OTHERS Flashcards
(38 cards)
What is ANCA associated vasculitis?
An umbrella term for:
Microscopic polyangiitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
These are small vessel vasculitis Ed’s that can affect arterioles, capillaries and venues
EGPA can also affect medium sized vessels
Whats the aetiology of eosinophilic granulomatosis with polyangiitis?
Genetics - HLA-DRB1 and HLA-DRB4
Medications e.g. montelukast, inhaled corticosteroids and omalizumab
What are the phases of eosinophilic granulomatosis with polyangiitis?
Prodromal phase: characterised by asthma and allergic rhinitis. Asthma occurs in 97% of patients. Usually precedes vasculitic phase by 3 years but may be delayed up to 10 years.
Eosinophilic phase: eosinophils infiltrate a variety of tissue without overt vasculitis. May see marked eosinophilia on full blood count.
Vasculitic phase: multi-system involvement with granulomatous inflammation. Can be life-threatening.
What are the clinical features of eosinophilic granulomatosis?
Adult-inset asthma is predominant
Lethargy
Flu-like illness
Weight loss
Fever
ENT involvement e.g. sinusitis, otitis media, nasal polyps, rhinitis
Lung symptoms - cough, dynspnoe, wheeze
Cardiac, cutaneous, neurological, kidney, GI and MSK involvement
What is granulomatosis with polyangiitis?
aka wegeners granulomatoiss
It is an autoimmune condition associated with a necrotizing granulomatous vasculitis, affecting both the upper and lower respiratory tract as well as the kidneys.
What is Kartagener’s syndrome?
aka primary ciliary dyskinesia
Immobile cilia which causes bronchiectasis, recurrent sinusitis, subfertility and dextrocardia
What is a lung abscess?
A well circumscribed infection within the lung parenchyma
What causes lung abscesses?
Commonly - secondary to aspiration pneumonia
Others - haematogenous spread, direct extension from emphysema, bronchial obstruction
What are the feature of a lung abscess?
Similar to pneumonia but more subacute and may have night sweats and weight loss
Fever, productive cough with foul-smelling sputum, chest pain, dyspnoea, clubbing
How should you investigate a lung abscess?
CXR - fluid-filed space seen within an area of consolidation
Sputum and blood cultures
How do you manage a lung abscess?
IV antibiotics
Percutaneous drainage if not resolving or even surgical resectin
What is found in the superior mediastinum?
Superior vena cava
Brachiocephalic veins
Arch of aorta
Thoracic duct
Trachea
Oesophagus
Thymus
Vagus nerve
Left recurrent laryngeal nerve
Phrenic nerve
What is found in the anterior mediastinum?
Thymus remnants
Lymph nodes
Fat
What is found in the middle mediastinum?
Pericardium
Heart
Aortic root
Arch of azygos vein
Main bronchi
What is found in the posterior mediastinum?
Oesophagus
Thoracic aorta
Azygos vein
Thoracic duct
Vagus nerve
Sympathetic nerve trunks
Splanchnic nerves
NICE guidance for managing respiratory tract infections:
Who should immediate antibiotic prescribing be considered for?
Children <2 with bilateral acute otitis media
Children with otorrhoea who have acute otitis media
Pt with acute sore throat, acute pharyngitis or acute tonsillitis when 3 or more Centor criteria are present
Pt deemed at risk of developing complications e.g. >65, pre-existing comorbidities, serious symptoms, systemically unwell
What are the Centor criteria?
Criteria that, when 3 or more are present, there is a 40-60% chance its caused by group A beta-haemolytic streptococcus
- presence of tonsillar exudate
- tender anterior cervical
- lymphadenopathy or lymphadenitis
- history of fever
- absence of cough
How long should acute otitis media last?
4 days
How long should acute sore throat/acute pharyngitis/acute tonsillitis last?
1 week
How long should the common cold last?
Up to 10 days
How long should acute rhinosinusitis last?
Up to 2 and a half weeks
How long should acute bronchitis/cough last?
Up to 3 weeks
What is Atelectasis?
Lung collapse
What is Caplan syndrome?
Lung nodules in the context of rheumatoid arthritis
