Respiratory Flashcards
Influenza
Three types: A (most common, can mutate its H and N proteins, B (less common, less mutation), C (less common).
C: Influenza virus. Spreads when a person coughs or sneezes.
S: 1-4 days after infection. Fever, runny nose, sore throat, cough.
D: Rapid influenza diagnostic tests, viral culture, PCR.
T: Self-limiting for most. In high risk groups (young, old, chronic) may need Neuraminidase inhibitors or M2 proton channel inhibitors. Prevention - vaccination.
Tuberculosis
Reactivation of the primary disease caused by Mycobacterium tuberculosis, an acid-fast rod-shaped bacillus.
C: Mycobacteria spread in macrophages in the blood to oxygen-rich sites in the body such as lung apices, kidneys, bones and meninges. Active disease tends to occur in the elderly, malnourished, diabetic, immunosuppressed, or alcoholic.
S: Pulmonary (persistent cough, fever, night sweats, weight loss, and loss of appetite) and Extrapulmonary (meningitis, lymphadenopathy, genitourinary symptoms, bone or joint pain).
D: CXR, sputum sample, may need ultrasounds/CTs etc. for extrapulmonary. Screening - Mantoux test and interferon gamma release assay (IGRA) blood test.
T: Pyrazinamine and ethambutol for the first 2 months and rifampicin, isoniazid for 6 months.
Directly observed therapy to ensure compliance.
Pneumothorax
A pneumothorax refers to a collection of air in the pleural cavity (between the lung and the chest wall) resulting in collapse of the lung on the affected side.
C: May be spontaneous, underlying lung condition, trauma, iatrogenic, catamenial (during menstruation in endometrosis)
S: Sudden, sharp, stabbing pleuritic pain, shortness of breath, tachycardia (over 135 - tension), pulsus paradoxus, tracheal deviation, breath sounds are reduced or absent, asymptomatic
D: CXR, CT, ultrasound, ABG
T: Simple observation, needle aspiration and chest drain are all options and the choice will depend upon the severity of the condition. Oxygen may be needed,.
If there has been recurrence or the risk is considered high then prevention of further pneumothorax by obliterating the pleural space by pleurodesis should be considered.
Open thoracotomy and pleurectomy for difficult or recurrent pneumothoraces.
Asthma
Chronic inflammatory disorder of the lung airways characterised by airway hyperresponsiveness and reversible airway obstruction.
C: Bronchial muscle contraction triggered by a variety of stimuli (allergens, infections, menstrual cycle, exercise, cold air, emotion), inflammation of mucous membranes, increased mucous production and secretions.
Can be eosinophilic or non-eosinophilic.
S: intermittent dyspnoea, episodic wheeze, cough, diurnal variation, morning tightness.
D: Exhaled nitric oxide test, Spirometry with reversibility, (FEV/FVC ratio <70%), Peak expiratory flow rate.
T: LADDER - Start with SABA for symptomatic relief. Then add low dose ICS. Then add LABA to low dose ICS (fixed dose or MART). Then increase ICS or add LTRA. Stop LABA if no effect.
Asthma attack: Oxygen driven nebuliser SABA and Ipratropium, steroids PO/IV.
COPD
Progressive airway obstruction with little or no reversibility.Characterised by infiltration of neutrophils resulting in airway obstruction, it encompasses chronic bronchitis (inflammation and obstruction) and emphysema (dilation of alveolar airspaces).
C: age, smoking, occupational exposure, family history of alpha a anti trypsin deficiency, provoking factors of infections and cold air.
S: Dyspnoea, chronic cough, regular sputum production, wheeze, no diurnal variation, tachynpoea, use of respiratory muscles, cyanosis.
D: Spirometry - FEV1 of less than 80% predicted and a reduced FEV1/FVC ratio. Reversibility testing. CXR, ECG.
T: LADDER - Short acting bronchodilator PRN, combination inhaler (LAMA and LABA or ICS and LABA), triple therapy (ICS, LABA and LAMA), consider adding theophylline.
Lifestyle choices, vaccinations, mucolytics, LTOT.
Acute exacerbation - SABA, steroids, antibiotics (amoxicillin)
Pneumonia
Infection in the lung tissue caused by microbes and the result is inflammation which brings water into the lung tissue, making it difficult to breathe.
Can be hospital-acquired, community-acquired, ventilator-associated, aspiration, interstitial, lobar.
C: influenza virus, Strep pneumoniae, haemophilus influenzae, staphylococcus aureus, fungi, TB.
S: Dyspnoea, chest pain, productive cough (blood or pus), fever, fatigue.
D: CXR (patchy areas), dullness on percussion, tactile vocal fremitus, crackles on auscultation. CRB-65 score for ?admission.
T: Antibiotics if bacterial (CAP - amoxicillin with doxy/clarithro as alternative, HAP - coamoxiclav with doxy/co-trimoxazole as alternative), cough suppressors, pain relief, may need fluids or oxygen. May need a bronchoscope if an aspiration pneumonia.
Pleural effusion
A collection of excess fluid in the pleural space.
Too much is made or too little is drained away.
C: Transudative (too much fluid leaving the capillaries either due to increased hydrostatic pressure or decreased oncotic pressure) or exudative (inflammation of the pulmonary capillaries due to trauma, malignancy, inflammatory condition, infection).
S: Asymptomatic if small, pain on inhaling, dyspnoea, worse on lying down.
D: Decreased breath sounds, dullness on percussion, decreased tactile fremitus, CXR (tracheal deviation, blurred costophrenic angles).
T: Treat underlying cause, small effusions due to HF - diuretics and Na restriction, large effusions - thoracentesis or surgery.
Bronchiolitis
Bronchiolitis is an acute viral infection of the lower respiratory tract that occurs primarily in the very young (under 2).
C: Most often respiratory syncytial virus (RSV), human metapneumovirus (hMPV), adenovirus, rhinovirus, and parainfluenza and influenza viruses.
S: cold symptoms, persistent cough, tachypnoea, chest recession, wheeze/crackles on auscultation, fever, poor feeding.
D: Pulse oximetry, viral throat swabs
T: Self-limiting - fluids, nutrition, temp control. High-flow nasal cannula oxygen may be needed.
Bronchitis
Inflammation of the bronchial tubes in the lung. Productive cough for at least 3 months a year for at least 2 years. Under COPD.
C: Exposure to chemicals and irritants causes hypertrophy and hyperplasia of bronchial mucinous glands in the main bronchi and goblet cells in the bronchioles. Smoking shortens cilia.
S: Wheeze, crackles, hypoxemia, hypercapnia, cyanosis, pulmonary hypertension which leads to right-sided heart failure (cor pulmonale), mucus plugs and infection.
D: Blood tests, CXR, FEV1 to FVC ratio
T: Lifestyle changes, managing associated illnesses - supplemental oxygen, medication - bronchodilators, inhaled steroids, antibiotics.
Pharyngitis
Sore throat usually caused by an infection.
C: colds, the flu, coxsackie virus or mononucleosis, group A streptococcus.
S: Hoarse voice, sore throat, fever, headache, nausea, fatigue, swollen glands, may be pus if bacterial.
D: Blood tests, physical examination, throat culture.
T: Fluids, pain relief, lozenges.
Emphysema
Alveolar air sacks become damaged or destroyed, and become permanently enlarged and lose elasticity.
Part of COPD.
C: Centriacinar (smoking) and Panacinar emphysema (alpha-1 antitrypsin deficiency) and Paraseptal (smoking)
S: Dyspnoea, weight loss, hypoxemia, cough with sputum, barrel-shaped chest, pulmonary hypertension and right-sided HF (cor pulmonale).
D: CXR (Increased anterior-posterior diameter, flattened diaphragm and increased lung-field lucency), ABG, FEV1 to FVC ratio.
T: Reduce risk factors. Managing associated symptoms - supplemental oxygen and medications like bronchodilators, inhaled steroids and antibiotics.
Bronchiectasis
Chronic inflammation causes the bronchioles to become damaged and dilated.
C: Primary cilia dyskinesia, Cystic Fibrosis, Airway obstruction due to a tumour growing inside or outside, or by a foreign object
S: Wheezing, coughing, dyspnoea, foul-smelling mucous, long-term hypoxia, clubbing, pulmonary hypertension leading to right-sided HF (cor pulmonale).
D: CT scan - dilated bronchi and bronchioles, pulmonary function tests, genetic testing.
T: Antibiotics to treat recurrent pneumonia, percussion or postural drainage to remove excess mucous, surgery to remove obstruction.
Acute respiratory distress syndrome
Rapid breathing difficulties that may be caused by a number of issues.
C: infection, sepsis, severe chest injury, inhaling vomit, smoke or toxic chemicals, near drowning, acute pancreatitis, adverse reaction to a blood transfusion.
S: Shortness of breath after insult, respiratory failure, hypoxemia, cyanosis, oedema (crackles).
D: CXR or CT shows ‘white out’, PF ratio: < 300mmHg.
T: Supportive care for breathing - supplemental oxygen, mechanical ventilation to maintain positive-end expiratory pressure to keep alveoli from collapsing. Treat underlying issue.
Pulmonary fibrosis
Pulmonary fibrosis describes a group of diseases which produce interstitial lung damage and ultimately fibrosis and loss of the elasticity of the lungs.
C: Replacement (infarction, TB, pneumonia), Focal (coal dust and silica), other causes include connective tissue diseases, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and Sjögren’s syndrome, medication (amiodarone, nitrofurantoin and bleomycin), birds or moulds.
S: Persistent dry cough, dyspnoea on exertion, bilateral crackles, clubbing, obstructive sleep apnoea.
D: CXR, lung function tests, blood tests, CT scan
T: Supportive therapy with oxygen, physiotherapy, smoking cessation, pulmonary rehabilitation, pirfenidone if FVC is 50-80%, Nintedanib.
Pneumoconiosis
A group of lung diseases caused by the inhalation and retention of dust in the lung. This causes a range of granulomatous and fibrotic changes.
C: Asbestos, exposure to coal or silica, inhalation of metallic particles, allergic immune response (beryllium sensitisation)
S: Abestosis (dyspnoea, cough, basal crackles, clubbing), CMP (asymptomatic, cough, dyspnoea, black sputum), Silica, Pulmonary siderosis and Berylliosis (cough, dyspnoea, pain, fatigue, weight loss).
D: CXR, Spirometry, Sputum microscopy, CT scans
T: Not curable - treat/palliate the symptoms (oxygen, brochodilators). Support the patient and their family through the disease and its social/occupational/legal ramifications.
