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PA- FCM > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is acute bronchitis

A

short term inflammation of the bronchi

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2
Q

common causative agent (3) of acute bronchitis

A

viral infection typically RSV, Rhinovirus and influenza

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3
Q

Pathophysiology of Acute bronchitis

A

Damage causes irritation leading to inflammation of airways and lead to neutrophil infiltrating the lung tissue

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4
Q

Risk factors (3)

A

Tobacco smoke
dust
air pollution

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5
Q

Signs and symptoms

A

Dyspnoea
Cough
wheeze
chest discomfort
Fever
Fatigue
Malais

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6
Q

Investigation for acute bronchitis

A

pulse oximetry
CRP
Chest x-ray

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7
Q

Management for acute bronchitis

A

self-limiting
if bacterial suspected then antibiotics

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8
Q

Complication of acute bronchitis

A

pneumonia

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9
Q

What is bronchiolitis

A

it is an acute viral infection of the lower respiratory tract that occurs primarily in the very young and affects small airways

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10
Q

Common pathogen that causes acute bronchiolitis

A

RSV

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11
Q

Pathophysiology of acute bronchiolitis

A

occurs when virus infect terminal bronchiolar epithelial cells, causing inflammation in small bronchi and bronchioles

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12
Q

Risk factors for acute bronchiolitis

A

attendance at nursery
fall/winter time for kids
overcrowding
prematurity

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13
Q

Signs and symptoms of acute bronchiolitis

A

persistent cough
tachypnoea
chest recession
wheezing
rales

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14
Q

investigation for acute bronchiolitis

A

FBC, CRP, CXR (if needed)

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15
Q

Indication of hospitalisation for acute bronchiolitis

A

Toxic appearance, lethargy, dehydration, apnoea
RR>70
Hypoxia (<92%)

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16
Q

A&E management for acute bronchiolitis

A

inhaled bronchodilator
IV fluid
O2
Intubation
Nasal suctioning

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17
Q

Complication for acute bronchiolitis

A

cyanosis
dehydration
low o2 levels

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18
Q

What is acute epiglottitis

A

Inflammation of the epiglottis
Life threatening and can lead to irreversible loss of the airways due to laryngospasm

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19
Q

Some examples of pathogens that cause acute epiglottitis

A

streptococcus spp, Staph aureus, haemophilus influenza type b(Hib)

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20
Q

Risk factors for acute epiglottitis

A

Male
Weakened immune system
Lack of Hib vaccination

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21
Q

Signs and symptoms of acute epiglottitis

A

Muffles voice
Hoarse cry
Stridor
Drooling
Fever
tripoding

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22
Q

Investigation for acute epiglottitis

A

Lateral neck xr-thumbprint signs

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23
Q

Management for acute epiglottitis

A

Emergency referral
Airway management
Mange symtoms
Gold standard- refer laryngoscopy

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24
Q

Complication of acute epiglottitis

A

abscess formation
meningitis
sepsis
pneumothorax

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25
Q

What is asthma

A

A reversible chronic respiratory condition associated with airway inflammation and hyper-responsiveness

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26
Q

what is the pathophysiology of asthma

A

exposure to irritants -> inflammatory response -> effect on airways

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27
Q

Risk factors for asthma

A

Genetic
environmental
stress
medication
Prenatal smoking
occupation
Diet and nutrition

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28
Q

Signs and symptoms of non-acute asthma

A

wheeze
cough sob
chest tighness

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29
Q

Signs and symptoms of acute asthma

A

Fatigue
Interrupted sentences
us of accessory muscles
cyanosis

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30
Q

Pulse rate in acute asthma

A

tachycardia

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31
Q

Resp rate in acute athma

A

tachypnoea

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32
Q

Chest observation in acute asthma

A

wheeze
rubbing
reduced breath sounds

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33
Q

Oxygen sat in acute asthma

A

hypoxaemia

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34
Q

Signs and symptoms in viral induced wheeze

A

upper resp viral symptoms
polyphonic wheeze on auscultation
nasal flaring
intercostal recession
tripoding

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35
Q

Diagnosis criteria for non-acute asthma

A

Presence of more than one symptoms
FEV1/FVC ration of less than 70%
BRD test - shows improvement of FEV1 of 12% and increase in volume of at least 200ml
FeNO result of 40ppb or higher
PEF helps diagnose

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36
Q

Moderate acute asthma criteria (3pts) in adults

A

increasing symptoms
PEF> 50-75 best or predicted
No features of acute severe asthma

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37
Q

Severe acute asthma (4 pts) in adults

A

pef 33-50% best or predicted
RR- >25/min
HR->110/min
inability to complete sentences in one breath

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38
Q

Life threating asthma (10 pts) in adults

A

PEF <33% best or predicted
Sp02 < 92%
Pa02< 8kPa
altered conscious level
exhaustion
arrythmia
hypotension
cyanosis
silent chest
poor respiratory effort

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39
Q

Near fatal asthma in adults

A

raised PaCO2 and or requiring mechanical ventilation with raised inflation pressures

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40
Q

severe acute asthma in child

A

Spo2<92%
PEF 33-50% best or predicted
can’t complete sentences in one breath or too breathless to talk or feed

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41
Q

Life threatening asthma in children

A

Spo2 <92%
PEF< 33% best or predicted

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42
Q

Investigation order for asthma in adults

A

FeNO->spirometry ->BDR -> peak flow monitoring ->refer for other tests

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43
Q

Investigation order for asthma in children

A

Spirometry-> BDR-> FeNO-> Peak flow monitoring

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44
Q

Management for asthma in adults

A

Regular preventer (Low dose ICS)
Initial add on therapy (add inhaled LABA to low -dose ICS.
Additional controller therapies (consider increasing ICS dose or adding LTRA)
Refer to specialist therapies

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45
Q

Management for paediatric asthma

A

Regular preventer (Very low dose of ICS or LTRA for <5 yrs)
Initial add-on therapy (very low dose ICS + Child>5 -> add inhaled LABA or LTRA and for children <5 add LTRA
Additional controller therapies consider increasing ICS to low dose or children >5 add LTRA or LABA
Refer to specialist therapies

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46
Q

Name 3 pharmacological smoking cessation

A

Nicotine patch
Varenicline
Bupropion

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47
Q

Name 5 Nonpharmacological smoking cessation

A

Vaping
Community support
Counselling
Hypnotherapy
Acupuncture

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48
Q

What is Bronchogenic Carcinoma

A

primary lung cancer
They can be classified into small cell and non-small cell lung cancers
Non small more common than small cell

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49
Q

Risk factors for branchiogenic carcinoma

A

Smoking
History of cancer
exposure to harmful chemicals
Lung disease

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50
Q

Signs and symptoms

A

Cough - may be bloody
SOB
chest pain
Hoarseness
Fever
Noisy breathing
Weight loss
Slowly resolving chest infection

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51
Q

What to look out for in blood investigation for branchiogenic carcinoma

A

Anamia
Thrombocytopenia
Raised leukocytes
ESR/CRP may be raised

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52
Q

2 imaging to do as investigation for branchiogenic carcinoma

A

CXR
CT-CAP

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53
Q

2 special test to check for branchiogenic carcinoma

A

Bronchoscopy
Biopsy

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54
Q

4 Management for branchiogenic carcinoma

A

Smoking cessation
Radiotherapy
Chemotherapy
Surgery

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55
Q

Complications of branchiogenic carcinoma (3)

A

Laryngeal nerve palsy
Metastatic
Superior vena cava obstruction

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56
Q

Bronchiectasis

A

Chronic inflammation of the bronchi and bronchioles leading to permanent dilation of these airways

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57
Q

Some causes of bronchiectasis

A

Half is idiopathic but others:
Post- infection (TB, pertussis)
Congenital
Immune deficiency
Connective tissue disease
Cystic fibrosis
Fibrosis

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58
Q

Risk factors for Bronchiectasis

A

Cystic fibrosis
Host immunodeficiency
Previous infection
congenital disorders of bronchial airways

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59
Q

Signs and symptoms of bronchiectasis

A

Persistent cough
copious purulent sputum
intermittent haemoptysis
fever
finger clubbing
coarse inspiratory crepitation
wheeze
large airway Ronchi

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60
Q

Investigation for bronchiectasis

A

CXR
CT- show dilation of bronchi with or without airway thickening
Sputum culture
FBC

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61
Q

What is carcinoid tumour

A

they are neuro-endocrine tumours
commonly originate from cells in the stomach, lungs, duodenum, thymus and liver.
The bioactive substances result in diarrhoea, bronchoconstriction, skin flushing, right heart problems

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62
Q

What is carcinoid syndrome

A

Carcinoid tumour cells secrete bioactive substances like serotonin, bradykinin. These bioactive substances with physical symptoms of flushing, abdominal pain and etc is called carcinoid syndrome

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63
Q

Risk factor for carcinoid tumour

A

Family history

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64
Q

Signs and symptoms of carcinoid tumour

A
  • Palpable mass
  • Pain
  • Weight loss.
  • Skin changes (pellagra)
  • Diarrhoea
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65
Q

What is COPD

A

Group of progressive obstructive lung diseases including chronic bronchitis and emphysema

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66
Q

Pathophysiology of chronic bronchitis

A

Damage to endothelium impairing the mucociliary response to clear mucus & bacteria
results in airway deformation and narrowing of the lumen limiting airflow

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67
Q

Pathophysiology of emphysema

A

Enlargement of airspaces (alveoli), leading to declining in alveolar surface area limiting gas exchange
loss of elastic recoil equals airflow limitation; loss of alveolar supporting structure leads to airway narrowing

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68
Q

Risk factors of COPD

A
  • Age
  • Genetics (alpha-1-antitrypsin deficiency)
  • Tobacco smoke exposure (smoking & second-hand smoking)
  • Smoking asthmatics
  • Exposure to fumes
  • Exposure to workplace irritants
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69
Q

6 Signs and symptoms of chronic bronchitis

A

Blue bloaters
Mild dyspnoea
Cyanotic
Obese
Crackles/Wheeze possible
Peripheral oedema

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70
Q

Hallmark of chronic bronchitis

A

Chronic productive cough: cough and sputum production for at least 3 months in each of 2 consecutive years.

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71
Q

8 Signs and symptoms of chronic bronchitis

A

PINK PUFFERS
Minimal cough
Pink skin, pursed lips
Cachexic
Accessory muscle use
Barrell chested
Hyperinflation
Decreased breath sound

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72
Q

Hallmark of emphysema

A

Dyspnoea

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73
Q

Investigation for COPD

A

Diagnosed by spirometry - FEV1/FVC less than 0.7
FBCs
U&Es
CRP
CXR
Sputum Culture

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74
Q

Nonpharmacological Management for COPD

A

Smoking cessation
offer pneumococcal and influenza vaccine
self-management plan

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75
Q

Pharmacological management for COPD with no asthma

A

Offer SABA or SAMA then…
if not asthmatic ->LABA or LAMA then…
if worsening symptom effecting QUALY then consider 3-month trial of LABA+LAMA+ICS
or if person has severe or moderate exacerbation within a year then consider LABA+LAMA+ICS

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76
Q

Pharmacological management for COPD with asthma

A

Offer SABA or SAMA then…
if asthmatic->LABA+ICS
then LABA+LAMA+ICS

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77
Q

Complications of COPD

A
  • Respiratory infections
  • Lung cancer
  • Heart disease
  • Pulmonary hypertension
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78
Q

Definition of cor pulmonale

A

Right ventricle failure through pulmonary artery hypertension due to a lung disorder

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79
Q

Pathophysiology of cor pulmonale

A
  • Most commonly as a result of high blood pressure in the pulmonary arteries (Pulmonary hypertension)
  • As a result, increased afterload causes structural problems
  • Most notably hypertrophy of the right ventricle (mainly chronic)
  • Because the right ventricle is a good volume pump and not a pressure pump this causes issues
  • Decreased right ventricle output results in decreased left ventricle filling and therefore reduced cardiac output
  • Acute cor pulmonale can be caused by pulmonary embolism (PE) or acute respiratory distress syndrome (ARDS)
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80
Q

Pathophysiology of cor pulmonale

A
  • Most commonly as a result of high blood pressure in the pulmonary arteries (Pulmonary hypertension)
  • As a result, increased afterload causes structural problems
  • Most notably hypertrophy of the right ventricle (mainly chronic)
  • Because the right ventricle is a good volume pump and not a pressure pump this causes issues
  • Decreased right ventricle output results in decreased left ventricle filling and therefore reduced cardiac output
  • Acute cor pulmonale can be caused by pulmonary embolism (PE) or acute respiratory distress syndrome (ARDS)
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81
Q

Risk factors for cor pulmonale

A

secondary to lung disease
Acute:ARDS, PE
Chronic: COPD

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82
Q

Signs and symptoms of cor pulmonale

A

Distended neck vein
cyanosis
raised JVP
SOB
Tiredness
Chest pain

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83
Q

investigation for cor pulmonale (bloods*3, imaging *3, special test *3)

A

Bloods
- FBC, ABG, Coag studies
Imaging
- CXR, Echocardiogram, CTPA
Special Tests
- alpha-1-antitrypsin
- Broncoscopy
- Lung Biopsy

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84
Q

Management for cor pulmonale

A

Medical(Usually initiated by secondary care)
- Treat underlying disease
- Oxygen
- Diuretics such as furosemide or Butenamide
- Vasodilate the pulmonary arteries
- Phlebotomy for severe hypoxia
Surgical
- Heart or lung transplant as last resort

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85
Q

Complication for cor pulmonale

A
  • Exertional syncope
  • Hypoxia
  • Limited exercise tolerance
  • Peripheral oedema
  • Tricuspid regurgitation
  • Death
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86
Q

What is cystic fibrosis

A

Cystic Fibrosis is an autosomal recessive disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, on chromosome 7

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87
Q

Signs and symptoms in neonates for cystic fibrosis

A

Failure to thrive, meconium ileus, rectal prolapse

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88
Q

Resp Signs and symptoms in adults for cystic fibrosis

A

cough, wheeze, recurrent infections, bronchiectasis, pneumothorax, haemoptysis, respiratory failure, cor pulmonale

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89
Q

GI Signs and symptoms in adults for cystic fibrosis

A

pancreatic insufficiency, distal intestinal obstruction syndrome, gall stones, cirrhosis

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90
Q

Other Signs and symptoms in adults for cystic fibrosis

A

male infertility, osteoporosis, arthritis, vasculitis, nasal polyps, sinusitis, hypertrophic pulmonary osteoarthropathy

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91
Q

Investigations for cystic fibrosis

A

Blood spot on newborn
sweat test
genetic screening
Faecal elastase

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92
Q

Management for cystic fibrosis

A

MDT approach

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93
Q

What is croup

A

aka acute laryngotracheitis
common childhood illness caused by inflammation of the upper resp tract as a results of a viral infection

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94
Q

2 most responsible organism which can cause croup

A

parainfluenza
RSV

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95
Q

pathophysiology of croup

A
  • Viral URTI causes nasopharyngeal inflammation that may spread to the larynx and trachea, causing subglottal inflammation, oedema and compromise of the airway at its narrowest portion
  • Movement of vocal cords is impaired leading to the characteristic cough
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96
Q

Risk factors for croup

A

mostly effects 6mnth to 6 yrs old
genetics

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97
Q

4 signs and symptoms of croup

A

barking cough
stridor
hoarse cry
coryzal

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98
Q

What are the investigations for croup

A

Modified Westley scoring system
clinical diagnosis but o2 stats less than 95 indicated resp impairment

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99
Q

Management for croup

A

well hydrated, manage fever
dexamethasone
Nebulised budesonide
Nebulised adrenaline

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100
Q

complication of croup

A

pneumonia
pneumothorax
pulmonary oedema
dehydration

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101
Q

What is empyema

A

collection or presence of frank pus within pleural space

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102
Q

Pathophysiology of empyema

A

often due to infections post pneumonia
Begins as free flowing pleural fluid that becomes infected
Bacteria colonises the free fluid during the exudate stage when there is an increase of fluid production

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103
Q

which infection is most common in empyema

A

Anaerobic, staph and gram neg infections are most common causes

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104
Q

What are the risk factors for empyema

A

Pneumonia
endoscopy
lung abscess
alcoholism
Diabetes
COPD

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105
Q

Signs and symptoms of empyema

A

SOB
Fever and sweating
Dry cough
Chest pain upon breathing
Weight loss
Tachypnoea
Rales
Ronchi
Dullness to percussion

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106
Q

Investigations for empyema

A

Bloods

  • FBCs, U&Es, CRP

Orifice Test

  • Throacentesis

X-ray/Imaging

  • CXR, CT Chest

Special Tests

  • blood cultures
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107
Q

Management for empyema

A

Medical

  • Thoracentesis/ Chest drain
  • Antibiotics based on causative agent

Surgical

  • removal of affected area
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108
Q

2 complications of empyema

A

Fibrosis
Empyema necessitatis

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109
Q

What is influenza

A

It is an acute respiratory illness due to infection with the influenza virus

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110
Q

What are the 3 serotypes of influenza

A
  • Influenza A - more frequent and the cause of major influenza outbreaks
  • Influenza B - tends to circulate with A in yearly outbreaks and causes less severe illness
  • Influenza C - tends to cause a mild or asymptomatic illness akin to the common cold

Influenza A and B viruses cause most clinical disease

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111
Q

Risk factors for influenza

A
  • Closed environments - e.g schools, prisons, and residential homes
  • Very Young
  • Elderly
  • Immunocompromised
  • Pre-existing cardiac or respiratory illness
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112
Q

Signs and symptoms of influenzas

A
  • Malaise
  • Anorexia
  • Headache
  • Fever
  • Myalgia
  • Non-productive cough
  • Sore throat
113
Q

Investigation for influenza

A
  • Diagnosis is usually a clinical one.

Available tests include:

  • Direct viral culture of nasopharyngeal swabs/aspirates
  • PCR
114
Q

Management for influenza

A

self-limiting

115
Q

complication for influenzas

A

acute bronchitis
influenza related pneumonia
exacerbation of other conditions

116
Q

what is mesothelioma

A

It is a cancerous tumour arising from the mesothelium including that of the pleura

117
Q

What can mesothelioma caused by

A

Can be caused by asbestos exposure

118
Q

does mesothelioma have long or short latency period

A

Long latency period

119
Q

What is the life expectancy after diagnosis for mesothelioma

A

12-month life expectancy after diagnosis

120
Q

What is metastatic tumour

A

Metastatic lung cancers are cancers that have spread to the lungs from a primary source

121
Q

where can primary metastases spread to the lung s from

A

brain
bone
abdomen
prostate
adrenal
kidneys

122
Q

Risk factors for metastatic tumour

A

Family history
exposure to industrial chemical agents
primary cancer
genetics

123
Q

signs and symptoms of metastatic tumour

A

Chest pain
SOB
Haemoptysis
Weight loss
Recurrent infection
Night sweats
Cough

124
Q

Investigations for metastatic tumour

A

FBC, ESR, CRP, LFT, RFT
CXR
PET scan
ECG

125
Q

Management for metastatic tumour

A

based on individual case

126
Q

Complications for metastatic tumour

A

Pleural effusion
Superior vena cava

127
Q

What is pneumonia

A

Pneumonia is a common lower respiratory tract infection, characterised by inflammation of the lung tissue. It is almost always an acute infection, and almost always caused by bacteria

128
Q

How to diagnose pneumonia

A

Cough and at least one other lower

respiratory tract symptom

AND

New focal chest signs on examination

AND

EITHER sweating, fevers, shivers, aches and

pains OR fever >38

AND

No other explanation for symptoms.

129
Q

Risk factors for pneumonia

A
  • Smoking
  • Age: infants and the elderly
  • Alcohol excess
  • Preceding viral infections: for example: influenza
  • Bronchial obstruction: COPD
  • Bronchiectasis
  • Immunosuppression: AIDS, chemotherapy
  • Hospitalisation
  • Underlying predisposing disease: Diabetes, CVD
130
Q

Most common organism that causes pneumonia

A

strep pneumonia

131
Q

common causes of pneumonia

A

staph aureus
mycoplasma pneumonia
haemophilus influenza

132
Q

less common organisms that cause pneumonia

A

Klebsiella pneumonia
strep pyogenes
pseudomonas
aeruginosa
Coxiella burnetti
chlamydia psittaci
actinomyces israeli

133
Q

examples of common organism that’s causes fungal pneumonia

A

Mucor spp/Aspergillus spp (mold), Candida spp/cryptococcus spp (Yeast), histoplasma spp/blastomyces spp/coccidioides spp (All dimorphic fungus)

134
Q

Signs and symptoms of pneumonia

A

Acute illness characterised by cough, purulent sputum, fever.

Other common symptoms aches and pains, vomiting, anorexia, pleuritic chest

pain, dyspnoea.

135
Q

Investigations for pneumonia

A

LFT
FBC
Blood and sputum culture
U&E
CRP (high)
Throat and nasal swab
CXR

136
Q

Management for pneumonia

A
  • Hydration
  • Resting
  • Use CURB-65 if in primary care to determine if the patient needs hospital care
  • Oxygen
  • Antibiotic
137
Q

CURB 65

A

Confusion
Urea
RR->30 per minute
BP- sytolic of 90 or less or diatolic of 60 or lkess
65 years of age or older

0 - low risk
1-2 intermediate if 2 consider hospitalisation
3-5- high -> urgent admission

138
Q

complication of pneumonia

A

pleural effusion
lung abscess
empyema
sepsis

139
Q

What is atypical pneumonia

A

less common causative pathogen, not detectable on gram stain

140
Q

organisms that cause atypical pneumonia

A

Mycoplasma. pneumoniae, Chlamydophila. pneumoniae and Legionella pneumophila

141
Q

2 types of antibiotics that responds well to atypical pneumonia

A

macrolide or doxycycline

142
Q

where and who is mycoplasma infection common in

A

barracks and institutions
children and young adults

143
Q

what kind of symptoms do people with mycoplasma infection present with

A

dry cough
sore throat
flu like symptoms

144
Q

complications of mycoplasma infection

A

myocarditis, meningo-encephalitis, maculopapular rash, haemolytic anaemia

145
Q

Treatment for mycoplasma infection

A

erythromycin/ clarithromycin
tetracycline

146
Q

Presentation of legionella pneumonia

A

Previously healthy patient

Contaminated air condition

Cough, chills, temp, myalgia

147
Q

complications of legionella pneumonia

A

confusion
hepatitis
renal impairment
Hyponatraemia
lung abscess
empyema
hypotension

148
Q

investigations for legionella pneumonia

A

CXR
blood culture
legionella serolgy

149
Q

Management for legionella pneumonia

A

Erythromycin 14 -21 days of antibiotics, O2, IV abx/fluids

Rifampicin BD by mouth or IV in combination to all severely ill patients in whom diagnosis confirmed or thought to be likely

150
Q

how is chlamydia pneumonia spread

A

droplet spread like coughing or sneezing

151
Q

presentation of chlamydial pneumonia

A

Pharyngitis
hoarseness
otitis media

152
Q

diagnosis of chlamydial pneumonia

A

PCR

153
Q

Treatment for chlamydial pneumonia

A

first line- azithromycin
Tetracycline
macrolides
fluoroquinolones

154
Q

common hospital acquired pneumonia organisms

A

Pseudomonas aeruginosa, Staphylococcal aureus and Enterobacteriaceae (especially Klebsiella, E. coli and Enterobacter spp.)

155
Q

how is hospital acquired pneumonia different to community

A

acquired 48 hours after admission to hospital

156
Q

Management or staph aureus pneumonia

A

Flucloxacillin
erythromycin

157
Q

Klebsiella pneumonia presentation

A

High fever
rigors
pleuritic chest pain
purulent and gelatinous blood stained sputumn

158
Q

what is klebsiella often associated with

A

alcoholism
diabetes,
copd
elderly

159
Q

Management for klebsiella pneumonia

A

cefuroxime

160
Q

pseudomonas pneumonia

A

common pathogen in bronchiectasis

161
Q

How is pseudomonas pneumonia diagnosed

A

sputum culture

162
Q

Treatment for pseudomonas pneumonia

A

antipseudomonal penicillin (e.g.,ticarcillin, piperacillin), ceftazadime, meropenem, ciprofloxacin

163
Q

common organism in pneumonia in the immunosuppressed

A

Pneumocystis Jirovecii (carnii) pneumonia (PCP)

164
Q

presentation of PCP

A

dry cough, exertional dyspnoea &desaturation, fever, bilateral crepitations.

165
Q

Treatment for PCP

A

co-trimoxazole, pentamidine

166
Q

What is pneumoconiosis

A

A group of lung diseases, also referred to as occupational lung diseases, including asbestosis, silicosis, coal workers pneumoconiosis and Berylliosis

167
Q

Risk factors for Pneumonoconiosis

A
  • Smoking
  • Occupation related: working in environments that expose one to the mineral dusts
  • Occupations include:
  • Mining, construction or foundry work
  • Underground coal mining
  • High temperature ceramics
168
Q

Signs and symptoms of pneumonoconiosis

A
  • Shortness of breath
  • Cough
  • Chest tightness
  • Wheezing
  • Haemoptysis
  • History of industrial work
  • Widespread wheeze and crackles on auscultation
  • Dullness on percussion
  • Clubbing
  • Cyanosis
  • Barrel chest
169
Q

what is pertussis

A

Highly contagious disease also known as “Whooping Cough”

170
Q

when is the vaccine available for pertussis

A

Vaccine: for 16-31 weeks pregnant and in childhood schedule vaccinations.

171
Q

Pathophysiology of pertussis

A
  • Transmitted by sneeze or cough or through touching of contaminated surface
  • Caused by Bordetella Pertussis (BP)
  • BP then releases toxins to help anchor itself to the epithelium
  • Toxins also paralyse the cilia, causing an excess of mucus build up
  • Mucus build up triggers violent cough reflex
  • Causes violent coughing spells called “paroxysms”
  • Swollen airways cause whooping noise
  • Significant cause of morbidity and mortality in infants younger than 2 years old
172
Q

Risk factor for pertussis

A
  • Vaccine wears off by teenage years so an outbreak can cause pertussis in teenage or adult years
  • Infants less than a year old who unvaccinated or haven’t received all recommended vaccines have a high risk of complications and death
173
Q

Signs and symptoms for pertussis

A
  • Runny nose
  • Nasal congestion
  • Cough
  • Low grade fever
174
Q

Investigation for pertussis

A

FBC
CXR
Nasopharyngeal swab

175
Q

Management for pertussis

A

Hospital admission for infants under 6 months of age and for any older child who has had apnoeic or cyanotic spells

Macrolides can reduce infective period -clarithromycin/azithromycin

Oxygen should be given if there is cyanosis.

176
Q

What is pulmonary HTN

A

Progressive increase in pulmonary vascular resistance (PVR) and, ultimately, right ventricular failure and death.

Increase in mean pulmonary arterial pressure ≥25 mm Hg at rest as assessed by right heart catheterisation.

177
Q

Risk factor for pulmonary HTN

A
  • Family History of PAH
  • Obesity
  • Obstructive Sleep Apnea
  • Female Gender
  • Pregnancy
178
Q

Symptoms of Pulmonary HTN

A

chest pain, exertional dyspnoea, fatigue, syncope.

179
Q

Signs of pulmonary HTN

A

small volume pulse, peripheral cyanosis, a raised jugular venous pulse (JVP), a parasternal - right ventricular – heave, peripheral oedema

180
Q

Investigations for pulmonary HTN

A

Right heart catheterisation is needed to confirm the diagnosis

ECG - right ventricular hypertrophy

Echocardiography - demonstrates a dilated right ventricle with impaired function

181
Q

What are pulmonary nodules

A

Lung nodules are circular/rounded structures that appears on CXR/CT thorax and are traditionally defined as <3cm.

182
Q

Risk factors for pulmonary nodules

A
  • Infection
  • Previous lung malignancy
  • Immunocompromised
  • Smoking
183
Q

Signs and symptoms of pulmonary nodules

A
  • Usually asymptomatic
  • If symptomatic, symptoms would be consistent with underlying pathology such as weight loss/haemoptysis/SOB if malignant, fever/joint pain/SOB/haematuria if infectious/inflammatory cause.
184
Q

what is pleural plaque

A

Pleural plaques arebenign areas of thickened tissue that form in the pleura, or lung lining

185
Q

what is pleural plaque indicative off

A

asbestos exposure
Pleural plaques develop 10 to 30 years after initial asbestos exposure and usually do not require treatment.

186
Q

What is pleurisy

A

Inflammation of the pleura which compromises lubrication and results in pain

187
Q

What can cause pleurisy

A
  • Pneumonia
  • Trauma
  • Cancers such as mesothelioma or lung Ca
  • Rheumatoid arthritis
  • Trauma
  • Pulmonary embolism
  • Viral respiratory illnesses
  • Allergic reactions to drugs
  • HIV
  • Respiratory conditions such as Asbestos etc
188
Q

Pathophysiology of pleurisy

A
  • The lungs, rib cage and chest wall are lined with epithelium known as the Visceral pleura and the Parietal Pleura
  • The Visceral pleura is known as the inner layer which lines the surface of the lungs
  • The Parietal Pleura is known as the outer layer and lines the chest wall, rib cage and mediastinum
  • Both layers are supplied by different nerves resulting in different pain sensations
  • Parietal pleura is supplied by the Phrenic nerve resulting in sharp localised pain
  • Visceral Pleura is supplied by the Autonomic nerve resulting in dull achy pain
  • Between both layers there is fluid which acts as a lubricate allowing for inspiration and expiration
  • When the pleura is inflamed (which can be caused by many illnesses); the pleural lining rubs together causing pain
189
Q

3 risk factors for pleurisy

A
  • Viral illness
  • Malignancy
  • Pneumothorax
190
Q

Signs and symptoms of pleurisy

A

Finding can vary depending on cause
chest pain
exacerbated by deep inspiration
cough
SOB

191
Q

Investigations for Pleurisy

A

These must be done to rule out other causes of Chest pain

Bloods

  • Routine including Troponin and ABG (D-Dimer may be done if appropriate)

X-ray/Imaging

  • to exclude cardiac cause

Special Tests

  • CXR: These will rule out common differentials such as Pneumothorax, pleural effusions, etc
  • A diagnosis of pleurisy/pleuritis can be done once other differentials have been confidently excluded
192
Q

what is the management for Pleurisy

A
  • This again is dependent on cause and patients PMH
  • First line (if patient is otherwise stable) : NSAIDS
  • Second line: Indomethacin
  • REMEMBER TO TREAT UNDERLYING CAUSE IF APPROPRIATE (e.g. Abx if cause is a bacterial infection)
193
Q

Complications of Pleurisy

A
  • Adhesions of the pleura which can leave patients suffering with Chronic chest pain and SOB
  • Pleural effusion
194
Q

What is tension pneumothorax

A

Abnormal collection of air in the pleural space

The pleural cavity pressure is more than the atmospheric pressure

195
Q

Pathophysiology of tension pneumothorax

A
  • Tension pneumothorax occurs when a large amount of air is present within the lung causing the lung to deflate
  • The pressure outside the lung is greater and can cause the trachea to deviate, eventually kinking the inferior vena cava which is what usually leads to death
  • Often called a collapsed lung
196
Q

Risk factors for tension pneumothorax

A
  • Male
  • Age
  • Smoking
  • Mechanical ventilation
  • Previous pneumothorax
197
Q

Signs and symptoms of tension pneumothorax

A
  • Sudden chest pain
  • Shortness of breath
  • In severe cases – struggling to breathe
  • PMH of Pneumothorax, Marfan’s Syndrome
  • Cyanosis
  • Tachycardia
  • Absent breath sounds
  • Hyperresonance on percussion
  • Tracheal deviation in tension pneumothorax
198
Q

Investigations for tension Pneumothorax

A
  • BOXES (bloods, orifices, x ray/imaging, ECG, special tests)

X-ray/Imaging

  • CXR: if not life threatening
  • CT Scan: if not life threatening
199
Q

Management for tension pneumothorax

A

Conservative

  • If less than 2cm and asymptomatic

Medical

  • Oxygen if SOB

Surgical

  • Wide bore cannula, 2nd intercostal space, midclavicular line to decompress in tension pneumothorax
  • Chest drain insertion
  • Pleurodesis: for recurrent pneumothorax
200
Q

Complications of tension pneumothorax

A
  • Can occur repeatedly again
  • May require surgery to prevent this
201
Q

What is Traumatic pneumothorax

A

Abnormal collection of air within the pleural space

The pleural cavity pressure is = the atmospheric pressure

202
Q

Pathophysiology of traumatic pneumothorax

A
  • Traumatic pneumothorax occurs as a result of trauma
  • Most commonly as a result of a stab wound with a knife
  • Can also occur with blunt trauma
203
Q

Risk factors for traumatic pneumothorax

A
  • Male
  • Age
  • Smoking
  • Mechanical ventilation
  • Previous pneumothorax
204
Q

Signs and symptoms of traumatic pneumothorax

A
  • Sudden chest pain
  • Shortness of breath
  • In severe cases – struggling to breathe
  • PMH of Pneumothorax, Marfan’s Syndrome
  • Cyanosis
  • Tachycardia
  • Absent breath sounds
  • Hyperresonance on percussion
  • Tracheal deviation in tension pneumothorax
205
Q

Investigations for traumatic pneumothorax

A
  • CXR: if not life threatening
  • CT Scan: if not life threatening
206
Q

Management for traumatic pneumothorax

A

Conservative
- If less than 2cm and asymptomatic
Medical
- Oxygen if SOB
Surgical
- Needle aspiration: Wide bore cannula, 2nd intercostal space, midclavicular line to decompress in tension pneumothorax
- Chest drain insertion
- Pleurodesis: for recurrent pneumothorax

207
Q

Complications for traumatic pneumothorax

A
  • Can occur repeatedly again
  • May require surgery to prevent this
208
Q

What is primary pneumothorax

A

Abnormal collection of air within the pleural space

The pleural cavity pressure is less than atmospheric pressure

209
Q

Pathophysiology of primary pneumothorax

A

Primary pneumothorax occurs without cause usually occurs in the absence of significant lung disease

210
Q

Risk factors for primary pneumothorax

A
  • Male
  • Age
  • Smoking
  • Mechanical ventilation
  • Previous pneumothorax
211
Q

Signs and symptoms of primary pneumothorax

A
  • Sudden chest pain
  • Shortness of breath
  • In severe cases – struggling to breathe
  • PMH of Pneumothorax, Marfan’s Syndrome
  • Cyanosis
  • Tachycardia
  • Absent breath sounds
  • Hyperresonance on percussion
  • Tracheal deviation in tension pneumothorax
212
Q

Investigations for primary pneumothorax

A

BOXES (bloods, orifices, x ray/imaging, ECG, special tests)

X-ray/Imaging

  • CXR: if not life threatening
  • CT Scan: if not life threatening
213
Q

Management for primary pneumothorax

A

Conservative
- If less than 2cm and asymptomatic
Medical
- Oxygen if SOB
Surgical
- Needle aspiration: Wide bore cannula, 2nd intercostal space, midclavicular line to decompress in tension pneumothorax
- Chest drain insertion
- Pleurodesis: for recurrent pneumothorax

214
Q

Complications for primary pneumothorax

A
  • Can occur repeatedly again
  • May require surgery to prevent this
215
Q

What is pleural effusion

A

Collection of abnormally present fluid in the pleural space

216
Q

Pathophysiology of pleural effusion

A
  • Occurs as a result of inflammation of the lungs or pleura
  • This causes exudative effusion
  • Systemic infections, heart failure, cirrhosis or malignancy can also cause an effusion
  • This causes transudative effusion
217
Q

Common primary aetiology of exudative effusion

A

Infection
cancer
autoimmune
drugs
pulmonary embolism

218
Q

Common primary aetiology of transudative effusion

A

CHF
Liver disease
ESRD
Nephrotic syndrome
Pulmonary embolism

219
Q

Common secondary aetiology of exudative effusion (right sided *2)

A

Meigs’ syndrome
Endometriosis

220
Q

Common secondary aetiology of exudative effusion (Left sided *2)

A

Pancreatic
oesophageal rupture

221
Q

Risk factors for pleural effusion

A
  • Congestive heart failure
  • Pneumonia
  • Malignancy
  • Recent CABG surgery
222
Q

Signs and symptoms of pleural effusion

A
  • Shortness of breath
  • Cough
  • Pleuritic chest pain
  • PMH of cardiothoracic surgery, liver cirrhosis, malignancy, renal failure
  • Decreased/absent breath sounds
  • Dullness to percussion
  • Decreased/absent tactile fremitus
223
Q

Investigations for pleural effusion

A

Bloods

  • WBC, U&E, CRP, Tumour markers

X-ray/Imaging

  • CXR, CT Chest

Special Tests

  • Blood cultures, Pleural fluid analysis (Light’s criteria)
224
Q

Management for pleural effusion

A

Medical
- Therapeutic pleural drainage
Surgical
- Pleurodesis

225
Q

Complications for pleural effusion

A

Pneumothorax

226
Q

What is pulmonary fibrosis

A

Restrictive disease

Pulmonary fibrosis is a condition in which there is diffuse fibrosis of lung parenchyma with a resultant impairment of gas transfer and ventilation-perfusion mismatching.

227
Q

Risk factors for pulmonary fibrosis

A

Family history

cigarette

smoking

advanced age

male sex

228
Q

Signs and symptoms of pulmonary fibrosis

A

Dyspnoea

Cyanosis

Clubbing

Slightly reduced chest expansion

Bronchial breathing

On auscultation there may be late-inspiratory and pan-inspiratory crackles heard

over the affected lung

229
Q

Investigations for pulmonary fibrosis

A

A combination of aforementioned clinical features and imaging/biopsy can suggest the diagnosis of pulmonary fibrosis.

  • CXR – shows typical scarring pattern in the lungs, suggestive of the disease. Typical basilar, peripheral, bilateral, asymmetrical, reticular opacities
  • CT scan of the lungs and/or a lung biopsy are usually needed to confirm diagnosis.
  • CRP and ESR mildly elevated
230
Q

Management for pulmonary fibrosis

A

Pulmonary rehabilitation

Corticosteroid therapy

Other immunosuppressive therapy - drugs such as cyclophosphamide and azathioprine have been used as a steroid sparing agent

Lung transplantation

Antifibrotic agents - pirfenidone is an immunosuppressant that is thought to have anti-inflammatory and antifibrotic effects.

Oxygen - to palliate symptoms of breathlessness

231
Q

What is pulmonary embolism

A

Clot in the pulmonary artery/arteries impairs perfusion of the lungs and can lead to lung infarction and death

A pulmonary embolus is a fragment of thrombus (or clot) that breaks off and travels in the blood until it lodges in the pulmonary vasculature in the lungs.

232
Q

Pathophysiology of PE

A

Endothelial damage, venous stasis and hypercoagulability lead to clot formation

233
Q

Different causes of PE

A

Right ventricular thrombus

septic emboli

Fat, air or amniotic fluid embolism

Neoplastic cells

Parasites

234
Q

Risk factors for PE

A

Any causes of immobility or hypercoagulability:
recent surgery
recent stroke or MI
disseminated malignancy
thrombophilia/antiphospholipid syndrome
prolonged bed rest
pregnancy, postpartum, COCP/HRT

235
Q

Signs and symptoms of PE

A

Small emboli may be asymptomatic
large can be fatal
SOB
Chest pain
Haemoptysis
Syncope
fever
Cyanosis
Tachcardia
Raised jvp
Hypotension

236
Q

What investigations are used for PE

A

WELLS score
PERC score
D-dimer
CXR
ECG
ABG
CT
V/Q scan
CTPA

237
Q

Acronym for PERC score

A

HAD CLOTS
Hormone
Age >50
Dvt/pe history
Coughing blood
Leg swelling
O2 less than 95%
Tachycardia- 100+
Surgery/ Trauma

238
Q

What is D-dimer and what is it used for

A

D-dimer is a breakdown product of cross-linked fibrin by the fibrinolytic system. D-dimer levels become elevated when there is lysis of cross-linked fibrin within the thrombus.
Used to rule out PE

239
Q

When are D-dimer worthless

A

Recent surgery or trauma

Patient has other auto-immune or inflammatory process going on in the body

Liver / Renal / Heart Failure

Pregnancy

Sepsis

Sickle cell disease

Acute MI or Stroke

240
Q

What is CXR used in PE investigation for

A

The greatest utility of the CXR in diagnosis of PE is exclusion of alternate disorders

241
Q

Management for PE

A

Manage airway

Anticoagulation

DOACS: dabigatran, Rivaroxaban, Apixaban

Lowe molecular weight heparin

Warfarin orally

242
Q

Complications for PE

A

Cardiac arrest

Pleural effusion

Pulmonary infarction

Death

243
Q

What is RSV

A

Respiratory syncytial virus
Contagious viral infection of the respiratory tract, most often the cause of Bronchiolitis

244
Q

How is RSV spread and what is the incubation period and where does the virus target

A

RSV is spread from person to person via respiratory droplet
2-8 days
The virus spreads to the respiratory tract targeting the apical ciliated epithelial cells

245
Q

What are the risk factors for RSV

A

Chronic lung disease
Immune compromised
In utero exposure to Tabacco smoke
low socioeconomic disease
Premature birth

246
Q

Signs and symptoms of RSV infection

A

Cold-like symptoms:

  • Low-grade fever
  • Cough
  • Wheezing
  • Rales
  • Cyanosis
  • PMH of premature birth, weakened immune system, heart or lung defects/disease
247
Q

Investigation for RSV

A
  • FBCs
  • U&Es

Special Tests

  • Rapid RSV antigen testing
248
Q

Management for RSV

A

Conservative

  • Observations
  • Hydration

Medical

  • Bronchodilators
  • Alpha agonists
249
Q

Complications for RSV

A

Bronchiolitis
Pneumonia

250
Q

What is sleep apnoea

A

The interruption of sleep as a result of a narrowing of the throat
This leads to irregular breathing at night and excessive daytime sleepiness

251
Q

Risk factors for sleep apnoea

A

Male sex
Obesity
Smoking
Hypothyroidism

252
Q

Signs and symptoms for sleep apnoea

A

Excessive daytime sleepiness
Impaired concentration
Snoring
Unrefreshing sleep
Choking episodes during sleep
Witnessed apnoeas - a ten-second pause in breathing
Restless sleep

253
Q

Investigations for sleep apnoea

A

Polysomnography - is the gold standard investigation.
Epworth Sleepiness scale.

254
Q

Management for sleep apnoea

A

Lifestyle advice/Behavioural interventions – weight loss, smoking cessation,

reduction in alcohol consumption.

CPAP – it is the gold standard treatment.

Pharmacotherapy but its role is limited.

Surgery

255
Q

What is sarcoidosis

A

It is a multisystem chronic inflammatory condition characterised by non-caseating epithelioid granulomata. Affects lungs, skin, lymph nodes and eyes most commonly. Accumulation of lymphocytes and macrophages and the formation of non-caseating granulomas

256
Q

Signs and symptoms of sarcoidosis (constitutional, lung, skin, eye)

A

Constitutional symptoms – fever, night sweats, weight loss

Lung – dry cough, dyspnoea

Skin – erythema nodosum (tender, painful, bilateral)

Eye – anterior uveitis

257
Q

Investigations of sarcoidosis

A

CXR – bilateral hilar

lymphadenopathy

CT

Blood tests

258
Q

What is TB and how is it spread

A

Tuberculosis (TB) is an infection caused by Mycobacterium Tuberculosis and mainly affects the lungs

The bacteria is spread by inhaling respiratory droplets

259
Q

Pathophysiology of TB

A
  • The disease is airborne - infection occurs through the inhalation of droplets that may be present in the air if someone with TB has been coughing or sneezing
  • TB is split into two categories: Latent and Active
  • Latent TB - you have the TB bacteria present within your body, however it is in an inactive state and therefore asymptomatic and isn’t contagious. It can become active at a later stage, usually when the immune system is weaker e.g. neutropenia through chemotherapy, HIV etc
  • Active TB - can occur either weeks after contracting the bacteria or several years later, now infective to others
  • The lungs are the most common site for TB infection
  • Extrapulmonary TB can manifest in other organs mainly the brain and spinal cord
260
Q

Risk factor for TB

A

Close contact of TB patient

Homeless patients, those with alcohol dependency and other drug misusers

HIV-positive and other immunocompromised patients

Elderly patients

261
Q

Lung symptoms for TB

A

cough, sputum, haemoptysis, breathlessness, lobar collapse, bronchopneumonia, hoarseness

262
Q

Pleura symptoms for TB

A

breathlessness, pain, effusion

263
Q

Heart symptoms for TB

A

pain, arrhythmias, cardiac failure, pericarditis

264
Q

Intestine symptoms for TB

A

malabsorption, diarrhoea, obstruction

265
Q

GU tract symptoms for TB

A

haematuria, renal failure, epididymitis, salpingitis, infertility

266
Q

Skin symptoms for TB

A

erythema nodosum, lupus vulgaris

267
Q

Eyes symptoms for TB

A

iritis, choroiditis, keratoconjunctivitis

268
Q

Bones symptoms for TB

A

arthritis, osteomyelitis

269
Q

Lymphatics symptoms for TB

A

lymphadenopathy, cold abscesses, sinuses

270
Q

symptoms for TB

A

tuberculoma, meningitis

271
Q

Investigation if active pulmonary TB is suspected

A
  • If Active pulmonary TB is suspected:

-Chest X-Ray

-Sputum culture sample: for acid-fast bacilli smear, mycobacterial cultures and nucleic acid amplification testing (NAAT)

272
Q

Investigation if active extrapulmonary TB is suspected

A
  • If Active extrapulmonary TB is suspected:

-Chest X-ray and sputum sample should be requested

-Also, additional investigations depending on the likely site of infection

273
Q

Investigation for latent TB

A

Tuberculin skin test (Mantoux test)

  • Injecting 0.1mL of liquid containing tuberculin purified protein derivative (PPD) into top layers of forearm skin
  • Check 48-72 hours after injection
  • Positive if ≥5 mm skin induration

Offer Mantoux test to:

  • Close contacts of person with active TB
  • Immunocompromised adults
  • Healthcare workers
  • Immigrants from high incidence countries
274
Q

Management for active TB

A

For people with active TB without central nervous system involvement, offer:

  • Isoniazid (with pyridoxine), rifampicin, pyrazinamide and ethambutol for 2months
  • Then isoniazid (with pyridoxine) and rifampicin for a further 4 months.
  • Modify the treatment regimen according to drug susceptibility testing
275
Q

Management for latent TB

A
  • Isoniazid (with pyridoxine) and rifampicin x3 months

OR

  • Isoniazid (with pyridoxine) x6 months
276
Q

Complications for TB

A

Pleural effusion

Empyema

Pneumothorax

Laryngitis

Enteritis

Mycetoma with Aspergillus fumigatus in a healed cavity

Cor pulmonale secondary to extensive fibrosis

Death

277
Q

What is extrinsic allergic alveolitis

A

Extrinsic allergic alveolitis is alung disorder resulting from repeated inhalation of organic dust
, usually in a specific occupational setting. In the acute form, respiratory symptoms and fever begin several hours after exposure to the dust.

278
Q

What is asbestosis

A

A lung disease that develops due to inhalation of asbestos fibre,which is a fibrous hydrated magnesium silicate. Asbestos fibres are used for building roofs, insulation etc. Long time exposure to asbestos leads to shortness of breath by causing fibrosis of the lung.

PA- FCM (10 decks)

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