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MAY MEDICINE 1 REVISION > Respiratory pathology 'Group 2' 1 > Flashcards

Respiratory pathology 'Group 2' 1 Flashcards

1
Q

Acute epiglottitis is a ….

A

Upper respiratory tract infection

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2
Q

What happens to the epiglottitis in acute epiglottitis ?

A

It and other surrounding structures become inflamed.

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3
Q

What is the epiglottitis ?

A

A (mainly fibroelastic) cartilaginous flap which closes over the trachea to prevent aspiration when swallowing

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4
Q

What happens to the airways in acute epiglottitis ?

A

Airways get narrowed by the inflammation making it hard to air to get into the lungs

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5
Q

What causes acute epiglottitis ?

A

Bacteria most commonly Group A streptococcus
Trauma
Inhalation
Chemical burns

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6
Q

What kind of bacteria causes acute epiglottitis most commonly ?

A

Group A streptococcus

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7
Q

What can acute epiglottitis also be called in adults ?

A

Supraglottitis

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8
Q

What is the difference between acute epiglottitis in children and adults ?

A

More common and more serious in kids

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9
Q

What are the signs and symptoms of acute epiglottitis ?

A 
Very upset screaming kids
Very sore throat 
Stridor 
Difficulties swallowing 
Sitting in the 'sniffing position' 
Mouth open and tongue out 
Drooling 
Fever 
Screaming
Asphyxia (passing out due to lack of air)
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10
Q

What investigation should not be carried out in suspected acute epiglottitis ?

A

You should not examine the back of there throat and it can close off the airway further

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11
Q

What other investigations can be carried out?

A

lateral view neck x-ray can be done but there may not be time for this
Blood tests
throat swab

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12
Q

What are the differential diagnosis of acute epiglottitis ?

A

Croup

foreign body aspiration

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13
Q

What is the treatment for acute epiglottitis ?

A

Call for help
Give oxygen + get patients to sit upright + put in canula for bloods + prep for IV assess
IV antibiotics, anaesthetic, incubation, (steroids)

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14
Q

What is the prognosis of acute epiglottitis ?

A

Patients may die, but with treatment they should be ok.

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15
Q

What are some of the complications of acute epiglottitis?

A

Bacterial infection causes abscess in the epiglottis, pneumonia or empyema

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16
Q

What is another name for croup?

A

Acute laryngotracheobronchitits

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17
Q

Croup is a …

A

lower respiratory tract infection

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18
Q

What happens in croup?

A

Inflammation of the trachea

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19
Q

What causes croup ?

A

floppy trachea such as in tracheomalacia can cause recurrent croup
Acute viral infections
An upper respiratory tract infection which moves down into the trachea

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20
Q

What are the signs and symptoms of croup ?

A 
Quite well patients 
Barking cough 
Inspiratory stridor 
running nose 
hoarse voice 
waking up in the night
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21
Q

What are the different severity levels of croup ?

A 
Mild = Barking cough and no stridor 
Moderate = barking cough, stridor, intercostal recession, tracheal tug 
Severe = Moderate symptoms and a decreased consciousness
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22
Q

How is croup treated ?

A

It is self limiting so there if often limited treatment

  • Single dose oral dexamethasone to all patients
  • Nebulised adrenaline to severe cases and some moderate cases if oral dexamethasone isn’t affective
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23
Q

What is tracheitis ?

A

Croup that doesn’t get better. It is rare.

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24
Q

What causes tracheitis ?

A

Staph or strep invasive infection

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25
Q

Signs and symptoms of tracheitis ?

A

Croup that doesn’t get better
Swollen trachea
fever
malaise

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26
Q

How is tracheitis treated ?

A

Augmentin antibiotics

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27
Q

Bronchitis is a …

A

Lower respiratory tract infection
common
Self limiting
Obstructive lung disease

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28
Q

How long does bronchitis last ?

A

about 4 weeks

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29
Q

What happens in bronchitis ?

A

There is inflammation of the bronchi, smooth muscle contraction, mucous hypersecretion, cell wall thickening.

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30
Q

What is bronchitis caused by ?

A

A descended upper respiratory tract infection
Caused by a virus most commonly
Can also be caused by a bacteria
Chances of having it can also be caused by second hand smoking

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31
Q

The viruses which cause bronchitis also cause ….

A

the common cold

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32
Q

What are the signs and symptoms of bronchitis ?

A

Rattly loos productive cough
Gag at the end of there cough
Shortness of breath

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33
Q

What are the differential diagnosis of bronchitis ?

A

Asthma

Bronchiectasis

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34
Q

What is the treatment of bronchitis?

A

Rest and fluids
Don’t really treat
reassure family

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35
Q

Bronchiolitis is a ?

A

Lower respiratory tract infection

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36
Q

What does bronchiolitis cause ?

A

Inflammation of the bronchioles

smooth muscle contraction, mucous hypersecretion and cell wall thickening

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37
Q

What age group does bronchiolitis affect ?

A

under 2s especially under 1s

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38
Q

Describe the course of bronchiolitis

A 
Cough starts on day 1 
Start to feel ill on day 2 
Get sicker until day 5 
Stabilise at the same Sickness until day 7 
Get better after day 7
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39
Q

How does bronchiolitis start ?

A

Upper respiratory tract infection

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40
Q

What causes bronchiolitis ?

A

RSV viruses

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41
Q

What are the signs and symptoms of bronchiolitis ?

A 
Cough
Nasal stuffiness 
Tachypnoea 
Feeling sick 
Crackles 
Wheeze
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42
Q

What are the differential diagnosis of bronchiolitis ?

A

other LRTIs

Asthma (unlikely in under 2s)

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43
Q

How is bronchiolitis treated ?

A

Maximum observations and minimum intervention

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44
Q

What is empyema ?

A

A collection of pus in the pleural cavity

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45
Q

What causes empyema ?

A

Most commonly lobar pneumonia,
Also peri acinar emphysema
acute epiglottitis
lung abscess

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46
Q

What are some risk factors for empyema ?

A

Recent pneumonia
Thoracic trauma
Immunocompromised

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47
Q

What are some signs and symptoms of empyema ?

A 
Severe chest pain 
Weight loss 
dry cough 
Fever 
Chills 
Sweating 
Malaise
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48
Q

What investigations are done in order to diagnose empyema ?

A

CXR
Ultrasound
History
Blood culture

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49
Q

How is empyema treated ?

A

IV antibiotics
Chest drain sometimes
Surgery to remove a lung abscess which might cause an empyema

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50
Q

What are the differential diagnosis for empyema ?

A

MI
Pleural effusion
Pneumonia
Lung abscess

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51
Q

Describe what coronaviruses are

A

Family of viruses which have a crown like spikes on there surface and contain RNA

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52
Q

What type of coronaviruses is COVID -19 ?

A

Beta coronaviruses

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53
Q

What kind of transmission does COID -19 have ?

A

airborne and droplet transmission

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54
Q

What is the incubation period for COVID -19 ?

A

1-14 days

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55
Q

How is the transmission of COVID -1 9 measured ?

A

R number

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56
Q

What are the signs and symptoms of covid 19 ?

A 
Cough 
Loss of taste and smell 
Headache 
fever 
fatigue
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57
Q

What are some of the treatments for COVID -19 ?

A

Steroids (Dexamethasone)

Supportive therapy

58
Q

What is an endemic ?

A

the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area

59
Q

what is an epidemic ?

A

an sudden increase in the number of cases of a disease above what is normally expected in tat population in that area

60
Q

What is a outbreak ?

A

same definition of epidemic but is often used for a more limited geographic area

61
Q

What is a pandemic?

A

an epidemic that has spread over several countries or continents usually affecting a large number of people

62
Q

What is herd immunity ?

A

Herd Immunity is when the population as a whole in immune to a condition (ruffly 94% of a population)

63
Q

What is a pleural effusion ?

A

A collection of fluid in the pleura

64
Q

What causes a pleural effusion ?

A

by a mismatch in production and absorption of pleural fluid. Normally the pleural lymphatics absorb fluid however if this dose not happen then a build up of fluid occurs.

65
Q

What are the names of the two types of effusion ?

A

Transudate

Exudate

66
Q

What is a transudate effusion ?

A

A non-inflammatory effusion where there is a low protein content in the fluid

67
Q

What is a exudate effusion ?

A

A inflammatory effusion where there is a high protein content in the fluid

68
Q

What are the most common causes a transudate effusion ?

A

Left ventricular failure

Liver cirrhosis

69
Q

What are the most common causes an exudate effusion ?

A

Malignancy
Parapneumonic effusion
Empyema
TB

70
Q

What is the rule of thumb about the protein content of exudate vs transudate ?

A

Protein content > 3g then exudate

71
Q

What is ‘lights criteria’ used for ?

A

Determining if it is an exudate or transudate effusion

72
Q

Describe lights criteria

A

A. Pleural fluid vs serum protein ratio. < 0.5 transudate

B. Pleural fluid vs serum LDH Lactate dehydrogenase ratio. < 0.6 transudate

C. Pleural fluid vs upper limit of normal LDH lactate dehydrogenase ratio. < 2/3 transudate

73
Q

What are the risks factors for pleural effusion ?

A

Recent lobar pneumonia

74
Q

What are the signs and symptoms of pleural effusion ?

A

Dyspnoea mainly
cough
pleuritic chest pain

75
Q

What investigations are carried out to explore pleural effusion ?

A

Ultrasound
CXR
CT thorax
fluid sample

76
Q

What does biochemistry do with a sample ?

A

analyse proteins

77
Q

What does microbiology do with a sample ?

A

check for bacteria, viruses etc

78
Q

What does cytology do with a sample ?

A

check for abnormal cells

79
Q

What are the differential diagnosis of a pleural effusion ?

A

Pleural thickening
Pulmonary collapse
Consolidation
elevated diaphragm

80
Q

What is the treatment for pleural effusion ?

A

treat underlying cause

81
Q

What is the spirometry of a restrictive lung disease?

A

> 80%

82
Q

What is a restrictive lung disease?

A

Lungs have poor compliance, and struggle to fill with air

83
Q

What is an interstitial lung disease ?

A

Where the interstitium is inflamed. the interstitial tissue which is found in the walls of the airways and alveoli and between the alveoli and capillaries. Therefore this inflammation causes a decrease in gas exchange

84
Q

What is the name of the most common interstitial lung disease ?

A

Sarcoidosis

85
Q

What are the signs and symptoms of sarcoidosis ?

A

SOB which hasn’t responded to inhalers
dry cough
Erythematosus Around scars or tattoos
red inflamed eyes

86
Q

What investigations are used to diagnose sarcoidosis ?

A 
High resolution CT gold standard 
CXR 
Serum Ca++
ACE 
Pulmonary function test
87
Q

How is sarcoidosisd treated ?

A

Corticosteroids
NSAIDs
Topical steroids

88
Q

What is sleep apnoea ?

A

Recurrent episodes of upper airway obstruction leading to apnoea (airway closure for more than 10s, if it is less than 10s then it is called a hypopnea) during sleep

89
Q

What is apnoea ?

A

Airway closure for more than 10s
Occurs during microarousals when the brain moves from a light sleep to a deep sleep
Microarousals are much more common in sleep apnoea patients

90
Q

Risk factors for sleep apnoea ?

A

Obesity
Hypertension
Alcohol
Endocrine disorders

91
Q

What are the signs and symptoms of sleep apnoea ?

A

Heavy snoring
Tiredness
Unrefreshing sleep
poor concentration

92
Q

What are the investigations used for sleep apnoea ?

A

Epworth questionnaire study

Overnight sleep study

93
Q

How is sleep apnoea treated ?

A

Reducing risk factors
CPAP
Mandibular repositioning splint

94
Q

Which organisation will you as the doctor need to contact if you diagnose someone with sleep apnoea ?

A

The DVLA the patient that they are not allowed to drive. However once’s conditions are managed then they can drive again.

95
Q

What are sleep apnoea patients are an increased risk of?

A

risk of stoke, heart disease and a car accident.

96
Q

What is narcolepsy ?

A

condition which causes people to drop into sleep at random times. There are some patterns of when it occurs however such as after strong emotion.

97
Q

What are the risk factors of narcolepsy ?

A

Family history (as it sometimes runs in families but normally it occurs in patients with no previous history of narcolepsy)

98
Q

Does most cases of narcolepsy family related ?

A

no

99
Q

When dose narcolepsy first present ?

A

Early in life

100
Q

What are the symptoms of narcolepsy ?

A

Cataplexy
profound sleepiness through the day, sometimes hypnagogic/hypnopompic (consciousness between sleep states) hallucinations and sleep paralysis.

101
Q

How is narcolepsy investigated ?

A

PSG

MSLT

102
Q

What are key characteristics of narcolepsy ?

A

go to sleep and if they manage to do this within 6 minutes

often they will also enter REM sleep immediately

103
Q

What is the treatment for narcolepsy ?

A

modafinil, dexamphetamione, venlafaxine, and sodium oxybate

104
Q

What is chronic ventilatory failure ?

A

when there is an inability to exchange gas which is chronic (Vs respiratory failure which is acute)

105
Q

What are some of the risk factors for choric ventilatory failure ?

A 
Conditions which can cause it:
i.e. 
COPD 
Bronchiectasis 
Chest wall abnormalities 
Motor neuron disease 
Muscular dystrophy 
obesity
106
Q

What are the signs and symptoms of chronic ventilatory failure ?

A

Elevated pCO2 (>6.0kPA), low pO2 (<8.0kPA),
elevated bicarbonate,
normal blood pH,
an underlying disease which may be causing it,
paradoxical abdominal wall motion in suspect neuromuscular disease, ankle oedema (occurs when there is a build of fluid in the veins i.e. in cor pumonale). Breathlessness,
orthopnoea,
morning headache,
recurrent chest infections and disturbed sleep.

107
Q

What investigations are carried out to help diagnose chronic ventilatory failure ?

A

Lung function tests

Assessment of hypoventilation

108
Q

What is the treatment for chronic ventilatory failure ?

A

cure is not possible
domiciliary non-invasive ventilation
oxygen therapy

109
Q

What is laryngomalacia ?

A

When there is a floppiness in the larynx

110
Q

What kind of patient is laryngomalacia often seen in ?

A

Kids

111
Q

What are the signs and symptoms of laryngomalacia?

A

Stridor

Worse when feeding or upset or excited

112
Q

How is laryngomalacia treated ?

A

Normally gets better itself within the first year of life

113
Q

What is tracheomalacia ?

A

When there is a floppiness in the trachea

114
Q

What are the signs and symptoms of tracheomalacia ?

A

Barking cough
Recurrent croup
Breathlessness on exertion
Stridor/wheeze

115
Q

How is tracheomalacia treated?

A

Often no intervention.
Sometimes antibiotics if there is a bacterial infection
Physiotherapy sometimes if not improving

116
Q

What is a tracheoesophageal fistula?

A

an abnormal connection (join) between the trachea and the oesophagus.

117
Q

What might co-exist with a tracheoesophageal fistula ?

A

An atresia

118
Q

What causes a tracheoesophageal fistula?

A

Genetics

it is a congenital disorder

119
Q

How does a tracheoesophageal fistula appear?

A

Chocking,
colour change
cough with feeding
unable to pass NG (feeding tube)

120
Q

How is tracheoesophageal fistula treated ?

A

Surgery

121
Q

What are some complications of a tracheoesophageal fistula ?

A

Tracheomalacia
Strictures
leak
reflux

122
Q

What is respiratory distress syndrome ?

A

Occurs in premature babies and is when there is an insufficnely of surfactant. (Which is not fully in place until 36 weeks)

123
Q

How is IRDS treated?

A

Antenatal steroids
Surfactant replacements
Appropriate Ventilation
Appropriate Nutrition

124
Q

What is a pulmonary embolism ?

A

Occurs when there is something sitting in the pulmonary ciruclation to the lungs and preventing the normal flow of blood.

125
Q

What is the most common embolise in a PE ?

A

A clot which have broken off from a DVT.

126
Q

What are risk factors for a PE ?

A 
Recent major trauma 
Recent surgery 
Cancer 
Significant cardiopulmonary disease 
pregnancy 
inherited thrombophilia 
Anything which alters Virchows Triad
127
Q

What is the inherited condition which increased your PE risk called?

A

inherited thrombophilia

128
Q

How can the probability of a PE having occurred be measured ?

A

Wells Score

Revised Geneva score

129
Q

Draw out the Wells Score

A 
Clinical signs of DVT = 3
Heart rate > 100 = 1.5 
recent surgery or immobilization = 1.5 
Previous PE or DVT = 1.5 
Haemoptysis = 1
Malignancy = 1
Alternative diagnosis less likely then PE = 3

PE likely < or = 4

130
Q

What are the signs and symptoms of pulmonary embolism ?

A 
Pleuritic chest pain 
Isolated acute dyspnoea 
Tachycardia 
Hypoxia 
Hypotension 
Evidence of thrombosis
131
Q

What are some investigations used to diagnose PE ?

A 
CXR 
ECG 
CT pulmonary angiogram 
V/Q perfusion scan 
D-Dimer 
Echocardiogram
132
Q

Describe a simple algorithm of how to diagnose PE

A

Draw it

133
Q

How is pulmonary embolism treated ?

A

General treatment (oxygen, fluids)
Anti-coagulation (Low Molecular Mass Heparin = Dalteparin and Warfarin and oral anticoagulants)
Thrombolysis (Alteplase)
Surgery (Pulmonary embolectomy)

134
Q

What does the prognosis after PE depend on ?

A

Size
Age
co-morbidity

135
Q

What is pulmonary hypertension ?

A

Elevated blood pressure in the pulmonary arteries.

136
Q

What BP number means that someone have pulmonary hypertension ?

A

Mean arterial pressure > 25mmHg

137
Q

What causes pulmonary hypertension ?

A

Underlying conditions most often i.e. lung cancer or respiratory disease or thromboembolic

138
Q

What are the signs and symptoms of pulmonary hypertension ?

A 
Exertional dyspnoea 
chest tightness 
exertional presyncope or syncope (Feeling of fainting or fainting)
symptoms develop slowly
Elevated JVP 
loud pulmonary second heart sound 
ankle oedema
139
Q

How is pulmonary hypertension investigated ?

A 
ECG 
Lung function test 
CXR 
Echocardiography (Gold standard !!!!)
Right heart catheterisation (for direct measurement)
140
Q

What is the prognosis of pulmonary hypertension

A

Gets progressively worse

141
Q

How is pulmonary hypertension treated ?

A 
Treat underlying condition
Oxygen 
Anticoagulation and diuretics (increased urine) 
CCB
Prostaglandins
Endothelin receptor antagonists
Thrombo-endarterectomy
Heart/lung transplant   
Phosphodiesterase inhibitors

MAY MEDICINE 1 REVISION (23 decks)

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