Respiratory Disease

Question 1

What is dyspnoea?

Answer 1

Shortness of breath

Question 2

What is orthopnoea?

Answer 2

Shortness of breath when lying flat

(Type of dyspnoea)

Question 3

What is paroxysmal nocturnal dyspnoea?

Answer 3

When patient is awakened by shortness of breath

Usually indicative of cardiovascular problem (eg left ventricular failure)

Question 4

What diseases cause sudden shortness of breath?

Answer 4

Foreign body
Pulmonary embolism
Pneumothorax

Question 5

What diseases cause shortness of breath that lasts for HOURS?

Answer 5

Asthma
Pulmonary oedema
Pneumonia
Extrinsic allergic alveolitis

Question 6

What diseases cause shortness of breath for DAYS?

Answer 6

Pleural effusion
Lung cancer?

Question 7

What causes shortness of breath for MONTHS?

Answer 7

Pulmonary fibrosis
Chronic airflow limitation

Question 8

What is wheeze?

Answer 8

Small airway noise
Expiratory
Any cause
Typically asthma

Question 9

What is stridor?

Answer 9

Upper airway noise
Typically inspiratory harsh sound

Question 10

What is haemoptysis ?
What are examples of conditions where it may occur?

Answer 10

Coughing blood

TB
Pneumonia
Pulmonary oedema
Cancer?

Question 11

Symptoms of respiratory disease?

Answer 11

• Cough
• Dyspnoea (+ the two types mentioned)
• Wheeze
• Stridor
• Haemoptysis

Question 12

7 examples of Upper Respiratory Tract infections?

Answer 12

1. Common cold
2. Sinusitis
3. Rhinitis
4. Pharyngitis
5. Laryngo-tracheo-bronchitis
6. Influenza
7. Inhalation of foreign body

Question 13

Common cold?

Answer 13

80-90% viral
Pyrexia (fever)
Malaise

Question 14

Sinusitis?

Answer 14

Inflammation of sinus lining

Leads to instructed antral ostia
Which leads to increased pressure therefore PAIN

Can cause toothache

Question 15

Rhinitis?

Answer 15

Sneezing
Blocked nose
Seasonal - pollen , hay fever

Medical prescription - antihistamines

Question 16

Pharyngitis ?

Answer 16

Also known as sore throat
Typically viral
Occasionally bacterial Eg:

• Beta haemolytic strep sore throat -> RHEUMATIC FEVER
• Staphylococcus Aureus

Question 17

Laryngo-tracheo-bronchitis?
Caused by?

Answer 17

Usually caused by viral such as measles + parainfluenza
Laryngeal oedema
Common in children
Croup (barking cough)
Stridor

Medication - oxygen, steam inhalation

Question 18

Influenza?

How do they always change ?

Answer 18

Orthomyxovirus A/B
Antigens are H and N
H = Haemogluttin -> for ADHESION
N = neuraminidase -> breaching mucosal membrane

Vulnerable to secondary bacterial opportunistic infection such as PNEUMONIA

Change because of ANTIGENIC DRIFT (of the H and N)

Question 19

Inhalation of foreign body?

Answer 19

Typically children/drunk adult/ could be DENTAL ENDO FILE

Back blows and Heimlich manoeuvre

Question 20

What is asthma

Answer 20

A common chronic reversible airway obstruction that resolves spontaneously or with treatment and features :

Hyper responsive airways
Inflammatory airway changes
Excess mucus produciton

Question 21

Epidemiology of asthma

Answer 21

M>F in childhood BUT M=F in adults
Most common in first decade

Question 22

Causes of asthma
Extrinsic?
Intrinsic?
Additional?

Answer 22

Extrinsic:
House dust mite faeces
Pollen
Cat, dog, pets

Intrinsic:
Increased sensitivity due to raised igE levels
Bronchial hyper-reactivity

Short arm of chromosome 11

Additional:
Cold air
Exercise
Stress
Pollution
Infection
Drugs eg NSAIDS, B BLOCKERS
Diet

Question 23

Pathogenesis of asthma

Answer 23

Oedema
Bronchoconstriction
Increased mucus secretions

Mediated by
Mast cells - release histamine
Lymphocytes

Question 24

Symptoms of asthma

Answer 24

SOB
WHEEZE
cough
Symptoms worse in the morning

Question 25

Signs of asthma

Answer 25

Quieting of voice and shortness of sentences Increased EXPIRATORY time Decreased FEV1/FVC Hyperinflation Barrel chest

Question 26

Test for asthma

Answer 26

No single test but there are a range of tests can do

Question 27

Management of asthma

Answer 27

Education - medication use Prevention - avoid allergens Therapy : sodium chromoglycate - mediates mast cells B 2 adrenoceptor agonist - bronchodilator

Question 28

What is it common to have from inhalers? How can you get over this?

Answer 28

Oral candidiasis (oral thrush) (White marks+fungal) Can get over this by using a spacer

Question 29

What are two types of chronic obstructive airway diseases?

Answer 29

Chronic bronchitis Emphysema

Question 30

What is chronic bronchitis

Answer 30

Bronchi inflamed Obstruction by narrowing airway lumen Oedema Excess mucus Airflow limited Cough produces sputum (fleghm) for 3 months of 2 successive years Epithelial cell layer can ulcerate and heal as squamous epithelium (metaplasia)

Question 31

What is emphysema

Answer 31

Alveoli are damaged Dilatation of air spaces by wall destruction Obstruction by decreasing lungs elastic recoil that golds airways open in expiration -> expiratory airflow limitation

Question 32

Aetiology and pathogenesis of chronic obstructive airway diseases?

Answer 32

Smoking Atmospheric pollution Alpha 1 anti trypsin deficiency

Question 33

Symptoms of chronic obstructive airway diseases

Answer 33

Cough Sputum Wheeze Dyspnoea

Question 34

Signs of chronic obstructive airway diseases

Answer 34

Hyperinflation Quiet breathing sounds Wheeze

Question 35

Question 36

Risk factors for chronic obstructive airway disease

Answer 36

Smokers People who live in dusty environment People who live in polluted environment

Question 37

Blue bloater vs pink puffer

Answer 37

Blue bloater = BRONCHITIS Pink puffer = EMPHYSEMA

Question 38

Cystic fibrosis Complication Treatment

Answer 38

INHERITED Autosomal recessive Mutation on CFTR gene Affects lungs and digestive system Heavy thick sticky mucus - blocks airway passage Complication - respiratory failure Pneumothorax Treatment - stop smoking Drug therapy

Question 39

Bronchiectasis

Answer 39

Dilatation of bronchi Dilatations caused by inflammation eg: Measles Obstruction Congenital

Question 40

What are examples of lung parenchyma

Answer 40

Pneumonia Lung abscess

Question 41

Pneumonia

Answer 41

Inflammation of substance of the lung Usually bacterial Can be viral or others

Question 42

What are the types of pneumonia

Answer 42

(A) LOBAR pneumonia - affects 1 lobe BRONCHIAL pneumonia - affects lobules and bronchi (B) By causative organism: - community acquired eg strep pneumonia - hospital acquired

Question 43

Risk factors of pneumonia

Answer 43

Smokers Immunocompromised Underlying lung disease

Question 44

Signs and symptoms of pneumonia

Answer 44

Pyrexia Cough -DRY OR RED SPUTUM /fhlegm

Question 45

Aspiration pneumonia

Answer 45

(From Google - inflammation when food/liquid breathed into airways or lungs instead of being swallowed) Aspiration of gastric acid into lungs (Mendelson syndrome) Often fatal Associated with period of loss of consciousness - EG DENTAL SEDATION

Question 46

What is a complication of pneumonia

Answer 46

Lung abcess

Question 47

Tuberculosis Affects? Risk factors?

Answer 47

Most common infective cause of death Affect lungs, lymph nodes and gut Risk factors- immunocompromised Diabetics Alcoholic Immigrants - Asians Doctors / nurses Multi drug resistant tb organisms

Question 48

Pneumoconiosis? Examples

Answer 48

Lung diseases that are caused by inhaling dusts Pneumoconiosis - coal miners lungs Asbestosis - brake linings, railway carriage insulation - Asbestos fibres cannot be broken down by macrophages Silicosis - mining, builders Berylliosis- electronics

Question 49

Bronchial carcinoma Aetiology

Answer 49

Most common malignant tumour More men than women Aetiology - smoking cigarette Occupation Air pollution

Question 50

Pneumothorax

Answer 50

Collapsed lung Air in pleural space Air sucked in but cannot escape Treatment is chest drain