respiratory_diseases_20190518182909 Flashcards
(232 cards)
1
Q
what is coryza
A
acute viral infection of nasal passage spread by direct (droplets) or indirect (door handle)
2
Q
what is cause of coryza
A
200+ viruses mainly rhinovirus and coronaviruses
3
Q
what is diagnosis of coryza
A
symptoms based
4
Q
how is coryza treated
A
self care
5
Q
what is the symptoms of coryza
A
blocked nosenasal pain and irritation runny nosecough hoarse voice sore throat (pharyngitis)mild fever?
6
Q
what is complications of coryza
A
sinusitis (frontal or maxillary)acute bronchitis
7
Q
what is it preceded by
A
coryza
8
Q
what are symptoms
A
purulent nasal discharge and tender sinuses
9
Q
how is it diagnosed
A
symptoms based
10
Q
how is it treated
A
paracetamol decongestant no antibiotics
11
Q
what are different kinds of decongestant
A
a adrenic agent eg phenylephrine
12
Q
what is it
A
irritated and inflamed bronchi preceded by coryza
13
Q
what are the causes
A
influenzacommon cold virus
14
Q
what are the symptoms
A
hacking productive cough with thick yellow-grey sputum tightness in chest transient wheeze slight fever
15
Q
how is it treated
A
home care - fluids etc
16
Q
when are antibiotics given and which ones
A
if vulnerable 1st line - amoxicillin 2nd line - doxycycline
17
Q
what are complications
A
pneumonia bacterial infection with strep pneumoniae or H.influenzae is common sequel esp in smokers/COPDmay cause respiratory acidosis
18
Q
what is normally found on examination in an acute exacebation
A
crackles, cyanosed, oedema, wheeze, dyspnoea
19
Q
what is treatments of acute exacerbation
A
said antibiotics, bronchodilator inhalers, short course of steroids
20
Q
what is it
A
inflammation and swelling of epiglottis normally in children medical emergency
21
Q
what are the symptoms
A
temp 38+severe sore throatdifficulty breathing abnormal and high pitched breathing dysphagia
22
Q
what is cause
A
H. influenza bacteria
23
Q
how do diagnose it
A
laryngoscopy blood test - WBC and bacteria
24
Q
how is it treated
A
urgent endotrachael intubation IV broad spectrum antibiotics (ceftazidime, ceftriaxone)
25
how to prevent it
vaccination during childhood
26
what is the incubation time
1-4 days then abrupt onset of symptoms
27
what is causes
influenza A - worldwide pandemicsinfluenza B - localised, milder outbreaks
28
what is symptoms
temp >38dry, chesty cough headache malaise chills and aching limbs myalgia upset stomachclear nasal discharge
29
how is it diagnosed
symptoms based lab not necessary but fourfold increase in haemagglutinin
30
how is it treated
bed rest and paracetomal for risk >65 use neumanidase inhalers
31
what are the names of these inhalers
oscitamivar oral zanamiviar inhaler
32
what are the complications
death primary viral pneumonia (haemoptysis, resp failure in 24 hours)secondary bacterial pneumonia (H. influenza - new fever on day 7)
33
what is it
infiltration of small airways and alveolar walls with neutrophils followed by T lymphocytes and macrophages - leads to non-caseating granulomas
34
what type hypersensitivity is it
type IV (or III)
35
what are the different causes
farmers lung - mouldy hay malt workers lung - whiskey bird fanciers lung - pigeons mushroom farm workers - turning mushroom compost drugs eg gold, bleomycin, sulphasalazine
36
what are acute symptoms
fever (pyrexia)rigors myalgia dry cough dyspnoea crackles (no wheeze)malaise
37
what are chronic symptoms
increasing dyspnoea weight lossexertional dyspnoea type 1 resp failure cor pulmonale
38
how is acute EAA diagnosed
blood - FBC (neutrophilia), ESR (up), ABGCXR - upper zone consolidationLFT - reversible restrictive, reduced gas transfer during attack
39
how is chronic EAA diagnosed
blood - positive serum precipitantsCXR - upper zone fibrosis, honeycomb lung LFT - persistent changes BAL - increased lymphocytes and mast cells
40
how is acute EAA treated
remove allergen give O2oral prednisolone
41
how is chronic EAA treated
allergen avoidance long term steroids
42
what is it
infectious disease of resp tract type 4 hypersensitivity - caseating granulomas and caseous necrosis
43
what happens during primary exposure (1st time)
affects hilar lymph nodes granulomatous due to immune activation
44
what happens during secondary exposure (2nd time)
fibrosing and cavitating apical lesions due to overactive T cell response this is the reactivation of latent TB
45
what are causes
mycobacterium tuberculin m. bovis
46
what are resp symptoms
cough haemoptysisupper lobe crackles dyspnoea
47
what are GI symptoms
peritonitis perforationbowel obstruction pain
48
what are spinal symptoms
pain deformity paraplegia
49
what are meningeal symptoms
drowsy headache fits
50
what are other symptoms
renal failure weight lossnight sweats lymphodenopathy and cold abscess pericardial temponade septic athritis and hypoadrenalism
51
how is it diagnosed
CXR and ZN stain of sputum for acid and alcohol fast bacilli
52
what does CXR look like
upper lobe prominance, cavity formation, tissue destruction, scarring and shrinkage, heals with calcification
53
when does the CXR contain bilateral infiltrates and reticulonodular shadowing
presence of ARDS/miliary TB - result of tubercle bacilli in blood stream
54
what is treatment
2 months RIPE (rifampicin, isoniazid, pyradizamide and ethambutol)4 months RI
55
what is side effect of rifampicin
stains fluids pink/orange break opiate and steroids (the pill)rarely hepatitis
56
what is side effect of isoniazid
polyneuropathy
57
what is side effect of pyradizamide
hepatic toxicity, reduces renal excretion of urate and may precipitate gout
58
what is side effect of ethambutol
optic neuritis, red/green colour blindness
59
how can it be prevented
BCG vaccine - reduces risk by 70% contact tracing
60
what is latent TB
symptom free, granulomas, -ve cultures, leave alone
61
what reactivates latent TB
steroids, immunosuppression and anti-TNF
62
what is anti-TNF
used to treat rheumatoid athritis, crohns, psoriasis, alkylasing spondylitis if have latent TB - give 6 months of I or 3 months of RI before starting anti-TNF
63
what is it
inflammation of one of both of lungs normally due to infection
64
what causes strep pneumoniae (community)
found worldwide - most common cause
65
what causes staph aureus (community)
recent flu, IV drug user
66
what causes mycoplasma pneumonia (community)
older kid, young adult
67
what causes legionella (community)
traveller - bad water
68
what causes gram negative enterobacteria (community)
alcoholic
69
what causes bordatella pertussis (community)
whooping cough / broncho pneumonia
70
what causes haemophilus influenzae (hospital)
atypical, nursery workers, COPD
71
what causes coxiella burnetti (hospital)
Q fever - sheep, goats, cattle, farm
72
what causes chlamydophilia pstaci (hospital)
pet birds
73
what causes klebsiella pneumoniae (hospital)
common in alcoholism, diabetes and chronic lung disease
74
what are other causes
viral (RSV, measles)aspiration fungal (aspergillus - chest infection become pneumonia)chlamydia pneumoniae (person to person)PCP (immunosuppressed patients)
75
what are the symptoms
cough dyspnoea tachypnoea fever rigors sweats pleuritic pain myalgia malaise arthralgia preceding UTIdiarhhoea headache haemoptysis AFconfusion sputum after 24 hours
76
what are the signs
fever rigors pleural rub cyanosis hypotension tachypnoeapleural effusion
77
what would be found upon examination
crepitations dull percussion consolidation tactile vocal fremitus
78
what other tests are taken to diagnose it
serologyblood culture CXR, ABC, FBC, U&Es, LFTssputum culture
79
what are severity markers
temp <35 or >40cyanosis - PaCO2 <9WBC - <4 or >30multi lobar involvement
80
treatment is dependent on CURB65 score - what is this?
confusion - 1 point Urea >7 - 1 point BP<90 or <60 - 1 point RR <30 - 1 point Age >65
81
community acquired treatment with CURB65 score of 0-2 (mild)
amoxicillin 5 days or doxycycline or IV clarithromycin if NBM
82
community acquired treatment with CURB65 score of 3-5 (severe)
co-amoxicillin IV and doxycycline allergic - IV levofloxacin
83
community acquired treatment if in ICU/HDU or NBM
co amoxiclav and clarithromycin allergic - IV levofloxacin
84
hospital acquired treatment if severe
amoxicillin IV and metrondiazole and gentamicinstep down to co-trimoxazole and metrondiazole allergic - IV co-trimoxazole and metrondiazole +/- gentamixin
85
hospital acquired treatment if non severe
PO amoxicillin and metrondiazole
86
what are complications
empyema lung abscess septicaemia
87
how do you prevent it
pneumonia and flu vaccine smoking cessation treat alcohol misuse
88
what is it
childhood condition (<3 most affected), commonInflammatory oedema extends to vocal cords and epiglottis causing narrowing
89
what are symptoms
initial cold symptomsstridorbark like cough hoars croaky voice
90
what causes it
parainfluenza virus
91
how is it diagnosed
symptoms based
92
how is it treated
oral/IM steroid (dexamethasone)nebulised adrenaline - short term relief
93
what are complications
airway obstruction secondary infectionother complications
94
what is it
restrictive, occupational diseasegranulomatous and fibrotic changes Increases risk of infection
95
what are causes
15-20 years quartz exposure eg granite, stone, mine, boiler, glass, foundry workersinhalation of silica (silicon dioxide)
96
what are symptoms
cough and dyspnoea
97
what are signs
finger clubbingpleural effusion?
98
how is it diagnosed
CXR- egg shell calcification of hilar nodes, pulmonary fibrosis, upper lobe shadowing more than lowerPFT - restrictive - FEV1 and FVC reduced, ratio normal/raised
99
how is it treated
palliative
100
complication
TBpulmonary hypertension heart failurearthritis kidney disease COPDlung cancer
101
what is it
granulomatous disease of unknown cause
102
what is a granuloma
mass or nodule composed of chronically inflamed tissue formed by response of mononuclear phagocyte system to insoluble or slowly soluble antigen
103
what type of hypersensitivity
type 4
104
what systems commonly involved
lungs, lymph nodes, joints, liver, skin, eyes
105
what are symptoms of acute sarcoidosis
sweats erythema nodosum (skin lesion)
106
what are symptoms of chronic sarcoidosis
lung infiltrates/alveolitis (scarring)skin infiltrates peripheral lymphadenopathyhypercalcaemia SOB persistent dry cough rashes on body
107
how is it diagnosed
CXR - bilateral hilum lymphadenopathy CT - check for peripheral nodular infiltrates Bloods - raised calcium and inflammatory markers Restrictive PFT
108
what is treatment of acute sarcoidosis
usually do not need specific treatment paracetamol anti-inflammatory
109
what is treatment of chronic sarcoidosis
oral steroid (prednisolone) immunosuppression (azathioprine, methotrexate)
110
what is it
imbalance in fibrotic repair system of lungs = lay down unrequired scar tissue chronic inflammatory infiltrate (neutrophils) causes fibrosis in alveolar walls and macrophages
111
what does it cause increased risk of
infection
112
prevalence
more common in males
113
causes
idiopathic
114
secondary causes
rheumatoid, SLE, system scleorisis, asbestosis, drugs
115
symptoms
progressive exertional dyspnoea dry cough
116
signs
clubbing bibasal crackles on auscultation dry cough
117
diagnosis
CXR - bilateral infiltrates, fine inspiratory crackles HRCT - bilateral lower zone fibrosis/shadowing - ground glassrestrictive PFT and low TLCO
118
treatment
oral steroids immunosuppressants (azathioprine)O2 if hypoxic pulmonary rehab lung transplant in young patients
119
complications
respiratory failure most patients dead in 5 years
120
what is it
restrictive, occupational disease causing granulomatous and fibrotic and restrictive changes major scarring acts like tumour and destroys lung
121
prevalence
now quite rare, often associated with COPD
122
what does it increase risk of
infection
123
causes
inhalation and retention of coal dust in lungs
124
symptoms
often asymptomatic when gets to massive fibrosis - cough, tight chest, SOB
125
signs
clubbing
126
diagnosis
CXR - upper lobe recticular shadowing / fibrosis Lung function not impaired
127
what is treatment
palliative - O2 and pulmonary rehab
128
complications
caplan's syndrome (rheumatoid athritis + coal + nodules which cavitate)chronic bronchitis (coal + smoking)
129
what is it
pleural disease (fibrosis) affecting lung lining and lung base progressive - latent period after exposure
130
what causes it
heavy prolonged asbestos exposure (5 years of daily exposure)
131
what are affects of asbestos exposure
benign pleural plaques benign asbestos pleural effusions diffuse pleural thickening acute asbestos pleuritis malignant mesothelioma
132
what is malignant mesothelioma
incurable pleural cancer which can invade chest wall - fatal in 2 years and almost always from asbestos exposure
133
what are symptoms of malignant mesothelioma
chest pain, PE, sweating, dyspnoea
134
what are signs of asbestosis
breathlessnessfinger clubbing
135
how is it diagnosed
pleural fluid aspiration - low cytological yieldCXR and CT - effusion, nodularity, local invasion, lung entrapment, upper love fibrosis biopsy - asbestos fibres sputum culture - asbestos bodies
136
what is treatment
no treatment known to alter course of disease pulmonary rehab and O2 therapy corticosteroids often prescribed
137
what is it
intermittent upper airway collapse in sleeprecurrent sleep arousal
138
what are symptoms
excessive daytime sleepiness personality change cognitive impairment major impact on daytime function
139
what are causes
obesity enlarged tonsils stroke MSopiates alcohol
140
how is it diagnosed
overnight sleep study (oximetry, airflow, thoracic movement monitored, full polysomnography) epworth sleepiness score (normal <10/24)
141
how is it treated
correction of treatable factors CPAP - delivered by nasal mark during sleep mandibular advancement device (gum shield - improves snoring) surgery - scar up back of throat to make tougher and resist collapse
142
what are complications
raised CRPimpaired endothelial and glucose function independent risk factor for hypertension
143
what are types of non-small cell lung cancer (majority)
squamous cell carcinoma adenocarcinoma large cell carcinoma
144
what is characteristics of squamous cell carcinoma
hypertrophic pulmonary osteoarthropathymost commonly cavitates
145
what is characteristics of adenocarcinomas
most common type usually peripheral in bronchi
146
what is the characteristics of large cell carcinoma
typically peripheral, poorly differentiated tumours with poor prognosis, may secrete beta HCG
147
what is characteristics of small cell lung cancer
arises from endocrine cells hormones secreted: ADH and ACTHspreads early and almost always inoperable
148
what kind of state does malignant cancer (especially adenocarcinoma) cause
hypercoaguable state
149
what is symptoms
cough that lasts >2-3 weekslong standing cough that gets worse haemoptysis unexplained dyspnoea malaise weight loss persistent chest pain/shoulder pain
150
what are less common symptoms
clubbing, hoarse voice, difficulty or pain swallowing, increased risk of infection
151
what causes it
smoking passive smoking occupational exposure
152
how is it diagnosed
CXR CT for small tumours and mediastinum (then biopsy)FBC for anaemia Urinanalysis
153
how to treat non small cell lung cancer
surgerychemotherapy radiotherapy targeted agents
154
how to treat small cell lung cancer
chemotherapy, palliative care
155
what is common sites of metastases
kidneyprostatebreastboneGI tractcervix or ovary
156
what is it
hyperplasia of smooth muscleoedema accumulation increased mucus secretion bronchoconstriction chronic airway inflammation (eosinophilic)airway remodelling
157
what type hypersensitivity
type 1
158
when does it come on
it is an episodic reversible bronchoconstriction early or late onset
159
what are intrinsic causes
exercise, cold
160
what are extrinsic causes
drugs, chemical, smoke, pollen, dust, animal dander, fungi, viral infection
161
what are symptoms
dyspnoea tight chest wheezing non-productive cough diurnal variationnon-progressiveepisodic/intermittent
162
how is it diagnosed
salbutamol reversibility >15%diurnal variation in peak flow rate normal gas exchange reduced FEV1 to under 75%preserved FVC and TLCOprovocation testing - exercise or allergen may find crackles if infection
163
1st line treatment
SABA (salbutamol)
164
2nd line treatment
low dose ICS (beclomethasone, budesonide, prednisolone)
165
3rd line treatment
add LABA (salmeterol) to low dose ICS
166
4th line treatment
leukotriene receptor antagonist (monteleukast)Xanthines (theophylline)LAMA (tiotropium)
167
5th line treatment
consider increasing ICS up to high dose or addition of fourth drug eg LTRA, xanthine or LAMA - refer to specialist
168
6th line treatment
use daily steroid tablet in lowest dose providing adequate controlmaintain high dose ICS and consider other treatments to minimise use of steroid tabletsrefer to specialist
169
what is COPD split into
chronic bronchitis and emphysema
170
what is chronic bronchitis
chronic irritation, defensive increase in mucus production and epithelial cell numbers (especially mucus glands) non-reversible obstruction (some may have reversible asthmatic component)
171
what is emphysema
tissue destruction in the alveoli leading to loss in alveolar walls and increase in size of airspaces distal to terminal bronchiole (without fibrosis)
172
what causes it
smoking passive smoking fumes dust
173
what are symptoms
develop over number of yearsincreasing breathlessnesspersistent cough with sputum frequent exacerbationswheezing weight lossmalaise swollen anklesincreased infection risk
174
how is it diagnosed
spirometry - decrease in PERF, FEV1, FVC and TLCOFEV1/FVC <75%FEV1 response to B2 <15%CXR - lung infiltrates if infectionBlood test - rule out other causeSputum culture - grow organism causing exacerbation
175
1st line treatment
SABA (salbutamol)or SAMA (ipratropium)
176
2nd line treatment (if FEV1>50%)
LABA (salmeterol)or LAMA (tiotropium) and discontinue SAMA
177
3rd line treatment (if FEV1<50%)
LABA (salmeterol) plus ICS (becomethasone, budesonide, prednisolone)or LAMA (tiotropium) and discontinue SAMA
178
4th line treatment
LAMA (tiotropium) plus LABA (salmeterol) plus ICS
179
5th line treatment
if patient has 2 or more exacerbations in 12 months despite triple therapy, PD4 receptor antagonist (roflumilast) used
180
what is used in acute exacerbation
oral corticosteroids (prednisolone) and antibiotics
181
1st line antibiotics?
doxycycline / amoxicillin
182
2nd line antibiotics?
clarithromycin, moxifloxacin, (AND IV aminophylline (methylxanthine))
183
what is it
excess fluid between layers of pleura
184
what are symptoms
worsening dyspnoea coughpleuritic pain
185
what are signs
wall movement - reduced unilaterally percussion note - stony dullbreath sounds - absent but bronchial superior to effusionvocal fremitus - absent
186
what is causes of exudative pleural effusion (protein more than 30g/l)
neoplasma PEinfections
187
what is cause of transudative pleural effusion (protein less than 30g/l)
LVFcirrhosis
188
what are other causes
congestive heart failure pneumonia renal failure cancer autoimmune (SLE)
189
how is it diagnosed
symptoms and signs CXR - >300 fluid, changes range from obliteration of costophrenic angle to dense homogenous shadowsCTpleural biopsy
190
what is treatment
thoracentesis symptomatic reliefpleurodesis (adhesion of pleural membranes)
191
what are complications
empyema subcutaneous emphysems haemorrhage vagus nerve irritation
192
what is it
abnormal and permanently dilated airways the mucocilary transport mechanism is impaired and frequent bacterial infections ensure
193
what causes it
severe childhood infection cystic fibrosis immunodeficiency
194
what are signs
cough production of large amount of sputum and dilated and thickened bronchi clubbing breathlessnesshaemoptysis can occur
195
how is it diagnosed
exam - coarse crackles at base on inspiration CXR - mid zone tram lines, dilated bronchi CT - bronchial dilation
196
how is it treated
damage cant be repaired so basis of management is to prevent or slow down further deterioration antibiotics may be needed bronchodilators useful in those with airflow limitation
197
what antibiotics
amoxicillin, clarithromycin, erythromycin, doxycyline if allergic erythromycin in pregnancy and breast feeding
198
what is it
collection of air in pleural space resulting in collapsed lung
199
what are primary cause
normal lungs then apical bullae rupture
200
what is secondary cause
pre-existing lung diseases eg smoking, severe asthma, COPD, marfans
201
who is it common in
those with existing respiratory conditions, cannabis users, smokers and tall, thin men
202
what are symptoms
sudden onset of pleuritic pain SOBtachycardia
203
what are signs
hyper-resonant percussion note reduced expansion quiet breath sounds on auscultation hamman's sign (click on auscultation at left side)
204
how is it diagnosed
CXR - small <2cm rim of air, large >2cmABG - hypoxia
205
treatment if <20%
observe, air will usually reabsorb
206
treatment if 20-50%
needle aspiration using 16-18G cannula sited in 2nd IC space, mid clavicular line
207
treatment if >50%
chest drainage - intercostal small bore drain in 5th IC space, mid auxillary line
208
treatment if recurrence
pleurodesis/pleurectomy
209
what is the follow up
CXRdiscuss flying and diving (not for 6 weeks)general recurrance risk smoking cessation
210
what is tension pneumothorax
medical emergencycan lead to cardiac arrest due to one way valve mechanism (between pleural layers) resulting in increased pressure in pleural space
211
what is signs of tension pneumothorax
tracheal deviation mediastinal shift to opposite side hypotension raised JVPreduced air entry
212
what is treatment of TP
O2 and needle compression usually with large bore venflon in 2nd intercostal space
213
what is seasonal rhinitis
hayfever
214
what is perennial rhinitis
symptoms throughout full year, sinusitis occurs in about 50% of cases due to mucosal swelling
215
what is perennial allergic rhinitis
allergy to faecal particles of dust mite - more sensitive to cigarette smoke, washing powders, perfumes etc
216
what is vasomotor rhinitis
perennial rhinitis with no allergy or nasal eosinophilia
217
what are nasal polyps
round smooth soft pale or yellow structures attached to sinus mucosa - occurs in patients with allergic and vasomotor rhinitis
218
what causes it
mucus - parasympathetic stimulation allergic rhinitis results due to interaction between inhaled allergen and IgE present on their mast cells (found in increased numbers in nasal secretion)
219
how is it diagnosed
history of allergic factors skin prick test indicates mechanism leading to allergic rhinitis
220
how is it treated
H1 receptor antagonists (eg loratadine, cetirizine, fexofenadine, cyclizine, cinnarizine)Decongestants (a adrenergic agents) Corticosteroids (beclomethasone or fluticasone propionate - polyps) Leukotriene antagonists (montelukast, zarfirlukast - esp history of NSAID or asthma)Anti-allergic (sodium cromoglicate)
221
what is it
alteration of viscosity and tenacity of mucus
222
what is genetics of it
autosomal recessive, 1 in 25 people carry CFTR gene
223
what are respiratory effects
commonest cause of recurrent bronchopulmonary infection in childhood
224
what is GI effects
85% of patients have steatorrhoea (excretion of fat with faeces) due to pancreatic dysfunction or insufficiency
225
what are other symptoms
biliary diseasehigh sodium sweatmalnutrition puberty and skeletal maturity delay males almost always infertile
226
how is it diagnosed
sweat test confirms in 98%molecular test for CFTR genesinux XR/CT - show opacification of sinuses CXR or CT thorax
227
how is it treated
symptomatic G551D - Ivecaftor F508Del - lumacaftor
228
what are complications
most of morbidity due to respiratory disease eg bronchiectasis, progressive airflow destruction, cor pulmonale, death
229
what is it
rare autoimmune disease in which antibodies attack basement membrane in lungs and kidneys lead to bleeding from lungs and kidney failure
230
what are symptoms
symptoms of URTIfollowed by cough intermitten haemoptysis tirednessanaemia
231
how is it diagnosed
CXR - transient blotchy shadows due to intapulmonary haemorrhage
232
how is it treated
some patients spontaneously improve whilst others proceed to renal failure treat with corticosteroids
