Respiratory pathology 'Group 2' 1 Flashcards
Acute epiglottitis is a ….
Upper respiratory tract infection
What happens to the epiglottitis in acute epiglottitis ?
It and other surrounding structures become inflamed.
What is the epiglottitis ?
A (mainly fibroelastic) cartilaginous flap which closes over the trachea to prevent aspiration when swallowing
What happens to the airways in acute epiglottitis ?
Airways get narrowed by the inflammation making it hard to air to get into the lungs
What causes acute epiglottitis ?
Bacteria most commonly Group A streptococcus
Trauma
Inhalation
Chemical burns
What kind of bacteria causes acute epiglottitis most commonly ?
Group A streptococcus
What can acute epiglottitis also be called in adults ?
Supraglottitis
What is the difference between acute epiglottitis in children and adults ?
More common and more serious in kids
What are the signs and symptoms of acute epiglottitis ?
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)
What investigation should not be carried out in suspected acute epiglottitis ?
You should not examine the back of there throat and it can close off the airway further
What other investigations can be carried out?
lateral view neck x-ray can be done but there may not be time for this
Blood tests
throat swab
What are the differential diagnosis of acute epiglottitis ?
Croup
foreign body aspiration
What is the treatment for acute epiglottitis ?
Call for help
Give oxygen + get patients to sit upright + put in canula for bloods + prep for IV assess
IV antibiotics, anaesthetic, incubation, (steroids)
What is the prognosis of acute epiglottitis ?
Patients may die, but with treatment they should be ok.
What are some of the complications of acute epiglottitis?
Bacterial infection causes abscess in the epiglottis, pneumonia or empyema
What is another name for croup?
Acute laryngotracheobronchitits
Croup is a …
lower respiratory tract infection
What happens in croup?
Inflammation of the trachea
What causes croup ?
floppy trachea such as in tracheomalacia can cause recurrent croup
Acute viral infections
An upper respiratory tract infection which moves down into the trachea
What are the signs and symptoms of croup ?
Quite well patients Barking cough Inspiratory stridor running nose hoarse voice waking up in the night
What are the different severity levels of croup ?
Mild = Barking cough and no stridor Moderate = barking cough, stridor, intercostal recession, tracheal tug Severe = Moderate symptoms and a decreased consciousness
How is croup treated ?
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
What is tracheitis ?
Croup that doesn’t get better. It is rare.
What causes tracheitis ?
Staph or strep invasive infection
Signs and symptoms of tracheitis ?
Croup that doesn’t get better
Swollen trachea
fever
malaise
How is tracheitis treated ?
Augmentin antibiotics
Bronchitis is a …
Lower respiratory tract infection
common
Self limiting
Obstructive lung disease
How long does bronchitis last ?
about 4 weeks
What happens in bronchitis ?
There is inflammation of the bronchi, smooth muscle contraction, mucous hypersecretion, cell wall thickening.
What is bronchitis caused by ?
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
The viruses which cause bronchitis also cause ….
the common cold
What are the signs and symptoms of bronchitis ?
Rattly loos productive cough
Gag at the end of there cough
Shortness of breath
What are the differential diagnosis of bronchitis ?
Asthma
Bronchiectasis
What is the treatment of bronchitis?
Rest and fluids
Don’t really treat
reassure family
Bronchiolitis is a ?
Lower respiratory tract infection
What does bronchiolitis cause ?
Inflammation of the bronchioles
smooth muscle contraction, mucous hypersecretion and cell wall thickening
What age group does bronchiolitis affect ?
under 2s especially under 1s
Describe the course of bronchiolitis
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
How does bronchiolitis start ?
Upper respiratory tract infection
What causes bronchiolitis ?
RSV viruses
What are the signs and symptoms of bronchiolitis ?
Cough Nasal stuffiness Tachypnoea Feeling sick Crackles Wheeze
What are the differential diagnosis of bronchiolitis ?
other LRTIs
Asthma (unlikely in under 2s)
How is bronchiolitis treated ?
Maximum observations and minimum intervention
What is empyema ?
A collection of pus in the pleural cavity
What causes empyema ?
Most commonly lobar pneumonia,
Also peri acinar emphysema
acute epiglottitis
lung abscess
What are some risk factors for empyema ?
Recent pneumonia
Thoracic trauma
Immunocompromised
What are some signs and symptoms of empyema ?
Severe chest pain Weight loss dry cough Fever Chills Sweating Malaise
What investigations are done in order to diagnose empyema ?
CXR
Ultrasound
History
Blood culture
How is empyema treated ?
IV antibiotics
Chest drain sometimes
Surgery to remove a lung abscess which might cause an empyema
What are the differential diagnosis for empyema ?
MI
Pleural effusion
Pneumonia
Lung abscess
Describe what coronaviruses are
Family of viruses which have a crown like spikes on there surface and contain RNA
What type of coronaviruses is COVID -19 ?
Beta coronaviruses
What kind of transmission does COID -19 have ?
airborne and droplet transmission
What is the incubation period for COVID -19 ?
1-14 days
How is the transmission of COVID -1 9 measured ?
R number
What are the signs and symptoms of covid 19 ?
Cough Loss of taste and smell Headache fever fatigue
What are some of the treatments for COVID -19 ?
Steroids (Dexamethasone)
Supportive therapy
What is an endemic ?
the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area
what is an epidemic ?
an sudden increase in the number of cases of a disease above what is normally expected in tat population in that area
What is a outbreak ?
same definition of epidemic but is often used for a more limited geographic area
What is a pandemic?
an epidemic that has spread over several countries or continents usually affecting a large number of people
What is herd immunity ?
Herd Immunity is when the population as a whole in immune to a condition (ruffly 94% of a population)
What is a pleural effusion ?
A collection of fluid in the pleura
What causes a pleural effusion ?
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.
What are the names of the two types of effusion ?
Transudate
Exudate
What is a transudate effusion ?
A non-inflammatory effusion where there is a low protein content in the fluid
What is a exudate effusion ?
A inflammatory effusion where there is a high protein content in the fluid
What are the most common causes a transudate effusion ?
Left ventricular failure
Liver cirrhosis
What are the most common causes an exudate effusion ?
Malignancy
Parapneumonic effusion
Empyema
TB
What is the rule of thumb about the protein content of exudate vs transudate ?
Protein content > 3g then exudate
What is ‘lights criteria’ used for ?
Determining if it is an exudate or transudate effusion
Describe lights criteria
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
What are the risks factors for pleural effusion ?
Recent lobar pneumonia
What are the signs and symptoms of pleural effusion ?
Dyspnoea mainly
cough
pleuritic chest pain
What investigations are carried out to explore pleural effusion ?
Ultrasound
CXR
CT thorax
fluid sample
What does biochemistry do with a sample ?
analyse proteins
What does microbiology do with a sample ?
check for bacteria, viruses etc
What does cytology do with a sample ?
check for abnormal cells
What are the differential diagnosis of a pleural effusion ?
Pleural thickening
Pulmonary collapse
Consolidation
elevated diaphragm
What is the treatment for pleural effusion ?
treat underlying cause
What is the spirometry of a restrictive lung disease?
> 80%
What is a restrictive lung disease?
Lungs have poor compliance, and struggle to fill with air
What is an interstitial lung disease ?
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
What is the name of the most common interstitial lung disease ?
Sarcoidosis
What are the signs and symptoms of sarcoidosis ?
SOB which hasn’t responded to inhalers
dry cough
Erythematosus Around scars or tattoos
red inflamed eyes
What investigations are used to diagnose sarcoidosis ?
High resolution CT gold standard CXR Serum Ca++ ACE Pulmonary function test
How is sarcoidosisd treated ?
Corticosteroids
NSAIDs
Topical steroids
What is sleep apnoea ?
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
What is apnoea ?
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
Risk factors for sleep apnoea ?
Obesity
Hypertension
Alcohol
Endocrine disorders
What are the signs and symptoms of sleep apnoea ?
Heavy snoring
Tiredness
Unrefreshing sleep
poor concentration
What are the investigations used for sleep apnoea ?
Epworth questionnaire study
Overnight sleep study
How is sleep apnoea treated ?
Reducing risk factors
CPAP
Mandibular repositioning splint
Which organisation will you as the doctor need to contact if you diagnose someone with sleep apnoea ?
The DVLA the patient that they are not allowed to drive. However once’s conditions are managed then they can drive again.
What are sleep apnoea patients are an increased risk of?
risk of stoke, heart disease and a car accident.
What is narcolepsy ?
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.
What are the risk factors of narcolepsy ?
Family history (as it sometimes runs in families but normally it occurs in patients with no previous history of narcolepsy)
Does most cases of narcolepsy family related ?
no
When dose narcolepsy first present ?
Early in life
What are the symptoms of narcolepsy ?
Cataplexy
profound sleepiness through the day, sometimes hypnagogic/hypnopompic (consciousness between sleep states) hallucinations and sleep paralysis.
How is narcolepsy investigated ?
PSG
MSLT
What are key characteristics of narcolepsy ?
go to sleep and if they manage to do this within 6 minutes
often they will also enter REM sleep immediately
What is the treatment for narcolepsy ?
modafinil, dexamphetamione, venlafaxine, and sodium oxybate
What is chronic ventilatory failure ?
when there is an inability to exchange gas which is chronic (Vs respiratory failure which is acute)
What are some of the risk factors for choric ventilatory failure ?
Conditions which can cause it: i.e. COPD Bronchiectasis Chest wall abnormalities Motor neuron disease Muscular dystrophy obesity
What are the signs and symptoms of chronic ventilatory failure ?
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.
What investigations are carried out to help diagnose chronic ventilatory failure ?
Lung function tests
Assessment of hypoventilation
What is the treatment for chronic ventilatory failure ?
cure is not possible
domiciliary non-invasive ventilation
oxygen therapy
What is laryngomalacia ?
When there is a floppiness in the larynx
What kind of patient is laryngomalacia often seen in ?
Kids
What are the signs and symptoms of laryngomalacia?
Stridor
Worse when feeding or upset or excited
How is laryngomalacia treated ?
Normally gets better itself within the first year of life
What is tracheomalacia ?
When there is a floppiness in the trachea
What are the signs and symptoms of tracheomalacia ?
Barking cough
Recurrent croup
Breathlessness on exertion
Stridor/wheeze
How is tracheomalacia treated?
Often no intervention.
Sometimes antibiotics if there is a bacterial infection
Physiotherapy sometimes if not improving
What is a tracheoesophageal fistula?
an abnormal connection (join) between the trachea and the oesophagus.
What might co-exist with a tracheoesophageal fistula ?
An atresia
What causes a tracheoesophageal fistula?
Genetics
it is a congenital disorder
How does a tracheoesophageal fistula appear?
Chocking,
colour change
cough with feeding
unable to pass NG (feeding tube)
How is tracheoesophageal fistula treated ?
Surgery
What are some complications of a tracheoesophageal fistula ?
Tracheomalacia
Strictures
leak
reflux
What is respiratory distress syndrome ?
Occurs in premature babies and is when there is an insufficnely of surfactant. (Which is not fully in place until 36 weeks)
How is IRDS treated?
Antenatal steroids
Surfactant replacements
Appropriate Ventilation
Appropriate Nutrition
What is a pulmonary embolism ?
Occurs when there is something sitting in the pulmonary ciruclation to the lungs and preventing the normal flow of blood.
What is the most common embolise in a PE ?
A clot which have broken off from a DVT.
What are risk factors for a PE ?
Recent major trauma Recent surgery Cancer Significant cardiopulmonary disease pregnancy inherited thrombophilia Anything which alters Virchows Triad
What is the inherited condition which increased your PE risk called?
inherited thrombophilia
How can the probability of a PE having occurred be measured ?
Wells Score
Revised Geneva score
Draw out the Wells Score
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
What are the signs and symptoms of pulmonary embolism ?
Pleuritic chest pain Isolated acute dyspnoea Tachycardia Hypoxia Hypotension Evidence of thrombosis
What are some investigations used to diagnose PE ?
CXR ECG CT pulmonary angiogram V/Q perfusion scan D-Dimer Echocardiogram
Describe a simple algorithm of how to diagnose PE
Draw it
How is pulmonary embolism treated ?
General treatment (oxygen, fluids)
Anti-coagulation (Low Molecular Mass Heparin = Dalteparin and Warfarin and oral anticoagulants)
Thrombolysis (Alteplase)
Surgery (Pulmonary embolectomy)
What does the prognosis after PE depend on ?
Size
Age
co-morbidity
What is pulmonary hypertension ?
Elevated blood pressure in the pulmonary arteries.
What BP number means that someone have pulmonary hypertension ?
Mean arterial pressure > 25mmHg
What causes pulmonary hypertension ?
Underlying conditions most often i.e. lung cancer or respiratory disease or thromboembolic
What are the signs and symptoms of pulmonary hypertension ?
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
How is pulmonary hypertension investigated ?
ECG Lung function test CXR Echocardiography (Gold standard !!!!) Right heart catheterisation (for direct measurement)
What is the prognosis of pulmonary hypertension
Gets progressively worse
How is pulmonary hypertension treated ?
Treat underlying condition Oxygen Anticoagulation and diuretics (increased urine) CCB Prostaglandins Endothelin receptor antagonists Thrombo-endarterectomy Heart/lung transplant Phosphodiesterase inhibitors
