Respiratory 🫁 Flashcards
What is the skin prick test?
Most commonly used test for allergies, involving drops of diluted allergen placed on the skin and pierced with a needle. Results interpreted after 15 minutes.
Includes histamine (positive) and sterile water (negative) controls.
What does the radioallergosorbent test (RAST) measure?
Determines the amount of IgE that reacts specifically with suspected allergens, graded from 0 (negative) to 6 (strongly positive).
Useful for food allergies and inhaled allergens.
What is skin patch testing used for?
Useful for diagnosing contact dermatitis by placing allergens on the back and reading results after 48 hours.
May include testing for irritants.
Define oral allergy syndrome (OAS).
An IgE-mediated hypersensitivity reaction to specific raw plant-based foods, often linked to pollen allergies.
Presents with tingling or pruritus in the mouth.
How does OAS differ from traditional food allergies?
OAS is caused by cross-sensitization to similar proteins in pollen, while food allergies are due to direct sensitivity to food proteins.
Non-plant foods do not cause OAS.
What is the epidemiology of OAS in the UK?
About 2% of the UK population has OAS, often under-diagnosed.
1/2 of general pollen allergy patients and 3/4 of birch pollen allergy patients report OAS symptoms.
What are common associations with OAS?
- Birch pollen allergy
- Rye grass pollen allergy
- Rubber latex allergy
What are the common symptoms of OAS?
- Itching and tingling of lips, tongue, mouth
- Mild swelling and redness
- Nausea and vomiting in severe cases
- Symptoms resolve within one hour
Is anaphylaxis a common complication of OAS?
False
Anaphylaxis is very rare in OAS.
What investigations can be used for diagnosing OAS?
Clinical diagnosis; standard IgE RAST and skin prick testing for common allergens may be performed.
Positive skin prick test indicates allergy.
What is the primary management for OAS?
Avoidance of culprit foods.
Oral antihistamines can be used if symptoms develop.
What defines local and systemic reactions to venom allergies?
Local reactions are confined to the site of exposure, while systemic reactions occur away from the site and may involve widespread symptoms.
Anaphylaxis may occur with or without systemic reactions.
What is the first-line management for anaphylaxis?
Intramuscular adrenaline, intravenous steroids, and intravenous antihistamines as needed.
Oxygen and nebulised bronchodilators may also be required.
What is venom immunotherapy (VIT)?
An effective immunotherapy for patients with a history of systemic reactions and raised levels of venom-specific IgE.
Recommended for those with airway compromise or hemodynamic instability.
What are the ‘Hs’ and ‘Ts’ in reversible causes of cardiac arrest?
- Hs: Hypoxia, Hypovolaemia, Hyperkalemia, Hypokalaemia, Hypoglycaemia, Hypocalcaemia, Acidaemia, Hypothermia
- Ts: Thrombosis, Tension pneumothorax, Tamponade, Toxins
What is the recommended chest compression to ventilation ratio for adults during CPR?
30:2
What are the major points in the 2015 Resuscitation Council guidelines for cardiac arrest?
- Chest compressions
- Defibrillation
- Drug delivery via IV or IO
- Administration of adrenaline and amiodarone
What is the typical presentation of myocardial infarction?
Sudden onset of central, crushing chest pain, possibly radiating to the neck and left arm.
May include nausea and sweating.
What is the characteristic feature of a dissecting aortic aneurysm?
‘Tearing’ chest pain radiating through to the back and unequal upper limb blood pressure.
Most common in Afro-Caribbean males aged 50-70.
Which condition is associated with sharp chest pain relieved by sitting forwards?
Pericarditis
What is the common treatment for a perforated peptic ulcer?
Laparotomy, with small defects excised and larger defects managed with partial gastrectomy.
What type of pain is typically worse immediately after eating in gastric ulcers?
Gastric pain
This is a characteristic symptom associated with gastric ulcers.
What diagnostic tool may show free intra-abdominal air in cases of perforated gastric ulcers?
Erect chest x-ray
A small amount of free air may indicate perforation.
What is the typical treatment for a perforated gastric ulcer?
Laparotomy
Smaller defects may be managed with an omental patch, while larger defects may require partial gastrectomy.
What syndrome is characterized by spontaneous rupture of the oesophagus due to repeated vomiting?
Boerhaave’s syndrome
This condition typically involves severe chest pain and mediastinitis.
What imaging technique is used to diagnose Boerhaave’s syndrome?
CT contrast swallow
This method helps visualize the rupture in the esophagus.
What ECG changes are associated with Anteroseptal myocardial infarction?
V1-V4
This indicates involvement of the left anterior descending artery.
What does a new left bundle branch block (LBBB) indicate?
Acute coronary syndrome
LBBB can be a sign of underlying cardiac issues.
What are common symptoms of Pancoast tumors?
Persistent cough, haemoptysis, dyspnoea, chest pain, weight loss, anorexia, hoarseness
These symptoms can occur due to tumor pressure on surrounding structures.
What paraneoplastic syndrome is associated with small cell lung carcinoma?
ADH secretion
This can lead to hyponatremia and other electrolyte imbalances.
What is a characteristic feature of acute severe asthma?
Worsening dyspnoea, wheeze, and cough not responding to salbutamol
These symptoms indicate a significant asthma exacerbation.
What classification is used for the severity of acute asthma?
Moderate, Severe, Life-threatening
This classification helps guide treatment decisions.
What is the first-line antibiotic recommended for acute bronchitis in certain patients?
Doxycycline
Alternatives include amoxicillin, but doxycycline cannot be used in children or pregnant women.
What is the primary causative agent of acute epiglottitis?
Haemophilus influenzae type B
This infection can lead to severe airway obstruction.
What is the ‘thumb sign’ on lateral x-ray indicative of?
Swelling of the epiglottis in acute epiglottitis
This sign can help in diagnosing epiglottitis.
What are the features of bronchiectasis?
Persistent productive cough, dyspnoea, haemoptysis
These symptoms arise due to chronic infection or inflammation.
What is the main cause of Chronic Obstructive Pulmonary Disease (COPD)?
Smoking
COPD encompasses chronic bronchitis and emphysema.
What is the post-bronchodilator FEV1/FVC ratio that indicates mild COPD?
> 80%
This is classified as Stage 1 - Mild according to the severity grading.
What is the most common cause of community-acquired pneumonia (CAP)?
Streptococcus pneumoniae
This bacterial pathogen is frequently responsible for pneumonia cases.
What is the CRB65 score used for?
Assessing pneumonia severity in primary care
It helps to stratify patients based on mortality risk.
What does a CURB65 score of 3 or more indicate?
High risk (more than 15% mortality risk)
This necessitates intensive care assessment.
What are common signs of pneumonia upon examination?
High temperature, tachycardia, hypotension, confusion, dullness on percussion
These signs indicate systemic infection and fluid accumulation.
What are potential features of pulmonary embolism?
Chest pain, dyspnoea, haemoptysis, tachycardia, tachypnoea
These symptoms can vary widely among patients.
What are the recommended antibodies for patients at intermediate or high risk of pulmonary embolism?
Ella antibodies
Ella antibodies are used to help in the diagnosis of pulmonary embolism.
What are potential features of pulmonary embolism?
- Chest pain
- Dyspnoea
- Haemoptysis
- Tachycardia
- Tachypnoea
- Clear chest on examination
In real-world clinical practice, findings may vary.
What is the frequency of tachypnea in patients diagnosed with pulmonary embolism according to the PIOPED study?
96%
This indicates that tachypnea is a very common sign in pulmonary embolism cases.
What are the common clinical signs associated with pulmonary embolism?
- Tachypnea (96%)
- Crackles (58%)
- Tachycardia (44%)
- Fever (43%)
These findings are based on the PIOPED study results.
What is pulmonary tuberculosis primarily caused by?
Mycobacterium tuberculosis
Other rare causes include Mycobacterium bovis and Mycobacterium africanum.
What are the features of symptomatic primary infection of tuberculosis?
- Fever
- Pleuritic or retrosternal pain
Pleuritic pain may be due to pleural effusion, while retrosternal pain may be due to enlarged bronchial lymph nodes.
What are common symptoms of upper respiratory tract infections (URTIs)?
- Nasal discharge
- Nasal obstruction
- Sore throat
- Headache
- Cough
- Tiredness
- General malaise
Other symptoms may include facial pain, earache, hoarseness, and nausea.
How often are adults affected by URTIs on average per year?
2-3 times
Children may average up to 5-6 infections per year.
What is the typical management for an uncomplicated cold in a healthy adult?
- Reassurance
- Paracetamol
- Fluids
- Rest
- Over-the-counter remedies if appropriate
The condition is self-limiting and usually resolves within 7-10 days.
What are the features of acute asthma?
- Worsening dyspnoea
- Wheeze
- Cough not responding to salbutamol
It may be triggered by a respiratory tract infection.
What defines moderate asthma according to PEFR measurements?
PEFR 50-75% best or predicted
Patients can speak normally, with a respiratory rate of < 25/min and pulse < 110 bpm.
What is the most common cause of acute bronchitis?
Viral infection
Around 80% of episodes occur in autumn or winter.
What are common features of bronchiectasis?
- Persistent productive cough
- Dyspnoea
- Haemoptysis
Patients may expectorate large volumes of sputum.
What characterizes chronic obstructive pulmonary disease (COPD)?
An umbrella term for chronic bronchitis and emphysema
The majority of cases are caused by smoking.
What is the criteria for diagnosing COPD severity based on FEV1?
- Stage 1 - Mild: FEV1 > 80%
- Stage 2 - Moderate: FEV1 50-79%
- Stage 3 - Severe: FEV1 30-49%
- Stage 4 - Very severe: FEV1 < 30%
Symptoms must be present to diagnose COPD in Stage 1 patients.
What are the common causative pathogens for pneumonia?
- Bacteria (e.g. Streptococcus pneumoniae)
- Virus
- Fungus (e.g. Pneumocystis jiroveci)
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia.
What is anaphylaxis?
A severe, life-threatening, generalised or systemic hypersensitivity reaction
It can be triggered by food, drugs, or venom.
What are the symptoms of anaphylaxis according to the Resus Council UK?
- Airway problems (swelling, hoarse voice)
- Breathing problems (wheeze, dyspnoea)
- Circulation problems (hypotension, tachycardia)
Symptoms progress rapidly.
What is the first-line treatment for anaphylaxis?
Intramuscular adrenaline
It should be administered as soon as possible.
What is the recommended dose of adrenaline for adults in anaphylaxis?
500 micrograms (0.5 ml 1 in 1,000)
Adrenaline can be repeated every 5 minutes if necessary.
What defines refractory anaphylaxis?
Respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline
IV fluids should be administered for shock in such cases.
What are the features of secondary infection (postprimary/reactivation) of tuberculosis?
- Cough, gradually becoming productive
- Haemoptysis (minority)
- Weight loss
- Fatigue
- Night sweats
- Low-grade fever
These symptoms typically develop as the disease reactivates.
What are the signs of pneumonia?
- Erythema or injection of the back of the throat
- Nasal discharge
- Tender cervical lymphadenopathy
- Mild fever
These signs may vary based on the underlying cause of pneumonia.
What may be required in less straightforward cases of URTIs?
Investigations
This is particularly true for vulnerable populations such as infants or immunocompromised adults.
What are the common complications of upper respiratory tract infections?
- Sinusitis
- Otitis media
- Secondary bacterial infection (e.g. pneumonia)
- Exacerbations of pre-existing respiratory conditions
- Viral wheeze, bronchiolitis, and croup in infants
These complications can arise from untreated or severe URTIs.
What is the feature that differentiates acute bronchitis from pneumonia regarding symptoms?
Sputum, wheeze, breathlessness may be absent in acute bronchitis
At least one of these symptoms tends to be present in pneumonia.
What is pneumonia?
A common inflammatory condition affecting the alveoli in the lungs due to pathogens entering the lower respiratory tract.
What are common causative pathogens of pneumonia?
- Bacteria (e.g., Streptococcus pneumoniae)
- Virus
- Fungus (e.g., Pneumocystis jiroveci)
What is the pathophysiology of pneumonia?
An inflammatory cascade begins with neutrophils migrating to infected alveoli, releasing cytokines, inducing fever, and causing fluid accumulation that impairs gaseous exchange.
What are the risk factors for pneumonia?
- Aged under 5 or over 65 years old
- Smoking
- Recent viral respiratory tract infection
- Chronic respiratory diseases (e.g., cystic fibrosis, COPD)
- Immunosuppression (e.g., cytotoxic drug therapy, HIV)
- Patients at risk of aspiration
- IV drug users
- Other non-respiratory co-morbidities (e.g., diabetes, cardiovascular disease)
What are the common symptoms of pneumonia?
- Cough with purulent sputum (rust colored/bloodstained)
- Dyspnoea
- Chest pain (may be pleuritic)
- Fever
- Malaise
What signs indicate systemic infection in pneumonia?
- High temperature
- Tachycardia
- Hypotension
- Confusion
What is the CRB65 criteria used for?
To assess patients in primary care for pneumonia risk stratification.
List the CRB65 criteria markers.
- C: Confusion (abbreviated mental test score <= 8/10)
- R: Respiration rate >= 30/min
- B: Blood pressure (systolic <= 90 mmHg and/or diastolic <= 60 mmHg)
- 65: Aged >= 65 years
What does a CRB65 score of 0 indicate?
Low risk (less than 1% mortality risk)
What does a CRB65 score of 3 or 4 indicate?
High risk (more than 10% mortality risk)
What is the recommendation for CRP < 20 mg/L in pneumonia treatment?
Do not routinely offer antibiotic therapy.
What is a tension pneumothorax?
A severe pneumothorax that results in the displacement of mediastinal structures, leading to respiratory distress and haemodynamic collapse.
What are the classifications of pneumothorax?
- Spontaneous pneumothorax
- Traumatic pneumothorax
- Iatrogenic pneumothorax
What are common symptoms of pneumothorax?
- Dyspnoea
- Chest pain (often pleuritic)
What are the signs of a tension pneumothorax?
- Respiratory distress
- Tracheal deviation away from the side of the pneumothorax
- Hypotension
What are common features of pulmonary embolism?
- Chest pain (typically pleuritic)
- Dyspnoea
- Haemoptysis
- Tachycardia
- Tachypnoea
What is the PIOPED study?
A study that looked at the frequency of different symptoms and signs in patients diagnosed with pulmonary embolism.
What pulmonary function test results indicate obstructive lung disease?
- FEV1: significantly reduced
- FVC: reduced or normal
- FEV1% (FEV1/FVC): reduced
What pulmonary function test results indicate restrictive lung disease?
- FEV1: reduced
- FVC: significantly reduced
- FEV1% (FEV1/FVC): normal or increased
What is acute bronchitis?
A type of chest infection resulting from inflammation of the trachea and major bronchi, often self-limiting.
What are the common symptoms of acute bronchitis?
- Cough
- Sore throat
- Rhinorrhoea
- Wheeze
How can acute bronchitis be differentiated from pneumonia?
- History: Sputum, wheeze, breathlessness may be absent in acute bronchitis
- Examination: No focal chest signs in acute bronchitis other than wheeze.
What is the first-line antibiotic recommended for acute bronchitis?
Doxycycline
What features characterize childhood infections?
- Chickenpox: Itchy rash starting on head/trunk
- Measles: Koplik spots and maculopapular rash
- Mumps: Parotitis and fever
- Rubella: Pink maculopapular rash
- Scarlet fever: Strawberry tongue and rash
- Hand, foot and mouth disease: Vesicles in mouth and on palms/soles
What CURB65 score indicates low risk for mortality?
CURB65 score of 0 or 1
Less than 3% mortality risk
What CURB65 score indicates intermediate risk for mortality?
CURB65 score of 2
3-15% mortality risk
What CURB65 score indicates high risk for mortality?
CURB65 score of 3 or more
More than 15% mortality risk
What does a chest X-ray typically show in cases of infection?
Consolidation
Opacity on the X-ray film
What does raised white cell count in blood tests indicate?
Infection
What is the definition of sepsis?
Life-threatening organ dysfunction caused by a dysregulated host response to infection
What is the definition of septic shock?
A more severe form of sepsis with greater risk of mortality than sepsis alone
What criteria must be met for quickSOFA (qSOFA) score?
At least 2 of the following:
* Respiratory rate of 22/min or greater
* Altered mentation
* Systolic blood pressure of 100 mmHg or less
What are the red flag criteria for risk stratification in sepsis?
Criteria include:
* Responds only to voice or pain/unresponsive
* Systolic B.P <= 90 mmHg
* Heart rate > 130 per minute
* Respiratory rate >= 25 per minute
* Needs oxygen to maintain SpO2 >= 92%
* Non-blanching rash, mottled/ashen/cyanotic
* Not passed urine in last 18 hours
* Lactate >= 2 mmol/l
What are the components of the ‘sepsis six’ management protocol?
- Administer oxygen
- Take blood cultures
- Give broad-spectrum antibiotics
- Give intravenous fluid challenges
- Measure serum lactate
- Measure accurate hourly urine output
What is the SOFA score used for?
To identify and categorize patients based on organ dysfunction
What is the most common cause of community-acquired pneumonia?
Streptococcus pneumoniae
What are the typical symptoms of pulmonary tuberculosis?
Cough, weight loss, fatigue, night sweats, low-grade fever
What are the features of a secondary (postprimary/reactivation) tuberculosis infection?
Cough, gradually becoming productive, weight loss, fatigue, night sweats, low-grade fever
What are some common causes of haemoptysis?
- Lung cancer
- Tuberculosis
- Pulmonary embolism
- Bronchiectasis
- Mitral stenosis
What distinguishes a transudate from an exudate in pleural effusions?
Transudate: < 30g/L protein
Exudate: > 30g/L protein
What imaging studies are recommended for evaluating pleural effusion?
- Posterior-anterior chest X-rays
- Ultrasound
- Contrast CT
What is Light’s criteria used for?
To distinguish between transudate and exudate in pleural fluid analysis
What are the classic examination findings in pleural effusion?
Dullness to percussion, reduced breath sounds, reduced chest expansion
What are the risk factors for pneumonia?
- Aged under 5 or over 65 years
- Smoking
- Chronic respiratory diseases
- Immunosuppression
- Recent viral respiratory tract infection
What is the typical presentation of pneumonia symptoms?
Cough with purulent sputum, dyspnoea, chest pain, fever, malaise
What is the CRB65 criteria used for?
To assess the risk of death in pneumonia patients in primary care
What does the ‘C’ in the CRB65 criteria stand for?
Confusion (abbreviated mental test score <= 8/10)
What is the mortality risk associated with a CRB65 score of 0?
Low risk (less than 1% mortality risk)
What CRP level indicates that antibiotic therapy should not be routinely offered?
CRP < 20 mg/L
What additional criterion is included in the CURB65 compared to the CRB65?
Urea > 7 mmol/L
What is the recommended action for patients with a CURB65 score of 3 or more?
Consider intensive care assessment (high risk, more than 15% mortality risk)
What imaging is typically performed to investigate pneumonia?
Chest X-ray
What does a raised white cell count in blood tests indicate?
Infection
What is the purpose of a sputum sample in pneumonia diagnosis?
To diagnose causative organism after culture
What are Light’s criteria used for?
To distinguish between a transudate and an exudate
What are the signs of systemic infection in pneumonia?
- High temperature * Tachycardia * Hypotension * Confusion
What are common symptoms of pneumonia?
- Cough with purulent sputum * Dyspnoea * Chest pain * Fever * Malaise
True or False: The incidence of epiglottitis has increased in adults due to the immunisation programme.
False
What is a key feature of acute epiglottitis?
Stridor
What is the management step for suspected acute epiglottitis?
Immediate senior involvement, including those able to provide emergency airway support
What is the common viral cause of croup?
Parainfluenza viruses
What is the recommended treatment for all children with croup, regardless of severity?
Single dose of oral dexamethasone (0.15mg/kg)
What does the PIOPED study relate to?
Features making pulmonary embolism more likely
What are the signs of pulmonary embolism according to the PIOPED study?
- Tachypnea (96%) * Crackles (58%) * Tachycardia (44%) * Fever (43%)
What is the first-line management for moderate or severe OSAHS?
Continuous positive airway pressure (CPAP)
Fill in the blank: The _______ scale is used to assess sleepiness.
Epworth Sleepiness Scale
What is a characteristic finding in chest X-ray for pneumonia?
Consolidation (opacity on the X-ray film)
What should be done if pleural fluid is purulent or turbid/cloudy?
A chest tube should be placed to allow drainage
What risk factors are associated with pneumonia?
- Aged under 5 or over 65 years * Smoking * Recent viral respiratory tract infection * Chronic respiratory diseases * Immunosuppression * Patients at risk of aspiration * IV drug users * Other non-respiratory co-morbidities
What is the consequence of untreated OSAHS?
Daytime somnolence
What is the typical presentation of cough in croup?
Barking, seal-like cough
What is the recommended action for patients with a CURB65 score of 2 or more?
Consider hospital-based care (intermediate risk, 3-15% mortality risk)
What is the ‘thumb sign’ associated with?
Swelling of the epiglottis
The ‘thumb sign’ is a radiological sign indicating epiglottitis.
What is the recommended dose of oral dexamethasone for children?
0.15mg/kg
This is recommended regardless of severity.
What are some emergency treatments for acute asthma?
- High-flow oxygen
- Nebulised adrenaline
What are the features of acute severe asthma?
- Worsening dyspnoea
- Wheeze
- Cough not responding to salbutamol
How are patients with acute severe asthma stratified?
- Moderate
- Severe
- Life-threatening
What PEFR indicates a life-threatening asthma condition?
< 33% best or predicted
What does a normal pCO2 indicate in an acute asthma attack?
Exhaustion
This should classify the situation as life-threatening.
What is the leading cause of acute bronchitis?
Viral infection
Accepted that around 80% of episodes occur in autumn or winter.
What are common presenting symptoms of acute bronchitis?
- Cough (may or may not be productive)
- Sore throat
- Rhinorrhoea
- Wheeze
What differentiates acute bronchitis from pneumonia in history?
Sputum, wheeze, breathlessness may be absent in acute bronchitis
What is the first-line antibiotic recommended for acute bronchitis?
Doxycycline
Cannot be used in children or pregnant women.
What is anaphylaxis defined as?
A severe, life-threatening, generalised or systemic hypersensitivity reaction.
What are common identified causes of anaphylaxis?
- Food (e.g. nuts)
- Drugs
- Venom (e.g. wasp sting)
What are airway problems in anaphylaxis?
- Swelling of the throat and tongue
- Hoarse voice
- Stridor
What are breathing problems in anaphylaxis?
- Respiratory wheeze
- Dyspnoea
What is the recommended dose of adrenaline for adults and children over 12 years in anaphylaxis?
500 micrograms (0.5ml 1 in 1,000)
What is refractory anaphylaxis?
Respiratory and/or cardiovascular problems persist despite 2 doses of IM adrenaline.
What is the pathogen responsible for most cases of bronchiolitis?
Respiratory syncytial virus (RSV)
Responsible for 75-80% of cases.
What are the common presenting symptoms of bronchiolitis?
- Coryzal symptoms
- Dry cough
- Increasing breathlessness
- Wheezing
What is the main management strategy for bronchiolitis?
Supportive management
What is a common cause of chronic obstructive pulmonary disease (COPD)?
Smoking
What are the features of COPD?
- Cough (often productive)
- Dyspnoea
- Wheeze
What is the FEV1/FVC ratio indicating airflow obstruction in COPD?
Less than 70%
What is the classification of COPD severity based on post-bronchodilator FEV1?
- Stage 1 - Mild: FEV1 > 80%
- Stage 2 - Moderate: FEV1 50-79%
- Stage 3 - Severe: FEV1 30-49%
- Stage 4 - Very severe: FEV1 < 30%
What is the significance of measuring peak expiratory flow in COPD?
Limited value as it may underestimate the degree of airflow obstruction.
Moderate asthma signs
- PEFR 50-75% best or predicted
- speech normal
- RR <25 per min
- pulse <110 bpm
Severe asthma diagnosis
- PEFR 33-50% of best or predicted
- can’t complete full sentences
- RR > 25/ min
- pulse > 110 bpm
Life threatening
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
