A preliminary diagnosis of extrinsic allergic alveolitis in a 55-year-old man.
Which one of the following features would most support this diagnosis?
Correct Answer D: A history of working in the steel industry and eosinophilia are not features of extrinsic allergic alveolitis. Clubbing and cyanosis are non-specific.
Extrinsic allergic alveolitis:
Extrinsic allergic alveolitis (EAA, also known as hypersensitivity pneumonitis) is a condition caused by hypersensitivity induced lung damage due to a variety of inhaled organic particles. It is thought to be largely caused by immune-complex mediated tissue damage (type III hypersensitivity) although delayed hypersensitivity (type IV) is also thought to play a role in EAA, especially in the chronic phase.
Examples:
Presentation:
Investigation:
*Here the terminology is slightly confusing as thermophilic actinomycetes is an umbrella term covering strains such as Micropolyspora faeni.
You are reviewing the management of a number of patients with chronic obstructive pulmonary disease (COPD).
Which one of the following factors should prompt an assessment for long-term oxygen therapy?
Correct Answer B:
COPD: long-term oxygen therapy:
The 2010 NICE guidelines on COPD clearly define which patients should be assessed for and offered long-term oxygen therapy (LTOT). Patients who receive LTOT should breathe supplementary oxygen for at least 15 hours a day. Oxygen concentrators are used to provide a fixed supply for LTOT.
Assess patients if any of the following:
Assessment is done by measuring arterial blood gases on 2 occasions at least 3 weeks apart in patients with stable COPD on optimal management.
Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
Each one of the following predisposes to the development of obstructive sleep apnoea, except:
Correct Answer B: Sleep apnoea causes include obesity and macroglossia.
The Sleep Heart Health Study showed that when these two conditions do coexist, this is the result of chance alone.
Obstructive sleep apnoea/hypopnoea syndrome:
Predisposing factors:
Consequence:
SIGN guidelines for the diagnosis and management of patients with OSAHS were published in 2003.
Assessment of sleepiness:
Diagnostic tests:
Management:
Which one of the following is not part of the diagnostic criteria of acute respiratory distress syndrome (ARDS)?
Correct Answer D:
ARDS
Basics:
Criteria (American-European Consensus Conference):
Causes:
A 62-year-old man with a history of recurrent lower respiratory tract infections is diagnosed as having bilateral bronchiectasis following a high resolution CT scan.
Which one of the following is most important in the long term control of his symptoms?
Correct Answer D: Symptom control in non-CF bronchiectasis - inspiratory muscle training + postural drainage.
Bronchiectasis: management: Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection or inflammation.
After assessing for treatable causes (e.g. immune deficiency) management is as follows:
Most common organisms isolated from patients with bronchiectasis:
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