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CMS1 > Respiratory Diseases > Flashcards

Respiratory Diseases Flashcards

1
Q

ASTHMATIC PATIENT PROFILE

A
  • Possibly a smoker but not necessarily
  • Young < 35 years old
  • Dry cough
  • Variable breathlessness
  • Night-time waking with breathlessness and/or wheeze - common
  • Significant diurnal or day-to-day variability of symptoms - common
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2
Q

COPD PATIENT PROFILE

A 
Smoker or ex-smoker 
35+ years old 
Chronic Productive cough 
Persistent and progressive breathlessness 
Wheeze uncommon 
Symptoms constant
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3
Q

COPD characterised by:

A

COPD characterised by airflow obstruction, which is typically:

  • Progressive
  • Not fully reversible
  • Does not change markedly over several months
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4
Q

Asthma =

A

= Chronic Inflammatory disorder of the airways.

In susceptible individuals, inflammatory symptoms usually associated with:
- Widespread but variable airflow obstruction
- Increase in airway response to a variety of stimuli
Obstruction is often reversible, either spontaneously or with treatment

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5
Q

Asthma characterised by:

A

Asthma = a chronic condition characterised by

  • Chronic inflammation of the bronchi with oedema and increased mucus secretion
  • Bronchial hyper-responsiveness leading to sudden, but reversible luminal narrowing and airway obstruction during an asthma attack.
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6
Q

Asthma symptoms:

A
  • *Wheeze
  • Shortness of breath
  • Cough
  • Chest tightness

Symptoms are:

  • Variable
  • Intermittent
  • Worse at night
  • Provoked by triggers including exercise.
NB: Wheeze = cardinal sign of asthma 
Typically:
o	Diffuse
o	Polyphonic 
o	Bilateral 
o	Particularly expiratory
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7
Q

Asthma triggers:

A

o Exercise
o Viral infections
o Iatrogenic - NSAIDs, Beta-blockers
o Occupational - common 9-15% of adult onset asthma.
Many triggers recognised - Isocyanates (paints), flour & grain dust, animals, colophony (pine resin) & fluxes (for soldering), latex, aldehydes & wood dust.
-> Affects:
Painters, chemical workers, bakers, forestry workers, electricians, welders, nurses, cleaners…
o Environmental - Dust, Pollens, Animal fur or feathers, Smoke e.g. tobacco…

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8
Q

Differential Diagnoses for some Asthma symptoms:

A
  • Infections
  • Pulmonary thrombo-embolic disease - Pulmonary embolus
  • Restrictive lung disease
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9
Q

Asthma Drugs:

A 
'Relievers' 
= Bronchodilators:
-	B2-agonist drugs 
-	Anti-muscarinic drugs 
-	Theophylline 
'Controllers/Preventers'
= Anti-inflammatory
-	Corticosteroids 
-	Leukotriene-receptor agonists 
-	Theophylline 
-	Cromoglycates
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10
Q

Inhaled drugs 3 Methods of delivery:

A
  1. Metered Dose Inhaler (MDI) / MDI + spacer
  2. Dry powder devices
  3. Nebuliser
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11
Q

Types of Metered Dose Inhaler

A

Blue = Short-acting B2-agonist

Brown or Orange = Corticosteroid

Green = Long-acting B2-agonist or Iptratropium

Purple = Seretide (combination preparation)

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12
Q

Alpha-1 Antitrypsin Deficiency

A

Recessive pattern of inheritance - mutant alleles commonly carried in the population
Disease manifestations and severity depend on the underlying genetic mutation, but may include:
- Lung disease - COPD
- Liver disease - Cirrhosis

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13
Q

COPD Symptoms

A

COPD should be considered in pts >35 years old who have a risk factor (generally smoking); and who present with:

  • Exertional breathlessness
  • Chronic cough
  • Regular sputum production
  • Frequent winter bronchitis
  • Wheeze

Pts with COPD may also experience

  • Ankle oedema
  • Cachexia (weakness and wasting of the body due to severe chronic illness)
  • Depression and anxiety

Airflow obstruction should be confirmed by spirometry
Mild: FEV1 50-80%
Moderate: FEV1 30-49%
Severe: FEV1 <30%

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14
Q

COPD Management Aims

A
  1. Limit complications (secondary prevention)
    - Remove factors driving disease progression - stop smoking
    - Should be offered - pneumococcal vaccination & annual influenza vaccination
  2. Control symptoms - no cure
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15
Q

COPD Drugs

A

Inhaled Bronchodilators:

**Anti-cholinergic bronchodilators (e.g. Atrovent) = first line drugs
(= Anti-muscarinic bronchodilator)

Combination Bronchodilators

  • Combivent (MDI or nebuliser) - Ipratropium & salbutamol
  • Duovent (nebuliser) - Ipratropium & fenoterol
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16
Q

COPD Management of Symptoms

A
  • Inhaled bronchodilators: **Anti-cholinergic bronchodilators (e.g. Atrovent) = first line drugs
  • Pulmonary Rehabilitation
  • Mucolytics
  • Ambulatory Oxygen Therapy
  • Long-term Oxygen Therapy
  • Non-invasive Ventilation
  • Surgery
17
Q

COPD Exacerbation Triggers

A

Infections e.g. Rhinoviruses (common cold), Influenza…

Common Pollutants 
"	Nitrogen dioxide 
"	Particulates 
"	Sulphur dioxide 
"	Ozone

** Cause of the exacerbation may be unidentifiable in up to 30% of exacerbations

18
Q

COPD Exacerbation characterised by:

A
  • Sustained worsening of the pt’s symptoms from his/her usual stable state that is beyond normal day-day variations
  • Acute onset
    Commonly reported symptoms:
  • Worsening breathlessness
  • Cough
  • Increased sputum production
  • Change in sputum colour
19
Q

Signs of a Severe COPD Exacerbation Include:

A
  • **Marked dyspnoea
  • **Tachypnoea
  • **Purse lip breathing
  • **Use of accessory muscles (sternomastoid and abdominal) at rest
  • Acute confusion
  • New onset cyanosis - bluish cast to skin and mucous membranes
  • New onset peripheral oedema
  • Marked reduction in activities of daily living
20
Q

COPD Exacerbation Management

A

Escalation of management for stable COPD e.g.:
- ↑doses of bronchodilators
- Nebuliser rather than space
Short (e.g. 2 week) course of systemic corticosteroids (prednisolone) - Osteoporosis cover if steroids taken repeatedly
Antibiotics if indicated

21
Q

Corticosteroids Risks

A

Inhaled
–> pts should rinse mouth with water after use to reduce chance of oral candidiasis
Good denture hygiene required

Systemic
–> increased risk of oral candidiasis
Morbidity associated with systemic steroids
‘Steroid cover’

22
Q

Acute URT Infections

A
  • Acute nasopharyngitis [common cold]
  • Acute sinusitis
  • Acute pharyngitis - including: Streptococcal sore throat
  • Acute tonsillitis
  • Acute laryngitis and tracheitis
  • Acute obstructive laryngitis [‘croup’ - usually caused by a virus. Infection -> swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of “barking” cough, stridor, and a hoarse voice] & epiglottitis
23
Q

Streptococcal Sore Throat

A

o Caused by: Streptococcus pyogenes = Group A beta-haemolytic streptococci (GABS) = part of the commensal oropharyngeal flora in some in health - do not always cause disease

o Common symptoms include: fever, sore throat, red tonsils, and enlarged lymph nodes in the neck

o Spread by close contact

o Mostly in children

o Symptoms last for approx.. 7 days in healthy people if left untreated

o Treatment typically includes Penicillin

24
Q

Common Cold

A 
- Caused by a range of viruses:
Rhinoviruses - most 
Adenovirus
Coronavirus 
Parainfluenza virus
  • Viruses replicate at temperatures slightly lower than usual body temperature -> Start in upper airways - slightly cooler
  • In otherwise healthy people no significant consequences
  • In pt with underlying respiratory disease these viruses can precipitate significant acute exacerbations
25
Q

Influenza Symptoms

A 
Fever 
Sore throat 
Muscle pains 
Severe headache 
Coughing 
Weakness 
General discomfort
26
Q

Influenza Vaccine Target Groups

A
  1. High risk patients >6 months old
    o Chronic respiratory disease - COPD, asthma (treated with continuous/repeated use of inhaled corticosteroids or asthma with previous exacerbations requiring hospital admission)
    o Chronic heart disease
    o Chronic liver disease
    o Chronic renal disease
    o Diabetes mellitus requiring insulin or oral hypoglycaemic drugs
    o Immunosuppression because of disease (e.g. asplenia or splenic dyfunction) or treatment (e.g. prolonged corticosteroid treatment)
    o HIV infection
  2. Others at particular risk of contracting influenza
    o People >65 years old
    o Residents of long-stay facilities e.g. nursing & residential homes
  3. Contacts of the above groups
    o Carers and healthcare professionals
27
Q

Lower Respiratory Tract Infections

A

Pneumonia - few

Others - most

28
Q

Lower Respiratory Tract Infections

Pneumonia
Causes:

A 
-	 Infections:
o	Bacterial**
o	Viral*
o	Other 
Microbes multiply in the normally sterile alveoli and induce inflammation -> alveoli fill with inflammatory cells &amp; fluid -> ↓gaseous exchange
29
Q

Bacterial Pneumonia

A

May be caused by many different bacteria
- Streptococcus pneumoniae = commonest
- Haemophilus influenza
- Staphylococcus aureaus
- Klebsiella pneumoniae
Antibiotic choice determined by causative bacteria

30
Q

Viral Pneumonia

A

Typically a consequence of an upper respiratory tract infection
Other causes less common but can have significant morbidity
- Herpes simplex virus
- Herpes zoster virus
- Cytomegalovirus

31
Q

Pneumonia Symptoms

A

Dyspnoea - breathlessness, difficult/laboured breathing

Fever

Cough - ‘productive’ = coughing up sputum; discoloured (green-yellow-brown) smelly sputum usually indicated bacterial infection

Chest pain

32
Q

LUNG CANCER TYPES

A

Small Cell Lung Cancers (~20%) - spreads rapidly

Non-Small Cell Lung Cancers (~80%)

  • Squamous cell carcinoma - most
  • Adenocarcinoma
  • Large cell carcinoma
33
Q

LUNG CANCER RISK FACTORS

A

Smoking**

  • Quitting reduces risk
  • Passive smoking
  • Genetic susceptibility varies amongst smokers

Radon gas
- Increased risk of this natural gas in some parts of UK rich in granite

Asbestos

34
Q

LUNG CANCER SYMPTOMS

A
  • Continuing cough, or change in long-standing cough
  • Chest infection that does not get better
  • Increasing breathlessness
  • Coughing up blood-stained sputum
  • Hoarse voice
  • Dull ache, or a sharp pain, on cough or deep breath
  • Loss of appetite and loss of weight
  • Difficulty swallowing
  • Excessive tiredness (fatigue) and lethargy
  • Finger clubbing
35
Q

LUNG CANCER MANAGEMENT

A

Aims
= Palliation in many rather than cure

Treatment modalities include:

  • Chemotherapy
  • Radiotherapy
  • Surgery - few; not for small cell cancers
36
Q

LARYNGEAL CANCER RISK FACTORS

A

Tobacco
Alcohol
HPV infection - evidence less strong that for cancer of tonsils or base of tongue
Occupational hazards - Wood dust, paint fumes

37
Q

LARYNGEAL CANCER SYMPTOMS

A
  • Hoarseness or change in voice
  • Difficulty swallowing
  • A feeling that there is a lump in your throat
  • Cough or chest infection
  • Being short of breath
  • Bad smelling breath (Halitosis)
  • Weight loss
  • Ear ache that doesn’t go away (rare)
38
Q

LARYNGEAL CANCER MANAGEMENT

A

Aims of treatment - cure in most, palliation in some

Treatment modalities include:

  • Chemotherapy
  • Radiotherapy
  • Surgery = Laryngectomy -> lose ability to speak normally
39
Q

LARYNGEAL CANCER PROGNOSIS

A

Survival rates in England and Wales (2011)
1 year: 86%
5 years: 70%

CMS1 (8 decks)

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