Respiratory Diseases, Investigations and Treatments Flashcards
(56 cards)
1
Q
Define bronchitis.
A
- LRTI
- inflammation of the bronchus
- usually caused by a viral infection
2
Q
List some symptoms of bronchitis.
A
- hacking cough
- thick, yellow-grey sputum
- coryza
- dyspnoea
3
Q
What are the most common infective agents in bronchitis?
A
haemophilus influenzae
- pneumococcus
4
Q
Define pleural empyema.
A
An accumulation of pus in the pleural cavity.
- may or may not follow pneumonia or bronchietasis
5
Q
What is the most common bacteria causing pleural empyema?
A
- Streptococcus
6
Q
List some symptoms of empyema.
A
- chest pain
- high swinging fever
- absence of cough
- dyspnoea
7
Q
What is the treatment for empyema?
A
- chest drain
- IV antibiotics
8
Q
Define asthma.
A
Immune system mediated inflammation of airways, leading to widespread narrowing of airways.
9
Q
List the risk factors for asthma.
A
- genetic (inherited tendency to IgE response to allergens)
- occupations
- smoking
- maternal smoking
- obesity
- diet
- reduced microbe exposure
- pollution
- environmental allergens
10
Q
List the symptoms of asthma.
A
- WHEEZE
- dyspnoea
- chest pain/tightness
- cough (paroxysmal/dry)
- occasional sputum
Symptoms are variable and intermittent
11
Q
How do you measure asthmatic control?
A
SANE
S - short-acting beta agonist
A - absence form school/nursery
N - nocturnal symptoms
E - exertional symptoms
all how often per week
12
Q
How would you treat asthma in children?
A
- start SABA (salbutamol)
- add ICS (beclamethasone)
- add LTRA (instead of ICS in under 5’s)
- add LABA
13
Q
How would you treat asthma in adults?
A
- start SABA (salbutamol)
- add ICS (beclamethasone)
- add LABA
- add LTRA
- oral steroids
14
Q
Define COPD.
A
A chronic, slowly progressive disorder characterised by airflow obstruction that doesn’t change markedly over several months.
15
Q
List the symptoms of COPD.
A
- breathless on exertion
- chronic cough
- sputum (clear or mucoid)
- weight loss
- peripheral oedema
- chest tightness
16
Q
List the signs of COPD.
A
- breathless
- pursed lip breathing
- use of accessory breathing muscles
- cyanosis
- flapping tremour
- hyperexpanded chest
- laryngeal descent
- decreased breath sounds
- prolonged expiration w/ wheeze
- cardiac dullness to precussion
- hepatomegaly
- oedema
17
Q
What are the essential investigations for COPD?
A
- spirometry
- pulmonary function test
- chest radiograph
- full blood count
- ECG
- CO gas transfer
- cor pulmonale
- tachycardia
- increased JVP
18
Q
What is the treatment for COPD?
A
- start with SABA
- add LAMA or LABA
- then LAMA and LABA
- then ICS
- perhaps diuretic or oxygen therapy
19
Q
Define pneumonia.
A
Inflammation of lung tissue accompanied with swelling and filling up of alveoli with inflammatory cells.
20
Q
What the patterns of pneumonia?
A
Broncopneumonia = often bilateral basal patchy opacification Lobar = one whole lobe effected
21
Q
List the symptoms of pneumonia.
A
- malaise
- fever
- pleuritic chest pain
- cough
- purulent sputum
- headache
- dyspnoea
initial symptoms are generally vague
22
Q
List the signs of pneumonia.
A
- pyrexia
- tachycardia
- tachypnoea
- central cyanosis
- dullness of percussion of affected lobe(s)
- bronchial breath sounds
- inspiratory crepitations
- increased vocal resonance
- reduced expansion of effected side
23
Q
What investigations are carried out when pneumonia is suspected?
A
- chest x-ray
- serum biomarkers
- full blood count
- throat swab
- blood cultures
- sputum microscopy and culture
24
Q
Which two bacteria are the most common cause of pneumonia?
A
- strep. pneumonia
- haemophilus influenzae
25
How do you assess the severity of pneumonia?
```
CURB 65
C - confusion
U - blood urea >7
R - respiratory rate >30
B - diastolic blood pressure <60
65 - age >65
```
26
How would you treat a patient with pneumonia?
CURB 0-1 = amoxicillin or clarithromycin/doxycycline
CURB 2 = amoxicillin and clarithromycin/levofloxacin
CURB 3-5 = Co-amoxiclav and clarithromycin
- oxygen
- IV fluids
- analgesia
- intubation/ventilation
27
How would you treat a child with pneumonia?
- first try oral amoxicillan
- second try oral macrolides
Only give IV if vomiting
28
Define bronchiectasis.
Localised pathological dilation and damage of the bronchi.
29
List some causes of bronchiectasis.
- idiopathic
- immotile cilia syndrome
- cystic fibrosis
- childhood infections such as measles
- hypogammaglobulinaemia
- allergic bronchopulmonary aspergillosis (exagerated immune response to aspergillus fungus)
30
What are the symptoms of bronchietasis?
- chronic cough
- daily sputum production (often copious/purulent)
- wheeze
- dyspnoea
- tiredness
- fitting chest pain
- haemoptysis
31
Give two signs of bronchiectasis.
- finger clubbing
| - course inspiratory crepitations
32
What investigations would you carry out if you suspect bronchiectasis?
- High resolution CT thorax
- sputum culture
- serum immunoglobulin.
33
How would you treat brochiectasis?
- chest physiotherapy
- antibiotics appropriate to infection (high dose and long course)
- may be treated with SABA/ICS
34
Where would a lung abscess be most likely to occur?
- an obstructed bronchus
35
What are the most likely organisms to cause a lung abscess?
- staph. aureus
| - pseudomonas
36
How would you treat a lung abscess?
- prolonged antibiotics
37
Define emphysema.
A condition is which the alveoli are damages and enlarged.
38
What are the symptoms of emphysema?
- dyspnoea
- cough
- frequent chest infections
39
Define tuberculosis.
A bacterial infection triggering a Th1 cell immunological response which leads to tissue damage and progressive disease.
40
List the symptoms of tuberculosis.
- usually no initial symptoms
- fever
- malaise
- erythema nodosum
- cough
- sputum
- haemoptysis
- pleuritic pain
- dyspnoea
- weight loss
- crackles/bronchial breathing
41
What is the organism causing tuberculosis?
- Mycobacteria
(numerous species)
- ubiquitous in soil and water
42
What are the three outcomes of a primary infection of tuberculosis?
- progressive disease
- contained and latent
- cleared/cured
43
Define cystic fibrosis.
An autosomal recessive gene mutation.
| it can lead to bacterial colonisation, inflammation, mucous plugging, airway damage, ulceration and brochiectasis.
44
What is the gene prevalence of cystic fibrosis?
one in twenty-five
45
Where is the gene mutation in cystic fibrosis?
- CFTCR (cystic fibrosis transmembrane conductance regulator) on chromosome seven
46
Name two things that the CFTCR gene is responsible for.
- transport for active chlorine
| - regulating liquid volume on epithelial surface
47
List the symptoms of cystic fibrosis.
- recurrent chest infections
- pneumonitis
- bronchiectasis
- abscesses
- chronic, purulent sputum
- onset diabetes
- weight loss
- fever
48
List the signs of cystic fibrosis.
- haemopytsis
- pneumothorax
- failure to thrive
- osteoporosis
- malnutrition
49
What are the investigations into cystic fibrosis?
- guthrie test
- sweat test
- pulmonary function test/ spirometry
- chest x-ray
50
How would you treat cystic fibrosis?
- oral or IV antibiotics
- anti-inflammatories
- ivacaftor - new class of drug addressing primary defect in the CFTCR gene
- often will need a lung transplant
51
What are the three main biological agents causing symptoms in cystic fibrosis?
- pseudomonas aeruginosa (60%)
- staph. aureus (42%)
- haemophilus influenzae (15%)
52
Define sarcoidosis.
A chronic disorder in which lymph nodes in many parts of the body are enlarged and a granulomatous presentation of inflammatory cells causing a multi-system disorder.
53
What are symptoms of sarcoidosis?
- may be none
- dsypnoea
- cough
- chest pain
54
List the signs of sarcoidosis.
- acute arthralgia
- erythema nodosum
- bilateral hilar lymphadenopathy
- abnormal chest x-ray
- heart failure
- hypercalcaemia
55
Who is most at risk of developing sarcoidosis?
- females
- blacks
- younger population
56
What is the treatment for sarcoidosis.
- corticosteroids
(only if affecting organs)
- NSAIDs
