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Phase 2a Resits > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What 2 conditions make up COPD?

A
  • chronic bronchitis

- emphysema

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2
Q

What is COPD?

A
  • chronic obstructive pulmonary disorder
  • non-reversible long term deterioration in air flow through the lungs
  • caused by damage to lung tissue
  • obstructive airflow through airways → SOB and prone to infection
  • not reversible with bronchodilators
  • exacerbations occur → if due to infection, these are called IE COPD
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3
Q

What are the classic presenting features of COPD?

A
  • long term smoker
  • SOB
  • cough
  • sputum production
  • wheeze
  • recurrent respiratory infections
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4
Q

How do you classify COPD?

A

MRC dyspnoea scale

  1. breathless on strenuous exercise
  2. breathless on walking up hill
  3. breathless that slows on flat
  4. stop to catch breath after 100m walking on flat
  5. unable to leave house due to breathlessness
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5
Q

Risk factors for COPD

A
  • smoking
  • usually between 40-60
  • secondhand smoke exposure
  • occupational exposure → mining, dust, cotton, wood
  • pollution → heating fuel, outdoor pollutants
  • alpha-1-antitrypsin deficiency
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6
Q

Why is A1AT implicated in COPD?

A
  • protein made by liver
  • protects lung from damage
  • deficiency can lead to earlier onset and increased severity of COPD
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7
Q

Diagnosis of COPD

A
  • clinical presentation

- spirometry

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8
Q

What can be seen in COPD spirometry?

A
  • shows obstructive picture
  • lung capacity > ability to forcefully expire air quickly
  • FEV1/FVC <0.7
  • does not respond to reversibility testing with SABA
  • severity of obstruction can be measure using FEV1
  • compare patient to predicted
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9
Q

What other tests can be done for COPD?

A
  • chest xray → exclude others
  • FBC
  • BMI
  • ECG
  • serum A1AT
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10
Q

What is emphysema?

A

Symptoms

  • dyspnoea/tachypnoea
  • minimal cough
  • pink skin, pursed lip breathing
  • accessory muscle use
  • cachexia
  • hyperinflammation → barrel chest
  • weight loss

complications = pneumothorax due to bullae

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11
Q

What is chronic bronchitis?

A

symptoms

  • chronic productive cough → purulent sputum
  • dyspnoea
  • cyanosis = hypoxaemia
  • peripheral oedema
  • obesity
  • haemoptysis
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12
Q

General management of COPD

A
  • stop smoking
  • pneumococcal vaccine
  • annual flu vaccine
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13
Q

Stepwise management of COPD

A
  1. SABA or SAMA
  2. if no asthmatic/steroid response → LABA/LAMA, if asthmatic/steroid response → LAVA, ICS
  3. long term oxygen therapy
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14
Q

Presentation of IE COPD

A
  • acute worsening of symptoms
  • SOB, sputum, wheeze
  • usually triggered by infection
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15
Q

Investigations for IE COPD

A
  • ABG
  • chest xray
  • sputum culture and sensitivities for Ab therapy
  • FBC and U&E
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16
Q

What does ABG show in IE COPD

A
  • CO2 retention = acidosis
  • are they in type 1 or 2 RF
    normal pCO2 and low pO2 = T1RF
    raised pCO2 and low pO2 = T2RF
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17
Q

Management of IE COPD

A
  • steroids AND
  • nebulised bronchodilators (salbutamol/upratropium bromide)
  • Abs
  • physiotherapy → sputum clearance
  • if severe = IV aminophylline (bronchodilator), NIV (CPAP/BIPAP)
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18
Q

How does A1AT deficiency affect the lungs and liver?

A

lungs

  • lack of normal A1AT
  • excess protease enzymes → attack lung tissue

liver

  • mutant A1AT builds up
  • tissue damage → cirrhosis → HCC
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19
Q

Signs and symptoms of A1AT deficiency

A

lungs
- COPD symptoms

liver

  • tiredness
  • loss of appetite
  • weight loss
  • oedema
  • jaundice
  • haematemesis
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20
Q

Diagnosis of A1AT deficiency

A
  • low serum A1AT
  • liver biopsy
  • A1AT mutant gene
  • CT thorax
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21
Q

Management of A1AT

A
  • no cure
  • stop smoking
  • symptomatic treatment
  • organ transplant for end-stage liver/lung disease
  • monitor for HCC
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22
Q

What is asthma?

A
  • chronic inflammatory condition
  • episodes of reversible airway obstruction due to:
    bronchoconstriction
    excessive secretion production
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23
Q

Causes of asthma

A

hypersensitivity of the airways triggered by:

  • cold air, exercise
  • cigarette smoke
  • air pollution
  • allergens → pollen, cats, dogs, horses, mould
  • time of day → early morning, night
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24
Q

Presentation of asthma

A

episodes of

  • wheeze → widespread, polyphonic
  • breathlessness
  • chest tightness
  • dry cough
  • family/personal history of atopy = eczema, asthma, hayfever
  • diurnal variability
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25
Q

Investigations for asthma

A

spirometry with reversibility testing

  • obstructive pattern
  • FEV1 <80% of predicted normal
  • FEV1/FVC ration <0.7

peak flow measurement

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26
Q

Treatment for asthma

A
  1. SABA eg salbutamol
  2. inhaled corticosteroid eg budesonide
  3. leukotriene receptor antagonist eg montelukast
  4. LABA eg salmeterol
  5. increase ICS dose
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27
Q

Epidemiology of TB

A
  • majority of cases in Africa and Asia

- cause of death for most people with HIV

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28
Q

Features of TB

A
  • 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
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29
Q

Pathophysiology of TB

A

spread via respiratory droplets → airborne infection

  1. alveolar macrophages ingest bacteria and 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
    - primary ghon focus
    - ghon complex = ghorn focus and lymph nodes
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30
Q

Systemic symptoms of TB

A
  • weight loss
  • low grade fever
  • anorexia
  • drenching night sweats
  • malaise
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31
Q

Pulmonary symptoms of TB

A
  • productive cough
  • haemoptysis
  • cough >3 weeks (dry or productive)
  • breathlessness
  • sometimes chest pain
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32
Q

Signs of TB

A
  • signs of bronchial breathing
  • dulness to percuss
  • decreased breathing
  • fever
  • crackles
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33
Q

What are signs of bronchial breathing?

A
  • loud harsh breathing sounds

- mid range pitch

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34
Q

Investigations for TB

A
  • chest xray → fibronodular opacites on upper lobes
  • sputum culture for acid-fast bacilli → ZN stain on Lowenstein-Jensen agar
  • biopsy → caseating granuloma
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35
Q

Diagnosing latent TB

A

Mantoux

  • tuberculin injected intradermally
  • inspect skin for signs of local skin reaction over 2-3 days

Interferon gamma release assay
- blood test that detects WBC response to TB antigens

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36
Q

Treatment for TB

A

RIPE

  • rafampicin → 6 months
  • isoniazid → 6 months
  • pyrazinamide → 2 months
  • ethambutamol → 2 months
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37
Q

MOA and side effects of rifampicin

A
  • bactericidal → blocks protein synthesis
  • red urine
  • hepatitis
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38
Q

MOA and side effects of isoniazid

A
  • bactericidal → blocks cell wall synthesis
  • neuropathy
  • hepatitis
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39
Q

MOA and side effects of pyrazinamide

A
  • bactericidal initially, less effective later
  • gout
  • arthralgia
  • rash
  • hepatitis
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40
Q

MOA and side effects of ehtambutamol

A
  • bacteriostatic, blocks cell wall synthesis

- optic neuritis

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41
Q

What is pneumonia>

A
  • inflammation of the substance of the lungs
  • acute LRT infection
  • typically caused by bacterial infection of distal airways and alveoli
  • inflammatory exudate formed
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42
Q

What are the types of pneumonia?

A
  • CAP
  • HAP
  • atypical
  • in immunocompromised patients
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43
Q

Pathophysiology of pneumonia

A
  • invasion and overgrowth of a pathogen in lung parenchyma
  • overwhelming of host immune defences
  • production of intra-alveolar exudates
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44
Q

Clinical features of pneumonia

A
  • fever
  • productive cough
  • increased resp and heart rate
  • low BP
  • dyspnoea, rigors, malaise
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45
Q

Signs of pneumonia

A
  • dull to percussion
  • decreased air entry
  • bronchial breath sounds
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46
Q

Diagnosis of pneumonia

A
  • FBC → elevated WBC
  • sputum culture
  • chest xray
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47
Q

What can be seen on a chest x-ray in pneumonia?

A
  • multi-lobar → strep pneumoniae, s.aureus

- multiple abscesses → s.aureus

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48
Q

How is the severity of pneumonia assessed

A

CURB-65 score → 1 point each for:

  • confusion
  • urea >7
  • resp rate >30
  • BP <90 systolic and/or <60 diastolic
  • age >65
0-1 = outpatient
2 = short stay inpatient/hospital supervised outpatient 
3-5 = manage as high severity pneumonia
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49
Q

Treatment for pneumonia

A
  • maintaining O2 sats between 94-98% (88-92 for COPD)
  • analgesia → paracetamol/NSAIDs
  • IV fluids
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50
Q

CURB-65 guided treatment for pneumonia

A 
0-1 = oral amoxicillin at home
2 = consider hospitalising, amoxicillin (IV/oral) and macrolide
3+ = consider ITU, IV co-amoxiclav and macrolide

macrolide → clarithromycin/erythromycin

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51
Q

What is CAP?

A
  • pneumonia acquired outside hospital/healthcare facilities

- commoner in extremes of age

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52
Q

What is HAP?

A
  • pneumonia acquired at least 48 hours after admission to hospital and no incubating at time of admission
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53
Q

Causes of CAP

A
  • strep pneumoniae
  • haemophilus influenzae
  • mycoplasma pneumoniae

rusty sputum = characteristic of strep pneumoniae

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54
Q

Causes of HAP

A

most cases caused by gram -ve bacilli

  • pseudomonas aeruginosa
  • e coli
  • klebsiella pneumoniae
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55
Q

What is atypical pneumonia

A

bacterial pneumonia caused by atypical organisms not detectable on gram stain/cannot be culture using standard methods

common organisms

  • mycoplasma pneumoniae
  • chlamydophila pneumoniae
  • legionella pneumophila

characteristic symptoms

  • headache
  • low grade fever
  • cough
  • malaise
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56
Q

What is a pneumothorax?

A

air in the pleural space

can be

  • spontaneous
  • traumatic → penetrating/blunt injury to chest
  • iatrogenic → central line/mechanical ventilation
  • tension
  • lung pathology
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57
Q

Risk factors of PTX

A
  • smoking
  • family history
  • male
  • tall and slender build
  • young age
  • presence of underlying lung disease
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58
Q

Pathophysiology of PTX

A
  • normally intrapleural pressure is -ve
  • when there is a bridge between alveoli and pleural space or atmosphere and pleural space
  • flow of air in until communication or gradient closed
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59
Q

Clinical presentation of PTX

A
  • stable patient
  • sudden onset pleuritic chest pain, dyspnoea, cough

on examination look for

  • evidence of trauma
  • features of tension PTX
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60
Q

Diagnosis of PTX

A
  1. erect chest xray
    - reduced/absent lung markings between lung margin and chest wall
    - visible rim between lung margin and chest wall
  • bloods → clotting
  • US
  • CT → if chest xray uncertain
  • ABG
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61
Q

Management for PTX

A

small primary spontaneous PTX and not SOB

  • consider discharge
  • follow up chest xray in review

large primary spontaneous PTX and/or SOB

  • needle aspiration
  • if not <2cm on repeat chest xray, insert chest drain and supplemental O2 if needed
  • admission

secondary PTX

  • large = chest drain
  • small = needle aspiration
  • admission and high flow O2
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62
Q

What is a tension PTX?

A
  • one way valve mechanism → air enters pleural space but cannot leave
  • increased +ve pressure in chest
  • collapse of ipsilateral lung
  • compression of contralateral, trachea, heart etc.
63
Q

Clinical presentation of tension PTX

A

cardiopulmonary deterioration

  • hypotension → imminent cardiac arrest
  • respiratory distress
  • low sats
  • tachycardia
  • shock

severe chest pain

64
Q

Physical examination of tension PTX

A
  • tracheal deviation to contralateral side
  • ipsilateral reduced breath sounds
  • hyperresonance on percussion
  • hypoxia
65
Q

Management of tension PTX

A
  • put out cardiac arrest call
  • start high flow O2
  • immediate decompression
  • insert large bore cannula into pleural space through the second intercostal space in the mid-clavicular line
  • hiss sound confirms diagnosis
66
Q

What is cystic fibrosis?

A
  • condition affecting mucus glands
  • autosomal recessive
  • defect in CFTR gene
67
Q

What are the key consequences of CF?

A
  • thick pancreatic and biliary secretions that cause blockage of ducts
  • low volume thick airway secretions that reduce airway clearance → susceptible to airway infections
  • congenital bilateral absence of vas deferens in male → infertile
68
Q

Symptoms of CF

A
  • chronic cough
  • thick sputum production
  • recurrent respiratory tract infections
  • steatorrhoea
  • abdominal pain and bloating
  • parents report child’s sweat tastes salty
  • failure to thrive
69
Q

Signs of CF

A
  • low height/weight on growth charts
  • nasal polyps
  • finger clubbing
  • crackles and wheezes on auscultation
  • abdominal distention
70
Q

Diagnosis of CF

A
  • newborn blood spot testing/heel-prick test
  • genetic testing for CFTR gene during pregnancy or as blood test after birth
  • GOLD STANDARD = sweat test → diagnostic Cl conc >60
71
Q

What organisms commonly colonise in CF patients?

A
  • s.aureus
  • haemophilus influenza
  • klebsiella pneumoniae
  • e.coli
  • psudomonas aeruginosa
72
Q

Management of CF

A

specialist MDT

  • chest physiotherapy
  • exercise
  • high calorie diet
  • CREON tablets → digest fats
  • prophylactic flucloxacillin
  • treat chest infections
  • bronchodilators
  • lung transplant in end stage resp failure
  • liver transplant in liver failure
  • fertility treatment
  • genetic counselling
73
Q

What is whooping cough?

A
  • URT infection
  • caused by Bordetlla pertussis → gram -ve bacteria
  • children/pregnant women are vaccinated against pertussis
74
Q

Presentation of whooping cough

A
  • typically starts with mild coryzal symptoms → low grade fever, mild dry cough
  • followed by paroxysmal cough
  • patients produce large inspiratory whoop at tne of cough
  • can faint/develop PTX
  • infants may present with apnoeas instead of cough
75
Q

Diagnosis of whooping cough

A
  • nasopharyngeal/nasal swab with PCR testing/bacterial culture
  • if cough present for >2 weeks, can test for anti-pertussis toxin IgG
76
Q

Management of whooping cough

A
  • simple supportive care
  • vulnerable/acutely unwell/infants may need admission
  • macrolide Abs can be given early on
  • close contacts given prophylactic Abs if vulnerable

key complication = bronchiectasis

77
Q

What is bronchiectasis

A

permanent dilation of airways

78
Q

Causes of bronchiectasis

A
  • post-infection
  • CF
  • lung cancer
79
Q

Signs and symptoms of bronchiectasis

A
  • dyspnoea
  • cough
  • haemoptysis
  • recurrent chest infections
80
Q

Investigations for bronchiectasis

A
  • chest xray → kerly B lines

- sputum → H.influenzae most common

81
Q

Management of bronchiectasis

A
  • physical training
  • postural drainage
  • prophylactic Abs
  • surgery if disease localised
82
Q

What is pleural effusion?

A

collection of fluid in the pleural cavity → space between parietal ad visceral pleura

83
Q

Types of pleural effusion

A

exudative → high protein count

- transudative → lower protein count

84
Q

Causes of exudative pleural effusion

A

related to inflammation
- proteins leak out of tissue into pleural space

  • lung cancer
  • pneumonia
  • RA
  • TB
85
Q

Causes of transudative pleural effusion

A

related to fluid moving across pleural space

  • congestive cardiac failure
  • hypoalbuminaemia
  • hypothyroidism
  • Meig’s syndrome
86
Q

What is Meig’s syndrome?

A

right sided pleural effusion with ovarian malignancy

87
Q

Presentation of pleural effusion

A
  • SOB
  • cough
  • stony dull percussion over effusion
  • reduced breath sounds
  • tracheal deviation away from effusion if large
88
Q

Investigations for pleural effusion

A
  1. chest xray
    - pleural US
    - thoracocentesis → diagnoses underlying cause
89
Q

What would you seen on a chest xray with pleural effusion

A
  • blunting of costophrenic angle
  • fluid in lung fissures
  • meniscus
  • tracheal and medial deviation
90
Q

Treatment of pleural effusion

A

dependent on cause

  • congestive HF → loop diuretics
  • infective → Abs
  • malignant → therapeutic thoracocentesis
  • large effusions often need aspiration or drainage
91
Q

What is interstitial lung disease?

A
  • umbrella term for conditions that affect lung parenchyma

- cause inflammation and fibrosis

92
Q

Diagnosis of interstitial lung disease

A
  • clinical features
  • high resolution CT thorax → ground glass appearance
  • lung biopsy if unsure
93
Q

Treatment of interstitial lung disease

A

supportive, prevent progression

  • remove/treat underlying cause
  • home O2 if hypoxic at rest
  • stop smoking
  • physiotherapy
  • pneumococcal/flu vaccine
  • lung transplant
94
Q

What are the three types of interstitial lung disease?

A
  • idiopathic pulmonary fibrosis
  • occupational lung disorders
  • systemic disease → Wegner’s, Goodpasture’s
95
Q

What is idiopathic pulmonary fibrosis?

A

formation of scar tissue in lungs with no known cause

96
Q

Presentation of IPF

A
  • dyspnoea
  • dry cough
  • bibasal crackles
97
Q

Treatment of IPF

A
  • prifenidone
  • nintedanib
  • treatments for ILD
98
Q

What is sarcoidosis?

A
  • granulomatous inflammatory condition

- varied severity

99
Q

Presentation of sarcoidosis

A

affects any organ in body

most common = lung

  • mediastinal lymphadenopathy
  • pulmonary fibrosis
  • pulmonary nodules
100
Q

Investigations for sarcoidosis

A

GOLD STANDARD = histology from biopsy

- non-caseating granulomas with epithelioid cells

101
Q

Treatment for sarcoidosis

A
  • if mild, resolves spontaneously
  1. oral steroids, bisphophonates
  2. methotrexate/azathrioprine
  • lung transplant if severe
102
Q

What is pulmonary HTN?

A
  • disease of small pulmonary arteries
  • vascular proliferation and remodelling
  • progressive increased in PVR
103
Q

What are the main vascular changes in pulmonary HTN?

A
  • vasoconstriction
  • smooth muscle cell and endothelial cell proliferation
  • thrombosis
104
Q

Symptoms of pulmonary HTN

A
  • exertional dyspnoea
  • lethargy, fatigue
  • ankle swelling
105
Q

Signs of pulmonary HTN

A
  • accentuated component to 2nd heart sound
  • tricsupid regurgitation murmur
  • fatigue, peripheral oedema, cyanosis
106
Q

Diagnosis of pulmonary HTN

A

initial tests

  • chest xray → enlarged main pulmonary artery/hilar vessels
  • ECG
  • trans-thoracic echo

GOLD STANDARD = right heart catheterisation

107
Q

Treatment of pulmonary HTN

A

supportive

  • treat underlying cause
  • oral anticoagulants
  • if fluid retention, diuretics
  • supplemental O2
  • supervised exercise training
  • avoid pregnancy

treatment-resistant patients

  • balloon atrial septostomy
  • lung transplantation
108
Q

What are the two types of bronchial carcinoma?

A
  • small cell lung carcinoma → worse prognosis

- non-small cell carcinoma → more common

109
Q

Why is it useful to identify different types of lung cancer?

A
  • different types differ in histology and behaviour
  • helpful for providing prognosis and determining treatment
  • presentations are similar
110
Q

Risk factors of lung cancer

A
  • smoking
  • asbestos
  • coal and products of coal combustion
  • radon exposure
  • pulmonary fibrosis
  • HIV
  • genetic factors
111
Q

Symptoms of local disease in lung cancer

A
  • persistent cough
  • SOB
  • haemoptysis
  • weight loss
  • chest pain
  • wheeze
  • infections
112
Q

Symptoms of metastatic disease in lung cancer

A
  • bone pain
  • headache
  • seizures
  • neurological deficit
113
Q

Paraneoplastic changes in lung cancer

A

increased

  • PTH → hyperparathyroidism
  • ADH → SIADH
  • ACTH → Cushings

finger clubbing

114
Q

Investigations for lung cancer

A
  1. chest xray → central mass, hilar lymphadenopathy, pleural effusion
  • CT chest/liver/adrenal glands → staging
  • sputum cytology → malignant cells in sputum

GOLD STANDARD = percutaneous/bronchoscopic biopsy and histology

115
Q

Treatment of lung cancer

A
  • depends on cell type
  • surgery → lobectony, segmentectomy, wedge resection
  • radiotherapy
  • chemo
  • palliative care
116
Q

Small cell lung cancer

A
  • strong association with smoking
  • arises from endocrine cells in central bronchus
  • secretes polypeptide hormones
  • treatment = chemo
117
Q

Squamous cell carcinoma

A
  • most strongly associated with smoking
  • arises from epithelial cell in central bronchus
  • associated with production of keratin
118
Q

Adeoncarcinoma

A
  • most common primary lung cancer
  • most common type in non-smokers
  • originate from mucus-secreting glandular cells
  • metastasises to pleura, lymph nodes, brain, bone, adrenals
119
Q

Secondary lung cancer

A
  • more common than primary

can spread from

  • breast
  • bowel
  • bladder
  • prostate
  • kidney
120
Q

Common sites of metastasis of lung cancer

A
  • liver
  • bone
  • adrenal glands
  • brain
121
Q

What is Goodpasture’s Syndrome?

A
  • autoimmune anti glomerular basement membrane disease
  • antibodies attack basement membrane in lungs and kidneys
  • bleeding lungs, glomerulonephritis, kidney failure
122
Q

Presentation of Goodpasture’s

A
  • haemoptysis
  • haematuria
  • dyspnoea
  • glomerulonephritis
  • chest pain
  • fever
  • fatigue
123
Q

Investigations for Goodpasture’s

A

lung and kidney biopsy → anti-GBM antibodies

124
Q

Treatment for Goodpasture’s

A
  • supportive
  • corticosteroids
  • immunosuppresants
  • removal/replacement of plasma → plasmapheresis
125
Q

What is hypersensitivity penumonitis?

A
  • type 3 hypersensitivity reaction

- alveolar and bronchial inflammation after exposure to inhaled allergen

126
Q

Presentation of hypersensitivity

A
  • dyspnoea
  • cough
  • fever
  • malaise
  • weight loss
127
Q

Investigations for hypersensitivity pneumonitis

A

bronchoalveolar lavage

  • raised lymphocytes
  • raised mast cells
128
Q

Treatment of hypersensitivity pneumonitis

A
  • remove allergens

- steroids

129
Q

What are examples of occupational lung disorders

A
  • silicosis
  • asbestosis
  • bird fanciers lung
130
Q

What is pharyngitis?

A

rapid onset of sore throat and pharyngeal inflammation +/- exudate

131
Q

Common causes of pharyngitis

A
  • EBV
  • adenoviruses
  • enteroviruses
  • group A streptococcus
132
Q

Symptoms of pharyngitis

A
  • sore throat
  • fever
  • headache, nausea, abdominal pain → kids
  • rhinorrhoea, nasal congestion, cough → viral
133
Q

What factors suggest a group A strep pharyngitis?

A
  • pharyngeal exudates
  • cervical adenopathy
  • fever
  • absence of cough/rhinorrhoea
134
Q

Diagnosis of pharyngitis

A
  1. clinical symptoms consistent with group A strep infection
  2. rapid antigen detection test for group A strep
  3. -ve → conventional throat culture
135
Q

Treatment of pharyngitis

A
  • supportive → analgesia

- if group A strep, add Abs

136
Q

What is sinusitis?

A
  • inflammation of mucous membrane of nasal cavity and paranasal sinuses
  • AKA acute rhinosinusitis
137
Q

Causes of sinusitis

A
  • streptococcus pneumoniae
  • haemophilus influenzae
  • rhinoviruses
  • can progress to secondary bacterial infection
138
Q

Risk factors for sinusitis

A
  • nasal pathology → septal deviation, nasal polyps
  • recent local infection → rhinitis, dental extraction
  • swimming
  • smoking
139
Q

Viral presentation of sinusitis

A
  • symptoms <10 days
  • clear nasal discharge
  • fever
  • sore throat
140
Q

Bacterial presentation of sinusitis

A
  • symptoms >10 days
  • purulent nasal discharge
  • dental/facial pain
  • headache
141
Q

Investigations of sinusitis

A
  • clinical diagnosis

- distinguish viral vs bacterial

142
Q

Management of sinusitis

A

viral

  • self limiting disease
  • treatment is symptomatic

bacterial

  • symptom-based therapy
  • Ab generally avoided but can shorten infection
143
Q

What is acute otitis media?

A
  • inflammation of the middle ear

- associated with effusion, signs of infection

144
Q

Causes of acute otitis media

A

viral

  • RSV
  • rhinovirus
  • adenovirus
  • influenza

most common bacterial

  • H.influenzae
  • S.pneumoniae
  • moraxella catarrhalis
145
Q

Risk factors for acute otitis media

A
  • young
  • male
  • smoking
  • frequent contact with other children
  • family history
146
Q

Presentation of acute otitis media

A
  • otalgia
  • preceding URTI symptoms
  • fever
  • sleep disturbance
  • irritability in children
147
Q

Diagnosis of acute otitis media

A

otoscopy → bulging and erythema of tympanic membrane

148
Q

Management of acute otitis media

A
  1. regular analgesia
    - amoxicillin
    - consider admitting kids <3 months/ 3-6 months with temp 39+
149
Q

What is acute epiglottitis

A
  • inflammation of epiglottis
  • airway emergency
  • typically 2-6, can be younger
150
Q

causes of acute epiglottitis

A
  • inflammation of supraglottis
  • classically with H.influenzae
  • can be S.pneumoniae
151
Q

Presentation of acute epiglottitis

A
  • acute onset high fever
  • toxic appearance
  • tripoding
  • sore throat
  • dysphagia and painful
  • difficulty breathing
  • decreased oral intake
  • stridor
152
Q

Diagnosis of acute epiglottitis

A
  • laryngoscopy during intubation in an OT

- lateral neck radiography → thumb print sign

153
Q

Management of acute epiglottitis

A
  1. secure airway
  2. IV Abs
  3. supplemental O2
    - maybe heliox and corticosteroids

Phase 2a Resits (10 decks)

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