Respiratory Flashcards
What is chronic obstructive pulmonary disease? What is its pathophysiology? How is it different to asthma? What may COPD patients experience? What are the two main types?
- NON-REVERSIBLE long-term deterioration in air flow through the lungs, caused by damage to lung tissue (almost always due to SMOKING)
- Px: obstructed airflow through the airways → difficulty ventilating the lungs → short of breath and prone to infection
- Unlike asthma, NOT REVERSIBLE with bronchodilators i.e. salbutamol.
- Patients may experience exacerbations; if due to infections, these are called INFECTIVE EXACERBATIONS (IE COPD)
- 2 main types:
– Chronic Bronchitis
– Emphysema
What are the risk factors for COPD?
- Smoking
- Age - symptoms usually present between 40-60
- Secondhand smoke exposure
- Occupational exposure - mining, dust, cotton, wood
- Pollution - heating fuel, outdoor pollutants
- Genetics - Alpha-1-antitrypsin deficiency. A1AT is a protein made by the liver and functions to protect the lungs from damage caused by infection, inflammation and smoking
What are the classic presenting features of COPD? What does COPD not cause?
- LONG-TERM SMOKER
- SHORTNESS OF BREATH
- Cough
- Sputum production
- Wheeze
- RECURRENT RESPIRATORY INFECTIONS
- COPD does NOT cause clubbing
How is COPD graded?
- Grade 1: Breathless on strenuous exercise
- Grade 2: Breathless on walking up hill
- Grade 3: Breathless that slows on the flat
- Grade 4: Stop to catch breath after 100m walking on flat
- Grade 5: Unable to leave house due to breathlessness
How is COPD diagnosed? What is the value of the FEV1/FVC ratio in COPD? What does COPD not respond to? How can the severity of airways obstruction be measured?
- COPD diagnosed by using CLINICAL PRESENTATION + SPIROMETRY
- Spirometry will show an ‘OBSTRUCTIVE PICTURE’ - overall lung capacity is better than their ability to forcefully expire air quickly
- FEV1/FVC ratio = <0.7
- Does not respond to reversibility testing with SABA, e.g. salbutamol
- FEV1 can be used to grade severity of airways obstruction i.e. Stage 1 = >80% of predicted, Stage 4 = <30% of predicted
Apart from clinical presentation and spirometry, what are the other investigations for COPD?
- Chest X-ray (exclude lung cancer/other pathologies)
- FBC (chronic hypoxia → polycythemia)
- BMI (weight loss i.e. Lung Ca)
- ECG - if concerns with cardiac function
- Serum Alpha-1-antitrypsin levels
What would be shown on a CXR for COPD?
- Hyperinflation
- Bullae
- Flat hemidiaphragm
What are the symptoms and complications of emphysema?
- ‘Pink puffers’
- Symptoms:
- Dyspnoea/tachypnoea
- Minimal cough
- Pink skin, pursed-lip breathing
- Accessory muscle use
- Cachexia
- Hyperinflation (barrel chest)
- Weight loss (due to increased work of breathing and cachexia)
- Complications = pneumothorax due to bullae
What are the symptoms of chronic bronchitis?
- ‘Blue bloaters’
- Symptoms:
- Chronic productive cough - purulent sputum
- Dyspnoea
- Cyanosis (hypoxaemia) - can cause secondary polycythemia, may develop pulmonary hypertension (reactive pulmonary vasoconstriction)
- Peripheral oedema
- Obesity
- Haemoptysis
What is the long-term management of COPD?
- General:
- STOP SMOKING!!! Refer to smoking cessation
- Pneumococcal vaccine
- Annual flu vaccine
- Step 1:
- SABA (i.e. salbutamol or terbutaline) OR SAMA (ipratropium bromide)
- Step 2:
- If no asthmatic / steroid response:
- LABA (i.e. salmeterol) + LAMA (i.e. tiotropium), switch SAMA to SABA
- If asthmatic / steroid response:
- LABA (i.e. salmeterol) + ICS (i.e. budesonide), switch SAMA to SABA. If still S.O.B. then LAMA + LABA + ICS
- Step 3:
- Long-term oxygen therapy (LTOT)
Under what circumstances would we give long-term oxygen therapy?
- FEV1 < 30% predicted
- Cyanosis
- Polycythaemia
- Peripheral oedema
- Raised JVP
- O2 less than or equal to 92% on room air
What is the acute management for COPD?
1) Bronchodilators and O2
2) Oral prednisolone
3) CPAP before intubation and ventilation
What is the clinical presentation of IE COPD?
Presents with acute worsening of symptoms i.e. SoB, sputum, wheeze. Usually triggered by infection
What are the investigations for IE COPD?
- ABG:
- CO2 retention → acidosis
- Are they in type 1 or 2 failure?
- Normal pCO2 + low pO2 = T1RF
- Raised pCO2 + low pO2 = T2RF
- Chest X-Ray, sputum culture + sensitivities for antibiotic therapy, FBC + U&E
Describe the management for IE COPD.
- STEROIDS (hydrocortisone / prednisolone) + NEBULISED BRONCHODILATORS (salbutamol / ipratropium bromide) + ANTIBIOTICS
- Physiotherapy → sputum clearance
- If severe: IV aminophylline (bronchodilator), non-invasive ventilation (CPAP / BIPAP)
What is tuberculosis caused by? What are its features?
- Tuberculosis (TB) is caused by mycobacterium tuberculosis bacteria:
- Aerobic, non-motile, non-sporing, slightly curved bacilli with a thick waxy capsule
- Acid-fast bacilli – turns red/pink with Ziehl-Neelsen stain
- Slow growing
- Resistant to phagolysosomal killing and able to remain dormant
What is the epidemiology of tuberculosis?
- Majority of cases in Africa and Asia (India and China)
- Cause of death for most people with HIV
What is the pathophysiology of TB?
- TB spread via respiratory droplets as it is an airborne infection
1. Alveolar macrophages ingest bacteria and the rods proliferate inside
2. Drain into hilar lymph nodes 🡪 present antigen to T lymphocytes 🡪 cellular immune response
3. Delayed hypersensitivity reaction 🡪 tissue necrosis and granuloma formation: caseating
a. PRIMARY GHON FOCUS - seen as a small, calcified nodule in the upper parts of the lower lobes or the lower parts of the upper lobes
b. GHON COMPLEX – Ghon focus + lymph nodes
What is the clinical presentation of tuberculosis?
- Systemic symptoms: weight loss, low grade fever, anorexia, drenching night sweats, malaise
- Pulmonary symptoms: productive cough, haemoptysis, cough >3 weeks (dry or productive), breathlessness, sometimes chest pain
- Signs: signs of bronchial breathing, dullness to percuss, decreased breathing, fever, crackles
What are the investigations for tuberculosis?
- Ziehl-Neelsen stain on Lowenstein-Jensen agar
- CXR: primary or reactivated = patchy consolidation, fibronodular opacities on upper lobe, disseminated military TB = ‘millet seeds’
- Biopsy: shows caseating granuloma
- Diagnosing latent TB:
- MANTOUX TEST - tuberculin injected into intradermal space, >5mm = positive result
- INTERFERON-GAMMA RELEASE ASSAYS (IGRA) - person with previous contact with TB will have WBCs that release interferon-gamma
What is the appearance of different types of TB on a chest x-ray?
- Primary TB: patchy consolidation, pleural effusions and hilar lymphadenopathy
- Reactivated TB: patchy or nodular consolidation with cavitation (gas filled spaces in the lungs) typically in the upper zones
- Disseminated Miliary TB: MILLET SEEDS
Describe the management for TB.
- Acute pulmonary TB (RIPE):
- Rifampicin for 6 months. Bacteriacidal - blocks protein synthesis. SE: RED URINE, hepatitis
- Isoniazid for 6 months. Bacteriacidal - blocks cell wall synthesis. SE: neuropathy
- Pyrazinamide for 2 months. Bacteriacidal initially, less effective later. SE: gout, arthralgia, rash, hepatitis
- Ethambutol for 2 months. Bacteriostatic, blocks cell wall synthesis. SE: optic neuritis
- Latent TB - otherwise healthy patients do not need treatment, but isoniazid can be used for patients at risk of reactivation of TB
A patient is started on RIPE for acute pulmonary tuberculosis. What should also be prescribed? Why?
Pyridoxine (vitamin B6). This is because isoniazid has a side effect on peripheral neuropathy
What is cystic fibrosis? What is it caused by?
- Cystic fibrosis = an AUTOSOMAL RECESSIVE genetic condition affecting the mucus glands
- It is caused by a genetic mutation of the CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATORY GENE on chromosome 7
What are the key consequences of cystic fibrosis?
- THICK PANCREATIC AND BILIARY SECRETIONS that cause blockage of the ducts, resulting in a lack of digestive enzymes such as pancreatic lipase in the digestive tract
- LOW VOLUME THICK AIRWAY SECRETIONS that reduce airway clearance, resulting in bacterial colonisation and susceptibility to airway infections
- CONGENITAL BILATERAL ABSENCE OF THE VAS DEFERENS in males. Patients generally have healthy sperm, but the sperm have no way of getting from the testes to the ejaculate, resulting in male infertility
Both parents are healthy, one sibling has cystic fibrosis and a second child does not have the disease, what is the likelihood of the second child being a carrier of cystic fibrosis?
2/3 - we know that the child doesn’t have the condition
How is cystic fibrosis generally diagnosed? What is often the first sign of cystic fibrosis?
- CF is screened for at birth with the NEWBORN BLOODSPOT TEST
- MECONIUM ILEUS is often the first sign - first stool (always black) is thick and sticky, causing it to get stuck and obstruct the bowel
If not diagnosed at birth, how does cystic fibrosis present later on in childhood?
- RECURRENT LOWER RESPIRATORY TRACT INFECTIONS
- FAILURE TO THRIVE
- PANCREATITIS
- Chronic cough
- Thick sputum production
- Steatorrhoea
- ‘SALTY’ to kiss - concentrated salt in sweat
What are the three key methods for establishing a diagnosis of cystic fibrosis?
- NEWBORN BLOOD SPOT TESTING is performed on all children shortly after birth and picks up most cases
- SWEAT TEST = gold standard for diagnosis
- Genetic testing for CFTR gene can be performed during pregnancy by amniocentesis or chorionic villous sampling, or as a blood test after birth
Patients with cystic fibrosis struggle to clear the secretions in their airways. This creates a perfect environment with plenty of moisture and oxygen for colonies of bacteria to live and replicate. Give two important examples of key colonisers.
Staphylococcus aureus and pseudomonas aeruginosa
Describe the management of cystic fibrosis.
- Chest physiotherapy to clear mucus and reduce risk of infection
- Exercise and high calorie diet
- Nebulised DNase (dornase alfa)
- CREON tablets to digest fats in those with pancreatic insufficiency
- Prophylactic flucloxacillin to reduce the risk of bacterial infections (particularly staph. aureus)
What is pneumonia? What does it cause? What is the aetiology of pneumonia? What are the different types of pneumonia?
- Pneumonia = inflammation of the alveoli caused by infection
- Aetiology: typically caused by a bacterial infection of the distal airways and alveoli with the formation of an inflammatory exudate
- Different types:
- Community acquired pneumonia
- Hospital acquired pneumonia
- Atypical pneumonia
- Pneumonia in immunocompromised patients
What is community acquired pneumonia? What is its epidemiology? What are its commonest causes? What is responsible for producing rusty sputum?
- Community acquired pneumonia = pneumonia acquired outside the hospital or healthcare facilities
- Epidemiology:
- Commoner in the extremes of age
- Commonest causes: STREPTOCOCCUS PNEUMONIAE, HAEMOPHLIUS INFLUENZAE, mycoplasma pneumoniae
- RUSTY SPUTUM IS CHARACTERISTIC OF STREP. PNEUMONIAE
What is hospital acquired pneumonia? What are its causes?
- Hospital acquired pneumonia = an acute lower respiratory tract infection that is acquired after at least 48 hours of admission to hospital and is not incubating at the time of admission
- Causes:
- Most cases are caused by bacteria that are AEROBIC GRAM-NEGATIVE BACILLI. Examples (PEK): Pseudomonas aeruginosa, E. coli and Klebsiella pneumoniae
What is atypical pneumonia? What are its common causative organisms? What are its characteristic symptoms?
- Bacterial pneumonia caused by atypical organisms that are not detectable on Gram stain and cannot be cultured using standard methods
- Common organisms (MCL): Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila
- Characteristic symptoms: headache + low-grade fever + cough + malaise
What is pneumocystis jirovecii pneumonia caused by? Who does it cause disease in?
- Cause by fungus pneumocystis jirovecii
- Causes disease in severely immunocompromised such as HIV +ve patients with CD4 < 200
What is the pathophysiology of pneumonia?
Invasion and overgrowth of a pathogen in lung parenchyma -> overwhelming of host immune defences -> production of intra-alveolar exudates
What are the symptoms and signs of pneumonia?
- Dyspnoea
- Pleuritic chest pain (sharp chest pain worse on inspiration)
- Fever
- Productive cough
- SEPSIS
- Signs: dull to percussion, decreased O2 sats, increased resp rate & heart rate, low BP + increased tactile fremitus
What are the signs on auscultation for pneumonia?
- Decreased air entry
- Wheezing
- Course crackles
- Bronchial breath sounds
- Increased vocal resonance
What is used to measure the severity of pneumonia? What does it stand for?
- CURB-65:
- Confusion
- Urea >7
- Respiratory rate >30
- Blood pressure < 90 systolic or < 60 diastolic
- 65 - age > 65
- 0-1= outpatient treatment, 2 = short-stay inpatient treatment OR hospital-supervised outpatient treatment, and 3-5 = manage as high-severity pneumonia
Describe the investigations for pneumonia.
- FBC - increased WBC, increased urea, increased CRP
- Sputum culture
- Chest X ray = gold standard: localised/widespread consolidation, effusion, abscesses, empyema:
o Multi-lobar – strep pneumoniae, s. aureus
o Multiple abscesses – s. aureus
Describe the treatment for pneumonia.
- Maintaining O2 Sats between 94-98%. In COPD patients: maintain O2 sats between 88-92%
- Analgesia: paracetamol or NSAIDs
- IV fluids
- CURB-65 guided treatments:
- 0 – 1: AMOXICILLIN 5 DAYS 500MG at home
- 2: AMOXICILLIN (IV or oral) + macrolide (clarithromycin, erythromycin)
- 3+ : consider ITU, IV CO-AMOXICLAV + MACROLIDE
What are the complications of pneumonia?
- Sepsis
- Pleural effusion
- Empyema
- Lung abscess
- Death
What is bronchiolitis? What is it usually caused by? What is its epidemiology?
- Bronchiolitis = inflammation and infection in the bronchioles
- This is usually caused by a virus. RESPIRATORY SYNCYTIAL VIRUS (RSV) is the most common cause
- Epidemiology: generally considered to occur in children <1 year (most common in children <6 months)
Why does a virus in the airways affect children more?
When a virus affects the airways of adults, swelling and mucus are proportionally small = little noticeable effect on breathing. The airways of infants are very small to begin with, so even the smallest amount of inflammation and mucus in the airway has a significant effect on the infants ability to circulate air to the alveoli and back out. This causes the harsh breath sounds, wheeze and crackles heard on auscultation when listening to a bronchiolitic baby’s chest
What is the clinical presentation of bronchiolitis?
- CORYZAL SYMPTOMS (running or snotty nose, sneezing, mucus in throat and watery eyes)
- Signs of respiratory distress
- Dyspnoea
- Tachypnoea
- Wheeze and crackles on auscultation
What are the signs of respiratory distress in children?
- Raised respiratory rate
- Use of accessory muscles of breathing, such as the sternocleidomastoid, abdominal and intercostal muscles
- Intercostal and subcostal recessions
- Nasal flaring
- Head bobbing
- Tracheal tugging
- Cyanosis (due to low oxygen saturation)
- Abnormal airway noises
Most infants with bronchiolitis can be managed at home. What are some reasons for admission?
- Aged <3 months or any pre-existing condition such as prematurity, Down syndrome or cystic fibrosis
- 50 - 75% or less of their normal intake of milk
- Clinical dehydration
- Respiratory rate above 70
- Oxygen saturations below 92%
- Moderate to severe respiratory distress, such as deep recessions or head bobbing
- Apnoeas
Describe the general management for bronchiolitis.
- Typically patients only require supportive management. This involves:
- Ensuring adequate intake
- Saline nasal drops and nasal suctioning
- Supplementary oxygen if the oxygen saturations remain below 92%
- Ventilatory support if required - capillary blood gases are useful in severe respiratory distress and in monitoring children who have ventilatory support
- PALIVIZUMAB = MAb given to high risk babies
What is bronchiectasis? What are its causes?
- Bronchiectasis is the permanent dilation of bronchi due to the destruction of the elastic and muscular components of the bronchial wall
- Causes:
- Cystic fibrosis
- Airway obstruction, e.g. cancer
- Infections, e.g. aspergillosis, H.influenzae (most common)
What is the clinical presentation of bronchiectasis?
- Cough
- Sputum production
- Crackles
- Haemoptysis
- Recurrent chest infections
What are the investigations for bronchiectasis?
- CXR - KERLEY B LINES - increased bronchial markings at lung periphery
- Sputum culture - H. influenzae most common
- High resolution CT - dilated bronchi/bronchioles
- FBC
Describe the treatment for bronchiectasis.
- Bronchodilators - beta-2 agonists, e.g. albuterol
- Inhaled corticosteroids, e.g. fluticasone
- Antibiotics (1st line in acute exacerbation), e.g. amoxicillin
What is a pleural effusion? What are the two types?
- Pleural effusion = collection of fluid in the pleural cavity (between visceral and parietal pleura)
- Can be EXUDATIVE (high protein count) or TRANSUDATIVE (low protein count)
What is the pathophysiology of pleural effusion?
Rate of fluid formation > rate of fluid removal = fluid accumulates = pleural effusion
What are the exudative causes of pleural effusion?
- Exudative causes are related to INFLAMMATION. The inflammation results in protein leaking out of the tissues in to the pleural space (ex- meaning moving out of). Think of the causes of inflammation:
- Lung cancer
- Pneumonia
- RA
- TB
What are the transudative causes of pleural effusion?
- Transudative causes relate to fluid moving across into the pleural space (trans- meaning moving across). Think of the causes of FLUID shifting:
- Congestive cardiac failure
- Hypoalbuminaemia
- Hypothroidism
- Meig’s syndrome (right sided pleural effusion with ovarian malignancy)
What is the clinical presentation of pleural effusion?
- SHORTNESS OF BREATH (effusion occupies space in the thoracic cavity and decreases lung volume)
- Cough
- Stony dullness to percussion over the effusion
- Reduced breath sounds
- Tracheal deviation away from the effusion if large effusion
What are the investigations for pleural effusions?
- 1st line = CXR
- Thoracocentesis identifies and diagnoses underlying cause
- Pleural ultrasound
How does pleural effusion appear on a chest x-ray?
- BLUNTING of the COSTOPHRENIC ANGLE
- FLUID in lung fissures
- Meniscus
- Tracheal and mediastinal deviation if large effusion
Describe the treatment for pleural effusion.
- Dependent on cause:
- Fluid overload or congestive HF - diuretic
- Infective - antibiotics
- Large effusions often need aspiration or drainage
In which individuals do we tend to find pneumocystis jirovecii pneumonia in? What is its clinical presentation? Describe its treatment.
- Pneumocystis jirovecii pneumonia occurs in patients that are immunocompromised - particularly those with poorly controlled or new HIV with CD4 < 200
- Dry cough without sputum, shortness of breath on exertion and night sweats
- Treatment is with co-trimoxazole (trimethoprim/sulfamethoxazole) known by the brand name “Septrin”. Patients with low CD4 counts are prescribed prophylactic oral co-trimoxazole
What is pharyngitis? What is its aetiology?
- Acute pharyngitis is characterised by the rapid onset of sore throat and pharyngeal inflammation (with or without exudate)
- Common viral causes:
- EBV
- Adenoviruses
- Enteroviruses
- HIV, chlamydia and gonorrhoea should be considered in sexually active people, especially those negative for Group A strep.
- Also can be caused by GROUP A STREPTOCOCCUS
What is the clinical presentation of pharyngitis? Which factors suggest a Group A strep. infection compared to a viral infection?
- Sore throat
- Fever
- Headache, myalgia skin rashes, swollen lymph nodes in the neck
- Viral = runny nose, blocked nose, sneezing, cough
- Group A strep. (bacterial) = pharyngeal exudates, cervical lymphadenopathy, fever, absence of cough or rhinorrhoea
What are the investigations for pharyngitis?
Clinical symptoms consistent with Group A strep infection:
- Rapid antigen detection tests for Group A strep
- Conventional throat culture
Describe the treatment for pharyngitis.
Confirmed Group A strep?
NO = supportive care (paracetamol and ibuprofen)
YES = phenoxymethylpenicillin (or clarithromycin if penicillin allergy) for 7-10d
What is otitis media? What is its aetiology?
- Otitis media: infection in the middle ear
- Most common bacterial cause = STREPTOCOCCUS PNEUMONIAE. Others = H.influenzae, Moraxella catarrhalis, Staph. aureus
- Viral causes: RSV, rhinovirus, adenovirus, influenza virus
What are the risk factors for otitis media?
- Young age
- Male sex
- Smoking
- Frequent contact with other children
- Family history
What is the pathophysiology of otitis media?
- Infection of nasal passages, eustachian tube and middle ear causes inflammation and impairs mucociliary action and ventilatory function of the eustachian tube
- Middle ear effusion develops and bacteria grows
What is the clinical presentation of otitis media?
- Otalgia
- Preceding URTI symptoms, e.g. Coryzal symptoms
- Fever
- Hearing issues
- Sleep disturbance
- Irritability in children
What are the investigations for otitis media?
Otoscope - bulging and erythema of the tympanic membrane
Describe the management of otitis media.
*Consider admitting children younger than 3 months, children 3- 6 months with T >39
- 1st line = regular analgesia: ibuprofen/paracetamol - most cases will resolve in 3-7 days without antibiotics
- For people who do not require admission but systemically unwell/ would benefit from antibiotics:
- Amoxicillin 5-7 day course, clarithromycin (in penicillin allergy) and erythromycin (in pregnant women allergic to pencillin)
What is sinusitis? What is its aetiology?
- Inflammation of the mucous membrane of the nasal cavity and paranasal sinuses - also known as acute rhinosinusitis. It is very common
- Aetiology:
- Common cause is a viral infection
- Some cases progress onto acute bacterial sinusiti: Strep. pneumoniae, H. influenzae, Moraxella catarrhalis
What are the risk factors for sinusitis?
- Nasal pathology, e.g. septal deviation or nasal polyps
- Recent local infection, e.g. rhinitis or dental extraction
- Swimming/diving
- Smoking
What is the pathophysiology of sinusitis?
Viral infection = inflammatory response within sinonasal mucosa = ↑oedema and mucus production which blocks ventilation and drainage = ↓mucocilliary clearance and stasis of secretions = secondary bacterial infection
What is the clinical presentation of sinusitis?
- Viral = symptoms <10 days: clear nasal discharge, fever, sore throat
- Bacterial = symptoms >10 days: purulent nasal discharge, nasal obstruction, dental/facial pain, headache
What are the investigations for sinusitis?
- Diagnosis is clinical. Distinguish between viral and bacterial infection:
- Viral: peak early and gradually resolve, symptoms for <10 days, clear nasal discharge, fever, sore throat
- Bacterial: symptoms for >10 days, purulent nasal discharge, nasal obstruction, dental/facial pain, headache
Describe the management for sinusitis.
- Acute viral sinusitis - analgesia and nasal decongestants, intranasal corticosteroids if symptoms over 10 days
- Acute bacterial sinusitis - PHENOXYMETHYLPENICILLIN in 1st line if severe
What is epiglottitis? How common is it? What is its aetiology?
- Epiglottitis = inflammation and swelling of the epiglottis caused by infection = airway emergency, especially in children
- Now rare due to routine vaccination programme, which vaccinates all children against haemophilus
- Aetiology: infection of supraglottis classically with H.influenzae type B, although others such as S.pneumoniae
What is the pathophysiology of acute epiglottitis?
Infection of epiglottis - swelling of the epiglottis which then obstructs the airways
What is the clinical presentation of acute epiglottitis?
- Acute onset high fever 39-40
- SORE THROAT and STRIDOR
- TRIPODING (sat forward with a hand on each knee)
- Toxic appearance
- Dysphagia
- Difficulty breathing
What are the investigations for acute epiglottitis?
- If patient is acutely unwell and epiglottitis is suspected then investigations SHOULD NOT be performed
- Laryngoscopy during intubation in an operating theatre
- Lateral neck radiography if laryngoscopy not possible - THUMB PRINT SIGN
Describe the management of epiglottitis.
- Secure airway:
- Direct rigid laryngoscopy and intubation is most useful
- Mask ventilation follows commonly - IV antibiotics, e.g. cefotaxime, ceftriaxone
- Supplemental O2 and possibly heliox as a temporising measure and maybe corticosteroids
- DO NOT DISTURB CHILD WITH ORAL EXAMINATION OR TRYING FOR IV ACCESS AS IT CAN RESULT IN RESPIRATORY DISTRESS
What is croup? Which individuals does it typically affect? What is its aetiology?
- Croup is an acute infective respiratory disease affecting young children. It is an upper respiratory tract infection causing oedema in the larynx
- It typically affects children aged 6 months to 2 years, however they can be older
- Aetiology:
- PARAINFLUENZA VIRUS
- RESPIRATORY SYNCYTIAL VIRUS (RSV)
- Influenza
- Adenovirus
What is the clinical presentation of croup?
- Increased WORK OF BREATHING
- “BARKING” cough, occurring in clusters of coughing episodes
- Hoarse voice
- Stridor
- Low grade FEVER
Describe the management for croup.
- Most cases can be managed at home with supportive treatment (fluids and rest)
- Oral DEXAMETHASONE is very effective
What is empyema? What are the risk factors? What is the mortality?
- Empyema = the presence of pus in the pleural space
- Risk factors: pneumonia, iatrogenic intervention in the pleural space, diabetes, and alcohol abuse
- Mortality is 15-20%
What is the clinical presentation of empyema?
- Pyrexia and rigors
- Productive cough
- Pleuritic chest pain
- Dyspnoea
What are the investigations for empyema?
- Blood cultures
- CRP
- WBC count
- CXR
Describe the management of empyema.
- Awaiting culture results:
- 1st line = IV empirical antibiotics (cefuroxime or ceftriaxone) PLUS chest tube drainage
- Culture results available:
- Antibiotics according to culture sensitivity PLUS chest tube drainage PLUS supportive care
What is asthma? What is its aetiology?
- Asthma = chronic, inflammatory condition, causing episodes of reversible airway obstruction, due to bronchoconstriction and excessive secretion production
- Aetiology: bronchoconstriction caused by hypersensitivity of the airways - triggered by various factors:
- Cold air, exercise
- Cigarette smoke
- Air pollution
- Allergens: pollen, cats, dogs, horses, mould
- Time of day: early morning, night
What is the clinical presentation of asthma?
- Episodes of wheeze (BILATERAL, WIDEPSREAD POLYPHONIC), breathlessness, chest tightness and dry cough
- Atopy (family/personal history)
- Diurnal variability