Resp Diseases Flashcards by Christie Hamon

What are these symptoms signs of?

Cough green sputum or bloodstained
Sometimes GI symptoms present (nausea, vomiting, diarrhoea, anorexia)

Legionella Pneumonia

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What is the treatment for sleep apnoea?

Weight loss
Tobacco and alcohol cessation
CPAP via nasal mask during sleep
Surgery relieving pharyngeal obstruction

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What is the treatment for epiglottis?

ITU (secure airways)

- Ceftriaxone (antibiotic)

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What complications can bronchiolitis cause to babies?

Resp failure
Cardiac Failure
Prematurity

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What is this condition?

Watery fluid build up in lungs
Difficult to breathe
Often caused by heart failure, high altitude exposure, acute resp distress syndrome, kidney failure and lung damage

Pulmonary Oedema

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What is this condition?

Chronic bronchitis and emphysema combined which causes loss of elasticity
Mucus secretion
Inflammation of neutrophils
Scarring
Airway obstruction with little to no reversibility
Smoking cessation improves symptoms

COPD

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What is this condition?

Severe croup in children
Could progress to respiratory obstruction in children ages 2-7
Haemophilus Influenza B is the most common cause

Epiglottis

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What is the one symptom of silicosis?

Progressive dyspnoea

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What conditions do these symptoms indicate?

Dyspnoea (laboured breathing)
Fatigue or syncope (temp loss of consciousness)
Cyanosed
Tachycardic
Raised JVP
RV heave pansystolic murmur

Cor Pulmonale

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What is the treatment for croup?

Oral steroid
- this reduces inflammation
Supportive Care

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What is this condition?…

complication of pneumonia
Pus in the pleural space

Empyema

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What are the complications of berylliosis?

Increased risk of lung cancers

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What are these symptoms likely to be?

Dry cough
Serious dyspnoea
Malaise (discomfort)
Weight loss
Arthralgia (pain in a joint)
cyanosis
finger clubbing
fine end inspiratory crepitations
crackles

Idiopathic Pulmonary Fibrosis

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What would this condition be?

chronic lung response to an allergy
chronic lung disease due to exposure to beryllium
occupational lung disease
associated with aerospace manufacturing

Berylliosis

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What are these symptoms signs of?

Acute SOB
Collapse
Pleuritic chest pain
Haemoptysis
Sudden death
Tachypnoea
Hypotension
Cardioreps arrest
Tachycardia
Pleural rub
Loss of pulmonary vasculature on CXR
Pleural effusion
Consolidation on CXR

Pulmonary Embolism

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What are the complications of pneumonia?

Resp Failure
Hypotension
Atrial Fibrillation
Empyema
Pleural Effusion
Lung Abscess

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What is the line of treatment for a tension pneumothorax?

High flow oxygen
Needle decompression
usually with large bore cannula, 2nd intercostal space anteriorly
Chest drain in the mid clavicular line

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What is the treatment for empyema?

Antibiotics
Chest tube drainage
Supportive care

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What is CPAP?

Treatment using mild air pressure to keep the airways open

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What is used to treat idiopathic pulmonary fibrosis?

Supportive care
Smoking cessation
Pulmonary rehab
Oxygen
Antifibrotic therapy

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These are all symptoms of what condition?

Dyspnoea (laboured breathing)
Cough
Normal chest exam
Crackles when auscultating
Wheeze
Some dullness on percussion
Cyanosis
Barrel chest
Clubbing
Weight loss

Coal Worker’s Pneumoconiosis

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What is the treatment for cor pulmonale?

treat the underlying cause (eg. COPD or pulmonary infections)
Diuretics for heart failure
24% oxygen for pulmonary failure

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What are these symptoms signs of?

Producing pink frothy sputum
Paroxysmal nocturnal dyspnoea
Shortness of breath
Require extra pillows at night

Pulmonary Oedema

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Side effects for pyrazinamide? P

Hepatitis
Vomiting
Hyperuricaemia

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What is this condition? - common cold - anti viral infection of nasal passages - the main cause are rhinoviruses - patient producing purulent nasal discharge

Coryza

What condition do these symptoms indicate? - Resolving pneumonia with a recurrent fever developed - Dullness when percussing - Low breath sounds - Low vocal resonance - Pleuritic chest pain - Productive cough

Empyema

What is a MAJOR classification of PE?

- Right ventricular dysfunction | - Normal right ventricular function

What is the type of bacterial pneumonia likely to be in patients with COPD or recent flu?

Staphylococcus aureus

What can bronchiectasis lead to?

- Pneumonia - Pleural effusion - Pneumothorax (collapsed lung, air leaks into between lung and chest wall) - Haemotpysis - Cerebral Abscess

What is this condition? - Acute respiratory tract illness - Associated with fever - Infection that inflames the air sacs

Pneumonia

What condition is this? - Idiopathic (unknown cause) interstitial pneumonia - Infiltration of inflammatory cells - Most common cause of interstitial lung disease

Idiopathic Pulmonary Fibrosis

What is this condition? - infection of the upper airway - obstructs breathing - causes barking cough

Croup

What is emphysema?

- Over-inflation of the alveoli - Causes shortness of breath - Gas exchange is impaired

What are the symptoms indicating? - Loud snoring - Daytime somnolence (sleepiness) - Poor sleep quality - Morning headache - Decreased libido - Decreased cognitive performance

Obstructive Sleep Apnoea

What is the line of treatment for a lung abscess?

- Antibitoics IV - Postural Drainage 2nd Line: - Surigcal Intervention

What can coryza lead to?

- sinusitis | - acute bronchitis

What is this condition? - fixed abnormal dilation of the bronchi - due to infection which causes fibrous scarring - the dilated airways accumulate sceretions of pus

Bronchiectasis

What condition would this line of treatment be used for?

- smoking cessation - management of symptoms/support - pulmonary rehab - oxygen therapy

What are the side effects for rifampicin? R

Orange bodily fluids | Increased liver metabolism

What can coal workers pneumoconiosis lead to?

Pulmonary fibrosis

Line of treatment for ACUTE asthma?

1. Oxygen 2. Nebulised SABA and ipratropium bromide 3. Prednisolone/ hydrocortisone 4. Magnesium sulphate or refer to ICU if that doesn't work

What condition are these symptoms indicative of? In Newborns (neonate) - Meconium Ileus (bowel obstruction) - Rectal prolapse (rectum turning inside out) In Children and Young Adults - Cough - Wheeze - Prone to infections - Bronchiectasis (dilated bronchioles) - Pneumothorax - Haemoptysis - Resp Failure - Cor pulmonale (hear failure) - Weight loss - Pancreatic Insufficiency - Gallstones - Cirrhosis (impaired liver)

Cystic Fibrosis

What are the complications that COPD can lead to?

- Heart failure (Cor pulmonale) | - Type 2 resp failure

What is this condition? - Tumour of the mesothelial cells (lines several body cavities) - Usually occurs in the pleura - Associated to exposure to asbestos through occupation

Mesothelioma

What are these symptoms indicating? - Swinging fever - Cough - Foul smelling sputum - Pleuritic chest pain - hameoptysis - malaise - unexplained weight loss

Lung abscess

What is the treatment for legionella pneumonia?

Erythromycin

What is this condition? | - Disease caused by the inhalation of droplets of water contaminated by the bacteria - LEGIONELLA

Legionella Pneumonia

What is a MASSIVE classification of a PE?

With shock or syncope (loss of consciousness)

What is the treatment for a massive pulmonary embolism?

- Thrombolysis (dissolution of blood clot) or surgery

What is a tension pneumothorax?

- Air is trapped in the pleural cavity under positive pressure - Displaces mediastinal structures - Compromises cardiopulmonary structures

What is this condition? - Inhalation of allergens causing a hypersensitivity reaction Acute Phase: - Acute inflammatory cells infiltrate the alveoli Chronic: - Granuloma formation - Obliterative bronchiolitis occurs

Extrinsic Allergic Alveolitis

What is the test used to identify a panic attack?

Metabolic Alkalosis on ABGs (pH)

What is the treatment for berylliosis?

- no cure | - to cope with it use oxygen, steroids and supportive care

What is this condition? - Autosomal recessive condition affecting only caucasians - Thick mucus clogs digestive system and lungs - Reduces life expectancy

Cystic Fibrosis

What is this condition? - From inhaled coal dust particles - When macrophages ingest coal dust particles which die and release their enzyme which causes fibrosis

Coal Worker's Pneumoconiosis

What is the treatment for Pertussis (whooping cough)?

Infants: azithromycin or clarithromycin Kids: Macrolide Adults: Macrolide Pregnant Adults: Erythromycin

What condition do these symptoms indicate? - Non-vaccination with Hib vaccine - Sore throat - Acute distress - Fever - Dyspnoea - DROOLING - Decreased oral intake - Stridor (high pitched wheezing sound)

Epiglottis

What are the most common bacterial organisms present in the acute exacerbation of COPD?

- H Influenza - Streptococcus pneumonia - Moraxella catarrhalis (all present in the upper respiraory tract flora)

What is this condition? - Multisystem granulomatous (inflammation) - Unknown cause - Causes pulmonary fibrosis - Mainly in upper lobes - Occurs in northern europe in female adults - afro-caribbean

Sarcoidosis

What is the treatment for mesothelioma?

- Surgery - Chemo - Radiotherapy - Palliative Care - Pleurodesis 9 talc to scar the pleura together preventing the build up of fluid) - Pleural catheter

What is pertussis another name for?

Whooping cough (infection)

These symptoms are signs of what condition? - repeating episodes of dyspnoea (laboured breathing) - cough and wheeze caused by airway obstruction that is reversible - airway narrowing

Asthma

What is the treatment for non-small cell tumours?

- SURGERY for peripheral tumours with no metastases (secondary growth) - CURATIVE RADIOTHERAPY if respiratory reserve is poor (volume of air inhaled after normal inspiration)

What is this condition? - Inflammation of the bronchi - Occlusion (blocking/ closing of bronchi) - Normally due to Syncytial Virus - Normally occurs in babies (1-2 yrs)

Bronchiolitis

What are these symptoms signs of? - Fever - Malaise - Myalgia (pain in muscle) - Headache - Cough - Prostration (lying down)

Influenza

What is this condition? - In coal workers with rheumatoid arthritis - Multiple lung nodules - Inflammatory reaction to external antigen

Caplan's Syndrome

What is the line of treatment for coal worker's pneumoconiosis?

- Smoking cessation - Remove occupational exposure - Compensation advice

What is this condition? - Inhalation of silica particles causes this - Fibrogenic particles (promoting development of fibres)

Silicosis

What are the complications of obstructive sleep apnoea?

- Pulmonary Hypertension (increased blood pressure within arteries) - Type 2 resp failure

What is this condition? - Right sided heart failure - Caused by chronic pulmonary arterial hypertension (high BP)

Cor Pulmonale

What are the causes of Extrinsic Allergic Alveolitis?

- Bird Fancier's Lung (proteins in bird droppings) - Farmer and Mushroom worker's lung - Malt workers lung Bagassosis or sugar workers lung

What is the treatment for small cell tumours?

- PALLIATION as they are nearly always disseminated at presentation (spread) may respond to chemo but theres usually a relapse

What are the signs of acute exacerbation of COPD?

- Increased breathlessness | - Increased volume and purulence of sputum

What is the RIPE acronym used for?

Remembering the drugs for TB - rifampicin - isoniazid - pyrazinamide - ethambutol

Condition caused by inhalation of asbestos fibres

Asbestosis

What condition are these clinical presentations all indicating? - cough - HAEMOPTYSIS - dyspnoea (laboured breathing) - stridor (high pitched wheezing sound) - chest pain - slowly resolving or recurrent pneumonia - hoarseness - seizures - facial swelling - dilated chest/neck/abdomen veins - unexplained weight loss - cachexia (wasting away of body and weakness) - clubbing - anaemia - consolidation - collapse - pleural effusion (build up of fluid on layers of pleura)

Bronchial Carcinoma

What are the complications of sacroidosis?

- Infections - Pulmonary embolism - Progressive fibrotic lung disease - Pulmonary hypertension

What are the three factors that contribute to airway narrowing?

- bronchial muscle contraction - mucosal swelling/ inflammation (eosinophils and mast cell degranulation cause this which releases inflammatory mediators) - increased mucus production

What is the bacterial pneumonia likely to be in patients with birds?

Chlamydia psittaci

What are these symptoms indicative of? - Cyanosis - Peripheral vasodilation - Bilateral inspiratory crackles

Respiratory Distress

What is this condition? - Collapsed lung - Air leaks into space between lung and chest wall - Spontaneous - Due to rupture of a sub pleural bullae - Many other causes eg. asthma and COPD

Pneumothorax

What is the bacterial pneumonia likely to be in patients that are around sheep?

Coxiella burnetti

What condition do these symptoms indicate? - constant cough - lots of purulent sputum (pus like) - intermittent haemoptysis - finger clubbing - coarse inspiratory creps - wheeze

Bronchiectasis

What is this condition? - Bacterial Infection of the respiratory tract - Recent trip to SE Asia/ India may cause this

Tuberculosis

What is the line of treatment for CHRONIC asthma?

1. SABA as needed 2. Standard dose ICS with SABA if it is required more than once daily 3. - Add a LABA, if this is not adequate, increase dose of ICS - If LABA does not help stop it and consider increasing ICS 4. If asthma is poorly controlled increase ICS and add a 4th drug (e.g. theophyline or montelukast) 5. Add oral prednisolone and refer to specialist

What is the line of treatment for tuberculosis?

2 months: - rifampicin - isoniazid - pyrazinamide - ethambutol 4 months: - rifampicin - isoniazid

What is the treatment for pulmonary oedema?

- First treat underlying cause - Oxygen - Diuretics - Nitrates

What is the treatment for respiratory distress?

- Oxygen | - Mechanical Ventilation

What are the causes of influenza?

Aetiology: - Influenza A, B - Flu like illnesses (parainfluenza viruses) - Haemophillus Influenza

What condition are these symptoms indicative of? - Occurs gradually - Cough - Sputum - Malaise - Weight loss - Night sweats - Haemoptysis - Breathlessness - Upper zone crackles

Tuberculosis

What are these symptoms indicating? - May be no symptoms - Possible sudden onset of dyspnoea and/or pleuritic pain - reduced expansion - hyper resonance - diminished breath sounds on affected side - possible trachea deviation if tension Patients with asthma or COPD... - May experience rapid deterioration

Pneumothorax

Treatment for a minor PE?

- Anticoagulants (LMWH) low molecular weight heparin | - Oxygen

What is the treatment for an acute respiratory infection in patients with cystic fibrosis?

- Antibiotics - Increase physio - Increase bronchodilators - Increase mucolytic

What is this condition? - Area of infection with pus forming within the lung - Cause: Pneumonia insufficiently treated, alcoholism, oesophageal obstruction, pulmonary infarction, septic emboli, sub phrenic or hepatic abscess

Lung Abscess

How to treat CHRONIC COPD?

(Depends on gold stage) 1. Mild = SAMA/SABA prn 2. Moderate = LAMA (DO NOT use LAMA and SAMA together) 3. Severe = LABA + ICS (combo inhaler) (ICS cannot be used alone) 4. V Severe = ICS/LABA/LAMA

What condition does these symptoms indicate? - In young baby - Fever - Cough - Wheeze - Coryza (inflamed nose mucous membrane)

Bronchiolitis

Treatment for major PE with normal right ventricular function and low bleeding risk?

- Oxygen - Thrombolysis - Anticoagulants (warfarin)

What condition are these symptoms signs of? - Chronic dyspnoea (shortness of breath) - Sputum production - Minimal FEV1 variation - Tachypnoea (rapid breathing) - Wheeze - Use of accessory muscles - Poor air movement on auscultation - Decreased expansion - Resonant/ hyper resonant percussion note - Quiet breath sounds - Wheeze - Cor pulmonale (high BP in pulmonary arteries causing heart failure on right side)

COPD

What is the line of treatment for a pneumothorax?

If Small and asymptomatic - No treatment If due to trauma or mechanical ventilation - Chest drain - less than 2cm: observe and give oxygen - more than 2cm: percutaneous aspiration and oxygen 2nd Line: chest drain All in the 4th or 5th intercostal space, midaxillary line

What is this condition? - Intermittent closure/collapse of the pharyngeal airway - Causes apnoeic episode during sleep (stopping breathing) - Terminated by partial arousal (waking up)

Obstructive Sleep Apnoea

What are these symptoms indicative of? - Cold symptoms - Paroxysmal cough (frequent and violent coughing) lasting two weeks - Vomiting - Residual cough for one month

Pertussis (whooping cough)

What are these symptoms signs of? - Discovered accidentally on routine CXR - Can be asymtpomatic - Acute: presents with erythema nodosum (skin inflammation) and polyathralgia (pain in joints) Pulmonary Disease: - Dry cough - Progressive dyspnoea - Reduced fitness - Chest pain Non-Pulmonary: - Lymphadenopathy (abnormal sized lymphnodes) - Heptomegaly (enlarged liver) - Splenomegaly (enlarged spleen) - Uveitis (eye inflammation) - Conjuctivitis

Sarcoidosis

Side effects for ethambutol? E

Colour blindness

What is the line of treatment for sarcoidosis?

- Steroids if vital organs are affected - Immunosuppresion (required to suppress hyperactive immune system thats causing the inflammation) - Monitor CXR and pulmonary function tests over years

What are these symptoms indicating? - Fever - Rigors - Malaise - Anorexia - Dyspnoea - Cough - Purulent Sputum - Haemoptysis - Pleuritic Pain - Cyanosis - Confusion - Tachypnoea - Tachycardia - Hypotension - Consolidation - Pleural Rub

Pneumonia

Side effects for isoniazid? I

Neuropathy | Hepatitis (inflamed liver)

What happens when... - CFTR gene mutates - Cl- is not able to get out of the cell - Na+ is able to get into the cell with water - Making secretions outside the cell very thick and mucus like

Cystic Fibrosis occurs

What is this condition? | Viral infection that attacks the respiratory system

Influenza

What is the treatment for cystic fibrosis?

- Chest physiotherapy - Inhaled bronchodilator - Inhaled mucolytic (makes mucus less thick and sticky) - Anti-inflammatory - ICS - Ivacaftor (aims to open up G551D gene to open channel to allow Cl- to move out of cell) - Monitor and optimise nutrition - Lung transplant

What is the method of antibiotics for pneumonia?

Based on CURB65 score... 0-2: Amoxicillin 3-5: co-amoxiclav IV and clarithromycin or levofloxacin Severe: IV amoxicillin, metronidazole and gentamicin Non-severe: Amoxicillin and metronidazole

What are the causes of a pulmonary embolism?

- Surgery - Immobility - Long-haul flight - Oral contraceptive

What is the line of treatment for Pneumonia?

- Oxygen - Fluids - Bed rest - Smoking cessation - Antibiotics - CPAP (assess curb65 score)

- progressive dyspnoea - clubbing - fine-end respiratpory crackles - pleural plaques are all signs of what condition?

Asbestosis

What condition are these symptoms signs of? - Stridor - Barking cough - Respiratory Distress - Fatigue - Hypoxia

Croup

How to treat ACUTE COPD?

1. 24-28`% oxygen 2. High dosed nebulised salbutamol and ipratropium bromide 3. Oral prednisolone 4. Amoxicillin/doxycycline 5. Intubation (Use antibiotics if sputum contains pus - purulent)

What are the complications that may occur from asbestosis?

- increased risk of bronchial adenocarcinoma | - increased risk of bronchial mesothelioma

When does acute exacerbation of COPD occur?

- Follow a viral infection | - Fall in atmospheric temperature

What is the treatment for extrinsic alergic alveolitis?

- Remove Allergen - Give oxygen - Oral prednisolone

How do we treat bronchiolitis?

- Support - Oxygen - Ventilation when necessary - Cohort nursing

What are the complications of influenza?

- Pneumonia - Bronchitis - Otitis Media (ear infection)

What is the most common type of bacterial pneumonia in alcoholics?

Klebsiella Pneumonia

``` What is this condition? Neonatal (newborns) - Relative surfactant deficiency - 1% of all births - Mainly preterm babies - Impaired gas exchange ``` Adults - Diffuse alveolar damage

Respiratory Distress

What is Chronic Bronchitis?

- Inflamed bronchial tubes producing a lot of mucus | - Cough

What is the 1st line of treatment for bronchiectasis?

- Exercise and improved nutrition - Therapy to clear airway - Antibiotics relating to pathogen sensitivities

What is the treatment for influenza?

- Antivirals Prevention: - Killed vaccine - Live attenuated vaccine given to kids

What is the most and least fibrogenic (promoting develpment of fibres) substance for asbestosis?

Chrysotile (white asbestos) - least fibrogenic Crocidolite (blue asbestos) - most fibrogenic

What increases the risk of bronchial carcinoma?

Smoking

What is the treatment for acute exacerbation of COPD?

If increased sputum purulence = antibiotics No increased sputum purulence = no antibiotics unless consolidation on CXR or signs of pneumonia 1st Line of Treatment = amoxicillin 2nd Line of Treatment = doxycycline

- cough - shortness of breath - chest pain - joint aches - weight loss - fever - spirometry test showing restrictive pattern all show signs of what condition?

Berylliosis

What do pulmonary function tests measure?

- Lung volume - Capacity - Rate of flow - Gas exchange

What are these symptoms indicative of? - Occurs 4-6 hours after exposure - Fever - Rigors (shivering with a high temperature) - Myalgia - Dry Cough - Dyspnoea - Crackles (no wheeze)

Extrinsic Allergic Alveolitis

What condition do these symptoms indicate? - Chest pain - Dyspnoea - Unexplained weight loss - Finger clubbing - Recurrent pleural effusions - Signs of metastases - History of working with asbestos

Mesothelioma

What is the most common type of bacteria that cause pneumonia?

Streptococcus pneumoniae

Treatment for major PE with right ventricular dysfuntion?

- Anticoagulants | - Thrombolysis

What is this condition? - Blockage in a pulmonary artery in the lungs - Arises from a venous thrombosis in pelvis or legs - Clots break off and pass through veins and right side of heart

Pulmonary Embolism