Resp Flashcards
What does a sputum sample film show in acute bronchitis?
Neutrophil granulocytes (inflammatory WBCs)
What pathogen causes influenza?
RNA virus - orthomyxoviridae
How is influenza diagnosed?
Clinical diagnosis
- viral culture - PCR
What are the symptoms of influenza?
- Coryzal symptoms
- Fever
- Headache
- Non-productive cough
- Sore throat
What is croup?
- Inflammation of the upper respiratory tract
- acute laryngotracheitis
- due to viral infection
What organism is most responsible for croup?
- Parainfluenza
- RSV
What are the symptoms of croup?
Seal-like barking cough
- runny nose
- fever
- stridor
- voice hoarseness
How do you diagnosis croup?
Clinical diagnosis
- Significant resp impairment ( O2 <95%)
Is RSV contagious?
Yes
What is the most common complication RSV?
Bronchiolitis
How is RSV spread?
air droplet
What are the RSV symptoms?
Cold-like symptoms:
- low grade fever
- wheezing
- chest congestion / rhinorrhea
- SOB
- Cough
What is bacterial pneumonia?
- bacterial mediated inflammation
- infection of the lung tissue in which the alveoli become filled with MO, fluid & inflamm cells
What are the most common microorganism causing bacterial pneumonia?
- streptococcus pneumonia
- H.influenza
- staphylococus aureus
What are the key symptoms for bacterial pneumonia?
- Green Productive Cough*
- SOB
- Fever
- Chest pain
What are the key signs for bacterial pneumonia?
- Increased tactile & vocal fremitus
- Dullness to percuss
- Bronchial breath sounds
- Late inspiratory crackles
Investigations for pneumonia?
- CXR : to identify location and extent
- CRP : inflammation
What score is used to admit pt to hospital with pneumonia?
CRB-65
> 3 = urgent admission
> 2 = hospital management
0 = conservative management at home
What are the key symptoms for viral pneumonia?
Non-productive cough
Systemic symptoms:
- fever
- runny nose
- myalgia
- fatigue
What are the investigation findings for viral pneumonia?
- Viral PCR
- CXR : more likely bilateral consolidation
What is acute bronchiolitis?
- Acute viral infection of the LRT
- Characterised by epithelial destruction, cellular oedema & airwary obstruction by inflamm debris & mucus
Most common cause of bronchiolitis
RSV
what are the symptoms of acute bronchiolitis?
- Fever
- Cough
- Poor feeding
- Apnoea
What are the signs of acute bronchiolitis?
Clinical diagnosis: < 2 presenting with 1-3 days hx of coryzal symptoms
- persistent cough
- tachypnoea or chest recession (both)
- wheeze or crackles OA (both)
Investigation for acute bronchiolitis
CLINICAL DIAGNOSIS
- check 02 sats
- CXR not recommended unless evidence of deterioration
What is acute epiglottitis?
Cellulitis of the supra-glottis - may cause airway compromise.
- Airway emergency in children
What is the most common cause for acute epiglottitis?
H.Influenza
What are the symptoms of acute epiglottitis?
- Sore throat
- Stridor
- Tripod position : lean forward + extending neck.
- Dysphagia
- Fever
- Drooling
What are the signs for acute epiglottitis?
High - pitched inspiratory wheeze
* DO NOT EXAMINE THROAT*
What are the investigation finding for acute epiglottitis?
Lateral neck radiograph - THUMB SIGN
What are the complications of acute epiglottitis?
- Abscess formation
- Sepsis
- Pneumothorax
- Meningitis
What is pertussis?
- Whooping cough
What organism causes pertussis?
- Bordetella Pertussis
How is pertussis transmitted?
- Sneeze or cough (airborne)
What are the 3 phases of symptoms called in Pertussis?
1st phase = catarrhal
- runny nose
- malaise
- sore throat
- low-grade fever
- dry cough
2nd phase = paroxysmal (1-6 weeks)
- short expiratory burst followed by inspiratory gasp (whoop)
- thick mucus secretions
3rd phase = convalescent (3 months)
- gradual improvements in cough frequency + severity
What are the key symptoms should you suspect for pertussis?
Acute cough > 14 days w/ no apparent cause w/:
- paroxysmal cough
- inspiratory whoop
- Post-tussive vomiting
- undiagnosed apnoeic attack
How to diagnose pertussis?
Nasopharyngeal swab
What is empyema?
Defined as the presence of frank pus in the pleural space.
What are the common infection causing empyema?
- Due to post pneumonia
- Anaerobic, staph & gram-negative infections
- Klebsiella: alcoholism, currant jelly-like sputum.
What are the symptoms of empyema?
- SOB
- Fever
- Pleuritic chest pain
What are the signs of empyema?
- Tachypnoea
- Reduced breath sounds
- Dullness to percuss
What are the investigation findings of empyema?
CXR: blunting of the costophrenic angle or effusion on affected side
CRP & WCC- raised in infection
What investigation is diagnostic for empyema?
Thoracentesis: aspiration of the frank pus
What is chronic bronchitis?
Long-term inflammation of the lining of the bronchial tubes
What are the symptoms of chronic bronchitis?
- Cough
- Sputum
- Fatigue
- SOB
- Chest discomfort
What is emphysema?
Condition causes SOB due to damaged alveoli in the lungs
What are the signs and symptoms of emphysema?
- SOB (progressive & at rest)
- Fatigue
- Central & peripheral cyanosis
- Persistent wheeze
- Productive cough
What are the signs of emphysema?
- ” Pink puffers”
- Accessory muscle use
- Barrel chest
- Hyper-resonance on percussion
- Absent or quiet breath sounds on auscultation
What are the investigation for emphysema?
- Bloods: Serum Alpha 1-antitrypsin
- CXR
- Sputum culture
- Lung function test
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
What is COPD?
- Airflow limitation
Group of progressive lung disease including chronic bronchitis & emphysema (treatable but not curable)
What is the pathophysiology of COPD?
CB: damage to endothelium impairing the mucociliary response to clear mucus & bacteria – airway deformation & narrowed lumen
EMP: enlargement of alveoli, leading to decline in gas exchange
What deficiency causes COPD?
Alpha 1-trypsin
What are the symptoms for COPD?
- SOBOE (progressive)
- Chronic cough
- Regular sputum production
- Wheeze
- Weight loss
- Fatigue
- PND
- Ankle swelling (cor pulmonale)
- Chest pain
- Haemoptysis
What are the signs for COPD?
- Frequent LRTI
- Cyanosis
- Raised JVP
- Cachexia
- Barrel chest
- Accessory muscle use
- Purse lip breathing
- Crackles OA
How is COPD diagnosed?
Clinical features + spirometry
What investigations are carried when suspecting COPD?
- Spirometry
- CXR
- ABG
- Sputum culture
- Serum alpha 1-trypsin
What spirometry findings confirms persistent airflow obstruction?
A post-bronchodilator FEV1/FVC < 0.7
How is the severity of COPD classified?
Post-bronchodilator FEV1/FVC < 0.7
FEV1 (of predicted)
> 80% : Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients
50-79% : Stage 2 - Moderate
30-49% : Stage 3 - Severe
< 30% : Stage 4 - Very severe
What are CXR findings in COPD?
- Hyperinflation
- Bullae
- Flat haemodiaphragm
(exclude cancer)
What are the asthmatic features when treating COPD?
1) any previous, secure diagnosis of asthma or of atopy
2) a higher blood eosinophil count
3) substantial variation in FEV1 over time (at least 400 ml)
4) substantial diurnal variation in peak expiratory flow (at least 20%)
What are the complications of COPD?
- Secondary polycythaemia : Increased haematocrit due to long-term hypoxia
- Respiratory acidosis: indicates BiPAP
- Recurrent chest infections
- Cor pulmonale
What can a large bullae in CXR in COPD mimic?
Pneumothorax
What type of bacteria is Haemophilus influenza?
- Gram negative rod
What is asthma?
Chronic respiratory condition associated with airway inflammation and hyper-responsiveness.
What is asthma associated with?
Eczema + Hay fever
What features is required for the classification of moderate asthma?
1) PEFR 50-75% best or predicted
2) Speech normal
3) RR < 25 / min
4) Pulse < 110 bpm
What features is required for the classification of severe asthma?
1) PEFR 33 - 50% best or predicted
2) Can’t complete sentences
3) RR > 25/min
4) Pulse > 110 bpm
What features is required for the classification of life-threatening asthma?
1) PEFR < 33% best or predicted
2) Oxygen sats < 92%
3) ‘Normal’ pC02 (4.6-6.0 kPa)
4) Silent chest, cyanosis or feeble respiratory effort
5) Bradycardia, dysrhythmia or hypotension
6) Exhaustion, confusion or coma
What are the features of klebsiella pneumonia?
- RF: alcohol and diabetes
- ‘red-currant jelly’ sputum
- Upper lobe
What are the common symptoms associated with asthma?
- Wheeze
- Chest tightness
- SOB
- Cough
What are the clinical signs associated with asthma?
- OBS : HR > 110, RR > 25
- Tracheal deviation
- Widespread wheeze OA
- Chest deformity/ hyperinflated chest ( chronic asthma)
When do symptoms of asthma commonly present (timing)?
- Worse at night
- Early in the morning
- In response to exercise
- Allergen exposure
- Cold air
- After taking aspirin or BB
What does normal PaCO2 in acute asthma indicate?
- Exhaustion
This is classified as life-threatening
When is chest X-RAY indicated in acute asthma?
Not routinely done”
- life-threatening asthma
- suspected pneumothorax
- failure to respond to treatment
What investigations are considered in asthma?
1) Spirometry : < 70 % in FEV1/FVC suggests airflow limitation
- -> normal spirometry does not r/o asthma
- -> BDR: confirms diagnosis, > 12% improvement, with an increase in volume of > 200ml is positive result
2) Peak flow : > 20% variability is positive result
- ->support diagnosis
3) FENO testing : esonophilic airway limitation support diagnosis (> 40 ppb)
4) Allergy testing