-
what is traction bronchiectasis? and which Ix and which disease?
- airway dilatation due to lung fibrosis
- seen on CT
- classical of idiopathic pulmonary fibrosis
-
What is the differential diagnosis for interstitial lung disease?
- Pneumoconioses (organic, inorganic)
- Sarcoidosis
- Idiopathic pulmonary fibrosis aka Fibrosing alveolitis
- Goodpasture’s syndrome
- Vasculitis: Wegener’s granulomatosis, Churg Strauss
- Post ARDS
- CT disease: scleroderma, rheumatoid arthritis
-
if you need to do a BAL, how do you know you have an adequate sample?
- there will be FEWER ciliated respiratory cells
- there will be alveolar macrophages
-
on BAL if cells are: bilobed and granular cells, what are these?
eosinophils
-
What would an increase in lymphocytes indicate?
Sarcoidosis
-
What would increase in neutrophils indicate?
Idiopathic pulmonary fibrosis
-
on auscultation what would you hear with idiopathic pulmonary fibrosis?
Bibasal fine end-inspiratory crackles
-
when Idiopathic pulmonary fibrosis is rapidly progressive, what is this termed?
Hamman-Rich syndrome
-
what is the age and gender more in Idiopathic pulmonary fibrosis?
-
what does end stage Idiopathic pulmonary fibrosis look like?, why?
honeycomb lung as interstitial fibrosis leading to cystic AIR spaces
-
what is the difference between interstitial lung disease and left heart failure on CXR?
LHF: big heart
-
what are the signs of Idiopathic pulmonary fibrosis on CXR, also in advanced disease?
- reduced lung volume
- bilateral lower zone reticulo-nodular shadows
- advanced disease: honeycomb lung
-
which investigation is key in the diagnosis of Idiopathic pulmonary fibrosis?
CT scan as more sensitive than CXR
-
what is the management of Idiopathic pulmonary fibrosis?
- many have irreversible disease, unresponsive to treatment
- give prednisolone for 4 weeks then re-asses and reduce dose
- alternative: cyclophosphamide
- monitor with: CXR, lung function tests, symptom check
- lung transplant
-
what age and ethnic group does sarcoidosis affect?
-
how does acute sarcoidosis often present?
- erythema nodosum
- polyarthralgia
- usually resolves spontaneously
-
what are the symptoms of pulmonary sarcoidosis?
- dry cough
- progressive dyspnoea
- reduced ex tolerance
- chest pain
-
what is the CXR sign of sarcoidosis? how is it different from lymphoma?
- bilateral hilar lymphadenopathy
- lymphoma (no separation between heart and node enlargement)
-
what are the extra-pulmonary manifestations of sarcoidosis?
- lymphadenopathy
- hepatomegaly
- splenomegaly
- eyes: uveitis, keratoconjuncivitis sicca, glaucoma, conjunctivitis
- phalangeal bone cysts
- enlargement of lacrimal and parotid glands
- Bell's palsy
- neuropathy
- meningitis
- brainstem and spinal syndrome
- erythema nodosum
- lupus pernio
- subcut nodules
- cardiomyopathy
- hypercalcaemia
- renal stones
- hypercalciuria
- arrhythmias
- pituirary dysfunction
-
what are the blood results for sarcoidosis?
- increased ESR
- lymphopenia
- inc LFT
- inc ACE
- inc Ca
-
what would lung functions tests show in sarcoidosis?
- reduced lung volumes
- impaired gas transfer
- restrictive defects
-
what would tissue biopsy of sarcoidosis show?
non caseating granulomata
-
what does BAL in sarcoidosis show?
- active: inc lymphocytes
- pulm fibrosis: inc neutrophils
-
what would US of the kidney and liver look like in sarcoidosis?
- nephrocalcinosis
- hepatosplenomegaly
-
what would bone x-rays in sarcoidosis show?
punched out lesions in terminal phalanges
-
why do patients with bilateral hilar lymphadenopathy not require treatment?
majority recover spontaneously
-
what is the treatment of acute sarcoidosis?
-
If pleural fluid was clear, what does this indicate?
normal or transudate/exudate (protein)
-
if pleural fluid was turbid or yellow?
- Empyema
- parapneumonic effusion (inflammation of pleura caused by pneumonia makes an effusion but is NOT infected…whereas empyema is infected!)
-
If pleural effusion was bloody what could that be due to?
- Trauma
- Malignancy
- Pulmonary infarction
-
If pleural effusion was bloody what could that be due to?
- Trauma
- Malignancy
- Pulmonary infarction
-
NB it is normal to see mesothelial cells pleural fluid in the pleural effusion
-
If there are too many mesothelial cells pleural fluid, what may this indicate?
Pulmonary infarction
-
If there are abnormal mesothelial cells pleural fluid, what does this indicate?
Mesothelioma
-
If there are multinucleated giant cells in the pleural fluid what does this indicate?
Rheumatoid arthritis
-
If there are lupus erythematosus cells pleural fluid, what does this indicate?
SLE
-
is normal to see mesothelial cells in the pleural fluid?
yes
-
If there are abnormal, multinucleate, pleomorphic cells in the pleural fluid, what is the differential?
- Malignant mesothelioma
- Metastasised adenocarcinoma: exclude by immunohistochemistry
-
when performing a CT guided biopsy, what must you warn the patient?
risk of rebleed, haemoptysis, pneumothorax
-
what must 3 things need to be done before doing a CT guided lung biopsy?
- 1. warn pt of risk (rebleed, haemoptysis, PT)
- 2.
|
|
