Month: June 2024

Acute epiglottitis This refers to acute inflammation of the epiglottis, which is often caused by the bacteria Haemophilus influenzae type B. It needs to be recognised and treated quickly as it can lead to airway obstruction. It usually presents in children. However, due to the Haemophilus influenzae type B vaccination, its prevalence has decreased.   Symptoms Rapid onset high fever and malaise Drooling of saliva Muffled voice – due to very sore throat Inspiratory stridor (is a high-pitched sound due to turbulent air flow in the upper airway)   Key tests Usually clinical diagnosis, but fibre-optic laryngoscopy may be performed

Pneumonia This used to describe a lower respiratory tract infection which often occurs when normal defences are impaired It is a blanket term which can be subdivided into a number of types, with different causes and features:   Lobar pneumonia This is characterised by continuous consolidation of a lobe of the lung. It is most frequently due to a bacterial agent, e.g., Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.   Bronchopneumonia This is characterised by discontinuous areas of consolidation, often bilaterally in the basal lobes, with predominance around the bronchioles. It is usually caused by bacterial agents: Staph

These conditions are characterised by a restrictive pattern of spirometry. They occur due to inflammation which leads to fibrosis (irreversible scarring) of the lungs, meaning they cannot expand fully, reducing the vital capacity. Both the FVC and FEV1 are reduced in restrictive conditions. However, the FEV1/FVC ratio stays constant as both FEV1 and FVC decrease proportionally. Different conditions cause fibrosis predominantly in the upper or lower zones.   Upper Zone Fibrosis (BREASTS) Lower Zone Fibrosis (BRAINS) Berylliosis Bronchiectasis Radiation Rheumatoid Arthritis Extrinsic Allergic Alveolitis Asbestosis Ankylosing spondylitis Idiopathic Pulmonary Fibrosis Silicosis Nitrofurantoin (+ amiodarone, bleomycin, methotrexate) TB Scleroderma Sarcoidosis     Interstitial

Acute Respiratory Distress Syndrome (ARDS) This refers to widespread inflammation at the alveolar-capillary interface, increasing the permeability of the alveolar capillaries. Fluid moves out of the permeable capillaries, resulting in non-cardiogenic pulmonary oedema that impairs ventilation. ARDS can progress to organ failure and carries a high morbidity and mortality risk. Causes Direct – this is due to direct lung injury (such as smoke inhalation) Indirect – due to conditions which cause inflammation (such as sepsis, shock and acute pancreatitis)   Symptoms Acute onset tachypnoea, dyspnoea Bilateral inspiratory crackles Low oxygen saturations and cyanosis with respiratory distress   Key tests ABG

Acute Respiratory Distress Syndrome (ARDS) This refers to widespread inflammation at the alveolar-capillary interface, increasing the permeability of the alveolar capillaries. Fluid moves out of the permeable capillaries, resulting in non-cardiogenic pulmonary oedema that impairs ventilation. ARDS can progress to organ failure and carries a high morbidity and mortality risk. Causes Direct – this is due to direct lung injury (such as smoke inhalation) Indirect – due to conditions which cause inflammation (such as sepsis, shock and acute pancreatitis)   Symptoms Acute onset tachypnoea, dyspnoea Bilateral inspiratory crackles Low oxygen saturations and cyanosis with respiratory distress   Key tests ABG

Pneumonia This used to describe a lower respiratory tract infection which often occurs when normal defences are impaired It is a blanket term which can be subdivided into a number of types, with different causes and features:   Lobar pneumonia This is characterised by continuous consolidation of a lobe of the lung. It is most frequently due to a bacterial agent, e.g., Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.   Bronchopneumonia This is characterised by discontinuous areas of consolidation, often bilaterally in the basal lobes, with predominance around the bronchioles. It is usually caused by bacterial agents: Staph

Acute Respiratory Distress Syndrome (ARDS) This refers to widespread inflammation at the alveolar-capillary interface, increasing the permeability of the alveolar capillaries. Fluid moves out of the permeable capillaries, resulting in non-cardiogenic pulmonary oedema that impairs ventilation. ARDS can progress to organ failure and carries a high morbidity and mortality risk. Causes Direct – this is due to direct lung injury (such as smoke inhalation) Indirect – due to conditions which cause inflammation (such as sepsis, shock and acute pancreatitis)   Symptoms Acute onset tachypnoea, dyspnoea Bilateral inspiratory crackles Low oxygen saturations and cyanosis with respiratory distress   Key tests ABG

This is a broad term which is most common cancer in the UK, which typically occurs in people of 60 years. It can be broken down into several types of specific types of cancers, which have different histology. Metastases are more common, typically arising from breast, prostate, colon, kidney and uterus. NICE Referral Guidelines   Carcinoma of the bronchus This type of carcinoma is generally divided into 2 main categories:   Small Cell Carcinoma This is a tumour which arises from neuro-endocrine cells in the lungs. It is named “small cell” because the cancerous cells look small when viewed under

These conditions are characterised by a restrictive pattern of spirometry. They occur due to inflammation which leads to fibrosis (irreversible scarring) of the lungs, meaning they cannot expand fully, reducing the vital capacity. Both the FVC and FEV1 are reduced in restrictive conditions. However, the FEV1/FVC ratio stays constant as both FEV1 and FVC decrease proportionally. Different conditions cause fibrosis predominantly in the upper or lower zones.   Upper Zone Fibrosis (BREASTS) Lower Zone Fibrosis (BRAINS) Berylliosis Bronchiectasis Radiation Rheumatoid Arthritis Extrinsic Allergic Alveolitis Asbestosis Ankylosing spondylitis Idiopathic Pulmonary Fibrosis Silicosis Nitrofurantoin (+ amiodarone, bleomycin, methotrexate) TB Scleroderma Sarcoidosis     Interstitial

Obstructive Sleep Apnoea This is a condition where the walls of the airway briefly collapse during sleep. This obstructs the airway causing cessation of breathing during sleep (apnoea) followed by partial arousal to regain breath. The patient then falls asleep again and the cycle repeats itself. It can lead to pulmonary hypertension and type II respiratory failure. It is classically seen in middle-aged obese men who complain of loud snoring.   Risk factors Obesity Large tonsils Large tongue (macroglossia) Symptoms Loud snoring Lethargy with daytime napping Morning headache Decreased libido Hypertension Compensated respiratory acidosis   Key tests Epworth sleepiness scale

Acute epiglottitis This refers to acute inflammation of the epiglottis, which is often caused by the bacteria Haemophilus influenzae type B. It needs to be recognised and treated quickly as it can lead to airway obstruction. It usually presents in children. However, due to the Haemophilus influenzae type B vaccination, its prevalence has decreased.   Symptoms Rapid onset high fever and malaise Drooling of saliva Muffled voice – due to very sore throat Inspiratory stridor (is a high-pitched sound due to turbulent air flow in the upper airway)   Key tests Usually clinical diagnosis, but fibre-optic laryngoscopy may be performed

Asthma Asthma is a disease that is characterised by reversible bronchoconstriction, bronchial hyper-responsiveness, and airway inflammation. Allergens induce a Th2 response which stimulates production of IgE and attracts eosinophils to the airways, leading to airway inflammation. This leads to the release of chemical mediators (such as histamine and leukotrienes) which leads to bronchoconstriction increasing airway resistance.   Risk factors Personal or family history of atopic conditions (allergic rhinitis, eczema) Air pollution Precipitants – cold air, allergens (ask about pets, carpet etc.) Drugs – e.g., aspirin intolerant asthma (usually features nasal polyps) Occupational (baking, factory work) – this classically causes reduced peak