Respiratory Disease

Question 1

Respiratory disease generalised symptoms

Answer 1

S/S-: generalised- shared with other diseases so HISTORY is VITAL

Cough: non-specific (child asthma esp. if worse at night/ waking/ post exercise

Dyspnoea: SOB
-> paroxysmal nocturnal dyspnoea: attack of severe SOB and coughing at night that can wake the person from sleep
•coughing and wheezing persists even in upright position

-> orthopnoea: SOB when lying flat- can be overcome by sitting upright and dangling feet
•can be due to pulmonary disease- oedema, chronic bronchitis), polycystic liver disease, abdominal obesity or LV heart failure
•LVHF- when lying down there is redistribution of blood flow from extremities to lungs- increased right venous return= increased pulmonary return to LV- in normal individuals, LV can increase CO to match increased venous return- but in pts with LVHF, LV capacity to respond to increase pulmonary return= pooling of blood in pulmonary circ.- increased hydrostatic pressure- fluid exudation into alveoli- pulmonary oedema

Onset: 
>sudden: 
• foreign body 
•pneumothorax
•pulm. Emb. 

>hours: 
•asthma 
•pulm. Oedema
•pneumonia 
•extrinsic allergy alveolitis 

> days:
•pleural effusion
•lung ca.

> months:
•pulm. Fibrosis
•chronic airflow limitation

• > wheeze: small airway nose- expiratory
• > stridor: upper airway noise- typ. Inspiratory harsh sound- usually caused by blockage or narrowing e.g. dangerous upper airway obstruction, laryngitis, upper airway edema
• > haemoptysis: coughing blood- TB, lung ca, pneumonia, oedema

Question 2

What are lung function tests

Answer 2

• spirometry

- lung volume test

Question 3

What is peak expiratory flow rate? Typ. Values?

What is FEV, FVC- significance

Answer 3

PEFR: Size and gender dependent
•male: 500-700 l/min
•female: 400-600 l/min

FEV: how much air a person can exhale during a forced breath in t seconds- amount exhaled in the first sec is FEV1

FVC: total amount of air exhaled

FEV1/FVC ratio can help determine if a pt has obstructive or restrictive lung disease
Obstructive: v low FEV, normal/slightly low FVC- ratio decreases <75%
Restrictive: low FEV, v low FVC- ratio remains normal/ >75%

Spirometry inc total lung capacity
Gas (CO) transfer factor- measures alveolar function

Question 4

What are the upper respiratory tract infections?

Answer 4

Common cold 
Sinusitis 
Rhinitis 
Pharyngitis 
Laryngitis-tracheo Bronchitis 
Influenza
Inhalation of foreign body 
Tonsillitis 
Epiglottitis?

Question 5

common cold

Answer 5

• 80-90% viral
• 12hrs incubation
• coryza (mucopurulent)
• resolves 1/52
• can be confused with seasonal rhinitis/vasomotor rhinitis

Question 6

sinusitis

Answer 6

• obstructed antral (and other sinuses) Ostia due to mucosal oedema
• increased pressure
• pain
• toothache by antral floor irritation
• pain can roll- differentiates between toothache

Question 7

rhinitis

Answer 7

• sneezing and congested
• blocked nose
• perennial: asthma type allergens
• seasonal: e.g. pollen hay fever
• Rx: antihistamines, decongestants, nasal topical steroid sprays
• can be allergic or non allergic
• inflammation in the nose and throat- increased mucus production

Question 8

pharyngitis

Answer 8

-runny nose, cough, hoarse voice, cough, swollen lymph nodes
-typ viral sore throat
-occasionally bacteria inc:
>strep pneumonia-The bacteria most likely to cause strep throat and bacterial sore throats in general are called Group A beta-hemolytic Streptococcus pyogenes (GABHS)- can progress to Rh fever
>haemophilius influenza: HiB throat oedema-life threatening- rapidly advancing- may require tracheotomy
>stap aureus

Question 9

epiglottitis

Answer 9

• sore throat
• high temperature
• AIR RAID
• airway inflammation- obstruction- can’t breath- get scared- tachycardia- panic
• increased pulse
• restlessness
• retractions- trouble breathing> muscles struggling to get air into lungs> lack of air pressure causes skin and tissue in chest wall to sink
• anxiety
• inspiratory stridor
• drooling- can’t swallow

Tx: position for comfort

• cool mist
• no oral fluids- IV fluids
• secure airways- oxygen
• severe cases: tracheostomy

Question 10

laryngo-tracheo-bronchitis

Answer 10

• ‘croup’
• barking cough
• stridor
• stuffy nose
• fever
• laryngeal oedema-eep children= hoarse voice,
• croup (barking cough)
• tracheitis> burning retrosternal chest pain
• triggered by acute viral infection of upper airway
• common in <3 y/o
• typ measles virus/ parainfluenza

Rx: steam inhalations, tracheotomy in advanced cases