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Respiratory Pathology > Pathology 2 > Flashcards

Pathology 2 Flashcards

1
Q

What is acute epiglottitis ?

A

Upper respiratory tract infection where the cartilaginous flap that prevents the inhalation of food gets inflamed and can cause breathing difficulties.

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2
Q

How will acute epiglottitis present?

A

If you have a young screaming child who is struggling to breath. It can also happen in adults though.

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3
Q

How is acute epiglottitis diagnosed ?

A

Throat culture and bloods

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4
Q

How is acute epiglottitis treated?

A

Oxygen / breathing tube
A cricothyroidotomy (needle through the trachea to get air in)
IV fluid and nutrition because its hard to eat
Antibiotics
Anti-inflammation medications i.e. ICS

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5
Q

What is croup ?

A

Upper respiratory tract infection where patients feel well, make lots of noise, running nose, wake up in the night, barking cough and often stridor.

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6
Q

How is croup treated ?

A

Single dose oral corticosteroids i.e. Dexamethasone or prednisolone

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7
Q

What is tracheitis ?

A

Described a croup that doesn’t get better. Uncommon. Makes people feverish and sick. Swollen trachea. Staph or step invasive infection

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8
Q

How is tracheitis treated?

A

IV antibiotics

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9
Q

What is Bronchitis ?

A

Very common. Starts as a upper respiratory tract infection and is in infection of the bronchi causing inflammation and increase in mucus. Found often in a children and isn’t very harmful, no wheeze etc, self limiting. Will just present with a cough, fatigue, sputum etc. In adults it causes a fever, high temp, SOB.

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10
Q

How do you treat bronchitis ?

A

You don’t treat it, it lasts about 4 weeks and reassure them or the family.

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11
Q

What is bronchiolitis?

A

Very common in under 12 months. Self limiting and rarely treated. Causes running nose, tachypnoea, feeling sick, crackles, sometimes a wheeze.

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12
Q

How is bronchiolitis treated?

A

Maximum observations and minimum interventions. It has a very predictable pattern where symptoms are worst on day 3.

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13
Q

What is the classification of COVID 19 ?

A

SARS-COV2 is a beta coronavirus which has airborne and droplet transmission

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14
Q

What is the incubation and infectivity period for COVID 19

A

It has an incubation period of 1-14 days and people are most infectious 24 hours before symptom

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15
Q

What is pleural effusion ?

A

When there is a build up o fluid in the pleural cavity.

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16
Q

What are the two types of pleural effusion ?

A
  • Transudate: Non-inflammatory with a low protein content in the fluid.
  • Exudate: Inflammatory with a high protein content in the fluid.
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17
Q

What are transudate and exudate effusions caused by ?

A

Transudate- Left ventricle failure and cirrhosis.

Exudate - Malignancy and TB

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18
Q

What is lights criteria ?

A

Used to help determine if an effusion is transudate or exudate. It looks at protein content comparing pleural fluid to serum. If pleural fluid/serum fluid is 0.5 or more then its exudate. It also looks at LDH compared to serum. if its greater than 0.6 then its exudate. It also looks at pleural fluid LDH compared to ULN serum LDH. If the pleural LDH is more than 2/3rds of the ULN serum LDH then its a exudate.

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19
Q

Investigations for pleural effusion

A

Ultrasounds
CXR
CT

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20
Q

How is an pleural effusion treated?

A

Treat underlying condition.

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21
Q

What is a pneumothorax?

A

Entry of air into the pleural cavity causing the collapse of part or all of the lung.

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22
Q

What is a primary spontaneous pneumothorax?

A

One which happens spontaneously in a health person

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23
Q

What are the different types of pneumothorax?

A
  • Traumatic pneumothorax caused by injury to the chest wall where blunt trauma breaks a rib which peruses through the pleura membrane.
  • Iatrogenic pneumothorax is caused by treatment.
  • Tension pneumothorax.
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24
Q

How does a pneumothorax present?

A

Sudden onset of chest pain or breathlessness. Tachypenic, hypoxic, reduced chest wall movement and reduced or no breath sounds.

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25
Q

How is a pneumothorax diagnosed?

A

CXR

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26
Q

How is a pneumothorax treated ?

A
  • Needle or chest drain in a tension pneumothorax
  • Watch and see
  • Surgery
27
Q

What is empyema ?

A

Collection of pus in the pleural space

28
Q

How is empyema treated?

A

Antibiotics and sometimes a chest drain

29
Q

What is sarcoidosis ?

A

Common restrictive lung disease. It is a multi system granulomatous disorder often effecting the lungs and lymph nodes.

30
Q

How is sarcoidosis diagnosed?

A

Based on clinical findings, good history, sometimes imaging, presents or erythematosus (red circles on the legs), anterior red inflamed eyes.

31
Q

How is sarcoidosis treated?

A

often there is no treatment needed but sometimes will need ICSs. NSAIDs to treat erythema, or tropical steroids to treat skin lesions etc can also be used.

32
Q

What are the symptoms of sarcoidosis?

A 
Tender and swollen glands. 
Tiredness. 
painful joints. 
Cough. 
Haemoptysis. 
Erythematosus.
33
Q

What is sleep apnoea ?

A

When a patent has recurrent episodes of upper airways obstruction causing stopping (for more than 10s) and starting in breathing while sleeping. This is caused by the relaxation of the muscles, a narrow pharynx and often obesity.

34
Q

How will sleep apnoea present ?

A

Heavy snoring

Patients feel unrefreshed from there nights sleep and so many sleep during the day or have poor concentration.

35
Q

If the breathing stops for less than 10s during sleep that is called?

A

Hypopneas

36
Q

What effect does sleep apnoea have on driving ?

A

Makes you much more likely to have a car crash.

37
Q

What is the Epworth questionnaire used for ?

A

Help to determine sleep apnoea. 11+/25 is abnormal You can also use an overnight sleep study to help determine if someone has sleep apnoea.

38
Q

How do you diagnose sleep apnoea?

A

Good clinical history
Epworth questionnaire
etc

39
Q

How is sleep apnoea treated?

A

Reduce risk factors i.e. eight or alcohol.

CPAP (Mask you wear overnight)

40
Q

What is narcolepsy ?

A

Genetic condition where the patient drops into sleep at random moments.

41
Q

How is narcolepsy diagnosed?

A

PSG
Day time study i.e. MSLT
If you fall asleep within 6 mins and or fall straight into REM sleep you are likely to have it.

42
Q

How is narcolepsy treated?

A

Modafinil, dexamphetamione etc

43
Q

What is chronic ventilatory failure ?

A

Where there is elevated CO2 and Low O2 all the time. There is also elevated bicarbonate.

44
Q

What are the symptoms of chronic ventilatory failure?

A 
Breathlessness 
ankle swelling 
morning headache 
recurrently chest infection 
disturbed sleep
45
Q

What conditions can cause chronic ventilatory failure?

A

Airway disease
Chest wall abnormalities
Respiratory muscle weakness
Central hypoventilation

46
Q

How is chronic ventilatory failure diagnosed and treated?

A

Diagnosed using a lung function test.

Treated with ventilation and oxygen therapy

47
Q

What is laryngomalacia ?

A

Floppy larynx. Causes stridor and is worse when feeding, or when upset/excited. Will normally improve naturally.

48
Q

What is tracheomalacia ?

A

Floppy trachea. Causes barking cough, recurrent croup, breathlessness, stridor, wheeze. Will normally improve naturally.

49
Q

What is a tracheooesophageal fistula ? and oesophageal atresia.

A

Abnormal connection between the trachea and oesophagus. Often genetic. Causes choking, colour change, cough, feeding issues, inability to pass a NG. Treated with surgery.

50
Q

What is infant respiratory distress syndrome ?

A

Lack of surfactant. Treated with steroids, surfactant replacement, ventilation and nutrition.

51
Q

How does a pulmonary embolism develop?

A

A thrombus in the venous system (usually in the deep veins of the legs) forms and embolises to the pulmonary arteries.

52
Q

Are all pulmonary embolisms fatal?

A

No, most are actually not however some can be.

53
Q

What are some of the risk factors to suffering from a pulmonary embolism?

A

Any event that may have altered one of the features of Virchow’s triad causing a thrombus to develop. These include major trauma, recent surgery, cancer, significant cardiopulmonary disease i.e. MI or pregnancy. It can also be an inherited thing where you inherit thrombophilia.

54
Q

What are the symptoms of pulmonary embolism ?

A

Pleuritic chest pain, Cough, haemoptysis, isolated acute dyspnoea and in the case of a large PE syncope or cardiac arrest. You will normally just see a couple of these.

55
Q

What are the signs of pulmonary embolism?

A

Pyrexia, pleural rub, stony dullness to percussion at the base (pleural effusion), tachycardia, tachypnoea, hypoxia and hypertension. You will normally just see a couple of these.

56
Q

Ways to estimate the probability of a pulmonary embolism

A

Wells Score and Revised Geneva Score

57
Q

What investigations can be done to establish if a pulmonary embolism?

A 
Full blood count 
Biochemistry 
Blood Gases 
CXR 
ECG 
C-Dimer 
CT pulmonary angiogram
58
Q

What is the blood pressure level required for a diagnosis of pulmonary hypertension ?

A

> 25mmHg pulmonary arterial pressure

59
Q

What are symptoms of pulmonary hypertension ?

A

Exertional dyspnoea, chest tightness, exertional presyncope or syncope and occasionally haemoptysis

60
Q

What are signs of pulmonary hypertension?

A

Elevated JVP, right ventricular heave, loud pulmonary second heart sound, hepatomegaly, ankle oedema.

61
Q

What are investigations carried out to help diagnose pulmonary hypertension?

A

Echocardiography is the definitive investigation however there are a number of other investigations that can be helpful: ECG lung function test CXR V/Q scan CTPA and right heart catheterisation

62
Q

What does right heart catheterisation allow you to observe in investigations into pulmonary hypertension?

A

his allows direct measure of pulmonary artery pressure, wedge pressure, and cardiac output and vasodilator trial

63
Q

Treatment for Pulmonary hypertension includes

A

The main two are endothelin receptor antagonists and phosphodiesterase inhibitors as well as treating the underlying condition. Other treatments include oxygen, anticoagulation and diuretics, calcium channel antagonists, prostaglandins, thromboendarterectomy or heart/lung transplant.

Respiratory Pathology (3 decks)

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