Respiritory Flashcards
1
Q
COPD definition
A
A progressive obstructive disease characterised by persistent airflow limitation and often caused by smoking.
2
Q
COPD epidemiology
A
- Elderly (>45)
- Smokers
- Males
- CV disease, cancer, renal failure, DM, weight loss, depression, anxiety
- Chronic bronchitis - long term inflammation of the bronchi, often leads to reoccurring lung infections.
Emohysema enlarged airspaes distal to terminal bronchioles with dstruuction of alveolar walls
3
Q
COPD risk factor
A
- Tobacco smoking
- Over 45
- Air pollution
- Dust, coal, cotton, cement and grain exposure occupationally
Alpha 1 trypsin deficiency
4
Q
COPD path
A
- Poos VQ match
- Low PaO2
- Obliteration and vasoconstriction
- The central receptors start to rely on O2 not CO2 for respiratory drive leading to a reduced reps rate if oxygen is given
- COPD is a combenatino of emphysema and bronchitits
- Emphysema - loss of alveolar integrit die to imbalcne of protease inhibitors triggerd by chronic inflamaiton
- Bronchitis - increased mucus secreion secondary to cillary dysfunction cauing parenchymal destircution and imparied exchange
- The FVC is loweres, the FEV1 is massivly lowers and the FEV1:FVC is lowerd
Here is VQ mismatch due to mucus plugging the smaller airways and the closure of airways due to emphysema, this leads to PaO2 decreass and incerased resp rate.
5
Q
COPD signs
A
- Tachycarida
- Barrel chest
- Hyperresonance/percussion
- Quiet breath sounds and wheeze
- Pursing of lips on expirarion
- Cyanosis
- Tar staining of fingers
- Loss of cardiac dullness
- Downwards displacement of liver due to hyperexmapnsion of lung s
- Dyspnea, wheeze cough
- Pyrexia
Cor pulmonale -peripheral oedema
6
Q
COPD symtpms
A
- Dyspnea
- Productive cough
- Wheeze
- Chest tightness
- Weight loss
- Co2 retention causing drowsiness, asterixis and confusion
7
Q
COPD test
A
- Clinical presentation if they are over 35, smoker and have 1 or more symptom, diagnose
- Spirometry FEV1/FVC<0.7, this is not improved by use of a bronchodilator
- Chest x-ray- flattened diaphragm, hyperinflation and bullae (emphysematous space >1cm
- FBC - COPD can result in secondary polycythaemia or eosinophilia might be present
- BMI as a baseline to later asses for cancer, or weight gain due to steroids
Classifications:
* GOLD - severity of obstruction classification based on what % of the FEV1 they fulfil compared to the predicted. There are 4 stages going from mild to very severe. Mild is >80 % and very severe is <30%
8
Q
COPD differential
A
- Asbestososis
- Lung cancer
- Pulmonary empbolsim
- Asthma
Heart failure
9
Q
COPD tx
A
- Smoking cessation - nicotine replacement, bupropion and varenicline
- Pulmonary rehabilitation
- Vaccinations - one off pneumococcal and annual influenza
- Good diet and obesity
- Bronchodilators - SABA (salbutamol) SAMA (short acting muscarinic antagonist - ipratropium) LABA (long acting beta agonis - salmeterol) LAMA (tiotropium)
- Combination of beta-2-agonists and an anticholinergic inhaler
- ICS - inhaled corticosteroid
- Gold group A (>80%) - SABA or LABA
- B (50-79%) - LABA or LAMA
- C (230-49%) - LAMA
- D (<30%) - LAMA or LABA+LAMA or LABA +ICS
- If dyspnoea persists keep adding until its LABA +ICS + LAMA
- Nebulisers
- Theophylline - bronchodilation
- Oral mucolytic therapy - to break down sputum
- Prophylactic antibiotic - azithromycin
- Phosphodiesterase 4 inhibitors - decreases airway inflamation
- Oxygen therapy
- For cor pulmonale - furosemide and long term oxygen therapy
10
Q
COPD complications
A
- Pnumothorx - due to bulla formaiton
- Cor pulmonale
- Pulmonary hypertension (chroinc hypoxia leading to vasoconstrition)
#infections
11
Q
COPD exacubation what is it
A
- An exacerbation is an acute worsening of symptoms such as cough, SOB, sputum production and wheeze
- Caused by infection or hear failure or pulmonary embolism or medication such as beta blockers
- Treat with prednisolone, antibiotics, physiotherapy for the sputum
- Doxapram can be used as a respiratory stimulent
- Intubation and ventilation in severre cases
12
Q
Asthma deinition
A
- Chronic inflammatory airway disease caused by airway obstruction and hypersensitivity
- Commonly starts between 3-5 and peak prevalence is 5-15
13
Q
Asthma epidemiology
A
- ATOPY - eczema, rhinitis, allergy
- Family history
- Allergens
- Viral upper resp tract
Cold weather exercise, medications (BB and aspirin)
14
Q
Asthma path
A
- Excessive reaction from Th2 cells
- Allergens are environmental tiggers such as cigarette smoke and are presented by dendritic cells which produces cytokines
- This causes IgE antiboy production and stimulates histamine production as well as leukotrienes and prostaglandins
- This causes the smooth muscle to spasm and increased mucus secretion
- There is increased vascular permeability to allow more WBCs in
- Over the years there is thickening of epithelial basement membrane which permanently reduces airway diameter
- Genetic and environmental factors causes of asthma
- Genetic susceptibility predisposed patients to hyperresponsiveness, such as virlal infections, allergises, cold and exercise
15
Q
Asthma sign
A
- Diurnal peak expiratory flow rate - worse at night and early morning
- Dyspnoea and expiratory wheeze
Samters triad - nasal polyps, Aspin insensitivity, asthma
16
Q
Asthma symptoms
A
- Episodic SOB
- Dry cough
- Wheeze and chest tightness
- Sputum
History of exposure to a trigger
17
Q
Asthma test
A
1st line test
- Fractional exhaled nitic oxide - >50ppb is positive in adults
- Spirometry - FEV1/FVC <70 if obstruction.
- If positive Bronchodilator reversibility should be carried out - this is an improvement of FEV1 by >125 and increase in >200ml in volume post bronchodilator
18
Q
Asthma treatmetn
A
Treatment
- Step one - SABA
- Step 2 (if patient is not controlled on 1 or has symptoms >3x weekly/night waking) SABA + low dose ICS
- Step 3 - SABA +low dose ICS + LTRA (leukotriene receptor antagonist (Montelukast))
- MART - maintenance and reliver therapy s a combined fast acting LABA and ICE for symptomatic relief and maintenance in a single inhaler
- Yealy flu jab
- Avoid smoking
- Exercise
19
Q
Asthma complications
A
Complications
- Exacerbations - triggered by a urti/pneumonia
- Pneumothorax
- Oral thrush - steroid medication
20
Q
TB definition
A
Definition
Granulomatous disease caused by mycobacterium tuberculosis
21
Q
TB RF
A
Risk Factors
- Contact with people with active TB
- Homelessness
- Alcohol/drug abuse
- Immunocompromised
- Silicosis - impaired macrophage functions
22
Q
TB path
A
Pathophysiology
- Macrophages find it harder to clear M tuberculosis because of its mycolic acid capsule wihc offers protection
- TB bacteria are slow dividing and have high oxygen demands
- It is spread in respiratory droplets from patients with active disease and can remain asymotomatic in immunocompromised patient s(latent)
- In immunocompraminsed patines it can reactivate and become secondary, then spread and become miliary
- Primary - focal causeating granuloma typically forming in the lower lobe (a ghons focus). This si atype 4 hypersensitivity reactions. A ghon complex will hold the infection untill a patainet become immunocompramised
- Latent - patinet remains asymptomatic and causes negative sputum tests put a positive Mantoux test
- Secondary - immunocompramised patinet may develop secondary TB when latent TB reactivates resulting in clinical features such as haemoptysis and fever. Patines are infection snad this normally occus in the apex where pO2 is the highest
- Miliary - lymphohematogenous spread to multiple organs - heart lungs, spleen, liver, bone marrow.
23
Q
TB signs and symptoms
A
Signs
- Auscultations MAY produce crackles
- Clubbing if long standing
Symptoms
- Cough
- Haemoptysis
- Fever
- Legarthy
- Weight loss
- Night sweats
- Lymphadenopathy
- TB meninigitis
- Pericardial TB
- Pain and swelling of the joints
- Adrenals - causing addisons
- Potts diseases - infections diseases of the spine
- Hepatitis
- Ascities and malabsorption
- TB epididymis dysuria, haematuria, frequency
Generally unwell !!!!
24
Q
TB test
A
1st line test
- Latent - Mantoux screening where purafied protine derivative (PPD) of TB is injected into the skin and an inspection is taken 48-72 hours later to see if there is a raised bump. If there is then the person has had the vaccine or has latent TB
- Latent - interferon- gamma release assay. Blood sample mixed with antigent form TB, if the WBC hava been previously exposed they will release interferon gamma. This si more sensitive than the mantoux test.
- Active - chest x ray - patchy consolidation, pleural effusion, latent disease may show Ghon complex
- Active - deep sputum samples - zheil nelson posiitve. Bronchoscopy with lavage
- Acitve - nucelic acid amplification test - rapid diagnostic test conducted on sputum/urine
25
TB treatment
Treatment
* BCG vaccine
* Latent:
* Isoniazid and rifampicin for 3 months, or isonazid for 6 months
* Pyridoxone (vit B6) prescribed with isoniazid to prevent peripheral neuropathy!!!!!!
Active:
* Notifiable disease
* Testing contacts
* RIPE! - rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months, then rifampicin and isoniazid for 4 extra months
* Pyridoxone (vit B6) prescribed with isoniazd to prevent peripheral neuropathy!!!!!!
* If its extrapulmonary there will be a longer course of antibiotics.
26
TB complications
Complications
* Milary TB
* Pnumothorx
* Emphyma
* Aspergilloma -fungus ball
27
Pneumonia definition
Acute inflammation of the terminal bronchioles and the area surrounding the alveoli
28
Pneumonia epidemiilogy
0.5-1% of people develop CAP each year
29
Pneumonia becterial causes CAP and HAP
Aetiology
* Streptococcus pneumoniae
* Haemophilus influenza
* Klebsiella pneumonia
* Pseudomonas aeruginosa
ATYPICALS:
* Mycoplasma pneumoniae, Chlamydophila pneumonia
CAP:
* Strep pneumonia (80%),
* Haemophilus influenzae - COPD
* Staph aureus - secondary infection
HAP:
* Gram neg
* Staph aureus
* Broad spectrum antibiotics are needed!!
* Pneumocystis pneumonia (PCP) is a serious infection caused by the fungus Pneumocystis jirovecii. And is the most common pneumonia in HIV patients.
30
Pneumonia rf
xtremes of age
* Immunosuppressed
* IV drug use
Asthma, COPD, malignancy, cystic fibrosis
31
Pneumonia path
* There is water brought into the lungs via inflammation which makes it harder to breath and it is most commonly caused by bacteria, but sometimes viruses and fungi.
* Community acquired pneumonia is ouside a healthcare setting
* Hospitla acquired pnumia - develops after >48 hours in hospital
* Aspiration pneumonia - forign material logeed in the lungs (srinks or aspiration of gastic contents)
* -Bronchopneumonia: infection can be throughout the lungs involving the bronchioles as well as the alveoli.
* -Atypical or interstitial pneumonia: infection is mainly just outside the alveoli in the interstitiam.
-Lobar pneumonia: infection causes complete consolidation of a whole lobe of t
32
Pneumonia signs and symptoms
Pneumocystis pneumonia is most common in HIV patients
* Reduced breath souds
* Beonchial breathing
* Coarse crepations
* Dullness to purcussion
* Hypoxia
* Tachycardia
* Tachypnoea
* Pyrexia
* Productive cough
* Haemoptysis
* Pleuratic chest pain
* Dyspnoea
* Fever
* Night sweats
* Fatigue
* Delerium
Atypical - dry cough, mild dyspnoea, flu like symtpsm, fever
33
Pneumonia test
* CXR -consolidation cuased by imnlamaotry exudate witin alveloi and bronchioles
* Atypical - causess interstitial pnumonia so CXR may look normal
* FBC - leukocytosis
* UandEs -derenged in sevre disease
* CRP - raised
* ABG- perforcm if hypoxic to asses risk of resp faliure
Sputume culture to allow assesment of organsims and senstivity
34
Pneumonia CURB 65
CURB 65 -
* Confusion
* Urea >7mmol/l
* Resp rate >30/min
* Blood pressure - systolic <90 or diastolic <60
* >65 years
Patient should go to hospital if they score more than 2
35
Pneumonia tx
* O2
* Analgesia
Antibiotics for CAP:
* Low severity - amoxicillin or doxycycline/clarithromycin if there is atypical or penicillin allergy
* Moderate - amoxicillin , add clarithromycin if atypicla pathogen is susoected
* High - amoxiclav and clarithromycin
HAP:
* Low - co-amoxiclav
* High - broad specturm - IV tazocin or ceftioxone
* MRSA - add vanvomycin to hight risk!!
36
Pneumonia complications and types
* ARDS
* Spesis
* Lung abcess if prolonged and especially with klebsiella and staoh pnumonia
* Pleural effusion
- Bronchopneumonia: infection can be throughout the lungs involving the bronchioles as well as the alveoli.
- Atypical or interstitial pneumonia: infection is mainly just outside the alveoli in the interstitium.
- Lobar pneumonia: infection causes complete consolidation of a whole lobe of the lung.
37
Cystic fibrosis epidemiology
Epidemiology
* 1/2500 live births in the UK
38
Cystic fibrosis causes
Aetiology
Mutation on chromosome 7q
39
Cystic fibrosis rf
Risk Factors
* Autosomal recessive
* Caucasian
40
Cystic fibrosis path
Pathophysiology
* Mutation on chromosome 7q codes for cystic fibrosis transmembrane regulator protein instead of the normal chlorine channel protein
* The imbalance of ions leads to thicker viscosity of mucus an and increased salt content in the sweat glands
* There is inflammatory response in the airways which leads to chronchicetasis, airflow limitation and resp failure
* There is thick mucus secreteoin from lungs manreases and gonads leadnifn to impaired mucocillary clearance, severe lung diseases and pancreatic insurfficacncy
41
Cystic fibrosis sign
Signs
* Recurrent infections
* Salty sweat
* Pancreatic insufficiency - steatorrhea
* Male infertility
* Nasal polyps
* Clubbing
* Sinusitis
* Bronchiectasis
* Spontaneous pneumothorax
* Reduced pancreatic enzymes
* Faliure to thrive
* Crackles and wheez on auscilation
* Abdominal disterntion
42
Cystic fibrosis test
1st line test
* Sweat test - high chlorine and sodium, this is diagnostic! Pilocarpine is applied to the skin and tehn electroed are put either side and a current runs between causing the skin to sweat. The sweta is sent too the lab and the chloride willl be >60mmol
* Genetic new born screening - measures immunoreactive trypsinogen (IRT) at time of neonatal heel prick test
* Genetic testing for CFTR gene
* Faecal elastase (due to not functioning pancreas)
* CXR - hyperinflation, increased pulmonary markings
* Lung function - early on only small airways are affected and later it becomes characteristic obstructive diseases with hyperinflation
43
Cystic fibrosis tx
Treatment
* MDT
* Smoking cessation
* Hight calorie diet
* Nebulised DNase (dornase alfa) is an enzyme that can break down DNA material in respiratory secretions, making secretions less viscous and easier to clear
* Regular chest physiotherapy
* Prophylactic antibiotics - long flucoxacliin for staph aureus, pseudomnas can worsen prognosis of pateints
* Lung function tests
* Sputum cultures
* Salbutamol
* Inhaled corticosteroids
* Lung transplant
* Long term monitering for the development of bacteria colonistation - pseudomonias s the worst!!
44
Bronchiectasis definition
Definition
Chronic infection of the bronchi and bronchioles leading to permanent dilation of central and medium airways due of inflammatory destruction of airway walls resulting in persistently infected mucous. Once establishes pseudomonas aeruginosa
45
Bronchiectasis epidemiology
Epidemiology
* Women more than men
* After lung infections
* Incidence increases with age
46
Bronchiectasis causes
Aetiology
* Infection, obstruction or fibrosis
* Obstruction - foreign body (penut), post TB stenosis , tumours, thick mucous
* Post infection - pseudomonas aeruginosa, TB, measles, pneumonia,
* Impaired defences - cystic fibrosis, immunodeficiency (AIDS, immunoglobulin deficiency)
* congenital - Kartagener’s syndrome, Immotile cilia, Chronic sinusitis
* Radiotherapy
47
Bronchiectasis rf
Risk Factors
* Female
* Smoking
* Age over 70
48
Bronchiectasis path
Pathophysiology
* Lower lobes are affected
* Pooling of secretions with further infection
* Chronic inflammation leads to damaged airways (elastin destruction and collagen deposition) this causes still large airways which are plugged with mucus.
*
49
Bronchiectasis signs and symptoms
Signs
* Chronic productive cough
* Recurrent chest infections
* Clubbing of singers - especially with cystic fibrosis
* Crackles over affected areas (base of lungs)
Symptoms
* Chronic cough with expectation of large quantities of foul smelling sputum
* Sometime haemoptysis
* Dyspnoea
* Wheeze
* Chest pain
* Rhinisitis
50
Bronchiectasis test
1st line test
* Lung function test -shows obstructive pattern- less lung capacity and less FEV1
* CXR - dilated bronchi with thickened walls - tramline and ring shadows, cysts as well
* Hight res CT - ticked dilated bronchi with cysts at the end, airways larger than associated blood vessels
* Sputum culture - so see colonisation status and exclude mycobacterium disease
* There may be pseudomonas aeruginosa, h. influenzae, s pneumonia, or s aures
51
Bronchiectasis differential
Differential diagnosis
* COPD
* Asthma
* TB
* Chronic sinusitis
* Pneumonia
* Pulmonary fibrosis
* Inhalation of foreign body
52
Bronchiectasis tx
Treatment
* Smoking cessation
* Improved mucus clearance - chest physio, mucolytics
* Antibiotics -
Pseudomonas aeruginosa – oral ciprofloxacin
H. influenzae – oral amoxicillin, co-amoxiclav or doxycycline
Some multi-resistant species needs IV cephalosporin
S. Aureus – flucloxacillin
Prophylactc azithromycin!
* Vaccination
* Bronchodilators
* Azithromycin to reduced exacerbation frequency
53
Bronchiectasis complications
Complications
Haemoptysis
Pneumonia
Pneumothorax
Fungal colonisation
Metastatic abscesses e.g. brain and heart
Amyloid formation
Emphysema
Septicaemia
Meningitis
Further necrosis and destruction of lung tissue leading to pulmonary fibrosis
Cor pulmonale
54
Pleural effusion definition
Definition
Excessive accumulation of fluid in the pleural space (clinically over 500ml or over 300ml on xray). There should normally be 25mls.
55
Pleural effusionepidemiology
Epidemiology
* Adults
* Reoccurent effusion suggests malignant mesothelioma
* Transudates or exudates
56
Pleural effusion causes
Aetiology
* Balance of hydrostatic forced in chest favour pleural fluid (congestive HF, fluid overload, constrictuve pericarditis, deceased plasma oncotic pressure, nephrotic syndrome, cirrhosis and liver faliure, hypoalbumineria)
Exudate causes:
* Impaired lymphatic drainage or damage to the pleura
* Trauma
* Neoplasm
* Collagen vascular disease
* PE and infarction
* Chronic CHF
* Pancreatitis
* Pneumonia
* Empyema
* Subphrenic abcess
57
Pleural effusion risk
Risk Factors
* Previous lung diseases
* Asbestos exposure
58
Pleural effusion path
Pathophysiology
* Build up of fluid results in pressure increases that causes breathing difficulties
* Transudate - less protein and transparent - there is increased pressure in the lungs which forces liquid into the space
* Exudate - pleural fluid protein is more than 30g/l due to gas in endothelial walls being larger allowing the proteins to flow out
59
Pleural effusion sign sna symptoms
Signs
* Tracheal deviation
* Decreased breathing sounds
* Decreased tactile fremitus – tactile fremitus is vibration that occurs when we speak, effusion absorbs some of the vibration energy
* Dullness to percussion
* Ipsilateral decreased expansion
* Bronchial breathing
* Pleural friction rub
Symptoms
* Cough
* Pleuritic chest pain
* SOB - worse when lying down
60
pleurla effusion test
1st line test
* Chest xray - transudates are bilateral and exudates are unilatera, there is blunting of the costophrnic angle
* Thoracentesis/pleural tap
* Drainage and analysis of fluid - transudaes it clear, exudate is cloudy, lymphatic looks like milk
* Pleural biopsy for TB or malignancy
* Ultrasoud
61
peural effusion treatment
Treatment
* Treat underlying causes (loop diruetics for heart faliure)
* Drainage if symptomatic
* Pleurodesis - infection that causes adhesion og visceral and parietal pleura to help to prevent reaccumulation of effusion
* Surgery - pleurectomy
* Thoracentisis- needle drainage t chest tube
62
pleural effusion complicaions
Complications
* Lung collapse
* Pneumothorax cuased by the drain (iatrogenic)
63
Empyema definiition
Collections of pus in a body cavity, an infection in the pleural cavity. Empyema is suspected in patients which have improving pneumonia but new/ongoing fever. Pleural aspiration will show pus, acidic pH, low glucose, and high LDL. Treat with chest drain to remove pus and then antibiotics.
64
Pneumothorax definition
Air in the pleural space causing partial or complete collapse of the lung
65
Pneumothorax epidemiology
* Spontaneously sedont to trauma
* More common in males
20-40 age
66
Pneumothorax causes
* Rupture of pleural bleb/sub pleural bulla (congenital)
* Primary - spontansou ruptrure of pleural bleb at the lin apec into the pleural space -healthy tall young male with marfans
* Secondary (complicated) trauma - cvp line, post thorancentisis, mechinical ventrllation, alveolar rupsure, rupture of subpleural bleb (COPD), necrosis of lung tissue - pnumonia, abscess
Catamenial pneumothorax - menstruation
67
Pneumothorax risk factors
* Male
* Tall and thin
* Smoking
* Age
Mechinical ventillation
68
Pneumothorax path
* Normally a negative pressure but when tehi is lost the elastic recoil of the lung causes it to partially deflate
This causes air to fill the space
69
Pneumothorax signs and symptoms
* Diminished breath souds
* Reduced chest expansion
* Hyper-resonant precussion notes on affected side
* Deviated trachea
* Asymptomatic
* Pleuritic chest pain
* Dyspnoea
70
Pneumothorax test
* Chest Xray - loss of lung markings, visible visceral pleural edge, radiolucent space
ABG
71
Pneumothorax differential
* PE
Pleural effusion
72
Pneumothorax treatment
* If it is small and no SOB leave it
* If SOB and where is a >2cm rim of air on chest Xray then aspirate (2nd intercostal space on midclavicular line)
* If aspiration fails twice then put in a chest drain
* Pleurodesis with sclerosing agent for repeated episodes
Bleb resection
73
Pneumothorax complications
* Tension pneumothorax is when a pneumotorax leads to isgnificant imparement of respiration and circulation
* Ventilation, rescusitation and traum patiens
* SOB, pleuratic chets pain, trachea deviation, tachycarida, tachypnoia, low O2, low BP
* ABCDE, 100% o2, needle aspiration and chest drain
74
Interstitial lung diseases definitinon
Definition
Umbrella term for a large group of disease which affect the lung parenchyma causing inflamation and fibrosis of the lungs.
75
Interstitial lung diseases test
1st line test
* Clinical fatures and high resolution CT
* It shows a ground class appearacne
* When diagnosis is unclear a lung biopsy might be needed
76
Interstitial lung diseases tx
Treatment
* Supportive to stop preogression
* Treat underlying cuases
* Stop smokunig
* Home oxygen
* Physiotheraoy and pulmonary rehab
* Pneumococcal and flu vaccination
* Advice and palliative care
* Lung transplant sometimes !
77
what is Idiopathic pulmonary fibrosis:
* SOB and dry cough over 3 months
* Examination shows bibasal fein inspiratry cracks and finger clubbing
* 2-5 year life expectanc
* Pirfenidone is an antifibrotic and anti-inflammatory
* Nintedanib is a monoclonal antibody targeting tyrosine kinase
78
what is drug induced pulmonary fibrosis
* Amiodarone
* Cyclophosphamide
* Methotrexate
Nitrofurantoin
79
what is secondary pulmonary fibrosis
* Alpha 1 antitripsin deficancy
* RA
* Systemic lumpus erythematous
Systemic sclerosis
80
what is hypersensitivity pneumonitis
* Type 3 hypersensitivity reaction
* Parenchymal inflamatio
* Bronchalveolar lavageg shows rased lymhocytes and mast cells
Farmers lung, malt workers lung, bird faciers lung
81
what is asbestosis
* Asbestos is fibrogenic and oncogenic
It cuases: fibrosis, adenocarcinoma, pleural thickening an dplacques, mesothelioma
82
sarcoidosis definition
Definition
Multisystem granulomatous disease characterised by non caseating granulomas throughout the body.
83
sarcoidosis epidemiology
Epidemiology
* Black
* Female
* 20-40
84
Sarcoidosis risk factors
Risk Factors
* Afrincan american
* Enviromental - previous infection with tb
* Family hisotry
85
Sarcoidosis path
Pathophysiology
Focal accumulation of epithelioid cells with macrophages and lymphocytes (mainly T cells)
86
Sarcoidosis signs
Signs
* Bilateral hilar lymphadenopathy
Extrapulmonary manifestations:
* Anterior uveitis
* Erythema nodosa
* Peripheral lymphadenopathy
* Hepatosplenomegaly
* Heart arrhythmias
Lofgren's syndrome (a specific presentation of sarcoidosis) :
* Erythema nodosum, bilateral hilar lymphadenopathy, polyarthralgia
87
Sarcoidosis symptoms
Symptoms
* Asymptomatic
* General - fever, weight loss, malaise
* Arthralgia
* If interstitial diseases is present- dyspnoea, chest pain, non-productive cough
88
Sarcoidosis test
1st line test
* Raised serum ACE - ACE is secreted by granulomas!
* Hypercalcaemia - excess vit D produced by macrophages
* Raised serum soluble interleukin 2 receptors
* Raised CRP and ESR
* Raised immunoglobulins
* CXR - hilar lymphadenopathy
* CT thorax - hilar lymphadenopathy and pulmonary nodules
Gold standard test
Histology from biopsy!
Bronchoscopy with ultrasound guided biopsy of mediastinal lymph nodes - the histology will be non-caseating grandmas with epithelioid cells.
89
Sarcoidosis differential
Differential diagnosis
* TB infection
* Lymphoma
* SLE
* Multiple myeloma
90
Sarcoidosis treatment
Treatment
* Often resolves spontaneously
* Oral steroids if more severe -give bisphosphonates as well
* Methotrexate/azathioprine
* Lung transplant is very sevre cases
91
Sarcoidosis complications
Complications
Spontaneously resolves in 6 months in 60% of cases but can causes pulmonary fibrosis/hypertension. Death normally occus when the CNS or heart have been affected.
92
Pulmonary hypertension definition
Definition
mPAP above 25mmhg
93
Pulmonary hypertension causes
Aetiology
* primary pulmonary hypertension or connective tissue like SLE
* Miscellaneous - sarcoidosis, haematological disease
* Pulmonary vascular disorders: PE, veno-occlusive disease
* Disease of lung and parenchyma - COPD, chronic lung disorders
* CV - mitral stenosis, LV HF, congenital heart disease
94
Pulmonary hypertension signs
Signs
* Right parasternal heave due to RV hypertrophy
* Loud second pulmonary sound
* Elevated JVP
* Ascites
95
Pulmonary hypertension symptoms
Symptoms
* Exertional dyspnoea
* Fatigue
* Ankle swelling
* Chest pain
* Syncope
* Tachycardia
96
Pulmonary hypertension test
1st line test
* CXR - enlarged pulmonary vessels, lucent lung fields, enlarged RA, elevated apex due to hypertrophy (right axis deviation)
* ECG - RV hypertrophy and p pulmonale (larger r waves on V1-3 and S on V4-6)
* Echo
97
Pulmonary hypertension tx
Treatment
* Treat underlying causes
* Oxygen
* Warfrin
* Diuretics for oedema
* Phosphodiesterase-5 inhibitors - sildenafil
* CCB e.g. amlodipine as pulmonary vasodilators
* Endothelial receptor antagonists e.g. bosenten
* IV proteinoids - epoprostanol
98
Mesothelioma definition
Rapidly progressive incurable pleura cancer that presents h unexplained pleural effusion. Patients have probably been exposed to asbestos and complain of a tight chest, SOB, chest pain and weight loss. Surgery and chemotherapy is normally palliative
99
Mesothelioma epidemiology
* Males
* Old age
* Asbestos exposure
* Genetics
Radiotherapy exposure
100
Mesothelioma pathophysiology
* Epithelial malignancy of the cesothelial cells of the pleura coverng which occurs 20-40 yeas after exposure
* Asbestos fibres tangle in te hcell chromosomes and activaes macropages to create ROS
101
Mesothelioma key presintations
* Finger clubbing
* Reduced breath souds
* Stony dull percussion
* Ascities
* Metasitasis - hepatomegaly, bnoe pain, abdo pain
* Sob
* Cough
* Bloody sputum
Fatigue, fever, night sweats, weight loss
102
Mesothelioma test
**CXR:** unilateral pleural effusion, reduced lung volumes, pleural thickening, lower zone interstitial fibrosis for asbestos
- **Contrast-enhanced CT chest:** performed following a suspicious CXR and may demonstrate ****pleural thickening, pleural plaques and enlarged lymph nodes
103
Mesothelioma treeatment, complication, prognosis
* Often inoperable
* Chemotherapy and radiotherapy
* Pnumothorax
* Local ivasion of structures - dysphagea metastasis
* 5 years
104
Lung cancer definition
Definition
* The uncontrolled division of epithelial cells in the respiratory tract. The majority are primary bronchial carcinomas which can be divided into small cell and non-small cell
105
Lung cancer epidemiology
Epidemiology
* It is the third most common cancer in the UK
* Smoking
* More common in men
106
Lung cancer rf
Risk Factors
* Age
* Smoking
* Environmental exposure - radon, asbestos, air pollution and radiation
* Family history
107
Lung cancer path
Pathophysiology
SMALL CELL:
* 20% of lung cancers
* A central lesion near the main bronchus
* Derived from neuroendocrine kulchitsky cells
* Can causes hyponatraemia, Cushing's and lamb Eaton myasthenic syndrome
* Rapid growth and patients are normally in an advanced stage when they present
NON SMALL CELL (80%):
Squamous -
* Central lesion
* arise from squamous epithelium that produced keratin
* Can causes hypertrophic pulmonary osteoarthropathy - inflammation of bones and joints in the wrists and ankles
* Can causes parathyroid hormone releases - hypercalcaemia
Adenocarcinoma (most common lung cancer)-
* Peripheral lesion - originating from mucus secreting glandular cells
* Causes hypertrophic pulmonary osteoarthropathy
* Gynaecomastia - enlargement of breast tissues in males
* Metastasis are common
* Linked with asbestos
Large cell -
* Peripheral lesion, often found throughout the lungs
* Lack glandular and squamous differentiation
* Hypertrophic pulmonary osteoarthropathy and ectopic HCG secretion
Mesothelioma -
* Mesothelial cells of the asbestos inhalation that is strongly linked with asbestos
METASTASIS
* Cancers that metastasis to lung are more common hen primary cancer
* Kidney, breast, bowel, bladder cancer
108
lung cancer signs and symtoms
* Recurrent chest infections
* Lymphadenopathy (often supraclavicular are found first)
* Extrapulmonary changes :
* pericarditis,
* oesophagus compression causing dysphagia
* phenic nerve compression causing diaphragm paralysis
* recurrent laryngeal never compression causing hoarseness
* Paraneoplastic - PTH secretion, SIADH, ACTH (Cushing's), finger clubbing, non-infective endocarditis, disseminated intravascular coagulation, myasthenic syndrome (lamb eaton), hypertrophic pulmonary osteoarthropathy
* Dry cough
* Dyspnoea
* Haemoptysis
* Chest pain
* Weight loss
109
lug cancer test
1st line test
* CXR is first line investigation - hilar enlargement, peripheral opacity - visible lesion in the lung field, pleural effusion, collapse
*
* A staging CT scan should be done with contrast to help looks at the different tissue types
* PET CT - helps to look for metastasis as they will take up more of the radioactive tracer
* Bronchoscopy with endobronchial ultrasound for biopsy
110
lung cancer differential
Differential diagnosis
* Not all lung nodules are malignant: TB, lymph node swellings, benign neoplasia
111
lung cancer treamtnet
Treatment
* Surgery - lobectomy, segmectomy, wedge resection
* Radiotherapy - non small cell
* Chemotherapy - non small cells
* Chemo and radiotherapy with platinum based agents together for small cell- prognosis is normally worse
* Smoking cessation
* Palliative care
* Immunotherapy
112
lung cancer complications
Complications
* Local obstruction
* Phrenic nerve palsy
* Bone pain/hypercalcaemia
* SVC obsturction
113
Hypersensitivity pneumonitis definition
Definition
Non IgE mediated immunological inflammation of the lungs
114
Hypersensitivity pneumonitisepidemiology
Epidemiology
Adults - often occupational
115
Hypersensitivity pneumonitis causes
Aetiology
Caused by a variety of organic antigens - coffee bean dust, mouldy sugar cane, bacterial spores.
* Bird fanciers lung - bird poo
* Farmers lung - mould in hay
* Mushroom workers - mushroom antigens
* Malt workers - mould on barley
* Air conditioner - spores of actinomycetes that grow in the warm water reservoirs
116
Hypersensitivity pneumonitis risk factor
Risk Factors
* Preexisting lung conditions
* Specifinc occupations - farmers , cattle, ventilaiton, vets, chemicals
* Bird keeping
* Hot tubs
117
Hypersensitivity pneumonitis path
Pathophysiology
* Type 3 hypersensitivity
* Develops over a few hours, activated b cells generate IgG antibodes that bind to organic antigen in the blood stream and form clusters of immune complexes
* A type 4 can develop a few days layer wihc leads to activated macrophages and T cells forming at the sight of antigen exposure and surrounding it forming a granuloma
* Chornic inflamation daages the elastin fibres and so fibroblasts deposit fibrin, this causes a restricutive lung disease
118
Hypersensitivity pneumonitis key presintations
Key presentations
ACUTE
* Fever
* Rigor
* Headaceh
* Myalgia
* SOB
* Cougig
* Chest tightness
* Crackles - no wheeze
* CHRONIC:
sustained SOB
* Cyanosis and clubbing
* Resp faliure
119
Hypersensitivity pneumonitis test
1st line test
* Chest xray- diffuse inflitrate
* ESR is raised
* Lung function tests are abnormal
* Brnochoalveolar lavage light number of lumphoctes and mast cells
* Lung biopsy - small granulomas arouf the bronchioles and lymphocytes infiltration I the alveolar walls
* Identify trigger - inhilation challenge - expose patient to antigens and moniter response
120
Hypersensitivity pneumonitis differnital
Differential diagnosis
* Infection
* Astha
* Pulmonary fibrosis
* Drig induced interstitila lung disease
121
Hypersensitivity pneumonitis tx
Treatment
* Eliminate trigger
* Steroids
* Give oxygen where necessary
122
what are some causes of dyspnoea - differntials
* Asthma
* Chest infection
* Smoking
* Panic attack
* COPD
* Idiopathic pulmonary fibrosis
* Heart failure
Lung cancer
123
what is teh MRC dysponea scale
* MRC dyspnoea scale is used to asses eth degree of functional disability due to dyspnoea
* I only get breathless with strenuous exercise 0
* I get short of breath when hurrying on level ground or walking up a slight hill 1
* On level ground, I walk slower than people of my age because of breathlessness, or I have to stop for breath when walking at my own pace on the level 2
* I stop for breath after walking about 100 yards or after a few minutes on level ground 3
* I am too breathless to leave the house or I am breathless when dressing/undressing 4
124
type 1 resp faliure Definition
causes
Disease:
Essence
Low PO2 and normal/low pCO2
V/Q mishmatch and O2 is less soluble than CO2 so struggles to be exchanged
Pulmonary oedema
Severe pnumonia
High altitude
Heart faliure
ARDs
Oxygen cant diffuse as easily, the blood flow is worng or its too wet!
125
type 2 resp faliure Definition
causes
Disease
Essence
Low pO2 and high CO2
Hyperventilation
Motor neuron disease
Guillina barr
COPD
Asthma
Myasthenia gravis
There just isnt as much breathing, so there is reduced gas exchange overall.
126
Occupational lung disorders definitions and list of examples
Definition
A wide range of resp conditions that are caused by exposure to harmful substances in the workplace. Pneumoconiosis are a group of lung diseases caused by the lung's reaction inhaling certain dusts.
* Asthma
* Acute bronchitis and pulmonary oedema from irritants such as sulphur dioxide, chlorine, ammonia, oxides r nitrogen
* Pulmonary fibrosis from inhalation of inorganic dust - cola, silica, asbestos, iron and tin
* Hypersensitivity pneumonitis
* Bronchial carcinoma due to asbestos, polycyclic hydrocarbons and radon
127
Occupational lung disorders epidemiology and causes
Epidemiology
* Male
* Older population
Aetiology
* Coal workers pneumoconiosis - exposure to carbon in coal mines
* Silicosis - aerospace industry and beryllium miners
* Asbestosis - construction worker, plumbers
* Byssinosis - cotton mill
128
Occupational lung disorders RF
Risk Factors
* Male
* Increasing age
* Substance exposure - asbestos, coal dust, beryllium, asbestos
129
Occupational lung disorders path
Pathophysiology
* pneumoconiosis are a group of lung diseases caused by the lung's reaction inhaling certain dusts
* The severity of it is relates to eth duration and extent of exposure #
* Dust particles are carried by macrophages and expelled as mucus but over a long period of time they can accumulate and causes immune system activation and lung tissue damage
* Simple pneumocosis - most common type of pneumoconiosis where they are asymptomatic but eventually develop progressive massive fibrosis
* Progressive massive fibrosis - dust exposure results in large masses f dense fibrosis in the upper lobes causing exertional breathlessness, cough and sputum that might be black
* There is a mix of obstructive and restrictive disease
* Silicosis causes increased risk of tb
* Berylliosis - non causeating granulomas. Increased risk of lung cancer
* Asbestosis - lung cancer and mesothelioma, pelural plauques
130
Occupational lung disorders signs
Signs
* Wheeze
* Crackles
* Clubbing of fingers
131
Occupational lung disorders symptoms
Symptoms
* Exertional dyspnoea
* Dry cough
* Wheezing
* Haemoptysis
* Weight loss
132
Occupational lung disorders test
1st line test
* CXR - fibrosis - nodular opacaties in upper zones are commmmon in silicosis and coal workers lungs, thre can be calcification of the lymoh nodes called eggshell calcification
133
Occupational lung disorders stagign
Staging
- **Category 0**: small rounded opacities are absent or less profuse than category 1
- **Category 1**: small rounded opacities are present but few in number
- **Category 2**: small rounded opacities are numerous, but normal lung markings are visible
- **Category 3**: small rounded opacities are very numerous, with normal lung markings partially or totally obscured
134
Occupational lung disorders treatment
Treatment
* Smoking cessation
* Pulmonary rehab
* Ocygen
* Corticosteroids in berylliosis
* Lung transplant
135
Occupational lung disorders complications
Complications
* Lung cancer
* Cor pulmonale
* TB in silicosis
136
Occupational asthma
time off yay
137
Occupational asthma Job
Causes
Presentations
Test
Treatment
Key info
Woodcutting
Bakery
Metal work
Chlorine
Allergens
* SOB
* Wheeze
* Tight chest
* Cough
* Mucus production
* Worse when at work
* Rashes
Peak flow diary to compare when at work and at home
* Avoid irritants
* Corticosteroid inhaler
* Lateten period when at home
* Deteriorating symptoms
138
Pneumonoconiosis Job
Causes
Presentations
Inhaling mineral dust - electrician, joiner, plumber, asbestos
* Pleural plaques
* Silicosis
* Asbestosis
* Coal workers pneumonoconiosis
* Clubbing (asbestos especially)
139
Hypersensitivity pneumonitis Job
Causes
Presentations
Test
* Farmers lung - mouldy hay
* Bird fanciers lung - pigeons
* Malt workers lung - germinating barley
* Mushroom workers
* Cheese workers -mouly cheese
* Type 3 hypersensitive causing inflamation and fibrosis
* SOB
coighing
* Non causeating granulomas later on
* Maialise
* Rigors
* Crackles no wheez3
* CXR
* Peak flow
* Raised WBC and ESR
* Bronchoalveolar lavage – shows increased T-lymphocytes and granulocytes
140
Goodpastures definition
Acute glomerulonephritis and pulmonary alveolar haemoray due to the presence of ant basement membrane antibodies.
141
Goodpastures epidemiology
Epidemiology
* Adults
* Men
142
Goodpastures path
Pathophysiology
* Type 2 hypersensitivity reaction leading to diffuse pulmonary haemorrhage and glomerulonephritis
* Anti-GBM antibodies are circulating
143
Goodpastures sigs and symptoms
Signs
* Haemoptysis
* Anaemia
* Acute glomerulonephritis
Symptoms
* Upper resp tract infection - sneezing, runny nose, congestion
* Fever
* Cough
* Tiredness
* Haematuria
144
Goodpastures test
1st line test
* Anti-GBM antibodis in the blood
* CXR - transient patchy shadows due to pulmonary haemorrhage in the lower zones
* Kidney biopsy
145
Goodpastures differential
Differential diagnosis
Idiopathic pulmonary hemosiderosis – similar to GP but no anti-GBM antibodies and kidneys less involved
SLE
Rheumatoid Arthritis
*
146
Goodpastures treatment
Treatment
* Perdnisolone
* Plasmapheresis
* Bilateral nephrectomy and dialysis
147
Wegners granulomatosis definition
* c-anti-neutrophil cytoplamic antibodu association vasculitis
Necrosisng granulomatosu inflamation and vascultis of small vessles
148
Wegners granulomatosis path
* Inflammation of blood vessels with granulomas
* Autoantibodies inappropriately activate neutrophils and causes ROS to be relases
* This causes micro abcess wihc leads to monocyte recrututment and a granuloma being formed
Affects the lungs and kidneys
149
Wegners granulomatosis symotoms
* Fever
* Anorexia
* Weigth loss
* Cough
* Pleuratic chest pain
150
Wegners granulomatosis test
* CXR - solitary or multiple lesions with marked tendency to cavitate
* C-ANCA positive, elevated PR3 antibodies
* Raised ESR and CRp
* CT - diffuse alveolar haemorrhage
Biopsy - lung or kidney
151
Wegners granulomatosis tx
* Corticosteroids - perdinisolone
* Rituximab
* There are used to being on a reission period
* Azathioprin and methotrexate used as maintenance
152
Upper respiratory tract infections definition
Definition
* Goes from nose to laryx above vocal cords
* Mucosal defences - cough, gage, mucocillary escilator, alveolar macrophages, comensa flora
* Soluble facots, neutrophils and alveolar macrophages
* B cellsa nd T cells
153
Upper respiratory tract infections causes
Aetiology
* Viral - rhinoviruses, influenza A virus, corona virus
* These causes sinusitis, pharyngitis
* Spread by aerosoles - coughs and sneezes, hand to hand contact too
154
Upper respiratory tract infections rf
Risk Factors
* age
* Smoking
* Alcohol
* Resp therapy
* Hypoxaemia
* Acidosis
* Immunoreaction
155
Upper respiratory tract infections path
Pathophysiology
* Influenza can be divided based on its 2 surface antigens - haemagglutin (hooks for getting tinot cells) and neuramidase (blot cutter for getting out of cells)
156
Upper respiratory tract infections key presintations
Key presentations
* Fever
* Malaise
* Weakness
* Myalgia
157
Upper respiratory tract infections treatment
Treatment
Higher risk if:
* Oler
* Diabeties
* Chronic renal disease
* Immuno surpressed
* Cardiac, pulmomanyr and liver problems
* Oxygenation
* Hydration/nutritino
* Homeostasis maintinance
* Antivirlas - Tamiflu (neuraminidase inhibitor)
* Tamiflu (neuraminidase inhibitor)
* VACCIONATION
158
Pharyngitis definition and epidemiology
Definition
Pharyngtos - sore throat
Tonsalitis - tonsills are affected too
Epidemiology
Most common in children
159
Pharyngitis causes
Aetiology
* 70-80% are viral - adenovirus is the most common causes
* Rhinovirus
* EBV
* Acute HIV
Bacterial:
* S.Pyogenes
* Mycoplasma pneumonia
* Neisseria gonorrhoea
* Fusobacteria necrophorum
* S aureus us the most common in roocurent
160
Pharyngitis signs and symtos
Signs
* Tender glands in neck
* Inflamed and swollen tonsils
* Stable vitals
* Tender anterior cervical lymph nodes
* Dehydration
Symptoms
Sore throat for more than 24 hours
Fever
Mailaise
Nausea/headache/vomiting/losss of appetire
161
Pharyngitis test
1st line test
* Clincla diagnosis
* Throat cultre for bacteria if it is reoccurent
162
pharyngitis treatment
Treatment
* Self limiting
* Fluid and alagesics
* persistent and severe tonsillitis treated with phenoxymethylpenicillin or cefaclor. Clarithromycin or erithromycin if penicillin allergic.
* Tonsilectomy
* Steroids if really bad swelling
163
Otitis media definition and epidemioology
Definition
Inflammation in the middle ear, associated with an effusion and accompanied by the rapid onset of symptoms and signs of an ear infection.
Epidemiology
* Children
* Associated with upper resp infection
* More commonly seen in winter
164
Otitis media causes
Aetiology
* S.pneumoniae
* H.Influenzae
* S.Aureus
* Rhinovirus
* Influenza
* Adenovirus
165
Otitis media risk factor
Risk Factors
* 6-24 months
* Family history
* Craniofacial abnormalities
166
Otitis media path
Pathophysiology
* Viral infections are more common in younger age groups and otitis media is more common in them due to their shorter and more horizontal eustachian tubes
* Bacteria can enter from the back f the throat through the eustachian tube
167
Otitis media
Otitis media signs and symtoms
Signs
Otoscpy findings;
* Red cloudy tympanic membrane
* Bulging tympanic membrane
* Middle ear effusion
* Tympanic membrane perforation
* Ottohoea - discahrge
Symptoms
* Ear pain
* Reduced hearing
* Upper resp infection
* Balance issues and vertigo
* Fever
* Irratability and poor feeding
* Sore throat
* Vomiting
* Cough
168
Otitis media test
1st line test
* Examinatin with otoscope - red, bulging tympanic membrane with discharde
* Triad of imparied mobility, redness/cloudiness, bulging
Could do a CT btu rare
169
Otitis media treatment
Treatment
* Observation
* Analgesia - paracetamol and ibruprofen
* Antibiotics - amoxicillin, co amoxiclav, clarithromycin if they have a penicillin akllergy.
170
otitis media complications
Complications
* Burst ear drum - need antibiotics
* Mastoiditis - infection in the mastid air cells - need IV antibiotics
* Facial nerev palsy
* Meningitis or abcess
* Heaing loss
* Reoccurent infetion
171
Sinusitis definition and causes
Definition
Infection of the paransal sinus - bacterial but sometiems fungi
Epidemiology
Aetiology
* S.pneumonia, H.influenzea
* Most common resp tract infection
* If viral often very acute
172
Sinusitis signs and symptoms
Signs
* Purulant nasal dishaharge
* Tenderness
* Fever
* Voice changes
* Change in smell and taste
Symptoms
* Frontal headache
* Facial pain
* Cough
173
Sinusitis treatment
Treatment
* Nasal decongestants - xylometzaoline
* Broad spectrum antobiotics - co-amoxiclav if bacterial
* Clarithromycisn, erethromycin and doxycycline if penicillin allergy
174
Sinusitis complications
Complications
* Brain abcess
* Sinus vein thrmobosis
* Orbital cellulitis
175
Acute epiglottitis def, epi, causes
Inflation of the epiglottis due to infection. It can lead to a life threatening airway
* Normally children under 5
* Unvaccinated
* Male
* H.influenzae type B
* Caused by additional pathogens in the immunocompromised
176
Acute epiglottitis signs and symptpme
Signs
* Severe airflow obstruction
* Meningitis
* Septic arthritis
Symptoms
* Sore throat and pain on swallowing
* High pich wheeze
* Diahrroea
* Fatigue
* Weight loss
* Fever
177
Acute epiglottitis tx and complications
Treatment
* Endotracheal intubation
* IV antibiotics - Amoxicillin, Co- amoxiclav, erethromycin, doxycycline
* Nebulised adrenaline to minimise oedema proir to intubation
* Dexamethasone
* H.Influenzai B vaccinatoin
Monitoring
Complications
* Airway obstuction
* Resp acidosis
* Cellulitus or neck abcess
178
croup definitino
Definition
Infective upper resp infection affecting children form 6 months - 2 years causing oedema in the larynx. The most common causes is the parainfluenza virus. It normally improves within 48 hours and responds to dexamethasone.
179
crou causes
Aetiology
* Parainfluenza
* Adenovirus
* Influenza
* Measles
* Diphtheria, this is very rare in the developed world but can lead to epiglottitis
180
croup key presintations
Key presentations
* Work of breathing
* Barking cough - occuring in clusters
* Hoarse voice
* Stridor
* Low grade fever
181
croup test and tx
1st line test
Clincal diagnosis
Treatment
* Oral dexamethasone
* Oxygen and fluids
* Nebulised adrenaline
* Intubation and ventilation
182
Whooping cough epi and cause
Epidemiology
Children
Aetiology
* Bordatella pertussis – gram-negative coccobacillus (rod)
* Bordatella parapertussis and Bordatella bronchiseptica produce milder infections
183
Whooping cough signs an symptoms
Signs
* Inspiratory whoop - lumen of younger indiciduales resp tract is comepramosed by mocus secretion and mucosa osedema
* Pneumonia, encephalopahy and sub-conjunctival haemmorage are all complications
Symptoms
* Chronic cough
* Vomitint
* Malaise
* Anorexia
* Male a whooping cough trying o get air in
* Rinnohoea
184
Whooping cough test
1st line test
* Nasopharyngeal or nasal swab wth PCR testing or bacterial culture
* anti-pertussis toxin immunoglobulin G. This is tested for in the oral fluid of children aged 5 to 16 and in the blood of those aged over 17.
185
Whooping cough treatment
Treatment
* Notafiable disease
* Supportiave care
* Macrolides - azithromycin, erethromycin and clarithromycin
* Co-trimozolae
186
Whooping cough complictions
Complications
Bronchiectasis
