to various pathologies. Staphylococcus aureus is a common causative agent (also occurs commonly in intravenous drug users).
Which groups of people are most likely to be affected by klebsiella pneumonia?It is typically due to aspiration by alcoholics, though it is more commonly implicated in hospital-acquired urinary tract and wound infections, particularly in diabetics.
What coloured sputum is associated with klebsiella pneumonia?“Red-currant” sputum.


Question Answer
Legionella pneumophila colonises water tanks kept at <60 degrees causing outbreaks of legionnaires disease. Which group is classically affected?It classically appears in patients returning from holiday.
What is legionnaires’ disease?A form of atypical pneumonia caused by any type of legionella bacteria.
How is legionnaires’ disease diagnosed (not including the clinical picture)?The antigen can be detected in the urine.
What is the most common causative agent of pneumonia from parrots/birds?Chlamydophila psittaci.
What is the most common cause of the common cold?Rhinovirus.
What is the most common causative agent of pneumonia in neonates?E. coli, group B streptococci.
How is pneumonia managed?Oxygen to maintain PaO2 >8kPa, antibiotics, IV fluids if required, analgesia for pleuritic pain. Normal treatment assumes the patient has streptococcus pneumonia and targets it with amoxicillin or erythromycin if allergic to penicillin.
Amoxicillin toxicity can result in what?Pseudomembranous colitis, hypersensitivity reactions.
Erythromycin toxicity can result in what?Prolonged QT interval, GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rashes.

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