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KingsResp - Love Your Lungs

@kingsresp.bsky.social
241 followers 65 following 270 posts

Education & research from the Respiratory Department at King's College Hospital, London. #RespEd #RespisBest #ThoracicThursday #medsky Free archive of SCE style Q&As at www.brainscape.com/p/4MNSM-LH-CAN86

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KingsResp - Love Your Lungs @kingsresp.bsky.social · 24/04/2025
No #ThoracicThursday quiz question this week & we’re off on holiday so can’t promise any Qs next week. What should our next Q be on? #RespEd #medsky #lungsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 24/04/2025
👍
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 22/04/2025
Link to booking page?
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Not sure what you mean? You asked for reference for the chart. It’s in the BSACI guideline which is linked to in previous posts
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
See the BSACI guideline
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Ok that's it for today! We're off to check the pollen forecast and take our intranasal steroids before heading out into the allergen-filled outdoors! weather.metoffice.gov.uk/warnings-and... 14/14 /end #RespEd #medsky
weather.metoffice.gov.uk
Pollen forecast
Pollen forecasts for the next 5 days, across the UK. Find out what the pollen count is today and the type of pollen in the air.
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Immunotherapy is the only treatment that can modify the course of allergic rhinitis, with long-term remission following discontinuation. The criteria are clear. Don't let your patients miss out! #RespEd 13/n www.bsaci.org/guidelines-a...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
The BSACI have great guidelines - take a look www.bsaci.org/guidelines-a... #RespEd 12/n
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Intranasal treatments only work if they are administered properly. No sniffing! 11/n #RespEd #medsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Good news! The more recent intranasal steroids have little systemic uptake and are suitable for use in children & for long-term therapy 10/n #RespEd
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
The BSACI treatment algorithm is a useful aide, taking a step by step approach, & guiding phenotyping to direct therapy. A combination of treatments is often needed for more severe disease. 9/n #RespEd #medsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Allergen avoidance advice is an important part of management, but most pollen avoidance interventions are untested in trials & have limited real world application/practicality www.bsaci.org/wp-content/u... 8/n #RespEd #medsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Skin prick tests are the favoured test for sensitisation, as they are more sensitive than SpIgE for cat epithelium, mould & grass pollen. But either can be used for diagnosis with an appropriate history 7/n #RespEd #medsky
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a man making a funny face with the words allergy season written below him
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Diagnosis of rhinitis is based on a detailed history incl seasonality (pollen, moulds), indoors/outdoors location (dust mite, pets), occupation, & relationship to potential triggers. Symptoms of sneezing, nasal itching & itching of the palate are common 6/n #RespEd #medsky
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tom and jerry are standing next to each other in a hallway and yawning .
ALT: tom and jerry are standing next to each other in a hallway and yawning .
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
NAR (non-allergic rhinitis) is a diagnosis of exclusion in patients with symptoms of rhinitis but without any identifiable allergic triggers, negative for systemic IgE & who have had other causes ruled out 5/n #RespEd #medksy
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Allergic rhinitis is an immunological reaction involving IgE antibodies for specific allergens bound to receptors on the surface of mast cells. Degranulation releases multiple cytokines & other inflammatory mediators. www.bsaci.org/wp-content/u... #RespEd #medsky #lungsky 4/n
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Gene-environment interactions are key to rhinitis, esp in early life. Epidemiological evidence suggests smaller family size, urban environments & reduced exposure to infectious diseases are involved in the increase in prevalence of rhinitis. #RespEd 3/n pmc.ncbi.nlm.nih.gov/articles/PMC...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
Rhinitis is strongly associated with asthma: 74%-81% of asthmatics report symptoms of rhinitis. Rhinitis, both allergic & non-allergic, is a strong risk factor for new-onset asthma. So as a Respiratory specialist you'll see lots of rhinitis. #RespEd #medsky www.jacionline.org/article/S009... 2/n
jacionline.org
Rhinitis as an independent risk factor for adult-onset asthma
Background: For many years, the association between asthma and rhinitis has primarily been attributed to a common allergic background. Recently, it has been suggested that asthma and rhinitis are asso...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
OK let's have a think about rhinitis. In the UK, prevalence is 10% in 6-7 yr olds, 15% in 13-14 yr olds & 26% in adults. It's common & has increased a lot in the last 50yrs. pmc.ncbi.nlm.nih.gov/articles/PMC... #RespEd #RespIsBest #medsky 1/n
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 21/04/2025
It's answer time! The answer to Q63 was C. Arrange subcutaneous immunotherapy. Were you correct? How much do you know about the treatment of chronic rhinitis? Can you tell allergic from non-allergic and inflammatory from non-inflammatory? Perhaps it's time for a refresher... #RespEd #RespIsBest
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 18/04/2025
Our latest quiz question is out! Why not mull it over, with an Easter egg or hot cross bun? Answers out on Monday! #RespEd #RespIsBest #lungsky #pulmsky #medsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 17/04/2025
Spring has sprung, which means it's rhinitis season! Have a look a this week's #SCE quiz question and remind yourself of best management! #RespEd #RespIsBest #medsky #pulmsky
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Burnet Institute @burnetinstitute.bsky.social · 16/04/2025
A new oral treatment regimen for patients with drug-resistant tuberculosis has commenced in Papua New Guinea, bringing treatment duration down to six months and increasing success rates. This is a huge step forward for the health of people in PNG. Read more: www.burnet.edu.au/knowledge-an...
burnet.edu.au
New treatment for drug-resistant tuberculosis commences in PNG | Burnet Institute
BPaL/M treatment is an oral regimen that slashes treatment duration by two thirds.
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 17/04/2025
Good morning lung fans! Incoming: a new #ThoracicThursday quiz question! Warm up your little grey cells & get ready… #medsky #RespEd #RespisBest #pulmsky #lungsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Congrats!
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Ok that's it for this week! Hopefully you now have a system for identifying cystic lung diseases, & have brushed up on your pathology. See you soon for another #ThoracicThursday quiz question! #RespEd #RespIsBest #medsky #lungsky #pulmsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
The pathological hallmark of sarcoidosis is of course well circumscribed granulomas +/- multinucleated giant cells. Fibrosis may also be present. www.pathologyoutlines.com/topic/lungno... 16/n #RespEd
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Sarcoidosis is also not a cystic lung disease but can have many manifestations, some of which can appear cystic. Nodules are a common feature. There is a cavitatory form which may appear cyst-like. 15/n #RespEd radiopaedia.org/articles/sar...
radiopaedia.org
Sarcoidosis (thoracic manifestations) | Radiology Reference Article | Radiopaedia.org
Pulmonary and mediastinal involvement of sarcoidosis is extremely common, seen in over 90% of patients with sarcoidosis. Radiographic features are variable depending on the stage of the disease.  For a general discussion, please refer to the par...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Pathological features of GPA are necrotizing granulomatous inflammation & evidence of leukocytoclastic vasculitis 14/n #RespEd www.pathologyoutlines.com/topic/lungno...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Answer D is GPA. This is not a cystic lung disease but can be confused with one if the predominant feature is necrotic nodules. Other radiology findings include pulmonary haemorrhage, reticulonodular fibrosis, and peripheral wedge like lesions. radiopaedia.org/articles/gra... 13/n #RespEd
radiopaedia.org
Granulomatosis with polyangiitis (thoracic manifestations) | Radiology Reference Article | Radiopaedia.org
Thoracic manifestations of granulomatosis with polyangiitis (GPA), which is a type of pulmonary angiitis and granulomatosis, are common; with lung involvement seen in about 95% of cases. For a general discussion of the condition, please refer to...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
You could confuse this with emphysema (answer C: hyperdistension of alveolar ducts associated with rupture of alveolar septa & respiratory bronchiolitis) but the patient is only 32 & there are numerous cysts & no bronchial wall thickening. #RespEd 12/n www.pathologyoutlines.com/topic/lungno...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
The pathological features of LAM are proliferation of smooth muscle-like cells due to activation of the mTOR signaling pathway. You will see pindled smooth muscle-like cells with mixed eosinophilic/clear cytoplasm. SMA, ER & PR may be positive. #RespEd 11/n www.pathologyoutlines.com/topic/lungtu...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Why are the other answers incorrect? You might have thought this was LAM - the patient is the right sex & age & it's a cystic lung disease. But the distribution is wrong & the shape of the cysts doesn't fit - bizarre shapes in LCH, regular in LAM #RespEd 10/n radiopaedia.org/articles/lym...
radiopaedia.org
Lymphangioleiomyomatosis | Radiology Reference Article | Radiopaedia.org
Lymphangioleiomyomatosis (LAM) is a low-grade destructive metastasizing PEComatous tumor 1 resulting from the proliferation of LAM cells in the lung, kidney and axial lymphatics. The disease is caused by mutations of the TSC2 or TSC1 genes and is...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Birbeck granules are rod shaped or "tennis-racket" cytoplasmic organelles with a central linear density & striated appearance that are only found in Langerhans cells. They can be detected by electron microscopy and are pathagnomonic. #RespEd 9/n en.wikipedia.org/wiki/Birbeck...
en.wikipedia.org
Birbeck granules - Wikipedia
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
The pathological features of LCH are granulomas of Langerhans cells which have a distinct cell margin & pink granular cytoplasm. Immuno will be CD1 positive. en.wikipedia.org/wiki/Langerh... #RespEd 8/n
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Pulmonary LCH can also be part of multiorgan LCH. This is especially the case in children, where is can affect organs such as bone, skin, lymph nodes, spleen, liver & even brain. It is assoc with mutations in BRAF genes. histio.org/histiocytic-... 7/n #RespEd
histio.org
Langerhans Cell Histiocytosis in Children | Histiocytosis Association
Langerhans cell Histiocytosis (LCH) occurs when too many immature Langerhans cells are produced which can form tumors. Learn more about LCH in children.
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Pulmonary Langerhans Cell Histiocytosis is associated with smoking in 95% cases. It starts as nodules, that cavitate & transform into cysts with an irregular shape (bizarre cysts, due to confluence of two or more cysts). It is usually diagnosed age 20-40. #RespEd 6/n radiopaedia.org/articles/pul...
radiopaedia.org
Pulmonary Langerhans cell histiocytosis | Radiology Reference Article | Radiopaedia.org
Pulmonary Langerhans cell histiocytosis (PLCH) may be seen as part of widespread involvement in patients with disseminated Langerhans cell histiocytosis or more frequently as a distinct entity in young adult smokers. This article focuses on the l...
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Yes, it's LCH! radiologyassistant.nl/chest/cystic... #RespEd 5/n
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
There are no other imaging features (nodules, ground glass etc), & too many cysts to be incidental. So we are left with a differential: LAM, LCH, BHD or LIP. The cyst character/shape is hard to say, but the distribution is clear - apices are affected, bases are spared. So this is...? #RespEd 4/n
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a woman with red lipstick is smiling and saying `` i don t know yet .
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
The imaging is key to this question as it shows cystic lung disease. If we recognise this, we can take a systematic approach to working out the diagnosis - Radiopedia can help! radiologyassistant.nl/chest/cystic... #RespEd 3/n
radiologyassistant.nl
The Radiology Assistant : Cystic Lung Disease - Differential diagnosisMenu
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
What info do we have in the question? We have a 32 year old woman who is a recent ex-smoker with obstructive lung function & reduced gas transfer. Not very specific, but together with the imaging it starts to paint a picture. #RespEd 2/n
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Let's dive into this question, & extract as much learning as possible! #RespEd 1/n
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
It's answer time! This was a tricky one, but several of you were correct! Well done! The answer to Q62 was B. B. Granulomas containing Langerhans cells with a distinct cell margin and pink granular cytoplasm. Immuno: CD1 positive. #RespEd #RespIsBest #pulmsky #medsky #lungsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 12/04/2025
Oooh so useful! #RespEd #lungsky #pulmsky #RespIsBest #medsky
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 11/04/2025
What do you think @shaheenshahid.bsky.social ?
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 11/04/2025
What do you think @shaheenshahid.bsky.social ?
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 11/04/2025
What do you reckon @ksiva84.bsky.social ?
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KingsResp - Love Your Lungs @kingsresp.bsky.social · 11/04/2025
Some great chats on this one in our team re the imaging, clinical presentation & path! Have you shared this on your ward round? What are your thoughts? #RespEd #RespIsBest #medsky #lungsky #pulmsky
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The BMJ @bmj.com · 11/04/2025
New #BMJInvestigation finds bans on junk food advertising in outdoor spaces have been derailed by industry lobbying. Some of the councils lobbied have among the worst rates of childhood obesity. Use our interactive infographic in the article to uncover more www.bmj.com/content/389/...
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The British Thoracic Society @btsrespiratory.bsky.social · 11/04/2025
Last month we hosted two webinars on the recent BTS/NICE/SIGN Joint Guideline for the Diagnosis, Monitoring and Management of Chronic Asthma. You can watch the recordings of these sessions on our website to get insights from respiratory professionals 👉 brit-thoracic.uk/AsthmaRecording25 #Asthma
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