Other resp conditions

Question 1

What is Sarcoidosis?

Answer 1

Multisystem disorder of unknown cause.

See non-caseating granulomas.

Question 2

Features of sarcoidosis

Answer 2

Bilateral hilar lymphadenopathy.
Swinging fever, polyarthralgia, erythema nodosum.
Dyspnoea, non productive cough, malaise, weight loss.
Hypercalcaemia.

Question 3

Sarcoidosis investigations and management

Answer 3

ACE levels- poor sensitivity and specificity
Ca2+ raised
ESR raised
CXR- hilar lymphadenopathy, infiltrates, apical fibrosis.
Biopsy- non-caseating granulomas.
Spirometry- restrictive disease.

Main management is steroids if stage 2/3, raised Ca2+ or heart/eye/neuro involvement.

Question 4

Acute respiratory distress syndrome
Causes?
Symptoms?

Answer 4

Increased permeability of alveolar capillaries leading to fluid accumulation in the lungs.

Causes: sepsis, massive transfusion, pneumonia, trauma, smoke inhalation, acute pancreatitis, cardiopulmonary bypass.

Symptoms: Dyspnoea, high RR, bilateral lung crackles, low sats.

Question 5

ARDS

Management?

Answer 5

ITU referral
Oxygen/ventilation
Organ support- vasopressors.
Treat underlying cause
Prone positioning.

Question 6

Pleural effusion- causes and symptoms

Answer 6

Transudative < 30g/L protein:
Heart failure
Hypoalbuminaemia
Hypothyroidism

Exudative > 30g/L protein:
Infection, TB
CT disorder
Neoplasia
Pancreatitis
PE

Use Light’s criteria to distinguish between the 2 if protein 25-35g/L.

Symptoms: dyspnoea, non productive cough.
Dull to percuss, reduced breath sounds and reduced chest expansion.

Question 7

Pleural effusion- investigation and management

Answer 7

PA chest XR
USS for pleural aspiration
Contrast CT

Pleural aspiration with 21G needle and 50ml syringe. Fluid sent for pH, protein, lactate, cytology and microbiology.

Question 8

Pneumothorax

Causes and symptoms

Answer 8

Pre-existing lung disease, CT tissue disease, ventilation including NIV, spontaneous, trauma.

Dyspnoea, pleuritic chest pain, sweating, tachypnoea, tachycardia.

Question 9

Pneumothorax

Management

Answer 9

Primary - no underlying disease.
If air < 2cm and no symptoms then consider discharge.
If air >2cm or symptomatic then aspirate. Failed aspiration -> chest drain.

Secondary- presence of lung disease.
Patient > 50 or air > 2cm- straight for chest drain. Otherwise try aspiration first. If air < 1cm consider oxygen and observe for 24 hours.

Question 10

Tension Pneumothorax

Answer 10

Hole acts as one way valve allowing pressure to rise.
Trachea shifts away from side effected.
Hyperresonance on affected side.
Treat with needle decompression and chest tube insertion.