Respiratory

Question 1

What is acute bronchitis?

Answer 1

lower respiratory tract infection where there is inflammation of the large airways but not of the lung parenchyma (i.e. not a pneumonia). Cough is the predominant clinical feature, and the majority of cases are mild and self limiting

Question 2

Epidemiology of acute bronchitis?

Answer 2

5% of adults affected per year
Higher in autumn and winter months
Smoking is major risk factor

Question 3

Aetiology of acute bronchitis?

Answer 3

Viral;
Rhinovirus
Coronavirus
Adenovirus
Respiratory syncytial virus (RSV)
Influenza A and B
Parainfluenza

Bacterial;
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Mycoplasma pneumoniae
Bordetella pertussis

Question 4

Presentation of acute bronchitis?

Answer 4

Cough
Headache
Coryza
Sore throat
Mild dyspnoea
Chest wall pain with coughing
Fatigue
Malaise

Signs;
Low-grade fever
Wheeze, especially on forced expiration
Rhonchi that clear with coughing

Question 5

Differentials for acute bronchitis?

Answer 5

Pneumonia
COPD
Acute asthma exacerbation
PE
Post nasal drip
ACE inhibitor induced cough
Lung cancer

Question 6

Investigations to diagnose acute bronchitis?

Answer 6

Respiratory viral swab
Sputum culture
CRP, LDH
CXR

Question 7

Management of acute bronchitis?

Answer 7

Supportive, fluids and hot teas
Smoking cessation
Safety net to seek advice if this does not resolve in 3-4 weeks

Paracetamol and antibiotics

Consider delayed antibiotics of doxycycline, a 5 day course

Question 8

Complications of acute bronchitis?

Answer 8

Pneumonia
Persistent cough

Question 9

Prognosis of acute bronchitis?

Answer 9

Most recover in 2-3 weeks
Recurrence is common, especially in smokers

Question 10

Common allergens?

Answer 10

Dust mites
Foods (especially nuts, shellfish, eggs, milk and certain fruits)
Grass and tree pollens
Animal dander
Medications (e.g. penicillins, aspirin, ibuprofen)
Insect bites and stings

Question 11

Epidemiology of allergies?

Answer 11

44% of UK population have atleast 1 allergy
Hygiene hypothesis; people who are less exposed to pathogens are more likely to develop allergies

Question 12

Presentation of allergic reaction?

Answer 12

Itchy skin or eyes
Rashes (classically urticarial in IgE mediated hypersensitivity)
Gastrointestinal upset (diarrhoea, abdominal pain or nausea and vomiting)
Swelling of the eyes, lips, mouth or throat
Rhinorrhoea
Sneezing
Shortness of breath or wheeze
Deterioration in asthma or eczema symptoms
Conjunctivitis

Question 13

Differentials for allergic reaction?

Answer 13

Chronic urticaria
Hereditary/ drug related angio-oedema
Food intolerance
Food poisoning

Question 14

Management of allergies?

Answer 14

Exclude allergens
Oral antihistamines
Assess nutritional status
Re-introduce allergens

Question 15

Complications of allergies?

Answer 15

Malnutrition
Anaphylaxis
Reduced quality of life