Diseases of the Respiratory System Flashcards
What viruses commonly cause coryza?
Rhinoviruses, coronaviruses and adenoviruses
What ear condition can be a complication of coryza?
Otitis media
In sinusitis, what is the treatment for someone who has had symptoms for 10 days or less?
Advise that acute sinusitis is usually caused by a virus it takes 2–3 weeks to resolve.
Symptoms, including fever, can be managed with self-care measures such as paracetamol or ibuprofen for pain or fever. Some people may want to consider a trial of nasal saline or nasal decongestants (although evidence is lacking to support their use)
In sinusitis, what is the recommendation if a person has had symptoms for around 10 days or more with no improvement?
Consider prescribing a high-dose nasal corticosteroid for 14 days
Reserve antibiotics for severe/deteriorating cases of >10 days duration. 1st line = penicillin V
What severe complications can be caused by sinusitis?
Intraorbital or periorbital complications - periorbital oedema/cellulitis/displaced eyeball/double vision/ophthalmoplegia/newly reduced visual acuity
Intracranial complications - swelling over the frontal bone/meningitis/severe frontal headache/focal neurological signs.
How is rhinitis classed by type and by timeframe?
Type = allergic or non-allergic
Timeframe = seasonal/intermittent or perennial/persistent
What is the treatment for allergic rhinitis?
- Allergen avoidance
- Nasal irrigation with saline
Mild-to-moderate intermittent, or mild persistent symptoms = intranasal antihistamines (azelastine) or oral antihistamine (loratadine or cetirizine)
Moderate-to-severe persistent symptoms = regular intranasal corticosteroid (eg fluticasone propionate or beclomethasone)
What is the most common viral vs bacterial cause of pharyngitis?
Viral - endemic adenovirus
Bacterial - Streptococcus pyogenes (Group A Beta Haemolytic Strep) aka strep throat
What are the complications associated with pharyngitis
hint - 1 ear, 2 throat, 1 skull
- Otitis media
- Peri-tonsillar abscess (quinsy)
- Parapharyngeal abscess
- Mastoiditis
What is acute laryngotracheobronchitis (croup)
A viral or bacterial infection of the larynx and/or the trachea that causes swelling and airway obstruction
What causes acute laryngotracheobronchitis (croup)
Commonly - viruses such as parainfluenza, influenza, measles, adenovirus and respiratory syncytial virus (RSV)
Rarely - bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
What is the treatment for acute laryngotracheobronchitis (croup)
Oral dexamethasone (all) and oxygen support/nebulized adrenaline/fluids (if needed)
What age group is at risk of acute laryngotracheobronchitis (croup)
6 months- 5 years
May rarely be seen in children as old as fifteen
What causes acute epiglottis?
H. influenzae
What is it critical NOT to do in acute epiglottitis
Inspect the epiglottis until the airway is patent
Which type of influenza causes pandemics and which type causes localised outbreaks?
Influenza A = pandemics
Influenza B = localised outbreaks
A “cold that goes to the chest” is the colloquial way of referring to what?
Acute bronchitis
What are the common causes of acute bronchitis?
Strep. pneumoniae/H. influenzae infections, or in people with COPD
What is the treatment of acute bronchitis?
NO antibiotics unless there is underlying chronic lung disease (amoxicillin)
What is the most common cause of pneumonia?
Streptococcus pneumoniae - 80% of cases
What organism commonly causes pneumonia in COPD patients?
Haemophilus influenzae
What organism commonly causes pneumonia following an influenza infection?
Staphlococcus aureus
What organism commonly causes pneumonia that presents with a dry cough and stypical CXR findings +/- autoimmune haemolytic anaemia and erythema multiforme?
Mycoplasma pneumoniae
What organism commonly causes atypical pneumonia that often presents with hyponatraemia and lymphopenia
Legionella pneumophilia
What organism commonly causes pneumonia in alcoholics that classically presents with bloody or yellow sputum
Klebsiella pneumoniae
What organism typically causes pneumonia in patients with HIV
Pneumocystis jiroveci
What does CURB 65 stand for?
C - confusion U - urea >7mmol/L R - respiratory rate >30 B - Blood pressure <90 systolic or <60 systolic 65 - 65 years or older
Predicts mortality in community acquired pneumonia
What is the antibiotic treatment for mild/moderate CAP?
Amoxicillin PO
What is the antibiotic treatment for mild/moderate CAP in penicillin allergic patients?
Doxycycline PO
What is the antibiotic treatments for severe CAP?
IV co-amoxiclav + PO doxycycline
What is the antibiotic treatments for severe CAP who are penicillin allergic?
IV Levofloxacin
What is the antibiotic treatments for severe HAP?
IV Amoxicillin + Gentamicin
What is the antibiotic treatments for severe HAP who are penicillin allergic?
IV Co-trimoxazole + Gentamicin
What are the 4 C antibiotics?
Clindamycin, cephalosporins (eg ceftriaxone), co-amoxiclav and ciprofloxacin
What antibiotic that starts with a C is not part of the 4C antibiotics but you keep thinking it is you dumb bitch?
Co-trimoxazole
What is the antibiotic treatments for non-severe HAP
PO amoxicillin
What is the antibiotic treatments for non-severe HAP who are penicillin allergic?
PO doxycycline
How long do you have to be in hospital before an infection can be diagnosed as a hospital acquired/healthcare associated infection?
48 hours
What 2 things is COPD comprised of
Chronic bronchitis and emphysema
What 2 major heart related complications are associated with COPD
Hypertension and cor pulmonale
What is the first line pharmacological treatment for someone with stable COPD?
A SABA (eg salbutamol) or SAMA (eg ipratropium)
What are the second and third line pharmacological treatments for someone with stable COPD?
2nd line = SABA or SAMA + LABA (salmeterol)+ LAMA (tiotropium)
3rd line = above + Inh. corticosteroid (eg beclometasone)
What does iSOAP in an acute exacerbation of COPD stand for?
I - ipratropium (nebulised) S - salbutamol (nebulised) O- Oxygen A - antibiotics (amox or doxy) P - prednisolone (PO)
What ranges of PEFR are classified as moderate, severe and life threatening in asthma?
- Mod = <80%
- Severe = <50%
- Life-threatening = <30%
What does FEV1 stand for?
Forced expiratory volume in 1s - the volume exhaled in the first second after deep inspiration and forced expiration
What does FEV stand for?
Forced vital capacity – the total volume of air that the patient can forcibly exhale in one breath
What would an obstructive pattern (eg COPD/asthma etc) show on spirometry?
- FEV1 reduced
- FVC normal/reduced to a lesser extent
- FEV1/FVC ratio reduced
What would a restrictive pattern (eg pulmonary fibrosis/pulmonary oedema etc) show on spirometry?
- FEV1 reduced
- FVC
- FEV1/FVC ratio normal
What is the first line treatment for asthma?
SABA inhaler (eg salbutamol)
What is added to asthma treatment if a SABA does not provide adequate control
Inhaled corticosteroid (eg beclometasone)
What scale is used to in the diagnosis sleep apnoea?
Epworth Sleepiness Scale
What is the most common cause of bronchiectasis?
CF
In which gene is there a defect in CF?
CFTR
What are the 4 main causes of haemoptysis?
- Cancer
- PE
- Infection eg TB, bronchitis, pneumonia etc
- CF
What GI issue prompts the diagnosis a large percentage of CF infants
Meconium ileus (SI obstruction)
What type of granulomas are seen in TB
Caseating granulomas
What stain is used in the diagnosis of TB?
ZN stain
What are the 2 main drugs in the treatment of TB?
Rifampicin and isoniazide
What type of granulomas are present in sarcoidosis?
Non-caseating granulomas
What type of hypersensitivity is sarcoidosis?
Type 4
What is the treatment for sarcoidosis?
Corticosteroids (oral prednisolone)
What relatively rare condition should a nasal mucosa ulcer combined with other resp symptoms make you think of
Granulomatosis with polyangiitis (Wegener’s)
What condition with respiratory symptoms can cause s necrotising microvascular glomerulonephritis?
Granulomatosis with polyangiitis (Wegener’s)
A high eosinophil count combined with respiratory and systemic vasculitis (fever, sweats, fatigue, weight loss, rash) symptoms should make you suspicious of what condition?
Eosinophilic Granulomatosis with Polyangiitis (EGPA/Churg-Strauss)
What is the treatment for granulomatosis with polyangiitis (Wegener’s)
Cyclophosphamide
What is the treatment for eosinophilic granulomatosis with polyangiitis (EGPA/Churg-Strauss)
Corticosteroids
What type of ANCA does GPA show
cANCA
What type of ANCA does EGPA show
pANCA
What type of hypersensitivity is lupus?
Type 3
What features in a cxr would indicate idiopathic pulmonary fibrosis?
Patchy scarring of lung with collagen deposition and ground-glass/honeycombing
What is extrinsic allergic alveolitis (hypersensitivity pneumonitis)?
Widespread diffuse inflammatory reaction in small airways and alveoli due to inhalation of foreign antigens
What type of hypersensitivity is extrinsic allergic alveolitis (hypersensitivity pneumonitis)?
Type 3
What are the classic features of extrinsic allergic alveolitis (hypersensitivity pneumonitis) on imaging?
- CXR = fluffy upper zone nodular shadows
- CT = ground glass opacity
What kind of crackles are heard in extrinsic allergic alveolitis (hypersensitivity pneumonitis)?
Coarse end-inspiratory crackles
Where should you needle aspirate in pnemothorax?
2nd IC space, midclavicular line
Where should a chest drain be placed?
5th intercostal space in the mid-axillary line
What is empyema usually a complication of?
Pneumonia
What is a transudate?
Transudate = pleural effusions that are caused by factors that alter hydrostatic pressure, pleural permeability, and oncotic pressure
Eg Congestive heart failure, liver cirrhosis etc
What is an exudate
Exudate = pleurql effusions caused by changes to the local factors that influence the formation and absorption of pleural fluid
eg Malignancy,
infection etc
What is the difference between a transudate and an exudate
Transudate =
Pprotein <30 g/L
Exudate= protein >30 g/L
What is the difference between type 1 and type 2 respiratory failure?
Typw 1 = hypoxia with normal or low PaCO2
Type 2 = hypoxia + hypercapnia
Give some examples of direct and indirect causes of ARDS
Direct = pneumonia, aspiration, inhalational lung injury, chest trauma, and near-drowning
Indirect causes = sepsis, shock, pancreatitis, trauma
What kind of crackles are heard in ARDS?
Fine bilateral crackles
What is the definition of cor pulmomale?
Cor pulmonale = right heart failure due to pulmonary hypertension.
Can occur in advanced COPD: alveolar collapse (emphysema) results in hypoxia which causes vasoconstriction, increasing pressure in the right side of the heart
What signs on a cardiac examination would point to cor pulmonale?
Ankle oedema, elevated JVP, parasternal heave and tricuspid regurgitation
What is Virchow’s triad?
Virchow’s triad = endothelial damage, abnormal blood flow or hypercoagulable blood
What is the most common type of lung cancer?
Bronchial carcinoma / squamous cell carcinoma
What nerve might be affected in a lung cancer causing hoarseness?
Recurrent laryngeal nerve
Invasion of which nerve in lung cancer can cause dysphagia?
Phrenic nerve
What hormone does small cell carcinoma produce?
ACTH
What lung cancer is common in non-smokers?
Adenocarcinoma
Which type of lung cancer is chemotherapy effective against?
Small cell lung cancer
