Respiratory Disease Flashcards

Question

Acute Bronchitis: Signs

Answer 1

Often no clinical signs >> coarse crepitations, wheeze

Answer 2

Resolved by itself- >> resolution typically 3 weeks >> analgesia, fluids, smoking cessation, rest >> typically no antibiotics because usually caused by viral infection >> consider delayed antibiotic with advice Immediate antibiotic if- >> over 80 with ONE of: hospitilisation within past year, heart failure, oral steroids, diabetic >> over 65 with TWO of: hospitilisation within past year, heart failure, oral steroids, diabetic >> prescribe amoxicillin 500mg, 3x per day

Answer 3

Influenza or 'flu' is a single-stranded RNA virus causing URTI Typically self-limiting >> resolves by itself without medical intervention >> can cause mortality in patients with co-morbidities

Answer 4

Three serotypes: A, B, and C >> A and B respnsible for epidemic respiratory infections >> seasonal influenza caused by mix of A and B

Answer 5

Viral: highly contagious, and transmitted by respiratory secretions

Answer 6

Incubation period is typically 1–4 days Patients can remain infectious for 7–21 days Fever ≥ 37.8°C Nonproductive cough Myalgia Headache Malaise Sore throat Rhinitis Infants and children: fatigue, irritability, diarrhoea, vomitting

Answer 7

Self-limiting disease Fever, myalgia, headache >> paracetamol, ibuprofen Fluids Rest Avoid smoking Throat loszenges Saline nose drops Decongestants

Answer 8

Acute bronchitis Influenza related pneumonia Exacerbations of asthma, COPD, HF

Answer 9

Influenza vaccine is an inactivated vaccine tailored each year according to recent outbreaks. Free flu vaccine eligability- >> pregnant >> front-line healthcare worker >> long-term care home residant >> carer >> patients with chronic conditions >> age over 65 >> very overweight Children- >> 6-12 months should have flu jab >> 2-17 years have yearly nasal spray vaccine

Answer 10

Lung tissue infection that causes the air sacs in the lungs to fill with fluid, inflammatory cells, and microorganism. >> leads to consolidation of the lung tissue >> impairs gas exchange and can lead to hypoxia

Answer 11

Types of pneumonia: >> Community-acquired pneumonia (CAP) >> Hospital-acquired pneumonia (HAP) >> Pneumonia in immunocompromised individuals

Answer 12

Pneumonia can be caused by viruses, bacteria, and fungi >> most common: Strep pneumonia >> common: Staph aureus, Mycoplasma pneumoniae, Haemophilus influenzae >> uncommon: klebsiella pneumonia, strep pyogenes, pseudomonas, aeruginosa, Coxiella burnetti, Chlamydia psittaci, Actinomyces Israeli

Answer 13

>> Inflammation of lungs due to infection >> fluid and blood cell leak >> consolidated tissue >> impaired gas exchange >> reduced ventilation

Answer 14

Age >> infants and the elderly Smoking Alcohol excess >> organ damage, aspiration pneumonia Preceding viral infections >> flu Bronchial obstruction >> COPD Bronchiectasis >> permanent widening and thickening of lung airways Immunosuppression >> AIDS, chemotherapy Hospitalisation Underlying predisposing disease >> Diabetes, CVD

Answer 15

Fever Sweating Shivers Malaise Rigors Cough Purulent sputum Pleuritic chest pain >> chest pain on inspiration Haemoptysis

Answer 16

Tachypnoea Tachycardia Hypotension Cyanosis Dullness to percussion over the consolidated area Increased vocal resonance/ tactile vocal fremitus over the consolidated area Pleural rub Lower lobe crackles

Answer 17

Sputum culture CXR >> consolidation and fluid FBC U+E >> for AKI LFTs

Answer 18

Oxygen if low saturations IV fluids if dehydrated Analgesia for myalgia or chest pain Escalate for respiratory support Oral antibiotics >> amoxicillin 500mg, 3x per day for 5 days IV antibiotics for those admitted with more severe pneumonia >> co-amoxiclav and clarithromycin >> check for penicillin allergies Antibiotics should be tailored to antimicrobial sensitivities Repeat CHX after 6-8 weeks >> screen for lung cancer

Answer 19

Infection of lungs caused by streptococcus pneumoniae bacteria Homogeneous consolidation of one or more lobes or segments >> also called pneumococcal pneumonia, community acquired pneumonia

Answer 20

All ages >> specifically early and middle adult life

Answer 21

Droplet spread Streptoccocus pneumoniae >> inflammation of lungs due to infection >> fluid and blood cell leak >> consolidated tissue >> impaired gas exchange >> reduced ventilation

Answer 22

Cough Purulent sputum Fever Aches and pains Vomiting Anorexia Pleuritic chest pain Dyspnoea

Answer 23

FOR ALL PATIENTS WITH PNEUMONIA- Chest X-ray Sputum culture >> only in secondary care and if urgent FBC >> WBC U&E >> urea LFTs >> albumin

Answer 24

Penicillin or cephalosporin

Answer 25

Classified using the CURB-65 score to determine severity and guide management One point is awarded for each of the following- >> confusion >> urea > 7mmol/L >> respiratory rate > 30 breaths/min >> blood pressure < 90 systolic and/or < 60mmHg diastolic >> 65 years or older A CURB-65 score of: >> 0-1 requires home treatment >> 2 should consider hospital admission >> 3-5 admit to hospital and consider ITU referral

Answer 26

Exudate Pleural effusion Lung abscess Bacteraemia >> sepsis, endocarditis, meningitis, arthiritis, otitis media

Answer 27

Less common Not detectable on gram staining

Answer 28

Commonly affect healthier people Typically less severe >> more severe in immuno-compromised

Answer 29

Organisms that cause atypical pneumonia- Mycoplasma pneumoniae Chlamydophila pneumoniae Legionella pneumophila

Answer 30

Caused by: Mycoplasma pneumoniae Most common cause of atypical pneumonia Epidemiology- Peak rate in autumn/early winter Epidemic every 3-4 years Risk Factors- Common in barracks and institutions Children and young adults at higher risk Symptoms- Present insidiously with flu-like symptoms >> progresses to pnuemonia symptoms >> PERSISTANT DRY COUGH Investigations- CXR or CT consolidation >> homogenous dense lobar, patchy, nodular Treatment- erythromycin/clarithromycin or tetracycline

Answer 31

Caused by: Legionella pneumophila Mortality 15% >> most commonly due to resp. failure Epidemiology- Typically present in water sources >> can spread via air conditioning Symptoms- Previously healthy paitent >> air conditions Present with: cough, chills, temp, myalgia, nausea, vomitting, diarrhoea, confusion PLEURITIC CHEST PAIN AND COUGH Investigations- CXR, blood culture, Legionella serology, urine antigen Treatment- Erythromycin 14-21 days, oxygen, IV fluids >> 1st line Rifampicin BD by mouth or IV >> severly ill patients Complications- Less severe: confusion, hepatitis, renal impairement More severe: hyponatreamia, lung abscess, empyema, hypotension

Answer 32

Caused by: Chlamydophila pneumoniae Mortality 15% >> most commonly due to resp. failure Epidemiology- Most common chlamydial infection Spread via droplets Biphasic illness Symptoms- Present with: pharyngitis, hoarsness, otitis media >> followed by pneumonia PRODUCTIVE WATERY COUGH Investigations- CXR, chlamydial PCR, nasopharyngeal swab, sputum or pleural fluid sample Treatment- Azithromycin >> 1st line Tetracyclin >> 2nd line

Answer 33

CXR, blood cultures, serology, chlamydial PCR Mycoplasma pneumoniae- ground-glass shadowing Chlamydophila pneumoniae- consolidation Legionella pneumophila- patchy consolidation

Answer 34

Responds to antibiotics: macrolides (azithromycin and clarithromycin) and doxycycline

Answer 35

Pneumonia acquired less than 48 hours after admission to hospital

Answer 36

More likely than pneumonia acquired at home

Answer 37

Most common causative organisms- Pseudomonas aeruginoa Staphylococcal aureus Enterobacteriaceae >> Klebsiella, E.coli, Enterobacter

Answer 38

Epidemiology: 2% of pneumonia in UK Typically secondary to influenza infection Pathophysiology: Widespread infection with abscess formation Seen in immunocompromised patients Risk Factors: Intravenous drug abusers >> puncture sites introduce infections Treatment: Flucloxacillin >> 1st line Erythromycin >> if allergic

Answer 39

Epidemiology: Uncommon High mortality 20-50% Pathophysiology: Massive consolidation and excavation of lobes >> ususally upper lobes Presentation: High fever, rigors, pleuritic pain Sputum is purulent, haemoptysis Risk Factors: Associated with alcoholism, diabetes, COPD, elderly Treatment: Cefuroxime

Answer 40

Risk Factors: Common pathogen in bronchiectasis, CF, hospital acquired infections (ITU, post-surgery) Diagnosis: Sputum culture Treatment: Antipseudonomal penicillin

Answer 41

Pneumocystis carinii pneumonia (PCP) Pneumocystic jirovecii pneumonia (PJP) Pnemonia in the immunosupressed

Answer 42

Caused by fungus: pneumocystis jirovecii

Answer 43

Dry cough Exertional dyspnoea Hypoxaemia Fever Bilateral crepitations

Answer 44

CXR >> normal OR bilateral peripheral interstitial shadowing Visulisation of organisam in sputum Bronchoalveolar lavage (BAL) >> tube with fluid put down and brough back up

Answer 45

High dose co-trimoxazole, pentamidine Steroid if hypoxaemia Prophylaxis if CD4 count <200 (normal CD4 500-1200)

Answer 46

LRTI of bronchioles causing inflamamtion in small bronchi and bronchioles

Answer 47

Typically seen in infants and young children <2 years During autumn and winter

Answer 48

Viruses infect bronchiolar epithelial cells >> inflammation in small bronchi and bronchioles Common caused by respiratory syncytial virus (RSV) >> commonly causes bronchiolitis in infant and pneumonia in adults >> other causes: rhinovirus, parainfluenza, influenza, COVID, adenovirus

Answer 49

Fever Nasal congestion Rhinorrhoea Persistant cough Dyspnoea >> difficulty breathing Wheeze Intercostal rescession Peripheral cynosis Typically begins with URTI, progresses to LRTI

Answer 50

Clinical diagnosis Respiratory exam CXR or virology >> only if other concerns

Answer 51

Self-limiting >> typically resolves within 1-2 weeks Supportive care- >> analgesia, hydration, nutrition Indications for hospitalisation- >> toxic appearacnce, central cyanosis, lethargy, dehydration, severe resp. distress, hypoxia A&E management- >> Inhaled bronchodilators, IV fluids, oxygen, nasal suction, intubation

Answer 52

URTI also known as acute laryngotracheobronchitis

Answer 53

Affects children between 6 months - 6 years >> peak incidence at 2 years More often in autumn and winter

Answer 54

Most common cause: human parainfluenza virus 1 Infection and inflammation of laryngeal mucosa >> laryngeal oedeam, thick tenacious mucus >> obstructed trachea and airways Onset slower than acute epiglottitis

Answer 55

Prodromal phase of coryzal symptoms Harsh barking cough Hoarse voice or cry Inspiratory stridor

Answer 56

Modified Westley scoring: >> chest wall retractions >> stridor >> cyanosis >> level of consiousness >> air entry 0–2: Mild croup 3–5: Moderate croup 6–11: Severe croup 12–17: Impending respiratory failure

Answer 57

Clinical diagnosis Use modified Westley score for severity

Answer 58

Largely self-limiting Supportive care- >> analgesia, hydration, nutrition, rested, oxygen, fever management Severe care- >> dexamethasone 150mcg orally (steroid) >> nebulised budesonide 2mg (steroid) >> nebulsied adrenaline 5mg

Answer 59

Highly contagious bacterial infection of the lungs and airways

Answer 60

Under 6 months >> increased mortality

Answer 61

Bordetella pertussis - gram negative bacteria

Answer 62

Cough paroxysm >> coughing fit Long-term hacking cough Whooping cough Post-cough vomitting

Answer 63

Nasopharyngeal swab >> idealy under 2 weeks Oral fluid swabs Serology-anti-pertussis toxin IgG >> over 2 weeks

Answer 64

Vaccine- >> for 16-31 weeks pregnant >> childhood scheduled vaccines Hospital admission if under 6 months, or severly unwell Macrolides to reduce infective peroid >> clarithromycin, azithromycin Oxygen if cyanosis

Answer 65

Inflammation and swelling of the epiglottis MEDICAL EMERGENCY

Answer 66

Rare Children 2-5 years Adults 40-50 years

Answer 67

Commonly caused by: haemophilus influenzae, streptoccocus pneumoniae Localised infection of supraglottic larynx

Answer 68

Muffled voice (hot potatoe voice) Hoarse cry Stridor Drooling Fever Painful/inability to swallow Tripod position Fever No cough

Answer 69

DO NOT LOOK INSIDE MOUTH >> may exacerbate

Answer 70

Emergency referal Airway management Manage fever Refer laryngoscopy >> gold standard IV antibiotics

Answer 71

Tuberculosis is an infection with the Mycobacterium tuberculosis bacterium Lung is the major seat of infection and the usual portal through which infection reaches other organs >> can infect multiple other organ systems Active TB: symptomatic, progressive, and contagious Latent TB: persistent immune response to prior acquired antigens, forms tuberculoma >> asymptomatic and not contagious

Answer 72

High incidence in Africa and Asia Multi drug resistant TB is a public health crisis >> notifiable disease in UK 2nd leading infectious killer TB is present in all countries and age groups but is curable and preventable

Answer 73

Mycobacterium tuberculosis: aerobic, slow growing bacteria >> acid fast bacilli: resistant to acid staining Spread via droplets >> Bacteria enters respiratory system >> 70% people will clear infection Others may become infected and supress the disease and so show no signs or symptoms >> latent TB >> latent TB: granulomas will form around the bacteria to prevent immune system from attacking it >> TB bacteria remains in body, inactive Others develop disease immedietly >> active TB

Answer 74

Active TB: patient is symptomatic or there is progression of the disease in the lung or other organs >> most common presentation Miliary TB: a severe and disseminated form of TB, where the bacteria spread through the bloodstream, affecting multiple organs throughout the body Latent TB: the immune system contains the infection, with alveolar macrophages playing a major role in the formation of granulomas which contain the bacteria >> asymptomatic and not contagious Reactive TB: if latent TB becomes reactive >> 5-10% of people with latent TB will experience

Answer 75

Close contact of TB patient Homeless patients or living in close quarters Alcohol and other drug misuse Immunocompromised patients >> HIV Elderly patients

Answer 76

Systemic- Night sweats Fevers Weight loss Malaise Lymphadenopathy Respiratory- Chronic productive cough Haemoptysis Shortness of breath Collapse, pain, or pleural effusion >> dull to precussion

Answer 77

Heart and pericardium: pain, arrhythmias, cardiac failure, pericarditis Intestine: malabsorption, diarrhoea, obstruction GI tract: haematuria, renal failure, epididymitis, salpingitis, infertility Skin: erythema nodosum, lupus vulgaris Eyes: iritis, choroiditis, keratoconjunctivitis Bones/Joints: arthritis, osteomyelitis Lymphatics: lymphadenopathy, cold abscesses, sinuses Brain: tuberculoma, meningitis

Answer 78

If active TB suspected- Chest X-ray Sputum culture x3 >> for acid fast bacilli smear, mycobacterial culture, nucleic acid amplification testing (NAAT) >> samples for microscopy, culture and sensitivity testing (MCS) >> stained with Ziehl-Neelsen or Auramine staining >> at least one sample from early morning Additional testing depending on suspected site of infection

Answer 79

If inactive TB is suspected- Mantoux test >> injecting 0.1mL of liquid containing tuberculin purified protein derivative(PPD) into top layers of forearm skin >> check 48-72 hours after injection >> positive if ≥5 mm skin induration Interferon-gamma release assay test >> a blood test which detects the white blood cell response to TB antigens >> faster, less false positives If Mantoux or IGRA tests positive, should exclude active TB >> history >> physical examination >> chest x-ray: granulmoas/nodules >> Any other abnormalities: send for sputum test

Answer 80

Initial 2 months of- >> rifampicin (colours urine, sweat, and tears red/brown 4 hours after dose)(not allowed contraception for 8 weeks after Rifampicin) >> isoniazid with pyradoxine (vit B6 to mitigate common neuro side effects) >> pyrazinamide >> ethambutol Followed by 4 month of- >> rifampicin >> isoniazid with pyradoxine (vit B6) TREATMENT STARTED IF SUSPECTED OF ACTIVE TB without waiting for culture results, then modified Compliance is CRUCIAL >> risk of multi-drug resistant TB Modify treatment regimen according to drug susceptability testing Longer courses of antibiotics in TB meningitis, pericardial and spinal TB >> affecting CNS Multidrug-resistant TB often requires 18-24 months of treatment with at least six drugs Contact tracing, care co-ordination via TB MDT, monitor adherence, mask until >2 weeks of treatment

Answer 81

For 3 months- >> rifampicin >> isoniazid with pyradoxine (vit B6) OR For 6 months- >> isoniazid with pyradoxine (vit B6)

Answer 82

BCG vaccination is a live attenuated vaccine that is given to protect against TB It is not a routine part of the UK's childhood vaccination schedule but is given to babies (or children up to 16) at higher risk

Answer 83

Pleural effusion Empyema >> collection of pus in pleural cavity Pneumothorax >> collapsed lung, air leaking from lung within pleural cavity Laryngitis Enteritis >> inflammation of small intestine Mycetoma Cor pulmonale Death

Answer 84

Accumulation of excess fluid within pleural cavity >> impede respiration as the lung cannot expand fully X-ray >> white=fluid

Answer 85

Causes classified into trasudative or exudative- Transudative: where changes in oncotic and hydrostatic pressure cause fluid to leak from the vasculature >> typically watery, transparent >> causes: HF, renal failure, liver failure, PE >> lower pleural proteins Exudative: where inflammation leads to increased microvascular permeability and drainage of pleural fluid may be impaired >> contains materials, pus >> causes: infection, cancer, autoimmune, drugs, PE >> can have right-sided or left-sided secondary causes >> higher pleural proteins

Answer 86

Used to differentiate between transudative and exudative plural effusion If any criteria met, then exudative: >> ratio of pleural to serum protein is greater than 0.5 >> ratio of pleural to serum LDH is greater than 0.6 >> pleural fluid LDH is greater than ⅔ of the upper limit of normal serum value

Answer 87

Shortness of breath Reduced exercise tolerance Dry cough Pleuritic chest pain >> sharp, stabbing, worsens on breathing in and out, holding breath helps

Answer 88

Reduced chest expansion on the affected side Dull on percussion over the effusion Reduced or absent breath sounds over the effusion Loss of vocal resonance over the effusion Tracheal deviation away from the effusion Respiratory distress >> use of accessory muscles HF: peripheral oedema, raised JVP

Answer 89

Haemothorax: >> a collection of blood in pleural cavity >> usually secondary to trauma >> can occur spontaneously >> due to malignancy or vascular rupture Chylothorax: >> chylous fluid in the pleural cavity >> due to lymphatic duct injury or obstruction >> common causes include iatrogenic injury during thoracic surgery, traumatic injury or lymphoma Empyema: >> a collection of pus in the pleural cavity >> usually develop as a complication of pneumonia Mesothelioma: >> tumour of the pleura >> strongly associated with asbestos exposure.

Answer 90

Respiratory exam: >> pleural tap, vocal resosonance, chest sounds Chest X-ray: first line >> blunting of costophrenic angle or white out of the lung FBC

Answer 91

Thoracocentesis: >> pleural tap or pleural aspiration >> is a minimally invasive medical procedure that removes fluid or air from the pleural space >> sit patient upright >> leaning on pillow >> insert needle and drain fluid out above rib to avoid neurovascular bundle for diagnosis and symptom relief Management and treatment depends on size, symptom and cause