Clinical Flashcards
Upper respiratory tract infections
Common cold
Pharyngitis
Sinusitis
Epiglottitis
Lower respiratory tract infections
Acute bronchitis Acute exacerbation of chronic bronchitis/ COPD Pneumonia Influenza Fungal infection
Coryza
Acute viral infection of the nasal passages
Often accompanied by sore throat
Sometimes mild fever
Spread by droplets and fomites
Viruses causing coryza
Adenovirus
Rhinovirus
Respiratory syncytial virus
Acute sinusitis
Preceded by common cold Frontal headache, Retro-orbital pain, Maxillary sinus pain, Tooth ache, Discharge
Diphteria
Bacterial infection
Produces toxin
Life threatening
Acute bronchitis
Productive cough Fever – minority of cases Normal chest examination Normal chest X-ray May have a transient wheeze
Rhinovirus incubation time
1-5 days
Group A streptococci incubation time
1-5 days
Influenza and para influenza virus incubation time
1-4 days
RSV virus incubation time
7 days
Pertussis incubation time
7-21 days
Diphtheria incubation time
1-10 days
Epstein-Barr Virus incubation time
4-6 weeks
Pneumonia
Signs and symptoms of a lower respiratory tract infection, with a new infiltrate on a CXR
CURB 65 Severity Score
C new onset of Confusion U Urea >7 R Respiratory rate >30/min B Blood pressure Systolic <90,Diastolic <61 65 Aged 65 or older
Score 1 point for each above
Only applies to community acquired pneumonia
Other severity markers for pneumonia
Temperature <35 or >40
Cyanosis PaO2 <8kPa
WBC <4 or>30
Multi-lobar involvement
Complications of pneumonia
Respiratory failure
Pleural effusion
Empyema
Death
Cases of pneumonia (4)
Community acquired
Hospital acquired
Aspiration pneumonia
Legionella
Aetiology of classical flu
Influenza A virus
Influenza B virus
Aetiology of flu-like illnesses
Parainfluenza viruses
many others
Aetiology of Haemophilus influenzae
Bacterium
‘Flu complications
Primary influenzal pneumonia Secondary bacterial pneumonia Bronchitis Otitis media Pregnancy complications
Causes of community acquired pneumonia (other than flu)
Microbiological causes:
Mycoplasma pneumoniae
Coxiella burnetii
Chlamydia
What are most cases of bronchiolitis caused by?
Respiratory syncytial virus
Empyema
Pus in the pleural space
Signs of complicated effusion
\+ve gram stain pH <7.2 low glucose septations loculations
Stridor
Inspiratory wheeze due to large airway obstruction
Possible causes of stridor in the supraglottis/larynx
Laryngomalacia
Supraglottic mass
Glottic lesion
Vocal cord paralysis
Main causes of stridor in children
Infection
Foreign Body
Anaphylaxis/ Angioneurotic oedema
Other (eg burns)
Main causes of stridor in adults
Neoplasms Anaphylaxis Goitre Trauma (burns, strangulation, irritant gases) Bilateral vocal cord palsy Cricoarytenoid arthritis Tracheopathia
Infections causing stridor in children
Epiglottitis Croup/ Pseudomembranous croup Retropharyngeal abscess Diphtheria Infectious mononucleosis
Tracheomalacia
Inflammatory condition which causes destruction of cartilage
Investigation in stridor
Laryngoscopy (beware in acute epiglottitis) Bronchoscopy Flow volume loop Chest X ray Other imaging
Treatment of laryngeal obstruction
Treat underlying cause eg foreign body removal,
Mask bag ventilation with high flow O2
Cricothyroidotomy
Tracheostomy
Treatment of malignant airway obstruction
Tumour removal (laser; photodynamic therapy; cryotherapy; diathermy; surgical resection)
Tumour compression
Radiotherapy
Chemotherapy
Acute anaphylaxis
Type 1 Hypersensitivity (IE) Flushing, pruritus, urticaria Angioneurotic oedema Abdominal pain, vomiting Hypotension Stridor, wheeze and respiratory failure
Treatment of anaphylaxis
IM Adrenaline IV antihistamine IV corticosteroid High flow O2 Nebulised bronchodilators Endotracheal intubation
Snoring
Relaxation of pharyngeal dilator muscles during sleep
Upper airway narrowing
Turbulent airflow
Vibration of soft palate and tongue base
Obstructive sleep apnoea
Intermittent upper airway collapse in sleep
Hypoxia
Sleep fragmentation
Risk factors for sleep apnoea
Enlarged tonsils Obesity Retrognathia Acromegaly Oropharyngeal deformity Neurological Drugs/alcohol Post-operative period
Clinical presentation of sleep apnoea
Excessive daytime sleepiness
Personality change
Cognitive / functional impairment
Major impact on daytime function
Consequences of sleep apnoea
Hypertension Activated sympathetic system Raised CRP Impaired endothelial function Impaired glucose tolerance Increased CDV risk
Diagnosis of sleep apnoea
Snoring & EDS (raised Epworth score) Overnight sleep study - oximetry - domicillary recording - full polysomnography
Treatment for obstructive sleep apnoea
Remove underlying cause
Continuous Positive Airway Pressure (CPAP)
Mandibular Advancement Device
Surgery
