respiratory_diseases_20190518182909 Flashcards
what is coryza
acute viral infection of nasal passage spread by direct (droplets) or indirect (door handle)
what is cause of coryza
200+ viruses mainly rhinovirus and coronaviruses
what is diagnosis of coryza
symptoms based
how is coryza treated
self care
what is the symptoms of coryza
blocked nosenasal pain and irritation runny nosecough hoarse voice sore throat (pharyngitis)mild fever?
what is complications of coryza
sinusitis (frontal or maxillary)acute bronchitis
what is it preceded by
coryza
what are symptoms
purulent nasal discharge and tender sinuses
how is it diagnosed
symptoms based
how is it treated
paracetamol decongestant no antibiotics
what are different kinds of decongestant
a adrenic agent eg phenylephrine
what is it
irritated and inflamed bronchi preceded by coryza
what are the causes
influenzacommon cold virus
what are the symptoms
hacking productive cough with thick yellow-grey sputum tightness in chest transient wheeze slight fever
how is it treated
home care - fluids etc
when are antibiotics given and which ones
if vulnerable 1st line - amoxicillin 2nd line - doxycycline
what are complications
pneumonia bacterial infection with strep pneumoniae or H.influenzae is common sequel esp in smokers/COPDmay cause respiratory acidosis
what is normally found on examination in an acute exacebation
crackles, cyanosed, oedema, wheeze, dyspnoea
what is treatments of acute exacerbation
said antibiotics, bronchodilator inhalers, short course of steroids
what is it
inflammation and swelling of epiglottis normally in children medical emergency
what are the symptoms
temp 38+severe sore throatdifficulty breathing abnormal and high pitched breathing dysphagia
what is cause
H. influenza bacteria
how do diagnose it
laryngoscopy blood test - WBC and bacteria
how is it treated
urgent endotrachael intubation IV broad spectrum antibiotics (ceftazidime, ceftriaxone)
how to prevent it
vaccination during childhood
what is the incubation time
1-4 days then abrupt onset of symptoms
what is causes
influenza A - worldwide pandemicsinfluenza B - localised, milder outbreaks
what is symptoms
temp >38dry, chesty cough headache malaise chills and aching limbs myalgia upset stomachclear nasal discharge
how is it diagnosed
symptoms based lab not necessary but fourfold increase in haemagglutinin
how is it treated
bed rest and paracetomal for risk >65 use neumanidase inhalers
what are the names of these inhalers
oscitamivar oral zanamiviar inhaler
what are the complications
death primary viral pneumonia (haemoptysis, resp failure in 24 hours)secondary bacterial pneumonia (H. influenza - new fever on day 7)
what is it
infiltration of small airways and alveolar walls with neutrophils followed by T lymphocytes and macrophages - leads to non-caseating granulomas
what type hypersensitivity is it
type IV (or III)
what are the different causes
farmers lung - mouldy hay malt workers lung - whiskey bird fanciers lung - pigeons mushroom farm workers - turning mushroom compost drugs eg gold, bleomycin, sulphasalazine
what are acute symptoms
fever (pyrexia)rigors myalgia dry cough dyspnoea crackles (no wheeze)malaise
what are chronic symptoms
increasing dyspnoea weight lossexertional dyspnoea type 1 resp failure cor pulmonale
how is acute EAA diagnosed
blood - FBC (neutrophilia), ESR (up), ABGCXR - upper zone consolidationLFT - reversible restrictive, reduced gas transfer during attack
how is chronic EAA diagnosed
blood - positive serum precipitantsCXR - upper zone fibrosis, honeycomb lung LFT - persistent changes BAL - increased lymphocytes and mast cells
how is acute EAA treated
remove allergen give O2oral prednisolone
how is chronic EAA treated
allergen avoidance long term steroids
what is it
infectious disease of resp tract type 4 hypersensitivity - caseating granulomas and caseous necrosis
what happens during primary exposure (1st time)
affects hilar lymph nodes granulomatous due to immune activation
what happens during secondary exposure (2nd time)
fibrosing and cavitating apical lesions due to overactive T cell response this is the reactivation of latent TB
what are causes
mycobacterium tuberculin m. bovis
what are resp symptoms
cough haemoptysisupper lobe crackles dyspnoea
what are GI symptoms
peritonitis perforationbowel obstruction pain
what are spinal symptoms
pain deformity paraplegia
what are meningeal symptoms
drowsy headache fits
what are other symptoms
renal failure weight lossnight sweats lymphodenopathy and cold abscess pericardial temponade septic athritis and hypoadrenalism
how is it diagnosed
CXR and ZN stain of sputum for acid and alcohol fast bacilli
what does CXR look like
upper lobe prominance, cavity formation, tissue destruction, scarring and shrinkage, heals with calcification
when does the CXR contain bilateral infiltrates and reticulonodular shadowing
presence of ARDS/miliary TB - result of tubercle bacilli in blood stream
what is treatment
2 months RIPE (rifampicin, isoniazid, pyradizamide and ethambutol)4 months RI
what is side effect of rifampicin
stains fluids pink/orange break opiate and steroids (the pill)rarely hepatitis
what is side effect of isoniazid
polyneuropathy
what is side effect of pyradizamide
hepatic toxicity, reduces renal excretion of urate and may precipitate gout
what is side effect of ethambutol
optic neuritis, red/green colour blindness
how can it be prevented
BCG vaccine - reduces risk by 70% contact tracing
what is latent TB
symptom free, granulomas, -ve cultures, leave alone
what reactivates latent TB
steroids, immunosuppression and anti-TNF
what is anti-TNF
used to treat rheumatoid athritis, crohns, psoriasis, alkylasing spondylitis if have latent TB - give 6 months of I or 3 months of RI before starting anti-TNF
what is it
inflammation of one of both of lungs normally due to infection
what causes strep pneumoniae (community)
found worldwide - most common cause
what causes staph aureus (community)
recent flu, IV drug user
what causes mycoplasma pneumonia (community)
older kid, young adult
what causes legionella (community)
traveller - bad water
what causes gram negative enterobacteria (community)
alcoholic
what causes bordatella pertussis (community)
whooping cough / broncho pneumonia
what causes haemophilus influenzae (hospital)
atypical, nursery workers, COPD
what causes coxiella burnetti (hospital)
Q fever - sheep, goats, cattle, farm
what causes chlamydophilia pstaci (hospital)
pet birds
what causes klebsiella pneumoniae (hospital)
common in alcoholism, diabetes and chronic lung disease
what are other causes
viral (RSV, measles)aspiration fungal (aspergillus - chest infection become pneumonia)chlamydia pneumoniae (person to person)PCP (immunosuppressed patients)
what are the symptoms
cough dyspnoea tachypnoea fever rigors sweats pleuritic pain myalgia malaise arthralgia preceding UTIdiarhhoea headache haemoptysis AFconfusion sputum after 24 hours
what are the signs
fever rigors pleural rub cyanosis hypotension tachypnoeapleural effusion
what would be found upon examination
crepitations dull percussion consolidation tactile vocal fremitus
what other tests are taken to diagnose it
serologyblood culture CXR, ABC, FBC, U&Es, LFTssputum culture
what are severity markers
temp <35 or >40cyanosis - PaCO2 <9WBC - <4 or >30multi lobar involvement
treatment is dependent on CURB65 score - what is this?
confusion - 1 point Urea >7 - 1 point BP<90 or <60 - 1 point RR <30 - 1 point Age >65
community acquired treatment with CURB65 score of 0-2 (mild)
amoxicillin 5 days or doxycycline or IV clarithromycin if NBM
community acquired treatment with CURB65 score of 3-5 (severe)
co-amoxicillin IV and doxycycline allergic - IV levofloxacin
community acquired treatment if in ICU/HDU or NBM
co amoxiclav and clarithromycin allergic - IV levofloxacin
hospital acquired treatment if severe
amoxicillin IV and metrondiazole and gentamicinstep down to co-trimoxazole and metrondiazole allergic - IV co-trimoxazole and metrondiazole +/- gentamixin
hospital acquired treatment if non severe
PO amoxicillin and metrondiazole
what are complications
empyema lung abscess septicaemia
how do you prevent it
pneumonia and flu vaccine smoking cessation treat alcohol misuse
what is it
childhood condition (<3 most affected), commonInflammatory oedema extends to vocal cords and epiglottis causing narrowing
what are symptoms
initial cold symptomsstridorbark like cough hoars croaky voice
what causes it
parainfluenza virus
how is it diagnosed
symptoms based
how is it treated
oral/IM steroid (dexamethasone)nebulised adrenaline - short term relief
what are complications
airway obstruction secondary infectionother complications
what is it
restrictive, occupational diseasegranulomatous and fibrotic changes Increases risk of infection
what are causes
15-20 years quartz exposure eg granite, stone, mine, boiler, glass, foundry workersinhalation of silica (silicon dioxide)
what are symptoms
cough and dyspnoea
what are signs
finger clubbingpleural effusion?
how is it diagnosed
CXR- egg shell calcification of hilar nodes, pulmonary fibrosis, upper lobe shadowing more than lowerPFT - restrictive - FEV1 and FVC reduced, ratio normal/raised
how is it treated
palliative
complication
TBpulmonary hypertension heart failurearthritis kidney disease COPDlung cancer
what is it
granulomatous disease of unknown cause
what is a granuloma
mass or nodule composed of chronically inflamed tissue formed by response of mononuclear phagocyte system to insoluble or slowly soluble antigen
what type of hypersensitivity
type 4
what systems commonly involved
lungs, lymph nodes, joints, liver, skin, eyes
what are symptoms of acute sarcoidosis
sweats erythema nodosum (skin lesion)
what are symptoms of chronic sarcoidosis
lung infiltrates/alveolitis (scarring)skin infiltrates peripheral lymphadenopathyhypercalcaemia SOB persistent dry cough rashes on body
how is it diagnosed
CXR - bilateral hilum lymphadenopathy CT - check for peripheral nodular infiltrates Bloods - raised calcium and inflammatory markers Restrictive PFT
what is treatment of acute sarcoidosis
usually do not need specific treatment paracetamol anti-inflammatory
what is treatment of chronic sarcoidosis
oral steroid (prednisolone) immunosuppression (azathioprine, methotrexate)
what is it
imbalance in fibrotic repair system of lungs = lay down unrequired scar tissue chronic inflammatory infiltrate (neutrophils) causes fibrosis in alveolar walls and macrophages
what does it cause increased risk of
infection
prevalence
more common in males
causes
idiopathic
secondary causes
rheumatoid, SLE, system scleorisis, asbestosis, drugs
symptoms
progressive exertional dyspnoea dry cough
signs
clubbing bibasal crackles on auscultation dry cough
diagnosis
CXR - bilateral infiltrates, fine inspiratory crackles HRCT - bilateral lower zone fibrosis/shadowing - ground glassrestrictive PFT and low TLCO
treatment
oral steroids immunosuppressants (azathioprine)O2 if hypoxic pulmonary rehab lung transplant in young patients
complications
respiratory failure most patients dead in 5 years
what is it
restrictive, occupational disease causing granulomatous and fibrotic and restrictive changes major scarring acts like tumour and destroys lung
prevalence
now quite rare, often associated with COPD
what does it increase risk of
infection
causes
inhalation and retention of coal dust in lungs
symptoms
often asymptomatic when gets to massive fibrosis - cough, tight chest, SOB
signs
clubbing
diagnosis
CXR - upper lobe recticular shadowing / fibrosis Lung function not impaired
what is treatment
palliative - O2 and pulmonary rehab
complications
caplan’s syndrome (rheumatoid athritis + coal + nodules which cavitate)chronic bronchitis (coal + smoking)
what is it
pleural disease (fibrosis) affecting lung lining and lung base progressive - latent period after exposure
what causes it
heavy prolonged asbestos exposure (5 years of daily exposure)
what are affects of asbestos exposure
benign pleural plaques benign asbestos pleural effusions diffuse pleural thickening acute asbestos pleuritis malignant mesothelioma
what is malignant mesothelioma
incurable pleural cancer which can invade chest wall - fatal in 2 years and almost always from asbestos exposure
what are symptoms of malignant mesothelioma
chest pain, PE, sweating, dyspnoea
what are signs of asbestosis
breathlessnessfinger clubbing
how is it diagnosed
pleural fluid aspiration - low cytological yieldCXR and CT - effusion, nodularity, local invasion, lung entrapment, upper love fibrosis biopsy - asbestos fibres sputum culture - asbestos bodies
what is treatment
no treatment known to alter course of disease pulmonary rehab and O2 therapy corticosteroids often prescribed
what is it
intermittent upper airway collapse in sleeprecurrent sleep arousal
what are symptoms
excessive daytime sleepiness personality change cognitive impairment major impact on daytime function
what are causes
obesity enlarged tonsils stroke MSopiates alcohol
how is it diagnosed
overnight sleep study (oximetry, airflow, thoracic movement monitored, full polysomnography) epworth sleepiness score (normal <10/24)
how is it treated
correction of treatable factors CPAP - delivered by nasal mark during sleep mandibular advancement device (gum shield - improves snoring) surgery - scar up back of throat to make tougher and resist collapse
what are complications
raised CRPimpaired endothelial and glucose function independent risk factor for hypertension
what are types of non-small cell lung cancer (majority)
squamous cell carcinoma adenocarcinoma large cell carcinoma
what is characteristics of squamous cell carcinoma
hypertrophic pulmonary osteoarthropathymost commonly cavitates
what is characteristics of adenocarcinomas
most common type usually peripheral in bronchi
what is the characteristics of large cell carcinoma
typically peripheral, poorly differentiated tumours with poor prognosis, may secrete beta HCG
what is characteristics of small cell lung cancer
arises from endocrine cells hormones secreted: ADH and ACTHspreads early and almost always inoperable
what kind of state does malignant cancer (especially adenocarcinoma) cause
hypercoaguable state
what is symptoms
cough that lasts >2-3 weekslong standing cough that gets worse haemoptysis unexplained dyspnoea malaise weight loss persistent chest pain/shoulder pain
what are less common symptoms
clubbing, hoarse voice, difficulty or pain swallowing, increased risk of infection
what causes it
smoking passive smoking occupational exposure
how is it diagnosed
CXR CT for small tumours and mediastinum (then biopsy)FBC for anaemia Urinanalysis
how to treat non small cell lung cancer
surgerychemotherapy radiotherapy targeted agents
how to treat small cell lung cancer
chemotherapy, palliative care
what is common sites of metastases
kidneyprostatebreastboneGI tractcervix or ovary
what is it
hyperplasia of smooth muscleoedema accumulation increased mucus secretion bronchoconstriction chronic airway inflammation (eosinophilic)airway remodelling
what type hypersensitivity
type 1
when does it come on
it is an episodic reversible bronchoconstriction early or late onset
what are intrinsic causes
exercise, cold
what are extrinsic causes
drugs, chemical, smoke, pollen, dust, animal dander, fungi, viral infection
what are symptoms
dyspnoea tight chest wheezing non-productive cough diurnal variationnon-progressiveepisodic/intermittent
how is it diagnosed
salbutamol reversibility >15%diurnal variation in peak flow rate normal gas exchange reduced FEV1 to under 75%preserved FVC and TLCOprovocation testing - exercise or allergen may find crackles if infection
1st line treatment
SABA (salbutamol)
2nd line treatment
low dose ICS (beclomethasone, budesonide, prednisolone)
3rd line treatment
add LABA (salmeterol) to low dose ICS
4th line treatment
leukotriene receptor antagonist (monteleukast)Xanthines (theophylline)LAMA (tiotropium)
5th line treatment
consider increasing ICS up to high dose or addition of fourth drug eg LTRA, xanthine or LAMA - refer to specialist
6th line treatment
use daily steroid tablet in lowest dose providing adequate controlmaintain high dose ICS and consider other treatments to minimise use of steroid tabletsrefer to specialist
what is COPD split into
chronic bronchitis and emphysema
what is chronic bronchitis
chronic irritation, defensive increase in mucus production and epithelial cell numbers (especially mucus glands) non-reversible obstruction (some may have reversible asthmatic component)
what is emphysema
tissue destruction in the alveoli leading to loss in alveolar walls and increase in size of airspaces distal to terminal bronchiole (without fibrosis)
what causes it
smoking passive smoking fumes dust
what are symptoms
develop over number of yearsincreasing breathlessnesspersistent cough with sputum frequent exacerbationswheezing weight lossmalaise swollen anklesincreased infection risk
how is it diagnosed
spirometry - decrease in PERF, FEV1, FVC and TLCOFEV1/FVC <75%FEV1 response to B2 <15%CXR - lung infiltrates if infectionBlood test - rule out other causeSputum culture - grow organism causing exacerbation
1st line treatment
SABA (salbutamol)or SAMA (ipratropium)
2nd line treatment (if FEV1>50%)
LABA (salmeterol)or LAMA (tiotropium) and discontinue SAMA
3rd line treatment (if FEV1<50%)
LABA (salmeterol) plus ICS (becomethasone, budesonide, prednisolone)or LAMA (tiotropium) and discontinue SAMA
4th line treatment
LAMA (tiotropium) plus LABA (salmeterol) plus ICS
5th line treatment
if patient has 2 or more exacerbations in 12 months despite triple therapy, PD4 receptor antagonist (roflumilast) used
what is used in acute exacerbation
oral corticosteroids (prednisolone) and antibiotics
1st line antibiotics?
doxycycline / amoxicillin
2nd line antibiotics?
clarithromycin, moxifloxacin, (AND IV aminophylline (methylxanthine))
what is it
excess fluid between layers of pleura
what are symptoms
worsening dyspnoea coughpleuritic pain
what are signs
wall movement - reduced unilaterally percussion note - stony dullbreath sounds - absent but bronchial superior to effusionvocal fremitus - absent
what is causes of exudative pleural effusion (protein more than 30g/l)
neoplasma PEinfections
what is cause of transudative pleural effusion (protein less than 30g/l)
LVFcirrhosis
what are other causes
congestive heart failure pneumonia renal failure cancer autoimmune (SLE)
how is it diagnosed
symptoms and signs CXR - >300 fluid, changes range from obliteration of costophrenic angle to dense homogenous shadowsCTpleural biopsy
what is treatment
thoracentesis symptomatic reliefpleurodesis (adhesion of pleural membranes)
what are complications
empyema subcutaneous emphysems haemorrhage vagus nerve irritation
what is it
abnormal and permanently dilated airways the mucocilary transport mechanism is impaired and frequent bacterial infections ensure
what causes it
severe childhood infection cystic fibrosis immunodeficiency
what are signs
cough production of large amount of sputum and dilated and thickened bronchi clubbing breathlessnesshaemoptysis can occur
how is it diagnosed
exam - coarse crackles at base on inspiration CXR - mid zone tram lines, dilated bronchi CT - bronchial dilation
how is it treated
damage cant be repaired so basis of management is to prevent or slow down further deterioration antibiotics may be needed bronchodilators useful in those with airflow limitation
what antibiotics
amoxicillin, clarithromycin, erythromycin, doxycyline if allergic erythromycin in pregnancy and breast feeding
what is it
collection of air in pleural space resulting in collapsed lung
what are primary cause
normal lungs then apical bullae rupture
what is secondary cause
pre-existing lung diseases eg smoking, severe asthma, COPD, marfans
who is it common in
those with existing respiratory conditions, cannabis users, smokers and tall, thin men
what are symptoms
sudden onset of pleuritic pain SOBtachycardia
what are signs
hyper-resonant percussion note reduced expansion quiet breath sounds on auscultation hamman’s sign (click on auscultation at left side)
how is it diagnosed
CXR - small <2cm rim of air, large >2cmABG - hypoxia
treatment if <20%
observe, air will usually reabsorb
treatment if 20-50%
needle aspiration using 16-18G cannula sited in 2nd IC space, mid clavicular line
treatment if >50%
chest drainage - intercostal small bore drain in 5th IC space, mid auxillary line
treatment if recurrence
pleurodesis/pleurectomy
what is the follow up
CXRdiscuss flying and diving (not for 6 weeks)general recurrance risk smoking cessation
what is tension pneumothorax
medical emergencycan lead to cardiac arrest due to one way valve mechanism (between pleural layers) resulting in increased pressure in pleural space
what is signs of tension pneumothorax
tracheal deviation mediastinal shift to opposite side hypotension raised JVPreduced air entry
what is treatment of TP
O2 and needle compression usually with large bore venflon in 2nd intercostal space
what is seasonal rhinitis
hayfever
what is perennial rhinitis
symptoms throughout full year, sinusitis occurs in about 50% of cases due to mucosal swelling
what is perennial allergic rhinitis
allergy to faecal particles of dust mite - more sensitive to cigarette smoke, washing powders, perfumes etc
what is vasomotor rhinitis
perennial rhinitis with no allergy or nasal eosinophilia
what are nasal polyps
round smooth soft pale or yellow structures attached to sinus mucosa - occurs in patients with allergic and vasomotor rhinitis
what causes it
mucus - parasympathetic stimulation allergic rhinitis results due to interaction between inhaled allergen and IgE present on their mast cells (found in increased numbers in nasal secretion)
how is it diagnosed
history of allergic factors skin prick test indicates mechanism leading to allergic rhinitis
how is it treated
H1 receptor antagonists (eg loratadine, cetirizine, fexofenadine, cyclizine, cinnarizine)Decongestants (a adrenergic agents) Corticosteroids (beclomethasone or fluticasone propionate - polyps) Leukotriene antagonists (montelukast, zarfirlukast - esp history of NSAID or asthma)Anti-allergic (sodium cromoglicate)
what is it
alteration of viscosity and tenacity of mucus
what is genetics of it
autosomal recessive, 1 in 25 people carry CFTR gene
what are respiratory effects
commonest cause of recurrent bronchopulmonary infection in childhood
what is GI effects
85% of patients have steatorrhoea (excretion of fat with faeces) due to pancreatic dysfunction or insufficiency
what are other symptoms
biliary diseasehigh sodium sweatmalnutrition puberty and skeletal maturity delay males almost always infertile
how is it diagnosed
sweat test confirms in 98%molecular test for CFTR genesinux XR/CT - show opacification of sinuses CXR or CT thorax
how is it treated
symptomatic G551D - Ivecaftor F508Del - lumacaftor
what are complications
most of morbidity due to respiratory disease eg bronchiectasis, progressive airflow destruction, cor pulmonale, death
what is it
rare autoimmune disease in which antibodies attack basement membrane in lungs and kidneys lead to bleeding from lungs and kidney failure
what are symptoms
symptoms of URTIfollowed by cough intermitten haemoptysis tirednessanaemia
how is it diagnosed
CXR - transient blotchy shadows due to intapulmonary haemorrhage
how is it treated
some patients spontaneously improve whilst others proceed to renal failure treat with corticosteroids
