Respiratory pathology 'Group 2' 1 Flashcards
(141 cards)
1
Q
Acute epiglottitis is a ….
A
Upper respiratory tract infection
2
Q
What happens to the epiglottitis in acute epiglottitis ?
A
It and other surrounding structures become inflamed.
3
Q
What is the epiglottitis ?
A
A (mainly fibroelastic) cartilaginous flap which closes over the trachea to prevent aspiration when swallowing
4
Q
What happens to the airways in acute epiglottitis ?
A
Airways get narrowed by the inflammation making it hard to air to get into the lungs
5
Q
What causes acute epiglottitis ?
A
Bacteria most commonly Group A streptococcus
Trauma
Inhalation
Chemical burns
6
Q
What kind of bacteria causes acute epiglottitis most commonly ?
A
Group A streptococcus
7
Q
What can acute epiglottitis also be called in adults ?
A
Supraglottitis
8
Q
What is the difference between acute epiglottitis in children and adults ?
A
More common and more serious in kids
9
Q
What are the signs and symptoms of acute epiglottitis ?
A
Very upset screaming kids Very sore throat Stridor Difficulties swallowing Sitting in the 'sniffing position' Mouth open and tongue out Drooling Fever Screaming Asphyxia (passing out due to lack of air)
10
Q
What investigation should not be carried out in suspected acute epiglottitis ?
A
You should not examine the back of there throat and it can close off the airway further
11
Q
What other investigations can be carried out?
A
lateral view neck x-ray can be done but there may not be time for this
Blood tests
throat swab
12
Q
What are the differential diagnosis of acute epiglottitis ?
A
Croup
foreign body aspiration
13
Q
What is the treatment for acute epiglottitis ?
A
Call for help
Give oxygen + get patients to sit upright + put in canula for bloods + prep for IV assess
IV antibiotics, anaesthetic, incubation, (steroids)
14
Q
What is the prognosis of acute epiglottitis ?
A
Patients may die, but with treatment they should be ok.
15
Q
What are some of the complications of acute epiglottitis?
A
Bacterial infection causes abscess in the epiglottis, pneumonia or empyema
16
Q
What is another name for croup?
A
Acute laryngotracheobronchitits
17
Q
Croup is a …
A
lower respiratory tract infection
18
Q
What happens in croup?
A
Inflammation of the trachea
19
Q
What causes croup ?
A
floppy trachea such as in tracheomalacia can cause recurrent croup
Acute viral infections
An upper respiratory tract infection which moves down into the trachea
20
Q
What are the signs and symptoms of croup ?
A
Quite well patients Barking cough Inspiratory stridor running nose hoarse voice waking up in the night
21
Q
What are the different severity levels of croup ?
A
Mild = Barking cough and no stridor Moderate = barking cough, stridor, intercostal recession, tracheal tug Severe = Moderate symptoms and a decreased consciousness
22
Q
How is croup treated ?
A
It is self limiting so there if often limited treatment
- Single dose oral dexamethasone to all patients
- Nebulised adrenaline to severe cases and some moderate cases if oral dexamethasone isn’t affective
23
Q
What is tracheitis ?
A
Croup that doesn’t get better. It is rare.
24
Q
What causes tracheitis ?
A
Staph or strep invasive infection
25
Signs and symptoms of tracheitis ?
Croup that doesn't get better
Swollen trachea
fever
malaise
26
How is tracheitis treated ?
Augmentin antibiotics
27
Bronchitis is a ...
Lower respiratory tract infection
common
Self limiting
Obstructive lung disease
28
How long does bronchitis last ?
about 4 weeks
29
What happens in bronchitis ?
There is inflammation of the bronchi, smooth muscle contraction, mucous hypersecretion, cell wall thickening.
30
What is bronchitis caused by ?
A descended upper respiratory tract infection
Caused by a virus most commonly
Can also be caused by a bacteria
Chances of having it can also be caused by second hand smoking
31
The viruses which cause bronchitis also cause ....
the common cold
32
What are the signs and symptoms of bronchitis ?
Rattly loos productive cough
Gag at the end of there cough
Shortness of breath
33
What are the differential diagnosis of bronchitis ?
Asthma
| Bronchiectasis
34
What is the treatment of bronchitis?
Rest and fluids
Don't really treat
reassure family
35
Bronchiolitis is a ?
Lower respiratory tract infection
36
What does bronchiolitis cause ?
Inflammation of the bronchioles
| smooth muscle contraction, mucous hypersecretion and cell wall thickening
37
What age group does bronchiolitis affect ?
under 2s especially under 1s
38
Describe the course of bronchiolitis
```
Cough starts on day 1
Start to feel ill on day 2
Get sicker until day 5
Stabilise at the same Sickness until day 7
Get better after day 7
```
39
How does bronchiolitis start ?
Upper respiratory tract infection
40
What causes bronchiolitis ?
RSV viruses
41
What are the signs and symptoms of bronchiolitis ?
```
Cough
Nasal stuffiness
Tachypnoea
Feeling sick
Crackles
Wheeze
```
42
What are the differential diagnosis of bronchiolitis ?
other LRTIs
| Asthma (unlikely in under 2s)
43
How is bronchiolitis treated ?
Maximum observations and minimum intervention
44
What is empyema ?
A collection of pus in the pleural cavity
45
What causes empyema ?
Most commonly lobar pneumonia,
Also peri acinar emphysema
acute epiglottitis
lung abscess
46
What are some risk factors for empyema ?
Recent pneumonia
Thoracic trauma
Immunocompromised
47
What are some signs and symptoms of empyema ?
```
Severe chest pain
Weight loss
dry cough
Fever
Chills
Sweating
Malaise
```
48
What investigations are done in order to diagnose empyema ?
CXR
Ultrasound
History
Blood culture
49
How is empyema treated ?
IV antibiotics
Chest drain sometimes
Surgery to remove a lung abscess which might cause an empyema
50
What are the differential diagnosis for empyema ?
MI
Pleural effusion
Pneumonia
Lung abscess
51
Describe what coronaviruses are
Family of viruses which have a crown like spikes on there surface and contain RNA
52
What type of coronaviruses is COVID -19 ?
Beta coronaviruses
53
What kind of transmission does COID -19 have ?
airborne and droplet transmission
54
What is the incubation period for COVID -19 ?
1-14 days
55
How is the transmission of COVID -1 9 measured ?
R number
56
What are the signs and symptoms of covid 19 ?
```
Cough
Loss of taste and smell
Headache
fever
fatigue
```
57
What are some of the treatments for COVID -19 ?
Steroids (Dexamethasone)
| Supportive therapy
58
What is an endemic ?
the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area
59
what is an epidemic ?
an sudden increase in the number of cases of a disease above what is normally expected in tat population in that area
60
What is a outbreak ?
same definition of epidemic but is often used for a more limited geographic area
61
What is a pandemic?
an epidemic that has spread over several countries or continents usually affecting a large number of people
62
What is herd immunity ?
Herd Immunity is when the population as a whole in immune to a condition (ruffly 94% of a population)
63
What is a pleural effusion ?
A collection of fluid in the pleura
64
What causes a pleural effusion ?
by a mismatch in production and absorption of pleural fluid. Normally the pleural lymphatics absorb fluid however if this dose not happen then a build up of fluid occurs.
65
What are the names of the two types of effusion ?
Transudate
| Exudate
66
What is a transudate effusion ?
A non-inflammatory effusion where there is a low protein content in the fluid
67
What is a exudate effusion ?
A inflammatory effusion where there is a high protein content in the fluid
68
What are the most common causes a transudate effusion ?
Left ventricular failure
| Liver cirrhosis
69
What are the most common causes an exudate effusion ?
Malignancy
Parapneumonic effusion
Empyema
TB
70
What is the rule of thumb about the protein content of exudate vs transudate ?
Protein content > 3g then exudate
71
What is 'lights criteria' used for ?
Determining if it is an exudate or transudate effusion
72
Describe lights criteria
A. Pleural fluid vs serum protein ratio. < 0.5 transudate
B. Pleural fluid vs serum LDH Lactate dehydrogenase ratio. < 0.6 transudate
C. Pleural fluid vs upper limit of normal LDH lactate dehydrogenase ratio. < 2/3 transudate
73
What are the risks factors for pleural effusion ?
Recent lobar pneumonia
74
What are the signs and symptoms of pleural effusion ?
Dyspnoea mainly
cough
pleuritic chest pain
75
What investigations are carried out to explore pleural effusion ?
Ultrasound
CXR
CT thorax
fluid sample
76
What does biochemistry do with a sample ?
analyse proteins
77
What does microbiology do with a sample ?
check for bacteria, viruses etc
78
What does cytology do with a sample ?
check for abnormal cells
79
What are the differential diagnosis of a pleural effusion ?
Pleural thickening
Pulmonary collapse
Consolidation
elevated diaphragm
80
What is the treatment for pleural effusion ?
treat underlying cause
81
What is the spirometry of a restrictive lung disease?
> 80%
82
What is a restrictive lung disease?
Lungs have poor compliance, and struggle to fill with air
83
What is an interstitial lung disease ?
Where the interstitium is inflamed. the interstitial tissue which is found in the walls of the airways and alveoli and between the alveoli and capillaries. Therefore this inflammation causes a decrease in gas exchange
84
What is the name of the most common interstitial lung disease ?
Sarcoidosis
85
What are the signs and symptoms of sarcoidosis ?
SOB which hasn't responded to inhalers
dry cough
Erythematosus Around scars or tattoos
red inflamed eyes
86
What investigations are used to diagnose sarcoidosis ?
```
High resolution CT gold standard
CXR
Serum Ca++
ACE
Pulmonary function test
```
87
How is sarcoidosisd treated ?
Corticosteroids
NSAIDs
Topical steroids
88
What is sleep apnoea ?
Recurrent episodes of upper airway obstruction leading to apnoea (airway closure for more than 10s, if it is less than 10s then it is called a hypopnea) during sleep
89
What is apnoea ?
Airway closure for more than 10s
Occurs during microarousals when the brain moves from a light sleep to a deep sleep
Microarousals are much more common in sleep apnoea patients
90
Risk factors for sleep apnoea ?
Obesity
Hypertension
Alcohol
Endocrine disorders
91
What are the signs and symptoms of sleep apnoea ?
Heavy snoring
Tiredness
Unrefreshing sleep
poor concentration
92
What are the investigations used for sleep apnoea ?
Epworth questionnaire study
| Overnight sleep study
93
How is sleep apnoea treated ?
Reducing risk factors
CPAP
Mandibular repositioning splint
94
Which organisation will you as the doctor need to contact if you diagnose someone with sleep apnoea ?
The DVLA the patient that they are not allowed to drive. However once's conditions are managed then they can drive again.
95
What are sleep apnoea patients are an increased risk of?
risk of stoke, heart disease and a car accident.
96
What is narcolepsy ?
condition which causes people to drop into sleep at random times. There are some patterns of when it occurs however such as after strong emotion.
97
What are the risk factors of narcolepsy ?
Family history (as it sometimes runs in families but normally it occurs in patients with no previous history of narcolepsy)
98
Does most cases of narcolepsy family related ?
no
99
When dose narcolepsy first present ?
Early in life
100
What are the symptoms of narcolepsy ?
Cataplexy
profound sleepiness through the day, sometimes hypnagogic/hypnopompic (consciousness between sleep states) hallucinations and sleep paralysis.
101
How is narcolepsy investigated ?
PSG
| MSLT
102
What are key characteristics of narcolepsy ?
go to sleep and if they manage to do this within 6 minutes
| often they will also enter REM sleep immediately
103
What is the treatment for narcolepsy ?
modafinil, dexamphetamione, venlafaxine, and sodium oxybate
104
What is chronic ventilatory failure ?
when there is an inability to exchange gas which is chronic (Vs respiratory failure which is acute)
105
What are some of the risk factors for choric ventilatory failure ?
```
Conditions which can cause it:
i.e.
COPD
Bronchiectasis
Chest wall abnormalities
Motor neuron disease
Muscular dystrophy
obesity
```
106
What are the signs and symptoms of chronic ventilatory failure ?
Elevated pCO2 (>6.0kPA), low pO2 (<8.0kPA),
elevated bicarbonate,
normal blood pH,
an underlying disease which may be causing it,
paradoxical abdominal wall motion in suspect neuromuscular disease, ankle oedema (occurs when there is a build of fluid in the veins i.e. in cor pumonale). Breathlessness,
orthopnoea,
morning headache,
recurrent chest infections and disturbed sleep.
107
What investigations are carried out to help diagnose chronic ventilatory failure ?
Lung function tests
| Assessment of hypoventilation
108
What is the treatment for chronic ventilatory failure ?
cure is not possible
domiciliary non-invasive ventilation
oxygen therapy
109
What is laryngomalacia ?
When there is a floppiness in the larynx
110
What kind of patient is laryngomalacia often seen in ?
Kids
111
What are the signs and symptoms of laryngomalacia?
Stridor
| Worse when feeding or upset or excited
112
How is laryngomalacia treated ?
Normally gets better itself within the first year of life
113
What is tracheomalacia ?
When there is a floppiness in the trachea
114
What are the signs and symptoms of tracheomalacia ?
Barking cough
Recurrent croup
Breathlessness on exertion
Stridor/wheeze
115
How is tracheomalacia treated?
Often no intervention.
Sometimes antibiotics if there is a bacterial infection
Physiotherapy sometimes if not improving
116
What is a tracheoesophageal fistula?
an abnormal connection (join) between the trachea and the oesophagus.
117
What might co-exist with a tracheoesophageal fistula ?
An atresia
118
What causes a tracheoesophageal fistula?
Genetics
| it is a congenital disorder
119
How does a tracheoesophageal fistula appear?
Chocking,
colour change
cough with feeding
unable to pass NG (feeding tube)
120
How is tracheoesophageal fistula treated ?
Surgery
121
What are some complications of a tracheoesophageal fistula ?
Tracheomalacia
Strictures
leak
reflux
122
What is respiratory distress syndrome ?
Occurs in premature babies and is when there is an insufficnely of surfactant. (Which is not fully in place until 36 weeks)
123
How is IRDS treated?
Antenatal steroids
Surfactant replacements
Appropriate Ventilation
Appropriate Nutrition
124
What is a pulmonary embolism ?
Occurs when there is something sitting in the pulmonary ciruclation to the lungs and preventing the normal flow of blood.
125
What is the most common embolise in a PE ?
A clot which have broken off from a DVT.
126
What are risk factors for a PE ?
```
Recent major trauma
Recent surgery
Cancer
Significant cardiopulmonary disease
pregnancy
inherited thrombophilia
Anything which alters Virchows Triad
```
127
What is the inherited condition which increased your PE risk called?
inherited thrombophilia
128
How can the probability of a PE having occurred be measured ?
Wells Score
| Revised Geneva score
129
Draw out the Wells Score
```
Clinical signs of DVT = 3
Heart rate > 100 = 1.5
recent surgery or immobilization = 1.5
Previous PE or DVT = 1.5
Haemoptysis = 1
Malignancy = 1
Alternative diagnosis less likely then PE = 3
```
PE likely < or = 4
130
What are the signs and symptoms of pulmonary embolism ?
```
Pleuritic chest pain
Isolated acute dyspnoea
Tachycardia
Hypoxia
Hypotension
Evidence of thrombosis
```
131
What are some investigations used to diagnose PE ?
```
CXR
ECG
CT pulmonary angiogram
V/Q perfusion scan
D-Dimer
Echocardiogram
```
132
Describe a simple algorithm of how to diagnose PE
Draw it
133
How is pulmonary embolism treated ?
General treatment (oxygen, fluids)
Anti-coagulation (Low Molecular Mass Heparin = Dalteparin and Warfarin and oral anticoagulants)
Thrombolysis (Alteplase)
Surgery (Pulmonary embolectomy)
134
What does the prognosis after PE depend on ?
Size
Age
co-morbidity
135
What is pulmonary hypertension ?
Elevated blood pressure in the pulmonary arteries.
136
What BP number means that someone have pulmonary hypertension ?
Mean arterial pressure > 25mmHg
137
What causes pulmonary hypertension ?
Underlying conditions most often i.e. lung cancer or respiratory disease or thromboembolic
138
What are the signs and symptoms of pulmonary hypertension ?
```
Exertional dyspnoea
chest tightness
exertional presyncope or syncope (Feeling of fainting or fainting)
symptoms develop slowly
Elevated JVP
loud pulmonary second heart sound
ankle oedema
```
139
How is pulmonary hypertension investigated ?
```
ECG
Lung function test
CXR
Echocardiography (Gold standard !!!!)
Right heart catheterisation (for direct measurement)
```
140
What is the prognosis of pulmonary hypertension
Gets progressively worse
141
How is pulmonary hypertension treated ?
```
Treat underlying condition
Oxygen
Anticoagulation and diuretics (increased urine)
CCB
Prostaglandins
Endothelin receptor antagonists
Thrombo-endarterectomy
Heart/lung transplant
Phosphodiesterase inhibitors
```
