Respiratory Flashcards
(138 cards)
1
Q
what is coryza
A
acute viral infection of the nasal passages; highly infectious due to rhinoviruses, coronaviruses and
adenoviruses. Spread via droplets, facilitated by overcrowding and poor ventilation.
2
Q
symptoms of coryza
A
watery nasal discharge mild pyrexia malaise sneezing tiredness sore nose and throat
3
Q
complications of coryza
A
sinusitis
acute bronchitis
secondary infection
otitis media
4
Q
treatments of coryza
A
bed rest
fluids
isolation
herbal extracts
5
Q
what is sinusitis
A
bacterial/fungal infection of paranasal sinuses, usually preceded by coryza. Can occur with asthma.
6
Q
symptoms of sinusitis
A
frontal headache, facial pain
purulent rhinorrhoea
fever
can be split into:
Acute: 1 week – 1 month
Subacute: 1-3 months
Chronic: >3 months
7
Q
investigations for sinusitis
A
CT of paranasal sinuses, MRI to demonstrate bony landmarks
8
Q
treatment of sinusitis
A
Nasal decongestants (xylometazoline)
Broad-spectrum antibiotics (co-amoxiclav)
Topical corticosteroid
(fluticasone propionate nasal spray)
FESS for ventilation and drainage
9
Q
what is rhinitis
A
Sneezing attacks, nasal blockage/discharge occurring >1hr on most days.
can be split into seasonal and perennial
10
Q
what is seasonal rhinitis
A
Limited period of the year; “hay-fever” but not restricted to grass pollen.
Intermittent rhinitis
11
Q
symptoms of seasonal rhinits
A
Nasal irritation, rhinorrhoea, sneezing
Itchy eyes and ears
Irritated soft palate
Wheeze
12
Q
what is perennial rhinitis
A
Throughout the whole year
Split into:
Allergic: caused by faeces of dust mites; cats; industrial dust and fumes.
Non-allergic: no identifiable stimulus, but eosinophilic granulocytes are present in secretions.
13
Q
symptoms of perennial rhinitis
A
Nasal blockage, rhinorrhoea
Loss of smell and taste
14
Q
treatment of general rhinits
A
Antihistamines (loratidine, cetirizine)
Topical corticosteroids (beclometasone, fluticasone propionate)
CysLT antagonist (montelukast)
Anti-inflammatory (sodium
cromoglicate)
15
Q
what is pharyngitis
A
Endemic adenovirus infection, causing reddened oropharynx and soft palate and inflamed tonsils.
16
Q
symptoms of pharyngitis
A
Sore throat
Tonsillar lymph nodes enlargement
Localised endemics of fever and
conjunctivitis
17
Q
treatment of pharyngitis
A
phenoxymethylpenicillin or cefaclor if severe
18
Q
what is acute laryngotracheobronchitis
A
Occasional complication of URTIs, particularly those caused by parainfluenza viruses and measles.
Most severe in children < 3yrs. Inflammatory oedema usually present which can spread to vocal cords.
19
Q
symptoms of acute laryngotracheobronchitis
A
Hoarseness Barking cough (croup) Stridor Progressive airway obstruction
20
Q
treatment of acute laryngotracheobronchitis
A
Nebulised adrenaline
Oral/IM corticosteroids (dexamethasone)
Oxygen and adequate fluids
Tracheostomy (rare!)
21
Q
what is acute epiglottitis
A
Life-threatening airway obstruction in children aged 2-7yrs caused by H. influenzae.
22
Q
symptoms of acute epiglottits
A
severe airflow obstruction
high fever
23
Q
complications of acute epiglottitis
A
mostly of H. influenzae meningitis diptheria osteomyelitis septic arthritis
24
Q
treatment of acute epiglottitis
A
Urgent endotracheal intubation
IV antibiotics (ceftazidime, ceftriaxone)
Prevention vaccine given to infants
Do NOT inspect epiglottis until airway is
patent
25
what is influenza
Influenza A (pandemics) and Influenza B (localised outbreaks) incubate within 3 days. Not a cold!
26
symptoms of influenza
Abrupt fever
Shivering and aching
Severe headache
Sore throat + dry cough
27
complications of influenza
Secondary bacterial infection/pneumonia
| Encephalomyelitis (rare)
28
investigations for influenza
Increase in complement-fixing antibody (hemagglutinin) between onset and after 1-2 weeks
Nasal/throat secretion analysis
29
treatment of influenza
Bed rest, fluids
Paracetamol
Neuraminidase inhibitors within 48hrs
(zanamivir, oseltamivir)
30
what is acute bronchitis
acute infection of bronchi causing them to become inflamed
| Usually arises from Strep. pneumoniae/H. influenzae infections, or in people with COPD.
31
symtptoms of acute bronchitis
Irritating dry cough; becomes productive
Wheeze
Breathlessness
Mild fever
32
treatment of acute bronchitis
NO antibiotics unless there is underlying chronic lung disease (amoxicillin)
33
what is pneumonia
Acute infection of the lungs causing inflammation. Community, Hospital and Immunocompromised
-acquired pneumonia. Main causes: Strep. pneumoniae, H. influenzae, Staph. aureus, Influenza A.
Atypical causes: Mycoplasma, Legionella, Chlamydophila pneumoniae/psittaci, coxiella burnetti.
HAP only diagnosed after 48hrs in hospital
34
symptoms of pneumonia
```
Fever and rigors
Pleuritic chest pain
Anorexia
Breathlessness
Cough – dry or productive
```
35
investigations for pneumonia
CXR consolidation, effusions,
collapse
FBC + U&Es, CRP
Sputum culture to detect organisms
CURB65 for CAP
36
treatment of pneumonia
CAP (see Antibiotic Man)
Mild/Moderate: (7 days) PO amoxycillin
If penicillin allergy PO doxycycline; if IV required IV clarithromycin
Severe: (10 days) IV co-amoxiclav + IV clarithromycin/PO doxycycline
If penicillin allergy IV levofloxacin
HAP
Severe: (7-10days) amoxicillin + metronidazole + gentamicin
Non-severe: (7 days) amoxicillin + metronidazole
Specific
Staph. aureus flucloxacillin/vancomycin if MRSA
Klebsiella cefotaxime
Pseudomonas ceftazidime/ciprofloxacin + aminoglycide
Mycoplasma clarithromycin/ciprofloxacin
Legionella levofloxacin/moxifloxacin/consider rifampicin
Chlamydophila doxycycline/clarithromycin
Pneumocystis jiroveci co-trimoxazole
Fungal amphoterecin
37
what is COPD
encompasses 2 main clinical syndromes: chronic bronchitis and emphysema
characterised by airflow obstruction that is most reversible with bronchodilators
38
symptoms of COPD
productive cough
wheeze
breathlessness
infective exacerbations
39
complications of COPD
Hypertension
Osteoporosis
Weight loss
Cor pulmonale
40
investigations for COPD
Smoking history/chronic history of
symptoms
```
Family history (α1-antitrypsin
deficiency)
```
Lung function tests (↓FEV1/↓FVC,
↓PEFR)
CXR classically normal
ABGs de-saturate over time
41
treatment of COPD
Smoking cessation and lifestyle advice
SABA (salbutamol) mild COPD,
LABA (salmeterol) mod-sev COPD
SAMA (ipratropium) or
LAMA (tiotropium)
Inh. corticosteroid (beclometasone),
PO corticosteroid if severe
(prednisolone)
Seretide (salmeterol + beclometasone)
Xanthine (theophylline)
Anti-mucolytic (carbocysteine)
42
treatment of an acute exacerbation of COPD
```
ISOAP
ipratropium (neb)
salbutamol (neb)
oxygen (24%)
amocillin/doxyclycine is purulent sputum
prednisolone (PO)
```
43
what is asthma
chronic inflammatory condition where reversible obstruction of the airways occurs.
airflow limitation -> airway hyerresonsivemess -> bronchial inflammation
44
investigations for asthma
Allergen skin prick test
Lung function tests (↓PEFR: mod<80%,
severe<50%, life-threatening<30%)
Bronchial challenge testing (histamine,
methacholine)
CO transfer (normal in asthma)
45
treatment for asthma
SABA (salbutamol)
```
LABA (salmeterol)
+ inhaled corticosteroid (beclometasone)
+ sodium cromoglicate
+ CysLT antagonist (montelukast)
+ oral corticosteroid (prednisolone)
```
46
treatment of acute asthma
```
O SHIT MAn
oxygen
salbutamol (neb)
hydrocortisone (IV)
ipratropium (neb)
magnesium sulpahte (IV)
prednisolone (PO)
```
47
characteristics of acute severe asthma
Unable to complete sentences
Respiratory rate >25 per minute
Pulse rate >110 beats per min
PEFR <50 % predicted
48
characteristics of life threatening asthma
PEFR <33% predicted
Bradycardia, hypotension, silent chest
Exhaustion, confusion, coma
ABG PaCO2 >5, PaO2 <8 or acidosis
49
what is OSA
airway becomes closed during sleep; muscles hypotonic during sleep and thus do not open airway. partial occlusion = snoring and complete occlusion = apnoea (cessation of breathing)
50
symptoms of OSA
```
Loud snoring
Daytime sleepiness
Unrefreshed/restless sleep
Headache
Large neck and tongue
Small mandible
```
51
aetiology of OSA
Obesity
Narrow pharyngeal opening
Co-existent COPD
Respiratory depre
52
investigations of OSA
Epworth Sleepiness Scale
Overnight pulse oximetry
Diagnose if >10-15 apnoeas in any 1hr of
sleep
53
treatment of OSA
Nasal Continuous Positive Airway Pressure (via mask during sleep)
CNS stimulant (modafinil
54
what is bronchiectasis
Abnormal permanent dilatation of airways, resulting inflammation and thickening of walls.
Mucociliary transport mechanism is impaired and thus recurrent bacterial infections ensue.
Cystic fibrosis = most common cause.
55
symptoms of bronhiectasis
```
Productive cough (yellow-green sputum,
can become haemoptysis)
Halitosis (bad breath)
Recurrent febrile episodes, malaise
Clubbing
Coarse crackles, pneumonic episodes
```
56
complications of bronchiectasis
Pneumonia, pneumothorax
Empyema
Metastatic cerebral abscesses
Life-threatening haemoptysis
57
investigations of bronchiectasis
CXR dilated + thickened bronchi
CT thickened bronchi, cysts
Sputum S. aureus, Pseudomonas, HiB
IgA deficiency
58
treatment of bronchiectasis
Postural drainage!
Antibiotics (mild: cefaclor/ciprofloxacin,
flucloxacillin if S. aureus;
persistent: ceftazidime)
Bronchodilators + anti-inflammatory
agents
59
what are lung abscesses
Localised suppuration assoc. with cavity formation on CXR/CT
60
aetiology of lung abscess
aspiration, TB, Stap/Klebs pneumonia, septic emboli, foreign body inhalation
61
symptoms of lung abscess
persisting pneumonia, foul sputum, malaise, weight loss, raised inf. markers
62
treatment of lung abscess
guided by culture results, surgical drainage
63
what is cystic fibrosis
autosomal recessive disorder in which there is a defect in the CFTR gene, a critical chloride channel.
Failed opening of Cl channel -> ↑cAMP, resulting in ↓Cl and ↑Na -> ↑viscosity of airway secretions.
64
symptoms of CF
```
Recurrent infections
Sinusitis, nasal polyps
Breathlessness
Haemoptysis
Steatorrhoea
Meconium ileus (SI obstruction)
Malabsorption
Abnormal teenage milestones
```
65
investigations in CF
```
Family history
Gene testing (sweat test)
```
66
treatment of CF
Lifestyle (smoking, vaccines)
Antibiotics (as per bronchiectasis)
SABAs, ICS for symptoms
Inh recombinant DNAse (dornase)
67
what is tuberculosis
Airborne infection spread by droplets by Mycobacterium species. Affects 1/3 of population.
Caseating granulomatous inflammation (necrotic centre; surrounded by epitheloid cells and Langhan’s
giant cells; formation of Ghon focus/complex). Primary=first infection. Latent=asymptomatic, smear –
ve
68
symptoms of TB
Persistent productive cough (>3weeks) +
occasional haemoptysis
Weight loss, night sweats, fever, fatigue
Hoarseness, pleuritic pain
69
investigations for TB
CXR consolidation +/- cavitation, fibrosis, calcification, pleural effusion, widening of
mediastinum
Latent: tuberculin skin test/Mantoux test (possible false –ve if previous BCG). If +ve do IFʎ test
Active: obtain tissue/fluid (induced sputum, bronchoalveolar lavage if unproductive cough,
aspiration of pleural fluid/biopsy, pus, ascites, urine, bone marrow, CSF)
Culture > PCR > ZN stain (but culture takes weeks, PCR is rapid so it is 1st line)
70
treatment of TB
2 months RIPE, 4 months RI
Rifampicin SE discolouration of
urine/tears, hepatitis, flu-like illness
Isoniazide SE neuropathy,
agranulocytosis, allergic reaction
Pyrazinamide SE hepatic toxicity (rare),
reduced renal excretion of urate, gout
Ethambutol SE colour blindness
developing into blindness
71
what is sarcoidosis
Multisystem non-caseating granulomatous Type IV hypersensitivity disorder of unknown aetiology
72
symptoms of sarcoidosis
Erythema nodosum
Fatigue, weight loss
Uveitis
Peripheral lymphadenopathy
73
investigations for sarcoidosis
CXR multiple abnormalities, BHL
Restrictive lung pattern
Hypercalcaemia, raised ACE level
Transbronchial biopsy
74
treatment for sarcoidosis
corticosteroids (PO prednisolone)
75
what is wegners granulomatosis
Granulomatous disease predominantly affecting small arteries. Lesions in URT, lungs, kidney
76
symptoms of wegners granulomatosis
Severe rhinorrhoea ->nasal mucosa ulcer
Cough, haemoptysis, pleuritic pain
Occasionally involves skin and nervous
system.
77
investigations of wegners granulomatosis
CXR nodular masses/pneumonia infiltrates with cavitation
Renal biopsy reveals necrotising microvascular glomerulonephritis
78
treatment of wegners granulomatosis
esponds well to cyclophosphamide or rituximab
79
what is churg-strauss syndrome
Eosinophilic infiltration with high blood eosinophil count, vasculitis of small arteries and veins.
Predominately affects 40 year old males
80
symptoms of churg-strauss syndrome
```
Rhinitis and asthma, breathlessness
Systemic vasculitis (fever, sweats, fatigue,
weight loss, rash)
Cough
Difficulty passing urine
Cold peripheries
```
81
investigations for churg-strauss syndrome
CXR pneumonic shadows (bilateral)
| ANCA +ve
82
treatment of churg-strauss syndrome
responds well to corticosteroids
83
what is systemic lupus erythematosis
Chronic type III hypersensitivity disease that causes inflammation in various parts of body
84
symptoms of systemic lupus erythematosis
```
Joint pain, fatigue
Skin rash
Pleurisy with or w/o effusion
Effusions (usually small/bilateral)
Basal pneumonitis (restricted chest
movement due to pleural pain)
```
85
what is idiopathic pulomary fibrosis
Patchy scarring of lung with collagen deposition and honeycombing. Late onset. Commoner in males.
86
symptoms of idiopathic pulomary fibrosis
```
Progressive breathlessness
Dry cough
Cyanosis
Fine bilateral end-inspiratory crackles
Clubbing
Assoc. with autoimmune diseases
```
87
investigations for idiopathic pulomary fibrosis
```
CXR initially ground-glass ->
honeycomb
CT bilateral changes, thick-walled cysts
Restrictive lung pattern, ↓CO transfer
Anti-nuclear antibodies
```
88
treatment of idiopathic pulomary fibrosis
Corticosteroids (oral prednisolone)
| Anti-fibrotic (pirfenidone)
89
what is extrinsic allergic alveolitis
Widespread diffuse inflammatory reaction in small airways and alveoli due to inhalation of foreign
antigens, usually from animals. Cigarette smokers actually have decreased risk. Type III
hypersensitivity
90
symptoms of extrinsic allergic alveolitis
Fever, malaise
Cough, breathlessness, wheeze
Coarse end-inspiratory crackles
Weight loss and IPF features (chronic)
91
investigations for extrinsic allergic alveolitis
CXR fluffy upper zone nodular shadows
CT ground glass opacity
Restrictive lung pattern, ↓CO transfer
Raised leucocytes + T cells
92
treatment of extrinsic allergic alveolitis
Prevent exposure
| Oral prednisolone in early stages
93
what is coal workers pneumoconiosis
Dust particles typically 2-5 micrometres in diameter are retained in small airways and alveoli
split into
simple pneumoconosis
progressive massive pneumoconiosis
94
what is simple pneumoconiosis and symptoms
More common form; refers to deposition of coal dust in lung.
| Symptoms usually COPD-related. CXR fine micro-nodular shadowing.
95
what is progressive massive pneumoconiosis
Round fibrotic masses several cm in diameter develop in upper lobes -> apical destruction of lung.
Necrotic central cavities.
96
symptoms of coal workers pneumoconiosis
Considerable effort dyspnoea
| Cough + black sputum
97
investigations for coal workers pneumoconiosis
Rheumatoid factor and ANAs +ve; restrictive/obstructive pattern, ↓lung volume, ↓CO transfer
98
what is asbestosis
Fibrosis causes by asbestos dust exposure
99
symptoms of asbestosis
Progressive breathlessness, clubbing
| Bilateral basal end-inspiratory crackles
100
treatment of asbestosis
No treatment alters progression, but corticosteroids can help symptoms
101
what is pneumothorax
Air in the pleural space. May be spontaneous (tall, thin males) or the result of trauma to the chest
102
symptoms of pneuothorax
```
Sudden onset pleuritic pain
Increasing breathlessness
Pallor, tachycardia
Mediastinal shift (tension
pneumothorax)
```
103
treatment of pneumothorax
Needle aspiration (2nd IC space, midclavicular line)
Chest drain if recurs using large bore
104
what is empyema
Pus in the pleural space. Usually complication of pneumonia. Exudate of pH< 7.2 very suggestive.
105
symptoms of empyema
Ongoing fever
| Persistent pneumonic symptoms
106
treatment of empyema
surgical drainage
107
what are pleural effusions
Excessive fluid in the pleural space.
can be split into
Transudate
protein < 30g/l LDH < 200
Heart failure, nephrotic syndrome, pericarditis
Exudate
protein > 30g/l LDH > 200
Pneumonia, cancer, TB, autoimmunity, MI, pancreatitis
108
symptoms of pleural effusion
breathlessness, sometimes chest pain but rarely
109
investigations of pleural effusion
Clinically detect when >500ml present
CXR detects when >300ml present, obliterated costophrenic angle, raised hemidiaphragm
Lights’ criteria (differentiates between transudate and exudate between 25-35g/l
110
treatment of pleural effusions
treat underlying cause but drain if empyema (purulent fluid).
Thoracocentesis 5th intercostal space, mid-axillary line
111
what is respiratory failure
Occurs when gas exchange is inadequate, resulting in hypoxia. It is defined as PaO2 <8kPa, subdivided
according to PaCO2 level
112
what is type I respiratory failure
hypoxia (PaO2 < 8kPa) with normal or low PaCO2
113
aetiology of type I respiratory failure
o Pneumonia
Pulmonary oedema
PE, fibrosing alveolitis
Asthma, emphysema, ARDS
114
treatment of type I respiratory failure
Treat underlying cause
Oxygen (15L) non-rebreather (hypoxia)
Assisted ventilation if PaO2 < 8kPa
despite 60% O2
115
what is type II respiratory failure
hypoxia (PaO2 < 8kPa) + hypercapnia (PaCO2 > 6.0 kPa)
116
aetiology of type II respiratory failure
Pulmonary disease (asthma, COPD, pneumonia, fibrosis, obstructive sleep apnoea)
Reduced respiratory drive (sedation drugs, CNS tumour/trauma)
```
Neuromuscular disease (cervical cord lesion, diaphragmatic paralysis, poliomyelitis, MG,
Guillain-Barre Syndrome)
```
Thoracic wall disease (flail chest, kyphoscoliosis)
117
treatment of type II respiratory failure
Oxygen (24%), recheck ABGs after 20min
If PaCO2 is steady/lower, increase O2 concentration to 28%
If PaCO2 rises > 1.5kPa and patient is still hypoxic, consider a respiratory stimulant (doxapram)
or assisted ventilation (NIPPV)
118
what is ARDS
Respiratory distress due to stiff lungs (reduce pulmonary compliance) and gas exchange impairment.
Lung injury, severe sepsis and pneumonia result in fibrous exudate lining alveolar walls, impairing gas
exchange and destroying alveoli.
119
symptoms of ARDS
Breathlessness
Tachypnoea
Increasing hypoxaemia, central cyanosis
Fine bilateral crackles
120
treatment of ARDS
Treat underlying condition (sepsis,
pneumonia), position patient prone
Diuretics
Inhaled nitric oxide (vasodilator
improves V/Q)
Aerosolized surfactant
PEEP
Inspired oxygen
121
what is pulmonary hypertension/cor pulmonare
Defined as mean pulmonary artery pressure of ≥25mmHg at rest.
Cor pulmonale = right heart failure due to pulmonary hypertension. Can occur in advanced COPD:
alveolar collapse (emphysema) results in hypoxia which causes vasoconstriction, increasing pressure in
the right side of the heart.
122
symptoms of pulmonary hypertension/cor pulmonare
```
Progressive breathlessness
Ankle oedema
Parasternal heave, tricuspid regurgitation
Pulmonary hypertension
RV hypertrophy
Elevated JVP, ascites
```
123
investigations of pulmonary hypertension/cor pulmonare
CXR enlargement of pul. arteries,
atrial/ventricular enlargement
ECG pattern of RVH
124
treatment of pulmonary hypertension/cor pulmonare
```
Encourage exercise, avoid overexertion
Oxygen (2l) during plane travel
Vaccination for influenza +
pneumococcal pneumonia
Oral anticoagulants
Diuretics
```
125
what is PE
Thrombus, usually from systemic veins, lodges in pulmonary arteries.
Virchow’s triad: endothelial damage, abnormal blood flow or hypercoagulable blood -> clot formation.
126
symptoms of PE
Sudden breathlessness
Sudden chest pain + haemoptysis
Tachypnoea
Fever, pleural rub, raised JVP
127
investigations of PE
CXR usually normal, possible blunting of costophrenic angle
D-dimer – if undetected, exclude diagnosis of PE
V/Q scan shows underperfused areas
Geneva score to predict PE likelihood
128
treatment of PE
Oxygen (60-100%) unless chronic lung disease
Anticoagulant (IM LMWH, IV heparin + warfarin)
IV fluids in massive embolus
Fibrinolytic (streptokinase
129
what is pulmonary oedema
accumulation of fluid in the pleural space
130
symptoms of pulmonary oedema
Breathlessness, orthopnoea
Cough + haemoptysis
Leg/abdominal swelling
Pale skin
131
treatment of pulmonary oedema
oxygen
| diureticss
132
symptoms of lung cancer
Cough (3 week cough merits a CXR)
Breathlessness(central tumours occlude large airways)
Haemoptysis (tumour bleeding into airway)
Chest pain (peripheral tumour invade the chest wall/pleuritic pain
Wheeze (monophonic when due to partial obstruction of airway by tumour)
Hoarseness (compression of the recurrent laryngeal nerve)
Dysphagia (invasion of phrenic nerve/oesophagus)
133
describe small cell carcinoma
Arise from APUD cells; secrete ACTH
Often centrally located
Rapid metastasis
134
describe adenocarcinoma
Common in non-smokers; smoking can cause it
Arises from mucus-secreting glandular cells
Metastasises widely
135
describe squamous cell caricinoma
Most common. Arise from epithelial cells
Occasionally cavitates; central necrosis
Local, slow metastasis. Hypercalcaemia, PTH
136
describe large cell carcinoma
Poorly differentiated
| Metastasises early on
137
investigations for lung cancer
CXR may be initially normal due to small lesion/confined to central structures
Common presentations: mass lesions, pleural effusion (large, unilateral), mediastinal widening or
hilar adenopathy, slow resolving consolidation, collapse, reticular shadowing
CT indicates extent of disease. Includes liver, adrenal glands. TNM staging can be done
PET characterises extent of mediastinal nodal involvement or distant metastases (2nd line to CT)
PET + CT for best correlation
Assess fitness for surgery
138
treatment of lung cancer
Surgery: early stage NSCLC surgery can be curative
If Stage III, treat with chemotherapy to downstage then surgical resection
Contraindicated if:
- Tumour is near hilum
- Evidence of metastasis
- FEV1 > 1.5 L
- Vocal cord paralysis
Radical radiotherapy: for patients with early stage NSCLC but adequate lung function, this is
ideal if surgery is not possible due to co-morbidities
Chemotherapy: effective against SCLC only
